Coronary artery calcification (CAC)

17th January 2020

I thought I should write a blog on coronary artery calcification (CAC), as it has become the latest hot topic. CAC scans, and CAC scoring are now increasingly popular, and the results are worrying lots of people who wonder what they mean, and exactly how worried they should be. I get many e-mails on this issue from people who have been scared witless, or another word ending in***tless, by having a high CAC score.

What is coronary artery calcification

Coronary artery calcification (CAC) is the deposition of calcium in artery walls. It represents the final stages in the life cycle of some/many/most atherosclerotic plaques. At the risk of oversimplification, it is generally accepted that atherosclerotic plaques go through four stages

  • Small
  • Bigger
  • Vulnerable
  • Calcified

Forget small and bigger. The important ones are vulnerable and calcified. What is a vulnerable plaque? It is a plaque that reaches a certain size (undefined) containing an almost liquid core, with a thin cap. If this thin cap ruptures, it exposes the liquid core to the bloodstream triggering a major blood clot than can fully block a coronary artery and cause a myocardial infarction.

This is generally described as plaque rupture. If it happens in an artery in the neck, a carotid artery, the clot will normally not be big enough to block the artery. But it can break off and head up into the brain, causing a stroke.

Which means that it is these ‘vulnerable’ plaques that are dangerous, and these are often not calcified, and therefore cannot be seen on a CAC scan.

Over time, assuming the vulnerable plaques do not rupture and kill you, some of them (all of them?) shrink down in size, become more solid and start to calcify. At which point they are less likely to rupture and may be considered relatively benign.

Calcification of areas of damage in the body is not restricted to atherosclerotic plaques. Almost any damaged area in the body, that is not perfectly repaired, is likely to calcify to some extent or another. Scars tend to be white, and the white is calcium.

At the extreme end of calcification is a condition called myositis ossificans, whereby almost any damage ends up becoming bone. With damaged muscle turning into bone. This does not end well.

Anyway, assuming you have plaques developing and growing in your arteries, they will in time calcify. Or at least some of them will. Are some people genetically more likely to get calcification than others? Almost certainly.

Some things are known to increase the rate of calcification. Statins, for example. Here from the Cleveland clinic:

  • Patients with coronary artery disease (CAD) who are treated with statins experience an increase in coronary calcification, an effect that is independent of plaque progression or regression.
  • Paradoxically, high-intensity statin therapy is associated with the largest increases in coronary calcification despite promoting atheroma regression 1

With statins the plaques get smaller and the calcium load gets bigger.

Another drug that whacks up the rate of calcification is warfarin (often called coumadin in the US).

‘The vitamin K antagonist, warfarin, is the most commonly prescribed oral anticoagulant. Use of warfarin is associated with an increase in systemic calcification, including in the coronary and peripheral vasculature. This increase in vascular calcification is due to inhibition of the enzyme matrix gamma-carboxyglutamate Gla protein (MGP). MGP is a vitamin K-dependent protein that ordinarily prevents systemic calcification by scavenging calcium phosphate in the tissues.’ 2

High intensity exercise also stimulates CAC.

‘Emerging evidence from epidemiological studies and observations in cohorts of endurance athletes suggest that potentially adverse cardiovascular manifestations may occur following high-volume and/or high-intensity long-term exercise training, which may attenuate the health benefits of a physically active lifestyle. Accelerated coronary artery calcification, exercise-induced cardiac biomarker release, myocardial fibrosis, atrial fibrillation, and even higher risk of sudden cardiac death have been reported in athletes.’ 3

An interesting mix, I think.

  • Statins increase calcification
  • Warfarin increases calcification
  • Intense exercise increases calcification

Yet, all three reduce the risk of dying of cardiovascular disease. Yes, even statins – a bit.

But, let’s turn this around for a second. If you have no calcification in your arteries, you have a greatly reduced risk of dying of cardiovascular disease. Which means that calcification can be both good, and bad? Yes, you are right, this area is not straightforward at all.

Even if you look at non-calcified atherosclerosis, or pre-calcified atherosclerosis, the picture is complex.

For many years I have studied the Masai villagers, on and off. They are fascinating because, amongst Masai males, the diet almost entirely consists of cholesterol and saturated fat – or at least it did. Nowadays, I believe it is more McDonalds and Subway.

Despite their previous super-high saturated fat and cholesterol diet, their cholesterol levels were the lowest of any population studied. However, they developed atherosclerosis at around the same rate as any Western male of the same age.

Added to this, and just to make things even more complicated, there were no recorded cases of any male Masai villagers dying of CVD. Which made me think, at one time, that atherosclerosis and death from CVD must be unrelated phenomenon.

You think not? Here, for example, is a study on the Masai from 1971 by George Mann (who helped to set up the Framingham Study and then became a trenchant critic of the cholesterol hypothesis).

Atherosclerosis in the Masai

‘Do the Masai not develop atherosclerosis or do they have it but remain immune to occlusive disease because of some other protective circumstances? The question was answered with autopsy material collected over a five-year period. The Masai do have atherosclerosis but they are almost immune to occlusive disease.’ 4

Now, if we bring these facts together, what do they tell us. At the risk of running the thinking too fast, these facts tell us that atherosclerosis, calcified or not, is necessary for someone to die from CVD. However, it is not sufficient, by itself, to cause death from occlusive disease.

In epidemiology this is the well-recognised concept of ‘necessary but not sufficient’. It actually applies to many/most diseases. For example, you cannot get TB, or die of TB, without infection with the tuberculous bacillus. However, you can be exposed to the bacillus and not have TB.

Why, because your immune system fought it off. Which means that the tuberculous bacillus is necessary but not sufficient, to cause infection and death from TB. As a slight aside, one sign of TB is calcified nodes in the lungs. Which can mean that you have active TB. Alternatively, it can mean that you had active TB, which has now been cleared out, leaving only calcification.

Turning back to atherosclerosis, and using the Masai as one example, it is clear that you can get atherosclerosis, and calcified atherosclerosis, and not die of CVD, or even have an increased risk of CVD. Why, because other factors are required to kill you. Which is why it can be said that atherosclerosis is necessary, but not sufficient, to cause heart attacks and strokes.

To put this another way, you are exceedingly unlikely to die from an acute blockage to an artery without any atherosclerosis [or at least this is vanishingly rare], but just having atherosclerosis is not sufficient to cause heart attacks and strokes.

Which means that for example, if your atherosclerosis is (only) caused by intense exercise you are at no significant increased risk of dying CVD. In this case your calcified atherosclerosis is not sufficient to cause CVD.

‘A new study of mostly middle-aged men in JAMA Cardiology found the most avid exercisers—averaging eight hours per week of vigorous exercise—did indeed show greater levels of coronary artery calcium (CAC). Nevertheless, they were less prone to dying over the average follow-up period of 10.4 years compared to men who exercised less, suggesting they can safely continue their workout regimens. 5

However, if your CAC score has gone through the roof because of say: diabetes, smoking, steroid use, air pollution, heavy metal toxicity, high Lp(a), lack of various nutrients etc. then you are at great risk of dying of CVD, and you need to do something about it.

Further complications

At one time atherosclerosis was defined as either athero…sclerosis, or arterio…sclerosis, in acknowledgement that there seem to be two distinct and different type of …sclerosis in your arteries. This concept seems to have fallen by the wayside.

This may be a mistake. Some years ago, the AHA tried to define all the different types of lesion* that could be found in arteries. The report was so big, that it got split in two 6.7. Then it got ever bigger, and then they gave the project up. The reports are long, and mind splittingly boring. One of them was a ‘twenty cups of coffee’ read. Followed by three Red Bulls.

(*lesion = abnormal thing)

What I learned, I think, in the moments when I was still conscious, was that atherosclerotic plaques are most certainly not all the same. Which lead me to think that we should attempt to bring back arteriosclerosis as a concept.

By which I mean the idea that some plaques develop, primarily, in response to biomechanical stress – such as is caused by physical exercise. On the other hand, some plaques develop in response to factors that independently damage the endothelium – such as a high blood sugar level, or smoking. With the addition of high clotting factors.

Whilst all plaques are now called atherosclerotic plaques, they do not all look the same, and they probably do not act the same. The arteriosclerotic lesions are thinner and more fibrous, they have no real lipid core and are very unlikely to rupture. They are, still, sometimes called fibroatheroma.

On the other hand atherosclerotic lesions are thicker, have a lipid core, more likely to narrow the artery and are also more likely to rupture, causing an occlusive blockage – leading to a stroke and/or heart attack.

Which is why the Masai (the most heavily exercising population on the planet – at the time) had …sclerosis yet remained ‘almost immune to occlusive disease’. Which is also why people who exercise intensely can develop …sclerosis and calcification but are not at an increased risk of dying of CVD.

However, both arterio and athero… sclerosis can calcify. So, they (probably) look much the same on the CAC san.

Moving on, again.

Sensitivity and specificity

Getting back to the CAC test, and what it means. The next issue is one that plagues all screening tests. Namely, what is the sensitivity, and what is the specificity? Something I always get the wrong way around in my head, then I must go back and look it up, to get it clear again.

To explain. A perfect screening test is one that is 100% sensitive and 100% specific. No test has ever achieved that, and I doubt any test ever will.

Sensitivity means, how good is the test at picking up that someone with the disease is identified as having the disease. Specificity means, how good is the test at making sure that people who do not have the disease are accurately told that they do not.

If we look at breast cancer, the first sign of breast cancer can often be that a woman feels a lump in her breast. However, many things that are not breast cancer, can cause a lump in the breast. Let us say 50% of palpable lumps are not breast cancer. If this is true, then the specificity of manual examination of the breast, in detecting breast cancer, would be 50%.

What of mammography? While it is clearly much better than manual palpation (from a sensitivity point of view) many cancers that cannot be felt, can still be seen on a scan, but it is actually worse from a specificity point of view.

This is because many/most ‘abnormal’ things seen on a mammogram will turn out to be benign. Sensitivity and specificity are often inversely related.

Some things sit in an intermediate area. In breast cancer screening a lot of women are told they may have breast cancer, but what has been detected is an abnormality called ductal carcinoma in situ (DCIS). This is something that may, or far more likely may not, progress to become a significant breast cancer. Should it be treated, or not?

The specificity problem is a problem for almost all screening tests. You have managed to find something abnormal on your test. Is it really abnormal? Does it need treatment? Would it have been better not to have found this ‘abnormality’ at all.

This is not a simple argument. Although it is usually presented in the most black and white terms if you question the breast cancer screening programmes. ‘Do you want women to die of breast cancer?’ Is a statement I have often heard from the pro-screening side. How does one answer this? ‘Well, of course I do. I see it as my role, as a doctor, to ensure that as many women as possible die from breast cancer.’

The real debate, of course, is far more complex and nuanced. Do the harms of finding benign abnormalities (with all the anxiety, further investigations, possible mastectomies etc. that this causes) outweigh the benefits of finding breast cancer at an early stage? Currently, the answer seems to be … yes.

If you want a far more detailed review of this area, you could buy the book ‘Mammography Screening’ by Peter Gøtzsche.

‘If Peter Gøtzsche did not exist, there would be a need to invent him … It may still take time for the limitations and harms of screening to be properly acknowledged and for women to be enabled to make adequately informed decisions. When this happens, it will almost entirely due to the intellectual rigour and determination of Peter Gøtzsche.’ Iona Health President RCGP (Royal College of General Practitioners)

Screening and scanning always seems a fantastic idea. Pick up a disease early, then you can treat it, even cure it. Presented in this, the simplest form, who could argue against it?

But it is not simple, in medicine very few things are. Breast cancer screening – in fact most cancer screening programmes – are far from black and white. You can argue for them, you can argue against them.

And, at present, cancer screening programmes are much better than CAC screening, for many other reasons. I will only deal with the most important one. Which is that… We don’t know what to do about the finding!

If you find a small, early stage, not yet spread anywhere, breast cancer you can remove it. It is gone, never to return. But what are you going to do with calcified plaques? You certainly can’t remove them. You do not know if they are going to rupture. They probably won’t. If you manage to stop the calcification getting worse, are you doing any good. Who knows? What caused them in the first place?

It is not even the calcified plaque that is the problem. The calcified plaque is only really a marker for earlier stage vulnerable plaques. If these start to calcify, this is probably a good thing, but whilst calcification is going on, the CAC score will be getting worse – while your risk of suffering a myocardial infarction is falling.

Sensitivity and specificity, false positives – and CAC scans (Pandora’s box)

My first general comment here is that you should never start screening and scanning until you are extremely certain, based on strong evidence, that you understand the natural history of the disease you are screening for.

Also, that you fully understand what the results of your test mean. And that you have an effective treatment for any abnormality you find.

These criteria are all missing with CAC scans.

Yes, a negative scan – no calcium detected – has reassurance value. If you have no calcium in your arteries, you almost certainly do not have any type of …sclerosis in your arteries. So, your risk of CVD is low.

However, positive scans, like positive mammograms, will include a very high number of false positives. Then what? You have been told you have significant calcification in your arteries. But it is ‘good’ calcification, or ‘bad’ calcification. Are you at increased risk, or not? This, no-one can tell you, for sure.

Equally, if you have calcification in your arteries, what are you going to do about it? Take statins… that makes it worse. Do more exercise…. that makes it worse. If you don’t know why you have calcification in the first place, it becomes impossible to take steps to do anything about it.

This is somewhat analogous to having a genetic test to discover if you have Huntington’s Chorea – if one of your parents had it. Do you want to find out that you have a disease – which will kill you – that you can do absolutely nothing about?

In a similar way should you have a test for Alzheimer’s, to find out if you are going to get the disease. Do you really want to know that you are going to have a terrible and devastating disease, and that there is nothing that can be done to prevent it?

In fact, CAC scans meet most of my criteria for ‘a bloody awful test that should not be done.’ It may or may not mean anything, there is no clear guidance as to what you can do about it if it is positive, and it spreads fear and anxiety in many, many, people. I should know, my inbox is stuffed with e-mails from people terrified by their CAC score.

Recommendations

My first recommendation is that, if you have not had a CAC scan, do not have one.

My second recommendation is that, if you have had a CAC scan, and it shows no calcification, good. Do not have another one.

If, however, you have had a CAC scan and it shows significant calcification. What then? What then indeed? You may want to read this paper: ‘Non-invasive vulnerable plaque imaging: how do we know that treatment works?’

‘Atherosclerosis is an inflammatory disorder that can evolve into an acute clinical event by plaque development, rupture, and thrombosis. Plaque vulnerability represents the susceptibility of a plaque to rupture and to result in an acute cardiovascular event. Nevertheless, plaque vulnerability is not an established medical diagnosis, but rather an evolving concept that has gained attention to improve risk prediction. The availability of high-resolution imaging modalities has significantly facilitated the possibility of performing in vivo regression studies and documenting serial changes in plaque stability. This review summarizes the currently available non-invasive methods to identify vulnerable plaques and to evaluate the effects of the current cardiovascular treatments on plaque evolution.’ 8

It will, at least, give you some idea of the other forms of investigation that are available.

Or, you might want to read this one: ‘New methods to image unstable atherosclerotic plaques.’

‘Atherosclerotic plaque rupture is the primary mechanism responsible for myocardial infarction and stroke, the top two killers worldwide. Despite being potentially fatal, the ubiquitous prevalence of atherosclerosis amongst the middle aged and elderly renders individual events relatively rare. This makes the accurate prediction of MI and stroke challenging. Advances in imaging techniques now allow detailed assessments of plaque morphology and disease activity.

Both CT and MR can identify certain unstable plaque characteristics thought to be associated with an increased risk of rupture and events. PET imaging allows the activity of distinct pathological processes associated with atherosclerosis to be measured, differentiating patients with inactive and active disease states. Hybrid integration of PET with CT or MR now allows for an accurate assessment of not only plaque burden and morphology but plaque biology too.

In this review, we discuss how these advanced imaging techniques hold promise in redefining our understanding of stable and unstable coronary artery disease beyond symptomatic status, and how they may refine patient risk-prediction and the rationing of expensive novel therapies.’ 9

The key words in that abstract are ‘hold promise.’

My final recommendation is that we should NOT be doing CAC scans, until it can be proved in a well conducted clinical trial, that we can do something positive and beneficial about the findings.

Yes, a ‘negative’ CAC is reassuring. This, however, must be set aside against the psychological damage caused by a ‘positive’ CAC scan. At present we are playing a form of psychological Russian Roulette. Half the population walks away reassured, half the population reels away, scared witless.

Also, often puzzled and disappointed. I have lost count of the number of people who have written to me saying that they: don’t smoke, exercise regularly, are not overweight, have low cholesterol levels, do not have high blood pressure, do not have high blood sugar levels, etc. etc. yet they have a terrifyingly high CAC score. What should they do?

Well, what can they do?

I don’t know. Because I don’t know what the test means. Not for sure. Not enough to provide any advice that I can be certain is right. Some boxes are better left unopened, however tempting it may be to peek inside.

Just because you can do something does not mean that you should.

1: https://consultqd.clevelandclinic.org/plaque-paradox-statins-increase-calcium-in-coronary-atheromas-even-while-shrinking-them/

2: https://www.amjmed.com/article/S0002-9343(15)30031-0/pdf

3: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132728/

4: https://thescienceofnutrition.files.wordpress.com/2014/03/atherosclerosis-in-the-masai.pdf

5: https://www.cardiovascularbusiness.com/topics/lipids-metabolic/intense-exercise-protective-even-cac

6: https://pdfs.semanticscholar.org/cff1/77c1afc2cd00f6db27cf498cb1d05933ec55.pdf

7: https://www.ahajournals.org/doi/full/10.1161/01.CIR.92.5.1355

8: https://academic.oup.com/ehjcimaging/article/15/11/1194/2399586

9: https://www.atherosclerosis-journal.com/article/S0021-9150(18)30135-7/pdf

 

 

390 thoughts on “Coronary artery calcification (CAC)

    1. Phoenix Hansen

      I loved this article on having a CAC scanning. It’s interesting that I found your article, as that is the conclusion I was pondering myself . . what would you do if you feel you are already eating a low-car/keto diet, exercise, etc.? I’d wig out! Thank you!

      Reply
  1. Le Chris

    Very good, thank you. Is the prevalence of scans another enriching test of little value? Enriching to the medical industry and of potentially little value to the patient?

    Reply
      1. KidPsych

        That’s my thought too. I saw my GP yesterday and he’d asked if I wanted my cholesterol checked. I told him I wouldn’t be doing anything radically different based upon the results, so why bother? (Plus, I gave him an earful about how such tests lack utility in predicting heart disease.) He shrugged and moved on from the topic.

        Reply
  2. smartersig

    Excellent article although you may have now made an enemy of the fat emperor who suggests we should get CAC scans. What would be your best poke at a hypothesis as to why the people with terrific habit and physical profiles get high CAC scans

    Reply
      1. Sue Madden

        I recently came across Cummins podcast and was disturbed by the intense promotion of CAC scans by an otherwise seemingly sincere person promoting a rational approach to the CHD topic. Not knowing a priori anything much re these scans, my personal reaction was; what on earth would I do if I got a high positive result etc etc.? Thinking about it, it seemed that Cummins was advising that you address the metabolic syndrome problem that you MAY have and that the high CAC score in his view confirmed this. Action in response to scan result therefore involved lowering carbohydrate consumption levels. OK.
        Yet I was still left with all the concerns that Malcolm has just so well described – which were illuminating and completely confirmed my suspicions and doubts re the sense of CAC scans. In summary it seems that Cummins is promoting them as a way of finding out whether you need to address the fact that you are eating enough of an EXCESS of carbohydrates to cause, in your case, the beginnings of (or full blown) metabolic syndrome. It seems to me that there are other, less invasive and threatening for any individual to find that out.
        I`m not sure if my analysis of Cummins promotion is fair but I really do wonder at a really intelligent chap going so all out for what even to my unpractised mind, is a really dubious test. Thanks Malcolm once more for the rigorous analysis – clears away all my unease!!
        From what you say Malcolm, from the evidence you discuss, it looks as if this calcification is an extension of the body`s response to the long process of plaque build up. It seems that the calcification is stabilising the plaque which should diminish risk of rupture etc This might be giving a window of reduced risk to those who started off with fatty unstable plaque. Not sure what happens later though as calcification gets worse and worse and arteries stiffen – resulting in high blood pressure? Processes, processes – complexity, uncertainty

        Reply
      1. Alan Hughes

        “Real Science isn’t about agreeing on everything. It’s about Exploring. That’s what makes fun” indeed; anyone talking of a “consensus” should be viewed with great suspicion; the cholesterol con- was built around a con-sensus, or consensus-nonsensus as Michael Oliver put it.

        Reply
  3. jeanirvin

    I have a friend who worked for the NHS and agreed about testing. The more you can measure something the more you are tempted to do something about it.

    Reply
    1. Alan Hughes

      thanks jeanirvin; Sue Madden’s post does not seem to allow a reply at present: we went “very low-carb” and what else can I do, methinks; if I do a CAC; and it is raised; just worry I guess;

      Reply
  4. Kishan Vasekar

    May interest u

    On Fri, Jan 17, 2020, 3:12 PM Dr. Malcolm Kendrick wrote:

    > Dr. Malcolm Kendrick posted: “17th January 2020 I thought I should write a > blog on coronary artery calcification (CAC), as it has become the latest > hot topic. CAC scans, and CAC scoring are now increasingly popular, and the > results are worrying lots of people who wonder what they m” >

    Reply
  5. Dave Nockels

    Quite brilliant, as usual. Defines pretty much exactly the issue I am facing. Gently fending off the natural motive of my interventional cardiologist, to use his hammer (PCI) to hit my plaque (nail). For me the devil is in the detailed history and surrounding circumstances.

    Reply
  6. Bob

    It would be great, Dr., if you could see your way to a short detour into warfarin, especially for DVT, and whether one might sensibly, safely take, say, aspirin instead.

    Reply
    1. Frederica Huxley

      I would also question the advisability of vitamin K2 with regards to calcium in the arteries; is it wise to decalcify plaque? And, do Warfarin and statins cause calcification by inhibiting K2?

      Reply
      1. Danny Evatt

        Just a quick note here. I have done much research into arterial calcification over the years (I have a high CAC score). And in all of my research, emails and discussions, I have yet to see actual evidence of even ONE human on Earth where the CAC score was actually decreased – by any means. In other words, there is no evidence -using before and after actual documented CAC scores using the same scanner, of anyone actually reducing arterial calcium. Slow down the growth? Yes. Reduce it, no. Most studies I have read say that one cannot actually remove (nor should one want to) existing calcium from arteries. Most fishy medical salesmen and bloggers use the term “reduction in plaque” instead of the actual term of a “reduction in calcium”. Obviously, there is a difference.

        Reply
      2. Matic Tepes

        It’s the obvious question yes… Another one is, even if, as Danny is pointing out, the reversal is not possible, and K2 is preventative, as in, slowing down Ca build up in the arteries, is this a positive thing? Or is K2 preventing dangerous unstable plaque calcification (a good thing)?

        Reply
        1. andy

          Matic/Frederica: re is it wise to decalcify plaque?- with K2
          To answer that question one has to understand how calcium ended up in the plaque in the first place. Let’s assume that the plaque process starts at an early age and takes decades of development to become visible on a CAC scan. Now assume that the plaque progression can be broken up into 10 steps. Using the traditional Masai as a model, whose arteries are gummed up with foam cells but have a CAC=0 they could be placed at step 5. They probably get adequate K2 from their diet. Now introduce donuts into their diet and watch their arteries ossify. Probably additional K2 would not change the outcome and they would progress to level 10 where CAC is high. Only solution in this case would be to stop the donuts. Would stopping the donuts be considered dangerous if the CAC score regressed?

          Now someone on a western diet low on K2 would probably slow down progression from step 5 to step 10 by supplementing K2. What happens to calcified plaque if one starts supplementing K2 at step 10 and improves diet.? My hypothesis that the earlier progression steps will see the most calcium regression. The calcium deposits at step 10 (the healthy artery strengthening stuff) will be hard to budge. This might not be observed on CAC scan. All 10 steps of plaque progression can exist in an artery at the same time in different locations. Vulnerable plaque and stable plaque can coexist.

          This scenario would apply to oxidized lipid hypothesis of CVD rather than the scurvy (vitamin C deficiency) model.

          Warning: this is an engineers perspective.

          Reply
        1. Sasha

          Yes, if possible, I would like for those who follow Dr William Davis’ work to answer this question (important in my mind): has he or has he not been able to show evidence of calcification regression in the arteries? Thank you.

          Reply
  7. robertL

    Hi Dr K.
    On this subject (CAD, warfarin, CAC, supplements etc.) : I have previously interacted on this site with a positive response from you – appreciated.

    I have AF. I am prescribed warfarin – nearly 25 years. When I discovered that this leads to higher CAC scores I changed some habits. I increased vitamin K2 (MK4 , 7), added magnesium, and Vit D; in order to mitigate warfarin increasing my CAC score (pushing calcium to the correct places) – and maybe reversing it = your positive response.

    I assume my CAC score is higher than “normal” for age 75 because of warfarin. It might be outrageously high – have not found anyway to assess this (to justify a CAC scan cost etc. to med insurance). And then what am I going to do with the info? take more K2, mag, D? that way leads to madness perhaps

    You refer to vitamin K above – I think you are referring to K1 but maybe K2 is buried in there somewhere – which may be confusing to some.

    So “we” know warfarin increases calcification; do “we” know if this a benign result? Therefore, is there relatively little to worry about from heart attack or stroke from this cause?
    Or;
    is the calcification from warfarin not so benign and should be “attacked” by K2, magnesium, vit D, and vigorous exercise?
    Or;
    is this just one more of the man known unknowns you list above?

    Alternatively;
    Allowing (or even promoting) plaque to calcify turning the lipid core into something less dangerous is perhaps a reasonable course to follow – to lock the danger down and so reduce risk?

    A debate I have had with myself for some time, still intrigues.

    Thanks

    Reply
    1. Alan Hughes

      we hope robertL that you are eating very low-carb; an anecdote: N=1; a good friend of ours went keto; as a senior citizen; she was having bouts of AF; and feeling very unwell when it kicked in; no more bouts of AF, till having sugar binges: she has now more strictly avoided sugar/starches as best she can.

      Reply
  8. Robert Dyson

    Awsome explanation with perfect analogies for clarification. It is not new material for me, but I will read a few times to feel the power of a perfect exposition.

    Reply
  9. Danny Evatt

    Thank you for the addition information Dr. Kendrick.

    I am one of those of whom you speak. My CAC score is 1100, though I am healthy, don’t smoke, etc. My last stress test METS score was even a great 15.3!

    In America at least, I believe CAC scores are used to get poor lost souls into the CVD medical money mill. Once inside the system, they prescribe Statins (I was given 2 prescriptions) and are encouraged to take all manner of invasive tests. My Cardiologist even said that I may even need stents, though he had no evidence of blockages – as my CAC test showed none. And since I know that stents are dangerous and unnecessary unless one is having a heart attack, I took the liberty of firing him after those silly comments. He was my third and final Cardiologist.

    I now avoid all doctors, eat right, continue to exercise and take L-Arginine and high doses of Vitamin C. I try and get plenty of sunshine (Vitamin D) and use no chemical sunscreen. I keep stress down and try to enjoy life.

    Lastly, I hope to get my CAC score up to an even 3000 before my death at the ripe old age of 95. 🙂

    Reply
    1. Doug from Canada

      Hey Danny, Good for you, try aiming for an even 100, I am lol.

      I had to fire my interventional cardiologist after I started taking Mag and had all my symptoms reverse. I think I was just another car payment to that guy.

      Good luck
      Doug

      Reply
    2. Tim Ozenne

      I think I’m a healthy 7 y.o. but my CAC 7 years ago was 2703. Prior to Dr. Kendrick’s essay, I had already figured out that my CAC score wasn’t useful and I reject statins, blood pressure med, etc. It just seems to me that CAC, cholesterol levels and such are just a marketing tool to scare patients into following “advice.”

      Reply
          1. Tim Ozenne

            Yep. Typo.
            Age Date Score
            60.5 3/1/2005 957
            62.0 9/1/2006 1087
            63.6 4/1/2008 1573
            65.1 10/1/2009 1849
            66.6 4/20/2011 2513
            67.8 6/27/2012 2703 Last test
            I was on high dose statins for most of this period.
            My CAC scores scared me then, but I no longer pay attention no do I take statins nor hypertension meds.

      1. kiajoey

        Tim, It seems obvious that high dose statins increased your CAC score year on year, probably by the following mechanisms: https://www.ncbi.nlm.nih.gov/pubmed/25655639

        Would you mind if I asked what type of diet or rather way of eating you followed during these years, and if you have any plans to make changes in diet/lifestyle as a result of the high CAC score. Have to say you probably saved your own life by just removing the meds. Statins are mycotoxins. I hope you have no long term “side effects” as a result.

        Reply
        1. Tim Ozenne

          Nothing special. No knowledge of nutrition, just of economics and statistics. No evidence I can see that statins “work.” Just a way for docs to sell advice. I’ll die when I die without help from so-called doctors.

          Reply
    3. George Clooney's better looking brother

      Thanks for your learnings Danny. What are your thoughts / rules for ‘eat right’, What is a high dose of C, Potassium? Melatonin?

      Reply
      1. Danny Evatt

        George – My ‘eating right’ simply means keeping sugar and carbs down (I found I cannot do a full Keto, though I know many can, I cannot). I do eat 2-3 eggs a day, drink whole milk, eat grass-fed butter, have apples every day, and I so do love whole oatmeal. I have a salad for lunch and meat (pork usually) w/ veg for supper. I try and not eat after 5-6pm and not again until 8-9am next morning. (Though many call this “fasting”, I have done this it all my life.) I drink 4-6 glasses of non-fluoride water/day and am an extreme morning person – having never needed an alarm clock. I don’t smoke, drink or take any prescription RX.

        And though many may think this silly, I try and avoid chemicals in everyday products; such as aluminum in deodorant – I use a natural deodorant, non-fluoride toothpaste, use no dryer-sheets (stinky things!) and use stainless steel or enameled cookery (no teflon). And though not discussed much here, I do think our world has an over-abundance and unhealthy amount of unnatural chemicals added into our foods and household products.

        Daily supplements include 4K Vitamin C powder, magnesium, L-Arginine and L-Citrulline powders. I get plenty of Vitamin D from gardening and walking 2 miles every other day. My potassium comes from salad and vegetables. I don’t use Melatonin as I don’t have trouble sleeping. I also tried Vitamin K supplements for a while though they gave me heart palpitations (PVC’s) – so I stopped though I am probably getting enough vitamin K by eating eggs.

        Sorry this is so detailed, but everything I do, I believe others can do as well – in their own variation. Simply eat good (old-fashioned, grandmotherly) foods in moderation, keep body weight in check, don’t smoke, don’t drink (or in moderation), get some exercise daily or every other day, drink lots of water, get some real sunshine, keep stress levels down and be happy and joyful for this one life we have all been given. Hope this is helpful information to you and others. 🙂

        Reply
        1. Frederica Huxley

          I fully agree with you that we should avoid the majority of commercial personal products – not least because synthetic fragrances are foul. I have also excised all commercial cleaning products, relying on vinegar, baking soda and Castile soap. There are ominous reports that a number of household products are toxic.

          Reply
      2. AhNotepad

        GCBLB, vitamin C dose is whatever amount is required to be symptom free. I have about 10 grams a day, unless I feel I might be catching something, then the amount goes up to whatever is needed so I don’t have the feeling. If I get contaminants on my skin, it goes up, if I am somewhere with exhaust fumes, or those horrid air fresheners, the amount goes up. As for the other supplements, I don’t know enough.

        Reply
        1. dan jensen

          I ran across this in an advertisement of a special formulation of Vit C. I haven’t heard this before.
          Any thoughts?…LIPOSOMAL VITAMIN C BENEFITS Your body can only absorb as much oral Vitamin C as your limited number of nutrient transporters can carry — from the digestive system to the bloodstream, and then from the bloodstream to the cells. The amount of non-liposomal Vitamin C absorbed in the blood decreases dramatically as the dose size increases. Of a 20 mg dose, 19 mg (98%) can be absorbed. Of a 12,000 mg dose, only 16% (1,920 mg) is absorbed, with all that excess causing some major gastric distress when it leaves the body. Vitamin C is water-soluble, so your body can’t store any excess when it gets left behind in either the blood or the digestive system. That’s why so much of the vitamin content from pills, powders, and even foods is passed as waste. And where it gets abandoned dictates the way your body passes it.Using patented technology, we wrap the Vitamin C in double-layered phospholipid spheres (liposomes) that protect the vitamin through the digestive system and transport it into the bloodstream for absorption in the cells. So, you get all the benefits of high-dose Vitamin C without the gastric distress. https://www.livonlabs.com/products/vitamin-c/

          Reply
          1. AhNotepad

            dan jensen, Liveon Labs are spinning a bit. I suspect 12g of ascorbic acid at one gomight cause a bit of distress, but if the dose is divided throughout the day it is unlikely to be a problem. I often have 12g and more a day. The Liveon Labs liposomal C (Altrient C) is a particularly good product. Not all liposomal C is the same, so do not buy only on price, research the product before parting with money. For more information, look up Tom Levy at powerenergy.com

    4. Harley

      I, on the other hand, had a CAC score of 600, and was having issues with fainting. I have high blood pressure and previously was diabetic, although going LCHF with intermittent fasting helped reverse my numbers for that. But after the CAC score I saw a cardiologist who recommended an angiogram just as a check. He found my right coronary artery was 90% blocked, with another 85% block a little further along. He did a couple of stents, and I’m doing great. I personally consider the CAC test as having saved my life.

      I realize this is anecdotal, and I also have no way to know the state of my arteries going forward. I’ve been put on Praluent, which I’m not sure about. But I wouldn’t take statins after having been on them for years until I found Dr. Kendrick. Probably what caused the high CAC score.

      I wish there was a better way of monitoring the condition of my CV system. I’m skeptical about the medical community in general, but at the same time I’m not sure about ignoring all their recommendations. I’m not ready to die yet. It’s a hard place to be.

      Reply
  10. Kim Amburgey

    Dear Malcolm,

    Wow! Your post is so timely and I can’t thank you enough! I just had a Calc Score last week – results were 0.

    I had test in the hopes of validating my refusal to go on statins, despite always having very high cholesterol (currently 400 at age 60). Can you imagine the flack I’ve gotten from GPs over the decades?? It didn’t make sense to me to take a statin, as my Mother and her 4 siblings all had sky high cholesterol, all lived to be over 85 and none had any heart issues, ever!!

    I realize the test could have gone a different way, and I’d be ******* bricks right now, but you can’t imagine (or maybe you can) the pressure GPs put on patients here to go on statins, and if you refuse – everything you say after that is dismissed as you are now a “difficult patient”. Grrrrrrr

    Reply
    1. KetoCandy

      I am grateful for my CAC scan as I was getting the heat from my Internist and my Endo to take a statin. I am latent T1D and both doctors want my LDL under 70. I am doing the Keto diet and my LDL cholesterol increased to 100 but my HDL is 59 and my TG is 66 giving me a very good ratio. They say “all people with diabetes should be on a statin” 😦 I asked for the CAC scan and was happy at 73 yrs old to have a 0 Score. Good ammo for me.! Now I made the Cardiologist appt on their recommendation scheduled for March and plan to continue to be that “difficult patient.” I want to be looked at for my situation and not grouped in the ” all people with diabetes must take a Statin.” I am tired of being the “good patient” as I did for so many years living on the roller coaster of blood sugars while all I had to do was cut the carbs. Now I am on less insulin with decrease in weight, better good cholesterol and lower triglycerides, more energy and no more roller coasters. It’s a lesson that took me a years to learn and is the “AHA” moment that gives one the strength to move forward taking responsibility for ones own health.

      Reply
      1. Arthur Jones

        KetoCandy: well done; you must be a latent T2D; a good friend of ours was using a CMG: 50c coin under the arm!! .. and was able to come off insulin quite quickly; whilst starting keto; good for you: we hope you make good progress on reducing insulin; ignore all the rubbish about LDL; you are doing all the right things: higher HDL: low TGs; all these things just seem to be proxies for “good metabolic health”: you seem to be getting there on your journey: best wishes

        Reply
      2. Simon Woodward

        Ketocandy, nice work. At 63, I’ve had similar experiences and have discovered the added benefits of fasting activated autophagy.

        Reply
    2. Alan Hughes

      well done Kim: stay staunch; there is so much evidence that those with higher LDLs live longer; just accept the label of “difficult patient”!! …… at least that way, they will give hopefully keep clear! Your family sound like N=6 so far!

      Reply
  11. Jennifer

    Fantastic start to this year’s informative work that you so kindly put together for us. I have always considered the downsides of tests carried out on us humans. I go back 40 odd years when my father died of motor neurone disease. My GP explained that any test showing a genetic link would cause anxiety, as there was no cure….so best live your life without knowing.
    I go back to 1965 when kindly radiographers gave up their free time to instigate the concept of breast screening, presumably to inform unsuspecting persons before they had even considered such a diagnosis. Yet it was understood back then that it was an inaccurate science, likely to cause extreme anxiety, and that the limited treatment options had practically no better outcomes than lesions self-detected and reported by the patient. ( I don’t know what the research data show in the present day.)
    I do know that a 10 minute appointment with any doctor is unlikely to touch the surface of the questions you have highlighted today, and that Big Phama can only benefit by patients being fobbed off with treatments and medications.

    Reply
    1. Sasha

      Shows pretty much the same thing, as far as I know. The book “Risk Savvy” breaks down the numbers pretty well, I think.

      Reply
  12. James DownUnder

    As usual, a sane and balanced explanation of calcification (stable END of process) and the more problematical ‘intermediate’ stages. I’m not concerned about my 870, means those lumps are neither going anywhere or growing. Thank you again.

    “Just because you can do something does not mean that you should.”

    This para from Dr Bernard Lown (Essay 28) shows a practical application in… practice. (!)

    “Forty years ago I stopped referring most patients with stable coronary heart disease (CHD) for cardiac angiography.(1) This procedure permits visualizing the extent of obstructed coronary arteries. What occasioned my deviation? The problem was that nearly all those undergoing angiography ended up having surgery, namely, coronary artery bypass grafting, or CABG (pronounced “cabbage”). ”

    https://bernardlown.wordpress.com/2012/03/10/mavericks-lonely-path-in-cardiology/

    Reply
  13. David

    Superb piece of scientific analysis from a man who who has made himself unpopular for understanding that statins can cause cause severe debilitation when inhibiting uniquinol and dolichols aswell as cholesterol in the mavelonate process. Science should not be used selectively to promote drugs or reinforce a shaky medical argument… sometimes understanding science as well as you do will produce a confusing and unplayable answer but an honest and more accurate one. The Masai are a favourite contradiction of mine as their exercise regime is so important and is the main factor in their healthy disposition in my view. I will not bore you with my medical details but I know stress is bad for you and that reading such an enlightened piece from your goodself is definitely good for my mental health… many thanks for your work as always.

    Reply
  14. Soul

    Nice article and thanks for your thoughts on CT scans of arteries. It does seem to be a troubling area, one that often leads to a unnecessary stent, is my understanding. I used to recommend to others that they have a CT scan to see if they have heart disease. Then like so many others things in medicine I began to see there are problems with this screening method. I had a CT scan done 12 years ago or so. The score came back high for my age. I then took sensible preventive steps.

    Reply
    1. AhNotepad

      Appalling. I stopped watching after the *&^%R$E%^& presenter said the best thing for babies was a live polio vaccine. My bigoted opinion conflicts with her bigoted opinion as I would gise extra vitamin C. Klenner demonstrated this had general benefits, and even specifically useful in treating, er, polio.
      This video (possibly carefully edited, but then most of the pro-vaccine videos are no doubt carefully edited) indicates there are some questions that do not have adequate answers https://youtu.be/JYtHY9AUXO4

      Reply
      1. Gary Ogden

        AhNotepad: I, too, gagged at that comment; nevertheless, this is important information. In the U.S. OPV (oral poliovirus vaccine) was discontinued sometime between the mid-80’s and the mid-nineties, I don’t recall exactly, because it was too dangerous. However, something in that vaccine is having a protective effect in children in Guinea-Bissau. Not the poliovirus, since it is not causal in paralysis, but simply appears in the spinal fluid of some victims of what is called paralytic polio. What would be even more protective would be clean water, good nutritional status, electricity, an end to poverty. Much more protective.

        Reply
      2. David Bailey

        Garry and AhNotepad,

        Thanks for responding! I am puzzled about this because her data was fairly damning in itself about other vaccines, and yet you seem to be reacting as if she is a stooge of Big Pharma.

        Was this live polio vaccine the same vaccine that was used when the oral vaccine first came out, when I was an early teenager, I think? I certainly do not remember any talk of this vaccine causing new instances of paralysis – but of course if it is true that the paralysis (my paralysis) was not caused by this virus, this is not a puzzle. However, what harm did this virus do – her data seemed to indicate it was positively beneficial for babies who received it.

        Reply
        1. Gary Ogden

          David Bailey: Excellent questions! I’m not sure if the OPV today is the same as what we got on the sugar cube; I was eight or nine when it was licensed, and we all trooped to an elementary school to get it. Tasted pretty good, as it was mainly sugar, after all, though the medicinal aftertaste wasn’t that great. In any case, that vaccine is no longer used in the U.S. because of its safety profile. It is a mystery why it has a protective effect in Guinea-Bissau, a mystery which likely will never be solved. As for Dr. Benn, I appreciate and applaud her work. The 500% increase in mortality from DPT should be a wake-up call to everyone. Her opening statement was a political one, and I forgive her for it. A proper scientific statement would have specified the protective effect to Guinea-Bissau infants, rather than generally to infants (assuming the audience members were from developed countries). As to the causal agent(s) in what is or was called paralytic poliomyelitis, clearly there is a viral co-factor in the majority of cases, though not all, but something else is allowing these to enter the spinal fluid. “Dissolving Illusions” has a very good chapter on polio, and Age of Autism an excellent piece by the late, great Dan Olmsted, which examines one of these cofactors, arsenical pesticides, making a strong case that the 1910 (I think this is the correct year, but maybe not) New York polio epidemic was caused by by the use of arsenicals on the Hawaiian sugar crop the previous growing season. They were only used one year, as they proved uneconomical. In any case, the number of cases of paralysis during the polio scare in the 1950’s were never large. While terrible for those who were affected, the perils of polio were hyped far beyond the actual impact. I don’t recall a single case in my city.

          Reply
    2. Gary Ogden

      David: Thank you very much for posting this. Dr. Benn is an associate of Dr. Peter Aaby, who has studied vaccination outcomes in west Africa for forty years. The information she has given here was recently published by Dr Aaby and Dr. Benn; I don’t remember the name of the journal. The great tragedy is that DTP is the most widely used vaccine in Africa. It proved to be so dangerous that it was replaced in the mid-80’s in the U.S. with DTaP. The pertussis component was the problematic part of DTP, but the acellular pertussis vaccine gives only short-term immunity, and turns vaccinees into asymptomatic carriers, thus outbreaks in the U.S. among the fully-vaccinated. Nothing will change. Vaccination policy is not about health, but about money.

      Reply
      1. AhNotepad

        Jerome, The Guardian is a newspaper. Their function is to sell papers and get advertising revenue. Wonder how much comes from pharma. Instead of pedalling what is (if you were an olympic rower might be called) rollocks, sorry wrong spelling, rowlocks, they might like to refer to the case of Alan Smith in New Zealand, whose doctors would have had him die rather than administer vitamin C. When he was recovering after his family persuaded the medics to treat him, the vit C dose was reduced from 50g to 3g, possibly in the hope that he would die, and so prove the doctors correct. What a thoughtless person Alan Smith was, he recovered.

        There is no science to prove the effectiveness of vaccines.

        Reply
      2. Jerome Savage

        Hi AHN. Why do U say Alan Smith was thoughtless ?
        My understanding of the Guardian newspaper is that it has less of a pro-corporate bias than almost all the others. But I hav no doubt they are capable of shoddy journalism that apes the corporate agenda.

        Reply
        1. AhNotepad

          Jerome, sorry, my comment about Alan Smith’s thoughtlessness was sarcasm. After all, he should have done the decent thing, and died. (More sarcasm) This would have supported the medical establishment.

          As an aside, this illustrates the tactics of the establishment at around 39mins, but all of it is revealing https://youtu.be/t2dHQSj90-A and also an example as to why the national, so called independent, broadcasters can no longer be trusted.

          Reply
  15. Micki Jacobs

    Timely.I believe some of my posts might have sent Kendrick here as well as increasing emphasis on CAC in the literature. I will respond to this – lots of it are topics I have shared previously – and present some data he has missed.There are articles that dispute the idea that calcification follows plaque initiation, that show microcalcifications prior the scale of calcium being visible via CT scans, and of course, I’ll present my whole thing about UBIAD1.And he’s right about no one knowing what to do with CAC…the very fundamental topic we tend to discuss. Also… mammograms look for calcium.Calcium patterns ID cancer in breast. Sent from Yahoo Mail on Android

    Reply
  16. Olga

    Thanks Malcolm. This has been my conclusion as well. Two things that come to mind. The fear mongering about calcium supplements. Is it because calcium is present in the plaque, or is there actual evidence that the more calcium you eat the more CVD deaths? This would go against the Maasai observations, since they drank large amounts of milk and were free of CVD deaths. Also, the suggestion that supplementing with extra vitamin K2 will lead to plaque regression. Do we want to regress the plaques? Once they are calcified, if the calcium is removed is the scar underneath completely healed?

    Reply
    1. Harry

      With my functional med doc’s support, I take 300 mcg of K2 daily, primarily to prevent kidney stones but also for my arteries. I also eat pomegranate seeds, take pom. extract capsules and drink pom. kombucha. I plan to go on doing these things and not worry.

      Reply
  17. John Goss

    Thanks again for explaining clearly in jargon-free English the actual meaning of the jargon. The “scared witless” shh, you-know-what pun made me laugh. Then I got a bit scared (not witless) since I exercise regularly (cycling) to try and keep my blood pressure under control without resorting to drugs. It was the study of “endurance athletes” in danger of accelerated “coronary artery calcification, exercise-induced cardiac biomarker release, myocardial fibrosis, atrial fibrillation, and even higher risk of sudden cardiac death. . .”
    So I went looking for evidence and found this. A study in Finland concludes that on average:

    Power athletes lived 1.6 years longer
    Team athletes lived 4 years longer
    Endurance athletes lived 5.7 years longer

    https://www.labmate-online.com/news/news-and-views/5/breaking-news/which-athletes-have-the-longest-life-expectancy/34105

    And now it’s stopped raining I’m off for a spin.

    Reply
    1. Vlad

      It would appear from this study that weightlifting is worse for one’s health than marathon running…yes, if one does it at a professional level, ie, lots of steroids and food (some of it unhealthy) so that you’re clinically obese.

      Reply
  18. Jean Humphreys

    I’m visualising . . .
    Small and bigger palques – grazes and cuts.
    Unstable plaques – scabs – dont pick it: you’ll make it bleed.
    Calcified plaques – scars – may be a bit sore and unsightly, but are not going to break open.
    My father died twenty years ago of extreme old age – everything was worn out. He had had his first heart attack nearly thirty years before that. He was only really inconvenienced by the heart disese in the last three or four years. One of his things “Dr Campbell told me never to take Warfarin” This Dr did not have a llot of time for cardiologists at that time. He had done his early general practice in the Jap POW camps in Malaya.
    I found quoting Dr Campbell useful – that was another drug fended off, Whether the Apixaban has some other nasty waiting for me – who knows- it is too new. Still, I am am now 23 years on from my first MI, so not doing too badly.

    Reply
    1. Doug from Canada

      Blood thinners: Here’s a story to bring the risk home…..

      My father in-law, whom I mentioned before the holidays, was on every form of heart meds after having 4 stents put in, including blood thinners. It’s hart to quantify his health as poor based on that though, he spent 10-12 hours a day all spring/summer/fall out in the garden. At 75 he did more on a daily basis than a man half his age.

      A minor fender bender (low velocity car accident) caused a brain bleed that killed him within 30 minutes. It took the body 4 1/2 days to finally stop functions but his brain was gone within the first half hour. High blood pressure and blood thinners were leading factors in this rapid failure. Emergency doctor said even rapid intervention would not have altered the outcome.

      It was a sin, the man easily had 10 years left. The choices the doctors make for us have consequences: Be the difficult patient, It’s your life……

      Interestingly, his father died of a stroke 10 years earlier while moving a fridge at 86 years young.

      Reply
      1. JDPatten

        Doug,
        What particular blood thinner (anticoagulant) was he on?
        It could have made a difference. They’re not all the same. Warfarin, for example, is known to be riskier of brain bleeds than apixaban.
        More complete info might be helpful for someone reading here.

        Reply
  19. Topsygirl

    What a very informative and useful article, I too have some concern about the plethora of tests we can be subjected to which often find things which cannot be treated and just leave folk so anxious and stressed, I am puzzled about why these are ordered and patients pushed in those directions as surely stress is a killer on its own. So much media attention is directed to these so called life-saving tests which in most cases are anything but that the mental health of people is suffering. Some years ago I was in the surgery waiting to have a blood test sitting next to a very young woman who disclosed to me that she was there having another series of tests as she was terrified of developing cancer; she regularly had every test available on Medicare (our public health arrangement) and those tests that were not available she was paying for herself. I thought this poor young thing, no joy or happiness for her just terrible fear and poverty trying to prevent something which she may never develop and if she does it will not be helped by being so stressed and anxious.
    Somewhere around that time I made a considered decision to forgo all tests, I took the advice of the hospital and later stopped my blood pressure medication which I had been taking for 30 yrs I was previously told if I did this I would die from a stroke or cardiac event and that is more than 6 yrs ago and I am not dead. Just because you can do something does not mean that you should. The following month we had kidney month and were informed that the greatest risk to developing a problem with our kidneys was blood pressure medication, I feel that I need my kidneys so I felt my decision was a good one.
    Surely as we get older we should be able to enjoy the time we have left we need to be informed and not worry too much about how we will eventually die, I often think that I could have tests have something disturbing found and be so muddled about that and not see the oncoming bus as I cross the road to go home and the tests would then mean nothing, no value at all. Eat a good wholesome diet, supplement with good quality vitamins as required, laugh a lot, spend time engaging in activities that bring us happiness, get some sleep and by all means sack any doctor that shows threatening or derisive behavior there are still plenty of caring informed medical professionals we just need to look, it is our life only we can live it.

    Reply
    1. Judy Robinson

      I SO identify with your comment! I succombed to getting a CAC and had a zero score. However, I then was baffled why I struggle with hypertension! If I had not one sign of “healed ” lesions in my heart, how in the world were my arteries “hardened” enough to generate high blood pressure! Isn’t that entire cardiovascular system connected? None of this made sense to me. Like you, I was medicated 7 years ago–and with each med developed very disturbing side effects. Dr. Malcolm’s book Doctoring Data really squared me away and made me fear a slightly elevated blood pressure even less! After doing my own homework and finding some VERY interesting studies that cast a dubious light on medicating anyone without doing a thorough lifestyle assessment, offering other alternatives and THEN allowing the patient time to make an informed decision(none of which happened to me) I TOO made the decision to stop my meds. I refuse to worry about this now. I am almost 70, very active, love gardening, cooking, keep my weight down, don’t smoke, don’t have diabetes or other problems! Moving on! Life is too short to stress about this. I should also add I am a retired nurse, saw FAR too many elderly with what we fondly call “polypharmacy”. I am committed NOT to belong to that group.

      Reply
  20. Paul

    Spot on! As a young man with a positive score, I ended up suffering in a corner watching all those online, celebrate their zero scores.
    With my doc left not knowing what to do (I am already well versed and taking care of all risk factors, yet have a bad family hx) I felt hopeless and full of unknowns; rumination; vulnerability.. I felt like asking a certain someone to help pay for the forthcoming therapy I will now require;) thanks for such a brilliant write up.

    Reply
  21. DV

    I agree with your basic assessment regarding the scan. I feel this way about the whole-body scans I see advertised all the time too. Even getting genetic tests for conditions that are still untreatable–why bother?

    Reply
  22. David Bailey

    Malcolm,

    You mention the fact that statins increase calcification and slightly reduce the rate of CVD.

    I wonder, does this apply even though people with muscle pains probably exercise less, or could it be that if that effect were taken into account, statins would have a zero or negative benefit?

    Reply
    1. Gary Ogden

      David Bailey: We must also take into account exclusion criteria in the trials. Drugs are trialled among a select group, yet prescribed to the general population. To me, this would indicate that the teeny, tiny benefit shown in trials probably means no benefit, or a negative benefit.

      Reply
    2. Arthur Jones

      David: “statins increase calcification” you would need to dig deep in the studies: I doubt they stratified them according to exercise: that is sort of like asking folks what they ate; when they do a food diary …. statinistas and those with slight reservations about statins .. all seem to agree: “statins increase calcification” …… you could say 97% of scientists agree: it works in other areas.

      Reply
  23. andy

    Is calcification of plaque normal?
    Is increased intima/media thickness considered plaque?
    At what stage can plaque be reversed?
    Possible steps in plaque formation:
    Step 1: endothelium gets damaged by any number of factors
    Step 2: inflammation of damaged area
    Step 3: stem cells attracted to sites of inflammation
    Step 4: stem cells differentiate according to type of cells that are required to heal damage.

    Epigenetic factors that complicate repair process:
    No 1: chronic and acute hyperglycemia- promotes smooth muscle cell migration and conversion to bone cells, glycation of lipids and proteins, mTOR in high gear, excessive mitochondria ROS
    No 2: statins- affects differention of stem cells in addition to other negative effects, less K2, Q10, more diabetes
    No 3: chronic stress- emotional and physical
    No 4: nutritional factors

    Reply
  24. Brian Daly

    For those old enough to remember Steptoe & Son on black and white TV :
    Steptoe Junior :” I’m off to get x-rayed – it’s preventative medicine dad”
    Steptoe Senior: ” Bah, that ain’t preventing nothing, it’s just looking for it….”

    Reply
    1. David Bailey

      I think I remember the episode, but not that comment. Steptoe Junior got a request for a re-test and went berserk, but it turned out his X-ray had been marred by his pocket watch.

      I also found screening rather stressful – I’d send of the requested sample of my poo, and feel the tension rise in me as the days wore on. If I had had piles, I dare say I would have been sent for a colonoscopy – a procedure not without risk.

      I now refuse all screening.

      I dare say at least a few people die from the stress of pending test results.

      I found this book good:

      https://www.amazon.co.uk/s?k=overdiagnosed&ref=nb_sb_noss_1

      Reply
      1. Arthur Jones

        well found David: Gilbert Welch has several good books; in various ways discussing screening and its pitfalls;

        Reply
      2. Stephen Rhodes

        Not without risk indeed.

        I was completely unaware of the cases where ‘removing’ of a polyp using heated wire loop ignited bowel gases (methane and !hydrogen) literally blew up the patient.

        On the other hand it is a rare risk, and I should probably stop reading Bill Bryson’s ‘Human Body: a guide for occupants’.

        Reply
  25. Jerome Savage

    More complications –
    1. “high-volume and/or high-intensity long-term exercise training, which may attenuate the health benefits of a physically active lifestyle. Accelerated coronary artery calcification, exercise-induced cardiac biomarker release, myocardial fibrosis, atrial fibrillation, and even higher risk of sudden cardiac death have been reported in athletes” and
    2. “study of mostly middle-aged men in JAMA Cardiology found the most avid exercisers—averaging eight hours per week of vigorous exercise—did indeed show greater levels of coronary artery calcium (CAC). Nevertheless, they were less prone to dying over the average follow-up period of 10.4 years compared to men who exercised less, suggesting they can safely continue their workout regimens”
    Seems to be a contradiction here. Do we assume that in 1 above “even higher risk” applies to extreme exercise vis a vis regular (for want of a better word) or is there a difference between high-intensity and vigorous, the latter preferable & safer ?
    Thanks for this thought provoking article (even tho only half way though)

    Reply
  26. Martin Back

    Good explication as to the benefits or otherwise of CAC scans. It confirms me in my decision to avoid all medical tests in future. Doctors seem to regard it as their duty to find something wrong with you, and test scores are their ammunition if you have no obvious symptoms..

    Regarding calcification, in bygone years one used to hear the term “hardening of the arteries”, particularly in respect of older persons. That phrase seems to have fallen into disuse. Does it mean the same thing as “atherosclerosis”?

    I ask because “hardening of the arteries” implies a sort of general stiffness of the arteries, whereas “atherosclerosis” I visualize as discrete patches of stiff plaque in otherwise flexible arteries.

    Reply
    1. LA_Bob

      Martin Back,

      I think “hardening of the arteries” can also reflect glycation of the arterial tissue. Gary Taubes, in Good Calories, Bad Calories noted that you can inflate a newborn’s aorta like it’s a balloon, but in a 70-year-old it’s like a rusty pipe.

      Reply
    2. David Bailey

      Martin, I agree so much with your first paragraph! I wish the NHS would return to being a service for people who are unwell, rather than regularly nagging everyone, even though they know everyone will die sooner or later however many of their pills they take! The latest awful example is to tell people who are overweight that they are at greater risk of cancer!

      Reply
  27. LA_Bob

    This is an outstanding post, above average even for the consistently above average Dr Kendrick.

    And in this era of “go get a CAC scan”, advanced by low-carb diet advocates, it is incredibly apropos.

    “My first recommendation is that, if you have not had a CAC scan, do not have one.” This has been my position. I would prefer not to know what I don’t know about myself that will only worry me if the news is “bad”.

    “Yes, a ‘negative’ CAC is reassuring.” And, yet, I recall reading Dr William Davis saying that occasionally someone can get a negative CAC scan and still drop dead of a heart attack. Not reassuring to me. Not at all.

    We humans are too impatient for answers. We fixate on “promising” and read “sure thing”. Isn’t that how the cholesterol hypothesis took off?

    Thanks for this write-up. Excellent.

    Reply
  28. Charles Gale

    Awesome! A subject close to many of our hearts (pun intended)!

    Dr Kendrick writes:

    “My first recommendation is that, if you have not had a CAC scan, do not have one”.

    Opening up a “constructive debate” (Dr Kendrick’s reply to Smartersig) – I disagree.

    If I’d known all about this 3 to 4 years ago, and was aware of my high CAC score, I might have been inclined to avoid intense manual labour and lead a more sedentary life style.

    I was employed as a gardener and was shovelling mulch onto a van when I went crashing down and ended up in intensive care.

    Reply
  29. Charles Gale

    Dr Kendrick writes:

    “But is it good calcification, or bad calcification Are you at increased risk, or not? This no one can tell you, for sure?”

    Surely the density and volume components of the scan can help with risk assessment and allay fears? Of course, if volume dominates over density it may not allay fears.

    For the non regulars to this site, you may wish to visit Dr Kendrick’s previous post called “Another new study” – there was quite a thread developed in the comments on CAC scans and included some comments on density and volume.

    Continuing with density and volume, I never got these results back in 2017 and I’m having trouble getting them now in 2020.

    To the CAC scanners – were these results included in your test results, or just the score? I’m trying to ascertain if it’s something the radiologists can print off easily, or it’s a time consuming,complex technical issue to work out the density and volume.

    Reply
    1. Danny Evatt

      I had 3 CAC scans over the last 15-20 years. Two had Score/Mass/Vol. while the third only had Score. All three were with different medical labs. Not sure why some offer all 3 and some don’t. One would think vol. and mass are calibrated at the time of the scan – so not sure if they can go back and recalculate(?).

      Reply
  30. AhNotepad

    Excellent. I shall take the advice of not having a CAC scan. I shall take vitamin C instead. Not only do I believe (therefore it must be so) vitamin C allows the system to work properly, and build robust blood vessels, but I will be far less likely to be one of the 14million who die each year of sepsis. This means I can contribute to the arguably excessive population we now have.

    Reply
  31. Judy Robinson

    VERY thought provoking article! I love your ability to present the often missed facts of a subject. Keep it up! Look forward to your blog posts every time!

    Reply
  32. Charles Gale

    Olga

    About your comment, specifically “fear mongering about calcium supplements. Is it because calcium is present in the plaque, or is there actual evidence that the more calcium you eat the more CVD deaths…Maasai…drank large amounts of milk”.

    Coincidentally, both to your comment and also this post on CAC scans, this topic was keeping me busy last night.

    Why?

    The onset of a cold and a vitamin C shock therapy to nip it in the bud. However, the vitamin C was Ester C i.e. the vitamin C supplement contains calcium. From the label of the recommended brand:

    Vitamin C = 500 mg
    Calcium = 60 mg

    I didn’t know whether or not to purchase some ester C and try out this shock therapy – the calcium being a big issue.

    This cold treatment came to my attention via the Vitamin C Foundation’s forum page, with a question about the calcium in ester C and doesn’t it contradict what Dr Thomas Levy said about calcium intake?

    Here’s the link:

    https://vitamincfoundation.com/forum/viewtopic.php?f=3&t=14655

    An interesting reply from the Foundation’s Owen Fonorow, especially the bit about the vitamin C in certain citrus fruits.

    However, this was not enough for me, especially as I’m familiar with Dr Thomas Levy (the vitamin C guy). And also Owen Fonorow was following the Medical Medium’s vitamin C shock therapy.

    (Bear with me! I’m getting to the milk part now!)

    Many of us here will be familiar with the excellent Dr Suzanne Humphries and her vitamin C work and presentations – there are 2 on youtube. Did she have a take on calcium and ester C?

    Indeed she did. Here’s the link to one of her of presentations:

    You should scroll forward to 1hr 30mins and you’ll see a slide called “Why not ester-C?”

    Here’s a quote:

    “…most people in the world are taking in too much calcium and they are not taking in the elements that tell the calcium where to go and that’s the problem”.

    (Which I think ties in with some of Frederica’s comments here and in the last post)

    The next slide is called: “True calcium requirements”

    The next slide after that is called: “Death from heart disease and milk protein consumption: is calcium excess in western diet a major cause of arterial disease?”

    One of her comments on this slide is:

    “…it’s probably not just the milk…because these cultures and their diets are all different but it’s something to think about that high calcium diets don’t go into the bone necessarily.”

    So, you may find 1.30 to 1.34 of interest.

    Never mind my cold, what do I do about my daily latte?!

    Reply
    1. Frederica Huxley

      I rely on the synergy of vitamins D3 and K2,along with magnesium to keep calcium in the bone matrix. It’s not just calcium in your latte; a good green veggie intake, along with seeds and legumes will give you an astonishing amount of calcium. I shudder to recall when I was prescribed copious amounts of calcium 20* years ago, long before I learned the damage it could do!

      Reply
    2. Dr. John H

      Charles,
      I recall reading a review of Dr. Levy’s calcium book in the Weston Price Journal. They disagreed with his conclusion, saying that the studies he used were based on calcium supplements, and not food. Of course, they are big fans of raw dairy products, and not of the pasteurized versions.
      In Daniel Cobb’s bone health formula, he recommends about 300mg/day of calcium supplementation (well below the RDA of 1,000 – 1,200mg) and cautions about overdoing it.

      Reply
    1. AhNotepad

      David Fraser, really? I think we need information as to how you justify such a statement. We also need your definition of “a plant based diet”. As it stands it is about as meaningful as “a mediterranean diet” or “a balanced diet”.

      Reply
  33. Greg Hill

    If you “don’t smoke, exercise regularly, are not overweight, have low cholesterol levels, do not have high blood pressure, do not have high blood sugar levels, etc. etc.” and have a heart attack anyway, and if you have ever had a root canal or tooth extraction, my advice would be to get a thorough check up by a holistic dentist. After my first relatively mild first heart attack at the age of 54 I could easily have been saved from having two more heart attacks — the last one nearly fatal nine years ago at the age of 61 — if only my cardiologist had known to ask me, “Greg, have you ever had a root canal?” It was ultimately a holistic dentist who found what was literally the “root cause” of my heart attack in an infected root canalled tooth — done at the age of 20 — and a seriously infected jaw bone above it. He pulled the tooth, cleaned out the infection, and I have been fine ever since. I’m sure that switching from a cardiologist-prescribed “heart-healthy” diet, which eliminated eggs and replaced butter with the trans fats in margarine, to a truly healthy diet which includes plenty of both pasture-raised eggs and butter from grass-eating cows (in addition to lots of fresh organic produce, a lot of other truly healthy foods and a few carefully chosen supplements), also contributed a lot to my current state of 100% medication-free amazingly excellent health at the age of 70. After my third “unexplained” heart attack I figured my life was probably close to over and made out my will. The way I’m feeling today I’m guessing that in just a few more years my life will be getting close to being half over.

    Reply
  34. Jeremy Nacewicz

    So that makes enough sense, but leaves me with the question of what are the best markers for endothelial damage? Avoiding plaque formation means keeping damaging conditions to a minimum. So probably low fasting insulin and HsCRP are clear enough, homocysteine seems relevant, but what are other markers would be the best for the money? TNF alpha maybe? I’m no longer convinced that cholesterol or apo-B is relevant for people without vascular damage, so looking to target more relevant markers of unhealthy inflammation and oxidative damage.

    Reply
  35. Göran Sjöberg

    Great comfort to read!

    Since I already know that my CAC score would hit the roof I would , and with all respect for Cummins, never dream of any testing. Simply there is no use for one of my MI sort and under all circumstances I would have continued with my LCHF diet and exercise to my moderate limit.

    Reply
  36. andy

    Re Masai ref #4
    50 subjects only 4 had calcified arteries. All relatively young subjects had fatty streaks. Authors message for Western persons is to consider blood pressure, fitness, and cholesterol.

    Came across this study:
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5906181/#!po=34.7222
    Plaque Calcification During Atherosclerosis Progression and Regression

    Looks like dead macrophages and smooth muscle cells are the source of calcium. High glucose plus oxLDL are the initiating factors. Looks like calcification starts at formation of necrotic core and keeps increasing as more macrophages and smooth muscle cells die. Increased calcification then cannot be considered protective but is only a measure of disease progression. Perhaps adding a few thrombi will do more for making plaque stronger.

    Reply
  37. dearieme

    For comparison, from WKPD, anent another Scot:

    Sir John James Cowperthwaite … was … the Financial Secretary of Hong Kong from 1961 to 1971. His introduction of free market economic policies are widely credited with turning postwar Hong Kong into a thriving global financial centre.

    He refused to compile GDP statistics arguing that such data was not useful to managing an economy and would lead to officials meddling in the economy. He was once asked what the key thing that poor countries could do to improve their growth. He replied: “They should abolish the office of national statistics.” According to Catherine R. Schenk, Cowperthwaite’s policies helped it to develop from one of the poorest places on earth to one of the wealthiest and most prosperous.

    Reply
  38. Gary

    How is this different from Lp(a) testing? If you have high Lp(a) there appears naff all you can really do about it and conventional medicine is to double down on high intensity statins and lowering LDL?! Your post is a subject I have often discussed with my wife, I am an engineer who wants the tests and to know, she is the pragmatist who doesn’t want to know for the reasons you give.

    Full disclosure in past year have discovered I have massive Lp(a) (top 1 percentile), and recently had a CAC and scored 1100. Not scared witless, but was a shock. My response was to double down on IF and low carb lifestyle and have adopted some voodoo supplement shtick (Vitamin K2 +D3 for Calcium regression, and Niacin, L-Carnitine for Lp(a)) that has some limited evidence they might help.

    Reply
    1. Mr Chris

      Maybe as a result of doubling my vitamin C daily dose and sprinkling flaxseed on my yoghurt and porridge, my Lp(a) came down by half.

      Reply
  39. JDPatten

    My CAC score from 5 1/2 years ago was 1,609.
    Yes, and I could build a tallish chimney with the bricks.

    I was a “body builder” in high school through college. Never got to Arnold’s size, but I learned how to push myself beyond perceived limits and have rather approached my subsequent living experience the same way.
    No doubt this might well have gotten me that score.

    There are other possibilities, though. No one has yet addressed infection on this page.
    There are bacteria that see endothelial cells as lunch. Extensive lesions caused this way might well heal and calcify without going through any fatty plaque stage.
    I had epidemic typhus twice in the last 20 years. That’s the bug that killed more servicemen in the two WWs than bullets did. Endothelial lunch & dinner! Rickettsia prowazekii. (Want to know more??) There are lots of other bugs that’ll do similar.

    Any one out there on flecainide?
    I was just prescribed the med for cardiac arrhythmias I’ve been having – probably brought about also by going beyond ordinary physical limits of exercise.
    I had a bit of a battle getting OKd for this med because it can’t be given to people with “heart disease”. Here is where my getting myself labelled with a high CAC score might have worked against me. It looked like it was going to. ( You get any test, it goes in your record – you’re labelled!) My excellent stress test from two years ago made me good to go. Not everybody in the Medical Establishment is unreasonable.

    Reply
  40. Gary Ogden

    Thank you, once again, Dr. Kendrick. One of your best posts. I’m against routine tests for myself, so I wouldn’t have CAC anyway, but it is very helpful to an overall understanding of CVD and human health in general to add this knowledge to the base.

    Reply
  41. Topsygirl

    I am so enjoying all your comments, David Bailey thank you for your input and the book info. sounds like something I could add to my collection.

    I have been giving some thought to why and what changed our attitudes to medicine, the current systems are buckling at the seams but I cannot help but think that this in a large part their own fault. Prior to the introduction of the public health systems and the so-called free medical treatment we had to pay for visits and treatment, we needed to purchase health insurance or use a quite limited public system. Doctors managed their accounts, liaised with patients and set payment arrangements. Growing up I had few doctors visits 3 or 4 for vaccinations the occasional sutures and suchlike I was a healthy child and not much went wrong, and from memory it seems to me this was the case with most people.

    Once the public system arrived however everything changed many of the medical interventions previously managed by our GP’s was taken and handed on to specialists, allied health and other clinical professionals and the local hospitals; now this seems to be not much different than some large corporation a medical merry go round which once you get on it is difficult to get off. That would be fine if it was coping which it isn’t and if people’s health was improving markedly which it isn’t. What it has done for many is to make them feel very insecure about their health choices and uncertain of making any decisions for themselves, where my Mother would say Ill’ just keep an eye on whatever it was cold, small laceration, small things folk now feel the need to race to the doctor or the emergency department many times for things which only require cleaning and a band aid or some paracetamol, rest & fluids..

    It reminds me of the episode from Doc Martin depicting a Mother sobbing in his surgery “You never think this will happen to you, you hope it won’t”….”It’s head lice woman it’s only head lice” so when it comes to larger issues many folk do not seem able to either understand what they are being told it is my experience that many have no idea what they are being treated for and in the main they just do what the doctor tells them.

    There is also condemnation if the patient researches something for themselves I experienced this after disclosing to a Clinic nurse that I had viewed my impending surgical procedure on a government health web site “We do not approve of our patients doing such things, we provide all the information we think it is necessary for you to know” It is not her life it is my life.

    Reply
    1. David Bailey

      By the time I arrived, the NHS was established, but I remember a leaner, saner system that we have now. Apart from my polio, I too had very few interactions with the NHS – I think everyone was more self-reliant in those days.

      I think that early NHS has gradually changed for the worse. For one thing, there is a certain additional stress involved in seeing several medical practitioners where one would have handled everything in the past. There is also a huge increase in bureaucracy. I am a software developer, but I sometimes thing computers must take a lot of the blame. Without computers, things could never have got as complex as they are today.

      Reply
  42. Malcolm Achtman

    After my identical twin brother developed heart disease and underwent a quadruple bypass at age 58, I realized I was vulnerable. Three years later (age 61), despite having no symptoms, I chose to get a non-invasive 64-slice coronary CT angiogram. I obtained my CAC score, which was 479 (high risk for my age), along with excellent images of my heart disease, showing both calcified plaque and uncalcified (or vulnerable) plaque. My images revealed about 50% stenosis in the LEFT MAIN artery and the radiologist said, “I would be watching you like a hawk.” I took the news in stride and didn’t panic or worry. Maybe that was because my father had heart disease too at our age and was still doing well at age 90. Anyway, I chose to learn as much as I could about heart disease and continue to do so. About 6 years after getting my 64-Slice CT scan I experienced definitive symptoms of angina. I obtained an angiogram in the hospital that revealed 90% blockage in the Left Main artery, 90% blockage in the RCA (right coronary artery) as well as 70% in the LAD (left anterior descending) and 50% in the circumflex. I ended up having a triple bypass. In hindsight, I’m happy I went for testing at age 61 and contrary to Dr. Kendrick’s opinion I think getting tested is valuable – because I learned I had heart disease and knew exactly what was happening when my angina occurred later on. I knew I had to seek medical attention and obtained it quickly – before any damage to my heart. But I do acknowledge that people who might worry a lot about a high CAC score might be better off not knowing.

    Reply
    1. David Bailey

      On the other hand, it sounds as though the first actual treatment you had was after you got actual symptoms. Presumably you would have gone to the doctor at that point, so unless you did something in response to the CT scan, presumably the outcome would have been the same.

      Remember that a lot of people would have gone to bits mentally after the original scan results – I guess you are tougher in that respect.

      Reply
      1. Malcolm Achtman

        David: After my 64-Slice CT Scan in July 2010 (at age 61) I made an effort to learn as much as I could about heart disease. In Dec 2011 the book “Wheat Belly” by cardiologist Dr. William Davis came out. Although part of that book was aimed at helping people lose weight (never my problem) another component dealt with ways to lower heart disease risk. I adopted some of the ideas, such as wheat and grain elimination, vitamin D optimization, reducing blood sugar spikes after meals, etc. I was quite strict but not necessarily as strict as Dr. Davis recommended. I may have slowed the disease process down somewhat but it wasn’t enough to stop the “moving train” of heart disease caused from the previous 60 years of eating junk, eating high-carb crap, basically eating like a child.

        Reply
    2. Göran Sjöberg

      Malcolm A.

      I was in the same very severe circumstances as you after my serious MI and also getting “knowledge” of my CVD status through an angiogram now 21 years ago. I though, as an old researcher, did my “homework”, although in a completely new area for me, but it didn’t take long for me to arrive at the conclusion of the uselessness of the comprehensive CABG offered.

      “They do it because they can but statistics is clear: no benefit!”

      And of course there is here a lot of money involved for the medical enterprise.

      BTW: one survives on the collaterals (“natural bypasses”) can be viewed as a kind of physiological homeostasis!

      Reply
      1. Malcolm Achtman

        Goran: According to my angiogram in May 2016, done a few days prior to my triple bypass surgery, I did have pretty nicely developed collateral arteries. One cardiologist said that was likely the reason I was still alive. But after learning that my heart disease included 90% blockage of the LEFT MAIN artery, I had no intention of tip-toeing around the problem. Remember, the left main artery leads into the LAD and circumflex. It’s analogous to having two hoses attached to a faucet and then turning on the tap, except there’s a major obstruction (of 90%) right at the tap where the water comes out. This was described to me as life-threatening. My angiogram had a comment on it stating “Urgent CABG.” Even though my twin brother had lots of blockages and underwent a quadruple bypass, there was no reference to “urgent” on his angiogram. My father had a triple bypass at age 72 and I believe that helped him live a long life. That feels like a “clear benefit” in my opinion. He died at age 96 – from colon cancer, not a heart attack.

        Reply
  43. g

    Hi Malcom, Here’s what I think those people you mentioned with a high CAC score should do:

    1) Understand the role of vitamin-K dependent proteins in vascular calcification: https://healthfully.net/2018/11/03/understanding-the-role-of-vitamin-k-dependent-proteins-in-vascular-calcification/

    2) Understand how to reverse the calcification of old and of presumably healed vascular lesions smoothly and naturally: https://healthfully.net/2018/03/17/reversing-calcification-and-the-miracle-of-vitamin-k2/

    3) Understand the genesis of disease and avoid creating the conditions that lead to it: https://healthfully.net/2013/05/05/at-the-heart-of-heart-disease/

    Reply
  44. Martin Back

    Typically, how many plaques are detected at any one time?

    I ask because it seems to me one has a range of plaques, some newly-formed and minor, some old and stable, and the dangerous ones — those developing and unstable. I don’t see how one number (the Agatston score) which presumably is based on an average, can accurately reflect the real risk of plaque rupture.

    Reply
  45. Ian Hall

    Cardiologist Dr.William Davis from the Undoctored Inner Circle forum believes spotty calcium deposits don’t stabilize or strengthen coronary plaque.Calcium deposits are distributed unevenly throughout the coronary plaque.
    I had a very low calcium score when I was 64 years old and decided to stop taking a statin.The CAC scan gave me peace of mind.Statistics showed my risk of having a cardiac event was low.I kept eating a low carb, no grain diet and took vitamin D3,magnesium,vitamin K2, fish oil,kelp tablets,selenium and a few other supplements to slow the progression of soft and calcified plaque.
    Coronary Calcium Scoring is not a perfect tool but it “sees” the disease and one doesn’t have to rely on blood tests to estimate risk.

    Reply
    1. Dr. Malcolm Kendrick Post author

      Yes, but what if the score had been high? What then? I know that everyone who gets a low score thinks CAC tests are good, to brilliant. But a high score is, frankly, not so good. I have had people now write to me saying that the high score stimulated them to do something about it. Which is also a good thing. But what if the things they were stimulated to do, actually made thing worse? With CAC scans we are operating in, virtually, an evidence free zone.

      Reply
      1. David Bailey

        Right – this is the problem with so much screening.

        Perhaps the answer is to offer troubled patients a fake screening test that gives everyone a clean bill of health – then at least everyone would get a decent placebo effect, and maybe they would stay out of your surgery for a while!

        Reply
      2. Ian Hall

        Yes, some people with a high calcium score could easily be stimulated to do things which make cardiovascular disease worse. Heart disease is a multi – factorial disease, Cardiologists,medical doctors,dieticians and nutritionists offer many treatment and preventative approaches and they can’t all be right.We still don’t have all the answers yet.

        Reply
  46. Mark Heneghan

    After nearly 37 years a doctor, I have given up almost all ‘preventative medicine’ advice. My current list is short:
    Don’t smoke. It’s hard to argue with the list of nasty things associated with smoking, and what other health advice SAVES you money?
    Do some exercise – I may be biased here because I like it myself, but there seems to be a lot of evidence supporting it.
    Childhood immunisations – probably worthwhile in that the cost to the patient for the most part is a one off (or two off) inconvenience of a needle and a low grade fever (some risk of serious reactions noted, of course) for the benefit of not getting the condition. Not perfect, of course, but compare it with the financial and side effect cost of lifelong drugs for mild hypertension or ‘hyperlipidaemia’

    Advice that isn’t worth it:
    Dietary – the importance of carbohydrates for diabetics aside, there is no such thing as an unhealthy diet – if it feeds you, it’s good for you. People that are fatter than they’d like to be already know it, by definition, and don’t need me to tell them. As Malcolm points out in ‘Doctoring data’ the ‘healthy’ BMI ranges my profession push are completely arbitrary and suspect.
    Alcohol and addiction – I’m not playing down how horrible addiction is, and I get great satisfaction from helping addicts, I just don’t think that telling them not to do it before they do it is very effective. As for weekly alcohol intake, my own modest levels are because that is all I want these days. There are risks associated with alcohol, but for the most part it is a self correcting drug.

    As for coronary calcification, readers of Richard Asher’s ‘Talking Sense’ essays of the 50s and 60s will note that his only advice for coronary heart disease prevention was to ignore any thing to do with saturated fats, but that if you lived in a hard water area ( high calcium) then move to a lower one! Based on post mortem findings, I suppose.

    Reply
    1. Jess

      Gosh, I am so surprised to hear your comment “there is no such thing as an unhealthy diet, if it feeds you, its good for you” – how on earth did you come up with that conclusion? So if my diet consisted of takeaways everyday, burgers, pizza, tinned food all thrown down with a couple of alcoholic beverages per day, then I am on track for a long life? Calcium isn’t the problem, where it ends up is the problem, and for that you need ALL of the 90 or so nutrients so that the body can do what it was designed to do.

      Anyway I don’t want to get off track and come back to the question in hand – atherosclerosis. As this disease is primarily an inflammatory disease, how is having a CAC useful in any way – apart from lining someone’s pocket. It only tells you what has already happened, surely the money would be better spent on avoiding the inflammation in the first place, such as avoiding pro-inflammatory foods. Inflammation damages the cell walls, and in its infinite wisdom the body wants to avoid an arterial bleed so it sends in cholesterol to plug up the damage.

      Reply
      1. Mark Heneghan

        Most people on here would agree that the saturated fat elements of the diet are not ‘unhealthy’ from the point of view of causing heart disease. I accept, and acknowledged it, that carbohydrate plays a special role for those with diabetes mellitus, but beyond the fact that it contains calories, how is it ‘unhealthy’? Including alcohol in the diet is a dirty trick – why not say that a diet of burgers and cocaine is unhealthy, or fish fingers and heroin? As for ‘processed food’, which I assume your point about tinned food was aimed at, the problem is coming up with a meaningful and measurable definition of ‘processed’. There was a paper from Spain a few months ago, reported on the BBC website, which managed to show a statistically significant,(but doubtfully clinically significant) difference in health outcomes for groups which were stratified according to how much ‘processed food’ was in their diets – basically the more processed food, the more unhealthy (just) the outcome. The problem is, that some food has had 40 processes done to them, some fairly innocuous like boiling, others probably more threatening like adding salt. So WHICH of these processes are the dangerous ones, and which are the protective ones? To have such multiple ways for food to be called ‘processed’ to qualify is as weak a scientific argument, in my view, as doing a study with multiple endpoints. Yes, most people seem to believe that processed food is ‘unhealthy’ but there doesn’t seem to be an hypothesis about how processed food is actually dangerous.

        Reply
      2. Martin Back

        I have a small garden and I use no poisons or artificial fertilizers whatsoever, so I get plenty of pests that I can observe at work.

        Regarding nutrition, the thing that strikes me is that in nature creatures eat their food so fresh it is literally alive and kicking, or if plant food, still growing. And I think that is what we should aim for — absolutely the minimum time between farm and plate.

        Maybe it’s vitalism, which has been discredited in our reductionist society, but I firmly believe there is some spirit or essence that separates the living from the dead, and that applies to our food as well. We must try to eat it while it still contains some of that essence.

        Reply
      3. David Bailey

        AhNotepad,

        Your video (I didn’t listen to all of it) seems to be about food with toxic additives. That doesn’t seem relevant to Mark’s point, any more than it would make sense to tell people to give up alcohol because in certain parts of the world contamination with methanol is common.

        What I find strange, is that takeaway food is condemned by the NHS primarily for containing too much saturated fat and salt. Now saturated fat is exonerated by most people here, and the evidence for salt being harmful is weak:

        https://drmalcolmkendrick.org/2014/05/13/salt-is-good-for-you/

        Despite this we seem unable to move beyond the concept of junk food, and those terrible takeaway meals. I don’t eat one very often, and when I do, I share it with my partner because the portion size it too great, but I don’t feel guilty for consuming it.

        Reply
        1. AhNotepad

          David, while it may be away from what intended, he made a broad statement that any diet was ok, and a “healthy” diet was no more beneficial than any diet that might be considered by some to be “unhealthy”. Most of the consumers of the concoctions in the video would not know what went into a dish they probably saw as traditional, and if we go to burgers, most people would no doubt not associate the bun part with refined carbohydrates, nor that that and other ingredients as possibly containing fructose. Very likely in the drink they have with it.

          My point is Mark’s assertion that a “healthy” diet is not necessarily different from an “unhealthy” diet is questionable, and there are many things it would be better to avoid ingesting. This is more important in today’s processed food world where it seems almost anything goes, as long as it turns a profit.

          In the west, where increasing amounts of food are imported from China, it might be worth questioning the ingredients. This also applies to most other processed foods.

          You might consider it’s worth examining the Thai prawn industry as yet another “healthy” option, or is it?

          Reply
          1. janetgrovesart

            I’ve almost finished reading “The Way We Eat Now” by Bee Wilson and jolly good it is. I’d recommend a reading of it. It’s a real eye opener and food-wise things are much worse, it seems, than I ever suspected. Order junk delivered to your door and watch tv. chefs cooking while you’re eating it. Sad.

    2. David Bailey

      Mark,

      Thanks for your comment – I think Dr Kendrick himself had a blog in which he stated that diet is not significantly involved in CVD. I also know that there is published evidence that any harmful effects from alcohol follow a J curve – a little alcohol does you good, PROVIDED you are not susceptible to alcoholism. So as a non doctor, I agree with you, and I wish all doctors took the same line.

      Does your avoidance of preventative measures include not giving statins? I discovered just how unpleasant the side effects can be.

      What advice do you give to T2 diabetics – the official high carb advice, or the low carb diet recommended by many?

      Do you follow the official guideline that an average systolic BP over 140 needs treating? At what level do you think intervention is a good idea?

      Is there good evidence for more CVD in hard water areas (or just higher CAC scores).

      Reply
      1. Mark Heneghan

        Re statins I usually quote the guidelines and then say why I wouldn’t take them, and thanks to blogs like this and Malcolm’s books I can usually give quite detailed evidence to support my stance. I have stopped giving the standard T2DM advice (when asked – it’s usually the dietitians these days) and explain why those not on insulin or sulphonylurea are in no danger of a hypoglycaemic attack if they restrict carbs and then advise them to try it. Re the systolic of 140 have a look at the website called NNT (number needed to treat) and see what they have to say about treating mild hypertension, which would cover this reading – they advise not to.
        Don’t know about CVD in hard water areas, but I wanted to point out how long ago he wrote it.

        Reply
    3. AhNotepad

      Mark, I think diet can be damaging, and consequently unhealthy. Weston Price noted the problems introduced by refined carbohydrates, John Yudkin pointed out the problems that would occur following the increased use of fructose, and lately explained in detail by Robert Lustig. Lack of vitamins is known to cause problems, both physical and mental, Early transplant surgeons had to stop using polyunsaturated oils to reduce the rejection of organs. Until they found their patients were growing tumours as a result.

      Gluten is a known problem, in the diet of some people. I would venture it is an unknown problem for many people who do not have clinical signs.

      As for needles, nutrition would be better, this inevitably has a diet implication. Good nutrition means individuals are able to avoid disease, where poorly nourished people are prone to developing disease.

      In short, diet makes a difference.

      Reply
      1. Mark Heneghan

        Of course any diet deficient in x is harmful, but easily remedied by adding x. Gluten is harmful to people with coeliac disease ( about 1% of the population) but is harmless otherwise, or at least not dangerous. And I already had a caveat about carbohydrate in diabetics. I am referring to the promotion of a ‘healthy’ diet, which when I was in medical school meant sufficient nutrients ( vitamins, fibre, minerals, carbohydrate, fat, proteins) to meet requirements, so that there were no deficiencies. No mention was ever made of the dangers of surplus of individual ingredients, except the danger of excess calories (and, as mentioned, carbohydrates in diabetics, and if you are being picky, mega doses of fat soluble vitamins, and salt – not likely to happen with ordinary gluttony). Then the diet heart theory started, and suddenly fat was treated as poisonous, and the concept of a ‘healthy’ diet was introduced, and even though readers of this blog must surely buy into the idea that it is all balls, and that the fat does no harm, we haven’t been able to shake off this ‘healthy’ option idea. These days so many ingredients enjoy their 15 minutes of infamy, when it has been decided that they are ‘bad’ for you, that ‘healthy’ food can be pretty bland. My definition of a healthy diet is one that has sufficient essential elements. If you give a cheeseburger and chips to someone dying of starvation, and they don’t die, how was that meal ‘unhealthy’?

        Reply
  47. Soul

    I just thought of a theory on why I tested high with an artery calcium score. Nobody laugh. I know, just what we need, another spur of the moment theory.

    For several years now I’ve known of a couple foods that will make me bleed easily. Pork if consumed for a few days in a row will cause my gums to swell up and bleed. I’ll also itch all over if I eat pork.

    There is a food worse than pork though. Garlic and onions will cause me to bleed easily all over. Quantity matters, and possibly the age of the garlic also, but if I consume a lot of garlic the skin around my finger nails will pull back and bleed. My gums will easily bleed also. My eyes too can easily become blood shot red after consuming garlic or onions.

    The bleeding I can visually see caused by eating these foods likely also effects internal tissue that I can not view. I can imagine that if other tissue easily damages and begins to bleed from consuming garlic and pork, that my under pressure arteries would be easier to damage, bleed, and scab up.

    It will have to a theory not tested though. I’m not interested in being a guinea pig.

    Reply
    1. Albany

      Soul
      Have you watched Elliot Overton’s YouTube interviews ( there are several) about oxalates in some plants – they form needle-like or razor- sharp crystals that can then damage ANY part of the body. Most prevalent in forming kidney stones. Maybe it is e.g. spinach with the pork that is the problem? Worth watching.

      Dr Kenrick,
      Maybe this is another way of damaging the endothelium?

      Reply
  48. Charles Gale

    Another reason for CAC scans

    In a previous comment of mine, my personal argument for CAC scans was my experience: perhaps if I had knowledge I was walking around with a high CAC score, an encounter with the Grim Reaper could have been avoided.

    I’m constantly on the lookout for new presentations from, developments and interviews with certain people e.g. Dr Suzanne Humphries, Dr Matthias Rath and a few others and I hadn’t spotted anything new during 2019.

    Until the other night on youtube when I saw a new presentation from Dr Rath, dated Nov 2019 and called:

    “Ending the cardiovascular epidemic by natural means”

    Here is the link:

    Most of us here are familiar with his work on lp(a)/vitamin C/CVD and this presentation doesn’t offer anything new. But it’s a concise 26 min running time and thus a good introduction to his work.

    Of relevance to this post on CAC scans is the research done on mice.

    This occurs at 13.55 with Dr Rath talking about genetically modified mice. They have been humanised i.e. no ability to produce vitamin C. What happens to the mice on low vit C diet? Plaques develop.

    Is this theory or does it work in humans? 20 years ago, over 60 patients got CAC scans and retested a year later. Plaques gone.

    This is covered from 13.55 to 17.13.

    I should point out that his 2018 Cyprus lecture provided a lot more details e.g. nutrients used, after 1 year progression stopped and reversal in some patients. He does caveat reversal by stating:

    “…it doesn’t mean that I’m teaching here that all forms of atherosclerosis can be reversed especially not when they are already at advanced stages and there are complicated lesions then it is impossible to reverse it or you can only reverse a certain part that is a accessible to regulatory mechanisms. But for early forms of cardiovascular disease it is possible.”

    In fact, I’m now concluding with 2 reasons advocating CAC scans:

    (1) research and hypothesis testing and advancing our knowledge of CVD. (I guess if no sort of testing was ever done on the human body we’d know nothing and we’d all be doing something else in our spare time)

    (2) nipping in the bud calcium progression. However, it seems after a certain point it is probably impossible.

    Not much hope of calcium regression for those us with high scores.

    I did find Dr Rath’s paper and provide a link to it some time back in the comments of a previous post by Dr Kendrick and dimly recall the calcium scores were quite low.

    I’m well aware of the claims about the reversal of arterial calcium but the data (i.e. a series of calcium scores never seem to be provided…how high were they?…) are vague and how controlled are the claims?

    I’d love to see solid evidence of calcium regression for those with high scores.

    Reply
    1. Martin Back

      “We find cholesterol in plaques therefore we must reduce cholesterol.”
      “We find calcium in plaques therefore we must reduce calcium.”

      More erroneous reasoning?

      Reply
  49. Kevin Frechette

    Hi Dr K,

    Is getting a non-invasive CAC scan better than having a Cardiologist wth a Catheter Roto-Root your arteries with a risk of triggering a stroke or heart attack?

    I live in Northern Ontario Canada. When my Dad had his heart attack about 20 years ago, he got an Angioplasty in Michigan but for years would get Angiograms at our local hospital that doesn’t perform Stents or Bypasses. Our nearest Hospital is about 3 hours away. Is it normal for the Cardiologists to perform operations without a safety net?

    From my reading, I’m thinking that the arterial blockage of scabs and calcified scabs isn’t the root cause of heart disease but it’s the lifestyle that is causing micro capiliary damage and poor mitochondial function.

    P.S. In defense of Ivor, us Engineers get suckered into working on badly designed equipment and until you figure out the design flaw, nothing works right. He’s grinding his way trying to interpret flawed studies, crappy drugs, risky procedures and dogma within the parameters of a rigged game.

    Kevin Frechette

    Reply
  50. Dr. Rick Zabrodski

    This one really hit home, personally. I am about to turn 65. I have numerous aunts and uncles and can confirm that virtually none of my relatives have ever died of cancer. It was a heart attack, somewhere between age 65 and 95 that did them all in. My dad had his first heart attack at 55 and both parents had CABG surgery in their mid 70’s.

    It was for this reason, exactly 20 years ago, that as a physician, I had one of the first coronary artery calcium scores done in Canada. It was indeed highly elevated, consistent with the average score of 65-year-old. While I did not have diabetes or elevated lipids my Bp was climbing. I had an angiogram that showed a single 50% lesion in the proximal LAD. I subsequently took a Statin and an ACE for the next 15 years, but more importantly, lost and have maintained a 55 pound wt loss, by avoiding all junk food and sugar, something which is now called a low-carb or keto diet.

    Unfortunately, at the request of my cardiologist I had a follow up corner artery calcium score a few years back. This showed an average score consistent with being somewhere in the neighbourhood of 100 years old. This past year, 20 years later, I therefore underwent yet another angiogram. Low and behold: the exact same UNCHANGED 50% LAD lesion was there with nothing else and no other concerns (actually, I do have grey hair now). I Have never smoked and have always been active.

    My only comment for your consideration is that there is that there is no doubt that I would not have made these lifestyle changes 20 years ago had I not had the test to scare me!

    I have therefore selectively used the CAC for folks who need verification of possible risk In order to make the required lifestyle change.

    All the best!

    Dr. Rick

    Reply
  51. Micki Jacobs

    While I totally agree that individuals are not well served by getting CAC scans in light of our ignorance of all that makes for this calcium deposition, I want to advocate for learning a lot more about just what does makes this CAC deposit by using this biomarker in studies: what affects its initiation, growth and possible regression and how can we see the data differently?
    Also, the role this calcium has in rupture is a very worthy approach.
    In fact, I want to advocate that calcium is where we should be looking – not so much at cholesterol, at least not the ways we have in the past – and in ways that are not usually put together.
    And I want to quibble about the etiology and understanding of plaque stability that you cited, Dr Kendrick. This story is what the vast majority of the literature claims about how calcium deposits later in plaque formation, claiming that it makes stability, and how we can identify the stability or vulnerability to rupture of plaques by calcium patterns or lipid patterns – but it’s ‘lipid-centric’ thinking because that is what we have always done: look at fats as they affect heart health. Fats sort of made us blind to calcium and with recent technology that allows us to see microcalcifications, where they are and possible actions in plaques, we can see a different story. Yes, plaques contain lipids, but there is actually evidence that non-calcified plaques are benign (1) such that the conclusion was “Calcified or mixed coronary plaques might be more associated with an elevated likelihood of having CVD than noncalcified coronary plaques.” Granted, this is only seeing risk scores and correlation, but do we really know that ‘fatty plaques’ cause events?
    Or (2) the finding that “…overall prognosis of patients with a zero CAC is largely unaffected by the presence of non-calcified atheroma.”
    The pesky accuracy of CAC in risk assessment means that we should look at it, IMO, but from a perspective of understanding just what this biomarker represents.
    And the accuracy of CAC in predicting other chronic diseases or a zero CAC predicting a 15 year warranty from death by all causes shows that it represents more than just heart health.
    Another way to see plaque stability is the mechanics of calcium deposition. (3) Worth the read, the conclusion: “Finally, from a clinical viewpoint, it is not the μCalcs per se that are dangerous, but their locations in the cap relative to the location of the minimum cap thickness and their spacing. This suggests that, if an adequate in vivo imaging technique could be developed, one might be able to use FEA to assess cap stability.”
    Again with the testing! And what we will do if we see vulnerable deposition in the caps of plaques? We have nothing. So testing is silly. Again.
    Plaque biomechanics must be considered, but this is to understand the processes of rupture, not to test individuals and offer advice (for which we have none, but with knowledge, this could change). (4)
    But these microcalcifications…what makes them go there? Are they the molecules that can go on to become measurable CAC via CT scans? Yes.
    Calcium is a signaling molecule. Calcium as CAC is hydroxyapatite, inappropriate in arteries and soft tissues and appropriate in bones and teeth: CAC is recognized as ossification. Microcalcifications preceded the CAC measurable in CT scans. So what makes are these various sizes of calcium molecules and the mineral complex act correctly and what interferes?
    It appears that some nutrients are big players (vitamin K, Mg, etc), that vitamin K has much more to it than is generally recognized in terms of pathways and processes, and that we interfere in these pathways and processes via some pretty common drugs, some pretty ubiquitous toxins, and via some aberrant dietary fats that were created in response to some upstream mistakes when it came to understanding lipids. Always with the lipids….
    Vitamin K is a huge deal, as you note Dr Kendrick, but K2 is something more than most realize.
    Among its many pathways and processes, consumption of it can be cleaved in the small intestine to create vitamin K3, menadione, which is carried by the lymph to bodywide tissues where this menadione is converted by UBIAD1, an enzyme that also controls calcium and cholesterol, into the form of vitamin K2, MK-4. MK-4 is the only form of vitamin K2 not made by fermentation and is the most common form of K2 in us, in our tissues. We can eat MK-4 in animal foods because animals also make this conversion in their tissues, but when we do eat it, it is hardly found in our serum. This has baffled all the folks who measure stuff in serum, but K is not only carried in serum – this gut/lymph/conversion of K is huge! And missed. And intimately involved in all sorts of things and is potentially representative of how well calcium is regulated because if these processes go well (and we stomp all over many aspects via many ways), it appears to offer great health benefits.
    We stomp in K2 actions via statins, warfarin, bisphosphonates, aspirin and, interestingly, these increase CAC and/or mess with calcium.
    We stomp in calcium behaviors with our pretty ubiquitous exposure to fluoride, with chronic exposure from water fluoridation, but also from some F-based pesticides, some consumer products (teflon, flame retardants), fire fighting foam (has polluted water) and of course, dental products. F is anti-calcium, believe it or not.
    We mess up calcium when we supplement it (you did not mention, but this is shown to increase risk of an event in women who were advised to supplement for bone health and makes for more CAC).

    Cholesterol and calcium share UBIAD1, the enzyme that is necessary to make the endogenously made form of vitamin K2, MK-4, a hormone found in a variety of tissues in varying amounts. (5)
    Higher TSH is correlated with higher serum cholesterol in humans. The thyroid in rodents is extremely high in MK-4…so is this so for humans? Who knows? But this vitamin K2, endogenously made and a hormone that affects many genes, is very high in rodents in the organ that directly affects metabolism – the thyroid. We have no idea of what we are doing when we consider thyroid functioning (my claim, but won’t go into this now), but I believe that inhibition of thyroid functioning is extremely common and unrecognized because of upstream mistakes (much like cholesterol, calcium).
    When CKD patients, who tend to die from CVD, were supplemented vitamin K2, their cholesterol dropped and then rose back to previous levels when supplementation stopped. Would this be the case for others? For healthy folks? Maybe.
    So can cholesterol actually represent vitamin K actions, which can directly affect calcium behavior?
    I think so.
    Seen this way, calcium may initiate plaques, not the other way around. And vitamin K2 is anti-inflammatory.(6) Calcium dysregulation may be the mechanical explanation for many of the common chronic diseases – my hypothesis – at subatomic levels and in ossified soft tissues.

    1 https://www.sciencedirect.com/science/article/pii/S089539881930073X
    Association between Coronary Atherosclerotic Plaque Composition and Cardiovascular Disease Risk (2019)

    2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6519430/
    A zero coronary artery calcium score in patients with stable chest pain is associated with a good prognosis, despite risk of non-calcified plaques (2019)

    3 https://www.physiology.org/doi/full/10.1152/ajpheart.00036.2012?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&
    A mechanistic analysis of the role of microcalcifications in atherosclerotic plaque stability: potential implications for plaque rupture (2012)

    4 https://www.ncbi.nlm.nih.gov/m/pubmed/30904335/
    Calcifications in atherosclerotic plaques and impact on plaque biomechanics. (2019)

    5 https://www.intechopen.com/books/cell-signalling-thermodynamics-and-molecular-control/vitamin-k2-a-vitamin-that-works-like-a-hormone-impinging-on-gene-expression
    Vitamin K2: A Vitamin that Works like a Hormone, Impinging on Gene Expression (2018)

    6 https://www.intechopen.com/books/vitamin-k2-vital-for-health-and-wellbeing/anti-inflammatory-actions-of-vitamin-k
    Anti-Inflammatory Actions of Vitamin K (2016)

    Reply
      1. Micki Jacobs

        As I pointed out, the pathways and processes of K are not the usual ‘ingest it, measure in serum’ approach. This has, incidentally, been a mistake regarding fats, too.
        We have been kind of clunky in this regard.
        This cleaving in gut to create vitamin K3 and then shipping this K3 throughout the body in lymph to ultimately make MK-4 is not being appreciated enough. Not understood enough.
        UBIAD1 wants K3 and it controls calcium and cholesterol.
        While K1 is known to undergo this complex conversion, whether menaquinones do so needs more investigation. And we can measure K1 in serum in a dose response.
        But MK-4 may be almost completely processed this way, so it might offer benefits that are unappreciated over other forms of dietary K2.
        Big fan of eating all forms of K, but the fact of higher or lower amounts in serum misses these important complexities.

        Reply
  52. JDPatten

    The trouble with screening tests, according to the Establishment:

    It makes absolutely no difference to the “end points” (something dire, like Death!) of the tested population.
    But, as I’ve yelled before, we’re each of us a discrete entity with unique personal characteristics.
    We’ve all heard stories of lives of particular people in their particular circumstances being saved by a test.

    We don’t hear so much about harm done to other individuals. My daughter refuses further mammograms after an extemely painful biopsy triggered by one. Negative. A friend had a scare and a difficult biopsy. Negative. Still gets mammogrammed. My wife usually gets called back for a redo. Negative. Still goes.
    Ah, but then there’s my mother-in-law with a positive, a lumpectomy, and radiation decades ago. She’s 99 now. Was the lump a DCIS and wouldn’t have made a difference? Can’t say for sure, but she’s regularly pointed out to indicate the worth of screening.

    I could go on about prostate testing on the guys I know. I’ll point out two. My doc has never recommended the PSA, so I never had it done. He also recently dropped the digital exam, citing literature indicating that it makes no difference to net survival of the examined. Again, this is about the masses, not you; not me.
    My neighbor had a PSA that was a bit high. Went back a (perhaps) crucial 3 months later and the PSA was through the roof. Dead within the year. What good did the established testing protocol do that individual?

    I suggest you think of yourself as the particular individual you are when contemplating screening tests such as the CAC. You represent one decimal place, not five or six or more.

    This is an eye-opener in that respect:
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142277/

    Reply
    1. Tim Ozenne

      “But, as I’ve yelled before, we’re each of us a discrete entity with unique personal characteristics.”
      I agree, though I imagine that recognizing our individuality would demolish virtually all “preventative medicine” and “screening.”

      Reply
  53. KidPsych

    Luckily, this could never happen again…

    https://codastory.com/disinformation/biosynthetic-insulin-disinformation/

    FTL: Manufacturers were well aware of human insulin’s reported dangers; but instead of addressing them, they embarked upon campaigns to discredit and even assassinate the character of those struggling to manage their diabetes with biosynthetic insulin.

    However, manufacturers’ greatest resource of disinformation was industry-funded organizations.

    Between 1986 and 1989, the British Diabetes Association (BDA), now known as Diabetes UK, had received over 3,000 letters citing adverse reactions. At first, the organization, hired an independent researcher named Natasha Posner to assess the risks posed by biosynthetic insulin. The BDA promised to publish Posner’s full report, which concluded that 10% of users had experienced dangerous side-effects while using biosynthetic insulin and that the problems often disappeared when they returned to animal insulin.

    Yet, in 1993, the BDA elected not to publish the report. It was “too alarmist,” BDA official Simon O’Neill told The Guardian in 1999, when the report was leaked. Posner’s report quoted individuals who had lost jobs, crashed vehicles, divorced spouses, or generally reported that life was “absolute hell” on human insulin. The BDA sponsored an ad in The Observer in 1995, condemning those who “unnecessarily caused distress,” such as whistleblower Matthew Kiln—a doctor and diabetic who had demanded government action on biosynthetic insulin—and the 700 individuals organizing a group litigation.

    Reply
    1. shirley3349

      I was nursing on an NHS medical ward in the early 1980’s when the changeover to human insulin happened.
      From memory, few patients had any problems. The most common was the lack of any physical warning of imminent hypoglycaemia. This danger was addressed by issuing all patients on insulin with BM testing sticks, (no electronic gadgetry then!) and teaching them how to use them. The undoubted advantages were fewer, rare in my experience, allergic reactions to beef or pork insulin and a more rational dosing system, where 1 ml on the syringe now represented 100 units of insulin, which must have prevented a lot of accidents.
      But recently,( in a conversation with my chiropodist whose elderly mother is an insulin dependent diabetic), I found out that the thresholds have been altered. She told me 4 mmols/l was now regarded as hypoglycaemic where, (if my memory serves me correctly), the normal range for fasting blood glucose in the 1980 s was about 3.3 to 5.5 mmols/l. If I am right, it must have been found necessary to increase the safety margin to prevent too many episodes of potentially dangerous hypoglycaemia. This must have lead to a corresponding weakening on average in blood glucose control.

      Reply
  54. Jill Mitchell

    Thank you Dr Kendrick. I agree. How many tests do we want to have? How often? How much time do we want to spend with medical people? A doctor’s waiting room is a high risk place to get the flu.

    Reply
    1. andy

      Hi Jill: tests for the average person
      Get annual cholesterol test, take a statin and save up money for stents and bypass operations.

      Reply
      1. Jill Mitchell

        Andy, please read Dr Malcolm Kendrick’s book The Great Cholesterol Con. I am not going to have my cholesterol tested in future.

        Reply
  55. Jess

    Mark: Calories will certainly fill you up, but are generally only useful to provide energy to the body,. They don’t necessarily provide adequate nutrition and the more a product is ‘processed’ the less likely it is to contain sufficient nutrition, manufacturers are only concerned with extending shelf-life.

    JDPatten: I agree with you, everyone is unique, and God help you if you don’t fit into the masses. My husband originally attended the doctor with difficulty passing urine with a noticeable amount of blood loss. His PSA levels were within normal range and it was decided that all he had was an enlarged prostate. It took 2 years for him to have TURPS surgery, during which they they discovered cancer (and his PSA levels were still normal) but by that time it had already spread to his bones, lungs and one of his adrenal glands, so much for depending on blood tests in his case. Blood tests are useful but they don’t always tell the full story and can often lead you into a false sense of security, especially when you are experiencing symptoms. Take Mg as an example. Blood has to maintain homeostasis to preserve life, when there is insufficient Mg it will be robbed from wherever else in the body it can get it. They only way of really measuring Mg is by having a Magnesium Red Blood Cell test.

    KidPsych: I don’t have diabetes myself, but I do include it in my reading as it is one of the many diseases that seems to be increasing at an alarming rate. Something like 350 million people worldwide have the disease, which has more than doubled over the past 30 years along with obesity. I assume you are referring to Type 2 diabetes but I understand it can help Type 1 as well. From what I have read, diabetes can be attributed to a deficiency, notably Chromium and vanadium. Apart from those two, the body needs something like 25 other minerals to metabolize sugar and sugar consumption has increased considerably over the past 30 years, mainly from processed food, soft drinks etc. The more sugar in the diet the greater need for our food to contain the minerals we require to metabolize it.

    Reply
    1. Mark Heneghan

      Jess, my problem with the idea that ‘processed’ food is ‘bad for you’ is that there is no hypothesis in any of the studies to explain how this is so. True, every one ‘knows’ that processed food is bad for you, but any evidence that I have found is weak. Usually retrospective studies with multiple endpoints being included to increase the chance of a statistically significant result. There have been vague hypothesising that the high salt content, or high refined carbohydrate contents are to blame, but if that is the case then why not attack just those elements rather than using the vague blanket term ‘processed’? Re your point that calories only fill you up, that is a good thing surely. Very few single foods contain every nutritious element, which is why we eat a varied diet. Mushrooms are tasty and provide fibre, but very little protein or fat. Fruit often has a lot of vitamin c, sugar, and water, but not much protein. This ‘being deficient in something’ is common to almost all foods – even breast milk doesn’t have much fibre – so why is processed food singled out for lacking certain nutrients?
      I wonder if there is any link between ‘processed foods’ and poor health it is because there is a strong correlation between eating them and poverty, which as we know is strongly correlated with illness.

      Reply
      1. Doug from Canada

        Hey Mark,

        I find it interesting that you quote ‘processed’ foods but fail to quote ‘fibre’. Taken to an extreme could you imagine someone taking a baby off a breast to spoon feed it fibre, lol….

        I would argue the newest mantra: fibre, fibre, fibre, to be more irrelevant than processed, processed, processed……., although other than processed meat and the occasional bag of crisps (that’s British for a bag of chips, am i correct?) I don’t advocate excessive processed food consumption in my own life, and I really don’t go out of my way to supplement fibre.

        And for all you poop fanatics, yes I’m quite regular without ‘fibre’.

        All things in moderation, except life, and coffee (what’s life without coffee lol)

        Reply
  56. Charles Gale

    Martin Back

    “More erroneous reasoning?

    Some new, interesting thoughts being raised by you and Frederica concerning what to do or not do about arterial calcium.

    Danny Evatt

    Thanks for the feedback on lab results

    Reply
  57. Charles Gale

    Reversal of CAC score by Dr Matthias Rath

    Further to my comment about Dr Rath having success in reversing CAC scores but quoting his caveat…I made a comment that I had previously found the report and posted it the comments somewhere/sometime on this website, and that I recalled that calcium reversal was achieved with those with low scores.

    The report can be found in the Journal of Applied Medicine dated 1996 vol 48.

    Here it is in its entirety:

    https://www.researchgate.net/publication/265537617_Nutritional_Supplement_Program_Halts_Progression_of_Early_Coronary_Atherosclerosis_Documented_by_Ultrafast_Computed_Tomography

    To cut a long story/report short, the scores at study entry were less than 100 – my memory wasn’t playing too many tricks on me!

    Plenty of interesting stuff about progression and reversal during the year long study.

    Reply
    1. andy

      Hi Charles: re Rath and CAC reduction, good start
      Study was done in 1996. Wonder what would be results for low carb, more vitamin D, and adding K2? CAC score useful for monitoring progress. Would be easy to do N=1 studies.

      Reply
  58. Charles Gale

    Andy “…wonder what the results for…”

    Indeed it would.

    I had a look at the contents of the nutritional supplement programme and it did include a very small amount of vitamin D (600 iu) and also (strangely?) calcium (150 mg).

    No vitamin K2. But this, as you point out, was many years ago, perhaps long before much was known about vitamin K2.

    I’m thinking of getting a second CAC scan done.

    However, I’m not following any protocol to remove the calcium so I won’t be much use for any n=1 study!

    Reply
  59. manarovici2008

    Hello Dr. Kendricks, Greetings from Vancouver, B.C. Canada ! Thank you very much for your articles and the last one on CAC. I am very interested in what you present and I looked also on you tube the interview with Dr. Mercola and others. I was diagnosed with Afib many years ago and prescribed coumadin. I change that “medication” to Xarelto, allowing me to eat salads and more green food. My doctor was not able to explain haw Xarelto works, the only explanation was that it allows me to eat what I like. I am not friends with medications since medication would not heal me. Is there any way of stopping, this electrical issue, thereby stopping the Xarelto ? At the same time I have BP and I take Coversyl 8mg and Amlodipine 10mg with no real results, average 160/79 I understand that long distance medical advise is difficult, but I trust your opinion as cardiologist. Thank you Doctor and have a Happy New Year 2020 ! Best regards,

    Dan M

    ________________________________

    Reply
    1. JDPatten

      Dan,
      I’ve been where you are.
      Concerning anticoagulation and afib, there is a school of thought that only a few minutes in this arrhythmia can cause blood chemistry changes and atrial substrate changes increasing the risk of clot and stroke. Rivaroxaban is better than warfarin (coumadin), certainly. Apixaban (Eliquis) might have an edge on both, equal at preventing clots, a bit better at preventing brain hemorrhage
      There are several risk factors for Afib that might improve your situation if addressed, though the longer you’ve been in afib, the less likely for success.
      Sleep APNEA is high on the list. Anyone with afib really ought to get a sleep study.
      Obesity is important. For some, it’s a matter of losing weight to see improvement.
      Diabetes is important. See references to Low Carb, High Fat dieting on this site.
      And, of course, there’s high blood pressure. On that point, I suggest you look into the possibility of hyperoldosteronism – when your adrenal gland(s) produce too much aldosterone. This condition has been implicated in afib as well as resistant hypertension.

      All this info is readily available to anyone searching the web, but I strongly suggest that you get yourself a really good electrophysiologist to guide you.
      Be sure to address these lifestyle changes before accepting an offer of an ablation. Ablation can be helpful. It also can create unexpected consequences.

      Reply
    2. andy

      Hi Dan: re the electrical problem, brief outline of my experience

      First AFIB episode at 72, now 8 years later and confident that the problem has been solved. There are many flavours of AFIB, mine was the lone type. Did not take blood thinners except low dose aspirin on three occasions in addition to C and Mg.. There are AFIB books on Amazon, but have not read any. Here is my current thinking what can affect the electrical system:
      OLD BATTERIES- the #1 place to look. Ageing mitochondria do not produce as much ATP.
      ELECTROLYTES- adequate amounts of vitamins and minerals for electrolyte composition
      FUEL CELLS- fatty acids ketones and lactic acid are main fuels for cardiomyocyte mitochondria. Soybean oil and other seed oils should be avoided until further notice.
      OXYGEN- acute oxygen supply disruption to mitochondria by exercise or stress is a trigger. More plaque will make problem worse.
      STIMULANTS- alcohol and MSG
      REJUVENATION- A bit of autophagic housecleaning via mTOR inhibition is essential. Practising the reduced eating window protocol.
      SYNAPSE MODULATION- via endocannabioid system. CDB oil is used for seizure control for epileptics. I have used CDB for last 2 years. Some consider this a master regulator.
      DIET- ditch glucose raising carbs, go for adequate protein and high fat
      HYPERGLYCEMIA- and insulin resistance affects coagulation among other things. Checked blood glucose for a few years before and after meals. Keeping a daily log of foods consumed.

      Reply
  60. Göran Sjöberg

    The importance of what we put in our mouth on a regular basis now and then pops up around CVD issues because there are people like me who believe in the importance of this while most of the medical establishment (and the food industry) consider it as grossly irrelevant. However metabolic diseases of different kinds are skyrocketing today so there must reasonably be a common denominator which in my eyes is that we are constantly ruining our immune system by poor nutrition, especially micro-nutrients.

    In this context Dr. Weston Price made groundbreaking scientific discoveries about the connection between good/bad health and the fundamental importance nutrition. His findings have been ignored by the medical establishment for almost a hundred years now. It though always surprises me that he seldom gets proper recognition among the very informed participants here on Malcolm’s blog

    Reply
  61. Shaun Clark

    Hi Dr Kendrick, Thank you for this. It was/is very illuminating! I recently watched 2 Vids of Ivor Cummins interview with Dr Arthur Agatston – which I found fascinating. In one of the Vids AA stated that a calcium score could not be reversed. No comment was offered by IC to this, but I think I am correct in believing that this is one of the core objectives of the Fat Emperor Website, more especially so in respect of the Websites sponsor – David Bobbit? Anyway, I am a BIG follower of both you and IC. I guess there is some way to go with CAC scores, and maybe in the future (if we do not get everyday diets sorted out!), a (…vastly simpler) CAC examination could be a standard yearly procedure.

    Shaun C.

    Reply
  62. John

    Fascinating read, and a little more confused. Had a CAC done with a score of 34 and have no real idea what that means, was told should take statins which I’m not, I take K2MQ7 and COq10 so am i just pi**ing in the wind?

    Reply
  63. Sue Pietersma

    The cat’s among the pigeons 🙂
    I’ve been following the interchanges on this subject with great interest. I have the greatest respect for both Malcolm and Ivor. I avidly read everything either of them writes. Personally I won’t have a CT scan. At 62 I have followed a low carb, no sugar, absolutely no processed junk, moderate exercise way of living for the last 6 years. Ditched the Statins at the same time. (grrrrr – get so angry when I think about those Statins…) I take a few supplements mostly – Omega 3, K2, D3, Mg. Most blood results pretty OK: TG < 0.5, HDL 3.something, LDL I don't care, BP normal, weight fine, etc etc – Just Lp(a) fairly high – don't care either. So really no reason to have a test – except interest – and I am tempted (same reason I keep having Cholesterol tests – just to see how high I can get my Cholesterol, my record is 8 🙂 ) However if a CT came back low I wouldn't change anything. It it came back super high, what more am I going to do than I already do? So, moving on…….
    Thanks for another brilliant post Malcolm.

    Reply
  64. TheFatEmperor

    Hey Malcolm I emailed you about having a Podcast to debate this one – should be good!

    In the meantime for everyone here I’ve jotted down initial thoughts on the matter – following PDF has my replies to your main points, then further down a reply I sent to William Davis MD’s “Cureality” website, in response to much discussion there on your provocative blogpost:

    https://drive.google.com/open?id=1NqcR-EKCMhR2DooZ9NCX8-LVYyglvMXY

    Looking forward to the debate – it should really help clarify CAC in people’s minds 🙂

    Best

    Ivor

    Reply
      1. Shaun Clark

        Hi Malcolm (and of course Ivor, if I may),

        Mmmm, well, your post and Ivor’s reply certainly got matters going somewhat!

        Given everything, I personally would always take the ‘red pill’, but I am all to aware of folk who shudder at the thought and would run screaming to grab the ‘blue pill’. Given the sheer cost to the NHS (for example), that to me is utterly shameful. Its much like smoking or big bread/carb/margarine/sugar intakers, their denial is absolutely deafening. Anyway, I need to ask, are you yourself anything of an exerciser Malcolm?

        Shaun

        Reply
      2. James

        What I like about this is; Ivor disagrees with you, and you disagree with Ivor.
        Neither of you are screaming at each other.
        You both respect the others point of view and are willing to debate the issues.
        What we can all agree on is; you both set a brilliant example of how science should be examined

        Reply
    1. Göran Sjöberg

      Great reading about CAC!

      As an engineer and researcher I feel since long strongly befriended with your attitudes concerning CVD through your excellent lectures on youtube.

      Since I had a near fatal MI twenty years ago and also suffered serious angina, although now mostly kept at bay, I could not possibly think that I wouldn’t hit the CAC roof on testing.

      I have for many years followed the same intervention protocol you are advocating – addressing the fundamental IR through a very strikt LCHF regime. (Dr. Kraft’s spirit looming here!) I also take what Malcom and many other well informed contributors advocate on this blog to my heart.

      In my “special case” (?) I though don’t see any strong reason for att CAC-scan to find out what I already know. It would off course have been great to have such a scan done thirty years ago to see the “truth” and take the same precaution actions I now belatedly am pursuing.

      Reply
  65. Randall

    I know after a CAC they give you your number (score). But what if you get your images and look at the amount of calcium in your arteries and then look years later and see if the calcium is accumulating and how fast. Coronary artery calcium testing: A call for universal coverage https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6525277/ Many studies listed in favor of CAC. Not to sound negative but I could not help but seeing a negative view because of a Doctor’s hand holding after a high score.

    Reply
  66. Stephen Rhodes

    .May I again raise a possible mechanism connecting low plasma ascorbic acid and CVD ?

    This; Relation of Ascorbic Acid to Coronary Artery Calcium: The Coronary Artery Risk Development in Young Adults Study
    Joel A. Simon, Maureen A. Murtaugh, Myron D. Gross, Catherine M. Loria, Stephen B. Hulley, David R. Jacobs, Jr.
    American Journal of Epidemiology, Volume 159, Issue 6, 15 March 2004, Pages 581–588, https://doi.org/10.1093/aje/kwh079
    Finds a correlation between low or marginally low plasma ascorbic acid levels and elevated CAC score.

    If Calcified plaque is the result of damage, might the link be; low plasma ascorbic acid > less deformable RBCs > arterial damage (by more rigid RBCs) > arterial repair > calcified remaining parts of plaque.

    Reply
  67. Ian Hall

    Cardiologist Dr.William Davis wrote,”Calcium is an index of total atherosclerotic plaque. In general, 2 cubic millimeters of calcium is equivalent to 10 cubic millimeters of total atherosclerotic plaque, soft, calcific, fibrous, and cellular elements. This is why a coronary calcium score so reliably reflects risk for cardiovascular events, because it is an index of total atherosclerotic plaque even though it is itself “hard.”
    In the future, I will have a second CAC scan because I want to see if my preventative regimen is on track in keeping my calcium score low.Prevention is better than cure.

    Reply
    1. Claudia Wilkinson

      Only one thing really irked me about this fascinating post – and that was your implication that Alzheimer’s is not preventable or curable ( in the early stages so far)! Please read The End Of Alzheimer’s by Dr Dale Bredesen.

      Reply
    1. Ian Hall

      A review published in The Journal of the American Osteopathic Association found Vitamin D can’t be metabolized without sufficient magnesium levels, meaning Vitamin D remains stored and inactive for as many as 50 percent of Americans. Magnesium deficiency shuts down the vitamin D synthesis and metabolism pathway.
      The problem is people may suffer from vascular calcification if their magnesium levels aren’t high enough to prevent the complication.
      Some patients have reduced the calcium deposits in their carotid arteries by 30% just by taking a magnesium supplement . Magnesium deficiency leads to endothelial dysfunction. https://openheart.bmj.com/content/openhrt/5/2/e000775.full.pdf
      In a study of 2,977 18-30 year old men and women, researchers at the Northwestern University School of Medicine in Chicago measured calcium scores and then measured the scores 15 years later for comparison. The study concluded that dietary magnesium intake was inversely related to coronary artery calcium levels. Eating dark green, leafy vegetables and taking magnesium supplements plays an important role in preventing calcification of arteries.

      Reply
    2. Martin Back

      I’m not a great believer in supplements, but scary advertisements telling us we’re all magnesium deficient have been running on local radio, so I looked on the internet to find a cheap form of magnesium.

      Dr William “Wheat Belly” Davis has a recipe for magnesium water made with soda water and Milk of Magnesia. https://www.wheatbellyblog.com/2015/07/magnesium-water-from-wheat-belly-total-health/

      I made a batch according to the formula and took my first dose. Now I have never had a magnesium test and have no idea what my magnesium status is, but the consensus on the internet is that generally we are about 100 mg short of optimum. So I took a 100 mg dose in a glass of water.

      Almost immediately I felt very light-headed, a feeling that lasted about half an hour and had me quite worried. Eventually I returned to normal, and now I take a 50 mg dose once a day with lunch. It doesn’t seem to do me any harm, but I don’t know if it does me any good either. I feel the same as always. Anyway, I’ll continue. They say magnesium is good for you.

      Reply
      1. Frederica Huxley

        Ah, the devil’s in the detail! Milk of Magnesia is made of magnesium oxide. Cheap but certainly not the best form of magnesium. It has a reputation for being a highly efficient laxative, but not particularly bioavailable. There are many better forms of magnesium, from magnesium citrate to magnesium taurate which is effective in AFib.

        Reply
      2. Kevin Frechette

        I am using the William Davis magnesium water. There is a chemical reaction between the carbon dioxide in the soda water with the magnesium oxide to form magnesium bicarbonate. This reaction converts a laxative (poorly absorbed) to a highly absorbed form.

        I’m taking over 300mg a day with no side effects.

        BTW if you take anything beyond your body’s ability to absorb it, there will be a laxative effect. High doses of sodium ascorbate (Vitamin C) will do this as well.

        Reply
  68. Jerome Savage

    Coconut Oil Consumption Linked to Increased LDL
    “New evidence is cracking open some of the positive health claims made about coconut oil. Combining the findings from 16 published studies, investigators found that use of coconut oil was associated with increases in low-density lipoprotein (LDL) and total cholesterol levels, potentially placing people at higher risk for cardiovascular disease (CVD).
    Compared to nontropical olive, soybean, or canola oil, high consumption of coconut oil substantially increased LDL cholesterol. Consuming 3 to 4 tablespoons of coconut oil daily was associated with an estimated 10-mg/dL increase ― about a 9% jump ― in LDL levels”
    https://www.medscape.com/viewarticle/923978
    But LDL as well as HDL is associated with overall longer lifespan, so no fear !
    But, does this include increases in LPa (or “LP little a”, as Dr Arthur Agatston calls it).
    Is LPa the new bad boy ?

    Reply
    1. shirley3349

      Personally, can’t abide coconut oil as it tastes too much of coconuts! But I have now found a use for the rest of the jar bought about 18 months ago, which has been sitting neglected in the fridge ever since.

      It is excellent for seasoning the cast iron skillet, which I acquired a few days ago to replace a worn out, non-stick frying pan. Just two thin coats of oil , melted, burnt and polished into the cooking surface passed the fried egg test for non-stickiness fine, and it’s supposed to get even better after further use.

      Just off to fry some pork loin steaks for our evening meal.

      Reply
      1. Nathan

        shirley,
        My first experience with coconut oil left me with the same impression. You can get coconut oil that doesn’t have the coconut smell/flavor. I buy this: Tropical Traditions Organic Expeller-Pressed Coconut Oil. It’s not processed with solvents, and not hydrogenated, just deodorized using a steaming process that leaves it tasteless and odorless.
        You can get it at healthytraditions.com There may be other places to buy it, but that’s where I get it. I hope that helps.

        Reply
    2. shirley3349

      Nathan
      Thank you for the tip.
      However, I think I’ll now carry on buying my saturated cooking fat as follows: beef dripping from our (very posh) local butcher who refines it himself – it’s expensive, but great for Yorkshire pud, and our local Tesco has now started selling lard again, cheap but good stuff, which does not have the most unpleasant smell when heated that the old make had.

      Reply
      1. Jean Humphreys

        On the matter of animal fat – lard and dripping used to have an off-putting smell and taste, which disappeared after the first use. Not any more. I discussed this with a butcher friend and he said that the industry has been made to clean up their act in the past few decades, and that the way these fats were produced was appalling. Back then we usedto ask for a piece of fat for rendering, and put it in the bottom oven for several hours. No longer necessary since the Elf and Safety bods have done something good.

        Reply
      2. Martin Back

        I bought lard years ago and the smell was so bad I threw it away and never bought it again.

        My mother always used to save the dripping from the roast and use it to fry eggs. I buy stewing steak with lots of white fat on it, cut the fat off and melt it down and save it for frying eggs, and make stew with the meat. Both stew and eggs are delish.

        Reply
        1. AhNotepad

          Beef dripping might be ok if it is from grass fed animals, but nowadays lard in the UK will be from pigs fed on a grain derived diet (plus soya, which is very likely GMO and loaded with glyphosate) and so high in omega 6 fatty acids. So we just fry in butter, which we hope is ok, though with the food industry there is no guarantee.

          Reply
  69. Emily Harrison

    LOVE your approach to health.

    The argument that people are giving; a smoker might have the scan and then be inspired to quit smoking doesn’t really ring true, at least for me. If a smoker was truly concerned about their health, given the overwhelming established evidence that smoking is terrible for overall health and longevity, wouldn’t they already be actively trying to quit smoking? If their score was low, would it make sense for them to just continue along their path of smoking? There’s no test or scan that can give us any indication of when we as individuals will die and of what. They can make rough approximations/predictions using population data, but people seem to be clinging onto individual results like they are gospel.

    I suppose it comes down to your individual approach to health. I used to have a lot of (needless) health-related anxieties but Dr Kendrick’s books really helped me to get over all that. I guess he’s given me a rather healthy skepticism for a lot of medical practices and beliefs.

    Reply
    1. Martin Back

      I knew a cardiologist who was a heavy smoker. When I remarked I was surprised he was smoking, given our knowledge of the dangers of smoking, he replied that he gets checked out every year and he knows the danger signs. The moment he sees that spot on the X-ray he’s going to give up.

      I’ve lost contact with him so I don’t know if he ever did give up. As an ex-smoker myself I know how difficult it is, and how easy it is to persuade yourself you need to keep smoking just a little longer to get over the current crisis in your life.

      Reply
      1. Emily Harrison

        I know what you mean, but doesn’t that just kind of prove my point? He was allowing himself to continue smoking because of the false reassurance of scans and tests.

        Reply
  70. Melanie

    I’m personally not in favour of having a CAC scan for the reasons Dr Kendrick has stated. Following a traumatic experience watching my 85 yr old Mum have a stroke, the worst kind, I underwent a period of horrendous stress. During this period I noticed the appearance of a common and highly visible CVD marker which sent me into a spin (I won’t share it as a quick google and a few Daily Mail articles later might send others into a spin also). I searched “how to prevent heart disease” and it was one of Ivor’s videos, on page 2 of google at the time, that drove me to a Keto diet and since then I have gratefully learnt and implemented so much more to help reduce potential risk e.g seed oils, K2, this blog etc. Having witnessed the terrible fate of my mother I have also written an advance decision and have LPOA in place to prevent any medical treatment should I find myself without mental capacity. It is my worse fear, and this ‘marker’ itself is a daily battle. Interestingly this marker disappeared for 3 days following a tooth extraction last year, but only to return. I’m strongly of the opinion that stress is a major factor in heart disease and that a lot of disease originates in the mind. Whilst I don’t dispute the CAC test is best in class for determinining heart disease, I’m reminded of one quote I read…”When patients are given a terminal diagnosis, they often oblige”.

    Reply
    1. Jerome Savage

      Melanie
      Dr Kendrick has identified stress as a factor. See part 63 2019 and XX from 2016.
      From the former;
      “How does a negative external stressor, lead to the internal physiological strain, that causes CVD? For that we need to turn to Sapolski, Bjortorp and Marmot.” Dr K touched on these researchers in the latter study but promised more in the former. Relaxation is very important, for me it’s getting in to the corner of my big couch with the remote control, a wildlife programme but more especially, some soulful ditties, affecting me with mastery of my own space, – momentarily. Hiking can do it & cups of coffee overlooking the sea after or during a long cycle. Resisted yoga so far, but lately as I look towards 60, the occasional church occasion, highly choreagraphed & ceremonial aided and abetted by a nice choir, can induce a certain comfort. Stented 16 years ago & enjoying life – but must resist RESIST, the double ended burning candle scenario.

      Reply
  71. Charles Gale

    So what happens if you decide to proceed with a scan after mulling over Dr Kendrick’s viewpoint, Ivor Cummin’s reply and all the comments generated?

    (n.b. I’ll be requesting a translator for this comment)

    The NHS?

    Here in England, the 1st point of call might be your GP. But what does he know? What’s the NHS policy? What’s the financial aspect? If our host, Dr Kendrick, isn’t too keen then I’m not convinced most GPs will be issuing referrals.

    Especially after a cardiac event. My GP’s response was there was now no point.

    Private?

    Having no luck with my GP, I got a few quotes (which was laborious) and decided to pay £400.00 for a CAC scan. But this needed my GPs referral. Sigh. But I got it eventually and set things up and asked the radiology dept if in addition to the calcium score I would get volume and density results. No response so I tried again…and again and let the matter go.

    And a few weeks later got the score but no density and volume.

    And let the matter go.

    (Minor aside: despite being the paying customer, I wasn’t allowed a copy of the report. It went direct to my GP and without any notification to me that it had been issued to my GP. More running around).

    This was 2017

    Fast forward to 2020 and I’m thinking about another scan and I thought I’d try the radiology dept to provide density and volume results for 2017, or to ascertain if they had them.

    And I’d use that as leverage before paying another £400.00.

    Here’s where I need a translator. The reply from radiology:

    “…there is no individual measurement of volume or density provided during the calcium scoring. The figures are used by the computer system in post processing of the images to give the overall calcium score. This is interpreted according to the agatston score.”

    Now, I know what it says but I can’t decide what it means: it appears they have the data…or don’t they? Or they are not going to provide the data.

    Don’t forget – my £400.00!

    It appears from Danny Evatt’s comment that there is a lot of variation in what the labs give you. So maybe this lab won’t or don’t.

    I’m for CAC scans but for me (based on the above experience) there seems to be a lot of hard work needed to be done in England about making CAC scans accessible, affordable, raising awareness (such as this post) and a bit of conformity and transparency and clarity in the data/responses provided to the patient.

    Good luck on your quest for a CAC scan!

    Reply
    1. JDPatten

      Charles,
      So, you still want to brand yourself with more numbers that you nor anyone else really understand the meaning of?
      Sample these. Is there common ground?
      https://blogs.bmj.com/heart/2014/04/13/coronary-artery-calcium-density-is-inversely-associated-with-coronary-risk/
      https://www.sciencedirect.com/science/article/pii/S1936878X17305223
      https://www.ncbi.nlm.nih.gov/pubmed/31049733

      The wait for this to be sorted out will be frustrating because the basic agatston is viewed as Received Wisdom by any professional you’re likely to deal with for the foreseeable future.
      My guess.

      Reply
    2. shirley3349

      My rudimentary knowledge of computer programming interprets the quoted paragraph as follows:

      The computer has the raw data in its memory and it used it to calculate the results it printed out. But it is not at present programmed to print out the raw data itself.

      My gloss: To do so, as an option, would require some re-programming which, as always, costs more money. And, as always, experts are wary of providing raw data to lay-people, who tend to have the nasty habit of interpreting it in unorthodox ways.

      Reply
  72. Göran Sjöberg

    (Posting problem)
    Charles, Your “story” seems very “probable”!

    It is another reason for me not to consider any CAC-scan beside knowing that I am already in a very bad artery shape. I am already fed up with meeting ignorant and not caring cardiologists.You must take responsibility for your own health and create your own health care system by alternative means and not let the NHS ruin it.

    To me our health care system is corrupt in the hands of Big Pharma and I would not trust them except if I had broken a leg or had been injured by an accident.

    Reply
    1. Danny Evatt

      Here here! Both to your comment about Cardiologists and Big Pharma.

      Same situation here in the States – unfortunately.

      Reply
      1. Danny Evatt

        Darn it! As an American, I wrote it as “here here”! I meant to write it as “Hear Hear!”. So sorry! (though we do spell “color” correctly) 😉

        Reply
      2. Sasha

        I think in the States it’s pharma on steroids. I forget the exact numbers but isn’t it something like US patients constituting 5% of the world’s population and they are taking 70% of the world’s drugs? I never double checked those numbers but if they are true, it’s amazing.

        Reply
  73. andy

    Is there an age, physical condition, or mental state when one should/will not be too concerned about testing their vital signs?

    Reply
    1. Göran Sjöberg

      Andy, well well well!

      I don’t know but as a general principle I think it is wise to keep away from all screenings offered by the NHS behind which Big Pharma fishing lurks. If you don’t feel really, really sick – don’t go there. This is my present attitude and it was strongly enforced upon me by reading a very well researched book on this subject a few years ago. “Over-diagnosed, Making people sick in the pursuit of health,”, written by Dr. H. Gilbert Welch, Dr. Lisa M. Schwartz and Dr. Steven Woloshin.

      The book cover a broad spectrum of diseases and where vascular screening is just covered on three pages in this 200 page book – though very interesting pages to read.

      The message is clear in the book – don’t do any screening test. They just cause you and your family worry and over-treatment (and profits) with no survival benefits in comparison with the not tested population. And it is not easy to get out of the medical trap, once you are caught there by the medics. It is certainly an uphill fight to take control and get out.

      Reply
      1. Dr. John H

        Well said Goran!
        I notice consistently in my practice that those who are enmeshed in the medical system fare the worst. As you say, it is a very difficult trap to get out of.

        Reply
        1. andy

          Hi Jerome: re too many drugs
          And in the future drugs will fix everything:
          “The experts said efforts to prevent multi-morbidities (the incidence of a particular disease in a specific locality) arising in the first place are important, potentially including drugs that mimic exercise or calorie restriction, boost immune response to vaccines or help clean up so-called “senescent cells” associated with ageing.”

          Reply
          1. Sasha

            Andy: if the information I have heard is correct, Pfizer a couple of years ago spent $720 million hoping to acquire such a technology. Recently they closed that division. Someone took them for a nice ride, from the looks of it.

      2. andy

        Göran Sjöberg: re screening
        I find nothing wrong with screening tests as long as they are not invasive. The solution is not to be stampeded into a therapy. Most treatments are for symptom relief anyways and will not be a cure. It is important to ask WHY the wheels came off and take charge of putting things back together again. You are a good example.

        Reply
      3. Göran Sjöberg

        andy, thank you for seeing me as a “good example”.

        But I don’t know.

        As you know I am basically trained as a researcher in the “hard” natural sciences of metallurgy and have done basic research for many years not least as an adjunct professor. So, when I turn my back towards the medical establishment and refuse treatments and medication I presume that i am not the “average patient” and I guess few are ‘capable’ of doing the necessary comprehensive homework to take my stand on their own.

        So far I have not met anyone having done the same thing as I have done (the NO to a comprehensive CABG and all the medications) but I have though inspired a few of my healthy friends to stay away from medics and go for alternatives.

        Reply
  74. Susan

    At age 68, after seeing 2 friends/relations my age get pancreatic cancer which they died from, one getting ovarian cancer, and one multiple myeloma, which she died from – I see no point in being “reassured” that I don’t have breast cancer after a scan……

    Reply
  75. Aaron Koldenhoven

    Hi Dr. Kendrick,
    I’m on warfarin and am scheduled for a CAC in a couple weeks. I’m only 40 years old and I’m on warfarin for life due to a blood clotting disease. I have been on a ketogenic/carnivore diet for 2 years now and have never had a CAC done. I’m also what’s considered a lean mass hyper-responder. While the article suggests not doing a CAC, would my situation change that sentiment? And would I be better off taking something other than warfarin (Xarelto, Eliquis, etc) or do the other drugs have the same effects?

    Reply
    1. David Bailey

      Aaron,

      As you can see, Dr Kendrick doesn’t exactly tow the establishment line on many things, and as he has explained on a number of occasions, if he were to answer a personal medical question like that without you being his patient, he would get forced out of the medical profession.

      Your case sounds rather complicated, and I think perhaps your best bet would be to seek a second opinion.

      Reply
  76. KidPsych

    Maybe more than anyone would like to know about the endothelium, but I think there’s interesting information in this talk:

    Reply
    1. andy

      Hi Kid: comments on video by Vlad, very good but
      Real scientists should not use relative risk. Statins are only 40% effective?
      What is composition of lipids in intima? Are they lipoproteins, TG, or something else?
      Exercise is important but what about insulin resistance, K2 etc. as affecting CVD?

      Reply
      1. KidPsych

        Agree, Andy. I just found the explanation of how the endothelium is composed and why it is unlikely if not impossible that LDL-P might embed themselves into the upper most endothelial layer illuminating. I’d love to hear Dr. Kendrick’s comments on this fellow.

        Reply
  77. Göran Sjöberg

    There seems to be a continuous fight against vitamin-C treatment since the days of Linus Pauling from the medical establishment not least regarding the benefits for people with CVD.

    More obvious is the ongoing fight against the IV C-vitamin treatment for sepsis when it has been clinically shown to astonishingly increase the survival rate of the hospitalized sepsis-patients. To me it is just incredible how the corruption in the medical community can continue with the obvious cost of many lives. I really don’t understand the “rationals” involved in these psychopathic doctors.

    How scary indeed!

    https://orthomolecular.activehosted.com/index.php?action=social&chash=d1f491a404d6854880943e5c3cd9ca25.133&s=580f651cc113b86bf68fd9628bad097c

    Reply
    1. Sasha

      Or, as one old and very good and very experienced doctor from Bessarabia liked to say: “Medicine is an uncertain science and it doesn’t give refunds”🤣🤣

      Reply
    2. Kevin Frechette

      The state of the current medical and pharma can be attributed to Andrew Carnegie his Carnegie foundation and Abraham Flexner. Flexner produced a report rating medical schools and set the standards for students and curriculum. He is another Ansel Keys type with no relevant training in the field that he highly influenced. The medical schools were brought up to his standards during 1902 to 1920. The competing alternative medical schools and practices such as Naturopathy were labeled quackery and abolished. The goal was to push pharmaceutical based treatments and surgical procedures. Any form of natural medicine including the idea that the body can heal itself has been suppressed and vilified.

      I think because Linus Pauling received a Nobel Prize as a researcher, he couldn’t be fully discredited and censored by the vested interest groups.

      Malcolm, have you ever considered jumping ship and practicing medicine under one of the alternative medical agencies like Dr. Ken Berry does as a Functional Doctor?

      Reply
      1. Kevin Frechette

        Keep up the good fight them. I can say that you do.make a difference. I have learned a lot from both you and Ivor. I think it is easier to change the patients than the doctors. Ideas are viruses. Spread good ones around liberally and they will flourish.

        Kevin

        Reply
        1. Sasha

          I would also like to add that there are good honest docs out there. Not everything is doom and gloom. They are just fighting a huge machine. The biggest business in the history of humanity, come to think of it.

          Reply
          1. Gary Ogden

            Sasha: Indeed, most of them are good, although in some specialties, such as pediatrics and interventional cardiology, i think it prudent to be skeptical of most of them.

  78. andy

    Hi Jill: I do have the book and have also read it
    The only useful info from a cholesterol test is the TG:HDL cholesterol ratio, in my opinion. Average person might not be aware of the benefits of high cholesterol and would accept a statin prescription. Very few people would ask questions and do otherwise.

    Reply
    1. andy

      JDPattem, they are predicting risk based on type of calcification. According to Ivor the plaque progression is the important factor. Does a stable situation make plaque more stable, ie more densely calcified?

      Reply
      1. JDPatten

        Jeez Andy, I wish I knew. I’m feeling my way through this with the scant information available like anyone else – including the researchers, it seems.
        I got my CAC of 1,609 five and a half years ago with no indication of density. The info is petrifying, optimistic, worthless? Choose. I humbly wear my scarlet letter “C” day to day. Any physician who reads my record looks at me and sees Calcified Cardiovascular disease.
        I often wish I hadn’t done it.
        Nobody knows what to do about it after the fact, really.
        Oh yes, I’ve been taking my various forms of K2 like a good boy ever since.
        Is this doing any good? …or worsening the situation by reducing any K1 density I might have? (Good old Sir Hounsfield.)
        Nobody knows, really.
        Not yet.

        Reply
        1. Tim Ozenne

          Same here. I have much higher CAC, which excites my cardiologists who apparently think this means statins. But I’ve decided, consistent w/ Dr. K’s analysis (but my own prior analysis was much the same) that it is best to just ignore the CAC score. 2703 7 years ago; I’ll not rescan.

          Reply
  79. KidPsych

    Interesting talk on why ingesting plant-based cholesterol is likely not good for you (particularly when paired with a statin).

    Reply
    1. Martin Back

      I found Dr Poothullil’s analysis of insulin resistance to be interesting, blaming it solely on carb intake.

      What was appalling was the 12 comments. Obvious scams for herbal medicines to cure diabetes, HIV, and anything else you can think of. I cannot believe that a reputable website permits such material to be displayed.

      Presumably Dr Kendrick gets the same type of quack cure advertisements and deletes them before subjecting us to them. In which case I applaud his heroic work behind the scenes.

      Reply
      1. Jerome Savage

        In Dr. K’s article on the lancet study on 11th december a Mr cure all sneaked in on 30th of the same month advertising particular cure – non cardiac related. Further peep at his portfolio indicated that he professed to have the cure for everything (with possible exception of bacon)

        Reply
      2. Martin Back

        “Your comment is awaiting moderation.” Trying again….

        Sasha, it depends what you mean by “cure diabetes”.

        If you are saying that herbs will enable you to eat unnatural quantities of sugar, refined carbohydrates, seed oils, trans fats, and innumerable preservatives, dyes, stabilizers, and flavorings, without ill effects, then I have to say no, herbs can’t do that.

        But the herbal medicines I was appalled by are the sort that appear on the pamphlet in front of me from Mama Aisha, herbalist healer, who claims she can help me with “Financial Problems Marriage Problems Relationship Probs Win Court Cases Removing Bad Luck Pregnancy Problems Business Problems Evil Spirits Curse Catching Lost Love 48hrs Win Lotto Long illness Win Contracts Attract Love Attract Clients Sell Property”. Nope, I don’t believe herbs can do that either. ;o)

        Reply
      3. Martin Back

        Talk of herbs reminds me that a friend of mine got to know an African herbalist. He asked him how he knew which herb does what.

        “Well,” replied the herbalist, “a herb can only do one of two things. It can either make you vomit, or it can make you poop. And the trick is, when you see a patient, you must know whether they need to vomit or they need to poop.”

        I’m sure there’s more to it than that, and herbalists in training spend a long time apprenticed to an older herbalist and learn where to find herbs and how to prepare them, but that’s what my friend told me.

        Reply
    2. andy

      Hi Tish: diabetes- wrong cause but right cure can still work imo

      “When freely available fatty acids are burned constantly, glucose, absorbed from the food as well as created by the liver, is left in the bloodstream. ”
      Maybe if there is no insulin?

      Reply
      1. Tish

        Yes, Andy. As I understand it, the insulin level drops since it is less necessary with the muscle cells burning fatty acid rather than glucose and because of the fullness of the fat cells with fatty acid and the high fatty acid level queueing up in the blood. Once the fatty acid level is normalised by greatly reducing carbohydrate intake, and the fat cells once again are permitted to have room in them, the muscle cells can revert to burning glucose. Whilst there is an excess of carbohydrate intake, the diabetes can only persist. So the body is not resisting insulin but adapting its level to suit the circumstances.

        Reply
        1. andy

          Hi Tish: I don’t understand this sentence “Once the fatty acid level is normalised by greatly reducing carbohydrate intake, and the fat cells once again are permitted to have room in them, the muscle cells can revert to burning glucose.”
          The diabetic is always burning glucose, switching metabolism to burn fatty acids takes a lot of effort. Diabetics get low blood sugar after a few hours of not eating (hypoglycemia). They are not capable of accessing fat stores, they are not burning fatty acids.
          When one is fat adapted then limited carbs can be consumed without causing problems. Reverting to glucose is the cause of the problem.
          Have not read the book, maybe this topic is covered.

          Reply
  80. daveketo

    Hi Malcolm — I’ve emailed again just now to check if you’d be available to interview for the documentary when we’re there next month in February. We a lot of heavy hitters on cholesterol booked for interviews on this trip (see email). Would be great if we could add yours as well. Again, it’s hard to imagine this documentary without you. ~Dave Feldman

    Reply
  81. Martin Back

    Statins Reduce Cholesterol, So Why Don’t People Take Them?

    A recent study finds that only 6 percent of people prescribed statins are taking them.

    … while 25 percent of people never filled their statin prescription in the first place, a similar number of people didn’t bother to fill their second one.

    “We really don’t know why people weren’t taking them, mainly because we had no contact with the patients, we didn’t talk to them,”

    I agree with this tweet — “Uh, because they suck. They have side effects and don’t prolong life.”

    Reply
    1. Göran Sjöberg

      Weird sick world indeed!

      Encouraging numbers of refusal though! Thank you for this information.

      Still there are many millions on these drugs if I am not wrong. To make these ends meet – are people dropping out (94 % ?) at the same rate as new innocent patients are hooked up?

      I don’t understand this.

      Reply
    2. Göran Sjöberg

      Looking now into that article I was chocked byt the the “unlimited” cholesterol lowering propaganda and the advocating of the statins. Such propaganda is to me today unbelievable.

      Reply
    3. Nathan

      Wow, Martin, that’s a very low compliance rate. Good news! Maybe this is more well-known among the masses than we may think.

      Of course the other thing at play is probably a decrease in trust and confidence in the medical system in general (UK and US, and probably elsewhere). Something that is sadly well justified.

      Reply
    4. LA_Bob

      Martin Back,

      The article doesn’t specify the study (as far as I can tell), but I found it by googling heidi may statin compliance study. The abstract is at

      http://www.onlinejacc.org/content/73/9_Supplement_1/98

      This appears to be a secondary-prevention study. So, the 5468 patients already had some diagnosis of CVD. I can’t tell from the abstract whether any had taken statins before diagnosis.

      So, the 6% figure is for people who are known to be sick — not just people with high cholesterol. That’s a huge surprise, because I’ve always read that statins work best in people known to have CVD.

      The other surprise is that men were the most compliant patients. Of course, men made up three-quarters of the patients, so maybe that is to be expected.

      I wonder if the sickest people are the ones who experience the most side effects from statins and thus lose incentive to take them.

      Reply
    5. David Bailey

      Martin,

      Quoting from the article you quoted:
      “May and her team found that patients who took their statins as prescribed at least 80 percent of the time reduced their risk of having a heart attack or stroke by nearly 50 percent.”
      Since the NNT for statins given to people with existing CVD is 83, that figure sounds way off.

      Reply
    6. Martin Back

      I agree the 6% adherence rate seems too low to be credible.

      Mind you, it depends how you define “adherence rate”. Two measures I found were:
      – “Outcomes were measured using the continuous medication possession ratio (MPR), categorical MPR, and medication persistency.”
      – “Nonadherence was assessed by the percent of days without medication (gap) over days of active statin use, a measurement known as cumulative multiple refill-interval gap (CMG).”

      It seems that “people who stop taking statins or never start taking them” is too simple a measurement for academic work. ;o)

      However you measure it, there’s a lot of non-adherence, even among high-risk patients:

      “A recent real-world evidence study assessing the effectiveness of lipid-lowering therapy on LDL-C in high CVD risk patients in a primary care setting in Italy found only 61% adherent to therapy 3 months after the initial statin prescription, and barely 55% were adherent after 6 months…. In a cohort study using linked population-based data from Ontario, 60% of patients with post-acute coronary syndrome (N=22,379) discontinued their statin therapy within 2 years of hospitalization”https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5973378/

      You would think that medical aid records would be definitive. They are connected to the doctor and the pharmacy, and they know if you don’t fill your prescription.But of course, if you don’t take your statins and have a heart attack they can refuse to pay out on the grounds you didn’t follow doctor’s orders, so it is known that some people fill their prescriptions then don’t take the drugs but flush them down the toilet.

      At the end of the day, who knows what the adherence rate is? You could ask the patients, but if they lie about what they eat on food frequency questionnaires, they probably lie about the medication they take or don’t take.

      The only way I can think of is to make statins radioactive and test people with Geiger counters. I hope it never comes to that.

      Reply
      1. Mr Chris

        Martin,
        Surely you tell who is taking their statins by looking at their blood tests. My lipidist saw immediately when I gave up

        Reply
  82. Lucie

    Thank you Dr Kendrick for making me know the book by P.C. Gotzsche. All women who have any doubts about the usefulness and potential harm of breast cancer screening should read this book.

    Reply
  83. Danny Evatt

    Came across a new study (Published: 19 January 2020) concerning Arterial Calcification:

    “Molecular and Cellular Mechanisms that Induce Arterial Calcification by Indoxyl Sulfate and
    P-Cresyl Sulfate” It’s in PDF format and can be found here: shorturl.at/klwDV

    Main Idea:

    “The protein-bound uremic toxins, indoxyl sulfate (IS) and p-cresyl sulfate (PCS), are
    considered to be harmful vascular toxins. Arterial media calcification, or the deposition of calcium
    phosphate crystals in the arteries, contributes significantly to cardiovascular complications, including left ventricular hypertrophy, hypertension, and impaired coronary perfusion in the elderly and patients with chronic kidney disease (CKD) and diabetes. Recently, we reported that both IS and PCS trigger moderate to severe calcification in the aorta and peripheral vessels of CKD rats.”

    Another study: here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5198552/

    “Indoxyl sulfate (IS) has also been associated with higher degrees of coronary artery calcification and cardiac drug-eluting stent re-stenosis.” “…Indoxyl sulfate is an extensively studied uremic solute. It is a small molecule that is more than 90% bound to plasma proteins. Indoxyl sulfate is derived from the breakdown of tryptophan by colon microbes.”

    “… Diet also plays an important role in the production of indoxyl sulfate. As indoxyl sulfate is derived from breakdown of tryptophan, higher dietary protein intake increases its production. Subjects with normal kidney function who consumed a high protein diet for 2 weeks had greater indoxyl sulfate level and urinary excretion than those who consumed a low protein diet [27]. In addition, subjects who consumed vegetarian diets had lower indoxyl sulfate excretion than those consuming an unrestricted diet with higher protein content [28].”

    So, from reading the last couple of sentences from the paragraph above, it appears that a KETO or Atkins diet may raise the level of IS – which may, in turn, be a possible cause of arterial calcification. (?) These causes are independent of LP(a), LDL, etc.

    Though I am not a vegan, these words do give me pause as I have always been a high protein eater and have shied away from Veganism – and have a very high CAC score. Perhaps the good doctor or someone else with far more medical knowledge can interpret and opine on these two studies(?)

    Reply
    1. LA_Bob

      Hi, Danny.

      Echoing Goran’s response below, I can only say that all this stuff is complicated, damn complicated. That’s what I’ve gotten from more than ten years of reading about it since I went low-carb. And I don’t consider myself near as learned or thorough as many of the commenters on this blog.

      Here’s something else that fosters calcification — sometimes:

      https://www.ncbi.nlm.nih.gov/pubmed/17606264?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

      I got that link from Hyperlipid, one of my favorite nutrition / physiology blogs. Well, it turns out the blog author Petro Dobrymylskyz (Peter) has a new post in response to Dr Kendrick’s current post (Hey, the best read the best, don’t they?).

      http://high-fat-nutrition.blogspot.com/2020/01/coronary-artery-calcium-score-and.html

      The gist of it is that in the early 1930’s a ketogenic diet resolved a child’s arterial calcification / ossification. Would a keto diet help with adult calcified plaques?

      Interesting, huh?

      It’s a mistake to focus on one small factor — in this case, indoxyl sulfate. Such narrow focus can make someone miss the forest for a little shrub. There is no end to these shrubs, and how they interact and what they mean is just mind-bogglingly complex, certainly for this layman.

      If I have read Dr Kendrick right over the last few years, the starting point for arterial disease is endothelial injury (from whatever cause). Calcification is just an endpoint in a process. So, indoxyl sulfate might be meaningless in the absence of arterial injury. And, to the extent calcification protects and stabilizes plaque, calcification may be a good thing, and so might indoxyl sulfate!

      We will be long dead (at least I will), whether from CVD or something else, before we have any good answers.

      Reply
    2. Randall

      From your listed study – The kidneys achieve high clearances of indoxyl sulfate… The majority of studies have assessed toxicity in cultured cells and animal models. The toxicity in humans has not yet been proven, as most data have been from association studies. No trials have yet tested cardiovascular or mortality benefit. Without such trials, the toxicity of indoxyl sulfate cannot be firmly established. I think it is about – hemodialysis patients.

      Reply
  84. Göran Sjöberg

    Danny,

    There is certainly a lot we don’t know about our complex web of physiology!

    However, if we believe in the evolution of mankind, what we have been accustomed to eat during millions of years we are probably adopted to – read a mixed diet preferably with a lot animal fats. Anyway it appeals to your tongue for reasonable reasons 🙂 BTW, our big brain is believed to be related to our hunting social abilities which tells you something.

    Reply
    1. Martin Back

      Most wild animals have very little fat on them. Explorers used to refer to “rabbit starvation” where they got plenty of protein but not enough fat.

      It might be that our ancestors were always on the lookout for extra sources of calories, and chewed anything that didn’t kill them.

      Reply
      1. Göran Sjöberg

        Martin, you are right.

        You can get real sick on lean meat and therefore the fat on animals, not least from the organ meat, was preferred.

        Vilhjalmur Stefansson, the arctic explorer was well aware of this fact especially when almost his whole team was sick and immobilized living on lean caribou meat. They were rescued by an eskimo who seal blubber on his sledge and they recovered rapidly – so much for the dangers of animal fat.

        BTW I just now happen to read “Moby Dick” which is all about whaling business. What they were first after was actually the valuable fat or blubber but early it was mostly used for lightning purposes in lamps. Later on the whale meat was taken care of as a delicatessen.

        Reply
  85. Charles Gale

    Acid/Alkaline body – another heart disease cause?

    Dr Daryl Gioffre just came onto my radar – his book on the acidity of the body was mentioned in the Vitamin C Foundation’s forum page.

    I thought I’d check him out and was very impressed by this 8 min presentation:

    And surprised.

    Because the opening question to Dr Gioffre was on heart attacks and statins (so on topic for this website). He totally dismisses the cholesterol hypothesis (hooray!) stating that cholesterol is not the problem and it can protect. He introduces his hypothesis – high body acidity damages blood vessels and the liver responds with cholesterol to plaque up the ulcerations…to plug up the injury. Cholesterol is the scapegoat at the scene of the crime.

    Diet, thoughts, movement, stress go into the blood = inflammation = problem with blood vessels = body raises cholesterol levels.

    Then he covers high blood pressure.

    Causes and symptoms and the nature of disease.

    Sugar and omega 6 are culprits

    There are good fats and bad fats (as with his vindicating cholesterol, he’s now going against mainstream vilification of good fats – hooray again).

    He’s also for salt – good salts (e.g. mountain salts) and not bad salts (e.g. processed table salt)

    Omega 3 = anti inflammatory
    Omega 6 = pro inflammatory

    Major causes of death: heart disease, cancer then alzheimers. You never used to hear of alzheimers so what’s changed? Is it our genes? Doctors will blames genes but they haven’t changed for 40,000 years.

    What has changed is the amount of sugar and inflammatory foods in our diets.

    He refers to type 3 diabetes – insulin resistance of the brain.

    And then plenty of nutritional info for the final 2 mins.

    I thought it was a great 8 min presentation. Check it out!

    Reply
  86. PeteM

    And interesting that one of the commenters mentioned Malcolm’s Wikipedia entry, which must be the awful RationalWiki version that a search nowadays picks up. I offered an opinion about statins on a forum last week and said I respected Dr Kendrick and Dr Harcombe but the original poster was not impressed – I had to be a cardiologist or work in the industry to have a contrary opinion to his GP (his 10-year risk of heart disease was 10.1% at age 60)…

    Reply
      1. PeteM

        AhNotepad: UKClimbing, which requires registration. I was trying to reply to the comments about Hyperlipid forum where Peter has mentioned this blog and others had tried to research Dr Kendrick and come to the correct conclusion about RationalWiki – to be avoided!
        The UKC thread died after I admitted I had no qualification beside being middle-class educated (which had been used by one commenter in a disparaging way, linking it to conspiracy theories etc). I don’t think there is much mileage in trying to assist the original poster further. Cheers.

        Reply
    1. Tish

      Andy:
      Here is a quote from John Poothullil’s book:

      “Your body’s natural process is to convert excess carbohydrate consumption into fatty acids to be stored as fat. Eventually, you fill your body’s fat cells, and when they reach their capacity, your fat cells become unable to accommodate any further acids for storage. This event leaves the fatty acids in the blood, triggering your muscle cells to switch from burning glucose to burning those fatty acids. The result: You end up with excess glucose accumulating in the blood, which leads to the diagnosis of high blood sugar, and eventually type 2 diabetes.”

      I couldn’t help being struck by John Poothullil’s comment:

      “Traditionally a scientific concept is not printed in medical textbooks before it is validated through logic, mechanism, and measurement. However, insulin resistance theory was exempted from this tradition when it was hypothesised about 90 years ago.”
      Now why doesn’t that surprise us?

      Reply
      1. andy

        Hi Tish: Maybe the problem in understanding the author is created by over simplification. High carbs means high blood glucose. Brain, liver, heart and other tissues handle high glucose in different ways. I was not able to find a switch that turns off glucose metabolism and then turns on fat metabolism when TG are high and then raise blood glucose level even higher. Need some study references of how this happens. Diabetics can also excrete excess glucose via kidneys.

        Reply
      2. andy

        Hi Tish: excess carb consumption can also produce fatty liver and abdominal obesity when normal fat cells get filled up. Metabolic syndrome?
        Found an interesting study that deals with problem of high TG. I don’t have a placenta but the same mechanism might produce visceral fat in males.

        https://www.ncbi.nlm.nih.gov/pubmed/23673156
        High glucose levels reduce fatty acid oxidation and increase triglyceride accumulation in human placenta.
        “We reveal an unrecognized regulatory mechanism on placental fatty acid metabolism by which high glucose levels reduce mitochondrial FAO through inhibition of CPT I, shifting flux of fatty acids away from oxidation toward the esterification pathway, leading to accumulation of placental triglycerides.”

        Reply
        1. andy

          Hi Tish: OK nothing we can do about number of fat cells. What is to be done?
          Had a quick look at fructose metabolism. Fructose is processed entirely by liver and is not regulated by insulin. End product is lots of fatty acids and TG. Sugar is 50% fructose. Starch is 100% glucose. Glucose metabolic rate is regulated. Eating lots of fruit and foods with added fructose (soft drinks etc) is a quick path to fatty liver and obesity.

          Reply
          1. Sasha

            Andy, have you ever met a fruitarian? I think if you do, you will find that many of them aren’t fat at all

          2. andy

            Hi Sasha: re fruitarians, never met one unfortunately
            A sedentary elderly male needs approx 2000 calories per day. A medium banana contains 105 calories, 5.722 g fructose and 5.88 g glucose. So eating 20 bananas a day would be about right. Maybe result will be skinny outside and fat inside?

          3. andy

            Hi Sasha: re hypothesis that fruit consumption could be detrimental to health. An apple a day is my limit.
            Some references that support this hypothesis:

            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372893/
            Fructose and NAFLD: The Multifaceted Aspects of Fructose Metabolism

            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3229276/
            “Nonalcoholic fatty liver disease (NAFLD) is a burgeoning health problem that affects one-third of adults and an increasing number of children in developed countries. The disease begins with the aberrant accumulation of triglyceride in the liver, which in some individuals elicits an inflammatory response that can progress to cirrhosis and liver cancer.”

          4. Sasha

            Andy: as far as I know, when you come up with a hypothesis, you don’t try to prove it. That leads to problems. You try to falsify it. If you succeed, your hypothesis is wrong.

            Your earlier post suggested that fruit consumption leads to weight gain. I said: look at fruitarians. Of course, it’s possible that fruitarians simply consume less calories. I think, that is probably the real reason many of them are thin.

          5. AhNotepad.

            Sasha, technically “proving” is the correct term. It means to “test”. Unfortunately as with many words that are misused, for example “cool” which now has nothing to do with temperature, “wicked” which is now something to be enjoyed, “enormity” which is really synonymous with “wicked” and “evil”, and has nothing to do with size as the modern misuse would have you believe. I suppose people are thinking “four syllables better than one (or two)”. “Hate” which is only something which offends “snowflakes”, and “hate” is just a way of describing it to make the person who said it look wicked, when it is really the leftist complainer who is merely trying to stifle freedom of speech.

            Look up Jordan Peterson for more perspective on this.

          6. Sasha

            AH: as far as I know, in science you can’t “prove” your hypothesis. You can prove the null, ie you falsify your hypothesis. If you fail to prove the null, you failed to falsify your hypothesis. Thus, further advancing your theory a little bit forward. But you are never really able to “prove” your hypothesis.

          7. AhNotepad

            Sasha, you are missing my point. “Prove” is to test. You propose a hypothesis, then you prove it. That is not the same as saying “confirm” it. “Prove” is an often misused word. Someone says “can you prove your hypothesis?”, yes would be a good answer, but that means you have to test it in ways to see if it appears correct, or to see if it fails. Either way you have “proved” it, however, that should not mean you do tests to confirm it, that is the way pharmaceutical companies work.Sometimes they get found out, and get fined, but that is not the case with all products. With vaccines they have no liability in several countries, so then the vaccines are always “safe and effective”. If you suffer some adverse effect, it is not the vaccine, it must be your fault, because after all, the vaccines are safe and effective.

            Can this be proved? Yes, of course, and it has been. The manufacturers can provide all the evidence you could need to show they are safe and effective, but others have carried out tests which demonstrate something very different, and rather like the effects observed in humans. Their proof was rather more honest. https://childrenshealthdefense.org/news/vaccines-induce-bizarre-anti-social-behaviour-in-sheep/

      3. Tish

        And

        https://academic.oup.com/jcem/article/99/10/E1870/2836156

        “In conclusion, this study shows that fat cell size and number, independently of body fat mass, associate differently with metabolic parameters in obese subjects. Increased subcutaneous or visceral fat cell size correlates with an adverse insulin/lipid profile, whereas increased subcutaneous fat cell number is coupled to a less pernicious phenotype.”

        Reply
      4. Jerome Savage

        AHN Even where any liability (responsibility?) is removed, a compensation fund exists in the states where huge amounts are paid out for “proven” side effects of pharma products. The fund delivers from a tax on a significant selection of pharma products. Thanks to Gary Ogden for his clarification some months ago.

        Reply
        1. Gary Ogden

          Jerome Savage: This compensation system only applies to childhood vaccines (biologicals), and is funded by a US $ 0.75 tax on every dose sold; it was put in place under the 1986 National Childhood Vaccine Injury Act, which fully indemnifies manufacturers for any and all vaccine injuries and deaths. Many doctors, and most of the public have no idea that such a system even exists. Most doctors deny vaccine injury in their patients, calling them “coincidental.” Thus no more than about 1% of actual or suspected injuries are reported to the U.S. government’s passive reporting system, called VAERS (The Vaccine Adverse Event Reporting System). Under the law, reporting vaccine adverse events is mandatory, yet no enforcement mechanism has ever been put into place. Swept under the rug, they are. Even those who manage to file a claim, which often takes years to be resolved, face daunting odds. This is not a court proceeding with rules of evidence, but an administrative procedure. Claimants have few rights, and face pit-bull federal prosecutors, with the Special Master both judge and jury.
          As for pharmaceuticals (drugs), anyone can can file a claim for injury in a regular court of law. They can be spectacularly successful (e.g. Vioxx). In fact, all four pharmaceutical companies who produce childhood vaccines for the U.S. market are multiple convicted felons from their drug trade, with multi-billion dollar payouts for fraud. Yet they nevertheless are sainted producers of the miracle products called vaccines.

          Reply
      5. Jerome Savage

        Thanks Gary – yes just after commenting it dawned on me that the compensation scheme applied to vaccines only. Appreciate the clarification and insight.

        Reply
      1. Tish

        Hi Andy
        Yes, we certainly need the studies! But what would the poor pharmaceuticals and food industries do if everyone went low carb. There’s the rub.

        Reply
        1. andy

          Hi Tish: Not to worry. The pharmaceutical and food enterprises will increase their advertising budgets and sponsor studies to show dangers of low carb diets. Business as usual, there is too much money at stake.
          Heard that some hospitals in USA are closing. They may be first casualties.

          Reply
    1. Göran Sjöberg

      andy,

      Well said!

      As I use to say, you have to develop your own health care system based on all accumulated knowledge now available from this research. (Well, the major parts was known already from the ‘beginning’ a hundred years ago – e.g. from Weston Price!)

      Long live this part of internet!

      (And Dr. Kendrik!)

      And as always, keep the doctors away to enable your own rescue!

      Reply
  87. KidPsych

    https://fireinabottle.net/an-alternative-hypothesis-for-the-rise-and-fall-of-heart-disease-in-the-us-in-the-20th-century/

    FTL: Compare this to vitamin K2. Chickens began being supplemented with menadione in the late 50s, preceding the peak in heart disease rates by a few years. The drop in butter consumption because of wartime rationing happened 15 years before the peak in heart disease rates. This is how I’d expect heart disease rates to behave – as a lagging indicator of a preceding dietary or environmental change.

    The heart disease curve was likely a synergistic effect of smoking rates and vitamin K2 status but I believe vitamin K2 played the dominant role.

    Reply
      1. Tish

        But an excess of carrots (and Steve Jobs apparently ate nothing but carrots for periods) can turn the skin yellow too. Surely this MD knows that.

        Reply
        1. Gary Ogden

          Tish: I have black carrots in the garden this year. They turn both cutting board and hands black when I slice them. Delicious, but what will they do to my skin?

          Reply
      2. andy

        Hi AhNotepad: watched the video on Steve Jobs, deserves a hypothesis
        If vegans develop health issues, the cause is bad luck. For the rest of us the cause is metabolic.

        https://www.cnbc.com/2019/10/03/ashton-kutcher-steve-jobs-fruit-diet-health-effects.html
        “Ashton Kutcher tried Steve Jobs’ all-fruit diet — and it didn’t go well”
        “Famously, Jobs experimented on and off with a “fruitarian” diet, which is a strict vegetarian diet that emphasizes eating mostly fruit, as well as some nuts, seeds and grains.”

        Reply
    1. Sasha

      Possibly. We don’t know what hastened his life. At this point we can only make assumptions. I am not defending frutarianism, though.

      Reply
    2. David Bailey

      It is generally said that eating fruit is good for you, despite the fact fruits contain varying amounts of sugar. However, a fruitarian must get a much higher dose of sugar, and particularly fructose.

      If Warburg’s theory of cancer has anything going for it, the excess sugar cannot have been helping.

      Reply
    3. Gary Ogden

      Shaun Clark: Yes, Steve Jobs had some bizarre eating habits, such as eating nothing but apples for a week or longer. But he was very good at taking the inventions of others and turning them into serious money. Says he who is typing on a Macbook Air.

      Reply
  88. Kevin Frechette

    I’m a big proponent of the pareto principle where 20% of the effort yeilds 80% of the results. If you were to propose 2 out of 10 things a person could do to immediately improve their health, what would they be?

    My choices are

    1 – Low Glycemic Index Diet
    2 . Elimination of all PUFA and reduced amounts of MUFA dietary fats.

    The reasoning is that insulin spikes are eliminated with the low glycemic index diet which prevents deneuvo-lypogeneis. PUFA and MUFA cause mitochondrial dysfunction that prevents or signifucantly reduces fat burning. If you can start the spark of fat burning, the source doesn’t matter. Your butter/bacon sandwich or love handles will both burn at the same intensity.

    I think CVD, Alszheimer and all the modern diseases can be reduced or repaired by these two choices.

    Kind Regards,
    Kevin Frechette

    Reply
    1. andy

      Hi Kevin: re low glycemic diet
      Glycemic load is also important. Apples are low glycemic, existing only on apples could be problematic.

      Reply
    2. Shaun Clark

      Hi Kevin,

      I agree. I’m 68 (69 in July). I am an ex-rugby player (…no really stellar achievements [I am/was a bit asthmatic, but a decent sprinter and tackler]). I stopped playing full-contact rugby in the Middle East when I was 58, and touch rugby when I was 65). I now play golf 4-times a week. Yes, that last bit is a bit boring to some.

      I take no medicine whatsoever. I am a butter, egg, fish, shellfish, and red meat aficionado from wayyyyy back. I never ever bowed to dietary bullshit, but I did switch to a low-carb diet in April this year when I accidentally ‘discovered’ Ivor Cummins et al. Up until that time I did often did everything imaginable to lose weight, and my belly – but to no avail.

      In the past, I have spent so much time in the gym doing just about every exercise imaginable (…as well as running), but to nada real effect. Yes, I got big muscles, but that was about it. In April 2019 I was 95 kg, and yes, I know, I drink far, far, far too much beer, but today I am a ‘Cummins’ trim 80.2kg. I hope to get to 80kg very soon, and yes, I still like my (good) beer.

      I am 6ft with a resting pulse of @ 60, and a morning BP of @ 115/60-ish. These figures have not really changed much in 10 – 20 years. I have only been to the doctor about 3/4 times in the last 20 years (the flu once, a bad upper and lower chest/sinus infection, thumb sepsis, an ear infection […toothache], an NHS poo test, and a very, very nasty bout of brachial plexus neuralgia. ‘They’ tell me I have done everything wrong, but maybe I was ‘doin all right all along. Anyway, I hope to continue my wrongful life for some time to come. It seems to work, and saturated fats are just so… rewarding.

      Shaun C.

      Reply
      1. Kevin Frechette

        Hi Sean,

        I’m a big fan of the Keto diet because it has done so much for me. I’m currently 57, when I was 38, I was pushing 240 lbs and I’m only 5′ tall. I managed to walk off 30lbs with a balanced diet and held my weight in the 180’s for most of my 40’s. During that time I got sick with a lung infection and the prednisone packed 20 lbs on nearly overnight. I have asthma too. I’m an active downhill skier, ski patroller and ski instructor. 6 years ago, I got sick with back to back lung infections and the prednisone packed the weight on again. This time my lung function dropped to 55-60% and I developed arthritis in my knees and couldn’t ski or even ride a bicycle around the neighborhood. This time, I didn’t come out of it and had to give up skiing for three winters.

        I found Jason Fung and Diet Doctor and started a Keto Diet with some intermittent fasting. I lost 30 lbs from August to November and most of the arthritis went away and I regained a great deal of lung function back. I went skiing on the Christmas break and it was -32C. The second day back skiing, I bought a season pass and never looked back, I finished the season with a trip to the Rockies and did Banf and Lake Louise. I’m now down to 155 lbs, cycle commuted 25k daily to work this summer and now I’m back on Ski Patrol and loving it.

        Kevin

        Reply
  89. Charles Gale

    Good news – Dr Mike Eades is back (blogging)!

    Many here will be familiar with Dr Mike Eades and it’s been a few years since his last blog, but I’ve been content to follow him on Twitter.

    I’m on his emailing list and was thrilled to get an email announcing his return to blogging. To quote:

    “I’m giving you an early alert to my latest proteinpower blog post. Let me know what you think. Last time I posted was a couple of years ago. I’ve kind of been itching to get back to it, but a thousand things it seems have gotten in my way. Here is a catch up explanation of what’s been happening and a little teaser of what’s to come. I apologize for the absence and plan to get back into it with some gusto. Hope you hang around for the ride.”

    Here’s a link:

    https://proteinpower.com/tfw-you-realize-you-havent-blogged-in-over-2-years/

    Dr Kendrick gets a mention too.

    Reply
  90. Martin Back

    The more you learn about Big Pharma, the more dismayed you get…

    Health-Records Company Pushed Opioids to Doctors in Secret Deal With Drugmaker
    https://www.bloomberg.com/news/articles/2020-01-29/health-records-company-pushed-opioids-to-doctors-in-secret-deal

    A pop-up would appear, asking about a patient’s level of pain. Then, a drop-down menu would list treatments ranging from a referral to a pain specialist to a prescription for an opioid painkiller.

    Click a button, and the program would create a treatment plan. From 2016 to spring 2019, the alert went off about 230 million times…

    Groundwork for the deal between the companies began in 2013, according to the statement of facts agreed to by Practice Fusion under a deferred prosecution agreement. The idea was to get the opioid maker’s pain drugs to certain kinds of patients: ones who weren’t taking opioids, or those being prescribed the company’s less profitable products. It also aimed to secure longer prescriptions, according to the court papers.

    Reply
  91. Soul

    I saw something interesting about statins on TV the other day. It was a commercial critical of statins. It was the first time I’ve seen something like that.

    Here in America TV programs are paid for by sponsors. How it works typically is that for an entertainment program there is around 10 minutes of entertainment and then 3 minutes of sponsor commercials for the companies that pay for the entertainment program. Close to every 3rd commercial shown is about a drug for sale or of a hospital in the area or a doctor advertising his or her services.

    So those that work in the entertainment industry, news presenters, or sports industry owe their salary in large part of the drug and medical industry. As a result, I suspect, it isn’t to common to hear of something overly critical of the medical and drug industry.

    The commercial was sponsored by some medical group. The commercial said heart attacks are the leading cause of death, and that statins only prevent about 25% of heart attacks. Then basically it went onto say contact their group in order to receive advise on how to limit the remaining heart attack risks. No details provided on what they believe those other risks to be. It’s not much but that’s the most critical item I’ve seen mentioned about statin drugs on TV.

    Reply
    1. Jerome Savage

      25% is off the scale compared to the actual benefits, which we might reckon at 1%. No reference to the adverse non coronary side effects that lead to an all round negative fatality score. (trying to summarise what I have gleaned from these pages)

      Reply
    2. andy

      Hi Soul: re 25% reduction by statins would be wonderful
      This is not being critical of statins, this is false advertising and should be banned. This is relative risk reduction between two groups (statin users vs non users) ie % divided by % resulting in a number in this case 25, but not 25%. Need to know % of one of the groups to calculate how many people actually benefitted, it is not 25 in a 100.

      Reply
    3. James DownUnder

      Maybe it’s the start of ‘doing a Schopenhauer…
      Or perhaps they’ve read up on what actually happens when a patient starts a statin…
      Here’s a summary:-
      “Key clinical point: Despite starting a statin or antihypertensive drug, people can regress on other cardiovascular disease risks factors like body mass and inactivity.

      Major finding: Nonobese people starting statin or antihypertensive treatment had a 82% higher incidence of obesity than those not starting these drugs.

      Study details: A review of prospectively collected data from 41,225 adults in the Finnish Public Sector Study”

      See? – the fine Print will get you every time !

      Reply
  92. Soul

    Of course, and I agree it’s deceptive advertising. As is the case I’d say with much of modern medicine. It was refreshing to see the ad somewhat critical of statins. It might get some people thinking there is more to heart disease prevention than just cholesterol. I’ve heard that mention from a couple people that experienced heart attacks – I don’t understand my cholesterol levels were perfect.

    Typically there for awhile all I would see with the TV shows I watch is drug commercials for AIDS and HepC. After that, I wouldn’t mind seeing all drug commercials banned from TV. It used to be that way in the past. About 20 years ago the rules were changed to allow drug commercials.

    Reply
    1. andy

      Hi Soul: re plaque and statin marketing, more than cholesterol
      https://www.nature.com/articles/s41514-018-0026-2 “statins promote plaque calcification, which may explain their stabilizing effects. Statins have been suggested to stabilize plaques by decreasing lipid-rich and necrotic plaque components, but increasing plaque calcification.”

      A paradigm shift in statin marketing will promise100% reduction in CVD, better than the 25% reduction presently achieved. Starting statins when symptoms appear is not enough. Statins must be started at a very early age in order to promote stabilized arteries that are able to resist endothelial damage. Using a 1% yearly improvement in absolute risk reduction, lifetime statin therapy by age 100 will result in 100% stable arteries.

      Reply
    2. Göran Sjöberg

      Soul,

      “I’ve heard that mention from a couple people that experienced heart attacks – I don’t understand my cholesterol levels were perfect.”

      I met the same reaction 20 years ago from the cardiologists in charge of me. The levels were so low they didn’t even prescribe statins to me. Though the last time I met one, seven years ago now, and with the same low cholesterol levels he didn’t hesitate to prescribe statins, as he claimed, not due to my cholesterol but by the virtue of statins to “reduce inflammation” though my low CRP values were at the same time indicating the absence of inflammation.

      I don’t trust these guys for a minute and if there will be another meeting with any of them it would be involuntarily through an ambulance. I consider cardiologist today as “slow killers”.

      But one day I will probably die ‘naturally’ anyway still without any medication and hopefully to my present wish not in claws of “Big Pharma”.

      Reply
  93. Soul

    I’m of similar belief as you Goran. I don’t want to find myself on a revolving door for test after test of questionable value, for my heart health or other health issues.

    I thought this funny but it’s sad in a way with medicine, at least in America. I have a serious IBD condition which I won’t bore you with, other than it is a big problem disrupting my life. So I had another meeting, another round of unpleasant tests with a Gi specialist. As had happened with other doctors he had no answers for what was causing my stomach distress. To my amazement though, after looking over my health data chart he began to scold me for not having done a cholesterol test! Another doctor had signed me up for the worthless test. I told him I wasn’t interested but that doctor didn’t listen. So here I was very sick, skin and bones, looking for help, with a GI butts and guts specialist but instead of talking about stomach helping ideas, he gave me a lecture on the importance of getting my cholesterol levels checked. Maybe he thought he was doing me good. It only made me distrust him though.

    Reply
    1. David Bailey

      Soul,

      I have become a recent convert to alternative therapy. They really only get their money because they actually help people and get patients by word of mouth. I have also received some good results with them – but nothing remotely as serious as IBD. I also know someone who had some very substantial help from them.

      I’d say that – particularly with problems that conventional doctors struggle with – they are definitely worth trying. The thing is, to turn off your medical thinking and natural scepticism, and spend a little money to see if they can help you. The one I have used only charges £40 for a one hour session. I’d be more cautious of anyone who wants a lot more money.

      Reply
      1. Soul

        Thanks David for the suggestion. Probably the most frustrating part about my journey to getting healthy is that I’ve succeeded a few times. I’ve made myself well with diet, with my definition of well being the stomach in working order, having good energy levels, and being able to concentrate. Trying to figure out what in my diet is causing issues though has been a bugger to say the least. There are no reliable allergy tests I’ve found.

        I know what you mean about alternative therapy doctors. I just happened to read about one group of them a month or two ago. Here in the US there appears to be a few different types of alternative physicians. I’ve seen a couple in the past but didn’t find help them.

        There is one alternative physician or medial theory that i wish I could see, and wish it was still practiced in America. There was a group of doctors that believed many health issues were caused by allergies to foods. This groups beliefs in allergies were broader than current medical thinking.

        One of those physicians was Theron Randolph. He wrote a book on his work in the 1970s called An Alternative Approach to Allergies, the New Field of Clinical Ecology Unravels the Environmental Causes of Mental and Physical Ills. In the book Dr. Randolph talks about patients seen, how the modern medical establishment did their best to make his life miserable, and how food companies didn’t like him either.

        While I don’t believe there are doctor’s like Randolph anymore, in some ways his ideas are still with us. There are many popular diets these days that eliminate many foods. Theories are put forward on why such and such diet help improve a persons health. It is hard to say if the theory is right or wrong though. Some follow vegan or vegetarian diets. Others find low carb, keto or paleo diets helpful. Many on these diets will report a long list of health improvements seen, anything from weight loss, to rashes going away, improved energy levels, BP levels improved, healthier appearing, wounds healing better, acne going away, mental health improving, depression lifting, etc. It is hard to say with certainty why one diet might help an individual improve their health but not another, but I’ve often thought that Dr. Theron Randolph and others that practiced an alternative approach to allergies were right. It’s the eliminated foods causing a reaction in some that led to the health improvements

        Anyway, that is just my theory. I’m currently avoiding pork, wheat, and melons. The stomach is improving and my energy levels have been good. Fingers crossed that over time I become healthier and finally have the right combination of food to avoid with my diet. If I happen to find an alternative doctor in the area that I thought good to visit, I’d do so.

        Reply
        1. Sasha

          That approach is still practiced in Russia. I think they test your blood for immunoglobulins and then determine the foods to which your body is reacting. You’re then given a list which foods to eliminate. I think they get good results.

          Reply
    2. Dr. John H

      In my experience the expensive invasive tests, drugs and surgeries that GI docs typically use make things worse for IBD, while never actually treating the root problems. A good natural medicine practitioner is a far better choice.

      Reply
    3. Göran Sjöberg

      Soul,

      Talking IBD my wife was seriously ill some ten years ago. In an acute face we then decided to go ZERO CARB from one day to another with just amazing and immediate improvements in her IBD-status and actually also her severe T2D status as well.

      This has kept us on the ‘narrow’ LCHF road for more than ten years now with reasonable health. But T2D, IBD and my own CVD still linger.

      So our opinion is that we cannot afford falling off our track 🙂

      Reply
  94. JDPatten

    Hmm. The “coronary artery calcification” aspect of this post’s replies seems to have petered out.
    Anyone interested in how best to sharpen kitchen knives? 🙂

    Reply
      1. JDPatten

        Jerome,
        Ah. There are some few long-time readers of this blog who’ll remember my detailed digression – for which I got scolded at the time. I brought up what seemed an interesting alternative topic, having been frustrated that the comments were diverging from the title topic.
        Made a point.

        Reply
        1. Gary Ogden

          JDPatten: Your digression was very well done, and correct. A bit of variation in comments makes life more interesting!

          Reply
      2. Jerome Savage

        JD Thank God for that, No, I see your point completely and actually felt like apologising after I posted -for my smart@ss comment. Just couldn’t resist it. Changing the subject to a slightly more relevant one, with my hiking habits in mind, I queried on a US hiking page this afternoon about the prevalence of lyme disease in the Smokie (or is it Smoky?) Mountains. Of those who experienced this awful condition, two had serious misgivings about the benefits of mainstream medicine and their treatment which they insisted, prolonged their condition. What was very interesting was that the only treatment providing a remedy or a benefit was provided by a herbalist. What I got was that mainstream medicine let people down in the area of lyme disease. That’s a narrative I have been hearing on this blog. I didnt go looking for that information, it just happened, was just there ! Just hope now that mainstream medicine doesn’t have the knives out for me for saying that. (There I go again)

        Reply
      3. Martin Back

        I think knife sharpening is on topic for a blog devoted to health. You cannot prepare a meal from scratch without a decent sharp knife or two to process the ingredients.

        I visited a museum that had old kitchen gadgets. I’d say about half of them were knife sharpening devices of varying complexity, so it’s been a problem since forever.

        At one point I got obsessed about sharpening knives, and discovered there’s quite a subculture on the internet devoted to knife-sharpening devices and techniques. The ultimate test is if your blade is so sharp it will cut a hair placed on it and cut through under its own weight only. I’ve seen a video of someone doing it, and he manually sharpened his blade on a stone, he didn’t use any fancy devices.

        I never quite mastered the art of getting a razor sharp edge with a stone, despite ruining a couple of knives trying. The trick is to keep a constant 20 degree angle while scraping the blade so you get a straight edge. I’m not so coordinated and rock the blade a bit and get a more rounded edge.

        Reply
        1. AhNotepad

          There are many cases where a razor sharp knife is inappropriate. What’s needed is a working edge, that is one that has sufficient support to carry on cutting for a reasonable time. A razor edge will need more frequent dressing to keep it that sharp.

          Reply
    1. Göran Sjöberg

      JD, I am sure cardiologist, experts on CABG, could help shine light on the problem with your kitchen knives. 🙂

      My last one, though, I don’t know if he is still alive; his aggressiveness certainly must have reduced his life span considerably. MI?

      Reply
    2. Janet Love

      “…Anyone interested in how best to sharpen kitchen knives?…”

      ‘ With a stone, dear Henry, dear Henry, dear Henry,
      With a stone, dear Henry, dear Henry, a stone…’

      Reply
  95. Dr Mark Heneghan

    Malcolm, if you ever do an ‘Any Requests’ blog I’d love you to apply your logic and research to ‘processed food’. It seems to be the latest public nutritional enemy number one, although I can find no strong evidence that it is any more harmful than non processed food, but despite this everyone knows that it is ‘bad’ for you. I suspect that snobbery plays a large rôle – it’s what the working classes eat, and look how ill they are so it must be bad for you – and that the rest is arguing from theory, that it is high salt, high fat,or high sugar, even though you have presented copious evidence on this blog undermining attacks on fat, and salt, so if it is just the high sugar, well there are plenty of non processed foods high in sugar – healthy honey, for example. Another theoretical criticism is that the foods lack certain nutrients, and could lead to deficiencies, although again I see scant evidence of that. Could you give it a shot?

    Reply
  96. andy

    Domestic dogs can teach us a lesson about calcification, don’t add plants to their diet. From now on I will behave like a true carnivore and not worry about cholesterol.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1312295/
    “Atherosclerosis affects only herbivores. Dogs, cats, tigers, and lions can be saturated with fat and cholesterol, and atherosclerotic plaques do not develop “
    “humans have characteristics of herbivores, not carnivores.”
    “The more years we live, the longer the time period we have to keep our cholesterol levels elevated and thus to develop plaques.”

    https://www.thedrakecenter.com/materials/heart-disease-dogs
    “Congestive heart failure is the inability of the heart to provide adequate circulation to meet the body’s needs. Unfortunately, this condition is quite common in dogs. In fact, about 10 percent of all dogs seen in primary care veterinary practices have some form of heart disease. This percentage continues to grow as dogs get older. Up to 75 percent of senior dogs experience some form of heart disease.”

    Reply
    1. Jean Humphreys

      Dogs DO add plants to their diet. They frequently eat grass; often to make hem selves throw up, but will also eat other plants (herbs) and retain them. Packs of wild dogs and relatives will eat the intestines of their prey, if they can – pre-eaten plants and all.

      Reply
      1. Gary Ogden

        Jean Humphreys: That is correct. Big cats will eat the intestines, containing partially digested plant matter, and the liver of prey first. When I make the food for my cats, I add about 5% (cooked) plant matter. Ten years of eating this way, and they are lean and muscular, and behave like kittens.

        Reply
      2. Sasha

        Be careful, Jean. You don’t want to upset the “plants are really, really bad for you” hypothesis. It’s already straining under the weight of contrary evidence…

        Reply
        1. mmec7

          Smiling – Some several years ago now, when out riding with my hound and ghastly cat in tow, along the byways and tracks in Lincolnshire, there was always a stop off to chomp on any delicious offerings from the hedgerows, blackberry time would see Miaouzelle (Korah) cat, at ground level, HPR hound somewhat higher up, then myself from the saddle, with oss stretching upwards to grab at the blackberries. Must have made quite a picture, but I didn’t have a digital camera then…let alone one of the new fangled i-phones. Rides out could take quite a time until we had had our fill… My dear companions no longer here, but many happy memories.

          Reply
          1. Jean Humphreys

            Now in South Lincolnshire, we have only a lurcher – who refuses to lurch. So no meat from her providing, and no fruit either since she has no interest in it, and the one wild damson that we know about would likely be non-reachable even from horsebaxk, placed as it is on the side of the drain. Sigh!

  97. Shirley3349

    When I was a young housewife and mother in the 1970 s in Leeds, a gipsy used come round about every six months with a treddle-operated grindstone. I think he charged about 30 p a knife and the knives stayed sharp enough, with me just using a steel, until his next visit. Long before I moved away, he stopped calling and I have never since found a better way of getting knives sharp.
    Our local iron-monger does have a sharpening service but it is expensive and not nearly as good.

    Reply
  98. shirley3349

    When I was a young housewife and mother in Leeds in the 1970 s, a gipsy used to call round about every six months with a treddle-operate grindstone mounted on wheels. He charged about 30 p per knife and the knives stayed sharp enough, with me just using a steel, until his next visit. Long before I moved away, he had stopped calling and I have never since found a better way of getting knives really sharp.
    Our local ironmonger still has a knife sharpening service, but it is expensive and not nearly as good. So any tips on D I Y methods would be welcome

    Reply
  99. Lucy

    Thank you Dr. Malcolm. I don’t know if you will read this. I have long suspected that the WHOLE HEART DISEASE THEORY IS WRONG. I will not let anyone check cholesterol anymore, I also won’t do these scans because IMO the scans don’t extend life or do much of anything. Unfortunately we are going to have to wait for this whole generation to die off before they will stop with the cholesterol theory. IMO the best we can do is sleep, exercise, have friends, stop worrying and eat foods that don’t come in boxes and are not refined.

    Reply
  100. JDPatten

    Coronary Artery Calcification . . . and . . .
    What would a scan uncover if it looked for Kidney Artery Calcification, for example. KAC.
    Or LAC, CAC, LAC, or FAC. (That is, Liver, Carotid, Lung, and Foot Artery Calcification. Surely there’s calcification in the foot I’ve had plantar fasciitis in for the last three years.)
    Confusing. They’d have to com up with discrete acronyms. RAC for Renal, PAC for Plantar. . .

    My point is that looking at an overall tendency to calcify when healing – or not to – might reveal something about the basics of healing and of calcification that could apply downstream to kidneys, feet . . . and coronary arteries.

    Reply
    1. Tish

      By ‘nocebo’ here, I mean, if you think there is a good chance that a virus will kill you because you’ve heard nothing but doom and gloom about it, death is more likely to occur.

      Reply
      1. Shaun Clark

        Tish: From what I can gather, its more a case of patients being so far below the Plimsoll line that they in all likelihood have no idea what is happening. It seems to be very, very grim.

        Reply
  101. Deborah Gordon

    I am second-ing one of the above comments. If you wish to be a little inspired to read Dale Bredesen’s book, The End of Alzheimer’s, you might enjoy his very brief TED talk https://www.apollohealthco.com/dr-dale-bredesen-at-tedxmanhattanbeach/?fbclid=IwAR271wvRjJr3G8ElLbfs_M0oLJAkcMSkwGyF_HQrpGuE1sJGMVXSaYSI0Pc.

    It is now clear to me that people should absolutely know their risk for Alzheimer’s because I have seen it reversed. (An interesting and personal to me–really personal to my brother–conundrum is the intersection of Huntington’s and Alzheimer’s… HD can cause dementia but not all dementia in an HD patient is due to their HD: a surprisingly high incidence of AD findings on autopsy of HD patients now suggests that HD patients should also be tested for AD to clarify the source of their cognitive challenges.)

    Reply
  102. MrChris

    Juliet
    Thank you for this information. Incidentally the name is Robinson Buckler. I see he can put spells on people as well, and make adulterous husbands return. People who follow Dr mcKendrick should be aware of his other talents. Thank you for drawing him to our attention

    Reply

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