#20 – Tom Dayspring, M.D., FACP, FNLA – Part I of V: an introduction to lipidology

KEYPOINTS

• 01

  Attia calls Dayspring 'the mentor to the mentors' in lipidology

  This first part of a roughly seven-hour, five-part conversation introduces Dayspring. He practised internal medicine in New Jersey for just under 40 years, has given about 4,000 lectures including over 600 accredited medical-education programmes, and received the National Lipid Association's 2011 President's Award. Attia calls him his single most important clinical mentor and 'a national treasure'. This episode is the gentler warm-up before the technical parts.

• 02

  At 72, Dayspring lost 67 pounds in 11 months with monthly low-calorie weeks

  Dayspring had lived for years with obesity, insulin resistance, fatty liver, gallbladder removal, a hip replacement and several spinal surgeries. After watching a talk Attia gave at MIT on longevity, he took on Attia's modified fast: one week a month of 700 calories or less with significant carbohydrate restriction. Attia's colleague Nicole helped plan the meals. Dayspring says days two and three were the hardest. Eleven months later he was 67 pounds lighter.

• 03

  His lab report went from red and yellow to all green

  Working for a lab company, Dayspring tests nearly every cardiometabolic marker on himself. A report that was largely yellow and red a year earlier was 100% green. He also feels his orthopaedic symptoms are about 90–95% better. He can walk to dinner, where a year before he had to stop after a short block. He suspects the fasting did more than weight loss alone, but offers this as personal experience.

• 04

  Fear of cognitive decline was a big motivator

  Dayspring says his biggest worry was cognitive impairment as he aged, with fatty liver and other problems 'sneaking up'. Seeing 'the light at the end of the tunnel', with US average life expectancy around 80, plus wanting to be around for his son, turned years of ambivalence into an all-in switch. Attia notes that once Dayspring commits to something, he never wavers.

• 05

  Coronary care has changed dramatically since the 1970s

  As a resident in a 700-bed hospital, Dayspring might admit a dozen coronary care patients in one night. He saw transmural heart attacks with Q waves and pulmonary oedema, and patients 'dropping dead before your eyes'. A 50-50 survival chance was common. Attia's concierge-practice colleague says he can't remember his last Q-wave heart attack. Dayspring still believes early prevention could all but end the disease.

• 06

  He taught himself lipidology over a decade

  Frustrated by middle-of-the-night heart attack calls, Dayspring moved into prevention: smoking, weight and aggressive blood-pressure control. After trials such as Framingham and MRFIT pointed to cholesterol, he says it took about 10 years of serious reading, often not understanding what he'd read for the first five, before it 'all made sense'. Early influences included Dan Rader, Virgil Brown, Allan Sniderman and Ron Krauss.

• 07

  His diagrams made complex lipid biology teachable

  Dayspring says he can't draw a person beyond a stick figure, but he learned to build detailed, animated lipoprotein diagrams in PowerPoint. Attia, who learned PowerPoint at McKinsey, assumed a professional illustrator made them. Dayspring also wrote Lipidaholics Anonymous, a free weekly newsletter of real case discussions read by several thousand people. He jokes that what he wrote in 2002 is 'mostly all wrong' now.

• 08

  Facts have half-lives, including 'high HDL is good'

  Attia contrasts very long-lived facts, like a round Earth, with the Framingham-era belief that high HDL cholesterol is protective, which he now calls grossly oversimplified and possibly incorrect. Dayspring goes further: no one should judge cardiovascular risk from HDL cholesterol or think raising it achieves anything. He considers it worth listing only for calculations like non-HDL cholesterol.

• 09

  Lipoproteins mainly carry energy and phospholipids, not cholesterol

  Dayspring stresses that almost every cell makes all the cholesterol it needs. The bigger problem is cells making too much, which can crystallise and kill them, so cells have powerful ways to export it. Lipoproteins mostly deliver triglycerides, fatty acids for fuel, to muscle or for storage in fat cells. They also deliver phospholipids, which make up their outer shells.