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

Is high cholesterol harmful on a low carb diet? What about saturated fat?
Does high HDL-C and low triglycerides eliminate risk? How about a calcium score of zero? Low Carb Cardiologist Dr. Ethan Weiss addresses common low carb FAQs.
ApoB & ASCVD risk. you can predict per milligram per deciliter reduction in LDL-cholesterol or apoB you'll see a specific reduction in risk
the simplest answer: what's your ApoB? the role of HDL in atherosclerotic coronary disease is fascinating. triglycerides: it's the apoB component of triglycerides probably that contributes to risk, so the simplest way to think about this is what´s your apoB.
statins are not LDL-reducing drugs, or apoB reducing drugs, they're heart attack risk-reducing drugs, they happen to also reduce LDL.
high ApoB and a high HDL-cholesterol.
calcium scoring. the power of zero is much more impactful in an older person. if you have calcium in your arteries at 20 you got a problem. having zero calcium score after three or four or five years of having hypercholesterolemia or high apoB doesn't necessarily tell us much, you could be growing soft plaque. statins can raise calcium score at the same time as they lower risk. statins increase deposition of calcium but they reduce risk.
is it the saturated fat itself or is it the carbs, if I'm on a low carb diet maybe that eliminates the risk? high saturated fat confers high apoB. if your ApoB is still good, from a coronary perspective it's hard for me to go beyond the ApoB. for me it's all driven by ApoB.
oxidized or modified LDL or ApoB. drugs to specifically modulate oxidized LDL independent of overall LDL have all failed. if you have less residence time, if your LDL receptors are upregulated, it's less likely to be modified. monoclonal antibodies against oxidized LDL failed.
next week: low carb diets to maximize cardiovascular health
Subscribe for more free nutrition and health tips: bit.ly/2toMJ9u
Connect with me:
Facebook: / drgilcarvalho
Twitter: / nutritionmades3
Animations: Even Topland @toplandmedia
References:
1-pubmed.ncbi.nlm.nih.gov/33870...
www.ahajournals.org/doi/full/...
2- www.sciencedirect.com/science...
3-jamanetwork.com/journals/jama...
4-www.sciencedirect.com/science...
5-www.ncbi.nlm.nih.gov/pmc/arti...
6-europepmc.org/articles/pmc298...
7-jamanetwork.com/journals/jama...
8-academic.oup.com/jcem/article...
9-www.sciencedirect.com/science...
10-apps.who.int/iris/bitstream/h...
11-pubmed.ncbi.nlm.nih.gov/16140...
12-www.jacc.org/doi/full/10.1016...
Disclaimer: The contents of this video are for informational purposes only and are not intended to be medical advice, diagnosis, or treatment, nor to replace medical care. The information presented herein is accurate and conforms to the available scientific evidence to the best of the author's knowledge as of the time of posting. Always seek the advice of your physician or other qualified health provider with any questions regarding any medical condition. Never disregard professional medical advice or delay seeking it because of information contained in Nutrition Made Simple!.
#NutritionMadeSimple #GilCarvalho
0:00 Intro
0:52 How Dr. Weiss got into low carb diets
2:20 High cholesterol on low carb
7:15 HDL-C and triglycerides
10:57 Calcium score
14:22 Saturated fat on low carb
17:07 LDL modification (oxidation etc)

[@StratsRUs]

This is a good foundation for part 2. I eat a little meat, a steak a week , a little chicken too.Grass fed. The rest is a range of all that is seen as healthy.I stopped added sugar totally..I stopped breads and cakes.I have rice sometimes.An egg every cupla days.I like an apple a day, blueberries etc. I love pulses and vegetable dishes.Salmon and other oily fish is a must. My weight is lowering. I eat only when hungry and I approximate the intake akin to a 16/8 ...but vary it , sometimes I push it more towards 18-20 hours. I don't beat myself up if I eat too many nuts here and there. I am losing a steady amount.About 6 pounds every 5 weeks but I don't obsess.I just feel more nimble. Walk about 2-3 miles a day. This channel is the best I have found because it doesn't feel like a cult. Not yet, anyway ! 😂 Thank you.

[@MeMe-dw1sm]

Exactly the way I eat, feel great

[@xnoreq]

​@@MeMe-dw1smBut feeling great is not an indicator of a healthy diet.

[@astcal]

if you run at least 6 miles a day 5 days plus intense 2 day resistance training per week, would you eat the same type of food ?

[@unitedintraditions]

I did Atkins for 5 years then went Keto and back to Low Carb. Last year I developed Hyperinsulinemia 316 pmol/L. I have switched to mostly Plant-based eating Fish once or twice a week and perhaps chicken once or twice a month. I am now at 107 pmol/L. Nutrition is not a one size fits all. Find what works for you ignore the rest.

[@Fearzero]

Animal products shorten lifespan for the majority of people.

[@xnoreq]

You are not at all alone in that. The liver primarily accumulates fat from dietary fat, which ultimately impairs suppression of glucose production in the liver. So now you have high blood glucose. You know what happens next. The pancreas compensates by producing more insulin. Hyperinsulinemia. If you kept supplying fat then both the liver and pancreas would keep accumulating fat, aided by the extra insulin, which results in a downward health spiral. This is how type 2 diabetes develops, because at some point the pancreas will burn out. At this point insulin production will go down and blood sugar will go up uncontrollably. It's sad there there are so many "health influencers" and people paid by the industry that spread so much misinformation and promote these sort of diets, so it often takes people several years to figure out that these diets are not healthy at all - at their own health's cost. But all the basic nutritional science has been known for many decades.

[@erastvandoren]

​@@xnoreq lol, where do you get this? He never said anything about high blood glucose

[@erastvandoren]

Actually, plant-based is the base diet for everyone

[@FacundoMontoya]

For Monkeys

[@thefreshprinceofnohair9703]

I have a Friend who has high triglycerides and very low HDL , he eats mostly refined carbs , I have low triglycerides and optimal HDL , I was eating a ketogenic diet at the time of the blood work, the only marker that he had that was better than me was LDL , I m not saying LDL isn’t important especially if APOB is high , but it interesting how someone that unhealthy ( he’s overweight and doesn’t exercise, still has totally normal LDL. I don’t know his APOB because his doctor only ran the standard lipid panel.

[@TomDOLAN-cb9th]

I have been a armchair nutrition student for many years after the death of my mother, now more than 20 years ago, I have found Gil´s videos and take on so many important topics to be one of the best resources on You Tube. I hope he keeps up this important work as so much that is presented in other places are simply confusing, poorly done, opinion driven and often, plain off the mark. Real food forms the basis of all things healthy. Hope you re well Gil...

[@seller559]

We need to re-define “carbs”. I think of fruits and vegetables when carbs are mentioned while others are thinking donuts and pancakes.

[@timsahkelebek5901]

YES. Carbophobia went so insane that people are even scared of whole fruits.

[@Radjehuty]

This is indeed annoying. In fact, it's gotten so bad that people will even claim fruits are bad for you because they're "full of sugar" as if equating apples to donuts. Unfortunately, we just don't have great differentiating terms.

[@seller559]

@@Radjehuty Agreed

[@joe1071]

Yeah, I think the research on fructose ruined the definition, lumping all fructose together and assuming fruit was the same as candy or sugar soda. Then the research showed fruit has positive health effects and isolated fructose did not. They are not the same

[@seller559]

@@joe1071 Exactly

[@aquamarine99911]

My ApoB shot up to >180 while on a strict keto diet. I was in good shape and good BP, but I've got two teenage kids I need to see through university. At least! I can't just die on them. So I switched to a low carbish diet by adding two cans of beans (protein + fiber) per day while swapping out SFAs and reducing dietary cholesterol generally. No more eggs or red meat, just chicken breast and fish. Now my ApoB is 83.

[@presence5426]

Nice. That's the way problems should be approached. Different strokes for different folks.

[@hikedayley9309]

Andrew, I applaud your individual approach. "Strict" Keto doesn't work for me. I include some beans too. Eliminating refined sugar is more important than eating some complex carbs the beans provide.

[@aquamarine99911]

@@hikedayley9309 To me, the main benefit of legumes is the fiber. Contrary to what low-carb "experts" say, I've come to believe the body needs lots of fiber, and legumes are the most efficient way of getting it. They are truly a wonder food. Their high protein content also helps to lower the amount of animal protein (and SFA's) you have to eat. .The net carbs they provide are their least important nutrient.

[@presence5426]

@@hikedayley9309 Beans can be a part of strict keto. As long as you're not going over 30g of carbs a day. But, like you say, strict keto is tough for many people. Just keeping a lid on carbs, especially refined, is probably better.

[@cartmansuperstar]

@aquamarine99911: so the two cans of beans and vegetables are your only carbohydrate-source ? And apart from that you consume mainly unsaturated fats and your apoB is still only 83? That sounds great. Please confirm. Thanks.

[@beinoutside7739]

What a great discussion! Very good, clear questions and good, clear answers. Thank you both for your time and effort, much appreciated!

[@angelocarrion3399]

I love videos like this. I'm always greatful when you interview scientists and experts who aren't plant based but also follow the science.

[@EljinRIP]

I love these conversations with specialists who closely follow the data and just care about what the facts are. Keep em comin!

[@bettesmith1117]

I'm glad to have come across your video. This was very interesting and helpful. Thanks. Will look for Part 2.

[@henkwerner]

I'm very much looking forward to the next video. I'm on a low carb diet now for two months and any guidance on best practices to keep ApoB under control is very, very welcome.

[@Joy80JJ]

Found you on my feed. Just subscribed. Yes looking forward to part 2...great content & info I am interested in.

[@patricknowlan4590]

These videos are terrific. Thank you so much. There's so much conflicting and confusing information out there, a lot of camps and a lot of agendas. Its refreshing and extremely helpful to listen to you cover the science without bias. Again, thanks so much!

[@francesnance9110]

Excellent video and very helpful. Thanks so much!

[@katiephillips5360]

Thank you, both! This is very helpful. Can’t wait for next video.

[@andyjacobs2384]

looking forward to part 2. Great video.

[@AlexBiohazardous]

This interview will probably confuse the hell out of most people, even those with a moderate science background. The cardiologist is constantly changing frames between him, his patients, and "evidence". However, the ultimate goal for any respectable healthcare professional towards their patients is a way of eating that: 1. lasts for a lifetime 2. is sustainable 3. doesn't exclude from the social sphere 4. doesn't introduce major health risks. These criteria may exclude most "diet clubs", but some do score better than others, and probably by a wide margin. All in all, I was not convinced. His patients should probably ask for a second opinion before gamefying their ketones and getting a high score on their LDL.

[@raithneach]

These type of videos are greatly appreciated, thank you. They bring clarity to really complex topics that could be difficult to understand, the explanations are just so accessible and clear. And so many of the points are pertinent given all of the noise that surrounds topics like LDL-C and cardiovascular risk. Please keep doing them, it's really helpful.

[@richardpells5974]

This is really helpful and fascinating. Many thanks!

[@IonTrone]

Great guest, keeping it real, having an open mind, and pointing out things that are currently unknown!

[@gerhardpet1]

This is really useful! Please continue to produce more content like this

[@evanlouis8853]

I do hope that Gil synthesizes and explains in layman terms what the low carb Cardiologist is talking about come the end of his interviews with him. If you put a gun to my head, I could not tell you anything definitive about this conversation

[@rossgooding7423]

What if their other risk factors-obesity, hypertension, blood pressure, inflammation, energy and mental health improve significantly on low-carb high fat-does LDL/ApoB become a less significant concern?

[@nicolabenson1155]

Just want to say thank you for the thorough reference list, and for flagging them during the video. Much appreciated Gil

[@vladeckk21]

Very clear and informative. Onward to part II!

[@jtucci5711]

Thank you for this interview, it brings well needed context to the conversation of a low carb diet which I just started as a 72 year old male with heart disease.

[@albrackets8446]

regarding the issue of high LDL-C and ASCVD risk, I am sure you have seen the hazard ratios of various conditions published in JAMA. At the top is diabetes, smoking, the various metabolic syndromes (such as obesity) on down to TGD and low HDL. At the bottom is LDL-C in terms of risk factors. So if you reverse the items with the highest risk, namely diabetes, ( and pre-diabetes assuming there is risk from that), obesity, hypertension but were stuck with higher LDL-C, wouldn't that be a good trade?

[@NutritionMadeSimple]

there are many technical issues with using these data to directly compare risk factors (e.g. contrast of exposure and adjustment models). also, bear in mind LDL-C is just a surrogate of ApoB, which associates more strongly with risk. all that aside, the key realization is that most people can control ALL their risk factors at the same time. glucose AND body weight AND cholesterol metabolism. a healthy lifestyle does all of that. choosing between risk factors is not needed in most cases. this video and next week´s continue to explore these questions

[@robertusga]

Why would that be a good trade if the only essential condition for CVD is high ApoB. Reduce that and the others are irrelevant. Not saying you should not try and keep all of them in a healthy range, but trying to ignore ApoB is just an excuse to binge on saturated fats while playing Russian roulette with heart disease and stroke.

[@AZ89231]

@@NutritionMadeSimple FYI, the paper is Association of Lipid, Inflammatory, and Metabolic Biomarkers With Age at Onset for Incident Coronary Heart Disease in Women and the HR for apoB was 1.26 to 1.89 whereas diabetes was 3.47 to 10.92 and LPIR was 1.15 to 6.4

[@AZ89231]

@@robertusga because it’s almost certainly not the only essential condition. I would argue it’s necessary but not sufficient (you also need inflammation and endothelial dysfunction generally) - see comment above - apoB as an independent risk factor is generally squashed by other markers of metabolic health and not very informative without interpretation in context. For example, when you use the AHA/ACC risk calculator, a higher LDL-c is trumped by TC/HDL-c ratio, I have patients whose LDL-c increased by 20% but their HDL-c incr by 25% and their total cholesterol stays the same and comparatively their baseline risks of ASCVD drops by 25%. LDL-c is a poor man’s apoB (sometimes). Beating up ApoB is VERY important for secondary prevention or VERY high risk individuals bc you’re taking the oxygen away from the fire of atherosclerosis, but to lower apoB into a “healthy range”…whatever that is…is perhaps a mistake IMO unless it’s absolutely necessary and it’s hardly playing Russian roulette. That is gross hyperbole.

[@robertusga]

@@AZ89231 except it is proven essential. Check the Mendelian randomization. Low ApoB, 0 heart disease.

[@jacobgise2479]

Great job as always. Keep it up!

[@202wcox]

Great topic and information! Please continue.

[@v.s.7860]

Thank you, great conversation.

[@jimmybee4768]

That was a great conversation. I am doing well on a low carb diet. I am looking forward to learning more about saturated fat in part 2. Thank you.

[@doherpa]

As am I. Don’t buy into the vilification of saturated fats.

[@mdh157]

Great conversation! Just what we need, an informed discussion vs absolutes that are all over the internet.

[@camozot]

Eye opening conversation on the calcium score, thanks I did not know the nuances of how it worked

[@NimpanZ]

These videos absolutely help. An actual breakdown of foods to eat, how much and how often is even more helpful and I look forward to part 2 although a comprehensive list that we can take away is more practical.

[@clavenbeth123]

Everyone is different though.

[@NimpanZ]

@@clavenbeth123 you can say that again. I'm one of those people that has to drink their veg.

[@AlwaysSeekingTruth13]

@@andrewclark3236, what is your ApoB count?

[@andrewclark3236]

@@AlwaysSeekingTruth13 I don't know. Haven't been to the doctors for years. Are you able to give me a reference to a randomized control trial that links eating high amounts of protein is significantly associated with ApoB levels?

[@scottcunningham79]

Do you have any idea when part 2 will be released? I’m new to this channel and am not sure how often he post new videos. I really want to listen to the follow up.

[@AndersWelander]

Looking forward to the next episode.

[@lis8725]

THIS absolutely helps! There is so much "info" out there and most of it is huey.

[@markobelosevic2183]

One of the most useful videos on this controversial topics I have ever seen. Looking forward to the practical implications in part 2!

[@maryclarence6429]

Great video, incredibly useful and informative, my wife was prescribed a keto diet and I was doing my research but there is so much bunk it is sometimes hard to navigate this field.

[@nvytebhygtvbvtyebr]

Great discussion! Have a couple video ideas for you! Would love a video on long term water fasting (3-7 days or more). Second, maybe something on how meditation can impact body composition or diets (dont know if there are studies for this). Thanks for your content as always

[@waynegolding14]

Nice haircut Gil. I liked the video and the guest speaker. Looking forward to part 2

[@alittlebitoflight]

Looking forward to next week.

[@SMABEM]

A couple of nutrition geeks in full flight. Great to see you talking to someone on your same level. High carb vegan here trying to keep an open mind on low carb.

[@jazzluvr87]

Very interesting! I can’t wait til next week 👍

[@elizabethk3238]

First of all thank you for this video. I'm 75 no meds no pain, eat low Carb, no sugar, and exercise regularly. My LDL however, is always a bit higher than it should be. I recently had an ApoB test done, and seeing my doctor soon to discuss. I am one of the fortunate people with a doctor who is a collaborator in my health-care. This video helps me to discuss my ApoB with some degree of understanding. ALSO thanks for your thoughtfulness in having an esthetically pleasing background for your viewers. So many ignore that they don't have to look at the "mess" but we do.

[@robertusga]

Nothing wrong with going low carb and adding low dose statin and ezetimibe to keep LDL-C and ApoB in healthy range.

[@elizabethk3238]

@@robertusga yes, a lot wrong when the lowest dose makes you very sick! Speak to your level of experience, not just what you're FED!

[@michealfriedman7084]

You can have high LDL. If you have large particle LDL you are OK. It's the tiny LDL particles that are the issue.

[@robertusga]

@@michealfriedman7084 particle sizes are irrelevant in the context of ApoB. If you know your ApoB, you know your CVD risk.

[@Pokerface8899]

Do you consume fruits are fruits bad for you

[@markotrieste]

Great video, thank you. I am on a low-ish carb diet, mainly because it helps me maintaining the intermittent fasting regimen (less cravings). I use MCT in the salad instead of or in addition to olive oil, for the ketones. What is your guest's opinion on MCT oil? Also, what is his opinion on the trygliceride/HDL ratio as a marker?

[@astonuk9403]

C8 C10 and maybe C12 are not considered the atherogenic fatty acids and don't damage the gut microbiome.

[@monikamastyk8200]

These were great questions! It's interesting that CAC is not a good indicator especially with people below 40. I wonder what could be said about inflammation markers and their link to CVD, and what specific markers would be meaningful in that context. Thanks!

[@marianblum1064]

Yes, very helpful conversation, Gil and Ethan. Thanks! What is "ideal" ApoB level? What is "reasonably good" ApoB level?

[@rubix01]

Ideal:

[@PauloSousaPinto]

kzbin.info/www/bejne/bZLLgIKkhL2masU

[@zanshin825]

Good video. Appreciate it.

[@im2old4this2]

Interesting. Good conversation. Thanks.

[@dimitripavlotskyartist2383]

Super helpful. Very hot topic. Please more like this conversation:)

[@raymondpaul123]

Well I found a lot of what he said confusing - not clear. if you’re going to sum it up for us that’s great. and I am looking forward to next week show so thanks.

Very interesting! Thank you!

[@irondirectprimarycare9440]

When you explained oxidized LDL you cited pharma drug development data. It is murky business to rely on pharmaceutical drug development data to determine practice.

[@mikeroll9868]

This is great info. Yes I do want to see a vid on CVD Low carb diet. I would love to talk to you about my CVD experience. How about a CVD patient viewpoint video?

[@lanazak773]

I'd like simplified "takeaways" from these interviews. If you could make a summary at the end, as if some of us are children, I'd sure appreciate it. And I DO have an RN plus a BS in computer science with a math minor, so it's not that I can't handle big or technical words. I could probably listen again and get it but I don't want to spend the time. All I got from this is that ApoB is the most important marker. If you are familiar with cholesterol study results and terminology, it's probably a lot easier to follow along.

[@safenders]

That’s a great idea

[@ebarr9476]

Heart disease is by far the # killer world wide. Anthogenesis.... the buildup of plaque that narrows arteries and more, can start very early in some people and occurs in almost all populations as we age. Therein, as the plaque burden grows over the decades, it's been shown that lowering APO B, a proxy for LDL and total cholesterol, will slow that process and even reverse it. Statins are the most well studied meds and their aggressive use can save as many as 50% of folks from so called "major events" like an MI or stroke. So starting early is important if indicated by one's blood work and family history. You will find lots of doubters/haters re. medicine here on KZbin and elsewhere but if you trust multiple (100's) research studies all over the world you will come to the same conclusion. However, you'll see that many Ytube docs and docs with dubious credentials ignore the papers and have HUGE followings that take no action and remain as or more smug than the Utube presenters making lots of money on life-years lost to modern day charlatan's pocket books.

[@spongebobsquaretits]

the notes do what you have asked if you take the time to read them

[@christopherbrand5360]

So good! Thank you and, yes, more please :)

[@chewiewins]

Learnt lots, thanks

[@Runpierre]

Excellent video.

[@unverozkol]

Very valuable info. 🙏

[@Tsugimoto1]

Lol, right after he made that point at 6:30, immediately got an ad saying "buy my book! Keyboard rich!"

[@metemad]

Great content. ❤

[@toomanytubes0002]

Glad to see you doing more interviews. Any plans to have high carb low fat/low-no oil advocates on?

[@mrbigsdaddy]

High carb life is a real drag. You will never understand the power of steady blood glucose until you test.

[@nourishedbyscience]

Good conversation, Gil and Ethan. These types of clear agenda-free, evidence-based conversations are a huge boon to the community (or at least those who are open to facts). Thank you!

[@uncoiledfish2561]

But their personal ‘facts’ disagree 😂

[@jarichards99utube]

Yes very true. Not all carbs spike glucose & insulin. I think of carbs as basically FIBER vs Non-Fiber (Sugar generating) carbs... Stay Well : )

[@arielmalanga]

Another great, great video, Gil. No bs or quasi-science. I argue with the keto crowd until I'm blue in the face and tell everyone I know and love to get their ApoB measured. Please continue this series. It's solid, very useful, and practical. Thank you to you and Dr. Weiss. A+ work. 🙏

[@janegarrick6282]

Yes, please, more videos like these. Although, I'm not sure I understand it all.....

[@mikeboyle5375]

The obvious un-asked question in the interview was why Dr Weis would continue a low carb ketogenic diet while acknowledging that it confers increased risk via Apob. Otherwise, quite interesting and I look forward to part 2. Thank you!

[@butterf1sh]

Completely

[@Madamegato]

While keto is low carb, there is a difference when saying you eat low carb (under 150g of carbs) and keto (under 50g and often under 20g). From what I gathered, this doc isn't keto anymore but went up to low carb.

[@jeffreywp]

He doesn’t do keto anymore. He’s only low carb.

[@Struwwel2]

This video answered a question I posted on another of your videos about whether there was a distinction between what happens on a high fat/high carb diet and a high fat/low carb diet. And the answer to that appears to be: look at ApoB levels.

[@meatflake]

Thank you for asking about calcium score. One thing I'm curious about is do we know what causes a persons calcium score to get high over time? Is it different than what causes high LDL and ApoB?

[@rjzlwop3153]

I agree with the first two people who left comments or should I say the last two people. Great video and thank you but this guy speaking was so choppy and all over the place. It was very hard for me to take away what he was trying to relay on most of the topics so some clarity and clarification would be very beneficial and helpful. Thank you and keep up the amazing job you do.

[@dansklrvids7303]

What an interesting dicussion!

[@DrAJ_LatinAmerica]

Absolutely great video. Yes more. We don't have to agree on every detail, we just have to take a moment to listen and learn a new perspective. 1000% agree, the keto carnivore world has not provided long term RCT'S. The rest everything one "but our ancestors ate meat". I still eat keto / carnivore but than again Im not here for a long time, just here to enjoy a short time then move on to the next life. My personal belief is that carnivore makes us strong, vegan helps us to live longer. Excess anything is bad. People have to choose and roll the dice. Driving a car or inner city living is a major risk. All part of life.

[@bugmanmech]

On Keto diet. High good fat low carbs. Hdl 51 up to 55. Triglycerides 55 down from 125. Ratio of 2.45 to 1.0. LDL 71 to 77. Glucose from 140 to 107. A1C from 6.1 to 5.0. Next visit going to have HOMA-ir to measure insulin resistance and Lipid NMR panel to measure particles. Eating good feeling good doesn't matter unless it's backed up with blood test? Dad was thin felt good never went to doctor until the first heart attack.

[@karenhoekstra4002]

Love your videos.

[@MrStarchild3001]

Question: Peter Attia said the ceiling for optimal ApoB is ~60mg/dl. What's your view on that? Any science behind this number??

[@robbailey464]

I'm definitely looking forward to Part 2. Low carb means going higher with fat and/or protein. It's hard to get my head around doing that without increasing saturated fat intake.

[@4rmi]

you may try getting the fat from MUFAs and PUFAs and some lean proteins are really low on saturated fat - 100gr chicken breast has 1g saturated fat 30 grams protein for example...

[@Fearzero]

​@@4rmiAll animal products shorten lifespan.

[@kdhoward83]

@@Fearzerono they don’t

[@Fearzero]

@@kdhoward83 Yes they do. Science. 0.70 is high correlation. Ignore at your peril. Food intake patterns and 25-year mortality from coronary heart disease: cross-cultural correlations in the Seven Countries Study. The Seven Countries Study Research Group -A Menotti et al. Eur J Epidemiol. 1999 Jul. Baseline surveys were carried out between 1958 and 1964. A number of individual characteristics were measured in 12,763 middle-aged men belonging to 16 cohorts in seven countries (USA, Finland, The Netherlands, Italy, former Yugoslavia, Greece and Japan). Population death rates from CHD showed large differences, ranging from 268 per 1000 in East Finland to 25 per 1000 in Crete, Greece. Animal food-groups were directly correlated, and vegetable food-groups (except potatoes) as well as fish and alcohol were inversely correlated with CHD mortality. Univariate analysis showed significant positive correlation coefficients for butter (R = 0.887), meat (R = 0.645), pastries (R = 0.752), and milk (R = 0.600) consumption, and significant negative correlation coefficients for legumes (R = -0.822), oils (R = -0.571), and alcohol (R = -0.609) consumption. Combined vegetable foods (excluding alcohol) were inversely correlated (R = -0.519), whereas combined animal foods (excluding fish) were directly correlated (R = 0.798) with CHD death rates.

[@prewin6]

Great2 video. The guy being low carb still gave a very unbiased opinion.

[@Dr_b_]

thanks, appreciate the discussions about LDL/ApoB, oxidation/glycation risk > vs its only bad if its so, otherwise its ok

[@jsmith5764]

Thanks for the video. Is Lp(a) part of VLDL cholesterol? And is VLDL part of apoB?

[@911mno]

Some of what he said went over my head. Your questions and comments helped make sense of it. The references are useful too. It's not just someone saying something because of the mood he/she is in or what people want to hear. Thanks. I appreciate the topic. Would appreciate more such interviews as you help create a bridge between scientists and lay people like me.

[@velikijoxotnik]

Very interesting. I've been low carb for over a year and a half, and have had really good results. But, my ApoB is 160. I'd bought into the narrative that high LDL-C doesn't matter. I still don't like making CVD risk determinations on LDL-C alone, but I have come around to understand that ApoB IS a very good marker for CVD risk level. My CAC Score was 70. I have agreed with my cardiologist that I need to lower ApoB, and am starting to back off of the quantity of saturated fat intake. I want to stay low carb (primarily, low 'bad' carb), but am trying to figure out how I can modify my low-carb lifestyle, so that my ApoB comes back down. I can't do statins because they give me muscle aches. My cardiologist has started me on Leqvario (injections). I'm hoping that they're effective. I find these videos to be VERY helpful and informative. I like it when professionals, like you, understand the low-carb lifestyle, but can point out the goods and the bullshits in the narratives, related to this dietary lifestyle.

[@NutritionMadeSimple]

hi Chuck, thank you for your comment. Thrilled to hear the information helps! Part II with Dr. Weiss will cover exactly that question; how to design low carb diets to optimize lipids and heart health. There's a lot of information out there, low carb (and even keto) is doable while maintaining ApoB in the healthy range. This is why I wanted to create this content. These videos with Ethan are the first stab at this but we'll definitely make more. definitely keep us posted with your feedback on the upcoming content and your results with inclisiran! all best.

[@timsahkelebek5901]

If you insist on low carb then plant dominant low carb mediterranian diet: high in raw nuts, fatty fruits (avocado and olives) and moderate amounts of olive oil. Low in saturated fat, high in benefical plant compounds. You can also try carbs from whole fruits and legumes. They are really benefical, you can almost eat them with no portion control, especially fresh whole fruits. Carbs are not the problem, where you get the carbs is the problem. As the commenter above stated we should differantiate between a whole crisp apple and a donut (which is also filled with oil, not just carbs) You can replace meat and dairy with small, fatty fish like anchovies and legumes.

[@velikijoxotnik]

I'm not interested in taking red meat out of my diet. Plant-based diets are totally unfulfilling for me. I agree that a Med style diet may be a happy medium. I'm not a huge fan of fish though. I get my fill VERY quickly. My primary focus is removing trashy carbs (as in sugary, starchy, and highly-processed foods). Whole, above-ground cruciferous veggies and leafy greens are very much a staple of my diet, and I don't count those carbs against my daily carb target (which I don't actively count or track). Pecans and almonds have a place in my diet. Avocado, blackberries and raspberries do too, but I do try not to overdo the fructose. I've already started cooking with more olive oil and Avocado oil. I am planning to reduce the amount of saturated fat intake, and adding some more whole grains, to see if that helps to lower my ApoB.

[@timsahkelebek5901]

@@velikijoxotnik If you don't want to take red meat out you can atleast pick the leanest cuts possible. Beef tendon is also good, lot's of collagen etc. For the fructose part, as long as you get it from whole foods like fruits and your liver is in good health (choline really helps) fructose is actually benefical. Basically: bad, unhealthy fatty liver + fructose from processed foods = high trigs, insulin resistance etc. Healthy, strong liver + lots of fructose from WHOLE fruits = good health, increased sex hormones, energy etc. (basically your liver health and how you get your fructose is the important part not the amount of fructose) So, in long story short you can do: some conservative amounts of lean meat/organs and tendon, lot's of legumes, whole fruits, fatty fruits, nuts, greens, using avocado and olive oil for cooking. Note: fruits increase your iron absorbtion from the meat so if you are a man or a menapausal woman check your iron from time to time just in case it gets too high.

[@NostalgiNorden]

@@timsahkelebek5901 lots of fructose = Lot's of diabetes.

[@rickfarber6242]

What is a healthy range for ApoB? I could have missed it, I have not heard any numbers. Thank you.

[@arvidlystnur4827]

I had a recent blood profile. Though I didn't include an Apo-b test my triglycerides was in the possibly too low category, LDL 40 and VLDL 7. Would this indicate my Apo-b is probably fine?

[@Austin-jp9pi]

Hopefully this doctor can put together a study showing that you can reverse heart disease on a low carb diet, I will be patiently holding my breath.

[@hiker-uy1bi]

Interested in learning his diet. From what I recall, he follows a kind of low-carb Mediterranean approach

[@mikemcnally1454]

I must confess, as soon as you mentioned you were interviewing a low carb cardiologist, I was slightly apprehensive. But that is a lesson learned for me, as Dr Ethan was completely reasonable - and interesting! Really appreciate you sharing this conversation and I look forward to seeing the next part.

[@creativesource3514]

Why would you get apprehensive?

[@dennis6248]

Thank you very much for the content, very insightful. I found that the link is no longer valid for reference 11 - it woudl be great if you could update that.

[@NutritionMadeSimple]

thanks!! fixed it. definitely let us know if you find other glitches

[@sittingfrogleg]

Excellent interview Gil, great questions.

[@themotivator2587]

Maybe you could interview Dr. Pradip Jamnadas sometimes. He is also a cardiologist who promotes a low-carb diet.

[@soufianemohammad1474]

I watch him as well but he’s says that saturated is not an issue what you think

[@themotivator2587]

@@soufianemohammad1474 You do have a point. He's probably not the best source of reliable information on the topic. But it could still be an interesting conversation. I've learned a lot more since I first heard Dr. Jamnadas around 2019.

[@soufianemohammad1474]

@@themotivator2587 even me I link dr pradip Jamnadas I think he’s great could be really good a conversation with him

[@seanet1310]

It's interesting to hear from someone who clearly has considered the risks and benefits to their dietary choices. Most of the loudest voices don't have this background knowledge orbjave rose tinted glasses. This lifestyle is not for me but maybe it is for someone. Great work Gill on this one

[@chingwing-gi2fl]

Dr Carvallo, would you say that the frequent and sudden increase in ldl we see in people losing weight on a lower carb diet is due to transcient hypercholesterolemia? If not, what is your take and what happens to the ldl liver receptors under such a diet?

[@mariedenoyer2173]

Ethan was a little hard to follow in that he never really completed sentences and would go into left field or right field around the topic. Kind of hard to follow.

[@itsm3th3b33]

Not kinda. Totally hard to follow.

[@mrddcass6540]

His brain needs some carbs.

[@nursehillary]

Exactly my thoughts. Very hard to follow. Glad to hear it wasn’t just me because it made me question my cognitive capacity 😂

[@HealthPoliticsAndProtein]

He finished plenty of sentences

[@dawngonzalez508]

Very helpful, thanks! Wondering if someone can provide some insight? I'm 52, not overweight, don't smoke, and have low blood pressure. My previous total cholesterol was 300! This last lab work, I had my doctor test APoB (she had no idea what it was!) and my number is high. Current results: Cholesterol, Total 244 mg/dL Triglycerides 76 mg/dL HDL Cholesterol 84 mg/dL VLDL Cholesterol Calculation 13 mg/dL LDL Cholesterol Calculation (NIH) 147 mg/dL APoB 116 mg/dL I was able to lower total cholesterol by 56 points - but this is still bad, right? Can I get APoB in a low enough range without drugs? What should I aim for?

[@MrStarchild3001]

This was awesome!! Low Carb diet is the only that works after you develop certain degree of insulin resistance (alternatively, GLP1-RA drugs or surgery) --- well at least that's my experience. So it's really important to learn CVD risk while eating low carb. Clear & straightforward advice in this video! References are super helpful too! TY!!

[@spiral-m]

"Low Carb diet is the only that works after you develop certain degree of insulin resistance ". Incorrect. Based upon successful peer-reviewed trials: "The Natural Food Interaction Diet (NFI diet) will allow you to eat what you want and as a much as you want each day, providing it is written on the plan. It is a personally tailored plan designed to give any person a sufficient and well balanced diet containing all the nutrient and minerals that you require and does not have any yo-yo effect whilst on the diet due to its specific tailoring to an individual." There is no calorie restriction at all.

[@doddsalfa]

Low carb makes you insulin resistance

[@keriwilliams8980]

@@doddsalfa ???

[@doddsalfa]

@@keriwilliams8980 overconsumption of animal fat is the cause of diabetes 2

[@ginadaley5414]

I'm sorry, but was very confused by "heart doctor"

[@creativesource3514]

Can you summarise the take home points of this discussion please?

[@finalfan321]

ok so avoid sat fats when you eat at the same time proteins so you dont get apoBs? I ll avoid cream in my coffee if i have it with a meal that contins proteins ?

[@JulienRoigHerr]

Interesting to hear his point of view on oxydated LDL.

[@finalfan321]

this was great

[@krisvette5874]

Another excellent evidence based video

[@helloman5576]

What about cacao butter, is that a good source of saturated fat?

[@jordanesquetyson8223]

Another great video! What about ketogenic diets and alzheimers disease? Dose our brain perform better on ketons compared to carbs? Can a keto diet reduce the risk of getting alzheimers?