Dietary Supplements for the Heart.
Dietary Supplements for the Heart.
Three supplements could round out your heart-healthy diet.
Don't Miss This
When I tell patients that they need to take one or more medications to improve their cholesterol profile, many of them ask me whether a natural, over-the-counter dietary supplement would do the job just as well. The answer is "No." As I mentioned earlier, because the supplement industry is not regulated by the FDA, most supplements have never undergone the rigorous scientific testing that is required for approval of a pharmaceutical product. Moreover, the research that has been performed on specific supplements — notably, antioxidants — has been very disappointing.
Are you doing everything you can to manage your heart condition?
A handful of supplements have withstood extensive scientific review, however, and I actually do use them in my practice.
Omega-3 Fatty Acid Supplements (Fish Oils)
At the present time, few supplements have been established as being safe and effective additions to cardiology care. One that has and that stands out as a valuable addition to a healthy lifestyle is omega-3 fatty acids, also known as fish oil. The active ingredients in omega-3s are docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), and both are listed on the label. A total of between 1,000 and 2,000 milligrams of fish oil a day is recommended. If you eat a lot of cold-water fatty fish, such as salmon, herring, and sardines, however, a supplement may not be necessary.
Omega-3s are a safe and effective way to lower significantly elevated triglycerides, but they must be taken at a much higher dose than that suggested above. A prescription omega-3 was introduced under the name Omacor. Because it has a high level of quality assurance, I now prescribe it for my patients with high triglycerides.
In 2002, the American Heart Association recommended DHA and EPA for patients who have coronary artery disease as long as they obtain their doctor's approval. According to a Scientific Statement published by the American Heart Association in its journal Circulation, members of the association's Nutrition Committee concluded that "omega-3 fatty acids have been shown in epidemiological and clinical trials to reduce the incidence of cardiovascular disease." The statement also noted that a daily intake of 0.5 to 1.8 grams of EPA plus DHA through supplements or eating fatty fish significantly reduced mortality among people who had already had a heart attack. How does fish oil help prevent heart disease? It does so by lowering triglycerides and reducing inflammation. It also reduces the risk of abnormal heart rhythms, including those that can cause sudden death. Moreover, fish oil does its good work without significantly affecting either LDL or HDL.
In addition to being heart-protective, omega-3s have also been found to be helpful to most of our other organs, including the brain, lungs, bowels, and skin. Omega-3s may also help prevent Alzheimer's disease. This is a supplement I take myself and that I strongly recommend. Does it matter which brand of fish oil you take? According to a July 2003 survey conducted by Consumer Reports, all of the top 16 brands of fish oil have the same high quality and purity and contain the amounts of EPA and DHA described on the label. For this reason, the organization recommends that you shop by price. In their survey, fish oil supplements offered at buying clubs such as Costco and Sam's Club were the best bargains.
Fish oil does occasionally have one minor side effect — "fishy burps" and a fishy taste in the mouth that some patients do not like. In recent years, however, enteric-coated capsules and tablets that minimize these effects have appeared on the market. The coating delays absorption until the supplements reach the small intestine. (Refrigerating your fish oil capsules will also help prevent that fishy taste.) As a cautionary note, fish oil can increase bleeding time, so anyone taking blood thinners or who has plans for elective surgery should tell their doctor that they are taking a fish oil supplement.
Another reason to consider a fish oil supplement is concern over the presence of mercury and other pollutants in fish. While we all need to be careful, pregnant and nursing women need to be especially vigilant. There's also the likelihood that farm-fed fish may not have the same omega-3 levels as wild fish. If you take a good fish oil supplement, you don't have to worry about mercury or getting lower than expected levels of omega-3s.
Plant Sterols and Stanols (Phytosterols)
Other natural substances with proven efficacy are stanol esters and sterol esters. These plant extracts (known collectively as phytosterols) have been shown to help lower LDL cholesterol. They are sold as dietary supplements in softgel form in health-food stores and are added to foods such as margarine, snack bars, and salad dressings. Plant sterol esters and plant stanol esters are structurally similar to cholesterol, and because of this, they block cholesterol absorption in your small intestine. In this way, the esters act like the medications we described on the previous pages that decrease cholesterol absorption and thereby lower cholesterol levels in your blood. They are very safe and have no apparent side effects.
In fact, plant sterols and stanols were included among the Therapeutic Lifestyle Changes recommended by the National Cholesterol Education Program panel of experts in 2002. And a 2005 study published in the American Journal of Cardiologyalso found them valuable. It concluded that "recommended intakes of about 2 to 2.5 grams a day of products enriched with plant stanol/sterol esters lower plasma LDL cholesterol levels by 10 to 14 percent without any reported side effects. Thus, plant stanols/sterols can be considered to be effective and safe cholesterol-lowering functional food ingredients."
If you have slightly elevated LDL, taking sterol/stanol supplements and eating products fortified with plant sterol/stanol esters as part of an otherwise healthy diet could be enough to bring your LDL down to optimal levels. If you are already taking medications to lower your LDL cholesterol, sterols and stanols may bring it down even further.
Fiber Supplements
As I noted earlier, Western societies — and especially we Americans — consume only a fraction of the amount of fiber that is considered ideal. This is unfortunate because fiber from food or supplements can help to lower your cholesterol. It also helps to slow digestion, which can prevent surges in blood sugar. For this reason, fiber can be very important for those with prediabetes or diabetes who need to control their blood sugar. It is also essential for good bowel function. If you are on the go or are concerned that you are not regularly getting enough fiber from your diet, fiber supplements such as psyllium, methylcellulose, and polycarbophil are safe and effective. Just be sure to take them with plenty of water.
Bottom line: Medicines and supplements are not magic bullets. And while they are invaluable components of my prevention strategy, they are not — and shouldn't be — substitutes for a healthy lifestyle. I can't say this too many times: The earlier you adopt a healthy way of life, the less likely you are to need medications to prevent a heart attack or stroke. more
Three supplements could round out your heart-healthy diet.
Don't Miss This
When I tell patients that they need to take one or more medications to improve their cholesterol profile, many of them ask me whether a natural, over-the-counter dietary supplement would do the job just as well. The answer is "No." As I mentioned earlier, because the supplement industry is not regulated by the FDA, most supplements have never undergone the rigorous scientific testing that is required for approval of a pharmaceutical product. Moreover, the research that has been performed on specific supplements — notably, antioxidants — has been very disappointing.
Are you doing everything you can to manage your heart condition?
A handful of supplements have withstood extensive scientific review, however, and I actually do use them in my practice.
Omega-3 Fatty Acid Supplements (Fish Oils)
At the present time, few supplements have been established as being safe and effective additions to cardiology care. One that has and that stands out as a valuable addition to a healthy lifestyle is omega-3 fatty acids, also known as fish oil. The active ingredients in omega-3s are docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), and both are listed on the label. A total of between 1,000 and 2,000 milligrams of fish oil a day is recommended. If you eat a lot of cold-water fatty fish, such as salmon, herring, and sardines, however, a supplement may not be necessary.
Omega-3s are a safe and effective way to lower significantly elevated triglycerides, but they must be taken at a much higher dose than that suggested above. A prescription omega-3 was introduced under the name Omacor. Because it has a high level of quality assurance, I now prescribe it for my patients with high triglycerides.
In 2002, the American Heart Association recommended DHA and EPA for patients who have coronary artery disease as long as they obtain their doctor's approval. According to a Scientific Statement published by the American Heart Association in its journal Circulation, members of the association's Nutrition Committee concluded that "omega-3 fatty acids have been shown in epidemiological and clinical trials to reduce the incidence of cardiovascular disease." The statement also noted that a daily intake of 0.5 to 1.8 grams of EPA plus DHA through supplements or eating fatty fish significantly reduced mortality among people who had already had a heart attack. How does fish oil help prevent heart disease? It does so by lowering triglycerides and reducing inflammation. It also reduces the risk of abnormal heart rhythms, including those that can cause sudden death. Moreover, fish oil does its good work without significantly affecting either LDL or HDL.
In addition to being heart-protective, omega-3s have also been found to be helpful to most of our other organs, including the brain, lungs, bowels, and skin. Omega-3s may also help prevent Alzheimer's disease. This is a supplement I take myself and that I strongly recommend. Does it matter which brand of fish oil you take? According to a July 2003 survey conducted by Consumer Reports, all of the top 16 brands of fish oil have the same high quality and purity and contain the amounts of EPA and DHA described on the label. For this reason, the organization recommends that you shop by price. In their survey, fish oil supplements offered at buying clubs such as Costco and Sam's Club were the best bargains.
Fish oil does occasionally have one minor side effect — "fishy burps" and a fishy taste in the mouth that some patients do not like. In recent years, however, enteric-coated capsules and tablets that minimize these effects have appeared on the market. The coating delays absorption until the supplements reach the small intestine. (Refrigerating your fish oil capsules will also help prevent that fishy taste.) As a cautionary note, fish oil can increase bleeding time, so anyone taking blood thinners or who has plans for elective surgery should tell their doctor that they are taking a fish oil supplement.
Another reason to consider a fish oil supplement is concern over the presence of mercury and other pollutants in fish. While we all need to be careful, pregnant and nursing women need to be especially vigilant. There's also the likelihood that farm-fed fish may not have the same omega-3 levels as wild fish. If you take a good fish oil supplement, you don't have to worry about mercury or getting lower than expected levels of omega-3s.
Plant Sterols and Stanols (Phytosterols)
Other natural substances with proven efficacy are stanol esters and sterol esters. These plant extracts (known collectively as phytosterols) have been shown to help lower LDL cholesterol. They are sold as dietary supplements in softgel form in health-food stores and are added to foods such as margarine, snack bars, and salad dressings. Plant sterol esters and plant stanol esters are structurally similar to cholesterol, and because of this, they block cholesterol absorption in your small intestine. In this way, the esters act like the medications we described on the previous pages that decrease cholesterol absorption and thereby lower cholesterol levels in your blood. They are very safe and have no apparent side effects.
In fact, plant sterols and stanols were included among the Therapeutic Lifestyle Changes recommended by the National Cholesterol Education Program panel of experts in 2002. And a 2005 study published in the American Journal of Cardiologyalso found them valuable. It concluded that "recommended intakes of about 2 to 2.5 grams a day of products enriched with plant stanol/sterol esters lower plasma LDL cholesterol levels by 10 to 14 percent without any reported side effects. Thus, plant stanols/sterols can be considered to be effective and safe cholesterol-lowering functional food ingredients."
If you have slightly elevated LDL, taking sterol/stanol supplements and eating products fortified with plant sterol/stanol esters as part of an otherwise healthy diet could be enough to bring your LDL down to optimal levels. If you are already taking medications to lower your LDL cholesterol, sterols and stanols may bring it down even further.
Fiber Supplements
As I noted earlier, Western societies — and especially we Americans — consume only a fraction of the amount of fiber that is considered ideal. This is unfortunate because fiber from food or supplements can help to lower your cholesterol. It also helps to slow digestion, which can prevent surges in blood sugar. For this reason, fiber can be very important for those with prediabetes or diabetes who need to control their blood sugar. It is also essential for good bowel function. If you are on the go or are concerned that you are not regularly getting enough fiber from your diet, fiber supplements such as psyllium, methylcellulose, and polycarbophil are safe and effective. Just be sure to take them with plenty of water.
Bottom line: Medicines and supplements are not magic bullets. And while they are invaluable components of my prevention strategy, they are not — and shouldn't be — substitutes for a healthy lifestyle. I can't say this too many times: The earlier you adopt a healthy way of life, the less likely you are to need medications to prevent a heart attack or stroke. more
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