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

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Dec 22, 2025

Join Michelle Routhenstein, a preventive cardiology dietitian, as she debunks heart disease myths and emphasizes personalized nutrition over rigid rules. Discover how cholesterol, particularly ApoB, plays a significant role in cardiovascular health. Michelle explains the importance of balanced diets rich in soluble fiber and unsaturated fats, while also navigating the complexities of menopause and its effects on heart risks. Learn practical tips for reducing blood pressure and cholesterol through smart food choices, making heart health sustainable for the long term.

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INSIGHT

Prevention Requires Nutrition Plus Medicine

Cardiologists often lack time and nutrition expertise, creating a prevention-treatment gap in care.
Michelle Routhenstein argues nutrition plus medicine, not either-or, better prevents heart disease.

ADVICE

Start With A Nutrient‑Adequate Plant‑Forward Diet

Build a nutrient-adequate, plant-forward pattern with whole grains, nuts, seeds, fruits, vegetables and lean protein.
Personalize it to culture and preferences so the plan is sustainable long-term.

INSIGHT

Plaque Type Dictates What Nutrition Can Do

Different plaque types matter: calcified plaque is stable and unlikely to shrink, while soft plaque can be shrunk or stabilised.
Nutrition aims to stabilise calcified plaque and reduce soft plaque to lower event risk.

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In this episode, I’m joined by cardiac dietitian Michelle Routhenstein to unpack why heart disease prevention is still so misunderstood. We explore cholesterol confusion, blood pressure, saturated fat, carbs, supplements, and why personalised nutrition matters far more than rigid dietary rules.

Michelle explains how food choices influence plaque progression, inflammation, gut health, and heart rhythm, and why sustainable habits, not extremes, are key for long-term cardiovascular health.

What We Cover

Why heart disease is still largely preventable yet so common
Cholesterol, ApoB, and the biggest nutrition myths patients face
Blood pressure as the most powerful but ignored risk factor
Soluble fibre, unsaturated fats, and gut health for heart protection
Menopause, metabolic changes, and shifting cardiovascular risk
Supplements vs food, and when medication still matters

A practical, evidence-based conversation on how to protect your heart for the long term.

You can learn more from Michelle Routhenstein by following her on Instagram, connecting with her on LinkedIn, or visiting her website for resources and ways to work with her.

Intro (00:00:00)
Nutrition Is Central to Heart Health (00:01:23)
Prevention vs Treatment: Where Cardiology Gets It Wrong (00:04:20)
Becoming a Cardiac Dietitian (00:09:47)
Preventing Cardiovascular Disease Before It Starts (00:12:39)
What a Truly Heart-Healthy Diet Looks Like (00:18:53)
Carbohydrates & Heart Health Explained (00:23:40)
Personalized Nutrition, Biomarkers & Omega-3s (00:30:35)
Cholesterol, Fats & Fiber Explained Simply (00:46:32)
Saturated vs Unsaturated Fats (00:48:17)
Adjusting Diets Based on Cholesterol Response (00:53:20)
Seed Oil Myths & Online Nutrition Controversies (01:13:28)
Sodium, Visceral Fat & Cardiometabolic Risk (01:24:56)
GLP-1s, Menopause & Individualized Heart Care (01:32:27)
Real Patient Transformations & The Future of Cardiac Care (01:42:43)
Supplements Can Support But Not Replace Nutrition (01:49:59)
Dietitians & Cardiologists Working Together (02:05:39)

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AirBnB

Right in the heart of the city, I’ve been hosting a hands-on Airbnb Experience at Little City Farm that’s all about plant diversity, gut health, and delicious food. For more information, or to find other experiences on your next trip, check out airbnb.com/experiences.

Simon Hill, MSc, BSc (Hons)

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