Sept. 2, 2019

Scottish doctor, writer, speaker, and outspoken cholesterol sceptic Malcolm Kendrick is back on the podcast this week. He continues to challenge the widespread use of statin medications, despite being targeted personally and professionally by those opposing his message. Since we last talked he has authored a new book, A Statin Nation: Damaging Millions in a Brave New Post-health World, elucidating his position against mainstream medicine’s rampant cholesterol-lowering tactics. 

On this podcast, Dr. Kendrick describes in detail exactly what he believes drives the process of cardiovascular disease, informed from 35 years of research on the subject.  He explains specifically why cholesterol has been misunderstood, and how medicine got it wrong. We discuss corruption in medical research and the money supporting the status quo, and Dr. Kendrick shares some of the best ways to avoid heart disease (which have little to do with diet!).

Here’s the outline of this interview with Malcolm Kendrick:

[00:00:07] Our first podcast with Malcolm Kendrick: Why Cholesterol Levels Have No Effect on Cardiovascular Disease (And Things to Think about Instead).

[00:00:30] Book: A Statin Nation: Damaging Millions in a Brave New Post-health World, by Dr. Malcolm Kendrick. His previous two books: Doctoring Data and The Cholesterol Con.

[00:02:00] Causes vs processes.

[00:03:40] History behind his journey and questioning authority.

[00:07:30] Articles written by Elspeth Smith.

[00:09:00] Karl Rokitansky’s paper discussing an alternative way of looking at CVD: A manual of pathological anatomy, Vol. 4. Day GE, trans. London: Sydenham Society, 1852:261; in print here.

[00:09:06] Rudolf Virchow, researcher who pointed to cholesterol in artery walls.

[00:10:55] Researcher Nikolai N. Anichkov: fed rabbits a high-cholesterol diet and cholesterol appeared in their arteries (sort of).

[00:12:07] Ancel Keys; blaming saturated fat.

[00:14:11] France - highest saturated fat consumption, lowest rate of CVD. Georgia - lowest sat fat consumption, highest rate of CVD.  See graph, here.

[00:15:16] International Network of Cholesterol Skeptics (THINCS). Study: Ravnskov, Uffe, et al. "Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review." BMJ open 6.6 (2016): e010401.

[00:16:50] Pleiotropic effects of statins.

[00:17:29] Movie: 12 Angry Men (1957).

[00:20:30] Robert Ross - response to injury hypothesis; Study: Ross, Russell, John Glomset, and Laurence Harker. "Response to injury and atherogenesis." The American journal of pathology 86.3 (1977): 675.

[00:20:40] TV show: Stranger Things.

[00:22:31] Infectious disease hypothesis.

[00:22:52] Analogy of rust in the paint of a car; Sickle Cell Disease as an example.

[00:27:12] 14-year old boy with Sickle Cell and atherosclerosis; Study: Elsharawy, M. A., and K. M. Moghazy. "Peripheral arterial lesions in patient with sickle cell disease." EJVES Extra 14.2 (2007): 15-18.

[00:28:57] Endothelial progenitor cells, produced in the bone marrow, discovered in 1997.

[00:29:31] Pig study of endothelial turnover: Caplan, Bernard A., and Colin J. Schwartz. "Increased endothelial cell turnover in areas of in vivo Evans Blue uptake in the pig aorta." Atherosclerosis 17.3 (1973): 401-417.

[00:31:48] Vitamin C's role in maintaining collagen and blood vessels.

[00:33:08] Lp(a) molecules - patching cracks in the artery walls.

[00:33:42] Depriving guinea pigs of vitamin C caused atherosclerosis; Study: Willis, G. C. "The reversibility of atherosclerosis." Canadian Medical Association Journal 77.2 (1957): 106.

[00:34:24] Linus Pauling - said CVD was caused by chronic low-level vitamin C deficiency.

[00:35:53] What else damages endothelial cells? Many things, including smoking, air pollution, high blood sugar, Kawasaki disease, sepsis/infection.

[00:41:19] Glycocalyx; Nitric oxide.

[00:43:30] Health benefits of sun exposure.

[00:44:26] Biomechanical stress (blood pressure) - atherosclerosis in arteries but not in veins.

[00:47:57] Things that interfere with repair: steroids, vascular endothelial growth factor (VEGF) inhibitors.

[00:55:00] The effects of stress on the cardiovascular system.

[00:57:55] Red blood cells are what brings cholesterol into blood clots.

[00:58:59] Cholesterol crystals in atherosclerotic plaques come from red blood cells. Study: Kolodgie, Frank D., et al. "Intraplaque hemorrhage and progression of coronary atheroma." New England Journal of Medicine 349.24 (2003): 2316-2325.

[01:00:55] Very low-density lipoproteins (VLDLs) are procoagulant; High-density lipoprotein (HDL) is anticoagulant.

[01:03:46] Familial hypercholesterolemia (FH); Factor VIII.

[01:08:15] Cholesterol-lowering pharmaceuticals; Repatha. In the clinical trial, the total number of cardiovascular deaths was greater in the Repatha group than the placebo group. Study: Sabatine, Marc S., et al. "Evolocumab and clinical outcomes in patients with cardiovascular disease." New England Journal of Medicine 376.18 (2017): 1713-1722.

[01:09:34] David Deamer, biologist and Research Professor of Biomolecular Engineering.

[01:10:05] Karl Popper, philosopher.

[01:10:28] Bradford Hill’s Criteria for Causation.

[01:13:52] Michael Mosley, BBC journalist.

[01:16:40] Statin denialism - an internet cult with deadly consequences?

[01:19:18] The money behind the statin and low-fat industries.

[01:20:06] Margarine; Trans-fatty acids, banned in several countries.

[01:24:37] The impact of food; The focus on food to the exclusion of other pillars of health.

[01:26:38] Dr. Phil Hammond; CLANGERS

[01:28:21] Avoiding internet attacks.

[01:32:00] ApoA-1 Milano. Original study: Nissen, Steven E., et al. "Effect of recombinant ApoA-I Milano on coronary atherosclerosis in patients with acute coronary syndromes: a randomized controlled trial." Jama 290.17 (2003): 2292-2300.

[01:33:05] The Heart Protection (HPS) Study in the UK: Heart Protection Study Collaborative Group. "MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebo controlled trial." The Lancet 360.9326 (2002): 7-22.

[01:33:36]  Scandinavian Simvastatin Survival Study (4S) Scandinavian Simvastatin Survival Study Group. "Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S)." The Lancet 344.8934 (1994): 1383-1389.

[01:33:49] West of Scotland Coronary Prevention Study (WOSCOPS): Shepherd, James, et al. "Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia." New England Journal of Medicine 333.20 (1995): 1301-1308.

[01:34:21] National Institute of Health’s ALLHAT-LLT trial: Officers, A. L. L. H. A. T. "Coordinators for the ALLHAT Collaborative Research Group: Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs. usual care: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT)." JAMA 288.23 (2002): 2998-3007.

[01:34:50] 2005 - Regulations guiding clinical trials changed.

[01:35:14] Negative antidepressant studies not published; Study: Turner, Erick H., et al. "Selective publication of antidepressant trials and its influence on apparent efficacy." New England Journal of Medicine 358.3 (2008): 252-260.

[01:37:11] Minnesota Coronary Experiment (MCE): Analysis of recovered data: Ramsden, Christopher E., et al. "Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73)." bmj 353 (2016): i1246.

[01:39:44] Why Most Published Research Findings Are False: Ioannidis, John PA. "Why most published research findings are false." PLoS medicine 2.8 (2005): e124.

[01:39:55] Richard Horton, editor of the Lancet: half of what is published is not true: Horton, Richard. "Offline: What is medicine’s 5 sigma." Lancet 385.9976 (2015): 1380.

[01:41:11] The problem with reproducibility; a database of clinical trials that cannot be challenged or reproduced.

[01:42:37] Editors of prominent journals losing faith in published research: Marci Angell, Richard Smith

[01:44:55] Parachute study: Yeh, Robert W., et al. "Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial." bmj 363 (2018): k5094.

[01:46:01] Benefits that are major are obvious; no randomized clinical trial necessary.

[01:48:33] Preventing vs. screening.

[01:51:42] Podcast: Movement Analysis and Breathing Strategies for Pain Relief and Improved Performance with physical therapist Zac Cupples.

[01:51:59] Analysis of women who died in various ways, examining breast tissue; found that a high % of women had what you could diagnose as breast cancer. Study: Bhathal, P. S., et al. "Frequency of benign and malignant breast lesions in 207 consecutive autopsies in Australian women." British journal of cancer 51.2 (1985): 271.

[01:53:34] Screening programs not associated with reduced CVD or death; Study: Krogsbøll, Lasse T., et al. "General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis." Bmj 345 (2012): e7191.

[01:54:26] Coronary Artery Calcium (CAC) scan. Podcast: Coronary Artery Calcium (CAC): A Direct Measure of Cardiovascular Disease Risk, with Ivor Cummins.

[01:54:46] Cardiologist Bernard Lown

[01:58:38] People who had measles/mumps less likely to get CVD; Study: Kubota, Yasuhiko, et al. "Association of measles and mumps with cardiovascular disease: The Japan Collaborative Cohort (JACC) study." Atherosclerosis 241.2 (2015): 682-686.

[02:00:55] Life expectancy in US and UK is now falling.

[02:06:46] Physical health doesn't exist without social health and psychological health.

[02:07:40] Negative Twitter messages correlate with rates of heart disease; Study: Eichstaedt, Johannes C., et al. "Psychological language on Twitter predicts county-level heart disease mortality." Psychological science 26.2 (2015): 159-169.

[02:09:58] People who take statins believe they’re protected so they stop exercising. Study: Lee, David SH, et al. "Statins and physical activity in older men: the osteoporotic fractures in men study." JAMA internal medicine 174.8 (2014): 1263-1270.

[02:11:45] Simple changes: make friends, have good relationships, speak to your kids, exercise, eat natural food, sunshine.

[02:16:53] Blood sugar measurements following funny lecture vs. boring lecture; Study: Hayashi, Keiko, et al. "Laughter lowered the increase in postprandial blood glucose." Diabetes care 26.5 (2003): 1651-1652.

[02:18:08] Dr. Malcolm Kendrick’s blog.

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