Is Intermittent Fasting Right For You?

Health & Wellness


Years before it became fashionable, I recommended to my patients interested in optimizing their heart health not only to eat their last meal at least 4 hours prior to bedtime but to also keep their dinner meal light (for more details see  “Heal Your Heart…” below).

As a researcher involved in numerous fat-feeding studies, it is well established that after we eat a meal containing fat, our triglycerides levels (blood fats) not only increase but can spike upwards of 2-3 fold with peak levels occurring ~4 hours after the meal.   Similarly, consuming carbs leads to a rapid rise in blood glucose and insulin levels that taper down over the next several hours (in the absence of insulin resistance).  The rise in blood glucose levels tend to be slower after consuming complex carbs contained in dietary fiber than in processed and refined carbs found in soft drinks (soda) and candy. However, if you keep your dinner meal light and engage in mild physical activities (such as an after dinner walk), you will boost your metabolism by revving up proteins involved in digesting fats and carbs thereby maintaining triglyceride, glucose and insulin levels under better control.  Left untreated, high levels of blood fats, glucose and insulin promote weight gain, insulin resistance, hypertension, diabetes as well as raise the risk of a heart attack and stroke.

It turns out that intermittent fasting (IF) can also help to boost metabolic (and vascular health) because increasing the number of hours in the fasting state reduces weight, blood pressure and blood levels of triglycerides, glucose and insulin.  For example, in a recent study of men at increased risk of diabetes, eating for 6-hours a day improved insulin sensitivity and blood pressure without increasing the urge to eat.  Keep in mind that a 6-hr time window for eating may be quite difficult especially if you work long hours; my most successful patients adhering to this regimen also have more flexible schedules. That is, they generally eat breakfast ~10 AM and conclude their dinner meal ~4 PM with weight loss in the 10-20 lb range (and in some cases more than 25 lbs).  Because IF represents a lifestyle change rather than a fad diet, weight loss can be sustained for years.  While many of my patients have found 6-hour IF to be too restrictive, they are able to maintain an 8 and especially 10 hour eating period (e.g., ~8 AM- 6PM) daily.  Whatever IF approach you decide on, the majority of calories should be consumed during breakfast-lunch followed by a light dinner with no snacking afterwards.

In addition to weight loss, my successful IF patients tell me they sleep better, have more energy, are happier and more productive.  Even though it can be very effective, make sure to speak to your physician and determine whether IF is an appropriate lifestyle consideration for you.

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland USA.  His book:  “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease” focuses on natural ways to improve your heart and emotional health.





4 Health Benefits of Mushrooms

Health & Wellness, Nutrition


Mushrooms may be among the most underrated superfoods, but make no mistake, they possess a veritable boatload of vital nutrients and properties guaranteed to enrich your heart, spirit and overall health. Whether they are cultivated or obtained in the wild (such as the yellowfoot mushrooms illustrated above), listed below are 5 reasons why I avidly endorse the consumption of these edible delicacies on a daily basis.

  1. Antioxidant Powerhouse: Edible mushrooms are an excellent source of antioxidants such as polyphenols (e.g., flavanoids), polysaccharides (e.g., beta-glycan) and vitamins (e.g., C and E) that help to neutralize free radicals from promoting cell damage, cancers and age-related diseases of the heart and brain. Consumption of edible mushrooms as part of a healthy lifestyle prescription may help to maintain and improve quality of life.
  2. Lowers Blood Pressure: Eritadenine is a compound isolated from shitake and other mushrooms that inhibits ACE (angiotensin-converting enzyme). ACE inhibitors are medications that are commonly used to treat elevated blood pressure.  in addition, mushrooms are a good source of dietary potassium, thereby providing another avenue to help reduce high blood pressure.
  3. May Reduce Weight: Have you heard of the mushroom diet?  If you are looking to shed some weight, try substituting portobello mushrooms for red meat and you may lose 5-10 pounds!
  4. Reduces Depression and Anxiety: Consuming the edible mushroom, “Lion’s Mane” has been shown to alleviate symptoms of depression and anxiety.  This should not be confused with psilocybin, another compound isolated from mushrooms that may elicit hallucinogenic behavior and result in panic attacks.
  5. Michael Miller, MD is a Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland USA.  His book, “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease” focuses on proven methods to manage stress and improve cardiovascular health.

Reflections on the REDUCE-IT™ Study

Health & Wellness, Heart Health


Among the highlights of this year’s American Heart Association meeting in Chicago was the REDUCE-IT Study, masterfully presented by my colleague, Dr. Deepak Bhatt and simultaneously published in the New England Journal of Medicine. The study examined the use of a highly concentrated and purified form of EPA, icosapent ethyl, in more than 8,000 men and women with high triglycerides and either cardiovascular disease or high-risk patients with diabetes.

We’ve known for many years that having high levels of LDL (the bad cholesterol) promotes heart disease and effective therapies such as statins, reduce rates of heart attacks and strokes.   And while high triglycerides also increase the likelihood of adverse heart-related outcomes, garnering support to conduct a large clinical trial aimed at studying men and women with elevated triglyceride levels was lacking. Elevated triglycerides are common in the U.S. and other westernized societies; approximately ~1 in 3 adults have triglyceride levels above 150 and ~1 in 5 have levels above 200 mg/dL.

After several large pharma companies passed on supporting such a study in men and women with heart disease and high triglycerides, the small Irish biopharma company, Amarin stepped up to the plate… the end result is the REDUCE-IT study.

Men and women assigned to the active treatment arm received 4 grams of icosapent ethyl daily. EPA is found in oily fish, such as sardines, salmon, herring and mackerel, but if you believe you can consume that amount in 1 serving of these fish, think again. With a single 3.5 ounce (100 gram) serving of salmon, the amount of EPA approximates ~0.7 grams.   In other words, you would need to consume ~20 ounces (570 grams) of salmon each day to get the amount obtained with 4 grams icosapent ethyl!

To quote some of my colleagues, the results of REDUCE-IT were “unprecedented”, “game changer”, “sea change”, et cetera, because of the magnitude in the reductions of heart attacks, strokes and cardiovascular death compared to other contemporary lipid trials. In part, this reflects the fact that clinical trials that study patients with heart disease must utilize standard-of-care therapies. This would include statins, where cardiovascular risk is reduced by 25-35%. Consequently, it has been very difficult to show additional benefit on the background of statin therapy. Not surprisingly, early studies failed and it wasn’t until the past decade when more effective therapies (ezetimibe, PCSK9i) were able to show significant lowering of events in the range of 6-15%. Now contrast that with REDUCE-IT, where a more robust 25% decrease in heart attacks and strokes was observed as well as a 20% reduction in cardiovascular death. Importantly, REDUCE-IT is the first lipid-based study to show improvement in cardiovascular death on the background of statin therapy.

BOTTOM LINE: We finally have a safe and effective therapy to treat men and women with heart disease, diabetes and high triglycerides.

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland USA.  He served on the Steering Committee for the REDUCE IT trial.

Open Sesame: Several Surprising Benefits of Seeds

Health & Wellness, Nutrition

4 seeds


Seeds are such a vital powerhouse of heart healthy and mood boosting nutrients that I recommend my patients consume up to a handful of their favorite seeds daily.  As illustrated, sesame, flax, pumpkin and sunflower seeds lower cholesterol, triglycerides (blood fats) and regulate glucose levels.  As excellent sources of magnesium, Vitamins B6, folate and zinc, seeds may also trigger the release of neurotransmitters to uplift mood. In fact, daily seed consumption is among the dietary cornerstones for prevention of depression.

Chia seeds may also effectively curb appetite- try soaking 1 teaspoon over a 10 minute period in a glass of water, then drink the water 20-30 minutes before your main meal and you may be pleasantly surprised by the results.

Certain seeds contain lignans, plant compounds rich in (polyphenol) antioxidants. Flaxseed and sesame are superb sources of lignans; recent studies support an anticancer role for sesame seeds.  Flaxseed has also been shown to reduce growth of breast cancer cells.

To get a “double-bonus” try a small handful of seeds covered in dark chocolate.  One of my favorite snack recommendations is dark chocolate covered pumpkin seeds (illustrated).  Keep in mind that just small amounts such as 1/2 handful is sufficient to boost mood by releasing the positive emotion neurotransmitters, serotonin and anandamide.   Each handful of seeds (without chocolate) will cost you ~200 calories, so plan not to exceed this amount in order to reap the health benefits.

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland USA.  His latest book is  “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease“.