Keying in on Ketogenic Diets

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if you are interested in losing weight,  the ketogenic diet as popularized by the late Dr. Robert Atkins, has had its share of controversies.  The diet, characterized by extreme carbohydrate restriction (usually less than 50 grams per day) results in depletion of our primary energy source, glycogen (glucose reserves stored in liver and muscle).  After several days of a very low carb, high fat diet, the liver converts fatty acids into ketones that enter the bloodstream and urine.  Certain ketones (e.g., acetone) have anti-seizure properties and in fact, the ketogenic diet has been prescribed for many years in the treatment of seizure disorders.  The Atkins diet can also result in significant weight loss in at least 2 ways.  First, by restricting carbohydrate intake from ~50% of daily calories to 10% or lower; in fact, the average caloric intake in Phase 1 of the Atkins diet is ~1500 calories (300-500 calories lower than generally consumed by women and men daily). Second, with accumulation of ketones, ketosis sets in and fat breakdown is accelerated. Not surprisingly, significant weight loss (2+ pounds per week) is readily achievable on a ketogenic diet and in the short-term (3-6 months) represents an effective weight losing platform.  In addition to weight loss, other positive aspects of a ketogenic diet (and correlated to weight reduction) are metabolic improvements. They include reduction in glucose, lipids (most notably triglycerides) and blood pressure.  However, keep in mind that ketogenic diets also have potential side effects ranging from lethargy, muscle wasting (carbs are required for muscle health and function), digestive issues such as constipation (due to lack of fiber) and halitosis (ketones induced bad breath).

Unfortunately, considerably less is known following decades exposure to ketogenic diets especially as it relates to the heart.  As a cardiologist, I was surprised to learn that the late Dr. Atkins in fact suffered from an enlarged heart and congestive heart failure.  Could this have been related to an associated nutritional deficiency that can trigger heart failure,  such as selenium or other micronutrients? A new study conducted in Finland shares this concern.  Of the nearly 2500 middle aged subjects followed over 2 decades, consuming the most animal based protein was associated with a more than 40% increased risk of heart failure. In contrast, increased consumption of protein from fish was not correlated with significant risk of heart failure and some studies have suggested that fish or fish oil supplementation may even protect against heart failure.

While the Atkins diet results in more weight loss than other popular diets over a 12 month period, you need to decide what might work best for you. Along these lines, if you are considering a ketogenic diet over a short-term duration, I would recommend that the dietary fat component contain low amounts of saturated fat, based upon our recent American Heart Association Presidential Advisory Statement on dietary fat and cardiovascular disease,   Otherwise, I generally recommend that my patients take a more moderate low carb weight loss approach as outlined in “Heal Your Heart” where your favorite foods are moderated rather than restricted and without downside risk.

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland USA.  He is a member of the American College of Cardiology Nutrition Workgroup and the American Heart Association Council on Lifestyle and Cardiometabolic Health.

 

 

Should We Marvel Over Moringa?

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Even though moringa has been used as an herbal remedy in Eastern cultures for centuries, it has garnered considerable interest in Western Europe and North America in recent years due to suggestive evidence, based primarily on animal studies, that moringa possesses important health benefits.

Moringa oleifera trees are native to India but also thrive in countries with tropical (e.g., Philippines, Sri Lanka)  and subtropical (e.g., Taiwan, Vietnam) climate conditions conducive to lots of sunlight, daily temperatures exceeding 70 degrees F and significant moisture (natural or via irrigation).  In the U.S., moringa trees thrive best in Arizona, California, Florida, Hawaii, Louisiana, Nevada, New Mexico and Texas.

Whether to marvel over moringa is largely derived from concentrated nutritional value in its edible leaves, seed pods and extracted oil.  They include high amounts of Vitamins (A, B6 and C), minerals (calcium, magnesium potassium)  and antioxidants (chlorogenic acid, quercetin).  If you do not have direct access to moringa, it is available for purchase as an organic powder (added to smoothies, soups, salads, cereal, etc) and tea.  Please bear in mind however, that it has an earthy taste and certainly takes a bit getting used to (as I can attest to).

In rat models, studies have shown that moringa supplementation yields a host of benefits such as robust antioxidant and anti-inflammatory activity, improvement in memory, cognition and mood as well as reduced blood glucose and cholesterol levels. Unfortunately, human studies testing moringa are scarce although one small study found that 1 tablespoon of moringa powder taken daily for 40 days did reduce blood glucose and LDL cholesterol levels 25-30%  in diabetic subjects.  A host of other human based studies testing moringa are either in progress or have recently been completed.  Needless to say. we anxiously await the published results….until then, adding some organic moringa powder to your smoothies, salads and teas has minimal if any downside and might even give you a bit of the boost you’ve been looking for!

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland USA.  He is a member of the American College of Cardiology Nutrition Workgroup and author of the bestselling book “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease“.

 

5 Bountiful Benefits of Beets

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Easily making the Top 50 Foods in “Heal Your Heart“, beets are a nutrition powerhouse, abundant in heart-protective antioxidants and mood-boosting compounds.   The latest research provides solid evidence to support intake of beets and/or beet juice on a regular if not daily basis to optimize heart and brain health.  Here are 5 impressive health benefits of beets:

  1. Lowers Blood Pressure:  Beets are a rich source of inorganic nitrates that when digested are ultimately converted into nitric oxide resulting in blood vessel expansion and blood pressure lowering.  In fact, one recent study found that drinking 8 ounces of beetroot juice each day for 1 month resulted in similar reductions in blood pressure (~10/5 systolic/diastolic) as typically observed following initiation of a starting dose of a blood pressure medication.
  2. Improves Insulin Sensitivity: Even though beets are a rich source of natural sugars, when non-diabetic obese men and women ingested 16 ounces of beet juice mixed with glucose, they experienced a lower surge in blood glucose levels over the next several hours than when consuming the beet juice mixed with mouthwash (designed to inhibit nitrate conversion). These results suggest that dietary nitrates improve insulin sensitivity and that beet consumption may help non-diabetic obese men and women keep their postprandial glucose levels under better control when incorporated in their meals.
  3. Improves Brain Function: A high nitrate diet that included beetroot juice in men and women older than age 75 years found increased blood flow in the frontal cortex, the region of the brain involved in higher learning processes  (also known as executive function) that help us to focus on the task at hand (and multitask as required) in order to manage our time efficiently.
  4. Improves Exercise Performance: Beetroot juice (8-16 ounces) taken within 60 to 90 minutes prior to aerobic activity may improve athletic endurance and performance  due to increased nitric oxide availability for exercising muscles.
  5. Improves Mood & May Reduce Depression: Beets are a rich source of betaine, an amino acid derivative that boosts production of the chemical SAMe (S-adenosylmethionine) leading to activation of dopamine, norepinephrine and serotonin, neurotransmitters that improve mood and reduce symptoms of depression.   As little as 4 ounces of beet juice may improve your mood!

    Words of caution regarding beets are the following: 1) they can change the color of urine and stool to red and should be avoided 1-3 days prior to colonoscopy; 2) they are high in oxalates that upon binding to calcium may form kidney stones. If you have a history of kidney stones, discuss with your physician whether it is safe for you to consume beets and/or beet juice; 3) they are high in sugar and may cause considerable glucose spikes when juiced (due to fiber removal).  If you have diabetes, discuss with your physician and/or dietitian the amount of beets or beet juice that is safe for you to consume.

    Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland USA.  He is a member of the American Heart Association Council on Lifestyle and Cardiometabolic Health and author of the bestselling book “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease“.

Alcohol: The Heart’s Double-Edged Sword

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In the wake of the National Institutes of Health deciding to withdraw funding for a study aimed at assessing moderate alcohol consumption and cardiovascular risk/benefit, I thought the timing could not be better to elaborate upon alcohol consumption and the heart.   I tell my patients that alcohol is a double-edged sword when it involves the heart. On the one hand, complete abstainers (or teetotalers), are at higher risk of heart disease than moderate drinkers. Yet on the other hand, too much alcohol causes a number of problems ranging from abnormal heart rhythms (such as atrial fibrillation) to enlarged hearts and heart failure. Clearly, a moderate amount of alcohol represents the “sweet spot” for keeping hearts healthy and enjoying alcohol’s protective effects  (see below). For women, that sweet spot is ~3-5 servings of alcohol each week (for men ~6-10 servings). One serving of alcohol consists of a 4-ounce glass of wine, a 12-ounce bottle of beer (or a pint of Guinness due to lower alcohol content) or a shot of your favorite spirits. Even though, any type of alcoholic beverage in moderation is protective to the heart, red wine and dark beer may offer a slight advantage due to the higher content of antioxidant polyphenols.

[Full disclosure….I’m a big fan of Guinness beer and Maker’s Mark bourbon].

Here are several heart health benefits of moderate alcohol consumption.

  1. Raises HDL (the good cholesterol):  A high level of HDL (60 mg/dL or greater) is most protective to the heart when no major cardiovascular risk factor is present (cigarette smoking, high blood pressure, diabetes, high cholesterol); moderate drinking boosts HDL levels ~5-15% on average.
  2. Reduces blood clotting:  Alcohol reduces clot buildup by inhibiting platelet aggregation.  However, excessive alcohol consumption (4 or more drinks daily) may increase the risk of serious bleeding, including a brain hemorrhage.
  3. Reduces risk of Type 2 Diabetes:  Moderate alcohol consumption lowers fasting insulin and HbA1c concentrations in men and women at increased risk of diabetes.  In women, moderate alcohol intake  also improves insulin sensitivity.

Light drinkers (1-3 drinks per week) also derive health benefits; a new study out this week found that lifetime light drinkers had a reduced risk of cancer.  This extends prior work finding that heavy drinkers exhibited increased risk of several cancers including head and neck, breast, esophageal, liver and colorectal cancer.

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland USA where he takes care of patients, conducts original research and teaches at the medical school.  His bestselling book “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease” is also Amazon’s #1 Rated book in Heart Disease.

Strawberry Fields Forever

strawberry fieldsstrawberriesIronically, one of my favorite Beatle songs, “Strawberry Fields Forever“,  is not about strawberries.  Rather it’s the name of an orphanage in the neighborhood where John Lennon grew up.  His verse, “cause I’m going to Strawberry Fields…
nothing is real” could not be further from the truth when it comes to strawberry gardens that produce incredibly delicious, healthy and mood boosting fruits.  In fact, June is strawberry season in Maryland so be sure to check out our Farmer’s Market selections.  Here are some other reasons why you should eat at least 1 handful of strawberries each day:

1.  Strawberries are loaded with fisetin: This antioxidant flavonoid helps to reduce cellular aging and improve memory.

2. Strawberries are an excellent source of catechin: Another powerful antioxidant that helps to expand blood vessels and may lower blood pressure.

3. Strawberries may reduce risk of a heart attack:  1 study in middle aged women found that the combination of strawberries and blueberries consumed at least 3 times a week reduced risk of a heart attack by 30%!

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland USA where he takes care of patients, conducts original research and teaches medical students.  His latest book is “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease” and check out Dr. Miller’s author page on Amazon.

Sweeten your day with corn-on-the-cob

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Few foods are as popular at cookouts than sweet corn-on-the-cob.  And contrary to popular belief, the glycemic index (how quickly a food is processed into glucose) for sweet corn is not high (less than 55) and similar to a mango or firm banana (see last week’s post). Click here for a list of foods low and high (above 70) on the glycemic index per Harvard Health.  In addition to taste, corn provides important nutritional properties that benefit your heart and mind.

  1. Eye health: Corn is a rich source of the pigment antioxidants, lutein and zeaxanthin that help to protect eyes from age-related processes such as cataracts and macular degeneration.
  2. Anti-Cancer properties: Cooking corn-on-the-cob releases the powerful antioxidant, ferulic acid,  that has been shown exert anti-tumor activity against breast, lung and colon cancers.
  3. Gut Health: Corn-on-the-cob contains ~3 grams of fiber (8-9% of the recommended daily allowance) to help promote digestion by establishing a healthier gut microbiome.

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland USA where he takes care of patients, conducts original research and teaches medical students.  His latest book “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease” has been Amazon’s #1 Rated book in Heart Disease for 3 years running.

Why You Should Go Ape Over Bananas

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Although often shunned by low carb advocates, bananas provide a power punch of vitamins and minerals that make this fruit a staple for my patients interested in overall health.  While a medium sized banana contains 100-110 calories including a reasonable number of carbs (26-28 grams/ 3 grams of fiber) you may be surprised to learn that the number of carbs is not different when compared to a medium sized apple or pear. Importantly, the type of carb in a banana (simple/complex) depends upon firmness and ripeness.   Unripe or green bananas contain “resistant” starches that are processed into sugars at the slowest rate.  This is followed by firm yellow bananas that I recommend to my patients based on taste and relatively slow conversion to blood glucose.  Soft or overripe bananas have a higher concentration of simple sugars than firmer bananas, lead to a more rapid increase in blood glucose levels and should be avoided if you have diabetes.   I also recommend refrigeration for yellow (not green) bananas to prevent them from becoming too soft and overripe.  In addition to the health benefits of fiber on digestive health, there are other reasons why bananas should be consumed daily (see below). Perhaps we should add “a banana a day” to “an apple a day”…. to keep us MDs away!

  1. Potassium and Magnesium enriched:  A medium-sized banana contains 422 mg of potassium and 32 mg of magnesium, ranking it 5th among top fruit sources for potassium and 3rd for magnesium.  (See the complete list in “Heal Your Heart…”).
  2. Folate and Vitamin B6 enriched:  Once again, bananas rank among the highest in content of these important vitamins that help to boost mood by regulating dopamine release and increasing brain levels of serotonin that in turn also help to ward off depression.
  3. Antioxidant enriched.  Bananas contain a host of antioxidants including the flavonoids, catechins, quercetin and rutin, 3 compounds with potent anti-inflammatory properties that combat tumor cells and promote cardiovascular health.

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland USA where he takes care of patients, conducts original research and teaches medical students.  His most recent book “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease” has been Amazon’s #1 Rated book in Heart Disease for 3 consecutive years.

The Allure of Artichokes

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Artichokes are among the heart healthiest foods on the planet.  Not only are they listed among the 10 richest foods in antioxidants, but they are also a super natural source for magnesium.  Magnesium, when consumed from natural food sources helps to keep our moods calm, heart rhythms in check and blood vessels healthy.  So what else makes artichokes so healthily alluring?

  1. Protective to the Liver: A number of studies have now found that artichokes to improve blood flow through the liver and reduce buildup of toxins.  A recent study even found artichoke extracts to reduce fatty liver.
  2. Reduces oxidized LDL: Several studies have found artichokes to lower LDL (bad cholesterol) 5-15% and a recent study demonstrated reduction in oxidized LDL, a more harmful form of the bad cholesterol due to its propensity to promote plaque growth.
  3. Improves glucose and triglyceride levels:  Artichoke extract has also been shown in preliminary studies to modestly lower blood glucose levels and blood fats (triglycerides).
  4. Inflammation Buster:  Not only are artichokes very rich in antioxidants as noted above, but they also exhibit powerful anti-inflammatory properties.  If you want to know why you should care about inflammation, read this!  Stay tuned for important information related to inflammation and the heart due out later this year.

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore where he takes care of patients, conducts original research and teaches medical students.  His most recent book is  “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease“.

5 Reasons to Savor Seafood

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Earlier this week, the American Heart Association released a science advisory statement on the benefits of seafood for cardiovascular disease. Two important conclusions of the report are that the benefits are most likely to be derived when seafood is prepared in a healthy manner (such as baked or grilled rather than fried) and when it replaces less healthy food options (such as saturated fatty foods and processed meats). Listed below are 5 reasons why incorporating seafood in your diet plays a pivotal role for excellent heart health.

  1. Seafood reduces the risk of sudden death: Consuming just 2 seafood meals each week (~250 mg omega-3 fatty acids) has been associated with a 50% lower risk of heart related sudden death.  This amount is contained in two 4-ounce portions of salmon, tuna, sardines, trout and oysters.
  2. Seafood reduces the risk of myocardial infarction (heart attack): Eating 4 fish meals each week is associated with a 22% lower risk of a heart attack compared to eating less than 1 fish meal per month.
  3. Seafood reduces the risk of stroke: In 1 large study, consumption of tuna fish, broiled or baked fish lowered stroke risk by 40%.
  4. Seafood may reduce the risk of heart failure: In another large study, 2 seafood meals each week reduced the risk of heart failure by 30%.
  5. Seafood improves biomarkers of heart health: Eating fish on a regular basis will help to lower levels of blood fats (triglycerides), C-reactive protein (inflammation) and aging of blood vessels (arterial stiffness).

The bottom line: enjoy at least 2-servings of your favorite fish each week and your heart will benefit immensely!

Michael Miller is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore where he takes care of patients, conducts original research and teaches medical students.  His most recent book “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease” has been Amazon’s Top Rated book in heart disease for the past 3 years.

 

5 Ways to Make the Most of Today… & Tomorrow

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The sudden and premature passing of Kevin Kamenetz should give us all time to pause and reflect why such a health conscious individual died suddenly at the age of 60. Perhaps the only hint came at his funeral service when his wife Jill noted that Kevin looked tired. In fact, he had been working very long hours in his bid to become the next Governor of Maryland. From all reports, Kevin had no history of heart disease, did not smoke, ate a healthy diet and ran on a platform to improve the education and health of Marylanders. In fact, just last week Kevin signed a County executive order requiring all vending machines to sell only nutritious items.

So why did this seemingly healthy appearing individual in the prime of his life, die so suddenly? Unfortunately, it’s a question that cardiologists encounter all too frequently.

While the majority of young men and women who die suddenly from a heart related event have 1 or more risk factors (cigarette smoking, diabetes, high blood pressure, high cholesterol, high triglycerides), at least 1 in 3 do not. But the one universal feature they all share is a body overridden by stress. So if a friend or loved one tells you that you look “worn out”, take them seriously-

Here are 5 ways to help manage daily stress and improve your positive emotion quotient (PEQ) to make the most of today… and tomorrow.

  1. Recharge: Take time each day for yourself to reflect, collect your thoughts and most importantly, catch your breath. Feeling rushed on a daily basis amps up release of stress chemicals to wreak havoc on your heart.
  2. Exhale: and slowly inhale too as breathing exercises are among the best ways to release endorphins and de-stress.
  3. Laugh: Another way to release endorphins- As our research indicates, laughter also helps to maintain health of the inner lining of our blood vessels (endothelium) and keep stress chemicals at bay.
  4. Appreciate: Don’t wait until tomorrow to enjoy today. As Kevin’s wife Jill said at her husband’s memorial service …they postponed celebrating recent milestone birthdays because of the upcoming election. Hug your loved ones daily and celebrate important milestones when they occur rather than delay…there may not be a tomorrow.
  5. Xerox: Routinely replace photos in your home, office, wallet (or phone) that brighten your day. Positive imagery activates brain regions that help to heal the heart.
  6. Dr. Michael Miller is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore where he takes care of patients, conducts original research and teaches medical students.  His most recent book “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease” has been Amazon’s Top Rated book in heart disease for the past 3 years.