Top 5 Questions to Ask Your Doctor about Alternative Heart Medicine

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The heart pounds when we get excited, skips a beat when our crush walks by and pumps the blood that makes our cheeks blush after tripping in front of the boss. It's also a great host, inviting oxygen-poor blood in and bidding it goodbye when it's feeling refreshed. Its likeness can even be used to dot our "I"s.

It's important to take care of the little pumper. Without such care, the dependable heart may exhibit its neglect in the form of chest pain, breathing trouble, weakness, dizziness -- and pudgy ankles. Even healthy hearts require preventive maintenance, while those with wear and tear may need a few different types of therapies and medications. The mention of medication might bring to mind clever pill commercials that end with a list of alarming side effects. However, when it comes to the heart, alternative medicine may be all you need to keep it happy.

Even a mere 10 years ago, alternative medicine was largely regarded as about as valuable as an IOU from your deadbeat brother. But today, many alternative medicines are regarded as bona fide treatments for a myriad of ailments including those that affect the heart, such as high blood pressure and high cholesterol. Using its broader definition, alternative medicine includes herbs, vitamins, yoga and meditation. Simply put, alternative medicine includes therapies that aren't likely taught in traditional Western medical schools. The term "alternative" isn't really accurate, as these therapies don't necessarily replace Western medicine. Today, the term complementary medicine is often used to describe these therapies, as the combination of these two approaches can be beneficial. (It's important to note that, like their more expensive prescription counterparts, alternative medicines can prove harmful to some patients. So before you go out and buy out the entire herbal aisle at your local drugstore, head to your doctor's office.)

In this article, we'll tell you the top five questions you need to ask once you get there. ­

Question #5: Have any supplements for the heart been proven effective in clinical trials?

Clinical trials have been used to test the efficacy of Western medicine for years, but you may be surprised to find out that some alternative medicines are put to the same tests. Before we get into the nitty-gritty, we should talk about clinical trials themselves.

Anyone who watches the news on a regular basis can tell you that one week an alternative therapy is said to be good for you, and the next week a new study states it may be worse than cigarettes. These confusing and conflicting stories are an excellent example of how clinical trials can be flawed -- some of them test only a small group of people, some use different strengths of an herb, or researchers might just calculate results incorrectly. To avoid any confusion here, we'll focus on those alternative therapies that have had their fair share of reputable clinical trials.

doctor holding fish and omega-3 supplements
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There's nothing fishy about omega-3s.

Omega-3s are one of those heart health no-brainers. Hundreds of studies investigating the effects of omega-3s on the heart have been published. The good news is that the vast majority of them had the same conclusion: They're good for you. Omega-3s are found in several different types of food, including nuts, oil and flaxseeds. While vegetarian sources like these are good, the most effective source of omega-3s is fatty fish, such as salmon and tuna. Fatty fish contain what science types like to call eicosapentaenoic acid and docosahexaenoic acid, most often referred to as EPA and DHA. Both of these fatty acids are needed in the body in order to produce eicosanoids, which are substances that help control functions in the body like inflammation. The heart-healthy benefits of EPA and DHA? They reduce inflammation in the arteries, lower triglyceride levels and can even help lower or regulate heart rate.

Keeping your heart in tip-top shape may be as easy as eating fish twice a week. Remember, the oilier the fish, the better. For folks with hearts that aren't so healthy, like those who have already suffered a heart attack, add to that supplements containing EPA and DHA [source: AHA Nutrition Committee]. This type of alternative therapy has been shown to reduce the risk of death due to cardiac causes by as much as 35 percent [source: Wang et al.]. Current recommendations are 1 gram per day for those with heart problems and up to 4 grams for those who need to lower their triglyceride levels [source: AHA Nutrition Committee].

Niacin is another friend of the heart because it's been shown to lower "bad" cholesterol (LDL) and increase "good" cholesterol (HDL). Why is this important? Increased levels of bad cholesterol can build up in your arteries, causing atherosclerosis. This plaque buildup can be a source of many heart problems, including high blood pressure and even a heart attack. Because niacin can reduce the amount of cholesterol in the arteries, it can help slow or, when paired with prescription cholesterol medications, even reverse atherosclerosis. As a result of these effects, one study showed that those patients taking niacin plus the cholesterol prescription medication simvastatin had a 90 percent decrease of cardiac events like heart attack, stroke and death than those on a placebo [source: Brown et al.]. If you're already on a prescription cholesterol medication, the amount of niacin you need should be decided by your doctor. For others, the current recommendation is between 1 to 18 milligrams a day and never more than 35 milligrams.

If you're not much of a pill popper, or just really hate fish, there are some alternative therapies that require only a sharp mind to achieve a healthy body. You'll learn more about these in our next section.

Question #4: What other alternative therapies have been proven effective in clinical trials?

Heart-friendly alternative medicines aren't confined to a capsule. In fact, there's a whole category of therapies that have been shown to help the heart in many of the same ways as those mentioned above. It's called mind-body medicine. As the name suggests, mind-body medicine addresses how your mind can enhance your body's health.

While each therapy may have its own specific advantages to the heart, the basic idea behind mind-body medicine is simple: It reduces stress. Stress is one of the heart's worst enemies. Extreme episodes of stress (like the death of a loved one) or chronic day-to-day stress (like an 80-hour work week) cause your body to release the hormones cortisol and adrenaline. In the short term, these hormones help us -- your body needs to be able to think fast and spring into action even faster. Adrenaline is what makes the heart beat faster and increases your blood pressure to get the optimal amount of blood to your brain and heart. Cortisol gives you a boost of energy by giving your brain the sugar it needs to function. In the long term, however, the constant release of these hormones can damage the body, including your heart, resulting in high blood pressure, high cholesterol and a lower immunity to illness.

Meditation is one of the simplest ways to reduce stress. In hard-number terms, one study found that meditation lowered a patient's chance of death due to heart problems by 30 percent, primarily by lowering blood pressure. That decrease is especially impressive when you compare it to those who take prescription medication to reduce their blood pressure, whose risk reduction was 25 percent [source: Schneider et al.]. While this study focused on transcendental meditation, many experts say that it doesn't matter which type of meditation you try as long as it works for you.

man doing yoga while his doctor checks his heart
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Yoga: good for the heart and for the mind.

Yoga probably needs no introduction, but here's a quick summary. It's an ancient practice from India comprised of both physical and mental exercises including breathing, stretching and meditation. The health benefits from yoga are well documented (and impressive): improved blood circulation, decreased stress, lower "bad" cholesterol and higher "good" cholesterol and lower blood pressure, among other benefits. One study showed that total cholesterol levels could decrease by as much as 25 percent [source: Innes et al.].

The concept behind biofeedback is learning to control functions in your body, such as heart rate and blood pressure, with your mind. It's not a skill you learn on your own. During biofeedback training, you learn physical and mental exercises from a certified clinician who monitors your progress using skin sensors. For example, if you're attempting to regulate your blood pressure, you get hooked up to a blood pressure monitor and you do the assigned exercises. When you achieve your optimal blood pressure level, your monitor alerts you so that you can then gauge what type of exercise, and at what intensity, is needed to control it. While studies have shown that biofeedback can help the heart, we don't know by how much. The good news is that the small studies that have been conducted are promising, with a few studies showing that biofeedback might even help repair a damaged heart [source: Moravec].

Using your mind to heal your body or adding a few vitamins and herbs to your diet sounds like a safe bet, right? Before you say yes, read the answer to our next question: Are alternative medicines safe?

Question #3: Are herbal and vitamin supplements safe?

You've probably heard this line of thought: If something's natural, it can't be bad for you. Not true. "All-natural" doesn't mean "all-safe," which makes sense to anyone who has walked through an all-natural patch of poison ivy. However, this reasoning means that many people omit herbal supplements or vitamins when listing their medications to their doctor. This can result in serious interactions with a patient's medications.

handful of vitamins
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A handful of vitamins might be too many vitamins.

A main issue in the safety of herbal and dietary supplements is that they aren't FDA regulated -- they don't go through the same safety standards that your prescription meds do. Makers of alternative medications don't have to prove that they're safe. Instead, the pills will only be taken off the market or the manufacturers given a warning if enough people get sick from them (and, of course, report their illness to the FDA). While the FDA is trying to set up more stringent standards for alternative medicines, right now adhering to standards is strictly voluntary.

Because of this lack of regulation, studies have shown that supplements may not contain consistent amounts of the active ingredient. For example, one brand of ginkgo biloba may contain 10 times more ginkgo biloba than another brand claiming to contain the same amount. Consistency can be the least of your worries when you consider that some tested supplements were found to have surprise ingredients not listed on the bottle, such as metal, actual prescription medications and even little organisms that managed to piggyback their way into the bottle. (A quick tip to avoid faulty supplements is to look for those approved by the United States Pharmacopoeia, NSF International or Consumerlab.)

The basic concept of "the more the better" can also lead to dangerous effects of alternative medicine. Organizations like The Food and Nutrition Board of the Institute of Medicine and the U.S. Department of Health and Human Services are the nice guys who wade through all the dense scientific research to determine the maximum daily amount that's safe, or as they like to call it, the upper tolerable intake level (UL). So just because niacin may be good for your cholesterol doesn't mean you should overdose on it. Daily amounts greater than those recommended by your doctor can damage your liver and may even cause liver failure.

We'll find out later how well supplements and other prescription medications play together. First, find out if mind-body medicine, with its lack of pills, is any safer than its supplemental counterparts.

Question #2: Is mind-body medicine safe?

Not surprisingly, mind-body medicine is safer than the herbs and vitamins mentioned earlier. We know that mind-body therapies such as yoga can lower blood pressure and regulate heart rhythm -- the same thing that medications do, but without the possible side effects.

Students practice Bikram yoga at a studio in London.
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Students practice Bikram yoga at a studio in London.

As we mentioned before, meditation is a well-documented friend of the heart. Experts agree that this type of mind-body therapy is safe for most people. Because meditation requires deep breathing, safety is usually only an issue for those with lung problems, like emphysema or asthma. In these cases, deep breathing may be painful and in the end, meditation may not be very effective.

While meditation is a part of yoga, the risks of this therapy are slightly greater due to the more physical aspects of this practice. There are several different types of yoga and all can be a risk for those with extreme heart problems, such as heart failure. One type, Bikram yoga, is done in a room that's heated to a temperature above 100 degrees Fahrenheit (37.8 degrees Celsius). Not surprisingly, this type of yoga tends to result in more injuries than the cooler kind -- it's not intended for those with serious heart conditions. The key to safe yoga is starting slowly. If done at the right pace, yoga can be the ideal initial exercise for people who aren't exactly excited about going for a brisk run. To minimize any risk, pick a certified yoga instructor, perform poses in front of a mirror and stop if you feel dizzy (those head stands can do that to the best of us).

OK, we've covered safety and now you're ready to add your chosen alternative therapy to all the other medications you take. Before you mix your medicine, read the answer to the next question.

Question #1: How do alternative therapies work with my prescription heart medications?

Anyone who's spent time in the dating world knows the difference between a good relationship and a bad one. In a healthy relationship, two people work together to bring out the best in each other. In an unhealthy relationship, two people clash and show the worst of themselves. The same can be said for interactions between prescription drugs and alternative medicines. So in this scenario, think of your doctor as a matchmaker. He or she can tell you which drugs and alternative therapies would make good couples and bad couples.

The heart-healthy alternative medications omega-3 and niacin haven't been found to interact negatively with other heart medications. In fact, when coupled with a statin, a popular type of cholesterol medication, niacin and omega-3 can have dramatic effects. One new study on omega-3s and statins showed that the combination of the two reduced the risk of a heart attack more than if you were just using the statin alone [source: Sekikawa et al.]. That doesn't mean all alternative therapies are good matches for patients popping heart pills. In fact, there's a long list of herbal medications that are on the "do not date" list.

There are a lot of drugs out there for those with faulty tickers. There are high blood pressure medications (ACE inhibitors, beta-blockers, diuretics), cholesterol lowering drugs (statins), medications that keep blood clots from causing heart attacks or strokes (warfarin and clopidogrel), and some that keep the heart beating like it should (digoxin). Which medication you use determines which alternative therapy you can use. For example, the heart-friendly vitamin D gets along with most of the medications listed above but can prove to be a bad mate to digoxin.

When looking for alternative medicine and drug interactions a search on the Internet will produce an impressive list, but many claims aren't fully proven by research. This is the very reason you should ask your doctor before adding any alternative therapy to your current medication line up. Here's a short list of the major offenders and what makes them, and your heart medication, a bad match.

Alternative Medicine Heart Medication Why They’re a Bad Couple
Ginkgo Aspirin or Warfarin Increases the drug’s action, possibly causing excessive bleeding.

Diuretic Can cause your anti-high blood pressure medication to instead be medication that causes high blood pressure.
Ginseng Warfarin Can reduce the amount of Warfarin in the blood, possibly resulting in blood clots.
Green Tea Warfarin Contains small amounts of vitamin K, which decreases warfarin effectiveness and may lead to blood clots.
St. John’s Wort Warfarin Makes the drug less effective, possibly resulting in blood clots.

Plavix Increases the drug’s action, possibly causing excessive bleeding.

Statins and Digoxin Reduced the amount of the drug found in the blood, thereby reducing it effectiveness. This can result in high cholesterol in the case of statins, and an irregular heart beat with digoxin.

[source: Hu et al.]

If you'd like to learn more about alternative medicine, from the effects of meditation on pain to the benefits of reflexology, try links to articles on the next page.

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More Great Links

Sources

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