How can we improve the capacity of our blood vessels to repair themselves?
How to Boost Your Endothelial Progenitor Cells (EPCs) for Heart Health
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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
How can we remain young at heart? The capacity of our blood vessels to repair themselves is dependent on endothelial progenitor cells that emerge from stem cells in our bone marrow to patch up any holes in our endothelium––the innermost lining of our blood vessels that keeps our blood flowing smoothly. Lower levels of circulating endothelial progenitor cells in the blood correlate with arterial diseases, like erectile dysfunction. Higher numbers, on the other hand, are correlated with a significantly reduced risk of death from cardiovascular causes. Before we explore how to boost our levels, let‘s first establish cause and effect.
A randomized, double-blind, placebo-controlled trial was performed in men and women with peripheral vascular disease––a circulation disorder characterized by the narrowing of blood vessels outside of the heart or brain. The arteries supplying blood to their legs were so ravaged by disease they could only walk about a minute before the muscles in their legs cried out in pain from the lack of oxygen. For each study participant, one leg was randomly selected to be injected with cells from their own bone marrow, and the other was injected with their own peripheral blood as a control. Not only was pain-free walking time significantly extended in the marrow-injected leg; they were less likely to subsequently lose it. Severe limb ischemia (lack of oxygen) from peripheral vascular disease carries a 10 to 40 percent amputation rate within six months. In the control group, 14 percent were forced to undergo a major amputation, compared to zero in the bone marrow group. Given these remarkable benefits, the link between higher numbers of endothelial progenitor cells and lower risk of dying from cardiovascular disease may indeed be causal. Short of sticking a large-bore needle into your hip, how else can we cultivate and release more endothelial progenitor cells into our system?
Smoking cessation is one of the most important and effective lifestyle changes to increase the number and function of active endothelial progenitor cells. Cutting down isn’t enough. There are twenty cigarettes in a pack. If you only smoke about one a day, wouldn’t you think you’d only have about one-twentieth the risk of cardiovascular disease, compared to smoking the whole pack? Based on a meta-analysis of more than a hundred studies, smoking only about one cigarette a day caused around ten times the risk of cardiovascular disease you’d expect by that logic, compared to smoking a pack a day. There is no safe level of smoking when it comes to heart attack and stroke risk. Even exposure to secondhand smoke can deteriorate our circulating endothelial progenitor cell count. So, even just being around smokers is risky.
Randomized controlled trials show exercise training can actually boost endothelial progenitor cell circulation. In a study of middle-aged and older sedentary men, for example, three months of moderate aerobic exercise—mostly walking with some participants starting to jog a bit as their fitness improved—led to a doubling of endothelial progenitor cells in the bloodstream. Regular aerobic exercise could be considered a “first line” strategy for helping to prevent and treat arterial aging. What about diet?
A randomized controlled trial showed that reducing saturated fat (mostly in the form of butter) significantly elevated endothelial progenitor cell numbers––consistent with a study on baboons showing that even a few weeks of a high-cholesterol, high-fat diet could cause dramatic premature epithelial cell senescence. Individual foods that have been shown to increase circulating endothelial progenitor cells include berries, onions, and green tea, and a diet centered completely around whole plant foods not only showed a boost in endothelial progenitors, but an improvement in endothelial function, along with a drop in LDL cholesterol.
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- Möbius-Winkler S, Linke A, Adams V, Schuler G, Erbs S. How to improve endothelial repair mechanisms: the lifestyle approach. Expert Rev Cardiovasc Ther. 2010;8(4):573-580.
- Wang M, Monticone RE, McGraw KR. Proinflammation, profibrosis, and arterial aging. Aging Med (Milton). 2020;3(3):159-168.
- Hackshaw A, Morris JK, Boniface S, Tang JL, Milenković D. Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. BMJ. 2018;360:j5855.
- Sharma S, Pandey NN, Sinha M, et al. Randomized, double-blind, placebo-controlled trial to evaluate safety and therapeutic efficacy of angiogenesis induced by intraarterial autologous bone marrow-derived stem cells in patients with severe peripheral arterial disease. J Vasc Interv Radiol. 2021;32(2):157-163.
- Tateishi-Yuyama E, Matsubara H, Murohara T, et al. Therapeutic angiogenesis for patients with limb ischaemia by autologous transplantation of bone-marrow cells: a pilot study and a randomised controlled trial. Lancet. 2002;360(9331):427-435.
- Altabas V, Altabas K, Kirigin L. Endothelial progenitor cells (Epcs) in ageing and age-related diseases: How currently available treatment modalities affect EPC biology, atherosclerosis, and cardiovascular outcomes. Mech Ageing Dev. 2016;159:49-62.
- Jeong HS, Kim S, Hong SJ, et al. Black raspberry extract increased circulating endothelial progenitor cells and improved arterial stiffness in patients with metabolic syndrome: a randomized controlled trial. J Med Food. 2016;19(4):346-352.
- Cavalcante SL, Lopes S, Bohn L, et al. Effects of exercise on endothelial progenitor cells in patients with cardiovascular disease: A systematic review and meta-analysis of randomized controlled trials. Rev Port Cardiol (Engl Ed). 2019;38(11):817-827.
- Ichim TE, Zhong Z, Mikirova NA, et al. Circulating endothelial progenitor cells and erectile dysfunction: possibility of nutritional intervention? Panminerva Med. 2010;52(2 Suppl 1):75-80.
- Kim W, Jeong MH, Cho SH, et al. Effect of green tea consumption on endothelial function and circulating endothelial progenitor cells in chronic smokers. Circ J. 2006;70(8):1052-1057.
- Choi EY, Lee H, Woo JS, et al. Effect of onion peel extract on endothelial function and endothelial progenitor cells in overweight and obese individuals. Nutrition. 2015;31(9):1131-1135.
- Hoetzer GL, Van Guilder GP, Irmiger HM, Keith RS, Stauffer BL, DeSouza CA. Aging, exercise, and endothelial progenitor cell clonogenic and migratory capacity in men. J Appl Physiol (1985). 2007;102(3):847-852.
- Keith M, Kuliszewski MA, Liao C, et al. A modified portfolio diet complements medical management to reduce cardiovascular risk factors in diabetic patients with coronary artery disease. Clin Nutr. 2015;34(3):541-548.
- Gao W, Chen D, Liu G, Ran X. Autologous stem cell therapy for peripheral arterial disease: a systematic review and meta-analysis of randomized controlled trials. Stem Cell Res Ther. 2019;10(1):140.
- Werner N, Kosiol S, Schiegl T, et al. Circulating endothelial progenitor cells and cardiovascular outcomes. N Engl J Med. 2005;353(10):999-1007.
- Weech M, Altowaijri H, Mayneris-Perxachs J, et al. Replacement of dietary saturated fat with unsaturated fats increases numbers of circulating endothelial progenitor cells and decreases numbers of microparticles: findings from the randomized, controlled Dietary Intervention and VAScular function (DIVAS) study. Am J Clin Nutr. 2018;107(6):876-882.
- Shi Q, Hubbard GB, Kushwaha RS, et al. Endothelial senescence after high-cholesterol, high-fat diet challenge in baboons. Am J Physiol Heart Circ Physiol. 2007;292(6):H2913-2920.
Motion graphics by Avo Media
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
How can we remain young at heart? The capacity of our blood vessels to repair themselves is dependent on endothelial progenitor cells that emerge from stem cells in our bone marrow to patch up any holes in our endothelium––the innermost lining of our blood vessels that keeps our blood flowing smoothly. Lower levels of circulating endothelial progenitor cells in the blood correlate with arterial diseases, like erectile dysfunction. Higher numbers, on the other hand, are correlated with a significantly reduced risk of death from cardiovascular causes. Before we explore how to boost our levels, let‘s first establish cause and effect.
A randomized, double-blind, placebo-controlled trial was performed in men and women with peripheral vascular disease––a circulation disorder characterized by the narrowing of blood vessels outside of the heart or brain. The arteries supplying blood to their legs were so ravaged by disease they could only walk about a minute before the muscles in their legs cried out in pain from the lack of oxygen. For each study participant, one leg was randomly selected to be injected with cells from their own bone marrow, and the other was injected with their own peripheral blood as a control. Not only was pain-free walking time significantly extended in the marrow-injected leg; they were less likely to subsequently lose it. Severe limb ischemia (lack of oxygen) from peripheral vascular disease carries a 10 to 40 percent amputation rate within six months. In the control group, 14 percent were forced to undergo a major amputation, compared to zero in the bone marrow group. Given these remarkable benefits, the link between higher numbers of endothelial progenitor cells and lower risk of dying from cardiovascular disease may indeed be causal. Short of sticking a large-bore needle into your hip, how else can we cultivate and release more endothelial progenitor cells into our system?
Smoking cessation is one of the most important and effective lifestyle changes to increase the number and function of active endothelial progenitor cells. Cutting down isn’t enough. There are twenty cigarettes in a pack. If you only smoke about one a day, wouldn’t you think you’d only have about one-twentieth the risk of cardiovascular disease, compared to smoking the whole pack? Based on a meta-analysis of more than a hundred studies, smoking only about one cigarette a day caused around ten times the risk of cardiovascular disease you’d expect by that logic, compared to smoking a pack a day. There is no safe level of smoking when it comes to heart attack and stroke risk. Even exposure to secondhand smoke can deteriorate our circulating endothelial progenitor cell count. So, even just being around smokers is risky.
Randomized controlled trials show exercise training can actually boost endothelial progenitor cell circulation. In a study of middle-aged and older sedentary men, for example, three months of moderate aerobic exercise—mostly walking with some participants starting to jog a bit as their fitness improved—led to a doubling of endothelial progenitor cells in the bloodstream. Regular aerobic exercise could be considered a “first line” strategy for helping to prevent and treat arterial aging. What about diet?
A randomized controlled trial showed that reducing saturated fat (mostly in the form of butter) significantly elevated endothelial progenitor cell numbers––consistent with a study on baboons showing that even a few weeks of a high-cholesterol, high-fat diet could cause dramatic premature epithelial cell senescence. Individual foods that have been shown to increase circulating endothelial progenitor cells include berries, onions, and green tea, and a diet centered completely around whole plant foods not only showed a boost in endothelial progenitors, but an improvement in endothelial function, along with a drop in LDL cholesterol.
Please consider volunteering to help out on the site.
- Möbius-Winkler S, Linke A, Adams V, Schuler G, Erbs S. How to improve endothelial repair mechanisms: the lifestyle approach. Expert Rev Cardiovasc Ther. 2010;8(4):573-580.
- Wang M, Monticone RE, McGraw KR. Proinflammation, profibrosis, and arterial aging. Aging Med (Milton). 2020;3(3):159-168.
- Hackshaw A, Morris JK, Boniface S, Tang JL, Milenković D. Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. BMJ. 2018;360:j5855.
- Sharma S, Pandey NN, Sinha M, et al. Randomized, double-blind, placebo-controlled trial to evaluate safety and therapeutic efficacy of angiogenesis induced by intraarterial autologous bone marrow-derived stem cells in patients with severe peripheral arterial disease. J Vasc Interv Radiol. 2021;32(2):157-163.
- Tateishi-Yuyama E, Matsubara H, Murohara T, et al. Therapeutic angiogenesis for patients with limb ischaemia by autologous transplantation of bone-marrow cells: a pilot study and a randomised controlled trial. Lancet. 2002;360(9331):427-435.
- Altabas V, Altabas K, Kirigin L. Endothelial progenitor cells (Epcs) in ageing and age-related diseases: How currently available treatment modalities affect EPC biology, atherosclerosis, and cardiovascular outcomes. Mech Ageing Dev. 2016;159:49-62.
- Jeong HS, Kim S, Hong SJ, et al. Black raspberry extract increased circulating endothelial progenitor cells and improved arterial stiffness in patients with metabolic syndrome: a randomized controlled trial. J Med Food. 2016;19(4):346-352.
- Cavalcante SL, Lopes S, Bohn L, et al. Effects of exercise on endothelial progenitor cells in patients with cardiovascular disease: A systematic review and meta-analysis of randomized controlled trials. Rev Port Cardiol (Engl Ed). 2019;38(11):817-827.
- Ichim TE, Zhong Z, Mikirova NA, et al. Circulating endothelial progenitor cells and erectile dysfunction: possibility of nutritional intervention? Panminerva Med. 2010;52(2 Suppl 1):75-80.
- Kim W, Jeong MH, Cho SH, et al. Effect of green tea consumption on endothelial function and circulating endothelial progenitor cells in chronic smokers. Circ J. 2006;70(8):1052-1057.
- Choi EY, Lee H, Woo JS, et al. Effect of onion peel extract on endothelial function and endothelial progenitor cells in overweight and obese individuals. Nutrition. 2015;31(9):1131-1135.
- Hoetzer GL, Van Guilder GP, Irmiger HM, Keith RS, Stauffer BL, DeSouza CA. Aging, exercise, and endothelial progenitor cell clonogenic and migratory capacity in men. J Appl Physiol (1985). 2007;102(3):847-852.
- Keith M, Kuliszewski MA, Liao C, et al. A modified portfolio diet complements medical management to reduce cardiovascular risk factors in diabetic patients with coronary artery disease. Clin Nutr. 2015;34(3):541-548.
- Gao W, Chen D, Liu G, Ran X. Autologous stem cell therapy for peripheral arterial disease: a systematic review and meta-analysis of randomized controlled trials. Stem Cell Res Ther. 2019;10(1):140.
- Werner N, Kosiol S, Schiegl T, et al. Circulating endothelial progenitor cells and cardiovascular outcomes. N Engl J Med. 2005;353(10):999-1007.
- Weech M, Altowaijri H, Mayneris-Perxachs J, et al. Replacement of dietary saturated fat with unsaturated fats increases numbers of circulating endothelial progenitor cells and decreases numbers of microparticles: findings from the randomized, controlled Dietary Intervention and VAScular function (DIVAS) study. Am J Clin Nutr. 2018;107(6):876-882.
- Shi Q, Hubbard GB, Kushwaha RS, et al. Endothelial senescence after high-cholesterol, high-fat diet challenge in baboons. Am J Physiol Heart Circ Physiol. 2007;292(6):H2913-2920.
Motion graphics by Avo Media
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Title
How to Boost Your Endothelial Progenitor Cells (EPCs) for Heart Health
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
We can also boost the ability of our endothelium to function by eating nitrate-rich vegetables, like beets and greens. See Oxygenating Blood with Nitrate-Rich Vegetables.
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