Billy Joel was Right…Just Ask Anthony

Health & Wellness, heart disease, Heart Health, Mental Health, stress, stroke, workplace stress

In his classic/catchy tune, Movin’ Out” (AKA, “Anthony’s Song”), Billy Joel once lamented to Howard Stern that the song reflected friends taking jobs to fulfill others rather than themselves.  Beyond the colorful characters, Mama Leone, Sergeant O’Leary and Mr. Cacciatore, it’s poor Anthony (among others) for whom it’s suggested that “working too hard can give you a heart attack…”

We’ve known for some time that working too many hours is associated with increased risk of cardiovascular disease.  For example, a study of more than 600,000 men and women published in the Lancet found that those who worked at least 55 hours each week experienced a 13% higher risk of a heart attack over a 5-year period, and 33% greater likelihood of a stroke, compared with those who worked 35-40 hours.

Let’s suppose that Anthony experienced his first heart attack after working more than 55 hours a week in the grocery store.  A new study now shows that if Anthony continues to work more than 55 hours a week he is 67% more likely to have another heart attack (or more than a 2.5 fold increased risk if there is associated job strain), compared to other heart attack survivors who dropped their workload down to 40 hours or less per week.

Bottom Line:  Working 55 hours or more per week may be hazardous to your health, unless of course, you thoroughly enjoy what you do.  After all, as my late father-in-law, Paul Miller (who taught math for 80 years) used to say “if you love what you do, you’ll never work a day in your life!”  

Below are additional tips related to workplace stress and the heart

  1. Jobs that are of high-demand, low-control are associated with increased risk of heart disease. They include factory workers, firefighters and postal workers.
  2. Jobs that are of low-demand, high-control are associated with reduced risk of heart disease. They include architects, dentists and sales representatives.
  3. A study conducted in Germany found that job stress was associated with increased inflammation and 2-fold increased risk of a heart attack over an 11-year follow-up period.
  4. Stressful working conditions are associated with reduced life expectancy of 2 and 1.5 years in men and women, respectively.

Dr. Michael Miller is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland. 

Let’s Keep this Party Going: New Insights into Laughter’s Cardiovascular Benefits

Health & Wellness, Heart Health, laughter, Mental Health

In case you missed it, World Laughter Day was celebrated this past Sunday.  Yet, our understanding of laughter’s influence on the cardiovascular system continues to grow since the inaugural World Laughter Day in 1998.  In fact, my interest in this area began in 1997, when Dr. Adam Clark, a recent graduate of Albert Einstein School of Medicine and one of our Medical Residents, approached me seeking a research project in cardiovascular prevention.  At that time, our laboratory was studying families with extreme levels of HDL (the good cholesterol); one of our interests was evaluating high HDL in protecting against heart disease.

We reasoned that if HDL served to counteract some of the adverse effects of LDL (the bad cholesterol) on the heart, might a similar story be played out when evaluating emotional health and heart disease.  While studies had previously established emotional stress as a contributor to heart disease, information was simply lacking as to whether positive emotions may offset this effect.

Our initial study of a 40% lower risk of heart disease among those who were able to find certain daily stressful situations humorous led to other studies that ultimately supported a direct link between laughter and vascular health; click here for the review paper co-authored with Dr. William Fry, the late Stanford University professor and pioneer in the field.

As additional research has been conducted in recent years, we’ve gained new insights into the role of laughter and cardiovascular health.  Listed below are some of the reasons why we should keep this party going (daily rather than yearly):

  1. A Japanese study of nearly 21,000 men and women (aged 65 years and older) found that daily laughter was associated with a 60% lower risk of a stroke compared to those who never or rarely laughed.
  2. A 15-year study in Norwegians found a greater than 70% higher survival rate from cardiovascular disease in women with a high sense of humor.
  3. Watching a funny video reduces stress cortisol levels (that in turn, increases inflammation/cardiovascular risk), improves short-term memory and learning ability.
  4. Laughter reduces/offsets some of the symptoms associated with a stressful event that promote inflammation and cardiovascular disease.
  5. Maintaining a humorous perspective about personal experiences is associated with resilience and better psychological -and by extension, cardiovascular, health.
  6. In the elderly, laughter therapy has been shown to reduce chronic pain (that in turn, raises blood pressure/cardiovascular risk) and improve overall life satisfaction.
  7. Laughter may slow/delay the onset and progression of vascular complications associated with diabetes.

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.


The New Sleep Study that is Outrightly Nightmarish

Brain Health, Health & Wellness, Heart Health, Mental Health, sleep

Upon awakening (and before your caffeine fix), if you can say the title of this post three times perfectly in less than 10 seconds (go ahead, give it a shot…), odds are that you just slept like a baby!

In all seriousness, I was taken aback upon reading the newly published study that found men and women aged 50 and over who (on average), slept just 6 hours (or less) per night saw an  increased risk of dementia by 30% compared to those whose average sleep duration was at least 7 hours.    Other studies showed similar findings though most were conducted over a shorter follow-up period (generally less than 10 years).

We still don’t know whether sleep deprivation that begins at an earlier age has a similar effect.  Suffice it to say that during our medical or surgical residency training, we were chronically tired having been subjected to 36 hour shifts every 3rd or 4th night over multiple years.  Fortunately, today’s trainees are not afforded the rigorous sleep deprivation of previous generations.  As a result, the amount of time during medical training where 6 or fewer hours of sleep occurs is a lot lower than in years past.  Still, physicians are commonly assigned on-call overnight shifts where fewer than 6 hours slept has been the rule rather than exception.  Mechanisms proposed to account for the relationship between poor sleep and dementia include inflammation of the brain with buildup of cholesterol plaques in the lining of brain vessels as well as impaired processing of proteins (such as beta amyloid).

For my patients who have difficulty getting a good 7-8 hours of restful sleep not due to a medical condition (such as sleep apnea), I make the following recommendations.

  1. Try to complete your dinner meal 4 hours prior to bedtime because a large part of digestion occurs during this period. Going to bed after a large meal is not conducive to a good night’s sleep if your body has to work overtime.
  2. Take a 20-30 minute walk after dinner. Physical activity not only helps in digesting sugars and fat but also enables a more restful sleep.
  3. Turn off the TV (or other stimulating activities) 1-2 hours before bedtime.
  4. Try a cup of valerian tea or 2-4 ounces of tart cherry juice 1 hour before bedtime.
  5. Engage in a relaxation activity (restorative yoga, meditation, lavender bath) 30 min-1 hour before bedtime.

Check out my heart health tips each day on twitter ( or Facebook: (healyourheartbook).

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.

How Can You Mend A Broken Heart? Try this Powerful Antioxidant

Health & Wellness, Heart Health, Mental Health, Nutrition

When the Bee Gees released their classic tune, “How Can You Mend a Broken Heart?”, I’m sure they didn’t have antioxidants in mind!  Yet, they were clearly onto something when they sang “Please help me mend my broken heart and let me live again”.  In fact, research that we and others have conducted show a direct link between emotional and vascular health.   When emotional turmoil/depression set in, chemicals are released that cause blood vessels to clamp down and blood pressure to rise.  Over, time chronic stress/depression sets the stage for other unwelcome/unexpected problems that can endanger your heart.

When the Bee Gees ask, “how can you stop the sun from shining?”, the answer is that gloom and doom will inevitably follow unless effective treatment is started. Fortunately and as described in “Heal Your Heart” many stress reducing tools are not only available but are also backed up with scientific evidence.  These tools may not only help to prevent a cardiovascular event but can also improve vascular health!

Along these lines, a new study has found that in addition to stress-reducing activities, consuming high levels of powerful antioxidants known as “flavanols” produce a similar effect. These plant-based micronutrients (or polyphenols) are among 6 subgroups derived from flavonoids (the other 5 are: anthocyanins, flavanones, flavan-3-ols, flavones and isoflavones).

In the new study, volunteers drank a cocoa beverage that contained a high content (680 mg) or low content (4 mg) of flavanols on 2 separate days.  Not only did the high flavanol drink lead to greater expansion of blood vessels (compared to the low flavanol drink) but it also reduced their blood vessels from clamping down after they were subjected to mental stress testing.

Bottom Line: This study supports incorporating plant-derived and powerful antioxidant flavanols as an important heart health strategy to protect your blood vessels from their daily stressors.

In addition to cocoa/cacao containing products that are high in flavanols, I recommend that my patients incorporate other sources of flavanols to enrich their heart and overall health: They include apples, apricots, beans, broccoli, cherry tomatoes, chives, cranberries, kale, leeks, pear, onions, red grapes, sweet cherries, and white currants.

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland, USA. 



5 Heart Healthy Reasons to Eat Spinach and other Leafy Greens Daily

Health & Wellness, Heart Health, Mental Health, Nutrition

Popeye was right….see below…

  1. Enrichment in Vitamin K. Vitamin K is an essential vitamin that helps to regulate bone health and blood clotting.  The minimum recommended daily intake is 90 micrograms (mcg) for women and 120 mcg for men. Vitamin K deficiency is most commonly the result of reduced dietary intake, digestive problems (such as malabsorption) and liver disorders.  In addition to increased risk of bone fractures and bleeding recent studies also suggest that low levels of Vitamin K may be linked to cognitive decline and higher risk of Alzheimer’s disease. Fortunately, leafy greens come to the rescue because of their high content of Vitamin K in relatively small quantities. For example, eating just 5-10 kale chips will provide a day’s worth of your Vitamin K needs.  Other leafy greens that are rich sources of Vitamin K include spinach, collards and beet greens.  A word of caution is urged for those prescribed blood thinners such as coumadin (warfarin) that interfere with Vitamin K.  Make sure to speak to your health care provider- we recommend that you consume the same amount of leafy greens each day to avoid significant fluctuations in “INR”.
  2. Enrichment in Natural Nitrates. Dietary nitrates (not to be confused with cancer promoting artificial nitrates used in processed foods), are mostly (~80%) derived from vegetables.  When chemically converted to nitric oxide the result is blood vessel dilation, reduced blood pressure and improved vascular health.  Foods highest in nitrates include the leafy greens, arugula, chard, kale and spinach.  In addition to vascular health, an Australian study found that eating at least 1 cup of green leafy vegetables per day enriched in cabbage, kale, lettuce and spinach was associated with stronger muscle function that was independent of physical activity.  The mechanism is believed to be due to nitric oxide mediated  improvement in muscle contractility as previously demonstrated with heart failure.
  3. Enrichment in Folate. One serving of spinach contains 2/3rds of the daily requirement of folate (Vitamin B9). Folate is key for both heart and emotional health.  By helping to regulate levels of the amino acid homocysteine, a risk factor for heart attack and stroke, high intake of folate may be associated with reduced risk.  In addition to spinach, other dark leafy greens high in folate are Turnip greens; one serving will provide ~40% of your daily requirement.  Because low folate levels are also associated with depression, a daily serving of spinach can also be mood uplifting (see also Magnesium below)!
  1. Enrichment in Potassium. Leafy greens from arugula to turnip greens are important sources of potassium, a pivotal mineral for regulating blood pressure. The DASH diet (Dietary Approaches to Stop Hypertension) is among the most effective for reducing blood pressure. Leafy greens are an important component of a potassium-rich diet, designed to help dispose of excess sodium.  The daily potassium goal from foods ranges between 3,500–4,700 mg and just a single cup of the following leafy greens will provide a good chunk of change as you aim for your daily goal; they are Beet greens (1300 mg), Swiss chard (960 mg), spinach (840 mg) and Bok choy (630 mg).
  1. Enriched in Magnesium: It has been estimated that nearly 3 of 4 Americans do not fulfill their dietary intake of magnesium (men: 400-420 mg; women: 310-320 mg).  If you are deficient in magnesium, you may experience muscle cramps, fatigue and/or an abnormal heart rhythm.  Low magnesium levels are also linked to depression, anxiety and panic attacks.  Fortunately, cooked spinach is an excellent source of magnesium with 1-cup providing 50% of the recommended daily amount for Olive Oyl (and other women).  With that said, can you think of a better ambassador for this post than the sailor man himself?                                                                                                                                                      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 & Reverse Heart Disease” published by Penguin Random House.

No Stroke of Luck: Why New Hypertension Guidelines will Save Hearts & Minds

Brain Health, Health & Wellness, Heart Health, Mental Health


bp image

New hypertension guidelines out this week now define high blood pressure (BP) as a systolic (top number) of at least 130 mm Hg or diastolic (bottom number) of at least 80.  These levels have come down from the “140/90” definition of hypertension established two decades ago.  Prior to that time…when I was a medical student, much less emphasis was placed on systolic BP.  In fact, physicians would simply take your age, tack on the number “100” and determine whether your systolic BP exceeded your age…if not, no worries.  But over the years, we’ve come to realize that living with a BP of 140/90 DOUBLES your risk of stroke or heart attack death and levels of 160 (systolic) or 100 (diastolic) QUADRUPLES risk!  Fortunately, it’s no stroke of luck that lowering systolic BP to 120 mmHg saves hearts and minds!

If you are told that your blood pressure is high at your physician’s office, you should check it at home using a digital monitor.  I suggest finding a quiet room, sit for a few minutes and obtain an initial BP reading. If elevated (as is often the case), discard the first reading and then take the average of a 2nd and 3rd BP reading spaced 3-5 minutes apart. Repeat this process at approximately the same time each night for 1 week to get a reasonably accurate assessment of your BP readings at home.

If your blood pressure is 130/80 or higher at home, I suggest the following to bring it down to a normal level (less than 120/80):

  • Weight loss: 5-10% of body weight loss can lower BP ~5-10 mmHg.
  • Try the DASH diet (aiming for less than 1500 mg of sodium or ¾ of a teaspoon of salt daily). A DASH diet can lower BP ~7-12 mmHg, and may be independent of weight loss.
  • *Increase potassium intake by ~3500 mg daily. The amount of potassium in top food sources is illustrated on page 42 of “Heal Your Heart”). Increasing potassium by ~3500 mg per day can lower BP ~8-12 mmHg.
  • Moderate activity such as brisk walking (3-4 miles/hr) for 30 minutes at least 5 days a week can reduce BP another ~5-10 mmHg.

*discuss further with your doctor if you have kidney problems

Dr. Michael Miller is a cardiologist and Professor of Medicine at the University of Maryland School of Medicine.  He is also a member of the American Heart Association (AHA) Nutrition Council and his latest book is “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease” – 100% of book proceeds are donated to the AHA.

Secret Words of Wisdom from a 100-Year Old Teacher

Health & Wellness, Mental Health, Relationships

Hall of fame 016I once asked Paul Miller, a 2011 inductee in the National Teachers Hall of Fame and featured this week on NPR, what he viewed as his secret(s) to a long, healthy and happy life.  Here are some of the words of wisdom he shared that if we live by can make this world a better place… Paul certainly has!

  1. Treat everyone with respect:  Paul not only taught but tutored students from all walks of life; for more than 75 years spanning the educational cycle from kindergarten through college, he taught math at public and religious (Jewish and Christian) schools, Universities (Johns Hopkins, University of Maryland, Towson University, Coppin State). In all, he taught at more than 25 different schools, displaying respect for his students.
  2. Love what you do: Paul loved to teach and even after he suffered a heart attack, the first thing he asked his doctor was when would he be able to go back to teaching.
  3. Enjoy being around younger people: Paul especially loved teaching young students and found elementary through high school to be the most challenging yet most rewarding. Young people have energy and an optimism that all too often recedes with age.
  4. Don’t hold a grudge: If Paul had a hard day at school, he would not let it get to him and move on the next day, often forgetting that anything happened the prior day.
  5. Keep your mind active: Paul always did crossword puzzles and solving math problems. Nearing 101, he is still adept at answering square root problems!
  6. Don’t take yourself too seriously: Paul continues to laugh easily and often, even when it is at his own expense.
  7. Maintain a spiritual connection: Believing in a higher power can be comforting and help to reduce stress during life’s most difficult times.


Mood Boosting Ingredients to CURE the Winter Blues!

Brain Health, Health & Wellness, Mental Health, Nutrition

Many of us experience the winter blues… the time of year when the days are short and energy levels are low. For my patients, I prescribe the following 7 ingredients to help give them a daily boost during these difficult days. I’ll share with you my favorite tea that I drink throughout winter (see below). Or if you prefer, you can also find these mood enhancers in my favorite Pressed Juicery products.

Cacao (Chocolate Almond): Cacao beans are among the richest natural source of antioxidant polyphenols that together with its high content of magnesium improves blood flow to our brain and provides increased focus and concentration. Cacao beans also contain the chemical anandamide that is similar in composition to marijuana’s THC and may account for the euphoric mood that is commonly experienced.

Cardamom (Spiced Almond): This mood elevating spice contains cineole, a powerful anti-inflammatory compound. Cardamom can lower heart rate and blood pressure but is also a mood enhancer. In a study of cigarette smokers trying to kick the habit, chewing gum flavored with cardamom reduced the anxiety and depression caused by cigarette withdrawal.

Cinnamon (Coconut Cinnamon): Cinnamon is one of my favorite recommendations to patients. In addition to lowering cholesterol, triglycerides and helping to regulate blood glucose levels, cinnamon also boosts memory and alertness. Without question, it will reduce irritability and put you in a better mood.

Cayenne (Greens 4): contains the powerful anti-inflammatory/antioxidant, capsaicin that not only enhances fat burning but also has an appetite suppressant effect. Another very cool and recently discovered property is cayenne’s protection against aging and age related diseases. It is one of the most powerful endorphin releasers and will energize you during the winter doldrums.

Ginger (Roots 3): Exciting research shows that ginger inhibits growth and buildup of proteins that cause Alzheimer’s Disease. Ginger’s powerful anti-inflammatory properties also reduce menstrual cramps, arthritic pain and migraines. By increasing levels of brain neurotransmitters, serotonin and dopamine, ginger is also among the best natural sources for an uplifting mood.

Turmeric (Fruits): Turmeric is the new kale. It contains curcumin, one of nature’s most powerful antioxidant/anti-inflammatory compounds that fights cancer, improves vascular health and regulates blood glucose levels. Turmeric has also been shown to reduce episodes of depression and may play a role in degenerative brain disorders such as Parkinson’s Disease.

Vanilla bean (Matcha & Hemp): The chemical vanilloid (similar to capsaicin) has antioxidant/anti-inflammatory properties that may slow cellular aging. Like cacao, the vanilla bean is also an aphrodisiac that enhances arousal and mood and a recent study found that it reduces anxiety and claustrophobia.

Winter Sun Turmeric Tea: I keep a jar of the paste on my desk and just add hot water, lemon and sometimes ginger or cayenne pepper. Could not be easier!

Make a paste using 1/3 cup of honey and 1-1/2 teaspoons of dried turmeric. Give a couple of grinds of fresh black pepper and stir to combine. To make the tea, take 1 teaspoon of the paste and place in mug. Pour hot water over and a squeeze of lemon. (If you want extra heat, add 1/8th teaspoon of cayenne pepper).


This blog was originally posted to The Chalkboard on Friday Jan 13, 2017





Chocolate Chip-Beet Cake

Heart Health, Mental Health, Recipes

chocolate beet cakeA favorite dessert in our home because it  contains natural heart healthy antioxidants, blood pressure lowering and mood boosting compounds that with added chocolate chips will make your day!

What you need:

1 cup almond flour

2/3 cup coconut sugar

1/4 cup unsweetened cocoa powder

1 teaspoon baking soda

1/8 teaspoon salt

3 tablespoons grape seed oil

1 egg

1 teaspoon vanilla extract

1/4 cup orange juice

2 medium beets (I recommend “Love Beets“), cooked and shredded

1/3 cup dark chocolate chip

Preheat oven to 350 degrees F.  Coat an 8″ x 8” baking pan with cooking spray.  In a large bowl, combine the almond flour, sugar, cocoa, baking soda and salt. In a smaller bowl, whisk the oil, egg, vanilla and OJ until blended. Stir oil mixture into flour mixture, using a wooden spoon.  Fold in the beets and chocolate chips.  Pour the batter into the baking pan.  Bake for 25 minutes or until a toothpick inserted in the middle comes out dry.  Cool the cake in the pan on a rack before serving.

Garnish with blueberries, raspberries and a sprinkle of powdered sugar (optional). Enjoy!

Makes 8 servings: Nutrition content per serving, 270 calories, 6 grams protein, 31 grams carbs,  3 grams fiber, 3 grams sat fat, 242 mg sodium.

From “Heal Your Heart: The Positive Emotions Prescription to Prevent and Reverse Heart Disease” (Rodale).




Health Benefits of Laughter in Older Men and Women

Health & Wellness, Heart Health, Mental Health

After “Heal Your Heart: The Positive Emotions Prescription to Prevent and Reverse Heart Disease” was released in late fall of 2014, a common question that my older patients would ask me is whether laughter can also be of benefit to them. That is because most research on laughter, including ours, focused on young and healthy men and women. However, two recently published papers provide new insights into how laughter may be especially useful in aging men and women. The first study was conducted in Iran and randomized men and women 60 years and older to laughter (or no) therapy twice a week for 90 minutes. The participants completed questionnaires before and after the 6-week study period. Those assigned to laughter therapy demonstrated improvement in sleep quality and anxiety levels (1). The second study examined short-term memory in men and women older than 60 who were tested before and after watching a 20-minute comedy video. Once again, the older adults assigned to the laughter group showed improvement in learning ability and memory recall (2). It’s been said that “you can’t teach an old dog new tricks”. Perhaps we should now revise that expression to “you can teach an old dog new tricks if you can get them to laugh beforehand”.


1. Ghodsbin F, Sharif Ahmadi Z, Jahanbin I, Sharif F.

The effects of laughter therapy on general health of elderly people referring to

jahandidegan community center in shiraz, iran, 2014: a randomized controlled

trial. Int J Community Based Nurs Midwifery. 2015 Jan;3(1):31-8.

2. Bains GS, Berk LS, Lohman E, Daher N, Petrofsky J, Schwab E, Deshpande

P. Humors Effect on Short-term Memory in Healthy and Diabetic Older Adults.

Altern Ther Health Med. 2015 May;21(3):16-25.