The Slidepacks to go with the Chronic Disease University! Number 1 - Chronic Disease Avoidance and Personal Longevity - Ultimate Summary

1. 2017 Ivor Cummins BE(Chem) CEng
Demystifying Cholesterol
How it Works, and the Data on it's Dangers
Ivor Cummins BE(Chem) CEng MIEI PMP®

3. Serum
GGT
Serum
Ferritin
Ivor’s Story (2013)
Cholesterol
< 200
approx < 5
112 530
6.8
<35
approx

4. When the experts don’t know…

5. July 2013 - Singapore
It’s Root
Causing Time

6. EXCESSIVE
CARBOHYDRATE
MEDIUM FAT/PROTEIN
HIGHISH FRUCTOSE LOW FRUCTOSE
LOTS OF NON-STARCHY VEG!
BUT LOW STARCHY CARBOHYDRATES
HIGH HEALTHY FAT /
MODERATE PROTEIN
Root
Cause
Solution

7. GGT
U/L
25
50
75
100
112
Start 6 Weeks
125
8 Weeks
42
35
The Power of a Proper Pyramid
Ferritin 530 230
BP 145/90 130/80
Cholesterol
Weight 95kg 83kg
Waist 35” 32”

8. Google “Cholesterol
Conundrum”

9. LDL (LDL-C) versus Number of LDL’s (LDL-
P)
LDL-C =
3
LDL-P =
1200
LDL-P =
1600

10. LDL-C LDL-C

11. The Lipoprotein Particles – Boats for Cargo
 The Chylomicron is the big one, created to ferry
dietary fat and cholesterol, for energy and healing
Chylomicron
 VLDL is made in the liver to ferry Trigs and Chol…
VLDL
2013 Ivor Cummins BE(Chem) MIEI
HDL
 HDL is the so-called “GOOD Cholesterol”
LDL
 LDL (from VLDL) is the so-called “BAD Cholesterol”
sdLDL
 Oxidized LDL is the real “BAD Cholesterol”
 The LIPOPROTEIN PARTICLES are transport vessels
(“boats”) created in the body to deliver
Triglyceride and Cholesterol (“cargo”), for energy
transfer, critical synthesis, and healing purposes….
Triglyceride/
Cholesterol
An Apo-
Lipoprotein
Phospholipids

12. VLDL, IDL,LDL…..and Small Dense LDL
C II
C II
LPL
LDLR
SR-B1
Ch
Ch
Ch
2013 Ivor Cummins BE(Chem) MIEI
Ch
To tissues
and cells
Ch
Moderate Uptake
Res Time >2 days
Poor Uptake
Res Time = ??
Tg
HL
Tg
Ch
Ch
Ch
LDL
B100
IDL E
B100
Tg
Tg
Ch
Ch
Ch
Ch
Tg
LDL
SD
LDL
OX
HL
Gluc
B100
B100
Tg
Ch
Ch
Ch
Tg
Ch
Ch
Ch
VLDL
Tg
Tg
Tg
Tg
Tg
Tg
Tg
Tg
Ch
Ch
Ch
Ch
E
C II
B100
Ch
Ch Ch
IMMUNE SYSTEM
MACROPHAGE / FOAM CELL

14. “Lipids, risk factors and Ischaemic heart disease” Atherosclerosis 124 Suppl. (1996) S1-S9
“The [Total/HDL] RATIO was found to be a better predictor of CHD
than TC, LDL, HDL and triglyceride -- not only in the Framingham Study,
but also in the Physician's Health Study and many other studies.”
“Unless LDL levels are very high - 7.8 mmol/L (300mg/dL) or higher - they
have no value, in isolation, in predicting those individuals at risk of CHD”
- William P. Castelli (Framingham Director)

15. 50 year old male with:
 Cholesterol > 8
LDL > 5
…but if he is NOT
Insulin Resistant?

17. LDL
CAC / Atherosclerosis Worsening
Progression of coronary artery calcification seems to be inevitable, but predictable - results of the Heinz
Nixdorf Recall (HNR) study Eur Heart J. 2014 Nov 7;35(42):2960-71
POORLY S
These 2 guys have same
LDL
- but extremely different
outcomes!

18. Blood
Pressure
Diabetes !
CAC / Atherosclerosis Worsening
Progression of coronary artery calcification seems to be inevitable, but predictable - results of the
Heinz Nixdorf Recall (HNR) study Eur Heart J. 2014 Nov 7;35(42):2960-71
WHAT STRONGLY
PREDICT
S

19. Risk
Ratio
for
Heart
Attack
2.0
3.0
4.0
5.0
1.0
High Blood
Pressure
1.9
6.0
7.0
High Total
Cholesterol
N/A
High LDL
“Bad Cholesterol”
N/A
High INSULIN
6.7
Hyperinsulinemia is a predictor of new cardiovascular events in Colombian patients with a first myocardial infarction. International Journal of Cardiology 148 (2011) 85–90.
What else, unlike LDL – strongly predicts
outcomes?

20. What else, unlike LDL – strongly predicts
outcomes?
Data taken from Table 2: Association of Hemoglobin A1c with Cardiovascular Disease and Mortality in
Adults: The European Prospective Investigation into Cancer in Norfolk
Kay-Tee Khaw, MBBChir, FRCP; Nicholas Wareham, MBBS, FRCP; Sheila Bingham, PhD; Robert Luben, BSc; Ailsa Welch, BSc;
and Nicholas Day, PhD

21. Rate
of
Heart
Disease
(IHD)
5%
10%
15%
20%
~ 13 %
LDL ≤
3.7
mmol/L
LDL >
3.7
mmol/L
“Study of the Use of Lipid Panels as a Marker of Insulin Resistance to Determine
Cardiovascular Risk” Perm J 2015 Fall;19(4):4-10
“We followed 103,646 men and women for 8 years...”
~ 14 %
???

22. Rate
of
Heart
Disease
(IHD)
5%
10%
15%
20%
~ 13 %
9 %
18.5 %
“Study of the Use of Lipid Panels as a Marker of Insulin Resistance to Determine
Cardiovascular Risk” Perm J 2015 Fall;19(4):4-10
???
More
Insulin
Resistant
Less
Insulin
Resistant
Low
Trig/HDL
RATIO
High
Trig/HDL
RATIO
“We followed 103,646 men and women for 8 years...”
~ 14 %
LDL ≤
3.7
mmol/L
LDL >
3.7
mmol/L

23. Insulin Resistance as a Predictor of Age-Related
 Apparently healthy, non-obese individuals aged ~65
Prospective Predictions Based on Insulin
Level
The Journal of Clinical Endocrinology & Metabolism 86(8):357
 Split into tertiles of Insulin Resistance using a post-glucose Insulin
Test…
What happened ~6.5 years later?

24.  Apparently healthy, non-obese individuals aged ~65
Prospective Predictions Based on Insulin
Level
 Split into tertiles of Insulin Resistance using a post-glucose Insulin
Test…
What happened ~6.5 years later?
Risk Multiplier:
High INS = 40x !
( CI = 35 to 45 )
Note: LDL was 1.001x, non-significant…
The Journal of Clinical Endocrinology & Metabolism
“children between the ages of 6 and 19 years with insulin resistance
syndrome
…showed a 15x increased risk of CVD at 25 year follow-up

25. Insulin Vs ‘Bad Cholesterol’ in head-to-head
Studies
Study
Insulin
/Glucose
‘Bad
Cholesterol’
'Abnormal glucose tolerance – a common risk factor in patients with acute…’
(2004)
Highly Significant Not Significant
"Insulin Resistance and Fasting Hyperinsulinemia Are Risk Factors for New…”
(2004) Highly Significant Not Significant
“Lipid levels in patients hospitalized with coronary artery disease:…” (2009) Not available Inverse ! 
“Interrelation between angiographic severity of coronary artery disease and…”
(1993) Highly Significant Not Significant
"Progression of Coronary Artery Calcium and Risk of First Myocardial…” (2004) Highly Significant Not Significant
“The joint effects of apolipoprotein B, apolipoprotein A1, LDL cholesterol…”
(2008) Highly Significant Inverse ! 
“Low admission LDL-cholesterol…increased 3-year all-cause mortality” (2009) Not available Inverse ! 
Association of Plasma Tryglyceride and C-Peptide with CHD…” (1990) Highly Significant Not Significant
Circ J 2004; 68: 47 –
52
Doi:10.1111/j.1365-2796.2004.01371.x
http://dx.doi.org/10.1016/j.ahj.2008.08.010
Am J Cardiol. 1993 Aug 15;72(5):397-401
Doi:10.1161/01.ATV.0000127024.40516.ef
doi:10.1093/eurheartj/ehp221
Cardiol J. 2009;16(3):227-
33.
Diabetologia. 1990 Aug;33(8):489-96.

26. The ELEPHANT
in the Room
…and likely 70-75% if using insulin
testing

27. KNOWN
Diabetics
!
MORE
Diabetics
!
YET MORE
Diabetics !
If
INSULIN
Tested
???
 Surveyed all Coronary
Disease
The 2015 EuroAspire Study
 Patients aged 18 to
80
 Across 24 European
countries
“If You Don’t Measure It
…you Can’t Understand It”

28.  40% of Non-Obese are
TOFI
The TOFI Epidemic?
 TOFI Heart Attack Risk is
right up there with the
Obese
 “Thin Outside, Fat Inside”
“If You Don’t Measure It
…you Can’t Understand It”

30. Modern Processed Foods and Lifestyles are the
Drivers
“Coronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study” Lancet. 2017 Apr 29;389(10080):1730-1739.
Homework:
Google “Insulin Resistance”
and the Disease of your
Choice

31. The ELEPHANT
in the Room

32. A Soupçon of the
Science…

33. “In the WHI randomized clinical trial (n=48 835), reduction of total fat consumption
from 37.8% energy (baseline) to 24.3% energy … had no effect on incidence of
Coronary Heart Disease, Stroke or total CVD”
“This was consistent with null results of 4 prior randomized clinical trials and
multiple large prospective cohort studies…”
In a pooled analysis of individual-level data from 11 prospective cohort studies in the
United States, Europe, and Israel that included 344 696 participants, “each 5%
higher energy consumption of carbohydrate in place of saturated fat was
associated with a 7% higher risk of CHD”

34. “Effectiveness and Safety of a Novel Care Model for the Management
of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized,
Controlled Study” Diabetes Therapy April 2018, Volume 9, Issue 2, pp
583–612
Professor Jeff S. Volek, Ph.D., R.D.
“Dietary Carbohydrate Restriction Uniquely Targets the Features of Metabolic Syndrome”
?
KETO /
LOW CARB

35. “Effectiveness and Safety of a Novel Care Model for the Management
of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized,
Controlled Study” Diabetes Therapy April 2018, Volume 9, Issue 2, pp
583–612
Professor Jeff S. Volek, Ph.D., R.D.
“Dietary Carbohydrate Restriction Uniquely Targets the Features of Metabolic Syndrome”
KETO /
LOW CARB

36. Dietary Carbohydrate Restriction Induces a Unique Metabolic State Positively Affecting Atherogenic Dyslipidemia, Fatty Acid Partitioning, and Metabolic Syndrome,” Progress in Lipid Research 47, no.

37. “Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year:
An Open-Label, Non-Randomized, Controlled Study” Diabetes Therapy April 2018, Volume 9, Issue 2,
pp 583–612

38. Improvement
in
Biomarkers
-20%
0
+20%
+40%
-40%
Weight Body Fat Visceral Fat Insulin Resistance
(~18 lbs)
-5.1%
-43.7%
-30%
Published:
16 March 2019

39. Improvement
in
Biomarkers 0
-80%
HOMA IR Fasting INS MoCA Cognitive
-89%
-60%
-40%
-20%
-85%
Trig/HDL
-55%
HbA1c
-30%
-20%
-40%
+26%
Published:
Jan 2019

41. Focus on Insulin and Blood Glucose for Health and Longevity
Isolated LDL-C is near-useless - and it drove the Low Fat Fad
LDL-P a little better - but still a distraction from primary root causes
Diabetic Physiology is “the seat of Modern Chronic Disease”
LCHF cornerstone of addressing Modern Chronic Disease

43. Risk Multiplier:
High INS = 40x !
( CI = 35 to 45 )
Note: LDL was 1.001x, non-significant…

45. 10
15
20
25
5
45-54
Heart
Attack
Rate
in
10
Years
55-64 65-74 75-84
CAC=0 CAC=1-100 CAC>100
Age:
Mayo Clin Proc. 2014 October ; 89(10): 1350–1359
CAC: THE MASTER MEASURE FOR HEART DISEASE

46. 10
15
20
25
5
45-54
Heart
Attack
Rate
in
10
Years
55-64 65-74 75-84
CAC=0 CAC=1-100 CAC>100
Age:
Mayo Clin Proc. 2014 October ; 89(10): 1350–1359
CAC: THE MASTER MEASURE FOR HEART DISEASE