Cardiometabolic Health

This page is designed to help you understand why you might be experiencing symptoms or have risk factors relating to your cardiometabolic health.

In this section we look at what cardiometabolic health is, classic symptoms of cardiometabolic dysfunction, possible testing considerations, and natural solutions to help you gain more control over your cardiometabolic health.

What is cardiometabolic health and what areas does it cover?

When I am talking about cardiometabolic health, I am not talking about one area, we are looking at a spectrum of conditions and risk factors, which include:

• Metabolic syndrome and insulin resistance
• Type 2 diabetes
• Cardiovascular disease
• Dyslipidaemia (imbalanced cholesterol)
• High blood pressure
• Obesity and being overweight – especially central obesity and high levels of visceral fat (deep abdominal fat that surrounds the organs)

Issues in the arena of cardiometabolic health are one of the biggest burdens on the healthcare system, yet nutrition and lifestyle factors are at the heart of all cardiometabolic conditions and risk factors.

Our modern society has developed into one of less movement, more refined and processed diets, less sleep, more stress, more toxins, more alcohol and so forth. These behaviours are undoubtedly contributing to the increased cardiometabolic risk.

As of 2005, 30% of the world population was either overweight or obese and as of 2015 cardiovascular disease is the leading cause of death worldwide. In 2013, 382 million people had diabetes and this is expected to be around 592 million by 2035. The estimated annual global health expenditure attributed to diabetes alone is said to be in the region of $855 billion.

The frustrating thing is that to manage this area of health, it is largely down to nutrition and lifestyle behaviours. We are crippling our healthcare systems and economies with these chronic diseases, that with the right interventions and support put in place we could do wonders to significantly reduce this burden and importantly save or extend billions of lives.

Testing considerations to assess key areas of cardiometabolic health

When it comes to assessing cardiometabolic health, it is important that we focus beyond just LDL cholesterol. The unfortunate reality is that cholesterol alone is often what is looked at to determine cardiometabolic risk.

When assessing cardiometabolic risk we want to be thinking about more global issues that contribute to risk.

Areas of assessment include:

• Body composition and visceral fat. In clinic we use detailed composition assessments to look at % body fat, visceral fat levels, muscle mass etc. A simple waist to hip ratio is also important.
• Blood pressure
• Insulin resistance risk – Fasting insulin or fasting C-Peptide levels, fasting glucose, fasting triglycerides, HbA1c levels
• Lipids – Cholesterol, LDL and HDL cholesterol, triglycerides and HDL to triglyceride ratios, VLDL.
• Advanced cholesterol assessments such as LDL particle size
• Inflammation and plaque risk markers – Lp PLA2, C-Reactive Protein
• Fibrinogen
• Homocysteine
• ApoE

Not all of these will need testing. Assessing nutrition, lifestyle, body composition and body fat distribution, family history and personal health history will provide context as to how detailed you may want to investigate the other markers. From there we will decide to what degree and detail we feel appropriate to test someone.

I will typically start blood testing looking at more basic markers such as fasting triglycerides, cholesterol, LDL, HDL, fasting insulin, fasting glucose, HbA1c and C-reactive protein. If I am seeing imbalance indications from these markers, then I may decide to dive deeper into cardiometabolic risk as this may guide the intervention and how aggressive it may need to be.

Nutrition & Lifestyle considerations for cardiometabolic health

There are many well established nutrition and lifestyle factors that contribute to our cardiometabolic risk. Some we have no control over such as ethnicity, age, family history/genetic predisposition and gender. Whereas others we have a significant control over such as our diet, body composition, exercise/movement levels, stress level and perception, smoking etc.

The great news is that the non-controllable risk factors are significantly influenced by the controllable ones. Our non-controllable risk factors are like loading a gun, whereas our controllable ones are pulling the trigger.

Below are just a few hints and tips to try and support your cardiometabolic health. We strongly advise on getting the support of a professional to guide your choices and to also support behavioural change.

Generalised Nutrition Guidance

There has been a great deal of research looking at nutrition and cardiometabolic health and we are going to touch on those more general recommendations here. There are of course instances where a dietary intervention needs to be more specific, but that’s for working with a practitioner on a 1-2-1 basis.

Introducing a modified Mediterranean approach

This dietary approach is perhaps the most well studied in relation to cardiometabolic conditions. The diet largely comprises of:

• Whole, unprocessed vegetables and some fruits
• Some whole grains
• Nuts & Seeds
• Legumes
• Dairy
• Extra virgin olive oil
• Spices and herbs
• Some lean meats, occasional red meat and fish
• The occasional amount of red wine

These choices typically result in a diet that makes it easier to manage total caloric intake, is low on the glycaemic index/load (blood sugar response to foods eaten), provides a high level of vitamins, minerals and phytonutrients, is high in fibre, provides a healthy balance of fats from saturated to mono and polyunsaturated fats, provides adequate protein intake and helps to manage total carbohydrate intake.

Foods that this approach is particularly low in, include:

• Sugar
• Processed grains/refined carbohydrates (flour-based foods)
• High amounts of saturated fat from dairy and fatty meats
• Margarine or any type of hardened or refined/heat extracted vegetable/seed oil

Whether you have an increased risk of cardiometabolic conditions or not, this diet is actually a great starting point for almost any health condition and the optimisation of health.

Depending upon the cardiometabolic area of interest for you, there may be some additional considerations, such as:

High blood pressure – Lower sodium intake, increased potassium foods, reduced caffeine intake etc.

Type 2 diabetes – further management of carbohydrates (quantity and type), calorie management for weight loss, increased antioxidant intake. More cinnamon, green tea, omega 3 fats and fibre etc.

Dyslipidaemia (imbalanced cholesterol, triglycerides etc) – Management of refined carbs, alcohol, saturated fats. More oily fish, green leafy veg, olive oil, garlic, rice bran oil, pomegranate etc.

10 Specific Foods for cardiometabolic health

1. Fish: Research studies support fish consumption for cardiovascular health. Even a modest consumption of 1 to 2 servings each week, especially of higher omega-3 fatty acid containing fish such as wild salmon, reduces a person’s risk of coronary death by 36%. Those who eat 5 or more servings of fish a week are advised to eat a variety of seafood, limiting their intake of high mercury-containing fish like tuna, swordfish etc. Some fish, such as bonito and sardines, contain small proteins that are protective for the heart and can help to reduce blood pressure. Where possible, choose only wild caught oily fish rather than farmed options, which can contain high levels of toxins and a poorer balance of fats. Oily fish have also been shown to support good levels of HDL cholesterol

2. Greens (beet, collard, dandelion, kale, mustard, turnip, Swiss chard, lettuce, micro greens, spinach): Green leafy vegetables are good for just about every person and many health conditions. When it comes to cardiometabolic disease, they are extra important because they supply a plant source of nitrates, a compound that opens up blood vessels. It has been estimated that 1 serving of a high-nitrate vegetable, like spinach, results in more nitric oxide production than what is naturally produced in the body in one day! Other foods that are particularity high in dietary nitrate include celery, celeriac, chervil, Chinese cabbage, cress, endive, fennel, kohlrabi, leek, lettuce, parsley, red beetroot, spinach, and arugula. The best lettuce choices are those that are darker green or magenta in colour, rather than the iceberg varieties.

3. Onions: Onions rank as one of the best sources of anti-inflammatory and antioxidant flavonoids, particularly quercetin. In addition, they contain detoxifying sulfur-containing compounds, which enable the body to excrete toxins more effectively. Animal studies show that onions may help to reduce both blood clotting and levels of cholesterol and blood fats (triglycerides).

4. Tomato: One staple of the Mediterranean diet is tomatoes. Tomatoes, especially cooked tomatoes, are excellent sources of lycopene, a free radical-quenching carotenoid. They also contain other heart-protective carotenoids like ß-carotene and -tocopherol. Cell studies have shown that the carotenoids in tomatoes prevent the oxidation of LDL-cholesterol and, therefore, help to prevent heart disease. Large human studies have indicated that greater intakes of lycopene in the diet are associated with better cardiovascular health.

5. Yogurt and kefir: Foods that contain live active cultures (“probiotics”) help in establishing healthy gut microflora. Some research suggests that the quality of the bacteria in the gut plays a role in inflammation, body composition, and even cholesterol levels in the blood. Good health starts in the gut, especially when it comes to cardiometabolic diseases.

6. Blueberries: Blueberries are packed with healthy phytonutrients for the heart and blood vessels. Studies show that the flavonoid anthocyanin in blueberries helps to keep blood vessels open and even lower heart attack risk. They have also been shown to help with blood sugar control in those with diabetes. Blueberries have one of the highest antioxidant levels among all fruits, vegetables, spices, and seasonings. Choose organically grown berries when possible, as they tend to be higher in phytonutrients compared with their conventionally grown counterparts.

7. Pomegranate: While it is advised not to drink fruit juices on this plan due to their high sugar content, there is one exception to the rule: pomegranate juice. Studies indicate that small amounts of pomegranate juice (50 millilitres, or a little over 1.5 ounces) has been shown to help reduce blood lipids, blood pressure, and plaque build-up in arteries.

8. Oats: Oats contain fibre, phytochemicals, and the beta-glucan compound that helps reduce levels of cholesterol. What makes oats unique relative to barley is the presence of antioxidant compounds called avenanthramides, which help prevent free radical damage to LDL-cholesterol, thus reducing the risk of CVD.

9. Cocoa: This plan allows for the inclusion of dark chocolate (85% cocoa and higher) because of the cocoa polyphenols that appear to be helpful in keeping arteries wide open and protected from harmful free radicals. The healthy way to eat chocolate is to make sure it’s somewhat bitter with a higher percentage of cacao and minimal sweeteners (and no milk) added. Dark chocolate has caffeine, so caffeine-sensitive people should take that into consideration or only consume in the daytime and not before bed.

10. Green Tea: Drinking green tea has been shown to be beneficial for reducing blood pressure and blood fats (triglycerides, cholesterol, and LDL-cholesterol) and may even help with lowering blood sugar. While studies vary in the amount and type of green tea used, the general recommendation for green tea consumption is based on the amount typically consumed in Asian countries, which is about 3 cups per day.

Exercise & Movement

Modern life provides the perfect environment for a sedentary lifestyle. Watching TV, working at our desks, commuting in cars and on public transport etc. It is said that we spend up to two thirds of our waking hours engaged in sedentary behaviours.

The more sedentary we become the higher the risk for cardiometabolic diseases. Engaging in some form of daily physical activity is one thing, however we should also be focused on general daily movement, reducing overall sitting time.

Exercise and movement have such an array of benefits, physically, mentally, emotionally and spiritually.

Qualifying whether you are sedentary is said to be around 6-8 hours per day of sedentary behaviour or lack of movement or standing.

Therefore, going to the gym a few times a week or even once a day does not mean you are not sedentary.

Being more sedentary leads to a 2x risk of developing diabetes and cardiovascular disease. In children and adolescents, being more sedentary strongly correlates with obesity; moderate correlates with worse BP and lipids, self-esteem, social behaviour and academic achievement.

Being less sedentary leads to individuals being 43% more likely to experience successful physical, psychological and social aging. Movement has been shown to significantly help with lowering inflammation. With every contraction, your muscles release messages, these include anti-inflammatory compounds.

When it comes to exercise and movement, it’s about finding what works for you, your current physical capabilities and importantly something that you enjoy and will therefore repeat. It is important that any increase in exercise is done in a graduate manner. Look at how much exercise and movement you currently do and try and build from that point. Don’t feel like you need to be jumping straight into training for a marathon, it’s much more about progressive overload. Progressive overload allows you to gradually increase the intensity, volume or duration of your exercise. This helps to minimise the risk of injury or complications. If you are concerned, find an exercise or health professional to help guide you.

One simple way of assessing your intensity you are working at is the singing test while moving/exercising:

• Low intensity – You can sing while exercising.
• Moderate intensity – You can easily talk while exercising but not sing.
• Vigorous intensity – It is difficult to talk while exercising, let alone sing!

Also consider how you can get additional movement in your day. Can you take movement breaks when working in the office or from home? Can you commute by walking or bicycle? Can you squat up and down 5x every time you get up or down from your chair? Can you spend more time outdoors enjoying your garden or taking a walk? Can you get a standing desk?

Try and be inventive with ways in which you can increase overall movement, it will certainly be worth it from an overall health and also specifically from a cardiometabolic health perspective.

Stress

Stress can be defined as a state one experiences when there is a mismatch between perceived demands and our perceived ability to cope.

Without appropriate management of stress, this can significantly impact on cardiometabolic health. Here are some examples of the cardiometabolic response to stress:

• Insulin resistance and increased blood sugar levels
• Increase in blood pressure
• Enhanced clotting

Chronic stress has also been linked with a number of chronic cardiometabolic risk factors as well:

• Weight gain, particularly the fat around the mid-section and visceral fat
• Increased levels of homocysteine
• Increased inflammation
• Increase fibrinogen

Stress comes in many forms, often one of the overlooked areas is that of psycho-social influence. These include life changing events, our perception of stress, social connection and relationships, acute stressful events and also our own personality and the traits that we have.

Our warning signs of stress include the loss of mental focus and clarity, a lack of ability to relax and sleep, loss of self-esteem and feeling tired, and perhaps angry. Anger alone has been shown to increase risk of heart attack by 230%!

For so many of us, our way of managing stress can come in the form of behaviours that further increase cardiometabolic risk and inadvertently increase stress even more. Some of the most common ways in which many people try to cope with stress include alcohol, smoking, drugs, gambling and overeating/comfort eating.

Check out ‘Learn how to manage stress and chill out like a pro‘ for some tips to help you manage stress.

We also encourage you to seek out guidance and support if you are under significant amounts of stress or have encountered significant life events that may still be impacting you even now.

Sleep

Sleep is fundamental to human health, yet for so many of us we knowingly struggle to get a good night’s sleep, one that is not disturbed and one that feels restorative.

Most of the research will point towards achieving at least 7 hours sleep, yet as many as 45% of adults do not achieve this.

When it comes to cardiometabolic health, sleep is again of primary importance. A loss of sleep is connected with adverse metabolic traits such as obesity, type 2 diabetes, imbalanced lipids such as cholesterol and triglycerides as well as high blood pressure.

Increasing sleep on the other hand has been shown to benefit many areas of cardiometabolic health. This includes improved glucose regulation and insulin sensitivity, less desire for high calorie foods and better portion control in general. If you scored high in the sleep section of the Health Score quiz, be sure to prioritise this area and reap the rewards.

Widen the lens

We have touched on some of the most common physiological, nutrition and lifestyle-based risk factors. Beyond this, there are numerous other contributing factors as well, these include but are not limited to:

• Specific bugs that reside in the gut may increase the risk of diabetes and cardiovascular disease.
• Dental issues are also strongly linked with cardiovascular risk and hormonal imbalances may increase cardiometabolic risk.
• Toxin accumulation/exposure and cardiovascular risk.
• Hormone levels/balance and hormone replacement therapies are linked with cardiometabolic risk.

This is why you have to view the body as a whole. As mentioned before, looking at one or two blood markers and diagnosing cardiovascular risk is absurd. The unfortunate reality is that this continues to be standard practice. This area of health continues to be mismanaged, with not enough emphasis and support being put in place for nutrition and lifestyle behaviour change and accountability.