Diet Doctor Podcast #3 – Dr. Jeffry Gerber & Ivor Cummins

Welcome to the DietDoctor podcast.
I’m your host Dr. Bret Scher. Today it’s my pleasure to be joined
by Ivor Cummins,, and Denver’s Diet Doctor
Dr. Jeffry Gerber. They are the authors of this fantastic book, “Eat Rich, Live Long, the power of low-carb
and keto for weight loss and great health.” And the two of them are a fantastic team,
I really enjoyed talking to them. We talk about coronary calcium scores,
we talk about the benefits of a low-carb diet, how it works, why it works and how it’s sort of one piece of the puzzle
for solving health problems. It’s a nice overview with some very good practical takeaways
that you can walk away with and see how can I improve my life now. So I hope you enjoy this episode. If you want to learn more
you can look at us at and you can learn more about me
at Now stay tuned, I hope you’ll enjoy this interview
with Dr. Jeffry Gerber and Ivor Cummins. Dr. Jeffry Gerber and Ivor Cummins, thank you so much for joining me
on the DietDoctor podcast today. Great to be here, Bret. Thanks, Bret. The first thing I want to talk to you about
is I learned from you guys you have to be very careful
who you choose to write a book with. Because then you’re sort of stuck
with that person, right? You guys are doing so much together,
probably so many joint interviews, you are scheduled to talk together
at the conference today and now we even have you
sharing one microphone. So maybe I want to ask you
if you’re happy with your choice, but I don’t know if we want
to talk about that right away, so instead talk to me a little bit about of what led up to your book “Eat Rich, Live Long, the power of low-carb
and keto for weight loss and great health”. Give me a little bit of the background. What inspired you to write this book
and what led to it? Well, Jeff your history with low-carb
goes back a lot longer, so maybe give your history first? Yes, Brett, it actually ties
into your original question. So I’ve been interested in nutrition
for over 20 years. As you know, I am a family physician
having done this for now 30 years almost and about 20 years ago I started
to teach myself about nutrition after patients had approached me,
family members approached me, I had some experience with losing
40 pounds on my own and just realized we didn’t learn much
about nutrition in medical school. You know we maybe had two hours or less
and so like all of us we taught ourselves. And so it was about four or five years ago
that I had met Ivor. I had a particular interest not only
in nutrition but cardiovascular disease. And I always joke if it wasn’t for cholesterol
we’d probably all be on a low-carb diet. So at any rate,
four years and a half years ago this chemical engineer out of nowhere puts
up this video, “The cholesterol conundrum” and I immediately contacted this guy
and I realized how connected we were that the engineer from one walk of life
and the doctor from the other walk of life, our paths crossed at this opportune time and realizing that we were both focused
on diet and cardiovascular risk and I had said back then to Ivor, we had done a little private video Skype and I said to the guy,
“I think we need to collaborate”. And you know he said,
“What’s the happening?” and then he said to his wife,
“Who is this crazy doctor from Colorado that wants to collaborate?” And so essentially
this is what it’s turned into. That’s fantastic. And the genesis
of the cholesterol conundrum was around 2012 I got
some very poor blood tests. I won’t go into details, but multiple doctors
I consulted couldn’t really explain the two key things about any challenge. You know, what’s the implication
for mortality/morbidity and what are the root causes
that would drive those blood metrics. And basically not getting any answers
I began to research intensively on… within weeks I was
on carbohydrate metabolism as the cause. Yeah, we see it time and time again, someone has this personal experience
that sends them on this is path of discovery and they end up with a low-carb diet as being such a powerful treatment
for what they’re looking for and yet we were taught nothing of that. We were taught nothing of that
in medical school and residency, so I’m amazed that you
had been practicing this way for more than a decade. And at that time these conferences like Low-Carb USA or Low-Carb Breckinridge
didn’t exist. So how do you feel now when you come
to a conference like this and they ask you or ask the crowd,
“How many people are physicians?” and so many hands go up? I mean you must feel
a little bit of pride in that. Yeah, when I first got involved with it
in the year 2000 I was on my own. And interestingly it wasn’t
until I think 2005. Still on my own I had done my own research,
reading medical journals, fascinated with the metabolic syndrome,
understanding how that was a root cause, but in 2005 the first person I reached out to
on social media was Jackie Eberstein, who was the nurse of Dr. Atkins. And my hands were shaking, I somehow found her website,
found her email and I thought that this person
would never reply. And she replied right back
and she was lovely, she was warm, she answered all my questions,
so that was kind of the beginning. And, you know, the Internet social media
was nothing back then, but slowly but surely it grew. I connected with Jimmy Moore
and we really have to give him credit, because if it wasn’t for him, I really don’t think this community would be
as connected as we are. So to his credit as well I became a member
of an obesity Society. And it was funny back then,
there were a lot of physicians and myself and Dr. Eric Westman
would walk around the room and real quietly say to the other doctor,
“I’m low-carb. Are you low-carb, doctor?” And you had to really like… Keep it on the down low. Keep it on the down low
and slowly but surely it’s grown, Dr. Westman became the president
of the society and that’s really helped to make, I think,
physicians aware and, you know, we’ve just watched
this blossom ever since. And Ivor and I both attended the summit
in Cape Town South Africa from Tim Noakes. This was back in 2015. And we thought it would be a great idea
to bring conferences to the United States. So with my co-organizer Rod Taylor
we have conferences in Colorado, we have one coming up next year in 2019
in March in Denver, and like you said it is just rewarding to see healthcare professionals
attending these things, because honestly they are the guys, they’re the gatekeepers
that need to learn this first. But we also love having the general public and these events that we’re at today
really helped to bring everybody together and advance nutritional science. Yeah, that’s so true and it seems
like the doctors are catching on, but Ivor engineers are leading the way
and that’s the fascinating part. And what I really like about most engineers,
I can’t group you all into one, but in general the problem-solving skills in the way of thinking things
as problem solvers is unique to the world of medicine
unfortunately, but that’s sort of what we need
and you talk a lot about the Pareto principle and you talk about
sort of problem-solving metrics. So give us a little overview of how you think
your approach to problems differ than the average physicians approach
to health problems. Right, Bret. Well, essentially we use a lot of tools,
systematic tools. So there is the Pareto principle, which is a rack and stack of the most
important factors based on the evidence and that’s really important. Those comparative analysis,
a tool called Kepner Tragoe, where you prosecute all of the distinctions
between what the problem is and is not and then you record the inferences. So it’s kind of like
a little epidemiological. It’s looking at all the differences
and what might cause them and that can become a very long list. And then there’s hypothesis for
against charts, where you look at many hypothesis
for a single problem. And we split up many, many hypothesis and they are constantly judged
against each other based on the evidence
for each individual one and against. And there’s never any clarity early
in a complex problem, especially a multifactor. So you have many, many hypotheses
and they are pitched against each other. And that’s
an enormously important discipline, which doesn’t really happen in medicine. Usually a hypothesis gains ground,
becomes established, the orthodoxy get behind it
and it kind of transcends into dogma. So there’s a huge difference. And then statistical inference and
design of experiments to test hypotheses is an automatic part of our life. An autopsy, so intense autopsy
with electron microscopes and other tools to dig in and scrutinize the problem
at a physical level. And again you don’t have
so much of that medicine. When I hear you go
through this checklist and then I think in my mind
how we write guidelines in medicine and they’re so polar opposite. I mean the guidelines are…
you get a group of people together that do a sort of a cursory evaluation
of the evidence, they come up
with their best case scenario and their opinions
of what the guidelines should be. That is a far cry
from what you just described. And one crucial thing I’ll just add,
there are many more tools, but also the experience
of decades of using these tools… you less and less make mistakes or jump
to conclusions through sheer experience. But a crucial one is to always look
for black swans, for contradictory evidence
against your hypothesis. So that’s an enormous part of the time
to resolution and success in engineering is you look for negative data
that conflicts with your hypothesis and you rapidly kill incorrect hypotheses or you rewrite them
to accommodate the conflicting data. And that’s just so central but I must say in nutritional medicine
that’s the most extraordinary difference. Confirmatory data is always looked for to build up more and more evidence
to support a hypothesis, whereas one or two conflicting pieces
of data could reset the whole team and get you back on the correct path
doesn’t happen. So we do have criteria in medicine
that prove or disprove hypotheses. And that’s the Bradford Hill criteria,
but we’ve set the bar so low that we don’t look at it
like a scientist or an engineer looks at it. Right and I wonder how many doctors
are even aware of the Bradford Hill criteria. And when you’re interpreting
an observational study that shows a relative risk of 1.18
and that makes it as causative, which, you know, that doesn’t even scratch
the Bradford Hill criteria, I think it’s just an underused tool for sure. And actually another example
of Bradford Hill that just springs to mind, there has to be directionality
of dose-response. So cause X supposedly driving Y,
as X increases, why should increase? But we have many examples including
cholesterol and other things, whether is not a dose-response. Yes so Bradford Hill is excellent actually
in principle, but it’s utilization is almost zero
from what I’ve seen. Let’s get into some of the specifics. So you talked
about the dose-response, Ivor. And you spoke about that
in your talk yesterday, specifically about coronary calcium score. So I know you’re a big proponent
of the coronary calcium score. And one of the things you said was
there are 17 studies I think you quoted where LDL does not correlate
with the degree of coronary calcium score. Yeah, actually there’s a 2009 paper
and a book publication I think in 15, can’t recall the author,
but I think it’s closer to 20 and even includes familial
hypercholesterolemia studies. And across the board
with one exception in 19 studies, there’s a very slight correlation between
prospective LDL and coronary calcium. Now coronary calcium is far and away the best metric of atherosclerosis extent
and future risk. It beats all the risk factors together. And it’s because it sees
the actual disease process, the calcification
that’s the response to injury for this inflammatory vascular disease. But it is interesting there’s almost
no correlation with cholesterol metrics. Interest needed do highlight
that insulin pops up several times, but not cholesterol. So I think to engineers
working on cholesterol, that and myriads other kind of negative
pieces of evidence would’ve caused us to totally retool
the cholesterol hypothesis very early in the prosecution
of the problem-solving effort. And we have 50 years now where the negative evidence
is essentially almost suppressed, but certainly ignored. So it’s interesting… mainstream, half of the cardiologists think
that the calcium score has a benefit, half of them don’t, but it’s interesting when you look
at guidelines, they try to tack on calcium score
with your AHA risk markers, and what we’re suggesting is that that’s not
the right way to use the tools that use… just simply look at calcium
score by itself, independent of cholesterol and what I can add is just clinically
we see that LDL cholesterol LDL-P is all over the board and it doesn’t correlate
with the calcium score. And this is especially… so we see lots of patients
who have been doing low-carb paleo diets and I had many over years where there are these cholesterol
hyperresponders where they tend to high LDL-C,
high LDL P and many of them
have calcium scores of zero, a perfect score of zero, which gives you a 15 year warranty. Let’s talk about that 15 year warranty
for a second, because I have to be honest, I have a little bit of trouble
with that term, because it almost implies the risk is zero. So I think we have to admit
if you have a calcium score of zero, your risk of a cardiac event
in the next 10 years is not zero. It’s very low, it’s between 1% and 2%,
but it’s not zero. So I think that’s important
to sort of clarifying the warranty. It’s really important to clarify and anyone that infers from the word
warranty it’s zero is mistaking obviously. And the warranty I think
there were two papers were warranty was used
in the title of the publication and it probably is unfortunate. So one of the largest study showed
just from memory that zero scoring middle-age people I think
12 years later at 99.6% were still alive. And high-scoring people 75.6
were still alive. Now that’s an enormous difference
in mortality. So although enormous, there’s no zero, and I think Jeff you probably agree
that if you’re zero calcium, there are exceptions. On one end there are people with zero who
have rapid progression of atherosclerosis and a soft plaque does rupture before there’s significant calcification
to show up in the scan. I mean later you could look
and probably find diffuse calcification, but not enough to register. Interestingly on the other end of the scale
there’s a small maybe 1% of people who have huge calcification
and who don’t seem to have events and they appear to be the people
where the protective effect of calcification, which is to protect the arteries
when they’re inflamed, is so advanced and rapidly progressing that they actually end up with massive
calcification but relatively stable arteries, they almost have a full metal jacket. So I think those two corner cases
around 1% at each end illustrate the protective nature of calcium,
it’s a fantastic evolutionary process, it’s actually bone matrix,
it’s identical to bone matrix formation, but of course people rapidly progressing
may have their event before the calcification establishes. So around 1% events
in the following 10 years for zero versus in your recent paper, Jeff,
around 37% for high scores close to 1,000. People just need to see
it’s not 100% perfect. And that’s a great point to bring up though
because I think we can fall into a trap of being sort of overly reassured
with a score of zero. It’s not, “Your score is zero, see you later,
you don’t have to worry about anything.” It’s, “Your score is zero,
but now you’re on our radar screen to follow again to make sure
there’s no progression.” So one other point is criticism of the test
is that it doesn’t visualize soft plaque. And when you look at the data first of all,
so when your score goes from zero to 1,000, this is independent of whether you see
soft plaque or not. If you have a zero score you still have
a small chance of having an event. Now the question is
if you can visualize soft plaque, would that change
your ability to predict risk for these people that have
a low calcium score? So you can do a CTMR,
you could do a CT angiogram and then you get to see the soft plaque. But in our experience it doesn’t change
the data looking at a CT calcium by itself. So Jeff, what do you think about
the carotid intima media thickness as a surrogate for that? Obviously again we’re not talking about the specific site
we’re concerned about and we’re not even talking
about plaque so much. It’s just the thickness of the intima
of the carotid artery, but something you can measure quickly
without radiation that might be a decent surrogate marker
for the soft plaque as well. Yeah, so again you describe
that nice… Well, the intima is just the lining
of the wall of the artery and so I don’t know
who created the technology, but what he tried to do
was to age the blood vessel based on the thickness of the intima. And on literature review it really does not
correlate with events and mortality. So it’s interesting, in our office
we actually do the CIMT, because it comes along
with a limited Doppler. So the limited Doppler, we’re actually
looking for plaque buildup within the lumen itself. And that perhaps is a surrogate test
for say a coronary calcium score. It’s not quantifiable
quite like a coronary calcium score. The idea is if you could image
all the blood vessels in the body and look at the plaque burden, that would give you a great idea
about overall risk. But we do like the calcium score, because it’s looking
at those tiny little coronary arteries that, you know, you are at risk
for heart attack and stroke. So CIMT doesn’t really correlate. I’d like to see the rate of change study
sort of like with the coronary calcium score that has a fast change or slow change,
same for CIMT, and correlate that. I don’t know if the rate of change studies
have been done quite as well. No not really. In fact there’s not much really linking CIMT
impressively to future risk prediction. I mean it’s a useful tool
to quantify and track, but it’s just very weak
compared to calcium. Because as you say it’s surrogate
in different vessel, there is operator variation, quite large, they have to pick the region, you know,
with to mouse clicks. And you can’t have people who have
quite a large intimal thickening, but really have very stable arteries
with no real vulnerable plaque and vice versa. It’s just the calcium is vastly better. You did mention an interesting point,
the radiation, and I researched that myself
out of interest because I often hear this, but machines nowadays are around 1 mSv, which is around the same
as a bilateral mammogram. And if you look back at research
in the past decades, Chernobyl and even Hiroshima
and the nuclear accident in Brazil, the biggest civilian nuclear accident, they tracked the people who had
much, much higher exposures than this. I mean much higher. And generally over decades
no signal between them and controls. So I think the expert Douglas Boyd
who invented the calcium scanner, I interviewed him the other day, he said that that risk is maybe one in 10,000
of some possibility, it’s theoretical for 41 mSv, it’s tiny and it really is a distraction
from the topic of how powerful the scan is. Yeah, that’s a great point about
how we interpret the risk of radiation, because in medicine there’s this concept
of ALARA, as low as reasonably acceptable, and it almost teaches us
to think of it as a way… it doesn’t matters
how high the radiation exposure is. What matters is how much is the test
going to contribute to the care. And is it worth it
for any amount of radiation exposure? Certainly a one-time calcium score
or following every five years or so. Where I get a little concerned is if someone
wants to follow a calcium score every six months or everyone year, because we don’t have data to say that
short-term of a progression on happens or what it means,
but more of the longer term following. Would you agree with that statement? Yeah. So interestingly I’ve been working
with my hospital next-door, that they’ve had a 64 slice GE machine
for quite some time, GE Optima, and last year they purchased
the cardiac package. And I’ve been bugging them right next door, I said, “Hey, we got to get this thing set up
for calcium scans.” And I’ve learned a lot because I’ve sat
in there with their radiologist, the radiology technician over lunch, we just sit down and just…
fascinating stuff. And first of all there’s much less
user input error when you do this calcium score. You know, they calibrate the machine and the machine does the calculation
to measure the calcium. And I actually have been looking
at the studies. So the radiating dosage,
so the effective radiation dosage… So the device puts out a certain amount
of radiation, so it’ll measure in DLP units, and I think our machine is about 165 DLP. So that is what the machine puts out and then you have to do a fudge factor
calculation for the effective dosage. So there’s a chest factor. And when we do the calculation,
our calcium score is… the millisieverts is about 1.2. And so you know I’m watching that
really carefully and there’s things that the technicians
can do so they can make a smaller window and the idea
is that really is a small dosage. And if you have a zero score you could
probably say that you don’t need any more, but it is okay to track…
you can track every 3 to 5 years, maybe sooner if people are concerned. Yeah, especially if someone’s changed
their lifestyle significantly and you want to see what impact that has. So yeah, I think that’s a pretty good
summary of calcium score. Let’s transition to a second about…
transition to weight loss. Jeff, you talked about weight loss
in your talk today and what is so interesting
is a lot of people come to a low-carb diet for the purpose of weight loss. But would you say weight loss
is the most important metric to follow? No, not at all. So again as I mentioned earlier, my understanding of cardiovascular disease
led me to the metabolic syndrome. And so I think why we’re here
as engineers and doctors is we’re trying to understand how do treat
and prevent chronic disease. And weight loss is just kind
of a consequence of doing all this. And so, Ivor, when we talk about
the mechanisms of weight loss or the mechanisms
of improving metabolic health, there’s the debate
of the calories in calories out versus the carbohydrate insulin model or some combination thereof
when you factor in psychological factors… How do you break down and say what is
the reason why a low-carb diet works? Yeah, that’s
the million-dollar question. So I will take a shot at it. I think that calories… there is a place
for calories, there’s no question. It’s not like the CI-CO,
that is simply eat less, move more, because the body is
far more complex than that, with myriad hormonal control
feedback loops. So I think the primary benefit
of a low-carb diet actually is appetite control
and management. It’s a really big factor. So when I went on a low-carb diet,
and I’m not speaking N=1, but it’s seen in studies
and all over the place, ad lib. low-carb diets have beaten
calorie controlled low-fat diets. And we see again and again that when you
switch over from a glucose based metabolism to a more fat burning metabolism, appetite comes under your control. In my case it was striking. I was actually shocked within weeks of how I could blithely not have to eat
when I didn’t want to. So I think that’s one of the big factors. Now when your insulin is high
and you are hyperinsulinemic, like probably the majority
of American adults today, that will tend towards trapping fat and tend against the burning
of your body fat, so that is another factor. But I would say appetite control
is the central linchpin with the metabolic advantage
that’s being discussed and the lowering of insulin
being another strong element, but it’s not fully quantified,
I think that’s fair to say. What would you say, Jeff? Yes, so there’s a lot of factor to consider
that it’s not necessarily all insulin. There’s many hormones and signals
such as leptin, the gut incretins, we have to all consider that when
we are thinking about regulating appetite, but of course insulin is probably
the master hormone involved. And when you consider that perhaps
two thirds of the US population adults over age 45 are currently diabetic
and prediabetic that when you treat them
with carbohydrate restriction, you’re going to have most success. And I think that’s a very good answer because we like to simplify things
and almost to a fault, because we want to know,
“Is it the calories in, calories out? Is it the carbohydrate insulin?” And the truth is
it’s far more complex than that. That’s basically how I would summarize
your answer, so I thank you for that. The next question though Jeff is I’m sure you see these patients
all the time in your office that they come in with a stall. And you can define the stall
on different ways, but basically whatever metric
they are following, whether it’s their weight loss,
whether it’s their insulin sensitivity, it just plateaus and they get frustrated. What kind of advice can you give to people
about your general approach? When you see a stall
what do you think about… what are your sort of go to top two
or three things to ask them to do? Right, so if you’re insulin resistant
you just respond rapidly, your appetite is controlled,
you correct insulin resistance and the fat that is trapped in a damper
behind insulin… it opens these insulin floodgates
and energy just pours out from fat tissue. But what often happens and I mean I’m just thinking
of a patient I saw last week… they never lost weight
from the beginning even though they were
markedly insulin resistant when we measured all the parameters. This particular person was told by a trainer, “You have to eat 180 g of fat a day. No matter if you’re hungry or not hungry.” And she was heeding the advice
and pumping in the fat. And nothing happened. I mean that’s just an extreme example, but the point is that what you are eating
at the beginning is not going to be the same
when you hit this plateau. And so guess what? Controlling appetite
becomes most important. This is what I think about, the quantity
of food that you consume, the calories the activity
and then it trickles downhill. But we have to make people understand that the quantity of food is really important
once you become more insulin sensitive. Yeah, very good point. And now to tag onto that a little bit more, to go a little bit deeper
into the specifics of the diet… Ivor, this one’s for you
as a good Irishman… How does alcohol fit into the low-carb diet
and the low-carb lifestyle? Rather well. No, actually alcohol, I think a glass or two
of red wine a day is fine. You know, the beers are generally carby. I’ve heard beer described as liquid bread,
which is a pretty good. A good description. Yeah so I think generally alcohol… interestingly there are studies done
in the 60s on humans and calorie controlled, calorie for calorie
alcohol replacing carbohydrate led to a slight drop in weight. And then replacing carbohydrate back in
instead of alcohol iso-calorific increased the weight again. So well alcohol is the fourth food group. So we know the protein
has the thermogenesis effect, so over 100 calories of protein you eat
maybe 75 will fully get into your system and there’ll be losses for heat and fat and
carbohydrate around 10% or 15% of losses. It appears alcohol as the fourth food group
has losses also because of its metabolism. But that’s just an amusing aside. I think the advice is, you know,
moderate alcohol, particularly something like dry red wine is low in carbs, low in sugar
and it’s a pleasurable social thing. But anyone who has any hint
of an overindulgence nature, you know, maybe it’s best
to avoid alcohol altogether. And drinking excessively
will knock people out of ketosis and will lead to many other issues including their work performance
and other things also. I see it sort of the same way as trying to decide
what’s the mechanism of weight loss. Well, you also have to factor in the psychological components
of what you eat. So with alcohol how it affects your liver,
how it affects your ketone production, but also the psychological aspects
of alcohol. Because let’s be honest, we don’t make the best decisions
once we’ve had a couple of drinks so we have to factor that in as well,
beyond the physiological effects. That’s a really, really important point…
I wish I’d remembered to mention. Absolutely, when under the effects
of alcohol that’s often where you will do your cheats. You will recharge your hands, you will eat things you would never eat
without being slightly affected by alcohol. So that indirect way
can certainly lead to failures. Let’s talk about your book for a second. It’s a fantastic book, very detailed
with great recipes, great scientific descriptions
of why this works and how this works and some very practical tips. Can you share with us
maybe one of the stories in this book that really jumped out at you, that’s a motivating story for you
and your patients? One particular female who was here
last year at the conference had come in to see us… It’s actually a typical story. She was… Actually I’d say it’s not
a typical story, it’s an atypical story… So this patient had been going
to the diabetes Center in Denver for many, many years and her weight kept going up and up,
diabetes was out-of-control, taking more and more insulin. And it was her partner that had brought
to her attention the low-carb diet. So she was very frustrated at this point. And so on their own as a couple
they pursued low-carb diet. On their own, not recommended
by the Diabetes Center, not recommended by any physician. Absolutely on their own. And by the time they had come to see me
she was already losing some weight. And to make the long story short,
her A1c was in the range of 12 to 13. Wow, that’s high! She got off insulin,
she got off all medication and presently… And it was funny because
as we were writing the book, she kept losing more and more weight
so we had to update… We had to keep updating the book. -What a great story!
-Yeah. So as of today, and this is probably
maybe two years now, she lost over 100 pounds,
I believe it’s almost half her body weight. And her A1c is 5 or 5.2. From 12 to 5.2
getting off her medications. Yes. That’s a great story. And you know she went
to the elite diabetes center in town and they couldn’t help her. Wow! So not your average case,
not your standard case, but certainly shows the power
that this can manifest in the frustration, that it wouldn’t be discussed
in an elite diabetes center. Now do you see that trend changing
with the evidence from Virta health in a peer-reviewed journal that we can get
people off their medications? You know, it’s not doctors around town
or N=1 stories telling their experience. Now it’s a published article. So do you see the tide changing for that? Again I’ve been at it for almost 20 years
and it’s much slower than I would like, but again we can do it one-on-one, but that’s not going to give us
that global message that we’re looking for. So you know hopefully we can infiltrate
the ADA meetings, the American Heart Association meetings and bring the evidence to the table
in that way and change the tide. So what’s next for you guys?
Ivor, what’s next on your plate? Well for me it’s mostly conferences
in the next few months where we’ll be obviously sharing the book
and circulating that. I’m in Glasgow
for a British cardiovascular society, I’m in Majorca for Low-Carb Majorca,
Low-Carb Houston is on, Estonia has popped up for September,
just a kind of health conference there and possibly Cuba in December,
a diabetes conference, not low-carb but diabetes and health. And actually quite a few more
heading into next year. That’s great to hear that
it’s a diabetes conference in there, cardiovascular conference in there,
so not just low-carb conferences. Well, actually my supporter, and I kind of report to David Bobbitt now
of Irish Heart Disease Awareness and we certainly share the focus on getting
the message out to wider communities because I think
within the low-carb community our obsession is giving people the chance to discover their heart disease
with the calcium scan and giving them the solutions
which include low-carb, but obviously low-carb is only one part
of the multifactor solution. But the challenges that people
within the low-carb community have a good idea for a lot of the science
and they are quite ahead of the game and they are even now learning a lot
about the calcification scan through our efforts and others. But the huge majority of people
are outside the low-carb community. So it’s really vital for us
to get to ordinary people, I mean those people at 52 or 53 of age that are going to drop dead
of a heart attack and leave children behind and they are not obese
and they don’t smoke, but they have hyperinsulinemia
unknown, undiagnosed, they have huge vascular disease
that’s going to kill them, but no one gave them a scan
to wake them up. So our fixation is to get to those people. So I agree any conferences that are not
just low-carb are our primary target. That’s a very good point. I love how you brought up that the low-carb
is one part of the solution and is so important to emphasize. And in your book you do put
a strong emphasis on sun exposure and sleep
and stress and physical activities and you have your list of 10 factors and I think that’s really important
to fall back on, that we focus so much on diet because
it’s something we’re involved in every day and we have such an intimate relationship
with food and it’s so complex. But it’s one piece of the puzzle
so I’m glad you brought that up. Yeah absolutely, Bret, and again
just thinking back to the Pareto principle, people say that heart disease
has 300 factors now. It’s apparently 300 that are listed. But obviously by the Pareto principle the top 5 or 10 will account for a huge amount
of the disease on mortality and people can’t focus on everything. So it’s very confusing to tell people
too many factors including many lesser ones. And cholesterol can suffer
from this problem as well, that is not a primary central factor,
it’s an interacting factor. But we like to focus on the top ones, the Big Bang for the book
that will save most people. Good point.
And Dr. Gerber, what’s next for you? Yes, so I don’t go
to as many conferences as Ivor, because I still have my day job
as a family doctor and that takes up most of my time. And I have to say, you know,
almost 30 years doing it I still enjoy it. There’s passion and helping
to take people off medication and giving them tools where they can really
make changes is really helpful. But just a backup in terms of conferences, Ivor and I did attend a really important
and interesting conference in Zürich. It was put on by the BMJ and Swiss RE. And the purpose of that conference
was consensus. So we actually had
the two sides come together and I’m a person of moderation
and so trying to find consensus and this was just wonderful. And we hope that we could see
more conferences like that into the future. So I pick and choose the conferences
that I attend, I’m busy with our Denver conference
that is coming up in March 2019 and we’re always looking
for interesting topics, keeping it fresh. We have some of the returned
regular speakers and then to find new speakers. And so our mantra for our conferences is that these are for doctors
put on by doctors, so we offer educational credit
and everyone else is invited. That’s great, very good. Dr. Jeffry Gerber, Denver’s Diet Doctor,
thank you so much for joining me. Ivor Cummins,,
thank you so much for joining me. -Thanks a lot, Bret.


  1. 15:30 Appreciated the discussion of the "warranty" of the CAC, and I think Ivor's case with the public would be stronger if he abandoned that language. (It may not be quite as bad as the statin crowd substituting "relative risk" for "absolute risk," but it is the same sort of word choice that is almost bound to lead to confusion for most listeners, so we shouldn't be using that language.)

  2. I suffered an acute MI with 99% blockage of the LAD this year, without high risk factors (didn't have high cholesterol, never a smoker, not diabetic, no real family history, etc) or warning signs. How am I to know whether I had soft plaque or calcium? I'm a bit confused on that.

  3. The problem solving capacity that seems to be inherent in the engineering mindset seems to be the reason why so many of our most prominent and cogent voices, within the low carb community, are either engineers themselves, or they are doctors who studied engineering as undergrads. Dr. Peter Attia, Dr. Ted Naiman, and Dr. Richard Bernstein are physicians who graduated with undergraduate engineering degrees, and they have contributed immensely to the low carb movement. Dr. Jason Fung studied engineering in college before switching majors, and he is the one that established the efficacy of intermittent fasting. Gary Taubes received a masters degree in aerospace engineering from Stanford, and his part in arguing for the low carb lifestyle is impossible to overstate. Then you have Ivor Cummins, Marty Kendall, and David Feldman – three engineers who have presented eye opening perspectives on subjects like heart disease, how insulinogenic certain foods really are, and the role of cholesterol. The fact that those who share an engineering background have imparted so much knowledge and understanding in such an unrelated field is a compelling argument as to why we must go out of our way to get different perspectives when trying to solve a complex problem.

  4. Thanks for the good information
    I am a recent kito dieter and it is going great with me

  5. Great chat, guys!

  6. It is said that in the world there are more than 400.000.000 of diabetics. Soon there will be not human and economic resources to cope with this disease.

  7. Great talk as usual. I learn more and more each day. Thank you. Does anyone know if you can get a CAC scan here in NZ. I rang one place and they had never heard of it. Thats scary!!!!

  8. Where have I seen the person in white shirt?

  9. 12:15 Re dose response: I brought up the ACCORD trial to a doctor, which showed diabetes medicine and insulin negatively correlated with outcomes — lower A1C was associated with worse outcomes when achieved with meds. He said the study should be viewed as exclusively showing "the A1C treatment goal was too aggressive" and a lower goal should be used. So I said basically what you're telling me is that the function between A1C and patient outcomes looks like this:

  10. While it's true that weight loss is perhaps "not the most important metric" of the low carb diet, many people learn that they have Metabolic Syndrome when they start getting interested in their health and think that weight loss is the way to achieve it. We know that high blood glucose, high blood pressure, etc. are signs of metabolic disorders, but we especially feel the acute pain of disrespect from society when we're carrying extra weight, so there's no shame in going on a low carb diet initially to lose weight. When my doctor mentioned that I'd have to be put on meds for Type 2 diabetes and very high blood pressure, I asked him to give me another month or two to 'look into it' and I started to research the best ways to lose weight because I truly believed it was my excess weight which was at the root of all my problems. I now realize that I likely had metabolic syndrome and some of the autoimmune disorders I dealt with before the excess weight became a problem, but it was my focus on weight loss that led me there. Anyway, I've reversed every health problem I had with a keto/carnivore diet and the weight has been coming off at a steady rate now, so it's all good no matter how you get there. Thanks for a great discussion..


  12. Excellent discussion, the knowledge available is invaluable. Many thanks!!

  13. Awesome I will share with my keto peeps. It is so frustrating when people you care about think keto and low carb is not a healthy way to eat. I hope they will listen to you two.

  14. Ivor, as an engineer, I expected you to mention the Ballmer Peak regarding alcohol. ๐Ÿ˜‰

  15. Great video. These videos are a great way to spread the knowledge. Thanks

  16. Dr. Eric Berg is the answer to helping YOU turn your life around.

  17. I wish we in the UK had support in following this way of living. My GP isnt interested in LCHF which is how my diabetic husband and I live now. This video is great thank you.

  18. Weight loss stalls introduce
    Intermittent fasting
    ThreeMAD- TwoMAD- OMAD
    I've had two, by the time you get to the first you will have got used to knowing that your appetite is under control, thus go from ThreeMealsADay to TwoMAD to OMAD, using bulletproof coffees as meal subs, or just drink water.

  19. Itโ€™s very frustrating to watch low carb expert / advocates dance around the calorie issue. It only confuses regular people trying to get a handle on all this information. Listening to Gerber who tells his patients to go on a low carb diet and then when they hit a plateau he defaults back to eat less move more. I noticed they got off that topic very quickly. For some reason this topic gets glossed over on all these podcasts. For more definitive info look up Ben bikman and watch his videos He is much more straight forward on the topic of calories. The bottom line is as you lower insulin in the body Metabolic Rate increases. When insulin is high Metabolic rate goes down. This is why you have a so called metabolic advantage. Ben Bikman states this directly gives an abundance of data on how Low carb changes the metabolism.

  20. went low carb, keto for 3 months, a1c went from 5.8 to 4.8 , ldl went form 103 to 140 cardiologist told me to get off diet and take a statin. i was concerned 4 years ago calcium score of 28 dad had heart attack at 51 i'm 59 no heart events, i also noticed blood pressure much better on low carbs, feel like i'm being pulled in two directions, any suggestions

  21. Amazing interview, I Heard you will have a conference in 2019, in Denver, I would love to be there.- Iโ€™m an Eye Doctor dealing with DR problems, one of the main causes of irreversible Blindness in my country, and I believe we need to do something. Thank you in advance for the information

  22. Three Heavy hitters. Great Video. Greater information.

  23. In my experience most diets are promoted as being suitable for all body types, or as a remedy for your ailments. If they are designed as a remedy they are a temporary, not a long term solution. If they are designed for life, they may not suit your body type. There are many ways to find your body type, you just have to do the research.
    I have identified my body type from the Ayurvedic health system. For instance, It recommends no raw foods. It does recommend fatty foods. Also there is more to health than eating. Psychologist's say that where the mind goes, the body follows. A spiritual healer will tell you that love (gratitude, compassion…) is the only true healer. From all the research and experiments I have done, I conclude that in order to be well, we have to discover how to live and love well. – Best wishes

  24. Excellent Information ๐Ÿ™‚๐Ÿ‘

  25. Ivor Cummins and Tim Noakes were the first people I started listening to over a year ago. Iโ€™ve eaten a relatively healthy diet all of my life, have no health issues and am not overweight. The overwhelming evidence presented by so many of these great speakers โ€” engineers and physicians โ€” convinced me to change my way of eating. Almost year on LCHF, I cannot even imagine eating any other way. If people just gave up on sugar, cheap โ€œvegetableโ€ oils and wheat, the health of people around the world would improve dramatically.

  26. Dr Jeff and Ivor, read the book it is fantastic. Hyperinsulinemia is the same as Insulin resistance is the same as Metabolic Insulin Resistance Syndrome.๐Ÿ˜ฎ๐Ÿ˜Š๐Ÿ‘Œ๐Ÿ‘๐Ÿ‘

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