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Nutrition Past and Future

17 Thomas Dayspring, Lipidologist Lost


This is Thomas Dayspring. As you can see, he has quite a collection of letters after his name. Dayspring is an expert in cardiovascular physiology and he is the author of a chapter in a textbook of mine. I am sorry to have to make a video that is critical of him but he has decided to lend his reputation in support the reckless and deceptive Gary Taubes.

The purpose of the Primitive Nutrition project is to neutralize the tidal wave of nutritional misinformation endangering the public now. Dr Dayspring has decided to enter the diet debate and he has chosen the wrong side. He must know that his recent statements are controversial so he can’t complain that he has drawn a response from me.

Let’s start with comments made by Dr Dayspring for which I commend him. Here he is alongside Taubes talking about HDL. If you look at the books that low-carb hero Robert Atkins wrote, you will see that he claimed that an important benefit of the high-fat approach was its tendency to raise HDL. This is one of the most common arguments in favor of low carb. Low carb dieters mistakenly believe that they don’t need to concern themselves with their high total and LDL cholesterol scores because they think HDL is protecting them. Let’s listen to what Dr Dayspring has to say about HDL, here in reference to alcohol.

DAYSPRING: Well, first of all, raising HDL cholesterol has never been a proven methodology to reduce heart disease, and certainly that method of raising HDL cholesterol is silly. Yet doctors, frustrated when they see low HDL cholesterol often cuz they don’t really know what it means think they have to raise it, even though it’s not a specific goal of therapy in the NCEP guidelines. They’ve often turn their patients on to way more alcohol than they should use. And it’s very interesting, epidemiologic data from Russia, where as HDL cholesterol goes high-high-high, mortality goes up. And how do, why do a lot of Russian men have such high HDL cholesterol? It’s the vodka.

I am no defender of alcohol but it must be said that Russian men tend to engage in less healthy drinking behaviors. What they drink and the way they drink it matters a lot but I digress.

Dayspring is right about HDL. This paper was a huge review of the research on this and its authors came up empty in their efforts to find any benefit to HDL raising. Instead, they concurred with current recommendations to focus on LDL.

Genetic research and drug trials all indicate that at this time, HDL does not appear to be as protective as was once believed. This study made big news in May. Genetic mutations associated with high HDL cholesterol were not found to affect the likelihood of heart attack in those who carry them. Dayspring is smart not to make much of HDL.

Yes, higher HDL is generally better than low HDL in populations with high LDL because it can compensate for the excess LDL that winds up as foam cells in the artery wall.

HDL can draw the offending cholesterol out of foam cells and clear it through reverse cholesterol transport. When HDL does this well, there is less disease and less risk of death. However, your HDL particles work as a clean-up crew. It’s better not to make the mess in the first place. As of now there are no known ways to improve outcomes by targeting HDL. Simply raising HDL levels does nothing to improve the action of HDL in clearing out cholesterol from foam cells. This was the finding of this very important study.

Dayspring has also written that all lipoproteins with an apoB particle are atherogenic. This is also somewhat refreshing as low carbers often believe they have a special pattern of LDL sizes that protects them from heart disease. I’ll talk more about this in my Large and Fluffy video. For those of you who do not know, lipids, or fats, in the blood must be transported through the circulatory system inside of protein structures called lipoproteins. The lipoprotein that is best known is LDL, which is short for low density lipoprotein. When you hear the words “bad cholesterol,” what is being talked about is LDL. Every LDL has one apoB molecule and that is what he is writing about here. apoB particles are also found on other atherogenic lipoproteins. Dayspring favors LDL-particle number as a way of measuring cardiovascular risk. That is fine by me.

Apo B does have the advantage of being directly measured in clinical practice, unlike LDL, and it remains stable regardless of  when someone has eaten. It is also probably a better measure than LDL for the obese and the insulin resistant. My criticism of Dr. Dayspring is that he seems to believe in a hypotheses that might be stated like this: metabolic syndrome and heart disease are just different sides of exactly the same problem, and that problem goes away if someone can make a select few novel biomarkers look better, and the way to do that is to eat a low-carb diet. I disagree with all this and I’ll tell you why, but I am still trying to telling you the things I like about Dayspring.

Dayspring’s understanding of ApoB is the reason he says that both large and small LDLs are atherogenic. He is very clear about this in his writings and I appreciate that a lot. LDLs enter the artery wall easily if there are too many of them, he says. This is really good. Low carbers, this is good information for you.

Viewers of my videos know that I emphasize LDL cholesterol, or LDL-C, as the lipid score we should be most focused upon. For purposes of nutrition and not clinical cardiology, as well as for practical purposes, I think this is the right place for our attention, but I don’t consider preferences for LDL-P or LDL-C to be in opposition. An important consideration not lost on this high-profile expert committee in Canada is the well-established pedigree of LDL cholesterol, and that is part of the reason they said that LDL-C should be the primary target of therapy. LDL-P has not been around in clinical practice for nearly as long, and it’s perceived importance today is mainly a result of our increasingly obese and insulin resistant condition. LDL-P may be more useful for a doctor when dealing with the sort of patients they see today.

Because Dayspring is so focused on particle numbers and fatty liver, I thought I would provide him with some thought-provoking research.

Here a low-carb, high-fat diet was compared to a high-carb diet. The high-carb diet did at least as well, if not better, than the high-fat diet, particularly in regard to ApoB. If he is really interested in the subject of ApoB, perhaps he should give healthy high-carb diets some consideration. Bear in mind both of these diets in this study were designed to cause weight loss.

Here are a couple tables from a prospective, randomized trial of a low-fat diet, here called AHA, and a high-fiber diet with the same amount of fat. You can see that in relation to the control group and the diet eating the American Heart Association way, the high-carb, high-fiber group had the greatest reduction in apoB-100 even though they had the least reduction in calories. High fiber and whole food wins for apoB just like practically everything else, it seems.

In this comparison of Chinese omnivores and vegetarians, the vegetarians had better scores across a slew of risk factors, including apoB.

This trial measured the effects of soy in older women. Soy nuts considerably lowered their ApoB-100 numbers.

Looking at fatty liver now, this study using non-diabetic obese women eating isocaloric diets demonstrated that whereas a low-fat diet dramatically decreased liver fat, a high-fat diet even more dramatically increased it. The high-fat diet also drove up insulin in these women. It is very important to understand that these diets had the same calorie content, unlike what you will see in the typical low-carb trials. This study took place on an even playing field.

There are the visuals for both liver fat and insulin. Low fat was very clearly superior.

When you see a study showing carbs having an adverse impact on liver fat, you are almost certainly looking at a study using junk carbs and insulin-resistant subjects. You are seeing the effects of junk food in the bodies of people who are metabolically damaged. I have much more on this in the later videos.

With this background out of the way, it is time for me to air my complaints about Dr Dayspring.

At this point you have seen that Dayspring has written that all apoB particles are atherogenic. You have seen that he says LDLs can easily enter the artery wall. You know that cholesterol is transported in the blood by LDLs. Now listen to Dayspring.

DAYSPRING: And if you read Gary’s books, it’s kind of amazing that they just kept doing study after study and they thought … And the studies were not supporting their hypothesis that cholesterol in the blood has anything to do with this but somehow their conclusions still stayed in there, so ...

How wild is that? Dayspring has completely and uncritically adopted the warped view of history I have just corrected for you in my previous videos, and he is now so enthralled with Taubes that he will actually suggest that cholesterol in the blood may not have anything to do with cholesterol in the artery wall. This is funny to him. He is a doctor and a specialist in lipidology.

Listen further as he once again pays tribute to Taubes and his demonstrably inaccurate and distorted book.

DAYSPRING: That is why I wrote that kind review of Gary’s book, because I’ve known a lot of the lipoprotein stuff for years but nobody has ever put nutrition (and) lipoproteins and this whole metabolic mess together (as) scientifically as Gary has, and I owe him great credit for that.

With all of his training and letters after his name, Dayspring is saying that he has come to understand his own professed area of expertise through that miserable book. Consider for a moment what has almost certainly happened here. Dayspring is an internist. He is not a historian of science. No doubt, in medical school he was strained near the breaking point learning human physiology and the pharmacopeia and everything else dumped on a medical student. He probably did a residency that was equally brutal. Then he went off to practice and worked long hours. This is just my conjecture but I think this is the usual story for doctors. Doctors try to stay up on the latest studies. Researchers naturally value their own research highly and pay attention to the research of their colleagues. They are all focused on studies of the sort of patients they are seeing. Here is my question: At what point do these doctors go back and look at the old research? How do they come to understand how we got where we are? I don’t think they ever delve into this, and I think there is nothing like this video project to bring this information into the light of day. Gary Taubes took the time to look at the old research. Unfortunately, he did so with a high degree of bias and with very low standards of accuracy and fairness as a journalist. He offers a perspective doctors don’t often encounter. This must be seductive to those doctors who deep down really like meat and fat. This is the only way I can understand what has happened to Dayspring.

With all the research I have shown you about the clear harm caused by saturated fat, listen to Dayspring’s attitude about it in this clip.

DAYSPRING: Well, the lipidologist says looking at … Oh, my God, is that saturated fat in your hands? And I know people who spend hours in the supermarket reading every label and they will not buy it if it says saturated fat on there. But I got some bad news for them. If they really could eat zero saturated fat in their diet, whatever they are eating, their biochemical machine called the human body is going to change a lot of it into saturated fat … And certain saturated fats raise cholesterol! And that’s … we’re right back to what we’ve been discussing all afternoon.

Now think about this. The research condemning saturated fat was done on the saturated fat you put in your mouth, not the saturated fatty acids your body makes. The fact that he can’t draw this distinction should tell you how much difficulty he has thinking logically about food. Moreover, the situation he is thinking of that causes the synthesis of saturated fat in your body mostly happens under unusual conditions. This is not the normal way a healthy body eating a healthy diet works. I’ll tell you more about that in my Evolved Fuel System videos. Then you see him say with a mocking tone that saturated fat raises your cholesterol. This is a lipidologist talking. This is a man who swore to first, do no harm to his patients.

Dayspring demonstrates a fundamental misunderstanding of the nature of heart disease. This following is an amazing example of a medical professional being so caught up in biomarkers that he forgets the basic nature of the disease for which we use those biomarkers. Listen to this.

DAYSPRING: The most famous person that’s helped a guy like me teach this disease is the late Tim Russert of NBC fame. Who’s (death happened?) with an LDL cholesterol of 66 which would be considered spectacular. But why is he dead? I guarantee ya, they autopsied him, his artery walls were full of cholesterol.

Why is he dead? Let’s hear from Tim Russert’s personal physician soon after his passing.

DR. MICHAEL NEWMAN: Tim had coronary artery disease. He had no symptoms, asymptomatic coronary artery disease as we see in many men and women. His risk factors were well managed. He was well informed. He did his best with respect to diet, exercise, lifestyle. His blood pressure was well controlled. His cholesterol fractions were optimal.

Understand what the doctor is saying. He is saying that first Russert had heart disease, then he got his risk factors under control and did his best with respect to diet. Tim Russert was not a vegan, Dr Dayspring. When the doctor says his risk factors were well managed, he is talking about drug therapy. How else do you think he could have gotten his LDL down to 68? Why do you think he was being treated so aggressively? Tim Russert, unfortunately, almost certainly had longstanding lifestyle habits which made him vulnerable to a tragedy like this. There is no mystery here.

Here is the same information in print. He was under treatment to get that LDL low. The horse had already left the barn, Dr Dayspring.

Here is Dayspring saying more outlandish and uninformed nonsense, this time about dietary fat.

DAYSPRING: Every first-year medical student knows fat has nine calories per gram whereas carbohydrates only have four calories per gram, so it’s obvious the way to stop eating calories and get skinny is to stop eating fat. They’re so calorie dense. But Gary points out, and I’m not sure even the highest people understand this: Different molecules with their calories are handled incredibly different by the human physiology. And there are hormones and a lot of substances in the body, enzymes that are involved with extracting energy from a given molecule or so. So even though fat may have nine calories per gram (and) carbs four, they are metabolized and handled very different ...

He is right, they are not handled the same way, but he clearly doesn’t understand what that means. This is going to get really basic now. It’s embarrassing that I should have to spell this out for him. But first, let’s acknowledge the elephant in the room. Dayspring is talking about diet and getting skinny. This is a video. We can see him.

Enough said.

Here are some of the basics of fats and carbs, Dr Dayspring. You are right. The body handles fat differently. It’s not enough to say that fats have nine calories per gram versus four for carbs. Fats are absorbed with very high efficiency, very nearly 100% efficiency. However many of those grams with nine calories you eat, that is pretty much how many of those grams wind up where they can make you fat. I consider this amazing level of efficiency to be evidence of both the importance of and the rarity of fats throughout human evolution. Fats were important because they were so calorie dense, and they are absorbed so well because they were so scarce in our ancestral environment.

On the carb side of the equation, much of the mass of natural carbohydrates comes packaged with fiber, which either does not convert to energy or does convert at a very low rate as it fuels the bacteria in your lower bowel. I’m referring here to prebiotics like fructans. Their conversion is around two calories per gram, so the calorie density advantage for fats is even greater than you might think. Fat has much more potential to cause you to eat more calories and make you fatter than healthy carbohydrates and nine versus four calories doesn’t tell the whole story.

This concept is called energy density and I’ve talked about it in past videos. The high energy density of fats has been demonstrated in a variety of feeding studies to cause people to consume more calories when they consume more fats. This is one of the fundamental problems for the low carb idea and it’s apparently information Dayspring has never encountered.

At the population level, lower saturated fat consumption is also associated with lower energy intakes. This is just how humans work, Dr. Dayspring.

And then, of course, there is the lipid profile problem associated with fatty diets about which Dayspring the lipidologist is so shockingly dismissive. You can see here how much havoc butter and other saturated fats cause. These changes were after only three weeks using liquid formulas with 40% of their calories from specific test fats.

Here is more sophistry from Dayspring about the influence of industry on food policy.

DAYSPRING: And there is no doubt there are … as this hypothesis with fat and cholesterol … Industry got involved, agriculture … So there are big money involved with promulgating these various type of lifestyles and diets, and once that and the lobbyists get involved with a government that’s writing these recommendations, sometimes wacky stuff comes out, or not totally peer-re .. the best type of scientific evidence winds up in these guidelines.

Dr Dayspring, the big agribusiness companies that represent the grain and soybean producers don’t mind people like you demonizing their products. They know that their biggest consumers are the animals low carbers like you eat. Animal foods just add layers of waste to food production that give them more opportunities to make big money. He’s a lipidologist. He’s not an economist.

This is the Perverse Pyramid, created by PCRM to represent where federal agricultural subsidies go in comparison to government diet recommendations. Are you saying that the organic soy and grain producers or the orange growers have as much power as the meat producers? Do you know anything about how the US Senate works?

Now the lipidologist holds forth on dietary cholesterol. Check this out.

DAYSPRING: Also, the only cholesterol that can be absorbed is what’s called free cholesterol. Much of the cholesterol you eat is esterified cholesterol, it’s got a fatty acid attached to it. If a lipase in your body doesn’t separate the fatty acid from cholesterol, that’s a non-absorbable molecule that you just ate. So there’s a process that ingested cholesterol has to go through before it can ever be absorbed. Any cholesterol coming outta your bile duct is free cholesterol, ready for absorbtion. So it’s a nonsensical theory and so many Americans are being told, “Oh, my God, if you just stop eating eggs then your heart disease will go away and it’s utter nonsense.

First he says that the only cholesterol that can be absorbed is free cholesterol. Then he says that a lipase, or an enzyme for breaking up fats, can free up, or hydrolyze, that free cholesterol from cholesterol esters. Sir, it is not a nonsensical theory. The absorption of dietary cholesterol has been extensively demonstrated under controlled conditions. I have a video on this topic just ahead.

Here are two references. The one at the top is Dayspring himself writing about the lipid-lowering drug Ezetimibe. Dayspring says it works by interfering with NPC1L1, an protein that as you can see at the bottom plays a role in the absorption of dietary cholesterol. Look at this and tell me how we are to make sense of Dayspring’s comments. This is not the only reference like this for Ezetimibe which specifically mentions dietary cholesterol in the intestine, so we are not just talking about reabsorbed free cholesterol here.

Now what about those lipases that would be needed to hydrolyze esterified cholesterol? Well you make them in your pancreas. Here are two textbook references for this. Pancreatic cholesterol esterase is secreted into your intestine where it performs this very task. Again, this is very basic information that a lipidologist should know.

These enzymes leaves you with free cholesterol after they’ve done their job which is, as Dayspring says, quite absorbable.

Here is another reference for this. Notice some of the cholesterol omnivores eat is free cholesterol. You see that the inhibition of this pancreatic enzyme is proposed as a way for a drug to limit the uptake of dietary cholesterol.

Here is another reference for this. Research on genetically engineered mice strains has demonstrated exactly how this works. Does Dayspring say all these researchers are wrong about something so basic?

Now I move to the core of Dr Dayspring’s problems, as I see it. Listen to his reaction when presented with a potato.

DAYSPRING: So that is carbohydrate you’re looking at there and in an insulin-resistant person that’s going to drive your insulin, it’s going to drive your triglycerides, it’s going to drive your particles …

“In an insulin-resistant person.” Note that language, please.

Here is Dayspring again, this time telling us that from his point of view, the world is insulin resistant.

DAYSPRING: So the carbs in our little insulin-resistant world are what’s driving these apoB and LDL particle levels

Now listen to Gary Taubes talk about fruit. Listen for the same qualifier about being insulin resistant.

TAUBES: (As) Dr. Dayspring said about the potato, if you’re insulin resistant they’re not doing yourself any favors. It doesn’t matter how many micronutrients, phytochemicals, antioxidants they have in them, they are going to stimulate insulin secretion, they are going to cause your triglycerides to up, fat to be accumulated, it doesn’t … Now if you’re 25 and you’re a marathon runner, then have a great time. The problem is we don’t stay 25 our whole lives, and as you know, Greenie, as an orthopedic surgeon, it’s hard to stay a marathon runner for your whole life before you have to visit the orthopedic surgeon. So, um, you know, it’s just we’ve got this obsession that it’s all about vitamins, it’s all about minerals, it’s all about these magical nutrients that we can say our foods have and we can sell our foods based on them ...

At the end he was just confusing the nature of whole foods with the separate subject of the way that processed foods with added nutrients are marketed. His thoughts aren’t very well organized but that isn’t the big problem here. According to Taubes, in order to eat fruit and not get fat and have your health fall apart, you need to be a 25-year-old marathon runner. This is patently absurd as you know but this mentality – the presumption of a broken metabolism – is at the core of misunderstandings today about diet. This creates the basis for the propaganda pushing meat and fat on people. In later videos, I’ll provide you with the information you need so that you don’t get sucked down into a life of low carb low standards along with Taubes and Dayspring.

Dayspring’s perspective is apparently affected by the ever higher numbers of patients out there with metabolic syndrome and diabetes. I think this is why he favors LDL particle number over LDL cholesterol. We should understand, however, that when LDL-C doesn’t accurately predict risk, that is primarily explained by the effects of these metabolic diseases. LDL particle number captures the risk better than LDL cholesterol for this reason, but that doesn’t mean LDL cholesterol isn’t what causes heart disease. Having people go low carb so that their biomarkers don’t look like metabolic syndrome misses the point of how these biomarkers are used to assess risk. Biomarkers are favored because they have proven predictive in a given population. That population has hardly anyone doing low carb because hardly anyone can do low carb long term. If you eat in some strange way, a way hardly anyone else is eating, then your biomarkers may look different from the rest of the population. But finding a way around the normal indicators of risk by being low carb doesn’t mean you aren’t giving yourself heart disease. It just means you are doing something weird to keep your biomarkers from representing heart disease the way they do for normal people. Atherosclerosis is caused by LDL cholesterol. Dayspring knows that. Why he thinks eating in a what that raises LDL is protective is beyond me but this is my best guess at his thinking.

Now I know what some of you must be thinking. Dayspring sure has a lot of letters after his name.You shouldn’t listen to a guy on YouTube instead of someone with so many letters.

Take a listen to this.

DAYSPRING: The highest honor of my life last year, the National Lipid Association awarded me what’s called their President’s Award which is a very prestigious award given to one person per year for contributions to clinical lipidology. And it’s kind of amazing, a real-world internist wound up there ...

Dayspring says his award from the National Lipid Association was the highest honor of his life. He considers this to be the peak of prestige in his field.

Here is a list of other award winners from the NLA. Dayspring is on the bottom. Look at the top. Those are the winners of the Distinguished Achievement Award. First you see the name Virgil Brown. Then you have Scott Grundy. Last is Antonio Gotto, Jr. A bit lower receiving another award you see Rodolfo Paoletti.

This is Virgil Brown saying that patients should reduce saturated fat and that dietary cholesterol restriction is helpful.

This is Scott Grundy saying that Gary Taubes did a disservice to the public in an article about diet-heart by not identifying saturated fat clearly as a problematic nutrient.

This is Rodolfo Paoletti on a committee giving high marks to the science supporting the restriction of saturated fat.

And here is Antonio Gotto, Jr making sure we understand the importance of Ancel Keys’ Seven Countries Study.

And here you see Gotto along with Grundy endorsing the findings about saturated fat and heart disease in the Seven Countries Study.

As you can see, Dayspring is a lipidologist lost. He has somehow formed misguided opinions about how nutrition can either help or harm our metabolism. I have made four videos to keep you from being similarly misinformed. Look for the videos called “An Evolved Fuel System” and “How to Become Insulin Resistant” later in this playlist. Before I get there, though, I want to first show you some of the common ways even the top experts get confused about cholesterol. We get into Cholesterol Confusion next.