The truth about 6 popular “heart health” supplements

If you’re looking to improve your heart health or manage a condition like heart disease or high cholesterol, you may have come across supplements claiming to improve heart health. But do these supplements really work as they claim? Here’s what you need to know about the most common dietary supplements used for heart health.

Food > supplements

Remember, dietary supplements are just that—supplements. Supplements cannot replace a healthy diet, so be sure to think about your total diet first before strolling down the supplement aisle. The nutrients in foods cannot all be isolated, replicated into a pill and have the same effects when compared to their whole food form.

It’s also important to educate yourself on the risk of taking supplements and the proper dosage. Too much of certain nutrients can do more harm than good. It’s always a good idea to talk to your doctor or a dietitian before starting any new supplement.

6 common supplements for heart health

1. Fish oil (Omega-3 EPA/DHA)

Several different omega-3 fatty acids exist, but the majority of cardiovascular research focuses on two forms, EPA and DHA, which are found in seafood and fish oils.

While there are observational studies that link higher intake of fish and other seafood with improved heart health outcomes, other factors may be influencing these potential health benefits, such as diet quality or other lifestyle factors. As with many research studies, it’s not all clear cut.

In a large analysis of research studies, omega-3 EPA/DHA supplements did not appear to significantly reduce the risk of most cardiovascular events, especially in healthy individuals. However, use of omega-3 EPA/DHA supplements in people with low dietary intake of omega-3s and with existing coronary heart disease may have some cardioprotective benefit.

Risks and side effects

There is an increased risk of atrial fibrillation with high-dose supplementation, so it is always a good idea to talk to your doctor before starting a fish oil supplement.

Recommended intake

• For people with heart disease: The American Heart Association (AHA) recommends consuming about 1g (1,000mg) per day EPA/DHA, preferably by eating oily fish. Supplements may be an option under the guidance of a physician.
• For the general population: The American Heart Association (AHA) recommends eating 1-2 servings (4-8 oz.) of seafood per week to reduce  risk of some heart problems, especially if consumed in place of less healthy foods. The AHA does not recommend omega-3 supplements for people without a high risk of cardiovascular disease.

Optimize intake of seafood first. If you do not eat seafood and want to consider a supplement, talk to your doctor. They may test your blood to measure your omega-3 serum index and adjust your recommended dose accordingly.

Food sources of Omega-3 EPA/DHA

• Salmon
• Skipjack tuna
• Sardines
• Mackerel
• Trout
• Herring
• Oysters

2. Coenzyme Q10 “CoQ10”

Coenzyme Q10 (CoQ10) is a substance the body makes naturally. Levels have been shown to naturally decrease with age. While there are theories that supplementation with CoQ10 may reduce muscle aches associated with statin medication use, research studies have failed to prove this.

There is some evidence that the addition of coenzyme Q10 to conventional therapy for congestive heart failure patients showed reduced hospitalization for worsening heart failure and reduced serious complications. However, keep in mind these studies are small and have limited application.

Risks and side effects

While no serious side effects have been reported, mild side effects such as insomnia or digestive upset may occur with supplementation.

Recommended intake

You can have your coenzyme Q10 levels checked with a blood test at your doctor’s office if you’re worried your levels are low. For most people, eating a healthy diet keeps their coenzyme Q10 level normal, even if they’re taking a statin.

If coenzyme Q10 levels remain low after optimizing the diet, then taking a supplement may be appropriate. You may see CoQ10 supplements under the names “ubiquinone” or “ubiquinol.” Ubiquinol tends to be better absorbed than ubiquinone. It should be taken with a meal that contains fat to increase absorption. Since there is no established recommended dose for CoQ10, talk with your doctor about if and how much CoQ10 supplementation may be appropriate for you.

Food sources of CoQ10

Foods that contain CoQ10 include:

• Oily fish: salmon, tuna, trout, mackerel
• Some plant-based foods: soybeans, lentils, peanuts, pistachios, soybean and canola oil

3. Red Yeast Rice

Red yeast rice is produced by fermentation of a specific type of yeast on rice. The active ingredient in red yeast rice, Monacolin K, is structurally identical to the statin medication lovastatin, which helps slow the production of cholesterol in the body.

Red yeast rice can be effective in lowering elevated cholesterol, but the amount of monacolin K in red yeast rice supplements can vary considerably. Product labels normally do not list the amount of lovastatin, so it’s hard to know how much of the active ingredient the supplement contains and whether it will be effective.

Risks and side effects

Red yeast rice products that contain significant amounts of monacolin K can have the same potential side effects as statin drugs, including muscle, kidney and liver damage. They may also cause digestive problems. Moreover,  Consumer Lab found that 30% of red yeast rice products contain a contaminant called citrinin, which is toxic and can damage the kidneys.

Recommended intake

For consistent cholesterol lowering, regulated medications, such as statin drugs, are more trustworthy and cost-effective compared to red yeast rice products. However, red yeast rice may be effective for some people who are intolerant to statins. Similar to statin drugs, it is best to take red yeast rice in the evening.

4. Vitamin D

Vitamin D is a nutrient needed for good health. It works with calcium and phosphorus to build and maintain strong bones, supports muscle and nerve function, and is necessary for a healthy immune system.

Vitamin D deficiency has been associated with increased cardiovascular disease risk factors such as high blood pressure, type 2 diabetes and obesity in observational studies. But clinical research studies have failed to show vitamin D supplements to be effective in reducing the risk of developing heart disease or dying from it, even if you have low blood levels.

Risks and side effects

Getting too much Vitamin D from supplements can be harmful. Very high levels of vitamin D in your blood can cause high blood calcium levels and lead to nausea, vomiting, muscle weakness, confusion, dehydration, kidney stones and cardiovascular events. In addition, cholesterol-lowering statins might not work as well if you take high-dose vitamin D supplements.

Recommended intake

The main source of vitamin D in humans is from a chemical reaction that occurs when our skin is exposed to the sun. However, clouds, smog, old age and having dark-colored skin reduce the amount of vitamin D your skin makes.

Food sources of vitamin D

• Fatty fish: salmon, herring and sardines
• Fortified foods: orange juice, cereals, dairy/dairy alternatives
• Egg yolks
• Mushrooms

Vitamin D deficiency is a prevalent problem caused mainly by low exposure to sunlight. If you are concerned that your Vitamin D levels may be low, ask your doctor to do a simple blood test.

5. Fiber

Fiber-rich foods play an important role in cardiovascular health and associated risk factors, such as high blood pressure, high cholesterol and inflammation. There are two main classes of fiber: soluble and insoluble. Both are important for health. However, research studies show that soluble fiber is most effective in lowering LDL cholesterol.

 An analysis of 250 research studies confirmed that eating lots of fiber from vegetables, fruits and whole grains can decrease your risk of dying from heart disease and cancer. However, despite these proven health benefits, only about 10% of adults consume the recommended amount of daily fiber.

Recommended intake

But what about fiber supplements? Fiber supplements do not provide the variety of fibers, vitamins, minerals and other beneficial nutrients that foods contain. Looking at fiber research studies, it’s difficult to determine how much of the observed health benefits come directly from dietary fiber, versus other health-promoting factors associated with a diet rich in fruits, vegetables and whole grains.

In general, it’s best to get your fiber from whole foods rather than a fiber supplement. However, if you are unable to meet the recommended fiber intake through diet alone, a fiber supplement may be used in conjunction with a healthy diet.

To reap the cholesterol-lowering benefits, choose a fiber supplement that contains a soluble nonfermenting fiber like psyllium, beta-glucan or guar gum. Remember to keep in mind the recommended fiber goals above. Consider how much fiber you typically get from your diet to determine how much may be supplemented to help meet your goals without overdoing it, and always talk to your doctor if you’re unsure.

Risks and side effects

Depending on the type of fiber and amount, you may experience digestive symptoms, like gas, bloating, diarrhea and/or constipation. Consuming the right amount, slowly increasing your fiber intake and drinking plenty of water can help reduce the risk of unwanted side effects.

Food sources of fiber

Soluble fibers found in the following foods can help lower total blood cholesterol levels by lowering low-density lipoprotein (LDL), or “bad,” cholesterol levels:

• Beans
• Lentils
• Oats
• Ground flaxseed
• Chia seeds
• Apples
• Blueberries
• Pears
• Brussels sprouts
• Avocado
• Sweet potato
• Broccoli

6. Phytosterols

Phytosterols are natural fat-like compounds found in plants that can help lower cholesterol levels. They compete with cholesterol for absorption in the body and block the total amount of cholesterol that is absorbed. Other names for phytosterols include plant stanols, sterols and stanol esters.

Recommended intake

Clinical trials have demonstrated that daily consumption of phytosterols can significantly lower LDL cholesterol along with a healthy diet. An average of 2g/day (2,000mg) phytosterols is associated with a reduction of 8-10% LDL cholesterol. LDL lowering effects may be even greater if combined with statin drug therapy. However, the long-term effect of phytosterols on cardiovascular risk is not known.

Risks and side effects

Few adverse effects have been associated with plant sterols/stanols. However, it is advised to not exceed 3g/day as there are no additional benefits and this may increase the risk of undesirable side effects.

There is some concern that sterol/stanol supplements may inhibit the absorption of fat-soluble vitamins, but this potential negative effect can be minimized by increasing fruit and vegetable consumption throughout the day. Phytosterol supplements should be taken with a meal, but avoid taking with fat-soluble supplements like Vitamin D and CoQ10.

Food sources of phytosterols

Small amounts of phytosterols occur naturally in certain foods including:

• Soybeans
• Peas
• Kidney beans
• Pistachios
• Cashews
• Sesame oil
• Safflower oil
• Oranges
• Bananas
• Brussels sprouts

To supplement or not to supplement?

While supplements can be helpful in some cases, they can also be harmful if not medically necessary. If you’re deficient in a vitamin or mineral or struggling with high cholesterol levels, it’s important to get to the root cause—what may be causing the imbalance in the first place? Look to your diet first.

Remember, there are potential risks or harmful side effects of taking supplements because of their active ingredients and medicine-like effects. Always check with your doctor and dietitian before starting any supplements to ensure there are no possible interactions between the supplements and medications you may be taking and that you are taking a safe dose.

Choose the best quality supplement you can find

The supplement industry is poorly regulated, and the FDA is not authorized to review dietary supplements for safety and effectiveness before they are marketed.

If after talking with your healthcare provider, you decide to take a supplement, look for the highest quality option. Here are a few tips for choosing the best quality supplement:

• USP stamp: A USP stamp indicates the supplement has voluntarily been submitted to the USP Dietary Supplement Verification Program for testing and auditing. This indicates the product was properly manufactured, contains the ingredients listed on the label and does not contain harmful levels of contaminants.
• Other independent organizations: Several independent organizations offer quality testing and allow products that pass these tests to display a seal of quality assurance that indicates the product was properly manufactured, contains the ingredients listed on the label and does not contain harmful levels of contaminants. However, these seals do not necessarily guarantee that a product is safe or effective. Organizations that offer quality testing include ConsumerLab.com, NSF International and US Pharmacopeia.

Questions about how your diet can support your heart health? Talk to your doctor or find a dietitian near you.