CoEnzyme Q10 (CoQ10)
CoQ10 functions in the mitochondria—the “powerhouse” of the cell—to assist in making energy (called adenosine triphosphate or ATP) from carbohydrates and fats.
CoQ10 primarily acts as an antioxidant in the heart and is involved in the synthesis of energy, but it also has other important functions inside the mitochondria such as stabilizing membranes. CoQ10 protects the “bad” LDL cholesterol—that’s implicated in atherosclerosis—from oxidizing. Because of CoQ10’s role in oxidative stress, energy production and stabilization, it’s useful in preventing damage to the heart during periods of stress.
CoQ10 levels have been shown to be depleted in patients with a variety of heart conditions and in those taking cholesterol-lowering statin drugs. Research of CoQ10 spanning over 30 years shows potential for its use for these patients.
Preventive doses usually range from 30-100 mg per day whereas therapeutic doses are usually greater than 100 mg per day. CoQ10 may be appropriate as an adjunct to conventional treatment or as a preventive treatment.
Fish Oil (EPA and DHA)
Most Americans consume about ten times the amount of omega-6 they need, but in contrast, many don’t meet the minimum requirement for omega-3. Because a high omega-6 intake can interfere with omega-3 metabolism, this disparity between omega-6 and omega-3 intakes throws off the balance between these two competing classes of essential fats, making the current imbalance worse. Thus, increasing one’s intake of omega-3 fatty acids (EPA and DHA) from fish or fish oil can have widespread health-promoting effects, especially for heart disease and diabetes. Unlike other supplements that have shown efficacy in reducing risk factors for heart disease, fish oil supplementation has actually been shown to decrease the risk of coronary artery disease death.
EPA and DHA are effective at reducing blood triglyceride levels on average 25-30%, with greater efficacy at higher triglyceride levels.
Fish oil works through several mechanisms to promote heart health such as improving heart rhythm, and preventing clot formation and plaque build-up in arteries. Fish oil may also lower blood pressure and increase plasma levels of “good” HDL cholesterol.
Omega-3s potently reduce inflammation and therefore have therapeutic applications in a number of conditions that are associated with pro-inflammatory mechanisms such as joint-related problems. Omega-3s have also been shown to protect against muscle loss and even enhance fat breakdown. Improvements can be obtained with 300 mg per day of EPA and DHA, while even better results may be achieved with 2,000-3,000 mg per day.
Citrus Polymethoxylated Flavones (PMF)
A combination of citrus derived polymethoxylated flavones (PMF’s) and tocotrienols may significantly lower cholesterol and triglyceride levels. For example, one 12 week placebo-controlled study in men and women with elevated blood cholesterol levels showed significant decreases in total cholesterol (-27%), “bad” LDL cholesterol (-25%), and triglyceride levels (-31%).
Animal studies indicate that PMF’s work through multiple mechanisms, including inhibiting synthesis and increasing clearance of cholesterol and triglycerides. Dosages used in the studies were 150 mg twice a day (approximately 135 mg of citrus polymethoxylated flavones and 15 mg of tocotrienols) for one month to produce results. The tocotrienols help by inhibiting an enzyme your body needs to make cholesterol (see more info below). Unlike statin drugs, this combination doesn’t appear to lower the body’s CoQ10 levels.
Tocotrienols (alpha, beta, gamma, delta), from the vitamin E family, have been shown to decrease plasma cholesterol by lowering the enzyme HMGR (HMG-CoA reductase), which produces cholesterol in the liver. Two studies showed the daily use of 75 mg of tocotrienols (delta and gamma form) for two months, reduced total cholesterol 13%. The “bad” LDL cholesterol levels dropped 9-15% and the “good” HDL cholesterol increased by 4-7%. Another study showed those taking 100 mg a day for 4 weeks reduced total cholesterol by 15-22% and reduced “bad” LDL cholesterol by 10-20%.
Typical vitamin E supplements (alpha-tocopherol form) may interfere with the body’s uptake of tocotrienols. For this reason, it may work better to take them at least an hour apart. About 50-100 mg of tocotrienols a day appears to be an effective dose.
Red Yeast Rice
Red yeast rice has also shown promise as a dietary supplement that may affect several different risk factors, including reductions in total cholesterol, “bad” LDL cholesterol, fasting triglycerides and triglyceride responses to meals.
One study showed that red yeast rice (1,200 mg per day) reduced the triglyceride response to a fat-rich meal 45%-50%.
Similar to CoQ10, carnitine levels are depleted in patients with various heart conditions and therefore supplementation may be beneficial. Carnitine assists in transporting fat into the mitochondria to be burned as fuel in muscle, including the heart. The most promising research with carnitine supplementation is in conditions of reduced oxygen like ischemia.
Carnitine supplementation may improve vascular function and have positive effects on symptoms of heart failure and may improve exercise tolerance and oxygen consumption. Effective doses are around 2 grams per day.
Vitamin D appears to play a role in reducing heart attack risk, regulating plaque buildup, and lowering blood pressure. It’s estimated that 50% of the population around the world may have insufficient vitamin D. Since your skin makes vitamin D from sun exposure, blood levels of D typically decline in the winter months.
Interestingly, heart attacks are more frequent in the winter. In the NHANES III 3,400 person survey they found that low blood levels of vitamin D were in fact associated with a doubling or tripling of heart attack risk.
Italian researchers have shown a strong correlation between low vitamin D levels and greater carotid atherosclerotic plaque buildup. Low vitamin K levels are also associated with more plaque.
Blood pressure is somewhat higher in the winter and lower in the summer, which is consistent with the seasonal variations of vitamin D levels. Further research shows that vitamin D can reduce blood pressure modestly by suppressing renin, a blood pressure-raising hormone, similar to how ACE inhibitor prescription drugs work.
Lecithin is an excellent and inexpensive source of beneficial phospholipids, and a rich source of choline. Lecithin supplementation has been shown to result in a slight decrease in cholesterol. Choline may also reduce the risk for heart disease though another mechanism involving lowering homocysteine levels.
In one study, subjects with moderately elevated homocysteine levels given 2.6 grams of choline per day had a 30% reduction in homocysteine levels compared to placebo.
Choline is also the precursor for a very important neurotransmitter called acetylcholine. Studies indicate that choline can help improve memory and cognitive function.
Arginine is a natural amino acid. It’s promoted for heart health mainly because it’s needed to synthesize a very potent substance called nitric oxide that causes dilation of blood vessels. It also has favorable effects on blood pressure.
Arginine supplementation prevented the vascular dysfunction associated with consumption of a high fat meal in one recent study. The dose of arginine was 6 grams per day (2 grams consumed three times per day) for 10 days.
One review of arginine studies concluded that the main benefit of arginine supplementation is to restore vascular function and to improve the clinical symptoms of various factors associated with vascular dysfunction.
Other Heart Supplements
Unfortunately, space does not permit the inclusion of many other supplements, but I’ll mention just a few more here.
Garlic – Aged garlic or extracts may mildly elevate “good” HDL cholesterol, lower triglycerides levels, and have a mild blood pressure lowering effect.
Plant Sterols – The American Heart Association recommends phytosterols (plant cholesterol) to lower “bad” LDL cholesterol by about 10%.
Policosanol – Some studies have shown it to reduce total cholesterol, “bad” LDL cholesterol and triglycerides.
Lycopene – A study showed that men with the lowest lycopene levels had more than a 3-fold greater risk of an acute coronary event or stroke, and had thicker plaque in their arteries.
Magnesium – Supports energy formation, a regular heart beat and overall heart health.
Niacin – This B-vitamin can help blood vessels to increase in diameter, and at higher doses, increase “good” HDL levels.
Vitamin B – B-6, B-12 and folic acid can keep unhealthy levels of homocysteine in check.
Vitamin K – Higher K2 intake has been related to less vascular calcification.
Hawthorn Berry – Good for blood pressure and vascular health.
Basic and applied research on a variety of foods and dietary supplements has shown great promise for the safe and effective management of cardiovascular risk factors.
There is a tremendous amount of variability in the way people respond to dietary supplements and medications. It’s therefore recommended that you work with your physician and regularly check your cholesterol and lipid levels in order to determine what is working and to help fine-tune your diet, exercise and supplement program.