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Letter from Dr. Janson
Supplements and More for Heart Disease
Coenzyme Q10 and L-Carnitine
Botanical Supplements for the Heart
Amino Acids That Help
Ginkgo and Aspirin Together?
St. John's Wort for Depression
In the Health News
Recipe of the Month: Healthy Summer Diet
Tip
References
Don’t be misled by some of the press reports on the supposed
dangers of alternative medicine, such as dietary supplements
and herbal therapies. The news media often mislead us on these
issues, and I’ll present one example later. I am in the
midst of watching my organic garden grow (well not literally
watching it, but slaving away helping it along). There is
something nourishing about growing your own food, and if you
have any chance to do it, even to a small degree, I “heartily”
recommend it.
Here is the rest of the story on heart disease, as
promised in last month’s issue. For prevention, consider
taking folic acid and vitamin B12, as these two vitamins lower
homocysteine levels. This is a substance in the blood that
apparently damages arteries and leads to increased atherosclerosis.
While many supplements help to prevent heart disease, some
of them are very important for treatment once you have heart
disease.
Coenzyme Q10 is essential for the production of energy
in every cell, in the membranes of the tiny engines called
mitochondria. It is especially abundant in heart muscle, and
it is an excellent antioxidant, about four times more potent
than vitamin E in some studies. Supplements can help angina,
shortness of breath, congestive heart failure, arrhythmias,
and high blood pressure. CoQ10 also increases exercise tolerance.
Side benefits of taking coQ10 are improved immunity, increased
general energy levels, and protection from free-radical damage
associated with aging.
Although coQ10 is not really a vitamin because your body
makes it, the amount you make declines with age and illness.
The typical dose for treatment of heart disease is 100 to
400 mg daily, depending on the severity of the problem. For
prevention, I think it is a good idea to take 50 to 100 mg
a day, especially if you are over forty, if you have any other
illness, or you have a family history of heart disease.
Another supplement that helps the heart is L-carnitine. This
derivative of amino acids is essential for transport of fatty
acids across the membranes of the mitochondria where they
are used for energy production (this is how it works well
with coenzyme Q10). When there is pain due to a lack of oxygen
in heart muscle (angina), the level of L-carnitine drops dramatically,
and the heart muscle switches to glucose metabolism instead
of fat. As a result, more lactic acid is produced, and this
makes the pain worse. If there is enough L-carnitine available
in advance, the pain is lessened, and the likelihood of damage
to the heart is reduced. Although you normally produce L-carnitine,
as with some other essential substances the production declines
with age. Supplements of L-carnitine are typically in the
range of 500 to 1000 mg twice a day. Some athletes take even
more to enhance stamina.
Garlic has been used for millennia, not just as a culinary
delight, but as a therapeutic dietary supplement. It helps
the heart in many ways. It reduces blood pressure, a risk
factor for the development of heart disease. Garlic supplements
also reduce the adhesiveness (stickiness) of platelets, reducing
the likelihood of excessive clotting inside the blood vessels.
Garlic reduces total cholesterol levels while increasing
the good HDL-cholesterol, so it helps in both prevention and
treatment. As a free-radical scavenger, garlic helps prevent
the oxidative reactions that promote atherosclerosis. It appears
to protect the enzymes in the cells lining the arteries, called
endothelium. These cells produce nitric oxide, a blood vessel
relaxant, and garlic appears to promote the production of
this substance.
As a side benefit, garlic can reduce the incidence of some
cancers, enhance immunity, and act as an antibiotic and anti-viral
substance without side effects.
I recommend eating garlic as part of the diet, and supplementing
for treatment. The usual dose of garlic is 500 to 1500 mg
twice a day of deodorized garlic (so you can take your garlic
every day without fear of being ostracized socially).
Hawthorn berry is a useful herb for heart disease. The active
components include several pigments called flavonoids. Hawthorn
has been used for centuries for the heart. It improves the
strength of the heart muscle, and it relaxes the blood vessels
for improved blood flow.
In patients with congestive heart failure, hawthorn berry
supplements can improve exercise tolerance and mildly reduce
elevated blood pressure. Many herbal studies have been done
in Germany using standardized extracts. These are more reliable
sources of the substances known to be helpful. The usual dose
of hawthorn extract is 250 to 500 mg twice a day.
Taurine, an amino acid, helps to increase the strength
of heart muscle and reduces excitability of the fibers that
conduct the impulse for the heartbeat. Supplements are safe
and effective additions to treatment for people with congestive
heart failure, and they may also reduce arrhythmias. In animal
studies, taurine has been shown to be helpful in controlling
blood pressure. The typical dose is 500 to 1000 mg twice a
day.
L-Arginine is a precursor to nitric oxide, the blood vessel
relaxant. In doses of 1000 to 6000 mg daily, it improves heart
failure, angina, hypertension, sexual function, and immune
function.
L-Lysine reduces the tendency of blood lipid components to
stick to artery walls, and even releasing deposits of damaging
“lipoprotein(a).” The usual dose is about 1500 mg
daily for treatment.
Putting together a complete program for either prevention
or treatment must include more than supplements and diet.
As mentioned earlier, exercise is helpful for the heart, and
stress management may be one of the most significant supportive
therapies.
I recommend some form of relaxation for all heart patients,
and many of them work well. Practice visualization, breathing
exercises, various forms of meditation, and laughter to reduce
your stress responses.
Norman Cousins, the author of Anatomy of an Illness, also
wrote about his recovery from a serious heart attack using
laughter and other healthful practices (The Healing Heart).
He emphasizes the powerful role that our minds play in healing.
Many doctors are now telling people not to take ginkgo biloba
if they are taking aspirin to protect their hearts. It seems
to be an increasing movement in the medical community, which
is just becoming aware of the therapeutic value of herbs,
to warn of their dangers, rather than warning of the far greater
dangers of medications, including aspirin, even in small doses.
Numerous deaths every year are the result of side effects
from prescription medications (well over 100,000), and many
others from the side effects of over-the-counter drugs, including
aspirin. Aspirin and ginkgo do not interfere with each other.
Rather, they both reduce platelet adhesiveness (similar to
the effect of garlic) and decrease the tendency of blood to
clot.
When a person takes both aspirin and ginkgo together, it
is true that they may end up with too much of the anti-clotting
effect and have a tendency to bleed excessively. Because of
this, many doctors warn of the dangers of ginkgo, when they
should be warning, more appropriately, of the dangers of aspirin.
The simple solution is not to take less ginkgo, which has
many therapeutic benefits, but to take less aspirin, or none.
Ginkgo biloba supplements not only can replace aspirin, but
also has the additional benefits of enhancing memory, reducing
migraine headaches, controlling vertigo (Meniere’s disease),
improving circulation in the legs and in small blood vessels
(such as in the retina), reversing sexual dysfunction in both
men and women on antidepressant drugs, and improving varicose
veins. It contains flavonoids and has antioxidant activity.
Whether you should consider avoiding ginkgo biloba if you
are also taking aspirin, or avoiding aspirin for all the benefits
that ginkgo might provide is a decision only you can make,
with or without your doctor’s advice and support (but
inform your doctor of your decision).
Ginkgo and garlic are not the only supplements that can reduce
platelet adhesion. Ginger, ginseng, curcumin, feverfew, and
astragalus have the same effect, as well as fish oil, flaxseed
oil, gamma-linolenic acid (GLA from borage or evening primrose
oil), and vitamin E.
Vitamin E in high doses can also increase the effect of coumadin,
the anti-clotting drug that is recommended for patients with
atrial fibrillation. When doctors say not to take your vitamin
E because of this, they are doing you a disservice. If vitamin
E can boost coumadin, a doctor can give you a lower dose of
the drug. A doctor will measure your coumadin effect regularly
while you are on the drug, so it is easy to monitor your need
and adjust the dose. You benefit if your doctor can reduce
your dose and get the same effect.
St. John’s wort is an excellent herbal treatment for
depression. It is a good idea to try it before using medications
such as Prozac, Zoloft, and Paxil (serotonin reuptake inhibitors),
or others.
Why? Because the medications have numerous side effects,
perhaps the most serious being agitation and aggressive behavior.
St. John’s wort has minimal side effects, and is equal
to or better than the medications. In a recent study reported
in the medical literature, treatment with St. John’s
wort was directly compared to Prozac.
It turned out that more people were helped by the herb than
the drug, and the level of effect was equal among those who
were helped. The serious difference was in the side effects–about
one fourth of the patients on Prozac reported problems compared
with only one in twelve of those on St. John’s wort.
The most common side effect with St. John’s wort was
digestive upset, while Prozac caused fatigue, sexual dysfunction,
anxiety, dizziness, stomach upset, and most commonly, agitation.
The daily dose of St. John’s wort is 900 mg.
Many non-drug treatments benefit depression. Better diet
(no sugar and avoiding food allergies), and physical activity
(especially aerobic exercise), help. Other supplements that
help include 5-hydroxy-tryptophan (5-HTP), 100 to 200 mg daily,
and B vitamins, including pyridoxine (B6), niacin (B3), and
others, all in individualized doses.
• A recent report in the New England Journal of
Medicine was misrepresented in the news and even in the title
of the article: “Urothelial Carcinoma Associated with
the Use of a Chinese Herb.” News reports left the impression
that a therapeutic herb caused urinary tract cancer. Even
in the first paragraph, the article makes clear that it was
not the therapeutic herb, but a manufacturing error substituting
a known carcinogenic and kidney toxic herb for the one that
was supposed to be present. The reporting appears biased.
You do have to be cautious with the use of therapeutic herbs,
which are valuable treatments but have some risks. But the
medical literature and news media often exaggerate the risks
and minimize the benefits. (NEJM 2000 Jun 8, 342:23; 1686-92)
• Niacin helps reduce serum cholesterol more than the
drug gemfibrozil (Lopid). A study done at Duke University
showed that high-dose niacin was more than twice as effective
as the drug in lowering cholesterol and raising good HDL-cholesterol,
and only niacin lowered the damaging lipoprotein(a). Gemfibrozil
did lower triglyceride somewhat more than niacin, but unlike
niacin, it raised the bad LDL-cholesterol by 9 percent. Timed
release niacin was studied at 1000 and 2000 mg daily. (Arch
Intern Med 2000 Apr 24;160(8):1177-84.)
• Carbonated sodas have been associated with loss
of calcium from bone, probably because of the sugar and phosphorus
that they contain. In a recent report from Harvard, teenaged
girls had an increased risk of bone fracture correlated with
soda consumption, especially the cola drinks. It is important
to educate children about better health habits.
Summer is always a difficult time to cook, as few people
want to spend time in an overheated kitchen. I have two solutions
– the first is to eat a lot of salads. I put in a wide
variety of vegetables, including some corn and peas, plus
two leafy greens (spinach and arugula, are my favorites in
addition to lettuce), shredded cabbage, tomato, cucumber,
scallions, and cilantro. Then I might add some marinated tofu
(Tofu Lin is one I like), and some organic hard boiled egg.
I top this with some balsamic vinegar-flaxseed oil-pepper-thyme-garlic
dressing. It makes an easy and cool summer meal. Second is
to quick stir fry some garlic, onions and broccoli with tofu–a
quick cooking meal served on top of some brown rice. It is
easy, and the quick cooking decreases the heat build-up in
the kitchen.
Crestanello JA, et al., Elucidation of a tripartite mechanism
underlying the improvement in cardiac tolerance to ischemia
by coenzyme Q10 pretreatment. J Thorac Cardiovasc Surg 1996
Feb;111(2):443-50.
Baggio E, et al., Italian multicenter study
on the safety and efficacy of coenzyme Q10 as adjunctive therapy
in heart failure (interim analysis). Clin Investig 1993;71(8
Suppl):S145-9.
Morisco C, t ao., Effect of coenzyme Q10
therapy in patients with congestive heart failure: a long-term
multicenter randomized study. Clin Investig 1993;71(8 Suppl):S134-6.
Mortensen SA, Perspectives on therapy of
cardiovascular diseases with coenzyme Q10 (ubiquinone). Clin
Investig 1993;71(8 Suppl):S116-23.
Ghidini O, et al., Evaluation of the therapeutic
efficacy of L-carnitine in congestive heart failure. Int J
Clin Pharmacol Ther Toxicol 1988 Apr;26(4):217-20.
Foushee DB, eta l.,Garlic as a natural
agent for the treatment of hypertension... Cytobios 1982;34(135-36):145-52.
Blesken R, Crataegus [Hawthorn] in cardiology.
Fortschr Med 1992 May 30;110(15):290-2.
Hishikawa K, et al., Role of L-arginine-nitric
oxide pathway in hypertension. J Hypertens 1993 Jun;11(6):639-45.
Akiba S, et al., Inhibitory
effect of the leaf extract of Ginkgo biloba L. on oxidative
stress-induced platelet aggregation. Biochem Mol Biol Int
1998 Dec;46(6):1243-8.
Cryer B, Feldman M, Effects of very low
dose daily, long-term aspirin therapy ... on mucosal injury
in healthy humans. Gastroenterology 1999 Jul;117(1):17-25.
Schrader E, Equivalence of
St John’s wort extract (Ze 117) and fluoxetine... Int
Clin Psychopharmacol 2000 Mar;15(2):61-8.
Wyshak G, Teenaged girls, carbonated
beverage consumption, and bone fractures. Arch Pediatr Adolesc
Med 2000 Jun;154(6):610-3.
drjanson@drjanson.com
November
through May: 386-409-7747
June
through October: 603-878-2256
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