HEART FAILURE & NUTRACEUTICALS
Getting to the CORE PROBLEM
Heart Failure is a disturbing condition that we most often attribute to aging and cardiovascular disease. However, it can occur in the young as I experienced in my 20’s with infectious mononucleosis. But what exactly is heart failure? In essence it is when the pumping action of the heart is inadequate. the heart fills up during diastole (when the heart is relaxed - this is the lower number of your blood pressure readings) but upon contraction (pumping) inadequate blood is ejected into the circulation. You may learn that the ejection fraction is low. This represents the amount of blood in the ventricles of the heart before and after contraction. If the ejection fraction is low it means that the heart was not effectively pushing blood into the arterial system. Too much blood remains in the heart ventricles after contraction.
This may be the result of damage to the heart muscle from a previous ischemic event (heart attack). In essence the pump is damaged. It could be the result of infection as noted with infectious mononucleosis, which establishes an inflammatory event. It could be stiffening of the heart, scarring such that it is not as pliable as when you were young and healthy. It could also reflect arrhythmias where the co-ordinated filling of the ventricles is mismanaged. Finally, as is often the case the pump, the heart muscle, is just not contracting adequately.
The nature of the initiating event dictates therapeutic interventions.
Often the approach is to use stimulants to enhance the force of contraction, but here I want to focus on nutraceutical approaches. A recent review ( Nutraceuticals & Heart Failure) assessed several options with a very mechanistic focus. Several key elements are apparent in heart failure subjects.
Mitochondrial dysfunction. Mitochondria are the energy powerhouses in cells, generating the currency of all cellular energy, ATP. If the cell is bankrupt (short of ATP), it is limited in what functions it can execute.
Excessive oxidative stress. This may come from leaky mitochondria. As they burn fuel mitochondria create free radicals, and these leak in dysfunctional states like heart failure.
Inadequate Endothelial Production of Nitric Oxide (NO). The heart muscle needs its own circulation to be optimal, just like any other organ. If NO levels are inadequate then the blood vessels are not dilated enough to supply the working heart muscle the resources they need.
Often, all elements occur at once as they are interconnected mechanistically, and contribute to the whole. Addressing these problems from a pharmaceutical standpoint has not been enviable. In actuality this type of defect is not their forte. Pharmaceutical approaches are still focused on enhancing the force of the contraction of heart muscle and not what caused it to FAIL in the first place. In my research career when I look at biomedical problems I try to understand what is the fundamental problem. Address that, and you have a better therapy. A targeted, specific approach that is more likely to have sustained benefits.
Given this, how can nutraceuticals help, and how would they address these 3 critical features?
Let’s focus on the last bullet and work out way up. Nitric oxide is a free radical that is produced in steady but small puffs by the lining of the blood vessels to cause relaxation of the smooth muscle in the blood vessels as well as keeping platelets in blood from getting too sticky and clumping - platelet aggregation can clog blood vessels ( NO, a little goes a long way). But NO is very short-lived, because it reacts. It reacts with hemoglobin to form nitrate ( Nitric Oxide & Hemoglobin), it reacts with oxygen to form smog (the brown gas NO2 : SMOG from NO & O2) and reacts with common oxidants like superoxide (oxygen with an extra electron) to form a powerful oxidant called peroxynitrite. So yes we need nitric oxide, but we also need to manage its chemical children, for they …. can be very damaging ( Nitrosative stress).
Think of disease related to nitric oxide and oxygen as when good parents have bad children.
When I discovered in the mid ‘80’s that the endothelium was dysfunctional in cardiovascular disease, specifically with impaired vasodilation ( Hypertension & Endothelial dysfunction), it opened a massive shift in thinking. Previously we all thought the endothelium was inert and functionless but now it regulated vascular tone and it was compromised in vascular disease. Then when Bob Furchgott and his student John Zawadski, subsequently discovered that this endothelial-derived relaxing factor (that they originally discovered) was actually nitric oxide and it originated from the amino acid L-arginine, then research was literally off to the races (Furchgott shared the Nobel Prize for his discovery).
We now know that natural products can have a remarkable influence on endothelial function and nitric oxide mechanisms. Antioxidants can negate the oxidative stress that acts to degrade nitric oxide. Further, in disease the enzyme in the endothelium that makes nitric oxide (eNOS) can switch camps and actually make oxidants (superoxide) instead of nitric oxide. A traitorous action for vascular health.
So dietary antioxidants, in many forms can abrogate this dysfunction in endothelial-mediated nitric oxide bioactivity. This links bullet points 2 & 3. Examples of effective agents include polyphenols - flavonols, flavanols, catechins, anthocyanins, proanthocyanidins (most like indirectly as they are hard to absorb but can be transformed by gut bacteria as an effective post-biotic), and then the more lipophilic agents like the carotenoids and vitamin E.
This leads us to bullet point 1 - Mitochondria. A truly common feature of heart failure is inadequate, dysfunctional and oddly malformed mitochondria. In this state you cannot generate adequate ATP and also it propagates the problem with leaking free radicals activating inflammatory gene switches. The problem will persists without resolution.
The best solutions address the core problem.
In the article by Mollace et al. ( Nutraceuticals & Heart Failure) that correctly identify CoQ10 as a critical factor. For indeed, CoQ10 is intimately embedded into mitochondria to limit the oxidate stress and leaking free radicals that come with burning fuel to make ATP. However there are plenty of case studies that show that even CoQ10 supplementation may not be enough. In these cases I have seen remarkable benefits with astaxanthin added to a CoQ10 regimen.
Why is Astaxanthin the ideal supplement for Mitochondria?
There are several reasons. Succinctly:
It is a pure free radical scavenger. In that unlike some antioxidants, it does not have any pro-oxidant activity. It simply pairs the unpaired electron in a free radical, thereby neutralizing it.
It is the MOST POTENT free radical scavenger. Compared to CoQ10, the commonly go to nutraceutical for heart failure it is 800x more potent as a free radical scavenger.
It has the perfect molecular structure for protecting membranes. Astaxanthin is the perfect length to bridge across membranes with polar ends to embed in the protein layer, like anchors in rivers banks to bridge it in place. By comparison, Vitamin E is too short to reach the other side and beta-carotene does not have the embedding polar groups so it floats down the membrane river like an adrift raft.
It stimulates mitochondrial biogenesis. Simply put, it activates the gene that controls the generation of new mitochondria. More mitochondria, more ATP, more cellular energy, the stronger the muscle.
So astaxanthin wins out as the premier nutraceutical supplement for heart failure on many grounds. If you are still struggling with this concept then think of the journey that salmon make to spawn. Swimming hundreds of miles against a strong current is a massive undertaking and requires not only strong set of muscles but a strong heart to feed them blood. Astaxanthin is the nutrient that makes salmon their distinctive color. Without astaxanthin they would never make that arduous journey. What are you doing to manage your journey?
Conclusion
When you are looking for therapeutic solutions to problems like heart failure I recommend understanding the nature of the core problem you are trying to solve. Address these issues for better outcomes, and in doing so, you may want to search Mother Nature, for she may have the answers, you just need to ask the right questions.