Medical Director Baszucki Group, Host Metabolic Mind podcast. Low Carb Cardiologist. Connecting metabolic, mental, & cardiac health. Views are my own.
San Diego, CA
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Why do so many people believe a keto diet causes heart disease when there’s actually no evidence for that? I explore that in my latest Metabolic Mind video!
There is NO evidence that a keto diet increases the risk of heart disease.
What there IS emerging evidence for is the potential metabolic & mental health benefits of #TherapeuticNutritionalKetosis. These alone merit future studies on its use as a medical treatment.
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Bret Scher, MD retweeted
🧪 Why are ketones often lower in the morning? Is stevia keto-friendly? And what does the research actually say about oxalates?
@GeorgiaEdeMD joins @bschermd to answer your ketogenic therapy questions in a new Metabolic Mailbag.
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The HHS recently announced an initiative for medical schools to require 40 hours of nutrition training for future physicians.
As clinicians who treat chronic disease, we’ve begged for this. But here’s the harsh reality:
If we just mandate 40 more hours of the exact same failed dogma, nothing will change. 🧵
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We have a massive, generational opportunity to overhaul medical education right now.
But we need to measure nutritional competency by real metabolic outcomes like falling triglycerides, normalized HOMA-IR, and reversed diabetes, not just by checking a box for logged lecture hours.
Read my full piece here. kevinmd.com/2026/10/nutritio…
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Saying LDL or ApoB is "causal" in heart disease is used to end the conversation. But that misses the point entirely.
Causality tells you a mechanism exists. It doesn't tell you how large the risk is for a specific person, or whether treating it will actually help them. And that’s what patients and doctors should actually care about. 🧵
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Telling a patient "ApoB is causal, so you need to lower it" takes a relative risk reduction from a large trial population and presents it as a personal recommendation.
But population-level data tells you what happened on average. The person sitting across from you is not an average.
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The next time you hear that ApoB is “causal” for heart disease, don’t let that end the discussion. Ask the follow-up questions.
What does that mean for me, with my risk factor profile, and what is my absolute risk and benefit from lowering ApoB?
It may be that lowering ApoB makes sense. Or it may not. But you'll never know if “causal” ends the discussion.
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A 2-year RCT published in eBioMedicine looked at what a low-carb, high-fat diet does to cardiovascular risk markers.
LDL went up. ApoB didn't change.
If your doctor only ran a standard lipid panel, they'd likely tell you to start a statin. Here's what the full picture actually showed. 🧵
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It’s important to note that this RCT had a significant decline in adherence over the two years.
This is the core challenge of any long-term nutrition trial. Taking a pill takes seconds. Sticking to a specific way of eating is a very different ask. The results need to be interpreted with that in mind.
And that’s why we can’t assume there is one way for everyone to eat. Food is personal. We need to keep that in mind and instead understand the true benefits and risks of a variety of dietary patterns. And more evidence is accumulating that the assumed cardiac risk from low-carb diets simply isn’t true for most people.
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Aside from the personalization of diet, we can also conclude that a standard lipid panel is not enough when evaluating someone on a low-carb diet.
That misses the true picture. Instead, we need to consider checking ApoB, remnant cholesterol, TGs, and assessing the full metabolic picture. A rising LDL in this context does not automatically mean cardiovascular risk is rising.
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