The TRUTH Behind Statins: Helpful or Harmful? | Mark Hyman & Aseem Malhotra

about 1 billion people around the world are prescribed statins total revenues from sales statins have reached a trillion us dollars and actually heart disease most of heart disease is rooted the biggest risk factor if you like is the most important thing people need to realize is that heart disease is not a statin deficiency number two that it's primarily driven by lifestyle and primarily by the amounts of carbohydrates that we're eating sugar and starch flour and sugar and three that the over focus on ldl is misguided and then in fact it may be other biomarkers such as triglycerides and hdl or the total cholesterol to hl ratio or the inflammation biomarkers or oxidative markers around cholesterol or the particle number particle size things that we're not typically looking at insulin i mean if i had one test to look at heart disease actually a risk i would do a glucose tolerance test measuring insulin fasting and one or two hours later because that that's going to tell me almost more than any other test and it's something that most people don't do so and then the the other thing we kind of covered was that we need to do the right cholesterol profile which is the nmr or cardio iq test from lab core quest which you can get from your doctor it's a much better way of looking at the total picture along with the other biomarkers of blood sugar insulin a1c inflammation markers and so forth and that and that the good news is that according to the epic trial and many other studies 90 of heart disease could be prevented by simple lifestyle changes eating a whole foods real food diet exercising a little bit not smoking keeping your ideal body weight i mean that's pretty simple and you had a meditation you might even get a better benefit that's a 90 reduction right absolutely actually really relevant and yet statins although they are good for certain patients with high-risk conditions or with lots of plaque or who've had heart attacks they do form part of the tool kit but i would just sort of emphasize i saw it as one sort of medical journal that said lifestyle doubles the benefits of statins i'm like oh god that is such a poor framing you know in fact lifestyle may be all you need if you are aggressive enough and i and i have patient after patient i'm sure you do who are on all the medications they're on high blood pressure medication they're on statins they're on aspirin they're on uh you know uh all kinds of cardiology medications and when we and they've had a heart attack and their numbers are better off the statin once we fix the underlying lifestyle issues yeah actually their whole profile looks better um so that's to say that you need to have a more nuanced view around statins a new svr on heart disease to deal with the root causes of it ninety percent of people with pre-diabetes are completely undiagnosed and one study i read from i think it was from the uk uh about um if i get the numbers right i think the the two-thirds of everybody coming into the hospital with a heart attack had either diabetes or or undiagnosed pre-diabetes yeah that was the biggest yeah so and so two-thirds of people admitted this large u.s study um several years ago that showed that two-thirds of people admitted to hospital with heart attacks had metabolic syndrome so that's the worst type of poor metabolic health you've got five markers which will go through and if you have three of those abnormal which basically is linked to high blood pressure uh pre-diabetes or type 2 diabetes increased waist circumference high blood triglycerides and low hdl those are the five if they're three of those are abnormally have metabolic syndrome 66 percent of people admitted with heart attacks in the us have metabolic syndrome so three of those abnormal um but 75 of them had normal ldl and normal cholesterol so clearly what did you just say wait wait wait wait wait wait wait wait slow down you're talking fast slow down you just said that 75 of people admitted to the hospital with a heart attack have normal ldl cholesterol yeah this is from 2009 yes but only 10 percent had optimal hdl yeah probably yeah that's true and i think i think i think about 70 had abnormal triglycerides yeah right yeah yeah so so the question is at that time so why have we not changed things i think one of the things you say you hit on the nail on the head there but lack of awareness of nutrition and that kind of stuff one of the things that's also there's a huge lack of awareness is about how rapid lifestyle changes would die at the forefront but the other things of course are crucial um can improve those risk markers of metabolic syndrome so one study showed that in uh you know 50 of people with obesity that had a dietary change which in this particular trial was low carb okay reverse their metabolic syndrome within 21 to 28 days mark right that's massive right so those risk markers are trying this right it's coming down hey sure coming up even blood pressure coming down some degree getting out of pre-diabetes getting out of type 2 diabetes they start to have an effect and that's why i wrote this it wasn't gimmicky i mean 21-day immunity plan was also based upon those principles uh and the same thing i talk about in this book as well is that people will see the improvements of those markers very very quickly if they adhere to the prescription the lifestyle prescription that we you know doctors prescribe for them that really focus on insulin resistance that's it if you focus on infra resistance as your end goal to improve that through various lifestyle mechanisms but dietary change alone is the only intervention mark from any study that lifestyle study that can rapidly improve those markers what's really striking to me is even at major major heart hospitals around the world the heart disease prevention diet the cardiology diet they get when they go in the hospital is a low fat high carb diet i know and i'm like what's going on here it's like we're living in the in the dark ages and the data that's now here is not getting incorporated into the practice of medicine which is really unfortunate so i love your work because what you're doing is you're you're you're not just taking things at face value you're looking under the hood you're looking at the data and you're creating nuanced conversations that aren't black and white it's like statins bad you know uh no absolutely it's really about about looking at the honest accounting of what we know we don't know and actually where should we be looking so as as a cardiologist what what really is the best predictor of heart disease if it's not ldl and and what can we do lifestyle wise to both prevent treat and reverse the risk and even the status of actually having heart disease yeah so um mark so i think again i would come back to this keeping the basics stuff that relatives relatively simple to measure inexpensive okay so what you know the things i always go through my patients like so let's go through these these five markers what's your blood pressure you want your blood pressure ideally to be less than 120 over 80. now the diagnosis is if it's more than one between 120 and 140 systolic um or between uh you know um 80 and 90 diastolic then you have pre-hypertension and that that doubles your risk of stroke and also contributes to heart disease so you want to look at the blood pressure hba1c should be less than five point seven percent between five and different i know different countries have different ranges but essentially between five point seven percent and six point four is pre-diabetic and six point five and above is type two diabetic so you want your hba1c to be less than 5.7 ideally um you want your waist circumference for a caucasian man to be less than 102 centimeters measured around the belly button and less than 90 centimeters if you're female um and then uh your triglycerides should be ideally uh less than one millimole per liter which the equivalent i think in the u.s is i think 150 milligrams per deciliter mark you would probably correct me on that if i'm wrong i think that's the range it should be less than 150. um and the hdl to be similar so when you're above 150 right so greater than one millimeter and if you have those all in range which is you said earlier on actually having all those markers in normal range for the average american adult is only about 12 percent of adults 80 of adults in the in the us don't have those in the normal rates which is which is very troubling right and this isn't just older people only one in four adults age between 20 and 40 mark in the u.s have those in the normal range and this is what we're dealing with but the good news is again those are really indirect markers of insulin resistance if you want to do more slightly more expensive tests and people get this in the us more easier than the uk is uh do a fasting insulin level and there's a the different units i won't give you i won't get it wrong with but there'll be a normal range i think it's less than it should be less than six international units i think if i'm not wrong in terms of insulin fasting insulin right so that's another marker that you can use so once any of those are out out of um out of the normal range then you've got some degree of insulin resistance so the question is what can you do about it and then it's well let's just go back to very basic principles i i keep it simple so um avoid ultra processed foods what are ultra processed foods well the data now and i know you've been a big advocate for this mark in recent years as well and writing about this is the you know more than 50 of the uk diet more than 60 of the us diet is now coming in terms of calories from ultra-processed foods i think here's 67 67 right it's unbelievable this is food that comes out of a packet that usually has five or more ingredients a combination of sugar starch unhealthy oils okay usually with additives and preservatives and that's a very simple rule of thumb so i tell my patients if it comes out of a packet and has five or more ingredients it's the ultra process of oil and that includes even packaged bread right so these are the things to cut out and then low quality carbohydrates so minimize sugar and low quality carbs so these are refined carbohydrates and lack fiber your white breads your pastas your rice your potatoes now it doesn't mean you have to completely eliminate it it depends where you're starting from so a lot of people have also metabolic health already who are generally doing this stuff right eighty percent of the time probably don't need to be as strict but if you're studying position where you're type 2 diabetic and all your markers are off then you have to be more extreme to see the bigger benefits right so um what you know listen my insulin levels are like less than five pretty much about two i have about six percent body fat yes i'm bragging but i i'm pretty bad about how they exercise a lot i eat really healthy and i went to sardinia last summer and i'm like you know here i am for a week i'm just going to like eat whatever and i'm going to eat the pasta the bread i'm going to drink the wine and i went i you know i was treated well and had a very you know abundant diet and i gained like five pounds and i got the belly fat and you know it was so even if you are extremely healthy if you start to eat more of that stuff you're gonna start accumulating that and yeah and it's really uh you know unless you're just like doing a marathon every day it's really tough to keep up with that carbohydrate that we have sure so that's a really important point yeah i think we have to be aware of that again we become um and the different people are more sensitive to these carbohydrates as well right so i think uh you know one of the there's a quote in the book from dean ornish i i quoted him just to give people a concept to understand a bit of nuance with this management mark is that it takes more to reverse disease than it does to prevent it well i think he was borrowing from uh benjamin franklin which says that uh an ounce of prevention is worth a pound of cure absolutely right so i think i think yeah but but the bigger picture for most adult you know in europe americans around the world the big issue is ultra-processed food low-quality carbs as you said um and i think if you get that out of the diet then it's about patient preference in the values i'm an advocate for the traditional mediterranean diet but minus then the way we're living now you know the ultra obviously the starchy stuff because there is as you know we talked about got microbiome as well the positive side comes from with the best available evidence we have and things evolve seem to be that there is antioxidants anti-inflammatory components with with whole fruit vegetables um you know extra virgin olive oil nuts and seeds um you want to be getting obviously enough protein you want to get all your nutritional requirements as well so you think about okay what how am i going to get all my nutrition requirements so i minimize the need for supplements i mean i know supplements have a role but minimize the need for supplements right um and and also reduce the chances of me developing insulin resistance from the diet and if you focus on that so i do with my patients then as long as you get the base of the diet right other things here or there doesn't matter so much so get the base right cut out the the the crappy stuff on my language right and then i mean and then it's about preference around these different cultures right different types of foods indian food chinese food whatever there's going to be obviously some some big differences in a lot of the food that people eat yeah i think that's right and i think i think the the um the lifestyle stuff is so huge and you know you talked about the piapi diet i talked about the pagan diet it's essentially focusing on quality so whatever you're eating the key concept is it should be high quality meaning nutrient dense unprocessed whole real food and you can kind of go up the chain you know eating a a feedlot steak is better than eating for example uh you know a bunch of of bread right but it's not as good as eating wild elk or eating a grass-fed steak so you can keep going deeper in the quality chain the second is to really understand that food is medicine and then everything you're eating is regulating your biology in real time and three it's personal everybody's biologically different and some people may be more carbohydrate tolerant than others some people may be more fat intolerant than others and there are ways to figure that out which is really absolutely absolutely so that that really covers a lot of the diet side of stuff and then obviously the heart you know from a heart disease perspective um exercise i think we've somehow over edited the most important message is keep moving do what you enjoy be careful of overdoing it a lot of people get injuries they overdo it there's uh you know um especially if you're stressed out and you're doing more than say 60 minutes of moderate to vigorous exercise as a day more vigorous side that can actually worsen your stress so the data really says that you know 30 minutes of moderate activity a day um and you can do different things you do pilates you do yoga you can do cycling you know i'm not a particularly big i used to be a runner i've kind of shifted multi cycling now because you know if running on the road generally is not particularly good for your knees i mean i do sprints once a week i do hit right so all these things are there but do enough but don't overdo it right with the exercise and then the big thing mark um something i've discovered in the last few years which certainly has a big impact in my patients is stress psychological stress chronic psychological stress which on in its own right and i write about in this book is the equivalent of another risk factor like high blood pressure or type 2 diabetes in terms of its cardiovascular risk but a lot of people aren't managing that not realizing how important is and of course it links to inflammation um there's a lot of emerging data there's this stuff related to clotting problems increasing fibrin in the blood which is involved in as a clotting factor um and what i do with all my heart patients is i ask them you know i do a very simple questionnaire kind of on them and i asked them in you know naught to ten in the last few years you know these people come they've already got diagnosed heart disease some people who've had scans done they've got some firing of the arteries and i say to them you know where is your stress levels in the last two or three years i know it's obviously been pandemic time so it's a bit skewed but in general most of them say you know that they are stress levels are kind of eight nine out of ten right for the last few years and they've not done anything about it and then i write about in the book you know we we need better quality data and more data but what's fascinating the the largest study on heart disease reversal which was done in india um by uh a cardio interventional cardio school mount abu healthy heart trial yeah um basically it took patients with a significant coronary disease so well over 100 patients moderate to severe so at least 50 to 70 blockages in their arteries these are people that didn't want to have a bypass operation they want to have stents and he put them through his healthy lifestyle plan now in india there's a lot of vegetarians so it was a very high fiber vegetarian diet yeah there was some starch in there but it was very high fiber vegetarian diet it was moderate exercise so two 30 minute brisk walks a day okay and then it was something called raj yoga meditation which also wasn't just about meditating it was like there was a bit of counseling it was about reconnecting with your family and your friends and the social aspect trying to reduce stress levels long story short the end of the you know after two years of the trial then followed for five years they found that uh in the people that adhered to the lifestyle program there was a 20 reduction on average in the stenosis of the arches which is unheard of right you mean the fifty percent of the clogged arteries got better yes yeah they got better they reduced from say seventy percent fifty percent fifty cents thirty percent i mean extraordinary right this is no statin no stan this is pre-stands no stands and then when they try to look into what was the most important factor by far of all the lifestyle factors that contributed to the reversal it was 40 minutes of meditation a day wow right so this is a big missing area i think and and i think the other thing about the stress reduction which links to chronic inflammation that's so the mechanism is that we think now heart disease these plaques that develop these blockages they're dynamic processes so you get some inflammation you get a plaque formation it then progresses you can potentially it seems it seems that you can potentially reverse those blockages or reduce them but the biggest factor so far i think that's been ignored is stress reduction through meditation and as you know as well if people incorporate that then they're also more likely to sustain the lifestyle uh the other lifestyle factors in terms of endearing to the diet but their mental health is better mark so it's quality of life it's not just about something potentially being helped with in the long term within a few weeks when people do this and some people need more help you know i i find it difficult to meditate um just from using an app um i have a pilates teacher that i started seeing a few months ago that comes to see me once a week i need to probably do more it was fascinating within an hour even that session of pilates one hour which is also you know it's a great exercise but it's meditative wow you feel your stress levels you just feel like a different person yeah yeah it's true i mean i i think that you know the mechanisms are interesting when you look at stress what it does is a number of things one as you mentioned increases inflammation two it increases cortisol which is a hormone that your body makes that actually causes your blood sugar to go up your blood pressure to go yes causes your lipids to get worse if you look at race car drivers before and after a race their cholesterol goes up a hundred points just from the stress and not only that but it actually uh it actually causes your fat cells to store more fat so if you eat under stress there's nerve endings that innervate your fat cells and the stress response communicates through your nerves and your autonomic nervous system to your fat cells and tells them to store the fat so it's kind of a big deal and i i agree with you i think you know we are under such a barrage of stressors in our lives whether it's work family stresses financial stresses cove stresses climate change i mean the new i mean just i don't watch the news anymore it's just too stressful for me uh and and yet it's it's so simple it's free it's accessible uh and i i've i've been practicing meditation for years and it's such a key thing to help regulate your life and your biology in so many ways it improves the stem cell production it reduces inflammation improves neuroplasticity and brain connectivity uh the data is just so powerful on this and if anybody's really interested you can listen to the podcast i did with daniel goldman about his book altered traits which studied advanced meditators using very advanced imaging technology looking at their brain function and their and their brain waves and see what happens when you have somebody who's been meditating for a long time but it really does you don't have to be a professional meditator or you're living in a cave for nine years just 20 minutes a day or 20 minutes twice a day is very powerful and i personally use a technique uh it's called ziva meditation ziva meditation you can look it up online you can take an online course learn how to do it it's super easy uh and you don't need any special equipment except you know sit on the floor or chair and and through that technique uh you're gonna have all kinds of benefits not just heart disease but all kinds of benefits so i encourage you to take heart to what you're saying because i think it is one of those neglected factors so diet exercise stress reduction sleep i think the the um the data you presented on the reversal is quite interesting because most of us don't think we can unless you take aggressive high dose statin uh you know dinosaur's work showed that there may be possibilities through lifestyle interventions to change the course and actually reverse reverse the treatment and mark anecdotally i'm getting patient and i will be writing about this soon and hopefully i'll be able to even fund a trial to try and get a bit more definitive in terms of the answers but i'm seeing patients many of my patients coming back who have either halted the progression of heart disease so you know from imaging and some have even had some reversal uh one patient recently contacted me and i was i'd forgotten you know i was and said you know dr martial i saw you in 2019 um she'd suffered a tia a mini stroke she'd had a blockage in one of her blood vessels of 75 and she remembered back saying i've followed your lifestyle protocol and uh and i was shocked mark to receive this i was i had to read it again and she said i've repeated the imaging and now the reduction is it's gone to less than 50 percent within two years i mean and i'm and i'm just doing what the data you know i'm saying the very least let's reduce your risk i don't give people promises and say you know there is some potential here but your quality of life is going to be improved we're going to improve your risk factors and you and hopefully you know there may be some reversal but at least we can help stop progression at the very least you know according to what would happen normally and uh and the feedback is extraordinary once people want to once people follow it so we need to try and get this more data of course but we need to get this more inculcated into medical practice as well across the board i mean the behavior change factor is a huge thing that's a separate topic which we could spend hours on i've yeah i had uh bj foggy talking about behavior change and i talked about the daniel plan and behavior change so the power of community and and the power of group support or medically um you know uh group of point medical group appointments or shared medical appointments can be very very effective and we we've seen this that even getting people to change their lifestyle is and the outcomes are almost three times better using groups than actually one-on-one doctor visits we've done that at cleveland clinic it's really quite interesting data to see i have always had a love hate relationship with statins because they are a drug which has some benefits but what seems to have happened is that there's been a wholesale embracing of this class of medication as the panacea for preventing and treating heart disease and your book challenges that thesis one that ldl cholesterol is the problem which is primarily what the statins do is lower ldl and two the statins are not a free ride that they come with a lot of inherent risks and side effects and three they're actually not that effective and that the data we have has been highly manipulated and uh and it reminds me of a quote from i think mark twain or maybe roger roger williams he said there's uh liars there's damn liars and they're statisticians and i think you know the way that the data get squeezed and manipulated uh often give the impression of a profound benefit but you challenge that hypothesis and you challenge us to think differently about statins before we continue down this track and more detailed discussion i think what people need to realize is that we are i am we are coming from a position about ethical evidence-based medical practice and about giving the right patient the right treatment at the right time with informed consent and uh and at the same time mark also give people an alternative plan uh whether or not they choose to take a statin and again that i would always argue that's the the patient's choice ultimately um but also to not be ignoring something that you've pioneered magnificently over many many years the impact of lifestyle which as you know is um more impactful in many ways than than medications and come without side effects and um mostly it has a lot of lifestyle lifestyle has a lot of side effects uh well-being happiness joy that's what it's about right because you know we're all going to die eventually but we want to have the best chance of having uh authentic happiness for as long as possible and of course our happiness is very much linked to our physical health as well so this is really the the heart of the book and uh you know i've researched this as you know uh in detail probably over a decade looking at cholesterol trying to understand the root cause of heart disease and trying to shift the conversation um and shift the balance towards you know overall improving individual patients health but also population health as well i think what we've gone wrong is we've grossly first and foremost grossly exaggerated the fear of cholesterol in its role of heart disease um we've then now uh because of that fear um the focus has been that the primary way of preventing heart disease is to reduce cholesterol and and the most effective drugs that doing that have been statins so widely prescribed markets estimated potentially about 1 billion people around the world are prescribed statins it's also one of the most lucrative drugs in the history of medicine um it's estimated i think last year total revenues from sales statins have reached a trillion us dollars so there's a lot of money involved as well and i think that is important for people to be aware because i think introduces a huge bias into the conversation a lot of vested interests depend on fear of cholesterol lowering and um and statins you know and other cluster lowering drugs so it's like well actually let's just break it down so that people are better informed and then you know one thing i've also advocated for is something called shared decision making um which is an approach where you have a more equal partnership when it comes to conversations with patients about any kind of treatment or investigation that they're going to go through but except that it's really important that we take into consideration patients individual preferences and values so if you look at the evidence-based medicine triad which is geared towards improving patient outcomes there are three big components so you'll use your best available evidence uh your individual clinical expertise and last but not least patient preferences and values and if you if and what i teach my medical students is if you are adhering to those principles then you are going to increase your chances of improving your patients health and well-being and that's really what it's about so um that's really the the background to the book that's great you know i think i think that's a very important framework and what i would like to do is zoom out for a minute and have you answer a couple of key questions because you know i hear conflicting versions of the data from cardiologists and it seems yes number one killer in the world is still heart disease um however i've heard cardiologists say we're winning the war because death rates are going down uh we're better at actually treating the disease we're betting at preventing the disease statins have played a big role in that and and we shouldn't ignore that fact but but you you suggest that maybe that's not true and in fact maybe you know that the death rates aren't going down um maybe heart attack rates aren't going down so can you kind of impact the data for us and what is the truth about yeah one you know this this massive this massive uh drive to put everybody on a statin if your cholesterol's a little high yeah um yeah absolutely and the fact that maybe um maybe it isn't doing all that it's cracked up to do so talk about so yeah that's a very good point right so let's try and break all of that down so death rates from heart disease uh started to increase in the 1920s um you know look at data in the u.s let's just look at u.s data which pretty much parallels most of western europe as well and it peaked around 1970 and then since 1970 the death rates have started to drop but you know something i've published on the bmj before so if you break that down to try and see what are the different factors that reduced heart disease the biggest impact actually was reduction smoking prevalence probably responsible about fifty percent of reduction in death rates other factors emergency care um emergency treatment of heart attacks so we had thrombolysis these drugs called thrombolytics that help people we had uh emergency stenting which in the acute phase in a heart attack certainly is life-saving not in the stable phase that's a different discussion but certainly in the acute phase um the development of coronary care units so what a lot of people used to die from heart disease um mark because they would suffer uh even once they were in hospital they would have a cardiac arrest which is more likely to happen within 24-48 hours of having a heart attack and uh we we then develop chronic cadence where we could monitor patients and then defibrillate them better rescuing them from what happens once you get a heart attack absolutely and in fact they're a lifesaver you know if you have a cardiac arrest and you're it's witnessed then you have oh you're in hospital and and it's because of a heart attack you know nine times out of ten you'll be saved from a defibrillator and then you're and you're fine your prognosis is the same somebody that didn't have a cardiac arrest so all these things are there um maybe to some degree the reduction of trans fats in the food supply as well um that also had a role but when you look at statins and this is something that's actually recently been analyzed they look to um western european countries over 12 years since 2000 2012 right to see had an increase in statin prescription for different risk groups low risk and high risk did that correlate with any reduction in cardiovascular death death rates from heart disease yeah and the answer was no the question is well how can that be explained so again let's break the data down if you look at the average increase in life expectancy from taking statins from industry sponsored data so we take that with a pinch of salt because industry-sponsored studies which are most of the statin studies in general are designed and the results are geared to kind of exaggerate the benefits and minimize the harms but if we take that at face value okay even though i want you to stop there for a minute because it's such an important point most of the data we have on statins is from drug company funded studies in which they actually often are contracting with research organizations to do the research they're hiring essentially hitmen names to put their name on the study they design the study they write up the study and then they get a bunch of cardiologists to sign off on it is that fair to say yeah mark absolutely you're spot on in fact just to take a a step back for a second if you look at the issues around um health misinformation you know we have something called the health misinformation mess a quote i take from john anita's professor of medicine at stanford yes and there's something called the seven sins that contribute to misinformed doctors and misinformed unwittingly harm patients they're rooted in biased funding of research right so research that's funded because it's likely to be profitable not beneficial for patients buyers reporting in medical journals bias reporting in the media buys biased patient pamphlets um commercial conflicts of interest defensive medicine and an inability of doctors uh to correctly communicate health statistics to patients and also doctors to not understand health statistics properly that's something that isn't taught very well at medical school and it's certainly not something we're encouraged to do so i've been involved with the bmj and the medical colleges in the uk in 2015 to try and help revolutionize medical practice through medical education and postgraduate teaching but it takes time i mean i was reading somewhere that when you try and revolutionize or change an approach to something that's been embedded for a very long time uh within medical practice apparently it takes 17 years mark before that change happens so we've got to keep fighting and campaigning for it but you're right this is the issue with statins is not dissimilar to many other drugs and given that information given those biases even if you take all those biases and consideration best case scenario there was an analysis done to look at randomized control trials of statins in people with heart disease forget about prevention for a second statins benefits seem to be there much stronger and people who've already had a heart attack or people have been diagnosed with severe blockages in their arteries okay if you look at the if the from those people from the trials who took statins religiously every day for about five years because the trials only tend to last about five years uh before they're approved and before it changes practice yeah the average or medium increase in life expectancy is over a five year period 4.2 days okay so if we accept that slight increase in life expectancy over a five-year period and then you add in the real world mark within a few years of stacking prescription even people at high risk about heart disease at least fifty percent of those patients stop taking statins within two to three years you can understand from a scientific perspective from a data perspective forget about any fraud or any conspiracy theories just from the data that's already there you can you can explain why statins may have not had any impact on reducing death rates from heart disease in the population now when you look at individuals and this is what doesn't often take place in the conversation between doctors and cardiologists and patients and you know to be to be fair and honest on this i mean i think most doctors actually don't even know this information that's another reason i wrote the book is to educate doctors so they can have better discussions with their patients if you've had a heart attack and this is by the way what i do all the time in my practice so all my patient letters that go back to general practitioners all the patients i see i always put this in there you know in the discussion if you've had a heart attack over a five year period from an individual the benefit of a statin taken religiously over five years is it prevents one in 39 of those patients from having a further heart attack and one in 83 in terms of delaying their death or saving their life right now people who already have had a heart attack or are at very high risk absolutely no we're not talking and by the way for everybody listening 75 of the prescriptions for statins are not for people who have had heart disease or who are very high risk it's for primary prevention and the data on that is even worse and i want you to explain that after you kind of unpack the fact that gee only one in 83 people have a death prevented it means means 83 people have to take this drug for five years with all the risks and side effects for one death to be prevented yeah and max why the caviar and that what's interesting is these are also most likely the patients that tolerated the statin and didn't get side effects because those people are somehow weeded out the trials often we have something called the pre-randomization run-in period before a randomized control trial starts where patients who don't tolerate the drug or are non-compliant they use this word non-compliant okay which doesn't make sense to me because if you're enrolling in a trial and you volunteered you're likely to be somebody who's enthusiastic about taking a drug right so that doesn't make sense to me but very likely that people with side effects are weeded out within the first few weeks of a trial and then you then report on the results from the people who tolerated the drug okay so this is still a bias so i talked to my base say well it's it's more likely those 1 in 83 1 and 39 figures are people that tolerated the drug and were able to take it for five years if you add in people who get genuine side effects and sometimes we don't know whether the side effects they experience or statin or not and i'll explain what i do with my patients to kind of weed that out um it's it's highly likely that that benefit is much smaller if not even potentially non-existent you know we don't really know but there's a chance that it's non-existent and and and that's uncertainties and we have to have those discussions with patients i think doctors aren't necessarily very good at saying listen there's a lot of things we don't know but let's just tell you what we do know and of course the potential biases and uncertainties and mark in my experience with all the patients i've had these discussions with even about talking about industry bias and all that kind of stuff patients appreciate that they want honesty from their doctors anyway so so that's on the on the second prevention the high risk if you look at primary prevention and you're absolutely right mark most of the people prescribed statins around the world are not high risk okay these are people who have got maybe a slightly high cholesterol or even have a risk profile more importantly that suggests they may have a say a 10 to 20 risk of having a heart attack or stroke in the next 10 years and there are risk calculators people can go online and look at those risk calculators if you have a less than 20 risk if you're lower risk of you're not high risk from having a heart attack or stroke um in the next 10 years then the statin data suggests a one approximately convicting data one percent benefit so one in a hundred in preventing a non-fatal heart attack or stroke over five years but this is crucial no mortality benefit you're not going to live one day like that's right and when you look at data and studies looking at when we presented this sort of information to patients in this way and this is without talking about potential side effects not even gone there yet most of those patients mark would choose not to take the pill can you think is this extraordinary so in if we are actually adhering to the principles of ethical evidence-based medical practice and informed consent in my view most people who are prescribed statins around the world would choose probably not to take the pill now that's not to say that cholesterol isn't a problem the question is how is it a problem and why is it a problem and it's quite different than what we think and yes the the overarching narrative has been that ldl cholesterol is the cause of heart disease and it's convenient because that is what statins do but it reminds me of that joke of this guy who lost his keys on the street and he's looking under this lamp post and his friend comes by and says hey what are you doing he says i'm just looking for my keys he says where did you drop him well i dropped him down the street he says why are you looking over here he says well the light's better here so wow we have a drug that can treat ldl but it actually doesn't deal with the real root causes and i just want to take a second for people to unpack why we're looking at the wrong thing when we measure cholesterol today for the most part most people get a total cholesterol hdl ldl triglycerides but it turns out that ldl isn't even that good of a predictor of heart absolutely yeah and there's a really good point mark so yeah absolutely let me just finish this thought and and the jupiter trial which is one of the largest trials looking at statins and heart disease found that if the statin lowered the ldl cholesterol but not the crp in other words if the c-reactive protein or the inflammation marker was high and you lowered ldl it didn't really have an impact only if the inflammation was lowered and so we now know that the underlying risks for heart disease are inflammation and insulin resistance which drives something that we call atherogenic dyslipidemia or a kind of cholesterol profile that makes you prone to heart disease so tell us about a new way we need to be thinking about cholesterol rather than just a simplified oversimplified dogma of ldl statin ldl statin ldl status all day long what is the things we should be looking at and and what why and what are those things and what are what are what are the causes of abnormalities in the real biomarkers of cardiovascular disease sure uh great great points to make that mark so uh taking a step back for a second just so people kind of understand where we've gone wrong with the science on cholesterol or why certainly it's outdated um and it's important for people to realize i think a lot of people have this misconception that medicine is an exact science and if something is truthful at one time it must be absolute truth and it can't be challenged but the reality is well yeah exactly but you and i know i mean the the founder if you like one of the founding fathers of the evidence-based medicine movement david sackett said 50 of what you learn in medical school will turn out to be either outdated or dead wrong within five years of your graduation the trouble is nobody can tell you which half so you have to learn to learn on your own so i bring that concept into how i've started questioning that dogma um and and i don't think this was a conspiracy theory or malicious i think vested interests have taken advantage of what is now outdated science but traditionally when people trying to investigate the cause of heart disease up until the you know the 50 60s 70s um we knew that we found and this is still true is that people with genetically very high levels of ldl cholesterol okay so this would be people who not everybody but usually at least have a um an ldl of more than 4.9 millimoles which i think in in us units is is translated to 139 milligrams per deciliter mark right so those people with who had at least an ldl of that level most of those people had the genetic condition which affects one in 250 people they had a very strong association with the development of heart disease at the same time people who have genetically low cholesterol and total cholesterol certainly we're talking about less than 3.8 millimoles per liter which i think would be um i can't remember the the cutoff but i think it's probably less than 150 if i'm not wrong total cholesterol those people one milligrams per deciliter would have less heart disease although they won't live any longer but most of the people in the middle when you looked at that data from from framingham which was one of the original big studies that followed up 5 000 people in framingham massachusetts starting in the late 40s over several decades to try and find links and associations with various markers or risk factors and heart disease in that they they found that um you know there wasn't really a strong association if you didn't have um cholesterol at the extreme ends so the next question then is um does lowering cholesterol if we move far fast forward does lowering ldl cholesterol mark make any significant impact on reducing heart disease is there a correlation and i published a systematic review in 2020 in bmj evidence-based medicine we investigated this two other i was co-author with two other cardiologists and we found that this mantra which comes out from cardiology societies that there's something with every one you know millimole lowering of ldl you have a 20 risk reduction in heart attack stroke whatever cardiovascular events it was simply not true it was not true we falsified it we said there was no correlation so there is no consistent if i'm being you know um skeptical of my own research i can say there is no consistent evidence to show reducing ldl reduces your risk of heart attack or stroke or or cause mortality then you add in the other issue is something other research helps involved in is if you're over 60 it is we did systematically publish in bmj open uh somebody if you're over 60 there is no association at all between ldl testosterone development heart disease and an inverse association without meals that when you're older if your cholesterol is higher you live longer absolutely statistically live longer but they may be confounded by other factors so go ahead of course but one of the explanations is cholesterol has a crucial role in the immune system and uh there's a very interesting so that may be why they're protected okay people are older with higher cholesterol and actually if you go look at the 19th century you go back when our average life expectancy for example is about 40 or 50 years people with fh genetically high cholesterol mark live longer than average and the reason for that is likely because well infectious diseases was biggest cause of death there so it wasn't you know so this is really interesting it's just something to think about on the other side of it the most recent data published in bmj um and this was last year a danish study looking 100 000 people following them up over 10 years different age groups they found when you look at all causes of death the optimal ldl cholesterol was 3.6 millimoles right which is way high how would you translate that to american units because um yeah it would probably be if we say that um it would probably be in the in between 200 250 something like that it was much higher than what people are recommended to lower ldl oh sorry no um it was something like i think 100 120 something like that okay okay well people should clarify that i can't remember the conversion at the moment but that paper's there and it's translated so danish study maybe you know we can pull it up later but um and it looked at the optimal for all-cause mortality what they found is if your ldl was very low okay then there was an increased risk of death from cancer so there is this association with very low levels of cholesterol and cancer and it could be again an immune system mechanism um so it just encourages us to think a little bit differently we shouldn't be obsessing as our primary focus in managing heart disease at the very least about lowering expression lower the better now how do you reconcile this information mark with statins benefits and you've alluded to this already is statins most people aren't aware of this so statins have an independent effect so they may lower ldl but they also have a slight anti-inflammatory and anti-clotting mechanism yeah and heart disease is a chronic inflammatory disease exacerbated by some called insulin resistance which we'll talk about but also linked to abnormal clotting and the reason i bring up the clotting issue is when you look and we publish on this as well and it's in the book if you look at fh patients so about seventy percent um of fh patients who are females familial hyperlipidemia genetically very high your cholesterol is like three hundred to four hundred is really high they will not 70 of those will not develop premature heart disease without treatment about 50 of men right well not so the question is are we able to differentiate in the fh patients the ones that will develop heart disease and the ones that don't know the first thing that's really interesting is we found there's no difference in their ldl between the ones that develop heart disease and the ones that don't which makes you think well hold on then ldl probably isn't even the issue with them what is an issue and there is some research on this is that they tend the people that tend to develop heart disease have some abnormal clotting factors not your routinely measured ones there's all sorts of different things that people can check but that seems to be from some from lab studies and from you know other studies that suggest that fh people with heart disease have clotting abnormalities but this is the good news when you look at the um risks and what do i do with my fh patients well of course statins may have a role from anti-inflammatory processes so you could still prescribe it from to them but we don't have this data about 1 in 39 183 there's never been a randomized control trial to break down the absolute benefits so we're presuming there's some benefit but the people who had low insulin levels and low waste circumference had the lowest risk of developing heart disease almost only slightly higher than the average person which is really interesting so the focus on fh patients should be lifestyle that targets insulin resistance okay which is basically you know your body's uh getting resistant to the hormone insulin you've spoken about this marker but you know because of lifestyle factors high glycemic index carbohydrates ultra processed foods not getting enough sleep being overstressed being inactive all these things contribute to insulin resistance so that should be the lifestyle approach and actually heart disease most of heart disease is rooted the biggest risk factor if you like is insulin resistance and you asked me the question about what you look at the cholesterol profile which is a marker of insulin resistance yeah and that's having high triglycerides and low hdl cholesterol and the rule of thumb is you want your triglycerides to be lower than your hdl in general to be to have your cholesterol levels optimized yeah and the way you do that lifestyle yeah i think i think it's so important when you bring up because when you look at the data i've looked at and i wrote an article which was fat what i got right what i got wrong where i sort of unpacked this a little bit and i wrote about this in my book eat fat kit then where essentially the the um the biomarkers that are most relevant for predicting heart disease is not just ldl cholesterol in fact it's not a very good predictor of when you look at it what the best predictors is the triglyceride to hdl ratio which you just talked about yeah and that and that should be one or less right and that goes up when you eat sugar and starch so triglycerides go up h still goes down also you get small dense particles you get small hdl dysfunctional hdls even if your hd looks okay it might be dysfunctional and then you can also get dysfunctional ldl which is the small dense ldl particles so it's not just that it's just not the total number when you when you get a regular cholesterol test you're just measuring the weight literally milligrams per deciliter you know per tenth of a liter how many milligrams of cholesterol it's just the weight when you when you don't know anything about the quality of that cholesterol so when you look at particle size and particle number through innovative testing called nmr or cardio iq which is developed in america from quest or lab core those actually help you figure out whether you've got this phenomenal we call atherogenic dyslipidemia which is far more predictive and what causes that is not fat it starts in sugar in fact fat can often be the cure for that it actually raises the hdl it can actually lower the triglycerides in fact triglycerides are fat made from sugar in your liver right absolutely so those are the real predictions so insulin resistance then drives inflammation inflammation drives heart disease so when you look at the data on this in america and i'm sure you're catching up in the uk but 88 of americans are metabolic and healthy meaning they have high blood pressure high cholesterol or high blood sugar and and all those are caused by insulin resistance or pre-diabetes this whole spectrum of metabolic poor health and that's really what's driving heart disease and this and so statins have become the go-to therapy but it misses all these other factors and it's just i think to me how many you know cardiologists and how many doctors just don't even look at this data which is which i don't i could not treat a patient if i don't know what their numbers are because i could see someone with a cholesterol of 300 and each still have 100 triglycerides of 40 and and they might be fine you know very few particles and no small particles and they're fine otherwise i'll see some of the cholesterol of like 150 but they're close by their triglycerides are 300 their hdl is 30 and i'm like terrified for that person right even though their cholesterol is 150 which sounds amazing perfect but it's not so i think you know the the thing about stats to sort of jump back to the statins is that they have what we call pleiotropic effects in other words they have multiple actions one is lowering cholesterol or ldl two is lowering inflammation through its effect on nitric oxide synthase which is a you know nitric oxide is what viagra does it makes nitric oxide but it actually also is a great vasodilator anti-inflammatory antioxidant so there's a lot of secondary benefits uh it may affect clotting but it also has some negative effects which i i think don't get talked about enough and i just i sort of want to unpack that with you a little bit the major one is is muscle damage and i i'd love to hear your perspective on this because i read a study once that was a biopsy study where they looked at muscle biopsies there were two that kind of really terrified me about taking statins and i want to hear your perspective because i do think stats have a role but i just think they're over prescribed the first study was looking at muscle biopsies and actually found that anybody taking a statin had mitochondrial injury in other words the energy factories that produce the fuel that your body runs on actually get damaged and you get a damaged mitochondria which you can measure on a muscle biopsy and mitochondria are the key to longevity and healthy aging and metabolic health so on one end you're doing something to help but you're also maybe harming two it seems to cause insulin resistance which is kind of counterintuitive because insulin resistance is the thing that causes heart disease so you've got that and the third thing is that this is i think related to the muscle biopsy study was it was also a terrifying study where they took two over overweight groups of people and they put them on an intensive exercise workout regimen one group got statin like 20 milligrams of zokor i think another group nothing and they actually measured all their fitness markers their their vo2 max their metabolism uh their muscle all of it and at the end of 12 weeks the group that took the statins despite the exercise program was worse off than before the exercise program because they took the statin and the other actually got much more physically fit so can you unpack that for us and take us down the road of of you know the pros and cons and and then take us down the road of of who should take this because i don't think it's a drug that we should ban or get rid of but i don't think it's overused and we need to sort of focus on one who should take it and who should benefit how we measure the benefits and risks and then and then we'll talk about the next part of the conversation will be how do we unpack what are the real root causes of heart disease what should we really be looking at and how do we really prevent it and treat it no absolutely mark so uh all really good questions and the kind of questions that patients ask as well that's most important um so in terms of the side effects issue i mean that's very been very controversial over many years um statins do affect uh they can cause many side effects but the most common that we see in clinical practice is one of muscle aches and fatigue um other side effects include people with stomach upset brain fog erectile dysfunction you know they can affect pretty much every organ system so the way i approach it is if a patient comes in with uh an unexplained um symptom um the first thing i mean that's been my default now anyway with all patients i think uh you know you need to this is a so you have to think my mindset is this is a side effect until proven otherwise okay so you look at the medication because we have a medicated society um and what you often find what i do is i as a trial and error um from a trial and error perspective you know i will give patients information about the potential benefit of the statin and say listen i think what we can most of these side effects generally are reversible very quickly so you stop the statin you have an informed discussion say listen why don't we just stop you know how you feel um you know and this is i ask the patient if they're complaining of a side effect and often they already have this in the background anyways is it interfering with the quality of your life and that's the crucial thing if it's likely an occasional niggle here or there nothing much of an issue then you know you still have the informed discussion but there isn't necessarily an urgent requirement stopping stats unless of course the patient's now fully informed and they're like doc you know what i'm giving that information i don't really want to take this bro fine okay yeah we've had an informed discussion but if they've got say fatigue or memory disturbance or something else and but i do this i've been doing this for for a very long time with many many patients now so i've got a lot of um certainly a lot of anecdotal evidence in my practice of this that usually the patient's side effects if it's if it's a statin disappears within a few days to a couple of weeks and people are amazed about how they feel their energies back all that kind of stuff and then the question is well do they want to go back on the statin or a different statin and then you can try a lower dose say they're high risk and they're kind of like well you're actually less likely to get side effects at lower doses say for example you've got 80 milligrams of statin which is the highest dose you give people who have heart disease you can then say listen let's try you on a lower dose and i explained that there's a slight anti-inflammatory mechanism for example let's try the low dose see how you tolerate that be reassured most of these side effects are reversible if this comes back again we just stop it for example so that's my approach to it in terms of the prevalence mark it's very interesting i mean you know data varies from say anything from you know if you trust the industry-sponsored trials they say like one percent of people may get muscle aches and fatigue um and then and then you know in my practice i don't know i mean it goes from twenty percent thirty percent whatever so you know there's like one in five people taking the drug have pain muscles and they stop it right seventy-five percent don't take it out well exactly well that's another issue in the real world when you look at studies and surveys um you know in one study in the u.s uh statin usage survey 75 of people stopped taking the pill within a year of prescription and when you ask the patients why 66 of those said um it was because they had side effects so that makes me think hold on a minute there's something that doesn't add up here and i don't think it's about um you know they talk about something called placebo effect if the patient is going to be aware of a potential side effect they'll imagine it and of course that exists but a lot of the awareness of side effects of statins mark in the mainstream only came out really in the last several years i mean they were prescribed for very long time under the belief those side effects didn't really exist so i don't think these patients were imagining i think it's more likely they genuinely suffered side effects i think that's really important but either way i think people should doctors should be aware patients should be aware that these potential side effects which aren't serious or life-threatening at all but interfere with the quality of life and that's of course very important for people um are very common and you should be afraid of discussing with our doctor and having a trial period potentially after discussing with your doctor often the other thing that we didn't mention is that when we talk about all this issue about management of heart disease with statins is that for many people it gives them the illusion of protection yeah so they think i can eat what i want my cheeseburger and whatever as long as i'm on my shoulder they continue to gain weight you know and there was one study in java internal medicine a few years ago that showed if you followed people of similar risk profiles who were on statins and ones that weren't on statins over a ten year period the ones on saturn's gained more weight and the reason for that probably is to some degree the illusion of protection so again this is about educating informed patients alone or maybe because maybe because it's insulin maybe because insulin goes up and insulin makes you gain weight absolutely absolutely that can and we also know it does now it's been established about one percent of people who take statins will develop type 2 diabetes because of the statin right so that's another except so there's a lot of information that people aren't being told and would change the decision-making process and that's really where we you know we need to change the conversation across the whole of medical practice and uh it's taking time i think people are becoming more aware doctors are becoming more aware i think one of the concerns and issues i've had and i've campaigned on in the uk is that when you financially incentivize doctors to meet certain targets of cholesterol lowering or targets of of treating certain people at certain risk um then it's more likely to bias a conversation and the patient really is the one that suffers at the downstream because they're not really getting involved in fully informed consent and that for me is ethically dubious yeah i mean the challenge is that you know most doctors are very busy uh and they are seeing patients and doing good work and they want to do the right thing and they don't have time to go into looking at all the data and analyzing and sifting through it and sorting through it and so they're hearing the sound bites they're hitting the sound bites that generally come from continuing medical education uh and uh i was once skiing and i joined a chairlift and i sitting on this trailer for this woman i'm like hey what do you do she's like well i'm in pharmaceutical marketing i said oh really i said what do you do she's like put on conferences for doctors so essentially a lot of the medical conferences are funded by the pharmaceutical industry and they are putting their speakers on they're having their spin on the data and so the average doctor really is is very hard pressed to actually get to the nuances of what all this data shows and it's really unfortunate because they're missing the boat and the other problem is you know in medicine we don't like to feel disempowered as doctors and when most of us have zero training in nutrition or lifestyle medicine and the biggest cause of heart disease is insulin resistance which is a lifestyle driven disease where for which there's really no good medication i mean metformin maybe a little but it's kind of marginal and doesn't work as well as lifestyle that's unproven many times over in the diabetes prevention trial and other trials so like you're you're you're you want to do something right and so the doctor want to help some you want to help your patient but this is all they know how to do and they don't even know how to diagnose insulin resistance you want to know my secret for living a long and happy and healthy life well all you have to do is check out my weekly newsletter mark's picks where i share my favorite tips for health longevity well-being and lots more check it out and the link below i i want to talk about um well it's a hypothetical patient because you know for me uh let's just say my cholesterol would be a little high and i do a cornea calcium score which is a way of measuring calcium deposits around the heart in the arteries which by the way calcium is the body's band-aid where there's inflammation calcium goes and so it's an indirect marker of potential plaque however there's some questioning of the data around the benefits of coronary calcium and there's new imaging techniques like a coronary angiogram with a ct scan that looks at soft plaque there's a company called clearly that looks at the analytics they use sort of artificial intelligence and and how do you use that technology to help uh influence your decision about how to treat the patient and which patient would benefit from a statin which which wouldn't because you know one of the things we're talking about with these these levels these numbers i mean abnormal cholesterol is not a disease right no right but but it but it's a predictor potential predictor but it's it's it's you know drawing a one-to-one correlation with any one patient is very difficult right so but when you look at their when you look at the actual plaque burden and not just the calcified plaque but soft plaque which is the more vulnerable plaque to rupture the more vulnerable shock to actually cause a heart attack how do you sort of navigate that decision tree with a patient and who would get what yeah it's a great question it's all individual based i think we have to walk before we can run so you've alluded to the issue of calcium scores um which in themselves are still very very predictive and they're very good in terms of their wrist stratification so they they supersede all the other risk markets in terms of heart attack risk you know high blood pressure types of diabetes whatever else if you get a calcium score that's zero close to zero less than 100 then your risk is very very low of having a heart attack in the next 10 years despite what's going on although i would always tell my patients listen you're lucky at this you know where we are right now it hasn't caused any significant damage but if you're carrying as you are probably this calcium scale is going to increase so at least we need to sort your lifestyle out and often i will repeat calcium scores in a year and give them some reassurance of what they are doing is having making a difference so that's some one way it can be used so sequential casting scoring instead of the regression of calcium can you see yes yeah for lowering this and the calcium score absolutely um but i think the other thing is mark you're right about soft plaque um so the calcium score can sometimes miss soft block but it's still very reliable so we come back to the basics of the history right what is their risk from the risk factors and an individual patient based and if they're also getting like for example you know i've seen some patients that have got quite typical symptoms of angina but think that they should just have a calcium score you know and it's you know often the calcium score could come back and being relatively low but you do a ct card in the underground i think that's what you're kind of referring to somewhere which actually looks more detailed and we'll see soft block and you can see a significant soft plug they're relatively less common so i think it's something to be aware of i think calcium scores still have a very important role but if there is doubt then of course you can just go for the full cd coronary angiogram and then you can see both calcified black and norse classified clark so i think they have a role but i think still calcium score still should be used much more frequently than just um than ct chronic angiograms based upon all the different risk profiles of that individual patient yeah very important and i think for some patients for example with a high calcium score or soft plaque they might be candidates for statins right yes and again the data that i've read most recently suggests that the ones with the calcium score more than 400 but then you're already automatically into the high risk group anyway which we've talked about which is the 1 in 39 benefit from non-federal heart attack over five years 183 so it's pretty consistent still with what we know um about and but but people with calcium support less than 400 there doesn't seem to be any big benefit from statins i think one of the other slightly confounding factors is statins also increase coronary calcium so they can potentially stabilize plaques but increase coronary calcium so you've got to also think about that in the context so patient come back two years later they've been understanding oh my god why is my calcium gone up well actually it may well be the stand but then it could be this progression of disease so in that situation mark you could then say well maybe we should have a cd chrono angiogram and actually look you know more in more detail to make sure there's not been any significant stenosis or soft block or whatever else developing um that's the way i would approach it but i think you know overall um in terms of where we're going with this and trying to make sense of what's going on in the world with ill health and everything else you know i i look at things also philosophically and and rationally you know and uh i always think about my purpose and our purpose as doctors ultimately is is to improve patient outcomes but you know what do we do for that we use knowledge and the ultimate purpose of knowledge is to reduce human suffering and but that knowledge needs to be based on the complete totality of evidence on the truth uh and one person i've recently i'm just going to throw this in there that i've been very fascinated with and i follow his work i know he's a bit of a controversial figure but i like what he says is jordan peterson the clinical psychologist and you know ultimately we need to speak the truth we need to know the truth and if we move away from the truth then we're really gonna increase suffering and we're in in his words you know we are going towards hell we need to redeem the world from hell and by not speaking the truth and that also also requires courage at times you know people speaking out doctors when there's misinformation being propagated from vested interest we have a role to actually speak the truth from a rational perspective because if we don't the situation's only going to get worse and even if we're avoiding conflict in the short term we're going to increase further damage down the line if not for us and for our kids and the kind of environment and their futures so i also have to look at this from a philosophical point of view as well when you come into the whole issue around yeah you know trying to help people understand what's going on and i think everybody knows mark you just look around you in the last 10 to 20 years you know um ill health is getting worse uh mental health is worsening you know there's a whole issue on a separate discussion about you know and i'm not going to go into any detail on this but even our management of the pandemic about coving about vaccines about informed consent all of that's there and if we don't speak the truth and we don't get access to the truth then the whole of the world and society is going to suffer and you combine that with hostility and division people taking becoming very tribal about statins or whatever else then um we're based and exacerbated by social media we are also losing my concern is losing our uh capacity for empathy as well as access to the truth and that's sending us down a very very good to a very very dark place so our job now is to reverse that if you loved that last video you're gonna love the next one check it out here and the reason we're really looking at cholesterol is because it's one factor that influences somebody's risk of cardiovascular disease right i like how you said one factor one factor exactly one piece of the puzzle and

Channel: Mark Hyman, MD

Views: 36,674

Keywords: Mark Hyman, Mark Hyman interview, Mark Hyman live longer, Mark Hyman diet, how to live longer, how to age in reverse, nutrition tips, healthy foods, health tips, health theory, fasting tips, how to never get sick again, prevent disease, self help, self improvement, self development, personal development, inspiration, motivation

Id: e7GDFuVEMn8

Length: 67min 25sec (4045 seconds)

Published: Wed Mar 09 2022