Crispy Tofu Salad
You don’t have to hate tofu, you just need to air-fry it.
Ingredients:
- Tofu
- Salt
- tapioca or rice flour
- Air Fryer
Time needed: 30 minutes
Gather your ingredients
Preheat Air-Fryer: 350 degrees
- Press Tofu
Crispy Tofu Salad
Crispy Tofu 2
Crispy Tofu Salad
You don’t have to hate tofu, you just need to air-fry it.
Ingredients:
- Tofu
- Salt
- tapioca or rice flour
- Air Fryer
Time needed: 30 minutes
Gather your ingredients
Preheat Air-Fryer: 350 degrees
- Press Tofu
Navigating Menopause Choices as a Blood Clot Survivor
There’s only thing more confusing and stressful than figuring out life after blood clots.
Navigating menopause and aging well as a woman who has survived blood clots.
The National Institute on Aging estimates that 1 million women go through menopause each year in the United States.
That number doesn’t include younger women who have gone through surgical menopause.
Recent studies asking peri and post-menopausal women how much they knew about menopause revealed a gap in both knowledge and reliable education.
In women under 40, an online study analyzed 738 women’s responses and 80% had no knowledge or just some knowledge of menopause.
PMID: 36533635
A similar study analyzed data from 829 women who identified as postmenopausal:
49.0% did not feel informed at all about menopause. More than 60% started looking for information regarding menopause as their symptoms started.
PMID: 36994487
According to those online studies, there were six themes identified when it comes to the menopause information gap:
- The need for education.
- Knowledge and understanding of menopause symptoms.
- Why is getting treatment so difficult?
- Feelings and attitudes towards menopause.
- The impact of menopause on a woman’s life.
- The importance of the media – are they getting it right?
That knowledge gap is greater for women with a history of blood clots, especially when hormone therapy (HT)(MT) comes into play.
In healthy women with a negative risk history, the probability of venous thromboembolism is generally low. This risk increases with age and the presence of additional risk factors, including the presence of cardiovascular disease, obesity, fracture, renal disease, and both congenital and acquired thrombophilic disorders. These risk factors are not rare. Therefore, it is prudent for the prescriber to carefully assess the personal and family history of patients before prescribing HT or ET.
ACOG Committee Opinion
Navigating Menopause and hormone therapy as a blood clot survivor
Women like me with contraindications for hormone therapy are often dismissed from the menopause conversation.
Worse, we’re told we’re doomed to a life of brittle bones, dusty veins and a host of cardiovascular and other health issues if we don’t “replace” our hormones.
Despite current major medical society guidelines that do not recommend hormone therapy for primary prevention of cardiovascular disease, dementia, and osteoporosis.
Labeled as “uneducated” on the latest research if we question the safety of hormone therapy as it specifically relates to us.
Health decisions should never be made out of fear or emotions.
They need to be made from evidence-based education with context and nuance.
Empowering women to make the safest and most effective menopause decisions for their individual health and risk factors.
When it comes to making hormone therapy decisions, (any health decision, really) women should understand there is a difference between studies using healthy women vs women with a history of blood clots.
There’s also a difference between women with a provoked blood clot vs an unprovoked blood clot.
small differences that oftentimes changing the risk vs benefit conversation.
These differences require a healthcare professional who practices from a place of context vs slapping a generalized study on all women.
Val Conley, Founder Speaking of Blood Clots
Life after blood clots is all about risk vs benefit
Here’s why it gets a little complicated for women with a history of blood clots making menopause decisions.
The evidence based clinical studies often cited, exclude women with a history of DVT, PE and VTE.
In the menopause conversations there is a tendency to say : “Data (research) Shows.”
But “data shows” doesn’t mean the results are safe and effective for all women.
Clinical research often measures the safety and efficacy of drugs and medical procedures for the broadest group of people or situations.
In the case of menopause research, healthy women.
Women who have had a blood clot are not longer healthy women.
We are healthy women with a history.
A history that requires more thought and vigilance from health care providers.
Menopause Education is Different for Women with a History of Blood Clots
No matter your choice, the goal is to educate you so you can become a critical thinker, asking good questions to make an informed decision with the guidance of your care team.
As noted by the Menopause Society when it comes to hormone therapy and venous thromboelism, certain types and routes of hormone therapy MAY be associated with less risk but randomized clinical trials (considered the gold standard or research) are lacking.
Because women with a history of blood clots are an excluded subgroup , context matters in the menopause conversation.
It’s why we teach women to verify the information, paying close attention to language.
Saying “transdermal hormone therapy is fine” based on observational studies to a woman who has survived a blood clot is inaccurate.
“May suggest less risk” in healthy women but the current science is unclear for women with with a history of blood clots is a response more doctors become comfortable saying.
Anything less than that robs women of vigilance to that could save their lives.
It’s the reason physicians advise women with a history of blood clots to avoid hormonal therapy.
It’s not because they’re all “unqualified doctors with outdated opinions.”
In the absence of those clinical trials it’s a best guess by your care team.
How to Start NavigaTING The Menopause Conversation as a blood clot survivor
Having a history of blood clots does not automatically disqualify you from hormone therapy.
It does mean you should seek nuanced conversations with any care provider (even online) based on your clotting history.
It should include an individualized risk assessment including lifestyle habits and baseline cardiovascular health numbers – cholesterol, blood pressure and glucose levels.
A DEXA bone density scan is another baseline measurement to discuss.
Most insurance will cover it at age 65, but having that knowledge earlier (even if it’s paid out of pocket) gives you a better prevention plan heading into menopause.
Whether you choose hormonal or non hormonal options, always know those numbers so you can use them to measure progress and changes and always lead with lifestyle as the foundation for aging well.
Menopause Specific Advise for Blood Clot Survivors
Hormonal Options:
Use the Menopause Society Hormone Guidelines to develop a plan with your hematologist and discuss the following:
- Discuss all the options from least invasive to most.
- Consider a route, dosing and timing recommendation associated with the least amount of risk for blood clots.
- Know and be vigilant for the signs and symptoms of a blood clot. (DVT, PE or VTE)
- Discuss the use of an anticoagulant (blood thinner) as an added layer of protection based on your risks.
- Follow-up. Don’t have a set-it and forget it mentality when it comes to hormone therapy. Have a plan to revisit the effectiveness of HT(MHT) on your symptoms and adjust accordingly.
In healthy women with no background medical problems, transdermal hormone replacement is not associated with an increased risk of thrombosis. However, much less is known about the safety of various HRT preparations in women with a high background risk of thrombosis.
PMID: 36573625
If you choose to manage menopause symptoms without hormone therapy, work with your care team to use the Menopause Society Non-Hormonal Guidelines to develop a plan that includes the following:
Non-hormonal Options:
- Heavy emphasis on positive lifestyle habits. Some research like the WAVS study suggests that certain aspects of a plant-based diet decreases frequency and severity of menopausal hot flashes.
- Discuss the use of non-hormonal medications, stress management tools and other lifestyle habits to manage menopause symptoms.
- Follow-up. If you are still struggling with menopause symptoms that are impacting your quality of life and overall health, speak up. It’s always okay to adjust your health plans to make them work for YOU.
Resources:
Hormone replacement therapy in women with history of thrombosis or a thrombophilia: PMID: 36573625
Identifying Women at High Risk of Venous Thrombosis before Administration of Hormone Therapy: Editorial
Hormonal therapies in females with blood disorders: thrombophilia, thrombosis, hemoglobinopathies, and anemias: PMID: 37274174
Menopause knowledge and education in women under 40: PMID: 36533635
Online Survey of Postmenopausal Women to Determine Their Attitudes and Knowledge of Menopause: PMID: 36994487
The Women’s Study for the Alleviation of Vasomotor Symptoms (WAVS): PMID: 34260478
LIFESTYLE SHOULD BE THE FOUNDATION FOR BLOOD CLOT PREVENTION AND RECOVERY
Tell me the first thing you think of when I say the word “cardiovascular”?
“It’s the heart, right”?
“Me too” !
But our cardiovascular system is the heart AND veins.
Blood clots are a cardiovascular event. (CVE)
As women, we have to think about the BIGGER picture when it comes to blood clot prevention and recovery.
Evidence based research shows us how to support and improve our cardiovascular health.
Let’s break down the different terms so you can have a meaningful conversation with your doctor.
Cardiovascular disease, cardiovascular events and cardiometabolic syndrome – what’s the difference?
CARDIOVASCULAR DISEASE
Cardiovascular disease (CVD) is an umbrella term used to talk about a group of diseases and conditions that impact the heart and/or blood vessels.
You can have a blood clot without having cardiovascular disease (CVD) and vice versa.
But cardiovascular disease and cardiometabolic syndrome (high blood pressure, cholesterol, and diabetes) can increase your risk of blood clots.
CVD are chronic conditions that are often linked to lifestyle risks, and in some cases genetic conditions.
Those genetic conditions may need long-term management with lifestyle intervention as the foundation AND/OR other pharmaceutical and surgical interventions.
CARDIOVASCULAR EVENTS
In contrast, cardiovascular events (CVE) are specific events that affect the heart and blood vessels – these events can be sudden, severe, and life-threatening – like blood clots.
CVE are also often linked to lifestyle risks.
CVE can be the result of underlying cardiovascular disease or in individuals without a history of CVD.
CARDIOMETABOLIC SYNDROME
Cardiometabolic syndrome is a group of conditions that increase the risk of developing cardiovascular disease.
High blood pressure, high cholesterol and Type II Diabetes are examples of cardiometabolic syndrome AND they’re also considered “related risks” for blood clots.
Blood clots and cardiovascular health are connected by shared risk factors and related diseases.
Cardiovascular risk factors are associated with VTE.
This association is clinically relevant with respect to individual screening, risk factor modification, and primary and secondary prevention of VTE.
PMID: 18086925
Managing cardiometabolic syndrome starts with lifestyle changes, like improving nutrition, increasing physical activity, quitting smoking, managing stress, getting enough sleep, and addressing individual risk factors.
Medical interventions may also be needed to lower blood pressure, lipids, and sugar levels.
RISK FACTOR MODIFICATION as the foundation for cardiovascular health including blood clot prevention
Risk factor modification means changing the things we can to reduce our risks of developing certain diseases or chronic health conditions.
You’ve most likely already experienced risk factor modification wrapped in the “eat less, move more” packaging.
But building a strong and healthy cardiovascular system is more than weight loss, it’s a connected system of positive lifestyle habits.
It’s a medical specialty called “Lifestyle Medicine.”
Lifestyle medicine draws from research and evidence in many fields of science to address physical, mental, and social health that is applicable to both primary and specialty care – care that puts you, the patient, as an active and encouraged partner in your healthcare.
The American College of Lifestyle Medicine
Trained healthcare professionals use evidence-based, whole-person, prescriptive lifestyle changes as the primary treatment for chronic conditions including (but not limited to) cardiovascular diseases, type-2 diabetes, and obesity-related conditions that often improve with positive lifestyle habits.
THE SIX FOUNDATIONAL PILLARS OF LIFESTYLE MEDICINE
Lifestyle Medicine breaks down the healthy habits for better cardiovascular health into six pillars.
A whole-food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connections.
These pillars echo the same recommendations from the American Heart Association’s Life’s Essential 8 as well as other reputable medical societies – American Medical Association, American College of Cardiology, Society of Vascular Surgery, American Society of Hematology, and the Menopause Society.
Lifestyle Medicine isn’t new. it’s foundational
For blood clot survivors, lifestyle changes alone may not be enough to prevent a blood clot or recurrence.
You may require anticoagulants (blood thinners) or other medical interventions.
The connection between lifestyle habits and blood clots is undeniable.
Lifestyle triggers should be a part of the conversation for identifying risk factors as well as the foundation for blood clot prevention and recovery.
Assuming the epidemiological associations are accurate, causal, and independent of each other, a reduction of obesity, physical inactivity, current smoking, and Western diet by 25% in the general population might reduce the incidence of unprovoked VTE by 12%.
PMID: 33191841
Resources:
Cardiovascular Risk Factors and Venous Thromboembolism: PMID: 18086925
Cardiovascular Risk Factors Associated With Venous Thromboembolism
Influence of Cardiometabolic Risk Factors on Platelet Function: PMID: 31963572
Joint effects of obesity and body height on the risk of venous thromboembolism: the Tromsø Study: PMID: 2152775
Exploring Opportunities for Primary Prevention of Unprovoked Venous Thromboembolism: Ready for Prime Time? PMID: 33191841
Healthy Lifestyle Choices Lessen Genetic Risks of VTE
Blood clots are rarely triggered by one thing.
Evidence-based research declares them “multifactorial” – a combination of more than one event or trigger, which may include genetics.
These triggers work together to form a perfect storm to develop deep vein thrombosis (DVT), pulmonary embolism (PE), or a combination of DVT and PE called venous thromboembolism. (VTE)
Having a genetic clotting disorder doesn’t mean you will form a blood clot. It increases your risk.
Recent research has added a layer of hope to the genetics and VTE link.
LIFESTYLE choices IMPACT Genetics
In 2020, the American Heart Association (AHA) released research from the Atherosclerosis Risk in Communities Study, (ARIC) showing Lifestyle Moderates Genetic Risks of VTE.
ARIC revealed among people at low or high genetic risk for VTE, healthier lifestyle factors, particularly normal weight, were associated with a lower incidence of VTE.
The American Heart Association (AHA) used an abundance of evidence from studies (like ARIC)to identify these healthier lifestyle factors.
Calling them Life’s Simple 8 (LS8).
LS8 is a blueprint for achieving ideal cardiovascular health, including risk reduction for blood clots.
A blueprint that closely relates to the foundational pillars of Lifestyle Medicine. (LM Pillars)
ARIC links cardiovascular health and related diseases to blood clots
Starting in 1987, the ARIC study enrolled 15,792 middle-aged (45-64 years) men and women in four communities in the United States.
The initial goal of the ARIC study was to investigate the root causes and risk factors of atherosclerosis, the buildup of plaque on artery walls to predict cardiovascular outcomes.
During the ARIC Study, researchers came to include risk factors for the prediction of other cardiovascular events like stroke, heart attack, AFIB, peripheral artery disease, venous thromboembolism (VTE), and other cardiovascular conditions.
As testing measures and understanding of the data improve, the ARIC study has become a valuable resource for the study of diabetes, kidney disease, and other chronic conditions.
Conditions that not only share the same risks with blood clots but have been linked to an increased risk of DVT, PE and VTE.
Because of ARIC, there have been more than 2000 ancillary studies (and counting) that have shaped guidelines that doctors now use to treat coronary heart disease, diabetes, stroke, and other conditions and chronic illnesses that impact cardiovascular health – including VTE.
Learn more about the ARIC Study here.
Knowing your genetic (family ) history for blood clots is important.
But knowing how genetics and risks work together helps you create a plan with your provider, to reduce your blood clot risks, and support your recovery and long-term health after thrombosis.
Resources:
Thrombosis Statpearls Publishing
Epidemiology and Genetics of Venous Thromboembolism and Chronic Venous Disease: PMID: 34110897
Lifestyle Factors and Venous Thromboembolism in Two Cohort Studies
Lifestyle Moderates Genetic Risk of Venous Thromboembolism: PMID: 32878478
Exploring Opportunities for Primary Prevention of Unprovoked Venous Thromboembolism: Ready for Prime Time?: PMID: 33191841
Obesity, Blood Clots and the Unique Risks for Women
My Mom had a saying, “it’s always in the approach.”
Wisdom tailor made for the awkward conversations about obesity.
How we approach someone with information dictates how they hear it and more importantly, move forward with it.
I know because I’ve lived the obesity conversations, more times than I care to admit.
The ones rooted in “tough love” were the worst.
So we’re going to talk about it together with the intent of making these conversations less awkward for you and your health care provider.
Because it’s not about a number on the scale, it’s about reducing a major risk factor for blood clots.
How We Talk About Obesity Matters
Let’s start with BMI – (body mass index) the tool most doctors use to size us up – no pun intended.
BMI by itself isn’t a perfect measurement for health. It doesn’t account for individual body composition – muscle mass, bone AND fat or where the fat is stored.
If BMI is used, it’s more helpful to ask your care provider to pair it with a tape measure for measuring waist circumference.
Research suggests that waist size is a better measurement than just BMI. (PMID: 2193761)
Weight alone isn’t the issue – we should be educating women on the types of fat that seem to matter most (visceral), where that fat is stored, and how it impacts other risk factors and total cardiovascular health.
Val Conley, Founder Speaking of Blood Clots
Obesity and Blood Clots – What’s the Link?
I can’t speak for every person that’s struggled with obesity. But I knew carrying excess fat was bad for my health.
I just thought I had time to put knowledge into action.
I didn’t know obesity is a major lifestyle risk factor for blood clots.
Visceral fat is more strongly associated with health risks like deep vein thrombosis (DVT), pulmonary embolism (PE), ischemic stroke, which occurs when a blood clot blocks an artery in the brain. and related conditions: high blood pressure, type 2 diabetes, high cholesterol and some cancers.
PMID: 33882682
Worse, obesity compounds other clot triggers like surgery, hormonal contraception, and menopause treatments.
Obesity is “synergistic” meaning the combined effects of obesity and other risk factors are greater together than the effect of individual risk factors on their own.
Women who present both obesity and use of combined oral contraceptives (COCs) have a greater risk (between 12 and 24 times) of developing venous thromboembolism than non‐obese non‐COC users. Obese women taking contraceptives should be viewed as an ‘at risk’ population. As such, they should receive advice to change their lifestyle, avoiding other cardiovascular risk factors, as a form of primary prevention. This indication should be extended to young women, as data show that COCs should be avoided in obese women of any age.
PMID: 36103980
Obesity and inflammation
We need Inflammation – it’s a natural response of the body to injury or infection.
Obesity produces low-grade chronic inflammation
Chronic inflammation raises the risk of blood clots and other cardiovascular health issues related to clots, like high blood pressure, diabetes, high cholesterol(Inflammation, Obesity, and Thrombosis)
Obesity tends to involve two types of fat:
Subcutaneous fat – under the skin and visible
Visceral fat – surrounds organs in the abdomen and is not as visible.
It’s visceral fat that releases a variety of inflammatory molecules into the bloodstream.
These molecules can disrupt the process of how the body clots, (coagulation cascade) leading to the formation of blood clots.
Visceral fat is considered pro-thrombotic, meaning it promotes the formation of blood clots.
Abdominal obesity appears to be a superior measure over overall obesity for detecting cardiovascular risk.
Waist circumference (WC) was the preferable indicator linking obesity to venous thromboembolism (VTE).
The estimated population attributable risk due to elevated WC was 23.7%.
A large proportion of VTE cases can be prevented if the population maintained a healthy BMI and WC.
Journal of Thrombosis and Haemostasis
Obesity can damage blood vessels by signaling the immune system to activate cells that may attack the tissues of the blood vessel walls.
This damage to the inner lining of the vessels, changes the way they function (endothelial dysfunction) and leads to the formation of plaques, which are fatty deposits that can narrow the blood vessels and reduce blood flow.
Over time, these plaques can become hardened and calcified, leading to a condition called atherosclerosis.
Atherosclerosis can cause further damage to blood vessels and increase the risk of blood clots, which can block blood flow to the heart or brain and cause a heart attack or stroke.
Obesity can impact physical activity, limiting blood flow, which results in blood pooling in the legs.
This pooling can lead to the development of deep vein thrombosis (DVT), a type of blood clot that can be particularly dangerous if it breaks loose and travels to the lungs.(PE or Pulmonary Embolism)
Obesity can also impact sleep, and may contribute to physical and psychological stress.
Obesity is a major modifiable risk that needs to be included in blood clot conversations for risk prevention and recovery, with empathy and a plan to improve visceral fat levels, especially for women considering hormonal contraception or menopause therapy.