Although heart health can be greatly enhanced by naturopathic lifestyle changes, sometimes medications are a necessary adjunct to disease treatment and prevention. The key here is ADJUNCTIVE, and not a stand alone treatment since dietary and other lifestyle modifications are important for addressing the underlying cause of cardiovascular risk factors.
Medications used in cardiovascular care include those that reduce cholesterol (statins) and blood pressure (diuretics, beta-blockers, ACE-inhibitors, angiotensin receptor blockers), as well as regulate blood sugar levels (metformin). As with many medications, various side effects and adverse events often tag along with these medications. Some of these side effects can be felt overtly such as lack of energy with beta-blockers. Other unwanted effects are more subtle in the body such as depletion of specific nutrients.
Nutrient depletions may or may not be noticeable in the body, but these deficiencies can hinder overall optimal health. As a naturopath, I am always looking to optimize health to prevent future disease. Below is an in-depth look at potential heart medication-induced nutrient deficiencies.
1. Statins & Coenzyme Q10
Statins are one of the most widely prescribed class of medications aiming to decrease cholesterol and subsequently the risk of heart attacks and strokes. They are most effective in those that have previously experienced a cardiovascular event such as a heart attack with controversial efficacy in otherwise healthy individuals (1). Along with decreasing cholesterol levels, statins also deplete a nutrient in the body called Coenzyme Q10. This depletion is seen with various types of statins including atorvastatin, simvastatin, rosuvastatin, and pravastatin (2).
Coenzyme Q10 acts as an antioxidant in the body meaning it prevents damage to blood vessels and other cells. It also plays an important role in the functioning of mitochondria, the energy production hub of a cell. Because the heart is constantly at work, muscle cells of the heart contain more mitochondria than any other cell in the body. This makes Coenzyme Q10 a key player in cardiac functioning. Long term supplementation of Coenzyme Q10 in those with heart failure has been shown to significantly decrease rates of mortality (3).
2. ACE-inhibitors / Angiotensin Receptor Blockers & Zinc
ACE-inhibitors (ACEi) and angiotensin receptor blockers (ARB) are similarly acting classes of medications used to decrease blood pressure, also known as antihypertensives. Antihypertensive medications are known to contribute to disturbances in electrolyte balance, but can also affect zinc levels. Certain ACEi and ARBs have been studied in hypertensive patients and found to decrease zinc levels. These include captopril, enalapril, verapamil, and losartan (4).
Zinc is the second most abundant trace mineral in the body after iron. It is involved in countless physiological functions with a pronounced role in the functioning of our immune system. This mineral directly impacts the activity of various immune cells. Zinc supplementation is a bit of a dance as high doses can also have a negative impact on immune cells (5). Furthermore, too much zinc can precipitate a deficiency in copper, as these two minerals are closely interlinked. Therefore, optimal supplementation requires close monitoring.
3. Metformin & Vitamin B12
Metformin is a medication used in diabetes to stabilize blood sugar levels. Since blood sugar dysregulation can cause damage to heart vessels, it is often used in cardiovascular disease. In those taking metformin, there is a significant association of vitamin B12 deficiency that’s dependent on dose and duration of treatment (6). This means the higher the dose and the longer the treatment with metformin, the greater the risk of vitamin B12 deficiency.
Vitamin B12 plays many roles in the body including healthy functioning of the brain and nervous system. A deficiency in vitamin B12 can lead to symptoms of fatigue, depression, and dementia, among others. Vitamin B12 deficiency is easily treatable as it is found dietarily in animal products, or can be supplemented orally or injected intramuscularly.
Optimizing Supplementation: treatment for these medication-induced deficiencies may include dietary modifications or nutritional supplementation. Because not all supplements and not all people are created equally, it’s important to talk to your naturopath or other health care provider about appropriate dosage of good quality supplements.
To start optimizing your medication and supplement regimen for heart health, come see me at Juniper Family Health (778-265-8340) in Victoria, BC.
1. Vrecer, M., Turk, S., Drinovec, J., Mrhar, A. (2003). Use of statins in primary and secondary prevention of coronary heart disease and ischemic stroke: meta-analysis of randomized trials. DARE Reviews.
2. Banach, M., Serban, C., Ursoniu, S., Rysz, J., Muntner, P., Toth, P… Sahebkar, A. (2015). Statin therapy and plasma coenzyme Q10 concentrations - a systematic review and meta-analysis of placebo-controlled trials. Pharmacological Research, 99, 329-336.
3. Mortensen, S., Rosenfeldt, F., Kumar, A., Dolliner, P., Filipiak, K., Pella, D… Littarru, G. (2014). The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure. The American College of Cardiology Foundation, 2(6), 641-649.
4. Braun, L., Rosenfeldt, F. (2013). Pharmaco-nutrient interactions - a systematic review of zinc and antihypertensive therapy. International Journal of Clinical Practice, 67(8), 717-725.
5. Ibs, K., Rink, L. (2003). Zinc-altered immune function. The Journal of Nutrition, 133(5), 1452-1456.
6. Ting, R., Szeto, C., Chan, M. (2006). Risk factors of vitamin B12 deficiency in patients receiving metformin. JAMA Internal Medicine, 166(18), 1975-1979.