Women, Hormones & Cholesterol: The Hidden Role of Ultra-Processed Foods

Today, we’re diving into a topic that should be getting far more attention:

Cardiovascular disease in women.

Heart disease is one of the leading causes of death in women—yet it’s often under-addressed, oversimplified, and misunderstood in clinical practice.

Most women are told: “Eat better. Take this prescription.”

But that approach misses something critical.

Full citation list:    •    Hall, Kevin D., et al. “Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake.” Cell Metabolism, vol. 30, no. 1, 2019, pp. 67–77.e3. Supports the core causal point that ultra-processed foods drive higher intake and weight gain even under controlled feeding conditions; this is not a women-specific lipid paper, but it is the cleanest experimental anchor for why UPFs create a high-throughput metabolic environment.     •    El Khoudary, Samar R., et al. “Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association.” Circulation, vol. 142, no. 25, 2020, pp. e506–e532. Supports the midlife women’s frame: across the menopause transition, LDL-C and ApoB rise, metabolic risk shifts, and cardiovascular prevention needs to become more deliberate during this window. This supports the “why I care about lipids in endocrine care” part of the episode.     •    Derby, Carol A., et al. “Lipid Changes During the Menopause Transition in Relation to Age and Weight: The Study of Women’s Health Across the Nation.” American Journal of Epidemiology, vol. 169, no. 11, 2009, pp. 1352–61. Foundational SWAN paper establishing that the menopause transition itself — not just chronological aging — is associated with adverse lipid shifts in midlife women. This is the original observation that the timing argument rests on.     •    Wu, Bingjie, et al. “Trajectories of Blood Lipids Profile in Midlife Women: Does Menopause Matter?” Journal of the American Heart Association, vol. 12, no. 22, 2023, e030388. Supports the claim that LDL-C, total cholesterol, and ApoB follow distinct trajectory patterns through the menopause transition, with subgroups of women showing rising lipids in the years before the final menstrual period — useful for the timing argument that body and symptom changes can precede the obvious lab story.     •    Matthews, Karen A., et al. “Age at Menopause in Relationship to Lipid Changes and Subclinical Carotid Disease Across 20 Years: Study of Women’s Health Across the Nation.” Journal of the American Heart Association, vol. 10, no. 18, 2021, e021362. Supports the point that ApoB and Apo A1 changes cluster around the final menstrual period and that adverse lipid shifts in the early postmenopausal years track with subclinical carotid disease later — connects menopausal timing to the longer cardiovascular arc rather than a one-time lab blip.     •    De Oliveira-Gomes, Diana, et al. “Apolipoprotein B: Bridging the Gap Between Evidence and Clinical Practice.” Circulation, vol. 150, no. 1, 2024, pp. 62–79. Supports the practical ApoB explanation: ApoB reflects atherogenic particle burden and outperforms LDL-C for ASCVD risk prediction in many settings, but adoption lags because clear apoB targets and triggers are still lacking in mainstream guidelines. Good support for the public-service “what the hell is ApoB anyway?” section.     •    Williamson, Laura. “The Slowly Evolving Truth About Heart Disease and Women.” American Heart Association News, 9 Feb. 2024, heart.org/en/news/2024/02/09/the-slowly-evolving-truth-about-heart-disease-and-women. Supports the broader clinical framing that women remain underrecognized or undertreated in cardiovascular care and that women’s heart disease still needs better public and clinical communication. This is more public-facing than mechanistic, but useful for your opening frame.

Dr. Brendan McCarthy is the founder and Chief Medical Officer of Protea Medical Center in Arizona. With over two decades of experience, he’s helped thousands of patients navigate hormonal imbalances using bioidentical HRT, nutrition, and root-cause medicine. He’s also taught and mentored other physicians on integrative approaches to hormone therapy, weight loss, fertility, and more.

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