Darwin suggested that in plants and animals, anything that has no function or loses its function will regress and disappear over time.

In the 1980s, I listened to the then highly talked-about vascular surgeon Herbert Dardik as he described the structure of arteries to an international group and explained why it is so difficult to develop and manufacture arterial prostheses for the thin vessels. At that time, the flip chart was a common tool for lecturers. He had drawn an artery and explained how the different layers in the arterial wall, tunica externa, tunica media, and tunica intima, are structured and what type of tissue is present in each layer. He mentioned nothing about the thin lines on the inside of the depicted artery, so I asked: What are these small lines? The answer was that it’s some kind of hair growth, and we don’t know if it has any particular function. This was as late as around 1985. About five years ago, I began to realize that this hairy inside of our blood vessels probably has a function because the glycocalyx, as it is called, would otherwise have regressed and disappeared a long time ago according to Darwin’s theories.

When I later asked some doctors if they knew about glycocalyx, assuming they all knew of its existence and could explain its function, I was surprised that the first six doctors I asked had no idea about glycocalyx – none knew what it was! Now it started to get complicated – none of the doctors had heard of glycocalyx. This sounded very strange. Could the reason for this be that glycocalyx has no function, as Dr. Dardik claimed? According to Darwin, this hairy surface would then have regressed and disappeared over the years. But it hasn’t! I must study this more closely.

Just as with my previous studies of medical questions, I now also use PubMed, the digital archive of the American health authority, accessible on the Internet. I searched for glycocalyx and endothelial glycocalyx. I was amazed at how much has been published about glycocalyx, this hairy surface on the inside of blood vessels, which six out of six Swedish doctors had no clue about. In the fall of 2021, the Scottish doctor Dr. Malcolm Kendrick released his book ”The Clot Thickens,” in which he initially mentions that he discovered something previously unknown to him – glycocalyx. This inspired him to quickly ask ten colleagues if they knew what glycocalyx is. Not a single one could explain to him what glycocalyx is. After that, Dr. Kendrick stopped asking more colleagues. Ten out of ten doctors did not know what glycocalyx is! A quick check with someone training to be a doctor confirmed my suspicions that learning about glycocalyx, especially discussing its impact on human health, is not part of medical training. After having five of my articles about glycocalyx published in the Swedish medical journal Medicinsk Access, I was stopped by an anonymous email to the editor-in-chief. Then I began to suspect that there are forces that do not want doctors to know about glycocalyx – especially not the significance of endothelial glycocalyx for human health.

Became my own ”test subject”
Glycocalyx is the hairy surface on practically all cells in the human body. In the airways, glycocalyx is known as cilia. In the intestine, it’s called intestinal villi or microvilli. In blood vessels, it’s referred to as endothelial glycocalyx because the innermost layer of blood vessel cells consists of a single layer of endothelial cells. Glycocalyx is everywhere in the body, and doctors don’t know what it is!!! In other words, they have no idea how important healthy glycocalyx is for our health. Can this really be true?

I left out the cilia of the airways and started a dietary experiment on myself to observe how my gut is affected by what I eat and drink. So, my interest was initially directed towards my intestinal villi and later towards my endothelial glycocalyx. I began eating the kind of diet our ancestors ate until the mid-19th century. This meant excluding sugar and foods that convert to sugar on their way through the digestive tract, i.e., flour and starchy foods, and compensating this with more animal fat and fresh dark green and dark red above-ground vegetables. The plan was to constantly monitor my observations of myself and cross-reference them with what I could find in PubMed.

After the dietary change
Two weeks into the diet, I noticed that my previously gas-rumbling intestine was now emptying regularly without explosions in or spray painting of the toilet bowl. There was no longer any need to warn the next person using the toilet about unpleasant odors. The fat around my waist disappeared within a few weeks, and my weight stabilized in the middle of the BMI scale. Since then, I had not only become lighter. I also started feeling like life was once before the intestine began to rumble, explode, and spray paint – my stomach and intestine were behaving as I once knew them.

What was happening in my gut that made me feel so much better? Food consists of fats, proteins, and carbohydrates, plus water, minerals, and vitamins. Water, mineral, and vitamin molecules are so small that they can easily pass from the digestive tract through the intestinal wall and into the blood vessels just outside the intestinal wall for further transport into the bloodstream. Fat, protein, and carbohydrate molecules are large and would not be able to enter the bloodstream unless they were broken down (hydrolyzed) into smaller molecules – fat into fatty acids, protein into amino acids, and carbohydrates into monosaccharides. This happens on the way down to the small intestine, where these small molecules then have to get out through the intestinal wall and into the bloodstream, just like the water, mineral, and vitamin molecules.

Since our diet in the last 150 years has come to contain more and more carbohydrates, i.e., sugar molecules, which was manifested in 1976 by the National Food Administration’s dietary guidelines recommending us to let carbohydrates dominate our diet, not all this sugar on its way through the small intestine can get out into the bloodstream, and much ends up in the large intestine where there are both ”good” and ”bad” bacteria. The ”good” bacteria produce butyric acid, which feeds the intestinal villi so that they remain healthy, i.e., dense and high, and form a defensive line so that no undigested fat, protein, or carbohydrate molecules, which together are called waste products, can get out of the large intestine and into the bloodstream. But when the sugar that did not manage to get out from

the small intestine and into the bloodstream enters the large intestine, the ”bad” bacteria begin to ferment and damage the intestinal villi, which become lower and sparser, i.e., sicker. This means that the intestinal villi lose their ability to protect against the intrusion of things that are not intended to enter the bloodstream, such as molecules of fat and proteins, which, if they enter the bloodstream, will burden your immune system, most of which is located between the intestine and the bloodstream.

A few weeks after the dietary change, I understood why my stomach was now functioning excellently, quietly, regularly, and ”odor-free.” But I had not yet understood why my ”spare tire” around the waist had disappeared. I continued into the bloodstream.

Sought Contact with Glycocalyx-Interested Academics
I contacted the Karolinska Institute, which referred me to the University of Gothenburg and one of the professors in the large group of researchers interested in the intestine and its intestinal villi, i.e., glycocalyx. Through email, I got in touch with him and asked if he knew anyone at the University of Gothenburg who is interested in endothelial glycocalyx. I didn’t get any name; instead, he wrote about how glycocalyx is present throughout the body and phrased it in a way that I was apparently meant to be discouraged from further study. The effect was the opposite. I became curious, first about this professor who didn’t seem eager to help me contact researchers interested in endothelial glycocalyx, a field of research not intersecting with his own. I wondered about the interests behind him and his large research team dedicated to the intestine’s glycocalyx, the intestinal villi or microvilli.

In PubMed, I looked up his name, which appears in an impressive number of studies along with researchers from all over the world. I found the latest study published two years ago, where he was the sole author with financial support from the Melinda and Bill Gates Foundation and other investors interested in the pharmaceutical industry. Some time later, I happened to listen to Swedish Radio interviewing another professor in the same large intestinal research team. The reporter asked what they aimed to achieve with their research. The answer was to develop a drug. This is very reasonable, but why isn’t there a similar research team for endothelial glycocalyx? The answer is that when it comes to blood circulation, there have been many best-selling and patented expensive drugs for decades, for example, to lower blood lipids, reduce blood pressure, and regulate heart rhythm, etc. So why would they disturb this biggest cash cow for the pharmaceutical industry? Of course not! It’s crucial not to inform doctors about the importance of healthy endothelial glycocalyx because knowledge of it would cause sales of these drugs to plummet. For the intestine, however, there aren’t equivalent patented and therefore expensive drugs. Therefore, it’s an open field for the pharmaceutical industry to develop expensive, patentable best-sellers.

My fifth article on glycocalyx managed to get into Medicinsk Access, but not the sixth, which I had already sent to the magazine. It was about how it’s damaged glycocalyx – not high cholesterol levels in the blood, that causes plaque formation on the inside of arteries, which is the beginning of what often leads to heart and vascular diseases. In practice, my claim is an attack on the pharmaceutical industry’s patented and biggest sources of revenue – patented and therefore expensive medications like cholesterol-lowering, blood pressure-lowering, and rhythm-regulating drugs.

My Studies of Blood Circulation
There, I discovered that on the inside of the blood vessels, there is a hairy surface on the endothelium (endothelial cells). It’s called glycocalyx and lives in the blood’s plasma, while the blood cells, i.e., red, white, and platelets, are kept at a proper distance from the glycocalyx. Healthy glycocalyx is dense and high and forms a physical barrier to prevent blood cells and cholesterol molecules from reaching the endothelial cell membranes, where they could penetrate through the openings between individual endothelial cells and begin to form plaque, electrostatic protection so that blood cells, which are negatively charged, cannot approach the endothelial cell membranes because healthy glycocalyx is also negatively charged. Blood cells and glycocalyx thus repel each other, as long as the glycocalyx is healthy and maintains its homeostasis, i.e., the balance between the components in the glycocalyx, including proteins and glycans.

As soon as homeostasis is disrupted, for example, by too much sugar in the blood, the glycocalyx loses its homeostasis, and blood cells and glycocalyx do not repel each other as strongly. The blood cells then begin to get closer to the endothelial cells and their intervening openings. When the glycocalyx no longer repels the blood cells, they risk penetrating between the endothelial cells and begin forming plaque, which often leads to heart problems and death.

What also happens when the glycocalyx loses its homeostasis is that an increasingly sick glycocalyx loses its normally regular movements following the heart’s pump strokes, which negatively affects the amount of NO (nitric oxide) delivered to the smooth muscle layer tunica media located inside the endothelial cells. For maintaining its homeostasis, the tunica media depends on deliveries of nitric oxide NO. When the thinnest arteries, the terminal arterioles with an inner diameter of 2-10 µm, don’t receive NO delivery, they become rigid.

The heart’s smooth muscles also require nitric oxide NO to maintain their elasticity and resilience to maintain full pumping capacity. Therefore, the heart is equally dependent on healthy glycocalyx to

  1. Allow the positive electrical signals from the sinus node in the roof of the right atrium via a healthy and negatively charged glycocalyx, without disturbances (as with damaged glycocalyx), to be able to reach the AV node at the bottom of the right atrium for further transmission into the heart.
  2. Enable the endothelial cells to deliver enough nitric oxide NO to the heart’s muscles so that they can maintain their elasticity and resilience for optimal pumping capacity.

Nobel Laureates Explain
In 1998, Furchgott, Ignarro, and Murad received the Nobel Prize in Medicine. They had demonstrated that the endothelial cells, on which glycocalyx grows, are suppliers of nitric oxide (NO) to the smooth muscle layer located inside the endothelial cells, known as tunica media. The tunica media, for maintaining its elasticity and resilience (homeostasis), is dependent on nitric oxide NO – the less nitric oxide NO, the more the vessel loses its elasticity and resilience (homeostasis), which can be expressed as the vessel becoming rigid.

What Damages Glycocalyx?
When glycocalyx is healthy, it is in homeostasis, meaning it contains the mix of various substances that should be there, such as glycans and proteins. Then, glycocalyx is negatively charged. For a long time, we have known that bacteria entering the bloodstream can quickly damage blood vessels and cause sepsis, which, if not treated in time, leads to organ failure and death. This is old knowledge. Note that the literature has long described it as the blood vessels being damaged, leading to organ failure and death if untreated. In recent years, it’s more accurately stated that the endothelium (endothelial cells) on the inside of the vessel is damaged, and this, if untreated, leads to organ failure and death. Indeed, there are now those who realize that it is actually the glycocalyx, i.e., the hairy surface on the endothelial cells, that gets damaged. However, how this damage to glycocalyx can lead to organ failure is rarely explained.

Suspicions that viruses can also damage glycocalyx are increasingly being expressed. Can viruses damage healthy glycocalyx? This is not entirely clear, but it is certain that when glycocalyx is damaged, viruses can access exposed ACE2 receptors on the membranes of endothelial cells. Exposed ACE2 receptors, with today’s dietary habits of constant eating without fasting periods for glycocalyx to recover, are probably very common and thus make viruses in the blood a serious threat.

The threat to glycocalyx now commonly found in literature, with our diet dominated by sugar, flour, and starch, is consistently high blood sugar levels over a long period. Even if one does not reach the levels defined for a diabetes diagnosis, glycocalyx can still be so damaged that the endothelial cells’ NO deliveries to the smooth muscle layer are reduced to such an extent that the terminal arterioles have ”stiffened” and do not allow as many red blood cells to reach the capillaries as needed. These capillaries are supposed to deliver enough oxygen to the cells so they can produce sufficient energy without having to compensate by fermenting glucose. It’s then that the by-product lactic acid is formed, which is felt as pain.

The Terminal Arterioles Must Not Stiffen
Back to the terminal arterioles, the thinnest arteries before the capillaries. Red blood cells, full of oxygen, have a diameter of about 7-8 µm. It becomes difficult for the heart to pump these oxygen-rich red blood cells (even though they are somewhat malleable) through an arteriole with an inner diameter of, say, 5 µm. This causes blood pressure to rise. Gradually, the number of red blood cells that manage to pass through the narrow, “stiff” arteriole and into the subsequent capillaries will decrease. As a result, the amount of oxygen leaving the red blood cell in the capillary to reach cells for energy production in their mitochondria through tissue diffusion decreases.

With thin arteries “stiffened” due to a lack of nitric oxide, fewer oxygen-filled red blood cells reach the capillaries (capillaries have no smooth muscle layer that can “stiffen” but consist of a single layer of endothelial cells), and from there, oxygen diffuses through the tissues to the individual cells. These then experience a lack of oxygen for the production of energy (ATP) and the “fuels” glucose, fatty acids, and amino acids. The cells’ mitochondria begin to produce ATP through the fermentation (fermenting) of glucose (fatty acids and amino acids cannot ferment). The amount of energy produced through fermentation is only a fraction of what is obtained with oxygen. If such fermentation occurs, let’s say, in the vital parts of the brain that control the body, it causes a lot of pain and lethargy sets in.

During the fermentation of glucose, the by-product lactic acid, which is acidic, is produced and causes nerve endings to react, resulting in pain. As soon as fermentation stops, the pain disappears because the lactic acid continuously loses an H and turns into lactate, which is basic and therefore does not irritate the cell’s basic environment.

Where Does Nitric Oxide (NO) Come From?
NO is essential to keep the arteries elastic and resilient and not to “stiffen,” so red blood cells can be pumped forward and into the capillaries where they release oxygen for diffusion to individual cells. Starting with oxygen O, it comes from the air we breathe in. Nitrogen N does not come from the air we breathe in, despite nitrogen being the dominant component in the air. We actually exhale slightly more nitrogen N than we inhale. The nitrogen N that mixes with oxygen O in the blood must come from somewhere else. After careful studies and logical thinking, I believe that the nitrogen content in vegetables plays a major role as a source of the nitrogen that mixes with oxygen in the arteries to form nitric oxide. A simple rule to know which vegetables contain the most nitrogen N is that they should be dark green or dark red and grown above ground. After you have chewed the vegetables well, they are broken down on their way through the digestive tract – nitrogen N is released and diffuses through the intestinal wall into the bloodstream, mixes with oxygen O from the red blood cells, and nitric oxide NO is formed. The role of glycocalyx in the mixing of N and O is not explained in the literature, but it seems logical that it plays a part in the process when endothelial cells deliver NO to the smooth muscle layer of the blood vessel, the tunica media (which is recognized with a Nobel Prize), since the smooth muscle layer, the tunica media, loses its elasticity and “stiffens.”

My Health Status Development
Already in 2011, I was diagnosed with angina pectoris, which after coronary angiography was specified as some type of vasospastic angina, i.e., angina with completely clean coronary arteries. I was prescribed Simvastatin and experienced very unpleasant side effects in the form of skeletal muscles that became like dough, preventing me from exercising as I always had. As my heart problems worsened, a renewed coronary angiography was performed, confirming that my coronary arteries still showed no signs of plaque. My fingers began to go numb. A professor of hand surgery suggested I had developed polyneuropathy and referred me to a neurophysiologist. When I got home, I looked up polyneuropathy and realized that it was a common side effect of statins, which I then stopped taking. Gradually, my skeletal muscles began to regain their strength. When I exercised twice a week with my standardized program, which included a stationary bike, I noticed I could do less and less and had to take breaks. I was referred for a stress ECG and heart ultrasound. A third coronary angiography showed the same results as before, i.e., completely clean coronary arteries. Soon after, I was diagnosed with atrial fibrillation and underwent an electrical cardioversion with dubious results. I was put on blood thinners and became a bruised homosapien like many others on blood thinners.

A few months later, I stopped eating sugar, flour, and starchy foods and increased my intake of animal fat and more dark green and dark red above-ground vegetables.

After noticing the positive effects on my intestine a few weeks later due to my dietary change, I was very curious to see if I would experience any positive effects on my heart and vessels. Very early on, I thought I noticed that my angina wasn’t occurring as often, and the same was true for my atrial fibrillation. I didn’t want to celebrate too soon, but after 18 months, I realized I no longer had either vasospastic angina or atrial fibrillation. My exercise bike at the gym confirmed this for me.

I wrote about this in one of my articles in Medicinsk Access, and in the fall of 2020, I was contacted by Karl Arfors, a professor of microcirculation, who was surprised it took so long, especially for the atrial fibrillation, to disappear. He mentioned that lab studies suggest that atrial fibrillation should disappear much faster when sugar, flour, and starch are eliminated from the diet. On Christmas Eve 2020, he called me again, saying he had been thinking a lot about the long time it took for me to get rid of atrial fibrillation. He described how in animal studies, glycocalyx could be healed in ”half a day” by not exposing it to what damaged it.

This got me thinking about fasting in general and intermittent fasting in particular. Could fasting be significant for the recovery of glycocalyx? My eating had then started at 08:00 and perhaps ended as late as 22:00. There was no intermittent fasting for ”half a day”. I thought about how people lived long ago, waking up when the sun rose and going to bed when it set, and they didn’t eat sugar, flour, and starch, at least not nearly as much as people do today. I began to finish eating by 18:00 at the latest, thus having a 14-hour fast until 08:00. To my surprise, I felt no urge to eat anything in the evening. My conclusion was that as long as I don’t eat sugar and things that turn into sugar on the way down to the intestine, there’s no problem fasting from 18:00-08:00, and I have continued this way. My weight remains stable in the middle of the BMI scale, and I feel great.

What Happened to Me
It wasn’t just that my intestine calmed down and became fine, and I got rid of my angina (vasospastic angina), my atrial fibrillation, and the constant running to the toilet due to my bladder’s urges. The first thing I noticed after my intestine settled was that I seemed to think much more clearly. It became easier to think long logical thoughts and to think in structures. I no longer had to get up at night as often to empty my bladder. My facial skin no longer became shiny in the afternoon, and on my legs and arms, where especially during the cold seasons it had become dry and white on the inside of my trousers and socks, this had disappeared. The hair growth and beard growth that had previously become lighter and disappeared on my face, arms, legs, and head, as well as around the genitals, began to grow back, now in their original dark color.

Explanations for the Positive Changes I Experienced

  1. The Quieting of the Intestine: The radical reduction of sugar, flour, and starch in my diet and the increased intake of animal fat and dark green and dark red above-ground vegetables had a positive effect on my intestine, as did the 18:00-08:00 fasting period.
  2. Disappearance of Vasospastic Angina: The drastic reduction in sugar, flour, and starch in my diet and drink initiated the change, but it was only when I started fasting between 1800-0800 every day that the vasospastic angina definitively disappeared. The small amount of sugar that might damage my endothelial glycocalyx during the day recovers during the fourteen hours of fasting at night, ensuring that endothelial cells’ delivery of nitric oxide NO to the tunica media functions and maintains the elasticity and resilience of the smooth muscle layer in the coronary arteries. This allows red blood cells from the arterioles to enter the capillaries and deliver oxygen to the cells through tissue diffusion, thereby producing maximum energy.
  3. Disappearance of Atrial Fibrillation: Just as the glycocalyx in all blood vessels could recover through a drastic reduction of sugar, flour, and starch in my diet and increased intake of animal fat and dark green and dark red above-ground vegetables, along with fasting from 18:00-08:00, the glycocalyx inside the heart could also recover. It continued to maintain its achieved homeostasis and allowed the positive electrical signals from the sinus node in the atrium’s roof to pass through the glycocalyx without disturbance down to the AV node and further into the heart.
  4. Improved Cognitive Abilities: Shortly after changing my diet, I noticed that my studies on PubMed became much easier. Long, logical thoughts and large thought structures became easier to hold in my head.
  5. Less Frequent Urination: The bladder wall consists of smooth muscle and needs regular deliveries of nitric oxide NO, like other smooth muscles, to maintain its elasticity and resilience to hold maximum urine, resulting in less frequent need to empty it. The deliveries of NO to the smooth muscle of the bladder come from branches of the internal iliac artery, which encircle the bladder.
  6. Revitalization of the Lower Package: What previously looked mostly like an empty bag with a flaccid appendage regained its resilience.
  7. Healthier Skin Appearance: No shiny forehead during the day, and the flakiness and itching on the legs disappeared. I no longer need to wash my hair every other day.
  8. Return of Hair and Beard Growth: My dark ash-colored hair and beard, which had grayed and slowly disappeared, slowly but surely came back in their original dark ash color. Everywhere where hair growth had disappeared on my arms, legs, abdomen, and around the genitals, it returned with its old dark ash color. The explanation for this, and for my skin’s healthier appearance, is that skin and hair cells regained oxygen deliveries thanks to the terminal arterioles regaining their elasticity from resumed deliveries of NO from endothelial cells, as the glycocalyx regained its homeostasis. This allows the optimal number of red blood cells to enter the capillaries and release oxygen for tissue diffusion into hair cells.

My Hope
Finally, it is my hope that doctors acquire knowledge about what a healthy glycocalyx means for health, so they can inform their patients how, by changing their diet and eating habits, they can improve their glycocalyx in both the intestine and blood vessels and live a healthy life well into old age, instead of sending patients home with prescriptions for medications.

Lasse Blomdahl, Glycocalyx in the light of Darwin’s ’On the Origin of Species

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