In This Article
By Jonny Bowden, PhD, and Stephen Sinatra, MD
In addition to staying physically active, eating nutritious foods, reducing stress, and maintaining a healthy weight, taking nutritional supplements can be an important component of a heart-healthy lifestyle.
The following 8 supplements have long been considered superstars for a heart-healthy lifestyle and may be taken alone or as an adjunct to conventional therapy.
Nattokinase and Lumbrokinase
Hyperviscosity refers to sticky, or sludgy, blood. When blood thickens, it bogs down as it moves through the blood vessels, causing platelets to stick together and clump. Blood vessels become more rigid, less elastic, and frequently calcified. The danger lies in the tendency to form clots that can block vessels leading to vital organs.
Nattokinase is extracted from the traditional fermented soy food natto—believed by many experts to contribute to the low incidence of coronary heart disease in Japan. It provides a unique, powerful, and safe way to eliminate clots, or reduce the tendency to form clots, and thus decrease the risk of heart attack and stroke.1
Lumbrokinase, developed in both Japan and China, comes from an extract of earthworm—a traditional source of healing in Asian medicine. These two separate products share a powerful property of great interest to anyone who wants to protect their cardiovascular system: They are natural clot dissolvers.
Here’s how it works: Your body naturally produces fibrin—a fibrous protein formed from fibrinogen. (A fibrinogen test is one of the blood tests we recommend because it is a good marker of how much fibrin you’re making.) Fibrin is both good and bad. More specifically, its clot-forming action is immediately activated when bleeding occurs, which is important, but excess fibrin activity can produce consistently thick blood.
To offset the danger—and to create thinner blood—the body produces another substance called plasmin—an enzyme whose function is to break down excess fibrin. A nice system of checks and balances. But if plasmin, the natural anticlotting agent, becomes overwhelmed, nattokinase and lumbrokinase may be effective.
Blood clotting in an already narrowed blood vessel can lead to obstructed blood flow to major organs. So, if you can dissolve the clotted material, you can open arteries and improve blood flow. If you reduce the clot even just a tiny bit, you get a significant blood flow boost.
Nattokinase and lumbrokinase are natural blood thinners and, best of all, they work quickly— within minutes to hours. Because of the antithrombotic and fibrinolytic activity, nattokinase may be used in prevention and treatment of cardiovascular disease.
Berberine for a Heart-Healthy Lifestyle
Berberine is an active biological compound that can be extracted from numerous plants, notably shrubs. Although it has a long history of use in traditional Chinese medicine, it’s now earning a reputation among modern-day health practitioners in the west as an effective adjunct treatment for a number of cardiometabolic issues. It is a powerful antioxidant and anti-inflammatory that also decreases triglycerides and blood sugar.
In fact, some research shows it may increase insulin receptors (which would increase insulin sensitivity and reduce insulin resistance). It also increases nitrous oxide. A meta-analysis of sixteen berberine studies performed in 2018 showed significant improvements in conventional measures of cardiovascular risk, including a reduction in triglycerides.
A meta-analysis looking at reductions in blood sugar concluded that “based on the existing evidence reviewed, berberine has beneficial effects on blood glucose control in the treatment of type 2 diabetic patients and exhibits efficacy comparable with that of conventional oral hypoglycemics.” In other words, berberine’s blood sugar-lowering capacity was found to be comparable to several well-established pharmaceutical medicines.2
Citrus Bergamot
Citrus bergamot is a fruit that’s endemic to the Calabrian region in Southern Italy and if it lives up to its promise—which it seems to be doing—it may turn out to be one of the most important supplements for the prevention of metabolic syndrome (aka insulin resistance syndrome or pre-diabetes).
Metabolic syndrome is a collection of symptoms (eg, high blood sugar, high triglycerides, high blood pressure, and abdominal fat), which greatly increases the risk for heart disease. Citrus bergamot has been shown to lower blood sugar, triglycerides, and blood pressure—a trifecta of cardiovascular health.
As with most supplements, you need to pay special attention to the label and the amount of active ingredients. Look for bergamot products with a high percentage of polyphenols (at least 30 percent, if not more). Citrus bergamot extract of 38 percent polyphenols has been demonstrated to suppress inflammation, inhibit plaque formation, and improve arterial responsiveness, thus contributing mightily to cardiovascular health.3
Omega-7
There is no disease we can think of that doesn’t involve inflammation, and that’s especially true with heart disease. As such, anything that can be demonstrated to reduce systemic inflammation gets our attention. Enter Omega-7.
Most people have never heard of omega-7 but it’s proving to be incredibly important. The main omega-7 fat in the body is called palmitoleic acid, and it’s been shown to work on the cycle of events we refer to as “diabetic physiology”—high blood sugar, elevated lipids (fats), excessive body fat, and, inevitably, insulin resistance. It’s this cycle—nearly always triggered by too much sugar and starch—that we believe is the number one set of risk factors for heart disease.
Omega-7 enhances insulin sensitivity (the exact opposite of the dreaded insulin resistance).4 Since insulin resistance and fat accumulation tend to go hand in hand, and since omega-7 helps fight insulin resistance, it’s not entirely surprising that omega-7 also helps with breaking down fat and increasing the enzymes that are needed for fat burning in the first place.5
Fat cells produce inflammatory cytokines and release molecules called adipokines, which can change the metabolic activity of tissues and ultimately produce higher levels of inflammation.6 That’s why reducing excess body fat is generally recommended if you’re trying to prevent heart disease.
Remember, heart disease is in large measure an inflammatory disease, and anything that reduces inflammation—like losing weight—is a net gain for your heart-healthy lifestyle. Which brings us to the remarkable study on omega-7 performed at the Cleveland Clinic.7 The first randomized control trial of omega-7 supplements in humans was done at the Cleveland Clinic Wellness Institute.
Overweight or obese adults with evidence of inflammation—defined as CRP levels between 2 mg/L and 5 mg/L—were randomly assigned to two groups. One group received 220mg of purified omega-7 supplementation, one group got a placebo. The “outcome” measure was CRP score, which stands for C-reactive protein and is a blood measure for systemic inflammation. The average baseline C-reactive protein level for all subjects in the study was 4.3 ml/DL, considered “high risk” for cardiovascular disease.
After only 30 days, there was a 44 percent reduction in CRP levels in the omega-7 group compared to the placebo group. Those who took the supplement wound up with an average CRP of 2.1, which, while not ideal, is well within the “average risk” range for inflammation-induced cardiovascular disease.
Pantethine
Pantethine is a metabolically active (and somewhat more expensive) form of vitamin B5 (pantothenic acid). The blood tests of patients with dyslipidemia—elevated blood levels of cholesterol—significantly improve with pantethine supplementation. And although this can’t be seen on a blood test, pantethine also reduces the oxidation of LDL.8
No fewer than twenty-eight clinical trials in humans have shown that pantethine produces significant positive changes in triglycerides, LDL cholesterol, along with increases in HDL cholesterol.9 In all of these trials, virtually no adverse effects were noted. The mean dose of pantethine in these studies was 900 mg per day given as 300 mg three times daily. This appears to be the optimal dosage, and it is the one we recommend.
According to a review of the literature on pantethine published in Progress in Cardiovascular Diseases, Mark Houston, MD, noted that in most studies, at the end of four months, pantethine reduced total cholesterol by 15.1 percent, LDL by 20.1 percent, and triglycerides by 32.9 percent, with an increase in HDL of 8.4 percent.10
Houston also noted that in studies of longer duration, there appeared to be continued improvement. The only adverse reactions were mild gastrointestinal side effects in less than 4 percent of the subjects.
Omega-3
More than thirty years ago, scientists began to notice very low rates of cardiovascular disease among Greenland Eskimos compared to age- and sex-matched Danish control subjects. Shortly afterward, they were able to link these low rates of heart disease to high consumption of omega-3s in the Greenland diet.11 This discovery triggered an enormous amount of research on the role of fish oil in preventing heart disease. (As of January 2020, a National Library Medicine search for “omega-3 cardiovascular benefit” produced 378 peer-review journal articles.)
One recent review of omega-3s and cardiovascular disease by Dariush Mozaffarian, MD, of the Harvard School of Public Health, concluded that omega-3 consumption “lowers plasma triglycerides, resting heart rate, and blood pressure, and might also improve myocardial filling and efficiency, lower inflammation, and improve vascular function.”12 Mozaffarian also noted that the benefits of omega-3s seem most consistent for coronary heart disease mortality and sudden cardiac death.
One of the landmark clinical studies of omega-3 supplementation in a high-risk population is known as the GISSI-Prevenzione trial. More than 11,000 patients who had suffered a heart attack within the past three months were randomly assigned to receive either 1 g per day of omega-3s, 300 mg of vitamin E, both, or neither, in addition to whatever standard therapy being administered.
Vitamin E had no effect, but omega-3s were associated with a 20 percent reduction in mortality and a 45 percent reduction in the risk of sudden death. These effects were apparent within a mere three months of therapy.13
International guidelines recommend 1 g of omega-3 fats daily for people who’ve already had a heart attack or for patients with elevated triglycerides.14 Experts believe these guidelines will soon be extended to patients with heart failure as well.
When you supplement with fish oil, remember that the total amount of omega-3s is not what’s important. Bargain-basement omega-3 supplements often tout on their labels how much omega-3 they contain. This number by itself is meaningless. You want to know specifically how much EPA and DHA are contained within each capsule. These are the gold nuggets in the prospector’s tin—you don’t care about the total amount of stones in that pan, you care about the gold. Aim to get at least 2 g daily of combined EPA and DHA.
Niacin
It’s been known since 1955 that cholesterol can be effectively lowered with doses of 1,000 to 4,000 mg of niacin daily. Subsequent studies have shown that niacin will lower triglycerides by 20 to 50 percent and LDL cholesterol by 10 to 25 percent.15
Niacin is one of two major forms of vitamin B3—the other is nicotinamide. Although both forms can be used for different roles in the body, only the niacin form has an effect on your cholesterol, triglycerides, and related compounds. And the effect is not just on overall cholesterol. Studies have shown that when LDL cholesterol is reduced with niacin, there is a preferential reduction of LDL molecules—the hard, small, BB gun pellet–type particles that stick to the artery walls, get oxidized, and cause damage. Niacin also reduces lipoprotein(a), or Lp(a).
Lp(a) is an independent risk factor for heart disease and heart attacks, yet it doesn’t get as much attention as cholesterol does because there aren’t effective drug treatments for lowering it, and no one really knows what to do about it. Niacin lowers Lp(a) levels by a remarkable 10 to 30 percent.16
Equally compelling is the fact that niacin raises HDL cholesterol 10 to 30 percent.17 But even better is the fact that it preferentially increases HDL-2, which is the most beneficial of the HDL subclasses.
The most clinically important side effect of excessive niacin is that it can be very taxing on the liver (a condition known as hepatotoxicity), although as Alan Gaby, MD, points out in his exhaustive review of nutritional supplements and disease, this is almost never seen in patients taking 3 g or less per day.
Abram Hoffer, MD, the great pioneer of nutritional and integrative medicine, stated that his thirty years of experience with niacin therapy (usually 3 g a day or more) showed that one out of every two thousand patients will develop hepatitis from large doses of this vitamin. However, Hoffer also pointed out that in all of his patients who developed hepatotoxicity, liver function returned to normal after treatment was discontinued.18
Note that sustained-release niacin is actually more hepatotoxic than regular niacin, and liver problems may occur at lower doses.19 Nausea may be an early warning sign of niacin-induced hepatotoxicity; if nausea occurs, the dose should be reduced or treatment stopped. For patients taking therapeutic doses of niacin, it’s a good idea to have your doctor check your liver enzymes periodically using a standard liver function test.
L-carnitine
Studies of patients being treated for various forms of cardiovascular disease provide the strongest evidence for the benefit of L-carnitine supplementation. One study showed that people who took L-carnitine supplements after suffering heart attacks had significantly lower mortality rates compared to those of a control group (1.2 percent of the L-carnitine takers died versus 12.5 percent of the subjects in the control group).20
One randomized, placebo-controlled study divided eighty heart failure patients into two groups. One group received 2 g of L-carnitine a day, and the other group received a placebo. There was a significantly higher three-year survival rate in the group receiving L-carnitine.21
L-carnitine improves the ability of those with angina to exercise without chest pain.22 In one study, the walking capacity of patients with intermittent claudication—a painful cramping sensation in the muscles of the legs because of a decreased oxygen supply—improved significantly when they were given oral L-carnitine. In another study, patients with peripheral arterial disease of the legs were able to increase their walking distance by 98 meters when they supplemented with L-carnitine; they were able to walk almost twice as far as those who were given a placebo. Further, congestive heart failure patients have experienced an increase in exercise endurance on only 900 mg of L-carnitine a day.
And if that were not enough to establish L-carnitine’s bona fides, it has been shown to be a powerful cardio-protective antioxidant. One paper published in the International Journal of Cardiology found that L-carnitine had a direct stimulatory effect on two important oxidative stress–related compounds (HO-1 and ecNOS). Both markers have antioxidant, antiproliferative (inhibitory effect on tumor cells), and anti-inflammatory properties. The researchers concluded that this action of L-carnitine “would be expected to protect from oxidative stress related to cardiovascular and myocardial damage.”23
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Jonny Bowden, PhD, CNS, is a board-certified nutritionist and a nationally known expert on weight loss and healthy aging. His no-nonsense, myth-busting approach has made him a popular guest on television (Dr Oz, The Doctors, ABC-TV, MSNBC-TV, CNN, CBS-TV, CBN, Fox News, NBC-TV and dozens of morning shows in America), and a popular speaker at venues ranging from Beijing University to the American Academy of Anti-Aging Medicine. He’s the best-selling author of The 150 Healthiest Foods on Earth, The Most Effective Ways to Live Longer, and the controversial book written with cardiologist Stephen Sinatra, The Great Cholesterol Myth.
Well Being Journal adapted the above excerpt from The Great Cholesterol Myth, Revised and Expanded: Why Lowering Your Cholesterol Won’t Prevent Heart Disease–and the Statin-Free Plan that Will by Stephen Sinatra, MD, and Jonny Bowden, PhD. Copyright © 2020 and reprinted by permission of Jonny Bowden.
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