Geoff

Ivor, Mr. Fat Emperor, welcome to the program.

Ivor C.

Hey, thanks a lot, Geoff. It's great to be here.

Geoff

As we were just talking about and warming up before the actual recording here is the observation that you have, engineers really shaking up the discussion within the nutrition, physiology, biochemistry side of the world. And you wouldn't expect a medical doctor going to a chemical engineering conference and I know you're a chemical engineer by background, and standing alongside and giving keynotes and being on panels with professional chemical engineers. But in the world of nutrition, that is very much on the case where you have been well received as a speaker and a thought leader on a lot of these topics with professors, academics who've been studying nutrition and physiology for their entire career. What do you think is going on here?

Ivor C.

Yeah, it seems incongruous for sure, Geoff. But I suppose at its most fundamental, medical doctors are very busy in their practice, and they get a certain education. And a lot of them don't have time to really research deeply, and they're not really quite into biochemistry and metabolic pathways. They're more physiology, anatomy and pharmaceuticals required for which disease and identifying the problem, all that stuff, and they're really busy. Whereas engineers, if you're a biochemical engineer like me, if you have an incentive to go and decode these matters, and the beauty is that health matters are so important for all of us. I have five children, I try and stay fit and healthy and I have an incentive in being healthy and accessing some longevity.

I'm incentivized to go after this sphere that's not really mine. Whereas a doctor is not really incentivized, a busy doctor to start digging into engineering, there's no driver. That's one difference. Also, I think the engineering mindset, the problem solving skill. I mean, it is called the problem solving profession and it's all around the logic and the philosophy of problem solving and data statistics, statistical inference. The more problem solving focused engineers, I was one. I'm a lead problem solver for 25 years. It's my art and trade, so when I do have a requirement to find out about health, like when I got poor blood test markers, and the doctors weren't sure what they meant, and I began to look them up in the published research, and I realized, "Oh my God! These markers are way more important than cholesterol.

I naturally drawn into saying I got to know. I have all the tools of my whole career that enable me to rapidly research, rapidly know the wheat from the chaff, rapidly assess the statistical significance and the data tables and go into the supplementary tables in these papers. Ignore the abstract because the conclusion to the abstract I found, it may be very, very misleading depending on the teams bias, so you got to go into the data. It's a playground for certain types of engineer, particularly with biochemical background as opposed to say mechanical, and particularly ones who specialize in technical leadership and problem solving, as opposed to project management and engineers who might be more, scheduling and organizational.

Geoff

I think that's interesting from a problem solving perspective. You wanted to problem solve some of your own medical results that you're seeing from blood panels, and we will get into that. But what inspired you to go from, "Okay, I want to debug myself." To saying, "Hey, I think I have gotten something that 'professionals haven't gotten' and I'm going to start actually being somewhat quite vocal about that." I mean, I think if you were to give a devil's advocate argument. I think us engineers, are folks are that are just rational. I think the argument to authority is not very a great one. But how did you deal with some of that, I imagine pushback? Hey, this is outside your lane, you're just a chemical engineer. You're misleading people, you're giving people bad guidance. How did you navigate that? And how did you think about it as you were beginning exploring some of these initial ideas and started disseminating it?

Ivor C.

Well, okay, Geoff. Well, firstly, I'm going to say to all my critics out there from other spheres in life who continue to come at me, I just want to let them know I enjoy it. But that said earlier on, it wasn't comfortable to be criticized for not being a doctor and not being whatever. But the reality was that when I did the research within two to three weeks of admittedly obsessive intensive research, I realized I had decoded my high liver enzymes and my high serum ferritin, and what they meant. And I had also discovered myself independently, the metabolic syndrome, and the insulin resistance syndrome.

And I put together the pieces and realized, wow! There's a whole world of disease pathways out there that are huge and I began to discover that they tower over cholesterol in terms of importance. I knew that no one really knew this, and I thought I discovered it. I'll admit now, I was under the impression that I had discovered and it was later I discovered the low carb community and began to discover other people talking about these topics. But at first I thought I'd really happened upon it with my research. I felt driven to tell the engineers at work because I knew we had overweight guys, and I knew probably half our engineers had some level of metabolic syndrome, and I discovered it was massively important. I said, "Okay, I'm going to go into work." And I made the decision I'm going to give a technical talk. I'd given many advanced technical talks ATTs on the technology in our high volume business. But I said, "I'll go in and give one on metabolic syndrome."

Geoff

And this is after you learning about it for about two, three weeks and you're ready. You're like, "Okay." Or did you study these for longer?

Ivor C.

Longer and fairness, yeah two or three weeks, I realized I was onto something huge. And actually one Wednesday evening, I realized I could predict from my research that I could make a hypothesis, that serum ferritin or the iron loading in the blob that I had high. I realized that that was a sixth marker for metabolic syndrome, and that was before I got any doubt on it. I went down and delved and I found a paper on a Wednesday night that proposed that serum ferritin should be the sixth marker for metabolic syndrome and I went, "Bingo!" 'Cause I predicted that with no proof and I realized then I had it. The moment as a problem solving engineer, you realize I've got 90% of it. I've got 90% of what I need to know.

I got very excited but then I went on and became obsessed with lipoprotein and cholesterol metabolism, because I was brought into all of that true insulin resistance which raises LDL particle count. And I realized that the LDL particle count was being perceived as a really good cholesterol risk measure. But I knew from my research that that's mostly because hyper insulin anemic states raise the particle number. I realized they were even misconstruing or misunderstanding that.

Six months of study and putting together a lot of material I gave the first lectures. I made sure I was very well researched before I actually went up in front of a room of a hundred plus, and actually lectured them on health. But when I did, there was an enormous positive response, because we have several hundred engineers, and all of them knew that I was who I was. And they kind of knew without being arrogant that if I've gone off and researched something heavily, it's highly unlikely I'm going to be incorrect. They were interested and we had the discussion on the 48 minutes, or 50-minute Q&A afterwards, and I was able to answer every question that came up, including all of the contradictory questions. That was important.

Yeah, but how could they be all wrong for 50 years on carbohydrate and fat? But how could they be wrong on cholesterol? Sure, we've heard it for decades and all of those questions, where the people found it hard to believe what I was saying could be true, and I answered them all and I brought them more papers and I explained the graphs, and I got the balls. Once I got this balls and I realized I was helping people, that was it I was hooked.

Geoff

Yeah, this is me speaking from Silicon Valley. I think the way I kind of see the world unshaken is that you see, the Internet revolution really disseminating and decentralizing the power of computing. You can make the argument that cryptocurrencies is decentralizing information around financial institutions, and this movement that you're a part of or collectively a part of, you could call it bio-hacking or citizen science. It's really decentralizing medical and health knowledge. And I think one thing that I want to just caveat and I think referencing the doctors that you were initially working with and bouncing ideas from.

I don't think they were saying that doctors have mal intention or bad intentions here. I think that it's a matter of training and time, it's actually in the American healthcare system. They're trained to build the codes, and you're incentivized, that's kind of trend through your patients. You have 10, 15 minutes to go through and knock out as many prescriptions as possible, essentially. But if actually have time to sit down with a doctor and we've had multiple MDs on the program talking about this. It sounds like they know the system is flawed, they know that training is not ... Some of my friends are going through medical school now just recently wrapped up, they had four hours of nutritional lecture out in an entire program of four years.

I think we're in this cultural, institutional glacial pace, and you're also fighting at the front lines at these conferences. Do you have any ideas or thoughts there, how to change a system? Because I think the doctors want to help people, I have no doubt that they're good people and want to do their jobs well. It sounds like there's some of the institutional reimbursement payment structure that might be flawed, but that might be impossible for just citizens to just engage with.

It seems like it's a government political decision at some level, especially in America. So just curious in terms of clarifying what kind of lifestyle you lived before, was it just nutrition? Was that something you thought about and you just ate a standard, I presume western diet or standard Irish diet that had standard carb load of breads, and all of that? I mean, would you think everything about nutrition?

Ivor C.

Well, I guess the diet I had eaten, I was relatively health focused. I would have eaten stuff I knew I probably shortened occasionally like chocolate and some sweets. I'd occasionally have pizzas, but I kind of knew they were junk food. I was eating good. My wife is a very good cook and I was eating good meals with fish or meat, but I was eating quite a lot of potatoes as well. And often when we had rice I'd eat a lot of rice, because a big pile of rice would need juices and sauce on it.

Geoff

It tastes good.

Ivor C.

Yeah, it's just wham! It hits you, and also it was the base of the pyramid and it was healthy clean. It was base of the pyramid, it was healthy. I knew I could eat lots of whole grain bread and rice. In my mind that was healthy, so I did. I was eating quite a bit of fruit too, but I was drinking a lot of fruit juice, because one easy way out that I had been doing for some time was, well, a glass of real fresh squeezed orange juice and the price had come down a lot is kind of one of your five a day. I didn't want to eat loads of fruits and stuff, and I wasn't crazy about vegs, so I figured I'll drink a lot of orange juice. I'm getting all this five a day stuff and it's nice. Of course it's nice, it's sugar.

Geoff

It's like 50 grams of sugar. I mean, it's a crazy sugar bomb.

Ivor C.

I didn't realize but I was piling fruit juice down to my liver, thinking I was doing the right thing, but I wasn't alone. I'm still not alone. I was eating a lot of fruit juice and a lot of food pyramid type stuff and I was eating stuff that I knew wasn't ideal occasionally. That makes for me in someone who's predisposed, like a lot of people are towards insulin resistance over the years, it just built up and obviously to the point my bones were kind of screaming.

Geoff

Yeah that's why it's super pernicious because you thought you're doing the right thing. It's not like you're fairly sensible. You weren't just trying to drink soda, eat pancakes and birthday cakes, you were trying to be sensible, and you were developing metabolic syndrome, which is ... I think that's why this is terrifying. I think we've touched upon this syndrome X, metabolic syndrome a number of times. It might be just good to define for folks who are just getting up to speed on the topic. There are five general markers that define what metabolic syndrome is, and I think depending on the definition, you need three or more of them to be considered metabolic syndrome. Can you help us define the five markers that make up the pillars for metabolic syndrome?

Ivor C.

Well, no that's a good one to cover. Reaven was the master way back decades ago of defining syndrome X. And he knows as Professor Reaven that there's these five measurements that when they're high or three or five are high they cluster. It links to heart disease, cancers and kind of everything bad. And later on he kind of tied them all into hyperinsulinemia syndrome and it got better named. But basically a low HDL, a low good cholesterol, a large waist size above a certain limit, hypertension above a certain limit, and blood sugar being high or triglycerides from your cholesterol panel being high. They're the five, now you can add in GGT and serum ferritin now and those loads more but the key point and the ratios are great that I mentioned earlier.

But the key point is all of these things are only hinting at the real problem, and the real problem is high insulin and insulin resistance. More recently, it got properly named, it's not really metabolic syndrome, it's insulin resistance syndrome. And all of these markers are not in themselves massively causal. Low HDL, you could argue it's not so much causal because you have less HDL. And HDL helps take our cholesterol out of your artery walls. It's not so much that. Low HDL indicates that your HDL functionality has been impaired, and it indicates your insulin resistance. Hypertension indicates you're insulin resistant.

It's not just that the hypertension strains your arteries. A lot of these things are not completely causal, they're just signs that something is wrong and that's why it was a syndrome. And to this day, it's true that even being overweight and failing that criteria, you can have grossly overweight people with enormous waists who are perfectly healthy, who are insulin sensitive. It's good for people to realize these five things are not directly causal, but when you start clocking them up, they more and more prove that you're insulin resistant, and that's the state that's problematic.

Geoff

Which makes sense because I think in terms of easily measured biomarkers, it seems that people tend to look at cholesterol or triglycerides as part of the standard panel. But it sounds like this notion of the fasting insulin just seemed to be less talked about. People never really thought about that. Do you have a sense of why that is the case as historically? I mean, it sounds like, now I think people hear about insulin resistance or maybe this is just bias for us because we're in the community. We hear people have insulin resistance, but I guess in terms of the broad global community, I think people think of insulin as probably this magical drug that cured diabetes.

There's probably the classic thing people think about when they hear insulin. Some scientists back in the 1900s invented this thing, put it off patent and it cured diabetes. And now we're saying, "Hey, actually too much of this is not good, and it's not actually solving the root cause when you're giving people insulin. You're actually just kind of giving alcoholic more alcohol type of a self." Can we talk about the historical direction that brought it to this place? And what are some of the most compelling evidence points that you saw that is retelling that story?

Ivor C.

Right. Yeah, there is an unfortunate history exactly as you say. Insulin was discovered and it miraculously cured type one diabetics who could not produce insulin, and literally people who would otherwise die quickly were now saved. Insulin was golden boy or girl, if you will. And type two diabetes then as we went through the 20th century became more and more of a problem. But it was always viewed as a blood glucose problem, because they knew well type two diabetics, the blood glucose gets higher and higher. And up until the 50s, they really did genuinely, honestly view type two diabetes as a glucose problem that may be required insulin to help manage this problematic glucose.

What they didn't realize was the real problem that defines type two diabetes is an excess of insulin. The only reason it becomes a glucose problem after maybe 20 years of having type two diabetes is you now can no longer produce enough insulin from your battered pancreas to keep the glucose under control, it skyrockets. They viewed it as a glucose problem. Now Yalow and Berson, I interviewed Dr. Joseph Kraft back in 2015, it's on my YouTube and he brilliantly in the 70s worked out by doing 15,000 glucose and insulin assays. Two things he worked out, you got to measure the insulin after drinking a glucose drink for a few hours, and that's the real test for diabetes. And he also realized from research that most heart disease links to type two diabetes, even if you're not diagnosed.

But he told me about Yalow and Berson. And Yalow and Berson in the 50s, were brilliant. But they discovered that type two diabetics actually had very high insulin. And it was such a shocking discovery that when they went to publishers, and they were completely correct, they had groundbreaking data now to say, "Wow, type two diabetes is actually a high insulin disease, it's not glucose." And they couldn't get published and they had gotten a lot of hot water, because the American Diabetes Association and all the groups and the medical profession said it's a glucose disease. What do you mean? High insulin.

Geoff

Standard of care is giving them even more insulin.

Ivor C.

Yeah, it didn't fit with the way the world works. They never really got that established and Kraft in the 70s brought out even more data, like I mentioned, that type two diabetes is vastly bigger than the diagnosed people. Because if you measured the insulin after a meal, you're going to find a ton more type two diabetics, but no one wants to hear that either. Because they didn't want to face the fact that maybe 50% of people are essentially diabetic, because that's bad news. Everyone who was discovering this was swimming upstream as Joe Kraft put it.

And the system just didn't want to go down this road. And it's kind of to this day, the same thing, they liked to view it as a glucose disease and it suits everyone. And maybe a lot of them really believe it, and the ones who understand otherwise know that rocking the boat too much is not going to help anyone. It's hard but that was the genesis of how we got here. But now it's becoming more and more apparent, and the failure of the accord trial where they shoved in more insulin and they got worse mortality outcomes. Now they're going for the SGL 2 inhibitors that basically make you not absorb glucose in your diet, and you pee it out, and it gives you your urinary tract infections, but they're pushing those now. They'll do anything but admit that, it's putting glucose in your mouth is the biggest part of the problem.

Geoff

I mean, again it sounds like you're giving alcoholics alcohol, a type of a way to solve, which will short term treat the symptom, but you're not solving the core root issue, that's fascinating. I think one of the things that I think interesting is that, people look at an oral glucose tolerance test, I think people are probably aware of it, hemoglobin A1C or a facet blood glucose test. It sounds like some of the earlier researchers really define that, we should really be looking at insulin as a core biomarker here. My understanding it's just hard to do. But it sounds it's more important than clinical biomarkers, isn't that not hard to do? Maybe this is asking you to project out a little bit, what would be your standard of care ideal in terms of diagnosing metabolic health? If you could say, "Hey, Ivor Cummins gets to define the assays and the panels now, what remains and what is added and what is taken away? What would you do?

Ivor C.

Yeah, well, I would, firstly with the cholesterol, the classic cholesterol panel, I would overwhelmingly focus on the ratios of total cholesterol to HDL and triglyceride to HDL as the most valuable markers from a standard cholesterol panel. I think a lot of doctors just look at total and LDL and they don't realize that. That would be a quick fix, and say that the ratios are a value and the reason is, because they are a pretty good proxy for insulin resistance ironically. The best thing from the cholesterol panel is that it mimics or it's a proxy for something else that's not to do with cholesterol. There's an irony, but you do that and the advanced cholesterol panels are more useful, and if you get the APO B, over the APO A1 ratio, it's getting easier to guess. Or the LPIR, the lipoprotein IR score, they're two good measures from the advanced panel, if you can get that.

Then we get to GGT as measured in Ireland as part of the standard liver panel and a recent study showed that people with high GGT combined with a higher BMI could have 15 to 20 times the risk for future type two diabetes. It's a massively predictive, and it's a cheap test and they don't do it in America. I'm not sure why. You drop a GGT and a ferritin there and the blood glucose I would combine with a blood insulin for most people, particularly in America where a recent study showed that 88% did not meet metabolic health criteria in the blood tests. In that kind of population you're going to want to do an insulin and a glucose and get the HOMA, the H-O-M-A.

There's a calculator online, HOMA insulin resistance and that one takes fasting insulin and glucose which are not massively accurate of fasting insulin and a fasting glucose. But together in the equation, they can be quite good, they'd be easy. Now if you get into more advanced tests, obviously an oral glucose tolerance is a bit more effort and it's maybe if anything turns up not great in the basic panel, maybe do an OGTT and just take the insulin at two hours after drinking the 75 grams glucose. It's not a big deal, do a blood draw two hours and just grab an insulin, which I believe is $28 now and I've heard lower costs. And then you get the two hour insulin, and if that's below 30, you're pretty sure to pass a more advanced test of diabetes and if it's above 40 units, you're probably going to fail an Advanced Test. It's a quickie version of the Kraft five hour assay and it's quite powerful, that's a sweet test. Now, you're getting then to adiponectin and leptin and more advanced hormonal tests-

Geoff

This is the appetite related hormones.

Ivor C.

Yeah, and also the health of your fat tissue and whether it's insulin sensitive. What you really want is a high adiponectin means your fat tissue is in great shape and signaling properly and a low leptin likewise means you don't have excess fat or dysfunctional fat. I mean, a couple of years ago when I was at my healthiest I've probably slipped now, I got a four leptin, which was flagged as being too low, but that's good. And I got a 20 adiponectin which was flagged as too high, but it was actually really good. But maybe not in the standard panels getting these hormones but for further investigation, they're the kind of things you start going into.

Geoff

Yeah and I think the point with reference ranges is that I believe they're just like 25 percentile and 75 percentile of some population. And if our reference ranges on people that are 50% with syndrome X, metabolic syndrome insulin resistance, is that even the benchmark that you want to be guiding towards? And I think as engineers, if you're benchmarking towards a sick population, you're optimizing towards a non optimal state, is that even a sensible thing to do?

Ivor C.

Exactly, Geoff, and you know what? I was laughing at this very early on back in 2012, 'cause I looked up the reference range for insulin, it was five to 25 micro units. I said, but anything over seven or eight and certainly 10, you've got action to take pronto and 25 is the upper acceptable limit. Teenagers' insulin has been going up and up and up over the last 30 or 40 years and I believe they've just nudged up the reference range. It's like the high volume in process. Your yield is getting worse and worse, and your quality is going down and down, and you just keep opening your inspection criteria and say, "Screw it."

But what's happening is you're letting human product pour out by the millions who have already heart attacks, cancers, all of this stuff, but no one's responsible for that. They just keep opening the ranges but I just say as well, the most important test for a middle aged person unless your blood tests are really nice, in which case you're truly low risk, or your blood tests are really bad, in which case you're a high risk anyway, and you need to be doing something. For all the middle risk people, which is the largest group where the most heart attacks occur, a calcification scan, it's in the 2018 guidelines, it will blow away the blood risk factors, in terms of predicting your true risk. And it will give you something to measure every couple of years. If you have an issue, you can change your diet, lifestyle, drugs, whatever. And a couple of years later, if your calcium is slowed down, you've got a huge ... Not guarantee, but you've got a huge reassert assurance that you've stopped your progression of atherosclerosis.

Geoff

Yeah, let's talk about that. It sounds like it a big area of focus for you. I think it would be helpful to provide the steel man version of standard of care, which is that high cholesterol as a risk for cardiovascular risk, for cardiovascular disease. Basically, eat less cholesterol, eat less fat that's kind of what the American Heart Association will tell you to do. And what we're talking about here is that, the cholesterol panel, the lipid panels not super interesting. It's an important piece like puzzle here but the CAC score is where we should be really looking at in terms of a predictive risk measurement here. Can you talk about what does the CAC score measure? What is actually going on in the veins, where calcium is such a predictive marker to look at and why we should be thinking about doing it, incorporating to our standard yearly checkup?

Ivor C.

Yeah, and perhaps not yearly but I get into that, and certainly the first one off on that middle aged man over 40, women over 50 is the key and then later, depending on what your result actually was. But I suppose the fundamental thing is people have to separate risk factors, like hypertension or cholesterol ratios. They are things that indirectly give you a marquee view into your future risk. You're looking very indirectly at things that kind of correlate with risk but you're not actually looking at whether or not the person has disease that needs addressing.

The huge difference with calcification scan it's a quick CT scan, five minutes, maybe $100 in the States and it measures the amount of calcium in your coronary arteries in your heart. It's a high speed strobe X-ray and what it does basically, atherosclerosis the heart disease of your arteries that causes heart attacks most heart attacks and all the other problems and strokes, that process as it progresses too dangerous levels, your body brings in calcium to strengthen the areas of the artery most affected. If you have bad atherosclerosis and you're heading for a heart attack, overwhelmingly you'll have a lot of atheroma in your arteries. And some areas of our artery will be clear and some will have pustules or atheroma that are really risky. And if you're in that stage, almost certainly your body has taken in more and more calcium to try and stop those areas rupturing, because evolution is not an idiot.

Geoff

Right, it's certainly trying to solve the problem and I think that's the thing, where I think people get confused where, "Oh, there's a lot of cholesterol that's floating around and it's blocking up my arteries. I got to reduce eating cholesterol." And I think what you're hinting at is that, no, that LDL is really response to the inflammation in your blood vessels, right? Can we unpack that story a little bit?

Ivor C.

Oh, well, that one yeah. The cholesterol the way I view it is, if you have higher a particle numbers, no one with any credibility talks about the old LDL concentration. That was the amount of LDL when they smash up all the LDL particles, the old LDLC. No one who's serious looks at that anymore. The LDL particle count from the advanced lipoprotein, the high particle count is seen to be a much better risk factor. And in fairness, it is. It makes a joke of the old LDL 'cause it tracks pretty well, like hypertension mice which future events. There's a series of problems with that.

One is the whole concept that the LDL is part of the repair process, that's still debated as the extent that that's true. The calcium certainly but the LDL particles, it's debated. But what you can say about the LDL particles is, A, having higher particle counts is a super strong indicator of insulin resistance, and that's where it gets a lot of its predictive power. In that situation, you'd say, "Well, I better fix the insulin resistance, not just the proxy, the number. People with metabolic syndrome have low HDL and high particle counts, it's clear as day.

The insulin resistance drives your particle count. Does that mean that someone who's not insulin resistant and who's really healthy with a hypothetical count is at risk? Probably not at all, because you are looking at a proxy for the problem, an indirect marker of something that potentially could give you a heart disease. But we have tons of people with high particle counts with zero calcium scores and no disease. I mean, it's just a risk factor. The second thing is that the particles it is arguable from much science, recent science, that if they're not oxidized in the blood by hyperglycemia or high glucose or inflammatory pressures, if your a particles are not oxidized, compromised, then they won't really cause a problem and get trapped in the wall.

There's another thing, well, you need to know is my high practical count got a lot of oxidation and problems? Or is it actually all fine? It's the second question, you need to know the answer. And there's multiple other layers that if your endothelium or the inner layer of your arteries is compromised, that is an extremely strong hypothesis that that's what allows atherosclerosis. And if it's healthy and you have no inflammatory condition and low insulin and glucose, you can have any number of particles and they're never going to become a problem because your artery is healthy. And if your HDL, I know I'm going on a bit here, but if you have a high number of particles and a genuine problem that's driving down your HDL functionality, then your HDL will not be properly moving cholesterol out of the wall.

You may have a problem with more particles then and benefit by lowering them. But what if your HDL is working fine, your endothelium is fine. You have no oxidation of your particles, then why would you be looking at a high number and being worried it doesn't make sense? It's like when they talk about the particle number, a lot of people it's like, that's the big thing. And in an engineering sense, that's one factor and a whole range of factors that may or not have any relevance depending on the other five factors. But they're not talking about the other five factors, that's the problem with the cholesterol theory. They're not talking about the other five massively important things. It's myopic.

Geoff

It's a network system. There are a lot of inter playing parts and one marker is not sufficient, it's required, but it's not sufficient to make a diagnosis.

Ivor C.

Yeah, and that phrase is good, it's required. In other words, if you take away all your particles, you probably can't really generate atherosclerosis, and that sounds quite convincing as to their importance. But I use the simple analogy for lay people. A plane, the rotor servo breaks, the rotor locks hard, pilot can't control it, hard landing crash, and no one gets killed in the mechanical impact, but everyone's burnt alive with the fuel. You could say the fuel is the root cause. If there was not fuel, no one would have got burnt. They all would have walked. But that's misleading.

Yes, the fuel is part of the process that killed the people, but what was the root cause? We've always had LDL particles, evolution designed them, we've always had them. They've been the same for all of human evolution before there was any heart disease worth a dime. Now our heart disease has gone through the roof in the last century. The LDL particles were always there, the root cause is something else overwhelmingly. And this simple analogy, just so frustrated when people say that, "LDL particles are fundamental, they are the sine qua non." In one sense they are, but in a very misleading sense. And this is the argument that's going to have to be heard in the coming decade.

Geoff

It sounds like when you've identified calcium as a marker in the artery, that's essentially a sign of damage that is directly causal to the cardiovascular. I guess disease.

Ivor C.

That is vastly more important because exactly, you only get calcium and diseased arteries, you only get calcium in diseased areas of our arteries and never heard they're healthy. It's a direct marker of dangerous atherosclerosis progression, direct marker.

Geoff

This it like seeing a scar on your skin or your muscle. I mean, just essentially some kind of scarring.

Ivor C.

Yeah, if you think of an analogy, if you were using chemicals and they were destroying your skin, and you were developing scabs all over your skin, well, you could look at your blood for markers of inflammatory reaction and they may or may not tell you things. They may correlate with your problem, but if you count on different people, the scabs on their skin, you're going to get a direct reflection of the damage, that's calcium. If you have zero calcium in middle age, you have on average from all the studies say the same thing, maybe a one to one and a half percent chance of a major heart attack in the next 10 years.

If you have a high score, up in the 500 to 1000. You may have 20 times the risk. Now a high LDL particle count on a good day might give you a double the risk. But high insulin and bad HOMA will be more than double. There's a million measures that will give you a better risk estimation than LDL particle. But calcification towers over them all. In fact, it towers over them so much, that if you take all the risk factors in the algorithm and put them all together to get the best possible risk estimation for an individual. If you scan those people, it's going to be all the risk factors pulled together in an algorithm and then some.

Ivor C.

And in fact, the middle risk people where most heart attacks occur, if you scan them all with a calcium scan, you will take 50 to 70% of those middle risk people supposedly middle risk for you're not sure what's happening. 60 to 70%, you can move them into genuine higher or low risk re-categorize.

Geoff

Yeah, I think, the data is just conflated. I think one way that helps me understand this better is from an energy model or a fueling model. Our cells require glucose triglycerides, things like ketones as substrates. And if you just have a lot of these floating around, that means that your body's not regulating itself that well. It's not homeostatically regulating, there's too much fuel going around. I think when it's of high glucose, high triglyceride, all these markers for metabolic syndrome essentially a way to just show that there's some root inefficiency, their body is not managing its energy that well.

And if you think from that perspective and say, "Okay," looking at one, in and of itself is not very interesting because sometimes it makes sense to have a snapshot of having high glucose. If you'd like doing a weightlifting competition or something, you probably want a lot of anaerobic fuel. I wouldn't say it's a no sugar all the time. There's some reason for having high sugar, maybe at some points, or it might be reasonable to have a little bit higher triglycerides if you're doing super long endurance race maybe. But when you have all this energy at the same time, and you're chronic, that's where it's problematic and I think it's unpacking this and looking at the biomarker at it's relevant context.

Ivor C.

Yeah, and exactly and I love that one Geoff but all at the same time. A healthy stage is to have low insulin and moderate blood glucose. But to be honest, it can be a little high especially if you're doing intense exercise. In the couple of hours following that, your body shoots glucose out of your liver and your glucose shoots up and your LDL particle count shoots up following intense exercise. There are times it's appropriate, but diabetes type two, Dr. Ron Rosedale, I love his description he said, "It's the perfect model of accelerated aging." And that's why the risk factor for type two diabetes is five or six times for heart disease most of them die of heart attacks, cancers are higher.

It's because type two diabetes is that model of accelerated aging, everything gets damaged. And type two diabetics to your point, they have high glucose, they have high insulin and they have high fatty acids in their blood simultaneously. And that is the control system utterly broken and everything gets burnt. The high glucose damages myriad systems, the high insulin independently damages myriad systems and the high fatty acids add fuel to the fire causing more insulin resistance and feedback to like receptor. It's chaotic destroyed and control system. And the beauty is, all you need to do is change the inputs like Virta are showing and Volek and Phinney and all these people like you've said all around the world, take away the offense from the mouth 'cause that's where it mostly comes in.

And the whole system generally starts fixing itself. Now, you'll have metabolic damage from long periods of type two diabetes, and as a molecular memory, you can't always go back to someone who never got it. But you can manage it to keep it non disease driving, you can get your insulin glucose down, and you can get the control system back again, we know this. And you can do it with diet, but not the diet they tell them to use, right?

Geoff

No, a perfect segue. I was actually going to just go into that. We have an assessment of the crime scene. Now, how do we prevent the crime from even getting started? Diet one of the primary inputs that we can control, what should we do there? What the standard recommendations are? I think we've kind of teasing about this is that, lower carbohydrate intake seems sensible given the evidence here, and because nutrition dietary consumption is zero sum if you're having low carbohydrate load. You necessarily need to replace it with either higher fat or higher protein load or some other substrate like ketones.

It could be an interesting kind of fourth macro that is coming, that's something that we've been thinking a lot about. But I think the fat summary is probably a good place to start because I think that's where the most controversy is. If you look at diabetes.org, which is the American Diabetic Association website, they'll have good fat, bad fat or healthy fat, unhealthy fat. And then the healthy fat area ... Or let's stay with unhealthy fat and let's unpack it. They'll write, "Cholesterol is, unhealthy, trans fat is unhealthy, and unsaturated fat is unhealthy." And then for the healthy fat area, they'll write, monounsaturated, poly unsaturated and omega three fats. I think probably especially cures that trigger thoughts about is, what are the fats that you would agree with? I imagine you would agree with some other critique on trans fat. But I imagine you'd also disagree on characterizing PUFAS or poly unsaturated as a fat to look to add into your diet. Can we unpack that a little bit?

Ivor C.

Yeah, Geoff. Yeah, the fats wow! Basically you agree that the trans are bad but that's a no brainer. It's almost you give them that but come on, it's obvious. It's been said, excuse me by Mary Annick and by other researchers, 40 years ago lost positions in university for saying that trans fats were a problem, and now they're banning them, finally 40 years. Trans fats are not good, but I would say that industrial seed oils, the industrial linoleic acid and omega six that are extracted from seeds with high pressure temperature, hexane, in the process they get so stinking that they nearly pass out and they use deodorizing chemicals and bleaching washes to deodorize the scum that they make, so that we will not be worn not eat them. That's the way I look at it.

It's crazy industrial process. These omega six polys and let's just say we agree with the omega three. There's an argument you shouldn't have too much omega three because it's a signaling molecule and shouldn't be a fuel and it also is delicate and too excess prone to oxidation. You should have enough but not too much, but let's say omega three is good. Certainly, it's pretty good. The omega six however, is exposed as the polyunsaturate to those hydrogen bonds. You've got the double bonds, it is delicate exposed to oxidation, it becomes incorporated in all of our cholesterol particles in the shell.

And all the fats in the cholesterol that's in atheroma, atherosclerosis. They're all poly unsaturated omega six basically that's just the way it is. Because the saturated are stable fats and they don't really oxidize, it's the polys that are the potential challenge. Now if we take these omega six poly, I did a two and a half hour podcast with Tucker Goodrich on this single topic a few weeks ago. People can go look at that, but essentially, we had around a half to 1% of energy in our diet from omega six poly in evolution. And we have gone up to 10 to 14% now.

Geoff

Primarily from things like soybean oil, canola oil, the seed vegetable oils, just to clarify.

Ivor C.

Exactly and I think we can say a blanket statement. Tucker might disagree. But if you just eat some more of the natural whole foods as part of a good nutrient dense diet that happened to have omega six, I don't consider that something to worry about at all. You're right, the overwhelming influx of omega six linoleic acid into our diet is from vegetable oils. So soy oil has gone up a factor of believe it or not, a thousand since the late 1800s, and it correlates pretty much all the way through with obesity and other disease. Ironically, while they tell us is good.

Recently soy oil, an industry body came out with a genetically modified soy bean oil, a new one. And this is industry and they claimed that their new genetically modified soy bean oil is less obesogenic than traditional soybean oil. Without realizing it, they acknowledged that soybean oil is obesogenic in animal models and in humans. But there's loads of papers on this with mice in 2013 to 2017. One team took mice on low, medium and high fat diets and they put in 10 to 12% of poly unsaturated omega six verses 1%. And the reason they did it was, they said in their abstract, "We want to model in animal models, the current consumption of omega six oils versus the evolutionary one and we want to see what happens.

On low fat diets, on medium fat diet and on high fat diets over a few years all was the same result. All the obesogenicity or the driving of obesity and liver fast, all went with the 10 to 12% poly, and they fixed everything else constant. I mean, this is proven anyone knows it, then you have industry coming out and admitting it and saying they've got a new concoction GMO that's not as bad as the old one. This is at the same time that the authorities are telling us to hose these into our bodies up to 10, 15%. It's kind of absurd from a scientific viewpoint, but they believe it because of some badly wrong trials 30 years ago, that seemed to show a slight drop in cardiovascular events over two years. What they're missing is, the long term obesogenicity, liver damage and everything else that's going to go bad. And even, it's argued in many papers when animal models cancer, that are the long term consequences of taking in these oils.

Geoff

And I just also want to underline the initial statement that you said that, it takes a lot of hyper processing, they get these vegetable oils. If you just think about it from a very lay perspective, I know where the animal fat is, I understand that there's a piece of saturated fat on the steak, but where is the oil in a corn or in a soybean? I mean, you're not just squeezing out oil from these things. So just from a very intuitive perspective, where are these oils even coming from? It's not like you squeeze a soybean, that it's like oil that just drips out of it where you squeeze a piece of bacon, get fat out of it.

Even from maybe holistic or natural way of living perspective we are kind of the soft intuitive side of nutrition, these oils don't even really exist in nature. How are you getting 15% of calories from this? And that might be avoided just like convince some folks out there 'cause it sounds like, "Okay, saturated fat, we've been indoctrinated that animal fat, bad ... And maybe there's some argument on how to be nuance there. But this vegetable oil thing, these are very unnatural, strange substances.

Ivor C.

Well, yeah, I mean, that is a good way of putting it for the layperson. I forgot who gave the quote but someone said, "The idea that clearly modern diseases could now be blamed on ancient foods is inherently absurd." Of course, it's absurd. Our modern disease epidemics have exploded in the backdrop of greatly increasing refined carbs, sugar and vegetable oils. Who the hell could even think of blaming an egg, but they're still saying it. I chaired a debate over 800 in the audience at Low Carb Denver couple of weeks back, between Dariush Mozaffarian the Tufts University professor who's up there, relish as the God of epidemiology, and Gary Taubes on my left.

And we had a 45 minute debate and I got a bit involved myself. But Dariush Mozaffarian has come a long way and he said, "Look, saturated fat is not so much an issue." And I agree with low carbers and low refined carbs, I agree. We have a lot of common ground. The big thing that really annoyed the audience was, he maintained powerfully that vegetable oils replacing natural foods is good for you. And that's where a lot of the heat was and you're right it makes no sense whatsoever.

Geoff

Yeah, and maybe just to be balanced here just give guidelines and not go over extreme. I think in a low carb community, I think oftentimes we just focus on demonizing ... Or I think rightly criticizing and counter balancing. I think the shift where there's a lot of movement towards, carbohydrate kind of vegan style foods, which again, there's another discussion there but carbohydrate, low fat, that's a healthy way to go. But where do you see in the community that people are going kind of too far on the fat story? What could be the guidelines to just make sure that we're not becoming character of ourselves?

Ivor C.

Yeah. And I've been guilty of this a little too. There's a few things and myself in Dr. Gerber's book, Eat Rich Live Long, we call it out as well. A couple of things about fat, that if you're not seeking to lose weight, and you're healthy and everything's working fine for you, having a tone of fat is okay and maybe your bulletproof coffee. But don't ever think if you're trying to lose weight, that you'll magically lose weight by eating more fat. Fat is energy, it may be a much more metabolically safe diet to be low carb and a high fat and it may be less obesogenic. However, if you keep eating lots of fat and you enjoy your food, you'll put on weight. You may be a healthy overweight person, but you've got to burn your own body fat if you want to lose weight.

Geoff

It's still energy surplus.

Ivor C.

The calories in calories out model is generally an overwhelming lie because that's not what the problem is, but Coca Cola would like you to think it's calories and exercise. That's a lie. But calories in and out is true at certain levels.

Geoff

I think the hormonal insulin carbohydrate model and the calories in calories out, I think there's some combination that makes sense, right? You don't eat infinite fat and still lose weight, there's some level that you have to control the amount of calories in while looking at the hormonal effects of the types of calories. I think there is some reconciliation there. I think you would agree with that right?

Ivor C.

I would and it's a system and you know what, there is individual variability. While I think that for a modern population, because most people are metabolically ill will benefit from a low carb healthy fats diet, there are people who can make a very low fat high carb diet work from whole foods and they can achieve insulin sensitivity through a different route. I just think it's a bit precarious and not very nice way to live. I'd always say it's better low carb. But like I say there's variability and people. Some people may be able to be really casual and eat all the fat they want and they really don't put on weight. But then other people who are insulin sensitive obese and myself and Dr. Gerber talked about this quite a bit in the book.

If you're insulin sensitive and overweight, your body may be perfectly happy to store plenty of fat for a future famine that may be your makeup. And if you eat all the fat you want and you enjoy your food, you might stay good and fast. And then you complain that the magic low carb isn't working. Low carb, high fat works better for people who have metabolic disruption, insulin resistance syndrome. And that's where simply switching our macros can greatly improve your health and also see very substantial weight loss and also that type of macro and a lower carb, higher of LD fat can enable you to control your appetite to allow you to eat less.

There's many moving parts and it can be great, but insulin sensitive obese people they have to start burning their body fat and that means you go on a low carb healthy fat diet, but you start pulling the fat back in your diet, and you replace the dietary fat with body fat. There's no getting around it. And another point is we were careful in the book to acknowledge the satiety factor of higher protein. Now we're a little careful because there was a lot of talk about mTOR and cancer with higher protein at the time the book was coming out and I think we're a little careful about pushing the high protein for weight loss. We acknowledged it and showed the studies where clearly a higher protein diet helps with satiety and weight loss.

But now I think Dr. Ted Naiman and he's great on this, he said the best diet for weight loss is a low carb, low fat diet and tend to have higher protein type foods for weight loss. It ties him over what I said a minute ago. You've got a low carb healthy, highish protein diet and it's high fat. You want to lose weight, start pulling back the fat element and replace it with body weight. It all links together but it can be very confusing for some people 'cause they want to know well, what's the macro? It does not own macro.

Geoff

I think that's an interesting point when I talked about ketogenic diet versus fasting and sometimes people treat them as very, very separate ideas. But I think as you're saying, they're very, very related in terms of what metabolic pathways are attacking. It's the only differences, instead of eating external fat, you're just eating your internal fat. You're eating your internal stored body fat, right?

Ivor C.

Yeah, and that is so much the case. We actually did tables in the book with data showing that effect and in real life, as you reduce the fat and your body fat starts getting burned. You're still taking 2000 calories a day but increasingly, as you reduce the fast, you're burning more body fat. You're still on a low carb, high fat diet, keto, even, but you're actually eating relatively low fat, but your body fat is failing in, and that's so important.

We always say if you want to do the keto thing in myself and Dr. Gerber's opinion, do a healthy low carb, high healthy fats diet with plenty of protein and simply skip more meals to go keto. So rather than thinking psychologically, more fat to make me keto no ... You want to go keto, just do more meal skipping and fasting and you're already low carb when you do that it turns into serious keto. But it's the safest best way to do it through fasting. Pushing in fat and exogenous ketones, I mean, there may be a place medically for certain diseases for exogenous but funny enough, I think of Ted again. Ted jokingly quipped that exogenous ketones are today's empty calories.

Geoff

Well, I would say that it depends on the application.

Ivor C.

Yes.

Geoff

I think if you're looking at exogenous ketones as an energy replacement or substrate it is energy. But I think some of the exogenous ketones could be interesting for signaling effects or recovering from energy deficits or for athletic performance when you can stack ketones and carbs at the same time. I think that is where the nuance is 'cause I think we make a ketone ester and my concern with a lot of the language around exogenous ketones, ketone salts out there is that they are selling it as a magic weight loss thing, and I think you're exactly right. This is still an energy substrates and it doesn't just solve the problem of eating carbs. I think with any substrate, there has to be like a nuance application of the product or any kind of thing that you put in your body. I agree with you there.

Ivor C.

Yeah, I know in fairness Geoff there are many specialized uses for that, but all I was referring to was the classic shove in ketones, make a bit more keto happen, magic weight loss. That's obviously simplistic and maybe misaligned but then for certain disease states. You said that they are, for specialized athletic performance which is something I don't really get into so much. There's all kinds of potential benefits for specialized purposes and many of them. But once the person knows they're doing a specialized thing, they know what they're doing, rather than just magic keto pills kind of thing, I think that's where the danger has been. That's all.

Geoff

No, I want to agree with you. It's not like okay, eat your normal diet, drink some ketone esters or drink some exogenous ketones, and you repair the damage. It's not that great. I wish there was something out there that could just do that. But that probably doesn't exist. But yeah, I think there's a lot of interesting work to be done in this space and maybe I want to get your quick thoughts and a couple ideas and I want to wrap up, in the respect of your time here. First, kind of rapid fire question. Carnivore, curious to hear your quick thoughts there. Obviously, it's been a popular topic of discussion over the last I would say year so in the low carb community, your quick thoughts there.

Ivor C.

Carnivore, you've got to be careful here. I think it has merits I mentioned that myself and David, my boss in terms of we're targeting the people most at risk for heart disease who have big disease. And there's certain evidence that extreme diets in people who have a lot of disease, diabetic dysfunction, they may have sensitivities, particularly APO A people, which 23andMe you can get the genetic test, it's around 17% of people. There's kind of a little caveat there, I'll mention that excessive proteins, fats, possibly for them they may be sensitive. It might be for everyone but that said, carnivore has a lot of merits. Now. it is a very extreme diet in many ways. I think it's dramatic and fascinating how it has helped the health of people with profound issues of autoimmune.

It almost seems like a magic bullet for serious autoimmune issues and I always say, I view it as the ultimate elimination diet. Forget your FORMAPS, that's just playing around. If you've got irritable bowel, celiac or severe autoimmune disease, or like I interviewed Michaela Peterson and released it a few weeks ago, fascinating story and Jordan's experience. I would say if I had a serious autoimmune type inflammatory problem, and I wasn't getting results, I would as an engineer, do the ultimate elimination diet of carnivore like say meat, fish and eggs. First six or seven weeks and give it time and see well have I dramatically improved my condition and if you do, then you say, "Okay, deep breath, don't move too fast here. I've got to be really careful now 'cause I know I'm sensitive and slowly add another foods and give at least a week to see 'cause you need ..." Michaela made it very clear, it might be five, six days before your reaction occurs. He got a lag time that kills engineers and problem solving.

Ivor C.

Give a lot of time and slowly introduce foods and any problems get worse again then retrace your steps, keep a diary. I just think of it as a potentially enormous tool for certain disease states that could be really powerful for everyone to start going carnival because it's the default best for everyone. Well, I'd wait on the date for that, I guess. What do you think Geoff?

Geoff

But I think it's interesting. I think they're asking the right questions and challenging the right paradigms. I think the notion of you don't actually need fiber. Look, it seems like the people that are doing it seem they're doing fine. I didn't have any issues personally, when I was doing a block of carnivore of four, I believe six weeks. I didn't have any problems with bowel movement. I'd say, it's an interesting and equals to one, these case studies, these stories just have broadened my perspective of what's possible or how little we know. I think it's also just flips into this side of people kind of think that a vegan diet is so great. There's not a lot of pushback in the same way there's pushback for carnivore and it's like, "Where's the RCTs? Where's the longitudinal data on vegan diets?

It is literally impossible to eat vegan back in the day, or you just cannot even forge enough calories from these things. From my perspective, it's reasonable. I don't think it's dangerous. I think either you're experienced, or have people around you that can maybe guide you through it, may be worth something to try, and see for yourself 'cause I've just realized over the last four or five years, diving into the space myself that love is personalized, love is dependent on your baseline of what your health is and then where you want to go. If you're looking to be a bodybuilder, you might have a very different nutrition strategy than trying to be a marathon runner or trying to live as long as possible. We all have to be sensitive to our baseline states and where we want to go. And then let's find the nutritional and exercise and all the other strategies that allow us to achieve our goals that's my thought.

Ivor C.

Excellent summary. Yeah, now that's exactly it. And David always reminds me that by looking out for the people like him who had huge disease, who may have sensitivities, if you want to save lives, you have to era on the side of safety. It may very well turn out that carnivore could be good for a person with major heart disease with lots of saturated fat but there are some signs it might not and you always got to go the safest route on behalf of those people. But then other healthy people like amber O'Hearn's carnivore and God help us with a zero calcium score Shaun Baker, big Shaun, and they have pulled out a ton of science, especially Amber, which in fairness, those counter the fiber argument, the vitamin C argument, and they've done amazing research work to counter all of the arguments against those, which is great to see. But I think you're right we let the science keep getting debated and I think it's a fair point to say that a vegan can call that an extreme diet any more than a carnivore can call vegan. They're both on polar opposites and historically an evolution no paleo anthropologist would ever argue with large-

Geoff

Whichever vegan. There's no way.

Ivor C.

There's no ancestral vegan people's at all and you could argue we're nearly old, if you go back far enough, we evolved through bone marrow and scavenging and becoming hominids and bipedal striding hunters. The paleo anthropologist who specialize in this almost to a man or a woman, just accept without a doubt that we evolve through the nutrient and energy density of animal foods. And then now that we've got here with flexibility over the ice ages, and over the millennia, we can make lots of choices now. But we got here, we have to access that super energy and nutrient dense to actually evolve, I think, is fair.

Geoff

Yeah, I think the data in the historical record, I think supports that. But I will say I think the strongest argument for the vegan side of things, is it ethical moral question around? Is it ethical to be enslaving animals and putting them in cages and all of that? I think that to me is the most compelling argument for that lifestyle, but I think when they step into this is healthier, this is more optimal for function that's where I don't see any evidence there. I think if you make the moral maybe the environmental argument I think that data is more nuanced. I think that seems like there's more ground there, more meat there to chew, excuse the pun, but the health side I think is a little bit of a stretch.

Ivor C.

It is and I wish they would use all their energy to argue about bad conditions for animals cruelty to animals, and even on healthiness of factory farmed animals with antibiotics and hormones, and focus on the real issues and just not try, and tell people they shouldn't eat in a ancestral way, properly reared meats, properly humanely managed. But they don't seem to stick to that, they seem to want to go for all the climate arguments and all of the nutritional meat kills you, arguments and it's not helpful.

Geoff

Yeah. And then one question I wanted to ask was, if you have infinite resources and infinite subjects to tinker with, what kind of clinical trials would you like to see done in the world? I think for me, I think some of the questions that you kind of raise up on exogenous ketones are ketone esters, I think would be interesting to me. I think there's researchers around like Stephen Cunnane or Mary Newport have looked at exogenous ketones or MCTs or precursors of ketones for rescuing brain energy deficit in Alzheimer's patients for example, as an interesting area. There's some interesting signal around traumatic brain injury and concussion prophylaxis with something like ketone esters or exogenous ketones. Those would be some of areas that I will like to see more work done. Turning the table to you if you had one, two, three studies that you'd like to see run in the world, what would they be?

Ivor C.

All right. Well, I agree with you. I mean, absolutely all of those disease states there's huge potential there of ketone esters and everything and ketone, salts, all that stuff. And for me, I'm more focused very much in my role and my job on the broad masses and that's diabetes heart disease and Alzheimer's but not necessarily trying to fix it but stop it ever happening and some of the cancers. But particularly heart disease I'd love to do a trial where I define the intervention and the control and do the control to follow the current guidelines, the food pyramid and have it very well tracked what they not just a questionnaire with six months, twice questionnaires.

Geoff

It could have been a metabolic board.

Ivor C.

I don't think I'm over the whole thing about metabolic advantage and needing to be an award I know Gary Taubes and GNA and they're all arguing. I'm not so worried about that, I'm not so worried about weight loss. I would like to put people on the control diet as per the orthodoxy and make sure that they are eating it and some track everything they eat properly, which often isn't done and I would like to choose the lifestyle route regime for the other group, and I would like to use healthy fats. I'd like to get sun exposure or UV, magnesium, potassium. Now I know it sounds multifactor Geoff, and I know you should change one factor but I'd love to put together my six years of research is around seven or eight factors including dietary. I'd love to put together the magic combo against the standard of care and just track middle age people.

Geoff

Oh, I have to ask them what is the Ivor Cummins stack of six eight things?

Ivor C.

Well, we had 10 rules in our book and I don't often remember them now 'cause so much water has passed since last year. But you eliminate all refined carbs, sugars and vegetable oils. So that's gone. Three eliminations, low carb, healthy fats. We won't define it here, but I'd have quite a lot of definitions as to what that should look like ideally. And then fasting is probably something you couldn't put in even though it's one of our big rules because you could argue it's cheating to have one side fast and the other not. In fairness you probably have to leave that out but the appetite control from healthy low carb well formulated and the ability to skip meals I think it's huge advantages, ketosis and everything else.

And then and some sleep stress. I'd probably accept that the sleep stress is randomized and not try and get people to sleep better and be less stressed not realistic. But soon I'd like to see with vitamin D lamps UV exposure, not necessarily vitamin D pills. I'd like to see the good group get UV exposure from FDA approved lamps, nothing on safe and get their vitamin D levels tracked and apt responding to UV which makes nitric oxide and vasodilation and many other folder products were not even sure what they do. Exercise then I think I would try and standardize for both sides. I know exercise benefits. But I'd like to see more of the other things rather than exercise in this trial.

So I don't know if I've covered them there and supplements is the other of the four S's. So song, supplements, sleep stress. So supplements you could, but basic ones, magnesium, potassium, some of the key minerals and K2. But in fairness she can't bombard your experimental group. But tones of supplements 'cause that would be going overboard, but a few key agreed ones, which I think are important, and I just get this, this combination of all the things that we have the best science for and patience against the Orthodox standard what you should do.

Geoff

I would love that and I almost just love to see what the orthodox ... No one has done an RCT on the orthodox, population. It's just funny when when people say, "Oh, what is the data on your recommendations like? Well, the standard orthodox food pyramid, no one's really actually done an RCT on that either. Everyone's just shooting from the hip a little bit.

Ivor C.

Yesterday I did a podcast with Bill Blanchet, who's an internal medicine specialist, preventive cardiology and a scanning specialist. He uses CAC all the time and he's all over it. He knows the value. But he said in 13 or 14 years with previous heart attack patients or high scores. He's only had one non fatal and one fatal case after he puts them on low carb, vitamin D, bit of niacin, low dose statin, da, da, da, da. I mean, he's basically dawned the wheat, barley or what we would largely agree with. And he said, I know it's not a published study, but I just have not since I started these regimens of low carb, et cetera, et cetera what we talked about, I just don't see repeat heart attacks. I have guys like who were in their 50s when they're the first one in the 60s and that's like 17, 18 years ago, no repeats. So I just wonder if you did it really right versus standard crap. What will they cardiovascular event rate carves look like? They could be just outrageous.

Geoff

Yeah, I love to see that data. I think that would save a lot of lives and would form a lot of people's lifestyle, or proven wrong here, and that would be great too. Let's see. Let us see. So this is a fascinating conversation. I know you have a book I know you have a podcast, you have Fat Emperor, both your Twitter handle and your website. How do people dive into, learn more about all your work? Where do people follow along?

Ivor C.

Yeah, well, I'd say if you Google, Ivor Cummins you quickly hit the YouTube channel, my website, thefatemperor.com and the podcast page is probably the big one there. I've done 14 in the last few weeks. I'm going to keep pumping them out two or three a week. One guest per week and one or two podcast shorts with just me With slides 10, 15 minutes on a health topic. That's probably a big thing. And next week we're going to revamp the I-H-D-A.ie website. It needs some love and attention. So we're redoing IHDA.ie and it will have a storehouse of all interviews with the top cardiologists and imaging professors and the free viewing of the widow maker movie, which I can give a link to you afterwards. So it's going to pull all the CAC information in one place, so I'm going to keep linking to that.

Geoff

All right, Ivor thank you so much for the time and keep keeping up the good fight.