Easing Angina and Heart Attack Recovery

If you’ve had a heart attack or suffer from angina, don’t underestimate the combined effect of a total nutritional strategy.

If you know you have significant arterial blockages or have had a heart attack, possibly leaving your heart muscle somewhat compromised, do not underestimate the combined effect of a total nutritional strategy, ideally personalised by a nutritional therapist depending on your test results. These steps are also worth taking if you are facing bypass surgery.

This may include:
• A low GL diet, with plant sterols, soluble fibres and antioxidant nutrients
• High potency niacin for lowering cholesterol and lipoprotein(a) and raising HDL
• Extra antioxidants, including CoQ10, alpha-lipoic acid, vitamin C, vitamin E and glutathione or NAC
• Extra lysine, especially if your lipoprotein(a) level is raised
• Extra omega 3’s both from eating fish and supplements
• Extra magnesium and potassium, and strict sodium avoidance, both eating more fruit and veg and supplementing 300mg of magnesium, which relaxes arteries

These form the basis of the diet and supplementary recommendations, together with building up exercise and learning techniques such as HeartMath for reducing your stress level. These kinds of actions have been shown to reduce angina, relax arteries, lower triglycerides and LDLs and reduce risk of a heart attack. However, there are a few other strategies that you might like to consider. Boost your nitric oxide level Your body produces a highly versatile nutrient, nitric oxide (NO), that does many of the things you need to recover after a heart attack and improve the health of your arteries. It expands blood vessels, it stops platelets in the blood clumping together forming clots and it helps to break down arterial plaque and, acting as an antioxidant, it helps to protect blood fats from damage. While a number of drugs, notably Viagra and ACE inhibitors, aim to boost NO, according to Louis Ignarro, who won a Nobel Prize for his research into NO, you can increase your body’s ability to make NO by taking a combination of certain supplements, as well as exercising.

He recommends: L-arginine, which is an amino acid found in all protein foods. From arginine the body makes NO. He recommends supplementing 2,000 to 3,000 milligrams (mg) taken twice daily – for a total of 4,000 to 6,000 mg. L-citrulline. Supplemental arginine doesn’t enter cells readily unless it is combined with L-citrulline, another amino acid. Melons and cucumbers are rich sources of L-citrulline, but they don’t provide high enough levels to significantly increase nitric oxide levels. He recommends 400 to 600 mg daily. Daily multivitamin including vitamin E. Vitamin E helps reduce the assault of cell-damaging free radicals on the endothelial lining and may promote higher levels of nitric oxide. The amount of vitamin E that is in most multi-vitamin/mineral supplements is about 50 international units(IU), which is an effective dose. Vitamin C.

Like vitamin E, vitamin C will reduce oxidation in the blood vessels and may cause an increase in nitric oxide. He recommends supplementing at least 500mg. Some supplements contain all these nutrients as naturally NO boosters. Exercise, which also helps boost your own natural levels of NO, needs to be part of your heart friendly action plan. CoQ10 plus carnitine – The dynamic duo If you’ve had a heart attack, especially if there is some residual damage, CoQ10 can really help recovery if taken in combination with the amino acid L-carnitine. Like CoQ10, carnitine is a semi-essential nutrient. This means that your body can make it, but it doesn’t make enough for optimal health – especially if you’re getting on in years.

Carnitine is made from two amino acids: L-lysine and L-methionine. However, it’s better to get a direct supply, especially for heart muscle function. More than half of your heart’s energy comes from fat, and since it’s working hard every second, it needs a steady supply. Carnitine is the delivery boy that brings in fatty acids to process for energy. It also takes away the toxic by-products, including damaged fats. Carnitine helps your heart liberate the energy it needs efficiently. Without enough, your heart would struggle to function properly, causing heart and blood pressure irregularities. Toxic waste would also accumulate, leading to reduced blood flow (ischemia), particularly in the legs.

A number of studies confirm its usefulness particularly if there’s stress on the heart, for example after a heart attack or heart failure, or if you suffer from angina. In a study of 47 patients with chronic stable angina given 2 grams a day of L-carnitine or placebo for three months, those receiving L-carnitine recovered more quickly and showed sufficient improvement to be able to start exercising [1]. In another study of people with coronary artery disease given both L-carnitine and the antioxidant alpha-lipoic acid for eight weeks their blood pressure decreased and the diameter of the brachial artery increased, indicating better circulation [2]. Very high doses (9 grams a day for six days intravenously, followed by 6 grams a day orally) also help recovery after bypass surgery.

A trial on 537 patients showed that propionyl-L-carnitine improves exercise capacity in patients with heart failure and keeps the heart healthy [3]. Carnitine choices There are actually three different kinds of carnitine, all with slight advantages for different processes in the body.

They are:
• L-carnitine
• acetyl-L-carnitine (ALC)
• propionyl-L-carnitine (PLC)

All three work in terms of improving heart muscle function. Probably the best if you had to pick one is PLC. It specifically helps heart and peripheral muscle function. It works so well that it’s in and out of your heart very quickly, showing the advantage of a continuous supply. L-carnitine and ALC are probably better for brain function. For example, I’d recommend ALC for people with age-related memory decline or Alzheimer’s, or to maximize recovery from a stroke. ALC also targets the eye and ear, and animal studies show that it can actually improve hearing. So, PLC is probably the best if you’ve had a heart attack, have angina, or suffer from intermittent claudication (lower leg pain caused by inadequate blood flow to muscles during exercise). You can purchase PLC on its’ own, or in carnitine ‘complexes’ that provide all three types. The best dosages Ideally, it’s better to take carnitine twice or more a day because it only hangs around in your body for a few hours. The best dosage depends on your level of health. I’d recommend taking 250 to 500mg a day for basic health promotion – that is if you’re essentially healthy and want to stay that way and live a long life. I’d go with 500mg a day, divided into two doses, if you are over age 50. However, if you have one of the above health issues – heart muscle problems, angina, heart attack, memory loss or stroke – I’d double or quadruple the dosage. Take 250 to 500mg of carnitine four times a day. Along with 30mg of CoQ10 taken four times a day, it can work wonders.

Although these two nutrients work in different ways, they both support your heart and brain by helping to provide a consistent, high level of energy and by reducing the toxic by-products of energy production. There really aren’t any toxicity concerns with carnitine, and certainly not at these levels. However, if you are taking the higher dosages and have an underactive thyroid, keep an eye on your thyroxine levels in case they go down. On the other hand, if you’re on anti-convulsive drugs (e.g.valproic acid), you’ll probably need the higher carnitine dosage, as long-term use of these drugs appears to deplete levels. Chelation therapy When there is significant arterial plaque, levels of coronary artery calcium go up. In fact, scans designed to detect this build up of calcium in the arteries are sometimes used to diagnose blockages.

High levels of coronary artery calcium is very predictive of a worse outcome in those with cardiovascular disease. If you are already pulling out all the nutritional stops but not making progress, one way to speed up the break down of arterial plaque is chelation therapy. This involves the infusion of EDTA, a chelating agent (chela means a claw) which latches onto calcium in arterial plaque and helps break it down. It’s approved by the FDA for treating hypercalcemia (high calcium in the blood). The chelation infusion, usually taking two hours, is done a number of times usually over a two or three month period. Chelation therapists also give cocktails of nutrients in the intravenous infusion, similar to those I recommend. This is especially important since EDTA also chelates, that is removes, other beneficial minerals such as magnesium, which must be replaced through supplementation.

Vitamin C is also a natural but weaker chelating agent that does, however, appear to enhance the effectiveness of EDTA. It has been around since the 1960’s but, despite growing evidence of its effectiveness, is considered controversial by mainstream medicine. This is hardly surprising since it could be seen as an alternative to bypass surgery, which is one of the most lucrative cardiovascular treatments. By the 1990’s there had been 19 studies involving over 22,000 patients with vascular disease, of which 87% had improved following chelation therapy [4]. In one study 58 out of 65 patients cancelled their scheduled coronary bypass surgery and 24 out of 27 cancelled amputation following significant improvements in circulation [5].

In another, patients who had blockages in their coronary arteries (stenosis) had a 30% reduction after 30 EDTA infusions [6]. However there are also small placebo controlled studies that have shown no effect. These studies have equally been criticised for faulty design. A more recent study of outcomes of those given at least 20 infusions of EDTA, often monthly, found a much lower incidence of heart attack, repeated coronary bypass surgery or PTCA and also less deaths [7].

Chelation therapy is certainly something you might want to consider if other options aren’t working or desirable. If you have an open minded cardiologist or doctor this is an option you might want to discuss with them. However, the first step is to apply an aggressive nutrition and lifestyle strategy.


1. R.N. Iyer, A.A. Khan, et al., “L-carnitine moderately improves the exercise tolerance in chronic stable angina”.The Journal of the Association of Physicians of India, 2000 Nov; 48(11):1050-2.

2. C.J. McMackin, M.E. Widlansky, et al., “Effect of combined treatment with alpha-Lipoic acid and acetyl-L-carnitine on vascular function and blood pressure in patients with coronary artery disease”. The Journal of Clinical Hypertension (Greenwich), 2007 Apr; 9(4):249-55.

3. R. Ferrari, E. Merli, et al., “Therapeutic Effects of l-Carnitine and Propionyl-l-carnitine on Cardiovascular Diseases: A Review”, Article first published online: 12 Jan 2006 [doi: 10.1196/annals.1320.007]

4. L.T. Chappell and J.P. Stahl, “The Correlation Between EDTA Chelation Therapy and Improvement in Cardiovascular Function: A Meta-Analysis”, Journal of Advancement in Medicine, 1993; 6(3)

5. C. Hancke and K. Flytlie, “Benefit of EDTA Chelation Therapy in Arteriosclerosis: A Retrospective Study of 470 Patients”, Journal of Advancement in Medicine 1993; 6(3)161-l 71

6. C.J. Rudolph, E.W. McDonagh, et al., “A Nonsurgical Approach to Obstructive Carotid Stenosis Using EDTA Chelation”, Journal of Advancement in Medicine 1991; 4(3)157-l 66.

7. L.T. Chappell, R. Shukla, et al., “Subsequent cardiac and stroke events inpatients with known vascular disease treated with EDTA chelation therapy”, Evidence Based Integrative Medicine, 2005; 2:27-35