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Old Fish Wives Tails – not any more

Evidence is building that high quality fish oils containing high levels of EPA and DHA are proving very useful to Heart Failure patients

For heart failure patients whose condition is controlled with standard care, omega-3 fatty acid supplements appear to improve their condition even more, a small study suggests.

“Adding n-3 polyunsaturated fatty acids, even in patients that had a major improvement [on standard treatment], showed a further improvement in heart function and exercise capacity,” said study co-author Dr. Mihai Gheorghiade, a professor of cardiology at Northwestern University‘s Feinberg School of Medicine.

This shows that even in patients who respond to therapy, “we can make them much better,” he added. “This opens the door for the potential of a natural therapy — so-called macronutrients — in the management of heart failure.”

Gheorghiade cautioned that this study is not conclusive, but nutrients such as omega-3 fatty acids might extend life and quality of life for these patients.

The report is published in the Jan. 5 online edition of the Journal of the American College of Cardiology.

Gheorghiade’s team randomly assigned 133 heart failure patients with minimal symptoms on standard therapy, which included beta blockers, to high doses (2 grams) of omega-3 fatty acid supplements or a placebo.

After a year, those receiving the omega-3 supplement showed a 10.4 percent increase in heart function, compared with a 5 percent decrease among those taking placebo, the researchers found.

In addition, blood oxygen levels increased 6.2 percent in the omega-3 patients and decreased 4.5 percent in the placebo patients. Also, exercise time went up 7.5 percent in those receiving supplements while it went down 4.8 percent in those receiving placebo, they added.

Moreover, among those taking the supplement the hospitalisation rate was 6 percent during the year, compared with 30 percent for those on placebo.

Gheorghiade speculated that the supplements improved the metabolism of the heart. “This is one example where a nontraditional therapy may also work,” he said.

However, larger studies are needed to really see if this supplement helps prolong life, Gheorghiade said. “It’s promising, but it’s not conclusive,” he said. “But it would be a mistake not to look at the value of the macro and micronutrients in the management of heart failure.”

Gheorghiade doesn’t recommend that people take large amounts of this supplement in hopes of staving off heart disease. Whether or not one should take a supplement is a topic that patients and their doctors should discuss, he said.

Treatment needs to be tailored to individual patients, he pointed out. “This is not a cookbook,” Gheorghiade added.

Dr. W.H. Wilson Tang, an assistant professor of medicine at the Cleveland Clinic and co-author of an accompanying journal editorial, said that “studies on omega-3 fatty acid in heart failure still have not been effectively tested, based on limitations on their designs.”

Tang added, “We need to know what are potential dose and timing of intervention before we can effectively demonstrate whether an intervention works or not.”

The current study suggested that doses far higher than commonly used may have some effect not seen in the larger studies, he said.

“That being said, whether every treatment approach needs mega-trials to demonstrate effectiveness is now being increasingly challenged. The current debate is whether a relatively safe intervention such as fish oil should be recommended based on the current data — it is currently written in some guidelines but not too many doctors are actively recommending them,” Tang said.

Douglas “Duffy” MacKay, vice president for scientific and regulatory affairs at the Council for Responsible Nutrition, which represents the supplement industry, said that “all adults should get 500 milligrams of omega-3 fatty acids, from either diet or supplements, just to maintain heart health.”

The American Heart Association also recommends that people get omega-3 fatty acids for heart health, with at least two servings a week of fatty fish, such as tuna, sardines or salmon, mackerel, herring or lake trout.

Super Heart Foods for Health

Below you will find some super foods for a Healthy Heart. Please note that if you are on Warfarin then remember eat regularly not in bursts to maintain your INR in range.

Food for the heart: spinach

We should all be eating as much spinach as Popeye, according to the British Dietetic Association, who cannot speak highly enough about the health benefits of this super food. Ursula Arens, a dietician and spokesperson for the BDA, says, “We can’t bang the drum enough in praise of spinach. As a nation we eat very few dark green things and this is jam packed with nutrients”.

The dark green, leafy vegetable (and its cousins such as kale, Swiss chard, broccoli, and spring greens) is high in vitamins, minerals, and antioxidants that may protect against cardiovascular disease; it’s also a source of Omega-3 fatty acids.

Spinach is also rich in folate, which helps reduce the blood levels of the amino acid homocysteine. An emerging risk factor for developing cardiovascular disease is a high level of homocysteine.

The BDA recommends eating a portion a day of your favourite dark green, leafy vegetable and says it does not matter if you eat it raw, boiled or fried.

Food for the heart: salmon

Nutritionist Kathleen Zelman, WebMD’s director of nutrition, says she’s a “huge salmon fan”. “Salmon is widely available, affordable, fast, and easy”, she says.

Oily fish such as salmon (as well as mackerel, herring, and sardines) contain high levels of Omega-3s. This “healthy fat” is believed to reduce the risk of developing cardiovascular disease by lowering the levels of triglycerides in the body-blood fats linked to heart disease and diabetes.

Research has also found that Omega-3 fatty acids prevent blood clots by making platelets less likely to clump together and stick to artery walls. Blood vessels are also less likely to constrict, making the heart less vulnerable to life-threatening irregular heart rates.

The British Heart Foundation recommends eating at least two servings of fish (including one of oily fish like salmon) a week; a serving is between 85 grams and 170 grams.

Food for the heart: soya protein

Rich in Omega-3 fatty acids, protein, vitamins, and minerals, soya protein is a good alternative for red meat, says Ms Arens. It is also lower in fat and higher in fibre than many meat choices.

In people with high cholesterol, studies show that soya protein, when eaten with a healthy low-fat diet, lowers cholesterol. In fact, researchers found that people who ate a diet of several cholesterol-fighting foods lowered their cholesterol as much as people who took medicine.

Both the BDA and the BHF encourage eating at least 25 grams of soya protein daily. You can get your soya from soyabeans (they taste a bit like Oriental broad beans and are sold frozen in supermarkets), soya nuts, soya milk, soya flour, energy bars, fortified cereal, tempeh, and tofu.

Food for the heart: porridge

Grandma may have known what she was doing when she served up a piping hot bowl of porridge every morning, says Ms Arens. A daily serving of porridge contains only about 130 calories while delivering five grams of heart-healthy fibre that helps to lower cholesterol and keep body weight at a healthy level.

Ms Arens says, “It’s really good for you. It releases energy slowly and will fill you up for a long time, meaning you won’t nibble unhealthy snacks between meals. Just don’t add extra cream, sugar or honey”.

Porridge oats and other whole grains such as whole wheat, barley, rye, millet, quinoa, brown rice, and wild rice also help reduce the risk of diabetes, which in itself is a risk factor for heart disease, says Ms Zelman.

It’s important to use whole grains, not refined grains, says Ms Zelman, “so you get the whole package”. Refined or processed grains lose their nutrients and fibre.

You can also get your whole grains from whole grain breads and pastas.

The daily recommendation for fibre intake is between 21 and 38 grams, depending on your sex and age, according to the BDA.

Food for the heart: blueberries

Tasty blueberries are considered a “super food” because they contain high levels of antioxidants.

Ms Arens says, “Blueberries and other types of British berries, like blackberries and blackcurrants, are high in antioxidants. There’s been particular interest in blueberries helping with eyesight and reducing the rate of age-related macular degeneration”.

Antioxidants help neutralise harmful byproducts of metabolism called free radicals that can lead to cancer and other age-related diseases. Anthocyanin, the antioxidant that is thought to be responsible for this major health benefit, can also be found in blackberries, black raspberries, blackcurrants, and red grapes.

Researchers believe that the antioxidants in blueberries work to reduce the build up of “bad” LDL cholesterol in artery walls that contributes to cardiovascular disease and stroke.

Studies have shown that blueberries rank very high in antioxidant activity — number one when compared with 40 other fresh fruits and vegetables.

Ms Arens says that, when in season, we should try to eat a portion of berries a day.

More evidence – Fish Oil and Heart Failure

This article has taken excerpts from the American Heart Failure Society. It is very important to note that the EPA levels were high which indicates very refined fish oil – this is very important.

These are my fish oils –
Fish Oil one
Fish Oil two

This article has been reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston. Oh and sorry it is a bit technical but it needs to be.

“Patients with early-stage nonischemic cardiomyopathy derived significant functional and echocardiographic benefits from the addition of omega-3 fatty acids to optimized medical therapy, results of a randomized clinical trial showed. Omega-3 supplementation was associated with significantly greater improvement in left ventricular ejection fraction (LVEF, P=0.0001), exercise capacity (P<0.00), and hospitalization for heart failure (P=0.0002), as compared with medical management plus placebo.

"Whether this intervention will have similar effects for patients with other etiologies, more advanced stages of heart failure, or for patients who are not on evidenced-based therapy remains unknown," Mihai Gheorghiade, MD, of Northwestern University in Chicago, said here at the Heart Failure Society of America meeting.

"I am hoping that further studies will be conducted to assess the effects of this potentially important therapy on left ventricular function and clinical outcomes in other patients."

The results build on previous evidence from an Italian intergroup study showing that omega-3 polyunsaturated fatty acid supplementation improved outcomes in patients with chronic heart failure, irrespective of etiology or LVEF (Lancet 2008; 372: 1090-1098).

In an effort to clarify the spectrum of benefits, Gheorghiade and colleagues performed a multicenter, randomized clinical trial involving patients with nonischemic cardiomyopathy and minimal or no symptoms; 93 patients were included in the final analysis.

Eligible patients had left ventricular systolic dysfunction associated with an LVEF ?45% on evidenced-based treatment for at least six months and stable clinical status for at least three months.

Patients were randomized to 850 to 882 mg a day of eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA) or matching placebo. Treatment continued for a year, and patients had monthly follow-up assessments.

Assessments performed at baseline and at the end of the study included electrocardiography, echocardiography, renal function, and concentrations of inflammatory cytokines and fatty acids. The echocardiographic evaluation included left ventricular end-diastolic and end-systolic diameter and volume, LVEF, shortening fraction, and extent of mitral regurgitation.

In the final analysis, measurement of EPA and DHA levels showed significant increases from baseline (P<0.001) and compared with levels of those in the placebo group (P<0.001), whose fatty acid concentrations did not change significantly from baseline to 12 months.

Cytokine assessment showed that concentrations of tumor necrosis factor-alpha, interleukin-8, and interleukin-1 all increased significantly in the placebo group (P<0.001) and decreased significantly in patients who received omega-3 supplementation (P<0.001).

Between-group comparisons showed significantly lower levels of all three cytokines in the omega-3 group (P<0.001 for all comparisons).

LVEF decreased from about 37% at baseline to about 35% at 12 months in the placebo group (P<0.001) but increased from about 35% at baseline to more than 38% at 12 months in the group that received the supplements (P<0.001 versus baseline and versus placebo).

Exercise tests showed significant improvement in the omega-3 group from baseline to 12 months compared with the placebo group, whether expressed as peak VO2 (P<0.001) or percent VO2 max (P=0.006).

In the supplementation group, patterns of NYHA functional class showed a shift from class I to class II and no patients in class III at baseline or 12 months. In the placebo group, the proportion of patients in class I did not change, the proportion in class II declined, and a substantial proportion of patients progressed from class II to class III.

The trial was not designed to assess the impact of supplementation on hospitalization rates. However, an exploratory analysis showed that the addition of omega-3 supplements to medical therapy was associated with significantly fewer heart failure hospitalizations (6% versus 30%, P=0.0002) and cardiovascular hospitalization (~15% versus 30%, P=0.0029) and a trend toward fewer hospitalizations for any reason (<30% versus >40%, P=0.0599).

Results of the study support the case for a “real” effect of omega-3 fatty acids in heart failure, Stephen Goldsmith, MD, of the University of Minnesota in Minneapolis, said during an invited discussion of the study.

“Given that some experts are already calling for the addition of omega-3 fatty acids to the guidelines for heart failure therapies, a second large randomized controlled trial would seem indicated, including both ischemic and nonischemic patients across a range of clinical severity,” said Goldsmith.

“It would be desirable in any such trial to include substudies dealing with left ventricular functional parameters, exercise capacity, and biomarkers, to confirm the current findings and potentially extend their applicability.”

Great News about Fish Oils

Not to say I haven’t been saying so for a while but this is great news about the effect of fish oils – however please note that the fish oil is highly refined but the article which is in the Telegraph Newspaper does tell you where you can get some. Be aware when you but fish oils. I get my fish oils from here -

A specific high quality fish oil sold by Holland and Barrett
A highly refined fish oil with added Ubiquinone from Xtend-Life which is a New Zealand based company

Be aware of cheap fish oil, they don’t contain the levels of DHA and EPA and always discuss any supplements with your Doctor or Heart Failure Nurse.

“A study found that people with heart failure, where the organ fails to beat with sufficient force, were less likely to die if they took fish oils.

Around 700,000 people in Britain suffer from the condition that has debilitating symptoms, including breathlessness and fatigue, that can be so severe patients may remain virtually housebound.

Prof Martin Cowie, of Imperial College London and the Royal Brompton Hospital in London, reviewed the study of almost 7,000 people with chronic heart failure and randomly assigned them to take 1 gram of fish oil capsules per day on top of their usual medication or a dummy pill.
There was a nine per cent reduction in deaths among those taking the fish oil after two years. There was also a cut in hospital admissions for the condition.
The results are now expected to be incorporated in Europe-wide guidelines for the treatment of heart failure.
Prof Cowie said if two thirds of heart failure patients took the capsules daily, it would mean around 10,000 lives a year would be saved.
Patients who have had a heart attack are already recommended to take 1g of fish oil per day and adding in all heart failure patients will mean the majority of people living with heart conditions will be taking the supplements.
The review, published in the European Journal of Cardiovascular Medicine, said cost-effectiveness studies were under way and are likely to show that prescribing fish oil in these patients would pass evaluation by the National Institute for Health and Clinical Excellence.
The fish oil used in the study was a high quality supplement containing 90 per cent omega-3 polyunsaturated fatty acid ethyl esters, called Omacor, rather than a standard over-the-counter product.
Omacor costs the NHS 51p per patient per day and it can also be obtained from a pharmacist without prescription.
The research paper said: “Although not yet licensed for use in patients with chronic heart failure, it is likely that updates on international guidelines will make a recommendation to at least consider increasing omega-3 PUFA ethyl esters consumption in the form of oily fish or capsules, 1g per day, in patients with chronic heart failure already optimally medically treated.”
It is thought the fish oils helps regulate heart rate and have an anti-inflammatory action which may help to relax blood vessels to ease the workload on the heart.
Dr Jeremy Pearson, deputy medical director at the British Heart Foundation, said: “Researchers have been trying to find something that fish oils really do so this is interesting. If people feel they can tolerate it, which most people do if they take capsules and not liquid, I don’t think there is any suggestion that they might be doing themselves any harm.”

Fish Oils and EPA – Whats all the fuss

Omega-3 fatty acids are very important to health. Whilst Omega-6 fatty acids are abundant in all sorts of vegetable oils and meats, the omega-3′s (including EPA) are much harder to come by. They can be found in oily fish (salmon, mackerel, trout) as well as some seeds and nuts, including walnuts, flax seeds and pumpkin seeds. Unfortunately, however, most of us are not including enough of these items in our diet – if we are including any at all!

Firstly, you can try to add into your diet the foods that contain EPA, listed above. In doing this, bear in mind that some Governments, such as the UK are now recommending that you eat no more than 200g of sea-fish a week, due to the levels of toxins such as dioxin and mercury in fish, especially fish livers, where toxins concentrate.

Secondly, and this goes for most people, you should add a high-quality EPA supplement to your diet. Be sure that the fish oil used to produce it is from sources that filter out all the toxins, ensure it is PURE Omega-3 and is not diluted with other oils, e.g. vegetable oils.

The essential qualities of Omega-3 Fatty acids

Make sure it is PURE Omega-3
Check it is undiluted
Ask if dioxin has been removed

A very good article by Dr Alex Richardson of the charity Food & Behaviour Research, and one of the world’s leading researchers into Omega 3.

What is a healthy diet?

A healthy diet can help to reduce your risk of getting coronary heart disease and therefore heart failure. If you already have heart problems, eating a good diet can help protect your heart from getting worse, as well as protecting you from other diseases such as diabetes and some cancers.

A healthy diet contains lots of fruit and vegetables, aim for at least five portions a day, either fresh, frozen, dried or tinned and starchy foods such as wholegrain bread, pasta and rice. It should also be low in fat, salt and sugar. Eating fish twice a week, including one portion of oily fish, such as salmon or mackerel) can also help to reduce your risk of heart disease.

I have no proof that supplements work however I am obsessed with the following but always check with your Doctor or Heart Failure Nurse first –

Fish oil supplements – make sure the EPA level is as high as possible High EPA Fish Oil
High Potency Vitamin C – read this opinion
High Potency Vitamin D – read this opinion
Acai Berry for it’s antioxidant properties – Acai Berry

As with all supplements and drugs it is very important that you discuss them with your clinician.