Talking to Your Doctor about Supplements

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

“My mother, who’s 73, recently had triple bypass surgery. The week after her surgery, I took her some of the supplements you recommended to help her get through recovery and to strengthen her heart. I gave her CoQ10, D-ribose, and your multivitamin. She said she’d ask her cardiologist if it was okay to take them. He said he “didn’t know enough about them,” so he couldn’t recommend the supplements. Now, my mom is afraid to take them.”

A member of my editorial team shared this story with me but she isn’t alone. For years, I’ve heard variations on this theme: I recommend certain nutritional supplements for heart health. Then, patients ask their other doctors about the supplements and often, receive negative or indifferent answers such as “they may cause harm,” or “there’s no science.”

Such responses are cop outs, to put it mildly. There’s an immense body of powerful research supporting the use and safety of supplements, and any smart doctor should certainly be up on the subject.

Supplements Are Safe

Here’s a revealing statistic: The American Association of Poison Control Centers reports 11 deaths, supposedly, from supplement use during the last 27 years. I say “supposedly” because the circumstances linking the supplements to actual deaths are questionable. This is a tremendous safety record.

Now, compare prescription drugs. A 2011 study reveals that each year in this country, adverse effects cause about 4.5 million visits to doctors’ offices and hospitals. In fact, prescription drugs are our fourth leading cause of death, killing more than 27,000 people in 2007—more than heroin and cocaine combined.

In addition to being safe, supplements are generally necessary because so many people have poor diets. Moreover, many medications cause nutritional deficiencies. I find it ludicrous that doctors believe supplements may cause harm but seem less concerned about the potential dangers of drugs.

Keep in mind that medical doctors get little, if any, nutritional training in medical school and rarely attempt to fill their knowledge gap once in practice. Years ago when I was a hospital medical education director, I had a hard time trying to encourage my physician colleagues to accept nutritional medicine. Most were simply annoyed by my efforts. They demanded to see studies, which I didn’t mind providing, but I had to spoon-feed them to make any progress.

What You Can Do

If your doctor disapproves of supplements, don’t be intimidated but be a messenger! Tell your doctor if you’ve had positive experience with certain supplements—convey your passion—and stick the evidence under his or her nose. To empower you, below I’ve capsulized information about supplements you are very familiar with: CoQ10, fish oil, and vitamin E. I chose them because a recent survey of physicians, including 300 American cardiologists, found that heart patients most often ask about these. The survey also found that 37 percent of cardiologists take supplements regularly and 57 percent take them “at least occasionally.”

If you face a reluctant or doubting physician, I hope that the key information and studies I’ve summarized here will help you to make your case.

CoQ10 Overview

A deficiency of CoQ10 was first identified in heart patients back in 1972. I started using the supplement in my practice in 1982 and have never been disappointed by its ability to help patients, in particular to boost the energy of weak, compromised hearts. Peter Mitchell, a British biochemist, won the 1978 Nobel Prize in Chemistry for showing how biological energy is created in cells, a process in which CoQ10 plays a central role. CoQ10 is a member of my “awesome foursome” nutrients (along with magnesium, carnitine, and D-ribose) that provide essential raw materials to the mitochondria, the energy-producing structures of cells. Moreover, CoQ10 is a major antioxidant.

In 1992, after years of trying to convince my colleagues, I was able to finally put CoQ10 on the pharmaceutical formulary of Manchester Memorial Hospital in Connecticut, meaning that patients in the hospital could be prescribed CoQ10.

I regard CoQ10 as a necessity for aging and ailing hearts, especially for individuals taking cholesterol-lowering statin drugs. Statins deplete the body of CoQ10, leading to problems such as muscle weakness and pain that reduce quality of life. In 2004, the Canadian Government ordered that all statin prescriptions carry a warning about CoQ10 depletion. I’m still waiting for that to happen in this country.

Important CoQ10 Studies

In 2008, a group of New Zealand doctors described CoQ10 concentration in the blood as an independent predictor of mortality in heart failure patients, and found that a deficiency leads to worse outcomes. My clinical observations over the years indicate that the bigger the deficiency, the more severe the symptoms. Heart failure patients are less symptomatic and have improved quality of life when they have CoQ10 blood levels greater than 2.5 mcg/mL (0.6– 0.8 mcg/mL is considered normal).

In 1994, a study of more than 2,500 Italian heart failure patients at multiple medical centers showed that 50–150 mg of CoQ10 daily, taken for three months, produced a variety of significant improvements in symptoms and clinical signs. Among these: cyanosis (tissue near the skin becoming blue as a result of low oxygen), 78 percent; edema, 79 percent; pulmonary rates, 78 percent; shortness of breath, 53 percent; palpitations, 75 percent; subjective arrhythmias, 63 percent; vertigo, 73 percent; and insomnia, 66 percent.

A 2011 study demonstrated that 300 mg of CoQ10 improved mitochondrial and endothelial function after eight weeks, in patients with left ventricular dysfunction as a result of coronary artery disease.

My Recommendations: For prevention: 50–100 mg daily; for heart disease: 100–200 mg or more; for heart failure: 300–600 mg. Choose a ubiquinone form for best absorption and always take CoQ10 with food.

Omega-3 Fatty Acids Overview

For many years, scientific research has recognized that omega-3 fatty acids, found in marine life, nourish the heart. For more than two decades, I have recommended fish oil to my patients and have seen it produce significant improvements in racing hearts, arrhythmias, atrial fibrillation, high blood pressure, and suppressed heart rate variability. Fish oil also helps to neutralize the toxic effects of Lp(a) (an ultra-inflammatory cholesterol particle), reduce arterial inflammation, improve endothelial function, and promote healthier blood flow and clotting. Recently, I switched from fish to squid oil, for two reasons:

Salmon, tuna, herring, sardine, and anchovy stocks are being depleted, yet these are the most common sources for supplements. Squid breed more rapidly and are not endangered. And, harvesting of squid does not harm the ecology of the sea floor.

Squid omega-3 fatty acids contain more DHA (docosahexaenoic acid) than EPA (eicosapentaenoic acid). DHA represents the more beneficial and protective component of the two, especially for the heart, brain, and retinas.

Important Omega-3 Studies

The most impressive study to date was done in Italy, where researchers followed more than 11,000 patients with a history of heart attacks, at 172 medical centers. Individuals who took 1 gram of fish oil daily had a 30-percent reduced risk of sudden death, from heart disease or any other cause, during the year following a heart attack—the period when they are the most vulnerable.

Another large-scale Italian study showed that fish oil provides protection for people with chronic heart failure. Among patients already receiving conventional treatment, approximately 2 grams of fish oil daily reduced deaths and hospital admissions. According to the researchers, fish oil helps to normalize heart rhythm and slow progression of heart failure.

A 2009 review of medical literature strongly validated the use of fish oil to prevent coronary artery disease and delay its progression. Researchers found that omega-3s reduce inflammation, lower blood pressure, and help to prevent fatty deposits that clog blood vessels.

My Recommendations: For general prevention, take 1–2 g daily, or eat fish (not fried—see next page) at least once a week. If you have heart disease, take 2–3 g daily. For fish recipes, visit drsinatra.com.

Vitamin E Overview

Vitamin E has been in the limelight as a heart-friendly antioxidant since the 1950s but over time, research results have been inconsistent with the most common type of vitamin E supplement: alpha tocopherol. In fact, this ingredient is only one of eight components that make up vitamin E in nature.

One reason for study inconsistencies may be the use of alpha tocopherol in isolation, without other members of the vitamin E family, leading to an imbalance of vitamin E components. Another may be that many supplements contain a synthetic form—dl-alpha tocopherol—rather than the natural form known as d-alpha tocopherol. (To avoid confusion, you can think of the “dl” in the synthetic form as “delivers less.”)

Yet another problem stems from taking too much vitamin E. An antioxidant in lower doses, alpha tocopherol in very high doses (800 or 1200 IU daily) can work in the opposite way and increase oxidation.

In recent years, research has begun to show that vitamin E should be taken in a form that more closely mimics nature. This includes the alpha tocopherol form and its sibling compounds, particularly gamma tocopherol and delta-tocotrienol, the most potent antioxidant substances in the family.

As I reported in March 2009, delta tocotrienol is particularly effective in reducing inflammation and deposits in arteries. In the early stages of atherosclerosis, it inhibits the activity of adhesion molecules—sticky substances produced in the walls of blood vessels.

For many years, I have routinely recommended a natural vitamin E formula with alpha and gamma tocopherol. In addition to its positive cardiovascular effect, vitamin E also protects the lungs from air pollution and the large bowel from carcinogens.

Important Vitamin E Studies

A 2008 review of previous studies by researchers at the University of Cambridge showed that vitamin E reduces the risk of heart disease.

A 2010 Chinese study using animal models found that delta tocotrienol may retard atherosclerosis by activating certain genes that influence energy metabolism and inflammation.

Laboratory studies have shown that mixed tocopherols are “much superior” to alpha tocopherol alone in protecting cell cultures from oxidative damage. “Lack of efficacy of commercial tocopherol preparations in commercial trials,” one study suggested, “may reflect absence of gamma- and delta-tocopherols.”

My Recommendations: Different components of vitamin E are listed separately on supplement ingredient labels. In a daily dosage, look for: 200 IU of d-alpha tocopheryl succinate, an especially absorbable form of natural d-alpha tocopherol; 50–100 mg of gamma tocopherol; and 25–50 mg of a combination of different tocotrienols (broad spectrum). And, a few times a week, eat foods that are rich in gamma tocopherol—almonds and wheat germ are best.

References:

  • Sinatra S, Roberts J, Zucker M. Reverse Heart Disease Now, Wiley, New York, 2008.
  • Sinatra S. The Sinatra Solution: Metabolic Cardiology. Laguna Beach, CA: Basic Health Publications; 2011.
  • Centers for Disease Control and Prevention. Prescription Drug Overdoses: An American Epidemic.
  • Sarkar U, et al. Adverse drug events in U.S. adult ambulatory medical care. Health Serv Res. 2011;May 10. [Abstract.]
  • Dickinson A, et al. Use of dietary supplements by cardiologists, dermatologists and orthopedists: report of a survey. Nutr J. 2011 Mar 3;10:20

CoQ10 Studies:

  • Molyneux SL, et al. Coenzyme Q10: an independent predictor of mortality in chronic heart failure. J Am Coll Cardiol.2008;52(18):1435–1441.
  • Baggio E, et al. Italian multicenter study on the safety and efficacy of coenzyme Q10 as adjunctive therapy in heart failure (interim analysis). Clin Investg. 1993;71(8 Suppl):S145–149.[Abstract.]
  • Dai YL, et al. Reversal of mitochondrial dysfunction by coenzyme Q10 supplement improves endothelial function in patients with ischaemic left ventricular systolic dysfunction. Atherosclerosis. 2011;216(2):395–401. [Abstract.]

Omega-3 Studies:

Vitamin E Studies:

This article, originally called “Your Doctor Says ‘No’ to Supplements – Now What?” first appeared in the August 2011 issue of Dr. Sinatra’s monthly written newsletter, Heart, Health & Nutrition. HMDI has reprinted this article with permission from Healthy Directions, LLC (© 2011 Healthy Directions, LLC).

Please note that we do not sell any of Dr. Sinatra’s supplements at Heart MD Institute. If, after reading this article, you have any product-related questions, please email csdrsinatra@drsinatra.com. More product information is available at Drsinatra.com.

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