Almond Supplementation Lowers Uric Acid Levels in Patients with Coronary Artery Disease

  • Almonds (Prunus dulcis, Rosaceae)
  • Coronary Artery Disease
  • Serum Uric Acid

Higher serum levels of uric acid (UA) are increasing in prevalence globally and are associated with coronary artery disease (CAD) and a higher risk of heart attack or stroke in patients with no history of heart disease and stroke. An increase of 1 mg/dL in serum UA has been found to cause a 12% increase in the risk of CAD mortality. Almonds (Prunus dulcis, Rosaceae) are recognized for their lipid-neutralizing effects and may reduce the risk of cardiovascular disease (CVD). A previous study found almond supplementation to prevent hyperuricemia in a CVD rat model. The goal of this randomized controlled trial (RCT) was to evaluate the UA-reducing potential of almond supplementation in patients with CAD.

The study recruited 150 patients with CAD from the Cardiology Clinic, Aga Khan University Hospital; Karachi, Pakistan. Patients who regularly consumed nuts or had nut allergies were excluded. Patients were randomly assigned into 1 of the following 3 groups of 50: no intervention (NI), supplementation with almonds grown in Pakistan (PA), and supplementation with imported American almonds (AA). Patients in the NI group were asked to abstain from consuming any nuts, specifically almonds, while enrolled in the RCT. Those in the PA and AA groups were given 10 g/day almonds and told to prepare them traditionally—soak overnight, peel, and eat before breakfast daily. Patients kept consumption diaries and compliance was monitored in twice-weekly phone calls. At baseline, blood was drawn and body weight, blood pressure (BP), and other measures were taken. Follow-up visits were scheduled at 6 and 12 weeks with the same measurements taken. Patients in the NI group received almonds at the end of the RCT.

Baseline demographics and serum UA were similar in all the groups (P>0.05). Patient weight and BP remained fairly constant in all groups throughout the 12-week study. At week 6, men in the PA group had a 15% reduction in UA, and women had a 12% reduction in UA, compared to the NI group (P<0.05). Men in the AA group had 17% less serum UA, and women 19% less, compared to NI (P<0.05). At week 12, men in the PA group had 17% less serum UA, and women 16% less, than those in the NI group (P<0.05). In the AA group at the end of the study, men had 20% less serum UA, and women 21% less, compared to NI (P<0.05). Compared to baseline, patients in the NI group showed negligible decreases in serum UA, whereas both the PA and AA groups had significant improvement (P<0.05) at both follow-up visits. Men in both active groups had 13% less serum UA at 6 weeks; women in the PA group, 11% less; and women in the AA group, 16% less. At 12 weeks, men in the PA group had improved 16% over baseline and women in the PA group had improved by 14%; and men and women in the AA group had 18% less serum UA than at baseline. This is the first almond intervention study in patients with CAD reporting on UA reduction.

Serum UA may be considered as a marker for vascular function, with anticipated pathways of damage including pro-oxidative and proinflammatory factors among others. Almond supplementation is known to positively affect some of these factors, including a possible reduction in C-reactive protein reported in some studies. Almonds contain L-arginine, a precursor of nitric oxide that has been reported to reduce BP in vivo. In this RCT, almost all patients were taking antihypertensive medications and no effect on BP was seen.

It should be noted that while this study differentiated between Pakistani and American almonds, and those in the AA group showed slightly more improvement than those in the PA group, there is no botanical difference between these almonds. Differences in constituents caused by time of harvest, a method of storage, and different cultivars might be considered in future studies. It should also be noted that the almond skin, discarded by patients in this study, is a rich source of vitamins and minerals, and possibly of other nutrients of interest. Future studies might compare effects of almonds with skins and those that have been peeled.


Jamshed H, Gilani AUH, Sultan FAT, et al. Almond supplementation reduces serum uric acid in coronary artery disease patients: a randomized controlled trial. Nutr J. August 19, 2016;15:77. doi: 10.1186/s12937-016-0195-4.


Doctors Should Discuss Herbal Medication Use with Heart Disease Patients

Physicians should be well-versed in the herbal medications heart disease patients may take to be able to effectively discuss their clinical implications, potential benefits, and side effects – despite a lack of scientific evidence to support their use, according to a review paper published in the Journal of the American College of Cardiology.

Herbal medications do not require clinical studies before being marketed to consumers or formal approval from regulatory agencies, so their efficacy and safety are rarely proven. In the U.S., herbal medications can only be found unsafe by the Food and Drug Administration after they have caused harm. Still, they remain popular among heart disease patients for their potential cardiovascular benefits. A recent survey said 1 in every 5 people will take an herbal or dietary supplement in their lifetime.

Researchers in this review paper looked at 42 herbal medications that have a possible indication for treating one or more cardiovascular condition, including hypertension, heart failure, coronary artery disease, dyslipidemia, thromboembolic disorders or peripheral artery disease. They then selected 10 of the most commonly used in cardiovascular medicine to discuss possible indications, biological and clinical data, and safety concerns.

The researchers said that despite all the clinical evidence on these herbal medications, there is an overall lack of evidence available, and it is not always possible to clearly establish a cause-effect link between exposure to herbal medications and potential side effects.

They concluded that because of the popularity of these medications and the potential for drug interactions or other safety concerns, physicians should start a conversation around herbal medication use to effectively counsel their patients. Many patients don’t volunteer information on their herbal medication use to their doctor because they do not perceive them as drugs. Physicians are also unlikely to regularly gather correct information on their use. However, herbal medication use has been associated with poor adherence to conventional medications, which is a serious concern.

“Communicating with the patient is a crucial component of the process,” said Graziano Onder, MD, Ph.D., senior author of the review paper and an assistant professor in the department of geriatrics, neurosciences, and orthopedics of the Università Cattolica del Sacro Cuore in Rome. “The pros and cons of specifics herbal medications should be explained and their risk-benefit profile properly discussed.”

Researchers said physician education is an important consideration as well since the study of alternative medicine is not part of medical school curriculums in the U.S. Obtaining the necessary knowledge to provide better care for patients around the use of herbal medications is solely up to the physician.

“Physicians should improve their knowledge of herbal medications in order to adequately weigh the clinical implications related to their use,” Onder said.

Living with A-fib: Tips and Outlook

Atrial fibrillation, commonly known as A-fib, is an irregular heartbeat. It can lead to the heart not pumping enough oxygen-rich blood to the rest of the body.

With proper medical treatment, people with A-fib can lead a full, healthy life. There are also several changes that people can make to improve their quality of life and help reduce the severity of symptoms.

Lifestyle changes

Though living with A-fib can be challenging, there are several steps a person can take to deal with the condition besides receiving regular medical care. These include:

Older people exercising in the park
Beginning or increasing an exercise routine is a recommended lifestyle change for people with A-fib.
  • Quitting smoking can improve living with A-fib and reduce further heart and lung risks.
  • Increasing and continuing exercise is important for people with A-fib. As with any exercise routine, a person should consult their doctor to ensure it is safe for them.
  • Eating a heart-healthy diet can impact on overall health and fitness and people with A-fib should eat less trans fat and sugar while increasing their green leafy vegetables, lean proteins, and fiber intake.
  • Maintaining a healthy weight, through both diet and exercise, can help.
  • Reducing alcohol consumption as alcohol intake can have a negative impact on the heart. Some people with A-fib need to avoid alcohol altogether, so everyone with the condition should consult their doctor before drinking.
  • Managing stress as this can complicate A-fib. People with A-fib can take steps to reduce their stress levels through exercise, meditation, or other methods.

People with A-fib should also maintain follow-up care with their doctor to ensure proper treatment is continued.

What does A-fib do to the body

A-fib can have a number of potential impacts on the body ranging from mild to severe. Some of these include:

  • Blood clots: When the heart is not pumping hard enough, blood can pool and form a clot within it. If a clot escapes it can cause issues elsewhere in the body.
  • Heart problems: Over time, the irregular beating can cause the heart to weaken.
  • Shortness of breath: Irregular pumping of the blood to the lungs can result in fluid building up, which can then lead to shortness of breath and fatigue.

A-fib may also lead to a buildup of fluid in the legs, ankles, and feet. Other problems can include weight gain, light-headedness, and a general sense of being unwell. Additionally, people may experience irritability and tiredness during previously routine activities.

A-fib itself is generally not life-threatening but the condition can lead to severe complications, which include stroke and heart failure.

A stroke may occur after a blood clot has formed in the heart and moved towards the brain, blocking an artery. A doctor will often be most concerned about a person’s risk of a stroke when they are diagnosed with A-fib. Symptoms of stroke should not be ignored, including a headache and slurred speech.

Heart failure can be a long-term effect of unmanaged A-fib. The condition weakens the heart over time, making a person more likely to suffer from new or worsening heart failure. The threat of heart failure can be reduced greatly by medical supervision of A-fib.


Electrical cardioversion for A-fib
Electrical cardioversion may be used to treat A-fib by shocking the heart to stop it so that it may restart with a regular beat.

Doctors treating A-fib typically look at treatments to reset the rhythm of the heart, control the rate it is beating, and reduce the risks of blood clots.

The way a doctor treats A-fib depends on a number of factors, including whether the person has other heart problems, other medications they are taking, their response to previous treatments, and the severity of their A-fib.


Cardioversion is used to reset the heart rhythm. It can be electrical or carried out with drugs.

Electrical cardioversion involves shocking the heart to temporarily stop it with the aim that when restarted, it will resume with regular beats. Typically, this procedure is done under sedation.

Cardioversion can also be delivered through medication, called antiarrhythmics, which are delivered into the vein, or by mouth. Very often, the initial treatment is conducted in a hospital. However, a doctor may prescribe similar medications to be taken regularly to prevent further episodes.

A doctor will likely prescribe blood thinners to be taken for several weeks to prevent clots before cardioversion treatment. A test for blood clots may also be done before cardioversion.

Preventive medication

Several types of medication can control heart rhythm and heart rate.

After a cardioversion, a doctor may prescribe anti-arrhythmic medications to prevent further problems with heart rhythm including dofetilide, flecainide, propafenone, amiodarone, and sotalol.

To control heart rate, a doctor may prescribe medications that include digoxin, calcium channel blockers, and beta-blockers.

Catheter and surgical procedures

In cases where medication is not effective, additional procedures should be taken. These include:

  • Catheter ablation: Long, thin tubes are inserted into the groin and guided through blood vessels to the heart. Electrodes at the tips can destroy the areas causing A-fib, scarring the tissue so that the erratic electrical signals return to normal.
  • Surgical maze procedure: Using a scalpel, a doctor creates a pattern of scar tissue in the upper chambers of the heart. The scar tissue can’t carry electricity, so the scars interfere with stray electrical impulses that cause A-fib. The procedure involves open heart surgery.
  • Atrioventricular (AV) node ablation: The tissue pathway connecting the upper chambers and lower chambers of the heart (AV node) is destroyed with a catheter. In this procedure, a pacemaker is then implanted to control the responsibilities of the AV node. People who have this procedure may still need to take blood-thinning medications to prevent clots from forming.

Preventing blood clots

warfarin tablets
Warfarin may be prescribed to help prevent blood clots.

As blood clots are a major concern for people with A-fib, a doctor is likely to prescribe medication that helps prevent these. This is particularly true if a person has issues with heart disease.

The two types of medication typically prescribed are warfarin and newer anticoagulants. Warfarin medications need to be used with care under direct supervision of a doctor, as they can cause dangerous bleeding.

Newer anticoagulants do not require such frequent monitoring as warfarin.

Coping and outlook

A-fib is a commonly diagnosed condition. As a result, there are many treatment options and therapies that can greatly reduce the symptoms or correct A-fib.

Treating A-fib can allow a person to live a normal life. Left untreated, a person could experience further complications such as stroke or worsening heart disease.

Recognizing the signs, being proactive in making lifestyle changes, and treating A-fib are the best ways to help prevent complications.

A-fib and Exercise: Health Benefits and Risks

Atrial fibrillation is an irregular heartbeat caused by faulty electrical signals in the upper chambers of the heart. In people with atrial fibrillation, the heart beats irregularly and often too quickly.

Atrial fibrillation (A-fib) can result in the heart not pumping enough oxygen-rich blood to the rest of the body, which may cause symptoms like heart fluttering, weakness, and dizziness. It may eventually lead to serious complications including stroke and new or worsening heart failure.

Is it safe to exercise with A-fib?

[woman looking at heart monitor while exercising]
Wearing a heart monitor during exercise enables people with A-fib to check their heart rate easily and reduce the risk of symptoms.

A-fib may reduce a person’s ability to exercise. It is generally recommended that people with A-fib do some exercise. However, people with A-fib should consult with their doctor and take proper precautions before starting any exercise program.

In some cases, a heart specialist may not want a person to start or increase an exercise program before treatment for A-fib starts. In other cases, moderate exercise and increases in current routines may be encouraged.

Homeopathy Digitalis


Digitalis purpurea

Foxglove is an herb-like plant that grows biennially. Foxgloves produce spirally arranged leaves that are simple and grow up to 10 cm to 35 cm in length and 5 cm to 12 cm in width. The leaves are grey-green in color, soft and have a finely jagged margin. During the first year of the plant’s growth, the leaves are in the form of a tight rose-shaped arrangement (rosette) at the level of the ground.

The foxglove plant bears a flowering stalk in the second year of its existence. Usually, the flowering stalk of the plant grows up to a height of 1 meter to 2 meters and at times even taller. The color of flowers of this species is varied – usually purple, but they may be a rose, pink, yellow or even white hued in selected cultivable varieties. These flowers are organized in a very ostentatious, terminal, lengthened cluster with each being cylindrical and dangling like a pendant or pendulum. Apart from appearing at the stalk terminal, the flowers may occur at the inside bottom of the tubular flowering stem. The plant blooms during the early part of summer and often when there are additional growths of flowering stems, the plant may also flower later than their flowering season. The plant bears fruits that are akin to capsules and when they are ripe, they rupture to discharge copious tiny seeds, each measuring around 0.1 mm to 0.2 mm.



The leaves, flowers, as well as seeds of this herb, are poisonous to humans as well as certain animals as they enclose a toxic cardiac glycoside called digitoxin. Consuming either of them may even prove to be fatal. However, 18th century English botanist William Withering was the first to extract cardiac glycoside digitoxin from the leaves and presently it forms the basis of the medication that is used to treat heart problems. Withering was also the first to identify that this organic chemical compound was helpful in reducing dropsy (a health condition distinguished by a buildup of watery fluid in the tissues), enhancing the flow of urine as well as having a potent influence on the heart. Very dissimilar to the distilled form used by pharmaceutical firms, the extracts obtained from the foxglove plant usually did not result in frequent intoxication as they promoted vomiting and nausea within a few minutes of ingesting them. In fact, such vomiting and nausea prevent patients from consuming more of this toxic substance contained in the extracts.


The homeopathic remedy digitalis is primarily used to treat heart ailments. Precisely speaking, homeopathic physicians prescribe this medication for patients who are susceptible to heart ailment and problems of the circulatory system. This homeopathic remedy is believed to be especially suitable if the symptoms endured by the patients are accompanied by apprehensions regarding their death. They may also suffer from the trepidation that any movement, particularly walking, may result in their heart to stop beating. In addition, such patients may also suffer from visual problems and have a craving for bitter things. People who respond best to the homeopathic remedy digitalis are patients who suffer from heart ailments that are accompanied by vertigo, pains in the region of the heart, a sluggish pulse rate and nausea. In addition to the conditions and symptoms mentioned here, digitalis is also prescribed for patients enduring liver ailments, especially when they take place concurrently with the symptoms related to heart disorders.

As fore-mentioned, William Withering, the 18th-century English botanist, and a physician was the first to prove that the flowers of the foxglove plant were a significant medication for treating heart disorders. Even to this day, the active elements of the plant’s flowers are made use of in preparing herbal as well as other traditional heart medications.

Despite being an attractive plant, the foxglove is a lethal poison. Hence, consuming the leaves, flowers or seeds of this plant may lead to gastrointestinal problems and most remarkably, result in heart and circulation problems. When any part of this toxic plant is ingested, it may slow the heart beat. This is a primary reason that allopathic medicines containing extracts of digitalis are only given to patients when their heart palpitates or beats exceptionally fast. However, in homeopathy, digitalis is given to a patient when his/ her heart is failing to carry on its normal pace, especially when the patient experiences problems in breathing normally.


When the tissues of a patient do not receive enough oxygen owing to poor blood circulation it results in their appearance turning blue, a condition known as cyanosis. In such cases, administration of the homeopathic medication digitalis may produce incredible results. In addition, patients who are always apprehensive and nervous regarding their health condition and suffer from the fear of imminent death also require digitalis most. In fact, the extracts from the plant foxglove are used to prepare potent and effectual medications in homeopathy to treat heart conditions discussed above. Dissimilar to several contemporary medications, the homeopathic remedy digitalis obtained from the leaves of the foxglove plant has been widely used for treating heart and circulatory problems for more than two centuries.


Scientific papers published during the later part of the 19th century noted that the homeopathic remedy digitalis possessed the potential to inhibit the pace of the heart as well as increase the heart rate according to the requirement of the patient. The scientists also experimented with digitalis as a diuretic and found that it facilitated in diminishing fluid retention among patients suffering from dropsy or edema. In another experiment, physicians administered digitalis to patients suffering from fevers and found that this homeopathic medication was effective in bringing down the body temperature. It may be mentioned here that fevers are often responsible for very rapid pulse rate.

While scientists have been working on foxglove for quite some time now to identify its therapeutic uses, presently they have a better understanding of this herb. Homeopathic physicians now prescribe digitalis to patients who are susceptible to heart failure and people who have a tendency to arrhythmia’s (any irregularity in the heart beat). In addition, this homeopathic remedy may also be prescribed for children with heart problems to help them to tide over a period till they are old enough to undergo heart surgery.

However, it may be noted that digitalis only possesses mild diuretic properties that are effective to a certain extent. Therefore, when any patient requires a medication only to regulate fluid retention by the body, physicians usually prefer other less toxic medications. The homeopathic remedy digitalis helps to promote the functioning of the heart better probably by getting rid of the excessive fluid retained by the body. Nevertheless, it may be said for certain that digitalis is not the best medication available for treating dropsy or fluid retention by the body and may be used only when any other more effective diuretic is not available to the patient.

The homeopathic remedy digitalis is known to interact with certain medications. Therefore, before you start taking digitalis, it is essential to tell your physician regarding all the other medications, minerals, vitamins or supplements you may be taking for other conditions. Digitalis may interact with certain medications for the heart, for instance, cholesterol lowering medications, anti-arrhythmia drugs and also nitro-glycerin. Even a number of antibiotics are known to interact with digitalis; it is also advisable not to take any anti-fungal medications concurrently with this homeopathic remedy. In addition, when decongestants, antacids, diarrhea medications and antihistamines are taken concurrently with digitalis, it may result in adverse after-effects. If any patient taking the homeopathic remedy digitalis has a cold or a cough, it is advisable that he/ she should consult their physician regarding the most appropriate and safe cold medications that they should take.


Like in the case with any other medication, using the homeopathic remedy digitalis may also result in a number of side effects, including some serious ones. The most common side effects of digitalis may include acute diarrhea, nausea, skin rash and/ or severe visual sensitivity to light. Any patient experiencing any of the above-mentioned symptoms after taking digitalis should seek emergency medical help as they require the immediate attention of a doctor.

However, there are numerous patients who find digitalis well tolerable and for them, it is one of the most suitable homeopathic medications for treating heart conditions. Along with antibiotics, the homeopathic remedy digitalis is considered to be among the most significant medications that have been developed thus far. This is all the truer since digitalis has helped in increasing the life expectancy of people who need to and ought to use this homeopathic remedy.

Homeopathic Remedy Use

Freshly obtained leaves of the foxglove plants are used to prepare the homeopathic remedy digitalis. The leaves are collected just before the plants begin to blossom in their second year of existence. Subsequently, the leaves are cleaned and expressed to obtain their juice. The juice is then blended with alcohol and diluted to the desired level to obtain the homeopathic remedy digitalis. As with preparing any other homeopathic remedy, even digitalis does not retain the slightest trace of the toxic leaves of foxglove.

Therapeutic Properties

The herb foxglove is known to possess a number of therapeutic properties and is specially used to treat conditions related to the heart and circulatory system. In ancient times, Britons used this herb to cure wounds. While in conventional medicine foxglove is a remedy for heart failure and irregular heartbeat, in homeopathy, digitalis, prepared from the toxic leaves of the foxglove plant, is an important medication to treat heart disorders.

In homeopathy, digitalis is widely used to cure an extremely sluggish pulse or an unbalanced, sporadic pulse that is related to certain conditions and symptoms, such as heart failure, queasiness even at the sight or smell of food, and debility accompanied by a slight, tumbling sensation in the stomach. Heart patients who might be requiring this homeopathic remedy most may also suffer from liver problems, for instance, hepatitis.

Foxglove is the source for the pharmaceutical drug Digoxin that has been widely used in the past to treat cases of congestive heart failure. In homeopathy, digitalis, prepared from the toxic leaves of foxglove, is a very important medication that helps to cure a very sluggish, irregular and sporadic pulse, usually below 60 beats per minute.

Interestingly enough, this homeopathic remedy may also be prescribed for patients who might be suffering from very fast and uneven pulse too. Patients having an irregular and rapid pulse often has a sensation as if the heart would stop beating any moment. The condition of patients enduring angina (any attack of painful spasms marked by sensations of suffocating) actually deteriorates when they exert themselves physically are very excited and/ or from having sexual intercourse. In such cases, the pain spreads to the left arm resulting in the debility of the arm. Turning to the homeopathic remedy digitalis in such cases helps to cure the condition as well as provide relief from the associated symptoms.

Patients for whom the homeopathic medication digitalis is most suitable always suffer from a strong fear of death. They are apprehensive that making any movement or even walking may result in their untimely death. They also suffer from nervousness, grief and insomnia owing to the intense pain they endure in the heart. In addition, physical as well as emotional exertions, for instance being disappointed in love and misery may result in palpitations – exceptionally rapid and irregular heart beat. Generally, such patients become all the more sad and melancholic when they listen to music.

The homeopathic remedy digitalis has a vital role to play in curing all ailments that are somehow related to the heart, wherein the pulse is feeble, irregular, sporadic, and exceptionally low as well as when the health conditions are accompanied by dropsy (fluid build up) in the external as well as internal parts of the body. This medication is also effective in curing debility and dilation or expansion of the heart muscles (myocardium). Digitalis is indicated primarily in the case of a collapse of compensation and particularly when auricular fibrillation (very fast awkward contractions of the atria of the heart resulting in a deficiency of harmonization between heartbeat and pulse beat) become entrenched. Such patients experience a sluggish pulse beat when they are lying down, but their pulse beat become erratic and dicrotic (double that of the heart beat) when they are in a sitting posture. In case the patients have recovered from a rheumatic fever, they may also experience auricular flutter (an irregularity of the heartbeat wherein the contractions of the atrium surpass in number those of the ventricle) and auricular fibrillation. Such patients may also have an extremely sluggish pulse and endure heart block.

In homeopathy, digitalis is also a great remedy for organic heart ailments, for instance, extreme debility and a sensation of diminishing strength, vertigo or wooziness, a cold sensation on the skin and erratic respiration. This medication is also beneficial for people who suffer from cardiac tetchiness and visual problems following tobacco use; jaundice caused by induration (hardening of tissues) and hypertrophy (abnormal enlargement) of the liver. People who endure heart diseases accompanied by jaundice would also find digitalis an effective remedy. Patients who require this homeopathic medicine most are those who become unconscious frequently and suffer from a feeling as if they are on the verge of death. Owing to the imbalance in blood circulation to all parts of the body, their appearance often turns bluish. Such patients are inclined to exhaustion even due to trivial physical exertion and may often collapse. Taking the homeopathic medicine digitalis helps to invigorate the muscles of the heart.


The plant foxglove, which forms the basis for the homeopathic remedy digitalis, is a flowering herb belonging to the family Plantaginaceae. Earlier, foxglove was classified in the family Scrophulariaceae but later included in the larger family Plantaginaceae. This plant species is indigenous to Europe and found growing naturally in most regions of the continent.