Cardiovascular disease has been recognized as one of the leading causes of mortality in the United States for decades.
There are a number of variables that have lead to this disease including nutritional intake, dietary patterns, lifestyle factors including smoking, excessive alcohol use, physical activity, psychosocial environment, and sleep. For women specifically over the age of forty, exogenous hormone uses, including oral contraceptives and postmenopausal hormone therapy, have also been investigated, as well as biomarkers in plasma and red blood cells (Yu, Rimm, Lu, Rexrode, Albert, Qi, Manson, 2016).
According to the article, Six Things Every Women Should Know About Her Heart (2017), heart disease is the number one killer amongst American women over forty, and the odds of just staying slim and exercising will not be enough to improve the chances of not getting it. If that is the case, diet and nutrition could be the biggest factors contributing to this epidemic.
That also may mean that many American women assume that just because they are slim, they are eating healthy enough to be at a low risk for this disease, which would be false (Levine, 2017).
A huge issue that needs to be addressed with this epidemic is the standard American diet. In the last sixty years, the American diet has moved from a whole plant, produce filled, whole foods diet into what is considered a more convenient diet. This convenient diet is now consumed of foods highly processed, and high in salt, sugar, and fat. This contemporary change may be the result in why heart disease is increasing.
“We’re all going to be victims of temptation at several points in our lives.” -Smokey Robinson
So, what do we do?
According to Dr. Michael Greger, physician and New York times best selling author of How Not To Die (2015), the best way to prevent a massive heart attack is to start with diet and nutrition which helps block the buildup of cholesterol. He states that this disease is a direct result of eating the wrong foods and giving in to those temptations, such as saturated fats, found mostly in meat, dairy, and eggs. Dr. Greger also encourages people to not intake trans fat, which are found mostly in processed foods and animal products. He also suggests that the consumption of cholesterol itself is found mainly in those same foods.
It’s not how much you’re eating but, what you’re eating.
The association among nutrients, food, and non-communicable diseases has been studied now for decades and is nothing new, however, according to the National Cholesterol Education Program, lowering elevated serum cholesterol specifically LDL cholesterol still remains as the primary target for cardiac therapy. Even the American Heart Association (2012), emphasizes how low intakes of saturated fatty acids, with an increased consumption of fruits and vegetables, and whole grains have direct effects on heart disease and its symptoms (Wong, Esfahani, Singh, Villa, Mirrahimi, Jekins & Kendall, 2012).
How do we avoid the pressures and temptations of unhealthy foods, when it’s all around us?
A huge factor that affects heart disease and what American women consume includes the amount of stress one is exposed to.
By learning how to cope with stress properly, you can eliminate cravings and control your eating behavior when times get tough, without going crazy counting calories.
This psychosocial issue, according to Suzanne Steinbaum, DO, and director of the women’s heart health at Northwell Lenox Hill Hospital in New York City, contributes tremendously to heart disease by raising blood pressure and inflammation. Dr. Steinbaum agrees with Dr. Greger that nutrition is a major factor, however, she suggests that increased levels of stress hormones, such as cortisol and adrenaline, are also culprits. She believes that,
“People who are stressed out are less likely to do things to take care of themselves, such as make healthy food choices, exercise and/or are more likely to smoke and drink excessive alcohol.”
Another key factor women need to know is that stress affects them differently from men. According to the Nutrition Action Health Letter (2016), in a recent study researchers gave a mental stress test to roughly 200 women and 500 men aged 34 to 79 with stable heart disease. A stress test, which looks at blood flow in the heart during exercise on a treadmill, was given to all participants. What they found is that women, more than men, were affected with impaired blood flow in the heart muscle during and after each test. Ignoring this biological factor is a mistake that many American women do by putting themselves last on the list of things to take care of. This kind of thinking is what may ultimately trigger a heart attack.
Stress management and diet go hand in hand, and keeping cholesterol and blood pressure numbers low should be our main priority.
Emotional interruptions for women like work stress, their children’s stress, or spousal stress can often develop into overeating frequently, poor choices in food, and eating calories that are high in fat, which all lead to the same risk factors. And among the most important risk factors besides the emotional associations for women and diet are psychosocial variables such as depression, hostility, lack of social support, and low socioeconomic status (Baranyai, 2006).
The issue of heart disease in women is not only about an unhealthy diet and/or stress. The bigger picture stems more from the models and theories of behavior as to why we do what we do, and why we choose to contribute to the problem, instead of focusing on prevention. The etiology of heart disease goes far beyond just saving blood vessels from damage, or stopping the buildup of fatty plaque in arteries.
Heart disease is caused by correctable actions that most American women choose not to do.
Dietary behavior, directly and indirectly through its association with certain lifestyle, predicts heart disease.
For example, when previously mentioning the biological and behavioral factors linking stress and heart disease, a substantial proportion of stress attributes to a women’s metabolic syndrome, such as high waist circumference, high triglycerides, high fasting glucose, HDL cholesterol, hypertension and inflammation (Ferris, Kline, & Bourdage, 2012).
Also in previous research, biologically it has been mentioned that high blood pressure, hypertension, and cholesterol are all familial linked, and that some women with this family history are predisposed to these symptoms caused by an inherited genetic defect in LDL receptors (Austin, Zimmern, & Humphries, 2002). A women’s age has also been known to increase blood pressure, total cholesterol concentrations, and glucose levels while increasing percentages in body fat.
If that’s the case, then what is the best way to control it ALL?
While family history is a huge biological factor in predicting heart disease, recent studies have proven that all of these risk factors can be prevented and reversed with a strict plant-based diet (Greger, 2015).
Yes, Dr. Greger states that plant-based diets or otherwise known as vegan diets, have been found to bring forth both biological and emotional healthy changes that significantly boost telomerase activity, the only intervention ever shown to do so. According to his suggestions, adopting a whole-food, plant-based nutritional diet is essential for a healthy lifestyle, and should be encouraged to avoid all age related chronic diseases.
An important message to take from these findings in my opinion, is that women need more plant-based interventions, and they should come from traditional and community connections. Looking at dietary patterns and using preferences for the standard American diet, then turning them into plant-based culinary creations, may be a good way to wean some individuals off of their bad eating habits.
The ability to teach women a favorable lifestyle and dietary health choices through public awareness, especially when they are directly connected to ones culture, may prove beneficial in public health campaigns and vegan outreach programs.
For example, encouraging individuals in lower tiers of the social-economic status who are strongly adhered to this negative pattern, to reduce their consumption of fried and processed meats, as well as sugar-sweetened beverages, could prove to be effective if they are given social support. This gives way for a substantial connection between health psychologists and patients by encouraging them to have an independent effect on diet choice.
Education itself can then be the driving force that increases an individual’s overall health understanding (Kell, Judd, Pearson, Shikany, & Fernández, 2015).
Other health knowledge that women should be aware of as well involves the psychological models mentioned previously such as depression, anxiety and/or other mental health disorders. Many studies have been completed on the diet-psychological relationship examining the effects of foods and nutrients, dietary patterns and these overall health conditions.
According to a recent systematic review and meta-analyses from researchers in BMC Psychiatry (2015), it has been indicated that unhealthy American western diets rich in fast food, meat, refined grains, and sweets may increase the risk of psychological distress such as depression, whereas healthy high quality diets that are rich in fruits, vegetables, and plants may have a protective effect (Rahe, Baune, Unrath, Arolt, Wellmann, Wersching, & Berger, 2015).
According to Rahe, studies examining the effects of depression on lifestyle habits also suggest that psychologically distressed individuals show more unfavorable health behaviors than non-psychologically distressed individuals. If that is the case, then what Levine says about women who are stressed is similar and correct in that individuals who are psychologically afflicted are less likely to do things to take care of themselves, and that includes making wise, healthy food choices.
The beneficial strategies that health psychologists can assist with is critical for any behavior change.
Seeking help from a qualified professional will maximize adherence to these recommended plant-based diets within real-life settings. These types of interventions that improve adherence are necessary for reducing risk factors and preventing coronary heart disease (Wong, Esfhani, Singh, Villa, Mirrahimi, Jenkins, & Kendall, 2012). According to a study published by the Canadian Journal Of Dietetic Practice and Research (2015), a systematic review assessed the effects of interventions enhancing adherence to dietary advice for preventing and managing chronic diseases in women, such as heart disease.
These interventions used strategies such as involving behavioral contracts, list exchanges, verbal feedback, self-monitoring, individualized menu plans, accountability, portion size awareness, telephone follow-up, and educational videos (Desroches, Lapointe, Deschênes, Bissonnette-Maheux, Gravel, Thirsk, & Légaré, 2015). All of these strategies were determined as highly effective in changing nutritional behavior.
Collaboration is the key in making cardiovascular disease and a plant-based diet more of a priority for women.
Health psychologists involved in programs collaborating with dieticians, nutritionists and coaches focusing on set behaviors that target these interventions for change should be highly advertised. What these health care providers working together can do for women is paramount.
In my research, these interventions are extremely valuable, not only to learn about food substitutions using a plant-based exchange list, but in understanding how to make sustainable changes in modern woman and their busy lifestyle. Education through books and videos, teaching patients to become self-efficient with their own behavior can be key factors included within these programs. A health psychologist could easily tailor these interventions for each patient coinciding with behavioral counseling.
As suggested earlier, health psychologists can even use evidence-based strategies like the biopsychosocial model for referencing knowledge and client information enhancing this modification process. The importance of applying the suggested interventions that enhance the adherence to these dietary changes not only increases the chances for preventing and managing this chronic disease, it may also reverse the damage that has already been done (Greger, 2015).
Goals for helping women achieve success with a plant-based nutrition plan, and preventing heart disease by avoiding the standard American diet, thrive on program activities that include social support and specific professional accountability.
Look for programs filled with interventions and lifestyle modifications that encourage positive behavior. Community settings in prime locations for these life-changing modifications where health psychologists and collaborators could put their practices into real world settings would be ideal. Teams of people such as registered dietitians, coronary heart specialists, nurses or nurse educators, volunteer medical staff, health and life coaches, plant-based nutritionists, and/or exercise experts can all work together with health psychologists to reach this common goal.
In conclusion, within the last sixty years the western world has moved away from its original home grown whole fresh foods and seasonal produce to a diet of mass produced, convenient, highly processed intake. This modernization and globalization of the world’s diet has resulted in a quartet of diseases that now seem linked to the modern age, such as cardiovascular disease (Robinson, 2014).
There is considerable evidence from numerous studies that following a plant-based diet has positive effects for the prevention and management of cardiovascular conditions in women, as well as numerous other health conditions. This diet has been shown to have a protective effect on the cardiovascular system, reduce stress and lessen factors such as high blood pressure, raised lipid profile and high blood glucose levels (Greger, 2015).
Biopsychosocial models and theories should be incorporated into behavior intervention plans that are designed for the modern women and her stress levels. In discussing the major components of what women are eating, further research is needed to assist in the application of dietary behavior changes.
Information and education can inspire and empower women to make healthy lifestyle changes, however, living a long and healthy life is largely dependent on the choices American women have to make, and taking on the responsibility for ones own health is essential.
For more information on how to live a less-stressed life please CLICK HERE to grab yourself a copy of my book on Amazon.
For more information on a plant-based diet please check out: Nutritionfacts.org
Baranyai, R. (2006). Biopsychosocial and behavioral correlates of coronary heart disease. Mental Health and Behavioral Sciences, Budapest. 115.
Desroches, S., Lapointe, A., Deschênes, S., Bissonnette-Maheux, V., Gravel,K., Thirsk, J., & Légaré, F. (2015). Dietitians’ Perspectives on Interventions to Enhance Adherence to Dietary Advice for Chronic Diseases in Adults. Canadian Journal Of Dietetic Practice And Research: A Publication Of Dietitians Of Canada = Revue Canadienne De La Pratique Et De La Recherche En Diététique: Une Publication Des Diététistes Du Canada, 76(3)
Ferris, P. A., Kline, T. B., & Bourdage, J. S. (2012). He said, she said: Work, bio-psychosocial, and lifestyle contributions to coronary heart disease risk. Health Psychology, 31(4).
Greger, M.D., M. (2015). How Not To Die. New York, New York.: Flatrion Books.
Kell, K. P., Judd, S. E., Pearson, K. E., Shikany, J. M., & Fernández, ,J.R.(2015). Associations between socio-economic status and dietary patterns inUS black and white adults. The British Journal of Nutrition, 113(11).
Levine, H. (2017). 6 Things Every Woman Should Know About Her Heart. Health, 31(1), 83–85.
Rahe, C., Baune, B. T., Unrath, M., Arolt, V., Wellmann, J., Wersching, H., &Berger, K. (2015). Associations between depression subtypes, depression severity and diet quality: BMC Psychiatry, 15, 38.
Robson, D. (2014). Positive effects of the Mediterranean diet in the Prevention and Management of Cardiovascular Disease: A literature review. Journal Of The Australian Traditional-Medicine Society, 20(3), 200–205.
Rucker, R. B., & Rucker, M. R. (2016). Research Article: Nutrition: ethical issues and challenges. Nutrition Research, 361
Wong, M., Esfhani, A., Singh, N., Villa, C., Mirrahimi, A., Jenkins, D., & Kendall, C. (2012). Gut Microbiota, Diet, and Heart Disease. Journal of AOAC International, 95(1).
Women Under Stress. (2016). Nutrition Action Health Letter, 43(9), 10.
Yu, E., Rimm, E., Lu, Q., Rexrode, K., Albert, C. M., Qi, S., & … Manson, J. E. (2016). Diet, Lifestyle, Biomarkers, Genetic Factors, and Risk of Cardiovascular Disease in the Nurses’ Health Studies. American Journal Of Public Health, 106(9).
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