Great cardiometabolic health is the first line of defense against serious chronic diseases like heart disease and type 2 diabetes. But one study of 55,000 American adults found less than 7% had optimal levels of the major determinants of cardiometabolic health. While these types of studies may seem disheartening, all hope is not lost. The truth is, great cardiometabolic health can be restored and maintained when the underlying causes are addressed. 

Since poor nutrition is a significant contributor to cardiometabolic dysfunction, diet is one of the most impactful therapies practitioners have at their disposal. Let’s take a tour through the Cardiometabolic Food Plan from the Institute for Functional Medicine (IFM).

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What is Cardiometabolic Health?

Cardiometabolic health is a relatively new term used to describe the fitness of the cardiovascular system and the overall metabolic health of the body. Cardiometabolic health is determined by assessing parameters like waist circumference, blood pressure, and blood levels of cholesterol, triglycerides, and glucose. When an individual has two or more of these risk factors, the chance of having a heart attack or stroke doubles and the risk of developing type 2 diabetes increases five-fold. On the other hand, having optimal levels of these seems to impart protection from these chronic diseases.

Cardiometabolic dysfunction is present if blood pressure is 130/85 millimeters of mercury or higher, if blood sugar is 100 mg/dL or higher, if insulin resistance or excess body fat around the abdomen (more than 35-inch waist circumference for women and more than 40 inches for men) are present, if blood triglycerides are 150 milligrams/dL or higher, and/or blood cholesterol is imbalanced (an HDL cholesterol of less than 40mg/dL in men or less than 50mg/dL in women). 

Risk Factors And Prevalence Of Cardiometabolic Conditions

Cardiometabolic diseases share some common underlying features, most notably inflammation, insulin resistance, and obesity. While there are some risk factors that are out of our control. like age and genetics, the vast majority of cardiometabolic disease risk factors are diet- and lifestyle-related. Some of the most common, controllable risk factors include consuming an inflammatory diet, having limited physical activity, not getting enough quality sleep, having unmanaged stress, and consuming alcohol or smoking. 

Despite many public health initiatives, the cardiometabolic health of Americans is poor and continues to worsen. It’s now estimated that about one-third of American adults have metabolic syndrome (as defined by having three of the five above risk factors), which has likely contributed to the fact that cardiovascular disease remains the number one cause of death. In addition, more than 37 million Americans have diabetes (28.7 million with a confirmed diagnosis and 8.5 million are undiagnosed), and another 96 million have prediabetes. 

Cardiometabolic diseases have personal ramifications but they’re also a burden on the already stressed healthcare system. Fortunately, there are many nutrition and lifestyle strategies that can help to reverse cardiometabolic risk factors to restore vibrant health.

Impact Of Diet On Cardiometabolic Health

Over the past several decades, Americans have gotten away from traditional diets, which were rich in whole-foods, and they’ve moved to more convenience-type fare. This has created a standard American diet full of processed foods that contain significant amounts of sugar, salt, and inflammatory fats. This type of meal pattern is thought to be a significant contributor to the rise of various chronic diseases like obesity, diabetes, cardiovascular disease, and cancer.  Part of the reason may be due in part to excess calories and fat in the diet, which has downstream effects of poor mitochondrial function and increased fat storage. Excess lipid storage ultimately allows fat to accumulate in and around organs like the liver, muscle, pancreas, and heart. Increased fat storage in these areas impairs insulin secretion and also contributes to insulin resistance, both of which significantly increase the risk of cardiometabolic dysfunction and ultimately type 2 diabetes and cardiovascular disease.   

But just as poor-quality food can create a disease-promoting environment in the body, nourishing foods can have the opposite effect. Plant-centric diets rich in whole grains, fruits, vegetables, nuts, beans, and seeds are associated with lower rates of cardiovascular disease and type 2 diabetes. This may be due to their bioactive compounds called phytonutrients that positively impact metabolic pathways and modulate inflammation. In addition, high-quality animal foods like lean red meat, fish, and poultry contain nutrients like omega-3 fatty acids, which may help to protect against cardiometabolic diseases.

The Cardiometabolic Food Plan is Designed for the Following Individuals:

The Cardiometabolic Food Plan is a balanced way of eating that’s beneficial for anyone hoping to maintain excellent cardiometabolic health as they age. But IFM designed this meal plan as a therapeutic option for people who want to reverse cardiometabolic dysfunction. As such, this food plan can be used for anyone who:

• Has been diagnosed with or has the risk factors for cardiovascular disease such as high blood pressure, high cholesterol, and obesity. 
• Has been diagnosed with type 2 diabetes mellitus, metabolic syndrome, or their risk factors like high blood sugar and increased abdominal fat.

Principles of a Cardiometabolic Food Plan

The Cardiometabolic Food Plan is a whole-foods way of eating designed to target the underlying causes of cardiometabolic disease like inflammation, insulin resistance, and obesity.  This meal plan is based on a modified Mediterranean diet with an emphasis on specific therapeutic foods. 

Modified Mediterranean 

The Mediterranean diet, which is rich in plant-based foods, fish, and healthy fat, is a well-researched meal plan that's been found in many studies to significantly lower the risk of cardiometabolic diseases, in part, by improving levels of insulin, glucose, cholesterol, and triglycerides in the body, and by reducing waist circumference.  

Low Glycemic, Low Simple Sugar, High Fiber

Poor blood sugar control is a hallmark of cardiometabolic dysfunction. One goal of the Cardiometabolic Food Plan is to keep blood sugar and insulin levels pretty constant throughout the day, which not only decreases the risk of cardiometabolic dysfunction but also helps to control hunger and mood. Since food significantly impacts blood sugar regulation, this meal plan highlights low or medium glycemic foods, limits sources of simple sugars, and focuses on fiber to prevent large swings in blood sugar and insulin levels, as well as improve gut health and balanced cholesterol levels.

Targeted Calories and Routine Meal Times

Tailoring calorie recommendations isn't always necessary, but the Cardiometabolic Food Plan provides practitioners with this option. Giving certain patients specific serving recommendations in each of the food categories may help with weight loss, nutrient balance, and create a foundation for meal plan structure.

Likewise, eating at routine times can help to establish structure in daily habits but also provides adequate nutrients, which are necessary for energy, blood sugar management, and satiety.  

Condition-Specific Phytonutrients

Certain phytonutrients (unique, health-promoting plant compounds) are beneficial for cardiometabolic health by controlling blood sugar, improving cholesterol balance, and normalizing blood pressure. For example, cinnamaldehyde found in cinnamon, soybean isoflavones, and beta-glucan from oats and barley help with blood sugar regulation. The carotenoids in tomatoes, polyphenols in green tea and dark chocolate, and the hydroxytyrosol in olive oil help to reduce the oxidation of LDL cholesterol. And the quercetin in onions, sulfur in garlic, and pomegranate polyphenols can help to reduce blood pressure. The Cardiometabolic Food Plan highlights these phytonutrients and includes specific recommendations for how to harness their benefits.

Balanced Quality Fats

People with cardiometabolic dysfunction may be under the impression that they need to avoid all types of dietary fat. But high quality, healthy fats like unsaturated fats (mono- and polyunsaturated) have been found to improve lipid levels, lower blood pressure, support brain health, and decrease inflammation. 

Components of a Cardiometabolic Food Plan

The Cardiometabolic Food Plan encourages a wide variety of whole, unprocessed foods. It also highlights certain phytonutrients and specific therapeutic foods that have been found to improve cardiometabolic function. Here are the recommended foods and why they’re included:

Healthy Carbohydrates: Fruits and Vegetables

There are two main categories of vegetables: starchy and non-starchy. The Cardiometabolic Food Plan encourages the liberal use of a variety of non-starchy vegetables daily as they’ve been found to protect against cardiometabolic diseases. Ideally, aim for 8-12 servings per day (1 serving equals ½ cup cooked or 1 cup raw), and choose a wide variety of colors. Therapeutic options include all greens such as beet, collard, dandelion, kale, mustard, turnip, chard/Swiss chard, and spinach as they’re great sources of nitrates that help to control blood pressure; onions since they may reduce blood clotting and blood fat levels, they contain the antioxidant quercetin, and detoxification-supporting sulfur compounds; and tomatoes, which contain heart-protective carotenoids.

When it comes to the starchy vegetables, low to medium-glycemic options are limited to one serving per day in order to keep blood sugar levels stable. Beets are the therapeutic option in this category as they contain a wide variety of heart-healthy compounds.

Fruit contains phytonutrients that help with blood pressure and blood glucose but they do have natural sugar, which can impact blood sugar levels. To minimize the impact on blood sugar, it’s best to eat fruit with a meal rather than alone and to limit it to two servings of fruit per day. Dried fruit and fruit juices (except for pomegranate juice) should be avoided.  Particularly therapeutic options include blueberries, which are very high in antioxidants and have been shown to lower blood pressure and reduce heart attack risk, and pomegranate juice, which has been shown to lower blood lipids, blood pressure, and plaque in the arteries. 

Lean Proteins 

The Cardiometabolic Food Plan includes a mix of plant and animal protein at every meal to help control blood sugar and hunger levels. Protein is a macronutrient made up of various amino acids that help to create new proteins for a variety of functions in the body. On this food plan, IFM recommends protein to account for about one-third of daily calories, unless contraindicated.  Choose lean, free-range, grass-fed, organically grown animal proteins, non-GMO, organic plant proteins, and wild-caught, low mercury fish if able. Particularly therapeutic options include soy-containing proteins (miso, tofu, tempeh, and soy protein), which are associated with lower blood pressure and better cardiovascular health. And fish that are high in omega-3 fatty acids (anchovies, herring, mackerel, salmon, sardines, and trout), which have been found to reduce blood pressure and the risk of a cardiovascular-related death. 

Heart-Healthy Fats 

Healthy fats are a source of energy for the body, but they’re also vital for cell structure, healthy brain function, and the absorption of the fat-soluble vitamins A, D, E, and K.  In addition, unsaturated fats (mono- and polyunsaturated) have been found to improve lipid levels, lower blood pressure, and decrease inflammation.  The Cardiometabolic Food Plan recommends fats and oils comprise about one-third of daily calories, with saturated fats being minimized and trans fats being avoided all-together. 

Choose minimally processed, cold-pressed, organic, non-GMO varieties of avocado, butter, coconut milk, ghee, cooking oils like coconut, grapeseed, extra virgin, rice bran, and sesame. And salad oils like almond, avocado, canola, flaxseed, pumpkin seed, high-oleic safflower and sunflower, and walnut.  Therapeutic fats and oils to highlight include avocado, which contains heart-healthy fiber, monounsaturated fats, and potassium; olives and extra-virgin olive oil, which contain polyphenols to lower blood pressure and prevent the oxidation of LDL cholesterol; and cocoa, in the form of dark chocolate, which has favorable blood pressure effects and is protective against free radicals.

Nuts and seeds are also great sources of healthy fats and protein, and they provide micronutrients like magnesium, which helps to control blood sugar and insulin levels.  On the Cardiometabolic Food Plan, choose 1-2 servings (serving size depends on the type of nut) each day of unsweetened, unsalted, and organic almonds, Brazil nuts, cashews, chia seeds, flaxseeds, hazelnuts, hemp seeds, macadamia nuts, peanuts, pecans, pine nuts, pistachios, pumpkin seeds, sesame seeds, soy nuts, sunflower seeds, walnuts, and their butters. Therapeutic options include flaxseed, which contains healthy fat and phytonutrients known to reduce CVD and metabolic syndrome risk. And mixed nuts and soy nuts, which contain plant sterols, healthy fat, polyphenols, and fiber to reduce inflammation and CVD risk.

Fiber-Rich Foods: Legumes and Whole Grains

Legumes provide protein, but they’re also a great source of complex carbohydrate, which provides needed fiber for gut health to lower inflammation levels. In addition, legumes provide micronutrients like B vitamins, potassium, and magnesium, many of which are lacking in the standard American diet. The Cardiometabolic Food Plan recommends one serving per day of legumes (serving size depends on the type of legume), which can include organic and non-GMO varieties of beans, soybeans, lentils, and green peas. Therapeutic options include black soybeans and edamame, which contain phytoestrogens that help to reduce blood pressure and CVD risk.

Whole grains provide a variety of micronutrients, fiber, and phytonutrients, which help to balance cholesterol and blood sugar levels. The Cardiometabolic Food Plan recommends limiting to 2 servings of organic, non-GMO whole grains per day (serving sizes vary based on the type of grain).  If celiac disease or gluten sensitivity are an issue, choose gluten-free options like amaranth, buckwheat, millet, oats, quinoa (not technically a grain), rice, sorghum, and teff. Gluten-containing grains include barley, bulgur, couscous, crackers, kamut, spelt, whole-grain cereals, bread, granola, pasta, and tortillas. Oats and barley are the two therapeutic options in this category as they contain beta-glucans, a type of fiber that helps to manage cholesterol and blood sugar levels. 

Therapeutic Foods on The Cardiometabolic Food Plan

The therapeutic foods listed above contain phytonutrients that help to reduce cardiometabolic risk factors like high blood pressure, LDL cholesterol oxidation, and blood sugar. The Cardiometabolic Food Plan provides practitioners with tailored recommendations for patients who already have specific cardiometabolic risk factors:

Functional Medicine Labs That Can Help Individualize The Cardiometabolic Food Plan

Here are some functional medicine lab options to consider when identifying the underlying causes of cardiometabolic dysfunction such as inflammation and insulin resistance:

Food Sensitivity Testing

The Array-10 Multiple Food Immune Reactivity Screen by Cyrex Laboratories is a food sensitivity test that measures the body’s immune response to various foods. This test analyzes blood samples for IgG and IgA antibodies against common food proteins.  Food sensitivities may be one driver of inflammation, which is a root cause of cardiometabolic diseases. Identifying food sensitivities in an individual will help the practitioner tailor the Cardiometabolic Food Plan.

Celiac Disease and Gluten Sensitivity

The Celiac & Gluten Sensitivitymeasureantibodies and genetic markers to help diagnose celiac disease and non-celiac gluten sensitivity. Gluten consumption in an individual with celiac disease or a gluten sensitivity can increase inflammation. This panel assists providers in tailoring the Cardiometabolic Food Plan to exclude gluten if needed. 

Diabetes Panel

Since hyperglycemia is a root cause of inflammation, a diabetes panel is agreat option for practitioners to assess early metabolic dysfunction and insulin resistance. This panel measures biomarkers like fasting insulin, fasting glucose, and hemoglobin A1c, which can be used to help practitioners tailor the carbohydrate content of the Cardiometabolic Food Plan.

BostonHeart Diagnostics

BostonHeart Diagnostics offers several helpful labs, including a basic lipid panel (LDL, HDL, triglycerides), a high-sensitivity CRP (hs-CRP), and two unique tests called the HDL Map Test and the Cholesterol Balance Test. These panels go beyond the basics to provide multiple markers of cardiac risk, as well as a unique analysis of cholesterol synthesis and HDL particle size. Together, these allow practitioners to better understand their patient's cardiac risk in order to personalize the therapeutic foods on the Cardiometabolic Food Plan.

Omega-3 Index

An imbalanced omega-6 to omega-3 ratio is indicative of inflammation and higher heart disease risk. The Omega-3 Index Complete from Ayumetrix can give practitioners insight into the percentage of EPA and DHA in the blood. An optimal percentage indicates less risk of heart disease. If the omega-3 index is suboptimal, practitioners can personalize the healthy fat recommendations in the Cardiometabolic Food Plan to improve it.

Micronutrient Testing

The SpectraCell Micronutrient Test analyzes 31 vitamins, minerals, and other nutrients to determine nutritional deficiencies, but it also analyzes the performance and functional micronutrient deficiencies. Poor nutrient status can increase the risk of high blood pressure, obesity, high blood sugar, inflammation, and insulin resistance. Practitioners can use this test to determine which nutrients a patient needs to highlight in their meal plan.  

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Summary

Cardiometabolic dysfunction underlies the most common chronic diseases that Americans face today. Since poor nutrition contributes significantly to cardiometabolic disease, nutrition-related changes can be a powerful way to restore optimal cardiometabolic health. The Cardiometabolic Food Plan from the Institute for Functional Medicine is one option that specifically targets the root causes of cardiometabolic disease like insulin resistance, inflammation, and obesity. 

This meal plan is a modified Mediterranean approach that’s low in simple sugars, rich in fiber and phytonutrients, and includes a balance of healthy fats. Additionally, the Cardiometabolic Food Plan offers condition-specific therapeutic modifiers that providers can use for patients who already have cardiometabolic disorders like high blood pressure, metabolic syndrome, and dyslipidemia (high amounts of fats in the blood).