What causes heart disease part X


Yes, part X, and not at the end… yet. Before trying to sum up I thought I should discuss calcification of the arteries. This is an area I have tended to shy away from in the past, because I am not sure exactly where to place it. Association, end-result, cause… Ignore.

Firstly, what is calcification? It is generally accepted, and I think it is true, that calcification represents the final stage of atherosclerotic plaque development, or growth – or whatever word fits most accurately. The best way of looking at calcification, within the spectrum of CVD, would be to define it as the end stage of plaque development.

Having said that, this is not always the case. Not all plaques calcify. Some do, some don’t, and there are many other factors that have a key role in calcification. Various vitamins, such as Vitamin K(K2) and vitamin D are important. Warfarin, which blocks the effects of vitamin K, increases plaque calcification. The picture is complex.

You may have heard of a condition called fibrordysplasia ossificans progressiva, where muscle turns to bone. Not nice, but it does demonstrate that, in certain circumstances, various other tissues can also calcify – to one extent or another.

The main reason for mentioning calcification is that the Calcium artery score (CAC) has become the latest way of frightening people about CVD. You do a CT scan, count of the amount of calcium you can see, and score it. The more the calcium, the worse things are.

In truth, despite my slightly sceptical tone, measuring calcification seems to be one of the most accurate ways of assessing overall plaque burden, and your true risk of dying of CVD. Like everything else in this area, the CAC score is far from perfect. However, even with many provisos in place, if you have a high CAC then you are definitely at a higher risk of dying of CVD. Equally, if you have a zero calcium score, you can pretty much relax. So it is important.

I suppose you may be wondering, at this point, why would plaques calcify? What is the body doing here? Well, you might find these quotes interesting:

“Atherosclerotic calcification is an organized, regulated process similar to bone formation that occurs only when other aspects of atherosclerosis are present.” L Wexler, et al., American Heart Association Writing Group

In short – and, by the way, I fully agree with the above quote, calcification is not an accident, or an unwanted effect. It seems to be an organised, and regulated process. But organised, and regulated, for what purpose…

‘This chapter will show that vascular calcification is a physiologic defense against active, progressive atherosclerotic disease, that it is produced by physiologic mechanisms similar to those required for normal bone formation and that it is potentially reversible. 1

You might well then ask the following. If calcification is a physiologic defense mechanism… why would you want to reverse it? You might just be making things worse. It is certainly true that plaques pass through several different phases. The most dangerous of which seems to be the ‘unstable’ plaque. This is when the central core of the plaque is a kind of liquid goo which, if it ruptures, stimulates a massive – and potentially fatal – blood clot. Plaques in this state are sometimes called ‘vulnerable.’

On the other hand, once a plaque calcifies, it appears to become more stable, and less likely to rupture… and kill you. Which means that reversal of calcification may look good on a scan, and your doctor may smile with pleasure at your reduced CAC. But… it is all good? I have seen an argument used (by the pro-statin camp) that statins accelerate calcification – but this might be a good thing, because the plaque is less likely to rupture. Is this true? [It would by a nice irony].

Perhaps, here, you can see why I struggle a bit with the whole calcification thing. Is it a natural progression of the plaque? It is a way that the body closes down further damage, and stops further plaque progression. Does calcification help to strengthen the artery wall to prevent it rupturing? Should we be trying to reverse calcification… would we simple be turning a calcified plaque back into a vulnerable plaque?

Calcification is certainly not a new thing. CT scans of mummies – from a number of different cultures – have demonstrated that many/most mummified bodies have large areas of arterial calcification. Ergo, CVD is most certainly not a disease of modern humanity. The mummies from Egypt are well over two thousand years old.

As you can probably tell I am not sure exactly what to make of calcification. However, I think you can probably make the following statements:

  • If you do a CT scan and have no demonstrable calcification – after the age of about forty to fifty – you are at very low risk of dying of CVD
  • If you have a high CAC score this means that you have been developing plaques for quite a while, and therefore (unless you change something) you are at high risk of dying of CVD. [However, bear in mind that CAC represents your history, not necessarily your future].
  • Calcification can reverse. Vitamin K2s (Menaquinones) seem to be more protective/able to reverse calcification than Vitamin K1. Menaquinones are primarily found in meat and dairy-based foods and fermented soybeans (known as natto, commonly consumed in Japan)
  • Calcification is not a cause of CVD, it is (or seems to be) the final stage of plaque development. It may be a protective mechanism to stabilise plaques.
  • There is no evidence, that I am aware of, that if you reverse calcification you improve CVD risk. But it seems likely there would be benefit.

Sorry, I am not sure if that is very helpful, but I thought I had to discuss calcification in this series.

1: http://www.ncbi.nlm.nih.gov/books/NBK2015/

123 thoughts on “What causes heart disease part X

  1. Dr. Göran Sjöberg

    Important part of the overall CVD-picture!

    My artery calcification is without doubt for 17 years now but I keep clear of all “health care” intervention. I don’t need more ‘over-diagnose’ and do reasonably well without knives in my heart region.

    Now, e.g., I will enter my garden and chop some more firewood for next winter.

      1. maryl@2015

        This is the big question and certainly worth further scrutiny. I am not sure about the whole calcium scoring process, but find it fascinating. And though we find our “score”, what does it truly mean? I don’t know. Perhaps it is the stage or timing of that calcification which is important. I like the information on how we can obtain more vitamin K2’s. That red meat keeps rearing its pretty head over and over again. I think we have something there. Actually, Dr. Kendrick, it has been there a long time, no…hiding in plain sight?

      1. Jill Mitchell

        Thank you Dr Kendrick. I am shocked by the amount of radiation involved in mammography! Does that mean the woman is given the equivalent of 2000 chest x-rays per visit to the clinic. Difficult to believe. GPs don’t explain this. My friend died from lung cancer aged 57. She never even tried one cigarette. I am wondering if mammography raised her risk of lung cancer. I refused mammography a few years ago. Dr Peter Gotzsche wrote Mammography Screening – Truth, Lies and Controversy. Now I am wondering if mammography contributes to the risk of heart disease.

  2. thefatemperor

    Loving this series Malcolm, utterly superb (the comments stream too!). Just in case you didn’t see this study on CAC – it is one of my favourites (engineers are inexorably drawn to the numbers as usual). http://www.thefatemperor.com/blog/2015/4/3/cholesterol-ldl-cac-progression-illuminates-fundamental-truths-lchf2015 . Agree with the part X content btw; ones ‘reversal’ method has to address the right mechanisms for efficacy – no point treating a symptom, right? On a separatish point, Interestingly they’ve shown that the CAC score is a double-edged beast. The current score amalgamates volume and density to give an overall Agatston. However, In studies where they separated out these components, a higher volume conferred higher risk, but a higher density conferred lower risk! So even the CAC score has a layer of detail that they miss in orthodox circles. Quelle surprise…

  3. raymm1942

    I recall someone used to advertise, on the web, his book on getting rid of killer calcium by consuming EDTA. The theory was that as a chelating agent it would sequester the calcium and thereby render it harmless. I often wondered what else it might sequester at the same time.


  4. Sylvia

    But calcification is most certainly interesting and I am very glad to know more about it. I love science and astrology as a complete novice. The unstable plaque with goo sounds like magma inside a volcanic chamber waiting to erupt or maybe stabilise depending on so many factors.
    Completely fascinating and unmissable Dr Kendrick.

  5. Colombo

    That was helpful, at least for me.

    I know old people take Strontium hoping that it will help grow stronger bones after a hip fracture. Is it possible that element also “worsen” the plaque in the case of CVD?

    Second question, if you reverse arterial calcification, does that calcium go back to the bones (perhaps lowering the risk of hip fracture in old people), or does it simply go out of the body?

  6. Gay Corran

    Thank you Dr K for your thoughts on calcification. I have been wanting to know more about this aspect of plaque growth for some time. When my husband and I came off statins some years ago, our daughter in law, who is a successful and conscientious surgeon, argued with us about it. There is always cholesterol in atheromatous plaques, she said, and therefore you should reduce chol by any means available. Yes, I said, but there is also always calcium in plaques, so should we remove that, as a villain in the story, as well? At that time our GPs were saying don’t eat chol, take statins, but keep up your calcium intake, (use fat-reduced milk, don’t eat butter, etc) especially after the menopause, in order to look after your bones. This despite the fact that the body cannot make use of calcium without (fat soluble) vitamin D, and that vitamin was being made unavailable by medical advice to reduce fat intake, stay out of the sun and use sunscreen at all times. This seemed to me as nonsensical as the medical advice given to all diabetics to eat at least 60% carbs at every meal, and as the diabetes progressed, as it inevitably would, come back to the health centre for metformin, et al. Quite a lot of medical contradictions there, it seemed to me. Thank you again for your enlightening blogs, Dr K. I don’t know how you have time to fit it all in to your day job as well…

  7. Diana

    It should be asked: where is calcium from, and why it is there…?

    Reversion of calcification: do not forget dietary boron.

      1. Diana


        It relates to my question: where is calcium from? The simpliest answer: from bones.

        “Association between atherosclerosis and osteoporosis, the role of vitamin D” (Stojanovic, 2011)

        “The inverse correlation of cardiovascular calcification and loss of bone calcium indicates that this is the parallel progression of two processes of tissue destruction. Postmenopausal women with atherosclerotic changes of the abdominal aorta, in comparison with those having no vascular calcification, have a significantly decreased value of BMD at the lumbar spine and hip, higher hip fracture risk (× 2.9) and vertebral fracture risk (× 4.8), as well as a higher incidence of fatal and non-fatal coronary events [17].”

        And boron is one of the key minerals for bone health, it helps keeping calcium where it should be.

        “Essential Nutrients for Bone Health and a Review of their Availability in the Average North American Diet” (Price, 2012)

        “Boron is increasingly recognized as an element that has several health benefits including bone health [53-55]. Boron is a semi-conductor with the atomic number of 5. The precise mechanism of action of boron for bone health is unknown, but boron stabilizes and extends the half-life of vitamin D and estrogen [28, 53, 54]. Approximately half the population in the United States consumes less than 1 mg of Boron per day [28]. Supplementation with 3 mg. of boron per day for post-menopausal women has demonstrated improved calcium and magnesium retention by the kidneys [56]. Increased bone strength has also been demonstrated in pigs fed a diet supplemented with boron [57]. Prunes are a rich source of boron with approximately 3-4 mg of boron for every three ounce serving of prunes [30]. A study of postmenopausal women reported that a 3-ounce serving of prunes daily for a period of one year improved bone mineral density but dried apples did not [58]. The Recommended Daily Allowance of boron has not been established, but no toxicity has not been identified and excess boron is rapidly excreted in the urine [28]. Thus, it is reasonable to supplement the diet with 1-3 mg of boron although this dietary need may also be met by increased consumption of foods such as prunes, raisins, dried apricots, or avocados.”

  8. Danny Evatt

    Thank you Dr.!

    I have a very high calcium score of over 800 (anything over 400 is very extensive.) http://www.radiologyinfo.org/en/info.cfm?pg=ct_calscoring Additionally, my second scoring test last year, after a five year break, showed a 12% increase in clacium – per year. Needless to say, this is when I started studying CVD, alternatives to Statins and baby aspirin (and discovered Dr. K.)

    Since I don’t smoke, am not overweight, exercise, etc., my cause of CVD is probably my high Lp(a). As a result, I started taking high doses of vitamin C (timed release), D, K-2, magnesium, garlic and L-Arginine – as well as fish oil (EPA/DHA). I am also on a modified Paleo diet and try to minimize sugar and carb intake.

    My research shows that most Cardiologists think calcium buildup (and therefore) scores are NOT reversible. There are two old studies where animals were studied and given massive doses of vitamin C (?) and showed some CAC regression, but there have been NO human studies of the reversal of arterial calcification that I am aware of. In addition, there is no evidence (online at least) of any CVD or high CAC score patient showing a decrease in CAC scores (the posting of the test results redacted for personal information) Though there are plenty of websites that state that reversal is possible, buy my products, etc. (though again, no evidence is given.)

    My goal, if possible, is to reverse my high CAC score. NOT because I am afraid of the calcium, but because a reversal of the score (or a decrease in the build-up of it) will prove that what I am doing (with supplementation, increased exercise, etc.) is having an impact – and therefore decreasing the chances of having a CVD event in the future.

      1. PeggySue

        Yet another thing that I thought I knew has just crumbled. I always understood that you shouldn’t mess with fat-soluble vitamins such as D and K, or with trace elements, as the stored exces can be harmful.
        I now find that taking large doses can be “the right approach”.
        Could you explain where my confusion could be?

        1. Dr. Malcolm Kendrick Post author

          You are listening to the pharmaceutical industry paid stooges. People are frightened of taking vitamins, some people get various illnesses as a results, pharma company swoops with highly experiences lifelong medication (that does little good), but makes you feel you need more and more drugs for ever and ever. Result. Kerching! I am sure that a few people have taken too many vitamins, and caused themselves harm as a result. However, this pales into utter insignificance next to the damage done by many pharmaceutical products.

      2. PeggySue

        My goodness – that was something I thought I’d “learned” in the dim and distant past, maybe even at A’ level (c. 1980). It’s always seemed to make sense as well, but then so did lots of things up until recently.
        There seems no end to the re-learning – that is what I find frightening.

      3. mikecawdery

        Dr Kendrick.

        The US runs a directory for adverse reactions to vitamins and while some in excess have caused non-fatal, reversible ARs there has not been a death caused by vitamins in decades. As you say it is Big Pharma and its KOLs astroturfing the rare adverse reactions to frighten off the public. Meanwhile, through the FDA they are doing their damnedest to make it as difficult as possible for the vitamin producers so they can take over this huge industry for their own profit. Meanwhile what is the FDA doing to prevent the 100,000 deaths a year from properly prescribed and properly used pharmaceutical? Absolutely nothing except make it easier and quicker to get new ones on the market with even less testing than in the past.

    1. mikecawdery

      Cardiologists think ……
      Being a bit of a cynic may i observe that most cardiologists “think” statins are God’s gift to mam.

    2. TheFatEmperorivor cummins

      Reversal seems to be comforting, but largely unnecessary. Stopping the advance rate is the key. Even a very high score can be ok. If you stop it rising further that is. That said, I’m happy with my zero score at 47 years. Dr. Jeff similar at 54 years. So what’s the upper end of the root-cause pareto to take care of for this sticky issue? LCHF, Hi Mg, hi D/Sun, hi w3, low w6, hi K2, lo stress, hi sleep, some exercise and a few more jewels. You won’t see many with >15% per year, when these vectors sorted… http://www.thefatemperor.com/blog/2015/4/3/cholesterol-ldl-cac-progression-illuminates-fundamental-truths-lchf2015

    3. SS

      Any updates on your health and CAC progression? Have a very similar situation and it’s now 5 years after your post. Just curious as to your current situation…. thanks!

    4. SS

      Danny Evatt – curious as to your results now that we are 5 years later. I’m in a very similar situation and would love to hear / see any results you have learned in the past 5+ years. Thanks!

  9. Barry

    I think, on balance, that it is better to remove both calcification and any other deposits in the CVS rather than hope they don’t cause any problems in the future – even if such action as a diet change slows/stops further deposits. Deposits are not part of the natural scheme of things in a healthy person and, by their very presence, are a source of potentially serious or fatal consequences if they break free.

    Although there isn’t any firm evidence (Pharma isn’t going to finance any research unless they have a drug to push) that reversing calcification reduces CVD risk, if having a calcium score of zero is considered good then surely it follows that less is better? Assuming there are no fundamental biochemical issues that have resulted in calcium depositing in the CVS (or elsewhere) and the issue is diet/lifestyle related then VK2, with appropriate vitamin D and A intake, would appear to offer a solution and Dr Kate http://doctorkatend.com/ provides evidence (case studies) that it does in her book. In her FAQ section http://doctorkatend.com/faq/ she addresses, briefly, the risk of a cardiovascular event with VK2 supplementation – no obvious risk it would seem. As for dosage people will need much more than they can obtain from a Western diet (unless they like natto as a side dish).

    For those wondering about CAC scores this may be of interest https://www.mesa-nhlbi.org/cacreference.aspx .

    Regarding the Ancient Egyptians; Prof Tim Noakes mentions the Egyptians in his book The Real Meal Revolution and paints a picture of diet and disease that mirrors the Western world today. They too adopted a high carbohydrate diet and, quote “The first experiment with the ‘heart healthy’ low fat, high-carbohydrate cereal based diet: A story of wide spread ill-health in the mummified bodies of the Ancient Egyptians. Not only did we become sicker but we became smaller and fatter and life expectancy halved from an average of forty to twenty years.”

    “ Most human beings have an almost infinite capacity for taking things for granted. That men do not learn very much from the lessons of history is the most important of all the lessons of history.”
    Aldous Huxley.

    1. Mr Chris

      Hello Barry
      Ancient Egyptian diet, high in carbs, obviously no sugar and little meat, but good quantity of fish and wildfowl.
      Of course, very much class skewed, and Pharaohs and high officials probably didn’t do much exercise.

      1. Stephen T

        Mr Chris, bread, beer and wheat were staples of the Egyptian diet. Their tomb paintings and models consistently show all three. They must have had high blood sugar levels and raised insulin, much like people eating the western diet, although without the sugar. The poor health of Egyptians and their chronic conditions have been much commented upon. I think Tim Noakes hit the nail on the head when he said the first low carb diet wasn’t good for health. The revised guidelines issued by Public Health England this week, with kind support from the food industry, are still advocating it.

        1. Mr Chris

          Agree with all that, the other thing the tomb paintings show are hunting scenes in the marshes and fishing, which is why I said the scenes are class skewed. The man in the mud hut, the guys who built the pyramids, the tomb builders from Deir El Medineh, we have records that show what their diet consisted of, as you say, cereals bread and beer. As for being able to examine mummified bodies for detaiied health indications, this is not easy. Coaxing DNA out of fragile remains, looking at the bones and the joints, is about as far as it goes.

      2. Barry

        Mr Chris,

        Internet searches come up with various and sometimes conflicting ideas on what the Egyptians ate. However this, based on carbon-12 to carbon-13 ratios, appears more scientifically based https://www.insidescience.org/content/what-did-ancient-egyptians-really-eat/1630 .
        Tim Noakes mentions Dr Michael Eades book Protein Power (which I haven’t read) in which Dr Eades describes what the Egyptians ate:

        “…diet consisted primarily of bread, cereals, fresh fruit, vegetables, some fish and poultry, almost no red meat, olive oil instead of lard and goats milk for drinking and to make into cheese – a veritable (modern) nutritionist’s nirvana”.

        So, little saturated fat or the dreaded cholesterol and no refined sugar; modern dogma would regard this as an excellent diet but the reality is that they suffered from decayed teeth, severely diseased gums, obesity, widespread arterial disease, high blood pressure and had a short life. These days we can deal with rotten teeth and gums but the underlying cause is still there and still produces the same problems internally.

      3. Craig

        That study was looking at c13/c14 ratios. I thought you needed n15 to work out animal food averages? It seems like a pretty poor study anyway.

    2. Frederica Huxley

      The questions I have from Dr Kendrick’s excellent discourse on calcification and this comment is, Did the Egyptian mummies showing signs of calcification in their arteries die from CVD, or did the calcification appear to stabilise plaque? Was calcification the body’s way to counter the effects of their high carbohydrate diet?

  10. Anne

    Before having my bicuspid aortic valve replaced I was given a CT angiogram just to check my coronary arteries for calcium/plaque since, once your chest is open they prefer to do everything at once rather than opening you twice for obvious reasons. I had no coronary calcification, calcium score zero. I was told the radiation these days from CT angiograms is lower than it used to be. There is also a certain type of scan called an EBCT scan which checks the calcium score which uses even less radiation. US cardiologist author and blogger Dr William Davis was always recommending them due to not so much radiation.

  11. JDPatten

    Dr Kendrick,
    Thanks for what you do.
    Calcification occurs in other soft tissue parts as well. Heel spurs in runners, for example.
    Is there plaque involved in that process?
    You said “Yup.” in response to my question about endothelial disease organisms as a factor in CVD.
    Perhaps such infection is a factor in causing calcification directly?
    I’m just wondering if a long-standing plaque burden is strictly required for a high CAC.

    1. Helen

      I’m glad you raised this point. I developed painful bone spurs on my wrists about 18 months ago. I’m an artist, so one might expect this, but around the same time I developed RA in my wrists and hands, which I expected also because of my family history of autoimmune disease. CVD is also been rife in my family, in both sexes. I’m trying to untangle all this in the light of this blog series, but I’m not a scientist, despite my interest.

  12. JDPatten

    Calcification stabilises, but…
    Might calcification “stiffen” arteries, causing a high pulse pressure which is said to be harmful?
    Might the calcium burden thereby increase blood pressure to levels not healthful?

  13. Gary Ogden

    Much food for thought here. If there is an ongoing healing process which removes the plaque debris from the artery wall once a new endothelial layer is in place, wouldn’t the removal of calcium be part of that process? Thefatempeoror post above seems to imply that this may be the case. A bit murky, though, as you say.

  14. Mr Chris

    Dr K
    I think you are incredible.
    You write erudite articles, with all the research that that entails, and then you moderate for about 200 comments.
    Thank you.
    One thing in episode x, how can I tell whether it is worth having a CAC scan?

    1. mikecawdery

      Mr Chris,

      Personally I would not worry about a CT scan; just eat properly and hope for the best with no worrying. As a choice of dying method a massive fatal heart attack seems to me far better than dying slowly with cancer, COPD, Alzheimer’s and many of the other causes of death, which is coming to all of us – probability = 1.00000000000000recurring

      1. Mr Chris

        My GP said the same thing, cholesterol average, CAC scans are for those with excessve TC. I did not start to demonstrate the contradictions in that.

  15. tw

    If Mg binds to Ca in the body, would higher doses of Mg help to stabilize or reverse CAC?
    I have read claims to this effect.

    1. John U

      I would not think that Mg binds to Ca. Ca might displace Mg in Mg salts or other compounds and thus be transformed into a compound that can be cleared, but it does not bind with it.

      1. B

        Is it worth it ?? – or would you say just carry on with diet – lifestyle – exercise – supplements etc etc – or is knowing that number really that important?

    1. BobM

      In the United States, I have found these difficult to find and you have to pay for them yourself. Cardiologists and primary care physicians are more about LDL and Total Cholesterol than these types of measures (including measures such as LDL or HDL subtypes, Lp(a), LDL-P, insulin, hemoglobin A1C, blood sugar, etc.). Both my wife and I have had blood sugar tests over 100 (US units) and neither physician said anything. Personally, I think high blood sugar/high insulin/high insulin resistance are much more important then any cholesterol value (though I’m not sure about calcification).

      1. Danny Evatt

        Bob – Not sure what part of the U.S. you live in, but in Texas, they offer them almost everywhere. A quick Google search of my immediate area showed one hospital that offers them for an amazing low price of $49. Though you are correct that they are not covered under insurance plans. And I might also add that when I have taken them in the past, I say I do not have a doctor, so please give me the results directly – that way they cannot be placed into any sort of permanent file.

      2. Stephen T

        Bob, if you had a CT scan would you find the information useful or just interesting? I tend to go with Mike in trying to do the right thing and staying well away from any type of test or treatment that isn’t absolutely necessary. Wouldn’t there be dangers in the US of such a test, if asked a question by an insurer?

  16. mikecawdery

    Dr. Kendrick,
    I remain in awe at your ability to outline your view of CHD and the common sense of those views. This series in particular is making sense of a very complex problem with its myriad of associations and intertwining of facts. No wonder there are so many views of the problem. Researchers get one idea as the “cause” and follow that but fail to see the big picture – tunnel vision! You provide a view based on the whole picture. While only time will tell if you are right, I suspect that Your view will be nearer the truth than many of the other current views

    Please keep it up.

  17. Professor Felix FitzRoy

    Interesting post – a small amendment.
    Vitamin K2 – menaquinones – only present in grass -fed animal products, so most people except natto eaters in Japan are very deficient. Dr. Goodman, New York University – gives up to date details in his book ‘Vitamin K2’, Author-House, 2015

    1. Dr. Malcolm Kendrick Post author

      Thanks for that information. I think one thing that seems to emerge clearly again, and again (to my mind at least) is that eating food that is as ‘natural’ as possible is the best possible action to take.

      1. Helen

        You’re right, of course, but eating grass-fed animals is a very expensive business, since one has to resort to organically really reared meat for this in the main.

        1. Frederica Huxley

          We feel very strongly about only eating organic meat and wild fish. To keep costs down, we have smaller portions, which is certainly not doing us any harm. Buying a whole organic chicken means that there are always leftovers and a hearty soup from the stock.

      2. BobM

        Joe, where do you live? Where I live, grass fed anything is about double the cost of regular. I’ve taken to buying half animals to attempt to reduce the cost (cost per pound goes down). Steaks, in particular, are quite expensive. Grass fed milk is several dollars (US) more than “organic” milk. The same can be said for yoghurt. And it’s basically impossible to get both grass fed and raw anything (cheese, milk, etc.). I eat raw milk cheeses, but none of them say they’re from grass-fed cows.

        I’ve just started using butter oil made from grass-fed cows. It supposedly has a high K2. It’s also supposed to be raw. But this is about the only thing I can find that’s grass fed and raw for a milk product.

    2. mikecawdery

      Luckily in Ireland most of the milk is basically from grass fed cows (silage in winter) with some meal as a supplement. I suspect much of the milk in UK is similar except in the very big commercialized outfits. This grass fed approach is much the best and should be supported but the idiotic attack on saturated fat has done much damage to this vital industry and human health.

      1. Gary Ogden

        And raw is best. Pasteurization damages the Wulzen factor, and possibly the CLA. The FDA, specifically a bureaucrat named John Sheehan, their dairy dictator, is doing everything in their power to stamp it out. But they are failing! It is growing every year, and West Virginia, among other states, has recently let raw dairy out of jail.

      1. Gary Ogden

        John Burton: That is correct. It is the bacteria in the digestive system of ruminants which convert the K1, abundant in grass and plants in general, to K2.

  18. Anne

    I had calcifcation form on the bicuspid aortic valve I had. There was no plaque on the valve, the calcification was due to the turbulent blood flow through the valve – injury ?
    If there is atherosclerotic plaque in an artery then will there be consequent turbulent blood flow ? And consequent calcification ?

    1. Craig

      I find that (the Gerber page) a little disingenuous. There is an implication but no outright claim that his zero score is the result of his diet being able to reverse calcification. He might have had a zero score all along and the adjacent image is of a different individual showing calcification as I read it. It’s a pity because I am otherwise quite willing to believe that a healthy low carb diet, up to the point of ketosis, might well give that result.

      1. Barb

        I don’t believe Dr. Gerber is claiming any reversal of plaque, simply that after all those years of a supposed “artery clogging” diet, not only is he alive, he has a zero calcium score.

      2. Jeffry Gerber

        Hi Craig. Others have interpreted my post about my ZERO calcium score post in the same way. However, I was never trying to imply that I reversed my plaque as Barb says below. I was simply showing what calcium looks like in a different person for comparison. I just changed the image caption: Dr. Jeff’s ZERO calcium score image (left) – High calcium score image (different person) for comparison (right). I hope that provides clarification. 🙂

  19. William Perkins

    I’m perplexed that Dr. K has lightly endorsed the use of statins for treating known CVD, because they “may have some value re the inflammation issues”! Didn’t the long term studies he presented in one of his blogs indicate that the gains were minimal over the long haul?

    1. JDPatten

      He also said that inflammation was necessary to the process of healing. Address the cause, not the symptom.

  20. Tim Ozenne

    So I guess my sky-high CAC scores are problematic. Damn! If I’m 71 now and have an Agatston score north of 2700 or so, what are the odds of living ten more years? (No, I don’t expect an answer.)

    1. Danny Evatt

      Damn! And I thought mine was high at over 800! Was that your first and would you consider getting another after about 6-12 months of heavy supplements to see if it lowers it or slows its growth?

      1. JDPatten

        This CAC and Agatston carry-on is really too new to the medical community for them to know what to do with it. There’s no protocol. There’s no guideline. My cardiologist didn’t order it; I did.
        My Agatston is 1,640. More than four times the scary 400.
        What is our demographic? The guys who figured this supposed 400 danger mark certainly don’t know.

        1. Mr Chris

          Exactly. When Dr K’S brilliant Part X came out, I posted asking if it was worth having a CAC scan. The consensus reply, with a bit of simplification, was “what for” and your post underlines that, like what are the norms, what does it all mean.
          Reminds me of Lp(a)

      2. Tim Ozenne

        First score of 957 was eleven years ago (age of 60); most recent 2703 was not quite four years ago. Six scans spaced apart about 1.5 years. The growth rate averaged about 15% per year until July of 2012 when I discontinued getting scores (since they are always increasing and I don’t have any notion that I can do anything about it.) Most of the scans were during a period when I was taking heavy doses of statins and had an “ideal” lipid profile. That “treatment” seemed to make no difference to my CAC progression,

        On the other hand, while my scores would seem to indicate substantial stenosis of my coronary arteries, in fact I have no blockage symptoms and I’ve passed my stress tests with flying colors. And I swim regularly, say 3 /week x 3000 meters (1 hr.) I’ll just continue to behave as though the “averages” aren’t useful to me personally. 🙂

      3. JDPatten

        Actually, the difference your statin made was to contribute to your CAC score. Statins are known to do that. Establishment thought suggests that that’s a good thing – stabilising plaque that’s there.
        I continue to wonder if there’s a way that calcification occurs without prior plaque.

      4. BobM

        If the 400 was like most other reference numbers (cholesterol, BMI, blood pressure, you name it), they simply made it up. It has no bearing on reality.

  21. robert

    How does “Mönckeberg’s arteriosclerosis” fit into this. Dr. Berstein (T1DM) said in his book / or in one of his many youtube videos that he had it (legs / feet) and it was reversed. Measured by pulse-pressure oscillometry.

  22. arijo06

    Wow – I have learned more from you, Dr. Kendrick, and from your thoughts and questions than from any other posts.

    I was reading a post the other day from an MD who is a radical vegan. He only seems to report results that concur with his theories and his followers shoot down anyone who brings in opposing data – or deliberately ignore it.

    With you I feel I am getting all sides of the question – and as a researcher I very much appreciate that.

    Thank you, Ariane Blackman

    Sent from my iPhone


    1. Dr. Malcolm Kendrick Post author

      Thank you. It has always been my intention to allow wide discussion, and pay attention to those who hold different opinions. It is, of course, sometimes very difficult. When my fondest ideas are challenged my first reaction can be very angry and defensive. It is a lifelong work to avoid becoming too emotionally entangled with ideas.

  23. Brian Bunk, PhD.

    I understand the Japanese govt. is engaging in a study to see if very large doses of K2 can reverse coronary calcification. It would seem they must have some indication that removal would not create serious instability or the rather large study would present serious risks to the participants. I’d be very interested to know what, if any, data they have in this regard.

    1. Anne

      Here’s a trial that was conducted at Maastricht University ‘The Effects of Vitamin K2 Supplementation on the Progression of Coronary Artery Calcification’: https://clinicaltrials.gov/ct2/show/study/NCT01002157

      “Both Coronary Artery Calcification (CAC)and its annual progression are a strong predictors of cardiovascular events. The development of arterial calcification results from imbalance between calcification promoting and inhibiting factors. An important inhibitor of calcification is Matrix Gla Protein (MGP): a protein present in the vascular wall where it is synthesized by Vascular Smooth Muscle Cells (VSMC). MGP requires Vitamin K-mediated carboxylation to function properly. Deficiency of Vitamin K has been demonstrated to cause arterial calcification and a diet containing large amounts of Vitamin K2 was associated with lower CAC and cardiovascular risk. In animal studies, active supplementation of Vitamin K2 caused regression of existing arterial calcification. Therefore, the aim of this randomized, double-blind, placebo-controlled clinical trial is to investigate whether daily supplementation of Vitamin K2 (Menaquinone-7) to patients with established CAC will lead to a decreased progression-rate of CAC after 24 months of follow-up in comparison to placebo.”

      It would seem the clinical trial has ended but the results haven’t been posted yet.

        1. Brian

          I’m sorry to say I have been unable to obtain a reply. It is interesting that this study’s text asserts CAC has been reversed in animal studies via K2 supplementation. I wonder what the details of the studies were.

  24. Martin Back

    Are plaques calcified in the same way as bones are formed?

    “First, the osteoblast puts up collagen fibers. These collagen fibers are used as a framework for the osteoblast’s work. The osteoblast then deposits calcium phosphate which is hardened by hydroxide and bicarbonate ions.” — https://en.wikipedia.org/wiki/Bone_cell

    I’m presuming fibrin is a type of collagen. So an osteoblast floating along in the bloodstream might see something about the fibrin of the clot that tells it to get to work and deposit calcium. The osteoblast doesn’t care that it’s a clot and not a bone it is working with. It is only interested in the nature of the collagen.

    Or is it a totally different mechanism?

    1. JDPatten

      As you can probably guess, little is really proven about these ideas. It’s assumed that bodily systems that rely on vit K2 handle calcium by keeping it from soft tissues and applying it to bones. Good idea. I myself have a very high coronary calcium score and am diagnosed with osteopenia – a few steps short of full osteoporosis. I’ve been taking K2 supplements since discovering this. I’m my own experiment and it’s too early for results.

      So, from personal experience, my answer to your question is… no.

      1. Gary Ogden

        JDPatten: I suspect it’s probably a good idea, to take K2, and to self-experiment. Make sure you have good vitamin A and D status, as the three work together (see Chris Masterjohn).

      2. robert lipp


        I too am doing an experiment of 1 – a little less scientifically as I have assumed a high score for my age as I have been taking warfarin for a number of years. I don’t have a before score.

        It is now one year later from the above comment. Do you have an update?

        I am also assuming that as I am still taking warfarin the best I can do is to stop the progression.


  25. michael goroncy

    Some points need to be addressed:

    (1) CAC Score. Is of no use post CABG. It’s not possible to access meaningful ‘Calcification’. I have the LAD 70% occluded and the others 100%. I rely virtually on ‘Collaterals’ for circulation.
    (2) Vit D3, being fat soluble need to be monitored regularly to keep within a safe level 25(oh)d. The danger lies in ‘Hypercalcemia’ due to supplementation. This happened to me. Off I went to consult a ‘Endochronoligst’, knowing I would receive their ‘stock standard’ answer of ‘Idiopathic’. It’s important to keep in mind the 2 ways we absorb D3.
    (a) Sulphated…the superior way, direct from the sun. Cannot overdose. 15-20 minutes of sun exposure will give you 10,000 iu. Also being out in the ‘Sun/Light’ enhances ‘Circadian rhythm’. Light in itself into the retina is healthful. As you know, it’s not always possible due to geography.
    (b) Supplementation a inferior second choice, but necessary to keep levels optimum. Unfortunately can overdose.
    (3) K2 and MK-7….Although I supplement. Sadly, there is no solid evidence of proof in this ‘miracle wonder’. The propaganda comes entirely from ‘Quacks’. People that have a vested interest. Selling of books or supplements. So! It’s not entirely ‘Big Pharma’. I stand to be corrected: if you can produce a shred of solid data.

    1. Gary Ogden

      According to Dr. Seneff, the sulfate attachment to D3 makes it water-soluble, and that sulfate plays many roles in metabolism. I think it best to get nutrients from food (and sunshine), though this is not easy for many people, so supplements play a role.

  26. bob

    So, with no calcification there’s little to no risk of CVD, but your risk doesn’t necessarily decrease with decreased calcification, but your past need not be your future…

    Hey, I’m glad you’re honest about what you don’t know, but it’s enough to make anyone nervous.

    Someone I know is a double leg amputee (but had pretty useless legs to begin with) with DVT (several years after the amputations) with no apparent cause, taking warfarin. To complicate matters, he often gets, and will continue to get, UTIs which require antibiotics. He’s significantly overweight, though it is coming down.

    Anybody have any thoughts as to what he should be doing?

    1. Gary Ogden

      Cranberries are an excellent solution for UTI’s. Both my cats and I eat them daily. Available fresh in the fall, and frozen year round. I make a (fermented) chutney with them and other berries. Yummy with gouda, or any cheese.

  27. Paul

    Layman’s question alert: if a high CAC score may be a fairly reliable marker of CVD risk, then doesn’t that imply that we should reduce the amount of calcium in our diets by eating fewer calcium-rich foods (at least in adulthood)? I have a feeling that you will say no, but from reading this article and the rest of the series, I imagine that would have more to do with other health benefits of calcium in the diet (bones etc).

  28. Charles Gale

    With reference to vitamin K2 supplementation, every manufacturer seems to advise taking medical advice if on anti coagulants or anti platelet medication (which I am).


    If medication such as warfarin blocks K2 doesn’t it make sense to supplement? Or do I remove e.g. gouda cheese from my diet as well?

    Personally, I’d rather ditch the meds and have K2.

    Am I missing something here?

    Anyone help?


  29. Tim Ozenne

    I have sky high Agatston figures. I’m looking into aged garlic extract based on a recommendation from an MD/researcher who does lots of heart scans.

  30. Tim

    I read with interest your article . I’d like to know if having kidney stones and gum disease would mean I have a high risk of athercolosis of my arteries . Some reports have linked these two conditions with calcified arteries ?
    Regards Tim

  31. Eyal Statia

    Hi Dr. Kendrick,
    Thank you for your insightful column.
    I’ll be greatful if you can answer my question regarding standardisation and technician-bias in CAC test. How can one know that the SCORE is accurate? Might this score be different if the test is done in another laboratory or performed and interpreted by another (unskillful) technician?


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