America's number one killer…"heart disease", has been the focus of much interest and energy by physicians, the media, and the general public. More that 40% of all human deaths are due to cardiovascular disease from high blood pressure, diabetes, smoking, obesity, and a sedentary lifestyle. Most of the funding of research money has been directed towards the treatment of heart disease and reducing cholesterol with drugs.

In comparison, very little money has been dedicated to preventing it, and maintaining "heart health"… especially in animals. But now, the tide is changing. Fueled by public awareness, and the limitations of drug therapy with its side effects, the demand for non-drug alternatives is increasing. The last 10 years of research has demonstrated that nutraceuticals and botanicals known as "cardio-protectant agents" can and will prevent some diseases such as cardiomyopathy, and assist the treatment of most other cardiovascular diseases. Most of these compounds are vitamins, antioxidants, amino acids, minerals, essential fatty acids, and botanicals.

The advantages of nutritional functional intervention (NFI) with cardioprotective agents are:

1.) improved heart function, (inotropic)
2.) reduction in oxidative stress to the myocardium
3.) safety with minimal or no side-effects
4.) increased longevity
5.) can be used with most standard drug treatment protocols.

In many cases, drug dosages can be reduced after a few weeks or months of supplementation depending upon the condition.

The veterinarian has the opportunity to do more for an ailing pet than just treat the symptoms of heart disease with drug intervention. "Feeding the heart" by supplementing the diet with the appropriate substances can create long-term beneficial physiological effects that will increase the longevity of the patient.
From my perspective, Heart Disease can be approached from the following perspective:

¨ Prevention
¨ Detection
¨ Intervention
¨ Maintenance

I. Prevention

A healthy heart can be maintained with a healthy diet, exercise, minerals and vitamins, and botanicals that support cardiac function and alleviate oxidative stress. Animals with a genetic predisposition to cardiac problems can also be assured greater longevity. Certain types of heart disease are common to specific types of dogs such as the Doberman pincher, Portuguese Water Dog, Great Dane, Irish Wolfhound, and to American Cocker Spaniels. Monitoring susceptible dogs with ECG, ultrasound, stress tests, and physical exams several times a year may be indicated to insure continued health.

Designing an individualized exercise plan that keeps the pet in good cardiovascular condition is key to long term heart health. Dogs must exercise regularly. Activities such as running, swimming, hiking, and walking hills support the strength and stamina of the heart muscle. Cats can be encouraged to hunt, play, climb, and chase balls for exercise.

Unfortunately, most people have a sedentary life-style and do not have time or commitment to exercise their pets properly. By encouraging both owner and dog to walk together frequently and regularly (aerobic exercise at least 3 times per week for about 30 to 40 minutes duration), the veterinarian can influence improved communication between the dog and owner with the added benefit to cardiovascular health.

Designing a diet for the pets' individual needs is also crucial for heart disease prevention. The AMA (American Medical Association) acknowledged that 80% of the heart problems in the USA could be prevented with moderate exercise, and a good healthy diet.

What is a good healthy cardiac diet? For humans, the "Mediterranean diet" seems optimal; a diet high in omega -3 (eicosapentaenoic acid and docosahexaenoic acid), mono-oils such as olive oil, vegetables, fruits, fish, and nuts.8 Consuming more beans, whole grains, fruit, vegetables, fish and soy protein can reduce risk factors of cardiovascular disease significantly.

I have included this in my discussion because veterinarians are not "immune" from acquiring heart disease, and many use their busy schedules to justify eating "fast food" high in fat, salt, and meat.

What is the optimal cardio-healthy diet for a dog or a cat? Recent research has discovered that many conditions such as congestive heart failure, cardiomyopathies, and health maintenance of the heart can be affected by a diet high in omega-3 (EPA & DHA) from deep water fish (salmon, tuna, sardines, mackerel). A "heart friendly" diet for a dog or cat would be rich in, vitamins B12, B6, folic acid and E & C. Minerals such as potassium and magnesium are found in high amounts in sea kelp.

The amino acids taurine, and L-carnitine important in preventing cardiomyopathies are present in such foods as organ meats (heart), and nutritional yeast.
Antioxidants, vitamin C and bioflavanoids can keep oxidative stress to a minimum in the myocardium, and are present in dark green leafy vegetables, carrots, beets, papayas, broccoli, and yams.)

An example of another cardiovascular friendly vegetable is the avocado. Avocados contain no cholesterol, are high in monounsaturated fatty acid content at 71%, are rich in dietary fiber, and are high in antioxidants with beta-carotene at 7%, vitamin C at 17%, and vitamin E at 29% of the (human) RDA per 100 g. Avocados are low in sodium and high in potassium with a potassium content of 24% of the RDA per 100 g. Avocados have received the Heart Mark awarded by the South African Heart Foundation as a useful part of a balanced diet.

Depending upon the breed, age, sex, condition, and life-style of the pet, a veterinarian could design a diet for a particular pet. It would consist of fresh meat, raw meat bones, deep- water fish, eggs, nutritional yeast, some cooked whole grains, and vegetables. But having the knowledge and the time to construct such a diet may not be practical. Owner compliance will be low because most people are too busy to prepare such a "designer diet". Clients want convenience, ease and the answer in a "pill". Because most commercial diets lack these cardioprotective agents and cause free radical formation, supplementation is necessary for heart health and would at least, guarantee the pet the essential nutrients.

II. Detection

It is important to check the heart completely at each annual examination, and breeds prone to heart disease, or dogs with a history of heart disease in their sire or dam should be monitored more frequently using ultrasound, echocardiograms, ecg, blood chemistries, radiographs and stress tests to determine heart health. For veterinarians trained in Traditional Chinese Medicine (TCM), tongue and pulse diagnosis is invaluable for detecting early signs of cardiovascular problems.

III. Intervention: Drugs or Botanicals?

Drug intervention can create immediate physiological effects that can be life-saving. Patients who need drug intervention to keep alive can also be supplemented with nutraceuticals once vital signs have stabilized. These supplements will insure improvement.

In many cases, the dosages of digoxin, ace-inhibitors, or channel blockers can be reduced, and diuretics could be discontinued with improving heart function.
In has been my experience that chronic heart patients supplemented with nutraceuticals will live longer and their quality of life will improve as their symptoms decrease.

Side-Effects?

When drugs and herbal pharmaceuticals are mixed inappropriately, reactions….mostly enhanced drug toxicity may occur. Caution should be exercised when using certain botanicals such as Siberian ginseng (Eleutherococcus), and Hawthorn (Crataegus, spp) because they will reduce the hearts' demand for digoxin. If doses of digoxin are not reduced at least 50%, digoxiin toxicity may occur. Some clients will use botanicals such as St. John's Wort for depression, or behavior problems in their pets which may cause a decrease of bioavailability of digoxin and theophylline and affect your treatments detrimentally

IV. Maintenance

A client may ask, "Is it possible a supplement can be given to decrease the medications, eliminate them completely, or just help heal the damaged heart tissues?" The answer is "Yes". Depending upon the condition of the animal, the side-effects of the drugs, and how the veterinarian introduces the nutriceuticals good results are expected.

After you have diagnosed and stabilized the patient with congestive heart failure or cardiomyopathy with your standard treatments of drugs, you may want to consider using a supplementation program that facilitates and supports longevity.
If a patient seems healthy without cardiac disease, but belongs to a breed that is susceptible to cardiomyopathy, or is related to animals with the disease, supplementation may be in order.

Lets review the individual nutraceuticals and botanicals that have proven to exhibit beneficial effects on cardiac care.

Vitamins

Vitamins A, E, C and beta-carotene may be protective against cardiac necrosis and oxidative stress and might be beneficial in preventing complications and cardiac events in myocardial infarction patients. One study showed that a combination of vitamins A, E, C and beta-carotene given within a few hours of symptoms of an acute myocardial infarction could be associated with a significant reduction in total cardiac end points including total cardiac death and nonfatal acute myocardial infarction.

Besides vitamin C's direct affect at quenching reactive-damaging free radicals, it has been shown to regenerate reduced tocopherol (tocopheroxyl radical) which provides high levels of vitamin E in the tissues. Vitamin E can also protect the conjugated double bonds of beta-carotene from oxidation and can spare beta-carotene. One researcher (Dr. Tomacz Chamiec of Poland) suggests that the inadequate availability of one antioxidant can result in a subsequent decrease in the bioactivity of other antioxidants even though the recommended dose of the antioxidants in question is administered.16b
In human medicine, much research is being directed at investigating vitamins B1 & B 6 for lowering cholesterol, plaque formation in the coronary arteries, and lowering blood pressure.

Mechanisms of Action?
Antioxidants vitamins may inhibit atherogenesis and improve vascular function by two mechanisms. The first mechanism is through lipid- soluble antioxidants present in LDL cholesterol such as vitamin E and water-soluble antioxidants such as vitamin C which are present in the extracellular fluid of the arterial wall and which inhibit LDL oxidation through an LDL-specific antioxidant action. A second mechanism is that antioxidants present in the cells of the vascular wall reduce reactive oxygen species production and release, inhibit endothelial activation, and improve the activity of endothelium- derived nitric oxide (EDNO). Therapies which included oral administration and IV infusion of vitamins A,E, and C exhibited great benefits to patients with acute myocardial infarctions by decreasing deaths, and reducing re-infarctions by 30% as compared to placebo groups.16e
Although most animals do not have so called "cholesterol problems" nor myocardial infarctions, the beneficial affects of these vitamins would help to maintain the health of the arteries and myocardium by reducing the oxidation (aging) process that occurs over time. These vitamins may be valuable in adult overweight animals with sedentary lifestyles that may make them more prone to obesity, and future heart disease.

Vitamin E
Antioxidants, such as vitamin E, have been shown to improve endothelial function in both animals and man.2 Tocopherols are the most abundant and efficient scavengers of hydroxyl radicals in biological membranes. Free radicals are formulated by the activated oxygen intermediates from the reduction of oxygen to water. Vitamin E is a lipid soluble antioxidant breaking the chain of lipid peroxidation in cell membranes. Vitamin E and a variety of thiol antioxidants have been shown to reduce adhesion molecule expression and monocyte endothelial interactions. Although in human studies using 400-800 units daily of vitamin E alone demonstrated no benefit reducing the incidence of cardiovascular disease, tocopherols have a positive effect by decreasing the amount of lipid peroxidation damage to arteries, and helped reduce risk by 47% of the incidence of non-fatal myocardial infarctions .These studies did not address diet, exercise, nor life styles changes.

Vitamin C
Vitamin C, which is the major water-soluble antioxidant, can enhance antioxidant defenses by reducing the oxidized form of vitamin E back to its antioxidant form. Vitamin C is regenerated by intracellular glutathione. Humans with high dietary intakes of vitamins C and E and beta- carotene have a lower risk of cardiovascular death and may have a greater life expectancy. In vitro studies suggest a combination of antioxidants may provide the most benefit, even though the evidence for vitamin C and beta-carotene remains unclear. There may also be a role for antioxidants such as polyphenols (pycnogenols).

It has been demonstrated in clinical studies that Vitamin C will enhance endotheilium-derived nitric oxide (EDNO) activity and normalize vascular function in patients with coronary artery disease and associated risk factors. Doses of vitamin C used in enhancing endothelium-dependent vasodilation in human studies are between 500 and 2000 mg orally/d and 10-25 mg infused/min.16d
The "B" Vitamins

In humans, it is interesting to note that supplementing the diet with vitamins B6, B12 and folic acid reduced the artherosclerosis producing homocysteine levels dramatically, and thus the incidence of coronary heart disease. Deficiencies in these nutrients lead to inadequate production of S-adenosyl-methionine, creating a condition of hypomethylation. It is hypothesized that this results in hypomethylation of DNA in cells in the arterial intima, resulting in mutation and proliferation of smooth muscle cells which leads to the formation of atheromas. It is believed that super physiologic doses of vitamins B6, B12 and folic acid can reverse this hypomethylation and thereby reduce or remove existing atheromas.

Folic acid improves endothelial function in people eating high fat diets by inhibiting "in flow-mediated" dilation, and by inhibiting the increase in free radical damage end products. Recent research in Israel has shown vitamin B1 is lost in the urine when people are taking furosemide (Lasix). At worse, thiamine deficiency can result in heart failure. Vitamin B1 at 100 mgs is recommended daily for 7 weeks in humans. It has been shown to improve heart function in human patients using furosemide.

The Amino Acids: L- Carnitine & Taurine

L-carnitine will improve heart function directly by supporting the transport of long chain fatty acids to beta-oxidation sites within the mitochondria. For example, in the case of cardiac insufficiency caused by a chronically ischemic heart; l-carnitine can improve the metabolic situation of an oxygen-starved heart in the mitochondria by removing the excess of acetyl-CoA respectively long-chain (LC) acyl-CoA caused by the congestion of acetyl-CoA from the citric acid cycle.

Excess of LC-acyl-CoA inhibits the activities of pyruvate dehydrogenase and adenine nucleotide translocase. When ATP cannot leave the mitochondria, the energetic situation of the heart deteriorates dramatically. L-carnitine causes a re- esterification of LC-acyl-CoA to LC-acyl carnitine, which can leave the mitochondria, thereby reducing the concentration of acyl groups and relieving the citric acid cycle. This process also abolishes the inhibition of the enzymes, and ATP can leave the mitochondria.

Canine idiopathic dilated cardiomyopathy may have direct correlation to deficiencies of taurine and L- carnitine. Deficiency results in the development of cardiomyopathy in several breeds of dogs. Research on families of boxers with dilated cardiomyopathy discovered that all dogs had decreased concentrations of myocardial L-carnitine when compared to control groups. Supplementing the diet with L-carnitine improved cardiac function, heart rate, and exercise tolerance, and decreased cardiac necrosis and will benefit dogs (and cats) with cardiomyopathy and congestive heart failure…improving survivability. When these improved dogs were deprived of L-carnitine, cardiac dysfunction returned. Tissue and cellular damages that occur in cardiomyopathy are characteristic of oxidative stress.

In human medicine the use of antioxidant drugs, such as captopril, taurine, carnitine, and metal transition chelators, have improved the therapeutic treatment of cardiomyopathy. In dogs suffering with cardiac disease related to a taurine deficiency, supplementation with L-carnitine improved their condition considerably and allowed the discontinuation of drug therapy.

Taurine is a non-protein amino acid obtained through the diet as a free amino acid. Taurine is absent from the vegan diet. It is formed in the body as an endproduct of the decarboxylation of cysteine and hypotaurine. Taurine has antioxidant properties, lowers blood pressure, reduces blood cholesterol levels and reduces platelet aggregation.

As an antioxidant, it functions by decreasing the levels of lipid peroxides which cause free radical damage to the myocardium. Some other actions of taurine include anti-arrhythmic effects and cardioprotective effects by regulating the sodium diuresis, minimizing the adverse effects of angiotensiin II, and exhibiting positive inotropic effects on the myocytes.

A lack of taurine in the diet will create cardiomyopathy in cats and dogs, especially in the Doberman pincher, Portuguese water dog, American cocker spaniel, and Irish wolfhound. It is extremely important in maintaining heart health. Because most commercially based diets are deficient in taurine, cardiomyopathy has become a common occurrence.

Taurine deficiency is associated with feline central retinal degeneration, reproductive failure, developmental abnormalities, dilated cardiomyopathy and compromised immune function. Phagocytic activity in polymorphonuclear leukocytes is reduced in taurine deficient cats. Naturally occurring sources of taurine include animal products, especially fish. It was found in the past that cats fed a commercially canned diet have a requirement for taurine that is almost twice as high as those fed a commercially dry diet.

Feline diets should contain at least 1,000-1,200 mg taurine per kg of diet, and canned commercial diets should contain at least 2,000 to 2,500 mg per kg diet on a dry matter basis. Normally present in heart muscle, taurine can be supplemented by either feeding carnivores a diet of cooked or raw beef heart daily, or giving a pure amino acid product. Supplementation could eliminate occurrence, and decrease pathological changes in animals already with nutritionally related heart disease.

Supplementing any dog or cat with a combination of L-carnitine and taurine cardiomyopathy or congestive heart failure will greatly improve survival rates.
The current National Research Council recommendation for adequate taurine in cats' diets is 400 mg per kg in dry food; to prevent dilated cardiomyopathy, dry cat food must supply 1,000 mg/kg of taurine in the diet, which is a two to threefold increase over the National Resource Council requirements. Taurine levels below 20 nmol/ml are a risk factor for cardiomyopathy and retinal degeneration. Oral replacement of taurine should be 250 mgs, given twice a day.

Minerals

Magnesium

Oral magnesium is probably of benefit at 300-500 mg/day as an anti arrhythmic agent in humans. High dosages of magnesium might affect congestive heart failure adversely, especially in the presence of ACE inhibitors which tend to spare magnesium. This is really of concern only with intravenous magnesium.
An overview of experimental and epidemiologic human data suggest that dietary magnesium intake has a beneficial effect on cardiovascular risk, especially for hypertension, which might be caused by mild magnesium deficiency.

Low concentrations of magnesium in laboratory animals seem to potentiate catecholamine-induced myocardial necrosis. Magnesium deficiency might adversely influence the healing and re-endothelialization of vascular injuries, the healing of myocardial infarction, and might also result in delayed or inadequate angiogenesis, effects potentially leading to inadequate collateral development and infarct expansion.

Low magnesium content in water has been associated with more heart disease than areas with higher levels of magnesium in the water. Magnesium deficiency is important in the pathogenesis of ischemic heart disease in humans. Lower cardiac levels of magnesium have been shown in autopsies of individuals who have died from ischemic heart disease. Magnesium supplementation has been known to reduce the symptoms of ischemic heart disease for over 50 years and has been beneficial in the treatment of angina.

Magnesium reduces vulnerability to oxygen-derived free radicals, reperfusion injury and stunning of the myocardium . Data support the potential for myocardial protection and for enhanced survival in patients with acute myocardial infarction who are treated with magnesium.Magnesium improves myocardial performance by reducing systemic and pulmonary vascular resistance, with a subsequent reduction in blood pressure and a slight increase in the cardiac index.

As an antiarrhythmic agent, magnesium may have benefit. Hypomagnesemia has been associated with atrial fibrillation and flutter. Magnesium sulfate (parenteral) is efficacious in treating atrial fibrillation and other supraventricular tachycardias, although given the many other medications available, it would not be considered a first-line choice. Magnesium is important for sodium/potassium- ATPase, which maintains the sodium and potassium gradients across the cell membrane. Lack of magnesium can lead to accumulation of intracellular sodium and loss of intracellular potassium.

The calcium gradient of the heart cell is controlled, in part, by the magnesium-dependent calcium-ATPase enzyme system. Magnesium may interfere with calcium fluxes over the cell membrane and may block both receptor-mediated and voltage-dependent calcium channels. Parenterally administered magnesium has been shown to prolong the conduction time in the AV node, increase AV nodal refractoriness and prolong the ECG PR interval. The greatest effect of magnesium is on nodal conducting tissue.

Digoxin toxicity results in inactivation of sodium/potassium-ATPase and, in acute massive digoxin poisoning, there is profound suppression of this enzyme so that intracellular potassium pours out and results in hyperkalemia. Magnesium potentiates the action of the sodium/potassium-ATPase pump and counteracts the effects of digoxin.

Magnesium is widely available, cheap, can be rapidly administered and is antagonistic cellularly to the actions of digoxin. Magnesium should be used for arrhythmias resulting from digoxin toxicity.44 Intravenous magnesium sulfate can be used for torsades de pointes ventricular tachycardia and digitalis toxicity induced arrhythmias, and possibly multifocal atrial tachycardia, re-entrant supraventricular tachycardia and atrial fibrillation. Investigationally, it may be used for monomorphic ventricular tachycardia.

Drugs that result in renal wasting of magnesium include amphotericin B, cisplatin, cyclosporine, digoxin, ethanol, gentamicin, loop diuretics and pentamidine.
In veterinary clinical practice, oral supplementation with either magnesium citrate, aspartate, or orotate salts could benefit animals taking dioxin and Lasix combinations by reducing loss of potassium, and preventing necrosis of the myocardium during stress. Oral supplementation can also improve exercise tolerance in animals who need the exercise, but seem "too tired" by their owners.

Selenium

Selenium is an essential trace element in nutrition, whose deficiency results in decreased activity of glutathione peroxidase, which plays a protective role against oxidant stress to cardiac muscles. Keshan disease is a type of cardiomyopathy and a well-known endemic disease in the middle areas of China where the dietary selenium intake is low due to selenium-deficient soil. Insufficiency of cardiac function is also believed to result from total parenteral nutrition on occasional cases where selenium intake is null. In these occasions and in experimental animals with selenium-deficient foods, cardiomyopathy is confirmed by pathological findings including focal necrosis and subsequent fibrosis of myocardium, as well as necrosis in the conduction system of the heart.

The most impressive finding in idiopathic dilated cardiomyopathy is the limited histologic and ultrastructural myocardial changes, even in the presence of a severely-compromised cardiac contractility. This points to the molecular level of the pathogenetic mechanisms of the disease. Both myocardial trace element accumulation (increased cobalt) and deficiency (decreased selenium) have been associated with a cardiac dilation and dysfunction not distinguishable from an idiopathic dilated cardiomyopathy.

Just maybe, some of what we see as veterinarians in cats or dogs is a chronic selenium deficiency in our patients with cardiomyopathy. A natural source of selenium and vitamin E is reindeer meat. Reindeer researchers report that particularly lichens and mushrooms are rich in selenium. The consumption of margarine, plus vegetable oils and cereals, which are important sources of vitamin E, is higher in the Sami people in Northern Finland than the neighboring regions to the south. Cold water fish is also a good source of selenium which is an important constituent of the diet in northern latitudes.

Humans undergoing long term tube feeding with low selenium diets developed impaired cardiac functions. Selenium supplementation at 5 ug/kg/d (sodium selenite) resulted in normalization of serum selenium levels, partial improvement of ECG abnormalities and an increase of cardiac function.This may be an important factor to consider when tube feeding anorexic cats long term.

Selenium is an important component of glutathione peroxidase which scavenges hydroperoxides to prevent cellular damage. Dietary selenium deficiency has been associated with cancer, heart disease, arthritis and AIDS.

Heavy metals & cardiomyopathy

Researchers observed a large (more than 10,000 times) accumulation of mercury and antimony only in the cardiac muscle of patients with idiopathic dilated cardiomyopathy, but not in patients with secondary cardiac dysfunction having similar age, gender and degree of cardiac compromise. Heavy metal accumulation can play a role in the pathogenesis of dilated cardiomyopathy. In fact, it can antagonize Ca++ at actin-myosin junctions, producing a progressive decline in sarcomere contraction and, thus, of myocyte function.

If diets are high in fish products, especially fish meal, we may be seeing cardiomyopathies forming because of chronic ingestion of heavy metals, more than a lack of taurine in cats.

Potassium

Potassium is usually not considered in cardiac therapies but is an essential mineral because it protects and maintains the integrity of the myocardial cell .
In human studies, it has shown to be an antihypertensive agent and vasculoprotective. Potassium levels are affected by thiazide diuretics, taurine, and magnesium levels in the blood. Taurine helps the body to retain potassium within the cells.

It is interesting to note that a magnesium deficiency can reduce serum levels of potassium even though there may be adequate potassium in the body. Low magnesium will create low potassium levels. When thiazide diuretics are used, both of these minerals should be supplemented because the diuretics will potentiate hypokalemia and hypomagnesia.

Sodium chloride

In human studies, there is a relationship between salt sensitivity and left ventricular hypertrophy, albuminuria, hyperinsulinemia and impaired endothelial function, suggesting that salt sensitivity may be a marker of susceptibility to hypertension and end-organ damage.

Generally speaking because NaCl will cause increased loading on the heart muscle and more oxidative stress, animals with cardiac problems should avoid most if not all commercial foods, and salty snacks.

Coenzyme Q 10

One of the most beneficial supplements I have introduced to my therapy of heart disorders in the past 15 years has been coenzyme Q10. In fact, if you were to pick just one supplement to use, this would be the one that has the most positive effects supporting the function of the heart with no side effects nor negative interactions with cardio-therapeutic drugs.

In Japan, coenzyme Q10 is widely accepted by traditional human medical practitioners for over 10 years as a therapy in cardiovascular diseases such as congestive heart failure, angina pectoris, hypertension, and arrhythmias.
I first heard about it from one of my clients a maxillo-facial surgeon-dentist who used it for severe gum problems in humans. Upon further study, I had discovered that this supplement was being used for cardiovascular problems also. What is it and how does it work?

Coenzyme Q10 or ubiquinone is an anti-oxidant with free- radical scavenging properties. It is a naturally occuring substance which plays an important role in transporting electrons in the mitochondria for ATP production. There is a lot of evidence showing that Coenzyme Q10 helps to regulate energy metabolism of the myocardium and decreases oxidative stress on the heart.

Other benefits include:
¨ Improved endothelium-dependent vasodilation with hypertensive patients
¨ Improved survival in acute renal failure, amyotrophic lateral sclerosis, and polymyositis.
¨ important in collagen formation;
¨ improves exercise tolerance
¨ decreases ventricular arrhythmias and peroxidative damage to the myocardium during cardiovascular surgeries such as grafting and by-passes and improves recovery.
¨ reduces elevated blood pressure, improves blood glucose control and improves insulin action, as well as improves blood lipid profiles
¨ decreases the incidence of fatal myocardial infarctions
¨ improved cardiac function in animals with cardiomyopathy
¨ improved cardiac function in animals with congestive heart failure
¨ no side effects or toxicity

When animals with cardiovascular diseases such as cardiomyopathy, heart worm disease, or congestive heart failure are presented to you, treatment with Coenzyme Q10 should be considered without hesitation. This naturally occurring antioxidant will help to decrease the progression of the disease and improve quality of life. Owners will notice their dogs will have more stamina to go on longer walks, express more energy and less coughing.

There is some controversy as to which form is more absorbable, and in human studies the "gel cap" which bi-passes the stomach shows quicker blood levels than capsules or pills of CoQ10.

Essential Fatty Acids

The supplementation of human diets with omega-3 essential fatty acids (eicosapentanoic acid and docosahexanoic acid) demonstrated a significant inverse correlation between the ingestion of fish oils and coronary heart disease, all cardiovascular diseases and all-cause mortality. The highest quintile had the lowest mortality rates of approximately 40-50%. Besides the anti-inflammatory properties in arthritic pets, and nutritional support of skin and hair, omega-3 fish oils can be used in overweight dogs with heart disease.

Omega-3 fatty acids reduced thromboxane, leukotrienes, fibrinogen, platelet activating factor, platelet-derived growth factor, superoxide formed by leukocytes and interleukin-1 and tumor necrosis factor. Omega-3 fatty acids increased prostacyclin, endothelial-derived relaxation factor and fibrinolytic activity. These factors resulted in an overall reduction in platelet aggregation and vasoconstriction, a slowing of blood clotting, a reduction of cellular damage and an increase in LDL uptake by macrophages, stimulation of smooth muscle cell proliferation and neutrophil superoxide formation, a reduction of arterial constrictor response, protection of the endothelial surface from thrombi and help in dissolving clots.

To put all this in more simple and palatable terms, omega-3 improve the flow of blood through the vascular system by decreasing factors that would impair normal flow "dynamics" and thus improve the "fluidity" of the blood through the vasculature.

Chronically overweight animals, and those living a sedentary lifestyle will be most prone to restricted coronary artery blood flow dynamics and therefore would benefit the most from supplementation with fish oils.

Other physiologic effects of fish oils include a reduction in
¨ blood pressure,
¨ blood viscosity,
¨ microvascular albumin leakage in insulin-dependent diabetics,
¨ plasma triglycerides,
¨ vascular response to norepinephrine,
¨ ventricular fibrillation from ischemia,
¨ cardiac toxicity of cardiac glycosides
¨ in vitro, platelet aggregation and leukocyte/endothelial interactions and
an increase in vascular compliance,
¨ thrombolytic activity of TPA and platelet survival.

Other indications for use of Omega-3 fish oils would be animals with cardiomyopathy, congestive heart failure, and dogs undergoing heartworm treatment.

The Cardiac Botanicals
The use of botanicals in the treatment of heart disease has been a great interest of mine for over 20 years. Unfortunately, much of the research and information has not been available or translated into English from Russian, Chinese, and Japanese until recently. I am convinced that if used correctly, these plant phytopharmaceuticals could prove more effective in the treatment of heart disease than the drugs currently available with less side-effects except with extreme cases.

Siberian Ginseng: Eleutherococcus senticosus
Commonly named Siberian Ginseng, this plant is not of the Ginseng family. This member of the Araliaceae family was first discovered by a Russian physician (Grorovoy) who observed wild deer eating a "spikey"shrub during harsh winter conditions. Pharmacologist I.I. Brekhman experimented with swimming mice, who were able to swim 30% longer and further than controls. Next he experimented with Russian athletes.20b By the 1950's Russian Olympic athletes were using this herb to improve performance by increasing endurance and stamina. The U.S. Olympic Committee currently includes this and all types of Ginseng on their list of banned substances.

Eleutherococcus is an "adaptogen". Soviet scientists first proposed the definition of an adaptogen in the late 1950's, namely, that it is any substance that exerts positive bioactive effects on both sick and healthy individuals by 'correcting' any dysfunction(s) without producing unwanted side effects. Its main effects are due to its "capacity to exert protective and/or inhibitory action against free radicals"

This "ginseng" is relatively safe. The LD50 of the whole root has been found to be 10 to 30 gm/kg in mice. Some researchers note that animals are affected by abdominal distention before a toxic dose can be reached.

Caution should be used when administering concurently with digoxin or digitalis because all ginsengs seem to potentiate the toxic effects of these drugs. Before any attempt is made to begin therapy with Eleutherococcous, or Chinese Ginseng (Panax ginseng) the dosage of digoxin must be reduced by 50%, and gradually lowered over a 2 week period. This "titrating method" of lowering digoxin doses gradually is necessary due to the strong interactions of the herb with the drug. In most cases digoxin can be eliminated.

It must be noted that Siberian "ginseng, Chinese ginseng, and American ginseng differ considerably chemically and pharmacologically and cannot be justifiably considered as mutually interchangeable nor substituted.

Siberian ginseng has been analyzed and it does not contain any digoxin or digitoxin although when used concomitantly will increase serum levels of these drugs.19b Instead it contains eleutherosides that may differ in concentration from one product to another. 500mg of one brand may differ in pharmacologically active compounds from another brand. One brands' eleutherosides content may differ from batch to batch because plants do not consistently create pharmacologically active substances which will be affected by weather and soil changes….and even the time of year harvested. In general, older plants contain more active substances. Wild crafted (harvested in the wild) contain more active substances than commercially farmed.

These facts complicate the use of many herbs because unless each batch is tested and the results are included on the label, the veterinarian has to make a "judgement call" as to what dose to use when initiating therapy. Fortunately, no side-effects have been reported when doses are within therapeutic range, and if digoxin is not in the animals' system.

The indications for use in animals are:

¨ substitute for drugs that either are not working well or causing
undesirable side-effects (dose of desirable cardiotherapeutic drug can be lowered to reduce side-effects, and Eleutherococcus added)
¨ do not respond well to stressful situations
¨ athletic competition
¨ strenuous hikes in high altitude
¨ Asymptomatic heart disease i.e, a heart murmur is present.
(ultrasound, echocardiogram or radiographs are necessary to accurately
determine the extent of pathology)

Chinese ginseng (Panax ginseng)
The "true ginseng" has been prescribed for heart disease in China for many centuries. In patients with heart disease, this herb improves myocardial utilization of nutrients and cardiac function. It is almost never used alone, but in combination with other cardioprotective herbs.

Ren shen has inotropic effects similar to those of cardiac glycosides (digitalis). It also is useful in reducing catecholamine-induced arrhythmias. Other effects include adaptogenic against stress and fatigue, improves glucose utilization in diabetics, and increases the synthesis of proteins and nucleic acids. Facilitates adaptation to stress by acting on the hypothalamus-pituitary-adrenal cortex axis.

Unless one has been trained in the use of Chinese herbal medicine, one should not attempt to use this herb alone especially in combination with digoxin. Besides potentiating the effects of digoxin, it can also acts as a synergist with phenobarbital. Caution should be used when mixing ginseng and barbiturates together.

Sour Date Fruit Seeds (Zizziphus spinosa)
The seeds of this plant contain saponins which have cardio-protective antioxidant effects on the myocardium. Effect of zizziphus( lu-duo-wei )on scavenging superoxide and hydroxyl radicals in vitro studies confirms its protection of myocardial cells against oxidative damage. In Chinese medicine, this herb "nourishes the Heart and Liver" and calms the "spirit" of the heart or rather anxiety caused by cardiac irritability and inflammation. This herb is non-toxic and does not seem to react with cardiotherapeutic drugs.

It's most beneficial effects are correcting the night time anxiety and restlessness in animals with heart disease.

Dan Shen (Salvia militiorrhizae)
Another botanical that has been used in primarily oriental medicine is Salvia militiorrhizae, or Chinese sage red root. One of Dan Shen's prime effects on heart muscle is that of an antioxidant. The herb has been used in Oriental medicine to decrease the inflammatory processes in the heart and improve blood flow through the coronary arteries.

In guinea pig and rabbit studies, Dan Shen exhibited vasodilatory affects on the coronary arteries, a negative chronotropic effect, and a transitory negative inotropic effect followed by an increase in contractile myocardial force. It has no beta- blocking effects.

In controlled human clinical studies in China, patients receiving dan shen prior to open heart surgery, had significantly lower increases in MDA, CPK, and LDH levels as compared to control group.

In other studies, Salvia miltiorrhizae prevented the production of free radical products, and leucocyte aggregation in the lung during and following cardiopulmonary bypass surgery.

Other uses in Chinese medicine recently have been for the treatment of asthma, kidney hypertension, epilepsy, stroke, and hypoxic-ischemic encephalopathy.

Hawthorn (Crategeus spp.laevigata, oxycantha, meyeri)
The primary constituents of hawthorn include flavanoids, oligomeric procyanidins, and catechins. Animal studies suggest that hawthorn possesses the unusual property of simultaneously increasing the force, amplitude and volume of cardiac contraction while lengthening the cardiac refractory period helpful in treating CHF.
Hawthorne will potentiate the effects of digoxin or digitalis, and therefore, these drugs must be titrated downwards in dosage.

Other benefits of this drug are in the treatment of angina pain which lessens dramatically due to the improvement in the blood and oxygen supply to the myocardium from the dilation of the coronary blood vessels, as well as improvementto the metabolic processes in the heart.

Grape Seed (Vitis vinifera)
Grape seed extract contains a family of chemicals known as PCOs (oligomeric proanthocyanidin complexes. Recent in vitro studies suggest that grape seed PCO's possess superior antioxidant activity to vitamin C or vitamin E. Proanthocyanidins are a group of polyphenolic bioflavonoids which has been reported to have a wide range of biological, pharmacological, and chemoprotective properties. At a 100 mg/L concentration of grape seed proanthocyanidin, there was a 78-81% inhibition of superoxide anion and hydroxyl radical. Under similar conditions, vitamin C showed 12-19% inhibition, while vitamin E succinate inhibited the 2 radicals by 36-44%. The primary uses of PCO extracts are in the treatment of venous and capillary disorders, including venous insufficiency, and capillary fragility. Grape seed extracts have also been shown in animal studies to prevent damage to the lining of the artery, lower blood cholesterols, and shrink the size of cholesterol deposits in the arteries. Other mechanisms include the inhibition of platelet aggregation and inhibition of vascular constriction.

Reishi Mushroom Ganoderma lucidum

Reishi mushroom, also known as the "divine herb" in the Orient, has been used for centuries for treating debilitating illnesses related to aging. This "cardiotonic"medicinal mushroom is known for its positive effects of immune system enhancement, improving stress adaptation (adaptogen) and increasing myocardial blood flow while reducing serum cholesterol. It can be safely used with drugs and other nutraceuticals.

This mushroom is very nutritional containing many essential amino acids, sugars, B vitamins, Vitamin C, selenium, sulfur, germanium, potassium, beta-glucans, glucosamines, sterols, unsaturated fatty acids, polysaccharides and triterpenes. The polysaccharide portions have anti-tumor, immunostimulating, and cardiotonic effects. The triterpenes inhibit cholesterol synthesis, are anti-hypertensive, and inhibit antihistamine release.

Reishi mushrooms' other common uses are:
¨ the treatment of chronic hepatitis
¨ cancer therapy
¨ to decrease the side-effects of chemotherapy and radiation
¨ analgesic, anti-inflammatory (glucosamines, GAG's)
¨ mild diuretic
¨ adaptation to stress
¨ increase performance and improve stamina in athletes

Nutraceutical/Herb/Mineral Maintenance dose (can be used with cardiotherapeutic drugs Therapeutic doseCaution with drugs = CX!
Vit B 1 Brewer's yeast 1-5 mg/ 10lb/bdwtparenteral - oral (daily)for over weight dogs
Vit B 12 Lamb or beef liver 100mcg/10 lbs/bdwt/ three times a week (injections)
Vit B 6 Torula or brewer's yeast 1-5 mg/10lbs/bdwt
Folic acid Brewer's yeast, liver, wheat-germ 1.0 mg/10lbs/bdwt once a week (injection)
Vit A Liver, carrots, kale, sweet potatoes, turnip greens, collard greens, parsley 1,000 units/ 10lbs/bdwtdaily
Vit E (d-alpha-tocopherol) Wheat germ oil, sunflower oil 2 iu/lb/bdwt 5 iu/lb/bdwt daily
Vit C Papaya, dandelion greens, red bell peppers, kale100mg/ 10lbs/ bdwt/bid 250 mg/10lbs/bdwt/ bid of ascorbic acid50-100mg/10lbs/bdwt/ of Ester C or Ascorbyl
L-carnitine Beef heart, liverdog: 50mg/10-25 lb/bdwt/ cat:100mg/ 10 lb/bdwt/B.I.D. dog:100mg/10-25lb/bdwt cat: 10mg/1lb/bdwtT.I.D
Taurine Beef heart, liver, kidneysDog: 50 mg/10-25lb/bdwtCat: 25mg/ 1lb/ bdwtB.I.D Dog: 100mg/10-25lb/bdwtCat: 50mg/1lb/bdwtT.I.D.
Coenzyme Q 10 Raw organ meats10 mg/ 10-25lb/bdwt/ bid 30mg/ 10-25lb/bdwt/ tid
Mg Kelp, wheat bran or germBlackstrap molasses 100mg/ 10-25lbs/bdwtbid (if arrhythmias)CX! with Ace-Inhibitors
Se Herring, smelts, wheat germ, apple cider vinegar, butter, scallops, barley, red swiss chard, oats 2 mcg/lb
K Turnip greens, broccoli, lettuce, cabbage, beef liver From diet
Omega -3 Avocados, cold water fish: sardines, cod, bluefin, salmon, oil supplements EPA 55mg/kgDHA 40 mg/lb
Siberian ginseng extract0.8% eleutherosides E & B 2mg/1lb/bdwt once daily 2mg/1lb/bdwt bid CX! Reduce digoxin dose by 50% after 1 week
Zizzyphus 5 mg/1lb/bdwt bid 10mg/1lb/bdwt bid
Hawthorne extract 1.8% vitexin-4'-rhamnoside or 10% procyanidin content 75mg/ 10 lbs /bdwt bid(weight management, and high hepatic cholesterol) CX! Reduce digoxin dose by 50 % after 3 days150mg/10lbs/bdwt bid
Dan Shen 2mg/ 1lbs/bdwt bid 5mg/ lb/bdwt bid
Grape seed extract92% oligomeric proanthocyanidins 5mg/lb/bdwt bid 10mg/lb/bdwt bid
Reishi Mushroom extract10% Polysaccharide 4% triterpenes 10mg/1lb/bdwt bid 10-25mg/1lb/bdwt tid

Summary:

From the evidence presented it is clear that nutraceuticals, herbs, and minerals can benefit patients with heart disease. Also, they can be used to help prevent diseases such as cardiomyopathy, and improve the quality of life and longevity in animals with congestive heart failure. This "functional nutritional intervention" (FNI) with nutraceuticals is growing in acceptance and is becoming the "gold standard" for treating heart patients. Using any one of the mentioned pro-biologically acting substances can be of benefit.

Clinical practice studies and research must continue in the understanding of how cases of severe CHF can be treated with and without drugs. In my "researching" of current and past research already performed, I found thousands of references from 100's of medical and science journals from all over the world. (I did not read them all). The information I presented is just the "tip of the ice berg". More research from other countries (especially communist block countries, and the Orient) needs to be translated into English and studied.

We have focused too long and have gotten too "dependent" on drugs for the answers in the treatment of heart disease in animals. Little attention is focused on prevention and maintaining heart health.

Functional nutritional intervention (FNI) with cardio-nutriceuticals consists of:

1.) decreasing hydroxy radicals and lipid peroxidation and therefore decreasing myocardium tissue death with antioxidants.
(Vit. E, C, Se, Mg, taurine, dan shen, zizzyphus, Coenzyme Q10)
2.) protecting the negative effects of stress on the myocardium
with adaptogens or cardioprotective agents:
(Siberian Ginseng, pycnogenols, Taurine, etc.)
3.) improving cardiac function, glucose utilization and contractile strength
(Ginsengs, Hawthorne, CoenzymeQ10, Mg, carnitine & taurine)
4.) nutrition that facilitates repair of damaged myocardium, and the
prevention of deficiencies that would cause cardiomypathies
( Taurine, carnitine, Vit e & Se, K, Mg, )
5.) after a cardiac crisis, or heart surgery… "damage control" and repair
to limit oxidative stress and support healing
(Coenzyme Q10, antioxidants, magnesium, and Oriental cardio-therapeutic herbs such as Dan Shen, and Eleutherococcus.)

The principles of FNI have been increasing in use in the past 10 years by conventional and complementary medicine veterinarians in the management of disease. This is complementary medicine at it's finest because it can be used with or without drugs, and exhibits little or no side-effects, and benefits the quality and duration of life.

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