Are there nutritional or herbal supplements that improve blood flow?

General responses to selected questions from Joel Braunstein, MD, of Johns Hopkins University and Joseph Toscano, MD.

Question:

I had a heart attack several years ago. I am overweight but am following a diet and exercise program that is working well. I am also taking several medications - including a beta blocker and Zocor - which seem to be working well. My question is this: Are there any nutritional or herbal supplements available to improve blood flow? Would chelation therapy help?

Answer:

In terms of standard medical treatment, beta-blockers and cholesterol-lowering medication like Zocor have proven beneficial in your situation. The diet and exercise program is also an excellent idea. In addition, if you are not taking aspirin, talk with your doctor about this. Simple old aspirin is an EXTREMELY IMPORTANT medication for someone to take after having a heart attack, arguably the most important. If you cannot take aspirin, clopidogrel (brand name, Plavix) is an alternative.

In terms of supplements and herbals, the information out there is varied. I'm not aware of any information that suggests a negative effect of taking anything, but the information in favor of various vitamins, nutraceuticals, and herbals is not very strong or consistent. There are reports of how a particular substance helped one or a few people, but in these reports there are no comparisons to those who didn't take the substance. Most of the large, well-designed scientific studies (there are not many) have not found benefit to most of the proposed remedies. As well, for some remedies, no one has studied them specifically using a scientific method. This doesn't necessarily mean that one or more might not be potentially helpful, but rather that we just don't know for sure at this point.

Some information on specific vitamins and supplements: One study did show that taking vitamin E supplements for 2 years reduced the risk of heart disease in both men and women by 30-60%; 400-800 IU/day seems to be a reasonable dosage. Another study showed no benefit from beta-carotene supplements. For those with elevated blood homocysteine levels, supplementation with folate (or folic acid) and vitamins B6 and B12 reduces these levels and the associated heart disease risk. While there is some inconsistent evidence that coenzyme Q10 may be helpful in heart failure, it doesn't seem to reduce the risk of heart attack. On the other hand, there is fairly good evidence that omega-3 or N-3 fatty acids (available as fish-oil pills and other supplements and present naturally in many types of fish) reduce heart attack risk. Chelation therapy can help with some medical problems, but does not seem to reduce heart attack risk when it has been examined using the scientific method.

Bottom-line: Don't replace standard medical therapy with any of these remedies, but consider using them in addition to this therapy. Of those available, vitamin E and omega-3 fish oils seem to be the most effective. If you can have your blood homocysteine level measured and it's elevated, strongly consider supplementing folic acid and vitamins B6 and B12. In each case, talk with your doctor first to make sure there will not be any interactions with your current regimen. Most importantly, don't forget the daily aspirin.