What causes heart disease part XV

Scientific hypotheses are easy. You can make up thirty a day if you want. In the arena of cardiovascular disease, I have watched many a hypothesis spring to life in the middle of a conversation. For example, I was at a meeting where an ‘expert’ was attempting to describe what foods cause CVD. Pizza was held up as a very unhealthy food.

I pointed out that there had only been one study done on pizza consumption and CVD. It showed, very clearly, that the more pizza you ate, the lower your risk of CVD. Quite a strong protective effect as a matter of fact. The study was done in Italy.

The moment the geographical location was mentioned, the expert simply replied. ‘Oh yes, but Italian Pizzas are far healthier than pizzas in the UK.’ Thus, ‘the healthy Italian Pizza hypothesis’, was simply plucked from thin air. It was based on no evidence whatsoever, but it seemed reasonable to the expert at the time I suppose. Who knows, it may even be true. Although I suspect not.

Now, I have nothing against the creation of any scientific hypothesis that anyone cares to put forward. Science progresses, primarily, through the development of new ideas. But if you are going to propose a new hypothesis it is beholden upon you to do something that few people then seem willing to do. You need to try and disprove it. There is no point looking for supporting data, you can find supportive data for almost any idea you decide to come up with.

There is a fairly well-known and humorous explanation for CVD (humorous the first fifty times you are told it anyway) that goes like this:

  • Japanese eat very little fat and suffer fewer heart attacks than us
  • Mexicans eat a lot of fat and suffer fewer heart attacks than us
  • Chinese drink very little red wine and suffer fewer heart attacks than us
  • Italians drink excessive amounts of red wine and suffer fewer heart attacks than us
  • Germans drink beer and eat lots of sausages and fats and sufferfewer heart attacks than us
  • The French eat foie-gras, full fat cheese and drink red wine and suffer fewer heart attacks than us

CONCLUSION: Eat and drink what you like. Speaking English is apparently what kills you

How would I disprove the ‘speaking English’ hypothesis? Assuming, that is, I could be bothered. I would point out that, currently, speaking Ukrainian kills you. Ukrainians have ten times the rate of CVD of the UK, and the US. Ergo, it is not speaking English that kills you. Next.

Moving to slightly more serious things. Disproving is where I started with in my long term search for a hypothesis about CVD. I did not start out with my own hypothesis. I started out trying to disprove other hypotheses.

Which inevitably meant that I started with the diet-heart/cholesterol hypothesis, as this was, and remains, the number one hypothesis in the area. I am not going to go through all the refutations again. Suffice to say that it failed in so many ways that it was clearly bunk.

Of course, this left me thinking, if CVD has nothing to do with saturated fat in diet, or cholesterol levels, it must be something else. What could that something else be? I began by looking at stress (I realise that the term stress is not remotely precise). I started with the thought that stress, whilst eating, could be a cause/the cause. If you are stressed you will be releasing stress hormones, these antagonise insulin, so when you eat blood sugar levels spike and VLDL levels spike etc.

I became interested in the idea that we measure almost all metabolic parameters e.g. blood sugar, VLDL, cortisol, glucagon in the fasting period. Yet, perhaps all the damage was being done within two hours of eating. So it seemed that we may, to use an analogy, be trying to understand football by visiting a football stadium only before and after the match is being played. ‘Blimey, nothing different ever happens here at all.’

I felt I was onto something, but thinking then moved on to a more general stress hypothesis. I felt that I got most of the way to creating a perfect scientific hypothesis. I had causes and pathways and a mass of supportive data. However, I could still find plenty people with an increased risk of CVD who were not in any way stressed. They had such things as antiphospholipid syndrome (Hughes syndrome). Or they were children with Kawasaki’s disease. Or they had type II diabetes, or they were taking drugs, such as non-steroidal anti-inflammatories, or Avastin. Or… the list went on.

Equally, I could find factors that reduced the risk of CVD, that had nothing to do with reducing stress. For example, aspirin (not a massive effect, but it does exist). Von Willibrand disease, omega-3 fatty acids, potassium, vitamin C. As with causal factors, the ‘nothing to do with stress’ list went on.

So, what did this mean? That stress did not cause CVD, or that it caused only one type of CVD. Or it caused CVD through a completely different process than other causes of CVD? It was at this point that I began to realise I was looking at things the wrong way round. There was no point in saying what things may, or may not, cause CVD – and compiling an ever-lengthening list of ‘risk’ factors.

I had to work out the process through which any factor may operate, both causal and protected. As some of you will know, in this series, I have pointed this out before… many times. But I think that it cannot be said often enough.

So I turned the entire thinking process inside out, and started again. I began by asking the question, what are atherosclerotic plaques? What do they consist of? What do they contain? It became very clear that they are primarily blood clots – in various stages of development and repair.

Having recognised this, I went further back, or forward, to look at the final event in CVD. This is, basically, the formation of a blood clot. Heart attacks occur when a blood clot blocks an artery supplying blood to the heart (there are caveats here, but I am not going into them at this point). Stokes occur when a blood clot blocks an artery in the brain (further caveats).

There is little disagreement that the blood clot is the final event in CVD. Most acute treatments for heart attacks and strokes are, essentially, ways of removing any clot that has formed. You can use aspirin, or more potent clot busters, or you can stick in a catheter to remove the clot/open it up/stick in a stent. You can do a bypass, diverting the blood round the clot… etc. Interventional cardiology could, pretty, accurately be described as ‘blood clot management.’

Many of the drugs used to prevent heart attacks and/or strokes are also anti-coagulants e.g. aspirin, Clopidogrel, warfarin, apixiban etc. [Statins are also potent anticoagulants]. Yet, and yet, no-one seemed willing even to countenance the possibility that blood clots also cause atherosclerotic plaque development. ‘Yes, blood clots kill you, but they have nothing to do with plaque formation.’

‘What, even when plaque contain such things as red blood cells, cholesterol crystals, fibrin, fibrinogen and Lp(a) and….’ the list of things found in both blood clots and plaques is very long.

But of course no expert can agree to this ‘blood clot’ hypothesis. To do so means that you have to discard the cholesterol hypothesis. Which ain’t going to happen anytime soon. So we currently have the dual hypothesis. Cholesterol causes plaques to form, then blood clots kill you. The ‘atherothrombosis’ hypothesis. Which can look as though the mainstream is agreeing about the importance of thrombosis, but is actually a way of keeping the cholesterol hypothesis alive.

For a while I half agreed with this atherothrombosis hypothesis, but the more I thought about it, the more it started to fall apart. I began to focus down on one thought. Can you explain CVD though the ‘abnormal’ development of blood clots alone? Can you link any and all factors, known to cause CVD by their impact on one of two things:

  • Endothelial damage (which triggers blood clot formation)
  • Increasing blood coagulability (making clots more like to form, become bigger and/or less easy to break down)

Then I started writing out a list of things that I knew did one, or both, of these things. There was no particular order to this:

  • Smoking
  • Cocaine use
  • Cortisol
  • Kawasaki’s disease
  • Diabetes
  • Rheumatoid Arthritis
  • Kidney failure
  • Non-steroidal anti-inflammatories e.g. brufen, naproxen
  • Biomechanical stress (within arteries)
  • Dehydration
  • Systemic Lupus Erythematosus
  • Antiphospholipid syndrome (Hughes syndrome)
  • Vitamin C deficiency
  • Raised fibrinogen levels (key clotting factor)
  • Homocysteine
  • Bacterial infections inc. gingivitis
  • Increased plasminogen activator inhibitor – (1 PAI-1) levels (critical factor in blood clot repair/breakdown)

I could have kept going, but that is enough for now. What do all of these things have in common. They increase the risk of atherosclerotic plaque formation, death from CVD. Most importantly, of course, they cause endothelial damage and/or increased blood coagulability. And I could not, and cannot, think of anything else that links them all together.

Then I started to think about factors that reduce the risk of CVD.

  • Exercise (overall, not whilst doing it)
  • Moderate alcohol consumption
  • Aspirin
  • Clopidogrel (expensive aspirin)
  • ACE- inhibitors (a blood pressure lowering agent)
  • Yoga
  • Haemophilia
  • Statins
  • Von Willibrand disease (lack of a specific clotting factor in platelets)
  • B vitamins (enough to reduce homocysteine)
  • Adequate Vit C (no idea what the correct intake should be)
  • Potassium (higher consumption reduces platelets sticking together)
  • Vitamin D
  • Nitric Oxide (through sunlight – and other nutrients e.g. l-arginine)
  • Magnesium (and other micronutrients)

Again, I could keep going. What do all of these things have in common. Well, once again, they either protect the endothelium, or they reduce blood clotting. And they all reduce the risk of CVD.

To my mind there was, and is, an almost perfect correlation. But, as I said earlier. Looking for supportive data is all very well. Can you find the black swan? Or black swans. Are there facts that completely contradict the ‘it’s all to do with blood clots’ hypothesis of CVD?

Warfarin could be one such black swan. Warfarin reduces the risk of stroke (in atrial fibrillation), but it does not really reduce the risk of heart attacks. It is a very powerful anti-coagulant, so surely it should do both. Yet it does not. Why not? Is this a black swan, or can it be explained?

My conjecture is, as follows.

Warfarin is a vitamin K antagonist. It is active in the liver, and interferes with the production of a number of clotting factors (mainly prothrombin and factor VII). This tends to inhibit clots forming, spontaneously, within the blood itself. Which is why warfarin is very effective in Atrial Fibrillation.

In Atrial Fibrillation, the upper chambers of the heart fibrillate (twitch rapidly) so some of the blood tends to get stuck in the upper chambers (the atria). Blood in stasis tends to start clotting. A clot forms, it is then ejected into the lower chamber (the ventricles) where it is then immediately pumped out into the rest of the body. These clots can get stuck anywhere the blood vessel narrows sufficiently – often in the brain, causing a stroke.

Warfarin also works well when you have blood stasis in the veins. For instance, if you break your leg, you will be put in a cast. At which point, due to physical immobility, the blood tends to stop flowing freely, if at all. At which point clots can form, a deep venous thrombosis – DVT. This can then break off and travel through your heart into your lungs causing a pulmonary embolus (PE), which can kill you. Warfarin tends to stop this ‘stasis’ blood clot formation. [Long distance flight and sitting anywhere for a long time can have the same effect]

So why does warfarin have little effect on the clots that cause myocardial infarction. This is probably because damage to the endothelium – the trigger for all the other downstream problems – exposes tissue factor (TF) to the blood. Tissue factor sits within the artery wall itself, and it is the big daddy of clotting.

As you can imagine, the body views damage to an arterial wall as a potential emergency situation that requires immediate and powerful clotting. A damaged artery wall exposes TF Once TF is in play, it will ride straight over such things as a lack of factor VII and prothrombin. TF will directly drive platelets to stick together, and form a plug over the area of damage. It can also directly activate thrombin etc.

Thus, whilst warfarin will prevent the slower ‘stasis’ clots from forming, it will have little effect on the emergency ‘damage to the artery wall’ clotting caused by exposure to TF. I am not going into any more detail on this, but it could be said that warfarin is a good ‘intrinsic’ anticoagulant. But has far less impact on the ‘extrinsic’ clotting system.

On the other hand aspirin, which prevents platelets sticking together, will have a more significant effect on reducing clot formation after activation of TF, as will Clopidogrel, as will a lack of von Willibrand factor (as found in Von Willibrand disease). This, to my mind at least, fits with the fact that ‘less potent’ anticoagulant factors can reduce risk of heart attacks (albeit by differing amounts), whereas warfarin does not.

So, the lack of effect of warfarin on heart attacks can be understood, in relation to where it actually acts in the coagulation system. In addition, because warfarin is a vitamin K antagonist, and vitamin K appears to protect against the build of calcium in various tissues, warfarin accelerates calcification in artery wall. Which could be a further problem in itself – leading to a higher rate of CVD.

Now, you could think this is all rather convoluted. An attempt to explain why an apparent contradiction is not a contradiction all. You could, of course, be right to think this. But firmly believe that the lack of effect on warfarin, on heart attacks, can be explained. Through a deeper understanding of the clotting system. In fact, the different effects of different anticoagulants on CVD risk supports rather than undermines the hypothesis.

Perhaps, now, you may gain an inkling as to why it has taken me so many, many, years to try and establish the true underlying cause of CVD. It did not take too long, at least once I got my thinking the right way round, to work out that blood clotting may be the underlying process that underpins CVD. What has really taken the time is looking for contradictions.

And, in the spirit of true scientific endeavour, I welcome as many attacks/contradictions as people can think of. What does not kill a scientific hypothesis can only make it stronger.

252 thoughts on “What causes heart disease part XV

  1. Dr. Göran Sjöberg

    Oh – what great humorist food for thought around CVD! – As we tend to getting used to 🙂

    Perhaps it is as with my super alloy metallurgy – the more you understand and get into the details the more confusing it tends be.

    But it is the first one-liners you to sell and live on: “Superalloys are great for the hot end of aircraft engines!” – Can keep you busy for a full professional carrier.

  2. Fintan Duggan

    At age 45 I had a cholesterol reading of 9, my doctor put me on statins and aspirin, one year later and even though my cholesterol had reduced significantly I almost died from a 95% blockage in the main artery. In 2012 when I read an article on how you can reduce plaque, repair the walls of your arteries by producing more nitric oxide gas I decided to try Proargi out. After taking the product for two years I went for an angiogram and to my amazement the cardiologist informed me that my cardiovascular system was completely clear. I now longer take station drugs even though my cholesterol and ldls are elevated

    1. Primal Blueprint Explorer

      I had been on the edge of my seat too. But looking at the list of things that reduce the risk of CVD, I am already doing most of them. Obviously not haemophilia nor Von Willibrand disease (duh), not Clopidogrel, and definitely not statins. There lots of resources for incorporating the good factors, such as my favorite, Mark Sisson’s Primal Blueprint. I do take baby aspirin and a “baby dose” of Lisinopril.

  3. rockingbass

    Fascinating….Did you know that veterinarian professor Jergan Shole found that over consumption of carbohydrates produced stress in warm blooded animals?

    1. Jillm

      I am on a very low carb, healthy fat, adequate protein diet. So far so good. I am 69. No meds. Good health.

  4. Diana

    This is not an attack on your CVD hypothesis. Bring up anything that does not involve fungi, and then I start re-considering my pet theory.

    A starting chemical in the preparation of Warfarin is 4-hydroxycoumarin (a fungal metabolite).

  5. Diana

    Scopoletin would be much more interesting to look at then Warfarin. Can you see the humble plants such as nettle and dandelion, as its source?

    Scopoletin is a coumarin found in the root of plants in the genus Scopolia such as Scopolia carniolica and Scopolia japonica, in chicory, in Artemisia scoparia, in the roots and leaves of Stinging Nettle (Urtica dioica ), in the passion flower, in Brunfelsia, in Viburnum prunifolium, in Solanum nigrum,[1] in Mallotus resinosus,[2] or and in Kleinhovia hospita. It can also be found in vinegar,[3] some whiskies or in dandelion coffee. A similar coumarin is scoparone.

    1. mikecawdery


      I was informed by a cardiologist/pharmacist that warfarin was about 4% effective for AF as against the ~2’6% for aspirin. In terms of patient benefit it reduces risk by about 1 in 40 patients but seriously increases the risk of adverse reactions, some fatal (MHRA DAPs).

  6. Erwin J.O. Kompanje

    I wonder, why do you not mention the overconsumption of high fructose corn syrup in the western food as cause of endothelian inflammation? A hugh body of literature is supporting this. Leaving the western ‘sweet’ diet result within weeks in lowering of CRP and improvemnet of endothelian function.

    1. Bob Niland

      re: why do you not mention the overconsumption of high fructose corn syrup in the western food as cause of endothelian inflammation?

      That’s sort of implicit in “Diabetes” as a factor. I would expand that to be “Metabolic Syndrome, et. seq.”. The full-time glycemic diets that our official diets amount to are a cardiac disaster (as well as being other sorts of disasters).

      HFCS per se is no worse than table sugar, it’s just cheaper, and thus more pervasive. And any simple sugars are actually less adverse than grains, which are 60% glucose, and the top grain (wheat) is loaded with other adverse components. Avoiding HFCS whilst continuing to eat wheat thins, for example, would be a major error.

      1. BobM

        I agree with Bob about grains, although Wheat Thins aren’t the best example of this, since they have HFCS and partially hydrogenated oils added to them (too many confounders). I’m personally against grains, particularly wheat, though it’s difficult to tell how bad wheat is. For instance, the diet advocated by the Wheat Belly author is also quite paleo/low carb. Is it the paleo/low carb aspects of this that are really the cause of the improvements or the lack of wheat or both? It’s difficult to tell. The only way to really tell is get two groups of people, put one on high carb but no wheat and one on the same amount of carb but without wheat, and see what happens.

        I personally believe I am negatively affected by (modern) wheat, as I think it causes congestion and other effects, but it’s really hard to tell. For instance, we went on vacation this weekend, and I had wheat (and sugar) for the first time in weeks. I had some pizza, though I avoided bread. I got congested (chest and sinus), but I also had sugar too. I haven’t been able to design a test that tests just wheat. I do know that dark chocolate (70%) does not seem to affect me, but that’s also not much sugar, as I don’t eat much of it.

        I personally think high carbs (and high seed oils) are bad, but it’s unclear to me how much of grains are bad due to carbs or due to other elements such as gluten.

      2. Bob Niland

        re: …although Wheat Thins aren’t the best example of this…

        That’s why I didn’t capitalize it, but your point…

        re: …they have … (too many confounders).

        Yup. When you switch to a very-low-net carb grain-free low-inflammatory diet, little is left that sports an Ingredients list. A lot of confounders are swept into the bin, including but not limited to: added sugars, ω6LA, grain pesticides, grain fumigants, gliadin, WGA, exorphins, Bt crops that are pesticides, food colorants, emulsifiers, preservatives, iffy flour fortifications like folic acid and excess iron.

        re: Is it the paleo/low carb aspects of this that are really the cause of the improvements or the lack of wheat or both? It’s difficult to tell.

        It would be nice to isolate the effects of each suspect element, but no one who recognizes that this is needed would consider any such trial to be ethical. And who would fund it?

        re: I had some pizza, though I avoided bread. I got congested (chest and sinus), but I also had sugar too.

        Sugar can be tested in isolation; grains can’t, really, because they are usually 60% glucose polymers that rapidly become blood sugar. People who shun simple sugars but embrace “whole grains” have been thoroughly victimized by deadly dogma, and usually have adiposity, bad teeth and high HbA1c as a result, not to mention all manner of skin and systemic ailments that mystify consensus medicine. To circle around to the thread topic, CVD is another predictable result.

        As you may know, Dr. Davis stumbled upon the wheat connection back around 2006 when he suggested to his cardiac patients that they try wheat elimination. It wasn’t just cardiac markers that improved promptly and dramatically.

        re: I do know that dark chocolate (70%) does not seem to affect me, but that’s also not much sugar, as I don’t eat much of it.

        There’s no reason why chocolates have to be sweetened with sugars. Stevia does the job. Then you only have to worry about Cd and Pb contamination (which is a real problem at the moment, but one that may be getting more attention in the EU than in the US).

      3. Sasha

        Bob Niland: by simple sugars that are “less adverse than grains” do you mean HFCS and table sugar?

      4. Erwin J.O. Kompanje

        Agree. Avoid refined sugar (and refined processed foods) at all. Eat whole fruit and get enough fructose for staying healthy. You don’t need any refined sugars (or processed foods) at all.

      5. Ray Davies

        Re: “Avoid refined sugar (and refined processed foods) at all. Eat whole fruit and get enough fructose for staying healthy. You don’t need any refined sugars (or processed foods) at all.”

        I am not aware of any requirement for fructose in any shape or form. I don’t believe we need fruit to be healthy either.


      6. Bob Niland

        @Sasha: …by simple sugars that are “less adverse than grains” do you mean HFCS and table sugar?

        Yes, I mean anything that is reduced to glucose and/or fructose before getting to the large intestine, including but not limited to sucrose, “evaporated cane syrup”, dextrose, “honey”, grain syrups like HFCS, “agave nectar” and the like. Some of these have varying glucose/fructose balances, and fructose, although it doesn’t immediately provoke BG, has its own distinct problems.

        My point, by the way, is not to endorse consumption of these, but to make people aware that grain carbohydrates such as amylopectin A might as well be sugars, because they are cleaved to simple glucose before reaching the large intestine, and spike BG. Grains actually contain more glucose (60%) than table sugar does (50%), and its just as available.

        Consuming grains has been a Faustian Bargain for all of recorded human history, and one that gained extra hazards in the last half century due to genetic tinkering, field practices and post-processing. The invention of agriculture made it possible for us to being having this web chat, but it came at some [still rising] cost.

        1. sasha

          Bob: I’m not sure I understood you, but if your point is that consuming 10 grams of table sugar or HFCS is “less adverse” than eating whatever portion of millet or buckwheat contains the same amount of sugar then it is incorrect.

      7. Bob Niland

        @sasha: if your point is that consuming 10 grams of table sugar or HFCS is “less adverse” than eating whatever portion of millet or buckwheat contains the same amount of sugar then it is incorrect.

        Strictly speaking, buckwheat is not a grain. Millet is (although there are some 500 species of it), and is nearly 70% starch, according to one reference. Precisely what kind of starch is not clear, so I would rely on the glucose meter. If it’s all rapidly cleaved glucose polymers, it might be expected to provoke a more adverse BG response than sucrose. If there’s a lot of fructans, that raises separate issue, although perhaps not BG.

        With some grains, their main hazard is net carbs (provoking BG), and they can be part of a VLC diet with attention to portion size. I’m not even sure that millet is one of these. While searching on its composition, I hit a Loren Cordain page warning about other hazards in it.

        But let’s be blunt, when we are talking about NHS-approved “healthy whole grains”, 98% of the time we are really talking about runt mutant goat grass (sold as semi-dwarf hybrid wheat) usually in flour form. This stuff also brings to the outpatient clinic: gliadin, zonulin, exorphins, phytates, wheat germ agglutinin, protease inhibitors, oil high in Omega 6 linoleic acid, and, depending on locale, herbicide uptake, pesticide uptake, bromine-based fumigant residue, and unwise fortification with folic acid and iron.

        1. Gary Ogden

          Bob: Correct about buckwheat. The common grains are all Graminae (unless the botanists have changed this since I learned it). Although eaten as a grain, buckwheat is a member of the Polygonaceae, along with rhubarb and sorrel. It is more nutrient dense than any of the grains. I, too, have heard warnings about millet. Native to, and widely eaten in, Asia and Africa. Except for nuts (and a few others, such as sesame), I suspect it is better to avoid seeds as food. Plants, after all, provide tasty nectar and fruit to animals in order to aid reproduction through pollination and seed dispersal, but unless a seed passes entirely through the digestive tract intact and unscathed, which they do, even seeds as big as the avocado, there is no advantage the plant. Seeds are not their gift to us, as fruit is, especially not ground up. By the way, I always soak and dry nuts to eliminate the bulk of the phytates, and they digest well.

          1. Diana

            “By the way, I always soak and dry nuts to eliminate the bulk of the phytates, and they digest well.”

            Gary, reconsider, please. Phytic acid is a perfectly natural iron chelator.

          2. Gary Ogden

            Diana: Interesting. They will also bind other minerals, as well. So it seems like a trade-off? The Aztecs soaked their pumpkin seeds with chile, and dried them. Perhaps only pumpkin seeds should have this treatment? They, and other corn cultures, developed nixtimalixation to render the corn wholesome, so they clearly had a reason for doing this as well.

          3. Diana


            ” Interesting. They will also bind other minerals, as well. So it seems like a trade-off? ”

            In my understanding IP6 preferentially binds excess iron.

            In my (limited) understanding of human physiology, IP6 s naturally secreted by the body. So it is there for a reason.

            The ancients surely knew what they were doing, in the context of their diet and environment.
            As far as iron is concerned, I would say that (iron rich) meat was scarce for most of the population. Nowadays, people eat a lot of meat, and some food sources are even iron enriched (in some countries by law).

          4. Gary Ogden

            Diana: Thanks. I hadn’t really thought about this aspect of it before, but pre-colonial Mexico was poor in grazers, thus the diet had little meat. Iron overload from meat would not have been a significant problem. The indigenous people of Mexico had to work very hard to figure out how to nourish themselves with relatively limited resources, thus at some point they learned to soak seeds. Most wheat growing cultures used sour leavening, which reduces phytates as well . . .but the domestication of wheat and cattle occurred in the same or overlapping areas. Rice was traditionally pounded to remove the bran, where the arsenic is concentrated. So you are probably correct. I don’t think I’ll bother soaking nuts any longer; this will save a bit on the power bill.

          5. Gary Ogden

            Upon further reflection, my argument about cattle and wheat makes no sense; likely it was as you said, that meat was only a small part of the diet for most of the ancients (as it was/is for the Maasai). They must have soaked it for some other reason, possibly to take advantage of wild yeasts, since commercial yeast is a modern invention. This is why I made sourdough, because the wild yeasts in my locale made truly delicious bread, much superior to even homemade yeasted bread.

        2. sasha

          Bob: I don’t think I’ll ever agree that HCFS and table sugar are less adverse than any grain (wheat included). HCFS and sugar are chemical products stripped of all essential nutrients of their mother foods. They’re basically crack while corn, wheat, and sugar cane have been and are being eaten by all traditional cultures who have access to them. Corn flour, for example, is one of the staple foods for rural Romanians and Moldovans. Good quality wheat and its flour have been eaten by everyone in Europe for centuries. Rural Chinese eat millet and don’t seem to suffer from it.

          The sugars that appear in grains and other high carb foods are bound together with other nutrients and don’t have the same detrimental effects on the body that HCFS and table sugar have. The problem isn’t grains but what’s being done to them: GMO, pesticides, food additives, etc. The bread that you get in a typical American supermarket has little in common with a baguette in France which by law can only contain traditional ingredients. The same with Italians who eat lots of carbs and yet live long.

          Basically, there’s a world of difference between Kraft Macaroni and Cheese and home made pasta that my friend makes which contains only high quality flour and farm fresh eggs. The problem isn’t macaroni, the problem is Kraft.

          Someone just mentioned Kitavans and I looked up what they eat:

          “The residents of Kitava lived exclusively on root vegetables (yam, sweet potato, taro, tapioca), fruit (banana, papaya, pineapple, mango, guava, water melon, pumpkin), vegetables, fish and coconuts [27-29]. Less than 0.2% of the caloric intake came from Western food, such as edible fats, dairy products, sugar, cereals, and alcohol, compared with roughly 75% in Sweden.”

          And yet no CVD disease for Kitavans. If that doesn’t refute LCHF idea, I don’t know what would…

          1. Gary Ogden

            Diana: Two questions about fungi: The roots of trees and grasses can grow dozens of feet into the soil. The fungal symbionts are there with them in their full array? Bacteria have been detected deep in the bowels of the Earth, in solid rock, and deep beneath the seafloor, in both cases far from any source of oxygen. What about fungi?

          2. Gary Ogden

            sasha: What the Kitavan diet, and all other traditional diets show is that macronutrient ratios in the diet have little or no bearing on the health of the eaters, providing the food comes from the Earth and the sea rather than a factory. I suspect one of the reasons LCHF has improved the health of many, particularly diabetics, is that it more closely mirrors traditional diets by forcing people to eat more nutrient dense food and avoid or limit the things, such as sugar or honey, that traditional people ate only occasionally, and the things they never ate, such as hexane-extracted vegetable oil.

          3. sasha

            Gary: something is off with my computer so I apologize if you get multiple answers…

            I agree about sugar but don’t know enough about history of honey to have an opinion. I’d guess beekeeping has been around for centuries and honey was probably available, at least in Europe. With honey I think it’s more of a problem of overindulgence.

            My main point was to the idea that grains are somehow more deleterious than HFCS or sugar. In my opinion, nothing can be further from the truth. It seems that we, modern people, forgot how to grow, cook, and eat food and it looks like it only takes a couple of generations to forget. Hence, proliferation of all the diets: Atkins diet, Wheat Belly diet, plant based diet, Ornish diet, bone broth diet… Whereas, the answer, in my opinion, is simple – get back to the way your great grand parents ate. And they ate everything – meats, fish, fats, cheese, milk, grains, bread, pasta, honey, vegetables. We don’t even need to go to exotic locales to see what Kitavans eat. Italians, French, and Germans seem to be doing pretty well as long as they stick to their traditional ways of growing food, cooking, and eating.

            Another point to make – many people don’t seem to realize that this business of picking and choosing what you’d like to eat is a very recent phenomenon, even in the West, let alone the rest of the world. For 99.9% of human history we ate whatever we could get our hands on because we never knew when and from where our next meal was coming. I grew up in Soviet Union, I still remember what it feels like.

          4. Gary Ogden

            sasha: All excellent points. Eat like our grandparents. My paternal grandpa lived to 86, from 1875 to 1972. Lived in a small town in Pennsylvania, and produced ten children. The twentieth century was hard on those children, as he outlived more than one of them.

      8. Bob Niland

        @sasha: re: I don’t think I’ll ever agree that HCFS and table sugar are less adverse than any grain (wheat included).

        It’s really a distinction without a difference at the table. In the specific matter of blood glucose, the final authority is the BG meter (although a postprandial 3-hour time series of triglycerides can be even more telling).

        The human MDR for carbs is: zero, although they can be beneficial if net carbs are taken into account (keep the sugar-equivalent very low)

        The ideal amount of ADDED simple sugars in the diet is: zero, period

        The ideal amount of grains in the diet is: also zero, period, but not just because they might as well be sugar

        I used to think that HFCS had some unique adverse properties compared to sucrose, but my posture now is that its principal problem is merely being cheap, and thus irresistible to food formulators, and consequently pervasive. Plus, anything that contains HFCS is highly likely to be loaded with other junk that needs avoiding.

        For anyone specifically avoiding HFCS, be aware that a stealth source of it is “honey”. Unless personally harvested by you from a wild hive, you need to assume that it’s partly or mostly HFCS, if only due to what the apiarist feeds the hive to replace the harvested honey. Random bottles in stores might easily be entirely just HFCS with colorants, flavorings and a wide variety of toxins.

        1. sasha

          Bob: this idea that the ideal amount of grains in the diet is zero – where does it come from and what evidence is there to support it? I would be grateful for any sources you can provide.

          As I mentioned earlier, I disagree that grains “might as well be sugar”. It’s almost like saying that snorting cocaine is the same as chewing coca leaves. Sugars in grains are bound with other nutrients and I don’t believe they’re metabolized in the same way as HFCS and table sugar.

        2. Diana

          “The human MDR for carbs is: zero”

          This blog is full of interesting comments but also, unfortunately, full of information from people who have their brains washed reading various diet and nutritional “gurus”. The one above is a fine example.

      9. Bob Niland

        @sasha: this idea that the ideal amount of grains in the diet is zero – where does it come from and what evidence is there to support it? I would be grateful for any sources you can provide.

        Wheat Belly Total Health (Davis, 2014), or Grain Brain (Perlmutter, 2013) both cover the topic pretty thoroughly. WBTH has 466 footnotes, mostly cites from the lit. Neither of these book series are the first to raise the alarm about grains – they are just the first to get some traction. Also, neither of those books are just about grains, not by a long shot.

        Disclosure – I do part-time work for one of these authors (my user name on replies here links to more details about that, and has for some time). I normally try to avoid posting anything here that could be construed as spammish, but you asked.

        re: As I mentioned earlier, I disagree that grains “might as well be sugar”.

        Check BG response after consuming comparable masses of sucrose, then later, wheat flour.

        re: Sugars in grains are bound with other nutrients and I don’t believe they’re metabolized in the same way as HFCS and table sugar.

        The amylopectin A in wheat is branched in such a way that it is rapidly metabolized.

        1. Sasha

          Thanks Bob, I will look at the references.

          In general, though, I would like to say that whatever diet theory is put out there, you can find a large enough group of people to refute it. The Eskimos refute Prof. Campbell’s idea that animal fats are carcinogenic while Loma Linda Adventists refute the notion that vegetarianism (or almost vegetarianism) is bad for you. The French refute “saturated fat is bad” hypothesis while Italians (with high pizza and pasta consumption) refute the idea that wheat is evil. Kitavans refute LCHF ideas and Israelis refute “polyunsaturated fats are good” camp.

          The only idea that keeps repeating itself through all of the world’s populations and hasn’t been refuted as far as I am concerned – whenever a group of people switches from their traditional nutrient rich diet (whatever it was) and adopts a diet of processed foods and refined sugars, they start getting sick. Just look at the Okinawans, for example.

      10. Martin Back

        When I die, I want a heart like this chap: “The epicardium was smooth, and no scars were visible. The endocardium and all valves were normal. … The coronary arteries were soft and pliable … there were no raised plaques and no compromise of the lumens. No clots were present. … No infarcts of any size, or other finding referable to vascular disease, were present in any organ. … In a man 69 years old, the near absence of atherosclerosis and the complete absence of its effects are remarkable.”

        That’s from the autopsy of Nathan Pritikin, who shot himself when his X-ray induced leukemia became terminal.

        The Pritikin Plan is a diet that is high in whole grains and dietary fiber, low in cholesterol, and very low in fats. Fewer than 10% of calories come from fats. The focus of the Pritikin Program is fresh whole foods like fruits, vegetables, beans, and whole grains. (per Google)

        Note: the Pritikin Program involves both the Pritikin diet and an hour of daily walking. Pritikin himself used to go on a daily run. (per Denise Minger)

        From Denise’s thought-provoking but very long blog post In Defense of Low Fat: A Call for Some Evolution of Thought (Part 1). Read about the Rice Diet and be horrified!

        Personally, I’m paleo-ish. I’ve had great results from upping the fat percentage in my diet. I’m probably medium carb, medium fat. But no way will I give up my home-baked sourdough bread. Grains are OK.

        1. Gary Ogden

          Martin: If it works for you, great. More power to you. I, too, love my sourdough bread, which I made for decades, but I’ve discovered I’m better off without it.

          1. Frederica Huxley

            I would be very, very sorry to have to foresake my sourdough bread! Bread made with flour, water and salt was the mainstay of many civilisations, and did not appear to cause harm. Nowadays, I will only use organic flour, thanks to the prevalence of dessication of wheat with glyphosate just prior to harvest. Using a wild sourdough starter also has a profound effect on the flour.
            Most commerical breads, made with the accelerated Chorleywood method, and full of additives and sugars, is a travesty. Last, but not least, homemade bread with homemade cultured butter is delicious!

          2. Gary Ogden

            Frederica: In recent years I used organic rye (rye is supposed to make the starter happier), grinding the berries fresh daily with a Jupiter. I always put on butter as thick as the bread. Heavenly!

      11. Bob Niland

        @Martin Back

        re: That’s from the autopsy of Nathan Pritikin, who shot himself when his X-ray induced leukemia became terminal.

        I tried Pritikin once, and found compliance to be a problem. Compliance is a major factor to be considered in any permanent (lifestyle) diet. If diet is the solution to CVD, it has to be something people can stick with. And it has to be something that doesn’t raise new risks…

        My personal view is that a full-time glycemic diet is a cancer enabler, and Pritikin is full time gly. Everyone needs to place their own bet on this. I’ve placed mine.

        I’m still waiting for DM’s Part II on reconsidering low fat. By the way, some people do actually need at least lower fat. It appears hat Apo E2s and E4s, whose lipidemias don’t respond to low carb, fall into this category.

      12. Bob Niland


        re: This blog is full of interesting comments but also, unfortunately, full of information from people who have their brains washed reading various diet and nutritional “gurus”. The one above [“The human MDR for carbs is: zero”] is a fine example.

        Let me first anchor the discussion by saying that I don’t endorse a zero carb diet, although there are people doing that, and not dying.

        There is also scattered science going back to the famous Vilhjalmur Stefansson experiment showing that carbs are not “essential” for humans. Glucose surely is, but we can make it via glycogenesis of proteins or even fat. It might be nice to have a well-designed met ward trial to really nail it down, but no IRB is going to approve that presently.

        Also, the instant context might be my mention of Davis & Perlmutter. Neither recommends zero carb diets. They do endorse ketogenic diets in certain situations. Their main diet programs, however are what I would characterize as borderline keto (part-time keto, part-time glycemic).

        As for being gurus, both of these doctors came to diet by way of trying to find effective treatments for their patients. Perlmutter is a Board-Certified Neurologist and Fellow of the American College of Nutrition. Davis is a cardiologist.

        To circle around to the thread topic (CVD), Davis wound down his conventional practice of cardiac interventions to focus on prevention. As I have put it elsewhere, he has given up stents and bypasses because he’s saving more lives writing cookbooks. That’s not a metaphor. My understanding is that since settling on a still-evolving grain-free, LCHF, low-inflammatory diet that is attentive to microbiome and key modern micronutrient deficiencies, he has seen no “events” in his patient population – and this is a population in which cardiac challenges like Apo E2, E4 and elevated Lp(a) appear to be over-represented. It’s pretty easy to put down the scalpel when none of your clients need it.

        1. Diana


          Some(!) of the people you mention may be partially(!) right but I stll call your “The human MDR for carbs is: zero” as BS, especially in the light of the suggested attention to “low-inflammatory diet that is attentive to microbiome and key modern micronutrient deficiencies”.

      13. Bob Niland

        @Sasha: whatever diet theory is put out there, you can find a large enough group of people to refute it.

        Yep, and with official advice being disastrous, we are on our own in deciding what to do. My general advice is:

        ► look for near-term testable, re-challengeable results
        (do xyzzy and you might live 7 minutes longer doesn’t cut it)

        ► look for consistency with human ancestral experience
        (requiring novel modern supplements instead of available legacy foods doesn’t cut it)

        ► look for easy long-term compliance
        (a diet that requires hunger, grit, determination, routine exhausting exercise, doesn’t cut it)

        ► look for a reference authority that is not stuck on dogma, and is willing to change with results (and willing to own their outcomes, which the FDA, USDA and NHS pretty clearly are not)

        re: Eskimos, Kitavan, Okinawans

        My general cliché on Blue Zoners is: expect BZ result if you have BZ genes, live in a BZ, eat the BZ diet, have a BZ microbiome, and follow the BZ lifestyle. Change anything (as some BZ’ers have done at their peril), and expect different results. The BZs have a lot to tell us, in particular on the relationship between diet and CVD, but it comes with extensive footnotes and disclaimers.

        1. Sasha

          Bob: my general argument to you has been that grains have been with us for 10-12,000 years since the beginning of agriculture. And probably before that for some if not most hunter gatherers. It is true that modern grain products (as many people consume them) are far away from what our ancestors even 200 years ago would have recognized. Especially in the US which seems to have become ground zero for chemical experimentation on humans.

          However, to claim that grains are unnecessary or harmful is both nutritionally and biochemically incorrect. There’s nothing stopping us from reviving the traditions that kept our great great grandparents healthy and well fed.

        2. sasha

          Bob: let’s not pretend BZ people have some special genes that none of us possess. Just look at what happens to Okinawans, for example, within just one generation that begins to consume standard American junk food. The same goes for microbiome.

          Any culture that maintains traditional ways of growing, making, and eating food remains a Blue Zone (or something close to it) – rural French, Italians, Germans, Russians, etc.

      14. Bob Niland


        re: I stll call your “The human MDR for carbs is: zero” as BS, especially in the light of the suggested attention to “low-inflammatory diet that is attentive to microbiome and key modern micronutrient deficiencies”.

        My understanding is that prebiotic fiber is available from animal sources, but that requires consuming more of the critter than is common outside isolated ancestral cultures. If you want to contend that such fiber is still carbs, then sure, I’ll concede your point.

        But your inference is valid, and is part of why I don’t recommend a ZC diet. We need prebiotic fiber, probably at least 20 grams/day, and it’s most easily obtained from slow carbs- which, for the benefit of the wider audience, get metabolized by the gut flora to things like SCFAs, and typically not blood sugar (BG).

        If one considers the FDA Nutrition Facts label, and works backward the %DV (daily value) for the Carbohydrate numbers, they are suggesting a DV of nearly 300 grams of net carbs (total carbs minus fiber carbs). Hello T2D trend.

        I’m aligned with programs that suggest ~50 grams net (which would be 70 total, 20 fiber). This ends up correlating to fasting BG under 90 mg/dL, often no rise postprandial, and an HbA1c of 5.0% or less.

        Long term elevated BGs have major implications for CVD risk. Everyone needs to look into this as part of figuring out their ideal macronutrient ratio. Expect no help here from consensus authorities.

        1. Diana

          Bob Niland

          “We need prebiotic fiber, probably at least 20 grams/day,”

          “I’m aligned with programs that suggest ~50 grams net (which would be 70 total, 20 fiber). ”

          Sadly, your “recommendation” is totally wrong. Stop misinforming people.

          We need much, much more fiber than 20 grams/day to keep our microbiome “healthy” – the estimates are nearing 100 grams/day. Traditional societies were shown to consume even more dietary fiber than 100 grams/day. You are free to count how much carbs it is.
          To confuse matters a bit, not only you have to deliver the fiber to your guts, you also have to have the microbes able to break it down into SCFAs etc. Sonneburg calls it MAC – “microbiota-accessible carbohydrates”.

          Here, just quick, from another study. Can you see the figure: 55 grams of daily dietary fiber?

          Can more fiber restore microbiome diversity?

          “People living in non-industrialized societies have an average intake of fiber that is much higher than the low norms of Western societies. The authors note the recent work from the Stephen J.D. O’Keefe lab in Nature Communications (doi:10.1038/ncomms7342) in which modern African-Americans were given a traditional South-African diet that contained 55 grams of daily dietary fiber and had improved markers for colon cancer within two weeks.”

          1. Gary Ogden

            Very good, Diana. I can say from personal experience that eating a large amount of a wide variety of plants, mostly vegetables, including wild greens and fermented vegetables, makes the gut microbiome healthy. My digestive tract performs flawlessly, and since the gut microbiome influences cognitive function, mood and immune function, all of those have improved, as well, from listening to what the Sonnenburgs and others have to say, and really chowing down on them. Giving up grains has not had any negative effect at all. I suspect the contrary is true. This is very good advice, to be certain that the diet contains lots of soluble fiber.

          2. Diana



            Evolutionary perspective on dietary intake of fibre and colorectal cancer (Leach, 2006)

            ” It is well known that dietary habits among westernized societies are characterized by increasing caloric intake from added sugars, fats and highly processed nutrient- and fibre-poor grains. This caloric shift is in discordance with our evolutionary past (Eaton et al., 2002) and continues to be at the expense of dietary diversity and consumption of fibre- and nutrient-rich plants. A few examples from the archaeological and ethnographic record demonstrate the magnitude of this shift as it pertains to the diversity and quantity of fibre in human diet.

            Located along the shores of the Sea of Galilee in modern-day Israel, a remarkably well-preserved collection of plant remains were recovered from the 23 000-year-old archaeological site of Ohalo II (Weiss et al., 2004). Ohalo II has provided an extraordinary window into a broad-spectrum diet that yielded a collection of >90 000 plant remains representing small grass seeds, cereals (emmer wheat, barley), acorns, almonds, raspberries, grapes, wild fig, pistachios and various other fruits and berries. Owing to excellent preservation, a stunning 142 different species of plants were identified, revealing that a rich diversity of fibre sources was consumed by the site inhabitants.

            In Australia, Aborigines are known to have eaten some 300 different species of fruit, 150 varieties of roots and tubers and a dizzying number of nuts, seeds and vegetables (Brand-Miller and Holt 1998). Based on the analysis of over 800 of these plant foods, the fibre intake was estimated between 80 and 130 g/day, depending on the contribution of plants to daily energy needs (Brand-Miller and Holt 1998). This daily intake is most likely higher when you consider that fibres in the form of resistant starch and oligosaccharides were not measured by the researchers among the economically important roots and tubers.

            In the semi-arid Trans-Pecos region of west Texas, a nearly continuous 10 000-year record of a foraging lifestyle has been documented in dry cave deposits. Considered one of the most complete records of foraging lifestyle in North America, nearly three decades of excavation and extensive analysis of well-preserved macrobotanical remains and human coprolites (faeces) from a number of cave sites (Sobolik, 1994) reveal a plant-based diet that conservatively providing between 150 and 250 g/day of dietary fibre from dozens of plant species. The fibre-rich diet is well illustrated by the visual presence (Figure 1) of undigested fibre (cellulose) in nearly 100% of the human coprolites studied throughout the entire 10 000-year sequence (Sobolik, 1994).
            With modern palates that trend towards less lignified portions of plants, in combination with a food industry that is likely to select added fibres more for their technical or economical characteristics than physiological ones (Redgwell and Fischer 2005), modern populations ‘most likely’ consume more rapidly fermented fibres over more slowly fermented ones than at any point in our evolutionary past. Said differently, rapid technological advances within food industry and a decreasing variety and quantity of fibre sources throughout much of western civilization has resulted in decreased metabolic and physiological activity in the distal colon, thus opening the pathogenic door to cancer in this region.”

      15. Bob Niland


        re: you seem to be agreeing and disagreeing re humans lack of need for dietary sugar…

        Carbs aren’t all sugars, and I’ll focus just on glucose here, as fructose is a separate can of worms.

        Rapidly metabolized carbs, such as sugars and easily-cleaved glucose polymers (such as many starches, esp. grain starches) end up as blood sugar before that carb makes it to the lower intestine. Amylase in saliva starts working on starches before you even swallow them.

        Prebiotic fibers/resistant starches/soluble fibers are carbs that are not cleaved by our enzymes, but do provide substrate for lower gut flora, who convert the liberated glucose to other things we need, principally short chain fatty acids.

        Insoluble fibers/roughage are carbs that just pass right through (unless you are a ruminant or termite, and even then, the work is being done by gut flora).

        The human body must have some glucose. The brain can run on a mix of ketone bodies and glucose, but must have some glucose. Muscles need glycogen. These needs are critical enough that we can synthesize glucose from protein or even fat, and will do so when no dietary glucose is available.

        We specifically do not need added dietary sugar, or any fast carbs that metabolize like it. It’s becoming widely recognized that refined sugars are a disaster. People concerned about that also need to know that there are other less obvious, but pervasive carb sources that might as well be refined sugar. Human amylase enzyme is really effective.

        My household hasn’t had any real sugar on hand for 5 years now. The only thing I eat that has any added sugar is the occasional square of 85% cacao choc (low-Cd, Low-Pb brands only). We mind the naturally occurring net carbs as well (fruits, nightshades, starchy veggies).

        Spiky and chronically elevated BG either matters or it doesn’t. If you think it matters, learn what drives it. From a CVD perspective, I would contend that it really matters (but is not the only provoker).

        1. Bob

          Bob, I think I was at cross purposes with my last reply to you; it seems we agree, pretty much. Apologies.

      16. Bob Niland

        @Sasha: re: my general argument to you has been that grains have been with us for 10-12,000 years since the beginning of agriculture. And probably before that for some if not most hunter gatherers.

        I’ve already opined on the role/cost of agriculture. Ötzi the Iceman (died 3300 years ago), an einkorn eater, turned out to be in much worse shape than I would have guessed when I first learned of his discovery. It was an arrow that got him, but he had bad teeth, and a fully expressed tendency to heart disease (hey, it’s even on topic).

        One of my clichés is: eat authentic neolithic grains, get authentic neolithic ailments.

        Ötzi doesn’t prove that, but he could have presented evidence to falsify it, and didn’t. We also can’t be sure precisely what drove his CVD – suspected Lyme disease is certainly a possibility.
        It’s my further understanding that the human dental fossil record generally shows problems rising with agriculture.

        People can elect to eat organic heirloom grains if they wish (and can find them). I wouldn’t. Modern grains are a runaway disaster, for multiple reasons that are off-topic for this blog.

      17. Bob Niland


        Note that I said “at least 20 grams/day” (prebiotic fiber). This is not inconsistent with your observation on the topic.

        re: We need much, much more fiber than 20 grams/day to keep our microbiome “healthy” – the estimates are nearing 100 grams/day. Traditional societies were shown to consume even more dietary fiber than 100 grams/day.

        I agree, and I think that’s where we’ll end up (no pun intended). I’m only responding to this, by the way, because there is a CVD connection. In the program with which I’m associated, it is accepted that remediating microbiome is a factor that contributes to reduced BG, improved insulin sensitivity, lower BP, reduced inflammation markers, improved immune system function, and there are strong indications of a reduction in small LDL particles over time (these thought to be among the most troublesome agents in the CVD disease process).

        Moderns, however, already usually have to work up slowly to 20 grams/day of added prebiotic fiber. If they exceed it, various forms of distress may ensue. Last I looked, even “resistant starch” bio-hackers were typically not doing much over 50 grams/day (I’m willing to be out of date on this).

        The problem, as your link suggests, is the diversity of our gut flora. What is it that we need to do to enable an even higher fiber diet? The top probiotic products, such as VSL#3, are helpful, but don’t seem to suffice to get us to “the next level”. An FMT from a Hadza tribesperson might, but introduces potential hazards, and might only be transient.

        All but a couple of commercial probiotics are just bacteria. The gut flora also includes eukaryotic parasites, fungi, protozoans, viruses, yeasts and strong suspicions of things that represent as-yet-unidentified Domains of life. Western guts have been nuked from orbit by incautious antibiotics, disinfectants, various gut antagonists posing as foods and food ingredients, and a full-time glycemic diet that probably fosters unfavorable strains.

        Fermented foods are great, but also tend to be bacteria-centric, have low CFUs (often 0 in commercial products), and limited strain diversity.

        re: You are free to count how much carbs it is.

        The net carbs could still be quite low, zero even.

        1. Gary Ogden

          Bob: This is why I sometimes eat produce directly from the garden without washing it, had the good sense to have chosen a vaginal birth from a mother with a nutrition degree, and the good fortune to come to adulthood prior to all this low fat nonsense permeating the world of dietary wisdom. I think that gut microbiome diversity and health can decline over generations, so fasten your seatbelts for further horrors to come.

        2. Diana

          Bob Niland

          No need to teach me about microbiome. Yes, I agree that we rather stop. I have said what I wanted. The problem with your “recommendations” and you, too, is that you are very, very loud.

      18. Martin Back

        Re fibre: African elephants in the wild live for 60-70 years, similar to humans.

        For some years I kept a dried-out lump of elephant dung as an ornament. I picked it up in Etosha Pan national park in Namibia. The best way to describe it would be, think of a large pot scourer made of wood fibres. With a daily scrubbing-out by these beauties, elephants guts must be the cleanest in the animal kingdom.

        Not that I plan to rush out and gnaw on the nearest mopani tree. But I’ve always eaten plenty of steamed green veggies and/or salads to get my fibre. My mother died of colon cancer. I never want it to happen to me.

      19. Sylvia

        Have come into this diet discussion late, it is all really interesting. You may have seen Dr Sarah Halstead on utube, she has a clinic for obese young persons and also an authority on diabetes. By all accounts she is successful in her low carb approach. Easy for dimwits like me to understand. We were apparently healthier in WW2 era, but of course the earth had not been poisoned to the extent it is now so growing on soils with all the trace elements that are missing now gave us produce singing with goodness. Nearest thing to fast food was beans on toast.At my advanced age and after health scare, I have put myself on LCFF diet, lost central obesity, don’t know what I will die of, hope it’s quick.

  7. abamji

    The most important starting point is that a hypothesis falls when a single fact refutes it. This is why any hypothesis, project or whatever should be examined, just as Malcolm suggests, for something that will disprove it. However scientific doctors like to think they are, this is one thing they fall down on, and I have encountered the problem time and again, not just with clinical hypotheses as here, but with management issues in the NHS. See my blog (Bamjiinrye) for examples. All medical schools should teach the importance of the null hypothesis and the Black Swan.

    1. mikecawdery


      The concept of the null hypothesis does seem to have escaped from some medical statisticians to be replaced by the desire to achieve “a significant result” however trivial to patients but greaat for the drug peddlers.

      My favourite example is: The data provided in the HPS study(Collins) that, over 5+ years 156 lives were “estimated” to have been “saved” (937 – 781) in the simvastatin treated group (n = 10269). The placebo group numbered 1026 7. Yes a significant difference but n is very large. It must be remembered too that eligibility for this trial included “are statin tolerant with a past medical history of:
      (i) coronary disease (ie, myocardial infarction, unstable, or stable angina, coronary artery bypass graft, or angioplasty); or
      (ii) occlusive disease of non-coronary arteries (ie, non-disabling stroke not thought to be haemorrhagic, transient cerebral ischaemia, leg artery, stenosis [eg, intermittent claudication], carotid endarterectomy, other arterial surgery or angioplasty); or
      (iii) diabetes mellitus (whether type 1 or type 212,25); or
      (iv) treated hypertension (if also male and aged at least 65 years, in order to be at similar risk to the other disease
      In short patients with a very serious risk of CVD or those with heart disease – not healthy individuals

      This reduction per thousand per year is (156/ (10269))*1/5*1000) = 3.04 or 3 per year saved per 1000 treated or an efficacy rate of 0.3%. This presumably led to the Collins public claim of treat 3 million, save 10,000 a year which reduces , in lay language, to simvastatin (+ standard medical therapy??) saved one extra life for every 300 treated compared to a sugar pill plus standard medical therapy.

      Applied to the general public that does not meet the study inclusion criteria one can add those who will suffer from adverse reactions – say 20% or 60 per 300.

      And that is irrespective of its anti-inflammatory or anti-coagulatory actions.

  8. Nigella P

    Wow! Most amazing of all, to me, is that I understood all of your post Dr Kendrick. I cannot reiterate enough what a rare gift it is to be able to explain theories such as yours to non-medics in a way that they can understand it. What will be fascinating, will be to see whether some of those items on your list of factors that reduce the risk of CVD have a more potent effect than others.

  9. Stergio

    I think of skin blemishes, ‘spots’, ‘pimples’, as minor events on our skin. Caused by what ? bacteria, hormones, or even as something that tends to occur when we are tired perhaps by overdoing things and not looking after our bodies, poor diet and increased alcohol intake. I have often thought it’s ok about those you can see but what about those you can’t see i.e. internal ‘spots’. Do we have ‘pimples’ on the wall of our liver or a rash on our stomach? Is it possible that the cause of the lining of the blood vessel to begin to form plaque is similar to that which causes the skin to ‘pimple’ and is it possible that the skin only mirrors what is going on internally?

    1. Stephen T

      One of the strange changes I saw when I abandoned the low fat diet and went LCHF was the noticeable improvement in my skin. Some dark blemishes have virtually disappeared.

      1. Chris H

        Yes, I’ve noticed this as well. Particularly obvious is a return of whiteheads on forehead, arms, shoulders and upper legs when I accidentally consume something with wheat in it.Takes a day or two to show up.

        I’ve had vasculitis in the past caused by a reaction to certain antibiotics and the similarity of some of the (leg) blemishes makes me wonder (a) what’s in the antibiotics and (b) what damage is being done internally by the wheat.

  10. Mr chris

    Doctor K
    I had understood that idiopathic atrial fibrillation can be much attenuated through lifestyle changes, exercise, weight loss and less booze? I also thought that Warfarin was for killing rats?
    You see, after each episode I become more confused.

    1. JDPatten

      Mr chris:
      Yes. Prash Sanders is doing work in Australia that shows promise of reducing AF burden with lifestyle overhaul.
      Warfarin: It’s poison in the right dose. Rats, not pretty themselves, die a not so pretty death by bleeding internally.

  11. mikecawdery

    Dr Kendrick

    Once again my thanks for another excellent and thought provoking article. To me it makes considerable sense particulary the list of “good things”. Unfortunately exercise is at 82.9 and statin damaged is not really practical though the rest are. I have a comment about ACE-inhibitors. They do cause “fibrillation” and I have a letter confirming that from the MHRA. In my case if my pulse drops below 50 it is almost inevitable. Experimenting with dose rates (wih my GP) has largely resolved the problem.

    You raised the question of Vit C dose rates. According to Klenner oral Vit C should be dosed up to tolerance ie diarrohea when used for infections etc.. IV it seems that massive doses as a drip(20-50 g) can be given daily with safety.

    1. JDPatten

      You put fibrillation in quotes. Is that the actual diagnosis? Atrial or ventricular? Quite a difference in the two.
      Can you explain what the MHRA letter says about the fib/ACEI connection? (I’ve had both. Cause and effect??)
      Interestingly, my electrophysiologist put me on verapamil to slow my heart rate in an effort to reduce atrial fibrillation incidence. Opposite treatment from yours.

      1. mikecawdery

        JD Patten,
        Indeed, fibrillation should have been in quotes. As the MHRA pointed out there are several causes of fibrillation (hence using it undefined) but precise definition would require going to my GP, probable referral to a consultant with a resultant battle over warfarin, I took it no further but my GP does know as he changed the prescription to minimize the “wobble” as shown by my BP meter. I am happy, he is (I hope) happy. He follows Dr Kendrick too.

    1. kelly trosper

      RE: Gilberts Syndrome being “protective” against CVD…

      Interesting. I’d venture to guess that it’s a Vit. K story, Nick.

      “Prothrombin time may be prolonged because of vitamin K malabsorption”

      Which is to say that your clotting times are longer.. So, if Kendrick’s theory is correct, the anti-clotting “feature” of your syndrome would indeed be protective.. However, you probably should have concern about calcification..

      Remember what Dr. K says above about warfarin, “because warfarin is a vitamin K antagonist, and vitamin K appears to protect against the build of calcium in various tissues, warfarin accelerates calcification in artery wall. ”

      So the question in my mind…
      Is GS analogous to warfarin and does GS accelerate calcification in the artery wall???

      Does GS reduces the risk of stroke (in atrial fibrillation), while not really reducing the risk of heart attacks (like warfarin)????

      very interesting.

  12. Sue Waddle

    Thank you Dr K – I love your reasoning and thinking beyond the “party line.”
    I was reading just now about the diabetic patients who have gone against official guidance and given up their carb based diets. Guess what – they are mostly rid of their diabetes! But is the official advice on nutrition for diabetics about to change any time soon?!
    The same process will happen with statins ( largely thanks to you and others like you) but we may not be around to see the day!

    1. Stephen T

      Diabetics were described in today’s Times as being in rebellion at official dietary advice and reaping large health benefits as a result. The ‘official’ response is still to recommend the Eatwell Plate and 50% carbs. If you can’t control your blood glucose, eat glucose.

      That obviously makes sense to The ‘Flat Earth Society’ at Public Health England.

    2. Maggie

      Not rid of my diabetes, but rid of the symptoms with LCHF diet. As Dr. Richard Bernstein, says, it’s not the name Diabetes that kills you, it’s the chronic excess blood sugar insulin.

  13. Jennifer.

    Thankyou, Dr Kendrick. Very interesting, and a most understandable paper, once again.
    I bet you were great at algebra…..I love your convincing logic.

  14. Sylvia

    Wonderful, Healthy Italian pizza hypothesis. What next.

    Aberdeen, healthy haggis, all ingredients locally sourced, 28 day aged, hypothesis.

  15. Bill

    “In addition, because warfarin is a vitamin K antagonist, and vitamin K appears to protect against the build of calcium in various tissues, warfarin accelerates calcification in artery wall. Which could be a further problem in itself – leading to a higher rate of CVD.”

    But how does calcification fit into your blood clot theory of CVD?

  16. Gert van der Hoek

    Great read as always. Being no expert at all I wonder about the risk factors of artherosclerosis you mentioned. Many of them could be related to stress. ( What is “stress” and what not, you can write books about that..) Some argue : “Atherosclerosis represents the local vascular manifestation of … neurologic dysfunction”. We may have to look at the parasympathetic nervous system?

    Aspirin, betablockers, cardiac surgery etc. “treat” symptoms, don’t adress the process of artherosclerosis. There is a heartdrug which adresses the parasympathetic nervous system, an old drug, out of fashion now: Ouabain, or Strophantus. It seems clinics in Germany had great succes with it to prevent further heart attacks. No patents for Ouabain, so no trials?

    If you adjust your diet (whole food) and lifestyle (F.i.: go outside for vit D, Vit K2, NO, exercise, watch your circadian rythm, do Yoga) it could well be this will balance your nervose system and diminish your atherosclerosis? And diminish your “stress”, which together could prevent CVD?

    “Is atherosclerosis a neurogenic phenomenon?”

    Click to access Is_Artherosclerosis_a_Neurogenic_Phenomenon.pdf

  17. Brian Wadsworth

    Doctor K,

    I cannot contribute any facts or contradictions to to your emerging hypothesis which continues to make sense even as you probe for fallibility. But I do think there is a supportive body of literature to your direction outside the discipline of medicine, per se.

    Over the past century we have had the opportunity to study primitive (i.e. pre-civilization) tribes and communities that were encountered with the expansion of european empires and exploration of remote regions. There is much credible evidence from recognized and qualified sources that CVD, and other degenerative diseases, are “diseases of civilization” in that they are missing from the natural world in general (think mammals in the wild) and tribal hunter/gatherers in particular (think the Inuit and Africa in the first half of the 20th century). This is much discussed and described today under various headings, sometimes as Paleolithic lifestyle/diet.

    Looking at your list of factors that reduce the risk of CVD, a high proportion are behavourial or dietary elements that restore or maintain a pre-historic state of nutrition and/or metabolism. I have marked my suggestions as to these below.

    **Exercise (overall, not whilst doing it)
    Moderate alcohol consumption
    Clopidogrel (expensive aspirin)
    ACE- inhibitors (a blood pressure lowering agent)
    Von Willibrand disease (lack of a specific clotting factor in platelets)
    **B vitamins (enough to reduce homocysteine)
    **Adequate Vit C (no idea what the correct intake should be)
    **Potassium (higher consumption reduces platelets sticking together)
    **Vitamin D
    **Nitric Oxide (through sunlight – and other nutrients e.g. l-arginine)
    **Magnesium (and other micronutrients)

    Like other commentators on your blog, I am old and in perfect health. Likely due to the lifestyle choices I made 15 years ago when I noticed a rapidly aging 52 year old body in the mirror.

    Your work has been a major inspiration to my discarding of conventional medicine in favor of prevention.

    Thank you

  18. Herb Dreyer

    You may want to consider establishing baselines. Take B6 for example. A deficiency causes homocysteine to form (and this is most scientifically provable). Then, for people without CVD and those with are they deficient or not. What levels make not; make so? Without a baseline you are helpless. A friend of mine wrote a piece on shifting baselines–which, I may have said before, is the heart of your work–here: http://www.shiftingbaselines.org/op_ed/

      1. Herb Dreyer

        I cannot find any textbook on the nutritional needs of the heart. Or, for that matter, any reputable book on the subject. To be sure there is beaucoup stuff on the intricate physiology of the heart including the geometry it creates while beating. In my studies on this topic it has all been hit or miss; more properly, accidental discovery. I know of no discipline in cardiac nutrition. It’s all bits and pieces even though such knowledge as the B6/homocysteine connection has bee laying around, nailed, for decades. Such study is just not sexy enough. I mean how hard would it be to measure the, say, taurine levels of patients, or any combination of other known nutritive requirements of the heart (magnesium, B6, potassium, etc) and see what you get?

      2. Herb Dreyer

        Dose like you do drugs: start low, say 50mg, measure, increase, measure, etc. that so-called protocall is well established.

      3. Hugh Mannity

        There’s some interesting work being done on Vitamin D over at http://www.grassrootshealth.net/

        Disclaimer: I’ve been part of their study for several years. I’ve raised my vitamin D level to around 62.5 nmol/L from less than 20!

        I’ve not seen anything much on any other vitamins or micronutrients.

      4. Frederica Huxley

        I think part of the problem finding baselines is that vitamins affect the whole body, not just a particular organ. Same with pharmaceuticals – always used to wonder how the aspirin knew to dampen down the headache one day and the stubbed toe the next! I think it was Dr Gerson who said that you don’t cure a disease; you heal the body.

  19. Sasha

    I would only point out that at least half of those Ukrainians (maybe more) dropping from heart attacks don’t speak Ukrainian. They speak Russian.

  20. Gary Ogden

    Dr. Kendrick: A clear and concise avenue to investigate. I eagerly anticipate learning more about clotting. The next Russian doll inside that being what perturbs normal clotting.

  21. JDPatten

    Warfarin is insidious. Understood.
    What about the Novel Oral Anti Coagulants? (NOACs)
    What insidious things might apixaban be doing? It’s touted as being the most effective and least harmful – so far.
    Atrial fibrillation: between a rock and a hard place.

  22. JDPatten

    Mice walk through the dry stone foundation wall of my 160 year-old New England farmhouse as if it wasn’t a wall at all. Chinks are open gateways. A problem!
    Warfarin is no longer an effective control. After many generations they’ve developed . . . what? Resistance?
    Do we??
    New measures – for mice – involve other anticoagulants such as brodifacoum.
    How medicinal might that be for us?
    The “poison” is in the dosing. And exposure time.

    1. Dr. Göran Sjöberg

      In our 100 year old “log” house mice enter every year when it gets cold. We rig traps to capture them and bring them at least 2 km away otherwise we see them again – checked that a spot of paint before the release.

      Once we had an exceptionally smart mouse who was able to catch the bait all the time without getting trapped. Then we got tired of the mouse and went into the wafarin business. I don’t know if we were smarter than the mouse but he (or she?) brought the block beneath the floor and just as a revenge (?) the mouse created a stench that lasted for weeks. The sad thing is that other mice also found the wafarin block and repeated the stench business now and then.

      Evidently there is no internal mechanisms telling animal that wafarin is a dangerous substance – not taste or smell? As far as I understand it causes internal excessive bleeding (what is that?) and were K2 is the antidote. I just wonder if people are committing suicide using wafarin? I have never heard about it but it sounds possible. Better than Vioxx?

    2. Gary Ogden

      JDPatten: Mice are truly amazing. We used to get them sometimes in the classroom, and while some of the girls would get up on their chairs, the mouse would scurry through a gap under a cabinet door not bigger than 1/4 inch (6 mm). Doesn’t seem possible, but this happened on several occasions.

  23. Frederica Huxley

    Warfarin is an interesting example of a pharmaceutical that can end up doing damage to the very system it is aiming to protect. Is there actually a medicine on the market that does not cause ‘side effects’ which can interrupt the innate workings of the body?

      1. Jennifer

        I agree, and that is why I now avoid prophylactic meds to the best of my ability. But…..I am beginning to think that 75mg soluble aspirin per day may be of some benefit. I need to do a bit more reading on the subject. Any ideas, anyone?

        1. Gary Ogden

          Jennifer: I suggest you get Joel Kauffman’s “Malignant Medical Myths,” and read Chapter one. From the overview of the chapter, by Dr. Graveline (spacedoc): “First of all, the buffer in aspirin has proven to be critical for its vital magnesium content. Secondly, after critical appraisal of its side effects and all cause death rates, the use of low dose aspirin in primary prevention can no longer be supported. Secondary prevention is quite another matter, with very favorable outcomes for limited periods of time after the thrombotic event (clot).” The FDA agrees, disallowing advertising of aspirin for primary prevention (because of excessive strokes). I took it for a while (for primary prevention) about twenty years ago, but stopped, although I don’t recall any problems with it. I may have seen a red flag somewhere in my reading.

  24. Mark Sanders

    I need to question homocysteine on your list as a cause of CVD. It seems back in the 90s they found that if you took B6 and B12, it would lower your homocysteine, but then some studies came back and showed no actual real-life reduction in CVD or CVD-related deaths from this reduction. Perhaps homocysteine is simply an indicator of CVD or potential CVD rather than a cause?

      1. Sasha

        Probably because meat is such a huge part of Georgian culture, together with lots of super fresh and tasty fruits and vegetables and lavash – their freshly baked bread that’s out of this world… Maybe that’s why Georgian nationalists feel threatened by vegans taking away their shashliks.

        Interestingly enough, throughout Soviet Union Georgians, Abkhazians, etc were known for their longevity, especially those who lived in the mountains with their sheep and goats (whom they ate by the way) and away from chlorinated and fluoridated water, stress and other “gifts” of modern civilization.

        There’s even an old Soviet joke that plays on a common Russian theme that no one really knows much about much:

        A Soviet TV crew goes to interview a 105 year old centennarian who lives in one of those mountain villages to find out his secret to long life. He tells them the key is to abstain from cigarettes and alcohol and to keep away from women. Suddenly, there’s a ruckus next door. They ask him what’s going on. He says: “Oh, it’s my older brother. He always fights with his girlfriend whenever he gets drunk…”

  25. Gary Ogden

    Sasha: Bizarre, but I bet the sausage is tasty. By the way, I’ve read Chapter 4 of Kauffman several times over the years, but I just reread it and am more confident now that weaning off of Lisinopril is a good move for my health. The evidence from Framingham shows no risk for BP below the 80th percentile for each age group, and little below the 90th. Port et al show a lower risk from the 60th to the 80th percentile than the risk from the 40th to the 60th, equivalent to the 10th and the 30th. The lowest risk being at the 20th percentile. It’s on p.102. The 90th percentile for 65-74 (my age group) is a SBP of 184! My last checkup my BP was 131/78, low for my age, but treated with 20 mg of Lisinopril. I shall see in two weeks what it is with 10 mg every other day, and report it. I’m getting my NO every day, and will bask up until the last minute before having it checked. Whatever it is, I’m confident I will be better off without any pharmaceuticals, as I’m in excellent health.

    1. Sasha

      Gary: also look into meditation or hatha yoga if you have an inclination. I think it does wonders for BP. I also think that Dr. Kauffman’s book is very good. I am studying it closely.

    2. JDPatten

      Giving up lisinopril? Even though Dr. Kendrick has ACE inhibitors on his list of factors reducing risk of CVD?

      1. Gary Ogden

        JDPatten: Yes. Statins are also on the list, but I’ve always refused them. And some unpleasant-sounding diseases are on the list as well. Wakame has the same effect as the ACE inhibitors, lowering both SBP and DBP by a mean of 8 mmHg. I can cycle over to the health food store and pick it up (expensive, though, about $0.40 per dose). There is a small but real risk of kidney damage from ACE inhibitors. In two weeks I will know if weaning from Lisinopril has raised my BP, but during the time I’ve been eating seaweed regularly (a couple of years), but before I knew about Wakame, my BP has trended downwards every doctor visit. It is clear from the Framingham data that BP at or below the 80th percentile for age and sex carries no additional mortality risk. The mortality rate for men (per year) are thus, by percentile for age (from Port et al): 10th: 1.25, 20th: 1.0, 30th: 1.25, 40th, 50th, and 60th, 1.5, 70th and 80th: 1.25, 90th: 1.8. For me the 90th percentile is 184, and mine is well below that, with my DBP consistently at 78. I no longer live in fear about my BP. Like many other things, what we’ve been taught over the past few decades about BP needs some revision. I feel fabulous, have no diseases or conditions, and can do anything physical I wish (except run as fast as I could in my fifties), including hiking uphill at altitude with greater ease than my wife or daughter. Although I don’t commonly use the term, my eating habits are essentially LCHF.

      2. JDPatten

        Have you tried yummy Grana Padano cheese? Same effect as ACE inhibitors.
        I can vouch for the yummy, but I have no personal experience with the touted effect.
        I, myself, have graduated from lisinopril to valsartan, an Angiotensin Receptor Blocker. After a few years of inhibiting my Converting Enzyme, my clever body devised a work-around with alternative enzyme(s) that did the job. Up went my BP even with increasing doses of lisinopril. The phenomenon is called “escape”. It seems my body really wants that angiotensin II. Trying to tell me something?
        I’m sticking with anti-hypertensives for now because elevated BP is the prime risk factor for atrial fibrillation. AF is horrendous to experience.
        Try the cheese. It’s great!

        1. Gary Ogden

          JDPatten: Thanks! Amazing. Those Italians really know how to do food, and lots of other things, well. I’m going out to buy some as soon as I finish this comment. I’ve always liked Parmigiano Reggiano, and I will grate an abundance onto my eggs for breakfast, before putting the habanero chile on (chiles are the richest commonly eaten food source of vitamin C). They also say cherry juice can have an effect, though I don’t much like fruit juice. Sounds like you have made a good call with the BP drugs. I feel very fortunate, and thankful, to have good health, and to be able to stop all drugs. I don’t for one second trust anything the pharmaceutical industry does. Best of health to you!

        2. Gary Ogden

          JDPatten: The cheese is fabulous, and yes, listen to the bod. I’m going to put it on my salad, too, because one ounce/30 ml is a lot to put on two eggs, and I’m going to alter my line of attack, since grating it right over the eggs in the pan can lead to some unexpected adventures. I’m going to grate the entire 12 oz./360 ml into a container so I can toss it on stuff with abandon.

      3. Hugh Mannity

        Gary: If there’s a risk of kidney damage with ACE inhibitors, why do they give them to diabetics to protect the kidneys? (Or is that part of the same mindset that gives glucose to people with damaged glucose metabolism?)

        1. Gary Ogden

          Funny thing is, nothing about kidney damage. That came from the insurance company! Thanks, Obamacare. And my doctor always tests my kidney function once a year, and lets me know that both measures (I know one is BUN, and I think the other is creatinine) look great. So kidney damage from Lisinopril is a mystery. Thankfully, she and I have agreed to no more cholesterol tests. By the way, the bold and caps are just as printed in the package insert.
          I see the bold didn’t cross the Atlantic. The word CAUTION and the words POSSIBLE SIDE EFFECTS are in bold in the package insert.

    3. Robert lipp

      My experience, after changing to LCHF while on long-standing BP meds – resulted in readings as low as 90/60. BP meds withdrawn. BP now 110 to 130 / 70 to 75. LCHF works.

      1. BobM

        In my opinion (from personal experience and reading), high BP can also be helped by intermittent fasting, which (for me) lowered BP more than just LCHF. I think if you’re insulin resistant, LCHF helps, but protein causes an insulin response. It’s possible to eat enough protein, especially if you make the mistake I did and eat many times per day (and even take protein supplements), to keep insulin high. Intermittent fasting (IF) allows insulin to go low — very low — which helps reduce the fat in the liver and pancreas, and “reverse” insulin resistance. There is also some evidence that milk protein causes a high insulin response, but I still eat cheese, yoghurt, and cream. (After not eating this for 30+ years of a low fat diet, I find it tasty.)

        90/60 is low, too low (for me, anyway). If I go under 100, I start to get lightheaded when I stand. I’m on both lisinopril and carvedilol (beta blocker), but it’s not for blood pressure reduction but heart failure. With LC, I lost about 20-25 pounds and my BP was 115-120/75-80. After adding IF, I lost another 25-30 pounds, but my BP is now about 100-105/65-70. I go under 100 and into the low 60s when I exercise and lose water. I’ll often drink water with salt and other minerals before exercising to try to prevent this.

      2. Gary Ogden

        Robert lipp: Absolutely. I began to make dietary improvements eleven years ago; six years now of HF and moderate carb, and two years of LCHF. Over those two years I’ve noticed my BP at the doctor’s office trending downward. In my reply to JDPatten I blamed it on seaweed, but it is just as likely to be from giving up grains, or a combination of both. I certainly feel better than I did when I was eating grains. I suspect grains lead to insulin resistance, and thus chronic inflammation (as opposed to the normal inflammatory response to injury). I do a fairly strenuous workout, and, though I sustain an occasional injury, like all athletes, I heal readily, and have no aches or pains at age 67, and sleep like a rock.

  26. Randall

    Dr. Kendrick, just a question and only meant to be a question – are you saying blood clots cause the arteries to plug? If so how would that cause them to inflame? Dr. Dwight Lundell heart surgeon , having done more than 5,000 open-heart surgeries who has “peered inside thousands upon thousands of arteries.” “Take a moment to visualize rubbing a stiff brush repeatedly over soft skin until it becomes quite red and nearly bleeding,” he writes. “This is a good way to visualize the inflammatory process that could be going on in your body right now.” If the picture I am posting does not show up please go here and view picture 2/22 http://www.medicinenet.com/heart_disease_pictures_slideshow/article.htm

      1. Jen

        Apologies for asking the same question but!
        Do you think some Auto Immune Illness like Lupus could be caused by Gluten damaging the gut lining, whether Celiac disease is diagnosed or not .
        Surely thes conditions arise from inflammation in the body?

  27. Bob

    Does someone who has had a DVT necessarily need to be on anticoagulant medication? Are the measures one would take to avoid a(nother) DVT or PE the same as those one would take to achieve and maintain heart health?

  28. Geoff Magrin

    Thank you Dr Kendrick for taking the topic to where it belongs, Haematology. As a ham scientist with type I VWD, mild heart disease and metabolic syndrome I am so interested in your discussion as it is me. I love the eloquent simplicity of the argument that the clotting cascade sequence is the culprit. Re endothelial damage there is a thought that sheer forces and turbulence at bifurcation of vessels injures endothelium. You have described the response but what causes the injury is then the real cause of heart disease

  29. Eric

    Malcolm, you are right in stating that today’s treatment of MI essentially consists of clot busting. You seem to buy into the view that clot formation is the main event.

    However, there seems to be considerable evidence that there are MIs without clots, and that most clots form only several hours after the MI or were present before the MI.

    Click to access on_the_genesis_of_myocardial_ischemia.pdf

    Click to access mw_2015-66-6_25324.pdf

    I found this webpage after Göran posted a link to this video:http://www.herzinfarkt-alternativen.de/herzkatheter-film/

    Of course, Dr. Knut Sropka subscribes the theories of Dr. Berthold Kern, which fell out of favour in the early 90s. I wonder if it is really either – or, or if we could profit from trying to use the observations of Sropka and Kern and the documented successful treatments with digoxin and oubain (g-strophanthin) to test and hone your theory?

    Maybe a synthesis of the theories is possible (such as in what is bad for arteries is also bad for collaterals)? Or maybe there are two distinct kinds of MI?

    What I don’t understand about the Sropka/Kern theory is why dying heart muscle tissue would result in clot formation in the arteries supplying blood to the affected areas. Can someone try to explain?


    1. Dr. Malcolm Kendrick Post author

      Sometimes when you look, the thing is gone. There is no doubt that the final event is far more complex than clot > artery blocked > MI. I have not discussed this in great detail in this blog, but you can find those with MI and no clot, those with clot and no MI, those with clot, followed by MI several weeks later. This can all be explained. I suggest you look up myocardial hibernation, a most interesting area.

    2. Dr. Göran Sjöberg


      What a complex CVD-world!

      Dr. Sroka also wrote a very interesting paper about “heart rate variability” as a measure connected to the balance between the sympathetic/parasympathetic autonomous nerve system basically controlling the internal nerve system in the heart. I talked with an experienced by-pass surgeon who had produced recently produce a Ph.D. thesis on arterial fibrillation which for sure is about the internal nerve system in the heart going awry and I thought he should be an “expert” on this subject but his ignorance on this subject was astonishingly complete. He didn’t understand what I was talking about so I dropped the subject.

      To me, an amazing ignorant world among the cardiology “experts”.

      I haven’t taken any heart medicines for 17 years now but have reluctantly started wondering about the “baby-aspirin” again. Perhaps I stick to my garlic – I am not sure.

      I am just now done with the all the wood chopping and enjoy the nice view of the great piles of firewood drying in the sun. Good feeling for the parasympathetic part of the control system.

  30. Craig E

    With respect to clotting I am heterozygous factor V Leiden and didn’t really ever know or care what it meant. My mother is homozygous and almost died in her thirties from a lung clot that started as dvt. She has been on warfarin for ages…and was also on statins even though no cvd aged over 70 (I convinced her to ditch them). I have a great degree of admiration for Dr K and others that seek the truth on controversial topics and keep an open mind. Sometimes it is overwhelming. Even with a biochemistry background and a few years of reading and research I often get lost. I am continually amazed at friends and family and how they form their beliefs in this space…mostly relying on ‘authorities’, articles in tabloid press and GPs…and when I challenge them they usually say ‘what would you know – you’re not a doctor…’ ho hum. Like the majority of the readers here i am keen for knowledge based on fact and I am happy if some of my long held beliefs are proven false. Keep up the great work Dr K.

    1. Dr. Göran Sjöberg


      So well put!

      Talking biochemistry I am now back with my nose deep in “THE CELL”, Alberts et al., now reading about cell signaling. I love this book not least because, despite it being “solid in the science”, it constantly stress the complexity of ANY physiology in the single cell but staggering in the multiple cell organisms.

      E.g., I read in the introduction to chapter 15, “Cell Signaling” :
      “Bewildering arrays of signaling systems govern every conceivable feature of cell and tissue function during development and in the adult.”

      Sharing this view my respect for categorically minded medical experts is not great.

  31. mikecawdery

    Today there was a statement in the Daily Mail promoting the use of statins for cancer. http://www.dailymail.co.uk/health/article-2912510/Statins-help-stop-spread-cancer-lower-cholesterol.html
    The Statinists are at it again.

    My response is relevant w.r.t to TC and treatment of CHD. If one is saved from CHD what is the next most likely cause of death? Cancer (or prescription drugs see Starbridge – JAMA, July 26, 2000—Vol 284, No. 4 483)!

    1. Anderson KM, Castelli WP, Levy DL: Cholesterol and mortality: 30 years of follow-up from the Framingham study. JAMA 1987;257:2176-2180 Extract from summary There is a direct association between falling cholesterol levels over the first 14 years and mortality over the following 18 years (11% overall and 14% CVD death rate increase per 1 mg/dL per year drop in cholesterol levels) The NHBLI and AHA (http://circ.ahajournals.org/content/81/5/1721.long The Cholesterol Facts A Summary of the Evidence Relating Dietary Fats, Serum Cholesterol, and Coronary Heart Disease) citing this paper claimed that “a 1% reduction in an individual’s total serum cholesterol level translates into an approximate 2% reduction in CHD risk” . May be a decrease in “RISK” does not tie in with an increase in mortality rate. Rather 1984-ish!
    2. JAMA. 1996 Jan 3;275(1):55-60. Carcinogenicity of lipid-lowering drugs. Newman TB1, Hulley SB.
    All members of the two most popular classes of lipid-lowering drugs (the fibrates and the statins) cause cancer in rodents, in some cases at levels of animal exposure close to those prescribed to humans
    3 Proc. Natl. Acad. Sci. USA Vol. 90,pp. 7915-7922, September 1993. Review, Oxidants, antioxidants, and the degenerative diseases of aging (cancer/mutation/endogenous DNA adducts/oxygen radicals); Bruce N. Ames*, Mark K. Shigenaga, and Tory M. Hagen “Oxidant by-products of normal metabolism cause extensive damage to DNA, protein, and lipids. (DNA includes mitochondrial{mtDNA} and nulear{n-DNA}).
    4. Even Merck is aware that CoQ10, a very important intra-cellular anti-oxidant necessary for the protection of mtDNA from ROS(reactive oxygen species) by their two US patents combining CoQ10 with simvastatin and lovastatin. (US Patent 4,933,165 http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.htm&r=1&f=G&l=50&s1=4,933,165.PN.&OS=PN/4,933,165&RS=PN/4,933,165 and US Patent 4,933,165
    5. Damage to the mt-DNA and its consequence of damage to the normal ATP energy cycle being replaced by an ancient fermentation process can be demonstrated in ~80% of all solid tumours irrespective of cell type by PET-CT scans (Christofferson, Travis. Tripping Over the Truth: The Metabolic Theory of Cancer).
    6 Of course cholesterol is used by cancer cells. They too, just like normal cells require cholesterol for their cell membranes which probably accounts for the fall in TC in cancer. What else would one expect?

    Why is it that like the 1984 leaders, history and fact have to be ignored, modified or destroyed by the current crop of medical researchers (for those under 60, the author George Orwell also wrote Animal Farm)

    1. David

      Perhaps a bit unfair on the Mail (I can’t believe I just wrote that)? It has been widely published, including in the Grauniad who published a similar story on June 3 last year. I would guess a press release, possibly on the occasion of an annual conference? The lead author has connections to AstraZeneca.

      On the statination front: if you set a target level for cholesterol then the mildest statin that will do the job could be prescribed. If you can convince the medical authorities that stain should be minimised in everyone, regardless of risk, then you go for the strong ones, Crestor by AZ? And if it cures cancer then you can forget concerns about side effects like muscle fatigue.

  32. Gert van der Hoek

    The habitat of modern man may resemble the disturbed habitat of the elephants mentioned in this article . Resulting in CVD.

    “The Disturbed Habitat and its Effect on the Health
    of Animal Populations, with Special Reference to
    Cardiovascular Disease in Elephants”

    Click to access procrsmed00159-0078.pdf

    (thanks to Staffan Lindeberg)

    1. Helen

      Gert, thank you for posting this link. I note the paper appeared in 1968. At the present time African elephants are facing severe pressure on their habitats from human encroachment, as well as an extinction threat from the increase in poaching. It would be interesting, and doubtless alarming, to read an updated study.

      I wonder about large human populations which suffer chronic severe stress, e.g. from political or social oppression, poverty, war and displacement. If infectious disease or starvation doesn’t kill people living in these circumstances, CVD will do so. I think Malcolm has touched on this, either on the blog or in one of his books, in relation to the population of Karelia.

      1. Gert van der Hoek

        Helen, sad stories indeed about the displaced persons and the elephants.

        What I had in mind when posting the link was the current habitat of modern man. Where and how do we live? We call it home, or village, city, school, plant, office. In many cases this environment seems to be a faint shadow of the habitat in which we became human sapiens.

        Modern man tries to adapt to this new habitat, apparently part of this process of adaptation is developing hart diseases and strokes. Number 1 en 2 causes of death , worldwide, according to WHO.

  33. Patrik

    Thank you Dr Kendrick for this interesting post, and the ones before it.

    I’m by no means a doctor but very interested in this question. Fist of all it seems modern health research has collapsed. The core scientific principles are not respected which is to observe, form a hypothesis and then try to *refute* that hypothesis by experiments and/or further observations. Epidemiology, prestige and commercial interests are probably to blame in no particular order.

    As for what causes CVD, I think the question should be revised. It’s a bit like asking what causes fever. CVD to me seems to be a secondary disease with many underlying causes.

    Our circulatory system needs constant maintenance and care, but if for some reason that process fails because of deficient maintenance or overwhelming damage, our body enters an emergency mode – CVD. Much the same way as fever is an acute temporary response to a disease. And if the underlying cause of the fever is not resolved our body eventually succumbs to it.

    Some candidates causing this damage and “deficiency in maintenance”
    A high consumption of sugar, starch and perhaps processed vegetable oils – Increases the amount of “bad” bacteria in our gut and mouth. They will eventually enter our bloodstream and colonize the walls of our blood vessels, causing damage and necrosis. The bodys acute response is to fight the bacteria and repair the damage of the vessels with a crust (atherosclerosis) the same way as an external infected wound is handled.

    High blood sugar will also lead to oxidative stress and cell damage.

    Inadequate consumption of animal fats protein and other essential nutrients. Our immune system and cells require a steady supply of animal fats and protein. Insufficient nutrition will lead to arterial stiffness and arterial damage.

    To frequent meals. We tend to constantly refill our digestive system, and this taxes our immune system because in constantly have to keep harmful bacteria and toxins resulting from the food consumption in check. Especially if the type of food digested is types resulting in bad bacteria growth.

    Just some unfinished view I wanted to share.

    I actually think cancer can be viewed the same way – A secondary disease/response from many different underlying causes. High consumption of sugar for example leads to oxidative stress and bacterial growth. If the immune system cannot keep up and remove the resulting toxins and damaged cells, tumors forms to be dealt with later, but if the immune system is deficient and the toxic and cell damaging process continues, the body succumbs to it and full blown cancer develops. An interesting theory is that tumors actually helps the immune system by containing toxins and damaged cells to be dealt with later, and that explains why the immune system does not attack some stages/types of cancerous cells

  34. Robert lipp

    Hi All
    Can somebody confirm or correct my thinking, please?
    For AF where the Fibrillation is continuous and relatively fast coagulation is more likely.
    While AF where the Fibrillation is intermittent (sometimes15 secs to 45 secs gaps) and slower is less likely.
    Therefore, are there natural foods or supplements that will moderate AF or even maybe stop it altogether?

    1. Dr. Göran Sjöberg

      As far as I understand it AF is one backlash of CABG – not surprisingly. It is a scary condition which I have luckily escaped during my CVD carrier. My unstable angina seems to have disappeared with 1600 IU natural E-vitamin I added two years ago.

      In my present world view it doesn’t hurt to try a strict LCHF way of life and avoid all heart medication. (I am just now a little hesitant about the baby-aspirin.) It is not a simple step to skip the carbs but it might help you to restore the health if it is damaged as in the metabolic syndrome, i.e. insulin resistance. Fasting for a day or two during the week (5:2) may kickstart the reversal if I understand Dr. Jason Fung right.

      If you have a serious problem you also have a strong driving force to solve your problem and I guess that is way you are here at Malcolm’s blog?

      1. Dr. Göran Sjöberg


        As you may have noticed I am i favour of a “natural” alternative approach and I think it should be broad out of my present attitude of caution. The great benefit of such an approach is that it is basically without “side affects”, besides wasted money, and it “might” help. Big Pharma is watching with falcon eyes so we can feel pretty safe about this being safe but they are trying their best to stop this kind of “quackery” to keep the monopoly on their own and definitely more sophisticated quackery.

        I am not that consistent with any of my supplements (except the E-vitamin and the C-vitamin which “seems” to work) but surly Q10 supplement doesn’t hurt and especially if you are not off the statins. Now and then i find Q10 among my “pills”.

        Actually I am today very much on grass fed organ meat (nothing more nutritious) and now and then there is an ox heart in the box of which I make ground beef – sometimes tartar beef – and here you find the Q10. I am not sure if you store Q10 as with fat soluble vitamins – anyone?

        Well tomorrow I will go for a can of sardines to boost my DHA, EPA store. I’ll top that with a couple of organic eggs and might be fooled by “quackery” – people tend to make money on whatever.

        And it is easy to get confused – it is there all the time 🙂

        Just now I am looking at a schematic figure (in my present reading of “THE CELL”) of how the insulin receptors in our cell walls works and signals into the interior. Shockingly complex to my understanding and that is just the beginning of what happens in the chain of physiological events if you eat a lot carbs. You are basically lost when you try to understand the details and put them into a context.

        Poor us!

        And about your reference, it looks solid, I though wonder if they have their guns out for my E-vitamins – wouldn’t surprise me. Easy research money! Anyway, the question on the antioxidants seems to be very hot and I have no clear understanding of the subject. Regarding E-vitamins the crucial thing, as far as I have been able to disentangle the subject, “refutation” studies are based on synthetic type of E-vitamins while “successful” treatments are all base on the complete set of alfatocopherols in natural vitamins. And as always, as Pauling relentlessly pointed out in his book about vitamins, it is also a question about the dose. He was so fed up with the hidden agenda of the “medical establishment”.

        I just wonder about the authors affiliation

        From the Biochemistry Group, the Heart Research Institute

        Anyway, myself, I am just an anecdote but feeling fine now with a glass of wine in front of me watching the five ducklings of the successful mallards chasing whatever the find in my pond and it doesn’t hurt to think about my firewood drying in the sun at the same time.

        1. Gary Ogden

          Dr. Goran: While heart is the richest source of CoQ10, liver also has significant amounts. To satisfy the authors of that paper eat plenty of avocados along with the heart. How do you prepare it? I cut them into cubes and marinate overnight in olive oil, apple cider vinegar, cumin, salt, pepper, paprika, annatto seeds and garlic, then broil them on skewers. Mighty good!

      2. JDPatten

        Goran: Back to you again.
        This fellow really sounds like he knows what he’s talking about. He did some of the original research on Co Q10. (He’s shown up on the blog before.)
        At 38 minutes into the video he describes how chicken heart is probably the best readily available food source of Q10.
        Your own heart is largely constituted of Q10. The higher your metabolism the more there is. Apparently it’s really essential. More so than vitamin E?
        Vitamin E:
        The chart that shows up at 29 minutes, 49 seconds indicates that more than 300 mg of E a day can interfere with Q10 absorption. True? Don’t know. But it made me think of your regimen.

      3. Dr. Göran Sjöberg


        Thanks for the link to the video – I will look into it.

        The bottom line (just now) is that I two years ago read about (through Pauling’s books) the E-vitamin regimen at those levels had been used successfully in Canada to treat many thousands of angina sufferers at the Shute clinic (now closed) and although BigPhamra is trying their best to scare people out of the vitamins I decided to see for myself if it could help and as far as I can judge it seems to work pretty well for whatever reason.

        There are though strong forces around to try to stop my kind of vitamin abuse. It might be BigPharma behind all this working with their ‘caring love’ for their potential customers – that is what I suspect. After reading Marcia Angell’s book I am very convinced that there is a tremendous amount of this kind of ‘love’ in the world.

    2. JDPatten

      I follow medical news concerning AF, so I can tell you some of what they’re saying.
      Recent news has it that paroxysmal AF is much more risky for stroke than originally thought. Almost as risky as continuous AF. Actually, what you describe, with just a few seconds of relief, sounds continuous. Have you had an “official” diagnosis?
      These might help for more natural approaches to anticoagulation and supplements:
      I tried all this stuff and eventually had an ablation when the AF kept recurring.
      Also look up Prash Sanders. His work in Australia seems to be successful at treating through lifestyle changes.

  35. Drifter

    Great post, as always. It would be interesting to see which risk factors decline or disappear in the absence of chronically elevated insulin. For example, I think the Kitavans are heavy smokers with little CVD, but they also have fairly low insulin levels, which from what little I know has been established as a direct irritant of the endothelium and enabler of cell damage such as by sugar. I haven’t read SL’s book so my info is second-hand and perhaps there is something else at play there, but it might be that the risk list needs to be in two categories; one for things that are always a risk and one that is a risk predominantly in a high-insulin environment, which outside traditional cultures and a few fringe groups, is almost everyone.

  36. Ash Simmonds

    I think just thinking about stuff like this as you read/write it is enough to form clots. I’m sitting here considering all these things going on in my body right now and am hyper aware of everything going on, I’m sure there is something bound to happen to me any minute now…

  37. JanB

    Thank you again, Dr. K. One of the things I love about this site is the ever-growing sense of community. It’s such a success and you should be very proud.

  38. Bob

    Folks, I really, really would be most grateful for any thoughts on my DVT question. I would also be extremely grateful for any any opinions on supplementing with D3, K, and magnesium whilst taking Rivoroxaban or Warfarin.

    I can hardly begin to tell you how much I would appreciate your thoughts on this.

    1. Barry

      Without a full understanding of your blood profile, general health, medical history and the circumstances leading to your DVT it is impossible to suggest with any assurance what you can do to resolve the current issue or to reduce the chance of another occurring. Also, only a doctor can legally provide medical advice – I’m sure you are aware of this. So, with that in mind, the following is offered as information for you to consider and act on as a personal decision and/or under the guidance of your doctor.

      Having suffered a DVT my main concern, other than clearing the clot, would be to prevent another occurring and, depending upon your lifestyle, this may mean making some significant changes with the aim of improving your blood profile and promoting a healthy cardiovascular system. First, if you smoke stop and if you are overweight start a LCHF diet to (a) lose weight relatively quickly and (b) improve your blood profile (the standard Western diet is a disaster for everything so eat real food -that’s food you can recognise for what it is and preferably organic – not processed nutrition deficient junk produced in a factory). Dump any oils such as canola, cottonseed (found in commercially produced “foods”), soybean, sunflower, safflower, corn etc. you may have – they’re stupidity promoted as healthy whereas they are anything but. Replace with coconut oil and butter (from grass fed cows) or lard for cooking and high quality olive oil for dressings. Also reduce sugar consumption as much as possible. Sugar has zero nutritional value – just provides energy, makes you fat, creates inflammation and depletes nutrients to process it.

      The drugs you mention are not recommended to be taken together see http://www.drugs.com/cdi/rivaroxaban.html for more information.

      Arterial clots are predominately platelet based whereas venous clots are predominately fibrin based so for a DVT treatment program typically two classes of drugs/natural supplements are indicated (a) fibrinolytic and (b) anticoagulant. Have a look at these https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2925348/ & http://patientblog.clotconnect.org/2013/05/01/natural-supplements/ . Also http://www.clotcare.com/dvt.aspx & https://integrativeoncology-essentials.com/2013/03/reduce-your-risk-of-blood-clots-without-a-prescription/ . More info from Life Extension (personally I’d ignore the cholesterol stuff – as a reader of this blog I’m sure you’re aware of the truth regarding cholesterol) http://www.lifeextension.com/protocols/heart-circulatory/blood-clot/Page-01 . For more serious conditions thrombolytics are used but only under direct medical care (hospital) as there is a risk of serious haemorrhaging.

      Note that if you wish to try curcumin it is best to purchase turmeric extract supplements rather than rely upon that contained in turmeric (approx. 1 %) see this for some info http://www.drweil.com/drw/u/QAA400915/Curcumin-or-Turmeric.html and note that black pepper (which contains piperine) must be used as well to aid absorption. Unless you like natto take a nattokinase supplement.

      Good luck!

      1. Bob

        Thanks Barry. I haven’t read all those links yet but I will. It may well be significant that I’m a double leg amputee who’s legs were not very mobile before due to paralysis. I smoked but stopped for a while then had a silly one day relapse in 2010. I have been a non smoker since. I went low carb about 3 years ago but I probably don’t have the best formulated diet and I have fallen from the wagon a couple of times.

    2. JDPatten

      If you decide to go the medical route, I suggest you look into Eliquis (apixaban) rather than rivaroxaban. Recent reports indicate that it is safer with respect to brain bleeds without sacrificing anticoagulant effectiveness (I take it for occasional cardiac arrhythmia.) Whatever means you use to decrease coagulation, you’re bound to increase the risk of bleeds to some extent. You gotta calculate the real-world trade-offs. Forget about warfarin. So many disadvantages!

      1. Bob

        Thanks, JDPatten, but there are only two drugs available where I am, unless you also have heart issues, which I don’t.

    3. Barry


      I now appreciate the seriousness of your dilemma – need to move to stimulate your circulation but, for obvious reasons, cannot be as active as you would like to be.
      Hopefully once your DVT has gone you’ll be able to stop the use of pharmaceutical drugs, which all too often have long term undesirable effects, and consider the use of some of the foods etc. listed in the links I provided earlier. Personally I would prefer to add supplements and certain foods to my daily regime which, used appropriately, reduce the risk of clotting without significantly increasing the risk of haemorrhaging rather than the use of pharmaceutical drugs.

      With respect to diet; I don’t know what sources you are basing your diet on (LCHF is interpreted in different ways) but if you have not read the following two books I recommend them (I have both) as sound and reliable sources of information: The Real Meal Revolution (Tim Noakes, Jonno Proudfoot and Sally Ann-Creed) and The Art and Science of Low Carbohydrate Living (Jeff Volek and Stephan Phinney). Both books contain useful information and recipes with Tim Noakes book biased towards recipes (with pictures) whereas the Volek and Phinney book provides a more comprehensive overview of the science behind low carbohydrate living. Neither is extreme or faddish so, in my opinion, both are suitable for lifelong commitment.

      1. Bob

        Thanks again, Barry. They have me down for life long drug treatment, and I’m not expert enough to assess when I could come off them if at all. I don’t think they’ll even scan me again.
        I’ve read various books and blogs and watched a number of people such as Noakes, Harcombe, Attia, Taubes and many more, but I’m not a medical man nor an especially scientifically minded one. I have heard of but not read the texts you mentioned. I’ll add them to the list.

      2. Bob

        Two bleeds in one week on Rivaroxoban, though the first one wasn’t diagnosed as such by a Dr who visited in the week, due to complications of my condition (and the fact he didnt listen to a patient who has lived with certain things for his whole life).
        So no more of that for me. For now, I’m on clexane until I change back to warfarin over the weekend. However, I am thinking about suggesting I go on clexane long term instead. The nurse told me it’s similar to rivaroxaban. Great.
        But then I have taken it before and it didn’t cause any issues. Clexane seems to have an antidote(?) and it plays nicely with other medications I sometimes need to take, which warfarin does not.

  39. Gerry

    A query regarding your book on Amazon……thanks for the your informitive and amusing blog. One question: why on earth is your book (Great Cholesterol Con) being sold on Amazon in various ‘bundles’ including books on diets to lower cholesterol?! Can you not request that such bundles be ‘uncoupled’, since they run counter to the information in your own book and will be confusing for the purchaser? I’m about to purchase my kindle edition – definately ‘unbundled’!

      1. David Bailey

        At least this may spread the truth to some people who might not have read about it – at least before it was too late!


  40. Doug

    Regarding the AF questions and comments: Have you tried removing caffeine from your diet?

    Does caffeine belong on you naughty list Dr. K?

    In looking back on my own experience I think I might have been a life long silent AF sufferer where ‘events’ would manifest as a single ‘heart hiccup’ in my youth.

    Lately, now approaching 50, they have manifest as full blown events lasting from 5 to 20 minutes, 6 to 20 times a year, always after a certain trigger. I will second someones earlier comment, THEY (AF) SUCK!!!!!!

    I am a LCHF’er ( 5 years now, lost 60 lbs and kept it off, also a wheat belly convert but will keep that dogma on a leash for now, yes dogma) and really took to the Bullet Proof Coffee as a delivery mechanism for coconut oil and butter.

    Near the end caffeine consumption, coffee and tea, approached 10 cups a day. Since adopting the LCHF lifestyle I’m more attuned to the effects of food and drink consumption so it didn’t take long to isolate the excessive caffeine consumption as an aggregator to my condition. I now use Bullet Proof Cacao. It’s even better.

    As a side note Dr. K, you might be pleased to know that here in Canada I’ve seen 3 cardiac specialists during this diagnosis and no one has even mentions the S word nor cholesterol testing as part of my tests. Maybe progress???

  41. Eric

    Hello Dr. Kendrick,
    Your writing helps confirm the following sorts of conclusions for me: The question of what causes disease in humans is meaningless, because humans are not identical as compared to, say, electrons. A dread poison to one individual is a super-food to someone else. As the secret of health is different for everyone, seeing a doctor when you are ill may lead to good health or death. One should ignore all advice from the medical profession and instead figure out how your own body responds to different inputs on one’s own. A physician could assist in such investigations but in practice this never happens in part because of the expense, but mostly because of disinterest. Cheers…

    1. David Bailey

      I’d put that slightly differently – medicine is clearly very flawed, so you should ignore medical advice (smoking and sugar excepted) unless/until you are actually ill.

    1. Dr. Malcolm Kendrick Post author

      Of course. But you cannot mention everything. However, in general, ischaemic stroke is far more common, so reducing the risk of a common thing will tend to do more good than increasing the risk of a less common thing at the same time though. As a general rule, though, once you start putting drugs into your body there will always be a downside – somewhere.

      1. Jennifer

        yes…….especially when self medicating, which ,as happened back in the mid 1980s with aspirin. I recall people having gastric haemorrhages, in particular ,due to regularly dosing themselves with a couple of 300mg aspirin each day. They assumed that was the thing to do, whereas, the medics were recommending 75mg soluble aspirin daily, for those who could tolerate the drug. A little knowledge is a dangerous thing, as the saying goes.

  42. Martin Back

    blood clotting may be the underlying process that underpins CVD

    I’d like a bit more detail on what is being asserted here. Are you saying that the ugly, lumpy plaque that lines the inside of an artery is really just an overgrown clot? That if you film it over time then rewind the film you will see that it started as a tiny clot on an endothelial imperfection, then grew into a fatty streak, then grew further into a calcified plaque? (Then either ruptured causing an embolism or obstructed the artery so much the blood flow became inadequate.)

    1. Dr. Malcolm Kendrick Post author

      No, not really. What I am saying is that repeated episodes of blood clotting over the same point creates plaque. The plaque that we see represents incomplete healing of the clot. If you film, over time, you will see clots form, clots being covered over by new endothelium, clots being broken down and removed. However, if the clotting occurs more rapidly than the healing, the clot will turn into a fatty streak that will eventually turn into a plaque.

      1. robert lipp

        Dr Kendrick
        Thanks for this clarification.
        To extend this summary.
        Therefore, am I correct in understanding that reduction of stressors by 1 diet = LCHF or similar. 2 better lifestyle work life balance. 3 moderate exercise. 4 Taking timeouts to allow endothelial repair processes. 5 Taking key supplements like omega 3, vit C, arginine, etc. 6 Removal of toxins etc.. and 7 Similar healthy stress reduction /stress support strategies. Will limit continued endothelial damage, will allow repair of past damage, and provide the best prognosis?
        Question, how long can endothelial repairs take – obviously this is an average as there are lots of variables?

      2. Peggy Sue

        Thank you for this overview Dr Kendrick. I think I’ve got quite a good grasp of the process thus far but I keep having to go back over it all. Even then it’s not easy to see wood from trees so to speak. Especially when all the excellent comments take things off on tangents.

        If only we knew where our own personal “tipping point” is likely to be (see comment below). Homeostasis is a fantastic but ultimately very personal thing.

      3. Mr chris

        Dr K
        This seems to be the key question, what causes new clots to form faster than the healing process can deal with them?

      1. Martin Back

        JD, I’ve been reading the series as it’s been posted, but it’s wandered down lots of highways and byways and I don’t have the dots clearly connected in my head.

        I come from a construction background, so where Dr. Kendrick says platelets, fibrinogen, and clots, I mentally translate to gravel, rebar, and reinforced concrete. Now I’m thinking, hmmm, too much concrete, what’s the bio-equivalent of a jackhammer?

        But of course it’s a dynamic process of continuously building up and breaking down, as Dr. Kendrick points out. Which is more complex to get your mind around.

        As a good Darwinist I have to keep reminding myself that the whole process is just an accumulation of random techniques the body happened to find useful at the time. It doesn’t have be efficient or make sense, it just has to work.

        Some of the body’s control systems are crazy. Like if you need less of something, don’t do the obvious thing and make less, but make more of something else that counteracts what you need less of.

        It’s fascinating reading this stuff, but I’m glad I don’t have to understand it all to make my living.

      2. JDPatten

        I myself am in the (re)construction trade. I got myself from my degree in fine arts, specialty sculpture, to the restoration of antique homes (New England). Just as unlikely a backgroun for grasping this stuff. I’ve been the one, though, to see various family members through hospital stays. (Battlefields!). Now it’s my turn. It doesn’t make my living, but getting a better understanding might make my life. 🙂

  43. maryl@2015

    Dr. Kendrick, please don’t say it is now all over. There will be more, right? Brilliant. I think were I in a position to knight you or bestow a Pulitzer prize, I would pick you hands down.

  44. jgt10

    On the subject of too much carbohydrates in our diet, I’d like to bring up an evolutionary seasonal theory. I’ve pulled this together from books by Dr. Kendrik, Dr. Atkins, and one by two kettle bell trainers (No! I’m serious!)

    Before our current use of agricultural technology to increase both the production and length of storage of carbohydrates, we only had substantial amounts in the fall or late summer.

    The theory goes (and I don’t claim it as mine), the increased availability of carbs triggers a metabolic response to prepare for winter. With carb fueled energy (the glycolysis metabolic pathway) running, the body stores fats, the normal energy source (the ketosis metabolic pathway). The activity level also drops, which could allow more fat to be accumulated if the body stays in carb burning instead of shifting back and forth between the two modes.

    The evolutionary argument here is that this change puts the human body in a better (fatter) survival state, by providing a longer time that can be survived with little or no food. I.E., those that don’t downshift and store up fat have a lower ability to survive a winter.

    What I get out of this is that glycolysis is a short term mode for the body. Humans evolved in an environment where carbs were only available in large quantities for a small portion of the year. The rest of the year, the body ran in ketosis.

    Running in glycolysis for years or decades is NOT the normal mode of operation.

    To use a probably bad analogy, it is like try to drive a car using the starter motor. (Hmmm, maybe that isn’t so bad.)

    Not that this is directly, or indirectly related to the causes and processes of CVD, but could be a contributing factor.

    1. Sasha

      Italians who eat enough carbs to sustain all of humanity’s carb needs before advent of agriculture do not seem to suffer from higher CVD rates. Nor do they have shorter life expectancy than pre-agriculture people even when you adjust for infections, accidents, etc

      1. BobM

        How could one possibly figure out life expectancy for periods when no one has data?

        As a person of half Italian descent, I can tell you that carbs killed my father. His blood sugar was out of control, and likely contributed to or perhaps caused his cancer. I personally avoid most carbs, since to me the evidence seems quite clear that we didn’t evolve to eat processed carbs like pasta. I ate pasta, brown rice and beans, and cream of wheat/oats for many years, as I thought low fat was good, and I couldn’t understand why I could eat food and yet be hungry 15 minutes later, why I’d get depressed and even violent, and why I had to eat all the time. Contrast that with low carbs, where I did not eat AT ALL Tuesday and Thursday of this week. I rarely eat breakfast now, and if I do eat breakfast, I tend to skip lunch.

        I took my blood sugar today and it was 109 (US units) before lunch (I did not eat breakfast and jogged for 45 minutes and had just coffee with a bit of cream). Lunch was salad with meats and cheeses and anchovies (with olive oil and balsamic vinegar), and additional taco meat with salsa and full fat sour cream. Oh, and two small fermented pickles. My blood sugar about an hour after lunch was 115. Contrast that with pasta, where my blood sugar would easily hit 160, and I’d be swooning and hungry 10 minutes later. Even if Italians can eat pasta, I can’t. It nearly killed me (I ballooned up to 250 pounds, and eating low carb I’m down to 200).

      2. Brian Wadsworth

        Italians in Italy do not regard pasta in the same way we do in the USA. Pasta is just one course in a multi-course meal made up of small portions of various food types. It is not consumed as the bulk of a substantial meal in itself.

  45. Randall

    img style=”width:380px;” src=”http://images.medicinenet.com/images/slideshow/heart_disease_s2_atherosclerosis.jpg” alt=”this is a diseased artery – tried to post the other day

  46. Gert van der Hoek

    Interesting hypothesis pointing to neovascularization of the outer tunica intima as the first step of the process of artherosclerosis.

    The way I understand it: stress – all kinds – could initiate thickening of the artery walls; the new cells are further away from the bloodstream, they get short of oxygen, so new blood vessels are created to provide oxygen. However the trade-off is lipid deposition, starting coronary atherosclerosis.


    1. Martin Back

      I think of a typical government department where everybody follows procedures and nobody uses their initiative. No one is saying, hey guys, this thing is getting out of control, maybe we better stop what we’re doing and have a re-think. They just continue mindlessly doing whatever it is that they do, and the plaque grows and grows…

      1. Gary Ogden

        Martin: Good analogy. And government departments inexorably grow in size, metastasize, so to speak.

    2. Dr. Göran Sjöberg


      Thank you for the reference – very interesting!

      It is so very striking for me today, as a severe “CVD-sufferer” and a nosy sceptic, how very little we “understand” about our physiology especially when I am now digging deep into the “Molecular biology of THE CELL”. I tend for every day to grow more and more allergic towards all official dogmas produced by medicine. Disgusted may be a more proper word for allergic when realising the obvious economic incentives behind these “screwed” dogmas.

      I find, myself, the theory of the Vasa vasorum and bacteria advocated by Ravnskov and McCully interesting but as far as I understand this theory is very disputable. With five of the numerous references in the paper to Ravnskov, one of my favourites, I now tend to get more interested and will probably read the full paper.

      Though, sometimes I wonder about the eternal philosophical question if knowledge – “understanding” – is at all possible. Perhaps it is just “doing” and measuring the outcome of the experiments which you are performing on your own body that may count.

      “It works for me!”

      E.g. with 1600 IU natural E-vitamin my angina seems to be under reasonable control. Why should I care about “understanding”?

      “Well, see, you are a typical ‘placebo’ “anecdote”!”

      Or perhaps more favourably looked at as a “case” with Malcolm’s eyes. 🙂

      And, still it feels nice to know that the earth is circling the sun and not vice versa but what does this “understanding” matter?

      1. Diana


        Dr. Subbotins’s paper was linked a couple of times over here, he even joined the comment section himself, in one of the previous “sonets”. There was not much follow-up, unfortunately.

      2. Dr. Göran Sjöberg

        With my present sceptic mind I “Googled ” on Vladimir Subbottin and arrived at him being a very productive researcher though covering a very broad range of subjects. He seemed to be or have been attached to an organisation “Arrowhead Research” now evidently a Pharmaceutical company specialising in gene therapies. Makes me pull back!

        However judging from his e-mail address on this specific paper from 2011 he seems to be an independent researcher as Uffe Ravnskov which adds to his credibility or is he hiding his affiliation just for credibility?

        Well – I must now read the paper and see if I convincingly understand anything and if I then will be “carried away” which too often seems to happen with me nowadays.

      3. Dr. Göran Sjöberg

        Well, initiating the reading my heart weakens when I se another reference to a favourite of mine , the 19th century greatest physiologist Claud Bernard. But I am easily pulled by my nose 🙂

        1. Mr chris

          Dear Goran
          Four sunny days in and around Goteborg for my granddaughters graduation from IHGR. Four days at 30° in your lovely country. No wonder you seem so relaxed.

      4. Dr. Göran Sjöberg

        Well, I am now almost through this paper and not only do I think I “understand” what I am reading but I am unfortunately also “carried away”. There seems to be an appealing and irresistible logic to me.

        And it is a lot of “new stuff” for me.

        First that the innermost layer of our coronary arteries does not consist of one single layer of epithelial cells but a multi-layer cellular compartment, or diffuse intimal thickening (DIT), developed early in life and nutritionally supplied by diffusion from the lumen.

        The pathological state, though microscopically indistinguishable from the benign state, is always (?) preceded by revascularisation in the outer layers from the Vasa vasorum with capillaries outside of the artery

        But then I am lost – someone – help me!

      5. Gert van der Hoek

        Apparently the outer DIT has a protein called “biglycan”, which interacts with collagen, and/or LDL lipids. Normally bigyclan in the outer DIT doesn’t have contact with blood, but when the thickening process causes hypoxia, this triggers neovascularization and now biglycan has direct contact with blood and it will do what it is good at: binding LDL The start of artherosclerosis.

        My 2 cents ..

        1. Diana

          Biglycan is a small leucine-rich repeat (LRR) proteoglycan. LRR motif suggests its role in innate immunity – PAMP (pathogen-associated molecular patterns) recognition and binding. This is the same priniciple in animals and plants.
          Biglycan is involved in driving and shaping the inflammatory signalling by interacting with TLRs.

      6. Gert van der Hoek

        Thanks Diana, you mentioned this article before. A copy of a comment by dr MK:

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

        Pondering about it: this hypothesis keeps the cholesterol drugs in business?

        1. Diana

          “But there are a couple of major problems with this hypothesis. Possibly the most important is that the abdominal aorta has no vasa vasorum, and this is an area of major plaque development.”

          Yes, I remember this. So, what else is there? Lymphatic microvessels?

          Does this possibly relate?

          Lymphangiogenesis and Angiogenesis in Abdominal Aortic Aneurysm (Sano, 2013)

          “Immunohistological examination also revealed intimal/medial lymphangiogenesis in the AAA wall, particularly in the area where medial elastin was marketly degraded. While lymphatic vessels are usually absent from normal aortic intima and media, podoplanin-positive microvessels significantly increased in AAA intima/media.”

      7. Diana


        The role of the lymphatic system in cholesterol transport (Huang, 2015)


        Over the past 30 years, although observational studies suggest a hypothesis that higher HDL cholesterol would reduce cardiovascular events, recent data indicate a system more subtle and complex than that basic notion. It is widely recognized that what really matters is cholesterol flux and removal from cells like macrophages. However, relatively little research examines the trafficking of HDL into and out of the interstitium. As trafficking out of the interstitium appears to be dependent upon functional lymphatics, we suggest that additional research into the maintenance of lymphatic transport with respect to HDL trafficking is needed.

    3. Gert van der Hoek

      Biglycan is believed to play a role in the mineralization of bone, according to Wikipedia. Reminds me of calcium and coronary artery calcium score.

  47. Barry

    Financialfundi (June 4),

    I think you are splitting hairs re “medical advice”. There is plenty of information on the internet about the distinction between advice and information (which is how various websites recommend whatever as the information provided is not specifically targeted at a person) see http://healthcare.findlaw.com/patient-rights/what-is-the-unauthorized-practice-of-medicine.html .

    We can all go through the comments and nit-pick various things said, but most of us recognise that they are said in good faith with a view to helping either a particular person or as information which others may find of interest.

    1. financialfundiRoger Arnold

      Inferring that only doctors can offer advice may be construed as an attempt to stifle debate. For example, it may persuade readers from relating their own personal experiences – which may be of benefit to the readers of this blog – for fear they may fall foul of some or other law. This is why I criticised your statement.
      PS, the info in the link provided is not relevant to the UK

      1. Dr. Malcolm Kendrick Post author

        Roger, Yes, good point. I was thinking of replying, but perhaps wearing too many hats to do so. Anyone can offer advice. Only doctors can be hauled over the coals for offering advice that goes against mainstream. Which is why I do not respond to individual requests for advice. Were I to do so I would lose my license to practice medicine pretty quickly. This blog is well patrolled.

        1. Bob

          What are the rules around that in the UK, and how do they compare to the rules of the South African organisation who have taken Tim Noakes to court, who say that a “we” question can be answered but an “I” question cannot?

          1. Dr. Malcolm Kendrick Post author

            Pretty similar I would think. Of course, you can answer an “I” question, but if things went wrong you would be in a bad place medico-legally. Same sort of thing with good samaritan actions. ‘Is there a doctor on-board.’ Well, there might be if no-one is going to sue me for trying my best, but failing. Which, of course, happens.

          2. Bob

            They may differ in an important way, then. In Noakes’s case the body in question (I forget the exact name) took the action and not the lady who was advised. Indeed, she chose not to take the advice.

          3. Gary Ogden

            Bob: The way I understand it, the case against Dr. Noakes doesn’t really fall into such categories. It was a “we” answer to a nutrition question. It appears to be nothing more than a rear-guard action by the nutrition establishment to defend at any cost their failed paradigm. The sheer volume of the public comment (mostly highly critical) leading up to the current Nutritional Guidelines for Americans delayed them for months; many now realize the advice we’ve been fed concerning how to feed ourselves is terrible advice, so those still pushing it are getting a bit desperate.

  48. Dr. Göran Sjöberg

    I think we are facing a fundamental philosophical/physiological gap relating to which seems to go unrecognised (deliberately (?)) and therefor is just slipped over.

    As far as I understand this it is mainly a psychological phenomenon when it relates to our in-saturable desire for ¨simple explanations”, e.g. CVD-Cholesterol-Statins. I guess that the desire for one-liners is why corrupt dogmatic leaders in the medical establishment have more often than not escaped being scrutinised.

    On the molecular biology level we have on one side of the gap an impressive scientific understanding of the association between a few fundamental items of our physiology and where there seems to be a firm thermodynamic foundation as far as I now understand thermodynamics. On the other side of the gap we have pathological phenomena of our physiology, which is the concern of ordinary people, and what medicine is supposed to be concerned with. Here the greatest (?) physiologist all time, Claude Bernard, successfully applied science 150 years ago. Today his sincere scientific approach seems to have been completely lost in the corrupt hands of Big Pharma who instead is abusing the science of the molecular biology but which still relentlessly is producing new “discoveries”.

    I am as a researcher sincerely impressed of what is happening on the one side of the gap and at the same time as a human being equally disgusted by what is happening on the other side of the gap.

    1. Dr. Göran Sjöberg

      It stinks doesn’t it?

      I think Polderman has half a million lives on his consciousness if I remember Malcolm right. A true medical “hero”!

      Well – to me, not least after having read Marcia Angelll’s book, all medicine stinks today and it gets worse all the time.

      What will stop this insanity?

      1. Dr. Göran Sjöberg


        I think that is actually what it is all about. It fits my personal experiences with my own surroundings. It is to scary to absorb for anyone.

        If you stop believing in the “Health Care System” what is then left of a our society in the true sense of the word society.

  49. Joe


    “Doctors have long warned that a lack of regular sleep raises the risk of obesity, diabetes, heart disease and even cancer.

    “But until now they have not been sure exactly why this is.

    “The new research, conducted by Northwestern University, Chicago, suggests allowing the heart to properly rejuvenate is key.

    “The research team believe this is strongly tied to an internal mechanism called the circadian rhythm.”

    The secret to avoiding a heart attack? Going to sleep at the same time each night. HPA axis dysfunction?

  50. Diana

    Off topic lesson (iron and dormant blood microbes) from AD research:


    Professor Douglas Kell of The University of Manchester’s School of Chemistry and Manchester Institute of Biotechnology is one of the editorial’s authors. He says that supposedly sterile red blood cells were seen to contain dormant microbes, which also has implications for blood transfusions.

    “We are saying there is incontrovertible evidence that Alzheimer’s Disease has a dormant microbial component, and that this can be woken up by iron dysregulation. Removing this iron will slow down or prevent cognitive degeneration – we can’t keep ignoring all of the evidence,” Professor Douglas Kell said.

  51. Sasha

    Not sure if this book has been mentioned already… “Science for Sale” by David Lewis, PhD. He was one of EPA’s leading scientists before becoming a whistle-blower. I just got the book and it looks very good. Fraud and scientific misconduct seem to be everywhere, even at the highest levels of agencies that are supposed to protect the public.

    1. Gary Ogden

      Sasha: Especially at the highest levels of government agencies. They are fully captured. Even agencies such as NIST and the NTSB cannot be fully trusted.

  52. Buck

    One of the risk groupings for CVD and Statin efficacy is:
    has had a heart attack… etc.
    Is there ever an escape from this group?
    My heart attack was 15 years ago and yearly check ups have shown no increase of plaque build-up.
    I have never taken a statin.
    I have been taking l-arginine for the last 12 years.

    1. John

      Hi, how much l-arginine do you take. Has it reduced your blood pressure. Ive been taking it but doesn’t seem to be doing anything.

    2. Gary Ogden

      Buck: What form do you take, how much, and how often? The papers I’ve read on PubMed concerning L-arginine show it can be hypotensive, particularly in those with elevated ADMA.

      1. ann

        are you saying not to take folic acid. I thought this was good for you. Ive been taking 3mg of arginine but it is doing nothing for my blood pressure. want to get of the meds.

  53. Buck

    The formulation I have been using, is one tablet daily consisting of:
    600 mg arginine
    0.1 mg folic acid
    0.5 micro-g B12
    0.75 mg B6

    1. Gary Ogden

      Buck: Thanks. I asked my question before I read your answer to John. A word of caution: Folate is an important nutrient; folic acid is not, nor is it a good folate substitute, and it can be problematic. Richest food sources of folate are: Liver (especially chicken), sunflower seeds, spinach, kelp, legumes, egg yolk, and leafy greens.

  54. Anna

    I feel the need to talk about diet because I am convinced it is very important to this issue and other health issues. I also find it puzzling that CVD could be going down when 50% of the kids I see are fat, and 75% of 30 year olds. My daughter who lives in Sweden tells me there are very few fat people, and the way they eat is VERY different. Now, someone mentioned exercise does not help you lose weight. Well, first of all I do not think that is true if you exercise on a regular basis. It does slowly change you. And the few people I know who are truly physically active are lean, irrespective of age. But exercise is not necessarily about weight loss. It’s about having good health, oxygenation and less insulin resistance, lower blood pressure and cardiovascular fitness, etc.

    Diana, thank you for the explanation. While I think that I need to be HCLF, I am still a bit puzzled as I feel this whole situation is multifactorial and that something has gone wrong when people have to limit carbs to such a degree. As to using a nutrition counter, the only thing I have ever been willing to put in some real effort to counting is carb grams, so that I can get a good feel for it. I know what foods contain fiber.

    Stephen T, I am not into calories in-out. Check out some Jason Fung videos about that. He’s a kidney doctor who treats many diabetics and got really serious about understanding insulin resistance and reversing it with diet and fasting. What’s a stone? About 20 pounds? As for your health reversals, I would like to present an article on this whole subject, one reason I found it interesting is the large number of interrelated health issues that go wrong when one has high levels of insulin.

    There were a few things he said near the end about what type of fat to eat that I suspect are wrong, but this is a very interesting speech indeed, making the case that yes, it IS all about insulin! It is called Insulin and its metabolic effects.


    The low fat craze got to the point that I several times found articles about diet and health and our paleo ancestors as well as Native Americans which stated that they ate lean meat! Hah!! that is absurd. Humans love the taste of fat and most certainly were not throwing away that fuel!

    1. Herb Dreyer

      It’s not the taste of fat. Fat is a carrier of taste. Try out this experiment: eat some fat all by itself and see what it tastes like. This is true for almost any fat. Oils are different. But you don’t eat meat with oil (at least not usually). You want the fat because it carry’s the flavor of the meat. Kind of like adding a little salt to you oatmeal water– it helps to bring out the taste.

  55. robert lipp

    My wife (diabetic) and I (both 72) went onto Low Carb Healthy Fats some 2 years ago we are IR. We lost 50kg between us. Doc took us off Blood Pressure meds and Satins. My wife has not used Insulin for many, many, many months – no raised blood glucose need. Our health is much improved – lipids are great.

    We did not count carbs, grams or whatever else. We ensured that we never had any “bad carbs”, never had any “bad fats”. Had moderate protein. Made sure that every meal had enough good healthy fats including “horror or horrors” saturated fat (Lard etc., butter, coconut oil (and olive oil)). Intermittent fasted every day 12 to 16 hours (only 2 meals). If weight went up we reduced the carbs until it went down. If we were starving we had more healthy fats. For us LCHF really works – for life!

    Prof Noakes has said that some IR persons on LCHF who don’t lower Triglycerides – science has no answer yet. Some therefore may need to try Dean Ornish as an alternative.

    Swedes: refer to the 2015 Gov announcement of a review of 16,000 odd science reports that indicated that LCHF was a winner – they changed official dietary guidelines.

    Carbs need to be limited (for those IR persons and maybe IS too should apply this) because they are IR. Fats and Protein are essential macro nutrients – Carbs are not.

    For long term weight control CICO is a myth. Reasonable exercise is good for long term health.

    It is multi-factorial – Dr Kendrick’s series indicates that – e.g. STRESS. However, for those who are IR carbs are largely a killer.

    “the few people I know who are truly physically active are lean, irrespective of age” not always true – read Prof Noakes’ story. He was putting on weight notwithstanding lots of serious exercise – while carbo-loading.

    Dr Mercola has a lot of good/interesting things to say – however I read his blogs with a pinch of salt as he seems to be more interested in selling products.

    Whatever you read, whatever you do, science works on averages but we are unique individuals with different genome, epigenetics, stress, toxins, gut biome, whatever you name it – so adjust and adapt to what gives you optimum health.

  56. Sally

    I’m interested in the BP ratios, as dictated by whatever the trend is from year to year. When we were told the SBP went up with ageing and 100+age was ok, who decided? Who decided it wasn’t ok and something much lower was now the thing? How complicit are the Pharmas in the published decision? Change a number, create a patient, and all that? How do we know, where is the objective diagnosis, of what is “high” and what is ok? Impossible to trust Pharma on most things it seems ( lots of law suits) why believe I should, at age 72, have the BP I had when I was 20?
    Oh and PS Where are all the other doctors who question things? The ones who don’t reach for the prescription pad five minutes in to your appointment. Serious question, answers badly needed.


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