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Supplements for a Healthy Heart

Do Supplements Really Help Your Heart?
  -- By Becky Hand, Licensed and Registered Dietitian
So you just found out that you have high cholesterol, or perhaps you have a strong family history of heart disease and want to do your best to prevent it. So you head to the pharmacy or health food store for help, only to be bombarded by countless supplements that tout their heart healthy benefits. Which should you choose? Are they all good for your heart? Are supplements necessary to improve your health and reduce your risk of heart disease?

Before you buy into the billion-dollar business of dietary supplements, remember a few key things.
  1. Dietary supplements are not regulated by the FDA in the same way as medications are regulated. Manufacturers have a lot of leeway in their ability to make health claims on their bottles—much more than most health professionals would like—and these claims can be very misleading. Some claims are not even true or are not based on good scientific research. Never trust what a bottle or advertisement tells you about a product. After all, the goal of both is to get you to buy it. Do your own investigation first.
     
  2. Dietary supplements are NOT a must for a healthy heart. Many people can reduce their risk of heart disease and improve their heart health by making simple lifestyle changes like eating a healthy diet, exercising regularly, and following the heart-health plan provided by their health care provider. Supplements alone cannot and will not undo an unhealthy (poor quality) diet or inactive lifestyle. If you do prefer to take supplements, think of them as an added insurance plan to the heart-healthy changes you're already making.
     
  3. Supplements can interact with other medications. Even something as seemingly benign as a vitamin or mineral supplement can cause adverse reactions when combined with certain over-the-counter and prescription drugs, so ALWAYS keep a list of all supplements you take and share it with your pharmacist and health care provider.
     
  4. Talk to your doctor first. Before taking any supplement, get advice and recommendations from your health care provider.
Here's a list of common supplements (listed in alphabetical order) that make heart health claims. Read on to find out which may help, and which supplements you should leave on the shelf according to evidence-based research. <pagebreak>

B Vitamins: Folic Acid, Vitamin B-6 and Vitamin B-12
The B-complex vitamins, which include folic acid, help keep your nerves and red blood cells healthy and strong. They are also involved in the metabolism (and reduction) of homocysteine, an amino acid that, when elevated, is linked to heart disease, blood clots, heart attack and strokes.

Several controlled research studies indicate that a combination of vitamin B-12, vitamin B-6, and folic acid can decrease homocysteine levels; but other studies have shown no benefit in reducing the risk of heart disease. Therefore, the American Heart Association has concluded that there isn't enough evidence to say that B-vitamin supplementation reduces cardiovascular risk.

It is important to work with your physician before taking B-complex vitamin supplements to improve heart health.

Baby Aspirin
This little over-the-counter pain reliever has been shown to have some great heart-healthy benefits as well. Aspirin interferes with your body’s blood clotting ability. For someone with narrowed blood vessels, a decrease in blood clotting may help to prevent a blockage and thus prevent a heart attack or stroke. To determine if you would benefit from taking an aspirin daily, talk to your doctor first about usage and dosage. If you have already had a heart attack or stroke, your doctor has probably already discussed this treatment option.

If you have strong risk factors for heart disease, you may also benefit from taking a baby aspirin daily. There is no standard dosage for aspirin usage and heart health: It can range from 75-325 milligrams. A baby aspirin (81 mg) is often prescribed. Some medical conditions such as bleeding disorders, asthma, stomach ulcer, or heart failure could become more dangerous if a baby aspirin was consumed daily. Aspirin can also interfere with certain medications, herbal supplements and dietary supplements, too, so talk to your doctor first.

Calcium
The mineral calcium is essential for strong bones and teeth, but the heart, nerves, and blood-clotting systems also need calcium to work properly.

In people with high blood pressure (hypertension), calcium supplementation appears to have a modest effect by lowering systolic blood pressure by 2–4 mmHg, but it appears to have little effect in people with normal blood pressure. Calcium seems to be most effective in salt-sensitive people and people who normally get very little calcium in their diet.

For people with high cholesterol, taking calcium supplements along with a heart healthy diet may modestly reduce LDL "bad" cholesterol by 4.4% and increase HDL "good" cholesterol by 4.1%. Taking calcium alone, without the heart healthy diet, does not seem to lower cholesterol.

Other studies suggest that simply eating a calcium-rich diet (not supplementing it) can improve heart health. Research has shown that individuals who eat a vegetarian diet that is high in minerals (such as calcium, magnesium, and potassium) and fiber, and low in fat tend to have lower blood pressure and a reduced risk of heart disease. Similarly, the Dietary Approaches to Stop Hypertension (DASH) study was conducted to test the effects of three different eating patterns on blood pressure: the "typical" American diet; a diet high in fruits and vegetables; and a diet rich in fruits, vegetables, and low-fat dairy products, now known as the DASH diet. The third group experienced the greatest reduction in blood pressure among the three groups, which signals that dietary calcium plays an important role in heart health.

A heart-healthy goal for calcium intake is to consume at least 1,000-1,200 milligrams daily. Determine how much calcium you are getting daily through your diet (tracking your food on SparkPeople's free Nutrition Tracker will do the math for you!) and then add a supplement to meet the remaining amount, if necessary.

Coenzyme Q-10
Coenzyme Q-10 (CoQ-10) is a vitamin-like substance found throughout the body, especially in the cells of the heart, liver, kidneys, and pancreas. It is involved in generating energy, cell respiration and cell transport. It occurs naturally (in small amounts) in meats and seafood, but can also be made in a laboratory for medicinal and supplementation purposes.

Preliminary research indicates that Coenzyme Q-10 supplementation MAY: Work closely with your physician when using or considering this supplement. <pagebreak>

Fish Oil
Fatty fish that are especially rich in the beneficial oils called omega-3 fatty acids include mackerel, tuna, salmon, sturgeon, mullet, bluefish, anchovy, sardines, herring, and trout. The omega-3 fatty acids can improve heart health due to their anti-inflammatory action. Fish oil can be obtained from eating fish or by taking fish oil supplements.

Studies indicate the fish oil can help prevent heart disease and lower the risk of additional complications in people who already have heart disease. Some research indicates that fish oil can: reduce triglycerides by up to 20-50%; modestly lower blood pressure by expanding blood vessels; and offer greater heart-protection benefits when combined with statin drugs (cholesterol-lowering medications).

Be sure to talk to your doctor about the amount of fish oil you should be taking. Your doctor will follow specific dosing guidelines based on your medical needs. A dose of 1 to 4 grams daily (with 240 milligrams of DHA and 360 milligrams of EPA per gram) is fairly typical, but the prescribed dosage will vary depending on your heart health and lipid profile.

Warning: Taking high doses of fish oil can be dangerous; more than 3 grams per day can keep blood from clotting properly and can increase bleeding in your body. High doses of fish oil might also reduce the functioning of your immune system. Taking fish oil supplements in large amounts can also increase levels of the LDL "bad" cholesterol in some people.

Green Tea Extract
Green tea extract can be made from the dried leaves of the Camellia sinesis plant, a perennial evergreen shrub. Since green tea is not fermented (as black tea is) and is produced by steaming fresh leaves at high temperatures, it maintain important molecules called catechins, a type of flavonoid thought to be responsible for many of the benefits of green tea.

Epidemiological evidence suggests that people who drink more green tea have healthier cholesterol and triglyceride levels. In one study, participants who ingested 375 milligrams of an oral theaflavin-enriched green tea extract daily for 12 weeks experienced reductions in total cholesterol, LDL "bad" cholesterol, and triglyceride levels.

Typical recommendations encourage the drinking of freshly brewed green tea, which appears to offer more benefits than supplementation. Drink up to 5 cups of green tea daily for heart health, or supplement with 375 milligrams of green tea extract daily. Talk to your doctor for more specific guidelines based on your medical needs.

Niacin
Niacin and niacinamide are forms of vitamin B-3, which is found in many protein-rich foods including poultry, fish, beef, pork, peanut butter, and legumes. It is also added to many enriched and fortified grain products (think cereals and breads). Niacin and niacinamide are required for fats and sugars to function properly in the body and for the maintenance of healthy cells. Research has shown that in high doses, niacin and niacinamide can help prevent heart disease by interfering with the body’s blood clotting action and possibly lowering triglyceride levels. Therefore, individual niacin supplements are sometimes used as a treatment for high cholesterol.

Only niacin—not the form niacinamide—appears to lower cholesterol. Some niacin supplements are FDA-approved as prescriptions for treating high cholesterol. These prescription niacin supplements typically come in 50- milligram doses or higher, while over-the-counter supplements (which are not regulated by the FDA) come in strengths of 250 milligrams or less. Since very high doses of niacin are required for the treatment of high cholesterol, dietary niacin supplements is usually not effective or appropriate for this purpose.

Niacin is safe for most adults. A flushing reaction is a common effect of niacin supplementation. This can occur as a burning, tingling, itching, and redness of the face, arms, and chest. Often starting with a smaller dose of niacin and taking aspirin before each dose of niacin will help reduce the flushing effect. Usually, this reaction goes away as the body gets used to the medication. Other side effects of niacin are stomach upset, gas, dizziness, and pain in the mouth. Serious and toxic side effects can occur when an individual consumes 3 grams or more per day. Talk to your doctor before using niacin as a treatment option for high cholesterol. <pagebreak>

Plant Sterols and Stanols
Plant sterols and plant stanols are components of certain plant membranes. They are found naturally in small amounts in some vegetable oils, nuts, grains, legumes, fruits, and vegetables. Research has shown that plant sterols and plant stanols have the ability to help lower total cholesterol and LDL "bad" cholesterol.

When you eat food that contains dietary cholesterol (found in animal products) your intestinal tract absorbs that cholesterol and puts it into the bloodstream. When the sterols and stanols travel through your digestive tract, they get in the way of dietary cholesterol, preventing it from being absorbed into the bloodstream. Therefore, less total cholesterol is absorbed by your body when plant sterols and stanols are present. The cholesterol that is not absorbed leaves the body as waste.

To be beneficial, plant sterols and stanols must be consumed in the correct amount on a daily basis. The National Cholesterol Education Program’s Adult Treatment Panel III recommends an intake of at least 2 grams of plant sterols and plant stanols daily to be effective at lowering cholesterol and LDL levels. Plant sterols and stanols are now added to some margarines, orange juices, yogurts and other specialized foods. They are also available as a supplement. To assure that one gets the 2 grams daily needed for effectiveness, many doctors now suggest taking plant sterols and stanols as a supplement.

Psyllium
Blond psyllium seed and psyllium husk (the outer covering of the seed) are primarily used as to make laxatives for constipation and fiber supplements such as Metamucil. You can also find psyllium added to cereals, breads and snack bars that are marketed as "high in fiber." In addition, psyllium alone can be found as a supplement.

The fiber from psyllium can reduce LDL "bad" cholesterol. Studies have indicated that taking blond psyllium in a dose of approximately 10-12 grams daily can reduce levels of total cholesterol by 3% to 14% and LDL "bad" cholesterol by 5% to 10% after 7 weeks of treatment.

Warnings: Blond psyllium is safe for most people when taken with plenty of fluids to prevent the fiber from forming an obstruction in the esophagus. Blond psyllium can lower blood sugar levels in people with diabetes, so monitor blood sugar levels closely. It can also decrease the absorption of certain medications. In some people, blond psyllium might cause gas, bloating, stomach pain, diarrhea, constipation, and nausea. For these reasons, make sure you talk with your doctor before using psyllium seed or psyllium husk.

Red Yeast Rice
Red yeast rice supplements come from the rice that is fermented with Monascus purpureus yeast. The active ingredient in red yeast rice supplements is similar to the active ingredient in the cholesterol-lowering prescription drugs (statins), such as lovastatin (Mevacor). While red yeast rice supplements can be used to maintain normal cholesterol levels in healthy people, and in reducing cholesterol, LDL "bad" cholesterol and triglycerides in people with high cholesterol, it can also cause all the same side effects as statin drugs: liver damage, muscle pain, and muscle damage.

Some red yeast supplements contain none of the active ingredient, and some contain significant amounts. Therefore, the American Heart Association warns against using red yeast until the results of long-term studies are available and the quality of the products become more standardized. It can cause stomach discomfort, heartburn, gas and dizziness. You should talk with your healthcare provider before taking red yeast rice.

Selenium
Selenium is a mineral found in foods and water sources. The amount of selenium in the foods you eat depends on where it is grown or raised; the amount of selenium in soils varies greatly, which means that foods grown in different soils have differing selenium levels. Crab, liver, fish, poultry, and wheat are generally good selenium sources.

There is some preliminary evidence that selenium may help to lower LDL "bad" cholesterol and decrease plaque build-up in the arteries. However, in people with coronary heart disease, selenium supplementation in combination with beta-carotene, vitamin C, and vitamin E does NOT seem to protect against the progression of heart disease. Currently there is insufficient evidence available to recommend selenium supplements for the prevention of heart disease.

Vitamin C
Vitamin C is a water soluble vitamin helps form and repair red blood cells and other body tissue. It helps keep blood vessels firm, prevents bruising, and helps keep the immune system strong. Good sources of vitamin C are fresh fruits (especially citrus) and vegetables, especially citrus fruits. Synthetic vitamin C can also be made in a laboratory to be used in supplements.

Taking vitamin C along with conventional high blood pressure medications appears to decrease systolic blood pressure (the top number in a blood pressure reading) by a small amount, but does not seem to decrease diastolic pressure (the bottom number). Taking vitamin C supplements alone, though, doesn’t seem to affect blood pressure.

Regarding cardiovascular disease, evidence from many epidemiological studies suggests that high intakes of fruits and vegetables are associated with a reduced risk of cardiovascular disease, partly due to the antioxidant content of these foods. However, results from research examining vitamin C intake and cardiovascular disease risk are conflicting. Results from most clinical intervention trials have failed to show a beneficial effect of vitamin C supplementation on the prevention of cardiovascular disease. So you're better off saving your money and just eating more fruits and vegetables to get the heart-protecting benefits of vitamin C.

Vitamin E
Vitamin E is a fat-soluble vitamin found in many foods including vegetable oils (such as soybean, corn, cottonseed, and safflower oil), as well as margarines and salad dressings made from such oils. Nuts, seeds and wheat germ are also good sources of vitamin E. It is known as a powerful antioxidant, and for years, vitamin E supplements were touted as having a protective effect on the heart.

Several observational studies have associated high dietary (not supplemented) intakes of vitamin E with lower rates of heart disease. However, clinical trials have not shown vitamin E supplements to be effective in preventing heart disease, stroke or chest pain. In fact some studies indicate that vitamin E supplementation actually increased heart failure and mortality.

Overall, clinical trials have not provided evidence that routine use of vitamin E supplements prevents cardiovascular disease. While taking vitamin E supplements may not help prevent heart disease, increasing your intake of vitamin E by eating more foods that contain it may be beneficial.

Sources
Davis, Jeanie Lerche. "Supplementing Your Heart Health: Omega-3, Plant Sterols, and More," accessed March 2011. www.webmd.com.

Grogan, Martha, M.D. "Calcium supplements: A risk factor for heart attack?," accessed March 2011. www.mayoclinic.com.

Grogan, Martha, M.D. "Can vitamins help prevent a heart attack?," accessed March 2011. www.mayoclinic.com.

National Heart, Lung and Blood Institute. "Your Guide to Lowering Your Blood Pressure with DASH," (PDF) accessed March 2011. www.nhlbi.nih.gov.

Office of Dietary Supplements. "Dietary Supplement Fact Sheets," accessed March 2011. www.ods.od.nih.gov.

Therapeutic Research Faculty. "Natural Medicines Comprehensive Database," accessed March 2011. www.naturaldatabase.therapeuticresearch.com.

Woolston, Chris. "Why Supplements May Do Your Heart More Harm Than Good," accessed March 2011. www.health.com.