Heath Notes

Congestive Heart Failure

Also indexed as: CHF, Heart Failure

CHF is a serious condition that requires support from health professionals. According to research or other evidence, the following self-care steps may help your heart keep pumping the blood your body needs:

Get help from hawthorn
Take 300 mg of an herbal extract three times a day to reduce symptoms and improve exercise capacity

Try taurine
Improve heart muscle contraction by taking 2 grams of this amino acid three times a day

Add a carnitine to your routine
Take 1,500 to 2,000 mg of an L-carnitine or propionyl-L-carnitine supplement every day to improve heart function and exercise capacity

Check out coenzyme Q10
To determine how much of this powerful antioxidant supplement you need daily, calculate 0.9 mg for every pound of body weight

Mix in some magnesium
Take 300 mg a day of this essential mineral to prevent a deficiency that can lead to heart arrhythmias

See a specialist
Find a health expert you can trust to help you manage this medical condition

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full congestive heart failure article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About congestive heart failure

Congestive heart failure (CHF) is a chronic condition that results when the heart muscle is unable to pump blood as efficiently as is needed.

High blood pressure can cause congestive heart failure. Failure of the heart pump can also result from many other causes, such as severe anemia, hyperthyroidism, heart attacks, and arrhythmias of the heart.

Caution: Congestive heart failure is a serious medical condition that requires expert management rather than self-treatment.

Product ratings for congestive heart failure

Science Ratings	Nutritional Supplements	Herbs
	Magnesium Propionyl-L-carnitine Taurine	Berberine Hawthorn
	Arginine Coenzyme Q10 Potassium	Arjun (bark extract)
	Creatine monohydrate	Coleus
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

CHF leads to breathlessness, fatigue, and accumulation of fluid in the lungs or the veins (primarily in the legs) or both.

Lifestyle changes that may be helpful

Even with severe disease, appropriate exercise can benefit those with CHF.¹ ² In a controlled trial, long-term (one year) exercise training led to improvements in quality of life and functional capacity in people with CHF.³ Nonetheless, too much exercise can be life-threatening for those with CHF. How much is “too much” varies from person to person; therefore, any exercise program undertaken by someone with CHF requires professional supervision.

Non-steroidal anti-inflammatory drugs (NSAIDs) appear to significantly increase the risk of CHF. The use of NSAIDs in one preliminary study was found to double the likelihood of hospital admission with CHF the following week. This likelihood increased by more than 10 times for patients with a history of heart disease.⁴ This study did not include people taking low-dose aspirin.

Vitamins that may be helpful

People with CHF have insufficient oxygenation of the heart, which can damage the heart muscle. Such damage may be reduced by taking L-carnitine supplements.⁵ L-carnitine is a natural substance made from the amino acids, lysine and methionine. Levels of L-carnitine are low in people with CHF;⁶ therefore, many doctors recommend that those with CHF take 500 mg of L-carnitine two to three times per day.

Most L-carnitine/CHF research has used a modified form of the supplement called propionyl-L-carnitine (PC). In one double-blind trial, people using 500 mg of PC per day had a 26% increase in exercise capacity after six months.⁷ In double-blind research, other indices of heart function have also improved after taking 1 gram of PC twice per day.⁸ It remains unclear whether propionyl-L-carnitine has unique advantages over L-carnitine, as limited research in animals and humans has also shown very promising effects of the more common L-carnitine.⁹

Magnesium deficiency frequently occurs in people with CHF, and such a deficiency may lead to heart arrhythmias. Magnesium supplements have reduced the risk of these arrhythmias.¹⁰ People with CHF are often given drugs that deplete both magnesium and potassium; a deficiency of either of these minerals may lead to an arrhythmia.¹¹ Many doctors suggest magnesium supplements of 300 mg per day.

Whole fruit and fruit and vegetable juice, which are high in potassium, are also recommended by some doctors. One study showed that elderly men who consumed food prepared with potassium-enriched salt (containing about half potassium chloride and half sodium chloride) had a 70% reduction in deaths due to heart failure and a significant reduction in medical costs for cardiovascular disease, when compared with men who continued to use regular salt.¹² While increasing potassium intake can be beneficial for heart patients, this dietary change should be discussed with a healthcare provider, because several drugs given to people with CHF may actually cause retention of potassium, making dietary potassium, even from fruit, dangerous.

Taurine, an amino acid, helps increase the force and effectiveness of heart-muscle contractions. Research (some double-blind) has shown that taurine helps people with CHF.¹³ ¹⁴ ¹⁵ ¹⁶ Most doctors suggest taking 2 grams three times per day.

As is true for several other heart conditions, coenzyme Q10 (CoQ10) has been reported to help people with CHF,¹⁷ ¹⁸ sometimes dramatically.¹⁹ Positive effects have been confirmed in double-blind research²⁰ and in an overall analysis of eight controlled trials.²¹ However, some double-blind trials have reported modest²² or no improvement²³ ²⁴ ²⁵ in exercise capacity or overall quality of life. Most CoQ10 research used 90–200 mg per day. The beneficial effects of CoQ10 may not be seen until after several months of treatment. Discontinuation of CoQ10 supplementation in people with CHF has resulted in severe relapses and should only be attempted under the supervision of a doctor.²⁶

The body needs arginine, another amino acid, to make nitric oxide, which increases blood flow. This process is impaired in people with CHF. Arginine supplementation (5.6–12.6 grams per day) has been used successfully in double-blind trials to treat CHF.²⁷ A double-blind trial has also found that arginine supplementation (5 grams three times daily) improves kidney function in people with CHF.²⁸

For people with congestive heart failure, intravenous injections of creatine have been found to improve heart function; oral supplementation has not been effective, though it does improve skeletal muscle function.²⁹ ³⁰

In a preliminary study, blood levels of DHEA (dehydroepiandrosterone) were found to be lower in people with CHF than in people without the disease. The lowered blood levels of DHEA among these people was proportional to the severity of their disease.³¹ However, there is no evidence that DHEA supplementation can prevent or reverse CHF.

In a double-blind study of people with established heart disease or diabetes, participants who took 400 IU of vitamin E per day for an average of 4.5 years developed heart failure significantly more often than did those taking a placebo.³² Hospitalizations for heart failure occurred in 5.8% of those in the vitamin E group, compared with 4.2% of those in the placebo group, a 38.1% increase. Considering that some other studies have shown a beneficial effect of vitamin E against heart disease, the results of this study are difficult to interpret. Nevertheless, individuals with heart disease or diabetes should consult their doctor before taking vitamin E.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Berberine is used in Asia to treat congestive heart failure. In a double-blind trial, supplementation with berberine (300 to 500 mg, four times per day) for eight weeks significantly improved heart function and exercise capacity and reduced the frequency of arrhythmias in people with congestive heart failure.³³

Clinical trials have shown that standardized extracts made from the leaves and flowers of hawthorn are effective in helping people with early-stage CHF.³⁴ ³⁵ Hawthorn extracts appear to increase blood flow to the heart, increase the strength of heart contractions, reduce resistance to blood flow in the extremities, and act as an antioxidant.³⁶ ³⁷ ³⁸ In a large preliminary trial, people with mild to moderate CHF were given 300 mg of hawthorn flower and leaf extract (standardized to contain 2.2% flavonoids) three times a day for two months.³⁹ Symptoms of CHF—including heart palpitations, chest pressure, and swelling in the extremities—decreased throughout the trial during the use of hawthorn. The efficacy of hawthorn for the treatment of CHF has been confirmed in a double-blind trial.⁴⁰

Hawthorn extracts are available in capsules or tablets standardized to either total flavonoid content (usually 2.2%) or oligomeric procyanidins (usually 18.75%). Doctors who work with herbal medicine often suggest 80–300 mg two to three times per day. Hawthorn berry products that are not standardized may be weaker, and the recommended amount is typically 4 to 6 grams per day for the whole herb, or 4–5 ml of the tincture three times per day.

Coleus contains forskolin, a substance that may help dilate blood vessels and improve the forcefulness with which the heart pumps blood.⁴¹ Recent clinical trials indicate that forskolin improves heart function in people with congestive heart failure and cardiomyopathy.⁴² ⁴³ A preliminary trial found that forskolin reduced blood pressure and improved heart function in people with cardiomyopathy. These trials have used intravenous infusions of isolated forskolin. It is unknown whether oral coleus extracts would have the same effect. While many doctors expert in herbal medicine would recommend 200–600 mg per day of a coleus extract containing 10% forskolin, these amounts are extrapolations and have yet to be confirmed by direct clinical research.

A small clinical trial found that supplementation with a bark extract of Arjun (Terminalia arjuna) improved heart function as well as lung congestion in patients with severe CHF.⁴⁴ Patients in the study took 500 mg of Arjun extract three times per day and began to exhibit significant improvement in heart function within two weeks; improvement continued over the course of approximately two years. The herb extract used in this study was concentrated but not standardized for any particular constituent. Commercial preparations are sometimes standardized to contain 1% arjunolic acid. Larger clinical trials are needed to confirm the results of this small study.

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

References
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12. Chang HY, Hu YW, Yue CSJ, et al. Effect of potassium-enriched salt on cardiovascular mortality and medical expenses of elderly men. Am J Clin Nutr 2006;83:1289–96.

13. Azuma J, Sawamura A, Awata N, et al. Double-blind randomized crossover trial of taurine in congestive heart failure. Curr Ther Res 1983;34(4):543–57.

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27. Rector TS, Bank A, Mullen KA, et al. Randomized, double-blind, placebo controlled study of supplemental oral L-arginine in patients with heart failure. Circulation 1996;93:2135–41.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires June 2009.