Heart Health: Part III – regeneration, genetics and supplements

heart health

Wear and tear, cell regeneration and impact on heart health

Most people pretty much accept the inevitable decline in heart health as they age, believing that the heart (just as the rest of the body) wears out with time.  It is almost expected that your heart, as you get older, will start changing for the worse – the cardiac muscle is expected to thicken (and weaken at the same time), arteries – to stiffen and overall cell regeneration process – to slow down.  The implied lack of exercise at an older age makes these processes accelerate even further.

This grim picture, however, doesn’t have to be your reality.

It is true that myocardium cells may not possess the same remarkable regenerative capacity as liver cells, for instance (although they do, of course, regenerate following normal cell death), but as long as you can prevent current cells from dying too quickly – you can extend the lifespan of the whole heart.  The rules we discussed in relation to overall aging prevention apply equally when trying to prevent premature aging of the heart.

As with most organs, aging of the heart means the loss of ability of myocardium cells to divide and replicate (at least, at a rate that surpasses the rate of normal cell death).   And the factors that drive this are the same as what we have previously discussed – excessive free radical damage, inflammation and muscle atrophy.  If you prevent these generally (by making slight adjustments to your lifestyle and diet) – you will keep your heart young, strong and healthy.

Hereditary heart conditions and DNA testing

Keep in mind that not all disorders of the heart can be prevented by exercise, diet and lifestyle.  Some conditions are hereditary or may be the unfortunate result of genetic mutation.  While reducing risk factors by addressing your diet and engaging in proper exercise remains a very good insurance policy in general, such conditions may need to be addressed in a special way with all the limitations that come with it.  Even if your lifestyle and diet are flawless – you still may have some risk of such genetic conditions.

Some of these may be managed by specific changes in your lifestyle and some you really cannot do anything about.  But in any case – finding out about them is the first step.  So make sure you have periodic tests done by your doctor to determine your current heart health.  You can even go a step further and look at your genetic risk factors by doing a DNA test.  There are several commercially available and affordable services today (23andme, DNAFit, etc.) that analyze your DNA and provide raw genetic information that, when run through various software, can warn you of potential risks.

Heart health supplements

As any other tissue or organ in our body, the heart needs adequate nutrition to develop and work normally.

Although having a proper diet (and, as you would already know from reading this website, “proper” in this case may be very different from what your conventional dietary guidelines may tell you) can be a major contributing factor for maintaining heart health, controlling what you eat may not be enough.

It’s true that most nutrients our bodies need come either directly from plants or from animals that convert or concentrate nutrients provided by those plants.  But – depending on soil quality, growing practices and plant species – there are always seasonal, regional and genetic variations that affect the availability of nutrients we get.  And, of course, some nutrients (like vitamin K2) are just hard to get with regular meals, unless you have some very specific preferences in food.  So although most of your nutrients may come with regular food, quite often – extra supplementation to make up for any deficiencies becomes essential.

So let’s talk about what you should and what you shouldn’t supplement with to maintain good heart health.

Should you ever take statins?

When we talk about any pills you take for heart health, we first need to address the most prevalent type of heart medication – cholesterol-lowering statins.  It is widely believed that statins reduce the risk of heart disease by lowering cholesterol and, thus, allegedly, preventing the formation of arterial plaques.

We have previously discussed the cholesterol myth in detail and covered the danger of statins, so we are not going to spend too much time on them today – let’s just reiterate a few important points:

  • Despite the relentless promotion by the Big Pharma , statins are not a panacea – and they are far from harmless. Even the “official” authorities (that often have guidelines that are too lenient for any health-conscious person to follow) admit that;
  • Statins are designed to fight the symptoms, not the actual reason for those symptoms. When you have too much LDL circulating in your blood, this is telling you something about your malfunctioning metabolism – supressing the symptoms by taking statin drugs, while continuing with bad dietary practices is the worst kind of ignorance and a total disservice to yourself;
  • In most cases, serum cholesterol – especially the bad kind – as well as other accompanying factors that lead to formation of arterial plaques can be controlled by limiting carbohydrates and lipids that are not suitable for human consumption (this will also have other positive effects on the rest of your body) – and this is what you should try first before taking any cholesterol-lowering drugs;
  • In a vast majority of cases, statins are unnecessary and too risky. That said – we are all genetically different and there may be a (much smaller) group of people who do not tolerate low-carb higher-fat diets.  For such small group of people lowering cholesterol with statins may be an option – but of course, after considering (and closely monitoring for) all the risk factors associated with statins and after (or while) trying other means of improving arterial health.  You may not metabolize fat as well as carbohydrates, but your first strategy would still be eliminating factors that lead to endothelial damage (cigarette smoking, vegetable oils, refined simple sugars, etc.) that serves as a starting point for plaque formation and making sure you get adequate vitamins and minerals (such as k2, for instance, which prevents calcification of arteries and ensures calcium is deposited where it is supposed to – in your bones and not in arterial walls;
  • Bottom line is: if you are worried about cholesterol – first make sure your worries are warranted and understand that cholesterol is not inherently bad. Second – make every effort to change your lifestyle (diet and exercise) to manage cholesterol (and heart health generally) before considering any medication.
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So, what about other supplements?  Let’s talk about what role calcium, vitamin D, Coenzyme Q 10 and a few others play in heart health.

Coenzyme Q10 (CoQ10)

Coenzyme Q10 (CoQ10, also known as ubiquinone and ubiquinol) – an enzyme that your body naturally makes in small amounts – is a component of electron transfer chain that plays a key role in aerobic cellular respiration.  It is especially abundant in the mitochondria – and is usually found in the highest amounts in organs that have elevated energy requirements – such as the heart.

Taking supplementary CoQ10 is vital for those who do end up on statins – as cholesterol-lowering drugs often also suppress endogenous production of CoQ10.

At the same time, among those, who experienced heart failure in the past, patients with lower CoQ10 levels have a much higher risk of dying compared to those with higher levels of this coenzyme.  Multiple studies show that CoQ10 supplementation significantly improves survival for even the most severe heart failure patients while dramatically reducing incidence of hospitalization.

But although it is the most abundant in and so important for the heart, CoQ10 is not just important for heat health.  One of the most important functions of CoQ10 is protection from oxidative stress (acting like an anti-oxidant).  Some studies even indicated its effectiveness as a supplement in cancer-treatment protocols (although most of these studies are inconclusive at this point).

Animal heart is probably the best source of CoQ10 in the diet.  Failing that, you might want to take supplements (preferably in the form of uniquinol, which is more bio-available than ubiquinon) – overdosing on CoQ10 is pretty hard (no toxic effects have been reported even at such high doses as 3600 mg.), but how much of it you personally should take (if any) depends on your current plasma levels.  That said – daily supplementation of about 100-200 mg. (granted you are not on statins, in which case the dose should be higher) is extremely safe (safe levels have been established at around 1200 mg. per day) and could be a cheap insurance policy against potential heart problems and oxidative damage.

Pyrroloquinoline quinone (PQQ)

Another interesting molecule that also reduces oxidative damage and serves as a co-factor for energy-generating reactions in the mitochondria is PQQ (pyrroloquinoline quinone)

In animal studies, treatment or pre-treatment with PQQ reduced the extent of ischemic damage and the degree of lipid peroxidation under oxygen-deprived conditions – as well as improved ventricular function and reduced arrhythmias.  Human studies have also confirmed PQQ’s role in decreasing C-reactive protein (a marker of inflammation), general growth and development, improvements in memory and learning ability and general changes associated with enhanced mitochondrial function.

Because CoQ10 helps better absorb PQQ, these two work especially well in tandem (that’s if you want to take supplements that contain both).  As for food sources, PQQ is found in most plant foods – with the richest sources being green tea, parsley, kiwi, green peppers, etc.

Once again, there is no known toxicity when it comes to PQQ – even at high doses, although it is generally agreed that to get the nutritional benefits of PQQ, the amount an average human would have to consume would be measured in milligrams, rather than in grams – so you should be covered if your diet includes a sufficient amount of plant foods (if it doesn’t – change your diet).

If you feel like you might not be getting enough (or you just want to experiment with slightly higher doses to see whether it changes the way you feel and perform) there are several forms of PQQ supplements available – typically as disodium salts or in the acid form.  There is some debate around the claim that the acid form is more bioavailable than salt – but, in the end, it is probably not that critical – most studies supporting the efficacy of PQQ were done with salts, plus the allegedly more bioavailable acid form typically gets converted into salts during digestion anyway.

Fish oil

Typically, the benefits of fish oil are discussed in the context of brain and general neuronal health – and for good reason, as quality fish oil is a great source of omega-3 fatty acids, such as EPA and DHA that are critical for brain development.  Omega 3 oils, however, have a wide variety of other benefits (including cancer prevention, eye health, joint health and cardiovascular function).  They are difficult to obtain from the diet in sufficient quantities unless large amounts of fatty fish are consumed, so extra supplementation is required in most cases.

Omega-3 fatty acids have been well studied for their prevention of cardiovascular disease, ability to reduce inflammation, hypertension, and reduction of the risk of cardiovascular mortality.

Given a multitude of potential health benefits, supplementing with fish oil (or krill oil) remains very important.  Omega 3 supplements typically contain a mixture of EPA and DHA – for optimal results, choose the supplements where the ratio of EPA to DHA is at least 2:1.

Vitamin D

We have previously discussed the role of vitamin D (some eve call it a hormone) in a very wide variety of cellular activities and an utmost importance of having adequate serum vitamin D levels for optimal health.  One of those many benefits is improved cardiovascular health.

Vitamin D deficiency has been strongly associated with heart disease. In fact, in studies of patients re-hospitalized with heart failure, up to 75% of patients were vitamin D deficient.

Vitamin D – in synergy with vitamin K2 – regulates the absorption of calcium (the presence of K2 is necessary to make sure calcium is shuttled to your bones, rather than ending up in arteries or other tissues, causing stiffness and loss of normal function and, thus, increasing in the risk of cardiovascular disease).  The fact that vitamin D also lowers high blood pressure (which is considered a risk factor in cardiovascular disease) provides additional benefits.

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Carnitine

Carnitine is a generic term for a number of compounds (such as L-carnitine, acetyl-L-carnitine, and propionyl-L-carnitine.  It has a critical role of transporting fatty acids into the mitochondria for oxidation and energy generation – as well as transporting the toxic byproducts of metabolism from cellular organelles, to prevent their accumulation.  As such, it is highly concentrated in tissues that primarily burn fat for fuel – including cardiac muscle.

A healthy body would synthesize enough carnitine for its needs.  So extra supplementation is typically not required.  Under certain conditions, however (such as in patients who have recently had heart failure) – administration of propionyl-L-carnitine (PLC) demonstrated statistically significant increases in exercise capacity, peak heart rate and oxygen consumption, as well as reduced pulmonary artery pressure and reduced ventricular size.

L-carnitine is often discussed among gym enthusiasts as a supplement that allegedly helps improve athletic performance (by improving energy metabolism).  Some small uncontrolled studies have reported increases in maximal oxygen uptake, strength index, power output, and post-exercise decrease in plasma lactate.  At the same time, other controlled double-blind studies demonstrated that PLC is ineffective for increasing muscle carnitine content and had no significant effects on aerobic- or anaerobic-exercise performance.

So, in conclusion – while carnitine supplementation might work in theory, the available data suggests that supplementation does not affect athletic performance in healthy individuals.  That said, carnitine is generally very well-tolerated and not associated with any toxicity even at high doses (3000 mg).  On top of that, bioavailability of oral carnitine supplements (as opposed to dietary carnitine obtained from food) is pretty low – 14-18%.  So, as usual – the primary solution is to make sure your diet contains enough high-quality meat, poultry and fish.  Failing that – and if you have reasons to be concerned about your carnitine levels or want to try to improve athletic performance – you may experiment with oral supplementation (around 1000-1500 mg) as it is relatively safe, to see how this affects you personally.

Selenium

Some of the benefits of Selenium that we discussed previously include improvement in efficiency of thyroid hormone synthesis, protection from oxidative stress, support for cognitive function, immune system and fertility.

But, being a cofactor necessary for the proper function of a number of cellular metabolic processes, it also has an effect on heart function.

For instance, animal models of hypertension and subsequent progression to chronic heart failure have shown that Selenium supplementation resulted in much higher survival rates. In humans, severe selenium deficiency has been linked to a reversible form of heart failure and Keshan disease– a condition potentially fatal if left untreated.

As usual – lab tests are the best way to determine if you are deficient in selenium.  Although selenium deficiency is officially considered a rare condition, its presence in your food depends largely on how much of it is present in plants you eat (or animals that ate those plants that you also eat) – which, in turn, depends on the quality of soil where these plants grow.  And because depletion of soil quality is a real problem in many areas, this condition may not be as rare as some people think.

If you need more Selenium – the most famous and biggest source of selenium is Brazil nuts. But remember that only two of these nuts per day will provide about 100 mcg – more than enough to meet recommended allowances.  So if you are considering eating them by the handful – please reconsider, as you can totally overdo it and lead to selenium overdose.

Also high in selenium are:

  • Organ meats
  • Lamb
  • Shrimp
  • Wild salmon,
  • Egg yolks
  • Crimini and Shiitake mushrooms,

In general, seafood, cereals and meat products contain relatively high levels of selenium, while low levels are also found in milk, vegetables and fruit.

Other remedies

There are several other remedies – herbal and otherwise – that promise results in helping maintain heart health.  Those include:

  • Hawthorn extracts – a traditional cardiovascular tonic of plant origin containing dozens of biologically active molecules including flavonoids and polyphenol. Although it has been in use since the Middle Ages, even modern studies confirm its efficacy in the treatment of heart failure;
  • Arjuna (Terminalia arjuna) extracts enhance heart muscle tone, improving ventricular function. Used in Ayurvedic medicine for centuries and, once again, supported by modern studies, Arjuna extracts exhibit significant antioxidant and moderate lipid-lowering effects. Studies have demonstrated effectiveness of these extracts as anti-ischemic and anti-inflammatory agents.
  • Epicatechin – a flavanol in cacao – stimulates mitochondrial volume and cristae density and protein markers of skeletal muscle mitochondrial biogenesis, potentially combatting Type 2 diabetes and heart failure.

In conclusion

Most importantly, your heart health is a reflection of your overall wellness (and vice versa).  A lot of preventive measures and interventions with diet and physical activity have a profound effect on cardiovascular health even before you consider any esoteric supplements and extracts.

A lot of bad things – including heart disease – can be prevented by eating right, increasing resilience through physical exercise and reducing unnecessary stress.  All of these factors have epigenetic influence (meaning – regardless of what is coded in your genes, they can regulate whether these genes are expressed or suppressed and, in the end, whether an even hereditary condition manifests itself).

Most of the rules to stay heart-healthy are easy to follow.  In fact – you don’t have to do anything outside of your typical daily routine that you wouldn’t do anyway as a part of your protocol of becoming healthier and stronger – which shows you, once again, how profound the impact of a few changes can be – not only on the system being targeted, but on the whole body.

This article simply gives you another reason to watch those little things that you can easily control to your greatest advantage.