This is something Ray has told people numerous time over email, but the studies are now solidifying as the main hypothesis. Namely, that many chronic heart conditions are inflammation-driven and that the main cause of said systemic inflammation is increased serum endotoxin/LPS due to gut barrier dysfunction. Since it is well-known by now that chronic leaky gut is itself driven by low NAD+ levels as a result of lower OXPHOS, one could also say that low metabolism is the ultimate cause of mitral valve disease. That disease used to be rare and manifesting mostly in people over 40, but now impacts even people in their 20s about as often as people twice that age or older.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0337580
“…Twenty percent of dogs in Group 1 had gastrointestinal clinical signs compared to 66.7% in Group 2 (P < 0.0001). Serum IL-6 (P = 0.037) and LPS (P = 0.024) concentrations were significantly associated with MMVD stage severity. Serum LPS and IL-6 were positively correlated (rs = 0.81; P < 0.0001). This study indicates that dogs with MMVD have evidence of loss of gastrointestinal barrier function as evidenced by bacterial translocation as the disease progresses in severity, which may be associated with systemic inflammation. These findings warrant further evaluation of gastrointestinal barrier function and maybe even the gastrointestinal microbiome as therapeutic targets in dogs with MMVD.”
