What causes heart disease part 60 – prediction

2 January 2019

It is difficult to make predictions, particularly about the future.’ Old Danish proverb

The hallmark of a great scientific hypothesis is prediction. Einstein’s theory of special relativity predicted that gravitational fields could be demonstrated to bend light – and he was proven right during observations made during a total eclipse of the sun.

Unfortunately, things are rarely as black and white as that. Even if you understand almost all of the factors at play, it can be extremely difficult to predict certain events, particularly the timing. Earthquakes, hurricanes, which flu virus will be active next year? There are so many variables interacting with each other that things get very complex. When will San Francisco suffer the next major earthquake? According to the best predictions – about twenty years ago.

Chaos theory can also play its part. A very small change in one part of a system can trigger massive downstream effects. A butterfly flaps its wings in Africa, and two weeks later a hurricane devastates Florida.

So, what of predicting your future risk of cardiovascular disease? How good are the current models? Are they of any use at all?

In the US, the calculator that is most widely used was put together by the American Heart Association and American College of Cardiology.(AHA/ACC). It is called the ‘cvriskcalculator’ It can be found on-line here http://www.cvriskcalculator.com/ It asks you to provide data on ten different parameters:

  • Age
  • Sex
  • Race
  • Total cholesterol
  • HDL (good) cholesterol
  • Systolic blood pressure
  • Diastolic blood pressure
  • Treated for blood pressure: yes or no
  • Diabetes: yes or no
  • Smoker: yes or no

After you input your data, an algorithm kicks into action to work out your cardiovascular future. If it calculates that your risk of suffering a CV event is greater than 7.5%, within the next ten years, you will be recommended to start on a statin. This, you will have to take for the rest of your life.

One word of warning, all men by age of fifty-five – even men with no other risk factors at all – will have a risk greater than 7.5%. At least they will, using ‘cvrisk’. Because age is by far the most powerful risk factor of all – at least it is on ‘cvrisk’.

In the UK, a more complex risk factor calculator has been developed. In truth, it is only more complex in that it has an additional ten risk factors to consider. It is called Qrisk3. It uses twenty different factors to calculate risk https://qrisk.org/three/:   They are, in no particular order:

  • Age
  • Sex
  • Smoking
  • Diabetes
  • Total cholesterol/HDL ratio
  • Raised blood pressure
  • Variation in two blood pressure readings
  • BMI
  • Chronic kidney disease
  • Rheumatoid arthritis
  • Systemic Lupus Erythematosus (SLE)
  • History of migraines
  • Severe mental illness
  • On atypical antipsychotic medication
  • Using steroid tablets
  • Atrial fibrillation
  • Diagnosis of erectile dysfunction
  • Angina, or heart attack in first degree relative under the age of 60
  • Ethnicity
  • Postcode

How good are they at predicting a future event? A study was carried out in the US to analyse, in retrospect, how accurate the cvriskcalculator had been. They looked at the historical risk scores of several thousand people, then tracked forward in time to see what actually happened.

In the study they looked at CVD over five years, not ten, so all figures should be doubled to establish the ten-year risk that is used in most calculators:

‘A widely recommended risk calculator for predicting a person’s chance of experiencing a cardiovascular disease event — such as heart attack, ischemic stroke or dying from coronary artery disease — has been found to substantially overestimate the actual five-year risk in adults overall and across all sociodemographic subgroups. The study by Kaiser Permanente was published today in the Journal of the American College of Cardiology.

The actual incidence of atherosclerotic cardiovascular disease events over five years was substantially lower than the predicted risk in each category of the ACC/AHA Pooled Cohort equation:

For predicted risk less than 2.5 percent, actual incidence was 0.2 percent

For predicted risk between 2.5 and 3.74 percent, actual incidence was 0.65 percent

For predicted risk between 3.75 and 4.99 percent, actual incidence was 0.9 percent

For predicted risk equal to or greater than 5 percent, actual incidence was 1.85 percent

“From a relative standpoint, the overestimation is approximately five- to six-fold,” explained Dr. Go1

What this means is that you carefully input your parameters into a risk calculator, which took many years of painstaking work to develop, using data carefully gathered by experts from the world of cardiology, and it overestimates your risk by five to six-fold. (I.e., 400 – 500% exaggeration!)

Excellent. Just for starters, this means that millions upon millions of people have been told to take a statin based on a calculation that is so wildly inaccurate as to be virtually meaningless. How so, Dr Go?

On a similar note, a group of researchers in the UK decided to look at data gathered on 378,256 patients from UK general practices. They wanted to establish which factors were most important in predicting future risk. The paper was called ‘Can machine-learning improve cardiovascular risk prediction using routine clinical data?’ 2

If the ACC/AHA and Qrisk3 calculators truly are looking at the most important variables, then we should see all the same factors appearing in this UK study. Below, just to remind you, are the ten factors used in the ACC/AHA calculator:

  • Age
  • Sex
  • Race
  • Total cholesterol
  • HDL (good) cholesterol
  • Systolic blood pressure
  • Diastolic blood pressure
  • Treated for blood pressure: yes or no
  • Diabetes: yes or no
  • Smoker: yes or no

Here is what the UK researchers found to be the top ten risk factors for CVD, in order, with number one being highest risk and number ten lowest risk:

  1. Chronic Obstructive Pulmonary Disease (usually a result of smoking)
  2. Oral corticosteroid prescribed
  3. Age
  4. Severe mental illness
  5. Ethnicity South Asian
  6. Immunosuppressant prescribed
  7. Socio-economic-status quintile 3
  8. Socio-economic status quintile 4
  9. Chronic Kidney Disease
  10. Socio-economic status quintile 2

Compare and contrast, as they say. Do these lists look remotely the same? As you can see, there are only two factors on the ACC/AHA list that were replicated by the UK researchers. One of them is age – which you can do nothing about, and the other is ethnicity – which you can do nothing about. As for the rest. Where have they gone?

What of cholesterol, and sex, and blood pressure, and smoking, and diabetes. Well, out of a total of forty-eight factors analysed, here is where they ranked in importance. In this analysis factors could either be ranked protective, or causal:

Smoking                                  = 18

Sex/female                              = 19 (protective)

Total cholesterol                    = 25

HDL cholesterol                      = 28 (protective)

Systolic blood pressure          = 29

Diabetes                                  = 31

LDL ‘bad’ cholesterol              = 46

Yes, LDL ranked 46th out of 48 factors, well, well, who’d a thunk. The only things that scored lower than LDL were FEV1 and AST/ALT ratio. Factors that, unless you are medically trained, you will never have heard of. The first one, FEV1 stands for forced expiratory volume (from your lungs), measured over one second. The other is the ratio of two liver enzymes.

At present, it is true to say that the established risk factors, and the risk calculators, are almost completely useless. Not only that, they get more useless if you try to use them across different countries. If I took Qrisk3, or ‘cvrisk’ to France, whatever risk it calculated, I would then have to divide whatever figure I got, by four.

This is because, for exactly the same set of risk factors, someone in France will have one quarter the rate of CVD as a man in the US, or UK. Which means that the ‘cvrisk’ would actually overestimate risk by twenty-fold in France. Five times too high a calculated risk in the US, multiplied by four times too high a calculated risk in France. 5 x 4 = 20.

So, what should you measure? What can help you to predict your risk of CVD? Coronary calcium score (CAC)? That is, looking at the amount of calcium in your arteries. This is probably the most accurate way to establish your burden of atherosclerosis.

However, a high(er) CAC score does not mean that you are at risk of CVD, it means you have already got CVD, it is already there. The CAC score is just telling you how far along the CVD path you have traveled. So, it is not really predictive, it is more of a historical record.

What you really want is to stop the calcium forming in your arteries in the first place. Or then again, do you? A ‘calcified’ plaque is not, necessarily, a dangerous plaque. A dangerous plaque has an almost liquid core, which is in danger of rupturing. A dangerous plaque is often called a vulnerable plaque, and they don’t show up well, if at all, on a CAC scan.

If you have lots of vulnerable plaque what should you do?

Take a statin. Statins accelerate calcification.

Take warfarin. Warfarin accelerates calcification

Both reduce the risk of dying of CVD – if only by a small amount (at least small with statins). So, you could both increase calcification and reduce your risk of a CV event – simultaneously. What then to make of your CAC score? If you find it is zero, great. If you find it is four hundred?

Logically, a high score only tells you that you have CVD, and already having CVD means you are at higher risk of dying of a CV event. Which comes as no great surprise. What you really need to be able to do is to accurately predict what your CAC score would be – before you did it. And if you could do that, you really would have a scientific hypothesis worthy of the name.

The LDL hypothesis for example. If you could find you someone with an extremely high LDL level, say four to five times average, and a CAC score of zero – at the age of seventy-two then you would remove it as a factor for prediction.

So, here you go – I have blogged about this before – from a paper called: ‘A 72-Year-Old Patient with Longstanding, Untreated Familial Hypercholesterolemia but no Coronary Artery Calcification: A Case Report.’

The subject has a longstanding history of hypercholesterolemia. He was initially diagnosed while in his first or second year as a college student after presenting with corneal arcus and LDL-C levels above 300 mg/dL [7.7mmol/l] 3

He reports that pharmacologic therapy with statins was largely ineffective at reducing his LDL-C levels, with the majority of lab results reporting results above 300 mg/dL and a single lowest value of 260 mg/dL while on combination atorvastatin and niacin. In addition to FH-directed therapy, our subject reports occasionally using baby aspirin (81 mg) and over-the-counter Vitamin D supplements and multivitamins.

In the early 1990s, our patient underwent electron beam computed tomography (EBCT) imaging for CAC following a series of elevated lipid panels. Presence of CAC (coronary artery calcification) was assessed in the left main, left anterior descending, left circumflex, and right coronary arteries and scored using the Agatston score.

His initial score was 0.0, implying a greater than 95% chance of absence of coronary artery disease. Because of this surprising finding, he subsequently undertook four additional EBCT tests from 2006 to 2014 resulting in Agatston scores of 1.6, 2.1, 0.0, and 0.0, suggesting a nearly complete absence of any coronary artery calcification. In February of 2018, he underwent multi-slice CT which revealed a complete absence of coronary artery calcification.

Prediction, prediction. The risk factor calculators cannot do it. LDL levels don’t do it. I cannot do it with perfect accuracy either. I cannot say to anyone that you will not die of CVD. I cannot say to anyone that you will die of CVD. I can only help you to change the odds.

If you are an elderly, depressed, diabetic South Asian man with Chronic Obstructive Pulmonary Disease, taking steroids, with chronic kidney disease, living in a small council house in the UK then your odds of dying of CVD in the next year are pretty damned high. What should such a person do? Write a will, I would think.

Not many of us are at such high risk. Few of us are in such a bleak situation. What can the average person do to shift those odds in your favour? If you have read this blog from start to finish, I would imagine that you already know. If not, I am going to tell you next time. I am going to tell you how to change the odds, but I am unable to tell you how to get them to zero.

1: https://www.eurekalert.org/pub_releases/2016-05/kp-crt042916.php

2: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0174944

3: https://www.cureus.com/articles/11752-a-72-year-old-patient-with-longstanding-untreated-familial-hypercholesterolemia-but-no-coronary-artery-calcification-a-case-report

400 thoughts on “What causes heart disease part 60 – prediction

  1. Chris

    Why not include details of the PLAC test as a predictor? I have a CAC score of zero but a dangerously high PLAC test result. Also inflammatory markers such as CRP could also be included surely ?

  2. Gearóid Ó Laoi

    One of your very best blogs on this, Malcolm and there were other excellent ones! Happy new Year, Hogmanay, whatever!

  3. Martin Back

    Actually, Newtonian physics already predicted that the sun’s gravity could bend light rays. Einstein predicted it would bend twice as much, and was proved right. (I think because you have to increase the sun’s mass by its energy using e=mc squared.)

    I was interested to see that one’s family history of heart disease is not included in the calculations, nor is one’s diet. Is this because they are irrelevant, or because they are difficult to quantify?

    1. Andy S

      These are current mainstream cardiologist generated risk factors, possibly 20 years or more out of date. Predict that future risk factors will include actual causes as discussed in these blogs, ie insulin resistance, seed oils, low fat etc..

  4. Agg

    Happy New Year Dr K!
    This post is a great treat, as well as your latest book I’m reading at the moment. Thank you for both.

  5. Charles Gale


    Back to health after the horrors and machinations of Wikipedia (which needed coverage – I learnt a lot). What a great start to 2019!

    Started reading through the risk factors and kept thinking and thinking “they are still not using coronary artery calcium (CAC) score” but I should have known better and that Dr Kendrick would at least mention this.

    But why don’t they the option? According to these calculators, I’ve minimal/normal risk but ended up fighting for my life. Subsequently found out I had a CAC score of 1500.

    I still think there is more needed to get CAC testing more prominent. I’m not sure if someone like Ivor Cummins (The Widowmaker film) would have any stats relating to the number of CAC scans done a year in the UK to measure any uptake?

    2 years ago my GP refused to put me forward for one,so I had to fork out £400.00 to have the scan done privately. With the hospital I went with, they still required a GP’s signature and that was another battle. Sigh!

    I.too, still can’t make my mind up about CAC. I like Dr Barry Sear’s description of the detectable calcium as being concrete over the soft, vulnerable plaques and securing/making stable the damaged areas.

    So, I find myself hesitating over vitamin K2 supplementation, part of its function being to keep calcium in the bones and teeth, not the arteries. But if there is damage there, you want the calcium there to make safe and secure, and not being prevented from getting there by vit K2.

    And it was with horror reading the label of one of my vit C supplement bottles to find it contained calcium.

    1. Jonathan Christie

      I so sympathize. As a diabetic, I’m a mandated statin Rx but with a normal HbA1c on a lowcarb diet, I didn’t buy in, insisted on an EBCT, calcium score zero, ecstatic that it finally shut my doc up! Chelation therapy tears the calcium out of the plaque, the plaque regresses. I imagine vit K2 does the same in a more physiological manner https://tinyurl.com/yauqxmrc the Rotterdam Study demonstrated the effect of vitamin K2 in a study of 4807 Dutch men and women, aged 55 and older, during a period of 8–11 years, showed that diets high in vitamin K2 (MK-4 to MK-10) dramatically reduced the risk of cardiovascular disease and mortality (arterial calcification by 50%, cardiovascular death by 50% and all-cause mortality by 25%). I know it’s a diet study, but it reassured me enough to take K2 supplements

      1. Eric

        @ Jonathan: Do you have more info or a regular link on the dutch study? Tinyurl gets blocked by my provider.

        Not sure I’d want calcium to be torn out of anything, be it plaques or bones.

        What do the Dutch cows eat? I doubt there is enough pasture to keep them fed on grass year round or even 100% grass fed in the summer.

        1. Jonathan Christie

          https://www.nutraceuticalbusinessreview.com/news/article_page/Vitamin_K2_MK7_prevention_and_treatment_of_arterial_calcification/123944 is the full link – well, chelation tears calcium out of plaque and you die less often, that’s got to be a plus, and “Clinically, vitamin K2 sustains the lumbar bone mineral density (BMD) and prevents osteoporotic fractures in patients with age-related osteoporosis, prevents vertebral fractures in patients with glucocorticoid-induced osteoporosis, increases the metacarpal BMD in the paralytic upper extremities of patients with cerebrovascular disease, and sustains the lumbar BMD in patients with liver-dysfunction-induced osteoporosis” – another plus I would think https://www.ingentaconnect.com/content/ben/cpd/2004/00000010/00000021/art00003 Dutch cattle eat silage in winter just like the Norfolk cattle where I grew up. Silage is a kind of fermented grass. Smells a bit rough!

      2. shirley3349

        Dutch cows also eat hay in winter. According to a recent, albeit literary, source I know, it is imported from the neighbouring, upland areas of Germany where it is grown as a cash crop. Apparently, German farmers find this more profitable than feeding hay to their own animals.

    2. AhNotepad

      Charles, the calcium would not be a problem if the supplement was just ascorbic acid. This is low cost, especially if bought in bulk. I do that ant then load it into capsules.

  6. Chris

    Also once someone is predicted as being high risk and that many of the factors identified are controllable – weight, BP, LDL etc – then they are likely to do something about it! That’s why the predictor seems wrong. Take TIAs for example. They’re a warning about a stroke. If you do nothing and ignore the warning then it’s an accurate predictor but if you make severe lifestyle changes etc then it’s not!

  7. Fergus Glencross

    So the guidelines are effectively useless. Another factor needs to be added ‘”Stress caused by reading the aforementioned risk factors”.

  8. Mr Chris

    Dr Kendrick
    I have been reading your blog for some time. I have thought about each edition, I have changed several life style things, like stopping taking statins.
    I reckon your blog number 60 is a real cracker, it contains punch, humour and erudition.
    If I wanted to depress myself, since I am over 79, I would fill in the figures in the risk calculators and take to drink. Instead I will try even more to apply my life philosophy, don’t worry, be happy
    Thank you
    By the way, Old Pulteney is a fine whisky.

  9. mmec7

    One of the best, certainly one of the best – and they are all splendid. Am certainly sharing, wide and far. Great piece of work Dr Kendrick. Thank you.

  10. mmec7

    Superb Dr Kendrick. All have been excellent, but this is superlative. I am sharing far and wide – thank you.

  11. Göran Sjöberg

    Thank you for another great input which discloses the “stupidity” of the official “medical science” relating to CHD/CVD. It is to me unbelievable that those involved can believe in all this nonsense about prediction and to propagate it to innocent CVD victims.

    1. JDPatten

      Ah, but it was medical research science that found 1. COPD, 2. steroids, 3. age, etc. etc. to be the actual factors. It seems you can’t throw out the baby (Medical Science) with the bathwater.
      In any case, it would be interesting to have a good analysis of the dependability of this particular research.
      Would Ioannidis approve?

  12. BobM

    For the cvriskcalculator, I calculate the age being 62 for 7.7 percent risk (where they put you on a statin after 7.5 %), if I chose male, other, 180 TC, 45 HDL, 110 systolic, 65 diastolic and no for everything else. The age of 61 is below the 7.5 % threshold (7.1 %). Reduce HDL to 37, though, and you get 8.8%. Those are about my values (not age though), although I’m on a beta blocker and ACE inhibitor due to cardiomyopathy (and I did not say I was being treated for high blood pressure, since I never had “high” blood pressure). So, at some point, everyone will be on a statin mainly due to age.

  13. Göran Sjöberg

    This reminds me!

    As having had a very serious MI 20 years ago when I refused CABG and also all heart medicines I should reasonably be at an extremely high risk of a new deadly one I guess. When I met a cardiologist a couple of years ago he strictly told me he was not the least interested what I had been doing as an alternative treatment: “It is all nonsense what you have been up to – almost a criminal activity – you have just been lucky to stay alive!”

    A great guy that one with a very strong self confidence.

      1. Göran Sjöberg

        During 15 years after the MI I was constantly doing just fine but on my retirement I was hit by unstable angina and a friend of mine suggested, although I was very reluctant, to see a cardiologist.

        He was “not interested” and although he found that everything looked fine in my heart he offered me his standard kit which he knew I wouldn’t touch so I did my own research “reading the thick books, and found that the natural vitamin E could be a remedy for the unstable angina. and it seems to have worked pretty well for five years now. Although when I get mentally stress it pops up now and then.

        I just returned from digging in my garden and I had now problem whatsoever with my angina.

  14. William Logan

    I do like your sense of humour, demonstrated in the penultimate paragraph. Reminds me of my favourite verse from Monty Pythons ‘always looks the bright side of life’.

    “Always look on the bright side of death,

    just before you draw your terminal breath.”

  15. Joe

    “If not, I am going to tell you next time. I am going to tell you how to change the odds, but I am unable to tell you how to get them to zero.”

    Hear, hear!

  16. Martin Levac

    Malcolm, the priciple of prediction inherently requires knowledge of causality. Merely knowing associations of a bunch of parallel effects cannot help us predict with any degree of accuracy. Even age is not a cause, it runs parallel to whatever causes the effect observed, because both age and the effect observed are a process-over-time. In the big picture, age would be akin to Laws of Physics, whereby none is cause (nor effect), but all causes (and effects) must obey them. Even genetics is not a cause of anything, because it’s akin to a hill where a rock rolls down it. Here, the cause is gravity, and the hill merely allows gravity to pull the rock down it. Even medical treatments are not a cause a priori, because they imply an underlying cause they are intended to treat/cure, with the caveat that medical treatments can then cause effects, especially for on-going treatments, but then if it’s an on-going treatment, there’s an on-going underlying cause, we’re back to square one.

    The result of statistical analysis of a bunch of associations is primarily expressed as float (fractions from 0 to 1), not as boolean (either 0 or 1). None of it can tell us anything in a boolean fashion, i.e. exact age, exact cause, exact effect, etc. The dataset is one of a group, not of an individual, so any prediction regarding any individual within this group is bound to be unreliable, i.e. we cannot predict which one, we can only predict how many. The only intervention (especially with statins) that can appear valid to any degree is at the group level, not at the invididual level. Finally, because float cannot predict individual outcome, the only possible outcome at the individual level is boolean – either we will die of CVD, or we will not die of CVD – and we can’t even predict that. But then death is, as far as we know, inevitable, so meh for that.

    Statinators try real hard to convince us that the choice is boolean, that the right choice is to take statins, but conveniently omit to tell us that they cannot tell us who will die of CVD, and who will not die of CVD, whether we take statins or not. They can’t tell us cuz they don’t know, and they don’t know cuz they can’t possibly know.

    In the end, we’re left with individual overall health as our only possible tangible goal, and this is quite achievable through self-experimentation – n=1. For myself, that’s the null hypothesis until proven otherwise.

    1. Martin Levac

      Malcolm, I can’t believe I didn’t see this before. It’s quite revealing.

      How do we convince somebody to buy our miracle snake oil? By pointing out everything and anything we can’t do anything about (on the face of it, at least). Check those lists again. Age, sex, race, diabetes, the list goes on. Granted, in those lists there are things we can do something about, but it’s either too hard or complicated for the average person, and in the end it’s the same sales pitch. Many things are said to be incurable/untreatable like cancer and mental disorders such as Autism and Alzheimer’s, or even Crohn’s and IBS. It’s the same scheme with those as well. All from the official stance.

      What does the list look like for people like, say, low-carbers or vegetarians or exercisers, i.e. people who do something tangible? Maybe it’s much shorter and includes only things that aren’t set in stone, like fat mass, muscle mass, brain fog, skin conditions, infections, etc. Maybe the list is personal and includes only things relevant to this person.

      In a way, I understand why those lists look like they do. In statistical analysis, static factors always _appear_ more reliable predictors but only because they don’t change much or at all, not because they _are_ more reliable predictors. On the other hand, those things we can do something about are inherently unreliable predictors – they’re all over the place over time and across a group – because we do something about them over time and across a group. To put it in the most ridiculously simple way, if you’re born male, it’s the strongest predictor of you dying male. Static factors are predictors of themselves. We could call this a fluke of statistical analysis, but it’s more likely to be a flawed understanding of statistical analysis. We could be fooled into thinking static factors are reliable predictors, (because) when in fact they are only predictors of themselves.

      So, it doesn’t matter whether they’re trying to sell us what they know (or don’t know) to be ineffective (or not), because they don’t or can’t understand the dataset they use to sell it, or that the dataset they use is patently flawed. I’ll go so far to say that even statisticians don’t understand this fluke. Effectively, this apocalyptic list of things we can’t do anything about (which will kill us in the end) naturally bubbles up from the dataset, in turn gets twisted into an effective sales pitch. Call it a convergence of natural tendencies.

  17. Margaret Yates

    Thank you for this. I have also been reading your blog for some time, particularly your posts about CVD. I am female, over 70, with a CAC score over 400 and therefore very interested in your next post. Along the way I have been addressing all the things I am aware of (no statins or any other prescribed medication) to stabilize the existing plaque and also hopefully slow the formation of new plaque.

  18. Soul

    There are more reasons to not take a statin in my family. I had mentioned earlier that my mom had developed severe problems with her hips. It was becoming painful to walk. She was often in tears. Mom also takes a statin drug. Mom is a big believer in what ever her doctor says.

    The hip problem was diagnosed by her doctor as being failed. Some scanning had been done that found bone was rubbing on bone my parents were told. Her hip needed to be replaced.

    I had been lobbing for mom to stop taking the statin drug for a short trial just to see if her hip improved. She resisted. She agreed the other day to give it a try. She stopped the statin.

    It has only been 3 days now since she stopped, but the hip I’ve been told is much better. She is moving around without to much issue. My father commented today that he is now thinking the hip problem to be a result of the statin. Fingers crossed this is the answer. Imagine we will know for sure in a week or two.

    If it is the answer, what an additional disaster statin drugs could be. I know people that have had knees and hips replaced that also take statins. An official connection will never be connected but after three days it certainly has my mind wandering.

    1. Jerome Savage

      Among other ailments I too developed hip arthritis (cartilage wear) after 6 years of statins. Mind you i put it down to my new taste for long distance running, aftet CVD incidernt plus a hip weakness resulting from a motor bike accident in 1980, not serious enuff to follow up on. But maybe, just maybe the statin had a non benign influence there too. Thought provoking – thanks for that.

    2. Frederica Huxley

      What a horrendous thought that your mother might have had to undergo major surgery to correct a possible side effect of a totally unnecessary drug.

    3. Christine Oettle Rusconi

      I am very interested in this, since it is exactly like my husband’s symptoms. He also is a firm believer in his cardiologist so he will never stop the statin. So sad. Breaks my heart.He is 73 and always in pain.

  19. Steve R

    Great post as per usual, Brad….sorry, Malcolm.
    I don’t like to be contrary, but I went on the cvrisk site, and put in my age (59) and some other parameters I knew and made up the ones I didn’t (like you do) and managed to get a risk of only 5.2%. I had to crank my age up to a massive 64 years before I was politely told to take a statin of ‘moderate to high intensity’. I still find this patently ridiculous, but not quite as patently ridiculous as 55.
    I have to say, it was these ludicrous risk-calculators that made me question the whole diet/cholesterol/CVD hypothesis. But surely I can’t be the only one, along with your good self, Malcolm. There must be hundreds (?thousands) of GPs who realise this is a load of Big Pharma generated BS. Why are they not rising up in the streets and shouting ‘We’re not going to take this anymore…. ‘?
    Sorry. I got a bit carried away there, but you know what I mean.

      1. BobM

        Actually, it might be better if they were AI doctor replacements. The second article referenced by Dr. Kendrick used AI including neural networks and had better prediction than the classical guidelines.

        Man, that second article/study is brutal for LDL. The average LDL of those who got CVD? 3.45 mmol/L. The average LDL of those who did not get CVD? 3.40 mmol/L.

        1. Dr. Malcolm Kendrick Post author

          This will be interpreted by the mainstream as absolute proof that LDL is deadly. It only needs to go up by 0.05mmol/l and it kills you. Other interpretations are, of course, possible. The reality is that facts have absolutely no impact on the cholesterol hypothesis. It is true, end of.

      2. chris c

        Yes it’s a tricky blighter that LDL isn’t it? Just look at all the factors it masquerades as. Of COURSE it must be the cholesterol, or Tom Dayspring’s head would explode.

  20. Gary Ogden

    Thanks, Dr. Kendrick. What a hoot are risk calculators. Sad to say, too many sheep will think they mean something. About as useful as the folks who periodically come out of their caves to prophesy the end of the world or the second coming.

  21. billinoz

    Malcolm I am not sure if I understood all of this post…But the parts I did were cheering.. Even more cheering to know that we have moved on from the rapids of weakapedia, back to discussion of CVD which is what we are all here for.

    1. chris c

      Something I only just discovered, Jimmy Wales is on the board of The Guardian aka Vegan Central. That could explain a lot.

  22. Gary Ogden

    By the way, excellent post today on Climate Etc. concerning the foolishness of prognostication and the current crop of climate prognosticators. Parallels with risk calculators.

  23. abdlomax

    I found the article covering the Kaiser Permanente study you reference. It was from May, 2016. http://www.onlinejacc.org/content/67/18/2118. That’s absolutely stunning.

    On the Wikipedia front, I’ve continued researching the activity of “Skeptic from Britain.” The latest results of that research are shown at http://coldfusioncommunity.net/anglo-pyramidologist/darryl-l-smith/skeptic-from-britain/#Update

    As you can see, SfB, under a new name, has taken up the same cudgel on RationalWiki. This is normal behavior for him.

    I’ve been searching for other Wikipedia socks. From past behavior, there is quite a good chance there were more. In looking around, I found the deletion discussion for Uffe Ravnskov (https://en.wikipedia.org/wiki/Wikipedia:Articles_for_deletion/Uffe_Ravnskov) and this comment by DGG, a prominent Wikipedia administrator and outgoing member of the Arbitration Committee:

    “Keep The relevant standard here is WP:PROF. The usual criterion is having an influence on the [field] from the published work, and for biomedicine this is judged by the [situation with] publisher peer-reviewed articles. People in this field publish many papers, and consequently there is a corresponding great number of citations, so [the] usual acceptance level here is 2 or more papers with over 100 [citations in search] as shown in GS or(or Scopus, or Wos). His highest citation figures are 233, 225, 139, ….all three from very respectable biomedical journals. There are 7 others with citation figures in the 60s and 90s, also all of them from very respectable journals. The WP:PROF guideline is completely independent of the GNG [General Notability Guideline], and there is no need to show secondary sources. But if we were to look for them, the discussions of his work in many of the citing papers would provide them. I also want to point out that the hypothesis behind his work is not pseudoscience, nor even alternative medicine, but a dissenting view from within the medical establishment, not unique to him, and which has very wide current discussion. The article furthermore is written in the normal manner, not as advocacy. DGG ( talk ) 19:39, 15 December 2018 (UTC)”

    These events show that the skeptical faction does not rule Wikipedia, though it does exercise substantial power, partly as an organized faction. If SfB had stayed on Wikipedia, good chance he’d have run into serious trouble, his past socks have.

    1. binra

      When necessary a proxy is used to dictate – er justify aggressive policy and because the flag waved is ‘insert label here’, ‘we’ associate the proxy with the crime while the intent to set up such a play uses plausible deniability for rogue elements, security breach or faulty algorithms.

      Control of information is simply too important (to the global risk management team) to risk NOT controlling it – while operating under masking tactics.

    2. Wikipedia user

      Abd, the person you claim Skeptic from Britain is, is the wrong person. Elsewhere, he came forward as “MCE”. I spoke to this person on Wikipedia briefly. I do not know him but he has left Wikipedia for good.

      It is not possible to “prove” who this person is beyond doubt. I Google searched his username and many different websites say it is someone different. Even some, claiming it is you. I am sure Dr. Kendrick is tired of this business, but you should stop spamming forums claiming you know who SFB is. There is no conclusive proof.

      It is not possible to identify real life individuals based on anonymous Wikipedia accounts. This is a very dangerous business, doxing. You should not accuse real life names without evidence. All of your evidence is circumstantial. There is no robust evidence who that account belongs to. It could be yourself.

      You were globally banned on Wikipedia – https://en.wikipedia.org/wiki/Special:Contributions/abd

      A google search for your name Abd Lomax says you are known “cyber harasser” and “internet troll”. Your own reputation appears to be rock-bottom.

      There are several websites on the internet that claim you own the SFB Wikipedia account. I find it suspicious you have written over 200,000 words about it on your website (?). That is not normal behavior. It is obsessional.

      1. Dr. Malcolm Kendrick Post author

        Thank you wikipedia user. I think the central problem here is that no-one knows who anyone is, for sure, and hides. Clearly, I do not. My identity is absolutely open. Perhaps Wikipedia should demand that everyone’s identities are also open and known – and can be checked in some way. You say that doxing is a dangerous business? Why? What dangers are there. That you can be attacked – on line. Well, welcome to my world. If you cannot cope with being attacked – on line – then do not attack others. Equally do not hide, and do not say anything to anyone else on-line that you would not say to their face.

        I can cope with being attacked. What I find difficult is that anonymous people feel that they can rip your reputation apart and are allowed to hide. My raionalwiki entry, for example is, libellous. Will I get a lawyer and go for damages? I am tempted. If only to do my bit to reduce this nasty, anonymous, behaviour. Nasty anonymous behaviour that Wikipedia appears to think is perfectly acceptable.

        1. Gary Ogden

          Dr. Kendrick: I don’t know about the U.K., but here in the U.S., it is exceedingly difficult to prevail in a defamation suit. This is why there are very few of them filed. Dr. Wakefield’s libel suit against Fiona Godlee and BMJ was thrown out by a Texas judge on a technicality; merit was never addressed. It is astonishing to continue to read, to this day, accusations of fraud against Dr. Wakefield in the Lancet case series, when this accusation was never made, in either GMC case, of Dr. Wakefield or Professor Walker-Smith. Only the journalist Brian Deer made these accusations, in BMJ. And today their findings, of bowel disorders in association with autism, are now widely known to those who treat these children, and treatment protocols include addressing this very issue by dietary changes. It seems his case had merit.

          1. Dr. Malcolm Kendrick Post author

            Yes, but the UK has ridiculous libel laws, which is why most people come to the UK to sue people for libel. Ironically, I have given money to people trying to change UK libel laws as they protect very unpleasant people and stifle debate – even scientific debate.

          2. Gary Ogden

            I did not know that. Litigation must be costly, though. I suspect that you have similar rules of evidence, so it would not be difficult to ferret out these anonymous little spineless worms through the process of discovery. Too damn much ugliness going on in the world today. Max Planck was correct.

          3. binra

            When the Big Guns come out in force you can be sure something true is leaking out.
            I met a surgeon whose opener in chatter was derisively referring to Wakefield – in exactly the same group think that any other MSM manipulated opinion tells people what to think and say.

            The more you see the more you can not un see.

      2. Martin Back

        “Perhaps Wikipedia should demand that everyone’s identities are also open and known – and can be checked in some way. You say that doxing is a dangerous business? Why? What dangers are there. That you can be attacked – on line. Well, welcome to my world.”

        Well said, Dr. Kendrick. Statements of interest are required for academic journals because it is known that one’s interests can override one’s integrity, unfortunately. Wikipedia is going to have to institute a similar rule if it is to remain a credible source.

        I comment under my own name and I live in Cape Town, South Africa. Everyone is welcome to visit my city. We have meat for the carnivores, veggies for the herbivores, and asylums for the vegans.

      3. abdlomax

        About “Wikipedia user”‘s post, I wrote a detailed response, for which I am entirely responsible, and I’m a known person, not anonymous at all. You have other comments here (i think on other posts) from probable impersonatiors. I rather doubt that Guy Chapman [WP account “JzG”], “Alexbrn”, or “Roxy the dog” actually commented here. They could be asked, but if I asked them, it could be considered harassment. (Any registered user with email enabled on Wikipedia can email those users, or ask them on their talk pages.)


        If at any time, you want me not to comment here, Dr. Kendrick, you may certainly ask. Your time is valuable, and these trolls will not give up. Wikipedia user’s comment had no connection to your post topic. If at any time you want advice about Wikipedia, you may ask me. You are performing a service to humanity with your work, and it is appreciated. Besides, you are a great speaker.

    3. Rationalwiki fan

      It is not possible to sue the Rationalwiki Foundation for having an article on Kendrick. Many people have tried and failed. For example a well known creationist’s lawsuit failed, he tried to sue the RW Foundation for $1million but ended up embarrassing himself.

      Every other filed lawsuit has been dropped or thrown out of court. David Gerard a skeptical Wikipedia user from the UK is one of their main trustees. https://rationalwiki.org/wiki/User:David_Gerard

      The website is hosted from America so it is under free-speech laws. It is not possible to sue a website that calls someone a crank, crackpot, quack or food-woo promoter. This is within the realm of free-speech.

      You will see their board of trustees here, and legal terms.

      Please see,


      RW are financially supported and backed by several skeptic organizations who give them donations. Their Google trafficking is very high. If Kendrick does choose to try and cause trouble for RW, it will back-fire. Every person that has ever tried has failed. There is a reason for this.

      1. Dr. Malcolm Kendrick Post author

        Libel laws are completely different in the US. However, if you are publishing in the UK, you come under UK laws and can be sued in a UK court. The question as to whether or not Rationalwiki can be dragged into a UK is of interest. In the UK all you have to prove is that you have damaged someone’s reputation by what you have published. It doesn’t even matter if it is true or not. Which is why UK libel laws are mad. However, in this case, they will be rather good for me – should I decide to do something.

        So, Rationalwiki fan, please do not tell me what a UK court can, and cannot do.

        I spent many hours discussion what I could put into my last book with UK libel lawyers, going through the issues point by point. They tell me that what is published about me on Rationalwiki is clearly libellous – in UK law. Barn door. The reason why large organisations win against most individuals is purely a case of resources. Large organisations have them, individuals do not.

        1. Gary Ogden

          Dr. Kendrick: What concerns me is this (U.K. laws may be completely different on this): the Wakefield suit was thrown out because the judge ruled BMJ does not have a “physical presence” in the U.S., despite evidence presented showing paper subscriptions as well as online ones.

      2. abdlomax

        Actually, there have been RW articles that were taken down as a RationalMedia Foundation action. Yes, there are protections under U.S. law, but the Foundation is likely to cave if actually sued. However, U.S. law does not protect the users, just a “service provider,” and the Foundation will claim that this is all they are. Calling you a “quack” may or may not be actionable. The matter is more complex than the trolls will claim.

        Most attempts to sue wikis have indeed failed, because they were unskillfully presented. The Smith brothers, however, by their actions with the WikiMedia Foundation, actually created a new possible cause of action for me, never before tested, that bypasses the service provider protection, I’ve been told by experts. I still have a question of whether or not it’s worth the effort and expense. Maybe.

        One wonders who is providing legal advice here to protect RW? This is simply more trolling.

        The Smith brothers often create accounts called X “fan”. Ridiculing the possibility of legal action against libel is again, a long-term Smith behavior. Oliver has already been sued. Darryl could be next. He’s certainly begging for it. (He’s located in England, where defamation is a criminal offense, he would not be protected by U.S. laws about service providers.)

      3. A word of advice from someone who knows about RW

        You should distance yourself from the Institute for Natural Healing (INH). They are selling a fake cancer cure for $149. Offering a fake unproven cancer cure for money is dishonest. If the FDA investigates this, there could be trouble for you.

        You are on the medical board for this institute so you are responsible. There are real people out there who are being damaged by this. I do not see any libel on your RW article. Calling out quackery is not libel. You talk about damage to your reputation but you have done this yourself by associating yourself with snake oil salesmen peddling fake cancer cures. I recommend that you immediately resign from the INH and offer a public apology. If you are a responsible GP you should do this!

          1. Dr. Malcolm Kendrick Post author

            They have special powers. I prefer the view of Wilfred Trotter: ‘The truly scientific mind is altogether unafraid of the new, and while having no mercy for ideas which have served their turn or shown their uselessness, it will not grudge to any unfamiliar conception its moment of full and friendly attention, hoping to expand rather than to minimize what small core of usefulness it may happen to contain.’

          2. Sasha

            “Full and friendly attention” is what so many of these people lack. They give themselves titles of sceptic, rational, and scientific, and then self-appoint themselves to decide who is a quack and who isn’t… And think that no one will notice that they are full of crap.

            There’s a war against you, Peter Goetzche, and other great physicians. Pseudo sceptics are mobilizing because they are starting to lose the war for hearts and minds of general public. And they will lose that war, I truly hope.

            Many commenters on Wiki thread called themselves vegans but they might be pseudo sceptics who would like others to think that they are someone else…

          3. Gary Ogden

            Sasha: This has all the earmarks of a pharma-funded troll campaign. They have begun to panic (the fake flu shots at the Golden Globes would be an example), as the public wakes up to their chicanery and perfidy. I began to notice this in 2015, when 100+ measles cases in California was turned, by the advertising arm of pharma, otherwise known as the entire media, into a national calamity. Vaccine-mandate bills were introduced in all 48 states which did not have them. Thankfully, only one succeeded, but new bills have been introduced in most of these states every year since. Pharma fully owns the U.S. Congress, but not all state legislatures. Sharyl Attkisson (Full Measure) had an excellent piece about this last Sunday. Essential watching for anyone concerned about pharma’s impact on our health.

          4. Gary Ogden

            Dr. Kendrick: I wanted to thank you for mentioning Dr. Alderman, of whom I had not heard. Listened to a 20 minute interview with him about salt. Impressive. A real scientist.

          5. Sasha

            Gary, I agree. I think all this stuff with Wiki is a bunch of pharma astroturfers and has nothing to do with vegans. I think scientists debate each other’s ideas not hide behind anonymous accounts and call real researchers names. Jesus, what a bunch of pathetic little loosers…

          6. Gary Ogden

            Sasha: I fully agree. Worms and cowards. Nothing more than a minor distraction. Yet if they libel anyone, such as Dr. Kendrick, they deserve to be drug into court.

          7. abdlomax

            The claims of pharma astroturfing are understanding, but very likely not what is really happening. I have been following the Wikipedia faction involved for more than ten years. They are “debunkers,” of the kind that took over the Committee for the Scientific Investigation of Claims of the Paranormal (CSICOP), which became the Committee for Skeptical Inquiry, substituting skepticism for science. Genuine science is skeptical, but belief in a certain world-view is not scientific and it’s knee-jerk rejection of whatever is not understood is certainly not scientific, nor is the ready descent into ad-hominem argument and other rational irrelevancies is not “rational inquiry.” Then, tossed into this crazy salad is a portion of trolls, people who use “RationalWiki” as a cover for their own psychopathologies. The Smith brothers have both announced at various times that they disagree with the “site politics” at RationalWiki, but they found it highly useful, and, in turn, the more-established pseudoskeptical faction has, on Wikipedia and RationalWiki, found these trolls to be useful for the creation of content that they, themselves, They are like attack dogs, molesting those who attack what they believe is “pseudoscience” and “quackery,” in ways that the more established editors would avoid. When those attack dogs are banned, they simply show up under new accounts, after a time.

            And those who would recognize them and request checkuser, for example, are mostly gone, banned or burned-out. Skeptic from Britain was an immediately obvious sock, an experienced user from the start. Someone from an opposing point of view — or, sometimes, simply attempting to create or restore neutrality — would have been heavily harassed and almost certainly blocked, quickly. This user was blocked and de-facto banned long ago (the best known incarnation was “Goblin Face.”)

            By Wikipedia rules, the Kendrick article was not (yet) sustainable, So it was “correct” that it was proposed for deletion. That then leads to extensive confusion, because it was irrelevant that Kendrick’s message was allegedly fringe. (It is more sensibly what is called “emerging science,” widely under consideration, and certainly, in the case of Dr. Kendrick’s work, not “pseudoscientific” or “quackery.” “Quackery” is not a scientific or objective term.)

            Kendrick’s article can come back when there is more coverage of the man himself in reliable source. Newspapers are fine for this. I’d be happen to consult on a draft, when the sources are available. (But once the article is there, the faction will dredge up anything negative they can find and stuff the article with it. Kendrick’s work is not harmed by the lack of an article.)

            This faction has been getting away with creating obvious bias in articles for a long time. The co-founder of Wikipedia, Jimbo Wales, demonstrated how successful the faction has been at influencing the encyclopedia. I’ve met Wales, and he believes in the project, but … he’s naive, half-blind, seeing only what he wants to see.


            The enemy of science (and humanity) is not this or that faction,or person, but contempt itself, fused with and maintaining ignorance.

          8. Sasha

            I hope that all this controversy exposes more people to the work of Dr Kendrick and researchers like him.

      4. Rationalwiki fan

        Abd ul-Rahman Lomax has been claiming to sue Rationalwiki for over a year, because it merely logs his internet bans. No law suit was ever filed. It is impossible.


        It is not possible to sue Rationalwiki and win. End of story. You will not win because there is no libel on the website, it is not illegal to call someone out for promoting quackery. Abd Lomax has been spreading the conspiracy theory that a group of skeptical brothers edit Rational Wiki for years. No proof has been presented, just allegations because he hates skeptics and is anti-science.

        Claiming an anonymous Wikipedia account is someone because you believe it to be someone is not evidence. You have no real life evidence that can be cited in any court, just anonymous screen names. See you in 5 years time, when you are still complain about this! No laws have been broken. Debunking quackery is not an illegal offense. Quackwatch makes a living out of it. Get in the real world people.

      5. Rationalwiki fan

        Abd ul-Rahman Lomax it is not illegal to create a RW article! But can you point out what is illegal on your RW article? https://rationalwiki.org/wiki/Abd_ul-Rahman_Lomax

        It merely logs your internet bans and your pseudoscientific views. This is why you could not sue the RW foundation, because it is a factual article, not defamation. If Kendrick wants to blog on his RW article and point out what is defamation I would be interested. There is no defamation there. The article quotes his own words.

        I have created over 600 RW articles going back over 9 years debunking pseudo-scientists. I have never been sued and neither has the RW foundation. Why would I stop now? Everybody on RW is immune and most of us anonymous. You can not prove in court of law who we are. I do not live in England btw. So could good luck suing me! I will be laughing in ten years time when I am still doing this. I get paid for it as well.

        Look up Gillian McKeith on RW for one of our best articles. She has never attempted to sue us but is from the UK. https://rationalwiki.org/wiki/Gillian_McKeith her article is 110% factual. Citing facts is not defamation! If McKeith can accept her article, why not Kendrick? =)

        1. Dr. Malcolm Kendrick Post author

          You say that I am a pseudo-scientist. What is the definition? Is it yours, or is there some society somewhere that makes these decisions. I am just interested. I have, for example, just been asked to give a talk to the Science and Technology Facilities Council in the UK, which advises the UK Govt on scientific matters. Last year I lectured on diabetes to the Scottish Lipid Society – and suchlike. Yet, you have decided, in your infinite wisdom, that I am a pseudo-scientist. The article on Rationalwiki on me makes no scientific points – at all – it is purely an attempt at character assassination. I have never managed to engage any of these Wiki warriors on any discussion, on anything. They simply attack, and hide, and will not reveal who they are. It is utterly pathetic. Perhaps you would care to stop hiding and tell me who you are. It is irritating being attacked by those who will not argue, are happy to make insulting comments – and hide. I have one called Vegan Warrior who e-mails me from time to time, but blocks any reply. Again pathetic, and the exact opposite of scientific discourse. You seem very proud of yourself – I wouldn’t be.

      6. Göran Sjöberg

        Malcolm, I fully agree with you!

        What pathetic guys who claim “science” and hide at the same time.

        A shameless way of making a living in my eyes.

      7. chris c

        Using words like “rational” and “skeptic” makes as much sense as Michael Greger calling his website “nutrition facts”. Truly rational and skeptic people question authority whenever better science comes along. These are just defenders of Conventional Wisdom who admit to being paid to do so

        “It is difficult to get a man to understand something, when his salary depends on his not understanding it.” Upton Sinclair

        SADly (pun intended) Conventional Wisdom isn’t. Now better information is emerging they want to ban it. On one level they are succeeding, look at the mainstream media now including Wikipedia. On the other hand they are failing, look at the Wisdom Of The Crowds

  24. Kati Rader

    The downside of calcium in the arteries is less in the bones, leading to osteoporosis. So what should someone with every risk factor for osteopororsis do? Or someone who already has it due to long-term warfarin use?

    1. binra

      Adequate K2 and calcium is important – as are the forms and contexts in which the body accepts and uses it. (Apparently the enzymes that would help our body do so in milk (dairy?) are pasteurized (killed). I have been looking at ‘biological transmutations’ and regardless of mainstream ignorance – I find it compelling. Cows do not eat vast quantities of calcium – but they output such in their milk as a result of high silica intake. You can duckduck your own research – but adding horsetail (organic silica) supps is cheap, simple and harmless. Or harvest your own.
      Science doesn’t boldly go where it has been told NOT to with rare and often unknown exceptions.

      1. Martin Back

        From the overview I enjoyed this comment on the proposed biological transmutation process: “For example, if … hens are indeed transmuting potassium into calcium (which is an exo-energetic reaction), the power they are radiating is so huge that it would, if in the luminous (electromagnetic) form, set everything on fire all around!”

        Okay, so he finds a way out of that difficulty by invoking neutrinos, anti-neutrinos, and cosmic rays. I didn’t understand that bit, but really, there’s no need. Animals can get all their minerals from what they eat. There’s plenty of calcium in plants, enough for cows, enough even for vegans! Body-temperature fusion is not needed.

        As for those experiments that seem to show nuclear transmutation, I’m pretty sure the tiny amounts involved are accounted for by experimental error. No need to re-write the laws of physics.

        However, if someone wants to try for a Nobel prize by proving biological nuclear transformation exists, go for it. Just don’t expect me to contribute to your Gofundme account.

      2. Martin Back

        I had a look at the feeding of cattle. Nobody seems to worry about their calcium intake, so presumably it’s always adequate. But maybe they are creating it by biological transmutation. Do the numbers check out?

        Roughly speaking, a steer will eat 2% of its body weight in dry mass a day. (Around 18 tons a year wet mass.) If it is slaughtered at 3 years old, it will have consumed 3 x 365 x 0.02 = 22 times its body weight in dry mass. A steer is approximately 20% bone, therefore it needs food containing 20/22 = 0.9% calcium to grow enough bone. The calcium content of its feed varies from 0.4% for grass to 1.5% for alfalfa. 0.9% seems a reasonable average calcium content. So, by back-of-envelope calculation, it gets adequate calcium from its food alone.

        1. binra

          The issue was a milk cow’s output of calcium relative to eating grass.
          i know many are now on GM corn in the US – but that’s another story.
          There are many other examples that are otherwise lacking explanation.

          My sense is that the ‘established narrative’ adopts or accepts ideas that extend and protect the established powers. Truth has no say in the matter. This has been long so but is becoming more obviously so in a ‘post truth’ technocracy of socially engineered inputs and outputs.
          But I hold that ‘garbage in is garbage out’

      3. Martin Back

        Lactating cows eat about 25% more food than ordinary cows.They don’t eat grass exclusively. As farmer Joel Salatin puts it, “Animals eat their pudding first.” IOW they first go for the most nutritious fodder in a pasture and only revert to grass when it’s all finished. That’s why they mob graze cows — to force them to eat all the pasture, not just the best bits, which over time would result in pastures becoming less nutritious.

        Also, it’s possible they build up calcium in their bones and mobilise some of it to add to their milk when lactating.

        It’s a pity that the late Mike Cawdery, a veterinary researcher and frequent commenter who was murdered by a madman, is no longer around to give definitive answers. I don’t know enough to go beyond mere speculation so I’ll stop now.

        1. binra

          Martin – I didn’t run the studies involved. I only read about them – and the cows were in the study – not presumably mob grazing. But the multiple examples that can be found under ‘biological transmutations’ is only worth pushing under the carpet to keep a seemingly tidy model – in my opinion.
          In any case silica for bone (and cartilage) health is well known even if explained entirely within the conventional model.
          Humans usually start off with what seems obvious and get it backwards and generate a pattern of resistance to greater understanding that protects sickness while seeming to treat it.

    2. robert

      Hi Kati.
      Based on my experience:
      I have AF (20+years). I am prescribed warfarin as a stroke preventative. Only recently (about 4 years ago) discovered that this promotes calcification of arteries. No idea of my CAC score – assumed it is higher than it should be.
      Thereafter (to move calcium away from soft tissues to bone) I take (1) vit K2 (watched effect on INR readings), (2) magnesium, (3) vit D (now at last above 50, it took 2 years). I have read somewhere that reversal takes 2 – 4 years (basis unknown). Plus for my AF (4) CoQ10 (300), (5) Omega 3 (EPA + DHA just < 2000), (5) potassium. Maybe I have expensive wee? I am also exercising (aged 74) for heart health and NO. Also, lifestyle change to LCHF + IF nearly 5 years ago (Thanks Prof Noakes). The good Prof probably saved my wife (T2DM + insulin) and I an untimely death.
      Have I noticed any benefits? Yes = (1) weight loss (BMI < 25), (2) No statins (after 20 years and severe adverse effects), no more blood pressure meds (< 130/80).
      Maybe I am doing good?

      Risk Reduction:
      I believe that from all of the above I have reduced my risk substantially. From what level by how much to what level I have no clue. Cardio Doc says it is still high (his risk calculator; probably because of my age). I perceive that doing anything further for risk reduction would be at the margin and produce little additional benefit. My AF is hardly self detectable now – previously it was a continuous merry thumping in my chest a permanent reminder. No more thumping chest, and self tests say to me no AF detected though Cardio Doc insists I am still in permanent AF. Really?

      Based on my research and experience I believe that there is a natural answer to both risk reduction and soft tissue calcium reduction (as above). Suggest you do your own research.

      1. Mr Chris

        Expensive wee? Maybe. I am roughly on the same stuff as you, plus l arginine and Citrulline. Costs me me about 400€ a year.
        Do I care? no. Am in good shape, see my doctor in the street sometimes, but very rarely professionally. As for the cost, well those iN poor health would probably be prepared to pay more than double.

      2. Göran Sjöberg

        Robert, thank you for your interesting “story”.

        To my own twenty years of cvd experience cardiologist have no clue of how to properly treat serious CVD to make it improve.

  25. robbramel

    Changing the odds is certainly an important goal; knowing current risk is the first step.

    Toward that end calcium scoring is without peer. From NewportBodyScan.com “The calcium score directly correlates with the risk of cardiac events…For asymptomatic individuals, a calcium score of 0 indicates absence of detected calcium and an extremely low likelihood (50%). The odds ratio (ratio of events in an interest group vs. events in a baseline population) of developing symptomatic cardiovascular disease is 3:1 for people with scores of 1 to 80 (where the zero score group is the baseline population), 8:1 for people with scores between 80 and 400 and nearly 25:1 for people with scores above 400. Compare those odds ratios to the odds ratios of the traditional risk factors for coronary heart disease: 1.8:1 for total cholesterol over 240 mg/dl; 1.8:1 for HDL under 35 mg/dl; 5.4:1 for diabetes; 3.6:1 for cigarette smoking; and 2.6:1 for hypertension. The calcium score alone is a more powerful predictor of future events than all other risk factors combined.” The website has many references and startling graphs.

    (It should be noted that although “soft” or “vulnerable” plaque is not detected by calcium scoring, for whatever reason the above statistics still hold. One reasonable interpretation is that soft or vulnerable plaque associate with calcified plaque and that low calcification means low soft or vulnerable plaque.)

    When everybody gets treated (with statins!) because a deeply flawed scoring system can’t discriminate between those needing treatment and those not, and when the effect of treatment on individuals is not accurately measured, it is obvious that little progress will be made determining better longterm treatments from worthless treatments.

  26. robbramel

    typing error:

    Second paragraph should read:
    Toward that end calcium scoring is without peer. From NewportBodyScan.com, “…For asymptomatic individuals, a calcium score of 0 indicates absence of detected calcium and an extremely low likelihood (50%). The odds ratio (ratio of events in an interest group vs. events in a baseline population) of developing symptomatic cardiovascular disease is 3:1 for people with scores of 1 to 80 (where the zero score group is the baseline population), 8:1 for people with scores between 80 and 400 and nearly 25:1 for people with scores above 400. Compare those odds ratios to the odds ratios of the traditional risk factors for coronary heart disease: 1.8:1 for total cholesterol over 240 mg/dl; 1.8:1 for HDL under 35 mg/dl; 5.4:1 for diabetes; 3.6:1 for cigarette smoking; and 2.6:1 for hypertension. The calcium score alone is a more powerful predictor of future events than all other risk factors combined.” The website has many references and startling graphs.

      1. Andy S

        Hi Chris, did a quick google about PLAC. It will show the presence of oxidizes LDL. Therefore PLAC comes before there is CAC. Soft plaque is result of macrophages+oxLDL=foam cells.. CAC is last step. PLAC should correlate quite well with TG:HDL ratio (an indication of sdLDL).

        A high PLAC score would indicate a high carb high PUFA diet. A zero carb breakfast of 3 eggs and roast lamb with butter awaits me. Second and final meal of day will be protein and fat again.

        1. Chris

          Wow.i did not know any of that. Therefore if you have a PLAC test AND CAC, the CAC May not be worth much especially as repeat CAC is not easily done. Best to have repeat PLAC. I read only statins and it niacin could reduce it plus low omega 6. High omega 3 of course. Any links expanding on your answer please – clearly it is even more important than I thought. From your answer I assume LCHF is the way forward?

          Many thanks


          1. Andy S

            Hi Chris, here is the reference:

            The PLAC® test measures the activity of the Lp-PLA2 enzyme associated with LDL particles when they are oxidized. David G. Harrison, MD, FACC, FAHA of Emory University School of Medicine in Atlanta, GA, notes, “if one has an elevated PLAC® test, it indicates that the person has [inflamed] atherosclerotic plaques in which LDL oxidation is occurring.”

          2. Chris

            Thank you.
            The article says yearly testing – it’s a blood test, why not three monthly? It also makes a strong case for high statin dose PLUS niacin etc. Dr Kendrick- any comment?

          3. Andy S

            Chris, cardiologists instinct is to recommend statins for anything to do with lipoproteins.
            What would you do differently if your PLAC or CAC is high?

          4. Chris

            Thank you.
            The article says yearly testing – it’s a blood test, why not three monthly? It also makes a strong case for high statin dose PLUS niacin etc. Dr Kendrick- any comment? Thanks again

      2. chris

        To Ivor: numerous references are given in Andy’s link. To Andy: you ask what would I do differently. Well the PLAC test can give you regular monitoring as to whether your actions are working. CAC cannot. Let’s say despite niacin, Omega 3, exercise, LCHF etc etc etc PLAC is still high then a statin would be strongly suggested, whatever the distrust or fear. Statins reduce cholesterol (no doubt on that) but that may be meaningless. Statins reduce PLAC (no doubt) and that may well (from the article) be very meaningful. (Statins also increase CAC but that apparently is ‘protective’) So for PLAC what would I do differently? a) three monthly testing to check whether b) low Omega 6, high Omega 3, low carb, healthy fats, exercise etc etc is working and is enough and if not then c) low dose statin (for anti inflammatory) and if still not then (sigh) d) statin plus niacin etc. For the CAC it is different as you cannot have regular testing BUT if my score was high then the various lifestyle things anyway – exercise, movement, etc – plus low carb. I suppose another action, though it might sound flippant and fatalistic, would be if both very high, to only plan short term.
        There is a problem with a) measurement and b) ‘high’. The UK method of measuring the PLAC test is different to that in USA, not the units (which also are different) but the actual way it is measured. Secondly, my PLAC was 208 mg/dl which is just above borderline on the website you linked to but on the lab report received (True Health) is ‘HIGH’.
        Big difference.
        I sometimes think ‘sod all these tests, just make sure you live your life as healthily as possible and be as kind as possible etc’ which may well be the best way.
        A sticking point is ‘healthily as possible’. One study says an hour a day of exercise increases heart disease risk. A youtube video (Nutritionfacts) says ‘this is the ONLY diet proven to reduce heart disease and is the healthiest diet’ – something the BHF cautions about…
        Down the rabbit hole we go…

      3. chris


        “Lp-PLA2 activity and mass each show continuous associations with risk of coronary heart disease, similar in magnitude to that with non-HDL cholesterol or systolic blood pressure in this population. Associations of Lp-PLA2 mass and activity are not exclusive to vascular outcomes, and the vascular associations depend at least partly on lipids.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2864403/

  27. Danny Evatt

    My CAC score is 1032 at 60 years of age (third and last test). Calcium level has grown every year around 10-15%.

    I’m in good shape, no smoking, no high BP, low/nonexistent CRP, exercise, no Rx, NO Statin, cholesterol 280. Started taking Vitamin K2 MK-7 & vitamin C (1000mg) 2 years ago – tho seems to have had little effect as the CAC continues to grow (sigh).

    There is no reason I should have a growing CAC score…

    My frustration is that as far as I can tell, there is no real ongoing research on the “true” causes of arterial calcification, other than to blame it on excessive cholesterol.

    However, I have another theory. Perhaps arterial calcification is caused by something else? Maybe genetic, or too much excess calcium, or maybe something is off with the parathyroid glands? Maybe it has absolutely nothing to do with the cardiovascular world, but is caused by something else entirely – maybe a virus. Much like ulcers being caused by H. pylori – who would have thought such several years ago?

    Unfortunately, we will never know, as the science on arterial calcification is “settled”.

    1. JDPatten

      My CAC of a few years ago was 1,640.
      I’m doing just fine at 74, thank you.
      Look for other causes in your history. Nothing is as simple as the foolproof image presented for CAC.
      Several years before that high score I had two bouts of epidemic typhus (Rickettsia provazekii), notorious for destroying endothelial cells. A coincidence, I think not.

      1. Grant

        I’m 68 and have just received a score of 1700. 2 1/2 yrs ago my heart was tested in every conceivable way in a hospital, including a cath. I was told I have a 40% narrowing in one artery and that was all. No balloon or stent. It was recommended that I continue on a statin (I no longer take it) and all the rest of the standard advice. NO ONE ever told me of any large amount of calcification. I have had 4 CTs of my chest prior to this CAC (my only actual CAC test) in the last 5 yrs as followup to cancer surgery, and NO ONE ever said,” hey, BTW, you have massive calcification in your heart.” How on earth does this happen in 2 1/2 yrs? I’m due for a stress test tomorrow and I’m counting every heart beat and am under great stress about the future. What does anyone make of this?

  28. billinoz

    I have just read the weather forecasts for the UK, Europe and Russia for extremely cold and windy arctic weather.. I hope all there can stay warm and well and wish you well as what i suspect is an episode of global cooling happens

    1. AhNotepad

      Yep, we are shivering with 9ºC forecast for the next few days and a perishing 4ºC by the end of the week. I’d better get my coat ready if I go out 😉

      1. chris c

        Yes the worst of it went much further east and south. Here it’s been so mild that a lot of the usual winter birds from Europe and Scandinavia never bothered to turn up. Another predictiion that didn’t go quite right.

  29. Ruth

    Loved your post thank you very much. I reside in Australia.
    On the 19/09/18 I had a routine fasting blood test as not been done for over a year. All fine except TOTAL Cholesterol was 9.8, Triglycerides 0.4, HDL 2.59, LDL 6.09 and Total GDL 3.8. My GP was away and this other GP wanted to prescribe statins. I stated strongly I needed time to think about that.
    Fasting again on the 30/11/18 Cholesterol was 6.8, Triglycerides 0.4, HDL 2.55, LDL 3.15 and TOTAL HDL 2.7. After discussion with my regular GP I requested a calcium score scan.
    GP surprised by the results as apart from family history no risk facts in her opinion. Weight ok, BP fine, diet has been LCHF for past 4 years.
    Coronary artery Area [Sq. mm]
    LAD 385.03
    LCX 36.19
    RCA 115.54
    Total Coronaries 536.76
    Results are stating I am considered in the 94% percentile in comparison to the group of patients asymptomatic for coronary artery disease with the same age and gender.
    I have been aware that Statins are a big no no and have read your book The Great Cholesterol Con and yes I did laugh from time to time.
    The recommendations in the scan report CAC > 400 High risk, >20%. Treat with statins and Aspirin. The Cardiac Society of Australia but I have not intentions of taking them. Wait in anticipation for you next blog. Thanks again for taking the time to share your wisdom love your sense of humour.

    1. James DownUnder

      MY CAC of 870 is worse than YOUR CAC,
      – Nyah! – so THERE !!!

      I had mine done up in Bali while having EECP treatment, as neither my (then) GP OR cardiologist supported / suggested having one done. Turns out it would have co$t me the same here in West Oz.

  30. Georges E. Melki

    Hi Dr. Kendrick!
    It’s not very often that I can correct you, but you gave me the opportunity here: the bending of light was a prediction of Einstein’s theory of General Relativity. The special theory had nothing to do with it!
    NB- I stopped taking statins after I read your book(no heart condition, no FH, 71 yo, strong as a bull!)

  31. Alec

    Many thanks Malcolm. Fascinating stuff.
    Thoroughly enjoyed your latest book.
    As a Mensa member, one aspect that doesn’t seem to have attracted enough attention is the effect of statins on IQ.
    Wasn’t there the case of the chess grand master who fell well down the ratings while taking statins, only to recover after stopping them?
    Of course I don’t believe in conspiracy theories- but I wonder why big pharma – and governments – might want to lower the IQs, levels of activity and lifespans of older (and, if statin-free, presumably wiser) citizens?
    Hint: these are the people referred to as “gammons” by remoaners…

      1. Alec

        Good point. However, soma was hallucinogenic – an early version of LSD? – so easy to “sell”.
        What I’d love to know (but of course never will) is if the present “Alpha” elite take statins, or is it only the “sheeple”.
        E.g. do the CEOs of Pfizer, Merck & co. put their mouths where their money is?
        Do the “medical opinion leaders” take their own medicine?
        What about politicians?

        1. Dr. Malcolm Kendrick Post author

          Many of the medical opinion leaders e.g. Rory Collins, say that they do. What about politicians. I think Donald Trump does take a statin, as did Mitt Romney. Judging them on their behaviour, I believe it may be true. Bit of a scary thought that the man with the nuclear button takes a drug that can cause transient global amnesia.

      2. Frederica Huxley

        There is also the theory that fluoride in the water lowers IQ, with predictable outcome on the masses.

      3. Jerome Savage

        Frederica Huxley – aren’t we constantly reminded that the level of Fluoride in water is so impossibly low that it cant possibly have any effect ?

        1. Frederica Huxley

          If the fluoride had no effect on people, it wouldn’t be effective for teeth! The fluoride used, often a toxic waste product from aluminium smelting, is ubiquitous in water and oral products in many communities, so one cannot help but ingest it constantly. I find it ironic that children are not allowed to swallow toothpaste or mouthwash, but they are daily exposed to fluoridated water, often from birth.

      4. LA_Bob

        Reminds me of something from Good Calories, Bad Calories. President Eisenhower grew more and irritable as he tried to diet his way to lower weight and lower cholesterol. Imagine how constant hunger might impact a president’s evaluation of an international crisis.

        I’ve also read that Krushchev’s Russian doctors faced the same problem with their boss while trying to get him to lose weight.

        Along those lines, for American Civil War buffs, I’ve seen speculation that one of the reasons the Confederates lost the Battle of Gettysburg was that General Lee spent a lot of time in the out-house. He and his army spent the march to Pennsylvania partaking freely of ripe berries and other fruit, and many ended up with, well, a serious distraction from the lethal task at hand. Lee apparently became uncharacteristically cross with one of his lieutenants who recommended a different course of action than the one Lee had (incorrectly) chosen.

  32. Tom

    I actually did build machine learning models based on a subset of the original Framingham study. It was slightly better than the original Fram score. The problem was not the type of model in this case, but poor data (garbage in – garbage out). There was a very limited number of variables in the original study(at least in a subset I was able not lay my hands on), but the order of importance in the ML model (if I recall correctly): Age, BMI, sex, smoking, LDL-C. I would love to run machine learnings algos on newer and better data but unfortunately it’s not available to non-academics.

  33. Chris

    If you go to your GP and s/he says: “You are doing these ten things. Unless you change, they will give you heart disease” it is probable that you will change. So, you change and don’t get heart disease. That does not make the GP’s predictions wrong. Likewise with the online calculators. High BP, LDL etc put you at higher risk. Change them and the risk is less. That does not make the predictor wrong.(Although the omission of a whole host of factors I assume is explained by the inclusion of blood pressure eg stress, lifestyle etc)

    1. Jonathan Christie

      What are you saying here? Dr K is saying the risk is over-estimated 5-6 fold, I don’t think he anywhere suggests that risk factors don’t correlate with elevated risk

      1. Chris

        It seems logical that if you a) are told you are at high risk and b) told that many of the CAUSES of that risk are controllable then c) you will try and control them (perhaps through medication) and therefore d) when analysis is done later you, Person B, at high risk did not have a heart attack (because you took action) and therefore the high risk person not having a heart attack proves the prediction to be false/over estimated.
        Let me give another example.
        20 people with high cholesterol and a host of other factors – seen as high risk.
        Ten years later all 20 still alive and healthy
        Two conclusions:
        a. risk overstated in the beginning
        b. those 20 took steps to reduce the risk

        1. Jonathan Christie

          Well it rather depends on the quality of the health advise you receive doesn’t it. I mean avoiding smoking is a no-brainer, but when I got Type I my doc explained that the HCLF fat diet was the only way for a diabetic to avoid heart disease …

  34. Ralph

    Thanks for an excellent blog. I’ve found reading both The Cholesterol Con and Doctoring Data very informative and useful and declined statins based on what I learned.
    I came across NTNU’s Cardiac Exercise Research Group’s risk calculator – it’s based on their work on the HUNT study, following 37,000 Norwegians for 24 years. https://www.ntnu.edu/cerg/vo2max#Risk
    I’d be interested in your observations – my numbers give me a ‘fitness age’ of 42 from CERG against qrisk’s 65!

    1. Gary Ogden

      Ralph: I got a fitness age of 30. I used age 70, because I will reach that milestone soon. What this means is anyone’s guess, but I do actually feel very fit, and have no difficulty hiking on steep ground and at altitude solely with nose breathing, since I’ve been practicing deep breathing.

      1. PeteM

        Ralph/Gary – I’m 68, just, and my fitness age calculates as 35, with a VO2 max of 50. My Garmin device says my running VO2 is 49 and my cycling VO2 is 53 so I am impressed by this assessment based on a handful of questions – thanks for the link!

  35. Chris Woollacott

    Excellent article, Dr K. A point of pedantry (sorry but I’m a physicist):- it was Einstein’s General Theory, not his Special Theory, of Relativity which predicted that gravity would bend light. The General Theory came about 11 years after his Special Theory and was his towering masterpiece.

    1. Dr. Malcolm Kendrick Post author

      You are the second person to point out this error. I can only apologise. I was going to check it out before posting, but I forgot. It is funny how you can remember something clearly… and still be wrong. I herewith humbly apologise to all physicists.

  36. dearieme

    Over the Christmas period I looked at a bottle of “Old Vine Carignan” and the penny dropped. Surely wine made from the grapes of old vines would help me live a long time?

    Then I thought “Hang on, that’s about as scientific as most of cardiology!”

    So I binned the idea. But not the wine.

  37. Paul Goode

    Thanks again Malcolm for your latest thoughts on CVD, the ‘stated’ risks and the risks that have foundation based on facts! I know you have mentioned HRV (Heart rate Variability) in previous blogs and wondered if you have any plans to explore this in greater detail and whether it should become a mainstream test such as BP and if it is likely to be another credible risk factor?

      1. BobM

        Interesting. Will you be doing a blog post on HRV? I asked for an HRV sensor for Christmas, but alas Santa brought me other gifts. As of now, I’m not sure what to do with HRV, though it does tell you things like stress, sleep deprivation, etc. Many of those I can determine on my own, though.

  38. Murray Braithwaite

    Dr. Kendrick. I enjoy and find great value in your work. So I want to point out to you a minor error that does not affect your analysis, just its presentation.

    It was Einstein’s theory of general relativity that predicted bending of light waves and was considered to be confirmed by observations from the 1919 eclipse.

    Keep up the good fight.

    Murray Braithwaite, Toronto

  39. Charles Gale

    Hi Chris – PLAC test

    I know I can google for further info, but could you let us have a few further details about it? Never heard of it.

    For example, what is it? Did you have it done privately (i.e. paid for by yourself) or through your doctor (I’m in the UK – can you get it here?)?

    You have a CAC of zero but high PLAC – how do you evaluate your risk? Surely a CAC of zero is the ultimate comfort? But there are the unstable, vulnerable plaques not yet calcified ready to burst – would the PLAC test hint at this?

    You mention crp as a marker – I quite agree. Better still, the hs – crp (high sensitivity) bespoke to CVD.

    And I would also suggest for inclusion fibrin/fibrinogen serum testing to detect the development of plaques.


    1. chris

      The PLAC Test measures Lp-PLA2 activity quantitatively. This assists with the prediction of risk caused by the thickening, or hardening, of the arteries caused by the build-up of plaque. There is an article posted in this thread – linked to Life Extension – which goes into PLAC in great depth.

      It seems to me that it has many advantages over CAC:

      1. Cheaper
      2. Easier to get done – I am in Oxford and a hospital here will do it. Also Bluecrest does it
      3. Can be done on a regular basis eg 3 mths so you can check progress
      4. According to the article linked this test picks up danger NOT included in CAC test ie plaques yet to grow
      5. Also anecdotally, some in this thread seem to have high CAC but are not worried
      6. Can be done in conjunction with NMR/VAP test as it is all blood
      7. Statins reduce PLAC risk but INCREASE CAC score and so distort progress

      My CAC score says I am very very low risk. My PLAC score says I am high risk – remember PLAC is pre-CAC iso presumably if I had not had a PLAC test in years to come my CAC would be high
      The main thing is that the PLAC test allows me to see progress regularly, CAC does not

      I engaged in lengthy correspondence with the laboratory who took my first PLAC – exchanged studies/papers etc etc . There is a strong case for statins here BUT I much prefer Omega 3 etc and so am using this and testing, retesting. The numbers are coming down

      One warning though: what is ‘high’ does seem to vary from site to site. My ‘high’ (Bluecrest) is ‘borderline on another website

      Second warning: the UK method of measuring is different to the USA (UK says theirs is better!) so if you test via USA labs eg True Health then the figures are mot necessarily comparable if you subsequently test in UK

      I hope that helps

  40. Charles Gale

    I found a this on the Weston A Price Foundation website from 2001, which possibly anticipates Dr Kendrick’s next instalment and covers risk factors featured in this instalment:


    A few highlights…

    For example, there are dozens of risk factors for heart disease such as:
    – high cholesterol
    – smoking
    – lack of exercise
    – stress
    – overweight

    There’s a checklist on how to fortify the body against stress:
    – high nutrient food
    – vits A and D to protect the heart
    – vit C
    – Kilmer McCully – need folic acid and vits B6 and B12
    – CoQ10
    – magnesium (the lack of which can lead to clots and calcium in the arteries).

    There is plenty more to read and it ties in nicely with this instalment.

    It concludes with 10 Commandments for avoiding CHD/CVD and the side bars include:
    -“Cholesterol – your body’s best friend”
    -“All about angiopathy”
    -“Other theories proposed to explain the CHD epidemic” – it lists the proponent’s name and their theory e.g. Pauling – vit C deficiency.

    Well worth reading.

  41. TheFatEmperor

    Hey Malcolm happy new year !

    Love the post generally, but perforce I must clarify on the CAC snippit you included:

    – the CAC is the best predictor *bar none* – because it most faithfully reflects the current plaque burden and hence the extent of disease – and hence of course the risk of having much soft plaque beneath the surface (visible on the CAC scan via the calcified plaque)
    – and hence the likelihood of a serious event – basic physics here
    – the “soft plaque is the problem” riff is inherently misleading unfortunately. Yes, the softer lipid-filled plaque is the most vulnerable – but that is almost by definition quantified by the amount of calcified plaque visible on the CAC scan. So in real “risk” terms, the “soft plaque is the problem” talk is besides the point….
    – the CAC score reflects the *active/historical disease extent* – and the rampant result of the disease process itself – and this disease process will generally keep progressing with vigor unless you take specific action (sadly rare)
    – thus the CAC score predicts future events with exceptional accuracy (relative to the weak and ambiguous “risk factors” currently used – you’re bang on point there)
    – this is a fundamental truth that people need to understand !
    – the CAC scan does not necessarily measure the exact plaque that is likely to rupture – but this scarcely matters – because the CAC scan measures an *excellent* indicator of the *quantity* and hence *risk* of any dangerous soft plaque present.
    – this is a really important point – so sorry but I need to hammer it home !!!

    This clip from the world’s premier cardiology and imaging expert explains in a single minute right here:

    And this clip here really reveals the reality:

    Remember that a zero CAC score indicates ~1.4% chance of an event in the next 10 years, while a very high CAC score >1000 indicates more than 35% chance.Now that’s prediction power 😉

    Happy new year again !


      1. BobM

        Let’s have a recorded discussion between you two! That would be awesome. Two of my favorites, who I think are on the “right” side (if there is such a thing) of the cholesterol debate, in one room.

      2. TheFatEmperor

        Thanks Malcolm ! I have a new podcast to release in 2019 – you need to be on it 🙂 I have 7 episodes on disk, but need ~12 before I begin releasing.

        Only question is whether I pop over there to do a goody, or you happen to be in Oirland in the next while and can do one in my studio – or worst case we do the whole Zoom thing online (I can send you a recorder if you don’t already have a good ‘un 😉



      3. Eric

        From the outside, this exchange appears a bit off. Malcolm posts an interesting riff, that it is soft plaques that matter. Ivor posts a few talking points and all of a sudden, Malcolm agrees mostly.

        I did watch the second video (much as I appreciate your work, Igor, I hate videos, way too time consuming compared even with reading a transscript), and it does make very valid points.

        Saying that CAC score rules is misleading. As the Ivor states in the video, it is CAC progression. This is consistent with Malcolms point in that only fresh calcifications can have soft plaque underneath.

        The thing I didn’t agree with is the statement that CAC has a very low radiation dose, same as a mammogram. A CAC is in the order of 1 – 10 mSv, a mammogram about an order of magnitude less, so one CAC is on the order of the yearly natural exposure. Also, for the heart, radiation may introduce additonal endothelial damage, wheras with breast tissue, you are mainly concerned about c ancer.

        The video seems to say CAC is mainly an indicator of IR, so why not test that instead?

        There was one graph in the video that surprised me. Statins are effective in people with a CAC score of > 400, showing about 40% risk reduction. That seems improbably high, even if CAC is used to preselect the population.

      4. Eric

        Actually, if the point of CAC is to detect IR and (pre-)diabetis and detoriated blood vessels, the best plan might be to enlist opthalmologists. They are said to be able to tell CVD from the state of the blood vessels in the retina.

    1. Fiona Stephens

      How lovely that all I really need to do is to reduce my systolic BP to 70. That alone proves the idiocy of the prediction. Bye bye kidneys.

    2. Phil

      How is it explained that an individual can have a CAC Score of 1000 and need a bypass and another individual with the same score can have no blockages. There are those with CAC Scores in excess of >2500 that have no symptoms or blockages.

      1. Danny Evatt

        As someone who is very healthy with a CAC score over 1000 (with no blockages), it’s my thought (very radical I know) that it’s possible that calcium deposits in arteries may have nothing to do with plaque, cholesterol or any other type of CVD (with apologies to the good doctor).

        Excessive arterial calcium deposits could be caused by some other metabolic, viral or unknown cause. We know from history that arterial calcification has existed since Egyptian times (mummies). But instead of classifying this malady as a seperate one, such as gout, it was combined and attached to CVD – probably because the malady was found in blood vessels.

        The current explanation (causality) for arterial calcification is that this arterial calcification “action” is the result of the body “healing” plaque deposits (or clots) by covering them up with calcium – much like a scab does on skin. Therefore, if one has arterial calcification, one “must” have CVD. The higher the CAC score, the nearer to CVD death one is. Or so they tell us.

        But this is not an adequate (or correct in my opinion) answer. Why? Because this bodily reaction for an arterial calcification “scab” to form as the result of plaque (or loose blood clots) doesn’t happen in all humans.

        Scrape your elbow and a scab will appear on all human skin. But have arterial plaque or a blood clot and will a calcification scab appear? Not necessarily. Many people who have a CVD event have a low or nonexistent CAC score.

        And as the good doctor has pointed out, age increases everyone’s probability of having a CVD event. Increased age also increases the probability of one having, what should be called – the arterial calcification malady. But having one doesn’t necessarily equate to having the other.

        1. Andy S

          Hi Danny,
          You piqued my interest in calcification. A quick google revealed that there could be several causes. You are not a black swan.

          “Although some of the identified causative mechanisms are not easy to target for treatment, it has become clear that a disturbed serum phosphate/pyrophosphate ratio is a major force triggering arterial and cardiac valve calcification. Further studies will focus on targeting the phosphate/pyrophosphate ratio to effectively prevent and treat these calcific disease phenotypes.”

          1. Jonathan Christie

            Isn’t it more likely that you have robust collateral circulation and therefore suffer no symptoms than that calcium has little to do with atherosclerosis?

        2. Jonathan Christie

          I really doubt that since plaque and calcium co-locate – grind up the plaque and 25% of it is calcium salts

    3. Chris

      You say: “the CAC is the best predictor *bar none*”
      OK some questions:
      1. A zero calcium score indicates very low risk. Owing to costs and radiation etc you are unlikely to have another CAC for two years minimum. During those two years plaque builds up, but you are unaware of this. If you had instead had a PLAC test then you would have been aware. Yes/No?
      2. Your calcium score is 200. You’re at risk. You take remedial action but are unable to quickly check and have a re-test as stated in (1). if instead you had had a PLAC test your risk would have been identified and too, you could have had a repeat blood test every three months. Yes/No?
      3. Does the CAC identify very very small amounts of plaque still forming? Yes/No (Does PLAC test do this? Yes.)
      These questions are based on the information given in the article someone posted later in the thread when I asked about the PLAC test.
      I look forward to your answers.

    4. Grant

      I’m 68 and have just received a score of 1700. 2 1/2 yrs ago my heart was tested in every conceivable way in a hospital, including a cath. I was told I have a 40% narrowing in one artery and that was all. No balloon or stent. It was recommended that I continue on a statin (I no longer take it) and all the rest of the standard advice. NO ONE ever told me of any large amount of calcification. I have had 4 CTs of my chest prior to this CAC (my only actual CAC test) in the last 5 yrs as followup to cancer surgery, and NO ONE ever said,” hey, BTW, you have massive calcification in your heart.” How on earth does this happen in 2 1/2 yrs? I’m due for a stress test tomorrow and I’m counting every heart beat and am under great stress about the future. What does anyone make of this scenario? I was expecting a high number, like 200 or something, but when I got 1700, I was stunned.

      1. JDPatten

        Welcome to the club.
        I think that the predictive factor of CAC is way overblown. At best, it can give you a limited glimpse of your vascular history. It can’t tell you “why”. It can’t tell you about your future unless you perpetually track it and be able to extrapolate the results. More radiation.

        Have you had any infections in years past that might have effected your endothelium? There’s quite a list. (See my story above.)
        There’s more than just CVD that can do you damage and cause calcification.

        Fear of that big heart attack leads us to all sorts of over testing.
        What do you do with that high score now that you know it?
        More statin = more calcification. More vitamin K2 might equal less calcification. Celation, if you could get it done, = less calcification.
        What’s better – more calcification for more stabilization? Less burden of calcification?
        I submit that no one can tell you for certain. Yet.
        The stress test might tell you something. It might not. It’s gotten low marks lately.
        “If it ain’t broke, don’t fix it.”

      2. Danny Evatt

        Grant – First, I wouldn’t make too much ado about it. My score is over 1000 and my life hasn’t changed a bit. You might get some comfort by asking to see the pictures from the scan. By doing so, you will see that your comment, “…massive calcification in your heart”, isn’t a correct statement.

        The pictures will reveal some small white “scabs” or streaks on the sides of some very large blood vessels. They are very stable and will (in all likelihood) not break-off. Some studies even suggest that since they are slow to form, the blood vessels may even expand a bit to accommodate for them.

        Lastly, your question of, “How on earth does this happen in 2 1/2 yrs?” is good one that medical science cannot answer. Medical science has determined that arterial calcification is caused by CVD or plaque buildup and Statins are the answer for everything.

        I believe calcification is a seperate malady that should not be directly tied to CVD. However, to my knowledge, there will be no more, nor will there ever be, any more studies on the true cause of arterial calcification or CVD. The drug companies now control most research monies and they have a drug (Statins) to sell.

        So, depending on your stress test, which I’m sure will turn out very well (further proving my point of calcification being a seperate malady), I just wouldn’t worry about it.

      3. JDPatten

        Dangers to your endothelium – and possible subsequent calcification – that go beyond COPD, prescription steroids, age, etc:
        From https://www.nature.com/articles/nrmicro2269

        Table 1 | Examples of pathogenic bacteria that target endothelial cells*
        Bacillus anthracis
        Bartonellae spp.
        Borrelia recurrentis
        Borrelia burgdorferi
        Brucella spp.
        Chlamydia pneumoniae
        Coxiella burnetii
        Ehrlichia spp.
        Francisella tularensis
        Haemophilus influenzae
        Neisseria meningitidis
        Rickettsia conorii and Rickettsia rickettsii
        Rickettsia prowazekii
        Rickettsia typhi
        Staphylococcus aureus
        Streptococcus pyogenes (group A streptococci)

        Cat scratch disease and baciliary angiomatosis
        Relapsing fever
        Lyme’s disease
        Q fever
        Human granulocytic ehrlichiosis
        Meningococcemia and cerebrospinal meningitis
        Mediterranean spotted fever and Rocky Mountain spotted fever
        Epidemic typhus
        Murine typhus
        Rheumatic fever

  42. Andy S

    Has anyone noticed that most of the mainstream risk factors are not involved in causing CVD? Predictions based on them is therefore meaningless.

    Risk factors that I keep an eye on:
    – carb consumption
    – sugar/fructose
    – seed oils
    – inactivity
    – stress

    Getting older happens but does not cause CVD.

      1. Andy S

        Gary, we die one cell at a time. Old cells get replaced by new cells via apoptosis. Need adequate nutrients to build new cells. A bit of autophagy via fasting can rejuvenate an old cell. Eventually cells stop replicating: end of story.

  43. Jonathan Bacon-Sandwich

    If you want my opinion, and that’s all it is, one of the central problems of modern medicine is trying to make individual risk assessments on the basis of population or cohort data.
    Or rather the problem is that pts want to know how long they’ve got etc., and few Drs will actually say they don’t know because getting the average person to understand probability is tricky when expectations are high and understanding is limited.
    It’s all nine-out-ten-cats stuff and you can’t tell which is the one cat, or rather you can’t tell the cat which one it is until it’s a dead cat.

    1. Fiona Stephens

      Exactly. I’ve been using the NHS Predict tool to help me make some decisions with my oncologist – and, as is so often said, when it’s you it is a statistic of 1 person. It’s all chance and can provide false hope and also false fear.

    2. David Bailey

      Well when you think of the process – something vaguely akin to a scab has to flake off the inside of an artery and lodge itself somewhere unfortunate, before another process mops it up – that sounds inherently statistical!

      My gripe is not with statistics as such, but with the fact that we are offered treatments that offer the smallest of gains. A gain can be statistically significant in a large study, and yet not worth an individual pursuing – particularly when there are nasty side effects potentially lurking.

      I like the Number Needed to Treat (NNT) statistic. If you look up the NNT for statins in assorted circumstances, the answer is revealing!

      1. Jonathan Bacon-Sandwich

        That NNT was interesting. As someone who likes a gamble I wouldn’t be putting any money on anything at those odds:)

        1. Dr. Malcolm Kendrick Post author

          I am not keen on NNT for ‘preventive’ medications. It gives the impression that something has been treated? This is not the same as giving antibiotics for a chest infection where the antibiotics will actually cure something. The NNT actually overestimates benefit, assuming that – at the end of the trial – something has been cured/prevented/treated. The reality is that an event has only been delayed, not ‘treated’. Death cannot be prevented – only delayed. I like to call preventive medicine ‘delayative’ medicine.

          1. Gary Ogden

            Dr. Kendrick: Thanks. I’m on my second reading of “Doctoring Data,” and just finished the NNT section. It strikes me that the “104” may very well be 1,040, or more, because it is not possible to compare treatment and placebo with all the statistical shenanigans in most, if not all, of the drug trials, such as multiple endpoints, and burying under the rug adverse effects. Plus, we’re all going to die of something. Nevertheless, NNT is certainly easier to understand than RR.

    3. Martin Back

      Ideally, they would want to slot you into a population group with fairly tightly clustered health outcomes.

      A group based on age and sex is an obvious one, but one would want to divide it into smaller, more homogeneous groups. The problem is, by what measurement? Cholesterol is useless, because the outcomes are so widely distributed as to have virtually no predictive power. Weight? BMI? BP? It has to be something easily and cheaply measured.

  44. David Bailey

    This is sort of off-topic, but I know someone whose knees hurt after going on a long walk.

    She was recommended CBD oil (a non-psychoactive cannabis compound that is sold in Holland and Barrett). The only thing that worries me a bit is that it is described as a “powerful anti-inflammatory 2x stronger than prescription hydrocortisone”.

    I am a bit worried because from what I read here, anti-inflammatories aren’t good to use for too long because they suppress the repair mechanisms that operate within the arteries.

    Does anyone have any thoughts?

    1. Gary Ogden

      David Bailey: I would suggest bone broth, or a collagen supplement, along with vitamin C. I put my knees through punishing activities three times a week, and I haven’t had any but very minor knee pains since I started taking these two. Knee pain, in my experience, signals injury. When it occurs, I lay off for a few days to heal, but this hasn’t happened in a long time.

      1. Agg

        And how about home made brawn? My mother swears by it, as well as gelatine – one teaspoon dissolved in a cup of hot water. Personally, I prefer brawn, with a dash of vinegar.

        1. Gary Ogden

          Agg: I don’t know what brawn is. My bone broth is homemade, from whatever bones I manage to acquire, usually beef. Gelatin is also excellent, since it is made from the same parts of the animal as bone broth, cartilage, connective tissue, etc. As I understand it, it is the particular protein profile in the broth from these tissues which makes it good for maintaining the health of those tissues in the body. Vinegar is good, too. I always add butter and salt to the broth. Tastes mighty good!

      2. Joyce

        GARY, re the Brawn. Good old Northern recipe, consisting of a Pigs head, trotters, etc. Would have made you one, but when I got to the bit of the recipe which states “cut the ears off with a sharp knife, shave the whiskers off with a disposable razor”, I started to flag. What finally did it was “cut the flesh attaching the eyelashes away with a sharp knife”. Will you settle for a bag of chips? lol. P.s. stick to your home made broth. Works every time.

        1. Gary Ogden

          Joyce: I’d use the head in a minute if I could get one. I do use the trotters, which we here in the colonies call “feet.” Not very imaginative, that. One of the best breakfasts I’ve ever eaten was pig brain scrambled like eggs. This was in a remote area of the Philippines where utensils were non-existant. We picked up the food with globs of rice. Yum!

        1. Gary Ogden

          Joyce: Had to look him up. I’m not in his league, but I love having adventures. Lots of other people do, too; I meet them every week on my hikes. People of all ages, from small children to folks in their 70’s and 80’s. I have yet to hear a complaint from any of them. There is hope for the human species! Maybe not for the rest, though.

    2. Jonathan Bacon-Sandwich

      They need to find out why it hurts before taking anything, even advice. If there’s any swelling they need to get it looked at pronto. If there isn’t it may well be gait or footwear problem. No offence but taking drugs to treat symptoms is another problem with all medicine, even (especially?) anything alternative.

      1. Gary Ogden

        Jonathan: Excellent tip about possible gait or footwear problems. I mentioned bone broth because it is a food rather than a medicine. On the same note, I consider my food (and a few vitamin and mineral supplements) to be the only appropriate medicine to shove into the pie hole.

      2. Gary Ogden

        Jonathan: Addendum: In 2011 I switched to what I believe are called “zero lift” (in the heel) running shoes (the only shoes I wear when I wear shoes). I think this has improved my gait. Took a bit of getting used to, in the calves, but I’ve had only minor and transient joint problems since.

    3. David Bailey

      First, the lady in question is a (non militant) vegetarian!

      Second I know a number of people who are disillusioned about the whole idea of going to the doctor to get a clear diagnosis of aches and pains. You get sent for one or more X-rays or scans, wait a while, and then get told it is just normal wear and tear!

      A while back, I got what I think was sciatica. I booked a non-urgent appointment with my GP, and while waiting, I decided to try alternative medicine. After about two sessions of acupuncture I could feel the problem melting away! My GP’s appointment was still pending, so I cancelled it!

      1. Mr Chris

        David Bailey
        Reading this blog has made me realise that there is an enormous industry for scans, xrays and even more sophisticated tests. The result is often style , ‘ normal wear And year’ or more tests. Often simple stretching will cure in less time than going to doctors and hospital ´s.

    4. Andy S

      Hi David, found some references about CBD and inflammation. In some cases inflammation is part of repair process and in some cases inflammation is damaging.

      Cannabinoids as novel anti-inflammatory drugs

      Cannabinoid-induced apoptosis in immune cells as a pathway to immunosuppression

      “At the optimal concentrations, cannabinoids do induce apoptosis in immune cells, alleviating inflammatory responses and protecting the host from acute and chronic inflammation. The cumulative effect of cannabinoids on all cell populations of the immune system can be beneficial, when there is a need for immune suppression. For example, in patients with autoimmune diseases such as multiple sclerosis, arthritis and lupus, or in those with septic shock, where the disease is caused by activated immune cells, targeting the immune cells via CB2 agonists may trigger apoptosis and act as anti-inflammatory therapy. CB2 select agonists are not psychoactive and because CB2 is expressed primarily in immune cells, use of CB2 agonists could provide a novel therapeutic modality against autoimmune and inflammatory diseases.”

      1. BobM

        My wife had a conversation with our neighbor, and he’s using those oils. He’s dropped his blood pressure and blood sugar significantly. Really significantly.

        1. Gary Ogden

          BobM: In the case of the BP, this may or may not be a good thing. Outside of primitive cultures, it is normal for BP to rise with age. I would consider the mean BP by age and sex in a given population to be what should be considered normal, not the guidance of conflicted KOL’s or public-health authorities. I rely on my kidneys, bless their little hearts, to keep my BP at a level it needs to be for optimal functioning and health. One of the scary things about salt restriction is that it significantly raises the production of renin and aldosterone, not a good thing for endothelial health. The more I learn, the stronger my conviction that it was the right call to stop all BP drugs.

    5. AnnaM

      I’d want to know the mechanism of action. If it suppresses inflammation, it might not be good. But if it actually reduces inflammation in a healthy way by reducing its cause, then it should be good.

    1. David Bailey

      That must sound quite worrying – how old are you?

      All the discussion here concerns ways in which medical science seems to be wrong about heart disease, so I guess the best thing would be to give a few details about what has been measured, or what symptoms you have.

      For example if your problem is high cholesterol, I would not worry at all. Dr Kendrick can’t answer specific medical queries, but if anyone replied to you with poor advice, he could always hold that post back.

      If you have been assessed by the risk calculator, then this very blog topic should reassure you a lot.

  45. Sally

    such a good post – thanks once again for cutting through the crap and looking at real facts/data – one can only hope that we must be getting near the rational ‘tipping point’ on this issue soon ….. and I wait with baited breath for your next post!
    all the best for 2019

  46. Mark Heneghan

    Glad to see the ‘test of proof’ applied to risk factors – effectively disproving some/most and suggesting that they are only associations, or even the other way round, in that cvd causes them. Hell, in my job I’ve wasted years chasing and treating patients for 2 dubious risk factors – hyperlipidaemia and mild to moderate hypertension. The fact that I was paid eases my pain, but not that of the taxpayers.

      1. binra

        That could be the most you’ve said with the least words.
        Hindsight is a false friend when used as a self-invalidating script.
        If I could have done different, I would.
        We cannot change the past, but we can change our mind about the past and carry it differently – such that all we have lived is part of who we are being now – and available because we are not invalidating ourself/inviting madness.

    1. Fiona Stephens

      Because you were doing what was right at the time. Maybe now you have moved on from then, but you don’t need to let it follow you. You did your best with what you had and that’s fine. Don’t worry too much about taxpayers – it’s what they wanted you to do way back then.

    2. David Bailey

      Forget the tax payers, the real problem (again not your fault) is the statins used to treat hyperlipidaemia . They are messing people up badly – at least if they go on taking the drugs.
      I got chatting to a lady at our ice rink, and she said that she decided to take up ice skating after she had a stroke (!!). I warned her about statins, and it turned out that she is a GP, and agreed with me.

      Thus, there are a lot of doctors that are realising the truth. You will certainly earn that salary if you can somehow help to stop the madness.

  47. Vaguely

    The Modern Witchhunt
    An Unwarrantable Assumption of Superiority
    Hugh Trevor-Roper (1914-2003), Archbishop Laud, 1573-1645, 3rd ed. (London: Macmillan Press, 1988), pp. 3-4:
    …an unwarrantable assumption of superiority in our own age, which has merely transferred its credulity to other things, attributing to pills and mixtures the miraculous properties which it denies to relics, and accepting from the advertisement hoardings dogmatic assurances which would come unheeded from the pulpit.

  48. Jean Humphreys

    I was somewhat amused the other evening to watch a programme about “The big fat diet lies” and see that the talking heads consisted of many glamorous ladies and chappies whose names were not recognised, plus Dr Malhotra, and The Angry Chef. That didn’t seem quite right somehow.
    Anyway, one of the lady dieticians said that a healthy diet consisted of less carbs and sugar, and plenty of LEAN protein. She couldn’t quite bring herself to say “meat” I suppose. I didn’t hang around to see their summing up – halfway through I spotted that it was a two hour prog, and I was fed up and wante to go to bed!

    1. chris c

      That meat is tricky stuff isn’t it? We ate it for millennia and suddenly in the last half century it started causing diabetes while we were eating less of it. Don’t trust it. In fact you can send it to me and I will ensure it is properly disposed of.

      1. Jean Humphreys

        chris c “Send it to me …”
        I will send the meat to you for isposal, but forgive me if I cut the fat off first – I need to dispose of that myself, since it is the tastiest bit!

  49. Mark Heneghan

    Re the quoted American study that looked at outcomes in the various risk groups (<2.5%, 2.5% to 3.74%, etc) had any of these patients had any treatment where it could be argued that their risk had been reduced, i.e. Statins and antihypertensives, so that by the time the incidence had been measured at five years they had had five years of treatment? Or had they been left 'untreated' for the five year period. I'm hoping the latter of course, and I can't believe that even statin prescriber maniacs would actually prescribe a statin for someone with a risk of under 7.5% over 10 years. That being the case, the predictors are duds.

    1. David Bailey

      Here are the Number Needed to Treat (NNT) for statins given to those at risk of heart disease, but without CVD:



      There is a slightly lower figure for people who have had a previous heart attack or stroke(I think).

      I like the NNT statistic – it is so easy to comprehend.

      I think the figures are a total scandal – I mean some people struggle on with their statins while they are actually damaging their muscles – convinced that not taking then means certain death. I mean the sheer inability to exercise while statins are attacking your muscles must surely offset any benefit.

      1. Bill

        And even those crazy high NNT’s depend on believing the analysis of the (to my knowledge) still mostly secret statin trial data. With effect sizes this small, industry funded trials, and no opportunity for independent raw data analysis, I’m not convinced any of it is believable. Science based on secret data. Karl Popper would not be amused.

      2. Jerome Savage

        David Bailey – Can I say that muscle damage, strain or pain or any issues relating to muscle tissue, is not something that I can identify with in the almost 6 years that I used statins. That I took up long distance running following my CVD event in 2004, and the resulting aches & pains associated with such may have disguised any statin associated problems. But i hav saide hete before that i found myself struggling to find words during conversations, with any attempt at analysis leaving me extremely frustrated. I was completley out of sorts at the time, the experience was disturbing. After stopping statins I recovered well but over a numbet of years. I also developed auto immune syndrome & cartilage damage which may or may not be connected. (From my own research it seems that A.S. has links to statin use, something that has not been explored in these posts. Maybe Dr Kendrick could consider applying himself to just that in time to come)

      3. Jerome Savage

        Mr Chris. There is little doubt tjat statins and muscle damage are related. But for this statin user it wasnt the main problem. Having said that, two conditions did manifest, achilles tendonitis and Morton’s neuroma, both of which I exclusively associated with Long Dist Running – at the time, maybe less so now.

        1. Mr Chris

          When I was taking statins I had tendinitis about every three months, it was only at the end that I found the connection.
          Previous I had put it down to stress, being a stiff sort of person etc.
          When you read Hannah Joseph’s book, or see what happened to Duane Graveline, I reckon I got away lightly

      4. David Bailey

        Jerome said:
        “That I took up long distance running following my CVD event in 2004, and the resulting aches & pains associated with such may have disguised any statin associated problems. ”
        I very much doubt that if you had had the statin muscle side effects, you would have continued running! Part of the deception is in calling this problem “muscle pains”, which sounds almost too trivial to mention.

        The reality is disabling to a greater or less degree, and some people report that they never fully recover from the damage. Browse this website for examples of what can happen:


        In some reports on that site, people have ended up in wheel chairs. I remember trying to use a TENS machine to ease the pain. This machine gives you electric shocks to distract from the pain! There was also painful cramps and random knee joint pain.

    2. Mark Heneghan

      Have now read the paper – no prior treatment for hyperlipidaemia or cardiovascular disease – presumably that includes hypertension.

  50. Angelica Nelson

    Thank you, Dr. K! My prediction turned out to be 1.8% at the moment. And I played around with it, it seems the American one will tell me to take a statin at age 70 no matter what I put in. Looking forward to the next article. I hope your Holidays were fun and restful. Happy New Year!

  51. Charles Gale

    Arterial calcification cause…or causes thread

    Danny Evatt – I’ve been thoroughly intrigued by your comments for this instalment. Like you, “as someone who is very healthy with a high CAC score of over 1000” I’m intrigued by your thoughts that “perhaps arterial calcification is caused by something else”.

    I went crashing down and ended up in intensive care with a diagnosis of some CVD event. Upon resuscitation, I couldn’t believe it because I’ve taken care like you. There were my suspicions that it was years of stress and possibly vit C that caused the near fatal incident.

    So, subsequent blood tests to find causes (e.g. lp(a), fibrin/fibrinogen, hs-crp, homocysteine) were fine but the CAC score was 1500 – hence my interest in your speculation as to other causes for arterial calcification, and Andy S’ link to some research.

    I know you have taken part in the comments over the years, but I can’t remember if you have had any heart or CVD incidents. If you are speculating on alternative causes for arterial calcification ,perhaps not? And if you have, perhaps like me, you are questioning everything about what happened, and what were you were told.

    Since my CAC scan, I’ve assumed the arterial calcium is there as part of arterial damage/repair process.

    More food for thought following your comments.

    Now, I’m not convinced that Dr Kendrick’s series of blogs will ever end!

    1. Danny Evatt

      Charles Gale – No, I have had no CVD event. As a matter of fact, the opposite. Low CRP, Low PLAC score, good health allround. However my Chol. LDL is somewhat elevated, as is my Lp(a).
      I will, never, however, take a Statin or any other Rx. I do not smoke or drink and exercise regularly – and am under no stress.

      The last CAC test (my third in over 10 years as it seems to be increasing 10-15% per year) was a little over 1000 (the test also noted there were “no blockages”). I ordered it and paid for it myself (as one can do this in the US.)

      I have come to the simple conclusion that, in my case at least, arterial calcification does not relate to wandering plaque or blood clots. I’m actually not sure why the medical community is so sure it does – as many (most I think) people that have a CVD event either have no or little calcification. And many people with a lot of calcification, seem to be just fine and die very old from “hardening of the arteries”.

      Unfortunately, there is little experimentation or study into the causes of arterial calcification – other than to say it has to do with plaque repair and high cholesterol – hence “take a Statin”. Even though studies show Statins increase calcification – though the speculative, no proof reason they give for this oddity is that the Statinit is taking the loose plaque and “calcifying it”. What rubbish – simply a guess and speculation.

      So what are people like myself and others with high CAC scores but no CVD to do? I am continuing to self-experiment with vitamin K and C, as well as a few other somewhat benign supplements. I don’t plan on getting another CAC test in the future as the radiation exposure I am receiving might be doing more harm than the empty and frustrating results.

      My advice, for what its worth, is a good diet of veggies, meat, butter and eggs (with low sugar/carbs). Plenty of exercise, real sunshine with no sunscreen, lots of unfluoridated water, no smoking and little or no alcohol and minimal stress. That’s about all I can offer since the science of the true causes of CVD and arterial calcification are now “settled” by our learned medical community – and we shall hear no more about it! 🙂

  52. Göran Sjöberg

    I often wonder why people are so “fact resistant”.

    If one realizes that most if not all of our modern life diseases didn’t exist in the hunter gatherer societies before agriculture arrived you would think that should make people open up their minds to alternatives. But on average this does not seem to happen, not before one is “facing the wall”.

    1. Craig

      Thanks Malcolm. You have always been quite sharp but lately you’re becoming more finely honed.

      I happened upon the Science blogsite of David Colquhoun recently. It is wonderful and he is a statistics wizard. Today I was reading his dissection of the placebo effect, with this quote from Medawar:

      “If a person is (a) poorly, (b) receives treatment intended to make him better, and (c) gets better, then no power of reasoning known to medical science can convince him that it may not have been the treatment that restored his health”


      It was round about part 35 of your current series that someone mentioned the nocebo effect, which concept was being used to discount reports of the harms from statins. Obviously the nocebo effect can be relegated to the same level of insignificance as the placebo effect, same=same.

      I did wonder however if the supposed benefits of statins could be partly explained away by this idea of regression to the mean. The pattern seems to fit.

      1. Martin Back

        Craig, thank you for the link to David Colquhoun’s blog. I was aware of ‘reversion to the mean’ but didn’t appreciate how it would affect medical trials. I am now starting to doubt any treatment that shows small effects!

      2. Göran Sjöberg

        I agree with Martin here.

        David Colquhoun’s blog is very revealing what medicine is “all about” in terms of twisted statistics. But I was of course already a strong “disbeliever”. Medicine has btw been “religion” from the very beginning, 40 000 years (?) ago. Today it is though more of a corrupt scam in the hands of “Mammon” in my eyes.

    2. David Bailey


      I never know how true that really is. I mean imagine living in the Amazon rain forest (say), there must be all sorts of dangers – obscure infectious diseases, sepsis from assorted injuries in the forest, or from wild animals – not to mention that ever present possibility of becoming lunch rather than eating lunch! Besides, are diseases such as CVD ever recognised as such?

    3. binra

      Are we not ‘corporately captured’ and managed or conditioned to operate within a techno-industrial (globally connected) state that operates a monocultural way of life – ie: any communitarian directions are regulated against or the economy stacked against — such that we cant afford to do anything truly constructive – but we can always afford to persist in a disposable negative debt, war and sickness economy?

      While we get enough of what we want we don’t look at changing things, When we feel insecure and afraid of losing the little we have we don’t want to lose even that to change.
      Facts can work a while before becoming ficts.
      If believe your life or career or family depend on at least seeming to conform, would you ‘come out’ in support of the facts that challenge the official narrative or survive in the terms you know?

      1. Göran Sjöberg

        Binra, interesting!

        When I used the expression “facing the wall” this implied on an individual level that there is no way to proceed the “old Way” if one wants to regain health. It is a true opportunity to start thinking about causes by oneself as it is not offered by the NHS and totally ignored if your own alternative turns out successful as in my own case 20 years ago. It is understandable that few manage to carry such a thing out.

        My expression “facing the wall” also refers to the more general concept when whole fields of medicine are facing dead ends e.g. CVD, T2D, cancer, mental illness to name a few such areas. This take brings us back to how “paradigm shifts” takes place in science – read Thomas Kuhn here.

      2. David Bailey

        The trouble is that areas of medical science don’t seem like science at all, someone termed it zombie science. I’m not sure paradigm shifts happen in zombie science 😦

    4. chris c

      Even in our own lifetimes we have seen major changes in the incidence and distribution of such things as obesity and Type 2 diabetes plus a whole horde of other diseases and conditions which were once rare. Many of them improve/go into remission when we stop doing what we are told.

      1. Gary Ogden

        chris c: Right you are! Best thing we can do is stop doing what we are told. Unless it is the police telling us.

  53. Randall

    Would a person want to take statins after reading the following – This proved that vitamin C and lysine could prevent and even reverse the aging of arteries. P.S. Dr. Gifford-Jones (AKA Ken Walker) is a graduate of The University of Toronto and The Harvard Medical School. He took post-graduate training in surgery at the Strong Memorial Hospital in Rochester, McGill University in Montreal and Harvard. (after a heart attack he takes these supplements) https://torontosun.com/health/diet-fitness/gifford-jones-dr-sydney-bush-why-not-the-nobel-prize

    1. Jerome Savage

      As always, there are differing opinions.
      Quick Google indicated as follows;
      Side effect of Lysine include:
      abdominal pain.
      chronic kidney (renal) failure.
      inflammation in the kidney (interstitial nephritis)
      increased calcium absorption.
      May 15, 2017″

  54. Göran Sjöberg

    Someone directed me recently to a video about the benefits of water fasting well worth the hour to watch it – there is a lot of knowledge here. The cheapest medicine ever, certainly a true claim, and it also seems to be very effective to help your body to heal not least against cancer.

    1. David Bailey


      Honestly, isn’t it better to just enjoy life and leave such questions alone? I mean, we aren’t going to last forever, and after realising how dodgy medical science is in this area, I realised that chasing more and more tests is as good a way as any to ruin what time I have left.

      Indeed, without the testing life is a lot more relaxing, and the lower stress may help your body heal. Somewhere in Dr Kendrick’s books, he says that he doesn’t even know his own blood pressure!

      1. Gary Ogden

        David Bailey: Yes! In “Doctoring Data.” And doesn’t care. My sentiments precisely. Medicine has nothing to offer the healthy. Finding joy in daily living is the best medicine. Except in the case of a medical emergency, to hell with all medical tests.

    2. JanB

      Patricia – there’s a super book by Gilbert Welsh called “overdiagnosis” which you (and everyone) might find useful, the basic message in it being that the harder we look and are able to look, thanks to ever more scrutinising and detailed scans, tests, etc.,the more we find potential for ill health even when often what is found is a false alarm that will come to nothing.
      My thinking is, why spoil today when what we fear may never happen. The more we look the more we find. Er…don’t look so hard. Be happy. 😁👍

      1. binra

        Once you realise the power of your mind – use it to look for what you truly want and not for what you don’t or ‘trying to look at fear less’.
        You can choose to take an educative journey out of happy curiosity in the same ball park as a fear of calamity might obsess over. It isn’t just the what you do – but the way you do it – which comes from the why.
        People presume they know why they act as they do without checking in.
        Chasing health in a framework of sickness.
        Getting in touch with our own being is accepting our decision as our own – instead of auto-yielding to seeming authority. I can listen to or research where I feel moved and compost it all to see what comes out. Or I can donate my body (and conscious quality of life) to a corporately directed and pharma-trained medical science… while still alive.

      2. chris c

        What really really annoys me is that a few simple tests would have shown what was wrong with me any time during the first fifty years of my life, but they were never done. I susoect the majority of the tests most people get are tests for drug deficiency. I ended up with statin deficiency, blood pressure medication deficiency, H2 blocker deficiency and antidepressant deficiency when in retrospect I was just eating too many carbs. And especially wheat.

  55. Charles Gale

    CAC scan and PLAC testing

    It’s been interesting to read the comments on the pros and cons of these 2 tests, and it seems to be that if nothing else the PLAC tests is more affordable and not without merit in risk assessment.

    Also, it seems from comments that the CAC is still prohibitive due to costs (scan and also maybe travel) and also accessibility too – not all hospitals offer CT scans, and that for many of us not something to be done on an annual basis.

    I had my CAC scan in Dec 2017 for which I had to pay £400.00 and still had to get my GP’s approval.

    I’m in England – has anyone here had a CAC scan for less than £400.00? Are prices coming down?

    Has anyone ever had their GP actually refer them to a scan on the NHS? Silly question – I expect not?

    Would a lethally high CAC score have any influence on getting a GP to give a NHS referral? Probably another silly question – why waste tax payers money on a dead man walking!


    P.S. Looking back at my CAC scan report I did get a few extras thrown in for my £400.00 – in addition to the CAC result, I learnt that (1) there was no lymphadenopathy in the mediastinum and (2) the limited image lung volume is clear.

  56. Charles Gale

    Patricia Daniels – “How can you tell if you have vulnerable plaques?”

    Answer 1 – see all the comments above for suggestions.

    Answer 2 – Ivor Cummins provided a link above in the comments to an interview with Prof Matthew Budoff. Here’s a link to another interview with Prof Budoff:


    A few takeaways to answer your question…

    …CAC plaque is approx. 20% of your plaque burden, with the remaining 80% being 3 forms of soft plaque more likely to rupture. This plaque is not seen on CAC testing.

    Soft plaque only seen with CT – Angiography.

    There are 3 types of soft plaque:

    (1) low attenuation plaque – pure lipid at core and most dangerous
    (2) fibro plaque has more fibrous material thus more stable
    (3) fibrous plaque – walls off the top of the plaque and protects against rupture

    And there are plenty more options to consider such as inflammation markers.

  57. Angelica Nelson

    I ordered your book and am looking forward to it, Dr. K. Amazon says it won’t ship until June 1st though. It’s going to be a long spring.

        1. Jean Humphreys

          Regarding the book – in the UK, Wordery ships post free worldwide. What I don’t know is whether they take orders from abroad. It would be worth looking at their wesite to check.

      1. Angelica Nelson

        Not here in the US yet 😦 Not even from Amazon. I can try Amazon UK though. I should’ve thought of that. (facepalm!)

  58. Soul

    I had written earlier about mom and her hip problems. Doctors recommended her hip be replaced. I suggested she stop taking the statin medication she was on to see if the hip pain went away.

    Good news, her pain is gone. She moves around without difficulty. Mom saw a hip specialist yesterday. Mom commented that she didn’t know why she was going to the appointment since her pain was gone but went anyway. Everything checked out with the doctor. He recommended rehabilitation therapy. It is doubted in the family that this is needed, but mom being a big believer in what doctors recommend signed up for the rehab. I hope the government is paying this.

    Mom is not giving credit to stopping the statin for solving her hip problems. Instead she will say her problem was likely caused by a nerve issue that comes and goes. Maybe. It is not possible to say with certainty what went wrong. Then again that is very typical of my mom. She doesn’t criticize the medical industry. She along with friends and family work in or used to work in hospitals. I suspect that plays a roll in being more of an advocate for.

    1. David Bailey

      That is great news, and I guess that Dr Kendrick’s blog must take some of the credit! I hope your mother doesn’t start her statins again, but if you do, try and keep aware of how she is managing. In a way, your mother sounds a bit like I used to be – confident that the statins were a valuable medicine.

      As a result, I suspected something else, and I stopped my statins three times because I thought they might just make the real problem that bit worse! Each time the pain came back after about a week or a bit longer – always most intense in the morning, because the statins are taken at night and do their ‘work’ while you are asleep. I still remember my surprise when I reached the obvious conclusion,

      Hopefully your mother will rapidly realise the truth – as I did.

    2. David Bailey

      I suppose this account also raises another question – given all the x-rays and scans that Soul’s mother presumably had prior to the decision to replace her hip, are we saying that these can’t distinguish muscle problems from severe arthritis?

      How many hip replacements are performed on people taking statins?

      1. Sasha

        The crazy thing – lots of hip replacements can be avoided if people take care of their hip joints. 90/90 exercise is one good place to start. It’s on YouTube.

      2. Jean Humphreys

        Are practitioners themselves sure the know the difference between arthritis and other pains? At the surgery I was asked by a nurse (mature, so presumably had learned all the “wisdom”) “Why did you stop taking statins?” I gave her the short answer – muscle pains. “Are you sure it wasn’t just a touch of arthritis?” 1. Does she know that a muscle is a muscle, and only joints can have arthritis? The clue is in the name – arth… referring to bony bits, and …itis, inflammation. 2. Just how ignorant and stupid did she think I was?

      3. Bill

        David, my guess is that the radiology showed a gnarly hip, but my understanding is that imaging findings like that don’t correlate very well with symptoms. So perhaps Soul’s mom is now one of the many walking around with gnarly but pain free hips. Think of all the back surgeries done based on imaging showing gnarliness near someone’s pain, with no benefit.

      4. shirley3349

        I have some arthritis in both my hips and knees but I would not have replacement surgery just for the pain, unless I was in the situation where painkillers no longer had any effect at all. For loss of function, especially when the joint can no longer be straightened to bear weight, yes, I would. But pain is one of those allusive beasts which may or may not be improved by surgery and one always runs the risk, I’m afraid, of ending up worse off than before.

      5. David Bailey


        From my experience, statins can produce joint pain as well – though it doesn’t feel like arthritis – more as if the joint has been twisted slightly.

        BTW, I wonder if the incidence of arthritis is dropping now that almost everyone is returning to butter.

        1. Jean Humphreys

          I did not realise that statins could cause joint pains – they did not do that for me. I always gave muscle pains as the short reply, and it was very definitey muscles – random intense pains as though I had sprained a muscle when I knew very well that I hadn’t put it under any stress at all. What I never said then was what I had not realised till it went way. – the way the drug messed with my brain. Unable to attempt the cryptic crossword which I had formerly finished every day. Needing the clock in the car to clue me whether I was halfway to town to do the grocery shop, or pick up the kids from school. Losing words for an hour at a time – halfway through sentence I would be unable to recall what I was talking about. It was only when I fell over Dr Duane Graveline’s writings that the penny dropped, and I knew what had been going on.

      6. David Bailey


        I was introduced to the idea of CBD (see my post higher up), by a lady of 78 who was in the queue for a knee replacement. She took CBD and after a short time the pain went away completely and she has regained full mobility, so any knee surgery is now on hold.

        I guess it is worth a try for any arthritic pain.

    3. Heather Green


      I’m so happy to hear you were able to talk your mother out of taking statins. I wish I had known what I know now when my own mother was on statins and complaining of fatigue and muscle problems. She had a stroke in November of 2014 and died almost a year later. After much reading and research I am confident statins were responsible for (at the very least) the initial overall decline in her health. After I educated myself I was very angry at first that my mother didn’t question her doctors or do her own research – she was a very smart woman but blind and trusting in this area.

    4. Aileen

      Soul, I had been wondering how your mother was getting on. Whatever the reason, it’s great that things are looking up for her!

      1. chris c

        Yes excellent news!

        I must be one of th few people who never had problems with statins – I know this because I stopped and restarted them a couple of tmes before I stopped for good.

        My mother was one of the only people I knew to have never been prescribed them, but she had a laundry list of other meds and in retrospect I can see several of her symptoms were caused by them. And some of them were for the side effects of the other ones. Breaking out of this can be hard.

      2. Joyce

        Chris C…Re your mother never having been prescribed Statins. My own mother(sadly in the last throws of Alzheimer’s Disease at the time,) was first prescribed Statins at the age of 93, whilst hospitalised after a heart attack! When I commented on the futility of this in her particular case, I was proudly put in my place by the nurse telling me, “everyone on this ward gets a statin!” Funny if it weren’t so bloody sad! 😢

      3. chris c

        That is somewhere between ridiculous and frankly dangerous. Even Evidence Based Medicine shows little “benefit” for those over seventy and especially for women. You’d almost think they were trying to kill their patients off. Oh wait . . .

    5. Göran Sjöberg

      Soul, congratulations!

      Every time you get someone off the statins it is in my eyes a victory but the medical imperium is striking back when they can.

      I got a friend off the statins many years ago but his trust in the doctors was greater than my “authority” so he was put back on them and with his health (mobility and memory status) visibly steadily deteriorating. He was, as your mother reluctant, to see any connection here. Finally he had new doctor, about a year ago, who told him that people of his age (he is now 80+) didn’t need them and his joint problems are now visibly getting better which I noted as late as yesterday when he with remarkable ease again climbed the stairs to the second floor of my house.

      Interestingly he avoid discussing this issue with me today but we both “know”.

      1. Göran Sjöberg

        Anyway, he still sticks with the LCHF idea he adopted from me those 10 years ago.

        Basically I think his conviction is more due to the fact that when he tried this LCHF regimen for a while and then returned to his diabetic nurse she told him, based on the result of her testing, that he was no longer a diabetic. No-one in the NHS had told him that what he was eating could have any profound effect on his health and this encounter with the nurse actually infuriated him.

        Also he has been rheumatic since young years and always had heard the same rejecting of any impact from the food. When he turned LCHF his rheumatic also improved considerably which adds to his present belief in this part of my “teachings”.

        As I use to say: “Nothing is more convincing than a successful experiment carried out on on your own body.”

        BTW I suspect that the statins brought the T2D on him from the beginning since it appeared some years after he had started with statins.

      2. Soul

        Thanks Goran. It is a relief that mom is doing better now. We went on a walk together last night and she was great. She didn’t experience any pain, at least none reported. Fingers crossed that the hip problem was caused by the statin taken. It sure is looking that way.

        it’s a relief too as my grandmother became in invalid. That was devastating for her and the family. I was worried that mom might be similarly heading along that same path.

        It’s a puzzle to me why so many people are not willing to be critical of the medical industry. many are that way though. It’s as Dr. Kendrick wrote once, a religion for some. I have an uncle by marriage that could be similar to mom. He is very accomplished. He was an engineer for NASA. He built GPS satellites. He’s a smart guy. When it comes to health care though he tends to follow orders blindly. He takes a statin drug. He’s now had a couple knees replaced. Are the two connected, of course I don’t know. I did send him articles in the past about the problems with statins though. Wish now he had stopped taking it. It potentially could have helped alieviate some suffering, if a test try had been done, to see if he was suffering from a side effect.

        1. Gary Ogden

          Soul: I call these people “rule followers.” I had the great good fortune to be rudely awakened by a person in authority (schoolmarm) at a tender age, so never became one. I have two lovely neighbors in their fifties, both on statins. I’ve spoken with them about them, with no effect. They may not have any serious adverse effects, as both are active and in good spirits. Wonderful news about your mother.

      3. Göran Sjöberg

        Soul, thank you for your response.

        I’ve got a very old friend and colleague who turned seriously diabetic. He is an engineer and a Ph.D. and you think he as an engineer should be rational when facing his illness – but no.

        When I met him a couple of years ago I told him about the dramatical success my equally seriously T2D wife achieved when turning away from all carbs (there is a damned sure logic involved here since this will dramatically lower your blood glucose levels) he was not at all interested and just said he trusted his diabetic nurse and took his insulin properly.

        With challenging CVD he has now been bypassed and is in a rather bad shape. It makes me sad to think about how reluctant he is to listen to reson.

        1. Gary Ogden

          Göran: Yes, I’ll never forget the figure Dr. Kendrick quoted for cognitive decline among CABG recipients-51%! Yikes.

      4. Soul


        I guess many live in Mayberry. Barney Fife is the sheriff and rules are rules. It’s kind of strange to me, but I have to agree with you.

  59. Soul

    Thanks everyone. I’m very pleased mom is back to her old self, exercising and walking. Talking with dad tonight he said the two of them were going to walk for miles. Her hip is that much improved. Fingers crossed her improvement continues.

    It is disturbing that likely others have had hips and knees replaced, when their problem simply is a side effect of taking a statin. Just a guess on my part that this happens, but from what I’ve seen with mom I suspect it possible.

    Thought to post this here if it might be helpful. I’ve known of Dr. Matthew Budoff’s work for awhile. He is why I take garlic capsules. He reports, in small studies done, that he has seen from CT scans, artery plaque reversal in patients that take aged garlic capsules.

    Dr. Budoff’s work reminded me of a combination of Dr. Kendrick’s writings and Stephanie Seneff PhD write up. (Dr. Budoff’s does believe in the cholesterol theory sadly though) Dr. Kendrick’s theory can be seen here and elsewhere of course, and Stephanie Seneff’s theory can be read in the book Fat and Cholesterol DOn’t Cause Heart Attacks and Statins are Not the Solution.

    One of Dr. Budoff’s videos can be seen here ~

    1. shirley3349

      Interesting. I love eating garlic and it grows surprisingly well in our Yorkshire garden on a terraced north-facing slope. My husband grows two varieties, a very small, very strong tasting and smelling one, and elephant garlic, a larger, much milder one. Dried off, both keep all winter but tend to sprout once the weather gets warmer. I use it in many dishes but my favourite is several cloves of garlic mixed with Greek yoghurt, cucumber, salt and black pepper to make tzatziki, eaten with (a weighed ration) of home made pitta bread and a glass of wine.

      1. Soul

        I agree Shirley. I like garlic and sulphur rich foods.

        About 12 years ago I had a heart CT can done. It came back with a plaque score slightly over 200. To prevent a heart attack I’ve been eating sulphur rich foods or taking a sulphur supplement, and getting plenty of sun exposure. Somewhat recently due to this blog I added a glass of wine a day. I also recently began taking a supplement to raise nitric oxide levels.

        Fingers crossed, so far so good, no problems with the heart over the last decade and hope it remains that way, which goes without question.

        1. Gary Ogden

          Soul: All good. Read “A Statin Nation.” You will learn much more about how to beat the odds; also everything you ever wanted to know about fatty acids (no such thing as fats!), triglycerides, cholesterol, BP, CVD, statins, and more.

    1. MCE was correct in what he did

      Lomax you are well known for causing internet drama but as you are doing it, I might as well feed you. According to your blog “As well, the author of the RW article on Kendrick is obviously Skeptic from Britain, again a U.K. resident”.

      The author of the RW article was Bongolian and John66 wrote most of it. John66 posted he was French! How do you KNOW these are UK residents? More libelous allegations from you Lomax, no facts. How the HELL can you prove any of the allegations you are making? How do you prove a bunch of anonymous Wikipedia accounts belong to a real life name – IMPOSSIBLE!

      You 0 evidence “skeptic from britain” created the Kendrick RW article, you have 0 evidence who these people are, all we have is thousands and thousands of obsessive words on your blog. You sound like a mad man. What you are doing is doxing an innocent person’s real name and connecting it to an anonymous Wikipedia account. This is libel Mr. Lomax!


      Your RW article is still live and well as of 2019. You said you were suing Rationalwiki years ago, why did it not happen? Like I said… it is impossible to sue RW! Shall we have this conversation in ten years when I am still laughing? See you then, shall I get the beers in 🙂

    2. Anonymous admin


      I am an admin on Rationalwiki, I will not reveal my username as Abd will no doubt attack me. I just want people to know that Abd was banned on both Wikiversity, Meta-Wiki, Wikipedia and Rationalwiki. This is a common theme with this individual.

      https://rationalwiki.org/wiki/User:Abd (check the user-template)
      https://en.wikipedia.org/wiki/User:Abd (check the user-template)

      Here is Abd ban’s reason “repeated doxxing as well as harassment, now attacking rationalwiki users on his personal blog”

      “Consistent with the Terms of Use, Abd has been banned by the Wikimedia Foundation from editing Wikimedia sites.”

      In regard to Wikiversity, an Admin banned Abd and wrote:

      “Your long term activity at Wikiversity shows a persistent pattern of long term disruption that has been going on for the past SEVEN YEARS! This activity has also drawn a great deal of unwelcome contentious activity to our site that distracts the community from developing learning resources. The unblocks in your log show repeated attempts by our community to assume that you are making a good faith effort to improve Wikiversity despite much evidence to the contrary. I’m not going to get into the minutia of your individual actions. I’m going to make a call based on the sum of your contributions. Wikiversity is not your personal podium. Your participation here has become a drain on the resources of our community and we will not allow this to continue.”

      https://en.wikiversity.org/wiki/User_talk:Abd#Blocked_2 (comment found on the edit history of the talk-page)

      There is a pattern here of disruption, no doubt the Kendrick business he is enjoying. He will write 2 million words on it.

      I am not saying he should be banned from this blog, but his internet shenanigans is well known. He has been doing this for years. If Kendrick wants his Rationalwiki article removed, please join the talk-page and make a request to why you want it removed. Thank you.

      1. abdlomax

        I’m not sure why Dr. Kendrick is approving the trolling posts, but that’s up to him. I have extended my comments based on extended “anonymous” (but obvious) comment here. There are additional developments on RationalWiki which I will cover elsewhere.


        A previous update was created yesterday


        These are long, and show evidence, and if anyone has questions, comments are open.

        1. Dr. Malcolm Kendrick Post author

          This is the last approval, until you tell me who you really are – in a way that can be validated. I am getting fed up with anonymous people claiming this and that. It is like some prolonged child’s game.

  60. Gary Ogden

    Off topic, but hopefully of interest. Although I’ve never given them a penny, I get both email and snail mail updates from the Linus Pauling Institute at Oregon State. The NIH is sponsoring a clinical trial there, conducted by Dr. Fred Stevens, on the effects of xanthohumol, derived from hops, on inflammatory bowel disease.

  61. Gary Ogden

    Good article in ZeroHedge today: “$3.5 Trillion A Year: Is America’s Health-Care System the Worlds Largest Money-Making Scam?” Yup.

        1. Sasha

          Andy, thank you for the link. Acupuncture effects are so varied that people have been trying to come up with explanations on what system (or systems) it affects. I, for myself, have made peace with the traditional explanation of Qi and its effects…

      1. chris c

        That sounds plausible. Acupuncture sounds like a placebo type effect but I’ve heard that even some vets have success with it so there must be something going on.

        1. Sasha

          Regarding animals, it’s a common argument against placebo effect but those arguing for it counter that even animals respond to emotional care and therefore can have placebo effect.

          1. Gary Ogden

            Sasha: I once subscribed to David Colquhun’s blog. He’s a fine statistician, but pooh-poohs the therapeutic value of vitamin C and doesn’t appear to know of vaccine injury. I unsubscribed after a couple of email exchanges. I wish him no ill will, but it appears his mind is not open to alternative views of some medical issues. That’s life. I’m convinced that acupuncture is a powerful and useful therapeutic tool, though I’ve never had use of it myself.

          2. Sasha

            Gary, I had a couple of exchanges with Colquhoun regarding acupuncture. In my opinion, he likes to present his opinions as medical facts probably because (in my estimation) he never cured anyone of anything, even a common cold. One of his big arguments against acupuncture in an op-ed he wrote was that one of Chinese emperors wanted to outlaw acupuncture. How does that change anything really? What if one emperor wanted to outlaw acupuncture but ten emperors before him thought it was the greatest thing since sliced bread? What if all of them wanted to outlaw it but a cleaning lady down the street thinks it’s wonderful?

            As many other pseudo sceptics (my term for people like Colquhoun) he takes anything he does not know how to explain, circles it with a red pen, and declares: “well, there be dragons”. Except in his case it’s regression to the mean.

          3. Gary Ogden

            Sasha: Yes, this is a dangerous way of approaching reality. Skeptical of skeptics, but fully accepting of official truth. Madness.

        2. Sasha

          I disagree about acupuncture and placebo. It has clear physiological effects which have been and continue to be studied. Soviets wrote books on acupuncture physiological effects in 1960s, for example. I don’t think it’s just a placebo or regression to the mean like this guy David Colqohun likes to claim. His name made rounds on this blog recently…

      2. Martin Back

        Daniel Kahneman, who won the Nobel prize for economics despite being a psychologist, likes to tell the story of how regression to the mean misled Israeli Air Force instructors. From https://www.spectator.co.uk/2011/12/he-knew-he-was-wrong/

        In the late 1970s, he was teaching flight instructors in the Israeli Air Force about the psychology of effective training. He told the instructors that praise rather than criticism was the best way to help the cadets improve. An experienced instructor disagreed with him: ‘On many occasions I have praised cadets… the next time they usually do worse. On the other hand, I have often screamed into a cadet’s earphone for bad execution, and in general he does better on his next try.’

        Kahneman realised that the instructor was making a mistake. If a cadet did something better than normal, his next attempt at the task would in all likelihood not be as good, whether or not he was praised. In the same way, if he performed unusually badly, his next attempt would probably be better, whether or not he was criticised. The trainer was attaching a causal interpretation to the fluctuations of a random process; simple regression to the mean. Kahneman had been teaching regression to the mean for decades, and had the scholarship to understand how the instructor was being misled by his intuition. He knew it was possible to infer wrong explanations even from accurate observations.

        ‘That was a true Eureka moment,’ Kahneman explains to me

      3. Martin Back

        The only person I know who had acupuncture was an elderly gentleman with a painful hip. I met him soon after he’d started treatment and he was raving about it. Best treatment ever!

        I met him again a few months later and asked how the acupuncture was going. He looked gloomy and said it was all a bunch of hooey. It didn’t help at all.

        Make of that what you will.

        1. Sasha

          I don’t know what to make of that story since I’m not sure what it proves or disproves. You met a guy who thinks “acupuncture is a bunch of hooey”. So what?

          I linked that cardiologist’s blog because this is a CVD forum and he relates his personal experiences with acupuncture and arrhythmia. This confirms my experience as well.

          And since you brought up Daniel Kahnemann’s story on Israeli air force and regression to the mean, I would be interested to know how in your mind it relates to acupuncture and regression to the mean.

      4. Martin Back

        Colquhoun’s point was that some days we feel better, and some days we feel worse. It’s the normal course of things. It’s only when we feel really bad that that we go for treatment. Then when we start feeling better, which we would have done anyway without treatment, we believe the treatment was responsible.

        The elderly gentleman’s story fits this pattern. He felt bad, he went for acupuncture, and he felt better. So his initial impression was that acupuncture was effective. It was only after several sessions (when due to natural fluctuations he would have sometimes felt better and sometimes worse after treatment) that he realised that overall, he was not improving, and concluded that acupuncture was not doing him any good.

        The Israeli pilot story had no bearing on acupuncture per se, but illustrates how regression to the mean can lead one to wrong conclusions if one does not recognise the phenomenon.

        To apply it to acupuncture:

        Say you go for an acupuncture session and feel better. You are now a believer in acupuncture. Then one day you go for a session and feel worse (due to regression to the mean). You say to the acupuncturist, what’s going on? He says, well, we know acupuncture works. If you’re not getting better, it’s because you need more acupuncture. So you go for more sessions and eventually start feeling better (due to regression to the mean). Until one day you feel worse…

        And so normal variability, whereby you sometimes feel better and sometimes worse for no particular reason, leads you to get more and more acupuncture, or whatever therapy floats your boat. I’m pretty sure a lot of conventional medicine is a victim of the same phenomenon. It’s a ratchet effect driven by misplaced faith in a treatment that may not be all that it’s cracked up to be.

        1. Sasha

          How about an alternative explanation for what happened to that elderly gentleman (and I apologize in advance for a long post):

          Acupuncture, despite its seeming simplicity, is actually a complicated art. In fact, Chinese medicine is quite complicated because its real strength, treatment of chronic illness, requires differential diagnosis unheard of in modern medicine. If you get a diagnosis of asthma, for example, you can go to a Western trained pulmonologist anywhere in the world and you will get the same treatment, no matter who you are or who that pulmonologist is. You will most likely get bronchodilators and possibly steroids. They will not cure your asthma, they will just “manage” it while you’re getting worse with each passing year. If you go to a Chinese medicine practitioner with what’s called asthma in modern medicine, there are at least 5 possible diagnoses (and that’s just off the top of my head): Heat in the Lungs, Cold in the Lungs, Spleen Qi deficiency, Kidney Qi deficiency, or Phlegm accumulation. Depending on the diagnosis you get, your treatment will be completely different. And this is just for asthma, a relatively easy condition to treat in Chinese medicine.

          Because of this complexity, it literally takes decades to get good at acupuncture and Chinese medicine in general. Until that happens, many practitioners (myself included) are engaged in what my first acupuncture teacher called a practice of “a blind cat catching a dead mouse”. It’s a hit or miss kind of thing because there’s acupuncture and then there are acupuncturists.

          So to get back to that elderly gentleman, there are a few reasons (that I can think of) why he wasn’t helped by acupuncture past his first treatment or couple of treatments: it could have been that hit or miss – his acupuncturist got lucky at first and then didn’t get lucky later. Or his acupuncturist could have properly manipulated the needles on the first treatment and didn’t do such a good job later because he was tired, off that day, etc. Acupuncture is a minor surgical procedure, you’re sticking needles into somebody’s body, a lot depends on manual dexterity which changes day to day especially in new or newer practitioners. Or the changes in the hip joint could have been so severe that in addition to acupuncture he should have been given therapeutic exercises. Or acupuncture wasn’t done close enough since it’s very dose dependent.

          For every person like your friend whom acupuncture didn’t help there’s at least one person who swears by it, possibly more than one. And not because they “regress to the mean” but because acupuncture treats pain (in many cases) quite effectively. That’s one of the reasons it’s taking off like wild fire all over the world and why PTs in US, for example, are trying to put “dry needling” into their scope of practice even though what they are doing is acupuncture and has nothing to do with the original practice of dry needling.

          Pseudo sceptics like “regression to the mean” explanation because they have a religious belief that acupuncture is placebo even though there are thousands upon thousands of cases every day that disprove that hypothesis.

          In addition, there’s been plenty of studies done on acupuncture physiological effects both in China and Soviet Union. Lots of that stuff is untranslated just like the Russian tomes on fasting in the movie Goran linked. It is beyond doubt (at least to me and many others, including conventional MDs who have read the studies) that acupuncture has clear physiological effects. It takes time, however, to get good at it and finding a good acupuncturist isn’t as easy as it sometimes seems.

          The cardiologist who wrote the blog post on CVD and acupuncture is on the front line. If his patients report reduction in arrhythmia with acupuncture which can then be objectively measured, he’s gonna write about it. It’s as simple as that.

      5. Martin Back

        Sasha, I’m not anti-acupuncture, just cautious about its benefits. If someone I trusted told me they’d had relief using acupuncture for a problem I might have, I’d give it a try, just as I’ve tried reflexology and massage therapy (both ineffective, in my experience).

        I believe in results, not theory. So if disciplined observation reveals that the same results will always arise from the same therapy, then use it, no matter what crazy theory is used to explain it.

        But as the Israeli pilots story demonstrates, results can be misinterpreted, leading to an ineffective therapy being employed. So be just as cautious about anything novel or alternative as you would be about allopathic medicine, which as we know is the third biggest killer these days..

        1. Sasha

          Martin, an idea that “the same results will always arise from the same therapy” comes with lots of caveats in medicine. It rarely (I would say almost never) happens that way. Give ten 50-year olds a drug for afib and you will get one batch of results. Give the same drug to ten 80-year olds with afib and you will get a different batch of results. There will also be lots of variation within each group among individuals. Moreover, give the same drug to the same person after they had a good night’s rest versus when they just went through a flu and you will get a variation in results.

          There is nothing novel or alternative about acupuncture. The oldest surviving acupuncture texts are from around 2nd century BCE. Alternative is a misnomer. There’s no such thing as alternative medicine. There’s good medicine, not so good medicine and bad medicine. What’s good in one instance may become not so good or even bad in another, so again it’s all context dependent.

          Many of the observations of modern medicine confirm or repeat what Chinese have been talking about for literally millenia. In “Statin Nation” Dr Kendrick says that he’s been “banging on for years” about emotions affecting physical organs and vice versa. 2,000 year old Chinese texts would agree. They say that emotions injure the Jing (or essence) of the internal organs.

          This year scientists discovered a new organ which they named interstitium.


          It corresponds to the organ within Chinese medicine called San Jiao or Triple Burner which Chinese physicians called an organ without a form.

          Acupuncture is a science based on careful observation of nature and how it affects the human body. That’s probably why physicists never have a problem understanding the basic tenets of Chinese medicine like yinyang. Maybe that’s why Niels Bohr had yinyang symbol engraved on his coat of arms. I’ve also heard that people who study cybernetics can immediately grasp the concept of 5 phases that forms the foundation of Chinese medicine.

          At the end of the day people are free to choose whatever approach they feel will work for them. I know what I would do if I developed afib, for example. What everyone else does is their business. However, when people start claiming that acupuncture is placebo or regression to the mean, I will argue that it isn’t and there’s plenty of evidence to prove them wrong.

  62. Justme5625

    “One word of warning, all men by age of fifty-five – even men with no other risk factors at all – will have a risk greater than 7.5%. At least they will, using ‘cvrisk’. Because age is by far the most powerful risk factor of all – at least it is on ‘cvrisk’.”

    This is simply not true. I just went to the calculator and entered the data myself and it indicated a risk of 1.8% and recommended against statin therapy.

      1. Justme5625

        I used cvrisk. Just used it again with a hypothetical 55 year old man with “normal” lipids and BP and it came out as 3.1%.

  63. Gary Ogden

    “A Statin Nation” arrived today, by pony express. Perfect timing, since I had just finished the second reading of “Doctoring Data” (my rule of thumb is that any book worth reading is worth at least three; each of my 50+ Wodehouse titles I’ve read six or seven times). But. It was the most perfect, sunny, warm January day. In addition one of our cats had spent nearly two weeks in kitty jail to heal a soft-tissue injury, which caused intermittent lameness, that the vet, upon detailed examination, couldn’t find. So I spent the day in the garden after springing the feline a day early. Poor thing suffered from massive cabin fever. Where did he go? The roof, incorrigible leaper and climber to high perches that he is. He was delighted to be outside. But, I’ve since made it to Chapter 7! Thank you, Dr. Kendrick for the CVD primer, that of “fats,” and especially of triglycerides, which I never really understood particularly well. I’ll be enjoying “Cholesterol” while digesting pork chops.

    1. Martin Back

      Talking about doctoring data, I read this today:

      “A stunning report published in the Annals of Internal Medicine concludes that researchers often make “inappropriate requests” to statisticians. And by “inappropriate,” the authors aren’t referring to accidental requests for incorrect statistical analyses; instead, they’re referring to requests for unscrupulous data manipulation or even fraud.

      The absolute worst offense (i.e., being asked to fake statistical significance) occurred to 3% of the survey respondents. Another 7% reported being asked to change data, and a whopping 24% — nearly 1 in 4 — said they were asked to remove or alter data. Unequivocally, that is a request to commit scientific fraud.

      Of the less serious offenses, 55% of biostatisticians said that they received requests to underreport non-significant results.”https://www.acsh.org/news/2018/10/30/1-4-statisticians-say-they-were-asked-commit-scientific-fraud-13554

    2. Sue Richardson

      I’m reading A Statin Narion too Gary. Haven’t finished it yet. You mentioned the wonderful PGW. In my humble opinion Dr K is the PGW of the medical world. He just has that way of turning a phrase that makes me laugh out loud. I know of no other author who could write a book about cholesterol, statins and heart disease and make me laugh at the same time. Pretty good writing I’d say.

      1. JanB

        Yes, hear, hear! A wonderful read, informative, engaging, thought provoking – everything I could wish for.
        Thanks, Dr. K.

      2. Gary Ogden

        Sue Richardson: How right you are! I’ve often thought exactly the same thing myself. Something utterly charming about British humor (as we spell it here in the colonies). The book is so fine, I’m beginning my second reading this very morning!

    3. shirley3349

      Nowadays, I probably have to read a book three times to remember it at all. This has its advantages, mind you. One’s library lasts far longer without replenishment. Novels, especially detective ones, hold one’s interest on each rereading: one has a good chance of remembering who done it, but one has forgotten all the intricacies of the plot.
      Scientific or medical matters are more difficult though. Though I can usually follow an argument when I am reading it and can often spot what I feel are inconsistencies at the time, I cannot recall it in detail to reproduce it at a later date without many re-readings. My husband says I get obsessed, but I feel that this going over things is just the necessary compensation for a failing memory.

      1. Gary Ogden

        shirley3349: As Dr. Kendrick says, sometimes reading this stuff makes your brain hurt, and I’ll freely admit, at one point in “A Statin Nation,” this happened. Hurt much less the second time through.

  64. Clathrate

    YAWN. I’m catching up on the blog having been in China.
    First point, you state ‘0 evidence’ – you are having a laugh. What comes across is there’s a bunch of crackpots who hide behind names, won’t (refuse and are chicken to) debate science and think they are laughing. Sorry, you have egg dripping down your face. You are numero uno one for 0 evidence.
    Second – you accuse someone of being a madman. Have you looked in the mirror.
    Third, about being in China – if it moves, it is eaten. At the end of a meal they bring out either noodle soup or rice to ensure people finish full. I’ve seen a lot of wasted noodles and rice at the expense of meat and sea creatures.
    What is your strategy going to be for dealing with Chinese meat/flesh eating (though you could be Chinese but as you hide in the shadows, who knows – not that people here care).

  65. Göran Sjöberg

    I often find the newsletters from Dr. Mercola interesting, bringing new ideas or confirming my own previous ones. I guess that the latter part is what keeps me attached.

    In todays newsletter with an interview with Dr. Ornish he brings up what may seem as totally contrary to my own ideas about LCHF to keep well.


    Still I think there is a common denominator between us that more connects than what separates our views and that is principally not about the diet but the softer and probably the most important parts of the Ornish program in my eyes which belongs to what Malcom often stresses – to be strongly connected with your social surroundings at different levels.

    Although I found Dr. Mercola’s interview with Dr. Ornish convincing I am still a strong believer in the benefits of the LCHF life style (based on my own strong experience and especially the ketogenic diet part if you now have been trapped in the metabolic syndrome with T2D/CVD) but the most important part is probably the part aimed at reducing stress and here I am also convinced that the high carb diets, especially the sugar part, adds to this stress with blood sugar values going up and down. Without being very familiar with Ornish program and his suggested diet I believe that also addresses this issue although I am convinced that taking the carbs away and going high fat moderate protein is far more effective in this respect.

    BTW Ornish is on Wikipedia and thus “politically correct”.

      1. Göran Sjöberg


        I guess by going into a “starvation” mood on green veggies for a while you will enter the ketogenic state which seems to be very favorable for healing ailments in general. I just encountered the Gerson therapy which is in the same veggie realm and it is also convincing to watch what one claim to achieve not least relating to malignant cancer.

        This is as I see it now what I achieve with a my very high fat LCHF way of life..

        I have a breathing meter (Ketonix) I use regularly to confirm that I am in a moderat ketonic state almost all of my time.

    1. Martin Back

      Goran, let’s not dismiss Wikipedia out of hand. Your hero Lierre Keith gets a Wikipedia page, and she is far from politically correct.

      Apart from Dr. Ornish’s dietary recommendations (more soy, less fat and cholesterol), which Dr Mercola wisely skips over, I think his program is pretty good, particularly the mutual support part. And to get it funded under Medicare is awesome.

      I had to laugh at the following:

      Medicare Officials: Well, we’ll do a demonstration project, but you have to get a letter from the head of the National Heart, Lung, and Blood Institute of the National Institutes of Health, that your program is safe for older Americans.

      Dr. Ornish: Safe compared to having your chest cut open?

      Medicare Officials: No. Just [that it’s] safe for older people to walk, meditate, eat vegetables, quit smoking and love more.

      Dr. Ornish: You must be kidding.

      Medicare Officials: No. We’re not.

      So Dr. Ornish gets his letter and after 16 years gets Medicare approval. But really, the timidity and ‘cover your ass’ mentality of officialdom on display here makes one despair of ever getting substantive changes made in the dietary recommendations.

  66. Dr. John H

    I think your last sentence says it all. Ornish appears politically correct, which is great when someone wants to get rich and famous. Not so great for someone who is interested in the truth.

  67. Andy S

    While investigating breathing I came across this:

    The physiological effects of slow breathing in the healthy human

    “Controlled, slow breathing appears to be an effective means of maximising HRV and preserving autonomic function, both of which have been associated with decreased mortality in pathological states and longevity in the general population [41, 111–119].”

    “HRV is therefore largely a product of parasympathetic and sympathetic nervous system activity [38]. HF HRV oscillations are thought to be predominantly parasympathetically mediated, while LF HRV oscillations are thought to be both sympathetically and parasympathetically mediated, depending on the circumstances as mentioned earlier [49, 99]. HRV is therefore regarded as a qualitative index of “sympathovagal balance”, reflecting the weight of parasympathetic versus sympathetic autonomic control, whereby a higher LF/HF HRV ratio reflects sympathetic dominance and a lower ratio reflects parasympathetic dominance [100–102].”

    1. binra

      This is – in my estimation – a very significant context or underlying condition for so many of the other ‘suspects’, co factors or associated symptoms of heart disease. It also brings us into the realm of conscious awareness, intention and responsibility for thought and behaviour.

    2. Göran Sjöberg

      Andy, a good point!

      Though this state, as a “cause”, seems difficult to “analyze” although it, according to Malcolm, is the most convincing “indicator” telling about an immediate MI. “Stressed” breathing as opposed to a slow regular one has always (?) been regarded as a sign of a severe stressed state.

      There is also a strong logic involved here since the heart muscle, contrary to other muscles, is governed by its own special autonomous nervous system but though strongly affected by what is happening around us through the vagus nerve connection.

      A few years ago I got seriously interested in this part of my CVD disease since I was struck by unstable angina. It was not least through Dr. Sroka’s papers on the importance of the HRV in connection with MI I wanted to pursue my own understanding. When the HRV equals zero the MI is a fact if I understand Dr. Sroka right. But WHY was my fundamental question.

      Through a common friend I then met with an experienced heart surgeon who just had finished his M.D. degree on research on the effects of ablation on AF which is of course all about the nervous system of the heart going awry. Before our meeting I thought he should be very right person to explain how all this connected.

      The scary part of our meeting was that I immediately realized that he had not “the faintest idea” of what I was talking about. He thought our meet was to be on how he could help me to “bypass” the waiting list to a CABG. He was evidently most interested to have “a good life”. Thiis realization was just the last “nail in the coffin” for my trust in any “heart specialist” a “scientist”. They are in my eyes more of a skilled kind of car mechanics than seriously interested in their understanding of their job in a broader context.

  68. Charles Gale

    Goran states “I am still a strong believer in the benefits of the LCHF life style (based on my own strong experience…).

    Indeed! N=1.

    On that note, I know there are many of us here, including me, who have had their (often) rage inducing encounters with their GPs.

    This comment from “Chronically Sarah” found it’s way onto Mike Eades’ Twitter today.

    Chronically Sarah posted this:

    Doctor: Don’t confuse your Google search with my 6 years at medical school.
    Patient: “Don’t confuse the 1 hour lecture you had on my condition with my 10 years of living with it”.

    I had that typical GP comment countless times – wish I’d had that great reply though!

    1. AhNotepad

      A friend’s GP went with to see an oncologist who was treating him. The GP went in to see the oncologist and came out somewhat bemused as the oncologist had looked up the condition using Google. Not any special medical Google, just the one we all have access to. So even the professionals use it.
      If a doctor ridicules a patient for using it they might indicate insecurity as well as arrogance.

      1. Martin Back

        They were discussing the state of our hospitals on the radio, and one lady phoned in to say she went in for a knee operation and the doctors were checking on YouTube to see how to do it. Not exactly confidence-inspiring! Although to be fair, maybe they were checking the finer points of the latest techniques.

    2. David Bailey

      I agree – this is a real problem for many people. It is intensely difficult because on the one hand we respect a GP’s expertise, but suspect they are being advised badly, and also maybe pressurised to do things that their instinct tells them might not be for the best.

      I think doctors should somehow band together and take this problem on board – realising that they are gradually losing their traditional status as highly trusted individuals.

    3. abdlomax

      This RW article was written by John66, who is (preponderance of evidence) Darryl L. Smith, a continuation of Skeptic from Britain. Links:
      John66 contributions: https://rationalwiki.org/wiki/Special:Contributions/John66
      Detailed coverage of the SfB affair: http://coldfusioncommunity.net/anglo-pyramidologist/darryl-l-smith/skeptic-from-britain/ (and see the subpages).

      RationalWiki, by creating an environment where trolls can anonymously create attack articles with no adult supervision, is allowing Dr. Kendrick and others to be smeared for “denialism,” a term which refers to skepticism of views that a pseudoskeptic author believes are the Truth, because allegedly mainstream. These are not skeptics, they are “believers” in cargo cult science.

      I am carefully reading the posts on this blog since the beginning of the “what causes heart disease” series. I have been diagnosed with CVD, I’m 74, I have high cholesterol tests and a diagnosed blockage with ischemia under stress (as seen in a nuclear stress test), I have refused an angiogram and stent and statins, so the topics are of high personal importance to me. Dr. Kendrick is a genuine skeptic, and has not so far fallen into *belief* in his alternate theory, which sounds very plausible to me. I will be writing more about this in various places.

      Kendrick does not, so far, deny that statins have certain benefits. He does claim with very ample evidence, that the “cholesterol” hypothesis is preposterous, in spite of it being treated as gospel truth by far too many. John66 completely confuses the issues, and on his user page he thinks that a study showing the benefits of high fiber in diets is somehow a “blow” to low carb diets. Low carb diets, such as Atkins, do not count fiber as “carbs” because they are not readily digested. In addition, fiber mixed with digestible carbs, like fat, slows down digestion, thus reducing possible stress from high blood glucose or the development of insulin resistance. John66 displays his ignorance with every move he makes.

      It’s obvious. Pseudoskeptics are looking for any mud they can toss. Want another genuine skeptic? I should know because my main focus of late is on cold fusion, which is a poster boy for “rejected by the mainstream,” even though the situation in mainstream journals flipped over ten years ago, and a major book author about the field is . . . Gary Taubes. Taubes is not, as he has been presented, a “believer” in low carb diets, he is actually a dedicated promoter of better research. As am I with regard to cold fusion.

      1. Steve James

        You have confused John66 with someone else. His name is John Slinger according to his user-page… a part time chef and former worker sewer museum worker!

        “Name = John Slinger aka John66Birth date = June 20, 1966Birth place = La Seyne-sur-Mer, FranceCurrent location = Great BritainOccupation = Part-time chef at a hotelDislikes = Fad diets, LCHF quackery, pseudoscienceLikes = Paris Sewer Museum (I used to work there), snowboarding!Email address = Ask me if needed”

        From his userpage


        Regarding the statin denialism thing.. it was taken from http://annals.org/aim/article-abstract/2645554/statin-denial-internet-driven-cult-deadly-consequences an editorial written by Steven E. Nissen, MD. Dr Kendrick has acknowledged this, he mentions Nissen briefly in his new book Statin Nation.

        “Denialism” is not a smear term. I do not think Nissen was trying to smear anyone. But he did describe it as a cult!

        1. Sasha

          In “Widowmaker” movie Nissen also describes people advocating CAC testing as a “medical cult”. I guess, in addition to cardiology, Nissen is an authority on cults…

          1. Gary Ogden

            Sasha: He is also a comedian, but is blissfully unaware of it. Read pp. 108-9 of “A Statin Nation” to ponder one of the most inexplicable statements ever uttered by man or beast. Folks like this are one of the reasons we have a $3.5 Trillion cash register called “health care,” yet are so unhealthy.

      2. Jeffry Bowden

        “Gary Taubes. Taubes is not, as he has been presented, a “believer” in low carb diets”.

        He is a supporter of low-carb dieting. Gary Taubes identifies as LCHF, check his interview with DietDoctor. Here is Taubes giving a presentation at Low Carb Houston, 2018. He also lectured at Low Carb USA 2017. https://www.youtube.com/watch?v=cm5Cdy4-KtU

        Taubes’ carbohydrate-insulin hypothesis has been falsified. See: Hall KD (2017). “A review of the carbohydrate-insulin model of obesity”. Eur J Clin Nutr (Review). 71 (3): 323–326. Run a Google search on this paper, you can find it online.

      3. shirley3349

        K D Hall’s “A review of the carbohydrate-insulin model of obesity” does not review any study where the carbohydrate limit of the diet was less than 20% of the total Calorific intake. This is high for a LCHF diet. The studies were also iso-Calorific, limited to comparing the effects of different ratios of the three macro-nutrients. Not surprisingly, the practical results were modest in the extreme.

        In the real world, a LCHF diet is anything but iso-calorific, compared to the dieter’s previous intake. The high fat content increases satiety considerably, so the dieter automatically reduces the number of Calories consumed. The problem is, as with all diets, the subsequent reduction in the body’s metabolic requirements for any given lifestyle, which will tend to cancel out any weight loss unless the dieter is extremely careful.

  69. Gary Ogden

    Well, I’m catching up with everybody here. Past my use-by date. 100,000 miles on the clock. But Dr. Kendrick says I may very well have another 30 years in the tank, if I continue what I’m doing, so cheers, all!

    1. Steve James

      The guy that wrote that was “John66” a part time chef. His birth date is listed as 1966.. so he is 52. Lol.

    2. abdlomax

      “John66” is extremely likely to be Skeptic from Britain/Darryl L. Smith. He’s about 29-30 years old. The user page bio on RationalWiki is SOP, fake.

  70. abdlomax

    While it is not impossible that John66 is a completely new user, it is extremely unlikely. His behavior is identical to that of Darryl L. Smith and a long succession of sock puppets, including, sometimes, a fake biography and many other red flags. Skeptic from Britain “vanished” (why? He had *not* been outed, rather various apparent trolls claimed that he was a certain person, who was actually someone who had confronted him on Wikipedia. So his “vanishing” was designed to divert attention to someone claimed to be a vegan (because he was vegan at one time).

    These trolls lie extensively, and “lol” is one of their favorite expressions. While there are two brothers involved, this affair appears to just be Darryl. Shortly before SfB vanished, John66 started up (on RationalWiki), but greatly increased activity once SfB finished his final flurry of edits.

    1. Simon Derricut

      Mr Lomax you come across as obsessive. I would like to see less spam and unproven allegations about this Rationalwiki (not the topic of this blog). Can you please point to 12 peer-reviewed scientific papers that support statin denialism from 2018-2019 please? I found only 1 publication by Aseem Malhotra and it was shot down, easily.

      Rory Collins, he compared statin denialism to a belief in a flat earth! He is the sort of man who has saved lives with his research. I am offended by this denialism. Statins have saved my life and my wife’s. How do you explain this? Clearly statins do work! No conspiracy. You said you are 74 and in bad health, perhaps statins will help you. Statin’s also improved my sex life (the wife don’t mind) 🙂

      Simon Derricut

      1. AhNotepad

        Simon Derricut, your unshakable belief in statins obviously permits you to make unsound statements such as “saved my life and my wife’s”. I regret to inform you that death is inevitable and your life will end, and according to the official figures is only an extension of days after years of taking statins. We (nor you) cannot know what research Rory Collins has done as he won’t release his data.

  71. abdlomax

    “Jeffry Bowden” wrote: https://drmalcolmkendrick.org/2019/01/02/what-causes-heart-disease-part-60-prediction/#comment-115530

    First, he quoted me:
    “Gary Taubes. Taubes is not, as he has been presented, a “believer” in low carb diets”.

    And then he wrote:

    “He is a supporter of low-carb dieting.”

    Taubes is first and foremost a science journalist, and literally a supporter of research. His research led him to expose the “Big Fat Lie,” and the work of Atkins and others. I placed “believer” in quotes because pseudoskeptics have claimed that he is a “believer,” which to them is an insult.
    Gary Taubes identifies as LCHF,

    He eats low carb, high fat, and he talks about it. However, this is relevant to what?

    “check his interview with DietDoctor. Here is Taubes giving a presentation at Low Carb Houston, 2018. He also lectured at Low Carb USA 2017. https://www.youtube.com/watch?v=cm5Cdy4-KtU

    I’m about half-way through that (the Houston presentation). Thanks for the link. I like Taubes because he really does understand the power of science — as well as at least some of the limitations. He is a skeptic, like Kendrick. I learned about the Keys study from Taubes, and have learned more from Dr. Kendrick. “Mr. Bowden” continued:

    “Taubes’ carbohydrate-insulin hypothesis has been falsified. See: Hall KD (2017). “A review of the carbohydrate-insulin model of obesity”. Eur J Clin Nutr (Review). 71 (3): 323–326. Run a Google search on this paper, you can find it online.”

    Again, thanks.

    Here is a link that just worked for me, so I have the paper:

    Click to access HallEJCN2017-1.pdf

    Taubes does not own the carbohydrate[insulin hypothesis, so calling it “his” is offensive. Taubes supported the research that supposedly falsified the hypothesis. This is what strikes me: that claim about that review is somewhere between misleading and false. What the paper says in the abstract:

    “Several logical consequences of this carbohydrate–insulin model of obesity were recently investigated in a pair of carefully controlled inpatient feeding studies whose results failed to support key model predictions. Therefore, important aspects of carbohydrate–insulin model have been experimentally falsified suggesting that the model is too simplistic.”

    Setting aside that a “pair of studies” might not be conclusive, and granting that “falsification” might be used as a brief way of stating “may be understood as falsifying evidence,” there remains a large gap between “aspects” and total falsification and the paper actually suggests that the carb-insulin hypothesis is plausible (but without strong evidence). Again in the conclusions:

    “It is important to emphasize that low carbohydrate diets may offer metabolic benefits beyond loss of weight and body fat regardless of whether the carbohydrate–insulin model is true or
    false. Furthermore, experimental falsification of important aspects of the carbohydrate–insulin model does not mean that dietary carbohydrates and insulin are unimportant for body fat regulation. Rather, their role is more complicated than the carbohydrate–insulin model suggests […]

    I have seen this “falsified” claim on Wikipedia, presented in the same misleading way. I will study the paper in more detail, to understand what was falsified and what might still stand.

    1. abdlomax

      I have now read the paper. I will want to read the original studies if possible. However, the review is of two studies and the review author was an author of both studies. This has been treated on Wikipedia as if it were a secondary source review. It is not, it is an extension of the primary sources (the two studies.)
      The studies suffered from a basic flaw, the participants were not allowed to eat ad libitem; rather, the paper has this:

      “Finally, it may be that the carbohydrate–insulin model operates primarily by affecting energy intake such that low carbohydrate diets decrease hunger, reduce appetite and promote satiety
      without offering any particular metabolic advantage for body fat loss. This aspect of the carbohydrate–insulin model was not directly examined in the recent studies as food intake was strictly controlled.[19,20] Under ad libitum feeding conditions, the possible effect of decreased carbohydrates and insulin per se may be difficult to dissociate from the effects of increased dietary protein that often accompanies carbohydrate restriction which may independently promote satiety, decrease overall energy intake, as well as increase energy expenditure, and beneficially influence energy partitioning and body composition.[41,42] Nevertheless, very low carbohydrate diets with limited protein likely reduce appetite by promoting an increase in circulating ketones,[48] although the mechanism for this effect is unclear.[49]”

      The two studies do indicate that simply replacing carbs with fat does not confer a large metabolic advantage, thus the author is technically correct that it falsified the hypothesis in part. There are also other caveats, however, which the author seems to attempt to minimize by emphasizing the failure of ad hoc theorization. To my mind, based on my own experience with LCHF diet, specifically Atkins, initially, the role of appetite is crucial. Being free to “indulge* in foods that I loved is part of what makes an LCHF food plan sustainable. Why should I “break the plan” when I’m having so much fun?

      In the studies, someone other the subject, decided how much the subjects should eat or be allowed to eat, thus the natural regulation through appetite would be suppressed. The author is likely correct that the rather mechanistic “hypothesis” is inadequate. What this all shows is what Taubes has been saying for years: human nutrition is complex.

      As well, the demonization of fat resulting from Keys’ political success causes many people trying LFHC diets to still avoid fat, due to years of conditioning that fat is dangerous, bad, “fattening.” This could easily contribute to failure of the food plan.

      I went in the opposite direction, even before reading Taubes. I started buying heavy cream for my coffee. I relish the fat on steaks. Atkins occasionally would eat a baked potato. So I occasionally eat one: baked with a crisp skin, smothered with butter and sour cream.

      If I’m having vegetables (like broccoli or brussel sproutes), I drench them with butter and parmesan cheese (or sometimes shredded cheddar.) Chicken thighs, I broil with the skin (and parmesan cheese sprinkled on them browns and crisps up, so it’s like fried chicken with crispy cheese instead of a flour-based batter). When I eat, I make noises of delight. (That is deliberate, but it is also natural.)

      This is in line with what I’ve found in Dr. Kendricks’ posts about enjoyment of food (and life in general) being crucial for heart health. Before I read it in his blog, I was writing about people treating eating as an unpleasant necessity. That is no way to live.

    2. Sasha

      Abdlomax, you may also be interested in Stephan Guyenet’s blog where he discusses some of the studies where that hypothesis was falsified. According to Guyenet, he was asked by Taubes and Attia to consult on the studies before they were ran. Dr Guyenet is a critic of Gary Taubes, in particular, carb-insulin hypothesis. He also wrote “The Hungry Brain” which is excellent in my opinion. His blog is very good if one is interested in nutrition, I think.

      1. abdlomax

        Thanks, Sasha. It is like Taubes that he would ask a critic, as did Dr. Atkins. The carb-insulin hypothesis is just that, a hypothesis, plausible but unproven, and that is how science advances. The hypothesis that has been “falsified,” which can be a misleading term, is an oversimplified one, and possibly overspecified, and is not crucial to the hypothesis that, in general, low-carb diets are healthier than the high-carb mainstream hypotheses. In life, we must make choices, based on incomplete information, and if we wait for definitive proof, we will likely die first. The carb-insulin hypothesis may be wrong in some ways, or need adjustment, but it is far more cogent and useful than the cholesterol-heart disease hypothesis, which has failed so many tests it is totally silly it is still being confidently maintained.

        Meanwhile we have actual liars, impersonators, posting here, such as “Simon Derricut,” a name stolen from a frequent commenter on my blog.

        I will look at that blog.

  72. Simon Derricut

    This statin denialism thing is not science. This is why Dr. Kendrick and his associates are confined to posting blog posts about it. It is rarely published in scientific peer reviewed papers. Ivor Cummins for example has no scientific papers! Where are all the 2019 scientific peer reviewed papers on it? Wait … there are 0. Medical journals do not publish this statin denialism.

    Harriet Hall in the Skeptical Inquirer has blasted it https://www.csicop.org/si/show/statin_denialism

    Statins have saved my life. This is nonsense what people here are saying that they do not work.

    Simon Derricut (life long atheist and skeptic from USA).

    1. Dr. Malcolm Kendrick Post author

      Calling something denialism is not a great start to a debate. You state that statins have saved your life. What evidence do you have to support this statement – other than the fact that you are alive? A study published in the BMJ open looking at the increase in life expectancy from statins was, as follows: ‘The median postponement of death for primary and secondary prevention trials were 3.2 and 4.1 days, respectively [after five years of treatment, on average].’ https://bmjopen.bmj.com/content/5/9/e007118 Perhaps you have evidence that contradicts this finding. In which case, perhaps you would like to present it?

      1. Simon Derricutt

        Dr Kendrick – looks like “Simon Derricut” above is a sock. As such, I doubt if he/she will produce any evidence to the assertions. Check the email address of the sock (which is probably a burner anyway) and if you deem it a good response then delete the comments as spam. For reference, I’m English and have never taken statins either, and would refuse them for the reasons you’ve given. Maybe he/she tried to use my name because I’m a friend of Abd.

    2. AhNotepad

      Ah, I see, from the USA. Love of statins and fluoride in the water proves that mind control works. We are lucky in the UK, we can do our own thinking.

    3. abdlomax

      Simon Derricut frequently comments on my blog. He does not live in the U.S.A. I’m sure he did not write that; impersonation has been a Smith MO for years.

      This is still Skeptic from Britain, Darryl L. Smith, continuing to troll, and misrepresenting here, as he does on RationalWiki, the actual positions of “cholesterol and statin skeptics.” He’s lying, it is that simple. There is a scientific debate in progress, and it is difficult to shift mainstream thinking, this is all well known by sociologists of science. Liars help not at all. If Dr. Kendrick, Gary Taubes, and others are wrong, the scientific process will sort it, eventually.

      I will be writing some responses to the “statin denialism” article on my blog, I think it has become important that I do that (even though the blog isn’t about diet). The troll involved here has been creating massive disruption for years and it’s time that it be confronted.

      Dr. Kendrick, there are legal (criminal) issues involved with impersonation, in addition to libel issues. Please obtain and preserve access logs if you can. While it is likely that this troll used an open proxy or Tor node, sometimes he slips up.

        1. Mr Chris

          In my opinion there are usually two types of trolling
          The first is pure evil, the taking of malign pleasure in annoying other people. Done by the very sick
          The second is an attempt to destroy blog communities, by boring them with endless off topic posts, and thus driving the sensibles away
          I think we are experiencing the second type.

      1. Henry

        Mr Abd Lomax – It is not impersonation. The name is different – Simon Derricut has one t. On your blog it has two. I believe this was a legit person. People do have similar names! Not everything is a conspiracy theory.

        No offense but this Abd person is a well known internet troll, who likes to stir up law-suits for people, law-suits that never materialize. He said he was suing Wikipedia because they banned him but the lawsuit never happened. He said he was suing Rationalwiki for creating an article about him but it never happened.

        His agenda is to stir up trouble for people. He has been banned on Wikipedia, Meta-Wiki, Wikiversity and practically every other wiki on the internet. You you should hosting his comments here.


  73. Henry

    I do not get why people hate drugs here, its mad. The institute for natural healing that kendrick is a medical advisor for, they say that blood pressure medication should be avoided, they also say that coronary angioplasty and stent insertion, bypass surgery, statins etc are all scams and should be avoided. This dangerous medical advice is literally killing people.

    1. Dr. Malcolm Kendrick Post author

      Stent insertion in the non-acute situation are of no benefit – as published in various medical journals https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32714-9/fulltext. Blood pressure medication should be avoided (unless systolic BP is above current guideliens). This is not dangerous advice, it is evidence based. https://medicalxpress.com/news/2018-11-benefits-blood-pressure-guidelines.html

      I am not against all drugs – of course not, but please review the evidence base before making broad statements, that are incorrect.

    2. binra

      The way you frame your seemingly innocent assertions denies any other view than YOUR assertion as sane. So though you don’t use the term denialism, you are framing the same accusation or insinuation of ‘dangerous advice’ as they.
      Kendrick has extensively researched and backs up his current views with facts. Show your substance or recognize you have no basis from which to speak apart from what SEEMS so to your current perception.
      You might assume that there are REASONS and thus be CURIOUS as to why others are critical of the way that many seemingly helpful medical interventions are operating more harm than benefit.
      You might read, listen or learn something of what you are saying before you say it – and thereby give and receive something worthy in a genuine exchange.
      As it is – you are doing the very thing you accuse against – knowingly or not.

  74. Sarah

    I believe that vegans are behind these “debunking” articles, and they have made it clear the purpose it to use Google, they went behind silly names like “Vegan Warrior” or “Vegan Lady”. You are looking at teenagers or people in their young twenties with nothing better to do but become hooked by a “cause”. They think they are promoting “science” and “debunking” anti-science.

    Rationalwiki is not a vegan website, they are just using it for their anti-low carb agenda. No doubt the person who created these articles will disappear soon or re-surface under a new name. The people behind this have caused a mass-load of confusion, impersonation, deception and manipulation to try and deflect. Tom Naughton has received fake emails from people claiming it is not vegans, suspicious.

    Big Pharma are not behind this, this is young adolescents with far too much free-time on their hands. Why else would every mainstream low-carb writer be added to this website, but no criticisms of vegans? This is probably a paid attack. If you look through the editing history of the person who has been creating these articles, he/she is online from 12 at night to around 10am in the morning.

    The latest:


    1. Time to move on folks

      Abd Lomax you come across as an obsessive individual. You have spammed your coldfusioncommunity website onto this thread many times. Cold Fusion has nothing to do with heart disease. You are merely trying to get web-clicks to your website. Please stop! We want to discuss heart disease here, not this nonsense of trolling.

      1. abdlomax

        I do not know why Dr Kendrick approved the obvious troll, “Time to move on folks.” I have preferred to respond with details on the attack on cholesterol skepticism and Dr Kendrick and the whole field, on a blog accessible to me, where it does not so much distract from, indeed, heart disease. There have been no objections from Dr Kendrick to the links to my blog. I am a real person, not anonymous, and I believe he has my email address.

        However, this is the connection with cold fusion and why I have focused on the socking. The faction that has pushed the idea that cholesterol skepticism is quackery, and the specific troll involved, most intensely, Darryl Smith, earlier attacked research into cold fusion, and specifically attacked the study of cold fusion and other fringe science on Wikiversity, thus damaging the neutrality of Wikiversity, which had, previously, maintained rigorous neutrality, neutrality by inclusion, appropriate for an academic setting, rather than neutrality by exclusion, more appropriate for an encyclopedia project. So what we have in common is an understanding of the importance of the freedom to investigate what is not “mainstream.”

        As well, there is another connection. A major book on cold fusion, Bad Science, was written by Gary Taubes, and it remains the best source for the early history of the field. In my view, Taubes was wrong about cold fusion, as to his general opinion, I have communicated with him, and he fully supports the work I am doing to encourage research, as I support his NuSi initiative.

        And the same troll is now attacking Taubes.

        Taubes had very good reason to be skeptical of cold fusion, and his reasons apply in spades to what he found about the cholesterol and fat/heart disease claims of the 1970s and on. Bad Science.

        Last night, I watched a news report on my phone about the decades-long diet confusion that featured Taubes. Tried to find the link. Couldn’t. It seems to have disappeared. Anyone know what it could be?

        I must say that Dr Kendrick has enormously clarified my understanding of atherosclerosis and why cholesterol in the blood does not cause it. This is literally a life/death issue for me, as I have both a heart blockage and have been following a low-carb high-fat diet for more than a decade (I think the blockage predated the diet, I had followed a low-fat recommendation from my doctor in about 1980. Low fat? Okay, I can eat pasta, which I never liked all that much. But it was filling . . . . And I gained maybe forty pounds. This is a very common story.

  75. smartersig

    Four different Machine Learning Alogorithms were tested on th data and not one of them managed to put LDL in the top 10 risk factors. Total appeared along with HDL


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