Taking this Study with a Grain of Salt

File:Rock salt, Klodawa Salt Mine, central Poland.jpg

Americans consume sodium in excess by approximately 1,000 mg per day (approximately 3,400 mg versus the recommended amount of 2,300 mg or 1 teaspoon of salt) in men and women younger than age 50 years and more than twice as much sodium than recommended (1,500 mg) for older men and women. Yet, despite promotional efforts by government agencies and the media to get this information out into the public domain, the progress made toward reducing the purchase of sodium-enriched products has not been well established. The new study examines the national trend in sodium reduction in U.S. households over a 15-year period by focusing on package foods and beverages, two of the richest sources of sodium consumed by Americans.

A recent study found average reductions in sodium of 12% from packaged goods purchased between 2000 and 2014. On the surface, this may seem like a significant improvement over the study period. However, the analysis did not include foods that did not contain a barcode, such as the popular, “grab-a-ticket” deli counters where lunchmeats are commonly seething with sodium. For example, one slice of deli ham often contains 300-400 mg of sodium. Because approximately one-half to one-third of daily sodium intake may be obtained from deli meats and popular store-prepared foods (also not assessed for sodium content), not having this information puts somewhat of a damper on an otherwise informative and interesting study.

This blog was originally posted on Healio (June 7, 2017).

Dr. Miller is Professor of Cardiovascular Medicine, University of Maryland School of Medicine and author of “Heal Your Heart” with 100% of proceeds donated to the American Heart Association.




Matcha is a finely ground, bright green powder made from tea leaves. However, in contrast to traditional green teas, matcha undergoes specialized processing that produces a 100-fold higher concentration of one of nature’s most powerful antioxidants, EGCG. Matcha also contains the mood-boosting compound, theanine; between this one-two power punch, I am convinced that matcha is the real deal to be routinely recommended for my patients as part of an overall prescription for vibrant health. Below are some of the impressive research findings to date.

  1. IMPROVES MOOD. Matcha provides a dazzling dose of the chemical L-theanine that, coupled with a modest amount of caffeine, facilitates focus, concentration and memory. The calming effect of theanine also helps to take the edge off, ensuring an immediate upswing in mood. It is rare to find a natural product that possesses such diverse mind-enriching properties.
  2. SLOWS SIGNS OF AGINGPromising animal research has found that the potent       antioxidants contained in matcha not only slow the aging process, but may protect the brain from the progressive deterioration accompanying dementia. Human studies are evaluating EGCG as potential therapy for early Alzheimer’s Disease, so stay tuned!
  3. BOOSTS ENERGY + ENDURANCEStudies involving moderate-intensity exercise have found that the compounds contained in matcha boost energy metabolism, leading to improved exercise endurance and stamina while reducing belly fat.
  4. HELPS US DETOX.  A study just published in March found that EGCG not only lowered blood sugar but also delayed the buildup of toxins that cause the eye, kidney and heart damage that all too commonly complicate diabetes.
  5. IMPROVES SLEEP QUALITYNot only does L-theanine produce a calming effect during wakefulness, but recent studies suggest that this compound can also influence the sleep cycle and promote more restful sleep cycles.
  6. HEART HEALTH BFF. The primary antioxidant compound in matcha, EGCG dilates blood vessels and lowers blood pressure, cholesterol, inflammation and development of blood clots. Taken together, matcha possesses inherent properties that protect against heart disease and keep our blood vessels young and healthy.
  7. FIGHTS THE BIG C? Matcha’s powerful antioxidant and anti-inflammatory properties inhibit the activity of tumor cells in lung, breast and prostate with a host of other cancers under active investigation. Clearly, we have only begun to scratch the surface in realizing matcha’s potential for preventing – and preventing the spreading of – invading cancers.
  8. REDUCES INFLAMMATIONA recent review found EGCG to reduce inflammation and impairment of brain function associated with MS. Two studies evaluating EGCG treatment for MS were recently completed and results should be available soon.

This blog was originally posted on The Chalkboard (May 22, 2017).

Dr. Miller is a Professor of Cardiovascular Medicine, University of Maryland School            of Medicine and Author of Heal Your Heart: The Positive Emotions Prescription          to Reduce and Prevent Heart Disease (Rodale Press).

Eggs: Do They Deserve A Beating?

The Doctors 2

Recently, The DOCTORS Show invited my colleague Andrew Freeman, MD and me to participate in “The Great Food Debate”. In this segment, our debate focuses on eggs. I don’t know about you, but I love eggs. Growing up, my grandmother would cook up my favorite breakfast: eggs over easy, with lots (and lots) of pepper…absolutely delicious!

However, over the years, eggs have been beaten up (in more ways than one); some of my colleagues, including Dr. Freeman, believe that eggs are unhealthy because they contain too much cholesterol and choline. Some studies even report that too many eggs cause diabetes!

As it turns out, the amount of cholesterol in egg yolks (150-160 mg) is about 50% lower than it was back in the 70s (due in part to changes in hen’s feed and accuracy of cholesterol measurements). Choline is an important nutrient that is not only necessary for brain function, but also improves mood and suppresses anxiety. In addition, choline reduces levels of homocysteine, an amino acid that can be toxic to our heart and blood vessels.

With regard to the concern that eggs “cause” diabetes, let me paraphrase a recent paper the nicely summarizes the evidence from multiple studies. That is, consuming 6-12 eggs weekly along with following heart-healthy eating patterns has NO effect on cholesterol, fasting glucose or C-reactive protein (a marker of inflammation).

What egg critics fail to point out are that egg whites contain a healthy content of protein and minerals (magnesium, selenium) whereas the yolk is enriched in vitamins (A, B12, D, E, Folate, K), minerals (calcium, iron, selenium, zinc) and carotenoid pigments (lutein, zeaxanthin) that reduce risk of eye diseases such as cataracts.

Overall, I place no restriction on egg whites, and the only time I recommend egg yolk restriction is for my patients with very high cholesterol levels (LDL levels above 160 mg/dL).  Otherwise, go enjoy your favorite omelet (mine is spinach, onions, mushroom and tomato)!

Dr. Miller is a Professor of Cardiovascular Medicine, University of Maryland School of Medicine and Author of Heal Your Heart: The Positive Emotions Prescription to Reduce and Prevent Heart Disease “ (Rodale Press).

“ASK Away”…The American Heart Association Facebook Q&A

Recently, the American Heart Association launched an innovative educational platform on Facebook designed in real-time to answer questions and elicit discussion on important and timely topics related to the prevention and treatment of heart disease.  In the most recent session in honor of Nutrition Month, I served as guest advisor addressing the topic of food-drug interactions (see below).

The bottom line is that when you are prescribed medication, always ask:

  1. what time of day it should be taken
  2. which foods (if any) should be avoided
  3. whether to take on an empty stomach or with/after meals
  4. what other medications it may interact with

Finally, medications do not always produce the desired effect.  For example, while the cholesterol lowering statins typically lower LDL (the bad cholesterol) anywhere between 20 and 50% (depending upon the specific statin and dose),  approximately 5-10% of statin users experience no LDL lowering benefit.  This lack of response can be independent of diet or other factors.   Consequently, if you are not attaining the expected results after taking a certain medication, make sure to discuss these concerns with your physician. All too commonly, your physician may interpret this lack of response as “patient noncompliance” so please make sure that your physician knows that you have indeed been taking the medication as prescribed.

Dr. Miller’s most recent book “Heal Your Heart: The Positive Emotions Prescription to Prevent and Reverse Heart Disease” is Amazon’s Top Rated book in Heart Disease.  All proceeds of the book are donated to the American Heart Association.

Mood Boosting Ingredients to CURE the Winter Blues!


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





Havana: An Energizing Experience

max-havana-clubilana-cuban-childOur recent trip to Havana was filled with a sense that this once favorite American destination will return to its former glory once some travel related kinks are ironed out. We departed from Ft. Lauderdale taking a Jet Blue flight and purchasing the required tourist Visa by simply checking off one of the 12 reasons for visiting Cuba (ours was to support the Cuban people). The flight was quick and smooth, landing approximately 1 hour after takeoff.   However, it took an additional hour to retrieve our luggage (presumably due to a single baggage handler). For exchanging money, I would recommend bringing euros or Canadian currency rather than the U.S. dollar that currently carries a 10% surcharge. If you plan to use a credit card, it must be International because neither American Express nor VISA credit cards issued by U.S. banks are accepted. We opted not to stay at one of the Government run hotels but rather selected from airbnb, a converted palace in Vendado (https://www.airbnb.com/rooms/6153074) sandwiched between architectural gems and downtrodden buildings, representing the economic paradox of the City.  A similar sentiment holds true for the colorful bounty of classic 1950’s American cars seen throughout Havana. Food continues to be in relative scarce supply and it is not uncommon for a restaurant to reduce its selection of menu items within several hours after opening. Our favorite dining experience was El del Frente, located at 303 O’Reilly Street (http://www.alamesacuba.com/es/la-habana/restaurant/el-del-frente/).

Yet despite language barriers and economic shortcomings, I was most impressed by how proud the Cuban people are. They are very friendly, hard working people with positive energy who seemed genuinely happy to have us visit their country.   If you plan to visit Havana in the near future, I recommend bringing the following:

Are All Sugars Created Equal?

sugar-623371_1920Our love affair with sugars is undeniable, as each of us is likely to consume at least 150 pounds of added sugar this year alone! Compare that to the 1800s when the average daily sugar intake only added up to 2 pounds per year. Just within the past 30 to 40 years, our sugar consumption has increased by more than 25 pounds per year, which helps explain why rates of obesity and diabetes have skyrocketed.

The American Heart Association has been so concerned about this alarming trend that they recently recommended that women should consume no more than 6 teaspoons of added sugar, or about 100 calories a day, and men consume no more than 9 teaspoons of added sugar, or 150 calories a day.

Most added sugars come from soft drinks, processed foods and condiments (especially ketchup), but reducing our daily sugar intake isn’t as easy as simply eliminating those foods. There are several misconceptions about added sugars for which my patients commonly request clarification. Here are the top three…

MISCONCEPTION ONE: All Sugars Are Created Equal.


Many think a teaspoon of added sugar is the same as sugar from natural sources, such as that found in lemons. The answer is yes in terms of the number of calories, but the sugar sources (and what each type offers our bodies) are different. In contrast to the heart healthy vitamins, minerals and potent antioxidants found in lemons – such as hesperetin and liminoids – added sugars are totally empty calories with no nutritional value. In other words, the only thing that added sugars truly add is an increase to our waistline that an adversely affect heart health over time.

Many natural juices do not contain any added sugars. As a result, potential health benefits include favorable effects on risk factors for heart disease such as blood pressure, cholesterol and overall vascular health.

I recommend that my patients aim for products that contain 5 grams or less of “added sugar” per serving. As current labeling practices don’t allow consumers to differentiate between natural and added sugars, we’re looking forward to new breakthrough labeling measures that will help all of us to choose better products with the right kinds of heart healthy sugars in them.

MISCONCEPTION TWO: Food Labels Are Transparent.

It’s fair to assume that food labels reliably tell us the amount of added sugar in a product. The truth is, today’s food labels fall short of that objective by only stating the total number of sugar calories. The good news, however, is that food labels are all set to change by July 2018, when companies will be required to provide not only the total sugar content, but also the quantity and percent of the recommended daily amount of added sugars per serving. This is important because the American Heart Association recommends that no more than 10% of daily calories come from added sugar. These new labels will allow for better monitoring our daily sugar intake.

MISCONCEPTION THREE: Fructose is the Enemy.

People often assume that all sugars are equal with respect to heart health. Fructose is a natural sugar found in agave, honey, pears, dates and other fruits. Consuming natural fructose containing foods has no adverse effect on health because the total amount of fructose is relatively modest (less than 50 grams) – unless of course you are binging on a dozen or more pears each day and coat all of your foods with honey or agave.

The problem occurs when the amount of high fructose corn syrup exceeds 100 grams daily, which is the equivalent of 4 12-ounce cans of cola. In my practice, this is not an unusual occurrence. Unfortunately, very high amounts of fructose cannot be effectively processed resulting in high levels of cholesterol and triglycerides in blood, a fatty liver and eventual heart disease. As it turns out, fructose in high quantities may be more harmful to the heart than table sugar (sucrose) or milk sugar (lactose).

This post was originally published on The Chalkboard Magazine.




7 Surprising Health Benefits of Rosemary

rosemary In the wake of a recent NYT article suggesting that cooking with Rosemary, a daily ritual in the Italian city of Acciaroli,  contributes to healthy longevity (living to 90 and older with excellent brain and heart function), let’s review 7 surprising health benefits of Rosemary and why it should also be part of your everyday diet!

  1. Improves Mood and Concentration: The aroma of rosemary oil can improve mood and concentration (http://dx.doi.org/10.1080/00207450390161903).  Not only does rosemary increase alertness in healthy men and women but studies found cognitive improvement in patients Alzheimer’s disease when Rosemary was used as part of aromatherapy over 1 month (https://www.ncbi.nlm.nih.gov/pubmed/20377818).
  2. Restores Hair: A recent study comparing rosemary oil to minoxidil (Rogaine), in bald men and women found significant increases in hair counts after 6 months in both groups.  However, there were fewer side effects following daily application of rosemary oil to the scalp (https://www.ncbi.nlm.nih.gov/pubmed/25842469).
  3. Reduces Anxiety & Stress:  As with lavender oil, the use of rosemary oil as aromatherapy also reduces anxiety.  This was especially pleasing to nursing students where this treatment reduced stress levels and improved their overall final test scores (https://www.ncbi.nlm.nih.gov/pubmed/19258850).
  4.  Regulates Blood Glucose: Recent studies have found that rosemary extract improves glucose uptake in muscle suggesting that rosemary may be useful in the fight against insulin resistance and diabetes (https://www.ncbi.nlm.nih.gov/pubmed/25794239).
  5. Improves Blood Flow.  In a group of young healthy volunteers, rosemary extract dilated blood vessels, improved blood flow and reduced susceptibility to blood clot formation (https://www.ncbi.nlm.nih.gov/pubmed/20734322).
  6. Has Anti-Cancer Properties:  Rosemary extract contains powerful antioxidant chemicals (polyphenols) that inhibit the growth and accelerate death of cancer cells (https://www.ncbi.nlm.nih.gov/pubmed/27470574).
  7. Prevents Wrinkles: Rosemary also possesses anti-inflammatory properties and studies have found that rosemary extract accelerates wound healing and may reduce wrinkles and skin aging (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931025/).

For more information, see Dr. Miller’s website: http://www.drmichaelmiller.org

His latest book “Heal Your Heart: The Positive Emotions Prescription to Prevent and Reverse Heart Disease” is Amazon’s top rated book in Heart Disease. Proceeds from Dr. Miller’s book are donated to the American Heart Association.




Dietary supplements are a multibillion dollar per year industry and they are not regulated by the FDA compared to over the counter (OTC) products such as Advil and Nexium.   Dietary supplements come in many forms and they include vitamins, minerals, herbs and amino acids.   Several manufacturers of herbal supplements have fallen under scrutiny recently for allegedly failing to include herbs.

There is another big problem with dietary supplements when it comes to heart health.   That is, even when all active ingredients are present, there is no evidence that they work better than a placebo pill! In fact, research has shown that Vitamins A, B, C and E in supplement form do not reduce “hard endpoints” such as risk of heart attacks, strokes or improve survival. They don’t even reduce blood pressure, cholesterol, or blood glucose. The jury on Vitamin D and omega-3 fish oil supplements is still out with a large NIH funded trial nearing completion, so stay tuned.

In the meantime, an alarming trend in the medical community is the growing number of doctors who are selling dietary supplements in their medical practices. They peddle these compounds without telling their patients that in most cases, they are simply swallowing very expensive placebo pills.   One example is nitric oxide (NO) supplements that are reported to dilate blood levels and improve vascular health. Yet, clinical trials to date have not shown that NO supplements either reduce heart attacks or even improve the health of heart attack survivors.

My colleagues and I who take care of patients at major academic Medical Centers take great pride in conducting randomized clinical trials to determine the effectiveness of treatments aimed at improving heart health. We do not prescribe dietary supplements because they lack sound scientific evidence and do not replace or supplement optimal lifestyle recommendations provided.   In the same vein, doctors who prescribe their brand of supplements also bear the responsibility of informing their patients of the “proven benefits”. This should not imply a “trust me, I’m the doctor” exchange but rather should include reprints of studies published in peer review medical journals. If your doctor(s) cannot provide that information, then I would be wary of their practice.

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine. He is Chair, Governor Hogan’s Advisory Panel on Heart Disease and Stroke Prevention, Section Editor for the Journal of the American College of Cardiology (the world’s premier cardiology journal) and a member of the American Heart Association Leadership Council.

His book “Heal Your Heart: The Positive Emotions Prescription to Prevent and Reverse Heart Disease” is Amazon’s #1 Rated book in Heart Disease. All proceeds from Dr. Miller’s book are donated to the American Heart Association.

The MUFFIN study

The American Heart Association recommends that we reduce our intake of saturated fats to about 5% of total calories. In the past, when we’ve replaced sat fats with carbs, the result was usually weight gain. That’s because much of the carbs being replaced were “non-filling” simple sugars. If you’ve ever had a “low fat” cake, you know exactly what I’m talking about. That’s because without a feeling of “satiety” or sense of fullness, you can easily eat much of that cake in a single sitting! And those calories will add up quickly even though the number of calories per gram of carbs is much lower than for fat (4 versus 9 calories). That leaves us with replacing sat fat with more complex carbs such as fiber or replacing sat fat with other fats.

The idea for the MUFFIN came about when we realized that no study had directly compared fats enriched in monounsaturated fats (MUFA) such as olive oil with fats enriched in polyunsaturated fats (PUFA) such as safflower, sunflower and canola oil.

We contracted with USDA to prepare the MUFA and PUFA muffins for our study. These muffins were delicious and our participants consumed 3 MUFA or PUFA muffins daily.

After 6-months of the assigned diet, both groups lost weight with the PUFA participants losing 10 pounds on average compared to 5 pounds lost with MUFA. Assignment to PUFA was also associated with greater reductions in blood pressure and triglycerides than MUFA. Perhaps most importantly was that 1 in 4 PUFA subjects were no longer classified with the metabolic syndrome compared to 1 in 10 assigned to MUFA.

So why did PUFA subjects lose more weight than MUFA subjects? Recent studies suggest that PUFA contains a chemical compound that suppresses appetite. This chemical compound is present to a greater extent in PUFA than in MUFA or sat fat.

Bottom line: You can have your (PUFA) muffins and eat ’em too.

For more information: