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Dr Leah Romay DDS

Hey there, and welcome! Here you’ll find inspiration and resources to live a clean and healthier life. To learn more about me, click here!


Pesto is an great way to add a ton of flavor to dinner and I especially love making pesto with arugula! In this recipe, I combine my arugula pesto with whole grain pasta and top it off with homemade cashew ricotta and blanched fiddlehead ferns. This recipe packs lots of fresh flavor and nutrition and comes together very quickly. 

fiddlehead ferns

There’s a couple of reasons why I love using arugula to make pesto:

  • I usually don’t have enough basil or can’t find a big bunch at the store
  • Arugula pesto won’t brown from oxidation
  • Arugula is generally more readily available throughout the year, as compared to basil
  • Arugula is rich in nitrates, which prevents heart disease (1)

Oil-Free Arugula Pesto

One of the issues I faced when making a whole-food plant-based pesto is the oil situation. You see, pesto usually has lots of olive oil. Dripping with oil. But my goal is to make food oil-free as often as possible. I worried that an oil-free pesto would be… just… blah or bad. Well, I have to say that it’s still totally delicious and I don’t miss the oil in this case! Once it’s mixed with the pasta, you cannot tell there is no oil!

Arugula Pesto (Oil-free, Vegan)

Arugula and Nitrates for Hearth Health


The most common killer of Americans is cardiovascular disease, which, according to the American College of Cardiology (ACC), was responsible for 840,768 deaths (635,260 cardiac) in 2016. Every 40 seconds, an American has a heart attack (2). Wow. That is astonishing and shocking. 

In my practice, the vast majority of my patients are taking medications for blood pressure. Heart disease is clearly a widespread problem with severe long term consequences. But what can we do about it?

The good news is that cardiovascular disease is preventable through diet! But the sad truth is that the standard American diet is so unhealthful. So much so that our most common killer is a completely preventable disease. Alright let’s start making some changes then! That’s why you’re here, right?

By recommendation from the ACC and countless scientific studies, eating lots of different fruits and veggies and reducing consumption of animal products is the best way to prevent heart disease. But then that raises the question – are some veggies any better than others, specifically for heart disease? 

And the answer is yes – nitrate rich vegetables. Beets have been making headlines because of their nitrate content, but the reality is that arugula has much more

Vegetables rich in nitrate supply the body with dietary nitrate which is an important molecule in the nitric oxide pathway. It has been well documented since the 1980s that nitric oxide is a signaling molecule within blood vessels that is responsible for regulation of blood flow and blood pressure. Nitric oxide is made by the endothelial cells within vessels and is essential for good cardiovascular health (3). The root cause of arterial plaques and atherosclerosis is from damage to the endothelial cells with poor diet being a major contributing factor (4). This damage to endothelial cells is what begins the process of heart disease and is the reason why over 200,000 Americans had bypass surgery last year (5)

“There is ecological evidence for a hypothesis that the cardioprotective benefit of vegetables may be conferred by nitrate. For example, a traditional Japanese diet is very high in nitrate from vegetables, and Japan has historically lower rates of coronary heart disease than the United States. In contrast, India, a country with a high incidence of coronary heart disease, has low levels of nitrate in the traditional diet, similar to a typical US diet. Usual dietary consumption of nitrate in the United States is estimated to be between 40 and 100 mg/day, with nitrite ingestion at much lower levels (0 to 20 mg/day)” (3)

Ok so what if you already have heart problems or have a family history of heart disease? Are you stuck and out of luck? No, absolutely not! You can reverse the damage!

In a landmark study by Dean Ornish, MD, (back in 1990) he significantly reversed heart disease in patients through lifestyle modification with a whole food plant based diet, stress reduction and exercise in just 1 year (6). His results truly are remarkable. Dr. Ornish is a great inspiration and has published over x articles in the realm of nutrition and lifestyle modification. He has a massive book called “Undo It” that I highly recommend as well. 

So the bottom line is this – heart disease is preventable and reversible if you eat lots of whole fruits and vegetables and limit animal products and refined foods! Couple that with regular exercise and you are golden!

Cashew Ricotta (Vegan)

The Recipe - Arugula Pesto Pasta with Cashew Ricotta

So – here’s a heart healthy recipe that you are going to love! It’s also quite simple to make. I recommend to first make the cashew ricotta because the cashews need to soak in filtered water a bit, which is the most time involved aspect of this recipe. The cashews are then blended with lemon juice, nutritional yeast and water (pictured above). Then you can make the arugula pesto with lots of garlic and pine nuts. Finally, boil water for pasta.

To top it all off, I blanched some fiddlehead ferns. Since fiddlehead ferns are very seasonal and may not be available when you want to make this, I think it would also be delicious to top this pasta dish with broiled cherry tomatoes. Simply place cherry tomatoes under the broiler for a few minutes until they are softened and the skin is lightly browned.

This arugula pesto pasta is a great spring or summertime dish that won’t weigh you down, but will fill you up with the cashews in the “ricotta” and whole grains in the pasta. It all comes together so quickly and your heart will thank you for it!



Dr. Romay



1. Webb AJ, Patel N, Loukogeorgakis S, et al. Acute blood pressure lowering, vasoprotective, and antiplatelet properties of dietary nitrate via bioconversion to nitrite. Hypertension. 2008;51(3):784–790. doi:10.1161/HYPERTENSIONAHA.107.103523

2. AHA 2019 Heart Disease and Stroke Statistics — from the American College of Cardiology

3. Ahluwalia A, Gladwin M, Coleman GD, et al. Dietary Nitrate and the Epidemiology of Cardiovascular Disease: Report From a National Heart, Lung, and Blood Institute Workshop. J Am Heart Assoc. 2016;5(7):e003402. Published 2016 Jul 6. doi:10.1161/JAHA.116.003402

4. Endothelial Cells in Physiology and in the Pathophysiology of Vascular Disorders. Douglas B. Cines, Eleanor S. Pollak, Clayton A. Buck, Joseph Loscalzo, Guy A. Zimmerman, Rodger P. McEver, Jordan S. Pober, Timothy M. Wick, Barbara A. Konkle, Bradford S. Schwartz, Elliot S. Barnathan, Keith R. McCrae, Bruce A. Hug, Ann-Marie Schmidt, David M. Stern. Blood May 1998, 91 (10) 3527-3561

5. Melly L, Torregrossa G, Lee T, Jansens JL, Puskas JD. Fifty years of coronary artery bypass grafting. J Thorac Dis. 2018;10(3):1960–1967. doi:10.21037/jtd.2018.02.43

6. D. Ornish, S.E. Brown, J.H. Billings, L.W. Scherwitz, W.T. Armstrong, T.A. Ports, S.M. McLanahan, R.L. Kirkeeide, K.L. Gould, R.J. Brand, Can lifestyle changes reverse coronary heart disease?: The Lifestyle Heart Trial,The Lancet, Volume 336, Issue 8708, 1990, Pages 129-133, ISSN 0140-6736, https://doi.org/10.1016/0140-6736(90)91656-U.

Which Veggies Have the Most Nitrates? - Dr. Greger, MD

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Arugula Pesto Pasta

Makes about 4 servings

Nutritious and zesty arugula pesto is tossed with whole-grain pasta and topped with cashew “ricotta” and fiddlehead ferns. This recipe is whole food plant based, oil-free, and heart healthy.

Author: Leah Romay


for the arugula pesto:

  • 5 oz arugula
  • 4 T pine nuts
  • 2 cloves garlic
  • 4 T nutritional yeast
  • 10 grinds of black pepper
  • 1/2 t salt
  • 1/2 cup water

For the pasta:

  • 1 box of whole grain pasta (such as whole wheat pasta, chickpea pasta, spelt pasta, lentil pasta)
  • Cashew ricotta (click for recipe)
  • Fiddlehead ferns (optional)
  • Whole wheat sourdough bread, for serving (optional)


High Speed Blender or Food Processor


  1. Make the cashew cheese (click for recipe).
  2. Make the pesto: combine all pesto ingredients into the blender or food processor. Turn on, then slowly add water. Adjust the consistency if desired. It can always be thinned out once the pasta is cooked, so it’s better to make it on the thicker side initially.
  3. Boil water to cook the fiddlehead ferns (if not using, skip this step). Salt the water with 1 tsp sea salt. Once boiling, add the fiddleheads and boil for 10 minutes. It is important to thoroughly cook fiddleheads. Drain and set aside. 
  4. Boil water to cook pasta. Salt the water with 1 T sea salt and cook pasta according to package directions. Before draining, reserve 1 cup of the pasta water and set aside. Drain the pasta and return to the pot. Add the pesto and toss to combine. Add reserved pasta water if needed to thin out the pesto sauce. 
  5. Serve pasta with a dollop of the cashew ricotta and the fiddlehead ferns.
Notes: If fiddlehead ferns are not available, try substituting roasted cherry tomatoes. Place cherry tomatoes on a baking sheet and bake under the broiler until softened and skin is lightly browned. 

Dr. Leah Romay is a dentist passionate about health and wellness and believes that health is possible for everyone. She’s been in the kitchen cooking from scratch for most of her life and greatly enjoys creating healthy and delicious recipes. In addition to practicing dentistry full time, she spends her free time developing recipes, reading scientific studies, and helping others live their healthiest lives through evidence-based lifestyle and diet. Read more about Dr. Romay and her story here.

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