Friday, April 5, 2019

How do you keep your cardiovascular system healthy from your fifties onwards?

Through robustification!

By making your cardiovascular system robust against aging.
Systems biology defines robustness as “… a property that allows a system to maintain its functions against internal and external perturbations.” [1]
When that “system” is your cardiovascular one, and the “perturbation” is aging then cardiovascular robustness is your ability to maintain cardiovascular function.
Measuring the latter gives you a benchmark to guide you to finding the strategies that work for YOU.
That’s important because not everything does. I’ll get back to that in a minute.
The other nice thing about robustification function is that it is your best bet at maintaining health AND living a little longer in good health.
Just look up the medical definitions of aging and chronic cardiovascular disease. Both share “progressive loss of function” as their key criterion.
So, why haven’t you heard before about robustness in the context of cardiovascular health? Because most medical practitioners and the majority of biomedical scientists haven’t taken note either.
Which is what all systems biologists find rather amusing. And which is why I have made it my vocation to change that (the “taking note” part, not the amusement). 
If you really want to read the heavier stuff on this you’ll find it for example in the Journal of Applied Physiology or others [2,3].
The CV system is unique in that it is the only system of the human organism that connects each and every cell. After all, the CV system’s chief task is to supply every cell of every tissue in every organ with the nutrients, the oxygen and the signaling molecules they need.
To accomplish that, Mother Nature has designed this system as a closed hydraulic system:
Its center piece is a pulsating pump (the heart) that pushes blood through a network of elastic tubes (the arteries).
Keep in mind that it is not the pump that does most of the pushing but the arteries. They expand to receive the heart’s output, and then recoil to push this “bolus” of blood further downstream.
This ability to expand and to recoil, together with the arteries’ ability to change their geometry, is what determines CV function.
In fact, what typically deteriorates first is not the heart. It’s the arteries.
With aging, arteries become stiffer. They progressively lose their elasticity (the correct term is ‘compliance’ but elasticity is easier to visualize), which puts more and more strain on the heart, until that strain becomes intolerable.
Long story short: the physical parameters that define arterial function (predominantly compliance and resistance) are the ones that tell you how slowly or fast you age.
Keep those functional parameters in the green zone, and you will have made your CV system robust against aging.
The only problem: you can’t measure them, yet.
My team and I have developed tools to do just that.
We use a common medical blood pressure measurement technique, such as the ones you know from your doctor’s office, or that you may even use at home to measure your blood pressure.
Until this technology becomes available to everyone, you can only go by what you have right now.
And what you have is blood pressure.
Blood pressure is determined by all those functional markers that I mentioned earlier.
Stiffer arteries means higher pressure.
Greater resistance to flow (for example when arteries are narrowed) means higher pressure.
Now I come back to the point I made earlier: what works for YOU.
Only if you monitor your CV function will you have a guide to what works for you and what doesn’t. Absent any method to monitor function, your second best bet is blood pressure monitoring.
Not every type of exercise, not every dietary or other strategy works the same in any two people.
Here is an example.
Green et. al. investigated the change of CV function (measured as flow mediated dilation, FMD, an indicator for arterial compliance) in 800 individuals following an 8-weeks exercise intervention. The result was a 7% increase in FMD on average. For that marker ‘FMD’ 7% is impressive [4].
Now look at the graph below, which breaks down the result for every one of the participants:
Each vertical bar in this graph represents the change in function of one participant.
Hardly anyone had a 7% change. In fact, the range goes from getting worse to improving by almost 15%.
Now you understand why you shouldn’t go blindly with the recommendations doled out by people who simply parrot what has been published in scientific research.
Aside from the dangers of getting mislead by the pseudo-scientific prattling of food fundamentalists, hardcore exercisers and people in general who present more aspirational versions of themselves, there is an actual need to monitor the effects of whatever you do.
In answering a Quora question related to improving blood pressure I have compiled a little chart that tells you where your CV system’s functional markers should be.
Monitor them regularly and compare their development against anything you do to improve CV health. You will soon find out what works for you.
Now here comes my personal anecdotal evidence.
I am 62, my wife is 64.
We have exercised for the past 20 years almost every day.
For the past 5 years we have practiced intermittent fasting (last meal of the day is at latest 15:00 – 16:00, following day’s breakfast comes at 09:00 after 60-90 minutes exercise, including high-intensity cardio routines and strength training). Breakfast consists of a smoothie that I designed to specifically address arterial function.
Our CV function places us at a biological age of around 40. The same goes for blood biomarker profiles.
Additionally, my wife has preserved the looks and the figure of a much younger age, as you can see from the admittedly amateurish video clip I made a few days ago.
Will that work for you?
It will in all likelihood do you no harm and probably improve your CV robustness. But the most essential point is: monitor your intervention’s effect on the markers of CV function. Even if you have only blood pressure to go by.
And if you are successful, you might even inspire others to pose that same question of yours already at a younger age. Because CV function begins to decline in mid-twenties already.
The earlier you start, the better.
Good luck.

1. Kitano H. Towards a theory of biological robustness. Mol Syst Biol 2007;3:137.
2. Kraushaar LE, Dressel A. The cardiovascular robustness hypothesis: Unmasking young adults’ hidden risk for premature cardiovascular death. Med Hypotheses 2018;
3. Kraushaar LE, Dressel A, Massmann A. A novel principled method for the measurement of vascular robustness uncovers hidden risk for premature CVD death. J Appl Physiol 2018;japplphysiol.00016.2018.
4. Green DJ, Eijsvogels T, Bouts YM, Maiorana AJ, Naylor LH, Scholten RR, Spaanderman MEA, Pugh CJA, Sprung VS, Schreuder THA, Jones H, Cable T, Hopman MT, Thijjssen DH. Exercise Training and Artery Function in Humans: Non-Response and Its Relationship to Cardiovascular Risk Factors. J Appl Physiol 2014;
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Tuesday, March 19, 2019

Weight Loss Aside, What Health Benefits From Intermittent Fasting?

I have been asked this question often enough to address it here.

Whether, and to which extent intermittent fasting (IF) transforms human health still needs to be seen, but there are some indications for beneficial effects.

IF refers to dietary patterns in which individuals (a) have no or very little energy intake for extended periods of time (e.g. 16–48 h), while having normal energy intake between these periods, and (b) follow this interval pattern on a recurring basis.

Naturally it is much easier to test the effects of such dietary patterns in shorter lived animals than in humans. Mice, with an average lifespan of 3 years, can give us much faster insight into intervention effects on health and life expectancy.

Some of the more promising effects of IF in animal models is improved glucose handling (relevant for preventing diabetes), and in aging related diseases such cardiovascular disease, Alzheimer’s dementia, and frailty.

One of the key pathways through which IF seems to work is cellular senescence, the aging of cells, that ultimately leads to functional decline and death. The fasting promotes an upregulation of the cellular repair mechanisms that are essential for keeping cells functional and preventing cell cycle arrest.

There is still a lot to be investigated because outcomes vary by animal model, IF protocol, age at which IF is introduced, and duration of the intervention. The same will probably hold true for humans.

Taken together, what we can safely say is that IF doesn’t harm you, in all likelihood improves glucose handling and potentially has some protective effects against cellular aging.

To which extent these effects prevent disease events (such as heart attacks, stroke, dementia) remains to be seen. We simply have insufficient data to claim either way.

The problem is that trials capable of showing such effects need to be of durations that are longer than what human participants willingly endure.

That’s why IF became a surrogate, and more tolerable, protocol for caloric restriction (CR) in the first place. CR refers to continuous restriction of energy intake to 30-50% below normal, while ensuring adequate nutrient supply.

This protocol has produced substantial expansion of life expectancy in primitive organisms, such as C. elegans (a microscopic round worm whose life is measured in days rather than in years).
But the higher up you go on the complexity ladder of species, the lower the returns. Still, in primates, our closest relatives, significant beneficial effects on health and life expectancy have been documented.

Unless you are really prepared to adopt a CR or IF lifestyle for good, my guess is that you may experience some subjective effects on health, but they will dissipate rather quickly, once you return to “normal”.

Let me give you a personal example. My wife and I have made IF a regular affair. Last meal of the day is latest at 16:00, first meal of the following day comes at sometime between 09:00 and 11:00, and always after 60-90 minutes pre-breakfast moderate-to-high intensity workouts.

Let’s call this a n=2 experiment/trial.
It gives us a 17-19 hours food-free period. Deduct from this 4 hours for the post-prandial period (the period of nutrient absorption following the day’s last meal) and we have a net fasting period of 13-15 hours.

We have been doing this for approximately 5 years now.
With my research focus on healthy aging and cardiovascular functionomics, I have, of course, designed this “trial” in accordance with best evidence, and I have the advantage of being able to monitor physiological functions for the 2 of us regularly, using a medical device that I specifically developed (together with my team) for this purpose.

Cutting a long story short: at 64 my wife has the cardiovascular function and fitness of a 35-years old woman, the body contour many 40-year olds wouldn’t mind to have (Just put a few seconds of, admittedly amateurish, video clips together, to prove my point).
At 2 years younger than her, I am not that lucky, but still can compete in the age range of men 20 years younger than I.

I attribute this to the summation of physical exercise, IF and dietary quality. In science speak, this is, however, only anecdotal evidence.

So, if you want to find out for yourself, go with the Nike motto:
Just Do It.

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Sunday, March 10, 2019

The Whole Superfood Thing is Way Overblown!

This whole „superfood“ thing is way overblown.

It is not just overblown, it is a confession of failure.
Failure on the part of preventive medicine, of public health, of all of us.
When we celebrate avocados, apples or anchovies as superfoods what does that make us – us, mankind, the most intelligent animal on this planet?

It makes us stupid. Seriously!

Why? Because we have come to a point where something that grows on trees, germinates in soil, or swims in the sea is proclaimed a superfood.

“Super” compared to what?
Quite obviously to what we are eating most of the time. Next to pizza and potato chips almost anything edible that you pluck from a tree, dig out of the soil or catch in the sea is a superfood.

Medicine and public health don’t talk about superfoods. 
Don’t even acknowledge it as a valid term. If they did, it would be the Trumpism of public health: Dressing up a failure as a victory. AND THEN BELIEVING IT, TOO.

No matter how much lipstick you put on a pig. It still is a pig.

How did we get here?
If you ask the left leaning folk, it’s of course the food industry. The evil purveyors of cereals, snacks and sodas. Villains going by the names of McDonalds, Nestle, Pepsi.

No doubt, these companies’ marketing messages contain a high dose of “alternative facts”.
But it’s not that we buy their dreck because they lie to us.


We create the demand, and they service that demand. So what solution do the left leaning folk offer?


Forgive them. It’s their thing. Their only thing.

They claim the numbers are on their side. And, to some extent, they are.

Increase tobacco tax, and fewer people smoke cigarettes.
Increase sugar tax, and people start to go easy on their sweet tooth.

Across a population taxation translates into some measurable health gains: fewer cases of heart attacks, diabetes, cancer.

Now, I don’t know about you, but with me, this tax thing doesn’t sit well.

For two reasons.

First, taxes punish all those of us who manage to have a healthy relation with enjoyable junk. We indulge occasionally, but we don’t drown ourselves in chips, cheeseburgers and chocolate pies on a daily basis.

If YOU can handle these things AND stay healthy and fit, why should YOU be punished for other people’s sins?

Second, such an “amusement” tax is pure hypocrisy. Just think about the withdrawal symptoms a government would suffer if, all of a sudden, nobody consumed those taxed sugars and junk foods anymore.

Well, we all know, this is not going to happen.

That leaves the government, and the lefties, in the role of cops who tell the junkies on their beat to NOT DO DRUGS - and then happily collect a percentage from the dealers’ trades.

Taxation is all stick, no carrot.

Do the right-leaning folk have a better solution?
Ask them and they will talk about freedom of choice.
Everybody should have the freedom to choose what they put into their mouth.

If you choose the things that make you fat, sick, and ultimately a nursing case, then you are obviously not the brightest bulb in the chandelier. 

The numbers are on their side, too.

The diseases of over-indulgent lifestyles follow an educational gradient. 
In plain English: the lower the education, the lower the rank on the social ladder, and the fatter and sicker the people are and the shorter their lives because of that.

So much about the no-stick, no-carrot approach.

Where left- and right-leaning folk agree is education. Educate the people. Tell them about their risks, about the consequences of living on the sofa with junk food in one hand and the remote control in the other.

Not a bad idea. If it wasn’t for the naïve expectation that education is enough. 
That people who are made to know about their risk will suddenly and willingly jump into line.

If that was the case, we wouldn’t have the epidemics of obesity, of avoidable heart disease and cancer.

But we do.
And the last 30 years of education haven’t changed that.

Neither has public health. They do what Einstein had once described as the definition of insanity (or was it stupidity?): Doing the same thing again and again and hoping for a different outcome.

It’s doomed to fail. That’s where I started this article: the confession of failure. So, what all these articles about superfood really are telling you – in this modern way of blowing everything out of proportion because otherwise we wouldn’t listen – is that the least processed food may actually be far better for you than anything the food industry has to offer.

That’s where the discussion about superfoods becomes meaningful. By alerting you to the fact that what nature provides can hardly be improved upon.

It’s “super” in itself.

So, just be aware of what makes natural food exponentially less super, and you should be alright. No need for gurus’ advice on superfoods.

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