Column: The forgotten side of heart health

Overall health is dependent on a healthy heart that can pump adequate nutrients and oxygen to cells throughout the body. The key focus of heart health has been primarily to prevent plaque buildup in arteries serving heart muscle rather than maintaining heart muscle strength. Since the late ’90s, however, there has been a growing epidemic in the U.S. of heart failure often unrelated to plaque accumulation contributing to 1 in 8 deaths in 2017 and responsible for 36% of all cardiovascular deaths.

Question:What is heart failure and what causes it?

Answer: Failure occurs when the heart cannot pump adequate blood throughout the body. Heart failure often develops gradually due to high blood pressure, a heart attack, stiffening of the heart muscle, heart rhythm problems, heart enlargement, heart valve problems or genetic susceptibility.

Often, people are unaware that heart failure is developing because symptoms are attributed to getting older. Difficulty in concentrating, fatigue, shortness of breath, persistent coughing or wheezing, increased urination at night, cold legs and arms, or swelling feet and ankles can all be caused by low heart output.

Q:Are there risk factors related to heart failure?

A: Diabetes, kidney problems, thyroid disorders, cancer treatments, HIV/AIDS, alcohol, smoking and lack of exercise are risk factors for heart failure.

Q: What dietary measures can be taken to prevent or improve heart failure outcomes?

A: The answer to these questions is dependent on whether you have hemochromatosis (iron overload) or have compromised renal function (requiring some limitation of dietary protein). Most popular websites provide a one-size-fits-all solution that can be the opposite of what most individuals with heart failure need.

There is new research showing that iron deficiency (with or without anemia) occurs in as many as 50% of heart failure cases. For this reason, European, Australian- New Zealand and French cardiology societies recommend an iron evaluation as part of the assessment and treatment of all heart failure patients. U.S. and Canadian cardiology societies have not yet adopted this recommendation.

Q: What are causes of iron deficiency or anemia?

A: In addition to blood loss and inflammation, absorption of iron is decreased in diets high in phytates (grains, beans, nuts and seeds), polyphenols (tea, coffee, wine, berries and a number of fruits and vegetables) and calcium. Anemia can also be caused by inadequate vitamin B12, folate or protein.

Q:What else might be beneficial in cases of heart failure?

A: For those without kidney problems, increasing the quality and quantity of protein in the diet can be beneficial, especially in older individuals. Also adding an L-Carnitine and/or Co-Q10 supplement has been shown to result in heart strength benefits.

Everyone should work to keep heart muscle strong, with or without heart failure. This includes a habit of regular exercise.

Alan Titchenal, Ph.D., C.N.S., and Joannie Dobbs, Ph.D., C.N.S., are nutritionists in the Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa. Dobbs also works with University Health Services.