What causes heart disease – part XXIX

Alcohol

Many moons ago when I wrote The Great Cholesterol Con I provided a very short section at the end on what people should do, to avoid heart disease. It went something like this:

1: Do not smoke cigarettes (to which I would now add  – or anything else).

2: Take exercise – that you enjoy. Don’t try to drive yourself into the ground. Walking outside is particularly good, especially on a sunny day.

3: If you don’t drink alcohol, start. If you do drink, drink regularly – don’t binge drink – and make sure that you enjoy what you drink. Drink with friends, drink sociably, don’t drink to get drunk.

4: If you hate your job, get another one – don’t feel trapped.

5: Make a new friend, join a club, find an area of life that you enjoy. Praise other people and try to compliment other people more often.

6: Look forward to something enjoyable every day, every month, and longer term.

Not a very long list I admit, and even at the time I was aware that there were other things that could be done. However, I was reluctant to write yet another ‘ten ways to stop heart disease completely – forever (money back if you die)’ type of book. My sister was critical of my ‘advice free’ book. ‘People want to be told what to do.’was her terse comment. She is good at terse.

My view was that advice should be accepted by the bucketful, but only given out by the thimbleful. People need, I replied with the utmost pomposity, to make their own decisions about what to do with their lives, and not keep looking for some fluffed up latter day prophet to guide them. Not giving direct advice has the added advantage that you won’t get sued, or lose your license to practice medicine. Or at least, it makes it far less likely.

However, in my long and winding series on what causes heart disease I have popped in a few bits of advice along the way. In this particular blog, I am returning to my Great Cholesterol Con advice on alcohol. Whilst writing that book I had noticed, and have continued to notice, that moderate alcohol consumption is associated with a lower risk of dying of cardiovascular disease (CVD). Also, that non-drinkers generally have the shortest life expectancy. In short, if you don’t drink, start drinking.

The rest of the medical profession absolutely hates this message. At heart, you see, most of them are secret puritans. The idea that doing something enjoyable, might also be good for you, is just too much to bear.

“Puritanism: The haunting fear that someone, somewhere, may be happy.” H.L. Mencken

Which means that the medical profession have done their best to attack any evidence that alcohol may be good for you. The most common argument used to dismiss the fact that non-drinkers have the shortest life expectancy, is that they have some underlying illness that stops them drinking. It is the underlying illness that then causes them to die, and not the fact that they do not drink.

There are ongoing debates about the role of combining different types of current non-drinkers in producing this apparent protective effect (of moderate drinking). Specifically, former or occasional drinkers might have reduced or ceased drinking because of ill health, making the aggregated non-drinking group artificially seem to have a higher risk of cardiovascular disease and mortality.’1

Or maybe not.

You may recognise the exact same argument used on cholesterol levels. In general, those with the lowest cholesterol levels also have the shortest lifespan. A phenomenon noted in almost all long-term studies. This, we are told, is absolutely and certainly NOT because a low cholesterol level is harmful. It is because an underlying illness lowers cholesterol levels and it is the underlying illness that kills people– not the low cholesterol levels themselves. Good try (no evidence).

The irony, of course, is that this would seem to be the perfect illustration of the fact that a low cholesterol level is caused by ill health, and not a sign of good health. Or to put this another way, if a low cholesterol level is caused by an underlying illness, that kills you, then a low cholesterol level can hardly be considered something to be striven for. Can it? (See under PSCK-9 inhibitors increasing overall mortality.)

At present our glorious cardiovascular experts are happy to inform us, in all seriousness, that a low cholesterol level can be both a sign of underlying illness, and a cause of good cardiovascular health.  Or, to put it another way, the cholesterol level can be both an effect of illness and a cause of illness. That’s the problem with logic. Misuse it, and it will come around and bite you on the bum.

Anyway, returning to alcohol. Is there any evidence that people who do not drink, do so because they are suffering from an underlying illness? No, there is not. Or, if there is I have never seen it. It is just a meme which, because it fits with firmly held underlying prejudices, has become accepted as a fact.

Actually, when it comes to prejudices, my own is that alcohol – as a chemical – is not protective against CVD. It is protective because in the various forms that humans drink it, it is relaxing, reduces stress/strain, and when it is drunk in company it is part of a lifestyle that is protective. In short, if you are looking for CVD protection, you would be best not to stir sixteen grams of pure alcohol into a beaker containing two hundred mls of water, then consume every morning before breakfast. [Two units].

Far better to uncork a bottle of red wine, (white wine, what is all that about?) thirty minutes before a nice home cooked meal. Then pour it lovingly into a glass, swirl it around a bit, then enjoy. If you can also do this outside, looking over a sapphire blue bay, with boats bobbing in a light breeze, so much the better. [This was never really an option whilst growing up in Scotland.]

In short, I do not believe drinking alcohol is a true ‘drug’ effect. The lifestyle around drinking has a major part to play. However, I may be wrong. Researchers have studied the effects of different types of drink on factors that I consider key for CVD. Endothelial function, and blood clotting factors. It seems that red wine, and beer are the most beneficial.

Here, from a paper entitled: ‘Acute effects of different alcoholic beverages on vascular endothelium, inflammatory markers and thrombosis fibrinolysis system.’

CONCLUSIONS:

‘Acute consumption of red wine or beer improves endothelial function and decreases vWF levels, suggesting that the type of beverage may differently affect endothelial function and thrombosis/fibrinolysis system in healthy adults.’2

vWF is von Willibrand Factor, something I have written about in the past. Research has demonstrated that people with low vWF levels are up to 60% less likely to die from CVD. vWF tends to make platelets sticky and more likely to cause blood clots. Alcohol consumption also considerably reduces fibrinogen levels, a key clotting factor, at all levels of drinking.

However, if you drink a great deal, the effects can reverse. You also get a sharp rebound in some clotting factors. Heavy drinking appears to increase tissue factor (THE key clotting factor), factor VII, and other pro-clotting factors such as plasminogen activator inhibitor 1 (PAI-1). 3

Clearly, therefore, there does seem to be a ‘therapeutic window’ for alcohol consumption. An amount of drinking where the benefits are greater than the potential harms. Actually, I hate writing the words ‘therapeutic window’ alongside ‘alcohol consumption’. To me, this turns the act of drinking alcohol into a dull and joyless disease prevention activity

Viewing alcohol as some form of drug completely misses the point that there is, I strongly believe, ‘happy’ drinking and ‘unhappy’ drinking. How you drink, is a least as important as how much. I make this point with great confidence despite having no evidence at all to support the statement.

However, if you want to treat drinking alcohol as something like taking a vitamin tablet, or a daily aspirin, then I suppose you can. And good luck with that. You would be like a relative of mine who had been persuaded that drinking red wine was particularly heart healthy. He drank one point five, standard, glasses of red wine every evening with his meal.  Not a drop more, not a drop less.

I have no idea if he enjoyed the red wine or not. He was not the sort of man to share that sort of information. He was more of a ‘life is to be endured, not enjoyed’, sort of a man. Still, with his meticulous wine drinking regimen, he remained alive for twenty-five years after a massive, nearly fatal heart attack. So, maybe he was right – and I am wrong.

Anyway, the main reason for writing this blog is that, just before I went on holiday, I noticed that there had been a massive study done on the effect of drinking alcohol on CVD, published in BMJ open. It had the snappy title:

‘Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population based cohort study using linked health records.’4

Ah, the poetry, the emotional power of it all. Why do researchers feel they must use such emotionally crippled language, the dreaded passive voice? Of course, I know the reason, they won’t get published if they dare use an active verb, or a personal pronoun. ‘I did this.’ Is not a phrase you will ever see in a research paper. More’s the pity. Language and emotion are closely linked, but attempting to use only the most stripped out passive language does not add scientific accuracy, it just makes it very, very, very, dull to read.

Back to the paper itself. It was, of course, observational. However, it was very big. They looked at 1,937, 360 people. And there were 114,859 cardiovascular events, of various sorts. From heart attacks, to strokes, to a first heart failure diagnosis. It also included something that I have not really come across before ‘unheralded coronary death.’ Which means, I presume, dropping dead of a heart attack without any prior diagnosis of heart disease, or any kind.

The results that I was most interested in were the following. The comparison between non-drinkers and moderate drinkers.

Non-drinking was associated with

  • 33% increased risk of unstable angina
  • 32% increased risk of myocardial infarction (heart attack)
  • 56% increased risk of unheralded coronary death
  • 24% increase risk of heart failure
  • 12% increased risk of ischaemic stroke
  • 22% increased risk of peripheral arterial disease
  • 32% increased risk of abdominal aortic aneurysm

Interestingly, these increased risks were very similar in heavy drinkers: Heavy drinking (exceeding guidelines) was associated with

  • 21% increased risk of unheralded coronary death
  • 22% increased risk of heart failure
  • 50% increased risk of cardiac arrest
  • 11% increased risk of transient ischaemic attack
  • 33% increased risk of ischaemic stroke (intracerebral
  • 37% increased risk of cerebral haemorrhage
  • 35% increased risk of peripheral arterial disease
  • 12% lower risk of myocardial infarction
  • 7% lower risk of stable angina

Which reinforces the fact that there is a level of drinking that is beneficial which lies somewhere between non-drinking and heavy drinking. It is called moderate, but it is very difficult to know what this means. I would guess between one and four units a day.

At what point does ‘heavy drinking’ start. Again, this is difficult to say, as researchers tend to clump anyone who drinks more than ‘moderately’ into the group of heavy drinking. This is a game that I call statistical clumping.

By which I mean, we have (for example) four groups. Non-drinkers, occasional drinkers (one or two drinks a week), moderate drinkers (one or two units a day), then heavy drinkers. ‘Heavy drinkers’ as a group, contains all those who drink more than two units a day. In effect, you are ‘clumping’ together those who drink more than two units a day with those who drink two bottles of gin a day. This kind of skews your figures and makes it impossible to know when beneficial drinking stops and damaging drinking starts. [The same game is played with obesity].

So, where are we? Adjusting left right and centre for all confounders, we are left with a simple fact. If you drink alcohol in moderation (with all the provisos attached to that statement), you will significantly reduce your risk of developing, and dying, or CVD.

So, I stand by my statement made in The Great Cholesterol Con. If you don’t drink alcohol, start. Did the authors of the study recommend that non-drinkers start dinking? Of course not. They would never dare. Here is as close as they got.

‘Similarly, while we found that moderate drinkers were less likely to initially present with several cardiovascular diseases than non-drinkers, it could be argued that it would be unwise to encourage individuals to take up drinking as a means of lowering their risk (although it must be noted that the findings from this study do not directly support this as we did not consider transitions from non-drinking to drinking).

This is because there are arguably safer and more effective ways of reducing cardiovascular risk, such as increasing physical activity and smoking cessation.’

Well, I would agree that stopping smoking and exercise would be more effective than starting drinking. However, the statement is still ridiculous. What of those who do not smoke, and who do take exercise. What of those who will not stop smoking and will never takes exercise. Should they still not drink alcohol, and thus fail to gain the obvious benefits?

The other statement is equally ridiculous…. ‘We did not consider transitions from non-drinking to drinking.’ So, we know that moderate drinking is beneficial. We know that not drinking increases risk. But we don’t know that if you start drinking, this will be beneficial.

I shall state this in a different way. ‘We did a placebo controlled study where we saw that those taking the drug gained benefit. However, we did not start giving those on the placebo the active drug, so we do not know if moving from taking placebo to the active drug would be beneficial.’ Using this logic, no clinical study ever done has ever proven anything. Sigh. Where is the God of logic when you need him – or indeed her.

In the end, I have this to say about alcohol. Moderate drinking (whatever that may be) is not harmful. It is probably beneficial. My own view is that alcohol consumption is tightly wrapped within healthy lifestyles to do with sociability friendship and suchlike, and that the amount of alcohol is only a part of the story. However, if you want to drink a couple of glasses of red wine in the evening – go for it.

1: http://dx.doi.org/10.1136/bmj.j909

2: https://www.ncbi.nlm.nih.gov/pubmed/18295937

3: https://www.ncbi.nlm.nih.gov/pubmed/9607117

4: http://www.bmj.com/content/356/bmj.j909

297 thoughts on “What causes heart disease – part XXIX

  1. JanB

    Welcome home, Dr. K. So glad you’re back. What a fabulous blog. Thank you. I raise a glass to you.
    Cheers.

    Reply
  2. Mr Chris

    Cheers
    I know there are ways of latching onto the comments by computer gymnastics which are beyond me.
    I would dearly love to know whajt moderate drinking is.
    As I understand it, the guidelines have been lowered, since someone very important in the guideline producing world is very puritan and totally abstemious

    Reply
  3. Dr. Göran Sjöberg

    Malcolm,

    What a great post!

    Sitting together with my wonderful life supporting wife in front of our fireplace looking at the flames around the logs I chopped last summer we both enjoyed reading your post while sipping on a couple of glass of wine and waiting for the the water in our large outdoor bath tub to heat up to 37 degrees Celsius.

    In that tub we will soon during a couple of hours enjoy the evening sounds of our garden which includes two different species of owls. And of course such a bathing sejour wouldn’t work without another glass.

    By the way, before my MI 1999 I was very moderat with alcohol. However, my wife realized that red wine might save my future life and brought bottles of great red wine into our house and liberally served since then.

    Reply
  4. AH Notepad

    Oh dear, I am not long for this life then. I hardly drink at all, even if I did, I don’t socialise with friends imbibing alcohol, as I have to get home again, and that wiould mean driving under the influence. Finding friends in the first place is difficult, and the ones who “drink to be sociable” usually seem to tend towards boring and moronic when they lose their self-critical function. They are interesting to all the other drinkers around, but they don’t appeal to me.

    If the drunken driver survives the impact but his/her sober victim dies, is that used to support the drinking hypothesis?

    Reply
    1. Socratic Dog

      Malcolm’s outed himself as a puritan with this one. What’s your problem with drinking alone, mate? If it’s good enough for George Thorogood,it’s good enough for me.

      I drink alone, yeah
      With nobody else
      I drink alone, yeah
      With nobody else
      Yeah, you know when I drink alone
      I prefer to be by myself

      Now every morning just before breakfast
      I don’t want no coffee or tea
      Just me and good buddy Wiser
      That’s all I ever need
      ‘Cause I drink alone, yeah
      With nobody else
      Yeah, you know when I drink alone
      I prefer to be by myself

      Yeah, the other night I laid sleeping
      And I woke from a terrible dream
      So I caught up my pal Jack Daniel’s
      And his partner Jimmy Beam
      And we drank alone, yeah
      With nobody else
      Yeah, you know when I drink alone
      I prefer to be by myself

      Yeah, the other day I got invited to a party
      But I stayed home instead
      Just me and my pal Johnny Walker
      And his brothers Black and Red
      And we drank alone, yeah
      With nobody else
      Yeah, you know when I drink alone
      I prefer to be by myself

      Reply
  5. Mark Johnson

    Dr Kendrick – I salute you!
    Cheers, Na Zdrowie, L’chaim.

    Interesting that “l’chaim”, the Hebrew for “cheers” literally translates to, “to life”.
    Na zdrowie translates from Polish to, “for health”.
    I’m sure that other languages translate similarly.

    Ancient wisdom?

    Reply
    1. Agg

      Na zdrowie is also the Polish equivalent of Bless you, when someone has sneezed – a handy phrase when among Poles 🙂

      Reply
  6. HotScot

    Cheers Dr. Kendrick.

    And a bobbing boat in Scotland is akin to a storm tossed dingy anywhere else. But hopefully, my wife and I will retire back home over the next 5 years or so, and enjoy the fine whisky.

    Reply
  7. Marguerite Harris

    I am learning so much from these posts. Having fun too… now I’ll add a lovely dark beer from a super local brewery…
    I shall live to 96, the age of my dad, and his mum before him.
    Thank you Dr. Kendrick! Wonderful stuff.

    Reply
  8. Ian Partington

    Cheers, Dr. K.!! My wife and I knock back a couple of (large) glasses of pinot noir most nights, after a nice fatty, low carb dinner. We’ve done this for over three years now and have never felt better. My recent cardio calcium scan scored a perfect zero and we NEVER seem to be poorly. So pass the cheese and the port over to us if you , dear reader,
    are an anti- fat dietician!

    Reply
  9. Angela

    Dr Kendrick, I must demur on your comment that you’ve never heard that people who don’t drink have an underlying illness. In common with most of my friends, I used to drink when I was younger but can’t now because I will get a migraine and an upset stomach. Sometimes I do it anyway and pay the price. Maybe I’ll die early because I must be puritanical?

    Reply
  10. JDPatten

    Welcome back!
    “My view was that advice should be accepted by the bucketful, but only given out by the thimbleful.”
    My take is the opposite:
    I was advised by my docs by the bucketful to avoid chocolate as a migraine trigger and to avoid coffee as a migraine/cardiac arrhythmia trigger. I lived in a mocha desert for decades. When I showed contrary research to my doc he told me, “If you indulge yourself, don’t expect me to show up for you in the ER!”
    I am now an espresso drinking chocolate connoisseur – no problems at all.
    I now take advice (such as for statins) by the thimble.

    Reply
  11. Jennifer

    “A little bit of what you fancy, does you good”, but put far more eloquently in your well written piece, thankyou.

    Reply
  12. nightskywp01

    Dear Malcolm

    Just want to say that I love reading your blogs (I also have read your books). In my own past life as a researcher in Information Systems (Informatics) my concerns in research in my field closely map onto some of your own concerns about mainstream medical research. In my field, where maybe 97% of all new systems introduced into organisations ‘fail’ (or used to – I’m a little out of touch since I retired 10 years ago), I found that there was never a ‘systems failure’, but always a management failure (‘System failure’ is a convenient euphemism). When systems were designed, the people for whom they were intended were often regarded by the designers as mere cogs in the machinery. I used what is known as ‘Soft Systems Methodology’ where history, attitudes, feelings and other ‘soft’ elements could be taken into account, and indeed MUST be taken into account if a new system is to be introduced successfully. The users must be involved in the design process. I also see my medical doctor as someone who should help and advise me, and not dictate to me – and I have had plenty of experience with this attitude.

    I see some parallels in your research, particularly in your criticisms of mainstream attitudes to medical research, and that to which I was accustomed.

    Anyway, I love what you do! Please keep it coming.

    Dr Tom McMaster (fellow Scotsman and Manchester resident until retirement – now southern Spain)

    Reply
    1. Mark Johnson

      In my field, where maybe 97% of all new systems introduced into organisations ‘fail’ (or used to – I’m a little out of touch since I retired 10 years ago), I found that there was never a ‘systems failure’, but always a management failure

      Tom, if it’s anything Capita has touched for the NHS it’s 99%.

      Reply
  13. annew

    Love it… as an unhappy drinker who hasn’t had any alcohol for over 40 years, and who had to get help to achieve that through meetings, etc. this totally makes sense to me. No clue if it’s true, but my understanding (no idea where I got this notion – but it ‘feels’ right) is that of the population that drinks alcohol, something like 10% will have a problem.
    I would also note that the only time I insist you do whatever my way is when I’m not sure of my own ground.
    I’ve way outlived both parents… stopped smoking only about a decade ago… and truly enjoy your writing and your message.

    Thanks,
    Anne Wayman

    Reply
  14. Andy S

    “For some people with Afib, even one drink is too much,” Dr. Mehta says. “They may have one drink in the evening and wake up at night or in the morning with atrial fibrillation symptoms.”

    “Low concentrations of alcohol induce increased release of NO from the endothelium due to activation and expression of NO synthase (NOS).”

    Gave up alcohol 5 years ago due to AFIB, maybe there were other causes. Since following LCHF no more AFIB and feel great, not tempted to experiment. Occasional beet juice would increase NO, unfortunately not the same euphoric effect on the brain.

    Reply
  15. Joe

    Dr. Kendrick:

    If you ever hear of a randomized, double-blind, placebo control study testing the effectiveness of 1-2 units per day of single malt-scotch on CVD, and they’re looking for test subjects, and as long as I wouldn’t have to be in the placebo group, I hereby volunteer. Anything for science!

    Reply
  16. Jeremy

    As usual, thanks for sharing this amazing blog post. As a French man, I have to say I do love my daily glass of red wine! Another piece of the “French paradox”puzzle revealed!
    (When are we going to start pouring saturated fat into our wine casks?)
    Have a wonderful holiday!

    Reply
  17. Tom Welsh

    “If you can also do this outside, looking over a sapphire blue bay, with boats bobbing in a light breeze, so much the better. [This was never really an option whilst growing up in Scotland.]”

    What on earth do you mean by that? We never used to have that trouble in Rothesay. (Well, the red wine did occasionally freeze solid – but the Firth of Clyde is no place for wimps).

    Reply
  18. Tom Welsh

    Most of what I know about alcohol comes from Tony Edwards’ optimistic book “The Good News About Booze” https://www.amazon.co.uk/d/Books/Good-News-About-Booze/0956656145/ref=sr_1_1?ie=UTF8&qid=1491078009&sr=8-1&keywords=good+news+about+booze

    That seems to say much the same as Dr Kendrick – i.e. moderate drinking, if regular, is known to be healthy. No one knows why. While the effects on various diseases vary widely, according to Edwards the “happy window” is between about 20 and 40 grams of alcohol per day. My rule of thumb is about half a bottle of wine – which is very convenient as I can split a bottle with my wife. (Of course I have a bit more than she does, as I am much bigger).

    One important question that I have not seen answered anywhere. Does anyone know *for sure* whether the human body metabolizes alcohol for energy? My experience suggests that it does not, as it makes no difference to my weight whether I drink or not. It is reasonable to suppose that our ancestors never developed the ability to metabolize alcohol for energy because they rarely came across it in any quantity.

    Reply
    1. Bill

      My experience too. Actually it there is one thing that blows the calorie theory out of the water it’s alcohol in my opinion. As far as I can determine the human body has no way of metabolising alcohol. This is why I assume, it comes out of every orifice of your body over a period of time. If we metabolised it I doubt anyone would be convicted of drink driving. Now, if you drink wine there’s a small amount of carbohydrate in it so that will be metabolised. Beer is bread in a glass hence the reason people who drink substantial amounts of it are prone develop beer guts. In days gone by diabetics were allowed spirits and red wine. Banting in his Letter on Corpulence drank a fair amount of wine etc very day but no beer.

      Just my opinion.

      Reply
      1. mark sanders

        I’m not sure what “metabolize” means exactly, but I understand the body does use alcohol as a fuel. Drinking will actually reduce your blood sugar levels for a certain amount of time, I’ve read because alcohol will be burned preferentially over glucose while it is available to the body. And by the way, wine can easily push your belly out if you drink enough.

    2. Mark Johnson

      I also rate “The Good News About Booze” book. I was once speaking with a “Health Care Professional” (even that job title annoys me) and began to get annoyed when she started spouting about “evidence based medicine” when I knew full well she was talking bollocks. She then started on about alcohol and according to her, “ALL THE STUDIES” say that any amount of alcohol is bad for you – even a drop. I lent her a copy of Tony Edwards’ book, “The Good News About Booze”. She returned it a week later, unread. In fact, she hadn’t even opened a single page. So much for open mindedness when the actual evidence doesn’t support your position.

      Reply
      1. Mr Chris

        Mark
        I have read the book, and though written in a rah rah style, I found it interesting.
        As regards the healthcare professional, did she not open the book because it might disturb her certainties, or because she was afraid she might lose her job?
        Certain subjects these days lead to positions being defended with religious ferocity, as in Brexit, as in Statins etc etc etc

      2. Bill

        Me too. I read this book. he didn’t really find harm. I know you can die from too much alcohol, in the same way you can die from having too much of anything. I worked all over the world, often in difficult situations. We all drank a lot but there were people who were alcoholics- they were different. They did not eat and changed character after a few drinks and weren’t able to function with alcohol in their system. The campaign against alcohol is a religion not science like so many things now. Its early and I’m watching the BBC news (why I don’t know). I saw the BHF rep who was, well fat, telling us we don’t do enough exercise (again). Maybe if the BHF looked at the real evidence and cut its ties with big food and Pharma it would maybe see where the real problems lie. Not likely though I fear.

      3. Socratic Dog

        Hang on a minute there Bill, BBC news cannot be so lightly dismissed. Why, they were the fellas who broke the news to a shocked world of the collapse of World Trade Center 7… shortly before it actually happened. Now that is some seriously competent reporting.
        Hmm. I think I may have just crossed the line from “moderate” to “heavy”.

    3. Eric

      The biochemistry of alcohol metabolism is in Lustig’s fructose talk. About 20% are metabolized in the brain (hence we get tipsy) and in body cells in general. The other 80% hit the liver and go through pretty much the same pathway as fructose (100% of which hit the liver). The outcome is triglycerides and storage in fat tissue and the liver (hence alcoholic or non-alcoholic fatty liver disease).

      Sad as it may be, it is hardly better than fructose. Then again, with up to 40 g / day, one should be reasonably safe.

      Reply
    4. Craig E

      Hi Tom. Ultimately the human body does use the carbon from alcohol (ethanol) for energy. Assuming the alcohol is absorbed there are 3 enzymes that metabolise ethanol. The main player is alcohol dehydrogenase. It converts ethanol into acetaldehyde which is converted into acetate then acetyl-CoA. The acetyl-CoA so produced has several alternate fates…it can be consumed in the Citric Acid cycle producing energy or used in fatty acid biosynthesis if the body doesn’t have an immediate energy needs. It can also be used in ketone body production. So in short the carbons in ethanol are used as an energy source.

      Reply
  19. Sarah

    For someone like me, who has always been “rewarded” with hangovers from even a small glass of anything alcoholic (female, 5 ft tall, 100 lb, prior [so-called autoimmune] bile duct scarring), drinking for health is not worth it. If in fact social aspects are the main point, it’s just as pleasant to go out with friends and have non-alcoholic beer or sparkling water while enjoying the identical relaxation experience.
    I’m hopeful that good health as I transition into late middle age will instead result from: organic low carb/high fat diet, detoxing, banning petrochemicals from home/personal care products, plus staying far away from rampant U.S. medical testing and resulting prescriptions.

    Reply
  20. Steve

    I’ll drink to that!

    (Actually… the wife and I were enjoying a glass of wine while I read parts of your post to her.)

    I hope you had a great vacation!

    Reply
  21. Vlad

    1: Do not smoke cigarettes (to which I would now add – or anything else).
    The same kind of associations some studies show between moderate alcohol intake and health benefits are true for cigars and particularly pipe smoking. But you have to go back in time a little bit (for instance SG report 1964) because antismoking mania has been on steroids for a while now. I find it strange you’re so against smoking (anything) but advocating drinking, quote ‘If you don’t drink alcohol, start.’ !

    I remember this statement from your book, it stood out then, and it’s the same now. I guess the biggest problem I have with it is this: suppose someone who is not attracted to drinking (like me) starts drinking on this advice but because s/he has an addictive personality or whatever reason, becomes an alcoholic. Or a binge drinker and after too many drinks on a night out something nasty happens. This sort of thing can’t happen with cigar/pipe smoking. Think about it.

    Reply
    1. Mark Johnson

      Vlad, I never used to drink. Just don’t like the taste of alcohol. However, based on Tony Edwards’ book, The Good News about Booze” and Dr Kendrick’s advice I started drinking! Now drink a glass or so of port most nights. Still can take it or leave it but on balance, why not take it?

      I’m not sure that alcohol addiction is just about alcohol or a particular personality.

      Reply
      1. Vlad

        Why not take it?
        Mark, as Dr. Kendrick says, I too believe the health benefits of alcohol that some epidemiological studies have shown have more to do with a way of life, the relaxation you have with a glass of wine or whisky than with the alcohol per se. So if I just decided to drink while writing this answer, I don’t think will do any good to my health. 🙂

        Thing is, what if at some future date, facing a lot of difficulties, I start to ‘drown my sorrows’ ? One glass can easily turn in one bottle or more in certain circumstances.
        That’s why I prefer the pipe to relax. There isn’t this abuse potential, the epidemiology is there, furthermore I’ve seen studies (done by NCI in the US during 1970s) where smoking mice not only didn’t have problems, but outlived the nonsmoking ones. Being a bit of contrarian, and with the current antismoking mania, I get further satisfaction by doing something the establishment is clearly against.

        Who knows, in the future, when they’ll really turn their guns on drinking (guidelines are already down to 14units/men from 50 in the early 90s), just to spite the ‘experts’, I’ll start drinking. 🙂

  22. karlwhitfield

    Dr Kendrick,
    Thank you, another excellent post in this enthralling series.
    Ah but so many other factors to consider.
    I 100% agree with you that I too think the noted benefits of moderate alcohol consumption are related to the stress-relieving benefits of the sociable lifestyle, more than the polyphenols from the grapes or any other such drug-effect of alcohol. But how do these studies of alcohol consumption and cardiovascular events correlate with studies looking at alcohol consumption and cancer (all types) and alcohol consumption and all-cause mortality and alcohol consumption and cognitive decline and so on?

    https://www.gov.uk/government/news/new-alcohol-guidelines-show-increased-risk-of-cancer

    As you certainly will know, Govt guidelines changed in late 2015, the Chief Medical Officer stating that any level of alcohol consumption carries some increased risk of cancer, and even 1 drink per day (2 units) increased cancer risk. The same guidelines downplayed CVD benefits to select demographic groups.

    How does this all correlate together?
    Could alcohol consumption as high as 2 drinks per day, offer some CVD protection while increasing cancer risk enough to negate any such CVD-busting benefits?

    Warmly,
    Karl Whitfield

    Reply
  23. JDPatten

    Moderate drinking significantly associates with risk of atrial fibrillation.
    http://www.docguide.com/analysis-sows-dose-dependent-association-between-alcohol-consumption-incident-af?tsid=5

    and
    Drinking, even at moderate levels leads to left atrial enlargement and the risk of atrial fibrillation.
    http://jaha.ahajournals.org/content/5/9/e004060

    What say you to this?

    I do understand that such arrhythmias are not strictly heart disease as defined here, but clogged coronary arteries IS a risk factor for AF which, itself, can lead to changes in clotting factors, stroke, and death.

    (So far, I still enjoy a nice Montepulciano d’Abruzzo with dinner and a good sip of Ardbeg a little later. Tell me I’m not slipping back into my pre-ablation AF. Please.)

    Reply
    1. Andy S

      JDPatten, When trying to figure out what causes AFIB one hypothesis is that there must be a relation to how healthy the heart cells (and all other cells) are. One factor is the accumulation of cellular debris that could be reduced by weight loss, exercise, reduced eating window and fasting. Excess nutrients equals cell growth ,angiogenesis, mis-folded proteins etc.. Autophagy by down-regulating mTOR gives cells a chance to clean house. When cells are healthy then effect of occasional injury can be tolerated//reversed.

      Reply
  24. Franklin

    My direct and related family history of CVD is awful. Myself excluded, no male made it past 49, many died in their 30’s and 40’s. My father had a completely occluded LAD at age 47. The women fared a bit better, but often die in their 60’s.

    After reading various early studies on CVD and alcohol, I, a staunch non-drinker (like my ancestors) , started with a glass of red wine a decade ago. I’ve since switched to rum and whiskey as I prefer it. One drink per night, with an occasional missed night if I forget. I can’t say it’s helped my CVD risk, other than to say I’m in my mid 50’s, reasonably fit, happy, I enjoy the alcohol and doing fairly well. I hold to the belief that the studies are correct, alcohol is the chemical that matters.

    Reply
  25. Craig E

    Hi Malcolm you have previously mentioned stress as a major contributor to heart disease. Certainly after a couple of glasses of cab sav or a few stubbies of pale ale I feel very relaxed. Could it be that ethanol inhibits cortisol and adrenaline production? The fight or flight response decreases with every subsequent beverage such that, were I to find myself heavily intoxicated on the African Savanna I probably wouldn’t even notice the lion…and even if I did I would probably laugh and say “here kitty”. All jokes aside, it does seem strange that ethanol is protective given that the liver sees it as a toxin and diverts metabolism into processing the ethanol first at the expense of other proceeses. Indeed us moderate (ahem) drinkers even express more alcohol dehydrogenase to deal with it more expeditiously. Am absolutely loving your blog!

    Reply
  26. Mary Jo Crawford

    A wall plaque I have…
    I feel sorry for people who don’t drink … They wake up and that’s the best they are going to feel all day !

    Reply
  27. Jeff

    “Is there any evidence that people who do not drink, do so because they are suffering from an underlying illness? No, there is not. ”
    Maybe not, but I have a liver disease (non alcoholic) and I stopped drinking completely even before I was diagnosed, simply because it made me feel sick.
    Many people suffer from liver disease in all its varieties, and will stop drinking sooner rather than later.

    Reply
    1. Mark Johnson

      The ability of the liver to regenerate and recover is quite remarkable.
      I don’t think it’s acceptable (in the majority of cases) for doctors to simply dismiss “liver disease” as chronic without addressing the underlying cause, eg NAFLD.

      Reply
  28. Anna

    Dear Dr Kendrick

    Love your blog but am unable to see the comments this time.

    Kind regards

    Anna Craig-Wood

    Sent from my iPad

    >

    Reply
  29. Judy Baker

    I used to try to drink a little red wine, in spite of the fact that I don’t like alcohol because I thought it was good for me. I quit after reading a post by Dr. Briffa who pointed out that most people who don’t drink alcohol at all are former alcoholics.They have probably damaged their health already. He noted that alcohol is poison and not likely to be good for anyone. I no longer make the effort.

    Reply
    1. Tom Welsh

      Ever since Paracelsus it has been understood that “the dose makes the poison”. Almost anything can be poisonous in sufficient quantity, although it may be beneficial in small doses. That is true of most mineral nutrients such as iron and iodine. It is even true of water; as you probably know, people can and do die because they drink too much water.

      So it seems quite likely to me that “doses” of alcohol up to a few units per day may be beneficial, while doses above (say) 10 or 12 units per day are more likely to be harmful.

      Of course, if alcohol has a bad effect on anyone, or if they simply dislike it, they certainly should avoid the stuff. But I am doubtful whether it makes sense simply to say that “alcohol is a poison”.

      Reply
    2. Socratic Dog

      Umm, actually there are quite a few non-former alcoholics who don’t drink. Most muslims, for example. About 25% of the earth’s population.

      Reply
  30. Bryan Hemming

    Obviously there seems to be a connection between drinking moderately and lessening the risk of heart disease. And I think you are right to point out that moderate drinkers probably enjoy life more than non-drinkers. But the factor that seems to escape most researchers is the stress factor.

    Stress can effect drinkers and non-drinkers alike. It is very likely that heavy drinkers suffer more stress, either as a result of drinking, or because they resort to drinking – and other substance abuse – to provide a temporary relief from stress. Therefore we can assume there are at least two categories of heavy drinkers. What they both have in common is a stress factor.

    Non-drinkers – as you point out – can eschew drinking on various grounds, one of which could be that they actually don’t like drinking. But, like you, I feel a good number do it for puritanical reasons, out of a sense of moral outrage against the world; a sort of fanaticism, which usually results in extreme anger and, yes, stress.

    It is this common stress factor I believe researchers have not paid enough attention to, as stress must release harmful chemicals into the body. I am not a doctor so I don’t know what those chemicals could be. Nevertheless, I do know that that our bodies release adrenaline to help us cope with stressful situations. I also know that massive amounts of adrenaline can be life-threatening, often causing heart problems. From that one might deduce that the release of smaller amounts of adrenaline too often, on a regular basis, might have a long-term degenerative effect on the cardiovascular system.

    But there may be other chemicals involved. One thing is certain, stress cannot be discounted as a factor and deserves a lot more attention.

    Reply
  31. Lorna

    Interesting research and responses to the results. Surprising that the drinks industry have not used it to defend their product. Maybe the ‘demonisation’ of drinking any alcohol helps the acceptance of taxation of it and thereby government revenue?

    Reply
    1. Stephen Rhodes

      Not really surprising.
      The drinks industry doesn’t make its shareholders rich on the backs of ‘responsible’ drinkers.

      Reply
  32. Charles Gale

    Another great post.

    Readers may like to check out some of Mark Sissons’ blogs on wine:

    http://www.marksdailyapple.com/why-are-some-wines-more-primal-approved-than-others/

    and

    http://www.marksdailyapple.com/the-definitive-guide-to-wine/

    I can’t seem to find any dry farm wines in England and currently persevering with an organic red from a major supermarket – yuk!

    Can any readers recommend a decent red I can try in England, which is dry farm or organic or natural as possible?

    Thanks!

    Reply
  33. Charlie

    I admire and appreciate most of what you write Dr. Kendrick but not this post, just like I didn’t agree 100% with the CVD and diet one. To me they are a little off the mark. Alcohol can be a poison to the liver. A large portion of the population now live with a fatty liver that contribute to their carbohydrates intolerance. I don’t believe that drinking will benefit their liver, the purposed benefit is epidemiological and weak. There is no need for alcohol to be social or to relax. Plus a large portion of the population with addictive personality will be prone to abuse it. So in my opinion there is little upside and too much potential for damage.

    Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data

    http://www.bmj.com/content/349/bmj.g4164

    Conclusions Individuals with a genetic variant associated with non-drinking and lower alcohol consumption had a more favorable cardiovascular profile and a reduced risk of coronary heart disease than those without the genetic variant. This suggests that reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health.

    Alcohol — Health Benefit or Hazard?
    http://www.benbest.com/health/alcohol.html

    VIII. CONCLUSIONS
    Most of the so-called benefit of light alcohol consumption is inferred from the bogus lumping of ex-drinkers with lifetime teetotalers in epidemiological studies. Even for studies which are careful to separate ex-drinkers from other abstainers, it is questionable to attribute the reputed better health of light drinkers to alcohol because many abstainers have other health problems which preclude alcohol consumption — including asthma, epilepsy, gout, hypertension, ulcers and diabetes. Many people with health problems are disinclined to drink — or prohibited from drinking — alcoholic beverages.
    When examining the multitude of studies showing that light drinkers are healthier than abstainers, ask how “abstainer” is defined (such as “patients who had allegedly abstained from all ethanol for a period of six months or more before the study” [THE AMERICAN JOURNAL OF MEDICINE 86:282-288 (1989)]). And even if ex-drinkers have been entirely excluded from the abstainers group, ask if other variables rather than ethanol might be critical. It is not hypocritical to learn from epidemiological studies that point to the harmful aspects of ethanol (such as the link between smoking & drinking and oral cancer) because the confounding proxy variables are not critical in such cases. But animal studies or studies of isolated cells, organs or even people subjected to ethanol under controlled conditions yield the most reliable information.
    There is reason to believe that ethanol might have some benefit for coronary heart disease for those with low blood HDL cholesterol. But the benefit can usually be achieved more safely by other means of raising HDL cholesterol. Brain atrophy and damage to the hippo campus by ethanol in even the lowest doses should be alarming to rational persons. Ethanol (and/or acetaldehyde) is so damaging to so many body organs, organelles and molecules — most troublingly the brain — that grasping at one possible benefit while ignoring all of the harms sounds suspiciously like the rationalizations of an addict. Or the rationalizations of an entire addicted society. Whatever the reputed health benefits of ethanol, the health costs (known and unknown) are vastly greater. By my values, the possibility of brain damage makes any mild cardiovascular benefit pale by comparison — especially when there are so many other ways to improve cardiovascular health.
    An editorial in the December 1997 issue of the JOURNAL OF THE ROYAL SOCIETY OF MEDICINE [JOURNAL OF THE ROYAL SOCIETY OF MEDICINE; Abdulla,S; 90:651 (1997)] concluded that because of the many obvious health hazards of alcohol (including temporary impairment of neurological function) and because of the availability of so many other cardiovascular drugs [ I would add niacin, DHA, weight loss and exercise ] and because “the benefits of alcohol are small and ill-understood” that the recommendation to be a light drinker is “not only meaningless but also irresponsible”.

    Reply
    1. Dr. Malcolm Kendrick Post author

      Thanks for your thoughtful post. I am not a fan of those who us statements such as ‘Most of the so-called benefit of light alcohol consumption is inferred for the bogus lumping….’ That is not a scientific statement. It is, however, entirely revealing of a mindset.

      Reply
    2. AH Notepad

      Thank you for this rational explanation. I don’t agree with the green light approach that many use to justify continued drinking. They are after all, “moderate drinkers” in their own opinion, and as you say, are they just trying to avoid the label of “addict”.

      I did wonder if the frequent washing the mouth with alcohol might kill some of the anaerobic pathogens which are known to be associated with heart attacks, and which find their way to the heart through the blood system.

      Reply
  34. liz3321

    Very pleasing for most.

    People with a family history of alcoholism are at increased risk of alcohol abuse though (I’ve seen the figure of 3-4 times more likely) and research is suggesting thee may well be genetic links. So some may prefer to leave alcohol alone. After the experience of a drink abusing great great grandfather, my teetotal family lived on to old age – almost all of them until their late 80s and their 90s – no early deaths from heart disease for them. There are plenty of ways of feeling good without alcohol for those who need to avoid it.

    Quite a few studies are showing a link between particular genetic mutations and drinking behaviour. Here’s one recent study. http://www.webmd.com/mental-health/addiction/news/20040526/researchers-identify-alcoholism-gene

    Reply
  35. Alan Tillotson

    Quoting the US Department of Health, Alcohol is metabolized by several processes or pathways. The most common of these pathways involves two enzymes—alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH). These enzymes help break apart the alcohol molecule, making it possible to eliminate it from the body. First, ADH metabolizes alcohol to acetaldehyde, a highly toxic substance and known carcinogen (1). Then, in a second step, acetaldehyde is further metabolized down to another, less active byproduct called acetate (1), which then is broken down into water and carbon dioxide for easy elimination (2).

    So, my contention, Malcolm, is that God gave each us a certain amount of these enzymes so we could be happy, but not too happy (It’s God after all). When we drink in moderation, we not only gets benefits of good company and relation, we also get the benefit of the extra fruit and vegetable servings from wine (grape juice) and beer (hops), but when we overdo it, God punishes us by turning the alcohol into a deadly liver poison.

    Reply
    1. Andy S

      Alan Tillotson, I believe you have found the answer to why alcohol is beneficial for most humans: the power of positive thinking. Problems and inhibitions disappear, everything is rosy, live for the moment, brain activity slows down, arteries relax and you enter a trance-like state. Nothing wrong with that, instant euphoria and stress relief.
      For abstainers stress relief is a bit harder to achieve. Slow thinking is the key, don’t jump to conclusions, look before you leap, breathe slowly, look at life through the other end of the telescope, count to 10, count your blessings, things could be worse, feel that you are in control and not a victim, etc..i.e. mind affects body. Stress kills, learn how to handle it.

      Reply
  36. Gordon Ferris

    Dear Malcolm, I fear your profound common-sense analysis will have just put a spike in the levels of heart attack across the entire medical profession wedded to the low cholesterol, high statin, zero booze myths.
    Cheers!

    Reply
  37. Bob

    So, the best you really have for us here (based on epidemiology, dodgy guidelines which even you say are dodgy, and an evidence free conviction that you are right) is “there is no evidence that moderate* drinking is bad for you”.

    There you go. One paragraph.

    *As defined by the guidelines we found up a random rectum, and which we recently changed due to the discovery of a more attractive rectum. Or something.

    Reply
    1. Dr. Malcolm Kendrick Post author

      You are always welcome to disagree with anything I write. However, please read what I write. There are no guidelines recommending drinking. Just guidelines stating a maximum possible amount. These guidelines, I agree, are based on no evidence whatsoever, and never have been. However, moderate drinking has been found, in multiple studies, to be beneficial for overall health. Various ‘experts’ have tried to dismiss this evidence in various ways. That appears to be the function of experts nowadays. They are more like theologians than scientists.

      Reply
      1. AH Notepad

        Maybe it has nothing to do with the intake of alcohol. Perhaps it is the genetic make-up of people who live longer happens to have an effect which causes them to consume a moderate amount of alcohol. Who knows? if those same people had not consumed the alcohol perhaps they would have lived even longer longer, and similarly, those who do not drink may have shorter lives if they did consume alcohol. I think this needs more research.

      2. Mr Chris

        Ah notepad
        These suggestions of Dr Kendricks are just that. He sees a lot of patients, he thinks and notes apparent anomalies.
        The major problem with life is you only get one go at it, so if someone intelligent writes, have you people out there considered alcohol? I am prepared to say to myself, that I like wine singlemalt Tomatin cask strength, I am happy and feel much better since I gave up statins.
        So why not. Now for me the evidence against alcohol when I look at it does not seem that strong, it is unlikely there will a rock solid double blind trial, there will always be different interpretations of results of epidemiological studies.

      3. AH Notepad

        I think the evidence for alohol is not that strong either. There is IMO a strong possibility that doctors see, generally, people who at least think there might be something wrong, whereas the people who they don’t see, either think there is nothing wrong, or they don’t want to know if there is.

        I do not agree with the suggestion to start consuming a known toxin, and it might well be that a couple of root canal fillings will get me, even if I did drink. One way or another most of us are likely to die. Is living longer an unqualified benefit?

      4. Martin Back

        If you could compare the health status of twins, one drinking moderately and the other drinking little or nothing, that should be reasonably definitive.

        I could find only one such study, done among youngish working-age Norwegians, comparing extended days off for sick leave which are available on a central registry (i.e. properly sick, not the “morning after” hangover sick).

        The increased level of sick leave observed with low level drinkers seems to be mainly explained by confounding from genetic factors. In all observational studies of the relationship between alcohol consumption and health, one should be aware that important genetic confounders are likely to influence the results. — http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3502-2

        Or to put it another way, moderate drinking was not beneficial, but not harmful either, in the population under study. People who choose not to drink are just naturally sicker than those who drink moderately. (At least that is what I think it says. I find it hard to translate academic medicalese into plain English.)

  38. Sylvia

    If you nibble something whilst drinking alcohol it slows the absorption rate. Also, I think, the smaller you are, weighing less, your toleration is less. It is important to know when to say no to the extra glass. I do need to take my own advice! Having my first child 1965, the midwives came round with milk stout for new mothers, a little iron I guess. Once youth has past we learn to enjoy without excess. If I did the driving after a family occasion, yes, I still enjoyed the get together, without alcohol, it is a contentious issue. Thank you for airing such important issues Dr Kendrick and allowing such diverse opinions on your superb blog.

    Reply
  39. Soul

    What a wonderful delightful way to help prevent a heart attack. I didn’t realize that alcohol in moderation can help prevent blood clotting.

    My parents have a neighbor that is a huge wine enthusiast. He knows all the best wines, and buys them with price being of little concern. Some of his mentions make me chuckle. He says he began drinking wine for the heart healthy benefits. My parents and the neighbor have a Friday evening gathering to taste the latest wine he discovered. Sometimes I’ll tag along. The neighbor tells me wine helps control his cholesterol levels which helps his heart. I tell him cholesterol levels do not play a roll in heart disease, or that is my belief. Now I can give the neighbor a better reason for why wine can help him and his heart. Anyway, I used to laugh at the mention of his concern over cholesterol levels. He refuses to see a doctor! As he says, he will see his father before he will see a doctor. (His father passed away a number of years ago) He never tests his cholesterol I’m guessing.

    Thinking on my family genealogy work, it would seem family members that drank lived longer. My father’s side of the family were and are drinkers. Some were even in the moonshine business for awhile, during prohibition times. Most on dad’s side lived into their 80s and 90s.

    Mom’s side of the family has fewer social drinkers that I’m aware of. Most of them lived into their 70s and 80s and most had heart disease. Hardly scientific but intriguing to me.

    Reply
  40. Martin Back

    I haven’t had a drink for 25 years, mainly because I had consumed my lifetime allocation of red wine by my early 40s. And I’m not going to start again to benefit my heart, which in any case seems to be doing just fine without alcohol. *touches wood*

    In any case, I don’t think it’s fair to judge statins by all-cause mortality, but alcohol by CVD risk alone. What about the dangers of driving drunk, falling into the swimming pool, picking a fight with the wrong person, etc?

    Forgive me. I may be a little grumpy from seeing all those beautiful people on the TV advertisements having fun while drinking, while I sit alone nursing my cocoa.

    To be serious, please never try to persuade someone to take a drink if they say they don’t want one. Don’t say it’s healthy for them or Dr. Kendrick says it’s okay or they shouldn’t be party poopers or any other reason. Just accept they don’t want a drink. You will never know how hard it is for some people to say no to alcohol.

    Reply
    1. Dr. Malcolm Kendrick Post author

      I understand the problems that some/many people have had with drinking. However, I do not believe – for one moment – that people who do not drink (who have never drunk) are at risk of becoming heavy drinkers/alcoholics. We need to give people some credit for understanding how the world works, and some ability to control their behavior. Anyone who starts drinking two glasses of wine a day, to protect their heart, is simply not going to be the sort of person who becomes an alcoholic. Extreme runners also damage their hearts, but I would still advice people to start taking exercise.

      Reply
      1. Martin Back

        As the saying goes: “The man takes a drink… the drink takes a drink… the drink takes the man.”

        For some people, even a small amount of alcohol can impair their judgement, and though they have every intention of controlling their behavior before that first drink, one thing leads to another… and another… and another…

    2. liz3321

      Just wondering how you would know they’re not the sort of people that become alcoholics? I know a number of alcoholics in recovery and I don’t think you’d think there was anything unusual about them. Some people who haven’t drunk in the past might still be at greater risk if there’s a family history of alcoholism – as with the mice in the study I linked to above in (and quite a few other studies too) which mice were bred to be deficient in the CREB “alcoholism” gene.
      These rats drank about 50% more alcohol than normal mice.
      They also showed more anxiety-like behaviour in a maze test.
      – chose alcohol over water much more than the normal rats did.
      – and showed more anxiety than normal mice, which decreased when drinking alcohol.
      Alcohol didn’t reduce anxiety as much in normal mice..

      Reply
    3. Martin Back

      Don’t get me wrong. I’m not opposed to booze, although it’s probably the number one cause of car crashes, domestic violence, rapes, and assaults in Western society.

      It’s the social pressure put on people to drink, or drink more, that I object to:

      – “Go on, have one more for the road.”
      – “Moderation in all things, including moderation.”
      – “A little of what you fancy does you good.”
      – “Water! Makes you rusty.”
      – “My booze not good enough for you, eh?”

      Reply
  41. smartersig

    How can we possibly say that if you are a non drinker then start moderate drinking. How do we know, as you state, that the benefits of drinking are not derived from the possibility that drinkers as a whole have a better network of friends and support than non drinkers ?. Unless we have a controlled study that looks at outward going, well connected non drinkers Vs outward going well connected moderate drinkers then we are on dodgy ground suggesting to people that they should start drinking for two reasons. First we do not know that drinking per se caused the benefits. Number two we know that drinking beyond moderation is bad. I will throw a third in as well, we know that some percentage of those heeding your advice will be addictive in nature and go on to become excessive drinkers. What you are proposing is guesswork at best. I would suggest that there are far stronger suggestions you could make that would benefit peoples heart. What about telling people to cut things that almost certainly contribute to HD for example sugar and simple carb’s

    Reply
    1. Dr. Malcolm Kendrick Post author

      I have already made many suggestions. I have advised people to drink in moderation and warned them against heavy drinking. I am not a paternalist, I do not think that people are incapable of maintaining control over their lives.

      Reply
      1. smartersig

        I was not suggesting you were a paternalist but there is a whole lot of difference between saying dont give up your moderate drinking because there is no evidence to say it will benefit you, to saying here are my 5 or 6 best suggestions for avoiding HD, number 3 start drinking if you are not already.

    2. David Bailey

      ” Unless we have a controlled study that looks at outward going, well connected non drinkers Vs outward going well connected moderate drinkers then we are on dodgy ground suggesting to people that they should start drinking for two reasons.”

      I really object to that, because such a clinical trial would never be done (mainly because the pharmaceutical industry could not profit) and so you are advising people not to do something that is pleasurable and almost certainly healthy, just because nobody can find an adequate financial reason to formally test it!

      The risk from alcohol consumption clearly follows a ‘J’ curve – as does almost everything we consume. The fatal dose of water is (if I remember correctly) 7 litres in one day – and people have died as a result of drinking more! People can die from consuming an excess of anything.

      Clearly alcohol does carry a risk of alcoholism, and people should be careful about that, but I would bet that most non-drinkers have consumed enough alcohol as teenagers or young adults to have run that risk already – they are probably the least likely to succumb to heavy drinking.

      Reply
      1. karlwhitfield

        “The fatal dose of water is (if I remember correctly) 7 litres in one day – and people have died as a result of drinking more!”
        These ‘fatal dose of water statistics’ need to be taken with a pinch of salt – pun intended.
        Unlikely anyone will ever die from drinking too much water, but they might die if they drink too much water and don’t take on board any electrolytes – then they may die of mineral dilution, hyponatraemia for example.
        I’ve drunk more than 7 litres of water in a day on many occasion and been fine – maximum was 12 litres on one day.

    3. Martin Back

      At university many years ago the students’ health service showed us a fascinating documentary called The Alcoholic Cat.

      The cat was trained to push a lever and a little box would open with his food pellets inside. This was a healthy well-groomed alpha marmalade cat who dominated other cats. They would put out several saucers of milk with varying amounts of alcohol in for him to choose from. He always sniffed out the saucer with no alcohol.

      Once he was used to the routine they began stressing him by giving him a blast of air in the face as he put his head in the box to get the food pellets. You could see from his reaction it was an unpleasant and scary experience for him, so he was quite nervous about pressing the lever and putting his head in the box again to get his pellets.

      This continued, with the blast coming at random intervals, so the cat never knew if he would be getting air in the face or not. He became nervous and timid, stopped grooming himself, and started being dominated by other cats.

      Then he tried the milk with alcohol in it and discovered the blast of air didn’t worry him so much if he was a little drunk, so he started drinking the milk with alcohol. By the end of the experiment he would seek out the saucer of milk with the most alcohol in it. By using alcohol to combat stress, he had become a complete alcoholic.

      Reply
      1. annielaurie98524

        This (especially since unaccompanied by a link to the article describing the “research”) is most likely a UL (urban legend). Seeing the post date, it seems to have been added 2 days later than it should have been.

      2. Martin Back

        Annie,
        I looked for a YouTube link for my April 3 post but couldn’t find one. Here is an article discussing the film, which actually had the catchy title “Neurosis and Alcohol: the induction and cure of alcoholism in cats”, made by Jules H. Masserman as part of a doctorate thesis, at the University of Indiana in 1948. I saw it in the late 1960s and might have misremembered bits of it, but I think I got the main thrust of it.

        “it showed the cats being introduced to alcohol; it showed cats preferring spiked milk to plain milk; it showed cats who began each meal by lapping up a small amount of milk spiked with alcohol. And it showed some cats who would drink only spiked milk until they fell over, dead drunk, i.e. confirmed alcoholics” — http://www.alternative-doctor.com/mind_stuff/very_human_cats.html

  42. Agg

    Cheers!! A double g&t (with extra lemon) in the late afternoon sunshine, hot tub with hubby and kids, then home made meal and a film – perfect 🙂 stress level ZERO

    Reply
    1. Dr. Göran Sjöberg

      Erret,

      Nothing is new under the sun!

      There is another famous Greek, Herodotos, considered to be the first “real” historian living a couple of hundreds years BC and he was well informed about the world surrounding Greek.

      Herodotos told the story about the encounter between the Persians,who wanted to rule the world at that time, and then wanted to incorporate not only Egypt but also Ethiopia. So the Persians sent a diplomatic mission to Ethiopia to get informed before attacking.

      Then the Ethiopians, who were adhering to strict LCHF eating , then basically only on cooked meat, asked the Persians how old the could get. Getting the answer 80 years, while the Ethiopians themselves claimed the mature age of 140 years, they remarked that they were still very impressed that the Persians could reach even 80 years of age since they were living on bread mostly and the only reason the Ethiopian could figure out was the the Persian also drank wine which helped them to live longer.

      Reply
  43. Hugh

    I do have a little question…

    The study apparently compensates for BMI between people (BMI is listed as a covariate). But does BMI not tend to increase after a few beers and some takeaway?

    If non-drinkers tend to have lower BMis is that not a real advantage for non-drinkers that should not be adjusted away?

    (Full disclosure, I loved drink, but drink didn’t love me back: I haven’t had a drink in the last 10 years).

    Reply
  44. Morgana

    Well of course I loved this article, because I enjoy my nightly glass of red wine!- (with a good home cooked, low carb meal of course).
    Just one thought though: I wonder what kind of drinks the teetotalers in the study were replacing the alcohol with? (And have researchers ever looked at that?) For instance, my observation is that the people I know who don’t like to drink wine or beer with dinner tend to prefer coke, and similar things. I would bet my right arm that sugary sodas would be bad for heart disease! Could the results have something to do with that as well?
    Otherwise, I just wanted to mention that I’ve read and enjoyed several of your books (as well as this blog). Thanks!

    Reply
  45. Sylvia Brooke

    Some say that laughter is the best medicine. If that is so, then your blog has given me a huge dose of medicine today.

    As a show of appreciation (and with tongue in cheek) I would like to share the following with you;-

    ‘The wonderful love of a beautiful maid and the love of a staunch true man, and the love of a baby unafraid have existed since life began. But the greatest love, the love of love even greater than that of a mother, is the tender and passionate, infinite love of one drunken sod for another.’

    Welcome home Dr. Kendrick. So pleased your holiday did you so much good.

    Reply
    1. Martin Back

      http://www.dailymail.co.uk/health/article-3086908/What-s-really-unhealthier-binge-drinking-small-daily-tipple-results-unique-experiment-identical-twin-doctors-surprise-you.html

      Drunkenness is often said to have a number of stages: verbose, grandiose, amicose (the ‘you’re my best friend’ stage), bellicose, morose, lachrymose (the weepy stage), stuperose (the incoherent stage) and comatose. Basically going from chatty to unconscious via being fun and then weepy.

      That poem captures the ‘amicose’ stage very well (says he, speaking from experience).

      Reply
  46. ROISIN COSTELLO

    Ah Hilarious Malcolm . cant wait to pass this on to my brother , also a GP . Thank God for for enjoyment and some feckin bit of craic .
    Roisin .
    Gp Tipp

    Reply
  47. David Bailey

    Thanks Malcolm for another post filled with good advice!

    I predicted as I read it, that you might lose a few of your following, who seem to think that everything that is good for you has to be in tablet form because it would otherwise taste horrible.

    Someone above wrote, “Good for CVD, but risk for cancer?” The answer is to be found in Tony Edwards’ book “The Good News about Booze”. As you might expect, the actual evidence is vastly different from how it is officially presented, and his many graphs of risk of particular disease against alcohol intake all follow a ‘J’ curve – i.e. the risk goes down for a bit, but then if you drink to excess, the risk goes up again. This includes a lot of different types of cancer – including breast cancer (I can’t remember if there were any exceptions). The optimum consumption of alcohol to avoid most diseases, is surprisingly high in many cases.

    The author also takes a Kendrickian approach to his writing – he explains the facts very precisely, and yet introduces plenty of humour. I’d strongly recommend this book except to those (above) who find alcohol gives them a migraine or upsets their digestion – I can confidently predict they would not enjoy this book!

    Reply
      1. annielaurie98524

        I highly recommend Edwards’ book, especially if you have a slightly nerdy bent (as I do) and enjoy getting at some of the science behind the claims on both sides of the drinking issue.

  48. Antony Sanderson

    For years I used to share a bottle of red wine during the evening dinner with the other half. However, 6 years preceding my retirement I realised I must do something about my 14.5st. In my 30s I was just under 10st. Solution: Started cutting down on the drink. I would only drink at the weekends. At the outset the weekends started on Friday evening and somehow managed to roll into Monday evening. After a year or so progress seemed to bottom out at 13 stone. Deciding I had to get serious, the weekend really became the weekend: only drinks on Saturday and Sunday. A couple of more years and I bottomed out at about 11.5 st. I did have a goal, and to reach it I knew I had to lose the Saturday . . . (Sunday dinner is very special after all). A while later I reach my goal . . . I had managed to pass the willy test! . . . (Don’t ask)
    Now, down to 10.5 st., indulgence is just high days, holidays and celebrations.
    Some of us are very good carb storers and judging from the rest of my family seem genetically adept with alcohol.
    Role on Easter Sunday.

    Reply
  49. Jean

    Now I’m worried! I do not drink alcohol, it gives me migraine. At first it was just red wine, then eventually all alcohol. It is very unsociable, I do feel like I’m missing out, I’m not a member of “the club”.
    I am also ill, the Drs have fobbed me off with Fibromyalgia, so now anything I see the Dr with is Fibro. I sometimes feel I’m dying very slowly, must be the Fibro! Perhaps a drink would help! I might not have much time left!

    Reply
    1. David Bailey

      I have always felt that if I were to fall ill with something that doctors couldn’t treat, I would look to alternative medicine. I did actually start to do this when my leg was cramping – but that problem turned out to be the statins my conventional Dr was prescribing!

      Reply
  50. Roy Firus

    I find your comment that” If you don’ t drink- start ” -insane beyond belief ! I can’t believe that such a brilliant- and exceedingly humorous -medical expert such as yourself would recommend a non-drinker to start because of the supposed ” lifestyle ” and very limited medical benefits offered ! Billions- yes billions of people worldwide can easily enjoy your ” lifestyle ” benefits without alcohol. You of of all people should know of the untold health and mental damage done by this addictive drug . You are one of the fortunate ones who ((hopefully ) can control their drinking but there are hundreds of millions who cannot and hundreds of millions in addition because they do not drink are not aware of it but soon would be if they followed your ” advice.”.As a medical doctor you should be ashamed of yourself ! !

    Reply
    1. Dr. Malcolm Kendrick Post author

      Insane beyond belief? I had an aunt, who was a headteacher, who had a phrase. Fact, or opinion, which she used with her more intelligent children. Fact – moderate drinking reduce CV and overall mortality. Opinion – some/many people who do not drink, who start drinking, will become alcoholics. So, my advice will cause more harm than good. Now, your opinion may be a fact, but there is (currently) no evidence to support it. If you can provide some facts to support your opinion I would be more than happy to see them. Until then…

      Reply
      1. Sylvia

        Moderate drinking, yes, now that I am passed the first flush of youth I have a granny glass, not those flower vase sized ones, though no need to fill them to the brim. I may have more than one. Remember the temperance societies, especially in America who fought the demon drink. Idiots who drink to excess and then become violent are indeed to be abhorred, but consider that to share a meal and a glass of wine with loved ones is one of life’s pleasures. No sensible, intelligent person would insist all must partake. A point is being missed by some.
        A loved one in my family has a drink dependency so do understand.

      2. smartersig

        Do you have any facts that show moderate drinking reduces CV compared to no drinkers and of course proves that it is the drinking ?

      3. Dr. Malcolm Kendrick Post author

        I did provide a reference for a study on over one million people. I would recommend that you read it, it is open access. You can then decide to dismiss the evidence if you like.

      4. smartersig

        The first study in your ref list looks interesting but the Cox analysis did not account for Diabetes and Obesity both of which were greater in the non drinkers who were not previous drinkers. In fact their Statin use was greater too. They acknowledge this
        “we found that non-drinkers were more likely to have diabetes or be obese”

      5. Dr. Malcolm Kendrick Post author

        Yes, well, but the enormous study on over one million poeple (ref 4) did.

        Sensitivity analyses

        Findings of sensitivity analyses are in the appendix. Interpretation did not change substantially when we adjusted only for age and sex or after additional adjustment for systolic blood pressure, BMI, diabetes mellitus, high density lipoprotein cholesterol, use of anti-hypertensive drugs or statins, and whether then patient had received dietary advice. Similar associations were observed when we restricted analyses to endpoints determined with secondary care and mortality data sources , as well as fatal events only. There were no notable differences in the associations we observed when we used data only from 2004 onwards. Our findings when we used complete case methods were broadly concordant with those obtained using multiple imputation.

      6. smartersig

        Thanks for getting back to me, I will check ref 4 later. Off out for dinner and a glass of wine

      7. Roy Firus

        “Opinion – some/many people who do not drink, who start drinking, will become alcoholics.” My word !! How in the world can this be an opinion ?? Obviously since there exists alcoholics who once did not drink- then there must logically be ” hidden ” alcoholics who for lack of exposure to ” moderate drinking ” then would become alcoholics ! Depending on the country and the organization involved- the reported percentage of the population who suffer from alcoholism -or the extremely ” cute term ” of : ” have an alcohol problem ” -ranges from 8% -15 %.Having worked with alcoholics for over 40 years in North America and in Scandinavia I personally would put the ” real ” number at closer to 20% .Due to similar variables including the wide acceptance of a “pub culture “and the lack of social stigma at drinking to excess I would except the same percentage for the United Kingdom. My point is simply that the risk of seriously damaging your health by far outweighs the limited proven benefits and do not in any way justify the recommendation by a medical doctor such as yourself that people who do not drink should start ! ! This is especially true since the major benefits that you yourself describe -the social atmosphere etc. -can easily be created without the lack of alcohol. The medical benefits of alcohol are virtually exclusively limited to the drinking of red wine and are only due to the polyphenols, tannins and various other both known and unknown phytonutrients etc. that are found in the red -or blue- grape skins and have nothing to do with the alcohol itself. Therefore to avoid the potential deadly effects of alcohol , it is much more safer to recommend that people should start drinking dark grape juice and /or eating dark grapes .( As a sideline I would also add that since grapes are very heavily sprayed with systemic pesticide that follow through to the juice -that both the dark grapes and the dark grape should ideally be certified organic.) At the risk of offending you Sir -and for that I sincerely apologize ahead of time-I have found that in over 40 years of “discussion” on the supposed benefits of alcohol that many of those people who most powerfully advocate and defend that position
        -have unfortunately, self-admittedly found out later to have been suffering from an alcohol “problem” themselves at the time .I am of course in no way suggesting that you do Sir -I simply mention it as an observation based on many years of work. I also want to thank-you yet again for your excellent series of articles that you have produced that I am sure have not made you many friends among your fellow professionals and most certainly will not win you the ” Doctor of the Year ” award though ( with the exception of your recommendation that non-drinkers should start drinking alcohol ) possibly should !

    2. David Bailey

      Roy Firus,

      Here is a link to the J curve relating to total morbidity as a function of alcohol consumed. It was published by The Spectator in an article entitled, “The great alcohol cover-up: how public health hid the truth about drinking”

      Compare that with the meagre evidence in favour of statins! The only problem with alcohol is that some people lose control, and obviously any teetotaller who decides to take Dr Kendrick’s advice will be cautious, and on the look out for signs that their booze is taking control – they won’t be like party going teenagers.

      Any health advice must carry some risk. Advising people to take more exercise, may result in someone breaking a hip and dying as a result. Surely the best we can hope for is advise that will benefit most people.

      Reply
    3. Stephen T

      Roy, aren’t people entitled to hear the truth and then take responsibility for their own actions?

      Reply
      1. AH Notepad

        But here they are getting what some people might see as almost an instruction. It is not quite in the form of presenting the information and then making up their own minds.

        There are many replies in this topic which I see as people almost, if not actually, pleased that they have a blessing to indulge their habit. Whether they are “moderate” drinkers is difficult to assess, as even hardened drinkers probably see themselves as “moderate”.

  51. Gary Ogden

    Dr. Kendrick: Thanks again for an eminently sensible post. I enjoy my 1/4 bottle of red wine every evening, and very pleasant it is. As for paternalism, we are absolutely plagued by it in the U.S., especially in California. It goes by the label “nannystate,” or “mommystate.” Hope things are better in Scotland on this account.

    Reply
  52. Sean

    “….pour it lovingly into a glass, swirl it around a bit, then enjoy. If you can also do this outside, looking over a sapphire blue bay, with boats bobbing in a light breeze, so much the better.” Satisfyingly, as I read this latest blog post, I had just poured a glass of beer and looked out over a blue bay with yachts bobbing on their moorings in the brilliant sunshine, here in Lindisfarne bay, Tasmania. Good advice Malcolm.
    Cheers, dears!

    Reply
  53. David Bailey

    “My sister was critical of my ‘advice free’ book. ‘People want to be told what to do.’was her terse comment. She is good at terse.”

    At the risk of getting into an argument with your sister, I am very glad your books stayed away from giving long lists of advice. When you write a book explaining how much of medical evidence is flawed and inconsistent, it would rather spoil the effect if you ended it with a huge list of recommended supplements, and precise advice on how much sun/exercise/meat you should eat!

    Reply
  54. Rachel Brett

    My only issue with the alcohol argument is this, is what about the liver and pancreas. And actually, some people can take alcohol and others can’t. So whilst is it a lovely idea, and I for one do imbibe on a regular, but sensible basis, think it is more to do about how to manage stress, which is very difficult to measure, unlike imbibing alcohol, which is much easier to measure the effects on the body, both good and bad. So I think you should be raising the stress-free argument as a measure of protection, and alcohol being one of the options you can drink to enjoy life…. And what other measures you can do to relieve stress.

    The other factor is that whilst I am losing weight, I tend to drink an awful lot less just because of the calorific levels of drinking, rather than for its medicinal purposes. It does make a hell of a difference for weight loss….

    Reply
  55. Andrew B

    If you believe the dogma that smoking is bad, then why do we have so many nicotine receptors in the brain? Surely it is the 2,000 chemicals in cigarettes that are carcinogenic and not the tabacco itself. We also have cannaboid receptors which is why we smoke maihuana and not daffodils, must be a reason? Ditto opiates. Surely the odd roll up/ cigar/ joint has a very beneficial effect on spiritual health, the animus, not to mention suppressing appetite? Nothing, in moderation is poisonous; everything in excess will kill

    Reply
    1. JanB

      Not at all sure about that, Andrew B – even the tiniest whiff of someone else’s cigarette smoke makes me wheeze.

      Reply
    2. John Burton

      “Surely it is the 2,000 chemicals in cigarettes that are carcinogenic and not the tabacco (sic) itself.”
      Nope.
      Go and Google snuff and chewing tobacco to see the carcinogenic effects of not smoking the stuff.

      Reply
    3. Martin Back

      Would you like a moderate dose of radioactive polonium-210? Keep smoking.

      According to a 2009 study, a person who smokes 1.5 packs of cigarettes per day receives an 8,000 millirem (mrem) radiation dose to the bronchial epithelium each year, which equals a radiation dose to the skin from 300 chest x-rays.

      According to a 2011 report in Nicotine and Tobacco Research, radioactivity in tobacco comes from two sources: the atmosphere and uptake through soil rich in calcium phosphate fertilizer contaminated with polonium phosphates. Phosphate fertilizer ore contains 50 to 150 parts per million (ppm) of natural uranium. Secret internal documents obtained from the major tobacco industries in 1998 reveal the industry was well aware of the presence of this radioactive element in cigarettes as early as 1959. — http://articles.mercola.com/sites/articles/archive/2016/10/04/vilsack-industrial-farming.aspx

      Reply
  56. puddleg58

    One of the things the recent Tsamine’ paper forgot to mention is that corn and manioc is consumed by them as chicha, or fermented beer.
    As for the suggestion that the protective effect of alcohol in epidemiology is due to reverse confounding; no, this cannot be the case. Why?
    Because alcohol is addictive; one of the best definitions of addiction, and the only one that matters, is a behaviour that you keep up even when you realise it is harming you.
    So if there are people who stop drinking because of some underlying unreported heath problem, there are also many people who keep drinking despite such awareness.
    These factors should – at the very least – cancel each other out.
    Cheers, doctor.

    Reply
  57. bill

    One has a dire disease, the Dr. says, “I suggest
    you stop drinking.” They stop, then a while later
    they die. Tally that death as a “non-drinker.” Pretty
    simple, really.

    Reply
  58. Kay Souter

    Dear Malcolm,

    Please never stop writing these missives…

    Regards,

    Professor Kay Souter Mobile: 0418 762 ***

    Reply
  59. gazzer90

    On a more light hearted note:

    Willie Nelson (Country singer of my generation…ie: old fart) with no intention to insult the good doctor and the medical profession, wrote a song in the 70’s….’I gotta get drunk’, the chorus line ended in…
    ‘There’s a lot of doctors tell me
    That I’d better start slowing it down
    But there’s more old drunks than there are old doctors
    So I guess we’d better have another round’

    So I raise my glass to you all & Doctor K.

    Reply
  60. Jim Chinnis

    We need to remember that the different “levels” of drinking are almost universally based on reported drinking amounts. And we know that reported and actual drinking differ by about a factor of two in the obvious direction (sales vs reported consumption confirm this). So the upper bound of “moderate” is really 4 units rather than 2.

    Reply
  61. Craig E

    Much of the discussion here seems to be on the merits (or not) of moderate alcohol consumption. Ethanol itself is not toxic but acetaldehyde – the first step in ethanol metabolism – is. The enzyme that converts acetaldehyde into acetate (harmless) quickly does its job but has a low saturation point which means that once it’s overloaded acetaldehyde builds up. Acetaldehyde then impacts on mitochondrial function amongst other things. So, in relation to comments about the link between alcohol consumption and cancer…if you believe that cancer is a metabolic disease resulting from impaired respiration (ie mitochondrial disfunction) as per the work of Thomas Seyfried the maybe that’s the link – ie acetaldehyde is the trigger?As to the evident cardioprotective benefits of moderate alcohol consumption I am not sure the mechanism has been documented but I wouldn’t be surprised at all if a reduction in stress plays a part. Now I just need to re-read the whole of Dr K’s series to see how this fits in. I found the below link useful in relation to alcohol metabolism and impacts in the body.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037055/

    Reply
    1. David Bailey

      Yes, you might expect that the extra acetaldehyde would give rise to lots of cancer. The official story implies that that is true – urging to people to think about the extra risk of cancer every time they drink – but the “Good News about Booze” book goes through the very meagre evidence that alcohol (and therefore acetaldehyde) causes any extra cancers in the range of moderate drinking (and that book seems to define that quite generously). Even many cancers follow that same J curve!

      Maybe the enzyme doesn’t saturate within the range of moderate drinking – I don’t know, but since I am not a biochemist (and even if I were) I tend to feel that epidemiological studies trump the theory.

      Reply
      1. Craig E

        Hi David I also believe the biochemistry would support moderate alcohol consumption not being a player in cancer given how rapidly acetaldehyde is broken down. But once the enzyme is saturated and acetaldehyde builds up in the body is where I suppose the damage can occur. I believe that our bodies can also upregulate the production of the enzymes involved in metabolism of ethanol which could be why frequent drinkers ‘handle their booze’ better than occasional drinkers. I might have to check out the book!

  62. JanB

    Goodness me, Dr. K – you’ve opened a whole can of worms with this one. Such fiercely upheld beliefs – almost a religious fervour in some comments. But surely you were suggesting that a modest glass of red wine would benefit most, not that we all get ‘rat-arsed’ every evening. Nothing nicer, I think, than to enjoy a glass of decent wine with nice food and good company. But I can take it or leave it, mostly leaving it. Both my brothers had trouble with alcohol, one died of it when he was 61 and the other has done his best to but survived until he is now 81 but in a wrecked state. Does that mean that they and I might have an ‘addictive personality’, that I might, having succumbed to the evil lure of a nice glass of Malbec become an alcoholic. Nah – don’t buy into that AT ALL. The biggest cop-out ever, in my opinion. “I can’t help it – I have an addictive personality.” Assuming that you allow this post through, I’d better hide behind the ramparts of my iPad, I think, to dodge the inevitable flak.

    Reply
  63. Charles Gale

    Cholesterol build up on the…knuckles??!!

    Sorry for the off topic intrusion (but not for followers of Dr K), but just had the most strange fall down a rabbit hole into NHS-land.

    So, went for an echo scan and got a rather unpleasant, intimadatory lecture on my cholesterol reading for starters (need to increase dosage or switch to a more potent statin).

    Then had the scan and another bullying talk on cholesterol and statins after.

    And then …he told to make a fist with my left hand. (1st time ever for this).

    Silence…silence…and I gave in…I had to ask why he was looking at my knuckles.

    I thought they all went white but no…I was advised that this could well be a cholesterol build up.

    I dunno …couldn’t believe my ears…what the!!!?? is all this now?

    Please…have any followers of Dr K had this cholesterol test?

    Or any comment on this at all. If nothing else, I thought cholesterol appeared in the arteries and nowhere else.

    Thanks!

    Reply
    1. Dr. Malcolm Kendrick Post author

      Tendon build of cholesterol is seen in FH. Sometimes called xanthelasma. Sometimes cholesterol build up can been seen around the eyes, or within the eyes. This is not that uncommon.

      Reply
      1. carol

        If you can see it in the eyes, as mine could when I had my eyes tested at Boots, is this bad.

      2. Ray

        Even in her forties my ex-wife’s mother had a considerable cholesterol build-up in the form of a ring around the irises of her eyes.

        She lived until she was 94.

        Ray

    2. janice

      Does it mean you have FH if you can see it in the eyes. Mine is 8.9 and my optician said he can see I have high cholesterol by my eyes

      Reply
      1. JanB

        Hi Ben – shortly after I stopped taking the beastly statins round four years ago, I was told when having a regular eye test that I had cholesterol in my eyes. Shock horror. Also, the same thing at my retinal scan. Even more shock horror. At the time my cholesterol levels were still adapting but since that time after several eye tests and retinal scans no one has ever mentioned it again. I assumed that it all settled down as my cholesterol levels stabilised. A much higher overall number (7.3) but rather magnificent ratios.

      2. puddleg58

        The cholesterol deposits on the eyelid (little yellow bumps) are cholesterol itself, rather than LDL. They can be seen in people with FH but also in people without it. My girlfriend gets these and I thought that allowing the cholesterol to esterify by having more fish omega 3 in the diet might allow them to clear. So it proved; eating plenty of salmon softened the bumps and made them less yellow within a fairly short time – a big cosmetic improvement anyway.

      3. kelly

        Does your girlfriend high cholesterol. How high is it. mine is 8.9 does that make me FH. I also have high bP for which I take meds but want to come off them. said no to statins.

      4. puddleg58

        We have no idea of her cholesterol level, however you cannot diagnose FH from cholesterol level as it is genetic and high cholesterol has other causes – it is just more likely (but the dangerous homozygous form of FH will give you very high cholesterol, and unusual subtypes of LDL and HDL not normally seen).
        If you have high LDL cholesterol, or heterozygous FH (the milder type) your best measure of long-term cardiovascular risk is your fasting TG/HDL ratio, if this is over 2 you are insulin-resistant, this will come down if you cut out refined carbs.
        There are other markers of cardiovascular health which are very accurate, like the CAC score, but may be harder to get depending on resources.

  64. Old fogey

    Thank you, as always, for this well-written, encouraging, and informative post.

    I am surprised that it has elicited so many negative responses. I have always thought this blog – predicated as it is on presenting facts and then making extremely careful and logical suggestions based solely on the evidence provided – had attracted a particularly open-minded audience.

    Reply
    1. Dr. Malcolm Kendrick Post author

      I understand many people have fears about alcohol consumption leading to alcoholism. It is a highly emotive subject, especially for those who have seen friends or family destroyed.

      Reply
      1. David Bailey

        Malcolm, I would guess that the people you were addressing – people who care about their health, and believe that alcohol should be avoided on health grounds – are the least likely to loose control with alcohol.
        Those who advocate (in effect) carrying on telling people a falsehood – that you are healthier drinking no alcohol – should reflect that the practice of giving people false or twisted medical information really has to stop. It is making people sick, and destroying everyone’s belief in the medical profession.

      2. karlwhitfield

        Ah, but David and Malcolm, this line “telling people a falsehood – that you are healthier drinking no alcohol” is not what this blog post says – this blog post suggests that some moderate level of alcohol consumption provides benefits to CVD risk, but the evidence presented and discussed in this post mentions nothing of cancer (all types), cognitive function, liver disease and so on. As this post only deals with CVD risk, and no other diseases of health conditions, we can’t use a statement like “you are healthier…” as that is not a reflection of the evidence presented.

        Right?

      3. Mr Chris

        Karl
        to be fair, this is a blog devoted to CVD, and that Dr Kendrick’s post starts out making it clear that he is making suggestions as to reducing risk from CVD.
        As regards the other results of moderate drinking, that you mention, like every other person who comments favourably, I can only refer you to “The Good news about Booze” where the first chapter deals very specifically with the (often exaggerated) negative side. He also in the other chapters takes each of those factors and shows that Alcohol has a positive effect in many cases.

      4. BobM

        To karlwhitfield: That’s because your chance of getting and dying from CVD is many times higher than are your chances of getting cancer or other diseases caused by ingestion of alcohol.

    2. Martin Back

      If alcohol were invented today it would be classed as a dangerous drug, considering social effects as well as medical effects. From most to least harmful:

      1. Heroin; 2. Cocaine; 3. Barbiturates; 4. Street Methadone; 5. Alcohol; 6. Ketamine; 7. Benzodiazepines; 8. Amphetamine; 9. Tobacco; 10. Buprenorphine; 11. Cannabis; etc…

      Reply
  65. Dr. Göran Sjöberg

    Ooh!

    Why are we so apt for “one-liners” taking the complexity of our physiology into account?

    Do we really like the categorical views better the the humble ones?

    Views, well founded on facts, like those of Dr. Kendrick seem to be “steamrolled” all the time since they do not fit the “consensus” paradigm.

    Reply
  66. anonymous

    I’m in love with Potassium these days. Does drinking wine or beer (or even distilled liquors) help to reduce the secretion of potassium in the urine? If so, perhaps that’s what lowers the risk of CVD. Not by adding potassium, but lowering its loss.

    Reply
    1. Martin Back

      Better nutrition might help to reduce mineral loss.

      Test rabbits were fed one of two lespedeza [bush clover] hays, one of which received a lime or calcium treatment and one which received no treatment. The hay from the lime-treated soil produced better growth in the rabbits. Surprisingly, the hay from the untreated soil was the better digested. The urine of the test animals was analysed for both phosphorus and calcium contents. The animals eating the hay from untreated soil excreted twice as much phosphorus and calcium in their urine as the animals eating the hay from the calcium-treated soil.

      In order for these minerals to come out in the urine of the test animals, they must have been both digested and absorbed. Yet something must have been missing in the hay from the untreated soil that was necessary to allow the animal to make full use of these minerals. Lacking enough of this essential factor would cause some of the minerals to simply pass through the body without being used, wasting the effort made by the body to digest and absorb them. — https://www.westonaprice.org/health-topics/farm-ranch/agriculture-and-nutrition/

      Several studies have shown that the fruit and vegetables of today are more nutrient-poor than they were sixty years ago.

      Reply
      1. Dee

        It’s sad about the nutrient content of most fruits and veggies today.

        Regarding the quote – I wish I could read the actual study. I’d be curious to know the oxalic acid levels in the hay from the different soils. The conclusion of the quote seems confusing, since a rabbits’ calcium metabolism is so different from most animals, and they normally excrete excess calcium in the urine anyway. It’s one of the reasons you’re supposed to keep an eye out for bladder sludge in pet rabbits.

      2. Jennifer.

        Dee, and in general response to Dr Goran, Sylvia, JanB…..all excellent points in observing the crazy world we live in today.
        I walk down supermarket aisles heaving with chemical ‘cleansers’, deodorants, lubricants, air fresheners etc etc.
        Then I walk up the next aisle heaving with de-natured, so-called ‘food’…..crispbreads, potato crisps, brightly coloured breakfast cereals and pots of luminous, dead, so-called yogurt.
        I turn the corner to be confronted with boxes of yucky birthday cakes, excessively decorated cup-cakes, sparkling doughnuts, ultra-sized tubes of sweeties and enormous bars of brown bars, pretending to be chocolate ( don’t lets even mention the chocolate eggs at this time of year).
        And then to the checkout…..seeing young children, (clinging to adults whose ears are pressed firmly to mobile phones), munching on the free apple provided by the supermarket to shush them up, and thus add a pinch of acceptability to the trolley full of rubbish they will be exposed to when they get home.
        Is it any wonder that we are in an unhealthy state? Never mind….Big Pharma will come to our aid with endless concoctions to address the problems associated with such artificial lifestyles…..pills for obesity, diabetes, hypertension, stress, depression, fungal infections, respiratory conditions, dry skin, lank hair, brittle nails, alcoholism…..on and on and on.
        Anyway….I’m off to plant some spuds in grow bags( no garden these days), change the water in my sprouting mung beans, tend to my living salad leaves, and, best of all, get out into the sun for an hour’s knitting.
        Yes….folks probably think I am as nutty as the nuts and seeds I add to my home made, full cream, live yogurt, and as cabbage-faced as the sauerkraut I have now achieved ( thanks Dr Goran), but I am convinced this lifestyle is adding to the quality of life for me and my other half.
        Yes…very time-consuming, and only possible because we have state and private pensions.How on earth can workers on poor pay, zero hours contracts, and unable to indulge in equipment I have to hand, and not to mention the indulgence of forward planning, ever get out of the whirligig of modern life?

  67. mikecawdery

    Not giving direct advice has the added advantage that you won’t get sued, or lose your license to practice medicine. Or at least, it makes it far less likely

    The above statement is unfortunately very true and pragmatic but surely given the Hippocratic oath and the principle behind it, this is quite the antithesis of medicine. It is where the pharmaceutical companies have become so involved in research for their own profit that nothing else matters. This in turn raises the issue as to whether the intention is ever to cure or simply to ameliorate the signs and symptoms so that once involved the patient becomes permanently associated with suitable drugs. Diabetes is a case in point. Is there a cure? There are those who claim it can be, but how many actually fully recover; how many actually get a fighting chance of recovering? And diabetes leads on on to CVD, Alzheimer’s and, by all accounts, cancer.

    Reply
    1. Jennifer

      Bloomin’ heck, Mike! A very good contribution.
      I reckon I may consider myself a ‘recovering type 2’, as it is 4 years since I left all the drugs behind me. Of course, there is no way of knowing if I have fully recovered from the condition, other than going for endless tests ..( I don’t participate in that game any longer)…but my general health is doing fine.
      However, occasionally I ruminate over the situation, comparing it with the constant message that we don’t know we are hypertensive, i.e. having no obvious symptoms. Maybe my dormant diabetes is masquerading in some part of my anatomy and physiology that requires diagnostic interventions to uncover….it seems like scare tactics are the order of the day in modern medicine.
      Scrambling quickly towards my 3 score years and ten is scary enough for me, without the state suggesting things for me to worry about.

      Reply
    2. smartersig

      The threat of having ones licence revokes is always upper most in any doctors mind. Only today I had some bad news. After 7 years of medical training and hard work, a very good friend of mine has been struck off after one minor indiscretion.She slept with one of her patients (they were good friends) and can now no longer work in the profession she loves. What a waste of time, effort, training and money. A genuinely nice lady and a brilliant vet.

      Reply
      1. David Bailey

        I agree – that is very unfair, and such an absurd waste. I also feel that a female professional is far less likely to do something like that in an exploitative sort of way.

        In many ways our modern society lets anything go, and yet it can be so mean-minded in cases like this. Can she appeal and get back?

    1. Mark Johnson

      Thanks for that Dr Göran.
      In a sane world Professor Noakes wouldn’t even be in court and everyone would be following what he advocates. In this back-to-front, on its head world, I fear he’ll be found guilty.

      Reply
    1. smartersig

      This would appear to be the best piece of evidence connecting levels of LDL with heart disease. No one seems keen to challenge or agree with it ?.

      Reply
      1. puddleg58

        If it’s genetic, no-one can change that; the question is whether and which changes are worthwhile, and genetics is not a possible change anyone can make.
        Your doctor cannot give you this, you cannot buy it in a shop.

      2. smartersig

        Thats not the point of my post or the article. The point is that this is as close as you will get to a double blind placebo controlled trial where one group have high cholesterol and others do not. These people are a cross section of society ie drinkres smokers fat thin etc etc and yet with genetically low LDL they do not suffer HD

      3. puddleg58

        Those people who don’t have the gene for low LDL, but have low LDL anyway, are not at lower risk for CHD and, depending what’s causing their low LDL, may be at higher risk.
        Those people who have the gene for low HDL don’t have an increased CHD risk, but in the general population low HDL, which is due to diet and lifestyle causes, is the best predictor of CHD risk.
        This is why we can’t extrapolate from genetic risks, and why we certainly can’t regard genetic variation as the equivalent of a randomised controlled trial.

      4. David Bailey

        Well given the fact that we have all been exhorted to lower our LDL levels for many years, you would expect there would be an abundance of evidence!

        From the paper: “White people with the less severe mutation in the gene had a 15% reduction in LDL and a 47% reduced risk of heart disease.”

        Doesn’t that seem rather odd, because I thought statins typically reduce LDL levels by more than that, and yet they don’t give you such a large reduction in heart disease?

        Aren’t you also rather suspicious that it is possible to lower cholesterol so much, and yet it plays a vital role in the body?

      5. smartersig

        What I am wondering is whether both camps might be correct. By camps I mean the pro cholesterol is the culprit aka Dr Gregers web site and cholesterol is not the culprit aka here. What do I mean by both being correct, well perhaps cholesterol is find in LDL numbers above 3.0 mmol despite what we are told but only if we do not subject it to inflamation and lets face it we have in the last 50 years bombarded it with our dietary changes. On the other hand if you lower LDL especially from an early age you lessen the inflamatory vehicles that can promote plaque build up. Hence even a crappy western diet will do less damage to the arteries if cholesterol is lower. Yes you may not live longer but nevertheless both of these camps can be correct. If am right I still think its sad that we attack the disease by suggesting that we smash cholesterol LDL below 2.0 without suggesting a dietary approach. Please feel free to correct my thinking.

      6. Craig E

        I read the study link but didn’t go into the studies referenced in that. My immediate questions are how big were the sample sizes? In one study there were I think 3700 in the whole study. Half were African American and only 2% of those had the genetics. Second question is were the quoted risk reductions relative? Third question is around Dr K’s post about Repatha which showed that although there was a huge reduction in ldl there was no impact on overall mortality – how could this be? I can’t see how at a Biochemical level ldl could cause heart disease. As per a previos post from Dr K, LDL starts it’s life as VLDL. As it drops it’s payload of lipids to cells it becomes IDL and then LDL. All 3 carry cholesterol esters but LDL has the highest %. Given that all of these lipoproteins circulate in the bloodstream and also through veins (which don’t get damaged), how is it that ldl specifically causes damage? It just doesn’t make sense on any level really

      7. Roger

        smartersig
        The link you provide is to an article written by a journalist. It does not contain one iota of fact proving that low ldl leads to lower mortality. i’d be interested to know if Tracy’s parents are still alive and at what age.

      8. Mark Johnson

        Doesn’t that seem rather odd, because I thought statins typically reduce LDL levels by more than that, and yet they don’t give you such a large reduction in heart disease?

        And where’s the dose response?

  68. Soul

    I like it. I can see a difference. It has only been a few days so far. Hopefully this will continue.

    I began drinking a glass of wine a day. Now my face has more color to it. It’s a healthier look. I don’t know what is going on, but my guess is that my circulation is improved by the little bit of alcohol taken.

    Reply
  69. Christopher Palmer

    Fire-fighters are at a significantly greater risk of suffering in service heart attacks. Furthermore the heart attacks arise (cluster) around fire suppression duties. Firemen are at greater risk of a heart attack either when fighting a fire, fighting simulated fires in training scenarios, or in the period following these suppression duties. Thinking has it that heat and physical exertion aggravate oxidative stress and dehydration.

    Oxidative stress has physiological implications, especially for blood and for platelets, and it would appear to leverage inflammation. The mechanisms at work remain imperfectly understood but it is reported that platelets are activated in some way and have increased tendency to form clots, and in addition dehydration brings on degrees of hemoconcentration which seem to compound the undesirable effects. You can read about this here:
    http://circ.ahajournals.org/content/135/14/1284

    I think this article is interesting, Dr Kendrick, for being in accord with your own thoughts that thrombogenesis may arise independently of atherosclerotic plaques rupturing (or even independently of atherosclerosis, perhaps). I also think it is also interesting for touching upon physiological risk factors for MI (myocardial infarction) and never mentioning cholesterol.

    My own thoughts upon the article are that discussion of ‘oxidative stress’ could have been opened up a bit.

    I don’t know but, from a theoretical standpoint a saliva test could have been incorporated into the study and would need not have cost more than the price of few indicator papers. I would have predicted / expected detectable alterations to the pH of saliva before and after the exertion of fire-suppression duties. Likewise, and for precisely the same reasons, ‘body voltage’ measured relative to ground and by means of electrode patches attached to sites about the body would reveal empirical contrasts in the ‘before’ and ‘after’.

    Reply
  70. Charles Gale

    Xanthelasma – cholesterol build up in knuckles and eyes

    Appreciate the further info/comments on this topic.

    I’ve heard so much nonsense from NHS/GPs and so on over the last year that I’ve become cynical and just thought this doctor doing my echo test was talking more gibberish.

    Perhaps something else to worry about now.

    Almost…almost at the point of taking statins in the interests of self experimentation to see if cholesterol levels drop and my strange knuckle returns to normal.

    But also getting to the point of closure after my alleged cardiac event and getting on with life like many visitors to this website.

    I have to say, I’m now coming around to the view point of stopping blood tests for this, that and the other..and tests for this, that and the other.

    I’ve argued and thought positively of various tests but not anymore.

    Or at least keeping the results from my GP.

    At this stage I can’t offer any answers to some of the comments on this topic

    Reply
  71. mike cawdery

    Beware – the drug floggers are out again
    http://www.express.co.uk/life-style/health/789034/high-cholesterol-levels-inherited-genetic-genes-heart-attack-risk
    A study has found that over a 30-year period 1,668 cases of heart attack, stroke and angina, as well as an additional 276 deaths caused by Familial Hypercholesterolaemia (FH), could be avoided, for every 12,000 first degree relatives tested for the condition. This works out at about 65 deaths per year or 0.026% p.a.

    But of course this is genetic BUT there is no mention of the risk of genetic intolerance to statins and the consequences of that. But flogging drugs is far more important than the “medical error” consequent on the adverse reactions caused by drugs.

    Reply
    1. Dr. Göran Sjöberg

      Mike,

      Of course you may ask what angina is. I am pretty familiar with this issue and when I was today actually struck by angina again it was a relative issue consisting of mental stress and physical efforts.

      Usually, today I am keeping my unstable angina at-bay with 2000 IU natural vitamin E but today i had still a bout of angina though of a rather moderat kind. And the “pain” scale associated was certainly relative and disappeared when I handed the shuffle over to my strong wife. (Would never dream of going to the emergency room although they would love to see me there me 🙂 and to hand me a number of drugs.)

      The reason today was that I am rebuilding my heating system in the house with a number of people and advanced drilling and digging equipment involved to tear out the existing for a replacement. So I found myself with a shuffle in my hand to support the project where stress met my heart limitations through the physical effort. Thus a combination of stress and physics.

      So my advice is to endure the angina rather than to give in to the charlatans of the medical profession. Your body is telling you that you have met your limit and tells you to immediately relax perhaps with the help of a double scotch which helped me before adopting the vitamin E course as a precaution step. Even my stupid cardiologist admitted the the double scotch approach was a no-nonsense part of my “ideology” around CVD..

      And by the way – LCHF eating makes wonder 🙂

      Reply
      1. Mark Johnson

        Dr Göran

        Does your angina never, ever “worry” you sufficiently to carry some nitroglycerin around or see a cardiologist?

        I don’t think I know anyone who suffers from angina but it strikes me as possibly quite a scary condition.

  72. Charles Gale

    Familial Hypercholesterolaemia (FH)

    Thanks Mike (Cawdery) for the link on FH.

    1. Can anyone confirm if this is the same as Familial Hyperlipidaemia?
    2. And following on from Kelly’s query about diagnosing FH, does anyone know how it is diagnosed? I provided a private cardiologist with about 6 total cholesterol readings taken over 6 years or so (all in double figures) and on his consultation report wrote “Familial Hyperlipidaemia”.
    Or, as discussed above, is it the appearance of nodules on the knuckles and around the eyes a way to diagnose? Presumably, you’d have to have high cholesterol over a prolonged period of time for this to happen?
    3. Puddleg58 – what amounts of salmon was being taken to soften the bumps? I’m intermittently taking the odd salmon oil capsule.

    Kind regards!

    Reply
    1. Dee

      My understanding has been that Familial Hyperlipidaemia includes elevated triglycerides, which Familial Hypercholesterolaemia does not. Although a person with Familial Hypercholesterolaemia may have elevated triglycerides if they are having insulin/blood sugar regulation issues.

      The deposits around the eyes and nodules on the tendons can also happen in people who don’t have genetic lipid conditions.

      The only way to get a definitive diagnosis for these conditions is genetic testing. But the diagnosis is often given based on blood levels, family history, etc.

      Reply
  73. Dr. Göran Sjöberg

    One of the readers/commentators of my comments on this blog personally alerted me to a few interesting books, one of which was “Ignorance” of professor Stuart Firestein and a book which justly brings our immense ignorance to the surface. Specifically this ignorance seem to be the true driver for “science”.

    Thus, today, and actually for long, categorical statements about our health issues do not impress on me the least.

    All understanding seems to work at three levels. First we realize that we understand a few fundamental details of the molecular biology working of our cells – rather impressing in the disclosure of the details. Then we may understand how we “feel” and why in relation to what we put in our mouth in the short and in the long term perspective. We are getting an immediate or a long term response. Finally we try to connect everything into a logic of understanding and here is where the real mental traps are set. When one of those latter closes you turn into a prisoner of categorical thinking.

    What do you think about that?

    Reply
  74. Mark Johnson

    Dr Göran

    I had a look at some of the reviews on Amazon for the book, “Ignorance” by Prof. Firestein and have copied a bit of the first review:

    W. B. Yeats admonished that “education is not the filling of a pail, but the lighting of a fire.” Stuart Firestein agrees, and in this marvellous book he argues that science is less about accumulating facts and rules and more like looking for “black cats in dark rooms.” The scientific process is not a tidy logical procession from one grand truth to the next. It’s “mostly stumbling about in the dark”, “bumping into unidentifiable things, looking for barely perceptible phantoms”. In short, it’s about dealing with ignorance.

    So why is it in medicine and “climate change” (aka global warming), the science is settled?

    Reply
  75. Soul

    Oh my. Things will be ratcheted. I wrote earlier about a neighbor and family friend having a heart attack. Politically I mentioned the friend is far to the left of the dial. I jokingly mentioned the cardiac event could have been due to a ramble against President Trump.

    Word came late this week that the Vice President is likely to visit this area. No mention given on where he was to be. Driving home this evening I found a heavy police presence. One street around the corner from my place has several police cars out front. Also out front were a crowd of people.

    I hear our family friend is back home recovering from his bypass. For his health and recovery I hope his wife unplugged the TV and threw away the newspapers!

    In light of this post, If I should happen to run into a VP out for a walk in the neighborhood, I’ll be sure to offer him a glass of wine for longevity. Not that I carry bottles of wine with me when I’m out on walks, but it’s the thought that counts.

    Reply
  76. Randall

    This is a real doozy of a study that was hid from publication until now (12 April 2016) – to test whether replacement of saturated fat with vegetable oil rich in linoleic acid reduces coronary heart disease and death by lowering serum cholesterol. There was a 22% higher risk of death for each 30 mg/dL (0.78 mmol/L) reduction in serum cholesterol. http://www.bmj.com/content/353/bmj.i1246

    Reply
    1. smartersig

      Even today vegetable oil is a standard in the average UK household. Restaurants use it by the bucket load to fry foods and I can tell you with confidence that its not changed in the fryers until its pretty darn rancid

      Reply
  77. John U

    There is so much interesting content on the internet these days on the subject of health that it is difficult to find the time to read it all. But if you haven’t listened to Dr. Ted Naiman’s presentation at LOW CARB BRECKENRIDGE 2017, then you really must. It is one of the best I have ever seen and covers the science at warp speed, so you might have to watch it at least twice. .

    Reply
      1. John U

        Wow, that was impressive. And scary. It absolutely impacted my way of thinking about a lot of things. Its all very much complicated to say the least.

      2. smartersig

        Glad you liked it, I though Mercola was going over the top with his intro of the guest but I have to admit he was right on the money. We have to admit that sometimes two people can give the same information but one is infinitely more listenable and that applies to this guy.

      3. Gary Ogden

        smartersig: Thank you very much for that link. Outstanding interview, and crucial information about human health and the epidemic of degenerative conditions which plague the modern world. For some reason none of the comments have been coming to my inbox for a week or so. Maybe clicking the square again will fix this.

      1. John U

        Yes, I have been following this case and that of Gary Fettke with a great deal of interest. As you say, Kafka like behavior. But that is what you get when “ignorance” (in capitals) is present in the population at large. I confess to having been “ignorant” of all this until about 5 years ago, when I “awoke” and couldn’t believe what has been happening. It is unfortunate that such agencies as the AHPRA and the HPCSA have the support of the legal system to sanction their own members to the extent of taking away their right to practice, and all that without due process of law. Shameful to say the least but not at all surprising when there is so much money at stake for the agencies, the pharma business, and the agri business. We have been duped and all the major players want it to stay that way, and not enough ordinary citizens know enough to take interest and force changes.

      2. Dr. Göran Sjöberg

        John,

        Yes, I think most of us may reach this “tipping point” from an innocent start and with horror, as you and me, if we have enough “interest” to question the established “order”.

    1. smartersig

      Great insight into how we burn either fat or glucose and why therefore when we eat lots of carbs fat burning is switched off and redirected to Triglycerides. Many thanks

      Reply
    2. Stephen T

      Thank you, John U.

      The part about food designed to make rats fat and the similarity with the American diet is telling (25 mins). Dr Naiman says that 60% of calories in the standard American diet comes from wheat, sugar and vegetable oil. In short, processed junk.

      Reply
  78. mikecawdery

    J Alzheimers Dis. 2017;57(2):633-643. doi: 10.3233/JAD-161016.
    CONCLUSION:
    IR is related to subsequent poorer cognitive performance and greater cognitive decline among patients with cardiovascular disease with and without diabetes.

    Just a reminder of what diabetes, statins and insulin can do. full text behind paywall

    Reply
    1. John U

      I first came across some hypothetical science behind Alzheimer’s in Chapter 13 of Gary T book Good Calories……..He presented information gleaned from research and addressing the impact of Insulin-like growth factor and the AGE’s on the plaque formations in the brain. Although all of this was still hypothetical, it all struck me as phenomenally plausible and sensible, and it really fit with the Insulin Resistance hypotheses. I am happy to see that there is research ongoing and progressing along these lines.

      Reply
      1. mikecawdery

        John U
        Some more refs on Type 3 (AD) diabetes – not that the “experts” seem to be interested.
        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3045545/
        Br J Clin Pharmacol. 2011 March; 71(3): 365–376.
        doi: 10.1111/j.1365-2125.2010.03830.x
        The evidence for a connection between T2DM and AD is based upon a variety of diverse studies, but definitive biochemical mechanisms remain unknown

        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769828/
        J Diabetes Sci Technol. 2008 November; 2(6): 1101–1113.
        Alzheimer’s Disease Is Type 3 Diabetes–Evidence Reviewed
        We conclude that the term “type 3 diabetes” accurately reflects the fact that AD represents a form of diabetes that selectively involves the brain and has molecular and biochemical features that overlap with both type 1 diabetes mellitus and T2DM.
        http://www.neurology.org/content/77/12/1126.abstract
        Glucose tolerance status and risk of dementia in the community
        The Hisayama Study Neurology September 20, 2011 vol. 77 no. 12 1126-1134
        Conclusions: Our findings suggest that diabetes is a significant risk factor for all-cause dementia, AD, and probably VaD. Moreover, 2-hour PG levels, but not FPG levels, are closely associated with increased risk of all-cause dementia, AD, and VaD.

        Expert Opin Drug Deliv. 2013 Dec;10(12):1699-709. doi: 10.1517/17425247.2013.856877. Epub 2013
        Growing evidence supports the concept that insulin resistance plays an important role in the pathogenesis of cognitive impairment and neurodegeneration, including in Alzheimer’s disease (AD).

  79. smartersig

    Message for Zoe Harcombe, I understand she is on this list. I am watching your 2016 Aussie presentation and you mention that plant sterols are connected with increased HD. Is this reliable given that you are stating this because Veg Oils contain plant sterols. Is it not possible that the instability of oils and not the plant sterols within are the culprit ?

    Reply
    1. John U

      Mike, this Ted Talk is one of my favorite and I often recommend it to my circle of friends and acquaintances. She is a bright star among the health professionals.

      Reply
      1. mikecawdery

        Goran

        As you say it is incomprehensible. I am left with the impression that in truth (if such exists in this day and age) the issue is simply one of money, status and “FACE” for the medical establishment.
        Do they ever mention the “six weeks STRICT bed rest” catastrophe? Do they ever mention the “Helicobacter pylori” abuse? Do they ever mention the GSK Study 329 data hiding and data selection fiasco? Do they ever mention the Polderman guideline leading to 800,000 deaths in Europe? That must have been one of the fastest ever cover-ups and whitewashes of all time,

    2. Antony Sanderson

      Thanks Mike

      You have solved a problem that has just landed on my doorstep . . . Three weeks ago I visited an uncle (late seventies, overweight, suffered T2D for quite a while) . . . He looked at me and said he didn’t recognise me. (On my LCHF diet, intermittent fasting, odd 24hr fasting sequences I had lost a lot of weight) . . . . and later, surprised, “Do you really not have diabetes anymore?” . . . then “What d’you do?” . . We talked.

      A couple of days ago I received a telephone call from my uncle . . . “I’ve lost nearly a stone in weight, and I’m not taking metformin any more. . . I am not eating bread or potatoes. . . eat mainly salad . . . I feel really good on it”. He mentioned that a couple of days after our meeting he went to his GP’s appointment who gave him the latest HbA1c results . . on the basis of which she decided that he needed to increase his metformin dose. “No” he told her “I am following a new diet, I am not taking the metformin anymore”. He is now booked to see her in 3 months, and he cannot wait to show her where he has got to. He measures his blood sugar constantly so has a good idea of where he is going. He was shocked that after mindlessly eating some mashed potatoes he immediately tested his glucose level . . . 8.5mmol/l . . . he was shocked. He was trying to keep the level between 5-6.

      So the problem . . . I live 250 miles away – so support is a problem. I wanted a video that was straightforward, have a good outline of the mechanics of diabetes, and that made clear the low carb solution that worked for me. (All the video references I have noted down are too technical). the TEDx video looks perfect.

      He worries about getting the odd sugar crash . . . getting very weak, taking a couple of chocolate biscuits to deal with it. In some respects this should be good news . . it looks as if he is is producing (over-producing?) insulin. He has been taught to pay attention to hypoglycaemia symptoms when on metformin and is jittery about sinking into a coma. I said to take the odd biscuit if he felt he needed it, but he would find that as time went on he would need it less and less.

      Now I need to Facebook him some recipes/sites to get him to move on from just salads.

      Reply
      1. mikecawdery

        Anthony Sanderson
        I am glad the video was of use. The problem as I see it is that officialdom has its “guidelines” that have nothing to do with curing diabetes, only limiting its effects and maintaining drug sales. Unfortunately, I have ended up as a Type 1; I have to take insulin despite the fact I eat very little carb of any sort. My entry to the LCHF diet was too late to resolve the issue and when I finally got my fasting blood insulin level tested it was too late, it was low despite high FBG. The blood glucose up regulators were already doing well and their control by insulin was non-existent. For people who are unfortunate to get insulin resistance and fail to go LCHF, failure of the beta-cells is a long term certainty. The research is to busy getting statistically significant results using HRs/ORs and using inflated Relative Results to make their studies look good rather than looking for an effective regime.

        Diabetes must be one of the few diseases where the the problem, hyperglyceamia (hyper blood glucose) is treated by feeding the cause of the condition, namely glucose. The “dietary plates” consist of 45-50% carbs thus ensuring a glucose blood surplus when insulin resistance exists and an ever increasing production of insulin to the point of finally wearing out the beta cells.

      2. Dr. Göran Sjöberg

        It is really unbelievable that we have a healthcare system that not only ignore the one and simple “cure” for diabetes T2 but actually prosecute practitioners (Fettke, Noakes) for advocating this cure.

      3. David Bailey

        I guess the phrase “mainly salad” is a bit vague. Does his diet have cheese or something in it to supply some HF in HFLC?

        I found it took a little while before I could eat butter or cheese without a twinge of guilt – even though I had become intellectually convinced that saturated fat was not a problem.

      4. Antony Sanderson

        Mike . . . I agree with the influence of guidelines in diabetes treatment; however, I must give a special mention to my doctor who 2 years ago told me my HbA1c had drifted below the diabetes level . . . and then added tentatively, in a way that seemed he expected a negative, suspicious reaction . . . “There are indications that T2D can be reversed” (He did know of my low-carb regime).

        I asked if I could keep the free glucose sticks on prescription, and was allowed – Even this year, after a further drop in HbA1c, when he took me off his books as diabetic, he let me keep my prescription.

        This all said to me that he did know of the reversibility of T2D if caught early enough, but at no point did he mention the possibility until the reversal was well under way.

        What should a GP do? With the guidelines in mind and the video you posted . . . and bearing in mind that GPs cannot hope to do much counselling in a 10min . . . I thought that perhaps a GP should have a number of goto videos like the TEDx one, given by a qualified doctor in obesity, that could be given to patients with a request make a re-appointment to discuss things after looking at the video.

        Other good goto videos would be Episodes 1,3 of the Doctor in the House – Dr Chatterjee – BBC – Gives good ideas on changing nutrition to overcome diabetes. (sadly only available by purchase)

        Just a thought.

      5. David Bailey

        Antony,

        You said,

        “and then added tentatively, in a way that seemed he expected a negative, suspicious reaction . . . “There are indications that T2D can be reversed” (He did know of my low-carb regime). ”

        My guess is that a lot of GP’s are starting to feel embarrassed about the various guidelines. I think my GP seemed glad that I had discovered that Simvastatin had caused my problem, and perhaps relieved that I wasn’t blaming him for the trouble! Maybe GP’s will ultimately lead the revolt against ‘evidence-based medicine’!

      6. Antony Sanderson

        David . .

        I think you are absolutely right about the embarrassment . . . And when, after months of ineffective physiotherapy on my top arms and shoulders (cost?), I said I thought the problems was the statins, and that things had improved since I took a month holiday off them, he acquiesced immediately – no arguments – no “you are signing you death warrant by your actions”. I could tell by his demeanour he was in no way inclined to defend the guidelines. From a later comment I suspect `I am down in his books as someone who “Does not get on with statins”.

  80. John U

    Mike C. Thanks for the links to the studies on DM and AD relationship. These were far above my ability to understand, but I did glean enough from the abstracts and discussions to understand that some scientists are following the leads which suggest that there is potentially a common cause to both diseases, and that cause probably involves insulin and insulin resistance. I keep following a near-keto diet in the expectation that they are right.

    Reply
  81. bill

    Many great interviews will be available for free,
    including Ivor Cummins, Eric Westman, Thomas
    Seyfried, Sarah Hallberg, Tim Noakes, among others.
    Here’s the link: http://lipedemaproject.org/
    Check out the great people they have interviewed.
    It’s free each day, starting April 19th.

    Reply
  82. Dr. Göran Sjöberg

    The older I get and the more I read about how to improve my own obviously wrecked immune system the more I get into a holistic view on this issue and where my CVD just is only a tiny part.

    Almost all of us tend to be weak for reductionistic explanations to find a single “cause” for a disease. Typically along this line researchers who are finding very weak but “statistically significant” associations easily get their “findings” published in merited medical journals if their association supports the koncensus paradigm while other researcher finding much stronger associations that goes against the existing paradigm struggle in vain to se their results in serious print.

    I goes without saying that nothing could happen without at least one cause but regarding our immunological diseases (like diabetes and CVD ?) there are several contributing factors (causes) of different magnitudes where though one may be the trigger.

    Adding to my increasing holistic view of the medical world I am now reading a book which was recommended to me by the reader here of Malcolm’s blog, the same who recommended me the book “Ignorance”. The present book is “The Human Super-Organism” by immuno-toxological professor Rodney Dieter and has so far (half-way) been very interesting although he has not specifically mentioned how the food could compromise your immune system.

    The convincing main theme in the book is that our immune system is developing and maturing from birth onwards in symbiosis with the many thousands of microorganisms that inhabit all of our external surfaces where the gut lumen wall seems to be of prime importance. The first few weeks in life are, according to Dieter, crucial for getting an immune system that will protect you properly all your life. If you are not meeting the pathogens in the very beginning your defense system will not develop properly and it can not later be repaired. Here is the danger with the cesarean delivery. With such a weak system along Dieter claims that you will be prone later in life to acquire our autoimmune diseases of various kinds.

    Reply
    1. AH Notepad

      At long last I am beginning to understand the need for a wholistic approach to health. The medical industry’s treatment of parts replaces one problem with another. You can confirm this from the so called “side” effects of the toxic drugs used to treat (damage) the unfortunate patient.
      There are other causes which people need to be wary of, especially when they thought they were helping. http://www.newsweek.com/facebook-use-damage-health-582773

      Reply
    2. Sylvia

      Also, children used to play outside, make mud pies, get dirty, only had a bath every Friday, clean clothes when they got dirty. I believe having a pet is also a way of exposing you to germs that are beneficial, helping to strengthen the immune system and to teach youngsters to love and care. Buy, prepare and cook proper food, goes without saying, to improve your chances should disease visit.

      Reply
      1. JanB

        Sylvia, I agree with you 100%. People’s homes seem almost to resemble operating theatres these days with all the horrible antiseptic wipes and goodness what else. We are quite simply too clean for our own good. People shower or bathe once or twice a day then replace the lost natural oils from the skin with nasty chemical body lotions and thereby doing god knows what to the environment. Crazy.
        There,I feel better getting that off my chest.

      2. David Bailey

        Well here in Northern Britain, people still go for walks on muddy tracks, and the children still enjoy the mud – as do their pets! It would be great to see some statistics – asthma rates with or without pets.

      3. Martin Back

        My mother was a great believer in dirt as an essential part of childhood. Growing up on a grape farm in the 1950s I experienced plenty of it. Coupled with getting all the childhood diseases, I seem to have a pretty robust immune system today. When I was working I would go for years without a day of sick leave.

        The downside of farm life is agro-chemicals. In our case, Bordeaux mixture, dusting sulphur, and the now-banned organochloride Dieldrin. I can remember my mother arguing with my father that he had to get rid of the latter and him saying he needed it for pest control. I wonder if it contributed to my mild autism?

      4. smartersig

        There is a wonderfully interesting post currently out by Dr Mercola on close cousin of the dirt issue. The book and research of a guy called Hoff I believe and how we strive to maintain a constant temperature in lour lives is damaging us. Our less modern lives contained both hot and cold periods and this gives out cardio vascular system a workout via vasolidation and contraction. Worth a read

        http://articles.mercola.com/sites/articles/archive/2017/04/16/environmental-conditioning.aspx?utm_source=dnl&utm_medium=email&utm_content=art1&utm_campaign=20170416Z2_UK&et_cid=DM142661&et_rid=1970411495

  83. Dr. Göran Sjöberg

    I wonder if we are atthe breaking down point of traditional school medicine.

    This strikes me when I read the daily newsletter received from Dr. Mercola this morning.

    This time it was about remedies for depression which is spreading like a wildfire today. Mercola is one of the a strongest advocate for turning your back to the abuses of the school medicine and instead go “natural”, alternative ways by a broad holistic attack on your health problems to possibly restore your health. There is an emphasis on going for the causes instead of being trapped by one or several pharmacologic remedies which in the long run makes things only worse. (Read Robert Whitaker’s books about this madness going on!)

    Going for causes fits my natural researchers mind.

    Thus, myself, I believe in this route not least since it has proven pretty successful for me and my wife although the health for both of us is probably too metabolically damaged for a “full recovery”.

    So I am, e.g., today enjoying my latest bone broth soup which I prepared in my recently acquired “Slowcooker” – a wonderful tool in my eyes.

    Reply
    1. mikecawdery

      Goran

      Like yourself as a researcher of many decades, I believe that “cause or causes” should be the the main direction of research. Unfortunately in the major general medical journals the papers published seem to be only concerned in “cure” rather than cause. A classic example of this was stated by the ADA (American Diabetes Association: Nutrition Recommendations and Interventions for Diabetes– 2008. Diabetes Care 2008, 31( Suppl 1): S61-S78.
      ) as follows:

      “Sucrose-containing foods can be substituted for other carbohydrates in the meal plan or, if added to the meal plan, covered with insulin or other glucose-lowering medications.”

      (from Feinman, Richard David. The World Turned Upside Down: The Second Low-Carbohydrate Revolution)

      Without actually saying it positively, can one get any clearer statement to saying sugar and other glucose producing foods result in hyperglycaemia but not too worry – just increase your drugs

      Reply
    2. Soul

      Mercola does offer a good deal of various advice. He is popular. Personally, I found most of the ideas unhelpful when tried and stopped going to his sight.

      Reply
    3. Martin Back

      A colleague of mine was putting in a full day’s work at age 80. He had to, he had no pension, but he was also very fit and healthy, and he used to say that depression is simply a lack of physical fitness.

      As someone who was self-diagnosed depressive most of my life, but not these days, I agree with him. Currently my weight is under control, I am eating fresh and healthy food, and getting plenty of exercise in the form of walking, gardening, etc (not actual gym), plus time outdoors in the sun, and I’ve forgotten was depression was like.

      Back in the day I would self-medicate for depression by drinking, as I suspect many people do. The problem is, alcohol is a chemical depressant, so while there is a short-term lift, in the long run it makes depression worse.

      So all of you taking alcohol for the sake of your heart, you might live longer, but you’ll be miserable ;o)

      Reply
      1. Dr. Göran Sjöberg

        Martin,

        Well!

        I fully agree with the physical fitness importance for mental health – well documented! The last days I have myself been almost exhausted with my shuffle in hand.

        Still I don’t feel miserable, to say the least, with my couple of glass of wine each day in front of my fireplace in the evening. Today I feel actually rather optimistic about life at 70+ – could it be the D-vitamin supplement that saves me here at my latitude in Sweden? 🙂

  84. mikecawdery

    Front Aging Neurosci. 2017 Mar 23;9:72. doi: 10.3389/fnagi.2017.00072. eCollection 2017.
    The Associations among Insulin Resistance, Hyperglycemia, Physical Performance, Diabetes Mellitus, and Cognitive Function in Relatively Healthy Older Adults with Subtle Cognitive Dysfunction.

    The participants with DM had lower general cognition and executive function. Executive dysfunction in the DM participants seemed to be partly explained by hyperglycemia and/or slow gait speed. Our findings confirmed that IR, DM, sarcopenia, and cognitive dysfunction are mutually associated in complex ways.</b?

    Diabetes. 2017 Apr 7. pii: db161444. doi: 10.2337/db16-1444. [Epub ahead of print]
    Metabolic Syndrome, Insulin Resistance and Cognitive Dysfunction: Does your metabolic profile affect your brain?

    “Using data from the Prospective Epidemiological Risk Factor study (n=2,103), a prospective study of elderly women in Denmark, we found that impaired fasting plasma glucose was associated with 44% (9%-91%) larger probability of developing cognitive dysfunction.”

    And guess what causes diabetes – statins; and what causes “cognitive dysfunction” – statins

    Truly great stuff.

    Reply
    1. mikecawdery

      JDPatten

      Many thanks for the link. Once again it raises the issue of the unpleasant potential effects of glucose and its precursor starch. Of particular interest to me is the Dr Naiman youtube presentation on the subject of HOMA-IR test. It appears that this test, a combination of Blood glucose level (FBG) and fasting blood insulin level is associated with many serious chronic diseases yet the insulin test is never(??) used in NHS hospitals.

      Consequently the value of this test is never available to doctors for differential diagnosis. Commercially the insulin test (including profit) is only £39, whlle NICE (and NHS) are quite prepared to spend £1000s in largely ineffective cures. Seems an odd misuse and waste of money to me.

      Reply
      1. Antony Sanderson

        A couple of years ago (this was after I had stopped taking statins and was beginning to deal with the T2D) . . . I paid my £39 for an insulin test – the local GP surgery took blood for free – I had tested my fasting glucose that morning. A couple of weeks later, plugging the insulin result and the fasting GL into the HOMA-IR calculator . . (actually downloaded the HOMA-IR app – but the calculator is online) gave an Insulin resistance of 0.53 (< 1.0 ok) and β cells at 30% functionality (100% is good). The β cell thing fascinated me – did it mean that the β cells were just working inefficiently, producing 70% less insulin . . . or that something had knocked out 70% of my β cells and the 30% left were working flat out to keep up. (I wonder what could have damaged my β cells?)

        Now you have raised this HOMA-IR issue Mike . . . 2 years on . . . I am minded to have another go and see where we are wrt β cells.

  85. chris c

    Old saw: definition of an alcoholic = someone who drinks more than their doctor

    Modern version: obesity = someone who is fatter than their dietician

    If you have one in your vicinity I thoroughly recommend the Co-Op: they have some excellent wine buyers. My favourites are various Chilean Carmenere and Argentinian Malbecs which are cheap and tasty.

    Looking at one of the papers listed above, I recently found this

    http://diabetes.diabetesjournals.org/content/55/6/1807

    which looks at the differing effects of hyperglycemia and hyperinsulinemia on CVD risk factors, and hardly mentions “cholesterol”. It explains why trials like ACCORD and VADT were such epic failures – using heroic quantities of drugs to force down the blood glucose caused by a low fat diet may reduce one factor but by increasing t’other – and the effect of alcohol on fibrinogen fits in nicely in terms of endothelial damage.

    Oh and look, are the executives at Pfizer reading your blog?

    http://www.pharmaceutical-journal.com/news-and-analysis/news/mhra-recommends-that-sildenafil-is-made-available-over-the-counter-in-the-uk/20202527.article

    One wonders what hoops the pharmacists will be instructed to make you jump through before they will well it to you. My guess – you will have to prove you are on a statin . . .

    Cheers!

    Reply
    1. Mr Chris

      Chris C
      I note that sildenafil will not be available to men with heart conditions. I would have thought that a bit of extra NO would be good?

      Reply
    2. mikecawdery

      Chris

      Many thanks for the links.

      Re; Diabetes 55:1807–1812, 2006 extract:
      The differential effects of hyperglycemia and hyperinsulinemia suggest that patients with hyperglycemia due to insulin resistance are especially susceptible to thrombotic events by a concurrent insulin-driven impairment of fibrinolysis and a glucose-driven activation of coagulation.
      Once again shows extent of effects of hyperglycaemia and hyperinsulin\aemia. I wonder how many citations it has received?

      In my view this move merely demonstrates that Pfizer is simply after the money – sex will always be a better advertisement than heart health,

      Reply
      1. chris c

        The current go-to guys on insulin resistance are Ted Naiman (see above) and Benjamin Bikman, both on Twitter and the latter also has a video I haven’t watched yet.

        Agree about Pfizer, and most other drug companies, but interestingly Novo Nordisk have put a lot of money into a forthcoming diabetes research centre in Oxford – and are employing Jim Johnson to head it up.

        As far as I can see he is an incorruptable and very knowledgeable scientist. I can only hope he reads the small print in his contract lest he finds himself muzzled.

  86. TS

    I’m thinking about stress, mental or physical, adding a lot of stored glucose to the blood. An unstressed person might cope better with modest amounts of carbohydrates from food than a chronically stressed one, and be less likely to fall prey to insulin resistance.

    The pathway – Stress-hypothalamus-pancreatic GLUCAGON release- liver-bloodstream

    Reply
    1. mikecawdery

      TS
      Does glucagon only .need stress to initiate gluconeogenesis? I suspect not. I believe low insulin levels fail to limit its action is a likely cause. Unfotunately the medical establishment and the NHS apparently are quite happy to guess at things like low insulin or insulin resistance while there is plenty of evidence on the glucose tolerance cum fasting insulin test or FBG glucose/insulin test leading to the HOMA-IR analysis. Why? I can only leave you to speculate.

      Reply
      1. chris c

        “There’s no point measuring insulin, it doesn’t change the treatment” is what several people have been told. Mostly it is only used on diagnosed Type 1s to see if any of their pancreas hasn’t been mashed yet. Obviously it would be a good way to diagnose adult onset Type 1s/LADA who have been misdiagnosed Type 2 “You can’t be Type 1, you are too old” is another common refrain though I believe adult onset now outnumbers childhood onset Type 1.

        A Joseph Kraft-style Insulin Assay would have diagnosed me 60 years ago, and many many others earlier than an A1c, plus differentiated between the different forms of Type 2 (which is NOT a uniform disease).

        I can still produce a lot of insulin, just not at a high rate, so my BG will shoot up after eating carbs, then the insulin turns up late to the party and stays after all the glucose has gone home. Not only an actual hypo but just a rapid drop in BG will generate not only glucagon but also cortisol, epinephrine, norepinephrine, neuropeptide Y and probably a bunch of other symptom-causing and damage-causing stuff in order to shoot the glucose back up again. So there’s also a reverse link between glucose levels and the stress *response*. Low carb/ketosis eliminates all this completely.

        Trigs/HDL ratio is a rough indicator of insulin resistance, but I note an increasing number of people can no longer get their trigs tested. Here the nurses won’t do it but the doctors still can. Probably another case of saving pennies and spending pounds later.

      2. puddleg58

        Hi Chris,
        from multiple analyses I’ve done of the data in other folk’s papers, fasting TG/HDL ratio is a VERY good proxy for your two-hour insulin response. That is, if your fasting TG/HDL ratio is 2x that of someone else, on average your insulin level 2 hours after a glucose tolerance test will also be twice as high as theirs.
        You can calculate a missing value here if the bastards won’t give you a TG test but do provide HDL, total cholesterol, and LDL.
        http://www.hughcalc.org/chol-si.php
        Just be sure to do it fasting whatever they tell you (it shouldn’t make much difference to the stuff they care about).
        Of course cutting carbs, and eating lower-GI carbs like beans if you do, will keep that delayed insulin peak (which is what the 2-hour response shows) and your fasting TG/HDL ratio down.

  87. Soul

    I watch TV news very little at my home. Visiting my father yesterday I saw on the news a segment on a device that helps a person avoid developing blood clots, in order to avoid a heart attack during an operation. I wasn’t paying all that much attention to the details of what was being discussed. It was a first time I can recall hearing something along those lines though.

    With that said, I had a grandfather that passed away during surgery. During the operation to improve circulation to a leg, we were told a blood clot came loose and traveled to his heart, causing his sudden passing.

    Reply
  88. TS

    From Giulia Enders’ “The Gut – the inside story of our body’s most under-rated organ”:

    “Lovers of wine or vodka appreciate the metabolic end-product of yeasts – known as alcohol. The work of these micro-organisms does not end in the wine barrel. Almost none of what the wine taster will tell you is actually to be found in the bottle. The wine’s ‘bouquet’, for example, develops so late because bacteria need time to do their work. They sit waiting at the back of the tongue, where the process of transforming what we eat or drink begins. The substances they release during that process create the aftertaste so appreciated by the wine lover. And each connoisseur will experience a slightly different taste – depending on the population of bacteria on their tongue. Still, it’s nice to get such an enthusiastic reaction to the presence of these much-maligned microbes”.

    Reply
    1. JanB

      TS, “Gut” by Giulia Enders is such a good read, full of information we all need to know and written in a very accessible style, full of wit and humour. Because of it I became properly aware of and learned to look after my microbiome. You’re the only person I have come across, apart from my daughter-in-law, to whom I gave it as a present, who has read it. I guess that means I have very selective (odd?) taste in reading material. Most people I have mentioned it to seem to get an attack of ‘lip curl.’ Which is a shame as it’s so good.

      Reply
  89. Errett

    Effects of Sugar-Sweetened Beverage Consumption on Microvascular and Macrovascular Function in a Healthy Population.

    Loader J1, Meziat C1, Watts R1, Lorenzen C1, Sigaudo-Roussel D1, Stewart S1, Reboul C1, Meyer G1, Walther G2.

    Abstract
    OBJECTIVE:
    To assess vascular function during acute hyperglycemia induced by commercial sugar-sweetened beverage (SSB) consumption and its effect on underlying mechanisms of the nitric oxide pathway.

    APPROACH AND RESULTS:
    In a randomized, single-blind, crossover trial, 12 healthy male participants consumed 600 mL (20 oz.) of water or a commercial SSB across 2 visits. Endothelial and vascular smooth muscle functions were assessed in the microcirculation using laser speckle contrast imaging coupled with iontophoresis and in the macrocirculation using brachial artery ultrasound with flow- and nitrate-mediated dilation. Compared with water, SSB consumption impaired microvascular and macrovascular endothelial function as indicated by a decrease in the vascular response to acetylcholine iontophoresis (208.3±24.3 versus 144.2±15.7%, P<0.01) and reduced flow-mediated dilation (0.019±0.002 versus 0.014±0.002%/s, P<0.01), respectively. Systemic vascular smooth muscle remained preserved. Similar decreases in endothelial function were observed during acute hyperglycemia in an in vivo rat model. However, function was fully restored by treatment with the antioxidants, N-acetylcysteine and apocynin. In addition, ex vivo experiments revealed that although the production of reactive oxygen species was increased during acute hyperglycemia, the bioavailability of nitric oxide in the endothelium was decreased, despite no change in the activation state of endothelial nitric oxide synthase.

    CONCLUSIONS:
    To our knowledge, this is the first study to assess the vascular effects of acute hyperglycemia induced by commercial SSB consumption alone. These findings suggest that SSB-mediated endothelial dysfunction is partly because of increased oxidative stress that decreases nitric oxide bioavailability.
    CLINICAL TRIAL REGISTRATION:
    URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366442&isReview=true. Australian New Zealand Clinical Trials Registry Number: ACTRN12614000614695.
    © 2017 American Heart Association, Inc.

    Reply
    1. chris c

      But . . . but . . . but . . . they didn’t mention cholesterol! Off with their heads!

      Another experimental group drinking alcohol/red wine would be super interesting.

      Reply
  90. TS

    Jan: PS – I wonder if many of us on this site are considered odd/quirky – or worse, arrogant/presumptuous (but entirely lovable, of course) – needing a site like this to find like minds.

    Reply
  91. barbrovsky

    How irrational is this? I go to see my gp because I’ve had an upset tummy since the beginning of the new year. The problem is, it’s not all the time. At the first visit I tell him the symptoms, he listens but nothing happens and I leave, dissatisfied, but I think, well it’s not serious, or maybe I’m imagining things.

    But the symptoms persist, so a week later I go see the gp again, and this time, it’s the one I normally see but it’s the same story, so I leave once again none the wiser and no closer to solving my ‘ailment’.

    But the symptoms get worse over the next couple of days and now they’re no longer intermittent. Eventually I go to A&E where the first thing I do is give a urine sample (now why didn’t the gps I saw, do the same thing?) but in both circumstances I realize that in fact the gps and now the hospital, think my ‘ailment’ is in my head, after all, I have told them that I’m turning into a hypochondriac. Big mistake!!

    But it means that I actually wasn’t getting properly diagnosed and really, it’s only because when you get admitted to A&E it’s pretty well mandatory to give a urine sample and mine turned up positive to a urinary infection! It wasn’t all in my mind after all! Who wudder believed it?

    But it gets even more bizarre. When the doc saw me in hospital (four-hour wait) the first thing she asked me was had I been abroad recently and I said yeah, Xmas, I went to Paris for a few days.

    ‘Did you have unprotected sex?’

    I didn’t have sex of any kind.

    ‘Have you had unprotected sex here, recently?

    No, I replied.

    So I thank her for the diagnosis and I get prescription for some antibiotics. But before leaving, the same doc gives a letter and disappears before I can read it in her presence.

    I’m stunned by what I read! In part, the good doctor says, and I’m quoting here:

    “Denied sexual activity during festive period. Denies GUM sx. no dysuria. blah-blah”

    Just think on all the assumptions littering the way toward and after, my visit to A&E (and just think of the cost!); Twice I went to my gp but I was never asked to give a urine sample at either visit. Why not? Was it because they too believed it was ‘all in my head’ as one nurse at the hospital actually said it was probably the case. So much so, I was beginning to believe it myself.

    It was then that I started to realize what was happening. This is really scary. Luckily, it was only a relatively harmless bug, but if it hadn’t been? No wonder I’m a hypochondriac!

    To end this minor saga, I then remembered my last meal in Paris was in an old-style Parisian restaurant opposite the Gare du Lyon where I had a delicious meal of some really nice French lamb, but it was virtually raw, not something I would normally eat. The bug manifested itself a couple of days after I got home.

    What is GUM sex anyway?

    Reply
  92. maeon1

    I wish someone would address the debate around whether APOE4 people should ever touch alcohol. What’s the best evidence on this now?

    Reply
  93. smartersig

    Could it be that small amounts of alcohol in the form of red wine assist with HDL Efflux, the ability for HDL to reverse transport cholesterol. This study supports the possibility. Also like other studies this adds more controversy to the is Virgin Olive Oil heart healthy. This trial suggests it is but others say it is not. VOO seems to really split the Heart disease experts. Any opinions here ?.
    http://www.medscape.com/viewarticle/875713#vp_2

    Reply
    1. puddleg58

      Alcohol increases HDL2 and HDL3; another food that does this is any fat supplying myristic acid.
      https://profgrant.com/2017/03/03/diet-and-hdl-the-effect-of-myristic-acid-vs-carbohydrate/

      HDL functionality is increased by CLA in butter and ruminant fat, olive oil polyphenols,[1] and the action of vitamin E (found in nuts and vegetable oils and other sources of linoleic acid) on protein kinase-C.[2] As substitution of all fats for carbohydrates tends to raise HDL, there will be a correspondence between intake of natural fats, HDL, and HDL functionality. Polyphenols administered without fat reduce inflammation but do not increase HDL or HDL functionality.[3]

      Thus there is evidence for a rather neat correspondence between the quality of dietary fat (and type of alcohol) and the cardioprotection associated with HDL.

      [1] Hernáez Á et al (2014) Olive oil polyphenols enhance high-density lipoprotein function in humans: a randomized controlled trial. Arterioscler Thromb Vasc Biol. 2014 Sep;34(9):2115-9. doi: 10.1161/ATVBAHA.114.303374. Epub 2014 Jul 24.[2] Mendez AJ et al (1990) Protein Kinase C as a Mediator of High Density Lipoprotein Receptor dependent Efflux of Intracellular Cholesterol (1990) Journal of Biological Chemistry Vol. 266, No. 16, Issue of June 5, pp. 10104-10111,199

      [3] Nicod N et al (2014) Green tea, cocoa, and red wine polyphenols moderately modulate intestinal inflammation and do not increase high-density lipoprotein (HDL) production. J Agric Food Chem. 2014 Mar 12;62(10):2228-32. doi: 10.1021/jf500348u. Epub 2014 Mar 4.

      Reply

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