I read Dr. Malcolm Kendrik’s book The Great Cholesterol Con in the UK-published edition several months ago, but have waited until now to review it because I was waiting to get the copy I had ordered from Amazon.com in the US to compare. Unfortunately, the version that Amazon.com sent me after three months of waiting was the same UK edition that I already had. Apparently the book hasn’t been picked up and published by a US publisher. More is the pity because the UK publisher did a sorry job on what is a truly wonderful book.
Dr. Kendrick’s writing style is accessible, humorous and to the point. He slashes and burns the diet/cholesterol/heart hypothesis in easy-to-understand terms and with great verve. I didn’t really find much in the first part of the book that I disagreed with except for one little throw away sentence about prions causing mad cow disease. I’m one of those folks who just don’t buy that entire premise, so Dr. Kendrick’s referring to it as established medical fact was a little jarring. Other than that one false note, I was completely engrossed in the book. As anyone who reads this blog knows, Dr. Kendrick was preaching to the choir with me, but the choir certainly enjoyed it.
I’m going to excerpt a fairly long section for a couple of reasons, one of which is totally self serving. First, I want you to get the feel for Dr. Kendrick’s writing style, and second, I’ve been wanting to write a section on this blog about ad-hoc hypotheses for a while so that I could link back to it and not have to explain the term each time I write about it. Dr. Kendrick has done it perfectly, so I’ll simply link back to this post and let him do all the work.
Here is Dr. Kendrick on the ad-hoc hypothesis
But there is no evidence that any of these three factors [he’s just been talking about how people claim that garlic, red wine, and lightly cooked vegetables are protective against heart disease] are actually protective. NONE. By evidence, I mean a randomized, controlled clinical study. Not epidemiology, meta-analysis, discussions with French wine producers or green-leaf tea growers, or a trawl through the Fortean Times. In reality, the only reason that these three factors appeared was to protect the diet-heart hypothesis. They are what Karl Popper would call ‘ad-hoc hypotheses,’ which are devices that scientists use to explain away apparent contradictions to much-loved hypotheses.
Ad-hoc hypotheses work along the following lines. You find a population with a low-saturated-fat intake (and a few other classical risk factors for heart disease) – yet, annoyingly, they still have a very high rate of heart disease. One such population would be Emigrant Asian Indians in the UK. The ad-hoc hypothesis used to explain away their very high rate of heart disease is as follows. Emigrant Asian Indians are genetically predisposed to develop diabetes, which then leads to heart disease. Alakazoom! The paradox disappears.
On the other hand, if you find a population with a high-saturated-fat intake, and a low rate of heart disease, e.g. the Inuit, you can always find something they do that explains why they are protected. In their case it was the high consumption of Omega 3 fatty acids from fish. Yes, indeedy, this is where that particular substance first found fame, and hasn’t it done well since?
This particular game has no end. In 1981, a paper was published in Atherosclerosis (a crackling good read), outlining 246 factors that had been identified in various studies as having an influence in heart disease. Some were protective, some causal, some were both at the same time. If this exercise were done today I can guarantee you would find well over a thousand different factors implicated in some way. Recently, just to take one example, someone suggested that the much lower rate of heart disease in south-west France, compared to north-east France, was because the saturated fat they ate was different. In the south-west they ate more pork fat and less beef fat. So now it is no longer simply saturated fat that is deadly, it is the precise type of saturated fat, in precise proportions. Just how finely can one hypothesis be sliced before it becomes thin air?
What this highlights, to me at least, is one simple fact. Once someone decided that saturated fat causes heart disease, then NOTHING will change their minds. There is no evidence that cannot be dismissed in one way or another. And there is also no end to the development of new ad-hoc hypotheses. You can just keep plucking them out of the air endlessly – no proof required.
Genetic predisposition is one of the most commonly used ‘explain-all’ ad-hoc hypotheses, and it is a particular bug-bear of mine. Someone I knew quite well had a heart attack recently, aged 36. He was very fit, almost to international level at cycling. He was also extremely thin. His resting pulse was 50 a minute, his blood pressure was 120/70 (bang on normal). His total cholesterol level was 3.0 mmol/l, which is very low [116 mg/dL, very low indeed]. He was vegetarian and a non-smoker. I know what you’re thinking: he deserved it. Steady, he’s a nice bloke, actually, if a bit worthy.
Now, you can go through all the risk factors tables produced by the American Heart Association, the European Society of Cardiology and the British Heart Foundation – and any other cardiology society you care to mention. According to the lot of them, he had no risk factors. Therefore, he should not have had a heart attack. However, it did emerge that his father had a heart attack aged 50. A-ha! He was genetically susceptible, then! Phew, there’s your answer. I beg to differ: if you think about this in any depth, it is a completely idiotic statement to make.
If someone is genetically susceptible to heart disease, that susceptibility must operate through some identifiable mechanism. Or does a big finger suddenly appear from the sky and go: ‘Pow! Heart attack time, bad luck.’ Genetically susceptible people don’t need high LDL levels or high blood pressure. They don’t need to smoke or eat a high-fat diet. They don’t need to be overweight or have diabetes – or anything, actually. They are felled by a mysterious genetic force, operating in a way that no one can detect.
Other people are killed by risk factors. But such factors count for nothing if you are genetically susceptible. I have one word to say to this – and it’s a word I’ve used before in a similar context. Balls.
The entire book is written in this engaging style and I found myself laughing out loud often. In fact as I was reading late one night I woke MD from a sound sleep with my laughter. The book is that funny in places.
Funny, but accurate in its laying waste to the idea that fat in general and saturated fat in particular have anything to do with heart disease. Dr. Kendrick has pretty much the same take as I do on the statin issue. He has a chapter detailing all the hoopla the drug companies put out and the reality, which is that statins work only for a very few people. He even mentions our old friend Dr. John Reckless.
The latter part of the book is an elaboration of what Dr. Kendrick believes is the driving force behind heart disease: stress. I hadn’t given stress a whole lot of thought until I read this book. Now I am reconsidering it as a major risk factor and working it in to my own ideas of what causes so much heart disease.
I really can’t recommend this book strongly enough.
That’s the good. Now let’s look at the bad.
First, the book has been terribly edited. The excerpt I printed above includes a number of corrections I made on the fly. Whoever edited the book hasn’t a clue about the proper placement of commas and other punctuation. There are spelling mistakes throughout, one of which is in a chapter title. The wonderful chapter on statins is titled: What are stains and how do they work? When your editor can’t even catch a spelling error in the boldfaced font of a chapter title, you know you’re in trouble.
Next, the book doesn’t have an index, which is a major failing as far as I’m concerned. There is so much good information in the book and no way to look it up other than thumbing through the book looking for it.
Since the book is published in the UK, the units used to describe cholesterol levels are different than what people in the US are used to seeing. In the UK (and in most everywhere but the US) cholesterol units are described as mmol/l, which are pronounced milli moles per liter. In the US cholesterol is usually labeled as mg/dL, milligrams per deciliter. To convert the mmol/l you find in the book to the mg/dL you’re used to seeing, multiply the mmol/l by 39 (38.67 to be exact).
Finally, there is no bibliography, no list of citations or references. This is not a fatal failing because most people probably won’t track the references down, but it makes it a real pain if one wants to. I’m familiar with most of the papers he refers to so it wasn’t a huge handicap to me, but is still a pain. I’m pretty skilled at running the articles to earth that he mentions by author’s name or other identifying info, but others not as skilled could have real problems should they want to read the actual scientific research cited.
This last problem I understand because none of our books have a bibliography through no fault of our own. MD and I turned in manuscripts that were longer than the publishers had anticipated, so they cut the bibliographies in both Protein Power and the Protein Power LifePlan. It was either that or cut information from the text and they opted to keep the text. Maybe something like that happened to Dr. Kendrick.
So how do you get your hands on this terrific book?
You’ve got a number of choices depending upon how long you want to wait and how much you’re willing to spend. You can order a new copy through Amazon.com, which at this writing projects a wait of from 3 to 5 weeks before delivery. (I’m sure Amazon gets it from the UK then sends it to you. It said 3 to 5 weeks when I ordered mine, but it took 3 months.) If you order through Amazon.com it will cost you $11.53 plus shipping. You can order it through the used book section of Amazon.com for anywhere from $11.07 to $34.80. (As of this writing there are 9 used copies available.) Or you can do as I did and order through Amazon.co.uk, the UK version of Amazon.com. I order books all the time through Amazon.co.uk. It works just the same as the domestic version, Amazon.com. You can set up an account and order just as you do through Amazon.com. The prices are in pounds and the shipping is outrageous. I usually combine a bunch of books to minimize the shipping, but it’s still horrendous. If you order Dr. Kendrick’s book through Amazon.co.uk you will pay about $12 for the book and $10 or so for shipping, but you will get a brand new copy in about a week.
However you have to do it, I recommend that you add this book to your collection.