Ivor Cummins at Ketofest 2017 – The Chronic Disease Spectrum: A Story of Root Cause and Solution

Ivor Cummins at Ketofest 2017 – The Chronic Disease Spectrum: A Story of Root Cause and Solution

September 13, 2019 90 By Ewald Bahringer


[Applause] well thanks to everyone for staying this long really appreciated I’m honored and I think it’s last and by all means least sometimes do I say so first I have a really important question to ask before I go ahead and the question is art and Carl and Richard just the coolest okay so I guess the pointer is not working so I’ll do this okay there’s the title yeah and I was gonna go into some heavy technical stuff and you’ll see in a minute but I’ve also included a story because I’m Irish so I’m gonna tell you an LG yarn as well okay hopefully up will be enjoyable so this is the material after cover and I’m gonna go I’m I love this stuff and I want to go true it and tortuous detail for 39 minutes and then I’ll do some light stuff at the end okay that’s a joke this would happen without a doubt especially late in the afternoon so we go ahead and we’ll do something a little different and I’ll tell you a story myself and how I got into this game back in 2013 and I hope you find it interesting and a little bit of science in there too so it’s not just a personal story so here was me going in to get standard blood test results back in 13 and it’s not a perfect likeness I never wear a tie but that was essentially how I felt because for many years I’d passed all my blood tests and they looked okay so I was here in my mid-40s feeling God and here’s a few measurements that were turned out to be interesting g-g-g-gia liver enzymes serum ferritin and iron loading in the blood and of course our old friend cholesterol and when I actually got the results from the doctor or the mg there were like this so I’ve been 25 years kind of leading teams and complex problem solving a date and that and although I didn’t know much about this fear I knew because I could see the lab reference ranges that these were really really high I mean they were outside the bounds so I kind of got a bit annoyed because I realized I’m hitting the jackpot here now as I’m talking to the doctor and they’re going true the stuff I’m thinking the back of my mind hold on a minute you know I’m thinking about the numbers and I know one thing straight away that these numbers are so unusual there will be some primary root causes not 50 causes they’ll be one maybe two primary root causes because that’s the way it works no matter how complex the system is there’s a few primaries and I immediately was thinking I’m gonna have to find those so I began to grill the doctor probably more aggressively than the average patient but I was either civil about it and when I got from from questioning fairly deeply was maybe hemochromatosis because Irish people it’s common it’s an iron loading disease for you hyper absorb iron from you’re got an iron is toxic when it goes to high levels and it destroys your organ systems so hemochromatosis people often die in their 50s and 60s from organ failure so that was a bit worrying but I figured well at least I got it now reduced the wine intake because most doctors really associate high GGT with excessive alcohol use now doc grossly underestimate its importance as a marker as I later discovered that’s a simplistic view and then eat more healthy whole grains for the cholesterol maybe so build that old cholesterol rubbish right and I went to a second doctor because I wasn’t happy with this while I waited for the hemochromatosis test results so again I got hemochromatosis I was still waiting for the results reduced the wine intake so we see again the darks GGT wine you know alcohol and made this person said it reduced the fact you know because for the cholesterol you know bit more of that riff so I still wasn’t happy and I went to a third doctor a very experienced person and pretty much the same stuff right now interestingly the third doctor said he’d been seeing serum ferritin rising inexorably and steadily over the past 30 years in Ireland particularly in middle-age men and he was really he was wondering what it was because he got them all tested for hemochromatosis and most of them were negative so he’s curious as to what that was what was going on and a couple of weeks later I was able to go back and explain it all to so so anyway yeah that’s actually true so we go ahead this is how I react where that the experts do not know and when I’m brought in to lead a complex problem you know I tend to get frustrated but what I have to do in those instances I have to get all the raw data from the problem and I have to analyze it myself so in this case I realized it’s the same as my work world I’m gonna have to research this myself because if the experts don’t have any clear guidance and by the way I got a negative hemochromatosis test so basically I got Jack and I’m gonna have to research it now the biochemical engineering degree and I for working with data and complex problem solving a long time so I felt I can go and do this just like I do in my work world you’ll see they’re in research gauge which I had a corporate log on to and there’s over 10,000 publications on ferritin so’s plenty of science out there and I know how to analyze it and there’s actually around 58 million for cholesterol and half of those at least are rubbish but yeah I went in and I began to research so the first one was cholesterol right which I didn’t know much about but apparently I was high bought very quickly i found the home study from europe and the last I checked I was the European so this was European sixty thousand over couple of decades and basically four men in blue and four women particularly in red the higher the cholesterol the lower D all cause mortality with no exception right and it was the same for cardiovascular mortality so I knew that a correlation with cholesterol must be very ambiguous because if you get an anti correlation there just can’t be a major problem here so I dug a little deeper into the LDL and I found out that if your LDL is high and sorry this isn’t millimoles and over to the right of the diagram there in the x-axis 5.68 if your LDL is right up to 250 milligrams which are HDL is high there’s no risk I’ve marked it in green there and this is middle-aged man and frame right and that kind of type of person I was so I realized that the ratio was crucial because LDL means almost nothing without the HDL I didn’t fully understand why yet so I moved on to GGT because I could see cholesterol at best was an ambiguous and probably noisy nuisance GGT however was really high I was in the top sent I’ll I researched and I found and I just remind people any associational study with America you want to if you’re over a 2x odds ratio you got to take it seriously I mean cholesterol might be a one point two X risk for being higher and that doesn’t really mean much but if you’re over 2x it’s significant and may speak to cause so some of the first papers I got in GGT this one here in heart failure showed 3 X 4 being above the median now that’s not like in the very top strata where I was that was just being in the upper half was a 3x risk and I knew from experience ok that’s pretty serious so I dug some more and I got this on coronary artery disease biggest killer in the world and you can see there does a 7 X 4 being in the top quartile and you can see the tightness of the error bars that’s a pretty hefty odds ratio right and it’s straight linear all the way up so now I know this GGT is serious here’s one from the early 2000s the Minnesota study and nine times the risk in the top quartile or quintile of GGG for coronary artery disease and I’ve already checked out cholesterol and the odds ratios are trivial so I’m kind of little disappointed with my doctors at this stage and this one kind of took the biscuit so from IBM I being in the upper quartile and I was I was at the top of us was a 15 X risk for future type-2 diabetes I knew that was a serious disease I later found out it causes most cardiovascular disease so this kind of shocked me really and you can see the interaction between body weight and GGT quartile GGT dominates the diabetes scene so I was pretty angry to say the least but I moved on to ferret and I figured well that can’t be too bad right not so first ferritin the top quintile is a 5x risk for atherosclerosis in this study and many studies and you’ll notice that when they adjusted for other factors he can see the solid versus the dotted line didn’t even change it so it had a strongly independent association with atherosclerosis and 5x is a big deal this one’s interesting you’ve got low LDL on the left there below 200 and high LDL on the right of both 200 milligrams right there really high LDL but your losses in this study they have no difference in risk the bars are the same height until you look at their ferritin now the high ferritin people in black with high LDL have a huge multiplier and even the low LDL people of a multiplier right so the ferritin is kind of mediating all the relationship between LDL and risk and that makes sense mechanistically because i went deep in the following months you know it’s in a strong indicator of inflammatory physiology so that kind of got me and this one for carotid arteries Gross’s nice study high ferritin 10x the risk in this study and I don’t show the pre menopausal women there but everyone pretty much knows the pre menopausal women of a much lower risk for heart disease right and I can argue what it is but I’ll tell you one thing the pre menopausal women here who at high ferritin had a 10x risk as well and they had no projection because the problem of atherosclerosis is an inflammatory wall as indicated by ferritin not so much cholesterol so now I’m really annoyed because I’ve got two got two Bingle’s okay I can write off the cholesterol but I got two pretty nasty risk factors so I was in Singapore on a business trip just following this first month research and I had crabs back then as well a chilli crab pepper crab yeah jumbo seafood Singapore I recommended delicious pepper crab so anyway I’m mulling over this you can see I was around 35 pounds heavier than I am now and you can see I was a pretty angry young man no I want to come near me during that period but what I did was to the next few weeks I dug even deeper and I went down many rabbit holes and I found out or discovered the metabolic or insulin resistance syndrome and I realized it was enormous ly important in today’s disease world and no one had mentioned it I realized it made a joke of cholesterol I mean the cholesterol isn’t really in the metabolic syndrome criteria because it just doesn’t really get in there and low fat diets made no sense for this type of problem which is near-universal in our world today and I realized we’d all been misled for decades I mean totally misled everything I thought about health was utterly upside down after my research so I then at a Eureka moment I hadn’t what I realized well not realized what you do when you create a hypothesis and it’s robust and you’ve triangulated all the data is you test the hypothesis with an experiment but first what you can do is test it with a virtual experiment you can predict something that must be true based on your research and then check is it true from the literature so I did I predicted and realized that serum ferritin GGT have to be powerful markers for metabolic syndrome even though I hadn’t yet seen that in research so I went ahead with targeted searching and of course they were on the Left ferritin here you see and as you move across you’ve got increasing criteria on severity of metabolic syndrome and it’s practically exponential for how ferritin I won’t read out on the right but you can see where GGG fits in to metabolic syndrome and a lot else okay so now I pretty much knew I was correct so I went ahead with an intervention and the intervention was going to be nutritional only because the docs had said alcohol but I knew that I didn’t drink a huge amount of alcohol I liked my red wine it didn’t make any sense to me mechanistically or intuitively that the wine could cause this crazy physiological response it just didn’t make sense so I did nutritional only I was on a relatively healthy high carb low ish fat diet and we eat well in our house traditional Irish meals yeah had the odd pizza and I certainly probably had a bit of milk chocolate now and then and I drank a lotta juice which I found a hood half quarts was kinda crazy I did the intervention and I switched to something I won’t need to describe to you guys right it’s a healthy fat low carb diet um pretty much dark chocolate for treats and cut out all the juices on the sugars okay and you’ll notice that I kept the wine constant right because I didn’t want to confirm my experiment by lowering though I there now yeah yeah you could say for science I I gave you could say I had other reasons to do that but no it was it was for science just like Dave just like Dave so anyway what I did basically and it’s a cliche now I know I inverted this guy right and I did the opposite I did Taylor it’s a little because I had a lot of knowledge now and of course I ate weak Ted a lot of the fruits the high sugar fruits and of course I made sure the base was solid I didn’t want any poor foundations in this this thing so I went ahead and here’s the guy insulin-resistant ferritin GGT belly low the subcutaneous fat I mean look at those arms and that’s not muscle believe me and I went to heaven I said right nutritional intervention what we got what are we gonna get so here’s my really bad markers and they know how about they are now so after eight weeks right not too surprising I have what and that’s to be expected because that’s the way the human body works but anyway but also the cholesterol which I had begun to deep dive into my metrics sorry they’re in European units which weren’t too bad cholesterol didn’t really show me open my problems they all got remarkably better which makes sense because when you get true root causes and you address them in processes and engineering anywhere often the thing you’re fixing gets fixed but many other beneficial effects occur because the true root cause is just multifaceted it will improve the whole system okay so at systolic and diastolic blood pressure for me I was always mildly hypertensive and I realized later that most idiopathic hypertension is hyperinsulinemia related not a lot of people seem to know that but I was always quite high unless I was training for triathlons and then I get it down but as soon as I wasn’t training hard to go back up again yeah but that came right down to really nice levels and the body weighed 35 pounds off on the waist down to around 32 interestingly the blood pressure fell in the first week long before I lost weight because the blood pressure is not driven by the weight the blood pressures driven along with the way by hyperinsulinemia and other problems so that’s what that’s important to know bruecke our solution approved and we got asked why why could I do that it doesn’t make any sense that the experts in the field of physiology can be so lost with standard blood tests and then I can do that in a few weeks and one reason is this turkey friend of ours and he had a head full of essentially junk science but that’s a big legacy and the legacy is still powerful only a couple of weeks ago the eh-eh-eh have come out talking some junk about coconut oil and it’s actually absurd it’s it’s become comical right if you actually understand the science so it’s still going on and you guys know that so I’ll go into beyond cholesterol then and some of these other things we’ve heard and look at more real genuine driver’s heart disease now I did do a talk a few years ago with the cholesterol conundrum it’s over an hour long but I went through all of the mechanisms of LDL and how the transport system works and Davis do a fantastic job abrogated the next level right but AB it’s on YouTube and I went through HDLs function as well it’s extremely extremely important as you can Google out if you wish but I won’t make you go through it today instead I’ll bring in a pal of mine you might not agree he’s the power but he’s a top lipid ologist in the States Thomas days bring a huge pedigree and cholesterol expert so I was delighted a couple years ago when I questioned them on some things and he clarified that the majority of heart attacks are due to connected to or related to insulin resistance right not really cholesterol and that was good I knew that but it’s good to see and LDL is a near worthless predictor for cardiovascular issues that could be very interesting to a lot of dogs right it might have heard that before and if it’s above 200 he’d claim it has relevance but that’s also debatable but we didn’t have to wait for Tom to come along because the 1996 William Castelli director framing and published a paper and I have a peer reviewed and he said this unless LDLs above 300 is no real utility in itself of predicting an individual’s risk so he jacked up to 300 and that’s pretty big glassful right LDL alone not total no one wants to hear him he also said this that the ratio of total to HDL and he didn’t get into trig over HDL but it’s very similar technically is a far better predictor than any of the other metrics not only in Framingham but in physicians and many other studies and it hasn’t changed since they all say the same thing right so the ratios are key Y I’ll show you here’s the women’s health study and you can see on the bottom the ratio of total and you can also see the advanced lipoproteins that Dave referred to and you can just see the ratios had much higher predictive power and LDL is kind of in the Dauntless seat of the top and even that one in other studies so that many studies shows no significance in this one it showed a bit right and one of the reasons the ratios are the main reason that are so powerful from the panel is this and here is a good study there are many the april-b over a PO a 1 ratio like total over HDL ratio is the massive predictor of your level of insulin resistance so the best thing you can get from cholesterol or even advanced lipoprotein tests by a country mile is as you use them to predict your insulin sensitivity right that’s the irony most people think they’re looking at cholesterol and they think it’s cholesterol stuff it’s not it’s mostly this so this misunderstanding going for 40 years is why we have this just to go months ago so heart disease burden is going out of control there 15 years ahead of projections Jeff mentioned 50% of Americans are gonna power disease in the coming years and they even said it’s outstripping their ability to combat it so I’d agree with Jeff they need to take their head out of the cholesterol hole and start getting with the science ok and maybe then we’d get some improvements so part three the real problem let’s just dabble a little in the mechanisms in the real problem so hyperinsulinemia insulin resistance is a state of being that is intimately connected to many modern chronic diseases and particularly heart disease this study very even was nice it was a few hundred middle-aged people they got them they split them into Turtles or thirds off their insulin sensitivity and they measured them with a very accurate steady-state plasma glucose test or a glucose infusion and it’s kind of like a craft test for you may have heard about dr. Kraft who was a good friend of ours it’s an accurate test fasting insulin and fasting glucose are not this is a proper one so we got to see some proper results so what happened as seven years later is the lowest third of insulin had no disease no death and actually no issues which is unusual for seven year tracking of people in their 60s you know it’s unusual because the problems went somewhere else but here was the medium insulin people they did a good bit of action going on here was the highest hurt off so he basically perfectly understands bear out here there’s no small numbers but statistical significance is huge for the trend because it was such dramatic result what were they diseases and deaths well or heart attacks cancers diabetes of course and severe hypertension all the diseases of modernity and we even called out in the end of his paper he said guys this is so important in chronic disease that we’ve really got to get on top of it but I was in 2002 I’m not sure who’s even read this so here’s another interesting one engineers always look primarily when you’ve got a major problem like say II test failures in a high-volume production with products you always look to the ones that are failing early in the lifecycle because if you have a lifecycle expected life the customer of five years and you start looking at ones that are failing at four point five years and accelerated testing you’re going a lot older noise in there right so you look at the early failures and yet they’ll most speak to calls this paper from Korea was was very good and they actually did that they looked at all of the things that are really important in young people who get accelerated atherosclerosis the early life failures so engineers would love this analysis and I did that’s what was called out in the paper and I’ve marked in red all the things that are intimately linked to this regulation of insulin and inflammatory problems and not cholesterol and they mentioned LDL but you kind of have to him your funding might be caught so but you can see there what’s important and he even showed the study and referred to many good studies one study the children between ages of six and 19 followed for 25 years having metabolic syndrome in youth was a fifteen X increased risk for coronary vascular disease after 25 year follow-up now again having a high or low LDL between six and nineteen might be a point nine or a one point two or it could be anything to be honest so that that’s indicative it’s an Associated but all the mechanisms and all the science back at all so dr. Kraft I won’t show all his data now many it we’ve gone through it many times before he did incredible work in the 60s and 70s and studied 15,000 people with 5-hour insulin assays and he cracked this thing way back but he made that statement those with cardiovascular disease not identified with diabetes are simply undiagnosed and that’s a powerful statement because in fairness not all heart disease victims are diabetic you know there are special causes and there other things can go on but I think he’s mostly right but let’s let’s see how right he is with a 2015 study and this is euro aspire and this is very important because they looked at all across Europe 24 countries ages 18 to 80 all heart disease victims coronary vascular disease victims right validated so you’ve got this perfect picture of all the heart disease across Europe and they looked at their glucose metrics now first they found out that are seven or thousand well a third of them are diabetic right that should tell you something already but they knew diabetes drove heart disease like nothing else so they said okay we’ll take those guys out we know we know why they of heart disease let’s look at the 4,000 non diabetics and let’s see what they’ve got going on the glucose so the people thinks there’s some hidden diabetics in there was Kraft maybe on the money making a few but they’re non diabetic so there shouldn’t be too many so when they looked at heard of them are full diabetic undiagnosed yeah and when they looked a little deeper they called them high risk for diabetes but they were diabetic trust me another turd were diabetic and would absolutely collapse a Kraft test and the remainder which is getting like small numbers now they never tested her insulin and as Kraft knows and we know unless you test insulin he can never be sure of diabetes the sailfin Gerber reckon half of those maybe more are also diabetic so roll the whole pie together bring back in all the diabetics and 81% are diabetic of all heart disease victims in Europe and the remainder hasn’t been tested for insulin so I think I think rafted pretty well as prediction wouldn’t you so I’m not even sure what’s next ah a little bit of mechanisms so I talked for a couple of years about livers being the seat of insulin resistance high currents from the Nemean leptin problems on the hollis dysregulation i only in the last six months working with Gabor Ordos II and hungry molecular biologists worked out that the adipose tissue is actually the initial thing that that Falls and it’s crucially important liver is still important but adipose is huge so we just look at a bit of that you have people who are metabolically healthy normal weight right they have got subcutaneous adipose tissue in the yellow there I’m too much of it because they’re apparently slim their insulin sensitive under low risk for disease right and their liver is protected by the radicals tissue from the food they eat even if they cheat a little or eat bad things okay it’s not inflamed their outer poles tissue we can take in the blows it can let out the energy it’s good right everyone wants to be that guy then we’ve got the metabolic ki obese normal weight now these guys are apparently slim right but their insulin resistant and their hyperinsulinemic and they are high risk just like a big heavy guy right the risk goes with the site with the physiology not with the apparent weight they’re so cool sorry Rebecca they’re subcutaneous adipose tissue right is beginning to get inflamed and they’ve developed Depot’s of visceral adipose tissue which you can consider like a second shield to protect your liver in your systemic system and they’ve got a problem right a big problem the next guys are classic they’re metabolically unhealthy obese you know very heavy people they’ve got enormous amounts of subcutaneous adipose tissue and even bigger v80 visceral adipose tissue they’ve got inflammation right a macrophage from immune components of common to try and mop up the problems with the adipose but they’re letting the bullets true and they’re getting systemic insulin resistance because their fat guy no longer protect them they’ve exceeded their for personal fat threshold and they’ve got problems and the really interesting guys are the metabolically healthy obese and basically what’s happening with them is they have not exceeded their personal fat treshold or their critical visceral adipose tissue treshold the cv ATT got some great papers on that and they have expanded our fat safely it is not inflamed they have moderate amounts of visceral which is not inflamed right and they are protecting their system their fat still working great so they’re the four types of people and it really confuses you know doctors researchers why some heavy people of no risk and this is why so I’ll show you one study I love and I’m gonna inflict it on you because I love it this is really great though here we have insulin sensitive obese people and insulin resistant obese like I just showed you there 45 BMI all big guys they’re all 45 years of age they’re not that old you’ll notice in the left column the insulin sensitive Opie’s have actually good biomarkers good as minor you know no problem trig over HDL is fine glucose infusion rate which is hugely important is way up in the healthy range insulin resistant obese are very different right look at their metrics that’s a heart attack when in the next few years no question about it I just included LDL just perform because as you can see LDL doesn’t tell you anything now what’s interesting with them is they even look different so the left has the insulin sensitive guy and you have a lot of subcutaneous adipose tissue that’s actually not inflamed and is healthy and it hangs outside folds the insulin resistant guy in the right though who has a problem has a much more kind of bulbous appearance and there’s a lot more visceral adipose tissue behind the muscle wall so they even look different and on the left at the bottom of the micrographs the insulin sensitive guy and these are the same scale these micrographs has adipose cells that are small and are healthy and there’s no black or blue between them so they have very little macrophage your immune system attack because they’re healthy look at the interesting resistant guy they’ve got hypertrophic expanded fat cells and when this fat cell expands the insulin signaling can no longer work within the cytosol and then immune system components come in and would you believe the people like this half the weight of their adipose tissue in their visceral compartment can be actually macrophage so half the weight of the visceral adipose is micro fiber immune system components and that’s the real problem when you exceed your fat tresh hold six fat safe fat and that’s what my cell phone girl Dan Ireland like to call oh this is a bit of a complicated graph but it basically just shows the insulin sensitive guys open the top right have the same glucose infusion rate as people with 25 BMI they’re metabolically okay and the insulin resistant guys down lower have a glucose infusion rate in the toilet their insulin resistant it’s not the BMI at all it’s the biology and the insulin leptin signaling and adiponectin so that’s the point one of the most amazing things from this study is and Dave know who will know this how often do you get a point nine HR squared in an experiment with a buncha humans there’s so much variability and never get up there never but the guys found that two measures out of all the biometrics they measured just two of them together could predict ninety-eight percent accuracy how insulin resistant or sensitive these guys wear and it’s the serum adiponectin which is a hormone released by healthy fat cells and greater amounts and the percentage macrophage in the adipose tissue which I showed you those two measures can entirely predict your health level and they are both measures of adipose tissue health whether you’re fat or not is not important how healthy is your adipose tissue so I’m going to introduce you to the spectrum we’re all on the spectrum if you can push down the bottom left you’re gonna live longer you’re gonna be more productive you’re gonna feel a damn lot better if you go up on the right not so much on the bottom left we have people who are truly non-diabetic they’ll pass a craft test a 5-hour insulin a say they have exquisite insulin and leptin signaling their adipose tissues in great shape in the crosstalk between a radicals in their liver and all of those are deeper kinds are all working those guys live long right if they don’t get eaten by a line or whatever open the top right we’ve basically got full-blown diabetes wheels off the wagon right and this is disaster ville and that’s the end of the spectrum where all hell breaks loose right and a lot of guys be familiar with that basically bottom left if you can get down there you got healthy hearts very unlikely to of heart attacks good health longevity vitality productivity all the good stuff right there’s a lot to play for here open the top right you got the M eyes the strokes he got type 3 diabetes Alzheimer’s you’ve got cancers much higher rates you got all the bad stuff and lack of productivity and lack of quality of life it’s a lot to play for on the spectrum as note again that on the bottom left you have big uns small people right it’s not your weight its how healthier tissue is okay in the middle same thing heavier slim all that matters is your insulin signaling and the measures I talked about and on the top right you got highly hyperinsulinemic insulin resistant people that are slim or fat I happen to be in there somewhere right I was flagged by the serum GGT in therapy I later got a calcium scan which is the ultimate test of where you’ve been on the spectrum for how many years my supporter David Bobbitt who’s enabling myself and Jeff to do the book on Jeff mentioned and attend places like this he got a calcium scan and all of his metrics were fantastic even as hba1c but he got a one-off calcium scan me find out he was in the worst 1% for his age for cardiovascular disease because the calcium scan never lies right the markers can be all over the place depending on your genetics and your behavior profile at nature he found out few weeks later his postprandial glucose and insulin were through the roof so he’s an undiagnosed diabetic like the tens and hundreds of millions who died of heart attacks without ever being diagnosed but what about you our four doctors in the audience what about your patients how do you how do you see where they are so as I mentioned you can get a calcification scan that’s the last word on the bottom right I’m just showing you can have not one two or three risk factors in this study and all the studies say the same and as you’ll notice having more risk factors the risk of mortality slightly Rises I cross the yellow bars the green bars yeah does they have some utility but going back into the page or calcium score obviously overwhelmingly dominates on what’s really going to happen to you and this is all cause mortality same for cardiovascular mortality you’ve got 10 15 X risk estimations based on CAC the risk factors are honest are very professionally judged and triangulated many of them they’re highly fallible and Jeff showed this earlier in this study very reason from the cardiology imaging Journal you’ve got between low and high else occasion up to a 37 axe risk of heart events so as you know risk factors give you a 1.5 or a 1.8 calcification is the last word you can also use besides the calcification test to see where you are and check back later there are a lot of very good metrics that if you triangulate them all and you can get good in all of them and they do involve postprandial or pulsed drinking glucose are the most accurate ones you can be pretty sure if you get all these right it’s highly likely or down the bottom left okay they’re good metrics I won’t read through them but how do you fix this so let’s say your metrics are kind of bad what kind of things do you do am I gonna finish with that what would I do and what does Jeff do and you’re probably familiar with some of these before I go into that I’m just gonna say one thing that it’s not that the hyper and slimming insulin resistance necessarily causes all the dysfunction one interesting thing is that hyperinsulinemia Instant resistance is a fantastic gauge for the human and I give an example if you have dysbiosis and leaky gut and you’re getting lipopolysaccharides and bacteria into your blood supply right you get an immune reaction and they have shown in interventions not associations that that will raise insulin insulin resistance along with the immune reaction and if you have oxidized lipoproteins that will trigger insulin resistance and increased insulin so insulin and insulin resistance are in a fantastic gauge if engineers were making high volume humans they would be looking at insulin metrics overwhelmingly to ensure production line quality it’s a great gauge as well as a causal factor high insulin causes problems so just to say it as does both those things in there you can’t switch off your microbiome and fix it really except for the people who are transplanting feces or some of that weird stuff ahem so you can’t switch it off so what do you do well you do a lot of things to get yourself down the bottom of the spectrum and fix all bolts the first few are myself and Jeff eliminate refined carob sugars eliminate processed foods not the ones Nick was referring to I’m talking about the bad stuff you know you know what the bad processed foods are you know it’s not like when you’re nice to Spain and you get this lovely cured sausage you know what they are and America is particularly follow them unfortunately and their Giles fair trials are no place in the human refined vegetable oils whatsoever for many many reasons I won’t get into so their eliminations the next thing you do is low carb healthy fat and high quality protein we favored animal products for the highest quality protein but you know you can do it vegetarian if you’re careful and this basically will not only give you the best chance to move to the bottom of the spectrum or fix dysfunction if you’ve already become diabetic right and if you’re very diabetic and very dysfunctional you need to push maybe to the keto into the spectrum whereas a lot of people might get away with low carb Salters choices this will not only though help in that way it will help at appetite because when I switch to this regime and in two or three weeks I realized I suddenly had an exquisite control of my appetite it was actually quite shocking I could not believe how I could skip meals so parent to my rapid waste loss it was the intervention but the intervention enabled meal skipping which accelerated my weight loss but it was the type of food that allowed me to not eat it can’t do it on a high carb diet at least I never cooked for 20 years so that’s really important and I’ll show the next one fasting behaviors of myself and Jeff call it meal skipping keep it simple you know you have your evening meal the next morning you just got some cream in your coffee you skip breakfast it maybe get launched some days right now the last I ate was yesterday at 6 p.m. so I’m kind of doing a 24 hour with no eating roughly speaking that’s fine I feel hunger I feel ghrelin hormone released for my stomach you know I feel the hollowness but it does not affect my mental acuity you know it makes me feel good I feel energized I feel excited to be here with you know that was an impromptu jaw so but you can see what I mean I’m obviously not feeling tired and lethargic and I haven’t eaten in 24 hours so I usually fast for 24 before I do a talk or a big meeting that’s going to be very stressful because I want to go in have my best you know interesting so fasting at the last three I won’t get into detail but there’s some sleep and stress they are very important factors which can completely scoper your efforts in spite of eating the right food now some people can get away with murder with those when I went through a period of 18-hour days around a year and a half ago managing a big issue huge stress didn’t get much sleep I put on like around 10 or 12 pounds now I was conscious often I let it go cuz it didn’t bother me because the emergency was so big I was working on but then I pulled it back down later but but certainly sleep and stress and all it’s a big problem for a lot of people exercise I’d recommend Ted Neiman’s routine on burn fat not sugar he has 15-20 minute routines with no equipment you do resistance type training okay you do squats you do lifts you do press ups and you do it a few times a week 15-20 minutes it boosts mitochondria muscle build up and you don’t need to do a whole lot if you do the right exercise and supplements I won’t go into detail to be in the book but we have a lot of favorite ones are particularly potassium magnesium and the salts if you’re on a low-carb diet or a keto diet is hugely important and it’s caused a lot of people to fail to not be adequate if you do all that and that’s gone wrong the fountain anyway there is ancestral health which can be achieved by anyone if you understand all of the levers and if you apply them properly you can get there right the overwhelming majority people can get down there and if you don’t unfortunately you pretty men oh one last thing there are metrics as well to tell you your way points in the journey and those calcification to tell you every couple of years that you’re not progressing so there are measures there but if you don’t do that you’ve got metabolic me I’m awaiting you and sadly unfortunately the majority of adult Americans and the majority of people in our world today are pretty much just heading inexorably up to that end of the spectrum and they don’t need to they just need the knowledge and they can move to safety thank you [Applause]