By Sayer Ji | Guest Writer
Congestive heart failure is a disease with a misleading name; it doesn’t mean that your heart has “failed” or stopped beating. Rather, heart failure is a chronic condition that occurs when the heart muscle fails to pump an adequate supply of blood to the body, causing an increasing amount of damage as organs and tissues are deprived of oxygen and nutrients carried by the blood.
Heart failure doesn’t come on overnight; it develops gradually and is often the result of underlying health conditions that weaken the heart, like heart disease, obesity and high blood pressure. The good news is a diagnosis of congestive heart failure may be preventable by making heart-healthy choices like losing weight, exercising regularly and incorporating more organic produce and healthy fats into your diet.
If you’ve already been diagnosed, it’s important to consult your health care provider and a cardiac specialist. As part of an approved treatment regimen, diet and lifestyle modifications may help strengthen your heart and improve its function. To aid in that effort, we’ve researched the top medical journals and scientific databases to compile a shortlist of herbs and supplements that have been verified by science as effective for supporting patients with heart failure.
The efficacy of coenzyme Q10, or CoQ10, is a matter of controversy among scientists. A 2017 meta-analysis of clinical trials sought to gain clarity on the question by pooling the results of previous studies evaluating the effect of using CoQ10 to treat patients with heart failure.
Researchers combed PubMed and other top medical databases for controlled trials of CoQ10, with 14 trials and 2,149 heart failure patients meeting inclusion criteria. Endpoints for the trials were death, left heart ejection fraction (a measure of the left ventricle’s ability to pump blood), exercise capacity and a standardized measure of overall heart function after treatment.
Final analysis showed that patients with heart failure who supplemented with CoQ10 had a lower death rate and a higher exercise capacity than placebo-treated patients.[i] Other studies support CoQ10’s ability to help patients with heart failure decrease serious complications and avoid hospitalization, significant findings that were attributed to CoQ10’s ability to support mitochondrial function and provide energy to cells.[ii]
Ubiquinol (pronounced you-bik-win-all) is a recently developed form of CoQ10 that has only been commercially available for around 12 years. Considered the active form of CoQ10, ubiquinol is an antioxidant that plays a key role in creating cellular energy.[iii] CoQ10 comes in two forms: ubiquinone and ubiquinol, both of which are made naturally by the body. The body must convert ubiquinone into ubiquinol to create cellular energy.[iv]
Production of ubiquinol begins slowing down at around age 40, as does the body’s ability to convert ubiquinone into ubiquinol, which is better absorbed by the body.[v] Studies have shown that ubiquinol is up to 70% more bioavailable than conventional CoQ10.[vi] For this reason, older adults may choose to supplement with ubiquinol to enhance the energy available to their cells.
A clinical trial on patients with congestive heart failure noted that patients who were given supplemental ubiquinone at doses of up to 900 milligrams (mg) a day, failed to achieve adequate blood plasma levels of CoQ10. Researchers postulated that intestinal edema in these critically ill patients had prevented their bodies from being able to adequately convert the ubiquinone into active ubiquinol.[vii]
When patients were switched to ubiquinol (between 450 and 900 mg/day), plasma CoQ10 levels increased significantly and clinical improvement was noted as “remarkable.” Researchers concluded that “ubiquinol dramatically improved absorption in patients with severe heart failure” and noted that improvements in plasma CoQ10 levels correlated with both clinical improvement and better left ventricular function in the heart.[viii]
A 2019 study supports these findings. On 400 mg ubiquinol per day for three months, patients with heart failure and reduced ejection fraction had significant improvement in peripheral endothelial function compared with placebo-treated patients.[ix]
Omega-3 and -6 Fats
The importance of including healthy fats in your diet has gained needed attention since the flawed logic of low-fat diets became exposed. Turns out, your brain and heart need fat to function, but it’s important to choose the right kinds of fat, including heart-healthy polyunsaturated fatty acids (PUFAs), like omega-3s and certain omega-6s.
While most people consume an overabundance of omega-6 fats from processed foods, a study published in the journal Lipids in Health and Disease found that low levels of dihomo-gamma-linolenic acid (DGLA), an omega-6 PUFA, circulating in the blood were associated with higher death rates in patients with heart failure. Conversely, higher levels of DGLA in the blood were associated with higher survival rates.[x]
Another study on omega-3s found that dietary supplementation with fish oil increased plasma adiponectin, a protein that helps regulate insulin sensitivity, suppressed inflammation and prevented cardiac dysfunction.[xi] Researchers did not observe the same cardioprotective properties in patients supplementing with flaxseed oil.[xii]
Hawthorn is a plant in the rose family that is native to the cooler Northern Hemisphere. Hawthorn (scientific name: Crataegus) has been used to make traditional medicine for hundreds, perhaps thousands, of years and has been most commonly applied in the treatment of diseases of the heart.[xiii]
In an effort to substantiate centuries of use, the European Journal of Heart Failure published a study on the efficacy and safety of hawthorn extract in patients with heart failure called the SPICE trial. Researchers performed a large-scale morbidity/mortality trial encompassing 1,442 patients in congestive heart failure.
Supplementing with Crataegus extract was found to reduce sudden cardiac death by a whopping 39.7% at month 24 of treatment in patients with less compromised left ventricular function. The treatment showed no significant adverse effects.[xiv]
Berberine is another plant-based medicinal that has demonstrated impressive heart benefits. Anecdotally believed to aid in producing stronger heartbeats,[xv] berberine’s place in our herbal pantheon as a heart healer has received scientific validation.
In 2010, a berberine derivative was found to strengthen the heart by blocking calcium influx, a central cause of a failing heart, and exerting powerful antioxidant activity.[xvi] Among berberine’s heart-boosting properties is antiarrhythmic activity that has been shown to prolong the duration of ventricular action potential; in other words, create a stronger, more rhythmic heartbeat.[xvii]
A 2020 study seeking to identify the mechanism by which berberine works on the heart did not mince words: “Berberine has been verified to protect cardiac function in patients with heart failure.”[xviii] Berberine’s effect on heart health is another example of the plant world’s deep symbiosis with the human body.
The mineral salt magnesium is critical for more than 300 enzyme systems in the body, as well as the regulation of blood pressure.[xix] Research has explored the use of magnesium in patients with heart disease, with some studies focusing on the role magnesium plays on endothelial dysfunction, a hallmark of heart failure in which the blood vessels of the heart constrict instead of opening or dilating.
One such study, published in the journal Congestive Heart Failure, found that oral supplementation with 800 mg/day of magnesium oxide for three months produced improved arterial function compared to placebo in heart failure patients.[xx] The importance of lost minerals to heart health has been clearly ascertained, with low magnesium levels contributing to oxidative stress, compromised antioxidant defences, tissue wasting and more problems linked to heart failure.][xxi
The amino acid arginine, also called L-arginine, is important for numerous bodily functions, including dilating and relaxing arteries.[xxii] Though arginine is produced endogenously, it needs to be consumed to maintain adequate levels. Foods like pastured red meat, fish, poultry and dairy products are primary sources; vegetarians can look to whole grains, nuts and seeds to boost arginine intake.
Arginine’s role in healthy heart function has been the focus of numerous studies in recent decades. Supplementation for six weeks was found to enhance exercise tolerance in heart failure patients, an important marker of heart stability.[xxiii] Adding arginine to a regimen of CoQ10 and vitamin D was found to be beneficial to both cardiac and endothelial cells that line blood vessels, due to a cooperative effect.[xxiv]
And a meta-analysis of more than 30 years’ worth of scientific studies on arginine found that oral supplementation exerts favourable effects in the prevention and treatment of a vast array of cardiovascular disorders, including mild-to-moderate heart failure.[xxv]
Before starting any herb or supplement regimen, it’s important to talk to your health care provider about possible contraindications with current medication and/or prescribed treatment protocols.
*WARNING: Always consult a medical herbalist or your health care practitioner when using both natural and pharmaceutical medicines for any diagnosed condition. This article is for informational purposes only and not intended to be used as medical advice.
- [i] Li Lei, Yan Liu. Efficacy of coenzyme Q10 in patients with cardiac failure: a meta-analysis of clinical trials. BMC Cardiovasc Disord. 2017 Jul 24 ;17(1):196. Epub 2017 Jul 24. PMID: 28738783
- [ii] C Morisco, B Trimarco, M Condorelli. Effect of coenzyme Q10 therapy in patients with congestive heart failure: a long-term multicenter randomized study. Clin Investig. 1993;71(8 Suppl):S134-6. PMID: 8241697
- [iii] Ubiquinol.org, Supplement Facts, https://ubiquinol.org/ubiquinol-coq10-supplement-facts
- [iv] Ubiquinol.org, Supplement Facts, https://ubiquinol.org/ubiquinol-coq10-supplement-facts
- [v] Ubiquinol.org, Supplement Facts, https://ubiquinol.org/ubiquinol-coq10-supplement-facts
- [vi] Ubiquinol.org, Ubiquinol Vs. CoQ10, https://ubiquinol.org/ubiquinol-vs-coq10
- [vii] Peter H Langsjoen, Alena M Langsjoen. Supplemental ubiquinol in patients with advanced congestive heart failure. Biofactors. 2008;32(1-4):119-28. PMID: 19096107
- [viii] Peter H Langsjoen, Alena M Langsjoen. Supplemental ubiquinol in patients with advanced congestive heart failure. Biofactors. 2008;32(1-4):119-28. PMID: 19096107
- [ix] Chika Kawashima, Yasushi Matsuzawa, Masaaki Konishi, Eiichi Akiyama, Hiroyuki Suzuki, Ryosuke Sato, Hidefumi Nakahashi, Shinnosuke Kikuchi, Yuichiro Kimura, Nobuhiko Maejima, Noriaki Iwahashi, Kiyoshi Hibi, Masami Kosuge, Toshiaki Ebina, Kouichi Tamura, Kazuo Kimura. Ubiquinol Improves Endothelial Function in Patients with Heart Failure with Reduced Ejection Fraction: A Single-Center, Randomized Double-Blind Placebo-Controlled Crossover Pilot Study. Am J Cardiovasc Drugs. 2019 Nov 12. Epub 2019 Nov 12. PMID: 31713723
- [x] Shohei Ouchi, Tetsuro Miyazaki, Kazunori Shimada, Yurina Sugita, Megumi Shimizu, Azusa Murata, Takao Kato, Tatsuro Aikawa, Shoko Suda, Tomoyuki Shiozawa, Masaru Hiki, Shuhei Takahashi, Takatoshi Kasai, Katsumi Miyauchi, Hiroyuki Daida. Decreased circulating dihomo-gamma-linolenic acid levels are associated with total mortality in patients with acute cardiovascular disease and acute decompensated heart failure. Lipids Health Dis. 2017 Aug 14 ;16(1):150. Epub 2017 Aug 14. PMID: 28806965
- [xi] Monika K Duda, Karen M O’Shea, Anselm Tintinu, Wenhong Xu, Ramzi J Khairallah, Brian R Barrows, David J Chess, Agnes M Azimzadeh, William S Harris, Victor G Sharov, Hani N Sabbah, William C Stanley. Fish oil, but not flaxseed oil, decreases inflammation and prevents pressure overload-induced cardiac dysfunction. Immunopharmacol Immunotoxicol. 2009;31(2):209-13. PMID: 19015135
- [xii] Monika K Duda, Karen M O’Shea, Anselm Tintinu, Wenhong Xu, Ramzi J Khairallah, Brian R Barrows, David J Chess, Agnes M Azimzadeh, William S Harris, Victor G Sharov, Hani N Sabbah, William C Stanley. Fish oil, but not flaxseed oil, decreases inflammation and prevents pressure overload-induced cardiac dysfunction. Immunopharmacol Immunotoxicol. 2009;31(2):209-13. PMID: 19015135
- [xiii] WebMD, Vitamins & Supplements, Hawthorn, https://www.webmd.com/vitamins/ai/ingredientmono-527/hawthorn
- [xiv] Christian J F Holubarsch, Wilson S Colucci, Thomas Meinertz, Wilhelm Gaus, Michal Tendera,. The efficacy and safety of Crataegus extract WS 1442 in patients with heart failure: the SPICE trial. Eur J Heart Fail. 2008 Dec;10(12):1255-63. Epub 2008 Nov 18. PMID: 19019730
- [xv] WebMD, Vitamins & Supplements, Berberine, https://www.webmd.com/vitamins/ai/ingredientmono-1126/berberine
- [xvi] Min-you Qi, Yu Feng, De-zai Dai, Na Li, Yu-si Cheng, Yin Dai. CPU86017, a berberine derivative, attenuates cardiac failure through normalizing calcium leakage and downregulated phospholamban and exerting antioxidant activity. Acta Pharmacol Sin. 2010 Feb;31(2):165-74. PMID: 20139899
- [xvii] C W Lau, X Q Yao, Z Y Chen, W H Ko, Y Huang. Cardiovascular actions of berberine. Cardiovasc Drug Rev. 2001 Fall;19(3):234-44. PMID: 11607041
- [xviii] Miyesaier Abudureyimu, Wenjun Yu, Richard Yang Cao, Yingmei Zhang, Haibo Liu, Hongchao Zheng. Berberine Promotes Cardiac Function by Upregulating PINK1/Parkin-Mediated Mitophagy in Heart Failure. Front Physiol. 2020 ;11:565751. Epub 2020 Sep 25. PMID: 33101051
- [xix] NIH.gov, Office of Dietary Supplements, Health Information, Fact Sheet, Magnesium, https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/
- [xx] Johanna C Fuentes, Adrian A Salmon, Marc A Silver. Acute and chronic oral magnesium supplementation: effects on endothelial function, exercise capacity, and quality of life in patients with symptomatic heart failure. J Periodontal Res. 1996 Aug;31(6):408-13. PMID: 16470086
- [xxi] Kevin P Newman, Matthew T Neal, Matthew Roberts, Kayla D Goodwin, Elizabeth A Hatcher, Syamal K Bhattacharya. The importance of lost minerals in heart failure. Cardiovasc Hematol Agents Med Chem. 2007 Oct;5(4):295-9. PMID: 17979692
- [xxii] WebMD, Heart, Arginine https://www.webmd.com/heart/arginine-heart-benefits-and-side-effects
- [xxiii] S Doutreleau, B Mettauer, F Piquard, O Rouyer, A Schaefer, J Lonsdorfer, B Geny. Chronic L-arginine supplementation enhances endurance exercise tolerance in heart failure patients. Int J Sports Med. 2006 Jul;27(7):567-72. PMID: 16802253
- [xxiv] Claudio Molinari, Vera Morsanuto, Simona Polli, Francesca Uberti. Cooperative Effects of Q10, Vitamin D3, and L-Arginine on Cardiac and Endothelial Cells. J Vasc Res. 2018 ;55(1):47-60. Epub 2018 Jan 5. PMID: 29301117
- [xxv] E Z Fisman, A Tenenbaum, I Shapira, A Pines, M Motro. The nitric oxide pathway: is L-arginine a gate to the new millennium medicine? A meta-analysis of L-arginine effects. J Med. 1999;30(3-4):131-48. PMID: 17312667
About the Author
Sayer Ji is the founder of Greenmedinfo.com, a reviewer at the International Journal of Human Nutrition and Functional Medicine, Co-founder and CEO of Systome Biomed, Vice Chairman of the Board of the National Health Federation, and Steering Committee Member of the Global Non-GMO Foundation.