Heart health: Natural alternatives

Cardiovascular disease has long been, and continues to be, the number one killer in the United States. Fortunately, lifestyle interventions including exercise, behavior modification and dietary treatments remain powerful weapons in the fight against this devastating disease. There has been great interest and some promising research on the cardiovascular health benefits of dietary supplements.


Arguably the most beneficial of dietary supplements on heart health is policosanol, a substance made of several long-chain alcohols isolated from the wax of sugar cane. Several recent studies have shown that policosanol (10-20 mg/day) works as well as statins in improving cardiovascular risk factors, with fewer side effects. The results include reducing total cholesterol (16% to 21%), LDL-cholesterol and triglycerides, increasing good HDL-cholesterol, inhibiting platelet aggregation and suppressing inflammatory factors.1-3

Three important points that make this supplement attractive are: (i) it favorably affects both standard and emerging risk factors for cardiovascular disease, (ii) it does not require a prescription, and (iii) it is cheaper than going on a statin to lower cholesterol.

Coenzyme Q10 (CoQ10)

CoQ10 functions in the mitochondria, the 'powerhouses' of the cell to assist in making energy (ATP) from carbohydrates and fats. CoQ10 primarily acts as an antioxidant in the heart and is involved in the synthesis of energy (ATP), but also has other important functions inside the mitochondria, such as stabilizing membranes.4 Because of CoQ10's role in oxidative stress, energy production, and stabilization, it is 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 patients undergoing therapy with a variety of cholesterol-lowering drugs including statins.

Research spanning over 30 years with CoQ10 show potential for use in prevention and treatment of cardiovascular disease in these patients.5 Preventative doses usually range from 30 to 60 mg/day whereas therapeutic doses are usually greater than 100 mg/day. CoQ10 may be appropriate to recommend as an adjunct to conventional treatment or as a preventative treatment.


Arginine is currently being promoted for heart health because it may enhance blood vessel health. Arginine is needed to synthesize a very potent substance that causes dilation of blood vessels called nitric oxide, which is produced in the endothelial cells that line blood vessels.

One approach to assessing the effects of arginine is to use high frequency ultrasound to measure the amount of dilation in response to some stimulus, like occluding the arm with a blood pressure cuff. More dilation means a healthy vessel and less dilation means a less healthy vessel or possible some hardening of the arteries. When you eat a fat-rich meal it has been shown that the ability of a vessel in your arm to dilate is impaired. However, if you supplement with arginine prior to a high-fat meal, the impairment in dilation is not as great, suggesting a positive effect on nitric oxide production.6 The dose of arginine in this study was 6g/day (2g consumed three times per day) for 10 days.

Another study showed the same positive effect on blood vessel functioning with a supplement mixture of arginine, CoQ10, carnitine, vitamins E and C, dried berry juices and extracts and other herbal extracts.7


Lycopene is found in many fruits and vegetables, but tomatoes and tomato products are the main sources of lycopene in the diet. Lycopene has been shown to have strong antioxidant properties. Studies indicate that people with high levels of lycopene in their blood have reduced risk of cardiovascular disease.

A recent study showed that men with the lowest levels of lycopene had more than a 3-fold greater risk of having an acute coronary event or stroke. The study also showed that low plasma levels of lycopene were associated with increased thickness of plaque in the arterial wall.8

Red Rice Yeast

Red rice yeast, or cholestin, has also shown promise as a dietary supplement to reduce several different risk factors for cardiovascular disease. Red rice yeast has been shown to decrease total cholesterol, LDL-cholesterol, and triglycerides.9 A recent study showed that red rice yeast (1,200 mg/day) reduced the triglyceride response to a fat-rich meal (45% to 50%),10 which has been shown to be an independent risk factor for coronary artery disease.


Similar to CoQ10, carnitine levels are depleted in patients with various heart conditions and supplementation may be beneficial. The most promising research with carnitine supplementation is in conditions of reduced oxygen, like ischemia.11 Carnitine may work by helping to reduce the toxic effects of long-chain fatty acids, increasing blood flow in the heart, or inhibiting production of free radicals.


Given the prevalence of heart disease, and the likelihood of the incidence increasing in conjunction with the epidemic of obesity, more rigorous clinical work and research is necessary to further validate the safety and efficacy of these and other dietary supplements to promote heart health. To date, the research looks promising for those dietary supplements listed above and there is little to no risk of adverse effects.


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