Dietary supplements cover a wide range of products, including vitamins, herbs, and minerals, many of which may be beneficial to your health. However, some supplements may not be safe if you are living with obstructive hypertrophic cardiomyopathy (oHCM).
“Many people assume that if something is ‘natural,’ it must be safe,” says Mariko Harper, MD, medical director of the Hypertrophic Cardiomyopathy Center at Virginia Mason Franciscan Health in Seattle. “But supplements can affect heart rate, blood pressure, hydration, and rhythm stability.”
Supplements can also change the way certain medications work, potentially reducing their effectiveness or increasing the risk of side effects.
“For individuals with health conditions like HCM, it’s important to talk with your doctor before continuing or starting any supplements,” says Azmey Matarieh, MD, a cardiologist at Advocate Health in Elgin, Illinois. “Many of these products can interact with medications you need to take to manage the condition.”
Here are seven supplements that can be risky when you have oHCM.
1. Caffeine Pills
Many people reach for a cup of strong black coffee to start their day. And no wonder, coffee is a rich source of caffeine, a stimulant that can help you feel more alert and awake. An 8-ounce cup of coffee contains about 100 milligrams (mg) of caffeine.
Caffeine isn’t inherently bad for you: The U.S. Food and Drug Administration has cited 400 mg per day as a safe amount for most adults (not typically linked to any negative side effects). Depending on the size of your coffee cup and the type of coffee bean used, that’s anywhere from about two to four cups of coffee.
You can also get caffeine in supplement form. While the amount of caffeine in supplements varies, many caffeine pills contain 100 or 200 mg of caffeine.
Too much caffeine can be a problem for anyone, making you anxious and jittery and interfering with your sleep. But people with heart issues need to be especially careful. “Excess caffeine can strain the cardiovascular system, causing it to work harder, elevating heart rate, and increasing blood pressure,” says Dr. Matarieh.
Some people with HCM can have caffeine in moderation, but others have to avoid it entirely. With oHCM, caffeine can worsen the obstruction and cause more symptoms. Caffeine pills are riskier than coffee, as they give you a large concentrated dose all at one time.
2. Pre-Workouts
Pre-workout supplements come in pills, powders, and gummies, and they are designed to enhance a workout. You use them right before an exercise routine, with the goal of increasing your energy, strength, and endurance. While the ingredients vary among products, they typically contain stimulants (mainly caffeine), amino acids, vitamins, electrolytes, and creatine.
Dr. Harper cautions patients with oHCM about using these products. “Supplements containing caffeine concentrates, guarana, bitter orange, yohimbine, or ‘pre-workout’ shots or drinks can raise heart rate and blood pressure and may increase the risk of palpitations or arrhythmias,” she says.
3. Ginkgo Biloba
Ginkgo biloba is a popular herbal supplement that’s promoted as being beneficial for a variety of health conditions, including anxiety, heart disease, cognitive impairment and dementia, and diabetes. Studies have shown that in moderate amounts, ginkgo leaf extracts are generally safe for most adults.
But when you have HCM, you need to be cautious with this supplement because it can raise blood pressure, says Cynthia Kos, DO, a cardiologist with the Advanced Heart Failure Center at Hackensack Meridian Health’s Jersey Shore University Medical Center in Neptune, New Jersey. “It may also interact with blood-thinning medications,” she says.
Many people with heart conditions need to take anticoagulants, or blood thinners, to prevent blood clots. Ginkgo may increase the risk of bleeding if you are taking these drugs. It can also interact with other types of medications.
4. Calcium
“Calcium is an essential part of our diet, but too much calcium for those with HCM can be dangerous,” says Matarieh. “Calcium supplements can contribute to the buildup of arterial deposits, making it more difficult for blood to adequately flow and heightening the risk of cardiovascular events.”
A study that analyzed the results of 13 randomized controlled trials (the gold standard for research) that involved almost 30,000 people found that calcium supplements significantly increased the risk of both cardiovascular disease and coronary heart disease. The effect was particularly pronounced in healthy postmenopausal women.
Calcium supplements are definitely something to discuss with your doctor, especially if you’re at a higher risk of developing osteoporosis. They can help preserve bone health if you don’t get enough calcium in your diet.
5. Vitamin E
Vitamin E is an essential nutrient that your body needs for optimal health. It helps boost your immune system, protects eye health, and may help lower cancer risk.
But the information regarding its role in heart health can be a little confusing. Is it beneficial or not? The answer depends on whether it comes from diet or supplements.
An analysis of health and nutrition data from almost 40,000 people found that those who got higher amounts of vitamin E from their diets had a lower risk of cardiovascular disease and death from all causes. But on the flip side, vitamin E from supplements can increase the risk of heart failure and stroke in some people.
The U.S. Preventive Services Task Force, a panel of experts that makes recommendations about wellness and disease prevention, recommends against using vitamin E to prevent cardiovascular disease. That’s based on two clinical trials that showed supplements were associated with an increased risk of hemorrhagic stroke.
“A healthy dose of vitamin E comes from eating things like fruits, vegetables, nuts, and fish,” says Matarieh. “Vitamin E supplements can thin the blood and interact negatively with certain medications, including cholesterol medicines.”
6. St. John’s Wort
St. John’s wort is a flowering plant that has been used for thousands of years in traditional health practices, including Greek, Islamic, and Chinese medicine. Studies show that it may be helpful for mild or moderate depressive symptoms, hot flashes associated with menopause, and somatic symptom disorder (a condition involving intense anxiety about physical symptoms).
But St. John’s wort doesn’t mix well with several drugs that people might take for oHCM. “This herbal remedy is known to interact with many medications, including those commonly prescribed for heart conditions like anticoagulants, beta-blockers, and calcium channel blockers,” says Dr. Kos. “These interactions can reduce the effectiveness of the prescribed drugs.”
7. Licorice Root
Licorice also has a long history of use in traditional medicines. Its use dates back to ancient Assyrian, Egyptian, Greek, Arab, Chinese, Tibetan, and Indian cultures. Currently, it’s mainly promoted for digestive, respiratory, and energy support.
While it is generally considered safe, it may not be a good choice for people with heart conditions. “This supplement can have an impact on heart function and blood pressure,” says Kos.
A component of licorice called glycyrrhizin, or glycyrrhizic acid, can cause irregular heartbeat and cardiac arrest, particularly if you have large amounts over a long period of time. Small amounts of glycyrrhizin have also been linked to severe adverse effects in people who eat a lot of salt or who have heart or kidney conditions.
