Congestive Heart Failure (CHF) Treatments and Remedies

Home treatment and complementary therapies may be all you need to manage mild-to-moderate heart failure. However, Seattle naturopath Donald Brown, N.D., warns that in moderate-to-severe CHF, which is life-threatening, they are no substitute for more aggressive mainstream drugs.

Congestive Heart Failure (CHF) and Your Diet

• Sip, don’t guzzle. Fluids you drink can aggravate the fluid retention of CHF. Ileana Pina, M.D., director of cardiac rehabilitation at Temple University School of Medicine in Philadelphia, urges people with CHF to drink no more than 2 quarts a day. But restricting your fluid intake can be tricky, becasue overdoing it can cause dehydration, itself a significant health problem, especially for older adults. When you feel thirsty, Dr. Pina advises, don’t reach for a big tall glass of water, juice, or soda. Instead, suck on a popsicle, or on a few ice chips, or, to stimulate salivation, chew gum, or suck on hard candies.

• Salt. CHF leads to fluid retention. So does a diet high in salt (actually, high in the sodium in salt). Salt also raises blood pressure in people who are “salt-sensitive.”

Salt restriction and weight control (see “Exercise” below) can make a big difference in your blood pressure, hence in CHF. At Tulane University School of Public Health and Tropical Medicine, a research team led by Paul Whelton, M.D., studied 585 elderly men and women who wanted to get off their high blood pressure medication. Some received usual medical care and made no lifestyle changes. Others adopted a low-salt diet with the help of nutritionists. Some enrolled in a weight-loss program. And others did both.

After three months, all the participants stopped taking their medication, but they resumed it if their blood pressure was high on any follow-up visit. The low-salt group cut their sodium consumption about 25 percent. The weight-loss group lost an average of 10 pounds. Two-and-a-half years later, compared with those who received usual care, the low-salt and weight-loss both groups showed virtually identical improvement, one-third less chance of having to return to blood pressure medication. Those who did both cut their chances in half. This study, and many others, persuaded The National High Blood Pressure Education Program, an organization of researchers, to recommend that Americans limit their sodium intake to control their blood pressure, and to treat CHF.

Even if you’re not salt-sensitive, you may well consume enough sodium to give you big problems with fluid retention. Your body needs no more than 2,000 mg of sodium a day. But the average American consumes twice that much—almost two teaspoons. “Never salt your food before tasting it,” says family practitioner Anne Simons, M.D., an assistant clinical professor of family and community medicine at the University of California’s San Francisco Medical Center. “If you decide it needs salt, add just a little, then taste it again.”

Good advice. Unfortunately, it’s not enough. For most people, the salt added to food in cooking or at the table is not the problem. Only 15 percent of dietary sodium comes from your salt shaker. Some 75 percent is hidden in processed foods: fast foods, canned soups, TV dinners, frozen pizzas, junk snacks, and most processed foods, along with additives, notably monosodium glutamate (MSG). (About 10 percent of average salt intake comes from sodium the occurs naturally in foods.) “Read food labels,” Dr. Pina urges. “Watch out for canned soups and sauces, lunch meats, frozen dinners, and fast food items. They’re usually high in salt.”

Recently, it’s gotten a lot easier to find the hidden sodium in foods. Nutritional labels require food makers to list sodium content. Check your food labels and try to limit your sodium intake. If you have CHF, naturopath Joseph Pizzorno, N.D., president of Bastyr University, the naturopathic medical school near Seattle, recommends limiting your daily sodium intake to no more than 1,800 mg.

Salt is an acquired taste. If you are used to salting everything, stopping cold turkey makes your food seem unacceptably bland. Dr. Simons offers two suggestions: Wean yourself off salt by combining it with other herbs and spices: “Garlic is a good one because it helps lower your blood pressure.” Or switch to a nonsodium salt substitute, for example NoSalt. “When the commercials say, ‘There’s no salt in NoSalt,’ they mean no sodium,” Dr. Simons explains. Salt substitutes usually contain potassium chloride. They taste salty, but contain no sodium. In addition to limiting sodium intake, the potassium helps lower blood pressure (see below), and replace the potassium lost by taking diuretic high blood pressure medications. On the other hand, potassium-based salt substitutes may be hazardous when used in combination with certain other medicines. Check with your physician or pharmacist before using salt substitutes.

• Magnesium. If you have CHF, chances are that you have low blood levels of magnesium (less than 1.6 mEq/liter). This happens in part because the disease depletes this mineral, and in part because a standard mainstream treatment, diuretic medication (see “And Finally…”) depletes it. A low magnesium levels bodes ill, according to researchers at Mt. Sinai School of Medicine in New York City, who tracked magnesium levels and survival in 199 CHF sufferers. Those with low magnesium had more severe symptoms, greater risk of kidney failure, and a one-year survival rate of just 45 percent. But for those with high levels, symptoms were milder and survival was 71 percent. “These results are not surprising,” Dr. Pizzorno explains. “Magnesium deficiency is associated with arrythmias and a higher death rate from heart attack.” New York City clinical nutritionist Shari Lieberman, Ph.D., author of the The Real Vitamin and Mineral Book, suggests eating more magnesium-rich foods, among them: wheat germ, soybeans, oatmeal, nuts, seeds, low-fat diary items, and seafoods.

• Potassium. Your potassium level may also be low if you have CHF. Like magnesium, both diuretics and the disease process of heart failure deplete this mineral. Low potassium also raises blood pressure, a big problem if you have this condition. Dr. Lieberman recommends these sources: fruits, vegetables, beans, whole grains, fish, and low-fat dairy items.

• Vitamin B1. Vitamin B1 is thiamin. Low levels have been linked to sodium retention and heart failure. Those at greatest risk are the elderly, the very people a highest risk for CHF. That was what researchers at the University of South Florida discovered in a study of 30 healthy elderly people. About half had levels low enough to aggravate CHF. Good food sources of thiamin include: beans, peas, peanuts, whole grains (brown rice, wheat germ), fish, eggs, poultry, and liver.

Supplements for CHF

• Magnesium. Your doctor can test your blood magnesium level. If it stays low despite a diet rich in high-magnesium foods, Dr. Pizzorno suggests supplementing with 200 to 400 mg three times a day. But don’t take too much, because high levels (greater than 2.1 mEq/liter) also hurt your prognosis.

• Potassium. Dr. Lieberman suggests taking up to 300 mg a day.

• Thiamin. If you’re concerned that your diet may not be providing enough vitamin B1, Dr. Pizzorno suggests supplementing with 200 to 250 mg a day.

• Carnitine. Carnitine, also known as L-carnitine, is chemically an amino acid, but in your body, it functions more like a B vitamin, Dr. Lieberman explains: “About 60 percent of the energy that powers your heart comes from fatty acids, and carnitine helps move fatty acids into muscle tissue, including your heart. Carnitine deficiency has been linked to heart failure, while carnitine supplementation helps treat CHF and prevent arrythmias.” In a study in Naples, Italian researchers at the Hospital Elena D’Aosta gave either a placebo or carnitine (1 g twice a day) for six months. Compared with the placebo group, the heart strength of those taking carnitine improved 12 percent, and they were able to walk on a treadmill 16 percent longer. At 1 gram a day, carnitine caused no side effects or toxicity. “If you have CHF,” says family practitioner Alan Gaby, M.D., a professor of nutrition at Bastyr University, it’s prudent to take supplemental carnitine.

• Coenzyme Q 10. Coenzyme Q10 isn’t really a vitamin because it’s made in your cells. But it acts like one. It’s most concentrated in your heart. People with heart disease often have low levels. And a good deal of research has shown that supplementation helps treat CHF:

In addition to their regular medication, Italian researchers in Naples gave 641 people with moderate-to-severe heart failure either a placebo or coenzyme Q10 (2 mg/kg or about 140 mg for a person weighing 150 lb.). After a year, those taking the supplement had signficantly fewer hospitalizations and less fluid buildup in the their lungs (pulmonary edema).

Researchers at the Scott & White Clinic in Temple, Texas, studied 143 people with moderate-to-severe CHF whose heart function was poor but stable on standard medication. Then each participant began taking coenzyme Q10 (100 mg/day) in addition to their other drugs. Within six months, 84 percent of the participants’ hearts were pumping substantially more powerfully. After two years, their death rate from CHF was significantly lower than that of people treated with standard drugs.

Another group of Italian scientists studied 2,664 people with moderate-to-severe CHF, all of whom were all taking standard medications. The researchers measured their shortness of breath and arrythmias. Then they gave the participants a daily 100 mg of coenzyme Q10. Three months later, their shortness of breath improved an average of 53 percent, and arrythmias subsided 63 percent.

“Coenzyme Q10 is a very good treatment for CHF,” says Alan Brauer, M.D., founder of TotalCare Medical Center in Palo Alto, California, one of the nation’s first clinics to combine mainstream and complementary therapies. “The research is convincing.” He recommends taking 150 to 200 mg a day.

Exercise and CHF

• Get moving. Not long ago, doctors recommended rest for people with CHF. Not anymore. “We strongly recommend exercise,” Dr. Pina says. “Exercise increases your stamina, builds self-confidence, and improves your heart function. It also makes you feel better.” Of course, with a seriously fatigued heart, you have to be careful about the exercise you engage in. But your physician can order a test that shows how much activity you can safely tolerate (cardiopulmonary exercise test). Chances are that you can take walks, swim, ride a bike, garden, play golf, or engage in other activities that aren’t too strenuous.

Finnish researchers showed the benefits of exercise in a study of 27 people with mild-to-moderate CHF. Some were not encouraged to exercise. The rest enrolled in a doctor-supervised exercise program—30 minutes of stationary cycle riding three times a week for three months. After that, they were encouraged to take walks, swim, ride a bike, or go rowing for another three months. After the six months, the exercisers showed signficantly less shortness of breath and more stamina.

Dr. Pina also recommends participating in a cardiac rehabilitation program. These programs, mostly recommended for heart attack survivors and people with angina, also help treat CHF, according to a study at Robert Wood Johnson Medical School in New Brunswick, New Jersey. Researchers randomly assigned 20 people with mild-to-moderate CHF to one of three groups: placebo, drug therapy (digoxin), or a cardiac rehabilitation program based on moderate exercise, salt reduction, and a support group with training in stress-management techniques. After 12 weeks, only the drug group showed improved heart pumping. But only the rehabilitation group showed greater exercise ability, less depression, and signficant weight loss. Ask your doctor for a referral to a cardiac rehabilitation program.

• Lose weight. Excess baggage raises your blood pressure and makes your heart work harder to move blood through all your extra tissue. Losing weight lowers your blood pressure and gives your fatigued heart a break. Regular exercise is key to weight control. Exercise burn calories and also raises your basal metabolic rate, how quickly you burn calories while resting. However, if you have CHF, Dr. Pina recommends a physician-supervised weight control program, especially if you’re taking diuretic medication (see “And Finally…”) below. If you’re not careful, the combination of exercise and diuretics can cause serious dehydration.

Relaxation Therapies for Congestive Heart Failure (CHF)

• Social support supports your heart. Heart failure is scary. The term “failure” is upsetting, and you suffer shortness of breath, which is frightening. Social support can help keep the anxiety of CHF under control. At Yale, Harland Krumholz, M.D., an associate professor of medicine, analyzed the medical records of 292 elderly women who had been hospitalized for heart failure within two years of participating in a larger study of emotional support. Compared with the women who reported the most support in the earlier survey, those who were most socially isolated reported eight times more suffering from CHF symptoms. They also had the highest death rate from CHF in the year after their initial hospitalization. If they did not die, they were significantly more likely to be hospitalized again. “It’s not difficult to introduce people who are isolated into support groups or other community resources that provide support,” Dr. Krumholz explains. “There’s great potential for benefit.”

• Blood flows better with biofeedback. In mainstream medicine, doctors often prescribe drugs that expand (dilate) your blood vessels (vasodilators), which lower your blood pressure and allow blood to circulate more easily. A similar effect can be achieved with biofeedback. Debra Moser, R.N., D.N.Sc., an assistant professor of nursing at Ohio State University, and co-researchers from Harvard and UCLA taught 20 CHF sufferers to use biofeedback to open their blood vessels in hopes of increasing their circulatory efficiency. Compared with 20 similar CHF sufferers, the biofeedback group showed a significant increase in blood vessel diameter, which increased circulation, and a significant increase in output of blood from the heart.

Herbal Medicine for Congestive Heart Failure (CHF)

• Hawthorn (Mayflower). Perhaps some Pilgrims had dropsy. Maybe that’s why they named their ship, the Mayflower, an alternate name for the hawthorn shrub (Crataegus oxycantha), an age-old herbal remedy for heart failure. “Hawthorn is very useful in CHF,” Dr. Pizzorno says, “especially in the early stages,” thanks to compounds its leaves and flowers contain (flavonoids) that improve the heart’s pumping ability and blood flow through the circulatory system. Varro Tyler, Ph.D., former dean of the School of Pharmacy at Purdue University, calls this herb “valuable…a relatively harmless heart tonic that…yields good results.”

Recently, German researchers gave either a daily placebo or a standardized hawthorn extract (160 mg) to 136 people with mild-to-moderate CHF. Eight weeks later, symptoms in the placebo group had worsened. But those taking hawthorn showed statistically significant improvement—less shortness of breath and less ankle swelling.

In another study, 78 people with mild-to-moderate CHF were given either a placebo or hawthorn (daily 600 mg of a standardized extract). After eight weeks, the hawthorn group showed five times the improvement in ability to ride a stationary cycle, and a significant decrease in blood pressure.

Hawthorn causes minimal side effects, and does not interfere with the action of mainstream CHF medication, Dr. Brown notes. Naturopaths typically recommend 160 to 900 mg a day of a standardized hawthorn extract for four to eight weeks.

• Willow. Willow bark (and meadowsweet and wintergreen) contain a compound (salicin) that’s a natural form of aspirin. Both the herb and the drug help prevent the internal blood clots that cause cause heart attack and most strokes. Because CHF has a similar underlying cause, atherosclerosis, researchers at Tufts University School of Medicine in Boston wondered if low-dose aspirin therapy (one-half to one tablet a day) might extend survival in those with CHF. They studied 6,800 elderly people with CHF for five years. Among those who did not take aspirin regularly, 41 percent died of or were hospitalized for CHF. But in the aspirin group, the figure was only 26 percent. Aspirin users also had a death rate from all causes (mostly CHF, heart attack, and stroke) that was 18 percent lower. If you’d rather go the herbal route than take those familiar white pills, Maryland botanist/herbalist James Duke, Ph.D., author of The Green Pharmacy, suggests drinking two to three daily cups of tea made from willow bark or the other herbs containing salicin.

Chinese Medicine for Congestive Heart Failure (CHF)

• Strengthen your chi and Kidney. In Chinese medicine, congestive heart failure results from chronic fatigue of chi. “As chi weakens,” explains San Francisco Chinese physician Efrem Korngold, L.Ac., O.M.D., co-author (with Harriet Beinfield, L.Ac.) of Between Heaven and Earth: A Guide to Chinese Medicine. “the heart pumps less efficiently, Blood doesn’t move as it should, and fluids accumulate around the body.” Fluids are Moisture in the Chinese view, and the Kidney organ system regulates them.

To treat CHF, Dr. Korngold prescribes chi- and Kidney-strengthening formulas that include such herbs as: ginseng root, astragalus root, lycium fruit, angelica (dang gui), and eucommia bark.

• Acupuncture activation. Acupuncture can also help treat CHF, Dr. Korngold says. He recommends several points, among them:

• Pericardium 6. On your inner arm two thumb widths above your wrist crease between the two tendons.

• Heart 7. On the wrist crease closest to your palm, on the little-finger side, in the hollow next to the bone.

• Kidney 7. On your inner leg two thumb widths above your ankle bone in the hollow between the muscle and your Achilles tendon.

• Stomach 36. Bend your leg slightly. The point is three thumb widths below the lower edge of your kneecap and one thumb width from your shinbone.

Ayurvedic Medicine and CHF

• Arjuna to the rescue. The leading Ayruvedic herb for heart failure is the bark of arguna (Terminalia arjuna). No wonder: It works. At the MGM Medical College of Indore, in India, researchers gave 12 people with severe congenstive heart failure either a placebo or arjuna (500 mg of bark extract every eight hours). After two weeks, the groups were switched so that the placebo group took arjuna for two weeks and visa versa. Compared with the placebo, arjuna significantly improved the pumping action of participants’ hearts. Some people in the study continued their arjua treatment for up to two years. They showed continued improvement.

Hydrotherapy and Congestive Heart Failure (CHF)

• Some like it hot. Hydrotherapy—hot baths—is widely recommended by naturopaths, but mainstream physicians usually discourage it in people with CHF for fear that it might tax their hearts. But in one recent study, it helped relieve CHF symptoms. The researchers asked 34 people with congestive heart failure to spend either 10 minutes in a hot tub or 15 minutes in a sauna. None experienced any ill effects, and their heart output rose a little.

Pharmaceutical Drugs for Congestive Heart Failure (CHF)

Doctors treat CHF with three types of drugs: heart stimulants that increase pumping efficiency, diuretics that help you eliminate fluid, and drugs that expand (dilate) your blood vessels (vasodilators), which lower your blood pressure and allow your blood to circulate more easily.

For 200 years, drugs derived from foxglove (digitalis and dignoxin) were first-line mainstream medical treatments for CHF. But then reports began cropping up that they might cause heart rhythm disturbances (arrhythmias).

Recently, the Digitalis Investigation Group, comprised of doctors at 302 medical centers around the U.S., and Canada, carefully tracked 7,000 people who took digoxin for CHF. Just as old Dr. Withering reported in the 18th century, their symptoms improved, their improvement lasted for four years, and compared with controls, they were hospitalized 8 percent less. But ultimately, digoxin did not reduce their death rate from CHF, and it increased arrhythmia-related sudden deaths. Digoxin is still used to treat CHF, but it is no longer a first-line medication.

Today’s first-line treatments are diuretics and vasodilators, notably ACE inhibitors, according to geriatrician Robert Tan, M.D., an assistant professor at Texas Tech University Health Sciences Center School of Medcine in Amarillo. These drugs are reasonably safe and effective, but they may also cause unpleasant, even hazardous, side effects. If you take them, follow your doctor’s directions, ask about side effects, and alert your physician if you experience any.

Your doctor might also advise taking low-dose aspirin—one-half to one tablet a day.