“The use of supplements in heart failure management is not well-established, and some supplements may interact with medications or have potential risks. Some supplements may be beneficial for heart failure patients, but more research is needed.”
This is the phrase that came up OVER and OVER again when I was doing my research!
I sure wish I could just say: “Take these vitamins, and it will fix your symptoms or improve your heart function,” but I can’t. However, some vitamins, minerals, and supplements may benefit heart failure patients.
Before you read any further, know this!
I became a dietitian because I believe in the power of food—healthy food—to prevent and manage disease. I also believe that nutrition is one of the most important factors in successful aging, and allowing you to live life to the fullest.
There will never ever be a vitamin or supplement that takes the place of a heart healthy diet. They don’t even come close. The most important thing you can do is eat well and my hope is this blog will help you do that.
That being said, it’s important to consider that certain vitamins, minerals, and supplements may help you optimize your nutrition, and I am all for that. There is a case to be made for their inclusion in a heart failure nutrition plan. This article will explain the rationale and possible benefits of commonly used supplements. So let’s take a deeper dive into this subject.
Common Vitamin Supplements for Heart Failure Management
Vitamin D
Vitamin D is not really a vitamin at all, but a steroid hormone, and is most known for its role in the development of healthy bones.
It turns out that Vitamin D may also have a role in heart health too. But Vitamin D’s role in heart health is somewhat fuzzy.
- Research has shown increased heart events in those with Vitamin D deficiency.
- And it seems Vitamin D may play a role in keeping vessels healthy.
- However, the most recent research on Vitamin D suggests that supplements don’t improve heart health. (Years ago I studied vitamin D at my hospital and was quite disappointed to discover this as I was really hoping it would be different.)
Check out the article for more information: https://www.nhlbi.nih.gov/news/2022/vitamin-d-heart-health-where-benefits-begin-and-end
So get your level tested and be sure that you are not deficient. Deficiency is linked with autoimmune disease, weaker bones, and depression. And the jury is still out on Vitamin D and your heart. Why take a risk?
There is no downside and possible upside to keeping your Vitamin D at a good level. If you do show a deficiency, your physician will provide a prescription dose to correct your levels.
If your Vitamin D is in a good range (lab values may vary, but a 25OH Vitamin D level of >30ng/dl is typical), I recommend taking 125mcg (5000 IU) once weekly and getting 10-15 minutes of sunshine on your face and arms.
Your body actually makes Vitamin D when sun hits your skin. While no one recommends a sunburn, 10-15 minutes of sunshine each day and a modest weekly supplement can help keep levels in a good range.
CoQ 10
CoQ10 is a substance that is naturally present in the body and plays a role in energy production. Some research suggests that CoQ10 supplements may be helpful for heart failure patients, but more research is needed.
Here are some of the possible benefits:
- Patients with heart failure who took CoQ10 supplements experienced fewer symptoms and complications than those who took a placebo. (1)
- CoQ10 might actually improve blood vessel health. (2)
It is possible that CoQ10 could help reduce muscle pains and side effects from statins, but more research is needed. As far as blood pressure, CoQ10 does not decrease blood pressure any more than placebo does. (2)
There is no established perfect dose, but I recommend 100-200mg daily. It is generally recognized as safe, but remember to check with your physician.
Omega 3
Omega-3 fatty acids: These polyunsaturated oils (DHA and EPA) are found in fatty fish and some plant sources. Here are some possible benefits:
- Decrease triglycerides!
- Help keep blood vessels smooth, flexible, and healthy.
- Slight blood pressure lowering effect
- Prevent arrhythmias (irregular heartbeats)
If you want to read more about Omega 3 and the research behind it, I suggest looking up an article from a reputable source like Medline. Here is a link to that article: https://medlineplus.gov/ency/patientinstructions/000767.htm
And another reason to consider Omega 3 supplements is that they may help treat depression, which is common in heart failure patients.
I recommend 1000mg or 1 capsule of Deva Plant Based Omega DHA/EPA daily, but there are a lot of acceptable brands out there. As always, check with your doctor, especially if you are on blood thinners.
Magnesium
Magnesium is a mineral that is important for heart health. This mineral actually helps with nerve and muscle coordination to initiate a heartbeat. In addition, magnesium is also involved in the transport of other essential electrolytes like potassium and sodium. All of these are crucial for proper heart function.
And magnesium deficiency is common and can be a big problem in heart failure.
As is the case with all vitamins and minerals, this means that we need enough, but it it does not mean that more is better. (3)
If you eat a wide and varied diet with plenty of plant foods like leafy greens, whole grains, beans and legumes, you might get enough from food. (The RDA is between 380 and 420mg depending on age and gender.)
- However, some common medications like antacids (pepcid, prilosec, tums, protonix) can interfere with magnesium absorption in the stomach, leaving you with low levels.
- And more importantly for heart failure patients, loop and thiazide diuretics like furosemide (lasix) torsemide, HCTZ, and others deplete magnesium levels.
- Antibiotic, steroids, hormone replacement, and other medications can interfere with absorption.
For this reason, I recommend a magnesium supplement of 500mg per day to my patients. Higher doses should be cleared by your physician. I also recommend you get your levels checked and keep in communication with your medical team to be sure you stay in range.
All this to say that I recommend a basic supplement and monitoring, but I do not recommend large or mega doses!
We just don’t have evidence that this will help your heart failure. Mega doses can be harmful, so don’t be tempted to overdo it. And as always, let your doctor know what medications you are taking.
Vitamin Deficiencies and Heart Failure
Vitamin B12
Vitamin B12 deficiency is dangerous for many reasons.
- For one, it can cause permanent neurological damage.
- And, B12 deficiency is also associated with an increase in homocysteine levels, which increases the risk of cardiovascular problems. Homocysteine is a substance that can damage artery walls. Your doctor can check those for you.
B12 is not directly correlated with heart failure, but heart disease and heart damage are factors in heart failure, so it’s important to monitor this vitamin and supplement as needed to keep healthy levels. (4)
I like my patients to have a serum or blood B12 level of at least 400pg/dl, but this number can vary depending on the lab you are using.
If you are deficient, you may be given a B12 shot monthly or a supplement that dissolves under the tongue.
I don’t have a recommended daily dose unless you are plant based. A plant based diet has many heart benefits, but B12 supplementation is needed. In most cases, 2000mcg of sublingual B12 per week will keep your levels in range.
Take home message: Get those levels checked as this one is too important to mess around with!
Folic Acid
Here is our friend homocysteine again.
It turns out that folic acid helps break down homocysteine, so a folic acid deficiency is harmful to heart failure patients.
Remember, our goal is to keep everything having to do with your cardiovascular system and heart function as healthy as possible.
My recommendation: Get those folic acid levels checked and take 400mcg per day or a higher amount if your doctor recommends it.
Iron
Anemia is often seen in heart failure and it is considered an indicator of disease progression and poor outcomes. Iron transports oxygen throughout the body, so anemia can leave you with low energy and exhaustion. Since heart failure patients often experience debilitating fatigue, managing anemia is imperative.
Anemia in heart failure is not generally caused by poor iron intake. It’s what we call an anemia of chronic disease and the reasons are complex (5). So I don’t really get involved in the treatment of anemia with iron supplements, and neither should you.
This is a medical issue, and while a diet rich in iron and vitamin C foods is always helpful, iron supplementation should be managed by your physician. I’ll cover heart healthy iron rich foods in future blog articles.
Just know for now, that eating lots of red meat is NOT the heart healthy way to get iron. Instead focus on plant sources of iron like beans, peas, dark greens, tofu, pumpkin seeds, fortified cereals, and dried fruits.
Vitamin Supplements and Heart Failure Medications: Potential Interactions and Risks
CoQ10 might make blood-thinning drugs, such as warfarin (Jantoven), less effective. This could increase the risk of a blood clot.
Conversely, Omega 3 oil may thin the blood and put you at higher risk for bleeding. If you are on a blood thinner, or any medications, review with your physician.
High doses of Vitamin D can have a toxic effect. In addition, it can interfere with statins and thiazide diuretics, two medications that heart failure patients often take. High vitamin D intakes can also increase blood calcium levels.
High doses of minerals like magnesium can interfere with the absorption of other minerals. Magnesium can also interfere with many medications as mentioned above. Overdosing can cause nausea, diarrhea, and cramping. A severe overdose can be fatal.
Should You Incorporate Vitamin Supplements into Your Heart Failure Management Plan?
You have probably noticed that I use the word “may” and “can” often. I wish I didn’t need to but the truth is that it’s really hard to study supplements and humans! I just can’t speak in absolutes.
Humans are all different, and we have unique experiences, environments, and daily lives, even if we are part of a study. So many things can affect the outcomes, and it can be hard to sort it all out. One study can show good things, and the next one doesn’t.
So for this reason, I can’t make any big declarations about vitamins. These recommendations are my best advice based on clinical judgement as well as the research I have read over the years.
Communicate with Your Healthcare Team Regarding Vitamin Supplements and Heart Failure
I hope you enjoyed this article. I tried really hard to give you a great summary while emphasizing that each person is different, and this is not to be used as personal medical advice.
Knowledge is power, and the more you know, the better partner you will be for your healthcare team. Speak with your physician before starting any new vitamins, minerals, or supplements, as some may interact with medications or have potential risks.
Don’t forget to check out the references listed below as well as the rest of the blog. And sign up for my email list so you don’t miss future articles!
References:
- Sharma A, Fonarow GC, Butler J, Ezekowitz JA, Felker GM. Coenzyme Q10 and Heart Failure: A State-of-the-Art Review. Circ Heart Fail. 2016 Apr;9(4):e002639. doi: 10.1161/CIRCHEARTFAILURE.115.002639. PMID: 27012265.
- Gao L, Mao Q, Cao J, Wang Y, Zhou X, Fan L. Effects of coenzyme Q10 on vascular endothelial function in humans: a meta-analysis of randomized controlled trials. Atherosclerosis. 2012 Apr;221(2):311-6. doi: 10.1016/j.atherosclerosis.2011.10.027. Epub 2011 Oct 25. PMID: 22088605.
- Douban S, Brodsky MA, Whang DD, Whang R. Significance of magnesium in congestive heart failure. Am Heart J. 1996 Sep;132(3):664-71. doi: 10.1016/s0002-8703(96)90253-7. PMID: 8800040.
- Pawlak R. Is vitamin B12 deficiency a risk factor for cardiovascular disease in vegetarians? Am J Prev Med. 2015 Jun;48(6):e11-26. doi: 10.1016/j.amepre.2015.02.009. PMID: 25998928.
- Silverberg DS, Wexler D, Iaina A. The role of anemia in the progression of congestive heart failure. Is there a place for erythropoietin and intravenous iron? J Nephrol. 2004 Nov-Dec;17(6):749-61. PMID: 15593047.
