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New physicians will learn what they’ve learned will be outdated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

The Mighty Chylomicron - or Why Dr. Robert C. Atkins was right! | Diet Heart Publishing

The Mighty Chylomicron - or Why Dr. Robert C. Atkins was right!

"Atkins was right - excess carbohydrates - not dietary fat - make you fat and predispose you to metabolic diseases like diabetes and heart disease"

"If the chylomicron - the largest lipoprotein - is the size of an 18-wheeler, liver-made VLDL is a large delivery truck, LDL is a van, and HDL is a motorcycle. Though smallest, HDL is the most numerous particle and you want as many of these motorcycles as possible bringing cholesterol back to the liver for recycling."

 
The Mighty Chylomicron - the largest lipoprotein - is sent out from the intestines (gut) to deliver dietary fat and cholesterol. Lipoproteins are specially designed vehicles used to transport cholesterol and triglycerides around the bloodstream. (A triglyceride is the way fat is assembled in the body - three fatty acids attached to glycerol.) Anything insoluble in water or blood, such as cholesterol, has to be carried/delivered in a lipoprotein; that is, a lipid/protein vehicle.)

There are two distinct lipoprotein systems, chylomicrons to deliver dietary fat, and VLDL - Very Low Density Lipoprotein - to deliver fat made in the liver - principally from excess carbohydrates. As VLDL circulates delivering its fat, it morphs into LDL, the lipoprotein that delivers mostly cholesterol.

That's right - LDL is the metabolic offspring of VLDL - intimately related to carbohydrate metabolism. 

Made in a separate pathway in the liver, HDL is reverse transport - scavenging loose cholesterol and returning it to the liver for recycling.

VEHICLE	ORIGINATES	PROTEIN	DELIVERING
Chylomicron	gut wall	apoB-48	dietary fat
VLDL	liver	apoB-100	liver-made fat
LDL	offspring of  VLDL	apoB-100	cholesterol to body
HDL	liver	various	reverse cholesterol transport

Of course, it would be a good idea if the medical profession stopped using terms like 'good' cholesterol and 'bad' cholesterol. LDL is not 'bad' cholesterol - LDL is a lipoprotein that delivers cholesterol. This sloppy terminology doesn't aid our understanding of heart disease, and evolved primarily to defend the failed hypothesis that cholesterol and fat cause heart disease.

Diet Heart News 1 and 2 discussed the liver-made carbohydrate-related VLDL system and the importance of the Triglyceride/HDL ratio. This report discusses dietary fat or chylomicron metabolism. To understand the difference between these systems, let's compare a high fat breakfast with a high carb breakfast. 

High Fat (Three eggs fried in lard plus two lamb chops)

When you eat fat and protein for breakfast, the fats (lipids) become separated from the protein in the intestine, are broken down into molecules, are absorbed within the gut wall, and then are reassembled into triglycerides and placed into the very large lipoprotein known as a chylomicron. (Cholesterol and other fat soluble nutrients like vitamin E share the ride.)  

If the chylomicron - the largest lipoprotein - is the size of an 18-wheeler, liver-made VLDL is a large delivery truck, LDL is a van, and HDL is a motorcycle. Though smallest, HDL is the most numerous particle and you want as many of these motorcycles as possible bringing cholesterol back to the liver for recycling.

Released from the gut wall through the lymph, chylomicrons travel in the blood until they have delivered their fatty bounty, shrink and disappear. (Chylomicron remnants are picked up by the liver.) Because chylomicrons have a specific apoB-48 protein attached, the cells in the body recognize the vehicle and send enzymes out to snatch up this fat - of dietary origin. So a few hours after our fatty breakfast, the chylomicrons are gone. If you were to measure apoB-48 levels a few hours after a high fat meal, they would have returned to a 'normal' fasting state.

Eat a high fat breakfast, almost all sign of the fat - apoB-48 - will have disappeared in a relatively short space of time. And there will be no change in any lipid level - your VLDL, LDL, and triglyceride numbers are not directly affected. As you can see, dietary fat is readily and almost completely absorbed by healthy people.  

High Carbohydrate (Cheerio's, skim milk, banana, and orange juice)  

Unlike dietary fat, carbohydrates (except fructose) are absorbed as sugar or glucose directly in the blood. Sugars are soluble in water so they are not carried in a lipoprotein. After our high carb breakfast, there is no immediate effect on lipid levels; instead you get a rise in blood sugar and an insulin response.

A certain amount of glucose can be absorbed into muscle and liver cells and stored as glycogen. But if you eat a big carbohydrate breakfast - like the one described above - the glycogen storage is exceeded and the excess sugar is absorbed by the liver and turned into liver-made fat - also called triglycerides - three fatty acids linked to glycerol. (The word "triglyceride" describes how fats are assembled in the body and also is a term used in blood work to measure residual blood fats in your blood. Triglycerides (TG) over 100 represent increased risk of heart disease.) 

Unlike chylomicron metabolism, VLDL production can go on for hours after a carbohydrate or mixed meal. The liver stays busy making and packing triglycerides into VLDL which is sent out into the bloodstream - along with some cholesterol. If you are also consuming excess fructose, which goes directly to the liver, you are at risk of developing fatty liver disease, essentially a metabolic traffic jam in your liver.  

Excess carbs > elevated blood sugar > chronic triglyceride production > more VLDL trucks needed to haul away the liver-made fat. Elevated liver-made triglycerides result in chronic high levels of VLDL. So, as you can see, LDL - the lipoprotein the experts call 'bad' cholesterol - is not related to dietary fat consumption. Dietary fat consumption is related to chylomicron metabolism and chylomicrons do not morph into LDL - they simply disappear.  

As we learned in Diet Heart News, Vol. 1, No. 2, the greater your triglyceride production and VLDL level, the more likely the LDL offspring will be the small, dense particle associated with increased risk of heart disease. Also, as VLDL is assembled in the liver, HDL must give up its proteins and is reduced in a teeter totter manner: Triglycerides go up; HDL goes down.   

Immediately after a high fat meal, you will have elevated chylomicron levels (apoB-48) that will fall relatively quickly - in 2 or 3 hours - with no direct effect on VLDL, LDL, or triglyceride levels. A high fat restricted carbohydrate diet reduces VLDL, raises HDL, and may even lower LDL. A high carbohydrate diet does the opposite. 

In short, the metabolism does exactly what you would expect it to. So you see, Atkins was right - excess carbohydrates - not dietary fat - make you fat and predispose you to metabolic diseases like diabetes and heart disease.