3. MOVE. Lymph flow depends upon the muscles in the body to move it along. Every time you walk, do yoga, breathe deeply, run, or move your muscles briskly, you are helping jostle the lymph along. Dr. Lemole reports that the average turnover time for proteins in lymph is once to twice per day. But when you exercise regularly, you can increase this figure to three to five times per day. So exercising gives your body three to five times more opportunity to get rid of excess cholesterol deposits in the blood vessels around your heart.
4. AVOID OVEREXERCISE. When we exercise, we actually increase the oxidative stress in our bodies, which results in the production of free radicals in our bodies. Over time this can do more damage than good. That’s why so many endurance athletes have impaired immune function, which makes them more susceptible to infections and illness. This needn’t be the case if you always breathe in and out fully through your nose as you exercise and never exert yourself beyond what is comfortable with this way of breathing. (For further information about this, read Body, Mind, and Sport [Three Rivers Press, 2001], by John Douillard.)
Dr. Lemole recommends that you walk at a pace of about 3.6–4.0 miles per hour, which means that it should take you about thirty to forty minutes to cover two miles. Any faster than that and you will incur a lot of oxidative stress in your body that will require you to take additional antioxidant vitamins to cover the potential damage. Remember that if you exercise so that you’re breathing comfortably in and out through your nose, your body will also be operating at a pace that decreases free-radical damage, because comfortable nose breathing results in a balance between your sympathetic and parasympathetic nervous systems.
Exercise lowers many cardiovascular risks, including high blood pressure. In one study, those who did not engage in vigorous exercise regularly had a 35 percent greater risk of hypertension than those who did. Though it helps to have been active in high school and college, you will not be protected unless you continue regular vigorous exercise throughout your life.
Here are three tips that will help you stick with healthy lifestyle changes (based on a 2010 study published in the journal Circulation): 136
~ Set specific goals that are realistically attainable within a set time limit, like committing to attend one water aerobics class a week at the local Y for at least six weeks. Goals are also best when they focus on a behavior (such as committing to start a walking program or promising yourself you will eat three servings of fish a week) rather than a physiologic number (such as a target cholesterol level or weight).
~ Monitor your progress (by keeping a chart or a log, for example).
~ Integrate more than one lifestyle change at a time (such as an exercise program and a change in your diet), because one will reinforce the other.
THE HEART-ESTROGEN LINK:
WHAT’S REALLY GOING ON?
Because the incidence of heart disease in women rises at about the age of fifty, the same time that estrogen levels start to decrease, scientists assumed that heart disease after menopause must be related to an estrogen deficiency. And because studies have demonstrated that estrogen lowers LDL cholesterol, raises HDL cholesterol, and helps support blood vessel walls, scientists naturally assumed that giving everyone estrogen would solve the problem of heart disease. But the original WHI study was halted when researchers found that Prempro (Premarin plus Provera) actually increased the risk of blood clots, heart attack, and stroke in healthy women. In addition, the Heart and Estrogen/Progestin Replacement Study (HERS), the Estrogen Replacement and Atherosclerosis (ERA) study, and the WHI study all showed that estrogen replacement did not decrease the incidence of heart attack in women who already have heart disease, and in fact even increased the risk for a while. These results certainly decreased the unbridled enthusiasm for prescribing Premarin that had characterized the medical profession during the 1990s.137
But now there’s a new wrinkle in the estrogen-heart connection that scientists have long suspected. In 2006, an analysis of the data from the Nurses’ Health Study co-written by researcher JoAnn Manson, M.D., Dr. P.H., who was also one of the lead researchers in the WHI study, found that nurses who began taking hormone therapy near menopause did indeed have about a 30 percent lower risk for heart disease than women who didn’t use hormones.138 In comparison, nurses who started HT ten years or more after menopause showed no benefit. The study showed no difference between those who took estrogen alone and those who took it combined with synthetic progestin. The study also reanalyzed data from the WHI study and confirmed that the risk of heart problems increased in women who began taking HT ten years or more after menopause. (There was a 22 percent increase in those who started HT from ten to nineteen years after menopause.) But those who started it within a couple of years after their last menstrual period experienced an 11 percent lower risk of heart disease. Even more striking, in the estrogen-only branch of the WHI, published in 2006, women who started HT between ages fifty and fifty-nine had a 44 percent lower risk of heart disease.
This latest study makes sense given the large body of research showing that estrogen has a beneficial effect on the heart and blood vessels (at least in younger women). Here’s a summary of the documented beneficial effects of estrogen on the heart and blood vessels.
~ Estrogen exerts a cardioprotective effect on blood vessels and helps coronary arteries dilate (not constrict inappropriately).139 It directly modifies and normalizes the function of the endothelium and vascular smooth muscle.
~ It has a favorable impact on lipoproteins, cholesterol, and fibrinogen levels and reverses some adverse effects of lipid metabolism.
~ It decreases endothelium retention of LDL by coronary arteries.140
~ Estrogen has been used as an alternative to cholesterol-lowering drugs such as lovastatin and pravastatin. There may even be an additive effect on cholesterol and lipoproteins by combining ERT and pravastatin.141
Research on the subject is ongoing. Particularly intriguing are two studies currently under way that are looking at the effects of bioidentical HT on risk for heart disease. The Kronos Longevity Research Institute is conducting a placebo-controlled study, called the Kronos Early Estrogen Prevention Study (KEEPS), comparing the use of bioidentical hormone therapy to conjugated estrogen therapy (Premarin) in decreasing the risk of heart disease in women who have reached menopause within the previous year or so.142 The study is expected to be completed in 2012. (See www.keepstudy.com for more information.) A study sponsored by the National Institute on Aging, called the Early versus Late Intervention Trial with Estradiol (ELITE) study, is looking at whether natural estrogen therapy started soon after menopause reduces the progression of early atherosclerosis. Results of this study are expected in 2013.
Despite the reanalysis of the WHI and Nurses’ Health studies, and pending results from the KEEPS and ELITE studies, I wouldn’t prescribe HT to everyone just to prevent heart disease. There are too many other factors to consider, including breast cancer and stroke risk. As always, women and their physicians need to make the HT decision in partnership with their own intuition and body wisdom.
HOW TO LOVE AND RESPECT
YOUR MIDLIFE HEART
The energies of love, enthusiasm, joy, and passion actually enliven your heart. To promote a healthy heart, you must have a goal, a passion, a reason for living.
Many women get heart disease when, for any number of reasons, their heart is no longer in their work or their life. A very healthy eighty-five-year-old patient without any signs of heart disease recently told me that she didn’t think she’d be around much longer. Her ninety-year-old husband had been hospitalized with heart disease and wasn’t back to his usual state of health. She said, “We’ve been married for sixty years. I couldn’t go on living without him.” It is well known that elderly spouses often die within weeks of each other. Even in the medical profession this is known as “dying from a broken heart.”
At midlife, more than ever, our hearts are calling us home. We must remember that for ev
ery behavior—whether health-enhancing or health-destroying—there are emotions that are processed by the heart and the entire cardiovascular system. And behind every emotion, there is a belief—a perception about reality. Thoughts and beliefs that support self-love and self-worth enhance health and well-being and the lifestyle behaviors that support them. The more women truly care for themselves, the better their health is.
Emotions that we can’t deal with directly and elegantly go into our bodies and drive our behaviors, pure and simple. The truth of this comes down the track like a freight train at midlife. This is the time when the dictates of our very souls cry out to be heard—a time when we must grow or risk slow (or sometimes rapid) decline and disease.
Though it has been said that “home is where the heart is,” in my experience home is also where the heart most easily gets broken. And that’s because we unerringly choose close relationships that re-create the dynamics of early childhood. For example, I recently had a reading with a very skilled astrologer who pointed out that I shut down my “desire nature” (the part of me that loved beautiful things, back rubs, cookies, soft fabrics, and so on) at about the age of four and a half—a time when I decided that I needed to hide some of who I really was, and also some of my personal power, in order to win the love of a parent or sibling. There are endless variations on this story. The good news is that at midlife and beyond, we invariably revisit the unconscious agreements we made in childhood because we now have adult skills and the perspective necessary to update them.
All of life is a birth canal. Midlife is a particularly powerful and important one. One of the greatest challenges of midlife is to come home to ourselves. We can do this only when we allow ourselves to get to the heart of the matter—and to tell the truth about what we really want and need. Our emotions will always lead us to the right place. The famous writer and feminist Gloria Steinem once said, “The truth will set you free. But first it will piss you off.” How true! Almost always, having the courage to name our needs and desires is associated with feeling and releasing childhood shame and guilt. And though this shame and guilt have many different names, I can guarantee that they always boil down to some version of “I am not lovable.” This belief is so painful that far too many women use addictions—to food, alcohol, smoking, too much or too little exercise, or recreational drugs—as a way to avoid the feelings that will lead them home. It is only through naming our needs, desires, and dreams and releasing our guilt, sorrow, and shame that we will truly reach the feeling of being at home within ourselves. Self-acceptance and self-love result from being true to ourselves and to our dreams and desires. And once we begin to truly feel good about ourselves, we find we are eager to support our hearts and bodies with a healthful diet, exercise, and supplement program. Though I suggest that you follow the dietary and exercise guidelines I’ve outlined, I believe that it is even more important to learn what it is to love and accept yourself and to have the courage to open your heart to the possibility of living joyfully. This journey home is always poignant and often painful, but inevitably always worth it, too.
One of my perimenopausal friends whose mother had been mentally ill, and who knew that she had always used food as a way to cope with the craziness of having to care for both her mother and her younger siblings, told me that when she turned forty-three she finally was able to allow herself to really feel the pain of all those childhood years and let it go. She said, “I remember the first time I sat in my therapist’s office and actually allowed myself to feel the absolute panic and terror within that was the result of fear that I’d become just like my mother. And in that moment I knew why people with severe weight problems often don’t lose weight—or why they put it right back on. They prefer overeating and obesity to allowing themselves to feel the depth of despair and pain within them.” Luckily my friend has a very strong faith, and with the help of God she allowed herself to finally get all those old feelings out in the open, a process that took several months and a lot of tears.
She credits this to the fact that she sailed through menopause with nary a symptom. She no longer uses food to quell her emotions and has kept her weight stable for over ten years. The only way out was through!
Whether or not you have midlife heart symptoms such as palpitations, hypertension, high cholesterol, chest pain, jaw pain, arm pain, or any other evidence of heart disease, or if you simply want to prevent heart disease in the future, you owe it to yourself to learn the language of your heart.
THE HEART-OPENING EFFECT OF PETS
One of the first things I did after my husband moved out was to go down to the animal shelter and get two cats, something I’d wanted to do for a long time—my husband had been allergic to them. I was shocked by how much love, companionship, and joy these two furry creatures brought into my life. The first cat I got, Buddy, is a real hunk of burning love. He adores being held and petted, and he’s a great cuddler. During those early years when I had no male companionship, Buddy was a godsend. Francine, a much smaller and daintier female, taught me a lot about being a desirable woman. She sashayed about the house with incredible style and cheekiness, as if to say, “I might allow you to pet me, but it will have to be on my terms.” Though she has since died, I still feel her spirit around me. She was a powerful teacher.
One of my midlife friends from New York City, a professional woman with a high-powered job, recently got a dog. She told me, “It’s really true that happiness is a warm puppy. What a wonderful thing to wake up each morning to such unconditional love! Everyone in my building loves him. And when I take him for a walk, I make all kinds of new friends!” Scientific literature on the health benefits of pets proves beyond the shadow of a doubt that our hearts are touched and healed, quite literally, by the unconditional love that animals can bring to our lives.
Though animals can’t offer all the different types of support that we humans need, they still provide companionship, security, and a feeling of being needed. They also help connect us to the world around us and give us a focus outside ourselves—which is very helpful for those who suffer from depression. Larry Dossey, M.D., an internist who has extensively researched the healing power of prayer, refers to companion animals as “four-legged prayer.”
The presence of a pet is associated with decreased cardiovascular reactivity—which means that the influence of a pet helps us stabilize our blood vessels and heart rhythm. People have been found to have lower heart rates and lower blood pressure when they are with their pets. This translates into thousands of fewer heartbeats over months and years, which can slow the development of arteriosclerosis. Research at Brooklyn College has shown that pets slow heart rate even among highly stressed, high-intensity type A personalities.143
Pets of all kinds lower blood pressure. Petting a dog has been shown to decrease the blood pressure of healthy college students, hospitalized elderly people, and adults with hypertension. When bird owners talk to their birds, their blood pressure drops an average of ten points. And watching fish in an aquarium has been shown to bring blood pressure below resting levels. Research has also shown that when children are sitting quietly and reading, their blood pressure is lower when a dog is in the room.144
Support from animal companions has been linked to increased survival in those with coronary artery disease. This survival was independent of marital status and living situation. University of Pennsylvania researchers Aaron Katcher, M.D., and Erika Friedmann, Ph.D., found that people with pets lived longer after experiencing heart attacks than those without pets.145 Subsequent research has shown that among people who have heart attacks, pet owners have one-fifth the death rate of those who do not have pets.146 If you can’t own a pet yourself, volunteer at an animal shelter or visit other people’s pets. They’re a cardiac tonic with no side effects.
THE INTELLECT IS CERTAIN IT KNOWS,
BUT THE HEART ALWAYS WINS
It has taken me half a lifetime to know one thing for sure: the intellect exists to serve the wisdom
of the heart. Our intellect-driven society, however, leads us to believe that it’s the other way around. And so we wait for the next drug or technological breakthrough, thinking it will save us. But in the end, the wisdom of the heart always wins.
All the drugs and technology in the world can’t mend a broken heart or heal someone whose heart is no longer in the game of life. As already mentioned, the EKG signal coming from the heart is thou-sands of times stronger than the EEG signal from brain waves. So when there’s a conflict between the intellect and the heart, the heart always wins. And the only way to heal the true discomforts of the heart is to feel them fully, heed their message, and have faith that your heart’s desires can come to you in many different ways. It’s also enormously helpful to have faith in a power greater than yourself, and then live your life robustly.
My Prescription for Preventing and
Healing Heart Disease
~ Understand that each heart is self-healing if given the space and permission to feel what it needs to feel.
~ Be willing to bravely and compassionately enter the unhealed places in your heart. When you are on intimate terms with your own pain and suffering and have made a commitment to heal them, you will eventually come to the joy that is your natural state. And you will also find that you have far less difficulty keeping your heart open to others. Your very presence becomes part of the healing as everyone around you realizes that they are not alone and are also worthy of openhearted acceptance, too.
The Wisdom of Menopause Page 76
