The Dr. Hyman Show - How Suppressed Science Led To Widespread Misunderstanding About Fat And The Root Cause Of Heart Disease

Episode Date: March 27, 2023

This episode is brought to you by Rupa Health, Athletic Greens, and BiOptimizers. For many of us, growing up we were told that eating foods high in fat is bad for you. Many people still believe that eating cholesterol and fat, especially saturated fat, causes heart attacks. Yet recent studies show there is no association between saturated fat consumption and adverse health outcomes like coronary disease or heart attacks. We also don’t hear enough about insulin resistance as a main driver of cardiovascular disease.  In today’s episode, I talk with Nina Teicholz and Dr. Aseem Malhotra about the origins of the hypothesis that dietary fat raises cholesterol, subsequently increasing heart disease, and how it caught hold. Nina Teicholz is a science journalist and author of the New York Times bestseller The Big Fat Surprise, which upended the conventional wisdom on dietary fat—especially saturated fat—and spurred a new conversation about whether these fats in fact cause heart disease. Nina is also the founder of the Nutrition Coalition, a nonprofit working to ensure that government nutrition policy is transparent and evidence based—work for which she’s been asked to testify before the US Department of Agriculture and the Canadian Senate.  Dr. Aseem Malhotra is an NHS-trained consultant, cardiologist, and visiting professor of evidence-based medicine at the Bahiana School of Medicine and Public Health in Salvador, Brazil. He is a founding member of Action on Sugar. In 2015, he became the youngest member to be appointed to the board of trustees of the UK health charity The King's Fund. He is a pioneer of the lifestyle medicine movement in the UK and in 2018 was ranked by software company Onalytica as the number one doctor in the world influencing obesity thinking. This episode is brought to you by Rupa Health, Athletic Greens, and BiOptimizers. Rupa Health is a place where Functional Medicine practitioners can access more than 2,000 specialty lab tests from over 35 labs like DUTCH, Vibrant America, Genova, and Great Plains. You can check out a free, live demo with a Q&A or create an account at RupaHealth.com. AG1 contains 75 high-quality vitamins, minerals, whole-food sourced superfoods, probiotics, and adaptogens to support your entire body. Right now when you purchase AG1 from Athletic Greens, you will receive 10 FREE travel packs with your first purchase by visiting athleticgreens.com/hyman. Magnesium Breakthrough really stands out from the other magnesium supplements out there. BiOptimizers is offering my community 10% off plus special gift with purchase, so just head over to magbreakthrough.com/hyman with code hyman10. Full-length episodes of these interviews can be found here: Nina Teicholz Dr. Aseem Malhotra

Coming up on this episode of The Doctor's Pharmacy. None of those studies, the billions of dollars spent by governments around the world, none of those studies have ever been reviewed by our dietary guideline committees, which is like our expert bodies making our national food policy. Hi, this is Lauren Feehan, one of the producers of The Doctor's Pharmacy podcast. Many of us were raised to believe that we should be eating low-fat diets and that cholesterol is the primary driver of heart attacks. Yet in 2015, the U.S. Dietary Guidelines came out to say that cholesterol is no longer a nutrient of concern, and the data

linking dietary fat and heart disease is weak at best and corrupt at worst. So where did these ideas come from? In this episode, we feature two past conversations from the doctor's pharmacy detailing how these ideas originated and the real dangers when it comes to cardiovascular risk. Dr. Hyman speaks with science journalist and author Nina Teicholz about the origin story of how we came to believe that fat was bad and how ideas become institutionalized once adopted by public health and medical institutions. He also speaks with cardiologist Dr. Asim Malhotra about why cholesterol may not be the cause of heart disease, and they explore the harmful effects of our

overconsumption of sugar and starch. Let's dive in. Starting from when I was a teenager, you know, I was taught like so many people, like all of us, that fat is bad. Meat is bad. Makes you fat. And so I stopped eating almost any bit of fat. No butter. No, you know, skim everything. I used to put water on my cereal in the morning because like why even eat? Why even have the skim milk?

I don't know how I bared that. That's discipline. It is. And I didn't get thin, of course. I was overweight most of my young adulthood. But I just thought this would make me thin. And the less fat I ate, the better chance I had of being thin. But, of course, it never happened.

For 20 years, it didn't work. But it's just so ingrained in you. I don't know why I never questioned. Maybe the basic advice is wrong. That really never came to my mind. I think I did what many people do is they just blame themselves. Like, if only I try harder, if only. So what happens when you're on a very low fat diet, like I was. You get depressed. Yeah. Well, I was depressed. And, but you also, you're hungry all the time because you're trying to stay full on carbs. And carbs, you know, make your blood sugar go up and then it crashes and then up and it crashes. So, and you don't, it's not as satiating. So then I'm, so then you're binging.

So then you're like trying to get by on like bagels and then you have to go sneak the cookies because you're starving. I mean, my story is just like so many people's, which is that you're just on a low fat, sad diet. Your experience sort of contradicted all the dogma, which is that fat makes you fat because it has more calories and carbs and protein. And that fat causes heart disease and messes up your cholesterol and is not good for you. Right. And that's the meme that we all believed for decades and decades and in your book it was fascinating because you really unearthed the origin story of why we came to believe that fat was bad and you kind of turned it upside down

and revealed all the flaws in the science and the thinking behind why fat wasn't the culprit in particularly heart disease and particularly saturated fat so can you talk about the origin story and what you discovered and the surprising things you found fat wasn't the culprit in particularly heart disease and particularly saturated fat. So can you talk about the origin story and what you discovered and the surprising things you found as you were researching your book that were like, oh my God, what happened? How did we get in this mess? Yeah. So, I mean, like any idea, the idea that fat and cholesterol are bad for you,

they have their origin in a moment in time. We've been living with it for so long. We just kind of think it's always been true, but it hasn't. So it really started in the 1950s when the nation was in a panic over the rising tide of heart disease had been pretty much non-existent in the early 1900s and had risen to become the number one leading killer, right? Even President Eisenhower, 1955, has a heart attack. He's out of the Oval Office for 10 days. Everybody's attention is fixed on this public health emergency, what causes heart disease? And there were a number of explanations. Maybe it was auto-exhaust. Maybe it was vitamin deficiency. Maybe it was the type A personality.

Remember that? But there was one theory- Which both of us probably have. And we're still alive. And there was one theory proposed by a physiologist by the name of Ansel Benjamin Keyes from the University of Minnesota. And it was his idea that it was saturated fats, the kind you find in animal foods, but also coconut oilurated fats and dietary cholesterol, think egg yolks, shellfish, that cause heart disease. And so that was called the diet heart hypothesis, right? So- There were some animal studies on rabbits

who never eat that stuff and gave them high levels of cholesterol to eat and they got heart disease. So, oh, it's cholesterol in the arteries, so it must be the cholesterol we're eating and the fat we're eating. Yeah, I mean, when you talk about the weak science behind, you know, when he came up with this idea, it was just an idea. And there, you know, there was a tiny bit of evidence behind

it, including these animal studies where they looked at, they gave rabbits a super high cholesterol diet and the rabbits got cholesterol in their blood. Well, rabbits are herbivores, you know, they're not omnivores like we are. So, um, and, and so there was like, there was just like a little bit of piecemeal, um, evidence out there, but it was this moment, there was this, this, um, this vacuum of information and into that stepped Ansel Keys with his diet heart hypothesis, saturated fat, dietary cholesterol. He was this incredibly charismatic, powerful man who was, according to his peers, able to argue anyone to the death. He was called aggressive even by his friends. And he was really able to get his idea implanted into the American Heart Association,

such that in 1961, the American Heart Association comes out with a recommendation saying, don't eat saturated fat and dietary cholesterol, cut back on meat, full fat dairy, cheese. And meat was vilified because it contains saturated fat. Because they contain saturated fat and they contain cholesterol, right? Which by the way, saturated fat in meat is a specific kind that doesn't raise cholesterol called stearic acid. Right. Ironically. And meat, the kind of fat in an average like porterhouse steak, only a third of that is saturated. All foods contain a mixture of different kinds of fatty acids. Olive oil is 20% saturated fat, right? Mackerel has more saturated fat per 100 grams of

fat than meat does. But it was just like, it was just this really simplistic kind of science that they were using. And it was taking a stab at trying to prevent heart disease, but it became policy. So that 1961 American Heart Association policy was the first time anywhere in the world that people were told, cut back on meat, cheese, eggs in order to prevent a heart attack. And that was the beginning of it all. So it's really important to say that at that time, it wasn't the total, a low fat diet. They didn't say reduce fat overall. It was just saturated fat. No, in fact, there was a lot of evidence around that time that carbohydrates were driving obesity and carbohydrate restriction was a standard recommendation for weight loss. Yeah. And also for controlling diabetes, it was, you know,

in the early 1900s. And actually there was a large amount of science on in the early 1900s, mainly in Austria and Germany. And the story is that that science disappeared with World War II. Those scientists kind of like were dispersed, But they had done the science on showing how weight gain is really not controlled by energy and energy out, calories and calories. It was really controlled by hormones. And they understood that. They didn't at that point understand that it was the insulin hormone,

which turns out to be the most powerful hormone for fat deposition. But they understood there was something going that was controlling fat deposition that was not about calories. And then all that was lost, that science. It was all written in German. And then the whole field of nutrition moved over to the United States, didn't read the German articles, and then it was just lost. So instead, center stage is Ancel Keys and his colleagues, and they become the most

influential nutrition scientists of the 20th century. They're very closely tied in with the National Institutes of Health, that they're the people who have all the money for all the research grants. They kind of take over the whole nutrition establishment, really. They're the editors at all the major journals. They're the top people at all the expert conferences. And they suppress dissent, right? Like John Yudkin was another scientist at a time that was showing that sugar was really the driver of all the cardiovascular risk factors. Yes. And they completely silenced him. And he ended up sort of dying in disgrace at the end of his career, basically kicked out of his lab in London. And the high-fat crew didn't do well,

and the low-fat crew ascended. Well, these were, you know, so these were, like, Yudkin, as you say, he was a professor in London, at a London university. His theory was that it was sugar that caused heart disease. And there was another MD in the U called Stefansson, and he had traveled all over with the Inuit in the Arctic, the Canadian Arctic, and he saw them being devastated by carbohydrates. So it was his theory that it was carbs and sugar. So there were these other thinkers with other hypotheses, and it is true that they were silenced. I mean, which is a shorthand way of saying, like, they were criticized.

They were told that, you know, really in the same way that we see today. They're accused of being backed by industry. They were, their science was attacked. They were attacked. They couldn't get their papers published in journals. I mean, that's the way that science is silenced. And the data that Dr. Keyes used was based on looking at patterns of consumption of foods in a certain number of countries in Europe.

There were seven countries. And it was just looking at correlation. And most people don't understand that science is not all the same. Science that shows correlation doesn't prove anything. It just shows a correlation. I could wake up every morning, the sun comes up. They have nothing to do with each other, but there's 100% correlation. I'd like to see the sun shines because of humor.

Oh, thank you. I don't think that's it. I don't believe that. And I think that they tried to follow up on that research because they believe the theory and they saw this association. But when they did the follow-up research, it was fascinating because they did a study that could never be done today. That was unethical. It was 9,000 patients in mental institutions who were captive. They gave half of them high saturated fat diet and half of them vegetable oil or corn oil. And they were sure that the corn oil group would do better, have less heart attacks, less

deaths. And in fact, their cholesterol dropped on the corn oil, but their heart attack rate and death rate was dramatically increased. For every 20, 30 point drop in cholesterol, there was a 22% increase in heart attack and death. And they suppressed that data for 40 years because they didn't believe it and they didn't want to publish it. And it was just published a couple of years ago. So yeah, that's the Minnesota Coronary Survey. Ansel Keys was one of the primary investigators and you're right. It was the biggest, most ambitious test ever funded by the National Institutes of Health of his hypothesis, right? And at the end of that study, what happened was they did actually publish it in 1979, but that was 16 years after

they had finished the study. So the study results come out, they don't publish them for 16 years, and they finally put it in this little out-of-the-way journal that they know nobody will read. And when one of the investigators was asked, why wait so long? Because it is, of course, a form of cheating in science not to publish your results. And he said, well, there was nothing wrong with our data. We were just so disappointed in the way it turned out.

But wasn't there more data that came out? So then, yes. So then in 2015, these researchers at NIH went back to that study, and they went back to the son of the investigator. And they found out that in the basement there were these magnetic tapes from the study that had never been fully analyzed. And they analyzed them and used special machines to try to get the data off of them. And they discovered that they had never published the full results. And so in 2015, they published a result that actually the more the men lowered their cholesterol, the higher their rate of heart, dying from heart disease.

So everything that, so and there's the exact opposite. And the butter group did better, basically. And the butter group did better, right? Yeah. And so, you know, it's, and actually, so the story is, the bigger story is that that study, the idea that study results are ignored, not published, that is not the only example of that. I mean. And this was a randomized control trial, which is the highest level of evidence. It's not like a population study where you can see a pattern, but you can't prove anything.

Right. This data is more convincing. Right. So this is the kind of data, randomized control clinical trial, gold standard of evidence. It's where you can demonstrate cause and anything. Right. This data is more convincing. Right. So this is the kind of data, randomized controlled clinical trial, gold standard of evidence. It's where you can demonstrate cause and effect, right? That's what they do for drug trials. They have to do a trial to show cause and effect. Otherwise, as you say, it's just this kind of weak observational data.

That data relies, it's data relies entirely on people recording what they ate, you know, these food frequency questionnaires. It's like, what did you, how many peaches did you eat in the last six months? Now, how many pears did you eat in the last six months? And then like, and repeat that for other 200 items on the list. And then. Somebody asked me what I ate yesterday. I can't even remember. I can't remember what I ate this morning. So that data has been shown to be just notoriously unreliable, right? And they can't, and they've actually tried, they've actually done tests on it, you know, see what do people actually eat and then what do they remember they ate. People, it's all confounded, like the fatter

you are, the more likely you are to lie about the data. I mean, it's really fascinating. But the point is- It also depends on what the prevailing view is. If you think meat is bad and you eat meat, you're going to minimize your reporting of how much meat you ate. Right. And you minimize your sugar. They've shown that people will under-report how much sugar they eat. They overestimate the exercise and under-report the diet. Well, that just sounds like human nature to me. But I think that the point is, is that's really unreliable data. And that was the data that Ancel Keys used as the foundation for that first American Heart Association policy. But then, you know, and that was in 1961. So what I want to say is that what happens after that

1961 policy is the government, the U.S. government and governments around the world realize, okay, we have to test this more rigorously. So they did these trials, these government-funded trials, including this Minnesota Coronary Survey. They actually tested like more than 75,000 people all over the world in a number of randomized controlled clinical trials. That's, again, gold standard of evidence. And I describe these trials in my book. I mean, they were, as you say, many of them, the kind of experiments you couldn't do anymore because they were in mental hospitals. You're not allowed to do that anymore.

Right. They were food. of them the kind of experiments you couldn't do anymore because they were in mental hospitals you're not allowed to do that anymore if you like force people their food but they were really that makes it very what we call well controlled meaning you're controlling everything that everybody's eating it's not like giving somebody a diet book and saying you know yeah and then you don't know what really happens so and none of those experiments could show that that replacing saturated fat with vegetable oils was able to prevent heart disease or cardiovascular death, right? None of them. One of them that was done in Australia showed that the men on the corn oil diet

died at much higher rates than people on the regular diet. And none of those, I think that kind of the blockbuster thing to me, which I didn't even really know until after my book was published, is that none of those studies, the billions of dollars spent by governments around the world, none of those studies have ever been reviewed by our dietary guideline committees, which is like our expert bodies making our national food policy. Extraordinary. They've just ignored all those trials. The best possible evidence on fat and saturated fat was completely ignored. Paid for by taxpayers everywhere. Right.

And it's absent from our guidelines, which we're going to talk about. So back to Dr. Keyes, because he has a fascinating story. He, at the end of his life, changed his mind, didn't he? He did on cholesterol. He decided that dietary cholesterol, which is, you know, why you have egg white omelets instead of regular omelets, in the late 1980s, he said, you know, I don't think cholesterol is such an issue. Yeah. And he recanted on that part.

I don't, and I think, I don't think he ever recanted on saturated fats that I know. And the data from that study, you went back and looked at it. And what was fascinating to me was that the signal that came up even far stronger than fat was sugar. Yes. So this is going back to the seven country study where they looked at what people ate in seven countries, and then they looked at to see who died and who had heart attack. And what he decided was that it was a saturated fat consumption that was most closely correlated with your likelihood of death, right? It turned out, or cardiovascular death. But so I went and looked at that study in a lot of detail.

And one of the things that I found was that later on when they reanalyzed the data, they found that sugar and sweets were actually much more highly correlated with cardiovascular death. And I actually asked some of Ancel Keys' colleagues, like, well, why did you not report on sugar? And they said, well, we had discussions about it, but Keys was just so opposed to the idea that it was sugar that caused heart disease. And he was very sure of his own idea that it was fat.

So, I mean, one of the things about Ancel Keys- So much for the purity of science and independent researchers, right? I mean, honestly, Nina, about Ancel Keys... So much for the purity of science and independent researchers, right? I mean, honestly, Nina, when I was in medical school, I thought that science was this beautiful, pristine, you know, honest field full of integrity and truth. And as I've learned and as I read the data, it's highly influenced by the food industry.

It's highly influenced by bias. It depends on the design of the study and who's looking at it, it's highly influenced by the food industry. It's highly influenced by bias. It depends on the design of the study and who's looking at it, who's paying for it. It's fascinating. Marin Nessel is writing a new book about how the nutrition science that we have is corrupted by the food industry, which basically obfuscates the truth. And they try to promote basically false science, like fake news, like soda doesn't cause obesity and dairy is great for your bones and all sorts of ideas that we have pretty much taken on in the society

are often corrupt by the food industry. So science is not this pure field of truth. It's essentially a often corrupt thing and you have to know how to read it and think about it. And that's what's impressive in your work is that you really go through the nitty gritty and you don't just look at the headlines. You go between the lines.

You look at the data. You look at the appendices of the data. You look at the appendices of the data. And you really kind of find out what's going on. It's very impressive. Well, thank you. I mean, but like you, I started off thinking like science was this sober, reasonable, rational process.

And my father is a scientist and was a professor at Stanford and, and, you know, his journals, like you open up his journals and, and, and there's like math problems on the page. Like, I mean, I just grew up in this world thinking this is, you know, science is about responding to observations, honestly. And then if you're, if your explanation doesn't, doesn't explain the observation, then you have to change your hypothesis. But the thing about nutrition science is the food industry is huge, and they have a stake in what nutrition science says.

If there's a study coming out that says that five walnuts a day helps lower your risk of heart disease, you can be sure the walnut industry is probably behind that study, but it makes a big difference for them. Like what can they put on their packages and, you know, can they claim they lower heart disease? So the food industry is really, and they know how to corrupt science at its very source, right?

They know how to fund studies and get them, get, you know, how to distort the, even the study design so that they can get a favorable response. But I think in this field, there's another factor at play, which is maybe even stronger, which is that the scientists and experts themselves, I don't believe that they were, you know, going back to the 50s, 60s, and 70s. I really don't believe that they were corrupt. I didn't really find evidence of that so much as I found their kind of, that they fell in love with their own ideas.

They were really just unable to see data to the contrary. And they couldn't accept it when there was contrary data. And Ancel Keys kind of did the opposite of a scientist, which he believed that he was right until proven wrong. Yeah. Science like- You're supposed to prove yourself wrong. You're supposed to prove yourself wrong. You're supposed to prove yourself wrong. And then like only after you gradually accumulate data,

do you think like, well, maybe, maybe I'm right, but let me see how I could prove myself wrong again. You know, that's the way science is supposed to work. So, and then I think the other factor is that these ideas became institutionalized, right? Once they're adopted by public health institutions, medical institutions, the entire government, and then you have this thing where the institutionalization of science, like institutional science is almost like an oxymoron because science requires self-doubt, the ability to change according to data, the ability to be flexible. Institutions just need the

exact opposite, right? They can't flip-flop on their publics. They need constancy. They need to further credibility. They can't be changing. So it's very hard. Once this was adopted by the U.S. government, the idea that you should not eat fat and cholesterol, it just became so hard to reverse out of those positions. It's true. I work at Cleveland Clinic and Steve Nissen is there, who's one of the leading cardiologists in the world. He's the head of cardiology there. And the vice chairman of cardiology, of cardiothoracic surgery also had these discussions with me that, you know, they think that the whole idea that fat is bad is wrong. And he may be even saturated fat

and that's bad is wrong. And yet at the cleveland clinic when you go into the hospital for heart surgery you are prescribed a heart healthy diet which is high carb low fat even though they know that's a problem it's just so institutionalized and embedded it's hard to change it's really hard to change yeah so true so when you um you wrote the book you know we had a certain set of beliefs that were pretty prevalent around fat and saturated. Have you noticed anything change about our beliefs about fat and carbs in the last few years since you wrote the book? Yeah. I mean, what has the conversation changed? You know, when I, so when I started my book, of course I was a vegetarian eating a low fat diet. And then that was in the early 2000s. I used to track what, you know,

do a word search on saturated fats to see what the conversation was about saturated fat. That debate has really changed in the scientific literature. So there's now like eight major review papers from teams of scientists all over the world saying that saturated fats have no effect on cardiovascular mortality. So in the scientific community, there is debate over that. I don't think it's really changed so much. You see many, many more articles in the lay press about it. But there's...

So it's an open question now. I would say it's sort of a wobbling open question now. And that was not true before. Before 2014, that really was just, it was like sealed, settled science. And now it's unsettled science. Um, and there've been two changes that I think will probably really surprise, uh, your, um, your audience's mind, which is, um, how many people know that there's no more caps on dietary cholesterol? In other words, eat as many eggs as you want. Don't worry about shellfish, eat liver if you like it.

That is no longer, there are no more caps on cholesterol. We had them for 35 years. And I love what I heard about that. One of the people on the guidelines committee said, you know what? We never really looked at the science. We just thought it was bad. So we eliminated it for 35 years and told people to eat egg white omelets and upsari. And they call it no longer a nutrient of concern, which is pretty amazing to me. And they did kind of, so that was in 2015,

the dietary guidelines dropped that limit. And the American Heart Association did the same thing a couple of years before. And that was, and that, and that went, went all the way back to Ansel Keys, right? That was his idea. Nobody really ever looked at the science too hard. And, but they did kind of tiptoe away from that advice. I mean, there were no big headlines. There wasn't a big, there was no press release around it, right? No, it's not a nutrient of concern. And we were wrong. And we're just not going to, we don't want to talk about it anymore. So true. But the other amazing thing is, is that they no longer recommend a low fat diet. Yeah, that's pretty shocking. And again,

there was no headlines about it. They just removed the limit. It used to be 30%, 35%. Now they were like, it doesn't matter, right? Now they're like, we don't talk about it. So what they did is actually they did a little, it's a little bit of a rhetorical jiu-jitsu, I think, which is that they just stopped talking about the low-fat diet. If you go to the Dietary Guidelines of the American Heart Association and you search low-fat, it's like it's gone. Like, wow, that was my life. And then what they've done is they've shifted over

to talking about dietary patterns. So now we have dietary patterns, which are all, you know, fruits, vegetables, whole grains, nuts, seeds, fish, low fat dairy, and lean meat. And they don't talk about how much fat you should eat. Yeah. And they talk about lean meat and they also talk about low fat dairy and they also talk about low saturated fat. Yeah. There's still a cap on saturated fats. So that's why you're supposed to have lean meat and low-fat dairy is because of the saturated fats. But the low-fat diet is gone. But again, no press release, no announcement. Nobody knows that they should stop avoiding fat.

Right. I mean, it's still news. I still go everywhere. I see egg white omelets and skim milk everywhere. And I think people haven't got the news. I'm like, I see this guy was getting coffee. I'm like, why are you having this skim milk? He says, well, isn't fat bad? And I know that that's old news. It's pretty amazing. The reason we still have an epidemic of heart disease and it's 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 campaign has failed, one, because the drugs are not as effective as we thought they were, two, because side effects are real and underreported, but in the real world,

people stop taking that drug. And three, the cholesterol hypothesis itself is flawed because it's not the most important risk factor for heart disease, which is insulin resistance. Now, Ancel Keys told the New york times this is the man who was the most influential man in way in in many ways in nutrition and medicine he was the guy who said we should cut out fat and saturated fat absolutely the seven country 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 important as we used to believe it was.

I mean, the fact that he says that is a big statement. What's fascinating is a Jupiter trial where we found that the statin drugs may not act by lowering cholesterol or LDL, may act by other factors such as anti-inflammatory factors or antioxidant factors. And in the 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 there benefit. That's extraordinary, Mark. You're right. And in fact, my BMJ saturated fat piece in 2013, I postulated that as well, that my own personal view. And in fact, I was also reflecting the view of my cardiology colleagues as someone that's treated thousands of people of people with heart disease done over a thousand angiograms and treated people with heart attacks and has been on the ward round after people coming with heart attacks and in the wards

we prescribe statins like smarties we put everyone on a high dose we rarely even check cholesterol because the guidance was saying it 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 and e we say in england in the uk in the usns er i would be the guy when the chap's been diagnosed with a heart attack before we're taking him to the cath lab you throw it on the statin i'm telling the nurse give him 80 milligrams of 12 statin right 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 all for event reduction for several months no benefit and 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 going to increase your risk of death or a heart attack at all and you know this you're talking about these side effects but the way they work is inhibiting an enzyme um which mg co-reductase which also produces something called co-q10 or coenzyme q10 which is an essential part of making energy in your muscle cells and 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 10 miles as fast you can and you get muscle pain and that's what happens to these people and it also affects the brain.

It also affects sexual hormones because your LDL and your cholesterol is what you make testosterone and other hormones from. So these are not side effects. They're 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 these new drugs these pk whatever c19 things they they are dropping people's cholesterol to seven or ten in ldl and then does that make sense no it doesn't make sense to me at all in fact we

um 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 the association with LDL and heart disease? And we were even quite shocked by the findings. There was no association with LDL and heart disease. And there was an inverse association with all cause mortality. How do you explain that? Well, we know cholesterol is a vital molecule in the body. We produce it for a reason. Without it, we 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 as well. Absolutely. So when we looked at that, there was good data to suggest that cholesterol is involved in the immune system. Elderly people are particularly vulnerable to dying from infections, such as pneumonia or stomach infections.

And 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, um, patients have been referred to me by their general practitioner and lady over 60, for example, with a high LDL and said she was very worried. And she came in the room with a look, you know, look like she'd seen a ghost. She was so fearful because she thought he was going to have a heart attack. And I said, congratulations, you're going to live longer, you know, and I explained it all to her. And she walked out my consultation room with a smile on her face. Well, it's true. The Honolulu heart study was fascinating where they found that actually the

higher your cholesterol as you're older, the healthier and longer you lived. Yeah. It's extraordinary, isn't it? So I think think we need to the paradigm needs to shift mark and i think when you look at the data that's there and i published an editorial with rita redberg who is here also for the conference and pascal meyer both editors of medical journals both practicing cardiologists we said there's 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 heart attacks in young men. And, um, and actually that would actually tackle many other chronic diseases because it's a precursor of a type two it's responsible for

50 to 70% 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. And, you know, people are coming off their blood pressure pills within weeks to months. Their cardiovascular risk 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 lifestyle approach is superior and going to reduce death rates we don't and we need more of that however the risk markers improve 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 biology so you you just mentioned something that I think is sort of the flip side of the story, which is insulin resistance. And that is a mechanism in the body that happens where your body becomes 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 2 diabetes obviously obesity even things like dementia which are now 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've been one of the most vocal proponents of sugar. You sort of remind me a little bit of Jamie Oliver, who was a chef where he, on his TED stage, poured out a whole wheelbarrow of sugar and said, this is what we're eating in a year. And you've been very active about this. And you wrote an editorial recently in the Journal of Insulin Resistance called the science against sugar alone is insufficient in tackling obesity and type 2 diabetes crises. We must 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 how do we begin to deal with those? Well, I think you might be right about sugar being, 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. It's estimated 50% of foods that people don't think are junk foods have added sugar in them. And our estimates suggest, you know, in the States and in the UK, people are on average,

are eating anything between 20 and 25 teaspoons of added sugar in their diet day, which is extraordinary. Now the latest about 35. Yeah. And you know, and the recommendations from the World Health Organization now who are put under pressure, say maximum limit of six. But they say limit. They don't say you should have it. Because actually, for optimal health, you don't need any added sugar in your diet. I mean, there's no nutrition in it. There's nothing.

It's a treat. There's no biological requirement. No, no, no. No biological requirements. Or sugar or carbohydrates, by the way. Well, you're actually right. There is actually no essential requirement for carbohydrates either um but with sugar yeah you can get you know you can very easily have a very very healthy life with zero sugar in your life um now when we wrote this

paper i would i would rephrase that you will have a very healthy life yes no you're right might take a few weeks to reach that point you might be a little bit you know a little bit for a while before you get there when you're breaking the addiction. But yeah, no, you're absolutely right. And, um, you know, the, 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, um, you know, if you don't learn from history, you're bound to live through it again.

And I think there's in some ways we're doing that because tobacco, big tobacco, we're able to store what it again. And I think in some ways we're doing that because tobacco, big tobacco, we're able to store what we call effective population interventions to reduce tobacco consumption by really adopting a strategy of denying cigarettes were harmful, planting doubt, confusing the public, even buying the loyalty of scientists

who would write papers and not declare they're taking money from tobacco, saying they don't think tobacco is harmful. And they did this for 50 years from when the first links between smoking and lung cancer were published and actually when eventually when we did manage to reduce tobacco consumption which was actually only through a lawsuit wasn't even a government policy and ultimately government policies followed but it was you know we i talk about the three a's in public health, tackling the availability, the affordability and the acceptability. So public education campaigns, cigarettes are harmful, um, banning tobacco advertising, smoke-free buildings.

When you combine those, that was responsible for most of the decline in death rates, cardiovascular mortality in the U S and the UK and Western European countries, certainly, um, you know, in the last sort of 40 or 50 years. And, you know, that is actually what's most, the biggest decline was only when regulation was introduced really from governments because governments have a duty and responsibility to protect citizens from excesses and manipulations of industry because ultimately people were lied to, Mark. People were lied to, people were were misinformed they were making decisions about their health based upon misinformation that was coming from industry and actually government had to intervene and 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 exist with sugar. Same playbook. There's a playbook. And they often are the same company. But Mark, yeah, exactly. But we've also got to have, we can't be naive about this. There are, you know, there are very powerful vested interests. There's 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 going to change overnight. And what industry do and people who support industry, who get funding from industry, often not obvious or declared, they will engage in tactics to go after people like me or other public health companies like 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 terms

of the science this is what they do this is there was 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 it turned out that's fully funded by monsanto so 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 even applies to scientists because otherwise, I mean, it makes a big difference.

It's 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 that, Mark, we're not really adhering to what I believe are true principles of democracy. Because people wouldn't change their opinion, their decision, if they know somebody who's giving them information is being funded by the very organizations that profits from what they're telling them. So, Triv, Coca-Cola's funding research on soda and obesity, of course, is going to find that it's, you know, not harmful. And you mentioned in this article that there were 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, absolutely. And it's not actually reported in the studies. Yeah, so it's not reported in studies.

But I'll add something else on this, which is interesting, is that I think declarations are really important. But actually, they're always a footnote at the end. They aren't the headline. They're not mentioned in the news stories. And actually, declaration doesn't remove bias. In fact, there's one in one of the law journals, there was a very interesting article that showed

that it can actually exacerbate bias sometimes. 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. In fact, it can sometimes make things so the implications well i'm i'm supported by them but i'm independent in my opinion because i'm declaring it 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 have no

you know i think that's that is something we need to adhere to for everybody um 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 um 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 it was all about calories in, calories out, and that 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 know if Coke has resource limitations. It's surprising to me, but I thought that was fascinating. So that's just sort of the tip of the iceberg. You've got

a woman who's running the Center for Disease Control, which is the nation's most independent scientific public health organization partnering 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, I know it is extraordinary and it's sad. And I think Brenda really is just a product of a really a system failure mark because, you know, really in this battle against misinformation, the greatest weapon we have is transparency and more of this. People need to be, be aware of it because most people wouldn't accept this then as being independent advice. Um, 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 the drug industry or the food industry, they're there. They have a fiduciary obligation to make profits for their shareholders. They're not, you know, pharmaceutical industry don't have a fiduciary obligation or legal obligation to give you the best treatment, although most people think that would be the case. The food industry, they're there to sell food, not look after your health.

No. When they can mislead and market and exploit the regulations. They talk about getting more stomach absolutely but the real you know the real scandal mark is that those with the responsibility to patients and scientific integrity that includes academics medical journals institutions they collude with industry for financial gain yeah and that's the real problem we have and we we talk about government guidelines and we realize for example example, you know, I was part of this campaign to get sugar reduction down in the UK. And when I came out with 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 sugar labeling of sugar on products to consume as part of their healthy diet guideline daily amount 22 and a half teaspoons of sugar a day and i thought how you know i'm how is there a recommended amount it's crazy i'm a practicing

cardiologist i'm not a nutrition scientist i had to do all this research on my own and then ask the scientific advisory committee of nutrition they're basically the um the academic group that advise government and produce the guidelines that they need to sort this out quickly. And eventually they succumbed, but they only succumbed after an investigation by Channel 4 dispatches program and the Sunday Times newspaper in the UK. Interestingly, they were exposed that 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 um that influences millions of people that is supposed to be independent it needs to be independent needs to even have the perception of independence, Mark. And be transparent. Completely transparent. And this has 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, um, he's quite a well-known,

uh, 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, um, too much influence by industry,

you know, a manipulation of data must be very popular over there. Well, you know, Mark, I mean, popular amongst two. At the end of the day, my job and duty is to do what's best for my patients, right? That's ultimately what we're here to do, isn't it? So, you know, and he looked at me and he looked me in the eye and he said, Asim, 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 saying. Yeah. No, it's true.

I remember speaking with a former secretary of the US Department of Agriculture, Ann Veneman. I said to her, why are our dietary guidelines not matching the science? Why do we say that we should have three glasses of milk a day? Why are we not recommending the right kinds of fats? Why our food stamp program spends $85 billion a year

for the poor that's serving mostly junk food spends $85 billion a year for the poor that's serving mostly junk food and $7 billion a year just on soda, 20 billion servings a year for the poor. Why do we have subsidies that support commodity crops that are turned into processed food that are consumed by Americans that make them sick and fat? She says, 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 top 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 are the problem turns out uh what they were doing was making an oreo cookie 90 calories instead of 100 calories which gives them more profit us less sugar but still is junk and and that's the kind of thing we see. And it's frightening. And you see it across the halls of government. I mean, $500 million 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 industry for giving them their heart healthy seal for things like Trixer for kids, which has seven teaspoons of sugar and all kinds of dyes and additives. I mean, how is, you know, a highly sugary cereal, heart-healthy cereal? So that's crazy. 40% of the Academy of Nutrition and Dietetics in America's budget is funded by the food industry. Pepsi, Coke, Nestle, all the big food companies.

How can that be independent? So 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 NAACP 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 in 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.

Yeah, I know. I think there's a number of things we can do, Mark. In fact, on that note, one of our recommendations is we said that any organization, including for example, the British Dietetic Association or the American Academy of Dietetics, if they take funding and sponsorship from food industry, they cannot claim their advice as independent. And we made that very strongly as one of our recommendations. We actually think- They should just put, we're a shill 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, do you really think most people would agree? No, they would find it quite extraordinary. They would be 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. 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 the consumption of processed carbohydrates significantly we could very easily you know know, if those were implemented, Mark,

we could very easily reverse type 2 diabetes epidemic within three years. And on that note, when one looks at ultra processed food, which is the major issue, there was a recent study published reporting in the Guardian newspaper in one of the nutrition journals that showed an association,

very 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 shocked the ultra processed food consumption in the average British diet, Mark 50% of the diet,

half of the diet is coming from ultra processed food. Now, if you break that down, it's almost 60%. Is it really? Wow. I mean, but if you break down the

ultra processed food where is it coming from more than 70 is coming from starch sugar sugary drinks ultra processed 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 processed dairy and meat as well to cut the fat and cut the meat and the public health crisis we have is actually the big macronutrient the big problem we're over consuming which is the key component of ultra processed 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 hear even the uk we need to get down the fat sugar and salt and salt. Why are we not discussing starch, ultra-processed carbohydrates? Why are we not discussing that? That is the big issue.

Yeah. And you also talk 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 inflate the prices of the good stuff. Yeah. So, you know, we have to make it affordable, Mark. I think one of the things that's also very true is that actually some people believe that following a healthy diet, I think you can follow a healthy diet on 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, know that will automatically across the population will change eating behavior. And even those small changes, but if it was across the population would have impact 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. I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below. Until next time, thanks for tuning in. Just a reminder that this podcast is for educational purposes only.

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