L-Carnitine and Congestive Heart Failure

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L-CARNITINE HELPS REDUCE DEATH FROM CONGESTIVE HEART FAILURE
September 1999, Vol. V No.9 - Author: Dr. Sinatra

While the number of heart attacks in the United States has dropped in the last 20 years?largely due to positive lifestyle changes?deaths from congestive heart failure (CHF)?an energy-starved heart?have more than doubled during the same period.
Why? We don't really know why. But I believe it's because we're not giving people the nutritional support they need to feed their starving hearts. Currently, the typical treatment for CHF is: Digitalis (Lanoxin, Digoxin), which increases the strength of the heart's contractions and also helps slow the heart so it can fill and empty better.
Diuretics (Lasix, Bumex, Aldactone, etc.), which help the body eliminate excess salt and water. Aldactone, which has been around for more than 30 years, has received a fair amount of news coverage recently because of its ability to preserve potassium and improve the survival rate of people with CHF. This low-cost diuretic should be used more often.

Other commonly prescribed drugs are ACE inhibitors or beta-blockers, which relax arteries and lower blood pressure, thereby reducing stress on the heart and allowing it to pump more effectively. I've written much about both in the past (see HeartSense, March 1999, p.6).
Patients and doctors applaud these conventional treatments because they offer immediate relief of common symptoms like shortness of breath, swelling of the ankles, chest pressure or discomfort and even water in the lungs.

Unfortunately, these drugs are now given like aspirin for a headache. Yes, the pain is gone, but do we know what caused the headache so we can prevent another one from occurring?
Certainly, it's wonderful to alleviate a patient's symptoms, but these remedies don't get to the heart of the problem. While many people feel better when they take these agents, their underlying heart problems rarely improve?and may even get worse.

What's missing from the equation? Nutrients. Chief among them is L-carnitine. I've just finished doing a massive amount of research on L-carnitine for a book that I'm writing. I've found many studies that show how L-carnitine improves the survival rate of CHF patients. This is great news! This nutrient, like coenzyme Q10, is often lacking in CHF patients. It not only reduces or eliminates symptoms, but also fuels the "energy" houses of the heart's cells (the mitochondria) so the heart can pump better. This is what I call a total frontal attack of the problem!

All of my CHF patients take L-carnitine in conjunction with conventional therapies. It has helped me lessen heart failure and keep many patients out of the hospital. In fact, it should come as no surprise, given that I'm a cardiologist, that I encourage 80% of my patient population to take L-carnitine. I'll never forget when I lost five patients in one week to CHF. That was in the early part of the decade?before I started using L-carnitine. Now that I employ it widely, I have much more hope for a better quality of life for my CHF patients, as well as an improved survival rate. Indeed, the high mortality rate for CHF patients is a major problem. Often these patients have so much scar tissue from multiple heart attacks that the amount of healthy, functioning muscle is limited. And that frequently sets these patients up for heart failure. There is absolutely no downside to L-carnitine, which is even more effective when coupled with CoQ10 (see HeartSense, March 1999, p.7).
Let's take a look at the research. L-carnitine Reduces Mortality, Study Shows
In one controlled study of 160 patients hospitalized for heart attack, 80 received 4 grams of L-carnitine daily for 12 months. The other half received placebos. Both groups, meanwhile, continued to take conventional drugs during the study. The upshot? Blood pressure and cholesterol levels improved and rhythm disorders and CHF symptoms lessened or abated. The most significant finding was a tremendous reduction in mortality among those taking carnitine supplements: 1.2% compared to 12.5% for the controls.

More recently, in a double-blind, placebo-controlled study, 100 patients with heart attack symptoms received 2 grams of L-carnitine a day for 28 days. Arrhythmia, angina, heart failure and muscle damage all improved. There also was a significant reduction in cardiac death and non-fatal heart attack in the L-carnitine group: 15.6% compared to 26% in the placebo group. Although a larger study is needed to confirm this research, the fact remains that L-carnitine improved arrhythmias, the rate of recurring heart attack and even death from heart attack.
In a European study published in 1995 in the Journal of the American College of Cardiology, 472 patients received intravenous doses of 9 grams of carnitine a day for five days, followed by 6 grams daily (orally) for the next year.

The incidence of CHF death was 6% in the L-carnitine group versus 9.6% in placebo group ?a reduction of more than one third. Again, this data further confirms that L-carnitine prolongs life in these vulnerable patients. Researchers also validated previous studies by demonstrating an improvement in the heart's ejection fraction (EF) rate (the proportion of blood that's pumped out of the heart on each heartbeat. In CHF, the EF is often as low as 10?15%; a good rate is over 50%), as well as a reduction in the size of the left ventricle. The smaller the heart size, the better the survival rate.
Cardiomyopathy
Numerous studies also show that patients with cardiomyopathy, another common cardiac condition, have L-carnitine deficiencies. This condition (characterized by heart tissue that's damaged, diseased, scarred and a heart chamber that's enlarged, stretched or dilated) is often caused by a history of chronic high blood pressure or long-standing alcohol abuse, valve problems, viruses that attack the heart or even atherosclerosis.

In animal studies, researchers concluded that an L-carnitine deficiency causes biochemical changes that impair the function of the heart. In the case of the Syrian hamster, researchers gave the rodent L-carnitine in the early stages of cardiomyopathy and successfully prevented further damage to the animal's heart. In a study of very young children with cardiomyopathy, researchers found that the children responded favorably to prolonged administration of L-carnitine.

Given the research on L-carnitine, I wouldn't hesitate to give it to anyone?whether that person was having an acute heart attack or had a history of heart disease and/or CHF. L-carnitine is a must for anyone with any form of heart disease. It is also a great preventive as well as an anti-aging nutrient. I take L-carnitine myself and I plan to add it to my coenzyme Q10 Q-gel formula in the future (it's patented by Sigma-Tau.) Please stay tuned.

References: Davini P, Bigalli A, Lamanna F, Boem A. "A controlled study on L-carnitine therapeutic efficacy in post-infarction," Drugs Exp Clin Res., 1992;18:355?365. Singh RB, Niaz MA, Agarwal P, et al. "A randomized, double-blind, placebo-controlled trial of L-carnitine in suspected acute myocardial infarction," Postgrad Med J, 1996;72:45?50. Iliceto S, Scrutinio D, Bruzzi P, et al. "Effects of L-carnitine administration on left ventricular remodeling after acute anterior myocardial infarction: the L-carnitine ecocardiografia digitalizzata infarto miocardioco (CEDIM) trial," JACC, 1995;26(2):380?7. Kobayashi A, Yoshinori M, Yamazaki N. "L-carnitine treatment for congestive heart failure: experimental and clinical study," Jpn Circ J, 1992;56:86?94. Bashore TM, Magorien DJ, Letterio J, et al. "Histologic and biochemical correlates of left ventricular chamber dynamics in man," J Mol Cell Cardiol, 1987;9:734.
© Copyright 1999, All rights reserved. Photocopying, reproduction or quotation is strictly prohibited without permission from the publisher. For subscription information, please call 800-211-7643. HeartSense is dedicated to the prevention and treatment of disease. HeartSense cannot offer medical services; Dr. Sinatra encourages his readers to seek advice from competent medical professionals for their personal health needs. Dr. Sinatra will respond in the newsletter to questions of general interest, and urges you to write him at Phillips Publishing, Inc. The recommendations in this newsletter should not be viewed as a substitute for personal medical care.

CONGESTIVE HEART FAILURE: YOU MAY HAVE OPTIONS TO STRENGTHEN YOUR HEART - June 1996, Vol. II, No. 6 - author Dr. Sinatra

Let me tell you about my patient Hugh, a 66-year-old once fond of daily three-mile walks. He thought his recent wheezing, mild cough and shortness of breath were simply a prelude to a pesky "cold." His physician heard fluid in Hugh's chest and suspected it was more serious. His tentative diagnosis: pneumonia. He sent Hugh home with inhalers and a powerful antibiotic.
But Hugh's condition worsened. Over the next couple of days his cough became incessant. It was a struggle to breathe, and when he tried to lay down, the sensation was one he described with panic: "I thought I was drowning." Exhausted and fearful after a miserable night, Hugh went to the emergency room at dawn and was immediately admitted into the hospital. The diagnosis: congestive heart failure (CHF).

What's Going On During Congestive Heart Failure?
In essence, CHF results from a tired, weak, energy-starved heart that is losing its ability to pump blood efficiently. Sadly, it results in approximately 30,000 deaths annually. In this article, I want to discuss how you and your physician can improve your condition, strengthen your heart, relieve or even eliminate your symptoms, and not only prolong the length but also boost the quality of your life.

What Causes CHF?

First, I want you to understand that CHF is only a symptom of an underlying problem. In other words, the heart doesn't simply "fail" on its own, even though the underlying cause might not easily be figured out. Why is this important? Because the treatment that's right for you will take into account many factors unique to your situation?the stage of your disease, the nature and severity of your symptoms, your sensitivity to traditional cardiac drugs, your tolerance for side effects as well as other factors and circumstances that might be contributing to (and possibly be the primary cause of) your heart's weakened state. These might include high blood pressure, cigarette smoking, diabetes, alcoholism, damaged heart valves, previous heart attacks, deficiencies of vital nutrients, stress, anger....The list goes on.

How Is CHF Treated?
The medical community has come a long way in the treatment of CHF, and for many patients traditional medicine is effective. Prescription medication, in particular, can be dramatically helpful in alleviating symptoms. However, as with all strong drugs, the side effects can be almost as problematic as the initial symptoms. In other cases, the drugs simply aren't providing enough relief?you feel better, but not "in the pink."

It is for these kind of patients that I usually prescribe a course of complementary natural therapies to improve their prognosis. In some cases, natural therapies, which have few or no side effects, can reduce the need for conventional medicines. In many cases, alternative therapies can augment traditional medicines (see sidebar at right) and provide the final measure of relief that was lacking with drug therapy alone. Many patients benefit greatly from blending conventional and alternative therapies?a strategy I recommend to you if you are dissatisfied with your current treatment plan for CHF.

What follows is a description of the alternative therapies I use in my practice, most often as an adjunct to conventional medicine, sometimes in place of it. Most of these therapies are readily available without a prescription at health food stores. I'll describe how to use them, how they work and the dosages that I prescribe for my patients. Expect to spend between $10-15 for a 30-day supply of each of these treatments.

The listing is in the order in which these therapies should be tried. You often need a four-to-six-week trial to determine whether they are doing any good. It is a good idea to tell your physician what you are up to. Remember, it's safe to use natural remedies with medication but not as an immediate substitute for a medication. Eventually, you may be able to cut back on your prescription drugs by as much as 50%.

Alternative Therapies For Treating Congestive Heart Failure

Coenzyme Q10 (CoQ10) is prescribed by many highly trained, board-certified cardiologists across this country as well as in Western Europe and Japan. Unfortunately, there are still too many cardiologists who not only fail to recommend it but actually scoff at the idea, perhaps because they've been trained to believe that anything natural can't be as potent and effective as a highly engineered drug. Nonetheless, my own experience with patients and the enormous body of science supporting CoQ10 have convinced me that CoQ10 is the greatest addition to the treatment of congestive heart failure in this century. Its primary role?the production of energy at the cellular level?fuels the heart's essential function: pumping blood. Since all cellular functions are dependent upon energy, CoQ10 is essential for the health and normal functioning of all human tissues and organs. Normally, the amount of CoQ10 within the heart muscle is 10 times greater than in any other organ, but in CHF the heart cells are CoQ10-deficient, and the heart literally is not strong enough to pump blood from its own chambers.

Clinical studies show that 87% of patients with congestive heart failure and hypertensive cardiovascular disease improved after taking CoQ10 for six months, and for some, the gentle, natural boost to their energy-starved hearts brought dramatic improvement. Take one CoQ10 softgel daily with meals (three per day). For CHF, start with 180 mg daily and increase to 360 mg over three weeks. Significant relief from symptoms may take a few weeks to months. If you are generally healthy and are interested in preventive health, take 30-60 mg daily. (For references, see the insert listing over 100 CoQ10 studies included with your April issue. If you don't have a copy, send a self-addressed, stamped envelope to Customer Service, HeartSense, Phillips Publishing, 7811 Montrose Rd., Potomac, MD 20854.) Side effects: none reported.

If your response to CoQ10 is insufficient, the next step is to add hawthorn berry (Crataegus spp.), a treatment I've used extensively, particularly in patients sensitive to digoxin. According to clinical research, hawthorn berry can increase the action of digoxin, making it possible to decrease the dose of digoxin, thereby avoiding or lessening digoxin-related side effects. In fact, some patients with mild CHF get significant relief with hawthorn berry alone, an effect supported by double-blind studies in Europe. It's interesting to note that hawthorn berries are recognized by the German government as an approved heart medicine.

How does hawthorn work? It is believed to improve the heart's ability to metabolize energy and utilize oxygen, and the berry's extracts contain flavonoids that increase the heart muscle's force of contraction. Hawthorn berries also normalize irregular heartbeats, help lower blood pressure and enhance circulation by dilating the arteries. Dose: 500-1500 mg daily or take as a tincture in water three times daily. For prevention, I recommend drinking hawthorn berry tea, which you can make by pouring boiling water over a cup of berries and letting them steep for 15 minutes. Side effects: none reported.

L-carnitine, an amino acid reportedly taken by marathon runners to enhance athletic performance, may increase energy available to the heart muscle cells by supporting free fatty acid metabolism. Dose: 500 mg twice daily. Side effects: none reported.

Also available at health food stores, L-arginine is an amino acid that improves blood flow to the heart by stimulating endothelial cell releasing factor (ECRF), thereby inhibiting a chain of complex reactions that might otherwise cause plaque to form in the arteries and stifle blood flow to the heart. Dose: 2-4 grams before bedtime. Side effects: none reported.

Taurine has been shown to stabilize the electrical activity within the heart and improve the heart's contractile strength. You'll find it at health food stores. Dose: 3 grams daily. Side effects: none reported.

In stubborn, severe cases of congestive heart failure, I turn to Levodopa (L-dopa). It's the natural counterpart of an intravenous drug called Dobutamine. When CHF approaches terminal stages, cardiologists sometimes opt to administer Dobutamine, although they must hospitalize the patient for half a day in order to closely monitor the individual for dose-related adverse reactions. Many patients experience an increase in heart muscle strength with this once-weekly treatment, improving the effectiveness of their heart's pumping action.

Like Dobutamine, Levodopa is converted to dopamine in the body and can have similar beneficial effects on the weakened heart, but it can be taken orally. Vitamin B-6 promotes the conversion of L-dopa to dopamine and should therefore be taken along with the L-dopa to maximize the beneficial heart effects. Dose: must be determined and carefully adjusted for each patient. Side effects: rhythmic muscular twitches, heart palpitations, lightheadedness, nausea, vomiting.

The whole point here is to give your heart, and your quality of life, the best possible chance for improvement. For this to happen, it's critical that you and your physician respect the uniqueness of your body and of your particular heart condition?every patient is different. For your best shot at good quality of life, you should have a cardiologist who is willing to try complementary options.
If you have CHF and are unhappy with your response to traditional treatment, take heart: the alternative therapies I've outlined here, along with eating the Mediterranean way, regular activity and opening your heart emotionally, could make the difference you've been searching for.

Standard Medical Treatments: A Brief Overview

Digoxin. Used in this country for over six decades, digoxin is used in CHF to increase the force of heart muscle contraction. By improving the "pump's" performance, digoxin can help clear the body of the excess fluid that accumulates in the lungs of CHF patients. Side effects: nausea, vomiting, diarrhea, blurred vision, headaches, psychosis.
Diuretics. Diuretics increase urine output, thereby clearing the body of excess fluid and, as a fortunate secondary effect, lowering the blood pressure. Side effects: dehydration, electrolyte imbalance.
ACE inhibitors (ACE stands for Angiotensin Converting Enzymes).ACE inhibitors lower the blood pressure by inhibiting the body's production of specific chemicals that cause arteries to constrict. The arteries relax, and the heart's job (pumping blood through them) becomes easier. Side effects: dizziness, headache, fatigue, severe coughing.
Beta blockers. A typical bodily response to a failing heart is the secretion of the hormone adrenaline, causing an increase in heart rate?a useful response when you're in a threatening situation, but one that is supposed to last only long enough to get you out of trouble. Bathe your system in adrenaline over the long haul, as happens in the patient with CHF, and the chronic pounding will cause problems for your already weak heart. Beta blockers interfere with the "adrenaline effect," thereby protecting the heart.
Side effects: fatigue, dizziness, depression, diarrhea, low heart rate, wheezing, impotence.
Nitrates. Nitroglycerin and its relatives are potent dilators of the coronary arteries, enhancing blood flow to otherwise blocked segments of the heart muscle. The most common and important role of nitroglycerin is to provide relief from angina and shortness of breath.
Side effects: headache, dizziness, lightheadedness.

References
Barron J, Parrillo J. "Dilated cardiomyopathy: management strategy." Choices in Cardiology 6:205-208, 1995. Koifman B, Wollman Y, Bogomolny N, et al. "Improvement of cardiac performance by intravenous infusion of L-arginine in patients with moderate congestive heart failure." JACC 36(5):1251-56, 1995. Azuma J, Sawamura A, Awata N, et al. "Therapeutic effect of taurine in congestive heart failure: a double-blind crossover trial." Clin Cardiol 8:276-282, 1985. Ioannis K, Rizos, Aristoteles N, et al. "Haemodynamical effects of L-carnitine on patients with congestive heart failure due to dilated cardiomyopathy." JACC Abstract 339a, 1996. Barron J, Parrillo J. "Dilated cardiomyopathy: management strategy." Choices in Cardiology 6:205-208, 1995. Koifman B, Wollman Y, Bogomolny N, et al. "Improvement of cardiac performance by intravenous infusion of L-arginine in patients with moderate congestive heart failure." JACC 36(5):1251-56, 1995. Azuma J, Sawamura A, Awata N, et al. "Therapeutic effect of taurine in congestive heart failure: a double-blind crossover trial." Clin Cardiol 8:276-282, 1985. Ioannis K, Rizos, Aristoteles N, et al. "Haemodynamical effects of L-carnitine on patients with congestive heart failure due to dilated cardiomyopathy." JACC Abstract 339a, 1996.
© Copyright 1996, All rights reserved. Photocopying, reproduction or quotation is strictly prohibited without permission from the publisher. For subscription information, please call 800-211-7643. HeartSense is dedicated to the prevention and treatment of disease. HeartSense cannot offer medical services; Dr. Sinatra encourages his readers to seek advice from competent medical professionals for their personal health needs. Dr. Sinatra will respond in the newsletter to questions of general interest, and urges you to write him at Phillips Publishing, Inc. The recommendations in this newsletter should not be viewed as a substitute for personal medical care.