Friday, January 14, 2011

Congestive Heart Failure

Congestive heart failure (CHF) is generally defined as inability of the heart to supply sufficient blood flow to meet the body's needs. It has various diagnostic criteria, and the term heart failure is often incorrectly used to describe other cardiac-related illnesses, such as myocardial infarction (heart attack) or cardiac arrest.

Common causes of heart failure include myocardial infarction and other forms of ischemic heart disease, valvular heart disease, and cardiomyopathy along with the 3 major silent killers, i.e.  high blood pressure (hypertension, diabetes, and obesity.

Other conditions that can contribute to congestive heart failure include an overactive or underactive thyroid, emphysema, a viral or bacterial infection in the heart muscle, and/or damaged heart valves.

Alternative Treatment Strategy
In the past, drugs such as digitalis were often given to strengthen and to some extent regulate heartbeat. Vasodilators (blood vessel opening drugs) are given to improve cardiac output and relieve backed-up blood from blood vessels throughout the body, especially in the lungs. Fluid buildup (edema) is commonly treated with diuretic drugs. 

However, more studies have indicated that  these drugs cause the heart muscle to become weaker over a period of years. This leads to more  side effects and more drugs to overcome the loss of effectiveness of the previous drugs! i

The good news is that recent studies have shown that it is possible to naturally augment, or perhaps substitute for, these pharmaceutical drugs, and improve the patient's cardiovascular system and heart muscle. 

A comprehensive alternative treatment strategy must consist of nutritional, physical, emotional, mental, and spiritual components.

Exercise Program: with consistent low intensity exercises every day is important to improve the health of the heart muscle over time.

Emotional Support Program: Stress Management, Quality Sleep and Emotional Support are key to dealing with the emotional side of CHF.

Wholefood Nutritional Program: As previously mentioned, the heart muscle is one of the few organs that responds very well to wholefood dietary and supplementation changes. [46] A high-quality macronutrient-dense plant-based nutritional program (such as the Death to Diabetes Nutritional Program) is critical to dealing with cardiovascular health issues.

This type of nutritional program includes antioxidant-rich and super foods such as green and bright-colored vegetables, dark-colored fruits, plant oils, wild salmon, and beans As a result, these super foods provide key nutrients that the cardiovascular system and heart muscle need to operate at an optimum level, i.e. Vitamin C, Vitamin E, magnesium, potassium, CoQ10, garlic.

We recommend that you use a comprehensive wholefood nutritional program such as the Death to Diabetes Wellness Program. Although this program was designed for Type 2 diabetes, the program was expanded to include  cardiotherapy, which is discussed in Chapter 15 of the Death to Diabetes book.

Nutritional Supplementation: Some nutritional supplements can be beneficial, as long as the supplements are not so-called "natural" vitamins/minerals  that are actually synthetic. Nutritional supplements should only be utilized as part of an overall wholefood nutritional program.

Co-Enzyme Q10: One of the best things about Co-Enzyme Q10 is that it is harmless, having no negative side effects or contraindications of any kind. No physician or hospital can make a case against taking it.  The down side is that it is pricey.  But then, so are heart transplants. Clinical studies and patient reports that show success with CoQ10 usually use somewhere around 400 mg a day, divided into several doses. 35-50 mg/day simply will not work.

"I have had patients with such severe CHF that they were waiting for a heart transplant. After taking CoQ10, they no longer needed a transplant."  Jullian Whitaker, M.D. (Health & Healing, December 1997.  http://www.drwhitaker.com
If there is higher praise than this, I have not yet seen it.

Key Point: Make certain that the CoQ10 comes from a reliable company! Do not buy your CoQ10 from a drugstore or large discount store -- most of their supplements are synthetic.

Omega-3 EFAs: One of the best supplements for the cardiovascular system is Omega-3 EFAs, especially if you don't eat cold-water fish such as wild salmon.

Vitamin E: One of the body’s most powerful defenses against free radical damage is the antioxidant vitamin E. The mixed tocopherols/tocotienols is the best form of vitamin E; and, can be cautiously used to strengthen and regulate heartbeat. An initial dose of vitamin E would be only about 50 International Units (I.U.) daily. This is roughly equivalent to 50 milligrams (mg). To avoid any possible risks of an asymmetric heart contraction, patients with congestive heart failure need to start small with vitamin E.  Doses may be gradually increased under medical supervision. For additional information, it is most worthwhile read any books by Drs. Wilfrid or Evan Shute (http://www.doctoryourself.com/biblio_shute.html ). If their books are hard to find, try an interlibrary loan at any public library.

Thiamin: Some congestive heart failure is actually caused by thiamin (vitamin B-1) deficiency. 25 to 50 mg with each meal might be worth a therapeutic trial. A thiamin-containing 50 mg "balanced B-complex" tablet each meal would be even better.

Herbal Diuretics: It may be possible to use herbal medicines to reduce swelling due to retained fluids. There are no fewer than 180 herbs with diuretic properties listed just on pages 53-54 of John Lust’s The Herb Book. (NY:Bantam. 1974. ISBN 0-553-13082-X). I am not suggesting that you take 180 herbs. You should read up on your options before committing yourself only to drugs!

Selenium: Selenium deficiency can cause a congestive heart disease called Keshan disease. 100 to 300 micrograms (mcg) of selenium daily would insure against this. In addition, selenium works to help your body recharge and efficiently reuse its vitamin E. 

Magnesium: The role of magnesium in normal heart function is tremendous. Profound magnesium deficiency causes muscles to underfunction, malfunction or not function at all. Several hundred of your body’s most important biochemical reactions depend on this mineral. "The synthesis of all proteins, vital cell nuclear materials such as nucleic acids and nucleotides, lipids, and carbohydrates require ionized magnesium (Mg ++)." (Williams, SR Nutrition and Diet Therapy, Seventh Ed, St. Louis: Mosby, 1993, pp 230-233)  Even most, "healthy" adults fail to get the US RDA of magnesium, which ranges from 280 to 400 mg for adults.  Green vegetables and whole grains contain quite a bit of magnesium. Pinto beans, almonds, and especially figs are oustanding food sources.

Of the oral supplements, magnesium aspartate or magnesium orotate may have the best chance of getting into cardiac muscle cells. These forms of magnesium are rarely found on store shelves.  Your doctor may be able to have them compounded for you by a cooperative pharmacist, or you might find them with an internet search.

Intravenous administration of magnesium may be necessary in more serious cases of congestive heart failure. Have a test ordered to check serum magnesium. Most doctors don’t. It is even better to check myocardial magnesium . This is because the amount of magnesium in the heart muscle cells may be considerably lower than in the blood.

A great deal of information about magnesium will be found at 
 http://www.mgwater.com and in the work of Dr. Hans Nieper, M.D. 
(listed at  http://www.doctoryourself.com/biblio_nieper.html ).

Potassium: Potassium deficiency is associated with congestive heart failure, and is connected with magnesium deficiency, mentioned above. Low potassium can cause erratic heartbeat (heart arrhythmia). A non-technical way of increasing dietary potassium is to eat lots of easy to digest fruits, and juiced vegetables. They are loaded with potassium. Nuts, whole grains and legumes (beans) are good, too. 4 ounces of almonds contains a whopping 800 mg Brazil nuts have almost as much. 

Amino Acids: Ideally, try to get your amino acids from protein foods  as part of your diet. With really sick people, a case can be made for amino acid supplementation. In Werbach's Textbook of Nutritional Medicine, the case is indeed well made.

Dr. Werbach recommends L-Arginine at a daily dose somewhere between 5,600 and 12,600 mg because it "causes peripheral vasodilation and improves cardiac output." (p 273). The benefit to patients was an increase in "the distance they could walk in 6 minutes, and the rate of blood flow during exercise." Arginine is normally considered by dieticians to be a "semiessential" amino acid, necessary only for growth. It is possible that growth includes regrowth, strengthening, and repair of cardiac muscle. Eggs, cheese, whole grains, and legumes (beans) are good food sources.  Peanuts (unsalted) are absolutely loaded with arginine, containing three times as much as meat does. You’d need to consume roughly a twelve-ounce can of peanuts a day to get in the middle of the dose mentioned above. Chew the nuts well for best absorption. That, or consider supplements. Or do both.

Taurine is an amino acid normally made in your body from another amino acid, methionine. Methionine is found in eggs, cheese, beans, nuts, and whole grains. Brazil nuts have over twice as much methionine as meat, ounce for ounce. Extreme stresses to the body (hospital food, perhaps?) can cause taurine deficiency. (Desai TK et al. Taurine deficiency after intensive chemotherapy and/or radiation. American Journal of Clinical Nutrition. 55:708, 1991.)  Taurine appears to help regulate heartbeat.  Dr. Werbach mentions a dosage of 4,000 to 6,000 mg/day. 

The amino acid L-Carnitine is essential for energy metabolism in heart muscle cells. This amino acid  is made in your body IF (and, to quote Ed Sullivan, this is a "really big" IF) you consume plenty of methionine, lysine, vitamin B-6 (pyridoxine), niacin, and vitamin C.  Most people, especially the elderly with chronic illness, do not get nearly enough of those three vitamins. This study recommends 2,000 mg of L-carnitine daily, specifically for CHF: Ghidini O, Azzurro M, Vita A, Sartori G. (1988) Evaluation of the therapeutic efficacy of L-carnitine in congestive heart failure. International Journal of Clinical Pharmacology, Therapy and Toxicology 26: 217-220. 

Hawthorn is an herb acts a little like digoxin, may increase heart-muscle strength and also provides a mild diuretic effect.

Large amounts of supplemental Creatine, still another amino acid that your body normally produces, may help strengthen heartbeat. As creatine phosphate, it is involved in supplying energy to power muscle tissue, especially cardiac muscle. Dr.Werbach cites studies that indicate that persons with CHF have a deficiency of creatine in the heart muscle itself, and that daily doses of 20,000 mg/day "improve cardiac function… physical strength and endurance." (Textbook of Nutritional Medicine, p 276)

Common Sense: No table salt (use only authentic sea salt).  No alcohol. No smoking. No extra weight. No kidding.

Note: If you want to ensure that you're buying high quality supplements, and not wasting your money, then, get the Nutritional Supplements ebook. This is very important, especially for important supplements such as CoQ10, Omega-3 EFAs, lipoic acid, multivitamins, etc. because many of these supplements are being sold  as inferior  and synthetic products, with little or no nutrient value.

CAUTION: Do not start taking these supplements on your own! Work with a licensed nutritionist or naturopathic doctor to determine the proper dosages for you. All quantities mentioned above should be divided up into several smaller doses throughout the day. Add vitamin C because of its antioxidant properties and also because of its role in amino acid synthesis.

If possible, take only wholefood supplements and 100% natural (additive-free) supplements such as those provided by firms such as Standard Process and ProCapsLabs. Refer to our Nutritional Supplements web page for more information.

Make certain that you discuss the use of any supplement with your doctor so that your prescription drug dosages can be adjusted (if necessary), and to prevent any side effects as these other measures take effect.

Since the heart prefers fatty acids for fuel, a long-standing deficiency of essential fatty acids causes deterioration of heart muscle. Lecithin, fish, and primrose oil are sources of essential fatty acids. http://www.doctoryourself.com/lecithin.html

If these natural options do not speak strongly enough to you, bear in mind that: 
1) there is no drug cure for congestive heart failure; and 
2) the pharmaceutical drugs given in an attempt to cope with the condition have many side effects.

More Information about Alternative Treatment
Cutting calories may slow age-related changes in the heart's genes that lead to chronic disease. Reduce caffeine from coffee, tea, and guarana. Avoid stimulants of any sort. Heart failure patients who are even mildly depressed may have a poorer prognosis than others with the heart ailment.

Arginine and Heart Failure
Dietary supplementation with the amino acid L-arginine may improve the physical fitness of heart failure patients by enhancing their endurance to exercise.

L-arginine is a precursor of nitric oxide, a compound that plays a key role in the heart and circulatory system, both at rest and during exercise. Nitric oxide helps the inner lining of blood vessels to dilate. Dysfunction of the "L-arginine-nitric oxide" pathway in heart failure leads to reduced blood flow at rest and during exercise, partly explaining the exercise capacity limitations of chronic heart failure patients.

Dr. Stephane Doutreleau and colleagues from Institut de Physiologie, Strasbourg, France, examined the potential benefits of 6 weeks of L-arginine supplementation on endurance exercise in 10 patients with chronic stable heart failure and compared to a placebo group. Patients who took L-arginine experienced a significant decrease in their average heart rate throughout exercise and the recovery period. There were no significant changes in blood pressure and respiratory parameters. The current study supports a prior study in which a group of heart failure patients were shown to benefit from a combination of exercise and L-arginine supplements. In that study, the combination appeared to help correct the abnormal functioning of blood vessels seen in chronic heart failure. International Journal of Sports Medicine July 2006.
L-arginine supplementation prolongs duration of exercise in congestive heart failure. Kardiol Pol. 2004.

In congestive heart failure, endothelial dysfunction may contribute to impairment of exercise induced vasodilatation and decreased exercise capacity. We hypothesised that administration of L- arginine, a precursor of nitric oxide (NO) and postulated antioxidant, may improve endothelium - dependent vasodilatation and exercise capacity and also exert antioxidant activity. In patients with chronic stable congestive heart failure, oral supplementation with L-arginine prolongs exercise duration which may be due to NO-induced peripheral vasodilatation. The antioxidant properties of L-arginine have not been confirmed in this ex vivo study.

Omega-3 EFAs and plant sterols are a lot better than Crestor and other statin drugs for heart failure:
Daily supplements of fish oil reduced deaths and hospitalizations of people with heart failure. But a cholesterol-lowering statin drug had no beneficial effect in a parallel heart failure trial. The omega-3 polyunsaturated fatty acid (PUFA) study was done by a consortium of 357 Italian cardiology centers, and enlisted more than 7,000 people diagnosed with heart failure. Half took a daily capsule containing fish oil, the other half took a capsule with a placebo. The death rate in the fish oil group was 27 percent, compared to 29 percent in the placebo group. The statin trial included more than 4,500 people with heart failure, half of whom took the statin rosuvastatin (Crestor), while the other half took a placebo. The death rate was 29 percent in the statin group, 28 percent in the placebo group. Lancet, August 2008.
Warning!: Statin drugs may actually cause damage to the heart muscle!

Psyllium reduces cardiac risk:
An article published in the American Journal of Clinical Nutrition reports that supplementing the diet with psyllium fiber has positive effects on blood lipids while potentially cardiovascular risk. Sixty-eight adults with high cholesterol consumed a high-fiber and a control diet for 1 month each in a randomized crossover study. The high-fiber diet included 4 servings per day of foods containing psyllium that delivered 8 g per day of soluble fiber than did similar, unsupplemented foods in the control diet. Fasting blood samples and blood pressure readings were obtained at baseline and weeks 2 and 4, and the subjects' weight was monitored weekly. Compared with the control diet, the high-fiber diet reduced total cholesterol levels. Applying the Framingham cardiovascular disease risk equation to the data confirmed a reduction in risk of 4 percent. Small reductions in blood pressure were found after both diets. The subjects reported no significant differences in palatability or gastrointestinal symptoms between the diets.

Dr. Sahelian says: Even though the reduction of cholesterol was small, it was nevertheless a positive response. Adding psyllium to the diet, for instance about a teaspoon in a glass of water two or three times a day with meals will help reduce cholesterol and also helps regulate bowel movements.

Magnesium is good for heart patients:
Patients with heart disease are often placed on several medicines including beta-blockers and nitrates, but doctors rarely think about suggesting mineral supplements. In a study published in the American Journal of Cardiology, researchers enrolled 187 patients with heart disease to try oral magnesium and compare the results with those on placebo pills. The dose of magnesium was about 200 mg twice daily and it was in the form of magnesium citrate. At the beginning of the study, blood magnesium levels were similar in both groups, but increased significantly in those who took the magnesium supplements. After six months of treatment, those taking magnesium were found to have a significant improvement in the amount of time they could exercise without chest pain, but there were no changes in cholesterol levels between the two groups.

Dr. Sahelian says: In patients who are already taking heart medicines and still have not had the best results possible, it seems that magnesium is a safe, cheap, and effective natural mineral to add to the regimen. The ideal dose of magnesium is not known, but it would seem reasonable to take 100 to 200 mg twice daily.

Eating fish that is broiled or baked seems to reduce the risk of developing an irregular rhythm of the heart's upper chambers, called atrial fibrillation. However, eating fried fish or fish sandwiches doesn't cut it.

Efficacy and safety of berberine for congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.

Am J Cardiol. 2003. This study was designed to assess the efficacy and safety of berberine for chronic congestive heart failure. One hundred fifty-six patients with CHF and >90 ventricular premature complexes (VPCs) and/or nonsustained ventricular tachycardia (VT) on 24-hour Holter monitoring were randomly divided into 2 groups.  After treatment with berberine, there was a significantly greater increase in LVEF, exercise capacity, improvement of the dyspnea-fatigue index, and a decrease of frequency and complexity of VPCs compared with the control group. There was a significant decrease in mortality in the berberine-treated patients during long-term follow-up. Proarrhythmia was not observed, and there were no apparent side effects. Thus, berberine improved quality of life and decreased VPCs and mortality in patients with congestive heart failure.

Exercise for heart failure:
Just 30 minutes of exercise twice a week can reduce the risk of hospitalization or death in heart failure patients, according to study findings presented at the March 2009 annual meeting of the American College of Cardiology. With more exercise, the benefit is even greater. Walking at a rate of 2 miles per hour for 30 minutes a few times a week will make a difference. Yoga practice could be of benefit.

Moderate exercise may help boost sexual health and function in men with heart failure. The results may be good news for some men with erectile dysfunction, because Viagra and other similar impotence drugs can have dangerous interactions with medications commonly prescribed to treat heart failure.

Prolonged and sustained endurance training prevents stiffening of the heart, a condition associated with the onset of heart failure, according to researchers at UT Southwestern Medical Center at Dallas. The researchers also report that a sedentary lifestyle, in addition to aging, puts older people at risk for heart failure, the leading cause of hospitalizations for patients over 65 and a condition that affects eight out of every 1,000 people older than 70.

Commuting to work on your own two feet, or while spinning two wheels, could help stave off this condition.And if your job keeps you active during the day too, even better.  Journal of the American College of Cardiology, 2010.

Benefit of yoga
Yoga in heart failure patients: a pilot study.
J Card Fail. 2010; Howie-Esquivel J, Lee J, Collier G, Mehling W, Fleischmann K. Department of Physiological Nursing, University of California, San Francisco, CA, USA.
Complementary therapies such as yoga practice have become commonplace, yet the safety, physical, and psychological effects on patients with heart failure (HF) are unknown.  Endurance and strength significantly improved, so did balance. Although no subject was depressed, overall mood was improved. Subjects subjectively reported improvements in overall well-being. Yoga practice was safe, with participants experiencing improved physical function and symptom stability.

There are quite a number of herbs and supplements that could have a beneficial effect on heart disease, some are listed below. But ultimately the use of supplements has to be done with the full knowledge and approval of your health care provider.

Omega-3 Oils or eating cold water fish reduces the risk for heart rhythm disturbances and may reduce the risk of heart palpitations, atrial fibrillation and ventricular arrhythmia. For patients whose condition is controlled with standard care, omega-3 fatty acid supplements appear to improve their condition even more. Journal of the American College of Cardiology, 2011.

Vitamin D deficiency is associated with heart dysfunction, sudden cardiac death, and death due to heart failure. An association between vitamin D deficiency and heart trouble is physiologically plausible since vitamin D is known to affect contractility of the heart.

Arginine may prolong exercise capacity in those with congestive heart failure. Arginine supplements are available over the counter.

Carnitine is potentially helpful since the heart uses carnitine for energy production.

CoQ10 is one of the key nutrients that nourishes and provides antioxidant protection to the heart muscle.

Garlic consumption improves blood flow and circulation.

Hawthorn helps dilate blood vessels, increases coronary flow, acts as an inotrope (stimulates heart contraction), decreases peripheral resistance, and has ACE-inhibitor-like effect. Daily dosage hawthorn berry herb 3 to 5g or 160 to 900 mg extract for a few weeks. Appears to be useful in mild heart failure.

Folic acid, vitamin B12 and vitamin B6 can help prevent reoccurrence of blocked arteries in patients who have undergone coronary angioplasty.

Psyllium fiber may help reduce cholesterol levels.

Magnesium mineral may help.

Ribose may be beneficial to individuals with congestive heart failure.

Astragalus has been studied in heart failure.

Note: If you want to ensure that you are buying high-quality supplements and not wasting your money on so-called "natural" supplements that are actually synthetic, then, read our Nutritional Supplements web page and get our Nutritional Supplements & Super Foods ebook. It will identify where (websites, 800 numbers) to purchase quality supplements (and super foods), and how to get them at discount.

Please Note: For more details, refer to the Death to Diabetes website. If you need additional help, obtain our Cardivascular Disease ebook or contact our office to set up a health coaching/training session.  But, whatever you do, do not allow this disease to take hold and put you in the hospital. The heart muscle is one organ that responds very well to nutritional therapy.

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