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Most American men will die from heart disease. I’m trying very hard not to be one of them. As such, I research heart-healthy strategies that go beyond exercise and diet. I’m talking about chemical solutions: supplements that destroy plaques, energize the heart, shrink oversized ventricles, prevent calcification of the heart and aorta, and eliminate inflammation.
There are no guarantees in this supplement world, but I have faith that I’m doing my heart some good, and maybe a whole lot of good. Here’s what I take and why.
Cardiologists agree that heart disease is a disease of inflammation. Granted, there’s all kinds of bad mojo associated with heart disease, including calcium deposits, plaque in general, ventricular thickening, and stiffening of blood vessels. Still, all of it is precipitated or at least exacerbated by inflammation, and that’s where fish oil comes in.
Take, for instance, athletes, and in particular steroid-using athletes. They’re vulnerable to left ventricular remodeling, which is kind of a medical euphemism to describe an enlarged heart – a major factor in cardiac heart failure (CHF).
The left ventricle is one of the heart’s four chambers, located at the bottom left part of the organ. It receives oxygenated blood from the left atrium (smack dab above it) and pumps it out to the body. Given its function, it’s the most muscular of the heart chambers.
Unfortunately, age and a host of contributing factors cause the left ventricle to thicken and alter shape (remodeling), causing its “ejection fraction” (the amount of blood it pumps out) to suffer. You’d think that having parts of the heart be thicker or more muscular would be a good thing, but not in this case. A thickening of the left ventricle makes it less pliable and less able to sloosh the right volume of blood through your arterial system.
Here’s where inflammation comes in. Several pro-inflammatory cytokines are directly implicated in this thickening of the left ventricle. These bad-boy cytokines include tumor necrosis factor, interferon gamma, interleukin-1beta, and interleukins 6,17, and 18.
Fish oil, however, appears to put a spoke in the wheels of these cytokines and prevent or ameliorate left ventricular remodeling.
Additionally, fish oil can modify cardiac ion channels, improve vascular endothelium, modulate autonomic nervous system activity, and enhance cardiac energy metabolism, in addition to simply thinning the blood. All of that translates to:
- Reduced triglycerides, a type of fat in your blood.
- Reduced risk of developing an irregular heartbeat (arrhythmias).
- Slowed buildup of plaque, a substance comprising fat, cholesterol, and calcium, which hardens and blocks your arteries.
- Lowered blood pressure.
What To Take: Fish oil requires a hefty dose or a highly concentrated formula, preferably high in DHA.
There’s a growing body of evidence that there’s an inverse relationship between magnesium levels and heart disease. That’s likely because magnesium is involved in so many enzymatic reactions and metabolic processes. Among the latter are ATP-dependent biochemical reactions, synthesis of DNA, RNA expression, cell signaling (at muscle and nerve levels), and glucose and blood pressure control, among other stuff.
Here’s where it gets scary. Up to 80% of the U.S. population is deficient in this important mineral. It’s probably even worse in athletes, though, as magnesium exits the body by hitching a ride on perspiration. The sweatier you are, the more likely it is you’re deficient.
On a more macro level, higher magnesium levels result in improved glucose and insulin metabolism, which leads to reduced glycation levels, a process that affects the suppleness and pliability of blood vessels, crucial to cardiovascular health. Magnesium also improves lipid profiles and acts as an antihypertensive and anti-inflammatory agent.
As a bonus, having adequate magnesium levels seems to help battle depression 5.
What To Take: Take 400 mg. of the chelated form for optimum absorption. Take it before bed because it appears to improve subjective measures of insomnia.
Nattokinase is an enzyme derived from natto, a Japanese food made from fermented soybeans. It looks like zombified soybeans that are connected by long, cheesy strings of organic matter that refuse to let go when you pull them apart.
Natto has been around for at least 2,000 years, but it wasn’t until 1987 that a team of researchers figured out that natto contained a potent clot-preventing enzyme they named nattokinase. Since then, a relatively small number of compelling studies have confirmed that finding, along with discovering that it also has antithrombotic, antihypertensive, and anti-atherosclerotic properties.
Clot formation is a common and serious pathology that’s the underpinning of heart disease, stroke, and embolisms. It’s why heart patients and people who want to avoid becoming heart patients use aspirin or prescription blood thinners.
Nattokinase, however, appears to destroy clots through several mechanisms. Most prominently, it leads to an increase in Tissue Plasminogen Activator (TPA), a potent clot buster often administered to heart or stroke patients in hospital ERs. Nattokinase also kneecaps a serine-protease inhibitor known as PAI-1 that plays a role in clotting. Lastly, nattokinase enhances the production of urokinase, another clot-dissolving agent.
Other reasons to take nattokinase? Atherosclerosis is the primary cause of heart disease and stroke. The blood vessels clog up with organic and inorganic deposits. Nattokinase appears to act as a medicinal Liquid Plumber.
While the mechanisms behind nattokinase’s anti-atherosclerotic effects aren’t known, they’re thought to be through the combination of its antithrombotic, anticoagulant, antioxidant, and lipid-lowering properties.
Nattokinase also appears to lower blood pressure. A randomized, double-blind study found that eight weeks of nattokinase supplementation reduced both systolic and diastolic blood pressure by 5.55 and 2.84 millimeters of mercury, respectively (Kim, 2008).
Nattokinase may also inhibit angiotensin 1-converting enzyme, which narrows blood vessels, allowing the blood to gush through your pipes like one of those amusement park water slides.
Lastly, nattokinase appears to “thin” the blood. While lots of people take aspirin to prevent heart attacks, stroke, and atherosclerotic diseases, studies comparing nattokinase with that old standby show it to be equal or superior to the task without the possible side effects.
What To Take: Nattokinase should be taken in divided doses. I take three 100 mg. capsules a day – one with breakfast, one mid-afternoon, and one at bedtime to maintain a consistent level of “blood thinning” throughout the day. If you choose to take it just once a day, take it after dinner or before bed because a blood clot is most likely to sneak up on you between midnight and early morning.
Until a few years ago, vitamin B3 or niacin was one of two supplements (the other being fish oil) widely recommended for heart health. But then along came the cholesterol-lowering statins. At first, doctors recommended people take statins and niacin together, but then a couple of studies showed that statin therapy did just fine on its own. So, niacin was relegated to the island of misfit supplements until a new research paper exonerated her.
The paper said that niacin positively affected the lipid profile and matched up well against statins but without any negative side effects. Niacin also helps cardiovascular health in another, easy-to-understand way – it increases the production of nitric oxide synthase, which relaxes blood vessels and causes them to pop open, allowing increased blood flow.
Niacin also appears to be one of the very few things that can combat lipoprotein(a), an almost ignored lipoprotein that hardly any doctors test for and is thought to triple the risks of having a heart attack at an early age.
While doctors routinely test for lipoproteins like HDL and LDL cholesterol, few physicians know about lipoprotein(a), even though high levels – presumably dangerous levels – are found in one out of every four or five men and women. We don’t even know exactly what purpose it serves, only that it really increases the risk of stroke or heart attack.
To make matters worse, diet and exercise have almost no effect on it. High levels of lipoprotein(a) may turn out to be the reason why so many men and women who eat well, exercise right, have “good” cholesterol numbers, and appear otherwise healthy, drop embarrassingly dead after bragging about what good shape they’re in.
As a bonus, niacin also lowers LDL cholesterol while increasing HDL cholesterol. It also has a greater effect on atherogenic dyslipidemia (a component of metabolic syndrome) than statins, but unlike statins, it doesn’t come with the potential side effects, like possible muscle pain and damage, liver damage, increased blood sugar, and neurological side effects.
What To Take: Niacin comes in several forms. There are immediate-release forms and extended-release forms, the latter using “wax matrix” or polygel delivery systems to slow down absorption.
A lot of people don’t like immediate-release niacin because it can cause a temporary surge of skin-flushing prostaglandins in sensitive individuals. The feeling is best described as ants with acid on their feet crawling all over your body, accompanied by a mild fever.
That’s why many people opt for the extended-release formula, which lessens or negates the side effects considerably. However, studies suggest that the immediate-release formula might work better in the long run, and if you take it with meals, you shouldn’t have any flushing or itching. For best results, eat half your meal, take a capsule, and then eat the second half.
You can also take immediate-release niacin with a bit of apple sauce. The quercetin it contains quells the flushing. If you choose instead to tough it out, the flushing should disappear in about an hour.
As far as dosage, studies suggest no more than 2,000 mg a day for the extended-release formula and no more than 3,000 a day for the immediate-release formula. Of course, those recommendations evolved out of studies with heart patients who were also taking statins.
For regular Joes just looking for heart insurance, take one 500 mg. immediate-release tablet with breakfast and another with dinner.
K2 has a superpower that makes it an essential component of your heart-health toolbox, and it has to do with its effects on calcium. The mineral helps maintain heart rhythms, but it has a treacherous side – it tends to accumulate on the insides of the arteries and around heart valves. This “misdirected” calcium ends up accruing on the inside of blood vessels, eventually impeding blood flow. Essentially, it can clog your pipes.
Vitamin K2, however, regulates calcium homeostasis through the activation of the “anti-calcific” protein named matrix Gla protein. In its “inactivated” form, the protein is associated with increased arterial stiffness, vascular and valvular calcification, and even insulin resistance, all of which contribute to the possibility you might drop dead prematurely.
Some or all of this could be ameliorated by supplementing with vitamin K2. Think of it as a benign Liquid Plumber. Oh, and here’s a stunner: Using statins tends to inhibit the absorption of vitamin K2, so while the statins might reduce your cholesterol, it’s possible they’re also causing more calcium to accrue in your arteries and heart, and hardly anybody knows about it. Go figure.
What To Take: Take 600 combined mcg. of the two main subtypes, M4 and M7, every day with a meal containing fat.
CoQ10, also known as ubiquinone, is a coenzyme synthesized in the inner membranes of mitochondria. It’s found in all organ systems, but the highest concentrations are found in the heart, kidneys, liver, and muscles.
Three out of four patients with heart disease have low levels of CoQ10. For example, in patients with ischemic (a condition where blood flow is reduced) heart disease, CoQ10 levels are much lower than in healthy ones. Further, depending on the severity of heart injury, circulating levels of CoQ10 levels decrease in direct proportion to the progression of the disease.
Most clinicians think that CoQ10’s primary role is as an antioxidant, thus preventing the oxidative stress and inflammatory cytokines that can lead to hypertrophy of the heart (lessening the heart’s blood-pumping capabilities).
CoQ10 possibly has a more important role: helping determine the energy and vigor of the heart. When the heart beats, it involves the release of calcium ions from the sarcoplasmic reticulum (a part of muscle cells), and the subsequent activation of contractile proteins requires energy, energy provided by the mitochondria, courtesy of CoQ10. Adequate levels of CoQ10 would then, presumably, lead to a more vigorous heart.
There’s also some evidence that CoQ10 regulates nitric oxide production, thus “blowing open” blood vessels, enabling more oxygen-rich blood to flow to and feed cells, especially those of the heart.
One surprising finding, at least in rat models, was that intravenous injection of CoQ10 within 10 minutes of coronary artery blockage resulted in a smaller area of cell death, less postinfarction (death of tissue resulting from reduced blood supply) hypertrophy of the left ventricle, greater stroke volume, greater cardiac output, greater ejection fraction, and increased contractility (relative ability of the heart to squirt blood through the chambers). CoQ10 may also improve oxygen utilization at the cellular level.
Oh, here’s another bit of statin-related irony. As is the case with vitamin K2, statins can inhibit CoQ10 absorption from food by as much as 40%. Obviously, this effect could be harmful to the functioning of the heart, especially in those patients with heart failure. Hence the recommendation that statin use be accompanied by CoQ10 supplementation.
What To Take: CoQ10 is fat soluble, so take it with the fattiest meal of the day for maximum absorption.
