Jimmy and MONICA: A Tale From the Heart

      38 Comments on Jimmy and MONICA: A Tale From the Heart
The alleged person Jimmy Moore

The alleged person Jimmy Moore

I’ve never actually met Jimmy Moore, so I can’t say for sure he’s real.  Sure, I read his Livin’ La Vida Low-Carb blog every day, we exchange emails regularly, we’ve spoken on the phone, and he’s threatened to drop by for a visit in October, when he’ll be in Nashville for a wedding.  Still, he may be a pod person, created by the meat and dairy industries to fool us into thinking their products won’t kill us. (His shows, after all, are called “podcasts” … coincidence?)

I’m suspicious because Jimmy’s total cholesterol is well over 300, which puts him in the category I sang about in the closing song for Fat Head:  “I’m shopping for my coffin, but don’t shed me any tears … ‘cuz according to the experts, I’ve been dead for several years.”

Score that high on a cholesterol test, and your doctor will break into an impression of the scarecrow from the Wizard of Oz, arms flying in opposite directions as he lurches for a bottle of Lipitor and a defibrillator at the same time.

To make matters worse, Jimmy has a family history of heart disease.  His father had a quintuple bypass a year ago.  His brother Kevin died of heart failure at age 41.  And Jimmy was morbidly obese for much of his life.

Worst of all, Jimmy lives on a diet that’s around 70% fat (much of it saturated), and he has committed the cardinal sin of refusing to accept the sacrament of statin drugs, despite many warnings from his doctor.  In other words, according to the Holy Church of Accepted Advice For Living a Long and Healthy Life, Jimmy is a condemned man, a heart attack waiting to happen.

And yet when he had a heart scan recently, the amount of plaque build-up in his arteries was measured at …(drum roll, please) … Zero.  None.  Nada.  No plaque.  Despite being a walking bundle of supposed risk factors, he has no signs of heart disease whatsoever.

This goes against everything we’ve been told about heart disease for the past 40-plus years. (Or, as his doctor put it when reading the test results, “That’s not possible.”)  If Jimmy does visit in October, I may have to serve him a drink in a cracked glass so I can send a blood sample to a lab.  There’s a good chance it will come back labeled “Not human, unable to identify.”

But let’s assume Jimmy is human, and is also alive and well.  Perhaps he’s just an outlier.  Surely, if we compare cholesterol levels and heart disease across large populations, we’ll see a pattern, right?

Hardly.

Check out this video by Dr. Malcolm Kendrick, author of the very enlightening and very funny book The Great Cholesterol Con, speaking about the world-wide MONICA study:

Dr. Kendrick arranged his data to demonstrate a crazy up-and-down pattern in the heart-disease death rate as you go up the cholesterol scale.  I was curious what the data would look like on a scatter chart.  (Yes, I’m that big of a dweeb.) 

So I went prospecting for MONICA data on the internet and ended up finding two useful nuggets:  1) average cholesterol levels for men in various countries, and 2) heart-disease death rates for men aged 35 to 75 in those same countries – in other words, men who died prematurely due to heart disease.  (If I die of a heart attack at age 95, I’ll consider it a victory.)

I plotted the results for 40 of the most populous countries.  But before we get to those, take a look at these charts, courtesy of Tony at Emotions for Engineers, demonstrating what different degrees of correlation look like:

A perfect correlation equals 1.0, which produces a trendline starting in the lower left and rising to the upper right.  If x (horizontal axis) causes y (vertical axis), the data from studies comparing them should be strongly correlated.  Researchers rarely get excited about a correlation of less than 0.8, unless their grants are running out.

With that in mind, take a look at the average cholesterol levels for men in 40 countries plotted against the annual heart-attack death rates per 100,000 men in those same countries:

Do you see a meaningful pattern there?  If so, you probably also see secret messages from the CIA in crossword puzzles and college baseball scores – published solely for your benefit, of course. 

Or perhaps you just work for one of the organizations that’s been promoting the Lipid Hypothesis for the past 50 years.  I found and downloaded the MONICA data from the official website of the British Heart Foundation, the U.K. equivalent of the American Heart Association.  The same site includes (of course) recommendations for reducing your risk of a heart attack:

It is now universally recognised that a diet which is high in fat, particularly saturated fat, sodium and sugar and which is low in complex carbohydrates, fruit and vegetables increases the risk of chronic diseases – particularly cardiovascular disease (CVD) and cancer … The dietary changes which would help to reduce rates of coronary heart disease (CHD) in the UK population were detailed in the 1994 report of the Government’s Committee on the Medical Aspects of Food and Nutrition Policy (COMA). This recommended a reduction in fat intake, particularly saturated fat intake, a reduction in sodium intake and an increase in fruit and vegetable and complex carbohydrate intake.

I ran the CORREL function on the data in Excel, and the result was -0.25 … a negative correlation.  In other words, there is no meaningful correlation at all, but the tiny correlation that does exist would point towards heart disease rates going down as cholesterol levels go up

I can only imagine the conversations that go on in organizations like this when they look at the results of large studies like MONICA:

“Did you finish analyzing the cholesterol data?”

“Yes, Doctor Higginbotham, all done.”

“And?”

“A careful analysis of the data from 40 of the largest countries shows no relationship between cholesterol levels and heart disease whatsoever.”

“Hmm … that’s it, then.  We’d better keep telling people to cut back on saturated fat.”

“Why, Doctor?”

“Because it raises cholesterol.”

“But … uh … I’m afraid I don’t understand.”

“Well, it’s complicated, so let me explain it this way:  Shut up.”

Fortunately, a lot of doctors like Malcolm Kendrick and Uffe Ravnskov and Mike Eades refuse to shut up.  Same goes for a lot of bloggers like Jimmy Moore.

Yes, Jimmy has high cholesterol – very high, by most standards.  But he also has very low triglycerides and high HDL, and only 2 percent of his “too high” LDL is the small, dense type that can penetrate the walls of an artery and lead to heart disease.  He achieved those numbers by ignoring the experts and cutting the sugars and starches from his diet, not the fats.  He’s not an outlier, any more than the hundreds of thousands of people who die from heart disease every year despite having low cholesterol. 

As for whether or not Jimmy Moore really exists …I’ll let you know in October.

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38 thoughts on “Jimmy and MONICA: A Tale From the Heart

  1. SkinneeJay

    This is a very good time for a conpspiracy. Or claiming he’s simply an exception, and everyone else must cut on calories and cholesterol.

    Why do people eat food if not for calories?

    I’ve eaten schnitzel for most of my life. It’s the main food in my diet. Obviously, not a heavy one, but even though I seem to be overweight, my body actually looks great and my depressions seem to come from different places. My only problem is exercise, but it’s all my business.

    Reply
  2. JaggedToaster

    This is all very interesting information and I have only recently been reading on this as well as paleo diets. My father had bypass surgery at 50. I’ve been to my doctor and my cholesterol is high and since my father had trouble I am now on statins after not being able to get my cholesterol level down with diet and exercise.

    I’m wondering what kind of research and information is available regarding the long term use of statins? I’d like to be around for my family. What kind of problems can the statins cause? Does it hurt to be on them if I am following the high-fat diet and should not need them based on this kind of information? I certainly don’t care for the long list of side effects and I hated going on the statin wondering what I would feel like.

    I’m interested in getting into the high-fat diet long term, but I would feel bad if I was wrong and dropped the statins only to have a bypass later in life.

    Statins have only been shown to decrease heart-attack rates in men who are under 65 and have existing heart disease. They probably work by reducing inflammation, not by reducing cholesterol.

    Good info about statins — the upside and downside — on Dr. Graveline’s Spacedoc site. He’s had a quite a history with them.

    Reply
  3. Amy Dungan

    Another great post! I makes me crazy to hear how they are marketing statins… especially to women when they pretty much do squat to help. Liver damage anyone?

    Oh, I can vouch that Jimmy is real. I’ve met him and talk to him often. But then… I might not be real, so you may not be able to trust me!

    You could be one of “Jimmy’s” handlers, spreading propaganda.

    Reply
  4. Keath Cole

    Tom, did you already mention somewhere the reason you moved to Tennessee?

    I wrote about it on the tomnaughton.com blog.

    Basically, I was tired of California, the loony politicians, the loony culture, the punitive taxes, etc. I realized I didn’t want to raise my girls there.

    We chose this area because I have friends who’ve lived here for many years, and I’ve always liked it. Plus I used to be a regular at the comedy club in Nashville, stayed in an apartment downtown for those weeks, and I liked the city as well.

    Reply
  5. Dr.LaTino

    If Jimmy certainly does exist… he sure creeps the heck out of me. He has that kind of smile that’ll scare kids. Maybe. The point is try and figure out for us, alright?

    It’s interesting on what you’ve said about cholesterol. It makes sense. Heart scans are usually performed for the more elderly, right? My cholesterol levels are probably shooting high with more than half my diet being saturated fat. I’ll probably scare my family to death first before I even show signs of any real damage.

    And I’ve noticed all the research across this site, Fat Head, and other sites. I don’t know how you find all the access to this information and make sense of it. >.>

    I’ll check Jimmy’s smile too.

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  6. Tinamemphis5

    Tom, you are so funny. I am sure Jimmy is getting a big kick out of this post. I will hopefully be meeting you and Jimmy in March on the cruise so I will find out if both of you are robots!! By the way my cholesterol was flagged at “high” because my HDL was 106! Switched doctors. Will see if the new one freaks out about my “high” cholesterol.

    You’ll meet us both on the cruise. That’s a fantastic HDL number; glad you switched doctors.

    Reply
  7. AmandaT

    Thanks, Tom, for another great post. My husband had a similar experience. He has been eating low-carb for a few years now and eats a huge bucket of sugar-free ice cream every single day, made with heavy cream and egg yolks, usually served with mascarpone and extra cream on top (and maybe a strawberry on top of that). He had a full medical recently: his HDL was very high, his triglycerides were rock-bottom, his LDL was slightly high (but don’t know how mich of that was big and fluffy).. his ‘Framingham score’ for 10 year heart disease risk was calculated at 3% (average for his age is 11%, ‘ideal’ is 4% for some bizarre reason.)
    So his heart health is better than ideal. The doctor still tells him to cut out saturated fat!

    Those are great results. It’s a shame we have to ingore our doctors to avoid heart disease, but that’s what it’s come to.

    Reply
  8. TonyNZ

    “And I’ve noticed all the research across this site, Fat Head, and other sites. I don’t know how you find all the access to this information and make sense of it. >.>”

    What I don’t get is how the low fat dogmatists can access the same information for such wildy different conclusions.

    That’s what mystifies me. I’m afraid some of these organizations have been preaching low-fat for so long, they can’t bring themselves to admit they’ve been wrong all along.

    Reply
  9. Vin - NaturalBias

    Great article, Tom! Despite already believing that the lipid hypothesis is seriously flawed and ridiculous, I still think the results of Jimmy’s heart scan are eye opening! His history, as well as that of his family, makes him a great case against the lipid hypothesis. Thanks for pointing out his blog!

    I thought his results were amazing as well. He believes if he hadn’t cut the sugar and starch, he could’ve easily been following in his brother’s path.

    Reply
  10. Elenor

    You know? Even if Jimmie IS a podperson, and not just a great podcaster, I’m STILL going to drink his koolaid (sweetened with Splenda, of course)!

    Tom, I showed Fat Head to a diet-education-resistant friend of mine, and when she stood up after, she asked if she could borrow “that Taubes book” (which I have been raving about for a couple years now, of course…) — and of course she could! She has now read the first couple chapters, and reports that she has cut out sweets and bread. You’re my hero!! (Got any more koolaid? {wink})

    Yeeeeeeeeeesss! Anytime the film convinces someone to read Gary’s book, I’m a happy man. I have a feeling your friend will soon consider you a hero as well.

    Reply
  11. Amy Dungan

    Well, I’m not one of Jimmy’s handlers, but I do try to help spread low-carb propaganda, so color me guilty.

    I’ll be on the cruise as well… so we can all see if we all really exist. Of course, if anyone doubts our existence, they’ll just have to go on the cruise to be sure.

    Looking forward to meeting everyone, pod people or otherwise.

    Reply
  12. AmandaT

    Anyone who loves Gary’s book will also like Barry Groves book, Trick and Treat. He also did a LOT of research and came to the same conclusions. These people are both heroes to stick their heads above the parapet.

    It’s on my to-read list. Right now I’m reading “How Doctors Think,” by Jerome Groopman, “Genocide,” by James Carlson, and “Heaven and Earth,” by Ian Plimer. For escapist relief, I’m also listening to “Brother Odd,” by Dean Koontz, when I take my evening walks. Nothing like listening to a novel about supernatural evils while walking down dark streets, alone. At least I think I’m alone …

    Reply
  13. Anders R.

    When you meet him don’t forget ask him about Sweden here it REALLY happens amazing things now, just google LCHF and use google’s translation service.
    Even Jim “sugar ” Mann have criticised Sweden in the medical journal The Lancet. Jim Mann is the engineer behind WHO’s diabetes recommendations i.e. eat starch and avoid fat. Here is a link of what he wrote:http://kolhydrater.ifokus.se/Forum/Read.aspx?ThreadId=25d40802-549a-4cb1-ab39-928374b5e014
    By the way this site have close to 10 000 members, petty good considering Sweden have almost the same population as North Carolina.

    I love it … it’s like a people’s revolt, tossing aside the supposed experts.

    Reply
  14. Dave, RN

    What kind of “heart scan” did he have? I’m assuming that it was some sort of non-invasive type? Can you elaborate? I’de like to see how my arteries are doing…

    I exchanged emails with Jimmy to get the facts before writing the post. Here’s the procedure, in his words:

    It’s basically just a CT scan of your entire chest area to determine if any calcified deposits are present in the arterial walls leading to your heart. Best of all, this heart scan is quick and painless. All you do is lie down on a table with a pillow behind your head and the machine slowly takes a scan of your heart. You breathe in, hold your breath for a few seconds holding still, the machine does the scan, and then you can breathe.

    Reply
  15. Derrick

    Aw, Tom, don’t muck up your evening walks (in what looks like beautiful country) with audio books or music. Remove those earphones, enjoy the sounds and smells of the outdoors, and RELAX!

    I do some of that too.

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  16. Dave, RN

    Oh yea, CT scans… the only kind I was even involved in when I worked in surgery was either the kind were we injected dye or the kind where we cut open the carotid artery and yanked out the offending plug-o-stuff…

    A friend of mine had the calcium scan as well. I guess the theory is that plaque consists partly of calcium, so a reading for calcium provides a good indicator of plaque.

    Reply
  17. MikieK

    I love your blog; the content of your posts and your writing style. With that said, I take issue with your statement that only a .8 correlation is something that gets researchers excited. Having taken a couple of stats and social scientific methods classes so far in college I can tell you that is simply not true. How the figure is interpreted in relation to what it signifies is what is important when taking the correlation into account. The correlation between smoking and lung cancer is .39. Condom use and sexually transmitted HIV is -.20. Exposure to asbestos and laryngeal cancer is .10. And these are widely accepted, influential and important figures but no where near .80. In fact, I think the -.25 correlation between cholesterol and heart disease is significant enough to suggest that perhaps the relationship between cholesterol and heart disease is inverse to what everyone actually thinks the relationship is.

    Keep up the good work.

    I appreciate the comments. A site on statistics for laymen gave the 0.8 figure.

    Funny you mention the lung cancer figure; I was debating a friend who thinks cigarettes should be outlawed, and when I told him a small minority of smokers get lung cancer, he simply refused to believe me. Once some people get an idea in their heads, there’s no way to blast it out of there. (I still think smoking is a bad idea. I just wouldn’t outlaw it.)

    The connection between cholesterol and heart disease is statistically meaningless. However — and you never hear the anti-cholesterol fanatics mention this one — it’s clear that among older people, those with higher cholesterol have longer average lifespans, perhaps because they’re less likely to develop cancer.

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  18. mrfreddy

    A few years ago, I too had a doctor tell me my cholesterol was way too high, in fact, she circled my LDL number (somewhere over 200) and wrote “too high! needs meds!”. Of course, I told her now way, never, uh uh, aint gonna happen. She then talked me into a CT scan, probably thinking the horrifying results would scare me into becoming a lipitor fiend. I oblige her, and secretly I wondered what kinda score I might get, because prior to discovering low carb, my diet was atrocious. Surely there’ll be some evidence of that caked up in my veins, right?

    To everyone’s suprise, especially the doctor, my score was exactly the same as Jimmy’s – a big fat ZERO. That was the last I heard from that doctor about “meds”….

    But that’s the scary part of it … they’ll put you on a statin based solely on the cholesterol number.

    Reply
  19. Paula

    If you want to find out more about calcium scoring with a heart scan, check out http://www.trackyourplaque.com. This is the site of Dr. William Davis, who is a practicing cardiologist in Milwaukee. Dr. Davis has been on Jimmy Moore’s podcast several times.

    There’s a great deal of information available in the non-member area, and so much more in the Member area!

    I think the theory is that calcium represents 25% of the arterial plaque burden. But it takes some time for soft plaque to calcify, so Jimmy’s score of “zero” isn’t really a “free pass” at his age (around 37, I believe).

    Interesting site. At what age would plaque start to calcify? My friend who had a reading is 54.

    Free pass or not on this test, Jimmy’s doing great. His HDL is 60, Triglycerides 49. That’s an outstanding ratio. And of course, 98% of his LDL is the large, fluffy kind.

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  20. Gerard Pinzone

    Just curious, what would the graphs look like if they just measured HDLs instead of total cholesterol? Would there be a greater (inverse) correlation? Small LDLs would probably be a better indicator, but I’ve never had a blood test that is so specific. If I want that kind of a test, what do I need to tell my doctor?

    Unfortunately, the MONICA data didn’t specify LDL vs. HDL.

    LDL is usually calculated, not measured. There are big problems with the calculation. If you have triglycerides below 100, the calculation will probably over-estimate your LDL.

    It’s much more complicated — and therefore more expensive — to actually measure LDL and determine particle size. If you want it done, tell your doctor you want a NMR LipoProfile test or a VAP test.

    Reply
  21. Paula

    I don’t know at what age plaque would start to calcify, but at age 59, I had a score of 17, and that put me in the 75th highest risk for my age group. I don’t remember what the beginning age recommendations are, but I do remember that a female DR on the site hadn’t had a scan because she was under 40, so she didn’t think a scan with a zero score would mean anything for her.

    Jimmy did a podcast about his cholesterol last June. Based on what I saw there, Jimmy’s total cholesterol was 326, his LDL was 250, his HDL was 65 and TG was 86. His LDL particle number was 145.3, only 30 (20%) of which was small dense. He seems to believe that the non-small, non-dense LDL particles (115.3 in his case) are protective, but the jury is still way out on that!

    I exchanged emails with Jimmy before the post. His latest stats are HDL 60, Triglycerides 49, LDL 228. He said the small particle count in his last test was 30 of 1453. Unless he missed a decimal point in there somewhere, that’s 2%.

    The most accurate predictor of heart disease you can deduce from cholesterol scores (short of an actual particle measurement) is the ratio of Triglycerides/HDL. If it’s over 5, you’re in trouble. If it’s less than 2, you are almost certainly producing very few small, dense LDL particles, and according to Dr. Jonny Bowden, it’s highly unlikely you are developing heart disease.

    Jimmy’s current ratio is 49/60 = 0.82. Mine, at last measurement, was 75/64 = 1.17.

    Mike Eades told me that in their practice, they treated patients with triglycerides of over 2,000. I can’t imagine what you have to eat to be that out of whack. He also said there’s some evidence that large, fluffy LDL has anti-inflammatory properties. I don’t know how strong that evidence is at this point, but it would make sense, since the body produces cholesterol in response to inflammation.

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  22. Brian

    Have you worked in government before? I used to work at NASA-JSC. And, “Well, it’s complicated, so let me explain it this way: Shut up” was not only funny but reminded me of some of the meetings I was in.

    I worked as a temp in government offices a couple of times. I also worked in a non-profit organization for awhile, where the mentality was quite similar. The meetings were so excruciatingly long and dull and pointless, I used to pretend I was taking notes while actually writing short stories or essays.

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  23. Paula

    Oops! I’m the one who slipped a digit: Total particle number was 1,453; not 145.3. But enough about Jimmy.

    You might want to take a look at Dr. Davis’s blog at http://www.heartscanblog.blogspot.com.

    I’ve seen his blog and heard him interviewed. He’s one of the few, the proud … the doctors who get it.

    Reply
  24. Ellen

    Great post.. whenever anyone starts to tell me about the dangers of cholesterol, yada yada, I just point them to this post by Peter over at Hyperlipid: http://high-fat-nutrition.blogspot.com/2009/03/cholesterol-within-nations-studies.html

    I just love the look of shock on each face when they see the correlation between blood glucose levels over time (HbA1c) and the risk of death from coronary disease.. I especially love the chart that compares HbA1c, LDL and total cholesterol effect on CHD.. it’s pretty clear what causes heart disease, in my opinion. Like Peter, says, personally I’d be looking to lower my HbA1c rather than my LDL..

    I remember reading that post. Excellent analysis.

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  25. dylan

    One thing I’d add to this whole topic that was mentioned in Good Calories Bad Calories – that even while Ancel Keys was pushing his crappy theory of the dietary fat>cholesterol>heart disease theory, one of the biggest obstacles he had to overcome was that study after study would show overall mortality dropping with higher cholesterol. The evidence wasn’t exactly sound that heart disease would increase with higher cholesterol either, but higher cholesterol appeared to lower the chances of getting certain cancers. Of course, once he started gaining undeserved clout, he just selectively picked out the studies that supported his hypothesis and called the rest bunk science. And of course, since almost all the studies down involving diet are epidemiological they aren’t worth basing any sort of knowledge off of.

    Malcolm Kendrick had a funny bit in his book on that topic. When higher cholesterol is associated with heart disease, the experts say cholesterol causes heart disease. When low cholesterol is associated with cancer, they say the cancer depresses cholesterol — even though the low cholesterol typically shows up years before the cancer does.

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  26. Sylvie O

    If I were you, I’d think twice about getting on that cruise ship. Pfizer et al. might try to blow up the boat, or at least highjack it and get all of you to erase the entire contents of your blogs. I mean, how else could they so easily get rid of the sticks-in-the-mud trying to blow their cover…? But then again, if that happens I’m sure we can get Taubes under some sort of witness protection scheme.

    Now how’s THAT for conspiracy?

    I like it. Someone should write the script.

    Reply
  27. Alcinda Moore

    Curious that both the highest rate and the lowest have almost identical cholesterol levels!!

    Also lowest cholesterol has a much higher death rate than highest cholesterol!

    Isn’t that something? It’s like trying to analyze the link between heart disease and hair color. You come up with pretty much nothing meaningful.

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  28. G

    Hi,

    Jimmy Moore is one of my heroes, as are you!

    Thank you for all your videos and sharing your insights!!

    Congrats to Jimmy for a ZERO EBCT heartscan and only 2% small dense LDL and massive HDLs!

    I think Jimmy beats out 99% of Americans with his scores.

    You beat me to the punch… Here are Jimmy’s and other folks who eat mod to HIGH saturated fat, low/no carb Paleo and wonderful cholesterol and EBCT reduction.
    http://drbganimalpharm.blogspot.com/2009/06/benefits-of-high-saturated-fat-diets_12.html

    -G

    Those are some off-the-chart numbers. Either you’re all pod people, or the Lipid Hypothesis is bunk.

    Reply
  29. G

    *haaa ah*

    BUNK!

    My sister LOVES loves loves LOVES your movie; she keeps lending it out and someday I’m next in line. Scott Miller is creator of Nukem Dukem FYI (and one of the directors at the Immortality Institute). Richard of course ROCKS the Paleo universe and is evolving in ancestral ways…. *wink* Keep up the fantastic work! I’m referring all my peeps to your website which is so full of *haa* BUNK.

    Tell your sister I appreciate the P.R.

    Reply
  30. Trish

    I would never hold up Jimmy Moore as any sort of low-carb role model. Check out his menus blog sometime–full of frankenfoods (ice cream, sodas). And he never reports his weight anymore because he’s gained back about fifty of the vaunted 180 pounds he’s lost. I’m sure he’s a lot healthier than he was but again, not someone to look up to.

    I don’t know what Jimmy eats, but if he can eat low-carb frankenfoods and still score a zero on a calcium test, it says a lot about how wrong the Lipid Hypothesis really is.

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  31. Felix

    Hmm…but what if… See, you just plotted the _deaths_ from heart diesease. To me it would make sense that more Aboriginals, Poles, Czechs…die because their health care is just worse than that of the swiss.
    I think it would be far more valuable if you plotted the actual CHD rates versus the cholesterol levels and not just the death rates.

    That might flatten the distribution a bit, but I don’t think it would show a meaningful correlation. There are dramatic differences in the death rates in the U.S., Switzerland, France and Britain, but I doubt we can attribute those differences to quality of health care. The U.S. system, despite its many critics, still ranks #1 in the world for “responsiveness,” a.k.a delivering medical treatment in a timely manner, and yet our heart-disease death rate is three times the rate in France.

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  32. jegesq

    The only thing Jimmy Moore proved he didn’t have when he got his heart scan score of “zero” was CALCIFIED plaque. To say that he had “zero plaque” is a gross over-simplification; he may have a huge soft, uncalcified (and highly vulnerable) plaque burden which wouldn’t be detectable at all on CT or EBT coronary calcium scanning alone, and his risk could be far greater than he assumes. To really know, he’d need an invasive angiogram with IVUS study (which does reflect and accurately depict all plaque, not just the calcified plaque visible on CT scanning), perhaps a carotid ultrasound, or a CT Coronary Angiogram with contrast dye injected (known as a “CTA” and involving much higher exposure to radiation than a simple heart scan).

    It is true that the presence of coronary calcium, i.e., calcified plaque lesions, is believed to roughly correlate to approximately 20% of one’s total plaque burden. In other words, if you have a positive Agatston calcium score, that means you also have soft plaques and that the calcium equates to approximately 20% (so you can extrapolate the other 80% based on the severity of the calcified plaque burden).

    The opposite though isn’t true. A score of “zero” calcified plaque does not mean Jimmy doesn’t have soft, vulnerable uncalcified plaques, the same type that ruptured and caused the death of Tim Russert and so many thousands of others.

    The point of getting a heart scan for coronary calcium is that it clearly identifies those who have coronary calcium, and thus atherosclerosis, and depending on the score, enables one to address the level of aggressiveness with which one will address the issue (frankly, any calcified plaque demonstrates the existence of atherosclerotic disease, and should, IMHO be addressed aggressively).

    But getting a score of “zero” doesn’t rule out disease, and given Jimmy’s past history of obesity, his family history of 1st degree relatives dying from heart disease prematurely, it would be foolish of him to take solace in the fact that he had no mature, calcified lesions when he could have diffuse, soft plaques all over. I sure hope he doesn’t because I enjoy listenening to his podcasts and reading his website, but he’s living in a fool’s paradise if he is taking solace solely in his coronary calcium scoring and low concentrations of small dense LDL (as a percentage of total LDL) given his known risk factors.

    Interesting. And I’m with you; I hope Jimmy is around for a very long time.

    Reply
  33. acanthusbk

    I’m a member of Dr. William Davis’ “Track Your Plaque” forum. Dr. Davis also authors the heartscan blog, as mentioned by Paula in her comment.

    Here’s what Dr. Davis wrote about soft plaque:

    “There is indeed a small percentage of people, probably around 5% of all people who have CT heart scans, who have scores of zero yet have a modest quantity of pure “soft” plaque. These people may be misled by having a zero score. How can these people benefit from better information?

    Several ways. First, people like this tend to have very high LDL cholesterols, generally 180 mg/dl or greater. They may have a very worrisome family history, e.g., father with heart attack in his 30s or 40s. This small proportion of people with zero heart scan scores may benefit from [additional testing]….”

    Dr. Davis has also said that soft plaque does not convert to hard plaque.

    By the way, Jimmy’s LDL of 228 isn’t accurate, instead, divide his LDL particle count by 10, so 1453/10 = 145 LDL.

    The LDL value from a standard cholesterol measurement (like Jimmy’s LDL values of 228 & 250) is estimated based on a formula known as the “Friedewald equation” rather than being directly measured, and can be wildly wrong.

    See Dr. Davis’ heatscanblog for his many comments about the Friedewald equation. He has called it “a dinosaur that should be retired”.

    Looks like Jimmy is doing ok after all.

    Reply
  34. jegesq

    I believe Acanthusbk is overstating the case with respect to the risk of a “0” CAC score in asymptomatic individuals with a significant history of familial CAD (such as in the case of Jimmy Moore’s father and brother) who also possess other traditional risk factors such as very elevated levels of LDL and elevated LDL-P (particle number).

    With respect to Moore’s LDL-P of 1453 based on an NMR, this is not a “low risk” particle number. NMR’s own guidelines describe the following risk stratification for LDL particle counts:

    Optimal 2000

    Second, Moore’s LDL measured in a standard lipid panel (not direct LDL, but rather calculated LDL) as Acanthusbk notes, calculates or estimates LDL by using a formula known as the “Friedwald formula” (so named for its originator). This formula is known to be wildly inaccurate at times, but is generally employed in large population studies because it is quick and cheap and easy to perform. The formula of Freidwald for determining LDL is total cholesterol minus high-density lipoprotein (HDL) cholesterol minus very-low-density lipoprotein (VLDL) cholesterol (estimated as triglyceride divided by 5)– or stated differently: LDL= TC – HDL -(TG/5).

    Acanthusbk states that Moore’s LDL is ipso facto inaccurate because it was derived by using Friedwald’s formula. This too is a very large overstatement. Friedwald’s formula has been demonstrated repeatedly to be accurate in fasting samples of individuals where Triglycerides were not elevated. (See, e.g., http://www.clinchem.org/cgi/content/abstract/36/1/15). Admittedly, it’s better to assay LDL concentrations directly rather than using a calculated formula such as Freidwald. But Moore’s reported TG’s were low and not elevated at all. The distortions which occur with the Friedwald formula occur not when LDL is reported to be high, but rather when TG’s (or rather VLDL estimated as a surrogate of TG’s) is elevated.

    Third, the use of an NMR LDL-P particle count “divided by 10” (or simply dropping the last digit) is a method which only has very crude observational support. It is a method used by Dr. Davis frequently to estimate LDL-C but it is by no means directly correlated by direct assay to actual LDL-C. It is merely a way to estimate LDL-C rather than from Freidwald’s formula where no direct assay has been performed.

    Acanthusbk is right about one thing: A “0” CAC score appears to be correlated with a lower risk of an adverse cardiovascular event in asymptomatic individuals with low traditional Framingham risk factors. In such individuals, CAC scores have a 95-99% predictive value. But in individuals whose family history indicates higher risk, combined with elevated LDL levels, there is much research which indicates a moderately higher risk and not as much predictive certainty for a “0” CAC score.

    The point is that Jimmy may or may not be doing ok, even with his “0” CAC score. I hope he is, because I genuinely like the guy, and he’s brought tremendous energy to health issues. But I stand by my original comments above, despite my personal hope that Jimmy Moore’s risk is indeed low, as Acanthusbk believes it may be.

    Reply
  35. jegesq

    Ok, let me try this:

    Optimal below 1000
    Above optimal 1000 to 1299
    Borderline 1300 to 1599
    High 1600 to 2000
    Very high above 2000

    Reply
  36. Beth

    Could you post a link to the source of the data you posted? I am curious about what happens after age 75.

    Thanks, Beth

    The MONICA spreadsheets only included data for up to age 75. They were tracking what they’d call premature deaths.

    Reply
  37. Roger

    I guess I’m completely confused by your final point. If, as has been stated on this blog many times, that the cholesterol/CHD theory is bunk, then why should we remotely care if Jimmy has high LDL of a certain size, or high HDL, or low triglycerides? What on earth does that prove, if there is no relation between lipids and heart disease?

    The theory as it’s been promoted and followed is bunk. That theory says high cholesterol — and especially high LDL — causes heart disease. That’s why there’s been so much emphasis on beating down cholesterol, getting it below 200 and getting LDL below 100.

    What actually matters — that is, what actually indicates the likelihood of heart disease — are 1) triglycerides, and 2) LDL particle size. The higher your triglycerides, the more likely you’ll develop CHD. The greater the proportion of your LDL that is small and dense, the more likely it’ll become stuck in your arteries. But few doctors warn patients about high triglycerides, and almost none of them measure particle size.

    Simply measuring total cholesterol and LDL is therefore next to worthless. You can have LDL under 100 but very high triglycerides. You can have total cholesterol of 165 and low LDL, but be producing mostly small, dense LDL that’s building up in your arteries. (I chose 165 because that was Dwight D. Eisenhower’s cholesterol reading shortly before his first heart attack.)

    Jimmy defies the Lipid Hypothesis because his LDL is very high by the current definition, but almost none of it is small and dense and he has no plaque buildup.

    Reply
  38. Roger

    Okay, thanks for the clarification. I’m familiar with this tweaked version of the lipids/CHD correlation, but I haven’t researched it enough to have a firm opinion. As you undoubtedly know, other cholesterol debunkers scrap the whole shebang, LDL particle size and triglycerides included, and instead blame other causes for the prevalence of heart disease. (For example, one of your links, “Cholesterol does not cause heart disease” by Fallon and Enig.)

    One further point is that about half of patients who take a Calcium CT scan will have a zero score, so it’s not particularly uncommon. It’s better news than receiving a high score, but as has been pointed out above, it’s by no means a foolproof predictor of future CHD events. See the following link for more info:

    http://www.inspire.com/groups/womenheart/discussion/cac-scanning-will-miss-soft-plaques/

    I am a big fan of Jimmy Moore’s overall crusade against useless carbs, and his interesting podcasts. I’m just not sure the jury is quite in on the fat question, which is extremely complicated. I look forward to seeing your movie.

    Reply

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