What causes heart disease part XXXIX (thirty nine)

9th October 2017

In this blog I would like to highlight some of the evidence that is not there. The missing link, the lost chord. The thief that steals in, in the night. The thing that is not there when you look for it.

“As I was going up the stair

I met a man who wasn’t there!

He wasn’t there again today,

Oh how I wish he’d go away!”

 

When I came home last night at three,

The man was waiting there for me

But when I looked around the hall,

I couldn’t see him there at all!

Go away, go away, don’t you come back any more!

Go away, go away, and please don’t slam the door…”

 

There was a theory, indeed there still is, that a myocardial infarction starts with damage to the heart muscle (myocardium), and the blood clot forms afterwards. Carlos Monteiro, a Brazilian researcher with whom I often communicate, promotes and supports this, the ‘myogenic theory of heart disease’. He is not alone.

Now, superficially this idea may sound completely daft. However, there is a great deal of evidence that can be gathered to support it. First, in a significant number of myocardial infarctions, no blood clot can be found. Here, from a paper entitled ‘Myocardial infarction without obstructive coronary artery disease.’

‘A substantial minority of myocardial infarction (MI) patients have no obstructive coronary artery disease (CAD) at angiography. Women more commonly have this type of MI, but both sexes are affected.1

So, how can you have an MI, if there is no blood clot, and no blockage of a coronary artery? A very good question M’lud.

There is also an increasingly recognised form of ‘heart attack’ called Takotsubo cardiomyopathy, named after the Japanese octopus pot. This is where you have all the signs and symptoms of a myocardial infarction, but it is not a myocardial infarction. It is due to extreme levels of stress – both positive or negative. Here I quote from the British Heart Foundation:

Takotsubo cardiomyopathy

This condition is also called acute stress-induced cardiomyopathy, broken heart syndrome and apical ballooning syndrome.

Takotsubo cardiomyopathy was first reported in Japan in 1990. The word ’Takotsubo’ means ‘octopus pot’ in Japanese, as the left ventricle of the heart changes into a similar shape as the pot – developing a narrow neck and a round bottom.

The condition can develop at any age, but typically affects more women than men. The good news is that often the condition is temporary and reversible.

What are the symptoms of Takotsubo cardiomyopathy? The main symptoms of Takotsubo cardiomyopathy are chest pain, breathlessness or collapsing, similar to a heart attack. In some cases, people may also suffer palpitations, nausea and vomiting.’2

You can, in fact, die from Takotsubo cardiomyopathy. Another myocardial infarction that is not a myocardial infarction.

Equally, you can find that people can suffer from a myocardial infarction days, or even weeks, after a blood clot blocked the artery. Here is a paper entitled ‘Plaque Instability Frequently Occurs Days or Weeks Before Occlusive Coronary Thrombosis.’

‘In at least 50% of patients with acute STEMI, coronary thrombi were days or weeks old. This indicates that sudden coronary occlusion is often preceded by a variable period of plaque instability and thrombus formation, initiate days or weeks before onset of symptoms.’3

So, there you go. You can have four types of myocardial infarction:

  • A myocardial infarction with no obstructive arterial disease
  • A myocardial infarction cause by stress, with no obstructive arterial disease
  • A myocardial infarction that happens weeks after the thrombus forms
  • The ‘classic’ myocardial infarction with thrombus formation followed rapidly by infarction.

What are we to make of this gentle reader? Three forms of ‘myocardial infarction’ that cannot be linked in time, or in any other way, to thrombus formation. Or, to put it another way the infarction a.k.a. the bit where the heart muscle becomes seriously damaged, is not related to a blockage in the artery either immediately, or at all.

In addition to this, there is the observation of ‘the completely blocked coronary artery, without myocardial infarction’. Here is a case history from the British Medical Journal:

A 75 year old man was admitted because of stable angina pectoris without any history of myocardial infarction. His risk profile consisted of arterial hypertension and hypercholesterolaemia. At the time he was being treated with 100 mg aspirin, 100 mg metoprolol, 20 mg pravastatin, and 40 mg isosorbide mononitrate daily. ECG showed sinus rhythm, no Q waves, and slight T wave inversions at lead aVL and I. A bicycle stress test resulted in horizontal ST segment depression of 2 mm at 75 W. Coronary angiography was performed and revealed coronary artery disease with complete occlusion of the proximal part of the left coronary artery.4

At this point you could very reasonably argue that there truly is no consistent association between blood clots, arterial obstruction, and myocardial infarction. Or, to put it another way, the widely held view that the blood clot, and subsequent arterial occlusion, immediately precedes the infarction, is contradicted by evidence.

Which leads to the inevitable conclusion that something else must be going on. Perhaps it is true that the infarction, due to extreme stress and build of lactic acid does come first. Then, as a consequence, the clot forms in the artery.

Hmmmm. I don’t think so. However, in order to understand what is actually going on it is necessary, unfortunately, to dig even deeper, to find the man that isn’t there. Banksy, a man who paints on walls, is never seen, but we know he was there because, otherwise, you can’t explain the painting.

1: https://www.ncbi.nlm.nih.gov/pubmed/22941122

2: https://www.bhf.org.uk/heart-health/conditions/cardiomyopathy/takotsubo-cardiomyopathy

3: http://circ.ahajournals.org/content/circulationaha/early/2005/02/21/01.CIR.0000157141.00778.AC.full.pdf

4: http://heart.bmj.com/content/83/6/672

489 thoughts on “What causes heart disease part XXXIX (thirty nine)

    1. smartersig

      Is it possible that cholesterol is not the cause but does get mixed up in heart disease such that if your cholesterol is high but your diet, lifestyle etc is good you have nothing to worry about however if your diet,lifestyle is poor you will suffer less if your cholesterol is low than if its high from the perspective of heart disease ?.

      Reply
    2. smartersig

      I have questioned the role of cholesterol on the logs of Nutritionfacts.org and as a result received a ton of vitriol and indeed I appear to have been blocked from the site or at least commenting. On here I have suggested that the pro cholesterol argument put forward by the black population study who have the low cholesterol allele needs some explaining. On here there has been some aggression, dismissal without any explanation by the good doctor and no opinions other than these two. Are the two camps as bad as each other?, are they both so entrenched in their own beliefs that any contrary idea is dismissed without consideration. Could I possibly end up banned by both the pro and neg cholesterol camps in which case maybe Dr Sennef is right, lifes a beach or else you die

      Reply
      1. Dr. Malcolm Kendrick Post author

        You will not be excluded from here unless you start personal insults, trying to advertise something (for yourself), or write complete gibberish that I cannot understand. Questioning, arguing, these are all highly valued (by me at least). I am afraid I do not have the time for a detailed critique of this issue at the moment. It is complex and time consuming.

      2. Sasha

        “To be uncertain is to be uncomfortable. To be certain is to be ridiculous”.

        Ancient Chinese proverb))

      3. Sasha

        I don’t know enough about LDL and CVD susceptibility to comment on the links you posted but I see dogmatism in both camps, at least in relation to diets. Our minds don’t like uncertainty and prefer linear relationships. Thus, if lots of carbs is bad then LCHF must be the answer. And both sides choose to ignore black swans that contradict their pet theories…

      4. chris c

        Yes it’s getting to look like the Vegan Attack Hordes have become the main defenders of the Cholesterol/Diet-Heart Hypotheses, and Keys, since anything which looks like falsifying them is like a brick being dropped through their glass-bottomed boat.

        Allied with them are Big Carbs and Big Margarine and of course Big Pharma with all the money, and it would seem the whole thing was started by the Seventh Day Adventists

        http://foodmed.net/2017/08/07/medical-evangelism-adventist-diet-advice/

        http://letthemeatmeat.com/tagged/Seventhday_Adventists

        Science currently appears to be losing the battle with dogma. Outcomes, ie. health, appears to be in third place.

      1. Dr. Göran Sjöberg

        Jillm,

        I would never touch them!

        Although the health service throw them on me as soon as they see me which though doesn’t happen very often. (By the way my cholesterol profile is on the LCHF “perfect” by the present standards so instead they claim the “inflammation reduction capacity” of the satins.)

        To put i “mildly”: There is to me as an old researcher no science, no logic, no sense and no benefits from lowering the cholesterol levels. It is only about a greedy criminal BigPharma industri with no other interests in our health than the incredible profits they can harvest from this unbelievable medical scam – be biggest ever!

      2. AnnieLaurie Burke

        Dr. Sjoberg hits the bullseye on the worthlessness of statins — why lower cholesterol, which is not shown to cause CVD? In fact, Dr. K had two references in one of the earlier parts of this series (sorry, didn’t have time to look them up) on studies that showed, for people over 65, the lowest all-cause mortality was associated with the highest cholesterol levels. Haha, maybe I should look for something to increase my cholesterol! But despite my HFLC diet, it just doesn’t change.

      3. Jan B

        Don’t you think, AnnieLaurie, that if we stop the constant meddling with the likes of statins our bodies find their own natural levels. When I stopped taking the statin my TC shot up to 7.3 and that’s where it’s been for the last four years. Never varies. My ratios though are really good and I feel well, well, well with all of the horrid side effects gone, gone, gone. Maybe your body just naturally chugs along happily on a lower level than mine. (My DN is not a happy bunny though) I am well adapted to my LCHF regime and wouldn’t change it for the world. Lucky me.

      4. smartersig

        Please explain why a bunch of people who genetically have low cholesterol levels get heart disease on a diminutive scale despite having all the randomly allocated risk factors eg smoking so that I can also then dismiss it.

      5. annielaurie98524

        The link you provided is not to a study, compelling or otherwise. It is to a video by Dr. Greger, a well-known vegan fanatic. Do you have a link to an actual study? I don’t have time to sit through a vid on Greger’s weird and unproven dietary theories trying to find how to access the study you reference. If the study is so compelling, why not reference it directly?

      6. annielaurie98524

        Finally, the much-desired links are posted! But, what a joke! First, one cannot access the full articles (unless one is a subscriber, etc.). One cannot, therefore, read the rebuttals from the conventional medical community, including the less-than-enthusiastic-and-universal acceptance of so-called Mendelian randomization techniques, not to mention the possibly biased text of the authors. Second, the synopses of both articles do not give an adequate idea of the methodology, assumptions, addressing of confounding factors, etc.. Third, there is no indication of the funding source of the studies, other than the cryptic reference to the use of statins and PCSK9 inhibitors, two popularly promoted drugs. So, it is worth my blowing $150 and a good deal of time on a membership to access the full text of what appear to be two SOS “Medelian randomization”, old (2012) “studies” that are not even completely endorsed by the conventional medical community, merely to respond to “some guy on the Internet”? The analysis and conclusion to this question are left as an exercise for the reader. If you actually have an accessible summary of the articles that includes the opposing professional comments, with the authors’ responses to same, I might find the time to look at them….

      7. smartersig

        Dr Kendrick, it would help if you addressed the question of why do genetically low LDL subjects seem to be protected from heart disease instead of brushing it under the carpet. We cannot be cholesterol sceptics by saying we will not examine any pro cholesterol evidence.

      8. Dr. Malcolm Kendrick Post author

        I tell you what. You read the paper and analyse it. I can warn you, this takes several days to do properly. Probably weeks. If you can find no flaws in it, fine. You should start by looking at general criticism of the Mendelian approach. There are a number of good papers on this. I cannot respond to any request to spend days of my time doing a detailed critique on speicific papers. It is not humanly possible.

      9. smartersig

        I have sent links to the studies twice because you failed to read the first one or perhaps chose not to pay attention. You can access the full article if you click the full text link but Annie I get the impression that you are just not wanting to try too hard or address the question of why genetically low level LDL subjects get protection from heart disease even when allowing for co factors

      10. AH Notepad

        Annie, I am at a loss to understand how your apparently confrontational style is helpful in these discussions. Could yoi give us all a clue please? It would be nice to understand, as it may remove the feeling of having a troll on board.

      11. smartersig

        Taken from the full text of the study and in addition to cardio events evidence.

        “To determine whether the three PCSK9 alleles associated with lower plasma levels of LDL cholesterol were also associated with a reduced risk of carotid atherosclerosis, we compared carriers and noncarriers with respect to carotid-artery intima–media thickness, a surrogate measure of coronary atherosclerosis. The mean intima–media thickness was slightly but significantly lower among carriers than among noncarriers, both in the group of black subjects (Table 1) and in the group of white subjects (Table 2).”

      12. annielaurie98524

        So, you took 2 sentences from the “study” (to which you have STILL not provided a link), and, although said sentences say nothing about cholesterol causing CVD, nor do they postulate any mechanism whereby cholesterol could cause CVD, I am supposed to believe it does? No. I want to read the actual study, and evaluate whether the assumptions, methods and conclusions support your contention.

      13. smartersig

        Annie I have sent the links to the studies please look again at the posts connected to this thread and stop being so aggressive

      14. annielaurie98524

        Yes, your links finally appeared in my inbox. As I responded, all one can get from them without paying is a very brief synopsis. This IS a science blog — why do you appear sensitive when other commenters challenge assertions you have made but have not substantiated with accessible citations?

      15. smartersig

        So Annie glad you now have the links and if you follow the full text link you can access the full text and of course Chris Masterjohns excellent input, any thoughts on the topic ?

      16. Ali

        “Here, take this nasty drug that could cause you a whole heap of problems like memory loss, muscle pains and diabetes”. “Diet? That won’t make any difference. Just eat all the garbage you want and keep taking the tablets, there’s a good boy…..”. Today’s Daily Fail headline? ‘BAD LIFESTYLES CRIPPLING THE NHS’……..

        They smile with their teeth, but not with their eyes……

      17. Mr Chris

        Ali
        I knew a guy who believed all the crap about cholesterol saturated fat etc, but loved his food, all the so called wrong things. So his doctor seems to have told him, eat what you like and I can get your cholesterol down with statins. So he did and died of pancreatic cancer. Cause, effect, anecdotal?? Who knows

      18. David Feldman

        With regard to cholesterol homeostasis, I’ve now compiled quite a bit of data (along with many of my readers now) demonstrating it’s greatest influencers are dietary fat (the Inversion Pattern, see here: https://www.youtube.com/watch?time_continue=2065&v=jZu52duIqno) and energy status (adipose and glycogen stores, see http://cholesterolcode.com/energy-status-experiment/)

        And note each of these experiments move cholesterol to levels typically exceeding cholesterol-lowering medication. The most recent status experiment certainly illustrates just how much of a confounding variable this is to existing research given it was isocaloric. In short, we’re showcasing just how unreliable the metric of LDLc/p, HDLc/p, and TG are when not taking into account the impact of energy metabolism in the body.

      19. daveketo

        Smartersig–
        Do you have MR study links that include all cholesterol-affecting SNPs and all-cause mortality?

      20. daveketo

        I’m certainly NOT a fan of altering PCSK9 functionality. From an engineering standpoint, it makes perfect sense regarding LOCAL status control on the part of the cell regarding receptor management. I’m not at all surprised by the cancelations as I’d fully expect all-cause mortality to increase with this kind of intervention.

    1. smartersig

      I am wondering if part of it is about me. Over 4 years ago I returned from a customary 2 mile run to sudden chest pain as I reached my front door. After 40 mins it had not improved so I went down the hospital. To cut the story short they did an angiogram and my arteries were fine except a pinch in a ‘minor artery’. The Cardio said to me and his trainee assistant that a stent was not mandatory but he would recommend it. At the time I am ignorant and agree to this but now I know stents are useless, that there are alternatives to reopening arteries and dare I say, that perhaps he was overly keen to let the trainee do a stent. Now I also wonder if at the age of 56 then, lactic acid build up was becoming a tad dangerous for my heart and it simply had some sort of spasm that produced the pain and the heart attack. There is no way of knowing for sure, it could have been plaque and a clot but would they have seen this from the angio gram ?.

      Reply
      1. Anna

        I had a very similar experience when I had an MI almost 3 years ago. I was strongly advised to have a stent – the surgeon I saw got his junior to do the procedure without informing. I was assured there would only be minor discomfort. It was excruciating & terrifying. Then I heard the senior chap say to the junior, “Oh, you’ve cut the artery.”
        Nothing was done apart from completing the procedure & I was sent to intensive care. After my arm was twice it’s normal size & my cries of pain were finally taken seriously they finally did something. I was in IC for a week and in great pain. No apology or acknowledgement of error. I was too traumatised & exhausted to do anything about it at the time.
        At no point was I told of any alternative treatment.
        Sorry if this is a bit too anecdotal.

      2. Janet

        Next time I see the cardiologist the Question… will be asked, as to. ‘Why’ EECP was not appropriate for me . Anna, you might ask the SAME question !

      3. smartersig

        Sorry to hear that Anna, what is sad is the one size fits all, alternatives are never considered.

      4. James DownUnder

        Yes Smartersig, and as you rightly pointed out to Anna (Oct 11), ‘alternatives’ are rarely – read “never” – presented. There are rea$on$ this is $o.. $ee if you can join the dot$. . .
        My quotes on EECP ranged from $15K down to $2K, depending on locale.
        Guesses on my CABG x 5 would leave little change from $80 to $100,000. Think of how many people were gainfully employed in that Private Hospital, compared with a Nurse + clerk needed to provide the EECP, – whatever the wage rates are!
        Even more sinful would be the suggestion of gobbling down cheap, small handfuls of Vitamin C per day to decimate the cardiac – and other – risks. Another ‘alternative’
        Or altering the diet beforehand…eaten leisurely,, and sharing with friends a bottle of Malcolm’s favourite French red. – Best Alternative… (unless Dr Kendrick discovers you in his cellar…)

      5. smartersig

        I would not promote the use of Statins there are alternatives that address the root problem directly. Statins have some benefits for a few but only on the assumption that they are too ingrained in their lifestyle to make changes

      6. Antony Sanderson

        :
        Smartersig . . . on your point “Statins have some benefits for a few . . . etc” . . . you have ignored the point that annielaurie98524’s was making: that overall mortality in many statin studies remains unchanged. Since CVD mortality goes down (albeit by a very little) the implication is that other causes of death increase . . . so using statins to neutralise an unhealthy lifestyle is probably not going to work in the long run.

        The increase in death from cancer or infection can be explained by the fact that the lipid transport system particles (LDL) are signed up members of the innate immune system. They can bind to pathogens including bacteria, viruses etc and this facilitates engulfing of the harmful stuff by the macrophages.

        So, while the statins are busy keeping down inflammation (a good thing, keeping a few cases of CVD at bay – and has nothing to do with reducing the numbers of kamikaze LDL particles recklessly launching themselves into artery walls! ) . . . it is also reducing the number of defensive cholesterol particles ( a bad thing)

        Studies have shown that older people (eg post 65 in men?) have a decrease in mortality as cholesterol increases. This inverse relationship could be explained by considering the LDL particles as being protective.

        Dr Ravnskov did an interesting study on families with familial hypercholesterolemia, looking at the rates of death within the family before the advent of antibiotics etc . . . (around the turn of the 20th century think). Presumably he had to trawl the family trees to work out who probably had FH. His study showed that those with FH had lower rates of death by infection than were typical of that time. This associated the lower mortality by infection with the higher number of protective LDL particles.

        And finally . . . the Mendelian study of those with LDL/cholesterol lowering SNPs and their effect on CVD. I looked in vain at the published paper to see what the effect on overall mortality rate was. It may have been affected . . . it may not . . . but it would be nice to know.

      7. smartersig

        I was referring to the view that for people with existing heart disease over around 50 some benefits are shown for statins, even Dr Kendrick agreed to this. However I still feel that these benifactors would gain greater benefit from radical diet and lifestyle changes and the scandal is that they are not offered this. I do accept however that when a GP/Cardis is faced with a ‘give me a pill so I can get back to my crappy lifestyle’ philosophy then Statins may be appropriate

      8. Andy S

        smartesig, I am searching for statin benefits.
        The only use could be short term use in post surgery like CABG or organ transplant to blunt immune response. Where is perpetual lifetime use warranted for average patient?
        According to my spouse’s cardiologist (2 days ago), cholesterol clogs arteries and diet is something that he is not an expert in and a patient must evaluate benefit/risk. Unfortunately have not met any medical practitioner who has explained the risks of statins, and they keep on increasing.

      9. daveketo

        AndyS, per your comment, “Unfortunately have not met any medical practitioner who has explained the risks of statins, and they keep on increasing.”…
        I’ve had a PhD tell me bluntly that some of the more “loose” practices with drug trials have gotten tightened up in the last decade and half, resulting in (surprise!) less attractive data. So it might not just be the drugs are getting worse, perhaps our view is getting clearer.

  1. Robert Dyson

    Truly gripping. You are a great story teller!
    My special interest is complex systems so this is wonderful material for me.

    Reply
  2. William Robinson

    What are the relative incidences of these?

    A myocardial infarction with no obstructive arterial disease
    A myocardial infarction cause by stress, with no obstructive arterial disease
    A myocardial infarction that happens weeks after the thrombus forms
    The ‘classic’ myocardial infarction with thrombus formation followed rapidly by infarction.

    Reply
      1. KidPsych

        I’m pretty sure Tom was a lifelong addict, both hard stuff and lighter, but just as dangerous stuff (cigarettes).

      2. William Robinson

        I’d really like to know if the tobacco alone would ramp
        up insulin or is it all the molasses and other sugars
        that the cigarette companies dope their products with.
        I’m certain that they know that sugar is the most addictive
        thing they sell.

    1. Eric

      Ivor, just finished watching the whole interview (and isn’t he a darling?).

      Can you please explain again the difference between the conventional OGTT test and his protocol? From your explanation in the video, they seem very much the same. I also looked up some current protocols for OGTT (they differ by country and organisation), but just to list one recommended in Germany:
      – at least 150 g of carbs in three previous days
      – at least 10 h fast
      – dring 75 g of glucose
      – measure every 60 min for up to 5 h

      Or is it that current protocols finally have been modified to account for Kraft?

      Reply
      1. Jillm

        Why not measure insulin and blood glucose after a normal meal? How useful is a test after creating a situation that doesn’t happen in the real world?

      2. Jan B

        Because, I would have thought, ‘normal meals’ vary, therefore giving variable results, whereas a fasting situation varies not at all. We all, or most of us, fast overnight so an early morning test isn’t so hard – a late afternoon one is a bit gruelling though.
        Just a thought.

    2. Eric

      Stupid me, OGTT measures glucose, Kraft insuiin. Missed that while watching.

      Now is there any benefit from measuring both?

      Reply
  3. JDPatten

    Maddening! You tell us of all these theories explaining unexpected presentations and then end with “I don’t think so.” Do you have something that you do think is true? XL?? (Forty?)

    Infarct before clot:
    The arterioles and capillaries that delve into the heart muscle to feed it are closed by the muscle’s contraction in systole. Back pressure reserved in the major coronary arteries then supplies those small vessels during diastole.
    I can visualize a scenario wherein unusual effects of sympathetic/parasympathetic tone imbalance increases unrelieved tension in the myocardium and a flaccid condition in the major coronaries at the same time. Myocardial starvation results. Death (infarction) of the area results from that. Clotting from stoppage is the final result.
    Makes sense??
    It might also explain the odd shape of Takotsubo.

    Reply
    1. James DownUnder

      JD, Yes, makes sense.
      A *decline* in parasympathetic activity – not a (natural) increase in ‘sympathetic’ – would tip the balance towards your visualization…
      Possibly the mechanism whereby EECP works so well. / FEELS well….
      and substantiates the damaging effect of chronic ‘stress’.

      Reply
  4. Jerry Melcher

    In post 38 you stated “However, it takes more than just biomechanical stress. You also have to have, at least one, extra factor present to trigger endothelial dysfunction.” Looking for explanation of the “extra factor”. Also how does one generate good levels of NO and will this lower CVD risk? Grazzi!

    Reply
    1. smartersig

      There are a number of foods that promote NO but my understanding is that the one that really kicks ass in the NO producing department is Aragula or Rocket to you and me. Thats not the fuel but the lettuce that looks pretty wimpy but is an NO super producer. Try it it a smoothie with beatroot, its a tad bitter but drinkable with almond milk mixed in.

      Reply
      1. Mr Chris

        Smartersig
        I drink beetroot juice mixed with apple or pear juice, to take the mud taste away and eat rocker when I can.

      2. James DownUnder

        Rocket added to the pan when frying mushrooms in grass-fed butter (Vitamin D) and Beetroot powder by the kilo… Particularly tasty when sprinkled (smothered….) on brie cheese. – for natural source of vitamin k2, 🙂
        Only needs good company and French wine…

  5. johnplatinumgoss

    I think the medical world may be full of metaphysicians. Charles Bowen: “On a metaphysician: a blind man in a dark room – looking for a black hat – which is not there.” Happy hunting.

    The large CERN hadron collider has cost a pretty penny in its search for the Higgs-Boson “God particle”. Are they getting anywhere yet? Is there some more useful project to which this money can be put? All this worry and stress is enough to give the planet MI.

    Reply
      1. Mr Chris

        smartersig
        Dr has told us a lot, I am certain that all the answers are already out there, and you pick the ones appropriate to your case. I have already, probably not 100% but 80% is better than the level before!

    1. AH Notepad

      Well those that have been here since part 1 (doesn’t include me I’m afraid) have now trod the 39 steps…………

      Reply
      1. Bill In Oz

        Dr Kendrick, I seriously doubt that after you say “this is it”, we here will all just accept it unquestioningly. We will all be grateful. But it will also set off another round of discussion,analysis and google searching.

        And this is after all is the process you have encouraged all along.

      1. Dr. Malcolm Kendrick Post author

        Nope. Primarily I want to stimulate debate and thought. The moment I say ‘this is it’ is the moment that I close down discussion, so I am delaying that as long as possible. The time however comes close.

      2. Bill In Oz

        Misplaced again ! Bugger !
        Dr Kendrick, I seriously doubt that after you say “this is it”, we here will all just accept it unquestioningly. We will all be grateful. But it will also set off another round of discussion,analysis and google searching.

        And this is after all is the process you have encouraged all along.

  6. Eric

    I have a question that is only very tangentially related to CVD, and I apologize for attempting to hijack your blog, but I was hoping someone here would have an answer to this.

    There is a ascorbic acid solution for IV injection that is nearly adjusted to nearly physiological pH by adding sodium bicarbonate, so one bottle of 7.5 g ascorbic acid has a proton excess of just 0.3 mmol which leads to absolutely negligable lowering of pH after injection.

    Yet, the professional guidelines contain a warning that patients with known respiratory illness might suffer acute dyspnea (shortness of breath) after injection of 7.5 g or more of ascorbic acid.

    Why is this? The lowering of blood pH I calculated will be on the order of 0.001 so this cannot trigger the need to increase breathing volume.

    Is there a secondary formation of protons? After all, the solution is mostly ascorbate when injected but manages to raise both ascorbic acid as well as DHA levels significantly.
    https://www.ncbi.nlm.nih.gov/pubmed/15054428

    Or does the resulting increased redox activity screw with some other equilibrium reactions that move the oxygen saturation curve independently from pH?

    Thanks!

    Reply
    1. Eric

      After sleeping over it:
      ascorbic acid is a much stronger acid than carbonic acid, so all that acetate will want to dissociate, forcing carbon dixode out of the blood stream. It may be difficult to calculate how much gets forced out because carbon anydrases are active.

      Now, provided the patient has sufficient lung function, will the increased breathing volume that is not paralleled by higher metabolism cause an incrase in oxygen staturation?

      Reply
  7. james

    Glad you bring up “the ‘myogenic theory of heart disease’.” That one has puzzled me no end since I first learned about it. There is an increasing number of heart scientist who are having problems with the heart being considered a pump. Fact is that when all the bloodvessels woul be laid end to end they could circle the earth three times?? ” The liquid in the vessels, meaning the
    blood, is this very sticky viscous fluid with a bunch of stuff floating around in it, the stuff being
    red blood cells, white blood cells, platelets, etc.
    Interestingly, most of the blood vessels are capillaries, which are very thin-walled, very narrow
    tubes. The stuff, meaning the red blood cells, is about the same diameter as the tube. ” (Cowan)
    Cowan again :” In other words, the pump theory is you could have a one-pound, somewhat thin-walled organ, and it’s going to pump sticky fluid around the earth and it’s going to do that every single day for 70 years, 60 to 70 times a minute. That one-pound, thin-walled organ can generate enough pressure by squeezing this thick blood three times around the earth.
    Frankly, that’s – I don’t know what other word to use – that’s ridiculous. But the interesting
    thing is that it actually gets worse than that. Because it turns out if you do a flow velocity
    diagram, it turns out that the blood is moving the fastest at the heart, both before and after the
    heart. As it goes into the arterioles and then the smaller arteries, it gets to the capillaries, which
    are the transition vessels where the blood and the gasses are exchanged. There it actually stops
    and does a little shimmy, or it goes very slow, depending on who you believe. But it has to go
    very slow”
    Not too sure what to think of it, but I am less and less inclined to believe any of the prevailing theories.

    Reply
    1. Dr. Malcolm Kendrick Post author

      Indeed, circulation of the blood is a very mysterious thing. Heart = pump. Of course it is a pump, but it cannot pump blood through the capillaries, something else is doing this. It cannot suck blood back into itself either, something else is pushing it back. Same thing, different thing? I think it must be something akin to the way that trees manage to get fluid up from the ground and all the up to their highest branches. In some cases three hundred feet up.

      Reply
      1. JDPatten

        Of course, part of the answer is the valves throughout the venous system. And the lymph. Every skeletal muscle contraction moves that sticky blood forward just a bit more but not back, like a ratchet.

        Circulation doesn’t work so dynamically during sleep. I sleep very well — no tossing or turning, wake in the same position I fell asleep in. (Lucky me!) Except: I very often wake with numb limbs and it always takes a while to get everything functioning well again. Slowed circulation? No musculature gently working in the night to help get the stuff around and back?

        So, is there more to it?

      2. Bill In Oz

        In Plants the sap is drawn upwards against gravity by the process of the leaves ‘breathing out’ oxygen and moisture during the day light hours. In a sense the process is powered by the energy of sunlight. But there is no ‘dynamic’ pump like a heart in animals..

      3. Eric

        Göran, I certainly can’t think about these reactions as fast as she talks, and structured water is an immediate distractor to me – no, this is not the famous water memory claimed by homeopaths, but rather gelled water caused by shulphates.

        After listening once, my take is that it may make sense qualitatively, but I am entirely unconvinced she’s got the quantities worked out. If eNOS production due to sunlight was a major factor in disease, we’d all be miserable in the Northern winter and Inuit should not be able to survive at all. If we’d even worked like a solar battery like plants, we’d even get fat from sunbathing!

        Towards the end, she even threw out a comment that we should ground ourselves. I don’t see how this would help even if everything else she said before that was correct.

        And I think she’s been way off before, such as in postulating lactate would be beneficial for heart health.

      4. Dr. Göran Sjöberg

        Eric

        I agree upon the “structure water” issue. I really don’t like that name. She though evidently knows what she is talking about and for me what she says is more of “food for thoughts” – an important part of the scientific process.

        And the “grounding issue” is not closed for me as mere metaphysics.

        Open-mindedness!

      5. Gary Ogden

        Dr. Göran: Fascinating explanation of the importance of eNOS and how it functions in Dr. Seneff’s talk.

      6. Stephen Rhodes

        Read Gerald Pollack – I know you have – he does comment of RBCs going through capillaries narrower than they are. This he puts down to charge separation created in the changed state of water H2O2 next to the hydrophilic capillary walls. Interesting that the flow can be in either direction – hence maybe the reason veins have one-way valves. He also mentions trees.

        Then there is a correlation, Russian studies, between the degree of geomagnetic disturbance and acute MI and stroke (http://adsabs.harvard.edu/abs/2014cosp…40E1114G)

      7. Bill In Oz

        Goran, thanks for the link to the Seneff video. It is certainly interesting and emphasises the importance of sulfates in our bodies. And thus fits with the results of Lester Morrison’s pioneer trials using Chondroitin sulfate in the 1960’s & 70’s.

        Putting it simply & bluntly – Sulfates have a major role in the body’s ‘electrical system’.
        I also heard with interest Seneff’s remark that all she had to say was cutting edge &, needs to be established by more experimental research.
        It also shows up how little we know about how our bodies work.

      8. Eric

        Göran, she does not give any rationale or explanation for grounding in her talk, this recommendation just pops up towards the end. Maybe she has explained it elsewhere?

        As I said before, here ideas about charges in the blood vessels are at least plausible, but I fail to see how these local potential differences would be any different depending on the total potential of the human body which acts as a Faraday cage meaning excess charges will just sit on the skin. AFAIR, she is a phyiscist by training, hence should know her electrostatics.

      9. Andy S

        Dr. Goran, I am inclined to believe that Dr. Seneff is on the right track with theory that red blood cells are propelled through capillaries by electromagnetic forces. The physical properties of the RBC will determine how well the system works. Reduced flow would result in hypoxic tissues that could be systemic, from eyeballs to toes. Diabetes is accompanied by clogged capillaries.
        According to Dr. Seneff RBC shed electrons when traversing a capillary. The fact that old blood cells have less negative charge supports her theory.
        High glucose will gum up capillary blood flow in many ways, stiff RBC membranes, glycated proteins (increased A1C), death of RBC, etc.. Guinea pigs could be very sensitive to RBC modifications.
        Why donating blood works: new healthy red blood cells will be produced.
        Vasa Vasorum: clogged capillaries= hypoxia= remodelling= plaque
        Myocardium: less oxygen delivered = hypoxia + lactic acid = angina or worse

        Question- how does spleen decide to replace a red blood cell?

    2. Frederica Huxley

      Similarly, how does the lymph system function without a pump? Or, are the mechanics of the two systems virtually the same?

      Reply
      1. Bill In Oz

        Eric, no we did not debunk Cowan here. We discussed his recent article in the Weston Price magazine “Wise Traditions” available online. In it there is ‘dross’ as well as ‘gold in that article..The Gold is a reflextion of his experience as a doctor in a hospital accident emergency ward in the USA. And that is worth reading and interesting.
        The dross mainly was the largely unnecessary & irrelevant stuff he wrote towards the end on Rudolf Steiner.

      2. Eric

        To be more precise, we discussed how his argument (derived from Steiner), that the heart is not a pump but a hydraulic pump did not hold water.

        His main argument is that it cannot be a pump because then blood would not be flowing fastest near the heart and slowest in the capillaries. However, fast flow in narrow passages and slow flow in wide is only true if we look at one serially connected path, such as a river without branches.

        Now imagine a water reservoir that keeps getting filled by a continously operating rotary pump. It has an outflow, but it also has hairline cracks through which some water seeps. Obviously, the water flow in the hairlines will be slower than in the main outflow. The hairlines are connected in parallel to the main outflow, and flow will be divided depending on the flow resisitance of each path. In the most extreme cases, the hairline cracks are mere capillaries and water propagation may even be mainly through interaction with calcium ions from the concrete rather than pressure differentials.

        Coming to think of the continously operating pump, some heart lung machines use these, so it is simply not true that pulsed operation is strictly needed for survival.

      3. John U

        Eric, I completely support all of your comments above. My reaction while listening to Seneff’s presentation was similar to yours – great skepticism. I completely forgot about the effect of electromagnetic field acting upon special non-Newtonian fluids causing great differences in viscosity. In fact I believe companies designed brakes and clutches using this property. When Seneff spoke about the propulsive force exerted upon the RBC’s in the arteries and viens due to the difference in potential between suspended particle and the charged particles in the artery wall, I thought that if this was true, one should be able to build an apparatus which would pump fluid along a pipe without using a pump per se – just electrostatic charge. That would be consistent with perpetual motion using a magnet. I have not seen that happen yet.

      1. Eric

        Yes, but is this true once the conduit beomes about as small as some particles in the fluid? I believe viscosity is a macroscopic quantitiy when we look at “mixed” fluids such as blood.

      2. TheFatEmperor

        http://pubs.rsc.org/en/content/articlehtml/2014/sm/c4sm00248b The cells deform to enable flow – The heart creates a repetitive pressure wave felt throughout the whole system, and a negative compensatory one on the venous side. This will keep the gear moving. What happens when you cut your self even slightly (e.g. tiny nick of tiny capillary in a nosebleed)? The juice flows out. No problem for blood flowing through the tiny capillaries. Unless you on two packs a day maybe…then you may be rather turgid… 🙂

      3. Steve

        This chart gives single numbers at one point in time, one shear rate (maybe none) and temperature. They do not list blood viscosity on their chart? Motor oil has a huge range of viscosities under shear and out of the bottle, motor oils vary greatly. there are many simple viscosity measurement methods that are not reasonable for non newtonian liquids. I would assume based on the chart that one of these was employed.

        Look at the chart in the article. water is the blue line at the bottom, blood ranges over a HUGE range based on shear rate alone. If you add in the other variables this would increase the standard deviation lines around this. Part of the problem with viscosity measurements years ago was that the apparatus was poor and results did not show the shear thinning behavior. We have to use the right test, either parallel plates, cone-plate or other rheometry with controlled shear and extremely sensitive sensors. Water is also newtonian over these shear rates, but it may not be at higher rates with more sensitive equipment.

        https://holisticprimarycare.net/topics/topics-a-g/functional-medicine/1297-blood-viscosity-the-unifying-parameter-in-cardiovascular-disease-risk.html

        http://www.viscopedia.com/basics/defining-viscosity/ Better list of viscosities for comparison, they provide the testing parameters.

        Blood viscosity on this table shows it to be 2.5x water, problem with this chart is the test parameters are not all provided. Kinematic viscosity is given but it is not derivable from the Lovis system as they state is below.
        ww.viscopedia.com/viscosity-tables/substances/whole-blood/

        My difficulties with Viscosity is the measurement of it. the reproducibility, are the measurements less than 10% of the range of the instrument, are the values near one side of the machine capability, is the COV% less than 5-7, questions on the oxidation of the blood prior and during the test, other variable present that skew results. If we can answer for these in controlled experiments, we should be able to perform wide ranging experiments, add hormones to see the changes of less than 5%. If we can see small variations then we should be able to make a lot of discoveries.

        As equipment and technology improves, expect this to be more accurate and capable. The more you look at things, the more you find. due to the poor viscosity measurements of the past I believe a lot was missed! Just taking care of the blood itself may be critical to basic understanding in this scenario.

      4. Antony Sanderson

        When the discussions on viscosity and “Is the heart a pump?” gained momentum I thought “We really need an engineer to dig us out of this” . . . . and blow me . . . we got one!!
        Damien

  8. james

    I am beginning to wonder what the connection of the heart to the blood is. What the connection of the blood to the heart is. It may not be what we think we see.

    Reply
  9. el4in3

    Have you discussed Spontaneous Coronary artery dissection (SCAD) ? 90% patients are female -it’s an under researched area and most people who have SCAD are young, fit with low cholesterol, normal blood pressure and healthy weight. And our arteries are not clogged! I had a SCAD at 51. Be good to know your thoughts on this

    Sent from my iPhone

    >

    Reply
    1. Dr. Malcolm Kendrick Post author

      I know. I wonder if it is due to prior Kawasaki’s disease when younger. This creates thinnings/aneurysms in the coronary arteries that can then rupture later in life. The wife of one of my colleagues suffered from this earlier this year. She was 41.

      Reply
      1. Bill In Oz

        Dr K today I had a consult with my new GP. He handed back the book to me the book Fat & Cholesterol Don’t cause Heart Attacks” which I loaned him 2 weeks ago. His comment was that he could not accept it. And mentioned that he is just an ordinary GP & bound ( my word) to accept the standard ‘authorised’ medical view by the specialists on such medical conditions. ( He did also state that that this ‘authroised’ view changes over time, but clearly does not want to be an ‘opinion’ leader at least at this time.

        I then changed the discussion & raised the subject of blood viscosity and hypertension. Steve’s comment in the previous post still has me thinking because in the last 6 weeks I have developed hypertension and have been taking BP medication as prescribed by my GP.( I tried potassium as suggested earlier this year by yourself. But it had not effect at all. )

        So….I am still wondering about what the role of blood viscosity in hypertension & CVD. Clearly they are associated. But is blood viscosity a cause of high BP ?

        I asked my GP this this morning. And he admitted that beyond the basic facts he admitted to not knowing anything at all about it. In fact I think I saw cross his face indicating he was like ’emperor without any clothes’…
        But he is a gentle person. He did not get annoyed. And afterwards I saw a look on his face of respect. So I am hopeful.

        Meanwhile fellow posters here on Dr Kendrick’s blog, what else is out there in wonderful world wide web on the issue of blood viscosity ?

        A final thought in my mind : recently A Dr. Allan Green in the USA has been advocating low intermittent weekly doses of rampamycin as a way of reversing aging by reducing MTOR 1 activity in the body which increases greatly with age..

        He came to this course after starting to ‘age’ rapidly at the age of 71 with shortness of breath and angina. After 4 month of the rampamycin treatment along with ACE bp medication, he was fit and strong again with no angina or shortness of breath. In view of what has been said here I wonder if at this low dose. it reduces blood viscosity. That suggests that the cause of thick blood is heightened MTOR. And MTOR is part of programmed aging.

        ( And yes, I know that at high daily doses it is a drug used to prevent transplant rejection by suppressing the immune system. )

        Here is my source for this thought:
        http://roguehealthandfitness.com/rapamycin-anti-aging-medicine-an-interview-with-alan-s-green-m-d/

      2. Bill In Oz

        DR K. I have misplaced this comment. It belongs below after your remark about your colleagues.

  10. James

    Now we are ‘Cooking with Gas’…!
    Was a tad reluctant to introduce Dr Cowan’s (actually, Rudolf Steiner’s) “heresy” , but since it’s in the open, now…
    I have no difficulty considering a combination of ‘pump’ and ‘4th phase of water’ as being the propulser of that red, muddy, Abrasive (& corrosive if you’re stressed…) liquid goop.
    In my case, despite near-perfect HbA1c / BP / LCHF lifestyle 14 months prior to the CABG x 5, the emotional, financial and personal-losses STRESS was, in my opinion, the major causative agent for my silent heart-attack.
    Naturally my cardiologist rejected that out of hand… – systemic deficiency of statins and coming off DAPT 18 months previously was his verdict…
    Then, to add insult to injury…some weeks later he exhorts me to ‘Do Something’ (medication-wise) about my Depression, – as it WILL damage my recovery !

    – Talk about having an Each-Way Bet !!!

    Reply
    1. Dr. Malcolm Kendrick Post author

      My colleagues have, mainly, switched their brains off. They have become passive recipients of ‘the truth, as revealed by the exerts’. They sit in the nest, helpless chicks, beaks open and squeaking, waiting to be fed the next meme.

      Reply
      1. Eric

        I don’t envy them, though. The human body is an increadibly complex thing, with many chemical, bio-chemical and physical processes interacting in such a way that is is difficult to tease out cause and effect of either a disease or a treatment. When I sometimes look at a medical textbook, I marvel at how many short cuts in the science are taken without any mention.

        On the other hand, the natural science is only a small part of what they have to learn and keep active, on top of treating patients in short time slots (which requires keen observation as well as standardized recipies), worrying about red tape and potential liability.

        I suppose that in many cases they have no choice but to accept the gospel.

      2. Sasha

        There’s always a choice. You have to understand the first principles, or attempt to understand them at least, before trying to heal people.

      3. James

        We feed the local magpies (Aussie bird) to distract their aggression during nesting season. Bribery works. Initially only in the morning, but they’ve worked out how to make the humans feed them on demand. Mutual interdependence…
        Bit like statin suppliers and statin-doctors

      4. Dr. Göran Sjöberg

        James

        I think my big garden with the large ponds is keeping me alive – a true CVD-remedy. There is a lot of hard work with my hoe or with my chain saws which is probably very good for my collaterals if I feel like that. Equally important is probably the very relaxing moments good for the parasympathetic nerves if I would work with that part of my physiology. Sipping a stiff whisky for a couple of hours sitting in a garden chair in the late summer sunshine and watching the five magpies of this year moving around, smart beautiful birds indeed, and all the blackbirds now turning all fallen leaves or diligently picking all berries up in the bushes and the trees.

        When the blackbirds are picking my hawthorns I am though a little bit suspicious so the don’t take them all since I am also having some as a natural heart medicine. They usually finish them by late autumn so I have to gather my own share before they are done with them for this year.

      5. james

        Of course this gets all off topic, but there are several pointers in Göran’s story about his back yard. All, if taken to heart and practiced would mean a lot less work for Malcolm. The activity a yard requires, the contact with the soil and being outdoors, the calming effect garden work can have and not in the least the belief that it renders health benefits. It’s what we have been doing for all those years since retirement. And instead of the hawthorn we have the aronia and goji berries. I think that if there is one thing that bugs me a bit in all the work that Dr. Kendrick has been sharing, it’s the focus on the heart solely. We have been bringing in the blood and the capillaries but still are a bit mystified how it works. Sometimes I even wonder why it works.

      6. James DownUnder

        Therefore, let us all tend our backyard gardens, hand-fertilize the soil with magnesium… and reduce Dr Kendricks’ workload.. that he may have more time to stir, tease -and educate… :))

      7. Bill In Oz

        Jamesdownunder, do check to see if magnesium is needed in your garden soil..A simple ph test is the first step to finding out this. The dryer parts of Oz tend to be more alkaline that the wetter areas..

      8. Martin Back

        “Autoritätsdusel ist der größte Feind der Wahrheit.” — Albert Einstein
        (Unthinking respect for authority is the greatest enemy of truth.)

    2. Sylvia

      I am so saddened about how many people have depression or anxiety, whatever you want to call it. Stress is a big player in my view, but sometimes a child or young person will develop it even with a loving family. And of course the old and lonely. We don’t care enough, but life is so fast and busy. Driving in the UK now is horrendous, my son has just escaped a bad RTA, with bruising, but badly shaken. Will experiences like this, and bullying, damage endothelium, or do we have to have a physical factor, to enable the start of CVD. I too need to read these wonderful posts again. So when we are in the dark place trying to ‘see’ we have to use all our senses as our ancestors did. Talk about bated breath Dr Kendrick.

      Reply
  11. James

    And, whilst we’re promulgating Heresies, how about looking for therapies or exercises or supplements that encourage the (natural) growth of our own ‘by-passes’. a.k.a. ‘collaterals’.
    Imagine the savings to all, if say, only 20% of stable angina patients could be thus treated.
    – I’d still have employment and be paying taxes…

    Reply
      1. James

        EECP may be time-consuming, but I did two sessions per day for 18 days whilst enjoying a holiday (with my ever-patient Wife) in Bali / Indonesia.
        Cost me under $AUD 2k. Thailand International Hospital was around $AUD 3k. Self-funded, as EECP is non-existent in Australia, and my private health fund nor Medicare does not support it.
        Worth-while result for me.

      2. Bill

        Dr. Doug McGuff believes that high intensity strength training strongly stimulates “natural bypass” collaterals. It does have to be high intensity, with very high cardiovascular effort at muscle failure. (This is not what you see in the weight room 99+% of the time.)

      3. JDPatten

        Bill,
        That is how I trained.
        That is how I approached my life’s work.
        That — I believe — is how I got atrial fibrillation.
        But, if the “collateral” result is true, maybe it’s why I’m still alive.
        ??

      4. Jennifer.

        I am lost in understanding much of the discussion in part 39……way above my head after years of previously enjoying this blog. What is EECP, please?

      5. James

        EECP.
        Too effective to be let loose on the public, and inimical to the interests of some cardiac surgeons …

      6. Jennifer.

        Thanks James.
        Sounds like much of what we are having foisted on us in the name of medicine!
        Reminds me ( going back well over 30 years ), of the plastic, pulsating yellow ‘banana’ sleeves that were fitted to the legs of patients suffering from oedematous legs, resulting from congestive heart failure.
        Nothing much new then?

      7. James DownUnder

        ‘Nothing new under the sun, – it has been of Old Time…’ With ECP being around 50 years old, there’s hope for such other therapies as Ozone Dialysis.
        It’s interesting what ‘Ozone’ was used for.

      8. James DownUnder

        Jennifer,
        You could ‘google’ it, but here’s the simplified version from my own experience in June this year (2017)
        (Enhanced – to differentiate from the original invention, ECP, / External Counter Pulsation). In essence, gives a sequential ‘squeeze’ of the lower/mid/upper parts of the legs, timed with the heart-beat, which sends a counter-pulse, pressure and flow, BACK towards the heart.
        This returns a small portion of the pumped blood, back into the heart tissue, giving it a second chance to exchange gasses, wastes, etc.
        Not only but also, the extra – and substantial – pressure-pulse, has a positive effect on the expansion of existing and generation of new bypasses, a.k.a. Collaterals.

        Here’s a link, and I’ve deliberately chosen an out-of-the-way source to illustrate how widespread it is, even though you haven’t heard of it in your part of the Western World. I have my own private suspicions as to the reason…

        http://www.krishnacardiac.com/EECP/PatientFAQ.asp

        A couple of extras,
        Firstly, it is possible and generally Ok to have two sessions per day, with at least one hour between. I had the 35 done over 18 days, some 3 to 4 hours apart… – nipping off to a new restaurant/shopping each day.
        Second, the Effective Pressure is around and over 250mm Hg, with 170mm being a safe, NON-effective level, and this is used for ‘placebo’ controls in various RCT’s. Yes, lots and lots and LOTS of Trials have already been done….
        It is also claimed that a course of EECP lifts depression. – My own experience would support that… 🙂
        In summary, depending on where you seek the info from, the value of EECP is in treating ‘Refractory Angina’, with the improvement in collaterals function being the likely mechanism to accomplish this. Exercise tolerance is also be enhanced.
        Oh, one more thing… None of the referring GP, Cardiologist, or surgeon… made any mention of EECP. (stumbled on it some months after surgery.)
        Again, tongue firmly in cheek, I have “no” idea as to why they didn’t – as it’s been around for over 50 years…

      9. Dr. Malcolm Kendrick Post author

        EECP is available within the NHS, although you would have to fight hard to get it. You need to have had other treatments first e.g. CABG, PCI etc. It costs the NHS about £35K for the treatment. I think it could be done much cheaper privately. It appears to be highly effective. Most doctors have never heard of it.

      10. Jennifer.

        That is kind of you, and the link was more informative than the one I found earlier on. I am pleased you gained from the experience. I am all for effective non-invasive techniques and of the opinion that no solution can be expected to be positive for everyone all of the time; but nothing ventured, nothing gained, as they say.

      11. James DownUnder

        “… but nothing ventured, nothing gained, as they say….
        – Which is why I also indulged in 3 sessions of EBOO – Extracorporeal Blood Ozone-Oxygenation. – Two ‘lines’, one out one return. Blood passes through a “dialysis” filter-thingy and has ozonated oxygen bubbled through it. – Can cure The Ague, Plague, baldness and has
        supposed positive effects on arterial calcium. – Didn’t die…and those Balinese Nurses gave me the absolute best six ‘line’ insertions I’ve ever had…. No small praise from a card-carrying Needle-phobic.
        Down side was the EECP machine was well-worn, and struggled to maintain heart synch and maximal (cuff) pressure of over 250mmHg. (Placebo dose is 170mm Hg) After 18 treatments, was put onto another, more capable unit. So, maybe I only benefited to ‘Half’ of what I would expect.
        Now that I’m better informed re. the technical aspects, I will be pro-active next time (3 to 5 years?) . Physical pre-compression of the lower leg cuff was also an issue perhaps, again solved with the second machine.
        On the other hand, that his machines (5 in total) were so over-used, speaks volumes. Most clients are mainland Chinese queue-jumping, and savvy retirees from the East coast of Oz. !!!

      12. Jan B

        Jennifer, so glad you asked that. I hadn’t a clue and felt too embarrassed to ask.
        A fair bit of this now is way over my poor head but I struggle on while deeply regretting my lack of a science education.

      13. Jennifer.

        Jan, I have had excellent answers to complex problems on this blog, and most responders are polite and helpful. Some instances have arisen on the blog lately, when ‘know-alls’ may put the likes of you and I off asking questions, but they know who they are, and are in the minority. I may not add much substance to the blog, but I get a lot out of it, as I know you do too.

      14. Jan B

        Thank you, Jennifer. How kind you are. I agree with you that t(e vast majority of contributors are not just knowledgeable, but very kind and helpful too. I love this blog and how it has enhanced my life

      15. James DownUnder

        “…EECP seems like milking a cow in reverse ;o)…

        But it IS effective, and so much so that even the Technicians/Operators noticed changes, during the early days of use…
        Yes, it can feel…. funny…if the lower cuff is not tight enough, – blood is pushed down the leg….and you get unbearably itchy toes ! Took me a while to work out that All Was Not Well… – Kept the Wife amused… ;))

      1. Dr. Göran Sjöberg

        James,

        Sorry, a typo that could have be misunderstood. No-one, in my garden is angry with me as far as I know except perhaps the worms just now. Although the hoe is good for them in the long run they don’t like the action. Well they will now have a rest until tomorrow.

        Myself I am fine (and my collaterals?) although I don’t trust the optimistic pulse meter.

      2. chris c

        Hahahahaha!

        I suspect something similar occurred to regrow my circulation around the problem, which was PAD in the legs/feet. The vascular surgeon recommended walking *through* the pain in my calves (though he did let me slow down a bit). It worked so well he took me off his list, and I just came back from the podiatrist (I no longer risk pruning my own toenails) who couldn’t believe my feet belong to the same person that she first saw a couple of years ago.

        Of course eating the exact opposite of what the dietician told me was also a major factor and has worked on most everything else that was wrong with me for twelve years now. The one factor that actually does require medical attention, ie. drugs, has been my hyperthyroid, which I am convinced through temporal association was a major player in the PAD. The biggest joke (except to the likes of people here, of course) is that when the thyroid goes up my LDL goes down – and that’s precisely when the arteries get worse again.

      1. Linda Cooper

        My now not-my-Dr replied to my question of what happens if I don’t take the statins with ‘how long do you want to live’. I was already doing my own research into heart disease (academia has lots to answer to) and came upon your blog late in the piece.

      1. AH Notepad

        I offered a copy (which I always carry) to someone the other day. “I think I prefer to trust my doctor, otherwise what’s the point of having a doctor?” was the response.

  12. xtronics

    Sure hints at something causing a muscular spasm – a breakdown in the NO system? Lactate?

    But one point missing here – one does not need to have a MI to die from CAD…

    Reply
    1. Andy S

      xtronics, we die one cell at a time. Maybe it is time to look at how a cell functions, thrives, dies, and is replaced. Some things to consider: mTOR, mitochondria, ATP, autophagy, mitophagy, dna damage and repair, stem cells, Q10, linoleic acid, glucose, insulin, vitamins and minerals, lipid rafts, effect of ageing, effect of medications, cortisol, and thousands of molecules present in bloodstream.

      Reply
      1. chris c

        An old friend was a very well controlled Type 1 diabetic – and having been misdiagnosed originally he learned a LOT about Type 2. It goes without saying he was an engineer.

        He believed that everyone would eventually become diabetic – but for most people it would happen at age 150, after they had already died from something else.

        I suspect much the same could be said of heart disease – it is what you die of if something else doesn’t carry you off first.

        This leads to the concept of “modern” diseases being premature ageing, environmental insults probably too numerous to list are causing diseases of old age to appear even in children. I’m trying to reverse this process by reverting to what we did – and ate – back before this started ocurring.

  13. Ali

    …and what does extreme stress trigger…? …..an acute (and sometimes catastrophic) loss of magnesium.

    ….and which is the electrolyte most lacking in our diet…?

    Magnesium.

    Modern farming methods do not replace Magnesium in the soil.it is not in our water in any great amount. We would struggle to get enough to counteract the stressors in our modern life.

    Stress leads to low Magnesium, low Magnesium triggers stress. It’s a maelstrom……

    Reply
    1. Stephen Rhodes

      I’m assuming most people who view Dr Malcolm’s blog will have seen such as this https://www.youtube.com/watch?v=zpIN-8Q9Ahw&t=10s describing changes to food composition over the last 80 years.
      It isn’t obvious, from just looking at it, whether our food is worth eating or not, at least when Bart Simpson complained of having rickets, the milk he thought he was drinking was actually labelled ‘Malk’.
      We are getting into the realm of what Zoe Harcombe terms ‘food-like substances’ even when we try to eat whole foods ‘like grandma’ did.
      I am aware of people, categorised as obese, who think they are eating a healthy diet but, on having blood tests etc, are also categorised as ‘malnourished’.

      Reply
      1. Peggy Sue

        I recently had my magnesium levels checked by the local NHS cardiologist – he added it to the routine blood screen.
        I asked my GP why she thought he had done this and she replied, “seems to be in fashion at the moment”. She was thankful it was within normal range as she had no idea what she’d do if it were otherwise!
        Was this a meaningful test? Can I rest assured my levels are fine?
        Or is it like vitamin d where they do a test but “normal” seems to be controversial, depending what you read.

      2. Mr Chris

        Peggy Sue
        As I understand it, the measurement indicates Mg contained in the blood. Is that available where it is needed, or are the enzymes/electrolytes able to take it up?

      3. Stephen Rhodes

        Carolyn Dean (The Magnesium Miracle) has said that serum magnesium levels bear little relationship to the tissue (cellular) levels. Best to up the very dark chocolate intake.

    2. Eric

      Stephen, re the food composition video, I watched about half of it, and it just reeks of fake data.

      Virtually every mineral going down by more than an order of magnitude between 1930 and 1990? Improbable, I’d really like to see studies.

      Multiple diseases going up by an order of magnitude betweeen 1960 and 2010? We know there was no 10x increase in cancer rates, even if it feels that way. We also know, as Dr. K has been pointing out, that heart disease has been going down since its high in the 70s. Yet this guy plots something labelled as heart conditions go up 2.5x between 1940 and 1980, level off and then go up 4x between 1990 and 2010. It just ain’t true, unless he was counting blood pressure or LDL over the standard mandated by the ADA over time. LOL!

      And what was that about experiments with sodium actinide on wheat in the 90s, about half way through the video? What is this substance that is apparently super poisonous? As far as I can tell, it does not exist because it would be a metal – metal salt.

      Reply
      1. Stephen Rhodes

        Hi Eric,
        Your point about sodium ‘actinide’ is well made as far as the video goes, the chemical that Dr Davis refers to in his quoted book ‘Wheat Belly’ is sodium azide which is described elsewhere as ‘very acutely toxic’.
        Can’t comment on the issues you have with the youtube as my intention in posting the link was to highlight the ‘unintended consequences’ of agricultural advances – as shown in the video – on the mineral content of foods. I certainly can’t defend any of the graphs showing increases in disease or that they are related to mineral deficiencies, though clearly some people do.
        The more nuanced view on nutrient deficiencies given by Marles (http://www.sciencedirect.com/science/article/pii/S0889157516302113) indicates that while the issues are real, they are not thought to be of concern as higher yields are more important, to feed a growing population (my interpretation), than maintaining historical nutritional value. Although I would contend that this is a complacent position to take in view of the way in which RDAs have been chosen – not to mention the ludicrous admonition that if we all eat our 5-a-day and we will be ok.

      2. Eric

        Stephen, I have no argument with your point that many staple foods are gettting adultered or diluted, which is why I buy organic whenever I can. I just don’t happen to think that video serves to illustrate that point. It is more like a half hour rage illustrated by graphs and talking points that don’t look right.This is more like the stuff a snake oil salesman would utter.

      3. Stephen Rhodes

        Hi Eric,
        I too try to buy organic, chiefly to avoid the effects of herbicides and pesticides, but my interest was raised on the matter of the chelating effects on essential minerals of Glyphosate, whose designation as ‘safe’ has encouraged its indiscriminate use likely well beyond the usage guidance.

        While I agree that the youtube comes across as a bit of a rant, it is a bit harsh to call someone raising the issue of the mineral/nutrient content of food on health, a snake oil salesman.

        There has been plenty of research into the effects of inadequate mineral intake on animal and human health, but it has received far less attention from those involved in the latter than those with a commercial interest in the former.

        See e.g. the abstracts in

        https://www.ncbi.nlm.nih.gov/pubmed/10721936 2000

        https://www.ncbi.nlm.nih.gov/pubmed/15704251 2004

        https://www.ncbi.nlm.nih.gov/pubmed/17543200 2006

        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1913565/ 2007

        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1913589/ 2007

        https://www.ncbi.nlm.nih.gov/pubmed/18607188 2008

        that not only highlight the effects of copper deficiency on the processes that Dr Kendrick has revealed to us as being involved in CVD and stroke, but also on aneurisms.

        What I am trying to raise is that the issue of the unknown variable micronutrient content (well described in the Marles paper I referred to) of the foods you and I purchase for our families, makes any recommendation of dietary intake, as in 5-a-day, practically worthless, since we cannot know our personal requirements as we age, and what to eat or supplement to maintain the right level for us.

        Sadly, simply banging down fistfuls of random mineral supplements, as some do in a desperate attempt to cheat death, might well be counterproductive, some are toxic at high levels, some even act as chelating agents on other essential micronutrients.

      4. Sasha

        Yes, the issue of mineral depletion is a huge one and it can’t be remedied, IMO, by taking supplements. The only way out is returning to traditional means of food production, if that’s possible…

      5. Eric

        Stephen, as I said, the issue of mineral content is perfectly valid, even if I don’t buy > 10x depletion.

        I din’t call him a snake oil salesman, I said he sounded like one. Big difference where I’m from.

        Frankly, I have no idea who he is (someone announced two names at the beginning of the talk but that was too fast to catch) nor if he is trying to sell anything (not having watched the second half). Assuming he isn’t, he certainly is not doing his cause any favors…

  14. Mark Johnson

    Shortly after my father died my Mum developed afib. I asked the doctors treating her and particularly the cardiologist whether the afib could have been brought on by the shock / mourning after almost 50 years of marriage and if a diet change / dietary supplement could help. My questions were dismissed. I trusted the medical profession at that time. One of the tablets prescribed back then was digoxin which has now been stopped as it’s been found that it causes more harm than good.

    I wish that I hadn’t listened to the cardiologist at the time because I’m convinced that supplementing with magnesium (including transdermally) would have quite possibly reversed the afib in those early stages. Dr Sinatra et al.

    Reply
  15. Janet

    Sadly, that answer shows that your Mother’s doctors did not understand the Heart, so how can they be so dogmatic about the cause of a problem? The Whitehall Study demonstrated the correlation between cardiac events and employment hierarchy, and grief is more intense than one’s place on the Totem Pole!

    Reply
    1. Mark Johnson

      That’s what so annoying and makes me so angry.

      I actually asked a cardiology consultant, ie someone who is supposed to be an expert of the heart / heart disease (I guess that should also encompass heart health) the question, “could the recent bereavement have caused the afib and is there a dietary supplement / diet which could help?”. His answer whilst scoffing was, “no”.

      In the intervening years I’ve read so many books / studies to know the consultant was talking bollocks and I’d now be able to tell him so. But why is it that the patient has to become an expert on his own condition because the medical treatment / advice he’s likely to receive will be wrong and could quite possibly shorten his life?

      Why is it that we repeatedly read on this board that consultants, medical experts, doctors etc seem to know jack sh*t apart from being able to prescribe a drug which won’t in reality help and quite possibly do harm?

      Reply
      1. Janet

        Generational learning, conflict$ of interest in $$& and status – reputation, laziness, arrogance, beyond God Complex (only I can fix something no one understands) – take your pick and brew your own mix …..
        I’m equally annoyed with and from Professors failing to take/act on patient history,,, to tunnel vision ‘Specialists’. Without doubt, most if not all of us here know more about preventative nutrition than our medical advisors !
        End of mini-rant.

      2. Frederica Huxley

        Quite! And if you question, you are condescendingly told that obviously you have gotten erroneous information from the internet, and are not in a position to understand what you have read and researched. Rather akin to the “vitamin C is just expensive pee”.

  16. Janet

    DownUnder we call them “Stirrers” – vital members of our Society as they expose the male cattle’s ‘produce’:)

    Reply
  17. Carlos Monteiro

    My good friend Dr. Malcolm Kendrick
    Thank you for your generosity by talking about the myogenic theory of heart disease, in the present post. As you know I’m fighting for the myogenic theory during many and many years (since its development in 1972) in order to have it internationally discussed in the medical scientific arena, always hard to get. One of my best opportunities in this direction was through the invitation by our common friend Dr. Paul Rosch who was one of the organizers of the IV International Conference of Advanced Cardiac Sciences – The King of Organs Conference, November 2012 in Saudi Arabia. There I have had the great honour and pleasure to know you and other members from THINCS. Coincidently, few days ago, I have posted in my Facebook the complete video with our presentations during the Session 9 titled “The Demise of the Lipid Hypothesis” This video is at https://www.youtube.com/watch?time_continue=7834&v=bTheMGgUWnM
    Malcolm, sorry for intruding in your space. This isn’t my usual behavior.
    However, taking in view your opening for the discussion about the myogenic theory I felt it was necessary to give more accuracy on the understanding about the myogenic theory, according the original ideas from Dr. Quintiliano de Mesquita, my father in law. This can be found in my article “Stress as Cause of Heart Attacks – The Myogenic Theory”. Published at the Journal Wise Traditions in Food, Farming, and the Healing Arts, Fall 2014. Reproduced by Positive Health Online, Edition 222 – May 2015 at http://www.positivehealth.com/article/heart/stress-as-cause-of-heart-attacks-the-myogenic-theory
    I have to thanks Dr. Tom Cowan, from Weston A Price, who gave a large contribution on disclosure of the myogenic theory since he turned convinced it was the real cause of heart disease. This story was told in the article What Causes Heart Attacks? From May 1, 2008 published at https://www.westonaprice.org/health-topics/what-causes-heart-attacks/
    Yesterday I have written in my Facebook about this post by you, saying:
    “In his last post Malcolm Kendrick mentions the myogenic theory of heart disease, that we advocate.
    He talked on the myogenic theory with his greatness, honesty, consideration and scientific respect, as he usually does, even when he has different views on the subject.
    Thank you Malcolm.
    You rock!!!”

    Reply
      1. Carlos Monteiro

        Dr. Göran Sjöberg,
        I’m not a medical doctor. I’m just a researcher who has had a long time involved with the medical science.
        In relation to Dr. Sroka, with whom I have had several contacts in the past with exchange of ideas, we share common interests related to the autonomic nervous system and its measures (like HRV), as well as the use of strophanthin (ouabain) in heart disease.
        I hope my above response attends to your question on how Dr. Sroka and the HRV issue fits in here.
        Regards,

      2. Anna

        I have been using Strophantin for about 9 months and have found it very beneficial in respect of my angina & more generally.

      3. Carlos Monteiro

        Anna,
        I’m not a medical doctor, as have told before, so not apt to give medical prescriptions.
        However, I like to go deep in the history of medicine.
        Please see our article “Digitalis and Strophanthin in Stable Ischemic Heart Disease and to Restrain or Reverse Heart Attacks — An Amazing and Shocking Story. Positive Health Online issue 229 – April 2016 at http://goo.gl/l6oxZ8
        Carlos

      4. Dr. Göran Sjöberg

        Neither am I a medical doctor but an old researcher in the natural sciences, metallurgy in my case, who for personal CVD health reason have dug into this issue during several years now.

        Based on the fact that all my arteries are more or less clogged since more than twenty years now and me surviving a very serious MI 1999 I am today a “strong believer” in the myogenic theory not least after reading a paper of Dr. Sroka. That paper made sense to me as a “scientist”.

        The big question mark now remaining for me is the coupling between the vagus nerve signals and the autonomous and rather special internal nerve signaling system governing the muscle activity of the heart. As far as I have understood (Sroka?) it is here the clue is to find but I have never understood how. Trying to discuss this with an experienced heart surgeon specializing on the nervous system of the heart he couldn’t even relate to my question. He had, to my dismay, not even the faintest idea of the myogenic theory.

        Are these “experts” really interested in their own subject of “expertise” I wonder as the researcher I am. When I asked the cardiologist I met a couple of years ago to recommend me a serious book on his own discipline I was chocked to learn that he couldn’t do that in all the arrogance he showed me.

      5. Carlos Monteiro

        Dr. Göran Sjöberg,
        I advocate more 2 hypothesis in medicine involving the autonomic nervous system dysfunction, as the cause of some diseases. One is related to atherosclerosis while the other is related to cancer.
        However, your questions should be answered by appropriated people. I’m a guest here, ethically obliged to follow the established rules, respecting in this way the space from others. Above all looking to keep intact my friendship (personal and scientific), at a high level, with Dr. Malcolm Kendrick.
        Carlos

      6. smartersig

        Goran you say your arteries are blocked, I was wondering given that Dr Ornish and Dr Esseltyn have claimed to unblock arteries through their methods, have you in the past or presently deployed their methods ?

      7. Antony Sanderson

        Smartersig . . . I am not sure I would be up for a full vegan diet (I did teach/lived in a vegetarian school for 5 years – my wife recently reminded me that I did not fair well on it) . . . Think I will join Goran and rely on my collaterals.

      8. smartersig

        I have to say I am astonished by this response. Esseltyn and Ornish claim to have reversed heart disease by getting patients to give up one set of delicious food that is bad for you and replacing it with another set of delicious food that is so good it contributes to reversing heart disease and yet you feel it might be better to bet on collatarels

      9. smartersig

        If the Ornish approach seems questionable then why not adopt the Pacific island diet mentioned in the Masterjohn presentation. They have pretty much zero heart disease. If of course adopting it under other western influences eg car pollution, means little or no benefit then you can assume that diet is simply not a very strong factor in the equation but I think most of us would expect the opposite to be true. On the other hand we can all keep eating our western diet and hope that going bare foot once in a while will do the trick

      10. Dr. Malcolm Kendrick Post author

        Ornish did a study, using his own diet (from which he makes lots of money). He proved it worked. When another group of researchers, with no horse in the race, verifies his findings, then I may/will take them seriously.

        ‘A lot of what is published is incorrect.” I’m not allowed to say who made this remark because we were asked to observe Chatham House rules. We were also asked not to take photographs of slides. Those who worked for government agencies pleaded that their comments especially remain unquoted, since the forthcoming UK election meant they were living in “purdah”—a chilling state where severe restrictions on freedom of speech are placed on anyone on the government’s payroll. Why the paranoid concern for secrecy and non-attribution? Because this symposium—on the reproducibility and reliability of biomedical research, held at the Wellcome Trust in London last week—touched on one of the most sensitive issues in science today: the idea that something has gone fundamentally wrong with one of our greatest human creations.’ http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736%2815%2960696-1.pdf

        What is most likely to be incorrect is research with a clear financial incentive.

      11. smartersig

        Why are you throwing a crtiicism of Bio Tech research methods as a question mark of Dean Ornish who is suggesting that stuff you can buy off a grocery store shelf’s are the answer to heart disease, an opinion that is backed up by an examination of large population diets.

      12. Dr. Malcolm Kendrick Post author

        If someone who does not have a financial stake in this issue replicates results then I shall pay attention. At present we have two researchers who make a living from promoting specific, money making diets. They have both done research, of a kind, to ‘prove’ they are right. Pardon me if I am not overwhelmed.

      13. smartersig

        Well Medicare, the insurance company are impressed and have recognised it, that is the Ornish approach. Insurance companies not known for placing risky bets

      14. annielaurie98524

        Seriously? Have you been following the news on the pharmaceutical front for the last few decades? There have been numerous “medical interventions” (drugs) that were embraced by both the med establishment AND insurance companies, that were subsequently pulled because unappreciative patients were dying and experiencing serious side effects, rather than being grateful for the all-knowing insurance companies’ coverage of same.

      15. Sasha

        I think insurance companies will support anything that doesn’t require them to spend money and that also goes together with the official medical guidelines.

      16. James DownUnder

        Correct me if I’m wide of the mark, but, Insurance companies make money in two ways. Premiums – Incoming, and paying claims – outgoings.. That’s it. So it’s in their interests to keep the former high…. and limit the latter. Being in the ‘box seat’ , they can dictate terms & conditions…thereby limiting risky behaviour by the client.
        There is more than a sneaking suspicion that the ‘Safety Of Life At Sea’ (SOLAS) international agreements were driven by the insurance Industry, following the TITANIC debacle. (Third big ship loss in a short time.) I’d say that there were now over a million good reasons to have better built ships, keeping a better watch and with more lifeboats…
        Swiss Re et al are simply being sensible, pro-active businesses.

      17. Sasha

        I think that adopting Ornish’s Program is definitely limiting risky behavior compared to the stuff many people regularly eat.

      18. smartersig

        I dont think you could call Ornish the official american guideline in fact when he published in 1991 he thought it would be a game changer but was stunned when very few in authority took any notice

      19. Sasha

        What I meant to say: Why wouldn’t insurance company support an approach that doesn’t cost them anything and puts all the responsibility on the individual? Especially when it doesn’t contradict an official opinion of “fats are bad” and also keeps people away from standard American diet.

        Wouldn’t that make sense from their standpoint?

      20. Dr. Malcolm Kendrick Post author

        I have asked people who work as actuaries why they don’t look at the evidence for themselves, and they would realise that most of what we are told about diet is nonsense. I actually contacted an Austrlian actuary who had looked at LDL and CVD and concluded that the risk did not exist. I was told that they cannot examine the guidelines themselves. They must accept official medical evidence and guidelines.

      21. Sasha

        Two days ago we had an argument about vaccines with two fellow acupuncturists and one of them (who agrees with me on vaccines) objected to me calling the current policies “medical fascism”. He feels it is disrespectful to victims of Nazism. But if one looks up the definition of “fascism”, it’s larger than Nazi Germany and I think it fits some of the current medical practices and dictates…

      22. smartersig

        All part of the betting process, insurance companies make bad bets as well as good bets but overall you would not mind being a pound or dollar behind them. Do they get caught on individual wagers, for sure

      23. annielaurie98524

        Your comments on diet make it sound as if there are only two choices — the Esseltyn-Ornish-almost-vegan-with-perhaps-a-little-fish type vs. the aptly-acronymed SAD (Standard American Diet), or what you call the Western Diet. This is simply not the case — it is the “straw man fallacy” that many vegan proponents fall into. One can follow an ancestral diet, a paleo diet (which is not so meat-centric as the popular press portrays it), HFLC, keto and cyclical keto, vegetarian in its non-vegan forms (lacto-ovo-pesco and all permutations thereof), Mediterranean, and so on ad infinitum. While there is an abundance of data showing that SAD is truly a sad choice, there are insufficient data on all the others to identify a champion at minimizing all-cause mortality, or even minimizing the development of CVD. All of the “studies” purporting to vindicate one over the others suffer from flaws — too short, too few participants, being merely “observational” (and often dependent on folks recalling what they ate ten years ago), lack of large-scale replicability, etc. Beyond these flaws, they are riddled with confounding factors. And certainly, as several commenters have noted, the near-vegan regimen of certain famous docs suffers from the potential taint of conflict of financial interest. And that includes the “blue zone” diet(s) — there are many, and most do not truly reflect what the “blue-zoners” eat — which earn their proponents a pretty penny from books, etc.

      24. smartersig

        I do not think a whole food plant based diet is the only way forward and I emphasize my preference is fora WFPB with some fish. The problem as I see it is that we are never going to get the meat and dairy industry to produce clean products and the majority of people are going to have problems dodging the bullets so my advice to friends is tread the path of least damage which is WFPB with some wild fish and Vit B12 and folate. I myself will eat a goat curry when one is put in front of me because I can be pretty sure the goat is wild and not factory farmed but if you invited me to your house and you were serving beef I would decline.

      25. smartersig

        James I do not consider myself attached to a belief system any more than those who advocate lots of meat with butter. I am merely searching for answers to what is the best diet for general health and indeed heart health. At the moment many on here seem to be seeing me as some sort of vegan nut out to convert everyone when in actual fact I am not even vegan. I do try to take a pragmatic view of things though hence my view that going down the supermarket and eating veg is better than going down the supermarket and eating meat for reasons I have already covered. I also think it is important to have contrary points of view on a forum like this otherwise we just keep slapping on the butter or slapping on the advocado along with slapping each other on the back.

      26. AH Notepad

        You may have a valid point, you certainly believe you have, but it does give me the impression of an evangelical crusade, and I suspect I’m not the only one.

      27. smartersig

        Thats interesting Notepad, you see on here if I provide studies and evidence that supports the WFPB approach I am looked at as evangelical. On the Nutrionfacts.org site when I questioned some aspects of the beliefs on there, I think it was with regard to fat, but the main point I was regarded as the evangelical enemy on there too. You see no one is viewing pro fat pro meat views on here as evangelical. I suspect that we all get a little suspicous of opposite views

      28. Andy S

        smartersig, assuming that the western diet is according to the existing food guidelines ie 60% carbs + pufa oils. In that case any other diet will be an improvement in the short term even no-food diet. Occasional short term cycling the LCHF with Ornish might be beneficial.

      29. Sasha

        It’s not just the Pacific Islands diet, it’s their whole lifestyle. Even now in Hawaii, for example, the lifestyle is very different from that on the mainland. Let alone how they lived before the contact when they had low rates of CVD.

      30. smartersig

        How do you know that, I mean how for example how do you not know that diet is 75% and other lifestyle factors are 25% or maybe the other way round. It does not matter what percentage we attribute to diet, if its protective to some degree it is worth adopting

      31. smartersig

        I agree but we are faced with a strong likelyhood that diet plays a role in heart disease and it would therefore be prudent to adopt the dietary practices of those people who have no HD. Would you suggest that we all ignore the dietary practices of say the mentioned Pacific islanders until some sort of categorical proof can be produced. Should we continue with our western diet because we cannot be 100% certain that a switch to tubers, fish and some heathy fats would not improve our risk ?.

      32. smartersig

        If ;publishing in the Lancet is a claim then yes he claims to have reversed heart disease. I fail to understand the negativity surrounding Ornish and Esseltyn. I am not sure if what they are doing is just too simple for some folks and there must be a more complicated solution or perhaps this anti vegan stance which I find is just as stupidly entrenched as the anti meat stance is the reason, but what I do know is that no one has replicated the exercise and proven it does not work. One thing I would say is that given that there is no real down side I would adopt their methods if I had badly blocked arteries and quite frankly even if I did not.

      33. Sasha

        Smartersig, publishing in the Lancet can still be a claim. Do you know if their findings have been independently verified and replicated? Also, for many people going vegan or even vegetarian can have down sides. As can going LCHF, I suspect.

      34. smartersig

        If I had severley blocked arteries I would verify it for myself given that the down side is neutral. The alternative is to wait although you may be dead by then. You also have to remember that the ‘machine’ is dead set on not proving or verifying his/there claims.

      35. Xochitl2#

        What is the “set of delicious food” that you consider bad? It was my understanding that patients following the Ornish and/or Esseltyn regimens give up many sets of foods, and follow an almost vegan diet.

      36. annielaurie98524

        Pizza, pasta and cheesecake are not a “food group”. The Esseltyn and similar regimens eliminate actual food groups, such as meat, fish, dairy, etc. Some even try to eliminate entire macronutrient groups, such as fats. People whom I know that follow a HFLC diet — like myself — have long since eliminated junk foods. And I would not agree that junk foods are “delicious”. After eating whole foods for a while, one finds junk foods taste pretty awful. BTW, this is AnnieLaurie. Last night, MS Edge froze up and I had to go back to using Google Chrome as my browser. It began using my password as my username — very weird. So I am trying to get it to change back.

      37. smartersig

        I do not go along with everything Ornish and Esseltyn prescribe although I think overall out NH system would within a generation find itself overfunded if the population all turned to following their diet. For me wild fish is OK to eat and I do so

      38. Frederica Huxley

        I love wild fish, but have become somewhat concerned by reports that fish now have nanoparticles of plastic in their flesh.

      39. Dr. Göran Sjöberg

        smartesig

        To tell you the truth both my wife and I love veggies but the fact is that the more vegetarian we turned about ten years ago the sicker we went and when my wife finally got seriously ill we decided to ditch all carbs. The beneficial health effects were truly dramatic and that is why we stay with our strict LCHF. As a side effect was that we lost all of our overweight although we didn’t suffer from those extra pounds.

        A limited amount of green leaf vegetables seems to work today if we don’t overdo it – we have strong tendencies. So we enjoy sallads like the Caesar sallads.

      40. Dr. Göran Sjöberg

        Xochitl2#

        Weston Price travelled the world extensively 80 years ago to visit the remaining indigenous peoples to understand the connection between food and general health.

        He was very firm that those who fared worse were the vegetarians and those who fared best were people living on sea food.

      41. Dr. Malcolm Kendrick Post author

        It is possible to find a study, in the world of nutrition, which can prove any possible diet allows people to live the longest. The only nutritional studies that are valid have failed (or very nearly failed) to disprove the null hypothesis.

      42. smartersig

        Coupled with the fact that Blue Zone regions tend to be occasional or no meat eaters and many of them are fish eaters suggests that a Pescetarian diet may be the best bet we have in a world of uncertainty. We all have to place a bet and in a western world no bet is almost certainly an early death bet. If we wait for certainty we will all be dead before our time.

      43. Sasha

        I don’t think it’s possible to separate a blue zone diet from a blue zone lifestyle. Eating coconuts in New York city will probably get you further than eating fast food but it may not get you as far as eating coconuts on a Pacific island.

    1. chris c

      Well over 40 years ago I was suckered into eating an Ornish-style high carb low fat grain based vegan diet. That was when I passed my first gallstone and had my first attack of gout. So no, I don’t think I’ll be doing that again.

      I continued dutifully eating my HCLF grain-based high PUFA non-vegan diet for the following 30 years, which brought me right up to the gates of diabetes. So no, I don’t think I’ll be doing that again either.

      Twelve years ago I started eating LCHF and tweaked it through paleo and into a ketogenic direction. This eliminated most of my symptoms – many of which I didn’t realise I had until they stopped – and improved if not normalised all of my “health markers”. So yes, I think I WILL be continuing to do this.

      Yeah, N=1 but it works for this 1, and a whole lot of other 1’s, which I ever so slightly think is more important than what “a new study (into 30 genetically modified mice) says”.

      Hint: go read William Davis, and Ted Naiman, two Real Doctors with Real Patients, who do not publish research (perhaps they should) for a counterpoint to your vegans. Bill Davis has changed his recommendations pragmatically over the years according to what he sees works using calcium scans. As a cardiologist you would think his best bet would be to maximise the number of profitable procedures he needs to carry out, but he appears to have done the exact opposite. Aseem Malhotra too, and Gary Fettke who became disillusioned about his day job of cutting off diabetics’ feet, and a small but rapidly increasing number of doctors who are fencing off the top of the cliff rather than buying more sophisticated ambulances to park on the beach.

      Reply
      1. chris c

        Just to add, Smartersig I believe YOU should definitely eat a HCLF vegan diet. What would be interesting would be to get a whole metabolic panel first, and again after say six months and see what changed.

        I suspect your LDL would drop (you need fewer fuel tankers), your HDL would drop proportionately more and your trigs would go up (you need more wheelbarrows for the sacks of grain and flour). Really interesting but probably unavailable would be your fasting glucose and insulin for a HOMA assessment, and a full Insulin Assay. Also the likes of CRP and homocysteine, B12, D3 and your neck diameter.

        I have absolutely nothing against anyone else eating whatever the hell they want. My vitriol is directed at the fact that your heroes want to see their diet imposed on EVERYONE, irrespective of the outcomes to their health or the environment, and that they have not only knobbled the WHO and UN but are now trying to ensure the Canadian Food Guide also becomes “plant-based” by sheer force of numbers of their well organised campaign, and that they already have most dieticians throughout the world championing veg(etari)an diets and attacking low carb/paleo/keto as “fads”.

        When you have dieticians happily recommending reducing fat and eliminating meat, and then having panic attacks when someone eliminates grains or sugar, and claiming that “eliminating entire food groups” is a symptom of “orthorexia” except for meat/saturated fat, and calling themselves the likes of “Plant Based Pixie” while trying to have doctors and professors sanctioned and prevented from practising for “inappropriately reversing diabetes” there is something desperately wrong. How long would a dietician calling themselves Paleo Pixie be permitted to continue in work?

      2. smartersig

        Chris I went WFPB with fish about 4.5 years ago. This is what happened, my LDL went from 3.9 to 2.9 my HDL stayed at 1.8 myt trigs are low at about 0.8 and my CRP which I never checked before is very low cant quite remember because I have stopped checking it. More importantly perhaps my weight went from 14st back to 11st 5lbs, my weight of 30 years ago within 3 months. The only thing I had a problem with was Homocysteine which I had the no refererence check for as I had never measured it before. It was 21 which is high but taking a daily modest B12 and Folate whacked it down to the current 7.8. I dont know what my previous fasting blood sugar was but it is now about 80 which is good. The only experiment I have done with this is with regard to fruit. I ate 6 bananas for breakfast and test and found it was 90 which backed up an experiment by a blogger who ate something like 20 bananas. With regard to WFPB with fish I have no interest in converting people for animal rights reasons although I do think the treatment is appaling. My decision is based on this.
        It strikes me that we have a few things that seem pretty bomb proof in terms of health benefits or at least not health damaging. Similarly there are some that are open to debate with some conflicting evidence and then there are some that all seem to agree on. For example in the latter would be trans fats and sugar consumption amongst others. In the middle would be meat, sat fat to name but two. Now in the first group I would suggest that it is difficult to find evidence that plants cause heart disease or that fish causes heart disease in fact quite the opposite whereas other substances like white flour products and bread do have damaging evidence. My decision therefore is to take this evidence coupled with evidence from the diets of those who live long and healthy and I am sorry but the meta analysis and the epidemiological do show that veggies and in particular pesco’s live longest, and couple this with the category 1 foods and eat in this manner. Those who chose to eat meat may find that it does not advance their heart disease but in my eyes they are taking a riskier bet in particular with regard to heart disease.

      3. smartersig

        Couple of other points, my Vit D is very good and do you really think the brussle sprout and spinach lobby has out bid the meat and dairy industry to get a foothold in the WHO. I was kind of impressed when the WHO came out about meat as I would expect the very powerful meat & dairy to have put a stop to it very quickly.

  18. Janet

    Nope. Low levels – esp. LDL – can be associated with good AND bad outcomes. An Engineer wouldn’t regard it as a serious marker for this reason.

    Reply
    1. daveketo

      That’s exactly right, Janet!
      I use the car analogy often… If I said, “I used a lot of steak last week, you’d know I meant for cooking, eating, etc.” If I said “I used my car a lot last week.” — that could be for just about anything.
      Low Density Lipoproteins are a multi-use, multi-stage biological device. They both carry a varied assortment of cargo (TG, Chol, vitamins, anti-ox) and are used mechanistically for operations such as clearing pathogens. So yes, there are both good reasons (energy transport, diet composition) and bad reasons (injury, infection, metabolic derangement) for it to be high.

      Reply
  19. Steve

    Great comments by many of you. It is a vast voyage of discovery. Thanks to Dr. K for the series. Obviously this one is one of the top killers in our civilization and an answer to what we can do to reduce/optimize it would change the world in which we live and possibly help loved ones, so i believe we all have skin in this game as health is true wealth.

    Answers to some of the comments/questions:
    The question as how to increase NO is found here:
    http://roguehealthandfitness.com/viagra-potent-heart-disease-drug/
    I take citrulline to increase my NO, also please note, this approach is far better than any statin because of the NO increase results in:
    “Men who got 1 prescription for Viagra had 34% fewer deaths.
    Men who got 2 to 5 prescriptions had 53% fewer deaths.
    Men who got greater than 5 prescriptions had 81% fewer deaths.”
    sure the heck beats statins by a mile. In my view because statins destroy the CoQ10 pathway, any doctor handing out a statin without adding CoQ10 is negligence. In the same article there are lots of other links for improved issues against heart attack.

    When I work out, I feel like crap, the days after my body has a heart attack and this is why:
    http://roguehealthandfitness.com/weight-training-causes-muscle-damage-and-inflammation/
    based on some of the comments, some where interested that this may be part of the heart attack problem. I agree, see the charts; 24 hours of inflammation, 96 hours of muscle repair elevated chemistry required. Result: I work out only 2 days a week max, work out everything at once so I don’t keep this level of chemistry going more than I have to. Feels like a heart attack in my arms, legs and other muscles. feels great 4 days later!

    Vitamin C comment, only 7.5 grams? I take more than 20 grams per day when feeling ill, around 5-10 grams every day or so and infusions I have priced will go up to 50 grams. You can get high C (therapeutic levels) into your system orally according to the NIH. see the graph here: http://knowledgeofhealth.com/the-vitamin-c-fanatics-were-right-all-along/
    Just need to take 3grams x 6 times per day! due to the fast half life. Peruse the rest of his site for lots of other vital info. Bill Sardi also harps on about iron and lots of vitamin deficiency issues, Vitamin B1 for alzheimers! I take it too.

    In my vascular search/study there were all kinds of hormones, stress hormones included, which activated certain areas and/or the entire vasculature. for example the fight or flight hormone activates the heart rate and increases blood to the muscles, taking it away from other areas. Other hormones do the opposite. If these hormones or receptors get messed up or fatigued, like the insulin receptors do, this could certainly apply to a heart attack. Are you constantly stressed, are you low in vitamin D (hormone precursor)? How about low in cholesterol another hormone precursor? You can check yourself out with saliva and other testing…

    Good discussions on MTOR. MTOR is the growth and also ageing pathway. we want to minimize this by not overdosing in protein, by not working out to fatigue, etc. See Roguehealth and Sardi, they both discuss this as do many others. It is a fine balancing act to optimize, many issues are U or J curves, with an optimal peak/valley and increased death rate at each side of the curve. so balance is required, don’t overdo things. Based on the precept, I tend to cycle on and off different foods and diets, fasting, Vitamins, etc. I also do anti cancer eating/supplement weeks or a month or two per year.

    As last time, I commented there seems to be slow and fast pathways to heart attack. certain things work slowly like buildup of plaques or calcium. some things act quickly like hormones, but maybe these are buildup of resistance over a time period? I have looked fro some of these, still looking…

    Viscosity/Vascular – there is a lot there. I know the technology and feel comfortable discussing it, but the technology even 5 years ago has vastly improved. the capability to measure these lower viscosity fluids and their components is probably realistic today. I mentioned the ability to measure viscosity of proteins unfolding, this is like measuring the weight of a grain of sand at the end of a meter stick….I believe that there are macro and micro issues in the circulatory system and blood viscosity to deal with. The fact that shear thinning (huge viscosity reduction) takes place means something is being arranged or breaking down (probably both). Some were mentioning the tree/water cohesion-tension theory, which is the only one that would seem to work, for trees. I don’t think this is the same, although all fluid systems have this to some extent, I mentioned ebbs and flows, pushing and pulling (some cohesion-tension there I suspect), that results in lots of turbulence which is probably a better description of the vast majority of plaque ridden areas. Mass flow rate in = mass flow rate out of static systems, this is not static as the shapes of the vessels can change! Another variable based on hormones. What are the real pressures in the system, there are a couple of books on the subject. Lots to learn and a PHD paper for numerous interested students. We also discussed the low pressure in the Lungs, which is well known and probable cause of no plaque buildup.

    My wife is a vascular ultrasound tech. she sees this stuff everyday, tons of occluded arteries and blood clots everywhere, especially arms and legs. She also sees occluded carotid with zero flow on one side and increased blood flow to the other side to compensate! So there are chemicals and processes to increase flow, increase vasculature by adding NEW branches or increasing flow in other areas to compensate for blockages. if there are problems. What if this process is not working? I need to ask her surgeons about some of this.

    I have mentioned Glucose before and it is referenced numerous places as a really bad actor. Dr. GS’s HFLC is a great place to be, part of my diet improvements too. Looking at the issues in our food system, everything processed or refined, chemicals abound, GMO’s, vaccines, insecticides, etc.

    So now we have the heart attack victims without any indications, or huge indications without suffering attacks! makes perfect sense when you look at the vascular and hormonal issues. Probably helped along by stress, iron or old blood, poor nutrition and the long list of issues. The same variables at work. Ill keep keep up my Mediterranean, HFLC approach, regular exercise, hiking long distances for fun, glass of red wine and rotating my supplements against the worst diseases and issues. I don’t have 30 years to wait for a corrupt medical system to learn a new paradigm, I have to act now at ~60 to ensure good health in the future. I spend more of my time on my health than my finances….LOL.

    Next time I will list out our findings and issues, which are based on logic, papers and analysis. Sorry for the large rant, but I wanted to give a lot of answers to comments when I have them.

    Keep it coming, thanks Dr. Kendrick

    Reply
    1. Bill In Oz

      Steve, there is too much here to deal with in one gulp.. So can we focus attention on a couple of things in the list?
      1 Blood viscosity : What else is out there in wonderful world wide web on the issue of blood viscosity ? I have googled and there are many many hits but lots are self referencing from clinics that measure blood viscosity… So can they be trusted ?

      2 And clearly you are familiar with PD Mangan’s ‘Rogue Health’ site. Any thoughts on Mangan’s interview with Dr. Allan Green in the USA ? Green responded to increasing angina and loss of energy at 71 by taking low weekly doses of rampamycin as a way of reversing aging by reducing MTOR 1 activity in the body which increases greatly with age..

      I wonder if increased blood viscosity and hypertension and CVD are all manifestations of increased MTOR gene activity with aging.. and maybe part of the programmed aging process..

      Reply
      1. Andy S

        Bill in Oz, while walking barefoot in the garden yesterday I got to thinking about viscosity. Arctic fish have blood and hearts and function at 0 deg C.. Fish do not have red blood cells. Would primates with excessive RBC be at increased risk of CVD?
        Glycocalyx has a negative charge as do the RBC. What can go wrong? Glycocalyx shedding due to hyperglycaemia would increase resistance to flow through capillaries. Reduced negative charge on RBC due to faulty nutrition increases clumping of RBC (fish oil helps).
        According to myogenic theory: “situations of stress on the myocardial (heart muscle) tissue, often as a result of small vessel disease, the myocardial tissue gets insufficient oxygen and nutrients”

        The other big part of the equation is the health of the cells receiving nutrients from the blood. This is where ageing, mTOR etc. come in.

      2. Bill In Oz

        Andy, does reduced negative charge in RBC’s imply a lack of sulfate ? I think we have already discussed this many times. Seneff’s video ( posted above by Goran ) is largely about this. But so too is the use of Chondroitin sulfate.

        nd yes MTOR has it’s impact at a. cellular level rather than an organ level. But as increased MTOR activity is a major part of the programmed aging process, reducing MTOR should have an impact throughout the body, including the arterial system.

        And as Steve mentions below, in default of rampamycin, the supplement berberine does have the same effect.
        https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-015-0450-z

    2. Andy S

      Steve, benefit of HFLC is low blood glucose, less glycated proteins, etc.

      https://www.ncbi.nlm.nih.gov/pubmed/17249336
      Indian J Exp Biol. 2007 Jan;45(1):121-8.
      Erythrocyte deformability and its variation in diabetes mellitus.
      Shin S1, Ku Y, Babu N, Singh M.

      Abstract
      Erythrocyte deformability improves blood flow in the microvessels and in large arteries at high shear rate. The major determinants of RBC deformability include cell geometry, cell shape and internal viscosity (i.e., mean cell hemoglobin concentration and components of the erythrocyte membrane). The deformability is measured by several techniques but filtration of erythrocytes through micro-pore membranes and ektacytometry are two sensitive techniques to detect changes in erythrocytes under varied experimental and diseased conditions. Diabetes mellitus (DM) is a metabolic disorder, characterized by varying or persistent hyperglycemia, which induces several changes in the erythrocyte membrane and its cytoplasm, leading to alteration in the deformability. A decreasing trend of deformability in these patients is observed. The shape descriptor form factor, as determined by processing of erythrocyte images, increases with the increase of blood glucose levels and shows a pattern similar to filtration time of erythrocyte suspensions through cellulose membranes. Fluidity of the membrane as measured in erythrocytes of these patients is decreased. With prolonged diabetic conditions the deformability of erythrocytes is further decreased, which may complicate the flow of these cells in microvessels.

      Reply
    3. Martin Thomason

      Thanks for the links Steve.
      Regards the NIH study on mega dosing of Vitamin C, do you know what the label of the horizontal axis of the table refers to ? It is missing from the web article when following the link – it is showing 5, 10, 15, 20, 25 but I’m unsure as to the units – perhaps minutes or hours ?
      Regards
      Martin

      Reply
      1. Philip Thackray

        Martin,
        From the 2.5g 4 times per day and 3.0g 6 times per day curves you can conclude that the horizontal axis labels are hours.
        Philip Thackray
        Renfrew, PA USA

  20. alan logan

    Don’t know if this has been posted before.

    http://www.research.ed.ac.uk/portal/files/8781160/Progressive_coronary_calcification_despite_intensive_lipid_lowering_treatment.pdf

    Conclusion: In contrast to previous observational studies, this randomised controlled trial has shown that,
    despite reducing systemic inflammation and halving serum low density lipoprotein cholesterol
    concentrations, statin treatment does not have a major effect on the rate of progression of coronary
    artery calcification.

    Reply
  21. zahccc

    smartersig said: “Here we go
    https://www.ncbi.nlm.nih.gov/pubmed/23083789

    https://www.ncbi.nlm.nih.gov/pubmed/16554528

    The second one deals with the genetic feature”

    There are some comments about the second paper here – https://www.ncbi.nlm.nih.gov/pubmed/27998881

    However, if the assumptions of Mendelian randomization are indeed true, and taking into consideration how little evidence there is implicating native LDL, a better explanation can be found here – https://chrismasterjohnphd.com/2011/03/14/genes-ldl-cholesterol-levels-and/

    Reply
    1. smartersig

      A big thank you for the Chris Masterjohn link. I am a big fan of Chris but had not read this piece. I have not completed it yet but he seems to be saying what I hinted at earlier but obviously with far more detail, that is cholesterol is involved but is not the main culprit. My suggestion that lower LDL coupled with a poor lifestyle is better than higher LDL and poor lifestyle but neither is the answer seems to have some validity.

      Reply
      1. zahccc

        Good stuff. Masterjohn is a proponent of the oxidative hypothesis and therefore believes that LDL is only harmful to the extent that it is oxidized. Check out his youtube talks also specifically one called “Oxidative Stress and Heart Disease | Masterclass With Masterjohn 1.12” that may be of interest to you.

    2. Eric

      Had not come across this 2011 piece by Chris Masterjohn before but am familiar with his general ideas on cholesterol. Basically, he says that LDL are only bad when oxidized, so if they keep circulating for too long, e.g. because of defective absorption receptors in the liver, this causes heart disease. My take on this was always, if this is really true, its one more reason not to eat fats that oxidize easily, i.e. PUFA, which he also hints at towards the end of this article.

      This 2011 article bothers me a bit more:

      – How does he know the 450 – 500 TC bump in the Framingham study has 100% CVD? I seem to remember a bit by Peter of hyperlipid that came to a very different conclusion. Did he conflate Framingham with later FH studies? The problem with most FH studies is that they took people with CVD and then looked at relatives who also had elevated TC. Pete argues rightly that they missed those mutations that caused FH without CVD, of which there quite many.

      – Not sure about the PSK9 stuff. At least two sentences seem to have a major typo. Anyway, if all this was true, PSK9 inhibitors should have been a gread success. Instead, they failed spectacularly which shot a big round hole in the receptor theory. I would like to see his position now that these results are our.

      – Nowhere does he mention that the cholesterol that was fed to rabbits was in all likelyhood heavily oxidized.

      Reply
  22. Steve

    Good comments all. Bill in Oz, I love the Rapmycin miracle, I think it shows that these drugs that are used for diabetes, and other targets that have showed life enhancing or anti-aging influences affect several important pathways (MTOR, IGF1, Blood, etc). Funny that viagra reduces heart attacks more than statins via NO pathway. do I think that there is a holy grail out there, I think the life extension community is better at identifying products that increase life extension and most of them do this via gene switches, incidental pathways, glucose control/reduction, iron reduction, blood improvement and other approaches that were unknown even a few years ago. I already take Berberine, IP6 and resveratrol. I went off of Berb and Res a few weeks ago and am feeling down, have to start them back up again. Sorry, but don’t rely on me for answers on the big stuff, especially more than the references I am providing, I don’t know how we can say anything definitively. As we are all different individuals at different points and what works best for some, may not for other people. I spend a lot of time as my own science project, trying out a lot of different things. some seem to work, some don’t. But we have to try because modern medicine is not interested in the subject. So I focus on the life extension community, as they seem farther out there and willing to spend the resources. Luckily I have an ultrasound tech wife that monitors me fro feedback. i also order some of my own testing, calcium scan, some bloodwork.

    MTOR, from what I understand it is a delicate balance between growth and ageing. As we slide into higher age groups, muting this is better. So I do it with diet. IGF-1 is also something that is good in the right area or time, but too much enhances cancer activity. “Humans that eat a carbohydrate-restricted diet see a large drop (50%) in plasma insulin, and about a 30% decrease in plasma IGF-1. This happened on a diet that contained 5% carbohydrate, as opposed to 60% before. Of interest, protein is thought to be important to IGF-1 levels, and this diet increased protein, to 35%, and IGF-1 still dropped, although muscle IGF-1 increased.” http://roguehealthandfitness.com/how-a-low-carbohydrate-diet-slows-aging/
    So based on this, I workout for muscle, eat a lot of Protein during the process, but back off a bit when I am not slinging weight.

    Viscosity leads to other areas
    I was worried about preparing blood for viscosity measurements and remembered about EDTA Chelation, and that EDTA is used in blood vials and it would inhibit the clotting process and screw up the viscosity measurements….Light bulb. (great issue for patent claims too)
    Any search about chelation sends us to hundreds of papers and websites claiming miracles and uselessness. However, it was first noticed that people using chelation for lead poisoning had improved heart outcomes. It is known that EDTA is an anti-clotting compound , so this must be one of the reasons it works so well, by reducing the stickiness, the oxidative metal species, etc. They believe that removing the oxidative species can clear up calcium, and other plaques. By reducing the stickiness and removing dense particles, it affects viscosity…no doubt, with more benefits. My regular life extension sites don;t really talk about this. But I am beginning to think that oral EDTA may be better than aspirin? but I need more study, I would happily use this on myself, I think this is a great area to look to improve stickiness, clean out arterial issues, remove heavy metals, etc. But I dont think this works for the instant heart attacks, so it may be good for long term issues, but not an answer for everything. Although there is EDTA in lots of foods, which might explain some of the points brought up.

    Rogue has a few more tidbits they have teased out on blood viscosity/pressure affects via Renin-Angiotensin hormone System which regulates blood pressure:
    http://roguehealthandfitness.com/blood-pressure-drugs-extend-lifespan/
    It turns out that we were on the right path: “In mice, disruption of the angiotensin II receptor increases lifespan. Not only that, but the increase is large, as large as that caused by insulin receptor disruption. “In rats, long-term angiotensin blockade exerts “a significant protective effect on the function and structure of the cardiovascular system in all treated animals.”

    This is a stress pathway, so it is partly due to a reduction in stress!
    Calorie restriction and angiotensin inhibition “display a number of converging effects, i.e. they delay the manifestations of hypertension, diabetes, nephropathy, cardiovascular disease, and cancer; increase body temperature; reduce body weight, plasma glucose, insulin, and insulin-like growth factor-1; ameliorate insulin sensitivity; lower protein, lipid, and DNA oxidation, and mitochondrial H2O2 production; and increase uncoupling protein-2 and sirtuin expression.”
    Get out that berberine and resveratrol, they also affect this pathway which has life extension properties.

    I was looking into what heart issues are caused by Glucose and out pops AFIB.
    Atrial Fibrillation and diabetes
    Sardi has also teased out a few things to think about: Afib
    http://knowledgeofhealth.com/controlling-atrial-fibrillation-without-drugs/
    The approach on AFIB is to use blood thinners to mitigate clots, because AFIB causes much higher stroke incidence. High A1c doubles the risk for AFIB, read the link for more.

    Looking more at AFIB, there is a higher risk of clotting,and other heart issues probably the result of higher pressure in the upper heart, viscosity issue? Could Afib also be the result of higher glucose blood levels, that increase blood viscosity or stickiness? having to pump harder, throwing the upper heart into arythmia? this is something that I have not seen addressed. But we also know that most heart attack victims have high blood glucose too.

    This seems to fit the story line better. High glucose in older, stickier blood, higher viscosity, roughness and damage to the epithilium, causing damage and reactions that result in long term issues and buildups. Years of this process working against most people eating high carb and sugar diets, building up, adding in a few more bad variables like stress, and possibly pushing us over into AFIB that can cause heart attacks and strokes. Suffering from AFIB, then Add in a few more variables, stress hormones and maybe we are looking at a unifying theory that can answer most of the occurrences.

    Take a look, let me know what you think?

    Reply
    1. Bill In Oz

      Thanks for that reply Steve..Yes i too have been greatly influenced by the anti-aging blogs over the past 5-6 years. So looking at Rogue Health is a daily thing for me, just as reading through the comments here is.
      And like you Berberine is already part of my daily supplements to promote autophagy as recommended by PD Mangan. And so is 10 grams of Vitamin C daily. And weekly fating..I would like to get to the gym 3 times a week but recently it has dropped off. Too many other interests and commitments like helping a mate out on his farm, my growing vegies in my big organic garden and dancing Argentine tango. 🙂
      This past year I have been following a low carb, high saturated fat diet, after decades of being mainly vegetarian. but my body has responded with high blood pressure which has never been an issue before in all my 69 years. IE, it is new. ( My GP has had me on 2 different HBP medications. Neither made any difference. I have also tried 4-5 grams a day of potassium and it made no difference either. I know this as I have an Omron BP measuring device here at home).

      My gut feeling is that this significant BP increase has to do either with my own major change in diet or with increased blood viscosity. ( Which cannot be measured here in this part of Oz) So I am doing lots of research to see if it can give me some insight into what is going on.
      I will follow up on the other suggested links as I get time.

      Reply
      1. Jillm

        Bill, is it true that many years ago doctors were taught that a healthy blood pressure was 100 plus the patient’s age?

      2. Bill In Oz

        Odd that you ask that Jill M. I have just read an article on the Weston A Price Foundation website by Dr. Paul J Roasch of THINCS, from 2003.
        “The Emperor’s New Clothes: Aggressive New Guidelines for Prehypertension”
        In it he states : “Just 25-30 years ago, doctors were taught that normal blood pressure was the patient’s age plus 100 over 90..Thus if you were a patient 50 years old, a blood pressure reading of 150/90 was considered completely normal; if you were 70, then 170/90 was normal. This guideline reflects the fact the physiological fact the systolic blood pressure gradually rises with age.As the blood vessels narrow and become more rigid, more pressure is needed to move the blood through the arteries & veins.In general the diastolic pressure rises until age 55 and then starts to decline.”

        Dr. Kendrick I wonder, can you explain what happened to change the guidelines away from this understanding of BP increasing with age ?

        PS The article it quite good and worth the read.

      3. Jan B

        Enter the pharmaceutical means of lowering it and the creation of untold wealth for the companies making the stuff. What a brilliant idea. And when we oldies are falling about in dizzy spells they can prescribe something else to deal with that. Even more brilliant.

      4. Sasha

        I know of at least one person who almost broke her neck when she blacked out and fell down the stairs, all because she was trying to control her mildly elevated BP. I am sure there were others who succeeded.

      5. JDPatten

        Money.
        That’s all nice and simple and straightforward!
        Except:
        Elevated blood pressure is one of the prime risk factors for atrial fibrillation. Recent research suggests that ANY increase from “normal” augments AF risk — particularly in the age group in which BP supposedly naturally increases.
        My group. My AF.

      6. JDPatten

        Humble is generally wise I’m sure, but this “probably A, B,& C” is too vague to have any meaning for me.

      7. Dr. Malcolm Kendrick Post author

        High blood pressure could lead to atrial fibrillation. Or, different perspective. Cardiovascular disease (atherosclerotic plaque development, endothelial damage etc) could lead to both high blood pressure and atrial fibrillation. Ergo, it is not high blood pressure that cause atrial fibrillation. An underlying disease process causes both of them. A leading to B and C. This concept is often used in smoking. People with yellow fingers have a high risk of lung cancer. So, yellow fingers cause lung cancer? Or perhaps something else causes both? Correlation does not mean causation.

      8. Sasha

        Or, as I recently saw, taking statins may possibly lead to CHF and afib. And mess someone up real good…

      9. Bill In Oz

        The issue of Wise Traditions issue of 2003 by Weston Price Foundation has a second article by William Campbell Douglas. It’s called “Everything you wanted to know about blood pressure drugs and how to avoid the,”.

        It’s a lengthy article and spells out the side effects of almost all the BP medications. Just a pity it’s a bit dated being written in 2003. It does not include the new BP class of drugs, Angiotensin regulations.

        But I realise that the BP prescription I am taking ( amlidopine) is having a side effect on me – making me feel bit ‘woosy’ soon after taking it.

        https://www.westonaprice.org/health-topics/modern-diseases/everything-you-ever-wanted-to-know-about-blood-pressure-drugs-and-how-to-avoid-them/

        Douglas like you Dr Kendrick is categorical in stating the a high bp is an indication of something else. going wrong and that just lowering bp, will not cure with that underlying issue.

        At which point my thinking returns to blood viscosity. In layman’s language, ‘thick blood’ is harder for the heart to get moving. So the heart responds by pumping harder with the result that bp levels are raised.

        So…Why does blood thicken ? And how can blood viscosity be reduced and so allow the load on the heart to be reduced ?

      10. Steve

        Hi Bill,

        Sorry to hear about the increase BP, my upper target as I age would be 130-140/90. I am actually on the low side of BP around 110/65 and the high side of Cholesterol at 240…average of human measurements but considered high. The J-curves on foods show that too much of anything is bad as is too little. I also have a tendency to over do it. I would back off of everything for a couple weeks, try to rebalance, get back to before and then start adding things back one at a time. You can always go back to Vegan and add one thing at a time to see what works or not.
        BP also is affected by stress, do you try relaxation or breathing techniques? Have you measured your BP in different positions…lying down, sitting, standing, after walking, after eating, after workout, waking up? BP is one measurement in time and it has high variation. I take three readings and try different arms to see if there is major variation. My daughter would say to add yoga and back off weights.
        My wife would measure my pressure at the various positions and times, different arms, then my pressure response in the legs at different levels with pressure cuffs looking for flow obstructions or collateral vessels to see if there was any damage.. she would also look at my carotids and subclavians, which is standard practice in vascular ultrasound.

        higher pressure, means more cardiac activity. is the heart beat faster? do you have any new warm areas on your extremities, a sign of new blockage? new foods, do they take longer to process? Gluten worse now than before? Maybe it is a food sensitivity that is new?

        PD’s articles show no more than every four days per body part for heavy lifting, I probably overdo that by full body in one day, (it bumps up the pressure via higher heart rates for a day) but I am trying to minimize the time at high cytokine chemistry and inflammation. I let my body rest an extra day, so 5 days between workouts. The only other exercise is hiking/walking some good 2-3 miles a few other days per week, when I am not too sore. Many of the blue zones, the centenarians walk several miles per day…

        Life Extension is also another good place for science based ageing research. Their latest magazine has a lot on sugar = bad. But they don’t add new articles more than once per month. Wish I could be of more help, but being you are here, means you are on top of the latest info.

    2. Bill In Oz

      Steve
      I have never read or thought about EDTA and it’s chelating properties. So I did some googling around and found this site which has some interesting info about EDTA and CVD
      http://www.smart-publications.com/articles/oral-chelation-the-strongest-natural-treatment-for-your-heart-arteries

      Mind you it is a commercial site with b interest in promoting products. So I do wonder if the claims made should be taken with a grain of salt. But maybe worth a try !

      Reply
      1. Sasha

        I remember reading that oral chelation is inferior to IV chelation but I don’t remember the details. Physiologically, that would make sense, though.

      2. Bill In Oz

        Yes Sasha, the editors of the publication I linked to above make this same point. And also provide a link to medical practicioners in the USA who do use IV EDTA as part of their practice. And the article as such is informative.

    3. Jillm

      My first health priority is to keep my blood glucose and insulin stable in the healthy range. I have Dr Joseph Kraft’s book Diabetes Epidemic & You on my desk. Recommended.

      Reply
  23. Sasha

    A bit off topic but not really. I came across this study through reading themedicalbiochemistrypage.org which is maintained by a biochemist writing on food, supplements, and biochemistry.

    The study was published in The American Journal of Clinical Nutrition:

    http://ajcn.nutrition.org/content/105/1/85.abstract?sid=bb97834e-f2b9-416f-b375-33b2ee13c518

    Visceral adiposity and metabolic syndrome after very high–fat and low-fat isocaloric diets: a randomized controlled trial.

    An interesting read and something I would expect.

    Reply
    1. Eric

      Sasha, the actual article is behind a paywall. Would be interesting to know what kind of carbs or fats they fed people. I suspect there was plenty of seed oils which are obesogenic in combination with carbs (Peter at hyperlipid explains this very nicely). How are these minimally processed??

      And what kind of carbs were used?

      Reply
      1. Sasha

        Eric, do you mean to say that VHFLC group was fed seed oils as fats? If that’s your assumption, I doubt it. The abstract says that VHFLC group was fed a diet that derived 73% of energy from fats. You can’t get that from seed oils.

        I assume by minimally processed carbs they mean carbs close to their natural state since they were low-glycemic. Thus, no white rice, white bread, etc.

        It seems that the study replicated conditions we observe in traditional populations where both LC and HC people do not develop metabolic diseases as long as they stick to minimally processed foods. This is one of the biggest arguments against many LCHF claims.

      2. Dr. Göran Sjöberg

        Eric,

        I think you are right!

        It is always in the details the “devil” dwells! So when you want to disprove a theory deliberately you work with the details.

        E.g. ditching LCHF “scientifically” you should make sure that the content of the high fat part is obscured to start. You may label transfats as saturated fats which doesn’t have much to do with basic science or use PUFA’s as the fats in the diets tested. I could easily myself set up a research program to “scientifically” prove that LCHF will kill you.

      3. Eric

        Not sure how they managed to achieve 73% fat at only 10% carbs. Even a diet rich in nuts and stuff would probably end up at more than 10% carbs, and would also be full of linoleic acid.

        Even if they stuffed lard down poeple’s throats, it now cotains about 25% linoleic acis. Just look at Pete’s blog.

  24. Sasha

    And here are the biochemist’s interpretation of the study resulhttps://therantingsofamadscientist.blogspot.ru/2017/05/low-fat-high-carb-and-high-fat-low-carb.htmlts:

    Reply
  25. David Bailey

    I suppose the question is just what percentage of heart attacks happen in these abnormal ways.

    Extremely rare events might not tell us much – because they may be the result of some rare combination of circumstances, or some unrecognised genetic abnormality. Also, I can’t help wondering if the various diagnostic procedures are 100% reliable. Could it be that the report of “with complete occlusion of the proximal part of the left coronary artery” that you mentioned, is one such example?

    Is it possible that some people suffer a heart attack as a result of a blocked artery, but that blockage breaks free again before the heart is imaged? Is it even possible that such an event can cause death – yet leave a body with no arterial blockage on autopsy?

    Reply
      1. xtronics

        So – what if one has silent non obstructive MI’s? Do we have the arrow of causation backwards – what if these silent obstructive MI’s cause damage to the artery?

        So could some type of stress – causes lactate build up, spasm in a coronary artery – damaging the artery some of the time – enough to result in plaque?

        One thing I’ve come to realize – the more papers I have read for myself, the more I realize that the accepted narratives are not well grounded – and what I used to think I knew has to be retired – and now I know less for sure than I did 10 years ago when my quest started. Really nice to have a voice in the blog-o-sphere that is a bit humble. .

      2. Dr. Malcolm Kendrick Post author

        If your not humble, you are going to look pretty stupid, pretty quickly. Also, I think that silent plaque ruptures, with thrombus formation, that do not cause silent MIs are – primarily – the way that plaques enlarge.

      3. Bill In Oz

        Because plaque formation is the body’s way of healing damage to the endotelial layer ( and the glycocalix) of the arteries ?

  26. Dr. Göran Sjöberg

    To my opinion CVD and angina are not only connected but weird! There is definitely ” a man in the stairs” (I love your poem!) who I don’t want to see any more.

    For a few years now I have been taking high doses of natural vitamin E to keep my angina (and the man in the stairs!) at bay which seems to have worked pretty well but recently I have realized that I had to increase the dosage for the desired outcome. So I decided to consult the old book, “Vitamin E for Ailing&Healthy Hearts” by W. E. Shute, a severely yellow paperback one originally from 1969 but reprinted many times, from my shelves to refresh my mind since this was the book which put me on this trail.

    It is really a fascinating reading about all Shute’s successful clinical experience with his 30 000 (!) cardiac patients but and experience which all the time has been completely ignored by main stream (Big Pharma) medicine – no money! For me anyway it is a very convincing reading which fits my own, and Linus Pauling’s, idea about “science”. That the Shute Institute had to be closed down is in my “conspiracy” mind not surprising at all since the institute was a real threat to the big medical business. Here we are talking about the immense and established bullying power of our prevailing medical establishment. Oh – how disgusting!

    What though really takes me are all the case stories reported in the book and basically they all tell me to continue what I am doing – especially the hard work in my garden.

    Another intriguing point mentioned in the book is the interaction between the PUFA’s (vegetable oils (!)) where Shute claims that the vitamin E, as an antioxidant, takes care of those damaging reactive PUFA’s moving around in the blood stream. No support för a vegetarian life style in this book!

    Reply
    1. Bill In Oz

      Thanks Goran for your comment from your own personal perspective.. I feel that such remarks are worth far more than the abstract ‘link shooting’ comments that some of us – including myself at times.
      😦
      And thanks also for the info re Vitamin E and W E Shute. I have never heard of him before. But seek out more info on him……

      Reply
      1. smartersig

        Goran have you tried low fat v high fat meals and there effect on endothelial function. There is evidence that fatty meals cripple arterial function and I wondered what your experience has shown.

      2. Dr. Malcolm Kendrick Post author

        I just looked up one of the authors, of the diabetes journal article. Glenn Gaesser is a professor of Exercise and Wellness in the School of Nutrition and Health Promotion, and is director of the Healthy Lifestyles Research Center, at Arizona State University. Professor Gaesser has had prior academic appointments at the University of Virginia and UCLA. He is a Fellow of the American College of Sports Medicine. http://grainfoodsfoundation.org/experts/glenn-gaesser-phd/. He is also paid by the Grain Foods foundation. And, amazingly, he found that grain foods improve endothelial function. None of this fits, at all, with the knowledge that raised insulin and blood sugar are two of THE most endothelial damaging substances known. Could anyone be bothered to do so, I know they could find far more evidence to support damaged caused by carbohydrate meals, than fatty meals. Perhaps someone on this blog would care to try.

      3. smartersig

        Hi simple carb meals would in my opinion be a mistake but high complex carb meals in form of lots of veg is what I think most people mean when they talk about no effect on endothelial function. I am disappointed that you have pretty much trashed 4 research articles because one author in one of them has a grain attachement.

      4. Dr. Malcolm Kendrick Post author

        Discussion like this can bounce back and forward endlessly. I have spent thirty years reading literally thousands of papers on heart disease. My conclusion has been that almost all of the research suggesting that fat(s) are harmful have been done by those with a clear agenda. The anti-fat hypothesis was created by Ancel Keys, and taking up with enthusiasm, but with no evidence to support it. In the end, when it comes to fat(s) and CVD, here is what I believe to have been established. One, saturated fat does not cause, nor cure, CVD. Two, polyunsaturated fats neither cause, nor benefit CVD. Three, Omega-3 fatty acids have some slight benefits on CVD. Four Omega-6 fatty acids should not be eaten to excess, or they appear to have a mild causal effect on DVD. Five, trans-fats, cause significant harm. That is it.

        And yes, I do pay no, or little heed, to research done by those with a clear financial incentive to obtain certain results. I would place myself, in this, alongside John Ionnadis, Richard Horton, Marcia Angell, David Sackett, Fiona Godlee, Richard Smith and Peter Gotzsche. I didn’t trash the research, I simply ignore it.

      5. james

        Thanks Malcolm, that basically sums it up what I have been doing since two angina (heart) attacks some 15 years ago. No by-pass, no stents, no statins, Just a better diet, no highly processed foods, lots of veggies, but also lots of fruit, moderate meat, couple of eggs a day, limited intake of N-6. Fairly active, still run a 15 acre fruit farm with my 75 years. I am not anti vegetarians but it doesn’t work for me neither does it work for integrated sustainable agriculture. But I must admit that whatever we buy is organic, especially now we know that farmers are spraying all grain crops with Roundup (glyphosate- a chelator).
        And no we haven’t done this on a whim, even though my professional specialty was psychology, but with a minor in biochemistry. We have done our research over a dozen years which is a lot easier than when I did research for my post grad work in the late sixties.

      6. annielaurie98524

        That’s an interesting set of citations you provided:

        The last article listed dates to 1955.

        The Lancet article used a monounsaturated (not saturated) fat milkshake as the fatty meal. I couldn’t find out what else it contained (e. g., what sweetener was used).

        Dr. K addressed the potential conflict of interest in the Diabetes Journal citation.

        But the most interesting, at least in my view, is the Science Direct reference. Here, the researchers compared olestra (a synthetic, non-digestible fat-substitute) favorably with a presumably conventional “fat” (level of saturation unspecified). Olestra was discovered “accidentally” by Procter & Gamble in 1968. P&G tried to get approval for it as a cholesterol-lowering drug, but tests did not confirm its efficacy, so they got approval as a food additive. Olestra was named by Time Magazine in 2010 as one of the world’s 50 worst inventions. http://content.time.com/time/specials/packages/article/0,28804,1991915_1991909_1991785,00.html. It impedes the absorption of nutrients and causes severe gastric distress in many people. It does not sound like a good trade-off for a fleeting “improvement” in perfusion. I could not ascertain what the nature of the “conventional fat” was, nor who provided funding, due to paywall issues.

      7. smartersig

        The best thing to do, as I suggested, is try for yourself. Check your own post meal blood flow varying the type of meal

      8. annielaurie98524

        Why waste the money and time to do this? There are any number of impacts on various parameters that occur after eating a meal. They are transient. The human body has had 2.5 million years of dealing with those — if foods had permanent, deleterious effects on our physiological systems, the human race would have died out long ago. None of your references indicated what you claimed they did; none postulated or documented any lasting effects. I’m puzzled why you are so interested in having other commenters take action to “verify” your claims — e. g., suggesting that Dr. Sjoberg try your modified Esseltyn diet. Again, why? It sounds as if he is doing well with his approach, so why risk the potential problems that a drastic change in the macronutrient composition of one’s diet might precipitate? I have no desire to change my diet — been there, done that, long ago. I now have what works best for me, and it sounds as if many other member-commenters have also optimized their diet/exercise/lifestyle regimen to maintain/improve their health. Why change because “some guy on the Internet” (that’s not an insult, btw, just an accurate label) thinks they should try “his way”? As a retired engineer/scientist, I fall back on one of the basic maxims of engineering — “If it ain’t broke, don’t fix it”.

      9. annielaurie98524

        Yes, he does have angina. And he has used his natural curiosity and scientific knowledge to fix the problem, and has shared with everyone on this blog how he does it, including how to proceed with the lifestyle tweaks (minor adjustments) any health-conscious person needs from time to time as our bodies change. There is absolutely no evidence whatsoever that a drastic change in the macronutrient composition of one’s diet will totally eliminate any health issue, and it may precipitate some. It is a bit frustrating for me to discuss topics with you, as you do not address any issues that are raised, including the unlikely possibility that ordinary foods humans have eaten for hundreds of thousands of years are destroying our bodies, that your citations do not support your beliefs, etc. Your laser focus seems to be pushing for folks to try your Esseltyn-Ornish approach. I saw a quote from one of those docs, I believe it was Ornish, who said he was sure his diet would be a major medical “game changer”, and that he was surprised what an insignificant splash it made in the health field. Perhaps the reason for that is that there are far less drastic, far more natural ways to address cardiovascular health.

      10. smartersig

        I think Ornish has not been mainsteamed because there is no money in it for those who control medical care. I may be wrong but my understanding is that Goran still gets attacks from time to time, I was merely asking whether he had experimented with a WFPB diet to see if it helped as it would only take a few months to see if attacks receded. I was kind of hoping Goran might confirm he had tried in the past to no avail or perhaps confirm he has not for whatever reason. My interest on here is for open and reasonable discussion about all the various avenues and approaches. As I said Ornish has published in the Lancet reversals of angina and blockage through diet I would welcome any published trials showing steak and butter reversing or unblocking arteries. The problem seems to be here that I see the last sentence as just a statement about diet whilst others get prickly as they see it as an attack on perhaps their lifestyle and beliefs. As I have said before I am not a vegan nor a vegitarian so I am not hell bent on pushing that agenda for its own sake, I am interested in what works.

      11. annielaurie98524

        You have several times referred to the “steak and butter” diet. While commenters on this blog occasionally make a humorous reference to “steak and butter”, there is no “steak and butter” dietary regime which anyone is advocating. There is no serious health blogger advocating even a mostly meat diet. Please don’t say Paleo and show that you are completely ignorant about what a Paleo dietary regime is.

        I mentioned some of the various dietary regimes that health-conscious people are currently following in a previous comment. It’s not very helpful to resort to the strawman approach in comparing various dietary styles. As I noted previously, this is the aggravating thing that many vegans and near-vegans do — comparing, say, a pristine, organic vegan diet to the SAD (or the imaginary feedlot-raised-steak-and-butter diet to a vegan-pescatarian one) and crowing that the results prove the superiority of the vegan regime over all others. As you even admitted, some vegans are junk food junkies as much as any omnivore. And omnivore is the proper term for the human alternative to vegan – not “meat-eater”, “carnist”, or “carnivore”.

        As for reversing various disease states with HFLC, Paleo, keto and other diets, there are numerous examples. Google Dr. Dale Bredesen’s work with Alzheimer’s patients (a group with a far more intractable illness than CVD), where part of his protocol is a keto diet. Likewise, Dr. Thomas Seyfried has used a keto diet to treat intransigent forms of cancer, such as glioblastoma, successfully. Admittedly, these are relatively new therapies, as both diseases were, until recently, considered essentially untreatable. Chris Kresser, a functional medicine professional, did a series a few years ago on the diet-heart myth, with a template for customizing a Paleo approach to CVD prevention and treatment. Dr. Paul Jaminet has been mentoring patients with the perfect health diet, and cites a large, long-term Japanese study that shows a significant reduction in CVD (stroke and heart disease) http://perfecthealthdiet.com/2010/09/saturated-fat-reduces-risk-of-stroke-and-heart-disease/
        And a ketogenic diet has been used in obese individuals to bring classic “cardiac risk factors”, such as high LDL and low HDL, to levels that are considered markers for reduced CVD risk. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/ I won’t clutter this comment with any more citation scattershot, as you can easily google Bredesen et al.

        And then, there are all those “paradox” countries with high sat-fat consumption and low CVD rates that conventional medicine has spent decades twisting themselves into knots trying to “explain”.

        But, we are probably never going to see large-scale, double-blind studies on whole-food HF diets and their effects on CVD. Who would fund them? Merck and Pfizer can’t patent grass-fed meat, wild-caught salmon, avocadoes, almonds, etc. And double-blind studies on foods tend to use unappetizing, unnatural methods to disguise what participants are eating. But then, Ornish and colleagues haven’t done those studies on their regimes, either.

      12. Dr. Göran Sjöberg

        smartersig,

        I would also like to see the evidence on this since I am always trying to maximize on the fat content of my meals, especially with saturated fats like butter, lard, coconut and olive oil. Our personal experience tells us that the higher the fat content in our meals (optimum 75 – 80 %) the better we fare and the opposite happens when we increase on the carbs.

        It is though a weird “refutation” of what I now claimed when I had a healthy visitor for lunch today who claimed that he was “allergic” to fat, especially the fat part of steaks which he finds totally revolting. Myself I am always asking for a lot of extra butter to put on my ordered steaks. Well, we offered him a sallad on wild caught Alaskan salmon with a lot of a very fat sauce but here he didn’t have any hesitation on grabbing in on the sauce.

        But he admitted that his aversion against fats was “all in his head” and he couldn’t actually see the fat in the sauce but only to enjoy the good flavor from the fat, well known to all chefs.

      13. smartersig

        Goran, as a sufferer of angina does it not tickle your curiosity to try a few months on a whole food plant based diet with no oils simply to see if your angina improved. I cannot see a downside other than to report that no improvement occured

      14. Jillm

        I bought a glucose meter without paperwork from a doctor. My experiment: One hour after starting a meal of rump steak, including the fat, plus spinach fried in butter, my blood glucose was 4.9. A few days later, I tested after baked beans on home made wholemeal bread plus two pieces of fruit. Blood glucose 11.2. I retested 11.1. I have been a low carber since that day. Dr Joseph Kraft’s book Diabetes Epidemic & You is excellent. Ivor Cummins interviewed him. Fascinating.

      15. Dr. Göran Sjöberg

        Jillm

        Yes, a glucose meter is an excellent tool to monitor your “health”. I am using it almost every day to confirm that I am on “the right track”. Usually I find as you that my glucose levels are just excellent even after one of my meals.

        When I sometimes encroach on carbs I often find that the values get out of bound and also strongly relate to the amount of carbs ingested. This is to me pure science relating carbs an insulin among metabolically injured peoples like myself.

        And Dr. Krafts book is here a “pearl” with little talk and a bulk of experimental clinical data that speak for themselves.

      16. Eric

        Göran,

        do you care to outline how you succeed in getting 75-80% of calories from fat? Yes, I have read about the steak with butter part, but I can’t picture you drinking glasses of oil or wulfing down jars of nuts…

      17. Dr. Göran Sjöberg

        Eric,

        To tell you the truth I have never done any calorimetric calculations. I am just using my intuition to maximize fat and minimize carbs but I am not eating butter with a spoon 🙂 Green leaves doesn’t seem to ruin the meals.

        As far as I have understood it (not least based on the Bellevue Hospital carful testing on Dr. Andersson and Vilhjalmuhr Stefansson about a hundred years ago in order to refute their claim that it is possible to live on an Inuit diet) the upper limit of fat in the diet is where you get dissatisfied/disgusted with your meal. To my opinion you should be just below that limit which should be around 75 – 80 % of your caloric intake.

    1. Bill In Oz

      Smatersig, I think you misrepresent Denise Minger’s current thinking with this comment. The link you provide to to an blog article she wrote on her blog back in 2012 in response to the vegan focused China Study book by T Colin Campbell. Check out her later writings on her blog. This one for example :
      https://deniseminger.com/2015/10/06/in-defense-of-low-fat-a-call-for-some-evolution-of-thought-part-1/

      There you will find these interesting remarks in her blog article about low fat diets
      “Something special happens at very high levels of fat intake (and very low levels of carbohydrate intake). That thing’s called ketosis. It’s where your body creates ketones to use when glucose is scarce, and where fat metabolism is optimized.

      Something equally special happens at very low levels of fat intake (and very high levels of carbohydrate intake). I’m not aware of a formal name for this, so I’m dubbing it carbosis until further notice. It’s a state where insulin sensitivity dramatically improves, and where carbohydrate metabolism is optimized.”

      Reply
      1. Dr. Göran Sjöberg

        Bill,

        I was really impressed by Mingers debunking of veggie.

        Another “killer” of veggie that impressed on me was Lierre Keith who dug deep into this issue in her book “The Vegetarian Myth”

      2. smartersig

        I have met plenty of veggies that eat a very unhealthful diet, like a diet containing meat it can be healthful or not depending what you populate it with

      3. Bill In Oz

        Goran, I respect Denise Minger a lot. She is a fearless researcher in the whole field of diet and health. And even willing to be humble and admit she is wrong and even apologise when this happens.

        The article I linked to does exactly this about the whole issue of fats and carbohydrates in the human diet. A high fat diet works for some people. And a high carb diet ( of the right carbs ) works for some people as well.

        I suspect that there is an interaction of genetics, microbiome and cultural dietary habits which makes each of use unique. There is no one best diet for all humans. on the planet.

      4. smartersig

        I would agree with that, it is important to remember that lowering fat (I am not pushing this) does not mean higher simple carb’s. I eat something in between a Pescitarian and Vegan diet I guess and I would consider it low carb but only low simple carb’s so for example I avoid bread. A lot of people think low carb means high fat and high meat because of the Atrkins connection.

      5. Sasha

        It’s also possible and maybe even probable that our gut microbiome changes and adopts to the foods we eat. It may happen within months of one’s life let alone in generations of people eating a particular diet. That’s why to me the argument “let’s give up grains we’ve only been eating them for the last 12,000 years” doesn’t make sense.

      6. Sasha

        True. It’s possible, though, to find bread made from heirloom grains and according to old methods.

      7. smartersig

        I agree and it is also possible to find meat that has not been injected with antibiotics and raised on corn but for most people sourcing these and affording them is not possible.

      8. Sasha

        That’s not true. There’s plenty of meat that’s raised without antibiotics and is grass fed. As far as being able to afford it, you don’t need to eat meat daily and it was never the case for most people evolutionary. Food was more often scarce than not for most of our existence for majority of people.

      9. Dr. Göran Sjöberg

        Bill, my basic take on the issue of carbs versus fat is that you should not indulge more than you can “take”.

        About 50 % of the world populations have now turned insulin resistant, i.e. pre-diabetic, and thus entered into the “metabolic syndrome” which means that they tolerate carbs badly. It is this people who should avoid the carbs and go high in fat instead to my opinion and experience.

        If you are young and healthy you can probably, as I did myself, “abuse” carbs for about twenty years although I was myself able to do it for 50 years until I had to “pay”. Lierre Keith just managed to stay twenty year on the veggie diet before the payment was due.

      10. smartersig

        You were a veggie for 50 years !!, just kidding.
        The high carb diets the western world is subjected to is not IMO comparable to a HFPD high carb diet. In other words the high carb of Okinawa’s is not comparable to a high carb western diet of french fries, bread and buns. Sorry to be nit picky about this but ti comes from talking about low carb perhaps incorrectly on my part and I should always say low simple carb.

  27. daveketo

    Another excellent article, Malcolm! I have to be careful visiting your site as I often lose half a day reading through many of the impressive comments by your readers as well. Perhaps we’ll run into each other at one of the conferences at some point. 🙂

    Reply
  28. Steve

    answer to the NIH curve for Vitamin C, they measured the blood levels at every hour, so the X axis is hours, showing therapeutic levles easily obtainable via oral administration, at 2-3 grams every couple hours.

    Sorry, have been traveling the last few days. however, the good news is that I dug out the wife’s Vasular tech books and am reading up on viscosity and lots of good info on strokes, flow, circulation and collateral pathways.

    So here is the Engineering approach that the medical community uses in their textbooks:
    Flow Q = P(Pi)(r^4) / 8nL
    where P= pressure gradient across arterial segment
    r=radius of the vessel
    n= Fluid Viscosity (Blood)
    L= vessel Length
    this is called the Poiseuille Law
    Flow is proportional to the pressure gradient and the size of the artery. Flow is inversely proportional to the viscosity of the blood and the length of the vessel. We can rearrange this equation in any form you would like to concentrate on any variable.

    So the driving force in this equation is definitely the radius of the vessel, or diameter changes. because it is multiplied by itself 4 times, which means that the diameter change of the vessel is a huge contributor when anything bad happens!

    Ok, so let me give some more input here. based on the other findings and discussions on viscosity and vascularity. This system in our bodies is not a constant (unfortunately thats the nature of the situation), in fact things are constantly changing, as we contract muscles, as we stand or sit or lay down. But all things being equal, changes to the arterial diameter have the largest effect on FLOW. diameter changes can be driven by movement, but also they can be greatly affected by hormones, especially stress hormones. So I am saying that this has a larger affect than viscosity, but…can viscosity increase and push the system to adapt, by releasing hormones to reduce the diameter? Remember this constant change, because I think that a lot of science gets it wrong when theories are based on static cases. Many things in science are moving and constantly changing and we have to take this possibility into account.

    The missing man
    one of the missing men here that seems to save people with occlusions is COLLATERAL PATHWAYS. in the brain we have the Circle of Willis, the size of a 50 cent piece, that takes flow from the carotids, vertebrals (from the subclavians) and feeds the cerebrals. If one of the Carotids or vertebrals is completely occluded, the circle of Willis feeds the rest of the system. a built in backup or redundant system with 4 inputs and two outputs.

    Likewise If we look at the heart, there are a several collateral pathways that are available, I don’t have all their names but I see they are mentioned. so we have built in redundant systems to take care of arterial issues…almost like it is expected to be a problem. Could be something that has been evolved as we lost the capabiilty to produce Vit C?

    Other vascular changes are possible. as Dr. K pointed out EEXX i forgot, the acronym, where they try to drive the use of or increase in vascular connections by using a pressure wave. I would surmise that the body compensates and maybe does not use this backup system in the heart or that it is sometimes not fully formed. the Vasc Tech book indicates that even the cerebral backup system is sometimes not completely functional as well.

    back to the textbook:
    in mechanisms of disease they describe:
    – Transient Ischemic Attack – TIA is fleeting neurologic dysfunction without lasting effects, with sysmtoms lasting a few minutes to a few hours, but never more than 24 hours. the etiology is usually embolic, with the heart or carotid artery mas typical source.
    – Reversible Ischemic defect -RIND usually lasts longer than TIA, but the defecit created resolves in time. This is complete recovery from damage.
    – Vertebrobasilar insufficiency – VBI usually causes bilateral symptoms, visual blur, parasthesia complaints of vertigo, ataxia and drop attacks.
    – Cerebrovascular accident of stroke – CVA produces permanent deficit three possible:
    – acute: sudden onset, unstable
    – stroke in evolution: symptoms come and go, considered instable
    – completed stroke: no progression or evolution of symptome, considered stable

    RISK FACTORS
    1. diebetes mellitus – the chronic complications are primarily vascular!!!!
    2. Hypertension – may be causitive factorin development of arterial sclerosis or enhance development therof. it MOST CERTAINLY helps to precipitate climical events associated with AS, e.g. embolism and aneurisms!!!!!
    3. Smoking – associated with irritation of the endothelial lining!!!!!
    4. Hyperlipidemia – they say it is closely associated with development of AS.
    These are from the textbooks of people constantly looking at vascular via ultrasound, the text is Davies, Vascular Technology, an Illustrated Review by Rumwell & McPharlin

    so there we have it from the authored sources of the latest info from the people performing the inspections. Lots of good input, hopefully this sheds some light on the missing man, the key contributors. there is a lot more here about mechanisms of disease; stenosis via fatty streaks, fibrous plaques, complicated lesions, ulcerative lesion, and interplaque hemorrhage which result in Embolism, thrombosis, aneurism. there are also nonathersclerotic lesions, Arteritis, Carotid Body, Collagen disorders (vitamin C?), Dissection, False Lumen, FMD, Neointimal Hyperplasia. A can of worms but Carotid Body is a chemoreceptor sensitive to oxygen changes in the oxygen tension of the blood and signals changes to respiratory activity to maintain homeostasis. Hyperplasia is a response to vascular injury resulting in platelet accumulation, endothelial regeneration and proliferation of smooth muscle cells.

    So the key contributors to problems in vascular tech are:
    Flow is affected greatly by the change in diameter of the artery (or vein)
    Viscosity is not as big an actor, but it is inversely proportional to flow
    Diabetes is mentioned in the textbook as the key contributor with vascular complications
    Hypertension is mentioned a the key contributor to precipitation of clinical events

    So I am now leaning more towards hypertension induced hormonal drivers which drive flow changes, with damages caused by diabetes that cascade into clinical events??

    anyways, quite an education.

    Reply
  29. Steve

    Dear Dr. K,
    How much do you want to get into with vascular inputs. The textbooks have a huge amount of information. Venous Hemodynamics is the next chapter and to cover it all is a tremendous effort, but it is a huge area with lots of pertinent information. There is a chapter on arterial evaluations: lot of discussion of Arterial flows, possible issues another place where there is discussions of flow separations with pressure gradients, bifurcations, curves, peripheral resistance, etc.

    Are there any areas you would like me to focus?

    Thanks

    Reply
  30. Steve

    OK, so I had some extra time and Bill is having a BP issue, so i am outlining chapters from the vascular Ultrasound texts. there are some things to think about, not any really exciting stuff,fills in some things about how the system works all the way through

    Outline of Physiology and Fluid Dynamics, chapter 2, Vascular Technology Davies, 4th ed 2011
    Arterial system
    Energy
    Blood flow characteristics
    Pressure/Flow (Reynolds)
    Pressure/Velocity (Bernoulli)
    Steady State Pulsatile Flow
    Peripheral Resistance
    Collateral effects
    Effects of Exercise
    Effects of stenosis on Flow

    Arterial system
    Oscillates every beat, delivers apprx 70 ml of blood every pulse into the aorta with a pressure wave. At the beginning of the cardiac contraction, the pressure in the left ventricle rises rapidly, exceeding the aortic pressure so that the valve opens, blood is ejected and pressure rises with the stroke volume.
    Increased heart rate = increased volume and likewise lower HR = Lower Volume. Cardiac status plays important role.
    Heart pump generates pressure, the stroke volume creates the pressure wave throughout the system. The speed, shape and strength of the pressure wave changes as it moves through arterial system. As the wave moves distally away towards the periphery, the propagation speed (pulse wave velocity) increases with the growing stiffness of the arterial walls.
    Variations in the characteristics of the vessels influence the alterations of blood flow, velocity and direction vary with each beat. As the pressure wave goes from larger to smaller (high resistance) vessels, capillaries then to the venous side, the mean pressure gradually DECLINES from fluid energy losses.
    The pump action of the heart maintains a high volume on the arterial side to sustain high pressure gradient to maintain flow.
    CARDIAC OUTPUT GOVERNS THE BLOOD VOLUME ENTERING THE ARTERIAL SYSTEM WHILE ARTERIAL PRESSURE AND TOTAL PERIPHERAL RESISTANCE DETERMINES THE VOLUME THAT LEAVES BY CONTROLLING VASOCONSTRICTION IN THE MICROCIRCULATION!!!
    A LARGE PORTION OF THE ENERGY FROM EACH LEFT VENTR CONTRACTION STRETCHES THE ARTERIES, PRODUCING AN ARTERIAL RESERVOIR THAT STORES BLOOD VOLUME THAT PROMOTES THE FLOW OF BLOOD DURING DIASTOLE THAT IS RELEASED WHEN THE WALL RECOILS!!!
    Gravity effects
    In supine patients there is negligible difference in the hydro pressure. Near the ankle pressure is near zero mmHg, When standing, hydro pressure of 100mmHg is added to the mean venous pressure so the ankle reads 100. The arterial pressure at the ankle will be 195 mmHg which is 100+95. Note the venous pressure is much higher than the arterial!
    Movement only occurs from a higher pressure to a lower pressure via a pressure gradient. As the energy dissipates away from the heart, the heart pumping action maintains the energy.
    Flow velocity and the cardiac cycle: during early systole, acceleration phase of the pulse, pressure is even . The greatest energy is at peak systole, where the highest velocities are observed. During deceleration, late systole/early diastole, output decreases and pressure declines due to peripheral resistance.
    VISCOUS FORCES, in the circulatory system, energy is lost on the form of heat as layers of red blood cells rub against each other. The thicker the blood, the greater the molecular force or energy is required to move it. Energy loss is mostly due to friction, which is partly due to the shape of the vessels. Although vessel length and viscosity also affect resistance and flow, vessel diameter has a most dramatic effect.
    Energy loss can be inertial in manner by changes in the direction and/or velocity. Flattened flow becomes disorganized, especially at the end of a stenosis.
    Velocity= Flow volume/Area. Vessel length and viscosity do not change much (according to the authors here), but vessel diametric changes are the main cause of blood flow changes.
    Pressure/Flow Relationships
    Flow is usually streamline, but becomes unstable and breaks up into small circular eddy currents and vortices. FLOW VOLUME INCREASES AS PRESSURE INCREASES, BUT ONLY TO A POINT, AS FLOW CHANGES FROM STABLE TO DISTURBED. AS PRESSURE INCREASES FLOW VOLUME, IT INCREASES FLOW DISTURBANCE CONTRIBUTING TO MORE EDDY CURRENTS.
    This has to do with Reynolds number, where Re=Vq2r/n where V=velocity, q=density, r=radius, n=viscosity. In this relationship, all variables have equal weight. The text says that blood density and viscosity are pretty constant…but we know that this may not be true. However, the laminar flow becomes disturbed for many reasons; body movement, blood pulsing, vessel irregularities, plaque.
    Bernoulli
    Fluid energy is a total of kinetic, potential and gravitational energies. If one of these changes, the others must change to maintain total fluid energy. Velocity and pressure are inversely related, such that an increase in velocity requires a reduction in pressure for conservation of energy. The converse is also true that increased pressure requires lower velocity to maintain steady state.
    The difference in pressure between two points in a vessel is called flow separations. These can be caused by changes in vessel geometry (with or without intraluminal disease) or by bifurcation or curves. At Flow separations, there may be regions of stagnant or little movement.
    Steady vs Pulse flow
    In steady flow, states are easy to analyze as the states are predictable. PULSATILE FLOW REFLECTS CHANGES IN DRIVING PRESSURE CONDITIONS AND RESPONSE OF THE VASCULAR SYSTEM. Unsteady conditions reflected by fluid acceleration, deceleration and rest and affect fluid behavior. During late systole there is even temporary reverse flow resulting in phase shifting of flow throughout the system. As pressure waves move through the system, the vessels recoil, maintaining flow farther from the heart. Flow always follows the least resistance. Diastolic flow reversal is a normal of vessels that supply high resistance peripheral vasculature. Flow reversal decreases or is absent with vasodilation which can be produced by body heat, exercise, and stenosis. Flow reversal is also not evident in the presence of arteriovenous fistula. Flow reversal increases in vasoconstriction!
    PERIPHERAL RESISTANCE
    Low resistance flow is steady throughout systole and diastole feeding dilated vasculature. This flow is characterized in the internal carotid, vertebral, renal, celiac, splenic, and hepatic arteries.
    High resistance pulsatile flow, with hydraulic reflections producing reversals are displayed in the external carotid, subclavian, aorta, iliac, extremity arteries and fasting superior mesenteric arteries.
    In response to vasoconstriction, the pulasatility of flow in medium and smaller arteries of the limbs INCREASES, but decreases in the minute arteries, arterioles and capillaries.
    In response to vasodilation, pulsitality of flow in medium and small arteries of the limbs DECREASES, but increases in the minute arteries, arterioles and capillaries. As perfusion pressure diminishes as a result of stenosis, the response of the high resistance peripheral vessels is to vasodilate to maintain flow.
    Collateral Effects
    In an extremity at rest, blood flow may be normal, even in the presence of severe stenosis or complete occlusion due to the development of collateral networks, as well as decreased peripheral resistance. Arterial obstruction may alter flow in nearby or more distant collateral channels, increasing volume flow, reversing flow or increasing velocity and /or altering pulsatility of the waveform. The location of collateral vessels helps to provide indication of the obstruction level.
    Secondary collateral changes provide some info on adequacy of the collateral system development or response.
    Effects of Exercise
    Exercise typically induces vasodilation of the microcirculation reducing peripheral resistance and increasing flow. Peripheral resistance can increase in response to heat, cold, tobacco and emotional stress. Vasoconstriction and dilation within skeletal muscles are also influenced by the sympathetic innervation fibers to regulate body temperature. Autoregulation also controls constriction and dilation to maintain constant flow at variations in pressure. During exercise the flow volume may increase as much as 10x.
    Autoregulation does not work normally when perfusion pressure drops below a critical level. High resistance vessels constrict in response to increased blood pressure and dilate in response to decreased blood pressure.
    By decreasing resistance in the working muscle, exercise normally decreased flow reversal in the extremity. The same can happen in response to proximal arterial obstruction.
    During exercise muscles need increased levels of oxygen and metabolites, while removing metabolic wastes, CO2 and lactic acid. Characteristics are; low oxygen tissue tension, increased CO2 and lactic acid levels in tissue, epinephrine from the adrenals, increased potassium ions, Endothelium mediated nitric oxide (NO) causing smooth arterial muscles to relax.
    During exercise heart rate and cardiac output increases, blood is shunted from the viscera to skeletal muscles, capillary A-V shunts close, 100% of capillaries open, dermal vasoconstriction.

    Effects of Stenosis
    A significant stenosis causes a major reduction in volume flow and pressure. A stenosis becomes hemodynamically significant with 75% area reduction which corresponds to a 50% diameter reduction.
    Two or more stenotic lesions in a series have a greater effect on volume flow and distal pressure than a single long lesion due to very disturbed flow patterns, turbulence and eddies. Many factors include; Length and diameter of the stenosis, roughness of the endothelial surface, shape and degree of narrowing, arteriovenous pressure gradient, Peripheral resistance distal to the stenosis, and collateral circulation.

    Lots of info . Hope it is helpful.

    Reply
    1. Bill In Oz

      Hey Steve
      What a huge bundle of info ! Thanks !

      I read the section about viscosity and this comment with interest ” The thicker the blood, the greater the molecular force or energy is required to move it.” Yep tht’s my own intuitive understanding. But I suspect that medical science & doctors have not cottoned on to this yet. My GP’s reaction to my initiating a discussion n viscosity being a good example. He said quite simply “i do not know about this.” ( And for that honesty I was grateful. )

      I read your comment about bp responding to exercise with interest as well. I was at the gym this morning for about 90 minutes.Then had lunch and then went out to a mate’s farm to help him there for a couple of hours; quite physical work. After all this I had my bp measured at the Australian Red Cross blood bank as part of providing a blood donation. ( Measured on a brand new fancy $3000 machine ) It was 163/85. And that is the lowest it’s been for a month despite the daily BP meds. So clearly exercise and physical work are part of the solution to hypertension.As explained by your latter remarks.

      And blood donation is mentioned time & time again as a way to reduce blood viscosity and also over time helpful in reducing bp. I will keep folks here posted on how that pans out. My own experiment on myself.Not a random double blind study with a placebo at all.But for me it will be useful.

      Reply
      1. Steve

        Great to hear your improvement Bill. A positive reaction/result is always welcome. I went off resveratrol/pterostene from Life extension a few weeks ago, then started feeling weaker than normal. I went back on it a week and I already feel better/stronger. probably will not cycle off of it again. I do however cycle on and off IP6 and I see that it has blood improvement capabilities by chelating iron and reducing ferritin levels, similar to giving blood. PD has a paper that shows those with the highest Phytate have the lowest all cause mortality. same with Dr. K’s data on potassium, and others on magnesium. We have seen that having newer blood cells reduces viscosity and a host of other ageing affects and diseases. May be part of the reason women have much lower HA risk prior to menopause. you may be on to something with this being part of the aging process, as most humans tend to increase BP as they age.

        I would push ahead as you are doing, be your own experiment and keeping us up on what works and doesn’t work will help others.

    2. Martin Back

      Interesting. A couple of things struck me as I was reading this.

      – 70 ml per heartbeat. Given there is about 5,000 ml of blood in the body, this gives about 72 beats to pump all the blood, i.e. the “lap time” of any blood particle to go around the body and back to where it started is about one minute at 72 bpm.

      Of course, blood rushing through coronary arteries and back to the heart has a much shorter path than blood wending it’s way down to the toes and back again, so one minute is just an average, it doesn’t apply to every bit of blood.

      – Expansion and contraction of the arteries means the arterial blood flow is more accurately modelled as a system of rigid pipes with a balloon reservoir somewhere in the system. As the heart contracts, it pumps blood through the pipes and blows up the balloon as well, absorbing some of the pressure, but then the balloon is fully distended and pressure in the pipes rises to a peak, then the heart relaxes and the balloon deflates, pumping the last bit of blood through the pipes.

      – Gravity effects. I wondered what happens to astronauts weightless in space.

      The team of researchers found that the shift of blood and fluid from the lower to the upper body caused by weightlessness was much higher than previously thought. The blood volume burden to the heart was also more than expected despite the heart rate remaining the same. At the same time, blood pressure was considerably reduced by 10 mmHg, which corresponds to the effect of normal blood pressure medication against high blood pressure. — https://www.sciencedaily.com/releases/2015/01/150114101638.htm

      Reply
      1. Steve

        Nice data on the space effects. I use an inversion table for my back to keep the fluids moving and decompress the spine. I wonder if this helps BP? I don;t know why I have such low BP, I was always 120/80 until I reached 50, then it dropped…I also started taking more vitamins and worrying about HA, cleaning up my diet. But inversion has lots of benefits, activating the lymph system, decompression of most joints. It definitely helps my back muscles not seize up, and when they do it only takes a few minutes inverted to relax them.
        I have not stepped into a mcdonalds in more than 15 years, the only soda I have in the last decade was sweetened with stevia.

  31. Steve

    Venous system

    Venous Hemodynamics
    Venous resistance
    Hydrostatic pressure
    Pressure/volume relations
    Effects of muscle pump mechanism

    Venous resistance
    Unlike arteries, veins are very compliant, expanding under pressure and collapsing when pressure reduces below surrounding tissue. Shape changes from round to elliptical and flat are common.
    Typically the cross sectional area of the veins are 3-4x larger than their corresponding arteries, the veins can carry more blood volume without an increase in pressure. If the veins were not compliant, increasing pressure would decrease the pressure gradient and reduce flow.
    Hydrostatic pressure
    the pressure increase by standing up, via the weight of the column of blood. When standing up, the pressure on the ankle increases by 100 mmHg.
    Pressure/Volume
    Even small increases in pressure cause veins to expand and change shape towards a round section. Much greater pressures are required to expand it further since the walls of an expanded vein are no longer compliant.
    Muscular Pump Mechanism
    Constriction of leg muscles squeezes the veins and propels the blood toward the heart. If the venous valves are working, blood will only travel in one direction. The normal venous flow pattern decreases venous pressure and pooling and increases venous return to the heart and cardiac output.
    With dysfunctional venous valves the opposite occurs, venous pooling and pressure increase and venous return decreases, which can decrease cardiac output.
    Although at rest the veins act a reservoirs, during activity they propel blood toward the heart. The power for this is the contraction of the leg muscles, especially the calf muscle, which can be referred to as the venous heart. When the calf muscle relaxes, blood moves from the superficial veins to the deep venous system. This process reduces peripheral venous pressure.
    Respiratory Variation
    Respiration greatly affects venous flow. Inspiration decreases intrathorasic pressure but increases intraabdominal pressure as the diaphragm descends. Increasing flow from the upper extremities and stopping flow from lower extremities. Expiration does the opposite, increasing venous flow from the lower extremities, while halting flow from the upper extremities.
    Flow in the portal vein of an adult is minimally phasic as there is almost no variation with respiration.
    Other references state that the intraabdominal pressure can collapse the IVC and reduce flow to the lower extremeties.
    Smoking constricts veins
    Anatomy of Arteries
    Endotheium is the single cell layer in contact with blood and allows: Permeability of nutrient and gases, prevents platelets and white blood cells from adhering to the artery wall and releases endothelin and prostacyclin which causes the artery wall to vasoconstrict and vasodilate respectively.
    Media the middle layer consists of smooth muscles, collagen and the external elastic membrane. The Adventitia is the outer layer consisting of connective tissue and collagen and the vasa vasorem, tiny blood vessels that supply the artery wall.

    Reply
    1. Martin Back

      “When standing up, the pressure on the ankle increases by 100 mmHg.”

      100 mm Hg is equivalent to a column of blood 1.28 m high, which I suppose is the height of the heart when standing up for an average person. (1.28 m is the height of my adam’s apple, but then I’m small, only 5’2″ tall.)

      “Endothelium is the single cell layer in contact with blood”

      This has led to a lot of confusion. At first I thought the endothelial layer was only one cell thick, but now I believe there can be many layers of endothelial cells forming the inner wall of the blood vessel. However, it is only the innermost layer of cells in actual contact with the blood which is referred to as THE endothelium. The endothelial cells between the endothelium and the media, like Fight Club, we don’t talk about.

      Reply
      1. Dr. Malcolm Kendrick Post author

        Indeed, I have come to accept that the endothelium is definitely more than once cell thick, at least in certain parts of the vascular bed. I am not sure how much this changes things.

  32. Doug

    Who here knew that “licorice poisoning” was a thing? We focus so hard on diet but even with diet there are outliers.

    http://nationalpost.com/health/how-jelly-beans-made-a-canadian-man-deathly-ill-and-highlighted-the-dangers-of-licorice

    “In Italy, a young boy came to hospital after suffering a sudden cluster of tonic-clonic seizures that were blamed on swelling of the brain related to hypertension. He had been eating licorice toffees for four months, ingesting 72 mg of glycyrrhetinic acid a day, according to another 2015 study.”

    “The 51-year-old man showed up at the emergency ward in crisis. He’d been suffering abdominal pain for three days, then appetite loss, vomiting and dry mouth. Tests showed he had both dangerously high blood pressure and hypokalemia — low potassium levels that can lead to lethal heart arrhythmia”

    We focus on stress but who here thought that just watching sports could more than double your heart rate?

    https://www.medicalnewstoday.com/articles/319621.php

    “A heart rate increase of 110 percent is equivalent to the cardiac stress resulting from a session of vigorous exercise, and a 75 percent increase is the equivalent of that resulting from a session of moderate exercise.”

    “The study also found that such peaks in heart rate occurred more frequently than expected. In fact, viewers’ hearts were racing during any scoring opportunity throughout the game and in overtime, either for their team or against it.”

    And what about sleep? People suffering from PTSD show a 75 to 80 % reduction of nightmares when using the high blood pressure medicine prazosin, which dampens adrenalin’s effect on the heart.

    https://www.huffingtonpost.com/dr-douglas-fields/nightmares-in-ptsd-dont-g_b_422368.html

    I personally believe that taking honey before bed can have the same effect. I’ve mentioned it a couple of times here.

    It’s the old question of which comes first the chicken or the egg. What comes first the nightmare or the adrenalin? Conventional thinking is that the nightmare releases the adrenalin but what if the brain releases the adrenalin for another reason and the dream becomes a nightmare because of the body’s reaction to the adrenalin?

    Here is a study that shows if you control adrenalin the dream doesn’t feel like a nightmare. I believe that these PTSD sufferers still have the same dreams but because the body doesn’t react to adrenalin (it’s being blocked) the dream doesn’t feel like a nightmare. Notice I used the word ‘feel’. We feel nightmares because there is a physical reaction to the release of adrenalin.

    Please, someone from this group of explorers please read “The new honey revolution” and try taking honey. I promise it won’t hurt. And if any of your children or grandchildren suffer from bad dreams or night terrors definitely have them try it. My daughter was suffering nightly bad dreams about death as most children suffer from and consequently would refuse to fall asleep for a hour or so each night. Just a half tablespoon each night and she immediately falls asleep (10 – 15 min) and hasn’t awoken from a bad dream since.

    Dr. K, if stress is a leading(?) Factor in CVD and nighttime stress from nightmares is a real thing wouldn’t putting a stop to them be beneficial? If the body can be tricked into doubling its heart rate just by watching sports could the same not be true from experiencing nightmares?

    P.S. Great blog. I’m a total believer in Seneff’s work. Our entire existence is made possible by the subatomic attractions, think electrons, protons and neutrons. Ions of atoms either have extra or are missing charges (electrons) and they are responsible for some pretty funky stuff. Why wouldn’t our human bodies be using attractive and repulsive forces? They are the dominate force at the nano scale.

    Reply
    1. Sasha

      At the root of it, it probably is all about attractive and repulsive forces and expansion and contraction. A million dollar question is how to properly understand it and translate it into tangible health outcomes. I think that acupuncturists have been struggling with that question for 2-3 millenia, if not longer…

      Reply
  33. Stephen T

    I think many people will enjoy this. Aseem Malhotra on statins, Sir Rory Collins, stents, breast cancer and much more

    Reply
    1. Dr. Göran Sjöberg

      Stephen

      Thank you for this link to this Malhorta talk.

      The content of the talk is also my own firm view on stenting, statins and CABG although Malhorta must have a more cautious attitude than myself. As Malcolm I guess that he mustn’t allow himself of any “sidesteps” if he wants to keep his medical license intact. They are both to my opinion working fine to clear up the minefield they are both moving around in.

      It is truly a sick corrupt medical world we are living in.

      Reply
      1. Stephen T

        Glad you liked it, Goran. Genuine consent means giving patients the facts, not just what suits the system.

        43% of cardiologists would still fit stents even when they know they’re useless? Are operations done just to keep cardiologists in work? This is as wrong as wrong can be.

      2. chris c

        54% of dieticians DO NOT recommend carbohydrate restriction for diabetics.

        This has led to an ongoing study, not into how many carbs would actually benefit diabetics, but how many carbs *dieticians believe* would benefit diabetics.

        Only 1 recommended a ketogenic diet. I wonder how many would actually permit their diabetics to use a glucometer, or better still a CGM, to work this out for thenmselves.

  34. Sylvia

    Doug, I had an aunt who became quite ill, turns out her potassium levels were way out of kilter because it was discovered she ate licorice, lots of licorice.
    I am with you on honey, it’s ingredients collected by glorious insects when the sun is shining and then like liquid gold poured on thick Greek yogurt, sublime. Only need a little, a teaspoon is enough, I know it is a sugar but it has beneficial vitamins and minerals.

    Reply
  35. Dr. Göran Sjöberg

    Since the question of a carnivore versus the vegetarian way of life has turned out to be a part of this blog I earlier mentioned a knowledgeable person who switched from 20 years of vegan life to restore her health on a “balanced diet”; Lierre Keith.

    Now, I listened to an intervju with her and I have to say that my view, on this broad connection between health and the way we produce food, is in full agreement with what she is saying in this interview. If you are interested please view!

    Reply
    1. smartersig

      Thanks Goran, I am a bit suspicious when one person pops up with health problems and attributes it to their veggie type diet when so many people do just fine even live the longest on a similar diet. Often it is probably down to poor formation of a veggie based diet as their are very few essential nutrients missing from a well balanced veg diet. Do you have a link to her talk I would like to check it out before getting the book

      Reply
      1. Dr. Göran Sjöberg

        Philip,

        Thanks for the link to the review of “The Vegetarian Myth” by Dr. Michael Eades. I fully agree with the following quote from the review.

        “But I can tell you that Lierre Keith’s book is beyond fantastic. It is easily the best book I’ve read since Mistakes Were Made, maybe even better. Everyone should read this book, vegetarian and non-vegetarian alike. If you’re a radical feminist, you should read this book; if you’re a male chauvinist, you should read this book; if you have children, especially female children, you should read this book; if you are a young woman (or man) you should read this book; if you love animals, you should read this book; if you hate vegetarians, you should read this book; if you are contemplating the vegetarian way of life, you should definitely read this book; if you have a vegetarian friend or family member, you should this book and so should your friend. As MD said after she read it, “everyone who eats should read this book.”

      2. smartersig

        Denise Minger makes an interesting point about Vitmain A deficiency on plant based and the BCMO1 gene but I needed to dig a bit further because she only skips over the idea. When looking at your 23andme profile as I have just done it seems you need to look at whether you carry the T allele at rs12934922 and the T allele at rs7501331 of BCMO1 which would mean 60% less active in conversion hence a need to get more Vit A. My profile on both comes out at C/T.
        Anyone any idea what this means, am I 30% less likely or is it saying they cannot nail so I could be 0% less likely or 60% less likely to convert properly. Any help appreciated.

      3. smartersig

        I have listened to the authors interview and she has a lot in common with Denise Minger in that she was a vegan when she got sick. What I find strange is that she now thinks Vega/veggie diets are bad for all of us, I lost count of the number of times she used the word ‘death’. You cannot visit Loma Lindy or other non or low meat eating pop’s and say Veganism pers se is bad. As I said before I have seen fat overweight unhealthy vegetarians.

      4. Dr. Malcolm Kendrick Post author

        Low meat eating is not veganism. The seventh day Adventists are not even vegetarian, let alone vegan. At the risk of repeating myself once too often. I cannot see any strong evidence that any particular diet is healthy, or unhealthy. However, those who do not deal with carbohydrates, and/or develop high insulin levels/insulin resistance, need to cut down the carbs and increase the fats. Failing that, reduce overall calorie intake and do lots of exercise.

      5. smartersig

        One other interesting point worth taking up whether you lean towards no meat or meat is the following booster point for getting those Vit C levels up

        “The lack of similar findings in British vegetarians28 remains interesting, and this difference deserves careful study. In both cohorts, the nonvegetarians are a relatively healthy reference group. In both studies, the nutrient profiles of vegetarians differ in important ways from those of non-vegetarians, with vegetarians (especially vegans) consuming less saturated fat and more fiber.38,43 It appears that British vegetarians and US Adventist vegetarians eat somewhat differently.44 For instance, the vegetarians in our study consume more fiber and vitamin C than those of the EPIC-Oxford cohort: mean dietary fiber in EPIC-Oxford vegans was 27.7 g/d in men and 26.4 g/d in women compared with 45.6 g/d in men and 47.3 g/d in women in AHS-2 vegans; mean vitamin C in EPIC-Oxford vegans was 125 mg/d in men and 143 mg/d in women compared with 224 mg/d in men and 250 mg/d in women in AHS-2 vegans.38”

      6. Jillm

        After a meat and green vegetable meal my blood glucose was 4.9. After a healthy vegan meal my blood glucose was 11.2. Retested 11.1.

      7. Dr. Göran Sjöberg

        Malcom,

        We LCHF adherents are usually advocating a moderate protein intake, one gram per kg of weight which for a normal adult translates to about a 200 grams steak per day. What is important for us is though to increase the fat part of the diet.

        Measuring 4.4 of blood glucose now in the evening confirmed to me being on track. My wife measured 4.6 so she is accompanying me 🙂

        But what did we eat today? Mutton steak on an an mushroom excursion picnic in our surrounding forests.

      8. Bill In Oz

        @ Smartersig, you cite a study of &th Day Adventists are showing that being vegetarian is better than non vegetarian.

        I looked briefly at it. I suggest that the numbers were ‘cooked’. Why ? Well over 25,000 7Th Day Adventists who volunteered to be in the study were excluded.
        “A total of 96 469 Seventh-day Adventist men and women recruited between 2002 and 2007, from which an analytic sample of 73 308 participants remained after exclusions.”

        Why the exclusions ? There is no reasoning or justification given.

      9. smartersig

        Bill you have only read the study heading in the full text it says and justifies exclusions

        “Exclusions were applied in the following order: missing data for questionnaire return date, birth date, sex, or race (n=1702); age younger than 25 years (n=434); estimated energy intake (not including write-in items) less than 500 kcal/d or more than 4500 kcal/d; improbable response patterns (eg, identical responses to all questions on a page) or more than 69 missing values in dietary data (n=4961); non-US residents (n=4108); or history of a specific prior cancer diagnosis (except nonmelanoma skin cancers) or of cardiovascular disease (CVD) (coronary bypass, angioplasty/stent, carotid artery surgery, myocardial infarction, or stroke; or angina pectoris or congestive heart failure treated in the past 12 months) (n=11 956). After exclusions, there remained an analytic sample of 73 308.”

      10. Antony Sanderson

        :
        Eric

        Having read the “Low-carbohydrate diet and climate change” post you referred to . . . It is clear Michael Eades uses the “Global warming” paradigm to couch his concern over the agricultural exploitation methods, increasingly on an industrial scale, of the land . . . eg for the purposes of grain production. I think he is using the tools that some vegetarians have used in saying that methane producing animals increase greenhouse gases and are detrimental to the planet. In the blog I see him as . . . hoisting those who argue such by their own petard. In other words he is using their own arguments against them . . . saying that livestock on balance produce less greenhouse gases not more.

        I suspect that he has not changed his mind . . . He just did not want to muddy the waters with the extra issue of the validity of the science around the global warming. Stating that he did not believe in human responsibility for catastrophic global warming would have switch off a good proportion of the potential audience . . . They would have lost his message that we could better nurture our agricultural land if we used animals (grazing and dung)

    1. Doug

      Hi Frederica,

      So is California red wine, meat (grain finished), water due to agricultural runoff, and of course all grains and soy. Humankind is the only species that causes such destruction.

      most honey in that article was at less than the EU recommended max. Thankfully I live in Northern Ontario but even that isn’t a sure bet. It really is quite sad what we do to the earth and ourselves. At lease the earth will recover once we’ve killed ourselves off. In the mean time I’m with Dr. Göran Sjöberg, nothing beats a nice relaxing drink on the dock by the lake once the chores are done…….

      Reply
      1. Frederica Huxley

        Depressing, to say the least. I have sourced my raw honey from the forests of Ghana, so fingers crossed that it hasn’t been polluted with glyphosate! The next thing we will have to worry about is Dicamba wind drift.

  36. Bill In Oz

    It is the 17th of October today. This blog was posted on the 10th – a week ago. And there are 358 comments ( And yes I have made quite a few contributions to that total. ) But I have reached saturation point. I cannot take in and follow all the comments & threads. and still lead a healthy active life away from the computer screen !

    I buggered if i know how our good doctor K does it.

    Reply
      1. chris c

        “Captain, the Kendrick is overheating. He’s about to blow!”

        “Quick Scottie, dissolve these two dilithium crystals in a wee dram and hand it to McCoy, he’ll know exactly what to do!”,

  37. Andy S

    Time to add this food group back to my diet; ethanol.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940038/
    Our results indicate that ethanol reversibly improves erythrocyte deformability and irreversibly decreases erythrocyte aggregation

    https://th.schattauer.de/en/contents/archive/issue/special/manuscript/4823.html
    ischemic heart disease associated with alcohol may be related, at least in part, to the modulation of vascular endothelial cell production of NO

    Reply
  38. Bill In Oz

    Dr Kendrick, earlier on you made this comment “The anti-fat hypothesis was created by Ancel Keys, and taking up with enthusiasm, but with no evidence to support it.”

    I have no argument with your assertion that fats do not cause CVD. However factually it was not Ancel Keys who started the diet/heart hypothesis. In fact it was started by a German doctor Walter Kempfer who fled Nazism to the USA in the 1930’s. A string of other doctor followed and developed after him….Using very high carb diets to relieve and maybe even cure heart disease.

    Denise Minger back in 2015 wrote a superb blog about this wrote subject. It’s long and detailed but definitely worth the read..

    https://deniseminger.com/2015/10/06/in-defense-of-low-fat-a-call-for-some-evolution-of-thought-part-1/

    Denise develops also the thought that some individuals do well on a diet which involves very high fat such that they are in ketosis. She also suggests that some individuals do well on a very high ( 80% ) carb diet and are in a state of ‘carbolisis’..

    IE there is a U shaped curve in human responses to diet….Where the high points of the U are the alternatives of very high far and very high Carbs. These represent good health. While the low bottom of the U (Denise calls this ‘in the swamp’ ) are those with chronic diseases like CVD & diabetes and having diets that are neither high fat not high carb..

    Reply
    1. Eric

      I saw her entry at the time and read most of it (she has so many words…). My thoughs were that maybe it is different people who thrive at the extremes, depending on genetics and previous habits (if they have already eaten themselves into metabolic syndrome, IR, diabetes, they are not likely to thrive in carbosis).

      I also wonder whether the “swamp” is necessarily bad for everyone. Sure, Peter of hyperlipid has a few pieces on how fats and carbs work together, and then there is also the nearly universally accepted truth that you will store rather than burn fats while insulin is high. But most of that can be allieviated if we have sensible pauses between meals of carb. We are not ruminants who need to feed their face all the time!

      Reply
      1. chris c

        Ever come across Jan Kwasniewski? He had a concept of a “forbidden zone” into which most diets fall, with very low carb and very low fat as outliers.

        Some of his stuff is very good and some of it is just plain weird.

        One side of my family has a preponderance of a weird kind of diabetes mostly in males which somewhat resembles one of the MODYs but with significant differences. Others I know with the same symptom set have it predominantly in females, or equally divided between (among) the sexes. It appears to be malfunctioning rather than missing beta cells, starts in early childhood and progresses slowly. Even after kicking the insulin resistance into touch I still can’t eat that many carbs and probably never could. But I have no problem at all metabolising fats and ketones. I’ve regained some metabolic flexibility but not all of it.

        http://www.gnolls.org/3637/what-is-metabolic-flexibility-and-why-is-it-important-j-stantons-ahs-2013-presentation-including-slides/

  39. Charles Gale

    With recent posts by Dr Kendrick looking at the arterial side of things, and potassium being mentioned in this post (and also by Dr Kendrick over the years), I found this bit of research via Mark Sisson’s Daily Apple:

    https://insight.jci.org/articles/view/94920

    Too technical for me but the results section stated “dietary potassium regulated vascular calcification and aortic stiffness in mice”.

    Thanks for the Dr Malhotra talk too. He always impresses and if nothing else, I now know Quality Outcome Framework QOF is pronounced “Kwoff”.

    Reply
  40. Sally Macgregor

    sorry to break into the vigorous diet debate, but I wanted to provide an anecdotal account/case study of what Dr Kendrick mentions – severe heart disease but no MIs. My husband had what we now know were angina attacks (infrequent) which eventually took him to the GP – and from there to the cardiologists. An angiogram revealed 4 blocked arteries (all the major ones, I think). The heart had cunningly made its own bypass round one artery but he was referred for urgent coronary bypass surgery. He was closely cross questioned about the fact that he’d never had anything approaching a heart attack – lots of surprised (cardiologist) faces. His BP has always been normal to low, cholesterol on the high side as far as the NHS is concerned but he’d never taken a statin.

    I have to say it was startling to think he’d been walking round for an unknown period like a ticking heart attack time bomb (he’s 67). We have no idea why he didn’t have a heart attack.

    Postscript: the standard post-bypass drug cocktail of statin, beta blocker and ace inhibitor was urgently pressed on him. As no cardiologist could provide any evidence that a man with no BP problems, a steady low-ish heart rate should take something that would lower both – he eschewed the whole lot, but does take a low dose aspirin daily. And is, touch wood, doing fine.

    Reply
  41. Stephen T

    Denise Minger is always interesting, but Walter Kempfer wasn’t the first man to wrongly condemn fat.

    Elliot Joslin in the U.S. and Harold Himsworth in Britain came to believe that diabetes was caused by a diet rich in fat, which fed into the belief that sugar could be absolved. In 1927, Joslin wrote “With an excess of fat diabetes begins and from an excess of fat diabetics die.”
    As early as 1917, Joslin was using the high carbohydrate diet of the Japanese, largely rice and barley, as the reason to question the widespread belief that sugar caused diabetes. He stuck to this belief for the next forty years, despite acknowledging that the rising death rate from diabetes in the U.S. coincided closely with rising sugar consumption. Neither Joslin or Himsworth seemed to know that the Japanese ate very little sugar at this time. Indeed, a century earlier diabetes had been rare in the U.S. and Britain when sugar consumption was of a similar level.

    Joslin blamed diabetes on obesity and a lack of exercise. In 1925, he gave a lecture partly blaming the rise in diabetes on the invention of the motor car. In Britain Harold Himsworth was considered the leading authority on diabetes and he agreed with Joslin that fat was the problem. Both men believed diabetics should eat a high carbohydrate diet. They constantly referenced each other’s work and their opinion became the damaging medical orthodoxy that we are still largely living with today. In 1949, Himsworth changed his mind, finding that the more fat consumed by laboratory animals, the harder it was to make them diabetic. He called this a “paradox.” It was too late. Joslin never changed his opinion.

    The mistakes of these two talented and dedicated men have, I believe, caused enormous harm. I do not know what influence they had on Ancel Keys, but he must have been aware of their work.

    This information is mostly taken from the excellent ‘The Case Against Sugar’ by Gary Taubes (pages 104 – 106).

    Reply
    1. Bill In Oz

      Stephen, I have not read Taubes.. So I was unaware of his writings about Joslin & Harmsworth..But I guess that in the more distant past medical people came up with lots of bizarre ideas based on very little evidence…There was less science then in the 1920’s and more seat of the pants type stuff…
      But on the other hand, there were cook books published then which emphasized low carbs to survive.. as illustrated by the comment from the woman in New Zealand in one of Dr K’s earlier blogs about Type 2 diabetes, ,

      Reply
      1. annielaurie98524

        Hah! You think modern medical types are any less prone to spewing nonsense than they were a hundred years ago? Here in the 21st Century, they may dress up their claptrap with a larger number of technical terms and a lot of statistical mumbo-jumbo, but they are still spouting nonsense. If you deconstruct it, you’ll find a lot of classic logical fallacies — circular reasoning is a fave. Just read the idiocy on statins.

    2. chris c

      Harry Himsworth is still regularly dragged out by vegans and other high carb apologists.

      He had a certain point if you dig through Peter at Hyperlipid’s researches into “physiological insulin resistance” but one crucial missing factor is that the body preferentially metabolises glucose to get rid of it before it goes round glycating everything, and while doing so it stops metabolising fat, so as Richard Feinman among others have pointed out, Free Fatty Acids in the blood increase on a high carb diet, quite apart from whatever happens to lipoproteins. Stop topping up your glucose every couple of hours like the dieticians recommend and the body will then make use of them.

      Reply
      1. Eric

        Quick comment: fructose has 10 – 20x higher glycation activity compared to glucose. What does the liver do? Sequester, convert to triglycerides, store some, ship out rest to be stored in adipose tissue

  42. Sasha

    A general question for Dr Kendrick and anyone else who may know: what’s the NNT for statins in secondary prevention?

    Thank you.

    Reply
    1. Stephen T

      Sasha, you might want to scroll up and take a look at the talk by Aseem Malhotra.

      He gives a statin NNT for stroke prevention of 77. That’s the best case pharma figure with all the caveats that come with that. No number is given for those harmed.

      The statin NNT for preventing death (not sure how that works) in high-risk patients from heart disease is 83. Again, the number harmed isn’t given.

      The NNT for low-risk patients is zero. No benefit.

      The NNT for a decent junk-free mediterranean type diet (no definition) is 30, almost three times better than a statin and with no side effects. I wonder how many patients are told that?

      Reply
      1. smartersig

        Zero patients are told that, you are sent to a seminar in which at half time you get despatched to a canteen for a break only to find that it serves around 70% food that put you there in the first place not to mention the plethora of coke and Dr Pepper dispensing machines. The health service, in the area of chronic disease, is not trying to cure or prevent any of these common chronic diseases, that is not the business it is in. It is full of well meaning professionals who enter it hoping that this will be there goal but I find they are least likely to recognise that the system they are working in is in fact designed to keep us sick. Great if you have a broken leg or need an emergency op but of little help with chronic disease mainly because this is where the money is

      2. annielaurie98524

        Yes! It’s appalling when one goes to a hospital, either for services, as a visitor, etc., to see what garbage they serve in the cafeteria and to the patients. You are right on the MONEY… literally.

      3. Sasha

        Thank you, Stephen. I will scroll up and watch the video. That was my recollection for high risk patients – around 80 something.

  43. Andy S

    Why capillaries could be more important than pipes:
    1- a capillary bed is the transition from artery to venous blood and beginning of lymph system
    2- hypoxic regions stimulate angiogenesis (sprouting of new capillaries) to restore blood supply
    3- collateral blood vessels formed ( initiated by capillaries) to bypass constrictions in arteries
    4- capillary remodelling is a dynamic process, new ones formed, redundant ones removed
    5- movement assists capillary blood flow: breathing, pulse pressure, exercise, effect of gravity
    6-capillary endothelial damage could stop blood flow in capillary
    7- capillary wall composed of a single endothelial cell, damage can happen quicker
    8- every cell needs to be close to a capillary for nutrients and O2

    Reply
      1. Andy S

        JDPatten, re clogged capillaries.
        Not a expert but if a capillary is damaged (endothelial dysfunction) and red blood cells get stuck then it is game over and a bypass capillary is required and soon provided. Plaque not required.

        Looks like PAD is all about clogged capillaries. Optimistically PAD would improve with proper diet and exercise. Probably applies to all tissues with capillaries. Capillaries are the first things that get damaged.

      2. JDPatten

        Right. As I understand it, an increase in your exercise load can increase your capillaries by many miles over a couple of months. I can see how such quick accommodation can work both ways – just resorbing when plugged against just one cell.

        But I’d like to know the mechanism of the arterioles’ immunity to plaque. Same thing?

  44. Dr. Göran Sjöberg

    Andy ,

    I am a strong believer in capillaries.

    Working hard in my garden with my famous hoe i think I treat the capillaries fairly this way. Releases eNO I read somewhere.

    I addition to the hard work I am just now enjoying a break with a glass of white wine by the side of a pond and surrounded by all colorful autumn leaves while the sun is setting. Parasympathetic actions! I don’t think life can be better for a CVD victim 🙂

    Reply
      1. Dr. Göran Sjöberg

        Malcolm,

        Thank you for your encouraging!

        But do you think there could a publisher who would be interested?

        My wife is also pushing me in this direction.

        Some years ago I did contact Swedish publishers on this issue but the interest was to say the least meager. At that time I just had the outlines and one chapter of a book to propose. Due to the lack of interest I though “shelved” the project.

        But I am still open for proposals.

        Otherwise I am “happy” on your blog 🙂

        And now to the final round with my hoe!

      2. Bill In Oz

        Goran, I too encourage you to write your own experiences up…
        But perhaps the readership would be bigger, and publishing interest bigger, if it was written in English.
        Sorry no put down intended of Swedish here, just a matter of the smaller number of people who read it. in the world compared to English.

      3. Dr. Göran Sjöberg

        Bill,

        Well, well!

        I am now getting more and more encouraged to pull the “book idea” from the shelf and as you I believe the writing then should be in English. It is a nice project for me as retired but I have to find the right “setting” before going ahead.

      4. Jan B

        Go for it, Dr. Goran. You are an example to us all and I would certainly want to read your book – assuming I live long enough. (I’m older than you)

      5. Dr. Göran Sjöberg

        Well, now there doesn’t seem to be a way out for me.

        “How to survive and thrive with heart disease” does seem to be an appropriate title. Perhaps a subtitle as “Leeson learned” might fit

  45. Randall

    My take on blood pressure. 120mmhg converted to psi is 2.32psi 170mmhg is 3.28psi. Here’s an experiment most people can conduct: get 2 bicycle tires and fill one to 2.3 psi and fill the other one 3.3 psi then get someone to release the 2 valves at the same time while you’re holding a finger in front of the valves the same time. If anyone can feel a difference in air pressure I will be very surprised. Actually the difference is miniscule. But the medical profession says if your blood pressure increases by 1.0 psi that will damage the arteries. Another example is 140mmhg to 160mmhg, difference of .4 psi. By the way normal pressure in the eye is between 10 and 21 mmHg. Estimate of 10-Year Risk for Coronary Heart Disease Framingham Point Scores https://www.nhlbi.nih.gov/health-pro/guidelines/current/cholesterol-guidelines/quick-desk-reference-html/10-year-risk-framingham-table You will note BP does not have a big score compared to other risks.

    Reply
    1. Bill In Oz

      Randal I am no expert on this but I suspect that bike tyres are a poor comparison to human arteries.

      Bike tyres are dead and made of thin rubber. And there is only air in them. Arteries are made up of living cells, constantly being renewed and even replaced as cells die.Also arteries have blood in them not air. Blood is far denser than air and far less ‘compressible’ than air.

      A BP measurement is simply a measurement. Originally it was simply how high the blood in an artery could push a thin ‘column’ of mercury. And over time it was realised that people with high chronic measurements ( over 140 ? ) developed illness far more often than people with low measurements. Nowadays many people use an electronic measurement device but it is still calibrated according to the old scale – ml of mercury in the glass column

      Reply
  46. Gary Ogden

    Eric: He is correct. Alan Savory’s insights into the health of grasslands (the largest percentage of Earth’s arable land) are brilliant. One of the keys to both feeding the human population and restoring these degraded lands is bringing properly-managed livestock operations to them. Properly managed grasslands store enormous amounts of carbon, and herds managed to mimic the behavior of the wild herbivores who once roamed them increase both the fertility and water-holding capacity of the soil. Go to the Savory Institute website to learn more. Conventional livestock operations are a disaster all around, but raising livestock for food, properly done is good for both the Earth’s ecosystems and carnivores (or as Gary Fettke says, vegetarians who supplement with meat).

    Reply
    1. Sylvia

      But the powers that be don’t give a damn about the health of their populations.you can bet your bottom dollar they eat from organic farm shops and such. However people should take responsibility for what they feed their families, it will be Aldi and nor Waitrose do doubt, nothing wrong with that. Another gloomy news story on Today this morning, German study about the loss of all our insects, what the hell are we doing to our planet. I could go into my political fairness and justice rant, but I won’t.

      Reply
    2. Mr Chris

      Gary
      Göran recently posted up a link to a video on sustainable farming, which was taking place in Vårmland not, far from him. In it the narrator says topsoil on the prairies used to be 9 metres thick, and is now 15 cms thick. Crazy

      Reply
    3. Eric

      Gary, who is correct? Eades for posting Savory’s video? No doubt about that.

      My question to those who may have been following Eades over the years was what caused his change of mind on climate change.

      Reply
    4. Dr. Göran Sjöberg

      Gary,

      Alan Savory really impresses on me. He had a famous TEDx talk which just throw you over.

      His view is about a truly holistic view on how we treat our planet in order not to harm it and how we should get our nutrient food. It is a balance of grazing animals and grass to improve the soil. In to week I will myself give a public talk on this subject “The WEB of the soil”

      Reply
      1. Martin Back

        If you like Alan Savory, you should look at Gabe Brown’s videos. By applying Savory’s principles and no-till methods he has transformed his farm in North Dakota, which probably has a climate similar to Sweden’s.

    5. Antony Sanderson

      :
      Eric

      I think I have said before that I am not sure Eades has really changed his mind. In the article brought to the attention of the blog I read he did not flaunt any anti or pro belief in human culpability in catastrophic global warming, but he did assume CO2 was considered by many as a climatic pollutant.

      I suspect he is doing what I did for a number of years. I never used to try and disabuse people over global warming even though I knew that the underpinning science was, to say the least, very weak. I was more concerned with the the issue of the exponential rate of removal/despoiling of Earth’s resources. However, one area where the global warming alarmists and the advocators of a sustainable future meet is over reducing our dependence on oil/coal. To me the global warming alarmists have got the carbon footprint thing right . . . but for the wrong reasons.

      To me it is like global climate alarmists are concerned with picking leaves off the railway track (for non-UK readers the leaves cause unbelievable railway disruption regularly), and while they are improving the situation, picking up the leaves . . . they do not notice the enormous express train of resource depletion that is hurtling down on them.

      Reply
      1. Eric

        Antony, thank you for your insights.

        I believe his 2009 entry was a bit more than not flaunting:
        “First, I’m not much of a believer in the notion of man-made global warming or climate change (as they now call it since temperatures have been constantly falling instead of rising). I’m a denier, in the pejorative term used by those who are believers.”

        I may have falsely assumed that he had converted when he may have simply found common ground in that carbon should be sequestered.

        Would you care to explain more about the “alarmists” being right for the wrong reasons? I suspect there is more to your view than just resource depletion. After all, the express train is already slowing down thanks to cheaper renewables, and you’ll have to wait a wee time until the cows have sequestered enough carbon to burn it for energy…

        I am not with you, by the way, about the science behind climate change being very weak. I have not done the math myself, and it might be very difficult to do so as the equations can only be solved numerically. My approach is this: as a research physicist, I have a pretty good idea when reading a scientific paper from a different field or just a journalist’s summary of the finding of how sound the work is. It was clear to me 20 years ago after doing very little reading that the cholesterol / CVD / statin science was very weak. This was long before I came across the work of Malcolm or his peers. I have also changed my mind on serveral other topics after finding an odd comment somewhere like this blog and following a link or searching for the original papers.
        On climate change, I have not seen a single credible paper or article on the denier side and many credible ones on the “alarmist” side. Serveral very good pieces were written by Phil Plait, who is an astrophysicist (so similar to my training), just google his articles.

        Ok, it could be that you agree that there is man made climate change due to carbon dioxide or methane accumulating in the atmosphere, but you think it is insignificant compared to past, naturally occuring climate change. Again, it would be very difficult to quantify temperature change without access to the supercomputers. There is admittedly some spread and uncertainty in what passes for reliable predictions, but even the most optimistic of those scenarios entails pretty devastating consequences. This is due to several built in tripping points (polar ice, flooding, release from swamps, …), which are borne out things like the great data vault we have in things like Greenland ice cores.

        This is an entirely different animal compared to air pollution where I think one can argue that while it is a problem that should be adressed, it should probably be further down on our list of priorities.

      2. Andy S

        Eric, a bigger concern would be global cooling

        https://www.sciencedaily.com/releases/2013/08/130807134127.htm
        “Ice ages and warm periods have alternated fairly regularly in Earth’s history: Earth’s climate cools roughly every 100,000 years, with vast areas of North America, Europe and Asia being buried under thick ice sheets. Eventually, the pendulum swings back: it gets warmer and the ice masses melt. While geologists and climate physicists found solid evidence of this 100,000-year cycle in glacial moraines, marine sediments and arctic ice, until now they were unable to find a plausible explanation for it.”

  47. Bill In Oz

    An off topic comment : Back in May, Denise Minger published a review on her blog about the book ” How Not To Die” by Michael Greger MD. It was a lengthy review with some significant criticisms of Greger and some compliments.
    Well today I was in a Salvation Army second hand Op shop and there in the book section was Greger’s book going for $4.00. So I bought it. just on spec, to see for myself if there is any value in it..
    And I chose to start by reading his chapter on Type 2 Diabetes. I was hoping to see what he had to say about Glugogen as the good doctor here makes some interesting remarks about it in his blog on diabetes back in 2015.But I am perplexed. In the 412 pages of text there is nary a mention of glugogen. Not even in the index !
    And reading his chapter on type 2 diabetes, I was surprised to read that Greger thinks that diabetes happens because fat in the blood stream blocks the absorption of glucose by the muscle cells. Thus his solution to T2D is a low fat diet, preferably a vegan on.
    Greger cites some sources for this ‘Very low fat’ hypothesis.And I will have a look at them as I find time. But as Denise Minger mentions in her review Greger sometimes cites sources which on inspection by her, sated the opposite of what Greger was stating. And on occasions emphasises statements in sources which are of minor significance for the author.
    But I wonder if any folk here have already gone through this process of source checking ?

    Reply
    1. Stephen T

      Bill, when I first began to look at nutrition I assumed Greger and the other vegetarian gurus were acting in good faith. I no longer believe that. Their culprit for all problems is meat, however implausible. Fat causing diabetes is just ridiculous, but if it furthers the cause, the deceit is justified. I’m glad to say that some vegans think this dishonesty is wrong and counter productive.

      By Virginia Messina, vegan dietician:

      “I realize that some activists believe that using any means necessary to get people to stop eating meat represents a win for animals. But putting aside the philosophical issue of whether the ends justify the means–that is, whether it’s okay to be dishonest if it saves animals–I think there are a number of problems with this argument.

      ” . . . the vegan movement’s credibility is undermined when we make claims that are so easily refuted. If we get caught lying or exaggerating about the health aspects of veganism, why should anyone believe us when we try to tell them about the treatment of animals on farms, in zoos, and in research labs?”

      https://www.vegan.com/posts/vegan-dietitian-review-what-the-health/

      Reply
    2. smartersig

      The problem with Gregers site and by association the book is that it is very pro cholesterol causes heart disease and vegans have low cholesterol therefore low heart disease. As I have mentioned I dont quite buy into this but I do buy into other aspects of his site and book and I think that provided you are willing to think as well as read his site is a useful resource. I also agree that it could be a bit more balanced for example if you are a meat eater and cannot or dont want to give up meat it could talk about the best and most healthful ways to eat meat whereas it tends to stay clear of this.

      Reply
      1. Bill In Oz

        Thanks Stephen & Smartersig for your replies. Since making my comment last night I have read some more of Greger’s book.. And I got to page 5 of his introduction where he claims that ‘relapsing’ vegetarians eating meat, have “a 146% increase in the odds of heart disease, a 152% increase in strokes, a 166% increase in diabetes, and a 231% increase in weight gain.” compared to people who stayed vegetarian.
        His source for this interesting claim is an article by PN Singh, KN Arther, MJ Orlich et al. ” Global Epidemiology of Obsity, vegetarian dietary patterns & non communicable diseases in Asian Indians. Am. J Clin. Nitr. 2014, Supplement 1: 3595-645.

        could not find the source on the web for a while but finally I found this:
        jcn.nutrition.org/content/100/Supplement_1/359S.long
        I read it quickly. And here is no claim I can find about ‘relapsing vegetarians’ in the article. Further the authors are very careful to point out that the chronic diseases that afflict the tens of millions of newly urbanised poor in India are a result of an almost all vegetarian diet which is full of processed foods, white rice, refined flours, sugars and industrial fats with meat being a rare and expensive treat on festivals maybe.

        Frankly this does NOT inspire me to continue reading. It is an abuse of science and and an outright deception of readers. There are 120 pages of notes and about 20 sources a page. How can anyone be expected to filter out the scientifically valid claims from Gregers’s fakes ?

      2. smartersig

        Your assessment is very misleading. The research article makes it quite clear that the increase in disease amongst mainly urban indians is due to a movement away from faith based vegitariansm to one of primarily increased processed carbs for example white rice and not brown rice, veg oils and not ghee and so on. They are also arguing that perhaps indians have genetic predisposition to some of these diseases due to a lower threshold for obesity. There is also some mention of increase in meat consumption but it would appear the real culprit is processed foods. I think Gregers opinion that these are lapsed vegitarians is correct, they are certainly lapsed whole food plant based eaters. Aslo taken from the research below

        “Change from a vegetarian (no meat intake) to a nonvegetarian (weekly meat intake) dietary pattern over a 17-y interval was associated with significant increases in the likelihood of weight gain (OR: 3.31; 95% CI: 2.26, 4.86) (67), diabetes (OR: 2.66; 95% CI: 1.79, 3.95) (67), stroke (OR: 2.52; 95% CI: 1.30, 4.90; PN Singh, unpublished data, 2014), and CHD (OR: 2.46; 95% CI: 1.62, 3.73; previously unpublished). During the 12 y after the transition, the exposure was associated with a 3.6 y (95% CI: 1.4, 5.8 y) decrease in life expectancy (68).”

      3. smartersig

        Also the weight gain, diabetes etc etc percentage gains are taken from the Adventist health study quoted in the table you have to expand in the research article we are discussing. Assuming these figures are correct as cited in the article then he is accurately mentioning them.

      4. Bill In Oz

        Smartersig, your ‘logic’ escapes me.
        You say these ‘lapsed’ Indian vegitarians…. are certainly ‘lapsed whole food plant based eaters’ because they eating increased processed carbs for example white rice and not brown rice, veg oils and not ghee and so on..
        And then go on to state that ” I think Gregers opinion that these are lapsed vegitarians is correct,”
        Come on mate, you cannot have it both ways..Unless you want to have us all laughing at you !

        By the way I agree about the lapsed Indian whole food plant eaters. I have known a number of Indian families here in Oz who are quite vegetarian but who never eat brown rice and are happy with industrial oils and high sugar treats. Diabetes and CVD is common in this immigrant community here….

        PS : Greger does not cite any Linda Loma researchers as his source for his assertion. He attributes it to the article by Singh, et al…Now that is either slip shod or intentional deceptive. .

      5. smartersig

        Bill I am sure the amusement is more firmly in your direction than mine. Greger is citing the paper which itself cites the Loma Lindy research. Please read the paper more carefully

      6. Bill In Oz

        Another vegan Gregerisms : I have just been reading page 119 of Greger’s book….He makes this statement :
        “The most interesting speculation is that trans fats naturally found in meat & dairy could be causing an inflammatory in patients bodies. The researchers found that a significant percentage of the fat under the skin of those who ate meat or dairy or eggs, was composed of trans fats whereas those on a strictly whole food plant based diet, had no detectible trans fat in their tissues”

        this set my brain spinning. Trans fat in dairy & meat ? I checked with Wikipedia here
        https://en.wikipedia.org/wiki/Trans_fat
        “Trans fats, or trans-unsaturated fatty acids, trans fatty acids, are a type of unsaturated fat that occur in small amounts in nature, but became widely produced industrially from vegetable fats for use in margarine, snack food, packaged baked goods, and frying fast food starting in the 1950s.”
        Ummmmmm…. ? So trans fats are not found in dairy & meat !
        And if trans fats are indeed found under the skins of meat & dairy food eaters, it seems very likely that they come from industrial ‘vegetable’ oils used in preparing processed foods.
        This seems like a very, very basic basic error…
        How the hell did Greger get this stuff published ?

      7. smartersig

        It seems that 1 to 5% can be found in meat dairy etc so I guess that even 1% over a lifetime may contribute to some detection under the skin but I guess none of us can be sure

      8. Jan B

        From what I’ve read I gather that the naturally occurring trans fats in animal fats, e.g. butter etc., are very different from those in manufacturered oils and margerine and are not harmful. I can’t offer any kind of reference at all, but I do know though that the likes of Flora used this ‘fact’, of trans fats in butter, in one of their scurrilous advertising campaigns. Disgraceful, IMO.

      9. Bill In Oz

        Smartersig, this discussion with you seems to me like a’ three shells game’ where the object is to make the obsevor lose.

        I looked at the chart in the link you put up. Sure enough that is what Greger is quoting from. Andnit’s about 7th Day Adventists not lapsed vegetarian Indians. There are some very potent confounders present in research if we are talking about 7th Day Adventists.

        So I then looked at the actual article which this figure comes from ( #68 ) and read that quickly. Here is what the authors of the article say in their conclusion:
        “Results: Our review of the 6 studies found the following trends: 1) a very low meat intake was associated with a significant decrease in risk of death in 4 studies, a nonsignificant decrease in risk of death in the fifth study, and virtually no association in the sixth study; 2) 2 of the studies in which a low meat intake significantly decreased mortality risk also indicated that a longer duration (≥ 2 decades) of adherence to this diet contributed to a significant decrease in mortality risk and a significant 3.6-y (95% CI: 1.4, 5.8 y) increase in life expectancy; and 3) the protective effect of a very low meat intake seems to attenuate after the ninth decade. Some of the variation in the survival advantage in vegetarians may have been due to marked differences between studies in adjustment for confounders, the definition of vegetarian, measurement error, age distribution, the healthy volunteer effect, and intake of specific plant foods by the vegetarians.

        Conclusion: Current prospective cohort data from adults in North America and Europe raise the possibility that a lifestyle pattern that includes a very low meat intake is associated with greater longevity. ”

        And Greger ? He’s buggerising around with the evidence…

    3. Bill In Oz

      Greger is not just against eating meat, fish, dairy foods and eggs, He is also against some plant foods. Hehas a list of green light plant foods he likes and a list of others that are red light.

      And curiously olives and virgin olive oil are in his red light list..He claims that olives & extra virgin olive impair “artery function that occurs within hours of eating..” ( page 298 )
      I was puzzled by this claim as olive oil in every other book or article about olives and extra virgin olive oil gives them a big green light as part of an anti-aging diet. So I looked further.

      Greger’s source for this claim is obscure. It is a list of berries, fruit and vegetable analyses in an Antioxidant Food Table : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2841576/table/T4/
      The list was prepared by Monica Carlsen, Nente Halvorsen et all in an article here : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2841576/
      However the article presents no evidence to support Greger’s claims about olive & olive oil.

      Once again Greger’s claim seems to be invented & spurious.

      Reply
  48. chris c

    Random musings. I recently speculated about varying levels of different pollutants over time in different places – looks like I was channelling another recent study based on PURE

    http://sci-hub.bz/10.1161/CIRCRESAHA.117.308903

    part 2 is a bit less interesting

    http://sci-hub.bz/10.1161/CIRCRESAHA.117.311849

    While Omega 6 oils are essential in small quantities in balance with Omega 3s – we probably evolved on a ratio somewhere between 1:2 and 4:1 – we are currently in a severe overdose situation of 20:1 or 30:1.

    Here they are producing endothelial damage

    http://www.jbc.org/content/287/14/11398.short

    and cardiac damage along with hyperglycemia

    http://m.ajpheart.physiology.org/content/287/6/H2518.long?view=long&pmid=15284064

    someone should tell the AHA. Oh wait, the donations from Bayer depending on sales of soybean seed have bought them some good earplugs. Fetch the baseball bat . . .

    Reply
  49. Steve

    Dr. K,

    your blog has helped numerous people, solved several issues, brought out new thinking. You have stirred up the masses and solved how Diabetes progresses, the etiology…in medical terms. Now you are working the same logical process on HA and commented that the blog would be over once complete.

    I beg to disagree.

    why could you not keep going, moving onto cancer(s), plenty to keep busy there. lots of fallacies to discredit,

    Then Alzheimers

    so I would say that we have at least Cancer and Alzheimers to research and solve. We know that the modern civilized, chemicalized, processed diet is probably a huge portion of the etiology for many diseases, and this is probably the same etiology for these other diseases. we may not get the etiology perfect, but we would at least be able to help others with better practices and offer solutions. you have generated a huge following a credit to your reputation, I don’t think we should stop when there are so many others you could help.

    Plus it gives us something interesting to do, maybe help our sympathetic nervous system?

    Reply
      1. Bill In Oz

        I suggest that you have earned some time out. But the blog does have a life of it’s own in many ways..

  50. Dr. Göran Sjöberg

    Well, on this blog medium I have been socially encouraged to write book of my health “journey.

    Here are now the first opening lines and it doesn’t hurt to get feedback from blog friends.

    ——–

    How to survive and thrive with heart disease

    In January 1999, that is almost two decades ago now, I didn’t feel well. I actually felt that something was very seriously wrong in my chest so I asked my wife to bring me to the emergency room at our local hospital where I though had to wait for my turn while my wife negotiated with the receptionist. All the while I was getting worse and finally my wife persuaded them to take me seriously since a heart attack was rather evident from my appearance.

    Then they grabbed me and took full action, first with a shot in my belly with what I suspect was a strong anti-clot remedy and it might well have been that drug that made me survive. Then I was hospitalized for almost two weeks and when the first lab results appeared they for sure took me seriously. Actually, they took my wife to the side to tell her how very surprised they were with the fact that I had survived, based on the values measured, and later when I was released from the hospital the cardiologist told me that I had better call for an ambulance “the next time” to avoid the waiting room. Since I, today, definitely don’t trust cardiologists I am not sure that this is the right thing to do.

    Perhaps it was just the fact that I had to move around a little which made me “pass” my first heart attack, which are often fatal in “young victims”, me being 52 at that time. It is a fact since 1952 when xxxx showed that if patients with a heart attack were allowed to move instead of being tied to a bed the mortality rate dropped from 50 % (?) to about 10 % at his ward unit and such numbers are rather impressive when talking about end point events. Although these numbers are impressive it took almost two decades before these obvious facts could bypass the existing dogma about the benefits of bed rest.

    It was obvious to me that this “lesson learned” also had been incorporated in the treatment of heart attack patients at the intensive care unit at our local hospital where I was interned. I was immediately encouraged to get out of the bed but then constantly remotely monitored by a mobile electrocardiographic equipment. Now they didn’t want to take any “risks” with me. When my heart was to be ultrasonically examined in another part of the hospital I suggested that I could liberally walk there by myself, but no way! For the first time in my life I was put in a wheel chair, which felt awkward to say the least.

    To their surprise the ultrasonic examination didn’t reveal much of damage to my heart and they congratulated my to this positive outcome of my serious myocardial infarction. The only reason they could come up with for this obvious good state of events was that I must have developed a substantial amount of collaterals since I had been regularly exercising at a moderate level for many years.

    Reply

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