I think I have become a connoisseur of scientific double-think. Swilling the most ridiculous statements around my glass with relish, and enjoying the finest vintages. Last week, whilst I was on holiday, someone sent me a piece about statins and coronary artery calcification. I’m not sure what such people think I do on my holidays – but reading medical reports is not one of them.
However, the moment I read this article, it immediately brought to mind a story about a patient who had a fixed delusion that he was dead. The psychiatrist he was seeing had repeatedly tried, and failed, to get this patient to admit that he was deluded. One day a conversation took place
Psychiatrist: ‘Would you accept that dead people do not bleed?’
Patient: ‘Of course.’
Psychiatrist: Pulling needle from pocket. ‘Would you allow me to prick your thumb to see if you do bleed?’
Patient: ‘Go ahead doc, nothing will happen.’
Psychiatrist: Pricks the thumb of the patient, which then bleeds. ‘Aha!’
Patient: Looks down with interest. ‘Well what do you know, I guess dead people do bleed after all.’
For many years now it has become, almost a known fact, that a highly significant sign of Coronary Artery Disease (CAD) is calcification of the coronary arteries. The most widely accepted thinking is that calcification represents the final stage of atherosclerotic plaque development. It is a clear indication that your arteries have been developing atherosclerotic plaques over the years. Or, to quote Medscape on the issue:
‘First and foremost, calcium is a marker for a diseased artery1.’
The same article expands on this simple quote: “Coronary calcium is part of the development of atherosclerosis; …it occurs exclusively in atherosclerotic arteries and is absent in the normal vessel wall.” Simply put, the presence of calcification in the epicardial coronary arteries indicates that the patient has coronary atherosclerosis.’
This could not be more clear, and has been almost unquestioned. Lots of calcium in your arteries means lots of arterial disease. More = bad. Less = good. Sorry to labour the point, but I am doing it for a reason.
Sherlock: ‘So, my dear Watson. If we find that one of our treatments for heart disease is increasing the amount of calcification in the arteries, it would seem strange. Would it not?’
Sherlock: ‘And what, pray, does this make you think?’
Watson: ‘I’m not entirely sure that I know what you are getting at?’
Sherlock: ‘Think my dear Watson. Think.’
Watson: ‘Our ideas about heart disease are wrong?’
Statins, as we know, reduce the LDL/cholesterol level in the bloodstream. They also reduce (albeit not by very much) the risk of dying of heart attacks – and strokes. The current thinking, as I am sure everyone knows, is that excess LDL/cholesterol in the blood causes atherosclerosis. Ergo, lowering the level will reduce the burden. If this model is correct then, as LDL/cholesterol levels go down, we should lower the risk of atherosclerosis… and therefore we should see less calcium in the arteries. I know, I am labouring the point again.
However – as I have known for some time – this is not what we see. If you take statins you will increase the amount of calcium in the arteries.
CLEVELAND, OH – ‘The results of a new study suggest that there is a paradoxical relationship between calcification of the coronary artery and atheroma volume among individuals treated with statin therapy. In the analysis, statins, specifically high-intensity statin therapy, actually promoted coronary calcification.2’
So, there you have it. At this point, if you are a scientist, you have a few possible explanations that you could look at. (Assuming that this research is correct – and no-one seems to doubt that it is true). You could, for example, say that that statins do not work by lowering LDL/cholesterol, and therefore must provide benefits through another mechanism. How else could you reduce the risk of heart disease, whilst increasing the atherosclerotic burden?
However, if you have a fixed delusion, namely that raised LDL/cholesterol is the most important causal factor in heart disease, and that lowering it must be beneficial, you need to look down at your, now, bleeding thumb and switch the game through one hundred and eighty degrees.
So, what would you do? What explanation would you come up with?
Well, and here I paraphrase. Steven Nissen – one of the most powerful and inexhaustible supporters and promoters of LDL/cholesterol lowering – a man of great influence throughout the world of cardiology. This man looked down at his thumb and said.
‘I guess coronary artery calcification is a good thing after all.’
In truth his actual words were:
“We have some physicians—some, not a lot—advocating for serial calcium scans to determine whether or not patients are doing well,” he said. “If you give them a high-dose of a statin and their calcium goes up that might actually be a good thing. Instead of saying, ‘Oh my goodness, your coronary calcium is increasing,’ we might be able to tell patients, ‘Your coronary calcium is up, your plaques are stabilizing.’ “
Or, as George Orwell may have put it. ’Four legs good, two legs better.’ ‘The creatures outside looked from pig to man, and from man to pig, and from pig to man again; but already it was impossible to say which was which.”
Brilliant, Malcolm, yet again you are able to expose the untruths behind the jargon and show us what we need to know about the push by big pharma to poison us all with statins.
Dr. Kendrick and Readers,
Please be aware that there are many widely-publicized animal studies showing that THE ANTI-INFLAMMATORY EFFECTS OF MODERATE EXERCISE INCREASES PLAQUE STABILITY by thickening the plaques fibrous cap.
Moreover, unlike statins, exercise produces this benefit WITHOUT increasing overall plaque volume and it does NOT increase calcification of the coronary arteries. Please see:
~ “The Anti-inflammatory Effects of Exercise Training Promote Atherosclerotic Plaque Stabilization in Apolipoprotein E Knockout Mice with Diabetic Atherosclerosis”, by N.P.E. Kadoglou et al, The European Journal of Histochemistry, 2013 Jan 15. Link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3683610/
NOTE: The full-text of the foregoing study is free and the reference list at the end contains numerous other studies in support of its conclusions.
It should be further noted that: ANY disease process that is modulated by the anti-inflammatory effects of statins will also be similarly modulated by the anti-inflammatory effects and other related benefits of moderate exercise.
Well, that seems to be another case of ‘the blind leading the blind, donning sun glasses, eye patches and blinkers as they go’. You would think these men were idiots, but I suppose they must have passed one or two exams. Certainly not any in logical thinking.
There was a lot of heavily loaded G scores on the entrance exams, Sue.
How could such an important personage as Steven Nissen have possibly been wrong all these years? Neither his ego or his reputation would be able to withstand it. (Not to mention his bank balance). I thought of Ancel Keys as I read this. What a very dangerous man.
Statins are so good that they let you survive higher calcium readings. Oh yes.
When I was still a firefighter one of my instructors for a building construction class said that the only way strategy and tactics – and standards for equipment – ever change is when the people in power die. This came up a lot during the course of this class regarding the insanity of expecting firefighters to go interior in certain types of buildings – he would just say that eventually they (the people who make the rules) will die and the thinking will change. Maybe that will be the case for statins. We can hope, anyway.
Absolutely correct but it applies in many medical directives.
Max Planck is reputed to have said “Science progresses funeral by funeral”
Thank you for another excellent blog.
Re Nissen’s comment: This is another example of what you call an “ad hoc hypothesis” based on no evidence.
An interesting item on spacedoc.
Comparing cannabidiol to Statins for Heart Protection. It seems that there are “safe” alternatives but not patentable; end of!
Philip Blair, MD
Could cannabidiol, a naturally occurring substances in hemp (cannabis sativa), replace statins for prevention of cardiovascular disease? Preliminary evidence indicates yes.
Br J Clin Pharmacol / 75:2 / 313-322 Stanley CP
Is the cardiovascular system therapeutic target for cannabidiol (CBD)?
Interestingly CBD has direct actions on isolated arteries, causing both acute and time-dependent vasorelaxation.
Searched MHRA and EMA for cannabidiol but found nothing. Not surprised.
I am not inclined to accept CBD as a “replacement” for statins stating it has direct actions on isolated arteries leading to vasorelaxation. This a little much. We have enough brain damage as a result of the statin crisis…do we really want to go here? We need our wits about us to live in a world that is very challenging. This theory needs a lot more than this to convince me. This is just not my cup of tea readers. Remember we are looking at quality of life factors to include the ability to function adequately in terms of winning the war on vascular disease.
I referred to CBD because it seems to have relevance in a number of serious conditions as well heart disease. I too was surprised to learn that cannabidiol had no psychiatric or neurological effects; cannabis has had a bad press because of the claimed bad effects but many of the molecules/chemicals do not cause psychiatric effects.
Is it not time that traditional “remedies” were examined with an open mind? After all many were effective such as quinine. The problem, of course, is that natural molecules cannot be patented; to me this suggests that governments need to be more involved in research as they used to be in my early research days.
The following reports can be downloaded and there are others on Pubmed
Br J Clin Pharmacol / 75:2 / 313–322 Stanley CP
Cannabidiol (CBD) has beneficial effects in disorders as wide ranging as diabetes, Huntington’s disease, cancer and colitis. Accumulating evidence now also suggests that CBD is beneficial in the cardiovascular system.
J Am Coll Cardiol. 2010 December 14; 56(25): 2115–2125. doi:10.1016/j.jacc.2010.07.033.
Am J Physiol Heart Circ Physiol. 2007 July ; 293(1): H610–H619.
Well, given the number of joints I “inhaled” in my youth I hope that’s true! Bill Clinton’s stuffed though. 😉
Many thanks for discussing this recently published paper by Nissen and coworkers.
To be fair it’s important to highlight that there was a regression of atherosclerotic plaque burden measured as plaque volume with statin therapy. However, at the same time the amount of arterial calcium increased. So, which is more important, plaque volume or calcium?
Although the amount of calcium is associated with risk, no study has managed to prove that reducing calcium lowers risk. Of course calcium score could be a surrogate marker (and in fact so could LDL-cholesterol). So, therefore targeting calcium per se might useless, just like targeting any other surrogate marker.
There is a great audio summary by Dr. Valentine Fuster accompanying the JACC paper.
Of course I know you want to twist and turn this all in favour of your own opinion, that’s what you’re good at and that’s why I love reading your blog. But sometimes a little bit of fairness is appropriate – that’s why I recommend listening to Dr. Fuster’s audio and learn about the possible role of calcium in atherosclerotic plaques.
Just re-dressing the balance a little I feel. When set against tens of billions of marketing dollars, a little freedom to focus on certain things is a luxury given to few.
Just thought you might appreciate an update from the Medscape news website which, incidentally, put a positive spin on the whole statin=caclification story. The following, however, is quoted from a cardiologist who expressed a very sobering opinion in the comments section:
Dr. JOSE CASCO RAUDALES| Cardiology, Interventional
~ “Honestly, I can’t see myself telling my patients “look, your coronary arteries are stiff and hard as a rock, but your treatment is doing well.” In fact, as an interventional cardiologist I have serious concerns about STENTING in massive calcified coronary arteries, because of adverse outcomes in this setting…And what if the patient needs a coronary artery bypass graft (CABG)? I’m pretty sure that the cardiac surgeon won’t like this situation either.”
I believe this adds some much needed balance from a medical perspective other than that of experts who are solely invested in drug management.
Indeed it does. Coronary artery calcification means your arteries are knackered due to prolonged and severe atherosclerotic plaque growth. Now we are being asked to believe that severe calcification is healthy.
Malcolm, excellent post to be sure and as always…entertaining and funny. However, it is also my understanding even as a layperson that once that plaque calcifies, a surgeon cannot stent it or possibly perform bypass. I am not sure what he is getting at and how this might represent any positive aspect of stable plaque. I have known a few for whom surgery was not an option for this reason alone. Honestly many surgeons would not touch it with a ten foot pole. What do they think people can do then…call Roto Rooter? (That is a plumber here in the U.S. who uses augers to push through waste in pipes) Now I have heard it all until your next blog.
I suppose the question you should ask yourself, is what would have been the media response if statins had been found to lower calcium levels in the relevant arteries! My guess is that we would all have heard about that result in the national newspapers.
I am not a medical doctor, and I came to this site because of my experiences with statins – which were pretty unpleasant – you will find more details if you trawl back through this blog. I am concerned that one form of bias, is to trumpet every surrogate measurement that goes in the direction Big Pharma would want, and explain away measurements that go the other way.
I guess from your name, that you are a medical doctor, so I am curious to know if you give patients information about the effectiveness of statins – e.g. the NNT value.
After my experience with statins, I talked informally with a variety of people of about my age. It was amazing how many had experienced nasty muscle problems (one guy also suffered memory problems) – most had simply abandoned their statins – some without bothering to tell their doctor! If the adverse side effect levels of statins were as low as is claimed, for example:
it simply wouldn’t be possible to find a group of sufferers without considerable effort – unless of course, except that these seem to get explained as the placebo (or rather nocebo) effect!
I too came to this site after suffering both muscle and memory problems with statins. I came off the statins first, but told my doctor after, but this was after a discussion with an Emergency Room Doctor relative. I have spoken to a number of friends who have had serious muscle problems. After my memory issues (which resolved) I do wonder about those with memory problems I have spoken to who simply regard this as old age and stay on the statins.
I usually try to give my patients a thorough insight into the pros and cons of statin therapy. If you’re interested in my view on statins you may find some articles on my blog. I do address side effects, NNT’s and much more. Here are few examples…
I have checked some of the links you gave in reply to David.
From one the reduction in cardiovascular events achieved by treatment. if you take the HPS as an example the actual probability of an individual being “saved” from dying was 0.003 per annum; conversely the probability of NOT BENEFITING in this way was 0.997 or rounded to two decimal places 1.00! This is to be compared with the probability of getting an adverse reaction (some very nasty indeed) of possibly 0.2. Much of the claimed “benefits” are a consequence of long time spans. There are, I understand, over 1,000 class action cases (and rising) against Pfizer in the US courts on the issue of diabetes and statins. Nothing in the UK of course with the removal of legal aid for this type of claim.
I also downloaded the Saverese report. Only 8 studies were SELECTED. Given the inclusion criteria, I find this extremely few. Personally, 50 years ago I would have welcomed the meta-analysis concept. But one problem is that trial reports are “selected”; thus they are not randomly chosen and therefore are subject to bias. This has been demonstrated. Meta-analyses commissioned by Big Pharma are invariably more favourable to their interests than wholly independent analyses.
So, therefore targeting calcium per se might useless, just like targeting any other surrogate marker.
Now there I think that you have identified the real problem associated with the estimation of risk which is so often based on mathematical associations of surrogate endpoints.
Having read just the first of your links to your blog (so far), I realise that I had quite unfairly placed you in the pro-statin camp! I guess it was this sentence, which I didn’t read to completion:
“Of course I know you want to twist and turn this all in favour of your own opinion, that’s what you’re good at………”
Your re-calculation of the statin NNT seems to correspond quite well with Malcolm Kendrick’s value – which is very encouraging, because I have sworn off statins for life!
I wonder, after you have explained that statins have an NNT of over 200 (for primary prevention) – plus some nasty side effects, do you actually patients who wish to take them?
Could it be that the Emperor of Cardiology at the Cleveland Clinic, Dr. Steven Nissen has no clothes. Just two months ago he said about the new dietary guidelines, “It’s the right decision.” “For years, we got the dietary guidelines wrong. They’ve been wrong for decades.” On top of that mia culpa, he adds a huge whopper, calcium buildup in arteries is a good thing.
This brilliant piece by Dr. Kendrick is one of the funniest things I have read in a long time. I thank Dr. Kendrick for giving me such a good laugh because laughter is still the best medicine – after satins that is, which will always be necessary for some reason or other. Now it’s to calcify arteries. You could not make this stuff up.
A hypothesis –
Statins increase calcification because they inhibit vitamin K2 synthesis; vitamin K2 would otherwise keep this calcium moving.
It’s a side effect of statins that limits their effectiveness. Because K2 is also important to the CNS, it produces cognitive side effects too.
I like a good hypothesis. My own hypothesis is that LDL/cholesterol has nothing whatsoever to do with heart disease. All facts support this contention.
Perhaps cholesterol-lowering is another side effect of statins that limits their safety.
It seems likely to me that ox-LDL, or sd-LDL, or some other LDL or VLDL subfraction is captured by the atherosclerotic process once it is progressing, but that it is a distal factor in terms of causation, and that its importance has been exaggerated due to the “keys under the streetlight” phenomenon. If so, does this has anything to do with the contribution of saturated fat to LDL (you would still have LDL in your blood if you ate no saturated fat at all)? That seems more unlikely.
You have not wavered from this opinion Dr. Kendrick and neither will I. My mom is at a point in her life when she keeps having to go to hospital, with everything breaking down rather quickly and all these meds that interact and make her look like a shadow of her former self. I was rather astonished recently when by happenstance I read her records of a CT done ( to see if she had a broken hip) and discovered that her abdominal aorta was full of “hardened plaque” according to the narrative report. So, is it any wonder that this poor woman can barely walk or talk after 12 years of statins? The poor soul probably has not had enough blood flow to the lower extremities in God knows how long. They only checked the heart apparently as though the rest of the arterial system is an after thought. But then, when I try to find a doctor at the hospital to talk to…I am told they get there in the am or pm. I swear I have tried to track one down by showing up at all hours and now can only see nurse practitioners and nurses and rehab people who come for 10 minutes and leave. Now…I asked the discharge representative…where are all the doctors? Have they been abducted by aliens? Or did the pod people get them? I would bet that bill to Medicaire is going to be a big old thing. The only doctors I have ever seen are in the ER and they ain’t sayin’ nothin’ but admit her!!!!! From that point on…you better watch your loved ones or they will get lost without any kind of care at all. So, yes statins do a great job of hardening plaque…they do indeed. But no doctor can or knows if it is true because he is not around.
As you foretold some years ago, the PCSK9 drugs would be on the market very soon. Studies (N Engl J Med 2015; 372:1489-1499 – Alirocumab; and N Engl J Med 2015; 372:1500-1509 – Evolocumab) have now been published with massive claims of reducing LDL and even reducing cardiac events. I have only seen the abstracts ($30+ for 9-10 pages is ridiculous) but already I have serious questions regarding the real efficacy of these compounds and their adverse reactions.
Reblogged this on Tala's Tracks.
For further reading via the Medscape pipeline, your readers may wish to peruse coverage that the website’s news outlet has just done on the satin/calcification research we are discussing here today. Please see the comment thread and story under the glowing headline: “Do Statins Promote Coronary Calcification? Study Says Yes, and It Might Be a Good Thing” (http://www.medscape.com/viewarticle/842499). The site may require registration but it is free of charge.
To be clear, Medscape does love to churn out pro-statin content and the public record shows that pharmaceutical and medical corporate entities are paying to prime the pump. By way of one example: MERCK GAVE MEDSCAPE $3,873,850 — in just the last three quarters of 2014.
NOTE: Merck disclosed that this particular sum of nearly four million dollars was earmarked for Medscape’s Continuing Medical Education (CME) program, whereby physicians earn credit toward maintaining their license to practice. Never mind that this type of corporate sponsorship is widely criticized for biasing CME content in favor of the sponsor’s drugs and medical devices. Never mind that Medscape’s numerous other outlets and activities, foreign and domestic, are also undoubtedly financed by a slew of corporate benefactors with similar vested interests.
Medscape’s funding sources do not appear to be available on its website. The foregoing sum to Medscape is derived from Merck’s official website, which posts an annual account of Merck’s worldwide grant disbursements, dating from 2008 to the present — as it is now legally required to do. The Medscape info can be found in the document titled: “MERCK – Disclosure of Grants Inside the United States”. For details, please see http://www.merckresponsibility.com/ethics-transparency/transparency-disclosures/disclosure-of-grants-inside-the-united-states/.
Suffice it to say, Medscape is a multi-pronged, multinational enterprise with global outreach and influence on both public and professional opinion in all matters of health. Certainly, it would be a good read if an enterprising sleuth were to drill down on the big picture of Medscape’s patrons and their potential influence on the whole of Medscape’s content.
Yes, the tentacles run deep. Stephen Nissen now, for example, states that he takes no money from the industry. But he works for the Cleveland Clinic, and runs trials for pharmaceutical companies at the clinic, who are pays millions and millions by the industry. Then the Cleveland Clinic pays him. We are supposed to believe that this means he has no financial conflicts of interest?
MERCK GAVE MEDSCAPE $3,873,850
Doesn’t compare with the $300 million to the CTSU.
No further comment necessary. Please read Prof Gotzsche’s book Deadly Medicines and Organized Crime.
Peter Attia made some remarks in his last blog post’s comment section, along the lines of vitamin k being good “if you believe coronary calcification is a bad thing”.
Spending too much time with a lipidologist, maybe?
Thank you for this great humorous piece.
Reading my 16 year old hospital angiographic journal about the artery calcification state in my heart I realise I should not bleed as easily as I do today.
What I prospect is that we could end up with ideas about ‘alternative medicine’ and that the number of comments would mount, and perhaps more than on your previous thread, and here, for sure, I would be one who could add a few items.
Hopefully with several squadrons of “Black Swans” to disturb the flocks of white medical swans
yes paradoxes = hypothesis fail
Many thanks for another great post.
Could I ask: Was it Ivor Cummins that sent you the piece about statins and calcification? I’m referring to his post here: http://www.thefatemperor.com/blog/2015/4/3/cholesterol-ldl-cac-progression-illuminates-fundamental-truths-lchf2015
Ivor has done some great stuff on cholesterol, especially his talks on YouTube.
From the “Fat Emperor” link which Brett linked to:
Statins can have a positive effect on Atherosclerosis in established disease peeps who refuse to fix their problem via nutrition, that is true I believe. The mechanism is via stabilizing plaque and encouraging laydown of calcium which protects against rupture, again in people who know not how to do this via nutrition.[My emphasis]
But as for ‘lowering LDL’ being the mechanism? This BS has simply got to stop. It is becoming a bad joke. Statins have their place, but be honest – it is through an anti-inflammatory, pleotropic shotgun mechanism, that is likely better achieved through informed nutrition – with the exception of specific complex genetic issues.
It has long been known that statins have pleiotropic effects that are beneficial to some people and those benefits clearly have little or nothing to do with cholesterol lowering ability unless, of course, one has familial hypercholesterolemia.
I think everyone might agree that statins are overpromoted, overprescribed and their side-effects are often underreported. That is true with most pharmaceutical drugs. Researchers and doctors must do a better job to determine who will benefit and those who will not.
Statins offer the following documented benefits:
1.Improved endothelial function
2.Reduced oxidative stress
3.Increased plaque stability
4.Increased calcium volume in plaque. Yes, that is correct, the increased plaque phenomenon strengthens the plaque making it less friable and less likely to rupture.
Pleiotropic Effects of Statins: Full Report http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2694580/
Of course, it has never been clearly shown yet that statins prevent heart attacks.
A 2012 study from the Journal of Atherosclerosis clearly shows that statins can increase plaque volume. “Statins use and coronary artery plaque composition: Results from the International Multicenter CONFIRM Registry”. I think it will open many eyes. My cardiologist calls this pleiotropic effect a “benefit” and I believe that to be true. Having a thicker fibrous cap on an atheroma with more calcium in it can be your best friend as it can be protective. We have been preprogrammed to think increased CAC is always bad but it is not always bad.
There are many potential downsides to statins for some people such as:
– Muscular myopathy
– Increased sterol absorption
– Reduced CoQ10 levels
– Reduced androgen levels
– Too many more to list
I believe this axiom could apply here … Just because a certain medication, diet or supplement doesn’t offer benefit for one group of people it likely also means it may offer benefit for others and vice versa.
“Of course, it has never been clearly shown yet that statins prevent heart attacks”.
My E.R. Doctor relative tells me he is seeing increasing numbers of heart attack patients who are on statins. He can’t be the only one seeing this, yet patients have been told statins will protect them from having a heart attack.
2.Reduced oxidative stress
Unfortunately this effect is mostly offset by the disruption of the mevalonate pathway and thus the disruption of the CoQ10 production, hence the adverse reactions caused by statins. To quote Dr Graveline in a recent corresponence:
Very relevant question but it just so happens that statins both reduces our ROS by one mechanism as well as inhibits the synthesis of CoQ10 which will ultimately increase ROS. I think what it does to CoQ10 over-rides the other. Graveline
Dear Dr Kendrick,
Your link to the Cleveland quote ‘The results of a new study suggest that there is a paradoxical relationship between calcification of the coronary artery and atheroma volume among individuals treated with statin therapy. In the analysis, statins, specifically high-intensity statin therapy, actually promoted coronary calcification.2’ does not take us to the article in which that quote exists. I see that JP Sand, above, has it here: http://www.medscape.com/viewarticle/842499#vp_1
You might want to correct it so people read it better.
Those doctors at the Cleveland are certainly under a very big delusion – maybe they should be seeing psychiatrists !
It is to me no doubt that the very small benefit with statins for people like me with heart disease comes from the ability of the statins (lucky strike there!) to reduce the level of inflammation in your body. Still I would never dream of taking any statins – the collateral damage is built into the design of this stuff – you don’t need to be a rocket engineer to figure that out!
To me it is ‘smarter’ to address the actual cause of the ‘inflamed’ state of your body than to ‘treat’ it by artificial means.
And as I understand this today there are actually several causes which stress your body to go into an inflammatory mode. Could this be seen as if your immune system has been compromised and overreacts?
– All kind of emotional stress – tough item to address but still possible to work on.
– High carb levels in your food – especially sugar – could it be the very rapid insulin ‘kick’ associated with the sugar which here triggers the inflammatory response? – with a sweet tooth this is an uphill fight – I know!
– Polyunsaturated fats from vegetable oils seems to work much like statins to lower you cholesterol but compromise your immune system at the same time – they are slow killers – throw all of them out!
– Polyunsaturated fats as processed vegetable oils rendering margarine are especially vicious with their transfats – killing you faster than the unprocessed oils – irrespective of any ‘Good for your heart’ label on the package.
– Saturated fats like butter and coconut oil are for your health – increase your cholesterol and of course there is only one type of cholesterol molecules and all such molecules are very good for your health – all other talk is just nonsensical Big Pharma talk!
– Too high omega 6 – omega 3 ratio – keep away from farmed meat, fish or beef, (ratio 20:1) opt for grass fed beef and wild catch of fish (ratio 1:1).
When you start to look at the absence of diseases (that is actually ‘health’) in terms improving your body’s immune system and thus your ability to resist external ‘attacks’ of any sort you are looking into a ‘new world’ of health.
Funny – all my life I have had at least two very nasty colds/flues every year but since I ‘converted’ to the ‘true’ LCHF-‘religion’ six years ago I have not had a single one – and this is a true relief for a guy who has spent at least two weeks every year in bed with a fever. Funny that the medical establishment seems to ‘hate’ us – can anyone figure out why?
How do you incorporate in your theory, the fact (at least I suppose it is a fact – nowadays you never quite know what to believe) that NSAID drugs such as diclofenac, are supposed to increase the number of CVD events – despite the fact they they are used to reduce inflammation!
Really – I don’t have the faintest idea! I don’t even know what NSAID stands for and advocates – I guess some kind of ‘guide-lines’ which makes me sick to think about.
And, basically, I really don’t trust any of the Big Pharma drugs, especially the ones that relate to my heart. This distrust is also why I don’t take any of them. I might die bleeding but I’ll take that!
My view on this is that BigPharma is pretty good at ‘pinpointing’ an effect, e.g. lowering cholesterol with the statins, by targeting a specific reaction in an anabolic or a catabolic chain of metabolic events but they are not interested in assessing any ‘collateral damage’ when proven successful. That’s where the money is.
To iterate, I think it is much more ‘scientific’ to try to address causes than effects. The pill does not address the cause but, to me, belongs to the religious paraphernalia of the medical establishment.
NSAID’s are non-steroidal anti-inflammatory drugs such as ibuprofen and diclofenac that are used for arthritis and pains of various sorts – reducing inflammation. They are very effective, but people are being warned off them because studies have shown that taking them tends to increase the incidence of cardiovascular events!
I have always found it strange that although they are very effective at reducing inflammation, it is claimed that studies have shown they are bad for the heart!
According to Peter Gotzsche, it’s quite possible that while NSAIDs help with pain relief, they don’t have a separate anti-inflammatory effect. Gotzsche calls the idea of anti-inflammatory action of NSAIDs a hoax. Another one of those “facts” about drugs invented and marketed by drug companies. He goes over his reasoning in “Deadly Medicines and Organized Crime” (which I have just started reading).
That is an interesting idea.
I must admit the cynic in me also wonders if these drugs, haven’t been subject to trials that have been subtly rigged in order to open the way to newly patented alternatives!
After reading your latest article Malcolm, it sounds as if you could do with a longer holiday ! Much longer.
Ill health is more about malfunctioning at a cellular level, than pricking the body with a needle to see if it bleeds ! This is typical of the “micky mouse” stuff we have heard from psychiatrists, for far too long.
Perhaps it’s time to give your thoughts to much more in – depth thinking and give statins a rest.
All too often medics overlook the fact , they were taught a system. A system which was more to do with administering synthetic chemicals, than learning how the systems in the body interact and work in synchronicity, at a cellular level. Without this knowledge GP’s fail to act on crucial signs, which would highlight the root cause of the signs and symptoms the patient presents.
This failure has inflicted terrible hardship and suffering, prolonged agony and premature deaths.
Treat the root cause properly and the body will re-establish it’s ability to carry out the myriad of functions necessary to keep it in good working order.
It’s called CURING !
I cannot imagine you could disagree with that.
Turning the NHS into a business has been an unmitigated disaster.
Britain has many many good professionals in the GP field, who unwittingly have added to the atrocious state it is now in.
Giving Andrew Lansley the GP who was the Minister for Health at the time, carte blanche freedom to change the system the way he did, was an outrageous betrayal
of all of us, including GP’s.
The tragedy is, they (GP’s) simply did nothing about it.
Britain now has the unfortunate accolade of having the highest rate of cancer sufferers in the civilised world. Where as in other parts of the world it is unheard of.
Now we learn doctors are to be “fined ” for failing to detect cancer. Then almost in the same breath, even more outrageous, taught how to detect cancer!
It simply does not add up.
Homo Sapiens is a ‘funny’ species to me in that we seem to build much more elaborate concepts or models about the observable world than all other species which evidently has made us ‘the master of all species’. But beware of the mosquitos in the approaching summer since you can be very sure that they also have efficient ‘models’ of the surroundings 🙂
And look out for the bacteria! Do they have ‘models’ of their environment as well? Anyway – they didn’t like the DDT and now even less so the Glyphosate and they might take a revenge if that has not already happened.
The most funny thing to me, though, seems to be that we are all ‘hard-wired’ to accept dogmas as ‘truth’, may it be from the church we happen to belong to, the medical community or any other of our ruling communities and to some extent also defend such dogmas ourselves. But when basic tenets/dogmas are challenged it does not seem as any ruler of any of these communities would waver when it comes to shedding the blood of any opponent – dead or alive.
Can we get away from this with the religion of ‘Science’? (I, for one, tend to be a believer in such an idea with all my own hard-wiring – a Catch 22?)
“What you are involved in is superstition! Me – I am a man of SCIENCE! Go and bleed!”
When me and my wife are just now reading about the interesting development, or rather establishment/organising, of the present day Europe in a religious context since prehistorical times it is ‘refreshing’ to keep the the hard-wiring aspect in mind all the time. How could you otherwise explain the otherwise unbelievable bleeding through this history when one prejudice is fighting another – endlessly?
We have also learned that the history of Homo Sapiens mainly seems to be about rulers who are more interested of putting ‘money’ in their own pockets than to care for their ‘brethren’.
I’ve taken the position that having calcium in the arteries is bad for my heart health. I had a CT heart scan a number of years ago and it came back positive, with a relatively high Agatston score. With that, before he was better known as the author of Wheat Belly, I began following Dr. Davis’s heart disease program. It was the only program I was familiar with that advertised as being able to slow calcium growth and sometimes reverse it. His program was basically to follow a low carb diet, take a few supplements such as vitamin D3 aiming for a testing level above 50g/ml, and taking medications when needed. He would mention in writings that his patients stopped having cardiac events. Fingers crossed that is true, & remains the case!
Of late as a new addition, I’ve begun taking aged garlic capsules. I came across a cardiologist, Dr. Matther Budoff mentioning doing some smaller CT heart scan calcium studies. He found those taking aged garlic often slowed their plaque/calcium growth, both soft and calcified, and in some cases reversed growth. Hopefully that is a positive! An interview on that ~
“Aged Garlic Extract Studies – My Interview with Dr. Matthew Budoff”
Have you read this study by Dr Davis
Click to access William_Davis_MD_Omega3_VitD_Study_2009.pdf
Effect of a Combined Therapeutic Approach of Intensive Lipid Management, Omega-3 Fatty Acid Supplementation, and Increased Serum 25 (OH) Vitamin D on Coronary Calcium Scores in Asymptomatic Adults
“The published study represented a retrospective analysis of the participants for whom we possessed complete data, including two serial heart scans (at least 6 months apart), lipid data within 60 days of each heart scan, and self-reported adherence to all advised treatments. Because the study was retrospective we were able to choose participants who were reportedly compliant with the program. The data for participants who did not complete the program or were lost to follow-up were not shown. The study is therefore skewed towards results that may be better than that achievable in real-life clinical settings. Nonetheless, these observations were simply meant to represent a proof-of-concept, i.e., a demonstration that it is indeed possible to exert an effect on coronary calcium scores.
The unique observation in this analysis is that a significant number of participants were able to prevent any further increase in coronary calcium score from one heart scan to the next, and several achieved substantial reductions in score. Of the 45 participants, 22 achieved either no change in score or a reduction after a mean scan interval of 18 months, with a mean score reduction of 14.5%.”
Interesting that you mention garlic as a ‘remedy’. Looking back 16 years now, when I had my most serious heart attack and then refused all medicine and the offer of by-passing, garlic was one part of my ‘alternative medicine’ parcel approach.The cardiologist I met at that time was a reasonable man and really didn’t argue with me about my decisions but still he asked why I didn’t take the Aspirin. My response was that as far as I had been able to grasp from my ‘home work’ garlic had the same ‘blood thinning’ ability as Aspirin and he admitted that to him this was also a ‘known’ fact.
I read somewhere recently that long time use of Aspirin is also considered quite disputable but I don’t really remember where the catch was. Could it be that it interferes with normal cell proliferation?
Has anyone here – including Dr Kendrick – read the ENTIRE study or just the abstract?
From the full study
“Aside from lipid regression within plaques following long-term potent statin therapies (35),
statin-mediated atheroma calcification may improve plaque stability. Microcalcifications are commonly found within an overlying fibrous cap, and were once thought to enhance the risk of plaque rupture (42). However, more recent research suggests that a very low proportion of plaques containing microcalcification actually rupture (43), and that if statins rendered plaque microcalcifications more confluent and dense, then vessel wall stresses might fall considerably, contributing to plaque stability (44). The current analysis provides supportive evidence for the possible plaque-stabilizing effects of statins via inducing microcalcification.
A mechanistic analysis of the role of microcalcifications in atherosclerotic plaque stability: potential implications for plaque rupture
Soul, Your reference to garlic (because of its high sulfur content) reminded me of this interview. I appreciate that they are discussing sulfated forms of cholesterol and vitamin D and I am no biochemist but I know enough to figure out that it’s difficult to obtain sulfated anything without sulfur in a form that makes it useable… I also know, from reputation, that UK is not the sunshine capital of the world 🙂 You will have to watch to the end (almost) to see the link to calcium, but I think it’s worth it.
Here is the link I missed. .https://www.youtube.com/watch?v=_hbNSHPco0g
Professor Göran Sjöberg and G. Mongeau,
I’m not terribly familiar with the use of aspirin for heart disease. When I had the CT scan done, found the calcium in the artery, and then discussed with my doctor, he recommended that I take a statin, an aspirin a day, and since I brought it up some fish oil. Somewhat humorously, my doctor was familiar with Dr. Davis and his work. He read his book he told me, and was following the plan too. He too had a heart CT scan, had a calcium score, was concerned he had been over charged for the scan too. Likely true I told him, he is a doctor. They saw him coming. (I was charged around half the price. They were having a sale when I went but cruelly I suppose didn’t mention that!)
I passed on the aspirin idea due to concerns over stomach issues. Later I’ve read on Dr. Briffa’s sight some articles shedding a negative light on aspirin use for heart disease. One of his articles along those lines.
“Aspirin for prevention of cardiovascular disease “ineffective or even harmful in the majority of patients” (just like statins)”
If aged garlic is helpful with slowing and possibly reserving plaque growth, I’m unsure of the mechanism. I have been reading a sight and books recently about the theory that yeast and fungus infection can lead diabetes and heart disease. Garlic, low sugar diets, and vitamin D, are some of the natural remedies recommended for that. it reminds me of Dr. Uffe Ravnskov theory that infections are behind heart disease. It’s just a theory. You can read a bit more about that idea in this interview of him ~
“Interview: Dr. Uffe Ravnskov”
Whatever one tend to hypothesise about the cause for ‘heart disease’ or ‘heart events’ tends to be ‘controversial’ except when you adhere to the official dogma according to which I would certainly be a very dead man by now and not bleed as easily as I do.
I am rather well acquainted with Uffe Ravnskov’s hypothesis about the bacterial ’cause’ which I find to have some ‘comprehensive power of explanation’ but still ‘unproven’.
There also seems to be an official concern about bacteria moving along with the blood stream and especially related to infected roots of ones teeth or even the gum and this is a concern not least for heart surgeons who don’t seem to want to operate before such tooth infections have been cleared.
One important point in Ravnskov’s theory is the fact that virtually all the lipoproteins (LPs) in your blood quickly eliminate bacteria and toxins in the blood by attaching to them and as such LPs constitute a part of our immune system. This goes well along with my current conviction the all cholesterol molecules are good for your body, Thus the LPs not only transport these good molecules to wherever they are needed but the LPs are also ‘good guys’ capturing bad ones.
So – if the cholesterol is high in your blood it seems to be something good for me.
One thing in favour of aspirin, is that nobody makes any real money out of it – so one might expect research results to be somewhat biassed against it. I still take my daily small aspirin.
I stopped Simvastatin 2 weeks ago having experienced paraethesia, particularly at night which, naturally, disrupted sleep. The ‘pins and needles’ effect still persists although, possibly, slighly less discomforting. It may be that Amlodipine is also inplicated. Who knows which is the culprit? Either way, a visit to my GP in Merseyside was called for. Regretfully he had no knowledge of Dr Kendrick or his book ‘The Great Cholesterol Con’ although he promised to read it. Fat chance! Surprisingly (or perhaps not !), he mentioned that a) newer guidelines were currently being considered to lower cholesterol limits even more than the current levels and b) an increasing number of cardiac specialists are themselves taking statins. I wonder what his sources are? Is it all part of the hype and spin? Anyway, I’m off to have more blood drained from my body to doubtlessly confirm I have high cholesterol and thence back to the surgery for another type of prescribed statin. There’s plenty more of where they came from…………
Professor Göran Sjöberg,
Very interesting about dental health and heart operation. I didn’t not know that, other than I’ve been told dental work and dental cleanings can sometimes lead to colds. I’ve not had that happen to me, but know of it seemingly happen to others, having a dental cleaning and then being ill shortly afterwards.
Thinking about it, and having time this evening, maybe more time than I should!, not only measured cholesterol might be good for fighting infection, but likely cholesterol consumed in meals is beneficial also. Your post reminded me of a study Dr. Briffa wrote about last year. It was a small one, but seemed compelling. It was about cholesterol eaten and infectious TB a mycobacteria. It was found that those that ate diets rich in cholesterol fared much better at overcoming their TB verses those on a low fat diet.
“More evidence links higher cholesterol with improved immunity”
The mention about cholesterol rich foods helping overcome TB reminded me too of Rene and Jean Dubos book “Tuberculosis, Man, and Society, The White Plague” In it the authors mention TB was largely overcome in the west long before antibiotics came along. (I’ve seen similar mention in another books that reviewed UK and US government disease records.) Additionally the two speculated that was due to the poor having improved diets, in particular having access to inexpensive clean meat. TB was a poor mans disease largely in the 19th and early 20th century. The authors didn’t know why meat was protective, he went on to mention, but it was a general well noted observation. Sunlight exposure was though to help too.
Saw this short article on PubMed, about the theory of heart disease caused by an infection. Special mention is made on TB
“Heart disease: the greatest ‘risk’ factor of them all.”
….Mycobacterial disease shares interesting connections to heart disease. Not only is tuberculosis the only microorganism to depend on cholesterol for its pathogenesis but CDC maps for cardiovascular disease bear a striking similarity to those of State and regional TB case rates. Ellis, Hektoen, Osler, McCallum, Swartz, Livingston and Alexander-Jackson all saw clinical and laboratory evidence of a causative relationship between the mycobacteria and heart disease. And Xu showed that proteins of mycobacterial origin actually led to experimental atherosclerosis in laboratory animals Furthermore present day markers suggested as indicators for heart disease susceptibility such as C-Reactive Protein (CRP), interleukin-6 and homocysteine are all similarly elevated in tuberculosis. It therefore behooves us to explore the link between heart disease and typical and atypical tuberculosis.”
Getting carried away with links, and speculation, as an added I remember seeing recently mention that fungal medications were successfully able to treat TB. Makes some sense, in my mind, in that “myco” means fungus.
“Antibiotic Resistance, or Change Resistance?”
“….The Journal Science published that certain bacteria, including the type that causes tuberculosis, can “pretend to be viruses when infecting human cells and cause them to hijack the body’s immune response.” Nonsense, I say! What if these “certain bacteria” aren’t bacteria or pretend viruses at all? What if they are fungus? I believe they are and so does Professor Andrew Munro in England, whose discovery in 2007 was funded by The Bill Gates Foundation, The European Union and The World Health Organization.
Munro discovered that Tuberculosis (TB), one of the world’s most deadly infectious diseases, responds favorably to “common antifungal drugs.” Why would TB die in the presence of antifungal drugs?….”
Lot of guessing, and theory, but had me thinking of articles read in the past this evening.
Concerning TB and TB’s virtual disappearance before antibiotics, the authors in the following book make similar arguments regarding many diseases and vaccines: the incidences of the diseases were much smaller before vaccines were used.
That is, the death rate from diseases were very high, then got dramatically lower to almost “zero”, then vaccines were introduced. They attribute the decrease to many factors, including non-contaminated water, hygiene, better living conditions, isolation of people with diseases, etc.
Thank you for deep digging!
“Mycobacterial disease shares interesting connections to heart disease.”
I found this statement intriguing since that was exactly what I suspected had triggered my last (?) angina eruption two years ago.
Sometimes I wonder where science may enter the ‘Religion of Medicine’.
Sometimes I wonder where science may enter the ‘Religion of Medicine’.
I no longer wonder. My personal hopes are that the “religion of money and status” can be removed from medicine and there is a return to the concept of “First do no Harm”, which, I suspect, is something that most doctors working with patients would welcome. Those concerned with “THE HERD” would no doubt disagree.
Received the following from Zoe Harcombe and could not resist passing it on. Another squadron of black swans to be ignored by the medical establishment!
Title: BMI and risk of dementia in two million people over two decades – a retrospective cohort study
Being underweight in middle age and old age carries an increased risk of dementia over two decades. Our results contradict the hypothesis that obesity in middle age could increase the risk of dementia in old age. The reasons for and public health consequences of these findings need further investigation.
Did you also read about one hypothesis as to why this may occur? It was suggested by a Seattle physician, Theodore Naiman, who said “Obesity-resistant persons take more glycation damage hit as their adipocytes don’t protect them by sucking up all extra glucose.”
“If we view the underweight, not unreasonably, as those most resistant to obesity – these are the people not storing excess glucose in fat cells. They are not laying down fat. It could be that they are underweight because they rarely ingest glucose. However, it is likely that the majority of this group do consume glucose, but their underweight status indicates that they are not storing it. The glucose still has to ‘go/stay’ somewhere and it can therefore be found/spend longer in other parts of the body, where we know sugar causes cell damage.
Conversely, the most obese people are extremely good at storing away excess glucose in fat cells. They may find this attribute undesirable, but it is actually very desirable for the body to ensure that potential glucose (glycation) damage can be minimised with glucose being whizzed away into fat cells very efficiently.
We know throughout evolution that the ability to store fat would have given a human a survival advantage. The fleshy people would out-live the lean people in times of scarcity. It would appear that the ability to store fat most efficiently may have benefit in today’s times of plenty – saving us from sugar damage to brain and body alike.”
Many thanks. I did not know that bit. However there are three papers by Flegal et al pointing out that the overweight (BMI 25-30) live longer than normal weight. The “Zoe” I presume is Zoe Harcombe.
Three attempts by the CDC to show that overweight was bad. All showed the reverse.
JAMA. 2005 Apr 20;293(15):1861-7.
Excess deaths associated with underweight, overweight, and obesity.
Flegal KM, Graubard BI, Williamson DF, Gail MH.
Overweights lived longer than normal weights
JAMA. 2007 Nov 7;298(17):2028-37.
Cause-specific excess deaths associated with underweight, overweight, and obesity.
Flegal KM, Graubard BI, Williamson DF, Gail MH
Overweights lived longer than normal weights
Flegal KM, et al. Association of All-Cause Mortality With Overweight and Obesity Using Standard Body Mass Index CategoriesA Systematic Review and Meta-analysis JAMA 2013;309(1)
Overweights lived longer than normal weights
Then of course there is the “Obesity Paradox” http://junkfoodscience.blogspot.co.uk/2006/11/obesity-paradox-1.html
by Sandy Szwarc !-15 blogs. Again it seems that the obese (30-35+ – not the morbidly obese) survive hospitalization better than normal or overweight. The sskinnies loose out as usual.
I would add despite the CDC’s own research showing a benefit of overweight in survival, its Director does not believe it!
Do you know if any of these studies were able to demonstrate which diseases dispatch the slim (of which I am one) before their time?
So far as I know the CDC studies (Flegal) were based on all-cause mortality. The Obesity Paradox (Sandy Szwarc) reports related to hospitalization for surgery and cardiac events.
Well, finally got and finished Doctoring Data. It was a very easy read for me, and quite enlightening. Unfortunately, it was also depressing. I don’t believe anything will change.
By the way, it’s questionable whether fish oil has arrhythmia prevention aspects. I have a site bookmarked that went through many of the studies (will see if I can find where I have the site bookmarked), and they were all over the map in terms of whether fish oil helped or not.
In one sense Doctoring Data is indeed pretty grim, but I am an optimist, and I think the demonisation of saturated fat, and the cholesterol/statin scandal will break. I find so many people know about both of these by now – the internet is so powerful – that the standard medical position is becoming really untenable. Because the likes of Rory Collins are holding on like grim death, the ultimate crash will, I hope be very dramatic – impossible to disguise as science steadily advancing.
One good scandal like this might bring the whole rotten edifice down!
David, I look forward to that happening, but fear much damage will have been done by then. We need a 180 degree about-turn, regarding the demonisation of natural fats, and the over medicalisation of society, but, as you suggest, it is going to take a much publiced scandal to have any impact in general, let alone a complete reversal of the status quo.
We need changes, and changes are at the whim of politicians, sadly.
Just look at Australia….no jab for little Jimmy….no state benefits for the family purse.
Has my 10 years of statinisation turned me into a pessimist?
I’ve just finished reading Doctoring Data too. Not being a brilliant mind like most who write on this blog, I found some of the statistics a bit hard to completely grasp, but that didn’t prevent me from finding the book totally absorbing and enlightening. I am once again, so grateful for your work Dr K – and wonder just how on earth you find time to DO everything. It must have taken many hours wading through the treacle of all those statistics, and then to put the findings into a fascinating read. Not to mention your GP work etc. Well, you simply must be superhuman that’s all. Anyway after all that hero-worshipping I simply want to say thank you for giving me and others like me, the guts to stand up to our blinkered nurses and GPs. I’ve got an appointment on Tuesday with one of them. The last time I went, she said “Your cholesterol is rather high, but you aren’t bothered by that are you?” (she said it with a look that seemed to say ‘I hope you’ve changed your mind you silly woman”) It is because of your blog, books and other reading you have recommended, that I had the confidence to refuse to be ‘statinated’. I suppose I’ll have to do it again, but at Doctoring Data has made me even MORE sure – about that and a whole host of other things. Thank for writing it, and thanks to your wife too. I bet she was glad when you finished it! By the way, are you having a rest before your next book!!!
I too can but wonder how Dr Kendrick finds time for all he does. I think he has discovered a secret drug – compound X – that gives him a totally focussed mind! Perhaps his next book will reveal the secret 🙂
Perhaps he could patent it and make millions 😳
Thank you for the nice comments. I am actually a bit of a lazy sod, I work in short bursts before watching the telly.
Another way of putting this. If you have a theory, and the facts do not fit it, then the theory is wrong, not the facts. Until, of course, someone proves that they are. Sometimes I fear that researchers are not taught about null hypotheses and Black Swans…
The reason statins calcify:
It’s been posited that statins block conversion of vitamin K1 to vitamin K2.
Research has suggested that K2 (MK-4; MK-7) regulates deposition of calcium in bones vs soft tissue.
Therefore, supplementing with plenty of K2 while taking a statin will obviate the calcification problem.
How’s that for a theory?
Reasonable. You could, of course, just stop taking the statin.
Yes, stop the stains.
Stop the anti-hypertensives.
Stop the rubbish carbs, and therefore the anti-hyperglycaemics otherwise needed to cope with them.
And let 2016 be the year our bodies are permitted to work properly, rather than contaminated with food-like substances which have mucked up our bodily mechanisms for many years.
Real food is the answer to curbing unhealthy indulgence.
Real food satisfies our appetite.
Real food will enable homeostasis to rule, so that we ( unless actually suffering from an illness), can take it for granted that levels of vitamins, minerals and macro nutrients will keep us ticking over very nicely, thankyou!
That’s my philosophy, and I am sticking to it. My body just loves the regime….and functions so much better than the years of over-testing which resulted in (unnecessary) over medicalisation.
Cheers to everyone for this New Year.
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