Supplementing Your Heart Health: Omega-3, Plant Sterols, and More

If you have high cholesterol, or if you're at high risk for heart disease and heart attack, you've likely had "the talk" with your doctor. For many people, making lifestyle changes is enough to lower cholesterol. Other people need medications like cholesterol-lowering statin drugs. Dietary supplements can be part of the prescription, too.
Of the $20 billion dollars spent yearly on herbs and supplements, those touted to improve heart health top the list. They range from fish oil and flaxseed oil to artichoke and garlic extracts.

Is there any evidence that these really work? Can they really lower LDL "bad" cholesterol or triglycerides -- or raise HDL "good" cholesterol"? Do they provide an added benefit to drugs? Just as important, which vitamins and supplements should you consider taking for heart health?

The Truth About Vitamins and Supplements for Heart Health

For a top cardiologist's advice on heart-health supplements and vitamins, WebMD turned to Mimi Guarneri, MD, the founder and medical director of the Scripps Center for Integrative Medicine in La Jolla, Calif., and author of the book, The Heart Speaks.

"Supplements can be very beneficial to heart health," Guarneri tells WebMD.

Here are some of the supplements that may benefit your heart:

• Fish oil
• Plant sterols
• Niacin
• Fiber (psyllium)
• Red yeast rice
• Green tea extract
• B-Complex vitamins (B6, B12, folic acid)
• Coenzyme Q10
• Policosanol

A few cautionary notes: Always check with your doctor before using supplements because some can interact with other drugs you take. Some people -- including women who are pregnant or breastfeeding -- should not take supplements other than prenatal vitamins.  Make sure you purchase supplements that have a standardized dosage, approved by the USP (United States Pharmacopoeia), which means they contain 95% to 100% of the active ingredient.

Omega-3 Fatty Acids (Fish Oil, Flaxseed Oil) for Heart Health

Omega-3 fatty acids -- found in fish oil and flaxseed oil -- provide significant reductions in triglyceride levels and increases in good HDL cholesterol. Omega-3 doesn't affect “bad” LDL cholesterol levels.

"Omega-3s have consistently been shown to improve heart health," says Guarneri. "Omega-3s are one of the most important supplements for the heart because of its anti-inflammatory agents. We know that inflammation is a common pathway for many diseases, including heart disease and Alzheimer's disease."

Several studies report that in people with a history of heart attack, regularly eating oily fish (like salmon) or taking fish oil supplements reduces the risk of heart rhythm problems, heart attack, and sudden death. There may also be reductions in angina (chest pain).

Fish oil supplements can reduce triglycerides by 20% to 50%, says Guarneri. "Fish oil is now available by prescription -- that's how good it is." However, because fish oil comes from real fish, mercury content is an issue. "You have to stick with brands that are tested for mercury,” she notes. Check the labels.

Omega-3 Fatty Acids (Fish Oil, Flaxseed Oil) for Heart Health continued...

She advises taking 1 to 4 grams of fish oil daily -- containing 240 milligrams of DHA (docosahexaenoic acid) and 360 milligrams of EPA (eicosapentaenoic acid) per gram. However, the prescribed dosage will vary depending on the patient's blood samples. "With very high triglycerides, we might use higher doses," she says. High doses of omega-3 supplements -- over 3 grams daily -- may increase the risk of bleeding and should be done only under a doctor’s care.

If you're taking a statin drug to lower your cholesterol, fish oil provides added heart benefits, Guarneri says. A large Japanese study showed 19% fewer heart-related events (like heart attack) in adults taking a fish oil supplement plus a statin drug, compared with those taking only a statin.

Taking fish oil plus a magnesium supplement is also a good combination -- decreasing blood pressure and preventing heart rhythm problems, Guarneri adds. Look for glycinated magnesium, which is more easily absorbed.

She's not as big on flaxseed oil because results are not so dependable, Guarneri says. "Flaxseed oil has to be converted in the body, and conversion will vary from person to person depending on age and metabolism. But flax is soluble fiber and can lower LDL by 8% to 18% with doses of 40 to 50 grams per day."

Plant Sterols for Heart Health

Plant sterols are derived from plant-based foods and are used to enrich margarines and other foods. Many human and animal studies have found that plant sterol-enriched products lower total cholesterol and LDL cholesterol. Plant sterols do not affect triglycerides or HDL levels, however.

"Plant sterols block cholesterol absorption and lower LDL by 10%, Guarneri says. "They also work synergistically with statins and can be more effective than doubling the statin dose." Taking a statin plus plant sterol supplement can reduce LDL by 20%.

Numerous studies have shown that eating more plant sterol-enriched foods lowers total and LDL cholesterol. In a study of 194 adults with moderately high cholesterol, each consumed 2 servings of low-fat milk that was plant sterol-enriched. By the third week, their LDL cholesterol was reduced by 9.5%; by week six, LDL was 7.8% reduced. 

Although some margarine and other specialized foods are made with plant sterols, Guarneri recommends powdered plant sterols because she says it’s easier to make sure you’re getting the recommended 2 grams per day.

Niacin for Heart Health

Also known as vitamin B-3 or nicotinic acid, niacin is a well-accepted treatment for high cholesterol. "Niacin is one of my favorites," Guarneri says. "It is tried and true in raising HDL and lowering triglycerides." She prescribes from 500 milligrams to 2 grams daily, depending on the patient's blood levels.

Numerous studies have shown that niacin can significantly improve HDL cholesterol with better results than with statin drugs. Niacin can also improve LDL levels, but less dramatically. "Niacin is one of the most powerful vitamins -- increasing HDL by 15% to 30%, reducing triglycerides by 20% to 50%," she says.

A very small percentage of patients who take niacin have heart rhythm problems. Some people do get hot flushes from niacin, so it's important to start with small doses and increase slowly, under a doctor's supervision.

Psyllium for Heart Health

Psyllium (ispaghula) comes from the husks of seeds from Plantago ovata. Psyllium, either through supplements or high-fiber foods, provides fiber that can reduce total and LDL cholesterol. Fiber’s effects on HDL “good” cholesterol are less clear, although some research suggests fiber may help increase HDL.

Guarneri likes fiber, including psyllium. Just 15 grams of psyllium reduces LDL by up to 9%, she reports. Psyllium also boosts the effects of statin drugs. In an eight-week study, one group of patients took 10 milligrams of psyllium plus 10 milligrams of Zocor, a statin drug. They were compared to patients taking 20 milligrams of Zocor plus a placebo. In the psyllium group, LDL fell by 63, compared with 55 in the statin-only group.

One caution: Psyllium can decrease absorption of other medications. Make sure you talk to your doctor before taking psyllium.

Red Yeast Rice for Heart Health

Red yeast rice is derived from a specific yeast that grows on rice. This extract has been shown to lower total and LDL cholesterol and triglyceride levels, help prevent heart attack, and improve blood flow. "If you want to reduce LDL cholesterol, red yeast rice can do it," says Guarneri. In fact, it contains a substance -- monacolin K -- that is identical to the active ingredient of the cholesterol-lowering statin drug Mevacor.

“Whether a red yeast rice supplement works or not depends on the formulation. There are many formulations, many brands. Some work, some don't. Ultimately, the only way to know is to get your cholesterol checked -- start taking red yeast rice at the therapeutic dosage of 2400 mg a day -- then re-check cholesterol in two months."

If you don’t see a change, Guarneri suggests trying a different brand of red yeast rice supplement. However, high cholesterol is a serious condition and should not be taken lightly. Make sure your doctor is aware you're trying red yeast rice, so the two of you can decide if and when you need a prescription medication.

“There are good products on the market in high-end health food stores,” she adds. Most red yeast rice supplements in the U.S. recommend taking no more than 2,400 milligrams daily. Higher doses increase the risk of side effects, such as muscle pain and tenderness, and possibly liver damage. In addition, do not take red yeast rice if you’re taking a statin cholesterol-lowering medication as this further increases the risk of side effects.

Red yeast rice should not be used by people with liver disease. In addition, it may increase the risk of bleeding and should be used with caution by people taking blood thinners.

Green Tea Extract for Heart Health

Green tea extract is made from the dried leaves of Camellia sinensis, a perennial evergreen shrub. Green tea is a staple in Chinese traditional medicine.

This supplement is one of Guarneri's favorites and is shown to decrease LDL by 16%. She advises 375 milligrams of theaflavin-enriched green tea extract daily.

B Vitamins: B-6 (pyridoxine), B-12, and Folic Acid for Heart Health

B-complex vitamins, including folic acid, help keep nerves and red blood cells healthy. They may also lower blood levels of homocysteine, an amino acid that’s possibly linked to heart disease, blood clots, heart attack, and strokes.

However, in May 2008, a study of more than 5,000 women at high risk of heart disease showed that daily folic acid, vitamin B-6, and B-12 supplementation did not reduce the rate of heart attacks, despite lowering levels of the amino acid homocysteine. The study appears in The Journal of the American Medical Association.

“I’m not ready to throw out B-vitamins yet for heart patients. That is still controversial. It’s important to remember that B vitamins are not just for cardiac issues,” Guarneri says.

“The bigger issue is inflammation associated with high homocysteine levels. Lowering homocysteine may help the heart, but it is also necessary to prevent osteoporosis and cognitive decline.”

She also says it’s important to get the right dosage of B-vitamins – either from a naturopathic doctor or another physician who understands the complexity of lowering homocysteine with B-vitamins.

More studies are needed to fully understand the link between homocysteine and vitamin supplements, researchers say.

Coenzyme Q10 for Heart Health

Coenzyme Q10 is produced by the body and is necessary for basic cell functioning. Small studies have suggested that CoQ10 may reduce chest pain (angina). For people with clogged arteries, CoQ10 may make exercise easier.

Guarneri recommends CoQ10 supplements for patients taking statin drugs for high cholesterol. Some researchers believe that statins may block the natural formation of CoQ10 in muscle cells, which could contribute to heart muscle damage. The evidence, however, isn’t clear. A 2008 Canadian study showed that statins did not significantly reduce tissue concentrations of CoQ10.

Policosanol for Heart Health

Policosanol is a natural plant mixture used to lower cholesterol. Studies have shown policosanol helps reduce LDL cholesterol.

An analysis of 52 studies found that taking policosanol reduced LDL cholesterol by 24%; taking plant sterols reduced LDL by 10%. Policosanol also improved total cholesterol, HDL cholesterol, and triglyceride levels more favorably than plant sterols.

Guarneri, however, is not a big fan of policosanol. No large studies of policosanol have been conducted in the United States.

A cautionary note: Don't take policosanol if you're taking blood thinners or drugs that lower cholesterol. Talk to your doctor first.

Soy for Heart Health

Soy has been shown to decrease total and LDL cholesterol, with smaller benefits to triglycerides. However, soy supplements have not been proven to reduce long-term risk of heart attack or stroke.

Two big cautions: Women with hormone-sensitive cancers (breast, ovarian, uterine cancer) or endometriosis may be advised not to take soy. People taking blood-thinning drugs should also talk to their doctors before taking soy.

Other Herbs, Spices, Extracts

Artichoke leaf extract, yarrow, and holy basil may help lower cholesterol, according to early studies. These and other commonly used herbs and spices -- like ginger, turmeric, and rosemary -- are being studied for their potential in preventing heart disease.

Globe artichoke leaf has become increasingly available in the United States. Preliminary studies suggest that these extracts may reduce total cholesterol and triglyceride levels.

Multiple studies of garlic extract have reported small reductions in total and LDL cholesterol over short periods of time (4 to 12 weeks), but it's not clear whether this benefit is lasting or short-term. Also, effects on HDL are not clear.

Lifestyle Solutions for Healthy Hearts

Supplements are no panacea. If you use them, use them in connection with proven lifestyle habits that benefit the heart -- and with medications prescribed by your doctor.

After all, a bad diet and an inactive lifestyle are the biggest risk factors for heart disease. Making changes to improve your lifestyle can make a big difference.

Food is medicine: "Food comes first," says Guarneri. "There are reams of research showing that the Mediterranean diet -- high in fruits, vegetables, whole grains, olive oil, nuts, wine, and fatty fish -- help decrease blood pressure and stroke." It's possible to reduce heart-related events (like heart attack) by 50% to 60% by following this type of diet, she adds.

One long-term study of 15,700 adults found these five factors were the most important:

• Eating at least five fruits and vegetables daily
• Walking or getting other exercise for at least 2.5 hours weekly
• Keeping BMI (body mass index) out of the obese range
• Don't smoke
• Salmon, mackerel, sardines, tuna, and other omega-3 fatty fish should be staples, she says.

Daily exercise is a must: The Clinical Council on Cardiology advises 40 minutes to one hour of aerobic activity every day and strength training three days a week.

A 2002 study showed that more intense exercise works better than moderate exercise in reducing cholesterol. The study involved sedentary, overweight men and women -- all with mild-to-moderately high cholesterol -- who did not change their diet. Researchers found that those who got moderate exercise (12 miles of walking or jogging a week) lowered their LDL levels, but those who did more vigorous exercise -- jogging 20 miles a week -- got even better LDL results.

Stress reduction is key: Stress increases cortisol (a hormone), which puts fat on the midline -- which increases heart risks. Stress also produces inflammation that leads to increased plaque in blood vessels, Guarneri explains. Two stress hormones -- adrenaline and norepinephrine -- raise cholesterol, blood pressure, and cause heart rhythm problems. They also constrict coronary arteries, cause blood pressure to go up. When we're under stress, our ability to fight infection is reduced.

"We have to factor in true mind-body-spirit approaches -- eating right, exercising, taking steps to reduce stress and anger," she says.

While any type of meditation is helpful, Guarneri advises using transcendental meditation. "It is well studied; there is a lot of research showing that it decreases blood pressure and improves insulin resistance. I also encourage people to look into computer programs that teach biofeedback -- helping people control their autonomic nervous system. Healing Rhythms and HeartMath are two biofeedback programs."

"It's all about lifestyle," she says. "It's not only what you eat, but who you're eating with. If you're in a bad relationship, you can eat all the Brussels sprouts in the world and it won't help your heart."
This information was obtained from WebMD 2009.

Cholesterol Management , Dietary Supplements, Herbs and Herbal Supplements