[Angela Foster] (0:00 - 0:10)
For someone who has either high non-HDL or high ApoB, what are the first five things you would have them do to reduce it?

[Michelle Routhenstein] (0:11 - 2:08)
So I would first look at their saturated fat intake, how much are they consuming, and I would assess that level so we can decrease that to help with the body's ability, the liver's ability to recycle LDL. The second thing I would do is I'd look at their unsaturated fat intake, and I would see, okay, saturated fat, are they having a lot of marbled red meat? Can I switch some of those to an unsaturated fat, for instance, omega-3 rich fish?

Because unsaturated fat helps make HDL more functional to help bring more LDL back to the liver to be recycled. Okay, so that's going to help lower those numbers. The third thing is I would look and assess their fibre intake, their total fibre intake for the entire day, and if that's very low, I'm not going to all of a sudden bring them to four or five times that volume.

They'll have a lot of GI distress. I will assess, okay, their total fibre is this much. Now, how can we add more into it slowly so that the body can tolerate it?

The fourth thing, though, I would say is determining the difference between their soluble fibre intake and their insoluble fibre intake. Okay, how much is it of the binding cholesterol, the soluble fibre, the viscous fibre, and make sure we're adding more of those relative to also insoluble fibre, which is the broom that pushes it through. So we need to be looking at both soluble and insoluble fibre as well, and then ensuring good hydration.

If we're adding in more of the fibre, you need to make sure that you are hydrated or also become constipated, and the ability to excrete the cholesterol diminishes without good bowel movements. So we want to make sure you're adequately hydrated as you transition into a good soluble and insoluble ratio in your diet to allow for proper excretion of cholesterol.

[Angela Foster] (2:09 - 2:18)
I love how practical you just made that. Soluble fibre, what are the top three sources of soluble fibre that we can eat to help kind of sweep up that cholesterol?

[Michelle Routhenstein] (2:19 - 2:41)
Yeah, so it's found in things like oats. That's a good source. Raspberries is a great source.

And things like chia seeds are a good source. You know, when you put things in water that expand, you put chia seeds in water, they goop up all the water. That shows some level of solubility that will help bind the cholesterol.

[Angela Foster] (2:43 - 2:48)
So for breakfast tomorrow, then everyone needs to be having oats with some chia seeds and tarts with raspberries.

[Michelle Routhenstein] (2:49 - 3:47)
I'd actually be careful because if someone's not used to eating soluble fibre, they may feel really bloated after that meal. So I wouldn't recommend that if you have no soluble fibre in your diet because it's too much, it's going to cause you to be backed up because it's too much soluble fibre. So it actually assess what you're eating.

If someone's having, let's say an egg, like an egg breakfast, maybe you add in half a cup of raspberries as your transition point and see how your body does. When we add in soluble fibre, slow and steady is very important in this in this in this diet plan. Because if you don't have it slow and steady, then you become constipated.

A, that doesn't feel good. B, it's not doing the mechanism of action you want it to and it's not sustainable. So it's important to say what am I already doing?

What's that one or two small changes I can make to make this A, tolerable on your GI track, enjoyable, and then we can easily add more and more as your body tolerates.

[Angela Foster] (3:47 - 4:21)
So go slowly and start small, I think is what I'm hearing there, which I think is really important. Because actually, a lot of the women that I see who have gone kind of gone for the carnivore diet or something like that is because they've been experiencing bloating as part of their perimenopausal symptoms. And so they go with that more kind of sort of protein forward, less plant based approach.

And I think building up slowly is so so important. As you say, one of the other things you mentioned here is that we need to create the environment for good blood vessel health. How can we do that?

[Michelle Routhenstein] (4:22 - 6:39)
Yeah, so as women age and as men age as well, our nitric oxide bioavailability declines. Oestrogen was protective because it also helped made our arteries more flexible. As nitric oxide declines, our blood vessel instead of being more in the ability to vasodilate, it could be more in the constricted state.

So blood pressure oftentimes can increase during peri and post menopause. It's another silent factor. Most people are not checking their blood pressure routinely, and we want to make sure that we are checking it at home.

Okay, so your blood pressure helps us assess for one component of endothelial health. Now, nitric oxide bioavailability decreases. That doesn't mean we can't produce it.

It just means that we need to really focus on that. There are many foods you can eat to increase nitric oxide bioavailability. Beets, leafy greens, all of that is wonderful, but you may not see a movement on your nitric oxide test strips if your gut microbiome is diminished.

So in order to make nitric oxide, your gut communicates with your oral microbiome to make nitric oxide. If your gut health is not in optimal condition, you may not have much nitric oxide bioavailability. And just to go back to the carnivore comment, I've seen people who are on the carnivore diet for a year or two, and they have a heart attack, and they've come to see me.

It is much harder for me to get them, or much slower for them to get to their fibre goals, because I need to shift their gut microbiome from being more in a gramme negative bacteria environment to be in a more conducive environment to be able to digest plants. The carnivore diet is a strict elimination diet. So many people feel better because they're taking out one or two of the culprits that was causing them the bloating.

If we can identify what those parts were, then we can address that much easier and also keep your gut health, your heart health, your brain health really in check as we age.

Lowering ApoB and non-HDL cholesterol starts with improving how your body clears cholesterol. Michelle recommends reducing saturated fat, replacing it with healthy unsaturated fats, gradually increasing soluble fibre, staying well hydrated, and supporting gut health. As oestrogen declines in perimenopause, maintaining nitric oxide production and healthy blood vessels also becomes increasingly important.

KEY TAKEAWAYS

Reduce saturated fat intake.

Replace with omega-3-rich and other unsaturated fats.

Increase fibre gradually to avoid bloating.

Prioritise soluble fibre (oats, raspberries, chia seeds).

Stay hydrated to support cholesterol excretion.

Support nitric oxide production with foods like beets and leafy greens.

Maintain gut health to support both heart health and fibre tolerance.