CHF, congestive heart failure, coenzyme Q10, Co Q10, L-carnitine, defibrillator, heart transplant, heart pump, D-ribose, L-arginine, L-taurine, digitalis, diuretics, beta blockers, ACE, ARB, sodium, water, Dr. Dale Peterson, incidence, prognosis, aldosterone, pacemaker,

Congestive Heart Failure's "Missing Drawer"



Congestive Heart Failure's "Missing Drawer"

© 2011 Dr. Dale Peterson & drdalepeterson.com

In 1998 I stood by the bedside of an attorney in his mid-forties while two consultants – one a heart specialist and the other a lung specialist – told him that his condition, congestive heart failure, was so advanced that his only hope of survival was to obtain a heart transplant. If he could not, they somberly pronounced, he would be dead within 3 months. He responded that he was unwilling to pursue that course.

After the other specialists left the room I told him that I was more optimistic. I had seen many other patients with congestive heart failure respond to specific supportive measures and I believed that he could do the same. He was willing take supplements that would help his heart pump more effectively. He recovered and continued to practice law for over a decade. I believe he would still be alive today had he not developed an aggressive form of cancer that took his life.

I had reason to be optimistic. A few years earlier I had been asked to assume the medical care of Eva, an elderly woman who was dying of congestive heart failure. Her condition was so grave that she had been placed in hospice care, something reserved for people whose condition is expected to result in death within a matter of months.

When I first saw Eva she was sitting in a wheelchair. Her formerly slender legs were the size of oak fence posts. Fluid was oozing through her skin and soaking her gown. The sharp wit and strong will I would later come to recognize as key elements of her personality were absent that first evening. She scarcely acknowledged my presence.

I had been asked to assume Eva’s care when her family brought her to Oklahoma from Louisiana to spend her last days in their home. She had been receiving hospice care for approximately three months, and her condition suggested that she was unlikely to survive longer than a few days – a week or two at most.

When I had completed my assessment I asked her family if they would be willing to consider nutritional supplementation along with some small adjustments in her medical regimen. After a discussion of the need to balance her reluctance to take pills with the potential benefit of improving the quality of her last days, they agreed. Eva’s medications were adjusted and she was placed on a supplement largely ignored by the mainstream medical community.

Her condition began to improve; she left her wheelchair and began taking walks around the property. The hospice administrator informed the family and me that she no longer qualified for the program. She spent the next two winters walking the beaches of Hawaii with friends. She never returned to the wheelchair. She remained alert and active until the night she passed on peacefully in her sleep.

Congestive heart failure (CHF) is a condition in which the heart muscle is too weak to pump the amount of blood required to keep up with the body’s needs. Because the pump is failing, fluid backs up in organs such as the lungs and the liver and leaks into the soft tissues. This can lead to shortness of breath and swelling in the most dependent (lowest) parts of the body. In most cases edema (swelling) will be most noticeable in the feet and legs, but it may concentrate in the back if a person is lying down rather than sitting or standing. Fluid can also accumulate in the abdomen; when it does the condition is called ascites.

The prognosis of congestive heart failure is generally believed to be very poor. Standard medical treatment is able to slow the progression of the disease at times, but offers no hope for reversal or long-term survival. Less than half of those found to have congestive heart failure live for five or more years. One study found that nearly 80 % of patients hospitalized for congestive heart failure died within 5 years. That means that most people hospitalized with cancer have a better chance of surviving for 5 years than those who are hospitalized with CHF. It is therefore not surprising that the cardiologist and pulmonologist did not offer hope to the man with severe congestive heart failure.

Congestive heart failure is becoming more common. In 1968 10,000 deaths were attributed to CHF. By 1993 that number had risen to 42,000. Today it is estimated that CHF plays a role in 287,000 deaths annually. CHF was listed as the primary diagnosis in 877,000 hospitalizations in 1996, but for 1.1 million hospitalizations in 2006. It is estimated that 4.8 million Americans have CHF and that 400,000 new cases are being found annually. CHF is the reason for nearly 3.5 million outpatient visits annually and the direct cost of the condition is said to be $39.2 billion each year.

CHF has become so commonplace that some cardiologists now subspecialize in its management and treatment. I recently attended a lecture given by a CHF specialist titled Congestive Heart Failure: What Works and What Doesn’t.

The presentation began with a review of the natural course of CHF, which included the dismal statistics I have given above. A discussion of the measures that are currently available for treating CHF followed. The specialist likened the available strategies to a tool chest with four drawers. I will first present the tools as he uses them. I will later explain why I believe some of the tools he uses are dull and suggest that an entire drawer is missing from his tool chest.

The first drawer in the heart failure specialist’s tool chest contains LIFESTYLE measures. He recommends that fluid intake be limited to 2 liters daily and that sodium intake be restricted to 2 grams daily. He advises his CHF patients to fill a 2 liter container with water each morning to serve as a monitor of fluid intake. Each time a liquid is consumed that amount of water is poured out of the container. For example, if an 8 ounce cup of coffee is drunk with breakfast, 8 ounces of water is emptied from the container. If 4 ounces of juice is consumed another 4 ounces of water are discarded. This continues throughout the day and when no water remains in the container the patient has exhausted the fluid allotment for the day. Sodium restriction is achieved by carefully reading food labels and recording the amount of sodium consumed in each serving throughout the day.

The second drawer of the congestive heart failure specialist’s tool chest is MEDICATIONS. Those he recommends are ACE inhibitors or ARBs (drugs that tend to cause arteries to relax and decrease the work the heart needs to do to pump blood through them), beta-blockers (drugs that slow the heart rate), aldosterone antagonists (a type of water pill that tends to increase excretion of sodium as well as water), and drugs that cause arteries to dilate. He also recommends fish oil and often statin (cholesterol-lowering) drugs. He discourages the use of standard diuretics (such as Lasix) and digitalis (digoxin) that help patients feel better because they have not been proven to extend life expectancy.

The third drawer in his tool chest contains ELECTRICAL DEVICES that are implanted to pace the heart or to shock the heart if it stops or slips into a potentially fatal rhythm. When used appropriately, electrical therapies can improve the quality of life while extending the length of life. Unfortunately, the devices are not foolproof. A benign (non-fatal) change in heart rhythm can trick the devices into shocking the heart repeatedly. This results in killing rather than saving the person in whom they are implanted.

The fourth and final drawer in the CHF specialist’s tool chest has FANCY STUFF – pumps that are placed in the aorta to assist in the circulation of blood, heart transplants, and artificial hearts. These are also capable of significantly improving the quality of life and prolonging survival.

I readily admit that I am not a board-certified specialist in congestive heart failure. I do, however bring decades of professional experience and recent personal experience to the table. The two individuals whose response to treatment I described earlier are dramatic examples of what can be accomplished when the body’s healing mechanisms are properly supported. I do not expect every person with congestive heart failure to respond as spectacularly, but I have seen consistent improvement in those people with CHF who have chosen to follow my advice over the past two decades.

On a personal note, I experienced an episode of congestive heart failure in early April. An electrocardiogram revealed that I had suffered a heart attack at some earlier time. An echocardiogram (ultrasound) of my heart showed that a large area of my heart muscle had been damaged and was not capable of pumping blood effectively. Heart function is measured in terms of ejection fraction – the percentage of blood that is pumped out of the heart chamber with each beat. An ejection fraction of 50 or greater is considered normal. My ejection fraction was 25 – 30 %, meaning that my heart was functioning at 50 – 60 % of its normal capacity.

The cardiologist who reviewed my echocardiogram was surprised that I was still alive, as the amount of damage my heart had sustained is fatal in most individuals. He was not very optimistic regarding my future. He said that the damage was irreversible and that the only thing he had to offer was the implantation of an electrical device that would pace the beating of my heart muscle and shock my heart should it stop or go into a fatal rhythm. The electrical device was recommended because anyone with an ejection fraction of less than 35 is considered at risk for sudden death due to a heart stoppage or fatal arrhythmia. His recommendation presented me with a dilemma.

For years I have been prone to episodes of an abnormal heart rhythm called atrial fibrillation. Suddenly and without warning the upper chambers of my heart will cease beating and simply vibrate. Since the heart’s pacemaker is located in the right upper chamber, the signal telling the lower chambers of the heart when to beat is lost when the upper chambers stop beating. Left to their own devices the lower chambers pump irregularly. The resulting heart rate may be either too slow or too fast to adequately supply blood to the body. It was during one or more of those episodes that my heart muscle was damaged due to the inability of the irregularly pumping heart to provide adequate blood flow to the area.

I mentioned earlier that non-fatal arrhythmias can trick electrical devices into shocking an individual inappropriately. Atrial fibrillation is one of the non-fatal rhythms that can cause an electrical device to repeatedly shock the heart, killing the person in whom it is present. Faced with the possibility of collapsing and dying without warning on one hand or being painfully shocked to death on the other I chose to take my chances with the former and refused to allow an electrical device to be implanted.

Because of my prior experience dealing with patients with congestive heart failure I was far more optimistic about my future than the cardiologist. I know that the body is designed to repair itself and that it will do so if given the tools needed to do the job. I immediately began giving my body the support necessary to improve the condition of my heart.

Two months later the echocardiogram was repeated. My ejection fraction had risen to 40 – 45 (80 – 90 % of normal), well above the 35 level that is considered the point at which a person is at risk for sudden death. I feel great and I am doing everything I had been doing prior to the heart attack and the subsequent episode of CHF. I do not consider my progress a matter of good luck; it is the result of effectively using tools that are missing from the congestive heart failure specialist’s tool chest.

The tools I used are found in a drawer labeled SUPPORT. Before I describe those tools I want to comment on some of the tools used by the CHF specialist.

The LIFESTYLE tools used by the specialist are fluid restriction and sodium restriction. While I cannot argue with his logic, I disagree with the manner in which the changes are implemented.

Water is the primary nutrient required by the human body. Water is not coffee, it is not tea, and it is not juice or milk. If fluid intake is restricted to 2 liters daily that fluid should be pure water, as 2 liters represents the minimum amount of water required by the body to meet its daily needs. If a person is stable while drinking 2 liters of water each day it may be possible to add other fluids, but coffee, milk, sodas, and juices should not be consumed at the expense of water intake if 2 liters is the most fluid that can be tolerated.

Activity is a valuable tool that was missing from the specialist’s LIFESTYLE drawer. Studies have demonstrated that CHF is very much a condition in which the expression "If you don’t use it, you’ll lose it” applies. People who restrict their activity because they have congestive heart failure will find their ability to perform physical activities progressively decline. Those who remain active and who seek to improve their physical capacity over time are nearly always capable of doing so.

I am also concerned about the use of tools in the MEDICATIONS drawer. I understand the importance of employing medications that ease the load on the heart and are capable of extending life, but I also feel that quality of life is important. Medications such as diuretics and digitalis can help people breathe more easily and function at a higher level and can significantly improve quality of life if used selectively and with the understanding that they alone will not improve survival.

I consider the SUPPORT drawer, the drawer that is missing from the CHF specialist’s tool chest, the most important drawer, for it contains tools that will give the body the support it needs to repair damage and restore effective heart function.

The first tool in the SUPPORT drawer is prayer. I believe that prayer played a major role in preventing me from dying when the heart damage occurred. It has certainly been a significant factor in my recovery. People from around the world have related that they have been praying for me and I appreciate their efforts immensely. From time to time I will hear someone say "praying is the least I can do.” I believe that a more appropriate statement is "praying is the best I can do.”

The second tool in the SUPPORT drawer is resetting the body’s computer to its optimum healing mode and instructing the computer to regenerate damaged tissue. I wrote about this process in the November 2009 issue of this letter, a copy of which is available at Talking to the Body.

The third tool in this drawer is coenzyme Q10 (Co Q10). Co Q10 is a substance needed for energy production in the cells of the body. It is deficient in nearly all individuals with congestive heart failure. One of the reasons that congestive heart failure has become so commonplace is that statin drugs, which are widely prescribed to lower cholesterol, block the body’s ability to manufacture Co Q10.

Supplementation of Co Q10 can improve quality as well as quantity of life. For purposes of assessing disability, monitoring effectiveness of therapy, and establishing a prognosis, individuals with heart failure are divided into four classes: those with no limitation of physical activity, those with slight limitation, those with marked limitation, and those who are unable to perform any physical activity without discomfort.

In one study involving 424 patients, 58 percent given Co Q10 improved by one functional class, 28 percent by two classes, and 1 to 2 percent by three activity classes! Nearly 90 percent of them experienced a significant improvement in their quality of life. Not only were they able to significantly increase their physical activity, 43 percent were able to stop taking between 1 and 3 prescription drugs! In another trial, 84 % of individuals given Co Q-10 were still living after 2 years in contrast to a 50 percent annual death rate with conventional therapy alone. A typical amount is 100 mg. two or three times daily.  I recommend Q-Best from Thorne Research as it has been shown to be significantly more bioavailable than other forms of coenzyme Q10.

Another valuable support is L-carnitine, a substance that carries fats like triglyceride into the energy factories of cells. It acts synergistically with Co Q10 to improve heart muscle function. The average serving is 500 mg. two or three times daily.

Additional benefit may be obtained by using a product called Xtra Mile. I formulated Xtra Mile several years ago to support cellular energy production. It contains coenzyme Q10, L-carnitine, and several other nutrients that work together to improve the body’s ability to use oxygen to produce energy.

D-ribose is a sugar that significantly improves energy production in the heart. Five grams are taken two or three times daily. Two amino acids, L-taurine and L-arginine are known to be helpful in improving CHF. L-taurine improves heart muscle function and helps stabilize the heart rhythm. Two grams two or three times daily is a starting point, but it can safely be increase to as much as 4 grams three times daily. L-arginine helps to relax arteries and improve blood flow when used in amounts of 1.5 grams or more two or three times daily.  Note:  Since this article was first published a product called Rhythmatrol has become available.  It contains the proper ratio of D-ribose, L-taurine, and L-arginine in a single preparation.  The starting amount is 1 scoop three times daily.  It is available from Vitality Corporation in Reno, Nevada, 800-423-8365.

Congestive heart failure can result from any condition that damages the heart muscle and compromises its ability to pump blood throughout the body. No matter what the cause, supporting the body’s ability to repair damage and produce energy can improve both quality of life and length of survival. Heart specialists may not recommend them, but the tools in the SUPPORT drawer are available to anyone who wishes to support their body’s ability to improve and maintain heart function.

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