Vlada,
Very detailed explanation of the metabolism of cholesterol and triglycerides. Good Job! When I am trying to explain this to my patients, of course, I have to skip multiple steps of this discussion. I do focus on the insulin piece and inform them that high insulin levels prevent weight loss and causes weight gain. I also stress, as you mentioned, dietary intake of cholesterol and triglycerides, has little effect on these numbers, instead, focus on carbohydrate intake to move the needle. I include in my discussion, that total LDL mass may not be a great measure and talk about large buoyant LDL vs. small dense LDL (seems to be evidence of a difference in risk). I let them know that low-carb, high-fat diet causes a shift from small-dense to large buoyant LDL in most. I discuss how the circulating apo B proteins become altered in a high glucose environment, preventing the liver reuptake receptors from recognizing them, resulting in a longer time in circulation, more opportunity for oxidation, and hence theoretically, more likelihood of atherosclerosis. I also acknowledge that almost all other physicians will try to prescribe a statin or other medication to lower their LDL. I tell them that these will indeed lower the LDL cholesterol. I am very skeptical that these reduce mortality risk, however. We discuss statin side effects, as well. In those patients that fit the phenotype of lean-mass hyper-responders (see Dave Feldman's work) and are also low-carb, high-fat eaters(which I am one), I counsel them about risk. Sometimes, we even get a CAC score for further clarification and tracking. I admit, I took the wrong approach for 20+years in medicine, but I feel that you and I are on the correct path now. This is an uphill battle against the established dogma, stay strong and true!