Apoptosis A New Way to Understand Congestive Heart Failure

November 15, 2020

Apoptosis: A New Approach to Understanding Congestive Heart Failure


Half of us will die with the condition "congestive heart failure" on our medical record. It may be the cause of death in only 10% or so, but many more have it is a part of the picture. Cardiovascular disease remains the number one cause of death in America, albeit Alzheimer's is catching up and will likely overtake it soon.


Congestive heart failure is essentially the loss of the ability to pump blood. It used to be thought that the heart cell lasted a lifetime. I was taught once upon a time that the heart actually replaced its muscle cells frequently. We finally have good data that shows that we replace about 1% heart muscle cells in a year at age 25 but only 1/2% per year at age 75. Replacing slows down.


You want to keep replacing those cells. 1% loss per year means you run out at 100. So, what is apoptosis? It is the orderly dismantling of the internal organs of a cell with proper recycling and folding up shop. The organ involved stays functioning and the surrounding cells keep at it. That is opposed to necrosis where a cell just dissolves with complete and dramatic loss or any "organ"-ization. You can only fix that by making scar tissue. The organ involved is damaged. A heart attack causes necrosis. That is a big problem. But what causes congestive heart failure?  Too much apoptosis.  If you want to take a gander at it, read the Biomed article on apoptosis. It's humdinger of complicated pathways and you will come away with reverence for the complexity of human physiology.


A new approach is needed. Try to wrap your brain around this one. Apoptosis is decided on in the mitochondria of your cell. Heart muscle cells have some 5000 mitochondria each. There is a constant cross-talk between the mitochondria and the nuclear of a cell. A mitochondrion only has 37 distinct genes in it, needed for minute-by-minute regulation. The other thousand or so it needs to duplicate itself come from the nucleus. A healthy cell is called "quiescent" meaning it is alert, awake, and ready to go: just chilling until needed. An unhealthy cell is "senescent" meaning it has become a zombie: unable to properly do its function with mitochondria that start spewing out reactive oxygen species and damaging the cells around it. Its mitochondria are in trouble and on the verge of issuing apoptosis orders.


Here is the emerging understanding of how to reverse that, how to pull back from senescence, how to fix imminent apoptosis, how to nip congestive heart failure in the bud. You need to repair your mitochondria and their conversation with the nucleus of the cell. Three things do that! Exercise: which makes a relative deficit of energy and induces the cell to hunker down, turn on its AMPK pathway and generate stem cells. Fasting: which makes a relative deficit of energy and induces the cell to hunker down, turn on its AMPK pathway and generate stem cells. (Oh, did I repeat myself?). And finally, the proper induction of sensitivity to growth hormone by the proper use of peptides that induce sensitivity to growth hormone.


What does that mean? You can't fight congestive heart failure by targeting the heart. You have to target the cell. Every cell. Your whole body. Every mitochondrion. And a healthy mitochondrion needs its own "exercise". It needs to have its genes activated and its conversation with the nucleus honored. New idea! But it's on the right path.


www.What will Work for me. We are beginning to understand the core cellular causes of cell senescence. It starts with learning the language and terms that define what the problem is. And I love connecting the dots so that I can understand why I have to drag my sorry, lazy butt off the couch and get some exercise. Now, when we go even deeper into the balance of NAD+ to NADH, we will get to real understanding. And David Sinclair's book about Lifespan, and his admonition to be on metformin and NAD+ will suddenly make sense. I took my metformin today.


References: NIH, CDC, Biomed Res Int, Annual Review of Genetics, Cells, FASEB, Nat Rev Mol Cell Biol, Fight Aging, Rejuvenation Research,


Pop Quiz 

1. What is apoptosis? Answer: the orderly dismantling of a cell. 

2. Is apoptosis a problem? Answer: Well, yes, if it means you have pushed a cell too far and tipped it over the edge, which appears to be at the "heart" of congestive heart failure. You don't want a dismantled cell. You want a working cell. 

3. What percent of heart cells are "dismantled" every year at age 75? Answer: 1/2 of one percent. That's new news to me. Each heart muscle cell is precious. 

4. What is the secret way to slow that down or fix it? Answer: Exercise, fasting, and growth hormone. 

5. And what is at the "heart" of those three? Answer: Maintaining a healthy NAD+/NADH ratio. Which taking NAD+ and metformin helps dramatically.

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