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

What is Cardiomyopathy?

Cardiomyopathy is a condition where heart muscle tissue becomes damaged, diseased, enlarged, or stretched out and thinned (dilated), and thus weakened. It is common, though lesser known, type of heart disease. Typically, heart disease involves inflammation and plaque build-up in the coronary arteries that supply the around-the-clock pumping action of the heart muscle with essential oxygen and nutrients. As this destructive process advances, the plaque may grow in size to choke off blood flow, or a piece of plaque may break off and also block blood flow. When a part of the heart muscle becomes oxygen-deprived, a heart attack can develop, sooner or later, and with or without symptoms.

Causes of Cardiomyopathy

Cardiomyopathy occurs as a consequence of heart attacks, chronic hypertension (high blood pressure), valvular disease, or some genetic glitch. Nutritional deficiencies, alcoholism, and infections may also trigger cardiomyopathy.

Whatever the cause, a weakened heart muscle can’t generate enough energy to sustain strong and healthy pumping action − contracting (pushing blood out into the body) and relaxing (refilling the heart chambers with blood).

Compromised pumping results in a variety of deficits that can severely affect quality of life. While early-stage cardiomyopathy may not produce any symptoms at all, as the condition progresses the common symptoms of heart failure (also called congestive heart failure) start showing up: shortness of breath with minimal exertion, fatigue, cough, and pain and fluid buildup (edema) in the legs and ankles. Fluid can also accumulate in the lungs and cause a serious congestion of blood in the heart.

Causes and consequences of cardiomyopathy are so varied that no single intervention can consistently be relied upon. The condition often leads to progressive failure and a high incidence of mortality: 20 percent after one year, and 70-80 percent after eight years for patients who develop outright heart failure. Cardiomyopathy is the third leading cause of heart failure after coronary artery disease and hypertension. Among women, heart failure is the leading cause of death over the age of 65.

Treatment for Cardiomyopathy

Conventional treatments for cardiomyopathy include drug therapy, defibrillators, and in the most serious cases of full-blown heart failure, heart transplantation. Lifestyle changes revolve around alcohol restriction, weight loss, exercise, smoking cessation, lowering stress, and an anti-inflammatory, low-sodium diet.

As an integrative cardiologist, I have used all these strategies in my clinical practice. However, I have taken an additional step that has made a significant difference in the quality of life of my patients and, I’m convinced, their longevity as well.

That added step is perhaps the most simple of all: targeted nutritional supplements that directly address the energy deficit of the heart muscle.

The specific supplements are co-enzyme Q10 (CoQI0), L-carnitine, magnesium, and D-ribose. I call them my “awesome foursome.”

In brief, the awesome foursome feed, protect, and facilitate the activity of the mitochondria, energy-producing structures within the trillions of cells in the body, including the hard-working heart muscle cells. Through a complex biochemical process, adenosine triphosphate (ATP) is produced inside the mitochondria. ATP is the fuel that powers cellular functions, just like gasoline runs the engine of a car. Patients with cardiomyopathy and heart failure suffer from ATP deficiency. Their hearts are energy-starved.

The awesome foursome helps significantly to rectify this situation. Moreover, they do not interfere with other treatment strategies. To the contrary, they support any comprehensive treatment approach. No prescription is needed; you can purchase them at a health food store.

My Supplement Recommendations:


CoQ10 is a vitamin-like substance and a central ingredient in the enzymatic process that produces ATP. It also has powerful antioxidant properties, and helps protect the mitochondria from oxidative damage. It is my favorite supplement because its efficacy is so superb.

As we age, our body’s natural supply of CoQ10 diminishes. In addition, the use of certain medication, namely cholesterol-lowering statin drugs often prescribed by doctors for cardiomyopathy and heart failure patients, depletes the body’s own CoQ10 production.

Multiple studies, beginning more than thirty years ago, have shown that CoQ10 supplementation significantly benefits patients with cardiomyopathy and heart failure. Every heart patient, I believe, benefits big time.

  • Dosage: 300-600 milligrams in divided doses daily with food. Use soft-gels for best absorption.


Molecules of this important amino acid provide a critical transportation service in energy production. They carry fatty acids into the mitochondria, a needed raw material for making ATP. They also carry wastes out.

Studies show that supplementation increases longevity, improves blood pressure, rhythm disorders, and signs and symptoms of heart failure.

  • Dosage: 1-2 grams once or twice a day, best taken on an empty stomach.


This VIP mineral is typically deficient in adults because it is stripped away in most processed foods. Whole grains, figs, and green, leafy vegetables are good sources of magnesium, but most people don’t eat enough of these healthy food sources. Moreover, stress depletes the body of magnesium.

Magnesium is essential for some 300 or so enzymatic activities in the body, cellular energy production among them. It is usually depleted in heart patients. Inside cells, it is most concentrated in the mitochondria. Nature designed it that way for a reason, so better make sure you have enough in your body. Magnesium also helps keep muscles and blood vessels relaxed, a factor that makes it beneficial as a natural remedy against high blood pressure.

  • Dosage: 400-800 milligrams daily in divided dosages. I like a broad spectrum supplement that combines these four forms of magnesium: orotate, citrate, glycinate, and taurinate. Start low and increase dosage gradually. Too much magnesium all at once can temporarily cause loose stool. I don’t recommend magnesium oxide, a common form used in many supplements. It is not well absorbed.


As a building block of ATP, D-ribose can rapidly restore depleted energy in sick hearts.

Every cell in the human body makes some of this simple sugar molecule but only slowly and to varying degrees, depending on the tissue. Heart tissue, for instance, can only make enough to manage day-to-day needs in a normal situation. Unfortunately, these cells lack the metabolic ability to make D-ribose quickly when stressed, as occurs with heart disease when the blood supply to the heart is compromised. When oxygen and nutrient deficits become chronic, tissues can never make enough D-ribose and cellular energy suffers. D-ribose is the only compound generated by the human body to replenish the diminished ATP energy stores.

Certain drugs, known as inotropic agents, are utilized in cardiology to make the heart beat stronger for patients. However, they place considerable strain on the heart and long-term treatment with these agents can further drain energy reserves.

Here is where D-ribose can come to the rescue. Research shows that supplementation reduces the energy drain without any negative impact on the activity of the drug.

  • Dosage: in the capsule form, take 15 grams daily in divided doses; if taken as a powder, a teaspoon three times a day. Either way, take it with meals.

The “awesome foursome” help nurture, “fertilize,” and support the mitochondria. Together they act like a sparkplug, stoking the mitochondrial production of ATP. They can recharge your heart like nothing else I know.

I suspect these four nutraceuticals were a prime reason why my re-admission rate for heart failure patients at the hospitals I served was practically nil. I was able to improve the quality of life of my patients and keep them out of the hospital! That’s what medicine should be all about – making healthier patients.


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