I’m not a doctor or nutrition professional. This article reflects my personal views and experience only — not medical advice.

Cardiac health is a big topic.  Many (all?) of the practices to improve heart health will benefit overall health.  Humans also tend to create oversimplified heuristics.  There are no silver bullet fixes.  It’s important to start by looking layers below the surface, e.g., “exercise” and “nutrition” have vague definitions.

Exercise

I’m going to focus on nutrition here.  Exercise is a huge topic itself, but worth a couple important points here.  Not all exercise is equal.  E.g., “Steps” are not sufficient.  And I cringe when I see people reading on the stationary bike, or holding up their weight on the Stairmaster.  Doing “time” like this is only cheating yourself.  When you get to Ironman shape (and realize this is how you should always feel), you see how low the exercise bar is set by society.  Consider doing all three of these types of exercise:

Balance and flexibility are also important, especially as we age. Stretch after workouts when skeletal system (muscles, ligaments, tendons) are warmed up to avoid injury.

If you need a spark, commit to something — sign up for a 10K, join a training group or class, or bring on a coach. Sometimes a clear target is all it takes to get moving. Exercise isn’t just good for you; it’s the closest thing we have to a real-life fountain of youth.

Nutrition

This topic is a “black hole”. If you’re ready to take the “red pill” (truth over comfort), then my blog Knewtrition.com has a getting started reference list here.

Measure

Michael Pollan says it well in Omnivore’s Dilemma: We can eat so many things, but what should we eat?

“You can’t manage what you don’t measure.” Start by measuring what you can. Following are key items you want to measure for heart health. Start by creating a baseline you can then measure against over time.

Blood Tests

• Cholesterol:
  • Total Cholesterol: Important but overhyped. Plenty of people with high cholesterol have no issues, and plenty with low cholesterol do have issues. I’ve watched the pharma industry lower the target number over the years, and having worked in CPG, I can imagine product managers seeking research to justify selling more product. (< 200 mg/dL ideal)
    • HDL: high density as a ratio of total is good (> 40)
    • LDL & VLDL: low and very low density lipids are the worst (LDL < 160, VLDL < 40, LDL/HDL < 3.5)
  • Homocysteine: See more info below (< 14 µmol/L)
  • C-Reactive Proteins (CRP): Stronger short-term risk predictor than LDL. Indicator of inflammation, which can drive cardiac plaque buildup. Even lower cholesterol with high CRP can indicate higher risk of artery rupture, clot and heart attack or stroke. Ideally, measure high-sensitivity CRP (hs-CRP).
  • Apolipoprotein B (Apo B): Actual count of plaque-causing particles. (< 3 mg/dL)
  • Glycated Hemoglobin (HbA1c): high long term glucose in blood can accelerate arterial plaque formation and indicate pre-diabetes. (< 5.6%)
  • Lipoprotein A (LPA): Mostly genetic, and hard to affect, so measure it once to get sense of genetic plaque risk. (< 30 mg/dL)

Other Tests

• VO2 max: good measure of how strong your heart-lung-circulatory system is, especially under load. Can identify hidden cardiac issues you won’t catch in blood tests.
  • Excellent: top 20% for your age/sex.
  • Protective zone: ≥40 mL/kg/min for most adults.
  • Athletic: 50–60+.
  • Elite endurance: 70–90.
• Resting HR (RHR): good measure of fitness level. The higher RHR, the higher your heart has to work just to maintain baseline. Each 10 bpm above 60bpm is linked to 10-20% rise in cardiac mortality.
  • Elite/very fit: 40–55 bpm
  • Healthy: 55–65 bpm
  • Borderline: 65–75 bpm
  • Higher risk zone: >75–80 bpm
• Blood Pressure: Hypertension (high blood pressure) is a leading cause of heart attacks/failure and strokes.
  • Optimal: Systolic <120 / Diastolic <80
  • Elevated: 120–129 / <80
  • Stage 1 HTN: 130–139 / 80–89
  • Stage 2 HTN: ≥140 / ≥90
• Ultrafast CT Scan: This is a video CT scan of your heart as it pumps. CT is still radiation, so don’t do this too often.
• Noninvasive tests for plaque also exist. e.g., a “Coronary Artery Calcium (CAC) score” can be done during the heart CT scan. There’s also a Carotid Ultrasound test. These are not guaranteed to determine if you have plaque built up in other arteries but they tend to be pretty well correlated.

There’s plenty more you can measure but tracking these will give you a pretty good view of your cardiac risk. And remember, if your doctor says it’s not covered by your insurance, that does not mean you can’t pay for it yourself — it never hurts to ask how much would it cost out of pocket.

Tipping the Scales

David Servan-Schreiber, MD, PhD wrote a great book Anticancer. While it’s focused on cancer (the author had brain cancer), a key point applies to nutrition in general. Your body needs good nutrition. Your body fights toxins. If your body gets too much toxin and insufficient nutrition, it loses its health battle.

Human Hubris

Your body needs a wide spectrum of nutrients (see “Diverse Nutrition Needs and Sources” below). Because we love quick fixes — and because the media loves simple headlines — you constantly hear point-solution advice: “You need more B12,” “Get enough omega-3s,” “Boost your iron,” and so on. They can’t all be wrong, and they aren’t. Your body really does need all of these things. The problem is thinking any one of them is the answer.

Supplement companies lean into this by selling you bottles for every micronutrient under the sun. But the truth is, we still don’t fully understand how the body extracts, packages, and uses nutrients inside real foods. There may be combinations of compounds in an apple — fiber, polyphenols, enzymes, and vitamins — that work together in ways we can’t easily replicate.

So instead of trying to reverse-engineer nature with a handful of isolated supplements, just eat the apple. Whole foods give your body the nutrients it needs in the form it evolved to absorb.

Empty Calories

To get all the nutrients your body needs, you have to eat a variety of foods — and those foods naturally come with calories. When you focus on whole, unprocessed foods, the calories that come along with that variety generally line up with what your body actually requires.

But when you eat non-nutritious, ultra-processed foods, you’re forced into a tradeoff:

• You can stay within your calorie limit but fall short on essential nutrients, or
• You can try to meet your nutrient needs through more food, but end up consuming excess calories that get stored as fat.

Whole foods make it easy to get both adequate nutrition and appropriate calories; ultra-processed foods make it almost impossible.

Industrialized Food Production

Farming let humans shift from nomadic hunters and gatherers to settled communities, but it also narrowed the range of foods we eat. Modern agriculture and large-scale production have pushed this even further. Selective breeding and genetic modification often prioritize yield — especially sugar-heavy crops like corn — over nutrient density. That’s why you have to look for heirloom varieties in stores to get a sense of what many foods used to be like nutritionally. Even the word “organic” shows how far we’ve drifted — it now describes the original way crops were grown (without synthetic pesticides or chemical inputs). Modern agriculture assumes chemicals as the default, yet the label that should read “chemically treated” or “pesticide-grown” is instead the unmarked norm.

Many livestock are raised on diets they were never built to eat — often masses of cheap, calorie-dense feed instead of the grasses or varied forage their systems evolved for. These mismatched diets make animals unhealthy and dependent on antibiotics, and changes the nutritional composition of their meat – e.g., throwing off the natural balance of omega-3 and omega-6 fatty acids and promoting inflammation. As Michael Pollan puts it: “It’s not just what you eat — it’s what what you eat eats.”

Food companies layer on another problem: they’ve figured out how to engineer hyper-palatable products. Our tastebuds evolved to reward scarce, energy-dense foods like animal fats and sugars. By loading ultra-processed foods with cheap inputs like corn syrup and industrial fats, companies create products that taste “great” but offer almost no nutrition — and often cause harm.

A simple way to stay oriented is to ask: What did our bodies evolve to eat? Mostly plants, berries, nuts, roots, and other whole foods — with only small amounts of meat when available. Eating closer to that pattern supports heart health, reduces inflammation, and naturally improves metabolic markers across the board.

The Carb Myth

Beware of oversimplifying nutrition terms like “carbs.” A good example is the word “fat,” which carries multiple meanings that often get blurred. Food companies promote “low fat” products because people assume that eating fat makes them fat. In reality, certain fats are essential for health.

Ultra-processed ingredients found in everything from Twinkies to Goldfish to many packaged pastas are stripped down so much that their carbohydrates hit the bloodstream as sugar almost instantly. That rapid spike comes with almost no real nutrition, so the body stays hungry even after you eat. That’s why, when foods like Twinkies or soda get treated as “meals,” you end up reaching for more, and the cycle pushes you toward weight gain, diabetes, and long-term heart problems.

Unfortunately, health experts call these “Carbs” but the real culprit is simple carbs. The mistake is avoiding all carbs, because guess what — fruits and vegetables which contain most of the nutrients we evolved to need also contain a lot of “carbs”. These are not bad carbs. These are parts of whole foods we must be eating.

A better way to think about carbs is through the glycemic index. Many people worry that fruit will “spike their sugar,” but fruit comes packaged with fiber that slows digestion, so natural sugars enter your system gradually instead of flooding it. This slow release is a major focus in diabetes prevention, but it’s just as important for heart health. Repeated sugar spikes drive inflammation, raise triglycerides, and increase the metabolic stress that damages arteries over time. Managing carbs wisely helps stabilize energy, protect your heart, and deliver health benefits that extend far beyond blood sugar control.

Microbiome Matters

Your mouth and gut are more than separate stops—they’re part of the same system. Emerging research shows a strong connection between the oral microbiome (the bacteria and other microbes in your mouth) and the gut microbiome—and through them both, your overall cardiovascular health can be impacted.

Why it matters:

• Harmful bacteria in the mouth (for example from gum disease) can travel into the digestive tract, disrupt the gut microbiome and contribute to inflammation. Whole Dental Wellness+1

• A poor gut microbiome can weaken nutrient absorption—vitamins and minerals key for dental (and heart) health may suffer. EatingWell

• Both mouth & gut inflammation can contribute to systemic inflammation, which is a major risk factor for heart disease.

Actionable steps you can take:

• Brush twice a day, floss daily. A water flosser will remove particles brushing and flossing miss. Plus, using a gum stimulator, and seeing your dentist regularly can keep your oral microbiome in check.

• Focus your diet on fiber-rich whole foods, minimize refined sugar and simple processed carbs which feed harmful oral and gut bacteria.

• Include probiotic or fermented foods (yogurt, kefir, sauerkraut) and prebiotic fruits (e.g., apples, slightly green bananas, berries, kiwi, pomegranates) & vegetables (e.g., onions, garlic, leeks) to support gut flora. I’m personally a big fan of vegan organic kefir.

• Stay hydrated and avoid frequent snacking on sugary/acidic drinks—acidic exposures harm enamel, and frequent food/drink feed bad microbes.

• Manage reflux or GI issues (if relevant) since acid or microbial changes in the gut often show up in dental damage or gum issues.

Reference

Homocysteine

Kilmer S. McCully is the researcher you’re likely referring to. In the late 1960s, while studying homocystinuria—a genetic disorder causing extremely high homocysteine levels and premature atherosclerosis—he proposed the “homocysteine theory of arteriosclerosis.” This argued that elevated homocysteine directly injures arterial walls, promotes plaque buildup, and drives cardiovascular disease, based on autopsy findings in affected patients.

McCully extended this to the general population, suggesting homocysteine as a stronger causal factor than cholesterol, which he viewed as a mere correlate or marker of underlying vascular damage. His 1969 paper in the American Journal of Pathology highlighted how homocysteine thiolactone (a derivative) could cause arterial lesions in animals, mimicking human atherosclerosis—independent of cholesterol levels. By the 1990s, his work, including books like The Homocysteine Revolution (1997), popularized the idea that lowering homocysteine via B vitamins (like folate, B6, and B12) could prevent heart disease more effectively than cholesterol-focused interventions.

This challenged the dominant lipid hypothesis at the time. Early studies, like a 1995 meta-analysis by Boushey et al. in JAMA, supported his view by showing a 5 µmol/L rise in homocysteine matched the heart disease risk of a 20 mg/dL cholesterol increase. However, later randomized trials (e.g., NORVIT, HOPE-2) found no cardiovascular benefits from B-vitamin supplementation, leading many to reclassify homocysteine as a risk marker rather than a direct cause—though McCully maintains it’s causal, criticizing trial designs for not addressing long-term effects.

Kilmer S. McCully was ostracized by much of the medical community for decades after proposing his homocysteine theory in the late 1960s, which challenged the emerging cholesterol-centric view of heart disease. Here’s a quick rundown:

• Initial Reception (1960s–1970s): As a young Harvard pathologist, McCully’s work linking elevated homocysteine to arterial damage was met with “stony silence” and outright rejection. Colleagues dismissed it as fringe, especially as massive, cholesterol-focused trials (costing hundreds of millions) gained traction. He was frozen out of grants, promotions, and collaborations, leading to his departure from Harvard in 1979.
• Career Fallout (1980s–1990s): Denied positions at top institutions like Massachusetts General Hospital for over two years, he was effectively “banished to the basement” at a less prestigious VA Medical Center in Providence, RI. His professional status tanked—he was shunned, ignored, and even denounced by peers, forcing him to commute long distances just to keep working.
• Vindication and Legacy: By the mid-1990s, as evidence mounted (e.g., meta-analyses showing homocysteine’s risks rivaled cholesterol’s), his ideas resurfaced. He earned the nickname “father of homocysteine,” published books like The Homocysteine Revolution (1997), and was profiled in The New York Times Magazine as a “medical outcast” who rose again. Trials followed, though results were mixed—some saw homocysteine as a marker, not just a cause, but his work influenced nutritional approaches to heart health.

Tragically, McCully passed away in February 2025 at 91, but his story remains a classic case of paradigm-shifting science facing institutional pushback. Alternative theories (like homocysteine over pure cholesterol focus) deserve at least a second look.

His ideas remain influential in nutritional cardiology, especially for those skeptical of statin-centric approaches.

Diverse Nutrition Needs and Sources

Bottom Line

Pick the big levers and repeat them.  Train across cardio, intensity, and strength. Center meals on real, minimally processed foods while limiting simple carbs and ultra‑processed snacks. Protect your oral and gut health. Track progress with the markers and imaging that best reflect your risk, and retest on a sensible cadence so you can course‑correct. Simplicity plus consistency is what compounds.