think let's start with a couple of the supplements from the proven category, and ask you both to address the research behind them. Let's start with fish oil supplements. What do they do?
NATE LEBOWITZ, MD: As a cardiologist, I can tell you that I think fish oil has clearly entered the standard of care or mainstream range. And I think this was highlighted by a very large study last summer, with thousands of Italian men who had had a heart attack. Those who were put on fish oil, or omega-3 supplements from fish oil, had a dramatic drop in arrhythmias, sudden death from arrhythmias, and repeat heart attack. So we're clearly in the realm, and we've also known that it lower triglycerides, it can help with cholesterol, and it can help protect your arteries.
LISA CLARK: Sam, how much and how often should people be taking fish oil supplements?
SAM BENJAMIN, MD: I think the dose varies, and I don't want to be held to this. I think it also depends on the medications you're taking. For example, if somebody is on Coumadin, or is taking aspirin, or both of those, they really need to discuss this with their physician, because fish oils as well will affect the clotting mechanism, and that's an important consideration.
If they have other problems going on, for example, if they had hemorrhoids, for example. Somebody that I treated, that became a real problem. You need to be very careful about it. If they happen to have other issues like inflammatory bowel disease, the dose would vary. So I think it's something they need to think about. And they need to consider the options. Flaxseed oil, if they can't handle the fish oil. And the other possibility -- well, I suppose flaxseed oil would be the best -- hemp oil, which can be gotten in stores, and is not psychotropic, but does come from the marijuana plant, are definitely possibilities.
LISA CLARK: And they all have those omega acids in them.
SAM BENJAMIN, MD: They have omega-3 and, in fact, the flaxseed and hemp have a substantial amount of omega-6 fatty acids, which are also really good for you.
LISA CLARK: Let's talk about Resveratrol. Now, this is made from the skin of grapes. What's so beneficial about grape skin?
NATE LEBOWITZ, MD: It's interesting that, again, this comes from the observation that certain populations of the world who eat a high fat diet, but who also drink red wine every night, have relatively lower levels of heart disease than you would expect, relative to the amount of fat that they take in. So the studies were done, and they found that in the skin of the grape, there is a substance that has almost 50 times the antioxidant ability of even Vitamin-E, for instance, and has been a home remedy.
The sister compound is called picnogenol, and is made from the bark of the pine tree, and has been used as a home remedy for varicose veins in Europe for decades. So we're finding now that in very good basic science studies, that it really helps the arteries, and it really protects the arteries.
LISA CLARK: What about drinking red wine or grape juice? I've heard that the dark grape juice is beneficial as well.
NATE LEBOWITZ, MD: Absolutely. You can drink a glass or two of red wine, or have a lot of grapes. Or, again, you can take a supplement.
LISA CLARK: The benefit of taking these supplements is that it's available in a much more concentrated form than you would be able to ingest in a normal diet.
SAM BENJAMIN, MD: I think one of the problems is twofold. First, you do want to encourage people to some amount to consider the supplements. On the other hand, what you can get in your diet naturally is always going to be the best way. One of the problems with supplements is that we can purify out sometimes, in what's called standardization in production, some of the more important but barely detectable active ingredients that could get lost in the production process.
So I would encourage people to consider either red wine -- in moderation, mind you -- or grape juice. And certainly considering Resveratrol as a supplement is definitely something that might be useful if you don't have the time to do it.
LISA CLARK: Let's talk about another supplement, L-carnitine. What is this supposed to do?
NATE LEBOWITZ, MD: In the realm of cardiology, this may be a supplement that has really entered the prime time. Within the last five years, in very good scientific research in good journals, L-carnitine has proven to be very useful in a number of areas. In the treatment of congestive heart failure, in the treatment of patients who are first presenting with a heart attack, or with symptoms suggestive of a heart attack, or in people who have had a heart attack, in whom you want to protect the heart from a dangerous remodeling of the left ventricle, the pumping chamber of the heart.
LISA CLARK: Again, there are so many things that you hear about in the media. L-carnitine is one. And so is coenzyme-Q. Ubiquinone, is that how you say it? What is the great thing about co-Q 10? That's even popping up in some cosmetics I've seen.
SAM BENJAMIN, MD: In larger doses, saying somewhere between 100-300 mg a day, depending on the person, there's no question that co-Q 10 has some very positive and salutary effects in people, for example, with congestive heart failure. Probably that's the area that has been most proven clinically. It's used in Europe, not only orally, but intravenously, and its results have been very, very impressive.
There are studies done by a group in Texas over the last 10-15 years, and while it has not yet met with popularity in the United States, it is something that people should consider for those that have congestive heart failure.
LISA CLARK: Now, Nate, I have to ask, do most cardiologists know about these products? Are they willing to let their patients try them?
NATE LEBOWITZ, MD: I think we're in an era of clear flux, where traditionally academically trained cardiologists are, in some cases, being pushed by their patients to learn about these things. The problem is that a lot of us did not receive official training about nutrition in general in medical school, and we're picking this up on our own. In this country, there really hasn't traditionally been a lot of research done about these things, and it's been done in Europe and the rest of the world.
LISA CLARK: Let me mention briefly a few other things that you might have seen at your health food store as being beneficial for heart disease. Green tea extracts.
SAM BENJAMIN, MD: Green tea extracts have this wonderful thing called polyphenols. Polyphenols lower serum cholesterol, and they do it in a substantial way. They are safe. I have not yet learned of any drug interactions or herb/herb interactions with polyphenols. The dosage has yet to be clearly ascertained, but there is nothing wrong with it.
The polyphenols, in an extract form, do not have caffeine in them. They have a salutary effect, and I think that people should strongly consider them, especially in the prevention of heart disease. If you have elevated serum cholesterol, you can take whatever your doctor prescribes, and consider the polyphenols as well. Would I tell my doctor about it? Absolutely. But is it something that one should consider? I think so.
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