Newsletter August 2000

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

Letter from Dr. Janson
Dear Friends,
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.

Supplements and More for Heart Disease
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 and L-Carnitine
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.

Botanical Supplements for the Heart
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.

Amino Acids That Help
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.

Ginkgo and Aspirin Together?
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 for Depression
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.

In the Health News
• 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.)

Diet and Disease
• 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.

Recipe of the Month
Healthy Summer Diet Tip

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.

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Supplements to Treat Heart Disease
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.

Aspirin and Ginkgo Biloba
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.

St. John’s Wort and Depression
Schrader E, Equivalence of St John’s wort extract (Ze 117) and fluoxetine… Int Clin Psychopharmacol 2000 Mar;15(2):61-8.

Diet and Disease
Wyshak G, Teenaged girls, carbonated beverage consumption, and bone fractures. Arch Pediatr Adolesc Med 2000 Jun;154(6):610-3.