An Engineering View of Modern - Low Carb …...2017 Ivor Cummins BE(Chem) CEng MIEI An Engineering...

2017 Ivor Cummins BE(Chem) CEng MIEI

An Engineering View of Modern

Chronic Disease Prevention From “Bad Cholesterol” to Hyperinsulinemia and CAC

Ivor Cummins BE(Chem) CEng MIEI PMP®

Disclosure

1. My work is directly supported by David Bobbett and his Irish

Heart Disease Awareness charity (http://www.IHDA.ie/)

2. No financial ties to the heart imaging industry (!)

http://www.ihda.ie/

Engineering Problem Solving

- Just a Primer

PART 1

Contrasting Worlds…

➢ Massive research effort to understand key

root causes and prevent failures. Stunning

progress in face of increasing complexity:

outcomes improved by factor of ~60

➢ Imperative that RC is found and resolved.

Resolution is crucial for good business.

Contrasting Worlds…

➢ Massive research effort to understand key

root causes and prevent failures. Stunning

progress in face of increasing complexity:

outcomes improved by factor of ~60

➢ Massive research effort to understand

root causes and mitigate failures. Some

notable wins. But CVD morbidity is

rising. Obesity & Diabetes exploding

➢ Imperative that RC is found and resolved.

Resolution is crucial for good business.

➢ RC is not the focus - resolution neglected.

Patching-up Strategy is excellent for

business.

Rule Zero: Always Honor Pareto

A

Know your ABC: Kepner Tragoe “Is - Is Not” Analysis


EXTENT

WHEN

WHERE

WHAT

A

EXTENT

WHEN

WHERE

WHAT

IS IS NOT DISTINCTIONS INFERENCES


A

EXTENT

WHEN

WHERE

WHAT

Integrate the

Logic

• Analyse

“Correlations”

• Scrutinise

“Coincidences”

• Highlight the

conflicts

• Prioritise the

Likely Causes


AIS IS NOT DISTINCTIONS INFERENCES

Know your ABC: Root Cause Diagram (RCD)

B

Chem

Acivate

Chem

Acivate

Cover

Mech

ChemMech

Cover

Ingress

Surface

Chem

Expose

THA

Adhesion

PHA

Stress

Mech

Tension

CTE

Chem

Fail

Surface

Chem

Surf

Chem

Ingress

Surf

Chem

Surf

Chem

TBD Surf

TBD

Ingress Strain

Adh

resist

Adh

inconsist

Mech:

Coverage

Chem

Attack

Chem

Attack


BChem

Fail


BChem

Fail

Integrate the

Mechanisms

• Ensure sound science

• Leverage team

expertise

• Highlight conflicts

• Prioritise the Likely

Causes

• Downgrade unlikely

Hypotheses !

HYPOTHESIS EVIDENCE FOR EVIDENCE AGAINST

C

Know your ABC: C – Hypothesis For/Against Tool

HYPOTHESIS EVIDENCE FOR EVIDENCE AGAINST ACTION

HYPOTHESIS EVIDENCE FOR EVIDENCE AGAINST

Integrate the

Hypotheses

• Weigh up evidence base

• Leverage team expertise

• Scrutinise conflicts

• Prioritise Best

Hypotheses

• Kill the Weak

hypotheses !

C

Know your ABC: C – Hypothesis For/Against Tool

HYPOTHESIS EVIDENCE FOR EVIDENCE AGAINST ACTION

A

B

C

Engineering Problem Solving

- for Heart Disease

PART 2

Rule Zero: Always Honor Pareto

Kepner Tragoe IS / IS NOT Excerpt for CVDA

WHATIS IS NOT DISTINCTIONS INFERENCES UNLIKELY

Kepner Tragoe Excerpt for CVDA

WHERE

IS IS NOT DISTINCTIONS INFERENCES UNLIKELY

Kepner Tragoe Excerpt for CVDA

Root Cause Diagram Excerpt for CVDB

HEART DISEASE

Excess

Fructose

Excess

Glucose

↓ Insulin

Signalling

Adipocyte

Hypertrophy

AND


HEART DISEASE

Excess

Fructose

Excess

Glucose

↓ Insulin

Signalling

Adipocyte

Hypertrophy

Liver and

Systemic

HI / IR

↓ Adiponectin

↑ Immune

IL1-β etc.

↓ Triglyceride

Trafficking

AND

↑ Visceral

Depot

HEART DISEASE


↑ InsulinElevated

Glucose

↑ Glycation /

AGE / RAGE

Atherogenic

Dyslipidemia

↑ Blood

Pressure

Excess

Fructose

Excess

Glucose

↓ Insulin

Signalling

Adipocyte

Hypertrophy

Liver and

Systemic

HI / IR

↓ Adiponectin

↑ Immune

IL1-β etc.

↓ Triglyceride

Trafficking

AND

↑ Visceral

Depot

HEART DISEASE

Sub-Opt

Omega 3

Sub-Opt

Magnesium

Excess

Omega 6

AND

/OR

Lack of Sleep

/ Exercise

Smoking

Low C Etc.

Lack of UV

Vit D / NO

Stress

Microbiome


↑ InsulinElevated

Glucose

↑ Glycation /

AGE / RAGE

Atherogenic

Dyslipidemia

↑ Blood

Pressure

Excess

Fructose

Excess

Glucose

↓ Insulin

Signalling

Adipocyte

Hypertrophy

Liver and

Systemic

HI / IR

↓ Adiponectin

↑ Immune

IL1-β etc.

↓ Triglyceride

Trafficking

AND

↑ Visceral

Depot

Root Cause Diagram Excerpt for CVD

HEART DISEASE

Sub-Opt

Magnesium

Lack of Sleep

/ Exercise

Smoking

Low C Etc.

Lack of UV

Vit D / NO

Stress

Microbiome

BSub-Opt

Omega 3

AND

/OR

↑ InsulinElevated

Glucose

↑ Glycation /

AGE / RAGE

Atherogenic

Dyslipidemia

↑ Blood

Pressure

Excess

Fructose

Excess

Glucose

↓ Insulin

Signalling

Adipocyte

Hypertrophy

Liver and

Systemic

HI / IR

↓ Adiponectin

↑ Immune

IL1-β etc.

↓ Triglyceride

Trafficking

AND

↑ Visceral

Depot

Excess

Omega 6

Root Cause Diagram Excerpt for CVD

HEART DISEASE

Sub-Opt

Magnesium

Lack of Sleep

/ Exercise

Smoking

Low C Etc.

Lack of UV

Vit D / NO

Stress

Microbiome

BSub-Opt

Omega 3

AND

/OR

↑ InsulinElevated

Glucose

↑ Glycation /

AGE / RAGE

Atherogenic

Dyslipidemia

↑ Blood

Pressure

Excess

Fructose

Excess

Glucose

↓ Insulin

Signalling

Adipocyte

Hypertrophy

Liver and

Systemic

HI / IR

↓ Adiponectin

↑ Immune

IL1-β etc.

↓ Triglyceride

Trafficking

AND

↑ Visceral

Depot

Excess

Omega 6

LDL “Bad

Cholesterol”?

ArteryClogging

SaturatedFat? ??

Hypothesis For/Against Excerpt for CVDCHYPOTHESIS EVIDENCE FOR EVIDENCE AGAINST

Hypothesis For/Against Excerpt for CVDCHYPOTHESIS EVIDENCE FOR EVIDENCE AGAINSTHYPOTHESIS

Heart & Chronic Disease

- the Solution Space

PART 3

Always Honor Pareto

Excess

Fructose

Excess

Glucose

RACK and STACK – and RESOLVE

CAUSE DO DON’T DO MAIN MECHS

Insulin Resistance

Hyperglycemia

Inflammatory vectors

Etc.

Excess

Fructose

Excess

Glucose


Sub-Opt

Omega 3

Excess

Omega 6



Cellular damage

Insulin Resistance

Hyperglycemia


Etc.

Excess

Fructose

Excess

Glucose


Sub-Opt

Omega 3

Excess

Omega 6

Sub-Optimum

Magnesium



Cellular damage

Biochemical Basics

Insulin Resistance

Hyperglycemia


Etc.

Excess

Fructose

Excess

Glucose


Sub-Opt

Omega 3

Excess

Omega 6

Sub-Optimum

Magnesium

Lack of UV

Vit D / NO



Cellular damage

Biochemical Basics

Biochemical Basics

Insulin Resistance

Hyperglycemia


Etc.

Excess

Fructose

Excess

Glucose


Sub-Opt

Omega 3

Excess

Omega 6

Sub-Optimum

Magnesium

Lack of UV

Vit D / NO

And so on… Move on down the Pareto…



Cellular damage

Biochemical Basics

Biochemical Basics

Many and varied…

Insulin Resistance

Hyperglycemia


Etc.

If you Don’t Measure It

- it Don’t Get Fixed

PART 4

CAC: THE MASTER MEASURE

Google “Budoff Ivor”

Calcium Score Risk Equivalent 10-Year Event Rate, %

0 Very low 1.1-1.7

1-100 Low 2.3-5.9

101-400 Intermediate 12.8-16.4

>400 High 22.5-28.6

>1000 Very high 37

J Am Coll Cardiol Img. 2015;8(5):579-596

Based on 100’s of thousands of subjects

Reproducible and quantifiable

CAC: THE MASTER MEASURE

CAC: THE MASTER MEASURE – Always Performs

Interplay of Coronary Artery Calcification and Traditional Risk Factors for the Prediction of All-Cause Mortality in Asymptomatic Individuals

Circ Cardiovasc Imaging. 2012; 5:467-473

All-C

au

se M

OR

TA

LIT

Y!

“Association of Coronary Artery Calcium in Adults Aged 32 to 46 Years With Incident Coronary Heart Disease and Death”JAMA Cardiol. doi:10.1001/jamacardio.2016.5493

Published online February 8, 2017.

➢ Adults aged 32 to 46 followed

➢ Mean event follow-up 12.5 years

➢ CAC score makes a farce of “risk

factors”

➢ …because it ain’t guessing.

CAC: THE MASTER MEASURE - Feb 8th 2017 Study

“Association of Coronary Artery Calcium in Adults Aged 32 to 46 Years With Incident Coronary Heart Disease and Death”JAMA Cardiol. doi:10.1001/jamacardio.2016.5493

Published online February 8, 2017.

CAC: THE MASTER MEASURE - Feb 8th 2017 Study

➢ Adults aged 32 to 46 followed

➢ Mean event follow-up 12.5 years

➢ CAC score makes a farce of “risk

factors”

➢ …because it ain’t guessing.

David Bobbett – one of the Saved* CEO/Owner of H&K International

* Jogging ~4 times per week

* Described by docs as “bulletproof”

* 52 years old, slim and fit non-smoker

David Bobbett – one of the Saved* CEO/Owner of H&K International


* 15 executive medicals…

* All Bloods Good

* Fittest 10% for age* Described by docs as “bulletproof”


* Treadmill Stress Tests/ECG

David Bobbett – one of the Saved

* CAC=906 ! Worst 1% for age.

* CAC supersedes all tests

* 75% chance of Heart Attack

* CEO/Owner of H&K International



* All Bloods Good








* Angio shows severe blockages

* No Surgery - meds+lifestyle fix

* David takes 6mths to study




* All Bloods Good











* All Bloods Good







* He was diabetic, undiagnosed

* But Heart Disease IS resolvable

* Meds + nutrition excellent path





* He was diabetic, undiagnosed

* But Heart Disease IS resolvable

* Meds + nutrition excellent path

* Founded www.IHDA.ie

* Funded The Widowmaker Movie

* Total Philanthropy

* Resolved his disease process




* All Bloods Good







Middle-aged?

Middle-Risk?

Middle-aged?

CACThe

Ultimate

Decider

Middle-Risk?

Middle-aged?

CACThe

Ultimate

Decider

+

Middle-Risk?

Middle-aged?

CACThe

Ultimate

Decider

+CAC

5-7 years…

Middle-Risk?

Middle-aged?

CACThe

Ultimate

Decider

Trig/HDL ratio

PP Insulin Level

PP Glucose / A1c

GGT / Ferritin

Blood Pressure

Homocysteine

+CAC

5-7 years…

sdLDL, ApoB/ApoA1Middle-Risk?

Etc. etc.

Adiponectin

Middle-aged?

CACThe

Ultimate

Decider

Trig/HDL ratio

PP Insulin Level

PP Glucose / A1c

GGT / Ferritin

Blood Pressure

Homocysteine

+CAC

5-7 years…


Etc. etc.

Adiponectin+

Middle-aged?

CACThe

Ultimate

Decider

Trig/HDL ratio

PP Insulin Level

PP Glucose / A1c

GGT / Ferritin

Blood Pressure

Homocysteine

+CAC

5-7 years…


Etc. etc.

Adiponectin+

CAC

~2yrs

An Engineering View of Modern - Low Carb …...2017 Ivor Cummins BE(Chem) CEng MIEI An Engineering...

Documents

Transcript of An Engineering View of Modern - Low Carb …...2017 Ivor Cummins BE(Chem) CEng MIEI An Engineering...