The human body is an amazingly complex network. The more we learn about how this network communicates, the better we are able to determine the true root cause of health issues and address those at the source. Much of the communication within the body is conducted by two key messengers – hormones and neurotransmitters. Hormones travel through the bloodstream while neurotransmitters travel via the nervous system. The two are intimately connected and both affect all systems of the body. As heart, bone and mental health functions are primarily impacted by hormone communication we will focus our discussion there.

Hormones are secreted by glands such as the adrenals, ovaries, testes, pineal, and pituitary gland. The pancreas, liver, kidneys, other parts of our digestive tract, and even fats cells also have a glandular function. Once released, the hormone travels the entirety of the body via the bloodstream connecting to receptors along the way, triggering a physiological response at every level. This complex integrated system is all controlled by a central mechanism: the hypothalamus-pituitary- adrenal (HPA) axis. The hypothalamus is the part of the brain that “listens” through biofeedback to signals from the body and environment, sorts out information that is important for hormone production, and initiates the cascade of messengers to direct the rest of the body, beginning with the pituitary gland. “Fight or flight” is the best example of this, where the hypothalamus triggers the production of adrenaline and other hormones to create a short-term state in our body that is best to deal with the situation.

When the body releases a hormone, it typically does so slowly and in tiny amounts. This is why we often only need low doses, delivered slowly over time, to make adjustments that can have profound effects in getting our body into perfect harmony. Just like too little hormones can result in health issues, so too can higher doses, introduced too quickly, which is why erring on the side of too little and building up slowly is often the best strategy.

During puberty, menses, pregnancy, peri- and post-menopause, (indicated by the end of a woman’s cycle for a full 12 months) hormones bring about the greatest changes in a woman’s body. Post- menopausal and perimenopausal changes are often associated with symptoms such as hot flashes, night sweats, mood swings, hair loss, acne, water retention, weight gain, sleep issues, headaches, and libido changes. However, many of these issues can be experienced at these other stages of life too. While antidepressants, pain killers, diets, sleeping pills, skin creams, and many other short- term solutions are prescribed or recommended to address these symptoms, the true root cause often comes back to hormone imbalance.

Hormones also relate to our body’s long-term health and function. Peri- and post-menopause are not just associated with the symptoms mentioned above, but also with a sharp increase in heart disease risk, decreased bone mineral density, and cognitive changes such as anxiety, depression, and memory issues. In fact, as we will discuss below, hormone balance is perhaps the most important factor in supporting heart, bone, and mental health and should be the first part of any health protocol for women of any age.

With all of these changes so closely linked to hormone imbalance in earlier life or lack of hormone production later in life, it is no wonder that replacing these hormones medicinally has been a focus of physicians for over seventy-five years.

Since the 1930’s synthetic estrogen derived from the urine of pregnant horses has been used. By the 1960’s, boosted by the publication of Feminine Forever which suggested its use to include maintaining youth and femininity, demand for hormone replacement therapy (HRT) spiked dramatically.¹ Physicians prescribed HRT to lower heart disease risk, improve bone density, and alleviate mood concerns... and it worked! It worked so well in fact, that in the 1990’s one of the most extensive research studies in history was initiated to determine just how good HRT could be for bone and heart health—the Women’s Health Initiative (WHI).²

However, in 2002 the initial results of WHI were published and the results changed the way we perceive hormones forever. It showed that women using HRT were at increased risk of developing breast cancer, stroke, heart attack, and blood clots. It also positively showed a decreased risk of hip fractures in this at risk population and improved cholesterol levels.³ Since then, additional in-depth studies have evaluated HRT and in 2012 a task force of experts concluded that despite the positive findings on bone health, the risks often outweighed the benefits for long-term use of HRT.⁴ 

Since then, bioidentical hormones (BHRT) have been proposed as an alternative solution, but many doctors and patients are still concerned about the potential safety issues. Hormones introduced to the body rather than being produced by the body seems to contradict the body’s mechanism of slow secretion and small amounts. Oftentimes, medically prescribed hormones are given in large amounts, all at once during the day. This makes other delivery systems such as patches, intra- uterine devices (IUDs), and injections interesting to consider but the jury is still out. In addition, what if a hormone is proportionately being over produced? How can we reduce the production of that hormone while increasing another? Does this require another drug causing further potential complications?

This hasn’t just been limited to the later stages of life. Nearly 20%⁵ of women ages 15-44 in the US are using oral contraceptives (birth control), which often consists of the hormones – progesterone and estrogen. With more than 15 million women in this age group using some form of hormone- based contraception it is worth noting that only 58% are doing so exclusively for contraception. 42% are also using oral birth control to help regulate the menstrual cycle and address conditions like acne, premenstrual syndrome (PMS), polycystic ovarian syndrome (PCOS), amenorrhea, endometriosis, fibroids, and many other conditions of hormone imbalance.⁶ However using oral contraception to address these conditions does little to correct the underlying problem. Rather, it manipulates the body, placating the situation and masking the cause. Many women come off birth control five, ten, or even twenty years after starting its use and symptoms come back, sometimes worse than before. In addition, manipulating the body for extended periods can result in adverse health responses including fertility issues, vitamin and mineral deficiencies, and other health issues.

So while many of these antiquated strategies from the 1950’s and 1960’s might be effective and were the best options we had at the time, research over the last ten years provides us with far more effective, safe options that address the root cause.

If the ideal is to have our bodies functioning optimally, then creating hormone balance and a healthy metabolism is the key. Supporting the body to function as it did when we were younger, while taking into consideration our stage of life, is ideal. For example, supporting hormone levels for a post-menopausal woman at an optimal level for her stage of life rather than levels for a thirty- year old woman is more appropriate. In this case optimal hormone balance would result in reduced menopausal symptoms (if she had them) as well as support for her heart, bone density, and mental health while not returning her to a fertile state!

All of this brings us back to the HPA axis. By nourishing these master glands that impact the entire endocrine system and our bodies, we have the ability to support optimal function. Instead of introducing hormones into the body in various amounts, through one or more delivery systems and doses, nourishing the HPA axis supports the body’s own hormone production, both increasing and decreasing production based on biofeedback and individualized needs.

Interestingly, no dietary supplement had ever shown in published clinical trials statistically significant improvements in hormone levels in peri- and post-menopausal women. This includes all the research on phyto-estrogens, adaptogens, vitamins, minerals and the like. However that changed in 2007 with the publication of clinical research into a novel ingredient called Maca-GO commercially known as Femmenessence.Femmenessence was the first natural product with published double-blind, placebo-controlled human clinical studies that demonstrated statistically significant improvement in the body’s own production of hormones in peri- and post-menopausal women. Furthermore the impact on hormones resulted in highly statistically significant improvements in menopausal symptoms and mood as well as effects on thyroid hormones, cholesterol and triglyceride levels within a normal range, adrenal stress hormones, body weight, and bone density in a nested sample.^6,7,8,9

Perhaps even more importantly instead of introducing hormones into the body, Femmenessence utilizes a different mechanism of action. By nourishing the HPA axis, Femmenessence supports the body’s own production of not just one or two hormones, but a whole host of hormones. Because of the ground breaking results, an abstract of the research was republished in Menopause the medical journal of the North American Menopause Society (the largest organization of its kind in the world), additionally Natural Health International, the company responsible for bringing Femmenessence to the market, was the first natural product company allowed to exhibit at the American College of Obstetricians and Gynecologists (ACOG). And now leading women’s health experts such as Christiane Northrup, MD (US), Tori Hudson, ND (US), Maryon Stewart (UK), Toru Tabei, MD, PhD (Japan) and Jan Roberts (Australia) are talking and writing about Femmenessence as a result of these remarkable achievements.

When we think about bone health we generally think of calcium, magnesium, vitamin D, vitamin K, and weight-bearing exercise. While these are important synergistic factors, when supporting bone health they are not the key factors.

To deduce what is the key factor, we just need to look at bone density data over a woman's life span. From birth through late twenties, bone density increases. From late twenties to menopause, bone density ostensibly stays the same. But, in the first 3-5 years of menopause, bone density drops by 7-10%.

So the question becomes “why?”

If we look at post-menopause in general, lifestyle, diet, and exercise don’t really change for most women from 45 to 55 years of age. Women don't stop eating foods and supplements rich in calcium or magnesium at menopause. Nor do they stop spending time in the sun for vitamin D production. They don't stop exercising at that stage of life either. So those primary strategies we recommend to support bone health for all women are not the key reason they lose significant bone density so quickly post-menopause.

The reason: hormones.

When we think about bone density we usually don't consider hormones and yet as this highlights it is the most important factor post-menopause.

How do hormones affect bone density? Bone is actually an active or living tissue, just like muscle. We are perpetually building bone. In fact, it is estimated we rebuild our entire skeletal structure once every ten years. This process consists of cells that break down old bone called osteoclasts and cells that build new bone called osteoblasts. However, these cells do not work by themselves. They are invigorated or slowed down by hormones.

Estrogen slows osteoclasts function so it slows bone loss. Testosterone and progesterone invigorate osteoblasts supporting bone growth. When women reach menopause, it is a double whammy as they break down bone too quickly and stop building it. In fact, it is often a triple whammy as gastrointestinal absorption and metabolism slows, reducing the absorption of key minerals like calcium.

This is similar to building a house. Imagine calcium, vitamin D, vitamin K, magnesium, and other minerals as bricks, concrete, and tiles needed to build a house. Now, if you deliver those building materials to a work site, a house doesn’t materialize out of thin air. You need builders and that’s where hormones come in. Hormones, osteoclasts, osteoblasts, minerals, and vitamins play a synergistic role in bone health.

In clinical trials, Femmenessence was shown to support the HPA axis which impacts hormone production in peri- and post-menopausal women as well as metabolism and thus calcium and mineral absorption in the blood.* Additionally, a nested sample of trial participants increased their bone mineral density according to dual-energy X-ray absorptiometry (DEXA).*

Because of this, women seeking to support bone health may use Femmenessence to help balance and regulate hormones without introducing hormones from outside the body and to impact mineral absorption. Ideally, Femmenessence is combined with exercise and targeted nutritional bone supplements with all the important co-factor vitamins and minerals.

Heart disease is not just the number one cause of death in men and women 65 and older in the United States, but is also a leading factor in deteriorating quality of life. Strokes can be disabling when not lethal. Not pumping blood efficiently leads to decreased oxygen to tissues throughout the body, causes low energy, and reduced endurance. Compromised heart health can also impact sexual health and put an end to many activities, travel, and experiences in our lives that bring us joy.

With the changing landscape of diet and nutrition globally, people of all ages are at a greater risk of heart disease earlier in life. However, just like with bone density, men experience a gradual increase in risk from their early thirties, while women experience relatively no changes until menopause when their risk skyrockets.

What happens at menopause?

When we investigate heart disease at menopause, we very quickly see that many of the solutions presented do not address the root cause of this significant jump in risk. In fact, while we know many heart health supplements are important and can have benefits, they don’t explain this dramatic increased risk at menopause. When women reach menopause, they don’t stop eating foods that contain omega-3 fatty acids or resveratrol, garlic, or many of the other compounds we know support heart health. They also don’t stop exercising, change their environment, or experience marked changes in stress levels. So what does change? What causes an increase in cholesterol, blood pressure, increased body weight, and much more?

It is the decline in the function of glands like the hypothalamus, pituitary, adrenals, thyroid, and ovaries that affect hormone production and metabolism. Just like with bone health, many aspects of cardiovascular health are affected by different hormones and metabolism:

• Estradiol maintains the elasticity of arteries and blood vessels.¹¹
• Estradiol activates the gene responsible for the activity of high density lipoproteins (HDL).¹² HDL helps transport cholesterol from the blood to the liver and other organs.
• Estradiol reduces low density lipoproteins (LDL) and may also act as an antioxidant.xiii,xiv High levels of LDL are thought to be a risk factor for cardiovascular disease.
• Estradiol acts as an insulin sensitizer. As cells become less sensitive to insulin, blood glucose rises increasing diabetes and heart disease risk.
• Progesterone protects arteries from spasms.¹⁵ 
• Adrenal hormones including cortisol affect sleep, energy, hair growth, muscle growth, and weight. Adrenal dysregulation and the biological effects of stress, mediated by hormones produced in the adrenal glands, plays a major role in obesity and its consequences, including inflammation, insulin resistance, hypertension, atherosclerosis, and other conditions that together constitute “metabolic syndrome.”
• Thyroid hormones impact the metabolic rate.

Clinical research on Femmenessence demonstrated support for estradiol, progesterone, cortisol thyroid hormones and healthy cholesterol levels.* In the landmark study Women’s Health Initiative results, triglycerides rose in those women taking HRT. In clinical trials of Femmenessence, this did not occur. Excess triglycerides may contribute the risk of heart disease although the mechanism is not entirely clear.xvi Femmenessence was also shown to reduce body weight by 6% after 3 months.*

Women seeking to support heart health may use Femmenessence to help balance and regulate hormones. Ideally, Femmenessence is combined with a healthy diet, exercise, emotional support, a stress reduction therapy and targeted nutritional supplements such as omega-3 fatty acids.

Cognitive function, memory loss, and mood fluctuations constitute mental health. As many women know, these three issues can occur at any time but are often exacerbated around puberty, pre- menstrually (PMS), during pregnancy, through peri-menopause and after the onset of menopause. If we look at these, one consistent theme is low levels of estrogen. Several studies have implicated estrogen in affecting brain function and mood. Sudden estrogen withdrawal, fluctuating estrogen, and sustained estrogen deficiency are associated with significant mood disturbances. However, treatment for depression with estrogen (HRT) has not always produced positive results. But, recovery from depression postpartum, peri-menopause, and post-menopause using estrogen may be effective. So determining whether your mood or mental health issues are exacerbated around these key stages of life can help determine whether these are related to hormones or not.

How do hormones affect the brain?

When we think of mood and the brain we generally think about neurotransmitters. What is interesting is that estrogen is both a hormone and has a direct effect on neurotransmitters.xvii One of its functions is to increase the number of dendrites on neurons. Dendrites are the connectors that impact the amount of information that is transmitted between neurons. Like cables for internet connections there are millions of connections instead of thousands so much more information can transfer. Low levels of estrogen means less connection points, which can result in mood changes, memory issues and brain fog. Thus, low levels of estrogen could impact the transmission of serotonin, the most important neurotransmitter for mood regulation, especially depression.xviii Cortisol, the main hormone produced during stress, has a myriad of effects on mood too.

Femmenessence was found to support estrogen and may reduce cortisol when it is secreted in excess.* Clinical trial participants noted improvements on the Kupperman Menopause Index and Greene Menopause Index suggesting improved subjective changes in mood. Women may use Femmenessence to support mood especially when the cause of unwanted mood changes is related to hormone balance both peri- and post menopause as well as around PMS and post-partum.*

Women seeking to support mental health may use Femmenessence to help balance and regulate hormones without introducing hormones from outside the body. Ideally, Femmenessence is combined with a healthy diet, exercise, emotional support, a stress reduction therapy, and targeted nutritional supplements such as omega-3 fatty acids and low- dose (0.3 mg) melatonin.

Hormones also affect hair, skin, and nails. For women, estrogen regulates the thickness of the skin, moisture content, suppleness, wrinkle formation, and blood flow to the skin. Sex hormones, including estrogen and progesterone, are some of the most significant factors affecting acne, both in puberty and adulthood. Estrogen also affects hair growth; after menopause, women may find their head hair thinning, while facial hair and other areas may grow thicker. This occurs because estrogen levels decrease even more than testosterone levels, leaving women with relatively more testosterone. When testosterone is too high relative to estrogen, this can also cause acne, especially around the mouth and jaw line, and cause hair to fall out in specific patterns especially on the crown of the head.

The skin responds to high cortisol levels by producing more oil, which in turn can lead to both oily skin and acne breakouts. Occasionally, hair responds to high cortisol by falling out, and can take from six to nine months to begin growing back.

Nail strength is also impacted by healthy hormone levels.

Femmenessence improved gastrointestinal absorption resulting in greater nutrient uptake which can improve nail strength.* Femmenessence also not only balances hormones including estrogen and cortisol without introducing hormones from outside of the body but improvements in complexion, skin elasticity, and quality of hair growth may be experienced.*

For additional reading, we recommend The Wisdom of Menopause and Women’s Bodies, Women’s Wisdom, both by Dr. Christiane Northrup. Look for her references to Femmenessence in both books.

References:

1. Centers for Disease Control and Prevention. Hormone Replacement Therapy: Knowledge and Use in the United States.
   <http://www.cdc.gov/nchs/data/misc/hrt_booklet.PDF>
2. National Heart, Lung, and Blood Institute (NHLBI). WHI Background and Overview. <http://www.nhlbi.nih.gov/whi/factsht.htm>
3. National Heart, Lung, and Blood Institute (NHLBI). Menopausal Hormone Therapy.
   <http://www.nhlbi.nih.gov/health/women/pht_facts.pdf>
4. U.S. Preventative Services Task Force. Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions.
   <http://www.uspreventiveservicestaskforce.org/uspstf/uspspmho.htm>
5. Jones J, Mosher WD and Daniels K, Current contraceptive use in the United States, 2006–2010, and changes in patterns of use since
   1995, National Health Statistics Reports, 2012, No. 60, <http://www.cdc.gov/nchs/data/nhsr/nhsr060.pdf>
6. Jones, RK. Beyond Birth Control: The Overlooked Benefits Of Oral Contraceptive Pills <http://www.guttmacher.org/pubs/Beyond-Birth-Control.pdf>
7. Meissner HO, Kapczynski W, Mscisz A, Lutomski J. Use of gelatinized maca (lepidium peruvianum) in early postmenopausal women. Int J Biomed Sci. 2005 Jun;1(1):33-45.
8. Meissner HO, Mscisz A, Reich-Bilinska H, et al. Hormone-Balancing Effect of Pre-Gelatinized Organic Maca (Lepidium peruvianum Chacon): (II) Physiological and Symptomatic Responses of Early-Postmenopausal Women to Standardized doses of Maca in Double Blind, Randomized, Placebo-Controlled, Multi-Centre Clinical Study. Int J Biomed Sci. 2006 Dec;2(4):360-74.
9. Meissner HO, Mscisz A, Reich-Bilinska H, et al. Hormone-Balancing Effect of Pre-Gelatinized Organic Maca (Lepidium peruvianum Chacon): (III) Clinical responses of early-postmenopausal women to Maca in double blind, randomized, Placebo-controlled, crossover configuration, outpatient study. Int J Biomed Sci. 2006 Dec;2(4):375-94.
10. Meissner HO, Reich-Bilinska H, Mscisz A, Kedzia B. Therapeutic Effects of Pre-Gelatinized Maca (Lepidium Peruvianum Chacon) used as a Non-Hormonal Alternative to HRT in Perimenopausal Women - Clinical Pilot Study. Int J Biomed Sci. 2006 Jun;2(2):143-59.
11. Guo X, Razandi M, Pedram A, Kassab G, Levin ER. Estrogen induces vascular wall dilation: mediation through kinase signaling to nitric oxide and estrogen receptors alpha and beta. J Biol Chem. 2005 May 20;280(20):19704-10.
12. Lopez D, Sanchez MD, Shea-Eaton W, McLean MP. Estrogen activates the high-density lipoprotein receptor gene via binding to estrogen response elements and interaction with sterol regulatory element binding protein-1A. Endocrinology. 2002 Jun;143(6):2155-68.
13. LaRosa JC. Metabolic effects of estrogens and progestins. Fertil Steril. 1994; 62(6, suppl 2):140S-6S.
14. Sugioka K, Shimosegawa Y, Nakano M. Estrogens as natural antioxidants of membrane phospholipid peroxidation. FEBS Lett. 1987; 210:37-9.
15. Miyagawa K, Rosch J, Stanczyk F, & Hermsmeyer K. Medroxyprogesterone acetate interferes with ovarian steroid protection against coronary vasospasm. Nature Medicine 1997; 3: 324-327.
16. AHA Scientific Statement: Triglycerides and Cardiovascular Disease. Circulation. 2011; 123: 2292-2333 <http://circ.ahajournals.org/content/123/20/2292.full>
17. Lasiuk GC, Hegadoren KM. The effects of estradiol on central serotonergic systems and its relationship to mood in women. Biol Res Nurs. 2007 Oct;9(2):147-60.
18. Douma SL, Husband C, O'Donnell ME, Barwin BN, Woodend AK. Estrogen-related mood disorders: reproductive life cycle factors. ANS Adv Nurs Sci. 2005 Oct-Dec;28(4):364-75.

Cardiovascular Disease (heart attack, stroke) is the leading cause of death among both men and women in the United States, accounting for nearly 40% of all deaths.¹ Interestingly, if all forms of cancer were eliminated, life expectancy would rise by only 3 years and yet if all forms of heart disease were eliminated, life expectancy would rise by 7 years.² When most people hear the word “disease” they often think of a virus or bacteria causing the condition and thus need a drug, like an antibiotic, to “cure” it. However, this is not the case with cardiovascular disease which is primarily a “lifestyle disease,” with the risk for cardiovascular disease being strongly correlated to diet, exercise, stress, smoking and declining hormone levels. Cardiovascular disease (CVD) is treatable, usually preventable and something you can often reverse by addressing these key factors. The most important first step is to:

Assess your current cardiovascular health and evaluate your current diet and lifestyle.

Many people do not know they have CVD until they experience a major health trauma, such as a heart attack or stroke but there are signs long before such an event. Cardiovascular disease doesn’t only affect the overweight or obese population, but also those with normal body weights. Additionally, more than 25% of Americans have high blood pressure and yet over 30% of those are unaware of their high blood pressure status.³ This is a vital component in reducing risk for future cardiovascular problems and should not be overlooked.

Traditionally, cholesterol has been the main indicator for cardiovascular health. However, research and clinical experience have led to a number of additional indicators, that may be of equal import such as triglyceride levels, C-reactive protein (inflammatory measure), high blood pressure, insulin resistance (i.e. diabetes), abdominal fat, endothelial dysfunction (leading to plaque build-up) and stress management.⁴

Other risk factors like smoking, family history of cardiovascular disease, stress levels in your daily life, lack of exercise and being a post-menopausal woman also increase risk. Furthermore, symptoms such as chest pain or chest tightness, impotence, reduced circulation in the extremities and shortness of breath on exertion, may indicate cardiovascular health issues. A health professional can offer a more specialized, individualized assessment to help determine your heart health.

In women a heart attack often has different signs than in men, which can lead to delays in treatment and a higher death rate. Seek medical care urgently if you have:

• Chest pain, pressure, or squeezing
• Pain in your jaw, arms, back, or neck
• Extreme fatigue
• Shortness of breath, nausea, and feeling lightheaded
• Unusual sweating
• Upper stomach pain⁵

Most information in the body is transferred by two types of messengers – neurotransmitters and hormones. Neurotransmitters help cells communicate through the nervous system and hormones enable cells to communicate through the blood stream. These two messenger systems control nearly every aspect of the body’s function. They are so influential and at the root cause of nearly all health issues that our risk for many health conditions, like CVD, are nearly identically correlated to our hormone production. Illustrated with men who have gradually decreasing hormone production from their thirties while their CVD risk gradually increases.   Conversely, women have relatively balanced hormone levels and reduced risk of cardiovascular disease until menopause, when hormones significantly drop and risk dramatically rises, emphasizing the probability that hormones have a significant impact on cardiovascular health.

Apart from the statistical evidence above correlating CVD to hormones, many women can attest that it is not until menopause that issues related to cholesterol, triglycerides, blood pressure or body weight become a concern. Similarly, for men as they enter andropause, the male equivalent to menopause. This is further exemplified by the fact that most men and women are still eating the same foods, doing the same amount of exercise and under the same stress as they did just a few years before their risk so dramatically increased. The only real change being the loss of hormone production.

This is why hormones are one of the most important factors in cardiovascular health, particularly growth hormone, estrogen, progesterone, testosterone, thyroid and cortisol. So how do hormones affect cardiovascular health?

• Estrogen increases HDL “good cholesterol,” which acts to reduce plaque buildup and possible blockages in arteries. It also reduces LDL “bad cholesterol,” which can cause plaque buildup and possible blockage in arteries. Estrogen also maintains the elasticity of arteries and blood vessels that could help improve blood pressure as we age.⁶
• Progesterone protects arteries from spasm. Women have much smaller arteries than men and spasm of coronary (heart) arteries can adversely affect blood flow to the heart.
• Adrenal Hormones like Cortisol, Testosterone and DHEA affect sleep, energy, libido, hair growth, muscle growth and weight, just to name a few. Adrenal fatigue and the biological effects of stress, mediated by hormones produced in the adrenal glands, plays a major role in obesity and its deadly consequences including: inflammation, insulin resistance, hypertension, atherosclerosis and other conditions that together constitute “metabolic syndrome” that further increases cardiovascular risk.⁷
• Thyroid Hormones control how quickly the body burns energy and makes proteins, as well as affecting the body’s sensitivity to other hormones.
• Testosterone increases HDL while reducing LDL and the production of pro-inflammatory factors, supporting healthy thickness of arterial walls and endothelial function. It also reduces hypertension, obesity, plaque build-up and waist-to-hip ratio; all of which are risk factors for cardiovascular disease. Administration of testosterone in men has been reported to decrease the risk factors for heart attacks. Men concerned about prostate issues should seek medical advice before increasing testosterone levels.⁸

There are a number of steps you can take to improve your own hormonal status naturally:

Reduce Stress

Stress, whether it is physical or emotional, is known to disrupt the adrenal glands and hormones. In response to stress the adrenals secrete cortisol. Chronic, elevated levels of cortisol in the bloodstream create a need for more hormones (e.g. thyroid, insulin, progesterone, testosterone) in order to do the same job.

Meditation and Breathing

Meditation and breathing exercises are great techniques that help to reduce stress. Taking half an hour in the morning and half an hour before bed to practice therapeutic breathing and relaxation techniques will significantly reduce stress levels. Individuals who routinely practice meditation experience dramatic decreases in stress, mood stabilization, better sleep and more energy. Research shows that these stress-reduction techniques benefit the immune and endocrine systems as well.⁹

Eat more whole foods and reduce saturated fats

A plant-based diet, like the Mediterranean diet, has been shown to be beneficial for hormone balance, heart health and longevity.¹⁰ What does this mean though? Incorporating more fruits, vegetables, grains, beans, nuts and seeds can provide valuable nutrients, antioxidants, minerals and vitamins to support healthy blood vessels, better blood sugar and reduce inflammation, all major contributors to cardiovascular disease. This does not mean you have to vegan or vegetarian, but the more plant-based proteins and foods the more beneficial, iIncluding some low-fat dairy products, fish lean meats and poultry is also acceptable. In focusing on these animal foods, your aim is to reduce how many saturated fats are in the diet, as those contribute higher cholesterol levels and inflammation. This also means avoiding things like processed foods, excess sugar and trans fats.

Drink Less Alcohol

Alcohol has been shown to be beneficial to hearth health if done in small amounts. We know red wine contains a number of beneficial antioxidants like resveratrol that have been shown to reduce inflammation in the cardiovascular system.¹¹ And while that is true, it has also been shown that only one small drink per day is beneficial to women’s health and no more than two small drinks for men.

Exercise

There is well-established evidence that physical activity early in life contributes to lower cardiovascular risk and improved hormone balance. Particularly aerobic exercise, like walking or jogging helps to relax the blood vessels and keep them flexible, improve circulation and increase oxygenation of our tissues. This can often be accomplished in even small amounts of time – 30 minutes 4-5 times a week can help us reduce our cardiovascular risk factors.

Get a Massage

Physical touch or massage is a key factor for maintaining hormonal health and reducing stress. Oxytocin, which stimulates growth hormone, is released during orgasm, labor and breastfeeding, but also through safe touch, such as massage. Therefore, regular massage should not be seen as a luxury, rather as a health necessity! Additionally, sexual activity is important and its recommended men and women have intercourse at least once a week to keep hormone levels active.

Sleep

Sleep recharges the brain and allows the body to relax and heal. The body’s blood supply to the muscles is increased, which helps to repair muscles while metabolic activity is at its lowest. Growth hormones peak during deep sleep, which allows for tissue growth and repair. Proper immune response occurs during adequate and regular sleep. Proper, restful sleep is also paramount, since poor sleep can reduce levels of testosterone by 40%.¹²

Hormone Therapies & Herbal Alternatives

Traditionally, doctors have used Hormone Replacement Therapy (HRT), or more recently Bio-Identical Hormones. However, concern about the slightly increased risk of breast cancer and stroke has meant that many women choose not to take any hormones or adhere to the current standard protocol of “the lowest dose for the shortest period of time." This means that while conventional HRT is NOT the best way to achieve heart health, there are herbal alternatives that can support hormones more gently and support cardiovascular health simultaneously.¹³ While there has been no clinical evidence that products containing black cohosh, red clover or soy have effect on hormones, there is evidence that a concentrated form of Maca can impact hormone production in the body. Clinical evidence on this herbal preparation has shown that by supporting the Hypothalamus-Pituitary-Adrenal Axis there is potential to improve the body’s own production of all hormones including estradiol, progesterone and testosterone, as well as support metabolic function and heart health.^{14, 15} 

One of the most important factors in maintaining cardiovascular health is to keep arterial walls flexible and free from plaque build-up, which can block arteries. The more flexible the arteries, the more freely blood circulates throughout the body. The key to diet and nutrition, for cardiovascular health, is to avoid foods that damage arteries, cause plaque build-up or increase oxidative damage, while at the same time increasing nutritional factors that protect the cardiovascular system, such as antioxidant-rich foods.

The most damaging foods for the cardiovascular system are unhealthy fats. “Bad fats” can come from higher fat dairy products such as cheese, higher fat meats and polyunsaturated oils. When these unhealthy saturated fats are consumed as part of the diet, they can upset the balance of HDL (good) and LDL (bad) cholesterol, increase triglycerides and contribute to inflammation and oxidative damage in the body, including the arteries. It is important, though, to realize that not all fats are bad. They can help keep both cell and artery walls flexible, are critical for brain function, vital in hormonal health and much more.

Dairy products from conventionally raised cows are high in unhealthy, saturated fats and the manufacturing process damages these fats and cholesterol even more, making them incredibly harmful to the cardiovascular system.¹⁶ If you choose to consume dairy, it should come from organically raised, pasture-fed cows, as the milk from these cows contains more of the healthy Omega-3 fats and fewer saturated fats. Furthermore, homogenization damages fat in milk, making it extremely harmful, so opt for unhomogenized milk or try milk alternatives, like almond, rice or soy milks.

All meat consumed should be from organically raised, pasture-fed animals. The diet fed to most commercially raised animals is not their natural diet and subsequently produces high levels of saturated fats in their meat. Pasture raised animals have less saturated fat and more of the healthy, polyunsaturated Omega-3 fats in their meat, due to their healthier, more natural diet.  

Nuts and seeds contain beneficial polyunsaturated fatty acids, however, due to their chemical structure these fats are damaged more easily from exposure to heat. Once damaged, these fats can cause oxidative damage in the body. Therefore, choose raw nuts and seeds rather than roasted, store them in the refrigerator and throw out any that smell rancid.  

Poor quality vegetable oils are perhaps one of the greatest dietary contributors to cardiovascular health problems in today’s standard American diet. The processing and refining of vegetable oils, like sunflower and canola, damages these delicate polyunsaturated fats and turns them rancid. Rancid fats are oxidized and wreak havoc on the cardiovascular system. High temperature heating of these oils, as in deep-frying, hot stir-frying and pan frying, further degrade these oils. Choose unrefined oils, like extra virgin olive oil and flax oil, but do not subject them to high heat and always store flax oil in the refrigerator. For cooking with heat, unrefined sesame oil and coconut oil are better choices, as these fats are not as easily damaged by heat. Additionally, avoid trans-fats (partially hydrogenated oil) in processed foods, as these are fats that have been chemically saturated as a preserving measure to lengthen shelf life and are extremely detrimental to the body.  

In general, choose fiber rich plant foods, such as fresh fruits and vegetables, whole grains, legumes, raw nuts and seeds; moderate amounts of healthy oils, such as extra virgin olive oil, coconut oil and flax oil; oily fish and small amounts of lean, pasture-fed meats and wild game for your diet. Do not eat to the point of feeling overly full and be sure to get some protein at each meal to help maintain steady blood sugar levels. Include plenty of antioxidant-rich foods, such as berries, pomegranates, green tea, grapes, legumes, oily fish (salmon, mackerel, sardines), cherries, artichokes, tomatoes, garlic, among others. Avoid deep-fried foods, overly rich foods, greasy foods, junk foods, processed foods and fast foods. By focusing on home prepared meals, you can know exactly what is in the foods you are eating. The diet described above is the Mediterranean diet, that has the most robust amount of scientific research documenting its ability to reduce the risk of CVD as well as improve outcomes in those who already have CVD.

In addition to avoiding the foods that are detrimental to cardiovascular health, the following nutrients are very important in supporting cardiovascular health:

Fish Oil

Fish oil is one of the most widely discussed nutrients in relation to cardiovascular health. It is very high in EPA and DHA – two Omega-3 fatty acids that are vital for overall health, particularly cardiovascular health. EPA and DHA help to keep cell walls flexible, thus more resistant to damage, which decreases susceptibility to atherosclerosis and clogged arteries. They also reduce inflammation throughout the body, lower blood lipids (specifically triglycerides), prevent excessive blood clotting, help balance blood sugar and reduce thickening of the arteries. Fish oils have also been shown to help lower blood pressure, slow atherosclerosis and reduce the risk of arrhythmias and their potential for sudden death. Currently, the average American diet contains a ratio of Omega-3 to Omega-6 fats of around 1:25.¹⁷ An ideal ration is closer to 1:3, so virtually every American should be increasing their consumption of Omega-3s.

Fatty, cold water fish, such as salmon, mackerel, halibut, anchovies and sardines are excellent food sources of Omega-3 fatty acids. Choose wild fish, not farm raised, as “Atlantic Salmon” and other farm raised fish contain extremely high levels of toxins. Additional sources of these important Omega-3s are flax seeds, walnuts, hemp seeds and chia seeds.  

Vegetarian sources of Omega 3 fats are not the same as fish oil.

It is important to note that vegetarian sources of Omega-3s require specific co-factors in the body to successfully convert them into DHA and EPA, the more usable forms of Omega-3 fatty acids. Many people are deficient in these cofactors,cofactors; therefore, fish oil is the most efficient way to ensure your body is getting the necessary quantity of these vital fats.

In addition to eating several servings of oily fish per week, supplementation with clean, high-quality fish oil is recommended. Many fish oils currently on the market contain unsafe levels of heavy metals and toxins, such as PCBs and Dioxins, making it imperative that you choose a third-party tested, quality fish oil.

Food Sources: Wild Salmon, Sardines, Herring, Mackerel, Omega-3 Fed Organic Eggs

Supplement Suggested Dosage: 3 grams/day taken with fat containing meals for general health and prevention. Significantly higher doses may be necessary for current cardiovascular disease. Talk to a natural healthcare practitioner for individualized guidance on a therapeutic dose for you.

CoQ10 (Coenzyme Q10)

CoQ10 is found in virtually every cell in your body and is vital for energy production within the mitochondria, the energy producing organelles, which supply about 95% of your total energy requirements, in the form of ATP.

CoQ10 is an important antioxidant that protects cells from oxidative damage by free radicals, with a particular affinity for cells in the heart. It is not only an antioxidant by itself, but further protects from oxidative damage by restoring other antioxidants, like Vitamin E, so that they can be used again. It is vital to note that statins deplete your body of its CoQ10 so,

It is especially important to supplement with CoQ10 if you have previously, or are currently, taking a statin drug.  

For a heart to function correctly it requires very high levels of energy to propel nearly 2,000 gallons of blood through 65,000 miles of blood vessels by beating almost 100,000 times per day, in the average person.¹⁸

There are two forms of CoQ10 – Ubiquinone and Ubiquinol. Ubiquinone is the energy supporting form, while Ubiquinol has more antioxidant capabilities and an affinity for the heart and brain. Additionally, Ubiquinol supplementation seems to better sustain desirable blood levels of CoQ10. If choosing a Ubiquinol form of CoQ10 make sure it is a stabilized form, otherwise, it will convert on its own to Ubiquinone and the benefits may not be as significant.

Food Sources: Salmon, Tuna, Liver, Whole Grains, Peanuts, Chicken

Thiamine (Vitamin B1)

Thiamine plays an important role in energy metabolism of heart cells. Deficiency often occurs in individuals taking diuretics to manage their blood pressure or in those consuming large amounts of alcohol, as both of these deplete Thiamine.  

Food Sources: Brewer’s Yeast, Whole Grains, Brown Rice, Tuna, Sunflower Seeds, Asparagus, Spinach

Supplement Suggested Dosage: 25-100 mg/day

Niacin (Vitamin B3, Niacinamide, Nicotinic Acid)

Niacin has been shown in research to be superior to statin drugs in many ways. Niacin has the ability to reduce LDL cholesterol, Lp(a) lipoproteins, triglycerides and fibrinogen, while increasing HDL cholesterol. It dilates blood vessels which can cause flushing, therefore, should only be taken under the supervision of a qualified healthcare provider, especially on the upper end of suggested dosages.

Food Sources: Peanuts, Liver, Chicken, Tuna, Salmon, Halibut, Legumes, Seeds, Crimini Mushrooms

Supplement Suggested Dosage: 25-200 mg/day

Much higher dosages are often necessary especially in individuals with high cholesterol, but Niacin can be toxic to the liver in therapeutically high doses and must be monitored by a healthcare practitioner in such circumstances.

Pantethine (Dimer of Vitamin B5, Pantothenic Acid)

Pantethine can decrease elevated total cholesterol, triglycerides and LDL, as well as increase HDL. Specifically, Pantethine inhibits several liver enzymes and blocks the activity of cholesterol producer HMG-CoA Reductase by about 50%, thus significantly lowering cholesterol.

Food Sources: Sunflower Seeds, Broccoli/Cauliflower, Crimini Mushrooms, Liver, Avocado

Supplement Suggested Dosage: 25-100 mg/day

B6 (Pyridoxine, Pyridoxal-5-Phosphate), Folate (B9, Folic Acid), B12 (Methylcobalmin) and Choline

These vitamins all work in conjunction to lower homocysteine levels in the body. Homocysteine is an amino acid formed in the blood and studies show that elevated levels are associated with an increased risk of cardiovascular disease. It is suggested that elevated homocysteine damages the lining of arterial walls, increasing the risk of blood clots and arteriosclerosis, which escalate the risk for heart attack and stroke.

Many health professionals now consider homocysteine levels to be as important as cholesterol and triglyceride levels as indicators of cardiovascular health.¹⁹

Levels of B vitamins can be depleted by many types of prescription medications, including oral contraceptives, asthma medication, anti-epileptics, anti-inflammatories and diuretics.

Strict vegans may have difficulty obtaining enough vitamin B12 from food. 

Certain vegetarian foods that are purported to contain vitamin B12, such as tempeh, tofu and Brewer's yeast may have only negligible amounts when prepared in sterile, commercial environments.

Many B vitamins are supplemented as one product under the umbrella term of “B complex” or simply, a “multivitamin.” This can be quite beneficial as deficiencies in some B vitamins can affect the body's status of other Bs. There are also more widely available formulas gaining popularity that are specifically targeted for individuals with elevated homocysteine levels containing only vitamins B6, folate and B12.

Look for vitamin B6 in the form of pyridoxal-5-phosphate, as this is a more bioavailable form and is preferred by many healthcare practitioners.

One out of eight people carry a genetic defect requiring an increased need for folic acid (folate), which as mentioned is a necessary component to maintaining proper levels of homocysteine. If you suspect that you are not benefitting from folate supplementation ask your healthcare professional to test you for the MTHFR gene, as you may require a different form of folate to properly utilize it in the body.  

Regarding oral supplementation, some people believe that under-the-tongue (sublingual) B12 may be more bioavailable than tablet or capsule forms. People with digestive problems may require B12 supplementation, as low levels of stomach acid (hypochlorhydria) and low levels of intrinsic factor can impede vitamin B12 absorption from food. Specifically, this includes individuals taking Proton Pump Inhibitors as treatment for heartburn because this class of drug further decreases intrinsic factor levels, a necessary component for B12 absorption.

• • Vitamin B6

Food Sources: Salmon, Tuna, Turkey, Chicken, Spinach, Bell Peppers, Leafy Greens, Bananas

Supplement Suggested Dosage: 25-200 mg/day

• • Folate

Food Sources: Lentils, Beans (Pinto, Garbanzo, Black, Navy), Leafy Greens (Spinach, Collard, Turnip), Asparagus, Broccoli, Citrus Fruits

Supplement Suggested Dosage: 400 mcg-800 mcg/day

• • Vitamin B12

Food Sources: Meat, Poultry, Fish (Including Shellfish), Organic Eggs

Supplement Suggested Dosage: 1000 mcg/day (sublingually)

• • Choline

Food Sources: Soybeans, Organic Egg Yolks, Peanuts, Sesame Seeds, Lentils

Supplement Suggested Dosage: 700-1000 mg/day

Vitamin E

Vitamin E is an important antioxidant that helps protect the body and cardiovascular system from oxidative damage. Many people eating a standard American diet may be deficient in Vitamin E because it is found in the outer part of grains, typically stripped during production of refined processed flours.  

Cholesterol-lowering drugs can reduce the body's supply of vitamin E, so supplementation may be especially important if you are on such medications.

Those with documented Vitamin K deficiency, or on blood thinners like Coumadin, should check with their healthcare professional before supplementing with Vitamin E, due to potential interference with clotting processes in the body.

If supplementing with Vitamin E choose the natural form, D-Alpha tocopherol, or use a mixed tocopherol blend (containing alpha, beta, gamma and delta). Avoid L-tocopherol and DL-tocopherol, as these are synthetic forms and are less bioavailable. Evidence of toxicity from vitamin E supplementation generally occurs at doses above 3000 IU/day and may include diarrhea, stomach cramps or double vision. Cease taking vitamin E if these symptoms occur.  

Food Sources: Sunflower Seeds, Almonds, Leafy Greens (Mustard Greens, Turnip Greens, Swiss Chard, Spinach), Fresh Oils (Olive, Peanut, Sunflower Seed) kept in tightly sealed dark bottles

Supplement Suggested Dosage: 400 IU/day

Vitamin K (K1 and K2)

Vitamins K1 and K2, especially the MK-4 fraction, are associated with a reduced risk of arterial plaques and mortality due to coronary artery disease. MK-4 has a short half-life requiring larger dosages, however, a newer form of Vitamin K2, MK-7, is gaining popularity due to its longer half-life, meaning it remains in the body requiring smaller dosages. There are many studies indicating the positive effects of K2 on reducing arterial calcification, heart attack and death. Vitamin K also maintains normal blood clotting and is therefore contraindicated if you are taking blood thinners, like Coumadin.

Food Sources: Green Leafy Vegetables (Kale, Spinach, Chard, Collard), Broccoli, Asparagus, Fermented Products (Natto, Soy, Cheeses), Organic Eggs

Supplement Suggested Dosage: 100-150 mcg/day

Adequate dosing can also come from a practitioner-grade multivitamin and 1 cup of green leafy vegetables each day.

Magnesium

Magnesium is a co-factor in over 300 biochemical reactions in the body, therefore, its importance to overall health and vitality cannot be overstated. It has been estimated that 61% of Americans do not receive the Recommended Daily Allowance (RDA) of Magnesium, making it one of the most common nutrient deficiencies in America.²⁰

Magnesium plays a vital role in the nervous system and helps to prevent overstimulation of muscles, thus increasing muscle relaxation. Through its role in supporting the nervous system, magnesium can also help to reduce stress, which is a major contributor to cardiovascular disease in general and elevated blood pressure specifically. Higher blood levels of Magnesium have shown decreases in hypertension, affecting both the diastolic and systolic numbers of blood pressure.

Magnesium has also been shown to raise HDL levels and lower CRP (C-Reactive Protein) levels, a marker of inflammation often used to determine cardiovascular disease risk. Magnesium also helps to modulate insulin and improved insulin sensitivity has been correlated with decreased triglycerides.

Many people are deficient in magnesium if they have been under prolonged stress, if they are taking oral contraceptives or if their diet is high in refined foods, especially refined grains. Other pharmaceuticals that may deplete the body's magnesium stores include warfarin, cyclosporine and corticosteroids. Furthermore, today's soils are often deficient in magnesium due to modern farming practices making supplementation even more necessary.  

Some evidence suggests that the chelated forms of magnesium, such as magnesium citrate or magnesium glycinate are better absorbed by the body than other forms. Magnesium is often supplemented in conjunction with calcium, due to their synergistic relationship. People with kidney disease or certain severe heart diseases should check with their health professional before supplementing with magnesium. If diarrhea occurs with magnesium supplementation, try lowering the dose.

Food Sources: Raw Pumpkin Seeds, Spinach, Swiss Chard, Black Beans, Fish (Salmon, Halibut), Nuts

Supplement Suggested Dosage: 400-800 mg/day

Resveratrol (Trans-Resveratrol)

Resveratrol is a polyphenol found in grape skins and is thought to be a major reason moderate red wine consumption has proven to be cardio-protective. Resveratrol appears to be heart protective due to its anti-platelet aggregation abilities (preventing blood clots from forming), as well as being an antioxidant and anti-inflammatory. It has also been shown to hinder fat storage and is somewhat protective against diet-induced obesity.

Resveratrol has been shown to inhibit growth and increase “self-death” of cancerous cells, specifically breast, prostate, stomach, colon and pancreatic cancer cells. This nutrient is also receiving a lot of attention from the anti-aging and longevity communities.  

If supplementing with Resveratrol make sure to use the bio-available Trans-Resveratrol, not the less absorbable Cis-Resveratrol form.

Food Sources: Red Wine, Red Grapes, Peanuts, Some Berries

Supplement Suggested Dosage: 125-175 mg/day

D-Ribose

D-Ribose is a simple sugar molecule with a wealth of health functions and is one of the key components to ATP (cellular energy) production. One researcher last year referred to the heart mitochondria, the cellular site where ATP is produced, as “the gates of life and death.” When heart muscles become unconditioned and diseased, they are often deprived of blood flow and unable to pump blood efficiently. This creates a sharp reduction of ATP, increasing the risk of heart damage and potential for a heart attack. D-ribose is an excellent therapy for cardio rejuvenation, chronic fatigue sufferers and for athletes wanting to increase their stamina and energy.

Supplement Suggested Dosage: Cardiologists often recommend 5 to 15 grams/day total, divided in 3 dosages

Taurine

Taurine is an amino acid that is vital for heart health. In fact, Taurine makes up greater than 50% of the total amino acid pool in the heart. This nutrient can lower blood pressure and aids in efficient heart contractibility.

Taurine also supports insulin production and protects from oxidative damage in the pancreatic cells that produce insulin, making it beneficial for diabetics. It may be helpful for Alzheimer’s patients by assisting with Acetylcholine neurotransmitter production and has an affinity for the eyes, specifically the retina.

Vitamin B6 is a necessary component for your body to form Taurine, therefore, people taking oral contraceptives, which deplete B6 levels may have a greater need for Taurine supplementation.

Food Sources: Meat, Dairy, Oatmeal

Supplement Suggested Dosage: 500-3000 mg/day best absorbed away from food

Garlic (Allium Sativum)

Fresh Garlic is known to inhibit atherosclerosis, normalize lipoprotein balance and decrease blood pressure. It also has anti-thrombotic and anti-inflammatory properties and functions as an antioxidant. However, not all garlic supplements are created equal. The general rule is go for the smelliest for the best health benefits. Over and over again studies have shown that aged garlic often has little effect on lowering cholesterol and blood pressure because most of the allicin has been removed. Allicin is the compound which provides the characteristic odor of garlic and is the strongest active constituent which contributes to heart health.

Supplement Suggested Dosage: Made from fresh garlic, enterically coated to provide a daily dose of at least 10 mg of alliin, or allicin potential of 4,000 micrograms/day

Turmeric

Turmeric has gained popularity as more and more people learn of the amazing benefits it has to offer. Turmeric has been used as an important part of Ayurvedic medicine in India for thousands of years and now scientific findings are supporting that historical use. Research has demonstrated that turmeric has potent antioxidant, anti-inflammatory and cholesterol lowering abilities.

Many of the benefits of turmeric have been studied through populations in India who eat it, as part of curry flavoring, several meals per day. Research has shown that to activate the beneficial health properties of turmeric it must be cooked with fat, such as ghee (clarified butter) or oil.²¹ This supports the traditional uses of curries cooked with spices and ghee and warmed whole milk spiced with turmeric.

If supplementing with turmeric ensure that the preparation has been processed in such a way that the constituents are active and bioavailable.

Supplement Suggested Dosage: 4 grams/day

Fiber

Fiber binds toxins, excess hormones, fats and cholesterol and helps eliminate them from the body. Fiber also decreases cholesterol levels, enhances gut health, increases gastrointestinal enzyme production, improves regularity of bowel movements and boosts satiety.

A daily intake of 20-35 grams of fiber per day is recommended, but most Americans only get about 12 grams daily. (22) Fiber is a natural component of fruits and vegetables and many grains, but much of the processed foods in today’s diet are void of this important nutrient.

Food Sources: Beans (Black, Pinto, Lima, Garbanzo), Raspberries, Leafy Greens (Collard, Mustard, Turnip), Broccoli, Cauliflower, Prunes, Apples, Pears

Supplement Suggested Dosage: Psyllium Fiber Acacia Fiber (Soluble Fiber) – take away from other supplements and drink at least 12 oz. of water with each dose.

Plant Sterols

Plant Sterols are the fats of plants. They "look" similar to cholesterol and fit perfectly into cholesterol receptors, preventing absorption of more detrimental cholesterol, which is eventually excreted from the digestive system.

Food Sources: Nuts, Vegetable Oils, Corn, Rice

Quit Smoking

Smoking increases risk of cardiovascular disease by 300%.²³ If that isn’t enough, smokers have 2 times the risk of heart attack compared to non-smokers and heavy smokers carry 4 times the risk. Smoking also reduces key antioxidants, impedes the body’s ability to heal and affects estrogen, which can lead to early menopause. The good news is that cardiovascular risk factors decrease significantly within 5 years of quitting, so smoking cessation can help reverse the damage caused.²⁴ Second-hand smoke should also be avoided.

Reduce Alcohol Consumption

Increased consumption of alcohol is associated with increased risk of cardiovascular disease. Excessive consumption of alcohol also affects hormone production and vitamin stores. However, it should be noted that moderate red wine consumption is beneficial for heart health. Red wine has high levels of antioxidants, flavonoids and polyphenol content, which have all been shown in studies to be cardio-protective. Your best choice would be wine made from muscandine grapes, which contain the highest trans-resveratrol content, well over 6 times that of other grapes.²⁵ Be careful men, too much alcohol has been shown to lower testosterone levels. For women, alcohol intake should not exceed 7 drinks per week and 5 ounces per drink. 

Manage Stress

Stress kills. Chronic stress has shown to be a contributing factor to imbalanced health and depletes the body of many essential nutrients. Combined with a poor diet and inadequate exercise, this may be a silent ticking time bomb.

Stress can increase blood pressure and negatively impact cardiovascular health, specifically. Dr. Christiane Northrup, in the Wisdom of Menopause, discusses the role emotional stress plays in this equation. “Emotions such as depression, anxiety, panic and grief have been shown to cause constriction in blood vessels, thereby impeding the free flow of blood. And anything that causes constriction in your blood vessels makes your heart and your vessels work harder to do their job. I’ve seen happy, joyful women with high cholesterol counts live healthy lives into their eighties and nineties, while much younger women whose lives were characterized by depression, anxiety or hostility might have the first sign of heart disease symptoms in their early fifties despite normal cholesterol levels.”²⁶ Those individuals who carry a heavy heart, fear, anxiety and worry not only significantly increase their risk for heart disease, but also shorten their life span dramatically. Positive relationships are paramount if you want to have a healthy heart.

Try to lower stress levels in your life by identifying causes and triggers and attempt to eliminate them. Effective stress-reduction techniques include yoga, meditation, breathing exercises, counseling, hobbies, exercise and fun times shared with loved ones.

Have Sex

Many sexual issues experienced today, such as erectile dysfunction or low libido, are precursors to other health problems, specifically heart disease. Sluggish blood flow, due to plaque buildup in arteries over many years, prevents normal sexual function and response for both men and women. For those who choose to be sexually active, having healthy, loving, vibrant relationships can be a cornerstone for quality of life. And sex can serve as a great stress reducer too.

One of the greatest risk factors for cardiovascular disease is being overweight and regular exercise is a vital component to maintaining a healthy weight. For those who are already at an ideal weight, regular exercise keeps the cardiovascular system strong, toned and healthy. An added bonus that occurs with exercise is the release of endorphins, which help to relax the body, reduce stress and improve overall health.

Ideally, your Body Mass Index (BMI) should be between 18 and 25. Healthy body fat percentage levels for most women are between 21-31% and between 14-25% for men. Fitness levels, and the most desired body fat percentage levels, are at the lower end of these ranges.

The latest research shows that you do not need to strain yourself at the gym. In fact, moderate exercise performed for at least 30 minutes a day, is just as effective at promoting cardiovascular health as more strenuous regimes. This can be easily incorporated into your daily life: consider parking a few blocks away from work or the grocery store and walking the rest of the way, take the stairs rather than the elevator and enjoy brisk walks with friends and loved ones.

If walking is your choice of exercise, ensure that it is brisk in order to obtain optimum results. Swimming is a great cardiovascular option for people with arthritis, joint pains or injuries. Yoga and martial arts are also excellent choices of cardiovascular exercise. If active forms of yoga and martial arts are chosen, they not only help get the heart rate up and increase circulation, but are also excellent for stress reduction.

The most important thing is to choose a form of exercise that you enjoy, so that you will do it more often. Mix up the routine and focus on the long-term results rather than a quick short-term gain, which may not be sustainable. For those looking to lose weight, exercise may need to be performed for slightly longer periods of time to achieve desired results.

If you have a history of a significant cardiovascular episode, such as a heart attack; or experience current cardiovascular symptoms, like angina or shortness of breath with exertion, it is best to consult with a doctor or exercise specialist in cardiovascular health for the safest and most effective exercise regimen for you.

Dedicating time to exercise and ensuring its effectiveness, so you gain desired results, can sometimes require help.

• The first step is to find a training partner, a class you like or an activity that is emotionally stimulating. It has been shown people exercise more consistently when doing so with others and when choosing exercise programs that are fun and engaging.
• Second, consider getting a personal trainer who has experience specifically training people to improve heart health. Professional direction will ensure you are doing things correctly, safely and effectively.
• Third, find one or several activities that are weight bearing, such as lifting weights, yoga, hiking up hills, brisk walking, Pilates, tai chi or dancing. Rebounding (small trampolines) have in recent years gained popularity as the ultimate, low-impact, fat-burning and heart healthy exercise!
• And finally, be consistent and get sweaty. To gain the most protective benefits of exercise, it is recommended you do a minimum of 5 sessions a week for at least thirty minutes per session. If you can do more, without overtraining, great. If you have to build up over time and can only manage 15 minutes to start, that’s great too. Being persistent and doing something small each day is actually healthier for you than exercising once a week for over an hour. Also, be aware that when you train properly you will sweat and when you train consistently you will see and feel results in as little as a month.

You and your doctor should look further into potential heart disease risk if:

• HDL is <50 mg/dL in Women, <40 mg/dL in Men
• Triglycerides are >150 mg/dL
• Blood Pressure exceeds 140/90 mmHg
• Fasting Blood Sugar is >100 mg/dL
• Excess Abdominal Fat – Waist Circumference is >35 inches in Females, >40 inches in Males
• BMI exceeds 27
• CRP levels >3.0 mg/dL
• Homocysteine >8.0 umol/L
• If you smoke, have a family history of cardiovascular disease, stress in your everyday life, do not exercise or are a post-menopausal woman

Furthermore, symptoms such as chest pain or tightness, impotence, reduced circulation in the extremities and shortness of breath on exertion may indicate cardiovascular health problems.

1. Empowerment & Knowledge

Although cardiovascular disease can manifest in men and women differently, we all can make small and simple daily choices to improve our heart health.

2. Hormone Balance

Managing stress, improving sleep quality, and using clinically proven Hormone Therapies and Herbal Alternatives can all improve hormones that impact heart health such as:

• Estrogen 
• Progesterone 
• Adrenal Hormones like Cortisol, Testosterone and DHEA 
• Thyroid 
• Testosterone 

3. Diet & Nutrition

Eating a daily diet rich in healthy oils such as fish oils, fiber, and B vitamins supports health. These food sources or supplements that benefit cardiovascular health should be rich in:

• CoQ10 (Coenzyme Q10)
• Vitamin B: Thiamine (Vitamin B1), Niacin (Vitamin B3, Niacinamide, Nicotinic Acid), Pantethine (Dimer of Vitamin B5, Pantothenic Acid), B6 (Pyridoxine, Pyridoxal-5-Phosphate), Folate (B9, Folic Acid), B12 (Methylcobalmin) and Choline
• Folate
• Choline
• Vitamin E
• Vitamin K (K1 and K2)
• Magnesium
• Resveratrol (Trans-Resveratrol)
• D-Ribose
• Taurine
• Garlic (Allium Sativum) 
• Turmeric
• Plant Sterols

4. Lifestyle & Environment

Lifestyle factors that improve cardiovascular health include quitting smoking, reducing alcohol consumption, managing stress, and engaging in healthy intimate relationships.

5. Exercise & Movement

Maintaining an ideal weight and regular exercise routine helps keep the cardiovascular system strong, toned and healthy.

References:

1. CDC (2014). Up to 40 percent of annual deaths from each of five leading US causes are preventable. Center for Disease Control. Retrieved from https://www.cdc.gov/media/releases/2014/p0501-preventable-deaths.html
2. American Heart Association (2000). Eliminating Cardiovascular Disease Would Increase U.S. Life Expectancy By Seven Years. Science Daily. Retrieved from https://www.sciencedaily.com/releases/2000/01/000104065154.htm 
3. Matthew R. Alexander (2019). What is the prevalence of hypertension (high blood pressure) awareness of in the US? Medscape https://www.medscape.com/answers/241381-7569/what-is-the-prevalence-of-hypertension-high-blood-pressure-awareness-of-in-the-us
4. Ryan, A. S., Ge, S., Blumenthal, J. B., Serra, M. C., Prior, S. J., & Goldberg, A. P. (2014). Aerobic exercise and weight loss reduce vascular markers of inflammation and improve insulin sensitivity in obese women. Journal of the American Geriatrics Society, 62(4), 607–614. https://doi.org/10.1111/jgs.12749 
5. (2019). Heart disease in women: Understand symptoms and risk factors/ Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-disease/art-20046167
6. Khalil R. A. (2010). Potential approaches to enhance the effects of estrogen on senescent blood vessels and postmenopausal cardiovascular disease. Cardiovascular & hematological agents in medicinal chemistry, 8(1), 29–46. https://doi.org/10.2174/187152510790796156
7. https://www.ncbi.nlm.nih.gov/books/NBK26/ or https://www.webmd.com/diet/dhea-supplements#1 ?
8. Morris, P. D., & Channer, K. S. (2012). Testosterone and cardiovascular disease in men. Asian journal of andrology, 14(3), 428–435. https://doi.org/10.1038/aja.2012.21
9. Institute of Medicine (US) Committee on Military Nutrition Research; Marriott BM, editor. Food Components to Enhance Performance: An Evaluation of Potential Performance-Enhancing Food Components for Operational Rations. Washington (DC): National Academies Press (US); 1994. 10, Endocrine and Immune System Responses to Stress. Available from: https://www.ncbi.nlm.nih.gov/books/NBK209065/
10. Katherine D. McManus, MS, RD, LDN (2018). What is a plant-based diet and why should you try it? Harvard Health Publishing. Retrieved from https://www.health.harvard.edu/blog/what-is-a-plant-based-diet-and-why-should-you-try-it-2018092614760
11. Vidavalur, R., Otani, H., Singal, P. K., & Maulik, N. (2006). Significance of wine and resveratrol in cardiovascular disease: French paradox revisited. Experimental and clinical cardiology, 11(3), 217–225.
12. Proper, restful sleep is also paramount, since poor sleep can reduce levels of testosterone by 40%.
13. Meissner HO, et al. Hormone-balancing Effect of Maca-GO (Lepidium peruvianum Chacon): (I) Biochemical and Pharmacodynamic Study on Maca-GO using Clinical Laboratory Model on Ovariectomized Rats. IJBS 2006, 2(3):260-272
14. Meissner HO. Short and Long-Term Physiological Responses of Male and Female Rats to Two Dietary levels of Maca-GO (Lepidium peruvianum Chacon). IJBS 2006, 2(1):15-29
15. Murray, M., Pizzorno, J. Encyclopedia of Natural Medicine, Revised Second Edition
16. Saturated Fat. American Heart Association. Retrieved from https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/saturated-fats 
17. Can’t find a source showing “currently, the average American diet contains a ratio of Omega-3 to Omega-6 fats of around 1:25” This one is related but doesn’t have the “1:25” current amount, only the ideal amount https://www.ncbi.nlm.nih.gov/pubmed/12442909 
18. Blood Vessels. The Franklin Institute  https://www.fi.edu/heart/blood-vessels
19. Fruchart, Nierman, Stroes, Kastelein, Duriez (2004). New Risk Factors for Atherosclerosis and Patient Risk Assessment 2004 https://doi.org/10.1161/01.CIR.0000131513.33892.5b Circulation. 2004;109:III-15–III-19
20. Fulgoni VL, 3rd, Keast DR, Bailey RL, Dwyer J. Foods, fortificants, and supplements: Where do Americans get their nutrients? J Nutr. 2011;141(10):1847-1854.
21. Hewlings, S. J., & Kalman, D. S. (2017). Curcumin: A Review of Its' Effects on Human Health. Foods (Basel, Switzerland), 6(10), 92. https://doi.org/10.3390/foods6100092 
22. Holly Larson, MS, RD (2019). Easy Ways to Boost Fiber in Your Daily Diet. Eat Right Academy of Nutrition and Dietetics. Retrived from https://www.eatright.org/food/vitamins-and-supplements/types-of-vitamins-and-nutrients/easy-ways-to-boost-fiber-in-your-daily-diet
23. Pacific Tobacco Taxation Project, World Health Organization (2012) Higher tobacco taxes save lives! Sydney: Pacific Tobacco Taxation Project.
24. Fact sheet about health benefits of smoking cessation. World Health Organization. Retrieved from https://www.who.int/tobacco/quitting/benefits/en/
25. Red wine has high levels of antioxidants, flavonoids and polyphenol content, which have all been shown in studies to be cardio-protective. Your best choice would be wine made from muscandine grapes, which contain the highest trans-resveratrol content, well over 6 times that of other grapes. https://www.youthflow.com/resinfo.htm
26. The Wisdom of Menopause by Dr. Christiane Northrup