What causes heart disease part XL (part forty)

27th October 2017

As readers of this blog will know, for many years I have pursued the idea that ‘stress’ was the primary cause of cardiovascular disease. Actually, it is strain. Stress is the force applied, strain is the effect that stress produces. For the sake of simplicity, I will just use the word stress.

This journey started when I began to take an interest in the rate of heart disease death in Scotland and France. Being Scottish born and bred, (OK, my father was English, but I forgive him) I felt I knew a bit about the lifestyle of the average Scot, aye Jimmy.

I had also travelled to France many times, so I felt I knew a bit about the French as well. The other reason for looking at France and Scotland was that, in my formative years, Scotland had one of the highest rates of heart disease in the world, perhaps the highest. I am talking primarily about death from myocardial infarction here. On the other hand, the French rate was very low, perhaps the lowest in the world, and has since then got lower.

Why such a massive difference? The conventional explanation was that the Scots had such a terrible diet. The famed deep-fried Mars bar is oft quoted. ‘How can a country that deep fries a Mars bar expect anything less.’ As if everyone in Scotland does nothing but stuff their faces with deep-fried Mars bars, all day, every day.

I do not have the statistics to hand, but I would be very surprised to find that even fifty per cent of Scots have eaten even one. Indeed, if you have made the mistake of eating a deep-fried Mars bar, you will never (unless very drunk) eat another. However, the Scottish ‘unhealthy diet’ meme is so firmly embedded in most people’s brain that it cannot be removed.

Ironically, a Mars bar contains almost no fat at all, it is made almost entirely from sugar a.k.a. carbohydrate. If you wrap it in batter, and stick it in a deep fat fryer full of vegetable fats, you have, according to current thinking, just made it significantly healthier. More carbs wrapped round the outside, and now dripping with vegetable/polyunsaturated fat. Mmmmm … you can just feel your arteries unclogging.

In reality, as with most other well-known facts about heart disease, when I started to look closely, the only significant difference that I could find about the diets in France and Scotland, was that the Scots ate slightly less saturated fat. They also ate fewer vegetables.

On the other hand, the French smoked more, took a bit less exercise and, at the time, had an identical BMI and blood pressure to the Scots. Rates of diabetes were also identical, as were average total cholesterol levels.

In short, I could find no significant difference in ‘classic’ risk factors. If anything, they slightly favoured the Scots over the French. Yet, and yet, age-matched, the French suffered one fifth the rate of deaths from heart disease. If you open up a risk calculator designed for a UK population, and use it to calculate risk for the French, you still have to divide the answer you get, by four. [Which might suggest that risk calculators are not capturing the major causes of CVD].

This gave me to think that there may be something else going on. Other than diet.

What? There have been many papers written about the ‘French Paradox’. The paradox being that they eat masses of saturated fat (highest consumption in Europe, probably the world), they have average to high cholesterol levels and a vanishingly low rate of heart disease.

Scientifically the French paradox should really be called the ‘French refutation of the diet-heart hypothesis and the LDL hypothesis, and all other hypotheses about cardiovascular disease you can think of’. Instead, a range of protective factors have been proposed. Eating garlic, drinking red wine, lightly cooked vegetables, and suchlike. But if you chase them down, and I have, they explain nothing – at all. Primarily, because they are just not true a.k.a. unsupported by evidence.

So, what was going on? What was the key thing that caused the Scots to die of heart disease in great numbers? One obvious and outstanding difference between the Scots and French was not what they ate, but the way that they ate. Scots saw, and in many cases still see, eating very much as a refuelling exercise. On the other hand, mealtimes, and eating, is a massive part of French life. Time is taken, food is appreciated, families tend to eat together – and suchlike.

Could it be, I thought, that the way food is eaten is more important that what is eaten?

If you eat whilst you are relaxed and socialising with friends and family, will your body deal with food in a different way? The answer is, of course, yes. Just to put it in the most basic terms. If you are highly stressed, either physically or psychologically, your fight or flight system will be activated. The sympathetic nervous system will be directing blood from the digestive system, to muscles, acid production in the stomach will be down, the heart rate will be up – and suchlike.

At the same time the stress hormone: adrenaline (epinephrine), growth hormone, glucagon, and cortisol levels will be high and surging round your bloodstream. This will be activating catabolism – the breakdown of energy stores – sugar levels will be up, free fatty acids circulating, blood clotting systems activated, insulin levels down, and on and on. This is not, it should be added, the perfect metabolic situation in which to eat food.

If you look at most animals, after they have eaten they like to lie down, relax and fall asleep. This allows the food that has been eaten to be digested. Humans seem happy to leap to their feet and rush about after eating. I started thinking about the fast food culture of the US. They began the trend for fast eating, fast living, eating and driving. Rush, rush, busy, busy, work, work, bang, bang. They were first to suffer a high rate of heart disease.

I began to study the effect of stress on metabolism. I looked at a condition known as post-aggression metabolism. The state the body finds itself in after trauma such as a car crash or major operation. In such cases the stress hormones are sky high, blood sugar moves into the diabetic level, insulin cannot achieve anything as it is battling against a catabolic system on full throttle. Not a good time to be eating food.

Then I looked at less dramatic situations. My attention drifted onto Cushing’s disease. A condition where the stress hormone cortisol is over-produced by the adrenal glands. Usually because of a cortisol secreting tumour. Cushing’s disease represents a form of chronic ‘fight or flight’, constant stress.

I discovered that, in Cushing’s there is a spectrum of metabolic, and other physiological, abnormalities such as:

  • High blood sugar level
  • High insulin level
  • High clotting factors
  • High VLDL (triglycerides)
  • Low HDL
  • High blood pressure
  • Abdominal obesity.

I also noted that, Cushing’s increases the risk of CVD by, at least, 600%.

I then realised that Cushing’s syndrome and the metabolic syndrome shared exactly the same set of metabolic and physiological abnormalities. So I began to think. ‘This is beginning to look interesting.’ Actually, I was thinking this before the term metabolic syndrome existed. At the time is was called either Reaven’s syndrome, or syndrome X. The term “insulin resistance syndrome” is now popular.

Then I was pointed to the work of Per Bjorntorp, who had been looking at the Hypothalamic Pituitary Adrenal axis (HPA-axis). This is the central control system for the stress/flight of fight response. It links together the sympathetic and parasympathetic nervous system, with the actions of the stress hormones, the adrenal glands, thyroxine, glucagon, insulin etc. etc. A complex beast of a thing.

Bjorntorp established that chronic psychological stress (chronic strain) creates a dysfunction of the HPA-axis that can be monitored, most easily, by looking at twenty-four-hour cortisol secretion. A dysfunctional HPA-axis leads to a flattened and unresponsive (burnt-out) cortisol release during the day. This does not mean cortisol levels are high, or low, they just flat-line.

He studied various populations e.g. Sweden and Lithuania, and found that the Lithuanians (at the time) were far more likely to have a dysfunctional HPA-axis than the Swedes, and their rate of CVD was four times as high as that in Sweden. A study done only on men at the time. I then started to look at other conditions where the HPA-axis is damaged. Depression, schizophrenia – in fact almost all psychiatric illness – PTSD, survivors of childhood abuse. In all cases the same pattern emerged. HPA-axis dysfunction, greatly increased risk of metabolic syndrome/insulin resistance syndrome and greatly increased risk of CVD death.

I detoured round spinal cord injury. Most people are probably unaware that spinal cord injury is associated with a very much higher rate of CVD. People who suffer spinal cord injury also have a damaged HPA-axis. Some more than others. It depends on the level of the damage, and whether or not the autonomic nervous system is damaged. [The autonomic nervous system is the name given to the network of nerve fibres that make up the sympathetic and parasympathetic nervous system. It travels down the spine, but not in the spinal canal].

I then had a look at corticosteroids. These are the drugs used in many diseases as anti-inflammatory agents. They are used in diseases such as asthma and rheumatoid arthritis and Crohn’s disease and systemic lupus erythematosus (SLE), all ‘auto-immune’ diseases where the body attacks itself. Corticosteroids dampen down the ‘inflammatory’ response.

Corticosteroids are synthesized from cortisol, which is one of the body’s own steroid hormones. Which is why they are called corticosteroids (steroids manufactured in the cortex of the adrenal gland). They are fantastic drugs, and widely used. However, if you take corticosteroids for a long time you will end up with the metabolic syndrome, and a greatly increased risk of CVD, around a 400% increase.

The more I looked, the more it seemed very clear that the unconscious neuro-hormonal system was the key player in CVD, both heart attacks and strokes. It also seemed that cortisol was probably the lynch pin. It still does. Which is why my favourite graph on CVD comes from Lithuania. I have used it before, and I make no bones about using it again.

The rate of heart disease in Lithuania was gradually falling during the 1980s, until the year 1989. At which point the Berlin wall came down, the Soviet Union broke apart and the structure of society was torn apart. It was a very, very, stressful time.

What happened to the rate of heart disease in men, under 65.

Latvia and Estonia showed the same pattern, as did Russia three years later when Gorbachov was deposed by Yeltsin. In non-Soviet European countries, nothing happened. Heart disease rates continued their gentle fall.

I had been looking for evidence that abrupt social disruption leads to stress which leads to CVD. The problem is that, normally, gigantic social disruption = war. During war medical statistics tend to get overlooked, or other causes of sudden death distort the picture.

For the first time in history, a gigantic social upheaval occurred right in front of our eyes. It was not war, and the WHO was there, recording away, as part of the MONICA project. [Myocardial infarction and coronary deaths in the World Health Organization]. Cause, and effect? I believe so.

Which takes me back to Scotland. Glasgow was a very big city, then it shrank. It shrank because social engineers decided to move people from the tenements, which were considered crowded and unhealthy, to wonderful new towns, and high-rise flats. Such as these shown below.

As you can imagine people very much enjoyed living in these inhuman monoliths. A great sense of community and fun developed. So much so that they have now all been demolished.

Whilst this great forced location of people was taking place, the rate of CVD in and around Glasgow exploded. Yes, Scotland as a whole had a high(ish) rate, but greater Glasgow, whilst all this was going on, had by far the highest rate of all. Cause, and effect?

So, my thought experiment that started in Scotland, ended up back in Scotland. I then looked around the world for populations with extraordinarily high rates of CVD. I hypothesized that populations that had suffered enormous social stress would have high rates. So I looked at Australian aboriginals, Maoris, migrant populations, native Americans, and suchlike.

What did I see. Well, pretty much the same things everywhere. Social upheaval followed by high rate of CVD. At present Australian aboriginals have, I believe, the highest rate of CVD in the world. A population where lifestyle and culture has been shredded. If you use a CVD risk calculator on a young aboriginal woman, you have to multiply the predicted ten-year risk by thirty.

Exceptions, of course, exceptions. The Rosetta community of Pennsylvania US. An immigrant population that had moved from Rosetta Italy to Rosetta US – en masse. They became famous for a very, very, low rate of heart disease. What made them different? Here is a section from a Huffington Post article:

‘What made Rosetans die less from heart disease than identical towns elsewhere? Family ties. Another observation: they had traditional and cohesive family and community relationships. It turns out that Roseto was peopled by strongly knit Italian-American families who did everything right and lived right and consequently lived longer.

In short, Rosetans were nourished by people.

In all ways, this happy result was exactly the opposite expectation of well-proven health laws. The Rosetans broke the following long-life rules, and did so with a noticeable relish: and they lived to tell the tale. They smoked old-style Italian stogie cigars, malodorous and remarkably pungent little nips of a cigar guaranteed to give a nicotine fix of unbelievably strong potency. These were not filtered or adulterated in any way.

Both sexes drank wine with seeming abandon, a beverage which the 1963 era dietician would find almost prehistoric in health value. In fact, wine was consumed in preference to all-American soft drinks and even milk. Forget the cushy office job, Rosetan men worked in such toxic environs as the nearby slate quarries. Working there was notoriously dangerous, not merely hazardous, with “industrial accidents” and gruesome illnesses caused by inhaling gases, dusts and other niceties.

And forget the Mediterranean diets of olive oil, light salads and fat-free foods. No, Rosetans fried their sausages and meatballs in…..lard. They ate salami, hard and soft cheeses all brimming with cholesterol.2

The tenements of Glasgow were filthy and rat infested and crowded and had poor sanitation. But if you speak to those who lived in them, their memories were of close family ties, strong community support, fun, playing football in the street. Then they were shifted to the Brave New World of sterile social engineering. Isolation, loneliness, breakdown of community. Death.

You want to know one of the most important ways to avoid dying of CVD?


1: 1https://www.researchgate.net/publication/13659734_Increased_Psychosocial_Strain_in_Lithuanian_Versus_Swedish_Men

2; https://www.huffingtonpost.com/dr-rock-positano/the-mystery-of-the-roseta_b_73260.html

765 thoughts on “What causes heart disease part XL (part forty)

  1. Linda Wilkinson

    Interesting programs on Radio 4 recently about keeping your mind healthy, similar conclusion not unsurprisingly. Factor in loneliness which often leads to depression and the interlinkage is pretty much complete. Holistic approaches to health and not compartmentalisation may at last be on the horizon.

    1. AH Notepad

      Regrettably I doubt wholistic medicine will gain much ground. You can’t make money out of healthy people. You need them to be sick so you can sell drugs and procedures in the pretence that it will make them healthy. If they get well, they may have done so anyway, and as we know, in many cases one medicine causes problems that require another medicine to fix. It doesn’t, so we need another, and another and……………….

  2. Paola

    @Malcolm I’m Italian. Mediterranean Diet does not exist. Fat free food? From North to South,
    we have always eaten a lot of butter,lard cheese,salami and ham. Now we have the cholesterol and vegan madness….

      1. Jillm

        Thank you for your article, Dr Kendrick. A doctor’s receptionist rang a patient. Dr wants to see you. Why? “Your cholesterol is too high. You have a high risk of a heart attack or stroke.” Very stressful for the patient.

    1. AH Notepad

      I understand your government are giving you the vaccination madness now to support the ailing pharmaceutical companies, or should that be to keep you free from diseases that don’t matter anyway, or is it to counteract the fat laden diet?

      1. Jillm

        A study in Canada looked at deaths from swine flu. The rate of deaths was higher in the regularly vaccinated group than in the never vaccinated group. I hope left-over Australian flu vaccinations will not be offered to those in the northern hemisphere. They didn’t work well here.

    2. Tom Welsh

      I think a lot of the nonsense about “Mediterranean diets” began when Ancel Keys was trying to prove his “Cholesterol Hypothesis”. He and his minions toured the Mediterranean (very briefly) and collected data on what people ate and their health outcomes. Unfortunately he committed such ghastly blunders as collecting diet data for Crete while the local people were fasting for Lent! (Honestly – you couldn’t make it up). So his data gave the wholly misleading idea that those people hardly ever ate red meat… Then later the olive oil industry piled on, sponsoring “conferences” at luxury beach-side hotels for journalists and academics where they were subjected to non-stop propaganda for olive oil. (Ironically, the big corporations that had the money for such stunts were probably the same ones that stored indifferent oil in warehouses for years then sold it as “extra-virgin cold pressed”).

      See Nina Teichholz and others…

      1. Paola

        Yes. Here in Italy the Mediterranean diet is something which includes a lot of pasta, pizza, bread and legumes. Free fat dairy and Sweets . There are tons of overweight children.
        When I was younger every italian region had his typical foods and fatty foods were the rule.
        Now it’s all the same everywhere: industrial food and goodbye to our traditions!


        Yet when Ancel Keys was older he went and lived in Italy for the last 28 years of his life, presumably eating a Mediterranean diet, and lived to 101!!

      3. Mr Chris

        Yes Ancel Keys went to livi in Pioppi, subject of Aseem Maholtra’s book, according to which, wood-chopping replaces the Gym.
        If he lived to be 101, it’s probably quite a good place.

      4. Mr Chris

        Dear AHNotepad
        Since he lived in Pioppi for the last 28 years of his life, I suspect the environment had some influence on his longevity. I am curious to know in what way this supposition is unscientific.

      5. AH Notepad

        Dear Mr Chris, Drawing a conclusion from circumstances where the result cannot be tested is belief, not science. There are no doubt other people who lived near Keys for his last days, who possibly died a lot younger. Why should Keys be the indicator of how good a place is, rather than one of the other desceased who, if they died much younger, arguably indicate how bad a place it was. You then have to bring in the confounders of course.

      6. Mr Chris

        Dear Mr AHNotepad,
        As far as my memory serves me, I said that Pioppi was probably quite a good place, and that I suspected the environment had something to do with it. Pioppi is a sort of blue zone, and Dr Malhotra describes it as a place where people forget to die. Keys, who spent something like 27 years there continuously came up with his enthusiasm for the mediterranean diet there. The current mayor points out that the word diet is derived ultimately from diaita which means as much”way of life” as anything.
        Now japanese immigrants to the US undergo a dietary modification and pick up many of the American dietary habits, so I suppose the environment has something to do with it. Unscientific?

    3. annielaurie98524

      And there are at least 22 “Mediterranean” countries, all with different cuisines, but none that you’d call “low fat”. In fact, the “classic” Mediterranean diet of the Greek islands, as fantasized and hyped by the 1960s low-fat proponents, based on observations post-WWII, was not the normal diet. The low-animal-protein regimen was routinely panned by the islanders. In fact, they told the researchers that. They noted that the meager diet was the result of scarcity during post-war recovery, and that it was neither long-term nor traditional. But that was ignored, as it inconveniently did not fit the low-fat paradigm.

      The same is true for the so-called blue-zone diets as reported by blue-zone book authors. And most Westerners have bought into the myth. While there has been no long-term vegan population in the history of the world, we see commenters, even on this blog where one would hope for more scientific skepticism, referring to the low CVD rates and increased longevity “among ‘traditionally’ no meat and low-meat populations”. Which do not exist.

      Anyway, I am gratified to see that Dr. K is finding that the emerging facts give additional support to the conclusions in his entertaining and informative book, “The Great Cholesterol Con”.

      1. smartersig

        If there are no no meat/low meat pop’s how do you account for the people of Loma Lindy to name but one. The traditional people of Okinawa would also be low meat

      2. annielaurie98524

        Get real. Loma Linda Adventists (not all of whom are no/low meat) are NOT a natural, sustainable population. They are an artificial, and very recent population. When nutrition scientists refer to “no natural, long-term vegan populations, they are referring to just that — a historical, homogeneous population that has existed in a relatively natural state for many generations. Veganism is a very recent trend in human history. If you go back and look at the older religious groups that purportedly ate “no meat”, you will find that there were plenty of loopholes and lots of “wiggle room”. Yes, even for Buddhists. Calling the Loma Linda Adventists (who are certainly not a homogeneous group by anyone’s definition) a sustainable vegan population is like calling corn and wheat native plants in the Midwest.

      3. smartersig

        Does it matter how recent a group existed and whether they fit a definition of population. If they have been around long enough to extract meaningful conclusions then they can be treated as a population for investigative purposes. The people of Loma Lindy are very amenable to filtering into vegan/low meat etc

      4. annielaurie98524

        One might draw “meaningful conclusions” if one approached this issue with some degree of scientific rigor, addressing all the confounding factors within this “group”, not to mention the data from other groups that do not fit the “model”. But “one” has not done this. I supposed the old saw applies that when one has only a hammer, everything looks like a nail. When one is pushing a near-vegan diet, everything looks like minimizing meat.

      5. smartersig

        I am not pushing a Vegan diet but I do like to examine all potential solutions out there and the number of common diseases helped or cured by a whole food plant based diet does seem quite comprehensive and backed by good science. By all means stick to meat and dairy if you wish but it does not have to be one or the other.

      6. annielaurie98524

        No one is arguing “one or the other”, so that’s a ridiculous accusation. The bulk of my food is, and has always been, plants, and I know I eat far more (quantity and variety) non-grain plants than any vegan of my acquaintance. All of the Paleo, HFLC, and even keto “gurus” recommend that the bulk of one’s diet be plants. Dr. Ballantyne (“Paleo Mom) has analyzed the natural diets of indigenous peoples, ancient and modern, and indicates that they are/were, on average, 75% plants, at least by weight. My objection is that vegan/near vegan types have co-opted the term “plant-based” (i. e., the bulk of the diet is plants) to mean little to no “meat”. And, keep in mind that “meat” is an ambiguous term. Some vegans mean any animal flesh (animal = any member of the animal kingdom). Generally, in the US, “meat” means mammal tissue and poultry. Not only that, but without good science, despite your re-iterating the mantra, such co-opters insist that eating little to no meat is “more healthful” and leads to lower all-cause mortality. Many of the co-opters, in their quest to “prove” their recommendations are the superior way of eating, have grossly distorted the dietary habits of any number of populations, whether the Cretans, the Okinawans, and, yes, even the Seventh-Day Adventists, attributing any health advantages such populations may have to their perception of what that population eats. Again, such assertions are without any sound scientific basis. In their almost religious fervor to push vegan/near vegan lifestyles, they conveniently ignore the fact that correlation (if there are such correlations) does not equal causation. They further completely gloss over the numerous confounding factors that are about impossible to eliminate when you are dealing with human populations and relatively short time spans. And I won’t even get into their myths about the environmental impacts of a “plant-based” diet.

      7. AH Notepad

        What someone (or no one) is arguing is not always relevant. It is the perception of what is being argued. I can see, and I suspect others can too, that you and smartersig have points to discuss. This is fair enough, and that is what blogs and forums are for, but the perceived stress generation may not be healthy.

      8. smartersig

        Could you explain with evidence how the Eventist study scientists grossly distorted the dietary habits of the subjects ?

  3. Gay Corran

    In the photograph it looks as if the merry makers are not only drinking wine together, but singing. And the baby is joining in. Singing is wonderful for unifying people. Perhaps we should sing more, and not be over-awed by the high-tec professionals we spend our days listening to. We shall have 16 round the table for a Hallowe’en dinner tonight, mostly children. I hope one day they will remember such gatherings and perpetuate them: eat, (real food) drink (water for the children, wine for the adults) and be merry is perhaps the axiom to live by!

    1. sundancer55

      Sorry to say, those kids won’t carry on the tradition, most likely. Why? Because the FDA is doing it’s best to scare people about “real food”. They make people afraid of everything that’s good for the human body, and they continually push synthetic drugs and vitamins, etc., with little to no liability so why shouldn’t they? It’s disgraceful but that’s what they do because that is their “purpose”. Canada is just as bad, and I don’t know about other countries but when we cannot have real food and are almost forced to eat crappy food, what’s the answer to that dilemma?

      And, my next observation is this: I’m disappointed by the way the article ends. What about those of us who don’t live near our families or those of us who despise our families or those of us who barely have any family members left? BigPHRma has nefariously done away with most of my family members, some well before the age of 60.

      Luckily my youngest son and his wife have 6 children and they live close by, but with working and all, we still don’t get to see much of any of them, which makes me sad because the kids are growing up sooooo fast.

      So what is the answer for the rest of the masses?

      1. Tony Youens

        A really good point. Whilst i do have family near(ish) by we rarely eat as a family. Famously PM margaret Thatcher told us the was “no such thing as society”. Perhaps a self-fulfilling prophecy. I don’t live in the place I grew up as I couldn’t afford to, so I live in an area with people I don’t know that well. Perhaps if we all grew up together in a small village we would have some sort of social cohesion. As it is we’re constantly being divided (and thus ruled?): Brexit/Remain, working/unemployed, haves/have nots, young old, Right v Left wing, the many/the few. I lose count.
        My wife and I have friends (a few) but I doubt you’ll manage to get a photo like the one shown. Can meditation and such like help I wonder?

      2. Gaetan

        Do whatever you can to make new acquaintances, join groups which share the same interests, volunteer to help around etc.

      3. robert lipp

        I think that what happened (for many reasons) is that we moved from multi-generational families to nuclear families that became more family isolated. Moreover, TV and now modern tech (phones tablets etc) destroyed family interactions. See Tom Selleck in “Blue Bloods” for family dinners = multigenerational, no tech, interactions, questions etc. etc. for an example.

      4. jeanirvin

        There are plenty of people around to relate to. We have relatives near but also belong to music groups, U3A, wildlife groups and are active in the village we live in. It has made a huge difference to us since my diagnosis of bowel cancer and subsequent chemotherapy. A little more effort needed to connect, maybe, but the rewards are immeasurable.

      5. Kay

        Sundancer, I’ve been hundreds of miles away from my parents, siblings, aunts, uncles, and all but one cousin since 1965. When possible, my family members have always made the trip — and still do — to be together for a day or a week or two to take up where we left off. Meanwhile, through the years I’ve had other close “family” among my friends wherever I’ve lived. The only difference between those families and my original family was in blood-relatedness and a shorter history of being together. I’m reminded of the time I rented the front half of a house in an old neighborhood. Shortly after I got there, I locked myself out of the place and had to go next door and knock on the door of total strangers to use their phone. They were first-generaltion Italians. A hour or so, and a couple of beers later, I had met my neighbors who immediately became like family. I now have loving step-children and lots of loving friends who live nearby. My experience has been that there are good people everywhere with whom one can share good meals and happiness.

    2. Martin Back

      Note in the photograph, the men are around the table, the women in the background, a typical patriarchal scene.
      Conclusion: Feminism causes CVD ;o)

      1. Martin Back

        Dr. Kendrick,
        Actually, I have been to Scotland, briefly, in the ’70s. I only saw the inside of pubs, followed by the inside of a hospital after being beaten up on the street by a bunch of yobboes with heavy boots.

        The doctor who attended to me said, with legendary Scottish parsimony, that I was so drunk there was no need to give me an anaesthetic, and proceeded to put fifteen very painful stitches in my head and face.

        The locals told me that people from Edinburgh don’t behave like that, must be those people from Glasgow come over to look for trouble on Hogmanay. No doubt in retaliation for being forced out of their nice friendly tenements.

      1. Bill In Oz

        Jillm, I watched this Catalyst program from 2016. It makes very clear the positive role that music can play for the elderly.But I was puzzled by the ‘personalised music programs’ with head phones.

        These individuals are isolated by this magical music pill behind their head phones in a private world…

        And yet Dr K here in this post has shown us how important strong family ties and being part of a caring community, are in preventing CVD by reducing stress in the HPA system.

        Meanwhile for the past 9 years I have been learning and dancing Argentine Tango. I love dancing and the music is wonderful. And I have a ( minor) place within a community of like minded people who all love dancing and the music. And friends in the tango community Geelong, near Melbourne are involved in helping aged care residents learn to dance as part of helping people with dementia.

      2. Gary Ogden

        Bill in Oz: That’s great. Dance is wonderful, although I’m completely hopeless on that score. I agree on the headphone music. I use a boom box. By the way, I just finished getting in the garlic crop, the largest I’ve ever planted. A huge job, after harvesting the sweet potatoes, which occupy the same space the rest of the year. Harvest in May/June. I’ll be swimming in garlic!

    1. AH Notepad

      Highly unlikely. They are not interested unless there is a way of making themselves rich. Look up https://youtu.be/RYYf8cLUV5E on Norweigian fish farming and then root around to discover the trail to Scotland where money is the only goal, and see who stands to benefit (members of the government perhaps?). Hint, it isn’t the consumer.

  4. Gaetan

    Fried Mars bars ”More carbs wrapped round the outside, and now dripping with vegetable/polyunsaturated fat. Mmmmm … you can just feel your arteries unclogging”

    lol, love your humour!

    Another well written article, i also agree with you that stress (strain) is the major cause of heart diseases and to an extent, all diseases.

    1. Tom Welsh

      It hadn’t occurred to me before that Dr Kendrick’s wonderfully dry humour probably qualifies as an aid to health in itself!

  5. Jean Humphreys

    Thanks for nailing it to the wall where all can see it. Sad that so many that could look and learn will not do so.
    Yes,Gay Corran, I do believe the baby is singing too. Sadly, after a lifeime of singing, two years on a statin, some twenty years ago, and I have lost control of my vocal chords to the extent that when trying to sing the sounds that come out are just random grunts. Which make my throat hurt.

    1. Jan B

      Jean Humphries – after 10 years on a statin the same has happened to me. I always had a lovely singing voice but now all I can produce is a wavering, quavering croak. I never connected it to the vile statins but they buggered up the rest of my body so why not the voice. So so sad about it.
      Dr. K, that new post is brilliant. Thank you so much. You brighten my life. Thank you.

  6. James DownUnder

    At last, the Answer we’ve all been waiting for. Makes perfect sense.
    Fittingly, it comes back TO the heart, – not the pump, but the capital ‘H’ Heart, seat of our emotions, our ‘soul’ or life-force, -whatever. Put simply, happy and loved hearts have reasons to stay alive… so they do.
    Lonely, miserable oppressed and sad Hearts don’t, – so they generate the conditions for their own demise.
    (Well, that’s the succinct theory!)

    Depressed people have a much higher rate of ‘heart disease’ and suffer more cardiac deaths and I’d been caught off-guard by the devastating consequences of unrelated surgery 12 months earlier. No surprise (now…) that my health spiraled into cardiac catastrophe!

    To add insult to injury, my (ex) cardiologist contemptuously scoffed at the suggestion that ‘Stress’ .. *might* be a contributory factor. – Statin Deficiency was the unspoken accusation.
    A year beyond the CABG x 5 and the light at the end of the Tunnel is finally being switched on …
    Thanks again for your Persistance.

    1. bill

      Yep Ive been through that criticism! Statin deficiency!!!!!! I had a quadruple cabg 10 years ago! I took all my medication and felt awful so i slowly weaned myself off my statins and my bisoprolol and my amioderone and ramipril and……….I bought some walking boots and I walked through the country every day, quickly, for around 4 miles!!! Every day!! Walk walk walk and walk some more!!!!!
      Take control of your life!!!! Eat well…get a social life…drink coffee….eat dark chocolate….laugh and laugh and walk and walk!!!!!!!

  7. Sylvia

    Wonderful, but families are so far apart now, I still cry when my children go home to their lives,so different from my childhood, before motor cars and foreign travel, get togethers were a joy. Thank you for a fantastic post, have sent it to my dear ones who live north, south, east and west from me, boo hoo. FaceTime has to do, but it isn’t the same.

    1. Gaetan

      I think we need to extend the concept of family to anyone we love spending time with. In other words, friends are family too, it’s a choice but also an awareness shift, that family is not confine to blood or marriage.

    2. Jan B

      The Doobie Brothers back in the 70s recorded a song “If you cant be with the one you love, love the one you’re with.” Some may say it’s cynical but to me, living hundreds of miles away from children and grandchildren, it makes perfect sense. As an old woman, I have recently become quite close to the most beautiful 5 year old and how he makes my heart sing. Lucky old me.

    3. annielaurie98524

      If you live alone, or perhaps with only a spouse for human company, whether you feel “lonely” or not is largely your choice. As May Sarton so aptly stated, “Loneliness is the poverty of self; solitude is the richness of self.”

      1. David Bailey

        I agree – and nowadays the internet has created lots of virtual ‘communities’ – such as this one – which hopefully play their part in keeping us healthy!

        On the other hand, other parts of the internet undoubtedly raise stress hormones etc!

      2. Sylvia

        May I just disagree about being lonely, it is not necessarily largely one of choice, though of course it can be. There is indeed plenty to do to help others and volunteering brings rewards.
        Annielaurie I feel it is part of growing older, coming to terms with this and accepting, but a little heartache has to be felt also. Emotions are a funny thing. Regards, Sylvia.

      3. Gary Ogden

        annielaurie98524: How true! How we approach life is indeed a choice. Having extended family around and a wide circle of friends is indeed healthful. But not essential to good mental health. I haven’t much of either of these, but I have spouse, cats, good neighbors, random strangers, and all the fascinating people I meet on the trails in the woods on my weekly hikes. This works for me (red wine at supper helps, too). But I guess mental health disturbances are common. A year or so ago my doctor had me fill out some questionnaires about such things. I found them perfectly silly, and suspected they were part of Pharma’s trolling for customers for their SSRI’s, and even the idea that these conditions are common are part of a stealth campaign to medicate everyone. I also joined the ADAPT study, which is apparently about nutrition, but there were several sets of questions mainly about mental health, which I thought odd. We are being played for fools by very sophisticated and clever marketers who operate the levers of media and government.

    1. robert lipp

      I like this. An argument to supplement in this day of more stressors, more stress, more strain plus reduced (real) food quality

      1. smartersig

        You mean you worry about whether you have taken your Vit C supp which in turn means that if you have then it only returns you back to where you were in terms of Cortisol.

    2. Joan Coleman

      I was dreading a further cholesterol check after having been told by my GP that my total cholesterol was 7.19. We yet again had “the statin chat” and I yet again said “no thankyou, not taking them”. I read a book by Linus Pauling in which he explained how Vitamin C lowered cholesterol and decided to give it a try. After 3 months of taking approx. 1 gram daily of pure Vit C powder dissolved in water I had a follow up blood test. My GP then telephoned to say that there had been “a dramatic reduction in total cholesterol from 7.19 to 5.4. She asked what I had been doing. As I explained I could hear the computer keys frantically clacking away in the background! She was astonished that this had been achieved without statins. Thankyou Linus Pauling!

      1. Antony Sanderson

        Joan, I groan when ever I hear doctors prescribing statins for women . . . All the studies I have come across conclude that there is no advantage in terms of all cause mortality taking statins.

        Since my last blood/lipid test I have been taking vitamin C daily . . . so it will be interesting to see what happens next February when my next test is due!

  8. Lorraine Cleaver

    Bravo Dr Kendrick! My own family were shunted out to these high rise monstrosities in Glasgow in the sixties and both grandfathers died suddenly, aged 60, of CVD. My grandmother, now 95, still talks fondly of the days living cheek by jowl in the tenements, with family on hand to support and nurture them. Thyroid wise, I’ve long said the increased rate of heart disease here is linked to the dysfunctional cortisol pattern that develops when the poor patient is dosed by TSH.

    On another note, my HDL is sky high and my Triglyceride low. Endo advised me to keep taking the red wine so it’s not all bad.

  9. Julian Corbell

    I loved reading this latest post on the causes of CVD. The photographs are brilliantly chosen to be memorable as well as re-enforcing the message. Will it all be dismantled in the next post?

  10. Donna

    I’m grinning ear to ear at your final thought and picture. Coming from a once large and well connected Italian family, the picture brought back fond memories. Love your articles!

  11. Bill Manahan

    Great article, Malcolm. Thank you for your great humor, excellent research, and wise advice. I am a big fan of yours. I am a 77 y/o retired family physician in the U.S.

    About 5 or 10 years ago, a woman researcher did a study that would give support to your point of view. Unfortunately, I cannot recall her name or find the study. It was something like Deborah Kestens, but Amazon and Google cannot find her.

    She and her husband (Larry something) had thousands of people complete a questionnaire asking questions about their eating. How long? At what location? With whom? Etc. Then she collated the answers with that person’s health, and the results were a linear curve. If all six criteria of eating were good (similar to how the French eat), those people had far less medical problems. And, of course, the reverse was also true.

    It always has surprised me that we do not look more closely at Rosetta and the French, because they are really showing us the WHY of heart disease. Your article explains why that is.

    Keep up your good work!

    Bill Manahan, MD

    Minneapolis, Minnesota


  12. Frederica Huxley

    Fascinating! Animals in captivity die from the same stresses, notwithstanding the right foods, and environment. Sad that the spike in Scottish CVD rates was collateral damage from planners whose one goal was to replace the tenements.

  13. Marjorie Daw

    Scotland uses chlorine to disinfect drinking water. The French oxygenate the water to make it potable. Have you read, “Coronaries, Cholesterol and Chlorine by Dr. Joseph M. Price who links our, “purified,” drinking water with the rising tide of heart disease. It does make a lot of sense that eating a bagel on the subway while rushing to the office isn’t a recipe for health but could there be more than one explanation for the French Paradox?

    1. Eric

      Not sure the French use oxygen. The approach on the continent is usually to make the water devoid of any nutrients. This is supposedly the best way because no resistant bacteria are bred.

      1. Col

        Suspect it’s Ozone they use. A more important difference is probably the higher mineral content of French water, not much limestone in Scottish topography.

      2. Eric

        Can’t remember tasting chlorine in tap water anywhere in continental Europe ever. There was a weird tasting desinfectant used in some remote villages in Norway in the early 90s that was used to sterlize surface water. Read up on Germany, apparently, chlorine was rendered illegal in 1991 but was not widely used before. Instead, ultra-filtration, ozonization and UV are used. Most of Northern Germany has very soft water, great for making tea. So it’s not like you need to use chlorine on soft water.

      3. Anna

        Don’t know what they put in the water in South west France but it often tastes disgusting. On the other hand when we moved here we made many friends of various nationalities ( including French of course) and enjoy a caring community, regular music making, red wine & fresh local market food.

  14. Dr. Göran Sjöberg

    Well! Then we are back to stress as THE cause. I believe in that and the HPA-connections with the heart. Benefits from food however not to be denied. I have just put a 55 kg wild boar I bought from a hunter into my freezer.


    “Both sexes drank wine with seeming abandon, a beverage which the 1963 era dietician would find almost prehistoric in health value.”

    This reminds me on the entry my last (?) cardiologist made in my journal three years ago.

    “The patient does not take any prescribed drugs by us. Takes alcohol as medicine!”

    I wonder a little about side the effects 🙂

  15. Peter Wrelton

    Interesting article as always, I have long held that stress (not to be confused with stimulus ) has a major part in heart decease and type 2 diabetes. Thank you for giving professional weight to the argument. Please keep pushing for progress.

  16. Kay

    Thank you! I’m always delighted to find another post from you.

    While this is a drop in the bucket compared to wars and relocations, I wonder if our chronic low level of stress over doing the “right” diet/lifestyle doesn’t have a negative effect. People have been led to believe that if they do things “right,” they can escape all illness — or who knows? maybe even death. Many schools, hospitals, etc., are required to eat a certain government decreed way. We have fancy watches — “watch” takes on whole new meaning here — that record every detail of a person’s lifestyle, sometimes penalizing them financially if they don’t follow the rules. I can’t imagine all of this doesn’t have an effect on people, even those who think it’s a good idea.

  17. JDPatten

    I asked my GP in Massachusetts If he’d seen a rise in emotion associated health issues since November 2016.
    Not so much a rise as off-the-charts!
    It’ll be interesting to follow CVD deaths in the months/years to come. Even more interesting, perhaps, to differentiate between red and blue states’ CVD.

    1. JDPatten

      ‘Course, Mass is blue — you’d expect that.
      But the way things are going, the blues might end up with a worse case of . . . well, the blues. And CVD.

      1. Bill In Oz

        This gives me another confirming reason for not taking any interest in US politics. Apart from being irrelevant to me here in Oz and frankly quite boring, now we know it is actually damaging to the health !

        My sympathies though to those living in the midst of it all.

    2. Gary Ogden

      JDPatten: Yes, and the rate of cognitive dissonance will surely rise in the blue states as it is becoming clear that everybody except Trump was colluding with the Russians!

    1. Gary Ogden

      Mr. Chris: Me, too. Not easy to learn how to eliminate worry, but possible. Concern about things warranting concern, but worry doesn’t do a damn bit of good, because the small things don’t really matter, and the big things we can’t do anything about, anyway. Social interaction has never been one of my strengths, but a few years ago I learned how to open conversations with nearly all the random strangers I encounter, and it has been a revelation. Most people respond well to this, and it usually brightens our day, just the act of brief, mundane chatting about the weather or whatever.

      1. Mr Chris

        I find most people are very ready to explain things they are doing or know how to do, that I don’t . I have had many an interesting conversation with total strangers starting like this.

      2. Gary Ogden

        JanB: Yes. Dogs are great conversation starters, and people certainly appreciate that you like their dog. When I lived in the boondocks I had both dogs and cats, and they were great pals, but here we have room only for cats. I like cats especially because, like me, they’re not too good at following rules.

  18. Lorna

    Scottish grandmother born 1888, 10 children, frequently without husband’s support but lived for 95 years in West Coast Scottish village with plenty of neighbourly support, a diet of fish, rabbit and vegetables and porridge, village school cook, cleaner and unofficial midwife when doctor not available or affordable. She took in extended family all her life and provided bed and board for trawlermen in the herring fishing season. She taught a raft of cousins and myself that hospitality was family and beyond. I agree with everything you’ve said Dr Kendrick and so would Thomasina. Thank you for your sound good sense.

  19. CureFacts

    Big WOW! And even a bigger laugh! Thank you for all these goodies!
    I am beginning to think that reading you is a very effective medicine on its own.

  20. Craig E

    Dr Kendrick I really admire your tenacity when it comes to turning every stone to get the full picture. It is…really…the only way to the truth. And what you have described over this series has had me intrigued from the start. You were partly the catalyst for me renewing my interest in biochemistry and its relationship to health. You have also helped me to appreciate that not all dogmas are true and how hard it is to dismantle them in the face of the establishment protecting their interests. If I had to look back though and pinpoint the single trigger that made me start to question conventional claims it was the ABC Catalyst Program on Statins. Without that show I wouldn’t have found your book or your blog…I never believed that cholesterol was an issue so started researching from that point. Trouble is there are too many balls in the air for me at the moment…heart disease, diabetes, thyroid, cancer…too much to research….not enough time! You and your readers are helping immeasurably…many hands make light work. Thanks.

  21. Bill In Oz

    Dr K. A great article ! So much we ( including me ) have all focused on the microscopic details of what foods we eat, or what magic potions or pills will cure us.

    And here you step back & present us ( again ) with the big picture of heart disease…And in that big picture the cause is revealed very starkly.

    I hope here we are able to focus on what works to reduce heart disease..

    1. Bill In Oz

      PS : In the light of what you say about the Rosetta community up to the 1970’s, I wonder if we should also rethink our ideas about the Kitavan Islanders in PNG.
      The Kitavan Paradox ?
      They smoke heavily, and have a high carb diet. but have ( had ? ) low levels of CVD ..
      But it is a society with very strong family & clan ties living together on a smallish island, a bit isolated from modernisation processes.
      Or the Okinawa Paradox, where again strong family & clan ties are CVD protective and people live long healthy lives.
      Or the Sardinia Paradox ?
      Or even the 7th Day Adventist Church paradox ?

      1. annielaurie98524

        When the majority of societies with good health are “paradoxes” because they go against the grain of current medical orthodoxy, perhaps it’s time to invoke Occam’s Razor? Or maybe just get back to the very basics of the scientific method, where only one data set against your hypothesis is enough to disprove it?

  22. Errett

    Antioxid Redox Signal. 2017 Oct 23. doi: 10.1089/ars.2017.7312. [Epub ahead of print]
    Loneliness, Social Isolation, and Cardiovascular Health.
    Xia N1, Li H1,2,3.
    Author informatio

    Social and demographic changes have led to an increased prevalence of loneliness and social isolation in modern society. Recent Advances: Population-based studies have demonstrated that both objective social isolation and the perception of social isolation (loneliness) are correlated with a higher risk of mortality and that both are clearly risk factors for cardiovascular disease (CVD). Lonely individuals have increased peripheral vascular resistance and elevated blood pressure. Socially isolated animals develop more atherosclerosis than those housed in groups.

    Molecular mechanisms responsible for the increased cardiovascular risk are poorly understood. In recent reports, loneliness and social stress were associated with activation of the hypothalamic-pituitary-adrenocortical axis and the sympathetic nervous system. Repeated and chronic social stress leads to glucocorticoid resistance, enhanced myelopoiesis, upregulated proinflammatory gene expression, and oxidative stress. However, the causal role of these mechanisms in the development of loneliness-associated CVD remains unclear.

    Elucidation of the molecular mechanisms of how CVD is induced by loneliness and social isolation requires additional studies. Understanding of the pathomechanisms is essential for the development of therapeutic strategies to prevent the detrimental effects of social stress on health. Antioxid. Redox Signal. 00, 000-000.
    cardiovascular disease; loneliness; oxidative stress; social isolation
    PMID: 28903579 DOI: 10.1089/ars.2017.7312

  23. Mike Smith

    Interesting read but something that always seems to be overlooked is Vitamin D, scots don’t get much sunshine, French people do. Also Cooking food in Beef Dripping, Lard and Butter is way more beneficial that the cacogenic yuck that is vegetable oil

      1. KidPsych

        Vitamin D had me thinking about differences between North and South in regard to CVD in France. Found this one, but perhaps you have stumbled across others:


        FTL: “Although the absolute estimates of rates were variable with the definition of the
        event, major findings in relation to trends and geographical disparities were fairly
        consistent across the definitions: the North-South gradient in mortality observed
        in France was found to be much more pronounced for case fatality than for inci-

        (Of course, there is more than just Vitamin D difference when contrasting Northern and Southern France – pace of life, for instance.)

      2. Bill In Oz

        @kidpsych : the same research paper has this statement in the discussion
        ” the North-South distribution of disease in France is in keeping with a higher proportion of low social groups, higher unemployment rate, lower educational level, & the higher frequency of poor housing in the North ”
        Yes all the usual confounders !

    1. Bill In Oz

      Mike I live in South Australia. We get plenty of sunshine here. In fact my lady & i spent today working in the garden in the sun.. Yet CVD is still a major disease and cause of death.

      Further back in the late 1970’s I lived in Paris for 7 months. For the first 3 weeks there was snow 5-6 inches deep in the streets.. Spring and Summer did come in time. But I still remember the warm but cloudy & humid days of Paris in July. Not much sun there.

      But I also remember the closeness & conviviality of french families at their meals whether in cafes, restaurants or at home.

      These things all lead me to say I doubt that sunlight makes huge difference.

      1. Bill In Oz

        Yes the french do make use of garlic in their diet. Far more than the English, Scotish, Welsh or Irish.

        However by pure coincidence I was from 2005-2015 a commercial grower of organic garlic. And garlic was a part of my diet. I still grow my own garlic in my home gardens. And do so organically as well – no chemicals !

        But still my CAC was 1067 when I was tested last year. I was told to take statins & recommended for stenting. Both of which I declined.

        However the past 3 years have been a time of huge changes and stresses for me. So Dr Kendrick’s hypothesis fits my life experience.

      2. Bill In Oz

        I fogot answer your question about how prevalent is the use of garlic here. A huge amount is imported from China, Spain & Mexico in addition to what is grown here in Oz. Currently imported garlic from Spain is $20.00 a kg. Yet stil it sells. Organic garlc at this time of the year ( Spring ) is about $50.00 a kg and hard to come by. I will be glad when my own garden crop is ready for harvest. Then we will have 4-5 kgs for the coming year.

      3. Gary Ogden

        Bill in Oz: One of my favorite things about planting time (which just finished here) is that there are a large number of the smaller cloves available for eating. I saved so much seed garlic last harvest, and ordered some new types, so I have a huge crop in the ground. I was so short of space, I even put some among the Chinese cabbages. I eat them with my eggs, put them in stews and salads, and put lots of them in fermented vegetables. Maybe this is why I don’t have very many friends?

      4. Bill In Oz

        I too am growing lots of varieties : 6 this year. And for want of space I am growing them under deciduous fruit trees which were all asleep & bare of leaves during Winter… All the garlic are still there starting to die back now.. I’m hoping for a good harvest. I do like my garlic in salad dressings, and with all my cooked dishes.

    1. annielaurie98524

      I’m not sure how old the song is from which that quote was taken, but even 400-500 years ago, people realized that a relaxing meal with good friends, and a bit of wine, was a great prescription for the heart.

      1. annielaurie98524

        Then you have grape juice. And juice, with its high sugar and low fiber content, is really no better than soda. That would be particularly true of wine grape varieties, which have been selectively bred to have a higher sugar content than table grapes. Have you ever tasted the juice from wine grapes prior to fermentation? The sweetness is cloying. The alcohol in dry wine is there because the sugar has been converted. And, if you look at all the many studies that have found a health benefit from modest alcohol intake, the effects are not limited to red wine by any means.

      2. smartersig

        The studies on red wine appear ‘mixed’ according to meta analysis but it does appear that red wine without the alcohol has improved benefits when it comes to blood flow measurements pos consumption. Perhaps if sugar is a concern then just take out whats left eg resveratrol

      3. smartersig

        That would only be Dr Das’s work there are other studies which have not been trashed or associated with him

      4. annielaurie98524

        The studies (and I won’t even touch on what the former editors of Lanccet and NEJM say about studies that get published) on ANYTHING edible or potable are “mixed”.– it’s those blasted confounding factors again! And how many studies on “red wine with the alcohol removed” do you have?

      5. AH Notepad

        annielaurie is quite right to remind people the opinion the editor of The Lancet voiced about articles that get published. https://www.ncbi.nlm.nih.gov/pubmed/15585989 Is hardly going to carry much weight when it is based on a study of 15 males. The suggestion that is worth consideration is, unfortunately, laughable.
        I find there are so many pubmed articles that provide conflicting evidence across a range of subjects, that I no longer see them as necessarily a credible source.

      6. smartersig

        I cannot agree with that. There is a general tendency amongst people who dont understand statistics to have blanket biases such that 15 people sounds low so it cannot be valid whereas 1000 sounds really good and maybe I should take notice. I am not saying that you fall in this category but it simply is not true to make such statements. You can get perfectly good statistical inferences from 15 people depending on the nature of the experiment and the outcomes

      7. AH Notepad

        I cannot agree with that. 🙂
        Even 1000 is a small sample to draw reliable conclusions given the number of confounders which have to be considered.

      8. Gary Ogden

        smartersig: You are correct. 15 people is what they call seriously under-powered, but then, their only conclusion was that FMD was reduced after consumption of alcoholic wine, and increased after consumption of non-alcoholic wine. They did note that this was a temporary phenomenon, and said nothing about long-term effects. I would call this perfectly good science, though its value in understanding CVD small to nil.

      9. smartersig

        I agree no alcohol V small amounts per week may be a small bit player in this but when people already have heart disease the small bit players can become more significant. If you have significant heart disease and want to stop or reverse it then perhaps it would be foolish to not incorporate all plus factors. Cheers good health 🙂

      10. annielaurie98524

        To paraphrase that literary character, “I do not think this study means what you think it means”. Fifteen men with CVD drinking 250 ml of wine and de-alcoholized wine on two days in a clinical setting to see if the beneficial effects of red wine were due to the alcohol, which is what had been postulated (no mention of resveratrol). This was a small sample, short-term, one-shot test — it might suggest further testing, but does not establish benefits for the consumption of de-alcoholized wine. As noted, producing a “non-alcoholic” wine requires additional processing (usually via vacuum distillation or reverse osmosis) then “reassembling” the wine components, and adding compounds to re-adjust the flavor. One of the flavor-adjustments in commercial “non-alcoholic” wines is … adding sugar.

      11. AH Notepad

        Taking the alchol out of red wine does not produce grape juice. Red wine is produced by converting the sugars to alcohol, removing that alcohol does not turn it back into grape juice.

      12. annielaurie98524

        Yes, I am thoroughly acquainted with wine chemistry. To remove the alcohol from wine is not the easiest procedure, and it would be an expensive method to ferment the juice to wine and then remove the ethanol. This is why several “experts” suggest, for people that do not consume alcohol, to drink the juice to get the benefits of the resveratrol – cheaper, quicker and less processing required than trying to undo an already-vinted wine.

      13. smartersig

        But that is precisely what alcohol free wine is ie wine without the alcohol not grape juice with sugar. You can buy it at many outlets and evidence suggests it would be a healthier choice.

  24. Linda Davies

    I don¹t think anyone is of the option ŒVn a deep fat fryer full of vegetable fats, you have, according to current thinking, just made it significantly healthier¹!!!! That only applies to good fats, not superheated cannoli oils, as I am sure you know. Linda

  25. Caroline

    Your articles are always thought provoking. I wonder if part of the French paradox is related to high levels of vitamin K2 in their cheese and foie gras. I believe there is a lower incidence of CVD amongst natto (very high in K2) eaters in Japan (more popular in the east versus west). In Japan they also promote the importance of eating slowly and mindfully so that blood sugar levels do not spike and cause stress. And the cortisol link would explain why some specialists promote magnesium for the heart.

  26. Håkan

    Yet another very interesting post.

    You have many international readers, dr Kendrick, so be aware that your irony, sometimes, is difficult to comprehend for foreigners.

  27. karlwhitfield

    Excellent as always Malcolm.

    Indeed, love and relationships and the stress-reducing effects of social bonds continue to prove out as more beneficial than almost any dietary intervention…

    Loving this series, thank you!


      1. annielaurie98524

        Yes! And a pompous one at that. Keys epitomized the epithet “a legend in his own mind”. True, he was a brilliant man, but his obsession with his own brilliance made him loathe to engage with dissenters, and led him far from the path of true science.

      2. Dr. Malcolm Kendrick Post author

        We also hate to discard a hypothesis, as he did. Ideas are enormously powerful. Even ideas that do not matter at all. I was listening to the astronomer who relegated Pluto from being a planet to a dwarf planet, for astronomical reasons that I cannot remember. Too small, I think. He was amazed how upset and angry people became. I mean, it does not matter in the slightest if Pluto is a planet, or not. There is no conceivable way that this can make any different to anyone, or anything. But it really mattered to some people. So it should come as no surprise to find that people defend scientific hypotheses with great ferocity. Especially their own.

    1. David Bailey

      The problem for medical science is to move from the dogma that salt and saturated fat are deadly, to one which accepts saturated fat as desirable, and also accepts higher levels of salt as healthy, and focuses on excess sugar.

      That is clearly tricky, because if you suddenly reverse the message on all the health websites, a few people might notice! Even worse, they might notice that certain ‘mavericks’ have been giving the new advice for decades.

      Therefore, step one, is to change the topic completely. Define a whole diet to be healthy based on geographic region, taking care never to actually define what that diet consists of. Since the previous advice was ‘scientific’ – specifying specific chemicals that were supposedly harmful, it is important never to mention actual chemicals in the new advice!

      It is also best if people don’t start recovering too quickly. Although that might seem desirable, it would focus attention on the cause of their previous ill-health – following medical advice.With luck this problem won’t arise because some versions of the new diet won’t actually be that healthy.

      It will be fascinating to see what step 2 will be.

  28. Charles Gale

    Lorraine Cleaver – same here with my HDL and triglycerides…and also a healthy TC/HDL ratio, and ideal trigs/HDL ratio.

    And yet they are statinating me like a force fed foie gras goose. It’s amazing the games they play with your lipid profile and cherry pick certain results with which to statinate. In my case high LDL-C and also a high non HDL chol level.

    To quote Dr Michael Eades from a 2009 post he did: the authors of a paper “are still fixated – as are most lipophobes – on LDL levels. They just can’t get their heads around the notion that there is more to cardiovascular risk and health than LDL – Cholesterol”.

    Which all followers of Dr Kendrick know.

    Spotted this the other week on Mark Sisson’s Daily Apple website called “the death of lipid research”:


    You subsequently mentioned 24 hour cortisol testing, which Dr Kendrick mentioned in his book and elsewhere over the years.

    Did your GP/doctor arrange this for you or was it a home testing kit and off to a lab?


    1. lorrainecleaver7

      Hi Charles, re cholesterol, I pay no heed to it, ever but my thyroid doc noticed it and congratulated me! I think the cholesterol: HDL ratio is 2.35 which is ok allegedly. I don’t care though because when I was very deathly ill on Levothyroxine, it was the opposite, with high LDL and low HDL. All it was doing was reflecting something else going on in my body, i.e. hypothyroidism poorly treated.

      Many thyroid patients order 24-hour saliva cortisol from Genova Diagnostics via Thyroid UK (for a slight discount and the benefit of having Thyroid UK named as your practitioner for the purposes of ordering labs online).https://www.gdx.net/uk/product/adrenal-stress-profile Sadly GPs and Endos dismiss the results as not recognised by the NHS. Which is odd, because there is wide NHS research into saliva cortisol levels in depressed young males. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3948242/

      Similarly, I attended a NICE scoping workshop into Thyroid disease guidelines last month. Someone mentioned the importance of establishing cortisol levels were adequate in thyroid patients before commencing treatment as there was an increased risk of Addisonian Crisis. An endo scoffed and said there was no need. When pushed for as to why, he blankly said “because they don’t die when given Levothyroxine”. Lovely.

  29. Charles Gale

    Many thanks Lorraine – very helpful.

    If your lipids are measured in mmol/L, then a TC;HDL ratio under 4 I’ve seen described as a “healthy” level, at least here in UK.

    After getting out of intensive care May 2016, I only managed to get 2 different cortisol tests done: the morning fasting blood test and then the one with the tablet. None of which tell you anything about the functionality of the HPA-axis over 24 hours. My GP didn’t want to know (nor did the NHS endocrinologist I saw privately) and I guess I ran out of steam.

    So, this post on stress is a timely reminder to revisit this test.

  30. Andy S

    Dr. Kendrick,
    Took me a while to appreciate role of stress in CVD not just for ulcers. Stress is part of living, the remedy is to find the appropriate stress relievers.
    Stress inducers: negative circumstances, bad diet, premature worrying, negative thinking
    Beneficial stress relievers: socializing, meditation, physical activities, hobbies
    Destructive stress relievers: smoking, excess alcohol, comfort foods, drugs

    After stress/strain is resolved food choices is the next biggest factor. And perhaps food choices can create stress by initiating diseases.

  31. dearieme

    Your social upheaval idea, doc, could be consistent with Kinlen’s Hypothesis. You move people around and mix them up: boom, vulnerable immune systems are exposed to unfamiliar micro-organisms that make ’em ill. So your Italians moving from one Rosetta to another: no mixing with people they hadn’t mixed with before, therefore no extra deaths by an epidemic of heart disease.

    My wife remembers attending a seminar where it was pointed out that deaths by CVD in Glasgow had occurred at wildly different rates from one street to another. So, your Glaswegians: people from different tenements, different streets, newly mixed up together in new tower blocks: boom, extra CVD.

  32. jbarnesbaker

    Hi Dr. Kendrick.

    I think my story disproves some of your theories about CVD.

    I don’t have a large, gregarious, family and we don;t get together often. In fact, my family has a higher than normal incidence of depression, bi-polar disorder, schizophrenia, etc,, probably because of a gene mutation (MTHFR). The same mutation gives us a much higher than average risk of heart disease and stroke.

    I was diagnosed with what was called chronic fatigue and fibromyalgia over 20 years ago and have never been able to exercise much, if at all. I had mercury poisoning (the level is now normal after getting a lot of root canal-treated teeth and fillings removed) but I still have toxic levels of lead from working with stained glass as an artist.

    I don’t drink wine or alcohol.

    I mostly stayed out of the sun and wore sunscreen every day when I lived in the South and then I moved to the Pacific NW where sun exposure is limited most of the year..

    I have had a high level of stress for most of my life. One year ago today my husband suffered a cardiac arrest as a result of low potassium caused by a blood pressure medication. They gave him a one percent chance of surviving. I think the stress of that situation contributed to my getting very sick about 3 months later and almost dying due to adrenal insufficiency that was not diagnosed for six months.

    And yet: when I went in for a stress test, my sonogram showed that my heart and arteries were perfect! The cardiologist was astonished. He said my heart was “beautiful, with thin, flexible walls,” and that my risk of a heart attack or stroke was zero. I doubt that he had ever seen a sonogram like mine, especially in someone my age. My husband also had a clear heart and arteries, which explains why he beat the odds and not only survived, but came through with no ill effects at all. The nurses at the hospital called him “superman!” When he went back to his GP for a checkup, the doctor told him he didn’t need to check his cholesterol any more.

    So what was different about us? The only thing that I can think of is that we have been on a low-carb diet, high in natural fat, for the last 17 years.

    I’m sure that neither the French nor the Scottish were eating a diet like ours when they were compared in regard to CVD risk. Perhaps all these other factors don’t really matter if you get the diet right.

    The story of what happened to my husband is here: http://www.carbwarscookbooks.com/the-worst-day-of-my-life-and-an-important-warning/

    The story of my adventure with adrenal failure is here: http://www.carbwarscookbooks.com/its-a-beautiful-day-and-im-glad-to-be-alive/

    1. Dr. Malcolm Kendrick Post author

      I am glad that you are so well. My entire series has been about looking at many different things that can have an effect on CVD. I have never, and will never, state that one factor can over-ride all other factors to cause CVD.

      1. jbarnesbaker

        Thank you. I appreciate your search for the cause of CVD and have followed your books and posts on the subject. I just wanted to share that in my case, stress clearly has had nothing to do with it, and neither has wine, sunshine, or exercise. In spite of my having multiple strikes against me, whatever I’m doing is working great.

        I eat a lot of pasture butter and coconut oil; is it possible that the difference between the French and the Scottish is that the French eat more butter, which is high in saturated fat, and the Scottish eat more lard, which is highest in mono-unsaturated fat? I don’t know the answer, I’m just asking, but Dave Feldman’s experiments show that eating a lot of saturated fat, combined with a low-carb diet, can “correct” cholesterol levels in just 3 days! Dr. Eades wrote about it here: https://proteinpower.com/drmike/2017/07/25/how-to-lower-your-cholesterol/

      2. Dr. Malcolm Kendrick Post author

        One thing Ancel Keys managed do do, above all, was to create the diet-heart hypothesis. However much we may disagree with his idea that saturated fat is bad, we still live, and argue, and discuss, almost entirely, on the diet-heart playing field.

    2. Gaetan

      you know, some people have this inner joy inside. Not happiness, i mean joy of life, joy of being alive, gratitude towards life itself and everything that exist. I believe those people will live long and free of diseases because they simply have found their way or path…

    3. annielaurie98524

      Neither Dr. K’s stress theory, nor the cholesterol-diet theory, for that matter, says that EVERYONE that follows a certain lifestyle, or has a certain set of risk factors, will develop CVD. Just as there are heavy smokers that do not develop lung cancer, the same applies to other health problems. Certain genetic traits, lifestyle practices, etc. raise one’s risk for various conditions, but do not lead to 100% of people so affected developing the condition. One would expect, however, that a population where most folks have those factors will have higher rates of the condition than a population where most people don’t have them. The correctness of the explanatory model lies in the statistical differences between the two groups.

  33. Charles Gale

    Hi Lorraine

    I’m not sure why I ended up in intensive care – I’d looked after myself and no conventional risk factors applied. But Dr Michael Eades’ great review of Dr Kendrick’s “Great Cholesterol Con” led me to that book and to Dr Kendrick’s website and blogs. And that led to me considering my chronic stress as a contender for my near fatal incident.

    And, as I said, I had 2 different cortisol tests done but not the important testing over a 24 hour period. Getting those 2 tests done was like getting blood out of a stone – my GP didn’t want to know…let alone arrange the 24 hour test. So, I saw an endocrinologist privately about the test and other questions about stress, HPA-axis functionality. I went in with Zapolsky’s Zebra book and other bits and pieces but she didn’t want to know…she said she “didn’t have time for reading”.

    It was a waste of time and money – even going private was no guarantee of NHS health care people straying from the party line.

    I mulled over getting a test kit but the idea fizzled out and I haven’t thought about it again until this instalment on stress and your comments on 24 hour testing.

    I have checked out the Genova website – but there was no conventional way to order the test kit e.g. no price, no P&P, no proceeding to checkout. As you said, Thyroid UK are linked to Genova but it seemed a bit unclear how it all works e.g. do you have to register/pay a subscription with Thyroid UK? They list some product codes but it doesn’t explain which code for which Genova product. At least not on my 1st look.

    But it all seems quite straightforward once you have the kit!

    However, and still on the subject of endocrinology and introducing thyroid function, I do have v.high total cholesterol and LDL cholesterol and I have just had an appointment with a genetics team about Familial Hypercholesterolaemia (FH) – inherited high cholesterol.

    No tests results until the new year but I am aware that poor thyroid function is another potential cause. If I don’t have FH, I guess I could be turning my attention to thyroid function. I’m not quite at that stage to sign off on my high chol as being normal for me.

    1. lorrainecleaver7

      Charles if you scroll down on this link, there are codes you must quote when ringing Genova for the cortisol test. This means they will post your kit out and when you return it, the results will go to Thyroid UK who will email them to you, Definitely worth doing a full thyroid profile too including T3 if you can. Endocrinologists have caused me more harm than good, even the private ones. The only well thyroid patients I know are the ones who are doing it themselves sadly. http://www.thyroiduk.org.uk/tuk/testing/genova.html

    2. Helen

      Charles, Lorraine has given you the details of how to purchase the adrenal profile test kit, but I just wanted to add that it’s well worth doing. My own results were a revelation to me.

      If you suspect you have a thyroid problem, that is all the more reason to look into adrenal health. The TUK website has comprehensive information on this range of disorders, and there is a large, active and friendly forum, associated with TUK, where you can seek advice. Another good thyroid forum with plentiful information can be found at tpauk.com.

  34. Philip M Lewis

    Is it still a reasonable assumption that inflammation (not high cholesterol) is the leading proximal cause of CVD? Stress produces higher levels of inflammation via most of the pathways you describe. What is your opinion regarding the role of highly processed wheat in the genesis of CVD?

  35. Andy S

    Searching for a stress free lifestyle?

    “Prevention consists of prevention of diabetes itself and if already diabetic attention paid to the risk factors such as high blood pressure and high cholesterol. In the case of prevention of diabetes it consists mainly of tackling the lifestyle factors such as diet, mental stress and lack of exercise. Drugs, too, have a place in the prevention of heart disease in diabetes. These consist of aspirin, anti-cholesterol drugs and drugs that reduce the blood sugar and blood pressure.”

    1. Bill In Oz

      Chip butties ! Bloody hell !
      My parents were both Scouse, ( from Liverpool for all the folks of non UK background here. )
      I remember as a 5 year old pomy migrant in 1952, in Melbourne Australia being introduced by my parents, to chip butties. They had lard spread on white bread; ( who could afford butter ? ) with salt with some vinegar; but no tomato sauce. If we were lucky my mum cooked them in hot boiling lard. ( No vegetable oil in those days ) I loved them then as a special treat.
      But I always though of them as a Scouse thing as none of the other English migrants we associated with ate them.
      Later in my 20’s I ecided they were cheap hot food born of the UK depression in the 1930’s & food shortages of the war. And then stopped eating them. I have not seen anyone eat them here for over 40 years.

    2. Kay

      KidPsych, many years ago, there was a parallel to the chip butty — a potato-and-bread sandwich — in our US comic strip, “Dagwood and Blondie.” Blondie would often make mashed potato sandwiches for Dagwood’s lunch.

      1. Gary Ogden

        My mother used to make onion sandwiches. Thick slices of red onion between bread spread with mayonnaise. Tasty, By the way, is there still an Earl of Sandwich?

      2. KidPsych

        Kay, one of my guilty (carb alert!) pleasures growing up was a potato burrito – essentially potato and some grilled peppers wrapped in a tortilla. Didn’t find them often in LA, but I ordered it whenever I saw it.

  36. Charles Gale

    Kind thanks yet again Lorraine.

    I spent my 2016 recovery time reading all Dr Kendrick’s blogs over the years and I distinctly recall the 2015 post on thyroid problems sticking out (just revisited it and noted your participation). For 2 reasons:

    On the one hand, it wasn’t yet fully on my radar from a CVD perspective (see Craig E’s 27 October 2017 comment above about “too many balls in the air for me at the moment”) and seemed a bit incongruous at the time (but Dr Kendrick hasn’t just posted about CVD) but I had noted it’s relevance and also it seemed very technical too.

    On the other hand, (1) I was very, very overwhelmed by how emotive the comments were and also that (2) another set of people had stepped forward to take part in Dr Kendrick’s website/blogs/comments and had plenty to say too.

    Anyway, I’ll make a few phone calls next week and hopefully get the “adrenal stress profile” kit.

  37. Col

    What interests me more than the difference between CVD in Scotland and France is the difference in overall mortality between Scotland and England. This is widely known of but glibly explained away by various fallacious reasons as noted by Dr K. But it really does deserve closer examination. Scotland is a European outlier here, has a similar genetic makeup to England and exists under the same sainted NHS but we die 2 years younger. If you can find some kind of difference between the 2 populations that would surely be an important avenue for research.
    My suggestions: diet, personal experience shows that home cooking in central Scotland is pretty dreadful. Minerals, are Scots deficient in these because of soft water? Vitamin D, sadly lacking!
    Stress, hard to credit and yet… Glasgow exploded economically in the 19th century and crashed equally spectacularly in the 20th. I mean, they went from producing a third of the world’s merchant shipping to none in about 50 years. We look at the city now and see magnificent cleaned up Victorian architecture and “culture” but compared to say Birmingham it has been traumatized. So maybe stress is thing and I think that Glasgow accounts for nearly half the longetivity gap.

      1. KidPsych

        In order to go out into the world and help kids, I first had to study them in early childhood settings. One became pretty cognizant of the idea that good things accumulated in these places – ones that were more well off had better food, more access to the outdoors, more books, were cleaner, safer, teachers were better paid and less depressed (and often leaner) – these protective factors added up to make real differences. Sadly, the children in most need of remediation in the form or a loving, warm, healthy environment, were often the least likely to be in one. I imagine if we had the resources to track heart disease over lifespan with these kids we’d find a pretty stark contrast.

  38. Bill In Oz

    It’s curious how our psychology works. Dr Kendrick in this post has pointed the finger at stress as a major factor in CVD. And pointed out that strong community & family ties help to prevent CVD. But still so many of our comments are focused on the magical pills which will cure our CVD symptoms. – K2, garlic, singing, oxygenated water, getting rid of infectious bacteria, etc etc…

    And yes, it’s clear that we all seek that ‘cure’ for the various CVD health issues we face like high blood pressure, blocked arteries, high CAC scores, or even high LDL-cholesterol ( for those among us who have not yet given the flick to the fat or cholesterol hypotheses ) And the dream of some sort of silver bullet or magical pill, is so attractive…

    Ahhhh well….

    Above we discussed the various paradoxes that exist in various cultures : like Crete, Kitavan, Okinawa & the 7th Day Adventists.. But there was one I missed : Sardinia. And recently I read a lovely book by Australian author Ben Hills, called ” Island of the Ancients: The secrets of Sardinia’s Centenarians”.

    Sardina has the highest number of centenarians of any society in the world. ( Or at least it had in 2007 when this book was published. ) And Ben Hills spent 3 months there with his photographer partner, interviewing 24 odd centenarians and their families.

    There are a couple of paras in this book which are worth typing here :

    Page 63 : their translator said ” We had a US visitor here and he was amazed..Everything in Sardinia is upside down. You people smoke when you are not supposed to smoke, you drink to much, you eat only meat and no vegetables- and yet you live to be 100. The Sardinian Paradox”

    And page 83 ” There is a remarkable characteristic of Sardina’s centenarians – the love and support and respect they receive from their families, no matter how needy and decrepit they become. Of the 24 we interviewed, only three were in nursing homes and many were supported by their daughters who had never married, staying home instead to look after their parents.”

    Another remarkable thing : we are talking about families that have lived for generations in their villages without the huge shifting about & travel of modern life.

      1. Bill In Oz

        Dr K. I have not read the Blue Zones book. But I checked out some of the websites available to brouse. The curious thing is that Dan Buettner on one of these sites emphasises a largely vegetarian diet as the entrance ramp to a longer healthier life….

        So I suspect he has missed the bleeding obvious….Even while the evidence is right in front of his nose.

    1. Martin Back

      To play Devil’s Advocate, heart disease rates have fallen substantially in the West since the 1960s, even as families have become more atomised and are living further apart.

      I believe they are rising again these days. From Facebook bringing us closer together?

      In my experience, close family ties are stressful, because they involve expectations and obligations and are not particularly supportive. But everyone’s family is different.

      1. Helen

        Very much my own feelings, Martin. I remember my childhood family mealtimes as a kind of bloodsport, with the kitchen table as an arena. After I left home at 18, I didn’t eat meals at the table for another 35 years. Tables were storage surfaces! Husband and I have only migrated to the dinner table within the last five years.

      2. Sylvia Brooke

        Martin. How very true. I agree with every word. Family members can indeed be the cause of unbelievable stress and, on occasion, their expectations almost feel like demands. Not everyone is blessed with a loving, caring family group.

        However, I have just spent a most enjoyable hour catching up on Dr. Kendrick’s blog, and it has certainly put a smile on my face. Better than any medicine I reckon. To quote the Krankies it has been simply “Fantastidozy”. Thank you so much Dr. Kendrick. Those of you not from the UK, the Krankies were Scottish comedians (man and wife?) who appeared on stage and TV for many years. Happy days.

        I hasten to add that, apart from the humour on here today, I HAVE over the last few years also learned an awful lot from this blog relating to CVD etc. even though lots of the discussions go “over my head” It has made me change my medication and my lifestyle and, to my G.P.s disgust I have even refused certain medication which I thought unsuitable for me. From my doctor’s reception I rather suspect that I am now on the naughty step at the surgery. Never mind eh?

        Thanks for everyone’s comments, I have enjoyed every one.

    2. KidPsych

      So Bill, what you’re telling me is that my plan to sing and eat cheese at night is not an optimal plan for heart health?

      1. Bill In Oz

        Singing has it’s own benefits KidPsych. Singing in company even more ! As for eating cheese, I love most cheeses, bries, camenberts, blue veins, cheders, tasty cheese cottage cheese etc..But eating in company seems to be even more beneficial….

    3. Mr Chris

      Bill in Oz
      I too have noted the tendency in comments to focus on magic diets molecules etc, when the tone of the articles is really about living contented lives in harmony with others?

  39. AH Notepad

    Chip butties? Mmmmmmmm…….delicious. Chips cooked in lard or dripping. Plenty of butter on the bread. Ok, probably a bad component of a diet, but delicious none the less. As for northern fare, I have never lived further north than I do now, and it’s not far enough to be called the Midlands.

  40. John

    I think the casual use of the terms stress and strain, particularly mixing psychological meanings with mechanical meanings, is muddying the waters here.

    Dr. Kendrick clarifies at the top the difference between mechanical stress (force applied), vs. mechanical strain (the effect of that stress on the material it is being applied to, such as compression or stretching of the material.)

    Most of us intuitively understand psychological stress. In the linked abstract about Lithuanian vs. Swedish men, my take is that the authors use the term psychological strain to mean the same thing as psychological stress.

    Using these terms loosely makes correlation, and even causality, seem to exist with no solid underlying reasoning. In the Lithuanian article:

    “The Vilnius men, representing the population with a four-fold higher CHD mortality, had unfavorable characteristics on a cluster of psychosocial risk factors for CHD in comparison with the Linköping men. We suggest that this finding may provide a basis for possible new explanations of the differences in CHD mortality between Lithuania and Sweden.”

    Really? What is the explanation? The data may show a correlation, but how does that explain anything? The correlation offers avenues for further exploration, but there is no causal chain even alluded at, let alone elicidated.

    Here is a possible causal chain: psychological stress -> hormonal changes (e.g. cortisol) -> blood pressure increase -> mechanical stress increase -> mechanical strain increase -> damage to endothelium.

    I don’t know if that’s right, but at least it is a plausible explanation to explore further.

    I’d suggest we try to use our terms as succinctly and accurately as we can, so as not to fall into the same vague, hand-waving mode which has led so many cholesterol/statin aficionados astray.

    1. Andy S

      John, I couldn’t resist looking into the Lithuanian stress problem and CVD. Lithuanians are the worlds biggest alcohol consumers per capita in the world, an effective way to deal with high stress. Risk factors studied were fat consumption and lipid parameters, not a word about alcohol effect. Lithuanian men were also slightly shorter than Swedish men.


      1. Martin Back

        You also have to look at the type of alcohol. In Russia, vodka initially was only allowed to be made from naturally fermented products, but later they started making a cheap type iof vodka in oil refineries, which was apparently real rotgut. And of course in times of financial stress illicit and potentially poisonous booze gets consumed.

  41. Dr. Göran Sjöberg

    A year ago I to sign up as a “Patient Reviewer” for the BMJ giving my “profile” as requested.

    Then I didn’t hear anything besides being accepted as a reviewer. (In my own profession of metallurgy I have been involve in such activities.)

    Now all of a sudden I was invited to review the following paper.

    “The effect of PCSK9 inhibitors on cardiovascular and all-cause mortality in patients with dyslipidaemia: A meta-analysis of randomized controlled trials” with Dr. Rowland as contact author has been submitted to BMJ.

    You who have followed my views and “biased” general attitude towards cholesterol lowering drugs here at Dr. Kendrick’s blog, do you think it is proper for me to participate or should I decline?

    1. KidPsych

      Goran, the fact that you have been so cautious in how you approach this would suggest that you would be an ideal reviewer. And… I’m not so sure there could possibly be an unbiased reviewer of anything.

    2. Lorraine Cleaver

      I was invited to peer review (as a patient reviewer) a paper on guidelines for subclinical hypothyroidism. I did and am pleased to say the guidelines were refused publication by the BMJ, in agreement with my own views and those of the medics who also peer reviewed it.

      I’d go for it Dr!

    3. Dr. Göran Sjöberg

      Thank you all for encouragement.

      I have accepted to review (it is an open process which I prefer) – it looks like a very good paper to me as it refutes the benefits of PCSK9 on CVD mortality as well as all mortality and is a well documented paper in my eyes. So what is then left is in my eyes is only the substitute variable, lowering LDL.

      Surprisingly the authors endorse the statins as a dogm without references,

    4. Stephen T

      Pharma are the most biased and they aren’t reluctant to promote their useless products. You’re clearly well informed. Go to it, Goran!

  42. Kay

    Martin Back, and Helen. I realized later that my comment probably sounded a bit pollyanna, pie-in-the-sky. That was not my intention. What I wrote has been my own experience, and I was hoping with the comment to offer some encouragement to others who might find themselves alone. Through the years, some of the good people who have become like family to me have had tragically different stories from mine — stories of childhoods of sexual abuse and/or threats with guns and knives; young people who were “in the way” when a new stepmother came on the scene, and so on. And before 1965, I worked for three years in a 1300 bed state psychiatric hospital. So, I’m sympathetic. I know that there are lots of people in this world for whom life is exceedingly difficult.

  43. Mark Johnson

    I’ve come to the sad conclusion that in all walks of life, the people in power and with authority, despite having evidence after evidence after evidence clearly refuting their entrenched position will not budge an inch and admit they were wrong. They would rather deny any problems and perpetuate their errors than admit they were mistaken. It takes a rare man (or woman) to act in any other way which is why I respect people such as Prof Tim Noakes who did change his mind on high carb / carb loading. His subsequent prosecution and persecution by the “diet / health authorities” was somewhat ironic in this regard.

    And despite all the evidence to show that cancer is, in many cases a metabolic disease, a UK cancer charity today announced that it has, “appointed a digital nurse to combat “fake news” online”. The nurse will be combating “fake news” such as, “sugar doesn’t make cancer grow faster” and that “Vitamin C cures cancer”. The news item was disingenuous to say the least. I had previously respected the work of Macmillan Cancer Support. One more “health charity” I’ll not be supporting in future.


    1. jeanirvin

      I gave up with Macmillan cancer support when they joined up with Lloyds Bank to support them ‘looking after cancer sufferers’ – a most blatant piece of advertising disguised as caring.

    2. Steve

      It would force them to say that their stupidity has resulted in millions of needless deaths! Facing that it is an easy choice to make to hide behind the false “science” security. and that’s why we are here to take the bull by the horns and solve the problem without them as they can not be trusted to solve it themselves, their lives and lifestyles depend on NOT solving it. Their practices are now the definition of INSANITY…doing the same thing over and over expecting a different result….90% of chemo is 98% ineffective, so when does 98% ineffective stop one from practicing it?

      1. AH Notepad

        Compared with 7 billion, a few million is not a great loss on a global level. It will be the case than when nature becomes dominate, the losses will rise dramatically.

  44. Carlos Monteiro

    Heart Disease Statistics – There are controversies……
    Follows some information from 21 years ago that is worth the reading
    “Deaths From Heart-Disease Are Occurring Later in Life
    Wall Street Journal of November 13, 1996 (Published at https://www.wsj.com/articles/SB847838448956368000
    Staff Reporter of THE WALL STREET JOURNAL
    NEW ORLEANS — Americans have been seriously misled into thinking that heart disease is on the decline, the new president of the American Heart Association charged.
    Deaths from heart disease haven’t dropped nearly as much as health officials have claimed and the prevalence of the disease actually may be increasing, asserted President Jan L. Breslow, a Rockefeller University researcher, at the heart group’s annual meeting here.
    Dr. Breslow said that for several years public-health officials and groups like the heart association have pointed proudly to a widely used chart that shows the death rate from heart disease has fallen to about 150 deaths per year per 100,000 people, about half of the peak rate in the early 1950s. Dr. Breslow said that the number of deaths is actually 260 to 270 a year.
    Chart Reflects 1940 Death Rate
    The original chart was used to support claims that the massive public-health campaigns to get Americans to reduce their risk of heart disease have been paying off. These campaigns urged people to reduce their dietary fat, lower blood-cholesterol levels, stop smoking, reduce blood pressure and lose weight. “Our philosophy was that to get more money from politicians, we had to show that good things were happening,” Dr. Breslow said.
    The researchers explained that the older chart showed the so-called age-adjusted death rate reflecting the death rate for each age group in the population. The older chart is based on the U.S. population in 1940, when the proportion of Americans over age 65 was relatively small.
    Thus, the older chart gives heavy weight to a decline in heart-disease deaths among 40-to-60 year-olds. But it gives very little weight to increases in the death rates among the older groups where most heart-disease deaths are occurring, the researchers said.
    Heart Disease at a Later Age
    The researchers said that deaths from heart disease, instead of declining, are only being postponed to later ages. This postponement is the real result of the efforts by Americans to reduce their risk of heart disease with low-fat diets, quitting smoking, blood-pressure control and weight loss. Improved care of people who have heart attacks also has helped push deaths to a later age.
    “The actual overall number of cardiovascular deaths is 60% higher than it was 30 years ago, despite a 60% decline in the age-adjusted death rate,”added Australian cardiologist David Kelly of the University of Sydney. Today,“80% of coronary deaths are in the over-65 group,” Dr. Kelly said.
    Dr. Kelly said that when the “baby-boom” population begins to move into the over-65 age group, in about 2010, “they’ll have a high incidence of coronary heart disease and there’s going to be a huge increase in the need for medical care.”
    Dr. Breslow said the strategy of pointing to successes against heart disease to coax more money for research,“although plausible as a strategy, … has backfired.” The proportion of funds from of the National Institutes of Health going to heart and vascular disease has dropped by 5% to $669 million since 1985.
    Copyright © 1997 Dow Jones & Company, Inc. All Rights Reserved.”

    1. annielaurie98524

      The statement by AHA (which makes handsome profits from the junk food industry) are illogical. IF it is true that CVD deaths are occurring at a later age, they are still deaths and still, if they are truly caused by CVD, would be listed as such, and would contribute to the overall “x deaths per y-thousand population”. Further, we are all going to die of some cause at some age, aren’t we? Even the longevity experts note that we are eventually likely to die of one of the “big three” — CVD, cancer or dementia. The idea is to postpone our inevitable deaths as long as possible.

      Or does this bozo think that, as more people are living to an advanced age than they used to, we should expect they’ll continue to live forever? If any cause of death is occurring later in life, that is a positive outcome. However, the ensuing 21 years have still shown a decrease in the population as whole in CVD, as well as in some cancers. Dementia seems to be increasing, along with other types of cancers. But, no one gets out of here alive.

      1. David Bailey

        This is something that really bugs me – if we are presented with scientific data that is wrong in the very units it uses, that doesn’t say much about its quality!

        A good example of this, is the claim that “40000 lives per year are cut short by air pollution in the UK”! The units should be years of life lost per year. Counting ‘lives cut short’ is utterly meaningless because where do you cut off – at 1 year lost, or maybe 5 minutes lost. Obviously, the lower you push that threshold (which is not normally mentioned) the higher figure you can obtain. Tune this parameter to suit the political message you want to endorse!

        We used to have science correspondents that would spot this nonsense before it gained any traction, but nowadays, claims like this get debated as if they were 40,000 people dead who would otherwise be alive and well.

      2. chris c

        This is what really bugs me about the “YOU ARE KILLING PEOPLE!!!” rhetoric from the Rory Collins of this world.

        I’d rather live well and go quick at the end rather than end up like so many, institutionalised, drooling and unaware – a state in which they can keep you going for years, until your/your family’s/your estate’s money has all gone into their pockets.

        My mother remained functional into her nineties. 94 was getting to be a bit of a stretch, 95 was a step too far, and while I still miss her (snif) I am eternally relieved that she didn’t end up like all too many friends and neighbours – not unsurprisingly her greatest fear was to end up in a “home”. Once seen, this is something you can never unsee.

        One of her friends was a highly sociable and capable person most of her life, but she remembered her weeping helplessly towards the end as she had become effectively blind, mostly deaf and totally incapable, yet unable to die because she had had a quad bypass and her poor heart simply wouldn’t shut down.

      3. annielaurie98524

        So true. I lost my own Mom at 96 to Alzheimer’s — the plaques and scarring radiated out from a brain trauma she had suffered years earlier. It is sad seeing someone you love go this way — the person you knew and loved is gone, but the shell is still there. Since the death rate for all populations is 100% (yes, even if they eat only porridge and sweet potatoes), the best we can do is postpone the inevitable and remain in good health, especially good mental health. Until Bredesen and colleagues developed their protocol to help dementia patients, which includes a ketogenic diet (HFVLC), the old saw was that everyone knew someone that had recovered from cancer, and someone that had recovered from heart disease, but no one knew anyone that had recovered from Alzheimer’s. As you say, better to go quickly from heart attack (or, maybe better yet, instantaneously from cerebral hemorrhage) while you still have your wits about you, than to become a drooling vegetable.

    2. Martin Back

      Translation: “We have to keep them alive for longer in their later years when their medical expenses are highest. It’s a much better use for their money than leaving it to their children who will only waste it.”

    1. AH Notepad

      Would it be better to not have the meetings? “Ammunition” suggests there is a bit of a conflict going on, and conflicts raise stress/strain levels, which lead to ………………. avoid if possible.

      1. Bill In Oz

        Roy, I second that thought by AH Notepad. Quarrels & dramas always have be feeling physically awful afterwards – even if some victory is gained.

  45. Antony Sanderson

    Posting comment to try and ‘switch on’ the new-post email notification after having already failed twice

    1. Gary Ogden

      Antony Sanderson: I had difficulty with this on number XXIX. I never succeeded. I assumed WordPress got mad at me because rather than “confirm follow,” I inadvertently deleted the notice. All the other posts have functioned properly.

  46. Steve


    Doctor Rosedale has some similar thoughts, but he misses the family connection in favor of a sugar driven insulin issue. He does blame the Parasympathetic side and also the hypothalmic connection along with hormone issue with cortisone, epinephrine and glucagon . which may not be far off the mark for someone without the family support structure. My reading also has taken me to look at the collateral artery networks that we are born with and some that magically generate…still being debated. could these blue zones have better collateral genetics?

    I would also add that another paper shows that the way we eat three meals per day is also a problem. It causes three waves of sugar and insulin to flush our systems and cause a myriad of issues…discussed by rosedale. If we look at how they eat more relaxed, but also maybe one large meal, instead of three? which may explain something akin to our digestive system being taxed more, causing more insulin releases which ages us faster….maybe 3x faster than is normal? being bombarded by the digesitve chemistry constantly vs once per day probably has some affect on the hormonal side?Have to give roguehealth a plug here:
    https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1819573? Sugar vs CAD

    Maybe there is some genetic traits in blue zones that result in a stronger/ better sympathetic nervous system?

    1. hemobrianwad

      Thank you for this new and interesting idea that multiple meals per day are potentially harmful. This is the first time I have seen this. I appreciate the information.

      I note that our fellow predator mammals seem to eat far less than three times per day (let’s ignore human snacking for the moment which means we eat for more than 3 times per day) and seem to rest for long periods after a meal.

      It does seem that there is a large body of literature on the subject. As example:-
      Eating two larger meals a day (breakfast and lunch) is more effective than six smaller meals in a reduced-energy regimen for patients with type 2 diabetes: a randomised crossover study

      How very interesting!

    2. chris c

      I like the way you’re thinking!

      Amy Berger hits this in her series of posts starting here


      then there’s Ted Naiman

      which certainly ties in with my experience

      The corollary is how much my mood swings improved since I started doing low carb/paleo/keto, and also how much more consistent my energy levels are. I routinely have a miniature breakfast like a thickly buttered oatcake with smoked salmon and a cup (OK two) of coffee, then go the rest of the day running off stored energy from the previous day’s meal(s), and finally get hungry some time between late afternoon and late evening when I eat a meal. Some days I have a second meal at night, others I just have another snack.

      I am sadly amused when I watch people walking round a local nature reserve. The main circuit is about two miles, yet so many can’t make it round without carrying snacks and “energy drinks”, after which they adjourn to the cafe before attacking the rest of the reserve, which amounts to another couple of miles.

      I routinely go 5 – 8 hours and sometimes 11 hours or more until I need to eat – then I remember back to my carb-eating days when I was just the same – couldn’t go more than two or three hours without having to stop and carb up or I would crash both physically and mentally.

      Of course this is encouraged by dieticians and their ilk, with their three meals and three snacks a day and their insistence that diabetics’ meals contain 45 – 60g carbs and the snacks 15 – 30g it’s little wonder that “diabetes is always progressive” and ends with premature CVD, or that so many “nondiabetics” suffer metabolic disruption.

      I just overrate quite drastically – half a pheasant (first of the season!) roasted wrapped in bacon, with a mass of Brussels sprouts and chestnuts, two thickly buttered oatcakes, two glasses of Carmenere and a square of 85% chocolate. Guess what happens next? Yes, it takes that much longer until I get hungry again. No spikes of glucose, insulin, glucagon, cortisol and its cousins, no mood swings, no weight gain, no overridden control systems. And negative levels of stress. In fact, distinct enjoyment. And as if that wasn’t enough, while pheasant #1 was still in the oven a friend dropped by with two more, freshly shot and plucked, which have now migrated into the freezer.

      And while dieticians would have a conniption fit about my “eating disorder” because I ate no wheat or “vegetable” oils or processed “food” made out of ingredients and additives, I suspect a lot of “traditional” peoples would be thinking “nothing wrong with that!”

  47. Bill In Oz

    @ Goran, you have mentioned garlic a couple of times as one thing which has been important to you with your heat problem. And I have disagreed saying I grow organic garlic and eat a lot of it but still have developed heart issues…

    Well today I read something in Sardi’s web site about garlic which may be important >. It said that it is uncooked fresh garlic which needs to be taken; and that cooked garlic is useless for this purpose…

    Ummmmm ! Yes almost all the garlic I eat is cooked..!

    1. Dr. Göran Sjöberg


      You are right about raw garlic health benefits and at times I press it on meat after cooking or on green salads. Usually I though cook it with food – I low the taste. It is though very complex issue and omega3 is said to have a similar action on the “blood thinning”

      1. Bill In Oz

        Thanks for these suggestions Goran. I will try them out ! I actually like the taste. But it will have to wait till the end of November as that is when my garlic plantings will come to maturity and harvest.. There’s only chemically treated garlic from Mexico or Spain available for sale here at the moment as all the locally grown spouted in September..( The chemicals include glyphosate, fungicides, pesticides and a truly potent poisonous biocide sprayed on as part of Australia’s agriculture quarantine regulations

        So for a while it is garlic paste made from organic garlic of course or garlic capsules.

      2. Gary Ogden

        Bill in Oz: How long do you cure your garlic? I hang mine in bunches tied with string in my garlic shed 4-6 weeks.

      3. smartersig

        Goran there seems to be reasonable evidence of plaque reduction from the use of Kyolic Aged Garlic. You will find Pubmed studies. I also seem to remember that raw garlic is more therapeutic than cooked

      4. Bill In Oz

        Gary, I usually bunch & hang my garlic to dry for about 5-6 weeks also. But that is to maximise storage capacity by drying it down. Garlic can be eaten and used in food immediately after harvest. In fact one or two commercial organic garlic growers here harvest ‘green garlic’ stems for sale from late October. But it does reduce the mature crop harvest.

      5. Gary Ogden

        Bill in Oz: Yes, some do that here (green garlic), but I don’t. The Creole and Silverskin types can and do keep for a year, so I never run out of garlic for eating. I also like the Turban types, which only keep a few months, but make beautiful, very fat bulbs; I’ve had some as big as 10 cm. And the Purple Stripe varieties with their lovely colors in the clove skins. I’m happy for you to be so close to harvest time. Mine are nearly all up, bless their little hearts!

    2. Jan B

      Hi Bill – I always crush garlic then chop it up really fine and add it to already cooked vegetables. I prefer it like this though it almost certainly makes me super garlicky. Keeps me safe from vampires though.

      1. Gary Ogden

        Jan B: Excellent idea! Thank you. Never thought of it, but will begin doing so. Easy enough, as the vegetable cutting knife is still sitting on the cutting board as the vegetables are cooking.

    3. David Bailey

      I once knew a couple that did enjoy eating raw garlic. I came to the conclusion that this practice was healthy because it kept others at a distance, thus preventing the spread of germs!

      After the fall (at least in my eyes) of the concept that saturated fat, salt and cholesterol are harmful, I seriously doubt any other claims that this or that diet item is good or bad – I mean can anyone ever collect enough good quality data to actually make such a claim?

      1. Bill In Oz

        @ Goran :I have been taking Kyolic garlic capsules 3 rimes a day since last Tuesday, in default of clean garlic from the garden .My Bp has now dropped to 147/84. Last Monday it was 174/90 despite taking prescribed a double bunger bp medication ( An ACE & Diuretic combo ) for a week.

        I was already convinced of garlic’s healthful properties. But I do wonder if there is any explanation out ther about how it works.

      2. smartersig

        My partner also got hers down from 160/90 to 127/80 using Kyolic aged garlic and more regular walking.

    4. Gary Ogden

      Bill in Oz: Very interesting point. Garlic, of course, is delicious cooked. Here are two ways I eat it raw: 1. Diced and flung into salads. 2. As an ingredient in fermented vegetables, which are eaten raw. Kimchi requires garlic, but I also use it in my sauerkraut and all other cruciferous ferments. This fall I have fermented, in addition to cabbage, daikon radish, watermelon radish, and rutabaga. Do you not ferment vegetables? Surely you eat bagoong. It is a fermented food which has garlic, although the factory kind has been cooked. I’ve never had it homemade, but it’s so good with green mango. Yum!

      1. Bill In Oz

        I’ve tried kimchi and have saurkraut in the fridge always.

        But where we live Winter is not too cold. Days up to 15 degrees celsius and just the occasional frost at night.. So I have a big Winter vegetable garden with peas, fava beans, celery, daikon raddish, brocolli kale, lettuce, chard, mustards, parsley, leeks, sping onions, onions, mizuna, bok choi, mints etc.
        As a result we tend not to need to store fermented vegetable for Winter..We have the joy of going out & harvesting fresh to make salads or to cook. But all the garden vegetables are now going to seed ! And fresh garden vegetables are in hard to find just now in Spring.

        And what is bagoong ?

      2. Gary Ogden

        Bill in Oz: Bagoong is fermented tiny shrimp, eaten in the Philippines with green mango, among other things. We have a similarly mild winter here, and I grow year-round. In fact the winter garden provides more than the summer garden. I don’t ferment vegetables to preserve them, but because of their healthful qualities (probiotic lactobacilli strains) and wonderful flavor. I eat them in small amounts, like a condiment. Habanero chiles I grow in summer and ferment. When they get a bit soft I put them in the food processor for the fiery hot salsa I like on my eggs and Mexican food.

      3. Bill In Oz

        Gary. my wife is from the Philippines ( Bicol ) and especially shrimp. But after asking just now I discover she does not like the taste of bagoong so it does not feature in our diet..
        Yes I suppose you are right about fermented vegetables like kimchi etc…(And certainly I like saurkraut ) But we do not have the time to prepare our own fermented foods & I shy away from store bought processed foods,,,

        I guess you are in Southern California as there are few places in the USA where one can grow a winter garden with heated glass houses..

      4. Gary Ogden

        Bill in Oz: Central California. The great Central Valley of California, the breadbasket of the nation, although it is all grassland, suitable mainly for grazing animals rather than crops (not enough water). Nevertheless it is agriculture from stem to stern. I avoid southern California like the plague. Basically it is wall-to-wall housing developments and a 24-hour traffic jam. I no longer eat bagoong, or any Filipino food available here, since it is all factory made, and contains horrid stuff, such as sugar, vegetable (usually corn) oil, and MSG. Last time I visited, though, in 2011, we went to a massive, sprawling farmer’s market which had lots of wonderful foods, like raw carabao milk, a whole butchered pig on a table, an amazing variety of fresh seafood. The vegetables in the Philippines are wonderful, grown in rich, volcanic soil. The carrots are particularly fat and delicious. They also had what they call “native” garlic, which I believe must be grown in the highlands, since garlic doesn’t do well in the tropics. I do like the taste of all the bizarre foods they have, but no longer eat balut. My first impression of the Philippines was that this is what Filipinos do all night, is eat balut, since in Manila vendors go around with their wooden carts all night long calling “balut.” Later found out it is a purported aphrodisiac. I never had a need for this, but ate them anyway out of curiosity. Pretty gross, actually.

      5. Gary Ogden

        Bill in Oz: Thank you! Koreans are pretty amazing. Invaded something like 400 times in recorded history, they are resilient. I don’t make it the Korean way, but use most of the same ingredients, except fish sauce and seafood. I like fish sauce (the original catsup), but don’t know where to get it any more. Most of what is sold is fake. Trader Joe’s carried Red Boat, a high-quality, fermented fish sauce, for a while, but discontinued it. Meanwhile, they have shelves of the latest sugary and floury “foods” in brightly-colored packages with silly writing on them.

  48. JDPatten

    Food, food, food . . .


    “Could it be, I thought, that the way food is eaten is more important that what is eaten?
    If you eat whilst you are relaxed and socialising with friends and family, will your body deal with food in a different way? The answer is, of course, yes. Just to put it in the most basic terms.”

    “One thing Ancel Keys managed do do, above all, was to create the diet-heart hypothesis. However much we may disagree with his idea that saturated fat is bad, we still live, and argue, and discuss, almost entirely, on the diet-heart playing field.”

    The words of our own Dr Kendrick.

    1. Bill In Oz

      JDP, yes ut’s an interesting discussion..There is a need to focus attention both on the ’causes’ of CVD but also discover the ‘magic’ pills” which will cure the damage already inflicted with existing CVD.

    2. Mark Johnson

      “Could it be, I thought, that the way food is eaten is more important that what is eaten?
      If you eat whilst you are relaxed and socialising with friends and family, will your body deal with food in a different way? The answer is, of course, yes. Just to put it in the most basic terms.”

      Playing devil’s advocate, if a family and lots of friends ate happy, bucket type meals everyday in a very convivial atmosphere, taking their time over every last mouthful, would that trump a “better” diet eaten everyday on the go and in a rush with only the phone for company?

    3. smartersig

      I am not sure if this is what you are saying JD but it seems rather dangerous to take from this article that how we eat more important than what we eat. You see the majority of people will extrapolate that a SAD diet is fine as long as you take a couple of hours over it and even more so if it topped of with a long relaxing cigar. I would suggest that anything we eat can be harmful if taken under stress but some are more harmful than others and some will cause damage regardless of stress

      1. JDPatten


        I came to this blog knowing that I understood very little and that what I’d read or been told might be on shaky ground. I still try my best to take in these different perspectives with an open mind.

        In my reading of Dr Kendrick, (everything since Roman Numeral I including his comments) it seems to be that he is of the opinion that, so long as we get enough essentials such as vitamin C, potassium, and such, and as long as we take in a minimum amount of refined carbohydrate and sugar and, perhaps, a minimum of trans fats and the concocted vegetable fats — it indeed matters less what we eat than how we eat it.
        I don’t want to put words in his mouth, and maybe he’ll correct this if I’m wrong or too shamefully incomplete.

        We virtually all look forward to the good doc’s next numeral and soak it up. Of course we’re free to ignore the thrust of his ideas, but it seems we (mostly) believe that his intellect and his over-the-top efforts provide us with something worthwhile. Nonetheless, most of the comments over the last year and three quarters — even in this segment dealing with stress and strain — deal with notions about what we put in our mouths. It begins to become tiresome.

        “We also hate to discard a hypothesis, . . . . So it should come as no surprise to find that people defend scientific hypotheses with great ferocity. Especially their own.”
        More from Dr Kendrick.

      2. Mr Chris

        I am happy to have read your comment, that diet is not THE thing, although many comments come back to implying it. I have tried to put this point sometimes myself, but you have done it more eloquently. Thank you.

      3. Andy S

        Mr Chris, re diet and stress, would an optimum diet prevent stress related CVD?


        “Sudden unexpected, unattended death is probably the most common mode of death in the United States,[3] with an annual estimated incidence of 300,000-400,000.”

        “The large body of observational literature that has evolved over many decades, beginning with magnesium concentrations in drinking water, suggests that low total body magnesium could be causative of sudden death. Others have recently noted that a low serum magnesium level is associated with increased likelihood of coronary artery heart disease and sudden cardiac death.”

      4. Gary Ogden

        JDPatten: That is my understanding, too, and I agree. Wholesome, good-quality food, and avoiding the “displacing foods of modern commerce” (Weston A. Price, DDS). I would add avoiding any and all fad diets and staying well hydrated.

      5. Martin Back

        Could stress be more important than food? Heart disease started declining in the 1960s, around the time Valium was introduced. Coincidence?

  49. Steve

    Sorry, here is the link for the paper on the insulin wave effect, causing endothelial dysfunction, neurohormonal imbalance, etc. Interesting that they are bringing in the nervous system like Rosedale.

    “The pathophysiology of postprandial hyperglycemia is characterized by hyperglycemic spikes that induce oxidative stress [9], which in combination with soluble advanced glycation end products (AGEs) and lipid peroxidation products, act as key activators of upstream kinases, leading to endothelial dysfunction and expression of inflammatory genes [10] (Fig. 2). This article is an overview of the role of postprandial hyperglycemia, as a major fundamental disturbance, in the pathogenesis of vascular failure.” thispaper tries to explain the reason that 2/3 of symptomatic patients have abnormal glucose homeostasis.

    “These effects of hyperglycemia are probably linked with reduced production and/or bioavailability of NO, as hyperglycemia-induced endothelial dysfunction is counterbalanced by increased production of arginine [28]. The inter-relationship between NO production and bioavailability has to be fully understood, because it is not yet clear whether hyperglycemia reduces production of NO, or more probably, increases NO production in association with significant increases in the levels of its inhibitor, the superoxide anion, resulting in a reduction in NO bioavailability [29]. ” so at some point NO availability wanes and the endothelium is not repaired….this seems like their theory of how the cardiac event initiates.

    “A recent study showed that even a single mixed meal of 450 calories caused substantial and immediate deterioration in endothelial function in diet-treated patients with diabetes [76]” I would think this is pretty important to our search…

    our endothelium is under attack each meal, and even more so in diabetics; can we fall back and forth across some diabetic line and what does that depend on? Acarbose treatment reduced HA by half! This fits with a diabetic effect .

    Oh, look it charts the after meal sensitivity..so you have a large meal, induce damage, in a rush you get up, start running around..have a cardiac event…….what if you only have one large meal over a long time period, is there less of a spike? or maybe you have better glucose tolerance due to this?

    At least we are seeing the weight of the evidence being placed on Sugar where it belongs, rather than Cholesterol. The sugar industry must be in a panic? I wonder if A.Keys was influenced by the sugar industry. I know that they found industry reports indicating that others were.

    So I am seeing these major issues (no special order):
    – Genetic traits wrt Collateral Arteries, artery genesis or dysfunction thereof (75% affected)
    – Lots of finger pointing to the diet via Sugar, which induces Insulin Sensitivity, a diabetic effect causing a cascade of cardiac dysfunctions, which could be affected after even a single large meal (66% affected)
    – Nervous system involvement, sympathetic and parasympathetic imbalances (I am looking for percent affected here) There are lots of discussions about this being adversely affected by sugar and polyfats. so I would guess this is around 75% range.
    – general exercise Level, maybe lifetime – I am thinking this one is important because it affects so many things and it seems to have a large effect like in the 75% range.

    I would guess that these are somewhat interdependent, exercise probably affects all of them. Sugar seems to affect most of them. Dr. K’s video indicated potassium as important, which can affect most of these. So take a good vitamin, lookout for a couple deficiencies, do basic exercise frequently – include some relaxation techniques, reduce sugar to minimum, throw out man made food products.

    Based on these we can do a lot of things to optimize our health to reduce HA. Also, the same would apply for stroke. Optimize these two medicine changes overnight. These affect metabolic health as well and would probably reduce cancer incidence, throw out general medicine altogether then.

  50. Dr. Göran Sjöberg

    Talking saturated fats they seem harmless contrary to the official claims.

    Though “partially saturated poly-unsaturated” fats, PUFAs, everyone including FDA admits that the “are not good” for your health since they contains trans-fats and these are to be found in all processed food. These kind of fats was the thing I ditched together with all sweets after my MI 1999.

    There is a trend for some years now by “industry” to reduce the amount of trans-fats in the processed food with a ban hanging above their heads.

    In my eyes it is quite possible that the reduction of CVD-deaths now seen coincide with this dowward trend.

  51. Nigella P

    Great article Dr K. Lots to think about.

    I had the great fortune to listen to Sir Harry Burns speak to a very small gathering when he was Chief Medical Officer in Scotland. I don’t know where he stands on cholesterol but he was very interesting on the subject of family dysfunction, social failure and the effects of stress/chaos in early life that never leaves people, leading to alienation, isolation & poverty and how all of those things lead to ill health and early death.

    He was extraordinarily patient with all of us and our questions afterwards. I will probably remember him and the talk forever. It had a lasting impact on my thoughts about the importance of early life stability and how incredibly damaging stress/strain is for us all.

    He did a good TED talk about the causes of wellness / salutogenesis, which is well worth listening too. He is an entertaining speaker. There’s something about clever Scottish doctors! 😉

    1. Kay

      Nigella, thank you for mentioning Sir Harry Burns’s TED talk. I googled it and listened to it three times in succession. At our church, we have both a ministry to the homeless, and a ministry aimed at finding employment for people who have been incarcerated. I want to share this with the people making these programs happen.

  52. Randall

    The endothelial cells have no GLUT4 (glucose transporter). The endothelium is vulnerable (due to one cell thick) to injuries. What causes the injury – Postprandial hyperglycemia. Why – because the endothelium can’t resist having a high intracellular sugar. This causes OX damage and can kill the cells, then letting white blood cells get under the endothelium, the “I” word. Note: this is a quick summary. http://www.ncbi.nlm.nih.gov/pubmed/9027391 https://www.youtube.com/watch?v=E5jgrB2RblY

  53. Errett

    Journal of Lipid Research, 2017; 58 (10): 1999 DOI: 10.1194/jlr.M077792

    Heart attacks and strokes are the crises we notice, but they result from a slow process of atherosclerosis, the hardening and clogging of the arteries with fatty substances called lipids. Immune cells stick to the walls of blood vessels, scavenge lipids, and multiply. The blood vessel walls inflame and thicken as the smooth muscle cells lining them change, swelling and dividing to create plaques, clogs, and warty growths called atheromas.

    For a very long time, doctors and researchers assumed that the lipids came from eating fatty, cholesterol-rich food. But the research hasn’t borne this out; some people who eat large amounts of the foods we thought were the sources of the fat, such as eggs, butter, fatty fish, and meat, don’t necessarily develop heart disease.

    UConn researchers believe they may have solved part of the puzzle. Using careful chemical analysis of atheromas collected from patients by a colleague at Hartford Hospital, they found lipids with a chemical signature unlike those from animals at all. Instead, these strange lipids come from a specific family of bacteria.

    “I always call them greasy bugs because they make so much lipid. They are constantly shedding tiny blebs of lipids. Looks like bunches of grapes,” on a bacterial scale, says Frank Nichols, a UConn Health periodontist who studies the link between gum disease and atherosclerosis. The bacteria, called Bacteroidetes, make distinctive fats. The molecules have unusual fatty acids with branched chains and odd numbers of carbons (mammals typically don’t make either branched chain fatty acids or fatty acids with odd numbers of carbons).

    Xudong Yao, a UConn associate professor of chemistry who analyzed the lipid samples, says the chemical differences between bacterial and human lipids result in subtle weight differences between the molecules. “We used these weight differences and modern mass spectrometers to selectively measure the quantity of the bacterial lipids in human samples to link the lipids to atherosclerosis,” he says. “Establishment of such a link is a first step to mark the lipids as indicators for early disease diagnosis.”

    The marked chemical differences between Bacteroidetes lipids and the human body’s native lipids may be the reason they cause disease, suggests Nichols. The immune cells that initially stick to the blood vessel walls and collect the lipids recognize them as foreign. These immune cells react to the lipids and set off alarm bells.

    Nichols and Yao’s team also showed that despite being non-native lipids, the Bacteroidetes lipids could be broken down by an enzyme in the body that processes lipids into the starting material to make inflammation-enhancing molecules. So the Bacteroidetes lipids have a double whammy on the blood vessels: the immune system sees them as a signal of bacterial invasion, and then enzymes break them down and super-charge the inflammation.

    Despite the havoc they wreak, it’s not the Bacteroidetes bacteria themselves invading. Usually these bacteria stay happily in the mouth and gastrointestinal tract. If conditions are right, they can cause gum disease in the mouth, but not infect the blood vessels. But the lipids they produce pass easily through cell walls and into the bloodstream.

    The next step in the research is to analyze thin slices of atheroma to localize exactly where the bacterial lipids are accumulating. If they can show the Bacteroidetes-specific lipids are accumulating within the atheroma, but not in the normal artery wall, that would be convincing evidence that these unusual lipids are associated specifically with atheroma formation, and therefore contribute to heart disease.

    This research was supported by a grant from the National Institutes of Health.

    Story Source:

    Materials provided by University of Connecticut. Note: Content may be edited for style and length.

    Journal Reference:

    Reza Nemati, Christopher Dietz, Emily J. Anstadt, Jorge Cervantes, Yaling Liu, Floyd E. Dewhirst, Robert B. Clark, Sydney Finegold, James J. Gallagher, Michael B. Smith, Xudong Yao, Frank C. Nichols. Deposition and hydrolysis of serine dipeptide lipids of Bacteroidetes bacteria in human arteries: relationship to atherosclerosis. Journal of Lipid Research, 2017; 58 (10): 1999 DOI: 10.1194/jlr.M077792

    1. Bill In Oz

      This implies that an anti-biotic that targeted bacteriodes bacteria, would be an effective preventitive for CVD.
      It also implies that a drug which effectively & selectively broke down these bacterial produced lipids, would be an effective way of sorting CVD.

      1. Errett

        Bill—Bacteroides species are normally mutualistic, making up the most substantial portion of the mammalian gastrointestinal flora,[3] where they play a fundamental role in processing of complex molecules to simpler ones in the host intestine.[4][5][6] As many as 10 to the 10th power–10 to the eleventh power— cells per gram of human feces have been reported.[7] They can use simple sugars when available; however, the main sources of energy for Bacteroides species in the gut are complex host-derived and plant glycans.[8] Studies indicate that long-term diet is strongly associated with the gut microbiome composition—those who eat plenty of protein and animal fats have predominantly Bacteroides bacteria, while for those who consume more carbohydrates the Prevotella species dominate.[9]

        The terms glycan and polysaccharide are defined by IUPAC as synonyms meaning “compounds consisting of a large number of monosaccharides linked glycosidically”. Wikipedia

      2. Errett

        Bill—I left out one more point concerning diets that are high in carbs—-About twenty identified species of Prevotella are known to cause infection, including Prevotella dentalis, which was previously known as Mitsuokella dentalis. Prevotella species cause infections such as abscesses, bacteraemia, wound infection, bite infections, genital tract infections, and periodontitis (Pavillion).Aug 6, 2010

        Studies indicate that long-term diet is strongly associated with the gut microbiome composition—those who eat plenty of protein and animal fats have predominantly Bacteroides bacteria, while for those who consume more carbohydrates the Prevotella species dominate.[9]

      3. AH Notepad

        Any such so called “targeted” drug would inevitabely come with a list of adverse effects. Pharmas always make unsupportable claims for their products. This means that such a drug will probably have all the benefits of statins. Trying to simplify a complex process doesn’t work. We don’t know enough, and once we do, we will know it won’t work.

      4. Gary Ogden

        Bacteroidetes species are crucial members of the gut microbiome. Targeting them with a drug or any other intervention would be a very bad idea.

      5. Bill In Oz

        @Gary, when I made that comment about anti-biotics I was being provocative. And in the back of my mind was the thought that such a treatment would inevitably result in more anti-biotic resistance.

        But it did serve some purpose as the replies here clearly show that the bacteriodes are a needed part of our gut microbiome.

        But I am still perplexed about the study which states that these bacteria create lipids which are associated with damage to the major arteries. What’s going on ? flawed research ?

      6. Gary Ogden

        Bill in Oz: The way I understand this article the findings were made in those with gum disease. So the presence, or abundance, of Bacteroidetes in the gum tissue was pathological, not the bacterium itself. I think this is where we go terribly wrong in our approach to responding to infectious diseases. Like the Earth’s climate, the microbial world, and its interaction with higher lifeforms is monstrously complex. We know so little about both, yet enact public policies routinely based upon such woeful ignorance in which the cure is often worse than the disease. Statins are just the tip of the iceberg of human hubris, cupidity, and stupidity.

    2. Bill In Oz

      A week or so ago I spent long hours reading a vegan tract and teasing apart the sources which were when I checked a few of them, all BS. It was a waste of time and energy for me.

      Now you come up with an abstract of some article which claims that carbs kill us via bacterial infections leading to CVD. But this article is only available as an abstract. It..has to be bought ..

      Excuse me I decline to waste my time or money on a similar exercise again..

      I think most of us here agree with Dr K’s hypothesis that CVD is ’caused’ by stress which has multiple manifestations…

      As for diet: different people do well on different diets. Why ? Probably genetics, microbiome and dietary cultural history…

      In short what’s good for me may kill you; and vice versa.

      There is no place here for zealotry.

      1. Bill In Oz

        PS : my attempts to check out the source you named, lead to me Mac computer having some of my settings being changed and slowing down considerably. . I suspect a virus has been downloaded. I suspect the article & you suggest we read is not a legitimate science site.

        Somebody’s little joke mate ?

      2. Errett

        Bill—Zealotry—really—fanatical and uncompromising pursuit of religious, political, or other ideals; fanaticism. What you did say was that there is no place here for people that disagree with your belief concerning the most likely hypothesis regarding CVD—-not really the scientific method is it? Anyway no problem—C’est la vie—-

    3. Eric

      So was any follow up ever done? With what you’ve written below, HFLC folks should be at a massive disadvantage, which is not borne out by the facts.

      Unless those strange fat molecules pass through the gums but not through the intestine, which is unlikely, or unless a specific subspecies lives in the gums which is the only one to make these strange fat molecules.

      1. Errett

        The revised paper was accepted in July 2017

        I haven’t found any mention of continued work ongoing——just the stated desire to continue looking at the nature of the contents of atheromas—

        I would imagine that this hypothesis—a foreign fatty acid—initiating CVD would be strongly contested by the Statin world—–but since there is no agreement concerning the ultimate cause of CVD—-and all of science is built on inductive reasoning in support of a working hypothesis–is it ever wrong to consider other possible hypotheses—-I don’t expect to discover the actual definitive cause of CVD on this blog—-I did enjoy the hunt and sharing information—-All The Best

      2. Bill In Oz

        1 : my comments to you were partially a consequence of my annoyance at having to deal with my new Mac desk top issues. When I tried to access the full version of your article it slowed down enormously, and suddenly the display was changed. I decided to restart and then those issues disappeared.
        2 : My comment about fanaticism is a response to you seeming to push a Paleo, high fat low carb, barrow here. But as I have said before I don’t think there is one size fits all dietary ’cause’ to CVD. Genetics, tribal, family and personal dietary history, and gut microbiome all play a part.
        3 Today the BBC website had an interesting article on the role that the gut microbiome cna have even on cancer survival !
        The curious thing is that having Bacteriodes dominated gut flora seem to lower cancer survival rates in this research.

  54. smartersig

    I have a bike ride that takes me across the salt plains here in the Algarve. The striking thing about it is the total absence of noise. Of course what I am really referring to is traffic noise. The effect is something that we have long forgotten. A level of tranquility that we are so deprived of that when we do experience it. the effect is most profound. I suspect the stress aspect of life is from multiple sources, some we even seem to accept as benign like light road traffic. Perhaps what we have here are certain foods are more acceptable to our ‘refuelling’ lifestyle whilst others are very antagonistic in such as setting. What we eat and how we eat may well be an equation in which some combinations are far more volatile than others

    1. Eric

      Just curious: where are those salt plains?

      Just having spent a week down there in September, I wonder if there are any quiet spots at all on the coast. If it isn’t full of people, there is at least plenty of surf and wind to be heard.

      1. smartersig

        Tavira East Algarve Eric, lovely place and the Portugese have one of the lowest incidence of HD which is easy to see why

  55. Frieda Paton

    I so absolutely relish this article! I have always maintained that my four episodes (five stents) were each triggered by high stress periods just preceding the incidents, although coronary artery disease runs strongly in my family on my paternal side. When I mentioned this to may cardiologist’s rather off-handed reply was “Possible, but we can’t measure stress.”

    The article also triggered my memory of the days before Cholesterol became the big “thing”. When I trained as a nurse in the 1970’s the major risk factor for MI was, besides smoking, a high pressured Type A personality vs the more laid back Type B’s. A circle back to this initial, observational wisdom? Something else that crossed my mind while I was following this trend of thought – could certain people not also genetically differ ito physiological regulation of stress hormones (ie that this could play a role in personality type and risk for coronary artery disease) with that being one of the explanations for the genetic risk?

  56. smartersig

    Moving the medical profession towards a functional approach will be difficult given its stranglehold on not just the profession but the mass media as well. Only yesterday Dr Mark Porter penned a damaging and in my opinion disgraceful article damming what people typically call ‘alternative’ approaches to cancer. He literally trashed Vitamin C as being of any value and indeed suggested food played no part for cancer patients. In the same article he championed the Macmillan cancer trust which actively in my opinion, promotes the proliferation of cancer through its sponsored ‘let them eat cake’ coffee mornings.

    1. AH Notepad

      I went to a local builders’ merchants recently. Coincidentally the Macmillan Trust was there offering coffee and, yes, refined carbohydrate loaded cakes. It was all I could do to stop myself giving them a lecture on their contradictory messages.

    2. Mr Chris

      hi Smartersig
      yes but here is an article of his on how statins are not much use
      Dr Mark Porter: Why a Mediterranean diet is five times more effective than a statin
      now, we can agree that “Mediterranean Diet” is a nebulous term, but the general trend of the article seems quite sensible to me.
      BTW I found it searching for the one you referenced on vitamin C and Cancer

  57. Dr. Göran Sjöberg

    That stress can be an immediate killer I am today more than convinced about.

    This belief is now strengthened when reading a very “strong” book by Owen Jones, “The demonization of the working class”

    In the book I just read about the severe stress imposed on the miner families by the confrontations in Orgrave 1984 between striking miners when being attacked by thousands of policemen not least on horseback. One housewife came home after the strike had being crushed and she didn’t “feel well”. She dropped down and was dead within minutes from a heart attack at 33 years of age.

    1. smartersig

      A great book Goran, another that I am only about 25% through but one which already has relevance to this topic is
      The Antidote:Happiness for people who cant stand positive thinking

    2. Stephen T

      Goran, I was a witness at Orgreave. The police officers were stood in a line blocking access to the coking plant. The miners then formed a wedge and attacked the line. Much violence followed, but the ‘attack’ came by the extremists, led by a union dominated by the extreme class war advocate, Arthur Scargill.

      The miners strike became violent when Scargill and the national union leadership refused to allow a national ballot before calling a strike. So the miners in Nottingham refused to go on strike because they felt their rights had been trampled upon. Scargill tried to impose his will by violence.

      The police cheered the horses because they dispersed stone-throwing miners who were happy to injure anyone they saw as a representative of the state.

      I’ve read Own Jones book and heard him speak. He wasn’t born when the miners strike took place, which has entered left wing mythology with all the violence and intimidation removed from the story. It was a sad episode, but the blame belongs to Arthur Scargill. The miners suffered for his folly, whilst he did very well from the union.

      1. Dr. Göran Sjöberg


        Interesting to hear!

        My main point is that severe social stress can evidently kill directly through MI. I have come across the same phenomena when reading about some Aborgins, when being expelled from their own social group, “voluntarily”, to the surprised anthropologists witnessing, killed themselves one by one just by lying in a circle on the ground and where each individual death was marked by a stick in the ground at the head of the one diseased.

        And,well, I find the book interesting as a Swede (it is actually translated into Swedish) and to tell the truth I didn’t even know what the word “chavs” meant before reading this book (I was familiar with the word “white trash” when living in the US but in Sweden this is not so pronounced) and even less about how widespread and flourishing this “chavism” evidently is in England. I find it horrifying to say the least and I guess, with such an attitude permeating a society, it puts a strong stress on yourself if you now happen to belong to the working class.

        The obvious question relating to this blog is now if the rate of CVD-mortality is higher in the poor parts of a population.

      2. Jean Humphreys

        “My main point is that severe social stress can evidently kill directly through MI. I have come across the same phenomena when reading about some Aborgins, when being expelled from their own social group, “voluntarily”, to the surprised anthropologists witnessing, killed themselves one by one just by lying in a circle on the ground and where each individual death was marked by a stick in the ground at the head of the one diseased”

        This is recognised in the animal kingdom – anyone who handles wild birds knows that they can just die of stress. We are animals too.

      3. AH Notepad

        We are animals too.

        I tried telling that to a fundamentalist religious groupe many years ago. They refused to accept it. 🙂

      4. smartersig

        Is there a facilty or map that shows HD by area but accounting for income. So how does the country look when you only take people on or around a certain income in various areas

      5. Dr. Malcolm Kendrick Post author

        The US a similar map, and if memory serves it does have income stats as well. As I live in the UK I can tell you with reasonable confidence that low CHD areas are richer and high CHD areas are poorer. Which is why the SE of England (rich) is almost entirely blue, whilst the NE and NW England (poor) is almost entirely red – with pockets. I live in Macclesfield (rich) where CHD is low. I also work in Winsford and Crewe (poor) where CHD rates are high. These places are geographically close together. There must be, I would assume, a map of income in various bits of the UK. The two could be matched.

      6. smartersig

        What I would like to see is the removal of income or the equalising of income in such a map so that we could say with greater certainty that something else, other than perhaps bad habits associated with low income are at play. For example air quality might be a factor ( I am sure it is) but its hard to extract it without removing the income field

      7. Gary Ogden

        Much higher in the north than the south. Vitamin D may play a role, and probably does, but I suspect other factors may be more important. I know very little about the UK, though, other than we speak a similar language, and that some very fine literature has been produced there.

      8. Mr Chris

        Göran Stephen T
        I well remember the battle of Orgreave, it formed part of the Miner’s war and was a deliberate confrontation. As Stephen says the miners suffered, Scargill and cronies Came out OK.

      9. Dr. Göran Sjöberg


        Thank you for this map. To me the map seems very intriguing! I guess that it strongly reflects the general “prosperity” of the different areas?

        I fully understand why people want to be rich rather than poor.

        What about Scotland?

    1. Stephen T

      Thank you, Goran. I am white and working class and I think you need to be a little bit careful with Owen Jones and ‘Chavs’. He makes some good points in the book, but I find him naive. I went to a talk he gave in Leeds and he spoke about the miners’ strike. What he described was totally different to the reality that I saw. I doubt that 10% of the audience were working class – they were left wing activists – but they all accepted this heroic version of the miners strike with the blatant suppresion of democracy and violence edited out.

      The argument was originally between miners from different areas with the police stood in the middle protecting the miners who’d been refused a right to vote and decided that they would work. The myth has won.

      The best book I’ve read on the subject is ‘Strike’, based on a Sunday Times Insight Team investigation.

      1. Dr. Göran Sjöberg


        This blog is about CVD so I don’t think we should go too deep into the political part of this issue.

        I am a Swede and am not very familiar with present life in the England but still, during my perhaps 10 visits to your country, I have certainly noticed through my Swedish colored glasses a strongly divided society in terms of wealth and class.

        What I take from the book is mainly the broad brush approach telling the story about the stigmatization of the working class presently going on in the UK if this now is true. If so, stress must be a factor involved among those who are subjected to this stigmatization which then may be a strong factor explaining the high rate of CVD in the affected areas on the map.

        When living in the US 25 years ago i was horrified by the flagrant division between areas with poor and areas with rich people so unfamiliar to a Swede. Well, Sweden is, to my sorrow, now going the same way with increasingly segregated resident areas and probably this will turn up in the CVD-statistics in Sweden as in England and the US.

      2. Bill In Oz

        Goran I remember even now how once when living in the USA, we needed to get petrol ( gas ) and went off the freeway in New Jersey and looked for a service station. We wound up at one in a very poor area. The driveway attendant was black and when we got out & said what we wanted he was friendly. He also recognised we were not Americans but Australians from our accents. And after paying for the petrol, suggested we leave the area quickly as it was in his word ‘ dangerous’.

      3. Dr. Göran Sjöberg


        We made the same experience – “We better get out of this area!” – a couple of times during our stay i the US.

        A Swedish colleague of mine when “economizing” looked for a cheap accommodation while visiting friends in Los Angeles and arrived with his wife in his car at a “prison-like” motel late Friday night. The attendant didn’t understand why they have chosen their accommodation and warned him to stay low during the night since “here it usually gets wild during the week ends”.

        They spent a terrifying night there at that motel while a “wild party” was going on outside their dwelling room. My colleague stayed awake all night with the heavy bottle of Champagne, they had brought as a gift, in his hand with the absurd idea that whatever happened they should not “die alone” in their room but to take a couple of possible “intruders” with them though nothing happened. I guess he had a “strong heart” to resist the stress.

        I was never myself tempted to stay in the US, after my contract was finished, due to the evident class division making you feel utterly insecure being “middle class”. BTW I gained about 10 kg during my one year stay in the US while 5 dropped when returning to Sweden but at that time, at the age of 40 +, I didn’t experience any heart problem – appeared ten year later.

        Stress is everywhere today I guess!

  58. jbarnesbaker

    There was an article in the news recently that said Iceland has the lowest death rate in the world and the most people who live to be 100. They attributed it to the habit of bathing and socializing in mineral-rich volcanic pools.

    1. AH Notepad

      I suggest Iceland has the same death rate of any other place. In the end, 100% of people will die. Either that, or they will overrun the place.

      1. Gary Ogden

        Professor Mark Baker says, “Familial hypercholesterolaemia is a serious, often undiagnosed but relatively common condition which, if treated early, ideally in childhood, will not affect normal life-expectancy for the majority of people with it.”
        Really? Oodles and gobs of clinical trials giving children statins have proven this beyond a shadow of doubt? Also, “common”? How common heterozygous? Homozygous?
        And: Drug them “before” age ten? Like six months, maybe?

      2. smartersig

        I mentioned on this blog some 18 months or more ago that when I attended the HeartUK conference which was heavily Statinated the distinct impression was that they knew the game was up on Statins for healthy but slightly ‘high’ cholesterol members of the public and the ege was now going to be on lowering the definition of Hypocholestomenia (spelling?). I appeared obvious that they were looking to get this way down and then this would allow them to prescribe much earlier in life.

      3. smartersig

        By the way I came under fire there too when I suggested to a group of doctors that Statins were not the best treatment for heart disease. One came right up into my face aggressively inviting me to get physical on the matter.

      4. David Bailey

        Can there be any doubt that giving children statins or PCSK9 inhibitors will have awful consequences because of the loss of cholesterol?

        Are there any animal studies of what happens if you do this? I mean cholesterol is used all over the body – particularly the brain.

      5. Gary Ogden

        annielaurie98524: That is the point. Population reduction by medical intervention. What could go wrong?

      6. smartersig

        Cholesterol in the blood does not pass the blood brain barrier. Is there any evidence that lowering blood cholesterol in turn reduces cholesterol in the brain and by what mechanism does this happen ?.

      7. Dr. Malcolm Kendrick Post author

        Because cholesterol is synthesised in the brain for its own use, in glial cells, and statins block this synthesis. Look, smartersig, before asking questions like this, can I ask to please make a prior effort to find out some underlying facts. Also, could you please give more attention about the question you are asking. How could anyone possibly measure the amount of cholesterol in the brain without carrying out multiple brain biopsies – which is never going to happen.

      8. smartersig

        Look Dr Kendrick I am not a doctor let alone a lipid researcher so like others on here I am quite likely to ask questions on subjects that to you may seem obvious but to me require some explanation. If somebody replies with ‘read this ….’ I am quite happy. I did actually do a quick search on brain cholesterol which is why I was aware of the blood brain barrier aspect but felt that I needed additional help to answer the rest of my question. I apologize deeply if I am not as knowledgable as yourself on this subject but I get the feeling that because I ask probing questions that challenge the general position on here I am quick to get a good kicking.

      9. smartersig

        Dr Kendrick, just touching back on this question. Is it possible that some enterprising researcher might have checked the brain cholesterol levels at autopsy on Statin users, somewhat similar to Vietnam teenagers who on autopsy were discovered to have disease in the arteries.

      10. annielaurie98524

        How can this even be ethical? Those children are too young to give informed consent. It’s appalling — they are being used as human lab rats. No doubt the parents had to sign away all their rights to compensation, and perhaps even to adequate treatment, when this perverted “science” experiment goes awry.

      11. Gary Ogden

        annielaurie98524: How right you are. How could this possibly meet IRB approval, unless it is being conducted in Central America, as the Guardakill trials were. What parent in their right mind would allow this to be done to their child? Or are they strictly using children in orphanages?

      12. JDPatten

        Look, smarter vs. Malcolm.
        On the one hand, the average commenter might feel cowed by Dr Kendrick’s admonition into not contributing something that might turn out to be valuable. On the other hand, it would be good for this blog, if only in terms of efficiency, if we all gave some critical forethought to our comments. There are a LOT of comments, many of which are fairly lightweight. After all, this blog is much more than a Social Medium and deserves the best we have when contributing.
        I’m gratified to see Dr Kendrick’s judicious managerial hand.

      13. smartersig

        I asked a question in the belief that someone with specialised knowledge on here would have an answer. There are numerous cases of questions being posed on here but none have been dealt with so harshly. I suspect that it was interpreted as me suggesting that Cholesterol drugs could not have a connection with brain function, actually I think they do but I find myself unable to answer the question as to why cholesterol has anything to with it. You see most posters on any forum will suggest that lowering blood cholesterol will deprive the brain but I was unable to see how that occurs.I can now see that Stains can cross the blood brain barrier and hence can effect the brain production. Now all it needed was someone to say ‘Statins can cross the blood brain barrier’

    1. AH Notepad

      Yet the UK government imposes on local authorities, a duty to ensure the health and well being of the population. Then requires them to give vaccines, fluoride, statins, carbohyrates, avoid saturated fats, …………….. GROAN!!!!!!!!!

      1. Mark Johnson

        By the way I came under fire there too when I suggested to a group of doctors that Statins were not the best treatment for heart disease. One came right up into my face aggressively inviting me to get physical on the matter.

        And it was precisely at that moment smartersig, that you knew you’d won the argument!
        I’d like to say the doctor was just ignorant but I think plain stupid would be more accurate.

    1. Bill In Oz

      I read the New York Times article on this ( linked above ) and then read a few comments as well. There is this comment by Jim Kress in Missouri ( ? )
      ” As a single study with limited number of participants and limited time of study, this study has zero statistical significance. In addition, with the reproducibility crisis prevalent in bio-medical studies, this study has zero significance until it can be reproduced at other, reputable organizations.”

      Reading further some comments express surprise that this research study involving a sham stenting procedure was allowed at all – as it could not have happened in the USA on ‘ethical’ grounds !!
      And thus this UK research is to be considered dubious.
      Such bizarre pig headed blindness !

      1. Eric

        Yeah, the amount of surprise feigned by cardiologists was the surprising part about this article. Still, it gave one pause enough to cancel surgery. What was he thinking before?

        The only thing I consider vaguely unethical is that even the fake precedure is not perfectly risk free. Still, such studies are needed excactly to figure out if the greater risks of doing the full procedure are justified at all. Don’t see how this would render the study dubious. What were the participants told? That they were possibly going to receive no stent or that they were going to receive a shiny new kind of experimental stent, sort of the emperor’s stent?

    2. Martin Back

      Interesting. So those pale lines are images of the blood inside the blood vessels, not the blood vessels themselves. I never knew that.

    3. Dr. Göran Sjöberg

      I find the following line in the article most revealing.

      “Stenting is so accepted that American cardiologists said they were amazed ethics boards agreed to a study with a sham control group.”

      Well – can we agree upon that the medical world is CRIMINAL.

      1. Gary Ogden

        Dr. Göran Sjöberg: Yes, the medical industry, the politicians, and the regulators are criminal. But doctors in general I hold in high esteem (with the exception of most, but not all, pediatricians in the U.S.). I have met, and been treated by, some very fine ones. Medicine is broken, but doctors generally mean well.

      2. Dr. Göran Sjöberg


        Of course you are right!

        The criminality is usually on a higher systemic business level – read BigPharma!

        I have met some very “nice” doctors and even collaborated with one of them during my lectures on my LCHF healthy lifestyle. And the very arrogant “besserwissers” I have met are quite few, my latest cardiologist though being one of them.

      1. annielaurie98524

        What’s been happening for the last 5 (or more) years? Many docs and hospitals (and medical device companies) have been making oodles of dough from stents and such. I have come to the conclusion that modern cardiology is no better than the so-called weight-loss industry and the hoodoo mystic medicine industries. “What? Our baking soda and vibrating crystal therapy didn’t cure your cancer? Neither did our fancy titanium stent cure your angina. So, what’s your point?” And BTW, while you can sometimes get your money back from, or at least get some prosecutory action against, the vibrating crystal folk, try doing that with your friendly local cardiac surgeon.

    1. Eric

      Medication such as nitroglycerine, g-strophantine (which was the standard treatment in German speaking countries well into the 80s), viagra?

    2. Eric

      Interesting comment by Ken S on the NYT article:
      Numerous studies have already found no evidence that stents save lives in these same types of patients (people with stable chest pain due to narrowing of a carotid artery). The biggest study testing that was the COURAGE trial (New Engl J Med, 2007;356:1503-1516). For that reason, stenting is not recommended for improving survival in such patients. But it had been thought to improve the symptoms of chest pain, which is what this current study was exploring.
      It is important to keep in mind that this study is only relevant to stable chest pain. Acute chest pain from a heart attack (myocardial infarction) is a different issue, and the use of stents in heart attack is not affected by this current study.

    1. Gary Ogden

      AHNotepad: And it is still grape season here in the Northern Hemisphere. I’m particularly fond of the Ribiers, which I purchase from a local Armenian organic farm. Seems to me that the grapes with seeds are much tastier than those without.

      1. annielaurie98524

        That MAY be (according to the researchers that made no such sweeping claim) for the short term, in a small sample of middle-aged men with CVD that consume red wine. As I replied to you earlier (but you did not respond), the general trend in studies on the effects of modest alcohol consumption show a health benefit FOR ALL ALCOHOLIC BEVERAGES, not just red wine. I always find it amusing when the “popular health press”, and others, make generalizations from such small-scale, short-term studies, when the researchers themselves are loathe to do so.

      2. smartersig

        Apologies your reply did not come through to me for some reason but then again you seem to be having the same problem in not replying to some of my responses. Here it seems we have a choice, do we trust studies of populations which show modest alcohol intake helps or do we trust specific tests on bio markers such as FMD which show that alcohol inhibits blood flow. The Pop studies are larger in numbers but as many people point out when a pop study is used for plant based diets or against meat, causation cannot be proved. However in the case of alcohol and wine it would appear as stronger evidence than a specific test on artery function. I would personally favour the latter in this case.

  59. Randall

    The French are the world’s biggest per-capita consumers of butter Eight kilograms (17.6 pounds) per person per year, according to a handy roundup of global butter consumption compiled by the Canadian Dairy Information Centre. http://www.dairyinfo.gc.ca/index_e.php?s1=dff-fcil&s2=cons&s3=consglo&s4=tb-bt The French have the lowest heart death rate in the European Union – only about one-quarter of the British rate. https://myheartsisters.org/2010/07/17/heart-disease-countries/

    1. Gary Ogden

      Randall: I do better than that, buying almost a kilo a month (about 2 pounds). So I should have a ridiculously low CVD risk. The cholesterol test I used to get always said “low risk,” or “below average risk,” so they do get some things right.

    2. Mark Johnson

      The French are the world’s biggest per-capita consumers of butter Eight kilograms (17.6 pounds) per person per year, according to a handy roundup of global butter consumption compiled by the Canadian Dairy Information Centre. http://www.dairyinfo.gc.ca/index_e.php?s1=dff-fcil&s2=cons&s3=consglo&s4=tb-bt The French have the lowest heart death rate in the European Union – only about one-quarter of the British rate. https://myheartsisters.org/2010/07/17/heart-disease-countries/

      Ah yes, but you’re forgetting about the French Paradox! 🙂

      1. Gary Ogden

        Yes! Should be considered a sacred food, a gift from the gods, as the first spring butter was to the Swiss of the Loetschental Valley. Orange in color it was, and rich, as we now know, in vitamin K2.

  60. Charles Gale

    BBC’s “Trust me I’m a Doctor” this week was a mental health special, which covered stress and cortisol and cortisol testing.

    Michael Mosley was at the University of Westminster to find out more. What they covered was the normal cortisol curve: a surge in the morning and then a drop off during the day. And how various mental health issues impacted on the normal cortisol curve. 2 of the university staff were doing an experiment on how (or if) various activities (e.g. yoga) made a difference.

    1. smartersig

      There was also an interesting film doc’ coming through via Dr Mercola yesterday about a guy and some friends journey through the use of Pschedelic plants to open up the mind. I have not looked into this but there has apparantly some positve mental health results with this approach. I will dig out the link if anyone is interested

    2. chris c


      Looks at the diurnal timing of various parts of the endocrine system.

      Quite how generally applicable this is is unknown – for example most but not all Type 2 diabetics have higher insulin resistance/lower sensitivity in the morning, often to a large degree. Many Type 1s have the exact opposite pattern. I suspect a lot of “nondiabetics”, mainly those who are just “not diabetic yet” will have the higher IR in the morning. right when your friendly dietician will tell you to eat the most carbs. I also suspect from personal experience that thyroid may have wide diurnal variations, maybe even cycling to and fro in the course of a few hours, and Dave Feldman’s tireless self-experimentation


      likewise shows that LDL can change hugely over a short timescale.

      DISCLAIMER: Sci-Hub has been blocked by the American Authorities and probably as a result is sometimes quite flaky/nonfunctional from the UK too, After I hit the link I had to this paper my browser locked up completely for several minutes

      (big wave to the guys at Menwith Hill, the CIA, FBI, NSA . . .)

  61. Andy S

    This appears to be the last chapter on CVD, stress/strain is the biggest factor.
    Some questions need to be answered: what effect does cortisol and adrenalin have on the endothelium, relationship to plaque, does plaque come first and stress (mental or physical) the final insult, relationship with mineral and vitamin balance, where does diet fit in including fad diets, etc..

  62. Bill In Oz

    @Gary… Thanks for the reply about your abode in the Great Valley of California.. I drove through it over 3 -4 days once in October and them saw the giant redwood trees further North.. We camped for 3 nights there and it was cold we needed a camp fire to stay warm. So I’ve always thought it would be cold in the Great Valley also in Winter… But I am wrong.

    As noted above in my comment to Goran, garlic oil capsules have really worked for me…BP down almost to normal after 4 months with significantly high bp readings…

  63. JDPatten

    A wonderful essay:
    Dr Lown started to figure out what was going on with guys like you back in 1972. I wonder what he would have thought of your case if you’d used him as your first cardiologist. He persisted with modestly sized research efforts in the face of scorn from the establishment for forty years. Maybe Dr Kendrick and Social Media will finally make a difference!?


    1. Dr. Göran Sjöberg


      Thank you for this reference.

      I didn’t know about Dr. Lawn’s clinical “second opinion” practice and his stand on the CABG issue.

      A great article and just as I see it!

      To me medicine is today such an obvious criminal world so any fight against this system will be a doomed fight against windmills as Dr. Lawn experienced. i am more and more turning to the attitude “never seek the NHS” being just a gigantic trap set by BigPharma and with the GP’s as hostage collaborators.

      I though did the mistake to see the “service” a few years ago only to see the obvious “big CABG trap” set.

      1. Dr. Malcolm Kendrick Post author

        I think it is not quite as bad as that. (Lown by the way). However, I think that cardiovascular medicine, in particular, has become a wing of the pharmaceutical industry. [Some feel that psychiatry is worse, I can see why]. Almost everything cardiologists say, or so, can be tracked back to pharma marketing.

    2. Bill In Oz

      JDP, thanks for the Lown link. I have just read it. Wonderful to think that at age 90, such an essay is even possible never mind so pertinent !

    3. annielaurie98524

      Thank you for the interesting article on Dr. Lown. It’s encouraging to know there were always some “medical mavericks” out there, but appalling to think that they were branded radical for their adherence to the Hippocratic Oath. It seems what many docs think of first today is not “First, do no harm”, but, “How much financial incentive will I get from Company X if I prescribe this patient their Drug Y?”.

      1. Antony Sanderson

        Thanks JD for the Dr Lown reference . . . It has gone into my “special” favourite” folder.

    1. Mark Johnson

      Wow! A brand new wonder pill that melts away plaque . . . . in mice.
      What else might it do to them?
      What might it do for… or to us?? (We’re not mice.)

      Professor Mirela Delibegovic from the University of Aberdeen’s Institute of Medical Sciences, who led the study, said: “All humans have some level of atherosclerosis. We all have these fatty streaks inside our arteries to some degree and as we age atherosclerosis is accelerated,’ she explained. Eating sugary and fatty foods contributes to this process which is why the disease is a big problem for people who are overweight.”

      Fatty streaks, fatty foods and a “miracle drug” to melt all the nasty fat away.
      I can predict what the human studies will show (the drug works) but real life use will show increased morbidity and early death. Real life results will of course be dismissed as anecdotal. It’s all so sadly predictable.

    2. Bill In Oz

      I guess we can wait ( with or without bated breath ) to see what transpires in the human trials…And not rush to judgement ?

    3. Bill In Oz

      This experiment was done with mice.. I wonder how the mice acquired their arterial plaques ? What was ‘done’ to them ? As I suspect that they do not usually develop them. Mice manufacture their own healing Vitamin C which helps repair the damage ‘properly’ unlike us humans and guinea pigs.

    4. chris c

      It also melts away the fat in your brain and nervous system, “but that’s not important right now”

      On a similar subject


      “ADAMTS7 — a nonlipid cause of CAD identified
      by human genetics studies. A 2010 CVAS identified
      a variant located in an intronic region of a disintegrin
      and metalloproteinase with thrombospondin motifs 7
      (ADAMTS7); this variant was associated with a 19%
      increase in risk of obstructive CAD (>50% narrowing
      of a major coronary vessel)60. This finding led to substantial
      interest in elucidating the underlying mechanism,
      particularly because the variant was not associated with
      blood lipid levels or other known CAD risk factors.
      ADAMTS7 belongs to a family of proteins involved
      in proteolysis (the cleavage of substrate proteins) and
      remodelling of blood vessel walls. The risk variant at
      ADAMTS7 seems to be associated with increased gene
      expression and proteolytic activity, and the ability to
      promote vascular smooth muscle migration in vitro61.
      Adamts7 knockout mice were noted to have significantly
      reduced atherosclerosis burden62. Furthermore,
      mice deficient in Adamts7 exhibited decreased cellular
      proliferation and enhanced endothelial cell repair in
      response to vascular injury62,63. These results suggest
      that a pharmacological strategy of ADAMTS7 inhibition
      could prove useful in attenuating the cellular
      proliferation that plays a key part in CAD progression.”

      Has anyone else heard of this previously (I hadn’t) and what can you do about it? Eat apples? (joke)

      1. annielaurie98524

        “It also melts away the fat in your brain and nervous system, ‘but that’s not important right now’”. Well, yes, because the pharma companies would rather you didn’t use your brain, anyway. Makes you too likely to question their hyped-up ads.

  64. smartersig

    Although I am firm supporter of the Cholesterol does not cause heart disease, it is merely dragged into the argument by association. When it comes to Saturated fat I have a more fence sitting position when it comes to my own diet. There seems to be plenty of evidence that SF causes impaired endothelial function via FMD measurement. On the other hand the following paper showed no difference between high carb and a sat fat fed group who beforehand were heavily diabetic. this set me wondering, could it be that with people on a god awful diet like the SAD diet or already impaired health both a LCHF with sat fat can be just as helpful as a low simple carb low sat fat diet. Is it possible that then following these shared benefits the extra bang for buck so to speak comes from limiting Sat fat especially in favour of the so called ‘good’ fats ?


    1. Bill In Oz

      A low carb & a low saturated fat diet, implies a very high protein diet…Now I wonder what the consequences of that are long term ?

      1. smartersig

        I think what I stated was low simple carb not low carb so plenty of veg and starches like sweet potato

      2. Dr. Malcolm Kendrick Post author

        All carbs are converted to glucose and/or fructose, during digestion. So, whatever form you eat your carbs, they end up as exactly the same thing, plus or minus vitamins and suchlike.

      3. Dr. Malcolm Kendrick Post author

        They don’t convert. ‘Complex’ carbs are just lots of simple carbs stuck together. The body can either cleave the bonds, holding the carbs together, or it cannot (the bonds in fibre are too strong for out digestive system to break apart). Ruminants can digest ‘complex’ carbs, we cannot. Ruminants do this within their digestive systems, breaking apart complex carbs and turning them into short chain saturated fatty acids, before absorbing them. Thus, you could say that ruminants primarily eat saturated fats.

      4. smartersig

        Would the insulin response, which is perhaps the crucial factor here, be different. For example the GI of Yams and sweet potato is much lower than mashed potato. If complex carbs offer a lower insulin response and insulin as we all seem to agree is one if not the main culprits in heart disease then complex carbs would be beneficial ?

      5. annielaurie98524

        smartersig, you are still missing the point that mashed potatoes ARE complex carbs, i. e., starches (material consisting of several sugar molecules). It’s true that various starches affect the insulin response at different rates, but that is more a function of the fiber associated with them. There are “resistant carbs” — fiber and other starches that are harder for the body to break down into simple carbs (sugars). The starches that we cannot metabolize directly, our gut bacteria often can. They produce butyrates from these indigestible starches. Butyrates are essentially saturated fats that have health benefits — their most common food source is butter (remember those butter-eating French?) and full-fat dairy. But any carbs we can metabolize are broken down into their component sugars eventually. Complex carbs (all digestible starches, whether from mashed potatoes, white bread, or yams) –> simple carbs (sugars).

      6. smartersig

        I was never making a point about the subtle similarities and differences between complex and simple carbs, I was making the point that complex carbs are what I eat and the fiber present in them mean I do not get the same insulin response. Why has this most important of point been hijacked and sidelined by a continual reminder of the chemistry/semantics of carbs. Would you agree that complex carbs such as Yams and sweet pot’s are the wiser choice amongst our Carb choices, I would have thought we would all agree on that.

      7. Dr. Malcolm Kendrick Post author

        If you eat simple sugars the insulin spike will be quick. If you eat more complex carbs, the slow release will keep the insulin level up for longer. Is the AUC important, or the maximum insulin release important? I don’t know, but there is an argument to be made that longer release of insulin may be more damaging.

      8. smartersig

        Thats interesting so I started to dig around and the first decent reference I came up with (and please dont shoot the messenger here) stated

        “Taken together, these data support the idea that high carbohydrate diets, at the very least, do not adversely affect insulin sensitivity and may be beneficial for insulin sensitivity. On the contrary, high intakes of dietary fat, particularly saturated fat, do appear in some of these studies to be associated with a decline in insulin sensitivity.”

        This is not first ‘expert’ I have heard connect Sat fat with insulin sensitivity loss


      9. Andy S

        smartersig, re benefit of high carbohydrate diet: tried to find out if author had grants relating to glycemic effects of honey, sugars and high fructose corn syrups.
        Another dietary study had the following warning:
        “The project is supported by the Technical Committee on Carbohydrates of the International Life Sciences Institute (ILSI) North American Branch. ILSI North America is a public, nonprofit foundation that provides a forum to advance understanding of scientific issues related to the nutritional quality and safety of the food supply by sponsoring research programs, educational seminars and workshops, and publications. ILSI North America receives financial support primarily from its industry membership.”

      10. Gary Ogden

        smartersig: It seems (in the JN article) he is saying, “Eat less, move more.” Kind of like “Drown less, swim more.”

      11. Gary Ogden

        annielaurie98524: Thank you for your comment regarding resistant starch. This is why potato salad is a health food, though not the hot dogs often served with it. Three cheers for butyrate! Dr. Mercola says that baking the potatoes produces much more of this indigestible starch than boiling (what I do, since it is the easiest). Do you know anything about this?

      12. annielaurie98524

        And, as I have noted before, all starches, whether from broccoli or refined white flour, are classified chemically as complex carbs. Simple carbs are sugars. I know you know this, Dr. K, but some commenters seem confused by the distinction between simple and complex carbs. So, a meal that is high in complex carbs, low in simple carbs, and low in saturated fat would be the “chip butty”, consisting of peeled potatoes (complex carb) fried in refined vegetable oil (unsat fat), sandwiched between two slices of commercial white bread (complex carb again), with a teaspoon or two of ketchup (low simple carb from the sugar in the ketchup). That’s likely not what many commenters have in mind for “health food”!

      13. annielaurie98524

        ANY and ALL starches are classified chemically as complex carbs. Starch = complex carb, sugar = simple carb. A complex carb is one that consists of several sugar molecules. Yes, I am sure that refined white flour is a starch, and is therefore a complex carb. I gave you a reference that explained the chemistry of carbs. Lay persons may use the term “complex carb” to mean what they think of as “healthy” carbs. However, if we are being accurate about the chemical nature of carbs, and the way the body responds to them, I will reiterate again: starches are complex carbs, sugars are simple carbs. It matters not if your starch comes from white bread or sweet potatoes, or if your sugar comes from HFCS or blueberries. That does not alter the chemical structure of the carbs therein. I never said that they are equivalent in terms of their health effects, but that, chemically, starch, regardless of source, is a complex carb that consists of several sugar molecules. I did not invent this, or make this up. It is chemistry, ure and simple.

      14. smartersig

        I think the confusion comes from the degree of complexity of carbs. It seems that the more starch and fiber the more complex a carb based food is, kind of a sliding scale. Perhaps wrongly I refer to natural foods with all fiber components left in as complex when in fact they are simply more complex than others. For example whole meal bread would be more complex than white. I am not the only one it seems who tends to do this. However having cleared this up, my main point is that I try to eat carbs that as complexed as possible. For example I do not eat bread but if I did it would be whole meal bread or perhaps Rye.

    2. annielaurie98524

      Many of the so-called “good fats” ARE sat fats. And if one is on a “LFLC” diet, what does one eat? High protein (as opposed to adequate, moderate protein) does not appear to be a good option. So, if you are limiting both carbs and fats, what macronutrient remains to contribute the bulk of calories to your diet? Or, is the “low simple carb-low sat fat diet” you mention based on non-saturated fats? Like PUFAs? Also a questionable option. As several other commenters have recently reminded us, we should try to be as accurate as possible in our comments. Sugars are “simple carbs”. Starches are “complex carbs”. Complex carbs are not necessarily whole, unrefined carbs. Chemically, refined white flour is a “complex carb”.

      1. annielaurie98524

        Simple carb = sugar. Complex carb = starch. Starches are called “complex” because they consist of several sugar molecules “stuck” together. Refined white flour is chemically a complex carb. Please see my reply to Dr. K. The reference below may help you understand the chemical classifications, and it is from a site that would agree with your low-meat approach to eating. http://www.pcrm.org/health/diets/recipes/complex-carbohydrates-vs-simple-carbohydrates

      2. smartersig

        Thanks for this link Annie I was aware of the difference between complex carbs and simple carbs and that is essentially the fiber. This is why I suggest that complex carbs of the type that I eat hopefully have a lo or lower insulin promotion whereas a chip butty on white bread would have a greater insulin reaction.

      3. annielaurie98524

        The classification of a carb has absolutely nothing to do with the fiber content of the food in which it is found. Fiber itself is a complex carb, but so is plain, refined starch. Simple carbs (sugars) exist in fruit is association with fiber, but that does not make the sugars in fruit complex carbs. Using a term that is a chemistry “term of art” to mean something that is subjective to a lay person is OK, I suppose, in everyday conversation, but it is not accurate if we are discussing the physiological effects of macronutrients on the body. In the US at least, we constantly say we need to put “gas” in our cars, but we are not putting gas (in the chemical sense) into our autos. Just as you used the term “paralyze” to describe the effect you postulate that saturated fat has on arteries, when there is no medical meaning of a “paralyzed artery”, you are using the terms “simple carb” and “complex carb” to mean something that has nothing to do with the meanings of these terms from a biochemical perspective.

      4. chris c

        If saturated fat is so dangerous, how did it suddenly become so only recently after we obviously ate it for millennia without harm? My money is on *something else* that we only started eating recently disrupting the metabolism of fats as well as carbs *cough* excess Omega 6 *cough* huge quantities of dense acellular carbohydrate such as sugars and flour

        The obvious question about carb quality can be easily answered by anyone with a glucometer. From the 1 hour postprandial glucose response you can get an indication of the likely insulin response. Mine tells me that there is effectively no difference between eg. brown and white rice – but I get a significant overreaction to wheat, the only thing worse than wheat is wheat mixed with other carbs. Even wheat bran will do this, I suspect not gluten but probably wheat germ agglutinin. But that’s just me . . . and a few thousand other N=1s

        Wheat mixed with loads of fat (aka pizza) doesn’t produce such an acute spike, but instead a long low rise in BG. Whatever, the same quantity of carbs requires the same quantity of insulin to process, only the timing might differ a bit – ask any insulin dependent Type 1 diabetic, especially one with a pump and CGM.

        Best not to ask Giles Yeo though, after lambasting “clean eating” and other fad diets he equipped himself with a CGM and discovered his postprandial BG spiked into diabetic range. His conclusion “even nondiabetics have glucose spikes”. er no you buffoon, you are just “not diabetic yet”. He is mistaking “common” for “normal”. I know scads of diabetics who have tested friends and family and found the same as Richard Bernstein – who used to test meter salesmen – GENUINE nondiabetics have VERY tightly controlled BG. Anyone who doesn’t is On The Diabetic Progression.

        The only thing more useful would be a pocket insulin meter, which is why I predict this will never be invented.

      5. smartersig

        Some very interesting points Chris, the type of Carbs with fat may well be provocative, anyone have any research links ?

    3. Martin Back

      My problem with the “saturated fat clogs your arteries” position is that it leaves out the very important step of digestion.

      The fat doesn’t somehow disappear off your pork chop and reappear unchanged in your arteries, it gets broken down by stomach acids and bile and a myriad of microbes, and it is the products of digestion that reach your arteries, where they will be further processed by circulating repeatedly through the immensely complex chemical factory that is your liver. By this stage they resemble the fat on your meat about as much as a pile of bricks and a bag of cement resemble your house.

      As Einstein said, a theory should be as simple as possible but no simpler, and I think dietary theories have been so over-simplified that they must be treated with extreme caution.

      1. Dr. Malcolm Kendrick Post author

        Fats, the great majority anyway, do not pass through the liver after digestion. They are packed into chylomicrons and are delivered directly to cells around the body – mainly fat cells. The chylomicron remnants are taken up by the liver. So, the fatty acids you eat, do mainly appear, unchanged, in your arteries, after eating. What they do not do, however, is end up within LDL. The facts within LDL are mainly produced as the result of lipogenesis (the making of fat) in the liver. These fats are primarily constructed from glucose and fructose, they are packed into VLDLs (triglycerides) and then transported out. As VLDLs lose fats/triglycerides they shrink down into LDL. The fats that the liver makes are (almost) entirely saturated fatty acids, primarily palmitic acid. Thus, if you want a high saturated fatty acid content within LDL, the way to achieve this is to eat carbohydrate.

      2. smartersig

        I agree with what you say Martin but it does not change the position that sat fat appears to have a paralysing effect on the arteries. My position is that unless someone can explain why that is I will tend towards leaving it alone

      3. annielaurie98524

        I’m curious how you manage to “leave saturated fat alone”. Besides the fact that your body makes oodles of sat fats, and that they are essential components of the epithelial cells you are concerned about, they are also present in many “healthful” foods in appreciable percentages: the fat in avocados consists of 14% sat fat; that in coconut oil is 86% sat fat; that in extra virgin olive oil is 14% sat fat; and that in wild-caught salmon is 22% sat fat.

      4. smartersig

        I minimize my exposure to them might be a better description. I avoid animal protein with the exception of fish and do not eat diary

      5. Gary Ogden

        annielaurie98524: That is what amuses me when I read anything about fat. All of them are mixtures of saturated (SFA), mono-satured (MUFA), and poly-unsaturated (PUFA). All of them, at least those found in foods. An excellent book which that will reveal everything one ever wished to know about fats is “Know Your Fats: The Complete Primer for Understanding the Nutrition of Fats, Oils, and Cholesterol,” by Mary G. Enig, PhD. A must have in the nutrition reference library. It is available from the Price-Pottenger Nutrition Foundation.

    4. Bill In Oz

      matersig, the source you quoted says this “”This study aimed to examine the effects of a 12-month hypocaloric very-low carbohydrate, low saturated fat …diet compared to an isocaloric HighCHO diet.
      One hundred and fifteen obese patients with T2DM …….were randomised to consume an energy restricted LowCHO diet (Carb:Pro:Fat:Sat-Fat 14:28:58….. or a HighCHO diet (53:17:30: whilst undertaking exercise…”

      Queer thing about this study.. No protein at all in mentioned in either groups diet….Duhhh ???
      And protrein is an essential part of any diet – even if in low proportion….

      1. Bill In Oz

        Smatersig, I appreciate your question mark here….But the study ( frankly ) does not say…Is thus a study where ‘mystification’ of readers is part of the agenda ?

      2. smartersig

        The article brief does not indicate the source of protein but I am pretty sure those numbers tell you how much Bill

    5. Eric

      What is FMD?

      Smartersig, the “good” fats are good because the travelling corn oil salesmen like Keys pronounced them to be good.

      There is really nothing good about them. For primers, please read “Know your fats” by Mary Enig or Peter’s hyperlipid blog. Among others, PUFA:
      – are obesogenic in combination with sugar
      – promote alcoholic and non-alcoholic fatty liver disease, whereas sat fats are protective
      – oxidize easily and are usually partially hydrogenated as a result of their production process, storage or heating when used for cooking or frying
      – while give rise to oxidized LDL, which is probably a problem, much unlike LDL per se
      – linoleic acid breaks down to 13-HODE which is carcinogenic (which is probably the reason why some trials on mice found LCHF to promote cancer – it turned out that the lard fed to the mice was up to 25% linoleic acid because pigs are fed with soy and stuff these days)
      – omega 6 PUFA give rise to inflammation
      – even omega 3 PUFA from fish oil is now being implicated as giving rise to AMD (age-related macula degeneration) and prostate cancer – why? it is angiogenic…
      – on of the trials where one of Key’s disciples fed mental hospital patients with corn oil actually resulted in increased mortality – those data were surpessed at the time and only recently found and reevaluated

      As for carbs, it is true that of the two most common starches, amilopectin is split into two glucose much faster than amylopectin, hence it causes a higher sugar and insulin peak and is probably more obesogenic. There appear to be resistant starches that are a little like fiber in that they are broken down by gut bacteria, so to some degree we are like ruminants. This is a good thing because there is no sugar peak, and the good bacteria produce saturated medium chain fatty acids which are just about the ideal fuel for the body. Interestingly, if potatoes or pasta are stored in the fridge after cooking, some starches will rearrange to form resistant starches.

      1. smartersig

        Eric, the fats I use try to use are Omega 3 fats and Monosaturated fats both shown to be heart protective. I am not sure how corn oil got into the equation but I dont use it. With regard to the Omega 3 Prostrate cancer connection this was quickly exposed as a flawed trial

      2. AH Notepad

        Are rats really a good subject to experiment on, then extrapolate to humans? A bit like Ansel Keys and his rabbits.

      3. Gary Ogden

        Eric: FMD: Flow-mediated dilation. Other than that I know nothing of the implication of changes in it. This is the acronym used by the researchers in the alcoholic/non-alcoholic red wine study.

      4. Eric

        Ancel Keys didn’t feed rabbits with cholesterol, that was Anitschkov.

        All animal models are imperfect, but when the same effect (agiogenesis, weight gain due to PUFA + carbs) happens in rats and humans, this is as good as it gets.

        Rabbits and cholesterol are a different story. First of all, rabbits do not naturally consume cholesterol, secondly, they can make their own Vitamin C, thirdly the cholesterol that was fed was almost certainly extracted from powderized dry eggs, hence it was highly oxidized. That stuff is almost certainly toxic waste!

      5. Antony Sanderson

        Eric, Re FMD . . . as Gary says . . . we are talking Eric: Flow-mediated dilation.

        I found a video that showed the ins and outs of how to deal with high definition ultrasound videos of the brachial artery to measure the FMD. I am sure there are better, but it does show how difficult it is to get readings from the video of blood flowing and how skilful you have to be to get meaningful results. Far too much detail; however, somehow I prefer to see the detail and then dismiss it as being of no concern.

      6. chris c

        Rose Corn Oil trial is a good one, 1965 AFAICR so predates the later excessive Omega 6 intake

        ps/ can you smell sea lion?

      7. Antony Sanderson

        Chris . . . on the Rose Corn Oil trial . . . very interesting find, and surprising that I have not come across it before. The summary says it all . . .

        “Eighty patients with ischaemic heart disease were allocated
        randomly to three treatment groups. The first was a control
        group. The second received a supplement of olive oil with
        restriction of animal fat. The third received corn oil with
        restriction of animal fat. The serum-cholesterol levels fell in
        the corn-oil group, but by the end of two years the proportions
        of patients remaining alive and free of reinfarction (fatal or
        non-fatal) were 75 %, 57 %, and 52 % in the three groups respectively.
        The likelihood that the worse experience of the patients
        treated with corn oil was due to chance alone was 0.05-0.1.
        The likelihood that the trial failed by chance to detect a true
        and important benefit from corn oil was extremely remote. It
        is concluded that under the circumstances of this trial corn oil
        cannot be recommended in the treatment of ischaemic heart

      8. Gary Ogden

        Eric: Yes, and he is a first-rate scientist. Connected to NIH (National Institutes of Health), rather than CDC. He apparently specializes in uncovering buried science.

  65. Steve

    OK Dr. K, reread the blog, you had a paragraph on elevated psyciatric issues. So I ran a search on this in Russia and they had started to use FASTING on psyciatric patients.


    There are a lot of other links for this, but this is from the textbook information and it provides the actual fasting approach, how to measure success and how to bring the pateint out of the fast. I then found a documentary on it and watched it. Pretty cool stuff.

    It seems like the fast is some sort of reset, a METABOLIC RESET! With your thinking of metabolic issues, and stress…..FASTING seems to bring a lot of patients out of their metabolic issues and resets their system. Not a high percentage of success, about 60% initially, with 30% cured and the other 30% need more fasting.

    Pretty interesting, ties it together pretty clearly to metabolic issues working on the mind, body balance, diet, etc.

    Bill in Oz – I measured my BP and HR, 5 times each arm sitting. Results were: 100/71 average with COV% of 3/7 respectyively and a HR of 66. so I am pretty happy, on the low side for sure, should keep me from getting heart issues. I’ll keep doing what I have been, back on Resveratrol feeling a little better, actually caught a cold first time in a few years. Upped the Zinc and up to 15-20 grams of Vit C daily.

    You may want to look up NEO40.

    1. Bill In Oz

      Hi Steve thanks for that info re BP. I looked at the NEO info..
      Curiously doctors here in Oz are quite willing to prescribe a nitrolingual pump spray to improve angina. It is available via our medicare system so the cost is significantly lower than NEO…
      My Gp got m to get some a while ago with the instruction only to use if I has severe angina…

      1. Gary Ogden

        Bill in Oz: Did you read Dr. Lown’s essay linked to a couple of days ago? He talks about how he successfully treated angina for many years.

  66. Bill In Oz

    It seems that research can ‘prove’ almost anything. Here is a study I have just seen that seems to show that a ketogenic diet can lead to hardening of the arteries.


    The research concerns young adults and kids with epilepsy where a ketogenic diet is apparently one of the favored methods of helping to prevent or minimise seizures…

    Now who among us knew that little bit of medical practise ? I certainly did not. I wonder what the unstated confunders were in this research ?

      1. Bill In Oz

        Annie, I never did like Freud and methods or analysis.. A vast distraction from the real psychiatric health issues…. So not a “freudian slip” But a slip none the less. Confounders is what I meant. .Though it may be the ‘cofunders’ has a real significance in this study

      2. Gary Ogden

        Bill in Oz: There is a new biography of Freud (with the “e” in the title replaced by an “a”) which completely rips him to shreds. I believe the author is Crewes. One of the UK papers reviewed it. I think we’re stuck with the figure of speech, though.

      3. Bill In Oz

        @Gary : Re Freud.. When I was young I remember a Maoist at Uni in a student lunchtime debate, using this phrase ” freudian slip’ as if he had illuminated something obvious..

        In fact it was just a way of putting down an opponent by way of some BS mystification…

        When I think of Freud I see him as part of the whole phalanx of European ‘intellectuals’ of the 1900-39 period who leave me totally mystified. Think Steiner; think Madame Blavatsky; think even George Bernard Shaw; think Wittgenstein..

    1. David Bailey

      I am not a medical doctor, so it is conceivable that I have seized the wrong end of the stick, but following Dr K’s example, I decided to search for the paragraph that hides the truth! here is a quote:

      “Preliminary data suggests that although serum lipid values increase in the first several months on the ketogenic diet, they decline to normal values by 12 months and remain normal on the diet for many years (4, 5). Long-term follow-up of children off the ketogenic diet (now often young adults) has not demonstrated any obvious cardiovascular issues, yet this is hardly proof that no subtle negative impact potentially exists.”

      This seems to indicate that they found a temporary disturbance that settled back to normal even while the patients continued on their ketogenic diet!

      In addition, I wonder if the techniques that are normally used on middle aged adult patients to detect (presumably more substantial) arterial thickening, are even properly calibrated to work on these patients?

      It angers me that the saturated fat scare, that started with a piece of fraudulent research, still encourages research like this, that just prolongs the folly – even as people are voting with their feet and switching back to butter.

      Finally, surely the fact that epileptics can be improved or cured with a simple switch of diet away from carbs, is evidence that a carb-rich diet does carry risk.

      1. Gary Ogden

        David Bailey: Thank you for your comment. I think you found it (the truth hiding in plain sight). By the way, I recall them saying that there was no intimal thickening in this group. Am I wrong about this?

    2. Andy S

      Bill in oz, from the study “The use of statin medications in patients on ketogenic diets has yet to be explored.”

    3. Antony Sanderson

      Bill . . . I was amused by the article . . . but it was obvious how the ‘commentator’, while presenting an objective disposition, presenting positive and negative aspects of the ketogenic diet . . . let his suspicion of this dietary approach show though out the article . . . finishing with a subtly emotive: “Obviously, it is too early to sound any alarm on the effects of diets on blood vessels. . . .” Implication: Yes, there is an alarm ready and waiting to be sounded . . . Just not quite at the moment.

      1. chris c

        I saw a similar kind of thread on Twitter a while back – some dieticians were actually beginning to suspect that carbohydrate restriction for diabetics might actually be beneficial, but were stumbling over the “fact” that there was no RCT defining an exact amount of carbs to be prescribed, so the consensus was that until this was definitively decided they would continue prescribing HCLF

        BIG HINT – using a glucometer provides indisputable individual recommendations

    4. Steve

      It was the conclusions from two studies

      It says that after a short time their arteries went back to normal. This is probably a small reaction to the complete change in diet and indicates some sort of inflammatory response. Once the body has switched over, it is probably fine. Similar to the FASTING approach, there are a few days to 1-2 weeks transition period where the body switches over to primarily fat/ketogenic state. It takes a day to use the glucose storage, then it switches to protein for a while and then keto. I would guess that the switchover time and the response type/time is dependent on what is being consumed. If you are eating ANY sugar or protein it probably prolongs the interim state and makes it worse. Once switched over it should be fine. Probably the result of having an excess insulin state during the switch.

      Hey Bill in Oz, what dietary/supplements worked for you to lower your BP? You mentioned Garlic? My mom is on BP medication and I want to get her off as she is having swelling in the legs and water retention side effects. We got her off the statin years ago, vit C, D, K2, weight loss and exercise, her chllesterol levels are perfectly normal for humans (250+/-). She has clean Carotid and low HR, but climbing BP, 85 years. Grandma made it to 96 with clear head.

      About that average human cholesterol number, it is found in the framingham study (japanese too) it is the normal distribution of the human body controlling and manufacturing cholesterol. why anyone would draw a line at 200 and say that above this is too high, does not pass the most basic statistical smell test. IT IS THE EXPECTED NORMAL DISTRIBUTION! Just based on this alone it points to some type of scientific misconduct in this area.


      1. Mr Chris

        Aged 78, I find beetroot juice gives me 13 /8 BP
        Sometimes, if in the mood I throw in some Citrulline.
        I doubled my vit C to 2gms a day, and it seems to be a long time since I had any fibrillation
        Ain’t life grand.

      2. Bill In Oz

        Steve, it is late Spring here so there is no clean fresh organic garlic to be had. In default of that I am taking three day of Nitralife Kyolic garlic capsules.
        RE LDL-C I have just given up taking any notice of the results from blood lipid tests. A few weeks ago Cardiobrief released a blog discussing how ‘Total non HDL- C’ was of more value than LDL-C. But Dr K here has said it is largely irrelevant.

        As for the effects of diet on CVD… I tend to agree with you about it being an inflammatory response.. But that is determined by individual genetics, gut microbiome and dietary cultural history…

      3. Bill In Oz

        MR Chris, I read the comments about beetroot and thought give it a try..High NO & all that… Umm I ate it after steaming it. I got massive pink diarrohea for 3 days ! Not so clever, at least for me.But that is me..Others may do better.

      4. smartersig

        Try this Bill, get a Nutri Bullet, blend it uncooked with spinach or better still rocket and banana to take the bitterness of the rocket away. You can bung in any other powders too such Baboa for extra Vit C… delicious

      5. Gay Corran

        I think Paola’s comment on Smartersig and Dr K’s response are both right, but every single comment from Smartersig makes me feel uncomfortable. (Dr K’s “look, Smartersig” gives away a certain understandable exasperation.). He leads us down blind alleys. There seems to me to be an underlying falseness: yes, I think he is playing with us.

      6. Mr Chris

        Jan B
        Please don’t unsubscribe
        if you don’t want to read somebody’s comments, you just delete them silently.

      7. Jan B

        Mr. Chris, I’d hate to unsubscribe, I really would. This is blog is tremendously important to me and I am an ardent follower. However, if one does not read certain comments then one does not read the replies either. That would mean a large and time consuming editing job, sorting out one from t’other. Nah – I’ll stick it out – nothing endures. And I must admit, I find it somewhat intriguing- where’s it all going to lead.
        Dr. K – I’m most impressed with your ENORMOUS reply.

      8. Gary Ogden

        Mr Chris: Agreed. Jan B, please don’t unsubscribe. Your voice is valuable here. If there is a comment here you don’t wish to read, just ignore it. This is what I do.

      9. Gary Ogden

        Exactly right, Dr. Kendrick. I think it would be wise for all of us to do two things: Examine our own biases, in order to understand how breathtakingly easy it is to filter all information through them. Learn how to read a scientific study, in order to see the biases through which the authors have filtered the questions they ask, the information they discover, and the conclusions they draw from that information. John Rappaport has three quotes from Thomas Jefferson in his post today, showing the evolution of his thinking regarding the veracity of newspapers. Wise words, instructive regarding both of these points point.

      10. annielaurie98524

        But it is frustrating to try to do so. Here is the most prolific commenter on the blog (as another commenter noted) that has posted numerous references to lengthy, highly technical articles. Yet, he refuses to accept standard, conventional chemical descriptors of some macronutrients and describes the effects of other macronutrients as “paralyzing the arteries”. Pray, what is “paralysis of the arteries”?

      11. smartersig

        Annie I was referring to the detrimental effect Sat Fat has on FMD, yes ‘paralysis’ is a little strong a term but it was meant not to be taken literally. You keep using this term repeatadly in posts along with the my unappreciation of the sliding scale of simple to complex carb, these are small sticks but you keep picking them up and beating me with them which suggests that you do not care for some of the questions I have posed because they challenge your long held beliefs. I do not understand why you cannot simply deal with the question and content. If I had reacted to peoples opposing views on meat and sat fat, (and let me be clear I am not violenttly opposed to both just not convinced so I leave them alone), as you have done towards me then I would have been ejected from this forum along time go. Ask yourself this, If I was a prolific poster but was solidly pro meat, pro sat fat and a bit anti vegan to boot would anyone be raising an eyebrow ?.

      12. Dr. Malcolm Kendrick Post author

        I think things are getting a bit heated here, which is causing some friction on this blog, and I was hoping to avoid that if at all possible. Smartersig I would ask you to, perhaps, let someone close to you have a look at your postings and give you some feedback on how they may appear. You use a number of techniques that would have been familiar to Schopenhauer

        These 38 Stratagems are excerpts from “The Art of Controversy”, first translated into English and published in 1896. Schopenhauer’s 38 ways to win an argument are:

        Carry your opponent’s proposition beyond its natural limits; exaggerate it. The more general your opponent’s statement becomes, the more objections you can find against it. The more restricted and narrow his or her propositions remain, the easier they are to defend by him or her.

        Use different meanings of your opponent’s words to refute his or her argument.

        Ignore your opponent’s proposition, which was intended to refer to a particular thing. Rather, understand it in some quite different sense, and then refute it. Attack something different than that which was asserted.

        Hide your conclusion from your opponent till the end. Mingle your premises here and there in your talk. Get your opponent to agree to them in no definite order. By this circuitious route you conceal your game until you have obtained all the admissions that are necessary to reach your goal.

        Use your opponent’s beliefs against him. If the opponent refuses to accept your premises, use his own premises to your advantage.

        Another plan is to confuse the issue by changing your opponent’s words or what he or she seeks to prove.

        State your proposition and show the truth of it by asking the opponent many questions. By asking many wide-reaching questions at once, you may hide what you want to get admitted. Then you quickly propound the argument resulting from the opponent’s admissions.

        Make your opponent angry. An angry person is less capable of using judgement or perceiving where his or her advantage lies.

        Use your opponent’s answers to your questions to reach different or even opposite conclusions.

        If your opponent answers all your questions negatively and refuses to grant any points, ask him or her to concede the opposite of your premises. This may confuse the opponent as to which point you actually seek them to concede.

        If the opponent grants you the truth of some of your premises, refrain from asking him or her to agree to your conclusion. Later, introduce your conclusion as a settled and admitted fact. Your opponent may come to believe that your conclusion was admitted.

        If the argument turns upon general ideas with no particular names, you must use language or a metaphor that is favorable in your proposition.

        To make your opponent accept a proposition, you must give him or her an opposite, counter-proposition as well. If the contrast is glaring, the opponent will accept your proposition to avoid being paradoxical.

        Try to bluff your opponent. If he or she has answered several of your questions without the answers turning out in favor of your conclusion, advance your conclusion triumphantly, even if it does not follow. If your opponent is shy or stupid, and you yourself possess a great deal of impudence and a good voice, the trick may easily succeed.

        If you wish to advance a proposition that is difficult to prove, put it aside for the moment. Instead, submit for your opponent’s acceptance or rejection some true poposition, as thoug you wished to draw your proof from it. Should the opponent reject it because he or she suspects a trick, you can obtain your triumph by showing how absurd the opponent is to reject a true proposition. Should the opponent accept it, you now have reason on your own for the moment. You can either try to prove your original proposition or maintain that your original proposition is proved by what the opponent accepted. For this, an extreme degree of impudence is required.

        When your opponent puts forth a proposition, find it inconsistent with his or her other statements, beliefs, actions, or lack of action.

        If your opponent presses you with a counter proof, you will often be able to save yourself by advancing some subtle distinction. Try to find a second meaning or an ambiguous sense for your opponent’s idea.

        If your opponent has taken up a line of argument that will end in your defeat, you must not allow him or her to carry it to its conclusion. Interrupt the dispute, break it off altogether, or lead the opponent to a different subject.

        Should your opponent expressly challenge you to produce any objection to some definite point in his or her argument, and you have nothing much to say, try to make the argument less specific.

        If your opponent has admitted to all or most of your premises, do not ask him or her directly to accept your conclusion. Rather draw the conclusion yourself as if it too had been admitted.

        When your opponent uses an argument that is superficial, refute it by setting forth its superficial character. But it is better to meet the opponent with a counter argument that is just as superficial, and so dispose of him or her. For it is with victory that your are concerned, and not with truth.

        If your opponent asks you to admit something from which the point in dispute will immediately follow, you must refuse to do so, declaring that it begs the question.

        Contradiction and contention irritate a person into exaggerating his or her statements. By contractiong your opponent you may drive him or her into extending the statement beyond its natural limit. When you then contradict the exaggerated form of it, you look as though you had refuted the orginal statement your opponent tries to extend your own statement further than you intended, redefine your statement’s limits.

        This trick consists in stating a false syllogism. Your opponent makes a proposition and by false inference and distortion of his or her ideas you force from the proposition other propositions that are not intended and that appear absurd. It then appears the opponent’s proposition gave rise to these inconsistencies, and so appears to be indirectly refuted.

        If your opponent is making a generalization, find an instance to the contrary. Only one valid contradiciton is needed to overthrow the opponent’s proposition.

        A brilliant move is to turn the tables and use your opponent’s arguments against him or herself.

        Should your opponent surprise you by becoming particularly angry at an argument, you must urge it with all the more zeal. Not only will this make the opponent angry, it may be presumed that you put your finger on the weak side of his or her case, and that the opponent is more open to attack on this point than you expected.

        This trick is chiefly practicable in a dispute if there is an audience who is not an expert on the subject. You make an invalid objection to your opponent who seems to be defeated in the eyes of the audience. This strategy is particularly effective if your objection makes the opponent look ridiculous or if the audience laughs. If the opponent must make a long, complicated explanation to correct you, the audience will not be disposed to listen.

        If you find that you are being beaten, you can create a diversion that is, you can suddenly begin to talk of something else, as though it had bearing on the matter in dispose. This may be done without presumption if the diversion has some general bearing on the matter.

        Make an appeal to authority rather than reason. If your opponent respects an authority or an expert, quote that authority to further your case. If needed, quote what the authority said in some other sense or circumstance. Authorities that your opponent fails to understand are those which he or she generally admires the most. You may also, should it be necessary, not only twist your authorities, but actually falsify them, or quote something that you have invented entirely yourself.

        If you know that you have no reply to an argument that your opponent advances, you may, by a fine stroke of irony, declare yourself to be an incompetent judge.

        A quick way of getting rid of an opponent’s assertion, or throwing suspicion on it, is by putting it into some odious category.

        You admit your opponent’s premises but deny the conclusion.

        When you state a question or an argument, and your opponent gives you no direct answer, or evades it with a counter question, or tries to change the subject, it is a sure sign you have touched a weak spot, sometimes without knowing it. You have as it were, reduced the opponent to silence. You must, therefore, urge the point all the more, and not let your opponent evade it, even when you do not know where the weakness that you have hit upon really lies.
        This trick makes all unnecessary if it works. Instead of working on an opponent’s intellect, work on his or her motive. If you succeed in making your opponent’s opinion, should it prove true, seem distinctly to his or her own interest, the opponenent will drop it like a hot potato.

        You may also puzzle and bewilder your opponent by mere bombast. If the opponent is weak or does not wish to appear as ife he or she has no idea what you are talking about, you can easily impose upon him or her some argument that sounds very deep or learned, or that sounds indisputable.

        Should your opponent be in the right but, luckily for you, choose a faulty proof, you can easily refute it and then claim that you have refuted the whole position. This is the way which bad advocates lose a good case. If no accurate proof occurs to the opponent or the bystanders, you have won the day.

        A last trick is to become personal, insulting and rude as soon as you perceive that your opponent has the upper hand. In becoming personal you leave the subject altogether, and turn your attack on the person by remarks of an offensive and spiteful character. This is a very popular trick, because everyone is able to carry it into effect.

      13. smartersig

        OK I will take a break from posting. I will take a look at your last post closely and maybe run off my posts and get someone to check them. The final point however in your check list states that a final tactic is to get personal and insulting. I think I can say that I have not done this but others have been insulting towards me. Some weeks ago I suggested drawing a line under a conflicting point of view only to find others or perhaps one other resurrecting the point of conflict. In the absence of my posting it would help if people ceased from making sarcastic somewhat childish remarks about any views or misunderstandings I may have. Mars bars may no longer be battered but this so called Vegan certainly has been.

      14. AH Notepad

        I agree, you’re right, or maybe I don’t and you are wrong. I’m so confused I don’t know if I’m coming or going.

      15. annielaurie98524

        First of all, I have no “long-held beliefs” in regard to food. Second, if we all start to “red-queen” terms that have conventional technical definitions, we are depriving ourselves of having a solid, scientific discussion that might benefit us all. Asking someone that has repeatedly posted links to complex technical treatises (that have presumably shaped his viewpoints) to use conventional medical/chemical terms properly is not “beating” that person. It’s not fair to commenters that want to engage you in debate to switch your personas without warning from “technically-informed reader of Lancet/NEJM” to “just a bloke talkin’ about me grub”.

      16. smartersig

        I am both Annie as I think we all are. As a Computer Scientist and these days Data Scientist I can hang on the coat tails of the medical studies published but when it comes to Biology and Chemistry I am the bloke and his grub. Sadly for me because I like this forum is that that former is not welcome because some of my questions/ideas go against the concensus and the latter is also derided for asking stupid questions. Tonight I will go quiet as promised but whatever you think of me I am not Vegan troll I have no Vegan agenda other than I think aspects of it are clearly heart healthy

      17. smartersig

        Paola let me say once again I am not vegan or Vegitarian, I have stated clearly what my diet consists of. I try to eat what is heart healthy based on all available evidence. The problem for all of us is that some areas of diet have a polarized effect with different camps feeling sure that they have the answer. Saturated fat would be one contentious area. What I have found on both Nutritionfacts.org and on here is that if I open up the debate on areas where a forum has a large collection of advocates of a certain stance then the response gets rather hostile. I have found this to be equally so whether I discuss cholesterol and its weak evidence on Nutritionfacts.org or meat and sat fat on here. This saddens me because both are reputable forums and I would hope that debating these areas can be done without being accused of a troll, told to ‘Get real’ or other generally disparaging remarks when dealing with a topic. I have bit my tongue on occasions on here when responses have been about me rather than about the subject. I am beginning to feel that a good number of people would like me to leave, if that is the feeling of the majority then I will leave the forum. But I want you to remember one thing, for many people on these forums, myself included, these questions we probe and try to get to the bottom of are of mortal importance to us. We have had heart disease or angina or some other Cardio factors and the decisions we end up making are real and can be life threatening. We got into this mess in the first place back in the 70’s because we all shut up and listened to the good doctors or at least the ones with the political forum. The rather stupid thing about this whole thing is that meat consumption of the right kind and vegan living are probably both pretty healthy and yet the stupidity of the two camps and how they attack each other is like two billionaires fighting over who will become a trillionaire.

      18. Paola

        The Big problem is that evidence against saturated fats does not exist.It is all flawed. I think you are only provoking .

      19. Gay Corran

        Yes, Paola, and Dr K, – provoking, using Schopenhauer techniques, playing the victim when irrefutably challenged: it all rings hollow. There is no genuine feel of truth in the smartersig stance, I find. The personas change, the arguments are not genuine: they evoke mistrust; they make me uncomfortable. I follow and enjoy all the regular posters on this brilliant blog, but there is something that doesn’t feel in accordance with this spirit in most of smartersig’s posts. And it is not simply that I don’t agree with what he says or the questions he asks.

      20. annielaurie98524

        smartersig, may I respectfully point out that you really have never answered the question of what you eat? You’ve said that you are “not a vegetarian” and that you eat “complex carbs”, but it seems you have your own definition of these terms. You’ve said you “try to leave sat fats alone”, yet they are part and parcel of the fat content of most foods that contain fat. You’ve said you eat “some omega 3’s” w/o getting specific — salmon? sardines? vegetable sources? supplements?. When other commenters have asked about your food choices, you say you don’t keep a food diary. I doubt most of us do, and I could not tell you what specific foods I ate 2 days ago, but I could easily rattle off a list of foods that comprise the bulk of my diet, and a list of foods that I don’t eat. So, what FOODS do you typically eat? Please don’t just say “complex carbs”, since none of us know what your personal definition of that term is. You also referred to changing your diet due to some form of CVD. Just as Goran and others have shared their insights on finding the ideal diet to address their health issues, why don’t you do likewise? I find it interesting and thought-provoking to learn how various commenters have experimented with different foods and found what works best for them.

      21. smartersig

        You have not read my posts Annie but as summary here go’s for a typical day. I want to stop posting as promised to Dr Kendrick so take the following and please let it be.

        Breakfast A Pink Grapfruit, Porridge with Kiwi fruit, Pomegranite and Flax seed, a handful of Walnuts Hibiscus tea

        Lunch Salad of various type, Green tea, Dark chocolate and some fruit

        Dinner Grilled salmon, sweet potato, grilled tomatoes, fruit salad
        or maybe veg chilli which I am fond of with brown rice

        And thats my dairy intake which I do not log in a food dairy Annie

      22. AH Notepad

        It’s the way you “open up the debate”. Being too direct will often get a hostile response. Why not try a softer approach?

      23. Mr Chris

        Hi Bill
        I take my beetroot as juice half and half with pear juice.
        Probably complex carbs, but definitely vegan.

      24. Gary Ogden

        Mr. Chris: Yes, I was going to suggest to Bill in Oz to try beet juice rather than beets, and in any case, start with a wee bit at first, and increase it as indicated. I take 3-4 oz (100 mL) twice a day, with the potassium bicarbonate stirred in. Very strong flavor, but I like lots of flavors.

      25. Bill In Oz

        @Paula.. He says that he eats fish.. That is hardly vegan….
        In my youth a close friend became a vegetarian but still ate fish when hungry.. And this ( with dairy foods ) was my own form of ‘vegetarianism’ for some years…So possibly ‘pescatarian’ is appropriate… But this is by the by.. Engaging in the discussion and debate is still the process of gaining understanding

      26. JDPatten

        All this tension is unfortunate… and fascinating.
        But, when it comes down to it, what’s the point?
        I submit that the point here and now might more profitably center around:

        “Could it be, I thought, that the way food is eaten is more important that what is eaten?
        If you eat whilst you are relaxed and socialising with friends and family, will your body deal with food in a different way? The answer is, of course, yes. Just to put it in the most basic terms.”
        Again, Dr Kendrick.

        This arguing about personal food convictions is a “strain”!

      27. Gary Ogden

        JDPatten: Agreed. Personal food choices are just that, personal decisions. They shed little light on how to keep the ticker healthy because there are so many ways to eat that are healthful. The list of things prudence dictates we avoid or limit is small.

    5. Stephen T

      Bill, the ketogenic diet has been used for over a century for seizures and is in the medical literature, but I doubt many doctors know that. There’s no money or kudos without complexity and expensive treatments.

      Here’s a famous example that led to a film being made, starring Meryl Streep.


      1. Bill In Oz

        An interesting link ! Thank you for posting it.

        As I read the story I did wonder what an 11 month old was eating/drinking that would cause seizures. I’ve always thought that breast milk is best at such an age.. And breast milk has lots of saturated fat and protein in it with no carbs. at all..

        Also the commet that 5 years later this young boy could eat whatever he liked without any epileptic seizures, was telling.

      2. AH Notepad

        “No carbs at all”? :SHOCK: :HORROR:

        The Carbohydrates Found In Your Breast Milk
        Lactose: Lactose is a type of sugar found only in milk. It is the main carbohydrate that appears in breast milk. Lactose is a type of carbohydrate called a disaccharide. A disaccharide is made up of two simple sugars or monosaccharides. When lactose is broken down, it turns into the two simple sugars known as glucose and galactose.

        Glucose provides an important source of energy and calories necessary for your newborn’s growth and development, and galactose contributes to the healthy development of your baby’s central nervous system.

        Lactose has been shown to improve a baby’s ability to absorb essential minerals including calcium. It is also linked to greater brain development. There are high amounts of lactose in human breast milk, and research indicates that animals with more lactose in their milk have a larger brain size.

        Oligosaccharides: Oligosaccharides are a type of carbohydrate that is formed from the union of a few monosaccharides. Oligosaccharides play a significant role in the health of the gastrointestinal tract (the stomach and intestines) of newborns and infants. The job of oligosaccharides in your breast milk is to build up the healthy (probiotic) bacteria located in your baby’s intestines.

        This bacteria is called Lactobacillus bifidus.

        L. bifidus can help to prevent infections from developing in your child’s GI tract, and it also fights off viruses, bacteria, and other microorganisms that can cause illness and disease. Additionally, oligosaccharides have been found to help protect newborns and infants from diarrhea.

        There are 130 oligosaccharides in human breast milk. Compared to cow’s milk, human milk contains a much greater amount of oligosaccharides (about ten times more). Some infant formulas add artificial oligosaccharides to their products. However, the natural substances found in human milk cannot be copied.

        Other Carbohydrates: In addition to lactose and oligosaccharides, there are other types of carbohydrates that can be found in your breast milk. Monosaccharides, polysaccharides (long chains of monosaccharides), fructose, and others are among the compounds that make up the unique and complex composition of human breast milk.

      3. Gary Ogden

        Bill in Oz: In a small subset of children vaccines can and do cause seizures. Publishing this information is not allowed in the U.S., and apparently not in Australia, either.

      4. annielaurie98524

        Actually, human breast milk, like that of other mammals, does contain carbs in the form of lactose (“milk sugar”), although the composition of colostrum, the milk first produced after a woman gives birth, has a lower carb content. But, yes, it has sat fats aplenty. Yet, none of the sat-fat demonizers has been able to explain how the human race has managed to survive all these eons with such a high-fat initial diet. You’d think we’d all have atherosclerosis and “paralyzed arteries” by six months of age 😉

      5. AH Notepad

        That last post about breast milk was a quote from a web page, but the “” bit didn’t seem to work.

      6. Bill In Oz

        AH Notepad.. Well I confess to be completely at sea as regards the composition of breast milk. Thanks for the clarification !

    6. Antony Sanderson

      Bill, the Meryl Streep movie suggested by Stephen T “First do no harm” is well worth the watch. Made in 1997 . . . it has not dated an iota – the lessons still as relevant today as then. When I watched it a month or so ago I was immediately reminded of the followers of this blog . . . people making it their business to find out about their own health issues . . . to help themselves. I couldn’t help but admire the actual hero portrayed in the film who educated herself without the luxury of the Internet that we now have. The closing credits are goose-bump provoking – no spoilers.

    7. Eric

      I have not followed the link, but I suspect that the standard ketogenic diet for epilepsy contains quite a bit of PUFA.

  67. JDPatten

    Wine. Grapes. Resveratrol. Ardbeg. Whatever.

    There are – as of this moment – thirty hits searching for “alcohol” on this page.
    The problem of alcohol-or-not is more complicated than might have been considered here.
    You will AVOID ALL ALCOHOL entirely if you want to avoid atrial fibrillation…if you accept this article at face value:

    You do want to avoid atrial fibrillation.
    AF is a nasty debilitating condition that destroys your quality of life whatever you do about it. Ant-arrhythmia meds are serious; some are toxic; most work temporarily or not at all. If they don’t, you must anti-coagulate if you don’t want a stroke. Of course, then you have a modest risk of a brain bleed. (Modest!?) Or you could have an ablation — with its own risks and side effects. It purposely scars the wall of your left atrium so that errant electrical signals are limited. (Scars your heart!?)

    Look at the graph in the link. It shows how nicely beneficial booze is for CVD. And, it shows that any booze whatsoever increases your likelihood of fibrillating.
    Ya makes yer choice and ya takes yer chances.
    (I wonder if those researchers considered that if you eat fruit, your digestion is likely to produce…alcohol.)

    1. Bill In Oz

      JDP, I suspect there are a lot of vested interests wnating to influence the debate about alcohol in either direction. And I suspect that some researchers have personal opinions in line with the ‘results of their research. But the direction of causality is uncertain.

      I like this discussion by PD Mangan on Rogue Health about drinking red wine. He suggests it is cardio protective….


      1. JDPatten

        If you study that graph on my link, you’ll see two sets of information. One indicates that imbibing anything at all will compromise the electrical substrate of your heart. The curvy curve indicates that imbibing moderately will bolster your cardiovascular system against CVD, just as your man Mangan does.
        Of course the article is behind a paywall and the two lines on the graph look a bit too perfect, so I don’t know for sure about their data, but I can tell you that the left atrium’s electrical substrate and the coronary arteries are two rather different propositions.

        To get back on topic: My rhythm following my ablations has been very close to normal for a few years. The lines of scarring in my left atrium from the ablation prevent erratic electrical rhythm feedback from disrupting my heart’s overall function.
        So, that graph notwithstanding, now I feel confident in relaxing at the end of the day with a dram of good Islay single malt to contemplate creating the evening meal for my wife and myself. I always try to be imaginative with dinner and it usually entails a small glass of wine to set it off just so.
        I makes me choice.

      2. Gary Ogden

        Bill in Oz: Thanks for the link. Excellent piece. I’m sold, but then I’m a red wine drinker, so that’s my bias showing.

  68. Dr. Göran Sjöberg


    Well well – the only thing I am aware of is angina now and then but usually it is kept att bay with natural vitamin E.

    But what is fibrillation? How does it manifest itself? I guess it is a very serious condition (MI ??) since I see the “antifibrillation” equipment at public places, e.g. at airports. It seems to have something to do with the nervous system in the heart going awry and especially after CABG it is a common condition. Electric shock resets the system??

    Oh – God!

    Well, again keep away from “them” experts!

    Go “natural” whatever!

    1. smartersig

      Goran I have friend who suffers from Angina, could you supply complete details of your Vit E approach so that I may pass it on to her…. Thanks

      1. Dr. Göran Sjöberg


        First I suggest doing the “homework” properly. Get the “old” book “Vitamin E for Ailing & Healthy Hearts” by Wilfried Shute which you probably can do easily over the internet.

        Otherwise you can visit Linus Pauling’s site to find accessible information on vitamin E


        Bottom line is that you should increase the dosage of Natural Vitmin E slowly until you get the desired effect especially if your heart is in a very fragile condition. Though i started successfully high myself on 1600 IU per day but had to increase that to 2400 today when the angina returned after a couple of years (evidently not uncommon) but it seems to work fine with very few angina relapses.

    2. JDPatten

      VENTRICUAR fibrillation is what those airport “shockers” are for because it’s much more immediately deadly. Fibrillation is beating so fast that it becomes an uncoordinated quivering. If that occurs in the ventricles, blood circulation doesn’t move much. It’s an emergency. If the atria are fibrillating, they are not being effective, but the electrical signal gets through, although erratically, to the ventricles. It’s a conga band playing in your chest. So the blood still manages to get around. The problem is that it can pool in the recesses of the left atrium (left atrial appendage in particular). Due to blood chemistry changes and stagnation, that pooled blood is much more likely to congeal. So, the need for anticoagulants. You can live with this disability for quite some time provided you take your medications. Without medication it can sometimes take only hours for that atrial clot to form. Sometimes weeks or years. If a chunk of that breaks off you have stroke. It’s how my father died without medical care in 1973. He was 75. I’m 73.
      I do not see how you can go natural with this.
      Risk factors include years of high blood pressure, sleep apnea, thyroid problems, obesity, diabetes, hereditary propensity and, yeah, heart disease. You can help yourself avoid it early on with a healthful lifestyle with those factors in mind, but it’s tough once you’ve got it.
      Mine was particularly symptomatic. No wood chopping. No stone masonry. No raking leaves. No quality of life. So, I had the ablation. And a second and a third. I’m mostly fine now. It left me with a higher heart rate and a bit short of breath, but I can chop wood for a while, rest, and chop more without the dreaded. ATRIAL fibrillation.

      1. Dr. Göran Sjöberg


        Really interesting to read and I am happy to hear that the ablation worked fine in your case,

        As you know I am a strong “believer” in LCHF and I would suggest that before getting exposed to the ablation procedure one should try to see if a strict ketogenic LCHF (all carbs eliminated) could help. There are no real dangers involved in trying except when an ablation intervention is urgently needed.

        I have read that with a CABG fibrillation is a common (30 % ?) “side effect” and CABG is basically a sham and thus a criminal activity to me.

        What I read in a Ph.D. thesis about fibrillation and ablation written by an experience Swedish heart surgeon I met though scared me. They don’t seem to understand how it works and destroying nerves in the heart sounds a bit weird in my ears – there doesn’t seem to be a way back if it is done.

      2. JDPatten

        For clarity: Yes, it’s very frustrating how little the electrophysiologists (EP: Cardiology rhythm specialty) know about AF. By trial and error, they have figured out which tinkering works best and which doesn’t. So far.

        The incoming pulmonary veins are lined with tissue that was identical to the tissue of the sino-atrial node in the developing heart. The mature node triggers the impulses to provide our normal sinus rhythm. The mature vein linings, for precise reasons unknown, sometimes contribute their own impulses causing a rhythmic mess — atrial fibrillation. The first thing the EPs try is to ELECTRICALLY isolate those veins from the body of the left atrium. They circle each vein entry causing an electrically insulating scar. That circle is a series of dots burnt with a radio frequency stylus. Alternatively, they can temporarily plug the vein opening with a small balloon filled with something like liquid nitrogen. Freezing was my method. Both methods work 70 odd percent of the time. That node is then free to do its job (mostly) normally. Mine was a bit more involved. One annoying effect of my ablation is a resting heart rate more than ten beats higher than prior. A typical effect. I learn to live with it. Preferable to AF!

        I was already avoiding carbs for a few years before the AF became intolerable. If I’d started low carb AND high fat earlier . . . who knows?

        Any sort of major surgery can trigger AF — if you’re already prone to it. It’s not only CABG. Emergency appendectomy triggered on of my worst episodes.

        If the medical establishment is good at all, it’s good for removing a gangrenous appendix! Also, for setting bones. I can personally vouch for these benefits.

      3. Antony Sanderson

        Goran . . . thinking about ablations:

        About 4 years ago I had these stress surges of cortisol(?) in the chest that coincided with a premature ventricular contractions (PVCs) . . . in effect you missed heart beats. Sometimes it was 1 in 8, but then when the stress increased, perhaps walking too fast, it dropped as low as once every other beat (giving an incredibly low heart rate). I was given an ablation by a very likeable doctor who described himself as “more of an electrician”, while talking a little disparagingly of the “plumbers” – presumably thinking of those who had inserted my stent.

        For 10 luxurious days after the ablation the surges in the chest went and so did the PVCs . . . I WAS CURED!
        Then they started up again . . . as did the hormonal surges in the chest. They contacted my GP who let them know there was still PVC issues and they offered a second ablation.

        By this time I had begun to think that the 10 holiday from PVCs was more to do with the anaesthetic effects, gradually wearing off, than any zapping. Like you, Goran, I felt the destruction of cardiac circuitry seemed to be a bit drastic . . . It was increasingly apparent that the problem was the chest surges. By this time I had been told I might have had pericarditis (an infection around the heart). So, I decided that the surges were more to do with an infection which just needed time to heal. I refused the fresh ablation – received a letter from the “electrician” advising against the move. A few months went by . . . the surges began to subside . . . the PVCs subsided with them . . . and 8 months after the original ablation I had mended.

      4. JDPatten

        Do you know exact what they did and where for that PVC ablation? It’s my understanding that ablating in the ventricle (left or right?) is more tricky and dangerous than in the atria.

        “Surges” sound a lot like epinephrine spilling into you bloodstream from an oversensitive sympathetic response. Were you prescribed a beta blocker to damp that? Does that make sense?

      5. Antony Sanderson

        Thanks JD for your comments . . .

        The PVCs were located in the left ventricle. When I was told there might be a possibility that I had pericarditis I did a search and found that pericarditis can be associated with PVCs. The doctor looking for the focus of the electrical activity gave a running commentary to his younger colleague . . . “Look see there”, excitedly “See how it spreads out” . . . “Mark that down” . . . “I think we have another one there” He found 3 areas producing “aberrant?” signals. Then he put me out and zapped them.

        Your comment: “Surges” sound a lot like epinephrine spilling into you bloodstream from an oversensitive sympathetic response makes a lot of sense.

        I used to call the surges . . . “adrenaline surges” . . . because it was the only hormone I was familiar with 4 years ago. For some reason in the last year I thought cortisol was the culprit . . . even though the Ablation doc had said, 4 years ago, not to worry if I was not producing the PVCs because he would give me a shot of adrenalin/epinephrine to set them off.

        On the beta blocker? I was prescribed a beta-blocker, which I took for 3 weeks . . . they did not make any difference at all wrt PVCs, but they did manage to lower my already low BP to the point I had to refrain from standing up quickly.

        Did find a case which mirrors my experience . . .

        “This past January I had a bout of pericarditis after receiving a Hep A vaccine. It was a very severe allergic reaction due to the vaccination. To make a long story short, I have not been right ever since. I now have PVC’s all the time and am full of anxiety and misery because of them. I would have occasional skipped beats every now and then before the pericarditis but now they are out of control . . .
        They were worse in the spring and am hoping that they subside as my body fully recovers from the pericarditis. I am hoping I have no permanent damage from the inflammation that occurs from the pericarditis. ”

        From your “oversensitive sympathetic response” comment it would seem that the anxiety over the PVCs will not help – sort of a vicious circle.

    3. Anna

      Goran, How would you describe your Angina symptoms & do you use a Trinitrine spray? I often feel unsure if I am experiencing an Angina attack or not. I usually either get an ache in my heart or sticking (pin like) pains which doesn’t usually go on for too long.
      I had an MI 4 years ago.

      1. Dr. Göran Sjöberg


        The simple answer to you question is “chest pain” of various severity. At worst I was unable to walk more than 10 m without unsupportable pain and had to rest. Happens very seldom today. In the mild form it is just a feeling of discomfort. Psychologic stress seems to be a main culprit today together with cold winds and moist air.

        Sometimes I feel extremely fit and strong, as e.g. today when me and my wife shopped furniture at IKEA and dragged heavy stuff from the first to the second floor in our house.

        Heavy work in the garden is though my favorite.

        Bottom line is that I never panic when hit by angina and call for emergence assistance – then I would be “doomed”. I have very little trust in cardiologists today – they don’t know! I endure the pain with the help of my collaterals 🙂

        And of course I don’t take any “heart medicines” except for a lot of vitamins like E, A, D, K. And then I sip on my 15 g of vitamin C per day (like Linus Pauling) in a large glass of water. Fish oil omega 3 supplement is a part of the treat. A few hawthorn berries each day; berries which I saved from my garden and dried before all were snatched by the blackbirds.

      2. Bill In Oz

        Goran, I have just discovered your comment about which supplements you take… I take most of these as well with the addition of Maritime Pine Bark, Ubiquinol, Chondroitin sulfate Alpha Lipoic Acid. potassium, lithium orotate (5 mcg every second day ) and now garlic capsules…

  69. Lucy

    As I was reading this I thought about the reasoning behind support groups. It’s the group of the people all together helping each other and it’s an antidote to being alone. All boats rise together and that’s why I think support groups work.

  70. Mark Johnson

    Fats, the great majority anyway, do not pass through the liver after digestion. They are packed into chylomicrons and are delivered directly to cells around the body – mainly fat cells. The chylomicron remnants are taken up by the liver. So, the fatty acids you eat, do mainly appear, unchanged, in your arteries, after eating. What they do not do, however, is end up within LDL. The facts within LDL are mainly produced as the result of lipogenesis (the making of fat) in the liver. These fats are primarily constructed from glucose and fructose, they are packed into VLDLs (triglycerides) and then transported out. As VLDLs lose fats/triglycerides they shrink down into LDL. The fats that the liver makes are (almost) entirely saturated fatty acids, primarily palmitic acid. Thus, if you want a high saturated fatty acid content within LDL, the way to achieve this is to eat carbohydrate.

    This is what I’ve never been able to reconcile or understand: LDL is demonised as being “bad” and we’re told to reduce eating (especially saturated) fat in order to reduce “bad” LDL. However, the very way of eating that the “health authorities” and nutritionists tell us to adopt (high carb) in order to reduce “bad” LDL actually, ultimately increases it. Or is my understanding incorrect?

    1. Dr. Göran Sjöberg

      Mark, as I understand it you are just right! Fifty years ago it was basically known that carbs produced high lipid content in the blood in vulnerable people (metabolically trapped) but this fact was also basically ignored and still is.

    2. chris c

      Richard Feinman (I think, among others) has pointed out that the body will preferentially metabolise glucose not because it “prefers” it as most dieticians will tell you, but to get it stashed out of the way before it goes around glycating everything. During this time it leaves the Free Fatty Acids in the blood until it gets around to them later. Of course if you then top up with moar carbz then later never comes.

      My doctor appears to have learned a lot over the past twelve years but is still totally convinced that triglycerides are caused by eating fat, not carbs. It takes a lot to break through decades of conditioning.

  71. Steve

    Thanks Bill and Chris I had some of these on the list but not all. Lots of good discussions on remedies. Thanks to the rest of you providing valuable information and approaches.

    There is a lot of information on the sym- and parasympathetic systems. They use different agents for signaling, one uses choline and the other uses norepinephrine. Both are made from glucose . I wonder if something goes wrong with one of the pathways when there is stress?

    Probably disrupted by stress hormones?

    Still studying up on this, so probably more to come.

    1. Gary Ogden

      Steve: Dr. Mercola has written about the sympathetic/parasympathetic balance. You can easily search it on Mercola.com.

    1. JDPatten

      Your man made an error. He suggests that warfarin and the newer NOACs all BLOCK vitamin K.
      Warfarin INHIBITS vitamin K. The degree to which you supplement with K while on warfarin is the degree to which you must increase your dose of warfarin to maintain your INR to avoid a stroke.
      Dabigatran inhibits thrombin.
      Rivaroxaban apixaban and edoxaban all inhibit factor Xa.
      The NOACs all have nothing to do with K.
      The NOACs, particularly apixaban and edoxaban entail a pronounced reduction of the risk of brain-bleed below warfarin’s risk. (Bleeding is necessarily a risk while anti-coagulating.)
      If he makes such a basic error on this, what else is there?

      I myself have taken on the unknown side effects and risks of apixaban in lieu of the fairly well known risks of stroke, even post “successful” AF ablation. Scarring of the left atrium increases mechanical dysfunction and, therefore, clotting.

      Convince me not to take apixaban. Please. I’d love a few good reasons to chuck it.

  72. Bill In Oz

    Can I nudge the discussion back to what Randal brought up a few days ago ?
    “The French are the world’s biggest per-capita consumers of butter Eight kilograms (17.6 pounds) per person per year, according to a handy roundup of global butter consumption com”

    That 8 kg of butter a head per year is extraordinary. In a family of 5 that means eating about 40 odd kilograms a year ( 88 pounds ).. Even though we like butter, my wife & I would not eat more than half a kilo a month – though it is always organic butter…

    Now I find all this interesting. It is a part of the French paradox. And I suspect the French love being ‘paradoxical’ to us Anglophones & good luck to them !

    But I would like to know if butter is an additional element that lowers the CVD rate in France along with a strong tradition of family ties and afmily meals in an unstressed environment..

    Or is the other way around where the lower stresses combat perhaps, the effects of saturated fat ?
    Ohhhh Dear : I’ve just remembered that we already know that saturated fats do not play any causative role in CVD. The results of that trial a month or so ago.

    Where does that leave us re butter ? Enjoy it while we can afford it as there is now a world wide shortage ?

    1. Bill In Oz

      And a PS : Dr K how does the CVD situation in France compare with other high butter consuming countries ? Belgium, the Netherlands, Denmark come to mind ?

    2. Mr Chris

      Bill in Oz
      I think there are big differences between regions in CVDI found this once but have not managed to do so again, and butter consumption is a fairly north of the the Loire thing.
      Any help anyone?

      1. Bill In Oz

        Ahhhh yes.. There was a discussion a week or so ago about this. I think I read that northern urban France has a higher CVD than the sunlit southern more rural regions. Ummm are these southern regions also low butter consuming regions ?

    3. Dr. Göran Sjöberg

      Well we are two in the family and scratching my head I realize that we beat the French with about 2 kg per month and that equals 12 kg per person per year and we are not eating the butter with a spoon.

      We use it liberally in all of our cooking. With boiled eggs and with baked salmon are favorites Just now we had coffee with homemade chocolate truffle (no sugar) made from butter with cream and crushed dried rose hips.

      All organic by the way.

      1. Bill In Oz

        Tanks Goran… I am salivating just thinking of your recipe ! Wild water salmon would be be lovely. But the only ‘fresh’ salmon here in Oz is fish farmed in Tasmania which I decline to support at all. So just tinned salmon for me. I wonder how it wold go baked with butter ?

      2. Gary Ogden

        Bill in Oz: Salmon with butter is excellent! Sometimes I cook fancy and make Hollandaise sauce for the salmon, sometimes I just melt butter on top when it comes out of the broiler. I used to make a reduction sauce with lemon juice, white wine, and creme fraiche, but that’s a lot of work. Baked in butter sounds delicious.

      3. Gary Ogden

        Dr. Göran: That’s about how much butter I eat, too. From childhood I’ve loved the taste, and occasionally just eat a gob of it all by itself. Expensive, though. High-quality raw, pastured butter is $16.00 per pound (a bit less than 1/2 kilo) here.

    4. Martin Back

      I eat about a kilogram of butter a month. My lunch is normally two or three slices of home-baked sourdough bread with butter and cheese. I have steamed veg with a generous knob of butter most nights, and often have eggs scrambled in butter. I’d like to cut down because butter has got so expensive recently, but I don’t seem to be able to.

      1. Jan B

        Martin – eggs are divine scrambled in coconut oil. I have mine (2) cooked thus every morning with plenty of strong Cheddar cheese grated in, a generous topping of cress and a side of a cheesy oaktKe very thickly slathered with g.f.butter. It all keeps me going for hours, and I’m very active.

      2. JDPatten

        I’ve always been fond of coconut so I was enthusiastic about using it to scramble or saute salmon – whatever.
        Didn’t last. Everything tastes overwhelmingly of coconut. Too much of a good thing.
        Do you not find that to be true?

      3. Jan B

        JD – at first yes but I soon didn’t really notice it. I don’t use an awful lot, maybe a tea spoon for two eggs. I did notice, however, that in certain recipes, eg my infamous Pork and Prunes, the coconut oil added a certain unctuousness. I use C.O., lard and butter for cooking generally and never ever the holy seed oils.

      4. annielaurie98524

        Martin, if the butter is contributing to your health and happiness (which is likely if it is from grass-fed animals), it might be worth budgeting for. When people are beset with rising food prices, I always remember the philosophy of my Mom, an old farm girl, “It’s better to give the money to the grocer than the doctor”.

      5. Martin Back

        I have tried cooking with coconut oil. To me, the resulting flavour and texture are inferior to cooking with butter, and the price of coconut oil is much the same (a little cheaper ATM), so I will stick with butter.

        I do however believe in the virtues of coconut oil as a source of omega-3 fatty acids, so I take a teaspoon or two in the evening with my turmeric.

      6. Gary Ogden

        Martin Back: Yum, yum! I don’t make or consume the sourdough any more, but agree it needs lots of butter. And cheese!

      7. Antony Sanderson

        Jan . . . what a great gem . . . scrambled eggs cooked in coconut oil.
        Read your post as lunch was approaching – mouth watered at the idea of grated cheese over the top – it would be a change from the lunchtime stir fry.
        I love to eat coconut oil neat but wondered if the taste would get in the way . . . . . no way, it turn out to be delicious.

      8. Martin Back

        So I was eating the right thing for the wrong reason! Not a problem. I eat eggs, fish, and fermented food as well, so I’m probably doing okay on the omega-3 front.

        I agree with your mother — good food is a good investment. I take no medication whatsoever these days (touch wood). But I have to stick to supermarket grade food, for financial reasons. If you buy fresh and cook it yourself, you can’t go too far wrong IMO.

      9. annielaurie98524

        It’s good to know you are getting your MCTs AND your omega 3s — just two of the fats that are so beneficial to our health. Sorry about the supermarket foods. I hope some of the supermarkets in your area are becoming more enlightened and offering more fresh, organic choices.

    5. Gary Ogden

      Bill in Oz: Butter has so many positive effects on human health it makes my head spin. It is the first food of all mammals. Among humans from, or descended from, dairy cultures, most of whom maintain the ability to digest lactose into adulthood, butter consumption has a long history; it is consumed by people in regions with both low and high rates of CVD. I suspect it plays only a minor role in CVD risk. But replacing it with a new-fangled “food” like vegetable seed oils cannot possibly be a good idea.

      1. AH Notepad

        Quote “Butter has so many positive effects on human health it makes my head spin.”

        That doesn’t quite sound like a positive effect. Dizzy turns may indicate a problem.

      2. Gary Ogden

        AH Notepad: Sorry. Didn’t finish the sentence:. . .”makes my head spin to contemplate them all at once, they are so impressive”

      3. Bill In Oz

        Yes I agree Gary…. Mind you I had the disturbing experience the other day when actually reading the ingredients of my ( formerly ) favorite ‘spreadible ‘organic butter. It turned out to be 20% organic canola oil….
        Bugger, fooled again. !
        I have gone back to just straight butter from a local BD certified dairy company…But I will have to blend it in with some organic olive oil to make it spreadible on my organic sourdough breads. etc. ..

      4. Gary Ogden

        Bill in Oz: Or you could just leave some out on the counter. The old fashioned way, prior to refrigeration. What I used to do with the hard-as-a-rock butter is slice thick slices and lay them on the bread so it was completely covered, them gently mash them down into the bread. Had to be thick enough to leave tooth marks.

      5. smartersig

        A crticism of the meta studies that support a ‘no contribution’ to heart disease by sat fat is that they did not examine what quality of carb replaced it. In other words if you replace sat fat with poor carbs sat fat will look neutral. This meta study did not do this and showed sat fat replaced with quality carbs was beneficial. I am not trying to push anything here just trying to unravel my own uncertainties on sat fat and what better place to get an alternative view than amongst sat fat supporters


      6. smartersig

        There are studies that show sat fat linked to type 2 diabetes which we know is a risk for heart disease. If memory serves me, something to do with Sat fat inhibiting the cells ability to respond to insulin resulting in insulin resistance. Putting that aside though the meta study that showed sat fat was OK but apparantly admitted itself that it needed to look more closely at what carbs replaced sat fat actually had a Risk Ratio of 1.07 for CHD and 1.0 for CVD. Now although these are slightly worse than neutral they are not the sort of risk ratios you get from something like beans. What I am wondering is whether it could be true that a life of healthy eating with sat fat will not expose you to great risk but if you have HD and want to reverse it then reducing sat fat and replacing with foods that have risk ratios below 1.0 is wiser. This is the approach I have taken. To summarise I dont think sat fat is the elephant in the room with regards to the heart disease epidemic but I am not convinced that its the best nutrient to consume if you are already fighting it.

      7. Gary Ogden

        smartersig: A risk ratio of 1.0 is neutral, and 1.07 essentially so. Meaningless for drawing conclusions.

      8. smartersig

        Yes but these figs were form the study that did not account for the alternative consumption to sat fat. If this was not controlled for then we can assume perhaps that there was a fair bit of rubbish in the alternatives which would help lower the risk ratio for sat fat. With that kind of help I would hope to see sat below 1.0 and it was above

      9. AH Notepad

        Living is the risk, the only way out is dying. I think most of the discussions here are about getting there without having to consume toxic substances, or having to suffer painful, and ineffective procedures. It is also obvious that consuming refined carbohydrates exposes you to the risk of the interference by the medical profession, some (few) of whom will try to help you back to health, while many will just do as they are told. I have some sympathy for them, it’s not their fault they are threatened or bribed.

      10. smartersig

        I agree or to paraphrase Woody Allen, one road leads to heart disease, cancer and general disease and the other to death. We must learn to choose wisely

      11. Jan B

        Smartersig – I have Mody3 Diabetes so any replacements of fats, saturated or otherwise, with carbs, high or low quality, will do me no good at all. It would just send my blood glucose levels high. I maintain good levels with low, low carbs, moderate protein and plenty of fats of all kinds except manufactured seed oils. I cook with lard, coconut oil, butter and olive oil depending on the temperature at which I am cooking.
        By the way, all you clever people out there, which would you say is worst – high-ish blood glucose levels or high insulin levels (which happily I do not have). All the talk just lately about the damaging effects of high insulin levels has got me thinking….

      12. Anna

        I also read it has anticancer properties. And yet, I have decided to give up dairy as my breast cancer was estrogen positive, meaning it responds to estrogen by growing. So I am making an exception for butter but not sure I should. I don’t like to be too fanatical, so I’m giving up 90% of the dairy, but still using some butter or dairy in the occasional recipe. It seems that dairy consumption is indeed associated with prostate and breast cancer, both often hormonally driven.

      13. Bill In Oz

        Gary, ummm yes indeed. A friend once said ” Bread is just a way of getting butter in the mouth ” 🙂
        Currently here it is Spring with lovely long mellow days of about 24-26 degrees .. But the Australian Bureau of Meteorology ( http://www.bom.gov.au ! ) is forecasting warm days of 32-33 degrees till next Tuesday…So butter on the bench is not going to be feasible…

      14. Antony Sanderson

        Bill . . . with your spreadable butter goal . . . You could try adding macadamia oil . . . less of an intrusive taste compared to olive oil . . . but then I do like the taste of olive oil.

        The word is you should have plenty of macadamia oil in “Oz”

      15. Bill In Oz

        @Anthony,,, Ahh yes Macadamia nuts and oil…. I love macadamia nuts but at around $50.00 a kg I cannot afford them often… Ditto for macadamia oil..

        Meanwhile I got a 500 ml bottle of organic certified olive oil the other day for $5.00 and it is in a dark glass bottle so it will not oxidise as it does in plastic or clear glass bottles. .. Good value…

        The odd thing is that Macadamia’s are a native tree species here in Australia..

        And I do like my own blended butter with olive oil..The problem is my lady does not..

      16. Frederica Huxley

        I was somewhat surprised this April to find macadamia nuts in a supermarket in Adelaide weren’t any less than I pay for them in the UK!

      17. Gary Ogden

        Bill in Oz: How right you are! Just looked it up. Also called “Queensland Nut” for its native range. Lots of representatives of the Protea family in Australia.

      18. Antony Sanderson

        smartersig: Your conciliatory “I do not think sat fat is the elephant in the room . . .” at the end of your piece is a little disingenuous. My the time I reached it I felt pummelled by one argument after another confirming your belief that . . . sat fat is a risk factor for CVD. Each argument crying out “I DO think sat fat is the elephant in the room.

        There have been studies to show an association between palmitic acid and insulin resistances in adipose cells. High rate of glucose intake into adipose tissue will result in increased production of saturated fats, notably palmitic acid. (This production is stimulated by insulin signalling) . Besides responding to the opportunity to store energy (converting glucose to fat), the adipose keeps glucose down to a level that will be less likely to lead to oxidative stress from hard pressed adipose mitochondria.

        Increasing concentrations of palmitic acid in the cell interfere with the insulin signalling pathways that lead to the translocation of GLUT4 (Glucose transporters) to the cell surface thereby reducing the transfer of glucose into the cell. This insulin resistance resulting from the action of palmitic acid helps keep glucose down to less damaging levels within the cell. The down side is that high glucose levels remain in the blood.

      19. smartersig

        Let me clarify, what I meant was that I try to keep sat fat down because I think that consuming high levels of it over a lifetime are not the main worry given an otherwise healthy diet but a risk ratio of 1.07 is not cardio protective either and as a 61 year old man who has had a heart attack I want to eat foods that have risk ratios shouting below 1.0 at least. I have 22 year old son who I hope has good arteries, if he asked me for a list of things to protect them I would not put Sat fat high up in the sense of reducing it. I choose to eat what I am pretty sure is heart protective, the stuff that could be i dont bet on, I leave out because maybe they would harm me maybe not.

      20. Gary Ogden

        smartersig: It is a good thing indeed that you are taking care of yourself and looking after your son. From the list of foods you posted, it seems you eat well. Just bear in mind that all fish, like all land animals contain saturated fat in the part you eat.

      21. Antony Sanderson

        Hi Jan B

        In a podcast exam Ivor Cummins, who knows a bit about all this, was asked about people who were fat adapted in their diet, therefore had very low insulin levels and yet had higher than expected glucose levels. This was because they did not have sufficient insulin supply to tell the liver to stop manufacturing glucose. He was firm in his opinion that the main thing to worry about was the insulin – too high an insulin concentration – too high persistence in high insulin levels is likely to cause more problems. (There is a growing list of areas where high levels of insulin are thought to contribute to problems . . . eg insulin as a growth promotor is thought to be implicated in cancer growth)

      22. Jan B

        Thank you, Antony. That is very useful and also kind if you. I follow The Fat Emperor’s posts when I have time and shall now certainly search for the relevant YouTube post regarding if not Mody3 then certainly low insulin secretion.

      23. Antony Sanderson

        Jan B

        The Ivor’s podcast where he talks about insulin vs glucose is available on his site http://www.thefatemperor.com/blog/ . It is an interview with KetoGeek. About 51 mins in they start talking about keeping insulin low . . . and then around 57min he gets into describing why glucose can “creep up” in people with very low insulin.

  73. Bill In Oz

    @Smatersig.. I would urge you to not with draw from the discussions happening on this blog.
    I do not think you are trolling.

    Yes we have had disagreed over a number of issues. But I think our disagreements was about those issues -eg Greger’s book on Veganism.

    I have said this before and I say it again. We are all different in many aspects : genetically, culturally, and even in our micobiomes. That is why I believe that there is no one diet which is best for all humanity.

    But for all of us here who have been affected by CVD in some way or other ( big or little ) Dr K’s posts & the discussions provide information & understanding which can help us improve our health and indeed our lives.

    This is not a blog to promote a ketogenic diet, or a paleo diet, or a vegetarian diet or indeed a vegan one. I remember Dr K stating that a wide range of food choices can work for humans providing we stay away from such unnatural stuff a pure white & deadly sugars and the various non vegetable ‘industrial’ oils.

  74. smartersig

    I intend to take Dr Kendricks advice seriously and seek some help on assessing whether I am too aggressive on here or perhaps too persistant. The first step was to seperate all my posts and all the discussions that have involved my input. I will get someone to take a look, my partner has read them and feels they are OK but she is probably biased. For anyone interested (I doubt it) the content is here. I hope everyone stays fit and healthy regardless of their dietary beliefs.



    1. annielaurie98524

      If I may note one example where your reply was, let us say, a put-down: I asked about specific foods you ate, as there seemed to be some confusion as to what you meant by certain categories of food (e. g., complex carbs). In your reply, you started by accusing me of not reading your posts. However, as I scanned through the content of your comments that you posted, I do not see any instance where you mentioned specific foods, other than a reference to salmon. So, perhaps if you would give other commenters the benefit of the doubt, that they are seeking information they may not have gotten from you before, rather than accusing them of ignoring your previous comments, it would make for more courteous exchanges.

      1. annielaurie98524

        No, that’s an old humorous expression that used to be pretty common in the US — apparently, long ago, some gullible folks purchased swampland in Florida that was advertised as “ocean front property”.

    1. JDPatten

      Yes. The mice will love this advertising.
      That’s as far as the controlled research has gotten. Yet to be seen is what harm this drug might do . . . to the mice. In the U S there are at least three phases a new drug must go through in humans, including safety studies, before approval.
      Be calm. Be patient.

      1. AH Notepad

        Must go through? That is not always the way it works. The manufacturers get results from the early trials, then because they are so amazing, they get permission to fast track it through the system. Guardakill was one such drug. Need I say more?

      2. Gary Ogden

        AH Notepad: It should be noted that biologics (vaccines) go through a less rigorous process of safety testing than do pharmaceuticals (in the U.S.). Nevertheless, the rate of serious adverse events (all quoted figures are from the trial data on the CDC website) for Guardakill 4 was 1%, and for Guardakill 9, 0.9%. One out of a hundred of these girls required emergency treatment or hospitalization. You are correct that it was fast-tracked-by Julie Gerberding, the director, who soon became head of the vaccine division at Merck (the maker of Guardakill).

      3. annielaurie98524

        The over-hype ad said it also treats breast cancer and diabetes! And simulates exercise! Maybe it walks your dog and makes your coffee too! More likely, it reduces the number of deaths from CVD, breast cancer and diabetes by killing patients early from toxicity.

      4. Eric

        AH, how about telling us the correct spelling of Guardakill? Google results with your spelling are not the most helpful…

      5. Bill In Oz

        @ AH Notepad :I am perplexed by your comments about Guardasil. In the 1980’s a good lovely friend of mine died an awful death from cancer of the cervix. A women who was loving in nature, careful about her diet ( almost all organic ) and caring of her 2 young children.

        Shortly after her death here in Oz two research scientists ( Ian Frazer & Jian Zhou ) at UQ discovered that it was mostly caused by sexually transmitted strains of the HPV. They worked to develop a new type of vaccine which could help the body fight this viral infection. And their work was taken up & commercialised by CSL here in Oz and eventually introduced across the globe. For their efforts they were awarded the Nobel prize for medicine.

        Wikipedia has the following lengthy section about the adverse effects of Guardsil.
        “As of April 2014, more than 170 million doses of Gardasil had been distributed worldwide.[39] The vaccine was tested in thousands of females (ages 9 to 26).[40] The Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) consider the vaccine to be safe. It does not contain mercury, thiomersal, live viruses or dead viruses, but virus-like particles, which cannot reproduce in the human body.[40]

        Publications of FDA and the CDC state that the vaccine has mostly minor side effects, such as soreness around the injection area.[40] Fainting is more common among adolescents receiving the Gardasil vaccine than in other kinds of vaccinations. Patients should remain seated for 15 minutes after they receive the HPV vaccine.[41] There have been reports that the shot is more painful than other common vaccines, and the manufacturer Merck partly attributes this to the virus-like particles within the vaccine.[42] General side effects of the shot may include joint and muscle pain, fatigue, physical weakness and general malaise.[41][43]

        An update on adverse events was published by the Journal of the American Medical Association and looked at data from the Vaccine Adverse Event Reporting System (VAERS), covering 12,424 reported adverse events after about 23 million doses of vaccine between June 2006 and December 2008.[44][45] Most adverse effects were minor and not greater than background rates compared with other vaccines, the exception being higher rates for syncope and thromboembolic events.[45] Venous thromboembolic events were noted in 56 reports at a rate of 0.2 cases per 100,000 doses distributed and included 19 cases of pulmonary embolism, four of which were fatal.[45] Overall, 772 events (6.2% of the total number of adverse events but only 0.003% of the total number of doses) were described as serious and included 32 reported deaths (1 per 1,000,000 doses).[45]

        Other adverse events include local site reactions (7.5 cases per 100,000 doses distributed), headaches (4.1 cases per 100,000 doses distributed), hypersensitivity reactions (3.1 cases per 100,000 doses distributed), and urticaria (hives) (2.6 cases per 100,000 doses distributed).[45] A Kaiser Permanente study tracking 190,000 girls and women post-vaccination for two years found that rates of the autoimmune disorders lupus, rheumatoid arthritis, juvenile rheumatoid arthritis, idiopathic thrombocytopenic purpura (ITP), hemolytic anemia, multiple sclerosis, thyroiditis and type 1 diabetes mellitus in vaccinated populations were the same as in unvaccinated populations.[46]

        The FDA and the CDC said that with millions of vaccinations “by chance alone some serious adverse effects and deaths” will occur in the time period following vaccination, but they have nothing to do with the vaccine.[47] More than twenty women who received the Gardasil vaccine have died, but these deaths have not been causally connected to the shot.[47] Where information has been available, the cause of death was explained by other factors.[48][49] Likewise, a small number of cases of Guillain–Barré syndrome (GBS) have been reported following vaccination with Gardasil, though there is no evidence linking GBS to the vaccine.[14][44][50] It is unknown why a person develops GBS, or what initiates the disease.[51]

        The FDA and the CDC monitor events to see if there are patterns, or more serious events than would be expected from chance alone.[48] The majority (68%) of side effects data were reported by the manufacturer, but in about 90% of the manufacturer reported events, no follow-up information was given that would be useful to investigate the event further.[45] In February 2009, the Spanish ministry of health suspended use of one batch of Gardasil after health authorities in the Valencia region reported that two girls had become ill after receiving the injection. Merck has stated that there was no evidence Gardasil was responsible for the two illnesses.[52]”

        There has also been a huge reduction in deaths & infections due cancer of the cervix among women as a result of this vaccine

        Frankly I think that Guardasil has proved to be a boon to the world.

      6. AH Notepad

        Bill In Oz, I can understand your view given your experiences, but Wikipedia is not to be trusted as a source of facts. Secondly ask the parents of girls damaged or killed by the Guardakill vaccine, which incidentally was never properly tested for safety, but fast-tracked after the manufacturers claimed succes on the back of their suspect trials, whether they think it is a boon. Thirdly the vaccine does not remove the need for testing for signs of cancer, which in the early stages can be cleared up by relatively simple treatments. Fourthly the vaccine is configured to address a small number of the variants of the cervical cancer causing vira.

      7. Gary Ogden

        Bill in Oz: Nobody knows whether or not HP viruses play a causal role in cervical cancer. Most infections clear within two years, and the routine pap smear is the only known way to reduce the threat of cervical cancer. Read the trial data for Merck’s version of the vaccine on the CDC website. The rate of serious adverse events (ER visit or hospitalization) was one out a hundred for the quadrivalent, and 0.9 out of a hundred for the nine-valent. There were 400 deaths in these trials. VAERS captures, at most, 1% (according to the former FDA commissioner Dr. David Kessler) of adverse events. Most doctors don’t even know VAERS or the Vaccine Injury Compensation Program, which has paid $3.6 billion in claims for vaccine injury, exists. Read what Dr. James Lyons-Weiler has to say about this vaccine. He is a good, honorable scientist. There is a reason the Japanese government no longer recommends the HPV vaccine, that uptake has dropped to 1%, and that there are multiple lawsuits by injured Japanese girls. The scientist who headed Merck’s safety trials said the licensing of the vaccine would become a great scandal. It was nevertheless fast-tracked to licensing, against the advice of CDC scientists, by the CDC Director, Dr. Julie Gerberding, who shortly became head of Merck’s vaccine division. It is not a boon, but a terrible disaster. Look at some of the stories of victims Polly Tommey has filmed. She’s a bonafide hero, and a lovely lady. The reason she was banned from Australia is that knowledge endangers profits.

      8. Bill In Oz

        @AH Notepad.. The relevant paragraphs contain the sources Wikipedia uses ..You claim that Wikipedia cannot be relied on.
        Are you saying that the sources Wikipedia cites are wrong or flawed or misleading ? If so be so kind as to state where & how.
        But so far you have just made a series of wild assertions with no ‘evidence’ to back them up.

      9. AH Notepad

        Not in this case, but in relation to statins as an example, Wikipaedia could for instance cite one of Rory Collins studies, does this make it a reliable reference?

      10. Gary Ogden

        Bill in Oz: Wikipedia is so unreliable citations from it are banned in papers written by university students. Phillip Roth attempted to correct an error concerning one of his books, and was told (by the anonymous “editors”) that he was not qualified to make the change! He who wrote the book. I wouldn’t even use it if all the other on line dictionaries and encyclopedias disappeared. It is a propaganda platform, like the mainstream media here in the U.S.

      11. AH Notepad

        Another wild assertion? https://youtu.be/qbnqO_vJVOk Merck, (whose direcor was institutional in celaring Gardasil through the CDC), uses amorphous aluminium hydroxyphosphate sulphate as an adjuvant in the vaccine. Then there’s more wild assertions in https://articles.mercola.com/sites/articles/archive/2014/10/21/gardasil-hpv-vaccine-adverse-reactions.aspx. Gardasil, that boon to humanity, does seem to be getting a hard time. Maybe someone was making wild assertions, but it wasn’t me, i would suggest.

      12. Bill In Oz

        AH I note that the source for your opinion on Guardisil is the writings of a single GP in the UK who is a doctor of Homeopathy…

        By the way Dr Kendrick, is there any official recognition as to the professional standing of homeopaths in the UK ? Here is Oz there is none. It is not covered by Medicare here, though I gather that some private medical insurance plans also cover homeopathic consultations.

      13. AH Notepad

        Maybe a good thing, maybe a bad thing, I don’t know enough about homeopathy, but I doubt Rory Collins or his cohorts will be forced out, and there are certainly questions there.

      14. AH Notepad

        Bill In Oz, I seemed to have touched a raw nerve in that you do not like your belief in Guardakill questioned. Jayne Donegan is a qualified doctor, she qualified as a GP, and a homeopathic physician. You might like to read her home page. She is not the only reference I have for this dreadful vaccine, but I feel any reference I give will be dismissed in a similar way, so there is little benefit in compiling a list. Jayne Donegan wrote the foreward for a book coauthored by Suzanne Humphries called Dissolving Illusions. I suggest you read the book and the foreward. The whole book is valuable information about the history of vaccines, and their ineffectiveness in many cases. I hope this helps.

      15. Gary Ogden

        AH Notepad: Indeed, there are a very large number of physicians and scientists here in the U.S., and around the world, who have researched vaccines and have raised alarm about them. Many of them stay quiet for fear of being Wakefielded. Such is the economic power the pharmaceutical industry has over government and media that most people know little but the official story. The entire industry is a cesspool of corruption. WHO developed an abortifacient vaccine combined with the tetanus toxoid in 1972. The Catholic Bishops of Kenya discovered this was being used in a mass vaccination program recently targeting only women of childbearing age. Granted, in poor countries, infantile tetanus is a real problem, but the solution is sanitation. I have 14 books on my shelves concerning the science and history of vaccination. Had I to do it over, I would not have allowed my child to be vaccinated with any of them. The HPV vaccines are dangerous, and it will be impossible to know anything about their efficacy before about 2030-2040.

    2. Gary Ogden

      Randall: The “stock photo” of a clogged artery in this article is hilarious. Looks like something cooked up in Hollywood.

    3. Bill In Oz

      trodusquemine ? I am puzzled. I would be slightly less skeptical if this report came from a science research report instead of a UK Daily rag.

      But maybe it does have the effects claimed. It should be easy to find out. After all it isn’t already available to type 2 diabetics on prescription ? Examining what has happened already to these patients arteries seems sensible. As well as what else happened to them.

      1. Dr. Malcolm Kendrick Post author

        Never say never. But this will be at least seven or eight years away from any potential launch, so I am not interested yet. I have read about possible mechanisms of action, and it seems interesting. But so do many things, before you stick them into human beings.

      2. Bill In Oz

        Is trodusquemine available already as a prescription mnedcine for type 2 diabetics ? My understanding is that it is. But maybe I have misunderstood this.

        But of so, then a purely observational study of those who are already taking it for this purpose would be informative…

      3. annielaurie98524

        The only “official” reference I could find (PubChem) refers only to its “potential” benefits. There were several “layman’s” articles along the same lines as the one from the “rag” — overhyped, with instant results (which is physiologically impossible).

      4. Bill In Oz

        Annielaurie, check out Wikipedia on trodusquemine. It lists research report sources going back to 2004.

        By the way that word “official” in your comment raises my eyebrows. Those of us who ‘live’ here do not ever rely just on any official sources….

      5. annielaurie98524

        The term “official” was in response to another commenter’s characterization of one article’s source as being a “rag”. Official = other than “pop press” report. I consider any reports by legitimate scientists/researchers to be official. That includes, of course, Dr. K, Dr. Mercola, Dr. Kresser, Dr. Bredesen, and many other folks that conventional medicine would consider “alternative” or “functional”. I do not, however, put much stock in tabloid articles, or even health “news” in mainstream news magazines.

      6. Bill In Oz

        Thanks Annie for the clarification of ‘official’ … For me it more usually means ‘government approved”, which usually means never to be trusted…

      7. annielaurie98524

        Hah! Government is the last source of nutritional info I’d trust. We have the best government money can buy, literally. Our USDA has a mandate with a built-in conflict of interest, and all “nutritional advice” from our government comes with the imprimaturs of the industrial farm, pharma, and fast food lobbies.

  75. Kay

    On the matter of coconut oil / butter: I often make my morning eggs with some of both. I like the taste of that. I also like to use just a small amount of coconut oil in place of the olive oil recommended in many recipes to coat a pan for searing a steak. I’ve never calculated how much [ordinary grocery store] butter I use in a year, but I probably go through a pound in a couple of weeks or less — have for years.

    1. Eric

      We go through a pack of 250 g or two per week in a family of four, one teenager of which does not butter his bread while the other would put it on both sides of her bread if it weren’t such a mess 🙂

      I find that virgin coconut oil has a distictive taste and odor I don’t fancy in a number of foods, eggs among those. I use refined coconut oil for frying a lot but usually add a dab of oilve oil or butter towards the end for the flavor. Unfortunately, the brand most widely available here is also totally hydrogenated but this does not hurt as there can be no trans fats if hydrogenated to the very end.

      By the way, Peter maintains that PUFA are probably more harmful than trans fats:

      So current issue margarine made of palm oil and PUFA is probably worse than the partially hydrgenated junk they fed us in the 70s. I occasionally buy a sandwich (well, its the continent, so a buttered roll with cheese, egg and veggies) at work. Recently, i thought there was a lot of mayonaise on that one and felt slightly nauseated afterwards. The next time I checked the label, I saw that had changed from butter to margarine of unknown composition. Well, there goes another temptation. Godd riddance.

      1. smartersig

        Are there any concerns amongst the group that when Denise Minger analaysed the raw data from the china study she found that the biggest risk factor for heart disease, and it was big, was wheat ?.

      2. Gary Ogden

        smartersig: Yes, I found that a bit alarming. She also found a weaker association in the data with salted vegetables. But those paradoxical French eat plenty of bread, so this association may be peculiar to China.

      3. smartersig

        That is true Gary but we only tend to drool over the French’s HD figures in comparism to other countries with poor stats. Compared to populations who do not get heart disease the figures for the French are not that desirable eg the Tsimane people of Bolivia

      4. Mr Chris

        We do drool about French MI numbers because they are very low and the,y are not far away and live mostly like us.
        Now the Masai have low numbers too but have a totally different dietary set up
        I’m always a bit puzzled, since I have quite good health and eat what is called real food with real taste, should I continue as I am, or adapt a diet from a totally different part of the world with different ways of doing things?

      5. smartersig

        If it aint broke dont fix it but on the other hand if Heart Disease is the silent killer then how can we be sure it aint broke. I thought I was pretty healthy until nearly 5 years ago when I came back from a 2 mile run and had a heart attack. When I talk to people now about health most will say that their diet is pretty good but having read so much about diet over these past years I can see holes everywhere in their ‘pretty good’ diet. I am not suggesting this applies to you but usually improvements can be found, I am still finding them in mine.

      6. annielaurie98524

        Now, smartersig, I know you hate the expression and consider it rude, but implying that the diet of the Tsimane has any bearing on their rate of CVD, or that it should be a model for Western countries, epitomizes the need for the admonition, “Get real!” Or, we could use one of kids’ favorite text expressions: “Srsly, bro?” Yes, the Tsimane have one of the lowest rates of CVD found in the world to date. We should also note that they have one of the lowest death rates from automobile accidents and from mass shooters. There is no evidence, and I mean, from a statistical and scientific perspective, NO evidence, that the diet of the Tsimane plays any role in their low CVD rates. These are people living in isolation, in a tropical rain forest, in a Paleolithic/early-Neolithic lifestyle; eating only unprocessed, seasonal food; in a relatively pristine environment, free of industrial pollutants; using no synthetic foodstuffs and additives; following a natural circadian rhythm; etc. How do you figure the diet is the main determinant of their CVD status, especially when one could point out people with vastly different dietary regimes, but similar lifestyles/environments, with similar CVD stats? Would you allow for diet being the cause of their high infant mortality, rates of infection, rates of inflammation, rates of intestinal parasite infestation, and lack of a native written language? And what of their prodigious consumption of beer made from manioc and alcoholic products from fermented plantains and other crops? And yet, practically no AFib! To attribute their low CVD rates to their diets is almost as bad as if we were to attribute the very, very low rate of prostate cancer in women to their … umm… use of lipstick.

        Why are we impressed with the low French rates of CVD? Because our lifestyles map very closely onto those of the French … modern, high-tech, industrial democracy, etc. They are so identical to us in most respects, but have much lower rates of CVD. And eat more butter and cheese. And drink more wine.

        Will following the Tsimane diet help you avoid CVD? Absolutely. Just move to the Bolivian rainforest, take up subsistence farming, eschew the use of electricity, and, voila! You can improve your chances of keeping CVD at bay!

      7. smartersig

        Soldiers in Vietnam had heart disease at 20, I am sure the research showed that little or no heart disease even amongst 40 year olds is pretty impressive. If you took a snap shot of 30 to 40 year olds in this country it would I guess be pretty miserable reading in terms of heart disease ?

      8. annielaurie98524

        You have to consider that what some of these reports consider “heart disease” were merely a few fatty streaks in the arteries. We now know (at least those of us that have taken the trouble to educate ourselves through Dr. K’s 40-and-counting blog posts and commenters’ posts on collateral circulation) that the cartoon version of an artery filling up with fat until it is blocked is an oversimplification. So, whether these folks actually had “heart disease” or not is open to question.

      9. smartersig

        You are starting to get personal now Annie, I have read all the blogs. If you are happy with lesions and fatty streaks at age 20 then fine, I am not.

      10. Gary Ogden

        As do the Yanomami of Venezuela, whose blood pressure is so low they should be a poster child for the American Heart Association.

      11. smartersig

        Its an interesting point Annie except I do not want to lower my risk to that of the French because that is not low enough when compared to others. With regard to other factors eg carcadian rythms etc, I suspect they do not trump the diet. There is a recurring theme among populations with very low heart disease, namely that starch/veg biased diets with little or low meat. It keeps popping up time and time again. Your point also gets countered by say the people of Loma Lindy who also are fairly close to our lifestyle in that they drive cars, go to work in office blocks, have electric lighting upsetting rythms etc and yet they too have very low levels of heart disease and even lower amongst the plant based only members. For this reason I suspect that diet is a major factor but not the only factor and I suspect that these diets pack the most punch, more punch that the beneficial french diet which may possibly be deriving its benefit form 2 hour lunch breaks, who knows ?. Please dont think I am pushing plant based again, I am just quoting what the pop’s that impress me eat, its just data I am not interested in persuading anyone, most people who are zealots about Veganism (again I am not vegan) are so because of moral views whereas my interest is only health……. Keeping it real !

      12. annielaurie98524

        As far as the Seventh Day Adventists of Loma LindA, CA (I lived within a few miles of the city for nearly 29 years), their diet is not so monolithic as some of the diet gurus would have you believe. I should have included them with the Cretans and Okinawans in my reply. Yes, you are correct in stating that many populations following a more natural lifeway eat a goodly amount of high-fiber starchy veggies. However, they also eat a fair amount of wild animal matter. Considering how nutrient dense said animal matter is, how do you know that it isn’t THAT component of their diet that confers any claimed health benefits? Or, more likely, it is a combination of those and other factors.

        BTW, while said populations may have low rates of adult CVD, as I noted, many of them have numerous other health problems. Perhaps the ones that had any genetic or other weaknesses that might have made it likely they’d develop CVD or other life-shortening diseases as adults died in infancy. Only the fittest live to be adults and are perhaps another “self-selected” group.

        Now, the animal matter consumed by populations living closer to the way humans evolved is not the feedlot-raised, antibiotic- and hormone-saturated stuff that too many in Western countries consume. They eat insects (especially in the larval form — very rich in healthful sat fats), terrestrial snails, amphibians and other critters most “Westerners” would gag at (and, yes, before you ask, I am sure that insects are animals — doubters can check any university zoology department on this fact). They also eat parts of animals that most Westerners would not consider eating. Considering how much our understanding of the complexity of macronutrients has advanced in just the last 20 years, anyone that thinks he has it all figured out is — well, at least guilty of enormous hubris.

      13. smartersig

        Because when they split off the whole food plant based people they did better than the some meat people in the Loma Lindy group

        With regard to the Bolivian group the following sums up the increased mortality
        “, over half of all deaths
        were due to infectious disease, especially respiratory and gastrointestinal infections. Accidents
        and violence accounted for a quarter of all deaths. Unlike typical patterns described by epidemiologic
        transition theory, we find a much larger period reduction of death rates during middle
        and late adulthood than during infancy or childhood. In the remote villages, infant death rates
        changed little, whereas death rates among older adults decreased sharply. We hypothesize that
        this pattern is due to a combination of differential access to medical interventions, a continued
        lack of public health infrastructure and Tsimane cultural beliefs concerning sickness and dying”

        A quarter would be randomly distributed if by accident and violence. With regard to infectious disease you are betting on perhaps that these people would have been ripe for heart disease should they have survived via modern medicine being available and thus push up the bad arteries count but everybodies CRP amongst the survivors is way high at 3.0 and lets not forget that the stress of living only to 50ish must have an effect on their hearts surely ?, but it appears not

        This diet is also echoed by Dr Macdougal who has been curing people with a similar diet for over 40 years, I have a lot of time for Dr Macdougal

        I agree with you point on feedlots and traditional food meat or otherwise

      14. Gary Ogden

        annielaurie98524: Thanks. Loma Linda, from loma linda, Spanish for “beautiful hillock or ridge.” I’ve eaten snails (in the Philippines). Not quite as challenging as chewing boot leather, but almost. But some of the crunchier insects are now being made into food products in the U.S. Mark’s Daily Apple has written about this. Rich in protein they are.

      15. annielaurie98524

        Since I’m fascinated by anthropology, I was intrigued by your reference to the Tsimane people. In doing just a little follow-up research, I found a trend that seems to plague so many of the reports on “super-healthy low-no meat” natural (or not) populations. Consistently, studies and reports on these populations by ethnologists/anthropologists — folks that are trying to observe and document these groups in an unbiased manner — don’t quite jibe with the “analyses” by diet experts, authors of diet books, health gurus pushing vegan/HCLF/”blue-zone” diets, etc. Namely, as has been the case for the Cretans, the Okinawans, and now the Tsimane, the reports of “little to no meat” are, shall we say, slightly exaggerated, as are the reports of “super health”. Ethnologists studying the Tsimane go into great detail on the hunting and fishing methods the natives use, document the types of game they hunt, note the status attached to hunting success in their culture, etc. There are even studies analyzing the impacts on the sustainability of local wildlife populations as the Tsimane adopt more modern and efficient hunting methods. Surely, they are not hunting the wily wild Amazonian carrot? As for “super health”: infant mortality among the Tsimane is 12x that in the US (and we have dismal stats among the developed nations), and 20% of their children die before reaching 15 years of age. Tsimane women give birth to an average of nine children, but their population is by no means exploding. I’ll provide just one short quick-read reference: https://www.unm.edu/~tsimane/tsimaneinfo.html

      16. Mr Chris

        When Paola said that Smartersig is a troll, I thought that surely not. Now I think she might be right.
        The question is whether you can be a troll by accident.

      17. Gary Ogden

        Mr. Chris: I’m not sure troll is the correct classification for smartersig’s more baffling posts. I’m willing to assume that he is sincere. What occurs to me is this: What is happening here among most of the commentators, just as it has for Dr. Kendrick over the decades he has pondered the nature of heart disease, is the natural evolution of thinking that occurs in an open mind when presented with new information, particularly information which contradicts what we thought was explanatory. We usually call this learning. Some things, such as basic arithmetic and basic literacy skills we must master by rote learning, but anything more complex requires a searching mind and a critical eye. We must allow our assumptions to be challenged, and if found wanting, accept it gracefully and move on. What I see with smartersig’s posts, not always, but too often is that he is so wedded to the idea that dietary choices are paramount in causing heart disease, he has not yet learned to question it, or perhaps how to question it. Or not interested in questioning it. I once thought along the same lines, but two or three years of reading everything here has completely disabused me of the notion. The elephant has many parts; none of them, by itself, descriptive of the animal. Since I was a small lad, I’ve wished to understand how to avoid heart disease, since it took my father at a very young age. I am now convinced that the stress of WWII was the most important factor, even though other factors surely played a role.