At the recent Real Food Rocks festival (#RFR19), Christopher Kelly from Nourish Balance Thrive asked me to chat about identifying, stopping and perhaps even reversing heart disease. No Problemo! Christopher will be releasing on their podcast in a couple of weeks, but he kindly offered for me to release it too.
00:01:00 Is “Eat Real Food” the unifying phrase or approach for all?
00:02:20 A summary of Cardiovascular Disease – a modern disaster – Insulin and Glucose are central
00:05:35 Smoking down, toxic food supply up
00:06:33 The Glycocalyx revisited – and focal atherosclerosis
00:09:10 Cardiovascular Disease as an Autoimmune problem?
00:11:10 Know Your Score – a low versus a high score in CAC
00:13:00 CAC in the UK – demand is rising!
00:16:00 Crazy statistics on CAC and Risk – New 2018 Guidelines
00:19:00 What a zero CAC means – and the old “Soft Plaque” chestnut
00:20:50 Low Cholesterol with huge disease, super-high cholesterol with nearly no disease
00:22:10 Dealing with a high score – psychologically and otherwise
00:26:15 CAC – breast cancer and heart disease identification
00:30:00 New Documentary: Reversing CAC and heart disease
00:32:35 A new paradigm for the next decade – widespread CVD reversal?
00:37:00 Exciting new TV & Movie Format – spread worldwide?
00:42:00 Machine learning to predict degree of CVD in people?
Christopher Kelly 00:47 Ivor Cummins, fantastic talk here at the Real Food Rocks Festival in beautiful Lake Windermere.
Ivor Cummins 00:55 Yeah, the Brathay Hall Estate. Very nice indeed. I agree.
Christopher 00:58 It’s absolutely incredible backdrop. Maybe I’ll get some pictures that we can share with people how beautiful it is here, really enjoying the Real Food Rocks Festival.
01:07 What do you think about this idea of real food versus paleo or keto or anything else that you’ve seen? It’s like people have put a name on it, haven’t they? I think I do want to get behind real food or like all things I’ve seen come and go, I think that real food might be the right brand. What do you think?
Ivor 01:22 Yeah well, I agree. Real food is kind of all embracing. So we’ve got people who are vegan and vegetarian and then even carnivore nowadays, and they’re all eating real food.
Christopher 01:32 Yes, that’s unifying.
Ivor 01:33 Yes. So I think like people who have severe disease and they want to change their lifestyle, they might go with an omnivore, a meat heavy diet, they might go with a very healthy vegetarian diet with the right supplements or even vegan. But there’s lots of ways to take away the standard American diet and start resolving your disease. So it would be nice if you’re all united in just eating real food, the right foods with the right magnesium, potassium, the right nutrients, nutrients dense and get away from this kind of faction fighting. I agree.
Christopher 02:04 Right. You’re just no bogeyman.
Ivor 02:05 Yeah, indeed. And it’s gotten pretty hot there out there, because I think people who have ideologies they are fighting for their corner and their belief system. But it might settle down now and everyone just gets behind the real food message, perhaps.
Christopher 02:22 Talk about cardiovascular disease. Why should we care about cardiovascular disease?
Ivor 02:26 Oh well, yeah, biggest killer in the world. Cancer is giving a run for its money in the past couple of decades. But they’re all modern chronic diseases with common soil or similar root causes from environment and nutrition, broadly, not so much genetics. So cardiovascular disease, in Medscape last year, I remember putting up a slide in Breckenridge, Colorado. And it basically said in Medscape that the rates of cardiovascular disease are going beyond our ability to control them. That was a quote, and they said, we’re seeing rates in 2015 that we decades ago predicted for 2030. So, it’s a massive issue. And other autopsy studies have shown that from the 70s to the 90s, subclinical or non diagnosed atherosclerosis, vascular disease in cadavers was actually falling down. But from the 90s, it began to rise again. And now we’re diabetes, obesity and all our problems, it’s rising again. Heart disease is a huge deal. Yeah.
Christopher 03:25 And have you got a two or maybe five minute elevator pitch? What causes it? We just talked about real food and keto and all of that kind of stuff. And I think sometimes they’re a little bit quick to jump to that is the treatment for cardiovascular disease. But can you explain what causes it?
Ivor 03:41 Right. Well, the causes, if you look at the causes in terms of biochemically or physiologically, they’re not food. The causes are, one of the big ones is hyperinsulinemia or high blood insulin and insulin resistance, often resulting from high insulin or other issues. And high blood glucose and particularly spikes and blood glucose after a meal, there’s a lot of evidence to suggest that a steady slightly high blood glucose, maybe not so bad, but big spikes and drops in glucose, which you associate with diabetic physiology, they can be very damaging through glycation and damaging of your cholesterol particles. So the insulin glucose access and all of that diabetic type physiology, that’s probably the biggest driver bar known. But then there are many other drivers as well, I mean, autoimmune conditions, lupus, arthritic conditions, anything where your immune system is overactivated can have a knock on effect of damaging your vasculature. So there’s a lot of that old soul. Heavy metal contamination being acknowledged now, the lead over the 70s and 80s, and [Inaudible 00:04:48].
Christopher 04:45 [Inaudible 00:04:45]
Ivor 04:47 Yeah. And in fairness to the world, they did wake up and they took all the lead out, but it’s suspected now that caused a huge surge of cardiovascular disease. But in the 20th century, the real rise in cardiovascular disease besides the triad of refined carbs, vegetable oils, and sugars, there was of course, smoking from 1900s up to 1970. There was a huge rise in smoking, which drove masses of heart disease. And a lot of the fall in heart disease are leveling in the last 30 years has been the huge reduction in smoking. Yeah, there were medications procedures, but a lot of it was smoking cessation, but now we’ve replaced smoking with our massive problem with insulin and glucose in the population.
Christopher 05:33 Yeah, I’m starting to notice it now. The reduction in smoking when I first moved to California 15 years ago, there was a huge difference. They’d already banned smoking in public in California. Whereas before in the UK, you sit down at a restaurant, there could be someone smoking like really close to you. Like, “What the heck?”
Ivor 05:50 It was insane. I mean, everywhere… I was in San Diego working with Hewlett Packard in 1996, and on New Year’s Eve ‘96, they brought in the first ban in California, in bars. And people suddenly have to go outside. It’s a long time back. From the 70s and 80s, with the Surgeon General warnings, that’s where the real drop in smoking happened. And then you saw the drops in lung cancer following that. And of course cardiovascular disease began to recover, or at least level off.
06:18 It was a huge factor. But I agree, it’s way down. But now we have new demons to deal with.
Christopher 06:24 So talk about the glycocalyx that didn’t make it into your talk today. But I find that incredibly interesting. And I have heard you talk about the glycocalyx before. And I wondered where it fits in terms of the key risk factors. So obviously, hyperinsulinemia is involved in smooth muscle cell proliferation and all of this stuff that leads to disaster. I wonder whether the first step is the glycocalyx, but it’s still what you just said, right? If you send these huge glycemic spikes and you’re stripping away the glycoproteins layer, then you can damage the endothelial cells. Obviously, you don’t think it’s important enough to go into your talk that you gave today. Do you think that hyperinsulinemia is still more important?
Ivor 07:04 Yeah. I think the glycocalyx is a fascinating part of the process. And I do have a paper, well, I’ve tens, if not hundreds of papers in glycocalyx now, which I delved into last year. But essentially the glycocalyx, you know, the paper I have, that’s really good summary – glycocalyx issues are the first step in atherothrombotic process progression. So there are papers out there and it’s arguable that the very first initiating step of having a problem in your artery is that the glycocalyx is damaged in that area. And it’s sieves or it controls LDL particle access to the inner wall of the artery. It controls by fluidic mecanal sensor, moving in blood flow. It actually releases nitric oxide, and it brings in inflammatory components and allows them access to the wall when there’s an inflammatory problems.
07:58 It’s like this slick shield, a nonstick shield, but with loads of signaling functions. It’s amazing! So yeah, if you do something to damage your glycocalyx, and certainly the papers are out there, blood glucose spikes is the classic one. There’s not much research on it though, because it was so delicate, it wasn’t discovered until 20 years ago, and there was no real drug to help with it so it didn’t get a lot of focus. But the glucose spikes is the one true thing shown to damage the glycocalyx.
08:28 Another interesting thing is atherosclerosis is focal. So you can have an enormous atheroma that’s going to kill you tomorrow, in your artery, in your tube. And right beside it or across the wall, the artery is perfectly healthy. And then two millimeters away of another enormous atheroma that could kill you. And all around it, the arteries are healthy.
Christopher 08:49 Interesting!
Ivor 08:49 So it’s very focal. And there are papers as well, which have tied the glycocalyx thinning at branch points to the focal nature of where it occurs. So yeah, it’s very important I’d say and it’s a very important step damaging it of initiating that damage to the wall that leads to atheroma and these pustules, yeah.
Christopher 09:11 Yeah, that’s incredibly interesting. You talked about cardiovascular diseases potentially having an autoimmune component. Tell us about that. I wanted to expand on that when you talked about that in the [Inaudible 00:09:25] this morning.
Ivor 09:25 Well yeah, I interviewed Gabor Erdosi who’s a microbiologist in Hungary, and he does deep research that makes me jealous. But yeah, more and more it’s coming up that autoimmune conditions carry a much higher risk for atherosclerosis. And it’s arguable that your immune system over responds when it’s chronic. So the immune system responds to insults. The inflammation is not the problem, it’s what caused you to have an inflammatory response. And if that’s acute, it’s perfectly correct. You get a [Inaudible 00:09:59], it swells, it gets painful, inflammation occurs, but that’s to resolve the issue.
10:05 So if your immune response is to resolve an acute issue, that’s great. And it’s an amazingly powerful machine, it’s a terrifying weapon, our immune system. It’s just incredible. So if it gets over excited in a chronic sense, it (through many mechanisms) can actually enhance the atherosclerotic process. So more monocytes, more macrophage, the immune killer cells coming in to engulf cholesterol, entrapment of cholesterol. This whole inflammatory cascade is intended to fix an acute problem, but it would appear that it is actually making a problem worse when it’s continually chronically stimulated. So there you have lupus and arthritic conditions, and even psoriasis now intimately linked to atherosclerosis progression. A whole range of immune conditions. So when your immune system, the most powerful weapon in the world is overactivated, there’s many pathways where it will actually exacerbate the situation. That’s kind of a simple summary.
Christopher 11:08 Talk about know your risk, how is that message being spread? How well is it being received? Are people going to get their coronary artery calcium scan? I had one done recently and it was zero, of course.
Ivor 11:20 Of course!
Christopher 11:21 I would have been very upset with everything less than a zero. And the reason I say that is because, I mean you showed in your talk that by the time you’ve got calcification, you’re pretty far down that disease process, right? And it’s not necessarily true that there’s no disease there and a zero score at age 43 is just telling me, “Well, you’re not completely screwed but you’re not necessarily all in the clear either.” But, talk about the coronary artery calcium scan, and are people… I mean, are you going and doing talks like you did just now and people are rushing out and getting them done?
Ivor 11:50 Generally speaking, yes. I mean, it’s a long term battle to get the message out there because for many political and economic reasons that scan was kind of fought against by the medical business and pharmaceutical for 30 years. And the Widowmaker movie, if people Google “Widowmaker CAC,” those two words, they’ll get a one hour version of the movie. And that explains all why we have a problem with awareness, all the conspiracy stuff, but it’s actually true.
12:15 So that’s one problem. So I’m pushing to get out there. And yes, the answer is I’m getting more and more emails, messaging in Facebook, streams of people coming back with their scores, hugely thankful to David Bobbett and IHDA, and myself, for getting the message out. It’s hard to quantify exactly how much but I had a beautiful comment on YouTube recently, and in the UK, on IHDA.ie, the website, all your resources are on the homepage for the calcium scan – the professor’s discussing, explaining but we now have all the scan centers in Ireland, UK and America couple of hundred in an interactive map. And one person came back to me and said they went to the lowest cost in the UK, which we recommend, the Rivers Hospital and said when he got there the lady was lovely. They’re still at 230 Sterling and she said in the last year or so they are inundated with people, lacking for calcium.
Christopher 13:06 Already. That’s great! That answered my question, right?
Ivor 13:09 It’s a one data point, but she was bemused by it, not realizing why. And I think it’s been around a year I’ve been pushing for UK people, Rivers Hospital is the low cost one.
Ivor 13:21 So, I think across America as well. It’s a pity we don’t, like from my corporate world have the metrics to be able to measure, but I think we just know.
13:32 I’ll give another quick example. I had a friend in Corvallis, Oregon in Hewlett Packard, his name is Hugh. And he wrote to me on LinkedIn. He says, “Ivor, my brother is a senior registrar, you know, internal medicine in a hospital here in Portland. And I was talking to him about heart disease and he says, “Hey, you, you got to see this guy, Ivor Cummins.” Just two years ago. And he said, “Ivor Cummins?” hardly, and he googled, and he said, “Wow, my brother randomly in America told me I got to see you and he’s an internal medicine specialist.”
14:02 So we’re getting a lot of that all over the world, which is great. And the more doctors know and become aware, the more they can help their patients understand. Direct though to the masses is important too. This is great. 700 people here with packed rooms from my talk. It’s great, because this is less low carb keto kind of nerdy. Real food rocks is real people.
Christopher 14:27 Yeah, definitely.
Ivor 14:27 That’s what myself, David Bobbett and the Irish Heart Disease Awareness want to get to medical professionals and real people. The low carb keto people I think mostly have kind of got the message, because I’m quite known. But how do we get to the masses and save the masses?
Christopher 14:45 Yeah, so at the moment you just got people like me who, I think I went through your website and found a scanning center close to me in Walnut Creek, California. And I didn’t need a doctor referral, I just phoned them up and they said, “Sure, we’ll take $400 and put you in the CT scanner.” And that’s great. The only people who were there were all there to get their coronary calcium scan. So I don’t know whether… I should have asked, How did you find out about this scan? Are you really going to solve this problem at the population level? If it’s going to require people watching a one hour documentary and then understanding the value of the coronary artery calcium scan, and then going and paying good cash money to get their own scan done? Or is this going to have to be well, my local GP knows about it and they’re going to refer me, when it shouldn’t, if everybody was doing it like to run that CT scanner only takes, how long does it take to get the scan done?
Ivor 15:33 It’s a few minutes in the scanner. And then the machine algorithm calculates the score. So there isn’t really human involvement. It’s super fast.
Christopher 15:41 Yeah.
Ivor 15:41 And the machines are expensive, but that’s a capital cost and they’re there. And all they need to do and they do for many CT scanners is simply put into software, the protocol for doing a CAC. And yeah, I’d agree. I mean, people need to look at it like a couple of hundred euros or sterling or $100 up to 400 in the states.
Christopher 15:58 Yeah. Mine was actually very expensive because I’m in Silicon Valley, and I’ve heard it can be as cheap as 150 bucks in Denver, Colorado
Ivor 00:16:04 50 has commonly come up on special, yeah.
Christopher 16:05 Oh really? Okay. Well like you said, it’s like a fixed cost. If the CT scanners pay for itself, then yeah. I mean, cost of goods sold is basically zero, right?
Ivor 16:14 Yeah, exactly. And the thing is, the companies will begin to realize that, yeah, you got to work, you got to work the capital. And of course, the annuities or maintenance is not too big. So yeah, you want to get as many scans and save as many people as you can. But people just need to understand that if you have a high score, or a very low score, your doctor won’t know. You can look at your cholesterol and your bloods, but that’s guesswork. You got to scan, you get a really high score, your 20 times or more likely to have heart attack in the next 10 years.
16:41 And another thing I like to tell people from a really good study, an 80-year-old with a low score is around 20 times less likely to have an event in the next 10 years than a 50-year-old with a high score. So if you just think about that, there are 50-year-olds, myriad 50-year-olds walking around unknowingly, his cholesterol looks fine, who have 20 times the risk of a heart attack in the next 10 years than an eight-year-old with a low score. And no one knows, because so few are measuring.
17:09 There is one important point is not just myself and Irish Heart Disease Awareness, the 2018 guidelines, Cholesterol Treatment Guidelines in the US from the American College of Cardiology. Well, it’s the mega guidelines for heart disease prevention so it’s tied to cholesterol. But the key thing was that in 2018, they took coronary calcification scan, and they brought it right up to 2a evidence level. That’s really high. And they are now recommending as we have pushed for years for middle risk people, which is the largest group to be quite honest. Middle risk means they’re somewhere in the majority and no one knows whether they’re high or low. A calcium scan will take 70% of middle riskers and take them out into high or low risk, because it’s actually looking at the disease. So that’s an engineering tool.
00:17:58 So ACC/AHA 2018 guidelines have enshrined calcification and the concept of the power of zero. If you have a zero even with blood risk factors indicating a potential problem, you’re really low risk patient. And if you have middle risk, blood risk, and are not sure about medication or preventative treatment or the extent you need, when you come out with a really high score, you’re a high risk patient, bang at the moment. And you can just see that the you know, separating people out into what their real risk is and getting the proper treatment before they have a heart attack, that’s crucial. We can all jump in with catheters and you know, bypasses after the attack, and one third had died so we can’t do anything. But why go in later when you can use a scan and find out who we need to treat upfront? Maybe 10 years before they have heart attack. Maybe have them never have one?
Christopher 18:51 Well, that’s interesting. It seems that you would disagree with my sentiment then that it’s either bad news or no news.
Ivor 18:56 Yeah, the high score, I get a lot of emails, people, who got a high score and they’re concerned and all and that’s why I keep explaining. It’s not the high score. A high score means you now know and you’ve got a project to do.
Christopher 19:08 With a zero score means you know nothing.
Ivor 19:10 Well, the zero score knows you have a very low level of disease. So essentially in heart disease and heart attacks. It’s soft plaque in the interface between the calcified and soft plaque where most ruptures occur. The key point is if you have zero calcium, it means you have a very low burden of dangerous soft plaque. And the higher the calcium score, the more masses of soft plaque you have. The iceberg under the surface. The calcium is the tip. So if you get a zero score, you basically know you have a very low level of heart disease. So you’re very low risk. And all the data says this. It doesn’t mean zero, you can still have an electrical problem of a heart attack.
Christopher 19:48 Yeah, of course.
Ivor 19:49 You could have a single large atheroma from a genetic weakness at one spot in your arterial tree. We have had a couple of people with a zero score who went in six months, had a heart attack. Two cases we know off, they both had a single atheroma and completely clear arteries elsewhere. But none of this takes from the power of the scan. Because the scan is vastly better than the blood risk algorithms. Overwhelmingly. In fact, a scan result beats all of the blood risk factors put together and then some.
Christopher 20:21 Right.
Ivor 20:21 It’s an engineering test. It doesn’t mean it’s 100% perfect, because nothing is. But AHA/ACC, it’s in the guidelines 2018. It’s on ihda.ie website, you can see Medscape doc there explaining. It’s time is coming, the next 10 years.
20:39 The fascinating thing is we’re going to see a lot of interesting stuff when we start scanning people. Not only will we save the lives of the high risk by treating them before the heart attack, and we’ll also take people off unnecessary meds who got a low score. That’s all great. But we’re going to start seeing people with low cholesterol with huge disease, we’re going to see people with super high cholesterol with zero disease.
Christopher 21:00 As someone said in the audience today, “But they must have had familial hypercholesterolemia and yet zero on the scan.”
Ivor 21:07 We have many people with in terms of British units or eu, scores of LDL a 10 millimoles with zero scores in…
Christopher 21:15 So what’s that in old money?
Ivor 21:17 That’s around 400 milligrams. Well, 380 of LDL alone. Not total. But they’re getting zeros. Now I often have to stress, that’s not to say you ignore cholesterol. Cholesterol values are a very good proxy for insulin resistance.
Christopher 21:32 Right. “I want to know your triglycerides, I want to know your thyroids.”
Ivor 21:36 Yeah. If you change your diet and your cholesterol shoots up, it could be fine, like those people were talking about who actually have no problem. Or the cholesterol shooting up or the ratio shifting could mean your diet is not actually ideal for you, even if it’s low carb. So the cholesterol can be a warning to look deeper at your older metrics and certainly refer to CAC or progression to be truly informed. So it’s not to say cholesterol is completely rubbish, it’s just hugely misunderstood and it should be used as an indicator to tell you to go and look deeper at the real measures of disease.
Christopher 22:10 Talk about how people are handling, were getting a nonzero score, right? So I know Tommy has written about this before, it’s not really about the absolute score; it’s the progression over time. And you mentioned that again in your talk today. But how do people handle that psychologically when they go get a scan and it’s not the zero they were hoping for?
Ivor 22:31 Yeah, it’s a good question because some people are very pragmatic about it. They’re very engineer like and they say, “Okay, I thought I might get a zero. I’m a slim guy, didn’t smoke, and I was eating healthy food pyramid and I’ve just got a 900.”
Christopher 22:44 Wow! Is that really…?
Ivor 22:45 That happens. And their doctor thinks they’re bulletproof. My own sponsor, David Bobbett, who set up Irish Heart Disease Awareness, his campaign is because he was passing stress treadmills, ECGs and executive medicals and he was told he was top 10% of fitness, and he was really focused on health – nonsmoking, slim was when he was 20 at 52, and acing all tests and then he got a calcium scan, he got a 906, and subsequent angiogram, he had three blocked arteries, 1990 70% blockages. The reality is in America, they rightly told him, “No stents, no surgery, because you are asymptomatic. You have very high disease levels, but optimal medical therapy and lifestyle will match a stent.” A stent does not stop heart attacks or extend life, it just relieves symptoms.
23:36 For people like him who are asymptomatic, now, I’d be very clear, a stent can save lives on the table and in emergency. But the COURAGE trial and ORBITA, and the other trials have shown that for decades unfortunately, they taught the stent would extend life or stop heart attacks. It’s no better than medical therapy and lifestyle. And the reason is because you have an extensive coronary tree and if you go into tree narrowed spots and that’s…
Christopher 24:01 That’s very naive to think that…
Ivor 24:03 Yeah, the rupture that kills you could be myriad other places and that’s why the stent helps in tree spots, but it just doesn’t reduce the chance of another spot blown.
Christopher 24:13 Right. For everybody listening to this will know someone that’s had one put in and then seen the change in symptoms. You see someone, in fact I can think of a teacher that I saw a couple of years ago that was teaching. He was like gray and sweaty and just terrible under the lights and then he in was emergency room, had stents put in. He looked great. Like two weeks later, he looked fantastic, and all of the skin color come back to his skin. Problem solved, right?
Ivor 24:39 Yeah. In crisis kind of mold where you’ve got major restriction, and you have a lack of collaterals,because David Bobbett actually had so many collaterals.The heart had widened all the other vessels so he had full flow under hard endurance.
Christopher 24:52 That’s actually adapted to it. [Inaudible 00:24:52]
Ivor 24:53 Yeah. Whereas that guy, probably genetically may have had fewer collaterals that could expand. So he’s really suffering the restrictive flow from those major arteries and the stent is opening them up and giving them a lease of life. Now often people who go in with a bit of a problem, they’re also getting medications and other things too. So even then it can be a bit confounded. There is a placebo effect.
25:15 This is a bit controversial, but the ORBITA trial came out last year. And what they did for the first time in history is they did sham operations with stents…
Christopher 25:23 Oh wow!
Ivor 25:24 … to explore if there was a placebo effect with stents.
Christopher 25:27 Who would sign up for that?
Ivor 25:29 It was a big deal. They did enough to power it, and they did 100 each and the people who went in under anesthetic, no one knew who got the stents. And incredibly, they saw that the relief of symptoms for these asymptomatic are not so symptomatic, not too severe disease people, a hundred each, it actually was a placebo effect. So they did not see a benefit with the stent when she did sham surgery.
Christopher 25:56 Wow!
Ivor 25:57 So the stent will relieve severe cases, but in terms of preventing future heart attacks or death, it doesn’t really have a role. Once you use optimal medical therapy, then you get pretty much the same result.
26:10 So it’s very interesting, but I think with the scan, the crucial thing is and I often use this analogy, I mean mammograms are maybe not a great comparison because they overdiagnosed sometimes whereas CAC just sees what you’ve got. But mammogram, imagine a woman instead of going in with a concern in breast cancer and some signs and they do a mammogram and they find a mass and then they give treatment, surgery, chemo, whatever’s needed, imagine you said to woman, “Well, we’re gonna ask you a few questions and look at a blood test. And we’ll work out your probability of having breast cancer.” And then they find it, “You’re a highest risk, you smoke and your blood tests aren’t great. We give you a little bit of radiotherapy.” That’s what happens with a heart disease of men and women. You basically use a risk calculator instead of just counting them and finding out if they’re high or low risk.
26:56 Years ago, I discovered this and I had to pinch myself and quite honest Christopher, to this day, when I think about what I just said, I have to pinch myself. It’s just an enormous group thing that has led to us taking the most serious disease in the world and not using the technology that tells you in five minutes what level you have and what treatment you need.
Christopher 27:15 I have my own biases about why that might be the case. But I’d love to know yours.
Ivor 27:20 I’d say the Widowmaker movie covers everything. And just briefly, when the scan was discovered, there was huge excitement. Enormous excitement. So the high speed ray gun could freeze the heart like a strobe and see the calcium. Immediately the Business of Cardiology got concerned because a Mayo Clinic study (and this is on the record, it’s in the movie) a team in the Mayo Clinic, which is very, very good clinic discovered that if we scan everyone with this new quick scanner, around 50% of our people who go into invasive cath (that’s a massive revenue generator) 50% of zeros, and there’s no point I’m going in. If you have a zero, middle age, it’s a 99.4% or 99% elimination of a stenosis over 17% being found.
00:28:08 So basically, they realized we can have the number of people going on to the table with this invasion of start surgery, which has risk. And the management team shut down the project immediately. Because 30% of the revenue at the Mayo Clinic was coming from the cath lab. You’re going to lose 15% of your top line revenue? I don’t think so. And this is not a conspiracy. If I was a manager there, I would do the same. I’m sorry to admit it. I’ve had to decide. I have to.
Christopher 28:33 But what about in the UK then, the NHS, they’re not driven by money.
Ivor 28:36 They’re led by America. America leads the world in dietary guidelines, in cardiology, all of the US guidelines, I told you that put CAC in a 2a, in a year or two the ESC European guidelines are going to follow up. They followed in 2010. They followed in 2016.
Christopher 28:51 Interesting!
Ivor 28:52 So to be honest, it doesn’t matter if Europe is maybe a little clever or a little fairer with these things. Everything in medicine largely still flows from America, especially cardiology. So we’re kind of caught there.
29:06 The other thing is pharma, six big pharma companies back in the 80s were brought in. I interviewed the professor who invented the scan. And they brought them and they said, “Guys, we’re going to be able to help you identify who needs your meds.” And they did the analysis and said, “Sorry, more people will come off from meds who don’t need them, then we’ll go on them who do need them. Forget it.” So all pharma walked away. So this is all in the record and the interviews I’ve done with these people. Money talks, and it’s not a conspiracy. It’s just, I’m a corporate guy for 30 years. I hate to say it, but I nearly… it’s just a no brainer, you are doing your job in your business, for the profits and for the quarterly revenues, you can’t hazard that.
Christopher 29:49 I get it, I get it, I get it. And it’s a business and the primary purpose of the business is to make money and you have a fiduciary responsibility to investors, right?
Ivor 00:29:57 Absolutely.
Christopher 29:58 Talk about my chances of regressing my score back to zero.
Ivor 00:30:03 Ah, the holy grail I think. I’m beginning to speak of that. So we made a documentary in Ireland last year with a substantial budget, David Bobbett and IHDA funded, and we scanned around 45 super sportsman from the 90s, the big Gaelic Football people. And we got a quarter of them with very high scores who needed immediate follow up with cardiology. And they were all deemed to be healthy, the 45. We found a quarter of them and it’s the same in the population, very high risk. But we got a few to take steps, low carb, magnesium, K2, you know, blood glucose meter, kind of eliminating all the foods to spike their glucose. And I’m happy to say four out of four we intervened with and gave advice to, two have stopped progression, which is unheard off in the medical literature.
Christopher 00:30:50 Right. You see, you better talk about this. The exponential curve, what’s supposed to happen to calcification over time.
Ivor 30:55 Yeah, well, Heinz Nixdorf is the big study but there are many more. And they said calcification increase is inevitable and kind of exponential based on your age, or sex and your starting score. And that’s just the way it is. There’s nothing we could do. And LDL doesn’t really affect it. And serial scanning is not worth it. Because it looks like it just keeps going up. So what the hell, let’s just treat people and forget about it. Now, they’re correct. That’s what you see in sad, standard American diet eating modern people. That’s what you do see. But the difference with our guys was they did something completely different than the standard procedure. They went low carb, and they got blood glucose meter and eliminated, like someone had to eliminate beetroot, bread, circling with? [Inaudible 00:31:39] dinner was causing huge rises in these people who had high scores, and they basically eliminated the foods that were a problem. They ended up with low carb, and they took K2 and magnesium, just some other basic vitamins and minerals are important for someone with heart disease. And we saw two of the four flatten, one went down slightly, which was unheard off as off. As per Heinz Nixdorf, “Should never happen.” One reduce from around 50 to around 25. One reduced substantially from a 1200 score at six months. And then at 12 months had nearly doubled the reduction.
Christopher 32:13 Wow!
Ivor 32:14 And that latter person is being… there’s a a case study being published by a cardiologist who got wind of it. And he’s fascinated because he also knows about Heinz Nixdorf and he says, “I’m 35 years in cardiology.”
Christopher 32:25 “This is not supposed to happen.”
Ivor 32:26 “This cannot happen.”
Christopher 32:27 Yeah.
Ivor 32:27 But here he is, and I’ve got a scores and I’ve got [Inaudible 00:32:30]. And he just can’t believe it.
32:34 I’ve got emails from all over the world now. I’ve a guy from 3600 down to 2600 in around two years. We got guys down from 1900 to 1200 and scores of 60 down to say 40. So in other words, there is no question this is a new paradigm literally for the next decade. This is the biggest thing because you know [Inaudible 00:32:57] got a kind of grainy resolution of heart disease, slight reversal on imaging. This is CAC reversal. This is taking away all the drivers of the progressive disease and it appears the body actually gently leeches back calcium.
Christopher 33:12 Well that’s what I was going to say. Have you had any idea what’s happening physiologically with this calcium that’s not supposed to go anywhere once it’s embedded in the soft tissue?
Ivor 33:20 Well, essentially like any scab or any kind of repair process, if you take away the driver off it, often the constituents just gently leech back in. Now, some people appear to just stop and the calcium sits there like a sarcophagus, just like a scar. But it appears that for many people who are seeing that the calcium no longer needed, no longer being deposited because there’s no disease driver anymore. These people are going to get super safe, maybe 15 times safer than they were when they were progressing. We know that from other studies, and it appears the calcium will unsurprisingly actually gently leech back into the system. Because we sequester magnesium in our bones. We take it back out when we need it. Same with calcium. This actually is what you’d expect. Take away disease process and the minerals get just gently reused.
Christopher 34:09 Right, right.
Ivor 34:11 Now some people say, “What if you’re taking out the calcium by what you’re doing and making them softer and more vulnerable?” And the only answer is, “That makes no mechanistic sense whatsoever.” It could be true, like anything could be true, the moon could be made of green cheese. But the reality is, this makes absolute sense with all the literature. The only thing is, it’s completely new. That’s what’s surprising people. It’s scaring and shocking people that this can be done.
Christopher 34:41 So, are all these good engineers that totally up for going back to their standard American diet and seeing if they could put the calcium back for the sake of completeness, right?
Ivor 34:50 Yeah. “I got to eat wonder bread and processed meat and drink Coke, and I’m going to get that calcium shove back in there to shore up those after atheroma.” That’s the reality. The joke tells the story.
Christopher 35:04 How did you find these guys and how did you get them to commit to the program? Because this is a non trivial task, right? Behavioral science is a thing. Most people, you know, they tend to put these things off. Hyperbolic discounting was something that Simon talked about on the podcast recently, the general idea is that if I say, “Ivor, do you want a 100 pounds now or 120 pounds in two years?” You say, “I want the 100 pounds now. Thank you very much.” And people do the same thing with their health, right? They say things like, “Oh, well, I’ll just eat the pizza now and I’ll get back to my diet on Monday.” So we know behavior change is non trivial. But obviously with these people that appeared in the documentary, was it the motivating, “Oh, I’m going to be on the telly therefore I must not screw this up.” Or do you think there was some other motivation for them?
Ivor 35:44 Actually, in this case, we have limited bandwidth. Basically the genesis of a walls? [Inaudible 00:35:51] Donal O’Neill who made the Cereal Killers Movie.
Christopher 35:52 Yeah, I know.
Ivor 35:53 He had an idea to do a Gaelic GA football movie. because he has a lot of strong contacts on leverage. And he thought he’d take the biggest 1991 [Inaudible 00:36:03] match (it was famous). Go with these guys in their 50s and look at their diet and lifestyle and just do whole thing like Cereal Killers. But then we’ve started talking and I said, “Well, how about you include the calcification, because that’s going to add a whole new dimension to it?” And he liked it. So we discussed, we met with David Bobbett inIrish Heart Disease Awareness a couple of times, negotiated, and David agreed to give the funding that would be required to bring it up a whole level. And that’s what happened and it went up a whole level. But the regression was not really planned. We only plan to get the scores and illustrate how a quarter of these healthy guys…
Christopher 36:41 that you knew…
Ivor 36:42 … that we knew and now they can get treated, they can go on a better diet and lifestyle. The regression kind of shocked us, and the movie version, which is out in November, the half hour documentary is currently free on ihda.ie on the top of the homepage. You can watch the half hour, but the movie will be much less sport and football clips and it will be much more the journey of high scores. And we have cardiologist brought in, Dr. Scott Murray from Liverpool who’s president of the BACPR. We flew him to Northern Ireland to get the second scans where we got the reversal so he delivers the message on video. So it’s a really exciting story of hope and reversal. It’s going to be fantastic.
Christopher 37:24 That’s amazing. So are you going to get it on mainstream TV? Am I going to see it on the BBC iPlayer?
Ivor 37:29 Well, RTE was very disappointing in Ireland, the main Irish channel, they just weren’t interested. They weren’t involved. And we released the documentary for free.
Christopher 37:38 Why is that? Do you know why that is?
Ivor 37:39 I think it’s the way they function. They have subsidiaries and subcontractors who make stuff they asked for and someone coming in from the side. And Donal was a controversial figure, he set up the Gaelic players Union, the first players union and you know, not everyone was happy with him for doing that…
Christopher 37:56 Okay.
Ivor 37:56 … helping the players. There’s lots of reasons. I think RTE are just very, very structured and very stiff in what feed channels come to them with product. It’s really tough. It is the way it is.
38:11 So I think the movie will be based on a release like Cereal Killers and other things. Relatively low cost accessible platform. It’s done in 4K video, so it’s Netflix capable. The guy has put the effort.
Christopher 38:23 I was going to say, what about Netflix?
Ivor 38:25 Netflix, but these will come later because I think they have to go in for some awards. And he can’t release the movie to live seen, if the documentary could win some awards. It’s just kind of an embargo. But I think towards the end of the year, it should be coming out on very accessible platforms.
Christopher 00:38:41 Okay.
Ivor 00:38:42 We’ll see then, BBC and all might pick up and realize what a great kind of idea concept it was. Because when you see all these sports, when we could do this with soccer, we could do this with cricket, in Africa, you could take any team of guys in their 50s still fit and healthy and you could find a quarter of them with big disease and save them and get them on a treatment program. And then if you go the whole step and take a few of them and start getting reversal. I mean, this is great television, obviously I’m biased, but this is superb television.
Christopher 39:12 Yeah, I agree with you. And I’m cringing a bit because the idea of it, you know, having to have you know, like fancy visuals and a fancy music score and all this stuff in order to get the message out there makes me cringe a little bit. But maybe that’s what you’ve got to do in order to get this message out there to make this Netflix worthy that people are going to download it and watch it in the tens of millions rather than in the hundreds of thousands, I think would be…
Ivor 39:34 That’s what we need Christopher, yeah. This is kind of an Irish flavor. So it’ll be watched worldwide, but there is that Irish flavor. What we’d ideally like to see is to get it done with a UK or US analogous team. I mean, they could do it with basketball, they could do it with rugby players, it could be done with anyone. And the beauty is for anyone listening who’s interested, the beauty is that when you do sportsman all over the Western world, you’re going to get roughly the same result. Around 15 or 20% of them are going to have shocker scores and are going to get looked after and treated. And if you properly implement the right solution, as you will, you will see regressors happening and stopping progression, which is against medical dogma. That’s very viewer worthy as well. So I just think that this story is a fantastic story and hopefully, people who are smart will pick up on it and see how how big it could get, with the right production, values, etc.
Christopher 40:34 What’s the best way for people to help you spread this message? If you’re listening to this podcast or watching the video now, what’s the best thing I could do? I feel really bad, I mean, maybe it’s just because I’m too closely connected to the industry and we run a business to help people improve their performance and health using diet and lifestyle advice. And so I don’t feel very comfortable talking to my friends or even family about what they might be doing to improve their health and performance. But maybe other people watching or listening feel differently. Like what do you think is the best way to evangelize this work to save lives?
Ivor 41:06 Well, on the CAC, specifically in the enormous value we discussed, the one stop shop is ihda.ie (Irish Heart Disease Awareness.ie) Because on the homepage, we’ve got two, three minute videos, a few of them very accessible with professors and medicine, professors of cardiology, top people, top of their field, explaining the calcium scan and the value very simply. And also the new guidelines are there. You know, in 10, 15 minutes, you’re going to get all of that.
00:41:32 I’d like to think that my podcast, the Fat Emperor Podcast…
Christopher 41:35 It’s great.
Ivor 41:36 Yeah. There’s a lot of guests talking about all aspects of health. We even had myopia the other day and how you can improve that. But it’s mostly cardiovascular and serious chronic disease. But that series if you look up and find one in an area of health you’re interested in, I mean, already I’ve 32. I’ve fantastic doctors, Professor Robert Lustig. You know, that’s good for all of the solutions type discussion.
Christopher 42:02 You know, I’ve been thinking about this is perhaps a postscript and a wacky bonus question. But, you know, I spent a lot of time over the last year or two looking at the potential of supervised machine learning to predict something like the results of a coronary artery calcium scan. So if we say that the scan looks directly at the disease, that’s the ground truth, as close as we can get to it reasonably without cutting someone open, then could I train a machine learning algorithm to do a logistic regression and predict the results of the coronary artery calcium scan using blood chemistry say as the independent variables? We’ve had really good results with trying to predict the results of other tests like that and I’m wondering whether we could do the same.
42:43 The challenge of course, is getting hold of the training data, like who is sitting on a big pile of blood chemistry data together with a coronary artery calcium scan? I’m not sure anyone has that data, but maybe we could collect it right?
Ivor 42:56 Very possibly, yes. It’s not something that’s our primary focus, because the blood test will always be a proxy. But I agree with you.
43:04 I have a study which pulled together 19 studies with calcium results for people. And it looked at whether LDL correlated and the answer was 19 out of 28 didn’t correlate.
Christopher 43:16 Yeah, of course. I understand that.
Ivor 43:17 Insulin did. So I think if you put together the really best post meal insulin and post meal glucose, and you know, maybe GGT, and ferritin and then some of the inflammatory markers, and you put them all together, and you got a really good predictive algorithms better than the current ones with just cholesterol, I think you’d predict pretty well the degree of disease, the calcium. But you’ve always got to remember that you can do all that and still, if you go in for five minutes to get a non invasive scan, you get the answer.
Christopher 43:46 Yeah, you’re right. That’s the big question is what’s the utility of such a test? Well, maybe the utility is, “Well I’m going to run this blood test anyway, because my GP is running this simple blood test. And then if I could train an algorithm to predict the results of the scan, I mean, you would argue, just get the scan. And I think I agree, but…
Ivor 00:44:04 Well, it could be. As an old boss of mine used to always say, it’s an and. In other words, he wanted both things. And often, that’s the case. So you got a calcium scanner. But let’s say it’s says high, what are you going to do and how are you going to track your progress until your next scan? If it’s high, maybe in a couple of years, you need to get another, make sure it’s not progressing fast. If it’s very low or a zero, like me, maybe seven, eight years later. You don’t have to do many. But what do you do in between scans, right, if that’s the final arbiter, the scan results, what do you do in between? Well, there you can use blood tests to keep yourself on the right vector to have no progression. So you’re not going to do scans every month. That’s absurd. Even a high score might come back in two years. But in between, you can use blood test, the best vector you’re arriving at your next scan.
Christopher 44:54 Some people have done it, we’ve done it, you can predict mortality using [Inaudible 00:44:53] test, right? And if you can hold data out to know how good the algorithm is, and say it’s off a little bit, you’ve got the ground truth plus the prediction side by side and then you track your bloods rather than doing a CT scan every, I mean, you can do about test as often as you want really, there’s no…
Ivor 45:12 That’s the advantage. It’s the between scans kind of vectoring yourself. Obviously, it’s going to be a blood tests, or even a really good operator with carotid intima-media thickness with limited doppler, like looking at the bulb. If you’ve got a high score in CAC and you’re going to come up with a CINT, that’s probably pretty bad showing some athero in the bulb in your carotid. Well, before your next scan, you might get a carotid measurement, which is ultrasound and easy, just to see that you’re going in the right direction. So carotid and CIMT ultrasound is very poor for predicting your risk. So in zero sense, replaces a calcium scan. It’s very poor for predicting. But if you’re just looking at, “Okay, I’m at 70 on the carotid, am I at least going to 69 or 71, or I’m going up 74?” Again, like a blood test, it could help you keep your ship as much as possible on an even kill until your next scan and enhance your ability to have the next scan come back not progressing.
46:12 So I think these are dynamic short-ish term tools, and the long term arbiter, the final word is of course, “Where’s my calcium?” Right? That’s more spread out. Yes,
Christopher 46:22 Yeah of course. That’s why I use that term the ground truth. I think that the feedback is important, though, is like how do I know that I’m doing this right? When you look at everything else that people get good at, say the game of tennis, for example, you find out pretty quickly whether you’re doing it right or not. Whereas with health and performance, it’s like way harder than that.
Ivor 46:38 Yeah. And Christopher, if we curl back to how we started the conversation with all the different ways of doing it, like a healthy vegetarian or possibly even a carnivore or omnivore or do I take more olive oil, or do I eat loads of fish? You know, you need to decide, well, how is my diet working for me, and that’s where a blood test comes in. You don’t wait for a calcium scan in three years to see what your diet is.
Christopher 47:00 I guess that last five year period didn’t work. I need to do it again.
Ivor 47:03 Oh! Well I can’t go back three years now and start eating this and stop eating that. So yeah, blood tests to keep you, you know, in a good vector until your next scan. I think that’s fair to say.
Christopher 47:16 Well Ivor, this has been fantastic. I very much appreciate you and the hard work that you’re doing. I will of course link to the websites that you mentioned, including your own. Everybody should be listening to the Fat Emperor podcast by now. I think you do a fantastic job with that.
00:47:29 Is there anything else I should link to in the show notes for this episode?
Ivor 47:32 No, I but I’d say the key one really is ihda.ie because we’ve revamped the website, all the resources there for someone who knows nothing within 10, 15 minutes still [Inaudible 00:47:43]. And then all the scan centers in America, UK and Ireland are expanding every week and the interactive map with all the scanning centers. That’s a huge facility that was nowhere available before, “find your local scan center.”
Christopher 47:56 And then tell us when you get a regression in your score I think I’ll be fantastic to collect up all of those so it’s not just like a single case study, like okay, it’s like well written up and it’s not a controlled trial but you might get to the point where like it’s undeniable that you’ve encountered something that works.
Ivor 48:13 For sure, Christopher. I mean, one of them is a black swan and you might argue against it but even one of them would be hugely interesting. But we’ve already got tens, and in the coming years we’ll have hundreds. And once you have hundreds of aggressors that conflict with Heinz Nixdorf, to be honest, you can ask for an RCT, but there’s no need. Even a dumb ass will realize this is possible and it can be done, “Wow! I want to get into this.”
Christopher 48:37 That’s great. Thank you, Ivor. I really appreciate it. Thank you.
Ivor 48:39 Thanks a lot, Christopher. Great stuff. Bye now.