Your Top Heart Health Questions Answered by Expert Michelle Routhenstein
Thanks to everyone who submitted questions for our special Q&A with heart expert Michelle Routhenstein, MS, RD, CDCES, CDN. We’re excited to share her answers with you!
February is National Heart Month, a time to focus on one of the most important organs in our body—our heart! Cardiovascular disease remains a leading health concern, but the good news is that many risk factors are within our control.
Research shows that the Mediterranean diet is one of the most effective ways to support heart health and reduce the risk of heart disease.
With its emphasis on whole foods, healthy fats, and fiber, this way of eating can help improve cholesterol, lower inflammation, and keep your heart strong for years to come.
Thanks to everyone who submitted questions for our special Q&A with heart expert Michelle Routhenstein, MS, RD, CDCES, CDN!
We’re excited to share her answers with you, covering important topics like:
The best dietary changes for lowering blood pressure
Whether to limit dairy with high cholesterol
Heart-healthy eating’s impact on artery blockage
The best cooking oils for heart health
And so much more!
Michelle is the owner of Entirely Nourished- her virtual nutrition counseling and consulting private practice. She takes a science-based, personalized approach to improve heart function. She addresses cardiometabolic risk factors to help increase quality of life and reduce the risk of heart attacks, strokes and cardiovascular complications.
Here are some of the top questions you submitted, along with Michelle’s insightful and practical advice!
P.S. If we didn’t get to yours this time, don’t worry—we’ll be covering more in the coming months. Stay tuned!
Q&A Highlights:
Q: Do I need to have my bloodwork analyzed to see how my diet is meeting my body’s needs?
Michelle’s Answer: Heart disease can develop silently, without obvious symptoms, and it can affect individuals of all sizes, shapes, and fitness levels. This makes bloodwork an essential part of taking a proactive approach to heart health.
To truly reduce your risk of heart disease, it's important to evaluate the full spectrum of heart health. This includes checking for atherogenic cholesterol markers (like apoB and non-HDL cholesterol), triglyceride levels, blood sugar trends (such as HbA1c), insulin resistance indicators (like HOMA-IR), inflammation (hsCRP), blood pressure, and kidney function. These factors are all crucial, and they can be elevated without any noticeable signs. Testing, rather than guessing, is key to being proactive about your heart health.
It’s also important to work with a healthcare team, including a registered dietitian, who can help assess your target levels for these metrics based on your risk factors and create a personalized, science-based nutrition plan to support you and help improve them.
Q: “Other than reducing sodium, what is the most effective dietary adjustment I can make to lower blood pressure?”
Michelle’s Answer:
Q: “Should I remove dairy with high cholesterol?”
Michelle’s Answer: Unless you have a dairy intolerance or allergy, it can still be included in your diet when trying to lower cholesterol levels.
If you choose low fat or higher fat options, take into account the saturated fat intake and plan it into your daily allotment.
Fermented dairy products like yogurt and kefir not only provide a good source of magnesium, calcium and potassium for your heart health but also probiotics that nourish the gut microbiome which helps to support heart health as well.
Q: “Is medication necessary to improve my cholesterol levels?"
Michelle’s Answer: A well balanced, nutrient-rich diet tailored to your individual needs—taking into account your lifestyle, culture, lab results, and medical history—is crucial for your heart health journey, whether or not you require medication.
Without proper nutrition, medications may not be as effective, and you could still cause harm to your bloodstream. While medication can be lifesaving and often necessary, it works best alongside a healthy diet to optimize heart health.
If simple foods work best for you, it's important to make sure they provide all the essential nutrients. The Mediterranean and DASH approach to nutrition can help with this, but adapting it to your own tastes makes it feel less overwhelming and more culturally meaningful. When necessary, supplements can help fill in any nutritional gaps.
Q: “If you have a blockage in two lower arteries & you exercise & change your eating habits to heart-healthy eating, can it undo the blocked arteries?"
Michelle’s Answer: If you have blockage in two lower arteries, exercising and adopting heart-healthy eating habits can’t undo the calcified plaque. Once plaque has calcified, it represents the final stage of atherosclerosis, and it cannot be removed through diet or exercise. However, if the plaque is still soft (a more dangerous type that can lead to blood clots), a heart healthy diet and exercise that focuses on vascular health can help shrink it.
Your goals are now to stabilize plaque formation and prevent the promotion of more plaque in the arteries. This will entail a more proactive approach to keep all of your cardiometabolic risk factors at tighter target points.
Q: “Wondering if you have worked with clients on meds for osteopenia/osteoporosis (Prolia or Evenity)? Prolia can cause an increase in cholesterol and Evenity has a “black box” for people with heart issues. Wondering about diet suggestions if taking these meds.”
Michelle’s Answer: I have worked with many clients who were on medications for osteopenia or osteoporosis, including Prolia and Evenity. There is a significant connection between bone health and heart health. Research has shown that postmenopausal women diagnosed with osteoporosis have a 79% increased risk of atherosclerotic heart disease, which highlights the importance of addressing both aspects to optimize overall health.
Evenity carries a "black box" warning because it may increase the risk of arterial calcification. While it helps build bone by blocking Sclerostin, it can also promote vascular calcification, which is concerning for those with heart issues. If you're at high risk for heart disease, it's worth discussing alternative options with your healthcare provider.
In terms of diet, focusing on nutrient-rich foods to meet your calcium, vitamin D, magnesium, and vitamins K1 and K2 needs can be beneficial. Additionally, addressing underlying inflammation is crucial, as it can worsen both bone and heart health.
Q: “Please share your thoughts about the link between high cholesterol and pre-diabetes. It seems that some healthcare providers do not believe that there is strong evidence of a link, while others do. Thank you for considering my question.”
Michelle’s Answer: Yes, there is definitely a link!
Insulin resistance and coronary artery disease (CAD) are closely connected, and several factors contribute to this relationship:
1️⃣ Atherosclerosis: Insulin resistance can lead to atherosclerosis, where arteries narrow due to plaque buildup. When cells become resistant to insulin, the body compensates by producing more insulin. Elevated insulin levels can encourage fatty deposits in blood vessels, increasing the risk of plaque formation and CAD.
2️⃣ Inflammation: Insulin resistance is often associated with chronic low-grade inflammation, which can damage the inner lining of blood vessels, making them more prone to plaque buildup and narrowing. Inflammation plays a significant role in the development of CAD.
3️⃣ Abnormal lipids: Insulin resistance disrupts lipid metabolism, leading to abnormal cholesterol and triglyceride levels in the blood. This imbalance can contribute to the formation of atherosclerotic plaques in the coronary arteries, increasing the risk of CAD.
4️⃣ High blood pressure: Insulin resistance is also linked to higher blood pressure, which is another major risk factor for CAD. Elevated insulin levels can affect blood vessel function and contribute to hypertension.
5️⃣ Endothelial dysfunction: Insulin resistance can impair the function of the endothelium, the inner lining of blood vessels. This dysfunction reduces the ability of blood vessels to dilate and regulate blood flow, contributing to CAD development.
Q: “What is the best cooking oil for your heart?
Michelle’s Answer: For medium to high-heat cooking, avocado oil is a great choice because it has a high smoke point of 500°F. This means that even at high temperatures, the oil remains stable and retains its monounsaturated fat content.
Olive oil is another excellent option for medium-heat cooking, with a smoke point of 350-410°F. It is rich in antioxidants and anti-inflammatory compounds that benefit heart health.
Q: “What do you find to be the most overlooked driver of heart disease?”
Michelle’s Answer:
PURPOSEful next steps:
We hope these answers help you feel more confident and prepared as you navigate your heart health.
To learn more about heart health and the Mediterranean diet, check out our blog:
🔗 5 Tips to Live a Heart-Healthy Life with the Mediterranean Diet
We have the answers to your burning questions about heart health, covering things like:
What are the biggest risk factors for heart disease?
How can the Mediterranean diet support heart health?
What are simple ways to manage stress and improve sleep?
How much exercise do you really need for a healthy heart?
Plus, we share heart-healthy Mediterranean recipes to help you take action today!
Ready to take a deep dive into your heart health?
Check out Michelle’s Optimize Program, a 6-week high-touch group program designed to help you take control of your heart health with clarity and confidence.
Michelle dives deep into the key areas that impact your heart and vascular health, focusing on the pump, plumbing, and electrical functions of your heart through nutrition.
Here’s what Optimize covers:
🫀 Week 1: Tackling inflammation
🫀 Week 2: Understanding insulin resistance (and how it can show up decades before blood sugar changes)
🫀 Week 3: Conquering oxidative stress—what it is, how to manage it, and the best exercise/nutrition pairings
🫀 Week 4: Improving blood flow and addressing endothelial dysfunction to optimize blood pressure
🫀 Week 5: Optimizing your lipid panel, with a focus on atherosclerosis risk
🫀 Week 6: Mastering micronutrients for heartbeat regularity
With expert-led sessions, a supportive community, and direct access to Michelle, you'll have everything you need to feel confident in your heart health journey.
Can’t make it live? No worries—every session is recorded, so you can catch up anytime.
📅 Next cohort starts February 28th—spots are limited!
Get connected with Michelle- follow her on Instagram and LinkedIn for valuable tips, recipes, and heart health insights. Or email her michelle@entirelynourished.com.
P.S. This email contains an affiliate link, which means we may earn a small commission if you sign up through our link—at no extra cost to you. We only share programs and products we truly believe in and trust to support your health journey.