Episode 34

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Published on:

23rd Jan 2024

Fueling Heart Health: Empowering Nutrition Strategies for Lifelong Wellness -34

In episode 34 of The Heart Chamber Podcast, nutrition expert Michelle Routhenstein shares valuable insights on heart health and nutrition. She emphasizes the importance of personalized care and finding qualified healthcare professionals, cautioning against one-size-fits-all diet trends. The discussion delves into the keto diet, ancestral diets, and the need for balanced macronutrients to support heart health. Host Boots Knighton praises Michelle's science-based approach to nutrition and highlights the importance of education in the medical field. Michelle's long-distance nutrition programs aim to address the root causes of heart disease through personalized, science-based nutrition. Listeners are encouraged to be proactive in their healthcare and ask questions, emphasizing the need for individualized nutrition approaches.

If you are looking for something specific - here's where you'll find it:

06:08 Dietitian focuses on heart health and prevention.

10:35 Emphasis on teamwork in patient care. Doctors lacking nutrition knowledge, refer patients to nutritionists.

14:37 Impact of stress on health; the importance of self-care for overall well-being; the need to choose the right medical professionals.

19:24 Avoiding one-size-fits-all diets. Emphasis on personalized, sustainable approach to diet for heart health.

21:16 Rethinking past advice.

25:18 Low carb diets may lead to heart issues and nutrient deficiencies.

27:28 Low carb diets lead to ketosis, but may stress kidneys, liver, and cause health issues like keto flu.

32:22 Adequate nutrition is crucial for athletes' health and performance, as improper balance of macronutrients can lead to increased free radical production and plaque formation in arteries. It is important to question and understand the biological mechanisms behind nutritional claims.

35:58 Group and 1 on 1 support for heart health with personalized guidance, blood work focus, resources, and accountability.

39:26 Be your own health advocate. Understand your numbers, ask questions, and take care of your heart.

40:29 Encourages reaching out to Michelle for heart health tips and joining her group. Airing weekly heart health episodes in February.

A Little More About Today's Guest

Michelle Routhenstein, MS, RD, CDCES, CDN, serves as the owner and president of Entirely Nourished LLC, a specialized private practice in nutrition counseling and consulting focused on the prevention and management of heart disease. Employing a science-based, holistic approach, she is dedicated to enhancing individual's heart health by addressing cardiometabolic risk factors and mitigating the likelihood of cardiovascular issues as individuals age.

Acknowledged as a thought leader and expert in heart disease management and prevention, Michelle is deeply committed to educating individuals on nurturing their hearts for healthy and thriving lives. She adopts a dynamic perspective on nutrition that addresses the root causes of chronic diseases, safeguarding individuals' hearts for longevity. Her passion lies in translating Nutritional Sciences into an easily understandable language that can be applied for the long term.

Michelle has a compelling presence on social media, particularly on Instagram (Heart.Health.Nutritionist) and LinkedIn (/in/michellerouthenstein/), where she shares valuable information to educate and empower her followers to take ownership of their heart and overall health, guiding them in reducing the risk of cardiovascular disease through nutrition and lifestyle changes.

As the author of "The Truly Easy Heart Healthy Cookbook" and a member of the Forbes Health advisory board, Michelle has delivered numerous lectures on heart health to diverse audiences. She has been cited in reputable journals, including Medical News Today, Fox News, Forbes Health, LiveStrong, Eating Well, Health, and VeryWell.

Michelle earned her Bachelor’s degree in Clinical Nutrition at New York University (NYU), her Master’s degree in Clinical Nutrition from NYU, and completed her dietetic residency at NYU. Before establishing her private practice, Michelle gained valuable experience on the surgical floor of New York City hospitals, including a level 1 trauma center, where she played a crucial role in managing various high-intensity clinical diagnoses.

How to connect with Michelle

Website: www.entirelynourished.com

Instagram: @Heart.Health.Nutritionist

LinkedIn: www.linkedin.com/in/michellerouthenstein/

How to connect with Boots

The Heart Chamber - A podcast for heart patients (theheartchamberpodcast.com)

Email: Boots@theheartchamberpodcast.com

Instagram: @theheartchamberpodcast or @boots.knighton

LinkedIn: linkedin.com/in/boots-knighton

If you enjoyed this episode, take a minute and share it with someone you know who will find value in it as well. You can share directly from this platform or send them to:

The Heart Chamber - A podcast for heart patients (theheartchamberpodcast.com)

Transcript

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Boots Knighton [:

Hello. Welcome to another episode of The Heart Chamber podcast. I am your host, Boots Knighton. Thank you so much for spending another little slice of your day with me and my guest, Michelle Routhenstein. Michelle serves as the owner and president of Entirely Nourished, which is a specialized private practice in nutrition counseling and consulting, which is focused on the prevention and management of heart disease. She employs a science based holistic approach, and she is dedicated to enhancing individuals' heart health by addressing cardiometabolic risk factors and mitigating the likelihood of cardiovascular issues as we age.

Boots Knighton [:

My conversation with Michelle was so eye opening, heart opening. She is someone I wish I had known years earlier. We get into how the health care industry works, why dietitians serve such an important role. We talk about how to choose the right dietitians to work with. We get into the great carb debate, to eat carbohydrates or not. Her answer to that was really surprising, and she backs it up with a lot of research. She is also the author of The Truly Easy Heart Healthy Cookbook. And she has been in many reputable journals, including Medical News Today, Fox News, Forbes Health, Live Strong, Eating Well, Health, and Very Well. She is a lecturer on heart health. She has an incredible presence on Instagram. She's just a wonderful human in general. So, without further ado, I am so grateful and excited to bring you, Michelle Routhenstein.

Boots Knighton [:

Welcome to The Heart Chamber. Hope, inspiration, and healing. Conversations on open heart surgery. I am your host, Boots Knighton. If you are a heart patient, a caregiver, a health care provider, a healer, or just looking for open hearted living, this podcast is for you. To make sure you are in rhythm with The Heart Chamber, be sure to subscribe or follow wherever you are listening to this episode. While you're listening today, think of someone who may appreciate this information. The number one-way people learn about a podcast is through a friend. Don't you want to be the reason someone you know gained this heartfelt information? And if you haven't already, follow me on Instagram, 2 different places, at Boots.Knighton or at The Heart Chamber Podcast. You can also find me on LinkedIn as well as Facebook. But enough with the directions. Without further delay, let's get to this week's episode.

Boots Knighton [:

Well, Michelle, thank you so much for taking a slice of your day to spend with me and my listeners of The Heart Chamber Podcast.

Michelle Routhenstein [:

Thank you so much for having me.

Boots Knighton [:

Yes. And you are such a wealth of information. And, obviously, I just, I went into a long, glowing introduction of who you are in the opening of this episode, but this is your opportunity to brag to us, you have done some really neat things to get you to where you are today. Like, you worked at a level 1 trauma hospital. You have so much education and training. Like, tell me, how did you become a nutritionist who specializes in cardiology.

Michelle Routhenstein [:

When I was in my residency so as a dietitian, you have to do a residency where you go into hospitals in different areas of practice. So, you're in the ICU, the intensive care unit. You're in the kidney clinic, you're in a weight loss clinic, you're doing rounds on different floors just like a doctor, but specialize within clinical nutrition if you're doing a clinical nutrition residency. And when I was there, I was noticing that every kind of department had its own kind of diet, so to speak. Like, the kidney diet was like, okay. We need to lower your potassium, and we need to lower your phosphorus, and we look at certain things. It was very 1 organ specific or one thing of looking at it. But when you looked at it from a stand back kind of perspective, you noticed that everyone was having issues with cardiovascular disease, whether they were having cardiac arrest or they were having heart attacks or they were having things that were causing their heart to overwork. And when you then took a step back even further and realized, you know, the number one cause of death and the number one cause of issues with health has all to do with the vascular system, your cardiovascular system. But research shows 80% of that is preventable through nutrition and lifestyle medicine. So, what is going on? Where's the gap? And so, when I saw this gap, I was like, there has to be something that people are not necessarily connecting the dots to or they're not really focusing in on. And so, that's when I niched out into preventative cardiology and cardiology specific for heart disease prevention and management. And what I still notice kind of to this day is most people are like, you know what, Michelle? I don't eat junk food. I don't eat things that are bad. I eat good things. Like, I don't know how I have heart disease. And while you look at it, they might be generally healthy, but when it comes to heart health, it's really about optimizing your blood vessel health and getting in the nutrients your body needs for it to do its job effectively. And that's really where I niched down into preventative cardiology, and I worked with electrophysiologists and lipidologists and heart failure specialists and all these different types of doctors in really optimizing the biological pathways in our body to improve nutritional status. So, I go to a lot of medical conferences and the doctors always say, like, why are you here? You're a dietitian. Because a lot of the lectures are based off of drugs. But if you look at the mechanisms of many of these drugs, our bodies do a lot of those biological mechanisms too, and they need certain nutrients to be enhanced. And so, I'm really looking at those optimal pathways, and that's kind of how I niche down to really halt the progression of cardiovascular disease and to avoid the heart from overworking and over stimulating itself so that you can have good blood flow, good heart health for the rest of your life.

Michelle Routhenstein [:

So, really focusing on that and optimizing risk management so that you can live a healthy life. So, really giving back quality of life through nutrition. And so, I mean, I'm seeing the power of nutrition so much so where cardiologists will call me and be like, we've never seen this before. We've never seen this research. What did you do? And it's really about personalizing the science and getting in those nutrients so the body is doing its job most effectively.

Boots Knighton [:

Incredible. Like, when I went through my whole heart journey, no one, not a single health care provider talked to me about any of this. Why?

Michelle Routhenstein [:

Honestly, it's not well learned. That's 1. And 2, the unfortunate truth is people are rushing. A lot of times, people aren't giving the time needed. And from a medical perspective, which I find so many people come to me and say, Michelle, like, I went to my doctor and I was expecting them to talk to you about nutrition, but they didn't. I'm like, well, take a step back. Their training was in medical intervention, and they're brilliant people at what they do, but they are studying how do I manage this through medicine? They're not looking at it as how do I manage this through lifestyle and nutrition. It's not what they study. It's not what they do. What they should be saying is, hey. Nutrition has a role here. Medication is important, but we need to couple that with nutrition. And they should be sending you to a registered dietitian who specializes in heart disease so that they can spend the time with you because it's a lot. Nutrition is complicated in the sense of we all have different cultural needs. We all have different things that have been ingrained with us with what we eat, and that personalization factor in getting in those nutrients can be often very hard to do without some guidance, but many physicians aren't well versed on that. And so, being able to say, that is a role that takes a role in here is important to acknowledge.

Boots Knighton [:

Okay. So, you know, you've probably heard the phrase, like, don't go to an empty well for water. And one thing I've noticed as a patient, heart patient, is everyone has their silo that they're in. They try to talk to each other. Like, I don't think there's been a single health care provider I've interacted with who wasn't giving their best. I can tell that everyone was showing up giving their best and had my best interest at heart, pun intended. And I still want to speak to the health care industry, but also do it fairly. Right? So, you just helped me as a patient understand a little bit better what's appropriate to expect of a doctor and what maybe isn't? And I still want to lovingly say we have to do better. We have to help educate patients, think a little further outside the box of medications, etcetera. Is that fair to say?

Michelle Routhenstein [:

Yeah. I think everybody, every practitioner is there to help you. There's no malintent at this at all.

Boots Knighton [:

And I don't want to imply that.

Michelle Routhenstein [:

Right. And also to kind of say from a personal note, I have patients who are nurses, who are cardiologists themselves who come to see me. And many cardiologists who I work with say, Michelle, I don't know anything about nutrition. They admit to it. It takes a lot for a doctor to say that because they know so much, but so many of the Greek cardiologists I work with will say, I don't know anything about nutrition. And that's where I refer to you. And I think that's a very humbling note to say that they're doing their job effectively, but we often expect them to do everything, and we need to be looking at it as this is a team, and we need to set your team up to give you all of those things that you need to help you thrive. And so, expecting, you know, that conversation and seeking that additional support as needed is definitely going to help.

Boots Knighton [:

I love that you just used the word team. And in past episodes, I've talked about our health care teams that each of us assemble. And the patient is I like to think of, like, I am the CEO of my team and I hire the nutritionist, the acupuncturist, the physical therapist. And, you know, there's not 1 person who can be all of that. You know, I have my cardiologist, my local one, and then I have a cardiologist at a bigger hospital further away, and they all play a really important role. And I have found where when I show up to all my different appointments and I'm ready to be not just a receiver of information, but participate. I have done my research. I've read my lab reports. I have come up with questions. Like, that's when I get the most out of my appointments and then that's when I can ask, like, my cardiologist. In fact, I have an appointment 3 days from now, and you're already helping me think of some new questions to ask her about nutrition. And she actually happens to know quite a bit, but I can't emphasize enough, like, you have to approach this as a team effort and not just as this 1 health care provider is going to tell you it all, and that's going to be the end all, be all answer. Fair?

Michelle Routhenstein [:

Yeah. 100%. And I loved how you said being a proactive participant in your team. You are the CEO, and that means that you should be asking questions. You should be asking why. A big thing of what I do with my clients is I explain to them what's going on in your body. Why would this be helpful with heart health? Why do we need it? And what quantities do we need it? And why for you? And that really helps not just to understand, but for you to then implement it more long term. So, ask questions. And if you're not getting the answers answered, maybe you need a different health care provider too. So, you want someone who's going to spend the time with you and make sure that you understand because that's going to build your confidence. It's going to help lower your health anxiety, and that's a big component to heart health. And so, understanding the why and requesting your labs just because the doctor says, oh, things are okay, look at last year's. Look at this year's and compare those values even if it's within normal amounts, but for you, it's trending in the wrong direction, that should be a conversation to be had before things go array. I'm very big about being proactive, but being proactive means asking questions, looking at all these results, and being sure that you have a team who can support you on those answers because we all need some guide to help us, and so choosing that team to guide you and make you feel confident about this is really going to help protect your heart the most in the long run.

Boots Knighton [:

Amen. And I can tell you from firsthand experience that, you know, I've just been turned into this barometer ever since my heart surgery and, like, the least bit of stress just sets my heart off. And I'm going to actually do, like, a solo episode the week after I air this episode. And I'm going to talk about that and how I had a huge stressor in November and then another one in December that actually caused an NSTEMI heart attack. And it really is the more you can regulate your cortisol, and the more you can regulate your nervous system, everyone's better for it. Because now my poor husband is still trying to recover from me having a heart attack, it's a ripple effect. When we care for ourselves, we care for everyone around us. So, let's turn the page and change topics here. Well, kind of along the same lines, I wanted us to touch quickly on how to choose the right cardiologist, dietitian? Can you just maybe give us, like, 3 things to look for? I don't want to box you into 3 things, but just like 3 quick hitting things of, like, what are some best practices that we as patients should be looking for?

Michelle Routhenstein [:

Yeah. So, you want to make sure that, A, the person is properly credentialed. So, a lot of times when you're looking, let's say, at a dietitian, there are a lot of health coaches out there. There are a lot of individuals who might be talking about weight loss trends or influencers, but they don't have the proper credentials that are very specific to heart health, and that's important because what's healthy in general, can actually do damage to the heart depending on who's giving that information. So, you want the right credentials.

Boots Knighton [:

What are the letters after your name that we need to look for, for credentials?

Michelle Routhenstein [:

So, RD, a registered dietitian, is somebody who's done an undergraduate degree in clinical nutrition. They've done a master's degree in clinical nutrition. They've done a dietetic residency in clinical nutrition, and they also have passed the board exams. They are upholding their license. They've done a lot more rigorous understanding of the science behind all of this. So, they're coming from a science background that can then allow them to give you medical nutrition therapy. If you go with a health coach, if you go with someone who just calls themselves a nutritionist but doesn't have these credentials, they can be just telling you general nutrition. They can be giving you anecdotal advice that does not pertain to the heart, and that can cause more damage than good if they tell you other things to eat. So, a lot of times people will say, you know, if I'm eating clean, I'm eating heart healthy. Clean means very different things to different people. We need to be looking and making sure that you're getting sound advice from the right person.

Boots Knighton [:

And eating clean, would you say that's just like a buzz phrase?

Michelle Routhenstein [:

Yeah. What does that mean? So, everyone who comes to see me, most of them will say I eat healthy. But when you go into their diet, everybody is eating something different. And what I find is most times when people say they're eating healthy, they’re focusing on what they're not eating versus what they're actually eating that's going to give them the benefit from a heart health perspective. And so, we need to understand those details. We need to understand for you, what does that mean, right? Especially based off your age, if you're going through menopause, if you're perimenopause, postmenopausal, you know, there's different things in terms of protein. We need to look at hormonal balances. There's a lot of things that are coming into the picture. We need to look at insulin resistance and diabetes, and so the person that you're seeing should be credentialed, and they should also be specialized in what you're looking for. So, if you have heart disease or heart related issues, it should be within the heart realm because that means that that's the only type of client they see. So, they've done for me, I only see people who have heart disease or heart disease related risk factors. So, my research and my experience are very specific, and that's important also from a standpoint of medical management. So, knowing about heart disease, I know all the medication that many of my clients are on, and that's going to have food and drug interactions. It's going to make certain nutrients below, other nutrients potentially be high, and we need to make sure that we are personalizing that so that we are making sure that it's going alongside medical management. And so, the credential, the specialization, those are all really helpful, and you also want to make sure that they're not just promoting 1 diet.

Michelle Routhenstein [:

So, I've seen many people say, oh, everyone needs to go vegan. There's no literature that shows that that's right. We do need to go plant forward, but if you take a step back at all of the heart related research in terms of nutrition, it's actually the nutrients that matter. So, we need to look at this from a perspective of what's going to be sustainable, what works for you and the medications that you're on, and are you getting the actual therapeutic amounts of these nutrients that have been shown to help optimize your heart health? And so, if someone's promoting that everyone needs to go vegan or everyone needs to go carnivore, they're not personalizing the journey for that individual, and then that is a red flag in terms of it actually working. If somebody says everyone needs to go low carb, first off, we need all of the macronutrients for your body to thrive, and it's going to lead to nutrient deficiencies. But we need to be looking at this from a more whole person approach, because that's the only way we can make sure that you're getting all the vitamins, minerals and nutrients you need for your body to do its job appropriately.

Boots Knighton [:

I'm just kind of sitting here in awe because I mean, the social media has its pros and cons. And a con can be I mean, here I am, a patient. I so desperately want to live a long, healthy life. I have a “special heart”. I put that in air quotes. I do my best to try to find and follow what I think are the right people that can help me find ultimate whole healing health. And then I listened to you. Thankfully, I found you on LinkedIn. You know, I think that is cool in and of itself. Thank goodness for LinkedIn. It's really, well, it's expanding my knowledge thanks to, like, meeting you. Right? And so, it gave me the opportunity to find you. And everything that you're presenting just as kind of flying in the face of what I have been told in the last couple of years. And I'm having to sit with this for a minute, and I'm a little mad, but a good mad. Right? It's like, well, okay. And I know that all these other people that I've worked with and spoken with are all well-meaning, but I will say I'm thinking of 1 person in particular. And that is the way what this person is professing. And what I'm hearing you say is this is not black and white. Like you said, it is really individualized, but a lot of health care can be black and white. And that's hard. You know, I broke my leg 5 weeks ago. That was black and white. Like, I needed surgery. I had to have a rod put in my leg. That was black and white. There was just no way around that. And that was not complicated. I just flat out broke 2 bones and needed a rod in my leg. But with nutrition, I guess I just didn't realize, like, I've been furiously taking notes over here, and I didn't realize to think about how your diet can affect the medications that you're on and vice versa. And I didn't think about what is truly sustainable. All of this is just, like, really clicking, and I'm like, man, I am 45 years old. I really would have benefited from having met you years ago.

Michelle Routhenstein [:

Yeah. I think social media is hard because a lot of times people are trying to make a name for themselves. So, they'll say, oh, don't do this. Don't do that. This is the way, and so they build their following and then they try selling you something. Right? So, a big flag for me on social media is, is the person selling a lot of supplements saying, don't eat this, but take all of these supplements instead. That to me is a big red flag. They're trying to gain profit from it. So, you see someone who has a big supplement store on their website pushing supplement use, first off, supplements need to definitely be individualized, and so that's a huge red flag. If somebody is talking about, you know, we need to have a balanced diet, all of these macronutrient’s matter. That's not black and white. It's actually the truth, but and they're not trying to sell you something, I think that's a big part. And you also want to take a big step back. You know? There's a lot of people, there's 1 doctor I'm thinking about in particular who will say, don't eat beans. Don't eat fruit. And all these things that inherently are known to be healthy for you, and the person's telling you don't eat it, but then go take all my supplements, and if you actually look at the supplements, they're all the nutrients that are found in fruits and beans. They're trying to gain profit from you, and so we need to be smart educators and realize when you're looking at these things, take a step back. Does this make sense? And if the person can't explain the why behind it, that's also a very big red flag.

Boots Knighton [:

Thank you. I really appreciate it. I'm all the necessary parts exasperated, enlightened. What the heck? You know, all the appropriate emotional responses to when you finally learn something that is so helpful. You wish you would know sooner. That's all. Okay. So, can we dive a little bit more into the no carb debate? I mean, is it fair to say it is a debate to preface it that way because, I mean, it feels like when I'm thinking about all the different people that I watch on social media, and it seems like, it is up for debate to some of these people who are so, so impassionate about the paleo lifestyle or carnivore or keto. Oh, my gosh. Keto. It's overwhelming.

Michelle Routhenstein [:

So, the low carb phase comes from the premise of if you eat carbohydrates, then you might gain weight, you might become insulin resistant, you know, all of those types of claims. But you have to look at the research. And when we look at the research, when you eliminate carbohydrates, when it comes to heart health, what can happen? One, you can actually go into an arrhythmia called atrial fibrillation, which increases the risk of blood clots and strokes. We don't want that because when you eliminate carbs, you can end up having deficiencies primarily in magnesium, potassium, calcium that are needed for heartbeat regularity. The other thing that happens we've seen is, especially in middle age, when individuals go low carb, the coronary artery calcium scores increase substantially over that time period. And what that means, just in layman's term, is that the plaque formation in the arteries increases on a low carb diet. So that atherosclerosis, that plaque buildup, the narrowing of the blood vessels, which is one of the leading causes of heart failure, heart attack, strokes, etcetera. The reason for this is because you are lacking fiber on a low carb diet. You're lacking viscous carbohydrates that pull-out LDL cholesterol, keep the artery clean and also from an insulin perspective, these are the same foods that actually help to become insulin sensitive. So, when you take out carbs, you are essentially telling your body, don't, it's like putting a band aid. We're not going to add carbs, so your blood sugar is not going to spike. Okay. But you're also not teaching your body how to use insulin, how to utilize carbohydrates appropriately. Now your brain uses carbs as its primary fuel. So, if you take out carbs, what does it have to do? It has to work extra hard to take the protein and the fat that you're consuming and turn it into a carb. And that's where we get ketosis, the keto diet. You are urinating out ketones, the fat molecules in order to allow your brain to work. But your body is not, that's a survival mechanism. Your body is not really meant to do that. So, a lot of individuals who go on these very low carb diets get the keto flu, where you feel really lethargic and because you're making your body overwork. But now take a step back. If you don't have the carbs, you’re now going to have a high fat and a high protein diet. That puts stress on the kidneys, could put stress on the liver, and it can cause more saturated fat to be consumed, which will cause insulin resistance and high LDL cholesterol.

Michelle Routhenstein [:

So, when it comes to heart health, it makes sense that a low carb diet's going to promote plaque in the arteries and lead to heartbeat irregularities. We need carbs. The issue with carbs you have to realize is, there's many different forms of carbohydrates, and this is where people say just get rid of them. If you tell me I'm not going to have any sugar, any refined carbohydrates, candy soda, I'll be like, okay. Great. We don't want to have too much of that because that can make your blood sticky. That can cause blood sugar to be high. We don't want insulin resistance, but that's one component, and I think a lot of times people are like, insulin resistance is the cause for heart disease.

Michelle Routhenstein [:

There are many causes for heart disease, and we have to be addressing all of them and not just one of them. Eliminating carbs does not address the problem. It makes it worse. We need those carbohydrates to bind cholesterol in our arteries. We need those carbohydrates to make ourselves more insulin. Hey. We need those complex fiber rich carbohydrates for our brain to work, to get the nutrients it needs. So, we do not want to eliminate them. We want to choose the right ones. We want to pair them appropriately with enough protein, with a small amount of heart healthy fat for optimal absorption, but to eliminate carbs is not the solution. It's choosing the right ones in the right quantities that's going to help you reach those goals.

Boots Knighton [:

What about the person who says, our ancestors didn't eat carbs.

Michelle Routhenstein [:

So, when you look at that model, though, did those ancestors live long and healthy lives? They kind of, the cavemen didn't really live past 50 years old, so that's 1. And so, we need to look at it from a chronic disease standpoint, and we know a lot of information now that we did not know back then. Also, we didn't eliminate necessarily carbs. There was still, you know, grains. There were still fruits and vegetables in that lifestyle too, and we have to acknowledge that. A lot of times, we know a lot more about biology and how our body works that we do need to consume that. I'm not saying only carbs. I'm saying we do need protein for longevity. We do need heart healthy fats that's going to help with absorption of fat-soluble vitamins and fat-soluble carotenoids, which is a subgroup of antioxidants. We need all that, but we don't need to eliminate carbs for us to achieve optimal health. We need to include them in order for us to optimize our arterial health and our blood vessel function.

Boots Knighton [:

Because, I mean, that is well rounded, well researched answer, and it's just a breath of fresh air. Because like I'm saying, a lot of these people that I watch on social media who are like, keto and carnivore, and it's just because it's how our ancestors ate, and then that's it. That's their reasoning. I mean, there's 1 lady that I follow that I'm going to now unfollow, who talks about, you know, it's the only way with the keto diet, the only way you can really activate autophagy in the body is through the keto lifestyle. Could you speak to that?

Michelle Routhenstein [:

Very odd to hear that. So, a lot of the times, they don't have research to back it on. Like, what's their reasoning? Cell damage in our body actually happens from oxidation and oxidative stress. If you take out carbohydrates, you've taken out probably 95% of the things that will help with quenching free radicals and preventing oxidative stress. What I mean by that is that when we look at high fat and high protein diets, we're promoting more oxidation in our body. We need to be having more of those antioxidants which are found only majority in our carbohydrates. You know, it's interesting because I have a lot of people who come to me who are athletes, who had a heart attack. They're like, I exercise. How can I have a heart attack? And when you look at their lifestyle, it is all paleo. It is all protein, protein, protein, carb, protein, carb it's mostly protein, fat. It's very limited in the appropriate balance of micro macronutrients to quench free radical production. And when you are an athlete and you're exercising, your body is actually producing more free radicals, more oxidative stress. So, if you don't pair it with nutrition, that's where we get in trouble where we see that endurance athletes can get a lot of plaque formation in their arteries because that LDL is oxidizing and causing more plaque to form. And so, we have to be looking at the research. So, I would question the person saying, how does that happen? If someone's making it so matter of fact, but they can't explain it through actual biological mechanism in the body, that's a red flag that does not work. You need to be asking the why. Don't take things matter of factly. This is why I spend so much time explaining the why so people understand, what is going on? What can I do? And they feel confident in their choices, so they're not flip flopping between diets. They're actually creating this as a lifestyle plan that they can do for the long run, and they're protecting their heart so they can live long and healthy lives.

Boots Knighton [:

And I want to just, to your horn here. You do such a beautiful job. I'm looking just at Instagram right now, your Instagram account, heart.health.nutritionist. And, of course, I'll have that in the show notes because I want everyone to know about you. But you do such a beautiful job explaining all the purposes of your posts and, like, you just back it up with the data, with the research, with the science. And me as a patient to who's just now recently found you, I'm just so grateful for that.

Boots Knighton [:

Before we have to go, like, couple more things I'd love to cover. I want to hire you. I mean, I immediately just want to start working with you. And I'm in Idaho. You're in New York. How do you work with someone long distance? Like, what is your approach?

Michelle Routhenstein [:

Yeah. So, I have individual programs. I have which are my 1 on 1, and then I have my group programs. And they are 2 different approaches depending on your style of how you would like to learn all of this knowledge and implement it. The group program is 6 weeks of live lectures. They're also recorded where I go through the underlying root causes of heart disease and how do we mitigate it through science-based nutrition. So, we have a whole week on inflammation. How do we know there's underlying inflammation? You don't feel it. You don't necessarily see it. How do we assess for it, and then what can we do through nutrition? And my approach is very, what can we add? Because a lot of times, they're all about, don't eat this. Don't eat that. This is bad for you. This is good for you. Well, what should we be eating? How do we get these nutrients to combat inflammation? Then we'll talk about insulin resistance. We talk about blood vessel health. We talk about lipid optimization. We talk about micronutrient sufficiency. We spent a whole lecture on oxidative stress and how do we approach it, and this really helps tie the understanding of how do we get plaque in our arteries? How do we get stiff arteries? Why does our heart have to overwork? How do we optimize it? What can we actually do? And that's the biggest component. So, I teach you a lot of what's going on in the body and then how do we adapt it into your diet to make sure you're successful. And so, this allows, you know, in my group program, I have individuals. Some are vegan. Some are carnivores. Some are omnivores. Everyone has their own style of eating, and I teach you how to be nutrient sufficient. How do we ensure that we're protecting the heart so that you can understand and apply this to your lifestyle? So, it's my group. And then I also have 1 on 1 if someone wants more personalization, more 1 on 1 support, and that really is a lot more tuned into your blood work, your blood tests, your medications that you're taking, and I create for you a health resource guide, a meal plan, and we have a lot of accountability and support in that model. So, a lot of people will start in the group and then move into a 1 on 1. Some people start in the group, they learn a lot, they do really well, and that's all they really need. I'm a very big proponent about teaching you what you need so that you can apply this and be your own advocate and then do it for the rest of your life. So, I'm very transparent. I welcome so many questions. You know, I'll always kind of ask, hey. Any more questions? Stop me in the middle of the lecture. Stop me at the end. Email them to me. Put them in the Facebook group. I want to debunk and explain, and everyone who works with me knows that I'm a very big, I'm not a yes or no. I'm usually like, yes. This is great because of blah, blah, blah. No. This isn't so great because of this, this, but what you can do instead is this. So, I'm very big about explaining because I want individuals to understand and so they can apply it to their lifestyle and continue doing it for the rest of their life. So, that's kind of the 2 different ways that I work.

Boots Knighton [:

What kind of blood test do you like to look at?

Michelle Routhenstein [:

So, I like to look at a lot of different types of blood work, but I'm going to preface this with you don't need extensive blood work. Some doctors are hesitant to order too much because they're not necessarily sure what to do with them on a medical management standpoint, but I do look at lipids. I look at glucose levels, your hemoglobin A1C, your insulin. I do like to look at inflammation, so like hsCRP levels, I do like to look at homocysteine levels and apoB levels. So, it's a little bit more comprehensive than a standard, but many times there will be pushback. And so, I use what I have to make sure that we're assessing what we have in improving the cardiometabolic risk factor profile based off of the information available.

Boots Knighton [:

And you can send a script for someone to be able to go get that blood work wherever they live.

Michelle Routhenstein [:

As a dietitian, I can't send the script. What I do is I'll communicate, like, these are the blood tests I'd like to see, and then they'll go to their physician and get them ordered.

Boots Knighton [:

Gotcha. Okay. Yeah. It fascinates me how one good thing out of COVID, I guess, is now we have such greater capability of working with people over the miles. Right? Like, thanks to Zoom, and it's kind of amazing how that has expanded our ability to receive care from providers beyond our communities.

Michelle Routhenstein [:

Oh, no. 100%. Before COVID, I was in my office in the city, and I saw all of my clients face to face. I didn't see anybody virtual. And then I had to switch my whole model, and it allowed me to bring more awareness and really expand my practice to be able to help more people too.

Boots Knighton [:

Michelle, this has been so valuable. I just feel really, really fortunate that I found you on LinkedIn, that we connected. You said yes to my invitation. Any other tidbits that I haven't touched on that you really want to speak to today.

Michelle Routhenstein [:

I think the biggest thing that I want individuals to take from this is know your numbers. Be an advocate for yourself. Understand what you can do so that you can really take your health in your own hands, and be a smart consumer. Take a step back. Am I taking too many supplements? Am I following someone who's trying to push all these things to me? Does it make sense? Are they explaining the why? Ask your questions. Know what you're dealing with because this is your health. You're the only person who can be that 1st advocate to prevent any future issues. So, I'm always about knowing these things, knowledge is power, and really being educated about how you can best take care of your heart health. So, I'm really happy that we were here that we got to speak, and I hope I've kind of implanted that seed in many people to be that own advocate for themselves and their health.

Boots Knighton [:

Thank you. And your next group, doesn't it start in February?

Michelle Routhenstein [:

Yeah. It starts February 9th.

Boots Knighton [:

Heart buddies, all my listeners, please reach out to Michelle. Follow her on Instagram. Your heart will thank you. Consider joining her group, your heart will thank you. And all during the month of February, I am going to be airing an episode every week on how to love your heart for heart month. And I will be recapping a little bit of this episode as well then because our hearts are keeping us going. It is the root of our health, and it deserves to be loved and it deserves to be cared for. And we as whole humans deserve to have optimal health, where we are thriving, not just surviving.

Michelle Routhenstein [:

Love it. Thank you so much for all you do.

Boots Knighton [:

Oh, thank you, Michelle.

Boots Knighton [:

Thank you for sharing a few heartbeats of your day with me today. Please be sure to follow or subscribe to this podcast wherever you are listening. Share with a friend who will value what we discussed. Go to either Apple Podcasts and write us a review or mark those stars on Spotify. I read these, and your feedback is so encouraging, and it also helps others find this podcast. Also, please feel free to drop me a note at boots@theheartchamberpodcast.com. I truly want to know how you're doing and if this podcast has been a source of hope, inspiration, and healing for you. Again, I am your host, Boots Knighton, and thanks for listening. Be sure to tune in next Tuesday for another episode of The Heart Chamber.

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About the Podcast

The Heart Chamber
Conversations on open-heart surgery from the patients' perspective
**The name of this podcast is changing on June 4, 2024. Be sure to subscribe so you don't miss the announcement!** Join Boots Knighton every Tuesday for conversations on open-heart surgery from the patient perspective. Boots explores the physical, emotional, mental, and spiritual experiences of surgery with fellow heart patients and health care providers. This podcast aims to help patients feel less overwhelmed so you can get on with living your best life after surgery. You not only deserve to survive open-heart surgery, you deserve to THRIVE!
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