Natural Foods Merchandiser

Women's Heart Health

The way to a woman's heart is through her stomach: What she eats may determine her cardiac fitness—or failure. Unfortunately, Western diets are notoriously inadequate, typically providing too much saturated fat and not enough omega-3 fats for heart health. But diet and other heart disease risk factors, including smoking habits, exercise, blood pressure and cholesterol levels, are well within women's control.

To enhance their diet and help control blood pressure and cholesterol levels, many women turn to nutritional and herbal supplements. It is true these products may promote cardiac health, but individualizing them to women's specific needs is essential. Women are just as likely to develop coronary artery disease as men, but the condition is often overlooked by both women and their health care providers, many of whom don't provide adequate treatment. Although cancer fears are more common, coronary artery disease kills far more women (and men). The American Heart Association calls it "the silent epidemic."

Cardiovascular (heart and blood vessel) diseases are often interrelated. Atherosclerosis, also known as coronary artery disease, occurs when cholesterol and blood fibrin form plaque inside vessels, stiffening them and decreasing the flow of blood, oxygen and nutrients. Reductions to the heart's supply vessels can cause myocardial ischemia (oxygen-deprivation damage to the heart muscle), angina pectoris (chest pain), or a myocardial infarction (heart attack) when the heart's blood supply is cut off by a coronary thrombosis (clot) or occlusion (vessel closure). Strokes result from brain blood flow alterations, caused by brain or neck clots, brain bleeding, high blood pressure and arteriosclerosis (hardened arteries).

When heart attacks, defects, disease or hypertension cause congestive heart failure, the weakened muscle can't pump properly. Backed-up blood collects in veins, pushing excess fluid into legs, ankles and lungs (edema), and damaging kidneys.

Although cardiovascular disease is Western women's leading cause of death and disability, effects of female physiology and lifestyle are little known.

"Risk factors, presenting symptoms, testing, outcome and therapeutic choices are different for men and women," says Marianne Legato, M.D., F.A.C.P., board-certified internist, professor of clinical medicine, and director of the Partnership for Women's Health at Columbia University, New York. "Even risk factors that are qualitatively the same are quantitatively different. Diabetes increases a woman's risk four- to sixfold, while a man's risk only doubles." Some studies indicate physicians and hospitals are faster to dismiss women's complaints and are quicker to test and treat men more aggressively.

Among anatomical gender differences, women's hearts, coronary arteries and other blood vessels typically are smaller than men's, explains Legato, so it may take less plaque to block their vessels, impeding blood and oxygen to hearts and brains. Women's coronary arteries are more reactive to stress and prone to unprovoked spasms.

"Women's hearts become stiffer [as estrogen decreases], making it more difficult to relax between beats," says Legato; inability to distend is the main cause of congestive heart failure. "In many ways, a heart attack is far more serious for a woman than a man. She is twice as likely to die within the first 60 days. After a year, she is twice as likely to have a second attack, and at any age, she is at greater risk of dying."

Women are more likely to develop high blood pressure, and typically produce more fibrinogen for clotting. Even heart attack warning signs can differ, says Debra Judelson, M.D., medical director of The Women's Heart Institute, Beverly Hills, Calif. Men, after exertion, tend to experience chest pressure, tightness and pain radiating to the arm. Women are apt to have symptoms at rest, at night or with emotional upset: shortness of breath; pain in the abdomen, back, jaw or throat; and feelings of "uneasiness" that are often dismissed, even by physicians.

Estrogen may provide women some protection against coronary artery disease, but once her estrogen production declines as a result of menopause or hysterectomy, her risk increases steadily.

Meeting Women's Heart Health Needs
Determining which nutrients and herbs are heart healthy, and which to avoid, demands expertise.

"Substances helpful for one cardiovascular condition can actually be dangerous for others," explains Sara Warber, M.D., board-certified in family medicine and holistic medicine and co-director of the Complementary and Alternative Medicine Research Center at the University of Michigan in Ann Arbor. "We give blood thinners to prevent clots and heart attacks, but too much can cause easy bleeding that appears in the brain as strokes. We frequently counsel patients to lose weight, so naturally they're drawn to OTCs, including ephedra-based products that create problems by increasing heart rate and blood pressure."

Warber, who studied with a native American herbalist for 14 years, in six months will complete the first major U.S. clinical trial of hawthorn. "European studies show it's very useful for congestive heart failure, and may help certain arrythmias, but studies don't show which, and it may not be useful for others," she says. "CAM research is growing so fast that what looks weak or strong now could change dramatically."

Estrogen replacement therapy, birth control pills and hormone replacement therapy all deplete magnesium, folic acid and vitamins B6 and B12, which are necessary for metabolism, explains Ross Pelton, R.Ph., Ph.D., C.C.N., director of education for Natural Health Resources, Cincinnati. L-carnitine helps transport fatty acids across cell membranes, and can be therapeutic for angina, heart attacks, peripheral vascular disease, arrythmias and abnormal blood lipids. "Supplements are no substitute for a healthy diet, but they can have a huge effect on cardiovascular health," he says. "It's essential to get optimal levels regularly."

Formulas are an alternative to choosing and consuming numerous individual supplements. Rainbow Light makes several nongender-specific heart health products tailored for conditions such as high cholesterol and heart muscle weakness. "[Nongender-specific formulas] appeal to a broader market and are easier to share," says CEO Linda Kohler. Ingredients include Co-Q10; magnesium; vitamins E, C and Bs; and herbal extract blends including hawthorn and grape seed. Rainbow Light's heart products include niacin and magnesium citrate formulas to maintain healthy cholesterol levels.

Other new approaches are on the market. Promensil, a proprietary extract of two isoflavones from red clover for menopausal and perimenopausal symptoms, may have other benefits. Mark Waring, B.Sc., director of clinical and technical affairs for Novogen Inc., Stamford, Conn., says several of the company's Promensil studies, although short and ranging from 37 to 250 participants had similar effects to HRT, including increased HDLs; decreased triglycerides; and positive effects on artery walls, vascular compliance and elasticity. "We're getting to the point where we're pretty confident it has positive cardiovascular benefits," he says.

Another theory suggests high levels of C-reactive proteins reflect inflammation that causes cardiovascular disease. Naturally Vitamins is bringing out a protease formula derived from bromelain and papain, intended as a preventive measure to offset protein messengers and restore immune balance.

To extend the reach of its aged garlic extract, manufacturer Wakunaga of America Co. Ltd., Mission Viejo, Calif., added components to create several cardiovascular-specific formulas: lecithin to reduce cholesterol, B vitamins for elevated homocysteine, and others.

Fort Collins, Colo., freelancer Wendy L. Bonifazi, R.N., A.P.R., has won numerous national awards for health and science writing.

Natural Foods Merchandiser volume XXIII/number 2/p. 30, 32, 34

Commonly Recommended Heart-Healthy Supplements

  • Magnesium to strengthen heart contractions, increase HDL, promote clotting, control diabetes, prevent lipoprotein oxidation and inhibit platelet aggregation ("stickiness").
  • Niacin, as effective as some medications for reducing LDL and total cholesterol and increasing HDL, can cause a niacin flush and itchiness, and, in slow-release products, liver toxicity. The preferred form is Inositol hexaniacinate or IHN.
  • Folic acid and vitamins B6 and B12 to lower homocysteine levels, reducing heart attack risk.
  • Potassium to reduce blood pressure.
  • Vitamin E to prevent free radical damage; limit LDL oxidation, atherosclerosis and CAD; increase HDL and fibrin breakdown.
  • Vitamin C to limit LDL oxidation, lower triglycerides, raise HDL and perhaps lower blood pressure.
  • Essential fatty acids/omega-3 oils, including fish oil, flax oil (rich in alpha-linolenic acid), and perhaps evening primrose oil (rich in gamma-linolenic acid), to lower blood pressure and reduce heart disease risk.
  • Pantethine, a metabolite of pantothenic acid (activated vitamin B5), which is a component of Coenzyme A, to reduce triglycerides, LDL and total cholesterol while raising HDL.
  • Co-Q10 to prevent LDL oxidation, protect vessels, control blood pressure and reduce atherosclerosis, CHF, angina and other CVDs.
  • Garlic to raise HDL and lower cholesterol, triglycerides and blood pressure.
  • Ginger to inhibit platelet aggregation and lower cholesterol.
  • Gugulipid to lower total cholesterol, triglycerides and LDL while raising HDL.
  • Grapeseed extract antioxidants may protect the arterial lining, inhibit artery constriction, decrease platelet formation and reduce cholesterol levels and deposits.
  • Green tea antioxidants may lower cholesterol and prevent atherosclerosis and hypercholesterolemia.
  • Soy isoflavones, an estrogen modulator, may prevent atherosclerotic lesions.

Natural Foods Merchandiser volume XXIII/number 2/p. 32

Combine Drugs And Herbs With Care

Combining herbs and prescription medications can trigger both synergistic and counter effects, so consumers should first consult their health care provider or pharmacist for guidance.

Professionals often seek guidance from the not-for-profit Women's Heart Foundation in Trenton, N.J. Any list of interactions is incomplete; among its recommendations:

  • People taking anticoagulants (warfarin) should avoid herbs that affect clotting. Goldenseal shortens clotting time; herbs that prolong it include garlic, ginkgo biloba, ginger, feverfew, dong quai and coumarin teas.
  • Ephedra increases heart rate and blood pressure and should not be used by people with cardiovascular disease.
  • Astragalus, a vasodilator, decreases blood pressure, which can be good or bad, depending on condition.
  • Use black cohosh with caution if blood pressure is high.
  • Dong quai has blood-thinning and vasodilating effects. It should not be used with anticoagulants or by those with bleeding disorders.
  • Evening primrose's gamma linoleic acid may lower cholesterol, but it should be avoided by patients with schizophrenia or seizures.
  • Garlic mildly lowers blood pressure; studies show inconsistent ability to lower cholesterol. Do not use with anticoagulant or diabetic treatment without health provider's approval.
  • Ginger, used for its cardiotonic, cholesterol reduction and clotting inhibition effects, should not be used with anticoagulants; those with bleeding disorders, diabetes or cardiac conditions should consult practitioners before use.
  • Ginkgo, used to improve circulation, should receive provider approval if used by patients taking blood thinners (including OTC aspirin and ibuprofen), anticoagulants and antiplatelet medicines.
  • Ginseng, a cardiotonic, potentiates estrogens and many drugs. It's contraindicated with high blood pressure and anticoagulant use.
  • Goldenseal is contraindicated for people with high blood pressure and those using heparin, which it opposes.
  • Gotu kola, used for venous insufficiency and blood vessel maintenance, shouldn't be used with antidiabetic or anticholesterol drugs.
  • Skullcap, a hypotensive, can cause an irregular pulse.

Natural Foods Merchandiser volume XXIII/number 2/p. 34

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