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Dr. Peter Brukner OAM3 min read

Dr Brukner's Book Review: The Clot Thickens

The Clot Thickens: The enduring mystery of heart diseaseAuthor: Dr Malcolm Kendrick

I love books. I buy a lot of books. I read some of them. That means I have a long list of books waiting to be read if only I had more time.

Every now then, quite rarely actually, a book comes along that demands to be read immediately and changes the way you look at something important. That happened to me a decade or so ago when I read two books, Gary Taubes’ Good Calories Bad Calories and Nina Teicholz’ A Big Fat Surprise, that changed the way I thought about nutrition. They not only explained the relative merits of fats and carbohydrates, but looked back to the history of why the low fat movement won out over the low carb movement back in the 60s and 70s for reasons that I had always assumed had everything to do with science and research, but in reality were all about power, money and politics.

Since then, I have read lots of good books, but none affected me in the same way until this week. I have been eagerly waiting for Malcolm Kendrick’s latest publication, firstly because

I enjoyed his first two books The Great Cholesterol Con published way back in 2007 and Doctoring Data (2015), and secondly, because I enjoy reading his irregular blogs both for the challenging content and Malcolm’s unique writing style.

One thing I like about a book is a clever title. When I was writing my own nutrition book a couple of years ago, I spent weeks agonising about the title asking all those near and dear to make suggestions, then one day the obvious title A Fat Lot of Good popped into my head and the search was over. Malcolm’s book on the enduring mystery of heart disease is called

The Clot Thickens - very clever. The book looks at the history of heart disease and why the long-standing diet-heart hypothesis cannot be correct. Malcolm spent many years looking for the real mechanism of atherosclerotic heart disease. He struggled to bring all the risk factors into a coherent hypothesis, until one fine day he was advised by a colleague, Prof Paul Rosch to stop searching for the cause, but rather consider cardiovascular disease to be a process. He claims that was his lightbulb moment.

What Malcolm presents in The Clot Thickens is a plausible theory that blood clots are the basis of the development of atherosclerotic plaques rather than the cholesterol contained within them. He is able to explain all the proven risk factors and associations of cardiovascular disease with this hypothesis. It's a fascinating read for those you want to dive deeper into the cause of the most common killer in our society. What makes it such anenjoyable read is Malcolm’s chatty, witty, self-effacing writing style.

This book will make you re-think everything you have learnt about the causes of cardiovascular disease. There are so many pearls in this book. Having just finished it today, I will start again tomorrow because I’m sure I missed things along the way.

In one fascinating section, Malcolm calculates the number of years of life lost due to certain conditions. I hope Malcolm won’t mind me sharing his top 5 with you.

  1. Drug and alcohol abuse = 24 years
  2. Raised blood sugar levels / Type II diabetes = 20 years
  3. Significant mental illness = 20 years
  4. Smoking = 10 years
  5. Lack of exercise = 5 years

As you can see, right near the top is type two diabetes. Malcolm estimates that the average person with Type II diabetes loses 20 years of life! Interestingly, later in the section on what one can do to prolong life, Malcolm shows he is a big fan of a low carb diet.

This book should be read by every doctor treating patients with cardiovascular disease, in other words, pretty much all doctors. Unfortunately, it will be read by very few, primarily those already in agreement with Malcolm’s thoughts.

I believe this book is a game changer and I strongly recommend you read it.

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