Dr. Ethan Weiss on Low-Carb Diets and Cardiovascular Health

Dr. Ethan Weiss emphasizes the critical importance of ApoB levels in assessing cardiovascular risk, regardless of diet.

### Dr. Ethan Weiss on Low-Carb Diets and Cholesterol
Dr. Ethan Weiss, a cardiologist and UCSF professor, has been on a low-carb diet for five years and shares his unique perspective on its effects. He became interested in low-carb eating and ketones as a biosensor after experimenting with a prototype breath sensor. Dr. Weiss emphasizes the **strong, linear relationship** between ApoB and ASCVD risk, questioning the idea that low-carb diets could be an **exception to this risk factor**.

### The Debate on Low Carb Diets and Cholesterol
The speaker emphasizes the need for **evidence to support the claim** that low carb diets are not risky, stating that they treat it the same **until proven otherwise**. They express concern about the argument that LDL and ApoB are **not important**, viewing it as a **more harmful perspective**. The speaker also highlights the common **cognitive dissonance** experienced by individuals on successful diets, leading to a desire to **challenge traditional medical views** and promote **diet exceptionalism**.

### Understanding ApoB and Heart Attack Risk
ApoB is a key marker for assessing heart attack risk, with **low HDL strongly associated with increased risk** but not being a mediator. Statins are primarily heart attack risk-reducing drugs, with **LDL and ApoB reduction** being a component of their effect. While HDL can be a marker of risk, trying to change it through lifestyle or medication may not have a **significant impact on overall risk**.

### The Role of Calcium Scoring in Assessing Heart Disease Risk
Calcium scoring may have a different impact based on age, with **zero calcium being more meaningful in older individuals**. The test is often not helpful in young people and is a **late marker of disease progression**. Serial calcium scanning is generally not useful, and statins can **raise calcium scores while lowering heart disease risk**.

### Understanding Calcium Scores and Saturated Fat
Calcium scores are not definitive risk indicators, as they can **increase despite statin use**, which lowers overall risk. High saturated fat intake is linked to **elevated apoB levels**, but the relationship is **complex and varies among individuals**. The speaker personally consumes some saturated fat, prioritizing **plant sources**, and believes that as long as **apoB levels are optimal**, there is less concern about dietary choices.

### The Role of ApoB in ASCVD Risk
ApoB is a key marker for assessing ASCVD risk, but its role in **modifying LDL** has been difficult to demonstrate experimentally. Efforts to develop drugs targeting **oxidized LDL** have failed, leading to the conclusion that it may be a **distraction**. The speaker emphasizes the importance of **upregulating LDL receptors** for better clearance and **reducing modification time**.

### Insights from Dr. Ethan Weiss on Low-Carb Diets and Cardiovascular Health
* 🩺 Dr. Ethan Weiss, a board-certified cardiologist and professor at UCSF, shares his expertise on **low-carb diets, cholesterol, and saturated fat**, stemming from both his professional research and personal experience.
* 🍽 Initially skeptical about low-carb diets, Dr. Weiss found himself adopting a ketogenic diet, where he measured his ketones and experienced **significant weight loss**, shedding **over 20 pounds in just six weeks**.
* 📊 He emphasizes the **strong, linear relationship** between ApoB levels and the risk of atherosclerotic cardiovascular disease (ASCVD), arguing that any new claims about low-carb diets mitigating this risk must be **substantiated by evidence**.
* 💬 Dr. Weiss addresses the prevalent notion that low-carb diets could be an exception to the risks associated with high ApoB, asserting that the **burden of proof lies on those making such claims**.
* 🔍 He critiques the idea of diet exceptionalism, noting that similar arguments arise from various diet communities, including veganism, where **cholesterol's significance is downplayed based on dietary context**.
* 📉 While HDL levels are markers of risk, Dr. Weiss stresses that they are **not mediators of risk** and that the focus should remain on **ApoB for assessing cardiovascular health**.
* He discusses the complexities of calcium scoring and its relevance in different age groups, asserting that a **calcium score of zero holds more significance for older individuals** than for younger ones.
* 🍔 Lastly, Dr. Weiss explains his approach to saturated fat consumption, advocating for **moderation** while emphasizing the importance of **monitoring ApoB levels** as the primary driver of **coronary risk**.

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

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