If I Wanted to Reduce My Risk of Heart Disease Post Menopause

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Good night. If I wanted to reduce my risk of heart disease in or after, as it would be in my case, menopause, this is what I would do.

I'm Debra Atkinson. You're listening to Flipping 50. I started this podcast over a decade ago to answer questions about fitness in menopause and beyond before you knew to ask them. The goal: to help accelerate your results with science and the practical application of proven protocols while living your best life. There's no more powerful health influencer in the world than a midlife woman. And it's not just about you, but the 3 generations that you influence. My unique 40-year career, including being a university senior lecturer in kinesiology, an industry subject matter expert, and an international speaker, to founder of the first and the only exclusively made-for-menopause and beyond fitness membership in the world. Every week I interview experts behind the scenes and the science of optimal hormone balancing, fitness, and longevity, and share answers to our community's questions so you can have the vitality and the energy that you want, need, and deserve.

So notoriously, women worry about so many other things and not necessarily heart disease, but heart disease is still the number one killer of women. It— you get that reminder every year when, when American Heart Association's Go Red for Women events come live. But then I think in between, we all somewhat forget about it if we can. Now, some of us, it has hit home more than others. So I had a good friend back in her early to mid-40s had a heart attack. She was tiny, like a size 2 or a 4 on a bad day. And yet, you know, all of the stressor signs and symptoms, and there it was. And it was a big deal. And because of repercussions afterward, it's been a big deal. So none of us can escape it. We all probably know someone, and/or your risk factors are higher. And here's the truth: women collectively, we catch up to men in their risk for heart disease by about age 60. And that coincides with the point where almost all of us are safely postmenopausal, that it is safe for me to say that. Now, there may be a couple of you who are just not quite there, but almost. We've had such a wide range at Flipping 50. I've seen women come in and start menopause in their, or hit menopause in their late 30s, and others still be at 58, 59, and like, nope, not yet, still hanging on. So for those of you, no matter where you are, it's normal. I want you to realize that this is largely because of our estrogen levels that we finally catch up, uh, to the same amount of risk, but we just simply don't tolerate stress as well because of changes in cortisol, losses of estrogen, which has a huge protection factor, as we well know, in muscle and in bone and in heart health. All of that comes from the American College of Cardiology's annual scientific session, April of 2024, and from the American Heart Association, different unique position statements set out in 2007, 2013, and 2023. I'm going to give you the spoiler alert right now. So the short answer to this podcast is you should be strength training if you really want to help your heart health. Now, I'm going to go through a little bit more than that, so I hope you stick around. Changes in blood pressure, cholesterol, visceral belly fat all seem to be a part of the menopause transition. At least collectively, maybe not you individually, maybe you've lucked out, but you also individually may be listening and be one of those unlucky ones. Post-menopause for at least 40% of their lives, that's, that's what we're looking at right now, you know. And for those women who say hit post-menopause in their late 30s, potentially much more of your life, if you're lucky, will be spent post-menopause. So that's a health risk if left checked, women who have had an early menopause have even more time of their lives post-menopause. So you should be the ones really sitting up and paying attention. But for all of us, we wanna live and we wanna thrive. Many women are advised or think about weight loss, stress reduction, and yet very few women think about heart health risk and, and even muscle loss until maybe very recently. Yet to define cardiovascular fitness, right? When we talk heart health, we think cardiovascular exercise because it's cardiovascular heart health, cardiovascular disease, we think cardio. And yet we've got to really look at the definition of cardiovascular fitness, number one. And number two, And I would say they're not necessarily in this order, but number 1 would be VO2 max. It's how we express how fit is your heart. That is how much oxygen capacity we have, and we express it in milliliters per kilogram of our body weight per minute. And that tells us something about how much oxygen are we able to consume every single minute that were there. So you might guess that VO2 max is tested by taking us to a very high level of exercise and measuring the amount of oxygen that both goes in, pure oxygen, and comes out in our expiration after it's gone through the cycle in our tissues and it's been extracted so we can breathe it out. It's not a comfortable test. Predictions of your VO2 max may or may not be so good, but they are valuable to take a look at. Where are you right now and where are you potentially? Yes, compared to other people. But I can tell you, you and I are not shooting for average. We're not shooting for what's been true and keeping up with the Joneses that, that aged 30 years ago very differently than we are. We're the first generation who probably will lift weights till we die. We're the first generation who will have smart scales in their bathrooms telling us how much muscle mass do we have. How much did we gain or how much did we lose? Now, if we choose to use that information wisely, then we are at an advantage. If we choose just to look at it, we may or may not win, but we wanna look at volume of oxygen consumed, and that's expressed again in milliliters per kilogram per minute. And we're asking how many liters of oxygen can you consume during exercise, really intense exercise. And the way it goes is for every 1 liter of oxygen consumed, roughly 5 kcal are burned. So there's an energy expenditure piece to that, obviously, when you're working at really high rates. But something that we don't often get to when we talk about VO2 max or your ultimate fitness is that it has two components to it. Number one, it's the delivery of oxygen to the tissues, but that's not enough. And that's like eating a lot of really, really great food, but not actually being able to break it down and use it for the use of your body. So you also, in addition to that delivery of oxygen, you have to extract that oxygen from the tissues. So it's like little cells have to be there to say, okay, we've got this, we can breathe, we can do more. And I want to make sure that we say this because this is almost never said. The delivery of oxygen. So imagine right now you have a package you ordered from Amazon. Where is it going to put it? Is it going to put it on your front porch? Is it going to carry it around to your back door and put it there inside of your fence? Where is it going to put that package? Generally, you know, or if you're ordering from Instacart, there's a message You know, what are you gonna say? Don't ring the doorbell 'cause the baby's sleeping. Don't ring the doorbell 'cause the dog will bark and I'm doing a podcast. That's what mine says, by the way. Leave it by the front door and just go quietly away. That's what I tell them. Doesn't always work that way 'cause people don't read the directions. But what's important here is the delivery. Where, where is that oxygen getting delivered? And we think, okay, well, through the body, like to the arms and the legs. Yes, but specifically, to muscle because the muscle is what needs it when you're exercising at a high level. We need to get the oxygen to the working places or we're gonna run out of gas. We're gonna hit lactic acid buildup and we can't do anything else. We can't go any further. This is— we're done. So I want you to pay attention to this. VO2 has two components: delivery of oxygen and the extraction of that oxygen from the tissues. But delivery to the muscle. So what do you think will happen if we have less muscle? Well, there's— can't drop off more packages if you have a small porch, and you're going to suffer from the extraction. The amount of oxygen extracted from the tissue is going to be reduced as well. We can't turn it all over if we've got less real estate. So I want you to think about how important is muscle then to VO2 max. And then what are we talking about really? We're talking about your heart health. So heart health can decline very rapidly after menopause. I want to make that clear as well. Heart health can, capital C-A-N, doesn't have to, right? So we now know the things that we need to start doing in our late 30s, if, if not sooner, so that we can protect ourselves, our heart health and our muscle in doing so. But all statistics are based on historically what's been true. Heart disease has been the number one killer of women, and today it still is. But are we changing that? That's the question. We sometimes forget that if we choose not to participate in the same activities that past generations had, we don't have to get the same results that they did. So if you lose muscle, however, bringing this home, you lose VO2. If you lose VO2, you and I will die more tired, sicker, younger, and probably fatter. Replacing the overemphasis on cardiovascular exercise, which seems to be the first go-to for women, for trainers, physicians alike, and with an equal emphasis on muscle is the first step to our success. But that negates the fact that muscle-building exercise improves blood sugar levels, increase strength, stamina, power to inspire and motivate further and greater activity that also will help your heart health. So we train wrong for women in midlife. Highs and the lows, the highs and the lows are the best thing for women. Not too much will replace the benefit of weight training and walking. And I'm talking, some of you Type A's, I hear you out there are thinking, I go for a brisk walk all the time. Here's my pace.

Okay, okay.

But the real thing is go for a walk at a level below the place where cortisol kicks in and negatively impacts you. That's why walking is so wonderful. It's not because it puts you in fat-burning zone, because the— I mean, we only have so much time. We can't walk and walk and walk and walk to burn fat. What we're doing is walking at a level where cortisol doesn't rise with exercise. We're staying out of that running and that gotta go hard all the time that increases cortisol and puts you smack in fat storage. We need to stay out of that. Moderate intensity exercise— do you remember that? If you remember the '80s, you remember that we emphasized, and we learned all too well by women who began adulting in the '80s— is an energy and a time robber that increases the negative effects of cortisol rather than mitigating stress that so many of us crave to do. High intensity to toleration during perimenopause, when hormones are doing the greatest fluctuation. Not all women, by the way, will tolerate. So when I'm talking high intensity interval training, I'm talking it gets you breathless in about 30, 40 seconds at most. And if it's not that, probably you're— you need to pick up and you need to find something that is all out. Needs to be all out. You're sprinting to a finish line. You're not going to hold back and say, oh, I'm gonna check, see if I'm in my heart rate zone here. No, you're not going to do that. So you need to go all out every single interval, and you will do much more good for your heart. We are putting a controlled stressor on it. That's the goal. But the equal goal is we are then going to let it recover completely, come all the way back down. And it gets so muddy you go to boot camps, and let me tell you what takes over. It's not just endorphins and, oh, this feels good, but there is something that is actually triggered in the brain during high-intensity interval training that is almost like a drug. It's like a little crack, and it feels so good. There's a sense of accomplishment that actually isn't there when you work out at lower levels, which is a huge plus. It's a huge kind of selling point for getting people to come back and do it again. But it's also a little bit dangerous because while you're in it, in that moment, you just feel invincible. You feel so good, but you don't want to forget that what goes up must come down. You need to let that recover completely so that you can actually go all the way up again. Super important that that happens for you. So if you're in perimenopause, just know this, because the roller coaster ride that your hormones are doing, trending down, yes, but there's that up and down and up and down. And you probably want to do some high-intensity interval training, but there may be times and phases during perimenopause that can last up to 11 years, by the way, that you may not and you may do better by not doing high-intensity intervals. So lean in. If you're fatigued, you're tired, you have this undue kind of waiting fatigue that you're not sleeping at night even though you're in bed, maybe not resting or getting restful sleep. That is just your sign. Step back a little bit from HIIT now in order that you can push on the accelerator in a bit, recover completely, and that's Whether we're talking between your sessions, we're talking between intervals in a session, or we're talking between days of exercise. If you're not really completely recovering, handle that first. Menopause hormones have stabilized and a woman is likely to tolerate more high intensity. And I don't mean longer sessions. These are still really short, 15 minutes, 20 minutes. And I mean start to end, warmup to cool down short. And Yet you're going to be able to do more volume, meaning more days a week. So rather than 0 to 2 in perimenopause, potentially 2 to 4, and you're doing them really short, but you're really pushing that. So you want fast-twitch muscle fiber. We lose it twice as fast as we lose it slow. We want to get that power in those reaction skills, quick ability to right yourself when you slip or trip. Slips and trips don't have to mean falls, right? So as long as you can catch yourself, we need to actualize those fast-switch muscle fibers in order to do it. The significant boost of growth hormone and testosterone that occurs with true high-intensity exercise provides a mitigation of cortisol levels. So you have to go well beyond that quote-unquote moderate level intensity to do that? Well, moderate intensity, either as intentional exercise level or as a drift to it after long enough duration. And I want you to hear that some of you start out going, you know, I'm just in a low level and I'm just gonna go for a long time and you're having such a good time.

Hey, this is Debra Atkinson and there is one thing you can't do in the gym at your age, and that's get all the protein that you need. You've got to do that in the kitchen. To make it easy for myself, not only to get the protein but the fiber, the fruits and vegetables I want daily, I started drinking a smoothie a day 30 years ago. But when I realized all the junk, the sugar, and the extras that you don't want, that I don't want hiding in most protein powders. That's when I finally caved in after years of saying I will never ever ever sell supplements. Stop skipping, skimping, and sabotaging yourself in the morning after workouts by always being prepared. Look, yep, I agree, real food first, but it's just not convenient to carry a turkey sandwich rich. Sometimes the protein— and don't forget the fiber— they kill cravings and they boost satiety. And you've got to make it easy to do the right thing. You can use code PODCAST for 10% off your first order at flipping50.com today. Thank you for listening. To listen to a decade of episodes and to get the show notes, visit flipping50.com where you'll be able to find all the previous episodes. And I made it super easy to make the most of your listening time and get exactly what you want to listen to as top priority. By getting the top 10 episodes in the areas you most care about, like how much protein do you need, weight loss, and other 3 ultra important topics we've identified as our community's top 5. There's no more powerful health influencer in the world than you, midlife woman. So go and listen right now. Do you have a question for a podcast? A question you would love to ask, or maybe a story you want to tell? Did you know we have a special group just for podcast question roundups and the answers? My community coaches and I provide answers daily inside of this group, but it's also where I go when I occasionally say, okay, open call for podcast questions, or tell your story, would you like to be a guest? So if you're looking for a community of women who are also interested in optimizing their health, strengthening their mindset, and looking forward to every new year, join the Flipping 50 Insiders group. That's Flipping 5-0 Insiders.

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