Introduction
When the heart sustains injury that weakens its pumping ability, a complicated physiological state called congestive heart failure (CHF) can develop. Fluid builds up in the lungs and lower extremities, the heart enlarges, and many symptoms develop, including severe fatigue, difficulty breathing while lying down, and altered brain function. Medical treatment for this condition is quite effective and sophisticated, consisting of several drugs used in combination.
Principal Proposed Natural Treatments
CHF is too serious a condition for self-treatment. The supervision of a qualified health-care professional is essential. However, given medical supervision, some of the following treatments may be quite useful.
The herb hawthorn appears to be effective for mild CHF and also may
be helpful for more severe CHF. However, while standard drugs have been shown to
help reduce hospitalizations and mortality associated with CHF, there is no
similar evidence for hawthorn. Also, adding the supplement coenzyme
Q10
to standard treatment may improve results.
Finally, the supplement vitamin B1
(thiamin) may be
helpful for persons who take loop diuretics (such as furosemide) for
CHF.
Hawthorn. Several double-blind, placebo-controlled trials, involving about 750 participants, have found hawthorn helpful for the treatment of mild to moderate CHF. In one of the best of these studies, 209 people with relatively advanced CHF (technically, New York Heart Association class III) were given either 900 milligrams (mg) or 1,800 mg of standardized hawthorn extract or matching placebo. The results after sixteen weeks of therapy showed significant improvements in the hawthorn groups compared with the placebo groups. Benefits in the high-dose hawthorn group included a reduction in subjective symptoms and an increase in exercise capacity. Subjective symptoms improved to about the same extent in the lower-dose hawthorn group, but there was no improvement in exercise capacity.
In an analysis that mathematically combined the results of ten controlled trials involving 855 persons, hawthorn extract was found to be significantly better than placebo for improving exercise tolerance, decreasing shortness of breath and fatigue, and enhancing the physiologic function of an ailing heart in mild to moderate CHF. In another study, however, researchers found that persons with mild to moderate CHF taking a special extract of hawthorn, 900 mg daily, were more likely to experience an initial worsening of their condition compared to those taking placebo. By the end of six months, however, there was no difference in the two groups. In light of numerous other studies supporting the safety and effectiveness of hawthorn in CHF, the results of this special extract study need to be repeated before drawing any firm conclusions.
A comparative study suggests that hawthorn extract (900 mg) is about as effective as a low dose of the conventional drug captopril. However, while captopril and other standard drugs in the same family have been shown to help reduce hospitalizations and mortality associated with CHF, there is no similar evidence for hawthorn.
Like other treatments used for CHF, hawthorn improves the heart’s pumping ability. However, it may offer some important advantages over certain conventional drugs used for this condition.
Digoxin, and other medications that increase the power of
the heart, also make the heart more susceptible to dangerous irregularities of
rhythm. In contrast, preliminary evidence indicates that hawthorn may have the
unusual property of both strengthening the heart and stabilizing it against
arrhythmias. It is thought to do so by lengthening what is
called the refractory period. This term refers to the short period following a
heartbeat during which the heart cannot beat again. Many irregularities of heart
rhythm begin with an early beat. Digoxin shortens the refractory period, making
such a premature beat more likely, while hawthorn seems to protect against such
potentially dangerous breaks in the heart’s even rhythm.
Another advantage of hawthorn involves toxicity. With digoxin, the difference between the proper dosage and the toxic dosage is dangerously small. Hawthorn has an enormous range of safe dosing.
However, digoxin is itself an outdated drug. There are many newer drugs for CHF (such as angiotensin I-converting enzyme inhibitors) that are much more effective than digoxin. Many of these have been proven to prolong life in people with severe CHF. There is no reliable evidence that hawthorn offers the same benefit (although one large study found hints that it might). Also, it is not clear whether one can safely combine hawthorn with other drugs that affect the heart.
Coenzyme Q
10. People with CHF have significantly lower levels of coenzyme Q10 (CoQ10) in heart muscle cells than healthy people. This fact alone does not prove that CoQ10 supplements will help CHF; however, it prompted medical researchers to try using this supplement as a treatment for heart failure.
In the largest study, 641 people with moderate to severe CHF were monitored for one year. One-half were given 2 mg per kilogram of body weight of CoQ10 daily; the rest were given placebo. Standard therapy was continued in both groups. The participants treated with CoQ10 experienced a significant reduction in the severity of their symptoms. No such improvement was seen in the placebo group. The people who took CoQ10 also had significantly fewer hospitalizations for heart failure. Similarly positive results were also seen in other double-blind studies involving a total of more than 270 participants. However, two later and very well-designed double-blind studies enrolling about eighty-five persons with CHF failed to find any evidence of benefit. The reason for this discrepancy is not clear.
Vitamin B
1
. Evidence suggests that the strong diuretics (technically, “loop diuretics,” such as furosemide) commonly used to treat CHF may interfere with the body’s metabolism of vitamin B1 (thiamin). Because the heart depends on vitamin B1 for proper function, this finding suggests that taking a supplement may be advisable; preliminary evidence suggests that thiamin supplementation may indeed improve heart function in persons with CHF.
Other Proposed Natural Treatments
A large Italian trial involving almost seven thousand persons found that
fish
oil may modestly reduce the risk of death or admission to the
hospital for cardiovascular reasons in persons with CHF. Several studies
(primarily by one research group) suggest that the amino acid taurine may be
useful in CHF and could be more effective than CoQ10.
Another treatment for CHF that has some evidence is the supplement L-carnitine,
especially when given in the special form called propionyl-L-carnitine. Carnitine
is frequently combined with CoQ10. Three small double-blind studies
enrolling about seventy persons with CHF found that the supplement
arginine significantly improved symptoms of CHF and improved
objective measurements of heart function.
Evidence suggests that the sports supplement creatine may
offer some help for the sensation of fatigue that often accompanies CHF. One small
double-blind study found preliminary evidence that the supplement ribose may
improve CHF symptoms.
Combination therapy with several of the supplements mentioned here may also be helpful. A double-blind trial of forty-one persons found that the use of a supplement containing taurine, CoQ10, creatine, and carnitine, along with other nutrients, improved objective measures of heart function. Also, a study performed in China reported that berberine (a constituent of various herbs, including goldenseal and Oregon grape) can decrease mortality and increase quality of life in CHF.
There is some evidence that supplementing with magnesium may
be helpful for persons taking both digoxin and diuretics; diuretics can deplete
the body of magnesium, and this, in turn, may increase the risk of digoxin side
effects. One study found that the use of magnesium (as magnesium orotate) may
improve exercise capacity and reduce heart arrhythmias in people with CHF who have
just undergone bypass graft surgery. Additionally, in a well-designed trial
involving seventy-nine persons with severe CHF, magnesium orotate significantly
improved survival and clinical symptoms after one year compared with placebo.
Weak evidence suggests that relaxation therapy (specifically
Transcendental Meditation), Tai Chi, and yoga may improve functional capacity and
quality of life in people with CHF. Also, vitamin E has been proposed as a
treatment for CHF, but a small double-blind study did not find it effective.
Herbs and Supplements to Use Only with Caution
One study found hints that supplementation with vitamin C at a dose of 4 grams daily might worsen muscle function in people with CHF. Various other herbs and supplements may interact adversely with drugs used to treat CHF.
Bibliography
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Jayadevappa, R., et al. “Effectiveness of Transcendental Meditation on Functional Capacity and Quality of Life of African Americans with Congestive Heart Failure.” Ethnicity and Disease 17 (2007): 72-77.
Keith, M. E., et al. “A Controlled Clinical Trial of Vitamin E Supplementation in Patients with Congestive Heart Failure.” American Journal of Clinical Nutrition 73 (2001): 219-224.
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