What Causes Cardiovascular Disease? | Lipid Series Part 1 | Dr. Thomas Dayspring | The Proof Ep 251
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- Опубликовано: 25 июн 2024
- If you’re a long-time listener of *The Proof*, you’ll know that I have a deep passion for better understanding heart disease and communicating this knowledge alongside the world’s leading scientists. This personal interest is one that I’m sure many listeners will share; almost everyone has either personally struggled with cardiovascular health or knows someone who has. In this three-part series with Dr Thomas Dayspring, we undertake an extended education journey on cardiovascular disease and blood lipids.
👇 Visit The Proof website for supporting studies and the full show notes 👇 theproof.com/podcast/
Episode #251 forms Part One of this series. In this conversation, Dr Dayspring provides the foundational, technical knowledge needed to understand blood lipids, taking a deep dive into how our body absorbs lipids (fats and sterols) and transports them throughout the body. All in all, we examine what the lipid transport system is, the key parts of the system, and what happens when it goes wrong.
Dr Thomas Dayspring is a Fellow of both the American College of Physicians and the National Lipid Association and is certified in internal medicine and clinical lipidology. He is currently a virtual cardiovascular educational research assistant and clinical lipidology at a prestigious national practice, and has given over 4000 domestic and international lectures among a suite of other career achievements. Dr Dayspring is a true expert in lipidology, and continuously helps wider audiences make sense of this complex topic.
In this introductory episode, listeners will gain a deeper appreciation for what cholesterol and triglycerides are, how they are absorbed in the small intestine, and how they are transported through plasma (circulation). Dr Dayspring clearly outlines the two primary places where lipoproteins are produced - the small intestine and liver - and the function of the major classes of lipoproteins (chylomicrons, VLDLs, IDLs, LDLs, and HDLs).
We consider risk factors for atherosclerosis, discussing what goes wrong within the lipid transportation system that causes cholesterol to be deposited into the artery wall in a process called atherogenesis. We also address misconceptions about cardiovascular disease and the endothelium that are commonly perpetuated online, genetic influence, dietary cholesterol, and much, much more.
Knowledge is power, and understanding your body is the most powerful tool you can have for taking control of your health. I hope you find value in Part One of this masterclass with Dr Dayspring, and appreciate his attention to detail, patience, and obvious passion. I know Dr Dayspring’s work has helped me make sense of this complex system, and the tips imbedded throughout this episode will help you better understand your own body. Stay tuned for Part Two and Part Three of this series, where we will examine how to assess cardiovascular disease risk, prevent it, and treat it.
00:00 - Intro
05:12 - Turning a family heartache into a mission
14:52 - Atherosclerosis and the role of lipids
28:01 - Lipoproteins & cholesterol transport and recycling
54:00 - Cholesterol's role in lipoproteins
58:38 - Is ApoB a more accurate marker of cardiovascular risk?
1:07:10 - Endothelial transcytosis of lipoproteins
1:16:42 - LDL aggregation
1:23:35 - LDL particle retention and inflammation
1:29:15 - Difference between veins and arteries
1:30:42 - Atherosclerosis and genetics
1:44:21 - High-fat diets and cholesterol
1:48:34 - Fiber and cholesterol absorption
1:58:08 - Outro
Connect with Dr Thomas Dayspring on Twitter at / drlipid .
We’ve also got a Summary PDF being created with the key learnings from each part of the series. To receive a copy of this simply submit your email at theproof.com/lipid-series/.
And we are working on transcripts for these episodes too (release date TBC).
If you have any additional questions you would like answered in the future, let me know in the comments.
The best way to support the show is to use the products and services offered by our sponsors. To check them out, and enjoy great savings, visit theproof.com/friends.
Enjoy, friends.
Simon
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I’m a retired internist who was motivated by Tom to become certified in lipidology through the National Lipid Association.
Tom is a national treasure, who as Simon indicated has a selfless passion to educate and the skill to communicate a very complex molecular mechanism.
I’m also plant based as is Simon - interestingly without rosuvastatin and ezetamibe my apo B is at the 75th percentile for Americans.
This interview series is one of Simon’s best (which is saying a lot.
I sat at the feet of Tom through high free website updates and podcasts. This is Tom at his expert fluid best.
I love you man (both of you) - as you are both examples of a mensch par excellence.
I agree. These interviews were amazing. I learned so much. I’ve been transitioning to a Whole Foods plant based diet over the last 7 years or so. I’ve had my lipids checked every couple years over this transition period. My total cholesterol started at 230 and has dropped to 165. However, by LDL started at 35 and is now 113. I’m not sure how this can be going in the opposite direction. I have always exercised regularly.
Yes, indeed, he is brilliant
@@jasonsmith8651
I heard with of the same doctor I believe that if we get the HDL cholesterol(the good one) TOO HIGH is eventually rise the LDL too
The question is how high is HDL good helper??
I listened to the podcast first. I've now watched the whole interview again, written 6 pages of notes, and am astonished at the brilliance of both of you taking a complex subject and making it so accessible to us non-medical folk. Simon, what can I say? Am so grateful for you and your podcast.
Agree wholeheartedly!!!
I wish I was impressed but I was not. More or less he said only the progression of heart disease could be stopped and that it would always be there.
He should look at me. As a 200 point 30% reversal of my CAC isn't likely an error.
I did like the talk of what happens when Doctors go against the grain and their careers go flat. The people that speak out I have a lot of respect for. Like Dr. Linus Pauling and Dr Thomas Levy.
@@SET12DSP I do have very high respect for Dr. Linus Pauling not only for his scientific work, but also for his contribution to peace. Please tell me how did you manage to reverse Coronary artery calcium (CAC). I am 53 years old, and I have been diagnosed with CHD advanced stage. All the main corona arteries of my left heart, 70 % and the arteries of my right heart 80 % are clogged and my CAC is above 1000. I am a born vegetarian, Non-smoker, BMI of 22.7. My physician should have advised me long ago and put me on a statin, but now I am so worried. I am scared even to go to bed because I have a heart attack or stroke. I have a family history (my mum died at the age of 39 as a result of a stroke) and I think I carry the gene 9P21. Now I am taking ASS 100 mg and statin along with Omega-3, Vitamins D3, K2 and magnesium
@@SET12DSPplease tell me how you achieved that 30% decrease in CAC
@@ronniekirby5406 I'll get back to you after I get to the person above you that I somehow missed..
Dr. Dayspring is a living legend.
What a darling man-an expert and yet so loving; clearly hanging on every word of the story of Simon’s father.
This guy is amazing. I could listen to him all day. He is very skilful at explaining the anatomy and physiology of the subject matter without bamboozling you or boring you. He's one of the best I've heard so far. Outstanding.
This is absolutely fantastic. I've been on a mission to understand LDL and my risk. I think Dr. Dayspring is a ROCK STAR. Thank you for asking really great questions. Well done!
I’m almost half-way through this and just wanted to say it’s BRILLIANT. I had zero knowledge of the lipid mechanisms in the body. Will definitely watch all the rest of their conversation. Just want to understand why my cholesterol is high for the first time ever and whether I need to do something about it! Thank you so much, Simon!
Do NOT take Statins toxic & cause cancer, FDA warns of confusion & memory problems, permanent muscle damage.
👉All for what = a 1% absolute risk reduction.
Risks higher than any meager benefit.
✅Solution = Magnesium acts as a natural statin Without destroying everything down the Mevalonate pathway.
👉 Read "Poisoned" by Hannah Yosephs MD
If you want the actual mechanism, look up Dr Malcolm Kendrick. He has it nailed. This guy is a Dinosaur!!
This is the clearest, simplest explanation of the lipid transport system and atherogenesis I've ever heard. The idea that the purpose of LDL is to return cholesterol to the liver, not deliver it, is amazing.
I've heard Dr. Dayspring before and he's always entertaining and so knowledgeable. My Dad has 3 stents from a lucky duck finding with some anginal pain and while he didn't infarct, he had a 99% Left Main, 95% LAD and 75% LCx. He had borderline lipids for years that went untreated. His Dad died at the age of 47 with MI in bed while my father and my Grandmother stood by helpless. I am passionate about my risk reduction and have pushed hard for ApoB and Lp(a) labs much to the dismay of my PCP. I am a nurse practitioner and have the labs drawn regardless. Thank you for your education and willingness to share.
Wow, what an amazing interview. Yes a bit high level, but wow to have this level of expertise in an interview anyone can watch on RUclips. That’s a true public service. Thank you Simon.
I was going to the same thing... wow, what a great video. Thank you Simon, and thank you Dr. Thomas Dayspring.
Simon, I have worked out 6 days a week my whole life and have always stayed between 12 to 14% body fat. Thought I was in incredible shape until I had a coronary calcium score of 550 and my Apob was off the charts of 189. Found out I was a walking time bomb. So crazy. I am now on an extremely low fat whole foods plant based diet with a small does statin and dropped my cholesterol and Apob dramatically. So happy I had my Apob tested. Thanks for all the great content you create.
@TheSavior888 Patrick, you should get your Lp(a) level tested....if elevated, it could explain in part your CAC score. It would not change your treatment (although with high Lp(a) you might want to be more aggressvie with ApoB lowering talk to your cardiologist) but more importantly, since it is genetic, you should have siblings/cousins/children tested too so they can see if they are at increased risk too. The sooner you know and treat, the better.
I'm so glad you got this information and were able to avoid a bad health outcome. Thanks for sharing your story!
Why statins? They have nothing to do with your calcium score being high
Good for you, man. Your example fits the nuances Tom spoke to.
@joek9339 I was on the SAD diet, but I never over ate and worked out a lot to stay in shape. I never took PEDs. Feel so much better now that cleaned up my diet. Less aches and pains and a lot more energy. I'm 55 now so I'm getting up there. A good whole foods diet is so important
The experts don't get any more expert than Dr. Thomas Dayspring. There's so much misinformation available online by people trying to either simplify complex problems or villainize certain groups that it is refreshing to see highly intelligent people like Mr Dayspring having their ideas represented. He was certainly correct at the end of the video that you really have to be your own health care advocate. Simon, your role in helping us do that is invaluable. Thank you so much for bringing his message to us.
Brilliant episode - WOW! It's rare to find an expert who can distill his decades of experience with such clarity while being so personable and humorous. I loved Dr. Lipid. He cut through all the popular misconceptions and made me smile in the process.
Wow, this video is a game-changer! 🌟 The life-saving information you've shared is invaluable and has the potential to make a significant impact on so many lives. The content of the conversation is top-notch, meticulously presented, and easily digestible. Kudos to Simon for compiling such high-quality questions and visuals! 👏
And let's not forget the speaker - absolutely phenomenal! 🎤 Dr. Dayspring's eloquence, enthusiasm, and ability to convey complex ideas with clarity and passion are truly impressive. It's evident that he cares deeply about the subject matter, and that energy is contagious. Bravo! 👌
This interview is a masterpiece that deserves all the praise and recognition! Keep up the fantastic work! 🙌🎉
Thanks to you Simon and Dr Dayspring.
Dr. Dayspring is a living legend.. Dr. Dayspring is a living legend..
Dr Dayspring is the best!
It was a true masterclass.! I think this info will outweight knowledge of many "qualified" doctors in my country :) Cant wait to see remaining 2 episodes. Simon thanks a Ton
I think that in a past life Dr Dayspring was a macrophage who died becoming a foam cell and now he redeemed himself by helping people and macrophages avoid the common enemy. Ahah.
Love him, great masterclass.
I love his energy. It makes it even easier to learn. 😀
I’ve been searching 5+ years for the answer at 1:10:49. Thank you both! ❤
Thank you Simon and dr Daysping for sharing your
mind blowing knowledge
So ApoB particle and a macrophage walk into a bar and meet a gang of aggreggated LDLs....
What a wonderful discussion with great slides. Those aggregated LDLs the coolest thing I learned about. Looking forward to his coverage of lp(a) , my personal risk factor. Thanks Simon and your team, great work.
Thank you Simon. A lot of it went over my head, but I’m so glad I stayed with it. So very detailed and interesting. Greg - Australia
I would ha ve needed this video for my biochem 2 I think exam. This is such a understandable way to explain lipid transport. He sounds like he has lots of knowlege and expertice. A true expert, unlike so many self proclaimed experts on social media. It is so great that you put out such quality content and find those experts in their field.
extremely helpful.... congratz Simon and Dr Dayspring... been listening to your podcasts since the beginning, and they are never disappointing!
I haven't understood half of these but still appreciates the podcast as it is wonderful to know about the World of Lipids.
Thank you so much for sharing your knowledge with us. Tony 🇬🇧
I love how this gentleman delivers his knowledge! I would have enjoyed his lectures/ transfer of knowledge!! Awesome video.
Glad you enjoyed it!
This is SO fascinating. Thank you for this.
This was so informative and educational. Many thanks to you and your host for this, much appreciated!
This was fantastic. Thank you both so, so much. I am currently having "discussions" with my doctors regarding my LDL and am undergoing investigations as we speak and this has helped me immensely.. plus as an ex clinical chemist/biochemist I found it excellent and stimulating. Really can't thank you both enough.
Wow, super-loaded, informative conversation. Gotta listen to it a few times. I don't mind though, Dr. Dayspring is a gem :).
Can’t be denied: I’m impressed!
This episode is brilliant 👌👏. Thank you . I have learnt so much more and feel way more informed to help clients I see.
This is a masterclass on the lipids
This is such a great talk, really looking forward to the other two. Thank you!
Great info on lipids. Thank you Simon
Soooo awesome. Thanks for this great interview.
Simon, this is a great podcast. I’m a physiology professor to undergraduates in nursing and allied health students. This information is invaluable. It is such convoluted topic with much misunderstanding and misinformation. I like how you accurately and succinctly summarize what Tom states. I don’t have the time to go into the details like your discussion brings. I’m going to link this podcast. Thanks!
Why doesn’t anyone talk to Robert C Williams has been the leading researcher in cholesterol and the heart for over 60 years,he’s now 90 and still going strong?
Some good information, but it sounds like an infomercial for pharmaceuticals.
So grateful so great a man Doctor Dayspring and Simon
This was SUPER informative and DENSE!!! Will definitely be re-listening and eagerly anticipating the rest of this series!
A lousy conversation. Simon can ask a generic question here and there but simon lacks the biochemistry acumen to really challenge anything Dayspring says - and so we let the lipid doctor ramble on. Dietary cholesterol or any kind of dietary fat has zero impact on what is going on in the body. All this talk or pathways and Chylomicrons etc. is moot null and void due to the psychical fact (fact of physics, laws of physics) that these exogenous molecules were already broke down prior to eating. Decay of cow, begins this process, then exposure to light and oxygen, heat, cooking (do you really think there is an intact cholesterol molecule post frying pan?).
@@oliverleslie7382 Do you have any links you can provide to support your assertions?
What an enthusiast doctor ,,,and nice person sharing his great knowledge
Thanks a lot !!
@rf9612.......Sorry, but enthusiasm does not always equate into scientific accuracy. Please investigate into alternate theories which scientifically and biologically challenge the current lipid theory of CVD. This mainstream theory only makes sense on the surface, but looking critically you see the pathways embraced do not actually exist in the body. Cell wall integrity and tight junctions between cells will not allow LDL in unless it has provided receptors for entry. Also, cholesterol found within plaques is pure cholesterol crystals, found abundantly only in red blood cell membranes. The other type of LDL found in circulating blood cannot form such crystals. But supposing LDL could enter why not also the entry of most everything else in circulation, many of which are way smaller than LDL. And, being that same blood supply but with less oxygen also flows in veins why does the LDL not cause plaque and arteriosclerosis within veins? It does rarely happen in a few places but not common except in veins grafted in the position of a bypass (CABG). Higher BP, and higher levels of mechanical damage is the main reason for that,.......but if LDL were actual cause of CVD it would happen in both arteries and veins and would be occurring uniformly the same on all surfaces, not just in selected spots. For more info please view You Tube videos of Malcomb Kendrick interviews. Specifically view this video around the 1 hr mark. ruclips.net/video/wRjQCG4NU-Y/видео.html
Wow- this is so interesting and I love the passion he is explaining everything. Great and exciting!
Thank you so much for your content. I subscribed. I'm extremely interested in your guests and all that they share. ❤
I've seen more and more studies correlating inflammation and CVD, but this is the first time I've seen the mechanism spelled out. Awesome stuff.
best expert info out here! keep up the good work
Enjoyed this....thank you to both of you. Learned so much. From a Pattern B small dense LDL guy.
What great information on APO-Lipoprotein B. I love the way Dr Thomas Dayspring makes the so complex medical subject that most doctors even some cardologists nocht aware of it so simple and comprehensive for laymen. Thank You, Simon for sharing such a valuble information for the humanity. I am fron India and have subscribed to your channell.
Good stuff!
Hello Friends,
I'm keen to find out which part of our chat you found most enlightening. Should you have any further questions on this topic, do please post them beneath this comment. I shall endeavour to include them in our next discussion.
It would be great to debunk or confirm the LMHR hypothesis.
Man, REALLY GOOD 🎉
What a great Interview! I think I listened to Dayspring first on Peter Attia’ Podcast and it was fascinating and very educational! The illustrations you inserted in yours helped a lot ( I watched it on my big TV-screen) to follow his great explanations. (And who else would think of cholesterol molecules having sex and change their type/identity by that😂 other than TD). Thank you again very much for this video and please never be afraid of long episodes to explain certain topics!
A lousy conversation. Simon can ask a generic question here and there but simon lacks the biochemistry acumen to really challenge anything Dayspring says - and so we let the lipid doctor ramble on. Dietary cholesterol or any kind of dietary fat has zero impact on what is going on in the body. All this talk or pathways and Chylomicrons etc. is moot null and void due to the psychical fact (fact of physics, laws of physics) that these exogenous molecules were already broke down prior to eating. Decay of cow, begins this process, then exposure to light and oxygen, heat, cooking (do you really think there is an intact cholesterol molecule post frying pan?).
Great episode!
This is so well done and provides so much more (visual) information to support the episode...it makes me regret that most of the time I have to listen is via audio only podcast! I will definitely be checking out the video versions more often when I can!
Glad you enjoyed it! Love to have you watch more of our episodes here on RUclips
Thank you
thanks so much
Thanks for this - interesting but difficult.
Extremely informative podcast regarding cholesterol flux. It would be great for you to interview Malcolm Kendrick who is also a luminar in this field. His opinion debunks some of Tom's theories. By the way your interview was brilliant, you covered some areas of lipidology which help me fill in some of the missing pieces of the puzzle.
@@TheProofWithSimonHill Care to elaborate on why you weren't? I'm doing the best a lay person can in trying to figure thus all out but it is SO difficult as there are many "experts" and many conflicting information. I have lost nearly 100lbs, now have no hbp, no pre diabetes but have extraordinarily high cholesterol. Like 618 total, 492 ldl, 86 hdl, 86 triglyceride.
@@TheProofWithSimonHillI've read Kendrick's book also and one of only two people who've given it 2 stars on Amazon. I'm with you.
“The alternative hypothesis is that blood clots, and blood clotting, are the key players in cardiovascular disease. “ Dr Malcolm Kendrick, author of the Clot Thickens. Can you get a representative of this school of thought. It’s becoming confusing to me as a sufferer.
This hypothesis explains why such things as smoking are far more causal than cholesterol. Dr Kendrick also seems as humorous as Dr Dayspring.😊
Really interesting. Both my parents had high cholesterol and so do I despite being plant based vegan and this helped explain things. I would have thought diet would have played a greater role but seems not. Thank you so much.
I was basing this on the ‘eat your eggs if you want to ‘ comment. Good to know diet can help.
Diet does play a massive role, namely carbohydrates, sugar, not fat. I study this subject and beleive his guys way outdated views and advice are highly influential in causing the huge rise in hart events. The interviewer askes the right questions but he ducks around them. Why is this guys decades long approach not working? Because it is wrong. Doctors Cywes, Diamond, Paul Mason, Ken Berry, Anthony Chaffee, Bikman, Huberman, Sayfried, Ekburg, Shawn Baker. All these doctors and many more would strongly disagree on many of the points he makes.
Does accumulation of fat in the liver is started by high blood LDL levels? Does accumulation of fat in pancreas, kidney and visceral region in general is started by high blood LDL levels? Does accumulation of fat in muscle is started by high blood LDL levels? Does accumulation of fat in the rest of the body is started by high blood LDL levels? From the little I have learnt, the answer seems to the be: No.
What I know is that all this fat accumulation in the many organs mentioned is a consequence of metabolic syndrome. And all these are signs of metabolic problems in different tissues.
Then why accumulation of fat in arteries and heart is assumed to be started by high blood LDL levels and not by metabolic syndrome? (I understand that many many years ago the plumber hypothesis of pipe clogging made sense, but it is already 2023! And we all know this is an alive biology system!) For me, clogging from blood content makes no sense. It makes much more sense that metabolic syndrome expresses itself in the cardiovascular system as accumulation of fat in arteries and heart.
Health status of US population does not help to elucidate the root problem, as 95% of their population lives with metabolic syndrome. Then doctors correlate high LDL with cardiovascular disease, but the root of CVD is in the metabolic illness and not in the high LDL. And even worse are their solutions of using statins instead of stopping the nasty plan of the Food & Beverage Industry sickening humans (and dogs).
@@TheProofWithSimonHill thanks a lot. I really appreciate your passion and honesty.
But there are other theories (with scientific publications) out there and a lot more to say from other points of view. Please bring on to the discussion Norwitz & Feldman to have a chat about the Lipid Energy model. And Dr. Subbotin, with whom I agree about sick arteries expressing their metabolic syndrome by getting fat themselves. Dr. Volek, D'agostino & Paul Mason also have a lot to say in this topic. Healthy discussion about the topic would be much more nurturing than turning your channel into an echo-chamber.
So, the ApoB protein truly is the ‘anchor’ of the freight ship dropping-off the cholesterol containers in that analogy you used in your discussion with Dr. Flanagan. Nice one, Simon.
1:46:48 Good coverage of a complex topic. Qs: levels of LDL particle number, LDL-C, Apo-B are all normed on a primarily sugar-burning population (small % of Intermittent Fasters/High fat-adequate protein-slow carb’ers). So why should the the lab numbers be “adjusted” with “therapies” - provided there is no evidence of atherogenesis (clean carotids on Doppler, large sized LDLs, low Ca score, low CRP etc). Aren’t we then chasing numbers normed on a different population? Thank you so much for this 3 part series. Learned a lot!
1:47:00 Why do saturated fats down regulate LDL receptor but polyunsaturated fats up regulate it?
I get it modified the LDL , obviously with Statins. My question is, I personally know people, because I am old, that been on Statins for decades, lower their LDL , yet still have bypass surgeries. . Lowering LDL for decades,, didn't stop thier arteries from getting plague.
Maybe that's because sugar damages the endothelial and the repair mechanisms inadvertently cause the plaque to begin.
That is why an OGTT test is the only test to determine if you have IR, which is common once you reach 65 and older. Go find the root cause that is creating soft plaque thereby its potential danger for causing thrombosis.
Try looking through the eyes of a 2-time Nobel Prize winner Dr. Linus Pauling and Dr Thomas Levy who expanded on Pauling 's work. The real issue is arterial scurvy. I have lowered my CAC said to be not reversible from 660 to 458.
Sam is very right here!
Statins don’t reduce heart disease in primary prevention
@@darrendigiacomo6889 I agree, not only that they narrow the arteries even further all in the name of stabilization of Plaque but after the stabilization and a much narrower artery a piece of Plaque comes along and boom heart attack. I prefer Linus Paulings approach and belief that the problem is localized vitamin C deficiency which Lp-a arrives first on the scene to start the Plaque and calcium process of shoring up the arteries holes and cracks from the mechanical stress of the arteries close to the heart depleting vitamin C. The RDA of C is not enough. Standard medicines approach to calcium and plaque build-up is a backwards approach IMO as well as others such as Dr. Thomas Levy Cardiologist. How do I know because I am using Paulings and Levy's solution and my heart disease is reversing with a CAC of 458 down from 660.
Excellent! He's so entertaining to watch. One thing that I don't get: SF inhibits LDL-R through these transcription factors, as he says, because "the liver doesn't want more lipids". But, aren't LDLs made by the liver in the first place (directly or through VLDLs)? So the lipids (which ones? Triglicerides?) in these LDLs are coming from the liver itself? Are the lipids/TG secreted by the liver in VLDLs coming from dietary fats or from de novo lipogenesis? As far as I understand, fatty acids (TG) from diet would mostly be packed into chylomicrons and be directly absorbed by others cells (eg muscle), am I right? So overall I don't see how SF from the diet would end up in the liver inhibiting LDL-R, whose function is to capture LDLs that served their purpose (according to Dr. Dayspring) of "bringing back cholesterol to the liver". Of course it's impossible to summarize lipid metabolism in a 2h podcast, but I'm confused and it's hard see how all these pieces fit.
Thanks for a great podcast!
As a Clinician//Scientist, I’m still parsing through some of this stuff. With all the treatments that we have for high cholesterol and LDL, why is cardiovascular disease still the leading cause of death? I think we’re being too myopic with LDL and ApOB. I’m not saying they don’t play a role. However, something else is going on is it hyper insulinemia chronically high blood sugars what else is the issue? There’s a brilliant study out of Sweden that shows the higher your LDL as you age the longer you live? Look, I don’t have the answers however, I’m convinced it’s more than ApOB and LDL. And I’m not so sure a high HDL means you’re healthier so I do agree with that. I think that’s just a marker for good metabolic health
Ever heard of Malcomb Kendrick? ruclips.net/video/wRjQCG4NU-Y/видео.html
Check dr Gregory Sloop on Research Gate for a better explanation on heart attacks, stroke, diabetic retinopathy, thrombosis, etc…
Very informative video, thanks!
I had elevated cholesterol levels but changed my diet towards a more plant-based diet or pescatarian-diet avoiding saturated fats from meat and dairy products.
I decreased my cholesterol levels just within the reference intervals.
But my HDL-levels was very low, 0,5 mmol/ L = 30 mg/dl, so I tried the LCHF-diet. My cholesterol skyrocketed, but my HDL.
After this I wanted to lower my cholesterol levels to the same levels as before with the Pescatarian-diet. But now I can't reach the same low levels.
It that because of the fewer LDL-receptors caused by the LCHF-diet?
And if so, how long does it take for the liver to start producing these LDL-receptors?
Simon and viewers!
Help & Thank you!
I’ve taken the rabbit hole dive spurred from a Cardiac scan putting me in the worst part of 98th percentile for someone my age ( female age 52!). Calcium score 102. Prior to this- I was a model wellness patient. Non smoker, former collegiate division 1 volleyball athlete, masters Cat 3 cyclist, triathlete before it was cool, spin instructor, body fat 10% in college - 25% post menopausal. Masters in Speech Patholigy, happily married and mom of two amazing humans. Only child but family hx of cardiac disease ( paternal grandpa and uncle).
I historically had slightly elevated LDL’s ranging up to 129 and HDL’s and triglycerides and total cholesterol “normal” for the 5 years prior. No worries? Right?
I had been loving Keto for 1.5 years. I was the leanest and felt amazing but I feared I had inherited atherosclerosis- so out went the saturated fat. I was terrified I was gonna have an infarct in the next 5-10 years!
The journey with my regular doc was a ride! I ended up the past 2 years avoiding saturated fats (meat and dairy including eggs.) Adding fish as often as I could - 1-2 x week. I love food and vegetables and beans. Life is fine and I don’t “want” for anything.
Lost maybe 7-8 lbs and finally went on statin 10 mg. Daily. Oh- went through menopause over Covid! Added .1 mg twice weekly estradiol patch and progesterone (PO) 100 mg. I started sleeping! Anxiety gonzo ( never was an anxious person) and hot flashes gone! Stress down.
This life, diet, medicinal and adaptogen combo dropped my LDL to 71. Total 126. Triglycerides and HDL normal.
My doc wanted to take me off statins. I’m scared to go off! Gulp!
I’m starting with a cardiologist in May. I want to rule out serious heart damage and discuss moving forward with statins. I don’t have any heart related symptoms. I’m learning by firehose through Simon’s videos. I’m arming myself with info so that when I see the cardiologist- I sound informed and knowledgeable.
Anyone have suggested videos I watch to prep and learn?!
Small morsels I’ve gathered is to stop fish oil supplementation, Canola oil is ok?!, deeper lab metrics requests ( I think?) APO a/b ? than traditional LDL/HDL , Total and Triglycerides.
Here’s videos I’ve watched and found informative for my situation:
Dr. Stacy Sims
Dr. Susan Davis
Dr. M Alo
Pub med alerts for statin research
Read The Menopause Manefesto
Informed reading and suggestions so welcomed! Thx big brained community.
I'm in a similar boat to yours. Lifelong non-smoker, BMI of 21-22 for 40 years, BP 120/75, low Lp(a), low hsCRP (inflammation marker) for last 20 years at least, never a symptom, no family history of early events, and have done aerobic exercise for decades. Double bowl of oatmeal with protein powder and walnuts for breakfast almost every day for the last 30 years and salmon for dinner when other people are eating beef and pork. Twisted my doctor's arm to get a CAC scan at age 65 and found out I was in the severe (Agatston score greater than 400) range . I spend a ton of time researching CVD risk now and reduced LDL-cholesterol from 105-125 to 45 with a statin and ezetimibe. From all I've learned, monitoring your Apo B (a more accurate risk marker than LDL cholesterol)and paying attention to whether you have symptoms are the best ways of monitoring your cardiovascular health with respect to atherosclerosis presently short of invasive imaging. A couple of the best RUclips channels I'd recommend are Nutrition Made Simple and Dr. Peter Attia's. However now that I have found Simon's RUclips channel, it's definitely on the list of great resources also!
By the way, endurance athletes are at much higher risk of arrhythmias than other people so you might want to discuss that risk with your cardiologist when you meet with him.
Loved this podcast! So important. Please,I hope you will ask about dietary saturated fat. I've eaten a vegan diet for years and was shocked to find out my TC was rising and my ApoB was slightly above optimal. I've had zero dietary cholesterol for over 10 years BUT plenty of vegan foods that have coconut and palm oil. Currently trying to turn this around with a WFPB diet.
Perhaps the plants were the issue. Cut it out or reduce it aggressively and I can almost guarantee you that all your health markers will improve. Just be sure to eat lots of fatty meat.
I also wondered why saturated fat was not discussed- but on a second viewing I heard him say at about 1:47:00, in response to Ketogenic promoters, that high (saturated) fat is detrimental because it shuts down the liver's LDL receptors needed to capture and then metabolize LDL-c
Yep, WFPB for the win! Not only are you avoiding sat fat/cholesteroI, but the detrimental animal protein itself, plus Arachidonic acid, Endotoxins, Carnitine - > TMAO, Neu5GC, Heme Iron, PAH'S/HCA's, Hormones, Antibiotics, etc.
This is the first time I have heard this doctor. I have been following Dr Robert Lustig, Dr Ali, Dr M Kendrick, Dr Paul Mason and others who say cholesterol is not the culprit of atherosclerosis but sugar is
I am confused now.
Both are bad.
They all are experts but they all have opposite ideas what’s ideal go figure
Simple and/or excess Carbs , sugar, seed oils. Avoid those. Done. You're good.
And lose weight/visceral fat with diet/lifestyle, exercise, build some muscles, rest. No stress.
Should get Ron Krauss on as a guest. Though he is essentially in agreement with Dayspring, his take is a lot more nuanced, especially where it comes to the role of particle size in determining cvd risk.
Such a fascinating topic and great explanation of it. The only thing that I don't think I quite understand is the claim that dietary cholesterol has little or no effect on cholesterol levels except for hyperabsorbers. It seems like there is such a strong correlation between people with high dietary cholesterol intake and blood cholesterol and inversely people who, like Simon, do not consume cholesterol in their diets and much lower levels. It's hard to believe this is all genetic and not influenced by diet.
Beautiful man
Thanks you both, amazing style of interview bring the excitement of the Dr. about the subject. I sure love to own/read the books with chapter of Dr. TD, in it please mention names of the books or where to find the chapters otherwise.
@theproof was there a summary done of key points ? I seem to remember you mentioning it .🙏🙏
I will have to come back to this probably several times to fully understand the pathways. Till now I was thinking its less of a macronutrient consumption that matters but rather importance of staying in nutritional balance. Overeating on simple carbs rather than fats may do more damage to system. Although if overeating on either saturated fat or sugar weightgain would be expected as outcome - becoming a risk factor for various diseases, excess simple carbs I believe, would create more damage in a process (through cells becoming insulin resistant over time). Conversely, if all macronutrients are metabolised well (nutritional balance is preserved through active lifestyle) no damage is created by neither sugar or fat.
Best treatment for atherosclerosis: Vitamin C
Why do only coronary arteries clog with cholesterol and not veins or small capillaries?
Scurvy = No vitamin C in your diet.
Symptom: Your blood vessels break and you bleed to death. Think of the sailor of the past.
Scurvy of the heart = Just enough vitamin C from food.
Symptom: Arteries around the heart are not strong enough to resist high blood pressure. Damage is repaired with cholesterol LP(a) to prevent worse. After years of repair, your arteries become clogged.
Enough vitamin C supplement of at least 3000 mg. per day gives strong and flexible arteries. Cholesterol is not needed as a repair agent. Cholesterol in your coronary arteries is broken down and burned in your liver.
Source RUclips:
- Cardiovascular disease and vitamin C (Dr. Rath Foundation)
- Ending the Cardiovascular Epidemic by Natural Means - Dr. Matthias Rath
I probably missed it, but I have a question. What determines how many LDL and VLDL particles the liver produces?
Simon briefly asked about the lean mass hyperresponders. I’m not a lean mass but I am a hyper responder with a close to normal weight after loosing 20 lbs. I have cut out, or drastically reduced, breads, pastas, pastries, candy and processed foods from my diet only to see my LDL-C increase drastically from normal. All other risk factors are normal. This is an interesting topic.
Your LDL likely increased because you replaced the things you used to eat with meat and eggs instead of whole grains, legumes, fruits and vegetables, nuts and low fat dairy. This is in line with what you'd expect.
Wouldn’t the treament be the same for either elevated LDL or APOb?
Fascinating conversation. Thanks! I was wondering if Nitric Oxide play a part in being protective of the endothelial cells?
Why don't people answer?
100% it does. It's a vaso dilator and immensely important. Insulin resistance in the endothelial cell will down regulate it's ability to produce it
The issue is not with dietary cholesterol, but with saturated fat, which really can affect the LdL levels, as far as I understand it.
Excellent quality conservation and topic expertly explained but there are an unusually high number of adverts interrupting too frequently? So many that it’s annoying… there’s a point where it causes switch off…
I just has a lipid panel and first time checking of lip a and Apo B100 scores were 253.4 and 141 respectively I am now going to be put on the mRNA version of PCSK 9 injection twice a year
Great episode! I've been on the fence with regards to taking a statin. The only time my cholesterol numbers ever came into alignment was back in 2019 when I was living in Florida and I had just the prior year had gotten into running. In 2019 I ran over 1,600 miles. I had my cholesterol levels checked many times that year and my levels have dropped by about 40% . I have since moved to Maine in 2020 and my numbers climb back up again. So the only difference is that I haven't been doing any running and of course without all that outside running I'm not in as much sun. So I'm wondering how the Sun may play into cholesterol levels and also wondering how cardio and body fat levels may play into the cholesterol picture. Something lowered my cholesterol significantly and I'm thinking it may be all that cardio that I did or that I was a few pounds lighter? Or being out in the sun so much? Or a combination of everything?
Check out dr Stephanie Seneff on RUclips, could be the sun exposure is processing the body to produce cholesterol sulfate, resulting in cholesterol results.
does niacin lower apob??
Very intresting talk, but what I want to know, is the health of the ldl particles and the sise of them matter ? and that about lean hyper responders with extremely hi level of ldl and hdl, but low triglycerides, being healthy with 0 plack
Can you post few of the studies linking Apo B or saturated fat or LDL -C to atherosclerosis in metabolic healthy people?
What is the normal range for ApoB in grams per litre?
Did Dr. Dayspring really suggest there aren't any LMHRs because they're not really lean? 🤔
He suggested that the status of LMHR was irrelevant to cardiovascular risk. You still have residual risk as a LMHR if you have elevated ApoB. Full stop.
1:00:31 I think the unit of measurement here should be nmol/L instead of mg/dL
Thanks Simon, great knowledge shared here and fan of the pod. What is your experience in getting tested for apob in Australia through general practitioners? I find I have to convince them just to get a standard lipid screen. I'm 42 and have family history of heart issues.
After listening to this series I was a bit disheartened to hear about diet and lifestyle not having much of an affect on lowering apob. Is that right?
Loving the level of detail here, I was surprised to hear him say in general the level of dietary cholesterol has little to do with systemic level of apoB and cardiac outcomes (except for genetics), therefore would the main benefit of lowering dietary cholesterol be that in eliminating those foods you are usually also eliminating saturated fat which is the real issue (at least in terms of dietary input)? Can’t wait for the next one, thanks Simon
It’s a hyperbolic curve. If your ApoB is already low and you consume zero cholesterol and then add a few eggs to your diet you will see a significant increase in blood ApoB. They should have clarified this. Nutrition Made Simple has a video about this.
That makes sense, thanks
@@reason3581 Yes, I was surprised this was not mentioned. It must be an advantage to not have this rise happen?
Yeah, cholesterol aside, eggs are 28% saturated fat...well above the 8-10% recommended range.
@@megavegan5791 Yes, most people probably don't limit the rest of their daily saturated fat intake enough to make room for eggs.
This was an extremely interesting discussion all around, especially of how Apolipoprotein B-100 functions. It seems that the evidence for the harm of ApoB comes from epidemiological studies and the reference range is set by association. Further, this data has been gathered from populations that eat tremendous amounts of sugar and processed foods.
Even if we grant the idea of phospholipids being deranged and changing from phosphatidylcholine to some other type of phospholipid, and then aggregating, and that's really the nexus of the problem, what causes this damage to the phospholipids?
What I want to know is the primary cause so I can eliminate that. Otherwise....?
What was disappointing is that there was no discussion of the role of the glycocalyx in the etiology of aggregating LDLs, if any.
Do omega-3 supplements raise LDL, regardless of the source (fish/algae)?
A track playing in the background in your Intro ❤ What's it?