Updated August 4, 2006
Nutrient Stew Nutrient Stew Nutrient Stew
What does Jon recommend?
I am not a doctor.
Taurine
An amino acid shown in trials to improve heart failure. I believe taurine is one of the big 3 supplements for us. I take 2000mg once a day after my weight training. I recommend 2000 to 4000mg daily for heart failure. If you take more than 2000mg, take it in 2 smaller doses twice a day (such as one 2000mg dose after breakfast and one 2000mg dose after dinner).
L-carnitine
An amino acid shown in trials to improve heart failure, this is another of the 3 best supplements for us. I take 333mg Carnitor three times a day after meals. This is a prescription form of L-carnitine. If you have drug benefits with your health insurance, ask your heart failure specialist to prescribe this. If not, buy L-carnitine over-the-counter. If using over-the-counter L-carnitine, I recommend 500 to 1000mg 3 times a day. L-carnitine also helps control body weight.
Creatine
This is another amino acid often low in heart failure patients. I take 6000mg creatine monohydrate once a day after my weight training. Take 4000mg a day if taking it just for heart failure. Take 4000 to 6000mg daily if also taking it for exercise recovery. If you are quite small or quite large, adjust the dose. Do not take "loading" doses. If you have kidney dysfunction, ask your doctor before taking creatine. However, trials have shown no stress on kidneys unless taking 7 times this much. I recommend drinking the powder form after mixing it with water in an electric blender.
L-arginine
Another amino acid, in trials, arginine improved exercise tolerance in heart failure patients. One trial showed that 5000mg three times a day improved kidney function in people with heart failure. It also helps control body weight. When you take L-arginine and exercise regularly, the benefits are even greater. I recommend taking 1000mg three times a day for heart failure. If you also exercise regularly, take 2000mg up to three times a day.

This Page - Nutrients

Links To Other Nutrient Pages

 

 Nutrients and Heart Failure

March, 2002 - Chronic disease can change the nutritional needs of organs like the heart. Several such deficiencies have been found in the failing heart, including low levels of:

Deficiencies of carnitine or taurine can actually cause heart failure. All these deficiencies can be fixed by taking supplements. Most trials only study using one of these nutrients. Perhaps correcting all these low levels at once is needed.
     In one trial, we studied hamsters with cardiomyopathy. They showed low levels of carnitine, taurine and CoQ10 in their hearts. In another hamster trial, we compared a placebo diet to a supplement with taurine, CoQ10, carnitine, thiamine, creatine, vitamin E, vitamin C, and selenium. After 3 months, the hamster hearts showed marked improvement.
     We also documented carnitine, taurine and CoQ10 deficiencies in biopsies taken from failing human hearts. The worse the heart function, the lower the levels. A double-blind, randomized, placebo-controlled trial of a supplement with the same nutrients, given for 30 days, raised the low levels in humans and a significant decrease in heart size was seen.
     These trials suggest that a broader supplement strategy to restore heart levels of important nutrients could benefit heart failure patients.
 
Title: Conditioned nutritional requirements: therapeutic relevance to heart failure.
Authors: Sole MJ (michael.sole@uhn.on.ca), Jeejeebhoy KN.
Source: Herz. 2002 Mar;27(2):174-8.
PMID: 12025462.

 Beta-carotene

February, 2000 - Beta-carotene is a pigment found in many green and yellow fruits and vegetables, and is a significant source of vitamin A. Unlike vitamin A, high doses of beta-carotene are not toxic.
Caution Most beta-carotene in supplements is synthetic, consisting of one molecule called all trans beta-carotene. Natural beta-carotene - found in food - is made of 2 molecules. Researchers saw no difference until trials indicated they may not have the same effect in the human body. In smokers and people exposed to asbestos, synthetic beta-carotene may have caused an increased risk of lung cancer. Until more is known, smokers should avoid all beta-carotene supplements.
Natural beta-carotene may have antioxidant activity that is different from the synthetic form. Some doctors now recommend that people supplement only with natural beta-carotene. In supplements, the natural form can be identified by the phrases "from D. salina," "from an algal source," "from a palm source" or as "natural beta-carotene" on the label.
Trials A study published in 1996 showed that beta-carotene supplements did not reduce heart disease in healthy volunteers. More information can be found on that in the next article. Extra beta-carotene may decrease sensitivity to light in some people. Evidence from lab studies suggests that beta-carotene is an antioxidant. A recently published study of more than 89,000 female nurses from 1980-1989 showed that women in the top 20% for vitamin A intake were significantly less likely to develop breast cancer than were women in the bottom 20%.
     Only 20 to 30% of beta-carotene is absorbed unchanged via the intestine. Fat is required for absorption. Yellowing of the skin usually develops after 4 to 6 weeks, when blood levels reach maximum. This may also mark the the start of protection against light. Protection decreases within 1 to 2 weeks after stopping supplements. Blood levels of 4 to 6 micrograms/ml are considered ok for most patients. Beta-carotene accumulates in the skin and fat. It is unknown if it passes into breast milk.
Deficiency People who don't eat many vegetables may develop vitamin A deficiency but since beta-carotene is not an essential nutrient, deficiencies do not occur!
Dose How much is usually taken? The most common dose is probably 25,000 IU (15 mg) per day. Six to 15 mg is considered a usual adult supplement dose. Whether an average person benefits in any way from beta-carotene supplements is unknown. If you take vitamin A supplements, you probably should not also take beta-carotene.
Side effects Beta-carotene does not cause any known adverse effects but high intake may turn your skin yellow-orange. The palms of your hands and soles of your feet will turn color first. People who take beta-carotene for a long time should also take vitamin E, since beta-carotene may reduce vitamin E levels.

  1.  Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. N Engl J Med 1996;334:1150
  2.  Lack of effect of long-term supplementation with beta carotene on the incidence of malignant neoplasms and cardiovascular disease. N Engl J Med 1996;334:1145-9
  3.  A prospective study of the intake of vitamins C, E, and A and the risk of breast cancer. N Engl J Med 1993;329:234-240

Source: GMS Integrated Medical Curriculum and various readings

 Does Beta-carotene Prevent Heart Disease?

December 30, 1999 - Taking beta-carotene pills for 2 years neither helps nor hurts in preventing heart disease or cancer in women, according to a report in the Journal of the National Cancer Institute.
     Beta carotene was first suggested as protecting against illness when studies found that people with who ate lots of fruits and vegetables containing the nutrient were at lower risk of cancer and heart disease. "People who eat lots of fruits and vegetables containing beta-carotene have lower risk of developing cancer. However, the few randomized trials of beta-carotene pills show no benefits; some even suggest harm," say the authors.
     Researchers analyzed data from the Women's Health Study to measure the effects of 50mg beta-carotene pills taken every other day in healthy women aged 45 and older. The study involved 19,939 women who took beta carotene pills and 19,937 women who took placebo.
     Beta-carotene did not prevent cancer at all. "When we examined site-specific cancers, there were no differences in risk between women taking beta-carotene and women taking placebo," they write. They also report, "there was no significant evidence of any effect on heart attack, stroke, death from heart causes, or death from any cause."
     Because previous studies suggest that beta-carotene pills may be harmful to smokers, the authors examined the subset of women who smoked (2,635 taking beta-carotene and 2,600 taking placebo). There were no differences in number of cancer cases or heart disease deaths.
     With the exception of skin yellowing, there were no differences in side effects between the 2 groups. "The report makes it clear that beta-carotene supplements have no value in preventing cancer," writes Dr. James Marshall in a related editorial.
 
Source: J Natl Cancer Inst 1999;91:2068-2069,2102-2106

 Taurine Vs CoQ10 For CHF

January, 1992 - We compared the effect of 3 grams per day of oral taurine to 30mg per day of oral CoQ10 in 17 CHF patients whose ejection fraction was less than 50%. Left ventricular function improved in the taurine treated group but not in the CoQ10 group.
 
Title: Usefulness of taurine in chronic congestive heart failure and its prospective application.
Authors:Azuma J, Sawamura A, Awata N
Source: Jpn Circ J 1992 Jan;56(1):95-99
PMID: 1538580, UI: 92167554
 
Jon's note: This was a very small CoQ10 dose compare to a normal to large taurine dose.

 Taurine Improves Heart Class

1983 - The effectiveness of taking 2 grams of oral taurine (2-aminoethane sulfonic acid) twice a day was studied in 24 CHF patients. We tested the severity of CHF based on clinical symptoms and MUGA. The worst CHF would have been a score of 23 points; The higher the score, the worse the CHF. How much the 24 patients improved after receiving taurine for 4-8 weeks was decided by the difference between their before-treatment and after-treatment scores.
     In 19 of the 24 patients, taurine was effective. In the group as a whole, CHF got better by an average of 3 points on our scale. Thirteen of the 15 patients who were class 3 or 4 before taking taurine, were class 2 after they completed the study. This small study should provoke further trials of CHF treatment with taurine.
 
Title: Therapy of congestive heart failure with orally administered taurine.
Authors: Azuma J, Hasegawa H, Sawamura A, Awata N, Ogura K, Harada H, Yamamura Y, Kishimoto S
Source: Clin Ther 1983;5(4):398-408
PMID: 6871923, UI: 83259125

 Interesting Taurine/CHF Note

I found this while browsing for something else entirely. This comes from a veterinary medical journal. I include it because dogs take the exact same meds we humans do for congestive heart failure! Please note that taurine is the least expensive supplement believed to really help CHF so it isn't a big financial burden to take pretty high doses. Here's the scoop:
     An association between low taurine level and DCM in cats has been known for many years. Recently, a prospective study was done of 11 Cocker Spaniel dogs with DCM. The findings suggest a direct relationship between DCM and low blood taurine level.
     All 11 dogs were in CHF due to DCM and had low blood taurine levels. After several months of taurine or taurine and l-carnitine supplements, most of the dogs had improved heart function and were weaned off all heart meds. While 9 of the 11 dogs have died since the study started in 1992, 8 of 9 died from non-cardiac causes and were not in heart failure at time of death.
     Taurine-related DCM may prove to be one of the rare instances that we as veterinarians can actually reverse primary heart disease and not just control symptoms. The growing impression is that dogs with DCM have improvements in heart function when supplemented with taurine and l-carnitine.
 
Title: Results of the multicenter spaniel trial (MUST): taurine and carnitine responsive dilated cardiomyopathy.
Authors: Kittleson MD, Keene B, Pion PD et al
Source: JVIM 11(4) 204, 1997)

 Heart Cell Nutrition Necessary For CHF Recovery

November, 2000 - Studies have shown many CHF patients to be deficient in some nutrients. Heart and skeletal muscle energy reserves are also low in these people. They don't expend a lot of energy during the day but high protein/calorie diets don't reverse their weight loss and malnourishment. This suggests that the wasting in CHF patients is metabolic.
     Specific deficiencies have been found in the failing heart: low levels of L-carnitine, CoQ10, creatine, and thiamine. These are nutrients important for energy production in the heart. Also, taurine is an amino acid important for controlling proper calcium levels. These deficiencies may reduce skeletal muscle function.
     Nutritional requirements changed by heart failure at the cell level should be considered part of skeletal and heart muscle dysfunction. A comprehensive program to restore heart cell nutrition seems essential to any strategy designed to benefit heart failure patients.
 
Title: Conditioned nutritional requirements and the pathogenesis and treatment of myocardial failure
Authors: Sole MJ, Jeejeebhoy KN
Source: Curr Opin Clin Nutr Metab Care 2000 Nov;3(6):417-24
PMID: 11085825

 Taurine's Effect On Angiotensin 2 May Benefit CHF

June 28, 2000 - The amino acid taurine is an important nutrient. Taurine is found in very high concentration in certain tissue. Lack of enough taurine in cells has been linked to eye damage, immune system weakness, reduced cell growth, and cardiomyopathies. One disease that responds well to taurine therapy is congestive heart failure. We see 3 possible reasons taurine benefits CHF:

  1. Taurine helps the body get rid of salt and water by its action in the kidney, its control of ANP, and its regulation of vasopressin release.
  2. Taurine has a mild inotropic effect by regulating sodium and calcium travel. This effect bypasses the major calcium transport defects seen in the failing human heart.
  3. Taurine mellows the actions of angiotensin II on calcium travel, protein production, and angiotensin II signaling. By doing so, taurine may reduce many of the harmful actions of angiotensin II, including heart enlargement, fluid retention (edema), and heart remodeling.

Since ACE inhibitors are the mainstay in CHF treatment, and since their action is to reduce angiotensin II and thus reduce its effects, taurine's actions may be very important in heart failure patients.
 
Title: Interaction between the actions of taurine and angiotensin II.
Authors: Schaffer SW, Lombardini JB, Azuma J.
Source: Amino Acids 2000;18(4):305-18
PMID: 10949914, ISSN: 1438-2199

 Taurine/Caffeine Drinks Have Big Effect

Jon's note: I do not endorse or recommend this product in any way, especially for those with heart failure. However, it points to a possible benefit to taurine supplement use.

September 13, 2001 - The effects of Red Bull Energy Drink, which includes taurine, glucuronolactone, and caffeine were studied in 3 studies in a total of 36 people. Measured areas included reaction time, concentration, memory, alertness and physical endurance.
     Compared to other (control) drinks, Red Bull Energy Drink significantly improved aerobic endurance (maintaining 65 to 75% maximum heart rate) as well as anaerobic endurance (continuously maintaining maximum speed) on cycle exercise machines.
     Mental performance also improved significantly, including choice reaction time, and concentration and memory. These consistent and wide ranging improvements in performance probably reflect the effects of the combination of ingredients in the drink.
 
Title:The effects of Red Bull Energy Drink on human performance and mood.
Authors:C. Alford, H. Cox, R. Wescott.
Source: Amino Acids 2001; 21(2): 139-150
ISSN: 1438-2199

 Carnitine In Kids With Cardiomyopathy

1997 - DCM is a rare disorder in childhood. We studied how carnitine blood levels related to prognosis in children with DCM. In 26 patients, carnitine blood level was measured before and after 6 and 12 months of L-carnitine treatment. At the study's start, the children were divided into 2 groups based on a ratio of short-chain acyl-carnitine to free carnitine, or AC/FC.
     Group one had an AC/FC ratio greater than 4. Average time from diagnosis to death was 36 months, and survival was 84% after 2 years. Group 2 had an AC/FC ratio less than 4. Average time from diagnosis to death was 8 months, with survival was 50% at 2 years. The only children to show significant improvement in heart function at 6 and 12 months after starting L-carnitine treatment were the surviving children in group 2.
     Carnitine blood level in children with DCM may help predict survival.
 
Title: Plasma carnitine status - a prognostic factor in children with dilated cardiomyopathy
Authors: M. Marx, M. Skyllouriotis, E. Legenstein, E. Proll, and M. Wimmer
Source: Amino Acids 1997; 12(2): 157-166
ISSN: 1438-2199

 PLC For CHF

November, 1992 - We tested the effects of PLC (propionyl-L-carnitine) on heart function in a randomized, double-blind study versus placebo. Fifty patients of both genders between age 48 and 69, were involved. They all had mild to moderate CHF. All patients were on digoxin and diuretics. Twenty-five patients took placebo and 25 took one gram PLC twice a day.
     After 90 days, in the PLC group, exercise time on treadmill increased 11% and after 180 days, it was up 16%. EF went up 7% after 30 days, 11% after 90 days and 12% after 180 days. Vascular resistances were reduced by 21% after 180 days. The patients taking placebo showed no significant improvement in any of these areas. No unexpected events or bad side effects were seen in any of the patients in either group.
     These results show that PLC (propionyl-L-carnitine) is a drug that should be tested extensively in CHF patients, in whom it may be usefully combined with the usual drug therapy.
 
Title: The clinical and hemodynamic effects of propionyl-L-carnitine in the treatment of congestive heart failure
Authors: Pucciarelli G, Mastursi M, Latte S, Sacra C, Setaro A, Lizzadro A, Nolfe G
Source: Clin Ter 1992 Nov;141(11):379-384
PMID: 1493661, UI: 93153974

 Six Month PLC Trial For CHF

September, 1992 - A double-blind phase 2 study of PLC (propionyl-L-carnitine) versus placebo was done with 60 class 2-3 CHF patients. These men and women were between 48 and 73 years old. They all had CHF symptoms despite being on digoxin and diuretics for at least 3 months. Thirty of these patients were chosen randomly and given 500mg oral PLC 3 times a day in addition to their usual treatment.
     At the study's start and after 30, 90 and 180 days, exercise time was tested on a bicycle and EF (ejection fraction) was tested by echo. After one month, the PLC patients performed much better than placebo patients on both tests, increases which became even more clear after 90 and 180 days. At 30 days, the exercise test times increased 16%, at 90 days, 23% and at 6 months, 26%. EF went up 8% at 30 days, 12% at 90 days and 14% at 6 months.
     On the basis of these results and having studied the specific ways in which PLC works, we conclude that it represents a drug of undoubted benefit for CHF patients. PLC could be effectively given along with standard drug therapy.
 
Title: Controlled study on the therapeutic efficacy of propionyl-L-carnitine in patients with congestive heart failure.
Authors: Mancini M, Rengo F, Lingetti M, Sorrentino GP, Nolfe G
Source: Arzneimittelforschung 1992 Sep;42(9):1101-1104
PMID: 1445476, UI: 93075368

 PLC For Left Ventricular Dysfunction

September, 1994 - We studied the effect of PLC (L-propionyl-carnitine) on patients with a left ventricular EF less than 45% in heart class 2, with symptoms despite drug therapy. This was a phase II parallel, double-blind, randomized, placebo-controlled study.
     Fifty patients (28 men and 22 women) aged 37-70 took 1.5 grams of L-propionylcarnitine or placebo on a random basis for 6 months. At baseline and at the 6-month bicycle exercise test, echo and clinical exam were done. There was an increase of 36 seconds in the placebo group versus a 1 minute and 40 second improvement in the PLC group. Left ventricular fractional shortening (another way to measure EF) and EF showed a significant increase in the PLC group whereas no difference was seen in the placebo group. Stroke volume and cardiac index improved in the PLC group. No similar improvements were seen in the placebo group. L-propionylcarnitine treatment was shown to improve patient symptoms and exercise tolerance.
 
title: Efficacy of L-propionylcarnitine treatment in patients with left ventricular dysfunction
Authors: Caponnetto S, Canale C, Masperone MA, Terracchini V, Valentini G, Brunelli C
Source: Heart J 1994 Sep;15(9):1267-73
PMID: 7982429, UI: 95073455

 L-Carnitine For CHF Muscle Weakness

September, 2002 - Skeletal muscle in CHF is responsible for tiredness and inability to do much exercise. This is partly from muscle cells weakening and dying, triggered by high levels of TNF-alpha, known to be high in CHFers.
     In a rat model of heart failure, we saw an increase in skeletal muscle cells suffering apoptosis. Blood showed higher levels of caspase-3, caspase-9 and TNF-alpha. Treating the rats with L-carnitine inhibited the caspases and reduced TNF-alpha levels. The number of muscle cells dying from apoptosis was also reduced.
     L-carnitine may help prevent apoptosis of skeletal muscles cells. It may have a role in treating CHF-related muscle weakness.
 
Title: L-Carnitine: a potential treatment for blocking apoptosis and preventing skeletal muscle myopathy in heart failure.
Authors: Vescovo G, Ravara B, Gobbo V, Sandri M, Angelini A, Della Barbera M, Dona M, Peluso G, Calvani M, Mosconi L, Dalla Libera L.
Source: Am J Physiol Cell Physiol. 2002 Sep;283(3):C802-10.
PMID: 12176737.

 L-Carnitine For CHF

April, 2003 - L-Carnitine helps protect the heart from lack of oxygen and from oxygen free radicals. Taking carnitine at 1.5 to 6 grams per day for up to one year results in fewer deaths and less heart failure episodes in heart attack patients. Compared to placebo, carnitine use slows heart enlargement over time.
     In shorter-term studies (one to 3 months), carnitine improved CHF symptoms and angina after a heart attack. It also seems to improve exercise tolerance and oxygen use in moderate to severe heart failure patients. Results of a 3-year study should be reported soon.
     Studies show that carnitine improves measures of heart function in dialysis patients. This is important because heart disease is the most common form of death in patients with end-stage kidney disease. Also, since a dialysis-related carnitine disorder is common in such patients, L-carnitine supplements should be considered in these patients.
 
Title: The role of carnitine in myocardial dysfunction.
Authors: Pauly DF, Pepine CJ.
Source: Am J Kidney Dis. 2003 Apr;41(4 Suppl 4):S35-43.
PMID: 12751052.

 Antioxidant May Help Diabetics

June 24, 1999 - A nutritional supplement available over-the-counter may help diabetics suffering nerve damage. Speaking at the annual conference of the American Diabetes Association (ADA), Lester Packer of the University of California said the supplement - called alpha-lipoic acid - can slow nerve damage in diabetics. "I recommend it to everyone. This is a treatment that can't do any damage," said Packer.
     Alpha-lipoic acid is an antioxidant that fights the injuries inflicted by free radicals, unstable molecules that are byproducts of cell activity. What is unique about alpha-lipoic acid is that it is both fat and water soluble, which enhances its ability to trap free radicals. "Protection from free radicals is one of the best lines of defense for people with diabetes," said Packer.
     A 1997 report in the journal Diabetes by German researchers found that diabetics taking 600mg of alpha-lipoic acid daily had a reduction in nerve-damage related pain and numbness. Other German researchers have shown that alpha-lipoic acid enhances the action of insulin in lowering blood glucose levels.
     Nerve damage is a serious complication of diabetes. It is believed to be the consequence of elevated blood sugar levels. Nerve damage can affect the heart, eyes, kidneys, sexual organs, legs and feet. Statistics from the ADA show that nerve damage is responsible for increasing diabetics' risk of leg amputations by up to 40 times greater than the general population. It is also the leading cause of new blindness among adults and is associated with kidney disease, which is experienced by 10-21% of diabetics.
     Alpha-lipoic acid is found in tiny quantities in foods like potatoes, spinach and red meat. To get the benefit of 30mg of alpha-lipoic acid one would need to consume 10 tons of beef liver. Packer recommends that healthy people take a daily supplement of 60mg. The recommended daily dose in Germany for diabetics suffering from nerve damage is 600mg.
 
Source: Reuters Health

 L-arginine and Exercise Important

March 1, 2000 - People with chronic heart failure can benefit from a combination of exercise and a dietary supplement known as L-arginine, say researchers. The combination seems to help correct the abnormal functioning of blood vessels seen in chronic CHF. People with CHF often have blood vessels that fail to dilate in response to certain drugs - a sign that the inner blood vessel wall (endothelium) is malfunctioning.
     Dr. Rainer Hambrecht assigned 40 heart failure patients to one of 4 treatment groups. The patients either continued their usual treatment, took L-arginine, did forearm exercises, or performed the exercises in addition to L-arginine treatment, according to the report in the Journal of the American College of Cardiology.
     Patients treated with L-arginine had a 4-fold increase in blood vessel dilation - from 2.2% to 8.8%. Regular forearm exercises increased the dilation response by the same amount. However, the combination of L-arginine and exercise training resulted in greater response, with an improvement from 2.9% to 12.0%.
     This is the first clinical trial to show that exercise and taking L-arginine improves blood vessel dilation more than either factor alone. This suggests that the combined treatment may improve blood vessel functioning in patients with chronic heart failure and perhaps increase their exercise capacity.
 
Source: Journal of the American College of Cardiology 2000;35:706-713

 L-Arginine Improves Kidney Function In Heart Failure

February, 2000 - We studied the effect of oral L-arginine (an amino acid) on kidney function, the body's sodium and water handling, and various hormone levels in patients with chronic heart failure. This was a double-blind crossover trial of 17 class 2 to class 3 CHFers. Average age was 56 years.
     Patients were randomly assigned to take oral L-arginine at 15 grams per day and then placebo for 5 days, or the other way around. Twenty-four hour creatinine clearance and other kidney testing was done. Kidney function, including creatinine clearance was better with arginine. Blood endothelin level was lower with arginine - a good thing.
     We conclude that oral L-arginine use benefits kidney function, reduces edema, and improves blood endothelin level in people with chronic heart failure.
 
Title: Effects of oral administration of L-arginine on renal function in patients with heart failure.
Authors: Watanabe G, Tomiyama H, Doba N.
Source: J Hypertens. 2000 Feb;18(2):229-34.
PMID: 10694193.

 L-Arginine Improves Exercise In Heart Failure

April, 2004 - In heart failure, endothelial dysfunction may prevent blood vessels from properly relaxing (dilating) during exercise. This reduces exercise capacity. Since nitric oxide dilates blood vessels and since L-arginine is necessary for nitric oxide to work, we studied whether giving L-arginine supplements would help heart failure patients exercise longer.
     This was a randomised, double-blind, cross-over trial. Twenty-one patients with stable class 2 to class 3 heart failure had 3 exercise tests during this trial. Patients took either 9 grams (9000mg) oral L-arginine every day for 7 days, or placebo. Blood was also tested for markers of oxidative stress. L-arginine patients had more improved exercise times (99 seconds improvement) than placebo patients (70 seconds improvement) after 7 days. Measures of free radical activity were unchanged.
 
Source: Kardiol Pol. 2004 Apr;60(4):348-53.
Title: L-arginine supplementation prolongs exercise capacity in congestive heart failure.
Authors: Bednarz B, Jaxa-Chamiec T, Gebalska J, Herbaczynska-Cedro K, Ceremuzynski L.
PMID: 15226784.

 Creatine Improves Heart Failure Short Term

September, 1996 - We studied the effect of IV creatine phosphate versus placebo in a double-blind, crossover trial of 13 hospitalized CHFers. Patients were 12 men and one woman. All were class 2 or class 3, average age 52 years, and all were on standard drug therapy. Meds were not changed during this trial.
     Patients took IV creatine or placebo for 4 days, then 2 days on no treatment, then 4 days on the one they had not yet taken. Each Infusion was 6000mg daily and took about 10 minutes. Echo was done at study start, after first infusion, and 12 hours after end of treatment.
     No changes were seen after placebo therapy. Creatine treatment reduced heart size (end-systolic diameter) from 4.5 to 4.3cm average. It also reduced systemic vascular resistance from 1065 to 951. Ejection fraction went up from 48 to 52%. IV creatine improved heart function short-term even in heart failure patients on standard therapy.
 
Title:Hemodynamic effects of creatine phosphate in patients with congestive heart failure: a double-blind comparison trial versus placebo.
Authors: Ferraro S, Codella C, Palumbo F, Desiderio A, Trimigliozzi P, Maddalena G, Chiariello M.
Source: Clin Cardiol. 1996 Sep;19(9):699-703.
PMID: 8874988.

 Turmeric is Anti-inflammatory & More

June 9, 2000 - In a study of "natural" preparations, only the spice turmeric showed an anti-inflammatory effect. Turmeric is a common ingredient in curries (curry powder). Its active ingredient is curcumin, which is thought to also be an antioxidant.
     In the study, Dr. Michael Whitehouse purchased a variety of herbal and Ayurvedic preparations from manufacturers, pharmacies and health-food stores in Australia, New Zealand, Britain and the USA. The preparations included celery (Apium graveolens), frankincense/olibanum (Boswellia serrata), ginger and turmeric (Curcuma longa).
     "All these products have been widely advocated as 'herbal' aspirins or anti-inflammatory agents, implying they are the natural equivalent of nonsteroidal anti-inflammatory drugs or analgesics, and are said to bring down fever" Whitehouse said. The researchers tested the herbal medicines in rats with oral doses.
     "None of these products had any fever-lowering effects against yeast-induced fevers, and none of the 11 ginger or 4 frankincense preparations had any effect on development of arthritis," Whitehouse said. Five of 23 celery-based preparations did cause a significant anti-arthritis activity, which was equivalent to a 50mg/kg body weight of ibuprofen. "The activity of celery seed appears to depend on careful processing at low temperatures," he said. Only tumeric showed anti-inflammatory effects when tested on irritated paws of the rats.
     "Until these products are tested in real clinical trials, we can only rely on this type animal testing to measure benefits and quality among competing products; and to tell what substances in each preparation are the 'active' ingredient, and what the side effects are," the researchers concluded.
 
Source: Reuters Health

 Extra Folic Acid May Be Bad Idea

March 30, 2003 - The FACIT trial suggests that folic acid supplements after getting stents increases risk for restenosis. The study included 626 patients who took either folate or placebo for 6 months plus standard therapy after stenting. Follow-up caths were done in 76% of patients.
     Six months of folate supplements narrowed the opening in arteries so that the average size in the folate group's arteries was 1.59mm compared to 1.74mm in the placebo group. Lead researcher Dr. Helmut Lange said the restenosis rate in the folate group was 35% compared to 27% in the placebo group.
     Dr. Lange said the study "was done to confirm that folic acid supplements reduced restenosis, so these findings were surprising." The results contradict results from the Swiss Heart Study, which reported that folate supplements reduced restenosis by 50%.
     FACIT patients took 1.2mg folate, 48mg vitamin B6, and 0.06mg vitamin B12. There is usually only 0.4mg folate in a multivitamin so maybe the high levels in the trial made the difference. Extra folate reduces homocysteine - a risk factor for heart disease.
     Dr. David Williams said that while Dr. Lange's study is interesting, "I wouldn't tell a patient to stop taking folic acid." Dr. Williams added that the patients in the study were low in folate, and that is not the case with Americans.
 
Source: ACC 52nd Annual Scientific Session: Session 31


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