Low Carb Cardiologist on Saturated Fat, Cholesterol & ApoB | Dr. Ethan Weiss | Summary and Q&A

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October 31, 2022
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Low Carb Cardiologist on Saturated Fat, Cholesterol & ApoB | Dr. Ethan Weiss

TL;DR

In this conversation, Dr. Ethan Weiss discusses common questions and concerns related to low-carb diets, cholesterol, and saturated fat.

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Key Insights

  • 🔍 The speaker, Dr. Ethan Weiss, is a cardiologist and professor of medicine at UCSF who researches metabolism, obesity, and diabetes. He has personal experience following a low-carb diet for five years.
  • 🎮 Dr. Weiss became interested in low-carb diets after using a ketone biosensor and finding it addictive to see his ketone levels rise. He also experienced weight loss while on the diet.
  • 💉 There is a strong linear relationship between ApoB and ASCVD risk, according to multiple lines of evidence. Reduction in LDL-cholesterol or ApoB leads to a corresponding decrease in risk.
  • 🙌 Dr. Weiss believes that the burden of proof lies on showing that a low-carb context mitigates the risk associated with high ApoB levels, rather than assuming it does. He treats low-carb diets the same as other contexts until evidence suggests otherwise.
  • 🌱 Other diet tribes, such as vegans, also engage in diet exceptionalism, claiming that certain risk factors do not apply in their specific diet context.
  • ❓ HDL cholesterol is a marker of risk, but it is not a mediator of risk. Modulating HDL levels, whether through exercise, alcohol intake, or medication, does not change risk.
  • 🔍 Statins are heart attack risk-reducing drugs that happen to also reduce LDL cholesterol. Their mechanism of action may involve factors beyond just LDL reduction, such as inflammation and plaque stabilization.
  • 💉 A calcium score of zero can be meaningful in older individuals as it may indicate better metabolic health and lower risk. However, younger individuals with a calcium score of zero may not find it as reassuring. Serial calcium scoring is generally not useful.

Transcript

today we talk to Dr Ethan Weiss, board-certified  cardiologist and professor of medicine at UCSF   where he researches metabolism, obesity and  diabetes. he's also been on a low carb diet   for about five years so I thought he'd be the  perfect person to ask some common questions that   the viewers, you guys, often ask about low-carb,  cholesterol ... Read More

Questions & Answers

Q: Should individuals following low-carb diets be concerned about their cholesterol levels?

Dr. Weiss emphasizes the importance of ApoB as a marker for cardiovascular health and highlights the linear relationship between ApoB and ASCVD risk. Although there may be differing opinions and debates on this topic, he recommends that individuals monitor their ApoB levels and consult with their healthcare provider for personalized recommendations.

Q: Is there a difference between the risks associated with animal-based saturated fats versus plant-based saturated fats on a low-carb diet?

Dr. Weiss acknowledges that there is evidence showing that high saturated fat intake is associated with high ApoB levels. However, he also mentions that individual responses may vary. While he personally prioritizes plant-based sources of saturated fat, he reiterates the importance of monitoring ApoB levels and working with a healthcare provider to determine the optimal dietary approach.

Q: What is the significance of calcium scoring in assessing cardiovascular risk?

Dr. Weiss views calcium scoring as a valuable tool, particularly when assessing young individuals with a positive score or older individuals with a negative score. However, he cautions against serial scanning unless necessary, as calcium scores may not accurately reflect current risk and can be influenced by factors such as statin use.

Q: Does oxidized LDL play a significant role in cardiovascular health?

Dr. Weiss states that the theory of oxidized LDL's impact on cardiovascular health remains inconclusive. He references failed attempts to develop drugs targeting oxidized LDL and highlights the difficulty in demonstrating its specific effects independently of overall LDL levels. He believes that, currently, the focus should be on overall LDL and ApoB levels in assessing cardiovascular risk.

Q: How should low-carb diets be designed to maximize cardiovascular health?

Dr. Weiss discusses specific foods and strategies for designing low-carb diets for cardiovascular health in part two of the conversation, which will be covered in detail in the next video.

Summary & Key Takeaways

  • Dr. Ethan Weiss shares his personal experience with following a low-carb diet and the addictive nature of tracking ketones and weight loss.

  • He emphasizes the importance of ApoB as a marker for cardiovascular health and discusses the linear relationship between ApoB and ASCVD risk.

  • Dr. Weiss addresses the misconception that low-carb diets eliminate the risks associated with cholesterol and saturated fats, advocating for evidence-based approaches to assess individual risk factors.

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