A Review of “Human Heart, Cosmic Heart” by Dr. Thomas Cowan

The heart is rarely front and center currently when it comes to discussing the system failures and dysregulation in ME/CFS.

Despite the focus some doctors (specialists such as the late Dr. Lerner and Dr. Cheney) have placed on the heart, most of the latest research is mostly focused elsewhere, leaving the quiet, mostly non-progressive heart issues seen in ME/CFS as a secondary problem –  yet one that surely affects the daily functioning of the average ME/CFS patient.

A New View of the Heart

Dr. Thomas Cowan’s new book, Human Heart, Cosmic Heart, turns all that we knew about the structure and function of the heart upside down. More importantly, it may cast a new light on what’s going wrong in ME/CFS from the standpoint of circulation.

For most of us, it’s a given that the heart is a most vital organ and has an important role in the blood circulation in the body.   But Dr. Cowan provides a new (yet old) way of visualizing the heart.  This model shows the heart as a hydraulic ram, rather than a pump, where geometry and form matter more than any overt force.

In his book, Dr. Cowan asks us to strive for a deeper, more accurate understanding of what makes the heart “tick”.  He asks us to ask ourselves whether conventional theories of how the blood circulates in the body actually do fit the “heart as a pump” model.    Along the way, we are encouraged to re-consider traditional prescriptions for healing the heart such as low-fat diets and statin drugs and consider some new possibilities.

So how did we get here? The story actually begins with Leonardo da Vinci…a familiar name.

Leonardo Da Vinci

The first conceptualization of the heart was perhaps created as early as 1513 by Leonardo da Vinci.  This short video better explains his methods and prescient findings.

[youtube https://www.youtube.com/watch?v=aIj2DL1geIg]


His early drawings and models showing how the heart creates vortices in blood flow through the blood valves is almost entirely correct when visualized next to a modern MRI done today.  It’s amazing that he could conceptualize this using a wax model!

But somehow, these models were shunted aside, and in 1628, Dr. William Harvey, an English physician, next conceived of the heart as a pump in his famous book, “Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus”.  Conventional medicine now considers Harvey as the Father of Cardiology and his ideas regarding circulation have persisted now for over 400 years without review.

Perhaps now is the time for that review.

The Heart as a Vortex – A Facilitator of Circulation

 Vortex:  Noun, A mass of air or water that spins around very fast and pulls objects into its empty center -Cambridge Dictionary

So, if the heart shouldn’t be thought of as a pump, as we were all taught, how should it be more properly conceptualized?  Under the conventional pressure-propulsion model, our blood moves because of the physical squeezing of the heart.

From Shutinc – https://commons.wikimedia.org/wiki/File:Whirlpool.jpg

But Dr. Cowan asserts that the heart would never be able to accomplish what it does given the size of our circulation and what we know about fluid dynamics.  It’s simply not powerful enough. (The full breadth of these arguments is well worth the cost of the book to explore in detail.)

In short, the structure of the heart itself does not favor the pump model.  For example, the heart is thinner at the apex (only one cell thick!) at exactly the place where the pump forces would be the highest; if the pump model were correct, the apex should be the thickest part of the heart instead of the thinnest.  We now know definitively that this is not the case.

Second, instead of stiffening at the moment of peak flow as a hose entering a pump would, the aorta – the main blood vessel to the heart –  relaxes. When you turn on a hose at maximum pressure, the hose stiffens and straightens out to carry the water away from the source of the tap.  The aorta does exactly the opposite: it relaxes.

Instead of a pump Dr. Cowan believes the heart behaves as a vortex which “facilitates the heavier elements of blood traveling down the central axis of a blood vessel and the lighter fluids toward the periphery of the vessel”.

The geometry of the heart supports this view.  Within the body the heart can be visualized as a regular, seven-sided, geometric form which resides in a “box” in the chest at a very specific angle. That angle supports the creation of a vortex.  The beauty of its placement can’t be explained well in words, so I invite you to view the work of Frank Chester, who has modeled the heart (called a chestahedron) beautifully.

But what does all this mean in terms of circulation, really?

It means that your heart doesn’t actually pump the blood, the action of the fluid does!  But this is no ordinary fluid.  To understand how the heart is able to move the blood through the body, one also must understand how fluid in our bodies is inherently different.  The answer lies in what Dr. Gerald Pollack has termed EZ, or structured, water in his book, “The Fourth Phase of Water”.

Cowan further explains that any time you have a hydrophilic tube, like a blood vessel, a gel layer forms on the surface that carries a negative charge.  The positively charged water is dissolved into the middle of that tube.  The repulsion between those two charges starts the flow moving.  This is the same process trees use to carry water and nutrients up to the heights of their crowns.

This phenomenon occurs even after the blood has nearly come to a standstill in the capillaries at the most distal ends of the body and then has to pick up speed again to begin the return trip back to the heart.  Dr. Cowan likens this to a bus trip from San Francisco to New York that stops in the Midwest.  No push from behind is going to get that bus going again.  So, unless you really want to enjoy the charms of say, Kansas City, the body must somehow create energy at the furthest point from the heart, not the closest.

So, what does the heart do then, if not pump?

The conventional view of the heart as a pump visualizes the heart as a driver of the blood flow out to the small capillaries.  Cowan believes, though that the heart is a facilitator rather than driver of our circulation. Its main goal is keeping the flow synchronized – not pumping it. The heart literally is the conductor of life and keeps the rhythm of the body synchronized in time.

So where do heart attacks really come from then, if not from blockages causing reduced blood flow?

Blood Vessels Take Center Stage

In Cowan’s model, the blood vessels take on a more crucial role.  Cowan asserts that much heart dysfunction is actually a result of blood vessel abnormalities rather than the other way around.   This is seen as the increased collateral circulation that develops around blockages to provide an alternate route for the blood flow.  Most people with blockages have extensively developed collateral circulation.  This is how someone with 95% blockage is still able to function at all.  The body creates a detour.

Autonomic Nervous System and Brain

So, what ultimately controls the heart?  The autonomic nervous system (ANS) and the brain do, of course.

Given that the regulation of the heart is under the control of the ANS, it makes sense that so many ME/CFS patients suffer from heart-related symptoms.

blood vessels

Blood vessels with lactic acid: blood vessels are the key in Cowan’s hypothesis

Typically, stress in the heart leads to sympathetic nervous system activation (“fight or flight”) and increased levels of stress hormones like norepinephrine as well as decreased heart rate variability (HRV) – both of which are seen regularly in ME/CFS.

As sympathetic activity is increased, a glycolytic shift occurs whereby energy production shifts from the clean burning of fat in the mitochondria which produces CO2, water and ATP to the dirtier glycolytic pathway in the cytoplasm of the cell – causing a buildup of lactic acid in the muscles, pain, fatigue, etc. Too much lactic acid in the heart muscle and a heart attack is almost sure to follow.

This shift can happen anywhere in the body.  If it happens in your leg, you get a cramp.  The muscle stops functioning and blood flow eventually washes out the waste products and homeostasis is restored.  But two organs in our body can’t ever stop and rest to flush out the excess lactic acid.  They are the heart and the brain.

In the heart, cramps and pain are called angina.  In the brain, they may present as panic attacks, anxiety, depression or stroke-like symptoms.

Many modern diseases including metabolic disorders such as diabetes feature small fiber system dysfunction.  Fibromyalgia has also been classified as a small fiber disease.  Pain syndromes in general seem to fall under the umbrella of this model very well.

The ME/CFS Connection

Indeed, one sees a few typically characteristic heart abnormalities in ME/CFS. Dr. Cheney argued that the heart failure in ME/CFS was of a different type and was related to problems in circulation that were dramatically worsened upon standing.  Most conventional heart function tests are performed laying down which might cause standing abnormalities in this population to be missed.

Dr. Martin Lerner also found characteristic heart problems in his ME/CFS patients.  Typically, his examination included a thorough heart evaluation including ECG, heart ultrasound and an overnight Holter monitor evaluation.  Dr. Lerner often found diastolic dysfunction, flattened and inverted T waves, and abnormal cardiac wall motion which he believed was caused by chronic infection with EBV or another one of the herpes viruses.

More recently Dr. Miwa, in a series of studies, has linked small hearts to orthostatic problems in ME/CFS.

Even those of us with the rapid heartbeats of Postural Orthostatic Tachycardia Syndrome (POTS) rarely think too much about the mechanics of the heart.  Interventions are mostly directed at symptom relief without much consideration of the organ itself and its underlying mechanics.

Under Cowan’s theory, the small heart issues and problems with preload found in ME/CFS and people with idiopathic exercise intolerance would be a direct result of the lack of energy creation in the small vessels that help propel the blood back to the heart.

The small hearts in ME/CFS appear to result from low blood volume and/or problems with blood vessels that impair venous return to the heart. The heart muscle adjusts by reducing in size.

David Systrom has found that people with idiopathic or unexplained exercise problems (many of which must have had ME/CFS) have reduced “preload”; i.e. reduced filling of the heart. This “heart problem” appears to be due not to some structural heart failure but to blood vessel problems and low blood volume, right in line with the theory of the heart as a hydraulic ram.

Cowan’s hypothesis also appears to agree with Newton’s work which conceptualized the circulatory problems in ME/CFS as a problem with “venous compliance”.  Venous compliance is how Dr. Newton has described the ability of veins to “push back” once they are filled with fluid.

Cort, in his earlier Health Rising review, describes this process as, “The fuller of fluid they are, the more the veins should – like a rubber band that has been stretched – exert pressure on the fluid to move. If ME/CFS patients’ veins are non-compliant; that is, if they’re kind of flaccid in response to filling they may not be moving the blood along as they should.”

This certainly appears to be true in ME/CFS and in other people with idiopathic exercise problems.


If veins are not doing their job to push the blood back to the heart then exploring treatments that help to strengthen the veins, perhaps using herbs like gotu kola or infrared sauna to increase the amount of EZ water found in the walls of the veins, might prove to be helpful.

Dr. Cowan concludes his discussion of the heart with information on a little-known treatment in the US that is based on a plant called Strophanthus which contains a substance called ouabain.  Ouabain is an endogenous cardiac steroid which helps to restore parasympathetic activity by enhancing release of its primary neurotransmitter, acetylcholine.

We have seen other parasympathetic nervous system enhancers be useful at alleviating symptoms in ME/CFS.  David Systrom has found that Mestinon (pyridostigmine bromide) can be very helpful for a subset of patients.

However, unlike most drugs, strophanthin/ouabain is identical to the cardiac glycoside produced in the cortex of our adrenal gland.  Ouabain is essentially a bio-mimetic neurohormone that has shown great efficacy in preventing attacks of angina and ischemia, as well as heart attacks.

Interestingly, ouabain also converts the lactic acid that may be a problem in ME/CFS into pyruvate so it can be used as a fuel for the heart.  Dr. Cowan believes ouabain gets at the very core of what causes heart attacks.

Unfortunately, ouabain does not seem to work the same in skeletal muscle as it does in cardiac muscle. One has to wonder, though, if improvements in cardiac and small fiber functioning wouldn’t ultimately produce other improvements for ME/CFS patients.  Certainly, this avenue looks promising for further study and represents a revolutionary new way to conceptualize circulatory diseases of the heart in general.

EECP by Bruce Blause – https://en.wikipedia.org/wiki/External_counterpulsation#/media/File:Blausen_0161_Cardiac_Enhanced_External_Counterpulsation.png

Dr. Cowan has found success using ouabain on his cardiac patients in his practice and prescribes it regularly.  It has an excellent safety profile in German studies and very few reports of adverse effects.

Ouabain is still occasionally used in Germany and is available by prescription through compounding pharmacies.  It is also available as a mother tincture through a company called Teebrasil as well.  Dr. Cowan is also working to bring ouabain to the US as a supplement in the near future.   Currently, it is available through his office to health care professionals.

Dr. Cowan also mentions another intriguing treatment in the book called Cardiac Enhanced External Counterpulsation.  This treatment works for people who are too debilitated to exercise by forcing new collateral circulation to form.

In this treatment, one wears what are essentially large blood pressure cuffs on the legs and buttocks and is hooked up to an ECG.  The cuffs then are set to inflate in time with the heartbeat.  Currently this is used only as a treatment for angina, but I would love to see it tested in ME/CFS as well.

The Heart of the Matter

Throughout history time humans have spoken about “the heart of the matter” or loving someone with “all our hearts”.  It’s no accident that the heart and, not, say the liver, has been used for these metaphors.  The heart truly does signify something special that has been represented countless times over hundreds of years in art, poetry and spiritual practices.  I guarantee that after you read this book, you will never visualize your heart in quite the same way again.

Finally, Rudolf Steiner’s idea about the three most important “things” for the further evolution of humanity are recounted in nearly every presentation I’ve seen by Dr. Cowan, so it seems fitting to close with them here as well. They are that:

  1. People stop working for money,
  2. People realize there is no difference between sensory and motor nerves, and finally:
  3. The heart is not a pump

Check out Dr. Cowan’s website here.

Dr. Mercola Interviews Dr. Cowan

[youtube https://www.youtube.com/watch?v=wEYrKJDN67w]


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