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Conditioned Nutritional Requirements: Therapeutic Relevance to Heart Failure

  • Michael J. Sole
  • Kursheed N. Jeejeebhoy
Part of the Progress in Experimental Cardiology book series (PREC, volume 9)

Summary

The advent of disease, genetic predisposition or certain drug therapies may significantly alter the recommended daily intake for specific nutrients published by government agencies and established in healthy people. That is the nutritional demands of a given physiological state or pathological process such as myocardial failure may result in “conditioned nutrient requirements or deficiencies” for the affected organ—in this case the myocardium and perhaps skeletal muscle. Several specific metabolic deficiencies have been found in the failing myocardium: (1) a reduction in l-carnitine, coenzyme Q10, creatine and thiamine—nutrient co-factors important for myocardial energy production; (2) a relative deficiency of taurine, an amino acid integral to intracellular calcium homeostasis; (3) increased myocardial oxidative stress and a reduction of antioxidant defenses. Deficiencies of carnitine or taurine alone are well documented to result in dilated cardiomyopathy in animals and humans. Each of these deficiencies is amenable to restoration through dietary supplementation. A variety of nutrients have been investigated as single therapeutic agents in pharmacological fashion but there has been no broad-based approach to nutritional supplementation in CHF to correct this complex of metabolic abnormalities. We have demonstrated deficiencies in carnitine, taurine and coenzyme Q10 in cardiomyopathic hamster hearts during the late stage of the cardiomyopathy. In another study, we randomized placebo diet against a supplement containing taurine, co-enzyme Q10, carnitine, thiamine, creatine, vitamin E, C and selenium to cardiomyopathic hamsters, during the late stages of the disease. Supplementation for 3 months markedly improved myocyte sarcomeric structure, developed pressure, +dp/dt and—dp/dt measured in a Langendorff apparatus. We also documented in carnitine, taurine and coenzyme Q10 in biopsies taken from human failing hearts, the levels correlating with ventricular function. A double-blind, randomized, placebo-controlled trial of a supplement containing these nutrients, given for 30 days, restored myocardial levels and resulted in a significant decrease in left ventricular end-diastolic volume. These experiments suggest that a comprehensive restoration of adequate myocyte nutrition should be essential to any therapeutic strategy designed to benefit patients suffering from CHE Future studies in this area are of clinical importance.

Key words

dilated cardiomyopathy congestive heart failure nutrition oxidative stress energetics creatine carnitine taurine coenzyme Q10 

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Copyright information

© Springer Science+Business Media New York 2003

Authors and Affiliations

  1. 1.University of TorontoTorontoCanada

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