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Cardiomyopathy

Cardiomyopathy
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This doctor gave a guy six months to live.
The guy couldn't pay his bill.
The doctor gave him another six months.
(Henny Youngman)

Dave was 51, intelligent and cheerful. He had brought his entire family to see me over the years. This time his wife brought him.

"So what's up?" I asked them. They looked awfully serious that morning.

"Dave has been to the doctor, and to a cardiologist," said his wife Sandra. "He has been diagnosed with dilated cardiomyopathy."

If you looked carefully, you could see that she was near tears.

Dave nodded his head.

"It doesn't look so good," Dave said.

"How bad is it?" I asked.

"The specialists said I have two years to live, unless I get a heart transplant, and there is even doubt about that."

He looked at his wife, and then down, and then at me.

"Anything we can do?" Dave asked quietly.

There it was again: that question, that single question that makes the difference between passive surrender and active resistance.

"What have the doctors offered besides a transplant?" I asked.

"They said there is no other treatment," Dave answered.

"It sounds like you have little alternative but to try some alternatives," I said. "There is in fact literature supporting the use of diet, vitamin E, vitamin C, a substance called coenzyme Q-10, and the essential fatty acids linoleic and linolenic acid. Want to hear about them?"

They sure did.

"Dave, the first thing you have to do is lose weight," I said.

He looked at me with a childlike, "Do I hafta?"

But Dave said, "I know. I've let myself go for the last five years at least. What's the best way to do it?"

"What do you think?" I responded.

"Exercise, right?"

"Sure." Everybody knows it; it's just that not everybody does it.

"What exercise is best for me?" asked Dave.

"The one you will actually do," I answered. It is a stock reply, but a true one. "What do you like to do?"

"Well, walking. Don't do it much, because I have a desk job. But I like walking."

I waited.

"I could walk on my lunch hour," Dave said presently. "Weekends, too. Sandra will walk with me."

Sandra nodded vigorously.

"What else should I do?" said Dave.

"Vegetable juice fasting: a week on, and a week off. Repeat until you've lost 30 pounds at least. Do you own a juicer?"

"Yes," smiled Dave. "But we haven't been using it."

"Well then, dust it off and start today," I said. "You will also need to supply the heart with the special nutrients it prefers, specifically the fatty acids. Linolenic acid is found in fish, leafy green veggies, and flaxseed oil. Linoleic acid is found in oils in general. Lecithin contains both."

"How do you pronounce that word again?" said Sandra.

"Lecithin? Remember it this way: 'You are less-a-thin than you used-to-a-be.'"

They both laughed politely at such low humor.

I continued, "There is about half a gram of linolenic acid in a tablespoon of lecithin granules. There's eight times as much linoleic acid. Try to have three to five tablespoons a day. Most people work up to that amount gradually."

"How do you take it?" asked Sandra. Dave pursed his mouth, bracing himself for the worst.

"Stir it into yogurt, or juice. It won't dissolve in liquids, but just drift around. Down it quickly, and follow with something you like to eat. It doesn't taste bad, but it's not everybody's first choice, either. It is by far the cheapest source of the essential fatty acids. Your heart preferentially burns them for fuel. It is analogous to 'high-test' premium gas for a car."

"You keep saying 'fatty acids.' Isn't lecithin high in fat?" said Sarah.

"It is if you ate nothing else. But even five tablespoons a day is 24 grams of fat, or about 30% of the Recommended Daily Value. On a vegetable juice diet, you will have no other source of fat, so you need it here. For that matter, lecithin is a lipotrophic compound, and may help mobilize and get rid of fat buildups in the body. That part is controversial, but the heart's need for the fatty acids is beyond question."

"What about vitamins?" Dave asked.

"Little doubt about those, either. In animals, vitamin E deficiency will cause heart conditions much like cardiomyopathy. Vitamin E seems to help the heart do more work on less fuel and oxygen. 'E' increases your heart's stroke volume, that is, the amount of blood pumped per beat. Stronger, more regular heartbeats are essential for you, Dave."

"No argument!" Dave replied. "How much?"

"Working up gradually to somewhere between 1,000 and 2,000 IU a day is what I've read. Be sure the vitamin E is the natural, d-alpha tocopherol type. 'Mixed Natural Tocopherols' on the label would be better still."

Sandra dutifully wrote all of this down on a notepad.

I went on. "Vitamin C is needed for all connective tissue. Deficiency, really severe vitamin C deficiency like scurvy, results in profound connective tissue and muscle damage. I'd also recommend calcium and magnesium, as orotates, aspartates or citrates for best absorption. Hans Neiper, MD, one of Europe's finest cardiologists, uses those extensively. You could and probably should double the RDA of both."

"That is a lot of stuff to be taking, along with the juicing and the lecithin," Dave said.

"Don't worry, there's more," I said with a cheesy grin. "Coenzyme Q-10 has shown promise in conditions like yours. It is a bit pricey, but worth it under the circumstances."

"How much of that will I need?" said Dave.

"Hard to say. Physicians use between 100 and 400 milligrams a day. It certainly will not hurt you if you take the high end of that, so get a bottle, read the dosage information on the label, and take as much as you can afford to."

"He can't afford not to," Sandra said, as if on cue. "We'll do all of it. Won't you, Dave."

"Yep," Dave said.

And he did. We talked a few times over the next two months, and each time Dave felt better and better.

"I lost over 30 pounds," Dave said. "I'm increased my walking to over two miles every day. I can handle 5 or 6 cups of juice easy, sometimes eight. And I'm taking all those pills you told me about."

"Vitamins, Dave. They are all non-prescription nutritional supplements."

"Vitamins, right. Sure, who cares! I feel great!"

"What have the doctors said?" I asked.

"They said I've gotten no worse, so keep doing whatever I'm doing."

"That'll certainly do for starters," I replied.

In healing, there are levels of achievement. We always hope for cure, fast and unconditional. We can be well pleased with improvement, even if gradual and partial. And any progress is good. Keeping a serious disease from getting any worse is success. Slowing a rate of decline is well worth doing. Improving length of life is a victory, and failing that, better quality of life is still desirable. You try for the best, and see what you get.

Dave and I talked again some months later.

"Just have been to the cardiologist!" said Dave. "I'm symptom free! They "know" I have dilated cardiomyopathy, but they can't find a single symptom of it. I have no pain at all. This is wonderful!"

Sure was. And after five years, he was still symptom-free.

MORE ON COENZYME Q10

By now, coenzyme Q10 (coQ10 or umbiquinone) should probably be accepted as a vitamin. Many other vitamins are coenzymes. CoQ10 is found in small quantities in foods. A person with cardiomyopathy may have a bigger requirement because of the illness. It has been established that heart muscle greatly benefits from coQ10 supplementation, resulting in improvement in cases of congestive heart failure and even cardiomyopathy. Because coQ10 is so absolutely vital to muscle cells, involved with growth control, cellular energy production, and other essential life functions, it warrants special consideration for persons with cardiomyopathy. The research cited below is promising, but not unequivocal. In my opinion, it would have been more conclusive if higher doses were employed. I submit that 300–600 mg of coQ10 per day would be a minimum effective dose. The limiting factors will be either cost and/or medical disapproval. As there are no harmful side effects with coQ10, much higher doses are worth a serious therapeutic trial.

FOR FURTHER READING:

Mol Aspects Med. 1997;18 Suppl:S145-51. Treatment of hypertrophic cardiomyopathy with coenzyme Q10. Langsjoen PH, Langsjoen A, Willis R, Folkers K. Langsjoen Clinic, Tyler, TX 75701, USA. “Seven patients with HCM, six non-obstructive and one obstructive, were treated with an average of 200 mg/day of CoQ10 with mean treatment whole blood CoQ10 level of 2.9 micrograms/ml. Echocardiograms were obtained in all seven patients at baseline and again 3 or more months post-treatment. All patients noted improvement in symptoms of fatigue and dyspnea with no side effects noted. The mean interventricular septal thickness improved significantly from 1.51 +/- 0.17 cm to 1.14 +/- 0.13 cm, a 24% reduction (P < 0.002). The mean posterior wall thickness improved significantly from 1.37 +/- 0.13 cm to 1.01 +/- 0.15 cm, a 26% reduction (P < 0.005). Mitral valve inflow slope by pulsed wave Doppler (EF slope) showed a non-significant trend towards improvement, 1.55 +/- 0.49 m/sec2 to 2.58 +/- 1.18 m/sec2 (P < 0.08). The one patient with subaortic obstruction showed an improvement in resting pressure gradient after CoQ10 treatment (70 mmHg to 30 mmHg).”

Pediatr Cardiol. 2005 Jul-Aug;26(4):361-6. The effect of coenzyme Q10 on idiopathic chronic dilated cardiomyopathy in children. Soongswang J, Sangtawesin C, Durongpisitkul K, Laohaprasitiporn D, Nana A, Punlee K, Kangkagate C. “A total of 15 patients with idiopathic chronic DCM were included, with the median age of 4.4 years (range, 0.6-16.3). Presenting symptoms were congestive heart failure in 12 cases (80%), cardiogenic shock in 2 cases (13.3%), and cardiac arrhythmia in 1 case (6.7%). . . CoQ10 was given at a dosage of 3.1 ? 0.6 mg/kg/day for 9 months as a supplementation to a fixed amount of conventional antifailure drugs throughout the study. At follow-up periods of 1, 3, 6, and 9 months, NYHA functional class was significantly improved, as was CT ratio and QRS duration at 3 and 9 months follow-up with CoQ10 when compared to the baseline and post-discontinuation of CoQ10 at 9 months (range, 4.8-10.8).”

Clin Nutr. 2005 Jun;24(3):331-8. Potential role of ubiquinone (coenzyme Q10) in pediatric cardiomyopathy. Bhagavan HN, Chopra RK. “About 40% of children who present with symptomatic cardiomyopathy are reported to receive a heart transplant or die within the first two years of life. In spite of some of the advances in the management of PCM, the data shows that the time to transplantation or death has not improved during the past 35 years. Coenzyme Q10 is a vitamin-like nutrient that has a fundamental role in mitochondrial function, especially as it relates to the production of energy (ATP) and also as an antioxidant. Based upon the biochemical rationale and a large body of data on patients with adult cardiomyopathy, heart failure, and mitochondrial diseases with heart involvement, a role for coenzyme Q10 therapy in PCM patients is indicated, and preliminary results are promising. Additional studies on the potential usefulness of coenzyme Q10 supplementation as an adjunct to conventional therapy in PCM, particularly in children with dilated cardiomyopathy, are therefore warranted.”