What causes heart disease part XIV

I have been much cheered by all the discussion on my series about what caused heart disease a.k.a. cardiovascular disease. Because of various comments, my series has gone off in a few different directions. I realise that not everyone agrees with everything (or anything?) I have to say, and that several issues I thought were clear, clearly are not. This is fine. Science should progress by discussion and debate and contradictions.

In this blog, in order to answer some of what people have written (albeit indirectly), I am going to look at two of the conventional risk factors for CVD in a bit more detail, and try to explain why they represent a major problem for conventional thinking.

As many of you may have discovered, if you go to see your GP – almost anywhere in the world – they will use a list of ‘standard’ risk factors to calculate your risk of a cardiovascular ‘event’ over the next five or ten years.

There are a few of these calculators, but two of most commonly used are probably QRISK2 and the ASCVD, created by the American College of Cardiology and American Heart Association. [ASCVD = atherosclerotic cardiovascular disease]. I cannot find out where the term QRISK comes from – perhaps someone can help me.

The ASCVD is a bit shorter than QRISK. It looks at:

  • Age
  • Gender
  • Race
  • Total Cholesterol
  • HDL
  • Systolic blood pressure
  • Diastolic blood pressure
  • Treatment for blood pressure
  • Diabetes
  • Smoker

The QRISK is a UK developed risk calculator. It is a bit bigger and more complicated than ASCVD. It looks at:

  • Age
  • Sex
  • Systolic blood pressure
  • Diastolic blood pressure
  • Total Cholesterol
  • Total Cholesterol/HDL ratio
  • Serum triglyceride
  • Smoking
  • Glucose Impaired glucose tolerance/diabetes
  • Left Ventricular hypertrophy
  • Central obesity
  • South Asian (South Asians, in the UK, have a far higher risk of CVD)
  • Family history of CVD

Now, there is no doubt that all of the factors on both lists are associated with CVD – to a greater or lesser degree. At least they are for the US and UK population currently living. It has to be pointed out thought, that if you use QRISK in France, you have to divide the risk by 4… ahem, slight problem.

A further problem is that it has been discovered that they both vastly over-estimate risk in US and UK population.

‘A widely recommended risk calculator for predicting a person’s chance of experiencing a cardiovascular disease event — such as heart attack, ischemic stroke or dying from coronary artery disease — has been found to substantially overestimate the actual five-year risk in adults overall and across all sociodemographic subgroups. The study by Kaiser Permanente was published today in the Journal of the American College of Cardiology.

The actual incidence of atherosclerotic cardiovascular disease events over five years was substantially lower than the predicted risk in each category of the ACC/AHA Pooled Cohort equation:

  • For predicted risk less than 2.5 percent, actual incidence was 0.2 percent
  • For predicted risk between 2.5 and 3.74 percent, actual incidence was 0.65 percent
  • For predicted risk between 3.75 and 4.99 percent, actual incidence was 0.9 percent
  • For predicted risk equal to or greater than 5 percent, actual incidence was 1.85 percent

“From a relative standpoint, the overestimation is approximately five- to six-fold,” explained Dr. Go. “Translating this, it would mean that we would be over-treating a good many people based on the risk calculator.”’1

So, you feed your risk factors in a risk calculator that took many years to create, using data carefully gathered by experts from the world of cardiology, and your true risk is overestimated five to six fold. Excellent. That mean millions upon millions of people have been told to take a statin based on a calculation that is so inaccurate as to be virtually meaningless. [This was always going to happen, because risk was established using clinical data from decades ago, since when, CVD rates have fallen dramatically]

Anyway, leaving the horrible inaccuracy of these risk factor calculators aside for the moment. What of the risk factors themselves? I am not going to look at all of them here, just two. Firstly, age. There is no doubt that age is the single most important risk for CVD. Your risk at 65 is around ten times as high as at age 35 – no matter what the overall risk may be in your particular country.

In fact, if you have no other factors at all, in the US, your future CVD risk at the age of 67 is so high (according to the calculator) it means that you are advised to go on a statin immediately, for the rest of your life. Ho hum. For women it is a few years later. ‘Here’s your first pension payment – with built in statin prescription.’

I find it fascinating that almost everyone seems to accept age as a risk factor for CVD, without really questioning why this should be so. Age does not necessarily increase the risk of diseases. There are many which are more common when you are younger, and the risk diminishes as you age.

The argument seems to be that CVD slowly progresses. Thus, as you get older, the risk increases. Yes, perhaps. However, if you have no conventional risk factors for CVD, why should it progress at all? At the risk of repeating myself, I shall repeat myself. You have no risk factors for CVD. Yet, as you grow older, your risk of CVD reaches the point where you are statinated. Because your future risk is so high.

But what is causing the atherosclerosis in your arteries to develop. Age? Through what process can age created atherosclerotic plaques, assuming no other risk factors? Raised cholesterol… well you don’t have raised cholesterol. Raised BP? Well, you don’t have raised BP. Smoking, well, you don’t smoke… etc.

The other major risk factor where we have an acceptance of a fact – without even an attempt at explanation is gender. In most populations younger men have a far higher risk of CVD than women. The different in risk varies greatly, but averages at about three to one. By which I mean, a women aged 55 women will have around one third the risk of a man aged 55 (living in the same country). Even if they have exactly the same risk factors.

For years it was stated, with great confidence, that this difference was due to female sex hormones. These hormones in some – never fully stated fashion – protected women against CVD. It has now been proven, beyond a molecule of doubt, that this is not true. Female sex hormones do not protect against CVD. Indeed, they probably accelerate it.

So, what does protect women against CVD. There is no explanation. It just is. Feed gender into the calculator and a different risk pops out for men and women. Why, because men and women, have a different risk of CVD. Why? Because they do. [BTW, the South Asian issue is much the same. Multiply the risk by 1.4. Why, because you do].

The reality is that age, and gender, are two of the most powerful risk factors for CVD. In that, if you use the ASCVD or QRISK calculator and change only age, and gender, the risk will go from close to zero, in a young woman to dark red – danger, danger, in an older man. Even if you set all other risk factors to zero.

It has always baffled me that experts in cardiology seem utterly unconcerned about this. They do not even consider that this is an issue. However, if the two most powerful risk factors you have for CVD, cannot be explained, are not explained, then you really have a major problem. Even if you cannot even comprehend that you do.

If you cannot explain why age, and gender, cause CVD… you cannot explain CVD.

1: http://www.eurekalert.org/pub_releases/2016-05/kp-crt042916.php

340 thoughts on “What causes heart disease part XIV

    1. JP Sand

      Hello Dr. Kendrick,

      Just came across this research news today from Harvard and Massachusetts General Hospital and thought you might be interested. Please see: “Human amyloid-beta acts as natural antibiotic in the brains of animal models”…http://www.massgeneral.org/about/pressrelease.aspx?id=1942

      EXCERPT: “A new study from Massachusetts General Hospital (MGH) investigators provides additional evidence that amyloid-beta protein — which is deposited in the form of beta-amyloid plaques in the brains of patients with Alzheimer’s disease — is a normal part of the innate immune system, the body’s first-line defense against infection. Their study published in Science Translational Medicine finds that expression of human amyloid-beta (A-beta) was protective against potentially lethal infections in mice, in roundworms and in cultured human brain cells. The findings may lead to potential new therapeutic strategies and suggest limitations to therapies designed to eliminate amyloid plaques from patient’s brains.

      “Neurodegeneration in Alzheimer’s disease has been thought to be caused by the abnormal behavior of A-beta molecules, which are known to gather into tough fibril-like structures called amyloid plaques within patients’ brains,” says Robert Moir, MD, of the Genetics and Aging Research Unit in the MassGeneral Institute for Neurodegenerative Disease (MGH-MIND), co-corresponding author of the paper. “This widely held view has guided therapeutic strategies and drug development for more than 30 years, but our findings suggest that this view is incomplete.”

      Perhaps this may add something to our understanding of heart disease.

  1. wabmester

    I would think the huge differences in risk based on gender would be a rich vein for clues about causality.

    And the fact that risk goes up for post-menopausal women should be another huge clue.

    1. Angela

      A long time ago I read a discussion on why women had less risk of heart disease and the conclusion was that men have a faster metabolism than women. (They’re always warm when the women in the office are cold). Seems reasonable to me.

  2. Stephen Rhodes

    ‘QRISK. Risk analysis and simulation add-in for Microsoft Excel or Lotus 1-2-3’
    I used it in the late 1980s and early 1990s but I forget what for!

  3. Stephen Rhodes

    I have just finished reading Travis Christofferson’s ‘Tripping Over the Truth’ – which I was pointed to by a regular poster on your blog.
    One possible reason for the link between aging and increased risk could be accumulated mitochondrial damage, resulting in fewer and less efficient ‘power plants’ feeding the body’s energy needs. Failure to meet the needs, rather as in the NHS, results in services/cell maintenance being cut and a general run down in the once swiss watch like running of cell function.
    Nothing runs for ever if not properly maintained, why should we expect it to?

      1. Kevin O'Connell

        ETC (electron transport chain) in mitochondria reliant on Coenzyme Q, which is depleted by statins (blocking mevalonate pathway). Mitochondrial dysfunction inevitable result. Explains increased cancer rates among statin users (assumption – cancer primarily a metabolic disease – cf Seyfried or, more accessibly, Christofferson).

  4. Stephen T


    If the risk of CVD has been over-estimated five or six-fold, will millions of people be taken off statins and, perhaps, blood pressure medication?

    If CVD has fallen dramatically, do we know the reasons?

    1. John U

      I just checked you reference and this is the kind of site which I would never consider worthy of my time.

  5. Dr Paul Travis

    How very true Malcolm. I remember a 93 year old gentleman coming to see me for a BP check (it was fine), but I ‘had’ to fill-out the online CVD risk assessment for QOF. Of course he was ‘at risk’ – very high risk, being 93, though otherwise extremely fit – but I completely ignored the result of the calculation/guestimate. Quite rightly, he wasn’t bothered or concerned. He was rushing off to our local nursing home as a volunteer “to help the old folk”. What a great man!

  6. Dr. Göran Sjöberg

    Fresh air when I came in!

    I also understand tonight that chain saw activities is a “risk factor” but not included in the calculators. My ‘effort angina’ varies from one “chopping day” to the next but tonight was a tough one – I had to rest a lot. I have though been through this , up and down, many many times during my CVD years so I don’t call the emergency number.

    They would love to see me at the hospital. Then, finally, they would conclude that they have been right about medication and CABG, all those 17 years, and I can just imagine the immense joy that would overwhelm “my own” cardiologist when he would see me brought in.

    1. Stephen T

      Goran, I think you won the argument with the cardiologist some time ago. And it pleases me greatly.

  7. ellifeld

    This is getting better all the time! Too funny. Even though we had a lesson regarding the sun, I came across this Ted talk that you Dr. Kendrick, being a Scottish doctor, should read immediately!

    1. Sylvia

      quite clearly Vit D supplements are a different animal than the glorious sun.
      No complete consensus on amounts of supps to take which dances with K2 mk 7.
      I feel so dim when presented with all the data, but keep it coming.
      Good video,

  8. Joe

    Dr. Kendrick:

    On March 26, 2016, you said the following: “Finally, I will put together, what I believe, are the ten (or so) best things you can do to protect yourself from CVD.”

    I looooove your blog, Doc, but I’m not getting any younger, and as you noted above, age is a major risk factor. Is there any chance that you could please list those ten (or so) things relatively soon? You know, while I’m still alive. Then we could all get around to discussing them here, along with any other topics you think are important. By all means, keep the current series going until you run out of Roman numerals if you want, but please give us that list soon. Please?

    Thanks for listening, Doc.

  9. JMH

    I always thought it odd that years ago when my doc calculated my risk she added 10% to my cholesterol numbers because my father had heart disease (reported previously by me). This pushed me into the orange sector and thus I got a prescription. That, in turn led me here!
    It seemed a bit arbitrary to me. How does anyone know I’ve not inherited my mum’s health where there is no heart disease at all?

    1. Gary Ogden

      JMH: Exactly. My father died of a heart attack at 32. My mother lived to 97, and died of old age. My brothers and I are 66-68. I wonder if the explanation for family history being a risk factor is based upon the same science that age and gender are?

      1. John G Thompson

        My grandmothers both lived to 83 and died within 3 weeks of each other. My father died of a brain tumor at 47 in 1966, my mother died of cancer at 61 in 1981. My older brother (9 years) is an alcoholic, but is still going strong. My older sister (7 years) was an over eater, taught in the Denver, CO school system for 30 years, is retired and dealing with CLL, but going strong none the less.

        My total cholesterol was first measured in 1989 at 254 (US) and was 255 last year. If the cholesterol theory is right (yea, yeah, I know) wouldn’t I have had several heart attacks? I have had two stress tests and passed them both. The first one showed an even profusion. The second I never got any results from. I’ve been on statins three times and within weeks or a few months had general weakness, and loss of muscle strength.

        I’ve been denied life insurance because of untreated hypercholestemia(?) (high cholesterol) and I couldn’t care less. My risk factors would appear to be cancer or “natural cases”. 🙂

        I happened to read an article in the “Epoch Times” an interesting free newspaper, that lead me to Dr Kendrick’s book.

        THANK YOU!


  10. Jillm

    Thank you Dr Kendrick. I am wondering about the damage medications and x-rays do to the heart. Perhaps as patients age, they have accumulated more damage from more medications and radiation. Also, I believe if we try to eat a nutrient rich diet and cut sugar and junk carbs, we will be healthier. Thanks again, Dr Kendrick.

  11. smartersig

    If you live in a society that promotes heart disease then clearly age will show up as a pseudo risk factor especially as HD is slow developing. Those societies that have little or no HD do not develop HD as they get older simply because they are older or at least not to life threatening levels. I am talking Plaque here and not arterial elasticity. Is not the women factor related to iron levels being lower during menstruation years ?.
    The age factor is of little interest the sex one more so but I would have greater interest in the order of merit touted about lipid profiles. It is common these days to hear that say Lp(a) is a more reliable risk factor than say Total to HDL ratio. I am not doubting this but can anybody point me to the figures that prove this statement.

  12. Sylvia

    Central obesity on the Qrisk list, I note. How, before too long might there be comparisons of a fit, healthy 65 yr old versus a very obese young adult, any sex, as we are seing commonly now. But as for now,is it some primitive unrecognised gene women needed long ago to keep bearing children that protects them. I read somewhere that women in some cultures bore children in their fifties and beyond. The Asian mystery, men at higher risk, why is this.
    Wonderful stuff again, the scenic route is much more interesting. I never realised how much I do NOT know. And until the suicide diets of many alters, surely our lifespan will shrink.

  13. Agg

    Thank you Dr K, a very intersesting post (and one I can fully understand without reading everything twice).
    Just got my first NHS MOT, a clear box ticking exercise. Risk calculated as orange (something to do with my weight and low activity level). Total cholesterol above norm (LDL too – not that I am worried), blood pressure well within, diabetes nowhere in sight. Wish they offered thyroid function test as routine; might claim problems with weight loss to get one (no other symptoms I can think of). Age and gender place me in lower risk category, so I hope they will not start bombarding me with letters and advice. Time to take swimming sessions seriously and stop making excuses.

  14. Frederica Huxley

    I had always been told that younger women were protected by two factors – estrogen and iron levels controlled by menstruation, but I have never seen any confirming research.

      1. JDPatten

        Aha! Um . . . so, either Frederica has hit on the answer you have in mind but no researcher was interested enough, or it misses the mark altogether.
        Such a tease!

      2. Alison

        As a women who has suffered from too little iron for many years without knowing it I do wonder if my CV system hasn’t had to work harder than necessary to keep me going. I’m open to all new ideas (especially in the paucity of ideas from my own GP) but I need some convincing that menstruation is a happy control mechanism. Curious to hear more.

      3. mikecawdery


        Talking to a an up and coming oncologist the other day about research. The comment was simply that if there was no profit there would be no research. end of! Frightening but true. The concept of cancer being a metabolic disease (Siegfried – Chritoferson et al) was dead in the water.

      4. Bill In Oz

        PD Mangan (who commented above ) has written a number of posts with peer reviewed science papers, showing that high ferritin Iron levels are a causal factor in heart disease.

        I’ve read Rogue Health a lot the past 7 months. Like Dr Kendrick, he seeks to explian the science clearly and informatively.

        Of course some folks here may refuse to read the posts on Rogue Haelth because Mangan’s focus is on high intensity fitness exercise, a low carb diet, intermittent fasting, supplements and keeping iron ferritin levels low among older men to prevent aging.

    1. Diana


      Iron: because it is little understood, or even misunderstood.


      Based on my understanding of this rather complex topic, that what you describe: “As a women who has suffered from too little iron” may be actually so called anemia of chronic disease (ACD). That means that iron location matters, your body might have been storing iron during chronic inflammation, but it is not manifesting as high iron, but as low iron in usual tests. So, your “anemia” may in fact be an iron overload! That’s why supplementing iron in such situation may lead to paradoxical worsening of the symptoms.

      Complex issue, and we’d better integrate the host-microbiome interactions in, right away, here just one link for a start:

      Iron at the interface of immunity and infection (Nairz, 2014)

      “Both, mammalian cells and microbes have an essential need for iron, which is required for many metabolic processes and for microbial pathogenicity. In addition, cross-regulatory interactions between iron homeostasis and immune function are evident. Cytokines and the acute phase protein hepcidin affect iron homeostasis leading to the retention of the metal within macrophages and hypoferremia. This is considered to result from a defense mechanism of the body to limit the availability of iron for extracellular pathogens while on the other hand the reduction of circulating iron results in the development of anemia of inflammation. ”
      “However, from all the evidence listed above it appears obvious that ACD develops from the endeavor of the body to withhold iron from invading, extracellular pathogens and to strengthen at the same time anti-microbial immune responses (Figure ​Figure1A1A).

      Accordingly, clinical trials which were performed to supplement iron to children in developing countries based on the notion that iron deficiency is associated with growth and mental retardation produced unpredicted results (Schumann et al., 2007). These studies demonstrated that iron supplementation resulted in higher incidence of or higher mortality from infections such as malaria, diarrhea or bacterial meningitis (Sazawal et al., 2006; Soofi et al., 2013). The pathways underlying these devastating outcomes remain elusive thus far. However, they may be linked to iron mediated modulation of anti-microbial immune defense mechanisms or traced back to increased availability of the metal for pathogens in the setting of subclinical parasitemia or bacteremia. “

  15. Ari

    Funny, that they want to statinate you, when you get old, even though the higher the cholesterol the longer you probably live. Do they want to make your life shorter?

    1. Gary Ogden

      Ari: Counterproductive it is to ensuring continuing sales. But then they don’t think. They just count their money.

    2. celia

      I wonder if it’s safer in terms of possible adverse effect reporting. “Oh no, it’s nothing to do with the statin. You’re just getting older. What can you expect at your age?”

    3. mikecawdery

      WHO-BHF seem to have lost the plot. First they publish data that show the TC (total cholesterol) level of >5.4 – 5.8 mmol/L is associated with the lowest mortality rates for all-cause, cardiac and non-communicable disease then hide/retract it. Real 1984-ish modification of fact.
      Estimated lowest mortality rates for TC blood levels
      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
      http://www.heartstats.org/documents/download.asp?nodeib=6797 This URL no longer exists? WHY?
      Now on https://renegadewellness.files.wordpress.com/2011/02/cholesterol-mortality-chart.pdf

  16. Martin Back

    Before I started reading Dr. Kendrick, I always thought of cholesterol in the blood as being like sediment in a river. If there’s too much, it starts settling out and clogging up your arteries. Over time, it builds up until it blocks off a vital bit of blood supply and you get a heart attack.

    Now, I don’t know what to think.

  17. sasha

    Dr. Kendrick: regarding “Female sex hormones do not protect against CVD. Indeed, they probably accelerate it.” Is it possible that it’s only exogenous female hormones (like HRT) accelerate CVD while endogenously produced female hormones are protective?

    1. Lisa

      I wondered the same thing. Seems like the only thing that’s been proved “beyond a molecule of doubt” is that is that giving post-menopausal women particular hormones in specific doses via certain delivery systems has not helped (and in some cases, has made things worse).

      We know taking vitamin D in isolation isn’t the same as getting D from sunshine, and taking a C pill isn’t the same as eating an orange. Maybe the same thing applies to endogenous vs exogenous hormones …

      (PS I love this blog – Dr K is the only blogging doctor I’ve encountered who never acts like a guru!)

  18. David Bailey

    There is a fascinating QRISK calculator to be found here:


    It is remarkably insensitive to some things – including weight (BMI), and even BP doesn’t seem to be that important.

    Adding my Stockport post code increased the answer somewhat, and yet adding an Oxford or Bournmouth post code also increased it marginally!

    However, I think I need a sex change operation, and a move to France (but the calculator only covers the UK).

    It is good to know you divide the answers by 6!

    1. Gary Ogden

      David Bailey: Using the calculator, I found a way to lower my risk dramatically. Go off BP medicine (which I’m in the process of doing)! My risk drops from 20.1 to 14.1. Does this mean more people should be doing this? Does BP medicine really increase risk by 50%? All other things being equal? Or have I found a fatal flaw in this silliness?

      1. David Bailey

        Since Dr Kendrick points out how these calculators overestimate risk massively (how hard would it be for them to normalise the results to get the overall probability of CVD) I rather doubt if they are good for anything.

        I too noticed that not being on BP medicines lowers the score, but from reading these blogs, I think this is because high BP is just a marker for potential CVD disease – not a direct cause – so lowering BP doesn’t achieve that much!

        Statins gave me very unpleasant side effects, so I have sworn off them, but BP medicine doesn’t seem to have any side effects for me, so I still take them. It is probably pure nonsense, but I imagine that excess blood pressure might actually cause some endothelial damage (but then, I used to imagine cholesterol and fat – neither of which is soluble in water – actually travelling round the body and blocking a blood vessel). On the other hand, maybe BP tablets have a placebo effect!

        1. Gary Ogden

          David Bailey: You may very well be right. The placebo effect is a most interesting phenomenon. If it applies to a drug, it may very well apply to food or other lifestyle interventions. I soaked some wakame overnight, to put in my salad today. It just seemed to me to be a flaw in the design of the calculator, or perhaps an inadvertent acknowledgement that treating BP increases risk, that for the same SBP, treatment is worse. But you’re right. It seems that age and sex are the big predictors in these calculators as they are in real life. Best to avoid them both.

          1. annielaurie98524

            Ok, Gary, we will avoid aging any further, good advice. However, on the matter of sex, it does not appear these risk models list any benefit to avoiding it. Perhaps you meant your advice to say avoid being of the male gender to improve one’s risks?

          2. Gary Ogden

            annielaurie: Meant in jest. I’m actually fully in favor of sex. And aging truly has its benefits, such as the joy that can come from a deeper understanding of things that can come from many years of experience and learning, and keeping an open mind. Dr. Goran always brightens my day when I read what he has to say. The only advice I would say would be universally good is to avoid flour, sugar, unfermented soy, and industrial seed oils, get sufficient sun exposure, stay active, get plenty of vitamin C, and be skeptical of anything an expert says. They may be right, or they may be wrong. I truly think that eating high-quality food, avoiding both toxic chemicals and unnecessary medical interventions are key to improving human health. Some effective treatments which are non-patentable have either been largely forgotten (such as intravenous or intramuscular high-dose vitamin C) or actively suppressed. But we can find them, and if we can find a practitioner, use them. What concerns me greatly today is that the message, and thus reality for many people world-wide, is controlled by a few giant media corporations. I worry that we’re losing the capacity to think for ourselves, as I see what is happening in education (and child health) at least here in the U.S.

  19. Gary Ogden

    Bravo. For age and gender, it’s trust us, we’re the experts. I’m inclined now to think, from recent comments, that insulin resistance is what leads to atherosclerosis, which can lead to heart attack. That that is an important pathway to pursue. Dr. Kraft said that the pathology of diabetes is vascular. And, if I recall correctly, Ivor Cummins referred to a 2015 study showing 49-52% of Americans failed Dr. Kraft’s insulin test, and thus are diabetic. Takes your breath away, that. This could explain the age part, damage accumulating over time. As for the women, it could be because they put up with enough already, and God is just giving them a break.

  20. Umberto Ucelli

    Brilliant reasoning indeed. OUtstanding.
    Kind of thing that seems so obvious , but only after someone else told you. Reminds me of the use of nitrogycerin for pulmonary oedema. We’ve (the oldest) have been having nitroglycerin in our pockets (I as a resident as I remember) for decades (no my residency didn’t last decades) and still we used boodletting (my slightly older did ) then furosemide, but why did’nt we think about using nitro ?

  21. Keith Hulme

    ‘Risk’ seems to be used so often when
    a more correct term should be rate of occurrence or prevalence within a certain group.

  22. Dr John Barr

    down here in Australia, we use another risk calculator. All of these have been developed by eminent groups of cardiologists
    I frequently suggest to my patients that they have a coronary artery calcium scoring CT to assess their risk. Significant numbers have a score of 0, meaning virtually no plaque. Lots of them have been put on statins by their cardiologists. I even have 1 patient who had an angiogram at the age of 65, was told that their was absolutely no sign of plaque or narrowings, and in the next breath was told to take Lipitor. When I pointed out that in 65 years he had developed no plaque, it was highly unlikely that he would rapidly develop much in the next 20 years, he replied that it would be at least 35 years, and didn’t take the statin.
    I would be very interested in seeing the conflict of interest declarations of the devisors of the assorted risk calculators, and whether any of the drug companies had a hand in suggesting it would be a good idea. Especially as the need for a statin in UK is, (or was), based on the cardiovascular risk. There will be much gnashing of teeth if the Kaiser Permanente advice that the risk calculators inflate the risk by 5-6 times is accepted.
    However, no doubt, like all evidence to the contrary of the idiots-sorry experts, to quote Dr K, it will quietly sink without trace.

  23. Afabrox

    Always enjoy your posts Dr. K, so please continue.
    In this particular one, I feel you are missing the point somewhat … yes the online risk calculators overstate risk, and yes we seem to have no explanation of why things like age or sex should even be factors, but as you yourself pointed out – they are based on ‘old’ data. They are statistical models that show that there is a correlation between CVD and things like Age & Sex, and probably even what postcode you live in. So what? They don’t profess to understand why this correlation exists, and I certainly agree we should strive to understand why it’s there. But beyond that I think you cannot read too much into these Risk Calculators … after all if the underlying data shows that more older men did in fact have CVD than younger women (in the 60’s-80’s, or whenever the data is from), then so be it. Try to explain it by all means, but don’t attack the calculators for being based on these statistics (even if they are old).
    If indeed, your gripe is why they even chose these particular parameters in the 1st place, as opposed to say … levels of daily exercise, or height … well, it most likely because that’s simply the data they had available.
    Anyway, apart from the somewhat unnecessary scathing of online risk calculators, I found that this part XIV (as opposed to all the previous ones) has really left me none the wiser on CVD.

    1. David

      If, say, high BP and age are risk factors for CVD and age is a risk factor for BP then you (we? , they?) are at risk of double counting. If you are factoring in age then you should account for that by reducing the weighting given to BP according to the way BP is determined by age. I think. I also think that to get something like QRISK correct you must have a good idea of what causes CVD, and it’s possible that the people who invented these calculators didn’t.


      1. mikecawdery

        I suspect the problem lies in the statistics. The multiple regression techniques involve a group of factors for which numbers are available. The mathematical process then works out the correlations to form a correlation matrix from which the “best” factors are selected. Unfortunately the matrices are never published and the associations may be indirect anyway.

  24. Lynda Cooper

    Shouldn’t there be more information requested when the question is asked if a parent has died from heart disease under the age of 60? My Father died aged 51…but that was 44 years ago. All his life he had eaten the diets that are considered so unhealthy for the heart, for all of his adult life he had smoked cigarettes (untipped) and had lived through the trauma of fighting for the entire duration of WW2 (completely alien to his personality as he was a quite gentle man). All of these thing surely impacted on his early death. Who’s to say without all of those factores he wouldn’t have lived until he was 90. Whilst I can understand the connection that can be made if your relative died within the, lets say, last 10 years, I really don’t believe that it is so relevant when they died so long ago.

    1. annielaurie98524

      Exactly. With our knowledge of how lifestyle impacts our health risks, what happened to a relative long ago is irrelevant. My own father had his first heart attack in his 40’s. He was an abusive alcoholic, a heavy smoker, a super-hyper Type A, weighed 350 pounds, and the attack occurred as he was about to do something violent. The wonder would have been if he didn’t develop heart problems. I don’t worry in the least about “inheriting” any risk from him. But docs are so wedded to their silly cookbook approach that they never bother to inquire about factors that should be obvious to anyone with at least 2 brain cells to rub together. They get 99% of their “education” from the pharmaceutical industry, even the supposedly “science-based” training in medical schools. It’s a corrupt system.

      1. Gary Ogden

        annie: Agreed. My father lived to 32, but his father made it to 86, outliving him by 20 years. Just another way of striking fear into us. I think in my father’s case, it was the stress of WWII.

  25. Justin Phillips

    Perhaps it’s like this – its all due to chronic inflammation:
    Inflammation gobbles up available Vit C (triage theory, the consumption of free electrons)
    Clotting process progresses steadily over time sans adequate Vit C (Pauling/Rath, collagen etc)
    Explains chronic aspect?

    Men have higher muscle body and muscle mass than women. So eat and drink more. Food metabolism is inflammatory (esp carbs), so men suffer more chronic inflammation? Explanation for Gender.

    I think these ideas correspond with the known associations with body mass, Inflammation markers such as CRP, and HBA1C. In effect they all markers for inflammatory processes.

    I am hoping that low carb eating and Vit C supplements will do it!

    1. JDPatten

      As Dr Kendrick has pointed out, inflammation is an element of healing. Injury first. If we injure ourselves each time we eat – woe is us. You think carbs in particular are that injurious? Hm. Maybe they are!?

      1. Justin phillips

        The starting point is the suboptimal amount of Vit c available for adequate collagen formation. According to triage theory, Vit C will first donate electrons to inflammatory processes before helping to synthesize collagen. So anything that consumes electrons will deplete Vit c, in humans, as Vit c is the body’s primary redox agent. This includes all oxidative stress such as toxins, infections, disease, and, for many people the carb metabolism. So low Vit c = low collagen = poorly maintained arteries = need for clotting process = IHD. The longer the worse, hence the chronic aspect. Stress that sugar often the worst culprit. Further, glucose competes with Vit c for cellular access via glut1 receptors, so a Vit antagonist. Men eat more than women, so situation exarcebated re carbs, if applicable…

      2. mikecawdery

        According to Klenner’s clinical reports from the 1940s through to the 1970s suggests that Vit C is itself involved in healing and combating infection. In dogs, as in most mammals that make their own Vit C, this production is increased several fold when infected. Mother Nature seems to have developed this process for health reasons but there is no profit in researching it.

  26. Jerome Savage

    Dr. Kendrick,
    Quote “Through what process can age created atherosclerotic plaques, assuming no other risk factors? Raised cholesterol”
    The implication seems to be here that there is an acceptance that cholesterol IS a factor in CVD.

  27. JanB

    Soooo, men and women in some way ‘live’ differently and the longer they live the more apparent becomes the difference.? My husband has acquaintances and I have friends. – a close knit, mutually supportive group of around 8. We meet up socially, play tennis together, celebrate our all our birthdays with a jolly lunch and much laughter and sometimes tears and generally enjoy each other’s company. We are all in our 60s and 70s and menfolk are not included in our get togethers, probably because we all unconsciously or otherwise acknowledge that their presence would alter the ‘vibe’.
    I don’t know whether this is in anyway relevant to my feeling of well-being, despite being in an at risk group – 73, thin, type 2 DM, MGUS but I know it makes me feel good – even though I get a fair amount of amused flak for not eating the cake.

    1. Dr. Malcolm Kendrick Post author

      Yes indeed. Sapolosky has much to say on the impact of social support (in baboons). His work is actually very interesting and relevant, in my opinion, to diseases in humans. Particularly CVD.

    2. mikecawdery

      I keep pointing out that doctors are a very important part of the placebo effect (old term bedside manner) or should be. Unfortunately some seem to be more interested in the nocebo effect.

      1. mikecawdery

        Bob Niland

        This extract sums it up nicely – a right little nocebo

        In other words, doctors perceive around 25-fold more benefit than there truly is. This is because studies (nearly all funded by the drug industry) perform a statistical sleight-of-hand by reporting something called “relative risk’ that misrepresents and exaggerates the real benefit (a topic for future discussion).

  28. Maureen Berry

    This was very timely, I had my review yesterday, my risk was 7%. At least I wasn’t harassed about statins, having been a steadfast Statin Refusor since 2009. My TC has gone down to 7.9 all on its own. “What diet have you been following, your TC has gone down?” “Low Carb High Fat, mostly saturated”. I don’t know why I bothered. Well I do actually, I wanted a liver function test, she had me down as 35 units a week, it was fine anyway, and I thought I was getting an HbA1c, but I think it was just a fasting blood glucose, could have done that myself.
    Anyway, got home to an email from a friend, diagnosed diabetic 6 months ago, now normal HbA1c, lost a shed load of weight, no medication, to all intents and purposes, cured. He had just got back from week 5 of 6 of his Diabetes Xpert course – this one was all about Cholesterol. “Think of LDL as Lethal, think of HDL as Happy.” Having read your book, my friend asked, “What does LDL actually stand for?”. “Can’t remember off hand, just think Lethal!” We have a long way to go!

  29. mr Chris

    Downloaded the ASCVD app for a laugh. Gave my risk as 26%, with a reduction to 19.6 if I got the TC down from 205 to below 170. My big problem is age, 76, and the ASCVD bods don’t seem to read this blog whereby my TC is perhaps a little low for a long life. Presumably the point of these calculators is to, literally scare the life out of you?

  30. James Alexander

    Clarification sought. On 12 May the news carried a story http://www.bbc.co.uk/news/health-36274791
    A third of GP surgeries have been told to contact people who may have been given an inaccurate assessment of their future risk of heart disease. The alert follows the discovery of a problem with a digital calculator for assessing heart risk and the need to prescribe cholesterol-lowering drugs.”

    Question: is this the same issue and same source as Dr Kendrick’ italicised censures above of the exaggerations inherent the Qrisk calculators. Or are these two separate condemnations, Pelion heaped on Ossa?

    Its just that I’m surprised not to find (as far as I can see) any specific reference in the post or comments to this shocking week-old news story that reveals serious IT cock-ups in the Qrisk programme itself. I was briefly on statins in 2007 afer a breezy Qrisk computer reading in the surgery. Trust no-one. Haven’t been recalled since 12 May revelations!

    As ever, we have to wonder how the ‘hear and obey’ zombie physicians can hold their heads up.

  31. JDPatten

    Age is probably the most important risk factor for atrial fibrillation.
    If we can figure out all that is causing atherosclerosis on our own before we die, will it all turn out the same as for atrial fibrillation?

  32. Robert Dyson

    This is stunning. I assumed that these risks were from population studies so that on average the risk will be correct. If one has has to divide the risk number obtained by 4 or 5, clearly I have totally misunderstood.

    1. David Bailey

      I think much of the information on here is stunning, and assuming that Malcolm isn’t censoring a stream of experts queueing up to explain in detail where he is wrong (which I really doubt, since he gave a whole blog to one guy to present the orthodox case – rather ineffectually), what can one make of conventional medical science?

      Indeed, even Malcolm Kendrick can’t censor GOOGLE (I think), and I have looked, and absolutely nobody seems to be trying to refute him – they would just like him to go away!

  33. Nigella P

    So, if the risk factor calculators are basically nonsense, is there any truth at all in women being less at risk than men?

      1. maryl@2015

        Dr. Kendrick, it appears that we can almost find as much information about our risk factors or how long each of us will live based on Census Data. If you go to any number of ancestry websites and enter your surname, you come up with a pretty amazing graph of information on marriage, death rates, migrations records (when and where) as well as individual members of your family and their longevity records. That might be as telling as all the risk factor assessment tools the medical profession congers up just about anywhere in the world, but particularly in the U.S. and Western Europe. Actually, it is pretty accurate if I just look at individual family members and their ages at death. I have looked and looked at those things and they seem to defy these risk factor assessments. Perhaps a quick review of those (family) records are more predictive than any physician I have seen thus far. I may be repeating something others have already stated but I find it quite telling overall. Sometimes, it seems that virtually no matter what one does, it might very well be a combination of luck and genes. For instance my father who led a pretty exemplary lifestyle lived to about the same age as his father who led a not so exemplary lifestyle. I find it fascinating.

        Great post as usual and thank you.

      2. Goutboy

        Insulin resistence lower in women?The study makes the connection between the ACC score and diabetic non statinated subjects.

      3. Craig

        Nick Lane makes an interesting point about gender in ‘Vital Life’

        ” On the Y chromosome, the gene that dictates male development in humans, the SRY gene, speeds up the growth rate by turning on a number of growth factors. There is nothing sex specific about these growth factors: they are normally active in both males and females, it’s just that their activity is set at a higher level in males than females. Mutations that increase the activity of these growth factors, speeding growth rate, can induce a sex change, forcing male development on female embryos lacking a Y chromosome (or SRY gene). Conversely, etc etc. ”

        It is impossible to quickly summarize the points he makes about gender and its purposes and foibles – read the book!

  34. Bill

    To me the very notion of “risk factors” is intellectually corrupt. What are they really? Just observed correlations between various factors such as age, gender, and blood pressure and certain disease diagnoses. “Correlation”—now that doesn’t sound very scary, does it?

    But when you cleverly rename the correlation a “risk factor” you make it sound like something that actively endangers you, something you may want to scramble to do something about. But knowing that there is a correlation tells you absolutely nothing about whether or not doing something about the factor in question will improve your health—e.g., drugs that raise “good cholesterol” don’t prevent CVD and may even promote it.

    Who came up with this medical term of propaganda? Why, the head of the Framingham Heart Study, in 1961, as far as I can tell. I’m guessing it played quite a role in morphing the traditionally quite modest field of medical epidemiology into the monster it is today, loudly telling the world what to eat and what drugs to take and the like based on evidence that would have Austin Bradford Hill wonder why he bothered.

    Perhaps if we abstained from this awful term, even if we just used the more modest, and generally more accurate, “risk marker” concept instead, it would be possible to have a more rational discussion. Perhaps.

  35. Dr. Göran Sjöberg

    As always, trying to find my way through the “science” of medicine I find astonishingly little.

    I wouldn’t have believed this before my closer acquaintance with this “science” but surely after having personally been exposed to practical applications of this “science” and starting to do my own natural science “homework”.

    On the molecular levels in medicine I find the true science while the “religious part” is to be found at the “higher” levels through the dogmatic parables made to medicine proper, the physiology. The two parts shouldn’t be mixed in my view but definitely are. Medicine proper is to me a “shamanistic” holistic art.

    On these “higher levels” in medicine today it seems all to be about nonsensical happenings one way or the other but with constant references to irrefutablescientific facts mostly in order to increase the “credibility” of the upper level nonsense. This is to me real abuse of the science I am used to and only for the benefits of Big Pharma.

    Remember the the first oath of Hippocrates!

    This kind of “risk calculators” now seems to me to be the epitome of the ingenious professional but disgusting actions of “the business” and fundamentally violating that Hippocratic oath. To sell a lot of drugs you need a lot patients and “CVD-calculators” is a great way to expand that market.

    If I now believe what the former chief editor of “New England Journal of Medicine” for twenty year, Marcia Angell, writes in her book , “The Truth About the Drug Companies”, about half of the revenue of Big Pharma goes to marketing. She makes a funny remark, or rather “commitment”, in my eyes, when she states that she truly believes in “Medicine”, naming a few drug which I personally wouldn’t touch; why should she otherwise have spent twenty years as the chief editor of a medical journal.

    Thank you Malcolm for this great revealing of the “CVD-calculator”-nonsense!

    If it not, in essence, had been a criminal activity put int clinical practice in order to harm and make money the whole thing would have been only ridiculous and a laughing stock.

  36. Kirsten

    I would also be really interested to hear your opinion of what role iron intake from food and supplements, and iron levels in the body in their various forms, have to play in CVD risk. I do hope you include your thoughts on this in your next blog post.

    1. Joe


      So would I. I think high ferritin levels are far more strongly correlated with heart attacks than cholesterol levels, especially for men. The vast majority of us have too much ferritin.

  37. Ken MacKillop

    Excellent post as usual. I myself do believe that CVD, almost uniquely, is inevitably advanced by age. Just as I do believe that “dying of old age” means not dying of any of the modern degenerative conditions but rather dying of congestive heart failure or gradually increasing lack of pumping for nutrient and oxygen supply to the body tissues.
    Coronary artery calcium scoring seems to demonstrate that individuals who live the longest always develop atherosclerosis at advanced age.
    The theory of cause that I believe is consistent with all of this is advanced by M. Brownlee and colleagues (i.e. Brownlee’s lab) at Albert Einstein College of Medicine. This theory is also consistent with endothelial injury as the first major step in CVD. It is also consistent with a lot of epidemiological evidence that is curiously ignored for the most part — CVD risk is more highly correlated with markers of whole-body insulin resistance than others that I know of (including simple glycemia).
    My hypothesis for the apparent inevitability of CVD with advanced age is simply cellular senescence (increasingly unrepaired somatic mutations and other cellular damage) — the same thing that makes us eukaryotes biologically mortal. This also ties in with the Brownlee hypothesis for accelerated CV degeneration.
    Dr. Kendrick, what do you think about EndoPat for early detection? I notice that it is virtually unused for clinical purposes. But economically it would seem to be viable.

  38. Ken MacKillop

    P.S. I should have written “cellular senescence of the endothelium”, more specifically.

  39. Cath Neill

    Hi Malcolm I’m still resisting blood pressure medication but my G.P just showed me an article from the lancet 2016 387.957 blood pressure lowering for the prevention of CVD and death.
    Is this new research or rehashing of stuff you have mentioned before?

    1. Gary Ogden

      Randall: This is true of the other risk calculators as well, that treated BP carries a higher risk that untreated. Are they inadvertently trying to tell us something? Though my first reaction is: What the hell?

      1. Mr chris

        Thanks for posting the Framingham calculator, it gives the same result as the ASCVD but with the advantage of easily seeing
        what the weightings are. For us seniors its age age age. Since I dont believe that, I am eagerly awaiting the 10 points of Dr K.
        Only I am not because the biggest thing I have taught myself from the blog, is, give health a chance, give up statins.
        Signed new man, Chris.
        Incidentally I draw a pension from the Crestor makers, so am I unprincipled?

        1. Gary Ogden

          Mr chris: Not a bit unprincipled. Soak ’em for every penny you can. It’s a beautiful thing to summon more guts than we thought we had, and truly take control of our own health. Dr. Kendrick and all the commenters her have helped us so well along that path. A community of curious people with their intelligence still intact.

      2. Anna

        Wow, that is really confusing. Untreated adds two points, treated adds 5. I’ve had a long ambivalence about taking blood pressure meds. I bought an Ayurvedic formula from India for years. I stopped it because it acted like a beta blocker and slowed my hear rate, which made me have difficulty exercising. It worked so well that I have wondered if they are legit or simply putting Atenolol in the pill? The reason I take lisinopril is that I worry that higher pressures may lead to endothelial damage and supposedly increases the risk of stroke as well.

        1. Gary Ogden

          Anna: Your point is well-taken. You certainly know what works best for you. Three thoughts: 1. Our BP is what it is for a reason, and lowering it with a pill may not address this reason. If doing so prolongs health and lifespan, this point is moot. But how can we know without full disclosure of all trial design and data? And perhaps we need it somewhat elevated to function well. The story of Dr. Graveline’s grandmother is compelling. I have yet to see convincing proof that artificial lowering of age-related moderately elevated BP offers protection from vascular disease. 2. The fact that wakame and other sea vegetables have the same effect as ACE inhibitors (which are likely derived from compounds found in these plants) is definitely a point in their favor. The Japanese live a long time. But I would rather eat the vegetable than take the pill. 3. If insulin resistance is the foundational cause of vascular disease, in its absence does age-related moderately elevated BP cause vascular damage serious enough to justify pharmaceutical treatment? Does it make any sense that a seventy-year-old would have the same BP as a twenty-year-old? Doesn’t it seem likely that a gradual rise in BP is a normal part of aging?

          1. Gary Ogden

            Diana: Intriguing possibility. How truly miniscule is our current knowledge of the microbial world. I’m looking forward to reading “The Hidden Half of Nature” in hopes of gaining some insight into this fascinating invisible realm.

          2. smartersig

            My partner has had good results lowering her BP from 160/90 to 125/80. What she did was drink hibiscus tea, take kyolic aged garlic and of course walk more. None are the above are difficult to implement.

          3. lisa

            How long did that take. Have been drinking hibiscus tea 3 times a day for a month now. Its not worked for me. Have tried the garlic before and that didn’t work for me. Walk about an hour and a half a day.

          4. smartersig

            Probably a couple of months, try them all together. For your info we use Quest Kyolic aged garlic. I would suggest also adopting a predominantly plant based diet, I eat some wild fish too.

          5. Sasha

            All very good points. And apparently there are a lot of data that treating anything not in the 90th percentile for that age group does more harm than good.

            Joel M Kauffman, PhD, “Malignant Medical Myths”. Myth #4.

        2. John

          Hi, what is you blood pressure with and without the meds. I am on two but would like to come off them. Have you tried to come off them.

  40. Dr Robin Willcourt

    We know little about telomeres but know that they are a critical factor in maintaining optimal cellular function. One of the leading causes of death in progeria, a disease of rapid aging due to is CVD. Here is a quote: “Signs and symptoms of this progressive disease tend to become more marked as the child ages. Later, the condition causes wrinkled skin, atherosclerosis, kidney failure, loss of eyesight, and cardiovascular problems. ”
    And: (A) study about progeria in the June, 2011 in an online edition of the Journal of Clinical Investigation concludes that in normal aging, short or dysfunctional telomeres stimulate cells to produce progerin, which is associated with age-related cell damage.

    A huge area of research, unfilled because we went down the wrong path. Forty years lost…

    1. Stephen Rhodes

      The telomere shortening is something that is known to happen but I am not aware of how it is considered to affect the functioning of the DNA.
      Mitochondrial dysfunction is also involved in ageing but this is another area where much time has been wasted since Warburg, but there is a lot of interest now that it is understood that we are electrical as much as chemical.

      1. Dr Robin Willcourt

        Indeed, DNA repair is inhibited as the telomeres shorten, because telomerase is essential for maintaining the integrity of DNA. The mitochondrial DNA has different mechanisms but taken together, telomerase, epigenetic ‘switches’ and mitochondrial dysfunction may well be the underpinning of many (most?) disorders. Increasingly, cancer looks more and more like a metabolic disorder impacting DNA as well as many other cellular components.

        If only our research organizations and researchers were honest, we might get the RIGHT answers sooner than later. That would be refreshing– and wonderful.

    2. Dr. Göran Sjöberg

      How true!

      By just going to the updated standard “textbooks”, e.g. “THE CELL” you get overwhelmed by the “epigenetic” complexity.

      No one seems to “know” but not refraining numerous dogmatic views to surface on the subject 🙂 I guess that this is unfortunately the “essence” of medicine as I see it today.

      1. Gary Ogden

        Dr. Göran: What I find fascinating about epigenetics is that it tells us that, not only can environmental factors alter gene expression without altering the gene, but that these changes in expression are heritable, which tosses the sabot right into the machinery of classical genetics. Our NIH is spending vast sums looking for the gene for this and the gene for that, as if epigenetics had never been discovered.

  41. JDPatten

    So, Dr. Malcolm, since the medical/physiological science required to figure this out is somewhat above my pay grade, I have to resort to deciphering the psychology of your responses to comments.
    There’s no science supporting the hormone or iron connections to CVD, but you’ve got it figured out anyway.
    Guys are much more shy than women in seeking out social support.
    Age: The healing process slows down such that the continuing endothelial insults don’t have a chance to clear so they accumulate. Because of those gender differences, it catches up to guys sooner.
    Wild guessing here. Consider this to be another dozen thumbs-up for Joe’s comment from the 18th.

  42. Diana

    Iron, Human Growth, and the Global Epidemic of Obesity (2013)

    Please note that one of the authors is from EPA. I guess he knows what he is talking about.

    Rahul G. Sangani 1 and Andrew J. Ghio 2
    1 Geisinger Medical Center, Danville, PA 17821, USA
    2 Environmental Public Health Division, National Health and Environmental Effects Research Laboratory, US Environmental Protection Agency, Chapel Hill, NC 27599, USA

    Iron is an essential nutrient utilized in almost every aspect of cell function and its availability has previously limited life. Those same properties which allow iron to function as a catalyst in the reactions of life also present a threat via generation of oxygen-based free radicals. Accordingly; life exists at the interface of iron-deficiency and iron-sufficiency. We propose that: (1) human life is no longer positioned at the limits of iron availability following several decades of fortification and supplementation and there is now an overabundance of the metal among individuals of many societies; (2) this increased iron availability exerts a positive effect on growth by targeting molecules critical in regulating the progression of the cell cycle; there is increased growth in humans provided greater amounts of this metal; and indices of obesity can positively correlate with body stores of iron; and (3) diseases of obesity reflect this over-abundance of iron. Testing potential associations between iron availability and both obesity and obesity-related diseases in populations will be difficult since fortification and supplementation is so extensively practiced.

    Chapter: Cardiovascular disease.

    It has been previously postulated that iron depletion protects against ischemic heart disease and that the difference in the incidence of heart disease between men and women could be explained by differences in levels of stored iron. In women, the risk of heart disease does increase following natural or surgical menopause [94]. Among men, there is an increase in risk of coronary heart disease with elevated iron stores. Men with high body iron stores had a two- to three-fold increased risk of myocardial infarction compared with men with low body iron stores [95]. In 1931 randomly selected men with no symptomatic coronary artery disease at entry, the adjusted risk of acute myocardial infarction with serum ferritin greater than 200 ng/mL was 2.2 fold higher than in those with lower serum ferritin [96]. The odds ratio increased by 0.2 for each 100 ng/mL increase in serum ferritin [96]. Mechanistically, evidence for a participation of iron in atherosclerosis was suggested by an ability of the metal to oxidize LDL [97] and damage endothelial cells [98], the observation of ferritin induction with the progression of atherosclerotic lesions [99], the inhibition of endothelial cell damage after oxidized LDL by chelators [100], and the prevention of endothelial cell dysfunction and vascular smooth muscle proliferation by chelators [101]. In animal models, phlebotomy, systemic iron chelation treatment, or dietary iron restriction reduces atherosclerotic lesion size and/or increases plaque stability [99,102,103].

    There were positive associations between myocardial infarction and dietary iron intake [99]. A significant association of iron intake and coronary artery disease (CAD) demonstrated that for each milligram of iron consumed, there was an increase of 5% in the risk of CAD [96]. Intakes of dietary iron, especially heme iron and red meat, were significantly associated with a greater risk of fatal CAD, coronary revascularization, and total CAD in diabetic women [104]. Compared with total iron (heme and nonheme) intake, heme iron has been more consistently associated with increased risk of CAD and cardiovascular mortality and the association between heme iron and CAD risk appears to be more marked in postmenopausal women [105,106,107,108,109].

    Changes in iron stores during a five-year follow-up period modified the risk of atherosclerosis with the lowering of iron stores being beneficial and further iron accumulation increasing cardiovascular risk [110]. Furthermore, studies on the effect of blood donation on cardiovascular events support the postulate that iron stores can be associated with coronary artery disease [111,112].

  43. Martin Back

    There are two slightly different causes of heart attacks:

    A) Plaques that grow so large they block the coronary artery they are growing in; and
    B) Plaques that grow elsewhere, break off, and block a downstream coronary artery.

    Is there any data that gives us the relative proportion of the two types, and how it changes with age? It might be a pointer as to whether one should focus on the growth of plaques or on their stability in looking at age-related CHD.

  44. SwineOne

    Dr. Kendrick,

    First of all, congratulations on this series, I learned of it yesterday and devoured it in a couple of sittings. It is absolutely fascinating, and I thank you for writing it.

    While I imagine that you’re planning to cover this issue in a future post of the series, just in case you haven’t thought of it, I’d like to suggest that you mention what CVD risk predictors are of actual value and how they fit in the context of your theory of heart disease — I’m thinking ApoB/ApoA1 ratio, TG/HDL ratio, HDL/TC ratio, and possibly others I haven’t learned about.

  45. Dr. Göran Sjöberg

    This might be a little “off topic”, late Saturday night concern, but environmental factors seems to have their part in our “modern diseases” but basically we don’t know for sure how they work.

    With age and ailing health I have myself, from earlier being quite ignorant, turned, by adopting caution to this issue, into a firm opponent of any new environmental experiments on the human species.

    So – today I used my democratic rights to oppose Monsanto who is the main proponent of herbicides (read glyphosate and adjuvants) as well as GMO crops in agricultural poisons that enter our food system. This opposition occurs all over the world through the “March against Monsanto”.


    I Gothenburg where I participated today, and where I also gave a speech, sadly there was only about a hundred participants. A true grass-root activity but still supported be science as far as I understand science.

    1. David Bailey

      Sadly, the Green movement has become obsessed with atmospheric CO2, which I think is a totally bogus concern, and this detracts from the real issues, Perhaps that is why the CO2 scam was devised!

      1. Dr. Göran Sjöberg

        I think you are all right about CO2 being an orchestrated scam. This is the really big elephant in the room.

        The sad thing is that my earlier acceptance of the many official dogmas just evaporates when scrutinised by the science I understand. I could make a long sad list. The cholesterol scam is at the top of the list.

        I am a strong believer in the natural sciences, having spent my life on it. It is the abuse (by corporate greed) which I am fighting and that was actually the main theme of my talk.

        “I really love this kind of science but hate the abuse!”

      2. Dr. Göran Sjöberg


        It strikes me now that what we want to see is is governed by belief or disbelief.

        For my part it is very much about disbelief today and I tend to see elephants all around.

        I am just now in Part Two of the great book “The Modern Nutritional Diseases” (Ottoboni & Ottoboni). The first section in this second part is “The Science” and perhaps it was caption that introduced this section that stroke me.

        “Far more crucial than what we know or do not know is what we do not want to know.” Eric Hoffer. “The Passionate State of Mind”, 1954.

        Might be something to put on my reading list.

      3. Gary Ogden

        David Bailey: Atmospheric CO2 may or may not be a bogus concern, but it is clear that its concentration is at historically high levels. What is certainly bogus is blaming industrial activity for this rise, when it is clearly agriculture (which is extractive, as opposed to farming, which is restorative) which has contributed significantly more to it than industry has. Soils are capable of holding enormous amounts of carbon. Undisturbed soils, particularly in grasslands, are a crucial part of the carbon cycle. This is one of the most fundamental mineral cycles which allowed for the evolution of life on Earth. But we’ve been plowing for ten millennia, and have plowed up nearly all the arable land on Earth, particularly since technological advances beginning in the early 20th century allowed for much more rapid population growth, mechanization of farming, and transport of commodities far and wide, disrupting this beautiful cycle and releasing untold amounts of carbon to the atmosphere and oceans. The IPCC doesn’t have a clue about this, nor apparently do activists on this issue.

      4. Dr. Göran Sjöberg

        David, Sasha,

        Without giving the subject of CO2 and the claimed greenhouse effect I tended to believe in this dogma.

        Though something, I don’t remember what today, made me start digging into this subject and all of a sudden the elephant was standing there in front of me.

        “Oh, God!” I have been fooled again.

        I couldn’t find any more scientific (as I understand science) support for this greenhouse effect than for the ‘cholesterol effect’. While the bogus of the latter is a clear cut scam by Big Pharma the reason behind the CO2 scam I cannot disentangle as easily. The only thing I can envision is that very sophisticated international corporate/political interests are at stake.

        Since the green movement is skyrocketing today the bogus might be intended to take the teeth out of the movement – anyway this is a plausible “explanation” in my mind.

        1. Sasha

          Dr. Sjoberg, I would be very interested to read up more on what you are saying (books, articles) or whatever else you can recommend… If you have time. Thank you!

      5. Diana


        “Undisturbed soils, particularly in grasslands, are a crucial part of the carbon cycle. ”

        How true. And guess who rules it all… 🙂

        Fungal traits that drive ecosystem dynamics on land. (Treseder, 2015)

        “Fungi contribute extensively to a wide range of ecosystem processes, including decomposition of organic carbon, deposition of recalcitrant carbon, and transformations of nitrogen and phosphorus. … Altogether, these relationships provide evidence for two functional groups: stress tolerators, which may contribute to soil carbon accumulation via the production of recalcitrant compounds; and decomposers, which may reduce soil carbon stocks. It is possible that ecosystem functions, such as soil carbon storage, may be mediated by shifts in the fungal community between stress tolerators and decomposers in response to environmental changes, such as drought and warming. “

      6. Dr. Göran Sjöberg

        Well, now I remember what triggered me to see the CO2-elephant.

        I was to give a talk about the evolution from ape to ‘modern’ man over 5 million years and reading a great book “The Story of the Human Body” by the professor of human evolutionary biology, Dr. Daniel Lieberman, it was obvious that climate change was an important driver.

        Then Googeling around looking into temperatures and CO2 changes I couldn’t in my wildest imagination envision that the changes in CO2 could have had any causal effect but rather being an effect of temperature changes. It was here a clear ‘bullet proof’ Popparian refutation of the presnt ‘politically correct’ CO2 dogma and as I stated “The elephant was there”!

        But please don’t loose hope of “a change” and that is why I gave my talk on Saturday in Gothenburg.

        Enjoy some Swedish ‘hot feelings’ from a seasoned researcher with a black cap on his head 🙂

      7. Sylvia

        Fordhall farm in Shropshire is a wonderful example of how to work with nature, a good site to learn about the wonderful Arthur and May Hollins and their legacy carried on by their children. Alas too few like this. Can buy the produce but it is expensive.

        1. Gary Ogden

          Sylvia: There is much good going on here in the U.S., too; farming that builds soil health. Our government (FDA and USDA) routinely harasses such people, especially if they produce animal products, but it is a growing movement. When we fail to mimic nature we all suffer the consequences.

      8. gettingmoresceptical

        There are a lot of elephants in the room regarding ‘Climate change’! One of the most obvious, is that while they will tell you about the shrinking North Pole, they won’t tell you about the South Pole, which has record ice levels!

        Another elephant can be found by considering Venus. This was long considered to be an extreme example of global warming – with an atmosphere composed almost entirely of CO2, and a surface temperature sufficient to melt lead! Indeed, perhaps it helped to start the scam.

        However, a US spacecraft went into orbit about the planet and measured temperature and pressure profiles in the atmosphere:


        The huge surface temperature is mainly the result of the fact that the surface pressure is about 92 times the surface pressure on earth. The data from the satellite lets you calculate the temperature in the atmosphere corresponding to earth’s surface. The answer is 66 C, which is hotter than earth, but it is a lot closer to the sun, and where is the famous greenhouse effect?

        The entire story is absurd – not least the fact that the supposed heating of 0.8 C since 1880 is measured by averaging the values obtained from ordinary weather thermometers! Satellite measurements tell a less exciting story:


        Everyone here must surely be aware by now that institutional science can lie through its teeth – it can kill people through wrong dietary advice, cripple people with statins, and yes, it can deprive people of affordable electricity as well.

      9. David Bailey

        Sorry, the above comment by ‘gettingmoresceptical’, was in fact by me – I’d forgotten to log out of WordPress!

    2. Sasha

      Environmental factors are certainly at play. The article by cardiologist that someone just posted links to TACT study set up by NIH to disprove EDTA chelation. Instead, after 10 years of data, it showed significant RR reduction in CV events. They are now setting up TACT2 to confirm.

      EDTA used in the study chelates cadmium and lead to which most Americans were exposed to until unleaded gasoline came along in 1980. That could partially explain CVD rise in mid-20th century and it’s subsequent fall afterwards.

      1. Gary Ogden

        Sasha: Also intriguing is the possibility that the rise in crime, and its subsequent fall, in the U.S. is related to the lead in gasoline. It’s an association that tracks beautifully, if graphed together.

      2. annielaurie98524

        Isn’t it pitiful that, in the US, major agencies like NIH, FDA, USDA, etc., set up studies to “debunk” natural health measures, rather than proactively and objectively analyzing same? It is a sad, sad commentary on the extent to which these supposedly independent government agencies are owned by conventional Big Pharma. Their top slots are filled with industry hacks, and the revolving door keeps spinning.

    3. gillpurple

      Just catching up with all this and still studying it all – many thanks, Dr K.

      Goran, thanks for the links to the Australian TV programmes a few blogs ago, tried to find them before and they had been removed.

    4. Gary Ogden

      Dr. Göran: Thank you very much for doing this. We are indeed guinea pigs for the testing of novel products. Glyphosate was initially patented as an antibiotic. It works by binding manganese, and blocking the shikimate pathway, which is not part of human metabolism, but is for our microbiota. If you haven’t yet read Dr. David L. Lewis’ “Science for Sale,” I suggest you do so. You will understand why our EPA allows this and other toxins into our environment.

      1. annielaurie98524

        When it was first formulated around 1950, glyphosate was actually a chemical chelating agent used to clean metal surfaces. Its herbicidal/antibiotic and other uses were found later. It is interesting that, while glyphosate itself seems to get the bulk of attention as to toxicity, there are carriers/adjuvants and other compounds that are generally used in herbicidal formulations containing glyphosate that may be as toxic as, or that may increase the toxicity of, glyphosate. I think this was briefly mentioned in the original IARC monograph listing glyphosate as a 2A carcinogen.

  46. Mike Wroe

    When we talk of smoking as a risk factor we are referring to self inflicted exposure to pollution and introducing toxins into our bodies through the lungs. Incidence of CVD I believe is higher in cities, and near to airports. Diesel fumes and invisible to the naked eye particulates introduced intentionally or unintentionally into the blood stream must destroy the cardiovascular system over time increasing risk as we age.

  47. mikecawdery

    Another excellent article which has a lot more sense in it than many if not most “guidelines”. Again it is these Hazard/Odds that inflate the trivial to a “serious” looking percentage and. with huge numbers of “statistical units” the real differences are tiny.

    Blood Pressure: Port S, Flawed Systolic blood pressure and mortality based on Framingham data..
    Lancet. 2000 Jan 15;355(9199):175-80. The paradigm used in these risk analysis programs is flawed.

    Kaiser Permanente is the medical insurance company that provided Solomon et al with the data for their study Midlife Serum Cholesterol and Increased Risk of Alzheimer’s and Vascular Dementia Three Decades Later Dement Geriatr Cogn Disord 2009;28:75–80
    DOI: 10.1159/000231980 but without any subsequent data on cholesterol levels or therapy details. In Tables 2-4 changing the row titles of cholesterol levels to US therapy recommendations changes the interpretation from high cholesterol to 2-3 decades of treatment as the “cause” of AD

    For predicted risk equal to or greater than 5 percent, actual incidence was 1.85 percent [for five years]

    I interpret this as 0.37% per year or roughly 1 in 270 or 5 in 270 over 5 years. Meanwhile five times as many will die despite therapy (HPS – Collins) or 25 in 270 and this in patients known to be tolerant and with prior MI. 265 out of 270 will not benefit in terms of life “saved” ie with a probability of 0.98 near certainty.

    The following may be of interest along with some links therein.

  48. Anna

    Someone above said:

    “According to triage theory, Vit C will first donate electrons to inflammatory processes before helping to synthesize collagen. So anything that consumes electrons will deplete Vit c, in humans, as Vit c is the body’s primary redox agent. This includes all oxidative stress such as toxins, infections, disease, and, for many people the carb metabolism. So low Vit c = low collagen = poorly maintained arteries = need for clotting process = IHD.”

    I’d like to add just as food for thought, that I’ve recently gotten interested in diatomacious earth, which seems to have many health benefits, one of which is relieving arthritis pain. In reading about it, apparently the main ingredient is silica (plus some minerals) and these sites say that silica is actually the most common element in the body by weight – and I had never heard of it! It is needed to make collagen…so it isn’t only vitamin C. Yes, we do get silica in our diets, but do we get enough? If the soil is abused, does that make a difference? If you’re supplementing with vitamin C but you don’t have enough silica to work with, it might not solve the problem. It stands to reason that the body will prioritize inflammation first, then collagen for arteries, and last collagen for joints. I sure have noticed that people are getting a lot of joint pain as they age.

    1. Dr. Göran Sjöberg


      Being a “layman” i completely lost my faith in the evidence based medicine since I realised it was by no means intended to go for any cause or cure for the diseases in my family. Instead I have completely turned to ameliorate my immune system instead to the best of my understanding. And this has to do with the “bulk” i put in my mouth to start with which is plain natural food without any chemical additions – food that we as human species evolved with.

      Basically grass fed meat, wild catch fish and green vegetables. No sugar, no flour! Low Carb High Fat!

      I am half way through one of the best books I have read about this issue and I have read a lot of books before. This one is “The Modern Nutritional Diseases” by Ottoboni & Ottoboni from 2013. In my eyes these two authors know what they are talking about and they are covering the whole width of the subject. Collagen is only mentioned in passing when treating sulphur bonds in fibrous proteins.

      Though it is a tough reading if you are not familiar with the basic principles involved in our physiology. They are very authoritative in their opposition to the current official nonsensical dogmas about nutrition. Their arguments are razor sharp in my eyes! Part of their “mission” is to advocate supplements, not least minerals, but with care and here they urge you to do your homework relating to your specific condition before jumping on some supplement. I did that myself before adding the 1600 IU E-vitamin for my angina. Seems to work pretty well as far as I feel now after two years.

    2. Martin Back

      Silica (silicon dioxide i.e. plain old sand and rock) is a major constituent of the Earth’s crust. The major element in the human body by weight is oxygen, but that’s because we are mostly H2O. The major element in human flesh is carbon. We are built of long chains of carbon atoms with a couple of oxygen atoms and lots of very light hydrogen atoms, plus a scattering of trace elements.

      When we lose weight, most of it is lost in the form of carbon atoms. And most of the carbon atoms leave via our breathing in the form of CO2. We breathe out more than 80% of our weight loss, something I found hard to believe, but if you want a professor of physics to explain it, Tom Murphy is your man. A Physics-Based Diet Plan

      1. Nigella P

        I read this & found it really disappointing. His advice is to skip meals – we’re back to the calories in/ calories out theory. Don’t eat so much & do some exercise is what he says! That’s what the mainstream advice has been since the late 1980s & it clearly isn’t working.

      2. Martin Back

        Nigella, I happen to believe there is no magic formula. At the end of the day, it boils down to calories in/calories out.

        The problem is, nobody manages to cut their calorie intake by following the recommended low-fat diets. Because the body doesn’t seem to recognise carb-based calories, and gets hungry soon after eating. The solution is to increase the fat percentage in your diet. The body does recognise fat calories and shuts down your appetite when you’ve had enough.

        FWIW I’ve managed to lose 15 kg and keep them off by following a few simple rules:
        – No breakfast (i.e. intermittent fasting) (I eat an orange in winter for the Vit. C)
        – No calories between meals. (Water, black tea, or black coffee only. No snacks. I don’t drink alcohol.)
        – No low-fat anything, nothing with artificial sweeteners, no PUFAs (sunflower and canola oils).
        – Fry in olive oil or coconut-based vegetable fat (Holsum).
        – Eat plenty of butter (I eat about a kilogram a month)
        – Meals are eggs, fish, or meat with steamed veggies and a bit of salad. Starch is home-baked sourdough bread or brown rice or maize meal or mashed potato.
        – Eat fermented stuff. I like my home-made sauerkraut, also amasi (African yoghurt).
        – Don’t eat too much. or go too hungry (you tend to over-eat if you are too hungry).
        – I don’t go to gym or do much PT at home, but I walk a lot. (No motor car.)

  49. Bob Niland

    Dr. Kendrick. Before wrapping up the series, the following page (not mine) might identify a few additional factors to be considered:

    I might also add that the excellent series so far might more precisely have been titled:
    What is the true etiology of heart disease

    It has not so far focused to a great extent on root causes, which, of course, If identified, are apr to automatically suggest strategies to avoid, slow, arrest and perhaps reverse CAD.

  50. Anna

    Age carries a big risk of death. An 80-year-old man has about a 30% chance of seeing his 90th birthday, but a 90-year-old has about 1 in 100 of seeing his 100th. So I am not really sure that putting age in as a risk factor is meaningful.

    1. annielaurie98524

      Can you provide us a link for the stats? It would be interesting to see how countries compare, how big a difference gender makes, etc. There are a number of statistic sites out there, but none I found made it easy to project likelihood of reaching age y if one is currently at age x. Thanks!

      1. Anna

        No, I had googled around for that and don’t remember where. It’s only a rough estimate and probably differs a bit in different countries. I just used it to make the point. One of my predictions is that the gender gap in age at death is going to decrease as women experience a lot of stress from conforming to a somewhat male designed work life and separation of work life from family life. It may not be as bad in Europe though.

  51. Anna

    They say things like CO2 levels are at historically unknown or unprecedented levels in human history. We have been in an ice age with some 23 glaciations for the past 1-3 million years. So, yeah, humans have not been around that long. But that is irrelevant. What’s relevant is what is a healthy ecosystem for plants and animals, especially mammals. Planet earth has been a warm and tropical planet for about 80% of the time, with some 3 prior ice ages. No one knows what causes them. There isn’t a periodicity.

    CO2 levels have been much, much higher for much of that time, while life was thriving and species were emerging. Some 25 times current levels. With high CO2, we have plunged into ice ages, and with low CO2 we have emerged from them. But it is true that for the past 800,000 years or so, the temperature and CO2 have been closely aligned, albeit that CO2 does not lead but rather follows rises in temperatures. Maybe it has something to do with the ice age conditions.

    Once I saw how hugely varying CO2 levels have been on this planet, I began to ask some questions. Is it likely that CO2 levels are like a lab value with very tight control such as the pH of the blood, or perhaps a more forgiving one, like platelets or potassium? Considering that it is carbon, carbon everywhere and just about everything participates to the carbon cycle?
    And, I wondered, isn’t it funny that just at that very moment of history when a species called homo sapiens had a technological revolution and could measure CO2 levels, that this brief moment happened to have the “right” amount of CO2, and that even a slight deviation should cause panic?

    OK, we know CO2 is sort of like oxygen, necessary to life. Plant life. So how low can it go? I’ve read about 180 parts per million before plants die. A hundred years ago we were at 280. Funny though, that CO2 levels have been at 5-7 THOUSAND parts per million and that plants like it and grow in green houses with added CO2 of about 1200 ppm. So plants like it way higher than it is now. Is that surprising when you find out how high the levels were as plants were evolving? So who says that a level almost at the bottom amount that will support plant life is the right one? And if you look at deep history, we are actually at historic low levels of CO2.

    1. Sylvia

      How volcanic activity affects co2 also comes into the picture. I understand it is difficult to distinguish fossil fuel emissions from volcano emissions and sulphur from volcanoes is beneficial. It is as if we humans are a virus on the shared planet. If we have clean water and abolish pesticides, surely things would improve. Too simplistic I guess. Globally we all have to agree best policy, GMO crops don’t don’t stay in a field, they become sociable and mingle.

    2. TS

      Holidaying in Ireland without much internet access so I can’t read much in detail but it surprises me that although so many of us have read Dr K’s “The Great Cholesterol Con”, little seems to be said about the hypothalamic-pituitary-adrenal axis (HPA) – differing gender reactions to stress (more cortisol produced by males). Men have needed a greater “fight or flight” reaction during our evolution – no shame in admitting that, is there? Why can’t stress be accepted as a necessary and normal thing but something to be controlled, if possible?

    3. David Bailey

      Here are the views of a Nobel Prize winning physicist on the subject of ‘Global Warming’:


      Just one of the many excellent points that he makes is that any small change in temperature would have positive as well as negative effects, yet practically all the research reports negative effects!

      Another very famous physicist, Freeman Dyson also opposes the ‘Global Warming’ scam. It is notable that both these men are retired and thus beyond the reach of academic spite.

      1. Sylvia

        Well worth watching, just as interesting as Anna,s analysis. Still, It has to be remembered that oil spills have done immense harm to the oceans and wildlife, is this the price we must pay. Such a good blog that has superb content.

      2. Gary Ogden

        David Bailey: Although difficult to watch because it kept starting and stopping, this was riveting. I had no idea that there was such a wealth of evidence utterly contradictory to global warming. He’s so right about the colossal stupidity of the corn ethanol mandate. Madness. Thanks, Al Gore.

  52. TS

    I had a nice reaction to my “I love cholesterol” T shirt in Cork. A young man came up to me and said, “May I say that that is the best T shirt I’ve EVER seen! I love it, LOVE it!”

    1. mikecawdery

      Open Journal of Endocrine and Metabolic Diseases, 2013, 3, 179-185
      doi:10.4236/ojemd.2013.33025 Published Online July 2013 (http://www.scirp.org/journal/ojemd)
      The Ugly Side of Statins. Systemic Appraisal of the Contemporary Un-Known Unknowns*
      Sherif Sultan1,2#, Niamh Hynes1,2
      1Department of Vascular and Endovascular Surgery, Western Vascular Institute, University College Hospital Galway, Galway, Ireland

      Got ticked off for contradicting official guidelines

  53. Martin Back

    Josh Mitteldorf, an evolutionary biologist, believes we are programmed to self-destruct as we get older. Epigenetics turns off genes that kept us young and robust, and turns on genes that are not so good for us.

    “The body is programmed to die, … the evidence for this hypothesis is robust. The genes that are turned on don’t protect the body—quite the opposite. Genes for inflammation are dialed up. Genes for the body’s defense against free radicals are dialed down. Cell turnover is dialed down. DNA repair is dialed down. The mechanisms of programmed cell death (apoptosis) are strengthened in healthy cells, at the same time that they are perversely weakened in cells that are a threat to the body, like infected cells and cancer cells.”http://joshmitteldorf.scienceblog.com/2016/05/09/epigenetics-of-aging-and-prospects-for-rejuvenation/

    1. Dr. Göran Sjöberg


      It differs!

      At 52 I was very close but at 70 today it feels still far away with the chain saw in my hand and now with a glass of wine in front of my fireplace 🙂

      Though I read recently about one of oldest “survivors” in the US who just passed away at 114. (That is still 44 years for me to go!) She had started every day with a breakfast on bacon and eggs – worth contemplating.

      I wonder about the Ethiopians who in ancient times claimed (in Herodotos account) to be able to reach 140 on a pure meat diet while the Persians just reached 80 on their bread diet. The Ethiopians were surprised that they even could reach such an age but believed that this was to be attributed to the fact that they also drank wine.

      1. Gary Ogden

        Dr. Goran: 116. And the new oldest person is an Italian woman, also 116, who has eaten raw eggs daily since her teenage years on the advice of her doctor to treat anemia.

      2. Martin Back

        Dr. Goran, like those Ethiopians, I have reached the age (68) where I start exaggerating how old I am. It’s so nice to hear people say, “Wow, you look so good for your age.”

        Searching for some reliable data on the age of meat-eaters, I came across this tidbit that should interest you:

        “Dr. Mann, who published some of the early research, did an autopsy study of 50 Masai men and found that they had extensive atherosclerosis. They had disease (coronary intimal thickening) on par with older American men. Over 80% of the men over age 40 had severe fibrosis in their aorta, the main blood vessel from the heart that supplies the rest of the body with blood. Yet there were no heart attacks shown on autopsy and these men still had functional heart vessels without blockages because their vessels had become larger. Researchers thought this might have been related to their rather extreme daily physical activity.”http://nutritionstudies.org/masai-and-inuit-high-protein-diets-a-closer-look/

        Note they are milk-drinkers rather than meat-eaters. And by “rather extreme daily physical activity” they mean walking rather than aerobic exercise like running.

        “If inactive Americans wanted to get the same amount of exercise, they would have to walk an additional 19km (almost 12 miles) per day”

        Getting back to the Mitteldorf theory, on the negative side it implies there’s not a lot you can do to extend your life, but on the positive side, assuming the pattern of self-destruction is the same for everyone, you know what symptoms to look out for and can have a schedule of medical counter-measures to keep you healthy until you fall apart all at once, like a well-designed one-horse shay.

        1. smartersig

          I have said it before but the constant examination of the nuances of various diets, thew fact that so and so’s next door neighbour lives to 100 on daily eggs and on and on. Start with a look at which populations live the longest and healthiest, the blue zones. Here we have large numbers with low incidence of chronic disease. The strongest underlying trend is low or no meat consumption, no processed, low or no dairy consumption and good social connections along with reasonable but not excessive exercise. Start form there rather than tweeking small individual components.

          1. annielaurie98524

            The “little to no meat” meme in the Blue Zones has been popularized by the author to sell more of his diet/lifestyle books. That’s not at all the common factor. If you examine the diets of people in the Blue Zones, they consume more animal protein than the myth leads one to believe. The common factors are strong social networks, unprocessed foods (their animal protein is not gobs of feedlot-finished beef raised on an unnatural diet of grains, or industrially manufactured pork), lifestyles based on more natural rhythms, and the incorporation of physical activity into the daily routine. Denise Minger and others have done a great job debunking the “fake bases” of the Blue Zone diets.

          2. Lisa

            Re: blue zones, I read Dan Buettner’s book, and I didn’t get the impression he was trying to minimize meat consumption. He described how in one place, meat-eating was concentrated at certain times of year. A family might eat no meat for a while, but then they’d kill an animal for a holiday ritual and eat it every day till it was gone. And they ate animal products daily – I think he said Ikarians often have goat’s milk for both breakfast and dinner.

            But you’re right that blue zone stories get distorted by people with agendas. Dean Ornish wrote in his intro to the Buettner book that the blue zone diets are low fat – despite the fact a few pages later, in the first chapter of the book itself, Buettner describes the Ikarian diet as 50% fat!!

          3. smartersig

            So what should we do with Ornish and Esseltyns results of reversing heart disease with low fat plant based diets?. Maybe the low fat aspect is not responsible but do you want to take a chance when something like the Ornish progam works ?. If it can reverse HD it sure as hell can stop it occuring

          4. Dr. Malcolm Kendrick Post author

            When someone other than Ornish and Esseltyn repeat these, their own studies, used to promote their own highly lucrative heart health programmes, I shall reserve judgement.

          5. smartersig

            Seems like you are waiting for a drug company to ruin an expensive trial to show sprouts work.

            You do not need another trial as the trials of Ornish to some extent mirror the lifestyles of those populations that do not get HD. We have populations that do not get HD eating this way. We have Ornish and Esseltyn patients reversing HD eating this way but hey maybe we should wait for one more trial.

          6. annielaurie98524

            Well, was “ruin” a Freudian slip, or are you just recognizing what the pharmaceutical companies usually do when testing a “natural” treatment? It’s unlikely that the corporations would be interested anyway — nothing patentable here. BTW, you do know, don’t you, that the Ornish and Esseltyn diets consist of far more than just “sprouts”, and that their programs entail other lifestyle changes besides diet? There are numerous peer-reviewed studies showing control/reversal of modern metabolic diseases with dietary regimes that emphasize natural, unprocessed foods. Some of these incorporate a moderate amount of animal protein, others less so. The common denominator is getting away from the manufactured cr*p that most Americans eat, and making modest, sensible lifestyle changes beyond diet.

          7. smartersig

            One other point about the Ornish Esseltyn programs is that they are pretty much freely available. They are not getting rich off it unlike the docs who are selling supplements off the back of worried patients.

          8. Gary Ogden

            smartersig: As far as I know, Dr. Ornish’ test group was fewer than twenty. Seriously underpowered, as they say. Has he done anything with a larger group, and has he published his findings? I prefer to look at the totality of the evidence, and to me it is clear that macronutrient ratios in a healthful diet can vary widely, and thus have little use in dietary advice. What is crystal clear is what Dr. Price discovered in the 1930’s: Healthy people capable of producing offspring with robust health ate traditional foods, and as soon as they switched to the “displacing foods of modern commerce,”-flour, sugar, vegetable oil, and canned goods, their health and reproductive success went to hell.

          9. Gary Ogden

            smartesig: The only Lancet articles I could find under Dr. Ornish’s name are in Lancet Oncology, the most recent of which (2013) was a pilot study concerning increased telomerase activity and comprehensive lifestyle changes. I think we are all in agreement here that comprehensive lifestyle changes are crucial for improvements in public health. Can you find anything Dr. Ornish has published concerning heart disease intervention? That was what I meant in my original question. Not that unorthodox ideas have an easy time getting published, but the preponderance of evidence clearly shows that, for nearly everyone, eschewing animal products entirely can lead to short-term improvement in health, but ultimately it is detrimental due to deficiencies in crucial nutrients.

          10. smartersig

            Taken from Wikipedia

            Ornish DM, Gotto AM, Miller RR, et al. Effects of a vegetarian diet and selected yoga techniques in the treatment of coronary heart disease. Clinical Research. 1979;27:720A.[15]
            Ornish DM, Scherwitz LW, Doody RS, Kesten D, McLanahan SM, Brown SE, DePuey G, Sonnemaker R, Haynes C, Lester J, McAllister GK, Hall RJ, Burdine JA, Gotto AM. Effects of stress management training and dietary changes in treating ischemic heart disease. JAMA. 1983;249:54-59.[16]
            Ornish DM, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary atherosclerosis? The Lifestyle Heart Trial. The Lancet. 1990; 336:129-133. (Reprinted in Yearbook of Medicine and Yearbook of Cardiology (New York: C.V. Mosby, 1991).[17]
            Gould KL, Ornish D, Scherwitz L, Stuart Y, Buchi M, Billings J, Armstrong W, Ports T, Scherwitz L. Changes in myocardial perfusion abnormalities by positron emission tomography after long-term, intense risk factor modification. JAMA. 1995;274:894-901.[18]
            Ornish D, Scherwitz L, Billings J, Brown SE, Gould KL, Merritt TA, Sparler S, Armstrong WT, Ports TA, Kirkeeide RL, Hogeboom C, Brand RJ. Intensive lifestyle changes for reversal of coronary heart disease Five-year follow-up of the Lifestyle Heart Trial. JAMA. 1998;280:2001-2007.[19]
            Ornish D. Avoiding Revascularization with Lifestyle Changes: The Multicenter Lifestyle Demonstration Project. American Journal of Cardiology. 1998;82:72T-76T.[20]
            Ornish DM, Weidner G, Fair WR, Marlin R, Pettengill EB, Raisin CJ, Dunn-Emke S, Crutchfield L, Jacobs NF, Barnard RJ, Aronson WJ, McCormac P, McKnight DJ, Fein JD, Dnistrian AM, Weinstein J, Ngo TH, Mendell NR, Carroll PR. Intensive lifestyle changes may affect the progression of prostate cancer. Journal of Urology. 2005;174:1065-1070.[21]
            Ornish D, Magbanua MJM, Weidner G, Weinberg V, Kemp C, Green C, et al. Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proc Nat Acad Sci USA 2008; 105: 8369-8374.[22]
            Ornish D, Lin J, Daubenmier J, Weidner G, Epel E, Kemp C, Magbanua MJM, Marlin R, Yglecias L, Carroll P, Blackburn E. Increased telomerase activity and comprehensive lifestyle changes: a pilot study. The Lancet Oncology. 2008; 9: 1048–57.[23]
            Dod HS, Bhardwaj R, Sajja V, Weidner G, Hobbs GR, Konat GW, Manivannan S, Gharib W, Warden BE, Nanda NC, Beto RJ, Ornish D, Jain AC. Effect of intensive lifestyle changes on endothelial function and on inflammatory markers of atherosclerosis. Am J Cardiol. 2010 Feb 1;105(3):362-7.[24]
            Silberman A, Banthia R, Estay IS, Kemp C, Studley J, Hareras D, Ornish D. The effectiveness and efficacy of an intensive cardiac rehabilitation program in 24 sites. Am J Health Promot. 2010;24[4]:260–266.[25]

          11. Gary Ogden

            Smartersig: Looking at the Lancet paper from 1990, “Can lifestyle changes reverse coronary heart disease,” I see that the evidence in support of their hypothesis was Quantitative coronary angiography. From Comparative validation of QCA systems (Circulation 1995; 91:2174-2183 Keane et al):
            “There is a marked variability in performance between [QCA] systems when assessed over the range of 0.5 to 1.9 mm. The range, accuracy, intercept, and slope values of this report indicate that absolute measurement of luminal diameter from different multicenter angiographic trials may not be directly comparable and additionally suggests that such absolute measurements may not be directly applicable to clinical practice using an on-line QCA system with a different edge-detection algorithm.” This is a polite way of saying that the measurements in these images are based upon the interpretation by the evaluator. The intervention was a one year period, and the changes in luminal diameter were very small. Interesting, but I find it underwhelming.

          12. smartersig

            Well in that case I guess Ornish and Esseltyn have gone on record and fabricated a bunch of patients that have reversed heart disease. No doubt they are making vast sums of money from the sprout and meditation industry that they have carefully cultured a controlling influence over.

          13. Gary Ogden

            smartersig. Intrepretation is not fabrication. I certainly didn’t mean to imply that any funny business was going on here. These are no doubt honorable people searching for evidence for their hypothesis. It is simply true that all images are subject to interpretation, and there is never a last word in science. What would interest me would be before and after calcium scores for the subjects of these papers. Following the Ornish protocol very likely did improve the health of these people in the short term; we have no reason to doubt that. However, it must be considered experimental, with long-term outcomes unknown, since no historical or contemporary group for which we have long-term data follows or has followed this regimen in the long term.

          14. Sasha

            The problem with these studies is that they all study a multitude of factors at once, so it’s impossible to say that vegetarianism is the one factor that drives these changes.

          15. Sasha

            Or look for factors that are responsible for people’s longevity across regions, lifestyles, and diets. It maybe harder than a wholesale adoption of a formula but probably more interesting.

          16. annielaurie98524

            Regardless what “gee-whiz” statistical or other analysis follows, when an author has to open the first two paragraphs of his “rebuttal” with comments that so demonstrably misrepresent the facts, he has conceded defeat. It’s called a “straw-man” argument, and it is probably the first logical fallacy that students of Logic 101 learn to avoid.

            Consider: “Proponents of Paleo and Low-Carb diets suggest that plant-based diets, particularly those rich in grains and legumes, promote disease, ultimately resulting in premature death. “
            And: “It is not news that Denise Minger has a tendency to downplay the health benefits of plant foods and plant-based diets.”

            Neither statement contains even a kernel of truth. One has only to examine the myriad “Paleo” cookbooks and “Paleo” sites that offer recipes to see what a bogus statement #1 is. Consider chriskresser.com and thepaleomom.com. Chris Kresser is a recognized Paleo diet expert, has published a few books on the subject, does a radio program on the subject, offers diet templates, etc. Check out his recommendations on plant foods. Likewise, Dr. Sarah Ballantyne (the Paleo Mom) offers numerous recipes. Beyond their emphasis on the role of plant foods, both, being parents of young children, offer parents numerous strategies to overcome children’s often-entrenched dislike of veggies. The downplaying of grains in the diet by some Paleo proponents is more a reaction to the questionable MyPlate/Food Pyramid recommendation of 11 servings of grains per day than a denial that humans have consumed grains for at least 30,000 years. One should note that, prior to the adoption of agriculture, humans consumed grains as they would any other food resource, i. e., in season, in limited supply, and in their natural, unhybridized, pesticide-free state. Cautions against overconsumption of grains (and, to a lesser extent, legumes) is based on soaring rates of gluten sensitivity and the recognition that many individuals have FODMAP sensitivities. The Paleo “movement” has likely done more to introduce Westerners to unfamiliar plant foods like plantains, than all the vegan blogs combined.

            Denise Minger is, by her own admission, as the author admits, a “plant-nosher”. To characterize her skepticism about one aspect of the role of fiber in the diet as “downplaying the health benefits of plant foods” so ludicrous that it does not even rise to the level of being disingenuous. As far as plant foods, the Standard American Diet (SAD) is built on those – refined wheat, refined sugar (sweetened beverages are now the largest single calorie source in the SAD), corn syrup, “textured” vegetable (hydrolyzed) protein, and adulterated potatoes fried in re-used refined seed oils. As someone that subscribes to a number of health and diet-related newsletters and blogs, I am disheartened to see many vegans (who try to project the image of “healthful food” proponents) spend endless posts arguing over which highly-processed “fake meat” tastes best, or whether their Oreos are vegan. They downplay the importance and the health benefits of a variety of fresh, raw or lightly-cooked vegetables in the diet.

      3. Dr. Göran Sjöberg


        I really like your informed comments and I also like the idea of dying suddenly in full health.

        Going to bed in the evening after some serious “wood chopping” and the glass of wine in front of the fireplace and after a good nights sleep then not wake up anymore is luring.

        My wife was in her youth for a short period of time ‘dead’ but revived. It was rather a ‘close to death’ experience which she remembers as extremely pleasant since all the pain from the ileus evaporated at the same time.

      4. David Bailey


        It sounds as if your wife had a Near Death Experience (NDE), which is a very interesting phenomenon.

      5. Bob Niland

        re: “One other point about the Ornish Esseltyn programs is that they are pretty much freely available.”

        As are any programs just based on books, which one can borrow from their library. Heck, there appear to be people following Wheat Belly just based on what they can read for free on the blog for that program. Not all alternative programs are subscription-only or require secret sauce.

        re: “They are not getting rich off it unlike the docs who are selling supplements off the back of worried patients.”

        There’s clearly a tension there. Drs. Davis (Wheat Belly) & Perlmutter (Grain Brain), for example, used to sell supplements, and no longer do. The user base wants them, but the business case for offering a high quality product is marginal, and what’s really needed is multis customized to each client. Subscribe to consumerlab.com until that future re-arrives (The Donald tried it, and failed).

  54. Anna

    Hi, Sylvia, not buying the CO2 panic doesn’t mean that pollution of various sorts aren’t concerning to me. Most of the people I know are heavily invested in the global warming scenario, and most of them don’t even know of my heresy, (I’m afraid they might no longer be friends) but we agree on most other environmental issues.

    1. David Bailey

      This is the tragedy of Global Warming – there is so many genuine Green issues, and the movement is distracted into something that is almost certainly bogus – wasting immense resources, and destroying Green credibility for a long time.

      I hear that the anti-AGW campaign in the US is close to forcing the release under FOI of a tranche of documents, which may expose some of the truth.

      1. Dr. Malcolm Kendrick Post author

        I watch the Global warming area more from an interest in the tactics used to discredit those who question the ‘orthodoxy.’ ‘Climate change deniers’ is a concept straight from the ‘your’re killing my patients’ school of attack against those who dare to question statins. It interests me that the parallels are so clear, yet the tactics still seem to work. The moment I hear someone described as a denier, or a contrarian, or dangerous, or killing people, my interest is piqued. I know that such people are almost certainly right. The establishment does not bother to attack those who are not a threat. As was explained to me years ago… ‘You know you are over the target when the flack is at its greatest.’

      2. JDPatten

        Dear Dr Kendrick,
        Whatever became of thoughtful analysis of issues? Whatever became of categorizing to “probable, possible or unlikely”, based on examination?
        To me, blanket statements concerning the establishment or its dissenters, whether positive or negative, are themselves suspect.

        You: “…not all of it is nonsense” – from two months ago:

        “Dr. Göran Sjöberg
        March 25, 2016 at 12:10 pm

        Thank you for the nice reference to Ionnaidis.
        Having successfully turned my back to all the medical nonsense I have been exposed to during 17 years it is good to see that I am not all alone in my attitude.

        Dr. Malcolm Kendrick Post author
        March 25, 2016 at 12:34 pm

        Goran. The problem is that not all of it is nonsense. Some of it is very good. The problem is ‘how can you tell?’ if I say ‘well, I don’t believe that paper because of blah, blah, blah. But I do believe this because of blah, blah, blah.’ I can be accused of hypocrisy. Only choosing to believe what I decree to be believable. Believe everything, believe nothing, believe some… what to believe? We should not be here, but we are. I have my own way of deciding which studies/papers I pay attention to. However, I do not think this is an objectively testable system. It starts with putting everything into one of three categories. Probable, possible, unlikely. Then moving forward.”

        I thought that this was one of your most valuable statements.


      3. Dr. Göran Sjöberg


        Thank you for these thoughts about denying science.

        I though wonder how, in my eyes at least, one of the greatest scientist in the nutritional field all time, Dr. Weston Price, fits into your picture. The official silence about him is to me almost ear-deafening .

        If one is the least interested in the connection between general population health status and food habits Weston Price research 80 years ago tend to revolutionise ones thinking about this issue.

        His groundbreaking research was summarised in his book “Nutrition and Physical Degeneration: A Comparison of Primitive and Modern Diets and Their Effects”, 1938.

        Price being the best dentist in the world at that time I asked my own “high-level” dentist if he had heard about him. I brought the book to show him the staggering pictures in the book. But no – and he was not at all interested. Perhaps this attitude is characteristic of everyone involved in the health care system? Denial for profit?

        1. Gary Ogden

          Thank you, Dr. Kendrick, and all of you who have made comments about “Global Warming.” I’m not ashamed to say that I believed it. After all, we are all capable of stupidity, and it wasn’t an issue I gave much thought to, since the fight to keep informed consent has consumed most of my research and activist energies in recent years. I didn’t know then, but know now, not to believe anything Al Gore says (yes, I voted for those two clowns). When vice president, he was the main promoter to European countries of Monsanto GMO crops, practically twisting the arms of the French to shove them down their throats.

      4. maryl@2015

        While Gore was screaming about Global Warming, he put on about a good 40-50 eating too many carbs. I think he was concentration on the wrong “environmental” issue. He is real well informed. I would not believe anything he says.

      5. Martin Back

        Dr. Goran, not all dentists are the same. I once accused my dentist of being a bad dentist because I had bad teeth. He was rather upset. He said bad teeth were caused by bad diet, and explained that in the 1940s and ’50s when mine labour was recruited from rural Africans, they would arrive at the mine with perfect teeth from their native diet (millet, maize meal, wild spinach, occasional meat, African beer), but after a couple of years of a Western diet their teeth were as bad as everybody else’s.

        I thought because I didn’t eat sweets my diet was okay, not realising the tea with milk and sugar, cold drinks, bread and jam, pastries etc etc were taking their toll. I have many dental problems today, despite a good diet in the last year or so.

      6. Anna

        David, I have that thought too. After all, a person is only capable of so much time and attention, and has just so much emotional reserves. I remember wistfully when I and my associates focused on real issues. Now, it’s all a lot of wing flapping and fear over a nonexistent issue, and now they think it is the most pressing issue of all. Was that a happy accident for the polluters?

        1. Gary Ogden

          Anna: Not an accident at all. If you want to better understand how we got where we are, not only with chemical pollution and chemical medicine and the industrial capture of regulators of dangerous substances, but many aspects of our lives and reality as we see it, read the corbettreport.com, Episode 310. It goes back to John D. Rockefeller, one of the biggest scoundrels of all time.

  55. Dr. Göran Sjöberg

    Behind the present great revealing post here about “risk factors” the “scientific” question about “cause” lingers (or ‘hovers’ above?) and this is the question we all relentlessly want to have a convincing response to.

    Throughout the history of official debates, and the progress of the natural sciences, few participants tend to argue about the actual disclosures of our physical material reality but where the hot air, the knives and the inquisition enters is when it comes to the explanatory, general “causal maps”. People tend to be willing to “die” for their own maps – religious wars! The establishment are more than willing to ‘exterminate’ heretics in one way or in another. The Galileo case is probably symptomatic. I just wonder why Malcolm survives 🙂

    Anyway, I am soon to have read through a book which has, to me, presented one of the most convincing causal map related to this issue which I have come across so far in my search to understand why I am today not a ‘dead man’ writing.

    The book is “The Modern Nutritional Diseases” by Ottoboni & Ottoboni, 2013. (A sincere ‘thank you’ to the one commentator on this blog who made me aware of the book!)

    Though I wonder if I have been led astray by this so very convincing book. That wouldn’t have been the first time for me. Are there any “quack” warnings around the authors? I haven’t found any on my own.

    1. Gary Ogden

      Dr. Goran: You can find “quack warnings” on the internet about just about anything. Some of the most well-known blogs with the word quack or skeptic in their title promote orthodoxy and attack those who disagree. I suggest avoiding them like the plague.

    2. John U

      Goran, I was made aware of this book (Modern Nutritional…..) by the blog of Dr. Mike Eades (who, btw, keeps a list of his favorite books on the blog and announces new ones on a monthly basis). I have great respect for Dr. Eades and have yet to be disappointed by any of his recommendations. I think that he mentioned on his blog that there is an established friendship between Dr. Eades, his wife Dr.Mary Eades, and the Ottobonis.. He said they do not always agree on the issues around nutrition but that they have very interesting and fruitful discussions and he enjoys their company. So I doubt that there will be any quack alert.

      1. Dr. Göran Sjöberg

        Before reading this book I thought I knew something about fat metabolism but now I realise that I am so far behind in the understanding of these extremely important and complex relations to chronic diseases if I am now to put my trust into this “causal map” in my now very pleasant mood in front of my fireplace again 🙂

        (PS I have now only three more trunks to go. I now all of a sudden realised the proper english word is rather log for the four meter lower part of a large tree instead of word trunk – well english is not my native language anyway.)

        1. Gary Ogden

          Dr. Goran: Your English is excellent.. Easy way to think of it is: trunk refers to the lowest part of a standing tree above the stump; log to the cut, limbed, and topped part on the ground. I’m a longtime woodcutter myself, though now a city-slicker. I miss that wonderful radiant heat, much better than the modern heater, and it makes you warm three times.

      2. Dr. Göran Sjöberg

        Gary Ogden.

        Thank you for your kind encouragement!


        Thank you for the semantic clarification!

        BOLE then seems to be the most appropriate english word, though trunk was evidently not that misleading, for what is now waiting for me in the garden and to keep me busy during the day – especially my heart. 11 am on this Saturday morning seems to be a time that might also be appropriate to gear up on my chain saw without getting bad reputation in the neighbourhood.

        Weekdays I can start at 8 am and tomorrow Sunday is the silent ‘contemplation day’ and with one BOLE per day (it is the chopping that takes time) and with the three boles more to go I will be done by Tuesday.

        Just now I think the most intensive (short duration) physical activity is what is best for my heart. Last year I had a pulse meter and then I tried to hit and surpass the upper rate limit for my age. I think it was around 160 beats per minute and I tried to reach that level a number of times during my “work out” sessions.

        Well I am still alive and the medical practice to enforce week long bed rest on CVD infarct killed numerous people in the hospital wards 60 years ago. Probably as great medical science as the statin business today!

        Talking about medical nonsense I remember that medical doctors 100 years ago gave advice to people taking swim tours at sea. “Never more than ONE minute!” could be a typical advice.

        1. mr Chris

          Dear Dr Göran,
          by the way the formulae for maximum heart rate is valid I think in 50% of cases.
          If you get up to 160 thats good, keep at it

        2. Diana


          your case – or at least how you describe that the blood flow somehow found a way around, despite clogged arteries – reminds me a bit of Clemens Kuby. He fell from the roof, L2 vertebra damaged, spinal cord as well. According to the docs, he should have been paralyzed and on the wheelchair forever. There was no operation (it happened in 1981). He decided to cure himself, meditated for many hours a day and could leave the hospital some time later, walking. The damage is still there, but he is not paralyzed. The signals that normally travel via spinal cord somehow found a way around, probably using nearby lymphatic vessels.
          Most links about him and his books are in German.

          I think you both share a will to live, get better and enjoy life. You cannot pack this into a pill or a diet prescription.

        3. Gary Ogden

          Dr. Goran: Yes, short periods of very intense exercise have developed a very good reputation for heart health in recent years. I believe the heart rate we wish to achieve during these bouts is 220 minus your age. Someone correct me if I’m wrong.

      3. Dr. Göran Sjöberg


        “I think you both share a will to live, get better and enjoy life. You cannot pack this into a pill or a diet prescription.”

        This might be the clue!

        Of course there are limits but my strong belief is that when you give your body/physiology the best nutritional and emotional prerequisites the healing/homeostasis may do wonders. Just now I fed it a salted large herring charcoal grilled in my stove. A lot of omega-3, DHA + EPA there. According to the Ottobonis this is probably the best treat.

        Presently I am using up some of my firewood (from last year) heating up my 2 m diameter outdoor bathtub where I intend to spend a couple of hours later in the evening with a large glass of Talisker – Ten years.

        It is in my journal which I have to honour: “Uses alcohol for medicine!”

        But first I have to finish the todays bole.

      4. JDPatten

        Dr Goran,
        You’re welcome.
        Cutting the “trunk” into “logs” and then splitting (chopping) them is wonderful exercise. “Bole” is probably reserved to descibe the living, standing tree trunk.
        Have you heard the expression from Henry Ford, “Chop your own firewood and it will warm you twice.”?
        Which brings me to a question: What do you do for exercise during the Great Swedish Winter?

      5. mikecawdery


        Fascinating story but it shows the power of self-healing that we all potentially have and also the power of the placebo which is all too often forgotten.

      6. Dr. Göran Sjöberg


        “Which brings me to a question: What do you do for exercise during the Great Swedish Winter?”

        Hopefully there is heavy snowfall which keeps me busy for many hours and chatting with people walking their dogs – very enjoyable. Sometimes there is enough snow where I live for me to go cross-country skiing – also very enjoyable. Otherwise go for a long walk now and then is always a possibility.

        Unfortunately my clogged arteries don’t allow me jogging as before.

        Regarding the Ottobonis I am very impressed by their book and fully agree with their views on nutrition and health – this is exactly how I live my LCHF life today. The only thing I don’t understand is their lax attitude towards the environmental pollution where they even question the banning of the DDT.

        1. Gary Ogden

          Dr. Goran: I’m jealous. My poor cross-country skis have stood forlornly in the closet for the past 30 years since I became a city slicker. They are of Finnish manufacture, of 17 laminations of hardwood, and beautiful. They’ve carried me many a glorious mile through the woods, and at times of deep snow, were the only transport available. An invigorating aerobic workout. I’m awaiting someone to invite me to a ski adventure.

      7. Diana


        yes to self healing and placebo. I was quite surprised to read recent papers about placebo effect observations in rats…

        And as to the soul, mind, consciousness, or whatever you prefer to call it…

        “This is the reason why the cure of many diseases is unknown to the physicians of Hellas, because they are ignorant of the whole, which ought to be studied also; for the part can never be well unless the whole is well.” Socrates (Plato)

    3. michael goroncy

      Hi Goran
      I am pleased that you appreciate the work of Fred and Alice Ottoboni.

      They are both PHD’s in ‘Toxicology/Pharmacology. And probably published papers before we were both born.
      Both Alice and Fred are in their mid nineties, and their minds are still ‘sharp as tacks’.
      They have a blog….’Ketopia’ and are pro ‘Keto’.

      I get the feeling, they would be in agreement with Dr Kendrick on this current post and would have seen it all before, over and over.

  56. mikecawdery

    Over this series and other chronic diseases the condition of inflammation seems to be a consistent finding along with ROS(reactive oxygen species) with anti-oxidants such as CoQ10, NO, Se and vitamin C being involved. May be then a test for total anti-oxidant capacity (TAC) of blood would be a useful test. But of course we have the problem that if there is no profit for the drug makers, who have the money for research, nothing will be done.

  57. Leon van den Berg

    Hi Dr. Kendrick

    Can you please supply a list of all the doctors and scientists that have appollogised to you after branding you a quack for daring to question the cholesterol theory about heart disease ( and other issues) . I am sure the list will not contain any names.

    After claiming for years that cholesterol is the culprit and making billions of dollar, and causing a lot of damage allong the way, they are subtly preparing the people for a new assault. This after a patent for an inflammation drug was granted,as pointed out in your articles.

    When I was young, in the fifties, we trusted our family doctors. Now , unfortunately it has reached the point where a lot of people have lost total faith in them and see the medical profession as a purely profit chasing profession . I have more faith in a used car dealer than most doctors.

    One can not believe any research that comes out nowadays , also pointed out in your articles.
    I am surprised that the medical council in the UK has not gone after you for having the audacity to publish the truth , and standing up to the mecical mafia.

    Keep up the good work.



    1. mikecawdery


      While I agree with much you have written I must defend the working docs (GPs and consultants). They do their best under conditions of threat if they do not follow explicitly the so-called “guidelines” issued from on high that are based on tiny minorities that may benefit from the guidelines but are effectively inappropriate or plain useless to the generally healthy population.

      Some examples include statin guidelines where claims such as “treat 3 million and save 10,000 lives a ye4ar abound. This reduces to treat “300 and save a one life a year” or alternatively 299 will not benefit but some 60 of the 300 are likely to have adverse reactions, some of which may be very serious. Then there is the work of Yudkin on sucrose and the official nutrition advice; the EU guideline on beta-blockers before surgery causing 800,000 deaths (paper withdrawn but never replaced – a cover up) etc, etc. I have even commented on these in the BMJ rapid responses.

      Don’t blame the working docs for the sins of their superiors.

      1. Gary Ogden

        mikecawdrey: I fully agree. Well put. Most of the physicians I’ve dealt with in my life are first rate. Small in number are those without scruple. If we’re going to blame anyone for this mess, the most responsible are the politicians, and from what I’ve seen, its just as bad on your side of the pond as it is here in the U.S. You’ve had a longer time for the rot to become sclerotic, but we’ve caught up to you. The collaterals have strengthened, though, thanks to the internet, and a whole lot of people aren’t going to take it any more.

      2. mikecawdery


        Many thanks for your support. I get very cross when I see docs so badly treated. It is working under conditions that I personally am glad that I never had to accept.

        My appreciation and gratitude to those like Dr Kendrick, who challenge the system

  58. Anne

    Autoimmune – thinking a lot about this series – could the inflammation and plaque build up be an autoimmune type problem ?

  59. robert lipp

    Following various posts from Dr Kendrick, I built a Statin matrix comparing life span vs. quality of life and the potential Patient Choice. Comments welcome.
    Unfortunately the table format does not come across with the word Paste command – please imagine them.

    MATRIX = Patient Choices: quality of life vs. life span
    ——————— Quality of Life —————————
    Better Same Poorer
    Life Span Longer Very good idea Probably good* May be a choice#
    Same Probably good* You are kidding? Poor choice
    Shorter May be a choice# Poor choice Very bad idea

    # These may sometimes be selected by a patient preferring
    Life over quality or Quality over life.
    * These may be chosen because of current prognosis.

      1. Martin Back

        Robert, I think this is is your table done with <pre> tags:

        Quality    Life       Comment
        of Life    Span
        Better     Longer     Very good idea
                   Same       Probably good*
                   Shorter    May be a choice#
        Same       Longer     Probably good*
                   Same       You are kidding?
                   Shorter    Poor choice
        Poorer     Longer     May be a choice#
                   Same       Poor choice
                   Shorter    Very bad idea

        # These may sometimes be selected by a patient preferring Life over quality or Quality over life.
        * These may be chosen because of current prognosis.

  60. Anna

    I would like to know the names of those societies who eat the Ornish way. I don’t mind stating up front that I doubt they exist.

      1. Dr. Malcolm Kendrick Post author

        Clearly, there are those who live a vegetarian lifestyle who do very well. Loma Lindy being one example. However, most of them are not as vegetarian as you might think. Certainly not vegan. As with most things, the truth is not black and white.

        1. smartersig

          I could not care less where on the sliding scale towards veggie or vegan they are, the fact is that they are way down that scale compared to the average non grass fed meat chomping dairy consuming westerner and they seem to thrive on it. Now I can either eat like them or dissect the latest chat or research on a micronutrient in a petri dish

          1. Dr. Malcolm Kendrick Post author

            That is fine. But you should also bear in mind that, of those in the Blue Zones, who live longest on the planet, the Loma Lindy were the only ones who were vegetarian(ish). They also have a lifestyle to go round their diet which you would probably also need to follow as well. Diet is one factor in health, there are many others which are – in my opinion – more important. Whilst I do not have the time this morning to look it up, my memory is that the Loma Lindy who lived the longest were those who ate some meat. (Perhaps someone else can find this reference?)

          2. Chris Harvey

            Dear Dr Kendrick, If I have learnt one thing from this series, and the comments, and the reading matter suggested, it is that there is no one answer, neither diet, nor supplements, nor life style. As you said yourself, when you list the ten or so factors to take into account, we will have noted many of them already for ourselves. What really strikes me Is the number of people who have confronted their own health problems, and found a solution which works for them. Sent from my diPad, excuse les tipos, fautes d’orthographe etc etc.


          3. Diana

            Absolutely agree on the neccesity to eat meat, from time to time, on the backround of predominantly plant based diet. Compare to chimps.

            Here my favourite paper, with a surprising proposal of a gut symbiont, Mycobacterium tuberculosis, providing a nutritional buffer when meat is not available. (There may be other “initially nonantagonistic” microbes serving us in the same way, TB is probably not the only one).

            Big Brains, Meat, Tuberculosis, and the Nicotinamide Switches: Co-Evolutionary Relationships with Modern Repercussions? (Williams, 2013)

            Meat-eating was a game changer for human evolution. We suggest that the limiting factors for expanding brains earlier were scarcities of nicotinamide and tryptophan. In humans and some other omnivores, lack of meat causes these deficiencies. Nicotinamide adenine dinucleotide (NADH) is necessary to synthesize adenosine triphosphate (ATP) via either glycolysis or via the mitochondrial respiratory chain. NAD consumption is also necessary for developmental and repair circuits. Inadequate supplies result in “de-evolutionary” brain atrophy, as seen with pellagra. If trophic nicotinamide/tryptophan was a “prime mover” in building bigger brains, back-up mechanisms should have evolved. One strategy may be to recruit extra gut symbionts that produce NADH precursors or export nicotinamide (though this may cause diarrhea). We propose a novel supplier TB that co-evolved early, which did not originally and does not now inevitably cause disease. TB has highly paradoxical immunology for a pathogen, and secretes and is inhibited by nicotinamide and its analogue, isoniazid. Sharp declines in TB and diarrhea correlated with increased meat intake in the past, suggesting that dietary vitamin B3 and tryptophan deficiencies (also associated with poor cognition and decreased lifespans) are still common where meat is unaffordable.
            We shall argue that the evidence suggests that even mild and intermittent shortages of meat have adverse consequences for energy and micronutrient-sensitive tissues, like the brain, that require “food for thought.” Sometimes, out of necessity, building brains on the cheap drives intraspecific variation but by reducing physiological capital impairs the ability to handle a second hit (such as brain trauma, hypoxia or further nutritional deprivation), thereby affecting an individual’s long-term cognition and survival. This is compatible with evidence that meat-eating, and associated nicotinamide and tryptophan content, improves cognition (including literacy and numeracy), social behavior, and motor development (such as speech and bipedalism), and later reduces the incidence of dementia.20–22 We suggest that these pressures led to the acquisition of specialist “hedge” mutualists as back-up sources of nicotinamide (and, therefore, NAD), and that one of these, initially nonantagonistic, symbionts was Mycobacterium tuberculosis.”

          4. Gary Ogden

            Diana: Thank you. Fascinating. We fail to recognize and nurture our symbionts at our peril.

          5. Gary Ogden

            Dr. Kendrick: There are a series of papers listed under Adventist Health Studies at the Loma Linda University (a Seventh Day Adventist affiliate) website, including a meta analysis of studies concerning low meat consumption and longevity (inconclusive). Dietary studies, with the exception of ward studies (which bear little relation to real-life circumstances), are all plagued by the problem of unreliable data (food-frequency questionnaires), healthy user bias, and a host of other confounders. Seventh Day Adventists do live longer than average, but it is impossible to know which of the combination of factors in their lives are most responsible for this. Among other things, they avoid alcohol and tobacco. They pay much more attention to healthful living than the general population (my dentist went to dental school there, and he’s the best I’ve ever had).

          6. smartersig

            Although others in the blue zone group were not strict veggies quite a few of them only ate meat on special occasions so es not strict veggies but hardly a classification of meat eaters

          7. annielaurie98524

            Or, you could stop kicking the stuffing out of your straw men, put your “petri dish” aside, and engage in a serious discussion about nutrition with the serious people that are commenters on Dr. K’s blog — compare notes, indicate what has worked for you, tell other readers how you came to hold your views, suggest what might be helpful (or not) for others, consider without bias the successes of folks whose approach differs from yours, etc. You, know, like most of the other commenters, whose contributions here indicate that they are sincere and open to discovery.

          8. smartersig

            I am statistician and computer scientist and as such individual cases such ‘as I eat meat and I am 85 years old’, do not interest me. I have to make a decision that has the best chance of avoiding HD and for me that means from a food point of view adopting the diet that a large group of people use and live long with little or no HD. For me that means no meat or very little, some fish, lots of veg, low simple carbs and plenty of fruit. No grains except porridge for breakfast and a few supplements

      2. Gary Ogden

        smartersig: The Seventh-Day Adventists do not eat the Ornish way. They’re all different, of course, but most eat some animal foods, including dairy and eggs, and some eat seafood. What sets them apart from the general population health-wise is their general avoidance of many of the bad habits of the general population, such as alcohol and tobacco, which, to his credit, Dr. Ornish also advocates, as well as avoidance of vegetable oils. This is likely the main reason for the health improvements he has seen in his patients. Dr. Price was disappointed that he found no fully vegetarian traditional people in his travels in five continents. He did find, in east Africa, two groups living in proximity to each other, one of whom was largely vegetarian, and the other largely carnivorous. The carnivores were of greater stature, better health, and greater physical beauty.

        1. smartersig

          Lost of talk here of meat directing our evolution and african people thriving on it. Problem is this meat bares no resemblance to the meat we eat. Firstly it was probably organ meat and even if it isn’t it will be grass fed not the rubbish we are forced to digest. If you do not like the idea of giving up meat I would suggest grass fed organ meat would be the way forward

          1. Gary Ogden

            smartersig: I fully agree. The only food sources of pre-formed vitamin A (retinol), the anti-infective vitamin, are animals, particularly liver. A significant percentage of the population do not convert carotenoids to vitamin A well, yet food companies are allowed to claim that carrots and other carotenoid-rich foods contain vitamin A. I have a bit of liver once a week or so.

          2. Sasha

            Smartersig, the idea that “primitive” cultures would eat organ meat and discard the rest of the animal is quite silly…

          3. Sasha

            Smartersig: this is total nonsense. Have you ever spent any time in a culture with scarcity of food?

          4. annielaurie98524

            That old nonsense about all the Native Americans feeding the muscle meat to the dogs is based on ONE anecdotal entry in their journal by Lewis & Clark, about ONE incident by ONE tribe. There is absolutely no evidence whatsoever to prove it was a valid observation, nor is there any evidence it was a widespread practice.

          5. Mr chris

            Dear Annielaurie,
            Your remark about nutrient quality being lower now than fifty years ago, do you have any reference for that, I have often seen it affirmed, but always without citations
            About organ meat, I have heard tht when lions kill an antelope etc, the chief lion eats the organ meat and leaves the lean meat for the kids. Anybody got a reference for that?

          6. annielaurie98524

            Sorry to take so long to get back to you. Life can be hectic at times.

            For a “popular science” answer on soil depletion, see the Scientific American article from 2011: http://www.scientificamerican.com/article/soil-depletion-and-nutrition-loss/
            If you google “depleted soils less nutrients”, you’ll get more than three-quarters of a million hits, including some that are more technically rigorous.

            However, depleted soils are only a part of the problem. The development of new (non-GMO) varieties of produce often involves selective breeding for qualities other than nutrition. Check out Jo Robinson’s excellent book, “Eating on the Wild Side”. She explains (and documents) the “progress” we have made on new strains of various produce, and how the emphasis on durability for shipping, sweetness, and other characteristics, have resulted in modern varieties that are far less nutritious than their heirloom forebears. Jo (one of our Pacific NW food mavens) also recommends, for the home gardener and/or farmers’ market enthusiast, still-extant heirloom varieties that are far more nutrient-dense than the common supermarket types.

          7. Mr chris

            Thanks for that. The book is now whizzing its way to my Kindle.
            What I have noticed as regards tomatoes is that the commercial varieties look great and taste of nothing. Near me there is horticulturalist who sells plants of old varieties, the fruit is delicious.

          8. annielaurie98524

            A few weeks back — and I don’t remember if it was on this blog or another — a commenter wrote “Vegans generalize too much”. While the commenter seemingly missed the inherent humor in his comment, your response that Paleo peoples fed the non-organ meat from their kills to their dogs is a prime example of the frustration he was trying to express. Perhaps it’s just a lack of familiarity with the word “some”. Some cultures, in some circumstances, on some occasions, may have given some of the meat from their kill to their dogs. Beyond the fact that the bulk of the “meat” would consist of non-organ meat, and the fact that you’d need a huge pack of dogs to consume it, there is no evidence that this was a widespread or routine practice, either from the paleontological record or from the observations of historical “Paleo” peoples by European explorers.
            Speaking of glittering generalizations, you made the statement recently that the meat consumed by modern man bears no resemblance to that eaten by our Paleo ancestors. There is some element of truth in that, in relation to some meats. But, if you want to see foods that bear no resemblance whatever to their progenitors, look to your plant foods. While Paleo man could likely see the family resemblance between a modern sheep and a wild sheep he hunted, there is no way he would recognize his wild teosinte in modern sweet corn, or his little okra look-alike in the modern banana. Not only do modern fruits/veggies look like aliens compared to their ancestors, their nutrient content has plummeted. Plant specialists went for sugar rather than nutrients. Check out “Eating on the Wild Side”, Jo Robinson’s excellent NYT best-selling book for an entertaining read on the “progress” of modern fruits and veggies from their humble, healthful beginnings to the sugar bombs of today (and how to get the best varieties).

          9. smartersig

            Despite the sugar bombs veggies continue to live longer. It may well be that the altered veggies are less damaging than the altered meat.

          10. annielaurie98524

            No, “veggies” (I assume you mean vegans) do NOT continue to live longer. This is one of the many vegan myths (along with the aforementioned pernicious one that the vegan lifestyle causes no animal deaths) that is flogged to a less skeptical public, with no credible scientific backing whatsoever.

          11. smartersig

            I am sorry but you are wrong the best evidence shows that vegitarians live longer than meat eaters

          12. Sasha

            This is too broad of a statement. India, for example, has one of the highest rate of vegetarians in the world. It also has one of the highest rates of CVD and diabetes. There are plenty of vegetarians there who are overweight and very sick. Despite the fact that India had no Western food until about 15 years ago.

            Vegetarians eat a wide variety of diets, some of them healthy, some nother so much. The same can be said of meat eaters.

          13. annielaurie98524

            The article opens by saying, “Red meat consumption has been associated with an increased risk of chronic diseases. HOWEVER, ITS RELATIONSHIP WITH MORTALITY REMAINS UNCERTAIN.” (emphasis mine). Beyond the authors’ own disclaimer for increased vegan longevity, one should note that to say something is “associated with” a factor does not imply causality. Statistics 101: “Correlation does not equal causation”. Many studies have found that the typical person that eats a lot of red meat is likely to have more unhealthy habits than the health-conscious omnivore.

          14. smartersig

            Annie my take is this. If someone tells me that taking ice cold baths every morning is associated with less HD but causation cannot be proved I am unlikely to start taking daily ice cold baths simply because it would be too torturous. However ruling out meat when there is a distinct possibility, although not certainty, that I will benefit, is a no brainer simply because the no meat option is not difficult to do and it will not harm me. I am placing a bet where the odds suggest that being veggie will help me but its not certain. The down side is pretty much nil provided I compensate with Vit B12. The reason I think most people would also benefit is because they cannot afford or source ‘real’ meat. For this reason they would be better off veggie. I agree that a veggie diet can still be a bad diet if you are eating lots of simple carbs and sugars but thats not the case with me.

          15. annielaurie98524

            We are all free to draw our own conclusions. I put more confidence in quantitative science than in subjective terms like “real meat” and “best evidence”. And in the 2.5 million years of human evolution as omnivores. Humans didn’t evolve eating manufactured fake meats and taking industrially-produced vitamin supplements.

          16. annielaurie98524

            Your saying it does not make it so. Other commenters to this blog have, on many occasions, posted links to peer-reviewed, science-based studies showing no differences in all-cause mortality and longevity between those following a healthy omnivore lifestyle and vegans. Let’s have your “best evidence”.

          17. annielaurie98524

            That’s your “best evidence”? A single, 17-year old study of self-selected participants, wherein the authors discuss their own study’s shortcomings? Well, if it works for you, go for it. I am too much a skeptic to take this limited analysis as scientific proof that vegans live longer.

          18. annielaurie98524

            This seems to be a fair comment, BUT… let’s deconstruct it a bit. What do you mean by “meat”? Some vegans define “meat” as ANY animal flesh/tissue. When they say they don’t eat “meat”, they are not sneaking in fish, shrimp, frog legs and such. The default (but perhaps seldom articulated) American definition is “red” meat (hooved mammals), chicken and turkey. Among the hooved, there are today more opportunities for pasture-raised non-standard animals like goats and sheep. There are also increasing numbers of “artisan” ranchers that provide pasture-raised beef, buffalo, and hogs. Then, there is rabbit, but it’s probably mostly raised on a commercial grain-based diet. Among poultry, it is getting easier to find duck, goose, and other birds that are more naturally raised than your standard industrial chicken and turkey. Despite turkey’s reputation as a “healthful” meat, I wouldn’t touch it or feed it to my pets. Not only is the modern turkey diet abominable, the bird itself is nothing resembling a natural creature — it cannot reproduce naturally, can barely walk, and (if not mercifully killed young for its meat) leads a short, miserable life from its “desirable, bred-in” physical deformities. When paleontologists and anthropologists speculate that meat fueled human brain development, they may be talking about an entirely different kind of “meat”. For many years, scientists thought (with no evidence at all) that early man first exploited the “land animal” inland resources, getting to the sea and its abundance later in the evolutionary game. There is mounting evidence that the reverse was the case. It may well be that the “meat” that fueled human brain development was sea-based (and lake/riverine animal life). This makes more sense, considering the unique nutrients such protein sources provide. Some commenters on the “Blue Zones” diets have noted that many include a fair quantity of land/aquatic/marine crustaceans. The Greek Isle diets include a lot of land/sea snails, for example. I am sure you know that one of the varieties of “vegetarian” is the pesco-vegetarian, who eats fish, shellfish and such. When I lived in CA, we spoke of another variety, the “California vegetarian”, a person who ate animal products other than mammal meat. The bottom line is that it’s not that hard to get the animal resources that most likely provided our evolutionary “brain boost”, and that it’s increasingly easy to get more natural versions of the “mighty hunter myth” red meat, if that’s your preference.

          19. smartersig

            You may or may not be right but I prefer not to dance around all those bullets. I live in a city and sourcing and trusting that a meat is grass fed does not seem worth the effort when there are populations eating little or no meat and living healthy lives

          20. annielaurie98524

            Why pick on meat as a food group whose quality may not be up to historical par these days? Do you realize how diminished most plant-based foods are in nutrients compared to those grown 50 or so years back? Since man evolved as an omnivore, and since there have been no successful historical vegan populations, I will stick to a varied, species-appropriate diet to get as wide a range of nutrients as I can.

          21. Gary Ogden

            annielaurie: Thank you very much for your last several posts. In a talk last fall Randy Hartnell spoke of a recently discovered cave in South Africa adjacent to a river delta and the sea, and occupied by humans well over 100,000 years ago, containing middens with very large quantities of a variety of shells, his point being that this is evidence that seafood consumption played an important role in the development of our large brains. Sorry about the life sentence.

      3. David Bailey

        I think there are two issues regarding vegetarianism – is it ethical to eat animals, and is eating animals good for you.

        I think too many people merge the two together and therefore just cloud the argument.

        My partner is vegetarian on ethical grounds, but we decided on a practical compromise and eat fish rather than meat at home.

        1. Gary Ogden

          David Bailey: Well put. One of the real tragedies of the extreme form of vegetarianism is that a crucial step in restoring the health of the Earth and its inhabitants lies in restoring her vastly degraded grasslands, many of which are, or are on the verge of becoming deserts. The only way to do this is by restoring grazing animals to them. Raising animals for meat is an essential part of planetary health and human health. We in the developed world can make the choice to eat or not eat meat, but among most of the world’s population meat is nothing more than a daydream. A little bit of meat once in a while would provide tremendous health benefits to these malnourished people. To anyone interested in this issue, go to the Savory Institute website, and read two books: “Grass, Soil, Hope,” and the much more comprehensive “Cows Save the Planet.” Both are published by Chelsea Green, in the State of Vermont.

      4. annielaurie98524

        I assume you meant “Loma Linda” (the supposedly primarily Seventh-Day Adventist and supposedly vegan) enclave — actually the city of Loma Linda, CA. First, they are not a natural community. Second, as the author of your previously-posted “rebuttal” article pointed out, a significant percentage of the Loma Linda Seventh-Day Adventists are not vegetarian (much less Ornish dieters, and even less vegan). The Seventh-Day Adventists, vegetarian or no, are what a research-study designer would call the perfect “self-selected” group in terms of health practices. As compared to the general public, they are much more health-savvy: they emphasize a balanced lifestyle, strong social ties through their faith, moderation in all things, getting sufficient sleep, abstaining from tobacco and alcohol, and other practices that the lay person would characterize as “health oriented”. It seems the “plant-based diet” advocates are very fond of the many permutations of the “straw man fallacy”. This not only includes the afore-mentioned tendency to mischaracterize the approach of non-vegan diet advocates (the easier to bash them for not appreciating plant foods), but also the tendency to compare the health/longevity of vegans eating a pristine organic diet with that of “straw men” (i. e., the typical SAD diet consumers, who are more likely to smoke, drink to excess, shun physical exertion, live a more stressful life, neglect sleep, eat junk food, etc.). They then smugly attribute said vegans’ better health to the absence of meat in their diet, rather than to the other more obvious and more significant factors.

        1. Sasha

          All very excellent points. I would like to know what kind of foods a well to do farmer ate in England, Russia or US in 1800 and go from there…

          1. annielaurie98524

            You may have found the ideal lifestyle! It may take me a while to track it down (I regrettably didn’t save a copy), but a while back, one of the natural lifestyle bloggers (maybe it was Chris Kresser) noted the evidence that the British gentry farmer of the early 1800s enjoyed remarkable health and longevity for that period of history. It makes sense — the livestock and produce at that time would have been “organically raised”, and farm families that were not impoverished and owned some land would have had sufficient resources to meet more than basic needs. And the lifestyle — natural circadian rhythms, moderately strenuous outdoor activity in a temperate climate, wealth enough to have time for leisure as well as work, extended families with strong social networks — would seem ideally suited to optimal health. I’ll start digging for it!

          2. Mr chris

            Anny Laurie,
            If you read in Charles Dickens’ The Pickwick Papers the description of Christmas ar Dingley Dell, you get the impression of the diet of the English gentry of the time, lots and lots of meat.

          3. annielaurie98524

            Thanks for the link! This sounds as if it could be the basis for the less-detailed explanation I saw a while beck.

          4. Gary Ogden

            Mr chris: I read the same article, and seem to recall that even working people in 1830’s and 1840’s England ate better and were healthier than before or since. Can’t remember where I read it, either.

          5. Frederica Huxley

            I happen to be rereading Plenty and Want, an excellent history of diet in England from 1815 to 1966 (date of publication). As you opined, the diet of the middle and upper classes was abundant, while the majority of people did not have food security; viz the difficulty in finding a sufficient number of healthy men to fight in both world wars.

        2. smartersig

          People are going down with HD who are not on the SAD diet. These people nee an answer now and of course its complicated. My suggestion is whilst people argue over what micro nutrients work or whether veggie outlive meat eaters I suggest that it would be wise to simply adopt the diet of those that live longest as clearly their diet is not sabotaging their health and life span

          1. Dr. Malcolm Kendrick Post author

            Agree. I understand, however, that the Okinawans have been knocked off their longest lived spot by another region in Japan – known for the highest meat/fat consumption in Japan. Have lost the ref, but will look for it. Also, the Okinawans were also known as pig eaters – eating everything but the squeak.

            What people need to do is look for the factors that are consistent in the longest lived – and vegetarianism most certainly is not a consistent finding.

            Good social relationships, strong family bonds, spending time outside walking and exercising and eating food that is produced close to where you live – these seem consistent. [As does attending church – which seems a very important factor].

          2. smartersig

            My message is that blue zones, on the whole, are low or no meat eaters and where its low its probably grass fed non processed.

          3. Dr. Malcolm Kendrick Post author

            The Masai, who had no recorded case of death from heart disease (prior to moving from their traditional lifestyle) ate nothing but meat and milk – and no vegetables at all (at least not the men – vegetables were considered to make a man lose his virility). A similar picture to traditional Inuit lifestyle. No vegetables whatsoever, and a complete lack of heart disease deaths.

            There is no consistent picture here – at all. At least with regard to eating animals, vegetarianism, and CHD. The answers are not, I believe, to be found here.

          4. smartersig

            There was a report where in actual fact arterialsclerosis was found in Masai but a low rate of heart attacks. One theory was that their rate of exercise counterbalanced the plaque build up

          5. smartersig

            What do people think of the theory that blood viscosity is the main thing we should focus on. It has a lot going for it in that plaque only seems to gather around junction of arteries and the idea that thicker blood moving through the arteries is likely to cause damage which is then repaired with cholesterol seems to have a logical sound to it. Of course if this is correct then we are still back to what we eat as the probable primary cause of poor viscosity but it should be easy to check and alter by either natural remedies or drugs.

          6. Gary Ogden

            smartesig: The longest-lived people appear to be quite fond of eating animals. Last month’s passing of the oldest human, a New York woman, at 116, is an example of this. She attributed her longevity to eating bacon and eggs daily. The current oldest, an Italian woman, also 116, attributes her longevity to eating raw eggs daily since her teen years (a full century of artery-clogging eggs) on the advice of her physician to treat anemia.

    1. Lisa

      Anna, I was wondering the same thing. Does any society truly get only 10% of their calories from fat (ie the Ornish way)?

      As I remember it, the Loma Linda inhabitants are vegetarians, but they eat animal products, such as cheese and milk. They also eat nuts and vegetable oils. So I would be surprised if their fat intake is 10% or less.

      I think the rest of the Blue Zoners eat meat an average of 1-2 times a week. (Though in Ikaria, meat-eating is clustered around holidays, that doesn’t mean it’s restricted to the one day; meat continues to be eaten till the whole animal is consumed, however long that takes. And at some times of year, the holidays come almost back to back.) They also consume goat’s milk and cheese daily (at least in Ikaria and Sardinia). So probably their diets are higher fat than Ornish would prescribe.

      In any case, I agree with Dr K that it’s impossible to untangle the benefits of diet from all the other beneficial factors, like good genes, sunshine, exercise in daily life, close knit families, simplicity, a relaxed attitude towards time, a sense of purpose, respect for old people, and so on. Probably the most we can say about BZ diet is that eating fresh whole foods (including legumes and bread) plus some wine, seems not to keep these people from living long, healthy lives.

      PS I remember in the interviews, several BZers described living through very hard times when young, often going hungry; but in pictures now, they do not look thin. For all we know, THAT’s the key to unusual longevity: calorie restriction till middle age, then some weight gain!

      PPS I don’t mean to be anti-vegan. I think it’s possible to eat vegan and be very healthy – see ultrarunner Scott Jurek’s book EAT AND RUN, about how he ran better and felt great when he became vegan. But I do worry about extremely low fat diets – especially in terms of brain health.

  61. Anna


    Please tell me your thoughts on alcohol for the low carber. I know of another online guy who low carbs and he rarely allows himself a beer because alcohol turns to sugar. I’m intrigued.


    1. Dr. Göran Sjöberg


      I have read a little about alcohol and health and there seems to be a U-shaped curve relating to longevity. Simply put – those who don’t drink at all live 5 years shorter lives than the moderate users and the alcoholics also live 5 years shorter lives.

      Before my serious heart attack 1999 my wife and I had almost turned into vegetarians and we used very little alcohol. Doing our homework afterwards we changed opinion and my wife brought nice bottles of red wine into our house and I have had that glass of wine a day now for 17 years. 2009 with the severe diabetes of my wife we also turned into strict no-carbers and this has worked wonders on our health status. Might be worth a try for people with more or less insulin resistance – about 60 % of the world population now. Lesson learned – bottom line – out with all sugar and out with the vegetable omega-6 fat as far as this is possible in our present alimentary corrupt world.

      It is true that alcohol metabolises the same way as fructose in the liver and excesses destroys your liver as do fructose – fatty liver one way or the other.

      In beer – liquid bread – it is mainly the sugar maltose which is the culprit as far as I understand.

      By the way, in the first book ever written, the Babylonian Gilgamesh Epos, there is a description how the “wild man” Enkidou was seduced, captured and ‘civilized’, with beer, bread and a beautiful woman. Funny twist on civilisation indeed!

    2. JDPatten

      Sugars get processed into alcohol by yeasts in your beer and wine, not the other way ’round. It’s a waste product to them. When their environment becomes too toxic to them (too much alcohol) they slow and quit. There’s always left-over sugars in beverages such as beer and wine. You must distill the stuff to reduce it further.

      1. Gary Ogden

        gettingmoresceptical: Thanks. That was good. No journalist here in the U.S. would be allowed to write something like this and have it published. So many cracks have appeared in print here in the dam of nutrition stupidity that it will ultimately turn into a flood, but several things are not allowed in print here: exposing the myth of climate change, raising questions of vaccine safety, or of “science” in general. Editors are so terrified of losing ad revenue that they self-censor anything that might anger the pharmaceutical industry, and likewise, politicians know better than to anger their patrons.

      2. David Bailey

        Sorry all – the above comment was mine – David Bailey! does anyone know how to escape from the clutches of WordPress?

      3. David Bailey


        As I expect you realised, I was the one who linked to that Daily Mail article about saturated fat.

        The Mail is a rather unusual paper. At first glance it contains an endless stream of trivia about celebrities, and other edifying stuff, such as videos of people squeezing out their spots, however it also prints a lot of information that other media censor.

        For example, here is an article from a few years back that explains (among other things) the graphical trick used to Dr Michael Mann in his article in Nature (!!) to hide the part of his graph that didn’t agree with Global Warming:


        As far as I know, his paper has not been retracted.

        1. Gary Ogden

          David Bailey: Thanks again, Wow! Tree ring data don’t lie. Adjusting records from ground stations upward, and done in each country prior to submission? This, then, is a data set as reliable as food-frequency questionnaires (usually done once, by recall, and used to extrapolate outcomes years later). The polite description of this is horse manure, although the Aussies have a more colorful descriptor which I can’t offhand recall (still early in the morning here).

  62. Dr. Göran Sjöberg

    I am so sad tonight returning from a walk on a gorgeous nature track in the present wonderful Swedish summer night. What makes me so sad is that I so clearly noticed the serious deterioration of the physical ability of an old friend of mine who I invited to participate.

    I was able to keep him of the statins for many years but his family and his GP have pushed him into that again and it is now a tabu subject since his family has forbidden him to discuss his medication with me. He was on several occasions during our slow walk to tip over and I had to give him support to avoid that.

    I feel so helpless in this corrupt world.

    Just now reading Marcia Angell’s book, “The Truth About the Drug Companies”, fuels my feelings of helplessness. It is a great book, revealing the total corruption of medicine, but I don’t understand how she can defend the statins as a true ‘break through’ medication.

  63. David Bailey

    Gosh Goran,

    I think you need to tell him that he will die one day whatever he does, and in the mean time does he want to live with disability?

    Tell him what happened to me – He probably didn’t have polio, but the effects of Simvastatin were overwhelming – I went from the kind of guy that goes hiking in the Pennines, to one that has difficulty walking from the car to the supermarket! For various reasons I abandoned the statins and got back to the state I was in before! Stress to him that the reversibility doesn’t always last – so he needs to stop now!

    I’ll email him if you give him my email address – dave at dbailey dot co dot uk

    1. Dr. Göran Sjöberg


      Thank you for your kindness. The basic fact is that he doesn’t want to challenge his family and I am just an old friend who in comparison is of light weight.

      He is though one of the brightest guys I ever met but he has not abandoned his own belief in the medical system where he has been trapped for 60 years. Still he keeps to a liberal LCHF which I lured him into and which he clearly realise saved him the worst outcomes of his diabetes T2 and irrespective of the advices he has been given from the “health care system”. This contradiction really upset him.

      What a crazy world!

      1. jgt10

        Dr. Sjöberg,

        Your friend is blessed to have you as a friend.

        You might consider slipping him a copy of Dr. Kendrick’s book.


      2. JDPatten

        It might be possible to convince your friend and family that, if he must have a statin, they might try pravastatin which, among all of them, worsens diabetes the least. Some even report that it improves insulin resistance. Not much, but it’s something.

      3. David Bailey


        He doesn’t need to challenge his family – all he needs to do – at least for a trial period – is to flush each daily pill down the toilet! In my case it took about 1 week before I could feel the problem easing! I would recommend (based only on my experience) that he then takes pain killers sufficient to enable him to exercise himself back to health.

        1. Gary Ogden

          David Bailey: Please, not down the toilet! In the trash can. At least here in the U.S., surface waters are contaminated with multiple pharmaceuticals. We’re drinking them in our water. Another uncontrolled mass human experiment.

      4. Dr. Göran Sjöberg


        Thanks for the kind remark about friendship.

        “You might consider slipping him a copy of Dr. Kendrick’s book.”

        I’ll do that!

        It can not hurt him but perhaps his daughter who is a nurse by profession and who is feeding her patients their prescribed pills all the time. She is presently living in his house which makes the situation more delicate.

        What is then left if his daughter stops believing in what she is doing all day and night? She is by the way in a fragile state firmly hooked on SSRI treatment since many years and now topped by being on strong pain relievers for a muscle injury.

        What a medical world!

        It is not only a crazy world but to me an insanely revolting one.

        This has to stop and one way or the other it will! I read this between the lines in Marcia Angell’s book. Corruption can never be without limits.

  64. jgt10

    Dr. Kendrick,

    I have read the “Cholesterol Con” three times. Each time finding I understood more and more. I just finished “Doctoring the Data” and my brain is slowly returning to normal size.

    I have read this series with rising interest! I have seen the pieces from the “Con” and other blog postings come together in a much stronger theory.

    I do hope that you take this series and turn it into a book!

    If a book isn’t possible, how about a pamphlet that we could print by the millions and drop at UK surgeries and US doctor’s offices in bundles of 50 and hospitals in bundles of a 100. 🙂


  65. Maureen H

    Dr Kendrick, you may find an interview of Dr. Stephen Phinney with Dr. Andreas Eenfeldt interesting re the explanation of how the Inuit managed to live without vegetables/fibre for at least nine months of the year. (Diet Doctor Blog)
    As far as I understand from Dr. Phinney’s explanation, the Inuit were in a ketogenic state most of the time. This results in the liver making Beta Hydroxybutryrate (sp?) a ketone body. This is released into the blood stream and can be used by the bowel microbiome directly as food, which then manufacture nutrients in addition to many other health effects. On a high carb diet it is necessary to eat lots of fibre to feed the bacteria, which the Inuit don’t have. This is just my quick and dirty explanation of it, way more explanation and info on the site. I am still trying to get my head around it. But the interview is really good, one of the best I have seen. Diet Doctor has many informative interviews and presentations, some are available to everyone, others, like the Dr. Phinney one, you have to be a member. It costs $10 a month but the first month is free and all the movies, presentations and interviews are available for that month. The interview is an hour long and well worth watching. Link to Diet Doctor: http://www.dietdoctor.com

  66. Gary Ogden

    Dr. Göran Sjöberg: There is an article about vitamin E in the Spring/Summer Research Newsletter of the Linus Pauling Institute. You might find it of interest.


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s