Cardiomyopathy
Heart-Protecting Nutrients
Cardiomyopathy is a special form of heart disease. It's a breakdown of the muscle tissue in the heart. This muscle tissue, known as the myocardium, becomes inflamed, then scarred and fibrous. As a result, the walls of the heart may become thick and hard or thin and weak. The heart sometimes enlarges and beats faster, trying to play catch-up because it isn't pumping blood efficiently.
People with cardiomyopathy may become breathless when they're active and sometimes even when they're doing nothing at all. They may tire easily, develop ankle swelling and have chest pains.
Compared with coronary heart disease, which is the most common form of heart disease, cardiomyopathy is rare. But it's one of the main reasons people become candidates for heart transplants. That's because traditionally, there hasn't been a whole lot available for cardiomyopathy. Most doctors use drugs to provide some relief by reducing demands on the heart.
"These drugs are indispensable and have been shown to be remarkably effective in some people," explains Robert DiBianco, M.D., associate clinical professor of medicine at Georgetown University School of Medicine in Washington, D.C.
Unlike coronary heart disease, cardiomyopathy isn't always caused by fat-clogged arteries, although it can be, Dr. DiBianco says. It may be caused by a virus or another type of infection, such as Lyme disease or AIDS; an inherited metabolic disorder; exposure to toxic chemicals such as cobalt, lead or carbon monoxide; sensitivity to commonly used drugs; toxins such as alcohol or cocaine; or heart damage caused by a disease such as diabetes.
Poor nutrition also seems to play a role in the development of some forms of cardiomyopathy or in worsening its symptoms.
Several of the "classic" deficiency diseases--pellagra (niacin deficiency), beriberi (thiamin deficiency) and kwashiorkor (protein deficiency)--can cause cardiomyopathy. So can imbalances of calcium and magnesium, which play important roles in proper heart function.
And shortages of other nutrients, particularly selenium and vitamin E, make the heart more vulnerable to damage.
Here's what research shows can help this potentially life-threatening problem.
| Food Factors Other than eating a well-balanced diet that's high in whole grains, fruits and vegetables, there's just one more thing you need to be concerned about if you have cardiomyopathy. Here's what experts recommend. Don't get pickled. Alcohol abuse can cause cardiomyopathy by depleting the body of nutrients and having a direct toxic effect on the heart, says Robert DiBianco, M.D., associate clinical professor of medicine at Georgetown University School of Medicine in Washington, D.C. Limit yourself to no more than two drinks a day. And don't "save up" your drinks for the weekend. Binge drinking is particularly hard on hearts, not to mention friends and family. |
| Coenzyme Q10: Good for Your Heart? Many cardiologists would consider it unproven, harmless at best--that is, if they've even heard of coenzyme Q10. "Today in medicine, most doctors don't know anything about it yet," says Karl Folkers, D.Sc., Ph.D., professor and director of the Institute for Biomedical Research at the University of Texas at Austin. (The American Heart Association says it has "no official statement" about coenzyme Q10.) But a growing number of nutrition-oriented doctors say that supplements of this little-known nutrient (it isn't exactly a vitamin) are absolutely essential for people with heart failure. They say it has allowed their patients to live longer, more active lives, has saved some people who would otherwise have died waiting for donor hearts and has even allowed some to take their names off the transplant list. "In some people, the improvement is clear, often dramatic," says coenzyme Q10 researcher Peter Langsjoen, M.D., a cardiologist in private practice in Tyler, Texas, with a special interest in nutrition. Some studies, mostly from Japan, have looked at coenzyme Q10's role in cardiovascular disease, says Dr. Folkers. They include two double-blind, placebo-controlled studies, which are considered the most reliable. The studies showed that coenzyme Q10 has clinical benefits for 70 percent of the patients having congestive heart failure, says Dr. Folkers. Coenzyme Q10 is normally concentrated in the heart muscle, and levels drop when the heart begins to fail. "Bear in mind, however, that some studies done in the United States found no benefits with coenzyme Q10 and were never published," says Robert DiBianco, M.D., associate clinical professor of medicine at Georgetown University School of Medicine in Washington, D.C. "Unless such studies are done and published, American doctors will remain rightly skeptical." Coenzyme Q10 is an essential ingredient in the body's production of energy. Dr. Folkers says it has "bioenergetic activity," meaning that it participates in biochemical reactions that provide energy. In cardiomyopathy and other kinds of heart failure, supplements of coenzyme Q10 are thought to help the remaining muscle cells do their jobs more efficiently, Dr. Langsjoen says. Coenzyme Q10 is manufactured by the body and stored in your organs: liver, kidneys and, you guessed it, heart. Dr. Folkers believes that people with low levels of coenzyme Q10 aren't getting enough of the vitamins necessary to convert the amino acid tyrosine to coenzyme Q10. These vitamins include niacin, vitamin B6, vitamin B12, vitamin C and folate. There are also coenzyme Q10 supplements, available in drugstores and health food stores. Dr. Langsjoen typically prescribes 120 to 360 milligrams of coenzyme Q10 a day, taken in doses of no more than 180 milligrams at a time. (This means that if you are taking more than 180 milligrams a day, you need to divide the dose). This fat-soluble nutrient needs to be taken with a bit of fat or oil (although some supplements are in an oil base, similar to vitamin E capsules). Dr. Langsjoen has his patients chew the tablets along with a spoonful of peanut butter. Dosage is determined by measuring blood levels of coenzyme Q10. (Your doctor can order this test by sending your blood to a lab for analysis.) "Generally, people who have heart failure begin to see an improvement in symptoms in about four weeks, although some people may take as long as three months," Dr. Folkers says. Maximum improvement occurs after six months, which is longer than ordinary drugs take to exhibit an effect, he says. If you're interested in taking coenzyme Q10, find a doctor who's familiar with its use or ask your own doctor to study up, Dr. Langsjoen suggests. Those using this nutrient in research or practice report no toxicity. |
Selenium Shields Hearts
Until 1979, researchers didn't know for sure that the mineral selenium is essential for human nutrition. That year, evidence came from Chinese scientists who reported an association between low selenium intake and a condition called Keshan disease, a form of cardiomyopathy that affects primarily children and women of childbearing age.
People in certain parts of China were getting little selenium in their diets because the soil in their region contains almost none. Since plants don't require selenium, they can grow in selenium-poor soil. But they offer no selenium to the people and animals who eat them, so there is simply no good food source, plant or animal, in the region. In fact, some animals suffered from the same heart condition, and it was Chinese veterinarians who first made the connection between human cardiomyopathy and selenium.
"Chinese doctors soon found that selenium supplements could prevent this potentially fatal problem," says Orville Levander, Ph.D., a research leader at the U.S. Department of Agriculture Beltsville Human Nutrition Research Center in Maryland.
Selenium deficiency alone doesn't seem to cause cardiomyopathy, however, Dr. Levander says. "Researchers now think this condition develops only in selenium-deficient people who have been exposed to certain viruses that zero in on the heart muscle."
Dr. Levander and his colleague, Melinda Beck, Ph.D., professor at the University of North Carolina at Chapel Hill, found that a particular kind of virus called Coxsackie remained its mild-mannered self in laboratory animals that were getting enough selenium. But in selenium-deficient lab animals, it caused extensive heart damage.
"Selenium seems to help protect the heart muscle from viral damage," Dr. Levander says. "We don't know exactly how, but it seems to be related to its antioxidant properties." Viral invasions cause the generation of free radicals, unstable molecules that steal electrons from healthy molecules in your body's cells to balance themselves, thus damaging the cells. Antioxidants disarm free radicals by offering up their own electrons, saving cells from harm.
Most researchers in the United States don't think Americans are deficient enough in this mineral to develop cardiomyopathy, Dr. Levander says. Chinese researchers found it takes only a small amount, about 20 micrograms a day, to prevent cardiomyopathy. Most Americans get well above that amount, averaging 108 micrograms a day.
But some research shows that so-called adequate amounts of selenium may not be high enough to provide optimum antioxidant or immunity-stimulating protection. That's why some doctors recommend selenium supplements of 50 to 200 micrograms a day.
If you're concerned about deficiency, ask your doctor to check your blood level of selenium, Dr. Levander says. If your blood level is low, you may need to take supplements. Supplements of more than 100 micrograms a day should be taken only under medical supervision, however, since selenium can be toxic in large amounts. Stop taking selenium if you develop a persistent garlic odor on your breath and skin, loss of hair, fragile or black fingernails, a metallic taste in your mouth, or dizziness or nausea with no apparent cause. These symptoms mean that you're getting too much.
Generally, fruits and vegetables don't contain much selenium. On the other hand, seafood and, to a lesser extent, meats are rich in easily absorbed selenium. Grains and seeds, garlic and mushrooms also offer some selenium, depending on where they are grown.
| Prescriptions for Healing Even if you decide to try certain nutrients for your heart condition, don't toss away your heart drugs! Doctors who use nutritional therapy for cardiomyopathy say drugs are still necessary for some people. Here are the nutrients they recommend. Nutrient Daily Amount
Magnesium 400 milligrams Selenium 50-200 micrograms Vitamin E 400 international units
MEDICAL ALERT: If you have cardiomyopathy, you should be under a doctor's care. If you have a kidney problem or heart disease, it's important to take magnesium supplements only under medical supervision. Selenium supplements of more than 100 micrograms a day should be taken only under medical supervision. In large amounts, selenium is toxic. If you are taking anticoagulant drugs, you should not take vitamin E supplements. |
Vitamin E Adds Antioxidant Protection
If you're concerned about giving your heart all of the protection you can, you'll want to add vitamin E to your arsenal.
"In animal studies, cardiomyopathy problems are more likely to be worse in the animals with simultaneous deficiencies of selenium and vitamin E. These deficiencies can be prevented or cured by supplementation with either nutrient alone," Dr. Levander says. (In animals, vitamin E can also protect the heart against cardiomyopathy caused by magnesium deficiency.)
Like selenium, vitamin E has antiviral and antioxidant properties, so it may help protect the heart against infection and toxins. It may also help prevent the development of atherosclerosis, or clogged arteries, which could make a failing heart even weaker, says Peter Langsjoen, M.D., a cardiologist in private practice in Tyler, Texas, with a special interest in nutrition. He recommends 400 international units daily. That high amount is available only from supplements.
Magnesium May Aid Weakened Hearts
In animals, the evidence is clear. When put on a low-magnesium diet, young animals develop heart muscle damage that leads to heart failure.
"In humans, the picture isn't so clear," says William Weglicki, M.D., professor of medicine and physiology at George Washington University Medical Center in Washington, D.C. "For people, there's no good proof that magnesium deficiency causes cardiomyopathy."
Magnesium is so intimately involved in heart function, however, that getting enough may help a compromised heart work better for a number of reasons, says Carla Sueta, M.D., Ph.D., assistant professor of medicine and cardi- ology at the University of North Carolina at Chapel Hill School of Medicine.
"Magnesium affects heart muscle contraction, and magnesium deficiency can cause abnormal heart rhythms and/or irregular beats," Dr. Sueta says. "Adequate amounts can help prevent constriction of isolated blood vessels, which can affect the blood supply to the heart muscle."
Apparently, magnesium also offers protection during a heart attack. "Magnesium-deficient animals have greater tissue damage after heart attacks than animals getting enough magnesium," Dr. Weglicki says.
If you are a heart patient concerned about magnesium, have your doctor monitor levels in your red blood cells, Dr. Sueta suggests. "If your levels are low, you know for sure you're low in magnesium. And if your levels are borderline, you still are probably low in magnesium," she says. You can have normal levels of magnesium, however, and still be low enough to have magnesium deficiency-related heart problems, she adds.
If you have kidney problems or heart disease, it's important to take magnesium supplements only under medical supervision.
If you're simply concerned about heart health, experts suggest that you make sure to get the Daily Value of 400 milligrams. Nuts, beans and whole grains are your best food sources, and green vegetables also provide a fair amount. Studies show that most people fall short of the Daily Value.
