What causes heart disease part IX

Heart disease part IX? I think my little series is getting a bit like the Superbowl, with the ever increasing roman numerals. Oh well, it just started that way, now I’m stuck with it. Never mind.

I know people have been reading this series with different purposes in mind. Still, a number of people seem to be asking ‘OK, what’s the cause?’ In which case, I have failed rather miserably in my quest. My main theme is that there is no cause. I shall repeat. There is no cause. Or, perhaps to be more accurate – there is no single cause. There cannot be.

There is a process.

To reiterated what I have been trying to say up to now, you cannot identify real causes, unless you understand what is actually going on with CVD. Indeed, I firmly believe that the search for causes has been the main reason why we are in the current situation – a multifactorial mess. In 1981 the Journal Atherosclerosis searched for all the factors that had been identified as either causing CVD, or protecting against CVD. There were nearly three hundred. Some, such as copper in the diet, were simultaneously causal and protective.

If anyone were to try to scour all medical papers to carry out such a study today, there would be thousands more factors – this I can guarantee. Cholesterol alone itself has split and multiplied into good and bad, light and fluffy, small and dense LLD-C, LDL-P, eight subtractions of HDL (good cholesterol), dyslipidaemia, Lp(a)… Each one has somebody waving a flag furiously in support of it. New and expensive tests developed each and every day.

How could anyone possibly try to make sense of such a thing? Three thousand eight hundred and fifty causal factors, four thousand two hundred and eighty-six protective factors. Go figure. Get a super-computer and run it for the entire life-span of the rest of the Universe. You may be a trillionth of the way through working out how they all add and subtract, multiply, or divide risk.

I spent twenty-five years looking for a cause, or causes, and gave up. It was a fool’s errand. It was the transmutation of lead into the gold, the search for the missing chord, the creating of a perpetual motion machine, a discussion of how many angels can dance on the head of a pin – an attempt to fit planetary motion into a Geocentric model of the Universe (Everything rotates around the Earth). In short, impossible.

The first step to understanding CVD (and this happened for me, many years ago) was to strip cholesterol/LDL cholesterol out of the model. For so many people, then as now, Cholesterol was/is the Earth at the centre of the Geocentric model. It still represents the key jigsaw piece placed triumphantly in the middle of the puzzle. Hammered in, and decreed immovable by the likes of Ancel Keys, before anyone really knew what the picture looks like.

I have read paper after paper where people seem to be going in the right direction about heart disease, then they find they have to shoehorn cholesterol into the centre of their research. At which point everything distorts into a mess of twisted logic. A truth may be jumping up and down in front of them shouting ‘Me, me, me. Here. Look.’ But the truth is invisible. There are no so blind as those who will not see.

There is a process

The conclusion that I came to, eventually, is that we have to define the underlying process. As we should do with all diseases I suppose. However, the ‘disease’ model that medicine has become fixated with, as a way of thinking, was in major part started by a famous microbiologist Robert Koch in the late nineteenth century. His thinking was mainly directed microorganisms e.g. bacteria, viruses and suchlike. He decreed that for any microorganisms to be identified as a true cause of a disease, the following postulates must be fulfilled.

  • The microorganism must be found in abundance in all organisms suffering from the disease, but should not be found in healthy organisms.
  • The microorganism must be isolated from a diseased organism and grown in pure culture.
  • The cultured microorganism should cause disease when introduced into a healthy organism.
  • The microorganism must be reisolated from the inoculated, diseased experimental host and identified as being identical to the original specific causative agent.

Now, these are pretty tough criteria. If not just from an ethical perspective. You try putting a cultured microorganism into a healthily organism nowadays and see how far you get. ‘We are not sure that Ebola virus causes Ebola in humans. Let me isolate if from a patient and introduce into a healthy human.’ Good luck with that.

However, the main point I want to make here is the ‘single causal agent’ concept of medicine has become the meme. You start by looking for the cause of a disease. Once you believe you have it, all research, and all thinking starts to crystallize around that cause. It becomes the centre of all thinking, and dominates the landscape.

I see this in CVD researchers all the time. There are those who are still convinced that cholesterol causes heart disease. All facts are twisted and bent around to fit this central fact. Contradictions are ‘immunised’ against in various ways.

Me:                           ‘People with low cholesterol levels can still have plaques and an MI. So a raised cholesterol level is neither necessary, nor sufficient, to cause CVD.’ {See under Koch’s postulates}.

A.N. Expert:         ‘Actually the normal level of cholesterol in modern humans is far higher than the ‘healthy level.’ So, everyone actually has does have a high cholesterol level. Look at hunter gatherer’s, neonates and other animal species. Where cholesterol levels are much lower.’

The argument here is almost perfect. Everyone has a high cholesterol, so you cannot rule out a high cholesterol level as a cause of CVD- in anyone. [Total nonsense of course].

Me:                           ‘In the Framingham study, those whose cholesterol levels fell, in the first fourteen years of the study, had a greatly increased risk of CVD over the next eighteen years.’

A.N. Expert:         ‘The is reverse causality. A falling cholesterol is caused by an underlying disease, and it is the underlying disease causing the problem, not the low cholesterol.’

Me;                           ‘The French have higher cholesterol levels than the Russians and one tenth the rate of CVD

A.N. Expert:         ‘The French are protected by drinking red wine and eating lightly cooked vegetables and eating garlic.’

Me:                           ‘Asian Indians do not have high cholesterol levels, yet their rate of CVD is far higher than the surrounding population

A.N. Expert:         ‘The Asians are genetically susceptible to CVD.’

‘Ad-Hoc hypotheses – that is, at the time untestable auxiliary hypotheses – can save almost any theory from any particular refutation. But this does not mean that we can go on with an ad hoc hypothesis as long as we like. It may become testable; and a negative test may force us either to give it up or to introduce a new secondary ad hoc hypothesis, and on and on, ad infinitum.’ Karl Popper.

One of my favourite ad-hoc hypothesis, which covers the entire diet-heart/cholesterol hypothesis, rather than just the cholesterol hypothesis, was the use of teleoanlysis. Here, the authors looked at all the studies on using a low fat died and found they had no effect on CVD. However, they knew (and claimed as fact) that eating saturated fat raised cholesterol levels, and they knew (and claimed as fact) that raised cholesterol causes CVD. Ergo, eating saturated fat must cause CVD, so the trials must be wrong.

At which point, rather than relying on the published evidence, they decided that you simply make up studies in your head, and use them to prove that saturated fat does, actually, cause CVD. If you think I am making this up, here is the quote from the study, published in the BMJ

‘….teleoanalysis combines different categories of study to quantify the relation between a causative factor and the risk of disease. This is helpful in determining medical practice and public health policy. Put simply, meta-analysis is the analysis of many studies that have already been done; teleoanalysis provides the answer to questions that would be obtained from studies that have not been done and often, for ethical and financial reasons, could never be done.’ http://www.bmj.com/content/327/7415/616?sso=

Yes, this was published in the BMJ, no less. I always enjoy this paper. It is so ludicrous that it goes well beyond despair and into surrealism. ‘Ceci n’est pas une Pipe.’ Ignore the evidence and, instead, rely on what you know to be true. This, of course, is the way high quality science should be done… not.

More recently we have equally mad studies on mendelian randomisation. Which may not immediately look like teleoanalysis, but at heart it is are exactly the same thing.

It has been found that older people with high cholesterol levels live longer than those with low cholesterol levels, and get less CVD. This does not fit well into a world where billions can be made lowering cholesterol levels – particularly in the elderly. The first attempt to refute this finding was to say that other diseases lead to low cholesterol levels (as mentioned earlier), and it is the other diseases causing the problem, not the low cholesterol. It was Iribarren who came up with this one.

This, so called ‘reverse causality hypothesis’, has been proven to be wrong in several major studies. So, a new attempt was made using ‘mendelian randomisation’ [Yes, genetics, after Gregor Mendel who proved the concept of genetic inheritance]. By using mendelian randomisation, you can identify people who would have had high cholesterol during most of their lifespan (they have genes associated with high cholesterol levels). So, their cholesterol may be low when you measured it, but it would have been high for most of their lifetime.

Ergo, people with low cholesterol levels, and higher mortality rates, actually had higher cholesterol levels when they were younger, and the lifetime effect of these high cholesterol levels will have caused them to die of CVD. Not, I repeat not, the low cholesterol levels they now have. Yes, this stuff gets published too, and rolled out to confuse the hell out of everyone. [Luckily, I have contact with people within the pharma industry who set up and run genetic studies. They tell me this stuff is simply smoke and mirrors].

I shall paraphrase mendelian randomisation studies. ‘Your cholesterol level is not your cholesterol level…. So there. It is whatever we decide it is.’

Believe me, attempts to refute contradictions to the cholesterol hypothesis get more complex than this. As you can see, in the world of CVD you can play the game of ad-hoc hypothesis, ad-infinitum. In the end there are so many ad-hoc hypothesis created that A.N. Expert can slip from one the other and back again without ever having to accept that any single fact represents a contradiction to the hypothesis. The final trick, when you are getting close to nailing them they just say ‘Oh well, CVD is multifactorial.’ This is not an answer. It is just a polite way of saying ‘shut up and do as I say.’

I ended up with a further realisation. There is no point attacking the cholesterol hypothesis. Those who believe in it have created a majestic Byzantine world of mind-numbing complexity where you can wonder the corridors of ad-hoc hypotheses forever, and never escape.

So, I made a decision, which I have just gone back on. Do not bother attacking the diet-heart/cholesterol (whatever you want to call it) hypothesis. You just get dragged onto a playing field that is not your own, chasing round and round in circles, trying to refute the latest made up ad-hoc hypothesis. It is like discussing the existence, or non-existence, of God with a Professor in theology. They can call on two thousand years of well-rehearsed arguments to confuse you with. You don’t stand a chance.

Instead I have spent, what I hope to be more productive, years and years, working out a hypothesis that actually fits the facts. There is no need for ad-hoc hypothesis, no need for teleoanalysis, or mendalian randomisation. No need for planets doing little circles in the sky, to support the Geocentric model of the Universe.

I could only do this by moving away from looking at causes, and trying to establish the underlying processes at work in CVD. I am not the first to attempt this. Rokitansky was first, Duguid had a good go, Ross also attempted to demonstrate the ‘response to injury hypothesis.’ Up to now, those who believe that CVD is, essentially, a disease of dysfunctional blood clotting have simply bounced off the well-guarded walls of the cholesterol citadel.

In the end, though, someone is going to break through. It is just a matter of time. You can stomp on the truth for many years. You can concrete it over. But the truth has a major advantage over sophistry. It is immortal. No matter how deep you try to bury it, It lies there, waiting to be discovered, pushing little green shoots up into the sunlight waiting to be discovered.

300 thoughts on “What causes heart disease part IX

  1. karlwhitfield

    I am just LOVING this series Dr Kendrick, your emails are the highlight of my week! Thank you.
    Doctoring Data was the best book I read in 2015 too, twice!

    Forgive my lack of detailed knowledge….but please can i ask a rather basic question.
    From reading all your work in this series, am I right in supposing that a DVT is almost exactly the same as any other blood clot?

    So DVT and pulmonary embolism fit the same ‘blood clotting’ model you have been discussing over the last few posts?

    Many thanks, keep up the fantastic work.

    1. Mr Chris

      I just read doctoring data again, making read number three.
      Each time, plus this series, I understand a bit more.
      I also have recently read the outpourings of Dr K ´s critics, and he has some, but I still stick with him.

      1. karlwhitfield

        Hi Mr Chris,
        Yes, I remember reading Cholesterol Con back in 2010, but Doctoring Data is even better, just superb.
        In Part 1 of this series, Dr K says the venous blood has the same level of LDL as arterial blood, yet “we don’t get plaques” in veins.
        But we do get clots in veins – a DVT is a clot in a vein.
        A DVT can float along the veins and cause a pulomnary embolism. It looks to me like the same process, but I am not a doctor (just a very passionately interested student) and I am sure I am missing some crucial difference, and I hope Dr K can explain this to me!
        Now, I can’t wait for Part X!
        Best regards,

  2. Diana

    The microbiologist in me should be happy to finally see some microbes mentioned in the talks about heart disease… but Koch’s postulates? They have been dead for some time. Calling a microbe a pathogen, or a commensal, or a symbiont is simply wrong. Microbes happily switch their lifestyle when the environment changes, become a pathogen from previously useful symbiont, by establishing a new interaction with the host tissue. There are no pathogens in the sense of Koch’s postulates. Rather, we are observing a series of outcomes in the microbe-host interaction, witnessing A PROCESS.

    1. Dr. Malcolm Kendrick Post author

      I think Koch’s postulates have been dead for some time (in a certain sense). However, many doctors are still furiously reductionistic and do search for ‘the’ cause of a disease. I was using the example of Koch’s postulates as a way of thinking, not as something still used by microbiologists. At least that was my intention

      1. Joe

        Dr. Kendrick:

        Koch’s Postulates didn’t just die a natural death. They were killed. Violently, in the night. By virologists, mostly. Because without those pesky postulates to keep virologists honest, they could blame just about anything on a virus. The death of KP has led us to such scientific shenanigans (it is, after all, St. Patrick’s Day) such as HIV=AIDS, Hep C, Hep B, HPV causing cervical cancer(!), FIV, SIV, FeLV, etc., and has just about destroyed the scientific method in the process. We don’t treat disease anymore, we just treat “markers,” “proxies,” etc.

      2. Gary Ogden

        Joe: Your comment has provokes some interesting thoughts. Is virology bunk? Since the little buggers are so small, has anyone actually seen one (with certainty)? Since they must be produced by cells, what is their actual role in pathogenesis? We now know that the polio scare was a complete scam, like the recent zika scare, but what about ebola?

      3. Joe


        Yes, much of virology is bunk. Viruses exist, but they just don’t cause the damage that many virologists attribute to them. They’re currently trying to pin microcephaly on ZikaV, but this virus has been around since the 40s (when it was first discovered), and it’s always been a mostly harmless little bug that 80% of its carriers don’t even know they were exposed to. It didn’t just all-of-a-sudden decide to give babies microcephaly. Viruses just don’t work that way. My own opinion is that the Brazilian clusters of cases of microcephaly are caused by certain vaccinations being recently mandated by the Brazilian government (especially the DPT vaccine) for pregnant women, or the overuse of pesticides and insecticides in northern Brazil (Brazil is the world’s largest consumer of such chemicals)..But they’re trying their damnest to pin this on a virus.

        Ebola is no danger to anyone who enjoys good nutrition, medical care, practices good hygiene, and avoids strange cultural practices. It’ll pop up from time to time in certain African locales, but it’s not going anywhere.

        Virologists mostly want to sell testing kits, vaccinations, and drugs. They do not want to prevent disease. Real disease has done a pretty good job of eliminating itself over the years (and well before the advent of vaccinations), thanks to better nutrition, better hygiene, clean water, better medical care, antibiotics, etc. But virologists want a piece of the action, and, unfortunately for all of us, are getting it. The CDC’s main purpose is to promote disease, not prevent it.

      4. Gary Ogden

        Joe: You’ve hit the nail squarely on the head. I agree 100%. I call them the Centers for Disease Creation and Promotion (or Propagation, not sure which I like better).

      5. Stephen Rhodes

        Hi Joe,

        As conspiracy theories go, the South American Zika virus outbreak/ microcephaly increase/pesticide-herbicide overuse is likely be a long distance runner, but it is a slippery slope we tinfoil hatters step onto when we dis each and every piece of research that doesn’t fit our worldview.

        http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00651-6/fulltext studied the recent outbreak in French Polynesia which, if you accept the methods used to treat the data collected, shows a significant increase over anticipated microcephaly rates.

      6. Joe

        Stephen Rhodes:

        The first word of that study should have tipped you off: ASSOCIATION. And a very weak one, at that. As we know, correlation does not mean causation. The US has approximately 25,000 cases of microcephaly per year. And ZERO ZikaV. Now imagine how many KNOWN ways there must be for a baby to be born with microcephaly, even in one of the most advanced countries in the world. It’s a pretty long list, and includes exposure to alcohol, drugs, toxic chemicals, phenylketonuria, and vaccination reactions. Couldn’t all of those things also contribute to the cases of microcephaly in French Polynesia? So why blame ZikaV?

        Actually, I don’t mind them looking for associations, even with a virus that’s never caused much of a problem anywhere before, but have you heard of any of these crack CDC researchers looking for associations with alcohol, drugs, toxic chemicals, phenylketonuria, vaccinations, etc? Things we already know can cause microcephaly. I haven’t. Even after a large group of doctors representing northern Brazil (where the cluster is situated) have called for such an investigation? They don’t think ZikaZ has a thing to do with these cases of microcephaly, and blame it on all the spraying of pesticides and insecticides, and perhaps the DPT vaccination, which was recently mandated for pregnant women. You should also know that this vaccination has never been tested on pregnant women.

        Go look up the ingredients in the DPT vaccine. Do you think it’s a good idea to inject this vaccine, and all it’s components, directly into the bloodstream of your still developing fetrus? Well, that’s exactly what they did in Brazil.

        So, no, I’m not buying this ZikaV scare. At least not until they FIRST look at the usual suspects.

      7. Gary Ogden

        Joe: Well put. Connecting Zika virus to microcephaly, as WHO has done, is one of the most blatant examples of a public agency clearly working for private interests that I’ve seen. The actual number of laboratory-confirmed Zika infection of mothers of microcephalic infants is quite small, under twenty, I believe. We also must consider the considerable amount of corruption in the Brazilian government. If you look at the web of financial interests connecting WHO, Bill Gates, the pharmaceutical industry, and government, it is clear what is going on here. Little different than stain promotion. The majority of WHO funding now comes from private sources, rather than governments. A real red flag for me was learning that Zika was discovered in the 40’s by the Rockefeller Foundation, whose history of vaccine development goes back to the early 20th century. Interesting to research John D. Rockefeller’s impact on the way medicine developed in the 20th century.

      8. Joe

        Gary Ogden:

        Cui bono?

        Who stands to benefit if the microcephaly is pinned on the ZikaV? Answer: BigPharma and certain virologists who stand to make a killing on patents, testing kits, etc.

        But if the microcephaly is caused by certain vaccinations and/or the overuse of insecticides and pesticides (which are put in the DRINKING WATER), the government (who mandated all of this), companies like Monsanto, and the Bill and Melinda Gates Foundation, stand to lose a LOT of money, not to mention jobs and reputations. Not to mention raise alarms all over the world.

        Yes, I’m a cynical old man (and not without good reason). So if I were a betting man, and I am, my money is on the latter. At least until I hear that the powers that be are at least looking into vaccinations, insecticides and pesticides (i.e., toxicology studies).

      9. Gary Ogden

        Absolutely right. It is the economic interests of those involved in promoting this that drives it, as it is with the bulk of medical interventions, rather than evidence. Last year in California they turned a few dozen cases of measles into something like the Black Death, and took away informed consent from parents. The vaccine has changed the demographics of risk, from almost entirely childhood, when it primes the immune system, to adulthood (the majority of the cases), and infancy, both of which carry greater risks; nevertheless, there were few serious complications, and no deaths. I say, beware the Jabberwock.

    2. Gary Ogden

      Diana: You’re comment makes me want to learn more microbiology. Can you suggest a good, general resource? Somehow I intuitively understood that the terrain matters more than the microbe-in my case never getting sick regardless of eating morsels accidently dropped on the floor, or unwashed garden produce, or mixing in the public without subsequent hand washing.

      1. Diana


        it is not my intention to make this blog comment section fuzzier than it is now. There is enough microbiology resources online – would you care for to learn about the microbes in the ocean, atmosphere, soil, human gut or blood?
        I study plants, and plants are actually COMPOSED of microbes, mainly endophytic fungi. No endophytic fungi, no plants. Full stop. It is a great fun to contemplate how much of this principle could be extrapolated to animals. But I digress.
        In general, microbes care for two things: obtaining and extracting nutrients (with help, or on the account of other microbes) to grow and multiply, and defending themselves against competitors. The rest – more complex systems, networks and processes are only emergent properties.

        If we should keep focused on the disease process in the heart disease, it looks to me as messed-up defence, used by microbes to grow, when there is a chance (yes, terrain). The host way to prevent or reverse it must be a process too, in my opinion. That’s why there is probably no magic bullet.

        This is probably a good piece of the puzzle:
        Biofilms, Lipoprotein Aggregates, Homocysteine, and Arterial Plaque Rupture (Ravnskov, 2014)

      2. Gary Ogden

        Diana: I’ve come to the conclusion, as I get within spitting distance of the proverbial three score and ten, that the microbiome, as mediator of our interactions with the environment in which we live, has centrality in human health and the disease process. But yes, soil, associated atmospheric, and precipitation-delivered microbes are of great interest and fascination to me as a life-long planter (and harvester) of trees and gardener. Three cheers for fungi! I think we err if we leave the microbiome out of the heart disease equation.

      3. Gary Ogden

        Yes! Though carrying on their work largely unseen, so absolutely crucial for life, and partly for rainfall. Plant life simply could not exist without them, although what used to called the Cruciferae (botanists can be so annoying-change specific or generic names if you wish, but leave family names alone!) appear not to join forces with mycelia. Odd, that.

      4. Diana


        Brassicaceae plants sometimes do develop arbuscular mycorrhizal associations, it depends if the plants needs it and suppports it (to obtain minerals from poor soil etc.). Otherwise the AM fungi normally grow within the plant tissues as endophytes (even in non-host Arabidopsis).

        “Arbuscular mycorrhizal fungi reduce growth and infect roots of the non-host plant Arabidopsis thaliana.” (Veiga, 2013)

        “Microscopy analyses revealed that R. irregularis supported by a host plant was capable of infecting A. thaliana root tissues (up to 43% of root length colonized), but no arbuscules were observed. ” (only hyphae and vesicles).

        Sorry Dr. Kendrick.

  3. Ann Walker

    Great work Dr Kendrick, and I admire your tenacitcy in the face of overwhelming odds. Even convincing my own family is more than I can deal with and I have given up. It sounds as if you have had enough too. But it might just be darkest before dawn? All my best wishes.

  4. annielaurie98524

    No, Dr. K, not at all like the Superbowls! Your series is a far more useful and entertaining way to spend one’s time than watching US-style football while stuffing one’s face with US-style junk food. Keep ’em coming! I’m eager to see what health issue you’ll tackle next.

  5. Sylvia

    Well you certainly do not follow the herd. You seem to ask us to lift up stones and do some good research. Because simply to ask our Doctors will just be possibly a pointless exercise if they are following the herd. Thank goodness for people like you. Is the tide turning, I do hope so. You now need to have a rest and let that lovely cholesterol bathe your cerebral cortex with its life giving properties. Such hard work and so worthwhile for us. Thank you.

  6. Kevin O'Connell

    It’s like reading Lord of the Rings for the first tile & watching Star Wars films, all rolled into one – we don’t want it to come to an end and we now have a prequel. Looking forward to X and hoping we don’t have to wait until XVIII for the conclusion.

    1. Emma

      Yes Kevin, that’s exactly what it’s like! Looking forward to more, to the final answers, yet simultaneously dreading the end.
      How about the metabolic / mitochondrial V gene theories of cancer next? Only joking… a bit…

      1. Anne

        I rather gathered that this was the end of the series:

        Dr Kendrick wrote:
        “I know people have been reading this series with different purposes in mind. Still, a number of people seem to be asking ‘OK, what’s the cause?’ In which case, I have failed rather miserably in my quest. My main theme is that there is no cause. I shall repeat. There is no cause. Or, perhaps to be more accurate – there is no single cause. There cannot be.

        There is a process.”

        I’m happy with that as a conclusion.


  7. annielaurie98524

    I shall start referring to the cholesterol-CVD hypothesis as the Ptolemaic model of CVD. Although, perhaps you are right, trying to discuss it with any adherent is like having checked into the Hotel California. At least, here in the US, the new FDA/USDA nutrition guidelines eliminated the 300 mg/day recommended max level of dietary cholesterol, as they concluded from numerous studies that dietary cholesterol intake does not raise serum cholesterol levels. They still warned that “high-cholesterol” diets were harmful. But this oblique condemnation of cholesterol wasn’t good enough for some — the agencies are being sued by a vegan group that wants the dietary limits re-instated http://www.businessinsider.com/usda-sued-over-new-dietary-guidelines-2016-1

  8. Kathy S

    Sooooooo……all these poor doctors really don’t know what to do about all of us with CVD other than the status quo. Every single article that comes out says the same thing, over and over again – lower blood pressure, lower cholesterol, exercise, eat your veggies, blah, blah, blah. So when that doesn’t work – then what?? Thus my frustration. At least with the knowledge you have provided, Dr. K., I am able to have a more intelligent conversation with my heart Doc instead of fixating on my already reasonable cholesterol numbers. After having a 90% blockage that was stinted, then a year later the same spot at 95% and re stinted – yet no heart attack thank God, if this happens again, they are looking at me to have by pass surgery. An event I really don’t want to have happen. I am doing everything I know to do to avoid this as well as to refuse the statins – I feel great, by the way – but here’s a question for you, Dr. K. Assuming the problem is damage to an artery which starts the plaque build up process and if the stint does not work in helping that artery to heal, thus it ends up being replaced by a presumably healthy artery from my leg – wouldn’t the surgery itself and the sight of that replacement be an injury that my body would rush to repair and thus form another plaque? Such a frustrating disease to have.

    1. Peril

      I too have heart disease (MI with 5 stents and one untreated lesion) and other symptoms indicating more general vascular disease. I think the good Doctor’s series is in two parts – understand the process first to then appreciate how the process may be disrupted, perhaps even reversed. If I’m right then the cause is irrelevant, a distraction even.

      I wait with bated breath

    2. Stephen T

      Kathy, Dr Kendrick covers coronary bypass grafting in his book ‘Doctoring Data’. And it’s been discussed here several times, noticeably by Goran, who turned it down. I don’t think I’ll be having stents or a bypass.

      1. Kathy S

        Stephen. I’ve read Doctoring Data – great book – and should probably read again. The two times I had the stents put in, the chest pain was quite debilitating and the only reason I did not actually have a heart attack, I believe, is from the collateral vessels that kept my blood flowing where it needed to go. I’m just not sure what to do or not do if this happens again.

  9. Nigella P

    So inspiring. I would like to say it is great work, but I am utterly unqualified to make such a judgement. I can say that you make very complex processes understandable to me & I do not have a medical background. Rather sadly, that is something to be applauded, far too many doctors hide behind ‘medico-speak’.
    I am sure in some circuitous way, the truth on this subject will eventually become mainstream but it will have to do a slow meander, so that it doesn’t look as though mistakes were made, or that commercial interests were a distorting factor (heaven forbid). A bit like the route that has & still is being taken to move away from demonising fat & taking a long hard look at sugar & junk carbs!

  10. Sue Richardson

    Masterly Dr K. And understandable too. It’s quite true what you say : “There is no point attacking the cholesterol hypothesis. Those who believe in it have created a majestic Byzantine world of mind-numbing complexity where you can wonder the corridors of ad-hoc hypotheses forever, and never escape.” In my own small way I try to talk to people. Those who have a medical knowledge (I have a nurse friend) think I am irresponsibly stupid. Others look blankly at me, tell me they see what I mean, and carry on trying to keep their cholesterol level low. I have been thinking all through this series that you seem to be saying that there is no one cause of CVD – so by George I got it! Thank you for such an interesting and informative series.

    1. Mr Chris

      I find your comment interesting, because debating with the believers is like a medieval theological debate. I find when I say I think the classification good and bad cholesterol is over simplistic, people shake their heads, and say I haven’t understood. As for saying that my cholesterol is the level of around 85% of the world’s population and therefore probably about right!
      I have a friend who had a mild stroke, he gave me his cholesterol readings, 90 HDL 70 LDL. He looked at me oddly when I said I thought he was the living proof of the incorrectness of the cholesterol hypothesis.

      1. Sue Richardson

        Chris. I think Dr K is right. There seems to be no point in trying to convince anyone. And yet – we were convinced in spite of everything we hear and keep hearing. So perhaps we should keep banging on. I have to say I have ‘t had any success so far, and it’s frustrating to see people having such a faith in error and not being able to convince them otherwise.

      1. Stephen T

        With friends like that . . .

        I think we do have a duty to try to tell people the truth and point them towards the evidence. As I asked my brother, “If cholesterol is bad for you, why are the countries with the highest rates of cholesterol those with the lowest rates of heart disease?” He’s an engineer and knows that when a theory produces the opposite result to that predicted, the theory is wrong. My brother was on statins and it took a year for him to decide to stop taking them. I wouldn’t have forgiven myself if I hadn’t tried to help, although I know it can be difficult.

        I couldn’t possibly smile if a friend told me that they were taking statins.

      2. Lindy

        It’s a resigned smile Stephen T, not a happy one. I have often had discussions with friends on the subject of Statins and tried to convince them not to take them without doing some research for themselves and steering them in the direction of Dr Kendrick, but they trust their doctor.

      3. PeggySue

        I agree with you Lindy. The majority of my friends / family wouldn’t listen to me anyway. Such is their faith in their doctor and acceptance of the low cholesterol, low fat, polyunsaturated, 5-a-day environment that we have lived in for years and years.
        They would look at me in the same way as some doctors do before they say “been googling again have we?”. Others would find it rather frightening.
        I’m also not sure how I would cope if something were to happen after I’d encouraged them to stop. After all, it’s not just a matter of statins is it. Readers of this blog are way further down the path than that and we have made our way gradually and for our own reasons.
        All I can do is keep an eye out for those that I can maybe guide towards the water and hope some may feel thirsty.

    2. BobM

      The nice thing about having people believe something is that you can use that against them at times. For instance, I’ve been on a low carb, high fat diet (with intermittent fasting) for almost three years now. During this time, my HDL (the so-called “good” “cholesterol”) has gone UP over 40%, my triglycerides (aka “blood fats”, though, as we know, this is a misnomer) have gone DOWN over 40%, and my total “cholesterol” and “bad” “cholesterol” (LDL) are basically unchanged (well, the LDL is slightly lower). Then I can tell them that I eat as much fat, and particularly animal fat, as possible every day, and in fact I eat exactly the opposite of how we’re “supposed” to eat according to the U.S. guidelines (eat no fruits, few vegetables, avoid most liquid oils, eat no “whole” grains whatsoever, eat lard and beef tallow and butter and liver and bone marrow and select the highest-in-fat cheeses and meats I can find, etc.), and yet my blood cholesterol markers have improved. And, I’ve lost 50 pounds while doing this. Why?, I ask them.

      Of course, then when they cannot reconcile this with their belief system, they tend to do what all good scientists do — they ignore it. 😉

      1. Gary Ogden

        joanne: I’ve had a similar experience with my blood lipids: TG 43, HDL 85, LDL 145. Makes me very happy. My doctor and I agree there is no further point in testing it.

      2. smartersig

        Wait a minute Cholesterol levels do not matter dont they ?. Don’t get me wrong I am not saying you are doing anything wrong, a similar things has happened to me although I am not high fat, just some fat eg nuts, avocados. If the main culprit is endothelial damage can we be sure that high fat does not damage the arteries

      3. Gary Ogden

        smartersig: I’m wondering what evidence exists implicating dietary fat in endothelial damage, and in what context. It appears from Dr. Kraft’s work that insulin resistance is the main driver of atherosclerosis, and dietary fat provokes only a small insulin response. What do you think?

      4. Dr. Malcolm Kendrick Post author

        No. The reason why I am putting together an alternative hypothesis is that I have come to realise that you cannot refute true believers in the diet/heart hypothesis. I am reminded of the tale of the psychiatric patient who believes that he is dead. No-one can convince him otherwise. A professor of psychiatry comes up with what he thinks is the ultimate refutation. He asks the patient ‘can dead people bleed.’ The patient replies ‘No.’ The professor brings out a small needle and pricks the patients thumb, whereupon a small blister of blood forms.

        The patient looks down at the blood on his thumb and says. ‘Well, what do you know. Dead people can bleed.’

      5. smartersig

        I am not one of the ‘true believers’ as I suspect are many others on here which is why I suggested refuting one or two. The main thrust of the piece was the criticism of conclusions drawn from non controlled studies and how the sat fat advocates may have used them to further their argument.

      6. Dr. Malcolm Kendrick Post author

        I am all for that. But you get drawn down and down and the arguments fracture and fragment. I will just make a couple of points. The dangers of smoking have never been subjected to a controlled experiment, the entire, saturated fat is bad for you hypothesis, started life as an observational study – as biased as biased can be – run by Ancel Keys. When Keys did, eventually study polyunsaturated fats vs saturated fats (in a controlled experiment Minnesota Coronary Experiment (MCE)) it demonstrated that saturated fats increased cholesterol levels, and reduced the risk of CVD and overall mortality. The more cholesterol was lowered the greater the risk. So he simply buried the data. Now he was a true believer. As were those who ran the Sydney heart health study – and buried the data. I think ‘the saturated fat is bad for you’ believers have done far more harm, and distorted the database far more than anyone on the other side.

      7. Gary Ogden

        Dr. Kendrick: Dr. Michael Eades published a blog post that everyone here should read, regarding original Framingham data which was never published. Why? Likely because it totally demolished the both diet-heart hypothesis, and the cholesterol hypothesis. In 1957! The statistician who worked on the first Framingham report put the data and conclusions into a monograph to be distributed to academics, and Dr. Eades found one to purchase. Damning evidence of the perfidy of 1950’s researchers, and what great harm this decision, along with the McGovern Committee, has done to the health of the public in the western world.

      8. smartersig

        What he seems to be saying is that the reliable way to test saturated fat and its effect on heart disease is to take a bunch of people and under controlled conditions decrease there fat intake and see what happens in relation to cardiac events. The emphasis has to be on cardiac events as Lipid levels are themselves are subject a whole raft of other possible influences when we say lower LDL means lower HD incidence. When you see results derived not from a controlled experiment but by simply sampling the population and asking them how much fat they eat you run into a problem. The problem is that no matter what fat consumption category they are in a whole load of other inputs cloud the issue. If you are cholesterol believer then cholesterol levels would be one such ‘noise’ input clouding the issue. My feelings are that although reducing sat fat may help, and if you look at the study he cites its only marginal although increasing over two years, its not the elephant in the room, sugar is.

  11. Håkan

    One favourite ad hoc hypothesis is how some proponants of the phlogiston theory suggested that phlogiston had negative mass.

    The phlogiston theory said that substances that burned in air were said to be rich in phlogiston. When burning the phlogiston left the fuel, and proof of this was that ashes were lighter than the wood. Problems aroused when e.g. Magnisium was burned; the Magnisium oxid was heavier that the original metal. So some people claimed that the phlogiston must have negative mass.

    Phlogiston remained the dominant theory until the 1780s when Antoine-Laurent Lavoisier showed that combustion requires a gas that has mass (oxygen) and could be measured by means of weighing closed vessels.

  12. Agg

    Dr K, whenever I read your blog I wonder how you manage to practise with your views so different from the mainstream. How do your patients take it? How do you deal with those who blindly follow the current official advice and keep their minds closed? Do you get many that actually appreciate your approach despite being bombarded everywhere – media, friends, colleagues – with opposite advice/views? Do you get many that complain?
    I have not had much experience with GPs – luckily so far – but the ones I met were all about ticking boxes, doing everything by the book, no thinking outside the box.

      1. JanB

        Hey, Dr. K – don’t call yourself that. You are 24ct gold and any patient who gives you flack doesn’t deserve you.
        THANK YOU!!!! (I’m shouting)

    1. Emma

      I’m sure we’ve all been wondering that! Hope your patients know how lucky they are.
      In a wider context, can’t help but be conscious of the shameful treatment of pioneering Drs who dare to rock the boat, despite being adored by their patients. There’s poor old Semmelweis way back in 1850 (worked out that Drs were killing patients by not washing their hands). Professor David Healy (pointed out that antidepressants can trigger violence / suicide). Among GPs – Dr Annika Dahlqvist (suggested Diabetics try less carbs), Dr Sarah Myhill (advised someone take a magnesium supplement, shock horror), Dr Skinner (prescribed thyroid treatment taking symptoms into account), and Dr Joseph Chandy (used safe, cheap Vitamin B12 to save his patients untold amounts of misery and disability). And doubtless many more beside.
      If anyone deserves to storm the cholesterol citadel, and plough the site with salt, it’s Dr K, though with so much at stake, hopefully it would not be a Pyrrhic victory. Long live the Stainless Steel Rat.

      1. Helen

        Emma: Interesting you should mention Drs Myhill and Chandy, since I receive advice and treatment from both (with Dr Chandy this comes via his charity, The B12 Deficiency Group). I see Dr Barry Peatfield too, without whom I would still be struggling on T4 and abnormally low cortisol. Dr Irving Spurr, a researcher into ME and its associated conditions, also had to put up with the idiocies of his colleagues, though fortunately he never had to cope with a GMC hearing. There are some other brave doctors out there. I never met Gordon Skinner, but from what his patients report, the stress of dealing with the GMC finally killed him.

  13. Håkan

    Malcolm, since your blog posts are labeled “What causes heart disease” it is consequential that people expect you to present the cause. 🙂

      1. Håkan

        Yes, you have made that clear! But I believe people would like to know what major factors cause the first step in the process, the endothelian damage. But are we thinking to sequential about this? Is it always an increased level/rate of endothelian damage that is the start of the desease? Or is there anything that we can regard as “normal” endothelian damage that then turns in to CVD by dysfunctional clotting and repair?

  14. Gay Corran

    Dr K, you have knocked the cholesterol hypothesis on the head, even though its proponents keep struggling to keep it afloat. I look forward to your discoveries on the process of CHD/ CVD. Thank you for enlightening us with this series and for making us laugh while doing so.

  15. 1truth1reality

    Before I give my halfpennyworth here – my identity. ‘One Truth one Reality’ is a previous nom de plume but equally descriptive of where I stand. As you have put it Dr Malcolm –

    “But the truth has a major advantage over sophistry. It is immortal. No matter how deep you try to bury it, It lies there, waiting to be discovered, pushing little green shoots up into the sunlight waiting to be discovered.”

    My real name – Geoff Broughton – famous for nothing but have as my response to Part VIII would demonstrate, been through the heart attack process, discarded statins after taking advice from Dr Malcolm’s book and many others (definitely does not include my GP, the hospital etc.). Again, not being a doctor, which, makes it easier for me to state that there is ‘one truth’. The uninitiated would not be bowled over by a statement such as this because one has to experience the truth first hand – a rare commodity! The truth is based on our very very human existence, that lies behind the conscious (or unconscious) ‘I am’ -although it would be equally futile to launch into some sort of diatribe on spirituality, which in itself would merely serve as ‘attack’ thoughts to ever so many. So, and like you Dr Malcolm I shall refrain, even though I have a very strong feeling that the truth lies behind some of the words used under that heading that merely serve as signposts to a general area of enquiry where the truth will eventually be found. But fortunately there is somewhere else that we can gain a modicum of that truth that is to come.

    I refer to simply taking on board the stories of those that have been through the process of heart attack and found their own healing processes. There are many, many of these of course and most have circumstances in common. In fact I would say that it is amazing how similar some of the stories are. Fortunately for those that prefer the scholastic remedy these ‘solutions’ can not be scientifically documented in such a way as to overthrow the medical academia as you Dr Malcolm have already pointed out in the past. But what we can do is to take these private solutions on board and say yes, that definitely worked for that individual, there is no doubt, just “look at him now”. Would the scholar then turn round and say “ah yes but he did die 20 years later, so….” Never ending circles of course. I would therefore suggest that we look at these solutions, and find those common threads.

    One massive one as I see it is the massive increase in the consumption of sugar in the last 150 years. TV, radio and other press reports occasionally touch on it – but are never serious in truly taking it on board, and that originally stemmed from the lobbying of the industries involved, mainly in the 60’s and mainly in the USA to increase the consumption of sugar and cereals (many cereals convert to sugar in the body but they are incredibly profitable) – hence it is predominantly displayed in most supermarkets. What cereals are bad for you?? They certainly can be, bread and obesity for instance, but yes including those cereals that you put in your breakfast bowl!

    Rather than so called medical science there is much in recent history that can serve as pointers.

    Reference: the amazing graph of Ancel Keys for instance!

  16. Mec Cham

    Thank you Dr Kendrick – superb. So, does one take it that possibly there is ‘no’ single factor in CVD, it is more likely multifactorial ? Let the hounds run, there is no single quarry to be brought to bay… You assuredly make the best ‘master’ ever. Again, huge thanks –

    1. Dr. Malcolm Kendrick Post author

      Multifactorial, of course. But one must attempt to understand the process around which the multiple factors operate. RBC membrane width, smoking, diabetes, fibrinogen, Avastin, RA, SLE, cocaine use, Hughes syndrome, anxiety… these are all causal factors. Until you can identify the process into which these all fit without twisting, bending – or simply ignoring, you are just mumbling multifactorial as a defence mechanism for the cholesterol hypothesis. [Not you, of course, but the mainstream]

      1. 1truth1reality

        Causal factors Dr Malcolm? Surely symptoms only where the only causal factor must stem from the state of mind which drives our thoughts and all our activities?

      2. Stipetic

        I see causation as follows. The inciting event – Dr. Kendrick mentions there are thousands of these – is damage to the endothelium. If the healing process is functioning properly, then the incidence of CVD should be low to non-existent. However, if the healing process is dysfunctional, it can lead to CVD. A quasi-binary choice, which should make the theory easily testable. In essence, mainstream sees one of the thousands of inciting events as the cause and remains focused on finding that cholesterol-rich needle in that haystack while a dysfunctional healing process looms in a pond that seems absent of black swans. My apologies for the mixed metaphors.

      3. ellifeld

        I’m pretty sure the reason the entire focus is on cholesterol is simply because there is a mechanism to control it. If they figure out other mechanisms then they will be the target.

  17. David Bailey

    That was a brilliant description of a process that is, I believe frighteningly widespread in modern science.

    I can only add a whimsical metaphor.

    First you start with a nice simple youthful hypothesis – that cholesterol causes CVD.

    Then some horrible fact comes along to damage the hypothesis.

    The medical research ‘body’ abhors an open wound like that, so it patches it over with the LDL/HDL hypothesis. The hypothesis isn’t quite so youthful any more – a bit lumpy – but at least it is still functioning.

    Then another horrible fact comes along to damage the poor cholesterol theory, so further arbitrary hypotheses are generated until one of them plugs the gap so the cholesterol theory can survive a bit longer.

    Then one day our poor hypothesis meets a really vicious attacker (known as an MK factor) that eats in to all the layers and exposes a huge wound that attracts blogers and even some of the medical researchers that are supposed to defend it.

    Now it is only a matter of time before the huge decaying hypothesis breaks loose and blocks the financial arteries of the medical research system!

    1. Martin Back

      As Max Planck put it: “A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.”

      We can be pretty sure that all those who defend the cholesterol hypothesis will eventually die, perhaps sooner than they might think.

  18. Joanne McCormack

    Dear Malcolm
    Your article made me laugh out loud after morning surgery finished- thanks. This morning I stopped another statin in the basis of total body pain for 12 months. I’m not the only GP who is totally with you & against the cholesterol hypothesis. Many GPs don’t believe in statins either , and wouldn’t take them. They are well aware of the controversies and about the hidden trial data on them.
    I’m disappointed you haven’t been able to find the cause of heart disease though 😊 , I expected no less than that from you!
    There is definitely a religious aspect to a belief in statins and so I’ve stopped directly challenging doctor believers. I just point out they can get even better lipid results from LCHF ways of eating Which is free from cost and side effects. I also say that the unpublished data stops me from being able to draw any positive conclusions about efficacy and safety. I also see a lot of statistical shenanigans going on with published data. Just my observations.
    Your readers’ doctors might appreciate the growing body of fun books and video clips against the cholesterol hypothesis. I’ve put them on my website- you get a mention of course – http://www.healthylivingsite.me under cholesterol references.
    Best wishes

    1. David Bailey


      I went to your website, and I want to commend you for taking a stand regarding statins and cholesterol. I am not sure how easy it is for a GP to come out in this way – particularly publicly on the website, but I am sure you get some flak for it.

      I wish more GP’s would come out against statins and the lack of decent side-effect data. I discovered just how horrible these can be, and consider myself lucky that everything cleared up when I stopped – how nice it would have been to have had a GP who warned me in advance!

      Since then I have talked to many people my age (in real life, not on the internet) with statin stories to tell, and clearly statin side effects are very common.

      1. Joanne McCormack

        I have taken no flak from GPs and I get various responses falling into these categories
        1. The data is compelling on statins and I firmly believe in them. Some of these people also admit statins are pretty useless for primary prevention.
        2. I have never liked them and I wouldn’t take one. Linked to this I hear- “you just end up demented in a nursing home on a pile of medication”
        3. They are like marmite , you either like them or you don’t- this one makes me go Aaaarghhh! Are you a scientist or what –answer no, no longer: I’m too busy to think for myself and question what I am doing.
        Actually, the busyness and low morale is a bit part of the reason for lack of progress on this IMHO.
        Spread the news, tell all your friends, inform all your GPs, we have been conned. A massive proportion of people are on statins for no good reason and without fully being informed of the risks and benefits.


      2. David Bailey


        I think even the people who are on statins for secondary prevention (i.e. after a CVD event) should be explained the relevant NNT and NNH for their treatment, because these really make people think. I know a man who has some problem with constricted arteries in his legs, and he struggled on statins for some time with memory problems and muscle cramps before he simply had to stop the treatments (before I knew him). I know someone else who had a heart attack but recovered and was put on statins, and she was finding it hard to walk because of pain in her legs. She had previously had a hip replacement that had not gone perfectly, so she wasn’t sure if the new pain was due to that or the statins. Her doctor didn’t want to blame the statins, but I showed her this site, so in the end she came off the drug on her own, and sure enough the extra pain has gone away.

        I mean exercise is also important in staying well, and I suspect that those people who don’t realise what the statins are doing, or who take the view that their doctor knows best full stop, may end up taking little or no exercise because it becomes too painful, or their walking becomes unstable.

        People have traditionally ignored medical advice from friends – indeed when I began getting pain in my polio leg, a friend suggested that it might be the statins, but she isn’t in medicine, so I ignored her, and was afraid I was getting Post Polio Syndrome (it must be frighteningly easy to rationalise painful limbs and joints in terms of past injuries, etc). I really think a lot of people are crippled by statins, but still taking the damn things!

        However, I also know a man in his 70’s who goes rock climbing while taking statins, so no rule fits all!

      3. Mr Chris

        Hi David,
        The reason I never try to convince people to come off Statins, is that I don’t know their full medical history, I don’t know why their doctor put them on them. I have a friend who had a stroke, his doctor put him on Statins. I pointed him in the direction of the books and this website. He asked me if I had read the Cochrane commission report, when I replied that I had, but was still not convinced, he smiled and told me I am not a doctor or a statitics expert.
        If he keels over with a heart problem, I don’t want reproaches from his widow.

      4. David Bailey

        Mr Chris,

        I totally agree that it is desperately unsatisfactory that non-medical people end up having to give medical advice to friends. I always try to give any advice semi-second hand by pointing them to this site and Dr Kendrick’s books. I also try to avoid being pushy about it. The problem is that people are having their lives absolutely ruined by statins. I know from first hand experience that I degenerated from someone who was quite fit and walked the hills, to someone who didn’t even feel completely secure on my feet (fortunately, and revealingly, all this gradually reversed when I stopped the statins). Nor did I feel comfortable sitting down. Living like that for long would soon have worn me down. So seeing someone else sliding down the same slippery slope, it is impossible not to do something.

  19. Danny Evatt

    Excellent summation! As a comparison, perhaps use a broken arm analogy.

    Current medical thinking would say all broken arms are caused by a lack of calcium in the bone (current CVD cholesterol mantra.) Whereas the good Dr. is telling us that broken arms can be caused by many things; falling out of a tree, etc.

    This correct way of thinking is worthless to the drug industry and the medical establishment as one size does not fit all. But it is correct none the less.

  20. Craig E

    I have really enjoyed reading the series. Since my Biochemistry days back in the late 80s I have never believed that cholesterol caused heart disease. When I found out that my 70 year old mum was on statins I wrote to her doctor citing references and such….her response was “i don’t have time to look at the studies you’ve referenced”. And that folks, is likely the response from the majority of GPs. The brochure says “high Cholesterol – feed statin”. I have also spent a lot of time looking into carb vs fat metabolism and diabetes. Dr K wrote some great articles in this area. However, like the elusive (until now) process of heart disease I need to understand the process of diabetes in more detail than just “it’s insulin resistance or decreased insulin production or sugar wearing out the pancreas or PUFA peroxidation “. After all, blood sugar can be high for many reasons, not just due to insulin/glucagon mix (eg cortisol, thyroid, adrenaline). What is really going on here? Hopefully one or more of the talented readers of this blog can point me to some studies that help here. Or may I suggest the next big Adventure for Dr K . The more I read, the more overwhelming it all becomes….no wonder these things can take 30 years to sort out!

    1. Tina T

      I’d love more on this one, too… and the link to statins. My 70+ yr old dad was on statins for the last year or two, and he FINALLY got the doctor to admit that the statins were causing undue increases in blood sugars… after they measured OVER 600! I just hope the damage done isn’t permanent. These unthinking doctor recommendations make me very sad. 😦

      My insulin resistance theory takes in the increased consumption of fake sugars… you eat fake sugar, your body sees “sweet! add insulin!”… but then it has nothing to do, so the body (which is highly adaptable) stops making insulin in response to sweet signals… and thus… insulin resistance is created.

    2. Jennifer

      Craig, I am deep into trying to understand diabetes 1.5, for personal reasons. ( not about myself, as I was considered to be plain and simple type 2). I am using the Internet to research as much as I can, and that is about as good advice as I can give you, I am sorry to say.
      I ceased visiting my GP and diabetic nurse 3 years ago, as I felt they had a limited understanding of their speciality, and had been steering me completely down the wrong road regarding dietary advice and pharmaceutical management of my ‘diabetes’. I use inverted commas, because quite honestly at the time of ‘diagnosis’, my blood glucose levels were really not much elevated in the great scheme of things. But I complied for 10 years……eating the daft recommended high carb diet, and taking ever spiralling medications….no blooming wonder I finally accepted being labled with type 2…..I was certainly feeling a very ill person, and deteriorating fast! I felt I had little to lose when I turned my back on the ludicrous situation 3 years ago, and the rest is history! ( I am fit and well). To be honest, I think I was heading for an early grave.
      However, I certainly accept that diabetes in various forms exists for many unfortunate people, and much work needs to be done in regard to causes and management regimes. We need a better understanding of the term ‘ diabetes’, because it covers a multitude of scenarios. At the present time, in my limited experience, our NHS management slots us into type 1 or type 2, end of, and blinkered GPs and diabetic nurse specialists seem reluctant to move with the times, and admit there is much for them to learn. What’s that old phrase? “Ignorance is bliss”…..but it is NOT ACCEPTABLE for medical professionals to languish in the time-warp of their student days.
      As I read Dr Kendrick’s new post this week regarding all the confusion about CVD causes, diagnoses and treatments, it rung a loud bell in my quest for looking for an explanation of 1.5 diabetes…..one thing for sure, there is precious little conclusive stuff out there on which to latch onto, so maybe I am being over critical about professional ignorance, because management of type 1.5 seems complex and individualised…..again, on a par with CVD.
      In the mean time, I use my own diet, LCHF-based, which is proving just the job for me and mine…..I no longer invite discussion about my apparent idiosyncrasy, …I just keep it to myself, ( apart from this blog), and succesfully get on with my life.
      It seems an imposition to ask Dr Kendrick to side step his core interest of cardiac disease, and take on the task of unscrambling the mish-mash we know as diabetes…..but it would surely make interesting reading.

      1. Dr. Malcolm Kendrick Post author

        I have looked at diabetes for many years. My views on this are even more ‘out there’ than my thinking on CVD. Firstly, stop calling a raised blood sugar level a ‘disease.’ Then, start thinking.

      2. Joanne McCormack

        Dear Jennifer
        You letter is so interesting that I have printed it off to show patients what can be done.
        Dr Kendrick is already helping many of us in our quest to get the right information into the public domain.
        I’m one of a group of 12 doctors from different spheres campaigning for accurate dietary advice for all people, and diabetics in particular. Our website is http://www.PHCuk.org and our first conference is on 11th June in Birmingham. If you look at my website you will see how I ( and my colleagues) approach diabetes. It is http://www.fatismyfriend.co.uk
        You can email me joannemccormack@nhs.net or Sam Feltham from the PHC website if you want to become involved. I love including people in my presentations who have been successfully following LCHF ways of life for a number of years. There are many other ways to become involved too.


      3. Helen

        Jennifer, I’m going off on a tangent again, I know (sorry Malcolm), but could you recommend a book for my father-in-law to read? He was diagnosed with Type 2 after a mildly raised blood glucose test about 10 years ago. He’s been on medication ever since and his health is deteriorating. He’s a retired academic in his 80s, who has lapped up various books I’ve given him including Malcolm’s books. Having read Dr K, he has avoided statins. He isn’t the type to stop a treatment once started though, so he’s still on the silly high carb diet for diabetes and taking metformin. He’s not on the interweb – only a (semi-)scientific tome will do! My grateful thanks for any suggestions.

      4. Jennifer.

        I must add that I never actually advise anyone to follow my example, but just to consider how I, and other contributors to this blog, have managed so well since doing an about-turn regarding the NHS dietary guidelines for diabetics.

      5. JDPatten

        Dr Kendrick,
        In August of last year there was a vigorous discussion here involving Dr. Roberto Illa on turning diabetes upside down. You voiced your intention to hash it all out with him one-on-one.
        Anything come of that?

      6. David Bailey


        I think you will find that Malcolm’s books cover well the fact that the evidence against the consumption of saturated fat was cooked up (sorry for the pun) by Ancel Keys. As I understand it, it is this bogus evidence that saturated fats cause heart disease that justifies the low fat high carb advice to everyone, and particularly diabetics. Perhaps a careful reading of those sections of his books would persuade your father-in-law to try a LCHF diet.

    1. Joe


      I hope the good doctor uses only one more Roman numeral – X. Where he sums up, including identifying the things folks should/shouldn’t be doing (diet, lifestyle, helpful supplements, etc.), and which covers the most bases possible, as far as avoiding/reversing CVD.

      Nota bene: There were only ten commandments.

      1. Gary Ogden

        Thirty seven posts would make me very happy, but I wouldn’t get anything else done except for feeding the cats and letting them in and out.

      2. Mr Chris

        Dear Dr K
        If we are looking for magic numbers, don’t forget the twelve days of Christmas.
        On a more serious note, and since part ix is a sort of summary of where we are today, I started reading the Cochrane Collaboration 2011 report on Statns in primary care, which is, I suppose, how many of us got here.
        It seemed to be from another planet, no side effects, get TC to very low levels etc. This probably seems off-topic, but could you give us a brief opinion on it, I used to have a high regard for them.

      3. Kevin O'Connell

        So, we don’t have to worry about getting to CLIV then (Shakespeare’s sonnets), only XXXVII.

  21. ellifeld

    I understand that since the low fat craze was instituted originally by Ancel Keys and then set in stone by George McGovern (from a grain producing state) with the Dietary Guidelines in 196? (at least in the US), has produced an explosion of obesity, heart disease, stroke, diabetes, etc. much to the delight of the pharmceutical industry. Since millions have taken statins in the last 30 years or so, is it just possible that these drugs are also contributiing to the increase in heart disease?
    Also there seems to be information about increases in alzheimer’s diisease occurring. If 25% of our cholesterol is used by our brain, and might not be making it there because of statins, wouldn’t it make sense that statins might be part of the problem here?

    1. Stephen T

      Memory loss is a well known symptom of statins. On the other hand, many people who abandon the low-fat diet and then eat more fat report a boost to mental alertness. Two big clues to Alzheimer’s and how to avoid it.

    2. Joanne McCormack

      Yes, cholesterol is essential for life and for our brains of course.
      Nursing homes are full of demented people on shed- loads of drugs including statins. Cause or effect? It’s not what I want for my final years.

  22. kenmorgan

    I’m dim. Can we identify the multifactorial suports for a healthy CV repair system? So where are Walk or run three miles a day? Drink plenty of fluids? Avoid high amounts of polyunsaturated oils and other inflametary substance? Don’t eat too much carbohydrate?

    1. Joanne McCormack

      Hi Ken
      We are working on it via a new organisation called the Public Health Collaboration. 12 doctors founded it with a crowdfunding initiative last month. It’s a charity- have a look at our website and support us if you like what you see. Our first conference is on 11th June in Birmingham.

      On Twitter too.

      1. kenmorgan

        Thanks for your response, but I can’t say I liked what I saw. Nina Teicholz’s book, “Big Fat Surprise” among others, has done a good job of deconstructing what has passed for diet “science” over the last 50 years and it is not pretty. Confirmation bias, moral hazard, incompetence, ambition, and group think has dominated the field. It seems your team is just tweaking advice that has been dolled out without good science to back it up. For starters, you might drop the notion that one diet is good for everybody. We may have genetic differences that are important. The Cheyenne and Souix nations consumed about 4 buffalo per person per year with very little carbohydrate in their diet and were taller and more robust than the European Soldiers who fought them. On the other hand, the Trobriand Islanders subsist largely on yams and seem healthy. Nutrition science is more of a shambles than heart science. I know I asked for answers, but I would be much more supportive of an organization that is ready to start from scratch in research and focus first on what we really don’t know instead of rushing to tell us what to eat.

      2. joanne mccormack

        Hi Ken
        Thanks for your feedback and we agree that one size does not fit all. When I deal with people 1-1 I tailor my advice to their preferences and amend it according to their subsequent response.
        We haven’t actually produced anything as a group yet, bar the website, but will by 11th June.
        Your points are very valid, and one of the reasons we started this was because the one size fits all advice was inappropriate.

      3. Jennifer.

        Joanne…yes, I like what I see on your site, but, one little crib after your great and positive encouragement for people to return to eating real food….’discuss with your GP or nurse’. Why?
        I think we have more or less shown over the last few years that a majority of NHS nurses, dieticians, nutritionists, and medics, are the last people to talk to about such an important issue. Yes, in their quiet moments, and in private discussion, some may well understand the issues….but in the current state of affairs, where NICE and Big Pharma rule the roost…..they are unlikely to pass on any decent knowledge they believe in, or indeed, put into practice for themselves and their nearest and dearest. Cynical, Moi?
        Good luck with your Public Health Collaboration….sounds great, and a brave move by you all.

      4. joanne mccormack

        Hi Jennifer
        The reason for advising people to discuss with their doctor or nurse is that they will be able to advise on decreasing the medication as the BP and blood sugar come down. Our local nurses and doctors are very aware of my approach and many people refer to me now. I realise this may cause confusion in areas where GPs and nurses are not enlightened so I will have to change the wording. Thanks for pointing it out. I’ll sort it shortly.

      5. Stephen Rhodes

        Hi Ken,

        You say “We may have genetic differences that are important.”

        We most certainly do, and there are probably quite a few of them.

        The one that interests me is the number of copies of the AMY1 gene that, in humans ranges from a couple to 15 (at the last count).

        This determines the amount of salivary Amylase you produce which in turn determines how you deal with starch in your diet. The more copies you have the ‘better’ you can process starch, there is an inverse correlation with a tendency to obesity/diabetes.

        Doubtless the number of copies would have been quite consistent within small tribal groups living on the same diet for thousands of years, but we are now much more genetically diverse. A simple test, either for salivary Amylase or – more expensively – the number of copies of AMY1 you have might lead to more soundly based dietary advice.

      6. kenmorgan

        Very interesting. That’s the kind of research that might explain my own miserable experience with low fat diets as well as their success for some people. Yes, you go to Vietnam and everybody looks the same. You go to New York city and on a walk down a few blocks you might see a hundred different physiological types from all over the world—people now mixing and breeding with one another. The indigenous community diet has been replaced with a cacophony of food choices along with the loss of some. I’d just like to know what my aboriginal diet was.

    2. maryl@2015

      What Kendrick has said for years is that although it is multi-factorial, you must look at each individual to assess his or her “risk” factors for vascular disease and many others for that matter. It does little to have a formula if you cannot figure out your own health profile. Therein lies the challenge

  23. Dr. Göran Sjöberg

    This inspiring post really appeals to my present inclinations of thinking.

    Since it is about the theory of science as well as the ‘paradigm’ shifts in science I think it is appropriate to remind interested readers not only of the seminal work of Thomas Kuhn, “Structure of Scientific Revolutions” from the 1960th, but also the pioneering book “Genesis and Development of a Scientific Fact” written 1935 by Ludwik Fleck; actually the same year Karl Popper published his “The Logic of Scientific Discovery”.

    Here I must say that Fleck’s book is much more “food for thought” then Popper’s not least since it puts knowledge/science of medicine into a social context and specifically how the concept of syphilis as a disease changed during the centuries since it was first recognised about 500 years ago.

    Even Susan Sontag’s “Illness as a Methaphor” may add some more ‘food for thought’ with a philosophical and social perspective and in her case about TBC,.

    1. 1truth1reality

      Hi Dr. Göran – Just for clarification my posts and replies have been under Geoff Broughton as well as this one shown here. I have not read the aforementioned books however I have been led to believe that it is all about first hand experience and the first hand experience of others when it has been expressed as such instead of a theory or opinion. What always gets in the way of course, is our opinions and theories the stuff of our ego. Unfortunately a great deal of what has been said here comes under that category, but fortunately there is also the accounts of people’s own experiences.
      So – what are we left with – your experiences, mine and those of others which you have already pointed out are very similar, and if I was more in tune with the effects of stress (we appear both to have experienced stressful events) then I believe that more similar accounts could be useful in going forward. The drug companies would dislike that I am sure – but also we may dissuade so much theorising. It might be advantageous if we didn’t have a clue what was under our skin and inside our bodies!!
      This is obviously the briefest of intros, and of a subject that I have tried to lead into, plus I am probably ill-equipped to take this forward. Please forgive the ramble and what may appear critical to many. Just trying to move some stuff out of the way.

  24. Martin Back

    When you say “there is a process”, is this the sort of thing you mean (very simplified)?…
    – at a break in the endothelium a clot forms
    – the clot grows and grows
    – eventually it breaks off and causes a heart attack

    The endothelium was damaged because of Faxtor X, the clot grew big because of Factor Y, and Factor Z caused it to break off.

    There is no “One Cause” — Factor X, Factor Y, and Factor Z all played a necessary part.

    The analysis of CHD becomes more like an aircraft crash investigation. Let’s say it’s determined that a vital part broke. It never ends there.
    – Was the part defective? What went wrong during manufacture? How did it slip past quality control?
    – Should the part have been replaced during routine maintenance? If so, were the maintenance manuals up to date? Were the correct spares available in the store? Did the technician have enough time to do the job properly?

    There are thousands of questions that need to be asked, and the system adjusted to accommodate the new knowledge learned. And as a result, air travel gets ever safer, but never completely safe.

      1. Maggie

        Dr Kendrick, Thank your for this wonderful series which gives someone like me with very high cholesterol numbers hope. I am confused about one thing. If CVD is a disease of dysfunctional blood clotting, at what point does the clotting become dysfunctional? If I’m understanding so far, the clot is initially a kind of bandage on an injured part of the endothelium, which gets covered over with another layer of endothelium and then dissolved/absorbed as the wound heals. Is that right? What makes the clot dysfunctional, how does that manifest, and what causes it? The clotting itself isn’t dysfunctional, is it? It seems in this explanation to have a very beneficial and necessary function. Pro-thrombotic elements can’t be totally bad if in fact the clot is a necessary part of healing. Thank you.

    1. Dr. Göran Sjöberg

      Most aircraft crashes are still due to the ‘human factor’ and my belief is that it is the same with CVD. In my own case I am pretty convinced that it was mainly my own ‘life style’ ‘fault’.

      1. celia

        Goran, I wonder if you were maybe following the current dietary advice at the time. I remember my doctor telling me about 15 years ago that I should eat at least 4 slices of bread a day: and then there’s the advice to give up natural saturated fats and replace them with manufactured vegetable oils. Just the opposite of what I have since learned to follow.

      2. Dr. Göran Sjöberg


        Before 1999 and my “crash” I didn’t bother much of what I put into my mouth from a health perspective. Everyone, and especially my wife, though noticed that I was very keen on cookies of every kind, a “cookie-monster” as my wife expressed it. At that time I was though very restrictive towards alcohol but evidently that didn’t benefit my health. Life at that time was also filled with a lot of ‘negative’ stress.

        What I then realised, by doing my homework to solve my ‘problem’, was that the combination of hardened vegetable oils (margarine), flour and sugar combined in the cookies was probably not the best health choice and I left my addiction behind although it is still luring. I got me another job as well to reduce the stress and took also my bike regularly to work. My wife added a glass of red wine a day together with some other supplements ‘good for the heart’. She was really keen on keeping me alive 🙂

        When my wife then turned seriously diabetic 2009 we adopted the strict LCHF-lifestyle and with amazing health benefits.

        My present belief is therefore that when you haver ruined your health and at 50 + have entered what is sometimes called the metabolic syndrome, with all its markers (“risk factors”), it is ‘all’ about insulin resistance (rather an effect than a cause) and then your body is fighting a downhill battle (which we all finally will lose) and the best choice in that situation is to “throw all carbs out” since the carbs are so strongly connected with your ruined insulin homeostasis.

        Anyway there seem to be a logic involved here and the ’cause and effect’ idea seems to work practically – at least for us.

        But as always the complexity of life is so overwhelming. One of the few items we actually can do completely without in our food system is nevertheless the carbs which might tell you something.

      3. Gary Ogden

        Dr. Goran Sjoberg: This is precisely what Dr. Price discovered in his world travels in the 1930’s (and which I didn’t learn about until 2010): that it was flour, sugar, vegetable oil (and canned goods), what he called “the displacing foods of modern commerce,” that destroyed the dental and physical health of once-vibrantly-healthy people. Nutrition and Physical Degeneration is still in print, and still a good read (available from PPNF).

  25. Stephen Rhodes

    It is very intriguing.

    Trying to get it clear in my mind where the clots can form and end up in the heart.

    Just had a look at the circulation in the heart – i.e. the places where a blood clot will cut the supply of blood to the heart muscle, causing a part of the heart muscle to die and either kill you then and there or lead to the death of enough muscle that you end up overworking the rest ?leading to fibrillation (cramp in the heart muscle).
    It appears that there are two branches (sinuses) off the aorta feeding the two coronary arteries (strangely there is a third sinus that does not usually lead to an artery ? do some people have an extra ‘feed’ to supply blood or is this sinus a sort of ‘appendix’ no longer used part of the anatomy or does it supply the collateral circulation should that form).
    These are coronary arteries are small arteries – compared to the aorta.
    So, either a blood clot forms in the pulmonary vein, passes through the chambers of the heart into the aorta then into one or other of the coronary arteries where it forms a blockage?
    Or a clot forms in the left atrium or left ventrical of the heart itself and from there passes into the aorta and into a coronary artery?
    Or, a blood clot forms in the short length of aorta (? how short) before the aortic sinuses, or the blood clot forms in one of the coronary arteries forming a blockage very close to clot formation?
    And, if a clot can form in a coronary artery, can one also form in the collateral blood supply network?
    I gather from what Dr Kendrick says, that plaques do not form in veins so, given the plumbing involved, any blood clots formed in the arteries after the aortic sinuses cannot be responsible for blockages in the heart, and even stroke has a greater length of potential clot-producing artery before the carotid arteries reach the brain.

    I guess I am looking for places where blood could be significantly ‘contaminated’ with anything that shouldn’t ideally be there, so post-liver, post-kidney, that might contribute to ‘kicking over the edge’ one or other factors of clotting dysfunction.

    1. Antonio Heitor Reis

      Good point Stephen!
      Here you are putting “clot theory” in trouble! The coronary arteries originate from the left side of the heart at the beginning (root) of the aorta, just after the aorta exits the left ventricle and its diameter is very small as compared to that of the aorta. Then, clots must be originated in the coronary artery, because due to the local hemodynamics they are unlikely to be originated in the aorta. Then, according to “clot theory” some plaque in the coronary artery has ruptured prior to clot formation. So far so good!
      Hence how “clot theory” explains why large plaques seem not produce clots. In fact we never heard about:
      a) liver attack and the consequent “liver ischemia”
      b) kidney attack and the consequent “kidney ischemia”
      b) arm attack and the consequent “arm ischemia”
      c) etc…..

  26. Gary Ogden

    Bravo, Dr. Kendrick. Best one yet. A disease of dysfunctional blood clotting. Elegantly and simply put.

  27. michael goroncy

    Kendrick MD
    Although not your responsibility, it would be a useful guide if you could address the people here that for some unknown reason: Refuse ‘medication and Intervention-al Surgery’.

    (1) Drugs..extend lifespan and heal disease. Problem: they are over-prescribed and often unnecessary/poorly chosen, which causes more problems than heals. Find someone savvy with a ‘Prescription pad’.
    (2) Surgery…same reason as medication. Greed often makes them unnecessary. Tricky situation, how to avoid ‘Stent happy’ surgeons.
    (3) Pharmaceutical companies…they lie, cheat and do not work in the ‘Publics interest’.
    (4) Don’t bother ever showing ‘medical literature’ to your GP. They regard you as a ‘Mosquito/pest’…find a GP that does not need educating.

    1. Joanne McCormack

      Rather than give medical literature to your GP I suggest you give them a little statin exemption form of your own design.
      I, insert name, hereby declare that I am not going to take a statin because I have assessed the risks and benefits and decided that the former outweigh the latter. References can be supplied on request. Please exempt me from the relevant QOF indicators.

      1. Gary Ogden

        ben: Like you, I’m quite interested in Dr. McCormack’s approach to high blood pressure therapy. Hope she gives us some insight.

      2. ben

        Hope so. I hate taking the meds. Don’t know what kind of damage they are causing but blood pressure goes really high if I stop.

      3. joanne mccormack

        Hi Ben
        I advise people to eat real food, and to minimize foods high in starch and sugar. If people have hypertension their BP may drop through doing this and they may eventually come off medication. I usually reduce medication once the BP is at or below 100-110/60-70. I have spoken to people who have come off multiple medications in this way, as their weight and BP have dropped. The only supplements I advise are added salt and magnesium, and those only if people get cramp on LCHF.

      4. Ben

        Thanks for replying. I do low carb but it hasn’t done anything for my blood pressure. Do you have to stop meds slowly or can you just stop.

      5. Joanne McCormack

        If your BP is still high you should stay on your medication and discuss it with your doctor.
        LCHF reduces BP on the whole, but everyone’s response varies. It can take some time to come down, but there are no guarantees.

      6. joanne mccormack

        With regard to BP therapy I discuss lifestyle changes and whether a person would like to try that as an alternative to an extra drug- or a drug in the first place. If lifestyle changes do not work then medication is an option. Lifestyle- real food, stopping smoking, less or no alcohol depending on wishes. Possibly ketogenic diet if a lot of weight to lose.

      7. Gary Ogden

        joanne: Thank you very much for your input. I do all of those things. It wasn’t till I gave up grains (two years ago), and became truly low carb, that my BP began a downward trend. I was once on three drugs: a beta blocker (dangerous positional hypotension from that one), a diuretic, and an ACE inhibitor. The last and final one is the one I’m weaning from, on my own volition, and with complete confidence that it is a wise decision. I am blessed with a GP who is comfortable with patient self-experimentation, providing it has a biologically plausible foundation and research to back it up. I have long since put behind me the stressors which raised my BP in the first place. My last reading in the doctor’s office was 131/78 (with 20 mg Lisinopril), in winter, when BP is normally higher anyway, and vitamin D and NO are less available. Dr. Kendrick’s blog has been a Godsend to many of us who are wresting control of our health away from a profit-obsessed industry/government cartel. By the way, giving up grains caused the melting away in short order of the small amount of visceral fat I had. Much to be said for this!

      8. John

        Hi Gary, you have done very well. Wish I could. Am mainly low carb. but do love wine. Do you still drink. my blood pressure hasn’t changed since going low carb am still on the meds but want to come off them.

      9. Gary Ogden

        John: Yes, I still enjoy red wine, but I’ve learned to moderate my consumption (a bottle normally lasts three days). Although on special occasions I throw out the rule book, I never desire more than two drinks. My continuing improvement in mental and physical health has made this moderation easy for me (retirement helps, too, since I have a wide variety of interests and activities which working made me largely put on hold). I can’t emphasize enough the liberating and health-enhancing influence of knowledge in my life, and building that knowledge into a scaffold of understanding, from Dr. Kendrick and all the commenters, from Dr. Mercola, Dr. Price, Dr. Holick, Dr. Seneff, Dr. Kraft, Mark Sisson, Denise Minger, Allan Savory, and many others whose names slip my mind at the moment, and all the vaccine research I’ve done. I no longer trust anything printed in newspapers or promoted by the government/medical cartel, unless diligent research on my part shows that it has a sound basis. It is enormously gratifying and liberating to begin to understand how the reality we have been spoon-fed is not actual reality. It is a construct which most of us don’t have time to examine because our lives tend to be filled with trying to make a living, and we have been trained to fear the unknown (heart disease! cancer! terrorism!) The beginning of understanding which is one of the clear benefits of aging has opened my heart to great empathy and love toward my fellow creatures, including humans (but not snails and slugs; I readily murder them). This joy is my replacement for religion, which I abandoned decades ago. Like Dr. Goran, I find the Bible enormously interesting, filled with insight and truth, but church and theology I can’t stomach. Having cats helps, too.

      10. Gary Ogden

        John: Sorry, forgot two things. First: Dr. Graveline, a very important source of understanding BP. Read everything he’s written about it (spacedoc). Second: Give it time. My BP has gradually improved over the two years I’ve been truly low carb. Healing takes time, and be open to tweaks in your diet. I aim, by confining my diet to nutrient dense foods, to consume all the necessary vitamins, minerals, and phytonutrients from food. Pay attention to your gut microbiome (fecal character, timing, and ease of elimination are important clues), and assist it by consuming fermented vegetables (and fruits if so inclined), and dairy if you wish. The fermented vegetables should be considered condiments rather than dishes, and eaten in small portions. I eat fermented foods at every meal, and (1 cup/240 ml) raw milk kefir daily. A healthy gut microbiome is absolutely crucial for optimal health. They feed on indigestible soluble fiber from fruits and vegetables (grains contain this, too, but have so many downsides I suggest avoiding them, especially wheat-my wife and I both like sushi, so I occasionally have white rice, which is the least problematic of the grains). The only good advice the government gives is eat your vegetables.

      11. joanne mccormack

        I discuss the options. Lifestyle vs drugs for hypertension. I find the LCHF way of eating helpful if people are interested http://www.dietdoctor.com
        Some people are on masses of drugs and many can reduce or come off if they commit to a ketogenic diet. Google “Jeff Cyr and how a ketogenic diet saved my life” – he did it for diabetes and liver disease and I have seen others do it for hypertension and gout.

    2. Joanne McCormack

      Dear Michael
      Re point 4 a GP would be responsive to a lilttle statin exemption form.
      Dear Doctor
      I …insert name…. Have assessed the risks and benefits of statins and found that the former outweigh the latter. I do not wish to take them but I realise this may make it difficult for you. Please take this as a declaration of informed dissent for the purposes of your QOF indicators. You should not feel any obligation to discuss this further, but if you wish I will supply references on request.
      Kind regards
      Insert name and email address
      (Many GPs already know they are useless but don’t know what to do about it).

      1. PeggySue

        I don’t know if anyone knows the answer to this – while researching holiday insurance recently my sister-in-law noted that every company asked whether she had been offered / advised to take cholesterol lowering treatment (or words to that effect).
        She could honestly answer no, but if you have actively refused statins in this way, does this alter the premium/cover?

      2. joanne mccormack

        Peggy Sue
        If you have been advised to take statins and you decline it does affect your insurance cover. However, this could be superseded if a subsequent doctor advised you that you did not need to take them. Sometimes doctors get it wrong even within current guidance( I have seen people advised to take one who have a normal risk- it’s an accident) , and sometimes the second doctor is one like me who has a different view point.

      3. maryl@2015

        I just used the old fashion method. I cried and begged my doctor not to make me get back on them. Case closed…”statin intolerant”. It was a lot less time consuming and much more effective. And, I felt better after a good cry.

    3. mikecawdery

      Dr Goroncy

      I like your four points – absolutely right but your assumption that for example drugs, per se
      “extend lifespan and heal disease”. This is certainly true of the anti-bacterials (penicillins, sulphonamides etc.) and I suspect they, more than anything else, are responsible for the extension to life expectancy. Other drugs such as the statins with their probability of benefit to the individual in the order of an efficacy rate of 1.5% over 5 years can hardly be described as “breath-taking”. The SSRIs (GSK’s Study 329) are similarly effective while some even increase death rate (Poldermans affair). One must admit that they do result in huge profits (the pharmaceutical industry is the most profitable in the Western world) and have increased the status of some researchers no end.

      1. Frederica Huxley

        Yes, but do these antibacterials actually extend lifespan and heal disease in the long term? Given what Diana wrote earlier, “Calling a microbe a pathogen, or a commensal, or a symbiont is simply wrong. Microbes happily switch their lifestyle when the environment changes, become a pathogen from previously useful symbiont, by establishing a new interaction with the host tissue. There are no pathogens in the sense of Koch’s postulates. Rather, we are observing a series of outcomes in the microbe-host interaction, witnessing A PROCESS”, is it not therefore possible that by altering the balance of microbes in the gut, we make it even more difficult for our immune systems to act effectively? And is this not also true with immune suppressants?

      2. David Mac


        A good question. I noticed this myself when researching holiday insurance. I have not been told I need statins, but the last time with the GP she said “I think it’s about time we tested your blood cholesterol”. I said “No thank you”. She then said “You must be frightened about the possible results”. I said “Not at all. I don’t believe in the cholesterol hypothesis”. No response from GP.

        However the insurance company questions also ask about BP and you can’t respond “White coat syndrome”. My scores in the surgery are high but OK when self monitored over long periods at home.

      3. PeggySue

        David – Re the dreaded hypertension, I think you’re safe as long as you don’t start reaching any of the official “labels” ie prehypertension or Stage 1. Neither necessarily require medication but I wouldn’t want to not declare it, just in case I was in the US and did have a stroke or something.
        If you have true white coat syndrome then your readings at home should be normal I believe, not just lower than in the surgery.
        Sadly immaterial in my case as I crept into needing meds (boo!).

      4. mike_cawdery

        Before the war millions died from bacterial infections from pneumonia, septicaemia etc. Indeed as a child I had a serious septicaemia and was cured with sulphonamide (M&B 125 as I remember). At 82 yes I think my life was extended along with millions of others. Indeed, I would credit this group of drugs with very high efficacy rates are responsible for the life extension seen since the war.

        In contrast, the efficacy of many modern drugs are pathetically trivial and they are plagued with serious adverse reactions, including death as pointed out by Starbridge (2000) cited above

      5. Gary Ogden

        There is no doubt truth in what you say, but don’t forget role of crowded, filthy cities, knee-deep in horse manure, contaminated water, the lack of sanitary facilities, and the scarcity of wholesome food as drivers of infectious diseases. These were, after all, plagues of cities. The good people of Leicester showed us that smallpox was caused not by a lack of vaccination, but by the lack of an intelligent response, though this has been largely forgotten. Yet the method of infection control they developed is still in use today (such as with Ebola), because it works.

  28. maryl@2015

    Great post, Dr. Kendrick. I have read most if not all of them along with both your books. Heart and vascular disease along with statin use has certainly affected my life. It has taken years to put it all together. I pretty much know why, in each case of those who I have lost to heart disease or to statin damage. I have been obsessed to say the least. Now, I can say that although my first stent placement was done 12 years ago and the second two years after that one, I have not had any more. It was my pure determination and actually fate that I led me to spacedoc. I am happy to say that I have had no further blockages since 2007, ditched the statins (along with about 10 other medications) and seem to be healthier now than 12 years ago. But, I am still 12 years older and can’t change that. I may not have beaten this thing for the rest of my life. It may very well rear its ugly head again. I am going to do my best to avoid it. I think my reason to be lies in my wish to teach those younger than I and to learn from those who have done all the hard work and who have lived life well. I think the biggest take away from it all is that I have learned how to learn. That is not such a bad thing either. Keep the faith…in humanity. Thanks again, Dr. Kendrick.

  29. JPA

    I loved your reference to Koch’s postulates. I recall being fascinated by them and their influence on the study of disease when I was reading about the early days of bacteriology as a child.

    However, those do not hold true all the time even for infectious diseases, and definitely not for disorders in complex dynamical systems where small changes in one variable may lead to a very different state (chaotic systems).

    My field is psychiatry and addiction medicine and I have the same attitude about causes. There are processes involved in the development of anxiety, depression and behavioral disorders. These processes have many contributing factors, and we have to think about the factors relevant to each patient and how those are contributing to the processes in order to come up with an effective treatment strategy.

    1. maryl@2015

      JPA, looking at your patients comprehensively is the most valuable tool you have. Over and over, people are convinced they are depressed for life and they cannot live or function without anti-depressants for instance. I don’t believe that to be true. How many in your profession would dare look at someone’s blood work, metabolic panels or take a true medical history? They just do not and I think they do their patients a disservice. I am sure there are exceptions, but I would like to see more psychiatrists look beyond what they hear from the patient. Your comments are very insightful and I am glad to see your willingness to look at these processes with an open mind.

  30. mikecawdery

    Dr. Kendrick,

    I wonder how you can continue producing these stimulating and thought provoking articles. This is what professors should be doing rather pouring out the gospel of the day.

    Ancel Keys I understand in his latter years admitted that cholesterol was irrelevant to CHD but too late to influence the monster.

    I firmly believe that the search for causes has been the main reason why we are in the current situation – a multi-factorial mess.

    Indeed, I think you are absolutely correct but this is the result of Bradford-Hill’s work but ignoring his criteria. It has been too easy to load a huge number of parameters into a modern computer, press the button and out pops an answer that can be the basis of several “erudite” papers. These days such papers are essential for status and grants for research but as you point out, the result of all this computer time is a “multi-factorial mess” with a lot of confusing and sometimes irrelevant benefits such as the 1 in 300 p.a. from statins.

    I some times wonder whether computers and stats programs should be kept well away from clinical medicine researchers. They have clearly found that large patient Ns can be used to demonstrate tiny differences that in real life merely confuse and distract from reality – great for Big Pharma’s profits though!

    1. Dr. Malcolm Kendrick Post author

      Interventional procedures can clear the blood of EPCs quite quickly. One presumes that they are all attracted to the area of damage. They are then replaced, but it can take a bit of time for this to occur.

  31. Robert Dyson

    I just have to read Doctoring Data, so just ordered a copy !
    Undoubtedly it will confirm my own ‘bias’ which will comfort me as when I have explained these issues to people I can see the ‘crank’ in their eyes.
    I got switched on to saturated fats after reading Uffe Ravnskov’s book many years ago. I have a friend who at that time did not eat such fats, did not eat egg yolks and was on statins after advice from a cardiologist friend – he then had myocardial infarction and three bypass interventions. I know I cannot claim cause & effect there, but I have passed the 3/4 century with not a hint of a heart problem. In about 1970 I had a student, who noting I had a bad cold, offered to lend me the Pauling book on vit C. I have taken a vit C supplement daily ever since. I have not found it does much for colds but it sure helps with soft tissue damage; in the case of burns it is spectacular. This has probably helped with cartilage & blood vessel repair as I certainly do not have any joint problems.

  32. michael goroncy

    Mikecawdery …I am not a MD..and if I were I would have been ‘Stuck off’ by now. I am a ‘Witch doctor’/Alchemist.

    Dear Joanne McCormack …I convinced my GP over 20 years ago to administer a radical/unconventional procedure IV. I also gave him a signed document exempting him from liability.
    So! your point regarding a desire to decline ‘Statins’ is a good one which effectively overcomes ‘Medical guidelines’ and ‘Litigation.

    In my last ramble regarding ‘Medications’, I neglected to mention:

    (1) Prior to taking ‘Drugs’ for a variety of reasons, ‘Hypertension’, ‘Insulin resistance’, ‘Lipid abnormalities’ etc. It is a wise move to trial ‘Amino acids’ and ‘Supplements’ that have an outstanding record of ‘Efficacy’ and ‘Safety’. And although they have a very low/high level of toxicity, they should be taken at a ‘Optimum dosage’ for effectiveness. Without the correct dosage they will be useless…..leave medication as a last resort.
    (2) For example: ‘Mitochondrial cocktail’…D Ribose x 5,000 mg, Creatine x 4 grams, L Carnitine x 500 mg….added to this can be COQ10 and Alpha lipoic acid. Anecdotally I have found that it has a powerful effect on ‘Hypertension’ and energy levels.
    (3) Fish/fish oil 2-5 grams works like magic to drastically lower ‘Evil Triglycerides’
    (4) Niacin/B3/Nicotonic acid for increasing HDL among other actions. 3 x grams. Although been taking for many years, there is no conclusive evidence one way or the other. Perhaps better to leave this out of your arsenal until there is a clearer picture.
    (5) As you know, there are many other useful add-ons ….Vit C, Cardio-combo/l-arginine.
    (6) Again experiment with other things before medication. Give it a fair amount of time and get the dosage right.
    (7) Nutrition and Circadian rhythm, grounding/earthing are big players.
    (8) Someone mentioned ‘Metformin’….this is a safe and effective drug with no downside.
    (9) Again, regarding ‘Statins’…if they give you discomfort….Don’t take them.

    1. mikecawdery

      My apologies Mr Goroncy – an admissable mistake I hope you will admit. 4 + 9 excellent points suggest otherwise though I would disagree with your view that metformin. There are downsides, one being diarrhoea which according to the MHRA DAP affects some 30% of those reporting adverse reactions. In my case I reported it to the MHRA as EE. Confirmed several times since as it is reported to be of benefit in cancer, presumably on account of its reduction in glucose absorption and reduction of glucogenesis.

      1. Craig

        Mike, yes re: metformin. This inhibits the mitochondrial glycero3phosphate shuttle in humans and a similar thing happens in most gut bacteria (not in mt of course) since this is a shared pathway ie goes back a long time in evolutionary history. Hence gut distress due to disturbed biome. Its a pretty serious disruption either way and metformin is not always a ‘free lunch’.

    2. joanne mccormack

      Hi Michael
      I’m a doctor who advises eating real food on the basis it appears to be safe, and to eat less of those foods that are naturally high in sugar and starch. I don’t advise on supplements unless people get cramp, when I advise adding salt to meals and taking magnesium supplements.

      1. mikecawdery

        Dr McCormac,
        I only wish more docs followed your advice. Incidentally for cramp I take quinine (5 grain = 300mg. Used to work in malaria as well)

        However, one thing factor that seems to have come out of this series is that NO of value in maintaining arterial endothelial health and integrity and is one factor in heart disease. Yet despite this knowledge and the many serious adverse effects of uncontrolled ROS, there seems to be no medical establishment advice on measurement or increasing this important molecule.

        I am also concerned that, while there is much advice and products to enhance NO levels in the health nutrition field, this is medically ignored by the establishment, which seems to be more concerned about the flogging chemicals with trivial efficacy inflated through the use of a statistical technique (HR/OR = a ratio of two ratios) which was never designed to inflate claims. As a patient reviewer to the BMJ this statistical technique seems to be ubiquitous., including the effects of inflation on “efficacy” (that is when actual numbers are available to reverse the calculations). I have also raised this issue in BMJ rapid responses. When I was trained for research at the LSH&TM many decades ago I was taught of the absolute integrity for ALL data and the interpretation of that data. As JP Ioanniddis in his seminal paper (Ioannidis JPA (2005) Why most published research findings are false. PLoS Med 2(8): e124.) showed that this no longer seems to be the case. Certainly in my experience of working with drug companies this change has occurred in the last 2-3 decades with the take-over of the administration of pharmaceutical companies by the “money men” who simply are concerned about the “bottom line” and shareholders; patients and their health is of no concern other than a few percent of the “herd” actually benefit. The non-beneficiaries are simply ignored as the Starbridge report clearly demonstrates (JAMA, July 26, 2000—Vol 284, No. 4 483)

        Sorry Rant over but this change in the ethics of the medical establishment in regard to patient benefit really does rile me.

        I did raise the issue of the Total Anti-oxidant Capacity of blood rather belatedly in series VIII and its absence as a standard test. In my own case I know my TAC which, for a Type 2 diabetic it is very high, even above normal for healthy people.

      2. Joanne McCormack

        Hi Mike
        Statistical shenanigans abound. Most of our education is funded by Pharma one way or another. I’ve been trying to keep them away from my training days
        because makes us harder for us to think independently.
        We all kid ourselves these inventions make a difference when they are all based on bad science.
        And it’s sad when people don’t have the funding to investigate new lines of enquiry unless there is a potential for money to be made.
        We need to make scientific publications fair and reasonable worldwide and not articles that break what I think of as natural trading standards( untrue, unethical etc) The BMJ and I presume other organisations are trying but it’s a mess.

      3. mikecawdery

        Dr McCormack,

        I would like to take up this issue with you in some detail but this blog is not the place. I have taken note of your details so kindly provided above. I wholeheartedly support Dr Godlee in her attempts to get some clarity and open access back into medical drug research; some “vetting” of data rather than the “doctoring” of data (astroturfing and agnnotology) that seems to be the current practice. However, while money and status flow, I have little hope of progress.

      4. Ems

        Hello Dr Mccormack
        Apologies for being behind the curve here, but would your advice include vitamin D3/K2 supplements?

      5. Joanne McCormack

        I don’t tend to get too prescriptive about supplements. Most people in the UK don’t get enough vitamin D in the winter, so in general supplementation would be helpful. I know there is debate about vitamin K2 but I don’t advise it specifically unless someone has good reason to believe they won’t get enough from food.

      6. Jackie

        Hi, what would you commend to naturally get blood pressure now. On meds but trying to wean myself off these. As you stop them how long does it take for you blood pressure to turn to normal.

      7. smartersig

        Hi Jackie, my partner has gone from BP at around 160/90 to a consistent 123/75. She did this by first of all taking daily Kyolic Aged garlic. She also took a Vit B12 Methocabalyin (spelling?) lozenge although I suspect the garlic was the real kicker. She also increase her daily activity to the basic 10,000 steps per day. She eats like me, no processed foods but I do not think that that is the main contributor as she had high BP during the first 18 months of our diet overhaul..
        Hope this helps

      8. Jackie

        Hi, I have tried those garlic supplements but they didn’t work for me. Tried them for 3 months. Did she take meds for her high blood pressure. I would love to come off these. Do you follow the low carb diet.

  33. Ken MacKillop

    Dr. Kendrick, your series has been great.
    With that said, though, is it not possible that your step 1 — endothelial injury — is closest to a cause? Could not CVD be a degenerative condition of the endothelium, as most diabetes is a degenerative condition of beta cells? Or do you think that modern humans’ response to the injury is the modern phenomenon rather than an excessive amount of the injury itself?
    As indicated by artery calcium scores, everyone who lives long enough seems to develop measurable CVD. But then our cells are senescent, and we are mortal as a result. Could not modern CVD in younger people be caused by an accelerated form of aging of the endothelial cells as the driving, earliest phase of the process?

  34. anton kleinschmidt

    If CVD is a process then it is probably fair to say that the process starts at birth (or earlier) and based on current evolving wisdom the process can be interdicted if all concerned ensure that:

    # You are never exposed to cigarette smoke
    # You are never exposed to added sugar
    # You never consume processed food thus avoiding hidden sugars
    # You are never exposed to alcohol
    # You are never exposed to unhealthy heavily processed vegetable oils
    # You are never a victim of current dietary guidelines which started with Keyes
    # You benefit from a mindset which says food is medicine
    # You exercise moderately throughout you life
    # You have a doctor who prescribes to these imperatives

    If this happens then all the other causes that drive the process will struggle to get a foothold

    1. David Bailey


      # You are never exposed to cigarette smoke
      I once drew a puff from a single cigarette, so I am damned already!
      # You are never exposed to added sugar
      I guess it depends on who added it!
      # You never consume processed food thus avoiding hidden sugars
      I must have done that!
      # You are never exposed to alcohol
      OK – I might as well be in my coffin.
      # You are never exposed to unhealthy heavily processed vegetable oils
      I used to use them too!
      # You are never a victim of current dietary guidelines which started with Keyes
      I used to believe that saturated fat was dangerous, but not any more!
      # You benefit from a mindset which says food is medicine
      I am not sure – maybe I pass this!
      # You exercise moderately throughout you life
      Definitely – I pass this, except that maybe I exceed the qualification “moderately”!
      # You have a doctor who prescribes to these imperatives
      I try not to have too much contact with my doctor! However I once took statins for 3 years – but never again!


  35. Barry

    Helen (17th),
    Apologies for butting in but if your father-in-law hasn’t read it he’ll probably find Joseph Kraft’s “Diabetes Epidemic & You” interesting. He may also find “The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable” by Jeff Volek and Stephen Phinney of value. Hopefully both will convince him of the error of the std diabetic diet “treatment”.

    1. Dr. Göran Sjöberg

      Being an ardent believer in the benefits of LCHF for people who with age have ruined their health like myself I realise that the whole issue about what to eat is still so overwhelmingly confusing. But everyone of us seems to love the the ‘one single causative explanation. Mine is simply ‘don’t eat carbs!’

      Reading Joseph Kraft book about all his thousands of clinical hospital investigations and measuring blood glucose and insulin response in parallel over time was a real eyeopener for me when reflecting the complexity involved.

  36. Stephen T

    Helen, I’d support Barry’s book recommendations about diabetes. In addition, the Ted talks on YouTube by Dr Sarah Hallberg and Prof. Wendy Pogozelski are short, very good and delivered by people doing important work in this field.

  37. Carolyn Magnus

    Two years ago a CT scan showed that there was high blockage (77-99) blockage in one artery and some blockage in two others. I do cardio exercise twice a week and have been feeling fine and stop and rest if I feel the need when outside. Today I saw the consultant who wants me to take Rovustatin 5mg once a week to see if they agree with me as he repeated that I have ‘sticky’ blood. I was on Simvastatin for about 20 years until about 5 years ago when I refused to take them due to side effects.He wants me to attend a lipid clinic and if that doesn’t work there is an injection i can do myself. I felt completely crushed and very upset once again when I left and really don’t want to do what he says. Feeling very confused as he hasn’t offered me anything positive. Would welcome any feedback, please.

    1. Barry


      Recommending exactly what to do to improve your medical condition is impossible without a full understanding of all of your issues – and the comment section of a blog isn’t a suitable place to start. Neither have I any idea of the extent of your knowledge regarding biochemistry so I’ll apologise in advance for saying anything you regard as obvious. However your comment suggests that you don’t like what your doctor is telling you but are uneasy about refusing the “treatment”.

      Nevertheless there are things that you can do that will be directionally correct so here goes with my pennyworth but please recognise that there isn’t a pill for an ill here – no single action will resolve your issues.

      I don’t know how long you have been reading Dr Kendrick’s blog but if a newbie I recommend that you read some of the early blogs (all really, but not all are directly relevant to you) especially those about statins and in particular this one https://drmalcolmkendrick.org/2015/09/21/a-swiss-investment-bank-gets-it-completely-one-hundred-per-cent-right/ and the referenced Credit Suisse report for a background on diet and health.

      Next, your choice, but I recommend that you don’t take any statin medication – just what does the doctor think taking any statin is going to do to help you when they have failed so miserably in the past? Your condition is not caused by a lack of statins and statins will do nothing to resolve calcification issues. Ask him/her just what is going to change, in a positive direction, as a result of using a different statin.

      Next you will probably need to do a 180 on much of your diet. Official advice is completely wrong and following it will make you ill. Just about everything you are told is good is bad and vice versa. Directionally you need to go LCHF, avoiding all processed foods (basically anything in a cardboard box or tin), vegetable oils, margarines of any sort and sugar in all its guises. Many books but if in doubt about what is suitable try The Real Meal Revolution by Prof Tim Noakes (primarily aimed at those who want to lose weight but principles apply to everyone). It has foods categorised under green, orange and red headings plus lots of recipes and some technical background. Also take a look at Joanne McCormack’s website http://www.fatismyfriend.co.uk/ .

      Various reasons for calcification (a couple of the many papers/articles here http://jasn.asnjournals.org/content/15/12/2959.full & http://bjcardio.co.uk/2008/11/vascular-calcification-mechanisms-and-management/ ) but it won’t do any harm to follow the advice given in Vitamin K2 and the Calcium Paradox by Dr Kate Rhéaume-Bleue (http://doctorkatend.com/). You should also ensure that you have sufficient magnesium (sadly lacking in the modern diet due to modern farming techniques) try http://www.mgwater.com/ for info. Take a look around Dr Mercola’s website (annoying adverts but some good info) for info on vitamins and minerals http://www.mercola.com/ and http://www.paulingtherapy.com/ (not the complete answer but part of the issue).

      For “sticky” blood have a look at the role of vitamin E http://lpi.oregonstate.edu/mic/vitamins/vitamin-E in cardiovascular health.

      This is just scratching the surface but as reached the point of TL;DR, however the main point is that you can improve your health without the help of a doctor who probably knows little about nutrition and, it appears, just wants to push the orthodox pharmaceutical based treatment.

      1. Jennifer

        Barry, you deserve 10 ‘thumbs up’ for that comprehensive response to Carolyn’s dilemma. It is a lot of work for her to research all the papers, but will give her a better understanding, and perhaps encourage her to have a more two-sided discussion, before declining or accepting advice. As often repeated here….no one solution fits all….we have individual needs and responses to our conditions.
        She is in the sort of situation some of us have found ourselves experiencing, that is….not understanding the management of our conditions, but feeling pressured into complying with all sorts of pharmaceutical interventions we (erroneously) believed, were tried and tested. And how many of us have left medical rooms feeling demoralised after doom-laden consultations?
        I don’t believe in hiding the truth from patients….but, come on, let’s have some hope instilled into us, as we make our way back home. Education is power, so let’s get educated in matters of health. I have had my eyes opened wide by subscribers to blogs such as this.

    2. Gary Ogden

      Carolyn Magnus: I have no qualification to dispense advice, but I suggest you go back to the post earlier in the series that linked to the development of the collaterals in the event of the narrowing or blockage of the coronary arteries, showing that even blocked arteries can be filled with blood (from the collaterals) to deliver to the heart on both sides of the blockage. Food for thought.

    3. Mr Chris

      I agree with what Barry has put as suggested reading. I would add as THE starting point, Dr K’s book ” Doctoring data”
      That plus more that is on these blogs will give you a good background for thinking and trying to see clearly.
      I have a less mainstream suggestion, read the Cochrane Collaboration report on statins for primary treatment, try to find stuff on the web that supports the main stream views views and criticizes Dr K, always a good idea to listen to contrary views.
      Lastly, its your health, can you find a doctor who has not been brainwashed and spouts the accepted religion, they do exist, and if what I have read on this blog is true, a large number of GPs don’t go along with statin theory.
      5 mg of rosuvastin a week seems very low, is it a trick to get you to up the dose , on the lines “there, that wasn’t too bad was it, now lets double it”
      Finally my own experience Omega 3 as fish oil is supposed to clean you up.

    4. Stephen T

      Carolyn, the major point of this site is that cholesterol doesn’t cause heart disease. So, statins are aimed at the wrong target and leave you with the side effects you described. Take your time and read the articles on here that are most relevant. Your doctor is giving you the standard advice, but I’ve long since stopped just doing what the NHS recommends because it’s so spectacularly wrong about cholesterol, diet and diabetes. There’s a wealth of information on this site, both in the articles and responses. Barry has also given you plenty of good information. I can’t imagine any circumstances that would lead me to take a statin. You need to get enough information to make you confident that you’re making the right decision and then put this behind you. See Dr McCormack’s advice for a written response to GPs on statins if you want to refuse. You’re exercising and feel fine. That should tell you something.

      You’re in charge and you don’t have to do anything that you don’t want to.

    5. David Bailey


      It only took 3 years for Simvastatin to demonstrate its toxic side effects in me! Fortunately I recovered fully after stopping taking the stuff. I was only taking it on a preventative basis, so it was easy for me to decide to stop, but I have also decided to refuse statins (or indeed any other cholesterol lowering medicine) whatever happens to me in the future.

      I decided that it is better to enjoy life to the full for as long as it lasts, than disable myself with statins for the sake of a possible increase in life expectancy. Besides, one medical fact is clear – exercise is very good for you – and that is very hard indeed when crippled by statins.

      Two things I learned from coming here, is that not everyone recovers properly when they stop taking statins, and that some medical scientists suspect that statins may also attack heart muscles and cause heart failure (as opposed to CVD).

      It is your body – so don’t feel pushed into treatment you don’t want!

    1. Dr. Malcolm Kendrick Post author

      No, but I am aware of it. I have long explained to people that major arteries are supplied with blood/nutrients, themselves, by small blood vessels (vasa vasorum). So, if LDL were to get into arterial walls from anywhere, it would be from the vasa vasorum. But there are a couple of major problems with this hypothesis. Possibly the most important is that the abdominal aorta has no vasa vasorum, and this is an area of major plaque development.

      1. Maggie

        Dr Kendrick, there’s been a lot of noise recently about sitting being the new smoking. Is it possible that this issue is related to injury to the abdominal aorta and subsequent plaque buildup?

      2. Diana

        This paper also mentions that textbooks are wrong, that’s why it has caught my attention too:

        “In addition to reporting significant findings on the precise location of lipid depositions during initiation of coronary atherosclerosis, this work univocally demonstrates that normal coronary tunica intima is not a single-layer endothelium covering a thin acellular compartment, as is commonly claimed in all mainstream scientific publications and educational materials (e.g. Figures 1 and ​and2),2), but a multi-layer cellular compartment where cells and matrix are arranged in a few dozen layers.”

    2. mikecawdery

      Many thanks for the reference. This seem to support Dr Kendrick’s view which he has expressed many times. When LDL-C is mentioned I always wonder at whether it is the VLDL fraction or the “fluffy” fraction which is an essential element of the immune system, Indeed, David Evans in his three books provides evidence of the value of high LDL-C

  38. madmikedavies

    I found this after reading Dr K and researching Pauling and Rath this link claims that type 2 diabetes is a cellular disease caused by vitamin C deficiency, and can be reversed via vitamin supplements. Have recently been diagnosed with HBP, high cholesterol and pre-diabetes. So I am going on a LCHF diet with vitamin C supplements. wish me luck. BTW both Pauling and Rath claim that these diseases, CVD and diabetes are chronic (but not acute) SCURVY

    1. Gary Ogden

      madmikedavies: Wish you all the best. You can’t help but improve eating real foods. Don’t forget the fat-soluble vitamins; a bit of midday sun for D, liver for A, gouda for K2, and nuts, spinach, avocado for the E.

    2. Dr. Göran Sjöberg

      I really wish you luck!

      I am just sipping on my daily glass of water with 6 g of ascorbic acid (inspired by Pauling) in front of my fireplace and I don’t think it hurts my arteries – might even help.

      With my severe CVD but with strict LCHF for seven years now my BP is always at rest 110/60. The weight is just perfect for my length and went down 20 kg within two years from when I started. My bad colds are today only memories but they disappeared immediately with the LCHF switch. I added the C-vitamin two years ago after reading Pauling’s books.

      The difficulty is to keep to this strict diet in our ‘toxic environment’ but it is today much more recognised than when I started and now even by the medical community for treating overweight and diabetes.

      By the way – there are no health guaranties 🙂

  39. Barry

    Dr. Kendrick and Jennifer (19th),

    Thank you. I hesitated in responding to Carolyn’s request for information because there is so much you need to know before an effective course of action can be advised and, of course, the outcome needs to be monitored to determine if the whatever changes occur are directionally correct. I could have written much more but there is more than enough in the links supplied to keep Carolyn busy and, hopefully, provide her with sufficient knowledge to be able to counter any pressure from her doctor (knowledge is power) and to have a better understanding of her condition.

    It is sad that so many patients effectively fear their doctor and equally sad that so many doctors resent any questioning of their directives. A genuine doctor should welcome questions and provide logical evidence based answers rather than adopting a take it or leave attitude. I can only recommend/advise on what has worked for me (68 yrs old and no known health issues), those that have taken my advice and witnessed improvements in their health. What limited knowledge I have is the result of reading many books and countless hours of internet searches sifting through the many sources of disinformation (typically Pharma supported sites or those influenced by them) to reach what I believe to be the truth. Clearly I cannot state that doing xyz will produce the desired result but if experience indicates that a certain approach works then that is the best I can do. However I’m very aware that one can never stop learning as, to quote Thomas Sowell, “It takes considerable knowledge just to realize the extent of your own ignorance.” If I have helped Carolyn in some small way then I’m happy and I’m sure that by reading the blogs here she’ll feel empowered to help herself.

    1. Eugène Bindels

      I would like for people to share what they decided to do for themselves (like taking 6 grams of vitamine C a day based on Linus Pauling). This could be a starting point for others with simular issues so they don’t have to reinvent the wheel which saves a lot of precious time.

      1. Kathy S

        Eugene, I understand your frustration in this matter as I too am searching for answers. Dr. K has helped me in opening my eyes to what I feel is really going on in the medical field and he is not alone in his determination. I have discovered a world of information that contradicts the status quo of cholesterol, stains, etc and the reason we aren’t hearing more of that is because we can’t get past the massive amounts of money the drug companies are using to market their products. As far as what I am doing for myself, I am continuing with the low carb, high fat diet which to me is a bit deceptive a description. Basically, it’s a diabetic’s diet – cut out the sugar, which includes those carbs. Stay away from the low fat products which are all processed and find good quality, whole, natural foods – real butter (grass fed cows if possible), even raw milk if you can find it. I supplement with what I have researched that aims toward cutting out inflammation, healing and maintaining healthy tissues – gums, arteries, etc which includes vitamins C, D, K2 -mk7 (a very important one I think), A, L-Lysine, magnesium, most in higher than suggested doses. I try to exercise (walking) on a regular bases, don’t smoke, and basically take care of myself. Overall, I’m a pretty healthy gal – always have been – almost 60 years old and the only medications I am willing to take is a blood thinner and a baby aspirin every day. I’ve had a stent installed in my LAD – that wonderful Widower maker artery – in 2014, it clogged up again so had another put on top of that one plus one underneath. I suspect they didn’t ‘get it all’ the first time and the plaque built up again and back into the original stent. My heart doc agrees. My doctors also don’t give me grief about my decision to not take statins or beta blockers. Good luck Eugene in your own search for good health. Who the heck knows if any of this will work or not. Either way, you have to do what is right and comfortable for yourself. I feel great, am happy about my decisions, am not frightened by this whole mess – you gotta’ go sometime and somehow, after all.

      2. Eugène Bindels

        Thank you for your input. I have been using vitamine K2, vitamine C, L-carnitine and fish oil for a couple of years now. I am 50 years old. I’m in good shape because I exercise regularly. I try to stay away from the sugars and milk. At the moment I’m looking into the LCHF diet but find it hard to change my eating habbits which are not so bad. My girlfriend prepares our meals mostly based on fresh foods. We use real butter and olive oil instead of transfatty stuff. The most difficult thing would be the stop eating bread. A alternative doctor told me the reasons Japanese get old in good health are vitamine K2 and l-arginine.

      3. Kathy S

        Eugene, you might already be eating a healthy diet. I find that the LCHF diet is not necessarily adding fat to the diet but in taking out the sugar/carbs. A high gluten bread is better than your standard, white, sliced stuff and in moderation is not a bad thing. If you are trying to loose weight – all that stuff has to go, at least until you’ve lost the weight. Commons sense, moderation and unprocessed food seems to be a ‘no brainer’, doesn’t it? Keep reading, researching and checking out this blog.

      4. Eugène Bindels

        That’s the thing. I don’t have to lose weight. My bmi is 23,4. I exercises regularly. My only risc factor (as far as I know) is my cholesterol (TC=9). My crp is low, my homocysteine is normal, my ldl high, my triglycerides (hope spelled this one correct) high. My only sin is 3 or 4 glasses of wine in the evening. And don’t forget the high (don’t know the exact number yet) calcium score in the last CT. The reason for switching to LCHF is that sugar does’nt agree with me. If I eat a bar of coco, within the hour am not feeling fine. My sugar levels were always ok when tested. I already leave sugar out of my beverages (coffee, tea) and stay away from milk (except cheese).

      5. JanB

        The thing is, Eugene, it’s not just about sugar. You need to cut back on starch as well, which means no bread, rice, pasta, starchy vegetables, flour based foods, eg pies, quiches. Before I went HFLC my BMI was 23.5. Compared to most I was ‘slim’ – I am an old lady and I felt ‘okay.’ After changing my eating habits my BMI had dropped to 18.2. Now I am lean and a 25″ waist. My TC is 7.3 but my ratios are great so I don’t worry at all, despite pressure from the GP practice. A really good indicator, I believe, is your waist measurement because it’s a marker for visceral fat. It should be less than half your height. Lean waist = lean internal organs.
        Just because your blood glucose levels are okay doesn’t mean that the carbohydrate you take in isn’t harmful. We are a woefully carb-orientated society so it’s hard to do the right thing though.
        Good luck,

      6. JanB

        ……..and I forgot to mention fruit – horribly high in sugars, though berries not so bad. I’m dreading the peach season.

      7. Gary Ogden

        The problem with fruit consumption is not so much the sugar content, but the fact that, like many modern plant foods which we eat, they have been bred for appearance, shelf life, and long-distance shipping, with a dramatic reduction in nutrients as a result (and as a result of “agriculture”). An apple today has only 5% of the nutrients of an apple of a century ago. I’m convinced that the reduction of nutrients in “healthy” fruits and vegetables is part of the obesity picture, that it is necessary to eat much more of them to supply the nutrients the body craves than a reasonable, healthful diet has room for. As for me, I eat berries (blueberries, cranberries, and raspberries) daily, fermented into chutney, garden fruits (pineapple guavas, persimmons, strawberries, navel oranges) in season, and cherries and figs in season but even here in the agricultural heartland of the West, it is almost impossible to get stone fruit worth eating; they have no flavor or nutrients, so I pass them by at the market.

      8. JanB

        Thanks, Gary, for your reply. I agree with you that many modern fruits (and vegetables, too) are pale apologies, but we are lucky enough to have in our garden a now rare Cornish Apple called ‘Johnny Voun.” It’s wonderful, unlike anything one can buy these days, deep streaked red skin and white flesh flushed with pink, but sad to say, it’s very disruptive of my blood sugars so it has to be an occasional treat. Berries are good though.

      9. Kathy S

        I too don’t fit inside that ‘box’ of risk factors and is what got me started in my research after a 90% blockage resulted in my first stent. As I look back on my life, though, I was not taking care of myself as I am today – I used to smoke, was a suger’holic’, didn’t exercise and was stressed out from birth on. Could be that this is what caused my blockage and now I am just trying to avoid any further problems with the idea that I need to keep my arteries and everything else as healthy as possible. After all, what else can we do? Who the heck knows what really causes all of this mess – my doctor certainly doesn’t but then again – how could he? It’s frustrating for sure but just being able to read a blog like this one where there are so many around the world that are experiencing what we are and are searching for answers and giving advice, suggestions and such is very helpful. We aren’t alone in this or our beliefs. Right now I’m just hanging out and hoping I can get through a whole year without this happening again with my New Year’s resolution being to stay out of the hospital and the morgue!

      10. Gary Ogden

        Excellent resolution! For me it is comforting to know that healing takes time. I feel better every year. For me it has three components.: 1. Diet. 2. Taking a posture class. 3. Strenuous exercise (but not too much or too often). My workout begins with spinal decompression (this is so easy anyone can do it, and crucial to healing for me). I stand against a wall, raise myself on my tippy toes, plant my head on the wall, and slowly lower my feet to the floor, leaving the head in the same spot, holding for 20-30 seconds. This works mainly the cervical spine, but, to some degree, all of it. Then some dynamic stretching, balance exercises (lunges), jumping jacks, and a short (1-2 km) run, with some sprints at the end. Then, pushups, pull-ups, and squats. Again, anyone of any age who is ambulatory can do these last three. Mark Sisson has a great tutorial on how to begin. Takes about two and a half hours, and gives me energy and a positive attitude all day. I have been doing this every third day (for two and a half years), and it has done wonders for my health. We lose muscle mass as we age, and I’m rebuilding mine-I was shocked a few years ago when I could no longer start the chainsaw, which long ago was part of the way I made a living.

      11. Kathy S

        Wow Gary, that is some work out! I’m good to get out for a brisk 3-4 mile walk. It’s a workout for me though as I walk at a pretty fast pace. I keep reading and researching and have tweaked my diet again to include more vegetables and less meat, eating my largest meal at lunch now and no dinner, maybe some nuts, small amount of cheese and a great recipe for flax seed crackers I found on this blog (no carbs). This tweaking is helping me loose those last few pounds. My conclusions are starting to settle into believing that not only is heart disease not caused by any one thing but that it is caused by possibly years of eating all of the foods that are now coming out as pretty much toxic – sugar, vegetable oils, processed foods and carbs, low fat, etc. Plus smoking, of course, is incredibly dangerous – not just because we are breathing in tobacco but because that product is also processed with unbelievable and undisclosed chemicals. It’s that steady stream of poison that eventually damages our internal organs, arteries, immune system. Why else would heart disease be the number one killer and cancer so prevalent? Anyway, thanks for your response, Gary. I am really enjoying this blog as it has helped me and clearly, people all over the world that are as frustrated and confused as I am about this whole heart disease mess. Best of luck with your own healthy progress. – Kathy S

      12. Gary Ogden

        Kathy S: Also check out the fat emperor blog post referenced by David on part XIII concerning calcium score. Outstanding presentation. Since I wrote my comment, I am now weaning off my only pharmaceutical (Lisinopril), and feel better. By the way, my workout took a full year to develop, beginning with a little bit, and gradually adding more. The benefits are both physical and cognitive. For anyone, the best exercise is the one you do (for obvious reasons). For me, I’ve always been interested in learning and experimentation.

      13. lee

        Hi, how are you weaning yourself of Lisinopril. Did you find as you wean yourself of it your blood pressure spikes and takes a while to settle. I am trying to wean my self of 2 blood pressure pills but when I do my blood pressure spikes and I get scared and start taking them again. Thanks.

      14. Gary Ogden

        lee: I’m weaning using a protocol (what I remember of it) from one of Dr. Rogers’ (referenced below) books. A half dose for a few weeks, followed by a half dose every other day for a few weeks. I’m not bothering to measure my BP, for a host of reasons. Drugs treat symptoms rather than foundational causes. Interestingly, wakame (Undaria pinnatifida), a sea vegetable eaten in Japan, but easily available in the U.S., contains compounds which mimic the effects of ACE inhibitors, and other species of sea vegetables have hypotensive effects, as well. A bit difficult to access the papers because they are published in Japanese journals, and, while available in English, are behind pay walls. The references are in “The High Blood Pressure Hoax,” by Sherry Rogers, M.D, but can be easily found searching wakame and hypotension. Another reason I won’t measure it is the fear-feedback-loop. I have abundant good health from lifestyle changes alone, no longer have any of the stressors which elevated my BP in the first place, and no longer have much confidence in chemical medicine. My BP is most likely what it needs to be, absent any underlying conditions, which I don’t appear to have, and if it is a little higher than what is recommended, so be it. I refuse to live in fear of the unknown, and I don’t want any side effects (such as tinnitus, which I have, or possible kidney damage). I would like to get the ADMA test, though, just in case (the solution for elevated ADMA is L-arginine).

      15. Kathy S

        I too am staying away from the medications. Won’t take the beta blockers for several reasons, even after 3 stents (damn it). First – because I don’t want to, second – I’ve never had high blood pressure and third because my first go round with a stent, I coded twice as my blood pressure crashed.
        I refuse the statins – why? Because I don’t want to, second – because of Dr. Kendrick’s and others that have written about these things and third – I don’t have high cholesterol, unless you want to measure it by the ‘new rules’.
        I have also made changes in my lifestyle and diet making me feel and look better. Will it prevent or stop my supposed heart disease? Who the heck knows! But it beats being chained to medications the rest of my life that clearly do more damage than good.
        The only thing I am taking, other than some supplements, is a blood thinner (Plavix) and baby aspirin. Will eventually get off the blood thinner once my year is up and I and my Doc and assess the situation. I do have a good heart doc – doesn’t give me grief about my decisions.
        Best of luck to you on your continued good health …Ks

      16. Gary Ogden

        Kathy S: Good for you! By the way, aspirin has no value in primary prevention, and little value in secondary. Better alternatives: Vitamin E, magnesium (very important for heart health), CoQ10, and omega-3 fatty acids. All of this information comes from “Malignant Medical Myths,” by Joel M. Kauffman, PhD. I get my magnesium primarily from nuts (pumpkin seeds and Brazil nuts are the number one and two food sources) and a spray-on magnesium chloride. Epsom salts are great, too.

      17. smartersig

        You are lucky, I was discharged from the hospital when I refused to take statins instead choosing an approach with a proven better track record ie the med; diet. My GP has never once asked to see me or check up on me. What I would give for a doc who understands current research and can check and liase with you intelligently instead of pulling the plug if you do not toe the pharma line

      18. Gary Ogden

        Bread is not the same in every place. In the U.S. (and the U.K.) wheat flour is fortified with, among other things, folic acid and iron, both of which are problematic for health. In most of continental Europe, though, it is not. So including bread as a part of what you eat may be perfectly alright, depending on where you live. I stopped purely as an experiment, and have done well with it, but you have to decide for yourself what works for you.

      19. Frederica Huxley

        If you wish to continue eating bread, may I suggest that you cease buying commerical products? Instead, make your own breads with sourdough; control the ingredients – make the breads that sustained populations for many hundreds of years.

      20. Jennifer.

        Eugene, I see where you are coming from, but one message oft repeated here is that we need to find out what works for us, albeit based on ideas submitted by others. Such suggestions may give us a start, but that is the extent to which any ‘recommendations’ should be understood.
        My road to recovery began by taking stuff OUT of my life…..i.e ‘recommended’ pharmaceutical agents…….and has progressed to ADDING so-called banned food stuffs.
        I read avidly about food and drugs, and anatomy and physiology,( some of which I find incomprehensible), and my rebellions are based on works I have read and am prepared to give a go at, in particular, changing to low carb and healthy fats. I have needed to learn what ‘low carb’ actually means, and what ‘high fat’ constitutes, and reading round these topics is a time consuming requirement, because it is not ‘common sense’…..it has to be learned. After 50 years of HCLF….this cognitive dissonance is challenging, and must be worked at!
        I have just received, by courier ( on a Sunday, no less), a book I have been promising to buy for a few years……”The art and science of low carbohydrate living” by Volek and Phinney, (so no housework getting done once I get my nose into it). I have been told it fills in some of the gaps presented in LCHF publications, and I now feel ready to progress a little more into the intellectual sphere.

      21. Jennifer

        Eugene. In my response to you on March 20th, I mentioned the book by Volek and Phinney which I was about to start reading…..well, 3 weeks on I would say it is a jolly good read for anyone wanting to improve their health status. Yes, it dwells on CHO intake, but there are mentions of other common topics often referred to in these good blogs over the last few years. e.g. The misconceptions over cholesterol and our fat consumption; how so much about good health and nutrition is very personal….indeed…no one method/diet/lifestyle will ever solve the ills of the masses.

  40. financialfundi

    Diagnosed with H Chol – 7.5 – in ’98 aged 54.
    Initially I followed my GP’s advice and started a course of statins.
    Interesting is that at one point during my brief period of statinisation my chol level dropped below 3.5 and the clinician who did the test (finger prick) told me to half my statin dosage.
    Confused about the true course of action i consulted with a cardiologist.
    He threw a wobbly when he heard the clinician’s advice and told me in no uncertain terms that she was a nutter and the lower i could get my chol, the healthier i’d be.
    He put me through a stress test and told me that my ticker was fine, and that, provided I took my statins, like he did, i would never need his services again.
    In point of fact I couldn’t have because shortly after the consultation he succumbed to a MI aged 48.
    Now even more confused and suffering side effects, I stopped taking them because some basic research told me that
    a) cholesterol was a must have
    b) therefore the clinician’s advice made sense
    c) I was quite fit for my age and
    d) there was longevity on the maternal side of the family.
    Late 2000 I purchased Dr R Atkins’ Age Defying Diet Revolution and soon became a disciple.
    It gets a bit technical at times but almost every new ‘fad’ LCHF diet – Paleo – for example, is basically a replica of the advice and information in Dr Atkins’ book.
    Now aged 72 my chol is well over 8 and my Dr says he is “amazed, given my level of chol, that I haven’t had a heart attack”.
    The senior partner says that “if he were me he’d be stuffing himself with statins”
    But I have, so far, avoided both – and the eatwell plate.

    1. Anne

      financialfundi – My cholesterol on my lipid test three weeks ago has reached 9.7 ! My HDL is still high at 3.4, Trigs 0.4. I’m 62 yo. Dr Kendrick said in a previous blog some people get to 10 – not talking about familial cholesterolemia here.

      1. Jennifer

        Anne, my last TC was 3.4, and that was 3 years ago, whilst on multi-medications. It was at that point I decided to leave the pharmaceutical merry ground. I no doubt had achieved 3 gold stars for reducing from the upper 8s down to that level, but to me it seemed wrong, as I was quite poorly. I have not had it measured since, and have no intention of ever finding out what it stands at, as I feel in excellent health.

      2. Anne

        I don’t take statins Jennifer ! I don’t mind it being high as I know the lipid profile is good – that is if you believe in all that. My lipids are measured becasue I have other health problems and I can’t stop the phlebotanist ticking the lipid box LOL I have eaten extremely carb/moderate portein/high fat for the past nine years, despite eating extremely well I am bordering underweight, I do exercise, walking and weight lifting !

      1. David Bailey

        Could it be nothing to do with diet – maybe some bacteria that are more common in the Russian environment? I do remember that at one point the bacteria involved in gum disease were said to be dangerous for the heart.

      2. Gert van der Hoek

        One explanation could be the Natto consumed in Japan? Natto contains vit K2 which keeps calcium in the bones and out of the arteries and nattokinase which prevents bloodclots.

      3. Craig

        At this point I stick my tongue firmly in my cheek and say it’s multifactorial!
        George Henderson described the Soviet experience as “The world’s longest running refined seed oil experiment.”
        If you add just one other factor to a high linoleic acid intake, a high consumption of alcohol, there is a strong risk for liver liver disease. There are many research papers demonstrating the ability of this combination to cause nafld and nash ( sorry, acronyms -> google)


        – and that saturated fats are hepatoprotective

        Liver disease can lead to diabetes/hyperglycaemia, out of control inflammatory processes, high levels of cytokines, thromboxane etc oxidative stresses, reductive stresses = a perfect storm of metabolic woes. If you add ‘political’ and economic stresses on top of that you can see how it all might end very badly.

      4. Chris Cuneo

        I understand your point, both here and in the blog. Even so, it would be nice to see a list of the CVD protective habits/foods/spices etc used by the Japanese and successful other groups. More specifically, it would be nice to have a comprehensive list of CVD protective items. In hopes of slowing the process. My techie friends quantify and compile complex data with relative ease. Why not do the same here?

      5. Gary Ogden

        Dr. Kendrick indicated earlier in this series that he would address this issue. Best, though, is personal research. I would suggest starting with Dr. Mercola’s vast archive. Since we are all different, a bit of experimentation is in order, and you can keep a diary or log of what works for you; this is the data that has value for you. And don’t pay too much heed to blood tests, unless something is far out of range (the ranges are taken from actual results from lots of people, but there are always outliers, so a little high or low is probably meaningless).

  41. Dr. Göran Sjöberg

    Cholesterol is a fascinating molecule.

    This very Sunday morning I am now reading in my “Cell” (Alberts et al.) how in our 1000 000 000 000 cell membranes almost all the phospholipid molecules which constitute these fatty bilayer sheets have a cholesterol molecule bonded as a “brother” with important stabilising properties. By comparison, the cell membranes of bacteria do not contain any cholesterol.

    It is only recently that it has recognised that there is a “bewildering” variety of 500 – 2000 different lipid species in our cell membranes. It goes without saying that little is known about how they interact in our life process.

    “Kill the cholesterol!” with statins without having the faintest idea of the havoc it may cause on these physiologically fundamental levels doesn’t seem, in my eyes, to be a very ‘scientific’ approach in our “evidence based medicine’.

    1. Diana

      Dr. Sjöberg

      Re “Kill the cholesterol!” with statins… it is rather about the information content of statins, and the context. All what you ingest (drugs included) is listened to (and processed) by gut microflora. The mevalonate pathway is so ancient….
      In my opinion, if you ingest (high?) dose statins, this information is delived to fungi in your body and they suddenly know: “we are in deep shit” and often strike back.

      “Statins as antifungal agents” (Galgóczy, 2011)

      1. Dr. Göran Sjöberg


        Do I understand you right now?

        Eukaryotes, with its essential membrane cholesterol, are higher order organisms compared with the bacteria. On top of my head I remember that the origin of the statin business during the 60-th was the observation that, since the bacteria didn’t enjoy being eaten by the eukaryotes, the bacteria invented the statins as an ingenious defence mechanism?

      2. Diana

        Dr. Sjöberg

        “the bacteria invented the statins as an ingenious defence mechanism?”

        Not only bacteria, mainly other fungi. That is, natural statins are fungal metabolites produced against other fungal competitors (targeting ergosterol biosynthesis, but not only!). Microbial secondary metabolites are rarely produced in lethal concentrations, they rather serve as signals to other fungal species – in smaller concentrations (along with lots of other metabolites) to deliver this information: “do not spread over here, this is my territory, my food source.”

        For instance, from the paper I linked, Penicillium, Aspergillus and Monascus are fungi, Nocardia are Actinobacteria (a special group indeed, they used to be considered as fungi because of their filamentous morphology. But they are bacteria, in nature living in consortia with fungi).

        “The first described statin, MEV, was isolated as a secondary metabolite of a Penicillium citrinum strain. Subsequently, further intensive fungal screenings for similar compounds revealed that a strain of both Aspergillus terreus and Monascus ruber produce a more efficient statin, LOV[5]. SIM is a post-methylated derivative of LOV[6], and PRA was isolated from the fermentation broth of an Actinobacteria species, Nocardia autotrophica[7].”

      3. Craig

        The use of statins as antifungals supports the idea that they should be classed as cytotoxic agents along with other drugs used to fight cancer. It’s easy to imagine how they could cause cancer with long term use via their metabolic disruption, interfering with the mitochondrial electron transport chain by lowering levels of CoQ10. That also suggests another potential short term use for them, as metabolic-chemotherapeutic agents due to their toxicity.

      1. Anne

        Thankgoodness osteoporosis patients (like myself) in the UK and Europe can be prescribed Strontium Ranelate which is not a bisphosphonate. In the US some people with osteoporosis will buy Strontium Citrate from their health food stores – exactly same amount of strontium (the ranelate and citrate being carriers) – this side of the pond it’s a medicine, that side of the pond it’s a supplement !

      2. Craig

        Annlee: In one of the papers Dr. K. referred to in part VII or VII, the suggestion was made that in addition to endothelial progenitor cells, some osteoblasts are released and this is part of the mechanism of calcification. Presumably osteoclasts might reverse this as part of a healing process. It’d be interesting to know if the biphosphonates greatly increase the risk of unstable CVD.

      3. MEC

        In reply to Anne, Bisphosphonates refer / Strontium Ranelate v. Strontium Citrate

        Anne – Strontium Citrate is available in the UK. There are a number of outlets. If you internet search for : Strontium Citrate – UK availability. A number of links appear, and there are a number of excellent outlets. Will also see Amazon, but, warning, do not use Amazon for ordering supplements; one needs to know provenance.

        The Stront’Cit supplement is pure, no aduvents.

        Strontium Ranelate : the Ranelate is chemicalised Stront’Cit together with aduvents, including Aspartame. It is not pure and there are many possible side effects, including cardiovascular :-
        Results (this from the French
        During the 3years of the study, 844 SE have been reported in France in patients treated with strontium ranelate. The 199 severe SE are cardiovascular (52%), cutaneous (26%), hepatodigestive (6%), neurological (5%), haematological (3%), osteomuscular (3%) and various (3%). Venous thromboembolic events (VTEE) are the most frequent cardiovascular SE (93/104) with an incidence of 1/31,052months of treatment. At least one VTEE risk factor is present in 26 (28%) patients. DRESS syndrom which median delay of advent is 35days is the most frequent cutaneous SE (19/51 SE) with an incidence of 1/13,725months of treatment. The 14 severe hepatodigestive SE are hepatitis (n=5), pancreatitis (n=2) and various others SE (n=7). The 10 severe neurological SE are confusion/amnesia (n=5), convulsions (n=4) and parenthesis (n=1). The seven severe haematological SE are pancytopenia (n=5), erythroblastopenia (n=1) and thrombocytopenic purpura (n=1). Among the seven deaths, only three (two pulmonary embolisms, one DRESS syndrom) are attributable to strontium ranelate. Apart from the severe SE, 685 SE have also been reported because strontium ranelate was the only drug with an imputability “suspect”.

        And this from Prescrire – an independent site, looks at pharma without blindfolds —

        And there is yet more on the Protelos pharma site …

        Strontium Citrate, ‘use of’, a useful site, many comments :-

        A small blog :-

        For myself- my story is much the same as the above blog : much the same numbers in osteoporosis; echoes the Actonel – except that I only took for two weeks. Then sawmy rheumatologist, who was not too keen on the Bis. drugs and prescribed Stront. Ran. I researched the S. Ran, found it contained Aspartame, then found S. Cit. Quite a journey. Then…Stront Cit was withdrawn from the UK market ! So ordered it from America. Moved to France, and low and behold, was available again in the UK, but from different outlets – war in the outlets ?
        As with the blog, so eventually with my own DEXA readings, normal, and, discovering the book, ‘Your Bones’ by Lara Pizzorno MA LMT. I took Strontium Citrate for some 10 odd years, with breaks every now and again. Also took, calcium; Boron; Vit D3; Magnesium Malate; Vit-C; Vit-K2. Normal readings and no side effects. Delighted.

  42. TS

    Many years ago I gave our kitten too much liver, every day, and he began to drag his hind legs. He could barely walk. I withdrew the liver and he was back to normal. (One of the liver’s jobs, of course, is to deal with the body’s toxins.) What I was doing was quite unnatural.
    We should not ingest anything to excess because we believe it to have health benefits. The only thing we can be sure of is our evolution and adaptation as omnivores. This makes things easier.
    We may know something about a substance or element but we cannot assume that anyone knows all we need to know. We shall probably be an extinct species long before we can know half we’d like to know about the body and all its reactions. (In my humble opinion.)

    1. Frederica Huxley

      What an appallngly damning article. It is no wonder why so many of us are sceptical of the findings of ‘scientists’.

  43. karlwhitfield

    Hi Dr K,
    Great series!
    In Part 1 you note that ‘plaques don’t form in veins’, only in arteries.
    In Part 5 you note that plaques and clots are one-and-the-same, a plaque being an ‘old’ clot, on the arterial wall.
    A DVT is a thrombus, a thrombus is a clot. A DVT is in a vein.
    So how is a DVT different from clots forming in arteries?
    Many thanks!

      1. maryl@2015

        I love this blog series, Dr. Kendrick. And I have long waited to understand the differences between the clots in arteries vs. veins. They are so different structurally but truly a clot is a clot afterall. So, if depressed, how can one increase tPA to ensure that clot busting thingy helps us along throughout our oh so stressful, depressing lives? Are we going to find out in the next blog, I hope? Bjorntorp’s citation is fascinating. I personally hate the idea of using anti-depressants, but wonder if they work at all. What say you?

  44. Dr. Göran Sjöberg

    I now understand that most of the participants here realise that the more we learn about health, diseases and “causes” the more confused we get.

    Still I am on the side of philosophy which believes that “knowledge is possible” and I wonder why Adam and Eve was forced out of the “Garden of Eden” for eating the fruit of knowledge – the apple. With Xenophanes I also believe that we will never reach the “truth” and if we did we wouldn’t understand that we have reached the “truth” or what to do with it.

    The problem we have got today is with an establishment that claims to know the truth (the one-liner “cholesterol is bad”) and that people in general tend to believe that. For the moment they prescribe statins for huge profits.

    1. Dr. Göran Sjöberg

      Being an confessed atheist I still enjoy reading the bible. One of my favourites is here the Preacher by the wise king Salomon.

      “And I set my mind to know wisdom and to know madness and folly; I realized that this also is striving after wind. Because in much wisdom there is much grief, and increasing knowledge results in increasing pain.”

      “What do you think of that my friend?”

      as Bob Dylan framed a comic twist on a serious subject in one of his lyrics.

      1. Dr. Göran Sjöberg


        I guess that our propensity to believe in miracles is nothing new (e.g. I tend believe in LCHF 🙂 while our establishment in the miracles of statins) and this is really hard wired into our brains. Pythagoras and not least Parmenides, 2500 years ago, were advocating a hallucinogenic approach to our reality and this might even go back to what happened in the caves in southern France 50 000 years ago. Platon summarised this idealistic state of affaires in those days pretty well in my eyes.

        But again, I believe in a the existence of a material world without sprits even if I never will be able to refute the hypothesis that ghosts exist but which actually also makes it a very poor hypothesis according to Popper and myself.

      2. maryl@2015

        Dr. Goran, you are an agnostic. Even believers are. I believe the bible (new testament) is the greatest book of ethics ever told. Miracles are all around us. I see them on this blog all the time.

      3. Sue Richardson

        Ah. Bob Dylan. My teenage idol. They don’t write them like him any more!

  45. Jonathan Bagley

    Dear Dr Kendrick,

    CVD rates have been falling steadily for several decades (before statins) all over the developed world. I don’t think this can all be explained by a drop in smoking, or can it? Many of my ancestors and neighbours, those who died in the 1960s and 1970s, generally seemed to die of “old age”, according to my mother, in their sleep – I’m assuming their hearts stopped, and often not that old – 70 or less. This has puzzled me for years. They ate more home cooked “healthy” food, didn’t drink much alcohol, often didn’t smoke, particularly the women and were generally more active. Did they just have hard lives, which wore them out?

    1. Mr Chris

      Dear Jonathan,
      That is a very good question. When I was a boy 65 years ago, the normal thing was to retire at 65 and die around 67. What changed? They say, advances in health care, but the people just keeled over two years after retiring, worn out, cumulative bad health or what? And why not now?

      1. Christine Whitehead

        I have to say that isn’t my experience.
        I grew up in industrial Lancashire – before smokeless zones and when most elderly men smoked thick twist “baccy”. Travelling on a bus in those days was a choking experience! Yet I was surrounded by people in their 80’s and 90’s – I knew more 90+ year old’s then than I do now. On the other hand I also knew more people who died young and failed to reach retirement age.

  46. Sean Parker

    Keep banging your head against a brick wall and you won’t have to worry about cholesterol, migraine will take over your life.

  47. smartersig

    As one other posted mentioned ‘how do we avoid endothelial damage’. I think the starting point is food and rather than get involved in the tug of war over individual components why not simply take a population that has little or no CD such as the Pritavians. Follow their diet of no processed foods, complex starches and fish but little or no meat and dairy.

    1. joanne mccormack

      Avoiding processed foods is a very good idea, but meat was a prehistoric staple so unlikely to be harmful in itself. Minimally processed high fat dairy has some evidence it its favour. The trouble is it is often processed with sugar and fruit, so cutting out dairy products often helps reduce sugar intake. Complex starches are not ideal for diabetics and overweight people and they can push the blood glucose up, push the insulin up and lead to weight gain. That is why I favour real food, with a low sugar and starch bias. I also favour an individual approach. Perhaps the Pritavians have another reason for having little heart disease, as well as a better diet. It would be an improvement for many of my patients, but not enough in itself for others.
      You may find this paper interesting

      1. smartersig

        That prehistoric meat would not be the meat we now consume via the supermarkets. Injected with anti biotics and growth hormones and fed on grains which depletes Omega3 content. It may well be that grass fed meat is fine but why take the risk when we have populations on a diet that produces little or no cancer or heart disease. Examining micronutrients in food not eaten by healthy societies is simply a way of saying ‘I cant seem to give up meat’

      2. Diana

        “That is why I favour real food, with a low sugar and starch bias.”

        I do not understand this anti-starch mindset. For instance potatoes are a perfect antiatherogenic food (just a quick list):
        – high vitamin C
        – polyphenols (chlorogenic acid etc.) and glycoalkaloids
        – complex fiber content including resistant starch to feed your gut flora
        – potato proteins called patatins – members of the Kunitz family of proteinase inhibitors (with Tissue factor pathway inhibitor (TFPI) function
        – even good for weight loss, etc.

      3. Mec Cham

        Quote : “I do not understand this anti-starch mindset. For instance potatoes are a perfect antiatherogenic food (just a quick list):”

        Starches are tend to be inflammatory for those with arthritic conditions. As with RA; AS; OA; MS etc. See Prof Alan Ebringer, starch free diet. Ebringer was not generally accepted in his day, but now the rheumatologists are coming round to his viewpoint that starches do not sit happily with the arthritidis conditions, especially AS – Ankylosing Spondylitis, an inflammatory spine condition, that carries with it many comorbidities. Many suffering from such control their condition by eliminating starches, some completely until the inflammation is under control. Then they can start to add back starches. Others take the low starch route, control inflammation and both groups are able to come away from medications; the biologics and NSAIDs. The work of the Human Microbiome Research Foundation has done a lot to reinforce the no/low starches approach.
        For myself, I rather like potatoes, but AS does rather preclude my having them in my diet !

      4. Gary Ogden

        What a pity! I’m actually more fond of sweet potatoes (swimming in butter) that potatoes, but have them once in a while. Your points are certainly sound and well-taken. We must each find what works best for us. I seem to tolerate carbohydrate-rich foods reasonably well, though I eat much more (animal) fat than carbs. What made a dramatic difference for me (in overall health; I don’t have any ailments) was giving up grains. What little visceral fat I had disappeared fairy rapidly, and I discovered I have abdominal muscles.

      5. Gary Ogden

        Good! It just goes to show that there are a wide variety of real foods which are healthful, and that looking through the lens of macronutrients in designing a personal dietary experiment can lead one astray. By the way, resistant starch develops after the potatoes are cooked and cooled, so eat heartily of your potato salad, just not with commercial mayonnaise (at least in the U.S. nearly all are made with soybean oil). We certainly vary widely in our tolerance for and metabolic response to carbohydrates in the diet, so experimentation is in order. Highly refined carbohydrates are another matter, however.

      6. Joanne McCormack

        In most cases eating LCHF leads to a normal lipid profile. If LDL is raised it tends to be large particle rather than small but we can’t measure the different fractions in the UK.
        If one of my patients with a FH of abnormal lipids wanted to try LCHF I would support him and check the lipids down the line to see what they were like.
        There is lots of evidence on this blog and elsewhere that healthy fat foods do not raise cholesterol and also that raised cholesterol in the blood does not cause heart disease. I find the main barrier to eating LCHF comes from the people with familial hypercholesterolaemia. They are nervous.

      7. smartersig

        Yes we can measure LDL particle size in this country, what you mean is the NHS wont do it. My advice is to get your lipid tests (not the useless ones your doctor prescribes) done in a country like Portugal. My panel of tests would cost about £600 here in the UK whilst in the Algarve it costs 150 euros, about £120. You can therefore have a long weekend out there, get some sun and still be quids in.

      1. ellifeld

        The Pritavians were another people, they followed the Pritikin diet and well, as we now know excluding fat is not such a good idea.

      2. Gary Ogden

        Yes. Senator McGovern was a Pritavian, and we’re still paying the price for it (and likely will for a good long while, since advances in government move at a far more glacial pace than advances in science and medicine).

  48. Mec Cham

    Re the starches – members might be interested in the following, authorship from Prof Alan Ebringer et al :-

    Clinical and Developmental Immunology
    Volume 2013 (2013), Article ID 872632, 9 pages
    Review Article
    The Link between Ankylosing Spondylitis, Crohn’s Disease, Klebsiella, and Starch Consumption
    Taha Rashid,1 Clyde Wilson,2 and Alan Ebringer1
    1Analytical Sciences Group, Kings College, 150 Stamford Street, London SE1 9NH, UK

    The references are of note, in particular, Nos. 69 to 86.

    As have mentioned before, many spondys have found relief in following the no starch / low starch diet. Starches definitely can/do play a part in exacerbating inflammation, and inflammation means pain (and all the rest !) As with everything though, including meds, works for many but not for all.


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