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Cardiac Health/Ejection Fraction

Swim15

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So I had an echo and nuclear stress test done this week. I won’t have the nuclear interpretation until Monday or Tuesday but got a preliminary interpretation that showed heart enlargement (no surprise) and an ejection fraction of around 45%.

Lower EF is somewhat normal in athletes and had a few people tell me it isn’t immediate cause for concern but obviously not a good trend since I’m 26 years old.

Diet is immaculate now due to having ulcerative colitis and exercise is frequent. My plan is to increase my HIIT frequency to ~3 times a week and also include more steady state/moderate intensity cardio as well.

On top of that, I’m going to add an ARB and increase my curcumin intake which I’ve been taking now for several years.

There are some threads on PM and elsewhere where guys went from 30-35% back up to 60% so I know it’s doable.

Growth hormone is out and I’m going to keep gear low-moderate from here out the rest of my life.


Got some intelligent guys here so I’d like to hear additional thoughts on lifestyle and also on the most productive form of HIIT and duration.

I see some guys say they’re doing HIIT for 20min but to me I’m dead after 5-10 if it’s true 100% sprint intervals and my heart rate will be over 200 for 50% of that time.
 

Swim15

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Also any additional thoughts on alternative medicine treatments, if any. Going to start looking through some research.
 

CFC

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I've explained this all before somewhere, but can't find where atm.

Cutting down anabolics for a time, lowering BP, eating healthy and low-normal sodium, taking plenty of good antioxidants and supps (high magnesium etc), some intermittent fasting, and an ARB (or alternatively high dose NAC if blood pressure already low) are all good ideas.

However, I see no emphasis on low to medium intensity cardio. HIIT isn't really ideal (not 20 mins of pure high intensity anyway!), because you're actually encouraging some degree of anabolism in the tissue, which runs counter to the objective.

Rather, you want to condition the cardiac muscle with lower intensity cardio, lowering stroke velocity but giving it a chance to fill and expand fully (ie volume). Jogging/running or swimming would probably be best since, by activating muscles all over the body, they cause larger volumes of blood to be squeezed around the body and back to the heart, thus promoting greater filling and emptying of the chambers. This will, over time, increase its elasticity and suppleness and thus functional volume, so it can squeeze more efficiently, raising EF, as well as increasing cardiac mitochondrial density, enhancing beneficial angiogenesis, nerve growth and so on.

Avoiding excess HIIT and also pushing less intensely while lifting (and dramatically cutting back anabolic growth factors) should ultimately allow the wall thickness to decrease as well, improving outcomes further and reducing overall 'stiffness'.
 

Swim15

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Thanks CFC, I know you’ve covered some of this but thanks for the update.

I’ve done or am doing a lot of that already so trying to figure out what else to do. Going to put more emphasis on cardio and bring my weight down from 220-225 to 210ish and try to maintain that.

Growth hormone is out for the rest of my life. I’ve had my anabolics relatively low (like I’m going to keep anabolics to probably about 300mg maximum for the long term foreseeable future, maybe forever.

Always have magnesium intake. My blood pressure has always been good which is also why this surprised me some but I’m going to get my doc to give me an ARB and also think I may try a low dose (12.5mg) HCTZ since I tend to hold a decent bit of subq water.

I’ve always emphasized medium intensity cardio so I’m going to add a larger quantity of that and go for 6-7 days a week since I’ve been slacking some. Was thinking maybe an additional 5min HIIT 2-3x a week.


I’ve always used a decent amount of curcumin but I’m going to increase that substantially and think I saw some lit on magnolia extract helping with EF.

Going to look into additional supps to help maintain plasticity and limit fibrosis. Definitely interested in any info on alternative medicine supps for EF if anyone stumbles across studies
 

CFC

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Leaving aside the endless debates about phytates and lectins in raw (fermented) cacao for a moment, I've personally always noticed decent objective (palpable) benefits from the powder at 25g/day. I can literally feel the relaxation of my blood vessels and fall in BP when I drink a cup first thing AM and for a few hours after - feels kinda weirdly heavy in my heart, like it's filled up and swollen out. Obviously not a cure all by any means, but my EF is now pretty high, despite being around where yours was 8-10 years ago. Which I partly attribute to that (its phytonutrients, highest natural source of magnesium, extremely high flavonoid & procyanidin content etc), since I can't be arsed with too many other supps these days beyond a very healthy range of veggies and oils, some NAC and taurine, plus glutamine and (especially) zinc carnosine for gut health.

Growth hormone is out for the rest of my life
I mean, by all means do so. But bear in mind that even 300-500mg test can result in dramatically elevated GH and IGF-1 at sustained levels, seemingly beyond what some (many?) low-dosed GH-regimens achieve. I don't see GH as much of a problem as AAS, which is far more anabolic in all regards to most organs in the body.

Tbh, given you're so young and have plenty of years to play around, I'd probably take a good 6-12 months where I dropped isometric training intensity dramatically, focused on low-med cardio, a little HIIT, cut calories, and stopped anabolics (or dropped to genuine TRT levels) and GH entirely. This should give the cardiac muscle a chance to reduce in thickness a fair bit, as obviously you need to be in essentially a prolonged, mildly catabolic state to shrink any muscle, especially the always active/exercising heart. That should help bring EF back above 50-60+%, and give a decent chunk of time for the break up of some of the (likely) excess collagen/fibrotic tissue in the heart and cardiovascular system.

Sure, you'll lose a few more lbs LBM than you ideally want or think you can psychologically handle, but you're unlikely to fall under 200-205 if you stay moderately active and have been above that mass for years. And once your heart's better, you can slowly, carefully, regain the mass with ease and little need for excess PEDs or risk to the heart.

FWIW I can't fall under 200 even without anabolics, barely training at all in recent years, and eating hardly anything. Which I attribute to simply having been muscular for so long my body's set point is comparatively high (cos it sure ain't my shitty genetics).
 

Serotonin101

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How did you get them to schedule you for these tests? Just curious so I can get em done in the next few years. Or did you get them done privately?
 

Swim15

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CFC - thanks my man! Really good info.

I’ve been a fan of raw cacao as well but I’m going to increase that. Is there a particular brand(s) you like? It’s hard to dissolve so do you just blend it or try and mix in hot water?

Honestly the psychological aspect of losing muscle isn’t nearly as much of a deal to me now and I’d much rather take care of my long term health than stress out about a few pounds of muscle haha. Fuck that. Definitely about longevity. I’m the same way now though where I hold muscle much more easily than I used to so not worried.

I eat a lot less food now after all my issues with ulcerative colitis so that’s now much more of a norm with fasting periods thrown in.

I’ll maybe get my growth and IGF-1 levels checked but also drop gear down to true TRT levels.



Also found this study on pine bark extract...over 20% increase in EF sounds absurd but I’ve got a lot and definitely going to add it back in at a couple hundred mg per day since it’s not that expensive.

 

Swim15

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How did you get them to schedule you for these tests? Just curious so I can get em done in the next few years. Or did you get them done privately?
I’ve actually been doing all the cardiac testing to get cleared for Ibogaine treatment. Not sure if they’ll clear me but if they don’t then I’m going to microdose it on my own.

I was sort of lucky because I had a slight abnormality (unspecified ST elevation) on my EKG and because of that I ended up getting pre-approved for a nuclear stress test cause they are like $6-7k.

My doc wanted to do an echo too and I’ll hit my out of pocket insurance max fast this year so most of it will be free because of that.

Really glad I caught this stuff now though so I can make some long term lifestyle changes to address it.
 

CFC

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I’ve been a fan of raw cacao as well but I’m going to increase that. Is there a particular brand(s) you like? It’s hard to dissolve so do you just blend it or try and mix in hot water?
I use a mini frothing whisk, but I add it to warm (not hot - can lower flavanoids) milk and organic forest honey as well. Cos I like to enjoy the taste of my first drink of the day, and that combo has always given me a pleasing (mild) psycho-stimulant effect.

I tried using only water for a while (milk is theorised to inhibit flavanoid intake somewhat), but with or without milk it gives the exact same somatic feel and my BP falls equally.

As for sources, no specific brands no. I like to try out all kinds of different sources, and prices vary dramatically from month to month if you don't shop around (due to commodities speculation and price hedging).

Peruvian raw organic is one of the more commonly available as they have a lot of independent cacao farmers, and typically tastes great too. Unfortunately it also tends to contain the highest cadmium levels of any origin cacao. Ghanian raw has the lowest cadmium, but typically also the highest aluminium levels. Ivory Coast is probably the most balanced in terms of heavy metals, low cadmium, low aluminium, but also very hard to find as most cacao farms there are owned by the big chocolate corporations. I recently sourced some South African raw organic, but fucked if I can find much research on their soil condition and contaminant levels.

Probably the best thing to do long term is just regularly mix sources from different origins, and rely on NAC and other supps to chelate any excess metals out.
 

Swim15

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So guys, good news.


Got the cardiologist’s interpretation of the results and basically things look good. There was excess uptake of the tracer in my gastrointestinal tract (probably thanks to UC) so that skewed the intial impression that the nuclear med tech gave me but my ejection fraction was falsely low at 46% and he said that with the stress test and the echo, it’s more in the 55% range, possibly higher.

That said, it’s still lower than I’d want and my heart is still enlarged. Going to continue with some of the lifestyle changes discussed so that this doesn’t become an issue.

Gear is going to stay under 400mg total long term with regular cardio 5-6x per week. My diet is good but I am going to change it slightly along with adding a low dose preventative ARB to help control the RAS system long term.

Supplements are still going to include copious amounts of curcumin and some things like pine bark extract that have been shown to help vessel elasticity and overall cardiovascular health.

Glad I got these done now to keep an eye on things and also have a baseline for a test in another 10 or 15 years.
 

Swim15

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Of note, I’ve been doing the raw cacao in the morning (20-25g dissolved in warm water) and holy fuck is it making me sleepy. Guessing because of the magnesium and tryptophan.

Moving the drink to pre-bed to see if that helps me sleep.
 
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