For decades, cholesterol has been the villain when it comes to heart disease. After all, consumption of saturated fat increases cholesterol levels, which, in turn, increase risk for heart disease, right? This hypothesis was born six decades ago, and cholesterol has been blamed for heart disease ever since.

Reality: Lowering cholesterol doesn’t save lives. In fact, up to 70% of people hospitalized with heart attacks have normal cholesterol levels, and half of people with high cholesterol have perfectly normal, healthy hearts.

What we know now: Heart disease has very little to do with total cholesterol. It does, however, have everything to do with insulin and insulin-resistance, which affects about 90% of Americans, at least to some degree.


Eating causes the body to produce the hormone insulin, which helps move sugar out of the blood and into the muscles, where it is used to power us through our day. When we eat too much and/or exercise too little, the body produces plenty of insulin that the muscles don’t need. That means blood levels of both sugar and insulin stay elevated, and the sugar gets stored in fat.

Researchers used to think that excess fat simply sat there, serving as a reservoir for energy. But now we know that fat cells secrete inflammatory chemicals. As you gain more fat, your overall level of inflammation increases. Inflammation is one of the major causes of heart disease as well as type 2 diabetes, Alzheimer’s disease, cancer and more. Over time, as the muscles continue to resist the insulin and its sugar payload, your body moves closer to developing insulin-resistance, meaning that insulin is no longer able to keep your blood sugar in the normal range. Result: High blood sugar, also known as prediabetes.


Many people are shocked to learn that insulin-resistance is the single most important predictor of heart disease. A person with insulin-resistance is more likely to develop heart disease than someone who is not insulin-resistant. And you don’t need to be obese or even overweight to be insulin-resistant— thin people with insulin-resistance may be rare, but they exist and are considered “normal weight, metabolically unhealthy.” A low-fat diet that includes lots of processed foods—energy bars and light ice cream, for example—can drive up insulin levels even though, in some people, it doesn’t cause weight gain.

Insulin-resistance also increases risk for high blood pressure, low HDL “good” cholesterol and elevated triglycerides (a type of fat in the blood). Each of these on its own is a heart disease risk factor, and combined with insulinresistance, they’re even more dangerous.

Also: The chronically high stress levels caused by the pandemic—and the resulting steady release of the fight-or-flight hormone cortisol— reduce the beneficial effects of insulin, adding to risk for insulin-resistance.

There is good news: More than 40% of heart attacks could be prevented by reversing or preventing insulin-resistance with proper diet, exercise and stress management.


First step—get this test: Ask your doctor for the High-Sensitivity C-Reactive Protein test (hs-CRP), which provides a snapshot of your body’s inflammation by measuring CRP, a marker for inflammation that has been identified in multiple studies as a predictor of future cardiovascular health. An optimal CRP level is less than 0.8 mg/L. If your CRP level is high, take these steps…

Diet: The following diet changes will help reduce risk for insulin-resistance and the resulting inflammation.

Reduce sugar intake. Sugar is a bigger threat to your heart than fat. The average American consumes 77 grams of sugar (about 20 teaspoons) per day, according to the American Heart Association—that is triple the recommended amount. Cut that down to no more than six to nine teaspoons of sugar a day. That still sounds like a lot, but a 1.5-ounce candy bar alone contains about five teaspoons of sugar. Best: Cut out soda, fruit juice and energy drinks…sweetened breakfast cereals…. baked goods…candy and other sweets.

Eat whole, unprocessed foods—vegetables and fruits, beans, nuts and lean, clean meat (wild salmon, grass-fed beef). And include anti-inflammatory spices such as turmeric and garlic in your meals.

Use extra-virgin olive oil, rich in anti-inflammatory omega-9 fatty acids… and reduce intake of vegetable oils (corn, canola and soybean), which mainly contain pro-inflammatory omega-6 fats.

Drink green tea and red wine. Both contain polyphenols, cardioprotective plant antioxidants that prevent damage to healthy cells.

Exercise: Engage in moderate-to-vigorous exercise for at least 30 minutes each day. Interval training—alternating bouts of fast- and slow-paced exercise (running and walking…fast spinning/ spinning with heavy resistance and easier spinning)—is particularly effective at improving cardiovascular fitness.

Stress reduction: There are many enjoyable, easy-to-learn ways to combat stress. Consider…

Slow, deep breathing (in through the nose, out through the mouth). Try this while sitting in a comfortable position in a quiet space with your eyes closed.

Massage. Being touched by someone, whether that person is a professional or a loved one, can reduce cortisol levels, decrease heart rate and blood pressure, and lead to an increased sense of relaxation and well-being.

Practice positive emotions. Humor, gratitude and joy are examples of emotions that counteract chronic stress. Watch a TV program that makes you laugh…keep a gratitude journal…play with your grandchildren…or engage in a hobby that makes you smile.

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