Malcolm Kendrick

I'm about half way through reading his series of outstanding blog posts which I thoroughly recommend, along with a huge selection of excellent comments.

Also I recently found Jerome Burne's blog

chris c wrote:I'm about half way through reading his series of outstanding blog posts which I thoroughly recommend, along with a huge selection of excellent comments.

Also I recently found Jerome Burne's blog

Yes Malcolm Kendrick recent heart posts have been well read - and I think, if you have time, it's always a good idea to read the comments

As for Jerome Burne I found his recent article about Alzheimer's very interesting
http://healthinsightuk.org/2016/02/08/prevention-is-the-best-way-of-tackling-alzheimers-so-why-is-it-being-ignored-and-discredited/

There are some good blogs and articles around, and good to have some recommended reading ...

All the best Jan

Dr Kendrik has posted another blog post in his series 'What causes heart disease'

What causes heart disease – part XIII

" Heart disease and inflammation.

A few people have sent me links to a recent paper called ‘Inflammation and Atherosclerosis.’ This was published in Circulation, and the authors were: Peter Libby, MD; Paul M. Ridker, MD; Attilio Maseri, MD. Remember two of the names.

Here is a relatively long section of the abstract:

‘Atherosclerosis, formerly considered a bland lipid storage disease, actually involves an ongoing inflammatory response. Recent advances in basic science have established a fundamental role for inflammation in mediating all stages of this disease from initiation through progression and, ultimately, the thrombotic complications of atherosclerosis. These new findings provide important links between risk factors and the mechanisms of atherogenesis.

Clinical studies have shown that this emerging biology of inflammation in atherosclerosis applies directly to human patients. Elevation in markers of inflammation predicts outcomes of patients with acute coronary syndromes, independently of myocardial damage. In addition, low-grade chronic inflammation, as indicated by levels of the inflammatory marker C-reactive protein, prospectively defines risk of atherosclerotic complications, thus adding to prognostic information provided by traditional risk factors.

Moreover, certain treatments that reduce coronary risk also limit inflammation. In the case of lipidlowering with statins, this anti-inflammatory effect does not appear to correlate with reduction in low-density lipoprotein levels. These new insights into inflammation in atherosclerosis not only increase our understanding of this disease, but also have practical clinical applications in risk stratification and targeting of therapy for this scourge of growing worldwide importance.’ http://circ.ahajournals.org/content/105/9/1135.full

This paper interested me for a number of reasons. I focused down for a few moments on the phrase ‘Atherosclerosis, formerly consider a bland lipid storage disease…’ Does this mean that the world is moving on… Atherosclerosis has nothing to do with lipids e.g. LDL a.k.a. ‘bad cholesterol’? Now that would be something. Especially as it was published in the mainstream CV journal ‘Circulation.’ "

Finish reading the article here

https://drmalcolmkendrick.org/2016/05/07/what-causes-heart-disease-part-xiii/

... always lots to read

All the best Jan

He's like the Energiser Bunny. I suspect I'll have died from CVD by the time he has gotten round to how to avoid it.

Seriously though, brilliant stuff which doctors ought to know and understand. A far cry from "fat goes into your blood and plasters itself on your arteries". I went back to the beginning and re-read the entire series.

You may have already seen it ...
Dr Malcolm Kendrick is now up to part XVI in his series 'What causes heart disease'

Read it here
https://drmalcolmkendrick.org/2016/06/08/what-causes-heart-disease-part-xvi/

All the best Jan

If his hypothesis is correct maybe then Rutin should be a great for preventing CVD.

Rutin May Prevent Number One Killer of Americans

From a field of more than 5,000 compounds, the scientists identified rutin (also known as quercetin-3-rutinoside) as the most potent substance for the job. After further extensive investigation and testing, the researchers found that “Rutin proved to be the most potently anti-thrombotic compound that we ever tested in this model,” explained Robert Flaumenhaft, MD, PhD, the study’s senior author and associate professor of medicine at Harvard Medical School.

http://www.emaxhealth.com/1275/rutin-may-prevent-number-one-killer-americans

Ah I thought that asparagus was doing me some good!

https://en.wikipedia.org/wiki/Rutin

https://en.wikipedia.org/wiki/Quercetin

I thought it was also in garlic but not listed here.

What causes heart disease part XVII


Epidemiology

If you are going to try and explain what causes cardiovascular disease (CVD) you need to study epidemiology. By which I mean, how many people die of heart disease and strokes in different countries, and communities. Also, what has been happening to CVD death rates over time.

You might think this would be relatively straightforward. If so, please think again. Then keep thinking again until your brain bursts. After that, start again. The reality is that there is almost no fact about CVD epidemiology that I have not seen challenged. Quite rightly challenged in many cases.

You might believe that when someone dies, it is pretty clear what they died of. Again, if you think that, please think again, and keep thinking until your brain bursts. You might further believe that that what is written on death certificates is an accurate record of cause of death… Ho ho.

When I started in medicine, if a patient was old, and developed a cough, then died, they would most likely be recorded as dying of chronic bronchitis. Thus it came to be that, chronic bronchitis was one of the most common causes of death. At least in the UK. Then, one fine day, it was decreed that you could not use Chronic bronchitis as a primary cause of death on a death certificate. And lo, no-one died of chronic bronchitis ever again. A fantastic medical achievement in curing the UK of chronic bronchitis?

Change your definitions, and codes, and you can cure the world of a disease – at the stroke of a pen.

Until 1948, not a single person died of Ischaemic Heart Disease (IHD), (IHD is what most people would call heart disease), anywhere in the world. Then, suddenly, millions were dying of IHD. IHD is a relatively broad diagnostic code, which incorporates myocardial infarction (MI).

What was the cause of this epidemic? Well, in 1948 the WHO decided that disease diagnoses ought to be standardised around the world, so that researchers would have some idea what they were actually looking at. So they created the International Classification of Disease (ICD). Which included IHD. And lo, an epidemic of IHD swept the world. Not, of course, in France, where they use their own diagnostic system – until 1968. A heart attack (MI) was called Cardiac Insufficience (I believe – I may be wrong on this exact terminology).

However, even after 1948, were people really diagnosing CVD/MI in the same way around the world. Were pathologists being accurate, or not. Were doctors simply writing the most likely cause of death on a death certificate, without having the slightest clue what the person actually died of? Who knows – for sure.

One thing I do know for sure is that, before 1948, you can forget looking at epidemiology for any answers, about anything to do with CVD. Now, you can argue this if you want, but I think the data are just too messy to rely on. In truth, you can probably forget anything before about 1960. Do you really think the entire worldwide medical community was suddenly diagnosing everything, in the same way, accurately, all of sudden, from 1948 onwards? If so, you need to go and lie down for a bit.

If you haven't already read Dr Kendrick's latest post and would like to the link is here:
https://drmalcolmkendrick.org/2016/06/19/what-causes-heart-disease-part-xvii/

All the best Jan

When I die it will be from "cholesterol" caused by eating too much fat and not enough starch for the last eleven years. The fifty preceding years of undiagnosed diabetes will go unnoticed, because, well, it was undiagnosed. And anyway it was only "a touch of prediabetes" and then it was only temporary since the diagnostic criteria were changed.

According to the PM, my mother died of a whole bunch of conditions, but because her A1c was "only" 6.4% diabetes wasn't one of them, despite running postprandial BG up to 11 - 15. Oh and that was only because of steroids - as if high BG/high insulin has no effects when caused by steroids.

Actually she died from being 95 and completely worn out. 

I suspect this is just the tip of the iceberg in diabetes NOT being involved in deaths from CVD. No doubt a whole bunch of other factors also still go unreported. Kendrick is doing a magnificent job in looking away from "cholesterol" and looking at the real causal factors.

Now even Malcolm Kendrick admits that this part took him a long time to write ...

What causes heart disease past XVIII

https://drmalcolmkendrick.org/2016/07/12/what-causes-heart-disease-past-xviii/

He's talking Mars Bars ... Red Pills ...even ' My evil twin brother who I have kept in the attic for the last twenty years, gnawing at the floorboards.'

There is a lot to read ...

All the best Jan

Grrr! I only just caught up with his previous post, and the comments, and I'm only halfway through 2011 on Dr Davis blog, and then there are all the other ones I'm not keeping up with. It's interesting how much common ground there is among all these bloggers, be they doctors, researchers or patients of numerous types, and how much it differs from what doctors are still being, well, indoctrinated in.

Well, you may have already seen it !!
But Malcolm Kendrick has another instalment out !

Yes, it's:

What causes heart disease part XVIIII

"Diet?

As I have written this series of blogs I have noted with interest the comments that people have come up with, and the discussions that have followed. It is interesting, though not unexpected, that almost everyone has focussed, almost entirely, on diet, and little else.

There are those who are utterly convinced that the cause of cardiovascular disease is a high carbohydrate diet. There are others who argue that this is not the case. There are also many who promote various dietary supplements, and vitamins and suchlike.

Within the mainstream, the discussions also seem to focus almost entirely on diet [and the effect diet has on cholesterol levels in the blood]. Over the years the ‘experts’ have moved on from cholesterol in the diet to saturated fat, to saturated/polyunsaturated ratios, to Omega-6 to Omega-3, to even or odd chained saturated and polyunsaturated fats… and on and on and on.

Sixty years ago Ancel Keys proposed the diet-heart hypothesis of cardiovascular disease. He started by stating that cholesterol in the diet raised cholesterol levels, which then cause cardiovascular disease. He ended up stating that saturated fat raised cholesterol levels and, well, you know that last bit. At least he only changed direction once.

Juhn Yudkin was Keys’ main rival in the diet-heart stakes. He stated that is was sugar in the diet that was the culprit. Unfortunately, Ancel Keys was a far better political operator and self-publicist. So he crushed Yudkin and won the argument. At least he won it for a while. Now, more and more people are saying that Yudkin was right all along.

Whatever you may think of Ancel Keys, and my thoughts should never be put down on paper without significant filtering out of swear words, he certainly managed to set the agenda for all discussions that followed. The agenda being that cardiovascular disease is caused by ‘something’ in the diet. Thus, diet has become playing field, and almost everyone fights here. It is this in the diet, not that. It is that, not this.

The problem I have here is that I do not believe that diet has much of a role to play in cardiovascular disease. There is evidence that vegetarians can live long, long and healthy lives. There is evidence that meat eater live long, long and healthy lives. In the West, we are eating more and more sugar and carbohydrate and the rate of cardiovascular disease falling. France maintains a very high saturated fat diet, and their rate of cardiovascular disease also falling.

I read the Blue Zones, which looked at people who live the longest, and I can see nothing whatsoever in the diet that links them together. Although the authors made various attempt to suggest that a vegetarian diet was healthy, the evidence does not stack up to support their assertions.

Of course I will be told that is not a simple as this. We need to look at sub-fractions of monounsaturated fats, or the glycaemic index, or grass fed this, or grain fed that or the specific impact of fructose on lipogenesis and insulin production…. On and on it goes. I sometimes feel that a complexity bomb has been thrown at CVD the purpose of which is to fractalise the debate.

Big fleas have little fleas,

Upon their backs to bite ’em,

And little fleas have lesser fleas,

and so, ad infinitum.

If there is anything, powerfully linking diet to cardiovascular disease, then I cannot see it. The only link that I can see is that people who eat a higher carbohydrate diet are more likely to become obese and develop diabetes. Or, perhaps I should say, develop diabetes and become obese. [A comment I may have to explain at some point].

As people who have diabetes are more likely to die of CVD then it seems highly sensible for those with diabetes to reduce carbohydrate consumption. This is also true of those who seem to be relatively intolerant to carbohydrates. Perhaps I should rephrase this as ‘people who tend to produce more insulin in response to diabetes.’

Blast, again here I am finding myself dragged into the diet debate. It seems impossible to release the discussion from this intellectual black hole. The meme is firmly entrenched. CVD is primarily to do with diet. Ancel Keys may be, posthumously, about to lose the argument on saturated fat However, he certainly succeeded in anchoring almost all discussions within the wider hypothesis that CVD is primarily due to diet.

It is not."

Article from here:
https://drmalcolmkendrick.org/2016/07/31/what-causes-heart-disease-part-xviiii/

... and sometimes it's good to go back and read the comments too

All the best Jan

The problem with all these gurus is they all have a different slant and contradict each other, even Kendrick contradicts himself.  I don't agree with some of the stuff Malcolm Kendrick puts out he seems to contradict Tim Noakes and Noakes appears to contradict Prof Ken Sakaris. Choosing a guru seems to me the equivalent of picking a lottery winner.
regards
Derek

There's a lot more commonality than differences IMO. The Neolithic Agents Of Disease include but are not limited to wheat, Omega 6 seed oils especially when laced with trans fats, sugar/HFCS etc. Delete them and health almost inevitably improves. You could say eat the exact opposite of what your dietician tells you.

I've seen from several sources that the "epidemic" of CVD appears to have come into being and then reduced again despite anything anyone has done or blamed. OTOH obesity, diabetes and a whole bunch of other "diseases of civilisation" have gone up and are still increasing.

chris c wrote:There's a lot more commonality than differences IMO. The Neolithic Agents Of Disease include but are not limited to wheat, Omega 6 seed oils especially when laced with trans fats, sugar/HFCS etc. Delete them and health almost inevitably improves. You could say eat the exact opposite of what your dietician tells you.

I've seen from several sources that the "epidemic" of CVD appears to have come into being and then reduced again despite anything anyone has done or blamed. OTOH obesity, diabetes and a whole bunch of other "diseases of civilisation" have gone up and are still increasing.

Hi Chris,
I think it is his last section where he claims diet has nothing to do with CVD. I found that a silly unsubstantiated claim.
What are we doing on a low carb diet and concerned about the balance of omega 6 and omega 3 oils etc etc?


I don't see a commonality there with other Low Carb luminaries or other authorities like Prof Tim Noakes and his latest video!
Derek

He may be right that diet doesn't "cause" CVD but it sure as hell is part of the "treatment". Remains to be seen if he is just being provocative in the face of the likes of William Davis who have had major results in reversing plaque through diet and supplements.

I have huge respect for Kendrick, but, although CV disease has many, shall we say trigger points, I believe diet has a huge impact. The very old cliche "we are what we eat" I believe is true. No-one proves this point better, than a type two diabetic. I will take a lot of convincing, a diet based on sugar/carbs/starch is not a major contributor to heart disease. Chuck in man made fats and you have a recipe for disaster.

I tend to agree, having discovered the likes of Joseph Kraft and Gerald Reaven and the effect of hyperinsulinemia quite apart from the effect of hyperglycemia, and more recent work on Omega 6 oils which backs up findings from long ago like the Rose Corn Oil Study, quite apart from the trans fats we were assured were "heart healthy". Waiting to see how Kendrick's contributors handle this . . .

Well Dr M Kendrick has been busy writing the next chapter - have you seen/read it yet?

What causes heart disease part XX

Stress/strain

When I started looking at cardiovascular disease I wondered why French people suffered far less than the Scots. I concluded, somewhat prematurely, that it was because the French ate food in a completely different way. They ate slowly, with the family, and food was an important part of life. Whereas, in Scotland, food was to be endured, not enjoyed. As scientific proof I would present Bovril and mince pie, at half time, at a Scottish football match.

When the French ate it was slowly, in a relaxed fashion. This allowed all the stress hormones, and all the nervous system involved in ‘flight or fight’ to settle down. So the French could digest and absorb food properly. Sugar levels would not spike; insulin would not spike. We would not have a battleground of cortisol and glucagon vs. insulin, and suchlike. Many animals after they have eaten simply find somewhere to go to sleep, to digest. Many humans just keep rushing about. Fast food indeed.

This brought me to led me to look at the overall concept of ‘stress’ in far more detail. Years and years later I have emerged – at times more confused than when I started. In the process I have fully embraced Einstein’s view that ‘Not everything that counts can be counted, and not everything that can be counted counts.’ I prefer it in the version. ‘Most things that can be measured don’t matter, and most things that matter cannot be measured.’ At one point this was my screensaver.

Stress fits well into this view of measurment. Stress certainly exists. Or perhaps to be more accurate ‘strain’ exists. In fact, both things exist, but measuring them… well, that it a trickier task. Which is one reason why medicine, obsessed as it is with ‘that which can be easily measured’, has tended to dismiss stress as a cause of anything. Focussing instead on blood pressure and cholesterol levels and blood sugar levels, and suchlike.

One thing I think I need to add at this point is to say that people do not actually suffer from stress, they suffer from strain. A subtle, but important difference. In that, two people can suffer exactly the same stress/stressor, yet react completely differently. One may feel strain, the other may not.

If, for example, two people are asked to stand up in front on an audience and give a talk. One person may dread this, the other may love the opportunity. They are both exposed to precisely same stressor, but the strains on the individual are diametrically opposed.

Extending this thinking somewhat, it became clear that stress, if indeed we should use this word at all, needs to be differentiated into, at least, four parts.

Lots more to read here
https://drmalcolmkendrick.org/2016/08/21/what-causes-heart-disease-part-xx/

I see where you are coming from Eddie; but the old adage 'We are what we eat', is often cited at the likes of us, carb sensitive 'fatties'. Because we are obese we must eat loads of fat. Well yes, I do now and I am losing weight. So maybe the confusion is because the word fat is a noun; and NOT an adjective!  What d'you reckon?

"Fat doesn't make you fat any more than vegetables make you green" Andreeas Eenfeldt.

I NEVER put on weight until after I saw a dietician who told me to stop eating things like avocados and nuts "because of all that fat" and replace them with even more carbs. She then accused me of "failing to comply" with the diet. Er, no, the diet was failing to comply with ME - and probably 2/3 of the population or more.

I'm somewhat leery of "stress" as a cause of anything, having spent most of my life being told all my symptoms were "psychiatric" in origin, or just plain made up. Strangely I stopped making them up when I stopped eating so many carbs, which were spiking my blood glucose, which was then spiking my insulin, which was then making my BG drop, which was causing the release of not only glucagon but cortisol, norepinephrine and epinephrine - "stress hormones". Once my BG fell into line a lot of my "stress", anxiety, neurosis, depression and "personality disorder" went away.

I suspect this is a big factor in "stress" - even nondiabetics eating too many carbs (probably "not diabetic yet" would be a better description) - who affect their BG causing spikes followed by drops do this.

Now to see what Kendrick says . . .

... and just in case you've not seen it!

What causes heart disease Part XXI is available to read now

Dr Kendrick starts with:

" Now, when I say that CVD is complicated, I suppose I mean it. Here is a slide that I have been pondering for a couple of weeks. "

... and his closing lines are

" Of course, I am also aware that many people will still be thinking ‘OK, this is all very well, and all very theoretical, but how do I avoid a heart attack. Give me the damned information.’

Ladies and gentlemen, I like to think that I am giving you the information. If not in exactly the form that everyone wants it. However, I promise that I shall try to lay it all out shortly – as well as I am able.

However, I can give you no absolutes. I can only help you change the odds in your favour. I do not have perfect knowledge, even if I did, the human body is still too complex (and maybe always will be) to state that ‘If you do this you cannot have a stroke, or heart attack.’

After all, whist it is an incontrovertible fact that smoking causes lung cancer, yet you can smoke all you like and never get lung cancer. On the other hand, you can never smoke, and still get lung cancer. I am equally certain that you can do everything possible to avoid CVD and still die of a stroke or heart attack. Equally, you can do everything wrong and stay CVD event free. The Gods do like to play dice with us feeble humans."

Full article is here:

https://drmalcolmkendrick.org/2016/09/21/what-causes-heart-disease-part-xxi/

It makes me wonder what may be coming next time?

All the best Jan

Fat and Cholesterol Don’t Cause Heart Attacks

There is a group of doctors, scientists and researchers called the International Network of Cholesterol Skeptics (THINCS) www.thincs.org. I am a member, and recently a number of us have contributed chapters to a new book called Fat and Cholesterol Don’t Cause Heart Attacks And Statins are Not the Solution.

This was written in honour of the founder of THINCS, Uffe Ravnskov, a Swedish doctor and researcher who has been arguing against the current die-heart/cholesterol hypothesis for many years. He has written several books, many, many, research papers, and had the dubious honour of having one of his book burned, live, on television. [Finland 1992, the book was The Cholesterol Myths]. He has also been ruthlessly attacked, both professionally and personally. Yet he has never given up.

Ravnskov, like all of us in THINCS, started looking at heart disease, or cardiovascular disease (CVD) and recognised that the widely accepted views were simply wrong. Something recognised by many people over the years, including Professor George Mann (who helped to start up and run the Framingham study).

‘Saturated fat and cholesterol in the diet are not the cause of coronary heart disease. That myth is the greatest scientific deception of this century, perhaps of any century.’

George Mann, like many others was silenced. Kilmer McCully, who discovered the role of homocysteine in CVD, and suggested that it could be more important that cholesterol was also attacked. Funding for his research disappeared, leading to the loss of his laboratory. His hospital director told him to leave and ‘never come back’. His Harvard affiliation and tenure were terminated.

Another contributor to this book, Professor Michel De Logeril, set up and ran the seminal Lyon Heart Health Study. Possibly the seminal work on the ‘Mediterranean Diet.’ Yet he is a trenchant critic of the diet-heart hypothesis, and believes that statins do more harm than good. He is, again, attacked ruthlessly.

Yes, there is a pattern here. Dare to criticise the current dogma that saturated fat in the diet raises cholesterol, which then goes on to cause CVD, and your chances of progression in the research world are, precisely, zero. Your chances of getting anything published are, pretty close to zero. You will be attacked both personally and professionally. You will be accused of killing thousands of people by putting them of taking statins – and suchlike.

However, those in THINCS have never given up in their efforts to get the ‘truth out there’ and never will. This book is a further way to help inform the public about the true facts. There are chapters on competing hypotheses as to the cause(s) of CVD, there are chapters outlining the flaws in the current ideas. Some chapters are technical, others not.

Everything is held together by Paul Rosch, a brilliant researcher, writer and editor, clinical professor of Medicine and Psychiatry and New York Medical College, Chairman of the Board of the American Institute of Stress, and a great, deep thinker, on many subjects. Would that there were more like him.

All words and picture taken from here
https://drmalcolmkendrick.org/

All the best Jan

You may have already seen Malcolm Kendricks latest about what causes heart disease.

He starts:
"In my long and winding road around cardiovascular disease I have often visited the same themes a few times. In part, this is because we are not dealing with Newtonian physics here. If billiard ball A strikes billiard ball B, at five metres per second, at an angle of 45 degrees, billiard ball B will move off at angle C at velocity D, assuming perfect elasticity. This will always happen, every single time.
On the other hand, with CVD, the complexity of human physiology and psychology, environmental factors, genetics the time of day, even sunspot activity – can have an effect – so some people have reported."

A lot in between ...

Then finishes

"So, what do we know?

A high level of Lp(a) is associated with a higher risk of CVD.
There is a probable causal mechanism linking Lp(a) to CVD death
Lp(a) is synthesized in animals that cannot make their own Vitamin C
A lack of vitamin C causes blood vessels to crack open – and potentially leads to atherosclerotic plaques development
Animal models have shown that a lack of vitamin C does lead to rapid atherosclerotic plaque development, and that replacement of vitamin C causes rapid regression of atherosclerosis
Some evidence from humans suggest that vitamin C supplementation causes regression of atherosclerotic plaques
Vitamin C supplementation does seem to lead to a reduction in Lp(a) levels
L-carnitine supplementation does lead to a reduction in Lp(a) levels
L-carnitine supplementation may reduce overall mortality.

What would I now recommend? If you have a high Lp(a) level take lots of vitamin C and l-carnitine and see if your Lp(a) level falls. If it does, keep taking lots of vitamin C and l-carnitine for the rest of your life. If it does not fall? Not sure.

As for the rest of us? Well I have no idea how much vitamin C anyone should take, or how much l-carnitine is required. There is literally no area of medicine that is less clear than our true vitamin requirements. You can find a thousand shouty people supporting high vitamin supplementation – any or all vitamins.

My view. I do not think the RDAs for vitamins are remotely accurate, or useful. They were established in times of absolute deficiency. The agreed Vitamin B12 levels, for example, were based on seven people, over sixty years ago, and remain unchanged to this day. All seven had pernicious anaemia (caused by vitamin B12 deficiency).

So, I do not believe in the RDAs at all. They are often, I believe, too low for optimal health. I can see no harm coming to people from taking lots of vitamin C or lots of l-carnitine. So, supplement away. You will probably reduce your risk of dying from CVD"

More here https://drmalcolmkendrick.org/2017/01/16/what-causes-heart-disease-part-xxiv/

All the best Jan

Does anyone here take niacin? D.