Science-based nutrition to prevent a heart attack | Michelle Routhenstein, MS, RD

What It Covers

Preventive cardiology dietitian Michelle Routhenstein explains evidence-based nutrition strategies to prevent heart attacks and strokes, covering ApoB management, blood pressure control, plaque stabilization, nitric oxide production, inflammation reduction, and debunking common myths about carbs, seed oils, and saturated fat.

Key Questions Answered

• •Nitric Oxide Production: Gut and oral bacteria communicate to produce nitric oxide for blood vessel dilation. Start with gut health through fermented foods, then add nitrate-rich vegetables like kale, arugula, beets, and garlic. Poor oral health from gingivitis or periodontitis directly impairs nitric oxide production and increases cardiovascular risk.
• •ApoB Reduction Strategy: Keep saturated fat below 6% of total daily calories by swapping red meat for fatty fish, which can lower ApoB by 30%. Add soluble fiber from oats, barley, beans, and flax seeds to bind bile acids in the gut and facilitate cholesterol elimination through effective bowel movements.
• •Blood Pressure Management: Focus on sodium-to-potassium ratio rather than just sodium restriction. Aim for 4,700 milligrams of potassium daily from beans, salmon, leafy greens, sweet potatoes, and dates. High blood pressure causes arterial micro-tears that accelerate atherosclerosis and increases risk of cognitive decline, kidney disease, and heart failure.
• •Carbohydrate Integration: Add half cup servings of whole grains like barley, oats, or quinoa paired with protein and healthy fats to improve insulin sensitivity and metabolic flexibility. Restricting carbohydrates teaches the body not to process them effectively, worsening insulin resistance rather than resolving it over time.
• •Inflammation Assessment: Evaluate nutrient adequacy rather than focusing on elimination. Common deficiencies include omega-3 fatty acids (target omega-3 index above 8%), vitamin C, folate, B12, and calcium. Test inflammatory markers like hs-CRP, Lp-PLA2 activity, and GGT to identify systemic inflammation requiring dietary intervention beyond standard lipid management.