Cardiovascular & Heart Health

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Cardiovascular& Heart HealthWritten by the Editors of Examine.comUpdated June 24, 2014

Medical Disclaimer & Important NoteThis guide is a general health-relatedinformation product, intended forhealthy adults over the age of 18.While we will mention major knowndrug interactions, it may be possiblefor any supplement to interact withmedications or other drugs. If you arecurrently taking medication, consult ahealth professional prior to using anysupplement in this guide.This guide is for educational purposesonly. It is not medical advice. Pleaseconsult a medical or health professionalbefore you begin any exercise, nutrition,or supplementation program, or if youSpecific study results described inhave questions about your health.this guide should not be consideredrepresentative of typical results. NotParticipating in exercise activities orall supplements provide the exactusing products mentioned in this guideamount of compounds as listedmay pose risks for people in poor healthon the label. Always investigateor with pre-existing physical or mentalsupplement companies, as well as thehealth conditions.supplement itself, before purchasingDo not use any products or participateanything. Herbs, rather than isolatedin any activities if you are in poorcompounds, may also have somehealth or have a pre-existing mentalvariability from one batch to the nextor physical health condition. If youthat can alter the efficacy.choose to participate, you do so ofTo read the evidence supporting claimsyour own free will, and you knowinglymentioned in this guide, please visitand voluntarily accept the risks.Examine.com.

Table of Contents0405091416172022How to use this GuideBase SupplementsProven OptionsUnproven OptionsCautionary & Overhyped OptionsAssembling Your Supplement StackStack Modification FAQPrecautions & Troubleshooting

How to use this GuideUnproven Options are another group ofpotentially beneficial supplements, but theylack evidence for their effects. They cannot berecommended with the same confidence asproven options. They could work or be a wasteof your money - there is not enough evidenceto know for sure. Keep unproven options inThis stack guide help you figure out whichmind, but approach them cautiously whensupplements can help you and which will hinder incorporating them into your stack.and/or be a waste of your money for yourCautionary and Overhyped Options aredesired goals.supplements that are claimed to provideThe following four sections presentbenefits but have been shown to be ineffective.information on supplements that are relevantIf a supplement is deemed too risky to be used,to Cardiovascular & Heart Health:it will also be found in this section. Do not add1. Base Supplementsthese compounds to your stack; they tend tobe a waste of money or potentially harmful to2. Proven Optionsyour health.3. Unproven OptionsThe team at Examine.com has beenpublishing research on nutrition andsupplementation since March 2011. Inthat time, we’ve learned a great deal aboutsupplements, especially how they can worktogether to help you with health goals.4. Cautionary and Overhyped OptionsOnce we have explained the varioussupplements that you need to be aware of, theBase Supplements are recommended for theAssembling your Supplement Stack sectionmajority of people with this goal. They are either will outline how different supplements can beeffective on their own or are required to boostcombined, based on your objectives.the effects of another supplement. These arethe first supplements to consider for your stack. After that, we follow up with the StackBase Supplements are more researched and have Modification FAQ, in which we coverless adverse drug interactions than options.common questions that may arise whenassembling your stack.Proven Options are supplements that willprovide a lot of benefits, but only in the rightLastly, we include information on Precautionscontext. They cannot be recommended forand Troubleshooting.everyone, but if you read the entry and findWith all this combined, you should be able tothat you meet the criteria, feel free to add theidentify and assemble a supplement stack bestsupplement to your stack.suited for your goals and objectives.04Cardiovascular & Heart Health

Base SupplementsProcyanidinsWhy you should take itProcyanidins are a class of supplements that share similar flavonoid structures.Procyanidin supplementation can improve blood flow and circulation.Procyanidin supplementation can help maintain nitric oxide (NO) levels.Low NO levels can cause blood vessels to narrow, leading to reduced bloodflow. This makes procyanidins a good preventative supplement for highblood pressure. It can also alleviate high blood pressure caused by low NOlevels. Keep in mind, not all cases of hypertension, or high blood pressure, arerelated to NO.Procyanidins include the polyphenols in cocoa, grape seed extract, andthe brand name product Pycnogenol, also known as pine bark extract.Pycnogenol is the most well researched procyanidin source, though it is alsothe most expensive. Grape seed extract is a similar compound. It has lessevidence for its effects, but is also less expensive. Cocoa has a different set ofprocyanidins but provides similar benefits.How to take itThe standard procyanidin dosage depends on the form of supplementation.To supplement Pycnogenol, take 100 – 200 mg a day. Doses as low as 40 – 60mg have also been used, though they provide fewer benefits.To supplement grape seed extract, take 150 – 300 mg a day.The standard dose for cocoa polyphenols is 1,000 mg. To get cocoapolyphenols through the diet, eat approximately 25 g of dark chocolate a day.This is not needed if you choose one of the other procyanidin options. Milk orwhite chocolate is not a source of polyphenols.05Cardiovascular & Heart Health

Base Supplements (cont.)GarlicWhy you should take itGarlic is a food product and supplement known for its ability to boost theimmune system and provide a variety of cardiovascular benefits.Garlic can improve blood flow without affecting blood pressure because of itsdietary sulfur content. Sulfur can improve hydrogen sulfide signaling, whichleads to better circulation.Garlic also supports nitric oxide (NO) signaling, which can improve theeffects of procyanidins.People with normal blood pressure will experience improved blood flow fromeating garlic, while people with high blood pressure will also experience areduction in blood pressure, in addition to the improved blood flow.Garlic is also good for people with abnormal cholesterol levels. It canreduce low density lipoprotein (LDL) cholesterol and increase high densitylipoprotein (HDL), which is sometimes called the “good” cholesterol. Garlicprotects arteries from plaque buildup and calcification, preventing excessminerals from stiffening the blood vessels.Garlic is a base supplement because of the variety of ways it can benefit thecirculatory system. When used properly, it is safe and makes a good base for aheart health stack.How to take itGarlic can be eaten or supplemented. Both methods of ingestion will providethe same benefits. Supplementation is recommended for people that dislikethe smell or taste of garlic. Supplementation of aged garlic extract will preventthe bad breath that comes from eating garlic cloves.Garlic has blood thinning and antiplatelet effects. Garlic should be ingestedcautiously if you are taking blood thinning medication like warfarin.06Cardiovascular & Heart Health

Base Supplements (cont.)To maximize garlic’s benefits, eat three cloves a day, split between severalmeals. The cloves may be eaten raw or cooked, but they should not be boiledor otherwise heated before they are cut. Crushing garlic before heating willactivate its bioactive compounds.To supplement garlic, take 600 – 1,200 mg of aged garlic extract a day, splitinto several doses and taken with meals.NitrateWhy you should take itNitrates are a dietary compound found in beets and leafy green vegetables.Due to restrictions surrounding sodium nitrate, a compound often added tomeat, supplements containing effective doses of nitrates are not legal. Nitratesmust be consumed through food products.Nitrates break down into nitrites after they’re ingested, which circulate in thebody and are turned into nitric oxide (NO) as needed. Elevated NO levelsare associated with improved exercise performance, blood flow, and reducedblood pressure.Nitrates are one of the major reasons that green vegetables are recommendedfor reducing the risk of hypertension and other circulatory disorders.Improved blood flow can even prevent cognitive decline, since blood flow tothe brain is not impaired as people get older.How to take itThe best way to supplement nitrates is by consuming leafy greens and beets.The standard dose for nitrates is between 6.4 – 12 .8 mg per kilogram ofbodyweight. This corresponds to: 440 - 870 mg for a 150lb person 580 - 1,160 mg for a 200lb person 730 - 1,450 mg for a 250lb person07Cardiovascular & Heart Health

Base Supplements (cont.)About 500 g (just over a pound) of fresh lettuce, rocket, swiss chard, crowndaisy, spinach, kale, or beets a day will maximize nitrate’s benefits. Cookingdoes not appear to reduce the bioavailability of nitrates from beets. If you eata lot of cruciferous vegetables, like spinach and kale, consider adding iodineto your diet by increasing your consumption of iodized table salt. Thesevegetables contain goitrogens, which are compounds that can disrupt thethyroid if consumed in high quantities, like the dose described above.08Cardiovascular & Heart Health

Proven OptionsCoQ10Why it is a proven optionCoenzyme Q10 (CoQ10) is a molecule found in mitochondria. It is veryimportant to the process of energy production. Though the body alreadyproduces CoQ10, supplementation can offer benefits to people with cardiactissue damage.People who have suffered a heart attack will experience the most benefit fromCoQ10 supplementation. Supplementation will reduce the risk of furtherheart complications.Statin medications can deplete CoQ10 levels in the body. If you are takingstatins, talk to your doctor about supplementing CoQ10.Further research is needed to determine if CoQ10 supplementation canbenefit people with less severe cardiac damage.How to take itTo supplement CoQ10, take 70 – 90 mg, once a day with a meal containingfatty acids.Though higher doses, in the 200 – 300 mg range, result in higher levelsof CoQ10 in the body, further research is needed to determine if higherlevels of CoQ10 will provide more benefits than the standard dose.L-CarnitineWhy it is a proven optionL-Carnitine is an amino acid that plays a role in preventing cardiovasculardisease. People with previous heart complications can supplement L-carnitineto reduce the risk of future complications.People who have suffered a heart attack can supplement L-carnitine toimprove heart health and lower the risk of angina, which is pain in the chest09Cardiovascular & Heart Health

Proven Options (cont.)or limbs caused by a lack of circulation. L-Carnitine will also reduce the riskof ventricular arrhythmia, during which the heart beats abnormally.How to take itTo supplement L-carnitine, take 5 – 9 g a day, with a meal.Studies using this dose have used the basic form of L-carnitine, and it isrecommended because it is cheaper than L-carnitine L-tartrate (LCLT) andglycine propionyl L-carnitine (GPLC).VenotropicsWhy it is a proven optionVenotropics are supplements that can improve the rate at which bloodreturns to the heart. Supplementation can reduce the risk of blood poolingin limbs due to poor circulation.Venotropic supplements are used to treat chronic venous insufficiency(CVI), which is characterized by blood pooling in extremities. Venotropicsupplements are also used by people that want to reduce varicose veins orleg swelling caused by prolonged sitting.Venotropic supplements include Aesculus hippocastanum, Ruscus aculeatus,Pycnogenol, and Daflon, a brand name for a mix of diosmin and hesperidin.These supplements have similar effects. Daflon was the first venotropicsupplement on the market, and it is slightly less effective than Pycnogenol.Pycnogenol is a potent venotropic supplement. Grape seed extract, due toits similarity to Pycnogenol, may also be effective at reducing leg swellingcaused by sitting.How to take itTo supplement Aesculus hippocastanum, take 50 – 75 mg twice a day, for atotal daily dose of 100 – 150 mg.10Cardiovascular & Heart Health

Proven Options (cont.)To supplement Ruscus aculeatus, take 375 - 750 mg twice a day, 12 hoursapart, for a total daily dose of 750 – 1,500 mg of the dry root extract. This isequivalent to 75 mg of a 10:1 extract.To supplement Pycnogenol, take 150 – 300 mg once a day with the first mealof the day.To supplement the flavanones initially branded as ‘Daflon’, take 500 mg of thecombination twice a day, twelve hours apart, for a total daily dose of 1,000 mg.This should be 90% diosmin by weight (900 mg) and 10% hesperidin (100 mg).Fish OilWhy it is a proven optionFish oil is made up of two fatty acids, eicosapentaenoic acid (EPA) anddocosahexaenoic acid (DHA). Fish oil is the most reliable supplement forreducing triglyceride levels.Fish oil is not a base supplement because its effects vary based on whois supplementing it. Fish oil, at the recommended dose, is not harmful.When supplemented by people with normal triglyceride levels, fish oil canreduce high blood pressure and may also alleviate inflammation, which canbenefit cardiovascular health by reducing plaque formation and the risk ofatherosclerosis, a disorder characterized by narrow arteries.Lovaza was the first pharmaceutical brand name for fish oil. Today, there aremany kinds of pharmaceutical fish oil brands. Vascepa, for example, is madeup of pure EPA to avoid the increase in LDL cholesterol caused by DHA.How to take itTo supplement fish oil, take 4 g of combined EPA and DHA, once a day with ameal. This dose will reduce triglyceride levels, and can be divided into severaldoses a day.11Cardiovascular & Heart Health

Proven Options (cont.)To supplement fish oil as a general cardiovascular health supplement, take300 – 600 mg of fish oil a day, with a meal, to reduce the chance of fishyburps. This dose is equivalent to adding fatty fish to the diet several timesa week. Consuming fish oil through food will provide the same benefits assupplementation.Vitamin KWhy it is a proven optionVitamin K is a fat soluble essential vitamin that can prevent hemorrhaging.Vitamin K supplementation can also increase osteocalcin levels. Osteocalcinis a protein that can remove calcium that has built up on arteries. Byreducing arterial stiffness, osteocalcin can prevent cardiovascular injury.More research on vitamin K’s effects is needed before it can berecommended as a base supplement.How to take itThe optimal dose for vitamin K is 1,000 mcg. This is much higher than therecommended daily intake (RDI) for vitamin K in many countries.Vitamin K can be supplemented through vitamin K1 (the plant form) andvitamin K2 (the animal form). Vitamin K2 is actually a series of molecules,designated by labels like MK-4 and MK-7.Vitamin K1 or vitamin K2 MK-7 supplements are recommended overVitamin K2 MK-4 supplements. To supplement vitamin K1, take 1,000 mcg.To supplement vitamin K2 MK-7, take 200 mcg. Only take one of these formsof vitamin K, not both.Blending 500 g of kale (consumed with a source of fat to improve absorption)will provide the same amount of vitamin K as described above. The fermentedsoybean food product natto is another source of vitamin K, though you would12Cardiovascular & Heart Health

Proven Options (cont.)need to eat 50 g a day to make supplementation unnecessary. Due to natto’stexture and scent, it may take some time to acquire a taste for it.As mentioned earlier, high doses of kale have a high goitrogen content, whichcan disrupt thyroid functioning over time. Heating the vegetable and addingiodine (through table salt) can supress the effects of goitrogens. Consideriodine supplementation if adding salt to the diet is not an option.Do not supplement vitamin K if you are taking warfarin or blood thinningmedication.13Cardiovascular & Heart Health

Unproven OptionsOlive Leaf ExtractWhy it is an unproven optionOlive leaf extract is supplemented for its oleuropein content, a compoundfound in olives. Olive leaves have higher concentrations of oleuropein, so theyare used to make dietary supplements instead of the olive fruit.Olive leaf supplementation can significantly reduce the amount of lowdensity lipoprotein (LDL) oxidation that happens after a meal. Prolongedsupplementation of olive leaf is thought to reduce plaque buildup in arteries,since LDL oxidation is one of the biggest contributors to plaque formation.Olive leaf supplements are not a base supplement because the reduction inplaque has not yet been confirmed. Though supplementation can reduce LDLoxidation in the short term, more research is needed to determine if this leadsto reduced atherosclerotic risk over a lifespan.How to take itTo supplement olive leaf, take 500 – 1,000 mg over the course of a day. Somestudies have found benefits from doses as low as 10 mg.Olive leaf should be taken with meals with a high fat content.Consuming olive oil products can provide the same benefits as low dose oliveleaf supplementation.Terminalia arjunaWhy it is an unproven optionWater extracts from the tree bark of Terminalia arjuna have traditionally beenused to improve heart health. Preliminary evidence suggests people whohave suffered heart attacks may experience various benefits from Terminaliaarjuna supplementation, although more research is required to confirm howTerminalia arjuna exerts its effects and how potent they are.14Cardiovascular & Heart Health

Unproven Options (cont.)Animal evidence suggests Terminalia arjuna supplementation can preventabnormal heart rates and protect cardiac tissue from damaging stressors.Terminalia arjuna supplementation may benefit healthy people as well byincreasing cardiovascular capability during exercise.Much more human evidence is needed before Terminalia arjuna can berecommended specifically for heart health, but current evidence is promising.How to take itTo supplement Terminalia arjuna, take 500 mg of the water extract once aday, 30 minutes before breakfast. People who have suffered a heart attackcan take this dose every eight hours.Do not supplement ethanolic Terminalia arjuna extracts.15Cardiovascular & Heart Health

Cautionary & Overhyped OptionsStimulantsPeople supplementing for heart health should be careful when using stimulantslike caffeine, fat burners like ephedrine or synephrine, and many preworkout supplements. Most stimulants are generally safe to use, but peoplewith heart problems are more at risk for potential side effects, which includeheart arrhythmia, increases in blood pressure and greater risk for a traumaticcardiovascular injury, like a heart attack.Do not take stimulants at a higher than recommended dose for a prolongedperiod of time. Do not increase stimulant doses to counteract the effects oftolerance. This can cause additional side effects and is not safe. Instead, stopusing the stimulant and allow sensitivity to return.16Cardiovascular & Heart Health

Assembling Your Supplement StackThe following outlines how to incorporate this supplement stack into yourdaily nutrition habits.Incorporating Base SupplementsThe base supplements in the Cardiovascular & Heart Health stack includeprocyanidin supplements, garlic, and nitrates. All of these compounds canbe ingested through food products, which would render supplementationunnecessary.To incorporate nitrates throughout the day, eat at least 500 g (about a pound)of Swiss chard, spinach, kale, crown daisy, lettuce, rocket, or beets.Other leafy greens and tuber vegetables like turnips provide lower levels ofnitrates than the foods listed

Cardiovascular & Heart Health Garlic Why you should take it Garlic is a food product and supplement known for its ability to boost the immune system and provide a variety of cardiovascular benefits. Garlic can improve blood flow without affecting blood pressure because of its dietary sulfur content. Sulfur can improve hydrogen sulfide signaling .

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