L-Carnitine and Congestive Heart Failure
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L-CARNITINE HELPS REDUCE DEATH FROM CONGESTIVE HEART FAILURE
September 1999, Vol. V No.9 - Author: Dr. Sinatra
While the number of heart attacks in the United States has dropped
in the last 20 years?largely due to positive lifestyle changes?deaths
from congestive heart failure (CHF)?an energy-starved heart?have more
than doubled during the same period.
Other commonly prescribed drugs are ACE inhibitors or beta-blockers,
which relax arteries and lower blood pressure, thereby reducing stress
on the heart and allowing it to pump more effectively. I've written
much about both in the past (see HeartSense, March 1999, p.6).
Unfortunately, these drugs are now given like aspirin for a headache.
Yes, the pain is gone, but do we know what caused the headache so
we can prevent another one from occurring?
What's missing from the equation? Nutrients. Chief among them is L-carnitine. I've just finished doing a massive amount of research on L-carnitine for a book that I'm writing. I've found many studies that show how L-carnitine improves the survival rate of CHF patients. This is great news! This nutrient, like coenzyme Q10, is often lacking in CHF patients. It not only reduces or eliminates symptoms, but also fuels the "energy" houses of the heart's cells (the mitochondria) so the heart can pump better. This is what I call a total frontal attack of the problem!
All of my CHF patients take L-carnitine in conjunction with conventional
therapies. It has helped me lessen heart failure and keep many patients
out of the hospital. In fact, it should come as no surprise, given
that I'm a cardiologist, that I encourage 80% of my patient population
to take L-carnitine. I'll never forget when I lost five patients in
one week to CHF. That was in the early part of the decade?before I
started using L-carnitine. Now that I employ it widely, I have much
more hope for a better quality of life for my CHF patients, as well
as an improved survival rate. Indeed, the high mortality rate for
CHF patients is a major problem. Often these patients have so much
scar tissue from multiple heart attacks that the amount of healthy,
functioning muscle is limited. And that frequently sets these patients
up for heart failure. There is absolutely no downside to L-carnitine,
which is even more effective when coupled with CoQ10 (see HeartSense,
March 1999, p.7).
More recently, in a double-blind, placebo-controlled study, 100 patients
with heart attack symptoms received 2 grams of L-carnitine a day for
28 days. Arrhythmia, angina, heart failure and muscle damage all improved.
There also was a significant reduction in cardiac death and non-fatal
heart attack in the L-carnitine group: 15.6% compared to 26% in the
placebo group. Although a larger study is needed to confirm this research,
the fact remains that L-carnitine improved arrhythmias, the rate of
recurring heart attack and even death from heart attack.
The incidence of CHF death was 6% in the L-carnitine group versus
9.6% in placebo group ?a reduction of more than one third. Again,
this data further confirms that L-carnitine prolongs life in these
vulnerable patients. Researchers also validated previous studies by
demonstrating an improvement in the heart's ejection fraction (EF)
rate (the proportion of blood that's pumped out of the heart on each
heartbeat. In CHF, the EF is often as low as 10?15%; a good rate is
over 50%), as well as a reduction in the size of the left ventricle.
The smaller the heart size, the better the survival rate.
In animal studies, researchers concluded that an L-carnitine deficiency causes biochemical changes that impair the function of the heart. In the case of the Syrian hamster, researchers gave the rodent L-carnitine in the early stages of cardiomyopathy and successfully prevented further damage to the animal's heart. In a study of very young children with cardiomyopathy, researchers found that the children responded favorably to prolonged administration of L-carnitine.
Given the research on L-carnitine, I wouldn't hesitate to give it to anyone?whether that person was having an acute heart attack or had a history of heart disease and/or CHF. L-carnitine is a must for anyone with any form of heart disease. It is also a great preventive as well as an anti-aging nutrient. I take L-carnitine myself and I plan to add it to my coenzyme Q10 Q-gel formula in the future (it's patented by Sigma-Tau.) Please stay tuned.
References: Davini P, Bigalli A, Lamanna F, Boem A. "A controlled
study on L-carnitine therapeutic efficacy in post-infarction,"
Drugs Exp Clin Res., 1992;18:355?365. Singh RB, Niaz MA, Agarwal P,
et al. "A randomized, double-blind, placebo-controlled trial
of L-carnitine in suspected acute myocardial infarction," Postgrad
Med J, 1996;72:45?50. Iliceto S, Scrutinio D, Bruzzi P, et al. "Effects
of L-carnitine administration on left ventricular remodeling after
acute anterior myocardial infarction: the L-carnitine ecocardiografia
digitalizzata infarto miocardioco (CEDIM) trial," JACC, 1995;26(2):380?7.
Kobayashi A, Yoshinori M, Yamazaki N. "L-carnitine treatment
for congestive heart failure: experimental and clinical study,"
Jpn Circ J, 1992;56:86?94. Bashore TM, Magorien DJ, Letterio J, et
al. "Histologic and biochemical correlates of left ventricular
chamber dynamics in man," J Mol Cell Cardiol, 1987;9:734.
Let me tell you about my patient Hugh, a 66-year-old once fond of
daily three-mile walks. He thought his recent wheezing, mild cough
and shortness of breath were simply a prelude to a pesky "cold."
His physician heard fluid in Hugh's chest and suspected it was more
serious. His tentative diagnosis: pneumonia. He sent Hugh home with
inhalers and a powerful antibiotic.
What's Going On During Congestive Heart Failure?
What Causes CHF?
First, I want you to understand that CHF is only a symptom of an underlying problem. In other words, the heart doesn't simply "fail" on its own, even though the underlying cause might not easily be figured out. Why is this important? Because the treatment that's right for you will take into account many factors unique to your situation?the stage of your disease, the nature and severity of your symptoms, your sensitivity to traditional cardiac drugs, your tolerance for side effects as well as other factors and circumstances that might be contributing to (and possibly be the primary cause of) your heart's weakened state. These might include high blood pressure, cigarette smoking, diabetes, alcoholism, damaged heart valves, previous heart attacks, deficiencies of vital nutrients, stress, anger....The list goes on.
How Is CHF Treated?
It is for these kind of patients that I usually prescribe a course of complementary natural therapies to improve their prognosis. In some cases, natural therapies, which have few or no side effects, can reduce the need for conventional medicines. In many cases, alternative therapies can augment traditional medicines (see sidebar at right) and provide the final measure of relief that was lacking with drug therapy alone. Many patients benefit greatly from blending conventional and alternative therapies?a strategy I recommend to you if you are dissatisfied with your current treatment plan for CHF.
What follows is a description of the alternative therapies I use in my practice, most often as an adjunct to conventional medicine, sometimes in place of it. Most of these therapies are readily available without a prescription at health food stores. I'll describe how to use them, how they work and the dosages that I prescribe for my patients. Expect to spend between $10-15 for a 30-day supply of each of these treatments.
The listing is in the order in which these therapies should be tried. You often need a four-to-six-week trial to determine whether they are doing any good. It is a good idea to tell your physician what you are up to. Remember, it's safe to use natural remedies with medication but not as an immediate substitute for a medication. Eventually, you may be able to cut back on your prescription drugs by as much as 50%.
Alternative Therapies For Treating Congestive Heart Failure
Coenzyme Q10 (CoQ10) is prescribed by many highly trained, board-certified cardiologists across this country as well as in Western Europe and Japan. Unfortunately, there are still too many cardiologists who not only fail to recommend it but actually scoff at the idea, perhaps because they've been trained to believe that anything natural can't be as potent and effective as a highly engineered drug. Nonetheless, my own experience with patients and the enormous body of science supporting CoQ10 have convinced me that CoQ10 is the greatest addition to the treatment of congestive heart failure in this century. Its primary role?the production of energy at the cellular level?fuels the heart's essential function: pumping blood. Since all cellular functions are dependent upon energy, CoQ10 is essential for the health and normal functioning of all human tissues and organs. Normally, the amount of CoQ10 within the heart muscle is 10 times greater than in any other organ, but in CHF the heart cells are CoQ10-deficient, and the heart literally is not strong enough to pump blood from its own chambers.
Clinical studies show that 87% of patients with congestive heart failure and hypertensive cardiovascular disease improved after taking CoQ10 for six months, and for some, the gentle, natural boost to their energy-starved hearts brought dramatic improvement. Take one CoQ10 softgel daily with meals (three per day). For CHF, start with 180 mg daily and increase to 360 mg over three weeks. Significant relief from symptoms may take a few weeks to months. If you are generally healthy and are interested in preventive health, take 30-60 mg daily. (For references, see the insert listing over 100 CoQ10 studies included with your April issue. If you don't have a copy, send a self-addressed, stamped envelope to Customer Service, HeartSense, Phillips Publishing, 7811 Montrose Rd., Potomac, MD 20854.) Side effects: none reported.
If your response to CoQ10 is insufficient, the next step is to add hawthorn berry (Crataegus spp.), a treatment I've used extensively, particularly in patients sensitive to digoxin. According to clinical research, hawthorn berry can increase the action of digoxin, making it possible to decrease the dose of digoxin, thereby avoiding or lessening digoxin-related side effects. In fact, some patients with mild CHF get significant relief with hawthorn berry alone, an effect supported by double-blind studies in Europe. It's interesting to note that hawthorn berries are recognized by the German government as an approved heart medicine.
How does hawthorn work? It is believed to improve the heart's ability to metabolize energy and utilize oxygen, and the berry's extracts contain flavonoids that increase the heart muscle's force of contraction. Hawthorn berries also normalize irregular heartbeats, help lower blood pressure and enhance circulation by dilating the arteries. Dose: 500-1500 mg daily or take as a tincture in water three times daily. For prevention, I recommend drinking hawthorn berry tea, which you can make by pouring boiling water over a cup of berries and letting them steep for 15 minutes. Side effects: none reported.
L-carnitine, an amino acid reportedly taken by marathon runners to enhance athletic performance, may increase energy available to the heart muscle cells by supporting free fatty acid metabolism. Dose: 500 mg twice daily. Side effects: none reported.
Also available at health food stores, L-arginine is an amino acid that improves blood flow to the heart by stimulating endothelial cell releasing factor (ECRF), thereby inhibiting a chain of complex reactions that might otherwise cause plaque to form in the arteries and stifle blood flow to the heart. Dose: 2-4 grams before bedtime. Side effects: none reported.
Taurine has been shown to stabilize the electrical activity within the heart and improve the heart's contractile strength. You'll find it at health food stores. Dose: 3 grams daily. Side effects: none reported.
In stubborn, severe cases of congestive heart failure, I turn to Levodopa (L-dopa). It's the natural counterpart of an intravenous drug called Dobutamine. When CHF approaches terminal stages, cardiologists sometimes opt to administer Dobutamine, although they must hospitalize the patient for half a day in order to closely monitor the individual for dose-related adverse reactions. Many patients experience an increase in heart muscle strength with this once-weekly treatment, improving the effectiveness of their heart's pumping action.
Like Dobutamine, Levodopa is converted to dopamine in the body and can have similar beneficial effects on the weakened heart, but it can be taken orally. Vitamin B-6 promotes the conversion of L-dopa to dopamine and should therefore be taken along with the L-dopa to maximize the beneficial heart effects. Dose: must be determined and carefully adjusted for each patient. Side effects: rhythmic muscular twitches, heart palpitations, lightheadedness, nausea, vomiting.
The whole point here is to give your heart, and your quality of life,
the best possible chance for improvement. For this to happen, it's
critical that you and your physician respect the uniqueness of your
body and of your particular heart condition?every patient is different.
For your best shot at good quality of life, you should have a cardiologist
who is willing to try complementary options.
Standard Medical Treatments: A Brief Overview
Digoxin. Used in this country for over six decades, digoxin is used
in CHF to increase the force of heart muscle contraction. By improving
the "pump's" performance, digoxin can help clear the body
of the excess fluid that accumulates in the lungs of CHF patients.
Side effects: nausea, vomiting, diarrhea, blurred vision, headaches,