Why Cholesterol May Not Be the Cause of Heart Disease with Dr. Aseem Malhotra

[Music] so welcome dr. Malhotra we're here at the Swiss free British Medical Journal conference about food for thought the science and the politics of obesity which is an food which is really what you've been focusing on and you're a kind of an extraordinary doctor you're a cardiologist from the UK you're one of the leading voices there and fighting obesity and disease and challenging the orthodoxy around cardiology statins fat and you're taking a lot of flack from it but you're also out there courageously sort of breaking through the noise and people are listening and I read that you had been working with a member of parliament and he had type 2 diabetes and you're able to get him off his British Dietetic Association guidelines and eat a higher fat lower carb diet and dramatically reversed his his diabetes lower his insulin and he wrote a letter to the Prime Minister of England which is pretty amazing how did you end up going from being a cardiologist that was trained that LDL cholesterol was the bad guy that stands where God's gift to mankind and they were show up eating a low-fat diet to your perspective now which is quite opposite which his statins aren't the miracle drug we thought they were and that saturated fat is not the enemy according to your British Medical Journal article that I read years ago how did you come to that from the traditional view you know mark I think for me I had a realization many years ago probably around till 2010 having qualified as a doctor in 2001 and then decided specialized in cardiology much later on I looked at basically what was happening with my patients so we I noticed more my observation was more and more people coming in with multiple chronic diseases more obesity and at the same time you're hearing the statistics in the media because you know 2004 was 14 years that the World Health Organization announced obesity as being a global problem made your issue so much progress we had we hadn't made much progress so I I was trying to initially look into the root cause of that because ultimately I felt as a there was more pressure on the system and then I went to investigate the evidence behind you know the the conventional wisdom around cholesterol or unsaturated fat um he actually looked at the data I looked at the day to look to all the research but also I think one of the other things that's really important is that when you look at the hierarchy of what's driving the obesity epidemic even if you take the what we think is flawed Dietary Guidelines aside the the food environment was just saturated with junk food you know my own Hospital the hospital so I thought to myself how can we be advocates for our patients for good health if we are basically selling sickness in the hospital grounds I mean half of the health care workers are overweight yeah absolutely and it you know it's the same for doctors for nurses for non clinical staff those statistics are the same so there's clearly something of something wrong and I knew that obviously the the food environment was contributing but when I look deeper I realized that what essentially had happened is the when you go into the roots of it all with the change in dietary guidelines which happened in 7 1977 in the US and 1983 in the UK which essentially said we should get only 30% of our calories from fat and reduce that rate of fats by the way no randomized clinical trials no really opposite absolutely keys you know the answer keys from his seven countries study which correlated saturated fat cholesterol and heart disease but one very passionate determined scientist genuinely believed in what he was doing but actually when you look at where we are now mark when we come forward and look at the totality of evidence and that's crucial and that's what we're gonna be discussing in this conference is people in very powerful positions in powerful organizations who have a lot of influence are ignoring the totality of evidence and when you look at the totality of evidence it's very very picking it absolutely cherry-picking but you know could be confirmation bias it could be that they just ignoring your evidence that challenges their own you know dogma in their in their but you see we also have to exercise as doctors mark you know more humility and less hubris you know the the one of the founding fathers of the evidence-based medicine movement said half of what you learn in medical school will turn out to be dead wrong or outdated within five years of your graduation the trouble is no one can tell you which heart that's what my Dean said when hey my first day of medical school no so yeah you have to bathe therefore you have to learn to learn on your own mm-hmm and actually many doctors because of the nature of the job often don't critically analyze a lot of the research I'm not trained in that you know it's really wrong actually yeah we we were handed down a set of beliefs and dogmas that we take to be true because our our teachers tell us that but they don't actually teach us how to critically evaluate science how to read literature how understand I mean took me years of range to the different observational study in a randomized control trial sure absolutely and I had to learn all of this myself because I didn't learn any of this in medical school and in fact the other aspect of this is well we learn nothing really of evidence-based lifestyle interventions and the evidence behind that to help our patients in medical school or even in postgraduate education I've been working on getting that into the curriculum as whatever years worth of nutrition and medical school not a single lecture not extraordinary you know I'm at scurvy but in terms of chronic disease there is really a lot of misinformation amongst doctors but I think as profession we also have to be more skeptical about medicine itself I mean it's interesting Richard Smith the former editor the BMJ wrote an article not so long ago where he said the 90% of people when asked of members of the public thought that medicine was an exact science when in fact it's not an exact science as I teach my medical students I said this is more the practice of the or of probabilities and if you think about the information that we've been given whether it whether it's to do with nutrition or whether it's do even with prescribing medications we now know that that information is biased it has lots of limitations and if we're making clinical decisions on bias information mark bias because the way the research was done because it was influenced by industry because number factors the qualities research a reliability are there the fact that you know results are not replicated the fact that there is industry influence on on the studies so we know for example biased funding of research is a big issue and if the study is funded by the industry then it's seven point six one times more likely to show outcomes positive in favor of those industries interests versus independent statements percent seven times seven times it's like 700 percent more so what when we look around us at the moment and what I'm going to be speaking about late today is you know the question that we're going to be asked in our panel discussion is you know what evidence can you trust I think the first thing we can say is the current true real-world evidence is more than 50 percent of the adult UK population and even US and many European countries are overweight or obese certainly at least one chronic disease that in my views are symptom that we have failed in our health care system and we are failing our patients and we know what the root causes are but most doctors also don't know for example there was a very good paper published by John Ioannidis who will be speaking through from Stanford and during the conference yeah I'm very much looking forward to what he has to say because then he's a guy who basically questions the whole research paradigm in and it's quality of the research we have and the assumptions we make and the conclusions we draw and how we over interpret and a lot of our guidelines and our recommendations are based on very weak evidence absolutely mark you know and I would describe and I gave a talk recently and I would describe John Juanita's because of his academic prowess he's a professor of medicine at Stanford and a statistician as well you know I would call him the Stephen Hawking like character of medicine and when he writes an article and he says only 7% estimates only 7% of clinical studies for medical prospective therapies fill full criteria for being both high quality and relevant to patients that's a huge problem it is it is we think you know in American College of Cardiology almost like here but there are guidelines that are we think are established recommendations from the field based on science and yet JAMA published an article showing only 10% of the American College of Cardiology guidelines and by the way cardiology has been the most researched field in medicine only 10% of those guidelines are based on good science absolutely most of the guidelines are sentence based 90% of a sudden expert opinion of course so one of the ways of tackling this no doctor everybody listen I believe most people intrinsically want to do the right thing almost every doctor goes into Medical School because they really want to help their patient you know and they have a responsibility scientific integrity but lack of knowledge of these problems mark is one of the reasons we're not able to tackle it the more people more doctors made aware they will not accept this and also the other thing mark is I think doctors are realizing that the way we have there's something seriously wrong in the system if we've got this huge epidemic of chronic disease and misery essentially yeah we keep prescribing pills but they don't get better in fact you you said that describing pills and medication is the third leading cause of death yeah the estimate coming that's and that's more prescribing pills in the right way for the right patient for the right reason not drug Garris no absolutely so well actually so and pizza Gosha who's one of the cofounders of the Cochrane Collaboration he he estimated that the third most common cause of death as you say between after heart disease and cancer is prescribed drugs and his estimates 50% of those are because of side effects and 50% of those are because of medication errors but I think the point he makes which I think's really interesting I even had a discussion with my patient yesterday about this who came in and was asked me all about all about different side effects so I was not aware of it with particular drug and I said listen many drugs that are prescribed and although they tend to be you know they wouldn't come on the market you would hope if they were very common side effects but side effects that exists you know many drugs have twenty or thirty side effects potential side effects most doctors we don't know all of these side effects for every drug but most of them aren't side effects their effects that we don't want absolutely like statins no choice but for your muscle damage that's not a side effect no that's an effect of the drug yeah absolutely absolutely so I think that you know we need to take a little bit of a step back and actually look at you know what we're doing medicine I think the overall view in my view now mark is we need a global campaign coming from the highest you know authorities in medicine even the World Health Organization say we have a public health crisis of an over medicated population and we need to now work towards getting people on less drugs and push more lifestyle because the reality is this mark good health rarely comes out of a medicine ball that's true so the pork right at the end of your fork yeah as I say what you find it in of your fork is more powerful than what you'll find mostly in prescription bottle so let's let's dig in here to whenever you know a lot about which happens to be the most prescribed drug probably on the planet which are status um psychiatric drugs as a whole are up there and acid blocking drugs are up there but statins are up there and they've been prescribed not just to people to prevent heart disease I mean to prevent a heart attack if you've already had one but for preventing people who never had heart attacks from getting one and you you challenge this as as a sort of flawed idea and you kind of talk about as cardiologists how you came to this heresy and why we should believe you well I think the first thing to think to talk about is cholesterol as a respective oh yeah so LDL is so called bad cholesterol as everybody everybody knows about this I mean the campaign has been so good it's so strong that everybody around the world when you mentioned cholesterol there is an element of fear when people are told about high cholesterol or decock and they immediately associate with heart disease so LDL cholesterol was sanctified as a major risk factor for heart disease and most of that in relation words sanctified absolutely like a like a priest there is almost you know that there is a very strong belief that getting your LDL lower is the way to combat heart disease but if you look at the original Framingham data yeah to Framingham the in the United States which was a a town where you know several thousand people followed up over decades to look at to try and draw draw risk factors for heart disease high cholesterol was one of those risk factors when they looked at the overall data they realized that the actual risk the most reliable risk factor for heart disease from cholesterol is your total cholesterol to HDL so total cost will divided by your so-called good cholesterol HDL LDL Denari all right now William Castelli one of the co-directors of Framingham he looked back in 1996 and published a paper and atherosclerosis and even um I found this extraordinary Martin yeah he rode the unless when they looked at the data from Framingham unless LDL was above 7.8 millimoles which I think in your terms in the states I think is well over 250 probably over 300 yeah unless it was over that value in isolation it was essentially useless as a biomarker and predicting your disease I mean that's extrordinary most patients we see mark don't have LDLs anywhere near that most have a genetic this work unless have a genetic disorder so people with what we call familial hyperlipidemia and we know from the data with people have genetic disorder where their cholesterol is high then which affects less than 1% of population probably anything between one and five hundred and one percent fifty seventy percent of women with untreated FH will have a normal lifespan and 50% of men so actually there is a huge proportion that will be half premature death because of heart disease but what's interesting is there is now data to suggest well is it the cholesterol or is it something else that's going on now when you look at the lowering of cholesterol of LDL specifically from lots of different drugs including statins when you look at the totality of data mark actually there were four - there are 44 randomized control trials both mainly involving drugs also involving diet the very robust studies in themselves had no reduction in mortality no reduction in CV mortality mortality most some had no reduction in any event reduction even non-fatal heart attack or stroke and some showed harm and that in that information in evidence is being ignored now ok let's talk about statins what does a totality of data tell us and I'm gonna bring in some caveats as well because what I'm saying to you now I often have this conversation before you dig in there I just gotta go back that was sort of breathtaking what you just said which was that 44 randomized trials lowering LDL cholesterol with lifestyle or diet had no impact on heart attacks death or any of those LDL and what's interesting is there was no also link between how much you lowered the LDL and where there was an event reduction because there are there is an academic community out there that believe the lower the Bedel the better and papers are published which in my view is selective reporting and cherry-picking data and making the making it look as if actually the lower your LDL the greater benefit you have the overall totality the data tells us that is false amazing absolutely false now when you look at statins and one of the websites I always I actually tell my patients to go to which is gray it's an independent web website called B n NT com yeah I wrote about that in my book yeah right it's fantastic isn't it and it's useful because this website is created by independent researchers and there are no conflicts there's no funding or advertising and they synthesize all the best high-quality data and put it together to basically calculate the patient's what is important outcomes to them but also for doctors so for example heart attacks debts those are the most important outcomes for most people from taking a drug that's what they want to know and when you look at a total to the data on the NNT dot-com and all the statin trials for people with heart disease so we'll come back to healthy people first but people with heart disease your mortality benefit if you take the statin religiously every day for five years your mortality benefit is one in eighty three as in it will there's one in eighty three chance it will delay your death listen we're all gonna die I mean people will take statins you know and no impact on their mortality and about one in thirty-nine to prevent a non-paid a recurrent non-fatal heart attack that's if you've already had a heart attack yeah then you have to treat thirty-nine people before you prevent another home on an article III before you prevent one death now what I say also to my patients this likely represents even the very best case scenario because all of the data on statins essentially comes from industry sponsored studies mm-hm and not only the industry sponsored studies but when you look at the patients of participants in them but it's known now that the side effects are underreported and many people who either experience side effects before the trial started or had characteristics that made them likely to get sick muscle symptoms because that's the most common symptom we see actually were taken out of the trial now when you look at the real world evidence mark in community studies about statin prescriptions and in patients taking statins there in the United States to staff in usage survey which is over ten thousand people are surveyed I was flabbergasted myself when I saw this statistic because this statistic which I'm about to tell you is based upon people having no this is before any media scare mongering or awareness about side effects so these are people who are most likely being prescribed by the doctor in the community to say this is like a magic pill it's gonna reduce your risk of heart attack 75% of people prescribed a statin in the community will stop it within a year of prescription when asked why 62% of those said it was because of side effects and many of those tried different statins that have the same problem the side effect most commonly reported is fatigue and muscle pain now that is a huge discrepancy mark between the clinical trial data which tells us really less than 1% really get muscle symptoms maybe one in 10,000 get a serious Myositis yeah it's a huge discrepancy mark between between the clinical trial data and what we experienced in the now I'll tell you something else very interesting that most people don't know people think convention widsom even I thought this in fact I published a paper where Ivan said statins have reduced mortality and second Airi prevention in the population I didn't use a citation it was just my understanding that I had done as Dogma you learn from your was I'm sorry nobody's presumed in second prevention because in the trial data there is benefit but it's very small really for many people all right I always say you know it's absolute versus relative risk the risk goes down by 30% that means it's going down from 3 percent to 2 percent in the population right now I know and absolutely and in fact we should be giving having that conversation with patients because if you don't then you're being non transparent in your communication of risk and that will exaggerate the benefits and often minimize her harm Spindler underreporting but I think was Roger Williams her Mark Twain said there's liars there's damn liars and they're statisticians yeah who can manipulate the data to say whatever they want exactly you know that's another concern isn't it but when you look at the there was a study published in the BMJ in 2016 and they looked at Western European countries over 12 years and looked at cardiovascular death great reduction from statins in different risk groups including secondary prevention no reduction in death rates and cardiovascular tality in the equation with people who are the most likely mature yes high risk who've already had a heart of how do you explain that well from a scientific perspective I can explain it even if we presume that the data is absolutely correct from the trials so another way of looking at the statistics from the trials on statins in people with heart disease is if you take a statin every day for five years what's your median which is a crude way of saying average not exactly the same but what's your median increase in life expectancy for taking a stand if you've had a heart attack every day for five years and when I ask the audience and ask people this they come up with figures like that add five years to your life several months whatever 4.2 days or 0.2 days that's if you average it all those days you're typically with muscle pain actually probably people who haven't tolerated debecker but what it tells me is if you think about that and you also realize more than 50% of people over the age of 65 we take a statin with heart disease mark will stop the statin within two years this is people who have had heart attacks again because the muscles have you can reenter reduction in the population because actually many people stopped taking a statin the benefits are marginal anyway do I think statins work I think probably yes but in such a small number that actually in the real world the benefit really it's it's failed to reduce heart disease I mean with reason we still have an epidemic of heart disease and still the number one killer mark you know there was a prediction by people pushing the cholesterol hypothesis and when statins came on the market that we would end heart disease the epidemic by the 21st century and we haven't and the global you know campaign has failed one because the drugs are not as effective as we thought they were too because side effects are real and underreported but in the real world people stop taking their drug and three the cholesterol hypothesis self is flawed because it's not the most important risk factor for heart disease which is insulin resistance now and sulkies told the New York Times this is the man who was the most influential man in weigh-in in many ways in nutrition and medicine he was the guy who said we should cut out fat and saturated absolutely the seven countries study author influenced the guidelines in a big way probably more than anybody else in 1987 he told the New York Times I've come to realize cholesterol is not as important as we used to believe it was I mean the fact that he says that is a big statement I mean what's passing there's a Jupiter trial were where we found that the statin drugs may not act by lowering cholesterol LDL may act by other factors such as anti-inflammatory factors or antioxidant factors and in a study where they looked at lowering LDL if they didn't lower inflammation levels but they lowered LDL there was no benefit only when the inflammation went down was their benefit that's extraordinary among you right you're right and in fact my BMJ saturated fat piece in 2013 I ocellated that as well than my own personal view and in fact I was also reflecting the view of my cardiology colleagues as someone that's treated you know thousands of people with heart disease done over a thousand angiograms and treated people with heart attacks and has been on the water and after people coming with heart attacks and the wards we prescribe statins like Smarties we put everyone on a high dose we rarely even check cholesterol because the guidance was saying doesn't matter what the cholesterol is get them on a high-dose statin yeah I would be the guy mark that in the ER in A&E we say in England in the UK in the u.s. NSA er I don't be the guy when the chats been diagnosed with a heart attack before we take him to the cath lab you throw down instead I'm telling the nurse give him 80 milligrams of tor Stan because I genuinely believe that the effects were immediate and it was anti-inflammatory interestingly when you look at the data actually there is no acute benefit from statins at Wharf of event reduction for several months no benefit in death rates event reduction so if you're a patient get side effect within a few weeks of taking a statin stopping a statin certainly is not gonna increase the risk of death or a hanukkah at all and you know this you're talking about these side effects but the way they work is inhibiting an enzyme which intentionally acai reductase which also produces something called Co Q 10 or coins I'm Q 10 which is an essential part of making energy in your muscle cells in all cells so when that gets blocked not as a side effect but as an effect it leads to a reduction energy production so it's like you just ran a mile or ten miles as fast you can and you get muscle pain and that's what happens these people and it also affects the brain it also affects sexual hormones because your LDL and your cholesterol is what you make estas to another hormone so as these are not side effects there are effects and they may affect different people differently and there's a lot of genetic variation in this but the whole philosophy of driving down LDL as low as possible doesn't seem to make sense in these new drugs these PK whatever c19 things they they're dropping people's cholesterol to 7 or 10 and LDL and then does that make sense no it doesn't make sense to me at all in fact we I published I was part of a team of people that published a systematic review in the BMJ specifically looking at people over 60 to see the association of LDL how strong was association with LDL in heart disease and we were even quite shocked by the findings there was no association with all the other heart disease and there was an inverse association with all cause mortality yeah how does that how do you explain that well we know custards a vital molecule in the body we produce it for a reason without it I would die it's not bad it's just there are certain forms of it that are worse absolutely and probably influenced by various factors like whatever absolutely so and when we looked at that we also there was good data to suggest that cholesterol is involved in the immune system mm-hmm elderly people are particularly vulnerable - dying from infections such as pneumonia or you know stomach infections and it's probably the mechanism is probably protective in the elderly because of their protecting you from those infections so I actually say to some of my patients that have come in who have you know patients have been referred to me by their general practitioner in lady over 60 for example with a high shel DL and said she was very worried and she came in the room with a look really look like she'd seen a ghost she was so fearful because she thought was gonna have a heart attack mm-hmm and I said congratulations you know and I explained it all to her and she walked out my consultation room with a smile and it was true the Honolulu Heart Study was fasting where they found that that actually the higher your cholesterol is your older the healthier and longer you lived yeah it's extraordinary so I think we need to chip the paradigm is to shift mark and I think when you look at the data that's there and I published an editorial with Rita red Berg who is here also for the conference and Pascal Meyer both editors of medical journals both practicing cardiologists we said that the paradigm shift needs to happen where we need to concentrate on really reducing insulin resistance which is you know really the number one risk factor for dat accent in young men and and actually that would actually tackle a many other chronic diseases because it's a precursor of a type 2 it's responsible for 50 to 70 percent of people with high blood pressure and mark I am you know advising many patients to follow a low sugar low refined carbohydrate what I call a high fat olive oil based Mediterranean style diet mm-hmm and you know people are coming off their blood pressure pills within weeks or months no we say they'll see us Chris Marker markers are improving they feel better you know it's extraordinary now okay let's critique it have we got long-term data to show that from randomized control trials to show this medical and by style approach is to peer and gonna reduce death rates we don't and we need more of that them risk markers improved there's no side effects their quality of life gets better and if they come off medications you know it's a win-win for the patient and for the healthcare system right it's by hachi so you just mentioned something and I think in sort of the flip side of the story which is in some resistance and that is a mechanism in the body that happens where your body becomes a numb to the effects of insulin when you eat too much sugar and starch and it turns out that all the separate diseases we see may be linked by this one common mechanism heart disease many cancers type 2 diabetes obviously obesity even things like dementia which are not called type 3 diabetes these are the major killers they're all driven by the same mechanism now if that's true you know you know we are living in a society where we're all at risk because sugar is everywhere and you've been the one of the most vocal opponents of sugar I sort of read you know you should remind me little bit of Jamie Oliver you know who was a chef where he on his Ted stage poured out you know like a whole wheel brown sugar and said this is what we're eating in a year and you you've been very active about this and you wrote an editorial recently in the Journal of insulin resistance set called the science against sugar alone is insufficient in tackling obesity and type 2 diabetes crises we must over also overcome opposition from vested interests so this is a very powerful statement so it's not just a matter of science it's a matter of politics and our policies that are driven by the food industry and you're taking this head-on tell us what are the biggest drivers in that and and how do we begin to deal with those well I think you might be right about sugar being a you know I describe it in an article I wrote in The Observer newspaper that you know it's public enemy number one in the Western diet because it's become so prevalent because it's been added to so many processed foods in the States decimated 50% of foods that people don't think of junk foods have added sugar in them and our estimates suggest you know in the States and in the UK people are on average or eating anything between 20 and 25 teaspoons of added sugar in their diet a which is extraordinary now there's about 35 yeah and you know and the recommendations from the World Health Organization now we were put under pressure say maximum limit of 6 but they say limit they don't say you should have it because actually for optimal health that's the upper limit you don't need any added sugar you die I mean there's no nutrition in it there's nothing you know it's a treat no biologic or no no no palate it's a sugar or carbohydrates by the way well you're actually right you know there is actually no essential require by address either but with sugar yeah you can go you know you can very easily have a very very healthy life with zero sugar in your life now when we wrote this paper I would rephrase that you will have a very popular when you're breaking the addiction but ya know you're up see right and you know there so the first thing to say is well how do we combat this and we can learn from lessons you know we need to learn from history mark you know you know if you don't learn from history you're bound to live through it again and I think this in some ways we're doing that because tobacco big tobacco we're able to store what we call effective population interventions reduce tobacco consumption by really adopting a strategy of denying cigarettes were harmful planting Dow infusing the public even buying the law to scientists who would write papers and not declaring money from tobacco saying they don't think tobacco's harmful yeah and they did this for 50 years from when the first links been smoking in lung cancer were published and actually when you eventually when we did manage to reduce tobacco consumption which was I really only through a lawsuit wasn't government and ultimately government policies followed but it was you know we I talked about the three A's in public health tackling the availability the affordability an acceptability to public education campaigns cigarettes are harmful banning tobacco advertising smoke-free buildings when you combine those that was responsible for most of the decline in death rates cardiovascular mortality yeah in the US and the UK and Western European countries certainly you know in the last sort of forty or fifty years and you know that that is actually what's most was that the biggest decline was only when regulation was introduced really from governments because governments have a duty a responsibility to protect citizens from excesses and manipulations of industry because ultimately people were lied to people lie to people are misinformed they were making decisions about their health based upon misinformation that was coming from industry and actually government had to intervene when the science was there that wasn't enough you know because there had to be a battle there were campaigners and people had to keep pushing this message and we see the same sort of things which we have to be realized the same sort of things is this we should get a playbook but me I've murdered the same company but mark yeah exactly but we've also got to have it we can't be naive about this there are you know they're very powerful vested interest is a lot of money invested in flawed science in you know pushing a message or a hypothesis that's so flawed and harmful you know that people make a lot of money out of this I mean the cholesterol fear of cholesterol lowering saturated fat I mean it's a multi-billion dollar industry that profits from that message so it's not gonna change overnight and what industry do and people who support industry who get funding from industry often not obvious or declared yeah they will engage in tactics to go after people like me or other public health campaigns me no absolutely this is you know we are here trying to push a message of truth and transparency and openness and we will get called names we will say that what we're promoting is junk science or whatever we reference in general design this is what they do this is an article about me in Forbes magazine totally discrediting me and I read the author was part of this group called the genetic literacy project and as I began to dig into that turn out that's fully funded by Monsanto so mmm wonder about the credibility of that story no sure and Mark you know this is an important point for journalists as well because actually my view is this there should be full declarations of interest in terms of financial interests specifically you know before people are asked to comment and I think this he under place the scientists because although I mean it makes a big difference as a huge bias it doesn't mean they can't comment but people need to know that these people really are acting as front men for industry interests because if we don't do their mark we're not really daring to why believe their true principles of democracy because people wouldn't change our opinion in their decision if they know somebody who's giving them information is being funded by the very organizations that profits from what that's a sort of coke colors funding research on soda and obesity of course it's gonna find that it's you know not harmful you mentioned this article that there 128 articles and 471 authors that were not disclosed by coca-cola and 19 academic investigators who we think are independent had direct email contact with coke that's completely unethical yeah it's not actually reported in this studies yes so it's not reporting studies but I'll add something else on this which is interesting is I think declarations are really important but actually they're always a footnote at the end they are the headline they're not mentioned the news stories and actually declaration doesn't remove bias in fact there's one in one of the law journals so it's very interesting article that showed that it can actually exacerbate by sometime so an audience listening to a speaker who declares his interest in something initially the credibility momentarily may drop slightly but then what that does is it gives the speaker the person with the vested interest a moral license to exaggerate their claims even further so actually there's no net reduction in that you know fact it can sometimes make things I saw the implications well I'm I'm supported by them but I mean independent of me yeah you can see this and then that then gives them that they're done let's just move on and in fact actually it doesn't in the declarations are extremely important I've no you know I think that's dies something we need to adhere to for everybody every scientist everyone who's publishing something but it does not remove bias no so so what are the other things that are happening besides the the the scientists being corrupted the public health experts being affected by this so I think the what so you talked about Brenda Fitzgerald who was the disgraced director of the CDC which partnered with coca-cola when she was Georgia's public health commissioner and bankrolled something called the global energy balance Network which was a consortium of three academics that said that actually was just all about calories and calories out and an exercise was the solution and eventually they were exposed by the New York Times and said well we have to shut down the global energy balance Network because we have resource limitations I don't have Coke as resource limitations that's surprising to me but I thought that was fascinating so this just says you've got a woman who's running the Center for Disease Control which is the nation's most independent scientific Public Health Organization partner with coca-cola to push a concept that's not founded in science that all calories are the same and saying that we should focus on exercise yeah it is extraordinary and it's sad and I think Brenda really is just a product of a really a system failure Marc because you know really in this battle against misinformation the greatest weapon we have is transparency and warned this people need to be be aware of it because most people wouldn't accept this then as being independent advice but you know when I look at the situation as it is we've got to understand as well that these industries whether it's a drug industry the food and she they're there they have a fiduciary obligation to make profits for their shareholders they're not you know farm superman' she don't have a finished fiduciary obligation or legal obligation to give you the best treatment although most people think that would be the case yeah the food industry there sell food not look after your health no when they can mislead and mark it and they talk about getting really sure yeah absolutely but the real you know the real scandal mark is that those were the responsibilities to patients and scientific integrity that includes academics medical journals institutions they collude with industry for financial gain yeah and that's a real problem we have and we we talk about government guidelines and we realize for example you know I was part of the this campaign to get sugar reduction down in the UK and when I came out or an article in the BMJ saying the dietary advice on added sugar needs emergency surgery where I had from my own investigation figured out that in Europe people were effectively being told from sugar labeling of sugar on products to consume as part of their healthy diet guideline daily amount twenty two and a half teaspoons of sugar a day I thought how you know I recommended amount it's crazy I'm a practicing cardiologist I'm not a nutrition scientist side to do all this research I'm on my own and then ask the scientific advisory committee and nutrition they're basically the the academic group that advise government of producer guidelines that they need to sort this out quickly and eventually they succumbed but they only succumb after an investigation by channel 4 dispatches program and The Sunday Times newspaper in the UK interestingly they were exposed several of the members of this panel had direct financial institutional personal links to manufacturers of sugar big sugar yeah that just doesn't make any sense to me so you know am i saying these people are corrupt no I'm not I'm saying that there is a bias there and I think that when it comes to giving advice the influences millions of people that is supposed to be independent it needs to be independent used to even have the perception of independence mark and be transparent completely transparent and this is clearly not been the case and this is one of the root problems of why we have this epidemic of chronic disease and over medication that we have is because actually those people who should be doing better should know better those people in positions of power and influence are too close to industry and I will not name this person he's a very is quite a well-known individual but somebody very senior in the Department of Health in the UK when I went to this person and said I'm very concerned about scientific integrity fraud in the research community in the UK too much influence by industry you know manipulation of data must be very popular over there I mean popular amongst to the end of the day my job and duty is to do is to do what was best for my patients right that's ultimately what we do isn't it's only you know and and he and he looked at me and he didn't look to me in the eye and he said a seam all I can tell you is the Department of Health is too close to industry and that was enough for me to know what he was here yeah no it's true I remember speaking with a former secretary of the US Department of Agriculture and Venom and I said her why are Dietary Guidelines not matching the science why do we say that we shed three glass of milk a day why why are we not recommending you know the right kinds of fats why why our food stamp program spends 85 billion dollars a year for the poor it's serving mostly junk food and 7 billion dollars a year just on soda or 20 billion servings a year for the poor why why do we have subsidies that support commodity crops that are turn to processed food that are consumed by Americans that make them sick and fat Jesus mark unfortunately the industry has a lock on Congress and the White House and I remember during the filming of fed up Michelle Obama was filmed early on in the movie coming out all guns blazing against the food industry and was excited and passionate engaged and then later on in the movie she was filmed standing on stage with a lot of hot food industry executives looking totally dejected and forlorn announcing this great initiative to remove six trillion calories from the food supply which sounded wonderful if you believe the calories of the problem turns out what they were doing was making an Oreo cookie 90 calories instead of 100 calories which gives them more profit in us less sugar but still is junk and that's the kind of thing we see and it's it's it's frightening and it's and you see it across the halls of government I mean 500 million dollars is spent just lobbying one bill the farm bill which is our major food bill in America and that is not transparent and people don't understand why that's happening so you've got corrupt scientists you've got corrupt public health organizations like the American Heart Association which essentially gives hundreds of thousands gets hundreds of thousands of dollars from the food mystery for giving them their heart-healthy seal for things like tricks are for kids which has seven teaspoons of sugar and all kinds of dyes in hand it is I mean how is you know a highly sugary cereal a heart-healthy cereal so that's crazy 40% of the Academy of Nutrition and Dietetics in America's budget is funded by the food natori Pepsi scope Nestle's all the big food companies how can that be independence we have the government we have scientists we have public health organizations we even have them usurping things in the community using corporate social responsibility like funding groups like the n-double-a-cp or Hispanic Federation which is why they oppose soda taxes so we have this really screwed up system where the industry is so heavy-handed how do we begin to sort of work to protect ourselves from that you you and this article laid out a whole series of initiatives and policies that you thought could make a difference can you talk a little bit about what we can do because it sounds kind of hopeless another thing there's a number of things we can do more in fact on that note one of our recommendations is we said that any organization including that for example the British Dietetic Association or the American Academy of Dietetics if they take funding and sponsorship from food industry they can not claim their advice as independent mm-hmm and we made that very strongly as one of our recommendations we actually they should just put we're sure for the food industry well you know mark I mean that's one interpretation absolutely I know and people would think that and in fact actually that also brings into you know I believe in democracy and very much but you know if you ask most members of the public do you think this is acceptable if you tell them you really think most people would agree now they would find it quite extraordinary surprised probably and they would find it unacceptable that their dietary advice is coming is being influenced by the very industry that wants to sell them food that is contributing to chronic disease so I think it's about transparency but ultimately you know the recommendations really concentrate from our paper on reducing sugar consumption through environmental change through regulation so it's about getting you know if we get you know the consumption of sugar down by at least 20 percent in the next few years if we ban junk food advertising you know essentially we reduce a consumption of processed carbohydrates significantly we could very easily you know those if implemented if those were implemented mark we could very easily reverse type 2 diabetes epidemic within 3 years and on that note when one looks at ultra processed food which is the major issue there was a recent study published reporting The Guardian newspaper in one of the nutrition journals the showed an association or a strong association between ultra processed food consumption in European countries and prevalence of obesity and the UK came at top okay and even I was short the ultra processed food consumption of the average British diet mark 50% of the diet half of the die is coming from ultra processed food now yeah if you break that in there and it's almost 60 versus it really Wow I mean but if you break down the ultra processed food where is it coming from more than 70 percent is coming from starch sugar sugary drinks ultra process fruit and vegetables most of it is starch and sugar yeah it's not coming from saturated fat or fat or meat or dairy there are process dairy and meat as well all that cut the fat and cut the meal itself crisis we have is actually the macronutrient the big problem we're over consuming which is the key component of ultra process food is starch and sugar and this is what we need to get down and that should be the public health message because we still here even the UK we need to get down the fat sugar and salt why we're not discussing starch optimizes carbohydrates and why are we not discussing them that is the big issue yeah and you also talked about other initiatives like changing subsidies for commodity crops that get turned into processed food that artificially suppress the prices of the bad stuff and fight the prices of the good stuff yeah so you know we have to make it affordable mark I think one of the things it's also very true is that actually some people believe that following a healthy diet I think you can follow a healthy down in a budget but it's more difficult a lot of the ultra-processed foods are extremely cheap and the slightly healthy ones are more expensive what we want to do is we need to shift that and again that will need government regulation so that we can make junk food more expensive and we know that will automatically across the population will change eating behavior and even those small changes but if it was across a population would have impact on pop on public health and again I always look at these from a point of view of are there any harms from this for the public or for my patients you know as doctors first do no harm there's no harm it's only it's only positive you'll talk about you know other initiatives that changed the food environment that we live in because you know had a patient once they said you know bye I'm in this food environment it's like an alcoholic living in a bar she's hard to resist so you talked about for example changing food advertising so and yeah banning advertising at sports events and getting celebrities to come out against junk food and soda said like Steph Curry and Tom Brady who don't actually promote any that junk where the others like they're setting a really good example yeah and you know this is the this is what happened with tobacco is exactly the same thing we can learn from that and do the same big sugar is the same we need we know it you know the reason there's advertising an association was spore it's a branding opportunity for them increases their sales so it's very and also there are certain things you know why are we allowing sporting events or the Olympic Games you know I did a I did a report for the BBC in 2012 mm-hmm as the angry cardiologists who said we're in the got a busy epidemic why are our main sponsors the London Olympics McDonald's coca-cola Heineken Cadbury's you know it doesn't make sense true I had a friend who owns a basketball team and owns a stadium and I said why are you having these big jugs of Gatorade on the sidelines with the players that that's one bad for them into promoting some product that's mostly sugar and color and dye because well we have to because we have contracts but actually what's in there is not Gatorade because the players won't drink it well that's really interesting yeah I mean that people need to know that you know also changing the environment you know how our supermarkets are structured you know changing what's at the checkout counter changing what the end caps of the aisles makes a difference in behavior those behavioral economics and studies that have shown that yeah you know so yeah we we need political traction mark and think one of the things reason I went to the European Parliament so this one of these members European Parliament Nathan Gill but I share type one type one diabetes and managed to reduces insulin by 50% by going low but only ten days ago and this will be a slow carb higher fare absolutely of course because the protein doesn't reach Ange much and you end up eating more fat for sure and 100% and you know I brought a book on this as you know which she get you know which really tries to put from my interpretation of all the evidence of where the best components of food of the Mediterranean diet are and we need to reduce our starch and sugar and having you know really good good effects and a lot of good feedback but what was interesting is only ten days ago I got a phone call from the deputy leader of the Labour Party in the UK Tom Watson and you know the opposition party is a deputy leader and he said to me essentially he'd message me a few months ago and he said he'd lost 56 pounds effort effortlessly from cutting out start to glucose from his diets and he'd fallen my diet plan yeah and I was like wow this is amazing and he's staining it and you know I think when the politicians in influence of power they almost have an emotional they baguette emotionally a wedded to this because it's helped them as well they I think that kind of thing ultimately will have an imp because you know these are the people ultimately that can really change things in terms of government and when they know what's going on and they realize I'm sure in their own minds that they probably been misled because they know we didn't deliberately think they were you know gonna get addicted to sugar all the effects that was having on them and then they got better I think they realized actually you know what everybody should have this opportunity to and what is our oldest politicians to help improve the food environment so I think it's a it's a these things are happening and I think they will happen they happen tomorrow you suggest fighting this view that it's gonna create a nanny state where we lose our freedom yeah so we market yeah so when people talk about freedom and it's so you know markets function first of all I've got to say mark markets function best on perfect information right so we're not actually practicing you know the current system is far from the perfect market if people are not getting what they think they're getting you know the payer in the transact I need to know exactly what they're getting and if people are being misled then there's something wrong with a regulation that isn't I don't think society anyone would want to live in mm-hmm so and when you talk about nanny state this is a term that's really used in my view is propaganda young people who want to you know keep perpetuating you're profiting from regulations that are so weak that they can mislead the people into buying their products that causes ultimately causes them harm let's just talk about you know what at the heart of the nanny stay is about personal responsibility yeah let's dig into that one so to define personal responsibility you need to have knowledge the correct information which you don't have if you're being misled to buy something that's high in sugar that's got the American Heart Association label on it yeah okay that's extremely misleading that's not quite the right knowledge and you need to have choice and if sugars become so prevalent that it becomes unavoidable you don't have choice and it's also biologically addictive which makes choice even more divorce once you get hooked it's hard to get absolutely so there's more reason for regulation and actually this nanny state argument doesn't stand up to evidence you know let's talk about evidence the evidence tells us this doesn't stand up this is nonsan this is propaganda people need to these organizations need to be exposed and if we don't do this mark then really we are we're in a big we're already in a big mess in terms of chronic disease quickly cars you know we we all drive cars why shouldn't we able to drive cars without seatbelts and no airbags and yeah you know no safety standards and poor emissions because it's not good for society and it saves lives if we do those things and those are all regulated no we don't and initially when was seatbelts were being brought in you know the industry actually opposed it they put the in the the the you know the car industry opposed seatbelts initially because obviously was gonna be more cost to their more work etc and once they're in you know area same with smoking you know I spoke to people who initially opposed the public smoking ban but now realize it was a good thing hmm you know so those vested interests in the airplanes and people lighting up on airplanes made a smoking section absolutely so I think as the awareness grows and people come more aware then I think this nanny-state argument will not stand up and the politicians will will respond to the public but the way the public get their information is also through the media in terms of getting at mass and mass mass media has a huge impact on public opinion reading to engage journalists and editors as well to realize that actually this is these discussions need to be had you can't keep this information from the public how long can you keep it from the public you know and is so not a free-market system when when the government uh know what is in the UK but in the u.s. ninety nine percent of subsidies in agriculture or for commodity crops that get turned into processed food high fructose corn syrup white flour refined soybean oil and one percenter for specialty crops when we spend three quarters of a trillion dollars supporting junk food industry through food stamps about I think eighteen percent of the annual revenue of a I mean a Walmart is food stamps I think coca-cola has 1/5 of their revenue in the u.s. coming from food stamps and so no this is not a free market system it's not at all it's not really a true free market so I believe in the free market but it isn't a free market and people need to know that hmm and that means industry will do better and if industry do better great because you know I'm gonna quote my friend Robert Lustig here he said to me once to seem I have no problem with people making money doing the right thing but I have a problem with people making money doing the wrong thing mm-hmm we need more people making money doing the right thing mark and we don't have that right now so when you talked about the right thing in the European Parliament for two hours which was extraordinary but what was her response you know listen did they shut you down then they try to go yeah I think a lot of people you know I think a lot of people hang this information for the first time and what was good and I was particularly pleased when I did this so that wanted people to know what was being talked about and to get the awareness out there because for me it's not about a scene malhotra this is about the message not the messenger and the more people they have a message the more chance we have on winning winning this battle against chronic disease or the Battle of truth versus money as Marcia Angell the for medicine you know medicine told me on the phone recently this is what it's about but the response has been generally positive I think people are becoming more aware it was front page of the eye newspaper in the UK the fact that this was happening the European Parliament I had other people with me as well who were the former queen of England's physician for 21 years Sir Richard Thompson he's fully on board with this you know and he's had a lot of experience lot more experience than I am you know he's been a doctor for you know he's you know he's at well over 70 I think he's I think he's close to 80 if I can't remember his exact age but he's you know very smart and very experienced and he says assume we need to keep going with this because this is the major issue so the response has been positive I then debated also the the CEO of Astra Zeneca I was invited to speak at the Cambridge University Union must have been fun and you know the motion was this house believes we need more new drugs and I basically said actually we need less drugs we need more lifestyle and this is the evidence of of why we need that because the current paradigm the current approach is failing our patients so you know it's good that I've got an opportunity to get that message at that sort of level but you know these people as I meet them you know he was a very friendly nice guy I thought he was a bit misinformed to be honest with the things he was saying but I don't think these people individually about people I think this is all again a product of a system failure Marc yeah you know and we need to change our system and the only way to change it is to tackle it it is at its root so then if you're if you're king for a day the King of England or the king of the world what would you do to change policy or a law or something that would make a difference in shifting this whole problem wow there's a lot of things I think I think you know you can have a list you get all day yeah yeah I mean so yeah so I think okay so I think did you do in a day what I think okay you know but make more and more people aware patience aware the public aware that actually we can use food as medicine mm-hmm it sounds a bit cliched but it's true really we know how important you know we we all need food to survive but we need good food to stay healthy right mm-hmm so I would get that message out to every single person I would empower every doctor to be able to prescribe food as medicine with the best available evidence mmm I would tell them be paid for by insurance by the NHS and Medicare prescription well it's a good question I think ideally not I think ideally what you want is to make those foods affordable for everybody in society so even people who don't go to the doctor can and have you know the opportunity to have LT don't see their doctor but I would make again the healthy food affordable I do whatever I could to do that I would you know highlight the harms of the fact we have a bit you know that your best way to good health is not through taking lots of pills to know that there are small benefits and you can choose to take it or not because I believe an informed choice most people I think would probably choose not to take a pill for many of these conditions they have mm-hm and again it's about also right care getting the right care to the right patient because when we're investing lots of money and spending it on very marginal or no gains through chronic disease with lots of pills for type 2 or blah blah straw we're also taking away resources from the people who need it most yeah so there's another ethical consideration there so it's about redistribution of resources and when we have a mouth this would be resources so that's what I would would also do and the other things I think we we haven't we're not gonna speak a lot about in this particular conference I think but I think you know the other aspects are so important to good health mark are as you know we've discussed this at length is okay you know keep moving let me sedentary with so mindful movement rather than exercise what about your you know how how could your relationships with people sense of community are you spending time with friends are you sitting down and having lunch together with your friends you sitting on your own and having fast food are you sleeping well what your stress levels like all of these things we need to concentrate on together as a community and then we will all be healthier and happier and that really is the key I think we need to put that to the very forefront it's a how do we and this is not just about health I mean this is about happiness this is about economic productivity it's you know it's all of these things combined so we're we're all gonna win as a society now you know if we tackle the obesity epidemic properly there will be a few losers and once a few losers I'm talking about industry that have made a lot of money mm-hm from selling junk food and if you really tackle the the food industry there will be a few losers in there but if we don't tackle the food industry don't tackle junk food mark everyone loses absolutely and they're trying to reconfigure and these big companies are seeing the trend coming and they're buying up innovative food companies and they're trying to read how they think about agriculture it's just too slow yeah exactly so we need to you know we need to just keep pushing and we need to keep fighting for this message and we need to get it out there and we need to keep going and there's no room for complacency to be honest we can't take off foot off the accelerator you know I think we're at a tipping point but we just got to keep going and see where it takes us and our patience markers you know and you you know you were this amazing clinic in Cleveland which I look forward to visiting one day you know and you know you've pine did this well but well before even I was on on the scene but you know we know from our patients how much you know how the how much better they get when they you know change their lifestyle and it's not difficult and that you know they're so grateful they feel better and you know that's why we became doctors and it's so rewarding when we see this happen and when we know this works in our patients and our well we have to get that everybody needs to be doing this well I'm so thankful for you dr. Malhotra because since you arrived in the scene I'm feel not so alone and like I can relax a little bit someone else out there crying in the wilderness for what the truth is and I just respect you immensely I can't wait to see what's next and how we're gonna do this change and we're all working together it's a whole coalition of us trying to make the change and we're here at this meeting and we're working together and collaborating all sorts of ways and I'm just really grateful for your courage and your wisdom and your willingness to dig into the science to look at the truth about what's happening in the politics and to call it out in ways that people can hear and listen it's really inspiring thank you thank you mark thank you and so you've been listening to the doctors pharmacy with dr. a si Malhotra from the UK breaking down our views about saturated fat statins sugar politics and lots more I hope you've enjoyed this podcast and if you have please leave a comment it matters to us subscribe on iTunes wherever you get your podcasts share with your friends and family and we'll see you next time on the doctors pharmacy [Music] hey everybody I hope you enjoyed the interview just reminded that this podcast is for educational purposes only this podcast is not a substitute for professional care by a doctor or other qualified medical professional this podcast is provided on the understanding that it does not constitute medical or other professional advice or services if you're looking for help in your journey seek out a qualified medical practitioner and if you're looking for a functional medicine practitioner you can visit IFM dot org and search there find a practitioner database it's important that you have someone in your corner who's trained who's licensed and who's a health cap it's important that you have someone in your corner who's a trained sorry it's important that you have someone in your corner who's trained who's a licensed healthcare practitioner and can help you make changes especially when it comes to your health

Channel: Mark Hyman, MD

Views: 99,234

Rating: 4.9211226 out of 5

Keywords: Dr. Aseem Malhotra, Aseem Malhotra, Mark Hyman, Dr. Mark Hyman, Heart Health, Statins, cholesterol, saturated fat, heart disease, statins, statin, The Doctor’s Farmacy, nutrition, diet

Id: fzZVJDzCAeg

Length: 61min 32sec (3692 seconds)

Published: Wed Oct 03 2018