#21 - Tom Dayspring, M.D., FACP, FNLA - Part II of V: Lipid metrics and cholesterol regulation 

Highly informative....I think I may have to come back to it again as it is difficult to digest so much information. I have a question for you Peter: I am not a lipidologist and neither a scientist on this subject however, I have read the physiology and have heard lot of experts from LCHF community. Almost everyone believes that cholesterol numbers are irrelevant if they increase if you are on LCHF and have probably attained 'nutritional ketosis. Whereas, I have always believed and now listening to this podcast is an affirmation of my thought process that excess cholesterol is a waste and perhaps it could even harm us if it stays in plasma. Especially considering we have a fantastic pathway via acetyl CoA for reproduce cholesterol. Excess has to be excreted else it can cause atherosclerosis. Ques: Why then LCHF folks are in favour of it? Why everybody is so adamant on 5% carbs? Why do we need nutrition ketosis if we are metabolising fat and glucose both? How do I know this - besides feeling energetic all of my clients have cut down on their weight from 5 to 10 kilos. Ques: What makes extra cholesterol in the plasma healthy regardless of what diet you are following? Especially considering our body is capable of making glucose and fat if it needs it beyond what is fed? Our body's preferred fuel is Glucose and yet our storage capacity for fat is 20 times more. Isn't this a way to tell us that our body needs both? Why do we get so head bent on fat or for that matter carbs? Example: I consulted a few people on nutrition lately and all of them (9 of them) have brought down their cholesterol from around 300 mg/Dl to around 200 mg/Dl staying on 20% carbs/55% fat/20 to 25% protein. All brought down their TAG from over 200 to around 120 on a average - mine is at 70 perhaps because of training. All brought down their VLDL numbers showing good processing of fat as I have understood. HDL numbers improved in all but incidentally most are around 45 mg/Dl mark. Genetics I guess..... LDL's have gone up in one case where the number of under 100 and increased to around 150 mark for all the rest. Now I know you don't value the lipid panel so much but there is a consistency so numbers are not lying for sure. All are healthy metabolically with no illness so this excludes illnesses. Let me know your views as am sure am missing something in the riddle. You can check who i am on: www.umeshchhikara.com umesh

Curious about phytosterols... Many claim they are highly beneficial, lower cholesterol, etc.. yet Tom is saying the body does NOT want to absorb these and has protective mechanisms to avoid doing so... Would this indicate that eating a plant-based diet can potentially be harmful? Would love clarification on that one.

44:00 ironic, cause your straight dope write-up speaks about "cholesterOl ester" ;P

As an organic chemist, it worries me that in this video cholesterol is defined as an "aromatic compound". It is not. That's a fundamental mistake on a very basic concept they teach you in your second day at the university. Often even in high school. Also, if you "desaturate cholesterol" (or any other organic molecule, really), you add an unsaturated group (i.e. a vinyl group) you don't remove one. Finally, cholestanol and coprostanol are not isoforms. Isoform is a term used for protein variants originating from the same gene or family of genes, which have small differences in their aminoacid sequences. Cholestanol and coprostanol are _isomers_ , that is, molecules formed by the same atoms, but connected in a different manner. From what i can see cholestanol and coprostanol are diastereomers (epimers, to be precise). Videos like this one above are so important and can even save people's lives. I am very worried, however, that if i can find so many mistakes on things i have a good knowledge of, how can i trust the parts i am less familiar with.

Attention all doctors.