Heart disease continues to be the leading cause of death in the U.S. The public conversation of heart disease often places a strong emphasis on the role of cholesterol. Cholesterol levels, specifically an elevated low-density lipoprotein (LDL), is one of the top modifiable risk factors for heart disease. However, there are other aspects that should be part of the conversation.

Classic measurements of some risk factors include measuring waist circumference, fasting glucose, full cholesterol panels and blood pressure. Behind all of these are underlying mechanisms in the body that drive the disease forward including insulin resistance, adiposity (fat cells), circulation of free fatty acids, inflammation, advanced glycation end products (AGEs) and HPA axis dysregulation (stress).

The interplay between all the cardio risk factors and underlying mechanisms of disease should be considered when striving to prevent and reverse heart disease.   

For example, with insulin resistance, glucose struggles to enter the cells of the body and thus lingers in the blood. This excess of glucose combines with amino acids to form AGEs which increase oxidative stress and inflammation. Additionally, insulin-resistant tissue converts excess serum glucose into free fatty acids that become stored in adipose tissue or are released into circulation. This causes the liver to increase LDL production and decrease HDL (“good” cholesterol) production. In this instance, insulin resistance can act as the first domino to fall in the progression of the disease. Fortunately, with exercise, balancing blood sugar levels, supplementation of certain herbs and minerals (such as berberine and chromium) as well as probiotics (such as Akkermansia), insulin resistance can be improved upon.

Minimizing sugar intake and balancing blood sugar levels is an excellent place to start when addressing heart health. An increase in fiber-rich foods is critical in this step. Ninety-five percent of Americans don’t consume adequate fiber on a daily basis. The Mediterranean diet is a great example of a fiber-rich regimen. It’s characterized by fresh vegetables and fruits, legumes and whole grains, fresh fish, nuts and olive oil, low-to-moderate intake of both dairy and red meat, and very low intake of refined grains and sugary foods. It’s one of the most recommended protocols for promoting cardiometabolic health with consistently beneficial outcomes. If a full adherence to a Mediterranean diet isn’t possible, simply pick a handful of characteristics to implement daily. Nutrition intervention for heart health is not an all or nothing approach.

The progression of cardiometabolic disease often goes unnoticed for decades, so the time to start thinking about your heart health is now. To streamline all of this information, simply follow this 2024 heart-health checklist:

1.   Eat a balanced breakfast every morning including protein, fiber, fat and carbs

2.   Engage in daily physical activity

3.   Minimize refined carbs and simple sugars

4.   Eat foods high in fiber daily