Congestive heart failure alternative
Natural treatment with vitamins supplements herbs
January 2 2018
by Ray Sahelian, M.D.

Congestive heart failure is a chronic condition in which the heart fails to pump blood efficiently to the body's organs. It can be caused by a number of things including clogged arteries, heart attack and high blood pressure. 

Supplements that may be helpful in congestive heart failure
There are quite a number of herbs and supplements that could have a beneficial effect on heart disease. I have listed some below. You may click on each one for more information but ultimately the use of supplements has to be done with the full knowledge and approval of your health care provider. Reduce calories from sodas. Also check out the link above for heart disease.

Fish 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.
   Fish and omega-3 fatty acids and heart failure. A high intake of fish and marine omega-3 fatty acids seems to provide protection against the development of heart failure as well as reducing the mortality of manifest heart failure. Tidsskr Nor Laegeforen. 2012.
Vitamin C
   Plasma vitamin C, but not vitamin E, is associated with reduced risk of heart failure in older men. Circ Heart Fail. 2013.
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. Carnitine has been tested in cardiomyopathy.
Carnosine has been studied.
   Nutrition. 2015. Effects of oral administration of orodispersible levo-carnosine on quality of life and exercise performance in patients with chronic heart failure. This study suggests that L-carnosine, added to conventional therapy, has beneficial effects on exercise performance and quality of life in stable CHF.
CoQ10 may be beneficial in heart failure, but use less than 50 mg.
Garlic consumption improves blood flow and circulation.
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.
Taurine amino acid has been evaluated with some preliminary positive findings.

Astragalus has been studied in heart failure.
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.

Natural Treatment for Heart Failure research
Cutting calories slows 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. 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.

Exercise training boosts the longevity of patients with heart failure.

Arginine and Heart Failure
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 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. To investigate the effect of oral supplementation with L-arginine on exercise capacity and markers of oxidative stress in patients with mild to moderate heart failure. The study had a randomised double-blind cross-over design. Twenty one patients with stable NYHA II-III heart failure underwent three exercise tests: initially, after oral administration of L-arginine (9 g/day for 7 days) or placebo. Blood was sampled prior to each test for plasma lipid peroxides, reduced sulphydryl groups and leukocyte oxygen free radical production. We found a higher prolongation of exercise duration time after L-arginine than after placebo. There were no significant differences in markers of free radical 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.

Fish oils as good or better than Crestor stating medication
Daily supplements of fish oil reduced deaths and hospitalizations of people with heart failure. But a cholesterol-lowering statin drug had no beneficial effect. 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, 2008.

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.
   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 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.

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. All patients were given conventional therapy for congestive heart failure, consisting of angiotensin-converting enzyme inhibitors, digoxin, diuretics, and nitrates. Patients in the treatment group were also given berberine 1.2 to 2 g/day. The remaining patients were given placebo. Symptoms, a 6-minute walk test, left ventricular (LV) ejection fraction (EF), frequency and complexity of VPCs, and quality of life were assessed after 8 weeks of treatment and during a mean 24-month follow-up. 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 a yoga program
Yoga in heart failure patients: a pilot study.
J Card Fail. 2010.
 Fifteen stable HF patients were recruited and completed 8 weeks of yoga classes. Data collected were: safety (cardiac and orthopedic adverse events); physical function (strength, balance, endurance, flexibility); and psychological function (quality of life [QOL], depression scores, mindfulness) before and after 8 weeks of yoga classes. No participant had any adverse events. 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.

Causes of heart failure
Coronary artery disease, previous heart attack, hypertension, cardiomyopathy, valvular heart disease, arrhythmia, drugs and certain medications, alcohol, aortic stenosis, mitral or aortic regurgitation, pulmonary hypertension. Use of a class of painkillers known as nonsteroidal anti-inflammatory drugs (NSAIDs) by patients with chronic heart failure is associated with increased risk of death and cardiovascular illness.
   The risk of developing heart failure increases with a person's weight: rising slightly in those who are only slightly overweight, and eventually doubling in those who are obese. The use of sleeping pills increases the risk of serious heart problems and death.

For elderly people, just a couple of alcoholic drinks a day can have adverse effects on heart function.

Expert Opin Drug Saf. 2014. Risk of heart failure following treatment with dopamine agonists in Parkinson's disease patients. Dopamine agonists (DAs) are frequently used to treat early or advanced Parkinson's disease (PD) patients. They have been shown to be efficacious for the treatment of motor symptoms and for delaying levodopa-induced dyskinesias. However, their utilization is limited by the risk of adverse drug reactions, some of which affect the cardiovascular system. Recently, the US FDA identified a possible association between exposure to pramipexole and the risk of heart failure. There is risk following use of pramipexole or cabergoline. Although the effects of cabergoline may be explained by the induction of cardiac valve fibrosis, the basis for the significantly increased risk associated with pramipexole is unclear.

Those who compete in triathlons could be putting their hearts at risk. Excessive exercise can cause scarring of the heart, known as myocardial fibrosis which could eventually lead to heart failure and irregular heartbeats.

Medications that increase risk for heart failure
Nonsteroidal anti-inflammatory drugs like ibuprofen or naproxen can cause sodium and water retention and antagonize the effects of heart failure medications. Additionally, OTC medications like pseudoephedrine, which many cough and cold products contain, can increase blood pressure and afterload. The risks these drugs pose becomes even greater when they are taken at higher doses.
   The oral hypoglycemic agent metformin should be used in patients with unstable heart failure or those hospitalized for this condition. Other prescription drugs listed as potentially having a major impact on causing or worsening heart failure include the antihypertensive drugs diltiazem, verapamil, and moxonidine, the tumor necrosis factor–inhibitors that are widely used to treat rheumatologic and gastroenterologic diseases, the antipsychotic clozapine, and a long list of anticancer medications, including several anthracyclines and many types of newer biologic agents.

Use of prescription-strength ibuprofen, naproxen and other commonly used pain relievers may be tied to a higher risk of heart failure.

For patients with existing heart failure, use of NSAIDs should either be avoided or withdrawn when possible.

Prescription drugs listed as potentially having a major impact on causing or worsening heart failure include the antihypertensive drugs diltiazem, verapamil, and moxonidine, the tumor necrosis factor–inhibitors that are widely used to treat rheumatologic and gastroenterologic diseases, the antipsychotic clozapine, and a long list of anticancer medications, including several anthracyclines and many types of newer biologic agents.

Symptom and sign
The clinical syndrome of heart failure manifests when cellular respiration becomes impaired because the heart cannot pump enough blood to support the metabolic demands of the body, or when normal cellular respiration can only be maintained with an elevated left ventricular filling pressure. Congestive heart failure symptoms include shortness of breath, weakness, fatigue and and fluid accumulation in the legs and feet. Other common symptoms of congestive heart failure are weight gain, swelling of feet and ankles, swelling of the abdomen, and in more advanced cases pronounced neck veins. Some individuals with congestive heart failure also report symptoms of loss of appetite, indigestion, nausea, fatigue and weakness. A common congestive heart failure symptom is difficulty sleeping since fluid accumulates in the lungs while lying down. Other symptoms of congestive heart failure are irregular or rapid pulse, cough, and decreased urine production. Cognitive decline is common.

Is vomiting a symptom of congestive heart failure?
   It can be, although nausea is more common. Vomiting would indicate a more serious condition.

The medical treatment of Congestive Heart Failure often includes
Salt restriction
Aspirin is a more cost-effective way to treat patients at risk of having a second heart attack or stroke than the new drug Plavix (clopidogrel), but may lead to more hospitalizations. Perhaps a lesser dose should be tried. 
Diuretics are often helpful
Angiotension-converting enzyme (ACE) inhibitors
Angiotensin II receptor blockers
Beta blockers
Natrecor (nesiritide) -- 2005 -- A panel of heart experts has recommended limited use of Johnson & Johnson's heart drug Natrecor (nesiritide) and backed the company's plan to conduct additional clinical trials. J&J had requested the panel to meet to evaluate all data on the heart failure drug after reports surfaced that it increased the rate of kidney failure and death.

A mechanical device that restores a failing heart's ability to pump blood contributes to a decline in memory and thinking in some patients. Left ventricular assist devices are surgically implanted in patients with advanced heart failure who are awaiting a heart transplant or unable to receive one. More than one in four patients who receive such a device experienced a notable decline in their ability to remember, plan and solve problems, and about one-third of patients with the devices experienced death, diminished quality of life or poor health after receiving the implan. The losses in brain function stem from major, minor and mini-strokes that occur due to blood clots caused by the devices; 2015, Circulation: Cardiovascular Quality and Outcomes.

Heart failure with diabetes
People with advanced heart failure and who also have diabetes that requires insulin treatment have about a fourfold greater mortality rate than heart failure patients who don't take insulin. Previous studies have shown that diabetes itself is associated with a moderate increase in mortality risk in heart failure patients. It is not clear whether the insulin itself leading to this dramatic increase in mortality risk.

Q. I have a condition known as cardiomyopathy and my doctor has me on prescribed medicines such as pradaxa, lanoxin, vestar, lipitor, lasix, and aldactone. Which supplements do you recommend.
   A. Your doctor knows your condition best and I am not able to provide specific advice.