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29: Dr. Thomas Dayspring | Cholesterol Testing: What Matters Most?

AIR DATE: October 4, 2012 at 7PM ET
FEATURED EXPERT: Dr. Thomas Dayspring
FEATURED TOPIC: “Cholesterol Testing: What Matters Most?”

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This week 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 him in Episode 585 of “The Livin’ La Vida Low-Carb Show” podcast and afterwards 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 clarification on any issues regarding cholesterol testing that concern you.

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Here are some of the questions we addressed in this podcast:

COLLEEN ASKS:
In an ideal world, should everyone know what their LDL-P number is? What is the ideal number or target range for LDL-P? How important is LDL-P as a biomarker for risk of heart disease? Other than diet, what would be common causes of high LDL-P?

TRISTA ASKS:
If someone has high cholesterol (mine is 307 total, 48 HDL, 239 LDL, and 95 triglycerides with mostly Pattern A LDL cholesterol), is that a reason to stop eating a low-carb diet? And who would you say needs to be taking a statin drug as an appropriate treatment option for lowering cholesterol numbers?

UROLOGIST FROM BRAZIL NAMED J.C. ASKS:
We know that statins raise insulin resistance and can interfere with blood glucose control in Type 2 diabetics. I have a patient who has already had two heart attacks and seen great improvements in his health since adopting a low-carb diet. Would you consider taking him off simvastatin if his Apo-B remains low after stopping the medication? And for those of us who live outside the United States, how good is an Apo-B test as compared with the NMR Lipoprofile? What is the desirable value for Apo-B?

ANDREI ASKS:
Do other favorable test readings, such as large fluffy LDL particles, high HDL, low triglycerides or low CRP levels, singularly or in combination, reduce the risk of heart attack posed by a very large LDL-P number?

DANNY ASKS:
You mentioned in your previous interview with Jimmy that sterols, not just cholesterol, have the potential to incorporate into arterial plaque. I did some research and found a study where arterial plaque was scraped and analyzed and a direct relationship was established between the amount of plants in the diet and the amount of plant based sterols that end up in the arterial wall. What is the mechanism behind plant sterols becoming plaque? Does the addition of plant sterols in the diet make our lab results, especially the calculated LDL tests, look good for no real benefit? And if this is true, why does cholesterol get a bad rap and these sterols enjoy the halo of healthiness?

ORLEATHA ASKS:
Recently, Paleo diet practitioner Chris Kresser wrote in a blog post that “the number of LDL particles in the blood…is a risk factor for heart disease.” After getting an NMR Lipoprofile test run, what number should be cause for concern?

BRIAN ASKS:
How do cholesterol numbers get calculated? We see LDL, HDL, triglycerides and total cholesterol. And why isn’t the NMR Lipoprofile test the standardized cholesterol measurement in the medical profession yet?

SHARI ASKS:
Is it possible for someone to have too low cholesterol? My total cholesterol has never been more than 95 testing over the past 15 years. Some people in the Paleo community have said I should be very concerned but my general practitioner thinks my very low cholesterol is great. What do you say?

FORTUNE ASKS:
What should APOE 3/4 or even 4/4 people look for in their lipid tests given that they will probably not be “normal?” And what should APOE 3/4 or 4/4 do to reduce their risk?

IKE ASKS:
My question is in regards to the test that is performed by Health Diagnostics Laboratory Inc called the Apolipoprotein E Genotype. What are the implications on the lipids of a high-fat, low-carb dieter with the 2/4 genotype combination? I believe that this occurs in 1-2% of the population. Would these people need to eat less saturated fat?

WILLIAM ASKS:
You have said in more than one interview I have heard that you believe it really boils down to the LDL particle number and that particle size is not as important. With that in mind I would think the Lp(a) test would be all you would need to run to obtain that information. So, what is the BEST, most cost effective lab test to have done if you could do only one test to give you the most information about heart disease risk?

ANN ASKS:
Does what I eat in the few days prior to my lab draw make a difference in my Apo B and small LDL-P…especially if I overindulge in carbs the day before the draw? If a lab report gives both Apo B and LDL-P and one is high and one is normal which one do you go with?

ALLYSON ASKS:
Why do you see HDL decrease with autoimmune diseases such as lupus? Is it associated or causal? Does the HDL decrease in response to the disease? Why do you suspect hyper absorption when you see high HDL-C?

KAY ASKS:
I have been eating low-carb Paleo since January and have lost 45 pounds. I just went to the doctor for the first time since 2007 and he ran blood work. My total cholesterol went up to 334, mostly LDL, and the doctor is alarmed. In order to prevent my doctor from ordering me to take statins, I told him that I had read that losing more than 30 pounds within a few months can temporarily elevate total cholesterol, and that I would have another blood test done in 3-6 months. Is it true that my weight loss may be the reason for the jump in total cholesterol and LDL?

ED ASKS:
I had the NMR test and it reveals an elevated (high risk) LDL-P count of 1573 but also a calculated, intermediate risk of Apo-B of 62. I recently noticed that these results were from a non-fasting test. Is it possible that the LDL-P and APO-B (both particle counts) are affected by the fact the the test was done in a non-fasted state? Would you recommend this test only be done in only a fasted state?

RICHARD ASKS:
It has been stated by Chris Masterjohn that within the same individual, cholesterol readings can vary from day to day. In fact, it was reported that total cholesterol has a standard deviation of +/- 17.5 points meaning that a reading of 200 for example, could easily vary between 165 and 235 over a two-day period. So if this is accurate, how meaningful are the various cholesterol readings particularly since most MDs only get one test and make their decisions based on that singular piece of data?

  • Riolis

    Great podcast! Do bring back Dr Dayspring for a second round :D

  • Jay

    I thought LDL particle size( big fluffy) was good to have, but Dr. Daying stated that wasn’t the case. I’m kind of confused, but great information by Dr. Dayspring.

    • LLVLCBlog

      There’s still debate about whether LDL-P or LDL particle size is most important. The question has not been fully addressed yet. Dr. D believes it’s all about the LDL-P.

      • Susie

        Jimmy, we really need you to publish that cholesterol book you are working on! This episode was interesting but was also troublesome for me. I have had both an NMR and a VAP test (Still trying to figure out the VAP, not as clear as the NMR) and both show enviable HDL and Trigs — but my total C is now over 300 and LDL-P is terrible. I am not overweight at all or insulin resistant. By Dr. Davis’ measure, all is good as I have large particles, but by Dr. Dayspring’s measure, I am in big trouble. And of course my conventional doctor thinks a statin drug and low/no fat diet is a must. I think Chris Kresser mentioned high LDL could indicate a thyroid problem but all is normal for me on those levels. I honestly don’t know where to turn on this one. Any thoughts on resources?

        • LLVLCBlog

          I’m working on it Susie. Coming Fall 2013. In the meantime, what I’m learning is LDL-C that is “high” isn’t a big deal in the absence of any measurable disease state. A heart scan will help with this (despite Dr. D’s objections), but I would never personally take a statin drug again without some kind of compelling argument in favor of doing it. Haven’t heard one that’s convinced me yet. Thyroid may be an issue, but maybe not. Read Dr. Peter Attia’s stuff on “The Straight Dope On Cholesterol.”

  • Glenjammin

    I would have to disagree with the Dr. on the point of low cholesterol. He said that everyone would want to have a TC of 95, uh, not me. There are a number of studies suggesting all cause mortality is higher in people with low cholesterol. Cancer, depression and suicide have correlated with low cholesterol. He says people with FH can die young from heart disease which is true, but he fails to mention that people with FH have been shown to be more protected from infectious disease so low cholesterol may have the opposite effect. Hasn’t he heard of SLOS??? I get the feeling he might think they have the best cholesterol numbers of all. They may have “minor” issues like autism and mental retardation, but hey their cholesterol numbers are close to 0 so they must be immune to heart disease. He had alot of great info, but I can’t believe he thinks you can’t have a cholesterol number too low.