What are the causes of CVD
The Clot Thickens: The Enduring Mystery of Heart Disease
By Dr. Malcolm Kendrick
Columbus Publishing Ltd
In this Scottish physician’s quest to find the true cause of atherosclerosis or cardiovascular disease (CVD), Dr. Malcolm Kendrick slogs through a multitude of dry, peer-reviewed studies and distills their findings with wonky humor. The title smacks of his humor as well as literary finesse. Throughout, Dr. Kendrick decries the insanity of the medical cartel, the pharmaceutical industry’s stranglehold and the culture that allows them to flourish. Amazingly, considering the subject matter, there is much that is celebratory in this book, including laugh-out-loud one-liners that could qualify for stand-up comedy.
Kendrick uses three constructs to guide the “gentle reader”: Rejecting Rubbish, then thoroughly Parsing the Process, and finally, Acknowledging the Axis—the essence of it all. First, he recalls that when he was at a tender age, his father tore a page from a math book, describing it as “Rubbish.” Kendrick then takes the reader through many such piles of rubbish in the scientific world, such as the work of Ancel Keys, who “jumped to the top of Mount Assumption” and “returned with a tablet of stone with the words ‘saturate and fat carved.’” He refers to “monumental stupidity in the conclusions when science and politics mingle”—where theory is derived from complete and total lack of evidence. Kendrick asks, “Who cares if saturated fats raise cholesterol if cholesterol doesn’t cause cardiovascular disease?” He surmises that Keys was a “bumbling fool, a misguided buffoon,” while starting a small, secret club of cholesterol deniers consisting of himself.
Regarding one heart disease study, Kendrick mentions that researchers studied people over age sixty, noting that studying “20-40 year olds is almost completely pointless, because almost no-one dies of heart disease in this age group.” (One wonders if investigators would make that same statement in 2022?)
There is no need to belabor the subject of cholesterol here, but Kendrick critiques many of those who have nailed cholesterol as the demon for CVD. He cites a study in Norway that gathered data from over fifty thousand people for over ten years—representing over half a million years of observation. He says, “For women, the higher the cholesterol level, the longer they lived. They also suffered far less cardiovascular disease.” For the purposes of getting published, the researchers softened this blow to dogma. Their understatement: “moderately elevated cholesterol may prove to be not only harmless but even beneficial.” The number that the Norwegian researchers deemed “moderately elevated” would now be classified as familial hypercholesterolemia. One might wager a guess as to what the prescribed solution would be.
Kendrick muses that cholesterol is cast as the “chemical of doom,” but low cholesterol has resulted in “nasty things [such] as “microcephaly. . . mental retardation, heart defects, fused toes, extra fingers, underdeveloped genitals in males, early death.” This leads him to proclaim, “you certainly need your cholesterol.” Cholesterol, he also opines, is one of two “unbelievably touchy” topics in the medical literature (the other, even touchier, being vaccines). Dr. Uffe Ravnskov’s book on the cholesterol scam, The Cholesterol Myths, was essentially torched due to this “touchiness.” This motivated Dr. Ravnskov to found a group called THINCS (The International Network of Cholesterol Skeptics) as a forum for like-minded thinkers.
Twice, the THINCS group gathered data and published reports in the journal BMJ Open, once in 2016 and again in 2018. The authors carefully stripped their articles of any emotion as they cited the data proclaiming the total lack of evidence supporting cholesterol’s role in CVD. Although these pieces were widely read, there was no discernible impact on health care.
In light of the raging debate about proposed causes of CVD, and after enduring two years of Covid controversies, this quote from Leo Tolstoy seems too pertinent not to include here: “The most difficult subjects can be explained to the most slow-witted man if he has not formed any idea of them already; but the simplest thing cannot be made clear to the most intelligent man if he is firmly persuaded that he knows already, without a shadow of doubt, what is laid before him.”
Because facts do not change perceptions, Kendrick hoped that maybe an attractive alternative hypothesis might do so, and he reviews several. For example, some heart researchers have suggested that bacteria found in “fatty streaks” (considered the first visible sign of atherosclerosis) cause CVD—possibly the rise and fall of CVD is from an infectious disease? However, a risk calculator in the UK called QRISK3, which calculates a person’s risk of developing a heart attack or stroke within ten years, lists twenty factors involved in CVD, and infectious disease is not associated with most of them.
Transitioning to his Parsing the Process construct, Kendrick then asks, could the way to study CVD be to focus on the process rather than the cause—a gestalt approach? He posits that atherosclerosis is, in fact, a process—a series of clots forming and resolving; this enlightening perspective leads him to his “attractive competing hypothesis.” To describe this hypothesis, he likens the CVD process to potholes in a highway; multiple factors contribute to them but there is no single cause. He describes how each of various risk factors contributes to the demise of the thinnest, most fragile tissue in the body—the epithelium—which he considers an organ in and of itself. In his view, the importance of the epithelium cannot be overstated because it supports every bodily function. The exquisite relationship between our health and the health of our epithelial tissue determines how long and how well we will live.
Of the many rabbit holes Kendrick unearths, one of the most intriguing is that mental illness is a significant risk factor for CVD. Turning to “the Axis,” he describes how stress—and more accurately, strain—results in alteration of pituitary size and function. This alters the hypothalamic-pituitary-adrenal (HPA) axis, contributing to CVD by sabotaging the endothelial tissue, compromising the ability to form nitric oxide (NO). NO lowers blood pressure, helps prevent blood clots and improves insulin sensitivity. It is also calming. As Kendrick says, “I don’t think it is an exaggeration to say that nitric oxide is the single most important molecule for cardiovascular health there is. Thus, anything interfering with its production will increase the risk of CVD.”
How can we make more of this good stuff? Breathe through your nose! Get in the sunshine! (For Kendrick, avoiding the sun is akin to smoking as regards risk of CVD.) Take Viagra—just kidding on that one—but you’ll learn interesting tidbits about Viagra and nitric oxide when you read the book.
Ultimately, the HPA axis makes the difference between a great day and a bad day. We can profoundly hijack our health with anger, regret and other energy-sucking emotions, or we can take Kendrick’s advice: “Learn the process; Guard your HPA; Be happy.”
One parting quote here: “Kill one man, go to jail. Kill thousands and they make you a king.” No finger-pointing here. . . but there are two thumbs up for this book.
This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly journal of the Weston A. Price Foundation, Summer 2022🖨️ Print post