How Heart Failure Happens. A Nutrition and Lifestyle Intervention.

Heart failure effects 5.8 million people in the United States and increases with age, despite the scientific progress over the past decade. It's one of the most common reasons people aged 65 and over are hospitalized (1). 

What is Heart Failure?

Your heart is a muscle that circulates about 2,000 gallons of blood throughout the body every day. As you can imagine, healthy expansion and contraction of the heart's four chambers is really important! Heart failure happens when the heart isn't able to pump enough blood throughout the body. This inability to pump blood effectively happens in one of two ways: the heart muscle becomes stiff or the heart muscle becomes weaker. 

3 Major Reasons for Heart Failure  

1. High Blood Pressure (Hypertension)

High blood pressure is a major risk factor for heart failure because it means your heart has to work harder to push blood around your body. It also means the force pushing on the walls of your arteries as blood moves through them is too strong. That pressure hurts your arteries and causes tiny tears in them that can turn into scar tissue. Scar tissue causes your vessels to narrow and stiffen, impeding blood flow and causing your heart to work harder. To cope with this extra effort, your heart thickens, and becomes stiffer and larger, which interferes with its ability to do its job (2).

2. Diabetes

Diabetes and heart failure are closely related, even if you don't have any other risk factors. People with diabetes have an increased risk of developing heart failure and vice versa: those wtih heart failure are at higher risk of developing diabetes. According to one large study, each percentage point increase in hemoglobin A1C is associated with approximately a 30% increase in heart failure risk (3).

The link between diabetes and heart failure is complex and multifactorial, but here are a few major reasons.

  • An abnormal amount of lipids in the blood: the blood of someone with diabetes is more likely to be high in triglycerides, lower in "good" HDL cholesterol, and higher in small, dense LDL particles which are more dangerous than large LDL particles because they more easily penetrate the arterial wall, and they're more susceptible to oxidation (4). This increase in fats in the blood reduced utilization of glucose as a source of energy during stress, and effects blood supply to the heart muscle.
  • Accelerated formation of fatty plaques in the arteries: this can result in an inadequate delivery of oxygen and nutrients to body tissues, which can cause organ system failure over time (5).
  • A decrease in nitric oxide: nitric oxide is an important vasodilator, meaning it expands your blood vessels, which decreases blood pressure. Diabetics have been found to have decreased bioavailability of nitric oxide, as well as increased secretion of the vasoconstrictor endothelin-1. This resulting state of vasoconstriction has been found in people with diabetes and well as those with metabolic syndrome. Diabetes decreases nitric oxide availability because of either insulin deficiency or defective insulin signaling (insulin resistance) in endothelial cells. High blood sugar levels also acutely inhibits the production of nitric oxide in arterial endothelial cells (4).
  • Inflammation: diabetes has long been considered a state of chronic, low-level inflammation, and may be the factor that initially increases cardiovascular risk in heart failure (4).

3. Metabolic Syndrome (aka: insulin resistance)

Insulin resistance happens when the body needs extra insulin to maintain normal blood sugar levels. When glucose enters the bloodstream, insulin is released which normally tells the liver to stop sending glucose into the bloodstream, and helps pull the glucose from the bloodstream into the body's fat and muscle tissues to use for energy. Insulin resistance damages both these processes so the liver may produce too much glucose or the body's fat and muscle tissues can't access the glucose from the bloodstream efficiently. Any degree of insulin resistance increases a person' risk of heart disease.

Ultimate Goals for Reversing Heart Failure

So now that we know the three major causes of heart failure, how does a person either prevent it from happening in the first place or support the heart failure condition so it doesn't worsen?

1. Improve vasodilation.

2. Improve mitochondrial health and ATP synthesis within the mitochondria. By doing this, there are more ATP available to the heart, which is the only way the heart can generate energy.

Inflammation and Heart Failure

We all know what happens when we cut ourselves = our skin thickens and the healing process forms a scar. But what about internal scarring due to inflammation? The body reacts in the same way it does when we cut ourselves – by forming excess tissue. This internal scarring process is called fibrosis, which can stiffen tissue and damage organs, especially the heart. Fibrosis of the heart can eventually lead to heart failure which means the heart isn’t able to efficiently pump blood and oxygen through your body. The heart compensates by beating faster which causes itself to wear out quicker than normal.

Signs and Symptoms of Heart Failure & Why They Happen

Water retention (edema) in legs, ankles and feet Why? As the blood flow out of the heart slows down, blood returning to the heart through the veins backs up, causing fluid to build up in the tissues. Also, the kidneys are less able to dispose of sodium and water, which causes fluid retention in the tissues (6).

Shortness of breath Why? Blood “backs up” in the pulmonary veins (the vessels that return blood from the lungs to the heart) because the heart can’t keep up with the supply. This causes fluid to leak into the lungs.

Fatigue and weakness | Reduced ability to exercise Why? The heart can’t pump enough blood to meet the needs of body tissues (a decline in cardiac energy). The body diverts blood away from less vital organs, particularly muscles in the limbs, and sends it to the heart and brain.

Rapid or irregular heartbeat Why? The heart beats faster to “make up for” the loss in pumping capacity.

Persistent coughing or wheezing that produces white or pink blood-tinged mucus Why? Fluid builds up in the lungs.

Important Labs Related To Heart Failure

Testing for heart failure isn’t as simple as measuring cholesterol or another blood test. However, there’s one test worth mentioning, but many docs don’t run it because insurance likely doesn’t pay for it, and it’s expensive (around $300 or $90 out of pocket): Galectin-3.


Galectin-3 is has a very high predictive value in terms of short- and long-term prognosis of heart failure (7). This β-galactoside-binding protein is involved in fibrosis (tissue scarring) and inflammation, and levels significantly increase in chronic heart failure (acute or non-acute onset), independent of etiology. Its main action is to bind to and activate the fibroblasts that form collagen and scar tissue, leading to progressive cardiac fibrosis (8). Internal scarring (fibrosis) stiffens tissues and organs, especially the heart. This impedes the heart’s ability to pump blood efficiently and compensates by pumping faster, which can wear the heart out.


A test your doctor needs to order. It measures the efficiency of the left ventricle, which is the part of the heart that pumps oxygenated blood to the rest of the body – it’s called the ejection fraction. Normal ejection fraction in a healthy person is 55 to 65%.

Supplements to Improve Cardiac Energy

These supplement choices keep in mind that ATP synthesis is the ultimate goal. ATP is the energy currency in the cell -- it’s how cells get their energy and this is how cardiac energy is increased.


  • It supports the mitochondria by improving fat burning as a source of energy for cardiac cells. It transports fats across the mitochondrial membrane.
  • It reduces oxygen requirements in a low oxygen state, such as traveling to a high altitude or hypoxia from reduced coronary circulation. This ultimately ends up reducing the negative effects of a low oxygen state on the heart muscle. How? By partly improving metabolic efficiency – making more oxygen available.
  • It improves oxygen utilization.
  • Doses of 1,000-4,000 mg/day have been utilized to support healthy heart function.


  • Must be one of the most bioavailable forms of magnesium.
  • Bioavailable forms of magnesium include: Amino acid chelates, Glycinate, Malate, Citrate, Aspartate, Orotate, Chloride, Taurate. Side note: Sulfate and oxide are not bioavailable enough. Magnesium threonate is great, but save it for brain health. 
  • Magnesium supports the mitochondria by improving the production of cardiac energy (ATP).
  • Magnesium supports healthy heart rhythm. It’s an electrolyte, which supports muscle contraction and relaxation. The #1 most important mineral for heart function.
  • Magnesium reduces cardiac stress, particularly from cortisol and adrenaline.
  • Dose: elemental magnesium at 250 to 600 mg/day, in divided doses, are typical. Be aware: too much magnesium taken at one time can cause loose stools or diarrhea.

CoQ10 (Ubiquinol vs. Ubiquinone)

  • Directly improves mitochondrial function.
  • CoQ10 helps provide energy to the cells, especially the cardiac cells. Ultimately, CoQ10 helps support optimal energy production.
  • It has antioxidant properties so reduces oxidative damage.
  • Improves ventricular function (the amount of blood the heart pushes out with a single beat).
  • CoQ10 is naturally occurring in the body.
  • Both -nol and -one are active in the body, but ubiquinol is utilized about 8x better. It’s also fat soluble, so to receive the full benefit, it must be consumed with some fat to be fully absorbed.
  • Recommended doses range from 200 to 600 mg/day of ubiquinone and 100 to 300 mg/day of ubiquinol for general heart health.


  • Creatine’s major function is to increase ATP production in the mitochondria, which increases energy production in the heart.
  • Dose: 5 to 10 grams/day, in divided doses, with or without food.


  • A 5-carbon sugar the heart uses to make ATP.
  • When the heart is under stress, it doesn’t produce enough ribose to maintain itself.
  • The body makes ribose through the same pathway as many other pentose molecules (pentose phosphate pathway). Once ribose is made, the mitochondria take it and directly produce ATP from it. The extra ATP allows the heart to become more efficient.
  • If the heart begins to fail (ejection fraction drops), it needs more ATP, but because its failing it can’t make more. Ribose is what’s needed to break that cycle to allow more ATP to be made.
  • Note: even though ribose is a sugar, it doesn’t raise blood sugar levels.
  • Dose: 5 grams, taken 2-3x/day, with or without food. You can even mix it with a smoothie.
  • Ribose normally comes in powder form because the dose is too high to come in a capsule form.


  • Helps reduce the amount of stress on the heart and circulatory system.
  • It reduces the negative effect of adrenaline and cortisol.
  • It can stabilize the heart rhythm.
  • It helps to hold magnesium and potassium inside the heart cell where you want it.
  • Dose: 1 to 4 grams/day, often taken at bedtime because it can cause grogginess during the day.

Foods that Support Cardiac Energy

  • Vegetables, especially green leafy vegetables. Aim for 3 cups per day.
  • Foods high in natural nitrates, which improve vasodilation (aka: circulation). This is important!
    • Beet greens, beets, kale, broccoli, spinach, grasses (barley grass juice, wheat grass juice & other grass juices), and any other green leafy vegetable you can get your hands on.
  • Foods high in Vitamin C support healthy heart function
    • Acerola cherry, citrus fruits (no grapefruit at all if taking statin drugs), apples, berries, baobab powder, camu camu
    • Side note: Grapefruit affects the P450 detox system in the liver, which is the same pathway the statin drugs get detoxified. The backup can cause the statin to become more toxic to the liver.
  • B-complex
  • Vitamin E: alpha and gamma tocopherols and the tocotrienols, particularly delta tocotrienol because it can reverse plaquing in the arteries
    • Tocotrienols should be taken within 6 hours of the tocopherols. Take one in the AM and one in the PM. Take with fat.
  • Vitamin K2 takes calcium off the artery walls
  • Eat healthy fats
    • Omega-3 fats (sardines, salmon, wild caught ocean fish)
    • Omega-9 fats (olive oil, olives, avocado oil, avocados, raw seeds and nuts)
  • Eat adequate complete protein to maintain muscle, bone and organ weight.
    • Lean meats, chicken and other fowl, eggs, seafood, dairy proteins
    • Choose organic, antibiotic free, free-range, grass-fed, no soy, no corn

 How to Improve Cardiac Energy via Non-Food Related Means

  • Exercise to tolerance and no further. You don’t want to overstress the heart.
  • Anything that reduces stress is going to help (ie: meditation, deep breathing, yoga, relaxation techniques). Really focus on things that lower excess stress hormones, such as cortisol and adrenaline.
  • In a pinch, I love this easy 1-minute meditation practice.
  • Sleeping 8-10 hours per night.

Take care of your heart,

Kelly Harrington, MS, RDN
Registered Dietitian Nutritionist for Healthy Goods
1. National Heart Lung and Blood Institute. People Science Health. What is heart failure?
3. Nichols et al. The Incidence of Congestive Heart Failure in Type 2 Diabetes. Diabetes Care 2004 Aug; 27(8): 1879-1884.
5. Rosano GM, Vitale C, Fragasso G. Metabolic therapy for patients with diabetes mellitus and coronary artery disease. Am J Cardiol. 2006;98(5A):14J–18J. 
7. McCollough PA et al. Galectin-3: a novel blood test for the evaluation and management of patients with heart failure. Rev Cardiovasc Med. 2011; 12(4):200-10.
8. Hrynchyshyn N et al. Galectin-3: a new biomarker for the diagnosis, analysis and prognosis of acute and chronic heart failure. Arch Cardiovasc Dis. 2013 Oct; 106(10):541-6.


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