Last year I wrote a post on how to control cortisol, sleep better, and heal. With Christmas still just in the past enough to remember all the unhealthy eating you did to prompt a coronary, I figured it’s time to revisit workout nutrition and discuss the importance of heart health and what you can do to up your chances of keeping your heart in prime condition.

I’ll definitely be making this into a podcast episode because I think it’s important everyone understands just how important heart health is. Let’s get started.

Workout Nutrition DIY: Heart Health [5 Things to Improve].

I think it’s safe to say most of us would like to avoid all heart related ailments throughout our lives. What we have to remember though, is that in order to dodge the bullet, the work has to be put in. For instance in both SUPP UP. nutrition guides (have you bought the paperbacks or digital version yet?), I mentioned the importance of fats and the key role they play when it comes to the heart; here’s an excerpt from one of the nutrition guides:

“Where glucose is the brain’s only source of fuel, the heart gets 60% of its energy from fat. Let that sink in for a moment for the low-fat diet cardio queens and kings reading this (told you this wasn’t a diet book). That percentage alone tells you just how much pull fats have at your body’s annual executive board meeting where your organs determine if you get to live another year.”

But let’s say you’re getting the whole food nutrition you need when it comes to heart health, and want to make sure you’ve covered ALL your bases – you know, in case you’re missing something. After all, any doctor worth their salt will agree heart disease is one of inflammation.

This is where, when used correctly, supplementation comes into play. While supplements aren’t guaranteed to keep you healthy, and while I always say in all of the guides that whole food should be the focus, supplements can sometimes feel like a little insurance policy in your pantry or medicine cabinet – better to have it and not need it, than need it and not have it. The key is making sure they’re quality, not bunk, and to make sure they’re an addition – not a replacement.

Nutrition and fitness are one of the many pieces that form part of the puzzle. When it comes to heart health, there’s no harm in making sure the puzzle is as complete as possible. Let’s run through some of the things that can mess with heart health, and what you can supplement with to keep things in check. Read the post all the way to the end and I’ll wrap things up with a neat and tidy summary of what to take, how much, and how often.

1. LIPID PROFILES

Let’s talk about lipid profiles and niacin. Also known as B3, niacin is one of the forgotten supplements when it comes to heart health. I covered Niacin in the ‘Vitamins’ chapter of the nutrition guides, providing over 10 different foods you can get niacin from (chicken breasts being one of them), and for good reason. Do a little research and you’ll find a paper from Superko et al (2017), which states that niacin beneficially affects the lipid profile (i.e. lowering of cholesterol) and and could hold its own against statins – but with zero adverse side effects (you can check out the paper for yourself under ‘References’ at the end of this post).

If that isn’t enough, niacin can also fight lipotprotein(a) or abbreviated, Lp(a), a virtually overlooked lipoprotein that doctors rarely test for but is thought to triple the chance of having a heart attack in early age. Doctors usually run tests for lipoproteins like HDL and LDL cholesterol (something I talk about in the guides), but very few are aware of lipoprotein(a), even though high levels can be found in 1 out of every 4 or 5 men and women. Made by the liver, lipoprotein(a)’s job is to carry fats around the body in the blood, but too much of it can increase the risk of heart disease. It’s ‘sticky’ causing buildup/clogging in your arteries.

It gets a little worse – food intake and exercise have nearly zero effect on keeping Lp(a) in check, meaning it may be the reason why some people who exercise regularly, eat healthy, and have good cholesterol, overall being pretty healthy, unexpectedly kick the bucket despite having bragging rights to how they’re in such good shape. This is where niacin comes into play.

Not only does niacin combat Lp(a), it also lowers LDL (“bad” cholesterol) while increasing HDL (“good” cholesterol). It’s effective on atherogenic dyslipidemia (a part of metabolic syndrome), similar to how statins are, but unlike statins, niacine doesn’t have potential side effects (to name a few, liver and muscle damage, muscle pain, increased blood sugar, and neurological side effects).

If that’s not enough of a reason to consider adding niacin to your tackle box (if you aren’t getting enough through whole foods), I’ll give you one more. Niacin helps cardiovascular health by increasing nitric oxide synthase (NOS), a family of enzymes that relax blood vessels and causes them to pop open, causing increased blood flow. Better blood flow = better heart health.

2. CLOT FORMATION

Another important thing to consider is clot formation. A serious and common condition, clot formation is a predicate of stroke, heart disease, and embolisms. It’s one of the key reasons people with heart issues or those who wish to avoid having heart issues take prescribed blood thinners or acetylsalicylic acid (aspirin).

Queue nattokinase, an enzyme derived from natto. If you’ve visited or lived in Japan, you might have encountered natto – either deliberately or as a cruel joke from friends. Slimy with a distinctive smell and an acquired taste, natto is Japanese fermented soybeans. While most Westerners can’t hack the taste and texture (I came, I tried, I failed), natto has been a staple and traditional Japanese food for over 2,000 years.

Only in 1987 however, did researchers uncover that natto had a powerful enzyme that prevented clot formation, and so the enzyme was dubbed nattokinase. Since ’87, small but solid research have reconfirmed that discovery, in addition to realizing nattokinase also has anti-atherosclerotic, antihypertensive, and antithrombotic properties.

Nattokinase eliminates clots through several means, the first one being a rise in Tissue Plasminagen Activator (TPA), a powerful clot eliminator often given to stroke or heart patients in the ER at hospitals. Nattokinase also boosts the creation of urokinase, an agent which dissolves clots, and stunts PAI-1, a serine-protease inhibitor which plays a role in clotting.

Atherosclerosis is the main cause of stroke and heart disease – blood vessels clog with inorganic and organic deposits. Nattokinase seems to flush these deposits out, like drain gel in a kitchen pipe. While the mechanistic details of nattokinase’s anti-atherosclerotic effects are unknown, they’re thought to be from a mix of nattokinase’s anticoagulant, antioxidant, antithrombotic, and lipid-lowering characteristics.

Nattokinase has other benefits too, including thinning the blood (without possible side effects), lowering blood pressure, and may also inhibit angiotensin 1-converting enzyme. Let’s run through each.

For blood thinning, studies show nattokinase can be taken like aspirin and perform equally or better to the task without the side effects. This also means it can be a good alternative to those allergic to NSAIDs but who still want to prevent stroke, heart attack, and atherosclerotic ailments. And no – more isn’t better. I wouldn’t recommend taking nattokinase with aspirin.

For blood pressure, a randomized, double-blind study conducted by Kim et al (2008) revealed that taking nattokinase as a supplement for 8 weeks reduced systolic and diastolic blood pressure by 5.55 and 2.84 mm of mercury, respectively.

Last but certainly not least, nattokinase can also potentially hamper angiotensin 1-converting enzyme, which narrows your blood vessels, allowing blood to more easily flow with greater force.

3. CALCIUM REGULATION

Let’s talk about calcium for a minute (pop quiz: see if you can remember what food from the guides provide a bigger boost of calcium than milk). Calcium is great for bones and teeth, and like I mentioned in the SUPP UP. Nutrition guides, it helps you sleep. Most importantly, it also helps sustain heart rhythms…but it has a flip side. Calcium can have a tendency to build around heart valves and on the insides of arteries. This means the calcium that takes a detour from its main objective starts accumulating on the inside of blood vessels and over time, hampering blood flow like bottleneck traffic at peak rush hour.

This is where vitamin K2 comes in. It gets calcium regulation back on track by triggering matrix Gla protein – an anti-calcific protein. When dormant, matrix Gla protein is known for vascular and valvular calcification, stiffness of the arteries, and insulin resistance – key contributors to the possibility of pre-mature heart failure.

Using K2 can help mitigate these issues because it keeps things flowing, fluid, and supple. Interesting fact: using statins has a tendency to hamper your body’s ability to absorb vitamin K2 – so even though statins help lower cholesterol, they can simultaneously cause calcium to build up in your heart and arteries. Not a good trade off in my opinion.

4. HEART ENERGY AND VITALITY

If you’ve ever tried TCM (traditional chinese medicine) involving tea pills, custom tea mixtures, or acupuncture, you’re bound to have heard on at least one occasion talk of heart energy and vitality come up in relation to Qi/Chi. For those of you that don’t believe in TCM, I’ll Westernize it for you with some “Western” science.

When the heart beats, it releases calcium ions from a part of the muscle cells called the sarcoplasmic reticulum. To make the heart muscles contract, energy is needed, which is supplied by the mitochondria with the help of CoQ10. Having enough CoQ10 in the body would then presumably lead to a more energetic, active heart. This is where CoQ10 could have a more important role than what it’s usually known for, which most doctors assume is primarily as an antioxidant.

To digress slightly, supplementation with CoQ10 is usually seen by doctors as a way to prevent oxidative stress and inflammatory cytokines that can lead to hypertrophy of the heart, issues which weaken the heart’s ability to pump blood effectively.

But beyond that, CoQ10 could also help influence the heart’s energy and vitality if we think of the role it plays in relation to contraction of the heart muscles. Research also shows some evidence that CoQ10 has the ability to regulate the creation of nitric oxide, effectively blowing open blood vessels, allowing for more oxygen-rich blood to go to and feed cells, in particular heart cells.

CoQ10 is also called ubiquinone, and a coenzyme – or put more simply, a helper molecule made inside the inner membranes of your mitochondria. It’s present in all organs, but the biggest amounts are found in the heart, liver, kidneys, and muscles. 3 out of 4 patients with heart disease tend to have low levels of CoQ10.

Some examples include those with ischemic heart disease (a condition of decreased blood flow) – in these patients, CoQ10 levels are much lower than in someone who’s healthy. Additionally, contingent on the severity of heart damage, moving levels of CoQ10 amounts decrease in direct ratio to the development of heart disease. Ironically, like K2, statin use can restrict CoQ10 uptake from food by as much as 40%. This effect could obviously, be detrimental to the heart’s functioning, particularly in those with heart failure. This is why it’s recommended to supplement with CoQ10 alongside statin use.

One interesting discovery, at least in studies with rats, was that injecting CoQ10 into the bloodstream within 10 minutes of a blockage in a coronary artery led to several positive effects. These included a smaller area of heart cell death, less enlargement of the left ventricle after a heart attack (death of tissue resulting from reduced blood supply), a higher amount of blood pumped with each heartbeat (stroke volume), improved overall blood flow from the heart (cardiac output), a better ejection fraction (how much blood the heart squeezes out), and increased strength of the heart’s contractions. If that’s not enough, CoQ10 might also help cells use oxygen more efficiently.

5. INFLAMMATION

Over the years I’ve talked a lot about inflammation in the SUPP UP. blog and in the SUPP UP. nutrition guides, and one thing I agree with heart doctors on is that diseases of the heart are largely inflammation related. Don’t get me wrong – there’s various problems that contribute to heart disease like plaque and calcium buildup, thickening of the heart’s ventricles, and blood vessels stiffening. Regardless, all of these issues are either caused or made worse by inflammation.

For example, take athletes, or more specifically, athletes who use steroids. They’re at risk of a process called left ventricular remodeling, which is a fancy way of saying their heart can become enlarged – a huge factor in heart failure. Being one of the heart’s four chambers, the left ventricle is located at the bottom left side of the heart. It receives oxygen-rich blood from the left atrium (directly above it) and pumps it out to the rest of the body. Because of its role, the left ventricle is also the strongest and most muscular chamber of the heart.

Sadly, as people get older in addition to other factors, this ventricle can become thicker and change shape (the remodeling process I mentioned earlier). This can reduce the ventricle’s ability to eject blood effectively, meaning it pumps out less blood with each beat. You’d think having a thicker or more muscular heart would be better, but in this case it’s the opposite.

When the left ventricle gets too thick, it loses pliability (which is why I stress muscle pliability is key as you age) and is less capable of moving the right amount of blood needed through the arteries efficiently.

This is where inflammation tips things over the edge. Many cytokines that promote inflammation are directly involved in thickening the left heart ventricle. These culprits include interferon gamma, tumor necrosis factor, interleukin-1beta, and interleukins 6, 17, and 18.

This is why I say DHA aka fish oil is so important (one of my go-to breakfast choices are DHA rich breakfast bagels – get the recipe here). Fish oil grinds this process to a halt, preventing or at least improves the changes in the heart’s left ventricle. If that’s not enough, fish oil can alter how the heart’s ion channels function, help blood vessels lining the heart, regulate the activity of the nervous system that controls automatic body functions, and improve the way the heart uses energy. Aside from just making the blood less thick, this also means:

• healthier blood pressure levels.
• less chance of developing arrhythmias aka irregular heart beats.
• less triglycerides (bad fats) in your blood.
• the slowing of plaque buildup, plaque being a combination of bad cholesterol, fat, and calcium, all which harden an obstruct arteries.
• and probably the best benefit, improved body composition. In other words, if you thought your obliques “popped” before, get ready for a pleasant surprise.

BONUS: GLYCATION LEVELS

As a bonus, I’ve decided to throw in some key information about glycation levels. First, you want these lower rather than higher, largely because they affect the pliability and suppleness of blood vessels which is vital to heart health, and this is where magnesium comes in. Healthy levels of magnesium means improved glucose and insulin metabolism, which in turn leads to reduced glycation levels.

Magnesium isn’t just good for regulating glycation levels, it’s also helpful for combating depression.

For those of you who’ve been following the SUPP UP. blog and read the nutrition guides, you’ll remember the insane amount of metabolic processes magnesium is involved in, and going a step further, there’s increasing evidence that lower magnesium levels are linked to a higher risk of heart disease. This is probably because magnesium not only plays a role in metabolic processes but enzymatic reactions as well. These include energy production through ATP, making and repairing DNA, how genes are expressed, nerve and muscle communication, and helping to regulate blood sugar and blood pressure, among other things.

Here’s where a lack of magnesium causes an area of concern – up to 80% of people in the U.S. alone are magnesium deficient. Can you even being to imagine what the rest of the world is like? Since magnesium gets lost through sweat, it’s probably even worse for athletes – because the more you sweat, the more likely it is you’re lacking in magnesium.

This is why I’ve always recommended getting magnesium through two sources – whole food, supplementation, and topically through the skin. For athletes, I’ve always believed it should be a mix of the three and I’ve written the two best types of topical and supplement magnesium to invest in. To source magnesium from whole foods, the SUPP UP. nutrition guides provide a good list of foods you can get it from, one of them being pumpkin seeds (among others).

WHAT TO TAKE, HOW MUCH, AND HOW OFTEN

Most of the things I’ve listed above can be found on iHerb – and no, I don’t make any commission recommending you buy through them nor am I or the SUPP UP. brand affiliated with iHerb. It’s just a solid website with quality products that, as the founder of SUPP UP., I feel comfortable recommending. Since the beginning of SUPP UP., I’ll recommend things based on quality at the time of writing, and if that changes…then the recommendation changes as I write new posts.

Niacin/B3. You can choose either extended or immediate release. Although studies indicate a maximum of 2,000 mg daily for extended-release and 3,000 mg for immediate-release in heart patients on statins, this most likely won’t apply to you. For preventative maintenance, just shoot for one 500 mg capsule (immediate or extended release) twice daily – once with breakfast and once with dinner, to distribute it evenly. While I don’t believe in promoting brand names because quality could change at any time, as I’m writing this, NOW Foods Niacin 500 mg 250 Tablets is a solid option for extended release and immediate release .

People generally dislike immediate-release niacin due to the temporary flushing they experience – kind of like the sensation you get with Beta-Alanine but with a mild fever to top it off. Many prefer extended-release to minimize these effects, though studies suggest immediate-release may be more effective long-term. To reduce or eliminate flushing, take immediate-release niacin immediately after a good heavy meal. For instance, eat your meal and immediately take the supplement at the last bite – do not take on an empty stomach. 

Nattokinase. It’s a good idea to split the dose here. Shoot for 100 mg capsules three times daily – once with breakfast, then mid-afternoon, and finally before bed. Or, take a single 100 mg capsule once daily after dinner or before bed – earlier is better since blood clots are more likely to form between midnight and early morning. Again, at the time of writing this, NOW Foods Nattokinase 100 mg is a solid choice and you can get it here.

Vitamin K2. Shoot for 600 mcg daily of the combined M4 and M7 sub-types with a fatty meal. NatureWise Vitamin K2 MK-7 & MK-4 Softgels are a good choice and you can get them here.

CoQ10. Shoot for 100 mg per day. With CoQ10 being fat soluble, you’ll want to take it with your fattiest meal of the day to make sure it’s fully absorbed. NOW Foods CoQ10 100mg can be found here.

Omega-3 Fatty Acids (DHA/EPA aka Fish Oil). Like I’ve mentioned in an earlier post, you want fish oil to be in high doses. My earlier post (find it here) provides a full breakdown of where you can get whole food sources for this, but if you need a top-up in addition to that or just really want to dial in on the numbers, you can supplement with DHA and EPA capsules. Shoot for 2 grams maximum of DPA and around 400 mg maximum of EPA per day. Take it just before bed – my earlier post explains why this is important so I won’t repeat it here. NOW Foods does the DHA in 1000 mg (NOW Foods DHA-1000 Fish Oil) and EPA (NOW Foods, Super Omega EPA Fish Oil) that gets close to 400 mg in separate bottles, if you really feel like dialing in and don’t have access to a lot of the fish sources mentioned in my earlier post.

Magnesium. Shoot for 400 mg a day, chelated form for best absorption. I’ve talked about magnesium and the best sources to get it from extensively in blog posts and both SUPP UP. Nutrition guides. My earlier post explains in detail why amount and when to take is important, but it’s mainly because it can be best absorbed and the fact that a lot of magnesium is lost through sweat – which you do a lot of when sleeping at night or working out. It also helps improve sleep quality (you can read about it here). I recommend it through ZMA, but be careful, because there are a LOT of knock-off ZMA formulas that don’t give you the quality magnesium found in the original SNAC version (found on Amazon in the link)…so I always recommend you check the ingredients label to make sure it mentions patent-protected SNAC in there. For my international readers, you can find this version through bulk ZMA.

I’ve said it before and I’ll say it again – do your homework – take care of your body and it’ll take care of you.

That’s all folks.

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References

1. Altura BT et al. (1990). Magnesium dietary intake modulates blood lipid levels and atherogenesis. Proc Natl Acad Sci U.S.A., 87(5), pp. 1840-1844. https://doi.org/10.1073/pnas.87.5.1840

2. Chakraborti S et al. (2002). Protective role of magnesium in cardiovascular diseases: a review. Mol Cell Biochem, 238(1-2), pp. 163-79. https://doi.org/10.1023/A:1019998702946 

3. Chang YY et al. (2008). Cerebellar Hemorrhage Provoked by Combined Use of Nattokinase and Aspirin in a Patient with Cerebral Microbleeds. Intern Med, 47(5), pp. 467-9. https://doi.org/10.2169/internalmedicine.47.0620

4. Chen H et al. (2018). Nattokinase: A Promising Alternative in Prevention and Treatment of Cardiovascular Diseases. Biomark Insights, 13:1177271918785130. https://doi.org/10.1177/1177271918785130 

5. Chen H et al. (2022). Effective management of atherosclerosis progress and hyperlipidemia with nattokinase: A clinical study with 1,062 participants. Front Cardiovasc Med, 9. https://doi.org/10.3389/fcvm.2022.964977

6. Ford E et al. (2003). Dietary Magnesium Intake in a National Sample of U.S. Adults. The Journal of Nutrition. 133(9), pp. 2879-2882. https://doi.org/10.1093/jn/133.9.2879

7. Gallelli G et al. (2021). Data Recorded in Real Life Support the Safety of Nattokinase in Patients with Vascular Diseases. Nutrients, 13(6), 2031. https://doi.org/10.3390/nu13062031 

8. Hodis HN et al. (2021). Nattokinase atherothrombotic prevention study: A randomized controlled trial. Clin Hemorheol Microcirc, 78(4), pp. 339-353. https://doi.org/10.3233/CH-211147 

9. Khalil, Zeyad et al. (2021). The medical benefits of Vitamin K2 on Calcium-Related Orders. Nutrients, 13(2), 691. https://doi.org/10.3390/nu13020691 

10. Kim J et al (2008). Effects of Nattokinase on Blood Pressure: A Randomized, Controlled Trial. Hypertens Res, 31, pp. 1583–1588. https://doi.org/10.1291/hypres.31.1583

11. Liu J et al. (2023). Effect of omega-3 polyunsaturated fatty acids on left ventricular remodeling in chronic heart failure: a systematic review and meta-analysis. British Journal of Nutrition, 129(9), pp. 1500–1509. https://doi.org/10.1017/S0007114521004979

12. Maier JAM. (2003). Low magnesium and atherosclerosis: an evidence-based link. Mol Aspects Med, 24(1-3), pp. 137-46. https://doi.org/10.1016/S0098-2997(02)00095-X 

13. O’Connor A. (2018). A Heart Risk Factor Even Doctors Know Little About. The New York Times. https://www.nytimes.com/2018/01/09/well/heart-risk-doctors-lipoprotein.html

14. Ren NN et al. (2017). A clinical study on the effect of nattokinase on carotid artery atherosclerosis and hyperlipidemia. National Medical Journal of China, 97(26), pp. 2038-2042. https://rs.yiigle.com/cmaid/997930#:~:text=j.issn.0376%2D-,2491.2017.26.005,-7495

15. Shah, N. C. et al. (2014). Short-term magnesium deficiency downregulates telomerase, upregulates neutral sphingomyelinase and induces oxidative DNA damage in cardiovascular tissues: relevance to atherogenesis, cardiovascular diseases and aging. International journal of clinical and experimental medicine, 7(3), pp. 497–514.

16. Shiol A et al. (2020). The Inhibitory Role of Vitamin K in Progression of Vascular Calcification. Nutrients. 12(2), 583. https://doi.org/10.3390/nu12020583 

17. Superko HR et al. (2017). Niacin and heart disease prevention: Engraving its tombstone is a mistake. J Clin Lipidol, 11(6), pp. 1309-1317. https://doi.org/10.1016/j.jacl.2017.08.005 

18. Vlasschaert, Caitlyn, et al. (2020). Vitamin K Supplementation for the prevention of cardiovascular disease: Where is the evidence? A systematic review of controlled trials. Nutrients, 12(10), 2909. https://doi.org/10.3390/nu12102909 

19. Zozina, et al. (2018). Coenzyme Q10 in cardiovascular and metabolic disease: Current state of the problem. Current Cardiology Reviews, 14(3), pp. 164-174. http://dx.doi.org/10.2174/1573403X14666180416115428

Workout Nutrition DIY: Heart Health [5 Things to Improve]. is a post from SUPP UP.

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