10th December 2023
A very important study – please watch
Very high low density lipoprotein levels with no impact on plaque progression
I interrupt my series on what is wrong with the health service to bring you breaking news. I was sent the e-mail below, directing me to a short YouTube presentation by Dr Shawn Baker.
It highlights a study which provides very strong evidence that a very high LDL (as seen in some people who go on a keto diet), has no impact on coronary artery plaque progression.
It was sent to me by Brian Fullerton MD, for which I shall be eternally grateful. E-mail below. I have edited the e-mail somewhat, but there is no change in meaning.
‘Transcript (ish) from video:-
“Professor Matt Budoff MD at UCLA recently presented a collection of data soon be published in the journal Metabolism. Abstract to be published shortly. What he looked at was a collection of people on very low carb ketogenic diets who also happened to have extremely high LDL cholesterol. As high as 600 milligrams per decilitre (15.5mmol/l).
They did a coronary CT angiogram study looking at the coronary vessels in the heart to find out how much plaque/calcium was in their arteries, and compared this to age matched controls, who were essentially, identical, in every other way.
Their body mass index was the same, as were ages. Average age was close to fifty-five in both groups. They were all healthy with none of them having diabetes, or hypertension, meaning that they were well matched.
The one major difference being that one group had high LDL cholesterol, and the other had “normal” LDL cholesterol. In those with the very high cholesterol it had been at that level for at least five years.
Matthew Budoff the principal investigator is arguably the world’s leading authority on how rapidly you can detect plaque accumulation in the coronary vessels over time. He states that five years is more than sufficient to detect any difference in plaque progression.
The prediction was that the group with the highest LDL-cholesterol levels should have considerably more plaques and/or calcification in their arteries.
They did not find any statistically significant difference between the two groups. So, it did not appear to matter if you had ‘super high LDL’ or ‘normal” LDL cholesterol. In fact, the trend was that the people with the high cholesterol had less plaque in their arteries.”
The presentation can be seen below:
Dr. Malcolm Kendrick 
Wow! That is stunning research!
Shocking!!! This may make many “doctors” apply for an early grave. The logic transition will be too much.
My wife was told by her GP that what mattered was the ratio between good and bad cholesterol.
I know, it is the hypothesis that can never die. Kill it, and it simply changes shape before rising from the dead.
Kendrick does make sport of the ever-mutating and revenant diet-heart hypothesis (e.g. first it was cholesterol causing heart disease, no wait, it’s saturated fats, naw that ain’t right, it’s LDL, etc.) More recent candidates are oxidized or glycated LDL, as well as varying particle sized LDL or other lipids. Heaven knows what they’re blaming it on these days. Global warming and Trump voters, I’d posit.
But wait a minute: Isn’t it possible that some of these could be A (as opposed to THE) cause of CVD? That arterial plaques begin with endothelial damage is, to my understanding, non-controversial. If that be the case, then various candidates that might cause such harm should not be dismissed out of hand.
In this particular case, Kendrick is dubious of one of the diagnostic ratios. But that doesn’t mean per se that all ratios are of no value. Let me pimp the “Atherogenic Index.” First, allow me to note that this term seems to have been applied to more than one metric. In this case I’m specifically referring to the ratio obtained by dividing triglycerides by HDL. (We need not worry about units here; they cancel out anyway.)
A number close to 5 indicates an unfavorable state. Closer to 2 (or even less) bodes good CV health. At the risk of stating the obvious, you’ll note that LDL doesn’t factor in the AI at all. Perhaps because it’s not important? Or, at least that it’s not the most important marker of CV health?
Just for reference, during my “junk food period” (2017-2019), of several lipid panels, my avg. TG was 165 and LDL was 154 (US units). In marked contrast, post-Atkins those are 90 and 136. Once I’d been on Atkins for a while, total cholesterol and especially TG dropped substantially. HDL went up slightly. LDL dropped. My personal results are wholly consistent with what the AI as well as the Atkins books indicates would happen with a keto diet.
I, for one, dispute the assertion that plaques start with endothelial damage. The endothelium is protected by the glycocalyx. The glycocalyx needs to be damaged first, before the endothelium can be penetrated. Once the glycocalx has gone, then it’s game on for all the components of the bloodstream to break open the endothelium, including blood cells. Once the pharmaceutical companies realise this they will be promoting drugs to cause anaemia because CVD is caused by red blood cells …..
My diet experience is similar (except I never had a junk food experience) in that when I eliminated carbs totally through my bacon and eggs diet the cholesterol went down into the “safe” zone for the first time of testing. My GP had another patient who did the same thing with the same result.
Bacon and eggs – the delicious alternative to statins.
For anyone still stuck on the cholesterol myth. There is a natural solution that not only lower cholesterol in a way that doesn’t do the damage that statins produce. But also has cardiovascular and metabolic benefits. It even is claim by some that has longevity benefits.
Cardiovascular and metabolic effects of Berberine
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2999047/
If you are also on the longevity aspiration there is also a natural solution with no downside and some very large proposed benefits.
Taurine deficiency as a driver of aging
https://www.science.org/doi/10.1126/science.abn9257
Something more in line with Dr. K to prevent problem with heart attacks and stroke. Without the drawbacks of pharmaceutical therapies is the flavonoid Rutin.
Flavonoid compound can prevent blood clots
https://news.harvard.edu/gazette/story/2012/05/flavonoid-compound-can-prevent-blood-clots/
Rutin- potent natural thrombolytic agent
https://www.researchgate.net/publication/233969257_Rutin-_potent_natural_thrombolytic_agent
“the longevity aspiration” the only tried and tested answer to that one is ‘choose your parents very carefully’.
This 82 yo. (Only 3 rounds of golf a week now) has been on the Dr Eades low carb eating plan for 15 years now. Have not seen a quack for 3 years (even if I could).
Also, and most importantly a pure blood, no Fauchi gene altering injections.
Yes the good cholesterol that comes and removes the cholesterol from arteries with his strong little hands and brings it to the liver bin while Ugly LDL with stronger arms does the reverse.
I never understood that, even after reading the beautiful figures in the Holy England Journal of Medicine in the early 2000s. Magic at work.
May I ask your opinion on this?
“The overall vascular effects of mercury [e.g. from dental amalgams] include increased oxidative stress and inflammation, reduced oxidative defense, thrombosis, vascular smooth muscle dysfunction, endothelial dysfunction, dyslipidemia, and immune and mitochondrial dysfunction.
[Therefore], Mercury toxicity should be evaluated in any patient with hypertension, coronary heart disease, cerebral vascular disease, cerebrovascular accident, or other vascular disease. Specific testing for acute and chronic toxicity and total body burden using hair, toenail, urine, and serum should be performed.
Role of mercury toxicity in hypertension, cardiovascular disease, and stroke
J Clin Hypertens (Greenwich), 2011 Aug;13(8):621-7.
https://pubmed.ncbi.nlm.nih.gov/21806773/
Sounds very credible and important
Thank you so much. I was hoping that you’d written on that subject somewhere.
BTW, I really appreciate your articles and the comments here are uniformly great as well. Have ordered 2 of your books so far and am confident they’ll be excellent.
Good one, so true
100%
The terms “good” and “bad” cholesterol are often used to describe LDL and HDL.
These terms are convenient for understanding, but they are not entirely accurate as they oversimplify the complex roles of cholesterol in the body.
No they are not convenient.They confuse people since they are wrong.Its confusing the carriers..LDL/HDL etc with cholesterol per se.
Then your GP should not give any advise on health.There is no such thing as good or bad Cholesterol.Its just cholesterol.He was confusing the carrier lipo proteins -LDL,HDL etc (which was another dead end) see article..
Actually “there is no such thing as good or bad Cholesterol” is not true, at least according to some authorities. At least, if one counts lipids that are abnormal in some way (oxidized or glycated) or one naturally present in the body — Lp(a).
If the above are true, then in a limited sense, the dogmatic assertion that LDL is “bad” has some basis.
They don’t even talk about colesterol, colesterol is colesterol(well colesterol esters and pure colesterol in the membran of red blood cells) they talk about LDL(bad) and HDL(good) particles . I hope you know that this is not colesterol. So just there it starts pretty bad for 99% of the doctors!
Not a surprise. Dave Feldman has been studying keto diet cholesterol hyper-responders for some years. We know those with familial hypercholesterolemia don’t suffer CVD effects from it. So many other studies indicate the good effect of more cholesterol. The real problem is clear – the foods promoting diabetes that destroys glycocalyx and damages LDL particles. Will another stake through the heart of this vampire idea kill it for good?
It’ll take decades. Beurocrats need at least a dozen meetings.
It’s much worse than that. Bureaucrats and politicians need to retire and be getting their pension before they can even consider the possibility that they may have been wrong.
I don’t know that those that have familial hypercholesterolmia don’t suffer CVD effects from it. Pretty sure Dr kendrick has not said that over all the years following him for that particular group. Hope you’re right as I do have it!!
One variable not addressed is genetics. There are many genetic reasons why high LDL-C will drive the progression of plaque. For example: Some individuals are genetically susceptibility to oxidative stress and LDL oxidation.
I would be interested to see your evidence for this?
There is a significant amount of evidence suggesting that some individuals are genetically susceptible to oxidative stress and LDL oxidation. This evidence comes from various sources, including:
1. Twin studies: Studies comparing identical twins, who share the same genetic makeup, and fraternal twins, who share only half of their genes, have shown that identical twins tend to have more similar levels of oxidative stress markers and LDL oxidation than fraternal twins. This suggests a genetic component to these factors.
2. Genome-wide association studies (GWAS): These studies have identified numerous genetic variations associated with oxidative stress and LDL oxidation. For example, a GWAS identified a single nucleotide polymorphism (SNP) in the GPX1 gene associated with increased oxidative stress markers.
3. Functional studies: These studies have directly examined the effects of specific genetic variations on oxidative stress and LDL oxidation. For example, a study found that individuals with a certain SNP in the APOE gene had higher levels of oxidized LDL than those without the SNP.
4. Animal models: Studies in mice and other animals have shown that genetic modifications affecting antioxidant enzymes or pro-inflammatory pathways can increase oxidative stress and LDL oxidation.
A 2012 study published in the journal “Free Radical Biology and Medicine” found that a SNP in the GPX1 gene was associated with increased levels of oxidative stress markers in humans.
A 2014 study published in the journal “Atherosclerosis” found that a SNP in the APOE gene was associated with higher levels of oxidized LDL in humans.
Overall, the evidence strongly suggests that genetics plays a significant role in susceptibility to oxidative stress and LDL oxidation.
So, raised LDL has nothing to do with CVD? Or it does?
High LDL-C can drive plaque progression in some people.
What are the absolute risk figures?
“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.”
-Marcia Angell MD
NEW YORK REVIEW OF BOOKS
Volume 56, Number 1 . January 15, 2009
Drug Companies & Doctors: A Story of Corruption By Marcia Angell
https://ahrp.org/marcia-angell-drug-co-doctors-a-story-of-corruption/#:~:text=Drug%20Companies%20%26%20Doctors%3A%20A%20Story%20of%20Corruption,have%20corrupted%20the%20integrity%20of%20American%20medicine.%20http%3A%2F%2Fwww.nybooks.com%2Farticles%2F22237
There is increasing concern that most current published research findings are false.
– John P. A. Ioannidis, Why Most Published Research Findings Are False, PLOIS Medicine, August 30, 2005
https://doi.org/10.1371/journal.pmed.0,020124
‘The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue…science has taken a turn towards darkness.’
– Richard Horton, Comment, Offline, Lancet, Vol 385 p1380 April 11, 2015
Click to access PIIS0140-6736%2815%2960696-1.pdf
More recent studies9-11have shown that there are still far too many papers being published in which the statistical analyses are incorrect. Conflicting results from similar studies can often be attributed to varying degrees of statistical competence.12-14
-Douglas G. Altman, Statistics and ethics in medical research, British Medical Journal vol. 281, pp.1181-4, 1 Nov. 1980
Click to access 1182.full.pdf
Even if genetics is a variable, it should cancel out if control and intervention groups are properly randomized.
I’m confused how Dr. Baker can say that LDL should still be considered a causal factor in heart disease, given this new information… Isn’t this kinda a black swan moment?
It is just what you have to say if you don’t want to be attacked from all directions.
I am strongly reminded of what I have just been reading about the court of the Persian Great King (in Gore Vidal’s superb novel “Creation”).
It was stringently forbidden to laugh or spit in the Great King’s presence. Spitting, at any rate, would earn you permanent banishment from his presence – if, as Vidal’s narrator adds reflectively, the 100 lashes didn’t kill you.
No one except a favoured few close friends were even allowed to look directly at the Great King. They had to avert their eyes, which was relatively easy as they were trying to burrow into the carpet. (The Great King must never walk on the ground or a bare floor).
I am curoius why i was censured in this thread? I will try again. About the podcast with Feldman and Baker, why do you even try to get any positive out of that podcast? It so much bullshit with many of these so called experts who kind of i would think, are leading towards the doubtfullness when it comes to LDL, but they can’t just cross the finishline. It shines trough everything. And we all know why they can’t
Roar
At long, long last some common sense research regarding LDL Levels for folk who have no other trigger points for a perceived risk of future heart problems and the knee jerk response of statins from the medical profession.
Thank you.
I read Dr baker’s excellent book “The Carnivore Diet” earlier this year, and I have rearely seen a book that impressed me more. This clip was the first time I had actually seen and heard him, and my word!What a big guy – and clever with it.
If he ever wants to try a different career, he would be perfect for the role of Jack Reacher. Although, as a doctor, he might not reslih even appearing to hurt so many people.
Yes, I agree, he does look like Jack Reacher from the books. The current series of Reacher on Amazon Prime TV features Alan Ritchson in the role – the right physique but too good looking, Reacher is more rugged.
Hi Dr Kendrick,
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div>Big fan of of the Clot Thickens and Doctoring Data. With regards to the keto and LDL news, was LDL partic
Glad to hear it. After all, that’s why I stopped taking statins.
Me too. Kendrick’s books have been a big part of my self-education since mid-2022.
I’m near my one-year anniversary of dropping several Rx drugs (all for primary prevention.) I recently had my one-year appt. with my cardiologist. I dutifully explained why I no longer took the drug regimen (in essence, that I’d looked at the studies and had come to the realization they were a low-value intervention). It may be worth mentioning that I was put on these drugs because my blood pressure was just over the limit, as was my “cholesterol.” I’m now technically within all the guidelines, even the latest ever-tightening-so-we-can-get-more-patients-on-drugs guidelines. Oops not quite, LDL is still “too high.” The nurse-practitioner replied approximately “Standard of care requires me to recommend you go back on the statin.” I understand she’s bound by certain regulations, but it was still a bit exasperating to experience this.
You mean “Standard of Scare”.
First thought does this meant the Pharma statins companies shares dive to oblivion along with all the doctors promoting them. My cardiologist when I had investigations to AF and had been put on statins by the GP, told me I read the Daily Mail too much when I complained of stabbing hip and shoulder pains when lying on my side. Second thought Thanks to Dr Kendrick’s The great cholesterol con which I read (slowly) completely, I chucked the statins and pass on the information to all I know. Truthfull Doctors are what we need more than ever nowadays and the ones around in West Sussex I wouldnt trust to put a plaster on. I am about to go Paleo/keto just started so great to hear I can enjoy real meat, not plastic printed rubbish, and not drop dead tomorrow as a result. Thank you again and again Dr Kendrick for your wise words, and all the others on the vaccine con who are putting their heads out there.
I read “The great cholesterol con” shortly after I discovered that Simvastatin had caused me considerable grief.
In one great gulp I learned that cholesterol didn’t cause CVD, salt did not cause high blood pressure, and that the supposed statistical evidence that statins saved lives came from a statistical trick (using relative rather than absolute statistics). I would never have believed any of this was true, except that every step of the way he cited actual medical studies. Since he is a doctor in the NHS, I’m pretty sure he would have been in very hot water if those links were not real.
It is now nearly 8 years since I took statins, and I am immensely grateful I came across this blog.
Gratifying for you, Dr Kendrick ! – and pleasing for your adherents. 🙂
So what’s the conclusion: a keto diet will significantly raise your LDL, but not to worry, because it won’t give you any more arterial plaque than you would have got without the diet?
Note that 1/3 of the non-keto people were on statins. Would this skew the results at all?
Me finks so.
Moderator and Dr Kendrick
Something has gone wrong with the system.
Somehow I have been labelled as “chaosjoyous637529f89e” which is most definitely not my name or label. I have always been and still am “robertL” – going back several years.
This has happened on several of my recent posts to Dr Kendrick’s blog.
At first I ignored it as a one-off glitch. Now it has become annoying.
How do I get this corrected?
No idea, sorry. I have no control over the technical aspects of this site.
My understanding of Feldman was that he found (hope my memory has not failed me) about 1/3 of Keto followers he measured had unexplained high LDL – named as a group Hyper Responders.
He found no apparent ill effects in this group. At that point I stopped following him (other reasons).
I am sure Feldman would find Baker’s studies fascinating. Though, I am also sure Feldman already knows about them and has obtained the data – he is a absolute tiger about data and data analysis.
Let’s hope the medical profession takes proper notice this time. They are the people who need to influence the general public – who in the main can’t seem to think for themselves.
Come on Tish, they’re still chanting “vaccines are safe and effective”. NO pharmaceutical substance can be classed as “safe” it’s an oxymoron. Chances of them taking notice of anything anti-statin will be countered strongly by such honourable organisations as Pfizer.
Fat (pun intended) chance! Too much money invested in the low-fat paradigm.
Ah! You said the magic word: “money”.
As Homer Simpson wondered about doughnuts, is there anything it can’t do?
Thankyou for this info. Another nail in the coffin for statins. I still wait for my GP follow up after being referred to hospital consultant for having high Ldl level when on keto diet. Was told to keep on statins & change to low fat diet to get Ldl down as low as possible as Ldl had no benefit to my health! No chance!! I wonder how my GP will respond. Thanks again. My wife & I may be able to sleep better now!
Yet even otherwise good nutritionists still claim that a part of a healthy diet is its ability to lower cholesterol ie ldl
While very bad for their patient’s general health, this widespread “cholesterol hypothesis belief syndrome” is a gold mine for psychologists. Why do otherwise highly intelligent, well educated doctors go on believing theories that are clearly untrue?
Personally I think the key lies in the concept “belief”. It isn’t nearly as simple as most of us… believe. As – was it the Red Queen – said, some of us can believe six impossible things before breakfast. Like marathon running, it’s simply a question of training.
Yes but high LDL has no impact to LMHR which have high HDL and BMI of 22 average.
There was no group for high LDL for others areas of causation.
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Another way of interpreting his comments at the end is that if you have heart disease and raised hdl then raised hdl is a risk factor for heart disease, but if you DON’T have heart disease then it isn’t a risk factor. It seems to me that the risk factor for heart disease here is having heart disease.
You could equally argue that being called Henry is not a risk factor for heart disease unless the individual already has heart disease.
So Henry is the cause of heart disease, I hope he knows.
Poor Henry! I was trying to emphasise the absurdity of the logic – it reminds me of a ‘Not the 9 o’clock news’ joke – ‘Cornflakes are very nutritious when sprinkled on food’
Another very good article/publication. More inconvenient evidence. The mountain of inconvenient evidence grows. Yet the promoters also has studies and narrative. This is as always very interesting.
I had an angiogram a few years ago after a stroke. No plaque whatsoever. Still I defer meds the the GP wants me on to reduce cholesterol. What’s the beef?
Regards as always
Deane.
Over the years I have been trying to get my mum off statins based on the reams of evidence that cholesterol doesnt cause heart disease. Unfortunately, she wont listen to anyone but her doctor – even when I send her information from you Dr Kendrick. It’s frustrating – and I even did my degree in biochem back in the day so I know a thing or two myself. Since 2013 I have thoroughly enjoyed your blog posts and books. Thanks for all you do.
So if your CT Plaque score is zero, does that imply that you don’t have to worry about your LDL level?
I made that choice 25 years ago, I spite of my HeFH and LDL level of 500 mg/dl. All against medical advice. Today my plaque is essentially zero.
Great believer in your work. I was wondering do you do private consultations?Thank you Warm regards Nick McArdle07963 588155
Sent from Yahoo Mail for iPhone
Thank you.
My question is then why do some people have high, or very high LDL? The body doesn’t usually produce more of a substance than it needs to. As in, forcibly reducing cholesterol in people leads to an increase in strokes. The cholesterol performed a function. ‘High’ Blood pressure, whatever ‘high’ means, makes sure people have enough blood to the organs to continue living (without falling over). The ‘genetic’ reason is in my mind analogous to Dr K’s paradox in cholesterol, an excuse not to do any more research – I gave up on ‘genetics’ as a blame-all when it was clear that deciphering the genome had not lead to an immediate cessation of all sickness as promised. Genetics is much more complicated than a string of atoms.
Not that I really care about the answer to my question, it’s almost a rhetorical one. If you’re healthy and happy, why bother about why your LDL is high?
Thanls. You know about the Cholesterol Code and the work on cholesterol
hyperresponders, right?
https://cholesterolcode.com/for-medical-professionals-part-i-hyper-responders-and-the-lipid-triad/
Isn’t cholesterol good for our brain? Isn’t cholesterol so important for health that our body produces it if we are lacking?
Your brain makes it’s own cholesterol, because LDL cannot get past the blood brain barrier BBB
Do statins also affect the brain’s production of cholesterol? I wondered if that’s why so many people have memory problems/dementia-like symptoms when on statins.
I wish my GP (whom I avoid) would be open to this info as she is pushing partner and me to go on statins to lower the LDL, the bad cholesterol!
I could have written your comment exactly! My doctor said the same thing – that my “bad” cholesterol was too high and I need statins. I just say no, and walk out the door. I cancelled my last checkup. I keep expecting her to call me and fire me as her patient.
Hello, thank you very much again,
This is quite interesting. I came across with a similar mystery. A colleague of mine heard about my book âCholesterol, de verkeerde vijand?â, âCholesterol, the wrong enemy?â (all the questions that the TINCS group has raised and still is raising about the matter). He told me that he had been taking statins for 6 years now (without any side effects) since he has a sky high level of triglycerides 1200 mg/dl). He didnâ t have any problems before with his liver, kidneys or thyroid. Now it is under 200. Could this be an exception to the rule? I havenât been able to find any studies on the matter. But it does exist seemingly. After having read your latest work âThe Clot Thickensâ I wonder if you could shed some light on this phenomenon.
Kind regards,
Ben Vanheukelom
Reporter
Belgium
Another validating study that the traditional ‘cholesterol is bad’ mantra is, well – bad, bogus, bollocks, BS.
I’ve already fired five cardiologists that can’t see beyond their pharma induced/university enhanced brain set that, “cholesterol is bad…you need to be on a statin and ‘X’ number of other pharma’s” mantra. I don’t have a cardiologist today. I do have a very good homeopathic Primary Care that works with me, listens to me…including reading Dr. Kendrick’s columns.
Less concerned about overall LDL. Working on understanding and correcting the inflammatory causes for low/very low density LDL particle counts.
There is an alternate hypothesis for the origination of CVD, by Prof. Subbotin. It matches well with Dr. Kendrick’s presentation of facts such as the improbability of LDL penetrating the arterial endothelium. The field seems ripe for a better explanation.
Perfect timing for me. I’ve been on strict Keto for 4 weeks and my bloods last week showed very high LDL and the world and his wife are trying to get me to “stop that dangerous diet!” I feel great on the diet so intend to carry on.
I’ll forward your email on to them all and hopefully calm their troubled minds.
Thanks Dr M
It wont
Apologies if this comment appears twice – login issues.
I’m confused by one thing: Big guy with nice Christmas decorations said something like “He’s not saying raised LDL cholesterol isn’t causative of coronary heart disease…he’s not saying that…”.
Doesn’t that seem to undermine the implied logic that raised LDL isn’t a mechanism for or indicative of a heart disease risk?
Can we explain this please?
If you are a doctor and you directly state that LDL cholesterol does not cause CVD you may well get reported to the regulatory authorities who will remove your license to practice medicine. I have been referred to the GMC (General Medical Council) several times but, so far, they have taken no action. So, you say, here is study showing that LDL cholesterol does not cause CVD. But it does not prove that LDL Cholesterol does not cause CVD.
You need to read between the lines and make your own mind up. There is a complex game to be played here, oen that involves splitting your brain in two and carefully guarding your language. I gave up playing that game some time ago, but I understand the need to do so.
Thank You! Lightbulb moment….
Yes, I’ve often noticed this at the end of studies in the ‘Conclusions’ or ‘Discussions’. A study suggests one thing and the conclusion waters it down or sometimes even seems quite unrelated to the study. Infuriating.
Did I not read this in your book years ago that STEMI’s presenting to the ER were noted to have high cholesterol AND normal (not high) cholesterol – is this keto addition merely reinforcing what we kindof knew already (anti to the narrative though)
Perhaps you should write a book for doctors explaining how to explain medical facts as they really are and not get sanctioned by the GMC!
With so much information (and misinformation) thrown at the population it’s hard to know what to believe!! Thank you for this email and for including the YouTube video which at the end shows the results presented.
Wonderful doublethink in conclusion.
This is what I would expect to see. Sean Baker mistakenly believes ldl is still causal but not for lean mass hyper responders, like those in the study. Maybe he is hedging. But I have learned from an actual expert, the author of this blog, that ldl is not causal. This, much to the dismay of my cardiologists who can’t believe I am still alive sans cholesterol lowering drugs.
I was put on a statin after an angiogram and then a stroke, but have pretty much given up any expectation of any use. Whether you believe in risk prediction algorithms like Qrisk or not, if you put in your values with your correct values, and then play about with fictitious cholesterol/HDl ratio, it makes very little difference to your risk. Age is by far the greatest predictor. It cannot be both ways; either the risk algorithms are correct, so there is very little reason to chase cholesterol levels, or the risk predictions, despite being constructed over many years, are plain wrong.
There are some big caveats on this study
From a purist point of view, releasing the results of a study via press releases and social media is very poor medical practice. Puffing up their data for publicity purposes is often used to exaggerate the researchers and for self aggrandisement. The proper approach is via preprint servers where the study can be peer reviewed by all
Secondly, this is observational data. This never gets past Pearl’s observational ladder of evidence from which nothing can be proved. There is a good video from Professor Fenton (censored many times, ie has some credentials, https://www.youtube.com/watch?v=nLGaINzfEVs) on Simpson’s paradox and confounding factors, of which there are likely to be many in this study. There are many other of his videos as it is not an easy topic, but without Bayesian analysis, very little can be concluded with certainty.
What are your views on the possible involvement of Epstein Barr Virus or other herpes viruses in the development of plaques?
This recent article from Grassroots Health might be of interest; LDL-C is mentioned. Could Cholesterol Levels Improve with Vitamin D, Magnesium and Omega-3s? https://www.grassrootshealth.net/blog/cholesterol-levels-improve-vitamin-d-magnesium-omega-3s/
Improve?
It appears that the higher your level is, the longer you live. Particularly so for those in their 70’s., link to recent study available.
So Improve should mean increased cholesterol levels – IMHO
As we know, cholesterol is a vital substance for every cell in our bodies. It repairs, is involved in making Vitamin D…… Power to its elbow!
Why should we care if our levels are high? If so, our bodies obviously need it to be. Correct me if I’m wrong but there would seem to be only 3 reasons for this:
1. It’s better for us
or
2. It’s a sign that something is going on in the body that is forcing levels up (or down) ie. It is a symptom. Can it be wise to treat a symptom and not the cause?
or
3. It is down to our genetics (as can be other substances such as alkaline phosphatase levels where familially high levels appear to do no harm).
Why can’t we trust our bodies to know what is best for us? They have evolved over millions of years which is something that pharmaceutical companies cannot claim for themselves.
Here is a reference for the benign familial increase in alkaline phosphatase for those who are interested:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC501460/
I was interested to see two of our correspondents reported a decreasein cholesterol on a keto diet while the study participants all had significant increases in their cholesterol.
Eggs ‘n beer – when I eliminated carbs totally through my bacon and eggs diet the cholesterol went down into the “safe” zone for the first time of testing. My GP had another patient who did the same thing with the same result.
Ben the Layabout – during my “junk food period” (2017-2019), of several lipid panels, my avg. TG was 165 and LDL was 154 (US units). In marked contrast, post-Atkins those are 90 and 136
It is clear that the study participants were specially selected because they were classed as “hyper-responders”, so I’m not sure the results can be generalized to the population at large.
From a different recent study:
Dramatic elevation of LDL cholesterol from ketogenic-dieting: A Case Series
“Previous studies describe only a modest, transient elevation in cholesterol in the average ketogenic diet participant without a clear impact on atherosclerotic cardiovascular disease. However, some individuals may experience marked elevation in LDL-cholesterol levels when on a ketogenic diet. These individuals, deemed “Lean Mass Hyper-Responders” colloquially, are frequently lean and fit, and may exhibit dramatically increased LDL cholesterol levels greater than 200 mg/dL in response to dietary alterations.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10121782/
I’m hoping Dr. Kendrick can voice an opinion of the Dr. Subbotin hypothesis, assuming he’s aware of it (see Ivor Cummins). In which case LDL perhaps becomes merely a marker for what mode your metabolism is tuned up for, fat burning or glucose burning (or is unable to clear LDL properly- liver dysfuntion ?).
I have read much about subbotinis hypothesis. It is not far removed from uffe ravnskovs thinking. It has much to commend it, but to my mind fails to explain why veins have no atherosclerosis when they have more Vasa vasotum than arteries, to give one example
Since LDL is used for repair all throughout the body, then is it possible that when someone who eats a very low carb diet and their LDL goes up dramatically that it could be a sign that their body is in need of more significant repair as a result?
In which case, then could it be that for that person, a very low carb diet is not right?
(Just speculating, any thoughts?)
Dr John H.
Re your comment “LDL is used for repair all throughout the body”. I have been wondering if LDL is protective and whether high levels could be the body’s attempt to address some hidden, adverse issue. That, In addition to all of Dr Kendrick’s writings, underscores the folly of artificially driving down the levels of something that the body may be using as a tool. (Although not specifically related to low carb diets, do you think that elevated ferritin levels could drive LDL levels higher?)
Regarding your speculation on the effect of very low carb, ketogenic diets, have you heard of the late Ray Peat (Ph.D in Biology). He has written much along these lines – the dangers of following low carb ketogenic diets for extended periods. Complex bio-chemistry that I would do a disservice to by trying to describe here.
If you are interested, this interview between Dr Joseph Mercola and Georgi Dinkov (Peat acolyte but not a medical professional) was a dense intro. That is – if you dont mind about 1.5 hrs listening to a guy with a Bulgarian accent who talks very, very fast!!
https://www.listennotes.com/podcasts/dr-joseph-mercola/why-you-may-need-more-carbs-3s0Fqf_lRQO/
Alternative is RayPeat.com which has a selection of articles.
I have looked at those Mercola interviews & some Ray Peat stuff. He reccomends massive amounts of sugar (like up to 1 pound a day). I don’t think very many people would do well eating that way. One of the big things that gets missed on a high sugar diet is yeast. A lot of people have an overabundance of it, and it feeds on sugar.
Don’t know about the ferritin.
I’m a big fan of Weston Price, who studied traditional cultures and none of the super healthy ones ate in extremes (except for eskimos, though their bodies were uniquely designed for their environment.)
Dr Weston A. Price (and his wife) yay. Among the bestest people EVER.
Just saying.
Have only recently started reading Ray Peat I have not come across the advice to eat 1lb sugar!! The carbs discussed in the interview are nothing this extreme – in fact the idea is to swap out some of the dietary fat and replace with best forms of sugar (raw honey/ organic fruit/ pure cane sugar) of roughly equivalent caloric value. If serum triglyerides rise than cut back on the carbs.
The “need for carb and sugar” viewpoint is a radical departure from everything I have accepted and followed for years. But I must say the interview has some compelling information on how long term keto, or any regimen that results in the unavailability of glucose to burn for energy) together with strenuous exercise can push the body into adverse metabolic pathways chronically elevating cortisol levels, (with all the problems that causes) and for tissues that absolutely cannot generate energy from fats (the brain and heart cited as examples) – initiating catabolic processes to release endogenous glucose from body tissue. … it just struck a note when you commented “… it could be a sign that their body is in need of more significant repair as a result?”
Here is a good article on the Ray Peat diet. Some quotes:
“Ray Peat himself eats more than 1,600 calories (400 grams of carbs) per day from sugar and sugary carbs alone.”
“Supplementing with white sugar, honey, and Mexican Coca-Cola (which, until recently, contained sugar rather than high fructose corn syrup) is recommended to give the body continuous sources of easy energy.”
https://optimisingnutrition.com/ray-peat-diet/#h-are-sugar-and-fructose-good-sources-of-energy
I wonder if Ray Peat has read John Yudkin’s “Pure, White and Deadly”. I won’t be trying Peat’s diet any time soon (or later)
LDL levels go up in response to significant VIT C reduction- I believe.
Hi Dr Kendrick,
This is reassuring news – I have been resisting “doing something” about my own and my husband’s high cholesterol for the last few years but have definitely felt uneasy about them. As I discovered my ferritin levels were higher than I would like I am waiting to see if lowering ferritin (by donating blood) will affect lipid levels.
Anyhoo … I have a question on a somewhat unrelated topic – fatty acids.
Anyone with bio-chem background who might care to comment would be appreciated:
I have been taking a liposomal Vit C product for about 2 years now because of the increased bio-availability and speed of absorption. Initially I assumed the liposomal encapsulation itself was utterly benign. With covid introducing us to lipid nanoparticles and new info I am reading on demerits of polyunsaturated fatty-acids (PUFA) versus saturated fatty acids/fats I am now beginning to wonder!
The manufacturer website (unnamed for obvious reasons) explains why “phospholipids make good liposomes” and the phospholipids are shown as having some “fatty acid” chains and some “omega-6 fatty acid chains”.
My question is -am I consuming PUFA, (potentially unhealthy fats) along with my healthy Vitamin C? – methinks Yes!
I wonder what the lipids are in lipid nano-particles and should we care?
I find that this is highly encouraging news for those, me included, that don’t believe that raised ldl causes heart disease, but I still wonder how this study got through an ethics committee? If the medical establishment as a whole believe that raised ldl is toxic, wouldn’t they have felt obliged to intervene and persuade the high ldl individuals to take a statin or pcsk9 inhibitor? Wouldn’t they have felt it unethical to condone leaving such a high ldl untreated?
Obviously they did get it through of course, but I wonder how much resistance there was?
A question for me is : would this apply to (Korean) people with “naturally occurring” and decades old elevated LDL ?
Then there is the ethnic issue.
there is no ethnic issue with CVD. Japanese living in the US (who take on the US lifestyle), have the same rates of CVD as the surrounding population.
Sorry I was referring to the Atherogenic Index Ben Layabout pointed to.
One important paper was based on a huge Korean cohort.
https://cardiab.biomedcentral.com/articles/10.1186/s12933-022-01522-8
(for fun, try the calculator: https://www.biomed.cas.cz/fgu/aip/calculator.php )
Yes I know the US fed Japanese have US arteries and BMI.
And I can’t imagine a rationale for an ethnic differnce for CV diseases and their link or lack thereof with dyslipemia. But I keep a space for scientific doubt
There seems to be an ethnic issue with Australian First Nations people (for some reason we can’t call them aborigines any more …..). When they adopt a western diet their CVD and diabetes is far worse than white, brown and yellow australians. This could be because they were basically on a keto diet for thousands of generations before the Poms arrived and they have little adaption to the vast amount of simple and complex carbs in the western diet.
Or, it could be somehting else, othe than diet.
True. It certainly could be cultural stress. Medications and vaccines.
Gary Taubes has several times highlighted the similar plight of the North American Pima tribe. (I read the story in his book “Good Calories, Bad Calories”). Before the advent of the European colonists, the Pima ate a varied diet including lots of wild game and fish. The Whites stole most of their land, also the game and fish, and gave them rations of white bread, sugar and tea. Within a single generation the lean, fit Pima had become grossly obese.
I have often seen Dr Kendrick express caution on such topics, but I have been convinced since I first read Taubes’ account.
That is true. But there were four fundamental changes occurring simultaneously. Change of diet. Change of exercise regime (no hunting or fishing, no moving around the country, no food preparation). Change of medical treatments. And change of culture. Dr. K has alluded to the last one in his books and whilst we know that the first two in combination would have to cause obesity/diabetes/heart disease the psychological stresses associated with sudden, compulsory culture change also contribute to diabetes/heart disease.
No easy solution to this issue, I think.
This is slightly off-topic, but Vitamin D is always on-topic because it seems to be related to so many medical issues!
I have noticed a number of YouTube videos are popping up to scare people out of using Vitamin D. Here is a typical
This video is in fact supportive of high Vitamin D consumption, but the title (which I assume are generated by YouTube itself) suggests that Vitamin D is easy to overdose on!
Here is a video that seems to want to scare people away from supplementation with Vitamin D:
Here by comparison is what Dr John Campbell has to say on this subject:
I think we are starting to see a concerted effort by Big Pharma to stop people from using Vitamin D to prevent illness!
It’s my understanding that, while Vitamin D can be toxic in excess, it takes an awful lot to cause harm. Orders of magnitude more than you would get by popping one of those capsules daily.
I have also read (usual disclaimer: I am not medically qualified) that Vitamin D should be balanced with appropriate intake of magnesium, Vitamin K2, and Vitamin A – the last-named being best consumed as food, e.g. liver, chocolate, etc.
There is a theory that, as with other “antagonistic” pairs of nutrients, it’s less the absolute amount of D or A you eat than the balance between them that matters.
I saw a discussion many months ago about vitamin D. It was about the time several videos were about with David Grimes. Sorry , I can’t remember if he was in the discussion, and who else was there. One of the participants mentioned that for at least several days, if not longer, he took IIRC 150,000iu a day. He pointed out he was still alive and had no blood problems.
Here is one of Ivor Cummins podcasts, in which David Anderson mentions vials of 100,000 units which would provide 3 months benefit..
https://odysee.com/$/embed/ep104-vitamin-d-and-viral-special-with/e540078a3c194e465c1358de7908b0c333ea96a9
What, all at once?! Surely not. I take combined 1000IU Vit D3 / 45mcg Vit K, daily. My last blood test registered:
Serum total 25-OH vit D level – (VALB) – Normal result
138 nmol/L
50 nmol/L: Vitamin D sufficiency
I have 20,000iu most days, that’s only 1/2 hr in decent summer sunshine, and as far as I know I’m not dead yet. Some may argue with that statement 🙂
Here in France it is normal to give loading doses of 200,000 or 400,000 iu of vit D in an ampoule. 50nmol/l is what the UK says is sufficiency. It is lower than most other countries where sufficiency starts at 75nmol / l
I’m rather late to this party…I used to take 8,000iu of Vit D3 per day during the autumn and winter and 4,000iu per day Spring and summer but having been recently diagnosed with heart failure (given 2-3 days to live 4 months’ ago) the consulting endocrinologist was horrified at my dosage of D3 and will only prescribe 800iu per day. As far as I know, they have not checked my levels, which were 120nmol/l before my stay in hospital, as I remember. I am not happy about this but given the rather terrifying health scare, I have not been brave enough to increase my intake (I am also on a lot of drugs and am not sure of interactions.). Why does the nhs doggedly stick to these guidelines when other countries do not ? Dr Coimbra (Vit D Protocol) thinks these guidelines are pitiful and advocates 10,000iu per day for everyone, as I recall.
Hello David
It may not all be about the pharmaceuticals making their money from more costly items. It may also be an attempt to keep people frightened or anxious, believing that there is no other way to remain healthy other than to have “vaccines”, new drugs, and loads of hand washing and house scrubbing. Then the unelected powers that be and their elected and strategically placed and bribed puppets will probably eventually step in with a Universal Basic Income paid to all who remain alive. We will be able to sit at home feeling grateful for such wonderful generosity which has saved us from such dire times when the world as we knew it disappeared.
A Happy Christmas and coming year to all.
I feared this might happen. I’d better buy more D3 and put the spare stocks in the freezer.
Living in the UK, I need supplementary vit.D all year.
Malcolm,
It is absolutely great to see you here debating actual medical science again, as opposed to the crazy way the NHS wastes its resources (important though that is), etc.
This blog takes me back years, just reading it!
Do you know when the result of your massive court case (together with Zoe Harcombe) will be out?
Isn’t it logical to say that because cholesterol is so important for repair in the body it is necessarily to be found in damaged blood vessels? An angel rather than a devil.
Long ago, I read of a study on the health effects of fat in the diet. If my memory serves, the study was carried out in Washington State (US), on a large group of nurses (~10,000 or more) over a long time period (~5-10 years). The participants reported what percentage of their caloric intake was fat. At the end of the study, there was no difference in the mortality between those who followed a low fat diet and those on a high fat diet.
This by itself is not too surprising, but what really floored me was the person administering the study was quoted in the news article saying “Of course, we are very disappointed in these results…” or something similar. I couldn’t believe it.
I wish I had recorded the details at the time. I think it was back in the 1990s. I know the details I have provided are pretty vague, but I wonder if this rings a bell for anyone.
Have not found that yet, but take a look at this!
Hiding unhealthy heart outcomes in a low-fat diet trial: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial finds that postmenopausal women with established coronary heart disease were at increased risk of an adverse outcome if they consumed a low-fat ‘heart-healthy’ diet
https://openheart.bmj.com/content/8/2/e001680
The Framington study.
Thanks for this – but I agree that little will come of it. Though the Kendrick Trilogy is my go-to on many health related issues – and it’s worked –
I’ve given up trying to convince others of the same, unless they ask directly. And even then, most won’t take it any further.
The Covid restrictions proved that most are content to outsource their health decisions to others.
And I was demonised for refusing the covaxx. Despite virtually everyone I know who took it still declaring multiple episodes of covid – whilst I had it once in Feb 2020.
I had two people I know diagnosed with Type II diabetes this week. One of which is female and younger than me. She had the blood sugar fasting test, which showed a level of 19 – mine was 3.8.
She received a booklet – Your Guide to Type 2 Diabetes- with a happy Type 2 diabetes stereotype on the cover – which as expected seems to find ways that she can continue to eat carbs! Fats are demonised as usual.
It also mentions cholesterol – weirdly termed blood fat levels – and she had her check done and prescribed statins.
I did mention look at the warnings on the box which often have being a woman as a risk factor.
But once they’re on that slope, they’re usually beyond help unless they’re willing to help themselves – in which case I’m happy to put them in the direction of Kendrick/Harcombe/Unwin/Cummins. But that is rare.
Published in 2015:
Statins stimulate atherosclerosis and heart failure: pharmacological mechanisms
In contrast to the current belief that cholesterol reduction with statins decreases atherosclerosis, we present a perspective that statins may be causative in coronary artery calcification and can function as mitochondrial toxins that impair muscle function in the heart and blood vessels through the depletion of coenzyme Q10 and ‘heme A’, and thereby ATP generation. Statins inhibit the synthesis of vitamin K2, the cofactor for matrix Gla-protein activation, which in turn protects arteries from calcification. Statins inhibit the biosynthesis of selenium containing proteins, one of which is glutathione peroxidase serving to suppress peroxidative stress. An impairment of selenoprotein biosynthesis may be a factor in congestive heart failure, reminiscent of the dilated cardiomyopathies seen with selenium deficiency. Thus, the epidemic of heart failure and atherosclerosis that plagues the modern world may paradoxically be aggravated by the pervasive use of statin drugs. We propose that current statin treatment guidelines be critically reevaluated.
Expert Review of Clinical Pharmacology, 8:2, 189-199,
DOI: 10.1586/17512433.2015.1011125
I was unable to give a “thumbs up” for some reason, but thank you.
Can anyone clarify where fats go when consumed ? We know they connect to bile & then enter the bloodstream, but where to from there ?
The are packed into chylomicrons which travel up the thoracic duct to be released directly into the bloodstream. They chylomicrons are then stripped of fats as they pass various tissues e.g. adipose tissue, until they become chylomicron remnants, which are then absorbed into the liver.
Ketogenic diet, there seems to be some interest in LMHR on a ketogenic diet and the LDL level response after eating high energy calories. Not sure if this had been mentioned by yourself or in comments, not been on here for a while. It was even featured on Rogan. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9048595/
From the New York Times in 2004:
“Even before federal health officials revised their advice about cholesterol last week, many doctors were recommending more aggressive statin therapy to help patients at risk sharply lower their L.D.L. And the authors of the new recommendations said they were prompted by data from five recent clinical trials indicating that the current cholesterol goals were not aggressive enough and that more intense drug treatment led to better results.
“But after the recommendations were published, consumer groups, including the Center for Science in the Public Interest in Washington, asserted that many of the experts on the panel that drew up the guidelines had received consulting fees, money for research or other money from companies making statins. The National Institutes of Health has acknowledged that eight of the nine experts on the panel that issued the recommendations had received financing from one or more of the companies that make statins.” [My bold]
— https://www.nytimes.com/2004/07/20/health/seeking-a-fuller-picture-of-statins.html
Surprise, surprise
But will the reality, that the C19 scam has exposed (well to some of us) lead us to start demanding radical change to the way we live?
Why not just change the way you live?
Well I could say, people need a reason to change the way they live, simply saying ‘you need to change the way you live’ is not sufficient.
You probably have changed, but because of government nudge scams you haven’t realised.
Yes, I have changed, I dug my heels in and it worked, the NHS has given up pestering me about statins, C19 ‘vaccines’, flu vaccines, shingles vaccines, in fact I’d say the GPs now performs the most perfunctory ‘examination’, mostly over the phone and mostly gets it wrong (surprise, surprise).
I’m fairly resistant to change; I need a pretty convincing argument to do so. Ask my wife. I think I’m totally impervious to government nudge scams. I thought the lockdowns were great, from a personal point of view. Travel times around the city were halved! Still dispensing the ivermectin …..
“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines.”
From Dr Marcia Angell, former Editor-in-Chief at the New England Journal of Medicine, one of the most respected medical journals in the world.
https://open.substack.com/pub/stephenmcmurray/p/the-medical-profession-is-a-cesspool?utm_source=share&utm_medium=android&r=1raver
Highlighted by Dr. Anne Mc Closkey today.
Hello Dr. Kendrick,
Best of the season to you and yours. Hope everyone is healthy.
My takeaway from this is that the body is so complex that it can adjust to many different lifestyles while keeping you as healthy as it can.
Why does the LDL go up? The liver makes more of it in response to what? Is the person on a carnivore diet also into muscle building? They are consuming less sugar so insulin isn’t competing with Vit. C usage so there is less Vit. C: incidental? Protective? I’ll ponder this while consuming my bacon and eggs.
Are the carnivores, by default, also intermittent fasting? Does this effect things?
All I know for sure is that this site and the contributors have radically altered my understanding of the “Health” industry and I can never thank them enough.
Regards,
Doug
Good thinking, although the liver does not make LDL.
.. but Canadian Doug deserves partial credit since “The Clot Thickens” informs me that the liver makes VLDL which shrinks down to LDL as it travels about the body …
LOL, tells you how much research I’ve done on it. I decided many years ago that It didn’t need to be monitored, in my personal opinion, and started enjoying my grass fed steak with lots of butter, mmmmmmmmmm, steak.
Doug
This is amazing. My cholesterol scores high for many years. In an effort to avoid taking statins (due to side effects) my doctor agreed I should do an EKG (normal) an Echo (normal) and coronary calcium CT (score 8). I am 76 years old. I thought this seems good. I have read dr Kendrick book on the recommendation of my son which is astonishing. I wonder if my doc will still push me to take statins.
‘I wonder if my doc will still push me to take statins.’
Jusst Say No 🙂
My doctor, who ever he or she is has no idea what my cholesterol levels are, and nor do I. What’s more I don’t care. Since all that might happen is they start thinking they know how to manage my system better than nature does, it’s better that way.
Merry Christmas to all.
Hello
Could you possibly change my email address to jochris8686@gmail.com, and
confirm.
Many thanks
Chris McGorrigan
If it’s to do with this blog, you just change it to whatever you like in the box below the comment box.
Did you see this 24 minute video from Dr. Rath?
Be cautious of anything coming from Dr Rath. He is, to put it in the most polite terms, over-enthusiastic in his promotion of vitamins. Read his Wikipedia entry to get a fuller story.
You mention plaques…
I’m reading about and thinking about cavitation and plaques. Cavitation is an explosive force caused by cavities in fluid that occur when fluids flow at or above a certain speed. You might have seen pictures of dam spillways damaged by cavitation.
Cavitation damage can occur in arteries because blood flow rate is high enough. Problems were discovered where cavitation damaged artificial heart valves.
https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1525-1594.2004.29001.x
Resilient, flexible structures are less prone to damage from cavitation than are rigid structures. Flexible arteries should be less prone to damage from cavitation than plaques, which are rigid.
Bear in mind that friction is a separate physical effect distinct from cavitation.
Stenosis may lead to higher blood velocity through arteries and to more damage from cavitation.
There are likely biological mechanisms that repair damage from cavitation. The glycocalyx may reduce damage from cavitation.
These guys seem to be looking at plaques & cavitation.
https://www.degruyter.com/document/doi/10.2478/jtim-2019-0014/html
For what it’s worth…in that same population (high-LDL ketogenics), eating oreo cookies was shown to bring down the LDL level more effectively than “high intensity” statin therapy.
I’m sure this comes as a huge shock to all here.
https://www.mdpi.com/2218-1989/14/1/73