Note: this transcript is not 100% accurate.
00:01
It is the number one killer globally, but 80 to 90 % is preventable. That’s huge. Most people are actually not testing their blood pressure at home. I hear so many times people are, you know, oh, I have white coat syndrome, I go to the doctor and I have anxiety, so it’s nothing. When we look at the research, 70 to 80 % of white coat syndrome is true hypertension that gets ignored.
00:25
It’s what you’re doing day in and day out for the rest of your life, which is so important. It’s a progressive disease and it needs to be a lifestyle change, not a diet change.
00:41
This is Dr. Meenal and welcome to Uncover Your Eyes, where we break down the most pressing health topics shaping lives today. Before we start, if I can kindly request all of you to hit that follow or subscribe button so we know that you’re listening and can bring you better episodes weekly. Did you know that globally, 32 % of all deaths are from cardiovascular diseases?
01:09
And 640 million people are living with heart disease. But here’s the crazy thing. 90 % of cardiovascular disease can be preventable through lifestyle modifications with diet playing the most crucial role. Today, we dive deep into the connection between heart health and diet with Michelle Routhenstein, who is a registered dietitian nutritionist.
01:38
Thank you so much for being on today, Michelle. I’m so excited to be here. Thanks for having me. Of course. So, you know, tell me, I mean, obviously there’s a clear association in studies between, you know, diet and heart health, but truthfully, is there? Oh, 100%. So just to give you a little bit of background, like why I even get into cardiology, I wanted to become a physician and I realized there was this gap between treatment and prevention.
02:07
And this is coming from a standpoint of primary and secondary prevention. When I was in my residency, I was in so many different aspects, liver health, ICU, kidney clinic, weight loss clinic, you name it. And everyone was having heart disease complications. I’m like, what’s going on here? And when you look at the research, it is the number one killer globally, but 80 to 90 % is preventable. That’s huge. And when we say prevention, we’re talking about what you eat.
02:36
your exercise, your sleep, your stress, all of the things that we do on a consistent basis. Because what we eat can increase or decrease our cardio metabolic metrics, right? What we eat can increase our blood pressure or lower our blood pressure. Because what we’re eating is gonna have an effect on our blood flow, which is what I call, you know, the pumping aspect. We’re looking at the electrical aspect. Your heartbeat regularity requires
03:04
nutrients for your heart to beat regularly. You know, the plumbing aspect, what are we eating? Is it clogging up our arteries? There are so many components to heart health. And so our diet is so important. And that comes from a perspective of, hey, if you have genetic susceptibility, which is 20 % of the picture, if you have, you know, if you’re on medications or you’re not, nutrition has to be a part of everybody’s outlook on heart health because it’s so impactful.
03:33
It’s so impactful to help improve all of these aspects of cardiovascular health. And so we can’t ignore it. We have to make sure it’s part of the picture. And is there like a secret sauce? mean, I want to say like, are there like, you know, magic foods that you feel are so important for heart health? It’s a good question. And I like to look at more of categories of food in terms of, for instance, like we want to improve the nitric oxide.
04:00
Right, the nitric oxide pathway helps our arteries vasodilate, allows our arteries to open up and allow for good blood flow. We see individuals who have gnome plaque in their arteries, it can actually be very low in nitric oxide and we need to improve this pathway further. How do we improve this pathway? It’s by foods we eat, but before we even start there, it’s about your gut health. In order for you to convert the foods that you’re eating into positive metabolites, we have to make sure
04:29
that your gut is nourished and able to do that conversion. So nitric oxide could be low because your gut health is compromised. Because in order to create it, your gut health speaks with your oral microbiome and produces nitric oxide. So I can list for you foods that may increase your nitric oxide levels like your beets, your kale, your arugula, your garlic, cocoa flavanols, all these beautiful things for your heart health. And you could be eating them, but if your gut…
04:58
is compromise, if we’re not addressing gut health first, it may not necessarily benefit you. So while we can look at all of these important foods, it’s nuanced, right? If someone comes to me and says, I hate beets, I’m not gonna make them eat beets. There’s other foods that can give you potassium and nitrates that we wanna include for your heart. So it needs to have a level of personalization to make sure we’re looking at the complete picture of things.
05:24
If someone’s been on, if they’ve been constipated their whole life, they had a lot of antibiotics, we need to address that gut before we start adding in all these great foods because it also won’t be tolerable. And if you can’t tolerate it, it’s not working in your body. And that’s something we have to address as part of the picture too. So if I’m understanding correctly, it’s basically the gut that, I mean, in layman’s terms, it won’t be absorbed. Those foods won’t get absorbed as well into our body unless our gut health is good.
05:54
Correct? Yeah. So basically, so there’s this really cool part of research called Nutri-Balomics and it essentially says when you eat certain foods, if your gut bacteria is in the right state, it will create metabolites that either will positively or negatively impact cardiovascular health and function. So we need to assess your gut health. There are many things like protein pump inhibitors, a lot of the acid reflux medication that could also impair certain absorption of nutrients.
06:24
We have to be looking at that. So there’s a lot to the puzzle. There’s a lot of nuance, but a lot of times with my one-on-one clients, we start with the gut because it needs to be in the right state in order for it to actually utilize these nutrients and absorb them appropriately. That’s so interesting. Okay, I wanna ask you about some questions about foods that I’m like, you know, stressed out about. You know, when you look at things like for our kids, right? Saturated fats, which are in a lot of the processed foods.
06:53
versus just sugar. Is there one versus the other that you would gear towards for heart health or are they both equally bad for you? It’s a good question. So we know that saturated fat has a linear increase for LDL and ApoB levels, meaning the more saturated fat someone consumes, the higher their ApoB, the higher their LDL cholesterol. And a lot of that is because
07:17
When we have over saturation of saturated fats, over consumption saturated fat, it can block the LDL receptors on our liver from breaking down LDL, which means more LDL is in our bloodstream. So we definitely want to reduce saturated fat. Now that limit will depend on your atherogenic LDL cholesterol. It will depend on your body size. It will depend if you have.
07:41
FH, familiar hypercholesterolemia. There’s a lot of pieces to how we calculate how much saturated fat you’re consuming, but we do want to limit that. So that’s an aspect. Your sugar is also an aspect of heart health. So refined sugar increases blood sugar. It increases insulin production. It can cause our blood to be more stickier and also lead to havoc in the blood vessel. So they both matter. But the thing, the bigger question we should be asking is, well, what are we replacing them?
08:09
So in the day in the research, okay, saturated fat and sugar are both not heart healthy, but first off, how much are we eating? Cause it’s not about completely eliminating it. It doesn’t need to be, that’s one, but what are we replacing it with? So we see in the research that if we take saturated fat and we replace it with unsaturated fat, that actually has a bigger impact on our atherogenic LDL cholesterol than just removing saturated fat from the diet.
08:38
Same thing with sugar. If we replace simple carbs, the ones that are stripped from fiber with fiber rich carbohydrates, we are also decreasing the risk of cardiovascular disease. The replacement, the swap is a lot more effective than just removal. Because a lot of times when we think I can’t eat this, I can’t eat this, I can’t eat that, what happens? You want it 200 times more. And so after a while, you’re just like, okay, I’m weak, I’m gonna give in. And instead of eating, let’s say a pizza, you’ll eat the whole pie.
09:07
If we can put it into your regimen and make it part of a realistic day-to-day routine, you will be able to enjoy it in a balanced way where you may not crave it as much. You know you can have it, but you add it into your routine where it’s still allowing for you to achieve optimal cardiometabolic metrics, still reduce inflammation and insulin resistance and atherogenic cholesterol, all the things we’re looking to improve. So how does one know that
09:36
maybe my metrics are off and maybe I’m at risk, know, besides genetics, like I need to go to the doctor and have these things checked. How does one have an early warning sign? You don’t. It’s asymptomatic. So I want everyone to go to the doctor. I had a client the other day. Her husband had a massive heart attack. I saw him four years ago. She comes to me because she found out she has osteoporosis. And I said, was your last physical?
10:02
And she’s like, I don’t know, I feel fine. I don’t wanna go. I’m scared they’re gonna tell me something’s wrong. I’m like, no, this is the opportune time. When you start seeing anything trending in the wrong direction, it can silently brew. Plaque silently brews in our arteries. Our heart will overcompensate. It will get larger and it will actually create a lot more stress on the cardiovascular system when we ignore high blood pressure, when we ignore high cholesterol, when we ignore high blood sugar and you don’t.
10:30
really feel it when it’s ascent, when it’s brewing in the arteries. So it’s really important that we routinely test the numbers. And if they’re elevated to your risk profile, we need to make sure we’re actually testing it again soon after. So if it’s elevated and then you add in dietary change after three to four months, you need to make sure you’re testing it again. So it’s going and staying in the optimal range so that we’re looking at all of these pictures because we can prevent heart disease.
11:00
but we can only prevent it if we take action early. And the best way to do that is by testing and retesting and routinely testing on all aspects of cardiovascular health. So not just lipids, while lipids is so important, also your insulin resistance, also your inflammation. We need to be looking at these because we can address it sooner so it doesn’t cause plaque in the arteries. So it doesn’t cause heart enlargement, stroke, heart attacks, et cetera.
11:29
but we have to do it timely. So I think a lot of us, I mean, a lot of people, especially 40 plus, we buy that Costco blood pressure home monitor and we test it and we’re like, oh, our blood pressure is good, so all is good. What are the other factors? You mentioned some of them actually already, like the inflammatory markers, the insulin resistance. What are those things that they are looking for to make sure that their family doctor is testing them for? Yeah. So first, before I even go there, so most people are actually not testing their blood pressure at home.
11:58
I hear so many times people are, know, oh, I have white coat syndrome. I go to the doctor and I have anxiety. So it’s nothing. But I tell you that when we look at the research, 70 to 80 % of white coat syndrome is true hypertension that gets ignored. Wow. Okay. And if I were to tell you what’s the, if you told me, Michelle, pick one risk factor that you think is most important at all of these. And I hate to pick a favorite. I’m going to tell you blood pressure.
12:25
Okay, so before you even have to run to the doctor’s office, I want you to get a blood pressure monitor because most people aren’t. And so if you’ve had white coat syndrome, especially you should be checking your blood pressure at home. Okay, so that’s number one, blood pressure and really targeting it less than 120 over 80. A lot of times you’ll be like, yeah, my doctor says it’s fine, but they don’t even know their number.
12:50
And your doctor may not say it’s a red flag until it’s indicative of, let’s give you medication. So the target levels for optimal and medication management are very different because we don’t want low blood pressure. But if your blood pressure is above 120 over 80, but not above 130 over 90, so the doctor doesn’t consider your need for medication, it’s still at a point where it could damage the arterial wall. It could still cause heart enlargement. It could still cause plaque to form.
13:19
Most people think, plaque is just from cholesterol. No, high blood pressure causes the microtear, which leads to endothelial dysfunction, which causes plaque to form even more rapidly. So please check your blood pressure. It’s one of the most important things you can do. So that’s one. The second thing- I’m on it. I feel like that was directed right at me.
13:41
I am totally going to listen to you after this. Good. It’s really important. We ignore it. We’re like, oh, maybe I’m just anxious. Maybe I’m just anxious. But like, no, there could be something happening. So that’s one. The second thing is your inflammation. So HSCRP is something that you can routinely ask the doctor to take. It’s for systemic low-grade inflammation, and it’s associated with cardiovascular health. So ideally, want that to be less than one milligram per deciliter.
14:11
So that’s the second one. We want to assess that because inflammation is a driver of heart disease. You can have soft plaque in the arteries, but if there’s inflammation, it’s causing the plaque to accelerate. It’s causing more potential for instability and rupture of existing plaque, which you may not know you even have. So inflammation is really important and we have to assess where is the inflammation coming from. So if that’s high,
14:35
Let’s make sure we kind of investigate, it coming from your gut health, an autoimmune, what may be the cause for it? Or is it coming from abdominal adiposity? So you could check for inflammation at home before to also, it’s not the only way to assess for inflammation. You can have a normal waist circumference, but at home, if you get one of those waist circumference measuring tapes, the ones you use at like a seamstress, and you don’t suck in, don’t suck out, but put it around your belly button.
15:04
not your pants size, your belly button. That should be for women less than 35 inches, for men less than 40 inches. But certain ethnicities, we actually want it two inches less than that because cardiometabolic disease happens at a lower waist circumference in South Asians, for example. So check your waist circumference, but also ask for HSDRP. Make sure you’re looking at both aspects of potential inflammation.
15:31
Okay, so we talked about blood pressure. We talked about inflammation. I want to also mention your insulin resistance. So you can check your hemoglobin A1c. It’s a three month average of your blood sugar levels, which is a great indicator of how much blood sugar is out of the cell in the bloodstream connected to hemoglobin in a three month period of time. But you can have a normal hemoglobin A1c, so less than five.
15:55
So 5.7 to 6.5 is more pre-diabetes and then higher than that’s diabetes. But you can have a normal hemoglobin A1C and still have insulin resistance for over a decade beforehand because your body’s pumping out more insulin to try to get glucose, the blood sugar to go into the cell. So your blood sugar levels aren’t high, but it’s still leading to insulin resistance. So there are some certain blood tests called LPIR or HOMA-IR.
16:24
that you can check for your insulin resistance. And that can tell us kind of what that looks like. If you have stubborn abdominal weight or you’re like, I gained weight around my stomach and I can’t get rid of it. A lot of times that’s usually inflammation, insulin resistance that needs to be addressed first in order to help with that reduction in weight. And cholesterol, I’m assuming is part of that panel. So that’s number four. So your cholesterol panel.
16:49
Usually there’ll be like a standard lipid panel, which is great. There is a lot of research showing how APO-B is a more surrogate, a specific marker for atherogenic LDL cholesterol that I like to add on to a basic lipid panel because APO-B is more direct of that atherogenic LDL. So LDL can be more potential for plaque formation or not.
17:14
And some people have discordance between LDL and APOB. So their APOB may be normal, their LDL may be normal on a standard lipid panel, but their APOB may be really high. So even though the LDL is not that high, most of the LDL is very atherogenic. It’s saying, hey, let’s make plaque formation. So we wouldn’t know that unless we test the APOB as well to make sure that we’re keeping the atherogenic LDL low. So those are the four.
17:42
most important tests that we need to have done? Yes. Okay. Age group. Anyone or like over 40, over 30? Everyone. So I was actually recently on a podcast and the guy, was like for a 20 year old group and he was like, why should we care about heart health? I’m like, because you can prevent it. The earlier the better. But I don’t put an age limit because there’s some people who are like, oh, am I too young? And others are like, well, am I too old? I already have plaque in my arm.
18:11
I already had a heart attack. In both situations, we still want to achieve optimal levels. And if you’ve had a heart attack, those levels will be much lower than someone who hasn’t or someone who’s not as high of a risk. But if we’re looking to prevent complications, we need to know these numbers in every population group because we can improve outcomes if we optimize them. And the only way to know is, well, what are these levels actually? And we have to test them. So
18:40
If we can, I always tell my clients, know, if you have grandkids, like, let’s make sure that everyone’s eating healthy and then we’re testing them. If you have a high LP little a, a genetic susceptibility of cardiovascular disease, test your kids. Let’s make sure we’re getting on top of this earlier, not to make it fear mongering, but more of empowering. If you know you’re at increased risk, it’s a risk.
19:04
We can lower that risk, but we have to be more stricter in our standards in terms of what those lab levels should actually be. So for kids, you mentioned what is the test that they are getting done? So you do a basic lipid panel in children, but you can also test the LP little a, lipoprotein little a. That’s genetic. If you’ve never done it, everyone should get the LP little a test done.
19:30
to make sure that you know if you have an increased risk genetically. If you do, we can be more aggressive with lowering the atherogenic LDL, improving blood pressure, improving all of these standards so that we reduce your risk substantially. And that’s important. You wouldn’t know unless you test it. So both in kids, but also in adults. Excellent. I had no idea. So that is great to know, especially children. There has been a lot of talk about something called CKM.
20:00
you know, short form, you know, and I want to say a lot of people have it walking around. So what is that and how is that different? Is that just a fancy word for heart disease or like, what does that mean? Yeah. So it stands for cardiovascular kidney metabolic syndrome. And I’m actually doing a talk on this to healthcare professionals. And it really, I’m excited, not excited about the term, but just really happy that people are bringing more awareness. The fact that our whole body works together.
20:29
So we see individuals who have dysfunctional adipose tissue, have a lot of inflammation in their body. It tends to impact all organs of the body, but also looking at it from a high blood pressure, high triglyceride standpoint that impacts our kidneys, it impacts our liver, and it impacts the subclinical atherosclerotic process. So we need to be more aware of this to know.
20:55
It is really prevalent, but we can prevent it. And there’s different stages of CKM syndrome. And the earlier we intervene, the more effective it is in terms of reducing potential risk. The reason why I like bringing this up is because I actually started out working in a kidney clinic and everyone was having cardiovascular issues. And it really came to say like, we have to stop looking at disease states and silos. We’re all connected.
21:22
Right, so someone comes to me and they say, I have osteoporosis, I have high calcium score, and I don’t know how to deal with both of them. I’m like, they’re actually very connected. And most people who have osteoporosis also have subclinical atherosclerosis because a lot of the processes overlap in terms of inflammation and vascular calcification, bone calcification, et cetera. But people are always surprised when I connect the dots. Everything’s connected, right? And we have to recognize that.
21:51
A lot of times people are like, oh, well, you want to eat meaty, healthy for my heart, but what about my kidneys? And I’m like, the reason why your kidney, your EGFR, your kidney function has declined is because your blood pressure was high, your cholesterol was high, and those things negatively impact your kidneys.
22:06
So when you’re looking at an optimal diet and an optimal lifestyle, it’s addressing all these factors. You improve kidney function, you improve liver health, you reverse fatty liver disease, you reduce the progression of plaque formation. And so that’s an important component. There’s so many crazy things on social media these days, and I hear every one of them or most of them. And one of the things that drives me crazy is that, oh, my blood sugar is high, so let me get rid of carbs.
22:35
And then I was on a discovery call with someone the other day. She’s like, I got rid of carbs, my blood sugar went down, now it’s rebounded up, but my LDL has been sky high. And everyone in these groups tell me that, oh, it’s okay, it’ll rebound, it’ll come back down, don’t worry about it. She goes, it’s three years and it’s still high. And I’m like, there’s no rebound. If you’re eating what your body is supposed to eat, you shouldn’t go up to come down. It all goes in the right direction.
23:01
And so I see this because we have to stop looking at things in silos. We have to be looking at our bodies connected and when you nourish it and you give it the adequate volumes of the vitamins and minerals that it needs and the macronutrients, you improve cardiometabolic health, which improves triglycerides and blood pressure and blood sugar and atherogenic LDL cholesterol. And if you don’t test it, you A, don’t know, but B, you may be going on a diet that’s steering you in
23:32
I’m glad you touched on that because a lot of people seem to believe, you know, when you have high blood pressure, let’s just cut out the sodium completely. You know, that’s just one component. Can you touch on, you know, how people should be focusing on it and whether certain ratios, I mean, your body still needs sodium. you know, cutting it out completely is not the best thing to do. So how do we manage that?
23:54
I think a lot of it is that a doctor, a lot of times when you have high blood pressure, doctors will be like, go on a low sodium diet. And many people will take that extreme to say, oh my God, it has to be zero milligrams on a label. And then they end up not eating what they need to eat to actually help their blood pressure. It’s kind of the same thing when someone’s trying to lose weight, especially in the perimenopausal transition. Many people are like, okay, you need so many calories and the only focus on calories. you actually…
24:19
Don’t get, you become nutrient deficient without realizing it because you focus on one nutrient. But what most people don’t tell you when it comes to sodium is sodium doesn’t work in the body alone. Sodium and potassium work in tandem together. And you should actually be focusing more on your sodium to potassium ratio than just your sodium intake. If you want to help with blood pressure, you need to be looking at things that vasodilate your arteries, but also what’s causing it.
24:48
So insulin resistance can actually lead to sodium retention, which can increase your blood pressure. We do need a cut back on sodium. I’m not saying not to, but we have to recognize that it’s, can’t just look at one piece of the picture. You have to realize that there’s other components and we need to balance it appropriately for optimal blood pressure management. Yeah. I mean, I think a lot of people just talk about sodium alone. So I’m glad you touched on that.
25:16
What do you feel about, there’s a lot of talk, you know, about endothelial dysfunction nowadays, right? And kind of treating that separately, I want to say. I mean, I know everything works together. It does work together with the rest of, you know, your, I mean, as part of your blood vessels, but how, how do people get tested for this? Or does everybody with heart failure or heart conditions have endothelial dysfunction essentially?
25:39
So there are a lot of tests that your cardiologist can do to assess for endothelial dysfunction. So that can definitely be brought up, but endothelial dysfunction kind of goes under the radar. Essentially it’s saying that like either your blood vessel health is damaged or the actual vascular tone of, know, constricting and contracting to allow for proper blood flow is not working as well.
26:04
It is actually one of the early signs of heart disease and is often not really addressed or talked about until much later stages. But we want to optimize the blood flow. We want to protect your endothelial lining. And so it is a big component. Whether we test it or not test it, it needs to be protected. And a lot of times,
26:26
the doctor will base it off of your blood pressure and the blood flow or an echocardiogram and assess it from that standpoint, which can be added to your test. But remember, if you don’t ask and you’re not an advocate for yourself of kind of like what is going on, you’re not gonna necessarily get those answers. There’s so many times people will say, I went to the doctor, they told me everything was fine. you know, then all of a sudden, five, 10 years later, they’re like, I had an event.
26:54
I went back on my blood tests and I wasn’t fine. The doctor just never said anything. And I’m like, yeah, because maybe it wasn’t high enough for medication. So get your records, ask questions, make sure you’re working with the healthcare team who explains it. I spend so much time explaining the why with my clients. People are like, why didn’t the cardiologist explain this to me? I’m like, unfortunately, a lot of it is time restraints, right? Like a doctor may only have five, 10 minutes with you and they have to see the next.
27:22
patient or else they’ll get backed up and it’s not from a mal intention. It’s just, that’s a lot of what our healthcare system is right now. And so a part of it is really kind of looking at the test results, trending your test results, looking at from one time to the next, don’t using Dr. Google. Dr. Google is never a doctor that’s personalized to your care and it can really make you more fearful of what’s going on than informed.
27:49
So work with the healthcare team who can help with the explanation of all of it too. I know, like you mentioned, doctors usually wait to that point where we’re prescribing medications. So ahead of that, things are controllable, right? And we can use nutrients and lifestyle modifications like exercise as well to help control things. But are there supplements? I mean, I know the supplements will not match for everybody and everybody’s individual.
28:18
but are there general supplements that you have tended to prescribe or recommend for people with heart disease? That’s a question. So again, it has to be looked at from many aspects. One is what medication are you on? Are there certain medications that may deplete certain nutrients that would benefit from a supplement? Like if you’re on a high dose statin, maybe we do need to give you a CoQ10.
28:40
But how is your CoQ10 supplement, what form is it in? Is there some oils that could go rancid that could potentially increase your LDL cholesterol? We have to make sure we’re picking the right form, the right dosage, and that really depends on what medication you’re on and the dosage of medication you’re on.
28:56
So when I say personalized, it’s really about going into that, even that nuance. So if you’re on supplements, bring it to your cardiac dietician, make her look at the medications, look at the supplements. I mean, I have clients who come to me who are on 30 plus supplements and I’m like, and they’re also on medication. First off, that’s too much on your liver and on your kidneys to metabolize. But like, you know, they’re on all these supplements because they have this halo of a promise that
29:24
oftentimes is not delivered and could do more harm than good. So we need to assess that on an individual basis. But one of the other ones that comes up a lot is vitamin D. But again, I need to know your level. A lot of times people think more is better, but you can have vitamin D toxicity.
29:42
And if you are on a mega dose of vitamin D, that can lead to other issues. So the right amount needs to happen. And I need to know what your vitamin D level is at baseline to know how much actual supplementation will work for you. Right? If your homocysteine levels are high, we might need, if all other causes are limited and it’s elevated, I want to see, okay, maybe you need a methylated B vitamin. What type?
30:07
I have a lot of times people will try to do their own research based off of their labs and they take the wrong form of B vitamins for homocysteine. Like that’s why those little details matter. And I think anyone pushing for everyone needs to be on this one supplement is not doing due diligence of what’s the dose, what’s the brand, what’s the, like there’s so many components to it. So I’m not against supplements. Many of my clients will be on a couple of them as needed, but food.
30:35
food, supplements can never replace food, and we need to make sure that it’s not negatively interacting with your medications or your condition or your labs and really focusing on that aspect as well to make sure it’s beneficial versus potentially harmful. So true. There are two questions that I came in, like I knew I had to ask you because I hear it all the time. Caffeine and red wine.
30:59
Right. We hear, you know, there’s the one group that’s all pro both, and then there’s the group that’s not. I mean, people even say a lot of cardiologists drink, you know, one glass of red wine a day, but, you know, I’m of the opposite camp that, you know, alcohol, you know, is not great for sugars, body, heart health. But what is your take on it? So you don’t drink alcohol for the heart health.
31:26
If you’re going to say, well, glass of red wine a day is going to protect my heart. We don’t add red wine to protect your heart. The research does not show that that is going to be protective. We actually see some studies that show the protective agent, Reservatrol, in red wine is not even present in many red wine vials because it’s highly oxidizable. So it’s hot oxidized by the time you open up your bottle, not really going to give you the benefit.
31:54
If you enjoy it and you have it with dinner and you have it once or twice a week and you stick to one glass and it’s okay with your medications, can it be added into your diet? Sure. But do we add it for cardiovascular benefit? We do not see that in the research. We actually see, the surgeon report advisory gave this whole new document mentioning, the guidelines mentioning that it’s a carcinogen.
32:22
And so we do want to reduce the amount, right? We want to take inventory on a weekend. How much alcohol are you drinking? You know, we know that the research has always shown more than two drinks in one sitting can increase triglycerides, can negatively impact our liver and our blood pressure and our blood sugar. There’s so many negative aspects, but really take inventory. How much are you drinking and what’s realistic to help to stick to lower guidelines?
32:51
So if you don’t like alcohol, I would not tell you to drink it. If you have it occasionally, I think it’s okay. But we need to kind of understand that more is not gonna help protect your heart. And if anything, it could be detrimental. Right, absolutely. With caffeine. Obviously I need my caffeine every day. I think it comes down to also individual preference, individual tolerance.
33:16
So there are genes that make people who have any ounce of caffeine makes them jittery, nauseous, headache. It increases their blood pressure. It just doesn’t work with many people. It causes them to go into atrial fibrillation, same with alcohol. But some people, that’s not the case, right? So it’s an individual tolerance of how much caffeine can your body tolerate. But I wanna give a couple of caveats, okay? One is, how much are you drinking? If you’re drinking more than
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16 ounces a day, we need to understand why. Are you drinking it because you aren’t nourishing your body and using it to kind of wake up at 3 p.m. when your body actually needs nourishment? We need to cut that back. Is it impacting your sleep? In two ways, right? One is I don’t want it to keep you up, but I have friends who will go out to dinner and at the end they’ll have like an espresso and I’m like.
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I’m like, you going to sleep tonight? They’re like, yeah, caffeine doesn’t bother me. I can drink it and go to sleep. And I’m like, no, no, no, no, no, no, no, no, no, no,
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And then also, what are you putting in your cup of coffee? Right? That’s the big question also, right? Are you adding a lot of high saturated fat creamers or whole milk? And that’s also increasing in your saturated fat load for the day. Are you adding a lot of sugar? Right? A lot of times that’s part of it too. And are you replacing breakfast with coffee? Because we know you to have a well-balanced meal before you have that.
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for optimal health and also for steady blood sugar, metabolism, heart health, we know the importance of that too. So there’s a lot of questions that come up with everything, because the personalization and nuance is important. If someone tells me my cup of coffee with this much milk and this much sugar is my non-negotiable, I’ll say, you keep that, I’m not touching it. We have a lot of other things we can work on. And we can do small steps to make it work more seamless.
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And then people come back and they’re like, Michelle, never guess what? I actually reduced this and that and it tasted great. I’m like, wonderful. But they did it at their pace. And that’s important to recognize, right? There’s some people who go, I cater, I go out to dinners with all these people. I can’t not drink alcohol. I’m like, okay, let’s leave that. Let’s work on the other. It works in the background when you’re ready to say, I’m gonna take that task and do that. So we have to also look at it. I think a lot of approaches of, no, you can’t have this. No, you can’t have that. Don’t work.
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And that’s why a lot of diets fail because you’re so strict. You’re so, no, no, no, no, no. And it’s more of like, oh, that’s easy. I can add this to my diet. Oh, you know what? This is actually, it’s not so big of a thing. Oh, I don’t need my coffee at 3 p.m. I can have a balanced snack instead. I feel better. I have more energy. I slept better tonight. You notice how your body feels when you make those changes and it makes you do it consistently. that’s the biggest part of heart health.
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It’s what you do on a consistent basis. It’s not what you do in one month or two months to get to a certain weight. It’s what you’re doing in day in and day out for the rest of your life, which is so important. It’s a progressive disease and it needs to be a lifestyle change, not a diet change. The take home is Michelle, we cannot go out for dinner together. I will feel too much. I’m kidding. you have a glass of wine.
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So, you know, what are the most common myths? Like, you know, I want to bust some myths that a lot of people believe that you hear all the time. What are they? I think a big one is like, especially now is like, cut out the carbs, like, oh, insulin resistance is the driver of everything, cut out the carbs, or cut out the carbs and like triple your protein. So literally, people are just eating protein. I had a client the other day who literally ate a protein shake, a protein rich yogurt,
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and a protein bar for lunch. I’m like, ooh, okay. Like you’re missing a lot of other micronutrients. You’re not getting enough fiber. You’re not getting enough healthy fat. And you’re just putting a bandaid on the problem. So by just removing carbs or just bulking up on protein, you’re trying to tackle insulin resistance, but you’re basically not allowing your body to understand how to process carbs. And we need carbs. brain…
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runs on 130 grams of carbs. It’s our primary fuel. We know our natural way of living. We should not be going into ketosis. Our body is producing, taking fat and making it into carbs so that our brain can work. It’s a survival mechanism. We really should be teaching our body how to become more insulin sensitive. How do we make sure that we’re adding in these foods to help with optimal digestion so that we can eat it?
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get all the nourishment, put it into our cell where it belongs, and so it’s not in our bloodstream. So it’s not about elimination of carbs, it’s about choosing the right ones, pairing it with adequate amounts of protein, fiber, healthy fats, and the right portion for you to help you reach that goal. And so we have to understand what’s going on underneath, not just saying, okay, let’s take this out. A lot of times we think, okay, you know, that’s one part. Another part is a big topic is bone health.
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Oh, for bones, just eat a lot of calcium. Calcium’s great, but if your body can’t absorb calcium because your gut microbiome’s not working effectively, you don’t have enough vitamin K and magnesium, that’s also an issue. So we have to look at the whole picture and realize it’s not just like do one thing. It’s really assessing how does our body work and how do we make it work more efficiently and without stressors on it so that it can do its job effectively now, but also in five, 10, 15 years from
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And that’s the big component of it too. I love that. So great. You know, all your tips are so helpful. So grateful of having you on today. Can you tell our listeners where they can find you, Michelle? Sure. You can reach me on my website, entirelynourished.com. I have an Instagram page. I post on LinkedIn. I have an email list where you could join and I give a lot of heart healthy prevention tips. I’m all about heart health and improving it and empowering you.
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to take positive action in your heart health journey. So feel free to check me out and reach out to me if I can be of any help. Absolutely. And we’ll have everything in the show notes as well so people can reach out to you. Thank you so much for being on today. Thank you for having me. Thank you listeners and viewers for tuning in. If you want to catch more episodes of Uncover Your Eyes, make sure to follow or subscribe on your favorite podcast platform and on YouTube. To learn more about me,
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Follow me on Instagram @Dr.MeenalAgarwal Until next time, keep those eyes uncovered!
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See comfortably, near and far.
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with total multifocal contact lenses. Feels like nothing.