#402 ‒ NMR blood analysis: how heart disease risk, insulin resistance, inflammation, and mortality risk can be assessed from a single blood sample | Jim Otvos, Ph.D.

**Peter Attia** (0:11)
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My guest this week is Jim Otvos. Jim is a biophysical chemist who pioneered the use of nuclear magnetic resonance or NMR spectroscopy to measure lipoprotein particles from plasma. After more than two decades on the faculty at North Carolina State University, he founded Liposcience in 1994, where he developed and commercialized the first FDA cleared method for direct LDL particle or LDLP quantification.
Liposcience was acquired by LabCorp in 2014, where Jim served as chief scientific officer of the NMR diagnostic group. He's authored more than 200 peer reviewed publications and holds numerous patents related to NMR based biomarker activity. I wanted to have Jim on because his work sits at the foundation of a test many listeners have seen in their own blood work, but probably don't realize traces back to him. Many of you have probably had an LDL particle number, and you may even notice that it mentions that it's done by liposcience. But what makes this conversation especially interesting is that the same NMR technology that began with lipoproteins has evolved into a much broader way of looking at metabolic health, inflammation, insulin resistance, and even mortality risk. And that's where we spend a lot of our time today. So in this episode, we go back and talk a little bit about the history. We talk about the unlikely story of how Jim turned a flawed cancer test into a new way of measuring lipoproteins. What standard cholesterol tests can miss and why LDL particle number can reveal risk that LDL cholesterol alone does not. Why this notion of large fluffy LDLs being benign is misleading. How LDL-P and APO-B help guide treatment decisions beyond LDL cholesterol alone. How NMR can reveal signs of insulin resistance before blood sugar rises. Glyc-A as a window into chronic low-grade inflammation as an NMR biomarker. The metabolic vulnerability index or MVX and what it may reveal about frailty, resilience and short-term mortality risk. The surprising finding that MVX in healthy young adults may predict risk decades later. And why NMR diagnostics remain underused despite the amount of information they can extract from a single blood test. So without further delay, please enjoy my conversation with Jim Otvos.
Jim, so great to be with you again. We were just talking a minute ago that I had forgotten briefly that we were together once in 2013
But in many ways, this is a pretty wonderful opportunity for me to sit down with someone whose work I've been following for literally 15 years. It was May, I still remember, it was May of 2011 when Tom Dayspring introduced me to your work. And I began voraciously consuming everything you had written in my personal obsession to better understand the fields of lipidology.
Again, I think there can't be that many people listening to us that haven't, at some point, probably had an LDLP or HDLP test done. And yet, most of them will never realize until now, presumably, that that test goes all the way back to you, and you are the creator of that. So maybe give us a little bit of a story, your journey. You did a PhD in physical chemistry, or?

**Jim Otvos** (4:37)
In chemistry.
And biochemistry. And yeah, so I was in academia for 20 years, doing the kinds of things that people did in academia, and do in academia using NMR spectroscopy as a structural tool. So NMR is a very common structural tool. You can find NMR machines in every chemistry department in the country. So I had appointments in chemistry at the University of Wisconsin-Milwaukee, and then moved in 1990 to North Carolina State University. So I was basically doing my thing, minding my own business, using NMR for the usual purposes.

**Peter Attia** (5:17)
And for the listener, we are going to explain how NMR works, because for people who didn't take chemistry and might not remember it, we'll come back to it. But I don't want to interrupt now to do that. Yeah, we'll come back.