30 Years of Heart-Related Discoveries/Advances at the University of Maryland School of Medicine

cholesterol, Diabetes, dietary fat, fish consumption, Health & Wellness, heart disease prevention, laughter, Uncategorized

As my 30-plus years as a faculty member at the University of Maryland School of Medicine and Medical Center has drawn to a close, I fondly recall 10 heart-related findings/discoveries and newsworthy events that gained worldwide attention, ending with the first genetically altered pig heart transplanted at UMMS last week.  Here they are in no special order.

1.         Poe likely died of rabies, doctor’s review shows: https://www.baltimoresun.com/news/bs-xpm-1996-09-11-1996255015-story.html

2.         Having high cholesterol levels early in life leads to heart problems by middle age: https://www.eurekalert.org/news-releases/823756

3.         Air Pollution and Diabetes: https://www.loe.org/shows/segments.html?programID=14-P13-00002&segmentID=5#:~:text=We’ve%20long%20known%20that,fatty%20diet%20can%20promote%20diabetes.

4. U.S. Amish gene trait may inspire heart protection: https://www.reuters.com/article/us-heart-gene/u-s-amish-gene-trait-may-inspire-heart-protection-idUKTRE4BA6JQ20081211

5.         Want a McMuffin? Take your McVitamins: https://greensboro.com/want-a-mcmuffin-take-your-mcvitamins/article_20be3661-d342-549f-9118-a2e355f4175a.html

6.         UMMC Implants the World’s Smallest Pacemaker: https://www.umms.org/ummc/news/2017/ummc-implants-the-worlds-smallest-pacemaker

7.         University Of Maryland School of Medicine Study Shows Laughter Helps Blood Vessels Function Better: https://www.sciencedaily.com/releases/2005/03/050309111444.htm

8.         Study finds no value in heart supplement: CoQ10 not shown to relieve symptoms, UM cardiologist says: https://www.baltimoresun.com/news/bs-xpm-1999-09-27-9909270293-story.html

9.         Secondhand Smoke Ups Heart Disease in Unique Group of Female Nonsmokers – Amish Women: https://www.umms.org/ummc/news/2017/amish-secondhand-smoke

10.       In a First, Man Receives a Heart from a Genetically Altered Pig https://www.nytimes.com/2022/01/10/health/heart-transplant-pig-bennett.html?smtyp=cur&smid=tw-nytimes

Dr. Michael Miller is Chief of Medicine, Corporal Michael J Crescenz VAMC in Philadelphia, PA   Check him out on twitter: @mmillermd1

On Babe Ruth, Hobbies and the Heart

Uncategorized

As we get set to leave Baltimore for Philadelphia, I can’t help but reminisce of the great friendships and memories made in “Charm City”.   As a baseball enthusiast, moving to Baltimore in the mid-80s brought me an even greater appreciation of GH (Babe) Ruth, the hometown hero and legendary “Sultan of Swat”.  Over the past several decades, my hobby of collecting baseball memorabilia rose to a new depth as I pursued Ruth-related collectibles.  Of the 7 baseball cards illustrated, 5 are of the Bambino himself (from the 1933 Goudey and 1948 Leaf set), 1 is of his teammate, Lou Gehrig (1934 Goudey) and on the upper right, is the 1909 T-206 Ty Cobb (green background) acquired from the estate of Babe Ruth’s cousin shortly after my move to Baltimore from Cincinnati.   

It is no surprise that we commonly refer to Baltimore as “Small”-timore because there are so many interconnections…in the case of Babe Ruth, I pass by his birth home nearly every day as the University of Maryland Hospital is just a block away.  Ironically and many decades earlier, my wife’s family (generations of native Baltimoreans) at one time owned the pub where Babe Ruth’s father was employed (currently the centerfield area of Camden Yards).  Even our 13-year-old cockapoo is aptly named “George Herman”!

Listed below are reasons to engage in a hobby that is appealing to you.

  1. Hobbies have a positive impact on the heart by improving psychological health.  Studies have shown that psychological health is an important component of wellness/well-being for patients at risk of heart disease (CVD).
  2. A recent study in spouses who were caregivers of patients with Alzheimer’s disease found that participation in pleasant leisure activities was associated with improvement in cardiovascular risk factors such as blood pressure and emotional stress.
  3. Engagement in a variety of art forms (2 hours each week) such as the performing arts, visual arts and literature is associated with better emotional and heart health (improved heart rate variability).
  4. A study conducted in Pittsburgh found that engaging in enjoyable activities was associated with lower blood pressure, stress hormone (cortisol) levels, waist circumference, and body mass index as well as a better overall perception of physical function.
  5. A study of 4,200 Swedes aged 60 and over found that gardening and do-it-yourself projects to be associated with a 25-30% lower risk of heart attack, stroke or death from cardiovascular disease over a 12 year follow-up period.
  6. Enjoyment of a hobby is associated with an 8-fold lower risk of future cardiovascular events such as heart attack or stroke due to improvement in vascular health.
  7. A newly published study conducted in Japan over a 16-year follow-up period found that compared to those that have no hobbies, engaging in 1 or multiple hobbies was associated with a 10-20% lower risk of cardiovascular events.
  8. Engagement in activities such as jigsaw and crossword puzzles reduce stress hormone (cortisol) levels; a recent study found that elevated levels of urinary cortisol predates the development of hypertension.

Dr. Michael Miller is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.  Check him out on twitter: @mmillermd1

Did You Hear That? If Not, Blame it on Your Heart

audiology, blood pressure, cholesterol, Diabetes, fish consumption, Hearing, Heart Health, Nutrition, omega 3's, Uncategorized

As we age, the loss of high frequency sounds becomes a common sign of hearing impairment due to degenerative changes in the inner ear.  High frequency hearing loss is common in the U.S. (~1 in 5 adult men and women are affected) and the classic sign is a decreased ability to hear high pitched sounds (voices of children/women) as well as to decipher conversations in a crowded room.  Loss of low frequency sounds (voices of men, thunder, bass) is less common but is also an important cause of hearing loss.

A study from the Yale School of Medicine suggests that having a history of cardiovascular disease or at least 1 cardiovascular risk factor (diabetes, high blood pressure, history of smoking) also raises the risk of both high and low frequency hearing loss.

Bottom Line: While heart related risk factors may promote hearing loss, it still remains to be determined whether intensive management of these risk factors delays progression of this process.

Listed below are some tips related to hearing and cardiovascular health

  1. High frequency hearing loss is common in patients with diabetes (Type 1 and Type 2) due to disease of small blood vessels of the (cochlear) inner ear.
  2. Treatment of high cholesterol with statins has been shown to improve tinnitus (ringing of the ears).
  3. In a study of 274 men and women aged 45-64 years, hearing loss was 2-fold greater among those with hypertension (140/90 or higher) than with normal blood pressure.
  4. A study conducted in Korea found that obese men and women with elevated cholesterol and triglyceride levels were at increased risk of high frequency hearing loss.
  5. Data from the Nurses’ Health Study found that women who consumed 2-4 fish meals per week experienced a 20% lower likelihood of hearing loss compared to women who consumed less than 1 fish meal per month over the 18-year followup period.
  6. Cigarette smoking cessation eliminates the excess risk of hearing loss within 5-years of quitting.

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

“Go with your Gut”: Unlocking Secrets of Centenarians

Brain Health, centenarians, gut microbes, Health & Wellness, heart disease, Heart Health, Nutrition, Uncategorized

Despite the ravages bestowed by COVID-19, more than 500,000 men and women worldwide have attained centenarian status (living to 100 years and beyond), including nearly 100,000 residing in the U.S.  Among this special group was my beloved father-in-law, Paul Miller, who taught math for 80 years and lived to the ripe young age of 104!

Many of us both inside/outside the medical profession find these individuals to be awe inspiring especially when they are still in relatively good physical and mental health upon reaching this major milestone. While we appreciate that exceptional longevity may be more heavily concentrated in a “Blue Zone“, the overwhelming majority of centenarians do not live in these regions.  In fact, there are nearly 2,000 centenarians living in the great (though non-Blue Zone U.S.) state of Maryland!

Now a new study published in the prestigious journal, Nature, is assisting scientific efforts toward unlocking secrets for healthy aging and longevity.  The study conducted in Japan, found that centenarians had high levels of protective gut byproducts.  Also known as isoalloLCA, these secondary bile acids, contribute to gut health by inhibiting gut bacteria that promote inflammation and disease (such as C. difficile). While a cause-effect relationship between protective gut byproducts and longevity has yet to be established, this study is an important step in furthering our understanding of the relationship between gut and overall health.

Listed below are other secrets to enhance the likelihood of healthy longevity.

  1. Keep Saturated Animal Fats at BayA study that we conducted with Dr. Stan Hazen and colleagues at the Cleveland Clinic found that a low fat Ornish diet was associated with reduced levels of the gut byproduct TMAO compared to a high saturated fat Atkins diet.  High levels of TMAO are associated with an increased risk of heart disease.
  2. Think Positively about Aging: A study from the Yale School of Public Health found that older men and women who were genetic carriers of a gene that promotes dementia (APOE4 variant) were 50% less likely to develop dementia if they felt positively about the aging process.
  3. Be Resilient: In a study of centenarians from Georgia and Japan, personality traits included a high degree of resiliency as characterized by high levels of openness and extraversion and low levels of hostility and neuroticism.
  4. Have a Sense of Humor:Jeanne Louise Calment, the world’s oldest woman who died at age 122, credited her sense of humor for successful aging. In fact, a 15-year study from Norway found that women with a strong sense of humor experienced a nearly 50% higher survival rate compared to those lacking a sense of humor even with pre-existing heart disease or other chronic ailments.
  5. Engage in Mentally Stimulating Activities: A Mayo clinic study found that participating in 3 mentally stimulating activities such as reading books, craft activities (e.g., quilting, or sewing) or playing card games/doing crossword puzzles ~age 70 was associated with a 45% reduction in cognitive decline over the subsequent 5 years.
  6. Volunteer: Volunteering, especially over age 60 is associated with meaningfully positive effects on health and overall well-being.

Dr. Michael Miller is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.  Check out his updated author page on Amazon.

 

 

 

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.

 

 

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. 

Chew on This: Understanding the Link Between Oral Health and Heart Disease

Heart Health, Nutrition, Other, Uncategorized

As a writing member for an American College of Cardiology Workgroup, we are tasked with interesting and timely topics related to cardiovascular disease prevention. Our latest review “Oral Health and Atherosclerotic Cardiovascular Disease: A Review” was led by my colleague and fellow cardiologist, Dr. Eugenia Gianos.

Listed below are notable highlights from this review:

  1. Periodontal disease (PD) is common in the U.S., (affecting 46% of adults) and is associated with a 3.5-fold increased risk of cardiovascular disease. Risk factors for PD include smoking, diabetes, obesity, emotional stress and poor oral hygiene.
  2. Severe periodontitis is associated with impaired vascular health and a higher risk of heart attacks.
  3. A specific bacteria isolated from dental plaque (Streptococcus sanguis) is associated with an increased risk of blood clots.
  4. PD is associated with insulin resistance and worsening glycemic control whereas intensive periodontal treatment improves glucose control in diabetics.
  5. Cigarette smoking is associated with a 20-fold increased risk of gingivitis and PD.
  6. Fifteen or more cigarettes smoked daily raises the risk of tooth loss by 3-fold.
  7. Poor oral hygiene may be an independent risk factor for hypertension.
  8. If you have PD and are hypertensive, you are less likely to respond to blood pressure medications or achieve BP control!

The Bottom Line: Good oral hygiene is pivotal for maintaining a healthy heart!

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.  Make sure to check out his daily heart health tips on twitter (https://twitter.com/mmillermd1) or Facebook: (healyourheartbook).

What is the New “Normal” When it Comes to Blood Pressure & Optimal Heart Health?

blood pressure, Health & Wellness, Heart Health, Nutrition, Uncategorized

“Back in the day…” is the way I like to regale stories of my medical school experience with current students.  In fact, just the other day I recalled that when I was a medical student, high blood pressure was defined by taking the age of the person and simply adding 100. In other words, a 60-year-old could have a systolic blood pressure up to 160 mmHg before many physicians would be concerned that it required treatment!

Fast forward a handful of decades later, and a systolic blood pressure of 160 mmHg is now considered very serious (Stage 2) and one that commonly requires multiple blood pressure medications in addition to a low sodium diet and healthier lifestyle. Yet many people with high blood pressure don’t appreciate the importance of following a low sodium diet. Back in the day, we permitted up to 4000 mg of sodium or ~1.5 teaspoons of salt daily (we called it a “no added salt” diet).

Today, if you are otherwise healthy, maintain a blood pressure of less than 120/80 and are younger than 50, it is reasonable to adjust your sodium intake ~2300 mg per day (1 teaspoon of salt).  However, if you are at least 50 years old or have a history of hypertension, diabetes or kidney disease, the recommendation is to consume less than 1500 mg of sodium (~2/3 teaspoon of salt) daily.

Listed below summarize 4 key findings related to blood pressure:

  1. A normal blood pressure is less than 120 (systolic)/80 (diastolic) mmHg.
  2. High blood pressure causes blood vessels to constrict/stiffen and leads to “premature vascular aging”.
  3. For every 20 mmHg increase in systolic (or 10 mmHg increase in diastolic) blood pressure, the risk of a heart attack/stroke doubles!
  4. In addition to heart attack and stroke, other feared complications of long-standing hypertension include kidney failure and heart failure.

Over the coming week, check out the “HeartHealth Tip of the Day” on Twitter: @mmillermd1 or Facebook: “healyourheartbook” for additional information on this topic.

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.  For many more tips on how to optimize your heart health, check out his book,  Heal Your Heart…”: published by Penguin Random House.

5 Fiber-Enriched Foods that Lower Cholesterol Naturally

Health & Wellness, Heart Health, Nutrition, Uncategorized

During my training, I had the good fortune to be mentored by the late Dr. Peter Kwiterovich Jr., a true pioneer in the cholesterol field.  In fact, “Dr. Pete” as he was affectionately referred to by his patients, (many of whom were children/teenagers since he was a pediatrician by training), started the Johns Hopkins Lipid Clinic in the early 1970s, years before “cholesterol” became a household word.  Needless to say, his 1989 book, “Beyond Cholesterol: The Johns Hopkins Complete Guide for Avoiding Heart Disease” has stood the test of time and remains a classic for anyone interested in learning why “it’s more than just cholesterol”.  Still, cholesterol remains an important predictor of heart disease (conferring up to 50% of heart attack risk) and lowering your levels of low-density lipoprotein (LDL) or “bad cholesterol” will reduce your overall risk of a cardiovascular event.  In this post, 5 foods are discussed that lower LDL cholesterol levels naturally.  If you incorporate each of these 5 foods daily, you can lower LDL upwards of 15-20%! Whether or not lowering LDL through diet/lifestyle alone is sufficient, depends upon your overall risk of a heart attack/stroke and should be discussed with your health care professional.

  1. Oats: oats are good sources of soluble fiber that bind and eliminate cholesterol from the gut. Consuming 1 bowl of oatmeal daily may reduce LDL cholesterol levels ~5-7 mg/dL.
  2. Pectin: pectin is contained in the inner white rind of citrus fruits (e.g., oranges, grapefruits). Eating 1-2 medium sized grapefruits daily lowers LDL cholesterol ~2-4 mg/dL.
  3. Legumes: these seeds derived from pod plants (lentils, peas, chickpeas), contain the soluble fiber, guar gum. Consuming 1 cup of legumes daily in place of red meat can reduce LDL cholesterol levels by ~6-8 mg/dL.
  4. Psyllium: another water-soluble fiber that is sold in husks, or as the laxative, Metamucil. Each packet of Metamucil reduces LDL cholesterol ~3-5 mg/dL and I commonly recommend 1 packet (or tablespoon of psyllium) mixed in at least 8 ounces of fluid (up to 3 times daily) for patients with high LDL cholesterol levels and ensuring that other medications are taken at least 45 minutes before Metamucil.
  5. Beta-glucan: a type of viscous fiber, found in barley, mushrooms (e.g., shiitake, reishi) and seaweed, can have significant LDL lowering effects; each gram of beta-glucan consumed daily reduces LDL ~2 mg/dL. Try a hearty bowl of vegetable barley soup with shiitake mushrooms and lower your cholesterol naturally! Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.  For many more tips on how to optimize your heart health, check out his book,  Heal Your Heart…”: published by Penguin Random House.