Feel Better, Live More with Dr Rangan Chatterjee - #3 The Importance of Heart Health with Dr Aseem Malhotra

Episode Date: January 31, 2018

In this episode Dr Rangan Chatterjee meets cardiologist Dr Aseem Malhotra - a world-leading obesity expert and one of Britain's most vocal anti-sugar campaigners - to discuss what food can help you live a happier, healthier life. Show notes available at: drchatterjee.com/aseemmahotra Follow me on instagram.com/drchatterjee/ Follow me on facebook.com/DrChatterjee/ Follow me on twitter.com/drchatterjeeuk Hosted on Acast. See acast.com/privacy for more information.

Hi, my name is Dr. Rangan Chatterjee, medical doctor, author of The Four Pillar Plan and BBC television presenter. I believe that all of us have the ability to feel better than we currently do, but getting healthy has become far too complicated. With this podcast, I aim to simplify it. I'm going to be having conversations with some of the most interesting and exciting people, both within as well as outside the health space, to hopefully inspire you, as well as empower you with simple tips that you can put into practice immediately to transform the way that you feel. I believe that when we are healthier, we are happier, because when we feel better, we live more. My guest today is Dr. Asim Malhotra, consultant cardiologist,

author of The Piyopi Diet, and one of the UK's most well-known health campaigners. Asim, welcome to the show. Pleasure to be here, Ronan. Now, Asim actually and myself went to the same school together, which a lot of people probably don't know. We both went to Manchester Grammar School, and we both went to Edinburgh Medical School as well. But we didn't actually sort of really occupy the same space. We kind of knew each other, but I wouldn't say we were necessarily close or really good friends because I think we just, you know, we were in different years, we did slightly different things. But we've been on our own journeys, but we've actually ended up coming back to a very similar

space, which is trying to promote nutrition and lifestyle and how beneficial this can be for people. Asim really is someone who I think has been very inspirational. I think he's one of the most vocal health campaigners out there, certainly in the UK, but his message actually goes around the world. And I wonder, Asim, if you could share with the listeners some of your inspirations and actually a little bit about who you are and what your journey has been and how you've ended up here today. Thanks, Rangan. Yes. It's interesting, yeah, that we both actually end up, we grew up in Manchester and we went to the same school and same university. And in some ways, I suspect what

we learned in Manchester Grammar in Edinburgh probably has actually influenced what we're doing now as well. You know, one of the motto of Manchester Grammar, if you remember, was sapere aude in Latin, which means dare to be wise. And I didn't really fully understand what that meant until much later on. And I think that concept is really rooted in both of what we're doing in the sense that we are, you know, changing the way we approach medicine. And the reason we're doing that is because the current system is failing patients, Rangan. And going back, for me, I've been qualified like yourself as a qualified doctor for over 16 years.

And about 10 years ago, I started to realize that there was definitely more pressure. I'd noticed even within a few years since qualifying for medical school that working in the NHS, working in hospitals, there was much more pressure on the system. There seemed to be an increasing number of people coming in with multiple conditions. And at the same time, we're hearing headlines about the obesity crisis. 2004, the World Health Organization announced that obesity was a global public health crisis. Yet there didn't seem to be any real action being taken or any effective interventions that, you know, we could see that was curbing it. So part of my journey actually started really investigating how did this obesity epidemic

actually start and what are the roots behind it? I think there was a flashpoint, if you like, a one moment for me where, you know, it kind of took me down this path really as becoming a campaigner. I was working as a specialist registrar in Harefield Hospital as an interventional cardiologist, so essentially doing keyhole heart surgery for people with heart attacks. And a gentleman comes in in his early 50s in the middle of the night, we treat him with an emergency stent, you know, unblock his artery, he survives. And the next morning, I'm doing the ward round, and I'm just trying to talk to him about the usual stuff, like stop smoking, make sure he takes all his pills religiously. And at the same time, trying to discuss the importance of a healthy diet with him.

And just as I'm doing that, he gets served up by the hospital staff, a burger and chips. And he looks at me and he says, Doc, how do you expect me to change my lifestyle if you're serving me up the same crap that brought me here in the first place? I've always been a foodie in the sense that I've always enjoyed eating good food. I started to cook when I was a teenager. I learned from my parents how to cook. And I was never particularly impressed with the food that was being served in hospitals. But it made me realize, actually, it wasn't just the fact that the food wasn't particularly great, but we've allowed our hospitals to become a branding opportunity

for the junk food industry. And then what happened is I actually then ended up writing an email during one of my lunch breaks, having got the email address of Jamie Oliver's PA from a friend who's a journalist, actually asking Jamie Oliver to sort out hospital food because he'd inspired me in the sense that he'd raised so much awareness about childhood obesity in school dinners.

And I thought, actually, why doesn't he come and sort out hospital food? Because it's pretty atrocious what's being served to staff and patients. And to my pleasant surprise, several weeks later, I get a reply basically inviting me to meet Jamie in his office in Nile Street and a number of doctors to have dinner with him and have a discussion about what needs to be done to tackle the obesity epidemic. So I ended up writing about that

in a comment piece in The Observer several months later about the meeting with Jamie and the fact that, you know, I'm a cardiologist and, you know, why are we serving junk food to our patients? And it actually seemed to have quite a big impact in terms of we got a lot of reach. And for me, that's when things started off. And then I went down more of a track at Rongan, really discovering that, you know, we had for a long time, for decades, I think we're realising now more than ever, I went on my own sort of investigation to the research around sugar

and the contribution of sugar to the obesity epidemic and chronic disease. Yeah, Asim, thanks for sharing your journey. I mean, it's just incredible to hear that. And it's remarkable to me as a doctor, and I think one of the biggest things for us is to listen to our patients. And you've quite clearly listened to what that patient said to you, you know, after their surgery on that hospital bed. I think that was a very insightful observation by your patient. It's remarkable that actually we need patients to say that sometimes because on one level, it is ridiculous. Why should a patient in a cardiology ward be served junk food? I'd go as far as to say it's completely unacceptable. I mean, people can laugh about

it and smile about it. But, it, but this is no laughing matter. This is a serious issue that we have to be not only helping our patients, but also preaching the right message and showing them the right behavioural strategies whilst they're in a hospital. And before we started this podcast, we were talking about this whole issue of personal responsibility. And I think a lot of the time, people think it's up to individuals, you know, individuals should know how to look after themselves, you know, what can we do if they don't? And I think, I don't want to speak for you, but I think we agree that the environment is actually a key determinant of our behaviour. And, you know, you mentioned hospital food,

you mentioned Jamie and school food, and, you know, I'm a father, I've got two young kids. And, you know, I see what happens at schools've got two young kids. And, you know, I see what happens at schools now. I see the conditioning that happens at schools. And it actually makes me very angry because you can try, we're a very empowered family, we try and make healthy lifestyle choices. But actually, your efforts can actually only go so far when they're surrounded by a society and an environment that puts priority somewhere else. And that's been incredibly hard for me, primarily as a father, because I'm trying to do the right thing by my kids. But I'm finding that when they go to school,

when they go to parties, actually, I run the risk of making them social outcasts by encouraging them to be healthy. Maybe you could comment on that. There's a really important point there, I think. Yeah, no, absolutely, Rangan. You're spot on. I think just very briefly, one of the reasons why we allowed our hospitals to become a branding opportunity for the junk food industry,

part of it is also the lack of appreciation and understanding amongst the profession, actually, that how important food is. So, you know, I know there are doctors. I remember even on ward rounds where having conversations with doctors who are very established consultants who would think, well, hold on, it know there are doctors. I remember even on ward rounds where having conversations with doctors who were very established consultants who would think, well, hold on, it doesn't matter what you eat as long as you exercise

and it's all about your weight and food doesn't really have much of an impact. And that's basically just a complete lack of knowledge and ignorance, really. So that's why it crept into the hospital food environment. It's only when you start looking at the research, you realize that actually the father of modern medicine, Hippocrates, was right when he said, let food be thy medicine and medicine be thy food. But somehow we've forgotten all of that. When you talk about personal responsibility, I think you're spot on. What we forget is that actually a lot of our behavior is determined by the environment around

us, especially when it comes to food. And the reality is that, you know, education itself is actually ineffective when the food environment is working against you. The analogy I give is it's like asking a child that grows up in a sweet shop to not eat sweets. You know, it's difficult. So what we want people to do is to swim with the tide, not against the current, if you like. And I think that's what the challenge we have. And that's why policy change is needed. And then let's also define personal responsibility.

No one can deny personal responsibility is extremely important. In fact, you know, we all have to exercise personal responsibility. But to do that, you need at least two things, you need the right information. And you need choice, but actually, we have neither. So we know that the information around what constitutes a healthy diet has been, and I don't use this word lightly, corrupted by commercial influence and the science around it. And at the same time, and you know, that basically goes to the whole low fat food movement ultimately resulted in a huge industry and market around low fat junk foods, which are loaded with sugar. And so people even who wanting to, you know, are buying products that are marketed as healthy, which actually have the opposite effects on your health. And I actually tell my patients all the time, I say, if you see anything marketed as proven to

lower cholesterol, heart healthy, low fat, I say, avoid it like the plague. Because the likelihood is it's going to have the exact opposite effects on your health. And the food industry know that people buy products based more upon the way it's marketed than the nutritional value. And people don't read the labels generally. So that's how they've got away with it. So that's the sad aspect is there are people out there, Rongan, as you know, who are trying to do the right thing, who actually want to lead healthy lifestyles, who want to eat healthy foods, and they're buying foods that are marketed as healthy that are going to have the opposite effect on their health. So where does the personal responsibility come in there? And that's why government need to intervene, because ultimately,

this is a consequence of the excesses and manipulations of the industry. And government's duty is to protect the public and children in particular, from those excesses. Yeah, I would agree with that. And I think, I don't think it's either or. I think, as you say, personal responsibility is clearly very important. But if we look around the world at healthy populations in general, and I, you know, I'm very much fascinated by the work from Dan Boettner and Michelle Poulin about blue zones and about these little communities around the world where they seem to have high rates of longevity. And I know your book, The Piopi Diet, also references a community where they sort of age well, and they live a long time, but they live

in good health, which is I I think, what we all want. What really struck me about these communities is I don't think that they are consciously thinking about health. I think the environment means that their default option is health. And I was very fortunate in June to go to Guernsey for a Live to 100 conference. And there were speakers there from around the world. And I had the privilege to actually meet Michel Poulin, who coined the term Blue Zones. And we went and we knocked on the door of this resident in Guernsey, he was 102 years old. It was quite a surprise to me. He came to the door and answered his own door. Now I know,

you know, that shouldn't be remarkable. But as a GP who does home visits, we rarely see that. I rarely see that when I'm going around doing my home visits and trying to help people in their homes. And so that was quite amazing for me. First of all, then he said his health deteriorated when he started going to see doctors. He never saw a single doctor until he was 94 years old. And he said, since I went to see see doctors I've been put on various medications and I think I won't go into too much more detail on that sort but I think there's a there's quite an interesting um parallel there with what we're finding in me as a as a GP in primary care you as

a cardiology specialist in secondary care but how medicine potentially and our health understanding and the education that we've been given doesn't really prioritise nutrition and lifestyle. And often the things that we're doing for patients, thinking that they're going to help, often actually are harming them. You've raised a really good point there, Ron. I think all of this problem that we're facing in terms of the increasing chronic disease, essentially increasing, as you alluded to at the introduction, is that healthier communities lead to happier people, happier communities. Health and happiness are completely intertwined. So we've also got an increasing burden, really, of misery in society

because we've lost touch with some very basic behaviours and things that we do that actually give us a good sense of wellbeing and improve our health. And when one looks at the problem that's happened in modern medicine as well, is that there is actually so much commercial influence that evidence-based medicine, and that means practicing medicine to improve patients' health and outcomes based upon best available evidence, your individual clinical expertise, and patients' values and preferences, has actually been hijacked by commercial interests. So what we're doing now, unfortunately, we're battling against

finance-based medicine. And the impact of that is really quite extraordinary. So Peter Gosia, who's one of the co-founding members of the prestigious group of scientists, an organisation called the Cochrane Collaboration, he's estimated that prescribed drugs, Rangan, now are the third most common cause of death after heart disease and cancer. The elderly are particularly vulnerable because a lot of them get put on pills that really are not helping them or make them feel any better. And they get side effects. If you're elderly and you fall and you break a hip, the mortality rate, up to 25% of those people will ultimately die within a month of breaking their hip. You know, this is a real public health crisis in itself. And it's intertwined with our inability to tackle the lifestyle-related diseases.

So just to give you one example, many people are aware of cholesterol-lowering drug statin pills. Now, they do have some beneficial effect to a marginal level based upon published literature, if you take it at face value, especially in people with heart disease. But for most of the people, they're not going to live any longer. And there was a study done which showed that people in middle age who consumed statins versus a similar group that didn't, with a similar sort of background and risk factors,

ended up heavier than over a period of several years as published in JAMA Internal Medicine. And the point made in the paper was actually that statins can give the illusion of protection to people, where they think, actually, I'm taking a pill that's lowering my cholesterol. That may reflect that I'm having a good diet when my blood cholesterol is checked, or it gives me an excuse, or it gives me legitimacy to gorge on junk food. Yeah, it's incredible when you think about it. That whole thing of illusion of protection, I think you can expand it out even further. And so obviously, we're talking about statins and cardiology issues and heart problems,

but actually across different strands and different specialities of medicine, so let's say psychiatry, let's say antidepressants. I've read some really good reviews and some articles suggesting that the benefits say antidepressants. I've read some really good reviews and some articles suggesting that the benefits of antidepressants have been very much overplayed and the risks have been very much understated. And actually, it's almost like a broken record now because you go across lots of these drugs and lots of different specialities. I think we really have overplayed some of these benefits. And again, it's not to say that they don't have value sometimes for some people, but not always. And if we do go back to,

you know, primum non nocere, first do no harm, one of the basic tenets of us as doctors and how we should be practicing what we take, this Hippocratic Oath, I find it remarkable how, let's say with an antidepressant, it is a documented side effect. This is not a conspiracy. It says right there in the BNFR, British National Formulary, that it can increase risk of suicide. So I think as a medical professor, we have to take a step back and go, okay, let's assume there is some benefit in some patients, but surely first of all, we should be trying harmless interventions. And I would also argue that although evidence is important, it's clearly very important,

I would argue that the level of evidence we need should depend also on the severity and the harm that is possibly being put to these patients when we undergo such an intervention. So change your diet and lifestyle, okay? It's harmless, right? Pretty much. It's not going to do any harm. If it doesn't work, okay, fine. It's not worked. So I think we really, as a profession, have to really look at risk-benefit again. And the other thing I'm passionate about, and I know you are, is that if doctors are not trained in this in the first place, we're not going to give it the appropriate priority in our consultation. So just saying to a newly diagnosed type 2 diabetic, well, look, you've got this problem. It's a lifelong condition.

Your body's not able to manage your blood sugar. If you can lose a bit of weight and exercise a bit more, that might help. But I think I'm going to have to put you on a medication. If that's the conversation that's very different from saying, hey, look, your blood sugar levels are in a range that we would call type 2 diabetic. Now, what's causing that is your diet, your sleep habits, your movements, the fact that you're very stressed. Why don't I help you understand how those things affect that condition, help you change them, and maybe together we can see if we can actually make an impact on this. It's a very different conversation. And I think we can help prioritise what patients think about this. And I've said for many years that,

and it makes me very sad to say this, but some of our patients would have been better going to see nutrition professionals or really good personal trainers who have a really deep understanding of nutrition and lifestyle rather than doctors and I think that's got to change. Yeah I know wrong and you're right and I think you've raised a few really important issues and points there I think the first thing is you know I remember when I was a medical student you know when you're you know you're studying for exams and you learn about all sorts of rare diseases and I remember one of my colleagues saying to their tutor you know why do we have You know, when you're studying for exams and you learn about all sorts of rare diseases. And I remember one of my colleagues saying to their tutor, you know, why do we have to learn about something that we're very rarely going to see in our practice?

And the response was, if you're not aware of it, if you don't know of its existence, you'll never diagnose it. And you'll miss it when it eventually comes across your path at some point in your career. And actually, you know, that's a really important concept and issue because, you know, doctors, as you say, are not trained in the impact of lifestyle on health, but actually it's extremely powerful and there's a lot of good evidence out there. And I think that that understanding of the fact that actually science evolves, combined with the fact that, you know, the man who's considered one of the forefathers of the concept of evidence-based medicine and evidence-based practice, Professor David Sackett, he said 50% of what you learn in medical school will turn out to be either outdated or dead wrong within five years of leaving. The trouble is you don't know which half.

So what you've got to learn to do is to learn on your own. I think both you and I have essentially been doing that for several years and realizing there's a lot of very powerful, useful information out there that can help our patients through lifestyle changes, but also simultaneously realizing that there are a lot of outdated concepts, certainly in relation to our obsession with lowering cholesterol by any means is necessary and that's the most important thing when we're realizing now cholesterol is a risk factor for heart diseases is much much smaller than we originally thought and certainly if you're elderly i was involved in some research with some scientists last year and we basically found out that if you're over 60 the so-called bad cholesterol ldl is not associated with heart disease and is inversely associated with all cause mortality in other words the higher your cholesterol the less likely you are to die. I've even had conversations with patients who've come in to see me, you know, over 60, and the fear of life has been put into them because they've been told by their family practitioner

with all the best will in the world that they've got high cholesterol. And I've said, congratulations, you're going to live longer. And they leave my consultation with a smile on their face. But I think we need to exercise a bit of humility and say, well, actually, you know, this is part of science evolving, but, you know, this is a huge U-turn, if you like, in what we were trained when it comes to, you know.

It is a huge, it's super interesting that. And what I find interesting about the whole cholesterol story is that it's traveled so far away from just medical conversations. Now, it's now in common parlance where it's just accepted as fat people will talk about cholesterol as oh you know it was great I've got low cholesterol or I've got high cholesterol and I remember a few years back at one of my last GP practices where I came up from my room into reception to pick up some prescriptions that needed signing and I heard one of the receptionists speak to a patient who had obviously phoned up about their results. And she was so convinced that a low

cholesterol is a good thing. She was saying over the phone, your cholesterol level's four, that's absolutely brilliant. I'd be really, really pleased if I had a level like that. Now, apart from the fact that arguably she shouldn't be giving that advice to a patient, I think sometimes that advice is plain wrong. And you are right. I think most doctors are trying to do the right thing for their patients. If they have been taught that those cholesterol numbers need to come down, and statins are the way to do that,

I think they are trying to do the right thing and help their patients. When I certainly became tuned into the complexity of cholesterol a few years back, and I'm sort of traveling the world and trying to learn about these different things, because I always had this slight disconnect with how I was being told to practice and what I intuitively felt was the right way to practice. I remember that I had this 54-year-old lady in fantastic health, fantastic weight, no issues at all. Yet on a routine screening, my colleague at the time, my partner, had actually said, you need to go on a statin. Now, she knew, I think, that I was maybe, I wouldn't say unconventional. I thought outside the box a little bit.

So she made an appointment with me the following week and said, hey, Dr. Chastity, do I need to go on the statin? And I said, look, here's the thing. From the markers that we have done, I understand why you've been recommended that, but cholesterol is a very complex story. And actually, she was able to. So she, on my advice, got a more advanced lipid profile test done. And again, I'm not recommending that everyone needs to do this, But she came back to me and said, look, I've had it done. Can you have a look at it? I said, interestingly enough, you were told to go on the statin because your levels of LDL, what is regarded the bad cholesterol, were high. But when we actually look at them in more detail, there's many different types of LDL. You've got large, fluffy, bouncy LDL, which actually isn't going to necessarily cause you too many problems,

rather than the small, dense, almost like like pellets which will damage your blood vessels and I said based upon that I don't think you're at any increased risk and these are the side effects of a statin and she was like well you know I'm not going to go on it then and you know I know five six years later she's doing really really well. So Asim I'm not sure if you've heard stories like that before, or if you can resonate with things like that. But I think cholesterol is a big issue, a big issue in the sense that I think we have a fundamental misunderstanding that cholesterol is a vital molecule for the body. It's a critical molecule for the body. And sure, maybe certain fractions

of it can indicate an increased risk of issues, but I don't think we should be hanging our hat on it. Absolutely. In fact, I've told my patients to stop fearing cholesterol. I think there needs to be a public health campaign, actually. Stop fearing cholesterol. Because actually, when you look at the original studies, which sanctified it as a risk factor, a Framingham Heart Study, for example,

looking at risk factors within a population within Framingham in the America and following them up over decades, you know, the original association between high cholesterol and heart disease was only really there when someone's total cholesterol was over 10. And their LDL was more than 4.9, which I mentioned briefly in my book, The Piopida and explain all of that. So that's a separate discussion to the impact of statin, to which I've written about is likely beneficial because of a reduction in having anti-inflammatory mechanisms. And heart disease itself is actually much more plausibly a kind of inflammatory condition that is influenced by a number of risk factors related to insulin resistance. And what I love about your approach with your book is actually all of these

different things will hit insulin resistance. And I talk about it in Peopie Diet as well. You know, it's about the right kind of diet. It's about movement. It's about getting a good sleep. It's about stress reduction. If we all of us collectively concentrate on all those things, I have no doubt very quickly, we would manage to significantly reduce population health problems, but individuals will feel better a lot more quickly. So I think we've got the solutions there, certainly much better. And science evolves and new information, of course, will come out. But where we are right now, this should be the priority. This should be the approach.

Yeah, absolutely. I'm in total agreement. social agreement, I think, if every single member of the population applied these principles, and we also helped create an environment where it was easy to apply these principles, I think the impact not only on health, but as I said, on happiness and purpose, all these things I think would be downstream consequences of that. See, my thing is great that you, you know, practicing cardiologists are, you know, giving this information in a way that both the public can learn from, but also doctors. And I think that's what's great about your book, The Piopi Diet. What I've done in my book, The Four Pillar Plan is, you know, I'm hoping doctors read it as a way of actually helping their patients. But I also think it's going to improve their own health if they understand the power of lifestyle and nutrition. I also think it's going to improve their own health if they understand the power of lifestyle and nutrition. But I also want to really be part of that conversation, helping educate the public so they feel, hey, you know what?

I'm in control of my health. It's not something that is done to me. I can actually do something about this. So there's so many great people out there really trying to raise awareness of this. I think hopefully we can add some value to the conversation by coming with our medical hats on. But Asim, look, I think we could end up talking for two or three hours. And I'd love to have you back on the podcast at a later date. But just to try and wrap it up, just a couple of things I'm going to leave it on. I very much talk about four pillars of health, food, movement, sleep and relaxation. And I love my patients to think about which one of those do they think needs the most work? And perhaps they could start there as a simple

framework to improve their lives. But maybe I could ask you, what are your four top tips that people listening to this podcast could maybe apply in their life to help improve their health? Yeah, it's a very good question, Ron. And I think I echo very much what you're talking about, what you're promoting. It's about following a dietary pattern that you enjoy, but it's a very good question, Rangan. I think I echo very much what you're talking about, what you're promoting. It's about following a dietary pattern that you enjoy, but is also going to be good for your health. Good food and enjoyable, tasty food doesn't have to be punitive. It can be very nutritious and delicious. You just got to search for it and listen to your body, really, essentially, and how you respond to the foods you're eating. And when you do eat healthier, actually, people tend to feel better and happier. It's about not sitting for prolonged periods. You know, movement is medicine. And it's one of the things we mentioned in our book as well is that, you know, it's actually very, very simple things. You don't need to necessarily join a gym or be counting how many calories you're burning on a treadmill. In fact, actually, the wrong type of exercise in excess can actually cause you quite a lot of damage to your body and to your joints as well especially as you get older so we need to be a bit more mindful about the way

we move absolutely think about your social interaction and and how that all intertwines with stress you know you talk you talk about stress you know that is actually a big big factor that there isn't a lot of good quality sort of what we call interventional research on stress that's there but we know it's a massive problem. We know that people who have stresses, even with childhood trauma, will live, you know, an average of 20 years less than the average person. So we know it has a big impact on our genes. In fact, one book that I really love, and I keep it by my bedside, I think it touches on this issue about social interaction, is called Happier. And it's written by a professor at Harvard called Tal Ben-Shahar. And his course on psychology is one of the most popular ones at Harvard.

And, you know, one of the lines in there, which I remember, which kind of really sums it up and just makes us think about our interactions with our friends, our relationships, our family. Aristotle said, without friendship, no happiness is possible. And actually, we know severe loneliness in old age is such a big risk factor for premature death affecting over a million people over the age of 50 and it's been likened to the equivalent of smoking 15 cigarettes a day so I think we need to think as a culture as well how that needs to change because good healthy relationships actually

improve your health and reduce your risk of disease. Yeah, absolutely. Asim, thank you for sharing that. I think that's going to be incredibly useful for people. I absolutely agree. Community, I think, is critical. And I think one of the great things about the social media movement that has, well, really social media is what, 10, 12 years old now,

something like that. What I think has been great about it is that things like health information, for example, are no longer the preserve of medical doctors. Anyone can have access to it. Now, lots of people get quite vocal about who's right and who's wrong, but I think just the more information is out there, the less information that is protected, that is held back from people, I think it's a good thing. It it is quite hard to be healthy in this modern food environment. And I think people can often feel quite isolated when they're trying to make these healthy choices. So I think sometimes these social media groups actually help create these little communities where people feel, hey, there's other people doing this. There's Professor George

Slavich at UCLA. He is showing how community and actually that feeling of connection can change the expression of our genes. And if you've got that, you have a less inflammatory genetic expression than if you feel socially isolated. And I call it four pillars of health. You could easily call it six, seven, eight. We can expand it out as far as you want, but community is one thing I have put in the book, but I put it under the relaxation pillar. And I talk about the importance of maybe just sitting around once a day with either friends or family and eating a meal. And the downstream consequences of that are huge. So thank you for sharing that. And also thank you for sharing that book. It's a book I haven't read. I'm going to buy it and I will read it now. So I'll let you know what I think, Asim. Asim, for people

listening who want to, you know, sort of keep up to date with what you're doing, how can they find you? Yeah, so I'm on Twitter under DrAsim Malhotra. I have my own website where I blog as well, drasim.com. That's probably the best resource to get information on things I'm tweeting or writing about. Well, Asim, thank you for joining me on the podcast today. I hope at some point in the future we get the chance to get you back on the podcast. Thank you. It's a pleasure to be here,

Rangan. Thank you. That's the end of this week's Feel Better Live More podcast. Thank you so much for listening. And I really hope you found the conversation useful, but also enjoyable. If you're not already, I'd highly recommend that you subscribe to this podcast so that you can be notified when the latest episode of my podcast comes out. I'd also be incredibly grateful if you consider going onto iTunes and giving this a five-star rating so that I can get this information out and reach more people. It really does make a difference. And if you have any suggestions for people you'd like to see me have conversations with on this podcast, I'd encourage you to get in touch with me on social media using the hashtag feelbetterlivemore. You can find me on Facebook and Instagram using the handle at DrChatterjee and on Twitter using the handle at DrChatterjeeUK.