Cardiovascular Supplementation- Which Supplements Actually Improve Your Heart Health?
When you walk into your local pharmacy or drugstore it’s easy to see which vitamins are the most popular among consumers. Typically there are rows upon rows of multivitamins, too many strengths of Calcium to keep straight, and choices of tablets, capsules, or softgels for vitamin D. The number of options is enough to make anyone crazy, including the pharmacy staff! But, what if I told you the best supplements for your heart are herbs you’ve probably only seen in your grandma’s kitchen?
Before you decide what supplements to choose, it’s important to have a strong understanding of the causes of heart disease. Heart disease can present in the blood vessels, also known as coronary artery disease (CAD), due to a buildup of cholesterol along the walls of arteries which is the result of inflammation. This buildup makes it harder for the blood to flow and requires the heart to pump harder causing high blood pressure or cardiac hypertrophy. Cardiac hypertrophy is thickening of the heart walls caused by years of overworking, making it hard to pump blood. Another common presentation of heart disease is irregular heart beats called arrhythmias. Heart disease due to valve problems can be worsened by both high blood pressure and arrhythmias. As you can see there are compounding problems that can cause heart disease. According to the CDC half of all Americans have one of the three key risk factors for heart disease: high blood pressure, high cholesterol, or smoking. Supplementation is an easy start to help reduce your risk!
Of note, commonly accessible and affordable supplements like Vitamin D, Vitamin C, Calcium, and Multivitamins haven’t had significant impact on cardiovascular health outcomes but are used for many other purposes.4 In the United States, over 68% of the population uses dietary supplements regularly, yet cardiovascular disease remains the main cause of death and morbidity since the 1900’s in most developed countries.2,7,8 Certainly nutrition and lifestyle play a big role here too. (think Mediterranean diet!)
So what does your grandma’s kitchen have that the pharmacy doesn’t? In short- bergamot, garlic, and berberine.
Bergamot is a bumpy green citrus fruit that is a member of the orange family. It is most well known for its place in Earl Gray tea. Traditionally it has been used for immune function and cardiovascular health because of its high level of flavonoids, but it has also been shown to provide a benefit in lowering cholesterol levels and reducing inflammation. Additionally, the pleasant smells have been used as aromatherapy to lower blood pressure levels. So can you drink Earl Gray tea with every meal to improve your heart health? While Earl Gray tea is probably a better choice than your can of Coke, the amount in tea is typically not enough to provide benefit. The optimal dose for supplementation can range from 150 mg to 1000 mg/day. Taking this supplement has been shown to decrease cholesterol levels and inflammatory markers.5,6 While decreasing cholesterol levels is beneficial, that isn’t the only impact bergamot has. It has been shown to decrease the atherogenic small dense low density lipoprotein (LDL), decrease triglycerides, and increase high density lipoprotein (HDL).¹⁰ These are signs that it is decreasing inflammation. Coronary artery disease (CAD) involves not only lipid accumulation in arterial tissue but also an ongoing inflammatory response. There are multiple immune mechanisms that are involved in initiating, promoting, and activating lesions in the coronary arteries.⁹ Because of its anti-inflammatory action and lipid reducing potential, bergamot is a great choice for cardiovascular health.
Garlic was a staple in my house growing up! Historically, garlic has been used across cultures for medicinal benefit for many years. Current literature suggests its broad benefit in lipid metabolism, heart rhythm, blood sugar control, and blood pressure control. Some studies have found a systolic blood pressure decrease of up to 20-30mmHg. As we know, blood pressure, lipids, and heart rhythm are key contributors to the development of heart disease and garlic addresses all three. Because of its use in the kitchen, we also know that garlic is safe to consume in a wide variety of doses. Studies have shown that it can lower total cholesterol at doses of 600-900mg per day. The low end of the range (600mg) equates to about 1 medium size, fresh clove of garlic. Studies have shown that garlic lowers cholesterol by decreasing its production in the liver and increasing its excretion. One study showed that LDL isolated from human participants was more resistant to oxidation. This is an important mechanism in decreasing atherosclerosis. 1
Berberine is a plant based component from the turmeric tree, a shrub that is very common in India and Nepal, and provides the yellow color in Thai curry. It can also be found in barberry trees which might be in your landscaping! Berberine has been used in traditional Chinese medicine for over 2000 years. One study calls it the most promising nutraceutical for cardiovascular disease. Berberine has been studied in doses ranging from 500mg to 2,000 mg/day to benefit a wide variety of cardiometabolic diseases. The benefits of berberine are seen because of its wide range of targets in the body. It has been shown to protect against atherosclerosis and decrease cholesterol levels. It is also an antioxidant and has anti-inflammatory properties.3 We also talk in previous posts about berberine’s glucose effects!
So next time you’re looking for something simple and over the counter to help combat the largest health risk in developed countries, consider skipping the traditional supplement options. Instead, try adding bergamot, garlic, or berberine to your supplement regimen. It might require some extra searching at the pharmacy or grocery store, but Grandma would be proud. Turns out she knew what she was doing in the kitchen!
The information contained in this post is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. You assume full responsibility for how you choose to use this information.
Written by Mackenzie Hoffman, PharmD Student University of Findlay
Edited by Lindsey Dalton, PharmD
1. Banerjee SK, Maulik SK. Effect of garlic on cardiovascular disorders: a review. Nutr J. 2002;1:4. Published 2002 Nov 19. doi:10.1186/1475-2891-1-4
2. Bronzato S, Durante A. Dietary Supplements and Cardiovascular Diseases. Int J Prev Med. 2018;9:80. Published 2018 Sep 17. doi:10.4103/ijpvm.IJPVM_179_17.
3. Feng X, Sureda A, Jafari S, et al. Berberine in Cardiovascular and Metabolic Diseases: From Mechanisms to Therapeutics. Theranostics. 2019;9(7):1923-1951. Published 2019 Mar 16. doi:10.7150/thno.30787
4. Jenkins DJA, Spence JD, Giovannucci EL, et al. Supplemental Vitamins and Minerals for Cardiovascular Disease Prevention and Treatment: JACC Focus Seminar. J Am Coll Cardiol. 2021;77(4):423-436. doi:10.1016/j.jacc.2020.09.619.
5. Nauman MC, Johnson JJ. Clinical application of bergamot (Citrus bergamia) for reducing high cholesterol and cardiovascular disease markers. Integr Food Nutr Metab. 2019;6(2):10.15761/IFNM.1000249. doi:10.15761/IFNM.1000249.
6. Perna S, Spadaccini D, Botteri L, et al. Efficacy of bergamot: From anti-inflammatory and anti-oxidative mechanisms to clinical applications as preventive agent for cardiovascular morbidity, skin diseases, and mood alterations. Food Sci Nutr. 2019;7(2):369-384. Published 2019 Jan 25. doi:10.1002/fsn3.903.
7. Centers for Disease Control and Prevention, National Center for Health Statistics. About Multiple Cause of Death, 1999–2020. CDC WONDER Online Database website. Atlanta, GA: Centers for Disease Control and Prevention; 2022. Accessed February 21, 2022.
8. Tsao CW, Aday AW, Almarzooq ZI, Beaton AZ, Bittencourt MS, Boehme AK, et al. Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association . Circulation. 2022;145(8):e153–e639.
9. Christodoulidis G, Vittorio TJ, Fudim M, Lerakis S, Kosmas CE. Inflammation in coronary artery disease. Cardiol Rev. 2014 Nov-Dec;22(6):279-88. doi: 10.1097/CRD.0000000000000006. PMID: 24441047.
10. Toth PP, Patti AM, Nikolic D, Giglio RV, Castellino G, Biancucci T, Geraci F, David S, Montalto G, Rizvi A, Rizzo M. Bergamot Reduces Plasma Lipids, Atherogenic Small Dense LDL, and Subclinical Atherosclerosis in Subjects with Moderate Hypercholesterolemia: A 6 Months Prospective Study. Front Pharmacol. 2016 Jan 6;6:299. doi: 10.3389/fphar.2015.00299. PMID: 26779019; PMCID: PMC4702027.