A Heart-Healthy Supplement Stack

Keep that sucker ticking.

Like most American men, it’ll likely be my heart that takes me out, and I don’t mean take me out to the zoo or dancing or anything fun like that.

It’ll probably happen this way. I may be walking. Maybe the first sunny day of the spring. I’ll probably be thinking about the usual stuff I think about, like baseball, all the Instagram models I’ll never have sex with, the collected works of F. Scott Fitzgerald and the other modernists, and maybe picking up some pretzel bagels.

Suddenly, my heart will feel like it just got drop kicked by the Hulk and I’ll clutch my chest, make a face that’s indistinguishable from my orgasm face, and drop dead.

“TC Luoma, aka ‘the Atomic Dog,’ died last Tuesday from an apparent heart attack. His wife, apparently channeling Tuco from ‘The Good, the Bad, and the Ugly,’ remembers him this way: “He was tall, blonde, he smoked a cigar, and he was a pig.’”

So it goes.

Don’t get me wrong, I’m definitely not a fatalist, but I know I’ll eventually have to die from some cause, but I’m trying very hard to make sure it’s not from something as mundane as a heart attack. Rather I go out like an old John Wick, the victim of equally arthritic assassins eager to claim their bounty of Applebee’s gift cards.

As such, I’ve spent a lot of time researching heart-healthy strategies. And I’m not talking about exercise and proper diet that every mook on the street knows about. Instead, I’m talking about chemical solutions, i.e., supplements that destroy plaques, energize the heart, shrink oversized ventricles, prevent calcification of the heart and aorta and eliminate inflammation.

My response to all my research is the following “healthy-heart stack.” There are no guarantees in this supplement world, but I have faith that I’m doing my heart some good, and maybe a whole lot of good. Here’s what and how much I take:

• Nattokinase – 100 mg. three times a day.

• Niacin – 250 mg. twice a day.

• Vitamin K2 – 100 mcg. twice a day.

• Fish Oil (Omega-3 fatty acids) –Up to 1 gram combined DHA and EPA (the two most important omega-3 fatty acids) once a day, but keep in mind that I get most of this from actual fatty fish as I’m skeptical of the freshness and integrity of most fish oil capsules.

• Magnesium – 500 mg. once a day.

• Coenzyme Q10 – 100 mg. once a day.

Here’s my rationale behind taking each of these supplements:

Nattokinase

Nattokinase is an enzyme derived from Natto, a traditional Japanese food made from fermented soybeans that’s often eaten for breakfast. It looks like zombified soybeans that are connected by long, cheesy strings of organic matter that refuse to let go when you pull them apart.

Natto has been around for at least 2,000 years, but it wasn’t until 1987 that a team of Japanese researchers figured out that natto contained a potent fibrinolytic (clot-preventing) enzyme they named nattokinase.

Since then, a relatively small number of compelling studies on both animals and humans have confirmed that finding, along with discovering that it also has anti-thrombotic, antihypertensive, and anti-atherosclerotic properties.

Consider that clot formation is a common and serious pathology that’s the underpinning of heart disease, stroke, and embolisms. It’s why heart patients and people who want to avoid becoming heart patients use aspirin or various prescription blood thinners.

Nattokinase, however, appears to destroy clots through several mechanisms. Most prominently, it leads to an increase in Tissue Plasminogen Activator (TPA), a potent clot buster that’s often administered to heart or stroke patients in hospital ERs. Nattokinase also kneecaps a serine-protease inhibitor known as PAI-1 (Plasminogen Activator Inhibitor-1) that plays a role in clotting. Lastly, nattokinase enhances the production of urokinase, another clot-dissolving agent.

Other reasons to take nattokinase -- Atherosclerosis is the primary cause of heart disease and stroke. The blood vessels clog up with organic and inorganic deposits. Nattokinase, however, appears to act as a medicinal Liquid Plumber.

While the mechanisms behind nattokinase’s anti-atherosclerotic effects aren’t known, they’re thought to be through the combination of its antithrombotic, anticoagulant, antioxidant, and lipid-lowering properties.

Nattokinase also appears to lower blood pressure. A randomized, double-blind study found that 8 weeks of nattokinase supplementation reduced both systolic and diastolic blood pressure by 5.55 and 2.84 millimeters of mercury, respectively (Kim, 2008).

Again, the mechanism isn’t clear, but nattokinase is thought to inhibit angiotensin 1-converting enzyme, a substance that narrows blood vessels, thereby allowing the blood to gush through your pipes like one of those amusement park water slides.

Lastly, nattokinase appear to “thin” the blood. While Lots of people take aspirin to prevent heart attacks, stroke, and atherosclerotic diseases, studies comparing nattokinase with that old standby show it to be equal or superior to the task, without the possible side effects.

Niacin

Up until a few years ago, vitamin B3 or niacin was one of two supplements (the other being fish oil) widely recommended for heart health. But then along came the cholesterol-lowering statins. At first, doctors recommended people take statins and niacin together, but then a couple of studies showed that statin therapy did just fine on its own, sniff, and it didn't need the help of niacin.

So, niacin was relegated to the island of misfit supplements until a newer research paper exonerated her.

The paper said that not only did niacin do more to positively affect the lipid profile than any supplement, but it also matched up quite well against statins, but without any of the negative side effects.

Niacin also helps cardiovascular health in another, easy to understand way – it increases the production of nitric oxide synthase, which relaxes blood vessels and causes them to pop open, thereby allowing increased blood flow.

Equally important is the fact that niacin appears to be one of the very few things that can combat something called lipoprotein(a), an almost ignored lipoprotein that hardly any doctors test for and is thought to triple the risks of having a heart attack at an early age.

While doctors routinely test for lipoproteins like HDL and LDL cholesterol, few physicians know about lipoprotein(a), even though high levels – presumably dangerous levels – are found in one out of every four or five men and women. We don't even know what purpose it serves, not exactly anyway. What we do know, though, is that it really increases the risk for stroke or heart attack.

To make matters worse, diet and exercise have almost no effect on it. High levels of lipoprotein(a) may turn out to be the reason why so many men and women who eat well, exercise right, have "good" cholesterol numbers, and appear otherwise healthy, drop embarrassingly dead after bragging about what good shape they're in.

Other reasons to take niacin -- Niacin is also known to lower LDL cholesterol while increasing HDL cholesterol. It also has a greater effect on something called "atherogenic dyslipidemia" (a component of metabolic syndrome) than statins, but unlike statins, it doesn't come with the potential side effects, like possible muscle pain and damage, liver damage, increased blood sugar, and neurological side effects.

Vitamin K2

If you were to ask your average doc about vitamin K, they’re likely to be able to recall something from their pre-med days and tell you it’s a vitamin that’s instrumental in blood clotting. If you pressed them further, however, and queried them about the differences between vitamins K1 and K2, they’d likely change the subject to that suspicious looking mole on your heinie.

What they likely don’t know is that vitamin K isn’t a single compound but a family of compounds with the common chemical structure of 2-methyl-1,4-napthoquinone.

These compounds include phylloquinone, commonly known as vitamin K1, and a series of menaquinones, which are commonly grouped together as vitamin K2. (The most important of these K2 family members is MK-7.)

Most importantly, K2 has a superpower that makes it an essential component of your heart-health toolbox, and it has to do with its effects on calcium. The mineral, in addition to helping maintain heart rhythms and being the main component of your bones, has a treacherous side – it tends to accumulate on the insides of the arteries and around heart valves.

It's like living with a long-haired woman or romance-novel cover model that uses a lot of hair product. All that hair, all that product, eventually clogs up the pipes in your sink, making it difficult for water to pass through.

In other words, “misdirected” calcium ends up accruing on the inside of blood vessels, eventually impeding blood flow. Vitamin K2, however, regulates calcium homeostasis through the activation of the “anti-calcific” protein named matrix Gla protein.

In its “inactivated” form, the protein is associated with increased arterial stiffness, vascular and valvular calcification, and even insulin resistance, all of which contributes mightily to the possibility you might drop dead prematurely.

Some or all of this could be ameliorated by supplementing with vitamin K2. Think of it as a benign Liquid Plumber.

Oh, and here’s a stunner: Using statins tends to inhibit the absorption of vitamin K2, so that while the statins might reduce your cholesterol, it’s possible they’re also causing more calcium to accrue in your arteries and heart, and hardly anybody knows about it. Go figure.

Omega-3 Fatty Acids (Fish Oil)

Let’s say you found yourself in a roomful of cardiologists and the only way you could get their attention was to place the paddles of a defibrillator against your head, causing the electricity to arc dramatically because of all the Paul Mitchell styling cream on your coif.

Now that they’re all looking at you, there’s probably only one statement you could make that would garner almost universal agreement:

“Heart disease is a disease of inflammation.”

The heart doctors would likely harrumph in agreement and nod their heads affirmatively like a bunch of Fernando Tatis Jr. bobblehead dolls.

Granted, there’s all kinds of bad mojo associated with heart disease, including calcium deposits, plaque in general, ventricular thickening, stiffening of blood vessels, etc., but all of it is precipitated or at least exacerbated by inflammation, and that’s where fish oil comes in.

Take for instance athletes, and in particular steroid-using athletes. They’re vulnerable to left ventricular remodeling, which is kind of a medical euphemism to describe an enlarged heart, which can be a major factor in cardiac heart failure (CHF).

The left ventricle is one of the four chambers of the heart and it's located at the bottom left part of the organ. It receives oxygenated blood from the left atrium (which is smack dab above it) and pumps it out to the body. Given its function, it's the most muscular of the heart chambers.

Unfortunately, age and a host of contributing factors causes the left ventricle to thicken and alter shape (remodeling), causing its "ejection fraction" (the amount of blood it pumps out) to suffer.

You'd think that having parts of the heart be thicker or more muscular would be a good thing, but not in this case. A thickening of the left ventricle makes it less pliable, less able to sloosh the right volume of blood through your arterial system (what's known as the "ejection fraction").

Here’s where inflammation comes in -- several pro-inflammatory cytokines (any of several substances that are secreted by specialized cells of the immune system that influence other cells) are directly implicated in this thickening of the left ventricle. These bad-boy cytokines include tumor necrosis factor, interferon gamma, interleukin-1beta, and interleukins 6,17, and 18.

Omega-3 fatty acids (e.g. fish oil), however, appear to put a spoke in the wheels of these cytokines and prevent or ameliorate left ventricular remodeling.

Other reasons to take fish oil – Fish oil can do plenty of other stuff, too. It can modify cardiac ion channels, improve vascular endothelium, modulate autonomic nervous system activity, and enhance cardiac energy metabolism, in addition to simply thinning the blood. All of that translates to the following:

• Reduced triglycerides, a type of fat in your blood.

• Reduced risk of developing an irregular heartbeat (arrythmias).

• Slowed buildup of plaque, a substance comprised of fat, cholesterol, and calcium, which hardens and blocks your arteries.

• Lowered blood pressure.

However, I recommend you get most of your omega-3 fatty acids from cold water fish rather than supplements as there’s no way to tell whether or not they’ve been left sitting out in a hot shipping container on the loading dock of your local Walmart, thereby rendering them ineffectual or worse (causing further inflammation).

Magnesium

There’s a growing body of evidence that there’s an inverse relationship between magnesium (Mg) levels and heart disease. That’s likely because magnesium is involved in an insane number of enzymatic reactions and metabolic processes. Among the latter are ATP-dependent biochemical reactions, synthesis of DNA, RNA expression, cell signaling (at muscle and nerve levels), and glucose and blood pressure control, among other stuff.

Here's where it gets scary. Several dietary surveys suggest that up to 80% of the U.S. population is deficient in this important mineral. It’s probably even worse in athletes, though, as magnesium exits the body by hitching a ride on perspiration. The sweatier a bastard you are, the more likely it is you’re deficient in this mineral (assuming you don’t eat tons of nuts, seeds, legumes, whole-grain cereals, or take magnesium supplements).

Above I listed all the invisible biochemical stuff affected by higher magnesium intakes, but on a more macro level, higher Mg levels result in improved glucose and insulin metabolism, which leads to reduced levels of glycation, a process that effects the suppleness and pliability of blood vessels, factors that are crucial to cardiovascular health. Mg can also improve lipid profiles and act as an antihypertensive and anti-inflammatory agent.

Other reasons to take magnesium -- You may have noticed that a lot of young athletes are being diagnosed with either intermittent or persistent atrial fibrillation (a-fib). While not generally considered life-threatening, the condition does increase the risk of stroke. It also sucks for athletic performance because it’s characterized by an erratic heartbeat, which would of course fudge up any kind of athletic performance.

Why the “epidemic” of a-fib in young athletes? No one knows for sure, but Mg plays a vital role in regulating heartbeat. Remember when I mentioned that the mineral latches onto sweat as it leaves the body? Did you have a “eureka” moment yet or do I have to spell it out for you? Nah, I’m going to assume you don’t need any help figuring it out.

Coenzyme Q10

CoQ10, also known as ubiquinone, is a coenzyme synthesized in the inner membranes of mitochondria. It’s found in all organ systems, but the highest concentrations are found in the heart, kidneys, liver, and muscles.

The most salient point is this: Three out of four patients with heart disease have been found to have low levels of CoQ10. For example, patients with ischemic (a condition where blood flow is reduced) heart disease, CoQ10 levels are much lower than in healthy ones. Further, depending on the severity of heart injury, circulating levels of CoQ10 levels decrease in direct proportion to the progression of the disease.

Most clinician’s think that CoQ10’s primary role is as an antioxidant, thus preventing the oxidative stress and inflammatory cytokines that can lead to hypertrophy of the heart (thus lessening the heart’s blood-pumping capabilities).

That’s important but given that so many compounds have antioxidant and anti-inflammatory capabilities, CoQ10 possibly has a more important role: Helping determine the energy and vigor of the heart.

When the heart beats, it involves the release of calcium ions from the sarcoplasmic reticulum (a part of muscle cells) and the subsequent activation of contractile proteins requires energy, energy provided by the mitochondria, courtesy of CoQ10 (the coenzyme is a main component in the production of ATP). Adequate levels of CoQ10 would then, presumably, lead to a more vigorous heart.

Other reasons to take CoQ10 – There’s some evidence that CoQ10 regulates nitric oxide production, thus “blowing open” blood vessels, enabling more oxygen-rich blood to flow to and feed cells, especially those of the heart.

One surprising finding, at least in rat models, was that intravenous injection of CoQ10 within 10 minutes of coronary artery occlusion (blockage) resulted in a smaller area of cell death, less postinfarction (death of tissue resulting from reduced blood supply) hypertrophy of the left ventricle, greater stroke volume, greater cardiac output, greater ejection fraction, and increased contractility (relative ability of the heart to squirt blood through the chambers).

CoQ10 may also improve oxygen utilization at the cellular level.

Oh, here’s another bit of statin-related irony -- as is the case with vitamin K2, statins can inhibit CoQ10 absorption from food, in this case by as much as 40%. Obviously, this effect could be harmful to the functioning of the heart, especially in those patients with heart failure. Hence the recommendation (by at least minimally savvy physicians) that statin use be accompanied by CoQ10 supplementation.

How to Best Use these Heart Healthy Supplements

Each of the 6 supplements I’ve listed has its “personality” quirks; almost none of them can be taken willy nilly, i.e., all shoved down your gullet together and chased down with a swallow of water, kombucha tea, or whiskey whenever you feel like it.

Here then are my supplement timing recommendations:

• Nattokinase should best be taken in divided doses. I take three 100 mg. capsules a day – one with breakfast, one mid-afternoon (with or without food), and one at bedtime. This way, I maintain a consistent level of “blood thinning” throughout the day. However, if you choose to take nattokinase just once a day, take it after dinner or before beddy-bye time. This is because thrombus (a blood clot) is most likely to sneak up on a person between midnight and early morning.

• Niacin is the trickiest of the bunch, but only because it comes in several forms. There are immediate-release forms and extended-release forms, the latter using "wax matrix" or polygel delivery systems to slow down absorption.

Now here's the rub. A lot of people don't like immediate-release niacin because it can cause a temporary surge of skin-flushing prostaglandins in sensitive individuals. The feeling is best described as ants with acid on their feet crawling all over your body, accompanied by a mild fever.

That's why many people opt for the ER formula, which lessens or negates the side effects considerably.

However, studies suggest that the immediate release formula might work better in the long run, and if you take it with meals, you shouldn't have any flushing or feeling of angry ants crawling on your skin. For best results, eat half your meal, take a capsule, and then eat the second half of your meal.

You can also take immediate release niacin with a bit of apple sauce, as the quercetin contained therein quells the flushing. If you choose instead to gut it out, the flushing should disappear in about an hour.

As far as dosage, studies suggest no more than 2,000 mg a day for the extended-release formula and no more than 3,000 a day for the immediate-release formula. Of course, those recommendations evolved out of studies with heart patients who were also taking statins.

For regular Joes like me who are just looking for some heart insurance, consider taking one 500 mg. immediate-release tablet with breakfast and another with dinner.

• Vitamin K2 and CoQ10 are fat soluble, so they should be taken with the fattiest meal of the day to ensure maximum absorption. Fish oil, too, is best absorbed when taken with foods that contains fat.

As far as K2, I take two 100mcg. capsules every day. CoQ10? I take just one 100 mg. capsule a day. Fish oil is a different matter in that it requires a heftier dose. While the dosages used in most studies vary greatly, I take approximately 1 gram of combined DHA and EPA a day. (While some studies suggest higher doses are better, there’s that one lone study that suggests higher doses may lead to a-fib.)

• Magnesium, as an element, is neither water soluble nor fat soluble, but you’d do well to take a chelated form for optimum absorption. You might also want to take it before bed because it appears to improve subjective measures of insomnia.

I take one 500 mg. capsule each night.

A Leap of Faith

I have no proof that this allegedly heart-health supplement stack will work. There’s plenty of research supporting the efficacy of each individual component, but as far as I can tell, no studies have been conducted on using them all (or even any two or three) together.

All I know is my heart is still ticking, but an N-of-1 trial (a study with only one subject) doesn’t carry a lot of weight. As such, you need to weigh the evidence and decide for yourself whether you want to follow my lead or simply continue to rely on exercise, clean eating, and stress reduction, all of which appear to be pretty effective on their own in thwarting heart disease.

But me? I need some extra insurance.

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References

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