Despite the fact that I am a functional and integrative cardiologist, I often look first at a patient’s gut health to shed light on the underlying cause of heart disease. What could the gut possibly have to do with the heart? It’s all about inflammation. We now know that inflammation is as or possibly more important than cholesterol as a risk factor for heart disease. If aliens were to take a human body and analyze it cell by cell, they would come to the conclusion that we are mostly a mass of bacteria with just a few human cells mixed in. Each of us house more than 100 trillion bacteria inside of us – more than 10 times the number of human cells!

This mix of bacteria is referred to as our “microbiome,” which begins to develop at birth and is affected by many surprising factors, including whether the birth is vaginal or via C-section, and when we first eat solid foods as children. As adults, our lifestyle choices – the quality of our diet, our body weight, exercise, stress, smoking, the use of antibiotics and other medications – significantly affect the quality and diversity of our microbiome for better and for worse.

Here are some simple steps you can take to optimize both the quality and the quantity of your microbiome or “friendly bacteria”:

Eat a fiber-rich, nutrient-dense diet that’s loaded in organic fruits, vegetables and legumes

A diet high in refined sugar and low in fiber encourages the overgrowth of “unfriendly” bacteria and other microorganisms (like Candida), which then lead to leaky gut and uncontrolled inflammation. Opt instead for a mostly organic, plant-based diet full of colorful phytonutrients and fiber that help our microbial friends to thrive.

Eat foods teeming with prebiotics (like garlic) and probiotics (like yogurt)

Some foods called “prebiotics,” particularly garlic and onions, contain inulin, a fiber that feeds our good bacteria. Certain other foods – yogurt, sauerkraut, kimchi – and supplements known as “probiotics” are already full of good bacteria, and help maintain a healthy microbiome.

Exercise to get your gut going

Working out releases beneficial chemicals, such as nitric oxide, that help your arteries expand, which reduces inflammation. In a study published in the journal Gut, Irish Athletes were found to have a much better microbiome (that is, less inflammation and much more diverse gut bacteria) than non-athlete control subjects.

Keep your weight down

Weight gain and obesity increases overall inflammation and can disrupt the microbiome. When you are living a healthful lifestyle, eating a nutrient-rich, mostly plant-based diet, moving on a regular basis, meditating, and, most importantly, connecting with family and friends, your weight will naturally stabilize in the correct range for you.

Stop smoking (Seriously!)

Smoking is the most preventable cause of death in the United States – on average, smokers die 14 years earlier than nonsmokers. There are 4000 chemicals in cigarettes, which can result in serious disease such as heart attacks and strokes, are a common cause of erectile dysfunction and makes skin look very old. Smoking also disrupts the good microbiome which results in inflammatory bowel disease and obesity. The good news is that millions of people succeed in their efforts to quit smoking every year and you can too.

Use antibiotics judiciously

When used appropriately, antibiotics can be life-saving. However, inappropriate or overuse of antibiotics, both in humans and in animals, can lead to both antibiotic-resistant organisms and a disruption in our microbiome – that is, antibiotics can kill the friendly, health-promoting bacteria in our gut.

We’re beginning to learn from a number of leading researchers, including Martin Blaser, M.D., director of NYU’s Human Microbiome Program and author of Missing Microbes: How the Overuse of Antibiotics is Fueling Our Modern Plagues, that our over reliance on antibiotics can negatively affect our friendly bacteria and may lead to diseases such as heart disease, dementia and brain diseases, asthma, food allergies, diabetes and obesity.

Consider getting a stool test

Speak to your integrative or functional health care practitioner about the specialized stool tests that can assess your personal microbiome. Stool testing can reveal that you have the wrong bacterial mix which would put you at risk for heart disease and other inflammatory diseases. Treatment could include a detoxification program, a gut restoration program, nutritional interventions (like yogurt or fermented foods), prebiotics, probiotics, and other modalities that will optimize gut microflora and reduce the risk of vascular disease, heart attacks, strokes and even death.

Clear your head to clear out stress

We are now discovering that microbiome in our guts communicate with our brains via the vagus nerve, hormones, the immune system and microbial metabolites such as short chain fatty acids. There is the emerging concept of the gut-brain, because as it turns out our gut is a bigger neurological organ than our brain. The gut microbiome is responsible for the majority of the production of serotonin in our bodies, which is a chemical essential for optimal brain and emotional wellbeing.