Vitamins, Nutritional Supplements and Heart Disease...: Top 10 things you need to know!

By: David G. Hurrell, MD, FACC

The consumption of vitamins and nutritional supplements has become a part of the daily American routine. The Third National Health and Nutrition Examination Survey taught us that 36 to 51 percent of adults take supplements. In fact, approximately 48 percent of children ages 3 to 5 consume them. The manufacture and sale of vitamins and nutritional supplements has become a $4 billion industry with more than 300 manufacturers selling at least 4000 products. Likewise, nutritional supplements, which are modified foods or food ingredients that may provide a health benefit, have invaded our grocery stores and include everything from ground flax seed to calcium-enriched orange juice. If we truly believe that we "are what you eat", better foods means a healthier you. With all of the choices that surround you and the wide variety of advertised health claims found on supplement and food labels, a little advice on the use of these products to promote a healthier heart may just be what you need. The following are 10 useful tips worth remembering.

1. Supplements aren't substitutes.
Proponents of the increased use of vitamin and nutritional supplements point to research that has supported their arguments. Opponents claim many of these products are untested, poorly substantiated in the literature, and not manufactured according to any standards. For now, let the debate rage on while you make choices about supplementation wisely. Recognize that vitamin and nutritional supplements are just that: supplements and not substitutes for well-researched, FDA-approved medications. Never substitute an established therapy or medication for a vitamin or nutritional supplement, which may have little proof of effectiveness. Also, nutritional supplements are no substitute for a well-balanced diet including fresh fruits and vegetables. On the other hand, don't be afraid to talk to your doctor about vitamins and nutritional supplements that may actually improve your wellness and complement the care you receive from your physician.

2. Vitamin E may still play a role in coronary heart disease.
Vitamin E is one of the more commonly consumed anti-oxidant supplements. It has been promoted as a way to prevent the formation of plaque within the heart arteries and to reduce the incidence of heart attacks. Several studies have supported these claims including the US Nurses Health Study of 121,000 female nurses between 30 and 44 years old. In this study, participants taking 100 IU of vitamin E daily had a 34 percent lower incidence of coronary heart disease after just two years compared to those participants who did not take vitamin E. Unfortunately, recent large scale trials have muddied the waters. One such study is the Heart Outcomes Prevention Evaluation study (HOPE) that examined 9,541 patients with heart disease or diabetes mellitus who received 400 IU of natural vitamin E for an average of 4 1/2 years. In this study there was no reduction in heart attack, stroke or death for the patients who took vitamin E compared to those who took a placebo. Critics will argue that this study evaluated patients who either had advanced disease or who were at high risk for coronary heart disease. Perhaps these patients already had significant plaque. If so, this study may not refute the potential role of vitamin E in preventing the formation of plaque before it is apparent. Therefore, a role for vitamin E may still remain. In addition, current research is being used to examine a combination therapy of vitamin E with other anti-oxidants. So far the results appear encouraging. For now, 400 units of vitamin E daily is the most commonly suggested dosage and may still be of benefit to the person who is at risk, but does not yet have evidence of plaque within their heart's arteries.

3. Put more fish in your diet.
Fish contain polyunsaturated fatty acids, particularly the omega-3 form, which is important in building healthy muscle cell membranes, and brain, nerve and eye tissue. A diet that does not include fish can actually contribute to obesity, adult onset diabetes, hypertension and coronary heart disease. Diets low in omega-3 fatty acids may actually lead to a reduced HDL cholesterol and high triglycerides. In those who consume fish oils on a regular basis, research has demonstrated a decrease in triglycerides up to 43 percent, and a rise in HDL cholesterol, "the good cholesterol," up to 18 percent. In addition, a recent study examining the health benefits of increased fish intake found a 44 percent reduction in heart attacks and heart related chest pain in the individuals who consumed the largest quantity of fish. In this study, there was a significant rise in their HDL cholesterol as well. Current dietary recommendations are to consume three ounces of fish 3 to 4 times per week. Fish highest in omega-3 fatty acids include mackerel, herring, sardines, salmon and trout. While these cold-water fish may be high in fat as well, they are packed with omega-3 fatty acids. If you don't like eating fish, you may consider supplemental gel caps containing omega-3 fatty acids. Dean Ornish, MD, who is well known for his heart healthy diet, suggests taking one gram of fish oils per day. Most supplements also contain high amounts of vitamin A and D as well.

4. Soy protein is good for the heart.
Foods rich in soy protein are becoming increasingly recognized as heart healthy in the role of cholesterol reduction, which decreases the risk of coronary heart disease. The FDA has now approved the following health claim for soy protein: "Diets low in saturated fat and cholesterol that include 25 grams of soy protein may reduce the risk of heart disease." Most grocery stores now carry a wide variety of soy products. One of the easier ways to provide soy protein in your diet is by adding 25 grams of soy powder to a glass of dairy skim milk or soymilk. Make them a part of your heart healthy diet.

5. Increase your fiber intake.
Dietary fiber is classified by how easily it dissolves in water. There are two kinds of fiber: insoluble (not easily dissolved) and soluble (easily dissolved.) Foods high in insoluble fiber such as bran cereals, popcorn, brown rice, whole grain breads, vegetables (especially beets, carrots, kale, okra, peas, spinach) and fruits (especially apples, pears, berries), move quickly through your intestines. While insoluble fiber has many desirable qualities, it has little impact on your cholesterol levels. Foods high in soluble fiber, on the other hand, such as fruits (especially apricots, mangoes, oranges, peaches, plums and rhubarb), dried beans and peas, oat products, psyllium and vegetables (especially broccoli, cabbage, white potatoes) act as a cement within the intestine, binding cholesterol and carbohydrates and preventing their absorption. Most fibrous foods contain both insoluble and soluble fiber. The American Heart Association recommends that your diet include 25-30 grams of fiber Ð from within the foods that you eat Ð per day. Unfortunately, the average American intake is 15 grams per day. Fiber, in the form of oatmeal, was the first food approved by the FDA to have a specific health claim: "Soluble fiber from oatmeal, as part of a low saturated fat, low cholesterol diet, may reduce the risk of heart disease." Regular ingestion of oat foods leads to a two-19 percent decline in total cholesterol in individuals with elevated cholesterol. For example, a daily 1/3 cup serving of oatmeal leads to a three percent reduction in your blood cholesterol. Increasing your fiber intake is a natural way to promote lower cholesterol and a healthier diet.

6. Garlic may not have what it takes.
Garlic is one of the most commonly ingested herbal supplements with a wide range of reported health benefits. Its role in cardiovascular disease has mainly focused on reducing cholesterol levels, but it has also been suggested that garlic may play a role in lowering blood pressure and preventing plaque build-up in our body's arteries. Although numerous studies have supported the benefits of garlic in reducing cholesterol levels, others have suggested no effect. Two meta-analyses reported that garlic can lower total cholesterol by 12 percent and 9 percent respectively. However, these results have been refuted in several more recent trials, which found garlic to be no better than a placebo. Perhaps as additional, larger studies assessing the potential role of garlic in lowering cholesterol are completed, its role will be better understood in cardiovascular disease.

7. Folic Acid, vitamin B6 and B12 may be right for you.
Homocysteine is an amino acid that is abnormally elevated in 30 percent of the population. An elevated homocysteine level has been clearly linked to the formation of plaque within the heart arteries. Therefore, it is worth noting that low folic acid levels have been associated with elevated homocysteine levels and an increased risk of heart attack. In affected individuals, folic acid, taken along with vitamins B6 and B12, can reduce homocysteine levels. Taking additional folic acid may be a good thing, particularly in those individuals who have been identified as having an elevated homocysteine level. Consider having your homocysteine level tested. If your homocysteine level is elevated, supplementation may be appropriate for you. The recommended dosage of folic acid is 800 mcg taken with a multivitamin, which commonly supplies an additional 400 mcg, for a daily total of 1200 mcg. The recommended supplementation of vitamin B12 is 1000 mcg, or 1 mg daily, and for vitamin B6,100 mg. For effective treatment of elevated homocysteine, all three supplements are required.

8. Should I have a little wine with dinner?
Researchers have known for many years that the French appear to have less heart disease than Americans. The reason for this occurrence is believed to be a rise in HDL, or the "good cholesterol", that seems to occur in those who consume red wine on a regular basis. While recent studies have demonstrated this to be directly correlated with the amount consumed, excessive alcohol intake can have many negative effects on the heart as well as other organs. Therefore, consume any alcoholic beverage in moderation. No more than two 4-ounce glasses a day is a good rule. Dietary guidelines actually suggest no more than one drink a day for women, and no safe level has been established for pregnant women. Also, keep in mind that a 4-ounce glass of wine contains approximately 80 calories and thus even modest daily use can lead to gradual weight gain.

9. Coenzyme Q-10 may aid in lowering your blood pressure.
Coenzyme Q-10, also known as CoQ10, may play a role in controlling hypertension. CoQ10 may decrease the body's chemical response to hypertension, specifically a rise in diastolic blood pressure, which is recorded when the heart is relaxed. Several studies have identified a potential benefit for coenzyme Q-10 in the treatment of high blood pressure. The largest study, which focused on 109 patients, found that people who received coenzyme Q-10 had a substantially reduced need for medications. In fact, 51 percent of patients taking coenzyme Q-10 were able to stop taking between one and three medications, contributing to a substantial cost savings. Patients also exhibited a marked improvement in their quality of life, with fewer symptoms. Potentially this improvement is related to an improvement in cardiac performance, or perhaps it is due to fewer side effects from medication. As a result, traditional drug therapy for high blood pressure may be supplemented with coenzyme Q-10 in an effort to limit the number and dosage of medications required, but it should never be used on its own for this purpose, nor substituted for proven therapies. Coenzyme Q-10 is available in pill form from several manufacturers and under a wide array of brand names. Clinical research in this area has suggested that 225 mg per day is the appropriate dosage. However, due to several different formulations, 200-300 mg per day is also acceptable. There is no data to suggest that there is a benefit to healthy people without elevated blood pressure taking a supplement.

10. Spread-on the Take Control and Benecol.
Both commercially-sold Take Control and Benecol are spreadable products, which are utilized in the diet similar to butter or margarine. They can be purchased in the grocery store cooler next to the diary products. Both contain canola oil, plant stanol esters and soybean oil as well as other ingredients which, in combination, actually lower total cholesterol and LDL cholesterol with no effect on HDL cholesterol. It is recommended that you consume three servings per day of Benecol, each of which contain 45 calories and 5 grams of fat. A "light" version is also available which contains 3 grams of fat. It is recommended that you consume two servings per day of Take Control which each contain 50 calories, and 6 grams of fat. Of course, neither product contains cholesterol.

Vitamins and nutritional supplements are clearly gaining greater acceptance in main stream health care. The information provided in this article shows that some vitamins and nutritional supplements are backed by more research that supports their use in controlling specific heart-related conditions. As the desire to learn more about holistic health care continues, further research and education will follow. Become a "savvy" health care consumer and consult your physician as to the role vitamins and supplements might play in your individual heart healthy plan!

Get started on the road to better health by considering the following:

1. Eat a well-balanced diet with plenty of fresh fruits and vegetables
2. Include 3-5 servings of fish in your diet weekly
3. Add more bran and fiber to your diet. Ground flax seed is a healthy choice
4. Get out and exercise at least 30 minutes a day, five days a week
5. Take time to relax and get plenty of sleep, at least 8 hours a day is best
6. Take a daily multivitamin including anti-oxidants
7. Try adding soy protein to your meal planning
8. Don't smoke
9. Drink alcohol in moderation

For more information on this topic or other cardiology related topics including Primary Cardiology Prevention services, please call one of our three Twin City metropolitan locations:

Minneapolis office located at Abbott Northwestern Hospital: 612-863-3900, or toll-free 800-582-5175

Plymouth office located at WestHealth: 763-577-7615

Edina office located at Abbott Northwestern's Center for Outpatient Care: 952-914-8300