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Herbs for Heart Health

The best natural remedies for heart disease.
By Karta Purkh Singh Khalsa, A.H.G., C.D.-N.
November/December 2002
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Garlic is a beneficial (and tasty) herb for treating hypertension. Studies have shown that garlic reduces blood pressure levels by about 5 percent to 10 percent.
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Heart disease is the nation’s top killer. The American Heart Association says that 1.5 million Americans will suffer heart attacks this year. The good news is that protective measures can dramatically reduce the threat. Men and women of all ages get heart disease. Genetics play a large role in this disease, but modern lifestyles are also laden with risk factors.

High blood pressure is a major cause of cardiovascular disease. One in five American adults has it. Usually, sufferers—those with blood pressure consistently above 150/90—can’t feel when their blood pressure is running high. More than 90 percent of high blood pressure patients have no obvious damage or disease. But what you don’t know can hurt you.

Called the “silent killer,” elevated blood pressure (hypertension) can lead to a dangerously increased risk of heart attack and stroke and is one of the most significant causes of atherosclerosis (hardening of the arteries). When blood vessels are exposed to chronically extreme high pressure, their linings become injured—the inauguration of the unhealthy changes of atherosclerosis. Although it is important to normalize your blood pressure in a purposeful manner, under most circumstances, you have plenty of time to bring it down. Just don’t ignore it. Given enough time, hypertension can damage virtually every organ in your body.

Dead in a heartbeat

Atherosclerosis, a buildup of fatty deposits on artery walls, contributes to high blood pressure and heart muscle degeneration. Fatty deposits and loss of elasticity narrow blood vessels and raise pressure. The high pressure continues to damage blood vessels, creating the vicious cycle of coronary artery disease. Numerous studies have linked higher blood low-density lipoprotein (LDL, or “bad” cholesterol) levels with higher rates of coronary heart disease. Oxidized LDL can become incorporated into the arterial plaque. High-density lipoprotein (HDL, or “good” cholesterol), by contrast, protects us by transporting cholesterol away from the arteries and back to the liver, where it’s excreted.

The heart, of course, is the stuff of verse. But you may not feel so poetic if you have a heart attack. With lowered coronary blood flow comes reduced heart efficiency and angina pectoris pain. A clot creates an obstruction, or atherosclerosis creates a narrowing, impeding blood flow to the heart muscle downstream—heart-attack time. This death of heart muscle cells is called myocardial infarction.

The evening news extols the latest medical treatments for atherosclerosis, and honestly, many of these treatments work quite well. Drugs and surgery are frequently lifesaving. But what about preventing the crisis before it gets to the stage that needs these emergency measures? And the side effects? The foremost class of cholesterol-reducing drugs, the “statins,” has been implicated as the cause of rhabdomyolysis, a condition in which the skeletal muscle degenerates, resulting in pain, spasm, and weakness.

The alternative—natural medicine—shines in the prevention and treatment of coronary artery and other heart diseases, especially for chronic problems that have not yet reached crisis proportions, such as blood pressure that has been slowly rising for a few years. Of course, always consult your health practitioner for advice on your particular situation. Cardiovascular disease is very serious and should not be self-treated.

Effective herbal medicines

Guggul (Commiphora mukul). “The results I got were phenomenal. I tell everybody I talk to about the great effect,” says Guruchander Singh Khalsa, D.C., a chiropractic physician practicing in Espanola, New Mexico.

Khalsa comes from a family with genetically high cholesterol and has been running a total cholesterol level of more than 300 for twenty years. His mother’s brother died at age forty-two of a massive heart attack, and all of her remaining siblings have had quadruple bypass surgery, along with heart attacks. Khalsa had managed to avoid serious disease with diet and yoga, but he knew the risks of his high numbers. His thyroid function was also depressed, with the thyroid stimulating hormone reading at triple the normal value.

After a bit of professional consultation, we decided he would try guggul (6 g per day) to quickly lower blood fats. He also took a combination of gotu kola (Centella asiatica), saw palmetto (Serenoa repens), skullcap (Scutellaria lateriflora), elderberry (Sambucus nigra), and willow bark (Salix spp.) for the thyroid issue. Four months later, he called me on the phone. “Are you sitting down?” he asked. Lab tests showed that his cholesterol had plummeted a gigantic 180 points and that his thyroid was precisely normal.

Guggul is a mainstay in Ayurvedic medicine for the management of blood fats, where it rivals any natural substance. In studies, guggul has lowered total cholesterol by more than 20 percent, while increasing HDL cholesterol by 36 percent, without dietary adjustments. In 2002, researchers at the Baylor College of Medicine in Houston discovered that an active ingredient, guggulsterone, acts as an antagonist, binding to and inhibiting a protein that binds to bile acids and halts their production, leading to a reduction of cholesterol and triglycerides. Guggul can help to reduce overall body fat. It seems to exert its effect at least partially through the thyroid, which could account for its fat loss benefit. Take a dose of 1,500 mg three times daily.

The combination of guggul and triphala—an Ayurvedic medicine formula containing amla (Emblica officinalis), bibitaki (Terminalia belerica), and haritaki (Terminalia chebula)—recently showed a startling effect in controlling body fat. Forty-eight obese subjects took these Ayurvedic combinations, 500 mg three times a day for three months, with no attempt to control their food intake. The ensuing weight loss averaged almost eighteen pounds, and total cholesterol reduced eighteen points.

Arjuna (Terminalia arjuna). Mary’s heart problems were becoming excruciating. Her nearly uncontrollable tachycardia (rapid heartbeat) would bring her to the emergency room at least once a week. The drugs used to steady her heart rhythm left her feeling like she was wearing a lead blanket. Her choice: lie around like a beached whale or endure a heart that raced like a Ferrari. At seventy-two years of age, Mary was becoming hopeless. “I’ll never have my life back,” she complained. I’d had great success with the famed Ayurvedic heart herb arjuna for tachycardia, so I suggested it to Mary. She never made that trip to the ER again.

Although it is rather new to us in the United States, arjuna is one of my favorite herbs. I’ve seen it provide benefit countless times, in just about any type of cardiovascular disease. Arjuna is a famous Ayurvedic medicine made from the bark of the Terminalia arjuna tree, a sixty- to ninety-foot deciduous tree that grows throughout India. The thick, white-to-pinkish-gray bark is probably the most widely used cardiac herbal medicine in Ayurveda.

Ayurvedic practitioners use this medicine for a wide variety of cardiovascular conditions—it is virtually a panacea for the heart and circulation in Ayurveda, a cardiac “tonic.” This herb holds a position in Ayurveda very similar to that of hawthorn in European herbalism. Among the diseases for which it is prescribed in India are cardiac failure, hypertension, angina, endocarditis, pericarditis, and edema.

Herb McDonald, a veteran herbalist with a clinical practice in Albuquerque, New Mexico, shares this view. He calls arjuna “far and away the number-one cardiovascular herb. It’s the foundation of treatment for all cardiovascular diseases, especially arrhythmias. I use it with guggul for high cholesterol. Using arjuna in my practice has eliminated my use of hawthorn.”

Clinicians in the United States are beginning to use arjuna for coronary artery disease, heart failure, and high cholesterol. Arjuna’s components include a variety of polyphenols, which probably account for much of its activity, including tannins, ellagic acid, gallic acid, proanthocyanidinic oligomers (PCOs), and flavonoids. It also contains triterpenoid saponins (arjunic acid, arjunolic acid, arjungenin, and arjunglycosides), phytosterols, calcium, magnesium, zinc, and copper. Arjuna seems to primarily improve cardiac muscle function and pumping activity of the heart. The saponin glycosides might be accountable for the heart-contracting benefits of arjuna, while the flavonoids and PCOs afford antioxidant action and vascular strengthening.

Scientific information about arjuna is beginning to accumulate. Angina pectoris, in particular, benefits from this medicine. A 1999 study indicated that arjuna was more effective than a standard drug for angina. Arjuna was effective for 80 percent of the patients and the herb reduced the number of anginal attacks from seventy-nine per week to twenty-four per week. In a recent study from Delhi, India, patients with stable angina had a 50 percent reduction of angina after three months of therapy with arjuna alone. When looking at the overall clinical conditions, treadmill results, and ejection fraction (heart strength), 66 percent showed improvement.

This herb is particularly effective for congestive heart failure. A recent experiment bears this out. A double blind, placebo-controlled, two-phase trial of arjuna extract treatment in patients with severe refractory heart failure was conducted. Arjuna was added to the patients’ regular drugs. In just two weeks, breathing difficulties, fatigue, edema, heart contraction, blood pressure, and walking tolerance all improved. In the second phase of the study, the subjects continued the arjuna for two years, and continued to improve for the next two to three months. Their improvements were sustained for the entire two years.

If that’s not enough, arjuna also benefits cardiomyopathy (disease of the heart muscle) and the treatment of heart attack. A 1997 study of heart-attack victims demonstrated that arjuna was superior to drugs alone for a wide range of related symptoms (angina, pumping strength, and enlarged heart). Arjuna also protects the tissue of the heart from damage.

Arjuna is used in Ayurveda to reduce blood lipids (high cholesterol). Clinically, I have seen this happen many times. Yet the scientific literature includes only animal studies to confirm this action. Several studies over the past few years have shown that arjuna, at least in animals, reduces total cholesterol and increases HDL. A study from February 2001 showed that this herb was as effective an antioxidant as vitamin E, and that it reduced cholesterol in the human subjects quite substantially. Herbalists use this herb to lower blood pressure. Considering its benefit for cholesterol, this is not surprising.

A typical dose of dried arjuna bark is 1 to 3 g per day, in capsules. For congestive heart failure, 500 mg of extract four times per day has been used in studies. You can also brew the shredded bark into a tea with a pleasant red hue. It’s a bit tart, so you may add other herbs, such as ginger, for flavor.

Garlic (Allium sativum). At least twelve studies have looked at the benefits of garlic for hypertension. According to published scientific literature, garlic seems to reduce blood pressure levels by about 5 percent to 10 percent. Every bit counts when you are treating the total damage from chronic high blood pressure. Clinical herbalists assert that higher doses produce larger reductions.

Garlic is often given in a dosage of 900 mg daily of a garlic powder extract standardized to contain 1.3 percent alliin. Garlic is a food—larger doses should not hurt, and you might experience better results if you are willing to include more in your diet or use a higher dose as a supplement. Garlic is generally regarded as safe; however, because it appears to thin the blood it should be used with caution with prescription anticoagulants.

Hawthorn (Crataegus spp.) is the most famous herb in modern Europe for safe and effective treatment of a variety of cardiovascular conditions. The actions of this herbal medicine come from an assortment of potent antioxidant, bioflavonoid-like complexes in the leaves, flowers, and berries. The berries have been used traditionally, but modern research has confirmed the content of active ingredients in other parts of the plant.

Hawthorn has various favorable effects on the heart and blood vessels. It seems to improve coronary artery blood flow and heart muscle contractions, according to research. Also, it may reduce resistance in arteries and improve circulation throughout the body.

Several investigations have shown that hawthorn extracts lower mild blood pressure over two to four weeks.

Standardized extracts with total bioflavonoid content (often 2.2 percent) or oligomeric procyanidins (usually 18.75 percent) are often used. A usual dose is 80 to 300 mg of the herbal extract in capsules, two to three times per day. You may also use a tincture of 4 to 5 ml three times daily. If you are using the berry in capsules, tea, or even jelly, the recommendation is at least 4 to 5 g per day. The effectiveness of hawthorn may still be increasing even after one to two months, so it should be considered a long-term therapy.

Ashwaganda (Withania somnifera). This ancient herb is showing promise in yet another round of recent scientific investigations. Ashwaganda is little-known in the United States, but that is about to change. The scientific literature includes more than eighty-seven studies on this herb, with thirty-four of them conducted since 2000.

Ashwaganda is sometimes named as the main tonic, especially for men, in the Ayurvedic pharmacopoeia. Holding a role similar to that of ginseng in Chinese medicine, and even called “Indian ginseng,” this adaptogen is a nightshade plant—a relative of tomatoes and potatoes. Although unrelated to the true ginsengs, it appears to share their many properties and actions. Ayurvedic practitioners consider this long-term building herb to be a rasayana, or particularly powerful rejuvenative herb. Modern clinicians are apt to use it for chronic heart disorders, especially for congestive heart failure, where it is often combined with arjuna bark. Ashwaganda is showing a variety of benefits for cardiovascular functions, including significant increase in coagulation time (blood thinning).

In another double-blind clinical trial, ashwaganda (3 g per day for one year) was tested on the aging process in 101 healthy male adults (fifty to fifty-nine years of age). Significant improvements in hemoglobin, red blood cells, hair pigment, and seated stature were observed. Serum cholesterol decreased, nail calcium was preserved, and 71.4 percent of those who received the herb reported improvement in sexual performance. A typical dose of ashwaganda is about 1 g per day, taken over long periods (up to many years) as a rejuvenator, but because ashwaganda is very safe, larger quantities are often used in Ayurveda short term. To increase its tonic effects, ashwaganda is prepared with pungent, heating herbs such as ginger and pepper.

Green tea (Camellia sinensis) has a host of beneficial effects for the cardiovascular system. The herb has been shown to reduce total cholesterol and LDL, as well as triglycerides, and to improve the ratio of LDL cholesterol to HDL cholesterol.

Green tea lowers blood pressure. One Norwegian study showed a lower average blood pressure in tea drinkers. Because many cases of high blood pressure are essentially caused by high blood fats, it is likely that this is the mechanism by which green tea brings down the blood pressure. Most of the research supporting the health benefits of green tea is based on the amount of green tea typically drunk in Asian countries—about three cups per day (providing 240 to 320 mg of polyphenols). Capsules containing standardized extracts of polyphenols, particularly EGCG, are available, some providing up to 97 percent polyphenol content—which is equivalent to drinking four cups of tea.

Don’t forget about a healthy diet

“Eat your heart out,” the expression goes. And that’s just what most of us are doing. We gobble such huge quantities of animal fat that our arteries are clogged like the Los Angeles freeways at rush hour—all this in spite of the fact that the diet we eat for the next few decades is probably the most important factor affecting our health for the rest of our lives.

Our bodies produce cholesterol from dietary fat. Saturated fats (animal fats and margarine) increase clotting, raise LDL, and lower HDL cholesterol. Every 1 percent decrease in total blood cholesterol reduces a person’s risk of coronary heart disease by 2 to 3 percent. So the primary goal of diet is to lower cholesterol by reducing the intake of cholesterol-producing fat.

Women, your heart will thank you if you eat your fruits and veggies. So says a study in a recent issue of The American Journal of Clinical Nutrition. Overall, women who ate between four and ten servings of fruits and vegetables daily reduced their risk of cardiovascular disease by between 20 percent and 30 percent. Women without any cardiovascular risk factors, such as diabetes or hypertension, fared even better, and the scientists said that, due to measurement techniques, the 20 to 30 percent risk reduction from fruits and vegetables might be a conservative estimate.

The data came from almost 40,000 women health professionals, all with no known history of cardiovascular disease, who took part in the Women’s Health Study. They recorded the total servings of vegetables and fruits they ate per day and were monitored for an average of five years for incidence of heart attack, stroke, coronary angioplasty, coronary bypass, or death due to cardiovascular disease.

The scientists maintain that it’s probably part of this whole picture we’ve been seeing concerning plant food and the health benefits for heart disease. It’s probable that, in addition to the antioxidants, vitamins, minerals, and plant hormones found in food plants, other enzymes and hormones, which both protect the plant from fungus or help to pollinate it, may help prevent disease in humans.

We all agree that it would be better to prevent cardiovascular disease. Natural medicine does that very well. But the stakes are too high to take risks. Because collapsing with heart-attack pain or being struck by a stroke is an all-or-nothing event, it’s a roll of the dice who will be a victim at any given time. If you do develop cardiovascular disease, go with conventional treatment if your life is in imminent danger, medically speaking. If your cardiologist is giving you some time, say to reduce cholesterol with diet, add herbal medicines. It’s best to work with a qualified herbalist or other practitioner while using natural medicines.

Otherwise, go with an integrated approach. Under no circumstances should you discontinue your medication without consulting your medical doctor. Heart disease is preventable, and comprehensive lifestyle changes can actually reverse the process without recourse to drugs or surgery. In a widely reported program, Dean Ornish, M.D., demonstrated this in humans nearly twenty years ago. Since then, repeated scientific studies confirm that his program dramatically improves the health of the majority of his patients.

Healthy heart, healthy life

This collection of diseases, caused largely by lifestyle issues, is the main killer of Americans, by far. Clearly, there are many things that you, as a concerned individual, can do to improve and extend your life. Using good judgment and consistent awareness, you can increase your chances of avoiding or surviving heart disease by a tremendous degree.

In many ways, a happy heart brings a happy life. Do yourself a favor and use these effective herbs to experience the power of a pump that keeps on tickin’.


Karta Purkh Singh Khalsa is an adjunct faculty member in the botanical medicine department of Bastyr University.


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