Ray D. Strand, M.D. Specialist in Nutritional Medicine
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Cardiomyopathy
or Congestive Heart Failure

View Related Case Studies

The heart is not a complicated organ. It is primarily a muscle whose main job is to pump blood throughout the body. It has its own electrical system, which allows it to beat in an efficient manner. And the heart’s valves keep the blood flowing in the right direction. It’s about that simple, as long as it remains healthy.

Though elementary in its function, this primary muscle’s responsibility for pumping life-giving blood to every organ in the body means it must continue beating consistently at all times and therefore has remarkably high energy requirements. It also needs a blood supply to provide itself with an adequate amount of oxygen and nutrients to perform its job. This is accomplished via the coronary arteries.

Here we are going to discuss congestive heart failure and cardiomyopathy, two diseases involving the heart muscle. When the heart muscle becomes weak it is not able to pump all the blood that it receives from the body and the lungs. It then attempts to compensate for its weakened state by dilating and beating faster, but blood backs up into the lungs, filling them with fluid. Essentially the person begins to drown. This is called congestive heart failure. Cardiomyopathy is a more severe form of heart failure; it’s hallmark being an uncommonly large, dilated heart.

Congestive heart failure and cardiomyopathy have numerous causes: hypertension, coronary artery disease, repeated or severe heart attacks, and viral infections, to name a few. The standard medical treatment for this disease is diuretics, digitalis, and angiotensin converting enzyme inhibitors known more commonly as ACE inhibitors, and more recently Beta blockers. Patients with cardiomyopathy usually have only minimal improvement on these traditional medical regiments. Therefore, the only option for many of these people is to be placed on a heart transplant list.

Heart muscle cells have a remarkably high-energy requirement. Biochemical research in recent years has demonstrated that the heart muscles in patients with congestive heart failure and cardiomyopathy are deficient in a nutrient called Coenzyme Q10. The more severe the heart failure, the more severe is the depletion of Coenzyme Q10 (CoQ10). This has been a consistent finding no matter what the underlying cause of the heart failure happens to be. In fact, there is speculation among researchers that CoQ10 deficiency may well be an underlying cause of heart failure.

WHAT IS COENZYME Q10?

Coenzyme Q10 (CoQ10) or ubiquinone is a fat-soluble vitamin or vitamin-like substance that is also a potent antioxidant. Trace amounts of CoQ10 exist in a variety of foods such as organ meats, beef, soy oil, sardines, mackerel, and peanuts. The body also has the ability to make CoQ10 from the amino acid, tyrosine, but this requires a seventeen step process needing at least eight vitamins and several trace minerals to complete. A deficiency in any one of these nutrients can hinder the body's natural production of CoQ10.

Coenzymes as a group are cofactors essential for a large number of enzymatic reactions within the body. Coenzyme Q10 is the cofactor for at least three very important enzymes used within the mitochondria of the cell. Remember, the mitochondria is the battery or furnace of the cell where the energy is produced. Mitochondrial enzymes are essential for the production of the high-energy phosphate called adenosine triphosphate (ATP), upon which all cellular function depends.

COENZYME Q10 DEFICIENCY AND HEART FAILURE

The normal blood levels of CoQ10 have been well established by numerous investigators. Significantly decreased amounts of CoQ10 have also been noted in several diseases. This deficiency can be caused by: 1) poor dietary intake 2) impairment of the body's ability to synthesize CoQ10 3) excessive utilization of CoQ10 by the body or a combination of these factors.

Because Coenzyme Q10 has been noted to be significantly depleted in the blood and heart muscle of patients with heart failure, investigators in the early 1980's began supplementing these patients with CoQ10 to test possible improvement. These clinical trials were made possible by the availability of pure CoQ10 in large quantities from pharmaceutical companies in Japan and the ability to directly measure the level of CoQ10 within the blood and tissue.

Several clinical trials have now been done comparing the effect of supplementing medication with CoQ10 for cardiomyopathy or congestive heart failure patients’ and comparing them with those who took a placebo. No fewer than nine placebo controlled clinical trials have taken place around the world to evaluate the treatment of heart failure with CoQ10. There have also been eight international symposia on the biomedical and clinical aspects of CoQ10 wherein physicians and scientists from eighteen different countries presented over 300 papers.

The largest of these international studies was the Italian multi-center trial by Baggio involving 2,664 patients with heart failure. In the United States the leading investigator has been Peter Langsjoen, M.D. who is not only a cardiologist but also a biochemist. He has reported several studies in the medical literature showing the beneficial effects of CoQ10 in cardiomyopathy.

The patients tested continued their conventional medical treatment and CoQ10 was added to their regime. Comparison was then made with those who either received a placebo or conventional medical therapy. Heart function was determined by the percent of blood that the heart was able to pump during a contraction (ejection fraction). In most cases, this was established by echocardiography, which is a sound wave study of the heart.

All of these studies have confirmed the effectiveness of Coenzyme Q10 in congestive heart failure and cardiomyopathy along with its safety. Clinical improvement was determined by using the New York Heart Association classification (NYHA) for functional capacity. The function of the heart showed gradual and sustained improvement in the muscle contraction as noted by improved ejection fraction, heart wall motion, and heart size. The overwhelming majority of these patients showed improvement in their symptoms of fatigue, chest pain, shortness of breath, exercise ability, and palpitations. The improvement in some patients was dramatic, with the heart size and heart function returning to normal.

The patients who started CoQ10 in supplementation shortly after developing their disease seemed to have the most dramatic improvement. For those who had suffered with their heart disease for a longer time improved but usually not to the same degree. In marked contrast, individuals with the worse heart failure actually had the greatest percentage of improvement. These amazing results were coupled with the fact that the CoQ10 did not create any serious side-effects even at the highest doses. An eight-year follow up study has shown that improvements were sustained as long as the patients continued taking CoQ10.

Approximately 20,000 patients under the age of 65 are eligible for a heart transplant that will cost in the area of $250,000 to $400,000. Thousands more patients over 65 have cardiomyopathy but are ineligible for a heart transplant due to their age. They are receiving maximal medical treatment but most are still totally disabled. Only one in ten who are eligible for a heart transplant will actually receive one; the other nine will most likely die from their disease. These numbers don’t include the hundreds of thousands of patients who suffer from congestive heart failure who are not able to function normally because of their disease, but whose conditions are not severe enough to be placed on a heart transplant list.

Dr. Folkers and Peter Langsjoen, M.D. reported a study in the medical literature in 1992 that I believe brings all of this to an obvious conclusion. They placed eleven exemplary transplant candidates on Coenzyme Q10. All patients improved remarkably and would have all been taken off the heart transplant list. Folkers and Langsjoen concluded that with these case histories and the substantial clinical trials already reported in the medical literature show proof that all patients with end stage heart failure awaiting transplantation should receive CoQ10.

CoQ10 is a prime example of a natural vitamin/antioxidant shown in several clinical trials to be effective and safe. This is nutritional medicine at its core. When the heart muscle is weakened, for whatever reason, it places an increased demand on the nutrients needed by the heart cells in order to create energy. Because of excessive utilization of these nutrients, the heart muscle eventually becomes depleted of CoQ10, which is the most important nutrient needed to create energy. When patients take this nutrient as a supplement, the weakened heart muscle is able to replenish its stores of CoQ10, generate more energy, and compensate for its weakened state.

A note of caution: Doctors should use CoQ10 in support of traditional medical treatment, not in place of it. This is complementary medicine, not alternative medicine. Although in many studies patients improved so much they were able to stop taking several of their medications, they were nevertheless not cured of their underlying disease.

It is important to also note that patients should continue taking supplemental CoQ10 long term. Clinical studies report that when patients discontinue using supplemental CoQ10, the needed fuel source becomes depleted again and heart function slowly decreases back to its previous poor level. On the other hand, Dr. Langsjoen reported after a six-year follow-up study of patients, those who maintained their supplemental dosage maintained their heart function improvement.

WHY AREN'T PHYSICIANS RECOMMENDING COENZYME Q10?

Here we have a life-threatening disease for which traditional medical therapy offers little hope for improvement. The cost of taking CoQ10 in supplementation is approximately two to three dollars a day. That is substantially less than a $250,000 to $400,000 heart transplant for which most of these patients are waiting! Furthermore, the use of CoQ10 has never shown any side effects or problems and most of the studies show marked improvement within four months. So why don’t physicians recommend a trial of CoQ10 to their cardiomyopathy patients?

I have never heard a discussion of the use of CoQ10 at any medical meeting or with any cardiologist. And I’ve never heard of a cardiologist placing any of my patients with congestive heart failure or cardiomyopathy on CoQ10. After reviewing these studies, I too am amazed at the unwillingness of the medical profession to offer this option to patients. It is not as if they have good alternative therapy. (I don’t consider a heart transplant as a great option even if you are able to get one).

The National Institute of Health has funded most of the studies involving CoQ10 in the United States. But unlike the plethora of synthetic drugs, Coenzyme Q10 is a natural product. As such, it cannot be patented through the FDA. Pharmaceutical companies are not going to spend the hundreds of millions of dollars required to get a drug or natural product approved by the FDA if there is little economic incentive. Why don’t doctors recommend CoQ10? Pharmaceutical reps are not presenting it to them--there is simply no money in it.

Physicians must become the patient's advocate. I cannot emphasize a basic principle here too much: when we support the natural functioning of the body and try to elevate this function to its optimal level, then and only then have we done everything possible to promote healing. The lives of several of my patients give testimony to this. After following the recommendation below, they too have been removed from the heart transplant list. Your doctor won’t recommend it, so you must be especially assertive in obtaining CoQ10 for treatment. Below you will find guidelines to help you.

Nutritional Supplement Recommendations

I recommend that all my patients take the basic nutritional support I refer to as cellular nutrition. This foundational regime provides all the necessary micronutrients to the cell at ideal levels (not RDA levels) for significant health benefits as documented in the medical literature. When the cell is given maximum support, it can then determine what it does and does not need. Over a six-month period each cell is able to not only overcome nutritional deficiencies but also to optimize ALL the nutrients, which are needed to combat oxidative stress.

The synergistic affect of providing all the nutrients needed by one’s body at the most advantageous levels results in optimizing and rebuilding the body’s natural immune system, antioxidant, and repair systems back to their fullest fighting potential against disease.

Minimal support for Cellular Nutrition:

My minimal recommendation for creating cellular nutrition is to simply take Usana’s Mega Antioxidant and Chelated Minerals, called "The Essentials" at their recommended doses (3 of each daily). The Essentials offers the cell ALL of the antioxidants, B-cofactors, and antioxidant minerals needed by the cell at ideal levels. In order to achieve the best results, I recommend taking 1 Mega Antioxidant and 1 Chelated Mineral with each meal. Nutritionals should always be taken with food because of better absorption and better tolerance. However, as a physician, I realize that compliance with taking supplements three times a day is a major issue. Therefore, if you tend to frequently forget the lunchtime dose, I suggest taking the supplements twice daily: taking 2 Mega Antioxidants and 1 Chelated Mineral in the morning with breakfast and 1 Mega Antioxidant and 2 Chelated Minerals in the evening with the evening meal.

Optimal support for Cellular Nutrition:

For the most favorable results for basic cellular nutrition, I also recommend adding to the Usana Essentials either OptOmega (2 tsps daily) or BiOmega-3 (4 capsules daily), which provides the essential fats and Fibergy, which assures the individual is receiving the additional fiber his or her body needs. I also recommend adding Active Calcium (4 tablets daily) to provide additional calcium, magnesium, and vitamin D that our bodies need. These recommendations provide all the nutrients at their ideal levels creating the cellular nutrition I recommend in my book, What Your Doctor Doesn’t Know About Nutritional Medicine May Be Killing You.

Optimizers

It is critical that you know the necessity of adding optimizers to your foundational cellular nutrition for optimal results. Patients who are suffering from a chronic degenerative disease or illness are under more oxidative stress than the average healthy individual. Therefore, adding potent Optimizers to the basic cellular nutrition offers you the best chance to bring this oxidative stress back under control. The synergy and increased potency created by this approach to nutritional medicine is why I’m able to get such consistent results in my patients.

However, to suit each individual’s unique needs, I always offer both an optimal and a minimal plan for cellular nutrition and for adding Optimizers. Obviously, one’s improvement will be quicker and more consistent with the optimal recommendations; however, a minimal regime can still produce significant clinical results.

Recommended Optimizers:

Optimal:

  • Proflavanol 90*--2 tablets daily
  • Coquinone 30—6 capsules daily
  • Additional Magnesium in the form of Active Calcium—6 tablets daily

Minimal:

  • Coquinone 30—4 capsules daily

*Proflavanol 90 is equal to 3 Proflavanol C

Optimal Recommendations

Nutritional Supplement Breakfast Lunch Dinner
Mega Antioxidant (Mega AO)
Chelated Mineral (Multi Mineral)
Active Calcium
Proflavanol 90  
Coquinone 30
Optomega 2 tsps.     
Biomega-3 (an option instead of Optomega)  
*Adding at least one serving of Fibergy daily will enhance these recommendations.

Minimal Recommendation

Nutritional Supplement Breakfast Lunch Dinner
Mega Antioxidant (Mega AO)
Chelated Mineral (Multi Mineral)
Coquinone 30

If you are frequently going to miss taking your lunchtime dose, it is better to simply take your nutritionals twice daily. I recommend taking 2 Mega Antioxidants, 1 Chelated Mineral in the morning with breakfast and then taking 1 Mega Antioxidant, 2 Chelated Minerals in the evening. You should try to divide up your Active Calcium, essential fats, and Optimizers equally as possible between the AM and PM dose.

Consider a Power Shake

USANA has a fantastic line of nutritionally balanced drinks that many of my patients consume as a meal substitute. In fact, I personally start every morning with 2 scoops of Fibergy, 2 scoops of Soyomax, and 2 teaspoonfuls of OptOmega. This provides me with a perfect, balanced, unpolluted meal to start my day. It allows me the opportunity to supplement my diet with soy protein; extra needed fiber, and essential fat. This meal is also a low-glycemic meal, which will not spike my blood sugar. Likewise, many USANA associates are using their imaginations to create exceptionally tasting meals with Fibergy and OptOmega. By blending in frozen, whole fruit for added flavor they are creating a variety of great tasting drinks.

Isn’t it remarkable that by simply taking USANA Essentials, Active Calcium and a power drink (remember, to consider this part of your food budget, since it is replacing an entire meal), the body is supplied with complete, and balanced cellular nutrition for every cell in the body? The synergy that is created, especially when adding needed Optimizers is phenomenal. Remember, the underlying problem is oxidative stress NOT a nutritional deficiency.

Why I recommend USANA Products

USANA strictly follows pharmaceutical-grade Good Manufacturing Practices (GMP). This means they not only purchase pharmaceutical-grade raw products, but also manufacture the products according to tough pharmaceutical-quality guidelines. In addition, USANA Health Sciences follows USP guidelines for potency, uniformity, and dissolution of the tablet. In a nutshell, USANA manufactures their products to the strict standards of over-the-counter drugs even though not required to do so—assuring all of their customers and associates that what is on the label is actually in the tablet.

Usana's essentials are complete and balanced and provides the cellular nutrition that I strongly recommend in my book, What Your Doctor Doesn't Know About Nutritional Medicine May Be Killing You. This improves compliance and makes taking these advanced levels of nutritional supplements easier.

Starting Your USANA Nutritional Program

Over eighty percent of my patients are able to start the USANA Nutritional Program with absolutely no set backs while beginning to experience the health benefits of high-quality nutritional supplements immediately. Please keep in mind these supplements are extremely potent and optimal levels of nutrients are being provided that the body has never had before. The body is therefore able to finally rid itself of toxins, which have been accumulating for years (called detoxification). This is especially true in those who are suffering from a serious illness and are taking a significant amount of medication. It is important to understand the possible signs and symptoms of detoxification so that you can deal with them confidently and properly.

Detoxification:

The most common detoxification reaction is muscle aches and/or mild headache. These symptoms will usually pass within a few weeks. If the discomfort is not unbearable, I simply have my patients continue their program as I have prescribed. However, occasionally there is a more severe reaction. The patient is not in danger, rather, the amounts of nutrients are just too much too fast. In this case, I have my patients quit their supplements for a few days until the reaction subsides. I will then have them start back on their program but initially at lower doses (approximately one third of the recommended dose). Once they are tolerating this amount of supplementation, I suggest slowly building up to the recommended doses.

Some of my patients actually develop a "detox" skin rash somewhere on their body. As you know, the skin is an important route for ridding the body’s toxins. This rash is a dry, red rash that looks almost like a mild sunburn. Some people confuse this with an allergic reaction to the supplements. This is not typically so. I have never seen an allergic reaction to the USANA Essentials and can only recall a couple of patients who reacted to Proflavanol because they were actually allergic to grapes.

Patients may also experience some aspect of loose stools or even diarrhea. This again is a common "detox" reaction because the GI tract is another prime route for eliminating toxins from the body. This symptom will usually diminish within a couple of weeks. It is an important part of the detoxification and healing process. Therefore, I usually encourage my patients to continue the supplements as recommended unless their bottom gets too sore. I will then again recommend lower doses of the supplements until they feel better and then begin adding the supplements back more slowly until the recommended doses are reached. Diarrhea can be the result of the magnesium in the Active Calcium or by the Proflavanol. Again, this is usually a mild reaction and will improve over the first week or two. However, some of my patients need to discontinue the Active Calcium and/or the Proflavanol until this settles down. I then have them slowly add back the Proflavanol and eventually the Active Calcium.

Increasing dietary fiber may also increase the amount of intestinal gas and the frequency of bowel movements. This will improve with time as the body adjusts to the higher intake of fiber, but is an important aspect of getting rid of the toxins, which have accumulated in the body.

Natural Relaxation Response:

A small percentage of patients develop a natural relaxation response when minerals are absorbed into their body. This is of great concern to those patients who have just been told that nutritional supplementation will help improve their energy level. They take the supplements as recommended only to find themselves more fatigued and dragging themselves through their day. If you experience this response, I recommend that you take all of your minerals (including the Active Calcium) with a light bedtime snack. This allows you to take advantage of your body’s response while getting a good night’s sleep.

Stomach Upset:

A small percentage of patients have difficulty tolerating vitamin C. It can cause an upset stomach that will usually become evident a couple days after starting their nutritional program. With USANA’s specially combined vitamin C into Poly C, I have seen many of people who could not previously tolerate any nutritional supplements do very well with USANA’s Mega Antioxidant. However, if nausea is experienced, I suggest taking one Mega Antioxidant with the largest meal. Once this level of supplementation is better tolerated, I suggest slowly adding another Mega Antioxidant to the next largest meal. I anticipate building them up to the recommended level of supplementation, but sometimes this is just not possible. For those extremely sensitive, I advise using Body Rox (the teenage dose of Antioxidants and Minerals) as the best alternative option.

Taking Your Supplements with Your Medication

I am often asked, "Can I take my nutritionals with my medication?" To this I respond with this question, "Can you eat?" I hope my point is made gently but clearly—nutritional supplements simply contain nutrients we should be getting from our foods, but at levels we can no longer obtain from our foods. If you can eat anything, you can also take nutritional supplements. The only exception to this is for those taking the medication, Coumadin (Warfarin), which blocks vitamin K in the body as a way of thinning the blood. If a patient is on Coumadin, I recommend he or she take the Canadian Essentials and Canadian Active Calcium because they contain no vitamin K. Also, patients who are on thyroid medication should take their medication on an empty stomach at least 1 hour prior to meals or prior to taking supplements. Thyroid medication should not be taken with food or with supplements because calcium can block the absorption of the medication.


Disclaimer

Every effort has been made to make this web site as accurate as possible. The purpose of this site is to educate and inform. As such it is based on scientific evidence and my clinical training and experience. No individual should at any time use the information found on this web site for self-diagnosis, treatment, or justification in accepting or declining any medical therapy for any health problems or diseases. Any application of the advice herein is at the reader’s own discretion and risk. Therefore, any individual who has a specific health problem or is taking medications must first seek advice from his or her personal physician or healthcare provider before starting a nutritional supplement program. Dr. Strand shall have neither liability nor responsibility to any person or entity with respect to loss, damage, or injury caused or alleged to be caused directly or indirectly by the information contained in this web site. We assume no responsibility for errors, inaccuracies, omissions, or any inconsistency herein. Any slights of people, places, or organizations are unintentional.

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© 1999, 2000, 2001, 2002, 2003, 2004 Ray D Strand, M.D. P.C.
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