The heart is a functioning muscle and needs oxygen
and fuel in order to do its work. It is the job of the
coronary arteries to supply the necessary oxygen
and nutrients to the muscle. When one of the
three major coronary arteries become narrowed
or blocked, blood flow to the muscle is reduced, resulting in
angina pectoris—a feeling of tightness or pressure in the chest
often associated with shortness of breath. At first, angina
may only be obvious during periods of exercise or emotional
stress, and may go away when the activity ceases. Later, it may
occur even while resting. If the blood flow to an area of the
heart completely stops, heart muscle cells die, causing a heart
attack, or myocardial infarction. While healing, the infarcted
or damaged area forms a scar, but is no longer a functioning
part of heart muscle.
Conventional medical treatments for angina include
blood vessel dilators such as nitroglycerine and other nitrites
and calcium channel blockers. If arteriograms show clogged
coronary arteries, bypass surgery is usually recommended.
Dietary Supplements: Primary Recommendations
Those pesky little free radicals really get around. They seem
to be involved in almost every cardiovascular condition, and
angina is no exception.1,2 Consequently, it's not surprising
that vitamin C and other antioxidants, which neutralize free
radicals, are beneficial in the prevention and treatment of
angina. In fact, studies have shown that men and women
with lower blood levels of vitamin C have a higher risk for
angina.3,4,5,6 Furthermore, research has also shown that vitamin
C supplementation, with or without other antioxidants, has
been able to reduce the incidence of angina.7,8,9 About 2,000
mg of vitamin C daily is recommended.
Co-enzyme Q10 is a vitamin-like substance involved in
cellular energy metabolism. It is also an antioxidant, like
vitamin C, that is beneficial in the prevention and treatment
of angina. In a study, which reviewed the scientific literature,
Co-enzyme Q10 was revealed to be used in oral form to treat
various cardiovascular disorders including angina.10 In one
study, patients with acute myocardial infarction experienced
a significant reduction in angina, arrhythmias (abnormal
heartbeat), and poor heart function when supplemented with
120 mg of Co-enzyme Q10 daily.11 Of course everyone knows that exercise is good to prevent
cardiovascular disease. But in one study, patients with ischemic
heart disease/effort angina were found to experience a faster
loss of Co-enzyme Q10 during exercise.12 Does this mean that
you shouldn't exercise if you have angina? No, it just means
you should supplement with Co-enzyme Q10. In another
study, 150 mg of Co-enzyme Q10 given to angina patients not
only increased their blood levels of Co-enzyme Q10, but also
increased their ability to exercise longer. These results lead the
researchers to conclude, "This study suggests that Co-enzyme
Q10 is a safe and promising treatment for angina pectoris."13
(Note: If you have acute angina, you should only exercise in
accordance to a program approved by your physician.)
Vitamin E is considered by many to be the granddaddy of all
antioxidant and cardiovascular support vitamins—and this
reputation certainly holds true in the case of angina. As with
vitamin C and Co-enzyme Q10 previously discussed, vitamin
E protects against the free radical damage associated with
angina. But what happens when there are inadequate levels of
vitamin E? Not surprisingly, research shows that blood levels
of vitamin E are significantly lower in patients with angina,
and that these lower levels render them more susceptible
to further cardiovascular damage.14,15,16 And what happens if
vitamin E is supplemented? Various studies show that vitamin
E supplementation, with or without other antioxidants, is able
to successfully decrease the incidence of angina in affected
patients.17,18,19 In fact, in a study, which examined vitamin use
in 2313 men, vitamin E supplementation was found to have
the strongest association with a reduced risk of ischemic heart
disease, including angina.20 Finally, vitamin E supplementation
together with conventional anti-anginal drug therapy has been
found to bring a higher response and exercise improvement,
as well as other positive changes, than drug therapy alone.21
About 100 –400 IU of vitamin E daily is recommended.
L-carnitine is an amino acid involved in energy metabolism.
Extensive research has also shown that l-carnitine has a valuable role to play in cardiovascular disease, especially where
angina is concerned. Several studies have demonstrated that
supplementation with l-carnitine (2000 to 4000 mg daily) is
able to reduce the incidence of anginal attacks in cardiovascular
disease patients.22,23,24,25 Furthermore, in studies involving
patients with angina pectoris and effort angina (i.e., angina
induced by physical effort, such as exercise), supplementation
with l-carnitine (2000 or 3000 mg daily) was able to improve
exercise performance.26,27,28,29,30 Furthermore, in a study where
l-carnitine was given to patients with effort angina along with
anti-arrhythmic drugs, the l-carnitine was found to improve
the action of those drugs.31
Germany's Commission E has validated the use of Hawthorn
in cases of cardiac insufficiency, resulted in an improvement
of subjective findings as well as an increase in heart work
tolerance, and a decrease in pressure/heart rate product.32
(Although Hawthorne Berry products are often marketed,
it is the Hawthorne leaves and flowers which have been so
carefully researched and validated.). In one study, a 60 mg
hawthorn extract taken three times per day improved heart
function and exercise tolerance in angina patients.33
Typically physicians will give their angina patients a prescription
for nitroglycerin tablets, which are used in case of an angina
attack. Nitroglycerine works through dilation of arteries,
which in turn, works through an interaction with nitric oxide,
which stimulates dilation. It is interesting to note that nitric
oxide is made from the amino acid arginine. Furthermore,
blood cells in people with angina have been shown to make
insufficient nitric oxide,34 (possibly due to abnormalities of
arginine metabolism). Of greatest significance is research
showing that 2 grams (2,000 mg) of arginine, three times per
day for as little as three days improved the ability of angina
sufferers to exercise.35 Additional research has shown that the
mechanism by which arginine operates is through stimulating
blood vessel dilation.36 (Note: If you have an active herpes
virus, you should avoid arginine supplements since they can
"feed" the virus.)
Dietary Supplements: Secondary Recommendations
The heartbeat normalizing effects of magnesium has been
described repeatedly since 1935, both as a factor in human
disease and in animal experiments. Nevertheless, this
therapeutic effectiveness is rarely mentioned in textbooks.
Both the therapeutic effect of magnesium and the correction
of magnesium deficiency have been used in treatment of
digitalis toxicity (a drug used to treat angina), angina, as
well as in arrhythmia (abnormal heartbeat) of unknown
origin. Magnesium deficiency can be caused by a number
of situations. Of possible concern to the angina sufferer are
the uses of drugs such as digitalis, diuretics, gentamicin,
as well as cisplatinum, which appreciably enhance urinary
magnesium loss. Correction of magnesium deficiency should
lead to recovery.37 About 300 – 500 mg daily is recommended.
Please note, however, that it may take weeks or even months of
magnesium supplementation, to achieve an angina-relieving
Omega-3 fatty acids
The omega-3 fatty acids EPA and DHA have been studied in
the treatment of angina. Some research indicates that 3 grams
or more of omega-3 oils (e.g., fish oils) three times per day
(providing a total of about 3 grams of EPA and 2 grams of DHA)
have reduced chest pain as well as the need for nitroglycerin,
a common medication used to treat angina.38 However, other
research did not confirm these benefits.39 In any case, if
omega-3's are used, vitamin E should be supplemented with
it, since the vitamin E may protect the oils against free radical
oxidation.40 Also, if you are using any type of blood-thinning
medication, consult with your doctor before using omega-3
Bromelain acts naturally as a blood thinner agent since it
prevents excessive blood platelet from clumping together,41
which would otherwise cause "sludgy" blood. Furthermore,
there have been positive reports in a few clinical trials of
bromelain to decrease thrombophlebitis (inflammation of
veins) and pain from angina and thrombophlebitis.42,43 About
1200–1500 mg daily (derived from at least 900 GDU/Gram
material) is recommended.
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- Kugiyama K , et al, J Am Coll Cardiol (1998) 32(1):103–9.
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- Singh RB, et al, Am J Cardiol (1996) 77(4):232–6.
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- Rapola JM, et al, JAMA(1996) 275(9):693–8.
- Singh RB, et al, Am J Cardiol (1996) 77(4):232–6.
- Motoyama T, et al, J Am Coll Cardiol (1998) 32(6):1672–9.
- Meyer F, Bairati I, Dagenais GR, Can J Cardiol (1996)12(10):930–4.
- Pimenov LT, Churshin AD, Ezhov AV, Klin Med (1997) 75(1):32–5.
- Singh RB, et al, Postgrad Med J (1996) 72(843):45–50.
- Davini P, et al, Drugs Exp Clin Res (1992) 18(8):355–65.
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- Ferrari R, Cucchini F, Visioli O, Int J Cardiol (1984) 5(2):213–6.
- Kobayashi A, Masumura Y, Yamazaki N, Jpn Circ J (1992) 56(1):86–94.
- Cacciatore L, et al, Drugs Exp Clin Res (1991) 17(4):225–35.
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- Cherchi A, et al, Int J Clin Pharmacol Ther Toxicol (1985) 23(10):569–72.
- Kamikawa T, et al, Jpn Heart J (1984) 25(4):587–97.
- Mondillo S, et al, Clin Ter (1995) 146(12):769–74.
- Blumenthal, M., et al, The Complete German Commission E Monogrpahs: Therapeutic Guide to Herbal Medicines/CD version (1998) American Botanical Council, Austin, Texas.
- Hanack T, Bruckel MH, Therapiewoche (983) 33:4331–33 [in German].
- Mollace V, et al, Am J Cardiol (1994) 74:65–68.
- Ceremuzynski L, Chamiec T, Herbaczynska-Cedro K, Am J Cardiol (1997) 80:331–33.
- Egashira K, et al, Circulation (1996) 94:130–34.
- Laban E, Charbon GA, J Am Coll Nutr (1986) 5(6):521–32.
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