I think that there's a lot of misinformation out there because a

lot of people are trying to cherry pick the data, right. They're looking at,

okay, Ldl cholesterol doesn't matter. Only insulin

resistance matters. You'll hear people saying, no, insulin resistant matters.

LDl doesn't matter. You can hear everything and anything. I want to break the

news to you. They all matter. Why are we picking which one matters? They

may show up in different ways, in different bodies. There

are many times where insulin resistance will actually turn

on genetic mutations that increase your risk of heart disease.

They are both important. And for anyone to tell you that

only one of these things is important is honestly not looking at the whole

picture. Welcome to a special October

edition of open heart Surgery with boots.

All month long, we're diving into heart healthy

eating with none other than my cardiac

dietitian, Michelle Rothenstein. Each

Tuesday, we are serving up bite sized ten to

15 minutes episodes to give you practical tips

to keep your heart in tip top shape. Whether

you're recovering from surgery or just looking to show your heart a

little extra love, Michelle's got you covered. Don't

forget to check out our Patreon at the

www.patreon.com

openheartsurgerywithboots. There we are building

a community of fellow heart buddies where we are going

to start meeting up on Zoom and being of support to each

other. And I'll be curating special

playlists to help you get started on your heart

journey if you're just starting out. So thank you so

much for being here. Thank you for supporting this podcast.

I am so excited to bring Michelle to you

every Tuesday for the month of October. So let's get right to

it. Hey, thank you for coming back. It's another

Tuesday with Michelle, our heart health

cardiac dietitian, who has been so

helpful to me, and I'm so excited that she

is joining us for the month of October. Last week we

were talking about LdL. Well, first of all, we talked about what is the

purpose of working with a cardiac dietitian. Michelle, you did a

great job of explaining that and the importance of your

work. And then we took a little side trip and started

talking about supplements and things to like,

be cautious about when taking supplements, which then led

us to this really great explanation about

LDL in particular. And so

that was such a fruitful conversation. And if you missed last week's, be sure to

go back because Michelle does such a great job

explaining about the impact of supplementation

and what it can do to your kidneys and your liver and

how that. And this is me explaining from how I

understood it, Michelle, but, like, the downstream effects of that.

So it was eye opening for me. So this

week, we in taking that topic and

now moving into blood tests in general. I mean, you are

so great in looking at not just

one value, say, like LDL, but you are

a big believer in looking at the whole

picture. Can you educate us on that

today? Yeah, happy to. I think that there's a lot of

misinformation out there, because a lot of people are trying to

cherry pick the data, right. They're looking at, okay, LDl

cholesterol doesn't matter. Only insulin resistance matters. You'll hear people

saying, no, insulin resistant matters. LDL doesn't matter, and you can hear everything

and anything. I want to break the news to you. They all matter. Why are

we picking which one matters? They may show up in different ways

in different bodies. There are many times where insulin

resistance will actually turn on genetic mutations

that increase your risk of heart disease. They are the both

important. And for anyone to tell you that only one of these things is

important is honestly not looking at the whole picture. Any

diet that you go on should lower. Atherogenic LDl cholesterol

should lower inflammation, should lower blood sugar levels to optimal

levels, should optimize blood vessel health, and blood pressure values

should lower. Uric acid levels should help with weight

reduction around the waist circumference, if that is pertaining to

you. Everything that you are eating should not cause

another metric to go in the wrong direction. It's all

cardiometabolic health, and they all matter. And so I really

want your listeners to understand that it may show up

differently in different bodies depending on your genetics. Depending

on the types of genetics you have, it also will show up depending

on what you're eating, it will show up based off of your athletic

ability. Heart disease does not discriminate based on body

shape or size. I have many athletes who have had heart

attacks. I have many individuals who are obese or morbidly

obese, who have quadruple bypass surgery. We need to be

looking at the individual, but really looking at all your cardiometabolic

metrics and making sure all of them are

optimized to your standards of risk

assessment. So what I mean by that is, when you look

at your blood test, there's a big range of numbers. And a

lot of times it'd be like, oh, my cholesterol levels are in range. My blood

sugar is in range. But if you look at your risk

profile or your genetic susceptibility. So if you have, for

instance, a high lipoprotein a LP,

your ranges are much tighter

and much lower than the general population. Those

ranges are actually designed for more

targeted treatment with medications. They are not

necessarily designed to prevent disease. And so

we need to be looking at these all and stricter standards

and ensuring that we're optimizing all of the metrics together.

A lot of times, we don't really look at inflammation. And

I want to bring that specifically because there's been a really good study

in the New England Journal of Medicine that looks at

individuals who've had a heart attack who have normal ldl because

they're on medication. But if they have a high

HsCRP, which is an inflammatory marker, their risk of

a subsequent heart attack is through the roof. And

so that's kind of the idea. The information to understand

if there is havoc in the blood vessel, it's going to

lead to more complications with heart disease, and havoc

can happen in many different forms. Havoc can happen from high

LDL atherogenic cholesterol that's inflammatory,

it can happen from inflammation. It can happen from

high blood pressure, it can happen from high blood sugar

levels. It can happen from a multitude of reasons.

It can happen also from your hierarch acid levels

or chronic kidney disease. There are many components

here that we must look at in order to really reduce your risk

of heart disease and realize that they all are important

when we're trying to reduce risk of future complications.

I'm just thinking about, you know, I rarely watch tv now, and

if I do, it's like YouTube catching my comedians from

the night before. So that to say I'm not

as exposed to commercials as I used to be, but

when I'm traveling or whatever, and I. And there's a tv

on, I'm still stunned by the amount of

pharmaceutical commercials. And it's

always like, they're always addressing one thing.

The person's always walking in the park hand in hand with someone, feeding a

duck, and, like, you know, and.

And this one pill is gonna lower this one value or

raise that value or whatever. And I just think

about how everything you just said is just not

common knowledge. And again, I was not educated

on any of this in the hospital, and I don't

know any heart patients who were. I just struggle

with how this is so siloed. Yeah, it's an issue.

You know, a lot of this is awareness and digging it into your own hands

of understanding what it is. The other truth is that's hard

is many of my clients will go, okay, I went to my doctor and

I asked for these additional tests and they told me I can take

them, and you should go here and you should go there, you have the

ability to be your own advocate and say,

I want these tests because of x, y, z,

and make that a component to the care, to your

care team. Because without knowing these, you don't really

feel these symptoms. You don't feel plaque brewing in

your arteries. You don't feel even borderline high blood pressure

values. You don't feel these things, so they silently brew.

And that's why heart disease is so prevalent, because

we don't have the opportunity to address them timely.

And so I'm always very big about advocating for these

components and really making sure it is part of standard

care. So being your own advocate is so important in this picture

and understanding why, right. If you just bring in a

whole slew of labs and say, I want these tested, but you don't give a

reason for it, it's more likely not to be taken

seriously versus being like, you're not asking for too much. You're

literally asking for an assessment of your cardiometabolic health,

and that should not be denied to you. You deserve to kind of

know, what are these values? And if they're elevated, we can do something about it.

So why wouldn't we test it, right? So if they're high, we can then

implement change and you can retest it and make sure that it's going down and

it's an optimal direction every three to six months, depending on the

values that are showing up on your blood tests. You know what's coming to me

right now is we take better care of our cars

than our health as a society, at least an american

society. And when the check engine light comes on, we're running to

the mechanic, right? And then they, they just, they

don't ask questions. They just have, like, this little dia diagnostic

tool that they can plug the car into and tell

us exactly what's up with the car, right? So I see

these blood tests as being no different. We should just

assume that the check engine light comes on every

year because we're, you know, fallible human beings.

We're mortal beings. And as we age, things start to,

you know, go a little awry and just

us plugging into the. To the diagnostic tool

and seeing what's up, and we are worthy

of that. We are worthy of taking care

of our bodies, and we deserve to have

excellent health care. We deserve to be listened to by our

doctors, and we are in the driver's seat of our

own. We are the CEO of our

health, and we have also got to change the culture

of just listen to the doctor. Like, sure, listen to the doctor.

Be respectful up to the doctor. And while

you're being respectful, stand up for your health. You deserve to know what

your numbers. Are so important, that piece of the

puzzle of standing up for yourself, because, listen, when

you go to a doctor's office, they have experience in medical management of treatment. They're

brilliant. I've worked with brilliant cardiologists and intransiges, and I love

their brains and all the things that they can do to save people's

lives. But you live in your

body the most, and so you have a

gut instinct of things in terms of, you

should get your questions answered. But if you're feeling

fatigued, if you're feeling different than usual,

please, I beg of you not to just think, oh,

it's because I'm getting older. You know, there's so many times my

clients will say, oh, I thought I was just getting older. So I was feeling

low energy, and I couldn't go up the hill, and I couldn't do the things

that I used to do when I was younger, because, you know, now I'm in

my fifties and my sixties and my seventies, and then when they nourish their

body, they're like, no, Michelle, I can actually, I'm faster

than my kids, I'm faster than my grandkids. Going up that

hill without huffing and puffing. It was an energy deficit. It

was the fact that I wasn't getting in these nutrients. So I say this

because a lot of times we get complacent in our care. We

say, like, okay, the doctor told me to do this. That's what he said.

But we don't ask questions. A lot of times, my clients are on medications.

They don't even know why. They don't know what they're for. And I'm here

explaining the interactions with food in those medications. I'm

explaining how these medications work. I'm explaining the side effects, so

that if they are intolerant to the medication, they're not just

ignoring it. Your body is telling you

things, and if you listen to it, you will help with

increasing your quality of life, increasing your ability for your heart

to function properly. And you're going to seal,

you don't need as many medications because your body is resilient

to recovery. Wow, excellent. Thank you for that, like,

overall picture. And it's just such

invaluable information. Let's leave it there for today.

Again, we're doing bite sized nuggets this month, so,

Michelle, thank you. And come back next week for

some more truth bombs. Thanks so much.