Ep. 10 - Unhealthy Heart? why it's the #1 killer worldwide with Prev. cardiology dietitian Michelle Routhenstein

April 5th, 2022

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Welcome back to the weight loss with hypnosis podcast. My name is Doug Sands and I’m the hypnotist and the host behind this show. And I’m so excited to share this week’s episode with you, because it’s a very important episode that I know you’re going to want to hear. Not many of us know just how important our heart health actually is for our overall health and for our longevity, but heart health and heart disease is the number one killer of people worldwide. And as my guests and I today talked about, it’s not just those who are overweight or middle-aged or quote, unquote, unhealthy who are suffering from these illnesses. It’s also people who do crossfit. People who do keto and intermittent fasting, and many other seemingly healthy methods who are also having heart problems. Many are even dying of cardiac arrest.

And so if [00:04:00] this sounds like you, this may be a very important episode to help promote your longevity and actually gets you towards that healthy golden age that we’re all working towards. This is a very important interview and I strongly recommend you listen all the way through. Today I am joined by Michelle Routhenstein, a preventative cardiology dietician based in New York city.

Michelle has had years of experience in the health industry before going into private practice. And since going in private practice, she says she’s never looked back. She still has many healthy connections with cardiologists and other health specialist in the overall medical field. And this was an absolutely fascinating conversation that caught my attention as well.

We touched on a lot of the science behind all of these things, as well as how people like me, people who are young and seemingly healthy, still should think about some of these things and make some of these changes to promote their longevity. I know I learned quite a bit about heart health in this interview, and I know that you will as well.

[00:05:00] And with that, let’s dive right into this conversation with Michelle Routhenstein.


Doug: Welcome back to the show. I’m joined today by Michelle Routhenstein, and I am so excited for this interview, Michelle, thank you so much for joining us. 

Michelle: Thank you for having me. 

Doug: Absolutely. Michelle, I’d love to learn a little bit more about your own story. How did you get into this field and what makes it personal for you?

Michelle: Yeah. So I am a registered dietician nutritionist that specializes in heart disease management and prevention. When I was in my residency. And when I was in my clinical practice, I was exposed to different people and different walks of life. So I was working in the ICU clinic, with people who had tube feedings and TPN to the cardiac surge unit to the gastroenterology surgery unit to dialysis clinics, weight loss clinics, you name it, and the underlying thing that I’ve noticed [00:06:00] with everybody is that, people, no matter where they were, were giving them advice about one organ. About, oh, you have kidney disease, you need to do this. Oh, you have diabetes, you need to do this. But everybody was suffering either having a cardiovascular event or dying from heart disease, it is the number one killer globally. This didn’t seem right. And when we look into the research, 80% of these events can be prevented through science-based nutrition. So why is it the number one killer globally year after year after year?

And so there’s this disconnect. And so that’s when I niche down into cardiology and preventative cardiology. Because there’s a lot of science behind having an optimal heart function. So why aren’t people knowing about it? And so my job is really to help people prevent heart attacks and strokes through science-based nutrition and making sure we can merge this science with their lifestyle in order for longterm implementation and to improve other [00:07:00] people’s quality of life.

Doug: That’s fascinating. Thank you so much for sharing that. Having that background with the large scale of medical industry, are you still with like a large scale hospital or are you are private practice now? 

Michelle: Yeah, so right now I’m in private practice. Um, I was in hospitals and I kind of was in private practice in hospitals and I stopped working in the hospital when my first son was born.

And so I’ve been doing private practice solely, and I’ve always been in private practice, but I would say I’ve been only in private practice for the last 7 to 8 years and I love it. I collaborate with a lot of physicians and a lot of, professionals from cardiologists, electrophysiologists to physical therapists and psychologists, because I do believe in optimal patient care that we need a team approach.

But I’m not in the actual hospital setting anymore. 

Doug: Gotcha. That’s excellent. And I should ask, what is your process look like when working with clients? 

Michelle: So the way that I work is, well, I have two different kinds of programs that I provide, I should say. I do group programs and I do individual programs.

[00:08:00] So my group programs is for someone who’s like, you know what? I have high cholesterol and my doctor wants me to go on a statin or I have high cholesterol and I was on a statin and I didn’t feel well on the statin, or I have a family history of heart disease and I just don’t understand what I need to do because there’s so much conflicting information out there. So in my six week heart optimization group program, it’s six weeks worth of lectures that we go and discuss the underlying root causes of heart disease to prevent atherosclerosis which is the number one leader of heart attacks.

And so it’s a six week close-knit community, where we have those live lectures along with a closed Facebook group. And so it’s a very nice community feel in group setting. My individual work is much more personalized, so it really takes in all of your medical information and combines it with your lifestyle to provide a plan for you.

So I review my client’s labs and supplements and medication lists prior to us meeting. And then I’d say [00:09:00] do a 90 minute comprehensive lifestyle and nutrition assessment to discuss their sleep, their stress, their hydration, their exercise, and deep dive into nutrition. I need to understand my client’s culture and lifestyle before I can provide them with the science, because a cookie cutter plan just doesn’t work. So after I do that 90 minute comprehensive assessment, I go home and create a roadmap. I create a health resource guide and a meal plan for my clients and present that in another 90 minute session. And then depending on their goals, we either have a two 30 minute followups, four 30 minute followups or eight 30 minute followups. And that can span anywhere from a month and a half to six months plus depending on the program that they choose. But I advise my clients on all the science and help immersion to their lifestyle so that they’re comfortable in a restaurant and social gatherings and travel.

And so that they feel really confident and are able to protect their heart, optimize [00:10:00] their lab parameters, and even reduce some of their medications or eliminate them depending on which ones they’re on and their progress. 

Doug: That’s fascinating. That’s quite a complex program that you got there. I’m curious, who do you tend to work with most often?

What kind of age group and demographic. 

Michelle: Yeah, so it varies. I have a large population who are wanting to be proactive before a heart attack and stroke. So if they have a very strong family history of heart disease, I’ll see them. I have some people who are heart attack survivors, and they’re trying to prevent a second one because once you have one heart attack, the chance of you having another one in the first five years after is very high.

And so I work a lot with heart attack survivors. Then I also work with people who are at high risk of a heart attacks. So people who have high blood pressure, uncontrolled or resistant hypertension, heart failure, cardiomyopathy, atrial fibrillation, abdominal adiposity, gout, fatty liver disease, all of these things that put them at a higher risk for heart attacks and strokes.

The age range is different, but [00:11:00] I would say that it’s usually between 40 and 60 is usually the right age group. And I would say that 60% of my clients are male and 40% are female. 

Doug: Interesting. That’s actually the reverse of what I tend to see a lot of times with working with nutritionists, their clients, and my own clients.

It’s often seems that women seem to be a little more in tune with their health, perhaps making generalization. But I’m curious, do you have an idea why that is, why more men are pursuing this? 

Michelle: I think people are just being more mindful of it, or the fact is, is that sometimes when they have an event, they’re the ones like, well, tell me exactly what I need to do and I’ll do it, you know? And so it’s that kind of mindset. I also work with many cardiologists who send me their clients and they have also a tendency for a lot of male clients that come through their door. And so it could just be that.

But, I do think that’s important that both men and women are taking care of their heart because both of them are at risk. Um, and they have different risk factors that we need to hone in on and make sure that we are [00:12:00] addressing. 

Doug: Yeah, absolutely. And looking at preventing those illnesses, what do you think the most important thing is, to know perhaps both for men and women if it’s different. What do you think the most important thing to know is about taking care of your heart and preventing these diseases?

Michelle: Knowing your numbers. I can’t tell you how many times I’ve had to explain what these numbers mean. And for people to even know what the numbers are. People will send me messages all the time saying Michelle, I’m nervous to go to the doctor. I feel like they’re just going to give me medication. If you don’t know your baseline, we can’t have a solution for you.

So I want you to know your numbers, like know your blood pressure. You know, if your doctor calls you and says, oh, your blood test is fine. I want you to get a copy of your blood tests and match it to the previous year. I’ve seen people after a heart attack, show me their blood work. And I don’t look at one blood work.

I look at many years of blood work and I look at it and say, wow, your LDL is normal according to the standards. But you went up 30 points when [00:13:00] you had your heart attack and you were on a statin. And people don’t realize that trends matter. We have all these numbers and if it’s a red flag, a really high red flag, then the doctor might tell you. But if there’s no medical intervention, they may not tell you.

That would be the opportune time to intervene. So know your numbers, be able to look at your lab parameters. If you don’t understand what it means, either ask a professional or seek a professional who can help translate this for you. You need to be your own advocate. You can’t wait for the doctor to tell you, oh, you need this or you do that because you know what? It might be too late. It might be, Hey, you need a stent. Oh, Hey, you need to go on this medication and you’re not ready for that, so let’s be proactive. And if your numbers are not ideal and not optimal, let’s work on it through science-based nutrition to get them where we need them to be.

Doug: It sounds like your practice is kind of a bridge between those two, trying to catch people before these things happen. Is that true? Yeah, 

Michelle: so that’s where it really was founded on, is that I’m a preventative cardiology dietician, and we can prevent all of this.

But unfortunately, and I think we’re changing, but a lot of times we [00:14:00] are focused, most people want to fix the problem when it happens and they don’t think it’s going to happen to them. If I can get you know, a dollar for every time someone has a heart attack and says, I don’t know how I got a heart attack.

And if I will get their blood work and I look at their story, I’m like you have 10 warning signs that nobody told you about. And I wish they did. Because it’s there, it’s just people aren’t aware of this. And this is one of the things that I really have a passion for. So on my Instagram and on my LinkedIn, I put out free advice of being aware and how do you take control of your heart health because you can. And so it’s there to empower people, but to really increase awareness and knowledge, because I think people just think it’s not going to happen to them. Oh, I don’t eat McDonald’s every day, I’m not gonna die from heart attack. Listen, if you don’t need to be eating fast food and processed foods to have heart disease, you can be eating a healthy diet.

Most people think they are eating relatively healthy, but it’s sometimes not enough. Especially if you have a genetic component that’s increasing your risk of heart disease. Yeah, 

Doug: absolutely. And mentioning [00:15:00] what you said about everyone thinks it’s not going to happen to them. Everyone thinks that they’re the outlier, that they’re going to avoid all of the odds.

I’m curious, what are some of the people just for example sake, I mean, you don’t have to go into too detail. But what are some of the people who, were outside the normal range of heart attacks, perhaps young or perhaps healthy, what are some of these examples that you see? 

Michelle: Yeah, you know, something that keeps popping up and I really increased awareness around is there’s been a lot of people who are in the CrossFit community, who on the outside look very fit, very muscular, very tone, not overweight, young who dropped dead from heart attack.

Or who had a heart attack and come see me and they’re like, I don’t want to have another one. I thought I ate healthy, I follow the CrossFit diet, CrossFit is supposed to be healthy. How is this happening? And I explained to them. When you are over-training, you can increase oxidative stress and cause aggravation in the blood vessels. We’ve seen in the research that people who have do heavy weightlifting can increase their blood pressure.

And this is not an error to be 400 over [00:16:00] 200. Okay. The normal blood pressure is 120 over 80 or less. Okay, so this is putting so much stress on your cardiovascular system and you think you’re doing things that are good. You’re working out six to seven days a week. How can that be bad for you? But that intensity of that over-training adds too much stress to the body and can really be negative for cardiovascular health.

So A the age doesn’t matter B your weight is just one risk factor for heart disease. There are a lot of people who have a heart attack who are not overweight. And so I like to always debunk those two big myths of, well, I exercise so I’ll do any bad that I’m doing with my diet and then no, no, no, no.

That’s not how it works. It’s oh, I’ve been on a statin for 20 years, wasn’t that supposed to protect me? Um, just cause you’re on a statin does not mean that you are in the safe zone of heart attack. Statins can save lives, but you need to incorporate science-based nutrition in order to really optimize your blood vessel health.

And also, you know, age, like there are people who have heart attack at the age of 30 or [00:17:00] 40. There are people who have a genetic predisposition to promoting that plaque in the arteries. There are many risk factors that if we don’t address them timely, they can present in a cardiovascular event. And depending on your genetics and your makeup, it can present at a very young age or it can present a little bit later.

 When we have high cholesterol levels and it’s in an inflammatory state, what ends up happening is the cholesterol becomes oxidized and it starts creating this plaque and hardened material inside the arteries and once that plaque becomes hardened, it can occlude the artery. So it blocks the blood flow or it can rupture and cause a blood clot. And so when we have stiff arteries, our heart has to work harder to pump blood throughout the body and that can lead over time that plaque can really block the blood flow and then you would need a stent to open it up.

So it’s like a bypass to open up the artery to allow for blood flow to actually happen. You don’t have blood flow going throughout your whole entire body, it can lead obviously, ultimately to death, [00:18:00] which we’re trying to avoid. 

Doug: Absolutely. And thank you for sharing that. And you mentioned cholesterol a couple of times in this questions, and I’d love to know, from the experts, what is the proper stance to take on cholesterol?

There are so many kind of fad ways of looking at it that, what’s the truth that we should know about cholesterol? 

Michelle: Yeah, so cholesterol is, there’s a cholesterol umbrella, right? We need cholesterol in our body for hormone production, for energy, there’s a lot of things that cholesterol does for us. But we know that there’s two types of cholesterol, there’s LDL and HDL to simplify it, okay. 

Your LDL is considered your bad cholesterol because it’s an indication that there is plaque in your arteries and that increases your risk of heart attacks and strokes. On the flip side is your HDL. Your HDL is your good cholesterol and it’s good because it helps scavenge the bad cholesterol and helps excrete it out, and reduces the amount of bad cholesterol to produce in your liver.

So we know that HDL is good and we know that LDL is bad. When we look at LDL, we want [00:19:00] that number to be in the general population, a hundred milligrams per deciliter or less. If you have a genetic history of heart disease, a family history of heart disease, or another risk factor for heart disease. So if you have diabetes, high blood pressure, metabolic syndrome, gout, fatty liver disease, we actually want your LDL to be less than 70 milligrams per deciliter.

If you’ve had a previous cardiac event, we want that number to be less than 70 milligrams per deciliter. And so it’s important that LDL is in that parameter. We want HDL to be high. So for women, we want that to be above 50. And then for men, we want that number to be above 40. But we really want to target that LDL because if those numbers are higher, it is indication that plaque has the ability to grow and be promoted in the blood vessel, which we want to avoid.

Doug: And I’m sure this changes from person to person, especially with past history. But you know, talking about these numbers, people might not have a baseline for it. How difficult is it actually to have a healthy range of cholesterol? 

Michelle: [00:20:00] It’s not hard at all. if you know what to add into your diet. A lot of people are very hyper-focused on what they should not be eating, but if you have a high cholesterol and you are focusing on what you shouldn’t be eating, you’re not going to increase it, which is good.

But you’re not going to decrease it because nothing’s there to bind it, to excrete it out when you go to the bathroom. So we need to make sure that we’re looking at both of that equation. I’ve seen that it usually will drop 30 to 50 points in a matter of three months and that’s not following a perfect diet.

That’s just implementing a couple of strategies to help lower the cholesterol levels. So definitely a doable approach. It’s just, you need to make sure you’re adding in those right foods. I’ve had clients come to see me or who call me and say, michelle I need your help. I’ve lost 50 pounds and my cholesterol hasn’t dropped one point and I go that’s because weight and cholesterol are not always correlated.

If you’re not eating the right foods, even if you’re losing weight. It’s not going to come down. So, that’s why I always emphasize we really need to make sure we’re [00:21:00] adding in the right foods in our diet and not necessarily taking away everything from our diet, because then we can become nutrient deficient and that won’t allow for proper cholesterol removal and an optimal blood vessel health.

Doug: Yeah, that’s excellent. And talking about that, looking a little bit about, LDL and HDL, I don’t want you to give us another like grand solution, you know, eat this and everything will be fine, but what are some of the strategies that people can follow as far as their nutrition? If you’ve got any, just very simple ones that you could share with us.

Michelle: Yeah. So one thing that I have to say is anything that is a coconut product. So coconut oil, coconut like coconut solids, coconut flakes, or those vegan cheeses that the first ingredient is coconut or coconut cream that are found in a lot of vegan plant milks. That is going to increase your cholesterol level and your LDL cholesterol.

So we need to remove that from your diet. That’s one, but we also need to add in certain things like chia seeds or flax seeds or beans because they contain soluble fiber, which helps [00:22:00] bind the bad cholesterol. We also need to include insoluble fiber to broom out all of that junk as well. And we can talk an insoluble fiber is really the outer layer of certain fruits and vegetables like berries, like broccoli, like brussel sprouts. And so we can talk about soluble and insoluble fiber without making sure your gut health is optimized. So good, effective bowel movements, making sure that we’re really enhancing the microbiome, that’s another point and also essential is water. If you don’t have enough liquids in your body, you can’t have a good bowel movement, but you also will have more thick blood and more sticky blood, which promotes that plaque formation in the arteries as well. 

Doug: Ah, that’s excellent. I had no idea about the point about water. And looking at water, we’ve all got these guidelines on how much water to drink.

Do you have any tips for those who might be a little hesitant about putting more water in their diet? You know, they don’t actually like drinking water. Maybe they’re used to drinking more sodas. Do you have any tips for them? 

Michelle: Yeah. So like anything it’s a titration. some people like to [00:23:00] go cold turkey, others don’t. But if water’s boring to you, make it exciting. Put a squeeze of lemon in there, throw in some berries, or maybe throw in a splash of some juice. That’s okay if that increases your water consumption. But also think about other things that not necessarily water like tea or soups or high water volume vegetables that will also count towards your hydration goals. 

Doug: Yeah. Thank you for sharing that. And shifting gears just a little bit, you mentioned a while ago talking about CrossFit and putting our heart on a too much strain.

And that was something I really did not expect. Looking at how much exercise we should actually get and perhaps even what kind of exercise we should get, what would you recommend for your clients? 

Michelle: Yeah. So again, you gotta meet people where they are. Because if I tell you to do something but you hate it, you’re not going to do it in a year from now.

And then my advice to you means nothing. I don’t need you to do something for a week that does nothing for your heart. I need you to do it for the rest of your life. So we really need to look at that component of it. That’s one. The second thing is, is the research really shows that we need to have aerobic, [00:24:00] anaerobic and stretching as part of our three prongs of exercise along with making sure we’re not sedentary the rest of the day outside of that scheduled physical activity. The ideal amount of time we would say is moderate activity of cardio for about 150 to 225 minutes per week. In terms of resistance training, we’re looking at least 60 minutes.

And then in terms of stretching, we’re really looking at having that incorporated throughout, but at least 30 to 60 minutes in a given week, because that helps with reducing arterial stiffness. So the stiffness of our arteries, it helps stretch out our arteries and allow for better blood flow.

Doug: Ah. Excellent. And looking at kind of the high end of this, some of my clients, they come to me for things like, Anorexia Athletica and bulemia and other things where they’re using exercise to control those issues. And, looking at the excessive side of things, what are some warning signs that you would generally say to clients that they might be doing too much exercise and perhaps damaging their heart?

Michelle: So I think it all has to do with how many hours in a given week, how many [00:25:00] hours in a day, how much it consumes them? A lot of times he will say, yeah, I worked out three times today and it would be three or four hours. And that becomes a very big warning sign. I think a lot of it is really assessing well, what does that look like in relation to food?

Because a lot of times it’s like, It’s that trigger of I’m hungry so, you know what, let me just go exercise. And that’s not a healthy correlation. When you’re hungry, you should be feeling your body. And so really assessing, what is the day to day activity look like and what is a realistic when we look at it all together from a nutrition and an exercise perspective.

Doug: Yeah. Thank you so much for sharing that. And shifting gears again, what do you think the most common issue is when the people first come in with? What is the first roadblock that people have to overcome? 

Michelle: That’s a good question. The first roadblock that people have to overcome, I don’t know if there is a universal roadblock that people have to overcome.

I think it’s more of figuring out what are people really struggling with. I think there’s just a lot of conflicting information out there. There’s a lot of [00:26:00] distrust in these big organizations promoting certain foods to consume because they’re being sponsored by different industries and you’re getting marketed of this supplement versus that supplement and it’s confusing.

So I think a big roadblock is well, can you debunk these like 20 things that I have to do? And this is one of the main reasons why I wanted to make my group program. I mean, You can’t expect like with all being the flutter out there, it’s hard to silence it. And so I wanted to put people in a safe space where they can be like, Michelle, I heard this, and I heard this and heard this, what about eggs? What about that? What about this? And giving them a solid answer and always explaining the why. So for me, I really believe that everything needs to have a good reason before you do it. And so I explained everything to my clients and explain the science behind it and the why behind the recommendations.

And many times I am having to do a lot of work of reversing trends and debunking myths that people have decided to take on to themselves, but are very detrimental to [00:27:00] cardiovascular health. 

Doug: Yeah. Thank you so much for sharing that. And you mentioned the group program again. How does the group program differ from the one-on-one?

What kind of benefits and what kind of results do they see from the group program? 

Michelle: Yeah. So the group program is really nice because I find that a lot of people are alone in their journey. So they go to their doctor, they get this diagnosis, they were told to get medicine and they’re stuck.

So they need an expert to guide them, which is me, the cardiology dietician. But they also need a support system that really says, like, that same thing happened to me and that’s what happens in the group. So the live lectures are run by me, but they’re very interactive. Everyone communicates really nicely together and the support system is really encouraging.

And so I screen everyone before they go into the group and everyone is just all on the same page going through the same health journey. And it’s just a nice close community and I’ve had such great feedback. I’ve been doing this group program for at least 12 to 15 times. Someone said to me, Michelle, I don’t want to let go of this community.

So I actually built a community on top of the group program where people who [00:28:00] graduated from my six week group program or who are past clients can join this community where I do have one hour live lecture on the newest science and research and I also have a close Facebook group so they’re still getting that daily support and people are really appreciative of that because there’s nowhere else to kind of go to help with this close community.

And so they feel really well heard and it’s just, you know, I think that’s important part that we often neglect in healthcare. 


Doug: I think that’s so important. When working with health experts, there are so few who offers such a comprehensive group program. And it sounds like there’s so much support even after the program is finished and so kudos to you, that sounds fantastic. And looking at perhaps any uncommon advice, are there any piece of advice that you give that perhaps run counter to what most people expect or what others recommend? 

Michelle: Hmmm. That’s an interesting question. I mean, I’m all about the science, so it depends the season. Someone could be like, oh my God, I can’t believe you didn’t recommend keto.

Okay. Well then I explain why I don’t recommend keto. Right? The keto [00:29:00] diet is a very high fat diet. It’s going to clog your arteries. I’ve never in my career, seen such high levels of cholesterol with people who are following the keto diet. It is not heart-healthy, it’s not liver healthy and it should not be done for any health issues, except for epilepsy in my opinion. You could say that that’s counter from what people would think of. But I mean, if you follow me, kind of my philosophy is very level headed and people are like, oh wow. Like I had a client yesterday who came to see me and she goes, oh, I’m doing intermittent fasting.

I was like, okay, how many hours are you fasting? Like when do you eat? She’s like, oh, I fast between 20 to 24 hours. And I said, but a whole day is 24 hours. Do you do that like, how many days a week do you do that? She was like, oh, I do it between six and seven. I’m like, wait so you eat only between a four hour window some days.

And she’s like, yeah. And I’m like, so take a step back. How can you get all of your nutrition, a hundred percent of your nutrition intake in one meal without your blood sugar spiking, without your blood pressure spiking, without your body digesting all of that in one meal?[00:30:00] You can’t. So while that might sound counter productive to what the standards are.

It just doesn’t make sense. And so when I simplify it that she was like, oh my God, you’re right. I can’t. I’m like, yeah, you can’t. And what’s happening is you’re now overeating at one meal and that’s spiking up your blood sugar and your blood pressure because your body can’t handle that much volume at one time.

So I’m not saying don’t do intermittent fasting, but it’s 20 to 24 hour cycle is not healthy for any condition. You’re going to slow down your metabolism and you’re not going to reach your goals. She’s been doing this for two years and her cholesterol is higher than when she didn’t do it.

Doug: Interesting. Yeah. And what do you recommend as a proper range if someone does want to do intermittent fasting, like how many hours? 

Michelle: I’m okay with resting your stomach? I don’t think you should be eating while you’re sleeping. I’m okay with 12 hours of a fast, but if your body’s telling you it’s hungry, please don’t ignore your body’s signals.

When do we become so unintuitive from your body? So my principles are very science-based, but there are very logical. And for some reason there’s a disconnect, a lot of [00:31:00] times between this logical stance, because we want someone to give us the magic pill and I’m sorry, but there is no magic pill. Right? There really isn’t. I wish there was, but there isn’t. So we need to make sure that we are looking at things in a more whole person approach and really addressing all of these conditions and issues appropriately. And so while mine might go against the trends, it goes with the science and I always have an explanation of why, because that’s very important.

And I teach people if someone can explain why, then question their doings. This is your body and you need to be your own advocate for yourself. 

Doug: That is so important. you mentioned keto and intermittent fasting. Looking at weight loss. That seems to be in our modern culture, the one standard or the one metric that we measure our health by, what do you feel are some of the negative consequences of only focusing on our weight?

Michelle: I think that’s a great question. So when we focus on our weight, a lot of times we think only of caloric deprivation. So I’ve had clients who said to me, Michelle, I need to like lose weight. Are you [00:32:00] going to help me lose weight? And I was like, yes, I can help you lose weight if that is a goal.

But I see that you have this, this and this. And I also want to address those things. But I just want to lose weight. I’m like, okay, I understand. Right. But when we look at what they’re eating, it’s like every diet food. They’re going on, things that are like 10 calories, 15 calories with no nutrients in them, junk.

So it’s causing inflammation, it’s causing insulin resistance. And those two things cause stubborn weight loss. So my way of shifting it is we’re not counting calories. We’re looking at nutrient sufficiency. Are you getting all the vitamins and minerals and macronutrients and micronutrients you need for your body to thrive?

And when people start doing that and they start becoming in tune with their hunger scale, the weight loss happens. And they’re like, Michelle, I’ve never done weight loss so easily. Like I’m actually eating more food than I did before and I’m losing weight and I’m like, exactly, you’re rubbing your metabolism.

You’re giving your body what it needs instead of it having to feel deprived and hold on to all of the weight because you aren’t feeding it. So we [00:33:00] need to shift this perspective of we’re not going to go on a caloric deficit diet. That’s not how we’re going to frame this, because that is a short-term goal.

And like I said before, heart disease is a progressive disease and everybody is at risk for heart disease. So we need to shift it to be more of what nutrients can I provide my body to heal it, to optimize the lab parameters and for it to thrive the way we need it to. 

Doug: Absolutely. It’s so important that we look at those other things. For those who have never gone into the lab who have gotten their numbers, what are some things to look for in their own health and some ways to kind of see if they’re on track or if they’re a little bit out in left field. 

Michelle: Yeah. So getting a physical, the doctor will do a comprehensive metabolic panel, which just look at your fasting blood sugar levels. It looks at your potassium, your sodium that’s in your blood, not yourself.

It looks at, your liver function, your kidney function. They usually will also add a lipid panel that looks at your cholesterol. You might have to ask for a couple of [00:34:00] other parameters, but it assesses to see how are those things looking? And if any of them are abnormal or different from last year, it is a part of you to say, well, how can I make this better?

Just because you have high cholesterol, doesn’t mean you’re going to be put on a statin. The doctor might say, oh, you need to go on a statin, and you, as your own person can say, well, I first want to try science-based nutrition to bring it down and if that doesn’t work, then I’ll consider it. You’re allowed to kind of give that feedback because you know, a lot of people are scared what the doctor’s going to say, and that’s why they don’t go to the physical.

But you knowing your numbers empowers you to take action and be more proactive in reducing your risk of heart attacks. So knowing that is super important. 

Doug: Yeah. And you mentioned multiple times in this interview, that being your own advocate is so important. And I think that’s such a great point that people in the healthcare industry, they’re just people.

And, oftentimes at least when I was growing up, it was seen that whatever the doctor said was ironclad truth. [00:35:00] And, having that conversation with them and learning a little bit more having that knowledge is, sounds like it’s such an important point of this. 

Michelle: Yes, exactly. 

Doug: Yeah, absolutely.

And you know, wrapping this up, do you have any resources or tools that listeners might be able to use at home? 

Michelle: Sure. have a lot of blogposts run on my website that you can reference and they all have my science references at the bottom if you wanted to dig deeper into that on my website in entirelynourished.com.

I also provide a lot of information on my Instagram. That’s complimentary that you can browse about creating awareness and protecting your heart. I’m at heart.health.Nutritionist on Instagram. And on there even, you’ll see me referring to other places too, for good resources to protect your heart. 

Doug: That’s fantastic.

And thank you for that. All of these links will be in the description or in show notes as well. And finally, Michelle, do you have any parting wisdom or thoughts that you’d like to leave listeners with? 

Michelle: Yeah. I hope that this empowers you not to be scared of your health, but more [00:36:00] empowered. If you know your numbers and you take action to reduce all of your risk factors for heart disease, we can beat this statistic together.

We don’t need heart disease to be the global killer because it’s preventable. 80% of it is preventable. So share this with your loved ones, share this with your family and take an empowered approach this year in order to really protect your heart and so that you can live your life in the best way with the highest quality and doing the things that you love to do, also with a peace of mind and confidence that you are really optimizing your health.

Doug: Excellent. Thank you so much for joining us, Michelle. 

Michelle: Thank you for having me. This has been fun. 

Again, what an incredible conversation. This was. I had a wonderful time learning more about how important our heart health actually is. Like so many others, I thought our heart health was only important if we were overweight or getting on in years.

And this really brought it home for me. So, if you gain a nugget of wisdom from this episode, I encourage you to subscribe. I’ve got so many great interviews coming up [00:37:00] with other health experts in this industry, and I know that you’re not going to want to miss it. And while you’re there, please, please do us a favor. Michelle and I put our time in to get this information out to you and please do your parts to help others find it. How do you do that? well, the easiest way is to rate and review on the podcasting platform that you’re listening to. Or if you’re on YouTube, simply click subscribe, and like. And this is especially important if you’re listening on apple podcasts, because apple podcasts is one of the largest distributors of podcasts in the world and getting a five-star review on apple podcast really help others just like you to find this info and to make these changes for themselves. Again, this doesn’t have to be hard. It could take literally 30 seconds of your time. Even a one word five-star rating really helps promote the show and get this information in the hands of those who really need it again.

Thank you so much for listening in wherever you enjoyed this podcast. If you haven’t seen the podcast on YouTube, I encourage you to go check it out. Search Anywhere [00:38:00] Hypnosis or The Weight-loss With Hypnosis Podcasts on YouTube to find us. And you can watch behind the scenes and see all the action that’s going on both with interviews and the solo shows. Finally, my name is Doug Sands and I help compulsive and emotional eaters to end the obsession with food and make peace with it. Often in as little as two sessions. Thank you so much for watching or listening in to this episode. And I look forward to seeing you soon in the next one.





Michelle Routhenstein is the dietitian behind Entirely Nourished, a private practice based in New York City. After having worked with the mainstream heart health industry, Michelle took her own path to start this practice, and she hasn’t looked back since.

Michelle maintains strong relationships with cardiologists and other heart experts, and she makes a point to stay on top of all the most recent scientific findings about our health. I highly encourage you check out Michelle’s work if you’re remotely curious about your heart health. And after listening to this episode, I have a strong feeling you will be.

Want to find out more? Check out Michelle’s work at these links!

Website: https://entirelynourished.com/

Instagram: https://www.instagram.com/heart.health.nutritionist/

Facebook: https://www.facebook.com/entirelynourished/

LinkedIn: https://www.linkedin.com/in/michelle-routhenstein-ms-rd-cde-cdn-362aaa21/

Like what you heard in this episode? Remember to Subscribe! Click the + button on your favorite podcasting app, because there are plenty of resources here to help you on your journey.

Want to watch the interviews happen? Check out the Weight Loss with Hypnosis podcast on YouTube! Whether on a solo show or a guest interview, you can view everything that’s happening behind the scenes.

Want to know more about weight loss and Hypnosis? Check out Doug’s website! Here, you can learn more about how Doug helps people with losing weight, changing their body image, and overcoming compulsive eating. You can also get your Binge Blocker Hypnosis, to help you overcome uncontrollable eating whenever it strikes!

Finally, if you’d like even more of the Weight Loss with Hypnosis podcast, check out the show on Instagram and TikTok!

To your journey towards better health,


P.S. If you’d like to see what Doug’s better half is up to, check out her travel site here!







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