In today’s interview, I get to speak with biochemical engineer, Ivor Cummins, also known as the Fat Emperor.
We talk about the Coronary Artery Calcium (CAC) score and why it is the best and most reliable measure of heart disease we have.
Being the current CPO of Irish Heart Disease Awareness he is also on a mission to prevent heart attack and strokes.
Each year seemingly healthy people, with no known risk factors die prematurely of heart attacks. Routinely preformed CV risk tests can often come back clear and there can be no prior warning until it’s too late.
We get a chance to talk about The Coronary Artery Calcification (CAC) scan; a cardiovascular diagnostic test that can diagnose the level of heart disease present directly and empower people who are high at risk to take action to stop disease progression.
If you know someone who is interested in learning more about:
- What is the Coronary Artery Calcification (CAC) score (heart scan)
- Why it’s important in determining heart disease as well as risk of heart attack
Then this interview is for them.
I really enjoyed this interview with Ivor who shared some invaluable information that not many people may be aware of. He explains why commonly used heart attack risk testing often misses heart problems.
For an accurate assessment of the level of our coronary arteries health the CAC scan is the best place to start.
Special thanks to Ivor for joining me on the show.
Enjoy the episode!
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Show Notes with Timestamp Links
Find summarised highlights of what we talk about during the interview.
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[00:19] – Introducing, Ivor Cummins commonly know as the Fat Emperor. He has a background in Biochemical Engineering and helping corporates with large worldwide teams in complex problem-solving activities. Currently the Chief Program Officer for Irish Heart Disease Awareness charity, he also hosts The Fat Emperor podcast.
[00:50] – To start, Ivor explains all about the coronary artery calcium score or CAC score; a CT x-ray that allows us to get a snapshot of the amount of calcium in the coronary arteries. Why is this important in predicting heart disease?
[04:36] – For someone who has concerns about their cardiovascular risks and is starting a new diet, in Ivor’s opinion, there is great value in getting their CAC score. Both to uncover underlying issues and getting a baseline for comparing the effects of the diet.
[06:09] – There are many cases of people with a good cholesterol score and other blood markers as well as a good treadmill stress test, who’s CAC score is poor and they actually have serious cardiovascular disease. Ivor recommends starting with the CAC score first to check your disease level.
[10:53] – Ivor explains what the CAC scores tell us in terms of risk, which people would benefit from drugs and how age affects results. 0 is obviously the best score, 1-100 range are higher risk but not high risk, 100-400 high risk range, above a 400 very high and 1000+ very, very high.
[13:38] – There are different types of plaque, such as the soft plaque and plaque that doesn’t contain calcium and won’t be picked up by the CAC scan. Ivor explains why this generally doesn’t affect the accuracy of the test results as the amount of different types of plaque correlate very well.
[16:24] – Dave Feldman talks about hyper-responders in his work. Ivor shares his thoughts on hyper-responders that come back with a 0 CAC score. There are nuances to this and it’s important to note that Dave’s experiments with diet are intended for relatively young and healthy people rather than those with a high heart disease risk.
[19:42] – What are other useful markers to test along with the CAC score? While CAC score is the crucial test; other than that, the best blood markers are the triglyceride/HDL ratio (good proxy for hyper-insulin) total cholesterol/HDL ratio and remnant cholesterol. There are also some insulin tests that are OK.
[21:49] – Putting our data into the official MESA calculator online, it will give us a 10 year risk. Ivor explains why this is a good tool to use.
[25:01] – There are millions of people who appear to be healthy but will die of a premature heart attack. There is a simple way to prevent this as the CAC scan is available and can tell us immediately if we have coronary disease.
[26:11] – Ivor explains that the CAC does not measure risk factors, it measures disease progress.
[28:04] – Ivor explains how fast a change can occur to your score with a change of diet/habits. A score of 0 could be a 15-year warranty or it can give you no warranty at all, depending on other factors.
[31:46] – A lot of people will start a ketogenic/low carb diet after diabetes diagnosis but even then they should be monitoring other factors to ensure their diet is right. Ivor explains that diabetes is a very high risk for heart disease and various biomarkers should be monitored closely.
[34:40] – For people who don’t see the desired results on a strict keto diet, Ivor recommends doing a low-carb/healthy fats, milder approach. Low-carb/healthy fats diet with regular meal skipping achieves similar keto results to a very low-carb/very high-fat diet without meal skipping.
[35:41] – There is some evidence that carriers of the ApoE4 genotype who have sustained heart disease may have sensitivity to cheese, rich protein and fatty foods.
[37:04] – Is it possible to reverse a high calcium score? Ivor shares there are anecdotal evidence that it is possible to do this. He also explains that an increase of only 5% per year is a similar lowering of risk to staying flat or reducing the score. The crucial thing is to stop the progression!
[40:16] – Ivor explains that there is a lack of data as the CAC score method wasn’t adopted as it should be. He recommends the Widowmaker documentary for more on the politics/corruption behind this.
[41:42] – If your score keeps increasing at 20% or more, perhaps it is time to ask questions. Do you have ApoE4 and sensitivity to certain foods? Do you have gingivitis and gum infections? Heavy metal contamination? There are many other factors other than diet that can cause a lot of damage.
[43:49] – Ivor explains that calcium supplements don’t have anything to do with the plaque build up. However, excessive calcium can cause problems. Instead he recommends other supplements such as magnesium, potassium, iodine or vitamin K2.
[45:45] – To find out where you can get a scan, Ivor recommends visiting ihda.ie which has an interactive map showing centres around the world; currently it is a work in progress with more coming. The problem is also that many doctors will not be familiar with it.
[48:31] – Do we have to go through our doctor to get this done or can it be paid for privately. It depends on location, it can also be pretty expensive. The score should be standardised however.
[51:40] – To follow Ivor and find out more he recommends googling him to find his YouTube, website and podcasts. He also recommends Googling Widowmaker CAC to find the movie on YouTube, also ihda.ie is the website with the new interactive map and great short clips with top professors of cardiology talking about this.
