The Wisdom of Menopause

by Christiane Northrup

  Hidden Emotions Lead to Hypertension

  There is no question that factors such as obesity, salt intake, and a sedentary lifestyle are associated with hypertension. And so is stress. But not in the way we’ve been led to believe. Samuel J. Mann, M.D., professor of clinical medicine at the Hypertension Center of the New York–Presbyterian Hospital Weill Cornell Medical Center in New York City, has seen thousands of people with all varieties of high blood pressure. Over the years, he began to notice a pattern that didn’t fit with the common view of hypertension. In his book Healing Hypertension: A Revolutionary New Approach (Wiley, 1999), he notes, “Even patients with severe hypertension did not seem more emotionally distressed than others. If anything, they seemed less distressed. Their high blood pressure appeared to be more related to what they did not seem to be feeling than to what they were feeling.”64 He began to see that old, unhealed, repressed trauma seemed to be a major culprit in his patients. After all, anger and stress can elevate blood pressure, but they do this temporarily and aren’t the root cause of hypertension. Instead, it is our hidden emotions, says Dr. Mann, the emotions we do not feel, that lead to hypertension and many other unexplained physical disorders. To deal with hypertension at its core (or anything else for that matter), it is necessary to bring those hidden emotions to the light, to consciousness, and to deal with them.

  My friend and colleague Annemarie Colbin, Ph.D., the founder of the Natural Gourmet Institute for Health and Culinary Arts in Manhattan, shared her personal experience with hypertension after she was diagnosed with it despite her very healthy lifestyle.

  I can testify to the validity of this approach. In the summer of 2000, I read about Dr. Mann in a little free newspaper that covers my New York neighborhood. At the time this seemed a surprising synchronicity, as I had suddenly found myself grappling with some episodes of extremely high blood pressure—as high as 220/120. I was unable to sleep at night, or at most slept two to three hours, a completely new development for me. I also had trouble concentrating. Although I am very opposed to taking pharmaceutical drugs, I did consult a physician and took some anyway. I also went to my usual alternative medicine practitioners, such as my chiropractor, homeopath, and acupuncturist, which helped a little, but I knew it wasn’t enough.

  After reading the article about Dr. Mann, I bought his book and read more on his unique perspective. Then I went to see him, and with his encouragement started looking at what kind of hidden emotions I could be harboring. It didn’t take long to figure out that the place to look would be in my repressed, or perhaps pre-verbal, memories of the three years I spent during World War II in Budapest, Hungary, when I was two to five years old. I was there with my mother (my father, I found out years later, was in a forced labor camp), and we spent many nights in cellars and basements with thirty to forty strangers, hiding from the bombs and grenades. In terms of emotions, I knew there was something there, but I had no memory of it.

  One day in August, after a weekend of sleeping one night out of three, I found myself again with high blood pressure, 200/100, and I went for a walk in the park, barefoot in the grass. (I had taken this up as a de-stressor.) Thinking about the war years, and also about how I felt the sleepless night before, I realized that my night wakefulness was quiet and watchful. I did not think, worry, toss, or turn. I was just on high alert. It felt as if I was just waiting. What, I wondered, was I waiting for?

  Then I remembered my mother telling me about one time when we were staying in a basement, and she was summoned upstairs by the occupying soldiers for a party, together with another young woman there. Thus, she had to leave me alone in the dark cellar with all the strangers, none of whom cared about me. I suddenly got in touch with a profound terror that a threeor four-year-old would feel—the fear that my mother might not come back. I remembered knowing that I would die if she didn’t return. I had no home, no family, no friends around, nothing—it was just the two of us, and without her I had no chance of survival. I think I must have stayed awake all that night waiting for my mother, and now, in my sleepless nights, I was reliving it. I lay in the grass, on the safe ground, and shook and cried, feeling and releasing that old terror.

  After a while of shaking and crying, I calmed down, got up, and went home, feeling strangely relieved. Then I checked my blood pressure. It had gone down to 137/82—in one hour! I knew I was on the right track. Since then, it still has gone up and down, and I had to do quite a lot more spiritual work, but at the time of this writing, four months later, my blood pressure seems to be keeping itself normal with no medication. It’s been a harrowing four months, and I’m not finished yet, but I am certainly on the path to cleaning out that old emotional baggage, thanks to Dr. Mann’s revolutionary insights.

  Depression

  Depression is consistently related to a high risk for heart disease in both men and women. In a survey of women in my wisdom community back in the early 2000s, 46 percent listed their biggest health concern as depression and anxiety. In contrast, only 18 percent indicated that heart disease was their greatest concern. What these and most other women don’t realize is that the emotions associated with sadness or grief, anger or depression, and fear or anxiety are very much connected to heart disease (as well as bone health).

  Women’s blood vessels are smaller than men’s and are extremely sensitive to the biochemical changes that occur in response to the emotions of daily life. These biochemical changes result in either constricted or dilated blood vessels. When your blood vessels constrict in response to emotions such as anger, grief, and fear, they do so because of an outpouring of chemicals from the sympathetic nervous system; blood flow is reduced, and tissue damage and high blood pressure are the result.

  Because at least 25 percent of women suffer from depressive episodes at some point in their lives, and because women are more apt to suffer from depression than men, depression emerges as a very important and modifiable risk factor for women. Though it is well documented that both men and women often suffer from depression after a heart attack, newer data conclude that depression is an important independent risk factor for heart disease. A study from the Ohio State University College of Medicine and Public Health recently showed just how profoundly depression affects coronary artery disease in women. Even after adjusting for other factors such as smoking, obesity, and lack of exercise, the risk for non-fatal coronary artery disease was 73 percent higher in depressed women compared with a control group.65 In their research, depressed women were also shown to be twice as likely to develop coronary artery disease as were normal, nondepressed women.

  Similarly, profound grief and emotional distress can also stress your heart. Stress cardiomyopathy, commonly called “broken heart syndrome,” is a term for sudden weakening of the heart muscle brought on by emotional trauma, such as grief, fear, extreme anger, or surprise. It can happen after experiencing the unexpected death of a loved one, a close brush with death, or being the victim of domestic abuse. While much about the physiology of broken heart syndrome remains unclear, we do know that a surge of catecholamines (stress hormones, such as adrenaline and noradrenaline) stuns the heart. This condition, which affects midlife women more than any other demographic, mimics a classic heart attack, with symptoms such as chest discomfort, shortness of breath, and a feeling of impending doom.

  Cardiologist Stephen T. Sinatra, M.D., author of Heartbreak and Heart Disease (Keats, 1996) notes, “The person’s EKG reading will be normal, as will the level of cardiac muscle enzymes in the blood and the function of the coronary arteries on angiography. The only problem is an echocardiogram pattern that shows the apex of the heart—the part that sits on the diaphragm—is ballooning outward.”66

  Although the heart isn’t permanently damaged and the weakness reverses itself, Dr. Sinatra notes that “heartbreak is a real component in ‘matters of the heart,’ from hypertension and arrhythmia to heart attacks and heart failure.” It can be a warning sign that you need to heed your heart’s messages and take b
etter care of it before more serious and irreversible damage occurs further down the line.

  CARBOHYDRATES, SUGAR, AND HEART HEALTH:

  WHAT EVERY WOMAN SHOULD KNOW

  By now you know that overconsumption of refined carbohydrates plays a role in developing type 2 or adult-onset diabetes, a disease whose incidence is rapidly increasing as our population grows fatter and fatter. But what most women don’t know is that the same carbohydrate consumption pattern that results in obesity, poor skin, and hormone imbalance is also a potent risk factor for heart disease, hypertension, and stroke. The diet most commonly prescribed for treatment and prevention of heart disease in both men and women is a high-carbohydrate, low-fat approach. Unfortunately, this diet may have exactly the opposite effect. When compared with a higher-protein, higher-fat diet with exactly the same number of calories, the high-carbohydrate diet has been shown to increase risk factors for ischemic heart disease, such as high triglycerides and insulin, in healthy postmenopausal women. It also lowers HDL cholesterol.67 Eating a high-carbohydrate meal has also been shown to trigger angina sooner and reduce exercise tolerance in patients with known heart disease. This is because high insulin levels can cause constriction of arteriosclerotic coronary arteries.68 (Ironically, a diet high in refined carbohydrates was first implicated in heart attacks back in the 1950s with the book How to Prevent Heart Attacks [Lee Foundation for Nutritional Research, 1958], written by Benjamin Sandler, M.D. In the book, Dr. Sandler shared his phenomenal success preventing fatal heart attacks in his angina patients by prescribing a no-sugar, nostarch food plan that kept blood sugar levels stable.)69

  The experience of many women whose husbands go on high-carbohydrate, low-fat diets following heart attacks is that the men lose weight and lower their total cholesterol while their wives gain weight and may lose some of their HDL (“good” cholesterol) on exactly the same food plan. In fact, an Italian study published in 2010 that followed more than 47,000 men and women for eight years showed that women who ate a high-carbohydrate diet (especially a high-glycemic-index diet) were nearly twice as likely to develop coronary artery disease than women who ate a low-carbohydrate diet.70 Yet these findings were not true for the men in the study. To prevent this increased risk, women need to be sure to eat only those carbohydrates that don’t raise insulin levels too high or too quickly.71 (See chapter 7.)

  To understand how excessive carbohydrate intake can contribute to heart disease, we have to return to the subject of insulin. When you eat carbohydrates that are converted into sugar rapidly, your body pours insulin into your blood from your pancreas. Insulin is necessary to move the sugar from your bloodstream into your cells, where it is used for energy. But insulin doesn’t simply regulate your blood sugar; it also helps control the storage of fat in your body. And heart disease is basically a disease associated with too much fat in our arteries.

  Here’s how it happens. Insulin directs amino acids, fatty acids, and carbohydrate breakdown products into our body tissues. It also regulates the body’s production of cholesterol. Insulin tells the liver to begin making LDL (“bad” cholesterol), which at high enough levels—and under the right circumstances—actually sticks to blood vessel walls that have already been damaged by glycemic stress (blood sugar that’s too high) and forms a plaque. And that is the essence of coronary artery disease and also cerebrovascular disease—the kind of arterial disease that affects brain function and enhances your risk for stroke and also dementia.

  If you eat a lot of sugar or a lot of high-glycemic-index carbohydrates, such as pasta, bread, candy, cookies, and potatoes (and/or alcohol), and you are prone to high blood sugar or insulin resistance (as about 75 percent of us are), your liver may well increase its synthesis of LDL, which tends to stick to your inflamed blood vessels, forming plaques and subsequently causing arteriosclerosis, or hardening of the arteries.

  Insulin also drives your kidneys to retain fluid, in a way that is similar to the kind of fluid overload that is seen in coronary artery disease and congestive heart failure. Excess insulin therefore poses a significant risk for hypertension, coronary artery disease, obesity, and high cholesterol levels, not just diabetes. Fluid retention from insulin is the reason why susceptible individuals can easily put on three or four pounds after a single large carbohydrate-rich meal. (I call these “liquid” pounds.)

  For information about how to effectively reduce your consumption of sugar, I recommend reading The Belly Fat Cure (Hay House, 2009) and The Belly Fat Cure Fast Track (Hay House, 2011), both by Jorge Cruise.

  Insulin and Blood Vessel Wall Thickening

  In addition to all its other important roles, insulin is also a growth factor in the body: excess insulin and high blood sugar result in inflammation in the lining of blood vessels throughout the body. Over time, this process promotes smooth muscle growth in your blood vessel walls, which contributes to the formation of plaque, causing your artery walls to thicken and become rigid. Excess blood sugar from chronic carbohydrate consumption irreversibly attaches to the LDL cholesterol molecules that are already stuck to the blood vessel walls. This disease process in blood vessels also includes free-radical damage, a type of cellular damage that is akin to rust on a car.72

  Here’s the bottom line: if you eat too many high-glycemic-index carbohydrates and don’t exercise, then your body will convert those carbs into excess blood sugar, fat, and LDL cholesterol. In addition, the higher your intake of refined carbohydrates, the more cellular inflammation, which is the final common pathway for heart disease.73

  Follow a diet that keeps insulin levels low—the same diet that also prevents middle-age spread, balances your hormones, and improves your skin.

  Some women are able to keep their weight and cholesterol levels normal by eating a lot of complex carbohydrates, including wholegrain breads, while others—like me and millions of others—are not. You can’t go wrong, however, if your diet consists mostly of lean protein, healthy fats, and lots of fruits and vegetables. Choose the most colorful ones, such as blueberries, strawberries, collard greens, squash, and kale. These are the highest in antioxidants. Hundreds of studies have confirmed that foods rich in flavonoids, carotenoids, and other antioxidants can reduce your risk for cardiovascular disease. Women who routinely eat four to five servings of fruits and vegetables per day (particularly the green, leafy, cruciferous, and citrus varieties) have a 28 to 35 percent decreased risk of stroke—an estimated 7 percent decrease in risk for each serving.74

  The isoflavones and other substances in soy have also been shown to have a beneficial effect on blood lipids. For example, an analysis of thirty-eight controlled clinical trials found that the consumption of soy protein rather than animal protein resulted in significantly decreased levels of total cholesterol, LDL cholesterol, and triglycerides.75 Regular consumption of soy protein and ground flaxseed is also associated with lowered cholesterol and a decreased risk for arteriosclerosis.76 In addition, oral isoflavone supplements have been shown to improve poor blood vessel dilation (an important factor in cardiac health) in postmenopausal women.77

  Last but not least, avoid trans fats.

  CARDIOPROTECTIVE SUPPLEMENTS

  The following is a list of some of the best-studied cardioprotective foods and supplements. You don’t need to take all of them. Many will be present in a good comprehensive formulation for women. But others, like a higher dose of vitamin C, a cup of green tea daily, or a clove of garlic, are easy to add to your day.

  Magnesium

  Among its many roles in the body, magnesium helps stabilize electrical conduction in the cardiac muscle. It also helps relax the smooth muscle in blood vessels,78 contributing to maintenance of normal blood pressure and vascular tone, and assists insulin in transporting glucose into cells, fighting glycemic stress. Because it helps all muscles (including coronary artery muscles) relax, it’s very effective in helping prevent cardiac damage and even death after a heart attack. (In fact, up to 40 to 60 percent of sudden deaths from heart atta
ck are caused by spasm in the arteries—not blockage from clots or arrhythmias!)79

  Magnesium deficiency is relatively common; because commercial agriculture today relies heavily on inorganic fertilizers, our food supply tends to be poor in this mineral. Food processing results in decreased magnesium as well. Chronic emotional and mental stress is also associated with magnesium deficiency because the stress hormones cortisol and adrenaline release magnesium from the cells; eventually it is excreted in the urine.

  Diuretics result in the loss of magnesium in the urine, too, which is why the chronic use of diuretics has been associated with sudden cardiac death. If you’re on diuretics for high blood pressure or any other reason, make sure that you take additional magnesium, potassium, and zinc. Excessive use of the stomach acid inhibitors cimetidine (Tagamet) and ranitidine (Zantac) can result in magnesium deficiency as well. Take 400–1,000 mg per day in divided doses with meals.