By Jack Challem
Copyright 2000 by Jack Challem, The Nutrition Reporter™
All rights reserved. This article originally appeared in Let's Live magazine.
By the time her 50th birthday rolled around, Betty Dwyer was feeling worse than she ever had before. She was gaining weight for no apparent reason, had trouble catching her breath, and was feeling totally wiped out. "I had trouble even getting from my bedroom to the bathroom, says the Dallas, Texas, resident.
Diagnosed with cardiomyopathy (a disease of the heart muscle) and on her way to heart failure, she knew she'd likely be dead within a few years. (See "Definitions.") That's the grim prognosis for people with these catastrophic diseases of the heart muscle.
"Being labeled with heart failure has the same emotional impact as a diagnosis of cancer," says a sympathetic Peter Langsjoen, M.D., a cardiologist in Tyler, Texas. "It's a heavy burden."
Heart failure, sometimes referred to as congestive heart failure, affects an estimated 4.6 million Americans, and a half-million more will likely be diagnosed with the disease this year. It develops when the heart is literally too pooped to pump. With inadequate blood flow, the body becomes deprived of oxygen and nutrients, and the heart eventually gives out.
The most commonly recognized risk factors for heart failure are ischemic heart disease, high blood pressure, extreme obesity, and cardiomyopathy. But recent research points to a number of other causes, including medication side effects, infection, and nutrient deficiencies.
Surprising Causes of Heart Failure
Doctors have known for years that common nonsteroidal antiinflammatory drugs (NSAIDS), such as ibuprofen, can sometimes cause heart failure, particularly among the elderly. But recent findings have shed new light on the dangers of NSAIDS.
In a startling revelation, Australian researchers earlier this year reported that regular NSAID use by seniors doubled their risk of heart failure. Among people with a history of heart disease, NSAID use increased the risk of heart failure by 10 times, according to John Page, M.D., and David Henry, M.D., of the University of Newcastle, Australia. In a sobering conclusion to their article in the Archives of Internal Medicine they estimated that nearly one-fifth of heart failure cases may be caused by NSAIDS.
Heart failure can also be caused by myocarditis, an inflammation of the heart resulting from a viral infection. Sometimes called viral cardiomyopathy, the most common culprit is the coxsackievirus B. But this form of cardiomyopathy has strong nutritional undercurrents.
The coxsackievirus B is a common cause of sore throats and cold-like symptoms and, as such, is relatively innocuous as a virus. However, studies by Melinda Beck, Ph.D., of the University of North Carolina at Chapel Hill, and Orville Levander, Ph.D., of the U.S. Department of Agriculture, have shown that the virus mutates when it infects a "host" deficient in either vitamin E or selenium. This mutated coxsackievirus attacks the heart, setting the stage for cardiomyopathy and heart failure. Animal studies by Beck and Levander have shown that adequate intake of vitamin E and selenium prevent mutations in the infecting virus.
Heart failure can also be induced by cholesterol-lowering "statin" drugs, including prevastatin, simvastatin, or lovastatin. According to Emile Bliznakov, M.D., a CoQ10 researcher in Pompano Beach, Fla., statins inhibit a key enzyme involved in the body's production of cholesterol. However, the same enzyme is also necessary for production of coenzyme Q10 (CoQ10), a vitamin-like substance that plays a crucial role in producing energy in heart cells. So when statin drugs block the body's production of cholesterol, they also stop production of CoQ10.
A Loss of Energy in the Heart
As it turned out, Betty Dwyer did have a little luck on her side. In 1984, three years after being diagnosed with heart failure, her cardiologist asked her to participate in a small clinical trial testing the effects of CoQ10. After taking 100 mg daily for four months, Dwyer recalls, she felt noticeably better. Her heart was stronger and her energy levels were higher.
Since then, under her cardiologist's care, Dwyer increased her CoQ10 intake to 240 mg daily and, later, added 500 mg of carnitine. At a feisty 69, her survival for almost 20 years with cardiomyopathy (and without heart failure) is astounding. "As far as I'm concerned, CoQ10 has given me my life. I won't ever give it up."
Langsjoen, who has treated Dwyer, believes the problem boils down to poor energy levels in the heart. Tiny structures called mitochondria provide the power for all of the body's cells, but moreso for those of the heart. The reason is the heart's enormous appetite for energy, beating about 100,000 times a day, 35 million times a year, and almost three billion times over a life. Without energy, there is no heartbeat; and without a heartbeat, there is no life.
Cellular energy production depends on a variety of nutrients, some of which have been shown to benefit patients with cardiomyopathy and heart failure. These nutrients-CoQ10, carnitine, and creatine, among them-work in a variety of ways. However, each plays a role in helping mitochondria convert glucose (blood sugar) and fat to energy in the form of the chemical adenosine triphosphate (ATP). Low levels of any one of these nutrients can be a "rate-limiting" factor that impairs energy-producing chemical reactions in the body.
Supplements That Energize The Heart
CoQ10. Also known as ubiquinone, CoQ10 serves two principal functions: it helps shuttle around energy-containing electrons in the mitochondria, leading to the production of ATP, and it is also an antioxidant. CoQ10 is so important that it was the basis of the 1978 Nobel prize in chemistry, awarded to the late Peter Mitchell, Ph.D.
CoQ10 is found in every cell of the body, though people with cardiomyopathy and heart failure typically have low levels of it. It's not surprising that replenishing CoQ10 improves heart function in these patients.
In one typical study, Langsjoen and his colleagues used CoQ10 supplements to treat 11 heart failure patients who were likely candidates for transplant surgery. All of the patients improved, some regaining normal heart function and being able to cease taking conventional heart medications. More recently, in the Molecular Aspects of Medicine, Langsjoen reported 200 mg of CoQ10 daily helpful in the treatment of hypertrophic cardiomyopathy, which is characterized by a thickening and stiffening of the heart muscle.
Dosage: 240-360 mg daily in divided doses.
Carnitine. A component of protein, carnitine helps transport fats into mitochondria, where they are burned for energy. It also regulates the use of coenzyme A, an energy-producing compound built around the B-vitamin pantothenic acid.
In a recent study, Ioannis Rizos, M.D., of the University of Athens Medical School, Greece, studied 70 patients who took either 2 grams of carnitine or a placebo daily for three years. The patients suffered from heart failure resulting from dilated cardiomyopathy. Those who took carnitine had a much better rate of survival compared with those taking the placebo. Over the three-year study, six of the patients taking placebos died, whereas all but one of the patients taking carnitine survived. In addition, only one patient in the carnitine group developed arrhythmias, compared with seven in the placebo group.
Dosage: 2 grams daily in divided doses.
Creatine. Used by many body builders to improve endurance, creatine plays an important role in recycling and reusing ATP. After cells use ATP to produce energy for muscle contractions, it is converted to ADP (adenosine diphosphate). Creatine donates a phosphorus molecule to convert ADP back to ATP, thus restoring energy levels. Studies on patients with heart failure have found that creatine supplementation do not directly benefit the heart, but it does increase energy levels in skeletal muscle, resulting in an overall improvement.
Dosage: Loading dose of 20 grams daily for 10 days, followed by a maintenance dose of 5 grams daily.
Vitamin B1. Patients with heart failure are commonly deficient in vitamin B1 (thiamine), needed for several key energy-producing chemical reactions. This deficiency can be exacerbated with furosemide, a diuretic drug commonly used to treat heart failure. Several studies have found that vitamin B1 can improve heart function in heart failure. In one , David Ezra, M.D., of the Sheba Medical Center, Israel, found that both oral supplements and intravenous vitamin B1 corrected deficiencies induced by furosemide and improved the pumping action of the patients' hearts.
Dosage: 100-200 mg daily in divided dosages.
Arginine. Rainer Hambrecht, M.D., of the Leipzig Heart Center, Germany, recently treated 40 patients with either 8 grams of the amino acid arginine daily, handgrip exercises, or both. After four weeks, patients taking either the supplements or performing the exercises benefited from a four-fold improvement in heart function. Patients doing both had a six-fold improvement.
Dosage: 8 grams daily in divided dosages.
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Each of these supplements is safe when used to prevent heart disease. When used therapeutically to treat cardiomyopathy or heart failure, some caution is warranted, says Langsjoen. The reason is that cardiomyopathy and heart failure are among the most serious of all heart diseases.
Prescription drugs for these diseases work by masking symptoms or forcing the heart to work harder. In contrast, CoQ10, carnitine, and the other supplements naturally strengthen heart function. To avoid over-stimulating your heart, you will likely have to reduce your risk of heart drugs. Such adjustments in medications, says Langsjoen, should be done with the guidance of a cardiologist or other physician skilled in nutritional therapies and knowledgeable about drug-nutrient interactions.
A Broken Heart
Can your emotions set the stage for heart failure? As more researchers explore the body-mind connection in disease, it's clear that emotions can have a tremendous impact on your physical well being.
Consider the case of the late Jeremy Brett, a highly respected British actor. Brett, who portrayed what critics regarded as the quintessential Sherlock Holmes on television, died in 1995 from heart failure. He was only 62 years old.
In reality, Brett may have died of a broken heart. His wife and closest friend had passed away ten years ten years earlier. "She was my confidence, and I had lost my confidence," he was quoted as saying of his wife.
When people say, even casually, that "my heart's just not in this any more," they reveal a lot about their lack of desire to go on, observes Caroline Myss, Ph.D., coauthor of The Creation of Health (Three Rivers Press, 1993). Such "emotional congestion" often parallels the congestion of blood in heart failure. The emotional-as well as nutritional-roots of disease must be addressed before recovery is possible. - Jack Challem
The information provided by Jack Challem and The Nutrition Reporter™ newsletter is strictly educational and not intended as medical advice. For diagnosis and treatment, consult your physician.