3 Heart Experts Reveal What Really Prevents Heart Disease

Mark Hyman, MD

Full Transcript

Automatically generated. Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Dr. Mark Hyman
Why are we still seeing so many people with heart disease?

Dr. Eric Topol
Yeah. It's still the number one killer around the world, not just here. And it's still the norm killer in women who, you know, they think that it's breast cancer. No. No.

It's this is it.

Dr. Aseem Malhotra
I concluded that one of the root causes, Mark, was this was this flawed hypothesis that we should have low fat diets to prevent heart disease.

Dr. Cindy Geyer
Cardiovascular disease is an inflammatory process. Yeah. That it's not just about cholesterol, but there's ongoing inflammation.

Dr. Mark Hyman
Monarch stress, loneliness, isolation, bad sleep. Those things are huge in heart disease.

Dr. Cindy Geyer
But we know that eighty percent of cases of heart disease and diabetes may actually be preventable with diet and lifestyle.

Dr. Mark Hyman
As part of our summer series, we're revisiting some of the most important conversations we've had on the topics that matter most to our health. And few are more important than heart disease. Heart disease remains the number one cause of death worldwide. Despite decades of research, millions of prescriptions, and billions of dollars spent on treatment, many people still are confused about

Dr. Mark Hyman
what actually causes it and what we can

Dr. Mark Hyman
do to prevent it. For years, the conversation on heart disease has focused almost entirely on cholesterol. But what if that's only part of the story? In this compilation episode, you'll hear from Doctor. Cindy Geier of the Ultra Wellness Center, Doctor.

Eric Topol, and Doctor. Simalhotra as they explore a different perspective on heart disease. One that goes beyond cholesterol and looks at the deeper drivers of cardiovascular risk, including inflammation, insulin resistance, metabolic dysfunction, lifestyle, and early detection. You'll hear why many experts now believe that heart disease often begins decades before symptoms appear, why traditional testing can miss important signs and that are warning signs, and how emerging science is giving us new tools to identify risk earlier than ever before. And more importantly, you'll hear a message that is both factible and hopeful, and that many of the factors driving heart disease are within our control, and that prevention remains one of the most powerful tools we have.

So let's dive in.

Dr. Mark Hyman
So let's talk about heart disease, because we think we know all about heart disease. Oh, it's cholesterol, and statins are the cure. If that doesn't work, you get a bypass and angioplasty, and if that doesn't work, you get a blood transplant. That sort of and then, of course, there's all the normal causes we know, like diabetes, and high blood pressure, and high cholesterol. But diabetes is a symptom.

High cholesterol is a symptom. Smoking is a habit. And yet, we're kinda missing the boat, I think, on a lot of the reasons we have heart disease and what we can do about it from a more systems perspective. So let's talk about just what a big deal this is and and how few people actually are meeting the simple behaviors that will prevent heart disease.

Dr. Cindy Geyer
Yeah. Again, this is another one of those conditions that the debate as well. It's in my family, so I'm doomed to get it. But we know that eighty percent of cases of heart disease and diabetes may actually be preventable with diet and lifestyle. And despite that really powerful message, fewer than three percent of The US population is meeting the core four basic characteristics that predict low risk.

And it's a pretty low bar, Mark.

Dr. Mark Hyman
And what are those? What are those four things?

Dr. Cindy Geyer
It's not smoking.

Dr. Mark Hyman
Okay.

Dr. Cindy Geyer
Getting the minimum recommended a hundred and fifty minutes of exercise a week, eating in the top two quintiles of what's considered a whole foods diet, and having a healthy body fat percentage. Fewer than three percent. I still find that shocking.

Dr. Mark Hyman
So not too much body fat, eating pretty healthy, little exercise, and don't smoke. Simple things to do, but like We're not even there yet. 3%. Yeah. And and what's really staggering is that, you know, not only do the people not meet those habits, but that there there are some really other big factors that we we are just so bad at in America.

Our whole society is set up to actually cause heart disease.

Dr. Cindy Geyer
Absolutely.

Dr. Mark Hyman
What are those things that that really are these risk factors that besides cholesterol.

Dr. Cindy Geyer
Well, of course, it's inflammation. I mean, you and I were working together back at Canyon Ranch when that pivotal study came out. I think it's been twenty one years ago.

Dr. Mark Hyman
That. New England Journal of Medicine review paper.

Dr. Cindy Geyer
Peter Libby and Paul Ricker showing that cardiovascular disease is an inflammatory process, that it's not just about cholesterol, but there's ongoing inflammation. And as you've talked about many times on this podcast, inflammation is not it's also a symptom that it can come from a lot of different places. Because in our paper, our local paper, when that article came back out, I don't know if you remember this, it said President Bush's doctors measured his CRP, which is the common marker of inflammation. Right. And they don't know what to do about it.

Dr. Mark Hyman
Right. Right.

Dr. Cindy Geyer
So it's one thing to say, well, we know inflammation matters. It's another one entirely.

Dr. Mark Hyman
Take aspirin.

Dr. Cindy Geyer
Take aspirin and a statin.

Dr. Mark Hyman
Right? Right. Right.

Dr. Cindy Geyer
But it's another to say, well, what are the root causes of inflammation?

Dr. Mark Hyman
Well, it's true. And and we there's a lot of them. Mhmm. And some of the things that we don't typically think of as causing inflammation. We know infections and allergens Mhmm.

Things like that, even toxins and bugs in your gut. But stress causes inflammation.

Dr. Cindy Geyer
Absolutely.

Dr. Mark Hyman
Lack of exercise causes inflammation. Yeah. Bad sleep causes inflammation. Loneliness and isolation cause inflammation. And those are pandemics

Dr. Cindy Geyer
Yes.

Dr. Mark Hyman
In America. That's Chronic stress, loneliness, isolation, bad sleep. I mean, those things are huge in heart disease, and we often miss miss the boat on helping our patients really deal with those.

Dr. Aseem Malhotra
Right.

Dr. Mark Hyman
So okay. So the typical person comes in. He's, you know, got a high cholesterol. He or she is a high risk for heart disease, maybe family history.

Dr. Aseem Malhotra
Mhmm.

Dr. Mark Hyman
Typical doctor does sort of what workup and and what kind of treatments?

Dr. Cindy Geyer
So a typical doctor might measure a glucose and an a one c to look at their blood sugar status, and they would do a standard cholesterol profile, which interestingly enough calculates your LDL cholesterol, the one we usually think of as being the lousy cholesterol, from a formula. Does it even really measure it? And base most of the decisions on that. Mhmm. If they have symptoms, they might send them to a cardiologist for a stress test.

Dr. Mark Hyman
If they have chest pain.

Dr. Cindy Geyer
If they have chest pain. Right.

Dr. Mark Hyman
Or shortness of breath on exercise. It's already kinda down the road.

Dr. Cindy Geyer
Right. But most doctors don't measure a c reactive protein because as I mentioned before, it's like, well, what do we do

Dr. Mark Hyman
with do with it?

Dr. Cindy Geyer
What do I do with it? Oh, statin and aspirin. And then they're probably gonna treat them with if they are prediabetic or diabetic, they're gonna give them metformin or medications to lower blood sugar and probably a statin to control the cholesterol. How often do they actually talk to them about those root causes such as diet and stress and sleep? Maybe not.

Dr. Mark Hyman
Yeah. They're talking about this polypill as a as a as a treatment, which is this combo pill of an aspirin, a statin, and a blood pressure drug.

Dr. Cindy Geyer
Yes. Put it in the water.

Dr. Mark Hyman
Just like give it to everybody. It'll prevent heart disease. I'm like, yeah. Okay. Well, why do we have high blood pressure?

Why do we have an asp a need for aspirin inflammation? Why is our cholesterol all screwed up?

Dr. Cindy Geyer
Yeah. And you know what's really interesting? There's, believe it or not, there's a potential behavioral component for patients who go on a statin, and their cholesterol's now normal. It's good.

Dr. Mark Hyman
Oh, yeah. I can I can eat my cheeseburger?

Dr. Cindy Geyer
I can eat my chicken. Isn't that interesting that people change their diet in an unhealthy way

Dr. Mark Hyman
Oh, yeah.

Dr. Cindy Geyer
When their number's better.

Dr. Mark Hyman
One of the worst things I ever read was there was a bunch of cardiologists advocating for selling statins over the counter at McDonald's and fast food restaurants. Oh my gosh. I think they do sell even statins over the counter and, like, you know, it's like it's like those commercials for the acid blockers. Like, take some Pepcid because don't worry, daddy. You can eat your peppers and sausage.

Just take the I remember that. And I was like, no. Don't eat the peppers and sausage. So, you know, you kinda mentioned they do a sort of a cholesterol profile, but there was a hint of a a subtext in that sentence where they really weren't measuring the right thing.

Dr. Eric Topol
Yeah.

Dr. Mark Hyman
So we tend to look at things that we're used to looking at

Dr. Eric Topol
Mhmm.

Dr. Mark Hyman
That are easy to test and measure. But one of the things that I think people forget, and I think doctors honestly forget, is we get trained in this panel of tests. Mhmm. And it's your blood count, your metabolic profile, and your cholesterol, and we measure a few things. Maybe it's thirty, forty things.

Maybe if it's a super fancy doctor, they'll measure a 100 things. And they think they're kind of checking everything. Oh, your tests are fine. Everything's great. You look good.

And the truth is that they're missing a huge amount. There are literally tens of thousands of different molecules in your body all doing things all the time, every minute, every second, and we ignore most of them. And they in fact, we may ignore some of the most important ones. And when it comes to cholesterol, we've covered this on the podcast with Doctor. Baum.

We went really deep into this. We just should just do a quick refresher because the test that most people get, not the one we get here at the Ultra Walnuts number, but the test that most people get is like an antiquated cholesterol test that doesn't really tell you a whole lot. And I I have a patient yesterday who's a classic example of that. Right? So tell us about and I'll tell you about his test in minute.

But tell us about about your you know, the new kind of testing that we're doing. It's not so new because we've been doing it for twenty But it's like and the and the discovery that allowed for the testing was, oh, fifth fifty years ago.

Dr. Cindy Geyer
Yeah. So so the focus has been on amount of cholesterol, but we wanna know the quality of the cholesterol. So we know, for example, LDL that's typically labeled the lousy cholesterol. There's big, fluffy, puffy pattern a LDL cholesterol, which is less easily made into a plaque in the artery, less prone to inflammation and oxidative stress and rupture. So it's a less risky LDL, whereas somebody could have small dense pattern B LDL, and that's the really risky LDL.

So quality matters. And if you have two people with a calculated LDL of one thirty, one of them could all have pattern A low risk LDL, and they're actually fine. Somebody else could have lots of those dense particles that's not captured by the calculated LDL of one thirty. So the quality matters. The same's true for HDL.

We've historically thought of HDL as being the good healthy cholesterol, but size matters there too. Small HDL doesn't seem to be as able to cart out the bad LDL and get rid of it. So we wanna know the quality and the size of both the HDL and the LDL, and we wanna know what other remnant particles are floating around, like very low density lipoprotein and intermediate density lipoprotein, and those don't show up on a typical panel.

Dr. Mark Hyman
Yeah. So so so practically, what you see is people come in with what looks like a normal cholesterol. Like, this guy yesterday has early dementia. His cholesterol, I think, was one sixty something.

Dr. Cindy Geyer
Sounds good.

Dr. Mark Hyman
Yeah. His LDL was a money under a 100. Mhmm. Triglycerides weren't bad. His HDL was 39, which is kinda low.

Dr. Cindy Geyer
Mhmm.

Dr. Mark Hyman
But we looked at his particle number, even though his his LDL, if a regular diet go, that's a great one sixty. That's a great cholesterol. They missed the boat because his particle number was was like 1,500. It should be under a thousand.

Dr. Cindy Geyer
Wow.

Dr. Mark Hyman
And his small particles, which should be like zero or less than 300 is, you know, you can live with. But Mhmm. Anything over that is high. His was 900. Wow.

So he was like and he was a skinny older guy. He was 84 years old and had, you know, lost muscle, belly fat, you know, underweight, over fat. And he was prediabetic, and that was driving some of his dementia. But they were, oh, your cholesterol's fine. Not an issue.

And we also look at a lot of other things besides that. And by the way, you know, in 2021, no one should get the regular cholesterol panel. Mean, you got answers from your doctor. You can get it from LabCorp Quest. It's called NMR or Cardio IQ.

It's so important to do. And I guess the problem is most doctors won't know what to do with it once they find it. There's no drug for it. Like, oh, your LDL's high. We'll give you a statin.

It's like we treat what can easily test and find, not necessarily what the right thing is. And and so with with heart disease, you know, it it really is a metabolic issue. Right. It's it's it's you know, they shouldn't be called cardiologists. They should called cardio endo immunologists.

Dr. Cindy Geyer
Right.

Dr. Mark Hyman
Right? Because it's all about the hormones, including insulin, all about the inflammation, the immune system. Mhmm. And and you mentioned earlier that study by Paul Rittger and and Libby, in which was sort of the beginning of the conversation. A lot of the follow-up studies like the Jupiter trial, they found that if patients had a high LDL, but they didn't have a high CRP, their risk of heart disease was negligible.

But if they had a high LDL and a high CRP, that was the problem. Right. So independent of inflammation may not be an issue. And also, can get falsely confused by cholesterol tests. Mhmm.

You've seen these these patients who were and I I don't mean to stereotype people, but it was this kind of cohort of women who were probably in their seventies and eighties, who were thin, who are fit. The ladies we see at Kenyon Ranch who like exercise, eat well, don't smoke, normal blood pressure, no diabetes, and their cholesterol is 300. And their HDL is a 100. And their LDL is like, I don't know, maybe one fifty or something. And and they're they have no small particles.

And they have all these large fluffy things. And they're in really no risk for heart disease. And they don't need a statin. Right? Right.

I even asked Peter Libby, who's the chair of cardiology at Harvard, like, do these women need a statin? They're like, no. They don't. We don't have any data to say that they do. And I'm like, oh, that's interesting.

So we kinda have to be really personalized in our approach. And that's the other feature of functional medicine. Not like one size fits all. Everybody gets the polypill. Everybody gets the statin aspirin and blood pressure pill.

Like, No. We have to start to think about what's the cause. And they're heart disease is a symptom. It's a syndrome. It doesn't there are many, many causes.

So let's talk about this whole idea of metabolic health.

Dr. Aseem Malhotra
Mhmm.

Dr. Mark Hyman
Because, you know, we're chatting a little earlier, and it's staggering to me as a physician just how poor our metabolic health is. Mhmm. So so how how how healthy are Americans metabolically?

Dr. Cindy Geyer
Yeah. Not very. So so a recent study was looking at the NHANES data from 2009 to 2016 as

Dr. Mark Hyman
government surveys.

Dr. Cindy Geyer
Government surveys.

Dr. Mark Hyman
Tests and health records and everything. Right?

Dr. Cindy Geyer
And trying to say, well, how many people are what we would call metabolically healthy? And it if you're not familiar with for people who may not be familiar with that term, sort of meeting the optimal numbers for a blood pressure less than one twenty over 80, HDL levels being in the high range, a good range, greater than 40 for men and 50 for women, having triglycerides that are low, having a glucose that's less than a 100. And they found that twelve point twelve percent of Americans

Dr. Mark Hyman
Twelve point two percent.

Dr. Cindy Geyer
Twelve point two percent. Thank you. Twelve point two percent of Americans were metabolically healthy.

Dr. Mark Hyman
Which kinda means that almost eighty eight percent of Americans are metabolically unhealthy. And since seventy five percent of people are overweight, there's another thirteen percent there.

Dr. Cindy Geyer
Yes.

Dr. Mark Hyman
It's like, what are the what's what's going on with the skinny people?

Dr. Cindy Geyer
Well, and that's the interesting piece. Fewer than one third of so called normal weight people were metabolically healthy. So that's another really important message.

Dr. Mark Hyman
Wait. Wait. Wait. Did you just say that two thirds of skinny people are metabolically unhealthy Yes. And have prediabetes like syndrome?

Yes. Two thirds.

Dr. Cindy Geyer
That's mind boggling to Okay.

Dr. Mark Hyman
So that that means that, what, like, ninety five percent of Americans are are metabolic? Like No. No.

Dr. Cindy Geyer
It's still the eighty

Dr. Mark Hyman
eight percent. Alright. I get answer.

Dr. Cindy Geyer
Looking at how strongly it correlated with

Dr. Mark Hyman
weight. And terrible.

Dr. Cindy Geyer
So just having a body mass index that's less than twenty five is not a guarantee that you're metabolically healthy.

Dr. Mark Hyman
So if you're a skinny sugar and bagel eater, don't think it's fine because you're skinny.

Dr. Aseem Malhotra
Exactly.

Dr. Mark Hyman
It's basically the bottom line.

Dr. Cindy Geyer
Exactly. Because foods have other impacts besides just what they do with cholesterol anyway. Foods directly impact the elasticity of the arteries, for example, which is another key point.

Dr. Mark Hyman
Food is more than calorie, Cindy?

Dr. Cindy Geyer
Food is information, Mark. You said that for years. It talks to our genes. It talks to our systems.

Dr. Mark Hyman
Yeah. Yeah. Wow. So you're talking about how the food impacts our metabolic health, and and and we're not really good at diagnosing metabolic dysfunction. Right.

I mean, ninety percent I mean, okay. One out of two Americans has prediabetes or type two diabetes. And if you look at this new study, I would argue that nine out of ten Americans have some degree of prediabetes or type two diabetes. Mhmm. Like, ninety percent of Americans.

So when you look at that data and you also look at the parallel data that ninety percent of Americans with prediabetes are not diagnosed by their doctor. Right. That's terrifying, especially because it's a one hundred percent reversible, preventable, treatable condition. And it gets worse and worse over time, and people just don't even know they have it, and doctors miss it because there's no pill to take. Oh, take metformin.

Well, that's not gonna help. Right? It's like and and so what are the kinds of ways that we look at these patients differently? What are the tests that we do? What are the things that we really focus on?

When someone comes in with a risk of heart disease or they're concerned about heart disease, you know, what's our what's our approach? It's not just looking at the typical cholesterol and even CRP.

Dr. Cindy Geyer
Yeah. So we would look at those, of course. We would also wanna know what is somebody's insulin. Most doctors measure glucose, but not insulin. Mhmm.

I personally like to look at somebody's glucose trends over time. Because if you think about something that's preventable, you don't wanna wait till they cross that threshold to prediabetes or diabetes. So even in the range of so called normal glucose mark, you know this. Somebody whose fasting glucose runs less than 85 is in a very different metabolic place than somebody whose fasting glucose is 95 to 99, even though they're both technically normal, that it's a spectrum of risk. And the farther along you mark that spectrum, the higher the risk of heart disease and diabetes.

So if somebody's glucose used to be 85, and then it was 91, and now it's 98, We're gonna talk to that person right off the bat about all the things they need to put into place to prevent it from progressing because they're already on that spectrum. So we also wanna know insulin levels, not just a fasting insulin, but sometimes the insulin response to food. Because the other thing that's emerged is insulin is a player. And way before somebody's blood glucose goes up, they might be pumping out tons of insulin to try to keep it in a good place. Mhmm.

And insulin by itself contributes to inflammation and more weight gain around the middle the the middle, that visceral adipose tissue. So we wanna know their insulin, both fasting and in response to a challenge.

Dr. Mark Hyman
So wait. Wait. Wait. Are you saying that sugar not bad that's causing heart disease? Is sugar the the thing that's driving the insulin?

Because fat doesn't Well, cause insulin

Dr. Cindy Geyer
there is some mean, fat is a player.

Dr. Mark Hyman
Fat by itself.

Dr. Cindy Geyer
Fat by itself is a

Dr. Mark Hyman
with the food, it will. But Yeah. Yeah.

Dr. Cindy Geyer
Yeah. And I would I would say that quality of fat does matter. And we can talk some more about that, but I think fat plays a role with artery elasticity, which is another component of vascular risk.

Dr. Mark Hyman
Yeah. So fried foods, trans fats Right. Fine oils, those are nasty.

Dr. Cindy Geyer
Absolutely. Absolutely.

Dr. Mark Hyman
But but fat in itself, if it's made from whole food sources and nuts and seeds and avocados and all Might actually be beneficial. Actually beneficial. Yeah. Yeah. So what you're talking about is is a set of diagnostic tests that are so important but mostly ignored.

So the the the particle size and number, which nobody's doing. And the second is not just measuring your blood sugar a one c, which may be perfect. Mhmm. And you may be in really bad trouble. But measuring also insulin in response to drinking like a couple of Cokes.

Right? I I have a patient, Cindy, that I remember who was at super high risk for heart disease, and she had I mean, she looked like the Tasmanian devil. I mean, she was just like a round apple ball like this. And her belly was just like this big thing. And I'm like, this woman is in big trouble.

And she's inflamed. She's a high score of heart disease, high blood pressure, diabetes. And I'm like, let's check her glucose tolerance test with insulin. And this is, you know, this is like twenty plus years ago, and no no one was like looking at this. Even today, no one's looking at this.

Like so so hard. Mean, it took fifty years from the time the guy said, hey. We should wash our hands before surgery for us to wash our hands. You know, McKinley died, president McKinley, because he got shot in the belly, and the doctor McBurney stuck his finger in the wound to check it out without washing his hands. You know?

Oh, that's like crazy. It took fifty years from the time the guy said, let's do a stethoscope so we don't get lice jumping into the doctor's hair to start using the stethoscope because the doctor used to put their head on the patient. So it takes forever, and we've been doing this. Anyway, this woman, I did this test. I gave her this drink, and it was the most shocking thing I'd ever seen.

And it taught me so much about what we miss in medicine. Her blood sugar was perfect, like 80. Like and and she took the sugar drink, and it was like perfect. Like Mhmm. Like, it never went over a 110 after taking, like, equivalent of two Coca Colas.

Oh, she's fine. Her a one c was perfect. Her insulin normally should be under five fasting and under, like, 25 or 30 after a drink. Her insulin was, like, 50 fasting

Dr. Cindy Geyer
Wow.

Dr. Mark Hyman
And, like, 250 after a drink. So her body was just pumping out insulin, which was making her hungry Mhmm. Slowing her tablets, putting fat in her belly cells Mhmm. Which were basically inflammation factories

Dr. Cindy Geyer
Mhmm.

Dr. Mark Hyman
And leading this perpetual cycle. And she was able to lose 50 pounds like that when we cut out starch and And I just feel like, you know, that that showed me so much because you can even do a normal glucose tolerance test.

Dr. Cindy Geyer
If you're not measuring insulin.

Dr. Mark Hyman
And if you were super hyperinsinemic, you're gonna you're gonna miss that patient's real problem.

Dr. Cindy Geyer
And, you know, it's interesting, Mark, because that scenario is also associated with that cholesterol profile we talked about with the small dense LDL and Yeah. And and low HDL and the sequelae that we usually link to diabetes, fatty liver, neuropathy, all these other organs that are affected, and it can happen with the high insulins alone before the sugars go up. Yeah. It's a metabolic imbalance.

Dr. Mark Hyman
Yeah. So that's really the take home here is that heart disease is really a hormonal issue around insulin and insulin resistance and an inflammation issue. So let's talk about the heart disease. Heart people say, well, that story's been told. You know, we've got statins.

We've got this piece of SK9 inhibitors. We're all good. Like, what's the big deal? What should we worry about? It's just all about LDL cholesterol.

What's new? Yeah. What should we be looking at? What should we be thinking about? And and and why why are we still seeing so many people with heart disease?

Dr. Eric Topol
Yeah. It's still the number one killer around the world, not just here. And it's still the number one killer in women who they think that it's breast cancer. No, no. This is it.

This is exciting because we do know the things that we've been reviewing for risk factors, but we have a way to now establish the risk. Are they really high risk? Without before they ever have heart disease, twenty years plus. And the way we do that is we can get a simple lipid panel, add the LP, ApoB, so a little more than what is the standard lipid panel. The LP will be part of a lipid panel in the next year or two.

Anyway, when we get that lipid panel, which is, again, very inexpensive, and we can also get a polygenic risk score, very inexpensive, we can also get a heart clock. Right? And we can get inflammation markers. Anyway, now you have the full stack with your records, and, know, and and you have somebody who is well before they've ever manifest heart disease. And you say, oh, wow.

This person is really high risk for heart disease. What do we do? Well, you get their LDL down, you know, not just to below 70. We go down to 20, or less than 30. Right?

We have so many ways to do that now. We have these injectables that are against this PCSK9. We've got new drugs, five new LP drugs that are gonna be out within the next year or so that are really potent.

Dr. Mark Hyman
And we've had none of them. None till now.

Dr. Eric Topol
Yeah. We never had one. We always tell, too bad your LP is over a 100. Nothing we can do. We're gonna be able to change that, and that's gonna have a big impact.

We can get all the inflammation, get all over it, right, in terms of bringing the inflammation down. We've already seen how GLP one drugs do that before any weight loss. So that should work well in people who aren't even obese. And we've seen how that can prevent heart preserve ejection fraction heart failure, which is half of all heart failure, right? GLP-1s prevent that.

So for heart disease, we're seeing some really breakthroughs for the treatment, particularly the new target of LDL that we have five different drug classes. Statins, you've mentioned. But the PCSK9, we have three different ways to do that now. We got other new drugs that are coming. Just recently, the CETP inhibitor worked really well on top of so we got Yeah.

We can stamp out inflammation. The other thing is we have a metric we never had before, which is AI. And by the way, that also goes with Alzheimer's. You can do a retina AI exam. So I have a picture of the retina, and you do AI on it, and it tells you when you're gonna have Alzheimer's, if you're gonna have Alzheimer's, five to seven years in advance.

The retina also tells if you're gonna have heart disease or a stroke in advance. It will even tell if you're gonna you know, your calcium score of your heart arteries through your retina. Remarkable. And we should that should be widely available. It isn't yet, but it will be.

We'll be doing smartphone retina checks someday. Right? But here's where we get a real kick on a jump on this because if you are concerned about high risk and somebody, let's say, forty, fifty, they have significant risk factors, you can do a CT angio, which is now becoming very inexpensive, and you can look at inflammation in the artery. I go through this in the book. Inflammation's in the artery without a narrowing.

Okay? So basically, does AI of the fat around the artery. And it and this is something that was developed in The UK and is now getting ready for FDA approval. This is a big jump because we always were

Dr. Mark Hyman
So this isn't the CLEARLY scan. This is something else?

Dr. Eric Topol
No. No. Clearly and the other ones in The US don't do this. But this is a Oxford University of Oxford spinout. I think it's called Carista.

They're gonna have that available soon. And I went through the data in the book. I mean, they've had multiple papers, but it's striking. If you have inflammation without a narrowing, it's you you you could have fifteen fold risk of a heart attack. So that's when you use that as a metric, just like we were talking about the p tau two seventeen for Alzheimer's.

Dr. Mark Hyman
Yeah. Yeah.

Dr. Eric Topol
We've got all these new things for cardiovascular. We are gonna get a a grip on this, and we gotta, you know, ideally start early. But the lifestyle factors work really well. This is the most preventable known of the three big age related diseases through lifestyle.

Dr. Mark Hyman
Because even without a lot of the drugs, lifestyle plays a big role. I've seen data up to ninety percent by healthy diet, exercise, stress mitigation, sleep, right?

Dr. Eric Topol
Yeah. Mean

Dr. Mark Hyman
Is that In the book,

Dr. Eric Topol
I found all these studies that I was really struck by that are recent that showed that if we practice the lifestyle factors that we've been reviewing with the details that we discussed, that gets us seven to ten years of healthy aging without one of these age related diseases. I mean, who wouldn't want seven to ten years of healthy aging just from the stuff we've been discussing without any magic ocean or pill? So that's I think people don't know about that. I didn't know about that. It's really impressive.

Dr. Mark Hyman
That's powerful. So so what you're saying is some of the advances in cardiology are more pharmacological that you're thinking are coming, like the drugs that lower this genetically determined lipoprotein called LP, which I've been checking for thirty years. APO B, which I've been checking for thirty years. I read some article the other day. It was like, there's this great new test that can be more predictive of your risk of heart attack than any other test.

It's just discovered. I'm like, what is that? I'm like, look. Click through the article. It's like, ApoB.

I'm like, oh god. Yeah. I mean you only

Dr. Eric Topol
you only need to get it once, and then you can tell if you need to check it further. But you're getting at a a key point here. It isn't just that we have better, you know, more armamentarium of drugs, but we didn't know how to get the risk down. You know, we didn't know how to say, this person's really high risk for atherosclerosis because we didn't really have we didn't use the polygenic risk score. We didn't have as we do now, we're gonna have a heart clot.

We we so there's a big debate out there, as you probably know. How low should we go on LDL? Should we pull out all the stops? Well, if you look at all the data, the lower you go, the more protection. But you don't wanna necessarily give people, you know, ezetimibe and statin and an injectable and all these things unless they really are high risk.

Then you go for broke, and you also get the LPA, and you get the inflammation down. We have ways that we can do that, and we're gonna keep having better ways. So this is a striking it's a combination of who's at risk, the partitioning of risk, and having better ways to work on that risk.

Dr. Mark Hyman
Just to play devil's advocate, because this conversation comes up all the time. You're a cardiologist, so your favorite organ is the heart. And so your idea is get the LDL as low as you can. Not every Your brain is made up of a lot

Dr. Eric Topol
of Only in people who are at high risk.

Dr. Mark Hyman
In people who are at high risk. Okay. So if you're really high risk. But, like, what what about the effects, for example, on the brain and cognitive function? Because the, you know, cholesterol is a big part of your brain and sex hormones, which is what your your testosterone is made from is cholesterol.

So how do you kind of navigate that, and what's the truth then? What do we know?

Dr. Eric Topol
Yeah. I mean, the statins are probably the most studied drug class in history, really. Some of the data that comes out of these big meta analyses would say, Oh, people don't get any leg cramps. That's not true. You and I know that's not true.

People do get severe leg cramps where they can't even sleep at night, you know? And all sorts of other leg and muscle related symptoms. Now with respect to cognitive and sexual dysfunction, the data really don't show a hit there at all. And in fact, I think that we have some data to suggest the chances of having dementia in people, and Alzheimer's, as you know, accounts for seventy percent of dementia, that if you don't have the LDL lowered to, let's say, less than a 100, less than 70, you're gonna be at higher risk for dementia. So if anything, the data support statins.

And the data for sexual dysfunction, it's again some of that's vascular. And if it's vascular, we're talking about atherosclerotic. And that again is gonna be ameliorated with and of course, we don't have to just rely on statins. A lot of people do have side effects from statins no matter what the group at Oxford keeps saying that everyone can take a statin, and it's it's mental if they can't. When I wrote an op ed in the New York Times like a decade ago, and I called out the diabetes from statins, okay, because if you take a very potent statin, you have a higher risk of developing type two diabetes, right?

Yeah. Oh, did I get slammed by my cardiology colleagues for that? I said, well, wait a minute. That's the data, folks. I'm sorry.

Over the years, we've seen many more reports about the potent statins, high doses, where you get a higher risk. Yeah. And you know what? Most physicians are not keeping up with this. They're not watching their patients to see if their glucose, glycohemoglobin a one c or fasting glucose.

And this is bothersome to me because that is a side effect of statins, particularly potent statins. So again, this is important because if we're gonna lower LDL and pull out all the stops and high doses of rosuvastatin, Crestor, or atorvastatin, Lipitor, that could also raise the risk of that person developing type two diabetes. We don't wanna do that. And we have cardiologists, my colleagues, they are really sold on statins, and they basically ignore this diabetes issue. Did I ever take grief?

No.

Dr. Mark Hyman
I agree with you, and I think there's a concern I have around its effect on mitochondrial function, and some of the data I've seen that even in people without muscle pain, even without elevated muscle enzymes, that there's mitochondrial damage on muscle biopsies. And for me, mitochondria are so key to healthy aging in the brain, in everything, from Parkinson's to to heart disease, diabetes. Diabetics have poor poorly functioning mitochondria that may be part of why it causes it. And so I I'm wondering, you know, some of these other drugs that are coming down the pike, even though some of them are expensive, may be a better solution.

Dr. Eric Topol
Well, people that have clear cut adverse effects, the PCSK9 injectable drugs are a winner because they're potent. And they have not been associated with diabetes, is really interesting. Have not been associated with cognitive or other side effects. So most insurers cover that now. Went through years where it was because they were so expensive, the cost has come down.

So as long as people have the right indication where they have significant side effects or they need to have their LDL substantially lower, it's usually not a financial stress for most people.

Dr. Mark Hyman
So heart disease still is lifestyle, but then there's a cocktail of other drugs in very high risk patients that you can detect early to figure out. What about lipoprotein fractionation, which is a lab test that we include as part of function health, as well as APOB and LPA, something I've been testing for thirty years. But do you think that's as important? Because to me, the particle number and particle size story is important, and it's a of a clue that there's insulin resistance, which is one of the biggest drivers of heart disease and all the other age related diseases.

Dr. Eric Topol
Yeah. I mean, I think it's it's mild, potentially mild incremental information. I just don't see that it has nearly the impact of just zeroing in on LDL and Lp. And I do recommend that everybody get an ApoB at least once, and then you can figure out whether that needs to be further assessed. These other things, you know, it's an additional expense.

I just haven't seen the the value. But, you know, I have colleagues that are lipidologists that test every known particle in the mankind. Right? I just haven't. I haven't really seen the benefit because it doesn't change usually to me, I gotta know the person's risk, and then I'm gonna go after inflammation.

I'm gonna work on their lifestyle, and if necessary, get their LDL down as low as possible. So the the other things just don't have a, for me, added value. But I do know there are people that are, you know, wild and crazy on every particle, small, large, dense, you know, you name it out there. Yeah.

Dr. Mark Hyman
Yeah. So I hear you on that. I think it you know, sometimes more information isn't always better, but, you know, then what is the most important information? I think you covered that in your book. And I think, you know, we're going down the kind of the horsemen of the apocalypse, you know, the the heart disease, the cancer, the the dementia.

I think diabetes is sort of all in there related. But you're talking about how there's kind of a newer with the advances in our diagnostics, whether it's imaging or retinal scans or new new ways we can measure dementia biomarkers we never had before cancer, we'll get into in a sec, that these diseases can become more optional. Like, they're not inevitable. They they have more agency than we ever had before, given what we know now. And when you layer up what we're learning with AI and using multimodal treatments, we're really able to actually make a big dent if people really understood how to navigate this.

And the sad part is that, you know, you spend your time thinking about what's coming. Most physicians are just trying to deal with the onslaught of what is and don't have the the bandwidth to actually apply this stuff until it kinda is way often decades later. And so I I I really appreciate your sort of paying attention to, you know, what's happening and keeping your nose to to the scent of where things are emerging because otherwise, people just don't know. And doctors, like you said, don't know. And and the average person doesn't know, but this is such a hopeful message.

And and I'd love you to sort of unpack how you came to go from being a trained cardiologist who basically swallowed the gospel Yep. To one who understands and has looked at the literature and has come to a different conclusion. Because it's not just that you're anti drug or you're anti medical care, anti the system. You're for the truth and for science and for an objective loop, look at the facts. So the question I have is, how did you go from being a trained cardiologist who believed in statins to one who started to question statins to one who's come to understand that our approach to cardiovascular disease might be a little bit misguided?

And we'll talk about what the right approach should be later. But I I kinda wanna start with unpack unpack the science for us because Yeah. Everybody listening has no one's heard if their cholesterol's high to take a statin. So statins cause side effects, which they do for a lot of people. Probably twenty percent get some muscle damage or some symptoms or increase risk of diabetes.

You know, we'll talk

Dr. Aseem Malhotra
about that data. There's still there's still a huge drive in our society for prescribing these and globally. Yeah. Absolutely. So my interest in this came from really looking at the initially, obesity epidemic.

So 2004, WHO announced it as an epidemic. You know, by 2010, I was in nine years qualified as a doctor. I was a specialist registrar in my cardiology training. I was seeing more people this viscerally. I'm very sensitive to, how to put it, suffering around me if you like, but also seeing my colleagues under more stress in the system.

I was like, hold on a minute. This if we carry on down this trajectory, the whole health care system's gonna collapse. We want them to even manage people acutely if they are ill. Right? I never thought that would happen, and and ultimately that one of my own two of my own pay two of my parents supposedly basically died because of failures in the system because the system's under some stress.

Right? Never predicted that would happen, but that's where I started from. And when I looked into the issue of obesity, you know, I I I concluded that one of the root causes, Mark, if not the main root cause, was this was this flawed hypothesis that we should have low fat diets to prevent heart disease. Food industry exploited that, increasing sugar intake, increasing refined carbohydrate intake. It became quite clear.

There was a clear correlation between that change in guidance in the late seventies in The US and early eighties in The UK Yeah. When the obesity epidemic started to then, you know, take its trajectory down the wrong way.

Dr. Mark Hyman
Yeah. And I covered a lot of this in my book Eat Fat, Eat Thin

Dr. Aseem Malhotra
Yeah. Which I would sort

Dr. Mark Hyman
of unpack the whole history of how we got this low fat craze

Dr. Aseem Malhotra
Yeah.

Dr. Mark Hyman
And led to this high sugar starch craze that then led to this dramatic rise in obesity, which now, of course, we're treating with other drug, the GLP one agonist and, you know, tirzepatide and some glutide or Ozempic and Mounjaro. It's kind of crazy. Right? Yeah. Just kind of flipped it upside down.

Dr. Aseem Malhotra
Oh, absolutely. So so when I looked at that, so I'm looking at data and spending years and and months and years looking at it and looking at different bits of data. I I was able to put it all together, and I wrote a piece in the BMJ in 2013 called saturated fat is not a major issue. Right? I

Dr. Mark Hyman
read it. That's how I first came across it.

Dr. Aseem Malhotra
Yeah. And that got a lot of attention. Right? It was international news and British news and CNN International and whatever. You know?

Because obviously, suddenly you've got a cardiologist busting this myth that we think butter has been bad for our cholesterol. But when I did that okay. So what I looked at the data, and it was very clear there was no clear association with saturated fat consumption in heart disease. So if that's true, then and we know saturated fat raises LDL cholesterol. That means LDL cholesterol can't be that important.

So and if LDL cholesterol or total cholesterol isn't that important as a risk factor, how does statins work? But I knew statins had a separate effect to low cholesterol, which is their anti inflammatory and their anti clotting, and I knew this even it's well known within cardiology circles. You know, I trained as an interventional cardiologist, and that means key heart surgery stents, for example. Patient comes in. We didn't even check their cholesterol.

Maybe some of the thinking was the lower, the better, which we'll come on to as well. So it doesn't matter what their cholesterol is starting from. The lower your cholesterol, the better. In fact, 02/2011, our cardiologist, one of the editors, I think, of the American Journal of Cardiology, wrote an article, which I I mentioned in my book, A Statin Free Life, which was entitled, it's the cholesterol stupid. Right?

And what did he say in that? He said, you can be an obese diabetic smoker that doesn't exercise. Sounds crazy. But as long as your cholesterol is low enough

Dr. Mark Hyman
You're not gonna get

Dr. Aseem Malhotra
heart disease. Not gonna get heart disease.

Dr. Mark Hyman
That's crazy. Like, really?

Dr. Aseem Malhotra
So, okay. I had to unpick that. And and what I what I also then did moving forward from 2000 and so that's how I got down this track realizing that our obsession with LDL lowering has has been

Dr. Mark Hyman
a saturated fat literature, and you weren't impressed, and data showed that it didn't seem

Dr. Aseem Malhotra
to Both be observational data and randomized controlled trials. No benefit, like, in lowering it, no association. Nothing. Right. Right?

And then when you look at all the data so that was the first sort of bit that I was, okay.

Dr. Mark Hyman
And some might even be protective, like some of the dairy fat. Well, we

Dr. Aseem Malhotra
know now. Yes. There is there is some suggestion that dairy fat could be protective. Absolutely. So there's all that.

And then coming back to the LDL

Dr. Mark Hyman
By the way, you're not alone on this. I mean, there was a major paper published by Darius Mazafarian from Tufts and others looking at butter and Yeah. And actually showing that there really wasn't evidence that it was So

Dr. Aseem Malhotra
Mark, this is what's interesting. That article I wrote, because it creates such a, you know, a lot of headlines and and then backlash or whatever else, that's when people like Darius started looking at this again. So it was all really from the back of that BMJ piece. Yeah. It all came together.

Yeah. So then everybody's like, you know, I know and at the time, I was I was writing this to a commentary, which was peer reviewed, but I could have got it wrong. I could have. Yeah. But I was like, you know what?

There's enough here for me to provoke the thoughts.

Dr. Mark Hyman
Right.

Dr. Aseem Malhotra
And then it all get got proven that, you know, what I'd written had validity. Right? Yeah. Which is good. But the other aspect to this, if we go back and you mentioned cholesterol, so the so is cholesterol so for is high cholesterol a risk factor for heart disease?

And is LDL cholesterol risk factor

Dr. Mark Hyman
for heart disease?

Dr. Aseem Malhotra
So you have to go back to square one. Right? So these are the framing of studies that, you know, started in Massachusetts in 1948 and went over decades looking at thousands of people where a lot of risk factors emerged for heart disease, whether it's diabetes, high blood pressure, smoking, for example. Now cholesterol. And high cholesterol.

Right? So you go and look back at the Framingham studies, and what and the just to summarize it without complicating the situation too much, William Castelli is a cardiologist, and he published he's a co director of Framingham. And in 1996, he published in one of the cardiology major cardiology journeys a summary of Framingham, specifically looking at LDL cholesterol. Let's just let's just look at LDL because that is the so called bad cholesterol. And he said, from Framingham, unless your LDL is above 7.8 millimoles, which by the way, I think in your units is probably two fifty or 300.

Two fifty probably, I think. Maybe we can look it up and calculate. But let's just say for argument's sake around two fifty, which is very, very high by the way, it absolutely had no it was useless as a predictor for coronary artery disease. LDL. Why is that?

When you correct for triglycerides and HDL, okay, which by the way is a more important predictor of heart disease, LDL loses its significance completely. So then if that's true, and I'm saying that means that LDL isn't really a risk factor of heart disease, and I believe with everything I know now that to be the case, okay, let's let's unpick every part of it. Does lowering LDL cholesterol from diet or drugs, but more specifically drugs because they're the most potent ways of lowering LDL cholesterol, whether it's p c k nine inhibitors, whether it's statins, whatever, is there is there a clear correlation? Is this dogma true that the lower, the better? So myself and two cardiologists did a systematic review of the totality of drug industry sponsored trials, by the way, and some diet trials, but many drug industry sponsored trials.

All of the randomized controlled trials on cholesterol lowering drugs, statins, p c k nine, blah blah blah. Was there a clear relationship as you lowered LDL in low risk and high risk patients, Mark? Okay? Over 30 studies Yeah. Was there a relationship with lowering LDL and preventing cardiovascular events?

Dr. Mark Hyman
No. Even in high risk patients?

Dr. Aseem Malhotra
Even in high risk. It's nonsense. It's nonsense. So the question then is

Dr. Mark Hyman
But why do we all so firmly So believe

Dr. Aseem Malhotra
does that mean stat but then I said, well, of course, statins have a role. They do have a benefit from the RCT data, which is small because I knew already they're anti inflammatory and anti clotting. So it's nothing. In my view, listen, I could be proven wrong here, but the evidence at the moment looks very clear that there is no consistent relationship. Right?

It's definitely not a clear relationship. So if even if it's a weak relationship, Mark, let's just argument's sake. Let's say there is a weak benefit in lowering LDL. What else is going on, and what else are you ignoring? Right?

Yeah. What else does statins do? They cause insulin resistance. Say, in a hundred people get type two diabetes because of statins.

Dr. Mark Hyman
One in two? One in a hundred. One in a hundred.

Dr. Aseem Malhotra
Yeah. One in a hundred. So about one to two percent, but one in a hundred. Some some studies say one in fifty. Right?

We'll get type two diabetes because of the statin. Probably reversible still, but not ideal, right, you're on a stand up. The second thing is, look at the whole patient coming in. We have the illusion of protection. We have patients I used to see coming in, and they thought, my cholesterol is low.

I can go and eat at McDonald's. It's fine. And they they eat and they're they're getting more and more of a weight, more insulin resistant. They're increasing their cardiovascular risk. They're not told the statin is gonna give them a one percent benefit, I.

E, more likely than not, they're not gonna benefit. So you could imagine that concept that the overall net effect of the way that statins are prescribed and the dogma around them, in my view, has been negative and has actually been one of the main reasons why we have got this pandemic of chronic disease.

Dr. Mark Hyman
Because we overemphasized an index on LDL cholesterol and forgotten everything else. Absolutely. Right. Because there's a drug for it. It was interesting to me.

If there was a drug for insulin resistance that worked really well, and we have metformin, but it's and it fixed insulin resistance, you know, everybody be prescribing it. But we don't even diagnose it in most people because we don't have a drug for it. Exactly. And it's it's stunning to me that you know, I was talking to the lab director at Quest Laboratories. He said, what percent of your tests you get that come in are measuring insulin, which is I think one of the most important things you need to know about your, biomarkers.

And he was like, less than 1%. And then it's part of why I cofounded this company Function Health to really look at a deep biomarker set around cardiometabolic risk factors, including insulin, including Lp, including something called ApoB Yes. Which I wanna talk to you Yeah. Not just your total LDL, HDL, and triglyceride levels, but also particle number, particle size, inflammation markers, all the things that are often missed, but that are much better at giving you a holistic picture of your cardiovascular risk. And then you know where to intervene.

And it and and one of the studies that was so interesting to me was actually, from I think Scotland or Ireland was where they looked basically a series of patients who came into an emergency room with a heart attack. And they did glucose tolerance tests on everybody who came in with a heart attack. And they found that two thirds either had diabetes or prediabetes Yep. Who had a heart attack. Yep.

That that was really the big driver. Yeah. Now there's a subset of people who have familial lipid disorders, you know, inherited genetic lipid disorders. And not those people probably need to be treated more directly. But but for the majority of people out there who are obese or have prediabetes or metabolic dysfunction, which is basically in America, ninety three percent of Americans, that's what's driving probably most of the heart disease.

Not Hundred percent. Butter or saturated fat or

Dr. Aseem Malhotra
No. LDL elevations. Well, something else to throw into the picture. Right? So you can make the argument, okay, doctor Mahatra, you're saying there's no consistent relationship.

It may be a benefit. Why not just lower your LDL? Okay. So 2016, and the reason we did this, me and a number of international scientists looked at we decided a systematic review of observational data looking at people 60. Was there a relation with LDL cholesterol and heart disease?

And the reason we did this, by the way, is that another thing that was interesting from framing it, which wasn't well publicized, is that when after people hit 50 years old, as their cholesterol dropped, their mortality increased. Yeah. So we thought, okay. Is there something you know, because for it to be a risk factor for heart disease, it should be consistent really across all age groups in both sexes. Right?

For mortality. For mortality. Yeah. But even for heart disease as well. Right?

You that's a good point. So we looked at, was there, first of all, any association if you're 60 with LDL cholesterol and heart disease? Right? We found none. Okay.

Interesting. But what was surprising was there was an inverse association with LDL cholesterol and all cause mortality. In other ways, statistically, if you're 60, the higher LDL, the less likely you are to die. So what's the reasoning for that? Well, something that's been forgotten or missed or not discussed.

Cholesterol is has a very vital role in many functions in the body, including, you know Brain. The brain, hormone production, but also the immune system.

Dr. Mark Hyman
Mhmm.

Dr. Aseem Malhotra
And it's likely that that's where the protective benefit comes because older people are more vulnerable to dying from infections. Yeah. And we also know there is an association. I'll use this word, an association. Right?

Can't say it's definitely causal, between low cholesterol and cancer. Again, it's probably related to the immune system.

Dr. Mark Hyman
I mean, I think I think the Which is

Dr. Eric Topol
very interesting.

Dr. Mark Hyman
This data, though, is and I'll just push back a little bit, is it's it's observational data. And the data, like, from the Hawaii study show that, you know, the if you're older and you have higher cholesterol, you know, you're more likely to live longer than if your cholesterol is lower. Yeah. But it may be because the people who have low cholesterol are malnourished, have cancer, and other reasons.

Dr. Aseem Malhotra
Let me push back on that. So we we counted for that, and we found actually, no, when you when you count like time lag, you would go back five or ten years. No. It's not it's not. That does happen, but it no.

It's independently, it does seem to be an issue.

Dr. Mark Hyman
Okay. So you sort of looked at all the data, and you came up with this very kind of contrary opinion, which is that LDL isn't all it's cracked up to me, that statins work a little Yeah. But not for the reasons we think. Meaning, they lower inflammation, and they may have other properties that may beneficial. We don't even know.

Call this pleiotropic effects. So they for example, they induce nitric oxide synthase, which dilates your blood vessels and reduces inflammation and helps your lining of your blood vessels. All that's protective. And so it maybe stabilizes plaque. It may help in those ways, but it may not be the LDL lowering effect.

In fact, Paul Richter from Harvard, I I remember he published a trial. I think it was the Jupiter trial where they showed that if you if you had a high LDL but didn't have any inflammation, you didn't have that significant risk of having heart disease. But if you had Interesting. A high level of inflammation, high LDL, you had a much higher risk. So it was the inflammation that was really driving the heart disease.

And that was really the seminal paper. It was in the New England Journal of Medicine over twenty years ago. I remember reading it Yeah. By Paul Richter and and and his crew that really laid out how heart disease is not a plumbing problem. It's an immune problem.

100%.

Dr. Aseem Malhotra
It's a chronic inflammatory process exacerbated by metabolic risk factors or insulin resistance. And I wrote a Metabolic

Dr. Mark Hyman
risk factors. By that, mean problems with your blood sugar and insulin Into resistance.

Dr. Aseem Malhotra
And prediabetes. Yeah. 100%. And actually, we published an editorial with two cardiologists I did in British owned sports medicine in 2017, which was a very long title, but it got a lot of publicity and over more than a million downloads, which was saturated fat does not clog the arteries. Coronary artery disease is a chronic inflammatory condition which can be effectively managed with lifestyle changes.

That was the title of this thing, but it's all there. People it's free access. People look it up and read it, but we talked that we've overdone the thing. I never probably just doctor Malhotra, his opinion being controversial. The two my two co authors were both editors of medical journals and cardiologists.

Louise Redberg, editor of Geometrical Medicine, and Pascal Meyer, editor of BMJ

Dr. Mark Hyman
Open Art. Why why why is this not getting more play? Why why is still the dogma and the orthodoxy that if you have a high LDL, you take a statin?

Dr. Aseem Malhotra
Do do you want my honest answer, Mark?

Dr. Mark Hyman
Yeah. I mean, not not all I mean, I know doctors are usually very good hearted. Sure. Very smart. Well intentioned.

Don't wanna hurt their patients. Try to do what's in the best interest of their patients, and follow the science. So why why are they not hearing about this?

Dr. Aseem Malhotra
Okay. So let's go to the root cause of the problem even in society today. What's what's the big issue in health? We have commercial distortions of the scientific evidence. Who is behind that and who has more power and control over medical education, medical training, the media than ever before?

Big corporations. In this case, big pharma. And the level of this control and power mark has got to a level where it can be very easily and rationally not in an inflammatory way or overplaying it as as being tyrannical. What all what all what what also happens with these big corporations in the way they exert their power is that they want to avoid conflict. Right?

They wanna avoid the truth coming out. So there's a debate and discussion because, ultimately, people like myself, like you, who are obsessed with the truth, who wanna get it out to help patients, when we speak and act from a place of of integrity and truth, it has a very powerful resonance with people, and it can very quickly destroy all these other dogmas that people have created because of that power that that that the truth has. They want that conflict to remain latent, to remain hidden. So that, you know, Noam Chomsky says the general public doesn't know what's happening, and they don't even know that they don't know.

Dr. Mark Hyman
That's right.

Dr. Aseem Malhotra
Right? So a lot of these doctors, and I agree, are are well intentioned, but they don't they're living you know, in many ways, they're living they're climbing up the wrong wall to success when it comes to helping patients because it's the drug companies that are are really calling the shots. Yeah. So we are under a situation of tyranny, and the reason I call it tyrannical is because there are doctors that know this, Mark. There are a few doctors that kind of know this, but then they're less they're afraid to speak out.

And only a minority of the doctors that know what's going on will then speak out.

Dr. Mark Hyman
If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Doctor Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to the doctor Hyman show wherever you get your podcasts.

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Dr. Mark Hyman
the Ultra Wellness Center, my

Dr. Mark Hyman
work at Cleveland Clinic, and Function Health where I am chief medical officer. This podcast represents my opinions and my guests' opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services.

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