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The LLVLC Show (Episode 635): Encore Week 2013 – Dr. Thomas Dayspring

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In Episode 635 of “The Livin’ La Vida Low-Carb Show with Jimmy Moore,” we are so pleased that you voted for noted lipidologist Dr. Thomas Dayspring to return for a brand new interview as one of the best of the best guests of 2012 for “Encore Week” 2013. After being gone for the past two months during my Australian speaking tour and the Christmas holidays, we’re back ready to take on 2013 with a vengeance bringing lots of great low-carb podcasting for you to enjoy! As has been the long-standing annual tradition of this podcast during the first week of the new year, we will be celebrating “Encore Week” 2013 with BRAND NEW EPISODES all week along featuring your favorite podcast guests of 2012 as voted on by you. We had a ton of outstanding nominations and whittled it down to you favorite five airing daily all this week. WE’RE BACK!

We kick off this special “Encore Week” 2013 of with the fascinating and very popular Dr. Thomas Dayspring who sprang on the scene in 2012 with a series of YouTube videos alongside Gary Taubes that put him on my radar screen. I started following him on Twitter and interviewed him in Episode 585 of “The Livin’ La Vida Low-Carb Show” as well as Episode 29 of “Ask The Low-Carb Experts.” Needless to say, Dr. Dayspring knows just a thing or two about the subject of cholesterol and what it really means regarding heart health. I had the unique opportunity to actually meet with him face-to-face for a couple of hours in his Richmond, VA-based office a couple of weeks ago which provided some great fodder for another fantastic discussion you’ll hear today about cholesterol numbers and what action to take to improve cardiovascular health. This is a critical subject and one that I hope my new book on reading cholesterol test results releasing in the Fall 2013 will help to address.

Listen in as I speak with this world-renowned lipid lecturer about my own odd-looking lipid test results, the possible need for cholesterol-lowering medications for people with familial hypercholesterolemia, tests that can be run to determine whether pharmaceutical intervention is needed on top of diet and lifestyle changes, what context cholesterol numbers mean in the presence of a ketogenic diet, his new theory about why LDL-P might not be an issue for some ketogenic dieters who experience elevated numbers, and so much more! This 42-minute episode is chock full of some fantastic information that you won’t want to miss if you are concerned about your cholesterol test results. We’re so glad to be back at it again and look forward to sharing these spectacular new interviews with you during “Encore Week” 2013. Don’t miss my fresh new conversations with Jonathan Bailor, Dr. Terry Wahls, Professor Timothy Noakes and Dr. John Briffa all coming later this week!

Listen to Dr. Thomas Dayspring during “Encore Week” 2013:

  • The overwhelming feedback I received about Dr. Dayspring
  • There are a lot of things we just don’t know about lipids
  • Science is “evolving” and we’re never as smart as we think
  • He can’t practice medicine in the same way he used to
  • Cholesterol measurements don’t give any heart health info
  • It comes down to what that cholesterol is actually doing
  • Measuring lipoproteins is better than cholesterol numbers
  • LDL is the most numerous, likely atherogenic lipoprotein
  • If you are in the 80th percentile or higher, you’re at risk
  • There are anomalies to this serving as outliers to the rule
  • LDL particles wrapped in Apo-B (LDL-P is parallel marker)
  • Particle number is much more important than particle size
  • The inner cell lining of the artery is the endothelium
  • They secrete compounds that serve as a line of defense
  • The strength of your endothelium determines your real risk
  • Strong arterial wall health may mean LDL-P is not as bad
  • People who eat low-carb, high-fat tend to have LDL-P drop
  • But some people eating ketogenic have higher cholesterol
  • Saturated fat can drive the LDL upward in a lot of people
  • LDL, total cholesterol, LDL-P and Apo-B goes up
  • It concerns a lipidologist like him about what to do
  • But maybe it’s not an issue with the diet, but genes
  • Familial hypercholesterolemia could be what’s going on here
  • Some with FH with high LDL-P have no atheroschlerosis
  • These people with genetic disorder may have strong artery wall
  • My 6-month lipid panel update on nutritional ketosis
  • Triglycerides, HDL, inflammation all improved greatly
  • People eating a ketogenic diet remove insulin resistance
  • Could you by erasing underlying basic biomarkers be okay?
  • We need a long-term study of ketogenic diets to see this
  • Exceeding saturated fat intake limit in some raises LDL-P
  • Instead of filling VLDL with triglycerides, uses LDL instead
  • Get an imaging test to know for sure is best way to track
  • Corony calcium scan or a carotid artery IMT ultrasound test
  • Watch my wife Christine getting a heart scan in 2011
  • I had a heart scan, but it should be done every 2 years
  • The carotid artery test can be done more often
  • Perhaps cutting saturated fat a bit would lower LDL-P
  • Nobody is saying go back to eating carbohydrates again
  • Is there a certain level of saturated fat that’s ideal?
  • Maybe you won’t reach ketosis like you want if you do though
  • The metabolic ward tests that NuSi will be doing on this
  • Ketogenic dieters should run these extra tests to be sure
  • If you wipe out insulin resistance markers, maybe not an issue
  • Medication needed for people not willing to change lifestyle
  • You’ve got to go to someone checking all these biomarkers
  • The benefits of ketosis is satiety and satisfaction
  • Whether olive oil would be good proxy for saturated fat
  • Everybody is so different that we need to individualize this
  • Biomarkers can change very rapidly with dietary changes
  • FH can “lie dormant” in people for many years
  • Cholesterol synthesis problems explain LDL-P increases
  • What is the thermostat for the liver to produce LDL-P
  • Dr. Jonny Bowden and Dr. Stephen Sinatra on Dr. Oz
  • Many of the statements on Oz were good overall
  • Particle size has “zero to do with” arterial penetration
  • Technology to count particles trumps old studies on size
  • Gotta get over “outright stupidity” of particle size
  • All bets are off about this for ketogenic dieters though
  • Pharmaceutical therapy doesn’t deserve to be vilified
  • Antibiotics, vaccines and statins have saved lives
  • Atheroschlerosis can show up as early in early 20’s
  • The unfortunate thing is drugs are way over-prescribed
  • Too many doctors are stuck in the old way of treating
  • Health Diagnostic Laboratory non-profit he’s associated with
  • HDL Labs one of biggest lipid labs in the Unites States
  • They’re willing to run tests for what insurance will pay
  • You get all of the latest and best results
  • The genetic markers in the tests you only run one time
  • Several inflammatory markers are checked like LpPlA2
  • Myeloperoxidase is another emerging heart health marker
  • Fibrinogen is a great inflammatory marker
  • Insulin resistance markers are also checked in these tests
  • The people at HDL Labs understands the low-carb diet
  • The nutritionists there don’t push low-fat diets
  • This consultation is FREE when you get the tests run
  • Even my wife’s own doctor is using HDL lab testing
  • The earlier in life we find disease, the better
  • We gotta take out the carbs to beat chronic disease
  • Definitely follow Dr. Dayspring’s tweets on Twitter

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    There are four ways you can listen to Episode 635:

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    How did you like what you heard in this brand new “Encore Week” 2013 interview with Dr. Thomas Dayspring? Share your feedback about it in the show notes section of Episode 635. Be sure to follow @DrLipid on Twitter to keep up with the work Dr. Dayspring is doing! Coming up on Tuesday, we’ll have another incredible chat with another one of your favorite podcast interview guests from 2012 named Jonathan Bailor who first appeared in Episode 570 of “The Livin’ La Vida Low-Carb Show” and then again in Episode 28 of “Ask The Low-Carb Experts.” This nutritional thought leader brings a whole lot of fodder for discussion in my brand new interview with him to kick off the brand new year on January 1, 2013! DON’T MISS IT!

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    • Kenneth MacKillop

      Hi Jimmy,

      Thanks for this interview — I have a ketogenic diet and lipid numbers just like yours. It’s nice of Dr. Dayspring to take an interest in this phenomenon, which I think is not that uncommon. By looking at studies of epileptics on ketogenic diets and other crude means, I would guess that more than 1 to 2 in 10 people will have this response to a ketogenic diet — I believe that it has not been much noticed until recently because very few people are actually ketogenic or even very low-carb. Eric Westman seems to have enough clinical experience to be familiar with it, and I suspect he probably has a higher percentage of patients compliant to a serious low-carb diet than most other bariatric physicians (and there are not many of these out there in any case).

      It is interesting that Dr. Dayspring hypothesizes an increased VLDL synthesis as the cause, especially since he thinks saturated dietary fat is involved. I would have thought LDL clearance by one of at least two commonly discussed mechanisms more likely:

      1. LDL receptor downregulation (activity/number): This is a favorite theory in the medical community, in response to dietary saturated fat in particular. There are tons of papers on it — it is much loved because via the lipid hypothesis and this supposed mechanism a diet rich in animal foods (e.g. meat, eggs, dairy) can be demonized. Maybe it has been discredited in recent years, but if so I am not aware. I personally do not believe it is involved in my own response to ketosis, however.

      2. “Low” tissue thyroid hormone: This is known as nonthyroidal illness syndrome (NTIS) in the medical literature. It really cannot be measured directly, but clinical measurements for serum free T3 and rT3 are commonly used as markers. Here’s one relevant link for anyone interested in a little reading on the subject: http://jcem.endojournals.org/content/84/1/151.long

      Of course, the normal range for our population as a whole is probably very misleading for what is healthy on a ketogenic diet. My own readings are over three times lower for the free-T3/rT3 ratio than the commonly cited minimum ratio for “tissue euthyroidism”, and so some fringe clinicians who look at these things might consider me to be “tissue hypothyroid” (for which they would probably prescribe T3 hormone supplementation). I am in perfect health as far as I know, though, and have come to the conclusion that my tissue (including liver) thyroid activity and concentrations are probably at a healthy homeostatic level in relation to my diet.

      I do believe, however, that my jump up in LDL-c after going onto a VLC diet (over three years ago) probably resulted from a downregulation of hepatic thyroid hormone activity. This, in addition to low insulin (my fasting insulin is < 2mcIU/L which is the lowest reading the lab equipment could detect), is well known to result in significant downregulation of hepatic LDL receptors and this is (ala Brown and Goldstein) well known to result in increased serum LDL concentrations. After all, statins induce the liver into upregulation of LDL receptors and thereby have a powerful effect in the opposite direction.

      What baffles me is why so many in the medical profession, such as Dr. Dayspring, believe that manipulating LDL serum concentrations using drugs will decrease risk of CVD. LDL-P is just a weak marker for risk (albeit somewhat stronger than LDL-c) — its correlation is much too weak to be a possible causal factor by standard epidemiological rules of measure. In addition, the drug trials' data has seemingly disproven a causal relationship in so many ways and instances that it is difficult to count (e.g. lack of dose-response relationship for hard end points). Statins work by various pleiotropic mechanisms that are pretty well known by now (e.g. Rho inhibition), and all the many other cholesterol-lowering drugs have no efficacy at all because they only reduce LDL without added beneficial pleiotropic effect. LDL is clearly a marker for something related to CVD (unIDed as yet, but maybe diet via a deleterious chronic postprandial endothelial response for example). Statins have a weak beneficial effect for a subpopulation in secondary prevention only. They are harmful in many ways, and their biological mechanism is truly terrifying IMO. I tried a couple for a few months to humor my medic, but never again. I had myopathy and a dangerous allergic reaction. And the statins were quite effective in lowering my LDL serum concentrations, but so what? Oh well…..

      By the way, I had a coronary multi-slice CT done, yielding a zero calcium score (like yourself) at age 54. I am mulling over the idea of getting an Endo-PAT (digital flow-mediated dilation / reactive hyperemia / endothelial function) test done to establish a baseline for future monitoring (even though I suspect I will die of something else, other than CVD — I think my genetic susceptibilities lie elsewhere). Have you any thoughts about this test, Jimmy?

      • LLVLCBlog

        I’d like to get a lot of tests done. I’m adding this one to that list.