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Q and A with Heart Health Dietitian Michelle Routhenstein, MS, RD, CDE, CDN

Updated: Jul 16, 2020

This weekend I reached out to Michelle Routhenstein, a preventive cardiology dietitian. I was interested to learn more about cardiovascular disease and how she educates and empowers her patients to adopt healthier lifestyles.

1. What should we all know about our risk for cardiovascular disease? How do we find out our risk?

We should be educated and aware of our own risk factors for cardiovascular disease because 80% of heart attacks and strokes are preventable through science based lifestyle medicine, and the first step to prevention is being aware of where you stand now.

Certain numbers are important for you to know:

1) waist circumference - this indicates excess weight around your abdominal region, the most dangerous type of fat.  You can easily test this by taking a tape measure and wrapping it around your belly button - not too tight and not too loose. Ideally it should be below 35 inches for a woman and 40 inches for a man. 

2) blood pressure - should be less than 120/80 mmHg

3) cholesterol, specifically LDL - should be less than 100mg/dL; LDL < 70 in individuals with a family history of heart disease or a previous cardiac event

4) diabetes, hemoglobin A1c - should be less than 5.5%

5) uric acid levels - should be less than 6.0 mg/dL

6) AST/ALT, liver enzymes - should be between 10-40 u/L for AST and between 7-56 u/L for ALT.

*If any of these parameters are abnormal, it is imperative to optimize your health with science based nutrition and lifestyle medicine to control these factors to reduce your risk of a heart attack and stroke.

2. How do you empower your patients to be healthier? Are there any particular strategies you have found successful?

I am a big proponent of explaining the why behind my recommendations. I empower my clients by giving them a clear understanding of the science and the reasons for my suggestions. For instance, a lot of my clients will send pictures of a grocery item, and instead of saying "yes" or "no," I will explain in a simple manner why it is yes or no, so that next time they are shopping for that grocery item, they can apply these learned tools. This helps create patient empowerment and long term success.

I also never give my clients a cookie cutter plan. Food is so personal and I ensure to provide suggestions that are relatable to my clients food preferences and culture. I want them to continue to enjoy eating, but add confidence and inclusion of foods that they need to gain more energy, strength, and health.

3. What lifestyle suggestions do you provide for your patients in reducing their risk for CV disease?

My background and expertise is in science based nutrition so we spend a lot of time focusing on including therapeutic foods to address their medical condition(s), to remove plaque from the arteries, and to optimize blood flow and blood vessel health. We also discuss hydration, stress, exercise, and sleep, since these lifestyle components have a big influence on their lifestyle and nutrition choices.

4. In terms of diet, are there some general guidelines that you can provide?

I am a big proponent of well balanced meals/snacks to ensure my clients are meeting all their essential macronutrients, vitamins and mineral needs for their heart to function optimally. This also helps with satiety to sustain weight loss and all other health goals for the long term. 

I don't believe in fad diets or removal of a major food group because it can cause deficiencies which affect heart beat, blood flow, and metabolic function.  There really is no one size fits all plan, and I repeatedly witness the success of merging science with personalization for optimal health. 

Michelle Routhenstein, MS, RD, CDE, CDN

Michelle Routhenstein is a Preventive Cardiology Dietitian, Registered Dietitian Nutritionist, and Certified Diabetes Educator who specializes in heart disease management and prevention. She has a Master of Science Degree in Clinical Nutrition and completed her nutrition training residency at New York University. She has over 10 years of experience counseling individuals and families on chronic disease prevention and management through personalized, science based nutrition and lifestyle medicine. She has a thriving nutrition counseling and consulting private practice, in which she sees clients in her New York City office and virtually.

Michelle's recently published Cookbook: The Truly Easy Heart-Healthy Cookbook can be purchased here.

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