Congestive Heart Failure
Principal Proposed Natural Treatments
Other Proposed Natural Treatments
When the heart sustains injury that weakens its pumping ability, a complicated physiological state called congestive heart failure (CHF) can develop. Fluid builds up in the lungs and lower extremities, the heart enlarges, and many symptoms develop, including severe fatigue, difficulty breathing while lying down, and altered brain function.Medical treatment for this condition is quite effective and sophisticated, consisting of several drugs used in combination.
Principal Proposed Natural TreatmentsNote
: CHF is too serious a condition for self-treatment. The supervision of a qualified healthcare professional is essential. However, given medical supervision, some of the following treatments may be quite useful. The herb hawthorn appears to be effective for mild CHF and may be helpful for more severe CHF, as well. However, while standard drugs have been shown to help reduce hospitalizations and mortality associated with CHF, there is no similar evidence as yet for hawthorn. Also, adding the supplement coenzyme Q 10
to standard treatment may improve results. Finally, the supplement vitamin B 1
(thiamin) may be helpful for individuals who take loop diuretics (such as furosemide) for CHF.
Hawthorn At least nine double-blind, placebo-controlled trials, involving a total of about 750 participants have found hawthorn helpful for the treatment of mild to moderate congestive heart failure. 53,54 In one of the best of these studies, 209 people with relatively advanced congestive heart failure (technically, New York Heart Association [NYHA] class III) were given either 900 mg or 1,800 mg of standardized hawthorn extract or matching placebo. 40 The results after 16 weeks of therapy showed significant improvements in the hawthorn groups as compared to the placebo groups. Benefits in the high-dose hawthorn group included a reduction in subjective symptoms, as well as an increase in exercise capacity. Subjective symptoms improved to about the same extent in the lower-dose hawthorn group, but there was no improvement in exercise capacity. In an analysis that mathematically combined the results of 10 controlled trials involving 855 patients, hawthorn extract was found to be significantly better than placebo for improving exercise tolerance, decreasing shortness of breath and fatigue, and enhancing the physiologic function of an ailing heart in mild to moderate congestive heart failure 62 In another study, however, researchers found that patients with mild to moderate CHF taking a special extract of hawthorn, 900 mg daily, were more likely to experience an initial worsening of their condition compared to those taking a placebo. But, by the end of six months, there was no difference in the two groups. In light of numerous other studies supporting the safety and effectiveness of hawthorn in CHF, the results of this special extract study need to be repeated before drawing any firm conclusions. 64 A comparative study suggests that hawthorn extract (900 mg) is about as effective as a low dose of the conventional drug captopril. 12 However, while captopril and other standard drugs in the same family have been shown to help reduce hospitalizations and mortality associated with CHF, there is no similar evidence for hawthorn.
Like other treatments used for CHF, hawthorn improves the heart's pumping ability. However, it may offer some important advantages over certain conventional drugs used for this condition. Digoxin, as well as other medications that increase the power of the heart, also make the heart more susceptible to dangerous irregularities of rhythm. In contrast, preliminary evidence indicates that hawthorn may have the unusual property of both strengthening the heart and stabilizing it against arrhythmias. 6-8 It is thought to do so by lengthening what is called the refractory period. This term refers to the short period following a heartbeat during which the heart cannot beat again. Many irregularities of heart rhythm begin with an early beat. Digoxin shortens the refractory period, making such a premature beat more likely, while hawthorn seems to protect against such potentially dangerous breaks in the heart's even rhythm. Another advantage of hawthorn involves toxicity. With digoxin, the difference between the proper dosage and the toxic dosage is dangerously small. Hawthorn has an enormous range of safe dosing. 9 However, keep in mind that digoxin is itself an outdated drug. There are a great many newer drugs for CHF (such as ACE inhibitors) that are much more effective than digoxin. Many of these have been proven to prolong life in people with severe CHF. There is as yet no reliable evidence that hawthorn offers the same benefit. (Although, one large study found tantalizing hints that it might.) 61
It is not clear whether one can safely combine hawthorn with other drugs that affect the heart. For more information, including dosage and safety issues, see the full Hawthorn
Coenzyme Q 10 (CoQ 10 ) People with CHF have significantly lower levels of CoQ 10 in heart muscle cells than healthy people. 42 This fact alone does not prove that CoQ 10 supplements will help CHF; however, it prompted medical researchers to try using this supplement as a treatment for heart failure. A large systematic review of 7 randomized trials found some benefits with coenzyme Q supplements. 72 The randomized trials evaluated CoQ 10 supplements in 914 patients with chronic heart failure. When compared to placebo, CoQ 10 was associated with an improvement in the severity of heart failure symptoms in 2 of 3 trials. In one trial of 614 patients, CoQ 10 reduced re-hospitalization, acute pulmonary edema, cardiac asthma, and arrhythmia when compared to placebo. 2 Although, a second trial of 87 patients showed no significant differences in mortality. Similarly positive results were also seen in other double-blind studies involving a total of more than 270 participants. 37-38,58 However, two recent and very well-designed double-blind studies enrolling a total of about 85 individuals with CHF failed to find any evidence of benefit. 3,41 The reason for this discrepancy is not clear.
For more information, including dosage and safety issues, see the full CoQ 10
Vitamin B 1 Evidence suggests that the strong diuretics (technically, loop diuretics such as furosemide) commonly used to treat CHF may interfere with the body’s metabolism of vitamin B 1 (thiamin). 14,43,44 Since the heart depends on vitamin B 1 for proper function, this finding suggests that taking a supplement may be advisable; in fact, preliminary evidence suggests that thiamin supplementation may indeed improve heart function in individuals with CHF. 15,45,46
For more information, including dosage and safety issues, see the full Vitamin B 1