Entries in Microbiome (12)



Novel Program 2016


PD Dr. med. Rainer Arendt
FMH Cardiology, Internal Medicine
Regenerative Medicine 

Klausstrasse 10
T +41 43 336 7260
M +41 78 825 0803
F +41 43 336 7261



The Dolder Grand Health & Aesthetic Link 

















  • Already today it is possible to increase the telomere length of the chromosomes, translating into an extension of human lifespan by approximately 10 years, by prudent eating, regular exercise, stress relief, regular chelation/detox treatment and especially by epigenetic rejuvenation, i.e. the gut, skin and vaginal microbiome exchange (the Élie Metchnikoff cure), with additional benefits for wellbeing, performance, fertility, increased vitality, and prevention of disease / neurodegeneration / hormonal involution (degeneration) later in life.
  • Recent scientific successes in rejuvenation, extending the lifespan, and discovery of a variety of species (including humans of advanced ages) having negligible senescence (decay due to old age), allow us to cancel accelerated or premature ageing for younger humans, reverse ageing or at least significantly delay it for older humans.
  • Our aim is to extend the lifespan in good health and full vitality




  • Epigenetics is the study, in the field of genetics, of cellular and physiological phenotypic trait variations, caused by external or environmental factors, mainly by the biofilms on our skin, in our mouth, in our lungs, in our gut, in our vagina, placenta and sexual organs,  that switch genes on and off and affect how cells read genes
  • The microbiota or microbiome is the community of commensal, symbiotic microbes that share our body space, or in a stricter sense stick to external or internal body surfaces as a biofilm
  • The microbiome and the human host emerged as a unity along evolution by a process of integration
  • The human microbiome has a significant impact on human development (before birth via the biofilm on the placenta), health and well-being
  • It is the rich array of beneficial microbes in our intestines and in our biofilms that makes us the human beings we are, preserves our health, and determines our lifespan.





  • The importance of the commensal microbiota that colonizes the skin, gut, vaginal, placental, and mucosal surfaces of the human body is being increasingly recognized through a rapidly expanding body of science studying the human microbiome
  • The human body consists of more than 90% of microbial cells. The gastrointestinal tract harbors trillions of beneficial microorganisms that influence the development and homeostasis of the host. Alterations in composition and function of the microbiota have been implicated in a multitude of metabolic and inflammatory diseases in humans
  • There is a burgeoning scientific field on the role of the human microbiome in ageing, age-related diseases, diabetes, obesity, atherosclerotic diseases,  allergic diseases, autoimmune diseases, neuropsychiatric illnesses, infections, inflammatory bowel disease, and cancer


Mayo Clin Proc. 2014;89(1):107-114

Current Opinion in Immunology 2014, 30:54–62

Best Practice & Research Clinical Gastroenterology 27 (2013) 127–137




  • The chromosomes contain almost all of a cell’s genes. The tips of every chromosome are called the telomeres, they protect the chromosome from damage
  • Each time a cell divides, a little bit of the telomere is lost (therefore, the telomeres are regarded as our biological clock). When the telomeres become very short, the cell can no longer divide and dies
  • Genetic and epigenetic factors, the interaction of the immune and hormonal systems with our microbiota, influence how quickly the telomeres shorten
  • Restauration of the youthful diversity of the human  microbiota, healthy eating styles, increased fitness, stress relief result in longer telomeres reflecting/causing extensions of our lifespan
  • We measure the length of the telomeres in a blood sample as a parameter of lifespan before and after treatment





Switzerland –the prime destination for health, vitality, rejuvenation and long life 

Since the early 18th century, Switzerland - along with Italy – began to be perceived by the contemporaries as the most beautiful landscapes in Europe. Ever since, it has been regarded a fountain of health, long before the first patients with tuberculosis were sent for the famous sun, air and mountain cures in the early 20th century.  


And especially today, Switzerland is a  frontrunner in medical technology, with a healthcare system rightfully acknowledged to be one of the best in the world, with its exceptional quality of care and the excellence of its medical facilities.

















University Hospital, main buildings of the University and the ETH, and the city of Zurich, Switzerland 




  • Ruling out treatable disease (by a comprehensive checkup examination, imaging, endoscopy, laboratory medicine)
  • Treating treatable disease, alleviating non-treatable disease (based on academic medicine and amended by the newest treatments from cellular, biological medicine, nutrition sciences, sports physiology, lifestyle medicine and neurosciences)
  • Extending the lifespan by restauration of the youthful diversity of our biofilms nIncreasing one’s resources and living well: staying quick-witted, social and sexual
  • Sidestepping risk factors for disease (preventive medicine, cardio-vascular prevention, lifestyle changes, exchanging non-beneficial microbes, neuroprotection)
  • Improving neurofunction, cardiac function by restauration of the gut-brain axis, of the gut-heart axis
  • Restauration of the senescent immune system, prevention of cancer
  • Regeneration of our endocrine (hormonal) systems




  • Prevention or treatment of accelerated arteriosclerosis of carotid or coronary arteries (stroke, heart attack or sudden cardiac death)
  • Prevention or treatment of metabolic disease, type 2 diabetes, obesity
  • Prevention or treatment of autoimmune disease (multiple sclerosis, rheumatoid arthritis, thyroiditis, type 1 diabetes, psoriasis, auto-immune hepatitis)
  • Prevention or treatment of neuro-degenerative disease (dementia, Alzheimer, Parkinson, depression, autism, rare and devastating neurological disease)
  • Prevention or treatment of eating disorders (anorexia nervosa, binge eating, bulimia nervosa)
  • Prevention or treatment of inflammatory diseases (colitis, allergies, eczema, chronic lung disease)
  • Rehabilitation following cancer treatment, restauration of the immune system
  • Infertility, improvement of reproductive health, prevention of pregnancy complications
  • Early menopause, hormonal involution, loss of libido, painful sexual intercourse, erectile dysfunction
  • Lifespan extension, improvement in vitality, male performance, female wellbeing






  • A 46 years old successful entrepreneur from Russia’s pacific coast, with alcohol dependency and depression, his fiancée requested him to undergo treatment before marriage. Following six gut microbiome transfers from a completely alcohol- and drug-free merry donor, he has been clear of alcohol for one year, and was able to resume “social” drinking of one to two glasses of wine only for dinner during his 2nd “sober year”. His mood is stable, work and social performance is no longer endangered.  By now the wedding has taken place and the marriage is harmonious.
  • A 61 years old housewife and society lady from Kazan with diffuse hair loss that is unresponsive to medical therapy, undergoes three microbiome exchange treatments, she is pleased with fuller hair and smoother skin six months later, therefore, doesn’t avoid public events anymore, and resumes her roles in beneficence.
  • A gifted 18 years young Australian student with polycystic ovary syndrome, menstrual abnormality, weight gain, acne, virilisation and severe reactive depression with indigestion and obstipation, undergoes three gut microbiome exchange treatments and is started on a combination oral contraceptive. She loses 12kg within 12 months, her skin clears, and virilisation is reversed, bowel movements normalised, she has become again a popular and outgoing young lady.
  • A 43 years old Chinese entrepreneur with premature menopause undergoes three gut and vaginal microbiome exchange treatments, her menstrual cycle has resumed and is regular three months later. There are no more hot flushes. Sexual intercourse is no more painful.
  • A 62 years old politician from Indonesia presents for general rejuvenation treatment, two months after three microbiome exchange treatments, his friends notice a “miraculously” improved golf swing that is now “silky smooth”. His exercise tolerance and oxygen uptake improved, and the telomere length increased from 6178 pb, i.e. second lowest quartile, to 6408 pb, i.e. second highest quartile of the normal range, reflecting an increase in lifespan.
  • A 26 years old Stanford creative writing student with long standing and recurrent inflammatory disease of unknown cause with constitutional complaints, musculo-skeletal symptoms, long confinement to bed, recurrent diarrhea undergoes three microbiome exchange treatments, almost a year later she has resumed her studies without limitations and had almost forgotten that she ever had been handicapped before. 
  • A 29 years old business student from Indonesia, got involved in a robbery incident, and suffered cerebral trauma when pushed from his motorcycle, with two weeks in coma. Recovery after the hospital stay had not been complete, due to cognitive impairment, slowed speech, double vision, decreased performance, anxiety, depression and impaired self esteem with consequent increase in body weight and loss in former interests. Following six microbiome exchange treatments and six months later, he has resumed working out twice per week with his personal trainer, restored his social relations and former popularity. He feels confident enough now to apply for a job.
  • A 22 years old model from Columbia, suffering from recurrent abdominal pain, and constipation following abdominal surgery for malrotation in childhood, becomes completely asymptomatic two months following microbiome exchange treatments.







  • We offer novel treatment programs in regenerative medicine at The Dolder Grand Health & Aesthetic Link practice, in cooperation with Double Check Swiss Academic Center Zurich and leading Swiss medical institutions, both private and University-associated
  • Stand out among your peers, come for measurable and lasting health benefits, fresh looks and vitality
  • Look and feel younger than your age
  • Increase wellbeing, prowess and physical magnetism
  • For hormonal renewal and lifespan extension (telomere length ↑)
  • For improved overall health and metabolism (blood lipids↓ & sugar ↓)
  • For prevention or treatment of difficult-to-treat ailments, accelerated aging, auto-immune disease, inflammatory disease, degenerative diseases of the nervous system, depression, anorexia nervosa, bulimia nervosa, diabetes, obesity, and heart disease (coronary artery disease, heart failure)




  • This program provides support for the application of microbiome-based regenerative therapy  in a controlled and safe setting. All accompanying state-of-the-art diagnostic and therapeutic measures including checkup examinations are provided by the Double Check Center in Zurich (www.doublecheck.ch). Basis of this program is a general health program, duration one to seven days.
  • Day 0:  Check-in at your hotel or clinic, first consultation, program set-up
  • Day 1: Somatic checkup (at Double Check)
  • Double Check examination, depending on the patient’s preferences and needs (Executive / Executive plus, Individual)
  • Comprehensive laboratory testing, toxicology screening
  • Biological age (as measured by telomere length)
  • Further diagnostics, imaging, endoscopy if needed and desired
  • Day 1-3: Choices of regenerative medicine therapies
  • Day 2-7: Choices of personal training and enhancement
  • Day 1-7: Final assessment  with PD Dr. R. Arendt, hand-out of medical report with recommendations and prescriptions


Our donors are the most active, enthusiastic and blissful young people






  • A Double Check Executive Checkup  
    Alternative: Executive Plus Checkup 
  • Additional laboratory (hormones, xenobiotic metals, toxins)
  • Genetic assessment  of life span (telomere length)
  • Micro RNA extracts
  •    8 I.M. injections for repair   
  •    12 I.M. injections for repair
  • Gut microbiome exchange
        for 3 treatments
        for 5 treatments
  • Face rejuvenation by skin microbiome exchange
        for 3 treatments
  • Vaginal rejuvenation by vaginal microbiome exchange
       for 3 treatments
  • Oral chelation (detox) therapy per week
  • Consultation with PD Dr. Rainer Arendt
      o internal medicine, cardiology
      o personal coaching, autohypnosis, EMDR, HT (per hour) 
  • Consultation with co-therapists
      o Personal coaching / training (per hour)
      o Mogalates posture and embodiment therapy (per hour) 
  • Optional: Consultation with specialists in all medical fields
  • Holistic and biological addiction treatment (per week)
  • Holistic and biological treatment of eating disorders (per week)




“Youth — nothing else worth having in the world…and I had youth, the transitory, the fugitive, now, completely and abundantly. Yet what was I going to do with it?
I wanted freedom, freedom to indulge in whatever caprice struck my fancy, freedom to search in the farthermost corners of the earth for the beautiful, the joyous and the romantic.”

Richard Halliburton, 
The Royal Road to Romance (1925)














For your individually tailored health and regeneration package contact us





THE HUMAN MICROBIOME 2016: the future in diagnostics and therapeutics

The Dolder Grand Health
Long Life & Vitality

PD Dr. Rainer Arendt
Internal Medicine & Cardiology FMH
Prevention & Regenerative Medicine

The future in diagnostics and therapeutics has arrived already today.

We look at a person's microbes and ensure the right balance is there and make adjustments if necessary to keep that person in optimal health.

Here we present 


  • An overview of the human microbiome project
  • Integrated omic analyses: including concomitant metagenomics, metatranscriptomics, metaproteomics, and metabolomics
  • Case studies: the microbiome and its role in inflammation, obesity, immunity, diabetes and cancer
  • Potential for microbiota-directed therapies
  • Skin microbiome - acne, eczema and wound healing
  • Oral microbiome
  • Impact of preterm birth prevention and management strategies on the vaginal microbiome
  • The lung microbiome and potential diagnostics and therapeutics
  • The microbiome-gut-brain axis and its impact on behaviour, addiction, and neurodegenerative diseases
  • Personalized nutrition and microbiome research
  • Impact of specific nutrients on the early life window
  • The development of next generation probiotics


The Human Microbiome has a well-documented and significant impact on human health and well-being. The advances in next generation sequencing technologies have aided scientific research in connecting an imbalanced microbiome (dysbiosis) to conditions as diverse as cancer, pulmonary, metabolic, inflammatory and mental/neurodegenerative disease.

Despite the recency of much of this research numerous applications are rapidly emerging. The strong evidence that gut microbiome transplantation/transfer (an individual biological therapy) is spectacularly efficacious in treating certain infectious or difficult-to-treat diseases and the percetion that the microbiome is uniquely manipulable is proving very exciting for researchers, physicians and patients alike.

Collaborations and research consortia are underway around the world surveying human microbiota at different body sites, characterising them, understanding their interactions with their host, their cause and effect role in diseases, and designing therapeutic or dietary interventions.

Whilst no on-the-shelf therapeutics exist yet, links between humans and bacteria are said to be on the cusp of a revolution in biological therapeutics. 


PD Dr. med. Rainer Arendt
FMH Cardiology, Internal Medicine
Regenerative Medicine 

Klausstrasse 10
T +41 43 336 7260
M +41 78 825 0803
F +41 43 336 7261





The Dolder Grand
Health & Rejuvenation

PD Dr. Rainer Arendt
Internal Medicine & Cardiology FMH
Prevention & Regenerative Medicine


by Clive Cookson, the FT’s science editor, Financial Times, June 12, 2015

Photograph: Alexandr Khrapichev/University of Oxford/Wellcome Images


Cross-sections of some of the fruit and vegetables that make for a healthy microbiome, as captured by magnetic resonance imaging (MRI)


What is the greatest advance in scientific understanding of the human body so far this century? With due respect to the progress made in human genetics, oncology and neuroscience, my answer is appreciation of the microbiome: the vast population of microbes that live within all of us and play a vital role in our health and wellbeing.

Although microbiologists have known for many decades that everyone hosts resident bacteria, beneficial and malign, their diversity and biological significance are only now becoming clear as scientists deploy new techniques of molecular biology to probe the microbiome. A healthy adult is made up of about 10tn human cells; microbial cells are smaller but there are 10 times more of them, weighing in at 3lb in total, roughly the same as the brain.

Recent research shows that the hundreds of microbial species populating this teeming inner world play essential roles in the most fundamental processes of our lives, from digestion to immune response and even behaviour. Imbalances in the microbiome, caused by aspects of the modern lifestyle such as medication, sanitation and diet, have been linked with diseases from obesity and diabetes to asthma and eczema.

The microbiome is fertile territory for popular publishing, combining as it does exciting and fast-paced science with medical self-help — how to adjust your own microbiome for a healthier life. The three titles reviewed here are good examples of this new biomedical genre. All focus on the gut, where the bulk of our bacteria live and work, while looking, too, at the significant populations inhabiting mouth, skin, genitals and other parts of the human body. And all three are models of clear, accessible and entertaining science writing by active researchers.

Tim Spector, author of The Diet Myth, is professor of genetic epidemiology at King’s College London — and famous for leading the Twins UK team that compares identical and non-identical twins to untangle the genetic and environmental influences on disease and physical appearance. He also leads the British Gut Project and is currently using DNA sequencing to study the microbiomes of 5,000 twins. Spector’s book is the most comprehensive of the three, with dietary advice detailing what is known about the impact on the microbiome of different categories of food ingredient (fats, proteins, carbohydrates, fibre, vitamins and sweeteners) as well as alcohol, caffeine, antibiotics and other drugs.

Rob Knight, who wrote Follow Your Gut with science journalist Brendan Buhler, is another high-profile author: a professor of paediatrics, and computer science and engineering, at the University of California, San Diego, and co-founder of the American Gut Project. His book is relatively concise but still manages to pack in colourful stories.

Giulia Enders, the author of Gut, is a young medical researcher working on her doctorate at Frankfurt’s Institute for Microbiology. Her book was originally published last year in German as Darm mit Charme (“Charming Bowels”) and the text retains a charming freshness in David Shaw’s translation, leavened further with some sweetly naive illustrations by the author’s sister, Jill Enders.


The average American child goes through 17 courses of antibiotic, most of them unnecessary


The key point made by all three books is that you cannot maintain a healthy diet if you ignore the impact of food and drink on your gut microbes, which are essential intermediaries in the digestive process. Indeed, Spector claims that examining the DNA of our microbiome is much better for predicting obesity than looking at human genes.

Over millions of years we have evolved together with microbes for mutual survival, yet recently this fine-tuning and selection has gone wrong. Studies comparing urban Americans and Europeans with people living in the Amazon rainforest or rural Papua New Guinea, enjoying rich and varied diets and without antibiotics, show how much microbial diversity has been lost in the industrialised world.

We are endowed with a microbiome at birth. A baby born in the conventional way is swarming with millions of microbes by the time she emerges from her mother, as Spector puts it. The first dose consists of vaginal bacteria from the birth canal. “Then because of their close proximity and the pressure on all the body’s sphincters, a light mixture of urinary and faecal microbes are sprinkled onto her face and hands, followed by a different set of microbes covering the rest of her body as a result of rubbing against the skin of her mother’s legs.”

All three authors point out the microbial deprivation suffered by babies born by caesarean section, who cannot pick up bacteria in the same natural way. Caesarean births are associated with higher rates of a broad range of diseases associated with the microbiome, according to Knight. Spector quotes a study showing that C-section birth increases the risk of obesity by 20 per cent. And Enders blames her own caesarean delivery and her mother’s inability to breastfeed her — maternal milk provides another good dose of bacteria — for the multiplicity of health problems she suffered during childhood.

Although the best advice for parents is to opt for natural childbirth and breastfeeding, an emergency may make a C-section unavoidable — which is what happened to Knight’s partner Amanda. “Our daughter was born via an unplanned caesarean section, and I was holding her 20 minutes later,” he writes. “But today’s medical technology doesn’t supply everything. When it came to her microbes, we took matters into our own hands and swabbed her with samples from Amanda’s vagina. Our baby needed those microbes.” A clinical trial of this process, now called “vaginal inoculation”, has started in Puerto Rico.

The microbiome grows and diversifies further during early childhood, picking up beneficial bacteria from the environment. Here we encounter the “hygiene hypothesis”, first formulated in the 1980s to explain the exploding epidemic of autoimmune and allergic disorders such as asthma and eczema. In its original form the hypothesis proposed that the young immune system needs “training” through exposure to diverse bacterial and viral pathogens; problems emerge in excessively clean modern homes that fail to provide sufficient immunological challenges.

The current version of the hygiene hypothesis focuses more on the essential role that the microbiome plays in our immune defences. As Enders points out, about 80 per cent of the human immune system is located in the gut. It has to be extremely careful to suppress its defensive instincts and allow the many beneficial bacteria to live there in peace, while recognising dangerous elements in the crowd and weeding them out.

All of which requires careful training through exposure to multiple microbes, good and bad, Spector explains. Gut microbes communicate with the human immune system through so-called regulatory T-cells, or Treg cells, in the intestinal walls. High Treg levels are generally healthy because they damp down excessive activity in the immune system.

Evidence to support the hygiene hypothesis is growing fast. For instance, Erika von Mutius of Dr von Hauner Children’s Hospital in Munich, a pioneer in this field, has shown that exposure to farming in early life reduces substantially the risk of allergies and asthma — and some of this effect can be explained by children’s contact with farm animals and unpasteurised raw milk.

“In general,” says Knight, “exposure to diverse microbes, whether through older siblings, pets, or livestock — or through good old-fashioned playing outdoors — seems to help, even if scientists are still sorting out the specific microbes involved. It may be that diversity itself is most important.”

Enders goes further. “Disinfectants have no place in a normal household,” she writes. “The aim of cleaning . . . should be to reduce bacteria numbers, but not to eliminate them. Even harmful bacteria can be good for us when the immune system uses them for training — a couple of thousand salmonella bacteria in the kitchen sink provide our immune system with the opportunity to do a little sightseeing. Salmonella become dangerous only when they turn up in greater numbers.”

Needless to say, all these authors advise against antibiotics unless you need them to fight a serious drug-sensitive infection, because the side-effects of killing beneficial bacteria alongside the pathogens can also be serious. Yet the average American child goes through 17 courses of antibiotic before reaching adulthood, most of them unnecessary, according to Spector.

How, then, can people restore their ravaged microbiomes? Besides eating a varied diet rich in fruit, vegetables and nuts, taking probiotics and prebiotics may help. To illustrate the difference between these two easily confused categories, Knight invites us to think of our microbiome as a lawn. Prebiotics are like fertilisers; they are mostly soluble vegetable and fruit fibres that can be fermented by bacteria in the large intestine to provide essential nutrients. Foods rich in prebiotics include artichokes, chicory, leeks and celeriac.

Taking probiotics is more like reseeding an unhealthy lawn with desirable grasses. Probiotics, often referred to as “good bacteria” or “helpful bacteria”, are typically yoghurt-based foods or drinks containing a few species of live microbes. Although taking these will do you no harm, there is not much convincing evidence of their benefit from well-conducted clinical trials. As Spector says, this is probably because we all have different microbiomes to start with; without knowing which microbes to replace, it is a lottery whether particular yoghurt concoctions will work for you. In the future it may be possible to tailor probiotics for people to compensate for their individual microbial deficits.

A more drastic option, which Knight compares with ripping out a weed-infested lawn and laying down fresh turf, is to have a faecal or stool transplant from someone with a healthy microbiome. This procedure has proven remarkably successful in curing people who are seriously ill with Clostridium difficile infection and have very abnormal gut microbes. Research is now under way to extend faecal transplants to other disorders.

If you want to discover the health or otherwise of your own microbiome, this is now possible through the British Gut Project or American Gut Project, in return for a contribution to their research funds (a minimum £75 for UK residents). Just Google them to discover how to proceed.

But bear in mind Knight’s cautionary words: “Much of the news you hear about disease in the microbiome can be confusing, contradictory, or sometimes overhyped . . . This complexity is worth keeping in mind anytime you hear sweeping claims about it or simple fixes for a variety of its ailments.”

Although the authors of these three books are enthusiastic practitioners of microbiome research, they stop short of making excessive claims. The revelation that each of us depends on our individual living world, with far more inhabitants than there are people on earth, is surely sensational enough.


The Diet Myth: The Real Science Behind What We Eat, by Tim Spector, Weidenfeld & Nicolson, RRP£14.99, 320 pages

Follow Your Gut: The Enormous Impact of Tiny Microbes, by Rob Knight with Brendan Buhler, Simon & Schuster, RRP£7.99/RRP$16.99, 128 pages

Gut: The Inside Story of Our Body’s Most Underrated Organ, by Giulia Enders, Scribe RRP£14.99/Greystone Books RRP$17.95, 272 pages


We offer gut microbiome exchange (transplantation) as novel opportunity in prevention and treatment of various and so far difficult to treat ailments (auto-immune diseases, metabolic disorders, neuro-psychiatric diseases and addictions, cardiovascular disease, endocrine disorders and infertility, cancer).


PD Dr. med. Rainer Arendt
FMH Cardiology, Internal Medicine
Regenerative Medicine 

Klausstrasse 10
T +41 43 336 7260
M +41 78 825 0803
F +41 43 336 7261




Atrial Fibrillation Care: Put the Catheter (and Rx Pad) Down

The Dolder Grand
Medical Wellness & Rejuvenation

PD Dr. Rainer Arendt
Internal Medicine & Cardiology FMH
Prevention & Regenerative Medicine



My approach to patients with atrial fibrillation (AF) has changed. Completely and fundamentally. This is a before-and-after moment in AF care.

Before: We saw atrial fibrillation as a disease rather than seeing it as a result of other diseases. That explains why our treatments (drugs and ablation) have performed so poorly. It is a wrong-target problem. It is akin to stenting an artery and saying atherosclerosis is fixed or prescribing an antipyretic for bacterial infection.

After: Atrial fibrillation in the vast majority of patients (excluding those with brief episodes that are a form of focal atrial tachycardia) is a sign that something is awry in the body—usually exposure to an excess. The atria, with their sensitivity to stretch, neural connections, and plastic cells, are a window onto overall health.

Year after year I have watched the drugs fail and the AF return after ablation. It is a relief to (better) understand AF and to be able to cite evidence that supports the concept that the atria fibrillate for a reason. And that reason is the main therapeutic target.


You may know the story. A group of researchers in Adelaide have shown—first in animal models [1,2] and now in humans [3,4]—that promoting basic health dramatically improves AF burden. Their methods and results have taught us how AF happens. Although work remains, it is clear that lifestyle diseases (with inflammation due to diet-induced intestinal dysbiosis, see below), via pressure- and volume-induced atrial stretch, inflammation, or neural imbalances, induce disease in and around the cells of the heart.


The coolest part about these data are that treatment of lifestyle diseases—mostly, the removal of excesses—not only reduces AF burden but also improves the structure of the heart. Even fibrosis (aka scar) can regress, which is a novel way to think about cardiac biology.

This "upstream" approach to AF is no longer a radical idea. Nearly all the leaders in cardiology agree. It changes the way doctors should treat people with AF. Namely, the idea that AF is fixable with rhythm drugs or ablation is as wrong as thinking a stent fixes atherosclerosis or that treating fever cures infection.

Before I go on, let me make a note of caution. I am not saying AF drugs or ablation have no role. They do. But their (much smaller) role now is similar to stents or beta-blockers in patients with coronary artery disease: to stabilize an acute situation or to help transiently restore regular rhythm so that patients can feel well enough to exercise and enjoy life—things that make the atria healthier.

I no longer think of an antiarrhythmic drug as long-term therapy. For instance, I cardiovert and medicate so that patients can feel well enough to exercise every day they eat. I buy time. Then patients can lose weight or address other lifestyle issues, such as sleep disorders, alcohol intake, and perhaps overexercise and overwork. This improves glucose handling, lowers blood pressure, and relieves inflammation. People start to feel better. When they come back for follow-up, I discuss stopping the rhythm drugs—because they have served their adjunctive purpose.

On the matter of stroke risk: think about what it means to improve high blood pressure, diabetes, inflammation, and hyperlipidemia. Now think what it means to do so in millions of people.

You can see how this new approach upends the role of AF ablation. It is one thing to prescribe a pill; it is yet another to deliver 60 to 80 burns to the left atrium. Recall that patients who choose AF ablation walk into the hospital the morning of the procedure. They may not be perfect, they have AF after all, but they are alive and functioning. What awaits them in the EP lab is nothing small. They will endure 2 to 3 hours of general anesthesia, vascular access in both legs, two transseptal punctures, a fluid load, and purposeful damage to the heart done in proximity to the esophagus, phrenic nerve, pulmonary veins, and the thin left atrial appendage.

And . . . that $100 000 procedure, with its (real-world) 5% to 7% risk,[5] often fails. Repeat procedures are required in one of four patients. Even when the procedure is done well, recent research [3] shows that long-term success is fivefold lower when patients do not remove excesses from their lives.

This new approach to patients with AF has significant implications for the cardiology and healthcare community.

Consider those affected:

•             Hospitals invest in expensive ablation labs. They have banked on the epidemic of new atrial-fibrillation patients who will "need" procedures. Recently, I did a marketing video for my hospital on AF treatment. We filmed in our EP lab, the ablation machines as the backdrop. I was excited to speak about the new discoveries in AF care. But I stammered when the interviewer asked me about the "procedures we do here." I thought to myself: we do procedures here, we do them well, we do them safely, but we are sure to do a lot fewer in the future.

•             Doctors—like me—have reaped the rewards of AF misthink. We are paid well to do and redo AF ablation. The financial reward for helping people help themselves pales in comparison. Yet I urge you not to blame overtreatment on fee for service. The main reasons doctors overtreat are do-something bias and the disease model of care. First, doing things is what we are taught, and it is what society expects. We might give cursory mention to lifestyle but then we rush to drugs and procedures. Second, the disease model of care tricks us into putting problems—like AF—into silos (cardiac, renal, pulmonary, etc), which we treat in isolation. So ingrained is the silo model that it has been daring to use the word holistic. As if things are not connected in the body.

•             Workforce needs will be disrupted. A few years ago, cardiology groups and hospitals felt like they needed more electrophysiologists to handle the epidemic of atrial fibrillation. Now it is clear that what we need more of is not people with catheter skills, but people with people skills. The painful truth is that American cities and American hospitals do not need more EP labs.

•             Policy makers and payers are bound to notice. Think about the billions of dollars spent to care for the millions of patients with AF. Why would any insurer pay for drugs and procedures that are doomed to fail unless lifestyle measures are addressed? I wonder whether this could be the spark that gets payers to see the value of helping people live healthier lives?

•             Industry will have to adjust. Imagine the boardrooms of pharmaceutical and medical device companies in the past decade: they saw atrial fibrillation as a major opportunity. We will develop drugs, catheters, and mapping systems to treat the millions of afflicted patients. What these companies should see now is that AF drugs and ablation will go the way of renal denervation—useful in very selected cases, but no gold mine.

•             Patients are most affected by this new discovery. Although there will be small numbers of people afflicted by fluky focal AF (a confusing fact), the vast majority of patients with AF will enjoy the best results when they and their caregivers treat the root causes. From now forward, when a patient with AF sees a doctor who recommends rhythm drugs or ablation without first exploring how that person sleeps, eats, drinks, moves, and deals with stress, it will be a signal to get another opinion. Rushing to drugs or ablation will be as wrong as prescribing antibiotics for a viral infection.

This discovery about atrial fibrillation teaches us that focal (easy) solutions for systemic diseases due to lifestyle are destined to fail. Given the rise of lifestyle-related diseases, this is a critical lesson, one we should learn sooner rather than later.

Source: John Mandrola, Atrial Fibrillation Care: Put the Catheter (and Rx Pad) Down. Medscape. Apr 07, 2015.


1.            Abed HS, Samuel CS, Lau DH, et al. Obesity results in progressive atrial structural and electrical remodeling: Implications for atrial fibrillation. Heart Rhythm 2013; 10:90-100. Article

2.            Mahajan R, Brooks AG, Shipp N, et al. AF and obesity: Impact of weight reduction on the atrial substrate. Heart Rhythm Society 2013 Annual Scientific Sessions; May 8-11, 2013; Denver, CO. Abstract YIA-01

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Gut microbiota serve as new targets for the prevention and treatment of cardiovascular disease

The Dolder Grand
Medical Wellness & Rejuvenation

PD Dr. Rainer Arendt
Internal Medicine & Cardiology FMH
Prevention & Regenerative Medicine


We are living in a bacterial world, and it's impacting us more than previously thought.




Recent studies reveal a contribution of intestinal microbes in the expression of metabolic or cardiovascular disease. The mechanisms through which intestinal microbiota and/or their metabolic products alter systemic homoeostasis and cardio-metabolic disease risks are just beginning to be dissected. Intervention studies in humans aiming to either selectively alter the composition of the intestinal microbiota or to pharmacologically manipulate the microbiota to influence production of their metabolites are crucial next steps. The intestinal microbiome represents a new potential therapeutic target for the treatment of cardio-metabolic diseases.

Vinjé S1, Stroes E, Nieuwdorp M, Hazen SL.: The gut microbiome as novel cardio-metabolic target: the time has come! Eur Heart J. 2014 Apr;35(14):883-7. doi: 10.1093/eurheartj/eht467. Epub 2013 Nov 11.


The human gastrointestinal tract is home to trillions of bacteria, which vastly outnumber host cells in the body. Although generally overlooked in the field of endocrinology, gut microbial symbionts organize to form a key endocrine organ that converts nutritional cues from the environment into hormone-like signals that impact both normal physiology and chronic disease in the human host. Recent evidence suggests that several gut microbial-derived products are sensed by dedicated host receptor systems to alter cardiovascular disease progression. In fact, gut microbial metabolism of dietary components results in the production of proatherogenic circulating factors that act through a meta-organismal endocrine axis to impact cardiovascular disease risk.

Brown JM1, Hazen SL.: The gut microbial endocrine organ: bacterially derived signals driving cardiometabolic diseases. Annu Rev Med. 2015;66:343-59. doi: 10.1146/annurev-med-060513-093205.


It has recently been discovered that certain dietary nutrients possessing a trimethylamine (TMA) moiety, namely choline/phosphatidylcholine and L-carnitine, participate in the development of atherosclerotic heart disease. A meta-organismal pathway was elucidated involving gut microbiota-dependent formation of TMA and host hepatic flavin monooxygenase 3-dependent (FMO3-dependent) formation of TMA-N-oxide (TMAO), a metabolite shown to be both mechanistically linked to atherosclerosis and whose levels are strongly linked to cardiovascular disease (CVD) risks. Collectively, these studies reveal that gut microbiota serve as new targets for the prevention and treatment of cardiovascular disease.

Tang WH, Hazen SL.: The contributory role of gut microbiota in cardiovascular disease. J Clin Invest. 2014 Oct;124(10):4204-11. doi: 10.1172/JCI72331. Epub 2014 Oct 1.

We offer gut microbiome exchange (transplantation) as novel opportunity in prevention and treatment of cardiovascular disease.