If your customers run marathons, meditate twice a day and eat fiber-rich oatmeal every morning, do their hearts still need a boost from supplements? "Unfortunately, a lot of people don't get adequate nutrients supplied by diet," says Ryan Bradley, N.D., who developed the Diabetes and Cardiovascular Wellness Program at Bastyr Center for Natural Health in Seattle. "And some nutrients are depleted by medications to treat cardiovascular concerns." So whether consumers are looking to reduce heart-disease risk or treat an existing condition, certain herbs and supplements can make a difference.

We consulted Bradley, as well as Dr. Glen Rothfeld of WholeHealth New England and Mark Stengler, N.D., a naturopath in La Jolla, Calif., for their top supplements picks for the ol' ticker:

1. Coenzyme Q10
Studies show that the energy carrier Co-Q10 helps treat congestive heart failure and heart arrhythmias, lowers blood pressure and prevents the oxidation of low-density lipoprotein (bad) cholesterol. Also, a side effect of taking cholesterol-cutting statin medications is lower Co-Q10 levels (Journal of Hypertension, 2007; Clinical Cardiology, 2004). The result: fatigue and muscle pain. "We don't know if this outcome matters for heart health, but some studies show that taking supplemental Co-Q10 does reduce symptoms of muscle pain," Bradley says.

Sales of Co-Q10 were $377 million in 2006, up 11 percent from the previous year, according to Nutrition Business Journal, also published by The Natural Food Merchandiser's parent company.

Best for? Anyone can take the lower doses. People with higher heart disease risk may benefit most.

How much? If you're symptom-free, take 30 to 50 milligrams a day. If you're on statin-class drugs or have cardiac symptoms, take 100 to 200 milligrams per day, Rothfeld says. How safe? Very.

2. Fish oil
Fish oil sales in 2006 were $489 million, up more than $100 million from the previous year, according to Nutrition Business Journal. Why the growth spurt? Research shows that omega-3 fatty acids in fish reduce blood triglycerides (American Journal of Clinical Nutrition, 2004). But cholesterol isn't the whole story. "Inflammation is also a big issue and can cause arteries to clamp down and form plaque," Rothfeld says. Anti-inflammatory fish oil prevents platelets from getting too sticky so blood flows freely through arteries. Fish oil also mildly lowers blood pressure, Rothfeld says.

Best for? Everyone. Women may opt for flaxseed oil instead because it lowers estrogens, protecting against cancer as well as heart disease, Rothfeld says.

How much? Look for an oil with 700 to 750 milligrams of two omega-3 fatty acids—eicosapentaenoic acid and docosahexaenoic acid?and take daily. If you have heart problems, you can up the dose to 2 grams of EPA and DHA per day, according to Rothfeld.

How safe? Stop taking fish oil a few days before surgery because the supplement thins blood.

3. Hawthorn
Studies show that extracts of hawthorn (Crataegus monogyna) berries, leaves and flowers help lower blood pressure, improve blood flow through coronary arteries and treat congestive heart failure (British Journal of General Practice, 2006; The American Journal of Medicine, 2003).

Best for? "Hawthorn is excellent for those with mild to moderate high blood pressure, and those with poor circulation," Stengler says.

How much? Take 100 to 300 milligrams of hawthorn extract two to three times a day, Stengler says.

How safe? Safe, as long as blood pressure doesn?t dip so low that you get dizzy. Also, the leaf and flower of the plant have diuretic effects and can possibly lead to dehydration, Bradley says.

4. Garlic
Garlic (Allium sativum) offers a mixed bag when it comes to heart health. The stinking rose seems to lower blood pressure?an effect that gets even stronger when taken in combination with vitamin C (Nutrition Research, 2007). And a German study found that taking garlic powder tablets not only stops plaque growth, but also slightly shrinks the buildup (Atherosclerosis, 1999). Yet, a 2007 study in Archives of Internal Medicine found that garlic doesn't lower cholesterol in people with moderately high levels. Regardless, garlic still ranks among the most popular supplements, but sales have dipped 6 percent between 2005 and 2006 to about $155 million, according to Nutrition Business Journal.

Best for? "I call it a second tier of things to take for heart health," Rothfeld says. Because the high doses used to cut cholesterol in studies can irritate stomachs, it's difficult to take enough garlic to lick unwanted lipids.

How much? Look for a supplement containing 10 to 20 milligrams of allicin, garlic's active ingredient, Rothfeld says.

How safe? Because garlic thins blood, stop taking before surgery or if you're on anticoagulant medications, Rothfeld says.

5. D-ribose
This unique form of sugar is a building block of andenosine triphosphate, the fuel that powers the body's cells, including those in the heart. Early-stage investigations on animals show D-ribose helps improve heart function after a heart attack (Academic Surgical Congress, 2007).

Best for? "It's very specific to those at risk for congestive heart failure," Stengler says.

How much? Consult a doctor for appropriate doses.

How safe? No cautions, according to Stengler.

6. Niacin
This B vitamin may well serve the heart better than statin heart medications: Niacin lowers LDL cholesterol, raises high-density lipoprotein cholesterol (statins don't), and lowers lipoprotein (an independent risk factor for cardiovascular disease that no drug addresses), Bradley says.

Best for? Niacin seems ready-made for people with multiple heart-health problems. "You see this combination commonly in diabetes patients," Bradley says.

How much? To treat high cholesterol, health care providers often prescribe niacin in doses of 500, 750 and 1,000 milligrams. "We don't know what low doses will do and whether they have strong cardiovascular effects," Bradley says.

How safe? For some people, high doses cause inflammation in the liver. A more common reaction is redness, burning and tingling of the face.

7. L-carnitine
This naturally occurring amino acid found in dairy and red meat "is great for recovery after a heart attack," Stengler says. Clinical trials show that L-carnitine ups your chances of surviving a heart attack and improves recovery after a cardiac event (Drugs Under Experimental and Clinical Research, 1992; Postgraduate Medical Journal, 1996).

Best for? The supplement helps people with fatigue and muscle weakness, including heart failure or arrhythmias, according to Stengler and Rothfeld.

How much? 500 milligrams once or twice a day is standard, Rothfeld says.

How safe? Those with kidney disease should consult their doctors before taking L-carnitine, Stengler cautions.

8. Magnesium
This common mineral seems to prevent heart disease and help regulate blood pressure (Cellular & Molecular Biology Research, 1995; American Heart Journal, 1998; International Journal of Epidemiology, 1999). Also, lower blood levels of magnesium have been associated with higher risk of heart attack.

Best for? "Magnesium deficiency is very common, so everyone should supplement with it," Stengler says.

How much? Take 400 to 600 milligrams daily, Stengler says.

How safe? Those with kidney disease should take caution. Too much magnesium can cause diarrhea, Stengler says.

9. Pomegranate juice
This crimson juice rich in antioxidants not only lowers blood pressure, but prevents LDL cholesterol from oxidizing (Clinical Nutrition, 2004). "Oxidized LDL promotes atherosclerosis even more than just high LDL by itself," Bradley says. Another notable, albeit small, study discovered that pomegranate juice improves blood flow to the heart (Journal of Cardiology, 2005).

Best for? "Individuals with known heart disease," Bradley says. How much? About 8 ounces of pomegranate juice each day, according to research.

How safe? The theoretical concern, according to Bradley, is that pomegranate juice may reduce the metabolism of statin drugs, which could increase any side effects.

10. Taurine
We still have a lot to learn about this amino acid found in animal products. "We do know that people with reduced blood flow to the heart have lower taurine concentrations in their blood," Bradley says.

Best for? Taurine helps people with congestive heart failure and arrhythmias. "I've had dramatic success with taurine improving patients' heart rhythms, reducing heart rates and improving exercise tolerance," Bradley says.

How much? Consult a health care practitioner because dosage depends on the individual patient.

How safe? Bradley has never witnessed problems, but he adds that patients taking medications for arrhythmias should have a doctor monitor their symptoms.

Pamela Bond is an Eldorado Springs, Colo.-based freelance writer.

Natural Foods Merchandiser volume XXVIII/number 12/p. 42