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Kaiser Wells Healthcare Tip of the Month
DIETARY SUPPLEMENTS AND HEART HEALTH
In 2005, more than 650,000 people died from heart disease, accounting for 27% of the deaths in the United States, making it the leading cause of death for both men and women. The development of cardiovascular disease is very complicated, and it is affected by multiple factors, including elevated cholesterol and triglycerides, coagulation factors, platelet aggregation, glucose metabolism, and smoking. To maintain good "heart health", the combination of a good diet, exercise, and no smoking is essential. For patients who need additional therapy beyond lifestyle modifications, doctor-prescribed medications are available and some dietary supplements may be considered. Some of the most common supplements used to improve heart health will be discussed. As with any over-the-counter products, it is very important to check with your physician before you begin taking any supplements as well as telling them of any you are currently using.
Omega-3 Fatty Acids:
There is good evidence supporting the conclusion that omega-3 fatty acids from fish or fish oil supplements significantly reduce triglyceride levels. They also may cause small improvements in high-density lipoprotein (HDL; "good cholesterol"). Increased levels of low-density lipoprotein (LDL; "bad cholesterol") were also seen, however. Multiple studies report a reduction in secondary events associated with cardiovascular disease, including reductions in nonfatal and fatal heart attacks and sudden cardiac (heart-related) death. It is important to note that patients in these trials were also taking prescription drugs for the heart and were being routinely evaluated by a physician.
The most significant side effect associated with omega-3 fatty acids is bleeding, although this is seen more often with excessive use. Patients who are also taking any medication that may thin the blood should check with their primary care provider before beginning any regular supplementation with omega-3 fatty acids. Upset stomach, diarrhea, and nausea were also common with the use of fish oil supplements.
The American Heart Association (AHA) has released recommendations for the use of omega-3 fatty acids for the treatment of elevated triglyceride levels. For patients without coronary heart disease, the AHA recommends eating fish at least twice a week. For patients with coronary heart disease, the AHA recommends consumption of about 1 gram per day of omega-3 fatty acids. These patients may consider using supplements, such as fish oils. For patients who need to significantly lower triglyceride levels, supplementation with 2 to 4 grams per day of fish oil is recommended. Lastly, vitamin E is essential for the metabolism of omega-3 fatty acids, and with long-term use of fish oil supplements, extra vitamin E is needed. Because of this, many fish oil supplements contain additional amounts of vitamin E.
Garlic:
Garlic is one of the oldest recorded remedies used to treat disease. In recent clinical trials, the most important effects of garlic are those of mild reductions in cholesterol and reduced platelet clotting. The decrease in platelet clotting leads to its most common side effect, bleeding. Other side effects include asthma flares, dizziness, sweating, bad breath, body odor, headache, itching, fever, chills, and runny nose.
The current recommended dose for garlic supplementation is 200 to 300 mg of garlic extract 3 times a day (600-900 mg/day). If taken as part of the diet, 2 to 5 grams of fresh garlic is recommended daily.
Coenzyme Q10:
Coenzyme Q10 (CoQ10) is a substance produced by the human body that is necessary for the normal function of cells. It has been noted that levels of CoQ10 decrease with age and are lower in some patients with chronic conditions such as cardiovascular disease. There is a lot of controversy surrounding the use of CoQ10 supplements. The only clear indication is in patients who do not have enough CoQ10. Other promising areas of research include blood pressure and some other heart conditions.
Few side effects have been noted and include nausea, vomiting, rash, insomnia, headache, and flu-like symptoms. Organ damage due to lack of oxygen and blood flow has been noted in patients with heart disease during vigorous exercise. Additionally, CoQ10 supplementation may reduce the effectiveness of warfarin (Coumadin), a blood-thinning medication. It may also affect thyroid hormone levels and change your response to levothyroxine (Synthroid). Finally, CoQ10 may interact with antiviral medications and some medications used to treat HIV. The recommended dose ranges from 50 to 1200 mg/day in divided doses.
The cornerstone of any effort made for the prevention of heart disease is eating healthy, exercising, and not smoking. In fact, quitting smoking is the single most important factor patients can change to reduce the risk of developing or worsening heart disease. The AHA recommends that healthy people get their nutrients by eating a variety of foods, in moderation, rather than by taking supplements. Emphasis should be placed on fruits, vegetables, and whole grains. In nonsmoking patients with a healthy diet who exercise regularly, supplementation with certain substances, especially omega-3 fatty acids, can be associated with reductions in cardiovascular disease. Most importantly, a physician should be consulted prior to beginning any supplement, especially for those patients with known heart disease or who are already taking prescription drugs.