Mending Your Heart Updated Sept. 26

Table of Contents
Introduction
Digestive Health Checklist
Part One: Know Your Good Microbes
CHAPTER 1: Tale of Two Microbiomes

CHAPTER 2: Heart, Inflammation and Microbiome
CHAPTER 3: Brain, Inflammation and Microbiome
CHAPTER 4: Metabolic Syndrome, Inflammation and Microbiome
Part Two: Diet and Lifestyle
CHAPTER 5: Food: The Biggest Exposure

CHAPTER 6: Exercise: Harm of Too Little or Too Much
CHAPTER 7: Sleep: A Priceless Medicine
CHAPTER 8: Rest and Stress Reduction: Art of Letting Go
CHAPTER 9: Supplementation: Filling the Gaps
Part Three: Putting into Practice
● The Kitchen Clean Out
1
● Recipes
INTRODUCTION
All disease begins in the gut
--- Hippocrates
SEVERAL YEARS AGO, one of my heart patients told me, “Doctor, I

did everything you told me to do. And I am still going to a
bypass.”
A few years later, another one announced, “I still have blockage in

the artery.” He paused for a second then asked, “So, what is it
that I should be doing?”
I was young and new in my career. Those statements came after I

had followed all the procedures and recommendations that were
expected of a professional, mainstream allopathic cardiologist.
This was a heart-wrenching place to be, one that you just don’t
get used to no matter how many times you go through it. These
questions made me reflect on the current state of affairs, and
eventually the realization that the current cardiological solutions
are flawed. I felt that there was something else that I should be
doing to help my patients - they deserved something better.
At the time, the current state of affairs was one area I felt
compelled to do some investigative work as well research from
unorthodox modalities; the scientific world is replete with
nutritional data, yet we take a blind eye to it. What gave me hope,
2
was a burgeoning area of study that has finally afforded me
revolutionary approaches to relieving the suffering. Heart Mend is
about this dazzling new science, and how your health can benefit
from it. I have used it to benefit my health, as well as that of my
family and patients.
Pure allopathic medicine is not likely to emphasize the role of diet

and lifestyle changes. Personally, getting to this stage was rife
with challenges, like being considered a renegade. Healthful
suggestions were put down at conferences. Investing a
tremendous amount of time into reading new research data as
well as books. I was given awkward looks when encouraged to
consider microbiome’s role in reversing illnesses. It takes a lot of
courage to choose to prioritize the welfare of the patient instead
of the reputation. And I was made to feel that it is the latter I
should be worried about.
What is Microbiome?
Microbiome is a mutually beneficial colony of bacteria, yeasts

and other microscopic beings that live in the gut. It performs
many functions, including the production, regulation and
breakdown of small molecules that complement the
physiological functions of the human body. For example, our
gut bacteria produce fatty acids, vitamins and amino acids that
have a range of beneficial effects for the body, from
promoting healthy immune system function to maintaining
the integrity of the gut lining. One of these functions is to
break down dietary fiber that has travelled through the
3
digestive tract, because the human body can’t.
I knew that if I wanted to help my patients, and others suffering

heart ailments, then I should not shy from starting to change
some things. I was willing to try what was claimed in the medical
journals I was researching. Positive results were quick to appear.
At 5 feet 2 inches, I was already at my ideal weight. But I was still

glad to say goodbye to 8 lbs. that melted away in all the right
places as I maintained my new lifestyle changes. Aches and pains
also went away which was a sign of inflammation minimized.
When my patients were offered the new program, within weeks I
started getting news of the positive results.
That was about 5 years ago. Now I am ready to serve a wider

audience so they too can turn their health around and lead a
happy and healthier life.
During the research days, one common thread that kept

resurfacing was how much has changed in our world over the past
few decades. Technology has advanced tremendously as far as
interventions, procedures and pharmaceuticals are concerned.
We no longer must worry about dying from tuberculosis,
smallpox, dysentery, diphtheria, or cholera, owing to improved
hygiene, living conditions, and public health programs.
Many of the life-threatening illnesses like HIV/AIDS, and certain

types of cancer are treatable, and patients can enjoy normal lives.
But when you consider cardiovascular disease (CVD), the picture is
4
vastly different. Despite advances in treating and intervention of
cardiac disease it remains the number one killer in the world. And
it does not appear to be changing. Sadly, we are quickly losing
ground as the incidences of these conditions are increasing in our
society. Even developing countries are catching up with developed
countries.
Let’s consider a few numbers. Cardiovascular diseases (CVDs) are

the number 1 cause of death globally, taking an estimated 17.9
million lives each year1. And the United States leads the way.
Mortality rates have decreased. But the incidence has not. The
drop is due to some improvements through certain drugs and
procedures. I consider that a band aid. In other words, we have
only postponed death by a few more months, at best. We are the
most advanced nation in the world, yet we have not conquered
this disease yet. So, this book is not just about prevention but
hope of minimizing, if not reversing what has already started. I am
looking for a ripple effect.
The value of prevention was apparent to Prof Christiaan Barnard,

who performed the world's first heart transplant operation. One
of his beliefs was that “If I had first concentrated on heart disease
prevention, rather than saving the lives of 150 people I could have
saved the lives of 150 million people”.
Speaking of prevention and reversal, for a long time we have

always been barking up the wrong tree - cholesterol this,
cholesterol that. There was never any evidence of causation.
There may have been association. These are two different things.
This is akin to thinking that because there are a lot of ambulances
1
https://www.who.int/health-topics/cardiovascular-diseases/#tab=tab_1
5
around the emergency room when a person has a heart attack,
that must be the cause of the heart attack. It is very erroneous
thinking that because of the association, we ascribe to it.
A controversial study has argued that if you have a high LDL (bad)
cholesterol level when you are aged over 60, you will live longer,
there is no increased risk of cardiovascular disease and that statins
will have little effect. The study reviewed research of almost
70,000 people and found that elevated levels of “bad cholesterol”
did not raise the risk of early death from cardiovascular disease in
people over 602. These seem like bold claims, but I have learned
from experience to be true.
When we talk about heart disease like atherosclerosis, we have

always thought that it is the cholesterol that did that, but no study
has ever proven that saturated fat causes plaque formation. Now
we know that there is a strong inflammatory set of causes for
heart disease and we can retrieve inflammatory markers in these
patients.
The Framingham Heart Study is a long-term, ongoing

cardiovascular study on the residents of the town of Framingham,
Massachusetts, which is now on the fourth generation of its
participants. It is under the direction of National Heart, Lung, and
Blood Institute (NHLBI). Risk factors found in the study include
cigarette smoking, high blood pressure, psychosocial factors to
increase the risk from heart disease. High HDL (high-density
lipoprotein), or as I tell my patients to help them remember, the
Happy Cholesterol. The opposite of it is LDL (low-density
2
https://www.telegraph.co.uk/science/2016/06/12/high-cholesterol-does-not-
cause-heart-disease-new-research-finds/?platform=hootsuite
6
lipoprotein), the Lousy Cholesterol. LDL cholesterol that is
oxidized, that is the risk factor for heart disease.
Historically speaking, most of our big food policies were born of

national security concerns in the 1940s. They were created during
a time of extreme caloric deprivation, when as many as 40% of
military recruits were ineligible for service because of malnutrition
and being underweight. Solutions like National School Lunch
Program and food stamp program helped solve that problem. But
other challenges created new problems.
Faulty nutritional leadership by people like Ancel Keys

compounded the health problems. There were competing ideas in
the medical field that it was fat or sugar that caused or
contributed to heart disease. Keys won that war and the sugar
hypothesis was put to rest (for a while anyway). It also got Keys to
the cover of TIME magazine3. He also seized the occasion when
President Eisenhower had a heart attack around that time in the
fifties. He mobilized the country to make sure that we do
something to prevent heart attacks. Nobody even looked up the
fact that President Eisenhower was a very heavy smoker. Then the
politicians got involved and created a governmental guideline as
to the American dietary recommendation. That is where the low-
fat recommendation got started. And then they started creating
pyramids with the base of which is unlimited carbohydrate and
above it is the protein and above it is the fat, so the three
macronutrients were represented. This book is about reversing
that pyramid: the base should be unlimited amounts of healthy
fats and the top is extremely limited sugar and refined
carbohydrates.
3
http://content.time.com/time/covers/0,16641,19610113,00.html
7
Sugar being this deadly substance promoted by Dr. John Yudkin
from the UK wrote a book called “Pure White and Deadly”, but his
idea was subdued because of Ancel Keys’ dominant force. And
then he had his seven countries study when in fact he had twenty-
two countries in his study, but he cherry-picked his data. He only
picked the countries that matched his theory. Much like we do
fake news now. Whatever matches the narrative, that’s what we
pick. And then sometimes the data and facts are distorted. So we
now see the fattening and the sickening of America.
Dr. Yudkin (1910 - 1995) was a British physiologist and nutritionist,

and the founding Professor of the Department of Nutrition at
Queen Elizabeth College, London. He wrote several books
recommending low-carbohydrate diets for weight loss, including
This Slimming Business (1958). He gained an international
reputation for his book Pure, White and Deadly (1972), which
warned that the consumption of sugar (sucrose, which consists of
8
fructose and glucose) is dangerous to health and a factor in the
development of conditions like caries, obesity, diabetes and heart
attack, an argument he had made since at least 1957. That shows
that in medical history right ideas and solutions can get swept
away, but when they resurface, new discoveries support them to
come back.
Mainstream medicine minimizes or totally ignores the power of

lifestyle changes. For instance, the capability of diet in reducing
inflammation. Most doctors in hospitals with their dieticians still
do not hesitate to recommend low-fat and high whole grain diets
to heart patients. Dr. Steven Gundry states in the Plant Paradox
these are the foods that made him sick.
My investigative research led me to areas, which at the time,

made me feel that I was moving away from my main mission -
saving people from cardiovascular diseases. We as cardiologists
are trained to focus on what goes on in the cardiovascular system,
and specifically in the heart, in a myopic way. Eventually, this is
where I parted ways with most, but thankfully not all, of my
colleagues. A common thread had started to surface that other
illnesses, along with CVD, had a common denominator --
inflammation -- and a large part of it comes out of the digestive
system, and the microbiome that inhabits it.
Generally, we have been taught to consider all microbes as bad,

harbingers of disease and even death. To a certain degree, they
were right as many illnesses were caused by bad microbes. Take
plague for instance. It decreased the European population to two-
thirds in about five years.
9
Like they say, each story has two sides, so now, it is time to look at
the other side of the microbe’s story. First it was Hippocrates,
then it was Élie Mechnikov, who have said the same thing all along
- the gut or the colon is where the disease and eventually death
arises. During the former’s times, they had no concept of bacteria.
Thanks to the “father of microbiology”, scientist Antonie van
Leeuwenhoek looked at his own dental plaque through a
handcrafted microscope in the late 17th century and discovered a
mysterious and invisible world of what he called “animalcules.”
Mechnikov, who as a biologist, made a remarkable connection

between our longevity and the healthy microbes inside us with his
signature statement “death begins in the colon”. Now, many
researchers are convinced that about 90 percent of all diseases
can be traced back to the gut and health of the microbiome. And if
illness and our demise begins there, then the opposite will be true
as well - our good health and long life.
Mechnikov made another claim that still holds true - the good
bacteria need to be higher in quantity than the bad bacteria. Now,
we also know that not just the quantity but the diversity of
microbes inside also matters.4 You experience the repercussion
first-hand if you disrupt the microbiome through antibiotics, as
one round of it decreases gut microbiome diversity by at least
30% - this can linger for months or years.
Unfortunately, most people have more disease-causing or

pathogenic microbes than they should, lacking a vibrant and
diverse microbial universe within. No wonder we suffer from so
many heart disorders.
4
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3577372/
10
Currently, we are outnumbered in our own bodies. We play host
to an extraordinary menagerie of bacteria and other microbes,
and it is frequently said that these teeming cells outnumber our
own by ten to one5.
If you could isolate them all, the microbiome would fill up a 5 lbs.
container. Scientists have so far identified some 10,000 species of
microbes. As each microbe contains its own DNA, that means we
have more than eight million genes 6. Although they live all over
our skin and inside your body, most of them are inside our
digestive system. And bacterial organisms outnumber fungi and
viruses. We not only interact in a symbiotic relationship with
them, but also their DNA interacts with ours.
This complex external and internal ecology of tiny organisms is

called microbiome; “micro” means microscopic and “biome''
means a large naturally occurring community of flora and fauna
occupying a major habitat, e.g., tundra or forest. In this case, our
body.
Research is acknowledging that microbiome has its own specific

physiology and pathology, therefore it is being proposed to be
considered a bona fide organ 7. In order to understand this organ
better, it is helpful to keep its evolutionary perspective in mind;
not only has the microbiome evolved with us humans, but it has
had a direct effect on the process as well8.
5
Thomas D. Luckey, 1970
6
http://www.nih.gov/news/health/jun2012/nhgri-13.htm
7
https://pubmed.ncbi.nlm.nih.gov/22647038/
8
https://msystems.asm.org/content/3/2/e00174-17
11
It’s now undeniable that our microbiome participates in a wide
range of physiologic actions, including immunity, detoxification,
vitamin production, nutrient absorption, signaling hunger or
satiety, utilizing carbohydrates and fat and most importantly,
controlling inflammation. All these systems determine whether
we get allergies, ADHD, autism, cancer, diabetes, or Alzheimer’s,
to name a few.
In a nutshell, everything about our health — how we feel both

physically, mentally, and emotionally — depends on the health of
our microbiome. Since we now know many of the factors that
affect the health of our microbiome and eventually the health of
our heart, nurturing a healthy microbiome today is easier than
you think. I have taken the guesswork out with the
recommendations presented in this book. I’ve seen dramatic
turnarounds in health using simple dietary modifications and, on
occasion, more aggressive techniques to reestablish a healthy
microbiome. In fact, this new knowledge can help virtually any
degenerative or inflammatory condition.
You are what you eat, and what you ate, ate. No, that is not a
typo. That means that the diet of what you consume, whether it is
a plant or an animal, and what they have consumed, affects your
microbiome. That is why there is so much emphasis on non-GMO,
organic food sources.
The idea that food is the most important variable in human health
is not a new concept. Hippocrates considered nutrition one of the
main tools that a doctor can use. More than that, dietary
measures play a lead part in the original oath of Hippocrates. If
literally translated, it says: “I will apply dietetic and lifestyle
12
measures to help the sick to my best ability and judgment; I will
protect them from harm and injustice.” What a great
endorsement for the notion that diet matters, overriding fear that
we may not entirely be able to control our health.
The microbiome is very receptive to rehabilitation through diet

and lifestyle measures. The recommendations in this book will
change your body’s inner ecology to enhance the growth of the
right kind of heart-sustaining organisms. This highly practical
regimen includes five essential keys: lectin/gluten-free foods,
healing the gut, probiotics, prebiotics, and healthful fat. I will
share information on how each of these plays into the health of
the microbiome, heart and the overall health. In addition to
lifestyle factors, diet, adequate sleep, stress reduction will be
discussed in the following chapters. Best of all, you can reap the
rewards of the Heart Mend program within a matter of weeks.
I am confident in saying that incorporating the information in this

book will revolutionize the treatment of cardiovascular diseases.
And I am happy to be able to share the leading research and new
data that goes around inconspicuously in medical journals.
Let us begin with a brief preliminary review of your risk factors.

Since there is no single microbial testing kit available today that
can give a conclusive and comprehensive state of your
microbiome; Even if these kits are used, it can be difficult to say
that a certain microbial makeup identifies you as “healthy.”
Therefore, the most effective way you can review your
microbiome’s health is through answering a few simple questions.
These questions will give you clues on what life events may have
affected the vitality of your gut.
13
Dr. Robynne Chutkan of The Microbiome Solution says your
unique microbiome develops over a lifetime and it reflects
everything about you; your parents’ health, how and where you
were born, what you have eaten (whether you were bottle-fed or
breast-fed), where you live, your occupation, personal hygiene,
past infections, exposure to chemicals and toxins, medication,
stress and hormone levels and even your emotions. The result is
so distinctive, that your microbiome is a more exact identifier of
you than your DNA.
((Need: Rationale for discussing brain health and metabolic

syndrome as a cardiologist.))
Digestive Health Self Check List

14
For the time being, you can respond to these questions to the best
of your ability. If you do not know the answer to a question, skip
over it. The more yeses you have, the higher your risk might be for
having a disrupted microbiome. But you are not doomed. The
main mission in writing this book is to empower you to take
charge of your heart’s health and, in turn, your overall health.
Past Years Stage:

1. Were you born by C-section?
2. Were you breast-fed as an infant?
3. Did you suffer from frequent infections as a child and took
multiple doses of antibiotics?
4. Did you have your tonsils removed?
5. Have you been diagnosed with CVD: heart or blood vessel
disease?
6. Have you been diagnosed with Autoimmune disease: IBS,
Arthritis, lupus, psoriasis, etc.?
7. Have you been diagnosed with Type-2 diabetes or pre-
diabetes?
8. Have you been diagnosed with depression, anxiety or
ADHD?
9. Circle any of the following medications on a long-term
basis you are taking. Add to this list any other medications
that you take: Antacids, Anti-inflammatories, Antibiotic,
Cortisone, Laxatives, Prednisone, Tylenol, or Oral
contraceptives?
10. Do you eat a lot of potatoes, peppers, eggplants, or
tomatoes (Nightshade family)?
11. Do you eat a lot of wheat-based foods - bread, pasta,
pastries, cereal, etc.?
15
12. Do you eat a lot of margarine and other trans-fat
vegetable and seed oils?
13. Do you eat a lot of fruit, soft drinks, fruit juices, sweets,
artificial sweeteners?
14. Do you chew tobacco or smoke cigarettes?
15. Do you exercise 150 minutes a week?
16. Do you have very poor-quality sleep, less than 8 hours a
day?
● If you answered yes to some questions, then not to worry,

most people these days could use some support for their
friendly microbes.
● If you answered yes to all the questions, then the sooner

you can follow the Heart Mend program, the earlier you
can reverse the existing damage.
I bet you are anxious and curious now about how these questions
are related to clues about your microbiome’s vitality. This book
will tell you everything you want and need to know and make
informed decisions for your health.
16
Part I
Know Your Good Microbes
BACTERIA WERE THE PLANET’S original life forms, and they will
probably be the last. That is because no living thing can exist
without them, not even you.
Although they are surprisingly simple, consisting of only a single

cell, yet, they are extraordinarily complex and sophisticated in a
myriad of ways. And do not let their diminutive size trick you into
thinking they are of small value. What they lack in size, they make
up in bizarre modes of survival. Some bacteria can live in locations
where you could get hypothermia. They can thrive in climes where
your skin and flesh would fall off the bones. They can also survive
several thousand times the dose of radiation that would kill
humans.
It does have a notorious reputation as a disease-causing agent.

But the scientists have held a more neutral opinion towards them
longer than the general population. The reason for that is because
substantial data points to co-existing in a symbiotic relationship -
we take care of them, so they return the favor. They not only
provide a coating for our insides and outsides, keeping almost all
our systems possible, stable, and interconnected.
17
In part I, we are going to explore the role of our friendly bugs in
keeping our other organs functioning well. By the end of this part,
you will have a new appreciation for your gut bacteria and a
renewed sense of empowerment for the future of your health.
CHAPTER 1
Tale of Two Microbiomes
SOFIA, 23, LIVES WITH HER tight-knit, extended family on the
island of Mallorca, Spain. She is engaged to be married, yet
according to local traditions, still lives at home. Growing up on a
popular tourist destination has brought some modern
conveniences to make daily life more convenient, but matriarchal-
run family home has helped preserve a lot of the traditions –
home birth with the aid of a midwife, usage of food as medicine
when children have fever or infections and majority of the regular
diet is organic and natural with lots of olive oil, fish, vegetables,
homemade yogurt and cheese, herbal teas and some wine.
Although she has never been to a gym, she is not a stranger to

physical work, as she works part-time at the family owned
vineyard, giving her opportunities to commune with nature.
Growing up, Sofia visited the local doctor less than seven times in
her life. Her grandparents are in their late 80’s and memories are
as sharp as a tack. In fact, she will, like them, be likely to live to a
similar ripe old age, as her island, as part of the Balearic Islands,
18
Spain9 has graced the highest life expectancy rate lists a few times.
They also boast about 24% fewer cases of cancer; similar trends
are observed for heart disease, loss of memory (Alzheimer’s) and
other degenerative diseases.
Now let us compare Alina’s lifestyle. She is also 23 years old, was
born in New York, and was introduced to the world via a C-
section. Her mother had trouble breastfeeding her so she was
bottle-fed a soy-based baby formula, which was quite common at
the time. By the time she was 3 years old, it was quite common
for her to have three to four antibiotic prescriptions per year for
ear and eye infections, scratchy throat, and stomach flu.
Throughout her school, and now college days, she has been
dependent on fast food take-outs. She is overweight and at a risk
of heart diseases that run in her family.
Social anxiety has also been a common challenge for her and has
been considering visiting a psychiatrist to see if she can get help
with her depression.
What is going on here? The answer lies in the vast lifestyle

differences of these two young women, and the impact they make
on their microbial communities, who in turn have a dominating
impact on the whole human system. Microbial communities
comprise of microorganisms that are indigenous part of a human
body and involved in several key biological processes such as
digestion.
9
https://www.thinkspain.com/news-spain/16414/pep-102-says-secret-to-
longevity-is-being-happy
19
Thanks to the new scientific developments, we are now able to
understand the connection between various factors that affect
our health, one being the microbiome – trillions of
microorganisms that live inside our gut and play vital roles in
maintaining health by controlling digestion and benefiting the
immune system.
I have exercised creative license in this theoretical scenario, and

there are numerous things that contribute to good health, long
life, and risk for certain diseases. But let us zero in on the fact that
the American girl’s early life experiences casted a significantly
different health path as compared to the Spanish girl. For
instance, the leading killers in the U.S are related to chronic
illnesses, such as the heart disease, rarely seen on Spanish islands,
although these were not part of Dan Buettner’s ‘Blue Zones’, a
book he authored in 2012.
Blue Zones
Blue Zones are regions of the world where Dan Buettner

claims people live much longer than average. The term first
appeared in his November 2005 National Geographic
magazine cover story, "The Secrets of a Long Life". Buettner
identified five regions as "Blue Zones" (a term he
trademarked): Okinawa (Japan); Sardinia (Italy); Nicoya (Costa
Rica); Icaria (Greece); and among the Seventh-day Adventists
in Loma Linda, California. He offers an explanation, based on
data and firsthand observations, for why these populations
live healthier and longer lives than others.
20
Despite not being mentioned, Spain is also on track to have the
world's longest life expectancy by 2040, with a lifespan of 85.8
years, surpassing Japan10.
I am quite confident that when science shows conclusive results

between these two vastly different places, and we can pinpoint
the causes of our health challenges here in the U.S., the human
microbiome will be at the forefront. I’ll prove to you that it’s as
crucial to your existence as water, food and air.
So, how do gut bacteria protect your health? One of the reasons
why the relationship between our species and the microbiome has
been described as interdependent is because of chemical
compounds (called metabolites) like butyrate.
In this case, our gut bacteria digest tough plant fibers for us and
turn them into a number of organic compounds, including “short-
chain fatty acids” (SCFAs), scientifically-proven health-promoting
molecules that are also an important energy source for the body,
providing anywhere from 5% to 15% of a person’s daily caloric
needs. Case-in-point, butyrate is a short-chain fatty acid that
provides fuel for the cells of our gut lining, supports immune
system functions of the colon wall, and protects against certain
diseases of the digestive tract. There are other SCFAs as well, such
as acetate and propionate, but the benefits of butyrate are
particularly well-researched.
Metabolites
10
https://www.thelancet.com/action/showPdf?pii=S0140-
6736%2818%2931694-5
21
Metabolites are intermediate products of the various
reactions that naturally occur within our cells. Microbes use
metabolites to regulate the environment in which they live,
and from this platform they control the function and shape of
much of the world’s biodiversity.
On the one hand, metabolites prevent disease-causing

organisms from invading our body’s cells by killing them
directly, resisting their colonization and internalization, or
inducing indirect immune responses. However, on the other
hand, metabolites are also involved in processes that
contribute to infection. Some metabolites serve as signaling
molecules to activate bacterial quorum sensing that allows
bacteria to produce toxins and form biofilms. This promotes
the invasion of disease-causing organisms by activating the
expression of certain factors that enhance their ability to
cause infections.
More importantly, these mechanisms also share common

characteristics. First off, the interaction between metabolites
and the membrane of disease-causing organisms is of great
significance. Secondly, metabolites also activate many immune
factors to defend against these organisms. These two common
characteristics may provide ideas for further exploring the
regulation of metabolites and disease.
However, we also found some problems in these studies. The

reasons for the diverse effects of some metabolites on
disease-causing organisms are still unclear, and we speculate
that this is related to the difference in their growth stages.
22
Butyrate has various benefits at many levels, ranging from
macroscopic (that you can visibly identify) to genetic, where it
helps regulate the function of a number of genes involved in
inflammation and immune response. It is the main fuel for cells
lining the gut, known as “colonocytes”, providing up to 90% of
their energetic requirements. In other words, butyrate helps these
cells fulfil their functions correctly, thus maintaining the integrity
of the gut lining, called “mucosa”. In fact, “several studies have
linked impaired butyrate metabolism with mucosal damage and
inflammation in patients with inflammatory bowel diseases,
including ulcerative colitis and Crohn's disease”.
As demonstrated on mice, these cells, when deprived of energy,

start to deteriorate; however, they can be rescued by increased
consumption of butyrate.
Butyrate is starting to sound important now, right? And there’s

more. Butyrate functions as “HDAC inhibitor”, meaning that it
performs anticancer and anti-inflammatory functions by
suppressing the activity of specific immune cells. These functions
are believed to contribute to its role in preventing colorectal
cancer and inflammation. Furthermore, by reducing the
inflammatory capacity of the gut, it creates an environment that
allows the microbiome to exist within humans without stimulating
an acute immune response.
Butyrate is also an antioxidant; it protects cells from charged

electrons capable of damaging the body (free radicals. It helps
maintain gut health by promoting the growth of microscopic
finger-like extrusions that line the intestines (called villi), and
enhancing the production of mucin, a gel-like substance that coats
23
the inside of the gut. These mechanisms explain how it helps
maintain the integrity of the bowel wall, known as the "epithelial
defense barrier" that prevents bacteria, toxins, and other
substances from being absorbed into the bloodstream from the
gut. It has been shown to help the colon (large intestine) absorb
electrolytes (minerals such as calcium, potassium, magnesium
etc.) that are essential for many physiological processes and may
be beneficial in the prevention of certain types of diarrhea.
Butyrate also regulates natural movements of the gut to facilitate

movement of food through it (colonic motility) and increases
blood flow in the colon.
Members of the Firmicutes phylum, a classification of bacteria, are

particularly known for their butyrate-producing capacities.
Research shows that by increasing the number of specific
prebiotics in your diet (foods that nourish the microbiome
directly), you can nourish and optimize the ratio of commensal
bacteria that produce butyrate. Moreover, prebiotics also contain
dietary fiber that passes through the body undigested to feed the
microbiome living in your colon.
Hence, enhancing your microbiome through food is an effective

and safe way to promote digestive health and butyrate
production. The best way to optimize butyrate production is to
adopt a high-fiber diet that will encourage butyrate-producing
bacteria of the microbiome in your colon. But it’s important to
remember that every person’s microbiome is unique, and each
bacterium has its own preferred source of prebiotics.
24
So, what does all this teach us? We have evolved with a
microbiome, and it’s essential we take care of it, keep it healthy,
and eat to feed it correctly. Put simply, they oversee our health.
Once the gut is healed and optimized, everything becomes easier
to address.
Talking about the abundance of this microbiome, it was earlier

thought that the gut microbiota comprised 500-1000 species of
microbes11, a recent large-scale study has estimated that the
collective human gut microflora is composed of over 35,000
bacterial species12. Furthermore, if defined from a perspective of
total bacterial genes, the Human Microbiome Project, and the
Metagenome of the Human Intestinal tract (MetaHIT) suggest that
there could be over 10 million different genes in the human
microbiome.
The majority of the gut microbiota is composed of five phyla,

namely Bacteroidetes, Firmicutes, Actinobacteria, Proteobacteria,
and Cerrucomicrobia, in which the relative abundance of
Bacteroidetes and Firmicutes phyla is about 90%13. Scientists
when comparing the gut microbiota of obese and lean people
revealed higher Firmicutes and lower Bacteroidetes proportion in
11
https://scholar.google.com/scholar_lookup?
journal=J+Clin+Gastroenterolandtitle=The+normal+bacterial+flora+of+the+hum
an+intestine+and+its+regulationandauthor=B+Ramakrishnaandauthor=S+Krish
nanandvolume=41andpublication_year=2007andpages=S2-S6and
12
https://scholar.google.com/scholar_lookup?
journal=Proc+Natl+Acad+Sci+USAandtitle=Molecular-
phylogenetic+characterization+of+microbial+community+imbalances+in+huma
n+inflammatory+bowel+diseasesandauthor=DN+Frankandauthor=Amand+AL+S
tandauthor=RA+Feldmanandauthor=EC+Boedekerandauthor=N+Harpazandvolu
me=104andpublication_year=2007andpages=13780-
13785andpmid=17699621and
13
25
obesity, and opposite was found in people after 1-year diet
therapy14.
Most of this population can be found inside the gut, and 80% of
the immune system is in the gut. This might sound weird, like
something out of a sci-fi movie. But the research is clear: Your
gut’s bugs may as well be considered an organ in their own right.
And they are just as vital to your health as your own brain, lungs,
liver, and heart.
Interestingly, people with particular diseases have a particular

pattern of microbiome. If we have a problem in the microbiome,
such as an unhealthy ratio of types of bacteria, it is called
“dysbiosis”. Many diseases are now linked to dysbiosis. For
example, patients with Multiple Sclerosis (MS) – an immune
condition that affects the brain and spinal cord – have a consistent
pattern of bacteria that is unique only to such patients.
For instance, Firmicutes, mentioned above as well, is labeled as a

“fat-loving” bacteria and the natural decision would be to
minimize its population as much as possible, the Firmicutes-to-
Bacteroidetes (or F/B) ratio is critical for determining health and
risk for illness. Moreover, higher levels of Firmicutes turn on genes
that increase the risk for obesity, diabetes, and heart disease
The structure of our microbiome depends on various factors: the

method of our birth, whether we were breastfed or bottle-fed, the
antibiotics we have had over time, the food we eat, stress,
hormone levels and much more. But as mentioned before, we can
14
https://www.nature.com/articles/4441022a?source=post_page
26
change the microbiome quite quickly through diet and other
interventions.
Apart from just maintaining gut health, your belly’s bugs also play
a role in preventing heart and related degenerative diseases. And
this role is more important than you ever imagined.
Although having an in-depth knowledge of the gut-heart

connection requires an understanding of heart (cardiology),
immune system (immunology), disease pattern (pathology),
neurons (neurology), and hormones (endocrinology),, I will
simplify it for you. You will continue to build and reinforce this
knowledge base as you read upcoming chapters.
Gut-heart communication is best demonstrated in the everyday

phenomenon of getting butterflies in the stomach on a first date,
nervousness on a job interview or stage fright during public
speaking. The microbiota, the gut, and the brain communicate
through the microbiota-gut-brain axis in a bidirectional way that
involves part of the nervous system (autonomic) controlling bodily
functions that are not consciously controlled, such as breathing
and digestion). “Although the gut microbiota can communicate by
endocrine and immune pathways, perhaps the fastest and most
direct way for the microbiota to influence the brain is by hijacking
the major nerves supplying to heart, lungs and digestive system
(vagus nerve signaling), writes Christine Fulling and colleagues
from APC Microbiome Ireland — the research center that
pioneered the microbiota-gut-brain axis.
Often referred to as the "second brain," this neural network is so

sophisticated that the gut continues to function even when the
primary neural channel between it and the brain, the vagus nerve,
is severed. The gut is so independent, that it is the only organ to
27
boast its own independent nervous system, referred to as the
enteric nervous system – an intricate network of 100 million
neurons embedded in the gut wall. This complex neural system is
capable of not only controlling muscles, immunity, nutrition
absorption, but also hormones; up to 95% production of the
happy chemical called serotonin is attributed to this system. And
not only does it produce serotonin, it also responds to it and other
similar hormone that the brain uses to regulate mood and
cognition, such as GABA, norepinephrine (adrenaline), dopamine,
acetylcholine, and melatonin. Many neurologists and psychiatrists
are now realizing that this may be one reason why
antidepressants are often less effective in treating depression
than dietary changes are.
Moreover, this information also helps to review the body's

reaction to stress – your system starts to be flooded with
adrenaline, steroids, and inflammatory markers (called cytokines),
to prepare your body for fight or flight response. On a short-term
basis, this response can save your life. But what if your system is
frequently under stress? In such cases, your body would produce
a prolonged immune reaction, resulting in chronic (long-lasting)
inflammation, which creates a domino effect and gives rise to
diseases such as the loss of memory (dementia), depression,
autoimmune disorders, heart problems and even cancer.
So, what role does your gut microbiome play here? Simply put, it
manages the immune system. In other words, it has a significant
role in the story of inflammation in your body. Let me break this
down a bit more for you.
Our body constantly defends us against invaders, such as viruses,

bacteria, and foreign bodies. This is possible through our
28
immunity system, which when compromised can cause wide-
spread damage. At the same time, it is important to recognize
that the immune system functions optimally when it is in balance.
When the immune system overreacts, the result is an allergic

reaction. When it is misdirected, the immune system goes awry
and attacks the body itself. This causes conditions called
autoimmune diseases and can impact the health of microbiomes.
As mentioned earlier, the gastrointestinal tract (GIT) represents

almost 70% of the entire immune system. It is rich with immune
cells (called lymphocytes, a type of white blood cells) and is
therefore called a lymphoid organ. Together with the lymphoid
tissue, the GIT lymphoid organ iss collectively referred to as the
gut-associated lymphoid tissue (GALT).
You might ask: why is the biggest percentage of our immunity

here? The answer: the intestinal wall is the border where effective
communication with every cell in the body takes place. Since the
wall is only one cell thick, this is where chances of foreign material
and organisms entering our body are highest. If a problematic
substance arrives, the gut alerts the rest of the immune system to
be on guard.
For this particularly important reason, we cannot emphasize

enough about the importance of retaining the integrity of the
delicate intestinal wall. It must remain intact while acting as a
conduit for signals between the gut bacteria and the immune
system’s cells.
Now, if for some reason this barrier is breached, our body’s

defenses come into play. These immune defenses are of two types
– innate and adaptive. The innate immune system is our first line
29
of defense. It has special molecules that recognize patterns in
proteins or genetic material that are only present in pathogens
(invading organisms). These molecules signal the presence of a
pathogen to the cellular genetic machinery, which then produces
effector molecules (molecules that act in response to a signal) that
initiate different processes to eliminate the pathogen.
The innate immune system is primitive and probably evolved

earlier in invertebrates and lower vertebrates. The innate immune
response has universal effects on the entire human body; every
cell can be considered a factory housing some components of the
innate immune response. Innate immunity starts at the cellular
level through conserved pathogen sensing proteins. Infected cells
secrete inflammatory molecules called cytokines and chemokines.
Cytokines such as interferons are molecules that signal
neighboring cells and induce an antiviral state in them. These cells
are then informed to resist an infection with the invading virus.
Cytokines also activate anti-viral genes in the infected and
neighboring cells. These genes are called interferon stimulated
genes (ISGs), since they are only made in the presence of
interferons.
The second type of response, known as the adaptive immune

response, kicks in at a later stage. Its job is to mount a much more
robust defense by destroying cells infected with a virus, or by
neutralizing the virus or toxins produced by bacterial pathogens.
The adaptive system also has ‘memory’, meaning that it activates
very rapidly if it encounters the same pathogen again. The innate
and adaptive immune systems are linked, and the innate system
primes the adaptive branch of immunity for a more robust
immune response.
30
The role of the microbiome in these scenarios is to help keep the
immune system watchful, but not in a needlessly aggressive
mode, triggering autoimmune responses.
The division between “good” and “bad” bacteria is not all black
and white. There are plenty of grey areas in between. Take E. coli,
for example. Most E. coli strains are beneficial to humans. They
live in our intestines and produce important vitamins, such as
vitamin K and B-complex vitamins, which we absorb. However,
there is one strain of E. coli which is very harmful to humans:
strain O157:H7. It is notorious for causing life-threatening
conditions involving bloody diarrhea and dehydration.
Another example is the common bacterium Streptococcus

pneumonia, which can suddenly switch from good to bad. It
dwells harmlessly in people's nasal cavities; however, when the
body responds to a flu virus by raising the temperature and
releasing stress hormones such as norepinephrine, the bacteria
react in turn to those changes in their environment. They disperse
from their colonies and begin expressing different genes that
make them more deadly to respiratory cells 15causing pneumonia,
which is the leading cause of childhood death worldwide.
So, what can make well-behaved microbes turn rogue? How does
the microbiome get obstructed? Commonly, antibiotics are the
most common culprit, and most common autoimmune diseases
can be traced back to the course of antibiotics. Some doctors even
prescribe antibiotics for viral illnesses, even though it is well
known that antibiotics are useless against them..
15
Breaking Bad, Bacteria-Style" in Scientific American 309, 6, 18 (December 2013)
doi:10.1038/scientificamerican1213-18
31
Body on Fire: New Information about Inflammation
Mr. D. B. was 85 when he succumbed to heart disease. He was

under my care for over 25 years and had type 2 diabetes, which
was mostly controlled with diet, oral medications, coronary
arteriosclerosis (major blood vessels supplying the heart become
damaged or diseased), and later also developed and aortic
stenosis (reduced or blocked blood flow from the heart into the
main artery and to the rest of the body). and
By and “fine tuning” his medications and adjusting his lifestyle, he

would always escape hear failure. Progressively, however, his
aortic stenosis got critical, with an aortic valve area of less
than .75 cm2 remaining. His options were discussed with him, one
of which was to replace his valve by a catheter- based procedure
known as Transcatheter Aortic Valve Replacement (TAVR). This is
a minimally invasive procedure used to replace the narrowed
aortic valve that does not open properly. He pleaded with me not
to send him for this procedure, and instead to monitor his
condition by doing an echocardiogram (test that uses ultrasound
to check if heart muscles and valves are working properly) every 6
months, to which I agreed.
While I was away, another doctor was taking care of him. Mr. D.B
had another bout of heart failure. When he improved, he wanted
to go home, but the doctor recommended TAVR again. This time
he agreed. But unfortunately, a complication arose during the
procedure and Mr. D.B was rushed to the operating room, where
he died due to uncontrolled bleeding.
Now this case elucidates a few points. First, should we offer all
procedures available to our patients simply because they can
32
afford them or might require them? Yes, this was indicated in this
setting, and I’m not blaming the health care professionals. In our
profession we are always weighing the benefits and risks of any
treatment. But could an in-depth discussion with Mr. D.B have
yielded the same response from him as I did? and Or, could he
have been better off with palliative care which he already
receiving for the last 2 years of his life?
Secondly, could we have postponed or avoided all the

complications of inflammation in this case, namely, diabetes,
coronary atherosclerosis, and aortic valve disease and heart
failure? At that age, his life expectancy had already surpassed
actuarial data.
Medical organizations, government agencies and medical societies

have had serious discussions about prohibitive costs and reduced
productivity, but no noticeable difference has come about.
Unfortunately, this pattern is not just here in the U.S but is now a
global phenomenon. Most recent data indicate that health care
takes 17% of gross domestic product, GDP and is only bound to go
up with increasing incidence of chronic illness.
As heart disease remains the number one killer in the world, we

must do our part as individuals to prevent the fate Mr. D.B had.
The program I have outlined in this book, which I am very hopeful
can make a difference, one person at a time. If we can encourage
our patients to live a healthier lifestyle, as we will discuss in this
book, not only would they live longer but, they could also avoid
the complications of the chronic illnesses they might develop with
time.
33
So, the question arises: what does inflammation have to do with
the microbiome? That is what we’re going to explore now. First,
I’m going to couch this discussion within the context of heart
failure, arguably the most dreaded heart ailment of all, which will
help you understand the undeniable connection between the
state of your gut’s microbial community and the fate of your
heart. Then, I’ll discuss similar connections between inflammation
and obesity, diabetes and other degenerative illnesses, which if
left to progress, can possibly lead to heart failure.
Heart failure is expensive. It affects some 6.2 million Americans,

and the cost for the average heart transplant, can reach $1.4
million16. This does not include the emotional expense borne by
family members whose lives are somberly compromised by this
disease.
Adding to this disturbing “wallet biopsy” is a trend of ineffective

and harmful medication used for treating heart failure. For drug
therapy, statins, a group of drugs that act to reduce levels of fats
in the blood, including triglycerides and cholesterol, remain the
first-line of defense for patients who are at high risk for a
cardiovascular event. Although currently approved by the Food
and Drug Administration (FDA) for treating heart failure, they are
not only ineffective but are also associated with severe life-
threatening side-effects, such as a decline in kidney function17.
Financial factors and the market are large obstacles for people
trying to resolve health issues. Since making a profit off of diet and
lifestyle changes is meager, not a lot is spent on spreading this
message, like it is done for drugs by the Big Pharma. Instead of
16
https://fortune.com/2017/09/14/organ-transplant-cost/
17
https://ora.ox.ac.uk/objects/uuid:7dbdb6a9-d8bf-42bc-bf66-db346e75dc5e
34
investing time and money into expensive and irrelevant
treatments for heart failure (or any degenerative ailment, for that
matter), we must focus on educating people about preventive
efforts. These preventive strategies are already well documented
in high-profile scientific literature and can have a revolutionary
effect in slashing the number of new heart failure patients in the
U.S. by more than half. And when you consider that the number
of people stricken with heart failure is predicted to double by the
year 2030, spreading the word about this information should be
top priority.
Let’s consider an example of how a major lifestyle change can

help resolve health issues: the stunning correlation between high
blood sugar and risk for heart failure.
Blood sugar, also known as blood glucose, is directly affected by

what we eat. Consuming excess of refined sugars and
carbohydrates makes it hard to control blood sugar.
In 2020, the Journal of the American College of Cardiology

published a study showing that the substitution of margarine,
mayonnaise, etc. with olive oil could lead to lower risk of coronary
heart disease and total cardiovascular disease in U.S. men and
women18. As reported in 2015 in the European Heart Journal:
Results of a large study show that even if someone arrives at the
hospital with no prior diagnosis of diabetes, and with blood sugar
levels within a range that could be considered as “normal”, they
are at higher risk of developing diabetes and early death 19.
18
https://www.sciencedirect.com/science/article/abs/pii/S0735109720343321?
via%3Dihub
19
35
For the study, researchers analyzed the results of 16,524 people
who arrived at hospital emergency departments in Ontario,
Canada, with acute heart failure between 2004 and 2007. The
patients were aged between 70-85 and 56% (9,275) of them did
not have pre-existing diabetes.
Associate Professor of Medicine, Dr Douglas Lee, senior scientist

at the ICES who led the research, said:
“Among patients without pre-existing diabetes, the majority (51%)

had blood glucose levels within ‘normal’ limits on arriving at the
hospital. Our results suggest that all such patients should undergo
further testing for diabetes before discharge. If the hospital tests
show that fasting blood glucose is not elevated, then they should
be monitored subsequently for the development of diabetes as
outpatients.
Implications of research like these has the potential to

revolutionize the current medical industry. It is time that we take
a new road and champion preventive medicine, especially for
heart health. An ounce of prevention is better than a pound of
cure. Rather than spend astronomical amounts of funds to find
cures, we need to practice and educate people about taking steps
for early prevention.
Having discussed the heart, now let’s explore inflammation, then

circle back to the underlying power of your gut bacteria.
Inflammation is our body's natural response to any harmful

invader, injury or poison.
There are three main stages of inflammation which vary in

intensity and duration:
36
1. Acute or “Screaming Inflammation”. This occurs immediately
after an injury.
2. Sub-acute Inflammation. This phase begins after the

termination of the inflammatory phase.
3. Chronic or “Silent Inflammation”. This involves scar tissue

maturation and remodeling.
These stages are the body’s natural healing responses and bring
more immune activity to the place of injury or infection. But,
when they linger on even after their purpose has been served, it
causes illnesses, such as diabetes, cancer, depression, autism,
asthma, arthritis, multiple sclerosis, Parkinson’s and even heart
attack.
After extensive research, chronic inflammation has now been

implicated in most chronic diseases as heart disease, diabetes,
metabolic syndrome, obesity and insulin resistance. The landmark
article by Dr. Ross PhD in 1999 titled “Atherosclerosis, an
inflammatory disease”, was the first to formally propose this.
In 2000, a major study linking inflammation to heart disease

identified CRP (C-reactive protein) as an inflammatory marker
(used in primary care for diagnosing and
monitoring inflammatory conditions). Those with highest CRP
levels had 5 times the risk of developing cardiovascular disease
and 4 times the risk of heart attack or strokes as compared to
individuals with lowest levels. This finding is also consistent with
the fact that more than half of heart attack patients have normal
cholesterol levels, hinting that something else is going on
37
The medical professions’ obsession with total cholesterol or even
LDL has been misplaced. According to prominent cardiovascular
surgeon, Dr. De Bakey: “Cholesterol is an innocent bystander that
got caught up in an inflammatory reaction in the surface of the
blood vessels.” To further reinstate this, in a study of 68,000
elderly patients, no connection was found between LDL (low-
density lipoproteins or bad cholesterol) and all-cause mortality.
(death due to a particular cause or disease).
A more predictive indicator of heart health is the ratio of HDL

cholesterol to triglycerides. More recent The China Study also
showed that there is no connection between saturated fat intake
and heart disease. This famous study looked at 55 rural
communities in China in the 1990s, and revealed no association
between cholesterol consumption, cholesterol levels and heart
disease. But high triglyceride levels are positively related with
heart disease, which are produced by high intake of sugar and
refined carbohydrates.
This preoccupation with cholesterol was particularly exacerbated

by statin makers exaggerating their benefit and downplaying their
side effects. In an article by David Diamond of the VA hospital in
Tampa Florida and Uffe Ravnskov, an independent researcher,
titled “The great statin deception” they analyzed data from some
of the biggest statin trials and concluded: “The drug company
funders use statistical deception to create the illusion that statins
are wonder drugs, when in reality their modest benefits are more
than offset by the numerous adverse effects of statin treatment.”
This is not to mention the conflict of interest exerted by statin
makers on policy makers recommending statins into the
guidelines. This was an eye-opening expose.
38
CHAPTER 2
39
Heart, Inflammation and
Microbiome
We have been taught since a young age that to fight heart disease
we must eat healthy and exercise. Cereal boxes are plastered with
"heart healthy" seals of approval and promises of decreasing
cholesterol. Schools even wage campaigns to teach children just
how important it is to take care of their heart.
Even with country-wide education and significant advances in

modern medicine, the last decade has shown an increase in the
number of people affected by heart disease with rates continuing
to climb, as mentioned in detail in the previous chapter. It makes
you wonder: Is eating 'healthy' and exercising really enough to
prevent heart disease?
Back in 1999, when the connection between inflammation and

heart disease was not well-known, I participated in a study whose
purpose was to show that inflammation causes atherosclerosis
(deposition of fats, cholesterol and other substances inside and on
the artery walls)20. We have come a long way since then, as
scientists have learned that long-term, persistent inflammation in
the body can actually lead to heart diseases and potentially fatal
coronary events such as heart attacks.
This evidence, and growing research, points towards two factors

involved in heart health: inflammation, and dysbiosis (microbial
imbalance or maladaptation inside the body).
20
https://www.acc.org/latest-in-cardiology/clinical-trials/2018/11
/08/23/16/cirt
40
So, how does the gut potentially contribute to heart disease? 21
First, bacteria that should be found only in the colon can migrate
to the small intestine and cause problems. Second, when we eat a
high protein diet, bacteria work on it and make lots of harmful by-
products, which are linked to heart conditions. And third, when
particularly troublesome bacteria leak through the intestinal lining
into the bloodstream, it can cause widespread inflammation.
Let's take a closer look at the risk factors of heart diseases; high
blood pressure, high cholesterol, and smoking. Almost half of all
Americans have at least one of these factors 22. And a quarter of
the American population is expected to have small intestinal
bacterial overgrowth (SIBO), but for those who have irritable
bowel syndrome (IBS) this is seen in up to 78% people (IBS is a
chronic condition of the digestive system with bouts of stomach
cramps, diarrhea/constipation and bloating). What researchers
are trying to find is the association between heart disease and the
gastrointestinal condition. Yes you read that right, a link between
heart and gut diseases.
A 2018 study published in the journal Digestive Disease and

Sciences, showed that patients with SIBO had 80% more risk of
having heart disease23, and had more numbers of affected
coronary arteries. SIBO is also associated with deep vein
thrombosis (when a blood clot forms in one of the deeper veins in
the body)24. This is possibly due to a lipopolysaccharide (LPS). It is
21
https://consultqd.clevelandclinic.org/researchers-discover-gut-heart-
connection-in-coronary-artery-disease/
22
https://www.cdc.gov/heartdisease/facts.htm
23
24
41
a toxin present in the outer membrane of gram-negative bacteria
(a classification of bacteria); if LPS manages to leak from the gut, it
can cause inflammation throughout the body.
So, the studies suggest that the composition of microbiome and

certain toxins produced by them possibly raises the risk of
developing heart disease.
Another bacterial metabolite under investigation is

trimethylamine N-oxide (TMAO). When certain gut microbes use
choline, a vitamin found abundantly in eggs, red meat, poultry,
and fish, they produce trimethylamine (TMA). TMA can then be
converted into TMAO, which links with plaque formation in
arteries (atherosclerosis). A review of 19 studies published in the
Journal of the American Heart Association confirmed that high
TMAO levels are associated with higher risk of heart disease, and
people with higher levels of blood TMAO were 62% more likely to
have heart conditions25.
High TMAO levels are also linked with higher mortality (death)
rates, independent of other linked risks such as kidney disease,
diabetes, and obesity. This means that TMAO levels need to be
considered when assessing the risk of developing heart diseases.
25
42
A disrupted gut lining could be the third potential underlying
cause of cardiovascular disease. When the gut lining weakens, it
becomes permeable or 'leaky.' A leaky gut allows particles such as
food and bacteria to move into the bloodstream causing
inflammation and allergies. This is especially problematic when
there are lipopolysaccharides (LPS) present. When large amounts
of LPS enter into circulation, it can lead to systemic inflammation,
causing a cluster of symptoms called metabolic endotoxemia
(when blood serum levels of LPS increase two to three times that
of the normal amount.)26.
In short, a leaky gut lining can increase the risk of LPS entering
into circulation, which can lead to metabolic issues and contribute
to the likelihood of cardiovascular disease and mortality.
Another interesting fact is that certain microbes have been found

in artery plaques of patients with heart disease, and for years,
scientists couldn't figure out how they got there. One hypothesis
was an impaired gut lining; certain microbes moved into the
bloodstream and relocated within artery walls, causing
inflammation and contributing to heart disease. However, more
research is needed to strengthen this connection.
In addition to the toxins, the gut microbiota also produce heart

protective chemicals, called the short-chain fatty acids (SCFAs).
As mentioned in the beginning of chapter 2, SCFAs such as

butyrate, are mostly made only by the gut microbiome 27. SCFAs
are actually more important than we previously thought, studies
show that these are involved in blood pressure regulation along
26
27
43
with other important routine functions28 to a point that it was
suggested future treatments for cardiovascular disease and high
blood pressure should be focused on improving the gut
microbiome29.
When it comes to nutritional elements, meat is a double–edged

sword. An example of its nutrients is choline. As mentioned above,
it is a vitamin that supports cellular growth, metabolism, memory,
learning and concentration. It is usually found in foods like meat
(obviously), eggs and milk; it can be taken as supplement, and
then the body can also make a little choline. It was officially
recognized as an essential nutrient in 1998 by the Institute of
Medicine. Choline and betaine, another vitamin, has been seen to
reduce inflammation in the Greek population. The effects of these
vitamins are assessed by some biomarkers in blood, and the
effects are close to those seen with Mediterranean diet- a plant-
based diet with lots of dairy, poultry, eggs and seafood.
But moderation is the key; too much and too little of anything can
cause problems. As discussed previously, excess choline leads to
excess trimethylamine N-oxide (TMAO) production by bacteria.
Choline also promotes the formation of clot, correspondingly, high
blood TMAO levels are associated with a raised risk of heart
attacks and strokes.
18 men at average age of 46 years, with or without risk of heart

disease, volunteered for a study. They were vegan, vegetarian or
omnivore. They were given 500 mg choline bitartrate supplements
twice daily for two months, compared to average intake of 302 mg
per day. Results showed that the blood level of TMAO rose more
than 10 times after taking the supplements and the tendency of
28
https://www.health.harvard.edu/heart-health/healthy-gut-healthy-heart
29
44
platelets to form clots also rose with the choline supplementation
but it was countered by aspirin.
Dr. Stanley Hazen, one of the authors for this study, called for
more aggressive cardiovascular disease risk reduction efforts
worldwide for those with elevated TMAO levels. This study
provides additional evidence for the harmful effect of TMAO in
the risk of a thrombotic event (formation of blood clots), Hazen
explained. It also shows that a low dose of aspirin can reduce
TMAO levels and helps reduce the risk of blood clots.
Dr. Hazen’s advises those with high TMAO levels to try reducing
the cardiovascular risk by exercising, dieting, cutting out read
meat, increasing vegetarian meal options, and avoiding
supplements which contain choline (unless prescribed). The study
was published in the American Heart Association journal,
Circulation.
However, the Council for Responsible Nutrition (CRN) stated that
due to lack of information and limitations of the study, meaningful
conclusions cannot be drawn about the effects of dietary choline
on cardiovascular disease. Cardiovascular diseases are
multifactorial and must be assessed considering the context of
lifestyle, genetics, and environmental factors. Further, it is
important to note that choline is an essential nutrient; it is
synthesized only in small amounts in the human body, and
therefore, it is mainly obtained from the diet, including
supplementation, which permits knowing exactly how much
choline is added to the diet30. This whole discussion is making me
say think twice before you pile up meat on your plate.
30
Source: Circulation\u200bGut Microbe-Generated Trimethylamine N-
Oxide From Dietary Choline Is Prothrombotic in Subjects Authors: Weifei
Zhu, Zeneng Wang, W. H. Wilson Tang, Stanley L. Hazen,\n",
45
Coronary Artery Disease (CAD)
Let’s take a look at the most common heart disease – coronary

artery disease – which is also the main cause of death
worldwide31.
CAD occurs when plaque builds up on the walls of the arteries,

impeding the flow of blood to the heart – a condition called
atherosclerosis.
The center of a “glob” of plaque is made up of tightly packed, fat-

filled cells and fat droplets. The top of this core is a more rigid
“cap” layer made of fibrous protein molecules.
31
National Heart, Lung, and Blood Institute - 2017 Jun;18. Coronary Artery
Disease
https://www.ncbi.nlm.nih.gov/pubmed/28286336
46
Now, imagine that someone’s arteries that supply the heart (the
coronary arteries) are lined with a reasonable amount of plaque.
The flow of blood to the heart is somewhat restricted, but not
severe enough to cause a major coronary event like heart attack.
But this situation changes drastically if chronic inflammation is
present in the body. Chronic inflammation fills the blood with
inflammatory response molecules, some of them can
biochemically “slice apart” harmful particles (like bacteria). These
chemicals can also rip away the firm “cap” of a plaque structure
and rupture the plague, spilling out all the debris which can seal
off the artery entirely and close off the blood flow to the heart
abruptly. The result: a heart attack.
About 735,000 people have a heart attack each year in the US. The
CDC estimates that heart disease causes 1 in 4 deaths in the US
every year; that’s 610,000 per year.
In the US, 1 in 4 males has some deposition in their arteries by 45

years, which is same for women when they reach 55. That is a big
number. However, heart disease is one of the most preventable
causes of death in the US. Apart from a few genetic factors, the
disease is mostly attributed to lifestyle factors, such as poor diet,
lack of exercise, smoking, alcohol or drug abuse, and stress.
47
An important question is: has the disease always plagued us, or is
our modern lifestyle to blame? Looking back at the history of
heart disease might be a surprise for you.
An American Heart Association conference in 2009 had a

presentation about 3,500 years old rich Egyptian mummies that
possibly lived with the same blocked arteries as modern humans.
A group of scientists performed CT scans (medical imaging
procedure) on 22 mummies housed in the Egyptian Museum of
Antiquities in Cairo, the same scan performed today to look for
calcium deposits in the coronary arteries. The oldest mummy
diagnosed was that of Lady Rai, a nursemaid to the queen, who
likely died in her 30s and had the same calcium deposits. Though
it cannot be confirmed that these mummies died of heart disease,
the papyrus writings by priests who cared for these people, gave a
good description of chest pain (angina) and sudden death, hinting
that the disease did exist at the time.
What shocked everyone was that though poor diet was an

obvious link to heart disease in ancient Egypt, how much the
plaque had built up in these Egyptians before they even reached
50!
History continues; Hippocrates (469-377 BCE) described angina

and sudden cardiac death.
John Hunter (1728-1793), a distinguished British physician and

surgeon to King George III, suffered from angina. Discovering that
his attacks were often brought on by anger, he stated, “My life is
at the mercy of any scoundrel who chooses to put me in passion.”
William Heberden first described angina in medical literature in

1768. He believed it had something to do with blood circulation in
48
the coronary arteries (arteries supplying the heart). Edward
Jenner, his younger colleague, was the first to mention a clot in
the coronaries in a letter he wrote to Heberden.
William Osler (1849-1919), physician and professor of Clinical

Medicine at John Hopkins, worked much on angina and was the
first to call it a syndrome rather than a disease (syndrome is a
collection of symptoms).
The invention of the EKG (electrocardiogram) by Wilhelm

Einthoven of Leiden in the early 1900s advanced the study of
heart diseases. But the British clinical investigator Sir Thomas
Lewis, was the one who made the EKG an essential part in
diagnosing heart diseases of rhythm and blood flow, in 1922. A
clinical fellow from Boston, Paul Dudley White, studied with Sir
Thomas and brought and popularized the EKG to the US in the
1920s.
Later in 1912, American cardiologist, James Herrick (1861-1954)

also concluded that the slow, gradual narrowing of the coronaries
could be a cause of angina.
In 1924, multiple heart associations joined to form the American

Heart Association. These doctors were very concerned about the
disease. They knew little about it and the patients they saw had
little hope for treatment. A few years later, doctors began
exploring the coronaries with catheters and it later developed into
the procedure known today as left heart catheterization (with
coronary angiogram). This involves passing a thin flexible tube
(catheter) into the left side of the heart to confirm the presence of
coronary artery disease and need for further treatment.
49
In 1948, researchers of the National Institute of Health (NIH)
began the Framingham heart study, motivated by the death of
President Franklin Delano Roosevelt from hypertension, stroke
and chronic heart disease.
The term ‘atherosclerosis’ was added to the ICD (International

Classification of Diseases) in 1948.
In 1950s researcher John Gofman (1918-2007) and his associates

discovered LDL (low density lipoprotein or bad cholesterol) and
HDL (high density lipoprotein or good cholesterol). He also learnt
that men who developed atherosclerosis had high LDL and low
HDL.
In 1958, F. Mason Sones (1918-1985), a pediatric cardiologist at

Cleveland Clinic, developed the technique for making high quality
images of the coronaries.
In the 1960s-1970s, Coronary Artery Bypass Grafting (CABG)

surgery was invented which used the heart-lung machine and
cardioplegia (intentional and temporary pause in cardiac activity,
mainly for cardiac surgery). For the first time, surgeons were able
operate on the heart while it was still and use veins as bypass
vessels.
In the 1980s, Andreas Gruntzig started balloon angioplasty, and

later coronary stents were developed to prop open narrowing
arteries. Balloon angioplasty uses a specially designed catheter
with a small balloon that is carefully guided to the arterial
blockage and then inflated to widen the blocked opening
improving the blood flow to the heart. A stent is often also placed
in the artery during the procedure to keep it open after
the balloon is removed.
50
***
Heart Attacks
Two decades ago, researchers discovered that; high levels of

inflammation are linked with a higher risk of heart attack or
stroke, and when a blood clot blocks an artery to the heart, it
causes a heart attack.
What they didn’t know was whether controlling inflammation and

maintaining microbiome health could prevent or reverse those
events.
As discussed previously in detail, factors that can trigger

inflammation include; changes in the composition of gut
microbiota (dysbiosis), elevated levels of trimethylamine N-oxide
(TMAO) - derived from gut microbiota metabolites of choline, and
food and lifestyle choices. Also addressed previously, eating
Mediterranean diet/plant-based diet might help individuals lower
high levels of TMAO32.
Stroke
32
51
Sudden loss or interruption of blood flow to brain depriving it of
oxygen and nutrients leads to a stroke. This requires immediate
medical attention; if treated promptly, brain damage and other
complications can be prevented.
There are two types of stroke: (1) ischemic stroke – which

accounts for 80% of all stroke cases and occurs due to blockage in
the arteries which supply the brain; and (2) hemorrhagic stroke –
which occurs due to leaking or bursting of a blood vessel in the
brain. The main signs and symptoms of stroke include speech
difficulties, confusion, paralysis or numbness of the face, arm, or
leg, vision problem, headache, and troubled movement.
Inflammation plays an essential role in the natural treatment of

ischemic stroke33. During inflammation, cells such as white blood
cells, platelets, endothelial cells, and mast cells are activated and
start releasing pro-inflammatory mediators (substances that
promote inflammation) such as histamine, prostaglandin,
lysosomal compounds, and cytokines that trigger vasodilation
(dilation of blood vessels) and increase blood vessel permeability.
As a result, blood supply to the affected area increases, which, in
turn, brings more defense cells to the affected site and triggers
the healing process.
One of the largest and longest studies34 done to assess the

connection between Mediterranean-style diets and stroke
enrolled 20,000 adults, aged 40 to 77. They were asked to record
33
Inflammatory mechanisms in ischemic stroke: role of inflammatory cells
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2858674/
34
https://www.ahajournals.org/doi/10.1161/STROKEAHA.117.020258
52
what they ate in a seven-day diet diary, which was later compared
to their stroke risk over 17-years.
People whose diet most closely resembled the Mediterranean-

style diet, had a lower risk of stroke compared to other
participants in the study. The overall risk was 17% lower, but there
was a big gender bias in the risk reduction— 22% lowered risk for
women versus 6% for men.
There is more, the gut microbiota, they have a say here too. Think
how important they must be. Some of the first findings linking gut
microbes to stroke appeared a few years ago. A study in New York
City reported that interrupting the diversity of gut flora in mice
with antibiotics affected the brain damage caused by stroke35.
Another investigation on rodents by a German team in 2016
showed that strokes disrupted mouse microbiomes36 and these
disruptions could worsen outcomes after stroke.
More recently, a team at University Of Texas Health Science

Center, Houston, led by Venugopal Venna, a stroke researcher,
examined whether age-related changes to the microbiome affect
recovery. “Stroke is mainly a disease of aging,” Venna says.
“Young people also get stroke but much less often.” Reported in
Annals of Neurology37, Venna and his colleagues studied whether
age-related changes to the microbiome would influence recovery
in mice. They found that young mice with older microbiomes had
worse outcomes as compared to mice with younger intestinal
flora. This means mice with older microbiomes had higher death
rates, bigger brain damage, slower recovery, and higher levels of
inflammatory molecules.
35
https://www.nature.com/articles/nm.4068.epdf
36
https://www.jneurosci.org/content/36/28/7428
37
https://onlinelibrary.wiley.com/doi/full/10.1002/ana.25250
53
“The big question now is how does microbiome affect the stroke
outcome?” says Arthur Liesz, a neurologist at Ludwig Maximilian
University of Munich, (his group also authored the German 2016
study). There are multiple possibilities, some researchers are
investigating microbial metabolites, while Venna’s team is working
on short-chain fatty acids (SCFAs). Their 2018 study shows that
SCFAs were lower in animals with old microbiomes leading to the
theory that these might be involved in stroke recovery. To test this
theory, they placed some SCFA-making gut bacteria into mice and
found that these bacteria were enough to improve outcomes after
stroke.
Heart Failure
Heart failure, medically termed congestive heart failure (CHF),

refers to the set of symptoms due to failure of the heart to fill
with or pump blood.
The signs and symptoms vary according to severity; yet the
common ones are progressive shortness of breath, congestion or
tenderness of the upper abdomen, and swelling in the ankles or
legs.
The pumping function of the heart is assessed by the “ejection
fraction” (EF), which is the percentage of blood pumped out of the
heart with each heartbeat. Normal EF range is between 55%-75%;
anything below 50% is considered abnormal and this type of heart
failure is named ‘systolic dysfunction’. An EF of 41-49% is
considered mid-range, and if the EF is normal then it is referred to
as ‘diastolic dysfunction’.
Despite having a normal ejection fraction, heart failure can still

occur with diastolic dysfunction because the heart muscle is too
54
stiff to accept the normal volume of blood and, therefore, a
reduced amount of blood is supplied to and pumped out with
every beat. The treatment for both systolic and diastolic heart
failure is the same.
There are various reasons why the heart may not pump blood
effectively, such as a disease of the heart muscle (myocardium),
the sac that envelops the heart (pericardium), the lining inside of
the heart (endocardium), heart valves, blood vessels supplying the
heart (coronary arteries) or metabolic disorders such as diabetes
and uncontrolled hypertension.
From the point-of-view of microbiome, heart failure leads to

pooling of blood (congestion) in the organs area of the abdomen
(splanchnic circulation). This leads to bowel wall swelling (edema)
and compromised intestinal barrier function, which worsens the
overall inflammatory state through increased bacterial products in
the blood38.
Treating heart failure involves correcting reversible causes, if

possible. For blocked coronary arteries, stenting or bypass surgery
might be recommended. For heart valve disease, surgery or trans-
catheter intervention might solve the problem.
38
55
For cardiomyopathy (heart muscle disease from a known cause),
restriction of alcohol consumption is recommended.
Medical interventions include diuretics (pills that increase

urination), ACE inhibitors or ARBs or ARNI such as
Sacubitril/Valsartan. Your doctor may add a beta blocker and
Spironolactone.
From the patient’s perspective, self-care is very important. It

includes compliance to medication, weight monitoring to identify
water retention, lifestyle modifications such as smoking cessation,
alcohol restriction or abstinence, and restricting sodium intake to
3-6 grams a day.
Ultimately, the goal of any treatment for heart failure is to reduce

symptoms, improve quality of life and functional status, reduce
the need for hospitalization and reduce death rate.
56
Erectile Dysfunction
Erectile dysfunction (ED), or impotence, is the inability to achieve

and sustain an erection suitable for sexual intercourse. The
condition is not considered normal at any age. Premature
ejaculation, infertility, or low sex drive are not the same as erectile
dysfunction, but these conditions may be associated with ED.
Several studies have shown that if a man has ED, he is at a greater

risk of having heart disease. In a study, 57% of men who had
bypass surgery, and 64% of men hospitalized for a heart attack,
had ED at least at one point in their lives39. It is also reported that
having ED predicts that a man will develop heart disease
symptoms within five years40. ED is as much a risk factor for heart
disease as the history of smoking or a family history of coronary
artery disease. Moreover, data from large population-based
studies show that ED is also a significant predictor of all-cause
mortality (deaths due to cardiovascular ailments).
In 2015, scientists investigated the gut microbiome in men with

erectile dysfunction (ED) in Japan41. In one group, there were low
numbers of Alistipes while Clostridium XVIII was much higher,
which is pathogenic.
Alistipes is a culturable bacteria and believed to produce

sulfonolipid. Sulfonolipids act as competitor on the von
39
Thomson IM, Tangen CM, Goodman PJ, et al. Erectile Dysfunction and
Subsequent Cardiovascular Disease. JAMA. 2005;294(23):2996-3002.
40
Böhm M, Baumhäkel M, Teo K, et al. Erectile Dysfunction Predicts
Cardiovascular Events in High-Risk Patients Receiving Telmisartan, Ramipril,
or Both. Circulation. 2010;121:1439-1446.
41
57
Willebrand factor receptor and suppress tumor necrosis factor-
alpha (TNF-a), both of which are related to micro-inflammation
and vascular endothelial dysfunction.
Which Biomarkers are Ready For Prime Time?
Results from large scale prospective trials have showed the

usefulness of C-reactive protein (CRP, inflammatory marker) in
predicting adverse cardiovascular events42 such as myocardial
infarction (heart attack), ischemic stroke 43 (reduced blood flow
and oxygen to the brain), and sudden cardiac death44. In fact,
clinical tests such as High-Sensitivity CRP, have greater predictive
value of these conditions45 than LDL cholesterol46.
The 2013 American College of Cardiology (ACC)/AHA Guideline on

the Treatment of Blood Cholesterol to Reduce Atherosclerotic
Cardiovascular Risk in Adults stated that hsCRP may be considered
to guide treatment decision. Other biomarkers, such as IL-6
(Interleukin 6) or IL-1B (Interleukin-1 beta), have not been
recommended for extensive use outside of research protocols (153,
154) #3
.
Interleukin 6 (IL-6) Interleukin 1 beta (IL-1β)
It is an interleukin that acts Also known as lymphocyte

42
https://www.nejm.org/doi/pdf/10.1056/nejm200003233421202
43
44
https://www.atherosclerosis-journal.com/article/S0021-9150(01)00595-0/
fulltext
45
46
58
as both a pro-inflammatory activating factor and other
cytokine and an anti- names, is a cytokine protein
inflammatory myokine. In that in humans is encoded by
humans, it is encoded by the IL1B gene.
the IL6 gene.
ROLE OF MITOCHONDRIA IN CHRONIC DISEASES
Mitochondria are the energy factories of the cell. The finest

running mitochondria generate 90% of the total energy required
for survival and staying healthy. It produces energy in the form of
ATP molecules (adenosine triphosphate). There are thousands of
mitochondria in nearly all cells (except the red blood cells),
especially abundant in cardiac tissue.
Mitochondrial function is disturbed mostly by eating a diet low in

healthy fats and high in carbohydrates, according to Dr. Mercola
in his book “Fat for Fuel”. This upsets the normal metabolic
signaling, which damages the cellular and mitochondrial DNA
resulting in a disability to repair the damage.
Mitochondrial Dysfunction and Oxidative Stress in Heart Disease
Mitochondrial dysfunction and ROS (reactive oxygen species)

contribute much to heart diseases. Elevated ROS levels result in
oxidative stress (imbalance of free radicals and antioxidants
resulting in disruption of cell and tissues) and damage DNA,
proteins, and lipids, leading to mitochondrial dysfunction and cell
59
death47. This chain of events is also involved in many cardiac
diseases, including:
● Cardiac hypertrophy (abnormal enlargement or thickening

of heart muscle)48,
● Heart failure49,
● Cardiac ischemic-reperfusion injury (IRI is a cellular
dysfunction and death of heart cells)50, and
● Diabetic cardiomyopathy (DCM is a disorder of heart
muscle in diabetic patients)51.
For all these reasons, interest is building to limit ROS production

and better ROS detoxification to reduce the severity of heart
disease.
Reactive oxygen species (ROS)
These are highly reactive chemical species containing oxygen, including

the superoxide (O2-) and the hydroxyl (OH-) anions, and hydrogen
peroxide (H2O2). Under normal physiological conditions, ROS levels are
strictly controlled through the activity of antioxidant enzymes, including
superoxide dismutase, catalase, and glutathione peroxidase [1–3]. In the
heart, ROS play a fundamental function in cell homeostasis when present
at low concentrations, since they regulate multiple physiological
signaling pathways and biological processes. Oxidative stress is defined
as a dysregulation between the production of ROS and the endogenous
antioxidant defense mechanisms, resulting in excessive ROS linked to
47
48
49
https://www.jci.org/articles/view/120849
50
51
https://www.liebertpub.com/doi/10.1089/ars.2015.6293
60
multiple pathophysiological pathways in the heart.
Mitochondria and Heart Attack
During myocardial oxidative stress, ROS are more produced, yet

the defense mechanisms of heart muscle cells are tainted. In
Acute Myocardial Infarction (AMI), better known as heart attack, 2
types of damages occur: ischemic injury-lack of blood supply and
oxygen to heart muscle, and reperfusion injury-tissue damage
when blood supply returns; both of these injuries lead to
mitochondrial dysfunction in heart cells.
Mitochondria in Heart Failure
Heart failure creates a mixture of cardiomyocyte hypertrophy

(enlargement of heart muscle cells), fibrosis (outside cell tissue
damage)52, arrhythmia (irregular heartbeat)53 and contractile
dysfunction (abnormalities in heart pumping) 54. While ischemia-
reperfusion injury in AMI occurs in a matter of hours to days, ROS
affects heart in more long-term ways. Chronic neuro-hormonal
activation (involving nervous system and hormones) and
consequent increase in Angiotensin-II (a hormone that increases
blood pressure) with added myocardial stress, all lead to ROS
production in heart failure55.
52
53
54
55
61
Under normal conditions, oxidative metabolism in mitochondria
produces ATP; it also produces heat in certain specialized cell
types, such as brown adipocytes. In addition to generating ATP,
intermediate metabolism in the mitochondria produces
metabolites for biosynthesis, protein modification, and signal
transduction. Oxidative phosphorylation is coupled with
generation of reactive oxygen species (ROS), which can either
serve as molecular signals or cause cell damage and cell death.
Mitochondrial metabolism is stimulated by calcium, but under
pathological conditions, calcium overload can trigger the opening
of the mitochondrial permeability transition pore (mPTP). The
release of mitochondrial content, such as cytochrome c, induces
apoptosis, or the loss of membrane potential (a consequence of
prolonged mPTP opening) causes ATP deprivation and necrosis.
Leak of damage-associated molecular patterns (DAMPs), such as
mitochondrial DNA and peptides, or excessive ROS generation also
causes inflammation that results in further tissue damage. The
transition of mitochondria from a powerhouse to a death engine
62
is key to the pathogenesis of many diseases, including heart
failure
Up to 70% of ATP generated by a healthy heart is through

oxidation of fatty acids56, while the remaining is made using
carbohydrates57 58. In diabetic cardiomyopathy (as mentioned
above, heart muscle disease in diabetics), there is high level of
circulating fatty acids and increased storage within
cardiomyocytes. During periods of high ATP demands in diabetic
hearts, FAO (fatty acid oxidation) continues to be the predominant
source of ATP (energy), but there is a loss in energy contribution
from carbohydrates and glucose. This loss of flexibility between
energy sources results in reduced cardiac efficiency and
contractile dysfunction, which is the hallmark of diabetic
cardiomyopathy.
STATINS
As we discussed in this book, atherosclerosis is largely due to

inflammation of the blood vessels including those supplying the
heart, rather than cholesterol deposition as was previously
believed. For secondary prevention, after a heart attack, stroke or
any major vascular event, there is some benefit of taking
cholesterol-lowering drugs, mainly because they are anti-
inflammatory too.
56
Opie LH. Heart physiology: From cell to circulation. Lippincott Williams &
Wilkins; 2004.
57
58
63
Prescribing statins for primary prevention only because of high
cholesterol levels or because of the false belief that statins
prevent heart disease, is not a logical practice of medicine,
particularly in the absence of risk factors 59. This is well explained
by Drs. Diamond and Ravnskov in a 2015 article, where they gave
a critical assessment of the research on reduction of cholesterol
levels with statins to reduce cardiovascular events.
To find out if statins actually prevent heart disease, a 5-year study

was conducted with 2,000 healthy, middle aged men. Half of the
participants were treated with statins and half with placebo (‘fake’
treatment).
The research used relative risk reduction (RRR) as opposed to

absolute risk reduction (ARR). The RRR shows how effective a
treatment is on the exposed group as compared to the placebo or
non-treated group, while ARR shows how effective a treatment is
on the population and, thus, gives more relevant information of
the actual situation.
By the end of the study, 2% of the placebo group and 1% of the

statin group experienced a heart attack. But, the benefit of 1% is
nowhere near impressive to the medical community or even to
public. So, by a play on the numbers, RRR exaggerates the benefit:
2% of the placebo vs. 1% of the treated group means a RRR of 50%
(1 divided by 2). Now, an average person may think 50% of 100
people benefit from the drug. You see the deception?
The most common side effects of statin include weakness, flu like
symptoms, pain in the back, legs or arms, liver abnormalities,
nervous system disorders and transient global amnesia in which a
59
64
person forgets who or where they are for a few minutes to hours.
When talking about any disease, 1% benefit may be valuable if the
drug is totally free of potential side effects. Unfortunately, this is
not the case. Statins can have serious side-effects including
diabetes60, cancer, cognitive impairment61, heart disease and
musculoskeletal disorders62 (expressed in ARR to minimize the
numbers).
Also, most studies on statin don’t aptly portray the side-effects.

For instance, in the British Heart Protection trial, 26% participants
withdrew from the study within a month because of drug
intolerance. This raises significant questions about the
representation of the actual rate of adverse events.
In addition, being over-reliant on pills can be misperceived by

patients as a chance to ignore lifestyle changes such as diet,
regular exercise, adequate sleep and keeping a healthy weight.
In my practice, a third of my patients cannot tolerate any statin,

no matter how low the dose; they would much rather try the diet I
recommend in this book than live with debilitating side effects.
Statins also have effects on the mitochondria, which we have

discussed in detail. Statins disturb the production of ATP,
particularly affecting the heart’s tremendous energy requirement.
Less energy makes the heart muscle stiff.
Statins block the formation of Coenzyme Q10 (CoQ10) in cells.

CoQ10 is an antioxidant produced naturally by the body, essential
for growth and maintenance. Statins block the biochemical
60
https://diabetes.diabetesjournals.org/content/68/7/1441
61
62
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1691918
65
pathway that is shared by both cholesterol & CoQ10. This stresses
the need for CoQ10 supplementation in anyone taking a statin.
Hence, supporters of statins have used statistical deception to

create the illusion of statins being wonder drugs, when in reality,
their adverse effects are far beyond their trivial benefit.
CHAPTER 3
BRAIN, INFLAMMATION AND
MICROBIOME
If the way to a person’s heart is through his stomach, then a way

to increase health and disease prevention may be through that
exact same spot.
Therefore, Alzheimer’s and autism, depression and obesity are all

diseases that could potentially be stymied, if not cured, by the
right balance of miraculous little creatures that live in our guts. It
turns out that the health of your brain is intricately linked to the
health of your gut. Gut bacteria provide your body with valuable
vitamins and helps to ward off infection, not to mention other
nasty bacteria that would rather trigger inflammation and lay
siege to your system.
The good news is that you can have a say in which group of
bacteria prevails, and in doing so, join a whole new world of
66
disease prevention by being smart about what you eat. The
human gut is colonized by tons and tons of bacteria. A thought
that’s not only strange, but also perhaps a little gross. Yet here’s
another strange fact: these colonies play a huge role in your
health.
Let’s start with how much you weigh. Interestingly, the type of
bacteria you’ve got in your gut can determine whether you stay
slim or become obese. Two groups of bacteria are accountable for
some 90 percent of your gut’s microbiome – firmicutes and
bacteroidetes. While scientists don’t know the “ideal” ratio of
these groups, they do know that when you have more firmicutes
than bacteroidetes, you can suffer from increased inflammation
and potentially from obesity.
Firmicutes are expert at extracting energy from the food you eat,
which means that they help you consume more calories. In
contrast, bacteroidetes aren’t so much involved with calorie
extraction but work to break down plant fibers and starches.
Harvard researchers examined the connection of obesity and a

person’s microbiome, focusing on two groups: people living in
Western countries and in Africa. Considering that obesity is
virtually non-existent in Africa, any differences in microbiome
were viewed as notable. And what researchers found was indeed
notable. Africans had more bacteroidetes in their gut, while
Westerners had more calorie-extracting firmicutes. So having
more firmicutes may be at least partly responsible for the obesity
epidemic in the West.
67
Your microbes not only help to keep you slim (or fat) but also help
support your liver. Many foods contain environmental toxins; it’s
the liver’s job to get rid of these once in your body.
Yet a healthy gut can also support the liver in its work, which is
why the gut is often called the body’s “second liver.” Gut microbes
help to neutralize toxins that reach the intestines, acting as a first
line of defense. In doing so, the microbes take a bit of pressure off
the liver, keeping it healthier!
The body’s inflammatory response protects you, but it can go

haywire and cause damage, too. When an insect bites you, often
the skin around the bite gets red and may itch. This redness is
called inflammation; a process the body sets in motion to protect
you and keep you healthy. Yet sometimes inflammation can get
out of control and actually be harmful.
Most people think that inflammation is just a patch of irritated

skin or a swollen, sore throat – but it is often much more. The
body’s inflammatory response is there to support the immune
system and help it fight infection or injury. But when this response
persists without reason, it can lead to a wide range of illnesses
such as diabetes, cancer, asthma, arthritis or even multiple
sclerosis.
But what exactly would trigger excessive inflammation in the

body? Some genes can contribute to excessive inflammation; yet
for this to happen, these genes need to be “switched on.”
Thankfully, there are things that you can do, such as getting
enough sleep and eating healthily, that will keep these bad genes
quiet while kicking into gear the more helpful genes.
68
Too much blood sugar can also increase inflammation in the body,
as high blood sugar levels can be toxic if your cells aren’t able to
process it. This situation can lead to glycation, a state in which
sugar binds to proteins or fats, which causes a buildup of
advanced glycation end products (AGEs). And AGEs trigger
inflammation.
So while a little inflammation can help you fight disease, too much
can have negative consequences when it comes to your body and
your health. But your gut microbiome can also trigger
inflammation that potentially leads to mental health problems.
If your gut and its microbiome aren’t in tip-top shape, your brain
might be in trouble, too. Did you know that your brain and your
gut are actually connected? If your gut microbiome is imbalanced
to the point where it no longer is assisting the immune system in
protecting the body, your brain could be in peril, too.
Your gut is mostly busy absorbing nutrients from food during the
day. While it’s performing this task, it must be protected from
potential pathogens that could harm you. As a means of defense,
the gut has a protective layer of cells that are responsible not only
for absorbing nutrients but also for blocking harmful bacteria. If
this cell layer becomes compromised, the gut’s defenses are
weakened, and potentially harmful bacteria could wreak havoc in
your body. Having an inflamed, “leaky” gut can thus lead to other,
more serious illnesses.
Research now shows that an inflamed, leaky gut can potentially

lead to a so-called leaky brain. This rather horrifying idea means
that the brain, previously believed to be securely protected by the
blood-brain barrier, can actually be exposed to harmful bacteria
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from the body, too. If bad bugs get into your brain, this can lead to
brain inflammation. And when your brain suffers from
inflammation, a lot of damage can be done before you even know
that something is wrong. Why? The brain doesn’t have its own
pain receptors; so unlike an inflammation of the skin (which you
can see and feel), an inflammation of the brain is a silent sufferer.
Brain inflammation is serious business. This symptom can lead to

illnesses such as Alzheimer’s disease or other severe neurological
diseases, such as Parkinson’s and depression. Even disorders like
autism may be caused by what’s happening in your gut. The
development of autism spectrum disorder is believed to be
strongly influenced by gut bacteria. Autism spectrum disorder
(ASD) is a perplexing condition. Scientists still don’t know what
causes it, and while many therapies attempt to address ASD
symptoms, there’s no known cure.
Examining the gut microbiome, however, may help us to better

understand and treat ASD. ASD covers a wide range of conditions
that are expressed during early brain development. People with
ASD often avoid eye contact, prefer to be alone, have difficulty
expressing their needs and display repetitive behavior, among
other behaviors.
One hypothesis is that problems in the gut microbiome might

contribute to the development of ASD. So far, we’ve explored how
issues in the gut can affect the brain and lead to illness. In the case
of ASD, a similar situation may be at play. If brain inflammation
exists during childhood, this might disrupt brain development,
potentially resulting in ASD.
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Studies have found that many people with ASD possess a
particular composition of gut bacteria that is typically linked to a
heightened inflammatory response in the body. For example, Jeff,
diagnosed with ASD, was given multiple courses of antibiotics as a
baby, which may have compromised his natural gut microbiome.
When he was 10 years old, doctors did a stool analysis and found
that he had almost no beneficial lactobacillus bacteria in his gut.
Fortunately, the symptoms of autism can be alleviated by healing
the gut microbiome.
One treatment method is to give a patient oral probiotics and

vitamin supplements, in order to cultivate a healthier gut
microbiome. For Jeff, this therapy led to some success. After only
three weeks, he showed a decrease in anxiety symptoms. He was
even able to tie his own shoes for the first time.
A new treatment called fecal microbial transplant, or stool

transplant, has shown promising results. In the treatment, a
doctor extracts stool bacteria from a healthy gut and transplants it
to a patient’s colon. This practice has proven effective at
improving a patient’s compromised gut microbiome.
Now the question is - if you know how important your gut

microbiome is, how can you best care for it?
Let’s take a look at our average American diet. It’s hard to say no
to the delicious taste of sugar. Yet a particular type of sugar, called
fructose, is today ubiquitous in prepared foods and drinks – and is
wreaking havoc with our health. Fructose, found in processed and
sweetened foods like soda and candy, is one of the most
consumed sources of calories in Western nations.
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While fruit naturally contains some fructose, a fizzy soda is
saturated with it. One 350-milliliter can of soda has around 140
calories from fructose sugar, whereas a medium-sized, fresh apple
has only 70.
Fructose has the lowest glycemic index (GI) of all the sugars, which
means it has no immediate negative effect on blood sugar and
insulin levels. Yet studies show that consuming too much fructose
is related to insulin resistance – a condition in which the glucose-
processing ability of insulin is compromised. This can contribute to
diabetes and hypertension. Consuming a fructose-heavy diet can
also stress out your liver, as well as compromise your health
overall, as this organ in particular is responsible for metabolizing
fructose – primarily into fat.
Another substance that can be harmful to your health is gluten.

Gluten is a protein found in grains and grain products; it gives
elasticity to dough, for example. And it’s everywhere, in your pizza
and pasta, even in your ice cream and cosmetics. And while only a
small percentage of people suffer from celiac disease – gluten
intolerance – many more people may have an averse yet often
undetected reaction to gluten, known as gluten sensitivity. Gluten
sensitivity can increase the body’s inflammatory response, which
as we now know, can lead to a wide range of diseases. If you feel
you may have gluten sensitivity, it’s best to avoid it in the foods
you eat.
Another concern is that as a society, we use too many antibiotics

and are exposed to many toxins that could harm our health. In
1928, Scottish biologist Alexander Fleming discovered penicillin.
One of the most important breakthroughs of the twentieth
century, Fleming’s discovery ushered in the era of antibiotics.
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Unquestionably, the use of antibiotics has saved many lives. Yet
today we take too many antibiotics, and in doing so, we’re
compromising both our gut microbiome and our overall health. In
2010, doctors in the United States prescribed some 258 million
courses of antibiotics – and the U.S. population is just over 300
million people. Often such prescriptions were for ailments that
antibiotics can do nothing against, like the common cold.
Another major – and unnecessary – use of antibiotics is in

agriculture. Farmers often pump antibiotics into healthy animals,
simply to make them larger and fatter. The excessive use of
antibiotics is risky, as bacteria can quickly adapt and become
resistant. Therefore the more antibiotics we use, the greater the
chance that bacteria will evolve to develop a resistance. Scientists
have observed this in strains of the staphylococcus aureus
bacteria. Now resistant to a majority of common antibiotics, these
bacteria can cause serious infections that can be fatal.
Antibiotics can also disrupt your gut microbiome by killing healthy

bacteria – giving an opportunity to harmful bacteria to take up
residence instead.
Along with antibiotics, many environmental chemicals can be

damaging to our bodies and health. Of some 100,000 chemicals
approved in recent decades in the United States, only 200
chemicals have been thoroughly safety-tested.
One example of a problematic chemical is Bisphenol-A (BPA).

Invented in 1891, BPA was used then both to alleviate menstrual
problems and as a growth drug for cattle. However, it was found
to trigger cancer and its use as a drug was banned. Yet since the
1950s, BPA has been used in the creation of certain plastics; you
73
can find BPA in many items, from notebooks to cash receipts.
Scientists have found that BPA exposure can not only disrupt the
body’s hormonal balance but also alter the gut microbiome.
What do wine, yogurt, sauerkraut and black tea have in common?

They’re all fermented food products. Humans have benefited
from the process of fermentation in food for some 7,000 years,
and nearly every culture has some kind of traditional fermented
dish or drink. It’s no surprise, as fermented foods are often good
for your health.
So what is fermentation? This organic process converts

carbohydrates, like sugars, into either alcohol and carbon dioxide
or organic acids. For fermentation to happen, either yeast,
bacteria, or both are needed.
One particularly useful fermentation process is called lactic acid

fermentation. Here sugar is converted to lactic acid, which
increases the number of beneficial bacteria (often called
probiotics) while safeguarding food from harmful bacteria, and
spoilage. During fermentation, bacteria also produce the valuable
vitamin B12.
Probiotic bacteria strains have many health benefits. They help

increase the availability of vitamins, reduce inflammation and
decrease the level of harmful bacteria in your gut.
An easy way to consume probiotics is by eating unsweetened

yogurt, created when milk undergoes lactic acid fermentation.
And when you eat fermented foods that contain beneficial
bacteria, your body can absorb them more readily and thus
benefit from them more than when you take probiotic
supplements alone.
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The practice of fasting can also help boost your microbiome and
overall health. Fasting was first mentioned in ancient Indian Vedic
texts, and people have been exploring the benefits of fasting for
over 3,000 years.
Health benefits from fasting include increased insulin sensitivity,

slowing the aging process and switching the body into fat-burning
mode to lose weight. Fasting also promotes positive changes in
gut bacteria. In one study, the restriction of calories encouraged
bacterial growth connected to a longer life, while reducing the
amount of bacteria associated with a shorter lifespan.
There are different ways to fast: you can restrict your caloric
intake for a period of time, or you can not eat at all for 24 to 72
hours, as some examples. This latter practice is called intermittent
fasting.
Now let’s talk about two food ingredients that can boost both
microbiome and brain health. Do you enjoy a spicy curry? Good
for you if you do, as this means the yellow spice, turmeric, is
already part of your diet.
Turmeric is a popular Chinese and Indian seasoning that is often a

component of curry powder, giving it a distinctive yellow color.
But it’s more than just a spice – turmeric is also good for your
body.
This spice is chock-full of anti-inflammatory and antioxidant

qualities, and can even increase your brain’s cell count. Even
though Chinese and Indian practitioners have been using it for
thousands of years, turmeric was discovered by Western medicine
only recently; research regarding its benefits is ongoing.
Importantly, turmeric contains curcumin, an organic compound
75
that can improve glucose metabolism, or the stabilization of blood
sugar in your body. So if you’re not a huge fan of curry, you might
want to consider taking turmeric or curcumin supplements to reap
the compounds’ benefits.
Another healthy “super food” is coconut oil. Coconut oil has

powerful anti-inflammatory properties, and is believed to be able
to prevent and possibly even heal neurological diseases, such as
Alzheimer’s disease.
If you want to introduce coconut oil to your diet, you can use it as
a cooking oil instead of canola oil, for example. Or you can
consume it directly, one to two teaspoons of pure oil every day.
While there are plenty of supplements available on the market, if

you want to explore a more natural approach to health, taking
turmeric and coconut oil are excellent options.
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CHAPTER 4
Metabolic Syndrome,
Inflammation and Microbiome
When it comes to inflammation, scientists have had to grapple

with the chicken-or-the-egg scenario applying to the various
illnesses - is it association or causation? Similar fate was
experienced by metabolic syndrome, also known by other names
including Syndrome X and insulin resistance syndrome and is a
cluster of clinical disorders, such as dyslipidemia (triglycerides
>150 mg/dl), glucose intolerance and hypertension. (high blood
pressure). Most obvious telltale sign is a large waistline, which is
larger than 35 inches for women and, larger than 45 inches for
men.
The worldwide incidence of metabolic syndrome ranges from
10% to 84%, depending on region, environment, sex, age,
race and ethnicity. There is evidence that the prevalence
and incidence differs between specific populations in high-
income countries, i.e., by sex, race, and ethnicity 63,64.
Adiponectin is an insulin-sensitizing hormone and in obesity,

it is down-regulated (decreased number of receptors so the
response of the hormone is lowered).
63
https://care.diabetesjournals.org/content/28/11/2745
64
77
Leptin, hormone made by cells of the small intestine, helps
regulate energy by repressing hunger; hunger reduces fat
storage in fat cells, modulates TNF alpha production and
macrophage activation.
3 recent studies highlight the association between metabolic

syndrome and inflammation. Firstly, study by Hebron et al (37
#3)
showed that BMI is associated with atherogenic
dyslipidemia (plague forming lipid disorder) and insulin
resistance in individuals with metabolic syndrome.
Additionally, it is also associated with low grade inflammation
as shown by the link between BMI and the pro-inflammatory
markers CRP and IL-6 (37 #3).
Secondly, looking at the effect of obesity on quality of life,

they found that quality of life is impacted by the grade of
obesity, type 2 diabetes, metabolic syndrome and
inflammation, and these all are mainly related to reduced
physical activity(38 #3).
Third, use of Mediterranean diet affects the expression of

inflammatory regulators in metabolic syndrome patients after
an 8 week intervention(39 #3). The inflammatory regulators are
microRNA (miRNA let-7b and miR-155-3p) and they are also
involved in the development of human diseases.
In obesity, human adipose tissue makes more IL6, thus,

possibly inducing hepatic CRP production and initiating
cardiovascular complications(4) #3.
In 2004, it was found that chronic inflammation may be a

triggering factor in metabolic syndrome: in genetically or
metabolically susceptible individuals, factors like over
nutrition (a form of malnutrition), physical inactivity, and
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ageing would result in excessive production of cytokine and
eventually insulin resistance and diabetes65.
Now that the cause for several apparently unrelated
diseases has been scientifically accepted to be metabolic
syndrome, new links between other diseases are starting to
show up as well. For example, cancer has always been
viewed as a disorder of proliferation, new evidence suggests
that it should also be considered a metabolic disease.
Growing tumors rewire their metabolic programs to meet and
even exceed the production and energy demands of
continuous cell growth66.
Why does this concern me as a cardiologist? Because
metabolic syndrome raises the risk 5-fold of type 2 diabetes,
and 2-fold increase in risk of cardiovascular disease over 5-
10 years. This means that patients of metabolic syndrome
have a high possibility of developing Type 2 diabetes, and
possibly, they will go on to develop cardiovascular disease.
There’s ample evidence of atherogenic damage associated
with metabolic syndrome. The role of pro-inflammatory
cytokines, ROS and FFA (free fatty acids) had been
implicated in regulating insulin sensitivity in animal models.
The underlying process is insulin resistance; however new
evidence points to pro-inflammatory cytokines, ROS
(reactive oxygen species), and free fatty acid intermediates.
***
The role of microbiome in metabolic diseases remains
equivocal. The reason being that the factors thought to be
the main drivers of the metabolic syndrome are also thought
to be the primary controllers of our gut microbiome
65
https://www.nmcd-journal.com/article/S0939-4753(04)80048-6/pdf
66
79
composition: diet and lifestyle. Theoretically, it is
straightforward that the gut microbiome and host metabolism
ought be interrelated, unraveling the cause and effect
remains a challenge. https://www.jci.org/articles/view/129194
(https://journals.sagepub.com/doi/pdf/
10.1177/0192623313508481)
***
TYPE 2 DIABETES
The combination of type 2 diabetes and obesity sets a

greater risk of heart disease and death. As hemoglobin A1c
(HbA1c, test for average blood sugar level over the past 3
months) levels rise from 5.0 to 6.5, the incidence of disease
rises, more sharply(40)#3. Approximately 79 million adults in
the US, aged 20 years or older, are likely to have pre-
diabetes, where blood sugar levels are high, but not high
enough to be diagnosed diabetes(4) #3. This indicates the
somewhat confounding presence of heart disease-related
problems(42-46)#3.
Insulin resistance and type 2 diabetes are also related to low

level chronic inflammation (47-49)#3. Rise of inflammatory
markers, such as cytokines, varies from ethnicity to ethnicity
(50-56) #3
. In the study called MESA (Multiethnic study of
arteriosclerosis), inflammatory markers differed much with
race/ethnicity; levels of IL-6, CRP and fibrinogen (mainly
involved in blocking blood vessels and stop bleeding) were
low in Chinese patients and high in Hispanic and Black
patients (50)#3.
HYPERTENSION
80
Hypertension is one of the most frequently encountered
metabolic syndrome factor in clinical practice (70)#3. Many
studies show that excess weight and visceral obesity (excess
fat around organs such as the liver, kidneys, pancreas and
the heart) are the major causes of hypertension (73) #3.
Research suggests that several factors play a role in this
regard including; impaired blood pressure in kidneys,
physical compression of the kidneys, activation of the RAAS
(Renin Angiotensin Aldosterone system–a multi-hormone
system that regulates blood pressure, fluid balance, etc.) and
the sympathetic nervous system (system that controls the
body's rapid involuntary responses) (78)#3. As obesity and its
consequences are continued over many years, kidney injury
gradually worsens hypertension; the longer the insult, the
more resistance to treatment.
Similar findings have been seen in animals too; blood

pressure rose in dogs and rabbits that were fed diets to gain
excess weight (74-77) #3. And the metabolic, endocrine
(hormonal system), cardiovascular and renal changes in
these experimental animals closely paralleled changes
observed in obese humans.
Considering hypertension a primary component of metabolic

syndrome has been beneficial. It assists in earlier detection,
proper management (72)#3 and also allows better
understanding of the other multiple factors involved in this
condition.
The most recent recommendations are to maintain a blood

pressure of 150/90 in individuals aged 60 or older, and
140/90 for younger individuals (71) #3. However, in patients
with diabetic or chronic kidney disease aged 18 and older,
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the upper value of blood pressure should be less than 140
mmHg and lower value should be less than 90.
DYSLIPIDEMIA
The primary lipid-related abnormalities seen in most

metabolic syndrome patients include over-production of very
low density lipoproteins (VLDL), and low density lipoproteins
(LDL), while reduced levels of high density lipoprotein (HDL)
cholesterols (89)#3.
LDL remains in the blood circulation for long periods, and is

hence, more prone to chemical changes and contributes to
the atherosclerotic plaque.
Isolated high triglyceride points towards type 2 diabetes or

the metabolic syndrome (94) #3.
In obesity and diabetes, high triglyceride and low HDL levels

act as pro-inflammatory agents (106) #3, and these contribute
much more to cardiovascular disease than high blood sugar
levels.
Non-alcoholic fatty liver disease (NAFLD)

Non-alcoholic fatty liver disease (NAFLD) is a clinical entity
being more and more recognized as a major health issue in
developed countries. It includes a range of liver damage,
from simple steatosis (fat build-up) to non-alcoholic
steatohepatitis (NASH), advanced fibrosis, and rarely,
progression to cirrhosis.
Recent studies highlight the roles of insulin resistance,
oxidative stress and subsequent lipid peroxidation, pro-
inflammatory cytokines, adipokines and mitochondrial
dysfunction, in the advancement of NAFLD. Moreover,
82
evidence also supports a link between NAFLD and metabolic
syndrome 67.
PART 2: Diet and Lifestyle
67
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IN MY 30+ YEARS OF experience, I have helped my patients make
the necessary dietary and lifestyle changes. During the initial days
of my practice, I did not see the connection between diet, lifestyle
choices, heart and overall health. Later on, I started to see
patterns that indicated that there are so many ways we can
control our health. I knew I had to find a way to boil it down. To
simplify the Heart Mend program, I emphasis on two factors:
1. Diet: Food, supplementation and fasting
2. Lifestyle: Exercise, sleep and rest
We also take a lot more medications. When my patients first come

to me, they are on an average of fifteen different drugs. Is this any
way to live? As Liping Zhao, a Chinese holobiome researcher, puts
it, “Eat right. Stay fit. Live long. Die quick.” No one desires listening
to their doctor give them a long death sentence where they die
slowly.
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CHAPTER 5
Food: The Biggest Exposure
IN THE PAST, LITTLE DID we know that our food is a big source of
exposure to us. The absorptive area of the GI tract is the size of a
tennis court. Not an ounce of what we eat goes unscrutinised.
Everything is there. In fact, the microbiome records it68.
We didn't realize that the food we are told to eat as “healthy” is

actually the very food that is exposing us to the harms we are
suffering. That is a very small part of why we get sick. Let me give
you an example. There are areas where there are environmental
exposures. Now granted, it's not the air these kids breathe.
Remember the movie Erin Brockovich? The movie, it's about this
area where the river was polluted and there were kids dying of
cancer. But see, they didn't die of cancer because they lived there,
they didn't die of cancer, and they didn't develop cancer because
they were exposed to that river. They developed cancer because
whatever toxin it was in that river, seeped through the food,
seeped through the water and they were ingesting that. So air or
pollutants, that's just a very small part and we get so consumed by
it and we don't even realize we are ingesting it firsthand.
68
A reliable clock for your microbiome Genetic oscillator records changes
in microbiome growth patterns in vivo Date: October 11, 2019 Source:
Wyss Institute for Biologically Inspired Engineering at Harvard -
https://www.sciencedaily.com/releases/2019/10/191011074719.htm
85
You have so many of these areas that are identified as
contaminated and whatnot, and so many things have been fought
over, but the thing is, all right, do something about what goes in
the food. For a long time, maybe they can just refuse eating food
derived from there or refusing to drink water derived from there.
Supply these populations with alternative sources of food. I'm
sure you could make a difference. Instead of blaming the air,
blaming the electric, whatever, which is nowhere close.
People worry about the quality of air or the electric poles near
their houses contributing to inflammation via radiation, but I
recommend being mindful of what they put in their body as food.
That comes face to face with our tissues, with our bodies, and
they never think about it. The thing is, with this electric whatever,
or polluted air, you have a choice, you could move out of there
and resettle somewhere else.
Regarding sun radiation exposure, my mother would always tell

me, "stay out of the sun; always be in the shade". Which I always
remember to this day, and she had a point, because there was a
time in medicine, when we were really blaming radiation,
especially the ultraviolet rays from the sun. That's the most
harmful UV light. That's so we were told. Now we've now turned
down and so people who are exposed to the sun have more
melanoma. Now we have rethought this because it's the
microbiome that protects you from the melanoma. 69 In any skin
condition, you cannot escape the microbiome. If we take care of
it, it will take care of our overall health.
69
University of California - San Diego. "Beneficial skin bacteria protect
against skin cancer." ScienceDaily.
www.sciencedaily.com/releases/2018/03/180301103701.htm
86
Feed Your Microbiome
One common question I get is how can we ensure what we eat is
beneficial to our gut? The simple answer is, by prioritizing your
microbiome’s nutritional needs on your daily menu planning is a
very good way to ensure that you maintain your health70.
When it comes to your microbiome, it likes certain foods, in

certain amounts, prepared in a certain way and at certain times.
You can say it is a picky eater, but for a certain reason – keeping
us healthy and happy.
Let’s break these three rules into simpler terms:
● Certain foods: The main component of this concept is that

what is not bioavailable for our human body is the actual food for
commensal bacteria in the gut.
Before we review what the microbiome likes to eat, let’s get the
list of foods out of the way so that they can be eliminated:
Lectins, gluten, Nightshade family, processed foods, charred

meats and simple carbohydrates.
Maillard Reaction
The Maillard reaction (or the browning reaction), much like the
browning of meat when grilled, bananas turning brown with
70
87
time, occurs in the body, between reducing sugars, including
fructose, and proteins or amino acids. Fructosylation, as it is
known with fructose is more rapid, seven times faster than with
glucose and can damage cells directly. This is the same reaction
that turns hemoglobin in red blood cells into Hemoglobin A1C,
what the doctor checks to monitor blood sugar control.
Some of the Maillard reaction products have mutagenic and/or

antioxidant properties. The Maillard reaction with fructose and
glucose may play a role in aging and the development of
complications of diabetes such as cataract, neuropathy and
collagen cross linking.
Fructose may also contribute to breakdown of the intestinal

barrier resulting in “leaky gut” as discussed under inflammation.
Data on Insulin resistance and dementia show a clear

association. African Americans and Latinos are the biggest
fructose consumers and the highest waist circumference, an
insulin resistance marker, they also have the highest risk of
dementia.
High insulin levels resulting in insulin resistance also drive

growth of many cancers.
The high insulin levels (Insulin resistance) blocks Leptin giving a

false message to the hypothalamus that the person is starving
which causes the person to eat more.
In 2018, singer Kelly Clarkson said her 37-lb. weight loss was a
positive side effect of a diet she followed primarily to overcome
her thyroid problem. "I read this book, and I did it for this
88
autoimmune disease that I had, and I had a thyroid issue,"
Clarkson said. "I'm not on medicine anymore because of this
book." And along the way, she also lost weight, she said.
Clarkson was referring to the book "The Plant Paradox" by Dr.

Steven Gundry, of whom I am a loyal advocate of. The book comes
with a big claim: Gundry says a broad group of plant proteins
called lectins — found in grains; beans and legumes; nuts; fruits;
nightshade vegetables such as eggplant, tomatoes and potatoes;
and dairy — are the root of modern illnesses, ranging from obesity
and gastrointestinal issues to autoimmune disorders and allergies.
Lectins, according to Gundry, bind to sugar molecules in cells
throughout the body, altering their function.
Autoimmune Disease
In 1932, gastroenterologist Burrill Crohn, MD, and his colleagues

at Mount Sinai Hospital published a paper describing fourteen
patients who had peculiar findings in the small intestine at
surgery that were unlike anything that had previously been
seen. The abnormalities were in the end of the small intestine—
an area known as the ileum—so they called the new disease
terminal ileitis, although it would eventually come to be known
as Crohn’s disease.
Inflammatory bowel diseases (IBD), such as Crohn’s disease and

its sister condition, ulcerative colitis, are examples of
autoimmune diseases. They represent a new breed of malady,
89
sometimes referred to as modern plagues, which has emerged in
the last century and includes conditions such as Hashimoto’s
thyroiditis, type 1 diabetes, lupus, multiple sclerosis (MS),
rheumatoid arthritis, and eczema. Their hallmark, regardless of
what organ they affect, is that the immune system wages war
against the body’s own healthy tissues, leading to chronic
inflammation.
There are almost a hundred different types of autoimmune

diseases. Chances are you or someone in your family suffers
from one, since they affect about fifty million people in the
United States alone. Different autoimmune diseases frequently
affect the same person, suggesting a common cause with varied
manifestations rather than multiple distinct ailments. The
million-dollar question is whether that common cause is an
abnormal immune system overreacting to normal stimuli in the
environment, or a normal immune system responding to an
abnormal trigger.
Gundry said, "Kelly Clarkson is a great example. All she did was to
remove these foods from her diet, and her thyroid problem went
away."
Gundry’s idea is based on ample research. He also uses data from

his own patients as evidence. (Gundry, a former heart surgeon,
now works in private practice.) Recently, at an American Heart
Association conference, Gundry presented the results of his study
of 102 people on a lectin-free diet 71. After nine months, 95 of the
71
Remission/Cure of Autoimmune Diseases by a Lectin Limite Diet
Supplemented With Probiotics, Prebiotics, and Polyphenols Steven R
Gundry Originally published29 Jun 2018Circulation. 2018;137:AP238 -
https://www.ahajournals.org/doi/abs/10.1161/circ.137.suppl_1.p238
90
people showed a reduction in biomarkers of inflammation and
autoimmune diseases.
What Are Lectins?

Lectins are proteins that attach to specific sites on carbohydrates
and glycoproteins (carb-protein mixtures)[1]. These are not the
same as leptin, lactose, or pectin. The word “lectin” comes from
Latin and means, “to select”.
They are found in all living beings; plants, animals, bacteria, and
viruses. In foodstuff, most are harmless while some are not.
Plants have these for their protection mechanism [2], for structural
organization, for communication with the environment, and as
reserve proteins[3].
Though quantities vary from plant to plant, lectins are mostly

centered in seeds, early-stage leaves, and roots. Leaves, such as
Romaine lettuce, have lesser amounts.
Foods with lectins can cause sensitivity or reactions [4, 5, 5]:, such as:
● Legumes (beans and pulses) - white kidney beans on

average have 15% lectins
● Cucurbitaceous lectins - lectins in the sap of gourds,
cucumbers, pumpkin family
● Prolamins - flour grains and cereals have alcohol-soluble
lectins; gluten and gliadin
● Soybean and wheat germ contain lectin agglutinin or
hemagglutinin that can cause blood clumping
(agglutination)
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Different lectins have different harmful effects. Some people have
a specific blood group, which makes them more at risk of getting
blood clumping and related health issues[6].
For example; castor bean lectin (ricin) is very toxic and is used in
weed and rat-killers[4], while white kidney bean lectin (agglutinin)
can cause nausea, vomiting and diarrhea in humans.
Harmful effects of dietary lectins
1. Resistant to Digestion
Lectins can resist heat and digestion in humans and rats.
They are easily absorbed from the gut into the blood [7, 8, 9]., and can
trigger a reaction, affect hormones, or attach to blood and
lymphatic walls[9, 10].
2. Damage to the gut lining
Some lectins, like those in wheat, can attach to the gut wall and
make small breaks in the wall[11, 12].
The gut then gets leaky, directly exposing dietary and bacterial
antigens to the immune system and disturbing the normal
nutrient absorption[13, 14].
3. Stimulate Immune System
When these lectins enter blood, antibodies are formed against

them[15, 16].
These antibodies do not necessarily protect against the lectins. In

some sensitive individuals, they instead provoke reactions against
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food items that are usually harmless. For example, egg white
protein is harmless to mice, but if given with wheat germ
agglutinin, the same egg white produces a strong antibody
response in mice[18, 19].
So, using lectin-containing products with other food raises the risk
of developing sensitivity to the other foods.
Lectins can also aggravate allergies and histamine intolerance by

inciting mast cell reactions.
But since they can boost the immune response to antigens, they
might be used with oral vaccines[20].
4.Cause Autoimmunity
In susceptible people, lectins can trigger autoimmunity by

connecting to glycoproteins and glycolipids (sugar molecules
attached to proteins and fat)[21]. One such complex molecule is
sialic acid. It is present on the surfaces of the cells in the brain, gut
and blood[22]. In the blood, it’s found on different circulating
proteins, like haptoglobin and transferrin.
Lectins also worsen inflammation by increasing certain chemicals

in the body, like IFN-gamma, IL-1, and TNF-alpha[11].
5. Affect the Gut Microbiota
Lectins affect the balance of the gut bacteria and can cause
dysbiosis (microbial imbalance). The process for this is not fully
understood but raises the risk of autoimmune diseases.
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Lectins reduce the level of intestinal heat shock proteins (iHSPs).
These are anti-inflammatory proteins important for the health of
gut bacteria and protection against oxidative stress[23].
In rats, lectins increase gut levels of E. coli and Lactobacillus lactis;

these are associated with autoimmune diseases such as
rheumatoid arthritis[24].
Kidney bean lectins cause E. coli overgrowth in the gut, while

snowdrop lectins and mannose-specific lectins decrease their
growth[25].
6. Cause Abnormal Cell Growth
Lectins can cause swelling and overgrowth of cells in the

intestines, pancreas, and liver[26, 3]. They also trigger lymphocyte
(fighter cells) growth and activation[5].
Insulin
In low amounts, wheat germ agglutinin acts similar to insulin for

fat cells. But, in larger amounts, it causes insulin resistance [27].
Dietary lectins in rats enlarge the pancreas yet reduce insulin

levels[5].
Obesity
Wheat germ agglutinin and castor oil ricin increase fat

production[28].
Brain Functions
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In roundworms, lectins are transported from the gut to dopamine
neurons, and interfere with brain functions, suggesting their
contribution to Parkinson’s disease[29].
Diet Formula
The lectin avoidance diet follows a simple formula: eat meat and
seafood, as much as you want, during the day.
● Eat seafood, meat, eggs (if not allergic), and most fruits
and vegetables.
● In vegetables, use Romaine lettuce, cruciferous veggies,
cucumbers, and celery.
● Use raw honey, citrus fruits, berries, and pineapple as
fructose-rich foods.
● Japanese and purple sweet potatoes are the best starches
to eat, pressure cooked are even better. Similarly, other
sweet potatoes, nightshade vegetables (like tomatoes),
and squash can also be taken if pressure cooked.
● And exclude grains, beans, nuts, seeds, most potatoes, and

all dairy.
However, even if you can get rid of lectins, they are not the only
anti-nutrients in plants. For example, tannins are found in many
plants and they also alter nutrient digestion and absorption 72.
Cure Autoimmune Disease
800 autoimmune patients were given a restricted diet, free from

lectin-containing foods; grains, sprouted grains, pseudo-grains,
beans and legumes, soy, peanuts, cashews, nightshades, melons
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https://link.springer.com/article/10.1007/s10886-006-9077-0
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and squashes, non-Southern European cow milk products (Casein
A1), and grain/bean-fed animals.
Most of these patients got their TNF-alpha (an inflammatory

molecule) levels reduced to normal after 6 months on this diet.
The study concluded that increased adiponectin is a marker for

lectin and gluten sensitivity, while TNF-alpha can be used as a
marker for gluten/lectin exposure in sensitive individuals 73.
Whole grains present lectins directly into your gut. The wheat
germ agglutinin (WGA) strikingly resembles the hormone insulin
and is considered responsible for celiac disease.
Now let’s take an in-depth look at the actions of insulin and

problematic effects that occur when WGA mimics insulin.
What We Share with Elephants
Elephants never had any heart conditions but due to habitat

destruction and change of food from tree leaves to grass, hay and
grains, half the elephant population is now a heart patient.
Lectins, including WGA, connect to a special sugar molecule called

Neu5Ac. It sits on the cells of blood vessel walls and gut walls in
humans, elephants, shell-fish, mollusks, and chickens. Other
mammals and animals make Neu5Gc.
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So, the lectins attach themselves to these Neu5Ac molecules and
damage the walls leading to heart and autoimmune disease.
Another fun fact: in the anti-aging approach, some people tend to
eat more red-meat to keep off carbs and maintain weight. Cattle
contain Neu5Gc, which is quite similar to Neu5Ac. But our
immune system recognizes it as a foreign entity, and that leads to
the development of antibodies. These antibodies not only react to
the “foreign” sugar molecule, but also against our own sugar
molecules due to similarity (friendly fire). This also proves why fish
eaters have better heart health than meat-eaters.
Moreover, cancer cells have Neu5Gc, the non-human version of

Neu5Ac, which humans might get from eating meat. The cancer
cells use a hormone, VEGF, to attract blood vessels to Neu5Gc. If
the immune cells attack Neu5Gc, more VEGF is released (this can
be measured in blood). Cancer cells, in fact, hide behind the
Neu5Gc.
So, all in all, excess red meat can present an altered form of sugar
molecule to our immune system, leading way to autoimmune
attacks, heart diseases, and cancer.
Now let’s highlight what we can feed the microbes:
Prebiotics:
Prebiotics are food that; cannot be absorbed by the gut, cannot be

fermented by the gut bacteria/microbes, and lastly, contribute to
the human well being74. All prebiotics are fiber but not all fiber is
prebiotic.
74 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5951603/#ref18
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Examples: Leeks, asparagus, chicory, Jerusalem artichokes, garlic,
onions, dandelion greens, konjac roots, burdoch roots, yacon rots,
jicama, seaweed, taro, broccoli, spinach, cauliflower, avocado and
berries.
The main component of food that affects gut microbiota is fiber.

Ever since ancient times, fiber has been a part of daily diet in
different quantities the current recommendation is above 25 g per
day. The dietary fiber goes through the small intestine into the
colon where it is broken down by fiber-degrading microbes. The
breakdown products, short-chain fatty acids (SCFAs), promote
health and act as anti-inflammatory, anti-carcinogenic, and
immune-regulating agents75.
The production of SCFAs is dependent on the amount of fiber

eaten and the makeup of gut microbiota. Vegans, vegetarians and
omnivores with a Mediterranean diet (lots of veggies) have high
SCFAs.5 Dietary fiber supplementation in Type 2 diabetes patients
also showed increased benefits in a similar pattern20.
Special Prebiotics: Polyphenols:
Phytoestrogens are plant-derived polyphenols similar to human

estrogens. They occur in vegetables, herbs, coffee, tea, and
chocolate in large amounts. But ingested polyphenols are poorly
absorbed in the small intestine, so, larger quantities get available
in the colon. The gut microbiota convert them to anti-
inflammatory and antiproliferative products. These compounds
are more easily absorbed and show better estrogenic/anti-
75
https://www.ncbi.nlm.nih.gov/pubmed/26416813
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estrogenic and antioxidant properties than the original dietary
form76.
Probiotics:
Before refrigeration was invented, people used fermentation as a

way to preserve food. Evidence of a fermented alcoholic beverage
made from fruit, honey, rice and dates can be found in history
way back to 7000 BCE. Even before fermented beverages, as far
back as 10,000 BCE, humans were fermenting the food with
notoriously poor holding qualities – dairy. It’s likely the
fermentation occurred spontaneously, rather than intentionally,
due to naturally occurring microflora in milk.
The marketplace is flooded with pills and tablets. What doesn’t

need to be encapsulated should be eaten in an enjoyable and
pleasant form.
The same goes for probiotics. For the sake of bioavailability and
cost-effectiveness, try a few fermented foods to your liking, and
some you can even prepare at home.
Fermentation is a big part of our daily life in the form of beer,

wine, and bread; yet, they all have a common “fermenting” factor
- yeast. Yeast converts sugar to carbon dioxide that leads to bread
rising. But we’re not focusing on traditional bread for obvious
reasons and also because it’s not a probiotic.
To be called a probiotic, a food item must undergo lactic acid

fermentation. In this process, the good bacteria convert the sugar
molecules in the food into lactic acid, while themselves, they
multiply and proliferate. This lactic acid, in turn, protects the
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fermented food from pathogenic bacteria by creating a low pH
(i.e., an acidic) environment. To jump-start the process of
fermentation, certain strains of good bacteria such as
Lactobacillus acidophilus, are introduced into the sugar-containing
foods. To make yogurt, for instance, all you need is a starter
culture (strains of live active bacteria) and milk. Lactic acid
fermentation is also used to preserve foods, extending their shelf
life.
The word probiotic has Latin and Greek origins and means “for
life”. It was first introduced by the German scientist Werner
Kollath in 1953 and it has much progressed to a specific
description by Fuller in 1992. He defines it as a live microbial food
supplement that benefits its host by improving the intestinal
microbial balance1. Hippocrates, moreover, declared, 2000 years
earlier, that “death sits in the bowels,” and that “bad digestion is
the root of all evil.”
The modern history of probiotics starts in early 1900s when the

future Nobel laureate and Russian scientist, Elie Metchnikoff,
worked at the Pasteur Institute, Paris. Louis Pasteur identified the
micro-organisms responsible for the process of fermentation,
whereas Metchnikoff tried to find out the possible effect of these
microbes on human health. He linked the enhanced longevity of
Bulgarian rural people to the regular intake of fermented dairy
products such as yogurt, specifically to the Bulgarian bacillus
discovered by a young Bulgarian physician Stamen Grigorov.
He suggested that lactobacilli might lessen the decaying effects of

gastrointestinal metabolism that contribute to illness and aging.
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Metchnikoff also claimed that toxins from bacterial decomposition
in the large intestine are released into the blood where they cause
aging. He called them putrefying bacteria, which are recognized as
proteolytic clostridia in modern medicine. Metchnikoff also stated
“the dependence of the intestinal microbes on the food makes it
possible to adopt measures to modify the flora in our bodies and
to replace the harmful microbes by useful microbes.” This
sentence describes the “probiotic concept.” Metchnikoff
considered the lactobacilli as probiotics (“pro-bios,” as opposed to
antibiotics); probiotics could have a positive influence on health
and prevent aging. The scientific hypothesis of Metchnikoff
favored the making and development of the dairy industry in
France, the first of its kind in Europe, thanks to the use of
fermented milk obtained from Bacillus bulgaricus.
The Beneficial Strains
The most commonly used probiotics are strains of two main

species, (also the most studied species):
1. Bifidobacteria: This species of bacteria is used in foods and

supplements. They support the immune system, limit the growth
of harmful bacteria in the intestine, and help in breakdown of
lactose (milk sugar) into nutrients the body can use.
2. Lactobacillus: This species of bacteria produces lactase enzyme

to breaks down lactose (milk sugar) and also makes lactic acid.
Lactic acid helps control the population of bad bacteria, serves as
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muscle fuel, and increases the body’s absorption of minerals.
Lactobacillus bacteria are found naturally in the mouth, small
intestine and vagina.
Common strains of probiotics
Probiotic strains are genetic subtypes of species. Each probiotic

strain has a different effect in the body. The probiotic strain
names are usually written on food or supplement labels,
combined with the species name. For example, the
Bifidobacteria or Lactobacillus species are often abbreviated as
B. or L. and written with the individual strain name, such as
acidophilus. This gives you the probiotic L. acidophilus on the
label.
Here are 6 common strains of probiotics that you’ll find on

labels.
B. animalis: This strain is an ingredient in Dannon yogurt’s Activia

product. It helps in digestion and fights food-borne bacteria.
B. breve: This strain normally lives in your gut and vagina. In both
places, it fights off infection-causing bacteria and yeast. It also
ferments sugars, breaks down plant-fiber, and helps the body
absorb nutrients.
B. lactis: This is taken from raw milk. It’s an ingredient in Nestlé’s

probiotic infant formula, Good Start Natural Cultures. It also
serves as a starter for buttermilk and cheeses, like cottage
cheese.
B. longum: This strain lives in your gastrointestinal tract. It helps
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break down carbohydrates and also acts as an antioxidant.
L. acidophilus: This strain is found in the small intestine and

vagina. It helps digestion and helps fight off vaginal bacteria. You
can also find it in yogurt and fermented soy products, such as
miso.
L. reuteri: This strain is found in the intestine and mouth. One

study showed that it reduces the oral bacteria that cause tooth
decay and also helps in digestion.
Designing food with a limited bioaccessibility could result in a low

bioavailability of proteins, carbohydrates, lipids, and
phytochemicals, resulting in higher levels of nutrient delivery to
the microbiota and less calorie absorption for the host. This is a
win–win situation, especially for subjects living in an obesity-
promoting environment and having no nutritional deficiencies.
It is worth noticing that virtually all of the undigested material can

be a substrate for the community of the gut microbes: the higher
the variability of the substrates available, the higher the diversity
of the microbiome. Mounting evidence showed that this
microbiome diversity is associated with a low inflammatory status
and lean phenotype. This is not a random association: the
expression of genes in the microbiome triggers biochemical
pathways, ensuring proper intestinal permeability and
immunomodulation77.
2. Certain preparation:
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● Heat: cooking induces severe modifications in food,
resulting in a generalized increase of macro- and micronutrient
bioavailability. The most relevant effect is starch gelatinization:
thermal treatment induces physical modifications of starch
granules, which are not well digestible to humans. Gelatinized
starch becomes a good substrate for human amylases, and starch
is rapidly converted to glucose.
● Intactness of Plant Food Tissue: Intact plant cells are not a

good substrate for the human digestive system: amylase, lipase,
and proteases cannot trespass the intact cell wall barrier and
reach their substrates present in the cytoplasm. A large moiety of
all macronutrients can reach the microbiota if the plant cell
structure have not been destroyed by mechanical and thermal
processes. This effect is well-known in raw almonds: up to 30% of
lipids travel through the gastrointestinal tract entrapped within
intact cells, limiting the extent of lipid digestion. On one hand, fine
milling and an extrusion cooking process combining heating,
pressure, and mechanical sheering to produce plasticized,
expanded, and cooked products disrupt all of the barriers and
organelles of the original plant material, maximizing starch and
lipid digestibility.
● Rapid gastric emptying: A small study, conducted in people

with gastroparesis, found that ACV slowed down, rather than sped
up, gastric emptying78.
When gastric emptying slows, it takes the muscles in the stomach

and intestines longer to push stool out of the body. The longer it
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remains in the intestines, the more gas it produces. Therefore,
ACV could potentially make your symptoms of gas and bloating
worse.
However, people who don’t have gastroparesis may find that ACV
aids in digestion, as many have claimed.
Olive oil79 and other fats80 is another ingredient that has a similar
effect. Oil at the beginning of a meal can cause the valve at the
outlet of the stomach to close, slowing things down. This can also
cause a sooner feeling of fullness and satiation, which explains
why dipping bread in olive oil as an appetizer can actually cause
people to eat less and lose weight by consuming fewer total
calories. Instead of bread, I would recommend a grain-free bread.
Thylakoids, found in green plants/vegetables also assist with rapid

gastric emptying and support good microbial activities81
3. Certain times: The digestion and absorption process is a time-

dependent function. Most of the food components can only be
absorbed after conversion into their basic units: proteins,
triglycerides, and polysaccharides into amino acids, free fatty
acids, and glucose, respectively. If a food has a strong and
entangled matrix, this conversion into the basic unit becomes very
slow and the nutrients become de facto less bioavailable. In this
case, they will become potential substrates for the gut microbiota.
79
https://www.sciencedirect.com/science/article/abs/pii/S2212826312000541
80
https://academic.oup.com/jcem/article/91/6/2062/2843371
81
https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/
s12986-016-0128-4
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Delaying the digestion process can be an effective strategy to
deliver the gut nutrients and micronutrients, which could be, in
theory, 100% bioavailable to humans. In this vein, food design can
be a powerful tool to modulate the microbiota. This targeted
delivery can be achieved in many different ways:
Fast: Allow Your Body to Heal
Hippocrates, the father of Western medicine, believed fasting

supported the body to heal itself.
Paracelsus, another great healer in the Western tradition, wrote
500 years ago, “Fasting is the greatest remedy, the physician
within.”
Ayurvedic medicine has long advocated fasting as a major
treatment.
Fasting has also been part of major religions - Muslims have
Ramadan, Jews have Yom Kippor.
Our hunter-gatherer ancestors lived involuntarily following this
fasting tenet because of famine and feasted when they found
food.
Our DNA has not evolved away from that, and what’s beneficial
for our body and microbiome is that our DNA retains those
factors. But instead of famine, we now have the option to fast.
Typically, brain is the most important organ that needs continuous

glucose supply. It gets the glucose from our food intake and in
between meals, from glycogen (stored glucose in liver and
muscles). Since glycogen reserves are limited, our body uses
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gluconeogenesis, that is create new molecules of glucose from
amino acids from the proteins primarily found in muscle.
Up side, we get more glucose; down side, it comes at the expense

of our muscles. Luckily, our physiology offers one more pathway
to power the brain. When quick sources of energy like glucose are
no longer available to fuel the body’s energy needs, the liver
begins to use body fat to create ketones. The leading ketone,
beta-hydroxybutyrate (beta-HBA), serves as an exceptional fuel
source for the brain. Beta-HBA allows us to function cognitively for
long periods during food scarcity or fasting. It reduces our
dependence on gluconeogenesis and, therefore, preserves our
muscle mass. And that’s the better option. Fasting is a way to
achieve this goal.
Can fasting strengthen your heart?
Research shows fasting can help lower blood pressure, reduce

cholesterol, control diabetes and reduce weight; all four of these
are the major risk factors of heart diseases. So, as a secondary
impact, intermittent fasting reduces heart diseases. Intermittent
fasting also prevents the build up of plaque in blood vessels,
increases adiponectin, and decreases leptin and resistin in blood82.
There are many other things too, that happen when we fast.
These either don’t happen when we are in a constantly fed state,
or happen very slowly in the background of glucose metabolism.
In a well-fed state, the individual cell in your body is in “growth”

mode. The insulin signaling pathways tell the cells to grow, divide
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and make proteins. These same pathways, when overactive, can
lead to cancer83. Meanwhile, the “mammalian target of
rapamycin” or mTOR tells the cell not to bother with autophagy.
Autophagy literally means “self-eating”, the recycling and cleanup
process that rids your body of damaged items, like misfolded
proteins. The well-fed cell isn’t worried about being efficient or
recycling its components – it’s too busy, growing and dividing.
Similarly, cells and their components are also highly acetylated in

the well-fed state. This means that various molecules in your cells,
like DNA packaging proteins called histones, are “decorated” with
acetyl groups on their lysine (amino acid) residues. Acetylation
loosens the DNA packaging proteins and lets the DNA be read for
protein production. This means that the flourishing cell has turned
on genes associated with cellular growth and proliferation, and,
on the opposite end, turned off other genes that relate to fat
metabolism, stress resistance and damage repair.
During deprivation, things are very different. When you fast, some
of your fat gets turned into ketone bodies that reactivate these
off genes, leading to lowered inflammation and stress resistance
in the brain for example. Your body reacts to what it sees as an
environmental stress (low food availability), it changes the genes
expressed into those that protect you from the “said” stress.
Our well-preserved starvation program kicks our cells into a

completely different state when food, particularly sugar, isn’t
around. During fasting and exercise, the body activates the AMPK
signaling pathway, the brake to mTOR’s gas pedal (remember
mTor tells cells to grow and divide, and not clean up). AMPK
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signals the cell to go into self-protective mode, activating
autophagy (recycling and cleanup) and fat breakdown. At the
same time, the levels of a molecule called NAD+ begin to rise
because you don’t have the dietary proteins and sugars that
normally convert NAD+ to NADH through the Krebs cycle. NAD+
activates the sirtuins, SIRT1 and SIRT3. (Have you heard of the
“longevity” molecule in wine called resveratrol? Yep, it became
famous as being a likely activator of the sirtuins). Sirtuins are
proteins that remove the acetyl groups we talked about above
from histones and other proteins. This activates cells to create
new mitochondria (the power-generating factories of your cells)
and clean up reactive oxygen species.
Ketones, produced during fasting, work as de-acetylase inhibitors

(that is, keep acetyl groups in place), turning on genes related to
antioxidant processes and damage repair.
Whew, that’s a lot happening when your body isn’t taking in any
calories. But when exactly do these things happen? We’ll help you
visualize the timeline below. In the LIFE Fasting Tracker app, the
icons on the LIFE Fasting arc represent the five stages of fasting!
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The Five Stages of Intermittent (and Prolonged) Fasting
Did you know that your brain uses up about 60% of your glucose
when your body is in the resting state?
After 12 hours of fasting, the glucose source is exhausted and the

body enters the metabolic state of ketosis (Anton et al., Obesity
2018). It starts break down of fat to produce ketone bodies or
ketones. As discussed earlier, ketones serve as an alternate energy
source for the cells of heart, skeletal muscle, and brain, when
glucose isn’t available. This use of ketones by brain is said to be
one of the reasons that fasting is claimed to promote mental
clarity and positive mood; ketones produce less inflammatory
products as they are being used than glucose. And they can even
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kick-start production of the brain growth factor BDNF! Ketones
also reduce cellular damage and cell death in brain cells and
inflammation in other cell types.
By 18 hours, you’ve switched to fat-burning mode and are

generating significant ketones. Blood ketone levels can then be
measured above your baseline values. The amount of ketones can
go up 100 times the normal range during fasting.
As their level in the blood rises, ketones start acting like signaling
molecules or hormones, to ramp up stress-busting pathways;
reduce inflammation and repair damaged DNA, for example.
Within 24 hours, your cells do more and more recycling and

cleanup of faulty proteins, such as those linked to Alzheimer’s
(Alirezaei et al., Autophagy 2010). This important process of
cellular rejuvenation or renovation is called autophagy.
When the cells are unable to initiate autophagy, bad things

happen. For example, neurodegenerative diseases occur as a
result of reduced autophagy that occurs with aging.
Going back to what we discussed before, fasting activates the

AMPK signaling pathway and inhibits mTOR activity, which in turn
activates autophagy. But this only occurs when the glucose stores
and insulin levels begin to drop.
In mice deprived of food, autophagy increases after 24 hours and
this effect is magnified in cells of the liver and brain after 48 hours.
In humans, autophagy is seen in neutrophils (a type of immunity

cells) starting at 24 hours of fasting. Exercise together with caloric
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restriction by fasting can also increase autophagy in many body
tissues.
From the perspective of heart health, autophagy is “must” for

maintenance of cardiac structure and function under normal
conditions84. It is even considered cardio-protective. Natural sugar
trehalose (also known as mycose or tremalose, which consists of
two molecules of glucose) is said to activate autophagy. Here, it
reverses the adverse structural changes of the heart that follow
myocardial infarction (heart attack), markedly lessening cardiac
inefficiency85.
By 48 hours with minimal or zero calories, your growth hormone

level goes up five times as much as when you started your fast
(Hartman et al.,1992).
Part of the reason for this is that ketone bodies boost growth
hormone secretion. Ghrelin, the hunger hormone, also promotes
growth hormone secretion.
Growth hormone helps preserve lean muscle mass and reduces
fat buildup, particularly as we age. It also plays a role in
mammalian longevity and helps in wound healing and
cardiovascular health.
By 54 hours, the insulin level drops to its lowest point since you
started fasting and the body is becoming more insulin-sensitive
(Klein et al., 1993).
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Lowering your insulin levels has a range of both short and long-
term health benefits. Low insulin level puts a brake on the insulin
and mTOR signaling pathways, activating autophagy. It reduces
inflammation, makes you more insulin sensitive (and/or less
insulin resistant, which is good if you are at a high risk of
developing diabetes) and protects you from chronic diseases of
aging, including cancer.
By 72 hours, your body is breaking down old immune cells and

producing new ones (Cheng et al., 2014).
Extensive fasting reduces circulating hormones, insulin-like growth
factor 1 (IGF-1) and PKA activity in various cell types. IGF-1
normally has growth-boosting effects on almost every cell in the
body. It activates signaling pathways that promote cell survival
and growth. While PKA, also activates the mTOR pathway (and, of
interest, too much caffeine during a fast may promote activation
of PKA).
You might see where this is leading – pressing the brakes on IGF-1
and PKA through nutrient restriction turns down the survival
pathways and leads to breakdown and recycling of old cells and
proteins. Studies in mice have shown that prolonged fasting
(greater than 48 hours), reduces IGF-1 and PKA and leads to stress
resistance, self-renewal and regeneration of hematopoietic or
blood cell stem cells. Through this same mechanism, prolonged
fasting of 72 hours has been shown to preserve healthy white
blood cell or lymphocyte counts in patients undergoing
chemotherapy.
Bonus stage: Refeeding!
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We almost forgot about the last and perhaps the most important
stage of intermittent fasting – the refeeding stage!
It’s important to break your fast with a nutritious, balanced meal
that will further improve the function of cells and tissues that
went through cleanup while you were fasting. From Mark Mattson
and colleagues at the National Institute on Aging: “Upon
refeeding, ingested carbohydrates* and glucose stimulate release
of incretin hormone glucagon-like peptide 1 (GLP1) from
enteroendocrine cells in the gut. GLP1 enhances removal of
glucose from the blood by pushing pancreas to release insulin and
increases the insulin sensitivity of cells. GLP1 crosses the blood–
brain barrier and can act directly on neurons (nerve cells) to
heighten cognition and bolster cellular stress resistance.”
*Update: It isn’t recommended to break your fast with lots of

carbs and sugars, which may in fact lead to problematic blood
sugar spikes. It’s best to break your fast with a balanced meal
including plenty of vegetables, plant fibers and plant fats, and
some healthy proteins.
What you should know about fasting before you begin
Before you begin, keep in mind that fasting is not safe for
everyone. You should consult your physician if you are:
● Women who are pregnant or breastfeeding
● Children and teenagers
● People who have type 1 diabetes
● And those who have eating disorders.
Tips to understand before you fast:
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1. Choose your fasting hours. People can fast from 8 hours to 24
hours or sometimes longer. Others cut back on calories for a
certain number of days each week or month.
2. Prioritize microbiome in meal planning. When you’re
consuming less overall, it's important that you make sure you
have adequate and sound nutrition before and after the fast.
3. Break your fast slowly. Don’t start eating everything in sight all
of a sudden when you’re done fasting. You don’t want to shock
the system. Instead, start by snacking on an avocado, for instance.
Take a break, and then eat other foods.
Autophagy
Autophagy or self-eating, is the mechanism by which the body

gets rid of and recycles old, defective cells.
It is an essential process by which cells break down their own
components; perhaps the most basic function of lysosomal
degradation pathways is adaptation to nutrient deprivation. The
system of autophagy responds to all sorts of dangerous stimuli,
such as infection. It balances the good and the bad effects of
immunity and inflammation, thereby, protects against infections,
autoimmune and inflammatory disease (including cardiovascular
diseases, obesity, diabetes, etc.).
The same genes used to plan the degradation of self-constituents
either for nutritional/energy balance or cellular damage control,
are also used for the degradation of foreign invaders (termed
“xenophagy”).
Proteasome is the primary protein complex that disposes
unnecessary or damaged proteins in eukaryotic cells (cells with
clearly defined nucleus).
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But what is not disposable by the proteasome is degraded by
autophagy, like intracellular organelles and large protein
aggregates. Autophagy also degrades micro-organisms (as viruses,
bacteria and protozoa) that invade intracellularly (get inside cell) (1-
2) #4
. For their survival and growth, intracellular pathogens have
evolved to resist the autophagic microbicidal defense responses of
the host. Thus, the interplay between autophagy and microbial
adaptations against autophagy governs the final consequence of
host-microbe encounters(1 #4).
Autophagy is thought to have evolved as a stress response that

allowed unicellular eukaryotic organisms to survive harsh
conditions by maintaining energy balance, and by
protein/organelle quality control. The same mechanism has
evolved in complex organisms to confront different forms of
stress. The autophagy system links with most cell-level stress
response pathways(3 #4), involved in immune responses and
inflammation. They share a complex mutual relationship; the
autophagy proteins work in both the initiation and inhibition of
immune and inflammatory responses. Moreover, defects in
autophagy may be the cause of infectious diseases and
inflammatory syndromes, similar to cancer, neurodegenerative
disease and aging(5 #4).
Mechanism of autophagy:
Autophagy refers to pathways for in-cell material, like large

normal or defective proteins and organelles, to lysosomes for
degradation(6 #4). Defects in this system are linked with numerous
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human diseases(21#4). Autophagy is initiated by nutrient starvation,
and the inhibition of mTor pathway.
There are at least 3 different types of autophagy processes;

macro-autophagy or simple autophagy, chaperone mediated
autophagy, and micro-autophagy.
The mTor pathway controls a number of activities of cell growth,

metabolism, and brain specific functions, using protein
production. Given the overall presence of mTor, it may also be
involved in systemic disorders, as diabetes, cancer, cardiovascular
diseases, and neurologic diseases, like dementia, Alzheimer’s,
Parkinson’s and Huntington’s disease (since these have a buildup
of defective, misfolded or toxic proteins and associated cell
death). So technically speaking, mTor inhibitors can possibly be a
treatment option for such diseases by giving way to autophagy
and having proper neuronal death means.
Autophagy and the microbes
Autophagy degrades foreign cell-invaders in a special form of

autophagy termed xenophagy. Does it happen in human cells too?
Yes. The autophagy dependent removal of mycobacterium (49 #4)
was a genetic risk for TB in a West African population(50 #4).
Another mutation in bacterial autophagy is associated with

infection risk of Mycobacterium leprae, mycobacteria that causes
leprosy(54 #4).
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Microbes try to fight back by developing strategies to block host
defense mechanisms. They can upset autophagy initiation or its
progress; dodge recognition or use components of the autophagy
pathway to help their own replication and intracellular survival.
How microbial resistance is contributing to the role of microbes in

diseases of defective autophagy still needs to be explored.
Low vitamin D3 levels are associated with increased susceptibility

to tuberculosis. Vitamin D3 makes an anti-mycobacterial peptide,
Cathelicidin, which induces autophagy and mycobacterial killing in
human immune cells(69 #4). This might have been the reason of a
century old Nobel Prize award (Nielo Ryberg Finsen, 1903) for the
use of UL therapy, UV light treatment (which makes active vitamin
D3), in the treatment of diseases as TB.
Autophagy and Inflammation:
Upsets in autophagy-dependent functions of immunity contribute

not only to increased risks of infections, but also to chronic
inflammatory and autoimmune diseases. Examples of such upset
include Crohn’s disease (a chronic inflammatory disease of the
small intestine), autoimmune disease SLE, obesity, diabetes and
cystic fibrotic lung disease.
Healing the Leaky Gut

Most of my patients who I see use bone broth to heal a leaky gut.
Some people believe it helps overcome food intolerances and
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allergies. Maybe it boosts the immune system. Maybe it builds the
bone; maybe it rebuilds collagen in your joints and skin; maybe
makes your hair grow thicker or improves nails. It’s quite a list of
claims. Anytime you have that big a list, you want to have some
degree of healthy skepticism, because now there are a number of
well-intentioned companies that want you to think that bone
broth is the cure-all.
Bone broth has been around a very long time and, interestingly,
different cultures have different versions of it. The East Indians
have Pa’aay in which bone-marrow-rich bones are cooked with
several spices until they get a gelatinous gravy. In Korea, its
seolleongtang, a rich broth made from ox bones. Then there’s
Jewish Penicillin, chicken soup with matzo balls.
If you ever had true pasture-raised and pasture-grass-fed beef,

you’ll notice that pieces of meat are quite tough. It takes a pretty
long time to cook. And the longer you cook it, the more gelatinous
it becomes, and that gelatinous material is actually where all the
collagen and the good stuff is.
As far back in history as the Middle Ages, particularly among the

poor, the bone broth was called restaurer, a kind of restorative
broth. Then there was beef tea in Britain. Many of you will relate
to consommé, a great starter soup served at restaurants, which is
basically beef broth. If it was a really fancy restaurant, they would
chill the beef consommé, and it would be a chilled bowl of gelatin
with beef flavor, literally. It was considered a delicacy; the
ultimate in fine dining. Fine dining that the poor were having back
in the Middle Ages, amazing how things come around.
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First of all, let’s talk about scientifically backed pros of drinking
bone broth. Bone broth is a great source of some amino acids
(protein building blocks) and collagen. Keeping in view that we do
not absorb collagen as-is from our intestinal tract. All protein is
broken down into individual amino acids, which are easily
absorbed through the wall of our gut.
Now, once they’re absorbed, the cells reassemble those amino

acids into the proteins that you need. Since there’s no instruction
book with the collagen that you ate in the bone broth, that tells
the body to make sure that the individual amino acids, you just
absorbed, should be made back into collagen. You’ll use those
amino acids to make what your body thinks it needs, one of which
is collagen, but certainly not all of which is collagen. So, taking
collagen, in whatever form, doesn’t guarantee that you’re going to
make collagen on the other side.
Another myth out there; the more collagen in bone broth, the
more collagen you’re going to make. Now, it’s great to have the
building blocks to do that, but remember, you can get these
building blocks without using the bone broth. Yes, you can make
collagen out of other amino acids. Bone broth contains the amino
acid glutamine. The intestinal cells, that one layer of cell that lines
our gut, and that lining is the size of a tennis court, those cells love
glutamine and use it to grow and repair themselves. That’s
scientifically proven.
What’s the easiest way of making broth? Take four pounds of

pasture-raised animal bones. Take two tablespoons of apple cider
vinegar, put in some salt, some onions, parsley, and garlic. Put it in
a pressure cooker, or a slow cooker. And just like my mother did,
cook it all day. Pressure cooker takes about 90 minutes, slow
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cooker a whole of 10 hours. Medium low heat will be fine. When
it’s done, you pour it through the strainer, and mind it, you have
to save the liquid, and there you go! Your own brand of bone
broth. You can put it in silicon ice cube containers and you’ve got
your own little bouillon cubes. Freeze it and use it as stock in other
recipes.
We had pastured turkeys for both Thanksgiving and Christmas this

year, and we saved the bones from both birds. We cooked those
bones all day long, actually two days and we got our bone broth.
Now we’re set for several months, because we don’t use it very
often, but we’re done and recycled our birds. That’s my take on
bone broth. It is not the miracle cure all of you want it to be, but
it’s a great source of glutamine and glycine.
Fiber and butyrate: Dietary fiber is an important component of a

healthy nutritious diet. Fiber works in a way similar to probiotics
to improve the microbiome. When the gut flora ferments fiber, it
creates a small amino acid called butyrate. Butyrate
supplementation may help mucus production and improve the
lining of the gut 86,87.
Curcumin: It is the plant-based compound that gives many spices

their bright yellow color — like turmeric. Many of the health
benefits of turmeric are due to the presence of its active
component curcumin. The body absorbs Curcumin poorly, but
when it is absorbed, it remains in the gut lining 88. And given its
86
87
88
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powerful anti-inflammatory effects89, it is healthful for the lining of
the digestive tract.
Pectin: Although fiber is beneficial to the gut, too much fiber may
actually worsen your bloating or gassy feelings, as might be seen
with leafy vegetables and broccoli. A fiber-rich diet that is also
high in pectins, speeds along the passage of gas and reduces
bloating.
Marshmallow Root: —Marshmallow root contains mucilage, a

gel-like substance that becomes slippery when wet. Mucilage
coats the digestive tract, soothes irritation and protects your gut
lining — it’s a great defense against leaky gut. 90 And when your
gut is strong and maintained, your “good” gut bugs will grow
strong and your immune system will flourish.
Other options:
● Remove sugar. Recent study in mice suggests that a diet

rich in sugar may cause damage to gut lining91.
● Remove inflammatory foods. Inflammation and intestinal

leakiness are linked92. It’s best to stay away from
89
90 Deters A, Zippel J, Hellenbrand N, Pappai D, Possemeyer C, Hensel A. Aqueous extracts and polysaccharides from
Marshmallow roots (Althea officinalis L.): Cellular internalisation and stimulation of cell physiology of human epithelial cells
in vitro. J Ethnopharmacol. 2010;127(1):62-69. doi:10.1016/j.jep.2009.09.050
91
92
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inflammatory foods, like lectins, gluten, nightshade family,
fried, and processed foods.
CHAPTER 6
Exercise: Harm of Too Little or
Too Much
Exercise is a medicine. And like every medicine, it also has an ideal
dose range, an under-dose range and a toxic range.
Physical inactivity may be the greatest threat to health in the 21st

century; but high levels of exercise may produce similar or even
lesser overall cardiovascular benefits93.
93
https://journals.lww.com/acsm-csmr/Fulltext/2015/03000/Exercise_and_the_
Heart___the_Harm_of_Too_Little.12.aspx
123
People think they can outsmart their heart by going to the gym
and not paying attention to other factors that affect health. This
review shows what happened to two fitness icons.
Jack LaLanne Jim Fixx
The 96 years old Godfather of The author of The Complete

Fitness, LaLanne, died of Book Of Running and
respiratory failure from credited with igniting
pneumonia. America's zeal for jogging in
the 70s, Fixx died by a heart
attack during his daily run at
52 years.
Jack exercised daily. Jim exercised daily.
LaLanne described himself as By age 35, Fixx weighed

an emotional and physical 220-240 pounds and
wreck before age 15 - pimply, smoked two packs of
nearsighted, and addicted to cigarettes a day.
sugar and junk food.
Exercise is the catalyst that Seventeen years of frequent

makes everything happen: intense workouts were not
your digestion, your enough to lessen the
elimination, your sex life, your damage he did to his body
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skin, and hair. Everything in his youth. His autopsy
about you depends on revealed considerable
circulation. And how do you plaque build-up:
increase circulation? By "atherosclerosis had
exercise. I'll tell you one thing, blocked one coronary artery
you don't always have to be on 95%, a second 85%, and a
the go. I sit around a lot, I read third 70%."
a lot, and I watch television.
But I also work out for two
hours every day of my life,
even when I'm on the road.
Include dangers of too much from here:
https://journals.lww.com/acsm-csmr/Fulltext/2015/03000/
Exercise_and_the_Heart___the_Harm_of_Too_Little.12.aspx
and
https://journals.lww.com/acsm-csmr/Fulltext/2015/03000/
Exercise_and_the_Heart___the_Harm_of_Too_Little.12.aspx
So how much exercise is ideal exercise? The National health

service (NHS) has issued recommendations for physical activity in
adults, they say:
125
● At least 150 minutes of moderate aerobic activity such as
cycling or brisk walking every week
and
● Strength exercises on 2 or more days a week that work all

the major muscles (legs, hips, back, abdomen, chest,
shoulders and arms)
OR
● 75 minutes of vigorous aerobic activity such as running or

a game of singles tennis every week
and

shoulders and arms)
OR
● A mix of moderate and vigorous aerobic activity every

week – for example, two 30-minute runs plus 30 minutes
of brisk walking equates to 150 minutes of moderate
aerobic activity
and

shoulders and arms)
As always, when we talk about heart and overall health,

microbiome will be involved in some way. So, what can exercise
126
do for the microbiome? Recent studies suggest that exercise has a
number of benefits for the gut microbiota; it increases good
microbial species and enriches microbial variety, and it enhances
short-chain fatty acid synthesis and carbohydrate metabolism.
Even little changes can yield results. For example, increasing the
regularity of moderate exercise from never to daily leads to a
greater diversity in Firmicutes bacteria, they contribute to a
healthier gut environment.
A study looked at how physical exercise in women links with

health promoting bacteria; F. prausnitzii and Roseburia hominis,
known for their butyrate-producing abilities, and Akkermansia
muciniphila, abundant in athletes and in low quantities associated
with metabolic conditions like obesity and diabetes.
Research comparing top athletes to regular humans that don’t do

much physical exercise, also emphasizes that the microbiome is
much more than just a gut thing.
The microbiomes of 40 professional, international rugby players

were compared to groups of common people of similar age with
either a high or low BMI. The results showed “notably better
intestinal microbial variety among the athletes”
Some other parameters also had more positive results.
These included “significantly higher levels of short-chain fatty

acids (SCFAs); acetate, propionate, butyrate and valerate, in
athletes comparative to controls.”
SCFAs are organic compounds produced by gut bacteria from

tough-to-digest plant fibers in your diet. In particular, butyrate has
127
a number of health-promoting functions. Butyrate is also the main
source of fuel for cells of the gut lining; it helps maintain their
integrity, reduces inflammation and prevents all sorts of toxins
and metabolites from crossing into the bloodstream.
The study also identified that metabolic pathways were more

active in the microbiome itself:
● Amino acids production- essential building blocks of cells
● Antibiotic production- supports immune system function
● Carbohydrate metabolism- provides fuel
In short, physical exercise provides noticeable improvement for

several indicators of performance and health, particularly good
bacteria and their functions.
You may wonder whether the physical exercise transforms the

microbiota or having a healthy microbiota makes you more active.
It’s a “who came first; chicken-or-egg” scenario.
For example, it’s true that dysbiosis induced inflammation leads to

depressive symptoms, and depression doesn’t encourage on
getting out and doing things. On the other hand, doing sports can
actually change your gut ecosystem.
Another study on women also showed that physical exercise “can

positively modify the composition of gut microbiota”. Differences
in gut microbiota profile between women with active lifestyle and
sedentary ones by Carlo Bressa and colleagues studied groups of
women between ages of 18 and 40.
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Active participants did at least 10 hours of physical exercise over a
7-day period during the trial. The sedentary group had quiet
activities, they weren’t particularly active in their daily lives, did
less than 30 minutes of moderate exercise, 3 times per week.
Eleven types of bacterial groups were “remarkably higher in active

women, with lots of health-boosting bacterial species, including
Faecalibacterium, Roseburia and Akkermansia”.
“Body fat, muscular mass and physical activity were also linked
with several bacterial varieties.” Basically, leading an active
lifestyle was more pleasing to some bacteria than others, and
that’s a good thing.
Depending on how your body produces energy to fuel your

performance, physical activity is of two types: strength and
endurance.
Strength sports require high-intensity effort, like weight lifting,

sprinting and boxing. These exercises build muscle mass using
your cells' anaerobic pathways. This means the muscles use their
limited glycogen stores to create ATP (the fuel for your muscles)
without using oxygen.
Endurance sports differ that they allow the body to perform

exercises at lower intensity and for much longer periods, such as
long-distance running, cycling and skiing. Such activities are
considered aerobic because the muscles use oxygen to transform
fats and sugars into ATP (fuel).
The most common way of measuring cardiovascular fitness is V02

max that looks at the maximum amount of oxygen your body can
use during intense exercise. It is used to check endurance
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performance, and can be much improved with the high intensity
exercises.
Several studies have shown a relationship between microbiota

composition and cardiorespiratory fitness. This relation can
account for more than 20% of the bacterial variation, independent
of other factors, such as age, fat and carbohydrate intake.
Aerobic exercises, commonly known as cardio, benefit your

microbiota, in terms of both increased helpful bacteria and overall
diversity. Cardio is all about endurance; going long and steady.
This includes any exercise that gets your heart rate up and keeps it
up for a prolonged period of time, ensuring the supply of oxygen
to your muscles so they can create fuel (ATP).
Walking, running, dancing, cycling, the elliptical machine and the

rower at the gym are all examples of cardio workouts. However
the intensity and duration of your workout will depend on your
general fitness level. If you are just dipping your toes into the
exercise pond, you might not be able to stand the effort for long.
And that is totally okay because cardio is all about the long run;
take it slow and easy, keep at it and your body will adjust!
Life is about moderation – if a little is good, then more is not

better. As Hippocrates noted centuries ago, “If we could give
every individual the right amount of nourishment and exercise,
not too little and not too much, we would have found the safest
way to health”94. These words from 2,500 years ago still seem
practical and sensible today.
Exercise and the Heart, what is too much?
94
https://www.brainyquote.com/quotes/hippocrates_118541
130
Physical activity has been unappreciated in the western world,
and this leads to the greatest health threat of the 21st century,
sedentary lifestyle. Some might say, “If some exercise is good,
more should be better”. Not so quick. Very high doses of exercise
may cause heart issues, like atrial fibrillation, coronary artery
disease and malignant ventricular arrhythmias.
Excessive endurance exercise (defined as >60-90 minutes of

exercise per session) is not nearly as common as low levels of
physical activity. Individuals are engaged in many hours of training
for many days, such as those competing in marathons, long
bicycle and swimming races, triathlons etc. (18, 27-30 #7). The US
Physical Activity Guidelines says that all Americans should
participate in 30 minutes of moderate exercise (like brisk walk) for
5 days a week or more, adding up to 150 minutes in a week.
Similar benefits can be obtained from more strenuous exercises
(like jogging) for shorter periods of time, like 15 minutes of jogging
done 5 days a week or 75 minute/week walk.
The dangers of extended endurance exercise have been noted for

centuries, especially in some high profile cases. During the Greco-
Persian war in 490 BBC, a 40-year-old Pheidippides, a Greek
herald, ran for 150 miles in 2 days and 26 miles (actually 24.8
miles) on day 3 to deliver the news of victory to the Athenians.
Just after making the announcement, he collapsed and died. Of
note here is a related fact, most cardiac events during marathons
occur in the last mile(29, 32 #7).
In the best-selling book “Born to Run”, Micah True, otherwise

known as Caballo Blanco, ran as much as 100 miles a day. One day
131
in March 2012, he went out for a run and never came back.
Autopsy showed idiopathic cardiomyopathy and it was assumed
that he died of a cardiac arrhythmia during exertion. Dr. James
O’Keefe Jr. of St. Luke’s Mid America Institute commented: Micah
True’s enlarged, thickened heart with scar tissue is a pathology
some extreme endurance athletes develop called Phidippides
cardiomyopathy by Peter McCullough and Justin Trivax (30, 31, 32 #8).
The author states that endurance sports call for a continued
increase in cardiac output for several hours, which puts the heart
into a state of volume overload. One third of marathon runners
can experience dilatation of the right atrium and ventricle, have
raised cardiac troponins and natriuretic peptides, and in a smaller
fraction, later develop patches of cardiac fibrosis that can cause
tachyarrhythmia and sudden death (33, 34 #8)
The number of Americans joining the marathon has increased 25

fold over the past 40 years (29, 29 #7). Fortunately, sudden death is a
rare occurrence during vigorous exercise. If anything, under-
exertion rather than over-exertion is the bigger problem.
Humans can have unfavorable structural changes in heart

following excessive endurance exercises (18, 27-30, 32 #7). Short term
and collective exaggeration endurance workouts commonly affect
the right chambers of heart (right ventricle and right atrium). At
normal conditions, the average cardiac output (blood pumped by
heart per minute) for an regular size human being is 5 Liters/min.
This typically increases 5 times to about 25 liters/minute with
vigorous exercise. During long-term high intensity exercise
training, the continuously raised cardiac output places strain on
the thinner walls of heart, which are the smaller right side
chambers. Following a marathon, about 30% of the runners
develop acute dilatation of the heart chambers especially on the
132
right side. Afterwards, the structure is restored, but recurrent
stretch from more training produces long-lasting enlargement of
the left atrium and right heart, and patchy myocardial scarring.
This can resolve over 24-72 hours but if the aggravation follows
over many years, it may lead to serious arrhythmia (irregular
heartbeat).
As Hippocrates said centuries ago, “Everything in excess is

opposed to nature”(9 #7). A large number of individuals, 2-5% of the
population may be overdoing exercise training. If exercise is a
medicine, it may be comparable to a drug with issues of
indication, contraindication, under-dosing and overdosing (27 #7).
From a public health point, limit vigorous exercise to no more
than 60 minutes per day. In fact it’s likely that close-to-maximum
health benefits occur at even much lower doses (15, 27, 36 #7). So, a
weekly cumulative dose of vigorous exercise of no more than 5
hours can be ideal, including 1-2 days/week off from exercise.
As Hippocrates noted centuries ago, “If we could give every

individual the right amount of nourishment and exercise, not too
little and not too much, we would have found the safest way to
health”(9 #7). These words from 2,500 years ago still seem practical
and sensible today.
133
CHAPTER 7
Sleep: A Priceless Medicine
Why do we sleep? Some view sleeping as a waste of time. After
all, when you’re sleeping—and all animals do—you can’t do
productive work, eat, reproduce, or defend yourself. Yet Matthew
Walker, of Why We Sleep, concludes that the evolutionary upsides
of sleep are far greater than these downsides. In brief, sleep
produces complex neurochemical baths that improve our brains in
various ways. And it “restocks the armory of our immune system,
helping fight malignancy, preventing infection, and warding off all
manner of sickness.” In other words, sleep greatly enhances our
evolutionary fitness—just in ways we can’t see.
Why is morning a balm to some and a bane to others? Well, it all

depends on your built-in body clock.
Nestled deep in the folds of your brain is a primeval timepiece, an

internal clock that ticks out your body’s personal circadian rhythm
– a 24-hour cycle that, regardless of morning alarms and evening
appointments, your body is naturally inclined to follow.
Your circadian rhythm dictates a great number of things. It’s what

guides your body’s desire for sleep – or the opposite of sleep. It’s
what makes you want food or drink at certain times. It’s even
134
responsible, to an extent, for moodiness and emotional ups and
downs, as well as your metabolic rate.
But here’s the thing: circadian rhythms vary from person to

person – a fact that causes a large chunk of the population both to
hate alarm clocks and to suffer from health complications.
This portion, which makes up about 30 percent of the population,

consists of “night owls,” people whose circadian rhythm inclines
them to seek slumber late at night and to rise late in the morning.
Distressingly for these nocturnal folks, society is morning-

oriented. School and work typically begin in the morning and last
through the afternoon, right when the body clocks of night owls
say they should be asleep, or at least still sleepy.
Being out of sync with society’s schedule puts night owls in a

tough position: they must get up early even though they fall
asleep late. Thus, they’re often sleep-deprived, which makes it
likelier that they’ll suffer from a range of illnesses, including
diabetes, depression and cardiovascular diseases.
As mentioned earlier, heart disease is so prevalent that the cost of

treating it is hamstringing the health-care budgets of multiple
countries. But the real cure couldn’t be cheaper. People simply
need to sleep more.
Consider a 2011 study which looked at more than 500,000 people

from eight different countries – men and women, young and old,
and of varying ethnicities – and concluded that sleep deprivation
increases a person’s risk of either getting or dying from
cardiovascular disease by 45 percent.
135
Another study traced employed Japanese males over the course
of 14 years and found that, when compared to workers who got
more sleep, those who slept six hours or less per night were 500
percent more likely to suffer a cardiac arrest.
Even when one accounts for other factors that cause heart
problems – such as smoking or obesity – the link between sleep
deprivation and cardiovascular disease is strong.
So why does less sleep mean more heart problems? Well, it

mainly has to do with blood pressure.
Whenever you don’t get enough sleep, the pressure in your veins
goes up. Even losing one or two hours of rest will do the trick. It
might take a while, but, eventually, these instances of increased
pressure take their toll: the walls of your blood vessels become
stretched and damaged.
Now, it’s common knowledge that high blood pressure is

responsible for many deaths – seven million of them per year, to
be exact – but not many people know that they could avoid a
similar fate just by catching a few extra z’s.
Does everyone really need seven or eight hours of sleep a night?

The answer is that you almost certainly do, even if you’ve
convinced yourself otherwise. In the words of Dr. Thomas Roth, of
the Henry Ford Hospital in Detroit, “The number of people who
can survive on five hours of sleep or less without impairment, and
rounded to a whole number, is zero.”
If you can possibly take a short midday nap like our ancestors used
to and some Mediterranean and South American cultures still do,
136
you should (but no later than 3 pm). It will likely improve your
creativity and coronary health as well as extend your lifetime.
Most of us don’t get eight hours’ sleep. Or, if we do, the sleep isn’t
exactly high-quality. We toss and turn; we wake up in the middle
of the night. Our minds are constantly on, thinking about
unanswered emails, approaching deadlines and the constant
chatter of social media.
First off, there are a couple of things you might want to consider
avoiding – such as alcohol, nicotine and LED bulbs, because they
emit the most sleep-corroding blue light.
Sure, a nightcap feels relaxing, and it might help your waking self
unwind, but alcohol also makes it harder for your body to enter
deep sleep. Alcohol is one of the most powerful suppressors of
REM [rapid-eye-movement] sleep95. And large quantities of
alcohol can impair your breathing when you’re asleep.
Furthermore, people usually wake up when the alcohol wears off,
which sort of defeats the purpose of all that pre-sleep relaxation.
Nicotine will also tamper with your slumbers. Smoking may feel as
relaxing as drinking, but nicotine is, like alcohol, a stimulant. Thus,
smokers tend to sleep lightly – and, because of morning nicotine
withdrawal, they often wake up earlier than they’d like.
In addition to avoiding these substances, you can also introduce a

few sleep-promoting routines into your day and evening.
Before going to bed, take a hot bath. The bath itself will relax your
body and mind – and, of equal importance, the drop in body
95
137
temperature that results from your exiting the bath will induce a
feeling of drowsiness.
If you’re fortunate enough to be able to control the temperature

where you live, set your bedroom to drop to 65 degrees at the
time you intend to go to sleep. “To successfully initiate sleep …
your core temperature needs to decrease by 2 to 3 degrees
Fahrenheit,” according to Walker.
You should also try to get a good amount of natural sunlight

during the day. This will help your body regulate your sleep
pattern. Another trick is to open your bedroom curtains before
you hop into bed, so that the sun, and not an alarm, is what
rouses you in the morning. Finally, keep the temperature in your
bedroom relatively low.
With these tips, there’s no reason you can’t start getting the sleep
you’ve been dreaming of.
***
Insufficient sleep had been linked to the development of obesity,

cardiovascular disease and diabetes.
1) Diabetes: Sleep duration and quality have emerged as predictor

of hemoglobin A1c (HgbA1c).
Knutson et al. Role of sleep duration and quality in the risk and
severity of type 2 diabetes. Archives of Internal Medicine 2006;
166: 1768-1764
2) Cardiovascular Disease: Persons with sleep apnea found to be

at an increased risk of a number of cardiovascular diseases,
notably hypertension, stroke, coronary artery disease and
138
arrhythmias; found to be more common in those with disordered
sleep than their peers without sleep abnormality. Likewise sleep
apnea and atherosclerosis share some physiologic characteristics,
suggesting that sleep apnea may be an important predictor of CVD
(cardiovascular disease).
Kasabeh et al. Inflammatory sleep apnea and their cardiovascular

consequences. South Med J 2006; 99: 58-67
3) Obesity: Lab research has found that short sleep duration

results in metabolic changes linked to obesity. Epidemiologic
studies also revealed an association between short sleep duration
and excess body weight. This association has been reported in all
age groups, but has been particularly pronounced in children. It is
believed that sleep in childhood and adolescence is particularly
important in brain development and that insufficient sleep in
youngsters may adversely affect the hypothalamus which regulate
appetite and expenditure of energy.
The link between short sleep duration and obesity: We should

recommend more sleep to prevent obesity. Arch Dis Child 2006;
91: 881-884
Studies have shown that people who habitually sleep <6 hours per
night are more likely to have a higher BMI (body mass index which
is a measure of height relative to weight, index for obesity).
Normal 18-25, 26-29 overweight, 30-35 obese, 35-40 very obese,
>40 morbid obesity), than those who sleep 8 hours. Lack of sleep
now seen as another factor contributing to obesity on top of
overeating and lack of exercise.
During sleep our bodies secrete hormones to control appetite,

energy metabolism and sugar processing. Poor sleeps leads to
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increased production of “cortisol”, a stress hormone. Excess of
stress hormone “cortisol” is exemplified by the common
complication of cardiovascular disease leading to increased
mortality and morbidity in patients diagnosed with Cushings
syndrome where there is primary or secondary over-secretion of
cortisol. Cortisol excess leads to inter alia, elevation of blood
pressure, truncal obesity, hyperinsulinemia, hyperglycemia, insulin
resistance and dyslipidemia, low HDL (good cholesterol) and high
Triglycerides. The elevated blood pressure is largely due to the
vasoconstrictor (the ability to constrict blood vessels reducing the
opening or lumen) effect of cortisol. This effect is the same when a
blood vessel undergoes “spasm” where there is no obvious
blockage but the artery constricts reducing blood flow which can
create an acute heart attack as in “Takotsubo” syndrome or
“broken heart syndrome” experienced by those who suffer
intense and sudden emotional or physical stress.
Poor sleep also increases secretion of Insulin which promotes fat

storage. Over time, sustained high levels of Insulin leads to Insulin
resistance leading to the metabolic consequences including
obesity, atherogenic dyslipidemia (high triglycerides and low HDL),
glucose intolerance or full blown diabetes and hypertension.
Metabolic syndrome as discussed earlier leads to an increase of
CVD risk by 300%.
Insufficient sleep also is associated with lower levels of “Leptin”, a

satiety hormone that alerts the brain it had enough food. But
levels of “Ghrelin”, the appetite stimulant hormone increases. This
results in food cravings even after adequate calories had been
consumed. It’s been known that that commonly 30% more
calories are consumed after sleep deprivation. Particularly,
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cravings for sweet is commonly experienced for a quick energy
boost, but too weak to burn off the excess calories.
4) Depression: The relationship between sleep and depression is

complex. While sleep disturbance has long been held to be an
important symptom of depression, recent research has indicated
that depressive symptoms may reduce once sleep apnea had been
effective treated and sufficient sleep restored. The
interrelatedness of sleep and depression suggests that sleep
efficiency of persons with depression be assessed and symptoms
monitored in those with sleep disorder.
Zimmerman et al. Diagnosing major depressive disorder: A

psychometric evaluation of DSM-IV symptom criteria. J Ment Dis
2006; 194: 158-163
Schwartz et al. Symptoms of depression in individuals with

obstructive sleep apnea may be amenable to treatment with
CPAP. Chest 2005; 128: 1304-1306
5) Hypertension: During normal sleep there’s a drop in blood

pressure relative to wakefulness, this is referred to as “nocturnal
dipping” and partly attributable to reduced sympathetic output.
Lack or diminished nocturnal dipping is a strong independent
predictor of cardiovascular risk.
David Calhoun et al. Chest 2010; 138 (2): 434-443
Although arbitrary, a reduction of 10-20% in mean nocturnal BP

(both systolic and diastolic) compared to daytime BP is considered
normal. In a Japanese study, The Ohasama study, which noted
that on average, each 5% deficiency in normal decline in nocturnal
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BP was associated with a 20% greater risk in cardiovascular
mortality, in particular for this study was stroke.
Ohkubo et al. Prediction of stroke by ambulatory BP monitoring

vs. screening BP measurement in a general population: The
Ohasama study. J Hypertension 2000; 18 (7): 847-854
With lack of sleep, those with hypertension will find a further rise.
I often find this in my practice when hypertension becomes harder
to control. On query into the patients sleep, significant sleep
deprivation is usually revealed.
Here are some helpful tips:
The protean metabolic abnormalities provoked by lack of sleep

leads to a vicious cycle and metabolic abnormalities can feed on
each other. And yet, a good night’s rest can easily fix and it’s
for free as far as cost and side effects. Think about it!! As I always
say to my patients “The graveyard shift is not called the graveyard
for nothing.”
Let’s face it! Healthy sleep is unavoidable to maintain health and

reverse health conditions though it’s among the first health habit
sacrificed and we humans don’t think twice doing it. We’re the
only species on this earth who routinely sacrifice it. Look at your
pets, do they ever sacrifice their sleep for anything? They sleep
when nature calls for it.
In Dr Dale Bredesen’s book “End Alzheimers Dementia” he writes

about his “Recode” protocol which is his program of reversing
cognitive decline. The first is avoiding glutens which are basically
all grains, avoiding sugar and refined carbohydrates, lots of fibers
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for prebiotics and probiotics. Additionally, he emphasizes on a
good restful sleep, stress reduction and regular exercise. There is
no magic bullet for dementia as you already know. By the time it
manifests, the changes of Alzheimers in the brain already had
gotten a foothold two decades earlier.
The association of poor sleep to dementia had been shown in

many studies. A good restful sleep had been equated to “mopping
the brain clean during sleep.”
In a study funded by National Institute of Neurological Disorders

and stroke, part of the NIH NIH (National Institute of Health)
published in October 2013 found that the brain may flush out
toxins during sleep, particularly those associated with
neurodegenerative diseases as Alzheimers dementia and
Parkinsons disease. This study showed for the first time that the
space between brain cells may increase during sleep, allowing the
brain to flush out toxins that build up during waking hours. These
results suggest a new role for sleep in health and disease. Sleep
changes the cellular structure of the brain. It appears to be a
completely different state, says Dr Nedergaard, the lead author of
the study conducted in University of Rochester Medical Center
published in 2012. This study through imaging techniques,
discovered the “Glymphatic System” of the brain which is an
important cleansing mechanism. Glymphatic because it utilizes
the lymphatic system but is managed by brain cells called the glial
cells.
For centuries, scientists and philosophers have wondered why

people sleep and how it affects the brain. Only recently have
scientists known that sleep is important in storing memories. In
this study, Dr. Nedergaard and her colleagues unexpectedly found
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that sleep may also be the period when the brain cleanses itself of
toxic molecules. It’s as if the brain has 2 garbage haulers. The slow
one that we’ve known about, the CSF (cerebrospinal fluid) and the
Glymphatic system. The CSF system which works more like a
trickle and percolating through the brain tissue and the
glymphatic system which is under pressure, pushing large volumes
of CSF through the brain each day to carry waste away more
forcefully. An in-depth look at amyloid beta, the protein that
accumulates in the brain of patients with Alzheimers, more than
half of the amyloid removed from a mouse under normal
conditions is removed via the glymphatic system. In every organ,
waste clearance is as basic an issue as how nutrients are
delivered. In the brain, it is an especially interesting subject
because all degenerative diseases including Alzheimers disease,
protein waste accumulates and eventually suffocates and kills the
neuronal network of the brain.
Undeniably, sleep also has gifted us as a human specie the

creative genius that came about during dreaming, in particular
during REM sleep.
Take for instance the genius of Dmitri Mendeleev, a Russian

chemist of renowned ingenuity who had an obsession of a
possible organizational logic to the known elements in the
universe, euphemistically dubbed by some as the search for God’s
abacus, referring to the periodic elements. For years he attempted
to deduce the rules of all rules, how these element all fit together.
For years he pondered the riddle of nature and for years he failed.
After allegedly not having slept for 3 days and 3 nights, he reached
a crescendo of frustration. Succumbing to exhaustion and with the
elements still whirling in his mind, Mendeleev went to sleep. As he
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slept, he dreamed and his dreaming brain accomplished what his
waking brain was incapable of. In Mendeleev’s own words: “I saw
in a dream a table where all the elements fit into place as
required. Awakening I immediately wrote it down on a piece of
paper. Only in 1 place did a correction later seem necessary.
Or take the case of Otto Loewi who received a Nobel Prize for his
dream-implanted discovery. He dreamed of a clever experiment
on two frog hearts that would ultimately communicate with each
other using chemicals (later called neurotransmitters) released
across tiny gaps that separate them (synapses) rather than they
were physically touching each other. So profound was the impact
that he received the Nobel Prize.
The artistic genius of Paul McCartney of the Beatles when he

dreamed of the songs “Yesterday” and “Let it be”, both of which
came to him during sleep. In his own words: “I woke up with a
lovely tune in my head. I thought “That’s great, I wonder what
that is?” There was an upright piano next to me to the right of the
bed by the window. I got out of bed, sat at the piano, found G,
found F sharp minor 7th-and that leads you through then to B to E
minor, and finally back to E. It all leads forward logically. I liked the
melody a lot, but because I dreamed it, I couldn’t believe I’d
written it. I thought, “No, I’ve never written anything like this
before.” But I had, which was the most magic thing.
Not to be outdone, Keith Richards of the Rolling Stones about the

famous song “Satisfaction”. After his performance in Clearwater,
Florida on May 7, 1965, he went to bed in his hotel. In his own
words: “I go to bed as usual with my guitar, and I wake up the
next morning, and I see the tape is run to the very end. And I think
“Well, I didn’t do anything. Maybe I hit a button when I was
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asleep.” So I put it back to the beginning and pushed play and
there in some sort of ghostly version, is the opening lines to
“Satisfaction”. It was a whole verse of it. And after that there’s the
40 minutes of me snoring. But there’s the song in its embryo, and I
actually dreamed the damned thing.
Countless literary ideas and epics were created through dreams.

Take the case of Mary Shelley who spent a summer night in 1816
while staying in one of Lord Byron’s estate near Lake Geneva. She
had the most frightening dream which she almost took to be a
waking reality and wrote the most spectacular gothic novel,
“Frankenstein”.
Ever wondered when you have a problem that you don’t seem to
have an apparent solution at the moment, you’re likely to say
“Well, let me sleep on it.” You never hear anyone say “let me stay
awake
over this.” It’s in the deepest slumber of deep REM sleep that we
seem to scour the crevices of our universe to find a solution. Often
enough we wake up with the answer.
12 steps for healthy sleep. Adapted from “Why we sleep” by

Matthew Walker PhD
1) Stick to a sleep schedule. Go to bed and wake up at the same

time each day including weekends.
2) Exercise is great, but not too late in the day. Try to exercise at
least 30 minutes on most days but not later than 2-3 hours before
your bedtime.
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3) Avoid caffeine and nicotine. Coffee, colas, certain teas and
chocolate contain stimulant caffeine, and its effects can take as
long as 8 hours to wear off fully.
4) Avoid alcoholic drinks before bed. Having a nightcap or

alcoholic beverage before sleep may help you relax, but heavy use
robs you of REM sleep, keeping you in the lighter stages of sleep.
You also tend to wake up in the middle of the night when the
effects of alcohol have worn off.
5) Avoid large meals and beverages late at night. A light snack is

okay but a large meal can cause indigestion, which interferes with
sleep.
6) If possible, avoid medicines that disrupt or delay your sleep.
7) Don’t take naps after 3 PM. Naps can help make up for lost
sleep but late afternoon naps can make it harder to fall asleep at
night.
8) Relax before bed. A relaxing activity such as reading or listening

to music, should be part of your bedtime ritual.
9) Take a hot bath before bed. The drop in body temperature

after getting out of the bath may help you feel sleepy, and the
bath can help you relax and slow down so you’re more ready to
sleep.
10) Dark bedroom, cool bedroom, gadget-free bedroom.
11) Have the right sunlight exposure. Daylight is key to regulating

daily patterns. Try to get outside in natural sunlight for at least 30
minutes each day. If possible wake up with the sun or use very
bright lights in the morning.
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12) Don’t lie in bed awake. If you find yourself still wake after
staying in bed for more than 20 minutes or if you start to feel
anxious or worried, get up do some relaxing activity until you feel
sleepy. The anxiety of not being able sleep can make it harder to
fall asleep.
13. Eat Butyrate-producing foods as this metabolite enhances

sleep-promoting signals96.
CHAPTER 8
Rest and Stress Reduction: Art of
Letting Go
You're stuck in traffic, late to an important appointment. Your

breath quickens. Your heart races. Your muscles tense. As your
anxiety builds, you might even feel like you're on the verge of
having a heart attack.
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https://www.nature.com/articles/s41598-019-43502-1
148
What you're experiencing is the phenomenon Harvard
physiologist Walter Cannon once termed the "fight-or-flight"
response. In a stressful situation, your body releases a flood of
chemicals such as cortisol and epinephrine (adrenaline), which
prepare your body for action. If the car in front of you were to
burst into flames, you'd be ready to leap from your car and flee.
But the reaction is counterproductive when you're just waiting in
traffic.
Chronic stress—whether from a traffic-choked daily commute,

unhappy marriage, or overbearing boss—has been linked to a
wide range of harmful health effects. It can interfere with your
mood, sleep, and appetite. But can stress cause heart disease?
There's no question that stress can exert real physiologic effects

on the body—including the heart. This is most true in the case of
severe and sudden (acute) stress. People who've received
traumatic news—like the death of a child—have, in rare cases,
suffered an immediate heart attack. This isn't just an anxiety
attack. When you do a cardiac catheterization procedure on them,
an artery that was previously open is now closed. The condition is
known as "broken heart syndrome,"
BROKEN HEART SYNDROME
A set of symptoms similar to those of a heart attack, but occurring

in response to physical or emotional stress is called broken heart
syndrome. Most people affected by broken heart syndrome think
they are having a heart attack because symptoms, such as
shortness of breath and chest pain, are similar in both conditions.
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Broken heart syndrome is also called Takotsubo cardiomyopathy
and stress-induced cardiomyopathy, stress-caused dysfunction or
failure of the heart muscle. Rising trend:
https://www.cnn.com/2020/07/09/health/broken-heart-
syndrome-coronavirus-wellness/index.html
Broken heart syndrome
TAKOTSUBO cardiomyopathy or stress cardiomyopathy or

broken heart syndrome.
Following an intense emotional or physical stress, there is

expansion of the apex (tip) of the heart in 75-80% cases or its
mid-section in 10-20%.
Worldwide, 90% of cases are postmenopausal women.
But in Japan, it’s more common in men who have had

physical stress.
The mechanism is not clearly known but the patient presents

as if they had a heart attack. Possibly, a rise in stress related
hormones contributes to expansion via disruptions in the
small vessels or by myocardial toxicity.
The most common symptoms are chest pain, shortness of

breath and dizziness.
Weakness and passing out may occur.
The patient may have classic signs of heart failure and
150
laboratory tests would show, just like a heart attack.
The EKG (also known as ECG) shows typical findings of a heart

attack.
On heart catheterization, no blockage of the coronaries is

found.
Mayo clinic has given diagnostic criteria that doctors can

follow.
Treatment is similar to that for heart attack and/or heart

failure if present. It is largely supportive and with use of
anticoagulants in severe cases.
95% of patients generally recover full cardiac function in

some weeks.
Broken heart syndrome is an example of the heart damage that

can result from a severe, acute form of stress. But what about
everyday stresses, like rush-hour traffic, marriage strains, and on-
the-job aggravation?
It has been suggested that stress triggers inflammation, a known

sponsor of heart disease. Yet stress may also influence heart
disease in more subtle ways by leading us into other heart-
damaging behaviors, such as smoking and drinking too much
alcohol.
151
Want to lower down the stress level and help your heart in the
process? Try these tips:
Stay positive. People with heart disease who maintain an upbeat

attitude are less likely to die of heart disease than those who are
more negative, according to research. Having a good laugh can
help your heart. Laughter lowers the stress hormones levels,
reduces inflammation in the arteries, and increase "good" HDL
cholesterol.
Gratitude: Expressing gratitude improves cardiovascular strength,

sleep quality and more, researchers said.
"Gratitude enhances performance in every domain that's been

examined, psychological, relational, emotional, physical," said
Robert Emmons, a professor and psychologist at the University of
California-Davis. "This is why it's been referred to as the ultimate
performance-enhancing substance."
The field of gratitude health studies is young, but researchers said

practicing gratitude may positively affect physical health in two
main ways: It can change your biology and your behavior.
"A health behavior change is when someone that practices

gratitude ends up engaging in more self-care behaviors, or
following the directions of their care provider more closely," said
Emiliana Simon-Thomas, science director at the Greater Good
Science Center, an interdisciplinary research center at UC-Berkley.
“Sometimes you’ll find that a study reports that a particular
gratitude intervention leads to lower blood pressure – that’s the
biology pathway."
152
Gratitude "interventions" are a method researchers use to
determine how expressing gratitude may directly cause positive
health effects. A common approach is to ask participants to write
down what they're grateful for each day in a "gratitude journal" or
to pen "gratitude letters."
Several studies have concluded that keeping a gratitude journal

improves physical health. In 2015, a study of 119 women at the
University College London found that just two weeks of keeping a
gratitude journal can improve sleep quality and decrease blood
pressure.
Researchers at UC-San Diego came to a similar conclusion the

following year. A study in 2016 of nearly 70 men and women at
risk of heart failure asked participants to keep a gratitude journal
for eight weeks. Researchers found that the participants who kept
gratitude journals had lower levels of inflammation, a biomarker
of heart failure.
"Along the lines of physical exercise, a healthier diet or higher-

quality sleep, gratitude is worth the time," Simon-Thomas said.
Practicing gratitude is also tied to lower stress levels, Simon-

Thomas said, because people who regularly express gratitude
have a greater capacity to regulate emotions in a constructive
way. It can even "short-circuit" the body's stress response.
"The holiday season can be very stressful," Emmons said. "People

are exhausted, worn down and worn out, feeling depleted and
defeated. That is why gratitude is especially important this time of
year. Grateful people are less likely to experience envy, anger,
153
resentment, regret and other unpleasant states that produce
stress and thwart positive emotions."
Jeff Huffman, a professor of psychiatry at Harvard Medical School

and director of the Cardiac Psychiatry Research Program at
Massachusetts General Hospital, said the field of gratitude studies
has a lot of ground to cover. In the past 15 years, there have been
less than 10 trials of gratitude-based interventions in patients with
chronic health conditions, according to an article published this
year in the British Journal of Health Psychology.
Forgive: Almost everyone has experienced being wronged by

someone. It could be a former co-worker, friend, or family
member. But hanging on to those negative feelings can do great
harm to your health.
"Forgiving a person who has wronged you is never easy, but

dwelling on those events and reliving them over and over can fill
your mind with negative thoughts and suppressed anger
Why would I, a physician, stop to discuss the act of forgiveness?

Mind-body medicine focuses on the interaction between the mind
and the body and the powerful ways in which emotional, mental,
social and spiritual factors can directly affect health.
Feeling bitter interferes with the body's hormone and immune

systems. Bitter and angry people have higher blood pressures and
heart rates, and they are more likely to die of heart disease and
other illnesses. Research also shows people who harbor
resentment from an inability to forgive are more likely to suffer
from depression.
154
Physiologically, when we feel negatively towards someone, our
bodies instinctively prepare to fight that person, which leads to
changes such as an increase in blood pressure. Feeling this way in
the short term might not be dangerous -- it might even be helpful
to fight off an enemy -- but the problem with bitterness is that it
goes on and on. When our bodies are constantly primed to fight
someone, the increase in blood pressure and in chemicals such as
C-reactive protein take a toll on the heart and other parts of the
body. Studies at Duke University show that having feelings of
resentment are as dangerous as smoking in risks for heart attacks
and stroke.
Resentment is defined as indignation or anger about having been

treated unfairly. It is a complicated emotion because it involves
feeling humiliated, shamed and sometimes wanting revenge. We
have all been there, waiting to see what "karma" would bring the
other person. Malachy McCourt's wisdom is the often hard to
swallow anecdote: Resentment is like taking poison and waiting
for the other person to die.
Meditate. This practice of inward-focused thought and deep

breathing has been shown to reduce heart disease risk factors
such as high blood pressure97. Anyone can learn to meditate. Just
take a few minutes to sit somewhere quiet, close your eyes, and
focus on your breathing. Meditation's close relatives, yoga and
prayer, can also relax the mind and body.
Yoga. Yoga — a mind-body practice — is considered one of many

types of complementary and integrative health approaches. Yoga
brings together physical and mental disciplines that may help you
97
https://www.ahajournals.org/doi/10.1161/JAHA.117.002218
155
achieve peacefulness of body and mind. This can help you relax
and manage stress and anxiety.
Similar to results from other physical activities, your body releases

mood-boosting chemicals called endorphins, chemicals produced
naturally by the nervous system to cope with pain or stress. They
are often called “feel-good” chemicals because they can act as a
pain reliever and happiness booster.
Dry brushing and FAR infrared sauna: Sauna use can help the
body and mind adapt to stress and reduce the risk of depression
and other mental health disorders. Heat bathing in a sauna
provides stress relief in a number of ways. It’s a warm, quiet space
without any distractions coming from the outside.The heat from
the sauna relaxes the body’s muscles, improves circulation and
stimulates the release of endorphins. Endorphins are the body’s
all-natural “feel good” chemical, and their release provides a truly
wonderful “after sauna glow.”
When combined with dry skin brushing, you can boost benefits.
Similar to massage, dry skin brushing is a self-care technique that
can decrease stress. When in a state of relaxation, your body can
function optimally and heal faster. Chronic stress eventually leads
to an imbalance in hormone levels that can increase inflammation
and result in poor endocrine system functioning.
Earthing: or Grounding, is a therapeutic technique that involves

doing activities that “ground” or electrically reconnect you to the
earth.The hippie wisdom in getting back in touch with our earthly
roots just may have had something to do with grounding’s health
benefits. Earthing can help protect our bodies against chronic
156
inflammation, which is, in part, caused by lack of electrons with
which to neutralize positively-charged free radicals. As with
antioxidant deficiency, electron deficiency due to insufficient
contact with the earth’s electromagnetic surface, or “disconnect
syndrome,” can result in excess oxidative damage.
When we attune to the earth’s electric potential, we soak up

negatively-charged electrons that neutralize free radicals in our
bodies. Many of Earthing’s reported benefits, such as chronic pain
relief and faster wound recovery, may simply result from
reduction of free radical activity and inflammation, which frees up
the immune system to perform other reparations. Other potential
antioxidant benefits such as lowered blood pressure and better
circulation may also result from the blood thinning effect of
grounding. While reduced inflammation may also explain
improved sleep and lessened menstrual symptoms, these
reported Earthing benefits may also be due to the favorable effect
grounding has on the autonomic nervous system (ANS), which can
lead to greater overall hormonal balance.
As a system which rapidly responds to emotional and

environmental stimuli, the ANS controls a wide range of bodily
functions. Cardiovascular, respiratory, gastrointestinal, hormonal,
urinary, and other body systems are regulated by the ANS’s
sympathetic and parasympathetic branches. The sympathetic
nervous system (SNS) branch prepares the body to deal with
stressors, while the parasympathetic nervous system (PNS) branch
relaxes the body. When we are chronically stressed, we may
experience symptoms like headaches, insomnia, muscular tension,
back or neck pain, fatigue, gastrointestinal distress, and even
cardiac problems.
157
In addition to using cortisol as a yardstick for chronic stress,
cardiologists also examine our heart rate variability (HRV) to
detect ANS imbalance and its impact on our heart function. HRV is
a measure of the beat-to-beat alterations of heart rate. People
whose heart rates do not vary much despite changes in external
stimuli are said to have low HRV. They are less able to “go with
the flow” when faced with stress and are more prone to stress-
related disorders, especially cardiovascular events. Low HRV
indicates that the ANS is imbalanced due to excess SNS activity.
With its balancing effect on the ANS, grounding is a natural means
of increasing HRV and promoting heart health.
Tai Chi. For centuries, millions of Chinese have practiced the

flowing, meditative exercise known as tai chi. In recent years, tai
chi's popularity has risen in the United States, thanks in part to
growing evidence for its health benefits. Hundreds of studies
dating back to the late 1950s show modest improvements for a
wide range of conditions, including heart failure, coronary artery
disease, and high blood pressure.
As with other mind-body practices such as yoga, tai chi's rewards

are thought to arise from its combined focus on movement,
breathing, and relaxation.
"Tai chi is a gentle, easily adaptable exercise that integrates

physical activity, breath awareness, and a variety of cognitive skills
that include focused attention and imagery," says Peter Wayne,
assistant professor of medicine at Harvard Medical School and
author of The Harvard Medical School Guide to Tai Chi.
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CHAPTER 9
Supplementation: Filling The
Gaps
About twenty years ago, I used to tell my patients that

supplements made expensive urine. That was before I started
measuring the effects of vitamins, minerals, and plant compounds
like polyphenols, flavonoids, and phytonutrients in my patients’
inflammatory markers. I also perform actual measurements of
each patient’s vascular flexibility, using an Endopat device, an
FDA-approved system that measures the response of blood
vessels in the arm before and after a brief period of blood flow
restriction. I can now reliably tell when patients have changed
their supplement regimen or even changed brands, based upon
these tests.
Let me tell you why nutrient supplementation is a critical

component of the Heart Mend Program. I choose no better source
to convince you than the United States Federal government. Here
is the actual wording in U. S. Senate Document 74–264:
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“The alarming fact is that foods—fruits, vegetables and grains—
now being raised on millions of acres of land that no longer
contains enough of needed nutrients, are starving us—no matter
how much we eat of them.”
It was written in 1936! Eighty-one years ago. Even then, scientists

knew that our soil has been depleted of vitamins, minerals, and its
own microbiome. And that was in the days before the use of
petrochemical fertilizers, pesticides, biocides, and Roundup. The
mind boggles at what our soil would contain now (and what it
wouldn’t contain). And we know for a fact that it’s worse, as
detailed in a 2003-report that compared the mineral content of
vegetables and fruits from 1940 to 1991.
The Awesome Four

Metabolic cardiologist Dr. Stephen T. Sinatra considers coenzyme
Q10 (CoQ10), L carnitine, D ribose and magnesium the ‘awesome
foursome’ of cardiovascular health.
Dr. Sinatra explains that while 1 + 1 will always equal 2 in

mathematics, in metabolic cardiology and nutritional medicine,
when you are talking about substances that are synergistic with
each other such as the ‘awesome foursome’, 1 + 1 can equal 5 or
even 10. In other words, the benefits of taking more than one of
these substances at a time far outweigh the benefits from taking
any of them alone.
The heart and the brain are especially rich in mitochondria, the
energy fuel ATP (adenosine triphosphate) is produced here. Both
organs have extraordinary non-stop work and need an enormous
amount of energy. Any mitochondrial damage would result in
160
decreased energy output. Dr. Sinatra explains that hearts, skeletal
muscles and every other tissue in our bodies have an absolute
need for ATP as their primary energy currency. Cells and tissues
will stop functioning if they don’t get a continuous and stable
energy supply. Both the total pool of energy building blocks (ATP)
in the cell and then its ability to recycle these compounds are
essential to healthy energy balance and cell function.
When heart is stressed by disease, energy building block “purines”

wash out of the cell and the total energy pool becomes severely
low. Disease also disrupts the heart’s ability to recycle its
remaining energy through other mechanisms. The combination of
energy pool depletion and dysfunction contributes to the severity
of the disease and impacts the heart’s health.
The same is goes for skeletal muscles that are stressed by disease
or high-intensity exercise.
CoQ10 and L carnitine are major players in the energy recycling

pathways. D ribose is the only compound usable by the body to
refill exhausted energy stores and rebuild energy pools.
Magnesium is a vital mineral used by the enzymes for making
energy and recycling. Or as Dr. Sinatra explains: D ribose fills the
tank, CoQ10 and L carnitine helps convert this fuel to energy (run
the engine properly) and magnesium is the glue that holds it all
together.
CoQ10
CoQ10 is a naturally occurring enzyme in the mitochondria of

every cell. It plays a key part in metabolizing energy from food and
stabilizing cell membranes. CoQ10 was first discovered in 1957
and scientists have been studying its effects on a wide variety of
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illnesses and conditions since then. CoQ10 directly supports ATP
recycling in the mitochondria, especially in cells of heart and
brain. Dr. Sinatra explains that CoQ10 helps any type of heat
muscle damage and the pumping abilities of heart.
The right ventricle pushes blood into the lungs, while the left
ventricle pumps blood to the rest of the body. The ventricles
(bigger chambers) empty when the heart contracts to pump out
blood (the systole), and fill when the heart relaxes (the diastole).
Diastolic dysfunction is when the heart does not have enough
energy to relax between contractions and so the ventricles fill
with blood in a abnormal way and an inadequate amount of blood
is pumped by the heart with each contraction. Dr. Sinatra explains
that a great deal more energy is needed for the heart muscles to
relax, than for them to contract. The diastolic dysfunction is best
measured using an impedance cardiograph machine.
Without CoQ10, the energy production process would break down

completely. This would be catastrophic. There has to be an EXCESS
of CoQ10 in the mitochondria to be effective. CoQ10 is an
antioxidant and also reduces cancer risk. CoQ10 support ATP that
in turn supports immunity, as the immune system has high ATP
needs. CoQ10 also protects brain cells against effects of
mitochondrial toxins.
CoQ10 reduces platelet size, distribution, stickiness and regulates

platelet accumulation and activation that makes blood clot.
Diseased gums may be a sign of low CoQ10 levels.
Levels of CoQ10 reduced by 25% cause impairment in organs and

if reduced by 75%, serious tissue damage and even death may
occur.
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CoQ10 decreases cardiac mortality. Dr. Sinatra found that 85% of
his cardiac patients responded to CoQ10 alone, 15% needed to
take CoQ10 and L carnitine before benefits were seen (even
where blood levels of CoQ10 were shown to be high). Although
CoQ10 comes in two forms, ubiquinone and ubiquinol, for many
years ubiquinone was the only CoQ10 supplement available.
Advances in CoQ10 manufacturing in Japan have recently led to
wide availability of ubiquinol supplements. According to Dr.
Sinatra, ubiquinol raises blood levels of CoQ10 just over three
times as well as standard ubiquinone- 15 mg of ubiquinol is equal
to 50 mg of ubiquinone.
To create cellular energy, the body has to convert ubiquinone into

ubiquinol. Aging and other factors however slow down or stop
this conversion, leading to low CoQ10 levels. If you are one of
those that have a problem converting ubiquinone, then prefer to
take ubiquinol. Some studies show ubiquinol as being up to 8
times as bioavailable (absorbable and useable) as ubiquinone. The
conflicts in clinical research are mostly due to the variations in
bioavailability of different types of CoQ10 and the doses used.
Water miscible forms are best absorbed, while powder forms are
least well absorbed.
Ubiquinol is the preferred form of CoQ10 and is better value than

ubiquinone. Ubiquinone may cause some side effects at high
doses (e.g. 1200 mg), however, ubiquinol supplementation gives
the same high blood levels at much lower doses, so, the potential
for side effects is also much reduced. Blood levels peak 6 hours
after ingestion.
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L carnitine
The name carnitine is form Latin meaning flesh, as carnitine was

first isolated form meat sources. Nutritionist Robert Crayhon,
author of The Carnitine Miracle, explains that carnitine is not an
amino acid (protein building block) but a coenzyme, a water-
soluble vitamin-like compound. It is similar to choline, one of the B
vitamins, and like the B vitamins, carnitine helps us turn food into
energy. More specifically, it is essential for the burning of the
long-chain fatty acids.
The heart depends on adequate concentrations of carnitine for

normal heart function.
The primary role of carnitine is to help transport fatty acids into

the mitochondria, the energy producing units in the cells, where
they can be converted to energy. This is a major source of energy
for the muscles, including heart muscles. Carnitine increases the
use of fats as an energy source.
Carnitine is useful in clearing the bloodstream of ammonia and

creating glycogen (glucose storage). Carnitine also moves out
waste products from mitochondria, preventing accumulation of
toxic waste products. Carnitine reduces the buildup of lactic acid,
which is responsible for the burn felt inside the muscles with
exercise.
Carnitine can help to prevent muscle degeneration/atrophy.

Carnitine protects the heart from damage when a heart attack or
a spasm cuts off the oxygen supply. Recent research shows
carnitine can aid in recovery after a heart attack. Michael Murray
N.D., author of ‘The Pill Book: Guide to Natural Medicines’ writes,
‘Subjects taking carnitine showed significant improvements in
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heart rate, blood pressure, angina attacks, rhythm disturbances,
and clinical signs of impaired heart function compared to the
subjects taking placebo.’
Carnitine may help in low thyroid function to overcome low

energy levels and the tendency to gain weight.
Carnitine can improve insulin sensitivity in type 2 diabetes.
Carnitine supplements may be advisable in dialysis patients;

dialysis rinses away amino acids, causing weak, tired condition,
and high triglycerides.
At doses of 1–3 g, carnitine reduces blood triglycerides.
The body manufactures carnitine if sufficient amounts of iron,

vitamin B1, vitamin C, niacin, vitamin B6, lysine, and methionine
are available. Food sources of carnitine include meat, poultry, fish,
and dairy. Robert Crayhon points out that due to high intake of
red meat, the Stone Age hunter probably got 500mg to as much as
2 grams of carnitine a day. Today, the average carnitine intake is
estimated at a mere 30 to 50 mg a day, while strict vegetarians
consume practically no carnitine.
Carnitine is generally not well absorbed, and its best absorption is

on an empty stomach. There are different forms of carnitine; L
carnitine fumarate is absorbed at a slightly higher rate than pure L
carnitine and L carnitine tartrate. L carnitine fumarate is stable
enough to be available in capsule form and has double effects as
the fumarate is also a beneficial compound.
Pure L carnitine draws moisture and so is not suitable for capsules

and tablets. It is commonly used in liquid carnitine products and
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pure carnitine powders. It has a very mild taste when mixed with
water and is thus preferred for use.
For heart, a new form of carnitine known as L-propionylcarnitine

appears to be the most effective, although it is the most expensive
and difficult to source (look for products labeled Glycocarn).
L carnitine tartrate is a tolerable form of L carnitine. When mixed

with water it has an unpleasant taste. L carnitine is thought to be
one of the safest nutritional supplements on earth, according to
Dr. Sinatra.
Nutritionist Robert Crayhon also explains that acetyl L carnitine

(ALC) is the best form for neurological disorders. It improves
cognitive function and increases mitochondrial energy production.
Besides improving fatty acid transport and use, ALC also increases
the brain cell activity by raising the level of neurotransmitter
receptors and chemicals acetylcholine and dopamine. It reduces
the buildup of lipofuscin (a waste product in lipid metabolism,
seen at high levels in dementia), counters glycation and promotes
melatonin (sleep hormone) production. Acetyl-l-carnitine also
restores cortisol receptors, acts as an antioxidant and boosts the
levels of glutathione and CoQ10.
Supplementation with ALC reduces degenerative processes in the

nervous system, and improves memory and learning ability.
According to Robert Crayhon, ‘Acetyl-l-carnitine qualifies as the
superstar of neuroprotection.’
One side effect of acetyl L carnitine is vivid dreams, possibly due

to increased melatonin production. Too much ALC can cause
neurological over-activation, especially in neurological diseases
involving seizure states and so a small dose of 500mg is
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recommended. ALC is not endorsed where seizure problems are
severe.
ALC is one of the most important supplements to be taken after a

stroke, to help speed recovery. The usual dose after for stroke
patients is 1500mg.
D ribose
D ribose (or ribose) is a simple 5-carbon sugar found in all living

cells. Dr. Sinatra explains that until 1944, D-ribose was primarily
thought to be a structural component of DNA and RNA with little
other significance. But, a series of studies till 1957 revealed that
this sugar molecule was an intermediary in the pentose phosphate
pathway, which is central to energy production, the making of
genetic material, and for providing substances to make fatty acids
and hormones.
Several notable papers published in 2003 show that D-ribose

improved diastolic (relaxing or non-pumping state) function of the
heart, increased exercise tolerance, and significantly improved the
quality of life of patients.
Research continues here and abroad. Yet, despite the powerful

scientific evidence, very few physicians have even heard of D-
ribose outside of their first-year medical school biochemistry class,
and fewer still recommend it to patients. We lucky ones who are
familiar with it, have the wonderful gratification of seeing it help
our patients on a regular basis.
Ribose is a now very well studied product. More than 100

researches have been completed or published on its
cardiovascular health benefits. In short: Ribose plays a role in
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making of glucose, which is used in energy production and,
cyclically, production of ribose. Ribose is the prime ingredient in
the production of ATP, the energy source for all muscles.
Ribose is found in heart and muscle cells, but the body cannot
manufacture it quickly enough in time of metabolic stress, such as
strenuous exercise or diminished blood flow or metabolic
insufficiency.
Ribose is vital in the formation of nucleotides, compounds needed

by the heart, skeletal muscles and whole body cells to; produce
energy, manufacture protein, glycogen and nucleic acids (RNA and
DNA), control calcium and other electrolytes, and relax the heart
and muscle cells.
Dr. Sinatra writes, about 97% supplemental D-ribose gets absorbs

through the gut and into the bloodstream. Any amount of D-
ribose given to energy-starved cells gives them an energy boost.
At the University of Missouri, researcher Ronald Terjung showed
that even very small doses of D-ribose –about 500mg- increase
energy salvage in muscles by more than 100%. Larger doses
increase the production of energy compounds by 340-430%,
depending on the type of muscle tested, and save the energy
compounds by up to 650%. Most amazing is that when muscles
are supplemented with D-ribose, they continue to add to their
energy stores even while they are actively working! Until this
study, it was thought that muscle energy stores in muscles only
refill at rest.
An adequate dose of D-ribose usually results in symptom

improvement within a few days. If the initial response is poor, the
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dose should be increased until the patient feels relief. Logically,
the sickest patients stand to gain the most.
Dosage recommendations
CoQ10/ubiquinol: Dr. Sinatra recommends the following daily

CoQ10 dosages (note that the ubiquinol figures have been
rounded to the nearest 25 mg):
Recommended
Ubiquinol 25 - 50 mg
Ubiquinone 90 – 150 mg
For cardiac disease prevention
For cardiac arrhythmia, angina and those taking statin drugs
For dilated cardiomyopathy and congestive heart failure
Ubiquinol 175 – 350 mg
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The dosage of CoQ10 in M.E. can be guided by blood levels of
CoQ10 or by raising the dose until the patient feels significant
improvement, or both. The maintenance dose is adjusted
downwards as much as possible, without losing the benefits. For
severely affected patients, the maintenance dose may need to
stay the same as the starting dose, in order to prevent relapse.
CoQ10 should be taken in 2 – 3 divided doses (with food). Do not

take medium or large doses all at once.
Dr. Sinatra recommends that patients be pre-treated with CoQ10

before any type of heart surgery. He says that very severely ill
patients may need three times as much CoQ10 as others. Benefits
will often be seen in 1 – 4 weeks but it may take several months
for the full effect to become apparent.
L carnitine: For those with serious cardiac issues, as in M.E., pure L

carnitine can be tried at 250 – 750 mg taken 4 times daily (for a
total intake of 1 to 3 grams daily), according to Dr. Sinatra.
If improvement is not seen at 3g, the dose may need to be raised

up to 6g according to severity of disease. The maintenance dose
may be very much lower than the initial dose, although in severe
cases, the initial dose might need to be maintained t to prevent
relapse. How you feel should be your guide to tell your best L
carnitine dose long-term.
Do not take doses larger than 1 – 1.5 g at a time as absorption is

quite low with large doses. L carnitine is best taken in 3 – 4
divided doses.
D ribose: The usual recommendation for D ribose in serious

cardiac issues is 10 to 15 grams daily divided into two or three 5g
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doses (roughly 1 heaped teaspoon). According to Dr. Sinatra, in
very severe cases doses of 15 – 30 g may be recommended.
A very cautious starting dose in M.E. is 550 mg (1/8th of a

teaspoon) taken daily, in divided doses, for the first week. It is
then raised 550 mg a week or a fortnight until a dose of 5 g (or
more) is safely reached or the treatment must be stopped due to
it causing relapse. Note that having smaller doses less frequently
increases your tolerance of D ribose and buying powders rather
than tablets may make taking smaller doses easier to manage.
Make sure to take D ribose with food to lessen its effect on blood
sugar levels. Ribose gives improvements in a few days.
Magnesium: See the Minerals paper for information on all aspects

of magnesium.
All four of these supplements are very safe to take long-term.
Antioxidants and mitochondrial and other supports
Nutritionist Robert Crayhon explains that mitochondrial supports

should be taken with antioxidants to balance for the increased
making of free radicals (a by-product of greater energy output).
Older people especially need to take extra antioxidants to
compensate for this. Lipoic acid is one of the most important
antioxidants, along with CoQ10, vitamin E and vitamin C.
Dr. Sinatra recommends that 50 -100mg of lipoic acid (and also a

daily multivitamin, extra vitamin C and fish oil) always be taken
along with the ‘awesome foursome.’ He says that life-long
supplementation with CoQ10, L carnitine, lipoic acid and vitamins
171
C and E is essential to help neutralize free radicals, to nurture your
mitochondria and to delay aging,.
Another important supplement for vascular health is the amino

acid L arginine. The dosage is usually 2 to 5 grams daily, taken in
divided doses. Some doctors prefer to recommend slow-release
forms.
Magnesium
I can’t stress enough how important magnesium is for your health.

Magnesium is vital mineral to all organs and cells of the body,
especially to muscles and heart.
Magnesium is involved in more than 300 biochemical functions

in your body, supporting:
● Your heart rhythm
● Arterial and muscle function
● Blood pressure
● Cell energy
Magnesium improves the metabolic efficiency of the heart cells

and thus useful treatment for a multitude of cardiovascular
conditions. The mineral being a muscle relaxer, helps maintain
vessel tone by, therefore; healthy blood pressure, reverse arterial
plaque, help alleviate chest pain and other symptoms of angina
caused by lack of oxygen and energy in the heart.
A shortage of magnesium can actually cause and worsen

congestive heart failure, atherosclerosis (plague), high blood
172
pressure, chest pain, heart attack, cardiac arrhythmias, heart
muscle disease (cardiomyopathy), and even sudden death. But
what is alarming to me is so many people are deficient in this key
mineral and this is impacting their heart health.
Once thought of as a rare condition, magnesium deficiency is a

vastly prevailing problem. It’s expected that over 70% of adults in
the United States consume less than the recommended daily
allowance (RDA) of magnesium, and 19% consume less than 50%
of the RDA1.
What’s causing such a rampant deficiency of this crucial mineral?
There are several factors at play, including:
● Stress: If the stress level in your life is high, and you don’t
exercise enough, your bloodstream may be flooded with
the “fight or flight” hormones adrenaline and cortisol on a
regular basis. This releases magnesium from your cells and
is lost in the urine.
● Medications: If you are on diuretics or heart medications,

you may be lessening your magnesium levels because
these drugs are known to dump magnesium into the urine.
● Diet: The typical American diet lacks this nutrient. Current

farming technologies use large amounts of inorganic
fertilizers, often low in magnesium. This combined with the
overuse of phosphates, nitrates, and ammonia, drains the
much-needed magnesium from the soil.
● Carbonated Beverages: If you drink a lot of dark colored

carbonated beverages you may be flushing magnesium out
173
of your system. These sodas contain phosphoric acid,
which binds with magnesium inside the gut, making it
unusable by the body. But phosphoric acid isn’t the only
bad guy, sugars in the drinks also reduce magnesium levels
● High Levels of Calcium Supplements: Calcium and

magnesium work synergistically in the body, but without
the right balance, magnesium levels get depleted.
The fact is that many people are magnesium deficient either due
to medical conditions or poor diet and/or other lifestyle habits.
But how to know if your magnesium levels are low?
You can ask your healthcare professional to test for a magnesium

deficiency but be prepared; the results may be misleading. Most
laboratories measure magnesium levels in the blood, but there is
a very weak correlation between the magnesium levels in your
blood and how much is in your heart cells. That’s because less
than 1% of total magnesium in your body is present in your
blood2.
However, if your blood magnesium is low, then it’s likely that the
level in your heart is low too. Likewise, if your blood level is high,
there is a sound chance that the level in your heart is adequate.
But what if the blood magnesium levels are in the normal range?
Is all well? Normal blood magnesium does not necessarily mean
that the heart has a normal level of this vital mineral.
Some tests measure levels in blood cells and skeletal muscle but
these tests are technically difficult and very expensive. Modern
technology has yet to develop an ideal system for measuring
magnesium.
174
Because of these drawbacks and the fact that magnesium is safe,
inexpensive, and easy to use, it should be given its due
consideration as a useful mineral for chronic and acute heart
problems.
If you suspect a deficiency, be on the lookout for these signs of

low magnesium:
1. Muscle Cramps: To stay healthy, the muscles require the right

balance of magnesium, potassium, and calcium. When magnesium
levels are low, too much calcium moves inside the cells, which
over-activates the cells making them jumpy. So, if you find
yourself getting leg cramps, charley horses, or muscle twitches
frequently, this could be due to a magnesium deficiency.
2. Heart Palpitations: A feeling of a fluttering, racing, and skipping

heartbeat are one of the scarier signs you may be low on
magnesium.
3. High Blood Pressure: Magnesium’s main job is to relax the

muscle cells in artery walls, which helps the arteries relax and stay
flexible. But when you are low on magnesium, arteries become
tense and rigid, and blood pressure goes up (gradually rising blood
pressure can be a sign of many things, including low magnesium
levels).
4. Fatigue and Weakness: Magnesium plays an important role in

cellular energy. If you’re feeling fatigued, your muscle strength is
compromised, it may be an indicator that your magnesium levels
are low.
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5. Depression, Anxiety and/or Insomnia: If you are prone to
depression, anxiety and insomnia, it could be due, in part, to low
magnesium levels.
If you are concerned about your magnesium levels, I suggest

adding the following magnesium-rich foods to your diet:
● Fish and Seafood: Wild-caught Mackerel, halibut, and

salmon are all good sources. Stick with smaller fish like
mackerel because they generally have less mercury than
larger fish.
● Leafy Green Vegetables: Spinach, kale, collard greens, and

Swiss-chard are healthy choices, don’t forget about kelp
and other seaweeds.
● Avocados: One cup of sliced avocado contains 44 mg of

magnesium.
Other good sources of magnesium include figs, apricots, and dark

chocolate.
In addition to foods, I recommend taking at least 400 to 800 mg of

magnesium daily. When selecting a magnesium supplement, I
recommend taking one that includes all four of the absorbable
forms, including: orotate, citrate, taurinate, and glycinate.
A word of caution here: If you have renal insufficiency or kidney

failure, do not take a magnesium supplement unless prescribed
and monitored by your physician. Excessive levels can be
dangerous.
It’s a good idea to take a magnesium supplement as part of your

nightly routine along with brushing your teeth. Sometimes
176
insomnia or anxiety can make you feel as though every muscle in
your body is tense. This can cause muscle cramps at night that
disrupt sleep, which is why I recommend taking magnesium at
night for the greatest effect.
You don’t have to worry about any side effects from consuming
too much magnesium from food because the kidneys remove
excess amounts in the urine.
If you’re concerned about side effects from taking too high a

dosage of a magnesium supplement, there’s a telltale sign: the
need for extra toilet paper! Bowel cleansing and constipation
relief are the biggest side effects of taking too much magnesium.
But it’s almost impossible to develop toxicity from too much
magnesium without you knowing it, because you’ll get loose
stools. And the good news is you can adjust your dosage of
magnesium accordingly.
I whole-heartedly believe taking supplemental magnesium is a

sound health insurance policy. That’s why I recommend a healthy
diet of magnesium-rich foods and supplementing with broad-
spectrum magnesium daily.
Dosage
Taking Magnesium bicarb. (Magnesium water, p. 351),

Magnesium malate or Magnesium Glycenate to get 400-500 mg
daily elemental Magnesium reduces blood pressure and prevents
abnormal heart rhythms.
Resveratrol
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Have you heard of the so-called "French paradox?" It refers to the
fact that despite having high cholesterol and high saturated fat
diet, the French do not develop heart diseases because of their
high red wine intake98. While this belief most likely stemmed from
a marketing campaign by the wine industry 99, there may be some
truth to this. Red wine contains a potent antioxidant known as
resveratrol100.
However, since red wine is not the only source of resveratrol, and
you should not rely too much on it as alcohol content can pose
serious negative effects.
Let's touch on what resveratrol is and how it may affect your

body.
What is resveratrol?
Resveratrol is also known as 3,4',5-trihydroxystilbene, a naturally

occurring, plant-based polyphenol compounds. It acts like an
antioxidant and may be a chemo preventive agent 4. Resveratrol is
actually designed to help increase the life span of these plants by
making them resistant to diseases, injury and various stressors,
including excessive UV radiation, drastic climate changes and
fungal infections5, 6.
Japanese scientist Michio Takaoka first discovered the compound

in 19397. He isolated it from the rhizomes of the white hellebore
(Veratrum grandiflorum Loes)8, which blossoms in the Nagano
Prefecture, Japan9.
98
99
https://nutrition.org/french-paradox-really-wine/
100
178
In 1963, another Japanese scientist Nonomura isolated resveratrol
from Japanese knotweed10. This herb has been used to help ease
cough, treat jaundice and manage hepatitis for many centuries in
traditional Chinese medicine11. Knotweed is known to have the
highest resveratrol concentration among plant sources12.
It was only in 1976 that resveratrol was found in grapes 13 and in

1992, it was discovered to be in wine 14. More studies to find
benefits of resveratrol are still being done.
Ditch the wine: other food sources of resveratrol:
People have a misconception that they can only reap the benefits
of this potent antioxidant by simply drinking red wine, but you can
get resveratrol from a number of plant foods too. Although
resveratrol is highly soluble in alcohol 15, making it more
absorbable in red wine, but this is not reason enough to rely on
wine as your main source. As mentioned above, red wine can pose
unwanted adverse health effects. Alcohol is a neurotoxin that can
severely damage your brain, heart and other organs 16 and it
increases your insulin levels17.
Some wines and alcoholic beverages, like beer, can be

contaminated with glyphosate18, the active and cancer-causing
ingredient in Roundup herbicide. So, I would advise you to get this
compound from healthier food sources or to take a resveratrol
supplement.
Muscadine grapes are known to have high resveratrol

concentration19. Most of the antioxidants in grapes, including
resveratrol, are found in their skins and seeds 20. 1gram of fresh
grape skin, in fact, contains at least 50 to 100micrograms of
resveratrol21. Other potent sources of this nutrient include22:
179
● Raspberries, blueberries and cranberries
● Mulberries
● Indian jackfruit
● Pomegranate23
● Raw cacao24
The problem with most of these food sources, specifically grapes

and berries, is that they' have a lot of fructose; consuming them in
large amounts may prove detrimental to the glucose levels,
especially if you are insulin resistant.
In addition, if you are using cacao or resveratrol, make sure to

consume organic dark chocolate or raw cacao, and not the milk
chocolate varieties (they are also sugar loaded). Another potent,
yet lesser known, source of resveratrol is itadori tea, made from
Japanese knotweed. It has a long history of use as a traditional
herbal remedy by the Chinese and Japanese, and is said to protect
against stroke and heart diseases25.
If you aren't getting enough resveratrol from food sources such as

these, I recommend taking a high-quality resveratrol supplement.
Ideally, look for a whole food complex that makes use of
muscadine grape skin and seeds.
What are the benefits of resveratrol?
As an antioxidant, resveratrol is known for offsetting free radicals

in your body26. It also has anti-inflammatory and anti-carcinogenic
properties27. That’s why this potent compound may be highly
useful for helping fight and reduce the risk of a variety of chronic
illnesses28.
180
One of the standout benefits is its neuro-protective effect, it helps
slow or prevent the progression of Alzheimer's disease, vascular
dementia and stroke29. Resveratrol supplements can cross your
blood-brain barrier to suppress the inflammation in your central
nervous system30 (if this inflammation is not stopped, it leads to
development of neurodegenerative illnesses31).
Resveratrol also shows improvement in cerebral blood flow 32,

which is protective against stroke and vascular dementia. To
summarize the effects that resveratrol can have on your brain
(and overall) health:
● May help protect against depression33

● Helps improve brain blood flow34
● Helps suppress brain inflammation35
● May inhibit plaque buildup; plaque can lead to
Alzheimer's36
● Has antioxidant and antimicrobial properties37
● May improve learning, mood and memory38
Another impressive way that resveratrol can boost your well-

being is its ability to improve mitochondrial (the power plant of
cell) health. According to a study, mice on a high-calorie diet
exhibited better health and improved survival rate after taking
resveratrol39.
In another study, resveratrol improved mitochondrial health and

helped protect against metabolic disease, diet-induced obesity
and insulin resistance. It does this by activating SIRT1 and PGC-
1alpha, controllers for mitochondrial functions 40. One other study
showed that resveratrol might improve sugar control and
decrease insulin resistance41.
181
References:
http://mercola.fileburst.com/PDF/References/resveratrol-ref.pdf
Nitric Oxide:
Take long, deep breaths through your nose. Breathing through

your nose helps release nitric oxide; it’s a chemical that expands
your blood vessels, lowers blood pressure and has an all-over
calming effect. This technique is central to yoga, meditation and
many other stress-relieving practices for its positive, soothing
effects. While helping calm your mind, this tactic helps achieve the
clarity you need to retrench and regain control of the tasks at
hand and encourage heart health too!
Nitric oxide is vital for a healthy cardiovascular system, and deep

breathing is just a start. It is produced by the endothelium, the
lining of the blood vessels, and its making is sensitive to healthy
heart habits, like regular exercise and low cholesterol. These
lifestyle measures turn the nitric oxide spigots on, relaxing the
blood vessels and increasing blood flow while curbing the build-up
of plaque. (Nitric oxide is the basis for the use of nitroglycerin in
treating the heart conditions like angina.)
Risk factors of heart disease like smoking, a poor diet, lack of

exercise and even psychological distress reduce the levels of nitric
oxide; this leads to fatty plaque building-up on vessel walls, setting
the stage for atherosclerosis. Heart attack or stroke occurs when
the plaque becomes inflamed and ruptures.
While production of nitric oxide is a good goal, certain

compounds, known as asymmetric dimethylarginine (ADMA) and
symmetric dimethylarginine (SDMA), work against it. If you are
concerned about damage to your blood vessels, Cleveland
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HeartLab has a test for these chemicals. The test can help
determine if you have increased chances of developing heart
disease or kidney damage by detecting the supply of nitric oxide
and injury to endothelium. In fact, it has been found that high
levels of ADMA autonomously predict cardiovascular risk in
patients with coronary artery disease. Those with the highest
levels of ADMA are two times more likely to suffer heart attacks or
die from heart-related causes, compared to people with the
lowest levels. The key factors to raising nitric oxide and lowering
ADMA and SDMA are the same.
Vitamin D
Our wild ancestors lived outdoors, bare, leaving their bodies

exposed to the sun. Hairless skin activates vitamin D on exposure
to the sun. Until our ancestors moved north or south from the
equator, they made ample amounts of vitamin D. Nowadays, even
in sunnier areas of the country like Florida or California, people
are commonly vitamin D deficient because of inadequate vitamin
D bare skin exposure to the sun. We wear clothes covering most
of our bodies and work indoors for the most part of any day.
The consequences of vitamin D deficiency are immense, including

increased inflammation as seen by raised inflammatory markers in
blood as HS-CRP, Interleukins, TNF and others. Vitamin D
deficiency causes insulin resistance, increased blood sugar leading
to type 2 diabetes, autoimmunity to beta cells (insulin producers)
causing to type 1 diabetes, and weight gain.
After age 40, we lose much of the ability to activate vitamin D. Fat
takes up vitamin D and prevents the body from using it. It’s
common to be vitamin D deficient and be at increased risk of
183
inflammation, autoimmune diseases, osteopenia/osteoporosis
(weak bones), bone fracture, heart disease, depression, cancer
and dementia. In the setting of vitamin D deficiency, persons
genetically inclined to type 1 diabetes are more likely to develop
autoimmune attacks on the pancreas (provoked by the gliadin
protein of wheat and other grains).
Ideally, a baseline vitamin D level should be taken and re-assessed

every 6-12 months after supplementation to a goal of
70-100ng/dl.
Restoration of vitamin D level restores virtually every organ

system in the body especially the immune system and skeletal
structure. Vitamin D is now considered a hormone, which impacts
over 300 processes in the body. Calcium supplementation is not
recommended.
Taking a vitamin D oil based gel capsule usually achieves an

optimal vitamin D level, typically with 4,000-8,000 units daily.
Iodine
For ideal thyroid health. Iodine is a trace mineral necessary for

optimal thyroid function and can be taken as Iodine drops or Kelp
tablets with a daily intake of 500-1,000 mcg.
Omega 3 fatty acids
DHA and EPA deficiency is common in modern diets. 3,000 to

3,600 mg of EPA and DHA yields maximum benefits on
cardiovascular, metabolic and neurologic health.
Many people still believe that there is a magic supplement tablet

—in other words, that one or more supplements will somehow
184
correct the ongoing typical Western diet, cause everything to
magically reverse and heal the body. I can assure you that this is
nonsense, and I say that because I have witnessed this
misconception in my patients’ blood work far too many times over
the last seventeen years. However, if you embark on the Heart
Mend Program, many of these supplements will and, as a matter
of fact, do measurable good. I have presented studies on such
benefits at prestigious national and international meetings.
Remember, true to their name, supplements enhance the results
of the Heart Mend Program—but they are not substitutes for the
program.
PART 3
Recipes
Lentils: https://drgundry.com/the-secret-life-of-lectins-transcript/
Mushrooms
https://www.health.harvard.edu/staying-healthy/fda-limits-
prescription-acetaminophen#:~:text=Acetaminophen
185
%20produces%20a%20toxic%20by,up%20and%20damage%20the
%20liver.
186
187

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Table of Contents

Part One: Know Your Good Microbes

CHAPTER 1: Tale of Two Microbiomes

Part Two: Diet and Lifestyle

CHAPTER 5: Food: The Biggest Exposure

Part Three: Putting into Practice

● The Kitchen Clean Out

SEVERAL YEARS AGO, one of my heart patients told me, “Doctor, I

A few years later, another one announced, “I still have blockage in

I was young and new in my career. Those statements came after I

Pure allopathic medicine is not likely to emphasize the role of diet

Microbiome is a mutually beneficial colony of bacteria, yeasts

I knew that if I wanted to help my patients, and others suffering

At 5 feet 2 inches, I was already at my ideal weight. But I was still

That was about 5 years ago. Now I am ready to serve a wider

During the research days, one common thread that kept

Many of the life-threatening illnesses like HIV/AIDS, and certain

Let’s consider a few numbers. Cardiovascular diseases (CVDs) are

The value of prevention was apparent to Prof Christiaan Barnard,

Speaking of prevention and reversal, for a long time we have

When we talk about heart disease like atherosclerosis, we have

The Framingham Heart Study is a long-term, ongoing

Historically speaking, most of our big food policies were born of

Faulty nutritional leadership by people like Ancel Keys

Dr. Yudkin (1910 - 1995) was a British physiologist and nutritionist,

Mainstream medicine minimizes or totally ignores the power of

My investigative research led me to areas, which at the time,

Generally, we have been taught to consider all microbes as bad,

Mechnikov, who as a biologist, made a remarkable connection

Unfortunately, most people have more disease-causing or

This complex external and internal ecology of tiny organisms is

Research is acknowledging that microbiome has its own specific

In a nutshell, everything about our health — how we feel both

The microbiome is very receptive to rehabilitation through diet

I am confident in saying that incorporating the information in this

Let us begin with a brief preliminary review of your risk factors.

((Need: Rationale for discussing brain health and metabolic

Digestive Health Self Check List

Past Years Stage:

● If you answered yes to some questions, then not to worry,

● If you answered yes to all the questions, then the sooner

Although they are surprisingly simple, consisting of only a single

It does have a notorious reputation as a disease-causing agent.

Although she has never been to a gym, she is not a stranger to

What is going on here? The answer lies in the vast lifestyle

I have exercised creative license in this theoretical scenario, and

Blue Zones are regions of the world where Dan Buettner

I am quite confident that when science shows conclusive results

On the one hand, metabolites prevent disease-causing

More importantly, these mechanisms also share common

However, we also found some problems in these studies. The

As demonstrated on mice, these cells, when deprived of energy,

Butyrate is starting to sound important now, right? And there’s

Butyrate is also an antioxidant; it protects cells from charged

Butyrate also regulates natural movements of the gut to facilitate

Members of the Firmicutes phylum, a classification of bacteria, are

Hence, enhancing your microbiome through food is an effective

Talking about the abundance of this microbiome, it was earlier

The majority of the gut microbiota is composed of five phyla,

Interestingly, people with particular diseases have a particular

For instance, Firmicutes, mentioned above as well, is labeled as a

The structure of our microbiome depends on various factors: the

Although having an in-depth knowledge of the gut-heart

Gut-heart communication is best demonstrated in the everyday