When the heart sustains injury that weakens its pumping ability, a complicated physiological state called congestive heart failure (CHF) can develop. Fluid builds up in the lungs and lower extremities, the heart enlarges, and many symptoms develop, including severe fatigue, difficulty breathing while lying down, and altered brain function.

Medical treatment for this condition is quite effective and sophisticated, consisting of several drugs used in combination.

Principal Proposed Natural Treatments

Note: CHF is too serious a condition for self-treatment. The supervision of a qualified healthcare professional is essential. However, given medical supervision, some of the following treatments may be quite useful. The herb hawthorn appears to be effective for mild CHF and may be helpful for more severe CHF, as well. However, while standard drugs have been shown to help reduce hospitalizations and mortality associated with CHF, there is no similar evidence as yet for hawthorn.

Also, adding the supplement coenzyme Q 10 to standard treatment may improve results. Finally, the supplement vitamin B 1 (thiamin) may be helpful for individuals who take loop diuretics (such as furosemide) for CHF.

At least nine double-blind, placebo-controlled trials, involving a total of about 750 participants have found hawthorn helpful for the treatment of mild to moderate congestive heart failure.53,54

In one of the best of these studies, 209 people with relatively advanced congestive heart failure (technically, New York Heart Association [NYHA] class III) were given either 900 mg or 1,800 mg of standardized hawthorn extract or matching placebo.40 The results after 16 weeks of therapy showed significant improvements in the hawthorn groups as compared to the placebo groups. Benefits in the high-dose hawthorn group included a reduction in subjective symptoms, as well as an increase in exercise capacity. Subjective symptoms improved to about the same extent in the lower-dose hawthorn group, but there was no improvement in exercise capacity.

In an analysis that mathematically combined the results of 10 controlled trials involving 855 patients, hawthorn extract was found to be significantly better than placebo for improving exercise tolerance, decreasing shortness of breath and fatigue, and enhancing the physiologic function of an ailing heart in mild to moderate congestive heart failure 62

In another study, however, researchers found that patients with mild to moderate CHF taking a special extract of hawthorn, 900 mg daily, were more likely to experience an initial worsening of their condition compared to those taking a placebo. But, by the end of six months, there was no difference in the two groups. In light of numerous other studies supporting the safety and effectiveness of hawthorn in CHF, the results of this special extract study need to be repeated before drawing any firm conclusions.64

A comparative study suggests that hawthorn extract (900 mg) is about as effective as a low dose of the conventional drug captopril.12 However, while captopril and other standard drugs in the same family have been shown to help reduce hospitalizations and mortality associated with CHF, there is no similar evidence for hawthorn.

Like other treatments used for CHF, hawthorn improves the heart's pumping ability. However, it may offer some important advantages over certain conventional drugs used for this condition.

Digoxin, as well as other medications that increase the power of the heart, also make the heart more susceptible to dangerous irregularities of rhythm. In contrast, preliminary evidence indicates that hawthorn may have the unusual property of both strengthening the heart and stabilizing it against arrhythmias.6-8 It is thought to do so by lengthening what is called the refractory period. This term refers to the short period following a heartbeat during which the heart cannot beat again. Many irregularities of heart rhythm begin with an early beat. Digoxin shortens the refractory period, making such a premature beat more likely, while hawthorn seems to protect against such potentially dangerous breaks in the heart's even rhythm.

Another advantage of hawthorn involves toxicity. With digoxin, the difference between the proper dosage and the toxic dosage is dangerously small. Hawthorn has an enormous range of safe dosing.9

However, keep in mind that digoxin is itself an outdated drug. There are a great many newer drugs for CHF (such as ACE inhibitors) that are much more effective than digoxin. Many of these have been proven to prolong life in people with severe CHF. There is as yet no reliable evidence that hawthorn offers the same benefit. (Although, one large study found tantalizing hints that it might.)61

It is not clear whether one can safely combine hawthorn with other drugs that affect the heart.

For more information, including dosage and safety issues, see the full Hawthorn article.

People with CHF have significantly lower levels of CoQ 10 in heart muscle cells than healthy people.42 This fact alone does not prove that CoQ 10 supplements will help CHF; however, it prompted medical researchers to try using this supplement as a treatment for heart failure.

In the largest study, 641 individuals with moderate to severe CHF were monitored for 1 year.2 Half were given 2 mg/kg of body weight of CoQ 10 daily; the rest were given placebo. Standard therapy was continued in both groups. The participants treated with CoQ 10 experienced a significant reduction in the severity of their symptoms. No such improvement was seen in the placebo group. The people who took CoQ 10 also had significantly fewer hospitalizations for heart failure.

Similarly positive results were also seen in other double-blind studies involving a total of more than 270 participants.37-38,58

However, two recent and very well-designed double-blind studies enrolling a total of about 85 individuals with CHF failed to find any evidence of benefit.3,41 The reason for this discrepancy is not clear.

For more information, including dosage and safety issues, see the full CoQ10 article.

Evidence suggests that the strong diuretics (technically, loop diuretics such as furosemide) commonly used to treat CHF may interfere with the body’s metabolism of vitamin B 1 (thiamin).14,43,44

Since the heart depends on vitamin B 1 for proper function, this finding suggests that taking a supplement may be advisable; in fact, preliminary evidence suggests that thiamin supplementation may indeed improve heart function in individuals with CHF.15,45,46

For more information, including dosage and safety issues, see the full Vitamin B1 article.

Other Proposed Natural Treatments

A large Italian trial involving almost 7,000 subjects found that fish oil may modestly reduce the risk of death or admission to the hospital for cardiovascular reasons in patients suffering from congestive heart failure.67 And, a smaller study involving 138 patients showed similarly beneficial results.68

Several studies (primarily by one research group) suggest that the amino acid taurine may be useful in CHF 16-22 and could be more effective than CoQ 10.23

Another treatment for CHF that has some evidence is the expensive supplement L-carnitine, especially when given in the special form called propionyl-L-carnitine.24-28 Carnitine is frequently combined with CoQ 10.

Three small, double-blind studies enrolling a total of about 70 individuals with CHF found that the supplement arginine significantly improved symptoms of CHF, as well as objective measurements of heart function.29-31

Evidence suggests that the sports supplement creatine may offer some help for the fatigue and shortness of breath that often accompanies CHF.32-34,71

One small double-blind study found preliminary evidence that the supplement ribose may improve CHF symptoms.55

Combination therapy with several of the supplements mentioned above may also be helpful. A double-blind trial of 41 individuals found that use of a supplement containing taurine, CoQ 10, creatine, and carnitine, as well as other nutrients, improved objective measures of heart function.47

A study performed in China reported that berberine (a constituent of various herbs, including goldenseal and Oregon grape) can decrease mortality and increase quality of life in CHF.56

There is some evidence that supplementing with magnesium may be helpful for individuals taking both digoxin and diuretics; diuretics can deplete the body of magnesium and this in turn may increase risk of digoxin side effects.48-52 One study found that use of magnesium (as magnesium orotate) may improve exercise capacity and reduce heart arrhythmias in people with CHF who have just undergone bypass graft surgery.57 Additionally, in a well-designed trial involving 79 patients with severe congestive heart failure, magnesium orotate significantly improved survival and clinical symptoms after one year compared to a placebo.63

In addition, it is important to pay attention to all the general considerations that bring health to the heart, such as those described in the article on Atherosclerosis.

Weak evidence suggests that relaxation therapy (specifically Transcendental Meditation)60 and yoga 66 may improve functional capacity and quality of life in people with congestive heart failure. Tai Chi, a Chinese martial art focusing on rhythmically gentle movements, may also be beneficial in improving the quality of life in people with congestive heart failure.65,69,70

Vitamin E has been proposed as a treatment for CHF, but a small, double-blind study did not find it effective.35

Herbs and Supplements to Use Only With Caution

One study found hints that supplementation with vitamin C at a dose of 4 g daily might worsen muscle function in people with congestive heart failure.59

Various other herbs and supplements may interact adversely with drugs used to treat congestive heart failure. For more information on these potential risks, see the individual drug article in the Drug Interactions section of this database.