EP302: Discussing Low Carb and Keto and CAD with Doctor Kostner and Doctor Sangster

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Introduction: Dr. Warrick Bishop, a cardiologist and CEO of the Healthy Heart Network, hosts this episode discussing low-carbohydrate and ketogenic diets with guests Dr. Tony Sangster (a type 1 diabetic for 56 years) and Dr. Karim Kostner (a lipid specialist). The episode explores how reduced-carbohydrate diets affect blood sugar control, cardiovascular health, cholesterol levels, and saturated fat intake. Key Takeaways: Tony Sangster achieved remarkable blood sugar control on a low-carbohydrate diet, reducing his HbA1c from above 7 to below 5.5 (non-diabetic range) without experiencing dangerous low blood sugar episodes. Low-carbohydrate diets work by reducing sugar intake since carbohydrates are chemical structures that break down into sugar, directly lowering blood glucose levels in the body. Ketogenic diets trigger ketosis, where the body switches from burning glucose to burning fat for energy, producing ketones as an alternative fuel source with potential anti-inflammatory benefits. Some people on ketogenic diets experience significant increases in LDL cholesterol (up to 10-15 millimoles per liter), particularly those with genetic predispositions to absorb dietary cholesterol differently. Short-term LDL cholesterol increases are not immediately harmful, but long-term effects in people with sustained elevated levels remain understudied and potentially concerning for cardiovascular risk. Low-carbohydrate diets provide metabolic benefits including improved weight control, reduced inflammation, better insulin resistance, and improved blood pressure control. The approach to diet should differ based on individual risk factors: patients with diabetes or existing coronary disease require LDL-lowering medication alongside dietary modifications, while healthy individuals without disease may not need immediate pharmaceutical intervention. Statins are well-tolerated by 95% of patients and are recommended for those with diabetes or coronary disease, though some individuals (like Tony) experience significant side effects requiring alternative approaches. The distinction between saturated fat intake and LDL cholesterol is important, as saturated fat can increase LDL levels through specific metabolic mechanisms. Long-term longitudinal studies are needed to determine whether the benefits of reduced-carbohydrate diets outweigh potential cardiovascular risks from sustained elevated LDL cholesterol in vulnerable populations.