The Clot Thickens: - Book Review


FOTCM Member
This book, The Clot Thickens: The enduring mystery of heart disease (Columbus Publishing, 2021) by Dr Patrick Kendrick, was mentioned in an article (Blood Clots may be the Root Cause of all Heart Disease) by Dr Mercola, which also included a video of the author discussing how this may be the case and some simple strategies for lowering the risk of heart disease).

As the title suggests, it is a detective story: to solve the mystery of the cause, or causes, of heart disease. The author has been obsessed with solving this mystery for the past 30 years. He has followed lead after lead in his search, knocking each back with a genuine scientific search for the truth. The usual suspect – saturate fat (lipid hypothesis) was quickly knocked down. Like all good detective novels, it was a chance remark that gave him his breakthrough, that put him on the right track: that was to forget about cause and look at the process, itself, by which heart disease forms. Then everything fell into place. He makes a formidable case for the true culprit being the thrombogenic (blood clotting as the start point) hypothesis as the perpetrator for all heart disease.
“We know blood clots cause the final event in cardiovascular disease. We know blood clots cause plaques to grow. Why don’t you accept that blood clots are the thing that starts heart disease in the first place? Because then we have one process all the way though, and it makes sense, because it fits with what you can see.” (Dr Malcolm Kendrick)

The first time this hypothesis, then called the encrustation hypothesis, was developed was in 1852 by a Viennese researcher called Karl von Rokitensky. For various reasons, one notably was the action of his student, the hypothesis did not gain much traction at the time.

Part 1 of the book is concerned with the process of cardiovascular disease. It covers the competing hypotheses, and considers if plaques can really be the remains of blood clots, the main players, processes, and risk factors. It also covers how the original research came to a halt with the advent of statins and big Pharma.

”The atherosclerosis plaque is basically a build-up of blood clot, repair, blood clot, repair, blood clot. If the clotting process is faster than the repair process, you have a plaque that gradually grows and eventually thickens the artery wall until it narrows sufficiently that the final blood clot, on top of the existing plaque, is the thing that can cause a heart attack or stroke. …”
“If you cut through the plaque and look at it, it almost looks like tree rings. You can see that there’s been a clot, repair, clot, … (repeated) over years.”

As to the actual mechanism itself, Dr Kendrick explains:
“Your blood vessels are lined with endothelial cells, a bit like tiles on a wall. Endothelial cells are also covered themselves in a thing called glycocalyx. If you try to pick up a fish, it’ll slip through your fingers; it’s very slippery. The reason it is slippery is because it’s covered in glycocalyx and the glycocalyx is incredibly slippery. It’s nature’s Teflon.
So basically, in our case, the glycocalyx [is inside] our blood vessels, to allow this kind of damage-repellent layer on top of your endothelial cells.
Now, if that layer is damaged, and then the endothelial cell itself underneath is damaged, then the body will say, ‘Oh we’ve got damage to a blood vessel, we must have a blood clot there because we could bleed out.’ So, a blood clot forms on the area of damage, and immediately stops [the bleeding].

In summary, a clot forms where endothelial cells in the blood vessel have been seriously damaged or stripped away. The blood clot itself is then covered over by endothelial progenitor cells (which are floating around in the blood stream) to create a new endothelial layer. This repair process will gradually create a thickening in the arterial wall.

Nitric Oxide protects the endothelium. It is anticoagulant – the most potent anticoagulant we have in the body. It’s really the magic molecule for cardiovascular health.
It … lowers blood pressure by opening up the arteries ... In addition, it stimulates the production of endothelial progenitor cells in the bone marrow, [as well as] prevent[ing] anything sticking to the glycocalyx/endothelium. It is the single most important molecule for cardiovascular health.”

In summary: decrease production or reduced bioavailability of nitric oxide can result in endothelial dysfunction.

Even moderate amounts of depression, anxiety, ‘stress’ (or strain as it actually is) is damaging from a cardiovascular disease perspective, in particular from the action of the steroid hormone cortisol. Periodontal pathogens (bacterial exotoxins) are associated with endothelial dysfunction.

Part 2 of the book looks at what to do to reduce the risk of cardiovascular disease; how to increase life expectancy; and necessary lifestyle changes – some of which are free.

In terms of damage to the endothelium, the key contributors are: type 2 diabetes; air pollution; raised blood pressure; the use of prescription drugs to reduce stomach acid; and homocysteine.

In order to lower your insulin and blood sugar levels, there are simple strategies to accomplish this. These include time-restricted eating, eating a diet high in healthy fats and low in refined carbohydrates, as well as getting regular exercise (short bursts of intensive exercise a few times a week). Cortisol is a major cause of high insulin levels. Meditation, mindfulness, relaxation and yoga are highly beneficial in lowering both cortisol and blood pressure. As is steering clear of negative expressing emotions, either externally or internally.

Exercise and getting plenty of skin time in the sunshine (sun exposure triggers Nitric Oxide synthesis that helps dilate your blood vessels and in lowering your blood pressure). Also, breathe through the nose, again for Nitric Oxide synthesis. Nitric Oxide also protects your endothelium, and increases mitochondrial melatonin to improve cellular energy production, as well as protecting and sustaining the glycocalyx. It is also advisable to reduce physical stress, or strain, caused by either cold and hot exposure, and dehydration. Curiously, statins also increase Nitric Oxide production in the endothelial cells.

Other beneficial techniques, food choices, blood thinners, and supplements are given too.

Finally, the book provides the references used in the text that back up his research.

The author has previously written two other best sellers: A Statin Nation, and Doctoring Data; and co-authored other best sellers such as: The Big Fat Surprize, The Great Cholesterol Con, and Fat Chance.

Dr Kendrick’s trademark style of writing is humorous and at times seemingly irreverent, yet engaging throughout in terms of understanding. In particular, he uses analogies to help readers to stay with the ‘plot’. It is easily to understand and follow his reasoning.

If you believe that there is more to heart disease than avoiding fat or taking a statin; whether you suffer from heart disease; or know someone who does, this meticulously researched book will either confirm your thinking, or it will shake up every aspect of your thinking about the cause of heart disease. The book will also help you understand what can be done to reduce the risk.

During the first read, it is advisable to simply absorb it as an overview, then when reading it for a second time; that is the time for taking in the details. Enjoy, it is well worth the read. Highly recommended.
I've been reading this book. I learned about it only last week, and I decided to wait for the audiobook to spare the eyes. That came out a few days ago. A considerable portion of the book so far parallels research I have been doing over many years (some of it involving this website), and I can vouch for that portion of what he is claiming.

I don't want to say too much before finishing the book, but the author is touching upon a good many points regarding the endocrine system that are important to me personally -- because I was born with major endocrine dysfunction -- and that seem to be virtually unknown to cardiologists and endocrinologists. I know about them as a matter of life and death, MDs and particularly the aforementioned cardiologists and endocrinologists having attempted to do me in a number of times (ignorantly, I presume).

I learned about the book from "A Midwestern Doctor" on Substack, who has been mentioned a few times before on this site. He recommended it to me personally after I shared a little about my situation. I don't know who this person is, and I am only assuming "he", but a post came through today mentioning the book Political Ponerology, published by Red Pill Press. That was a surprise!
Hmm... no mention of vitamin C. Suggest him reading up on Linus Pauling. His research figured out how heart disease works a long time ago. Some of the things mentioned here are good, but seem to be missing the crux of the matter. I haven't read the book, so maybe it is mentioned there.
Hmm... no mention of vitamin C. Suggest him reading up on Linus Pauling. His research figured out how heart disease works a long time ago. Some of the things mentioned here are good, but seem to be missing the crux of the matter. I haven't read the book, so maybe it is mentioned there.
Vitamin C is mentioned -- and is characterized as rather central as I recall -- but I won't say more on that until I have finished the book.
Hmm... no mention of vitamin C. Suggest him reading up on Linus Pauling. His research figured out how heart disease works a long time ago. Some of the things mentioned here are good, but seem to be missing the crux of the matter. I haven't read the book, so maybe it is mentioned there.
Vitamin C is discussed within pages 69 to 72, with numerous additional mentions later in the book. A supplemental dose of a gram a day is suggested.
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