Tim Noakes found not guilty – of something or other

Many years ago I started looking at research into cardiovascular disease. Almost as soon as I began my journey, I came to recognise that many facts I had been taught in medical school were plain wrong. This did not come as a great surprise. Anyone familiar with the history of scientific research will soon find out that widely established facts are often not ‘true’ at all. My mother still likes to tell me that when she was at school it was taught, with unshakeable confidence, that there are 48 human chromosomes. There are 46.

In addition, it became clear that, not only were certain key facts wrong, there seemed to be a co-ordinated effort to attack anyone who dared to challenge them. One stand out example of such an attack was what happened to John Yudkin, the founder of the nutrition department at the University of London’s Queen Elizabeth College.

He did not believe that saturated fat was to blame for heart disease, the idea at the centre of the diet-hypothesis. At the time, this theory was being relentlessly driven by Ancel Keys, and it had gained widespread acceptance amongst the scientific community. In 1972 Yudkin wrote the book ‘Pure white and deadly’ in which he outlined why sugar was the probable cause of heart disease, not fat(s). He was then ruthlessly attacked. As outlined by the Telegraph:

‘The British Sugar Bureau put out a press release dismissing Yudkin’s claims as “emotional assertions” and the World Sugar Research Organisation described his book as “science fiction”. When Yudkin sued, it printed a mealy-mouthed retraction, concluding: “Professor Yudkin recognises that we do not agree with [his] views and accepts that we are entitled to express our disagreement.”

Yudkin was “uninvited” to international conferences. Others he organised were cancelled at the last minute, after pressure from sponsors, including, on one occasion, Coca-Cola. When he did contribute, papers he gave attacking sugar were omitted from publications. The British Nutrition Foundation, one of whose sponsors was Tate & Lyle, never invited anyone from Yudkin’s internationally acclaimed department to sit on its committees. Even Queen Elizabeth College reneged on a promise to allow the professor to use its research facilities when he retired in 1970 (to write Pure, White and Deadly). Only after a letter from Yudkin’s solicitor was he offered a small room in a separate building.

“Can you wonder that one sometimes becomes quite despondent about whether it is worthwhile trying to do scientific research in matters of health?” he wrote. “The results may be of great importance in helping people to avoid disease, but you then find they are being misled by propaganda designed to support commercial interests in a way you thought only existed in bad B films.”

And this “propaganda” didn’t just affect Yudkin. By the end of the Seventies, he had been so discredited that few scientists dared publish anything negative about sugar for fear of being similarly attacked. As a result, the low-fat industry, with its products laden with sugar, boomed.’1

Let us scroll forward some forty years or so, to Professor Tim Noakes. Regular readers of this blog will have heard of Tim Noakes who is, to quote Wikipedia.. ‘…a South African scientist, and an emeritus professor in the Division of Exercise Science and Sports Medicine at the University of Cape Town.

At one time he was a great supporter of the high carb low fat diet, and even helped to develop high carb energy foods for long distance runners. However, for various reasons (most importantly studying the science again) he completely changed his mind. He is now a very well-known proponent of the high fat, low carb (HFLC) diet, as a way to treat obesity and type II diabetes – and improve athletes’ performance.

A couple of years ago, he was dragged in front of the Health Professions Council of South Africa (HPCSA) after being charged with unprofessional conduct for providing advice to a breast-feeding mother in a tweet. “Baby doesn’t eat the dairy and cauliflower. Just very healthy high fat breast milk. Key is to wean [sic] baby onto LCHF.”

The case against him was obviously, and almost laughably, bogus. The HPCSA did not even (as I understand it) have any guidelines on what constitutes an on-line doctor patient relationship. You could make the case that it is difficult to find someone guilty of breaching rules, when there are no rules. Despite this, I thought they would get him on some technicality or other.

Just as happened to Gary Fettke in Australia

‘Prominent Launceston surgeon Gary Fettke has been banned from giving nutritional advice to his patients or the public for the rest of his medical career. He was recently notified by the Australian Health Practitioner Regulation Agency that he was not to speak about nutrition while he remained a medical practitioner.

Dr Fettke is a strong advocate for a low carb, high fat diet as a means to combat diabetes and ill-health. AHPRA told Dr Fettke “there is nothing associated with your medical training or education that makes you an expert or authority in the field of nutrition, diabetes or cancer”. It told him the ban was regardless of whether his views on the benefits of the low carbohydrate, high-fat lifestyle become accepted best medical practice in the future.’ 2

Lo, it came to pass that Gary Fettke cannot even talk about a high fat diet, even if it becomes accepted best medical practice…. Ho hum, now that really makes sense. At this point you may possibly, just possibly, see some parallels between Tim Noakes, an advocate of the high fat low carb diet in South Africa, and Gary Fettke, an advocate of the high fat low carb diet in Australia. Also, of course, John Yudkin, who was attacked and effectively silenced by the sugar industry many years ago.

This would be, I suppose, the very same sugar industry who paid Harvard researchers in the 1960s to write papers demonising saturated fat and extolling the virtues of sugar.

‘Influential research that downplayed the role of sugar in heart disease in the 1960s was paid for by the sugar industry, according to a report released on Monday. With backing from a sugar lobby, scientists promoted dietary fat as the cause of coronary heart disease instead of sugar, according to a historical document review published in JAMA Internal Medicine.

Though the review is nearly 50 years old, it also showcases a decades-long battle by the sugar industry to counter the product’s negative health effects.

The findings come from documents recently found by a researcher at the University of San Francisco, which show that scientists at the Sugar Research Foundation (SRF), known today as the Sugar Association, paid scientists to do a 1967 literature review that overlooked the role of sugar in heart disease.3

A pattern does appear to emerge does it not?

With my views on diet, and cholesterol, and heart disease, and suchlike, I have often been accused of being a conspiracy theorist – which is just another way of saying that I am clearly an idiot who should shut up. I simply smile at people who tell me this, and say nothing. However, my motto is that…‘Just because you’re paranoid, it doesn’t mean they are not out to get you.’ In the case of the High Fat Low Carb advocates, they are out to get you, and there truly is a worldwide conspiracy to attack any silence anyone who dares criticise sugar/carbs in the diet.

The attacks and distortions have not stopped with the ‘Harvard researchers’, or John Yudkin, or Gary Fettke or Tim Noakes, they continue merrily today. In the Sunday Times of April 23rd 2017 an article appeared, entitled ‘Kellogg’s smothers health crisis in sugar – The cereals giant is funding studies that undermine official warnings on obesity.’ Just to choose a few paragraphs.

One of the food research organisations funded by Kellogg’s is the International Life Sciences Institute (ILSI). Last year if funded research in the Journal Annals of Internal Medicine that said the advice to cut sugar by Public Health England and other bodies such as the World Health Organisation could not be trusted.

The study, which claimed official guidance to cut sugar was based on “low quality evidence”, stated it had been funded by an ILSI technical committee. Only by searching elsewhere for a list of committee members did it become clear that this comprised 15 food firms, including Kellogg’s, Coca-Cola and Tate and Lyle.

In 2013 Kellogg’s funded British research that concluded “regular consumption of cereals might help children stay slimmer.” The study, published in the Journal Obesity Facts relied on evidence from 14 studies. Seven of those studies were funded by Kellogg’s and five were funded by the cereal company General Mills.

And so on and so forth. Interestingly, no-one from the world of nutrition has suggested that Kellogg’s should be dragged into court for distorting data, trying to discredit honest researchers, and paying ‘experts’ to speak on their behalf. It is the Golden Rule, I suppose. He who has the gold, makes the rules.

This all has obvious parallels to the tricks the tobacco industry got up to over the years. They did everything they could to hide the fact that cigarettes cause heart disease and cancer. Now the sugar industry, and those selling low fat high carb products, are trying to hide the fact that sugar/carbs are a key cause of obesity and type II diabetes.

And the techniques used by the sugar/cereal/high carb companies are drearily familiar – and sadly still highly effective. As with Yudkin, Noakes and Fettke, go for the man, not the ball (discredit the person, not their data). Dismiss any damaging evidence that does manage to emerge as ‘weak’, pay your own experts to write bogus reports, and create uncertainty everywhere. Some people should be very ashamed of themselves indeed. Instead, I suppose, they are getting massive bonuses.

The nutrition society of South Africa said, in response to the Noakes judgement: “We are glad that the hearing has been finalised after almost three years, unless there is an appeal. The judgement, however, has absolutely no bearing on the current or future status of nutrition or the dietary guidelines in South Africa.’4 So there, nyah, nyah, nyah. Any apology to Tim Noakes? No. Any apology for wasting huge sums of money on a court case they lost? No. Just a threat that they may appeal. They are not going to change a thing.

So, whilst Tim Noakes won his case, any scientist looking on gets a very clear message. If you say things we don’t like, we will attack you and drag you through court and make your life a living hell for three years. Now, that is how you silence people, just as they silenced Yudkin nearly forty years ago.


1: http://www.telegraph.co.uk/lifestyle/wellbeing/diet/10634081/John-Yudkin-the-man-who-tried-to-warn-us-about-sugar.html

2: http://www.couriermail.com.au/news/national/surgeon-gary-fettke-banned-for-good-on-food-advice-by-regulatory-body/news-story/d973faa72dc64836f2209469a67592d5

3: https://www.theguardian.com/society/2016/sep/12/sugar-industry-paid-research-heart-disease-jama-report

4: https://www.pressreader.com/south-africa/the-sunday-independent/20170423/281681139761415

339 thoughts on “Tim Noakes found not guilty – of something or other

  1. Teresa Elvidge

    I know it is off the subject but same for anything vaguely alternative especially in relation to conditions like Parkinsons and types of Cancer – I could elaborate but you can see the facts anywhere, just another case of follow the money esp in the field of medicine ho hum

  2. Agg

    Very good.
    Slowly but surely we’ll get there.
    What amuses me most is the conclusion in such cases repeated over and over again – the studies showed this and that, however we are not going to change our recommendations/guidelines. Or guidelies rather.

  3. John Midgley

    Whew, your article has got me worried.The medical world behaves like little Stalins. On another topic, our group has demonstrated in thyroid function diagnosis and treatment that a) presentation of patient should have priority for possible treatment over biochemical test results, b) the present cutoffs for diagnosis and treatment of hypothyroidism (as measured by TSH) are too high, c) free triiodothyronine (FT3) is the test of choice for controlling treatment, not TSH as used at present, d) medics do not understand the meaning of normal ranges as being statistical (probability) rather than absolute, e) their shoehorning mentality that being “in the normal range” is the same as being normal individually, f) that the instrumentation used for obtaining biochemical results is wildly inconsistent from source to source and g) that we can identify those patients who are likely to require T3 in addition to T4 to regain health (many medics refuse to believe there are such people, and T3 should never be offered). Oh and finally that all the trials done so far to establish if a minority of patients need T3 as well as T4 are fatally compromised and thus invalid as are those that assert that suppressed TSH inevitably leads on to osteoporosis and atrial fibrillation. I feel a Yudkin moment coming on as I’m due to present all this in public in Scotland’s parliament on June 15th. Fortunately I’m not medically qualified, merely a biochemist/molecular biologist so all the establishment can do is the “Edwardian “cut-dead”.

    1. Craig E

      Hi John I am most interested in finding out more about your group. I suspect my wife has hypothyroidism but doc has merely ordered bloods for TSH. I need more info on what to ask for to get the real picture.

    2. Jill heathcock

      I’m with you 100% . It took 5 years to reach a dose of levothyroxine on which I felt well; ridiculous that anywhere within the ‘normal’ range is considered ok. In the meantime a huge toll on my health, confidence and ability to do my teaching job. Not only that but I had the clear impression that the GP s at my previous medical practice thought I was paranoid and depressed.
      Your presentation topic is of great interest to me and I sincerely hope it has an impact.

      1. John Collis

        My GP insists that my hypothyroidism is under control because the numbers are ‘right’, I’m not convinced as I am slightly bradycardic (tachycardia for me would >85 bpm), I feel cold and I feel tired, so symptomatically I still have a thyroid problem despite the numbers being within normal range . However, this same GP also advocates a HFLC diet to help control my Type 2 DM. I have also unilaterally stopped taking the statin to see if this has an effect on my HbA1c levels.

    3. Izabella Natrins

      Right on the money John! Much of my work is rooted in helping people restore a stronger metabolism and better digestive function – so thyroid issues are huge for them. I do wish you well with your submission to Parliament. Can’t help thinking that ‘lay people’ (even politicians) will be more receptive to hearing sound science than are those intellectually, morally and ethically bankrupt citizens actually tasked with the duty of our care?

      1. Deborah Waroff

        May I mention that in the pilloried and misunderstood disease myalgic encephalomyelits patients who are low in T4 and T3 nonetheless tend to score low on TSH. There is a paper about this, which has reassured my GP. Also I take Cytomel as well as the “normal” levothroid; this started with my now retired psychopharmacologist. Cytomel is endorsed by many psychiatrists as adding more energy. My GP has indulged me by continuing.

    4. Linda Sanday

      I am one of those with the conversion from t4 to t3 problem, and I thank for standing up in the Scottish parliament and giving your speech.
      I am also Keto because I was heading towards diabetes, not now though.
      And, I am so grateful for the likes of Yudkin et al for speaking the truth. I would like to make the NHS justify the sums of money spent on diabetic clinics when generally there is no need for them.

    5. benfury22

      I know. I’m one of them. On Synthroid synthetic T4 I had no improvement. On porcine derived natural T3/T4 I had an immediate dramatic improvement. My PCP refused to prescribe it. I had to go to a “quack” naturopath to get the prescription. Who’s the REAL quack? The one getting results or the one refusing to try anything new?

      1. Nigella P

        The tragedy is that NDT is not new, it was used very successfully for decades before a pharmaceutical company invented synthetic T4. Then lo & behold studies started to appear discrediting NDT and saying the only reliable way to get thyroid hormones was with the synthetic version. Big pharma spin & now NDT is blacklisted or unapproved, even though it worked perfectly well & continues to do so.

      2. Susan

        I switched from a GP to a Naturopath 18 months ago and started taking NDT rather than T4 only. I feel much better. Now if I could just get my insurance company to quit messaging me that NDT is not recommended for people with heart problems and I should discuss changing the prescription with my doctor. I’m old, but I have no documented heart problems so they can just go stuff it!

      3. benfury22

        Synthroid (levothyroxine), is the top selling drug in America. 21.5 million prescriptions per year. A LOT of bucks gained by the synthetic sellers by bashing the naturally derived competition. Unfortunate for those who can’t afford going through the process to get a prescription for the natural form when the synthetic doesn’t work. How many millions of thyroid sufferers are suffering needlessly taking Synthroid while their body fails to make the T4 to T3 conversion?

    6. sasha

      Very interesting. Please let us know if you presentation becomes available in the public domain.

      1. barbrovsky

        Re the Thyroid treatment:
        I have an under-active thyroid and can only get Thyroxine on the NHS and trying to get my dosage increased a little has proved impossible due to my heart condition (they claim). Thus the two major symptoms I still have, low tolerance to cold and brittle nails, remain untreated. I tried to get an appointment with a thyroid specialist and was turned down because the blood test showed that my Thyroid was working as it should (except for the symptoms of course).

      2. chris c

        Another scandal, made worse by the fact that there are HUGE geographical variations.

        A friend not 20 miles down the road was left with a TSH around 5 and many resulting symptoms for years. She tried going private (husband’s insurance) and was only able to get T4 tested, not T3 as “the lab didn’t have the equipment”. It took a massive amount of arm-twisting before she was finally permitted to see an endocrinologist, and fortunately she is one who doesn’t have the conversion problem as jacking up the synthroid seems to have worked.

        When I went hyperthyroid I had no problem getting TSH, T4 and T3 tested via the NHS – different hospital, different lab, different rules. A little bird tells me there are some patients who are able to obtain T3 on prescription. Not at all common, and frankly it should be 😦

  4. Christopher Palmer

    It’s a real tale of woes. Ideas that should not have gained traction did, and ideas that ought to be be gaining traction can be slow to. I am thinking of relocating to Derbyshire simply so I can say I live in Hope and not be telling a lie.

  5. Marian Callender

    My father worked for British Sugar as a chemist, for forty years, retiring in 1986. I remember the debate about John Yudkin’s work and the derision that was employed to discredit him. The mildest comment was “Yudkin doesn’t like us (British Sugar) very much.” I had a long debate with him after I read Robert Lustig’s introduction to the 2012 edition of Pure, White and Deadly. He would not be moved from the idea that sugar was responsible for so much ill health. At 90 he wasn’t going to change his views. No surprise then how difficult it is to change thinking on this matter.

  6. chewingthefats

    The sad fact is that whilst doctors study for a considerable length of time to qualify, the nutrition element of their studies is negligible.
    I know more than my local gp by a huge margin. Until doctors learn that they need to prevent the onset of disease and not keep handing out prescriptions for drug companies, we will not progress at the pace required.

    1. Andy S

      Comment by young cardiologist yesterday, “we treat symptoms”.
      Take home message, your health is your own responsibility.
      We need Malcolm to raise questions and generate discussions about health issues to maintain momentum. Looking forward to many more episodes. The Roman numerals might get unwieldy, suggest using both systems.

      1. Dr. Göran Sjöberg



        After my own very serious MI 1999 and my refusal of CABG and all “heart medication” I was regularly called for checkups. After five years I was though “dismissed” by claiming that they at the hospital were only treating illness. Asking if I was then considered cured the answer was “No, but we consider you as coronary “stable”.

        The null interest in my own alternative health care “system” was so striking to me at that time. Today I understand why.

    2. Jean Dale

      Agreed. In the early 1920s a little booklet was published: You are what you eat. I read this in the 1950s and used it as a template for bringing up my 5(healthy) children . The booklet details studies done in a prison, where a changed to a healthier diet made an enormous change to the behaviour of the prisoners. The facts of nutrition have been known for a century, but Big Business and Big Brother continue to bully those who threaten their profits. This is criminal . And fascist.

    3. Be Healthy

      Agreed though what they would learn today if they had to learn nutrition? Still the garbage from the 1960s. The whole medical industry is in this fantasy world of the heart-health movement based on high carbs and low fat and that fat to be polyunsaturated fats. They learn the same old so might as well not learn anything.

  7. John Wright

    Nice Article Often wondered how you have managed to avoid pharma’s litigous wrath. Will be over next month as some very interesting happenings afoot. Hopefulky there may be a chance to catch up. All the best to Nikki.


      1. Linda Colback

        Good news for Tim Noakes! Scurrilous scapegoating… unlikely to improve in these times.

        Oh, I do so hope you bite! And thank you for “that is how they get you”. I was, due to needing sound medical advice again, about to make contact: (I took NDT, now T3 but left undiagnosed so long = heart and other persistent issues). Doctors ‘with a clue’ seem as scarce as hens teeth!

        Following the demise of stalwart Gordon Robert Bruce Skinner, (‘they’ still criticize him to this day!), so many are really flagging yet with ‘no one there for them’. Every once in a while I laugh at having danced a jig and raucously sang with Dr S at his Glasgow facility.

        ‘Odds n ends’ going on but it really requires a huge concerted effort, as intended by Dr Skinner with his World Register. Fine man, simple and honest philosophy and look what was done… worth a read if you haven’t, especially re ‘Chateau Le Bung’.


  8. David Winter

    Hello, Malcolm
    Thank you for your ongoing blog, in a way it gives me a sense of freedom, if you can understand that.
    As i get older [68] the more i find that in all areas of life we are marshalled by the “establishment” whether medical, political or commercial to conform to what suits their particular interest. I have also been called a conspiracy theorist but I believe with due reason. During the Brexit debate, for example, we were assailed with what we now know were undoubted lies and mis-information from ALL the parties and from their senior leaders. As with the medical establishment they unashamedly said whatever would gain them traction, so how can we believe ANYTHING in future. It is a very disturbing and unsettling situation, which certainly is worrying from the medical profession who, took the oath to protect and care for us !!!

    Kindest regards,

    David J Winter.

    Sent from my iPad My website : http://www.davidjwinter.co

    1. Mary Jo Crawford

      Great article as always! I wholly agree with what David says …so many of these folk in the establishment for their own selfish wants will tell us anything that will make them lots dosh and elevate them in their given occupation/profession. It’s becoming a very sad world as trust and truth is disappearing very rapidly !

  9. David J Winter

    Hello, Malcolm
    Thank you for your ongoing blog, in a way it gives me a sense of freedom, if you can understand that.
    As i get older [68] the more i find that in all areas of life we are marshalled by the “establishment” whether medical, political or commercial to conform to what suits their particular interest. I have also been called a conspiracy theorist but I believe with due reason. During the Brexit debate, for example, we were assailed with what we now know were undoubted lies and mis-information from ALL the parties and from their senior leaders. As with the medical establishment they unashamedly said whatever would gain them traction, so how can we believe ANYTHING in future. It is a very disturbing and unsettling situation, which certainly is worrying from the medical profession who, took the oath to protect and care for us !!!

    Kindest regards,

    David J Winter.

    Sent from my iPad My website : http://www.davidjwinter.co

  10. Shirley Moir

    Following recent bowel surgery and having an autoimmune disease, I decided I needed to eat the most nutritious food possible. I decided to tr read Sarah ballantynes books on the paleo approach to reversing autoimmune disease. I have followed the programme for nearly 2 years now. I have always had raised blood pressure, but recently when having my blood pressure taken I have been told that my blood pressure is perfect. Could there be a link between my now paleo approach to eating and my blood pressure suddenly dropping to good levels. I think so. I love the food too it it is delicious. Also my endo is not putting me on thyroxine as he says research shows that those hypothyroid individuals over 70 like myself live longer than those taking thyroxine. He says the two main indicators for this disease are being overweight and lack of energy. Neither of which describe me. At seventy one I teach ballet full time and run my own business

    1. KidPsych

      I think that there is quite a lot of evidence that diet can impact blood pressure. I’ve been scouring the internet for information that might help my wife remove her own medications. Here is one that I found recently that astonished me (and might be of interest to readers with high BP):


      If you’re feeling lazy, here’s a table:


      Here was a helpful overview of dietary effects:


      1. Carol

        Let us know how you wife gets on with sesame oil if she tries it. I’ve tried all kinds of things to lower mine but have had no success

      2. Mr Chris

        Have you tried beetroot for BP lowering?
        It works wonders with me when my BP goes over for a period?

    2. chris c

      IMO the culprit for “idiopathic hypertension” is hyperinsulinemia/insulin resistance. Many many people find BP drops or normalises on LCHF. There’s not a little research but sorry I don’t have a list of links to studies.

      1. chris c

        Maybe you’re just too broken. I know I am, my BP came down as did my medication but I still need the minimum dose of Amlodipine to be what my GP considers “normal”. After 30 years of hypertension and gradually increasing meds, I’ll accept that!

        It does seem to go up and down a bit but not reliably enough that I can discover what causes this, thyroid is a factor, also possibly walking in the sun, maybe the balance between sodium/potassium and calcium/magnesium, maybe just ageing. I strongly suspect getting off my low fat diet decades earlier would have helped. So would a better choice of great grandparents.

  11. Tom Welsh

    “A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it”.
    – Max Planck, Wissenschaftliche Selbstbiographie. Mit einem Bildnis und der von Max von Laue gehaltenen Traueransprache. Johann Ambrosius Barth Verlag (Leipzig 1948), p. 22, as translated in Scientific Autobiography and Other Papers, trans. F. Gaynor (New York, 1949), pp. 33–34 (as cited in T. S. Kuhn, The Structure of Scientific Revolutions).

    1. dearieme

      A psychologist looked into Planck’s argument and concluded that the older physicists had adopted Planck’s new physics at about the same rate as the younger men. In other words, it seems that Planck was wrong.

      1. Stephen T

        Dearie, the difference is that Planck was the authority. Also physics has always been much more open to new ideas, unlike blockhead dietitians who can’t cope with the enormity of being completely wrong for forty years.

      2. chris c

        SADly (pun intended) there are a whole bunch of New Young Lions who have wholeheartedly swallowed the cholesterol/fat/meat hypotheses. They are going to outlive a lot of us (though I suspect not a few of them may later become fat and/or ill in the process). They will of course be well reimbursed for their loyalty.

  12. Tom Welsh

    Much to John Yudkin’s credit, he never exaggerated. He did not say that sugar was toxic; merely that there was a practical limit to how much of it can be consumed without harm. From memory, he suggests in “Pure, White and Deadly” that British people could greatly improve their health by reducing their sugar consumption by about half – a modest proposal and extremely practicable.

    Personally, I feel much more extreme about the matter. My blood boils when I see references to the Tate Gallery, or Tate and Lyle praised as benefactors. On the contrary, I think they should be vilified as mass poisoners – as well as being complicit in the institution of slavery, which was necessary for the mass production of sugar until about 150 years ago. (The main reason the US government decided to free the slaves was that they were no longer economically necessary with the advent of suitable machinery).

      1. Tom Welsh

        No reason why you should! Neither did I, until recently I saw a write-up in some newspaper that mentioned the back story.

    1. Tom Welsh

      OK, I have just given a very convincing demonstration of how emotion clouds our judgment! Tate & Lyle wasn’t even founded until over a century after the abolition of slavery in the USA.

      1. dearieme

        The precursors were older. WKPD: 1869 in Liverpool for Tate, 1865 in Greenock for Lyle.

        Still, these dates are long after slavery was abolished in the British Caribbean islands.

    2. anglosvizzera

      Don’t forget that sugar consumption was a lot less back in the 70s – so cutting it by half would leave a much smaller amount back then. Now the equivalent must be something like cutting by 90%, I’d imagine!!

    3. Stephen T

      Tom, I agree with you about sugar.

      But if the South had won the Civil War slavery would have continued because it was widely supported. It was about much more than machinery.

  13. Craig E

    Hi Dr K, I have been following the Tim Noakes and Gary Fettke cases with interest. I am astonished at the way they have been treated particularly given what they’ve achieved over distinguished careers. Is this the same perhaps as the vilification of Dr Kanematsu Sugiura and research into vit B17. Apparently was a world renowned cancer researcher…until his research showed that a natural substance was proving effective as a treatment for cancer. And what about Linus Pauling, multiple Nobel laureate, who apparently lost his marbles when suggesting high dose Vit C as a treatment for cancer. I see the pattern here….anyone – no matter how decorated they are in their field – turns into a quack when they threaten multi billion dollar industries. That said, I am a little cautious about some of the sugar claims. Are we in danger of going over the top with sugar like we did with Saturated fat? I haven’t read Yudkin’s book but years ago I saw Lustig’s YouTube presentation ‘sugar the bitter truth’. And I can say that much of his claims weren’t well supported and were indeed just plain wrong. In your piece Dr K you mention ‘the sugar industry, and those selling low fat high carb products, are trying to hide the fact that sugar/carbs are a key cause of obesity”. When I studied biochemistry in the 80s I read texts compiled by distinguished Biochemists whose research was based on the notion of scientific discovery, not making money. Pathways were meticulously researched and described…and in my learnings I did not come across anything that indicated that sugar (and carbs more broadly) was inherently bad. Indeed every cell in the body can metabolise glucose and the liver/muscle can convert excess into glycogen. De novo lipogenesis will only occur after glycogen stores are full. So, I believe that sugar only becomes problematic when it is consumed in excess (which I guess these days is much easier to do). I also don’t believe that LCHF is necessarily a key to weight loss. There’s been a half dozen metabolic ward studies that have proved this when you keep calories constant. I do think however there is merit in low carb for diabetes but have read conflicting stories as to how this works. For me, the ‘what causes diabetes’ is probably something that someone needs to write a series about like you are doing with heart disease Dr K. Given how knowledgeable your readers are, I am sure someone can explain it to me cause I am keen to learn.

    1. Dr. Malcolm Kendrick Post author

      Defining ‘excess’ is the problem. Your glycogen stores are full at about 1,500kcal total. If you don’t exercise it takes very little to fill up with glycogen. At which point, if your calorie consumption exceeds output, and if you continue to eat carbs, insulin will rise, lipogenesis will begin, VLDL levels rise and HDL levels will fall. At which point fatty liver begins, subcutaneous and visceral fat stores increase, ‘insulin resistance’ begins and – in time – blood sugar levels rise. It is not complicated. Clearly, some people deal with this situation better than others and can cope with lots of sugar. Others cannot. Look up Beradinelli Siep lipodystrophy for a good example of how those who cannot create fat cells rapidly become diabetic.

      Currently we have a model which tells us that obesity leads to diabetes. This is wrong. It is an inability to store fat that leads to diabetes.

      1. Craig E

        Thanks for the response. Yes defining excess is hard. In relation to storage I haven’t seen the kcal figure but does this equate to around 500g? I am sure I read an isotopic tracer study that indicated de novo lipogenesis was around 3% for ingested carbs but can’t remember the doses. You mention exercise and this is key. What some people don’t realise is that overconsumption of fat will lead to weight gain too. Dietary fat is ultimately transported via chylomicrons to the adipose tissue if in excess. Many think that fat is harder to overconsume. But from a satiety point of view isn’t the order protein, carbs, fat with fat being the lowest? There are those that write about the addictions and cravings associated with carbs that may lead to overconsumption. So maybe that it part of the reason carbs are over consumed. I spose I am spoilt with your amazing series on heart dishes ease cause I’m now after th mechanism for ‘fatty liver begins, subcutaneous and visceral fat stores increase…’. I shall have a read of Beradinelli

      2. Richard

        I thought diabetes was the failure of the pancreas to regulate the production of glucagon, which is supposed to happen when the beta cells release insulin in the close proximity of the alpha cells releasing the glucagon

      3. JDPatten

        Hm. A quick look-up suggests that Berardinelli Siep is an extremely rare condition. Diabetes is not.

        “It is an inability to store fat that leads to diabetes.” . . . Which then leads to becoming obese??

        I, myself, have always been skinny, always – until recent years – obeyed the pronouncements about the innocence of carbs; guilt of fat, and, now, wind up as “pre-diabetic”.

      4. anonymous1234

        everyone is born pre-pre-diabetic. Then, as you follow the “rules” to be a good citizen, which you can find in any magazine, you become pre-diabetic. If you keep following the rules, you become diabetic. And then you die, perhaps without one of your feet. Which is of no importance, because, where are your supposed to run to? See, you don’t need your feet for nothin’. Just as you don’t need your brain: a useless lump of uncivilized fat.

      5. chris c

        Yes, the theory fails to explain the legions (5 – 20% of Type 2s depending who you believe) who are non-overweight..

        Also worth pointing out that the entire volume of the blood contains a mere 5g glucose at any one time, while we are instructed to eat 230 – 300g carbs per day (even more according to some dieticians) which basically amounts to three glucose tolerance tests per day. Diabetes is diagnosed when the blood contains a mere 11+ g glucose so it doesn’t take much to go wrong with the metabolism to cause it.

    2. Bella

      You could read Gary Taubes – The Case against Sugar, published last December and whilst he stops slightly short of making direct accusations against the sugar industry his research is clear and compelling that we have been sold a sugary pup for years and it is high time doctors, nutritionists and the government wake up and smell the sugar-free coffee.

    3. BobM

      In my opinion, you learned wrong. Fructose, in particular, is very bad for you, and it’s half of table sugar. Fructose causes fatty liver (and fatty pancreas). Fatty liver (and pancreas) causes insulin resistance. Insulin resistance causes obesity and diabetes. The chain isn’t as simple as this, but this is basically it.

      Is it possible to eat high carb and not get insulin resistance? Sure. I ate whole grain hot products for breakfast, pasta for lunch, and rice and beans for dinner, and did that for years. Never ate fat at all, kept to less than 10% of calories. I was exercising my butt off and was young (thinking biking hours per week, walking many miles per week, playing tennis, lifting weights, etc.). As soon as I got injured and could no longer exercise, I blew up like a balloon, had violent mood and energy swings, and depression. Was constantly hungry, tired at 3pm/1500, etc. All of that helped by low carb, and subsequently intermittent fasting and low carb together. Eating this way, I’m down around 55 pounds (about 25 kilos). Will never eat high carb again.

      1. Craig E

        Hi BobM I would be happy to read something credible that proves fructose is as evil as you say. It is true that fructose is metabolised primarily by the liver but it can be converted to glycolytic intermediates or glycogen. The same is true of galactose, mannose and other simple sugars. Our food labelling (here in Australia) is misleading because it lists sugars and carbs separately. All carbs are sugar. Fructose also has a lower glycemic index than does glucose so doesn’t lead to blood sugar spikes. Many of the studies that are referred to when demonising fructose were based on rats and using very high doses of pure fructose. I have no doubt that over consumption of high levels of carbs are problematic, but when you say fructose causes fatty liver, what’s the biochemical mechanism? Also, when reading about insulin resistance, some say that it’s to protect the of the inside cell from too much glucose…others say that it’s because the inside of the cell in starved of glucose and the body thinks it needs more. Again what I said before was that when I studied biochemistry the scientists involved eg Albert Lehninger had researched enzymes, pathways etc to describe what’s going on at a biochemical level in the body. They weren’t trying to profit from this. Now it may be that what I learned is out of date but for the past 4 years I have done a lot of reading and can’t really find much that changes my views.

      2. Sasha

        I agree completely. Fructose, as it appears in fruits, doesn’t cause fatty livers. It is beneficial and has been a part of healthy diet for centuries.

      3. Sasha

        Saying fructose is very bad for you is like saying that eating fruit is very bad for you, isn’t it? If that is what you are saying, then, IMO, you’re very wrong.

      4. Sasha

        Has anyone ever fed people lots of fruit and found out that it’s bad? I will agree that a diabetic eating lots of grapes will spike his BG but the problem isn’t grapes. The problem is what that diabetic did for years prior to get himself to that state.

        IMO, in an individual with normal metabolism and endocrine profile eating fruit, even lots of it, will not have deleterious effects. Besides, it’s hard to eat lots and lots of fruit in one setting. It’s quite filling.

      5. Antony Sanderson

        Hi Craig
        A quick search on “fructose metabolism liver” gave . . .
        “How bad is fructose?” 2007 http://ajcn.nutrition.org/content/86/4/895.full
        Fructose is metabolized, primarily in the liver, by phosphorylation on the 1-position, a process that bypasses the rate-limiting phosphofructokinase step (refn given). Hepatic metabolism of fructose thus favors lipogenesis, and it is not surprising that several studies have found changes in circulating lipids when subjects eat high-fructose diets (refn given).
        Many papers I have read point to fructose metabolism leading to fat being stored in the liver.

      6. Craig E

        Hi Antony S. In the article you mention I agree that fructose bypasses the rate limiting step of phosphofructokinase in the liver but how does this ‘favour lipogenesis’? Also the references in the article seem to draw associative conclusions rather than offering anything definitively causal. As I mentioned before, all simple sugars enter glycolysis at different points. I would agree that when you feed unnaturally high levels of fructose as is done in many studies the outcome will lead to the production of triglycerides, but to see what’s really happening with fructose in the body my belief is that isotopic tracer studies reveal the most. For example look up ‘fructose metabolism in humans- what isotopic tracer studies tell us’. This is a very good review but does point to the complexity involved given the common pathways and interconversions at play. Of studies referred in this article they showed fructose to triglyceride conversion were very low. What does all this mean? From my readings and previous Biochemical studies I believe that it’s excessive amounts of sugars that cause problems. In fact excessive amounts of any macronutrient will ultimately be problematic. The first place to look IMO is beverages loaded with energy (can be sugar/fat). They are easy to overconsume. Were these part of our diet 100 or more years ago in such volumes? I still can’t see how fructose is the enemy it’s made out to be.

      7. Antony Sanderson

        Hi Craig: A number of years ago I remember watching a lecture on the metabolism of fructose in the liver (prior to seeing the same in a Lustig lecture); and after the Lustig lecture I have come across other presenters who describe the preferential metabolic pathway of fructose to lipids. I cannot say I went through the details of the “How bad is fructose?” 2007 paper . . . but at the same time it came up on my search (as item number 2), the paper you mentioned . . . ‘fructose metabolism in humans- what isotopic tracer studies tell us’ came up as item number 3.

        I liked the approach of the isotopic tracer study – it is the sort of physiological study that appeals to the chemist in me – their conclusion on the relative rates of the different metabolic paths was at variance with what I had previously come across . . . This got me interested (and made me groan at the same time because I have so many other things I was looking into), but when I looked at the end of the paper . . . under competing interests it detailed . . . “The authors are employed full time by Archer Daniels Midland Company (ADM). ADM is a major oilseed and grain commodity processor and produces, among other products, fructose-containing sweeteners.”

        So, I had the excuse to leave it and get on with other things . . . but it has left a little mental post-it note to watch out for similar studies . . . not least because the authors were open about the conflict of interest.

    4. Vicki Postl

      Dr. Jason Fung has written The Obesity Code which clearly outlines how insulin, and insulin spikes are key in causing diabetes, and showing that obesity is really due to insulin resistance. Worth a read.
      I also just read Gary Taubes Good Calories, Bad Calories which picks apart nutrition research, showing how terribly flawed so many of the studies are that we have until now relied on for dietary advice. It made my blood boil with outrage, as I am a victim of all the bad nutrition advice out there, dutifully following the low fat, low calorie advice, and losing and gaining probably hundreds of pounds as a result.

      1. mikecawdery

        There are other youtube presentations on insulin resistance, Dr Naiman being one that has been mentioned on previous blogs. I have commented below on some non-diabetic disease associations of insulin resistance but as the NHS does not include fasting insulin testing in its standard testing armory an independent medical testing lab has to be used such as Medichecks

  14. Anne Lucas

    Excellent summary Malcolm. It is so sad how money, greed and power rule our lives at the expense of health.

    1. JDPatten

      Yes. If we allow it to. We have. Fear is part of that mix. It gets you the current world political situation as well.
      I’m optimistic though. Establishment Cardiology – among the thinking set – is beginning to see the true picture. Instantaneous factual information can be seen as contrasting with alternative facts by growing numbers of people who understand that they must think for themselves for their own critical life decisions. The least critical observation makes the contrast embarrassingly obvious.
      It does take the effort of that “least critical observation”, though.

  15. Janet Rice

    OMG — just starting the day with my Bulltetproof coffee. Did I really want to read this right off the bat? I am now all hyped up and mad at the world., But with that said — funny how people are people (or scientists are scientists or bureaucrats are bureaucrats or enlightened activists are enlightened activists, etc.), and whatever innate behavior drives us all has not evolved all that much over the millennia.

  16. mikecawdery

    Dr Kendrick

    Another brilliant expose. You keep astounding me.

    I am delighted to hear that Prof. Noakes has been acquitted. As you point out the sugar industry has been responsible for much of the astroturfing and agnotology supporting the use of sugar with flawed and manipulated research; the standard of the flawed promotion would do credit to the tobacco industry in their defense of cigarettes. I also note that little credit is given to Prof. Yudkin, the importance of sugar seems to be a recent discovery.

    But they (the sugar industry) are not the only ones to blame. The medical research “industry” is also seriously responsible through their failure to retain an “open mind” and examine ALL the available data. As Prof. Hawking pointed out a hypothesis stands while the data supports it. Once contrary evidence (data that does not fit the hypothesis) exists, the hypothesis falls. In medical research (backed by the medical establishment) it appears true to say that contrary evidence to the gospel is simply ignored. Look at the reference list of most published clinical medical reports and it will only contain supporting reports; there is rarely any attempt to examine and discuss the contrary evidence.

    The more I research the problems of CHD, diabetes and associated diseases such as Alzheimer’s, the more it becomes evident that the official guidelines (ie Directives) are simply out of date and designed to promote the use of drugs as I have pointed out in the past. In this I am simply following the views of medical free thinkers such as Dr Kendrick. Another very important author is Dr James Le Fanu whose book “ The Rise and Fall of Modern Medicine I find to be very inciteful.

  17. dearieme

    Well done for citing the chromosome example.

    I am completely persuaded of the damage done by the anti-fatters in the vile tradition of Ancel Keys. But I am also sceptical of anti-sugarists: puritans and careerists will mount that bandwagon too, and lie, and distort, and exaggerate the case, while bullying and censoring opposition. It’s in the nature of things in our world of bent medics and scientists, alas.

    In the end, if the most hysterical anti-sugarists prove right it will be by coincidence, not by the quality of their arguments or evidence.

    1. Andy S

      Hi dearieme
      I don’t have that much time to wait for the final verdict on sugar. In the meantime my motto is “keep the blood glucose and insulin levels low”.
      Fortunately there are medications for diabetics that are supposed to take care of excess blood glucose.

      1. mikecawdery

        The medications, if pharmaceuticals, have some scary adverse reactions including I fear damage to the β-cells leaving one an adult Type 1 and insulin dependent (not enough insulin left to be insulin resistant)

    2. Chancery Stone

      What, or who for that matter, is a “hysterical anti-sugarist”? John Yudkin, Gary Taubes, Robert Lustig? They’re the only real “anti-sugarists” I can think of and none of them are hysterical, by any definition of the word. The fact is, because of a combination of the obesogenic environment that we now live in, the addictive qualities of sugar/fat foods, and some people’s genetic predisposition for addiction/fat gain, sugar is downright dangerous when unchecked. In view of that, and the obvious increasing numbers of people who are affected, I think being hysterical is the last thing any “anti-sugarist” could be accused of.

  18. dearieme

    A small, nay tiny, point. “Key is to wean [sic] baby onto LCHF.”

    Who inserted the “[sic]” and what did they mean by it?

    1. Stephen T

      Dearie, I think in the original tweet ‘wean’ was misspelled as ‘ween’. The mistake was corrected but the [sic] ‘thus’ retained. Maybe we should have a [sic] after the [sic].

      1. dearieme

        Thank you. I was taught when young that good manners dictated that one silently correct a spelling error in a quotation. One should not use “[sic]” to pour scorn on the quotee, or to brag. Good advice on the whole, I’d say.

    2. Stephen T

      Dearie, your good manners in correcting of mistakes is sensible in many settings, but the convention is not to do so when directly quoting someone because you can then be accused of not exactly reproducing what they said or wrote, and that might have importance. A quote has to include mistakes and grammatical errors. The purpose of [sic] isn’t to pour scorn, but I accept that could be the intention.

  19. thelastfurlong

    This will not be a popular comment. People always repeat this “This all has obvious parallels to the tricks the tobacco industry got up to over the years. They did everything they could to hide the fact that cigarettes cause heart disease and cancer.” But there are also parallels to the tricks Tobacco Control have played (are playing) over the years in proving that cigarettes do cause heart disease and cancer. There has been the purposeful exaggeration about Second Hand Smoke put about with malice aforethought and wild exaggeration. Tobacco Control are a very profitable business whom no one may criticise in a society muzzled by political correctness and fear. They are a good example of tricks. Their template of success is being used now by all sorts of other groups. Thought I’d just point out. Big Tobacco was small potatoes compared to Tobacco Control.

    1. David Bailey


      Regarding exaggeration of danger, I am now wary of almost any new scientific ‘fact’. I seriously wonder if the demonisation of diesel is also happening for a commercial motive. My superficial impression is that the justification has shifted from nanoscale particles of carbon to oxides of nitrogen – which is always suspicious. The numbers of deaths from diesel obviously come out of a computer model, which is also a red flag for me.

      The problem is, maybe this is a real threat – does anyone know definitively?

      1. thelastfurlong

        Good point! There is also lying by omission. I wonder how the hundreds and hundreds of nuclear tests affected my generation – I’m 72. No one is saying….

      2. dearieme

        The particulate problem was becoming recognised thirty years ago. I was rather surprised to find NOx in the dock too. I suspect that the figures bruited about for extra deaths are piffle. But where is there an honest, competent source of information?

      3. chris c

        Yes my thoughts also. Diesels are fundamentally more economical than petrol engines but historically harder to make in small sizes. Now we can, I suspect the shift of balance between petrol sales and diesel sales has impacted the efficiency of refineries so a push back is required. Why do you think diesel used to be much cheaper than petrol and now is more expensive, unless you can buy in bulk quantities like big hauliers?

        Diesel engines are fundamentally more long-lasting, so forcing everyone to scrap and replace their cars represents a massive and ongoing profit centre for the car makers. Likewise making people ill represents a massive profit centre for drug companies, as is premature death for the Pensions Industry.

        See also, the price of carbs and industrially produced Omega 6 seed oils vs. what farmers are actually paid for their production, compared to the middle men’s markup on grass-fed meat and vegetables. Is fruit and ten a day being pushed for reasons of health or profit from imports from Third World countries?

        Likewise there has pretty much been a press embargo on the Noakes Trial, which like useful health information is mainly to be found on the Blogosphere, Twitter etc. and there appears to be an ongoing campaign of support for the status quo in mainstream media due to an unholy alliance between the likes of Coca Cola and Kelloggs etc. (ILSI) and militant vegans – PETA via PCRM and CSPI, also involving the likes of the WHO

        Sometimes paranoia is a rational response.

      4. Paul Ellis

        A 2016 RCP report stated that “Each year in the UK, around 40,000 deaths are attributable to exposure to outdoor air pollution…”. This statement became the newspaper and TV news headline, but if you examine the evidence you soon find that this is “fake news”. These estimated “excess deaths” are actually shortened life expectancy of anything from a few days to a year, depending on your exposure to particulates. As far as I am aware, the statistical estimates are derived from an air pollution study carried out in the USA using data between 1970 and 2000 and published in the NEJM in January 2009. I don’t know whether the results of this study are applicable to the UK but, given that the “experts” very recently promoted the use of diesel cars but now cast them as the villain, it leaves me rather sceptical. In my jaundiced opinion, the air pollution problem in London owes much to the town planners who do everything to reduce the speed of traffic to a crawl through inefficient traffic lights, all day bus lanes, speed humps, 20mph limits, etc.

      5. Stephen T

        David, I don’t know for certain, but diesal engines have long been known to cause problems. There was recorded resistance to the Government’s encouragement of diesal cars in the 1990s. Some people said the policy was a mistake, but the priority was CO2.

        I share your scepticism, and figures are thrown about casually, between, for example, causing deaths and contributing to deaths. My feeling is that this is a real problem. Industry isn’t pushing this problem, but rather resisting it.

      6. JanB

        Wasn’t there an ENORMOUS increase in chest related deaths in London at the time when diesel buses were introduced?

      7. David Bailey

        Stephen and JanB,

        You may be right, but my feeling is that pollution standards are perpetually tightened. Those involved in campaigning for a limit of X, don’t give up if they get their wish – they just start campaigning for a limit of X/5.

        There is no real reason (I suspect) to assume that the damage that pollutants do is proportional to their concentration – they could even follow a J curve like alcohol.

    2. Stephen T

      I don’t know how dangerous second-hand tobacco is, but I do know that it stinks and makes me cough. I’m happy for people to smoke away from me, but I don’t want to ‘share’.

      1. thelastfurlong

        Quite understandable. Point was about “facts”manufactured from guesswork and how many “lives could be saved”(that’s the new one) if we tax things, or regulate people’s behaviour for their own “health”. Or witch hunt /abuse non-conformists with different ideas not politically correct.

      2. dearieme

        I agree. But I still hate the fact that lying has been so widely used to bring about the change.

    3. dearieme

      That’s been my understanding for ages – that the passive smoking scare is baloney. I haven’t kept up – the evidence still points that way, does it?

      1. thelastfurlong

        Well, for me, I find it astonishing that the generation that was saturated in passive smoke are the ones who are now a “drain” on society by living longer than ever before!

        I think there can be no reliable scientific evidence on SHS because it relies on collecting verbal reporting and memories. But it’s a great tool to terrify the population with. Example of unscientific “science” published with great confidence can be found here – https://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/

        including quote – “Since the 1964 Surgeon General’s Report, 2.5 million adults who were nonsmokers died because they breathed secondhand smoke.” That’s a FACT (it seems) ! 😀

  20. Roy Firus

    Superb and crucially important article!
    Well done !!
    I read ” Pure White and Deadly when it first came out and well remember how tremendously attacked it was and how it was totally dismissed by both the leading medical and nutrition ” “experts.” at the time -whom virtually all were found out later to have received direct grants or indirect grants through their universities from” Big Sugar ” ( You know -exactly like today-from “Big Pharma.” etc.as well…).
    Thank-you for your courage in standing up for the truth and going against the ” Professional Paid Prostitution Industry ” which is so very hard at work in so many fields to create profit at the expense of health.
    Of course you must now realize now that you can now kiss your chance of getting the Nobel Prize for Medicine good-bye !! Perhaps the Alternative Nobel Prize ??

  21. Gay Corran

    Once again, a brilliant piece, Dr K. And once again, I fear for your head above the parapet! I know they can’t get you for giving individual advice, but how they must want to silence you, particularly the sugar and pharma industries!

  22. Richard

    I’ve commented before that diet should not be a one size fits all approach. In particular science has shown that those with type A blood have a low level of Intestinal Alkaline Phosphatase, so do not digest fat very well. That’s about 40% of the population that should not follow an LCHF diet.

    1. robert lipp

      I have seen similar comments before.
      Do you have science evidence references in support of this? I would love to see it
      many thanks

      1. Richard

        “Involvement of intestinal alkaline phosphatase in serum apolipoprotein B-48 level and its association with ABO and secretor blood group types.”

        “Intestinal alkaline phosphatase and the ABO blood group system–a new aspect.”

        From the Lancet, vol 288 no. 7475, (Dec. 3, 1966) p. 1232, “Blood Groups and The Intestine”

        The descriptions by AIRD and his colleagues of the associations of blood group O with peptic ulcer (1) and of blood group A with gastric cancer (1) have been confirmed by others;(3,4) and the observations have been extended to cover associations of blood group A with pernicious anemia,(1) and with salivary tumors.(6,7) Moreover, inability to secrete ABH blood group substances in the gastrointestinal mucus (a genetically determined characteristic) has been shown to be associated with peptic ulcer (11,9) and possibly with gastric cancer and pernicious anemia.(9,10) The causes of these associations are not known. But a simple protective action of the ABO(H) blood group substances in the mucus seems an unlikely explanation, because the total titer of blood group substance is the same for ABH secretors as for non-secretors (in non-secretors Lewis substance is substituted for the A, B, and H mucopolysaccharides). Furthermore a blood group effect on peptic ulcer can be shown in non-secretors alone. But the large quantities of blood group mucopolysaccharides found in the gastrointestinal mucosa suggest that they have some function.(11-13)

        Since the prevalence of both pernicious anemia and gastric cancer is higher in individuals of blood group A, and duodenal ulcer in those of blood group O, a hypothesis relating blood group effects to acid secretion naturally followed. Early work seemed to confirm that acid output tended to be greater in blood group O than in blood group A subjects,(14,15) but the observed differences, which were in elderly subjects, could well have been due to gastric atrophy (which would, by analogy with pernicious anemia, probably be more frequent and severe in blood group A than in blood group O individuals). Studies in younger healthy subjects have given conflicting results. In one series (16) gastric secretory potential, as measured by serum-pepsinogen levels, differed little between blood groups O and A; acid output was higher in blood group O subjects. In another study (17) however, gastric acid output was found to be higher in individuals of blood group O than in those of blood group A and slightly but not significantly greater in non-secretors than secretors.

        Another approach has been to study possible associations between ulcer symptoms and prognosis and the ABO blood group and secretor characteristics. Although earlier work was inconclusive, LANGMAN and DOLL (8) found a higher frequency of blood group O among patients with bleeding gastric or duodenal ulcers than among those with non-bleeding ulcers. Non-secretors seemed more liable to need operation for ulcer, though blood group did not seem to have any striking effect on likelihood of operation, nor did secretor status seem to influence the likelihood of hemorrhage. The association of blood group O with hemorrhage has been confirmed by others,(19) and the strength of the association of blood group O with liability to ulcer rather than with bleeding clearly must be reassessed. All surveys of blood groups in ulcer patients so far reported have been largely retrospective, and since the individuals for whom blood group data are readily available are those with bleeding ulcer, a strong bias in favor of blood group O is introduced. The same kind of error may well be present in data collected on secretor status, and an unselected consecutive ulcer series will be required to solve these problems.

        An intriguing blood group association with a serum isoenzyme of alkaline phosphatase has been described.(20) Serum alkaline phosphatase can be divided by starch-gel electrophoresis into two fractions, a faster moving component of liver or bone origin and a slower moving band probably derived from small intestine.(21) BECKMAN and his colleagues found that the frequency with which the slow-moving isoenzyme appeared in the serum was much affected by the subject’s ABO blood group.(20) This observation has been confirmed (22-24) and it is now clear that the presence of the slow-moving band in the serum is affected by both ABO blood group and secretor status. It is rarely found in non-secretors, whatever their ABO blood group, but in secretors it can be distinguished progressively more often in those of blood groups A, AB, and O or B (the last two have equal effects).

        A natural question is whether the blood group associations noted in disease could be more readily explained by relationships with the serum isoenzyme patterns of alkaline phosphatase. For instance, is absence of the slow-moving intestinal component in blood group A patients correlated with liability to gastric cancer? An association between peptic ulcer and the presence of the intestinal isoenzyme seems unlikely, because the disease is common in individuals of blood group O but not in those of blood group B. But simple comparisons of serum isoenzyme patterns in healthy individuals and patients with gastric cancer are impossible, for the presence or absence of the intestinal isoenzyme in the blood seems to depend greatly on diet. H. HARRIS and his colleagues (25) have shown that in normal individuals after an overnight fast the slow-moving component is present in considerably reduced amounts and can be clearly detected only in blood group O and B secretors. After normal meals the band of activity becomes much stronger in blood group O and B secretors; in blood group A secretors a weaker though distinct band appears; while in non-secretors little or none is detectable. Fat ingestion seems to stimulate the appearance of the intestinal isoenzyme in the serum. In blood group O or B secretors a synthetic breakfast of protein and carbohydrate did not seem to alter the serum alkaline phosphatase isoenzyme characteristics, but the substitution isocalorically of fat for part of protein and carbohydrate resulted in a notable increase in serum alkaline phosphatase activity. These findings agree well with independent observations showing that the administration of fat, but not protein or carbohydrate, increases the alkaline phosphatase content of human thoracic-duct lymph.(26,21) Further study of intestinal alkaline phosphatase should, however, increase our understanding of the relation between blood groups and alimentary function, and perhaps give us some idea of the physiological role of one form of alkaline phosphatase.

        Aird, I., Bentall, H. H., Mehigan, J. A., Roberts, J. A. F. Br. Med. J. 1954, ii, 315.
        Aird, I., Bentall, H. H., Roberts, J. A. F. ibid. 1953, i, 799.
        Clarke, C. A., Cowan, W. K., Edwards, J. W., Howel Evans, A. W., McConnell, R. B., Woodrow, J. C., Sheppard, P. M. ibid. 1955, ii, 643.
        Roberts, J. A. F. Br. Med. Bull. 1959, 15, 129.
        Roberts, J. A. F. Br. J. Prev. Soc. Med. 1957, 11, 107.
        Cameron, J. M. Lancet, 1958, i, 239.
        Osborne, R. H., de George, F. V. Am. J. Hum. Genet. 1963, 15, 380.
        Clarke, C. A., Edwards, J. V., Haddock, D. R. W., Howel Evans, A. W., McConnell, R. B., Sheppard, P. M. Br. Med. J. 1956, ii, 725.
        Doll, R., Drane, H., Newell, A. C. Gut, 1961, 2, 352.
        Callender, S. T., Denborough, M. A., Sneath, J. Br. Haematol. 1957, 3, 107.
        Glynn, L. E., Holborow, E. J., Johnson, G. D. Lancet, 1957, ii, 1083.
        Szulman, A. E. J. Exp. Med. 1960, 111, 785.
        Szulman, A. E. ibid. 1962, 115, 977.
        Koster, K. H., Sindrup, E., Seele, V. Lancet, 1955, ii, 52.
        Sievers, M. L. Am. J. Med. 1959, 27, 246.
        Niederman, J. C., Gilbert, E. C., Spiro, H. M. Ann. Intern. Med. 1962, 56, 564.
        Hanley, W. B. Br. Med. J. 1964, i, 936.
        Langman, M. J. S., Doll, R. Gut, 1965, 6, 270.
        Merikas, G., Christakopoulos, P., Petropoulos, E. Am. J. Dig. Dis. 1966, 11, 790
        Arfors, K. E., Beckman, L., Lundin, L. G. Acta Genet. Statist. Med. 1963, 13, 89.
        Hodson, A. W., Larner, A. L., Raine, L. Clin. chim. Acta, 1962, 7, 255. 22. Arfors, K. E., Beckman, L., Lundin, L. G. ibid. p. 363.
        Shreffl~r, D. C. Am. J. Hum. Genet. 1965, 17, 71.
        Bamford, K. F., Harris, H., Luffman, J. E., Robson, E. B., Cleghorn, T. E. Lancet, 1965, i, 530.
        Langman, M. J. S., Leuthold, E., Robson, E. B. Harris, J.. Luffman, J. E., Harris, H. Nature, Lond. 1966, 212, 4 1.
        Keiding, N. R. Clin. Sci. 1964, 26, 29 1. 27. Blornstrand, R., Werner, W. Acta chir. Scand. 1965, 129, 177.

      2. chris c

        Wow now that IS interesting. Something else which was studied decades ago and now almost unknown.

    2. chris c

      N=1 but type A and I have no problem with fats. I have a BIG problem with carbs though. Would be interesting to know how many of my diabetic/prediabetic relatives were also type A.

  23. Marjorie Daw

    Another inconvenient truth for the sugar industry is the fact that sugar causes cavities. Tobacco science or in this case, “Sugar Science,” came to the rescue of the sugar industry over 70 years ago with the introduction of artificial water fluoridation in the US. Several other countries followed suit but most of the world rejected this stupidity. Cavities could now be blamed on lack of fluoride rather than sugar. Putting toxic fluoride and fluoridation chemicals, (which are in fact industrial toxic waste), into drinking water is an ongoing unethical, dangerous and illegal fiasco It ruined the careers of scientists, doctors and dentists who dared to speak out against it. Although there is overwhelming scientific evidence that fluoridation doesn’t work and that fluoride is a neurotoxin, endocrine disruptor and carcinogen, opponents of this quackery still find themselves faced with ridicule.

    An excellent short film on water fluoridation is, “Our Daily Dose”

    1. chris c

      Interesting factoids from a previous dentist, now long retired, who used to carry out research.

      He opined that genetics were a factor in the incidence of caries but wasn’t sure what they affected. In my case I was not that much of a sugar eater but loved me my starch, which obviously affected my blood glucose, which wrecked my teeth starting in early childhood – my “permanent” teeth more or less came through with holes already in them.

      When “low fat” diets were first pushed, it was accepted that this would lead to more tooth decay, but at the time this was seen as a “trivial” problem. Some research into dental/gum diseases and CVD might suggest otherwise. Was fluoridation brought in in the UK around the time of the low fat mania?

      One of his toothpaste trials was so spectacular that it effectively unblinded itself. Said formulation never made it onto the market – he suspected it was a “proof of concept” too expensive to manufacture. He suggested that the nearest equivalent was probably Aquafresh Ultimate.

      Since I went low carb my teeth hardly ever need scraping, unlike in the past. A very common observation, and I believe the WAPF peeps have shown cavity healing from vitamins D and K2. Fat soluble so lacking in HCLF diets and responsible for calcium metabolism and placement. Maybe fluoride can be seen as statins for teeth? A treatment for the lack of prevention.

      1. Eric

        Chris, did your friend suggest what the magic ingredient was? There does not appear to be an Aquafresh Ultimate. I looked at the ingredients of Aquafresh Ulitimate White and Aquafresh Cavity Protection and could not find anything I haven’t seen elsewhere. Both seem to rely on fluoride mostly.

        I have downloaded and partly read Weston A. Prices magnum opus. Apparently, tooth decay was rampant in the 1920s in places such as Switzerland and the UK, much worse than it was say in the 1970s or today. White flour and industrial sugar were available, as was canned food, but there was probably no bombardement with chocolate bars, soda and the whole low fat craze.

        This is a mystery similar to CVD which peaked and started going down long before the brunt of poor food, poor diet advice and treatments of very limited efficacy came about.

      2. amie

        WAPF? I used to have quite bad gum disease and constant cavities. Since I stopped drinking all fruit juice and now only water, and lowered carbs generally (eating no bread), these decreased. I can however correlate an even more dramatic effect to starting to take K2 along with D (and magnesium). From then on, 3 years ago, they have found almost no gum disease, and no new cavities: Indeed, one tooth which the dentist said he was keeping an eye on and that would definitely need extensive treatment at the following checkup, he said no longer needed treatment. And yet: he insisted there is no evidence for the role K2 has in dental health, even as he acknowledged it did have in bone health. (As it happens, my osteoporosis has also reversed to osteopoenia since the K2 regime started and I am no longer on any osteoporosis medication.)I didn’t point out to him that Weston Price was a dentist.

      3. chris c

        Sorry no, he wasn’t even supposed to know which test paste was which let alone what they contained. Yes you’re right, the original Ultimate went off the market, it was always expensive so I suspect was replaced with something cheaper to manufacture.

        These days mostly the only problems I have relate to mechanical damage – nuts breaking off the corner of a tooth filled long ago – and ageing – fillings starting to “leak” after having been in my face a long time. Oh and I suspect the ham-handed dentist driving the ultrasonic cleaner into my gum causing the first abscess I had for decades.

        I only recently started supplementing with K2, my D levels were so high anyway that I don’t bother with that. You should have seen my doctor’s face when she gave me the test result and I said

        “That’ll be all the grass-fed butter and cheese then!”

        Currently I have Brie . . . be right back . . .

      4. JDPatten

        Might those problem fillings be silver amalgam? People worry about the dangers of mercury (Rightly!) but I have stories about the mechanical damage that’s done – old amalgams actually slowly prying molars apart.

      5. chris c

        That’s interesting, I simply assumed age was the factor – decades back when most of them were done there was no alternative to amalgam. Trouble is, if the same thing happens with “modern” fillings we won’t know for more decades since they were introduced.

        Further interesting factoids – amalgam is considered safe while still in your mouth but toxic waste when you come to be cremated (or buried?) but the outgassing may adversely affect the health of dentists – and this is also true (but different fumes) of the modern plastics and glues, which may be one reason so many dentists retire early.

  24. Sylvia

    Doug English, an Australian vet has been using Turmeric with good effect on animals, for several years, made into a paste, golden paste as it is widely called. Also benefits humans.
    I read how it is discredited by some with an agenda, it would seem. By all accounts he certainly uses other meds at his disposal and his evidence is largely anecdotal. He is up there with the brave rebels such as yourself Dr Kendrick in my view. No person or body should hijack health, it is for us all to get involved, to try and use what may help an individual gain holistic health. Money of course is King. Thank you for another thought provoking post.

    1. mikecawdery

      The FDA is attempting to re-define vitamins as medicines and put them under the same requirements for authorization as pharmaceuticals. This with the intention of bringing them into the sphere of Big Pharma to take over. Indeed this is what the allopathically oriented AMA has wanted since it was set up – the total elimination of ALL alternative medicine.

      1. Frederica Huxley

        The FDA are considering banning Ubiquinol and nettles! Don’t say a word about the nutritional values of walnuts, because the FDA has threatened the growers with full pharmaceutical testing as ‘drugs’.

  25. Joanne McCormack

    Great article and very sad what is happening.
    So far so good here. The 12 members of http://www.PHCuk.org teach low carb, as do an estimated 150 other GPs in the U.K.. rather a lot to take on, but we will see. Internationally there are many lowcarb doctor groups now. I’ve just heard that I have NHS funding for my group low carb clinic too. Who will they tackle next?

    1. Antony Sanderson

      Public Health Collaboration got a good press from Prof Noakes in his deposition to the HPCSA . . . he implyed that there was hope for the UK.

  26. Stephen T

    Ancel Keys was paid by the sugar industry to attack John Yudkin and his work. Gary Taubes talks about this in his latest book ‘The Case Against Sugar’.

    So, what’s causing or contributing to western society’s health problems? Meat and fat, foods we evolved to eat and have always eaten? Or sugar, a substance that didn’t exist in most people’s diet until 250 years ago? Everyone except Kellogg’s and Tate & Lyle knows the answer.

    1. mikecawdery

      Stephen T
      Crazy is it not. But the officially recommended diet for diabetics is starch (grain, potatoes, roots) and sucrose containing vegetables. Starch is simply a string of glucose molecules while sucrose is a combination of glucose and fructose.
      What is diabetes – hyperglycaemia (too much GLUCOSE) and the treatment – glucose from grain and sucrose. which leads in turn in the unfortunate to insulin resistance which in turn is associated with MI, Alzheimer’s, cancer as well as diabetes and generally to increased mortality. The supposed intent is to “cure” or “manage” diabetes – the logic I am afraid defeats me

      1. Stephen T

        Mike, I couldn’t agree more. The treatment of diabetics is a scandal. It’s little better than giving whisky to an alcoholic. The current pressure on the health service might eventually push them to a more rational position.

        I have lost a huge amount of faith in the NHS and avoid it. I won’t attend ‘routine’ GP appointments, take ‘preventative’ tests or accept any vaccine. Statins, diabetes and stupid dietary advice discredits the system, despite the many good people that work within it.

  27. Rick Zabrodski

    Clear and concise

    I sympathize and emphasize. As an expert witness in pain, I smile when attacked personally in court. I know my report was done so well that the only recourse is to attack the author, which is in the end, seen as a compliment by the trier of facts

    Well done

    On Wed, Apr 26, 2017 at 02:18 Dr. Malcolm Kendrick wrote:

    > Dr. Malcolm Kendrick posted: “Many years ago I started looking at research > into cardiovascular disease. Almost as soon as I began my journey, I came > to recognise that many facts I had been taught in medical school were plain > wrong. This did not come as a great surprise. Anyone familia” >

  28. anton kleinschmidt

    #HPCSAmust fall
    At last does justice come to pass
    Long litany of spite,
    Rank ignorance on full display
    Then failed to get it right.
    Decimation thus achieved
    An aura of deep shame
    The end result is plain to see
    Just who must take the blame.
    Much squandering of finite wealth
    Betrayed their members trust
    On any measure of the facts?
    Unfettered power lust.
    She made her plaint – they ran with it
    Sheer ignorance writ large
    The sub-text of their every word
    To prove that they’re in charge.
    So what then of the future
    Is reckoning in sight?
    Can they be trusted to prevail
    Or ever do what’s right?
    Their standing long in tatters
    The time comes to disband
    Return the high-ground to the best
    All those who understand
    Who work towards what’s right for all
    To use their skills with care
    With no agendas to protect
    This lifts us from despair.

  29. TS

    Currently we have politicians on election rants shouting about lack of NHS funding. On the one hand I think, wouldn’t it be good if they were made to see that the pharmaceutical companies are controlling the NHS and its funding.
    Then I think that, even if the politicians knew this, and perhaps some do, they would not admit it to the public whose votes they covet – since most people seem to want their drugs and have come to expect and rely on them, in their ignorance.
    How can this be got around?

    1. chris c

      My carbimazole (for hyperthyroid) comes in two strengths, 20 mg and 5 mg. They cost the NHS approximately the same. If a garage sold fuel at the same price for a litre as for a gallon there would be an outcry. It may not even be legal.

      See also, massive price increases, hundreds or thousands of percent, for insulins and many other drugs, and the cartelisation of pricing between “competing” manufacturers. Tony Soprano would be proud.

      LCHF diets for diabetics would save the NHS half a billion a year. That would mean the drug companies would LOSE half a billion a year. This is why opposition is so strong.

  30. Gary Ogden

    Nutrition science, tobacco science, vaccine science, all of the same ilk. Only the tobacco industry has been put in its place; the others are simply too powerful. They have captured governments worldwide.

  31. Martin Back

    Microsoft used similar tactics to drive people into the Windows fold. It got a nickname — FUD — for Fear, Uncertainty, and Doubt.

    1. Chmeee

      Actually, it was IBM that started FUD. Microsoft just thought ‘ Hey, great idea, we’ll use that’. As they did with a few other things. Trust me. I work in IT. 😀

    1. robert lipp

      What’s wrong is that *any* diet is not necessarily the optimal diet for a specific individual.
      I readily accept that it my be a whole lot better than the high carb fake food diets.

      1. Nigel Kinbrum

        *All* of the longest-lived (Blue Zone) populations eat HCLF diets based on produce. I accept that LC can help people who have been made ill by eating the SAD or SED, but stating that LCHF is the best diet for everyone is *wrong* and actually helps the Food Product Industry.

        As long as a diet faction pushes a certain macro ratio as the “best”, a different faction will contradict them with loads of studies “proving” that their macro ratio is the best. Then there are the veg*ns, who’ll show loads of studies “proving” that the other, non-veg*n, factions, are wrong.

        Instead of all the factions attacking the common enemy (i.e. the Food Product Industry), they’re all attacking each other over irrelevancies. Edward Bernays would be laughing his head off, if he was alive today. Watch http://www.dailymotion.com/video/x2d29tf_the-century-of-the-self-part-1-of-4-happiness-machines_school , to see how easy-peasy it is to get populations to want things that they don’t need.

      2. Dr. Malcolm Kendrick Post author

        Nigel, that is not correct. The seventh day Adventists are (theoretically vegetarian, but eat lots of eggs and cheese and suchlike). In Okinawa they are famed for eating everything of a pig, apart from the squeak – and are known in Japan as the ‘pig eaters.’ In Sardinia they eat a high animal/animal fat diet. Your general point, however, is valid. As those who read this blog probably know, I am not a great believer in any particular [macronutrient] diet being healthy, or not healthy. Other than the perfect storm. Highly processed foods, high in carbohydrates, associated with no exercise whatsoever and excessive calorific intake. [Pretty much the diet of, much of, the Western World].

        My view – with regard to diet. Eat food that looks like real food, not too much, take exercise, chill.

      3. Nigel Kinbrum

        As I can’t edit posts, I retract the word “All”. I should have written “Most”.

    2. Gary Ogden

      Nigel Kinbrum: Thanks! Excellent explanation of why humans thrive on a wide variety of diets, if they consist of wholesome food. The gut micro-biome is in charge; good idea to keep it healthy and happy.

    3. Martin Back

      Insightful comment from Dr Chatterjee:

      One of the problems is that in medical school we are mostly taught a model of care suitable for acute problems, that is primarily pharmaceutical based. However, the health landscape in the UK has changed dramatically over the past few years. The vast majority of chronic problems that I see today – such as type 2 diabetes, obesity, gut problems, insomnia and headaches – are largely driven by lifestyle choices… I believe that there is a strong case to put nutrition and lifestyle at the heart of medical education so that together we can better serve our patients. It is time to change the trajectory of chronic disease that is already making the NHS as well as many other healthcare systems unsustainable. — https://www.drchatterjee.com/blog/medicine-needs-to-change.cfm

      1. Craig E

        Stephen T the documentaries were great but the Australian media crucified Ms Demasi over the programs despite an independent investigation revealing nothing was factually incorrect in the two programs. We have a show called Media Watch on the ABC that really laid the boot in. The backlash from ‘the establishment’ was so fierce that the ABC caved to pressure and yanked the two episodes from its website. It’s the stuff nightmares are made of.

      2. Antony Sanderson

        Both of the videos on cholesterol and statins are on YouTube.
        I always give the links to people who are wavering over starting statins.

  32. Gaetan

    thank you again for your writings.

    There is one thing i do not grasp, if the sugar industry can pay scientists to write rubbish and claim their stuff is healthy, it would also be plausible to wonder why can’t the fat industry do it as well?

    i mean there was a time, not so long ago, where food was tasty and made out of fat.

    1. Dr. Malcolm Kendrick Post author

      I have pondered, along with others, trying to get sponsorship for a ‘fat is good for you campaign.’ Thus far, the feeling is that we will simply be attacked for gaining funding from industry. Yes, I get the irony.

      1. mikecawdery

        Dr Kendrick
        On a daily I am amazed at adverts for this food or that being promoted as low or zero fat on TV. The pro-fat data is simply ignored. In the circumstances I suspect the food industry is very unlikely to support a pro-fat campaign. Just look at the shelf space dedicated to lo-fat or zero fat products.
        One wonders at the educational system and its teaching of comparison.

    2. mikecawdery

      There was also a time that salt was used in meat pies; now it is replaced with sugar.
      I have several papers that demonstrate that higher intake of salt results on average in a longer life. Also that halving salt in the healthy has little effect in reducing BP – 1-3mm Hg in SBP, This idea that because it is useful in patients with salt allergies or kidney problems it is useful in healthy people is not necessarily true.

    3. chris c

      Look out my back window and you will see fields and fields of carbs – wheat, sugar beet, potatoes, peas, other grains – and margarine (rape). Tucked in between are small farms containing cows, sheep, pigs and vegetables.

      Some years the farmers get less than the cost of production for their wheat, and dairy. It’s the middlemen who profit from the status quo. They are “paid” subsidies but they only get to hold the money for a while and then pass it on/back to the industry.

      Apart from “vegetable” oils I don’t see how this system could be established for Real Food.

      One reason I’m cynical about the anti-sugar industry is that it will lead to its replacement with more wheat, which will do many people naff all good.

      1. benfury22

        Not without howling from many. The knowledge that wheat and other grains are primarily nutrient poor long chain sugars quickly broken down into glucose is better and better known each day. Sugars eliminated from the diet need to be replaced with healthy protein and fat, not grain carbage.

        In conversation with average people, I’ve noticed a strong uptick in carb/sugar awareness in the last year. The word is spreading. Sugar in ALL its forms is getting marked for avoidance.

      2. Sasha

        Sugar in processed form (table sugar, HFCS, etc) is very different from sugar found in fruits, wheat, etc. In the same way that snorting cocaine is different from chewing coca leaves.

      3. chris c

        Sorry Sasha but my glucometer strongly disagrees with you. ANY carbs in excess of around 10g at breakfast and 50 – 80g by evening will spike my blood glucose irrespective of their origin. I wish I had a pocket insulin meter.

      4. Sasha

        Oh yes, I just saw what you were replying to… Yes, they probably would spike your blood sugar temporarily because they contain glucose but they also contain other nutrients not found in other food groups. Unless the idea is to completely eliminate blood glucose spikes.

      5. chris c

        Simple tech like a glucometer can be very useful, especially when used by thousands if not millions of others.

        I can eat significant quantities of blueberries, strawberries or cherries (especially when diluted by ground flaxseed, clotted cream and brandy!) but about half an apple is my limit. I can’t really do citrus at all, except when I use the juice of a lime or half a lemon in a stir-fry or similar, and I can’t even be in the same room as a banana without a massive glucose spike. As for fruit juice, forgetaboutit.

        This is a common pattern – yet I know other individuals who can eat what I can’t, and vice versa. I do just fine with most forms of meat, and fat, and vegetables except starchy roots.

        Wheat will spike my glucose worse than anything – except wheat mixed with other carbs, which is worse than sugar. Probably not gluten, my money is on wheat germ agglutinin. Again common to a significant number of other diabetics but by no means all.

        My carb tolerance is much less in the morning than the evening – again common to most but not all Type 2s and many Type 1s (and probably also many “nondiabetics” especially those who are actually “not diabetic yet”.

        An insulin meter would probably be even more useful in unpicking the difference between what I can and cannot eat at different times of day, and again in showing the similarities and differences between different individuals.

        Scientists like Noakes and many others research this kind of stuff and the pathways involved. Dieticians are horrified that science may show up their house of cards, built on quicksand and held up by an infinite number of turtles.

  33. mikecawdery

    To return to the HOMA-IR. It seems that insulin resistance is associated with many conditions.
    Diabet Med. 2002 Jun;19(6):470-5.
    Insulin resistance in non-diabetic subjects is associated with increased incidence of myocardial infarction and death.
    Insulin resistance, as assessed by the HOMA method, was in this cohort of middle-aged non-diabetic subjects associated with an increased incidence of myocardial infarction and death.

    Acta Diabetol. 2012 Dec;49(6):421-8. doi: 10.1007/s00592-011-0361-2. Epub 2012 Jan 4.
    Insulin resistance/hyperinsulinemia and cancer mortality: the Cremona study at the 15th year of follow-up.
    Individuals in the highest quintile of serum insulin had a 62% higher risk of cancer mortality (HR = 1.62 95% CI: 1.19-2.20; P < 0.0022) and 161% higher risk of gastrointestinal cancer mortality (HR = 2.61 95% CI: 1.73-3.94; P < 0.0001)

    Neurology. 2010 Aug 31;75(9):764-70. doi: 10.1212/WNL.0b013e3181eee25f. Epub 2010 Aug 25.
    Insulin resistance is associated with the pathology of Alzheimer disease: the Hisayama study.
    The results of this study suggest that hyperinsulinemia and hyperglycemia caused by insulin resistance accelerate NP formation in combination with the effects of APOE epsilon4.

    The interesting point is that most GPs (and consultants???) are not able to avail of this test for insulin resistance and β-cell effectiveness because fasting insulin blood level is NOT a standard NHS test and without fasting insulin blood level it is impossible to do the test. I find this somewhat perverse

    1. chris c

      “We don’t test insulin as it doesn’t alter the treatment”

      see also

      “There’s no need to test your blood glucose, we already know you are diabetic”

      Do NOT look at the elephant in the room. There is no elephant.

      1. mikecawdery

        Chris C

        Why then do they test for hyperlipideamia when on statins – same thing? I presume it is money.

        As for “We don’t test insulin as it doesn’t alter the treatment”. This is a lie. In my own case the test for insulin through the HOMA-IR tests led me to radically change my treatment from gliclazide to insulin injection. My β-cells were 10% effective (even with the aid of gliclazide) and I am not insulin resistant. I find that qan adequate reason to request my GP for a A CHANGE OF TREATMENT; clearly something that would not have happened under normal guidelines.

        No say the least, I am somewhat “miffed” at this situation. May be if they had tested my insulin level years ago something (other than official medical guidance by DIRECTIVE) could have resolved the problem and the subsequent MI.

      2. chris c

        “We don’t test your “cholesterol” again once you are on your statin” (a nurse).

        If they do test it again it is only to titrate the dose upwards.

        Totally agree on the insulin, a whole bunch of adult onset Type 1/LADA diabetics go through what you went through because “you can’t be Type 1, you’re too old” despite that I believe adult onset is now about twice as common as childhood onset. See also “you can’t be diabetic, you aren’t fat”

        Saving pennies to squander pounds while following memes. Health is a much lower priority.

      3. Karl Schmidt

        It is more complicated than that – Insulin changes rapidly – you would really want to see an average.

        We also know that LA(Linoleic Acid) causes insulin resistance long term – and also inappropriate insulin sensitivity in adipose tissue. Having insulin resistance results in having higher insulin – and one narrative is that one effects of insulin is as a growth factor that they think may cause the initial thickening of the inner intima of arteries – thus causing CAD. The damaged arteries – as does most injuries – causes LDL to increase (to fuel the repair process) thus the correlation of LDL and CAD has the arrow of causation backwards.

      4. mikecawdery

        Karl Schmidt

        Indeed insulin level does change through the day. However fasting insulin level if taken after a specified fast (say 24 hrs) is basically stable. It is this measure used in HOMA-IR and the Oxford program.

        Also hyperinsulinaemia is bad for brain and heart whether due insulin resistance hyped insulin injection or naturally by the pancreas

      5. mikecawdery

        chris c

        For what its worth I believe that the failure to test for insulin results in the use of drugs to “manage” diabetes with the result that insulin resistance increases due to the recommendation to eat starch (grains) which is pure glucose followed by serious damage to the β-cells, which in turn develops into Type 1.

        Alternative insulin resistance (aka hyperinsulinaemia) is further increased. Hyperinsulinemia in itself is bad as previously posted references show. One paper I reviewed for the BMJ provided data from which I was able to show that after an MI in diabetics, the addition of insulin therapy to the treatment protocol resulted in a 1 in 7 increase in risk of dying in the next 2-3 years. I suspect that this might have been due due to existing insulin resistance with an increase in hyperinsulinaemia consequent on additive insulin therapy with serious adverse effects. May be prior measurement of fasting insulin levels and use of the Oxford program could have helped avoid this issue and even change the treatment and nutrition protocol for better results.

        Once the β-cells are damaged to the point of Type1 diabetes there is no cure.

      6. chris c

        Technically you don’t change from Type 2 to Type 1, you become an insulin-dependent Type 2. The pathways to pancreatic destruction are different, AFAICR some inflammatory cytokines are common to autoimmune and non-autoimmune damage but some are different.

        Having said which, childhood onset Type 1 generally goes from healthy to “die without insulin” in days to weeks whereas adult onset/LADA may take months to years, and I’ve actually seen some Type 2s (insulin resistant) progress faster than some (non-IR) Type 1s.

        Then there are MODYs and other genetic types which follow different patterns, which probably explains why some “Type 1” diabetics can subsequently come off insulin. A genuine Type 1 may be able to significantly reduce the dose, and interestingly Joslin did some studies of their long term Type 1s and showed there was still some (very small) insulin production in some of them, so it all becomes as clear as mud.

        Many Type 2s are told when they are (finally) diagnosed that they will be on insulin within five to ten years, which is frankly farcical and ridiculous, and unnecessary if they are not put on a HCLF diet – there are still some elderly diabetics wandering around who have not progressed for 40 years or more because they were diagnosed back when low carb diets were the default.

        Current Standard Of Care is to diagnose only by HbA1c which must be over 6.5% twice, put the unfortunate patient on a high carb low fat diet while exhorting them to lose weight and move more, then add more drugs whenever A1c reaches 8% or whatever is the current value, ending up on insulin. Unhealthy but profitable


        Fasting insulin would be good, a full Kraft-style insulin assay better, even looking at 1 hour postprandial BG would be a step up – IF you want to diagnose people as soon as possible to minimise damage, then control the disease process via LCHF, and eventually add drugs IF required. Type 1s would be spotted immediately and could go straight onto insulin.

        This may well also improve CVD – microvascular complications are associated with A1c, macrovascular complications with postprandial BG spikes, and obviously insulin is a big player.. But where’s the fun in that?

    2. Martin Back

      All these dysfunctions could be lumped under the heading “too much food disease”.

      The body must have evolved short- and long-term energy storage mechanisms. Short-term (daily cycle) to tide one over between meals, and long-term (annual cycle) to tide one over between harvests, or mammoth migrations for the meat-eaters.

      But for the cycles to operate effectively, the energy buckets have to be emptied at regular intervals.

      On a daily basis, you need to stop eating between meals. But every overweight person I know is munching and snacking continuously. Hardly an hour goes by when they are not eating or drinking something containing calories.

      On an annual basis, you need to shed any weight you put on during the year. Typically, you would diet off the winter fat to get your body trim and beach-ready. But these days overweight people accuse others of “fat-shaming” and flaunt their adiposity. Small wonder that diabetes etc is on the increase.

      1. Stephen T

        Martin, that’s often true. But many people do try hard but are endlessly hungry because of the disastrous low-fat nonsense which means they are endlessly hungry. Personal responsibility has a part to play, but so does terrible advice to eat low fat (high sugar) food and exercise.

        When I see pictures from the 1950s, 60s and 70s, where were the overweight people? They barely existed and the few that did were usually wealthy.

      2. chris c

        There’s more to it than that though. I always ate hordes of carbs or I would sometimes literally fall over. In retrospect I had all the “health markers” of an obese person except the obesity. It took a dietician carefully eliminating what little fat was left in my diet and replacing it with even more carbs before I finally gained weight. Naturally I was accused of “failing to comply with the diet”.

        When I actually STOPPED complying with the diet, all the weight came off, my energy came back and my hunger suddenly started working properly. Now I routinely go 5 – 8 hours and often 11 hours or more until I get hungry and need to eat again. Often I have a snack-sized breakfast, only one main meal and a late snack – sometimes I have two smaller meals. I often don’t “refeed” after an active day, but I might the following day or even the day after that.

        Yeah OK I’m broken. I can still produce a goodly quantity of insulin, just not at a high rate. I used to have massive IR and now I don’t so said insulin goes further. So sorry to the insulin deniers but it is a CRUCIAL part of my (familial) brokenness. I run just fine off fats and ketones and wish I had discovered (or been told) this decades ago.

        N = thousands if not millions.

  34. Mark Waters

    Been going an along time…. Dr Richard Mackarness was drummed out of the UK and went to Australia……His books are well worth reading “Not All In the Mind” and “Chemical Victims” and of course “Eat Fat and Grow Slim”

  35. TS

    And what of this?
    “Why Haemoglobin A1c is not a reliable marker – Chris Kresser”

    An excerpt:
    The main problem is that there is actually a wide variation in how long red blood cells survive in different people. This study, http://care.diabetesjournals.org/content/27/4/931.full
    shows that red blood cells live longer than average at normal blood sugars. Researchers found that the lifetime of hemoglobin cells of diabetics turned over in as few as 81 days, while they lived as long as 146 days in non-diabetics.
    …. In a person with normal blood sugar, hemoglobin will be around for a lot longer, which means it will accumulate more sugar. This will drive up the A1c test result – but it doesn’t mean that person had too much sugar in their blood. It just means their hemoglobin lived longer and thus accumulated more sugar. The result is that people with normal blood sugar often test with unexpectedly high A1c levels.
    This confused me early in my practice. I was testing blood sugar in three different ways for all new patients: fasting blood glucose, post-meal blood sugar (with a glucometer) and A1c. And I was surprised to see people with completely normal fasting and post-meal blood sugars, and A1c levels of >5.4%.
    …On the other hand, if someone is diabetic, their red blood cells live shorter lives than non-diabetics. This means diabetics and those with high blood sugar will test with falsely low A1c levels.

    1. Craig E

      Very interesting. I wonder whether many people diagnosed with T2D actually have anything wrong at all and it’s just an excuse to prescribe meds. I thought diabetes was originally a spill over of glucose via kidneys into the urine. Is this no longer a viable means of diagnosis? Dr K wrote a really good blog article a few years on glucagon and whether the role of insulin was to put the brakes on glucagon’s influence…since uncontrolled hypoglycemia leads to immediate and life threatening problems. For fasting blood glucose to be high one of two things must be happening a) uncontrolled gluconeogenesis or (b) uncontrolled glycogenolysis – although glycogen stores are finite. Where else would the sugar come from? So many questions….

    2. mikecawdery


      Many thanks for the two links; a very useful contribution.

      Unfortunately the official Directives (aka guidelines) I am becoming to believe are not genuinely designed for patient benefit but to ensure doctors follow the “approved therapeutic path”. This being backed up by QoF. Reason – well the “experts” do not like being proved wrong and dislike even more having to admit it!

  36. jill.leslie@btinternet.com

    Dear Dr Kendrick

    Just a quick note to say not only how much I enjoy your blog – and VERY glad to hear that you are well over the poor health that beset you in the winter – but also to say that I LOVE this re-visit to times gone by and to Professor John Yudkin’s work. I was at Queen Elizabeth College (QEC) during the late 60s/early 70s as a nutrition student and remember him as a true gentleman, excellent teacher and caring medic.

    I may have already told you that II write an (intermittent) Nutrition blog for a website, called Independent Living, which is for disabled persons, their families and carers, updating them on mobility aids and other helpful products etc, on the law and disability and on innovative programmes, as well as other health-related information..

    The Editor forwarded this from The Guardian to me today, which I am sure you have probably seen but I thought you would say “Hooray” to it!


    For your interest, here are my blogs on the Yudkin/Keys nutrition “war”. Disgraceful behaviour. And I passionately believe that nutrition research of this kind (and pharmaceutical) should be open about its sponsorship.



    Cheers! Good health and keep the blogs coming! And yes … I will raise a glass of red to north of the border!

    Jill Leslie

    1. mikecawdery

      Dr Leslie

      Many thanks for the links; most useful.

      Once again the Guardian report demonstrates that the “experts” wedded to lofat are loathe to look at ALL the data, but repeatedly return to flawed studies like those of Ancel Keys and similar. Their careers have been built on falsehoods and they are just not man enough to admit they are wrong and have been led down the garden path by commercial “research” such as the Harvard research that “”showed” fat to be bad and sugar good which was recently outed by the New York Times (gave the link in a comment to a previous blog).

      There are many examples of this type of response, notably the original “expert” response to Dr . Barry Marshall (H. pylori), Dr Polderman (subsequent whiewash), The six weeks strict bedrest post MI which killed (all slunk off), reports on deaths from pharmaceuticals and “medical error” (which the medical establishment fail to acknowledge and do nothing about) and so on and so on

      1. Craig E

        Hi Mike it’s particularly interesting how Dr Banerjee in the Guardian article cites the Cochrane meta-analysis and quotes the 17% reduction in events across the studies – a relative risk reduction. The absolute risk reduction is so trivial it’s laughable but supposedly knowledgeable people hang their hats on it to try and discredit the authors…and of course the journos just swallow it rather than questioning

  37. brainunwashed

    [In 2013 Kellogg’s funded British research that concluded “regular consumption of cereals might help children stay slimmer.”]. ONE question for the aforementioned British researches. MOST Live stock farmers can only make a profit by fattening their cattle quickly. What do they feed the cattle to achieve this. A) Grass B) Cereals……….now go figure.

      1. mikecawdery

        Indeed this is true but most of those antibiotics are not allowed in the UK and the EU. However, one (monensin) if used in dairy cattle before in very small doses does protect against post-calving ketosis, a very serious condition. I know, A colleague and I did the published research over 30 years ago. The milk is tested for antibiotics and is discarded if there is any antibiotic activity above a very low limit.

    1. Stephen T

      Pasta, crisps and sweets is the diet designed to rapidly fatten cattle on one farm in New York featured in a recent BBC2 documentary. The farmers go high carb and sugar, but don’t allow fat because it surpresses appetite.

      I think these farmers understand more about the foods that make us fat than the dimwit dietitians in our health services.

  38. Dr. Göran Sjöberg

    Malcolm – What a great summary of a perverted medical world!

    In the name of “health care” sophisticated criminality from Big Pharma is today systematically carried through by our authorities. My own philosophy is, if possible, never to get in touch with this system since there are “screening” traps set everywhere. Instead I developed, slowly during 17 years now, my own “personal health care system” which seems to work reasonably.

    Acute infections where antibiotics are badly needed, though, forces me to get in touch with this ugly system now and then.

  39. Lor

    Hello Doc,
    Did you get a chance to listen to Professor Graham MacGregor on BBC Radio 4 Life Scientific (26 April 2017)? He said his research on salt was quashed by John Major because the Tories were backed by big bucks that came from the food industry. I do not suggest you post this comment but perhaps those who have the BBC iPlayer might like to listen to the interview. The Prof was candid and blunt.

    This is a copy and paste from the website

    The food we eat is the greatest cause of death and illness worldwide. The main culprits – salt, sugar and fat – are now so embedded in our diet, in the form of processed foods, that most of us consume far too much.

    Yet Professor Graham MacGregor doesn’t believe it’s up to us to reverse this situation. It’s up to the food industry, he says, who manufacture the processed foods, to take the ‘rubbish’ out.

    Now Professor of Cardiovascular Medicine at the Wolfson Institute of Preventative Medicine, Graham MacGregor has spent much of his career campaigning tirelessly to persuade the food industry to do just that – to reduce these demons in our diet – firstly salt, and now sugar.

    And he’s had remarkable success. As a nation we now eat thirty thousand tonnes less salt each year than we did fifteen years ago, saving the NHS a staggering £1.5 billion per year.

    Blood pressure lies at the heart of this huge saving and, as Graham explains to Jim al-Khalili, blood pressure is not a natural consequence of ageing. High blood pressure is simply a consequence of too much salt.

    1. Dr. Malcolm Kendrick Post author

      I completely disagree with Professor MacGregor on salt. Here is the recent Cochrane review, pre-publication, so I cannot provide huge detail, but these data have been released. Paper entitled

      ‘Does salt reduction provide any benefit in people with normal BP?


      This Cochrane review shows that a low- vs high-sodium diet in white people with normal BP decreases BP less than 1%.
      In white people with elevated BP, sodium reduction decreases BP by about 3.5%, indicating that sodium reduction may be used as a supplementary treatment for hypertension.

      The effect of salt reduction on BP in people with a normal BP has been questioned.Key results

      The average sodium intake was reduced from 201 mmol/d (corresponding to high usual level) to 66 mmol/d (corresponding to the recommended level).

      The reduction in systolic BP/ diastolic BP (SBP/DBP) in white people with normotension was about 1/0 mmHg, and in white people with hypertension about 5.5/2.9 mmHg.
      In plasma or serum, there was a significant increase in renin (P<.00001), aldosterone (P<.00001), noradrenaline (P<.00001), adrenaline (P<.03), cholesterol (P<.0005) and triglyceride (P<.0006) with low sodium intake compared with high sodium intake.'

      In short, severe salt restriction (in people without high blood pressure) resulted in a difference in blood pressure so small as to be, effectively, non measurable in an individual. Yet salt restriction causes massive increases in various hormones that have been shown to be damaging to the CV system. Salt restriction is a complete myth, and potentially very damaging indeed.

      1. mikecawdery

        Dr Kendrick
        I entirely agree with you as I have posted on your blog a few times. This concept of using trivial benefits, often grossly inflated by using relative rates, ORs and HRs to make the point is simply a device to flog more drugs in the case of pharmaceuticals. In foodstuffs it seems to be used more to inflate sagging status.

        It is certainly not for the benefit of the general healthy public!

      2. David Bailey

        It seems increasingly obvious to me that the body’s response to anything it needs – such as water, salt, cholesterol, etc absolutely must follow a J curve – i.e. there must be an optimum amount to be consumed (or be found in the blood), and either extreme is bound to be damaging. In addition, it would seem that several non-essential substances, such as alcohol seem to follow the same curve.

        Likewise, there must be an optimum BP – because zero BP means you are dead!

        Also around the optimum there will be a range within which the health outcome will be negligibly different from optimum

        Therefore any simplistic attempt to put a straight line through the data, or to try to reduce people’s intake as low as possible, is simply bound to be wrong.

        Of course, a J-curve is going to take more data to fit accurately……

    2. Stephen T

      Lor, I listened to the interview with interest and was disappoined that the interview was so unquestioning. Dr MacGregor may well be sincere, but he’s also convinced that cholesterol causes heart disease. Hasn’t he seen WHO figures on serum cholesterol and heart disease? The countries with the highest cholesterol have the lowest rates of heart disease. How does this theory work?

      Dr MacGregor long ago decided that salt was bad for us and I don’t think any kind of evidence will ever change his mind. I like his determination, but I got the impression of a very inflexible man. I prefer the courage of Tim Noakes who changed his mind about a high carb diet.

  40. geo lou

    A beautiful summation of the way it is ,, a distortion of true Science is being carefully manipulated through the Art Of Deception ,,, the creation of epidemic

  41. puddleg58

    One thing that has been forgotten was the Prof Yudkin wasn’t just against sugar, at the time he was well-known as an expert on LCHF diets for weight loss.
    His usual reduction diet worked out to around 100g fat, 100g protein, and 50g carbohydrate to restrict calories relatively painlessly.

  42. Dr. Göran Sjöberg

    I now read the following written by my favorite philosopher 150 years ago which suits well the essence of the present blog.

    “In this he does not allow himself to be led astray by the right or by humanness, but with harsh consistency crushes and pulverizes everything that opposes his plan; he plunges millions without pity into every kind of misery, and condemns millions to bleed and die. Nevertheless, he royally rewards his adherents and helpers, and always protects them, never forgetting anything and thus attains his end.”

    Who was the philosopher, what was the subject he was addressing and where can you find this quote?

    1. Martin Back

      Yudkin writing about Ancel Keys? JFK talking about Castro? George Bush talking about Saddam Hussein? Could be any political commentator writing about any of a number of despotic regimes today.

      Just hope they never have to say that about Trump.

      1. Dr. Göran Sjöberg


        You are for sure right!

        In my quote it is Schopenhauer who when criticizing Kant in an appendix to his main work “The World as Will and Representation” discuss how criminality on a high level can not work without cleverness or reason.

    2. Errett

      “In the sphere of thought, absurdity and perversity remain the masters of the world, and their dominion is suspended only for brief periods.” – Arthur Schopenhauer

  43. angelinn

    I believe it’s true that the WHO guidance on “free sugars” intake is based on modest or low quality evidence, as they say so themselves in the evidence base documentation.

    There are, for example, no isocaloric crossover RCTs that determine the effect of the % free sugars within a fixed macronutrient composition diet.

  44. Joyce

    So, so frustrated! Still no light at the end of the tunnel, and their deceit is literally AND metaphorically breaking my heart! Don’t know how you keep it up MK….but glad you do. Thank you. x

  45. Sasha

    This is a bit off topic… I just got “NO More Heart Disease” by Dr. Louis J Ignarro. I am wondering if anyone on here read it, implemented its recommendations and what you think of it? Thank you.

    1. Mr Chris

      Yes I read the book “Say NO to heart disease” and took his suggested dosing of L Arginine and L Citrulline.
      It jacked up my uric acid and Bilrubine, which is not surprising, so I gave them up, in favour of beetroot. Although beetroot only came in at number 10 for nitrating, it is the vegetable that seems to have a good effect on me, but no BCT involved.
      Hope this helps.

      1. Sasha

        Mr Chris, thank you. What’s BCT? And how are you using beets? Do you cook them or juice them?

      2. Mr Chris

        BCT = Blind Control Trial
        For the beets, I buy them cooked and grind them up in blender, sometimes with almonds. I prefer to put up with beets rather than than gout.
        Hope this helps

      3. Sasha

        And why those 2 supplements were raising your bilirubin? Were they stressing your liver? If you ever get tired of ground up beets, try making borscht. Easy to do and very good for you))

      4. Sasha

        Yes)) even if it tastes a bit different from traditional kvass which is made from wheat, if I am not mistaken.

      5. Sasha

        Oh, rye! This forced me to go read up on it. It’s amazing how many good qualities it has.

      6. Gary Ogden

        Sasha: I’ve been wondering if you meant kvass or beet kvass; now I know. I have made kvass in the past (and found it wonderfully refreshing) by fermenting dry bread in a bowl of water with whey and salt, straining and adding apples and raisins to finish in the fridge (when the fruit floats). I don’t make it any more because I no longer make bread. By the way, thanks for the borscht recipe. Sounds fabulous.

      7. Gary Ogden

        Sasha: Please give us a good recipe for borscht. I have made it in the past, but I would like to know the way you like it.

      8. Sasha

        Gary: here is one I make often. Fill a big pot 3/4 with water and put a couple of lbs of pork ribs with some bay leaves. Bring to boil and simmer for 30 min. In the meantime cut up a few potatoes and shred half a large cabbage.

        Also shred 2 large carrots and one large beet and chop up an onion.

        After 30 min add cabbage to the pot, simmer for 5 min. Then add potatoes and simmer for 15 minutes. Add some salt.

        In the meantime, saute onions in the frying pan, then add shredded carrots and beets. When they’re almost done, add tomato paste. Can also add some chopped up tomatoes. Salt, pepper. When it’s done, add the contents of the frying pan to the large pot. Simmer on very low for another 10-15 min and it’s done))

        Good thing about borscht – because of the cabbage, it continues to ferment for days even when stored in the fridge. So it’s usually even better on day two and three.


    1. Antony Sanderson

      I keep looking for ONE ‘supportive’ comment at the end of the blog . . . . I am surprised it has not had the comment facility removed.
      If you find a supportive comment you are allowed a wish.

    2. Martin Back

      As one commenter pointed out, on ADSA’s own website you will find “Food-Based Dietary Guidelines for South Africa”. On page 133 of the guidelines is written, for babies older than six months:

      Suitable complementary foods
      PAHO and WHO provide the following guidelines with regard to complementary foods that can provide adequate nutrients to meet the growing breastfed child’s nutritional needs:
      — Provide a variety of foods to ensure that nutrient needs are met.
      — Meat, poultry, fish and eggs should be eaten daily, or as often as possible. At this age, vegetarian diets cannot meet nutrient needs, unless nutrient supplements or fortified products are used.
      — Vitamin A-rich vegetables and fruit should be eaten daily.
      — Provide diets with an adequate fat content.
      — Use fortified complementary foods or vitamin-mineral supplements for the infant, as needed.

      How is this materially different from Prof. Noakes’s tweet?

      1. Mr Chris

        Its not materially different from what Noakes tweeted, which, in my opinion, proves they were out to get him. Their own kangaroo court didn’t shut him up, so they went the full Monty.
        Were they sincere that he was wrong etc? I doubt it

      2. amie

        The fact that ADSA’s own advice didn’t differ was pointed out at the trial, and the question asked was how then could Noakes have been guilty of providing unconventional advice. In fact one of the key findings of the tribunal was that there is no offence in providing unconventional advice per se.

    3. David Bailey

      One comment from someone called Carol summed it up:

      “I followed your food pyramid and became fat and sick. Then I followed Tim and lost weight and got healthy. In my mind you were killing me. Tim rescued me. Search your conscience .”

  46. Kerryn Wheeler

    The more I read the more I feel so sad. For my family, my grandchildren. For their health. I can only do so much for them myself. And as much as they understand what I teach them, they are still bombarded by the wrong information daily. Not to mention their well meaning GPs. 😦

  47. JanB

    Having been without broadband for several days I have come to realise that I have a very serious Kendrick addiction. Having suffered severe withdrawal symptoms I am now back online and have just read this truly excellent post. Already I am well on the way to recovery and look forward to reading all the many replies. I may well overdose, but I’m not worried because I know that it’s all very good for my physical and mental wellbeing, regardless of what some cynical naysayers might think.
    I don’t t know whether to say welcome back to you or to me; either way it’s grand to be back and reading your blog. Thank you. 🌹

  48. mikecawdery

    Malhotra A, Redberg RF, Meier P. Br J Sports Med Published Online First: [please include Day Month Year]. doi:10.1136/bjsports-2016-097285
    Br J Sports Med 2017;1:1–2. doi:10.1136/bjsports-2016-097285

    Evidence that supports the prescription of low-carbohydrate high-fat diets: a narrative review
    Free Timothy David Noakes1, Johann Windt2,3

  49. John U

    Sasha, I read “NO More Heart Disease” by Dr. Louis J Ignarro” because I wanted to know how to increase NO production to see if it would positively affect my skin issues. However the author delved into so many various human ailments which in his view could all be connected to, and in fact, rectified by increases of NO, that I was left unconvinced by his arguments and became uninterested by the content of the book. I would not recommend it to anyone. Anecdotally, I find that 10,000 i.u. of vit D3 daily in the winter months and lots of sun exposure in the summer does the trick for me.

    1. Sasha

      Thank you, John U. I’m only a quarter of the way through the book but it does seem like he links virtually every human ailment to lack of NO. It makes the book appear sensationalist and in search of a panacea (always a red flag, at least for me).

      Mr Chris just mentioned that taking two recommended supplements: arginine and citrulline jacked up his bilirubin and uric acid. I guess I will have to read up on them to see why that is but if you know, I would like to hear your opinion…

      1. John U

        Yes I saw Mr. Chris’s reply and I am no more knowledgeable about the increases in Bilirubin and uric acid than you are, I guess. Perhaps Mr. Chris can explain. But I am happy to hear that you shared my opinion of what you have read so far, and that was indeed a “red flag” for me as well. I was afraid that maybe I was missing something or just biased.

      2. Mr Chris

        Sasha, John U
        here is one link concerning L Arginine and Uric Acid:
        What Is the Connection Between L-arginine and Gout? – Livestrong.com
        http://www.livestrong.com › Food and Drink
        there are many others as a Google search will reveal
        As regards Bilrubine, I have no documentation, it doesn’t seem harmful, since L Arginine is put forward as a cure for damaged livers!
        As regards the book, Say NO etc, it struck me as superficial and populist, but the writer got a Nobel Prize for Medicine so he knows what he is talking about.
        I don’t really like rah-rah books like that.

      3. Sasha

        Mr Chris

        Thank you, I will read up on the biochemistry of these supplements. Hopefully, it will become clear why they can raise uric acid and bilirubin.

    2. Sasha

      And, yes, sun is great for many skin ailments. Also Chinese herball medicine which often works wonders in dermatology.

  50. Antony Sanderson

    Just to get back to Prof Noakes . . .

    I came across a worrying but measured analysis of the part the food industry played in the trial of Prof Noakes. In particular it details the significant players in the process, a number of whom are associated with the International Life Style Institute, which appears to be a front group for Big Food.

    This is the blog: https://rsasoldier.blogspot.co.uk/2017/01/ . . . search for “Big Food vs. Tim Noakes: The Final Crusade”

    I said a week ago how elated I was over Prof Noakes’ acquittal and that Strydom’s ‘complaint’ (see the above blog) gave Prof Noakes a platform. . . . Well . . . my son, a rugby and sports health fanatic, who was very indulgent to his old man going on about the case (in an eyes raised to heaven sort of way) , picked up on the safety in rugby aspect of the testimony and Noakes part in changing of sporting diet conventions. He became captivated, and continued watching the testimony beyond his immediate interest. Today he showed me a book he had just bought for some married friends who have just had a baby. “Super food for SuperChildren”. So . . . +3 for Prof Noakes.

    PS Still on cloud 9.

  51. TS

    I’ve written to my Member of Parliament about the exploitation of the NHS by the pharmaceutical companies and the need for public re-education to make the NHS viable.
    Worth a try?

    1. Andrew Larwood

      Hi TS,
      Absolutely!!! I wrote to Stuart Andrew, chair of the APPG on Heart Disease to ensure there was an open debate on prescribing statins for CVD prevention and not to be influenced by the pharmaceutical lobbyists. However, the pharmaceutical companies now making the PCSK9 inhibitors (statin replacements) are a deceitful bunch because they used a charity called Heart UK to lobby Stuart et al., to endorse and funding of PCSK9 inhibitors by the NHS. Heart UK is not surprisingly sponsored by these companies!!!!

      And another snippet in the continuing saga was published today copied below for reference:
      “Those of you who have been following the Daily Health for a while, will know that one of the biggest thorns in my flesh is cholesterol-lowering statin drugs.

      It’s not only the unnecessary over-prescription of these drugs that grinds my gears, but also the fact that the mainstream refuses to acknowledge the long and growing list of debilitating side effects associated with statins…

      And then sometimes, I read a news headline that gives me a glimmer of hope that somehow the mainstream is beginning to see the truth behind these drugs.

      Risk versus benefit ratio

      “People are taking this drug to prevent a problem and [are] creating a disaster.”

      Those are the words of Professor Sherif Sultan, President of the International Society for Vascular Surgery, who analysed various studies investigating the cholesterol-lowering drugs and he concluded that the so-called benefits of statin drugs were based on “statistical deception”.

      I’ve been saying this for years… a few medical experts have stepped forward and said the same… and now, yet another heart specialist is warning people that taking statin drugs is doing much more harm than good.

      Professor Sultan also warned that the positive results of the use of statins in past studies, like the JUPITER trial, may have been influenced by bias as they were conducted by researchers who were employed by statin manufacturers.

      He added that the results of many studies have been kept under wraps because they demonstrated that statin drugs can accelerate artery hardening (atherosclerosis), which is a known risk factor for heart attacks. These are the same studies that showed a link between statin use and an increased risk of diabetes, cataracts, impotence, breast cancer, nerve damage, depression, muscle pain, and renal and liver failure.

      Commenting on the findings of Prof. Sultan, Sir Richard Thompson, former President, the Royal College of Physicians, said: “Data needs to be urgently scrutinised. We are very worried about it and particularly side-effect data which seems to have been swept under the carpet.”

      In addition, a group of highly respected European doctors said that the theory on which statins are based – that lowering ‘bad’ cholesterol cuts heart disease – is “fundamentally flawed”. They added that the supposed evidence that statins save lives is “underwhelming”. (By the way, they are right, because no direct link between high cholesterol levels and cardiovascular disease has ever been scientifically established. It’s true!)

      As expected, the statin camp is not batting an eyelid. Dr June Raine, Director of Vigilance and Risk Management, of the Medicines Healthcare Regulatory Agency (MHRA), said: “The benefits of statins are well established and are considered to outweigh the risk of side effects in the majority of patients.”

      Uh… yes… that argument almost sounds like the rhetoric we are hearing from politicians lately.

      Perhaps Dr Raine should consider that the supposed “benefits” of statins are well-established only because the risks and associated side effects (of which there are plenty) are being ignored by those who are benefitting most from these drugs being pushed to millions of people — Big Pharma, medical regulators and researchers receiving backhand deals and doctors who are incentivised when they prescribe statin drugs.

      Unfortunately, the statin debate doesn’t look like it will ever come to an end… And while we’re waiting, if you are taking a statin drug and are worried about physical symptoms you’ve never experienced and your doctor is dismissing your concerns, the final decision lies with you if you want to continue taking this drug.

      Just remember, if you follow your doctor’s recommendation taking this drug will continue for a lifetime and so will the side effects.”

      Francois Lubbe

      1. barbrovsky

        I was put through a year of torture because I refused to take the damn things, statins that is! Tested up the yazoo and even lied to about alleged alternatives to statins. It’s the worry associated with it that concerns me as I think it contributes directly to creating hypochondria, whereby every little unexplained ache and pain gets translated into panic. This is especially so, when you get older as things break down with use and don’t always get repaired accurately by the body’s mechanics.

        And it strikes me that virtually all the doctors I’ve interacted with since my heart attack five years show an incredible insensitivity to my feelings and fears about my condition. Thus when asked, phrases such as, ‘Well you have a 50/50 chance of another one’. No time scale offered of course. Or, “well after five years, stents clog up” (my five years was just up). Thanks for that. Both may be true or not, I don’t know but the way these statements fall from numb lips, appalls me. So you leave with yet another worry to add to the ones they’ve already given me.

      2. David Bailey


        From my experience, and others I have talked to, the one thing you don’t need to worry about is statin side effects that are too small for you to be certain if they are real! The ‘muscle aches’ that are described on the patient information sheet are actually really nasty cramps, pains in the joints, and weakness. The joint pain isn’t like osteoarthritis, it is fairly weird!

      3. mikecawdery

        Andrew Larwood,
        I complained to the Charities Commission over Heart UK’s support. Not much satisfaction there. There was apparently an enquiry in progress on the general problem of charities misusing their position to act as advertisers for the products of commercial reporters. Never heard the results of the enquiry.

      4. amie

        And just look at this latest “study”! Hope Dr Kendrick will write about it:
        “Most of the aches and pains people blame on statins are the result of self-fulfilling expectations and have nothing to do with the drugs themselves, a study has concluded.
        Scientists claimed that millions of patients might get better by themselves if they understood this truth about the drugs. Regulators face calls to remove warnings about side-effects from medicine packets to prevent this “nocebo effect”, where fears of problems result in real harm.
        Professor Peter Sever of Imperial College London, lead author of the paper, said: “Just as the placebo effect can be very strong, so too can the nocebo effect. ..If people understand that this drug is not actually causing the symptom, they would feel a little more reassured, given the overwhelming benefits.”..Scare stories about statins’ side-effects have been likened to the MMR scandal by scientists who say that people with heart problems are gambling with their lives because of overblown worries…
        While there is little dispute about the benefits of statins for those who have had a heart attack, they are increasingly recommended to help lower “bad” cholesterol for people at lower risk and with less to gain.”


      5. Andrew Larwood

        Professor Peter Sever’s response is typical and expected since wasn’t it the same Professor Peter Sever of Imperial College London, lead author of the paper, on the expert FOURIER trial committee funded by Amgen; FOURIER ClinicalTrials.gov number, NCT01764633?

    1. Mr Chris

      life is totally crazy as regards medical advice. Here is a stupid example.
      My son aged 45 asked me why I don’t do barbecues in the summer. I replied that they could cause cancer etc. Then I reflected, the origin of that opinion was endless bombardment by journalists; Next reflection, these same journalists were at the origin of my former convictions concerning statins, evils of saturated fat, virtues of LFHC etc.
      So who do I believe? A system where before taking a mouthful of any food, I would need to spend hours researching aspects such as origins, likely preparation methods etc is impossible, I do not have the time!

      1. mikecawdery

        Mr Chris

        Most of these “eggs are good, eggs are bad; barbecuing is bad; etc” are based on meta-analyses of which most do not fulfill the criteria that Bradford-Hill proposed; essentally the results must be consistent and coherent. Check Dr James LeFanu’s book “The Rise and Fall of Modern Medicine” (page 80) where these criteria are listed. Alternatively In Feinman;s book (The World Turned Upside Down:………….. Kindle Locations 3915-3919) the criteria are listed as:
        Biological gradients.
        Experiment. and

        All meta-analyses should be tested against these criteria and in my opinion they should also be tested against the selectivity of analysis together with the number of statistical units (ie “patients” = “n”). The greater the “n”, the smaller the significant real difference is likely too be.

  52. Errett

    Cigarette smoking accounts for about one fifth of cases of coronary heart disease (CHD), one of the leading causes of death worldwide, but precisely how smoking leads to CHD has long been unclear. Now, a team co-led by researchers from the Perelman School of Medicine at the University of Pennsylvania and Columbia University has uncovered a molecule that may at least partly explain the smoking-CHD connection. Their findings are published this week in the journal Circulation.

    The molecule is an enzyme called ADAMTS7 that is normally produced in the linings of blood vessels. Studies in recent years have suggested that when ADAMTS7 is produced in excess, it promotes the buildup of fatty plaque in coronary arteries, leading to CHD.

    In the team’s new study, they discovered that many people have a DNA variation that reduces their production of ADAMTS7 and also apparently lowers their CHD risk. However, carriers of this DNA variation who are smokers loose this natural protection. The study identified the likely reason: smoking appears to boost ADAMTS7 production.

    “Findings from this study will hopefully encourage the development of novel therapeutic and preventive programs for CHD, specifically targeting those who smoke,” said lead author Danish Saleheen, PhD, an assistant professor of Biostatistics and Epidemiology at Penn. The study is part of a large, ongoing effort by scientists to determine how genetic variants influence CHD risk, either directly or through interactions with behavioral and environmental factors, in this case smoking.

    Saleheen and his colleagues pooled DNA data from 29 prior studies, involving more than 140,000 people, making this study the largest ever to study the interaction of genetic variation and smoking. To find clues to smoking’s effect on CHD, the scientists examined 45 small regions of the genome — known as loci — that had already been associated with an abnormal risk of CHD.

    “Our hypothesis was that for some of these loci, the associated CHD risk would be different in smokers versus non-smokers,” Saleheen said. “By identifying the genes involved, we could hopefully discover clues to how smoking promotes CHD.”

    The analysis revealed that at a certain spot on chromosome 15, very close to the gene for ADAMTS7, a change in a single DNA “letter” — found in about 40 percent of people of European heritage, for example — was associated with a 12 percent lower CHD risk in non-smokers. By contrast, smokers with this same DNA variation had only a five percent lower CHD risk, representing a loss of most of the apparent protective effect.

    DNA variations that lie just outside of a gene often inhibit the gene’s transcription, leading to lower-than-normal levels of the associated protein. In follow-up laboratory experiments, the researchers confirmed that this was the case for the variation they discovered: In cells that line arteries of the human heart, ADAMTS7 production dropped significantly when the cells contained this single-letter DNA variant.

    How does smoking modify this effect? In another laboratory experiment, the researchers applied a liquid extract of cigarette smoke to coronary artery-lining cells, and found that the cells’ production of ADAMTS7 more than doubled.

    ADAMTS7 has been implicated not only in CHD but also in arthritis and some cancers, making it a potential target for treatments for these disorders. The new findings suggest that reducing the activity of this enzyme could be particularly beneficial for smokers.

    “This has been one of the first big steps towards solving the complex puzzle of gene-environment interactions that lead to CHD,” Saleheen said.

    Saleheen and colleagues are now planning larger studies to uncover genetic variants that interact with lifestyle factors such as smoking to influence CHD risk.

    “We hope that these studies will lead to more cost-effective targeting of existing interventions, identification of new therapeutic targets, and a better understanding of the biology of CHD,” he said.

    Story Source:

    Materials provided by Perelman School of Medicine at the University of Pennsylvania. Note: Content may be edited for style and length.

      1. chris c

        Oh I DO like it when some new information escapes through a fold in the Known Universe and enters reality!

        I was pondering earlier in the day about the time when the likes of Gerald Reaven published studies showing a graph of the individual responses. Often you would see a similar effect, varying only in magnitude, between most subjects – then you would see one or two whose graphs zinged off in a different direction.

        Here lies some important factor which in “modern” studies would be obscured by statistical shenanighans or even deleted from the study as an “outlier”.

        Nothing to see here, move along! Fat causes cholesterol causes CVD. Meat causes fat and diabetes and cancer. Holy Health Grains and vegetable oils are the cure (plus statins, PCSK9s, BP meds, diabetes meds, etc.) Do not rock the cash register . . .

    1. Andy S

      While waiting for a wonder drug that stops ADAMTS7 production I will continue to follow the LCHF dietary intervention for CHD.
      Curious to know what is effect of methanol from tobacco smoke on ADAMTS7 level, or chronic methanol from any other source.

      1. mikecawdery

        As I understand it, hyperinsulinaemia of itself is an important “marker” for CHD, AD and even cancer. Of course, as the NHS does not measure fasting insulin levels, this association will never, ever be recognized in UK medicine.

  53. Sylvia

    the side effects of statins are not caused by the drugs, but by people’s expectations of them.
    So says an article in the Guardian today. The nocebo effect. What.

    1. Martin BackMartin Back

      Same article in The Times, The Guardian, Dr. John, and no doubt many other publications.

      It’s clear that someone is pushing an agenda.

      The ‘nocebo effect’ is a wonderful way to explain away any and all deleterious side-effects of medication. No doubt it will be trotted out for many years to come, and for many different pharmaceuticals.

      1. chris c

        And have you seen anything in any of these august publications about the Noakes Trial? Thought not . . .

        . . . the Guardian especially is pushing veganism too.

        I must have a VERY strange nocebo effect. I routinely don’t get the common side effects to common drugs, but I do get strange and obscure side effects from other well tolerated drugs. Hmmm, so do a bunch of other people, the problem is they all respond differently to different drugs. We must all be mentally ill and probably in need of treatment. Kerching!

  54. TS

    Speedy reply from My MP:

    I wrote:
    “A great worry is all this talk of the NHS needing more funding. Doesn’t the Government realise that vast amounts are spent on drugs that are at least totally unnecessary and at worst, downright harmful? (I’m not suggesting that no drugs are beneficial here.) The taxpayer is preyed on by the pharmaceutical companies. In general, it is the drug companies who dictate what research is done and if they don’t like the outcome of the research (i.e. it does not support a drug manufacture) it is unlikely to see the light of day. And it’s often the case that the taxpayer is further financing the research through giving to charities.

    The public has been gravely misled. They are fooled into thinking they need their numerous drugs. A re-education programme is required. This is the direction to go in to make the NHS healthy and viable. The alternative is more fodder for the pharmaceutical companies and an impoverished NHS.

    A very useful blog is http://www.drmalcolmkendrick.org

    Mr Peter Heaton-Jones MP replied by letter:
    “I feel you have raised some interesting points regarding the money wasted on unnecessary drug funding. At a time when our NHS is under massive strain, with a growing and ageing population, we must ensure that taxpayers’ money is spent wisely.

    I feel that in this instance, as the points you have raised are very sensible, it would be best to pass your concerns on to the minister Jeremy Hunt, for a more detailed response on what the government is doing to tackle this issue.”

    1. mikecawdery

      I tried to get my MP to get answers from the Health Secretary on at least two occasions but never got an answer

    2. Frederica Huxley

      I seem to recall reading that certain pharmaceutical companies are blackmailing the NHS: if NICE won’t buy their exorbitant drugs, they are threatening to leave the U.K.

    3. AH Notepad

      TS, the government is made up of politicians. The politicians are courted by lobbyists from pharmaceutical companies and have all sorts of bribes, sports matches, Glyndebourne opera holidays, oops I mean fact finding missions. They don’t care in the least about the cost otherwise we would all have a bucket of vitamin C in the larder and would only rarely need a doctor. But if that were so, lots of people would be out of a job.

  55. JDPatten

    Muscle problems from statins?
    Probably not !?
    A BLINDED Randomized Controlled Trial indicates that only one to two percent of the participants on statins ACTUALLY got muscle problems.
    BRCTs are the Science standard, right?
    “Dr john” discusses the nocebo phenomenon and its effect on the PERCEPTION of statin and of beta blocker side effects.

    Perhaps someone would like to comment over there?

    1. mikecawdery

      JD Patten
      May I suggest that you check out the Stopped_Our_Statins@yahoogroups.com web site. There are an awful lot of seriously damaged individuals involved.
      The Collins HPS study was based on selected statin tolerant tested patients hardly a sample on which to judge adverse reactions but a great example of how to manipulate data.
      Dr Duane Graveline in his books and website ( https://spacedoc.com/ ) which is still up and running is probably the best source of statin adverse events. There are many statinists that are prepared at any cost to refute statin adverse reactions.
      BAYCOL had to be taken off the market because it killed but it worked in exactly the same way as all statins. Add in the adverse reaction of diabetes and AD (Solomon Neurology. 2007 Mar 6;68(10):751-6.;Dement Geriatr Cogn Disord 2009;28:75–80). The second report provides numbers but no therapy details (hidden data) but you only have to assume that in the US any patient has been so terrified of high cholesterol that either the doc would prescribe a cholesterol lowering drug or the patient would demand it. I have done the sums and high cholesterol (assuming treatment) results in a 40% increase in AD (relative but why not doctors and Big Pharma do it all the time)

      1. chris c

        AFAICR some of the statin studies showed a similar level of side effects in subjects and controls.

        The elephant in the room is that in different studies the level of side effects in BOTH groups varied by more than an order of magnitude.

    2. David Bailey

      I added a comment, describing my experiences, and it didn’t appear. Part of what makes Malcolm’s blog valuable, is that he does not remove comments that are not supportive of his views – he answers them!

  56. JDPatten

    No need to convince me. I’ve been through the side effects and then refused the stuff.
    I see that you have not taken my suggestion and brought the struggle to where it might make a difference, to a cardiologist representing Medscape, a cardiologist who has the ear of plenty of his peers – Dr John. Did you read the comments?
    Tell him. Be your intelligent forceful self. Be respectful. Push.

    1. mikecawdery

      JD Patten
      No I did not for the simple reason that I have seen so much of that nonsense that really can’t take any more. Add to the fact that people like Dr John are so tunnel visioned that they just ignore anything contrary. My BP can take a lot but not that!
      When you posted that link I just wondered why and in case any body might think Dr John was “right” , it was necessary to re-iterate why he was wrong

      1. JDPatten

        OK. I see where you are.
        I myself still talk back to my own doctors. My GP and my electrophysiologist actually appreciate being “kept on their toes”. True, its not good for my BP

  57. mikecawdery

    N Engl J Med 2017; 376:1713-1722May 4, 2017DOI: 10.1056/NEJMoa1615664

    Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease

    Over 2.2 years the probability of NO BENEFIT for the primary endpoint is 66 in 67 (p = 0.985) or 144 in 145 per annum (p = 0.993 p.a). Not much use to the vast majority of patients. The secondary end point was essentially the same at 1.5% efficacy over 2.2 years (0.75% p.a)

    It is claimed that the study is double blinded but any physician looking at the routine lipid profile would be able to identify the treated patients by their reduction in LDL. This in turn turns clinical observations into a subjective ones.

    The study was funded by Amgen the maker of PCSK9
    What is the cost of treating 67 patients for 2 years to save 1 patient? Not given in the paper!

    This is hardly impressive. This study once again demonstrates that by using huge patient numbers that trivial benefits, unlikely to benefit the individual, can be shown to be “significant Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease

    Over 2.2 years the probability of NO BENEFIT for the primary endpoint is 66 in 67 (p = 0.985) or 144 in 145 per annum (p = 0.993 p.a). Not much use to the vast majority of patients. The secondary end point was essentially the same at 1.5% efficacy over 2.2 years (0.75% p.a)

    It is claimed that the study is double blinded but any physician looking at the routine lipid profile would be able to identify the treated patients by their reduction in LDL. This in turn turns clinical observations into a subjective ones.

    The study was funded by Amgen the maker of PCSK9
    What is the cost of treating 67 patients for 2 years to save 1 patient? Not given in the paper!

    This is hardly impressive. This study once again demonstrates that by using huge patient numbers that trivial benefits, unlikely to benefit the individual, can be shown to be “significant

    1. Martin Back

      As you say, the results are underwhelming. It makes one wonder how many times the same trial was run before they got the result they wanted.

      There is a statistically significant chance that if you do enough trials you will get at least one statistically significant favourable result, even though, statistically speaking, there is no statistical significance to the result.

  58. Antony Sanderson

    I followed the same line of thinking as Mike and was about to rush off a personal history of statin damage and slow repair, pointing out that I took them for 3 years and only came across statin side effects when I started suffering . . . -1 for the “nocebo” effect.

    (The problem was your “ . . . comment over there” – I thought you were talking to blog followers . . . but after your last comment you meant Dr John’s site)

    I did have a look at the site. There were are one or two comments questioning his assumption that a significant proportion of statin complaints can be laid at the ‘nocebo’ effect, with one or 2 other doctors adding support to Dr John. Eg “You’re doing a fine job of stirring up statin-haters this week! The quote about questioning whether we doctors should be informing patients of possible side effects really resonated with me . . . .” (The last doctor found he had more people complaining of aches and pains when he told them that one of the statin side effects was muscle problems . . . But of course we know that most people, like myself, when they start getting statin induced aches and pains put it down to growing old.)

    Reading the posting it occurred to me that he and his fellow doctors are well aware of the level of suspicion of statins side effects among the general public, and they are happy to ignore it . . . in fact they are bolstering their notions of minimal statin side effects by their own, I suspect selective, experience. Writing to them will not change things. (That must come from above)

    What will change things ?. . .
    Convince those around you to lay off statins (In my wallet I carry around a print of a graph of deaths vs TC level in a Japanese statin trial showing a “j” shaped curve with a minimum deaths at TC = 6.5 mmol/l . . any lower than that and the death rate rises rapidly) . . .
    Write to the papers when a statins PR push occurs. (The papers will get the message eventually)

      1. Antony Sanderson

        Hi JD

        I am not talking trickle down to the doctors . . . . I am talking pronouncements or even diktat from the authorities to the doctors. . . The sort of thing that is slowly happening in the world of diets. The US, Sweden and Canadian authorities have either removed or are seriously considering, based on research, removing dietary cholesterol and saturated fat as significant contributors to CVD and CVD events. One assumes the doctors/dieticians will adopt the new rules. The position of the authorities is likely to have a significant effect on many more doctors rather than a few newspaper stories . . stories that contradict their training.

        It is instructive to see how the above change is coming about. There were plenty of people in the 1950s, 60s, 70s who had evidence that cholesterol and saturated fat were not deleterious to health. Take Yudkin for example . . . even though he wrote a serious book casting doubt on the position of saturated fats in CVD, and suggested sugar was a more likely culprit . . . he was not ‘heard’ by the authorities . . . (Think McGovern in the US 1977) . . . the authorities dictated the new diet position . . we all followed, most doctors included . . . very top-down.

        Today, we have people of integrity who critically look at the data, like Yudkin did, who publicise their opinion, like Yudkin did; people who court bringing down the opprobrium of the authorities . . . being taken to court, banned from speaking, losing their license as doctors. But . . . what we have now, that Yudkin did not have, is the power of social media. The video lectures educating anyone who cares to listen; the comments after those lectures with people giving their experiences; the diet blogs, again inviting people to participate. It is so easy when you meet someone who is interested in changing their diet to give them useful resources to assist them.

        The power of this swirling sea of knowledge, with people participating, lending their support, must provide some comfort and strength for those like Noakes and Fettke; it must help them in their push to get things changed. At the same time, the grinding publicity will gradually erode complacency and will make ignoring all of this more problematic to the authorities, authorities who are reluctant to move position.

        Someone on the MK blog mentioned writing to MPs about the questionable efficacy of statins and their damaging side effects. . . . again, the potency of the new media to sting one or two extra people to try and influence people who *might* have influence on the authorities.

        So, rather than “trickle down” being the main effect, the saving hope is the “trickle up” effect.

    1. mikecawdery

      Antony Sanderson

      Would you have the url for the Japanese curve. I carry the WHO-BHF curve which gives a somewhat lower TC level at 5.75 mmol/L. This raises the possibility that the said WH0-BHF graph was not updated because it would have had to increase the minimum. That of course would have been an absolute NO-NO

      1. mikecawdery

        Antony Sanderson

        Thanks for that link. Dr. Vos is well known as a statin skeptic. I note too that the reference list has some interesting reports. Useful

  59. Errett

    Several years ago, Prof. Shmuel Pietrokovski and Dr. Moran Gershoni of the Weizmann Institute’s Molecular Genetics Department asked why the prevalence of certain human diseases is common. Specifically, about 15% of couples trying to conceive are defined as infertile, which suggested that mutations that impair fertility are relatively widespread. This seems paradoxical: Common sense says that these mutations, which directly affect the survival of the species by reducing the number of offspring, should have been quickly weeded out by natural selection. Pietrokovski and Gershoni showed that mutations in genes specific to sperm formation persist precisely because the genes are expressed only in men. A mutation that is problematic for only half the population, no matter how detrimental, is freely passed on to the next generation by the other half.

    In the present study, the researchers expanded their analyses to include genes that, though not necessary for fertility, are still expressed differently in the two sexes. To identify these genes, the scientists turned to the GTEx project — a very large study of human gene expression recorded for numerous organs and tissues in the bodies of close to 550 adult donors. That project enabled, for the first time, the comprehensive mapping of the human sex-differential genetic architecture.

    Pietrokovski and Gershoni looked closely at around 20,000 protein-coding genes, sorting them by sex and searching for differences in expression in each tissue. They eventually identified around 6,500 genes with activity that was biased toward one sex or the other in at least one tissue. For example, they found genes that were highly expressed in the skin of men relative to that in women’s skin, and they realized that these were related to the growth of body hair. Gene expression for muscle building was higher in men; that for fat storage was higher in women.

    Yet another difference

    The two then looked at tendencies to accumulate mutations, to see if natural selection puts more or less pressure on genes that are specific to men or women. That is, to what extent are harmful mutations weeded out or tolerated in the population? Indeed, the researchers found that the efficiency of selection is weaker in many such genes. “The more a gene was specific to one sex, the less selection we saw on the gene. And one more difference: This selection was even weaker with men,” says Gershoni. Although they do not have a complete explanation for this additional difference, the researchers point to a theory of sexual evolution first proposed in the 1930s: “In many species, females can produce only a limited number of offspring while males can, theoretically, father many more; so the species’ survival will depend on more viable females in the population than males,” explains Pietrokovski. “Thus natural selection can be more ‘lax’ with the genes that are only harmful to males.”

    Aside from the sexual organs, the researchers discovered quite a few sex-linked genes in the mammary glands — not so surprising, except that about half of these genes were expressed in men. Because men have fully fitted but basically nonfunctional mammary equipment, the scientists made an educated guess that some of these genes might suppress lactation.

    Less obvious locations included genes that were found to be expressed only in the left ventricle of the heart in women. One of these genes, which is also related to calcium uptake, showed very high expression levels in younger women that sharply decreased with age; the scientists think that they are active in women up to menopause, protecting their hearts, but leading to heart disease and osteoporosis in later years when the gene expression is shut down. Yet another gene that was mainly expressed in women was active in the brain, and though its exact function is unknown, the scientists think it may protect the neurons from Parkinson’s — a disease that has a higher prevalence and earlier onset in men. The researchers also identified gene expression in the liver in women that regulates drug metabolism, providing molecular evidence for the known difference in drug processing between women and men.

    “The basic genome is nearly the same in all of us, but it is utilized differently across the body and among individuals,” says Gershoni. “Thus, when it comes to the differences between the sexes, we see that evolution often works on the level of gene expression.” Pietrokovski adds: “Paradoxically, sex-linked genes are those in which harmful mutations are more likely to be passed down, including those that impair fertility. From this vantage point, men and women undergo different selection pressures and, at least to some extent, human evolution should be viewed as co-evolution. But the study also emphasizes the need for a better understanding of the differences between men and women in the genes that cause disease or respond to treatments.”

    Prof. Shmuel Pietrokovski’s research is supported by the Leo and Julia Forchheimer Center for Molecular Genetics; and the estate of Georges Lustgarten. Prof. Shmuel Pietrovski is the incumbent of the Herman and Lilly Schilling Foundation Professorial Chair.

    The Weizmann Institute of Science in Rehovot, Israel, is one of the world’s top-ranking multidisciplinary research institutions. Noted for its wide-ranging exploration of the natural and exact sciences, the Institute is home to scientists, students, technicians and supporting staff. Institute research efforts include the search for new ways of fighting disease and hunger, examining leading questions in mathematics and computer science, probing the physics of matter and the universe, creating novel materials and developing new strategies for protecting the environment.

    Story Source:

    Materials provided by Weizmann Institute of Science. Note: Content may be edited for style and length.

    Journal Reference:

    Moran Gershoni, Shmuel Pietrokovski. The landscape of sex-differential transcriptome and its consequent selection in human adults. BMC Biology, 2017; 15 (1) DOI: 10.1186/s12915-017-0352-z

    1. mikecawdery


      Intriguing; but some of the observations,such as increased growth in men would seem to be obvious and expected.

  60. mikecawdery

    some interesting refs:


    Misleading Recent Papers on Statin Drugs in Peer-Reviewed Medical Journals

    Low Cholesterol is Associated with Mortality from Cardiovascular


    Cholesterol Issues in Japan – Why Are the Goals of Cholesterol Levels Set So Low

    Confirms the WHO-BHF redacted page for optimum TC level for minimal all cause mortality


  61. Errett

    Discov Med. 2017 Mar;23(126):183-188.

    Acidemia and blood free fatty acids: analysis of cardiovascular risk factors in a new context.
    Reis AH1.
    Author information

    Following a hypothesis developed in an earlier paper, here it is discussed how deviations of blood pH from the normal range (namely states of acidemia) together with high blood levels of free fatty acids (FFA) may offer a rationale for many important risk factors for cardiovascular diseases (CVD) by shaping a context for formation of fatty acid micelles and vesicles with an acidic core, which fuse with the endothelia, disrupt vital cell processes, and thereby may initiate atherosclerotic plaque formation. Acidemia may arise primarily from dysregulation of the systemic buffers that control blood pH, chronic diseases of kidneys and lungs, inappropriate diet, or may be induced by some common drugs. The level of free fatty acids may be increased and maintained high by chronic stress, and adrenergic shocks. Elevated concentrations of blood FFA in a context of acidemia allow to understand important cardiovascular aspects: the increased risk of menopausal women, the protective effects of physical exercise, the changes in vascular behavior characteristic of metabolic acidosis/acidemia, the role of diet in the pH balance, on how some known medicines like metformin, steroids, NSAIDS, proton pump inhibitors, and calcium supplements may influence CVD risk, and an explanation is offered for the role of statins.

    PMID: 28472612

    1. mikecawdery


      Many thanks for the reference,
      on how some known medicines like metformin, steroids, NSAIDS, proton pump inhibitors, and calcium supplements may influence CVD risk, and an explanation is offered for the role of statins.

      This all seems to tie CVD, diabetes and other chronic conditions back to hyperinsulinaemia, insulin resistance and HOMA. Yet the NHS, in its wisdom, excludes fasting insulin blood level from its testing protocol, thus denying GPs and consultants the facility of using the HOMA-IR algorithms as an aid in their diagnoses.

    1. Andy S

      What raises FFA? Answer is low fat/high carb diet. Therefore no risk for CVD from FFA on LCHF diet.

      pH apparently heads lower with increased age. pH is regulated by kidneys using bicarbonate.
      Would there be any benefit from ingesting juice from 1/2 lemon + 1/2 t baking soda in glass of water every morning?

      1. Gary Ogden

        Andy S: What about mineral water? The Gerolsteiner I enjoy has 1,800 mg/L bicarbonate.

  62. mikecawdery

    To confirm my personal view of meta-analyses sponsored directly or indirectly by Big Pharma
    the a quote from http://www.jpands.org/vol12no1/kauffman.pdf
    is pertinent:
    A systematic search of the Cochrane Database of Systematic
    Reviews, considered by many to be the most objective medical
    science reporting of all, showed that all of the industry-funded
    meta-analyses of drugs recommended the experimental drug
    without reservations, while none of the Cochrane reviews did so,
    even though the estimated treatment effects were the same in both
    cases. Peter C. Gøtzsche at the Nordic Cochrane Center in
    Copenhagen, a coauthor of the meta-analyses report, said in an
    interview that he would now ignore any meta-analyses funded by
    drug companies
    Gotzsche also wrote the book “Deadly Medicines and Organised Crime:…..
    This is well worth reading and is, I believe, a BMJ prize winner. It should be in every practice and clinic.

    1. Martin Back

      I have had little faith in meta-analyses since I read a comment by someone to the effect that they are based on the assumption that if you pile garbage high enough, it miraculously becomes non-garbage.

      In any case, many of the relevant studies don’t get published if they are unfavourable to the drug concerned, so the meta-analyses are not based on a true unbiased sample.

      1. Antony Sanderson

        I came across a similar reported comment from a supervisor to his research student on meta-analyses: “30 sows’ ears still do not make a silk purse”

      2. David Bailey

        I put the problem with meta-analyses of health studies this way.

        Either there are several studies (with adequate statistical power) that don’t come to the same conclusions – in which case it is far better to dig into the reason for the discrepancy – not use a fancy statistical technique to fudge over the issue.

        Or, there are several studies and the health benefits demonstrated by all of them are so slight that you need the meta-analysis. However, if the study is supposed to demonstrate the value of a drug (or an unattractive change of life style), why bother if the benefit will be so small?

  63. Mark Johnson

    I put the problem with meta-analyses of health studies this way.

    Either there are several studies (with adequate statistical power) that don’t come to the same conclusions – in which case it is far better to dig into the reason for the discrepancy – not use a fancy statistical technique to fudge over the issue.

    Or, there are several studies and the health benefits demonstrated by all of them are so slight that you need the meta-analysis. However, if the study is supposed to demonstrate the value of a drug (or an unattractive change of life style), why bother if the benefit will be so small?

    I often think along similar lines. Most drugs show exceedingly small benefit and that’s after the usual statistical torture and sleight of hand that the pharma companies put the raw results (which they won’t generally reveal) through. So what has “modern” medicine really and truly got to offer? Is your average GP depressed by the revolving door situation of most chronically sick people continually returning for the same largely useless drugs which at best, only massage the symptoms?

  64. brwims

    “In addition, it became clear that, not only were certain key facts wrong, there seemed to be a co-ordinated effort to attack anyone who dared to challenge them.”

    Another obvious example is climate change, and whether it is caused by CO2 levels. Cui Bono?. (usually politicians).

  65. Kane Johnston

    “Dismiss any damaging evidence that does manage to emerge as ‘weak’, pay your own experts to write bogus reports, and create uncertainty everywhere.” That about sums it up ‘profit at all costs’ corporate machine.

  66. Frieda Paton

    This witch hunting in the medical profession has been going on for centuries – a good historical example is when Semmelweiss tried convince everyone that washing your hands between working with corpses and delivering babies reduced child birth fever. They ended up having him put into a mental institution.


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