The Case for Treating Cholesterol Before Plaque Appears | Dr Thomas Dayspring and Dr Dan Soffer

Almost all of us have atherosclerosis, and almost none of us are told so, because "normal" cholesterol is a population average rather than a physiological target. Dr Thomas Dayspring and Dr Dan Soffer, both Masters of the National Lipid Association, join me for a conversation devoted entirely to primary prevention. They do not agree on everything, and that is the point. Tom argues ApoB is the cause of atherosclerosis. Dan calls it the necessary substrate. Between them you get an unusually honest look at how two experienced clinicians weigh evidence, uncertainty, and their own bias when treating someone who feels perfectly well. What We Cover: Why genes matter less for atherosclerosis than most people assume Is ApoB causal, or simply necessary? The disagreement, in full What "normal" cholesterol means, and the levels we are born with LDL-C years: a five-second calculation you can run on yourself What the 2026 dyslipidemia guideline changed How they would manage a healthy man in his thirties with a family history and an ApoB of 100 Statin muscle symptoms, and the simple test that settles it If you have ever been told your cholesterol is fine and wondered what that actually means, start here. To connect with Dr Thomas Dayspring, find him on X, where he posts as @Drlipid. To connect with Dr Daniel Soffer, visit his Penn Medicine profile. Want to support the show? The best way to support the show is to use the products and services offered by our sponsors. To check them out and enjoy great savings, visit theproof.com/friends. You can also support the show by leaving a review on the Apple Podcast app and sharing your favourite episodes with friends and family. This episode is brought to you by: 38TERA Consider 38TERA's DMN prebiotic supplement a daily multivitamin for your gut. Formulated by yours truly and gastroenterologist Dr Will Bulsiewicz. Use code THEPROOF for a discount at checkout. 38Tera ships to the United States, Australia, and New Zealand. Skylight Families are better when they’re working together. Right now, Skylight is offering our listeners $30 off their 15 inch Calendars by going to MySkylight.com/THEPROOF. Skylight ships within the U.S. and to Canada, Australia, and the United Kingdom. Pique Pique’s Nandaka combines fermented Pu’er tea, full-spectrum Reishi, ceremonial cacao, and L-theanine for calm, sustained energy without the coffee crash. Unlock 20% off and establish your powerful foundation for sustained well-being at Piquelife.com/SIMON. Pique ships within the U.S. and to Australia, Canada, and select EU countries. Function Health Take charge of your health with advanced blood testing and personalised insights. Function Health offers a practical way to track key health markers such as cholesterol, blood sugar, and more. Learn more and join at functionhealth.com/simonhill for a $25 credit toward your membership. Only available to those living in the United States. Function Health ships to 48 U.S. states, excluding Rhode Island, Hawai‘i, and Puerto Rico. Shopify Shopify, the world's leading e-commerce platform, helps you turn browsers into buyers with the internet’s best-converting check out–up to 36% better compared to other leading e-commerce platforms. To boost your conversion rate, and grow your business, sign up for your one-dollar-per-month trial at shopify.com/proof. IM8 With 92 nutrients, including Vitamin B12, Iodine, Selenium and Vitamin D, in highly absorbable forms, IM8 Daily Essentials is the perfect all-in-one daily multi-vitamin to ensure you meet your daily micronutrient needs. IM8 is offering an exclusive 10% off your first order with a free welcome kit when you enter the promo code SIMON at checkout on im8health.com. IM8 ships to 27 countries including the U.S., Canada, the U.K., Australia, and many regions across Europe, Asia, and South America. WHOOP Whoop, the most advanced fitness and health wearable available. Your personalised fitness and health coach to recover faster, sleep better, and train smarter. Claim your first month free on join.whoop.com/simon. Whoop ships to 56+ international markets, including the US, Canada, most of Europe, Australia, New Zealand, UAE, Singapore, and parts of Asia. Simon Hill, MSc, BSc (Hons) Creator of theproof.com Host of The Proof with Simon Hill Author of The Proof is in the Plants Subscribe & Connect: YouTube Apple Podcasts Spotify Instagram: @simonhill Twitter: @theproof Facebook: The Proof with Simon Hill Nourish your gut with my Plant-Based Ferments Guide and download my Two-Week Meal Plan.