I’m thrilled to announce that the first Insight into Health, LIVE! event!! Please join me on August 24th, 3 - 4:30 pm, at the Sonoma Community Center, where Dr. Mary Flett will join me to talk about “What Does it Mean to Be Healthy, Anyway?” More info and to register HERE.

Tofu Primer

The idea for this post, along with the three recipes to follow in the coming weeks, came from the many questions I received about how to prepare tofu during the recent Cancer Support Sonoma Day of Wellness.

In addition to enjoying the Mix & Match Salads I demonstrated for the group, many people tried — and found they enjoyed — a tofu dish from a local market. Now that they knew they liked it, they weren’t sure where to start with it in their own kitchens. This post is for them (and you).

What Is Tofu?

Tofu is a plant-based protein made from soybeans (think edamame) through a process that is similar to cheesemaking. In short, the protein extracted from soybeans is condensed into a “block” of tofu that you find in the grocery store, often in three different types based on consistency:

1. Silken: consistency of Greek yogurt

2. Firm: consistency of feta cheese

3. Extra Firm: consistency of cheddar cheese

The type of tofu you use depends on what you are making; more on that below.

Why Eat Tofu?

Tofu is high in nutrients and low in cost and environmental impact:

• Nutrients:

  • A half-cup serving of firm tofu provides roughly 10 grams of complete protein, making it one of the few plant-based protein options to provide all essential amino acids.

  • As most tofu is made with calcium sulfate, it is a good source of calcium.

  • Regular consumption of whole soy foods1, including tofu, may reduce the risk of heart disease, certain cancers, and improve bone health.

  • Despite past concerns about soy phytoestrogens and breast cancer risk, we now know that regular soy consumption may reduce the risk of breast cancer diagnosis and recurrence.

• Cost:

  • Tofu is one of the best protein values at the grocery store, regularly coming in at one-third the cost of beef and half the cost of chicken.

• Sustainability:

  • Soybeans are one of the most sustainable proteins on the planet, since they require a fraction of the land, water, and emissions that animal proteins do.

Where to Start?

All too often, tofu is turned away before it’s been given a chance. It deserves a chance!

1. First, choose the right tofu consistency for the job:

• Silken Tofu: Best for smoothies, soups, & desserts.

• Firm: My personal favorite for stir-fries, curries, and salads.

• Extra Firm: Holds up best for grilling, baking, and crumbling for a plant-based substitute for ground beef or turkey.

2. While silken tofu can be used as is, firm and extra-firm tofu are nearly flavorless right out of the package, despite the delicious-looking dish shown on the label.

3. Adding flavor starts with removing water. Tofu blocks come submerged in water in a firm plastic container covered with plastic. Remove the plastic by cutting through it with a knife on three sides and folding it back:

   

4. Remove the block of tofu from the water, and slice into 1/2” thick pieces:

   

5. Lay the tofu in a single layer on a kitchen towel:

   

6. Cover the slices with the remaining portion of the kitchen towel and carefully place a heavy object on top of the bundle for 20-30 minutes to help squeeze out more water.

   

   

   7. Remove tofu from the towels and proceed with the recipe! Here is a resource to get you started, and stay tuned each Friday in July for a new tofu recipe from me!

Thanks for being here,

~Allison

You can find it wherever you listen to podcasts, including Apple & Spotify.

This is the 3rd and final piece in my series all about sleep. In Part 1, I shared my thoughts on the importance of good sleep (and what “good” even means). Part 2 explored the hormones that manage, and are managed by, sleep.

Today is all about how to leverage the systems within each one of us that are made to help us sleep.

Foundations of Good Sleep

• Morning sunlight — Even a few minutes of direct morning sunlight increases alertness by decreasing melatonin production and increasing alertness hormones. Set yourself up for an energized day and better sleep tonight.

  • Take your morning cup of coffee or tea on your porch, get out on a short walk with your furry friend, or simply step outside to hear the goings on.1

• Simulate sunset — Sleep doesn’t happen like a light switch. Give your system a head start by reducing light in your environment 1-2 hours before bed so that melatonin production has time to ramp up in time for bedtime.

  • Turn off bright overhead lights, use dimmer switches or lower wattage light bulbs, and create a bedtime routine that doesn’t rely on screens.

• Increase sleep pressure — As introduced in Part 2, accumulation of adenosine in the brain is an important driver for sleep. Regular exercise helps promote that sleep pressure, establishes your circadian rhythm, and may decrease the stress and anxiety that often makes sleep difficult.

  • Try your favorite cardio and/or resistance activities earlier in the day for better sleep later that night. Relaxing practices such as restorative yoga and tai chi before bed may also be helpful.

• Consistency is key — There doesn’t appear to be one “right” time to go to bed. Instead, it may be dictated by your chronotype. Consistency may be more important than sleep timing because it supports your internal sleep system. Going to bed at vastly different times each day is akin to being chronically jetlagged.

  • Go to bed and wake up at the same time every day to mimic regularity in sunrise & sunset. If shifts to your sleep schedule are needed, do so in ~15-minute increments (for context: sunrise and sunset change by 1-3 minutes per day!).

Sleep & Your Senses

• Sight — In addition to leveraging the power of naturally produced melatonin by being exposed to sunlight early in the day, throughout the day, and by mimicking sunset ahead of bedtime, sleeping in complete darkness can help you stay asleep. Consider blackout curtains, eye masks, and other tricks to decrease even small sources of light in your sleeping environment.

• Sound — Sudden changes in noise from outside or inside your bedroom during sleep trigger your alertness reflex, making it difficult to fall back asleep. Decrease noise disruptions with white noise machines/apps or earplugs.

• Touch — Body temperature affects sleep, & natural decreases in body temperature at night promote good sleep. Amplify this effect by warming yourself up before bed (e.g., a bath, shower, or tea) to support sleepiness as you cool down. Sleep with the room temperature at least a few degrees cooler than it is during the day, if possible.

• Taste — Avoid caffeine (coffee, tea, soda) for 8 hours before bed to support sleep pressure. Finish eating 2-3 hours before getting into bed to improve digestion & decrease heartburn. Limit fluids for 2 hours before bed to prevent bathroom wakeups. While alcohol may appear to make it easier to fall asleep, alcohol actually disrupts deep sleep.

Other Factors to Consider

If you’re concerned about your sleep, energy levels, or health, please consult your doctor. Several medical conditions can be both symptoms and causes of poor sleep, including sleep apnea, restless leg, chronic pain, anxiety & related disorders, heartburn/reflux and other GI conditions, and any medical and/or medical cause of excessive nighttime urination.

Additionally, there are several other factors that I wasn’t able to cover in detail in this series, but I’ve linked to more information for the following sleep-related topics:

• Pets in the bed/bedroom

• Naps

• Shift work

• Travel/Jetlag

• Melatonin Supplements

• Insomnia

I hope this series has provided some helpful insights and, hopefully, some better nights of sleep for you! Thanks for being here,

~Allison

Interested in more of the Insight into Health podcast? New episodes are published every Wednesday. Follow on Substack, Apple, Spotify, or wherever you listen to podcasts.

Remember that this information is meant to educate and inspire, but is not medical advice. Please consult your healthcare team to determine what is most appropriate for you.

This is Part 2 of my series all about sleep. In Part 1, I offered my thoughts on why sleep is so important, what “good” sleep actually means, and how to decide if sleep trackers are right for you.

Today, we’ll explore how sleep happens and what goes on while you are getting your zzz’s.

How Does Sleep Happen?

1. Melatonin

I’m guessing you’ve heard of melatonin. It is the most common sleep supplement in the US.

Many people don’t realize that melatonin is naturally produced in our brains to help us fall asleep, yet it has little value in keeping us asleep.

Naturally produced melatonin is light-dependent, a system that evolved when sunrise, daylight, and sunset were the main drivers of our sleep-wake cycle.

The amount of light coming into our eyes directs melatonin production:

• As light increases (think sunrise), melatonin production goes down

• As light decreases (think sunset), melatonin production goes up

Disruptions to melatonin production because of artificial light exposure at night, such as lights in our homes and screens, and inadequate sunlight exposure during the day, are at the core of poor sleep for many.

2. Adenosine

Adenosine is the byproduct of energy metabolism (ATP for any biology folks out there). The longer you are awake, the more adenosine builds up in your brain. As the day goes on, adenosine slowly accumulates, which causes you to feel more tired. This is known as “sleep pressure.”

Getting a good night of sleep clears adenosine from the brain.

(Fun fact: Caffeine blocks your brain from recognizing that adenosine is there. That’s right, caffeine does not give you energy. It just tricks your body into not realizing how tired it is.)

Importantly, both adequate melatonin production and sleep pressure are required to fall asleep and stay asleep. Easier said than done, I know.

Your Hormones on Sleep

If you think that melatonin and adenosine are impressive/complicated/overwhelming…we are just getting started.

In Part 1 of this series, I shared that chronically poor sleep affects nearly every area of health: metabolic, cardiovascular, immune, mental, and more.

Why is that? How is sleep so powerful?

The answer has to do with more hormones. Hormones that follow sleep-wake cycles and are affected by poor sleep:

• Cortisol is the “alert” hormone that gradually decreases throughout the day and spikes in the early morning to prepare for wakefulness. Poor sleep confuses cortisol production, often resulting in high levels at night, making it difficult to fall and stay asleep, and low levels in the morning, making it difficult to feel awake.

• Leptin & Ghrelin are “appetite” hormones that play opposite roles. As leptin goes up after a meal, you feel full. On the other hand, ghrelin1 levels make you feel increasingly hungry the longer it’s been since a meal.

• Insulin is the “energy shuttle” hormone, responsible for moving energy-rich blood glucose (blood “sugar”) from the bloodstream into the cells. Sleep deprivation makes insulin less effective, raising blood sugar and increasing the risk of Type 2 Diabetes and other metabolic-associated conditions.

• Growth Hormone is the “repair” hormone, released during sleep to stimulate tissue repair, immune health, and metabolism. Poor sleep can impair recovery and healing.

I could go on, but I’ll spare you.

I hope that I have left you feeling a little bit more impressed by the role of sleep in your health.

Thanks for being here,

~Allison

P.S. Interested in listening to the Insight into Health podcast hosted by yours truly? New episodes are published every Wednesday (here are the links to Apple and Spotify).

Remember that this information is meant to educate and inspire, but is not medical advice. Please consult your healthcare team to determine what is most appropriate for you.

Each month I’ll explore one health topic through four conversations with colleagues, family, & friends to provide different perspectives and expertise.

My inaugural topic?

Sleep!

You may be surprised that, as a Registered Dietitian, I chose to cover sleep before nutrition.

It was a very deliberate choice.

As I talked about on Episode #1 with Dr. Larry and on Episode #2 with Dr. Mary, I have grown to deeply respect the impact sleep has on health.

In fact, there are several situations when I will encourage a patient to work on their sleep before we tackle nutrition.

It’s that important.

What’s the Big Deal?

Sleep is at the core of my Insight into Health framework. Ongoing poor sleep increases the risk of chronic disease, cognitive decline, and decreases in emotional health and quality of life.

Next week I’ll dive into why sleep is connected to nearly every factor of health. For now, let’s get some definitions out of the way.

What does “good” sleep even mean?

I define good sleep in terms of quantity (how much) and quality (how well).

• Quantity: Most adults regularly need 7-9 hours of sleep per night, ideally continuously.1

  • To figure out how much sleep you need, go to bed (and to sleep) at the same time every night for a week and let yourself wake up naturally — no alarms, pets, or partners. You may sleep more than 9 hours the first night or two if you are in sleep debt. The amount of sleep you get on the 6th and 7th night is a good indicator of your natural sleep needs.

• Quality: How easily can you fall asleep? Do you typically stay asleep? If you wake up, how easy is it for you to fall back asleep? Do you feel refreshed in the hours after waking?

  • Sleep quality is subjective and difficult to evaluate outside of a sleep lab. Yet, it is probably the most important metric for an individual. Poor sleep quality (or the perception of it) affects how we think, how we feel, and how we show up for ourselves and others for the rest of the day.

What’s Your Chronotype?

I know this sounds like a Seventeen Magazine quiz, but stick with me here.

Chronotype2 refers to your preferred sleep timing, which is largely genetically determined. Think early bird (me) and night owl (my husband).

Note that chronotype is preferred, which is not necessarily consistent with the timing of your life responsibilities (work, school, etc.). This mismatch is a big driver of poor sleep quantity and quality.

Society has placed judgments on each end of the chronotype spectrum. As an early bird, I get teased for going to bed early, and many night owls are deemed “lazy” when they sleep in. Yet, there is no one best chronotype.

You likely already have an idea about your chronotype, but here is a quiz if you are curious (and no, not from Seventeen magazine).

To Track or Not to Track

I have learned to refine how I ask a patient about their sleep.

Instead of asking “How are you sleeping?”, which often gets the reflexive “good” response, I now ask “How do you describe your sleep?” The most common answers I get are “horrible” and “terrible” — words that speak volumes on their own.

Though more commonly, I am also hearing, “My phone says…”

While sleep trackers can certainly increase awareness about sleep duration and quality, there are some important factors to keep in mind to determine if they are right for you.

First, while sleep duration accuracy on common sleep-tracking devices continues to improve, they often have trouble evaluating the nuances of sleep stages (more on that next week).

Second, for some people, the use of sleep trackers may sabotage sleep because of the anxiety and obsession that come with data overwhelm. There is even a term for it: orthosomnia3, which is the pursuit of perfect sleep data at the expense of actual sleep.

Third, the more we outsource how we feel to technology, the greater the risk we have of losing touch with… how we feel. And our bodies have a lot to tell us; it’s usually a matter of whether we listen.

That said, if using a sleep tracker helps you feel informed and empowered, keep using it.

If it leaves you lying awake wondering why your deep sleep percentage was low, it may be time to take a break.

As I mentioned above, in Part 2, I’ll dive into why sleep is connected to nearly every factor of health. Subscribe below to get it straight into your inbox:

Subscribe now

Interested in getting new Insight into Health podcast episodes? I publish a new episode every Wednesday on Substack or wherever you listen to podcasts (here are the links to Apple and Spotify).

Thanks for being here and supporting my work,

~Allison

Remember that this information is meant to educate and inspire, but is not medical advice. Please consult your healthcare team to determine what is most appropriate for you.

It has been a crash course in getting out of my comfort zone, being ok with making mistakes, and learning to explain things without my hands.1

Plus, it has given me the perfect excuse to get to know more of the awesome people in my community (after I awkwardly ask them to come on air with me, that is).

I’ve had so much fun, in fact, that I am branching out into podcasting. The Insight into Health Podcast launches this Wednesday on all major podcast platforms. Check out the trailer, below, and follow wherever you listen to podcasts!

Insight Into Health

Insight into Health Podcast Trailer

The Insight into Health podcast trailer is live…

Listen now

a month ago · 3 likes · Allison McKeany, MS, RD

Thanks for being here,

~Allison

1

Today, we are moving beyond calcium to better understand the other factors that contribute to bone health.

Bone Fuel

Every process in your body requires energy. Energy that comes from food, which we call calories.

While calories often get a bad rap, energy is essential in fueling bone metabolism and is key to promoting healthy bones throughout life.

While consuming more calories than your body needs is a common concern, consuming an inadequate amount of calories (regardless of weight) also has risks. Inadequate energy intake increases the risk of low bone density, low muscle mass, as well as falls and fractures.

I’ve worked with many individuals who chronically underfuel themselves in an attempt to change the size of their body or to “get healthy.” Yet these often shortsighted attempts overlook the essential role of adequate energy for health, including bone health.

If you are curious about your own energy needs, I encourage you to work with a Registered Dietitian!1

Protein Power

Protein is having its time in the spotlight. When it comes to bone health, adequate protein intake plays two important functions:

1. Provides the building blocks for bone collagen, which makes up roughly a third of bone mass.

2. Promotes building and maintenance of muscle mass, which acts as an important stimulus for bones to stay strong.

So how much protein do you need? That’s a hard question to answer for everyone reading this. As is the case with most health and nutrition topics, the amount you need is highly individualized and best calculated by a nutrition expert (dietitian!).

As a guideline, most adults benefit from starting with ~1.2 grams of protein per kilogram of body weight, using adjusted body weight for those with high body weight. (If you are thinking, “kilograms!?”, I hear ya. We are stuck in the metric system over here in healthcare…) This is ~0.54 grams of protein per pound of body weight.

Please remember that protein needs vary based on several factors, including age, activity level, and health status.2

Raising the Bar

Ok, we’ve gone through nutrition for bone health, but that is only half the story.

Your body responds to the demands you put on it, and bones are no different. If you don’t ask much of your bones, there is no reason to spend precious energy and resources to maintain them.

This is where resistance training comes in.3 When combined with adequate protein intake, resistance training builds and maintains muscle mass.

Because muscles connect to bone via tendons, the bigger, stronger, and more frequently those muscles are used, the more force the bone has to brace against. It is this demand that motivates your body to prioritize bone structure.

I’ve only recently started doing resistance training. If you are new to it, too, here are a few things to consider:

• Resistance training is any movement that challenges your muscles to work. You do not need a gym membership or a barbell to get started! Bodyweight exercises like squats, lunges, and knee pushups count, as do resistance bands, free weights, and more. Here is an online resource I recommend to many of my patients who aren’t sure where to start.

• To keep your bones motivated to stay strong, resistance training needs to be progressively more challenging. This means that as you gain strength, slowly increase the challenge by adding more resistance and/or trying different movements.

• The ultimate goal is 2–3 strength/resistance sessions per week that work all major muscle groups.

• Working with a professional to learn proper resistance training technique is well worth the investment to decrease the chance of injury.

Of course, check with your doctor first before starting a new exercise program, particularly if you have existing health conditions or known bone loss.

Prevention is the Best Medicine

We’ve now spent the bulk of this three-part bone health series talking about the things you can do to build and keep strong bones. Most of us care (or should care) about this because breaking a bone later in life can be serious and threaten independence, mobility, and, in certain cases, even increase the risk of death.

That being said, preventing a fall in the first place goes a long way toward protecting your bones and the rest of your body. Balance-focused activities such as tai chi, yoga, and single-leg exercises can help promote better balance, stability, and reaction time.

A few simple home modifications can prevent falls at any age: removing trip hazards like loose rugs and floor clutter, installing grab bars in the bathroom, and placing non-slip mats in the shower and on slippery floors. More home fall prevention tips here.

I hope this series on bone health has been helpful for you. If you have any questions, leave a comment below. And please don’t hesitate to share any of my posts with your friends and family!

Leave a comment

Thanks for being here,

~Allison

Remember that this information is meant to educate and inspire, but is not medical advice. Please consult your healthcare team to determine what is most appropriate for you.

Bone Metabolism: Basics

Bone is alive and in a constant state of being broken down and rebuilt, a process known as remodeling. This complex cycle is fueled by nutrients and orchestrated by two key cells: osteoblasts and osteoclasts.

I know, I wish their names weren’t so similar either. Here’s how I remember them:

• OsteoBlasts — B for Builders (build bone)

• OsteoClasts — C for demolition Crew (break down bone)

During childhood, adolescence, and young adulthood, osteoblast activity dominates and bone mass increases. Starting around age 30, osteoclasts gradually outpace osteoblasts, and slow bone loss begins. In women, the loss of estrogen during and after the menopause transition accelerates this process by ramping up osteoclast activity.

Bone Metabolism: Necessary Nutrients

If osteoblasts and osteoclasts are the construction and demolition crew, they rely on having access to supplies, delivery drivers, and apprentices. This is where vitamins and minerals come in.

• Calcium — the star building block of bone

• Vitamin D — required for calcium to be absorbed from your digestive system

• Vitamin K — the K2 directs that absorbed calcium to your bones (and not somewhere less helpful, like an artery)

• Zinc and Vitamin B12 — support the osteoblast builder cells

• Magnesium — supports Vitamin D

While it might be tempting to rush out and buy supplements to cover all of the above, a food-first approach is the ideal way to ensure your body gets the most out of these nutrients. Remember, our bodies weren’t designed to absorb 100% of what we need in a single swallow.

The following is a quick reference guide to the vitamins & minerals involved in bone health, how much most people need, common food sources, and some things to think about when it comes to supplementation. This list is not all-inclusive. Please remember to check with your healthcare team regarding your specific needs:

In my experience, the most commonly needed supplements for bone health are Vitamin D3 and K2, as both are difficult to obtain in meaningful amounts through food alone. Many supplements now conveniently combine them in a single pill.

I recommend basing Vitamin D3 dosing on blood test results (the 25-OH vitamin D test). If testing isn’t easily accessible, 1,000–2,000 IU of D3 daily is generally considered safe for most adults, but more is not always better, so testing is worth it.

If this feels like a lot to take in, keep in mind there is another act to this story. Having the right vitamins and minerals available is important, but the body also needs a reason to build and maintain bone. That's where exercise, protein, and adequate energy intake come in — more on that in Part 3. Subscribe below to get it straight into your inbox next week.

Subscribe now

Thanks for being here,

~Allison

Remember that this information is meant to educate and inspire, but is not medical advice. Please consult your healthcare team to determine what is most appropriate for you.

This is unfortunate because the most critical time for bone health is when many of us think we are invincible: our teenage years.

What exactly is bone?

While it is easy to picture bone as a solid structure, it contains an inner “spongy matrix” that resembles honeycomb, surrounded by a hard outer shell.

Nearly half of bone is made of protein (specifically collagen) in addition to minerals such as calcium and phosphorus.

Unlike hair and nails, bone is alive and constantly being remodeled, meaning it is in a constant state of being broken down and built back up. An estimated 10% of your skeleton is being turned over in this fashion every year!

Bone provides the obvious structure and foundation for movement, but also plays an essential role in mineral storage and blood cell production.

Bone Throughout the Lifespan

The rate of bone remodeling depends on several factors, one of the most important being the stage of life:

• Infancy and childhood: Bones are rapidly being built as part of the growth process.

• Adolescence: Nearly 40% of total bone mass is accumulated during this window.

• Early to late 20s: Peak bone mass is achieved.

• Around age 30: Most people begin losing 0.5–1.0% of bone per year.

• Menopause transition: For women, bone loss accelerates to 2–3% per year, as estrogen plays a protective role in bone health.

• 50s and beyond: Gradual bone loss continues, accompanied by an increased risk of fracture.

Why Peak Bone Mass Matters

Given the somewhat inevitable decline in bone mass over time, reaching maximum bone density in your 20s is a critical piece of lifelong bone health:

The challenge is that this bone-building window comes at a time when long-term health is rarely top of mind. Some of my most challenging nutrition conversations are with teenage audiences, as I try to find compelling ways to convince them that calcium-rich foods really are important.

It’s Not Too Late

While most of you reading this are likely beyond your peak bone-building years, there is still plenty you can do to slow bone density decline, and that’s exactly what we’ll dig into in my next post.

In Part 2, we’ll explore bone metabolism and the essential nutrients needed to support your bones.

In the meantime, I’d love to hear your questions about bone health so I can make sure to address them throughout this series.

Leave a comment

Thanks for being here,

~Allison

Remember that this information is meant to educate and inspire, but is not medical advice. Please consult your healthcare team to determine what is most appropriate for you.

In Part 1, I reviewed what cognitive health is and the most common causes of cognitive decline (Alzheimer’s disease tops the list).

In Part 2, I explained the non-modifiable risk factors for Alzheimer’s disease (age, genetics, and biological sex).

In Part 3, I explored the 14 modifiable risk factors that contribute to up to 45% of all dementia cases, which are things you and your healthcare team can monitor for and address.

Today, I’ll dive into what we know about brain-healthy eating and how dietary patterns can work for, or against, your cognitive health.

Until about a decade ago, we had a hunch that the Mediterranean diet was good for the brain, but we didn’t have much good evidence to be sure.

That changed in 2015, when research on the MIND diet first made headlines1. (Note: I prefer “approach” because I’m not a fan of the 4-letter “D” word).

What is the MIND “diet”?

MIND is an acronym (which, it turns out, encompasses another acronym “DASH” which stands for Dietary Approaches to Stop Hypertension):

Mediterranean-DASH

Intervention for

Neurodegenerative

Delay

In short, the MIND intervention combines the cognitive and cardiovascular benefits of Mediterranean eating with the cardiovascular benefits of the DASH plan.

Results of the 2015 study showed that after following 960 people for almost 5 years, those who consumed the recommended MIND foods most of the time showed slower cognitive decline.

In fact, these “most of the time” folks had cognitive function equivalent to being 7.5 years younger in age than those who ate MIND foods the least.

Importantly, perfection was NOT required to see benefit.

This is good news for all of us.

If you can incorporate the MIND foods into your routine a moderate 70-80% of the time, your brain gets the benefits.

Plus, the research doesn’t suggest that you have to give up the foods that you love.

Research from around the world has continued to support the MIND intervention for reducing the risk of dementia:2

MIND Foods

The MIND approach first focuses on foods to consume more regularly (a refreshing change from “diets” that start with what to avoid):

• Green leafy vegetables — daily

• Other types of vegetables — daily

• Berries — 2+ per week

• Nuts & Seeds — 5+ per week

• Olive oil — daily

• Whole grains — daily

• Fish — 1+ per week

• Beans — 3+ per week

• Poultry — 2+ per week

While participants in the MIND studies were also encouraged to decrease intake of butter, cheese, red meat, fried foods, and sweets, the focus on what to consume more of is likely the most important part.

“Neuro” Nutrition:

As you can see, the brain-healthy MIND foods are largely plant-based, meaning that they are rich sources of fiber, vitamins, minerals, and phytochemicals.

These components, along with ones we likely haven’t discovered yet, promote brain health by:

• Improving cardiovascular health — blood pressure & cholesterol

• Supporting metabolic health — blood sugar & inflammation

• Increases micronutrient intake — vitamins and minerals (including B-vitamins, choline, zinc, iron, magnesium, and more)

• Supporting neurotransmitter (brain cell) function — healthy proteins

• Supporting brain structure — healthy fats

• Providing reliable energy for the brain — healthy carbohydrates

• Fueling the microbiome — fiber

A note on alcohol

While a glass of wine daily was originally seen as a positive dietary addition in the 2015 MIND publication, we now believe there is no safe level of alcohol consumption for brain health.3

Brain Healthy Eating = Healthy Eating

I often get new patients who come to me in a panic that they need a diet for their diabetes, high blood pressure, and cognitive health.

How will they manage it all!?!

The reassuring news is that brain-healthy eating is healthy eating. The MIND foods aren’t just good for your brain; they are good for your heart, your blood sugar, inflammation, cancer risk, and more.

Once again, the research points us to more plants, including fruits, vegetables, nuts, seeds, and grains.

No magic. Just real food.

Leave a comment

Thanks for being here,

~Allison

Remember that this information is meant to educate and inspire, but is not medical advice. Please consult your healthcare team to determine what is most appropriate for you.

Not long ago, an Alzheimer's diagnosis came with little more than advice to "get your affairs in order."

Those worried about their own risk had little guidance and even fewer concrete steps they could take to prevent the onset or progression of the disease.

I don’t blame science or medicine for this.

The brain is so complex. If back then we were in the infancy of understanding its complexities, then today we are mere adolescents.

We’ve come a long way, and we still have a way to go.

I have been lucky to have had a front-row seat to how far our understanding of Alzheimer's disease has come.

Back in 2016, while working at Sonoma Valley Hospital, I was asked to join a team with the Buck Institute to develop a program built around the emerging evidence that nutrition and lifestyle could play a meaningful role in preventing and slowing the progression of Alzheimer's disease.

I was a baby dietitian back then. I didn’t appreciate what a gift this opportunity was.

Nevertheless, I jumped headfirst into getting myself up to speed on Alzheimer’s disease research and haven’t slowed down since.

Over the years, I have learned that there is so much we can do to protect our brain health.

In fact, a 2024 Lancet Commission report estimated that 45% of all dementia diagnoses are due to modifiable causes, meaning things that you can monitor and address with your healthcare team.

This is huge!

In Part 1 of this series, I provided background about what cognitive health is and the most common causes of dementia (with Alzheimer’s disease leading the pack).

In Part 2, I explored the non-modifiable risk factors (age, genetics, and biological sex) and how these factors can work as motivators to understand and act on the many modifiable risk factors.

Today’s post is all about the modifiable risk factors. Oh, and by the way, these factors aren’t just good for your brain, they are good for your whole body:

Modifiable Risk Factors:

1. Level of education — While most research refers specifically to formal higher education, being a lifelong learner in any sense of the word can only help support your cognitive health. Take a class, join a book club, learn a language, pick up an instrument. Curiosity counts.

2. Traumatic brain injury (TBI) — Falls, car accidents, and sports are the leading causes of concussion and brain injury. While we can’t go back and change any history of brain injury, we can stay off of ladders, put handrails and anti-slip mats in the shower, and always wear seatbelts.

3. Elevated LDL-cholesterol — The adage “What is good for your heart is good for your brain” continues to hold true. It includes monitoring for and managing plaque-forming cholesterol. Talk with your doctor about whether the more aggressive LDL targets published recently apply to you.

4. High blood pressure (hypertension) — Working with your doctor to keep your blood pressure in a healthy range won’t just make them happy; it will protect your heart and brain.

5. Smoking — While smoking increases the risk of dementia, long-term cessation significantly lowers it. In fact, quitting in middle age or later and staying smoke-free may reduce dementia risk to that of a non-smoker after 8–10 years. It is never too late to quit.

6. Diabetes — Chronically high blood sugar damages the brain and may increase Alzheimer’s Disease-related pathology over time. Monitoring for and managing high blood sugar, prediabetes, and diabetes goes a long way in protecting your brain.

7. Excessive alcohol intake — "Excessive" is currently defined as more than 21 units of alcohol per week, compared to fewer than 14 units, with a 4–5oz glass of wine, 12oz beer, and 1–1.5oz of liquor each counting as one unit. That said, some research suggests there is "no safe level of alcohol consumption for dementia," especially for women and those carrying the high-risk APOE-4 gene.

8. Obesity — The number on the scale is my least favorite health metric, for it is often more harmful (to mental health) than helpful. That said, excess body weight, particularly around the midsection, is associated with increased risk for several chronic diseases, including dementia. If this applies to you, focusing on the lifestyle and medical strategies covered here is a more meaningful and comprehensive place to start.

9. Physical inactivity — Any movement is better than no movement (and it isn’t too late to start!) was a primary takeaway from the Women’s Health Symposium I attended yesterday. In fact, physical activity may be the most important factor in protecting your cognitive health, with regular movement being the key.

10. Depression — Appropriately treating depression and other mental health challenges, especially in midlife, is an important step in protecting long-term brain health. Seek support, whether through therapy, medication, lifestyle changes, or a combination. Your brain health is worth it.

11. Social isolation — Humans are wired for connection, and the brain thrives on meaningful social engagement. Chronic loneliness and isolation have been shown to accelerate cognitive decline. Prioritize your relationships, stay involved in your community, and don't underestimate the powerful protective effect of simply spending time with people you care about.

12. Hearing loss — Sensory input is essential for keeping the brain active and for maintaining and forming new brain cell connections. Untreated hearing loss not only reduces a critical sensory channel, but it is also often socially isolating, compounding the risk even further. Wear those hearing aids if you need them!

13. Vision loss — Untreated vision impairment can be socially isolating and may reduce engagement in cognitively stimulating activities such as reading, writing, and art. Stay current with regular eye exams, and let this be extra motivation to manage your blood sugar and blood pressure, both of which can also affect your vision.

14. Air Pollution — This risk factor is often considered a "social determinant of health," meaning that people of lower socioeconomic status are more likely to work and live in communities with higher levels of air pollution. Relocating away from polluted areas is not a realistic option for most, but it is worth acknowledging that chronic exposure to this environmental factor does play a role in long-term brain health.

Next week, I’ll share what we know about how dietary intake affects many of these risk factors, as well as the risk of cognitive decline.

In the meantime, I’d be honored if you shared this with someone you care about.

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As always, thanks for being here,

~Allison

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Please remember that this information is meant to educate and inspire, but is not medical advice. Please consult your healthcare team to determine what is most appropriate for you.

1

Confession: While I was looking forward to the speakers and mingling at the Women’s Health Symposium, I wasn’t sure what to expect with the boxed lunch that was included. Let’s just say that I couldn’t have planned the offerings better. No, it wasn’t a sandwich and a cookie. It was an array of healthy, hearty salads. Socks. Blown. Off.

The vast majority of people choose the latter without much thought.

As I introduced last week in Cognitive Health - Part 1, cognitive function is so much more than memory.

It is identity.

It is independence.

Until recently, it seemed that the risk of cognitive decline and dementia (now more commonly called “neurocognitive decline”) was left to fate.

We are lucky to live in a time where we know more and can be proactive about understanding our risk.

Alzheimer's disease accounts for an estimated 60–80% of diagnosed dementias, making it by far the most studied and the primary focus of research on cognitive decline prevention.1

Alzheimer’s Disease risk is due to both non-modifiable and modifiable risk factors.

Let’s start with the risks you can’t change.

Non-Modifiable Risk Factors:

• Age — risk of chronic diseases, including Alzheimer’s disease, goes up with age.

• Biological sex2 — Women represent approximately two-thirds of all Alzheimer's cases, which we are still trying to understand.

  • This difference is not fully explained by longer lifespan, and research is actively exploring the roles of estrogen/menopause, depression, reproductive history, and historically lower access to education and cognitively stimulating work.

• The vast majority of Alzheimer’s genetic research has focused on the APOE gene3, which accounts for an estimated 20–25% of population-level risk. Importantly, APOE risk is not deterministic, meaning even the highest-risk combination does not guarantee developing the disease.

  • The APOE gene comes in three forms:

    • APOE-2 — associated with decreased risk of Alzheimer’s disease

    • APOE-3 — associated with neutral risk (neither increased nor decreased)

    • APOE-4 — associated with increased risk of Alzheimer’s disease

  • Since we each inherit two copies of the gene (one from each biological parent), the six possible combinations are:

    • APOE 2/2, 2/3, 3/3, 2/4, 3/4, 4/4

      • APOE 3/3 is the most common combination

      • APOE 3/4 increases risk approximately 2–3x compared to APOE 3/3

      • APOE 4/4 increases risk approximately 8–12x compared to APOE 3/3

Ok, I know that went deep into the science for a moment. So let’s take a step back and put everything into perspective.

The vast majority of Alzheimer’s Disease and other dementias are related to both non-modifiable and modifiable risk factors.

Understanding each risk factor is important information as you figure out where you are and what you need to do to influence what happens going forward.

When it comes to genetic risk, I know it can be scary, and some people would rather not know. That’s ok.

For me, I choose to look at genetic risk as a motivator. I want to know all the cards on the table so I can make my next move.

Even if my genetic risk is high, remember it is not guaranteed that the disease will develop.

This is an important distinction.

Next week, for Cognitive Health — Part 3, we will dive into the important topic of modifiable risk factors. These are the risk factors that put you in the driver’s seat to decrease your risk of dementia and other chronic diseases.

Now that is inspiring and motivating.

As always, thanks for being here,

~Allison

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Please remember that this information is meant to educate and inspire, but is not medical advice — please consult your healthcare team to determine what is most appropriate for you.

I remember when my grandma’s memory started to falter. I was in grad school.

She would tell me the same stories.

She would ask me the same questions.

She knew something was off.

But, like her doctor at the time, I brushed it off:

“Grandma,” I said, “you need to focus so you don’t forget.”

Now, I feel awful about saying that.

Placing blame on her probably did more harm than good.

It wasn’t a matter of focus at all. It was the first sign of Alzheimer’s disease.

Fast forward 8 years, and, because of one of those situations of being in the right place at the right time, I had the opportunity to work with a program for the Buck Institute for Research on Aging, which is just over the hill from where I live.

At the time, research was emerging that suggested that much of one’s risk for Alzheimer’s Disease is modifiable.

So I dove into the literature, and sure enough, there was hope after all.

I had the honor of developing a nutrition education curriculum and working one-on-one with patients and providers to use lifestyle (including nutrition) approaches to support their cognitive function.

The research and the hope have continued to grow. Alzheimer’s disease isn’t inevitable. Modifiable risk factors (meaning, things you can do something about) make up an estimated 45% of the risk for developing Alzheimer’s disease.

That isn’t a small number.

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What is cognitive health?

Cognitive health is the ability to think clearly, learn, remember, and make decisions that support independent daily life and overall well-being. It encompasses several interconnected domains of brain function, including:

Yes, cognitive health includes memory, but it is waaaaaay more than memory.

It is identity.

It is independence.

Is Cognitive Decline Inevitable?

For the most part, no.

A little slowing of processing speed — recalling a name, following fast conversations, for example — may be part of the brain aging process. But this certainly doesn’t impede identity or independence.

Anything more than mild processing speed changes is cause for investigation because it suggests there may be some pathology in the brain, disrupting how it functions.

Pathology is a complex word that I’m going to over simplify as something in the brain that isn’t supposed to be there. In the case of Alzheimer’s disease, the pathology is accumulation amyloid-beta and tau-tangle proteins.

Understanding the basics of the pathology of cognitive decline can provide you with the information and inspiration you need to decrease the risk that the pathology accumulates in the first place.

The list of factors that can decrease pathology accumulation is growing. A 2024 publication in The Lancet included 14 well-researched factors to consider, and that list is expected to grow.

More on that next week in Part 2.

As always, thanks for being here,

~Allison

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Please remember that this information is meant to educate and inspire but is not medical advise — please consult your healthcare team to determine what is most appropriate for you.

Today, we are diving into the world of micronutrients, understanding why I included many of the foods in my meal-planning template in Part 2, and the growing evidence that “whole” foods provide much more than their isolated parts.

Micronutrients

Micronutrients are underappreciated and misunderstood.

If macronutrients (protein, carbs, and fat) provide the raw materials for the body to function, repair, and build, then micronutrients are the cofactors, aka “workers”, that get stuff done.

The energy from carbohydrates, for example, doesn’t just jump to work as soon as you swallow. After a complicated process of digestion (breaking the carb down into its smallest units) and absorption (the smallest units moving to the bloodstream), an even more complicated metabolic process turns it into energy for the cells:

Don’t worry, I won’t test you later. This dizzying diagram demonstrates that Vitamins B1, B2, B3, & B5 (in brown), as well as minerals iron & magnesium (in purple), are essential for carbohydrate metabolism.

Now, consider that this is only one part of carbohydrate metabolism!

Without enough of vitamin and mineral cofactors in this, or any other of the numerous processes that occur throughout the body, your health, energy, and function are impaired.

Inadequate Vitamin B1, for example, can cause a condition called beriberi (very rare in the US), which may cause fatigue, weakness, numbness, heart failure, fluid retention, memory impairment, confusion, irritability, and more.

This condition can be avoided by regularly consuming whole or enriched grains, nuts & seeds, and soy, and avoiding chronic alcohol abuse, which is the main risk factor for this deficiency in the US.

Below are two charts I put together for a recent class. I was trying to show why I included each group of foods on the macronutrient chart shared and discussed in Part 2.1

I don’t want you to just take my word for it that eggs are a good protein source, for example. I hope that the charts below speak for themselves2.

You won’t be tested on these charts, either. Full disclosure, I would probably fail the test, too.

The point is to demonstrate all the good and important factors in each of the included foods.

After looking at this, I hope you can see that nuts & seeds, for example, are more than just trail mix. They are a secret source of more than half of the vitamins and minerals that your body needs to work at its best.

Well, there you have it. This is the end of my 3-part series, where I did my best to sum up the big take-home messages about the field of nutrition.

What was your top takeaway?

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Thanks for being here,

~Allison

Please remember that this information is meant to inform and inspire and is not personal health or medical advice. Please speak with your healthcare team about what is right for you.

1

Today, we are diving into the world of macronutrients (or “macros” as the world knows them now): Protein, Carbohydrates, and Fat.

Nutrition Trends

Each macro has had its time in the spotlight:

• The 1980’s and 90’s were the low-fat days

• The 2000’s brought around the stubborn low-carb craze

• We are currently in the midst of high-protein everything

The tricky thing about these fads is that each is based on what I call “a nugget of truth.” A nugget that, unfortunately, gets blown out of proportion, overgeneralized, and loses its nuance.

So what are the nuggets of truth for each of these macro fads?

• Low-Fat:

  • Eating too much of some kinds of fat may increase your risk of heart disease, obesity, and other chronic diseases.

    • This doesn’t apply to all fats. Sure, not overdoing it on the butter, bacon, cheese, etc. is generally a good approach. Unfortunately, the low-fat trend also pulled down unsaturated fats like those found in fatty fish, nuts, seeds, avocados, and olive oil, etc., which may decrease risk of heart disease, some cancers, Alzheimer’s disease, and more.

• Low-Carb:

  • Frequently consuming food and drinks high in added sugars & highly processed flours (which replaced much of the fat in the low-fat days) is linked to increased weight, blood sugar, and other metabolic-associated diseases.

    • This doesn’t apply to all carbs (sound familiar?). High-quality, minimally processed carbs such as fruits, beans, and sweet potatoes have no business being associated with sodas, chips, or cookies.

• High-Protein:

  • I’ve been convinced that the RDA (Recommended Daily Allowance) for protein greatly underestimates how much protein most of us need, especially in midlife and beyond. Adequate protein can help maintain muscle mass (which decreases with age), promote satiety (feeling satisfied between meals), and manage blood sugar.

    • But, this doesn’t mean that eating high-protein chips, ice cream, and popcorn (yes, these are all real products) is the answer to our health goals.

Meal Planning Principles

I don’t make meal plans for people, despite being asked for them all the time.

I’ve learned that even if I create what I think is the most amazing, delicious, and healthy meal plan, it is too subjective of a task for me to get it right for someone else (“oh, I don’t like avocado,” “I don’t know how to cook that,” “ugh, I can’t stand cottage cheese!”).

Instead, I’ve found that by teaching the principles I use to make a meal plan, not the meal plan itself, people are empowered and can make healthy eating their own.

Some overarching principles to keep in mind:

1. Meal planning needs to be realistic, sustainable, and enjoyable. If you love to spend 3 hours on a Sunday cooking meals for the week, great, go for it. If Sunday rolls around and meal prep is hovering over you like a black cloud of obligation, that’s probably not the right approach for you.

2. Use mostly “whole” foods and keep it simple. You don’t need to have gone to culinary school (I didn’t) or spend hours in the kitchen to eat healthy-ish, delicious meals. Simple is the key to making healthy eating realistic & sustainable. We’ve got lives to live, after all.

3. Put your food to work! By understanding how different macronutrients work in your body, you can manipulate how those macronutrients work to better meet your goals:

   1. Protein: Makes the meal more satisfying, promotes balanced blood sugar, and provides the building blocks for muscle growth & maintenance.

   2. Carbohydrates: Provide the energy you need to power your brain, heart, lungs, muscles, and more. “Single-ingredient” carbohydrates (see chart below) provide a slow, steady drip of energy between meals to help keep you alert and focused.

   3. Fats: Improve absorption of Vitamins A, D, E, and K, provide essential brain structure, and act as a secondary energy source.

   4. Fiber: While not really a macronutrient, the fiber found in veggies, beans, lentils, fruit, avocado, and nuts & seeds supports bowel function, blood sugar and cholesterol levels, and more.

Make it Your Own

If it sounds simple, it is. I’ve just walked you through the framework that I use with most of my patients. Understand what different macros do in your body, and then, depending on your needs and preferences, experiment with how changing the types, amounts, and pairings of different macros.

Use this simple chart to get you started. For most people, including a protein and a carb with each meal and snack is a good place to start, and if you can get a healthy fat and/or a starchy veggie in there too, awesome.

Thanks for being here,

~Allison

Be on the lookout for Part 3 coming up next week. Subscribe below to get it straight in your inbox:

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Please remember that this information is meant to inform and inspire and is not personal health or medical advice. Please speak with your healthcare team about what is right for you.

It is a challenge for me to distill the world of nutrition into just one post, or even just one month. So, I’ll be putting out a series of posts highlighting what I think are the big take-home messages and hopefully pass on a little awe about the human body while I’m at it.

So what is nutrition anyway? It is one of those terms that is thrown around without really grasping what it is referring to. My favorite definition is:

There’s a lot there. Way more than just eating your broccoli, that’s for sure.

Over the next several publications, I’ll do my best to break it down for you in a way that allows you to make better-informed choices about how you use nutrition to work toward your health goals.

Science

Nutrition is a science. Principles that I share are based on well-designed scientific studies. But science changes. When we learn better, we pivot, often leaving a generation of frustrated people in our wake. I get it. But I’d much rather admit when I got it wrong than dig my heels in the sand.

Nutrition is not a diet, a fad, a headline, or a supplement. Nor is it about perfection, restriction, or guilt. There is no one-size-fits-all here.

Nutrients

Much more about nutrients in the following posts. For now, know that nutrients include energy (Calories), macronutrients (protein, carbohydrate, fat), and micronutrients (vitamins, minerals, & phytonutrients). Stay tuned and subscribe to receive future posts, if you aren’t already.

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Digestion & Absorption

Cue the awe. Our bodies are amazing. When you take a moment to appreciate everything going on “behind the curtain,” it is remarkable and humbling to admire the orchestra that keeps us alive.

Digestion is the process of breaking down food using mechanical and chemical processes so that it can be absorbed. This occurs in the mouth, continues in the stomach, and really gets to business in the small intestines.

Absorption is the process of nutrients passing from the digestive tract into the bloodstream on their journey to provide energy and building blocks for growth, maintenance, and repair. Most absorption happens in the small intestine, with some further down in the large intestine.*

Metabolism

Metabolism is about so much more than body weight. It is all of the processes and reactions within your body (the “orchestra”) that keep you alive.

Metabolism powers your heart, lungs, brain, muscles, & more. (Fun fact: The brain makes up ~2% of body weight but uses about 20% of energy at rest).

Metabolism builds, maintains, & breaks down muscle, bone, body fat, hormones, enzymes, & immune cells.

Metabolism helps manage blood sugar, facilitate nerve signaling, fluid & electrolyte balance, inflammation, body temperature, and cell, tissue, & organ repair.

Metabolism keeps you alive.

Thanks, body, for being so remarkable.

That’s all for today. Next time, we will dive into the “macros” and how to build a meal that lasts.

Thanks for being here,

~Allison

Please remember that this information is meant to inform and inspire and is not personal health or medical advice. Please speak with your healthcare team about what is right for you.

*I recently gave a class where I went (probably too) deep into my fascination with digestion. Here is the visual I shared. Even if you can’t make sense of it, hopefully you can appreciate the beautiful complexity:

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This is the third and final installment in my “Matters of the Heart” series. Part 1 introduced the basics of cardiovascular health, Part 2 explored how to evaluate your risk of cardiovascular disease, and today is an overview of how nutrition contributes to heart disease risk1:

More Oat Recipes to Try:

• Savory Breakfast Oatmeal

• Dinnertime Baked Oats

• Creamy Protein Oatmeal

• Overnight Oats Starter Recipe

While I was preparing the above oat-based recipes in a recent class, I fielded some great questions about food, nutrition, & heart health. Here is a sneak peek at what we discussed:

• “What can I do to lower my triglycerides?”

  • Triglycerides are a type of fat affected by much more than dietary fat intake. If you are trying to lower your triglyceride levels, here is a checklist to get you started:

    1. Limit or avoid alcohol.

    2. Limit highly processed carbohydrates, including:

       1. Beverages that contain carbohydrates/sugars — even “natural” beverages such as fruit juices.

       2. Added sugars, including refined sugars as well as “natural” options (see below). You can now find “added sugars” on the nutrition facts label. I typically recommend consuming no more than 25g of added sugar per day.

    3. Limit saturated fats:

       1. Saturated fats are fats primarily found in animal-based products. This includes fatty meats, poultry skin, butter, cheese, cream, etc.

          1. Exception #1: Fat coming from most fish is low in saturated fat.

          2. Exception #2: Fat from tropical oils (coconut, palm) also contains saturated fat, despite being plant-based.

• “Is honey better than sugar?”

  • Not really. Honey, maple syrup, agave, coconut sugar, and similar sweeteners are often marketed as “healthier,” but they raise blood sugar and triglycerides much like refined sugar.

    One advantage of honey or maple syrup is that their stronger flavor may allow you to use less, which can help reduce overall sugar intake. However, they should still be used in moderation.

• “Is bread a highly processed carb?”

  • It depends. All grain-based flours are made by grinding the whole grain, which breaks it down and makes the carbohydrate easier for your body to digest and absorb.

    If the flour is refined (like white flour), the fiber-rich bran and nutrient-dense germ are removed, leaving mostly the carbohydrate-rich center. This makes refined bread more processed and typically faster to raise blood sugar.

    So yes, most breads are processed to some degree. However, that doesn’t mean they can’t fit into a healthy diet. Whether and how they fit in depends on your overall eating pattern, metabolic health, activity level, and personal goals.

• “Does gluten-free mean low carb?”

  • Not necessarily. Gluten is a protein found in wheat, rye, and barley. When products are labeled gluten-free, they typically replace those grains with ingredients like rice flour, tapioca starch, potato starch, or cornstarch.

    While these alternatives are gluten-free, they are still carbohydrate-dense and can raise blood sugar, sometimes even more quickly than whole-grain, gluten-containing options. Gluten-free does not automatically mean lower in carbs or healthier overall.

Thanks for being here,

~Allison

I’m pleased to announce that the American Heart Association (AHA) & American College of Cardiology (ACC) have updated cholesterol guidelines in effort to increase early testing and intervention to reduce risk of cardiovascular disease!

Learn more HERE!

Before we get started today, I’m excited to share that I have a new website! I like to think of it as the hub where you can find everything I’m up to (my writing, radio show, upcoming events, etc.). You can find it at allisonmckeany.com!

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This is the second of three installments in my “Matters of the Heart” series. Part 1 introduced the basics of cardiovascular health. Today’s post is all about evaluating your current and future risk of cardiovascular disease.

Evaluating Your Risk

Knowing where you stand on each of these objective markers of cardiovascular health can help you prioritize lifestyle changes, monitor if interventions are effective, and help guide discussions with your healthcare team about the need for any medical management of your risk1.

1. Goal Blood Pressure (BP): <120/80 mmHg — Chronically elevated blood pressure damages blood vessels throughout your body (heart, brain, kidneys, eyes, etc.).

   1. Follow these tips to ensure you are getting an accurate blood pressure reading at home or in the doctor’s office.

2. Goal Resting Heart Rate (RHR): <80 bpm — A higher resting heart rate strains the heart muscle over time, increasing blood pressure and increasing risk of cardiovascular disease.

   1. Here is a step-by-step guide to measuring your resting heart rate.

3. Cholesterol is carried through the blood by lipoproteins (such as LDL and HDL). It is essential for building cell membranes and hormones, but elevated levels of certain types of lipoproteins can contribute to plaque buildup in arteries.

   1. While Total Cholesterol was initially thought to be a good marker for cardiovascular disease risk, we now know that different types of cholesterol provide a more nuanced assessment:

      1. Goal Fasting LDL-Cholesterol: <70 mg/dL2

      2. Goal Fasting Non-HDL-Cholesterol: <100 mg/dL3

      3. Goal Fasting HDL-Cholesterol: >60 mg/dL4

4. Goal Fasting Apolipoprotein B (ApoB): <40 mg/dL5 — ApoB is a protein found on all plaque-forming lipoproteins, providing a better indicator of cardiovascular disease risk than LDL-C alone.

5. Goal Lipoprotein(a) (Lp(a)): <50 nmol/L6 — Lp(a) is a genetically-determined type of LDL with an extra protein attached that is an independent risk factor for cardiovascular disease.

6. Goal Fasting Triglycerides (TG): <100 mg/dL — Elevated triglycerides contribute to plaque formation.

   

7. Goal Fasting Blood Glucose (FBG): <90 mg/dL — Chronically high blood glucose (aka “blood sugar”) damages the lining of blood vessels, resulting in inflammation that supports plaque formation and accumulation.

8. Goal Hemoglobin A1c (HgA1c): <5.2 % — A marker of long-term (~3 months) blood sugar levels.

9. Goal Fasting Insulin: <5 µIU/mL — Released by the pancreas in response to rising blood sugar levels, high fasting insulin is an early marker of poor blood sugar management, even if blood sugar levels are at goal.

10. Goal Homocysteine (Hcy): <9-10 µmol/L (age dependent) — Elevated levels damage blood vessels and increase risk for plaque formation and blood clots.

11. Body Composition — Excess body fat, especially in the midsection (visceral fat), increases blood pressure, cholesterol, blood sugar, and inflammation.

    1. Although total body weight and Body Mass Index (BMI) reflect overall body weight, they do not account for the distribution of fat throughout the body.

    2. Assessment of visceral fat provides a more accurate indicator of cardiovascular disease risk:

       1. Goal Waist Circumference: Men <40”, Women <35”

          1. Use this guide to accurately measure your waist circumference at home.

       2. Goal Waist-to-Hip Ratio: Men <0.90, Women <0.85

          1. Here’s a handy ratio calculator.

Navigating today’s medical system requires self-advocacy. If your doctor isn’t yet aware of the updated guidelines, here are a few resources to share:

American Heart Association

JAMA Learning Network - What’s new in the updated lipid guidelines? (March 27, 2026)

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Thanks for being here,

~Allison

Significance

February is American Heart Month, a time when we celebrate love and (hopefully) the amazing organ that is our heart.

Surprisingly, heart disease continues to be the leading cause of death for both men and women in the US,1 even though we’ve learned so much about risk factors and both lifestyle and pharmaceutical management.

Heart disease, or more broadly, cardiovascular disease, encompasses several conditions that affect the heart muscle and/or the blood vessels that circulate blood throughout the body.

Blood delivers oxygen, nutrients, and immune cells and removes waste products that would otherwise be toxic.

Every cell in your body depends on adequate blood flow to survive.

In that sense, taking care of your cardiovascular health is taking care of your whole body health.

Definitions:

The most common cardiovascular diseases include:

• Heart Attack: Sudden blockage of blood flow to the heart muscle.

• Stroke: A blocked or ruptured blood vessel in the brain.

• Coronary Artery Disease (CAD): Narrowing of arteries caused by the buildup of plaque (atherosclerosis).

• Heart Failure: Weakened heart muscle, which includes symptoms such as fluid accumulation (edema), fatigue, & shortness of breath.

• Peripheral artery disease (PAD): Narrowing of arteries and decreased circulation in the arms and legs.

• Arrhythmias: The heart beats too fast, slow, or irregular; Atrial Fibrillation (AFib) is the most common.

Risk Factors:

Cardiovascular disease risk factors include both non-modifiable and modifiable.

Non-Modifiable Risk Factors (Things we can’t change, but are important to be aware of):

• Age — Risk increases with age.

• Sex at birth — Men are at an increased risk earlier in life, and women are at increased risk postmenopause.

• Genetics / Family history — Especially for early heart disease in close relatives.

Modifiable Risk Factors (Things we can change):

• Smoking — Injures blood vessels, increases blood pressure, & increases risk of atherosclerosis.

• Nutrient intake — Excess salt, sugar, & unhealthy fats increase blood pressure, cholesterol, & inflammation that promotes atherosclerosis.

• Alcohol — Excessive intake raises blood pressure.

• Inactivity — Reduces blood circulation & weakens the heart muscle.

• Sleep — Poor sleep quantity & quality increases blood pressure, blood sugar, & inflammation.

• Stress — Chronic stress increases blood pressure & inflammation.

This is a lot of information, I know, which is why I am going to end here for today. I will follow this up with a piece about the objective markers that you can use to evaluate your cardiovascular health now and ongoing (blood pressure, labs, etc.). Subscribe to stay tuned!

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Thanks for being here,

~Allison

Please remember that this information is meant to educate and inspire, but is not medical advice. Please consult your healthcare team to determine what is most appropriate for you.

Thanks for being here,

~Allison

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P.S. - Photo credit goes to Uncle Mark, who was the lucky recipient of my last batch of muffins.