flowers and a small bowl of mixed supplement capsules

Q & A: Vitamins and Supplements

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

Q: Can D-ribose be taken by those who have a defibrillator?

The body makes D-ribose so it’s a safe ingredient to take even if you have a defibrillator.

Q: I understand that it is not a good idea to drink alcohol while taking melatonin, but is it OK to have the occasional glass of wine provided one does NOT take the melatonin on the day one drinks the wine? Or is it better to avoid alcohol completely when taking melatonin?

It is OK to have a glass of wine the same day that you take melatonin, just no alcohol after 8pm and take the melatonin at bedtime.

Q: Dr Sinatra, you mention taking magnesium …I understand it is best to take with calcium…if you agree, what is the ratio? Also my triglycerides are 66mg/dL and HDL 87mg/dL…seems way out of whack, am trying to do everything correctly, what am I not doing?

Old data and recommendations suggested 1000mg calcium for premenopausal women, and even higher in postmenopausal women. However, this guideline has been refuted and much lower dosing of calcium is advised. Most of us get adequate amounts of calcium in the diet, especially if taking supplemental vitamins and minerals as well. I love your triglyceride and HDL levels and, if you were my patient, I would advise that you continue with your current program.

Q: I have Central Retinal Artery Occlusion damaging my right and also have osteoporosis. Can I take Nattokinase and Calcium with Vitamin K2 together since both seem to work against each other – one is anti-clotting and the other is clotting?

Vitamin K-2 helps the liver produce clotting factors that remain inactive until called upon – so it won’t promote unnecessary or excess blood clotting. K-2 really shines when it comes to bone health, as it helps to shuttle calcium into the bones. On the other hand, Nattokinase assists in the break-down of fibrin – a component of blood clots. The two work side by side providing different effects and won’t counteract one another. Please be sure to consult with your doctor before taking these supplements, especially if you have a history of blood clots or are on prescription blood thinners.

Q: I’m working on bringing down my LDL cholesterol through my diet, but, in the meantime, are there any supplements or nutrients that I can take to protect my arteries from hardening?

The key to keeping your arteries supple and relaxed is to keep the endothelial cells, which line the surface of your vessels, healthy and happy. I talk a lot about these cells because they keep blood flowing smoothly. And they contribute to your vascular tone by producing chemical substances, such as endothelium-derived releasing factor (EDRF), which keeps your arteries from contracting.

Vitamin E and other antioxidants are your bodyguards against toxic LDL cholesterol. Vitamin E prevents the dangerous oxidation of fats by neutralizing the free radicals (oxidized LDL) produced during normal metabolism. Endothelial cells and other members of our natural defense system, such as white blood cells, normally pickup and neutralize harmless LDL. However, during times of acute stress, strenuous exercise, infection or inflammation, your defense system can be overwhelmed. A proliferation of oxidized LDL causes fatty, sticky streaks that injure the walls of your arteries, creating a site for plaque to adhere and build up. Research has shown that if enough vitamin E is present, it can prevent up to 40% of this harmful oxidation from occurring. On hundred IU of vitamin E per day is sufficient to help prevent the oxidation of LDL cholesterol.

Excellent food sources of gamma tocopherol include wheat germ and almonds. Fish oil or squid oil (1 – 2 grams) is also an endothelial friendly supplement that helps protect LDL.

I also recommend that you take the equivalent of 120 to 180 mg of coenzyme Q10. This potent free radical scavenger recycles oxidized vitamin E while serving as an antioxidant at the same time.

Quercetin may also protect your arteries by interrupting the oxidation of LDL cholesterol. Although clinical research has not determined an exact dosage, I believe that 50 to 100 mg daily can help to neutralize free radical damage. Onions, grapefruit, apples, black tea, broccoli, shallots and red wine are all good dietary sources of quercetin.

*Q: My doctor says I have congestive heart failure because my heart is weak. Can I take coenzyme Q10 to strengthen my heart?

The treatment of congestive heart failure (CHF) is perhaps the toughest challenge I face as a cardiologist. That’s because many CHF patients either fail to respond to conventional treatment or they develop side effects with their own set of complications.

I believe that hydrosoluble coenzyme Q10 is the first-line defense in the treatment of CHF. CoQ10 works by enhancing energy at the cellular level, especially in the heart, thereby enabling the heart muscle to pump blood much more efficiently. It is a crucial, life-enhancing therapy for CHF patients, even when traditional medical therapy is successful. CoQ10 supplements may allow some CHF patients to reduce their use of traditional drugs like ACE inhibitors and diuretics, as well as minimize their chance of developing other cardiac problems like fluid in the lungs and cardiac rhythm disturbances. In the November 2008 issue of the American Journal of Cardiology, the higher the blood level of Q10 in patients with CHF, the better the survival. I use coenzyme Q10, 200 to 600 mg for the treatment of congestive heart failure.

Q: I’ve read that magnesium can reduce blood pressure and even help relieve angina. Is this true?

Yes, borderline or low blood levels of magnesium can cause angina symptoms. Over time, low magnesium levels may predispose the interior of your blood vessels to go into spasm, constricting blood flow to the heart. Also, there is a direct link between inadequate magnesium levels and high blood pressure, which places an extra oxygen demand on the heart. This vital mineral is endothelial cell friendly, coming to the rescue of constricted vessels by helping the surface lining of your arteries to stay smooth and elastic.

Be aware that if you take diuretics, a common treatment for high blood pressure or congestive heart failure, you may be depleting your magnesium stores. For others of you, inadequate dietary intake of magnesium may cause your low levels.

If you suffer from intermittent angina attacks or are concerned about high blood pressure, try to eat more whole grains, fish, leafy green vegetables, bananas, brown rice, seeds, nuts and soy products to boost your magnesium intake. The foods highest in magnesium are kelp, tofu, figs and pumpkin seeds. I also recommend you supplement your diet with 400 mg of magnesium daily. I like CA citrate, glycinate, taurinate and orotate. For more on this formula, visit

*Q: Can a vitamin B deficiency be a cause of coronary artery disease?

Yes, as demonstrated by Dr. Kilmer McCully, the pioneer researcher on B vitamins and heart health at Harvard University. If you have a vitamin B deficiency, particularly folate, B-6 and B-12, you are at risk for developing heart disease. This is because when you eat large amounts of red meat, your body becomes overwhelmed by methionine, an amino acid in red meat. Without adequate B vitamins, the body is unable to metabolize, or break down the overload of methionine and a toxic byproduct known as homcysteine is formed. Homocysteine disrupts the cell membranes in your blood vessels, causing premature fat and cholesterol buildup (atherosclerosis).

You can prevent this accelerated aging of your circulatory system by getting enough B vitamins. It may seem inconceivable that in our society we are seeing evidence of a deficiency of B vitamins, but, sadly, not everyone eats enough daily servings of fresh fruits and vegetables. Processed foods are stripped of these nutrients and microwave ovens destroy the B vitamins.

The best way to make sure you are not B vitamin deficient is to drink fresh squeezed orange juice and eat plenty of leafy green vegetables such as spinach and kale. For extra “healthy-artery insurance,” take a daily multivitamin with folic acid and the other B vitamins. By taking these simple steps early in life, you can avoid being one of thousands who continue to have heart attacks and/or strokes often occurring in those with high homocysteine levels.

*Q: Are you comfortable recommending lipoic acid as a supplement?

There’s lots of excitement about lipoic acid, a sulfur-based antioxidant essential for energy production that researchers are touting as a “universal antioxidant.” It is a rare and versatile nutrient easily absorbed almost anywhere in the body because it is both fat and water soluble. Because it crosses the blood/brain barrier (only a select group of nutrients can penetrate the brain’s screening membranes to support the functions of the brain), lipoic acid can protect the cells and blood vessels of the brain from the ravages of free radical damage.

Studies show that this substance recycles its antioxidant partners, vitamin C and vitamin E. It has the ability to restore these vitamins to their original form once they have scavenged free radicals, the toxic byproducts of metabolism. For example, lipoic acid molecules replenish vitamin E as it is used up in the process of blocking the oxidation of LDL cholesterol.

This nutrient has been approved in Germany for treatment of diabetic neuropathy where it has shown to improve blood flow to peripheral nerves and to stimulate the regeneration of new nerve fibers.

Lipoic acid has also shown to help normalize blood sugar levels in people who have a high intake of sugar in their diets. For this reason, this antioxidant is very helpful for type II diabetics.

Finally, lipoic acid may have a chelating effect on excess iron and copper. There is also evidence that it may remove cadmium, a toxic metal by-product of cigarette smoking.

Current research into lipoic acid is very promising, and, even better, no side effects are evident. I recommend 20 to 50 mg of lipoic acid daily for general nutritional support and between 100 to 200 mg for people with heart disease. Diabetics may take up to 500 mg per day to teat diabetic neuropathy. A word of caution: At that high dosage, insulin levels may need to be adjusted for insulin dependent diabetics because of the powerful effect on blood sugar levels. Please work with your physician if you take more than 300 mg a day.

*Q: Why must I take supplements? They are expensive and a bother. And besides, my diet has always been healthy, so it seems foolish to take extra pills.

Your question often comes up from patients who are concerned about the health of their hearts and are savvy about the benefits of good nutrition. Unfortunately, in today’s world, not everyone is aware of the degree to which our bodies are assaulted from harmful chemicals in our homes, offices, food, air and water supplies. Our food just doesn’t supply enough nutrients to detoxify residues of chemical fertilizers, insecticides and pesticide sprays, let alone neutralize free radical damage to your cells from excess sugar, saturated fats, trans-fatty acids, caffeine, alcohol or drugs and air pollution. Even if you eat the recommended five to nine daily servings of fresh fruits, vegetable and whole grains (and fewer than 10% of Americans do), how can you be sure they are farm fresh, free of pesticides and loaded with protective vitamins and minerals?

You may not realize that the heart is the most susceptible of all your organs to the destructive effects of free radicals. If you lack sufficient levels of antioxidants such as vitamins C and E, coenzyme Q10 and the minerals selenium and magnesium, accelerated aging to blood vessels may occur as a result of chronic, unremitting free radical stress. For example, when your diet does not supply enough vitamin E, which helps to prevent the oxidation of LDL cholesterol, fatty streaks may build up and narrow your artery walls. To protect your arteries, I recommend at least 100 to 200 IU of vitamin E. To get that amount in your diet, you would have to eat one to two jars of peanut butter and at least one large bowl of what germ daily. And we have recently discovered the danger of developing atherosclerosis if you eat red meat regularly and don’t have sufficient levels of B vitamins, particularly vitamin B-6, folate and B-12.

Fortunately, the heart is especially receptive to the benefits of carotenoids, flavonoids, phytonutrients and other nutritionals in supplemental form. For more than 30 years I have successfully prescribed more nutritional supplements and fewer drugs in the treatment of high blood pressure, arrhythmia, angina, congestive heart failure, high cholesterol and premature atherosclerosis. The majority of my patients responded positively to targeted nutritional supplements, which help to limit cardiovascular damage.

I am certain that in the next few years conventional medicine will endorse recommendations that go well beyond the minimal recommended daily allowance (RDA) that the so-called “experts” claim are sufficient. Several clinical studies have found that doses far greater than the RDA should be taken to protect ourselves from free radical stress. For example, vitamin D3 at 400 IU’s is just not enough. I am now recommending up to 3000 IU a day for healthy people and up to 5000-10,000 IU for those with chronic or severe disease.

*Q: Dr. Sinatra, it seems that many doctors push “mega-doses” of various vitamins, though you recommend lower doses. Why is that?

There’s a lot of controversy regarding the mega-dosing of vitamins and minerals. That’s why I have a streaming video on this subject on the website. Most people are aware of the dangers overdosing on fat-soluble vitamins – A and E espcially – which should never be taken in excess because they are stored in the body and can build up to toxic levels. As for water soluble vitamins, I am cautious about overdosing because people differ in their absorption patterns. And some vitamins have powerful interactions with other compounds. For instance, if you take large doses of vitamin C and you have undiagnosed hemochromatosis, and iron storage disease, you are compounding your problem because vitamin C enhances the absorption of iron.

Also, new studies have revealed that people who take high doses of pure beta carotene (without taking other carotenoids), may have a “wash-out” effect at carotenoid receptor sites in the gastrointestinal tract that prevents the absorption of other dietary carotenoids such as beta cryptoxanthin, lutein and other carotenoids. For this reason I have insisted on putting a mixed carotenoid base in formulas to avoid the overdose/wash-out cycle. Also, smokers should not take beta carotene supplements in excess of the RDA.

You must also be wary of the toxic effects of large amounts of calcium (>1000 mg/day) and magnesium (>400 mg/day) if you have any problems with your kidneys. In addition, too much selenium (>400 mg/day) creates problems, because in higher doses it can cause poor appetite, anemia and even cirrhosis of the liver.

Bioavailability (the potential for absorption) and the delivery system (how the formula is delivered to your tissues) are far more important than the amounts of individual vitamins and minerals when planning your supplemental program.

**Q: Is it safe for women with hypothyroidism to take L-carnitine?

A: Low-dose carnitine – up to 1 gram per day – should be absolutely no problem; however higher does –  3 to 4 grams per day –  may accentuate the hypothyroidism.

**Q: My father has been diagnosed via heart muscle biopsy with amyloidosis of the heart. He is at home with a dobutamine pump. He is 84 years old and is getting increasingly weak. I would like him to try D-ribose, coenzyme Q10 and L-cartinine but don’t know what doses to start with and work up to. Thanks for your input.

A: Amyloidosis is a tough situation, especially when a person is on dobutamine. A good place to start would be to take 5 grams of D-ribose 3 times per day, 100 mg coenzyme Q10 twice a day (and perhaps double this dose in 2 to 3 weeks), and 1 g L-carnitine 2 to 3 times per day. Providing that renal failure is not an issue, 100 to 200 mg of magnesium per day would also be helpful in giving your father a metabolic advantage.

Ask Dr. Sinatra:

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Please note that we do not sell supplements at Heart MD institute; visit for more information about, and to purchase, Dr. Sinatra’s line of proprietary supplements.

Please also note that Dr. Sinatra does not provide medical advice through Heart MD Institute; any and all information found on this site is intended solely as an informational tool, and it should never replace a visit to your physician, nor be considered medical advice upon which you rely when making health-related decisions. *Indicates that Q&A has been reprinted or adapted from Candid Advice About Your Heart, a Heart, Health & Nutrition supplement, with permission from Healthy Directions, LLC.

**Indicates that Q&A has been posted in response to emails or comments submitted to Heart MD Institute. © 2012 HeartMD Institute. All rights reserved.

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