Opening Remarks Day Two by Dr Aseem Malhotra | PHC Conference 2018

[Music] further ado I'd like to start proceedings with a chap who is just new to this to this industry and he's starting to get to make some noise in the media just just a little bit of flutterings here in there it's dr. s Imahara [Applause] good morning everyone can you hear me the back yeah great stuff great stuff well really delighted to be here to start the kickoff proceedings this morning I'm sorry I wasn't able to be here yesterday I was actually in Prague to give a talk which unfortunately had to cancel because I've been pretty sick for the last several days but I've got just enough energy to to hopefully get through the next 45 minutes but if I don't there's enough doctors to resuscitate me I think here today to sort me out okay so I'm going to take you a bit of a journey which is going to involve some science and politics some intrigue some hope ultimately and I think that's what we need more than anything with what's going on at the moment my talk is today's some lessons in public health advocacy I wanna give a special thanks to Professor Simon Chapman who you will know a little bit more about by the end of the talk is a public health professor in Australia so some of you may have seen the slide several times because I've given it in a few talks recently but I think it's a really important slide because as a doctor we want to practice evidence space medicine so we can improve outcomes for our patients but not just for us as practitioners as healthcare practitioners but also for us as patients when we go and see the doctor we want to make sure that we've got somebody who uses his individual he or she uses individual clinical expertise use the best available evidence but also takes into consideration our values and preferences sadly evidence-based medicine has been hijacked by commercial influence and I think there are lots of things that are going on that hopefully will make Venice medicine great again that's what we want to do and patient values and expectations I think a crucial again are being missed and you know the father of evidence-based medicine of the movement professor David Sackett said half of what you learn in medical school turned out to be either dead wrong or outdated within five years of your graduation the trouble is no one can tell you which half so you have to learn to learn on your own and over the last several years I've been doing that and many people with me have been doing the same thing that we're trying to you know the science evolves how can we resolve the current crisis that we're in and one of the reasons about the main reason that many of us are here today many of us are campaigning and doing what we can in our own communities and in different medium different platforms is because we have this big public health crisis you know more than 60% of the adult population still remain overweight or obese in the UK one in three children in the same category and the costs are really astronomical type 2 diabetes is costing the NHS 20 billion pounds a year that's from direct costs to the NHS and indirect costs to the economy and the trends suggest that this will hit 40 billion unless we act appropriately and I think you know when I started my journey you know I think one of the things I understood at the very beginning is that you know we have in a be so genic environment that the processed food environment is actually probably the number one factor we can argue about dietary guidelines and we'll come on to that later but ultimately the fact is that the reason we're having this problem of obesity is that the default choice has become sugary processed foods wherever you go and what really inspired me is that you know the biggest scandal really is the fact that we allowed our hospitals to become a branding opportunity for the junk food industry and 2000 the summer of 2010 I was working as special registrar in her field hospital and I had performed an emergency procedure in the middle of the night and a patient who had a heart attack and we saved his life and the next morning on the ward round is I'm trying to you know tell him to take all his pills religiously including statins we know the magic drug statins and you know talking about stopping smoking healthy diet he gets served a burger and fries and he looks at me and he kind of you know perplexed that this is just to make any sense you know he told me about healthy diet and I'm served burger and chips so I you know I looked around and I realized also that many many hospital staff were also suffering from the same problems and diet-related disease overweight or obese and the first thing I did actually I remember that lunchtime I actually decided to write an email to Jamie Oliver I've been inspired by what he'd been doing and highlighting how bad school dinners were so I wrote to him but said well listen we need to sort out hospital food can you get you know can we can you make this part of your campaign strategy and I wrote an email and I didn't expect the reply I got an email address from a friend of mine who's a journalist for to his PA in about six weeks later he replied and we end up meeting for dinner several months later and he organized a dinner with several doctors and I think there was a consensus of opinion that actually yeah we've got an obesity epidemic hospitals should be certainly setting the right example and I wrote a piece in The Observer a few months later which I didn't predict you know the editor thought it was so important that he put it as a front page comment piece and the significant of that was significance of that piece was that you know even I was shocked that it was a front page comment piece of The Observer which is you know very prominent newspaper in the UK I mean a newspaper that I learnt later on Winnie Mandela said was probably the most significant most important newspaper campaigning for the release of Nelson Mandela so as a campaigning sort of newspaper certainly it was a good it was a good opportunity to get a message out there and they put it as a front page on the second page they had half a page from David Cameron as a new prime minister so that's how important they thought this this was and I was like a bit overwhelmed I was only a specialist for till the junior doctor at this stage so you can imagine you know there may be in a few look that I got a few looks in the hospital from some of my colleagues and my bosses there wasn't really any congratulations from anybody to be honest but part of that was because they didn't get it and you know that you know that still there's a big problem with doctors understanding of nutrition how impacts on health but anyway I wrote that I wrote that piece but then I thought you know there's more that needed to be done and less than two years later I wrote a piece in the BMJ really putting the evidence together I mentioned the slide at the beginning so we had to make a case for what is the evidence first of all that this is important the hospital food impacts upon patients and staff and actually there was a lot of good evidence it actually becomes you know people become more acceptable you know there's data in the states that shows that you know visitors that go to hospitals with who sell junk food on site are more like to buy junk food when they leave the hospital so I put this all together and said we need to stop selling sickness in the hospital grounds and it was press release and it was picked up by BBC News and then on the same day I'd actually strategized this as well I'd already planned a few months in advance that I was gonna up in the British Medical Association house and give a speech to time with with this piece which also hit the news and I got up and gave a speech and in in BMA house to make sure that the British Medical Association made it part of their policy that we need some banned junk food from being sold in hospitals and I gave that speech an overwhelming majority there was some opposition ninety-seven percent voted in favor so we then got the BMA involved and that was really important that there was a consensus amongst doctors and just moving forward I'm really delighted that only a few months ago I learnt that my local hospital where I grew up in Tameside just a few months ago was the first Hospital to ban all sugary products from the canteen I spoke to the chef only a few weeks ago who I'm gonna meet tomorrow for the first time and he had actually been following a lot of this stuff he himself had a family history of type 2 diabetes etc and he'd been following a lot of the work he'd been following Tim Noakes work he'd read my book he was using recipes from my book in the canteen and there's already having amazing results with their staff so I think you know what's amazing is they've actually banned all high glycemic index carbs from the canteen of the hospital so I think they deserve a round of applause paint [Applause] so I think this is probably the first in the world hospital to have low carb options in their hospital which is amazing so hopefully this is a start for more things to come okay what else do we know well when it comes to poor diet it is responsible for more disease and death and physical inactivity smoking and alcohol combined at the moment we no nutritional sciences and perfect but certainly it's quite clear that the the poor diet is the major issue now when you look at poor diet this shocked me actually a few months ago and this was published as a new story in The Guardian from a report that come out with basically suggested across Europe they linked and it's probably not surprising ultra-processed food consumption with obesity across many countries across Europe and England was was one of the worst UK was one of the worst half half of the British diet is now all too processed food half of that diet now where do you think where is that ultra processed food what are the food sources of that is it fat we keep still hearing dietary guidelines that we need to get saturated fat down we need to get fat down well no you know the evidence is telling us the ultra processed food most of that is coming from starch sugary drinks sugary products ultra process fruits and vegetables on this it's as fats 2% I was even surprised that that 2% from fats now vegetables are clearly a problem I suspect some of that is vegetable oils but most of the consumption of ultra processed food which is clearly the problem is is coming from starch and sugar so as Sam coined the the phrase for Public Health collaboration real food really does Rock right now it really does rock ok putting it in context if we're going to sort out the population wide problem then I think I need to reinforce this message that it needs to be a needs of population one intervention and Tom Frieden health impact pyramid tells us that making the default choice is going to have the biggest impact the healthy choice is gonna have the biggest impact than counseling their education is education is of course important but it will not be helped unless we actually make sure that everybody has the opportunity to have healthy food that's affordable and the reason for that is because these policy based interventions which include regulations such as taxing junk food or sugary sugary drinks will have the potential to reach all parts of the population even people who are not have the opportunity to have very specific education so their default becomes that they're eating more healthy food which has less sugar certainly so let's just go back in time a little bit here so you know the sugar issue has been raging for several decades actually and Jonghyun was as you know was the british nutritionist who said sugar was a real problem in relation to heart disease but he was hung out to dry and he was on his own he didn't really have much support for many other people and his own research had analyzed suggested sugar not saturated fat was a problem but when he came out with this there were lots of various industries in particular the sugar industry that attacks him they they did various things to impede his work you know they that you know he was he was he was called names they interfere with his research publication his funding and sadly you know answer keys at the time as you know he proposed saturated fat was the main cause of heart disease and you know there was the rancorous language personal smears I think this is important to remember this stuff because you know he that does not remember history is bound to live through it again and I think there are lots of examples I'm going to come on to how history could be repeating itself at the moment and yet condign in 95 and his warnings were learning to taken seriously until professor robert lustig comes along pediatrician University of California San Francisco and he gives a talk which has now about six million views where he says sugar is a real culprit behind type-2 diabetes and heart disease not saturated fat and he also wrote an editorial in Nature now I in my journey over the last few years when I was doing all of this camp started my campaign on obesity and trying to improve the best genic environment I looked at real Lustig's work and I thought to myself wow this is really impressive but this this guy seems to be on his own but he's getting attention here so let me look at this as well and see what I think you know does this make sense how can I apply this to the British population one of the things that was really interesting which I really which really resonated with me as a cardiologist is many of patients that was coming in with it were coming to my hospital who I was treating with heart disease and having heart attacks they weren't obese but they all seemed have the phenotype of metabolic syndrome and that's crucial because when you look at the data on sugar the the implication the actual science is telling us that it seems to be promoting metabolic syndrome through insulin resistance and actually 66 percent of patients who admits hospital now with heart attacks fulfill criteria for metabolic syndrome seventy-five percent of them will have normal cholesterol and more than 50 percent will have so-called normal LDL so for me that was what what Lustig was saying was sugar was actually its impact on health with independent of calories and that really resonated with me from my own observations so I started looking into this myself I thought that science was very robust it was strong it made sense and the other thing as well is that you know slightly crude slide is that there's no such thing as a healthy weight because about 40% of people with a normal BMI BMI will Harbor the same metabolic abnormalities as people with obesity now I'm not saying obesity isn't an issue of course it is you can have an unhealthy weight but there's no such thing as a healthy weight only a healthy person so I think that's a really important concept so I started looking at all of this stuff I looked at the American Heart Association and lusting in fact had actually infiltrated that particular recommendation and this was in 2009 and the American Heart Association's own analysis at that point it suggested that we should have no more the average male should have no more than nine teaspoons of sugar a day of added sugar and for the average female adult female 6 for the average four to eight year-old child that was suggesting no more than three but the average intake in America was saying that you know suggesting that they were having 22 teaspoons of sugar a day which is really quite a lot more than what were they were recommending as a maximum limit so trying to understand why that was and interestingly I looked at how did this apply to Europe and the UK and the first thing I did is I went to supermarket and started picking up some products and looking at you know because I wasn't sure I didn't understand you know what worked well what were the recommendations on sugar in the UK maybe they were up to date and reflected the science but they weren't in fact the European Union in fact all countries throughout Europe were recommending 22 teaspoons of sugar a day as part of a healthful diet it's quite extraordinary and they'd been doing this for a long time so I started to investigate this to work out how had this all happened and I even went to the root source I spoke to one of the public health nutritionists who was involved in the guidance and what I found was really quite shocking basically what happened was the food industry had really hijacked the nutritional information when the Public Health nutritionists were essentially suggesting sugars as part of you know what you find in fruit and vegetables whole fruit vegetables I know there's some debate about that but certainly whole fruit and vegetables for most people is not a problem they had hijacked it and basically suggested that what you get from a can of coca-cola or what they're adding is exactly the same sort of impacts on your health from a food which may be an apple or an orange for example and that is how they had managed to hijack this information so a Mars bar for example which has about a and a half teaspoons of sugar with giving similar advice saying this represents you know thirty odd percent of your guideline daily amount which is really quite shocking so I looked at this a bit a little bit more when I found out also in America they didn't even have any G da for sugar so no none of the consumers in America were allowed to really be able to decipher how much sugar they were consuming or how much they should be and that's important because actually about 50% of what's being consumed in America through added sugar comes from foods that isn't associated with junk food so you could argue okay well people know you know biscuits and candies and chocolates and ice creams are junk food but actually about 50% while they we're consuming of sugar their sugar consumption was coming from things like bread and salad dressings and foods they wouldn't consider to be junk so that was clearly a big problem so what else did I look at well the other thing that was real bugbear for me as well in all of this and i had kind of been passively absorbing this information myself well I didn't intrinsically believe it was that the whole problem that basically was due to lack of activity it wasn't because of what we're eating it was because we were doing we were more lazy now than we were 30 or 40 years ago and I looked at you know some of the there was a paper published by Kelly Brownell there really was a brilliant paper which really looked at the the food industry's sort of corporate playbook so deflect blame you know their role in obesity and how they'd influence dietary advice as well as as policy was basically they had focused on it being personal responsibility you know nanny state anyone who wants regulation nanny state but neglected you know too you know we get to understand that actually most of our increase in life expectancy and from public health regulations where those who involved safe drinking water seat belts in cars smoke-free buildings and you know they did various things like corporate social responsibility deals where when one particular city in America was considering a soda tax several years ago you know the local one of the the junk food industry companies gave the local hospital ten million dollars which was nothing for them you know and an essentially the sugar tax didn't happen and the other things I think that's quite crucial as well as that you know the is this as well so people who were speaking out you know they call them out you they have they're they're trolls they have their representatives calling food fascists you know perpetuating junk science all sorts of smears so that was something that I was aware of at the time anyway physical activity of a diet as we know you know when you look at the data yes exercise is great for many things you've heard it yesterday from Zoe Williams it's you know a very very good you know I would call it almost like a pill if you do it the right way but when it comes to obesity it's almost all what you put in the top end and the denialism by the the food industry was you know by the story tobacco industry which again managed to stolen through you know any government regulation for many years from the links between first things between smoking and lung cancer involved you know denialism where the CEOs of every major tobacco firm went in front of US Congress and I nights for and they swore under oath they did not believe nicotine was addictive or smoking caused lung cancer anything to protect profit so I'd been gathering all of this information and essentially I wrote a commentary in the BMJ in May 2013 because sugar was having no attention I was reading about this stuff I was looking at the labeling I was you know there was some information suggesting we were probably and I was looking around me and seeing all these people going and buying low-fat foods I remember where I live in North London there was a fat-free ice-cream place and you know it was just a line of people and I looked at them and most of them were overweight and they were there you know sort of gorging on this 0% fat smoothies or ice cream and I thought this is just this is just nonsense I mean do they know that sugar is probably causing its cause a lot of harm so I put this all together in a piece and I basically you know highlighted that the Scientific Advisory Committee and nutrition there is responsible for the guidelines I'm calling them out and said they need to update these guidelines because actually we are giving harmful advice to the public and this is causing in my view type 2 diabetes and contributing to obesity and the BMJ a press release did and in fact I remember calling Tim beforehand now in those days I'd kind of realized from other work I'd done that actually when a press release the likelihood of it having more impact if you have other people supporting you he'll have authority then it's more like to hit the news so I had support from from a number of people and Terrance Stevenson who at that time was the chair of the medical world colleges as well which was very powerful and I called Tim and Tim also give a very powerful quote about this as well about sugary drinks in particular being harmful and it was picked up by the press which was great because I thought that was a good start to try and get it into public reach and I went on BBC Breakfast and I talks about it and basically you know there was no one from the from the soft drinks industry or the food industry that was willing to debate debate me which really for me was very telling if that bill Turnbull said this to me at the very end after our we weren't offering said it's very telling a seem that non nobody came to debate this with you that you know people are being misled about sugar so you know that really started the ball rolling and then a few months later this became one of the probably most controversial articles I've ever written and again you know it's it's great to have so many inspirational characters here today I mean Zoey harcum I had I'd started reading her book my father had actually recommended it to me he hadn't he hadn't read it be read the reviews about it so I decided reading Zoey Hawkins book and I I was really fascinated about you know her take on calories and saturated fat and I read it in a lot of depths and I then started looking at some of the research around it and and sort of looking at all the information but one of the other things I was realizing at the same time is that we were giving statins to many of our patients along getting side effects to try and understand why saturated fat doesn't cause heart disease you then have to realize that cholesterol isn't linked to heart disease either or certainly the link is weak so I had to put the jigsaw together and in fact a lot of people warned me afterwards that I seen why you can go after the you know the food industry why do you go after the suta community at the same time and it still is still having a knock-on effect now but basically I said yes saturated fat wasn't the problem and you know we need to focus on sugar but I then added in we've also over medicated millions of people on statins and really we should be going down the Mediterranean diet which is you know according to the randomized control trial data much more effective than status now this had a huge impact and I think you know if there were lots of other people independently doing things at the same time Nina tight calls was in the middle writing her book which didn't come out for a few months later Zoe had already written a book on the saturated fat issue as well and I really wanted to give it more publicity in fact I referenced Zoe's book I think I'm quite sure I reference your book in certainly in this article I'm probably the last one as well and you know it got huge attention so it was front I was still a specialist registrar by the way just to just to let you know and I was working at cordon University Hospital this time and it got a lot of attention it was front page news of three newspapers including The Times I was debating with a professor from Imperial College about statins on CNN International News I was on Fox News it was it was crazy it really had a huge impact and it went on for months and months and months and as many of you know there was also later on calls for retraction by Professor wory Collins and there was a you know trial and all of that kind of stuff and that's probably another story for another time but the reason I'm mentioning this is that when this happened and I'm not said this publicly before when this happened about two days after it happened I just started working in Croydon and I was there as the interventional fellow basically doing all the cases I was sort of the main person doing all the angioplasty all the keyhole heart surgery cases for my bosses and I had a job there for a year and about two days after this happened and you know the nurses the staff they were overwhelmed you know coy Dan's name was on the you know in the newspapers are really happy you know well Don Meldrum and one day I walked in and one of the secretary said to me said assume the the medical director wants to see you and I my gut was this isn't going to be good and but they went oh no no I'm sure he wants to congratulate you you know for you not sure about that so anyway so I went up to this this chaps office had never met him before and he greeted me at the door and he was red in the face he was fuming he was almost frothing at the mouth and I went down and I sat inside and he just looked at me and the first thing he said to me is do you know your duties as a doctor I've been speaking to the GMC about you now several months ago one a journalist who's a good friend of mine who I won't name had said to me has seen me doing a lot of great stuff here but be very careful because it just takes one phone call and this may happen may or may not happen from any I didn't believe him really he said the sex state for health could just make one phone call to the chief executive and say shut him up okay not saying this happened but it was very interesting that he said he's been to the GMC and one of the things he did that I've know I don't think I've ever told him this but when the press release for the saturated fat article went out I'd again asked him for one of his great quotes you know for the press release and Tim had said something along the lines of after looking at all the evidence I concluded never prescribed a statin to a loved one now Tim had tweeted this as well and as I sat there opposites chap he had a computer screen and he turned the computer screen round and he had seen my retweet he said what is the meaning of this and it was Tim's tweet and it was a retweet there i sat there very calmly and I said listen this has been published peer-reviewed in the BMJ this is what the evidence says we have a real issue and he kept calm he didn't say anything he was quite polite by the end of it and that was the end of that conversation my job did not get renewed and basically I had to within two months notice I had to change jobs anyway I moved on I was okay but anyway let's say let's say there may have been some influence of what I said there okay so we move on what had happened in the interim when I published the sugar piece I've been contacted by a number of academics and they basically wanted to form a coalition to sort of the sugar problem out and they've liked what I've written and etc etc so you know we spent a few months strategizing how we were going to have a big media push to say number of academics come together say sugar is a problem and Simon cake walls quote in the press release with sugars in you tobacco and that was really a killer line and the reason I mentioned killer line is what I'll be more relevance to you at the end and when this happened on the front page of what is considered a right-wing newspaper The Daily Mail I knew we had won the battle for sugar because we had a right-wing government and they were there are most scared of the Daily Mail and when the Daily Mail put this on the front page that means they're backing it they'd already been some mutterings and we'd written several articles about sugar there was more and more articles coming up and they put this on the front page just became a huge story in the early 2014 and then we didn't look back you know it was it was crazy from then on I mean I think sugar has been in the news ever since but the Empire struck back within a few days we had a pallet we had political backing from the chair of the All Party diabetes group Keith Vaz and Keith basically put an early demo motion forward with lots of ramp he's backing what we were doing and saying listen yeah we need to back these guys we need to get sugar consumption down it's a big problem Andrew Lansley I don't know how many of you know who he is but he was a former secretary for health and he got up in Parliament just after Keith Mane's have put the motion in literally within a couple of days and he basically said that the analogy between sugar and tobacco was inappropriate sugar is essential to food he actually said that in Parliament sugar is essential to food and I thought anyway I spoke to the editor of The Observer comment editor of The Observer and I thought okay well this is a good time to you know there's a lot of stuff going on here this needs to be called out so we called out Andrew Lansley and I said that he would have be more accurate in saying sugar is essential to food industry profits and lining the pockets of its co-opted partners lanzhi was a paid director of marketing company preferred to the end of 2009 prefers clients have included Pepsi Mars Pizza and DHS Guinness and we didn't hear from Andrew Lansley on this ever again that was the end of it so I think that silence now when I wrote the sugar piece and I called them sack and the Scientific Advisory Committee nutrition to update the the guidance on sugar I really honestly had not looked into their conflicts of interest I'd suspected there may be an issue but I hadn't done and then Channel four dispatches basically found that five of the eight members of second had some financial ties or in future institutional ties to sugar manufacturers and I think that was really powerful sunlight for these guys because really I think they were put on the spot because up to that point they had been really responsible for since 2003 advising now you can argue the science wasn't strong enough and that's fine but for several years you know there was good science at sugar was harmful and they had been responsible for advising essentially that people should be consuming 22 and a half teaspoons of sugar a day so they got called out and we had further progress Jeremy Hunt called us and I went to meet Jeremy Hunt and then he asked us for a child obesity plan and I think really this will not have happened without the media without the media really backing us and going behind this I don't think we would have got as far as we would have got and certainly the politicians also became more aware because they were reading things in the media about sugar we move on 2015 again there was still a bugbear for me about chol activity and obesity and I thought that you know it's time that we nearly need to put this to rest so myself and Tim and Stephanie and a very I think another very courageous person who's here today at a very courageous editor of the British on Sports Medicine Karim Khan you know he was very encouraging that we write this so he wrote this editorial and again this had a huge impact was press release by the BMJ and I think you know I don't know I think ultimate trick scores tell you how impactful they are but it was pretty high and I think it became the most one most read pieces of the British Journal Sports Medicine from that for that year and I think what was important there is again it had a lot of media impact and what we also said in this is we needed a so that there was still mutterings about sugar tax and we said it needed a regulatory approach as well we needed to bring a sugary drinks tax in and that was one of the conclusions that we made and you know within a year 2016 George Osborne announced the sugary drinks tax which has just come into play in the last few months so I think that's a huge victory from really 2013 if you like about sugar becoming a major issue to having regulation so I think that's that's a really really good impact for the popular and we will see we will see that have benefits and I've no doubt in the next few years okay so I'm getting more towards the end of the talk now but you know one of the things I wanted to do and everybody said it seemed you know you need to write a book and you sort of put everything that you've been doing and writing about into a book and evidence-based lifestyle plan so III liaised with Donal O'Neil who's a film producers you know and a former international athletes had done serial killers which was fantastic and I'd watched and we basically got together we went to this Italian village in southern Italy were and silkies had actually spent a lot of time but had huge had really good life expectancy healthy lifespans to try and look at the secrets of the village and then marry that with all their best available evidence really cutting through the the BS the misinformation that was out there and try and give people a sort of new narrative and you shift the paradigm and how they understand their health how dietary changes can be very impactful very quickly and how they shouldn't really fear saturated fat but they should really cut the cut the processed carbohydrates out of the diet and we made the big fat fix which you know we were very honored that got a lot of support from many people here and we actually crowdfunded because we want to of commercial influence and it was covered in the New York Times and all of that really helped we then wrote the book the PRP diet which for me you know as many of you who know me know that you know I was more for what was most important for me is that this had impact on a very high level the you know the influences the politicians those people would read the book the the establishment doctors so that we could change medical training and I you know I Center and I spoke to the chair of the medical or colleges I had Cochrane researchers look at it and all of them were good enough that they would give support and they gave great endorsement so for me that was the most important thing and then it got announced in Parliament you know so Keith Vance got up and suggested that all MPs with high prevalence of type two diabetes and their constituencies should follow the 21-day plan the reason we call it a 21-day plan was because we wanted to also shift the narrative that dietary changes have an impact on health very quickly so I wrote this book and you know it was I got you know decent sort of decent impacts and some and some very good reviews from the right places and mentioned obviously mentioned in Parliament busting a few myths that I think many of you know now and acknowledged but we need to really get it out to the wider public and it was based upon science you know we wanted to base it upon the best available evidence so around just before that actually another editorial I wrote with Pascal Meyer and Rita Redbook both practicing cardiologist very eminent editors of medical journals as well really wanted to reinforce this message that saturated fat does not clog the arteries so look at the actual pathophysiology of what's the most likely cause of heart disease and how it develops and in some resistance is really the key and I put this slide together I put this sort of drawing together which was put into a slide and really you know it's a little bit crude but generally I think what it what it illustrates is if you construct an insulin resistance through the right kind of diet which removes processed carbohydrates reducing stress you know walking everyday briskly you know most of 80% of cardiovascular disease we could probably tackle both prevent and to some degree treat through these lifestyle changes and this again you know it was was yeah I think the fact that we had two other cardiologists involved I think you know helped really get more notice amongst establishment and I think it became the most again peace in 2017 in the British of any BMJ Journal but I think this message and he really needs to be reinforced but you know as expected there was David Haslam the former chair of the national beast before him wrote a foreword for the book and basically suggested that there will be slings and arrows that have already come a seams away but probably will continue to come his way and but I got a phone call from actually Zoe I think I was about to go in holiday and it was November last year wasn't it I think and it seemed have you seen the the Daily Mail the congratulations something like the British Dietetic Association having go at the P or P diet as a celebrity diet to invite her to avoid in 2018 the first thing I thought was like celebrity diet I don't know any celebrities on this diet but they basically made BBC News BBC journalists called me and I was like okay here we go so at least they gave me the right of reply and it was a decent right of reply but I think what was interesting it was that the the chief dietician of the British Dietetic Association essentially made some absolutely false statements so I think she'd either not read the book or being misinformed herself so I then hit back in the men's health in a long read and basically called called called the BDA out they said that the book was recommending a high consumption of saturated fat which it was and it was exonerating saturated fat as a cause of heart disease but it wasn't saying eat lots of lots of saturated fat they said that the evidence that we had used had been cherry picked which is also false because we had used systematic reviews to come up with this data as for the British and sports medicine peer-reviewed piece and you know the other thing was the Dwayne Mellor who's also one of the chief spokesperson for the BDA had said that our plan of 21 days was not evidence-based but there was clear evidence that dietary changes have massive impact in a very short space of time on whether its type 2 diabetes or cardiovascular risks so again there was a number of false statements that were made so I think what's interesting is when you look at the John Cleese did this tweet a while back and I looked at their cherry-pick statement and I thought that interesting so on Wednesday I was on Radio five life to take part in a discussion about fats and I was up against Susan Jeb one of the government's chief nutritional advisors and a dietician from rich Heart Foundation who I thought was actually very reasonable very good and the debate and discussion was generally quite quite civilized up to the point where when Nihal the presenter talked about the the changes that you know the the advice on saturated fat he'd mentioned the national obesity forum public health collaboration report said what about this you know they said all of this and Susan Jed said yes well it was quite clear that they cherry picked you know the evidence and all that kind of stuff and I said well no no I'm sorry I think the people that are doing the cherry-picking what concerns me are the establishment they are cherry-picking evidence at suits industry and not what reflects a total to the data and our patients and scientific integrity so I think this important for people to realize what's going on because you know there is a battle going on over here and some people in the establishment who have a lot of eminence in my view are actually purposely cherry-picking data and accusing others who want to look at the totality of the data as doing the same thing now there are many amazing stories amongst people here friends you know we've all heard these stories people going low-carb you know this stuff does work and I'm seeing many many patients that are coming to see me that really within you know within weeks two months of changing their diet cutting out the process carbohydrates are coming off medications are dropping their blood pressure this is Stephan who I've never met and with permission he's allowed me to put this slide up who posted on my facebook wall and this really keeps us going because for me personally what really gives me more energy and inspiration to carry on in this battle and it's not an easy one is is my patients is the fact that the patients are coming back and with their positive amazing stories and you know he wrote this which is really quite extraordinary story but we know that when people actually put this into practice it has an impact now I don't know whether the British Dietetic Association have a psychic or some sort of clairvoyant as part of works for them but only last week Sarah Cox who is actually I would say a celebrity figure probably the first one who's publicly come out having heard me talk about sugar on the Jeremy Vine show basically adopted the PRP diet for 21 days and has basically managed to have benefits already and she concludes that she and we all know this when you cut the sugar off the Alina energize less bloated and more healthy I generally feel like this is no longer a diet plan it's just the way I eat so yeah maybe you know it now is a celebrity diet I don't know at the same time now I'm not going to talk about this in great length but we have this obesity crisis we also have a massive problem with an over medicated population and a lot of the data that's driving clinical decisions has been corrupted by commercial influences no doubt about that the evidence for that is overwhelming you know and pizza Gosha is one of the cofounders of the Cochrane Collaboration his own estimates suggest that the third most common cause of death now after heart disease and cancer prescribe medications what your doctor prescribes for you 50% of that is because the side effects 50% of that is because of medication errors but it's a huge problem and these things are interlinked you know if we're going to combat the obesity and chronic disease we also have to highlight the too much medicine aspect as well they are they're not separate entities they are very much interlinked and we need to put one in front of the other we've got an imbalance at the moment as you know but there's another problem is that there is corporate crime going on and between 2009 2014 most of the ten largest pharmaceutical companies were found guilty of fraud and paid fines up to 14 billion dollars combined for illegal marketing of drugs hiding data on arms and misrepresenting research results so this is a major issue and it's not being tackled head-on and a few weeks ago I was invited to speak in the European Parliament and really highlighted this issue and I it was myself and some other eminent doctors a former queen of England's for his personal physician for 21 years so Richard Thompson he was a really great man and he you know he has been following this for a very long time he was a present Royal College of Physicians he's got a lot of experience and he realizes his problems been going for a while and we called really for something called like a Chilcott quiet Chilcott style inquiry like into the war to solve this problem because I think it's so deep-rooted with academic institutions hiding research misconduct we know there's a big problem in British institutions and again for me when this was happening I thought you know what let let everybody as many people as possible know that we are talking about this to get this information out there because ultimately sunlight is going to be the most powerful disinfectant and when the reason this has gone on for so long is because people are not aware of it I think most people are intrinsically good they want to do the right thing even people within these companies you know everybody has is affected by this that their patients sorry their friends their family as us as individuals when we go and see the doctor we want to make decisions about our health based upon the best available information which has been least corrupted as possible by commercial influence so we call for a Chilcott style inquiry and in fact I just so you know I also made sure that the chap who's in charge of the Science and Technology Committee the chair of the Science and Technology Committee Norman lamb president MP iíve had some message exchanges with him he seems like a good guy and I said to Norman over a text message I said Norman you know he's currently there currently looking at scientific integrity and there should be a ruling on this in the next few weeks but I said this and I think this is a much bigger issue and how ultimately we need this Chilcott style inquiry to sort this out because I don't think tinkering on the edges is going to is going to solve the problem so he's aware of it and let's see what happens but you know that people at the top and know what's going on and I have the other thing that's happened over the last several years I've had the opportunity and privilege to meet many politicians across all parties and I do keep them updated with all the stuff that's going on and they are aware of what's going on so hopefully that will will continue to help to make change happen now almost finishing up just to reflect so Simon Chapman is probably one of the most influential figures in Australia for tobacco control so he wrote a paper which is a great paper to read you can access it it's a free online access he gives some advice about his 38 year career in public health advocacy and he makes a number of points which I think I think important for people to to appreciate so always respect the evidence you remember the site at the beginning 50% you know science involves so respect the evidence and if the evidence changes so should you now a lot of academics are still took stuck in you know old dogma and they're not changing for whatever reason some of it just because of intellectual conflicts of interest some of it because they don't admit they're wrong but you know medicine is not an exact science nutritional science even less so and I think we need to accept that as new information comes along we need to adapt and change with it be clear and concrete about what you want to change your support so you know our goal may be that we want to reverse Abbey city in a few years ok so be very clear about that make those make those comments study the media without media attention in the the chances of success are much much less you know the more people are aware of it the more likely change is going to happen you know this is about making what is an injustice visible you know there has been a gross injustice it's still being committed on the good British public and people around the world because of misinformation because of commercial influence and if you make that injustice visible it can change any revolution that's happened has happened because you know whether it's people like Nelson Mandela or Martin Luther King or Mahatma Ghandi they have made their injustice visible through use of the media use killer fax so you know killer fax have you know your information you know know that the average British citizen for example is consuming 20 teaspoons of sugar a day and it should be closer to 6 you know these sorts of killer facts are really important other great lines you know type-2 diabetes a condition of carbohydrate intolerance you can't outrun a bad diet this is for use of the media fitting for people to really acknowledge and understand what's going on David Unwin has a great line out you one thing that really annoys me when people say you know you hear in the media and some commentators oh it's about everything in moderation and I find it really annoying and I just think well actually what would be great a great response whenever I hear that now I use David's line I say well actually telling a type-2 diabetic to consume sugar in moderation is moderately poisoning them that usually shuts them up values of everything you know people make people care about it affecting children's health our health you know there are great stories as well I think experts are good you know it's good that I can go up in front the media and talk about something and that has an impact what has more impact as a patient story it's people like Stephen who say you know I'm feeling better I ignored my doctor's advice and I've reversed my type 2 diabetes those stories are very very powerful so having for media purpose for it for a story when you read articles as always if you notice as a patient story at the beginning because that actually you know people are we're emotional beings a lot of this is driven by our emotions but then we obviously I need to use evidence to support that use social media huge way obviously a lot of us here use social media great way of getting the message out successful advocacy takes time Simon Chapman talked about the fact that it took in 1976 they first banned smoking on buses in Australia but then it took another 30 years before they banned it in working environments in fact that was more importantly takes time I think we've done very well within a very short space of time of getting awareness about sugar to get some impact but it does take time and last but not least grow a rhinoceros hide okay he says it's finally unless you're an advocate of an utterly uncontroversial policy as soon as your work threatened is an industry or ideological Cabell you will be attacked sometimes unrelentingly and viciously and that's what Simon Says and I think you know we know that this happens there are many people here who have who have put their head above the parapet and you know even amongst colleagues in your community but even on Iran on a scale in terms of mass media you know but there's hope we can do this you know there are many public health successes which have gone through the same process but there is a battle and I think that you know if we carry on that we walk we will eventually get there and this final slide I'm going to credit to Sam he doesn't know that I what I was going to put up but actually Sam Sam Felton has been for me in terms of helping we wouldn't me with my social media a lot of the videos that you see that go online because I want to see if something happens I want to get out there so people can see what I'm doing as well and without fail I've called him up I by the way I'm a complete technophobe I have no idea how to do this myself and without without without any failed Sam without any hesitation he always does this for me and puts puts videos up of things I'm doing which is great and one of the things he did a few years ago which I thought was brilliant I thought it had to put up is at the end of a discussion I was on it was a men who made us fat and I was part of the medical Royal Colleges obesity group and we talked about the fact we need government regulation and it was an interview and Sam put this video together at the very end at the very end of this and I said you know we converse obesity if we do this this isn't this and Sam put this brilliant sort of mock and newspaper article at the very end which I just thought there is her we will get there in the next few years and it was this is that UK reverse the obesity epidemic now can we get there by 2:30 2021 I believe we can if we fight for it we can do this absolutely we can okay so my final slide just what one of my inspirations is is Gandhi many people especially ignorant people want to punish you for speaking the truth for being correct for being you never apologize for being correct or for being years ahead of your time if you're right and you know it speak your mind even if you're a minority of one the truth is still the truth we are no longer a minority of one we are actually the many and those dark forces that profit private profit in front of public health they are the few we are the many and we can do this thank you [Applause] you

Channel: Public Health Collaboration

Views: 14,271

Keywords: diabetes, diet, nutrition, health, public health, low carb, obesity

Id: M6UnBOWQ8Bc

Length: 49min 2sec (2942 seconds)

Published: Mon Nov 05 2018