What causes heart disease part XI

This blog was going to be all about bringing together all of the strands about what causes heart disease. However, as often seems to happen, I was sent an article about a study that will be presented at the American College of Cardiology conference in Chicago. It led me down a slight detour, which is actually highly relevant to what I have been discussing.

At present I have no more details of this study than can be found in this press release.

Depressed CAD Patients May be at Higher Risk For MI, Death

Patients with coronary artery disease (CAD) who are depressed may have a much higher risk of myocardial infarction (MI) or death compared to those who are not depressed, according to research published March 23 which will be presented at ACC.16 in Chicago.

The study, conducted by Natalie Szpakowski, MD, and colleagues, included 22,917 patients who had been diagnosed with stable CAD following a coronary angiogram for chest pain. Results showed that the incidence of depression following a diagnosis of stable CAD was 18.8 percent. Patients who were female or who had more severe angina were more likely to be diagnosed with depression.

Further, depressed CAD patients were 83 percent more likely to die from any cause compared to those who were not depressed. They were also 36 percent more likely to present at a hospital for MI. Those who were diagnosed with depression 90 to 180 days following the diagnosis of CAD were at greatest risk.

According to the authors, these findings suggest that these patients may need to be screened for mood disorders, either by their family physician or their cardiologist.

“Based on these findings, there may be an opportunity to improve outcomes in people with coronary heart disease by screening for and treating mood disorders, but this needs to be further studied,” says Szpakowski. “Stable chronic angina due to narrowing of the coronary arteries is common, and our findings show that many of these patients struggle with depression. Our follow-up was at most five years, so many more might be affected.”1

Here, I thought, was an opportunity look at the process(es) by which depression can lead to heart disease. Up to now, the ‘experts’ in cardiology have stated that have heart disease causes depression…yawn. In this way they have dismissed the need to explain how, or why, depression could cause heart disease. Primarily, because this association cannot be explained using the currently accepted risk factors.

I thought this study represented a perfect opportunity to demonstrate exactly how, and why, depression will increase the risk of CVD, using the four step model for CVD (cardiovascular disease) which I have outlined in this series:

  • Endothelial damage
  • Clot formation/dysfunctional clot formation
  • Clot repair/dysfunctional clot repair
  • The final, fatal, blood clot

Your first thought may well be. How does depression damage the endothelium, or increase clot formation… or anything else in the four step process?

Well, clearly depression cannot directly damage the endothelium, or increase dysfunctional clot formation. However, the pathways that lead from depression to the four step process are easily defined, pretty straightforward, and supported by a mass of evidence, and they go like this.

Depression, from whatever cause, creates a dysfunction of the hypothalamic-pituitary-adrenal axis (HPA-axis). Sorry to bring in the jargon straight away. However, in an attempt to keep this is simple as possible, think of the HPA-axis as the ‘unconscious’ system of hormones, and nerves, that control how we react to stress. We are talking about hormones such as adrenaline, cortisol, glucagon and suchlike.

We are also talking about the sympathetic and parasympathetic nervous systems which control heart rate, pupil dilation, blood flow to muscles, contraction of the bladder – so just about involved in everything we do. The HPA-axis can also be thought of as the central management system for the ‘flight or fight’ response.

When I use the term, ‘dysfunctional HPA-axis’, what I mean that the HPA-axis has been knocked out of whack. Usually this means it is overproducing stress hormones (particularly cortisol), and is overdriving the sympathetic nervous system. [Yes, I know it is actually all far more complex than this – for those who will undoubtedly write in to tell me so].

The type of things that damage the HPA-axis are: episodes of extreme stress, leading to PTSD, anxiety, depression, schizophrenia. In fact, most mental disorders will be reflected in a dysfunctional HPA-axis – to one degree or another.

If you want more information on this, I suggest going to Google and typing in depression and HPA-axis and/or stress. Or PTSD and HPA-axis dysfunction etc. You will find that much information springs to life before your very eyes. Essentially, you will begin to see how stress, mental illness, depression, anxiety etc. can all be linked through the HPA-axis, to one degree or another.

In short, if you suffer from stress/anxiety/depression… etc, your HPA-axis will go wrong. It will go wrong in many, many, different ways. The complexities and interactions of HPA-axis dysfunction stretch as far as the eye can see – and further. Believe me, I have disappeared over the horizon in many different directions over the years.

However, for the sake of brevity, and understanding, I will look at focus on one hormone, Cortisol. Cortisol is quite easy to measure, and it usually the hormone used to diagnose HPA-axis dysfunction. If the levels of cortisol are high, or low, or do not go up and down in a flexible fashion during the day, you have HPA-axis dysfunction.

Yes, unfortunately, measuring cortisol levels can result in much confusion. I can guarantee that if you look into this area you will end up mind-boggled and mired in apparent contradictions. Just to give one example. Finding a low cortisol level in the morning does not mean that do not have a ‘stress’ related problems, which would normally lead to high cortisol levels.

It simply means that your neuro-hormonal system has ‘burnt-out,’ leading to low cortisol levels in the morning (but overall higher levels over 24 hours). Somewhat similar as to what happens in diabetes where the pancreas eventually gives up the effort of producing insulin to overcome insulin resistance, and ‘burns-out.’ At which point you may well be diagnosed with type II diabetes.

Is that a good analogy… yes, I think so. Because I have seen papers stating that raised cortisol/stress/anxiety/depression cannot be causes of CVD, because many people with CVD have low cortisol levels in the morning. Bong! Wrong answer. A low cortisol level in the morning is probably the single most powerful indication of HPA-axis dysfunction. [Look up Bjorntorp on Google]

Anyhoo. Getting back to depression. If you are depressed, your HPA-axis will become dysfunctional. You will have abnormal cortisol levels, and you will become insulin resistant (because cortisol is a direct antagonist to insulin at many sites). In fact, severe depression can actually cause type II diabetes. Yes, you can look that up too.

Even if you don’t develop frank diabetes, you will end up with a whole serious of metabolic abnormalities. For the sake of keeping this short, you will also end up with blood clotting abnormalities too. Just to give one example, depression increases fibrinogen level in the blood.

‘In cross-sectional analyses, a stepwise increase in fibrinogen percentile categories was associated with a stepwise increase in risk of psychological distress, use of antidepressant medication, and hospitalization with depression.’ 2

Another important clotting factor is Plasminogen Activator Inhibitor-1 (PAI-1). This stops blood clots getting broken down/repaired after they form. Another quick quote here from a paper called ‘Mental disorders and thrombotic risk.’

‘Patients with psychosis, severe depression, or chronic stress are at increased risk for thromboembolism. Evidence suggests that tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) imbalance may play an important role in pathophysiology of mental and thromboembolic disorders. tPA facilitates clot dissolution and participates in several brain functions, including response to stress, learning, and memory. Depression is characterized by high PAI-1 level.’ 3

Linking it together

I hope that, at this point, it has become very clear how depression can, should, and in fact does link directly to an increase in the risk of CVD. Depression causes creates HPA-axis dysfunction and abnormal cortisol secretion, leading to insulin resistance and even diabetes (in severe cases).

This, in turn, stimulates the over-production of various clotting factors, such as fibrinogen. In addition, there is an increase in PAI-1, which prevents the breakdown/repair of the blood clot. [It causes other things too, but I am trying to keep this as concise as possible]

Clearly all this links directly to the four step model. Diabetes/raised blood sugar levels are directly damaging to the endothelium. Raised fibrinogen and PAI-1 are very powerful risk factors for CVD, primarily because they make the blood more likely to clot, and the clot more difficult to clear up.

In short, it is extremely straightforward to link depression to CVD, through the four step process:

  • Endothelial damage
  • Clot formation/dysfunctional clot formation
  • Clot repair/dysfunctional clot repair
  • The final, fatal, blood clot

Next, I will try to demonstrate how a number of other apparently unrelated conditions link to CVD through the ‘four-step’ process. Finally, I will put together, what I believe, are the ten (or so) best things you can do to protect yourself from CVD. I suspect you will already have worked out a number of them for yourself.

Then, anyone who cares to, can attack the four step hypothesis of heart disease and, I trust, do their best to pull it apart. I welcome the debate.


1: http://www.acc.org/latest-in-cardiology/articles/2016/03/23/15/41/depressed-cad-patients-may-be-at-higher-risk-for-mi-death?w_nav=LC

2: http://www.ncbi.nlm.nih.gov/pubmed/22981529

3: http://www.ncbi.nlm.nih.gov/pubmed/24114008

P.S. For those who like this sort of thing. Here is a paper by Bjrontorp which outlines how the HPA-axis dysfunction actually happens, and how it can be measured. http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2796.2000.00603.x/epdf

P.P.S. Bjorntorp worked out the main cause of CVD many years ago

214 thoughts on “What causes heart disease part XI

  1. Henry Barth

    Fascinating series of articles.
    I would like you to explain the differences between ‘Heart Attack’ and ‘Sudden Coronary Arrest’
    There is much confusion in the media with those terms; they are mixed.
    Thank you.

    1. Joe


      Think of a HA as a blockage in a coronary artery (the heart usually keeps beating); a SCA as a malfunction in the electrical system.(the heart suddenly stops beating).

    2. Kathy S

      funny, I just googled that very question the other day – I suggest you do the same and will find an easy answer

    3. Norah Power

      A heart attack is said to be like having a blockage in the plumbing while a sudden cardiac arrest is more like an electrical malfunction. I think that a ‘sudden coronary arrest’ might be a misnomer.

  2. dearieme

    It’ll be rather ironic if at last a useful understanding of CVD is developed just as the epidemic of CVD in “The West” tails off. Still, better late than never.

    1. Mr Chris

      If it did tail away to zero’ or thereabouts, it would be announced as a triumph for statins.
      How ironic.

    1. Craig

      Excellent post Dr K. I have learned a great deal from this series of posts, leading me to add some new tricks to the things I do to keep myself healthy. The Bjorntorp paper gives a great deal of food for thought too.

      Diarieme – interesting statistics. Probably explains the drive to prescribe statins and bp meds etc based on lower and lower levels of supposed risk factors. As the disease itself is in decline then so are the sales of the pills so you have to think of other ways of promoting their use.

    2. annielaurie98524

      Interesting article, but Dr. Grimes is unnecessarily depressing and defeatist in regard to increased lifespan. After making the point that the CVD “epidemic” disappeared unexpectedly, he misses the irony of his woeful predictions of an “epidemic” of aged senility and enfeeblement. The aged that are today succumbing to “age-related” infirmities, dementia, etc., causing it to appear we are starting on a new kind of health “epidemic”, are likely to be part of the same type of phenomenon as 60-80 year-old males were at the height of the CVD epidemic. It’s likely there were factors in the youth and middle age of those CVD victims that the current crop of men in those age brackets avoided, causing CVD rates to drop. Just as it was unexpected, according to Grimes, that the CVD epidemic began to peter out, I think those planning on an epidemic of senile, feeble nonegenarians and centenarians in coming years will find their projections equally inaccurate. I don’t have time right now to do a morbidity analysis, but I have no doubt it would show that a large percentage of people “in the West” that are now in their 70’s and 80’s are “younger”, in terms of their activity level, types of activities, outlook, and many other markers, than those of the same age in the early years of the last quarter of the 20th century. Researchers are now considering the possibility that we will be able to achieve human lifespans of 150 years or more, and that those extra years will be active, healthful years, IF one chooses to take the responsibility for keeping oneself healthy.

      1. Anna

        Gosh, I’m predicting a precipitous drop in lifespan as well as a drop in healthy and useful lifespan. How are we going to have 150-year-olds when half the children are fat? When teenagers are now getting type 2 DM? Don’t know where you live, but this is true for most of USA. Those who choose to take responsibility may do well, but are a distinct minority with a huge uphill battle of misinformation which causes them to do the wrong things and such an adulterated food supply that even very careful and intent efforts can hardly overcome the low quality of food.

    3. Anne

      Thanks for posting that link to Dr Grimes’ blog. Seven years ago I bought his wonderful book ‘Vitamin D and Cholesterol’. I also exchanged emails with some questions for which he was very helpful. I didn’t know he started a blog. Adding the bookmark on my internet browser along with Dr Kendrick, Dr Eades, Statin Nation, Dr Malhotra, and others who keep us informed and educated !

    4. Martin Back

      Thank you for that link. The story of the 20th Century epidemic of CHD that Dr. David Grimes tells is fascinating. What caused it? We’ll have to wait and see what Dr. Grimes says. Another medical cliff-hanger!

      1. Martin Back

        To reply to my own post, I see that in an earlier post Dr. Grimes fingered a micro-organism as initiating Step One of Dr. Kendrick’s 4-step process:

        “CHD, like atherosclerosis in general, is the result of an inflammatory process within the walls of the arteries. This in turn is result of invasion of the walls of the arteries by micro-organisms. The 20th century epidemic appearance of CHD suggests that the cause has been a single micro-organism, possibly but not definitely Chlamydia pneumoniae, but perhaps several micro-organisms are involved.[…] As inherited immunity has developed within the population, so the epidemic of CHD has subsided and is almost at an end.” — http://www.drdavidgrimes.com/2015/01/what-is-purpose-of-cholesterol.html

        Or could it have been the widespread over-use of antibiotics that halted the epidemic? That would be ironic.

      2. dearieme

        Martin, I have floated that idea on blog comments over the past few years. It has elicited no enthusiasm, which persuades me that I (and you) might be right.

    5. Old fogey

      Thank you very much, Dearieme, for linking to Dr. Grimes’ excellent post. It is very rare to have such good news brought to our attention.

    6. mikecawdery

      Thanks for the link.. I find Dr James LeFanu’s book, the “Rise and Fall of Modern Medicine” is very insightful. Following his line of thought brings me to the conclusion that the antibacterials are probably more likely to be responsible for the increase in life expectation over the decades than statins and others of the new pharmaceuticals. Indeed the latter have become the 4th greatest cause of death in the US.

      1. John U

        Just started reading his book – a real page turner I can’t put down. I love it. Still have 300 pages to go.

    7. Stephen Rhodes

      How well does the drop in CVD mortality over those years match to the general improvements in the British economy over the same period? The period during which the benefits of the post-War settlement really came home to millions of ordinary working people and removed a lot of the fear and worry from everyday existence as inequality decreased.
      And how long will it be before the turn-around, begun during the administrations of Thatcher and Reagan in the mid 1980s, results in a return of the CVD epidemic as the lives of ordinary people are blighted by unemployment, worry, and depression?

      1. Sylvia

        Inequality growing, our NHS destroyed, further education comes with a millstone of debt. Inability to afford decent housing, buy or rent. All in it together! You are spot on Stephen.
        Startling statistics on ‘Today’ this morning informing us that more people in the world are obese than not, that is some data. How will we fare as this trajectory keeps on track.

  3. Kay

    “According to the authors, these findings suggest that these patients may need to be screened for mood disorders, either by their family physician or their cardiologist.” When I read that, I wondered what should be the next step if someone is believed to be depressed. Antidepressant drugs seem to have their own potful of problems.

    Thank you for this series. I’m looking forward to your conclusions.

  4. Marjorie Daw


    This article is very timely as a scientifically based new book by Kelly Brogan MD on this subject has just been released. “A Mind of Your Own, The Truth About Depression and How Women Can Heal Their Bodies to Reclaim Their Lives,” is, to quote Robert Whitaker, author of “Mad in America and “Anatomy of an Epidemic,” a “new prescription for thinking about the causes of depression and how best to treat it.” Dr. Brogan takes down the sacred cows of psychiatry, debunking the myth that depression is caused by a chemical imbalance and proves that drugs prescribed for depression work no better than a placebo and are harmful. Instead she shares a holistic prescription for a healthy mind and a healthy heart which go hand in hand. This remarkable book which combines thorough research and Dr. Brogan”s compassion is a must read.

  5. Sylvia

    This demonstrates so well that emotions cannot be divorced from physical problems. To feel fear and anxiety as many of us may have felt for various reasons, causes us to have symptoms,I know I have, where everything inside you collapses, the need to eliminate, heart banging away, fighting to stay focused. But of course if those with CVD also have to cope with depression, whether brought on by the CVD or already a sufferer how much harder for them to be positive. This seems very strong evidence Dr Kendrick, something I had not thought about, you have given a marvellous blow by blow account of the journey. Thank you .

  6. Gay Corran

    So, stress disrupts normal physiological function, as well as the hormonal and nervous system. This ties in with Linus Pauling and Dr Abram Hoffer and Andrew Saul’s work with vitamins as a major part of the solution, especially where addiction is concerned, and especially where breakdown has been caused by prolonged trauma, abuse and stress. We have experience of this in the family, and have found massive doses of niacin and other vitamins have enabled recovery. Fascinating. Thank you again, Dr K, for putting this in front of us. It is very good of you; please don’t feel unappreciated for the huge amount of time and work you put in on all this. We shall all buy the book when you distill these blogs into another book – please!

      1. Gay Corran

        In reply to Hilary, asking for specific recommendations for vitamins, quantities, etc, I recommend reading The Vitamin Cure for Alcoholism by Drs Abram Hoffer and Andrew W. Saul; (How to Protect Against and Fight Alcoholism Using Nutrition and Vitamin Supplementation). Someone in our family was in a very bad way after years of horrific abuse, and was using alcohol as an anxiolotic, trying, and failing, to ease the intense stress and mental pain caused by, as it now becomes clear, dysfunction of the HPA-axis, following years of over production of cortisol and fight or flight hormones in response to mental and verbal abuse, including violence. From the first mega-dose of niacin, as recommended by Dr Hoffer in his book, he turned a corner, and began to recover. He followed Dr Hoffer’s vitamin and mineral supplement advice as given in the book, and got his entire life back on track. Three years on, his recovery remains complete. Another book which was also very helpful, read in conjunction with Dr Hoffer’s book, is Seven Weeks to Sobriety, the proven program to fight alcoholism through nutrition, by Joan Matthews Larson, Ph.D. In it, she relates how her son committed suicide, while clearly suffering from a dysfunctional nervous/hormonal system. She then devoted her life to helping such people. A third book on the subject which we found had a brilliant description of the plight of such sufferers and a very helpful self-help programme based on vitamins and nutritional supplements as well as real food, is The New Alcoholism Story Everyone Needs to Know by Suka Chapel-Horst, Ph.D. All three books tie in with what Dr Kendrick is saying about the inter-connectedness of the nervous/hormonal system with CVD, depression, anxiety, diabetes, etc. Hope this is helpful, Hilary.

  7. Sharon Caswell

    I really hope you will read Dr Kelly Brogans new book “A mind of your own” if you are delving into the area of depression – she has been blacklisted for it so that should tell you of all people that she’s a kindred spirit and that she’s on to something

  8. JanB

    Thank you, Dr. K. I’m not at all surprised about this having observed the effect of stress on my blood glucose levels. Let’s hope the yoga works.

  9. Frederica Huxley

    Fascinating article. Where I cannot square the circle is the actual cause of depression, as I had naively thought that it was dysfunction of the HPA-axis that caused depression, not the other way round. Given that the HPA-axis is thrown out of whack by depression, what is the physiological cause of depression in the first instance?

  10. Wizard

    A very welcome post indeed Dr K. I had hoped that you might mention depression in your CVD blogs at some point and you just have! I have long suspected as much, purely from the experience of my mother. She has lived an exemplary life in terms of diet (wholesome home cooked fresh food ), plenty of regular exercise and yet was diagnosed with severe heart failure at age 66 following a silent MI. No family history of CVD and no obvious symptoms. Unfortunately, she has been a lifelong sufferer of anxiety/depression. When I suggested that this may have been a causative factor, he brusquely exclaimed “utter rubbish” .
    And there you have the problem with the so called experts!

  11. Helen

    I’m so glad you’ve raised this complex subject in the context of CVD and you’ve explained it so clearly for the lay reader.

    I was told many years ago that my HPA axis was ‘disordered’, possibly as the result of a chronic enterovirus infection, plus assorted endocrine malfunctions, which in turn lead to greater disorder… But the long term implications for CVD were never spelled out to me. Added to that, a ‘difficult’ early life led to complex PTSD, from which I have largely recovered – but it has taken decades and I fear it must have added to the risk. Oh well, carpe diem and all that!

  12. Craig E

    It is true that less people are dying from CVD but I’d like to see the figures for incidence. That may show a different story. Does anyone have a reliable source for incidence?

  13. John Foote

    Absolutely fascinating. I have a pheochromocytoma which has not only caused me to suffer tremendous stress but also managed to create a crisis that cunningly put me in hospital with a suspected heart attack. Adrenaline is a powerful ally and enemy. Well done Dr. Kendrick for illustrating stress so well.

  14. Cam

    So this indicates that some of the major side effects of Statins – insomnia, depression and T2DM – actually feed back, through overproduction of cortisol and other stress hormones, to increase the risk of CVD?

  15. primalscream101

    Crystal clear, but I would also like to add that there are confounds not accounted for here. Behavioural risk factors compound the biochemical processes you have described: people who are depressed and / or anxious are prone to poor diet and lack of exercise, which is probably the same reason they were diagnosed with CVD in the first place. So while there is a distinct biochemical process that you have so clearly described, a healthy diet and quality exercise will negate that process even in depressed and anxious people.

  16. dan

    The Chinese knew the connection 5000 years ago. Depressive disorders are treated by moving stasis, in particular the use of what are termed ‘blood moving’ herbs which decrease clotting mechanisms in conjunction with other herbs. There’s nothing new under the sun…

  17. Solomon

    Youtube suggested an interview by David Perlmutter, MD with Dr. Kelly Brogan ( https://youtu.be/q_IRDA3En1U ) after I had read this article. I had a deeper understanding because of what I had learnt here. And a lot of the non-chemical approaches that mitigate CVD also work for depression.

  18. Danny Evatt

    A humorous (but shockingly true) video for your enjoyment! (Thank you Dr. for your objectivity and honesty to other viewpoints.)

    1. mikecawdery

      Thank you for that. Made my day – laughter is the great healer and infinitely better than statins of any ilk.

  19. Gary Ogden

    It was a real pleasure to open Mark’s Daily Apple today and see part X reposted, complete with all 184 comments. Also spacedoc posted some interesting articles today. What interested me particularly was the metabolic importance of sulfate, including in the clotting process.

  20. commenting101

    It is still difficult for me to stop caring about my LDL and triglyceride levels. These have been hammered into my head for so many years. Old habits die hard.

    But this has been excellent. It sounds so logical and makes so much sense.

    1. Craig

      Commenting101, the fastest and most reliable way to drop your triglyceride levels is to cut back on high carb foods. This is widely known, even amongst the statin-pushers.

      Ldl is seldom measured but rather imputed by some strange formula. In one paper linked here recently, amongst the various risk factors the correlation between total ‘cholesterol’ and ldl was 0.84, very nearly but not quite in lock step. This is because of that method of estimating ldl, not because of any measurement of the real value of it, neither by any breakdown of the various lipoproteins which are lumped together under the ldl heading. Its a pretty useless metric!

      1. Malcolm

        As well as eating fewer carbs, taking a fish oil supplement or better still, eating oily fish regularly, also reduces trig readings. My understanding is that you should watch your trig readings, aiming to improve the ratio of HDL / Trigs.

  21. Paul Helman

    I appreciate your willingness to engage in constructive debate. You will get none from me but I dearly wish some of my colleagues would in regards to my efforts to point out some of the seemingly obvious facts that you have so effectively provided. I recently suggested to a gentleman of 65 who was on 40 mg of Crestor ( secondary prevention)that his total cholesterol of 105 was below the normal physiologic range and suggested at a minimum that he increase his intake of saturated or monounsaturated fat. I further added that the benefits derived from his STATIN were not from any parameter that we routinely measure and that cholesterol was vital multi systemically. Within 24 hours the wrath of his regular practitioner who accused me of some sort of malpractice. His guide seems to lockstep adherence to one or another of the “risk calculators”. While the patient was actually in for evaluation of an episode of hematuria I had the temerity to review his history and do a review of systems! All this is quite frustrating and sad. I could , I suppose, point out that to that physician that in his scheme cholesterol seems unique in our physiology in that the principle of homeostasis need not apply. Great regards, Paul Helman,M.D Wilmette, I’ll

    Sent from my iPad


    1. mikecawdery

      Dr Helman,

      May be you should send the following to the said practitioner.

      The WHO produced a graph that shows that compares cholesterol levels (BHF-HEARTSTATS) with WHO All cause mortality age standardized per 100,000 (source WHO Mortality ) for various conditiations. This graph showed a series of J-curves. The cholesterol levels with the lowest mortality for three conditions are as follows:
      All Cause mortality ~222 mg/dl ~5.75 mmol/L
      Non-communicable disease ~210 mg/dl ~5.49 mmol/L
      Cardiac Disease ~208 mg/dl ~5.44 mmol/L
      These levels are way higher than the current medically approved target levels

      You will also note that the risk of a heart attack is as great at 240 mg/dl (6.2 mmol/L) as it is at 150 mg/dl (3.9 mmol/L ie < 155 mg/dl???)

      http://www.heartstats.org/documents/download.asp?nodeib=6797 This URL no longer exists? I WONDER WHY?
      Taken down presumably because it contradicts Big Pharma
      Now on

      Click to access cholesterol-mortality-chart.pdf

      1. Mr Chris

        Dear Mike
        The graph is very interesting, perhaps you know the answer to this question? Why does it have the word “adapted” after the sources? The ill-intentioned and blocked minds tend to seize on that.

      2. mikecawdery

        Mr Chris,
        “adapted” “adjusted for ” are well used terms in medicine. I suspect they often could be replaced by “transformed” or “selected” . Without access to the detailed methodology the specific meaning cannot by identified. Usually they are involved in showing significant benefit for X however trivial.

  22. Jean Humphreys

    Thanks. Your explanations all tie in with my non-science based narrative of the run up to my first MI. This happened nearly twenty years ago and I am still fighing the cardiologists (poor deluded souls) who think they can “cure” me with poisons.

  23. paul

    What an extraordinarily malthusian sign off on that piece by Dr Grimes.
    People are living longer should be seen as a sign of success, not something to lament.
    The quality of these extended years is the real question, and I don’t see years of medically maintained, largely inactive existence as particularly appealing.
    How our societies adapt to these changes is largely a policy problem, generally rising living standards seems to stabilise populations.
    War,famine and pestilence aren’t the only method of control.
    Increased longevity affects the balance of age groups within a society but at least we have enough information to plan for this, if there is the political will.
    Also I’m not sure that the extension of lifespan will pan out as dr grimes sees it, the current cohort of over 70’s grew up in a rather different environment (jobs,nutrition,stability,stress) than following ones. This might well take a toll on their life expectancies.
    Perhaps the real worst case scenario would be an increased proportion of long living, medically maintained, chronically ill people who noone wants to take responsibility for.

    1. Martin Back

      I recall a comment by a doctor on another blog. He said he had several patients in their 80s and he wouldn’t like to end up like any of them. The only ones with a reasonable quality of life were the ones who exercised.

      1. maryl@2015

        Martin Back, I agree. However, I think it more than that. Diet plays a part as those who eat fresh or cook their own food more often than not are living longer and better. People might well partake of a little sugar here and there or some carbs, too without much in the way of consequence. They often love to tend to plants or a garden and listen to their bodies when it comes to food as well as physical activity. They eat to live instead of the other way around. Could it be that elderly who feel cared for by family and friends, who remain actively “engaged” in life and who do some form of daily meditation (in whatever form best suited to them) seem to have the best chance for quality of life in their 80’s and beyond? And I don’t necessarily think these “old timers” have escaped a good deal of anxiety and stress in their lives either. That is impossible, not realistic at all. It is the attitude about stress that seems to be key. They still laugh and joke and love to be around those younger than themselves, too. They draw people to them and feel “useful”. They love to learn and teach, too. So apart from the physiological part as mentioned so much in Dr. Kendrick’s brilliant series, looking at lifestyle might hold more valuable clues than we think.

  24. Hoekstra

    Very good articles and hard work by Dr. Malcolm.

    I believe also that cardiovasculair problems is caused by a wide range of factors.
    My first symptoms appeared by high bloodpressure ( 160/100) when i whas 40 years of age.
    My home doctor found it to early to put me on medicines, so i went on with my life and activity,s like jogging, i did cycle racing my hole youth, and experienced sometimes a little chest pain, but thought i do sports my hole life, i don,t smoke, i don,t drink much, eat pretty normal and regular.
    But at the age of 43 i survived in 2 ours time 5 cardiac arrest, 2 at home, 1 in the ambulance and another 2 in the hospital. It became clear that i needed bypasses, 3 pieces the doctor could make. I became on medication, 3 medicines for lowering bloodpresser, 1for thinning and the statin. When i came home i stayed tired, my eye sigt whas far from clear, muscle weakness, sometimes suddenly chest pain in the heart muscle area, when i pick something up from the ground i felt that i could collapsing, i discovered afterwards that the statin whas the cause.

  25. mikecawdery

    This begins to hang together in a believable series of events. One just wonders what all the “experts” are doing. There is a recent review on coronary heart disease in the Lancet but it is not open access as usual.


    The Abstract is:
    No disease can have been so extensively studied. The work of recent years has yielded remarkable advances in our understanding, and in diagnostic and interventional cardiology, surgery, and pharmacology—effort well spent for a disease that carries such heavy social and economic costs. The clinical condition of coronary heart disease (CHD) presents as (i) angina, (ii) myocardial infarction, (iii) sudden death, and (iv) consequent chronic heart failure. It is responsible for about 50% of cardiovascular mortality, which itself accounts for 30–50% of all deaths in developed nations.

    Which is not helpful. Indeed sudden death, and (iv) consequent chronic heart failure seems odd. After sudden death one gets “chronic heart failure”

    1. stipetic

      Mike, if you press on the pdf logo on the upper right, the full opens. It just did for me. If it still doesn’t for you, send me a email and I’ll get it to you.

      1. mikecawdery

        Stiptec Many thanks. Yes it did download this time. Last time all I got was an invitation to buy at $30.00 for which I could get 3 copies of Dr K’s “Doctoring Data” – much better value medically.

  26. Dr. Göran Sjöberg

    A friend of mine I “converted” a few years ago recently met an englishman on statins and tried to get him off the medication. I got a mail where he asked for support through a link to the Australian ABC Catalyst program which unveiled the statin business two years ago.

    As some of the participants on this blog know Big Pharma went into action and had the program withdrawn but with our “wonderful” internet nothing is lost which has once appeared and other friends of mine helped me to find the links to the programs. The ‘statinised’ englishman is now very happy to be able to see the programs before he will meet his GP on Wednesday.

    And here are the links for those of you who missed this great program.

    1. mikecawdery

      Thanks Goran
      I missed saving the links last time round. Some things do go AWOL like the CDC/NHBLI US CHF Epidemic (NHBLI and CDC) retracted from their websites but later found on http://library.thinkquest.org/27533/facts.html archived from there but I have recently refound it at:
      The first graph shows the rise in congestive heart failure (CHF) rising with increasing use of cholesterol lowering drugs. Retracted when statins were becoming the drugs of choice in the 1990s. A US cardiologist informed me that the epidemic was alive and going strong.

      1. BobM

        Heart failure also follows increasing carb intake, and is relatively highly associated with insulin resistance. Personally, I think insulin resistance is likely a cause of heart failure (and statins likely don’t help much), mainly because people with heart disease have insulin resistance. The insulin resistance comes first, then the heart disease, then the statins are prescribed (at least in the beginning when statins were first prescribed — now, they’re handed out like candy). Statins are a follower in this theory, not a leader. It’s difficult to know, though.

  27. BobM

    I’m reading a book about probiotics in the mouth, but the author goes on to list studies done where the intake of probiotics helped with depression.

    I used to think that we knew everything about the body. The more research I do, the more I realize that we probably know next to nothing about the body. And what we do know has a high probably of being wrong and/or unsupported by scientific evidence.

    1. Dr. Göran Sjöberg

      Your view is exactly the same I have arrived at in my own efforts to understand the medical field from a more fundamental natural science perspective.

      E.g., reading my ‘dear’, most solid, textbook “Molecular Biology of THE CELL” I am now halfway in my third reading of it and presently in the chapter dealing with how our cells are organised in all their intricate biochemical interactions and which constitutes what we usually call ‘the life’ in every single one of our about 10 000 000 000 000 individual cells. The complexity on this basic level is just shocking and overwhelming to me.

  28. Annlee

    Dr. Mike Cawdery –
    After sudden death one gets “chronic heart failure”

    Well, it doesn’t get better, does it? 😉

  29. mikecawdery

    Dr Kendrick

    Having had time to read, learn and inwardly digest this series of articles, the epidemiology, metabolism and physiology of heart disease becomes more understandable. Please, please can you put pen to paper and present it as a scientific paper in a general medical journal (not the Lancet – it would not take it with a £million note). I suspect it would be widely read by your GP colleagues.

    I have always believed, urban myth or old wives tales, that stress was associated with heart disease. To find that this is in fact true despite all the agnotological waffling on cholesterol is encouraging. However, to find that this was medically demonstrated many years ago (Bjorntorp worked out the main cause of CVD many years ago) makes me wonder why it was ignored in preference to the Cholesterol Myth.

    It seems to me that progress has resulted in the death of truth to be replaced by astroturfing by governments, commercial corporates and many other institutions. For example, the FDA has admitted that prescription drugs are the fourth largest cause of death in the US. Is this not the result of their drug approval system?

  30. Rufus Greenbaum

    One of the common factors in all these illnesses might be Inflammation caused by an imbalance in the Omega-3 and the Omega-6

    A key indicator seems to be the Omega-6/3 Ratio

    Increasing your Omega-3 is relatively easy, but REDUCING your Omega-6 involves major changes to your diet and lifestyle, since it is present in most of the processed food that we eat

    To see a little more about this, search for “GreenVits” and read my blogs on Inflammation

    1. Jennifer.

      Rufus, it ought not be that difficult to at least improve the ratio…..just ensure all processed foods are banished.
      I have been increasing Omega 3 in as many ways as possible, and omitting all processed junk, but as I am doing it under ‘ blind faith’ there is no way I can actually measure such things. Fingers crossed I am heading in the correct direction!

    2. BobM

      And if you’re really militant about reducing Omega 6, you have choices to make. Chicken, for instance, has a higher Omega 6 ratio than does beef for instance, and dark meat (the only type I like to eat) chicken has a higher ratio than white meat. Personally, I’m not a big fan of chicken, but sometimes for variety we have to eat it. It’s also easy to buy and cook. You don’t have to be concerned with type of cut and how to cook it, for instance.

      To reduce Omega 6, the easiest thing to do is cook everything yourself and don’t eat anything prepared (any salad dressings, condiments that have fat, packaged food, etc. will have high Omega 6 from soybean/canola oil). But even then, some folks don’t eat pork or other meats because of their high Omega 6 ratio. Personally, I’m not that militant, and just try to eat a variety of meats and cheeses. My diet is more akin to “primal” (basically, paleo + dairy), and I eat fish as often as I can convince myself to do so.

      Anyone see this?


      Their secret to long life? No exercise, smoking, and being overweight. Oh, rosemary and anchovies. And lack of stress. I think the real secrets are genetics and lack of stress, with a tiny bit of Omega 3 thrown in there.

      1. TS

        Bob. re. “I eat fish as often as I can convince myself to do so.”
        Have you tried adding a few frozen prawns to whatever you’ve cooked? (Lidl sells good sized ones trawled from the North-West Atlantic.) Very tasty, nutritious, a whole animal, and of course pre-cooked. In fact further cooking will make them rubbery. Just need to add them to whatever you’ve prepared if it suits the dish to do so.

  31. Eugène Bindels

    To anyone who might have some insight on this: according to my cardiologist is an MRA (MR angiography) is not accurate enough to determine the severity of stenosis. Any comments?

  32. Eugène Bindels

    Any comments on drug eluding stents? According to my cardioligist bare metal stents are hardly used anymore (only for big arteries). He says drug eluding stents are the most commonly used while they have less restenosis.

    Does anyone knows what drugs they contain? Howlong do they keep emitting drugs?

    1. Kathy S

      Hi Eugene – it’s me again, Kathy. I had a drug eluding stent placed in my LAD – left coronary artery in Oct 2014 after a 90% blockage. A year later – restenosis to the tune of 95% so another put inside the first one and one more just below it. We think the first stent did not fully cover the lesion and plague built up just outside of the stent and backed right up into it. There is a new stent out that eventually dissolves which my heart doc and I talked about our last visit. Might be worth exploring. I don’t think the type of stent resulted in my restenosis but the lack of completing the job in the first place. Who the heck knows.

      1. Dr. Göran Sjöberg

        All my arteries were more or less blocked 1999 according to the angiographs and I was offered a comprehensive by-pass operation. In my ignorance I asked if the couldn’t use stents instead but my case was too severe for any benefits. Today,17 years later after my total refusal (the by-pass and medicine) I am very happy that stents were not ‘applicable’.

        I have never seen any proofs that there should be benefits in the long run with any of the suggested interventions.

        1. Kathy S

          Hi Dr. Sjoberg,
          I have read in earlier blogs that you refused the stents which I find interesting. In my case, the chest pain was debilitating and I credit my having good collateral vessels that prevented me from having a heart attack and probably saved my live in both instances. I could barely walk a few feet without that pain and once the stents were in place, I was good to go. What I really want to avoid is open heart surgery! I find this blog very interesting, entertaining and more important – enlightening. What made you decide to not to go forward with stenting??

      2. Eugène Bindels

        Thank you very much for your reply. It’s helpfull in more than one way. One very important thing is that I’m no longer feeling alone in this. If you talk to people around you (even relatives) about doing something different than what the doctors advice, you might as well put on the straight jacket yourself. Mainstream cardiologists do mainstream stuff, which I think is not the way to go. But who am I. I’m not a doctor but I have to make decisions regarding my life. I’ve tried to decipher studies but they are abracadabra to me. I have read “Doctoring data” which is at least readable for an average person. My father died at age 43 as a result of his second MI. I already managed to live 7 years longer dan he did and intend to stick around for quite a while longer. Quality of life is important to me. Again really thank you.

        1. Kathy S

          precisely what I feel – I have to be comfortable with the medical care and intervention for myself. It’s my life and my body. I am fortunate that my doctors have not given me grief over my decisions. Things need to make sense to me and Dr. K’s books have helped me make sense of a lot of this stuff. Oh, by the way, my husband who has naturally occurring high cholesterol read Dr. K’s book and stopped taking his statins. A few months later after a blood test, his numbers were in the 300’s, freaking his doctor’s office to the point they doubled his dosage, which of course, he didn’t take. Today, after loosing about 15 pounds, is down to 204! Ha! Not to mention that we don’t really care what that number is but it didn’t take statins to get there. Eugene – you are not alone!

  33. Nigella P

    Interesting mention of cortisol Dr Kendrick. Over at TPAUK.com, which I frequent because I am hypothyroid, we talk a lot about adrenal function, stress and cortisol output. There is a view that thyroid function can be adversely affected when cortisol is out of whack (a well known medical term!). It seems that prolonged stress has a negative effect on just about every organ of the body, heart included.
    At the moment many in the medical profession are reluctant to entertain the idea of ‘adrenal fatigue’, which I would see as the cortisol levels starting to go awry, rather than Addisons or Cushings. Do you have any thoughts on this term / concept?

    1. Dr. Malcolm Kendrick Post author

      I think the term is a good one. I am not entirely sure how to define this problem. But it is clear that in hypothyroidism, the adrenal glands (probably the entire neurohormonal system) becomes chronically stressed/fatigued. As Lenin said ‘everything is connected to everything else.’ True of society and very much true of human physiology. I try not to get too dragged down into this area, as things rapidly get very complicated indeed, and I start to lose sight of the bigger picture.

      1. Joe

        Dr. Kendrick:

        Patty Duke recently died of a massive heart attack at 69, while she was in a hospital being treated for bronchitis. Cortisone and other corticosteroids are typically used to treat bronchitis. They also can increase the heart rate quite a bit. Any chance that Duke’s treatment contributed to her heart attack?

      2. JDPatten

        From USA Today:
        The news was confirmed Tuesday by one of her representatives, Mitchell Stubbs.

        “Anna ‘Patty Duke’ Pearce passed away this morning March 29, 2016 at 1:20 am,” his statement read. “Her cause of death was sepsis from a ruptured intestine. She was a wife, a mother, a grandmother, a friend, a mental health advocate and a cultural icon. She will be missed.”

  34. Jean Humphreys

    1st April, so I still can’t decide about the top headine in today’s Telegraph.
    “Statins will be useless as obesity crisis grows.”

    1. Jennifer

      Jean, the headline flummoxed me too. And on last night’s BBC News Channel’s 10:45pm discussion about the newspapers, the link commentator referred to ‘life-saving’ statins……I jolly well think NOT! More BBC propaganda to confuse the masses.
      I think we need a straight forward, informative TV series of programmes about anatomy and physiology and the actions of pharmaceuticals. The general public needs much more education to help them to make informed decisions.
      Oh….it is April 1st…..I must be kidding myself; silly me.

      1. Danny Evatt

        Jennifer – It was probably the same “ground-breaking study” that was reported on the National ABC news in the United States on April 2nd as well.

        At the very least, the news announcer did mentioned that the study was paid for by…. you guessed it, the maker of the Satin! Here is a direct quote from the article:

        “The study used 10 milligrams daily of rosuvastatin, sold as a generic or under the brand name Crestor. The editorial authors said other statins would likely have similar results. Crestor’s maker, AstraZeneca, and the Canadian Institutes of Health Research paid for the study. Yusuf reported receiving grants from both; and several co-researchers reported grants and personal fees from the company and other drugmakers.”

        What continues to shock me is that this type of “study” – paid for by the very people making the “study” would even be reported and (worse) be regarded as fact! Would they report that massive amounts of table sugar, taken orally 8 times a day, is good for you if the sugar industry paid for it?

        This is truly a concern for everyone when a “study” such as this is presented as fact, paid for by the drug company making the drug used in the study and then subsequently published in the New England Journal of Medicine and presented at an American College of Cardiology meeting in Chicago. Truly shocking…

    2. mikecawdery


      “Statins will be useless as obesity crisis grows.”

      I was under the impression that statins were next to useless (p (no benefit) approaching certainty) without any help from obesity.

  35. mikecawdery

    Two papers that may interest:
    A fatter more healthy world http://www.thelancet.com Vol 387 April 2, 2016

    Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 192 million participants

    1. JDPatten

      Yes, interesting papers.
      But when we try to plug ourselves into these findings to make some personal sense of it, we have to understand what BMI means.
      BMI is like using a hammer ’cause most are nails when we ourselves might be screws. 🙂
      At my fittest and healthiest my doctor worried about my “obesity”. He couldn’t see for lookin’ that I’d been weight training for the previous four years. No fat. Just muscle.
      Imagine what Arnold’s BMI might be.
      And then there are the underweight obese.
      We’re each of us unique.

    2. David Bailey


      Here is an amusing quote from that paper:

      A controversial aspect of the BMI mortality association is estimation of the optimum BMI. Some observational studies show that mortality rates are lowest in people classified as overweight,6 with the publication of such studies generating glee in the popular media and Twittersphere. If this association between overweight and low mortality were a causal relation, it would resolve the apparent paradox of increasing aggregate BMI and improving health. However, much evidence suggests that this association is generated by the BMI-reducing effects of prodromal factors related to mortality and other confounding factors.

      1. mikecawdery


        Flegal of the US CDC published three times on this subject. They were not April fool jokes..

        Three attempts by the CDC to show that overweight was bad. All showed the reverse.

        JAMA. 2005 Apr 20;293(15):1861-7.
        Excess deaths associated with underweight, overweight, and obesity.
        Flegal KM, Graubard BI, Williamson DF, Gail MH.
        Overweights lived longer than normal weights

        JAMA. 2007 Nov 7;298(17):2028-37.
        Cause-specific excess deaths associated with underweight, overweight, and obesity.
        Flegal KM, Graubard BI, Williamson DF, Gail MH
        Overweights lived longer than normal weights

        Flegal KM, et al. Association of All-Cause Mortality With Overweight and Obesity Using Standard Body Mass Index CategoriesA Systematic Review and Meta-analysis JAMA 2013;309(1)
        Overweights lived longer than normal weights

        This article is a classic example of Big Pharma’s astroturfing and agnotological practices used to spread confusion, disssension and lies; much practiced by the tobacco companies in the past…

        There is also the “Obesity Paradox”; google it and you will see what I mean. Lots of refs.


        Sandy Szwarc has some interesting refs on the subject.

        In short it is better to be overweight in one’s old age despite the astroturfing of conflicted interests.

      2. mikecawdery


        Thanks for the link. If it was an April Fool joke then all that can be said for it is that it is in very poor taste and I am surprised at the DT publishing it. Nonetheless in that it states that statins are useless it may do some unintentional good as I suspect it was still promoted by statinists.

  36. TS

    Perhaps these expressions show that folk knew what hastened death an awful long time ago:
    Worried to death
    Scared to death
    Bored to death

  37. Dr. Göran Sjöberg

    I believe that ‘knowledge’ is possible! This is why I relentlessly keep to my ‘dear’ textbook “THE CELL” where I this very Saturday morning, with wide open eyes, happen to read the following about how our cholesterol levels are ‘regulated’.

    Hold on!

    It is all about the communication between what is happening in the cytosol and the nucleus in our cells.

    “An appropriate stimulus releases the gene regulatory protein from its cytosolic anchor or mask, and it is then transported into the nucleus. One important example is the latent gene regulatory protein that controls the expression of proteins involved in cholesterol metabolism. The protein is made and stored in the ER. When a cell is deprived of cholesterol, the protein is transported to the Golgi apparatus where it encounters specific proteases that cleave of the cytosolic domain, releasing it into the cytosol. This domain is then imported into the nucleus, where it activates the transcription of genes required for both cholesterol uptake and synthesis.”

    And this is just a detail of the complex web of physiological reactions involved in the cholesterol regulation.

    What scares me here is that with this kind of ‘knowledge’ there are ample possibilities to put a stick somewhere in a running wheel by a ‘well designed’ drug and then sell this drug under the presumption that cholesterol essentially is a ‘bad molecule’. This is exactly where, in my eyes, the corruption and the abuse of true basic science by Big Pharma enters the medical equation.

    In my ‘dear book’ I have still not found a single indication that the cholesterol molecule should be fundamentally ‘bad’ so I keep to the book! 🙂

    1. David Bailey

      That was a fascinating paper. It raises the possibility that even the tiny benefit of statins, reluctantly accepted by Dr Kendrick, and supposedly due to their anti-inflammatory effects, may not be real!

  38. Sylvia

    Quite alarmed and surprised to read that migraine with aura puts you at risk of cardiovascular disease, those without aura are OK. I have aura and low grade headaches 2 or 3 times a year, it is in the older age group. Migraine is neurological, vascular or both, so it seems, one site saying double the risk of stroke. Ignorance is bliss, serves me right for looking.

    1. Caroline H

      Sylvia, I wonder whether this migraine-stroke link is complicated by the group of people who are more prone to migraines due to a PFO (hole in the heart). It can be a stroke which alerts the person to the fact that they have a PFO. Subsequent surgery to close the PFO seems to reduce or eliminate migraines. This happened to my sister.

      1. Sylvia

        Thank you, have looked at this. Risks involved to find out, catheters, radio opaque dyes. Some dispute this effect. It has panicked me a little, had a TGA last year. I guess we know too much and we can’t live forever. Dr Kendrick is going to present us with some armour to help us get the best out of life I think. I do use homoeopathy, tissue salts, flower essences. I know it is controversial, but have found it to be effective on my family and animals. Would not dream of suggesting it is the answer to all but has a part to play in my opinion. Caroline hope all is well with your sister.

  39. Alan

    Really starting to look like the cause is not Cholestrol anyway…

    “Nicholls and Dr. Steve Nissen, the head of cardiology for the Cleveland Clinic, who co-lead the evacetrapib study, on Sunday reviewed the baffling evacetrapib data in a presentation at the annual scientific sessions of the American College of Cardiology in Chicago.

    “This drug lowered LDL by 37 percent and raised HDL by 130 percent and had absolutely no effect” on preventing deaths and heart attacks, Nissen said in an interview.”

    1. Dr. Malcolm Kendrick Post author

      Yes, there have been many drugs that lower cholesterol over the years. Up to now, statins are the only ones that have had any impact on CVD (a small impact, not worth the adverse effects in my opinion, but it seems to exist). Still, the ‘experts’ continue to tell us that statins reduce the risk of CVD by lowering cholesterol. Now, I can understand why they continue to do this, for reasons that start with m and end in oney. What I find increasingly baffling is the fact that anyone still continues to believe them. Oh well.

      1. mikecawdery


        Thanks for the link. Actually makes my point Cardiovascular death, heart attack or stroke occurred in 3.5 percent of patients receiving both drugs and in 5 percent of patients receiving only placebo

        The actual difference between drug and placebo is 1.5% over 5.6 years or circa 0.3 per yeare; pretty much the same as the HPS study or 1 life “saved” for 300 treated as claimed by Prof Sir Rory Collins.

        And as usual in statinist reports there is no mention of adverse reactions – frankly no ARs is an unlikely event in this number of patients.

    2. mikecawdery

      Dr Nissen seems to have changed his tune – a right old-fashioned U-turn no less.
      I have always had doubts about risk as a diagnosis for treating the individual patient; it is OK for treating a herd and even humans with a vaccine that is effective and lasts for a long time. A disease such as malaria is treated in such a way but in the long run ended up with most drugs being ineffective through drug resistance.
      Also the risk estimate is around 10% in 10 years – reverse that and one gets 90% negative risk. In short the “risk diagnosis” is 90% WRONG for the individual patient and simply exposes a lot of patients unnecessarily to a 1 in 5 chance or more of an adverse reaction. Not confidence building for patients

      1. LeonRover

        Survival synonym for negative risk;

        Life insurers use population survival tables when calculating annuity tables.

        (Whenever I see a risk %age, I usually calculate the implied survival rate. Most GPs hate it when one does this.)

      2. mikecawdery


        Life tables are very interesting. I have downloaded some for England and Wales. On the basis of the qx values (is the mortality rate between age x and (x +1),) the sum of q(65) to q(74) for men (2008 tables) comes to ~0.10 or roughly 10%, which is what the risk algorithm calculates for heart disease.

        Which poses the question: If the risk of death from all causes is 10% for a 65 yr-old man in the next 10 years, what is the CHD risk estimate measuring?

      3. barbrovsky

        Absolutely!!! I was sent to see a specialist lipid nurse at a London Hospital who told me I’d die (soon?) if I didn’t take a statin. When I asked her how much ‘extra time’ it could give me if I took it, she had no answer(obviously). Again it ain’t medicine, it’s the combined onslaught of gangster capitalism and a gangster state on us uninformed public.

  40. Sasha

    Dr. Kendrick, just like you predicted in one of your earlier posts: now that many statins are off patent, researchers are suddenly beginning to find that there are plenty of people who can’t tolerate them after all. And PSK9 inhibitors just may save the day… Steven Nissen & Co are there to show us the way:


  41. Jean Humphreys

    April 4th and the Telegraph are still at it. “Scientists” (my quotation marks) have proved that statin muscle pains are real. But it doesn’t matter – there is a drug called Evolocumab the will reduce the dreaded cholesterol without the pain.
    In other words, this is a ploy to campaign for the pesky-canines.

  42. Stephen T

    Goran earlier attached a link to the excellent Catalyst programme about statins. The same team have now produced another programme called ‘Too Much Medicine’? It features a number of subjects, including breast screening, statins (18.30) and polypharmacy. The speakers are impressive and mostly British.

    1. barbrovsky

      That’s exactly how I feel about the state of my dis-ease. In fact my GP apologised to me for, and I quote, “over diagnosing me”, which in turn caused me to get depressed and start getting anxiety attacks and feeling ill! It started with my blood pressure readings.

      I’m one of those people that’s affected by the ‘white coat syndrome’. When my BP is taken by my gp or at hospital, it shoots up to 159 over something or other. A 24hr BP test revealed that for someone who is 71 and had smoked for the better part of 50yrs (and Gitanes no less!), my actual BP was 128/81.

      Perhaps it’s to do with living in an imperialist state on the backs of the rest of the planet and wanting hang onto our ill-gotten gains for as long as possible? Just a theory.

  43. Dr Robin Willcourt

    The Medical Journal of Australia’s Newsletter, the 6minutes Newslatter, just published the results of three studies: “Statin use in primary prevention should be broadened to include people at intermediate risk of cardiovascular disease, according to trial findings presented over the weekend.

    The first of a series of three studies found a 24% lower incidence of a major cardiovascular event in moderate-risk men and women randomised to rosuvastatin, compared with placebo, with a mean follow-up of almost six years. The Heart Outcomes Prevention Evaluation-3 (HOPE-3) studies involved nearly 12,000 men and women aged over 55 and 60, respectively, with no clinical disease but with intermediate risk factors.

    Patients were enrolled in 21 countries including Australia, with the involvement of five Australian investigators led by Professor Chris Reid from Monash University.

    Heart Foundation national CEO Professor Garry Jennings, who was not involved in the HOPE-3 studies, notes that present Australian guidelines recommend statins in primary prevention only for patients at high risk of a CV event.

    “However, future guidelines committees might consider expanding this eligibility to people at moderate risk of having a heart attack or stroke,” he says.

    Oh boy. Pfizer just won’t let up. Another worthless lot of results that have relative risks being compared and then called ‘statistically significant’ when they are clinically NON-SIGNIFICANT.

    Statins cannot work because cholesterol and LDL are NOT the causes of CVD. Look at the roles that triglycerides and HDL play in both clot formation and thrombolysis and THEN you get at least some sense of what causes plaque formation/prevention. Statins DO NOT alter these components in a clinically meaningful way,

    Of course the shills for the drug companies will trumpet the benefits of statins but the public is getting the picture and I am finding droves of patients coming off these useless poisons and opting for IF and low carb high saturated fat diets and they see their HDL and triglyceride results change to favorable and their oxidised LDL particles plummet. Every doctor and medical student should read the extraordinary series of blogs from Dr Malcolm Kendrick to get a much closer understanding of what causes CVD.

    1. Danny Evatt

      This “study” received quite a lot of press in the U.S. as well – including a mention on the ABC nightly news. However, not picked up in the shorten versions of the press releases was this tidbit:

      “The study used 10 milligrams daily of rosuvastatin, sold as a generic or under the brand name Crestor. The editorial authors said other statins would likely have similar results. Crestor’s maker, AstraZeneca, and the Canadian Institutes of Health Research paid for the study. Yusuf reported receiving grants from both; and several co-researchers reported grants and personal fees from the company and other drugmakers.”

    2. mikecawdery

      Dr Willcourt,

      Many thanks for your forthright comments. The BMJ is, I believe, trying to remedy this in a series of editorials on views based on “little evidence” but point to the fact that, to quote: “that doctors with dissenting opinions should be heard, but that they may not feel able to speak openly if they fear being struck off (Watkins (doi:10.1136/bmj.i1768)”.

      I must say I am somewhat surprised that Dr. Kendrick has survived/avoided the attention of the medical establishment so far.

  44. Trevor

    STUDY: Cholesterol drug fails to improve heart health

    Tuesday 5 April 2016 – 1:07am

    File: Researchers have found that experimental drugs that increase levels of good cholesterol have no effect on the heart, and that these drugs were found to be ineffective.

    WASHINGTON – An experimental drug that greatly increases levels of “good” cholesterol has no effect on heart health, a comprehensive clinical trial found, leaving researchers shocked and disappointed.

    It is also a blow to patients who were hoping for an alternative because they cannot or will not take statins, which can cut low-density lipoprotein (LDL), or bad cholesterol.

    The study involving more than 12,000 patients at high risk for serious cardiovascular problems found that evacetrapib had no benefits, according to research presented Sunday at the American College of Cardiology conference in Chicago.

    Manufacturer Eli Lilly stopped the trial in October when the drug was found to be ineffective but now experts have given a comprehensive explanation of what happened.

    Two other drugs in the same class as evacetrapib, known as CETP inhibitors and designed to raise levels of HDL cholesterol — high-density lipoprotein, the “good” type — have also failed, presenting experts with a quandary.

    “We have a paradox: here we’ve got an agent that more than doubles the levels of good cholesterol and lowers bad cholesterol and yet has no effect on clinical events,” said lead author Professor Stephen Nicholls.

    “We were disappointed and surprised by the results,” added Nicholls, of The University of Adelaide in Australia and cardiologist at Royal Adelaide Hospital.

    On average, patients taking evacetrapib daily for at least 18 months lowered their LDL cholesterol by 37 percent and increased their HDL cholesterol — high-density lipoprotein, the “good” type — by 130 percent compared with patients taking a placebo.

    However, there was no difference between the two groups in terms of the primary “endpoint” of the research including the amount of time until cardiovascular death, heart attack, stroke or coronary artery bypass surgery.

    “As we close out the trial, we’re trying to understand how a drug that seems to do all the right things in terms of blood cholesterol levels doesn’t then translate into reducing clinical events,” added Nicholls.

    Steve Nissen, chairman of Cardiovascular Medicine at Cleveland Clinic, attempted to put a positive spin on the disappointing outcome.

    “These findings illustrate the importance of performing large, high-quality outcome trials,” he said.

    “Just looking at the effects a therapy has on cholesterol levels doesn’t always translate into clinical benefits.”

    However, Nicholls cautioned that evacetrapib could potentially benefit patients with low risk of serious heart trouble, although that was not part of the study.

    The findings could challenge conventional thinking regarding the benefits of HDL cholesterol in protecting against cardiovascular problems, he said.

    They also suggest that existing treatments, such as statins, are already so effective that they cannot be improved upon.

    However, some people with high cholesterol were hoping for an alternative to statins because they complain about side effects such as muscle pain and weakness.

    – AFP

  45. mr Chris

    fans of dubious statistics will love this quote lifted from Dr OZ.

    Dr. Oz and Dr. Roizen, MDs
    How to Kick Your Dangerous Red Meat Habit

    By Dr. Oz and Dr. Roizen, MDs

    One hundred and fifty-seven pounds of beef, veal, pork, lamb and mutton – that’s how much red meat the average North American male eats every year; women average about 100 pounds; and many people eat much more! That’s at least 4,000 grams (9 pounds) of artery-clogging, brain-damaging, cancer-promoting saturated fat.

    But that’s not all the harm it can do to you! For every half-serving increase per week in your usual intake of red meat (that’s 1.5 ounces), you up your risk for Type-2 diabetes by 42 percent. Go on a summertime grilled-steak-and-hamburger binge, and you’re looking at a saturated fat and blood glucose disaster.

    1. Kathy S

      ……..and if they would just complete the scenario with what else is being eaten I think they will find it’s not the meat at all but all the extras – buns, chips, soda, beer, potato salad, desserts, etc. What else do you serve at a summer BBQ???? Geeeezzzzzz……..

    2. Kay

      Too late! My glorious meat-eating disaster has me in glowing good health with no sign of diabetes or any of those other scary diseases.

    3. David Bailey

      I have some sympathy with the moral concept of vegetarianism, but from a nutritional point of view, it does begin to look as if meat has been attacked completely unfairly. Those quotes (which I assume are not your views) make me see red, because people have been badgered and badgered not to eat all the foods their grandparents would have served up, and have instead been encouraged to eat synthetic stuff plus endless carbs.

      Every dietary statistic sounds more impressive if it is quoted on an annual (or preferably lifetime) basis – just as relative statistics for treatments such as statins are more effective (in a perverse sense) than absolute ones. I think the West made a huge mistake when it embraced PR – why can’t we all return to telling the unvarnished truth!

      You cannot open a newspaper nowadays without being assailed by medical ‘experts’ nagging us all to change our habits. It is very sobering to realise just how meagre the actual evidence is for all this, and I am sure it adds to the stress of life, and thus makes some people ill.

      1. Mr chris

        GDear David,
        Do not worry, the views cited are not mine, a year off statins and reading all Dr K’s books and blogs have, I hoped sharpened up my perceptions.
        The bit I found most amusing was the pseudo scientific 42 minutes per ounce and a half of hamburger.
        On a more serious note I am amazed at how this stuff is still churned out.

      2. Eugène Bindels

        Let us all spread the word. If enough people had enough, it has to change. Me mystelf just posted 2 links about big pharma on my facebook page. These links lead to 2 broadcasts of a television program showing some of their “dirty tricks” (understatement). The links (for anyone who understands Dutch): http://radar.avrotros.nl/uitzendingen/gemist/28-04-2008/tweeluik-farmaceutische-industrie/ and http://radar.avrotros.nl/uitzendingen/gemist/05-05-2008/tweeluik-farmaceutische-industrie-deel-ii/.

  46. TS

    My interest in this blog relates chiefly to the hypothalamic pituitary adrenal axis (HPA) and children’s special needs. They may not seem to be connected, but indeed they are.
    As a speech and language therapist I kept asking myself “Why is he like he is?” when seeing children in my clinics. It is difficult to help children if you don’t understand what is causing their problems. Developmental problems such as speech and language difficulties, dyslexia, etc., are in the ratio 1female : 3or 4 male, so that I was seeing 3 or 4 times as many boys as girls – an interesting but rather ignored ratio.
    Over about 30 years I enquired into the children’s behavioural traits from birth and confirmed my suspicion that developmental difficulties arose from expression of tension. There is a reason for males being bigger and stronger than females. They have evolved as the hunters, fighters and as protectors and suitors. To succeed, they have required more adrenaline. Their HPA is more active. Whilst males are pumping out more cortisol than females under the same provocation, it is not only their hearts that are threatened. When we are tense or anxious we can become repetitive, prone to panic, etc. Witness this in a classroom of children learning to read. If a child feels at all threatened by the challenge and under pressure, the HPA axis kicks in and the brain can be swimming, panicking, switching off. This is an understandable and really quite normal reaction.
    Enter conditioning. We all need to be conditioned to a degree as otherwise we’d have to think about everything we do. Yet habits can be problematic too. They can build up into ‘conditions’. Dyslexia arises from a child’s early panic driven switching off in the classroom. Eventually the brain’s behaviour is automatic, patterns are formed and the problem set. We cannot prevent or cure dyslexia until this is appreciated.
    Then take stammering (or stuttering which is the same thing). It always arises from repetition of sounds or words. Young children like repetition and the more tense they are feeling, the more they like this outlet for their tension. They are capable of repeating all types of behaviour. And the more tension that is felt, the less one likes change. The more change, the greater can be the repetition. So, when a 3 year old finds he has a new baby brother or sister he may start repeating sounds. The repetitions can become conditioned and automatic and ensuing struggles against the repetitions result in prolongations and blocks in his speech.
    But trying telling this to colleagues! No matter what we have discovered we are expected to keep within our professional boundaries and follow the status quo. Especially if one is a worker in the field rather than a university researcher. Common sense does not reign. Meanwhile, after being rigorously tested for their ‘condition’, children are given more practice at failing.
    I hope Dr Malcolm Kendrick’s work has even greater effects than he has imagined. I hope he can change things. (I’m heartily sick of trying.)

    1. Kay

      TS, thank you for your post. While I’m not involved in any work such as yours, I found your information most interesting. There are so many areas of human health that still are not fully understood. The “we-already-know-everything-there-is-to-know” blockade is a disservice to so very many people.

  47. mikecawdery

    Cholesterol, not just cardiovascular risk, is important in deciding who should receive statin treatment
    Handrean Soran, Jonathan D. Schofield, Paul N. Durrington
    DOI: http://dx.doi.org/10.1093/eurheartj/ehv340 2975-2983

    But the ESC are the group that published Poldermann’s guidelines that resulted in 800,000 deaths followed by a massive cover-up. Hardly an institution on which to base ones life.

    1. Dr. Göran Sjöberg

      Thank you for the reference to this article in The Guardian!

      To me it is an excellent summary of what I myself have arrived at, now after seven years of inquiry into the matter of nutrition and health.

      Interestingly, the present strong LCHF grass root movement in Sweden is just now under vicious attacks from the establishment. Although the attacks are all nonsense they are official. Evidently we are a threat to the established order.

    2. TS

      Yes, excellent.

      I hope the promised reduction of sugar in drinks, etc. will not simply lead to more sweeteners being added in their stead. There needs to be a readjustment in thinking and taste. It doesn’t seem to be appreciated that stomach acid is naturally so very much stronger than any sharp food can be in its acid content. This fear of anything sharp is so unwarranted and unhealthy.

  48. maryl@2015

    I think a lack of magnesium over time can cause cramps in many muscles, including the heart. The heart is a muscle and stress can deprive the body of magnesium causing severe crippling spasms, so it just makes sense it could cause some kind of spasm of the heart (muscle). Just throwing this out there. If those who have thyroid problems are more likely to have heart attacks or heart disease, it is not a far stretch.

    1. John U

      I wish that I could find evidence that magnesium can help in eliminating or diminishing muscle cramps. When I retired from working full time, I started to play a lot more tennis and initially suffered severe cramps in my leg muscles, mostly in the evening while watching TV or in bed after a stretch or sudden move. These dimished in frequency and intensity over time as I perhaps became more adapted to using these muscles. 8 years later, after having tried many different chemical treatment such as magnesium, calcium, potassium, quinine, more salt, etc., I have not found anything which eliminated cramps. I still get them in my feet and legs, much less frequently than 8 years ago, but they still happen even though I do not take any special nutrients to aleviate them. In a book which I read called “The First 20 minutes”, the author mentioned that to her knowledge all research into cramp solutions did not pan out, and to this day no one really know what the cause is. If you have any literature which is useful, please share it.

      1. Dr. Göran Sjöberg

        For whatever reason (I haven’t found any real good one) a third of us going low carb seems to experience cramps in our leg muscles. I was myself one of those who suffered in the morning hours in bed and rather badly. An internet search suggested that magnesium supplement in the liquid form could help.

        And – yes – it helped me – no more cramps but when cheating on the magnesium supplement the cramps tend to return. As far as I understand, there are large difficulties for us to absorb magnesium depending on the actual form in which it is given. My present magnesium supplement is a mixture – a powder dissolved in hot water and it seems to work fine. A dose-effect connection also seems to be at play.

      2. Dr. Göran Sjöberg

        I just wonder why we low-carbers tend to get muscle cramps when we turn to eat what we have otherwise found to improve our health.

        Could it be that we have homeostaticly adjusted to the western carb loaded fare we continuously are exposed to for many years and which finally made us metabolically sick. Does an abrupt break with those habits inflict some physiological backlash?

        What we put in our mouth is though not without importance for our health as Hippocrates emphatically pointed out 2500 years ago but systematically ignored by present day ‘evidence based medicine’.

      3. Dr. Göran Sjöberg

        By the way I will now bring out my chain saws and cut down two big trees in my garden into firewood during the day. I will see if that could induce any muscle cramps tonight.

        We’ll see 🙂

      4. Diana

        “For whatever reason (I haven’t found any real good one) a third of us going low carb seems to experience cramps in our leg muscles.”

        Micronutrient deficiency. Your LC diet may be the reason.

          1. Diana

            Mg, Mn, Cu, Zn, etc.

            Plants store polysaccharides for future use, and close to them also the metals needed to activate carbohydrate metabolism. Refined carbs are not good source – these microelements are eliminated during processing – but whole foods (grains, seeds, tubers, veggies) are OK.

            LC stands for low carb. I think many people are scared by “all sugar is bad” motto and remove the “evil” carbs from their diets, any by doing so, remove fiber (needed for the gut flora) and micronutrient (needed in general) sources as well.
            It should be kept in mind that long term LCHF might be damaging for many people.

          2. Diana

            Sure they are. In the whole animals. People eat mostly muscle meat, though, not nose to tail.

      5. mikecawdery

        Cancer. 1984 May 15;53(10):2034-40.
        The detection of environmental mutagens and potential carcinogens.
        Ames BN.
        PMID: 6367933 [PubMed – indexed for MEDLINE]
        Comment: Identifies toxins in the skin of seeds which protect the seed from being digested but on milling are released to be involved in cancer production.

      6. John U

        No, no statins or any other meds. I am in very good health to my knowledge.
        I suspect that the cramps are a natural progression when stressing muscles beyond what they are used to, and it takes time to adapt. My frequency of getting cramps is greaty reduced compared with the earlier days, but the do still occur infrequently, but usually after heavy use.

        I do still take a Mag Citrate 1000mg pill 3 times a day, so maybe this needs to be increased or changed to a different form of Mag.

      7. John U

        Re Diana,
        I have been low carb for only about 4 years and the muscle cramps started about 8 years ago, and they were a lot worse then.

      8. Dr. Göran Sjöberg

        Vegetables doesn’t hurt us low-carbers – on the contrary. My favourite here is the homemade sauerkraut and broccoli. And we eat a lot of organ meat from grass fed animals, liver, kidneys, heart and broth made on marrow bones.

        Funny that you get this most nutritious organ meat for almost nothing compared with what you have to pay for the muscle meat which was given to the dogs by the Canadian indians who preferably stayed with the organ meat and the fat parts of the animals if I should believe what I have read. Glands, lungs, the brain are today just discarded but not a hundred years ago.

        Can anyone explain why our eating habits have gone so awry today?

        I just read a book about the traditional lapps in northern Scandinavia living with their reindeers and they actually ate all parts of the animal including the hoofs where the fat was considered a delicacy. But that was about a hundred years ago and as with most indigenous peoples their health started to seriously deteriorate with the introduction of flour and sugar.

        The famous dentist Weston Price did a great research effort during the 1930th that clearly exposed what happened with these people when cought with European eating habits but a research that, now not surprisingly to me, has been meticulously ignored by the medical establishment.

        1. Diana

          Glad to see hoofs mentioned. The minerals I pointed above: Mn, Zn and Cu are particularly important for hoofs health (look it up). LCers, do you eat hoofs?

          Jokes aside – the red line through this series of comments is: “what to supplement with, and how much?”… and I have merely provided my opinion that avoiding eating plant storage organs is a mistake, in this respect.

      9. JanB

        I’ve always been a somewhat ‘crampy’ person, as were my mother and grandmother as I recall, so maybe there is a genetic element to it but when I was 10 years on statins I was crippled by severe cramps in toes, feet, ankles, calves, hamstrings, and hands and it wasn’t until I ran out of tablets for a week that I made the link between cramps and statins. I recommenced the dose, they came back; I stopped and they disappeared. I did that 3 times to be sure and then I weaned myself off them. To this day though I have to supplement with magnesium, quite a hefty dose, and be sure to take enough salt in my diet. On the rare occasions when I am smitten in the middle of the night I find that magnesium oil smoothed in to the afflicted area works wonders, and quickly too.
        Because I fast on Tuesdays and therefore have no salt at all, I usually have at least one cramp attack in the middle of Tuesday ithat/Wednesday morning.
        Do try the magnesium oil. It’s easily available and really, really works.

      10. TS


        Strange timing but yesterday evening I ate far more carbohydrates than I’m used to eating and I had awful foot cramps which I hadn’t had for some time!

      11. TS

        P.S. for Goran:
        To quote http://www.gpnotebook.co.uk
        “In people aged 60 years and over on a general practice register, about a third reported cramps during the previous two months, and in those aged 80 years or over the proportion rose to half.”

      12. Stipetic

        Muscle meat contains all of those minerals in decent amounts and can easily be topped off with vegetables if needed, which as one of “us” low carbers, you probably eat plenty of already. Cramps are unlikely to have anything to do with trace minerals, Goran. Have a glass of broth or bouillon or just some salt in water prior to doing some activity if cramps are a problem for you.

      13. barbrovsky

        I exercise daily and still get cramps in the back of my lower leg when I wake up and stretch. Magnesium? Who knows? Take any more pills and I’ll rattle when I walk.

        1. Colin Cartwright


          In his book ‘How Not To Die’ author Michael Greger, MD uses a quote on page 22 from Dr Roberts author of ‘It’s The Cholesterol, Stupid’ that-and I quote: ‘There is only one true risk factor for coronary heart disease: cholesterol, You could be an obese, diabetic, smoking couch potato and still not develop atherosclerosis, as long as the cholesterol level in your blood is low enough.’ end of quote. According to Michael Greger the optimal level of cholesterol is probably 50 or 70 mg/dl and the lower the better.

          Have I just wasted £15?

          As an aside, I am also reading the Anthony Colpo book which is top-class, as was yours.



          On 17 August 2016 at 19:03, Dr. Malcolm Kendrick wrote:

          > barbrovsky commented: “I exercise daily and still get cramps in the back > of my lower leg when I wake up and stretch. Magnesium? Who knows? Take any > more pills and I’ll rattle when I walk.” >

  49. Frederica Huxley

    I have found that the form of magnesium that works the best against cramps and muscle aches is transdermal Magnesium Oil – fast, and effective!

    1. David Bailey


      Thanks for your response! Unfortunately I can’t find any message in my junk folder that looks as if it could be you.

      Do you want to try again to dave at dbailey dot co dot uk – if you reply here as well I should be able to spot what has gone wrong.

  50. maryl@2015

    After being tortured by statins for years on end, I still had significant leg pain with spasms. Magnesium seems to this day to keep them away. I have also found that a good swig of pickle juice could stop the cramps within minutes or even less than a minute
    . Wouldn’t it be funny to find out that someone with stable angina could make those pains go away by simply drinking something as the seemingly innocuous as “pickle juice”? It certainly would could be therapeutic as well as diagnostic. I keep a lot of pickles close at hand, although I have more pickles than juice it seems. It works, so what is it with this pickle juice?

    1. Sasha

      Ah, yes, pickle juice. The famous Russian remedy for a bad hangover. Works like a charm, every time…

    2. JDPatten

      Fascinating! Dill? Sweet? Kosher?
      What sort of pickle? The brines can be very different.

  51. maryl@2015

    https://www.youtube.com/watch?v=sE_xyfuVMu4 Just an example of a man who lived to be 95, still worked, and lived his life with enormous gratitude, a sense of purpose and attitude. Clear your mind of all pre-conceived notions that this is just some “rich guy” in Hollywood. Look and listen to his words, look at body language and that wonderful sense of fun. This means something. FYI

  52. Maureen H

    Diana. You say that low carb may not be healthful in the long term. It may not be, but then again it may be. There is a ton of anecdotal evidence that it is beneficial, as well as many quality studies. Many people have been eating this way for 10 years or more with no obvious ill effects, the reverse in fact. Is that long term enough for you? I see this comment ‘may not be beneficial in the long term’ a lot when LC is being denigrated. And yet when the low fat high carb dogma was forced on people there were no studies done to show the long term effects. And now we know what those effects are; rampant obesity, diabetes, various other degenerative diseases. Still there is opposition by mainstream nutritionists and the medical establishment to a diet that has been shown to improve the health of many, especially type 2 diabetes. On this blog alone there are people who have drastically improved their diabetes, heart disease and other serious ailments through their L.C. diet.
    Most people on a LC diet eat loads of vegetables, there is no shortage of fibre. There are plenty of micronutrients in animal products as you acknowledge, in fact way more than in plant based products except for flavinoids and a few others that don’t come to mind right now, which can be obtained from fruits and berries. It’s true that many people don’t eat ‘nose to tail’, however that is not a good reason to increase carbs when a person is intolerant to them and/or gain substantial weight when eating them. I believe many people if informed of the substantial health benefits of eating organ meats would certainly try them, and some realise they actually like them, it’s just a matter of them having the information. Lastly, you using the words ‘evil carbs’ shows a certain judgemental frame of mind, as though those of us who believe LC is healthy are sadly misled.

  53. Randall

    From LIPITOR- Parke-Davis Div of Pfizer Inc web site – CLINICAL STUDIES – Study sited – Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT ) Quotes from – The Anglo-Scandinavian Cardiac Outcomes Trial from http://hyper.ahajournals.org/content/60/2/248.full and http://eurheartj.oxfordjournals.org/content/early/2011/08/26/eurheartj.ehr333 no benefit was apparent among women, From our UK ASCOT data, the number to treat (NNT) to prevent 1 death from treatment with atorvastatin for 3.3 years was 286 Because – in those formerly assigned atorvastatin attributed to a reduction in deaths because of infection and respiratory illness. Conflict of interest – Sources of Funding ASCOT was funded by major grants from Pfizer etc. . . . The Author – Peter S. Sever, has received research grant support and consultancies from Pfizer and Laboratoire Servier. Received travel expenses, or payment for speaking at meetings, or funding for research from one or more pharmaceutical companies including Pfizer for ASC. I wonder how many MD’s pushing it read the studies, 1 in 286 lived longer?

  54. John U

    I have just finished reading the book “The rise and fall of modern medicine” by James Le Fanu. Also recommended by Mike Cawdery earlier in the comments section, this book I found to be very, very fascinating to read. The historical review of the 12 most interesting medical advances which occurred in the earlier part of the 20th century was super well presented. He did emphasize that almost all of these advances came about often by sheer luck due to good guesses or fortuitous circumstances. Nevertheless, if you are looking for something for long enough, you just might stumble onto something important.

    He wrote also about the discovery of the cure for stomach ulcers, by Barry Marshall, a young and keen doctor who was not encumbered with too much bias, and chose to have a look for a solution. What Barry M found was a bacteria that was missed by so many others who looked, the bacteria then named Helicobacter, which most of you probably know. The interesting part was that most medical professionals immediately discounted this discovery because it just did not seem plausible. How could bacteria survive the acid environment and the body’s immune system, they proclaimed. There must be another explanation. So this discovery and its solution languished until Barry proved it by infecting himself and curing himself.

    You all likely know this historical account, but Le Fanu clearly wrote about it because it was an example of something that should have been obvious to other researchers at the time as it was to Barry Marshall, so why was it not discovered earlier? It seemed that many others were suffering from some form of confirmation bias and just didn’t look carefully enough.

    So what Le Fanu hypothesizes regarding the causes of so many unsolved diseases is interesting, similar to what Dr. Grimes wrote on his page. Is it possible that CVD and other “unsolved” maladies are in fact caused by bacteria or viruses which have not yet been identified? Is it possible that some as yet unidentified organism is circulating in some of us and not in others? Is it possible that such an organism finds some way to embed itself in the endothelial layer and start causing harm which then starts the cascade of events that Dr. Kendrick has already described? Is it further possible that such an organism is helped by the pulsating action of the blood flow near the heart to embed itself in to the arterial membrane helped by the higher flow rates and pressures in the areas of bifurcation of the arteries, explaining why insults occur more frequently at bifurcations?

    I found the idea that the source of heart disease may be an infectious agent very appealing (I had never come across this before). I am an engineer so I don’t possess the tools to determine if such an hypothesis has any merit, so I was hoping that some of you might share your thoughts on this.

    BTW, the book covers a lot of history and this small part above is just a little diversion. All of it was fascinating and well worth the time it takes to read the 500 pages, excluding the reference section.

    1. Dr. Malcolm Kendrick Post author

      A lot of people find this idea appealing. I have a few problems with it. Mainly, that the epidemiology of CVD does not fit with an infectious cause. Why, for example, do Russian and Japanese men have an eighteen fold difference in heart disease death (men under 65). Is there an infectious agent that does not move across the sea.

      Why have the rates of CVD gone in different directions in different countries that border each other e.g. (historically) Austria and the Czech republic. Why do some population e.g. australian aboriginals have thriteen times the rate of heart disease of the surrounding population. Why do women get less heart disease than men. Why did the population of Rosetta, in Pennsylvania, have no case of an MI before the year 1968 (they were not all living in biosuits). I could go on, and on, on this matter.

      I also do not like the idea of non-falsifiability. Heart disease is caused by an infectious agent. We don’t know which one, we can’t tell you which one. But it is there.

      This is like the Popparian concept of gravity fairies. They push all matter towards all other matter. They cannot be dectectd in any way, but we know they must be there because all matter is pushed towards all other matter.

      It is an explanation that fits, it cannot ever be disproven. But scientifically it is a useless hypothesis for it can never be tested, nor disproven. Once someone says it is organism x, or organism(s) x,y and z then it may be possible to disprove the infectious disesease hypothesis. Until then it is merely a interesting conjecture.

      1. TS

        Please don’t bring up gravity theory again! I’m embarrassed to have accepted it so blindly and thank David Bailey for putting the other side.

      2. Diana

        “Once someone says it is organism x, or organism(s) x,y and z then it may be possible to disprove the infectious disesease hypothesis. Until then it is merely a interesting conjecture.”

        My apologies. Wrong view point, à la Pasteur. There si probably no causal organism, or a pathogen per se. A microbe often only becomes a pathogen when the terrain changes. And the body tries to fight back… resulting in a messed-up defence?

        1. Dr. Malcolm Kendrick Post author

          Yes, of course, sort of. Clearly various pathogens do cause specific conditions. if the arguement is that any organism can become a pathogen in the correct conditons…fine. But you then have a non-disprobable hypothesis. Any organism you find could be a cause of any disease you find, depending on individual circumstances

          1. Diana

            “if the arguement is that any organism can become a pathogen in the correct conditons…fine.”

            No, I didn’t say this.

            “But you then have a non-disprobable hypothesis.”

            I have no finished hypothesis. Clearly, some pices of the puzzle are missing.

      3. TS

        re: “A microbe often only becomes a pathogen when the terrain changes.”
        But something must make the terrain change.
        Aren’t we returning to the mistake of listing causes rather than keeping to the process?

      4. JDPatten

        I say it is this organism: Rickettsia prowazekii.
        Now, how do I go about proving it or disproving it? It’s (today) too rare a disease to interest researchers.
        I was told by the CDC that it infects the endothelium of vessels smaller than coronary arteries. OK, how about the vasa vasora that serve the coronaries?
        It’s recently been shown – in dogs – that the bacteria sporify and hide in subcutaneous tissue, to reemerge when resistance is down. Well, how about they emerge bit by bit and constitute a chronic sub-acute condition in those vasa vasora?
        It’s also been suggested that cholesterol is an immune agent – explaining its contribution to plaque.
        There. Solved. No?

    2. Dr. Göran Sjöberg


      “I have just finished reading the book “The rise and fall of modern medicine” by James Le Fanu. Also recommended by Mike Cawdery earlier in the comments section, this book I found to be very, very fascinating to read. ”

      I couldn’t resist that – just ordered 🙂

      1. Mr chris

        Me too, put it on my Kindle reader and am reading about penicillin.
        By the way, about cramp, i note three thing that seem correlated:
        Exercise, when I used to suffer, it seem inversely related to the amont of exercise
        Magnesium phosphate, 1.8 Gms, the easiest to tolerate form of Mg supplementation, even if said to be among the worst for absorption
        Finally, an unusual cure/correlation, I had a total hip replacement.
        Incidentally I am sort of low carb, and came off Crestor and Ezetimibe

  55. John U

    Correction – re my comment on the dose of Mg (as citrate) which I take daily – should have said it was 150mg capsule three times daily, not 1000mg.

    1. JanB

      John, I’m very relieved to hear that – though the arm and a leg it would have cost you would, I suppose, mean you wouldn’t be bothered any more by leg cramps, at least in the one missing leg.
      Pardon my levity.

      1. John U

        Jan B, I was just guessing the dose when writing and thinking it was 1000mg because most of the other supplements which I take are mostly in that dose (except the vit D, of course). Didn’t check until later. I didn’t understand why I would lose a leg however. Is 1000mg toxic?

        Dr. Kendrick, thanks for your detailed repy re the micro organism hypotheris. Certainly the epidemiological evidence is very persuasive. I am glad that you brought it up.

        1. JanB

          I think a daily dose of 1000mg would be quite expensive and the saying goes that something expensive “costs an arm and a leg.” I didn’t Intend to alarm you, so please accept my apology.

  56. Charles Gale

    Hi all

    I’ve just requested cortisol testing (saliva swabs over the period of a day) and been turned down by my GP (and practice). As readers of this particular blog (part XI) know, a solitary blood test at 9am proves nothing as regards HPA Axis function.

    Can anybody suggest what I do now about cortisol testing?


    Charles Gale

  57. Sean Parker

    60 Million people are reported to have been displaced in the last 3 years. Any chance that depression may effect their HPA-axis so it becomes dysfunctional, to the extent that it will cause them to have abnormal cortisol levels, become insulin resistant (because cortisol is a direct antagonist to insulin at many sites). And, find themselves on a list of people who have died of heart disease?
    Get real, or still living in cuckoo land?


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