Move over Wheaties: The New Breakfast of Champions is…

chocolate, Gut Health, Health & Wellness, Nutrition, Uncategorized

It’s been nearly a century since Wheaties featured Lou Gehrig as the first of many star athletes to grace the cereal box cover and represent “the breakfast of Champions”.   While Wheaties continues to have its fair share of dedicated breakfast fans, a new study suggests that at least from a heart health perspective another food source rises to the top when it comes to the breakfast of champions.  No, I am not referring to cheerios, oatmeal or egg white omelettes.

In fact, this breakfast is not only decadent and mood uplifting but also lowers blood glucose and burns fat.  And the answer is….chocolate!

In the new study conducted in Spain, female volunteers were assigned to consume 3.5 ounces (100 grams), the size of an average bar of milk chocolate.  Beyond their typical food intake, the women were randomly assigned to complete 3 phases; no chocolate phase, chocolate for breakfast phase or chocolate for dinner phase.

The results found that despite the additional ~500 calories from chocolate, there was surprisingly no weight gain when chocolate was added to breakfast.  In fact,  300 fewer calories were consumed on average per day with shrinkage of waist size and reduced cortisol (stress) levels.  Eating chocolate in the morning was also associated with 4.4% decrease in fasting blood glucose levels (by slowing carb digestion) and increased concentration of powerful antioxidants, such as epicatechins.

Bottom line: Women who ate the equivalent of a bar of milk chocolate for breakfast were less hungry throughout the day and consumed less fat and carbs. In addition, the compound theobromine derived from cacao beans, is thought to have contributed to the increased fat breakdown (oxidation) and smaller waist circumference provided that the chocolate was consumed within 1 hour of awakening.  If these benefits were derived with milk chocolate, imagine what a dark chocolate breakfast can do for you!

Listed below are more reasons to start your day with chocolate, the (new) breakfast of champions!

  1. Reduces Cholesterol: Combining dark chocolate with almonds and cocoa powder reduces LDL cholesterol; lower LDL is associated with lower risk of heart disease. 
  2. Affects Platelet Function: Casual consumption of chocolate was shown to reduce platelet clumping (aggregation).  These antiplatelet effects contribute to the reduction in heart disease associated with consumption of flavanol-enriched foods.
  3. Lowers Blood Pressure: The equivalent of 30 calories of dark chocolate (1 Hershey’s dark chocolate kiss) was shown to lower blood pressure. This is due to  blood vessel dilation and improvement in endothelial function (nitric-oxide mediated).
  4. Improves Memory: Consuming a drink containing cocoa flavanols improves memory and reduces several measures of age-related cognitive decline.  As a rich source of cocoa flavanols, not only do I add CocoaVia to my morning coffee but I recommend the same for my patients.

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland and author of  Heal Your Heart: The Positive Emotions Prescription to Prevent and Reverse Heart Disease.”: published by Penguin Random House.



A Handful of Clues to Uncover Cardiovascular Disease

Health & Wellness, heart disease, Heart Health, signs of heart disease

Clues revealed during physical examination can inform physicians and other health care providers about potential heart related concerns.  In this regard, examination of the hands can be quite revealing, especially if the patient had been unaware that any such issue existed.  Shown below are some hand-related clues that we’ve encountered in our medical center.

  1. Yellowish-orange discoloration in palm creases: Yellowish-orange discoloration in palm creases of the hand may be seen in a rare medical condition (familial dysbetalipoproteinemia) associated with high triglycerides and increased risk of heart disease.
  2. Little Bumps on the back of the hands: Cholesterol deposits on tendons (known as xanthomas) may appear as little bumps resembling knuckles on the back of the hand.  They are due to very high levels of LDL cholesterol found in a rare medical condition (familial hypercholesterolemia) and associated with an increased risk of cardiovascular disease.
  3. Bony swellings in the thumb and fingers: These swellings occur in the base of the thumb, fingertip joint and the middle joint of the fingers due to “wear-and-tear” or osteoarthritis. Inflammation results in painful hands and increased risk of heart disease.
  4. Blue clubbed fingernails. First described by Hippocrates, clubbing or enlargement of the fingertips and downward sloping of the nails occurs when blood levels of oxygen are low over time and is associated with certain types of congenital heart disease.
  5. Raised red circular nodules. “Osler’s nodes” are raised reddish appearing nodules that are tender to touch and found on fingers and fleshy area of the hand (thenar eminence). They consist of small clots (micro-emboli) due to endocarditis (bacterial/fungal infection of the heart).
  6. White spots on the fingernails. White spots on the fingernails may be a sign of calcium or zinc deficiency. Severe calcium deficiency adversely affects the heart’s conduction system and may cause a dangerous heart rhythm (Torsade de Pointes).
  7. Discoloration of the Fingers. Raynaud’s disease includes discoloration of the fingers/toes (red/white/blue) in response to cold temperatures or emotional stress and is associated with reduced blood flow to heart muscle and increased risk of cardiovascular death.


Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.  For additional clues to protect your heart, check out Dr. Miller’s latest book, “Heal Your Heart“.

More Justification to Enjoy Java in June

Coffee, Health & Wellness, heart disease, Heart Health, Uncategorized

Several new studies out this year continue to point in a favorable direction when it comes to your morning (and afternoon) cup of java as it related to cardiovascular health.  The first study analyzed coffee drinking in more than 20,000 men and women in the U.S. and found that compared to non-consumers, drinking 2 cups of caffeinated coffee daily correlated with a 31% lower risk of developing heart failure.  Although the specific mechanism(s) underlying this effect has yet to be established, coffee is a rich source of antioxidants such as polyphenols that may in turn limit/prevent cell damage and minimize adverse changes to heart function over time for those who regularly consume this beverage.

A second study of more than 170,000 Koreans aged 40 and older found that compared to non-drinkers, 1-3 cups of coffee each day was associated with a 38% reduced risk of cardiovascular death over the ~9 year follow-up period.  The authors believe that chlorogenic acid, was a prime contributor to this effect due to its robust anti-inflammatory, anti-oxidant and anti-diabetic properties (see also below).

The third study found that adding caffeine, or a cup of coffee (for the purpose of this post) approximately 30 minutes prior to an aerobic workout (preferably in the afternoon), increases breakdown of fat.  Though not tested in this study, anticipated benefits of boosting fat oxidation over a prolonged period might include weight loss, triglyceride reduction and improved cardiometabolic health.

For my patients who enjoy their java, I recommend 1-2 cups daily, with the 2nd cup consumed in the early afternoon, at least 8-10 hours prior to bedtime to reduce insomnia.  In addition, because of cancer concerns related to the toxin acrylamide that is released when coffee beans are roasted, I recommend staying away from instant and light roasted coffee brands (due to higher amounts of acrylamide) and stick with medium and dark roasted varieties.

Below are additional health benefits from your morning (and afternoon) mug.

  1. Improves Mood and Concentration: The sweet spot to boost mood and alertness is a moderate dose of caffeine (100-300 mg) whereas higher doses (above 400 mg) may result in anxiety and impaired performance. For example, a  “Grande” cup of Starbuck’s coffee varies in caffeine content from 260 mg (dark roasted) to 360 mg (blonde roasted) whereas a large cup (20 ounce) of Dunkin’ Donuts is ~300mg.
  2. Reduces Glucose Levels: Coffee contains the phytochemical, chlorogenic acid that slows the absorption of carbs, thereby lowering blood glucose levels and possibly the risk of type 2 diabetes.
  3. May Reduce Risk of Several Cancers: According to the American Cancer Society, drinking coffee has been associated with reduced risk of several cancers including prostate, liver and uterine cancer.
  4. May help Asthmatics. Coffee contains trace amounts of theophylline that dilates lung airways and at higher medicinal doses is used as a treatment for asthma.  In fact, caffeine has been shown to improve lung airway function for up to four hours, in people with asthma.

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

Another Reason to Eat an Apple a Day…

Diabetes, Gut Health, Health & Wellness, heart disease, Heart Health, Nutrition, Uncategorized


The original proverb, “Eat an apple on going to bed and you’ll keep the doctor from earning his bread,” is well recognized in its simplified form (“an apple a day…”) and may now also “keep diabetes away” based on a study released earlier this week.   The new Australian study surveyed dietary habits in more than 7,500 men and women and found that consumption of at least 2 servings of fresh fruits daily was associated with ~35% decrease in developing Type 2 diabetes over the 5-year follow-up period.

Fruits that contributed to this benefit were apples, bananas, oranges and other citrus fruits whereas drinking fruit juice had no effect.   Among the individual fruits tested, only apples were independently associated with lower blood glucose levels and improved insulin sensitivity.

In addition to being a rich source of fiber that slows the absorption of glucose (thereby keeping the pancreas from overworking/overproducing insulin that over time may lead to insulin resistance), apples also contain the flavonoid, quercetin, that suppresses inflammation, a chronic process that promotes insulin resistance.

Because there is a tight intersection between metabolic syndrome, Type 2 diabetes and heart disease, cardiologists are becoming more involved in coordinating care with our diabetes and endocrine specialists.  Ironically, two of the newer classes of medications used to treat diabetes, the SGLT2 inhibitors and GLP1 agonists are being embraced by heart specialists because of proven benefit in reducing cardiovascular risk.

Below are some useful tools to reduce the risk of diabetes and/or lower heart related complications associated with Type 2 diabetes.

  1. A new study suggests that eating  an apple a day may also keep diabetes away!
  2. If you are overweight and prediabetic (fasting blood glucose 100-125 mg/dL), losing 5-7% of body weight is associated with ~50% reduction in conversion to diabetes; losing 10% of body weight correlated with an 85% decreased risk.
  3. The flavonoid quercetin has potent anti-inflammatory properties to combat insulin resistance. Foods with the highest quercetin content include onions, apples, blueberries, broccoli and kale.
  4. Large waist size (at least 35 inches in women/40 inches in men) is associated with a greater than 20-fold increased risk of diabetes compared to smaller waist size (less than 31 inches in women/37 inches in men).
  5. Treatment with the highly purified EPA compound, Icosapent Ethyl reduced the risk of a heart attack, stroke or death from cardiovascular disease in Type 2 diabetics with elevated triglycerides.
  6. Treatment with the diabetic medication known as SGLT2 inhibitors (dapagliflozin, empagliflozin) reduces the combined risk of cardiovascular death or hospitalization from heart failure (with low ejection fraction) in the presence or absence of diabetes.
  7. Treatment with the diabetic medication known as GLP1 agonists (liraglutide, semiglutide, dulaglutide) reduces the risk of heart attack, stroke and heart-related deaths in diabetic patients with a history of heart disease, or in the case of dulaglutide, with or without heart disease.
  8. The GLP1 agonist, semiglutide used to treat diabetes was just approved by the FDA as a weight management drug to treat overweight/obese adults with diabetes, hypertension or high cholesterol in addition to lifestyle (diet and physical activity) measures.

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland and author of  Heal Your Heart….”: published by Penguin Random House.