The Heart is Not A Pump (Tom Cowan, MD)

The Heart is not a Pump: lecture by Tom Cowan, MD (Wise Traditions Conference, King of Prussia, PA, 11/14/10)

The following is a transcription and adaptation by me (Sarabeth Matilsky). Any mistakes are undoubtedly mine, although I made an effort to leave out any details or insert a (?) when I felt unsure about Dr. Cowan's intended meaning.

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Rudolf Steiner said that three things stand in the way of the proper development of humankind:

--People working for money.
--Believing in the myth that there are separate motor and sensory neurons.
--People thinking that the heart is a pump.

I spent twenty years on that last one. How could this _possibly_ be standing in the way of the proper development of humans? I tried to debunk it, but kept finding that Steiner is correct. And so I began to see that _not_ thinking that the heart is a pump really might fundamentally change everything...

First: What is a pump? There are lots of definitions, but this is the one I use currently: “A force-creating instrument that causes fluids to move.”

The heart-as-pump theory started with William Harvey 1627 or so, who came up with theory that the reason that blood circulates is that the heart pumps it through circulation. (He's been known as the “Father of Cardiology” ever since.)

Think for a minute. We've got this heart, and there's blood that's passing through, going down the arteries, slowing down all along the way, and ending up in all these capillaries. Then the blood has to travel back through the veins, and up again to the heart.

If you put all the blood vessels end to end, you'd get 3,000 miles of veins--and then it's another three thousand miles to get back up to the heart again. We're talking about a very sticky fluid traveling through 3,000 miles of really tiny pipes. So are we _really_ saying that the heart can push the fluid all the way from San Francisco to NYC--and then stop for a bit, once it reaches the capillaries!--and then reverse itself to push the fluid all the way back to San Francisco? Many times a day, for maybe eighty years??

This strains the imagination.

First, you've got velocity (speed) and volume (quantity of blood). Check out a flow diagram (google “heart is not a pump”). The speed of the blood as it enters and exits the heart is just about identical. The volume is almost zero, and the speed in the veins is Really Fast.

The capillaries, by surface area, would cover three football fields. Once the blood gets to these, the volume is almost infinite, and the speed is zero. The blood, once it's reached the capillaries, has essentially stopped.

And remember, once the blood leaves the capillaries and heads back into the veins, it speeds up and up till it comes back to the heart, going just as fast as it did when it exited the heart.

This whole system is predominantly downhill at first (blood leaving the heart), and predominantly uphill on the way back (blood coming back in).

Think about it another way: imagine you're a farmer, and you need to irrigate your fields. You have a pond on one side, at the top of the hill. Your fields are at the bottom, and you want to bring the water down to a small pond near to the fields. This is the theory of heart pump: you put the pump at the top of the hill. Really?? Would _you_ put the pump at the top of the hill, or at the bottom?? You don't need to pump to a _decreasing_ velocity at the bottom of the hill.

You have this fast flowing river beginning at the top (at the heart), which can use gravity to reach (through the veins) a pond (the capillaries) that's still. It's the _getting back up_ that you need help with! Besides which, the the pump doesn't need to make the water go faster, so what does it do, up there at the top? Once you start pumping, the water starts going _slower_?? This doesn't make any sense.

Another thing to note: the outflow of the heart/”pump” is facing uphill. Here you've got this flexible tube that starts out with a curve that goes around and back. If you pushed water really hard through your garden hose, what would happen to this tube that's facing uphill, and also curving around and down?? It would straighten out temporarily. But when the heart “pumps,” the aortic arch bends _backwards_ – downhill. What? The “pump”'s outflow tube bends IN?

This does not make sense from the perspective of fluid dynamics and how the blood circulates in the system.

So...what IS the pump? Here's where Steiner left it to us to figure out: it has to do with eating, maybe, and metabolism. Nobody has figured out how blood moves. Here's my version of a theory.

The fluid, when it stops at the bottom “pond” (capillaries), needs something to move it back up. This is where the fluid actually starts: at this point, the blood is in a bunch of creeks, thousands of little tributaries, flowing into one big river. The wider the river, the slower the river. The narrower the river, the faster the movement. Once you're moving, at least some, narrowing the river all the way, it will by _itself_ go faster and faster because it naturally squeezes while it's narrowing. But now, it's coming up to the heart, and what does the heart do? It stops the blood at the top.

Here's where the heart is: the veinous blood comes in, and hits a dam, dividing the chamber in half. The heart stops the blood, and the whole chamber expands. Pressure increases on one side, and on the other side, there's more and more of a vacuum. The vacuum sucks the aortic arch in, until the pressure allows the blood to move along through the system again.

One of the things that's very peculiar is the dynamic of circulation to the head. Blood exits the aortic arch, goes up, then down, then up again and finally goes to the head. But the amazing things is that when this vacuum pulls inward, the suction pulls the outflow tube in, which sucks the blood in...like a hydraulic ram. There is no pushing involved with the muscles. (These can only pull back, not push.) the heart is perfectly off center, so the aorta can go upward during systely (?) and the rest of the blood falls down to the feet.

How does this movement get started? The volume of blood entering the capillaries is X, and the volume exiting is the same, after gases are exchanged. Think of it like a semi-permeable membrane is dividing a chamber with salt and water. If the salt and water are the same concentration on each side, the level in the tank will stay the same.

But the purpose of exchanging gases is to exchange oxygen and food, and create carbon dioxide and water. That's what happens when you eat. The metabolism of food into fuel creates water. The water/extra blood has to go somewhere. Because there are valves keeping from going backwards, the water that's created has to go toward the veins, and thus up to the heart. It's as if you have a constant flow into one side, that raises the level of the water on that side. _The creation of water from food_: that's the pump. It's an unbelievably exquisite mechanism for correlating the water flow that's needed. If the muscles are working harder, they're metabolizing more food into water, and the blood will flow faster and faster. At rest, the water flow will be less, and circulation will slow down. Blood is needed to a degree that depends on how hard muscles are working.

There are a million pumps! Eating food, combining with oxygen--here are your pumps. Fat, protein, carbohydrates. The more water you generate per gram of food, the faster the pumps run, and the more robust the circulation will be. Dealing with one gram of protein nets you 2 grams of water; one gram of carbohydrates gives you 6 grams of water; and one gram of fat, depending on its saturation (hydrogen), gets you 14-18 grams of water.

Conclusion: the more your muscles are metabolizing fatty acids, the better off your circulation will be.

What does this change about the way we think about our hearts?

Imagine that you have a shower on the third floor, and a pump in the basement that's old and leaky, and you don't want to change your pump, but you think about changing your tubing. You could put more water in the tubes, but lots would leak out at the pump. Also, then the fluid is heavy, and harder to pump--or, you pee all the time. There's no need to put more water in the system, because it's harder on the old pump.

So what if you made the tubes bigger? Then it would definitely be harder to pump with your old pump, especially once you got the fluid all the way to the top.

If your body had any sense, it should make your tubes narrower and narrower. This is why the body causes atherosclerosis. Because you didn't fix your pump!

Narrowing your tubes even further is a necessity if you can't fix your pump, because you still need to get the water up there. You should fix your pump by eating fats, and doing movement with muscles, so your body doesn't need to narrow your tubes...

So: this changes everything about whether atherosclerosis is a disease, or a compensatory mechanism. You don't want to treat the compensatory mechanism!

What does this have to do with saving humanity?? Pure [anthroposophic??] speculation:

If the heart IS a pump, we're pointing the pump toward china when we're trying to get to NYC. If you want to make a metaphor about this belief system involving the heart-as-pump, try this: the theory says that if you want to go over here, you should start off in the opposite direction. This leads to the cultural myth of redemptive violence: “The way to achieve peace is through war.” “If you kill enough people, you'll end up with a peaceful planet.”

And that is how we live. We believe in punishing people to make them good. Making kids sit in school all day when they hate it, so they'll learn more...

The opposite of this is, If you want to go toward peace, start moving in a peaceful direction. You have to make things go that way – peace is the process, not the outcome. There is no peace in this pump theory outcome.

Also, It's an unbelievably precise metaphor illustrating centralized vs. democratizing forms of life. The reason there is circulation is because of one central organ in the land?? The heart is not a pump; there are millions or billions of independent and cooperatively working units, who all come up with their own unique take on how to do things, forming a circulation system, and the central organ only has a listening role in this process. “Central governments will kill us all.” - Steiner

[At this point, Dr. Cowan began talking about some Steiner theory that was completely beyond me and my ability to suspend my skeptical disbelief. You will have to do your own research, to understand (if it's possible to) why Steiner said that “The heart is a regular, seven-sided form that resides in a box in the chest that collects the spiritual emanation from the sun in order that the human being can perceive himself as an individual.”]