Everyone in the health and wellness space talks about heart disease this month, so we wanted to weigh in on the discussion a bit.  Many people look to Heart Healthy Supplements to prevent having to use drugs. In fact, I don’t think there’s another group of supplements used as frequently for this same reason. Doctors are wary of this, and rightfully so.  The natural product industry has weak enforcement of lax regulations, so there’s too much variance between the same products.  Most importantly, while some supplements can change numbers on a test (i.e. make cholesterol go down), there is no data to prove that they can actually prevent major cardiovascular events like their drug counterparts.

That being said, I do think Heart Healthy Supplements have their place and will help support your cardiovascular system. When discussing heart disease, we can’t be as thorough as the experts, but we do have some unique insight as your tour guides in this wellness journey. In particular, I hope to bring to light how serious this issue really is, what steps we MUST take to modify our risks, and give you a no-nonsense approach to what real Heart Healthy Supplements can actually accomplish.  

Heart Disease – Serious as a Heart Attack

Heart disease isn’t one thing, but a bunch of different conditions that negatively affect our cardiovascular system, resulting in not-so-fun outcomes like strokes, heart attack, or death.  For many, heart disease is the end result of high cholesterol, high blood pressure, or diabetes.

The first thing you must understand is that this is a real issue. It’s not some remote risk that happens to other people.  Literally ⅓ of the country will die due to heart disease. Look to your left, then to your right.  If you’re alone this analogy won’t work. Nevermind…

Most of the things that lead to heart disease aren’t some fluke. They are the result of choice after choice over a lifetime.  For many people, heart disease is almost completely preventable. Despite this, we’re fat (38% obesity rate) with high cholesterol (20% of us), high blood pressure (34% of us), and diagnosed or undiagnosed diabetes (about 30% of us).  Crazy enough, 40 million people still smoke.

It’s difficult to make the connection between high blood pressure in your 40s and the bigger picture. I believe it’s because people don’t make the connection between the nagging of your doctor about “silly” numbers and the end results of heart disease.  It may help, then, to start at the end:

Why do people start eating “clean” after a cancer diagnosis? Or a get flu shot way late in the season? We don’t act until it feels more real. So here it is, a clear-cut statement, backed up by lots of research: Unhealthy lifestyle choices lead to diseases that lead to big problems, which lead to death.  It’s up to you to make that real.

Even with this breakdown, people will still put the seriousness of this off, usually because of confusion. There’s a lot to digest, and sometimes the mixed messages get overwhelming.  “Cholesterol is just a number” “Statins aren’t that effective.”  “There are things more important than cholesterol.”

If I may, let’s make this muddy water crystal clear for all of you. There is a BIG difference between someone with slightly-high cholesterol and no other risk factors, and reality.  In reality, most people are a mix of many different risk factors that are all out of control.  If you have high cholesterol but have a perfect diet, low blood pressure, no heart disease family history, and work out 5 of 7 days, sure, we can take our time getting serious about this.  If you have high cholesterol and the rest of the risk factors are a mess, you may more serious action now.  

Because there is such a wealth of data about heart disease, we have a REALLY good understanding of how this chain all links together. In fact, they’ve developed risk calculators that can predict – VERY accurately – someone’s real risk of having a major cardiovascular event in 10 years.  

This isn’t something to just be “meh” about.  It’s wacky, but using a few lab tests and a couple of questions about you, they can predict the future. How many movies do we have where the main character has to go back in time and stop something from happening to save the future?  Well, this is the real-life version of that.

Your doctor knows there are more important factors to consider along with numbers from a test, and they’re not trying to be nags. What’s most important to your doctor is the message that these numbers can accurately predict your likelihood of dying. Cholesterol, blood pressure, diabetes risk, activity level, alcohol intake, smoking, age, and genetic factors all come into play. The test should wake you up. The power is then yours. You can reduce or eliminate almost all of those risks yourself.

You can figure out what your risk is using one of these great tools. Try it here.  

Unfortunately, I can’t give you lottery numbers now or advise you on a stock that will make you a millionaire in the future, but what we can do is help dramatically lower your risk of dying from a heart issue, which I think is worth more than money.

We Have To Do Something

With this knowledge, we can’t NOT act. In fact, I’d say EVERYONE should make some changes now, whether you have heart disease risk or not, and doubly so for those of you with high cholesterol, blood pressure, or diabetes.

To make a better future:

1. By Odin’s Beard, please stop smoking. It turns out they’re not good for you, the cigarette companies were lying to you, they manipulated you by tying an “identity” to their products, and they actively worked to suppress research that proved they were killing people. (Sounds like something else going on today…)
2. If you have high cholesterol, blood pressure, or diabetes, manage it. This shouldn’t be taken lightly. Get your numbers to goals set by your doctor.
3. Eat better. I’ll dive into this more in the next section, but diet is the #1 poor choice that will contribute to heart disease.
4. Exercise. Get 30 minutes of aerobic exercise most days (i.e. 4-5 out of 7)
5. Get some stress management. Meditate, yo. Stress contributes to high blood pressure and arrhythmias.

If you have risk factors and they are not controlled, it doesn’t matter how many fish oil pills you down. If you smoke, it doesn’t matter how often you meditate. If you have uncontrolled diabetes, it doesn’t matter how frequently you run. Both help, sure, but you’re trying to punch away waves of the ocean. It’s all additive, and some things have WAY more impact than others. I put them in order of importance, but all of the things have to be done.

I’m spending so much time on the setup because Heart Healthy Supplements are a small part of this whole picture and can only do so much. It is disingenuous to sell a supplement for heart health without having these other important discussions.  

Inflammation

There’s a lot of chatter about the role of inflammation in heart disease. Some people rank it as more important than chasing numbers.  

What we currently know about inflammation is that there is no causative link between inflammation and heart disease. But in patients with heart disease, inflammation is always skulking around. Inflammation hasn’t been proven to be the robber, but he always shows up around people who get convicted.

Foods that cause inflammation are leading risk factors for developing heart disease and diabetes. High cholesterol, alcohol, toxins from cigarettes: all will increase inflammation. Getting rid of these is more important than trying to fight them; ingesting inflammatory foods will always win over any anti-inflammatory actions you take.

Our dietary advice is based on heart and diabetes healthy diets already, so much of this might seem like a repeat if you’ve been reading our articles. So, Eat to Fuel Your Fire as before, and try to ensure your diet follows these rules:

Inflammation Support Supplements:

After reducing inflammatory foods and eating better, there are some supplements that can further support healthy inflammation. Of all the options out there, we feel these three are the ones that actually will accomplish what people want them to:

• Fish Oil like Alaskan Omega have been shown to reduce inflammation and help prevent chronic diseases.  Fish oil is a  Vital Five Supplement because it can deliver the Omega-3’s we lack from our diet.  
• Antioxidants like Supergreens  – True whole food blends of antioxidants can help support heart health and healthy inflammation.  Be wary about the type of antioxidant you buy; avoid fake whole food antioxidants.
• Turmeric like our organic turmeric root powder – adding whole turmeric to our diets can help support healthy inflammation as it has natural inflammation-support properties.

Cholesterol & The Statin Debate

Uncontrolled cholesterol leads directly to hardening of the arteries and heart disease. The knee jerk reaction was to completely obliterate cholesterol levels and remove all fat from diets. In reality, simple carbohydrates and bad fats contribute to the bad cholesterol (LDL and triglycerides), while good fats are 100% needed by our bodies for practically all body systems. Over-correction is unwise, but action still must be taken.

A majority of the work in making cholesterol healthy and acceptable comes from diet and exercise. In fact, exercise is one of the few things that will improve HDL (good cholesterol) so drastically.

But it may not be enough. There are plenty of reasons why skinny, healthy people have elevated cholesterol. They need something to lower these numbers, because as we said before, the risks are real.

I’m going to say it – statin drugs. Did anyone get nauseous? Anyone get a shiver down their spines?

No class of drugs is so reviled by many in the natural products world. Note, I’m not pro-statin, but I’m anti-death. If people can be healthier – diet, exercise, stress management, and more – statins may not be needed, which is the ideal path!  

Statin drugs not only lower bad cholesterol most effectively, but they have lots of data showing they will decrease heart attacks, strokes, and death.  “Wouldn’t all drugs that lower cholesterol do that?” No – and that’s the point. We don’t care about the numbers, we want to save people’s lives. Unless the direct connection exists between an intervention and preventing these outcomes, we can’t assume anything.

Case-in-point:  HDL.  High levels of HDL, the good cholesterol, was thought to help lower risks of heart attack or stroke.  After some studies, it doesn’t.  Healthy HDL levels are important, and low HDL is still a risk.  Exercise is what works.  Using those products to chase a number won’t change the outcomes, so there’s no point in taking them (for most people). 

Back to statin drugs. I know I said it was “The Statin Debate”, but I’m really not going to debate. I can’t convince most people that all drugs carry risks and statin drugs, while they have their liabilities, aren’t the demons they are made out to be. 

Instead, I’m going to take my approach used with flu shots: If you don’t want to take a statin, don’t. But let’s be honest with ourselves…  

Many people who won’t use a statin will run to a health food store and get Red Yeast Rice. We discussed this before, but Red Yeast Rice is literally a statin. In fact, it’s lovastatin, a high side effect, high drug interaction risk statin. If your doctor chose that statin for you willingly, I’d raise an eyebrow. Most Red Yeast Rice on the market is contaminated with citrinin.  On top of that, no Red Yeast Rice product has been shown to decrease heart attacks and strokes like it’s pharmaceutical version.  Bergamot is another popular supplement with statin-like activity.  These should NOT be used with statins – just one or the other, please!

Big Point Here:  Supplements that support healthy cholesterol can only do so much, if anything.  As I was getting ready to publish this, I had this discussion with a customer using Bergamot BPF over a statin.  His total and bad cholesterol went up.  And not a little bit, but close to 20%, and he ended up in high risk territory.  

What do you do then?  Even though there seems to be a lack of consensus around statin use, there is no argument about the risk calculations.  So until further notice, we’re lowering cholesterol.  I recommended this patient surrender.  He gave a good fight.  But his diet wasn’t perfect, he wasn’t exercising like he needed to be, and he had high blood pressure.  Time to work with his doctor to find the best statin choice for him.    

I advised him of my plans if it ever happens to me. After dramatic dietary changes and exercise, heart-healthy supplements (not Red Yeast Rice or Bergamot), and stress management, I’ll be strategic in my statin selection. There are a lot of statins on the market – atorvastatin, rosuvastatin, simvastatin, etc – and they all have different potencies and side effects. I’ll pick something like pravastatin. It’s less potent, water-soluble (that means less muscular side effects), with fewer drug interactions. But if my risks are higher, I may have to be more aggressive.

Again, you don’t need to take a statin if you don’t want to.  Just make sure you are doing everything in your power to make all other risk factors negligible.  

Drugs with statin-like effects can deplete the body of an important antioxidant, CoQ10.  Many people supplement with CoQ10 but don’t realize our bodies are actually converting that to the active form, Ubiquinol (U-bick-win-all).  After age 40, we don’t reliably convert CoQ10 to Ubiquinol, so it’s best to just supplement with Ubiquinol. We often recommend people who take statins, Red Yeast Rice, or Bergamot take a proper dose of Ubiquinol, usually 100 mg once daily, or more if they have high dose or high potency statins.

Cholesterol Support Supplements

There are many supplements out there that say they support healthy cholesterol levels.  Of those, there are only a handful that we’d recommend. This is mostly due to quality concerns such as adulteration, contamination, or potency.  Also, the following products are respected even by most traditional practitioners as being natural options for cholesterol support:

• Fish Oil like Alaskan Omega – Omega-3 fats EPA and DHA can lower triglycerides  In fact, there is a prescription version that delivers 3200mg of EPA and DHA a day that accomplishes that.  Most of us need Omega-3 supplementation because we get so little in our diet.
• Plant sterols like those found in our Cholesterol Complex– Beta-sitosterol is a steroid found in plants that has recently earned approval from the FDA and AHA as add-ons to statin therapy. They work by lowering dietary cholesterol levels.  The most important thing to remember is to get the proper dose – almost 900 mg daily is what was studied, and most supplements don’t even get near that.
• Red Yeast Rice like our Red Yeast Rice – when done right, Red Yeast Rice has statin-like activity.
• Cholesterlow – This is a unique formula that has different herbs that support healthy cholesterol. Anecdotally, we’ve had people say they love it!
• Whey protein like Myocep – yes, just normal whey protein supplements have been reported by the Mayo Clinic to lower LDL and total cholesterol. 
• Ubiquinol like Healthy Origins – used along with statins, Red Yeast Rice, or Bergamot.
• Hawthorne – a commonly used herb used to support healthy cholesterol.  Make sure you only buy products that uses the berries, not the leaves.

Vascular Support

Controlling blood pressure is another big step in preventing heart disease. When people ask us for natural alternatives, this is where I opt-out.  Managing blood pressure is kinda complicated. There are lots of systems intertwined that keep your blood pressure right, meaning there are lots of points that have to be kept in sync with one another. The way supplements that practitioners use as natural alternatives to blood pressure meds work is by introducing compounds that cause a broad dilation of vessels. This is an unsophisticated approach that is widely unnecessary.

There are many blood pressure medicines that have been around the block; studied in millions of people, we have some of the best, well-established data with their use, and they cost next to nothing.  Use a sniper rifle (meds) rather than a shotgun (supplements).  

Supplements Supporting Vascular Health

In this category, these supplements support health vascular tone and blood flow and get my seal of approval, if you want good options:

• Vital Heart   by Woodstock Vitamins – a combination of olive fruit and grapeseed extract, both which support vascular health.
• Beet Powder can support healthy nitric oxide levels, which helps support blood flow.  Many endurance athletes use these products.
• Garlic – dietary garlic has been touted as being beneficial for heart health for many years.  One of its functions is to support healthy blood flow.

The Heart Healthy Supplements

To put this all into perspective, we’ve separated the Heart Healthy Supplements into three groups.  The first line is for everyone – risks or not – as they support healthy hearts. The second line is heart-healthy options that have data to support their use.  The final group is the “Sure, try it” line, as they are solid options but should only be used after all other changes are made.

Someone new to the high cholesterol or blood pressure world should make diet and lifestyle changes first, then maximize the First Line and dip into the Second Line before they go into “Sure, Try It” land.

The First Line

Use these products for everyone, if you have cardiovascular risk factors or not, as they help support healthy hearts.

• Fish oil/Omega-3 fatty acids EPA and DHA
• Real whole food antioxidants

The Second Line

If you are on statins, Red Yeast Rice, Bergamot, or have Type II diabetes, you would probably benefit from taking Ubiquinol. Otherwise, if you are wading into cholesterol support supplements and are taking our first-line recommendations, try Plant Sterols. 

• CoQ10 – Ubiquinol
• Plant Sterols
• Whey Protein

Sure, Try It

If you are looking to go all-in on natural products, for whatever reason, give these a try along with the recommendations for first and second line.  Our no-BS approach carries this warning:  sometimes these are not going to be enough, but you certainly can and should try them with guidance from your doctor.

• Cholesterlow
• Red Yeast Rice
• Hawthorne
• Garlic
• Turmeric
• Vital Heart
• Beet Powder 

Supplements To Avoid

It’s important to remember that not all supplements that say they can help you be heart healthy are being honest.  In fact, many of them are straight up lying and can hurt you. Some products can make heart disease worse. These supplements are Heart UnHealthy and should be avoided if possible:

• Traditional Vitamin E – synthetic Vitamin E at high doses actually increases stroke risks as it has pro-oxidant effects over 400 IU daily.  If you are looking to get more Vitamin E, use products like Wheat Germ Oil.
• Resveratrol – Resveratrol just doesn’t work despite what the internet says.  GlaxosmithKline halted studies on it because it didn’t show any benefit.  Heart healthy diets will be rich in foods with resveratrol, so don’t waste your money supplementing with it.
• Omega 3-6-9 supplements – We get far too much Omega-6 from our diets, which is part of the reason we need to take so much Omega-3 for the benefit.  Omega-6’s can be pro-inflammatory, which is what we want to avoid.
• Green tea – Used by some for cholesterol, but it isn’t very effective and many products contain a synthetic eCGC, which can lead to liver failure.
• Herbs that increase blood pressure – Non-DGL type licorice, guarana, bitter orange, kola nut, yohimbe, green coffee bean, chinese ginseng, and bayberry all can increase blood pressure.
• Poorly made or rancid fish oil – Besides being gross, this can actually contribute to higher levels of bad cholesterol and triglyceride.

My Heart Will Go On

A yucky Titanic soundtrack reference to end the blog article…what a guy, huh?

It’s critical that the message here is clear: suffering with and from heart disease is unnecessary for most of us as it is mostly preventable. Lifestyle interventions like a diet that lowers inflammation and disease management will have the biggest impact on lowering your risks for heart disease. If you choose to use natural products to help manage heart disease, it should only be done in addition to diet and exercise. As always, there are some supplements that aren’t what they’re cracked up to be, so be aware. A heart-healthy life can be made stronger with the right Heart Healthy Supplements!

Just trying to keep it real…

Neal Smoller, PharmD
Owner, Pharmacist, Big Mouth