Dr. Ethan J. Weiss has been passionate about health since a young child, growing up around a cardiologist father. He eventually went on to attend Vassar College before moving on to medical school and residency at John Hopkins. He came to UCSF in 1998 to complete his clinical and research fellowships in cardiology and has remained on the faculty since then. Dr. Weiss has maintained an active clinical practice with expertise in the emerging intersection between endocrine and metabolic disease and cardiovascular diseases. He is a leading authority on novel tools to predict and prevent cardiovascular disease and has special interest in using technology as a tool to enable lifestyle changes.

When you look at the role of nutrition in cardiovascular health, you’ll find that there is imperfect information. So, we need to review the information that we have and take the best approach going forward. Dr. Ethan believes that cholesterol is causative in cardiovascular disease. In the past ten years, there has been an abundant amount of information that LDL is a massive risk factor.

Dr. Ethan explains the effects of cholesterol. If you look at plaque in human arteries, there is definitely LDL cholesterol. How LDL contributes to the growth of plaque is still something we are learning about. We are hindered in this field because it is difficult to get ahold of the tissue. We don’t have the best or most refined understanding of how this happens. However, the latest theory is that cholesterol will cause problems by inducing an inflammatory response.

Diet relates closely to lipid health. In the seventies, we told people to eat low fat; therefore, people started eating high carbs. However, Dr. Ethan doesn’t want to say that he has the answers prematurely. No one has the answers; there is still a lot to learn about nutrition. If you take a low carb and high-fat diet, the impact is an increase in LDL cholesterol. After digging deeper, Dr. Ethan felt more comfortable with the rise in LDL because it didn’t increase the risk of cardiovascular disease. Some individuals will have a much more significant change to their LDL when they start eating low carb. Dr. Ethan says people have five choices:

-      Ignore it.

-      Keep an eye on things by measuring calcium.

-      Try a different diet by adding more carbs.

-      Start taking a statin.

-      Replace saturated fats with plant-based fats.

Dr. Ethan is most excited about the last choice, replacing saturated fats with plant-based fats. When people have heart attacks, it’s important to treat things differently. So, Dr. Ethan does not recommend using diet to treat heart attacks alone. However, food should be part of the recovery.

Then, Dr. Ethan explains the relationship between keto and diabetes. You don’t often see people coming into the doctor’s office with fewer and fewer drugs. However, people with diabetes are coming off of their diabetes medications and blood pressure medications once trying the ketogenic diet. Dr. Ethan has found publications on low carb diets and diabetes in 1795. So, the relationship between keto and diabetes is not a new phenomenon.

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