This post explores how estrogen, exercise and fish oil regenerate your heart and keep it younger and healthier for years to come.

You have heard the term “have heart,” which means to have faith and hope. But how do you regenerate and protect your actual heart muscle itself? Since heart disease is a major cause of illness and death as we age, you are going to want to listen up.

Did you know that as of 2013, the leading cause of death in BOTH genders was heart disease. More people die of heart disease than all cancers. Death by heart disease often unfolds with months, if not years, of suffering.

Today, medicine is all about regeneration. How to fix what’s broken, or prevent it from getting broken in the first place. This is called regenerative medicine.

Can you regenerate your heart? You betcha.

Turns out it’s a recipe of three basic ingredients to keep your heart younger for longer ➤ Exercise + Hormones + Fish Oil. As you will soon learn, this means a very specific type of fish oil.


Normally your heart doesn’t have much innate capacity to regenerate itself. This means the ability to make more of its basic cells, called cardiomyocytes . Did you know that? I didn’t.

Now you might wonder why I didn’t know that. Well, many cells of our body are renewable. Your liver can renew a significant portion of itself if damaged. Your gut wall renews itself every four to six days on a regular basis. Brain nerve cells can rejuvenate and rebuild. So one might assume that your heart cells, so critical for our every day functioning, would be also able to renew themselves  more than a very tiny percentage of itself. In best case scenario it’s very low actually. So it’s good to know about factors that may up your potential to renew your heart cells.

Young healthy adults typically only renew about 1% of their heart muscle cells every year. Yikes. This is a low rate to begin with but it also decreases as you age.

This means we renew less than 1% of our heart, and in fact, we most commonly loose heart cells, from middle age onward.

  • Losing heart cells and less heart cell renewal, is linked to heart disease, heart failure and increased risk of heart attack.
  • In contrast, gaining healthy heart cells is linked to prevention and protection against heart disease and heart attack.

Thus, scientists have been sleuthing for how to boost heart cell production and protection. Their search is targeted on looking for what can actually grow NEW healthy heart cells and boost that typical 1% renewal rate, in a healthy younger person or in even us older folks, to a higher rate.

A prestigious team of scientists from the Harvard Department of Stem Cell and Regenerative Biology, Massachusetts General Hospital, Harvard Medical School, and the Harvard Stem Cell Institute—uncovered the outstanding realization that EXERCISE stimulates the heart to actually make more of itself.

Mice that were given treadmills to “work out” on made new heart muscle cells while they exercised. Sedentary mice (the equivalent of you sitting in your favorite chair every night in front of the TV) did not.

Exercise makes new heart muscle cells both in an ill heart (for example, after a heart attack) or in a healthy heart under normal conditions. Instead of only making 1% new heart cells, we can make many more new heart cells. So we need to regularly move it, or we lose it.

In other words, exercise helps us “co-create”’—along with the universe—to keep making our body suits better and better, rather than older and unhealthier.

This means YOU can make your heart younger with the true vitamin D; discipline.

Move every day!

However this is not the only way to regenerate your heart!


Hormone replacement

Today, hormone replacement has a dark cloud over it in some women’s minds due to the statistical fiasco of the Women’s Health Initiative. Yet, proven by science, it’s often more protective than risky. But many women have not gotten that memo.

It turns out that an even more powerful recipe for a younger more renewed heart, points a finger to adding hormonal therapies to your exercise regime.

Exercise, added to individualized hormone replacement therapy (HRT), protects and regenerates your heart even more than exercise just by its lonesome.

Women who take hormone replacement, compared to those who do not take hormone replacement, have been found to have lower levels of plaque buildup in the heart’s arteries. Plaque build-up leads to increased risk of heart damage and heart attacks.

Investigators at Cedars-Sinai Medical Center in Los Angeles reviewed health records of more than 4,200 women, along with a Cardiac CT scan to get their coronary calcium score. This test is better than a blood test as it shows exactly what plaque, if any, is in your arteries. It’s an exact measurement of the calcium plaque in your coronary arteries. The higher the calcium level, the greater your risk of heart attack and stroke. The closer to zero, the less your risk of heart disease, heart attack or stroke.

  • Women on HRT were 20% more likely to have a coronary calcium score of zero – the best and lowest score you can get – which indicates a very low likelihood of having a heart attack or stroke.
  • Ladies on HRT were 36% less likely to have a coronary calcium score above 399, a number that indicates extensive atherosclerosis (clogged arteries) and a 10-fold increase in heart attack risk.
  • Women on HRT were 30% less likely to die during the course of being on hormone replacement, than those who weren’t taking hormonal therapies.

Here in Austin my clients can walk into an outpatient clinic that’s part of a hospital and order this calcium score test for $99 on their own. Crazy as it sounds, it is not covered by insurance. It is not cogent to even initiate recommendations for hormonal replacement unless a woman has at least had this test, if not other heart indication exams.

Estrogen has long been appreciated (though not necessarily by your primary doc) as protective of the basic heart cell (remember the name is cardiomyocyte) and the heart architecture, or shape, itself. That’s why women have less heart disease during their premenopausal high-estrogen years than when they become menopausal and their estrogen blood levels tank.

There have been headlines about studies that seem to indicate that women on hormones are more prone to heart disease. But those studies are done on women taking synthetic versions of hormones. Progestins—synthetic and patentable versions of the natural progesterone. Synthetic progestins have been linked to worsening heart disease while natural progesterone has not.

Hormone replacement also protects lung tissue, brain function, vocal chord quality, kidney function and on and on. You can read Safe Hormones, Smart Women or SEXY BRAIN and learn more about the benefits, pitfalls and exact tests to run.

Many gynecologists and endocrinologist don’t realize that healthy hormones are not only about blood, urine or saliva levels. Hormones depend on a number of factors to successfully deliver their hormones signals.

Hormones rely, for example, on receptor functionality. Receptors are proteins in the shape of satellite dishes that accept the signals hormones are trying to deliver. You can have perfect hormone levels, but if your receptors aren’t functioning 100%, these hormones may not be able to deliver their heart healthy signals.

Hormone receptors must contain specific nutrients for the hormones to effectively dock and deliver their signals. These nutrients depend on your food choices and your digestive capabilities. One step depends on another.

Further more, receptors must not be clogged by competitors that can “block” your hormones from delivering signals productively, even if your tested hormone levels appear healthy. For example, plastics, heavy metals, cigarette smoke by-products, and an excess of various natural hormones such as your stress hormone cortisol, can all “block” heart healthy estrogen (or other hormone) signaling. And all this can be happening even if your blood, urine or saliva levels of hormones look perfect.

In physiological reality show time, hormones are a “tapestry” of various converging factors all contributing to whether your estrogen, testosterone or progesterone are able to successfully signal. So many factors play a role in helping your hormones keep your precious basic heart building block, your cardiomyocytes, supremely well.

Now, some high-risk ladies such as those with breast cancer, may be shaking their heads sadly that they are not candidates for hormone therapies. But other hormones like testosterone and progesterone also protect the heart. Some of these women, while on aromatase inhibitors or tamoxifen, may be candidates for hormone therapies with the blessing of their oncologists, “IF” they are up on this new data. I talk about this on my 100th podcast, toward the end of the show, on “Gender Differences in Medicine” with Sellma Vlassi functional nurse practitioner. She and I have worked on mutual patients for the past 8 years.


Fish oil

Several studies have shown an inverse relationship between fish oil consumption and death from heart disease. The more fish oils you consume (and hopefully digest), the healthier your heart. Omega-3 oils also boost a healthier heart shape (referred to as heart architecture or remodeling).

Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are the primary omega‐3 fatty acids present in oily fish and much more bioavailable than precursor molecules found in seeds.

Observational studies of the Greenland Inuit population and Okinawa islanders indicate that the low risk of death from coronary artery disease in these groups was related to an abundance of fish oils in their diets.

But, as with all things in health, there’s been shadowy confusion. Some studies show heart health benefits from fish oils, while one well-controlled randomized study showed no benefit.

Why? It may come down to the type of omega-3 oil. It appears that EPA is the star of the oil and heart health story.

The Japan EPA Lipid Intervention Study was the only large‐scale prospective study conducted using only EPA. The results indicated that long‐term use of EPA reduced the risk of major coronary events. In addition, patients with pre-existing coronary artery disease benefited more from EPA treatment than those without pre-existing coronary artery disease.

This means if you have heart disease, down EPA. But there are nuances on how to do this optimally, which I will chat about a bit further down.

About a year ago, Japanese researchers published in an American major heart journal that long‐term EPA supplementation, before and after a heart attack, improved your risk of being healthier and not suffering from yet another heart attack. How? This specific fish oil, EPA, reduces nasty pro-inflammatory and heart damaging molecules. Also, EPA oil keeps the shape of your heart (remodeling) healthier.

But when taking oils, dosage, quality, and protection are essential. You need to take adequate amounts of EPA (dosage), which usually means much more than the inexpensive ones you buy at Costco or a drug store. Dosage is everything! It’s best to work with a very smart medical nutritionist that can individualize your dosage, which often should be much higher than you realize.

Then, you need to take the oils with a fatty meal. Sometimes you need to add digestive support to absorb these healing oils.

You will also need to take adequate antioxidants. Fish oil is high in fragile oils that can oxidize and harm you more than help you if you don’t have enough antioxidants on board. Often, giving higher full-spectrum vitamin E (mixed tocopherols as opposed to only alpha-tocopherol) or other protective nutrients, is critical.

Another consideration is how “clean” are your fish oils, so you aren’t exposing yourself to damaging contaminants. Fish oils should be pure. Some nutraceuticals are more pure than pharmaceutical grade, while some nutraceuticals are contaminated. Use doctor’s lines or work with a knowledgeable medical nutritionist to navigate these fishy waters (so to speak).

By the way, estrogen and fish oils are a match made in heaven. Fish oils (both DHA and EPA) makes estrogen’s work more safely in the body (I write at length about this in Safe Hormones, Smart Women). Estrogens cause higher DHA concentrations in women than in men, by up-regulating synthesis of DHA from vegetable precursors. Nature wants women’s hormones to be lubed. Both genders, Venus and Mars, utilize fish oils to protect heart and brain, function and form.

In Summary, here’s your Healthy Heart Recipe:

  • Regular exercise = increases the number of heart cells.
  • Hormones + fish oil = keep these heart cells healthy.

I’m sure that attitude, intimacy, food and more, all play a role in your heart health. But those considerations are for another discussion.

But you can get started on this heart-healthy recipe today!
  1. Exercise daily (combo of cardio bursts, stretching, and resistance muscle building). Do at least something every day.
  2. Get your hormones tested and treated. Even high-risk women can take certain, safe hormones or learn to eat specific foods that care-take hormones.
  3. Add EPA and antioxidants to your supplement tool bag.
Related Content


4 Strategies to Protect Your Estrogens

The Unjustified Fear of Estrogen

Estrone – A Most Maligned Estrogen

Estrogen Naivete Needs to Wake Up


National Vital Statistics Reports Vol. 64 Number 2 Deaths: Final Data for 2013. Division of Vital Statistics US.

Exercise induces new cardiomyocyte generation in the adult mammalian heart. Nature Communications, 2018; 9 (1) DOI: 10.1038/s41467-018-04083-1

The Role of Estrogen and Estrogen Receptors on Cardiomyocytes: An Overview. Can J Cardiol. 2016 Aug;32(8):1017-25. doi: 10.1016/j.cjca.2015.10.021. Epub 2015 Nov 2.

Hormone Replacement Therapy Is Associated With Less Coronary Atherosclerosis and Lower Mortality,” a presentation at the American College of Cardiology’s 66th Annual Scientific Session, March 17, 2017, in Washington D.C

The Role of Estrogen in Cardiac Metabolism and Diastolic Function. Methodist Debakey Cardiovasc J. 2017 Jan-Mar;13(1):4-8. doi: 10.14797/mdcj-13-1-4.

17β-estradiol treatment reversed left ventricular dysfunction in castrated male rats: an echocardiographic study. Can J Physiol Pharmacol. 2018 Apr 10. doi: 10.1139/cjpp-2017-0596.

Myocardial protection of contractile function after global ischemia by physiologic estrogen replacement in the ovariectomized rat. J Mol Cell Cardiol. 1997 Sep;29(9):2403-14.

Lipid metabolism and ischemic heart disease in Greenland Eskimos In: Draper H, editor. , ed. Advances in Nutrition Research. New York, NY: Plenum Press; 1980:1–22.

Eicosapolyenoic acids of serum lipids of Japanese islanders with low incidence of cardiovascular diseases. J Nutr Sci Vitaminol (Tokyo). 1982;28:441–453.

Prevention of sudden cardiac death with omega‐3 fatty acids in patients with coronary heart disease: a meta‐analysis of randomized controlled trials. Ann Med. 2009;41:301–310.

Effect of fish oil on arrhythmias and mortality: systematic review. BMJ. 2008;337:a2931.

Omega‐3 dietary supplements and the risk of cardiovascular events: a systematic review. Clin Cardiol. 2009;32:365–372.

Efficacy of omega‐3 fatty acid supplements (eicosapentaenoic acid and docosahexaenoic acid) in the secondary prevention of cardiovascular disease: a meta‐analysis of randomized, double‐blind, placebo‐controlled trials. Arch Intern Med. 2012;172:686–694.

Effects of eicosapentaenoic acid on cardiovascular events in Japanese patients with hypercholesterolemia: rationale, design, and baseline characteristics of the Japan EPA Lipid Intervention Study (JELIS). Am Heart J. 2003;146:613–620.

Docosahexaenoic acid concentrations are higher in women than in men because of estrogenic effects.

Am J Clin Nutr. 2004 Nov;80(5):1167-74.

Long-Term Administration of Eicosapentaenoic Acid Improves Post-Myocardial Infarction Cardiac Remodeling in Mice by Regulating Macrophage Polarization. J Am Heart Assoc. 2017 Feb 21;6(2). pii: e004560. doi: 10.1161/JAHA.116.004560.