Dr. Thomas Dayspring | Cholesterol Testing: What Matters Most? - ATLCX (Episode 29):

ATLCX (Episode 29): Dr. Thomas Dayspring | Cholesterol Testing: What Matters Most? « Jimmy Moore's Livin' La Vida Low Carb Blog

In Episode 29 of “Jimmy Moore Presents: Ask The Low-Carb Experts,” we’re very excited to bring to you one of the world’s leading lipidologists and experts on just about everything you could ever want to know about cholesterol numbers named Dr. Thomas Dayspring from LecturePad.org.

He’s the Director of Cardiovascular Education at the Foundation for Health Improvement and Technology in Richmond, Virginia and is one of the most requested speakers in the United States with expertise on atherothrombosis, lipoprotein and vascular biology, advanced lipoprotein testing and more. Dr. Dayspring has given over 4000 lectures in all 50 states educating medical professionals and the lay public alike.

Many of you first heard Dr. Dayspring in Episode 585 of “The Livin’ La Vida Low-Carb Show” podcast and afterwards my listeners had lots of questions for Dr. Dayspring about cholesterol. That’s why we decided to bring him back on ATLCX to take on the topic “Cholesterol Testing: What Matters Most?” so you can speak directly with him about your burning questions on your cholesterol concerns.

This was a golden opportunity to get better clarification on any issues regarding cholesterol testing that concern you. Listen in to hear what Dr. Thomas Dayspring had to say as he took on your questions about the most important factors in cholesterol testing in EPISODE 29 on October 4, 2012.

Listen to Dr. Thomas Dayspring on “Cholesterol Testing: What Matters Most?”:

People are concerned (and confused) about cholesterol

Gary Taubes/Peter Attia turned him on to community

Atheroschlerosis “build-up of cholesterol” in arterial wall

Blood tests help doctors determine heart disease risk

People with heart disease have cholesterol levels “all over the place”

Even persons with seemingly “perfect cholesterol” can get atheroschlerosis

Tim Russert is a perfect example of this

No human has any cholesterol floating around in blood as a free molecule

Lipids must bind to protein to become soluble in water (plasma)

Lipids bound to apoproteins are lipoproteins which traffic lipids in plasma

This “illegal dump job” (lipoproteins carrying cholesterol into the artery) can lead to atherosclerosis

Thus atherogenesis is a lipoprotein-mediated disease

Atherogenic lipoproteins (lipoproteins that enter the artery wall) are the “bad guys”

The goal is to avoid lipoproteins from penetrating the artery wall

We have to have labs that measure lipoprotein concentrations, rather than lipid concentrations

This (particle concentrations) is the type of testing we all need to have done

Omega-3 and omega-6 fatty acids are within the phospholipids delivered by lipoproteins

The types of lipoproteins: VLDL, IDL, LDL and HDL

Traditional tests look at cholesterol measurements like the total cholesterol (TC)

TC is the amount of cholesterol carried within all of the lipoproteins per deciliter of plasma

HDL-cholesterol has as its surface apoprotein, apolipoprotein A-1

ApoA-I measurement serves as an HDL particle count

You can have a lot of HDL particles, but low HDL-cholesterol

Thus although apoA-I and HDL-C usually correlate, in some folks they do not (discordance)

People with low HDL-C but normal apoA-I tend not to get heart disease

Those with high HDL-cholesterol could have low Apo A-1 (low HDL particle count)

There is one apoB molecule per VLDL, IDL and LDL particle: apoB is not on HDL particles

Apo B testing measures how many VLDL, IDL and LDL exists per deciliter of plasma

Apo A-1 particle do not deposit cholesterol in the artery: they may in fact remove it.

Apo B particles after entering the artery sticks

White blood cells (macrophages) ingest apoB particle carrying cholesterol and initiate inflammation

VLDL takes lipids (mostly TG, but also cholesterol) out of the liver;

VLDL traffic TG to muscle and fat cells and as TG exit the VLDL shrinks, creating IDLs

Most IDLs are cleared at the liver but some IDL shrink and become LDLs

Liver isn’t as efficient at clearing LDL particles compared to IDLthus extending LDL plasma residence time

A normally composed LDL half-life is 2-3 days; compared to VLDL 2-6 hours or IDL 1-2 hours

Thus Apo-B test actually measures LDL-P in the blood (vast majority of apoB particles are LDLs)

Standard LDL cholesterol test may or may not help

LDL cholesterol might be low, but LDL-P could be high: normally the two tests should correlate very well: when they do they are concordant and when they do not they are discordant

Particle size has no bearing on whether LDL enters the artery wall or not

Insulin resistant Diabetics typically have the small LDL regardless of LDL-C

How you can have low LDL-cholesterol and yet high LDL-P numbers (discordance)

LDL is supposed to carry primarily cholesterol with little TG (4:1 ratio)

Increased LDL/triglyceride level occurs when LDLs are trafficking more TG than normal – in such cases they are therefore carrying less cholesterol than they should. These are therefore cholesterol-depleted LDLs.

It takes 40-70% more cholesterol-depleted particles to traffic a given amount of cholesterol

In such cases we need a therapy to remove triglycerides from LDL

High triglycerides/low HDL-cholesterol ratio (> 3.0) is very indicative “insulin resistance”

You can’t guess particle levels by looking at TG or cholesterol values provided in traditional test

Triglycerides should be well under 100, even below 70 to be physiologic

What if you have large LDL particles and normal Apo B (i.e. normal LDL particle count or LDL-P)

Total cholesterol minus HDL is called non-HDL cholesterol: it reveals how much cholesterol is in the apoB particles and thus serves as a better measure of atherogenic apoB particles than does LDL-C

However, even Non-HDL cholesterol misses 30% of persons with high apoB (LDL-P) at-risk cases

Just get an Apo B and/or LDL particle test and know exactly if atherogenic particles are present

It’ll be the best money you’ll ever spend on health

You can get Apo B test run in any lab in America

Why the NMR Lipoprofile test (LDL-P) is the one to get run (nuclear magnetic resonance spectroscopy)

LipoScience is the only lab that runs this test now

FDA just approved smaller versions of their analyzer for other labs to purchase

Two other technologies exist that measure LDL-P, but those methods are “unproven” in clinical trials

Everyone needs to know their LDL particle number (LDL-P or apoB)

When you order LDL particle test, they also report standard lipid concentrations

Even kids should have a LDL-P test if there is a family history of heart disease, high cholesterol or diabetes or if the kids are obese

Severely elevated LDL-P disorder can and should be treated early in life

But almost nobody is screening these children at all

LDL cholesterol levels under 100 mg/dL has long been the standard

LDL-P of 1600 nmol/L is in the 80th percentile

A desirable LDL-P of 1000 is the 20th percentile population cut point: 80% of the populations has a higher level

LDL-P under 700 is in the 5th percentile population cut point: 5% of folks are less and 95% are higher

If particle counts are high, nutritional therapy first and then maybe drugs

The most common cause of why LDL-P becomes high: insulin resistance

You gotta take carbs out of your die to combat IR or take drugs or both

Insulin resistance is at the heart of high LDL-P

Why NCEP guidelines don’t say anything about LDL-P: Actually 5 US specialty Society guidelines do advise apoB or LDL-P testing

Apo B is in the European guidelines, but not LDL-P (LDL-P by NMR is not available in Europe)

Guidelines are never meant to take be cutting edge

LDL particle tests are more expensive than regular lipid concentrations

LDL-P by NMR in a patient without insurance coverage is four times more costly than traditional tests

The majority of doctors don’t know understand or know of Apo B and LDL-P

If these tests are done, because so many with fine cholesterol levels will have high apoB, drug use will quadruple and third party payers and govenrment does not want that

Drugs are almost always necessary unless you start eating low-carb ASAP

The low-fat diet (without carb restriction) is the “worst thing you can do” in a person with IR and high LDL-P

The specialty societies (ADA, ACC, AACC, ACE, NLA) are on board with new tests

Individual patients often have “discordance” between cholesterol measurements and apoB (LDL-P)

I convinced my own doctor to start doing NMR testing

Dr. Dayspring’s story about personal lipid revelation:

Dr. Jim Otvos inventor of NMR LipoProfile in reality likely saved his life: Dr D had a perfect lipid profile, but a very high LDL-P that never would have been discovered without doing the NMR LipoProfile

His 2012 study of diabetics looking at LDL particles (American Journal of Cardiology Sept 2012)

Check out information on why LDL particle tests good

Once LDL is 190 mg/dl, that’s familial hypercholesterolemia

Definitely get an Apo B and LDL-P immediately to see the extent of apoB elevation

Normal cholesterol and high LDL-P suggests IR and calls for low-carb diet

Some low-carbers have “paradoxical” rise in both LDL particles and LDL-C

These people might require aggressive use of drugs

The drug therapies that are needed for people with FH

Most FH take up to 4 medications to control LDL-P

Several new drugs are “in the pipeline” coming soon

I’ve personally seen my LDL-cholesterol and LDL-P go way up

That shouldn’t happen under normal circumstances

These people are “enigmas” with potential yet to be discovered genetic abnormalities

This doesn’t mean you should stop your low-carb diet

If you’re insulin resistant, you need low-carb

My current high-fat, low-carb n=1 experiment

Apo B is a worldwide standard for lipid/lipoprotein health

If patient is stable, it’s not unreasonable to stop statin and test again (no more than 4 weeks later)

Statins (can) have downsides, so take off if possible: in general for folk with high apoB the benefit of statins is vastly superior to any downside)

Lipoproteins can change drastically in 2-3 weeks with lifestyle and drugs

Retest again after one month to see how it goes off statins

Any studies looking at low-carb and decreased LDL-P

This is the type of thing modern researchers will be doing

There’s support for this, but mainly from Atkins diet studies

Lifestyle and/or meds reduce risks of high LDL-P

Risk of sterols in the development of arterial plaque

Watch Part 1 of Dr. Dayspring’s lecture on sterols

Cholesterol, a zoosterol, is one sterol; plants also produce sterols called phytosterols

Intestines usually push out plant sterols; not always

Some make into lipoproteins and penetrate arteries

Measuring phytosterols is probably a good idea: they serve as a biomarker of intestinal sterol absorption

Physicians are starting to measure this more and more

Cholesterol-absorption blockers can reduce intestinal hyperabsorption of sterols

Phytosterols sold in stores may be more harmful than good if taken by a person who is a hyperabsorber

Humans with normal sterol absorption would not be harmed by phytosterols

A hyperabsorber taking phytosterols might lower LDL cholesterol, but raise phytosterols

Without assaying sterol absorption These products may not be “heart-healthy” at all, just “hocus pocus”

The phytostanol, sitostanol, (Benecol) reduce cholesterol absorption and stanols are not absorbed, so this canbe an excellent functional food that safely lowers LDL-C and LDL-P

LDL cholesterol levels may or may not be associated with LDL particle concentrations

20 years ago, in assaying LDL we’d were “extolling” LDL-cholesterol tests

Changing things in medicine is a slow, hard road

Patients must educate yourself and get what you need done

Don’t assume doctors are “genius” on all health matters, especially cardiovascular biomarkers

How the various cholesterol numbers are calculated

Calculated LDL-cholesterol is an imprecise equation

If your trigs are under 100, divide by 5 for VLDL-cholesterol determination: Once you have VLDL-C, you can calculate LDL-C using the equation LDL-C = TC minus HDL-C – VLDL-C

Triglycerides is a key marker that few health care professionals truly, understand

Trigs over 70 in an IR adult, LDL-P needs checking

Large VLDL’s and high total and small LDL-P are markers of insulin resistance

Kids need to “get off the damn carbs” and substitute fat and protein instead

Whether it’s possible to have “too low” cholesterol

You don’t need cholesterol in blood, but in the cells and all cells in the body manufacture it

a href=http://en.wikipedia.org/wiki/Hypobetalipoproteinemia>Hypobetalipoproteinemia have low LDL-P (apoB) and very low cholesterol levels

These people tend to live a very long life and suffer no cholesterol deficiency issues

What Apo E genotype issues you should be aware of

Apo E4 is a marker of elevated risk of heart disease”

ApoE2 is usually desirable but Apo E2 with high triglycerides is a high risk lipoprotein abnormality with normal LDL-P: they have too many VLDLs and IDLKs, but not LDLs.

Apo E4 is also associated with Alzheimer’s disease

A ketogenic diet might ward off Alzheimer’s longer

“Drown yourself in omega-3 fatty acids” if Apo E4

ApoE genotyping just a one-time genetic test you run

Whether an Apo E4 needs to lower their fat intake is truly not known at present

Are they REALLY over-absorbing fat–maybe, maybe not

If your lifestyle controls Apo B, no need to worry

What one test gives most info on heart disease risk: ApoB and LDL-P

No matter what Apo B is, other tests such as inflammatory markers can also tell about CV risk

The totality of tests help doctors treat you better

Triglycerides and Apo B/LDL-P gets most info needed to start

Christine had 300 trigs, dropped to 130 in 6 weeks

Can’t change LDL-P by eating carbs day before test (LDL half life is typically 3 days)

Takes trigs a few days to alter lipoprotein metabolism and jack up your LDL-P

If Apo B and LDL-P come back one high, one normal – discordance is present

It happens in 10-12% of people; repeat test again

If LDL-P is high and Apo B is normal, there is no consensus on what to do

LDL-P tends to “outperform” Apo B as a key marker

Why HDL cholesterol decreases on autoimmune issues

Endothelial lipase expressed with such diseases increases HDL catabolism

Women with anorexia tend to have transient high cholesterol as adipocytes are a cholesterol storage tissue

Wait one month after weight loss and then test again with high LDL-C and LDL-P

Thus weight loss can make transiently make your LDL cholesterol seem higher

What he thinks about having a heart scan conducted

His concern over having a CT scan of your chest: too much radiation

Why do I care about this if LDL-P and Apo B is high: the image result would not change therapy

Whether LDL-P and Apo B are impacted by non-fasted: NO

LDL particles are present in plasma on average 3 days and are is a steady state and thus levels are stable over several days

Liposcience does not offer apoB testing: they provide LDL-P by NMR. If you have LDL-P you do not need apoB

The VAP test offers a calculated Apo B–BOGUS!

You have to insist on a MEASURED Apo B test (using a protein immuno assay)

Chris Masterjohn says major deviations in cholesterol

You’re “playing with fire” with traditional testing

It’s time to say goodbye to these kinds of tests

You gotta move on when newer biomarkers come along

We must abandon traditional cholesterol testing

Get the new tests in there as the standard bearer

It’s a “total joke” when heart disease is #1 killer

Doctors often think someone advocating particle testing is “some quack”

Never be afraid to change doctors if necessary

Publisher asked me to write layman’s cholesterol book

Peter Attia’s “Straight Dope On Cholesterol” series

Your doctor better know Apo B and LDL-P or fire him

Dr. Dayspring on Twitter: @DrLipid

Dr. Dayspring on Twitter: @DrLipid   TRY THIS NEW LOW-CARB SNACK OPTION FROM NICK’S STICKS:

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Jimmy Moore - background to 6-Month Lipid & Nutritional Ketosis N=1 Experiment

6-Month Lipid Panel Update On My Nutritional Ketosis N=1 Experiment « Jimmy Moore's Livin' La Vida Low Carb Blog

Ever since I began my n=1 experiment of the concept of “nutritional ketosis” in May 2012 that has resulted in a 50+ pound weight loss so far while consuming lots of healthy high-fat foods to raise my level of blood ketones, people have been asking me about what’s been happening with my lipid panel.

But as we heard from Dr. Jonny Bowden in Episode 632 of “The Livin’ La Vida Low-Carb Show” podcast this week discussing his brand new book on this subject entitled The Great Cholesterol Myth: Why Lowering Your Cholesterol Won’t Prevent Heart Disease and the Statin-Free Plan That Will, is this something we really need to be concerned about? Whether the answer to that question is yes or no, what do the numbers really mean anyway?

And are they different for people who eat a high-fat, moderate protein, low-carb diet to produce an appropriate level of beta-hydroxybuterate (blood ketones) that Dr. Stephen Phinney and Dr. Jeff Volek discuss as optimal for health and performance in their bestselling 2012 book The Art and Science of Low Carbohydrate Performance?

I’m currently on a personal quest to find the answers to these questions and more by speaking directly with as many of my expert friends in the medical, nutrition and research fields over the next six months researching and writing my book all about this topic tentatively titled A Patient’s Guide to Understanding Your Cholesterol Test Results (releasing Fall 2013). People are so confused about what to believe about their cholesterol test results that this book is way overdue. Arming people with solid information will help them make a more informed decision about what to do about the current state of their health rather than blindly following some dubious drug therapy promoted by their doctor to treat risk factor numbers. It’s high time we start treating actual DISEASE rather than risk factors anyway.

But every single week, I receive at least a dozen e-mails from people all over the world who are concerned about their cholesterol test results. Even for those people who have gotten away from the traditional lipid testing that only shows LDL-C, HDL and total cholesterol to the more advanced particle size testing from places like the Raleigh, NC-based LipoScience who created the NMR Lipoprofile test, there is pause for concern because their doctor tells them they need to be taking a statin drug lest they fall victim to a heart attack or worse. I’ve never understood the scaremongering that goes on regarding “high cholesterol” and the knee jerk reaction that taking a pharmaceutical drug such as a statin will somehow protect people from ever having a heart attack. A timely example of this is the late television newscaster Tim Russert who had “perfect” cholesterol numbers while ostensibly on a statin drug and yet tragically died of a heart attack in June 2008. Watch Justin Smith’s $TATIN NATION documentary for more information about just how insidious this push for a risky drug therapy to treat a non-existent disease has become.

I’ve been a big fan of having my cholesterol tested using the NMR Lipoprofile test for many years because they are the only truly accurate cholesterol particle testing company in the world. According to lipidologist Dr. Thomas Dayspring who addressed cholesterol testing in Episode 29 of the “Ask The Low-Carb Experts” podcast recently, this cholesterol test from LipoScience is the only one that he’s aware of that will directly measure your LDL-P (the total number of LDL particles in the blood) and Small LDL-P (the dangerous Pattern B LDL cholesterol that penetrates the arterial wall and leads to atheroschlerosis). Knowing where your numbers stand is a critical starting point for anyone wanting to optimize their health. Your doctor can actually run this test if you ask for it (although some will think it’s unnecessary or a “fad”) or you can use one of those online health testing outfits like Private MD Labs that work with your local LabCorp offices to pull the blood without a doctor being involved like I did last week to get my latest lipid panel update.

In mid-November before leaving on my trip to Australia for a three week, 5-city “Low Carb Down Under” speaking tour, I’ll be sharing a 6-month update about my nutritional ketosis n=1 experiment (read all of my updates for Day 1-30, Day 31-60, Day 61-90, Day 91-120 and Day 121-150). I’ve got some really interesting information to share with you regarding an experience that has happened to me during this 30-day cycle that could help those of you who might be wondering why your blood ketones aren’t where you want them to be. I’m amazed by how much I’m STILL learning about all this and look forward to passing along what I’ve discovered with you in the months to come. My target date for publishing my Day 151-180 results is November 11, 2012 or sooner. Stay tuned!

There’s still a lot of controversy about whether the LDL-P number (and the parallel marker of Apo B) is as or more important than the LDL particle size. Dr. Dayspring is adamant that it’s all about the LDL-P number and that the size isn’t relevant when it comes to heart health. He explained his reasoning for this position in Episode 585 of “The Livin’ La Vida Low-Carb Show” podcast. And in his popular “The Straight Dope On Cholesterol” blog post series, Dr. Peter Attia notes that the number of LDL particles and not just their size determine the atherogenic risk.

But a Gilbert, AZ-based family physician who specializes in heart attack prevention named Dr. Rocky Patel (listen to him in Episode 62 of the “Low-Carb Conversations” podcast) noted in his September 2012 blog post entitled Does LDL-P Matter? that his personal LDL-P score of “over 3000″ was initially “horrifying” until he had a Carotid Intima Media Thickness (CIMT) test showing his vascular health was equivalent to that of a 16-year old! Additionally, his low-carb diet has helped him lose weight, feel energized and brought his inflammation (CRP) levels to “not detectable.” Cool! Dr. Patel concluded his blog post by stating a truth that should be the basis of all healthcare decisions: “We must always remember to treat the patient/disease and not the number.”

With that in mind, let’s talk about my various health numbers. As you know, I’ve been actively losing weight and body fat (we’ll know for sure I’m losing body fat when I get the comparison results of my DEXA scan coming hopefully before I leave for Australia) on my nutritional ketosis plan and that has not stopped nor do I expect it to in the coming months. But before I even started on this plan in May 2012, I had a Berkeley HeartLab panel of tests run in February 2012 to see how my low-carb diet was working for me. Despite weighing over 300 pounds at the time, some key health markers were pretty remarkable:

C-Reactive Protein (CRP) – 0.7 (less than 1.0 is “low risk”)

HDL-C – 78 (over 50 is considered stellar)

Triglycerides – 89 (under 100 is excellent)

I’ve said it many times before, but reducing your carbohydrate intake, moderating your protein consumption and consuming higher levels of healthy fats that include saturated fat are the best ways to not just lose weight but making critical positive changes for the better in your lipid panel happen.

Laura Dolson discusses Three Reasons Not To Worry About LDL Cholesterol On A Low-Carb Diet and notes that HDL over 50 and triglycerides under 100 will almost always mean your LDL size is the Pattern A (large, buoyant kind) that you want. Dr. Jeff Volek has found in his research patients a greatly improved triglyceride/HDL ratio eating a low-carb diet and that this is a much better marker for heart health than LDL or total cholesterol. As far as I know, the advanced particle size lipid testing has not been used by Dr. Volek, Dr. Eric Westman at Duke or others looking at low-carb diets in their research. I hope that they do add this extra bit of data for the benefit of those who may see some crazy numbers like Dr. Patel and I (and I’m sure many other low-carbers) are seeing.

So what about my latest test results from my fasting blood draw on October 25, 2012? Some of the numbers shouldn’t be a surprise knowing that I’m eating a very strict high-fat, moderated protein, low-carbohydrate diet with a fat/protein/carbohydrate ratio of 85/12/3:

HDL-C is 65 (down slightly from Berkley but still over 50)

Triglycerides are 46 (virtually cut in half since Berkeley)

Small LDL-P is 221 (just 6% of my total LDL-P number)

VLDL was “too low” to measure exact number (A GOOD THING!)

LP-IR Score was 11 (means I’m no longer insulin resistant)As amazing as all of these numbers were, the ones people will likely be most interested in are the “high” ones. Let’s take a look:

Total cholesterol is 359 (not a relevant number at all)

LDL-C is 285 (again, this tells you nothing really)

LDL-P is 3451 (ideally it’s supposed to be below 1000)

Apo B is 238 (parallel to LDL-P and should be under 80)

What I want to know is how I can simultaneously have outstanding insulin sensitivity, an A1c score of 4.5, average blood sugars around 81, a heart scan score of zero, undetectable inflammation, 94% of my LDL particles are the large, fluffy kind (Pattern A), a microscopic triglyceride/HDL ratio of 0.7 and active weight/fat loss AND a greater susceptibility for atherosclerosis because of an extremely high LDL-P and Apo B. The answer is out there and I’m bound and determined to uncover it for my book next year.

But this is more than about some book I’m writing…this is my life. I wholeheartedly believe my healthy high-fat, moderate protein, low-carb diet is vastly improving my health in ways that no other eating plan could even possibly touch. And yet the jury is still out on whether or not there should be concern about the direction my numbers have been going. I did an Excel spreadsheet showing how although my total cholesterol, LDL-C and HDL have all remained relatively constant for the past 4+ years, LDL-P has gone precipitously higher and higher (will it ever stop going up and what’s making that number continue to rise?):


Interestingly, before I started on the Atkins diet in January 2004, my highest total cholesterol was only about 230. Of course, my doctor put me on both Lipitor and Crestor to lower that number and it did get down to 130 at some point (don’t know what the breakdown was of HDL and LDL nor do I know what my triglycerides or LDL-P were at the time either). But people have claimed I have familial hypercholesterolemia because my total cholesterol is now over 300. But I disagree.

Something has happened since I began eating high-fat, low-carb and I can’t help but wonder if there is a purpose for that extra cholesterol in the body since we know there are benefits to higher levels of cholesterol in the body. The jury is certainly still out on this.

If there’s one thing you know about me, it’s this: I won’t stop seeking the truth about this and sharing with you what I find. Dr. Dayspring has already invited me to visit him at the Richmond, VA-based Foundation For Health Improvement And Technology to see why despite all my incredible lipid numbers the LDL-P and Apo B seem to be out of whack. It will be interesting to see if these numbers are found to be less important for people on low-carb diets than those eating other kinds of diets. Now that’s some research that could help a whole lot of people. In preparation for my book, I’ll also be interviewing various health professionals from cardiologists to practitioners and everyone in between to get to the heart of what matters most. I’m anxious to get going on this project and can’t wait to see where my journey takes me on this.

Got any comments about my latest lipid numbers? I’d love to hear your thoughts in the comments section below. Feel free to share any knowledge and experience you may have on this subject.

Lipidologist Dr. Thomas Dayspring Explains The Truth About Cholesterol (« Jimmy Moore)

The LLVLC Show (Episode 585): Lipidologist Dr. Thomas Dayspring Explains The Truth About Cholesterol « Jimmy Moore's Livin' La Vida Low Carb Blog

nb: he says that LDL particle size is irrelevant, and that only particle number is relevant 

In Episode 585 of “The Livin’ La Vida Low-Carb Show with Jimmy Moore,” we welcome the Director of Cardiovascular Education at the Richmond, VA-based Foundation for Health Improvement and Technology (FHIT) and lipid expert Dr. Thomas Dayspring.

Listen to Dr. Thomas Dayspring enlighten on cholesterol:

When he came out of medical school, there was nothing on lipids

How he’s tried to bring clarity to lipid health

The science has “so radically changed” in recent years

Everything that’s been taught is “pretty much dead wrong”

Cholesterol measurements can be “incredibly deceiving”

Total cholesterol was all there was in the 1970s

Higher cholesterol was considered a risk for heart disease

The Framingham Study tied heart risk with high cholesterol

All research started to “chase cholesterol” after this

It seemed if you could cut cholesterol then risk lowered

This started a race to create drugs to drop cholesterol

Why do 70% of heart events still happen despite the meds?

You need skeptics with anything that we’ve been told

New physicians will learn what they’ve learned will be outdated

Many young doctors tend to be a little more “open-minded”

Unfortunately, med students are taught by the old guard

Atherosclerosis is simply an accumulation of sterols

Growing plaque gets inflamed which leads to a clot

Cholesterol is the killer but only if it’s in the artery wall

But cholesterol is a vital element in the human body

Cholesterol in your plasma (blood) isn’t hurting anyone

If cholesterol is high in blood, people think it’s high in arteries

Tim Russert a prime example of cholesterol theory failure

Cholesterol are oils and not soluble in liquids

No human has lipids “floating around” in the blood

These oils are wrapped in proteins called lipoproteins

Lipids go nowhere in the human body without lipoproteins

This is the only way cholesterol gets into artery wall

A lipoprotein that “crashes your artery wall” is atherogenic

If particles carrying LDL cholesterol are high, lower it

You can have low cholesterol and a nightmare particle number

This is why people can die with normal cholesterol numbers

If statins remove LDL cholesterol, it may not get particles

When VLDL loses triglycerides, it becomes LDL cholesterol

HDL is “classically but erroneously” called “good cholesterol”

How total cholesterol is calculated on lipid testing

Doctors tend to only pay attention to LDL particles

If LDL is high, it’s assumed you have too many LDL particles

NMR Lipoprofile counts the number of LDL, VLDL and HDL particles

Apolipoprotein B (ApoB) is a “much better predictor of heart attack”

Normal ApoB is what you are looking for more than anything

There’s “no use” for getting a VAP test conducted

You need to “insist” on getting ApoB or LDL particle counts

Berkeley does give you an ApoB, but it focuses on wrong things

Small LDL particles are “irrelevant” as a risk factor

Familial hypercholesterolemia is horrendous on health

Why spend your money on useless lipid testing?

The treatment strategy varies according to risk degree

First line therapy is “always nutritional”

When your liver makes VLDL particles, it turns to triglycerides

Doctors ignore triglycerides unless they’re high–BIG MISTAKE!

What raises triglycerides? It’s the carbohydrates!

LDL cholesterol can look fine but LDL particle count is “lethal”

But you won’t be fine because they’re loaded with triglycerides

Doctors need to be telling patients to “cut the damn carbs”

Ignore cholesterol and check your triglycerides first

The total cholesterol limit of 200 is “ancient history”

HDL and triglycerides should both be 50

The HDL world is “radically changing” now too

CETP will pull triglycerides out of VLDL to LDL and HDL

The mechanism behind why triglycerides go up, HDL goes down

On a low-carb diet, triglycerides go down and HDL increases

The only thing that really matters is HDL particle count

If you have high HDL cholesterol but low HDL particle count…

You can be at greater risk for heart disease

Pay attention to the HDL particles you have over anything

There have been no goals for HDL cholesterol because of this

Low HDL is usually a risk factor because of high triglycerides

Low HDL is no risk for heart disease if triglycerides are low

More important: ApoB, LDL particles and HDL particles

The American Heart Association’s “Get With The Guidelines”

136,000 people with heart disease were included in this

55% had an LDL cholesterol under 100

18% had an LDL cholesterol under 70

Flip a coin: heads you win, tails you lose

Average American triglyceride level: 140-150 (NOT GOOD!)

Get an ApoB or an LDL particle count

If you’re insulin resistant, read Gary Taubes‘ booksThere are four ways you can listen to Episode 585:

1. Listen at the iTunes page for the podcast:

2. Listen and comment about the show at the official web site for the podcast:

3. Download the MP3 file of Episode 585 [48:35m]:

4. Listen on the Stitcher app–NO DOWNLOADING!


It’s not often we are privileged to have someone quite like a lipidologist with the credentials of Dr. Dayspring also from LecturePad.org joining us on the podcast. You might remember seeing him in a series of YouTube videos from Specialty Health in December 2011 with Gary Taubes.

The way he spoke and the information he provided in those videos made me want to have him appear on my podcast.
After being in private medical practice for 36 years helping his patients understand the importance (or lack thereof) of their cholesterol test results, Dr. Dayspring has turned his attention to educating his fellow physicians, medical school students and laypeople alike on the various intricacies of advanced lipoprotein testing like the NMR Lipoprofile test through his very popular lectures given all across the United States.

He is THE go-to expert on the subject of lipids and what they mean as you’ll quickly hear in today’s interview. Listen in as I get Dr. Dayspring to zero in on the heart of the issue regarding what cholesterol test results really mean and the key markers you need to be aware of in determining your overall health that nobody is currently talking about. A publisher has commissioned me to write a book about a layman’s perspective to understanding your cholesterol test results and Dr. Dayspring will certainly be one of my key resources for information in researching and writing about this extremely critical subject. This podcast today is a keeper and will surely stir the pot of controversy a time or two by the end. ENJOY!

NOTE: My apologies for the poor sound quality of this podcast interview. I have updated my recording equipment for better stability and future episodes will sound better than this. THANK YOU again for your faithful support of this podcast!

LDL Cholesterol vs. LDL Particle Number, LDL-P and ApoB Measurements - YouTube

myHDLinc·44 videos

Uploaded on 29 Jul 2011

Dr. Thomas Dayspring explains the relative utility of the traditional LDL cholestrol measurement versus measures of LDL particle number, LDL-p and apoB. Health Diagnostic Laboratory, Inc. measures this information with advanced testing.