Over the decades leading teams in complex problem-solving I have used many structured methods to ensure the speediest possible resolution of major issues. Among them have been Comparative Analysis, Root Cause Diagrams, Hypothesis For/Against tables and more. But underlying all of these advanced methods lies the fundamental of the Pareto Principle. Everyone will no doubt be familiar with this rule of thumb, in short that roughly 80% of an issue’s consequences originate from 20% of the causes (often termed ‘the vital few’). But while this principle should remain central in the psyche of anyone resolving complex problems, often even relative experts in this field lose sight of it; they can become fixated with say, a ‘pet hypothesis’. Over the decades I have become ruthless in maintaining sight of the principle – and ensuring that the teams under me do so too. I used to regularly quip: “hypotheses are like a**holes – everybody has one” – just as a sardonic reminder to the specialists. For the leader in this field, it is crucial to remember the maxim: “If in doubt, zoom out.”

I trust that most readers would acknowledge that achieving resolution of metabolic health issues is very much a complex issue. Also, that metabolic health dynamics underpin most modern chronic disease. Therefore, it is crucial to maintain best problem-solving practice when addressing this arena, leveraging all of the established methods. And most importantly to resist getting lost in the weeds.

Anatomy of Rapid Resolution

Around a dozen years ago I was thrust into the world of metabolic health science. Perforce in a sense, as I had received some very worrying blood test results – way outside the normal range. I gave the attending doctor a good grilling on the potential causes and implications of these nasty results. That was when I got my first shock: from decades of ‘specialist interrogation’, I was able to work out quite quickly that this ‘expert’ was not one. Okay then – I found another more senior doctor; cue grilling number two. Same result essentially. Going for third time lucky, I connected with a teaching professor of medicine. And sadly, the outcome was not much better.

After the final interview, I realized to a certainty that there was something huge to be discovered in this debacle. Potentially even a universal truth that had somehow been missed, however improbable this might seem. The briefest of research on PubMed and Researchgate showed that I was far from alone. For me this meant that there was an enormous hole at the center of modern medicine; a black hole of fundamental ignorance. I smelled Pareto…my technical senses and intuition were positively buzzing.

And so I launched myself into the resolution of a very personal complex problem. It is true that my Biochemical Engineering background proved helpful along the journey. But it was the decades of scientific and logical analysis experience that delivered the prize. Within three weeks I had cracked the case, working on it only evenings and weekends (as I still had my fulltime job to manage). With hundreds of published papers analyzed and now covered in scribbled notes and cross references, I had arrived as always in my career…at the kernel of the 20%. I had comprehensively mapped out the Insulin Resistance / Cholesterol Axis – essentially the epicenter of modern chronic disease. And I was certain of it.

The Solution Space

Without going into all the details, let me brutally summarize the strategy I deployed. Having discovered over those three weeks that most of what we have been told about nutrition was essentially nonsense, I largely eliminated all starchy carbohydrates. By the latter process of elimination, I ended up simply eating meat, fish, eggs, cheese and other healthy ancestral foodstuffs. Vegetables were allowed, but non-starchy was the rule I stuck to. I chose not to increase my exercise level or reduce wine intake etc, as I was ruthlessly testing my hypothesis in a controlled manner. Could I collapse my insulin levels, and dramatically resolve all the problem blood markers?

It turned out that that…was the least of it. My appetite came under control for the first time in decades. I began to eat fewer meals with impunity. My excess weight began to fall off rapidly. My staff and other employees were increasingly astonished at my greatly improving appearance. My sleep improved. My energy levels soared. My mental acuity and focus surged. I was on fire, if you will, and everybody could see it in the flesh.

THAT is what happens when you correctly identify a true ‘Root Cause’. ALL boats rise in the problem system – not just the ones being targeted with the intervention. THAT is hitting Pareto dead center, with a hypersonic missile.

One Ring to Rule Them All?

So, am I claiming that Insulin Resistance is the universal kernel of the modern chronic disease epidemic? ‘The cause’ in all of the millions afflicted with heart disease, cancers, Alzheimer’s etc?

Not quite. There are a lot more issues floating around in the sea of the 80%. However, Hyperinsulin is the very first malady to ‘eliminate from your inquiries’, so to speak. Only a novice problem solver would leave the insulin axis underattended, and go running off for other causes. Fix the insulin first, wrestle it to the ground – then proceed through the rest of the potential issues.

In fact, one of the most tiresome tropes from the establishment goons over the past twelve years has been the ‘one ring’ accusation. In short that by highlighting the Insulin imperative so strongly, one is oversimplifying the issue and ‘playing favorites. People who screech this are generally the same people who push the cholesterol nonsense. It is comical to observe, as they are generally playing a near-irrelevant favorite, while we are simply providing powerful focus.

One powerful fundamental in judging a scientific position is to ask what predictive power it has. Can the position accurately predict outcomes? I have shown you my example of where it decisively did; in fact all boats rose, way beyond the targeted ones. In contrast, the cholesterol distraction predicts Jack.

EUROASPIRE For the Win

Let’s now have some fun with data and real science. You will enjoy this if you are not familiar with the 2015 EuroAspire Study – hell, you’ll enjoy it even if you are!

The team chose approximately 7,000 heart disease patients from all across Europe (24 countries included, so ‘genetics’ well controlled for). Importantly they chose patients across the age range 18 to 80, so nobody could whine that their results only applied to certain demographics. Crucially they looked REALLY closely at their Blood Glucose dynamics. And what they found should have shocked the world, front page news everywhere. So pray tell what did they find?

They found that approximately one third were Type 2 Diabetics, on their medical records. Another quarter were also T2D – simply not yet diagnosed. Yet another quarter were what they called ‘high risk for T2D’ i.e. their glucose was screwed but not quite badly enough to be called T2D. But yes of course…they were of course T2D, by any scientifically sound definition. Roughly a quarter remained, and the team never measured their insulin. And you must assess insulin levels to properly diagnose all potential T2D patients.

So there you have it: Coronary Heart Disease, the biggest metabolic health killer out there…and overwhelmingly the sufferers are insulin resistant. Do the same study for the other metabolically- driven chronic diseases, and you’ll see similar outcomes for many.

There are countless examples like this, and I’ll just mention another: the Coronary Calcification study on Tsimane men’s heart health, versus that of Western men. The contrast is so dramatic it almost looks like there was scientific fraud involved, but there wasn’t! In short the Tsimane men show almost zero coronary calcification while the Western men are absolutely riddled with it. It catalogs one of the most extreme differences in disease rate I have ever seen. The paper is useless at telling us why, so I will add that root cause aspect here. Essentially the Tsimane men’s insulin level is in their boots, super-low. Same for blood glucose. Same for other markers that are generally high in the West. That’s the distinction.

HOWEVER…the Tsimane men have much the same APOB (‘bad cholesterol’ particle count) as the Western men do. Nice.

Pareto Principle anyone?

Yeah.

How Nonsensical is the Cholesterol Nonsense?

Before we finish this article, we need to address the persnickety and annoying problem of the ‘Cholesterol Conspiracists’. These people (often drug industry affiliated), seek to convince us that the most important molecule to enable mammalian life…has a large role in prematurely ending said life. We could of course leave it just there, as the absurdity speaks for itself. But in the interest of fairness, allow me to briefly explain why so many indulge in the sterol stupidity. In my metabolic research journey I analyzed hundreds of ‘cholesterol’ studies and publications, culminating in me releasing my magnum opus presentation which nicely decoded the whole arena (The Cholesterol Conundrum). And here is the simplified reality.

Dr. Joseph R Kraft memorably quipped that “Insulin Resistance and Hyperinsulinemia are not combatants; they are one and the same.” This metabolically deranged condition is now shared by at least ~64% of US adults over 45 years of age, and much more if Insulin measurements were inspected rather than just glucose. This state of metabolic mayhem drives heart disease, many cancers, Alzheimer’s and more with a certain level of ferocity. Crucially, this state of metabolic mayhem also drives down HDL (‘good cholesterol’) and drives up LDLp and sdLDL (these are the more correct metrics for the vintage LDLc ‘bad cholesterol’).

Tragically for the Cholesterol Conspiracists (I feel so sorry for them sometimes), they are following a proxy. They are seeing the real root cause through the blurry lens of the changing ‘cholesterol’ metrics, which are a weak and misleading reflection of the underlying root cause.

I could write reams on this topic, but that’s it in a nutshell. The real genuinely expert problem-solvers never fall for proxies.

The whole thing is painfully embarrassing actually – like I said, I sometimes feel sorry for the poor dupes.

“If the Rule you Followed has led you to this…of what use was the rule?”

And so dear reader we must draw to a close. The quote above is from one of my favorite movies and it says so much. Spoken by the psychopathic main character Chigurh, it also nicely touches on the scientific imperative of predictive power.

So what rule did we follow since the “eat high healthy carbs and guzzle heart healthy seed oils’ official nutritional directives from the 1970’s? Well from the data we largely followed that nonsensical rule, and here we are as a population. Overwhelmed with obesity, diabetes, myriad cancers, Alzheimer’s and the rest. Nice job guys – Chigurh would be delighted.

And now comes the Rocket Science, actually revealed earlier in this article. The rule to follow which will have huge benefits for metabolic health is so simple and elegant it almost seems just too damn easy. The relatively low heart disease French knew it. The British had the healthy diet phrase ‘Meat and Two Veg’. Indigenous cultures all around the world practiced it before the era of chronic disease hit us. I call it meat, fish, eggs and low-starch vegetables. The former for protein and nutrient-density wonder, the latter mainly for topping up on minerals etc. Add Organ Meats for the win. Keep an eye on beneficial supplements where there is any chance of deficiencies.

On the non-nutritional side of the house, exercise is so important. I focus on the highest benefit type, resistance training (weight training essentially, pushing reps to failure). Healthy sun/UV exposure without burning is massively beneficial too. There is much more to say here but space is limited – but myself and Dr. Jeff Gerber’s book ‘Eat Rich Live Long’ has all the details.

So there you have it folks, short and I hope sweet. Honor Pareto, find and follow the guys who have done proper unbiased research, demonstrating excellent predictive power; and above all:

“Respect Your Insulin”!