Scottish GP Dr Malcolm Kendrick says there is good reason that the Inuit of Canada had frequent nosebleeds but zero heart disease. Kendrick is an author and a sceptic. He has also studied cardiovascular disease for decades.

Thus, he knows as much, if not more, about heart disease than many cardiologists. He knows all the theories of causes and best treatment options.

Consequently, he is no fan of cholesterol-lowering drugs called statins. Kendrick wroteThe Great Cholesterol Con. If you haven’t read it, I advise you to do so now for your heart’s sake. Here’s why Kendrick says that the diet-heart and lipid hypotheses are ‘the perfect shapeshifters’.  – Marika Sboros

By Malcolm Kendrick

I have been studying heart disease for many, many, years now and I have read hundreds of different hypotheses as to what causes it. When I say heart disease, I mean the build-up of atherosclerotic plaques (narrowings) in the arteries.

Dr Malcolm Kendrick

This can happen in the heart, the blood vessels leading to the brain, the aorta, the femoral arteries etc, etc. Usually followed by the formation of a blood clot over the plaque – leading to death.

I have read a hundred theories as to why this happens. From infective agents to lack of micronutrients, to stress, copper deficiency and on and on. I have read theories suggesting that plaques are actually healthy adaptations. And  that heart attacks happen before the blood clot blocks arteries, causing the heart attack.

That atherosclerosis has nothing to do with dying of heart disease. Thus, the Japanese, with a very low rate of heart disease, are just as likely to have atherosclerosis as anyone else.

In amongst this cacophony, I have searched for the one factor that is consistent, and I have found nothing. Yes, mainstream medicine still fixates on the LDL/cholesterol hypothesis. But it is perfectly simple to find populations with low LDL/cholesterol levels and stratospheric rates of heart disease.

Russians and Australian aboriginals spring to mind. Equally, you can find populations with high LDL/cholesterol levels and very low rates of heart disease, e.g. the Swiss or the French.

This leads us to the concept of necessary and/or sufficient. By this I mean a factor may be necessary for a disease to develop. Yet that factor cannot cause the disease alone. Koch demonstrated this by drinking water full of the cholera bacillus. He did not get cholera because he was otherwise fit and healthy. He stated that a healthy person could fight off cholera but if you were unhealthy it could kill you.

Click here to read: Teicholz: how low-fat diets can kill you


Thus, the cholera bacillus is “necessary” to get cholera, but not “sufficient” – on its own. Something needs to compromise the host in some way.

So, have researchers identified any “necessary” if not “sufficient” factors for heart disease? The answer is quite clearly no. Many people have died of heart disease without a single identified risk factor. In short, there is no single factor that is necessary, or sufficient, to cause heart disease.

Malcolm KendrickThis is why doctors now consider heart disease  “multifactorial”. It has many different causes that all, sort of, act together – in some yet to be fully defined way. Whilst this must be true, to a certain extent, the concept of multifactorial allows anyone to say virtually anything. It also means that nothing can either be proved, or disproved.

A skeptic: “Here is a population with a low LDL/cholesterol level and a high rate of heart disease.”

An expert: “Ah, that is because they have a low HDL level, they lightly cook their vegetables, they have a Mediterranean diet, they drink red wine, they [insert any one of 300 different factors here].”

This type of discussion becomes utterly pointless after a while. You cannot, ever, get anywhere. It is like attacking the Hydra:  chop one head off and another two grow.

Which is why we now have just to look at blood lipids: good cholesterol, bad cholesterol, small and dense bad cholesterol, lightly and fluffy bad cholesterol, the good/bad cholesterol ratio.

Also, “dyslipidaemia” high triglycerides, LDL particle number, and on and on. Try pinning anything down and it simply fragments in front of your eyes.

Currently, you cannot disprove the LDL/cholesterol hypothesis as it has become the perfect shapeshifter.

Which means that I decided many years ago not to waste my time on attempting to argue against the LDL/cholesterol hypothesis too often, and pointlessly. Instead, I searched for the factor that is necessary to cause heart disease.

The factor that is consistent, where there are no contradictions. No need for adaptations, additions, sub-theories, sub-sub-theories.

I have to report that I never found one. Yes, it is true. There is no single factor that is either necessary or sufficient, to cause heart disease. None. Or at least none yet identified. In truth, I do not think that such a factor ever will be found. Actually, I am certain that this will be so.

The reality is that you have to move away from causal factors and start thinking about processes. Here, I believe, is where the answers lie.

When you start thinking about process, you can understand why the Eskimos suffer a lot of nose bleeds and had (when eating their traditional diets), a rate of heart disease that was….zero.

You can also understand why warfarin – an anticoagulant – protects against strokes, but does not protect against heart attacks. Whereas aspirin, which is also an anticoagulant, primarily protects against heart disease.

Yes, Eskimos, nosebleeds and heart disease. And yes, I do know that they are now called Inuit. But I still like Eskimo as it conjures up positive images in my brain.

PS: A small prize for anyone who can correctly answer the warfarin/aspirin conundrum.