Try This: Becoming Heart Attack-Proof by Protecting Your Endothelial Health

If you care about becoming heart attack-proof, you need to learn more about your endothelial lining and how to protect it!

Your endothelial lining is a single-celled layer that coats the inside of 60,000 miles of blood vessels.

The endothelium acts as an “air traffic controller,” deciding what substances in the blood will have access to the underlying tissue in the arterial wall. Endothelial damage is the first step leading to plaque formation in the arteries (atherosclerosis).

Today I’m giving you the top factors driving endothelial damage I learned from interviewing my cardiologist, Dr. Michael Twyman, and how to protect your arterial lining with diet and lifestyle techniques.

Spoiler alert—some of the suggestions might surprise you!

Endothelial Dysfunction: a Root Cause of Heart Disease

More than 700,000 people die of cardiovascular disease every year, and more than half of these cases have no prior symptoms before experiencing a heart attack or stroke. 😱

That doesn’t mean heart disease just shows up one day—it’s the result of decades of damage. In fact, the first signs of heart disease can occur in your early teenage years, depending on your lifestyle habits and genetics.

Here are the three main events that happen before full-blown heart disease develops.

1. Endothelial Damage. 

The endothelial lining is super sensitive to insults. Some of the top contributors that damage it include high blood sugar and insulin levels, high blood pressure, high sodium levels, alcohol, lack of sleep, physical or mental stress, and exposure to heavy metals, polluted air, toxic chemicals, and bacterial endotoxins.

2. Endothelial Dysfunction. 

Your endothelial cells are the primary site where nitric oxide (NO) is produced, a super-important molecule that promotes vasodilation and smooth blood flow. (Fun fact: I had Dr. Louis Ignarro on the podcast to discuss the role of NO in cardiovascular health, a discovery so groundbreaking he was awarded the Nobel Prize in Physiology or Medicine in 1998.)

When our endothelial cells undergo damage, they produce less NO, which causes our blood vessels to constrict and slows circulation. This allows a greater chance for lipoproteins (which carry cholesterol, triglycerides, phospholipids, and fat-soluble vitamins), white blood cells, and platelets to stick to the endothelial lining, kicking off a process of inflammation, plaque formation, and atherosclerosis.

3. Atherosclerosis.

Plaque in the arteries sort of resembles a pimple and can either be “soft” or “hard” depending on if it is calcified or not. As the body continues to try to “heal” the pimple, it forms scar tissue and calcifications.

The medical field used to think hard plaque was the only plaque to worry about because it accumulates in the arteries, blocks blood flow, and causes chest pain. But soft plaque is worrisome too. When soft plaque builds up, it can rupture and form a blood clot in the artery, which can lead to a heart attack or stroke.

The challenge has been that for a long time, the main test people were encouraged to get was a CT scan, which only identifies hard plaque. But now, Functional Cardiologists like Dr. Twyman are putting the spotlight on tests like the Cleerly scan, which can also identify soft plaque, helping patients identify the earliest stages of endothelial damage and dysfunction.

By the way, in case you missed it, I got my Cleerly scan (no affiliation) with the encouragement of Dr. Twyman, and we discussed my results together on the podcast.

Final Stop: Heart Disease

And so, if plaque begins to accumulate in the arteries, our risk for cardiovascular events increases dramatically. But there’s good news! We can intervene with strategies to protect our endothelial cells and lower our risk for heart disease by reducing our exposure to factors that cause damage.

Protect Your Circadian Rhythms, Protect Your Mitochondria, Protect Your Heart 

Let’s talk about what Dr. Twyman suggests you can do to protect your endothelial cells. Surprisingly, his first priority is not nutrition but supporting and protecting our mitochondria!

Your cardiovascular system is densely packed with mitochondria, which are super attuned to our light environment, so they know when to make energy and when to repair themselves. Because we need healthy mitochondria for our hearts to function optimally, providing them with the proper light cues is imperative.

Try This: 

Here are Dr. Twyman’s suggestions for how to optimize your light environment:

  • Get morning sun. Step outside within the first hour of waking up and get the morning sun in your eyes for a few minutes. This signals your brain that it’s time to wake up and tells the body to start making energy and daytime hormones like cortisol.
  • Take sun breaks and avoid junk light at night. Light signals our mitochondria to produce energy, but light exposure at the wrong times causes confusion and damage.Dr. Twyman recommends getting outside for frequent “sun breaks” during the day and minimizing blue light at night. If you have a dimmer switch, try lowering overhead light intensity at night to tell your body it’s time to wind down and get ready for sleep.
  • Wear blue-light-blocking glasses at night. This is a big one that Dr. Twyman swears by! Wearing blue-light blockers an hour before bed helps protect your mitochondria and circadian rhythms, which means you’ll fall asleep faster.

Sleep, Stress, and Dietary Recommendations 

  • Sleep hygiene. We need to prioritize getting high-quality sleep to give our mitochondria time to repair and rejuvenate. Make sure your room is cool, dark, and quiet, with the exception of a sound machine to muffle out any noise.
  • Find healthy ways to manage stress. Chronic stress causes endothelial damage and significantly reduces NO levels. Shift your nervous system into a rested and relaxed state by engaging in activities like walking, reading, journaling, time in nature, or meditation.
  • What about diet? Of course, diet matters, but according to Dr. Twyman, it’s more important to focus on the basics (sleep, stress, and balancing your circadian rhythms) to protect your endothelial lining than thinking there’s a perfect diet for everyone.
    • When you eat is at least as important as what you are eating. Your body is better at metabolizing and digesting food during daylight hours. This will also help protect your sleep. (Try This: How to Eat with Your Circadian Rhythm)
    • Reduce consumption of ultra-processed foods. The Standard American Diet (SAD) is high in processed carbs, sugar, and oil, which drives insulin resistance, oxidative stress, inflammation, and… you guessed it! Heart disease.
    • Eat a predominately whole-foods diet. The backbone of your diet should be made up of whole foods and include healthy fats, high-quality protein, and fiber. Your heart will thank you!

🫀 The Status of My Heart-Health Journey

After working with Dr. Twyman and doing the Cleerly scan, I’ve learned that the things I’m doing to protect my endothelial lining (eating a clean diet, exercising, sleeping well, and taking care of my circadian rhythms) are paying off, and my arteries are virtually plaque-free!

Not only that, but Dr. Twyman said my Cleerly results were the cleanest he’d ever seen! Not to toot my own horn, but this is pretty major considering my South Asian background and being genetically predisposed to high LDL and apoB levels. I’m still working on improving my lipid panel, and I’ll keep you posted in a future newsletter.

Needless to say, there are many different factors that contribute to our cardiovascular health, and just because you might be predisposed to heart disease doesn’t mean that’s your fate!

Final Thoughts

I’m so happy I got to connect with Dr. Twyman because his message is so unique and powerful. Even if your lipid panel is perfect, if your endothelial health is poor, you could still be at high risk for cardiovascular events in the future.

Try these strategies to protect your endothelial lining and improve your chances of becoming heart attack-proof today!

If you’re interested in following Dr. Twyman, follow him on Instagram @drtwyman, or to explore working with him directly, check out his website,

Here’s to your health,
Dhru Purohit

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