Congestive Heart Failure-B

Covering All the Bases: Complementary Approaches to Treating CHF

Managing CHF means coordinating many influences and factors. The idea is to first stabilize the patient's condition (especially if the patient has acute CHF that may lead to cardiac arrest), then develop a pharmaceutical and lifestyle program specially suited for the patient's metabolism. Dosages of the most popular medications often start at the lower end of their recommended range and are frequently adjusted by physicians until they get the right mix of medications to prevent symptoms, slow the disease, and keep side effects under control. A major problem with these medications is their significant side effects, which may severely reduce a patient's quality of life.

In terms of lifestyle changes, patients may be advised to limit their salt intake to 2 grams per day and their water intake to 1.5 to 2 liters per day. A heart-healthy diet—including increased intake of monosaturated oils (such as extra virgin olive oil), fruits and vegetables, fiber, and essential fatty acids—is also recommended. Finally, patients may be advised to increase their intake of garlic, onions, and celery, all of which have been shown to lower blood pressure.

A successful complementary approach uses the same principles but relies on nutrients and supplements that have far fewer side effects than conventional pharmaceuticals. The goal of complementary treatment is to:

Restore neurohormonal and metabolic integrity.
Improve the pumping action of the heart and increase myocardial efficiency.
Decrease oxidative stress throughout the body.
Restore mineral balance (especially sodium/potassium ratios).
Decrease vascular resistance to improve blood flow.
Lower the risk of blood clots.
Lower the risk of abnormal heart rhythms.
Working with a knowledgeable physician, patients with CHF may consider adding any of these supplements to their program:

Hawthorn —This plant extract has been shown to improve the symptoms of patients with NYHA class II or III CHF (Tauchert M 2002). Hawthorn's benefits include relaxing blood vessels to lower blood pressure, increasing blood flow to the heart, and controlling heart rate in a way that is similar to digoxin (Schwinger RH et al 2000; Tauchert M 2002). Hawthorn helps improve exercise tolerance (Tauchert M et al 1999) and has shown promise in the treatment of left ventricular dysfunction (Leuchtgens H 1993; Schmidt U et al 1994; Tauchert M et al 1999; Weikl A et al 1996).
Magnesium and potassium —Patients who are treated with a common diuretic (furosemide) often develop low magnesium and potassium levels, which may cause cardiac arrhythmias. Many physicians recommend that patients who are on furosemide also be given potassium to help prevent arrhythmias (Braunwald E 2001). Studies have also shown that magnesium supplementation may normalize potassium and magnesium levels within the heart (Cohen N et al 2000). Blood tests can help determine if magnesium or potassium levels are low in response to diuretic therapy.
Antioxidant vitamins —The dangerous effects of oxygen-free radicals on the body are well known. Elderly populations with higher blood levels of antioxidants such as vitamins C and E have been shown to have a lower incidence of heart disease (Maxwell SR 1993). Among people who have had a heart attack, supplementation with vitamins C and E has been shown to diminish the formation of free radicals and reduce damage to the heart (Eichholzer M et al 1992). These studies demonstrate that heart health is related to antioxidant levels. Because these antioxidants are well tolerated and slow the progression of CHF, it may be prudent to consider adding them to a CHF supplementation program.

Alpha-lipoic acid —Alpha-lipoic acid is an antioxidant that stimulates the creation of glutathione, another powerful antioxidant (Patrick L 2002). Because oxidative stress is associated with decreased cardiac function (Maxwell SR 1993), alpha-lipoic acid might be another valuable addition to the CHF antioxidant regimen.

Fish oil —Although fish oil, which is rich in omega-3 polyunsaturated fatty acids, has not been studied extensively in patients with CHF, there are many studies showing its value to overall cardiac health. For example, patients who take fish oil before heart surgery may avoid acute degeneration of heart tissue (Berger MM et al 2003). Fish oil has also been shown to reduce the frequency of sudden cardiac death in patients who have recently had a heart attack (Witte KK et al 2004). Researchers in the United Kingdom have launched studies to examine fish oil's ability to improve myocardial function in patients with CHF (Witte KK et al 2004).

For More Information
CHF usually occurs in the presence of other forms of heart disease, especially CAD. Also, conditions such as hyperhomocysteinemia (elevated homocysteine levels) and hypercholesterolemia (high cholesterol) are associated with CHF. Patients with CHF who also have underlying cardiac disease may wish to read the following chapters and design a program that will address the full range of their cardiac problems:

Atherosclerosis
Coronary Artery Disease
Hypercholesterolemia
Hyperhomocysteinemia
Managing High Blood Pressure
Inflammation and Heart Disease


CHF and the Hormonal Connection
Many people think of the heart as a simple pump that keeps blood flowing through the body. While this is true, it is also a vast oversimplification of the heart's role in the body. In fact, the heart is a highly complex organ that is responsive to all sorts of influences, including hormones. For example, when people are stressed, the body is flooded with adrenaline (epinephrine), a hormone that stimulates the heart to contract more forcefully and raises blood pressure.

Although there is still much to learn, there is a clear connection between the hormonal system and cardiac health. Studies have shown that early in CHF, the body tries to compensate for reduced cardiac function with a series of neurohormonal adaptations. These changes cause certain blood vessels throughout the body to constrict (resulting in more blood flow to vital organs) and boost the output of the heart by increasing its contractile strength and heart rate (Dzau VJ et al 1981; Dzau VJ 1987).

These changes, however, have significant drawbacks. Elevated blood pressure may lead to swelling (one of the symptoms of CHF) or to congestion in the lungs that leads to coughing (another symptom). The increased force of the heartbeat may also aggravate CAD. Overall, scientists believe that the net effect of these neurohormonal adaptations is negative. The adaptations may help short term, but they ultimately make the condition worse (Benedict CR et al 1994).

Patients with CHF have been shown to have low levels of dehydroepiandrosterone (DHEA) (Moriyama Y et al 2000), testosterone, and insulin-like growth factor I (IGF-I) (Kontoleon PE et al 2003). These hormonal deficiencies reflect an imbalance in the catabolic (destructive) and anabolic (constructive) hormonal systems ( Anker SD et al 1997). The body's main catabolic hormone is cortisol, while one of the body's main anabolic hormone is testosterone .

While hormonal supplementation is somewhat controversial among heart patients, there is evidence that supportive testosterone therapy can restore testosterone levels to normal. In one study, testosterone therapy was shown to significantly improve exercise capacity and quality of life in men who had moderate to severe CHF. During the study, the men were given testosterone therapy in small doses for 12 months, enough to restore levels to within physiologic range (Pugh PJ et al 2004). Hormonal restoration therapy has also shown promise in lowering cholesterol levels in patients with CHF (Dzugan SA et al 2002). A youthful hormonal profile is closely associated with good overall health. Undoubtedly, the future will expand our understanding of the complicated interaction between hormones and CHF.

Life Extension Foundation Recommendations
CHF is a serious condition that requires close cooperation with a physician to manage. The goal of therapy is to strengthen cardiac function, impede cardiac remodeling, and reduce the severity of symptoms. In scientific studies, various supplements have been shown to help patients with CHF slow the progression of their disease and increase their quality of life. The Life Extension Foundation suggests:

CoQ10—100 to 300 milligrams (mg) daily
L-carnitine—1 to 3 grams (g) daily
Taurine—2 to 3 g daily
Hawthorn—3000 mg daily
Magnesium citrate—160 mg (in capsule form) 1 to 6 times daily
Potassium (if low potassium levels are confirmed by a blood test)
Vitamin C—1000 mg daily
Vitamin E—800 international units (IU) daily
Alpha-lipoic acid—150 mg daily
Fish oil—700 to 1400 mg of eicosapentaenoic acid (EPA) and 500 to 1000 mg of docosahexaenoic acid (DHA)


CHF Safety Caveats

An aggressive program of dietary supplementation should not be launched without the supervision of a qualified physician. Several of the nutrients suggested in this protocol may have adverse effects. These include:

Acetyl-L-Carnitine

Acetyl-L-carnitine can cause gastrointestinal symptoms such as nausea and diarrhea.
Coenzyme Q10

See your doctor and monitor your blood glucose level frequently if you take CoQ10 and have diabetes. Several clinical reports suggest that taking CoQ10 may improve glycemic control and the function of beta cells in people who have type 2 diabetes.
Statin drugs (such as lovastatin, simvastatin, and pravastatin) are known to decrease CoQ10 levels.

EPA/DHA
Consult your doctor before taking EPA/DHA if you take warfarin (Coumadin). Taking EPA/DHA with warfarin may increase the risk of bleeding.
Discontinue using EPA/DHA 2 weeks before any surgical procedure.

Hawthorn
High doses of hawthorn are toxic and may induce sedation and abnormally low blood pressure.
Do not take hawthorn if you take digoxin. Hawthorn can interfere with the effects of digoxin.

Lipoic Acid
Consult your doctor before taking lipoic acid if you have diabetes and glucose intolerance. Monitor your blood glucose level frequently. Lipoic acid may lower blood glucose levels.
Magnesium

Do not take magnesium if you have kidney failure or myasthenia gravis.

Vitamin C
Do not take vitamin C if you have a history of kidney stones or of kidney insufficiency (defined as having a serum creatine level greater than 2 milligrams per deciliter and/or a creatinine clearance less than 30 milliliters per minute.
Consult your doctor before taking large amounts of vitamin C if you have hemochromatosis, thalassemia, sideroblastic anemia, sickle cell anemia, or erythrocyte glucose-6-phosphate dehydrogenase (G6PD) deficiency. You can experience iron overload if you have one of these conditions and use large amounts of vitamin C.

Vitamin E
Consult your doctor before taking vitamin E if you take warfarin (Coumadin).
Consult your doctor before taking high doses of vitamin E if you have a vitamin K deficiency or a history of liver failure.
Consult your doctor before taking vitamin E if you have a history of any bleeding disorder such as peptic ulcers, hemorrhagic stroke, or hemophilia.
Discontinue using vitamin E 1 month before any surgical procedure.