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

[@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...

[@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

[@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 ?

[@zentzu4003]

an egg is only 3g saturated fat

[@tatjanakane503]

This is the healthiest approach and the healthiest diet I have heard of. Well done. Truly admire you.

[@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.

[@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.

[@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?

[@EljinRIP]

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

[@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.

[@kj_H65f]

Doesn't total cholesterol matter more than either ldl or hdl by themselves? I dont know what my apoB is but I had very high total cholesterol on my lipid panel and it convinced me to cut sugar/processed food

[@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.

[@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.

[@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

[@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

[@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.

[@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

[@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.

[@Nimzzeee]

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.

[@Nimzzeee]

@@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.

[@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.

[@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.

[@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!

[@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 : )

[@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.

[@tikibarry2279]

I agree. After every topic please recap like it's a written test question ..with the correct answer. I'm a retired Airline pilot and flight instructor. I have multiple flight instructors certificates. I can talk theory for hours... But we use a simple Checklist when we fly.

[@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

[@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.

[@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.

[@beinoutside7739]

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

[@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

[@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.

[@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?

[@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.

[@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?

[@AstonAcademia]

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

[@RockAndRose]

I did Low carb + time-restricted eating and got myself to a pre-diabetic state on my glucose levels. Got the Nutrisense tracker and saw my spikes go UP for every "breakfast." I started adding in healthy carbs and breakfast and my A1C went back to below 5.2. I'm working now toward whole food plant-based, as my LDLs have always been high and I haven't really paid attention to saturated fats in my diet.

[@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?

[@littlemswolf]

What exactly is low carb? What foods make up low carbs? Are we talking about removing certain veggies? As a plant base whole food consumer who was on keto, I found it hard on me with so much animal fat. With the WFPB lifestyle I do not count my carbs, calories, or protein but I do watch my saturated fat intake. I am an oval vegetarian who will eat eggs when the mood hits or my husbands wants them. Since April my overall cholesterol dropped from 205 to 180, LDL dropped from 134 to 110. Tri and HDL stayed the same.

[@Nobody-Nowhere]

im a square vegan

[@eitant7]

What does he eat then? Being low carb yet staying aware of the sat fat link to disease... How do you reconcile it into a low carb diet? Just greens and some meat?

[@NutritionMadeSimple]

next week's video covers his diet in some detail :)

[@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

[@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.

[@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.

[@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!

[@MrStarchild3001]

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

[@scienceislove2014]

Elevations in apob may be due to a high-fat diet and/or decreased clearing of LDL from the blood. Some genetic disorders are the direct (primary) cause of abnormal levels of apo B. For example, familial combined hyperlipidemia is an inherited disorder causing high blood levels of cholesterol and triglycerides. How To Lower ApoBs. Consuming less dietary fat and cholesterol and many more fiber-rich, whole plant foods , will greatly reduce the amount of chylomicrons and their atherogenic, apoB-48-containing lipoproteins in the blood.

[@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. 🙏

[@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.

[@nicolabenson1155]

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

[@SandysDIYHealthAdvocacy]

Thank you for your channel... no agenda, just intellectual honesty. Would you consider asking Dr. Will Bulsiewicz on as a guest? He's a gastroenterologist and author of "Fiber Fueled." He asserts that low carb, particularly keto, is bad of the gut microbiome. Thank you again.

[@gummiesrule88]

Great video, as usual. Looking forward to Part 2. I takes some work to avoid saturated fat on a low carb diet, especially as an omnivore. Will be interested to see how he keeps that element relatively low in his diet.

[@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.

[@lis8725]

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

[@IonTrone]

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

[@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"

[@Megaterranova]

It's interesting how some people can tolerate consuming relatively high amounts of fat and cholesterol without raising LDL either due to age and metabolism or through genetics. Then these people tell other people to do the same just because it works for them giving rise to misinformation and seriously dire consequences for many. Personally, I have had the best overall results in my health from following prudent advice of eating a high amount of leafy greens, avoiding animal products and process snack and fast foods.

[@Tendertroll1]

Totally agree with you. Trying to figure out how to lower my LDL , and keto is not the answer for me. Looking at the plant based Or Mediterranean diet right now

[@mongofan1]

Thank you, Gil. I struggled with Dr. Weiss's tendency to not complete his thoughts. Still, looking forward to more. So far, though, I think I prefer your presentations of the literature in which you walk us through key articles. Alex

[@Connie7881]

Agree 100%. Broken sentences.

[@allencrider]

High blood lipids can cause a 25% reduction in oxygen delivery to the brain.

[@mongofan1]

I think I take back my earlier comment. I listened a second time and found Dr. Weiss to be quite clear. I was listening while at my desk at work the first time so may not have been sufficiently focused on the interview.

[@calikokat100]

me too...its frustrating to listen to,,,and try tomake sense

[@chrisconklin2981]

My question is: does ketosis exclusively belong to a Low-Carb diet? As a vegetarian there is nothing imposable to keep me from doing fasting to produce ketones.

[@davidwinebrennerjr4196]

Absolutely fantastic. This should be a mandatory video to watch before anyone gets on a LC diet:) Thank you both!

[@asarcadyn2414]

Dr Weiss is on a low carb diet himself, as I understood from the video. He is saying low carb isn’t the problem but high ApoB is.

[@davidwinebrennerjr4196]

@@asarcadyn2414 close. SF is the problem.

[@asarcadyn2414]

@@davidwinebrennerjr4196 Thanks for sorting that out for me 😂. Why do you think SF is the problem when we have evolved eating it mostly ?

[@davidwinebrennerjr4196]

@@asarcadyn2414 oh boy. You are one of those. Hey good luck. Darwin was right :)

[@asarcadyn2414]

@@davidwinebrennerjr4196 I could say the same back to you. Of course you have no response to my question. Why do you bother commenting at all?

[@katprowler6805]

SO ... The million$ question.. how do I genuinely lower my ApoB?????

[@NutritionMadeSimple]

kzbin.info/www/bejne/Z2mpd2emjrGrm80

[@modo1896]

This interview made things less clear concerning saturated fat. And what does this low carb guy's diet look like? Moderate protein and fat from unsaturated sources? Isn't low carb unhealthy long term?

[@amfohr]

I heard Thomas Dayspring say that testing oxidized LDL cholesterol is a waste of money. Oxidized LDL cholesterol is taken out the blood stream by your immune system. It is possible that LDL oxidizes embedded in the artery wall but in that case you can't measure it anymore. He also said that ApoB is causeal for atherosclerosis if a certain threshold is exceeded. So in all cases you want to avoid high ApoB. The reason is that once the amount of particles exceed an amount that can be taken out the blood stream by the receptors of the liver it will result in increasing amounts of particles that will penetrate the artery endotheel surface.

[@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?

[@susanchiavaroli5050]

I'm pretty good at following these videos and understanding the message. Dr. Weiss talks in circles and I cannot figure out what his message is. More confused now than I was before!

[@samelder7530]

What is a target level for Apo B for people with elevated LPa and a high calcium score?

[@ebarr9476]

As low as possible.... below 50 according to Dr. T Dayspring

[@camozot]

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

[@prewin6]

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

[@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

[@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.

[@joeycmore]

Great topic. Awesome approach. Personally, this guest is hard to follow for an average layman. Thanks for the video.

[@georgem2742]

This is one of the most difficult conversations to follow

[@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

[@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

[@mdh157]

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

[@irfanmohd091]

a brief summary at the end of the video would be nice

[@rdpmackie]

Thanks for telling us he's a "low carb cardiologist"! You just saved me 19 minutes, and 9 seconds!

[@youbeever]

Could you please elaborate and demonstrate the science behind your reasoning?

[@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.

[@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.

[@andyjacobs2384]

looking forward to part 2. Great video.

[@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?

[@CJP3626]

Lo-carb cut my trigs from 150 to 50, then Rosuva20 and Eze10 cut my apo-B from 105 to 52. I'm finally satisfied I'm on the right track. Had I not gone lo-carb against Drs advice, I might be dead today. In 2004 (at 49) I had a CAC of 70. starting in 2009 I started asking for a follow-up. Finally, after demanding one this year(2022) I got one. Score is 1870! , Almost exactly what the math predicted at 20-25%/yr

[@CJP3626]

@Bladerunner2049 Yes and no, it's a little complicated. First, when lipoproteins begin to stick to, or slip though the inner lining( Endotheliam)of the artery wall which is just one cell thick, they'll form soft "plaques". The best description I've heard is to think of them as pimples inside your artery wall. Most heart attacks aren't caused by this "pimple" getting bigger and bigger until it blocks the artery. Most heart attacks are caused by when the plaque wall ruptures and releases the inflammatory materials into the artery and attracts all the bodies to clot the problem off. This clotting causes a blockage of blood flow. If it's it's serving the heart, it's a heart attack, the brain it's a stroke. Over time, if you take away the root causes of the inflammation, that is to lower the LDL count, ( measured as APO-B or LDL), any sign of insulin resistance or diabetes, etc., The plaques will begin to heal by thickening the Endotheliam and eventually calcifying preventing the rupture. While calcification is , quite literally, hardening of the arteries, (arteriosclerosis) which can't be reversed at this time, at bay though reducing LDL cholesterol, tryglicerydes, lower insulin resistance, and intense exercise. Because I couldn't get a scan when I started the keto diet, i don't know where my score was, but I've heard of scores more than doubling when root causes of the lesions are removed. My Dad had a quadruple bi-pass at 65, angina but no heart attack, he had problems similar to mine, but he passed away at 90 of something else. I'm hoping to beat him by at least 5 years.

[@StevenMorello]

This kind of video is ok, but I find the ones where studies are flashed on the screens more helpful. That way we can look them up if we're interested. You could always post-edit the video to add them. Showing some images from scientific papers might also be helpful, for those who like diagrams and charts.

[@NutritionMadeSimple]

bear in mind the references are still linked in the description and listed on screen in subtitles. we´ll play with flashing them during interviews, thanks

[@StevenMorello]

@@NutritionMadeSimple Thanks! You can do it post interview as well, doesn't have to happen while talking. Just add the paper as an image later.

[@Poetry-For-The-Itch-Of-It]

I went on Lego after losing 50 pounds. The net result after consuming less than 30 grams of carbs a day for six months was 15 pounds of weight gain (from 165 to 180). I was hoping to maintain the weight I lost on a low calorie plant based diet.

[@megavegan5791]

Dr. Klaper is the only vegan doctor I’ve ever heard make the argument for vegan high cholesterol exceptionalism.

[@phwshopping1426]

Hi! I’ve never heard of this can you explain?

[@hiker-uy1bi]

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

[@creativesource3514]

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

[@waynegolding14]

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

[@worldcitizenra]

My only dissatisfaction about this video is that there was no explanation as to why ApoB is such a strong measure of cardiovascular risk. Dr. Weiss mentioned the various types of LDL that carry cholesterol around the body, plus of course triglycerides. My understanding of the LDL number in a lipid panel is that it shows the total volume of cholesterol carried in all the types of LDL particles, but the amount of cholesterol that could be in each type of LDL particle can be substantially different among the various types of LDL particles. The ApoB score is a proxy for the number of LDL and triglyceride particles in the blood. Lower ApoB represents fewer LDL particles for a given volume of cholesterol, but not necessarily lower total cholesterol. Rather the low ApoB score indicates on average larger sized LDL particles carrying more cholesterol per particle. Higher ApoB represents more LDL particles for a given volume of cholesterol, resulting in lower amounts of cholesterol per LDL particle with the LDL particles being significantly smaller. The theory being that the smaller LDL particles penetrate the artery lining more easily at inflammation points. Knowing why ApoB is such a significant risk indicator would potentially validate or refute the LDL particle size impact theory and allow more precise focus on efforts to delay cardiovascular disease onset. I'll watch the Part 2 video about the diet Dr. Weiss recommends, especially considering that he said he moved from a Keto diet, which is very low carbohydrate plus has a higher meat and saturated fat component, to what he describes as a low carbohydrate diet, despite several statements in this video discouraging the idea that low carbohydrates had significance in reducing either cholesterol or cardiovascular risk.

[@mikehodgetts4864]

I am in no way an expert so take my comment with a pound of salt. The lipids going in the blood from the liver to the body start as chylomicrons which are the largest "particle". Cholesterol needed by cells in the body receive what they need as the lipid packages circulate and get smaller. These have different names as they shrink. The packages continue to get smaller and only the smallest are called LDL particles. These are supposed to reenter the liver and be recycled into new chylomicrons, or so we have been told, and the high insulin blocks this. The LDL particles are said to accumulate and oxidize, becoming an even bigger danger. Some review shows that Dr. Gil Carvalho Phd debunks this in another video. The Keto diet will lower the insulin and this is supposed to allow the LDLs to be recycled and reduced in number. Review tells me, I am in error.

[@worldcitizenra]

@@mikehodgetts4864 - It appears very similar to what I've seen explained by several cardiologists. However, it seems a bit different than Dr. Weiss's comments. Although as I mentioned, he didn't seem to give any information about the effect of the different types of LDL particles.

[@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?

[@VTVT1306]

Two years ago I had a calcium score of zero, recently they discovered angina pectoris in two small veins . So what does the CAC mean? I agree with him on that. Right now I’m in great doubt: taking a statin and continue eating meat, or going vegetarian without a statin.

[@davidabramovitch4289]

Correct me if I'm wrong but he never actually made a claim in favor of low carb diets right, other than the fact that he tried it and lost some weight?

[@soufianemohammad1474]

Exactly he seems a bit confused

[@nickbuis3307]

It still amazes me that some consider being in ketosis as bad! The same could be said of being in a constantly fed state, it's just a change and stressor in the body. It would be bad if you do it all the time like most things but there are countless benefits to being in a state of ketosis. The key is moderation and balance. Being in a state of ketosis is good for you, just as exercise is, you just don't do it all the time.

[@jjstix]

sources?

[@cyberfunk3793]

@@nickbuis3307 If ketosis is so good on the body, why does the body not prefer it as an energy source? Why do even little kids that are on keto have drastically higher risk of kidney stones? If you don't have epilepsy, why should one be in ketosis?

[@nickbuis3307]

@@cyberfunk3793 the theory on why the brain burns first sugar as opposed to ketones is because the body like to maintain a stable blood sugar hence it needs to use it up or get rid of it, kind of like the liver metabolizes alcohol first, it does it not because it prefers it but because it needs to get it out of the body. One of the main reasons one would want to be getting into ketosis is for metabolic flexibility, it is likely more beneficial for the body to be able to rely on both sources of fuel and as I stated earlier I believe the key is to maintain balance. I see getting into ketosis kind of like exercise. Many people go through life without exercising however many would agree that it's necessary for optimal health. Do you need to exercise? You can probably argue that no but it would be a hard case to make if you want to be better. As far as children developing kidney stones I am not aware of it but I will definitely look into it, that being said I wouldn't recommend children getting into high levels of ketosis just as I wouldn't make them lifting heavy weights, not at least until they reach puberty but it is totally fine for children to burn ketones and in fact babies, especially newborns have higher levels of ketones than adults and that's probably because they burn lot's of brown fat. Hope this helps.

[@cyberfunk3793]

@@nickbuis3307 I don't believe ketosis increases any metabolic flexibility but in the contrary increases the carb sensitity of a person without addressing the underlying insulin resistance. So when a person is on keto they mask their diabetes but their symptoms return even worse when they start consuming carbs again. The saturated fat in a keto diet causes insulin resistance. If you wish to have some sort of fasting effect, why not just periodically fast for some days instead of being on keto for extended periods?

[@nickbuis3307]

@@cyberfunk3793 ketosis does increase metabolic flexibility, frankly it's not a matter of belief or discussion, it's a proven fact and no, saturated fat does not cause insulin resistance, that has not been proven, it only makes it worse but it is not the underlying cause. Studies have only proven correlation and not causation. What causes insulin resistance is the constant abuse of sugar and refined carbs and just overeating overall which causes us to have insulin levels constantly high hence the body develops a resistance to insulin, it's in the name "Insulin Resistance". As far as fasting, I do fast and do keto from time to time because both work. Fasting and a ketogenic diet has been the solution for many including myself. It helps improves insulin sensitivity, the ability to burn your own fat a lot more easily due to the increase in the metabolic flexibility and becoming highly fat adapted, it also improves mitochondrial function. I personally went from 217lbs to 155lbs about 5 years ago and it has been a game changer for me and many people that I know of, I struggle with my weight all my life especially when I was living in the US, I have tried numerous ways to lose my weight and nothing worked, until I've tried intermittent fasting and a ketogenic diet. Do I think it's end all be all? No, everyone is different and diets are very personal but I certainly see people who's life has been turned around in such a positive way that I truly believe it is overall a positive diet that one can try.

[@mikecain6947]

A cardiologist on a ketogenic diet with elevated LDL, told me that the LDL was the large fluffy LDL and did not penetrate the endothelium, but can anyone verify this?

[@NutritionMadeSimple]

we have a couple videos going over the evidence on particle size, e.g. the Dr. Eric Berg fact-check

[@longshanks5531]

Interesting conversation… I just wish the guy who is being interviewed would talk in complete full sentences instead of changing it up every few seconds

[@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.

[@Joy80JJ]

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

[@zhilahaghbin4766]

Dear Dr. Gil and Ethan, thanks much for practical advice, all your videos are helpful, and truly gives the points evidenced based why those who minimize the risks of saturated fat, need to be followed cautiously, for a healthy person that may not be an immediate issue, but over time will become. Thus very helpful to have such balanced and evidence based, talk

[@YamatoForever]

What about eating a stick of butter? Seems like a lot of low carb folks seem to think it's OK to do this. Go on a butter fast?

[@danz4928]

I am more unclear now after your interview with Ethan than I was before. Seems like there isn’t a one approach to prevent and or reverse heart disease. I was hoping to hear a more definite clarification on the entire interview.

[@JamieR]

There's a lot of talk around resistant starch over the past few months. Many discredit it. Would love a video on it.

[@tofu-munchingCoalition.ofChaos]

That would be indeed very interesting.

[@minimal-vegan]

3rd 🤙🏼

[@richardpells5974]

This is really helpful and fascinating. Many thanks!

[@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?

[@markobelosevic2183]

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

[@howdy2496]

Have you considered interviewing Peter Attia? Would be good dialogue.

[@applerunner1184]

Thanks for the video. Great information. It would be great of you could talk about other studies cited by the low carb folks. One is a study that looked at “outcomes” versus “risk” for taking statins - it showed that taking statins increased your longevity by a whopping 3 days (in other words - the effect is so small, so why bother?). Other studies showed that folks with higher LDL in the elderly population (over 60) lived longer. Also the large study where the original author did not release the results as they did not agree with his narrative. The results were released after his death by a family member. The results showed that folks with high LDL did not have higher risk. I think that some of these studies were mentioned in Dr Mike Hansen’s recent video on this subject.

[@NutritionMadeSimple]

we've covered most of that in the past. see the video on statins and the part on absolute risk. it always depends on the time of followup. we also have one from a year or 2 ago covering the cholesterol and death risk question

[@nagitoultimatehope2356]

@@NutritionMadeSimple I'm really confused about HDL, on one hand I see research saying that people with high HDL have a lower risk of CVD, and on another hand, I see conflicting research saying that HDL doesn't matter, in fact high HDL might even increase the risk of CVD and that it's all about the Apob particles. These flat-out contradictions about HDL are so annoying. Can you shed some light on this or should I just accept that this is controversial among scientists?

[@NutritionMadeSimple]

@@nagitoultimatehope2356 there's legitimate uncertainty on some points, esp. the function of the actual particles. there's overwhelming consensus that HDL-Cholesterol is not a therapeutic goal. no point trying to raise it. we´ll 100% make more content on it, at some point I´ll try to get a lipidologist to talk about HDL-C and HDL for a whole video

[@nagitoultimatehope2356]

@@NutritionMadeSimple Yes!!! Thank you so much!

[@alan2102X]

@@NutritionMadeSimple HDL:triglycerides RATIO is the thing. NIacin works beautifully to move both in the right direction with huge improvement in ratio.