Share:

In Part 2 of this two-part episode, Faraz Khan and Dr. Tom Dayspring, How to Lower Your Risk of Heart Disease Using Diet, Lifestyle, and Medicines.

If you haven’t listened to Part 1, make sure you go back and listen to it to get all the basics out of the way.

Dr. Tom Dayspring is a world-renowned expert on lipids (which includes LDL, HDL, LDL particle number, LDL particle sizes, ApoB) and more. Since heart disease is the #1 killer of Americans worldwide, it is important for you to learn this information.

What to do when cholesterol and ApoB numbers do not match

• If you have normal cholesterol and high ApoB, or high cholesterol and normal ApoB – then these numbers are inconsistent.
• When particle counts (ApoB, LDL-P) agree with cholesterol measurements (LDL-C, not HDL-C), they are said to be concordant
• In the event that they disagree, particle numbers are more accurate
• So always trust ApoB or LDL-P

How is cholesterol transported in LDL particles?

• Large LDL particles have more cholesterol on them
• Small or dense LDL particles have less fat and cholesterol on them
• LDL particles usually carry 80% cholesterol and 20% triglycerides
• If there are too many triglycerides in an LDL particle, these particles are depleted of cholesterol
• When LDL particles are depleted of cholesterol, you need far more of them to carry the cholesterol
• When triglycerides rise, you get a mismatch between LDL-C and ApoB
• The LDL particle number is number 1 that drives cholesterol into the artery wall

Does the size of LDL particles matter?

• Some experts believe that having smaller LDL particles is more dangerous because smaller particles penetrate artery walls more easily
• But people with small LDLs are usually dealing with insulin resistance and a whole host of risk factors in their blood
• Small LDLs linked to diabetes and hypertension
• Most people who have large LDLs do not have insulin resistance
• The primary factor in heart disease is not the size but the number of LDL cholesterol particles
• Could small LDL be more inflammatory?
• It is best to evaluate lipid numbers taking into account all measurements and the patient’s lifestyle

Are your LDL numbers genetic?

• It’s true – there is a genetic component to LDL
• Genetics determine what proteins you make. These proteins can be lipoproteins.
• But lifestyle also plays a role.
• Toxins, heavy metals and the gut microbiome also play a role in LDL numbers

How your diet changes cholesterol in your body

• Cholesterol in your diet may be used by the apoproteins in your body
• The vast majority of cholesterol is made by your own cells
• 80% of absorbable free cholesterol came from the liver and bile – and not from the food you eat
• Most cholesterol from meat is inactive form – it is bound, not free cholesterol
• This cholesterol cannot be absorbed unless your pancreas secretes a de-esterifying enzyme
• The only people who need to worry about eating too much cholesterol are those who have high genetic hyperabsorption
• Fat is handled differently than cholesterol
• Fatty acids associated with various problems (especially saturated fat, see below)

Why do so many people have high cholesterol?

• Every cell in your body needs fats to make cholesterol
• Saturated fat is worse than other types of fat for overproduction of cholesterol
• If your cholesterol becomes too high in the cell, your cell transports it outside the cell into the HDL particles in the serum
• This causes the HDLs to become larger
• First – large HDL deposits cholesterol to the gonads and adrenal cortex
• Second – HDL can also deposit cholesterol into fat cells
• Third – HDL can deposit the cholesterol to the intestine to be excreted
• HDL can also take cholesterol back to the liver – this is called direct reverse cholesterol transport
• HDL can bump into LDL – and transfer cholesterol to LDL to be transferred back to the liver

So what really causes atherosclerosis

• LDLs can attack and penetrate the walls of blood vessels even without inflammation
• LDL passes through the endothelium
• Although oxidative forces are bad, it is not the primary way
• Enough LDLs bind and mess up, the white blood cells attack them
• This mechanism causes cytokine and growth factors to be released by white blood cells
• Anyone with an autoimmune disease has a high incidence of atherosclerosis
• Inflammation is not necessary for atherosclerosis, but can make it worse
• Bottom line of the story: Keep ApoB low, LDL particle low, and inflammation low too

How to lower the risk of heart disease with the help of drugs?

• It is important to upregulate the clearance of ApoB, the LDL receptors
• The pharmaceutical drugs are ezetimibe, PCS K9 inhibitors and bempedoic acid
• Induce LDL receptor upregulation of the liver
• The extra LDLs will grab the extra ApoB particles, internalize them or excrete them in the gut
• Some of the above drugs cause the liver to produce more LDL receptors
• The second strategy is to make the LDL receptors last longer
• All the substances above do not affect ApoB production very much
• Reducing triglycerides can be helpful, especially in insulin-resistant people

How to lower the risk of heart disease using diet?

• Low carb diet is helpful for insulin resistance
• The low-carbohydrate Mediterranean diet may be helpful
• When you change your diet, retest markers in 2-3 months to see if the diet has changed anything
• A blood test measures whether you are a hypersynthesizer or hyperabsorber of cholesterol
• If you are a hyperabsorber – then not much can be done from a dietary perspective
• For overabsorbers – Ezetimide would be the drug of choice
• If you are a hypersynthesizer, reduce saturated fat in your diet
• For hypersynthesizer – statins and bempedoic acid work well
• Try reducing saturated fat and test again after 2 months

Where to find Dr. Tom Dayspring