How to Naturally Lower Cholesterol with Dr. Aseem Malhotra - Transcript
Dr. Mark Hyman
Coming up on this episode, part of the problem with the statin research is that it's not that they're bad or good. Every drug has a role. It's a tool. Yeah. You know, it's like saying water.
Is water good or bad? Well, if you drink too much water, you can die of seizures, but you need water to survive. Right? Everything has a role. Before we jump into today's episode, I'd like to note that while I wish I could help everyone via my personal practice, there's simply not enough time for me to do this at this scale.
And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out function health for real time lab insights. If you're in need of deepening your knowledge around your health journey, check out my membership community, Hyman Hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website, supplement store, for a summary of my favorite and tested products. Hi.
I'm Doctor Mark Hyman, a practicing physician and a proponent of systems medicine, a framework to help you understand the why or the root cause of your symptoms. Welcome to The Doctor's Pharmacy. Every week, I bring on interesting guests to discuss the latest topics in the field of functional medicine and do a deep dive on how these topics pertain to your health. In today's episode, I have some interesting discussions with other experts in the field. So let's just jump right in.
So welcome back to the podcast. It seems great to have you back in person here in Austin, Texas in my new studio.
Dr. Aseem Malhotra
Yeah. It's so nice to see you again, Mark. I think, yeah, we did. It's been about, what, six years since
Dr. Mark Hyman
I was
Dr. Aseem Malhotra
on the podcast?
Dr. Mark Hyman
That's right.
Dr. Aseem Malhotra
Yeah. We got a lot of a lot of interest. So I think, yeah, let's,
Dr. Mark Hyman
we did. So, as you heard this 1 too. Introduction, it seems an esteemed cardiologist from The UK who's been a vocal critic of a lot of the mainstream ways of thinking about cardiovascular risk, cardiovascular health, and the use of statins as our primary therapy for reducing cardiovascular disease, which is, after all, the number 1 killer in the world. We're gonna dive deep into the issues around these drugs, around what we need to actually be looking at for cardiovascular disease. And I think your opinion is going to be a little bit jarring for people because it goes against the conventional wisdom, which isn't necessarily always wise.
And I think it's a much more nuanced conversation that people need to be having around cardiovascular disease than high LDL cholesterol, bad cholesterol, take a statin, end of story.
Dr. Aseem Malhotra
Yeah.
Dr. Mark Hyman
Essentially what we all do in medicine, if we're trained in traditional medicine, high cholesterol equals statin. And if statin causes side effects, you can play with a bunch of other drugs like PCSK nine inhibitors. But we're gonna start out at the at the end, which is this lawsuit that was filed by 2 of your colleagues that you were gonna be a part of but decided not to be for various reasons because you couldn't actually talk about the issues that you care about, which I guess has a lot of integrity. But the case was brought by Zoe Harcombe and doctor Malcolm Kendrick against Associated Newspapers, which is the publisher of The Mail on Sunday. And there were a series of articles published in they were part of a campaign called fight fake health news.
This is even before COVID and the whole misinformation. And in these articles, they named the claimants and statin deniers, including you, which isn't actually true. And they accused you among and your colleagues of spreading misinformation about statins, which they described as, quote, deadly propaganda. The newspaper's article suggested that their statements led people to avoid taking statins, which was a big public health risk. In response to these articles, your colleagues filed a defamation lawsuit arguing that these articles falsely portrayed them as deliberately spreading lies about statins.
Now the high court has seen multiple legal arguments, particularly around the public interest defense under the Defamation Act of 2013 in The UK. But in 2024, just recently, the case was ruled in favor of your colleagues against the newspaper. So in some ways, you've been vindicated by the legal system that what you're raising in terms of concerns about statins, and I'm kinda quoting from you at this point, which is their their data is flawed on statins. It's overemphasized. It's overprescribed.
It has risks, and there are other factors that need to be considered that are often being missed. And you know, it's a more nuanced view that you have. It's not just drugs are bad. You know, food is good or drugs are bad and, you know, wheatgrass is good. It's it's basically looking at very nuanced science to help unpack what we know and what we don't know about cholesterol and cardiovascular risk.
So kinda walk us through what happened with that case and what the findings were and and and and, how you how you have all been vindicated as a result of the the legal decision around this this, court case that was basically defending you, essentially, not you were directly involved in the final suit, but you were kinda part of the whole thing you said.
Dr. Aseem Malhotra
And first of all, to clarify, Mark, the reason I did not decide, I mean, it was something I thought about, to sue the Mail on Sunday. I think I was, at the time, there was a lot going on. My mom had just died. You know, for me as an activist in the campaigner, I made the decision that I'm gonna keep talking about this issue and carry on and just take it on the chin. I've been in this situation before, which we'll talk about later.
So I decided that I wasn't gonna sue them, but I'm so pleased and happy for for Zoe and Malcolm because, you know, it it these sorts of things, they do have an impact on you. I I before I tell you that what happened in the case specifically, because of that newspaper article, about a month later, because my hospital was named in the article and obviously they got a bit panicky, I was told that my services were no longer required. So I lost my NHS job. I and and by the way, I have an impeccable track record in terms of my clinical care, getting on with my colleagues. You know, I'm probably an unusual doctor and probably lucky as well, because I throughout my whole career, twenty three career year career as a doctor, I've never had a single patient complaint, which is unusual because, you know, that can happen for any reason.
It doesn't mean the doctor's done something wrong. So with all of that background, that's what happened. And then I wasn't able to get a job back in the NHS. I I I applied and got
Dr. Mark Hyman
You got blacklisted?
Dr. Aseem Malhotra
Basically. Yeah. And it doesn't mean that all cardiologists were kind of against me, but the situation arises in hospitals, teaching hospitals. And I know a lot of cardiologists in London because I trained in, you know, some of these hospitals and had good relationships with with cardiologists there who respect my opinion. And it would be the case where, say, in a cardiology department of 8 people, if 7 of them said, it'd be great.
Let's have a scene here to do clinics and when working for a bit, just 1 of them would object. No chance. You can't get in. And it was always it came back to when I asked the reason, it was, you know, there are antibodies that have been developed against you because of your statins, essentially. Right?
Statins.
Dr. Mark Hyman
People are allergic to you because of your opinion on statins. Exactly.
Dr. Aseem Malhotra
So but also that So what happened in the case is that, you know, this was a front page news story. What made the news story, and this is the really interesting bit around the evidence of what happened during the case that I submitted because I was asked to, is that the front page linked article said essentially got the Secu State for Health at the time called Matt Hancock, you may have heard of him, to say that there was no place in the NHS for these sites of doctors who are spreading misinformation on statins. Now interestingly and and, of course, 1 of the most extraordinary bits in in the actual newspaper, the editorial from the health editor headline was, there is a special place in hell for doctors who say statins don't work.
Dr. Mark Hyman
Okay. And then imagine the picture of
Dr. Aseem Malhotra
me, Zoey Aacom, and Harkom. Right? Yeah.
Dr. Mark Hyman
You have your corner in hell all picked out. Exactly. Right?
Dr. Aseem Malhotra
I mean, it's it's I mean, I find it funny, to be honest. I mean, of course, a lot of other people were more upset than I were. I was. In fact, the the former queen of England's Doctor, and the and the past president of royal culture physician, sir Richard Thompson, who I'm friends with, I mean, he called me up and he was so upset. He's like, this is unbelievable.
How can they say, yeah, this is not what you say, blah blah.
Dr. Mark Hyman
Right.
Dr. Aseem Malhotra
And I was calming him down and saying, well, to this you know, we take this as a backhanded compliment. You're over the target. You get 1 of the most powerful influential newspapers in the world to go for you like this. You know? And I'm someone that
Dr. Mark Hyman
And who's their advertisers?
Dr. Aseem Malhotra
Well, I don't well, that's a that's a fair point. But I think ultimately, what came out in the case as well, Mark, and there's also again, I'll I'll mention this crucial bit of evidence, which is extraordinary and helped, I think, shift the case and win it, is that the people who were fueling the health editor to write the article and the people who are commenting on it were all connected or part of something called the CTT, the Cholesterol Trialist Collaboration in Oxford. These are the most powerful, statin promoters and some of the most powerful doctors in the world in medical research. But, again, what wasn't declared Yeah. Is that their institution has received hundreds of millions of dollars from drug companies that manufacture statins or new cholesterol lowering drugs.
Dr. Mark Hyman
Yeah.
Dr. Aseem Malhotra
Okay? So listen. That for I
Dr. Mark Hyman
wanna double click on that for a sec. Just so people understand, We think academic institutions are squeaky clean. They're neutral. They're objective. They're scientific, medical schools, researchers.
But the truth is that a lot of their funding comes from pharma who are funding trials that they're executing. And I I remember Peter Libby, who you might have heard of, who's basically the editor in chief of the main cardiology textbook that all fellows take called Brunel's Cardiology. He he he, is, you know, chairman of cardiovascular disease at at Harvard. And I said, Peter, why don't you study lifestyle interventions for cardiovascular disease versus just studying medication. He said, Mark, I know lifestyle works, but I can't get $5 to study lifestyle.
I can get $150,000,000 to study a drug, and that's funding my department, that's funding my staff, that's funding me. And it's the reality of how the system is set up. So you have to understand that that, you know, there's there's an inherent bias in in a lot of how we think about things in medicine because of of the money. If you follow the money, you you understand where things are are driven from.
Dr. Aseem Malhotra
Yeah. Absolutely right, Mark. And that reminds me actually of somebody who I cite quite regularly, professor John Aeneidus. I I refer to
Dr. Mark Hyman
In Stanford. Yeah.
Dr. Aseem Malhotra
In Stanford. I refer to him as as a Stephen Hawking in medicine. He's the most cited medical researcher in the world. He is a professor of medicine and epidemiology and statistics at Stanford. He's a he's a mathematical genius.
And he published a paper in 02/6 that we we've talked about before, I think, which is called Why Most Published Research Findings are False. Yeah. And 1 of the risk factors for false research is this: the greater the financial and other prejudices in a given field, the less likely the research finds it to be true. Think about that. So when you start with statins, you're talking about 1 of the most lucrative drugs in the history of medicine.
It's a trillion dollar industry.
Dr. Mark Hyman
Everyone selling drug in the world.
Dr. Aseem Malhotra
So so start from that kind of overview to try and help explain what's going on and why these sort of this confusion's happening and where the battle's happening. And then you can make your own decision who you trust more, but also the most important thing is to try and give people information in a way that you can understand. We'll get there in a second. So what happened in the case? So we have this kind of defamatory, you know, attack on us, but what made the story was the Secretary of State for Health getting involved.
Now interestingly, one week earlier, just before this news story broke, I was speaking in parliament about type two diabetes reversal and the benefits of, for example, of a low carbohydrate in a real food diet for that purpose. Matt Hancock had agreed to meet me. He had, was aware of my work because of another politician who had lost 94 pounds from following my diet plan.
Dr. Mark Hyman
Is he the 1 who said you need to have a special place in hell? Or
Dr. Aseem Malhotra
No. That was the editor of the of the of the actual of the, of the newspaper. So Hancock, all Hancock was involved in the story because he had basically said he'd been contacted by the mail on Sunday and said there were these doctors saying this. Do you have a can you give us a comment? And he gave a generic comment saying there's no place for this misinformation.
Right? And that it looked as if he knew who we were and we were so I met Matt Hancock a week before. I gave him a copy of my book. He was very respectful, very appreciative of what I'm doing and lifestyle, and gave my lecture in in parliament, which got a lot of attention, by the way, as well, which may have been the reason why they decided to suddenly do this you know, the news story is like, okay. We we're getting something that's challenging our views on cholesterol, on on on low fat diets, or whatever.
So that was probably the peg because that was getting a lot of attention to then come back and and have a go at me and 2 other people. I think that's probably what happened. That's why it happened at that particular time. So I texted Matt through Twitter, DM ed him. Yeah.
I was like, Matt, really? And he replied, Asim, I had no idea they were referring to you or Zoe Harcombe. And I was like, okay, this is very interesting. So I I kept that, obviously. When the case then evolved and went to court, the the lawyers for Zoe and and Malcolm contacted me.
And I gave them that evidence. And apparently during the case and Malcolm fed this back to me, Malcolm Kendrick, he said, this turned the judge. Because they put Barney Callman, who was the health editor on the stand and essentially made him admit that, you know, that in a way that they had misled Matt Hancock because they hadn't told him. Because if if Matt knew because I'm I'm a, you know, for all intents and purposes. So probably so this is what really changed the case.
And I think that that is yeah. That well, it
Dr. Mark Hyman
is what it is. So what what were you actually saying? And what was Zoe and doctor Kendrick saying that raised that concern and that why was why was the the
Dr. Aseem Malhotra
the male on Sunday so vocal about criticizing? What were were they coming out? So this is basically based upon probably both Malcolm and Zoe and my public advocacy on the overprescription of statins, the lack of informed consent, the lack of access to the raw data, which is still an ongoing problem, going over a decade or so. So I think because this story and the statins saga had been getting more and more of an airing, and, Mark, I've been publishing in medical journals on informed consent and a lot of I've been publishing a lot about the prescription of statins and the conflicts of interest and not knowing the true benefits and harms. Right?
Because as you've said already, a lot of the data that we get from drug industry sponsored trials, if not most of it, is never independently evaluated. Most people don't know this. Right? Yeah.
Dr. Mark Hyman
And the only people don't know, Hassim, is that is that when studies are done, they don't have to be published. So if studies come out that are showing
Dr. Aseem Malhotra
Yeah.
Dr. Mark Hyman
Not a positive benefit for a particular drug, that has to be submitted to the FDA or whatever the equivalent is in The UK, but they don't actually have to be published in a medical journal. No. So you're not seeing the full spectrum of what the data show. You're just saying cherry picked data that shows Absolutely. That's massaged and twisted.
You know? I think it was Mark Twain who said there's liars, there's damn liars, and they're statisticians. Yeah. You know? And so Absolutely.
It's part of the problem with the statin researchers that it's not that they're bad or good. Every drug has a role. It's a tool. Yeah. You know?
It's like saying water. Is water good or bad? Well, if you drink too much water, you can die of seizures, but you need water to survive. Right? Everything has a role.
But how it's used, how frequently it's used, who it's prescribed, how often it's prescribed, the manipulation of the medical system, the manipulation of the scientific research, and the lack of transparency about the data, the lack of publication of all the data gives us a warped view of how great these drugs are. And they're the number 1 class of drugs sold in the world globally. Absolutely.
Dr. Aseem Malhotra
I mean, it's estimated between two hundred million and one billion people are prescribed this drug. So it's a big deal. And especially for me as a cardiologist whose primary purpose is to help my patients and also with my special interest to really understand the root cause of heart disease and how we can reverse it in the population. We hadn't we hadn't done that. That that's how my journey started.
I was somebody that believed in statins. I was 1 of the biggest prescribers. I was giving it in the ER to a patient coming with a heart attack and get telling the nurse to give it in them in the ER before they've even gone to the cardiac hospital lab for them to have a statin.
Dr. Mark Hyman
I heard a cardiologist saying you should should serve it at at McDonald's with your, you know, quick track and a fries
Dr. Aseem Malhotra
I know.
Dr. Mark Hyman
Or have it over the counter. I mean, there there was, in in 2021 globally, it was $15,000,000,000 spent on statins. It's projected to age 22,000,000,000 by 02/32. I mean, this is a staggering amount of money on 1 drug. Absolutely.
And it's it's so the the there's a lot at
Dr. Aseem Malhotra
stake here. %. Hundred %. So understanding that that there's a barrier to the truth, which is essentially a financial barrier because there's so much at stake as you say, not just with statins alone, but the cholesterol lowering industry, the low fat food movement, the fear of cholesterol is a trillion dollar industry. Right?
So I think people need to understand that. So how have we got here and what is the truth or what is the greater truth? K? And the reason I say what is the greater truth, this is another myth that we need to bust for people listening to kind of try and get cut through the confusion. The first thing is we have to understand, the public needs to know, doctors even need to know this, Medicine is not an exact science.
It's not even close. It's an applied science. It's a science of human beings. It's a social science. It's constantly evolving.
Right? We were also taught at medical school by the founding father of the evidence based medicine movement. Half of what you learn will turn out to be either outdated or dead wrong within five years of your graduation.
Dr. Mark Hyman
And we can't tell you which half.
Dr. Aseem Malhotra
And we can't tell you which half. So you have to learn to learn in your own. Right? But how many doctors have got the time or the skill to try and cut through, you know, all the stuff that they're getting through medical journals, looking at independent evidence, and then, you know, being able to try and get to something that a level of information that they can utilize for really benefiting when helping their patients. So it comes down to informed consent.
And for me, 1 thing that, you know, I think it was Mark Twain that said that truth often lies in simplicity. And the most elegant analytical framework we have for teaching and practicing medicine is called the evidence based medicine triad. Right? Published in the BMJ in 1996. I love this.
It's beautiful. I put it up in my talks. It's 1 of the first slides, and I say, listen, this is the most important side of my talk. If you get this, you can probably not not only understand why our health is going the wrong direction, but you can probably explain most problems in the world as well. Right?
So what does that mean? Okay. In the middle of the of the triad, our role as healthcare practitioners, as doctors, is to improve patient outcomes. Manage risks, treat illness, relieve suffering. How do we do that?
There are 3 inputs. Our clinical experience, our knowledge, our, you know, intuition as doctors over many, many years the best available evidence on a drug, on a lifestyle, on a surgical intervention, on ordering a test and last but not least, David Sackett said, taking it into consideration individual patient preferences and values. Right? That's where the informed consent comes in. So what's the problem?
What what are the limitations? Why have we not really, advanced evidence
Dr. Mark Hyman
based medicine? You know, we we that's really I just wanna double click on that too because when we hear evidence based medicine, what it usually is interpreted as is only what the science says, not what the patient is experiencing or what the clinician expert understands from their decades of experience, which are part of the evidence based trial. %. And that's really the failure here. And evidence based medicine is held up as this holy kind of idol in a sense that we that we bow to.
But often we kind of think misinterpret what it means. And I think your your explanation of it is is is really important because it's not just what the data show. It's also which data and who funded the data and and what wasn't studied. And the absence of evidence is in the evidence of absence. So there's a whole bunch of stuff that's going on.
Dr. Aseem Malhotra
So then you pick up so so then the next stage is, okay. So if you accept this as a a pretty solid framework for improving patient outcomes, it doesn't take a rocket scientist to figure out that if there's anything wrong with 1 or all of these, at best, you're gonna get suboptimal outcomes, and at worst, you're gonna do harm. So in terms of these inputs. Right? So if we just take the best available evidence and I've just said, already, John Ioannidis, okay, most publishers are finding their faults, etcetera.
You know, you've got Richard Horton, editor of The Lancet, in 02/15 writing an editorial saying that possibly half the published literature is simply untrue. It's not just John Ioannidis saying this. So you've got all these fact so so what happens ultimately is doctors invariably are making clinical decisions for patients unbiased, not saying completely false, biased and corrupted information, which invariably will exaggerate the benefit and safety of those drugs because that's in the interest of the drug industry who wanna get as many people taking them because their only interest is profit. They're not here to give you the best treatment. So once you acknowledge all of that, then it's for me, and as a cardiologist and as an expert who has spent a decade
Dr. Mark Hyman
really But I would I would challenge you. I think I think I think a lot of people, it's like the Truman Show. People in the system, it's like the Truman Show. They think they're in this perfect world and that they're doing good. And I think they're good people, and they're trying
Dr. Aseem Malhotra
to do good.
Dr. Mark Hyman
They're not deliberately trying to harm people. But they can't see what they don't see because they're in this sort of almost Very
Dr. Aseem Malhotra
good point, Mark. And actually, you know, the way I would just summarize that is medical knowledge is under commercial control, but most doctors don't know that. Right.
Dr. Mark Hyman
That's right.
Dr. Aseem Malhotra
That's right. And, and that's what we're trying to sort of get them to think outside the box because, again, I 100% agree with you. Most healthcare professionals, most doctors genuinely wanna help their patients and are well intentioned. And actually, you know, I'm very proud of being a doctor because I think of all the professions, I know things are changing and we have to protect our profession. I think we are people that actually have some of the strongest ethical principles, right, when it comes to how we, you know, do our jobs.
And we have to. And we're held in that esteem because of that reason. So for me, trying to break out of that conventional paradigm happened because I came came to realize that the information that I believed as being gospel truth as a medical student, as a junior doctor, it's published in a medical journal, it's science. Right? Didn't question it.
I then came to realize that, hold on a minute. There's a lot more to this. And I used, of course, the, you know, the heart disease paradigm to understand why we hadn't curbed heart disease, even though it was predicted by Nobel Prize winners Brown and Goldstein, I think, in the who discovered the LDL receptor was involved in, you know, coronary artery disease. They predicted the end, the eradication of heart disease may completely end by the
Dr. Mark Hyman
Didn't happen. It's still the number 1 killer on
Dr. Aseem Malhotra
the planet. And despite this vast prescription of statins. Right.
Dr. Mark Hyman
Despite more and more people are getting heart disease, but less people are dying from it.
Dr. Aseem Malhotra
Is that accurate? Correct.
Dr. Mark Hyman
Because we have better management. We can deal with risks.
Dr. Aseem Malhotra
We can 3 reasons I can tell you, big low hanging fruit. Why have we got less death rates from heart disease? If you were a smoker, your mortality rate increased fifty percent. We've smoking reductions played a big role. Emergency treatment in specifically in in the acute setting of an acute heart attack stenting or thrombolytics, which we used to use.
Dr. Mark Hyman
Right? Like clot buster.
Dr. Aseem Malhotra
But the third one, which, the Bernard Lau, pioneer in cardiologist, got the Nobel Prize
Dr. Mark Hyman
for Yeah.
Dr. Aseem Malhotra
Was the defibrillator. Yeah. Right? So what used to happen in patients who would be admitted to hospital with a heart attack, In the first twenty to four twenty four to forty eight hours after having a heart attack, you're most vulnerable to having a cardiac arrhythmia that causes you to have a cardiac arrest. Right?
And patients would die. They develop coronary pain.
Dr. Mark Hyman
They're better at saving people after they've had a problem.
Dr. Aseem Malhotra
Completely.
Dr. Mark Hyman
And that's kinda why there's less less deaths.
Dr. Aseem Malhotra
Hundred percent. It hasn't well, so the next question is people think, oh, must be statins as well. Well, paper in the BMJ, a few years ago, looked at millions more people taking statins in Europe over a ten year period to see, was there any reduction in cardiovascular mortality in Europe because millions more people were taking statins? And they found there was none. None.
0. No change. But how you can actually explain that, Mark, because 1 way of looking at the statistics, looking at industry sponsored trials, which we've already alluded to, should be taken with a grain of salt because they are best case scenario. They're curated information.
Dr. Mark Hyman
Or a tab of butter, maybe?
Dr. Aseem Malhotra
Well, actually absolutely. Butter would be better. We we might need to come back about a butter story and me being hauled into a medical director's office to talk about butter, by the way, when I busted the myth of saturated fat and heart disease. You know, when you look at the data from industry sponsored trials and you look at the statistics that looks at the average or median increase in life expectancy over five years, right, in the highest risk groups where there is a a greater benefit, the median increase in life expectancy over a five year period in the person that's had a heart attack, right, and say in their fifties, just over four days.
Dr. Mark Hyman
Now So wait. We just have to back that up for people. So there's 2 kinds of treatments for for cholesterol that are happening. 1 is we call primary prevention. You've never had a heart attack, but your cholesterol is high.
Your doctor will give you a drug like a statin. Yeah. Then there's secondary prevention, which means you already had an event, and it's trying to prevent a second event. And that's what you're just talking about. If you Absolutely.
Already had a heart attack and you take a statin, it shows that you'll only live an extra four days?
Dr. Aseem Malhotra
Yeah. If you look at the median increase in life expectancy in that group, another way that we use in medicine when we talk about informed consent or I call it ethical, very controversial topic, ethical evidence based medical practice, Mark, which means true informed consent, which means telling patients the numbers needed to treat or their absolute individual benefit. And you look at the totality of evidence. I know there are lots of studies we can talk about, but for me, it's about what does the totality of evidence tell us. Right?
Yeah. And there's a great website which is independently evaluated by doctors, and it goes through peer review in the 1 of the, family physician journals in in The US called the nnt.com, numbers needed to treat. People look it up. It's great.
Dr. Mark Hyman
What that means, everybody, is how many people you need to treat with a certain drug to get a benefit.
Dr. Aseem Malhotra
Yes.
Dr. Mark Hyman
If you have a bladder infection or strep throat and I give you an antibiotic Yeah. It's, you know, pretty much a %.
Dr. Aseem Malhotra
Like Absolutely.
Dr. Mark Hyman
It's like you need to treat 1 Yes. Person to get 1 person better.
Dr. Aseem Malhotra
Yeah.
Dr. Mark Hyman
Or maybe if they have a resistant antibiotic, it's 2. Right?
Dr. Aseem Malhotra
Or you take paracetamol for a headache, it's like one in two. So it's like 2. Right. You see 2 people, 1 will get their headache completely.
Dr. Mark Hyman
Oh, with the steroids, you need to treat eighty nine people for five years to prevent 1 heart attack?
Dr. Aseem Malhotra
Yeah. So it's actually so so I know this stuff inside out. So if you've had a heart attack already, let's say the high risk group, you have to treat eighty three people over five years for 1 to have their life saved or life prolonged. Right? Okay?
And for preventing a further heart attack, one in thirty nine. Now most people around the world, Marco prescribed statins are not in that group. They are in the either low risk
Dr. Mark Hyman
seventy five percent, right?
Dr. Aseem Malhotra
Yeah, exactly. Low risk or what we call high risk primary prevention. Now the benefits of a statin over a five year period in that group, at best, is one percent in preventing a nonfatal heart attack, a non disabling stroke, okay, but without prolonging your life by 1 day.
Dr. Mark Hyman
So essentially, you if you if you've never had a heart attack and you have high cholesterol and you take a statin Yep. It won't prevent you from it won't prevent 1 single death. It will It won't prevent a heart attack.
Dr. Aseem Malhotra
Yes.
Dr. Mark Hyman
If a hundred people take it on 1. It'll prevent 1 heart attack. So ninety nine people taking it for five years will have no benefit.
Dr. Aseem Malhotra
Yeah. So this again comes back to now this is just my opinion. It's like, oh, is it Seymour Hodge just cherry picking statistics here? 02/9, the director of the Max Planck Institute in, for health literacy in Berlin, okay, this is the same institution that that Einstein taught and trained in, brilliant guy, He wrote in a WHO bulletin 02/9, it is an ethical imperative for every doctor to understand the difference between absolute risk reduction, the numbers needed to treat, and relative risk reduction. And he said to protect patients from unnecessary anxiety and manipulation.
So in other words, I paraphrase this, if you have that information, and again, most doctors are not trained this way, Mark. This is a problem. You should use it and tell patients, this is what I do. And I I the patient comes in, he's like, should I take a statin or not? I said, well, let me just let let me empower you with the information and tell me what you think.
Most patients with the one percent thing think, hold on a minute. I don't think that's that great, doc. And then they'll say, well, is there anything else I can do? And, of course, you and I are empowered with
Dr. Mark Hyman
Right.
Dr. Aseem Malhotra
The understanding lifestyle. Right? So this is what how we should be practicing medicine. But, Mark, one quick thing is that I didn't just talk about this. I wrote about it, and I even got this in front of every Royal College president in The UK saying that the British Medical Journal were doing this campaign, it's too much medicine.
They're talking about informed consent by use of entities. We need to launch a campaign because over prescription is a big problem. We know there's a big problem with side effects. We know that 1 estimate suggests that prescribed medications is the third most common cause of death after heart disease and cancer globally because of side effects. It didn't take long for me to convince the Royal College presidents.
I was an ambassador for the overall academy of Royal Colleges at the time and to say that we should have a joint campaign with the BMJ. So I then wrote a paper. I was lead author. I had the chairman of the General Medical Council, the chairman of the medical colleges on that co of the paper to say, okay. This is a campaign we can get and change medical education, change postgraduate medical ed training.
And we got there. It's in the media. It was a big news story. BBC, all over the news, front page of British newspapers. Campaigns obviously need to be sustained.
But what happened is, of course, if you engage in true informed consent with patients, most patients will choose less treatments. Now who's gonna suffer from that? The drug industry. They in my view, it's very clear. It's not a conspiracy.
This is clearly how they do business, and this is what they wanna do is they wanna, they they engage in a tactic called opposition fragmentation. Anyone that threats threatens their, their bottom line, they will do smearing. They will do all these things behind the scenes. There's there's a whole documented history of it. Oh, I'm
Dr. Mark Hyman
a bad guy. If you Google me, you'll find many groups that are attacking me like the American Council on Science and Health, which sounds great, but it's actually a front group for pharma, big food, and big ag that think trans fats, pesticides, smoking, and, you know, glyphosate are all healthy for you. And I'm like, okay. And if they they come up with something very, you know, airy diet and smart
Dr. Aseem Malhotra
So you've experienced it
Dr. Mark Hyman
more. Right? Mobile guy. Right? Science based medicine, American health and science and health.
I mean, quackbusters, quack watch. I mean, I I I've I've been there all all through it. And
Dr. Aseem Malhotra
You get it.
Dr. Mark Hyman
I totally get it. And I actually I I find a badge of honor, you know? It is.
Dr. Aseem Malhotra
Well, no. So actually, in a way it is. Although, you've gotta grow a thick skin. Right? Because, you know, 1 of the lessons in public health advocacy done by written a great paper written by Simon Chapman who took on big tobacco in Australia and talks about his thirty eight year career in taking on big tobacco.
He says, as soon as your work threatens an industry or an ideological cabal, because it's also about this is about mind. It's not just about money. It's about indoctrination in the brain. Right? As soon as your work threatens an industry or an ideological cabal, you will be attacked, sometimes unrelentingly and viciously, so you have to grow a rhinoceros hide.
Yeah. Right? So for me, what happened after that is there was I kept pushing this this message, but they then behind the scenes, Royal College physicians, I think, funded by pharma some scientists funded by pharma, started making complaints to the Academy of Medical Colleges where I was 1 of their ambassadors for seven years. Yeah. Right?
To say, this guy's got his own agenda. He's exploiting people for his own agenda. He's trying to make money off all all nonsense. And that and that was so relentless that they then, I in 02/18, I got an an email from the the new chair of the Royal Colleges saying that the campaign that I had started or was that they had took on and instigated, that I was no longer part of that because of of of stuff that I apparently said publicly on statins. Even though everything in the newspapers that was written about statins for me was coming from medical journals, and I was a very strong advocate for informed consent.
But, again, this is
Dr. Mark Hyman
accuse me with the facts. My mind's made up. Well, exactly. Exactly.
Dr. Aseem Malhotra
Yeah. Exactly. So this is what they do. And, of course, it does have its personal toll. And then it culminated coming back to where we started is that because we were having an effect, Mark, and, of course, you're absolutely doing the same thing, 1 of my inspirations, right, revolutionaries, Mahatma Gandhi.
And 1 of his quotes, which I love, is, you know, and he took on the system. I mean, he got British colonialists out of India, I mean, almost single handedly. And he says, First, they ignore you.
Dr. Mark Hyman
Britain was bigger than the pharma companies. Yeah. Oh, it was.
Dr. Aseem Malhotra
Absolutely. I mean, America was founded on anti corporate sentiment taking on the British East India Company. Right? It was a it was a big corporate tyrannical system, and now we've come back to the same problem right now. But what he said was, first, they ignore you, then they laugh at you, then they fight you, then you win.
Dr. Mark Hyman
Yeah.
Dr. Aseem Malhotra
So when you're getting attacked, you're getting you're over the target and you're closing to you're getting closer to winning. But you have to it's it's tough. It's tough.
Dr. Mark Hyman
So let this so so essentially, this is interesting legal case that we started out with has sort of indicated that you and your colleagues were speaking truth to power. Yeah. So let's get into the details here because everybody is listening going, yeah. Well, my doctor checked my cholesterol, and my LDL is high, and they recommend a statin. And like we said, it's the number 1 prescribed drug in the world.
Yep. Seventy five percent of the prescriptions are for preventing heart attacks if you've never had 1. It's called primary prevention, and there's very weak data to show that that actually works, especially for women, especially for over a certain age. Yep. There is benefit for people who've had a heart attack, no doubt.
It's not like taking an antibiotic for a strep throat, but
Dr. Aseem Malhotra
there
Dr. Mark Hyman
is a benefit. 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 1 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 look at the facts.
So the question I have is, how did you go from being a trained cardiologist who believed in statins to 1 who started to question statins to 1 who's come to understand that our approach to cardioblasties 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 has heard if their cholesterol is high to take a stat. Sure. And if statins cause side effects, which they do for a lot of people, probably twenty percent get some muscle damage or some symptoms or increase the risk of diabetes.
You know, we'll talk about that data. There's still there's still a huge drive in our society for prescribing these and globally.
Dr. Aseem Malhotra
Yeah. Absolutely. So my interest in this came from really looking at the initially, the obesity epidemic. So 02/4, announced it as an epidemic. You know, by 02/10, I was then nine years qualified as a doctor.
I was a specialist registrar in my cardiology training. I was seeing more people 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. And 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? And I never thought that would happen. And and ultimately, that 1 of my own my 2 of my own pay 2 of my parents both basically died because of failures in the system because the system's under so much 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 1 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 in The US and 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 Yeah.
Dr. Aseem Malhotra
Which I
Dr. Mark Hyman
we sort of unpacked the whole history of how we got this low fat craze Yeah. 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, just appetite and some agglutide or Zempic and Majara. It's kind of crazy. Right? It just kinda flipped it upside down.
Dr. Aseem Malhotra
Oh, absolutely. So so when I looked at that, it's like looking at the data and spending years and 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 02/13 called saturated fat is not a major issue.
Dr. Mark Hyman
Right? I 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 do statins work?
But I knew statins had a 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 Kiel 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's starting from. The lower your cholesterol, the better. In fact, 2011 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 heart disease. That's
Dr. Aseem Malhotra
frightening. Like, really? So, okay, I had to unpick that. And and and what I what I also then did moving forward from 02/30 so that's how I got down this track, realizing that our obsession with LDL lowering has has been a problem.
Dr. Mark Hyman
So you looked at the saturated fat literature and you weren't impressed, and data showed that it didn't seem to be
Dr. Aseem Malhotra
Both observational data and randomized controlled trials. No benefit. Like in lowering it, no association, nothing. Right. Right?
And 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 have been protective, like some of the dairy fat.
Dr. Aseem Malhotra
Well, we don't 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 hypothesis
Dr. Mark Hyman
By the way, you're not alone on this. I mean, there was a major paper published by Daresh Mazafarian from Tufts and others looking at butter and Yeah. So actually showing that there really wasn't evidence that it was
Dr. Aseem Malhotra
So 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. It all came together. So then everybody's like, you know, I know and at the time, I was I was writing this to a commentary, which is peer reviewed, but I could've got it wrong.
I could've. Yeah. But I was like, you know what? There's enough here that for me to need 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 a cholesterol risk factor
Dr. Mark Hyman
for heart disease?
Dr. Aseem Malhotra
So you have to go back to square 1. Right? So these are the Framingham studies that, you know, started in Massachusetts in 1948 and went over decades looking at thousands of people where a lot of risk factors emerge for heart disease, whether it's diabetes, high blood pressure, smoking, for example.
Dr. Mark Hyman
Now High cholesterol.
Dr. Aseem Malhotra
And high cholesterol. Right? So you go and look back at the Framingham studies, and what and and the just to summarize it without complicating the situation too much, William Castelli is a cardiologist, and he published, he was a co director of Framingham. And in 1996, he published in 1 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 was above 7.8 millimoles, which by the way, I think in your units is probably two fifty or 300. 2 50 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.
LDL. Now 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 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 2 cardiologists did a systematic review of the totality of drug industry sponsored trials, by the way, and some diet trials, but mainly drug industry sponsored trials. All of the randomized controlled trials on cholesterol lowering drugs, statins, PCK 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
Dr. Mark Hyman
Yeah.
Dr. Aseem Malhotra
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
So why do we all so
Dr. Aseem Malhotra
firmly believe So does that mean stat but then I said, well, of course, statins have a role. They do have a benefit from the 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 one in a hundred people get type two diabetes because of statins.
Dr. Mark Hyman
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, if 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 McDonald's. It's fine. And they they eat and they're they're getting more and more overweight, more insulin. 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 1 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, 1 of the most important things you need to know about your, yeah, biomarkers.
And he was, like, less than 1%. And 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 l p little a, including something called Apo b Yes. Which I wanna talk to you about. 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 1 of the studies that was so interesting to me was, actually from, I think, Scotland or Ireland was where they looked basically a a a 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 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 No. LDL elevations.
Dr. Aseem Malhotra
Yeah. Well, something else to throw into the picture. Right? So you can make the argument, okay, doctor Malhotra, you're saying there's no consistent relationship. There may be a benefit.
Why not just lower your LDL? Okay. So 02/16, and the reason we did this, me and a number of international scientists looked at we decided to do a systematic review of observational data looking at people 60. Was there a relationship with LDL cholesterol and heart disease? And the reason we did this, by the way, is 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 and both sexes. Right? For mortality.
For mortality. Yeah. But even for heart disease as well. Right? 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 words, 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. Mhmm. 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. Yeah.
Dr. Mark Hyman
I mean, I think I think
Dr. Aseem Malhotra
the the the problem with this data
Dr. Mark Hyman
though is, and I'll just push back a little bit, is it's observational data. And the data, like, from the Hawaii study show that, you know, the you are older and you have higher cholesterol, you know, you're more likely to live longer than if your cholesterol is lower.
Dr. Aseem Malhotra
Yeah.
Dr. Mark Hyman
But it may be because the people who have low cholesterol are malnourished, have cancer, and other reasons.
Dr. Aseem Malhotra
Thank you so much. 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 look 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, but not for the reasons we think.
Dr. Aseem Malhotra
Meaning they
Dr. Mark Hyman
lower inflammation and they may have other properties that may be beneficial. We don't even know what we call this pleiotropic effects. So they, for example, they induce nitric oxide synthase, which dilutes your blood vessels and reduce inflammation and helps your lining of your blood vessels. All that's protective. And so it may be a stabilizes plaque.
It may help in those ways, but it may not be the LDL lowering effect. In fact, Paul Rittger from Harvard, 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 a 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 a number of twenty years ago. I remember reading it by Paul Richter and and his crew that really laid out how heart disease is not a plumbing problem. It's an immune problem.
Hundred percent.
Dr. Aseem Malhotra
It's a chronic inflammatory process exacerbated by metabolic risk factors or insulin resistance. And I wrote
Dr. Mark Hyman
it before. Risk factors. By that, you mean problems with your blood sugar and insulin Insulin resistance.
Dr. Aseem Malhotra
And prediabetes. Yeah. Hundred percent. And, actually, we published an editorial with 2 cardiologists I did in British owned sports medicine in 02/17, which was a very long title, but it got a lot of publicity in 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. And it wasn't just doctor Malhotra, his opinion being controversial.
The 2 my 2 coauthors were both editors of medical journals and cardiologists. Louise Redberg, editor of JAMA Total Medicine, and Pascal Meyer, editor of BMJ Open
Dr. Mark Hyman
Art. 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 being tyrannical. 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 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 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 already calling the shots. 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
That's hard. I mean, listen, you know, I practice medicine. I've seen patients. You're busy. Like, I literally had to slot myself in a room, you know, download every paper on this, read it carefully myself, synthesize it all, try to make sense of it, and it's still confusing.
And I wrote a whole book about it. And it's, you know, call you fat get thin. And I think it's it's still hard. So the average doctor doesn't have time to kind of do that. They kinda take it face value when they get taught in their training, and they try to look at the evidence the best they can.
But also they're looking at at sort of biased evidence that is published. Absolutely.
Dr. Aseem Malhotra
Absolutely. And then, of course, there's a psychological side of it as well because as human beings, you know, they say changing one's mind is 1 of the most, you know, emotionally traumatic things a human being can go through. Right? And that's where you need humility. Right?
John Kenneth Calbraith, the Canadian American economist said, faced with a choice between changing one's mind and proving there's no reason to do so, almost everybody gets busy on the proof. Yeah. So what for the medical profession, we need to have also more humility. I mean, 1 of the interesting like, there's a there's a great, there's a great YouTube, channel called AfterSchool, which I watch a few times. It's brilliant.
It goes through, like, ancient wisdom and philosophy and psychology. And it says, 1 of their titles, you should look this up, Mark. You'll love it. Why do intelligent people believe stupid things? And And the answer is?
And well, because, our intelligence evolved not for seeking objective truth, but more about belonging to a tribe, you know, for personal gain, whatever else. So what is what do we need to break out of that? There are 2 characteristics in the human being that are most important for you to think outside the box and be willing to change your mind and not being afraid of it. 1 is humility, and the other 1 is curiosity. So ultimately comes down to character.
And we've got a system over the years that has become more and more corporatized. Right? You have in America, suddenly, you know, and I consider this my honestly, I'm I'm I'm, you know, I, I consider America my second home. So I have a lot of love for America and the American people because I have relatives here and I've been here a lot. But you have now the highest healthcare expenditure in the developed world, over $4,000,000,000,000 with the worst health outcomes.
Oops. Right? So what's happened is, you know, because of all of this situation around corporate capture. So, you know, the the counter, of course, from a philosophical point of view is that living a a life in darkness has no meaning. Yeah.
And we need to get people out of the of this darkness to understand the root of the problem, and then we can then start
Dr. Mark Hyman
making sure that You have to take time to think and learn. I mean, John F. Kennedy said we enjoy the comfort of opinion without the discomfort of thought.
Dr. Aseem Malhotra
And I
Dr. Mark Hyman
think it's hard to kinda sort through it all. I mean, I found it very hard. You know, I I just sort of reflect back on some of the data that I I uncovered as I was sort of researching this, and it was just 1 very large study showing that that, it was, I think, two hundred and thirty one thousand people in 541 hospitals that had had a heart attack. And it was looked at over a six year period, and they looked at cholesterol lipid levels for everybody. They found that seventy five percent of people who had a heart attack had, quote, a normal LDL under one thirty, which is what's considered normal.
Fifty percent had optimal levels Yep. Under a hundred. 17 percent had super optimal levels under 70. But what they did found was really interesting, and again, it confirms this whole metabolic hypothesis of heart disease that it's really related to mostly insulin resistance, that those with low HDL and high triglycerides, which goes along with small dense cholesterol particles, were much at a high risk of having a heart attack. And so in fact, the average HDL in that group was 39, which is should be ideally over 50, and the average triglycerides was 160, should be probably under 100, ideally under 70.
And it didn't really seem that that LDL was really the driver. It was the triglyceride to HDL ratio. It was the triglycerides and the HDL, and it was what is what we generally call an atherogenic Yep. Lipid profile, which is not just about the total number of cholesterol or the LDL number. Yep.
It's about the the quality of your cholesterol, which is the size and number of the particles. And the smaller dense particles are the ones that are more putting you at risk. And those are the ones that are caused by sugar and starch, not fat. Fat fat actually improves the size of your lipid particles.
Dr. Aseem Malhotra
Yeah. No. Fascinating. And and it makes sense. But also interesting, something else that I came across in the last few years, which you'll find fascinating, Mark, and I don't know if you know this.
David Diamond, who's a cholesterol researcher, published a paper, I can't remember which journal it was in, very recently, and they looked at the primary prevention randomized control trials done by, obviously, by the drug companies and secondary prevention trials. And subgroup analysis found so these are people with statins who had neither either were high risk of a heart attack or had a heart attack. In the patients in the trials that had normal triglycerides and HDL, no benefit at all from statins. Think about that.
Dr. Mark Hyman
So if your triglycerides and HDL were good
Dr. Aseem Malhotra
Even people who've had a heart attack, there was no benefit from the statin at all, which which fits with what you just said.
Dr. Mark Hyman
And it's kinda interesting because, you know, you get the benefit in some ways of inflammation protection, but you also get increased insulin resistance.
Dr. Aseem Malhotra
You do. And, of course, we haven't even talked about side effects, and that's another issue. Right? So if you look at you know, to try and explain why there's no reduction in cardiovascular mortality even if we expect accept a four day increase over five years in high risk patients, 1 of the my explanations is this. In the real world, at least fifty percent of patients prescribed statins, even in high risk groups, will stop taking it within a couple of years.
And when you do surveys, most of them say they felt they got side effects. Muscle fatigue, muscle pain, brain fog, erectile dysfunction. And how prevalent That's a big Well, how prevalent is that? And you look at the data and it's mixed, but anything from in my experience, anything from twenty to fifty percent of patients at some point I've I've had patients who took statins for twenty years and then get side effects for twenty years, and then he got side effects and it gets better when you stop stan. So they're they're very prevalent.
I wouldn't say they were serious or life threatening, but, you know, the question I ask the patient always, does this interfere with your quality of life? Right? And it's very simple. You know that as a person. It's a very subjective answer.
Yes or no. If it does, we need to do something about it. Because listen, we're all gonna die at some point. What we want to live our lives in the best health we can for as long as possible. Right?
That's the in in many ways, that's probably more important than our longevity. Right? It's having good quality of life. So that is something that I, address with patients as well.
Dr. Mark Hyman
So if you're gonna sort of cement the argument and sort of argue the other side, how would you argue against yourself for this? Because, you know, I've had these conversations with cardiologists, with experts, and they're like, listen, the data is just so strong about statins, and
Dr. Aseem Malhotra
there's
Dr. Mark Hyman
no question that they lower risk, and there's no question they're a benefit. And yes, there are side effects. It can cause mitochondrial injury. It can cause muscle pain. It can cause, insulin resistance, but the trade off is worth the risk.
And and the data is so prevalent and so strong and so clear that we should all be taking sense.
Dr. Aseem Malhotra
I think I think, you know, the arguments to be made on interpretations of the evidence, trust in the evidence, and different bits of evidence. So all I can say, Mark, for me, is that we all have our biases. And you could argue that I have a bias because I have an obsession with lifestyle, and I'm a foodie, and I started cooking when I was 16. I was taught by my dad. And, you know, I I 1 of the reason I got annoyed or pissed off in the hospital and got into this whole my campaigning started about hospital and just, you know, why are we giving junk food to patients?
Because I also, as a doctor, was, like, frustrated. I can't get any healthy food anywhere. So that could be my bias. Fine. But, and I accept that.
1 of the things I do myself, and I think the reason I've been through a process why I've had to change my mind several times on saturated fat, on sugar, on low fat diets, on statin prescriptions, on cholesterol, on something more recent and more controversial, which we're not talking about, is you have to have an element of humility. But when I do that, my analysis myself, I try and counter my own arguments and then try and find a way of a nuance. I can't really see a strong counterargument, and I'm not saying this from a place of hubris, because okay. Let me give let me give you 1 argument. So so if and this is a hypo hypothetical.
If statins didn't have side effects or they were almost nonexistent, I could actually say put them in the water supply. Because even if, you know, there is a concept in medicine, you've got to treat the many to benefit a few. So let's just say that they save lives in, I don't know, on average, say one in three hundred people are gonna live longer because of statins. Right? It's
Dr. Mark Hyman
a public health.
Dr. Aseem Malhotra
Yeah. For public health. So, you know, put in the water supply. You know? Give to 3000000000 people.
We're gonna are gonna have you know, you're gonna save one in three hundred of those 3000000000, you know, whatever that is.
Dr. Mark Hyman
It's a lot of people.
Dr. Aseem Malhotra
It's a lot of people. Yeah. It's it's tens of millions of people at least, not hundreds of millions. So, you could make that case. But that isn't true though.
That's just simply not true.
Dr. Mark Hyman
Yeah. If there were no side effects.
Dr. Aseem Malhotra
So so so I am very for, you know, and that and that is an argument that has been put forward and the issue
Dr. Mark Hyman
about there's marginal benefit.
Dr. Aseem Malhotra
Yeah. But I'm saying that if you it's a it's a public health intervention that doesn't have any downside. But but if it doesn't have any downside, that's fine. Then go for it. Put it in the water supply.
But unfortunately, it does. And that Yeah. That's simply just not true. So therefore, you then have to then talk about, you know and and some of the doctors come from a mindset, Mark, where they don't even they they and this is a different school of thought, but I I don't agree with it. It's not about agreement.
I mean, okay. Maybe it's my opinion. Is that they think that there should be an old school paternalistic practice of medicine. Doctor knows best, patient do what I say.
Dr. Mark Hyman
That's right. I'm a It's not working so good anymore.
Dr. Aseem Malhotra
I'm about I'm about shared decision making. I'm about explaining patients a way that that's, you know, in queue, that empowers them that I agree. It's a more equal relationship. You know? And that that's fine.
That's a maybe it's a philosophical disagreement, but that's the stance I'm gonna take, and I'm prepared to die on that hill.
Dr. Mark Hyman
I think that's right. I mean, I think, you know, we we we we have to sort of look at this at a high level. Like any tool, there is a use for statins, there's a use for the PCSK9 inhibitors, there's a use for the new CTP drugs that are coming out. There are people who benefit, and I don't think it's heterogeneous. I think we have to sort of and I've noticed this as sort of as a doctor's been doing this for forty years, not everybody's the same.
Saturated fat is fine for most people, but not for some people. Yeah. Right? Sugar can be tolerated more by some people, but not by others. I just came back from Utah and was in the Native American reservation, the Navajo Reservation.
It was just staggering to see the amount of obesity. I mean, you look at, you know, one hundred and fifty years ago, there wasn't a single overweight Native American. Yeah. Period. And and why?
It's because the metabolically, they're genetically, they're different. So I think I think, you know, I'd love to sort of explore who might benefit from these drugs because there's a class of people we we refer them as lean mass hyperresponders, where people like you and I maybe who are athletic, who are fit, who may actually have an adverse response to increased saturated fat in the diet, or who might have a family history, of lipid disorders and actually have some genetic issues, which I do in my family. So how how do you sort of handle those cases?
Dr. Aseem Malhotra
So I deal with those actually quite regularly. So interestingly about the saturated fat, I think you're right, Mark. There are definitely a subgroup of people who have more who have very high saturated fat intake. Actually, it does affect their inter resistance or make their triglycerides go up. And in fact, there was a paper done by I think his name is Ronald Craft, if I'm not wrong.
Ron Krauss. Ron Krauss. Sorry Krauss. You're right. Yep.
And he showed and he showed there was an abnormal effect on lipids if your saturated fat consumption in this, obviously, certain groups was more than 18% of your total calories. Right? It's still very, very high. But, again, that you're absolutely right. That might happen with a with a certain subgroup of people.
I've seen, for example, a patient on a carnivore diet who actually had something like that. And when they when they reduced their saturated fat intake, their lipid profile got better. That's all they changed. So I agree with you. There are gonna be a subset of people.
What do you do with FH? The people with the familial hyperlipidemia. So let's just lay it out for people. Right?
Dr. Mark Hyman
And I think there's more than just that 1 subtype. There's many different types of genetic lipid disorders Of course. That I think we're just starting to figure out.
Dr. Aseem Malhotra
There there are. But, you know, you talk about ApoB and lipoprotein little a, which are all these other extra markers of risk that are added in. Basic teaching in medical school, certainly what I teach medical students and junior doctors. Right? Don't organize a test unless it's gonna change your management plan.
Mhmm. Right? Because what's the point? So you create unnecessary anxiety, for example, for some people. Now I get it.
People may wanna know, and if that's what they wanna know, that's fine. But, you know, the the and we'll come on to management as well. If you're not gonna add in a statin or whatever else, then okay. Maybe those people need to be more extreme in the lifestyle. Maybe that's a reason to do it saying you need to be like, instead of meditating for thirty minutes a day, I want you to meditate for an hour.
Right? And then fine. I mean, maybe that's what the best we're gonna offer them. Right? Yeah.
Yeah. To to to keep the risk down. So we've gotta just be a little bit careful about how we about ordering these tests and then but but thinking a little bit more about, okay, is it gonna change anything? And am I just gonna give this patient unnecessary extra anxiety? And I'm Listen, I'm a doctor.
Doctors are the worst patients. I probably have, partly because my dad was the same. I I I have moments of being a hypochondriac. And I know on the receiving end, like, you know, tests that are done but didn't need to be done. And then now I'm like, okay, what does this mean?
And you're going down a rabbit hole. So we've gotta think about that as well, right, in terms of if you haven't got a clear solution, then then don't order the test. I'm not saying don't do the test, but I just want us to think about that a little bit.
Dr. Mark Hyman
I I it's true. We learn that in medicine. I'm not sure I have the same view because I think that that that the more data you have, the better you can make sense of what's going on. And I think there's a movement towards this deep phenomics. I've had Jeremy Nicholson in my podcast, Leroy Hood in my podcast, and they're about more data and dense dynamic data clouds of information from your biomarkers, your metabolism, your microbiome, your genome, your transcriptome, and then all teach you about sort of subtle changes that may not represent a disease today, or they don't have a drug treatment today, but that if you left intended would ultimately lead to a disease or But but may not.
Or may not. But but I'd rather know if my insulin is going up over 10 way before I get diabetes. No.
Dr. Aseem Malhotra
I agree. So a %. I agree. There are definitely certain yeah. So I think there's a nuance there again.
There are certain things where we know, okay. There's a very likely benefit here of you getting your insulin down, etcetera. I think some of the other biomarkers is still in a certain, you know, ear area. But, again, Mark, you said that, okay. You're a guy, and this is if I was having a conversation with you and this is your preference of values, you want the data.
That's your preference of values. I wanna know more and more and more, and that's fine, Mark. I'm gonna help you, and let's do all these tests for you. Yeah. Somebody else comes in, you know, and then suddenly they come back.
And and the thing is, I see this this is what happens with the whole cholesterol hypothesis. Right? I've got patients coming to me for a second opinion as a cardiologist. I do, you know, international consults and virtual and whatever else all around the world. And they and and I talked to them, and I just started to tell me what's been going on.
And they they they've been living in absolute fear of death for months. And some of them break down in tears when I just say to them, listen. I've just done a cardiovascular risk here. Your LDL cholesterol is so called high, but it's not an issue, and you're fine. And your risk is only two percent.
And you can just see a sigh of relief and say, doctor, thank god. I've been going on thinking that I'm then that's again misuse, not good use of maybe numbers or statistics. I've been going on thinking that I've got in the next five years, there's an eighty percent chance I'm gonna die of a heart attack. I'm like, no. It's two percent in ten years.
Right. Right. Right. Right. So so there's also that as well.
So I do think we need to think a little bit carefully on it. But go back to FH. FH affects familial hyperlipidemia, genetically very high cholesterol. Okay? Fifty percent of men and seventy percent of women, right, with FH untreated, big numbers, will not develop premature heart disease.
But thirty percent of women will, and fifty percent, which is a lot, will A lot. Yeah. Even before maybe fifty or sixty will get heart disease. So I did actually a review paper with with a number of international scientists as well, and we published it in BMDA evidence based medicine. And we thought, okay.
That's interesting. Fifty percent of men with FH, familiar with hypnothermia, very high LDL, don't get heart disease, and fifty percent do. Is there anything we can find that's different between them that highlights the subgroup? Like, what is the difference between them? First thing, was it the LDL?
Is the LDL higher in those ones that get heart disease versus the ones that don't? No difference at all. Ah, that's interesting. It can't be the LDL then. What is it?
Well, we found, and this is a marker you're gonna like this, 1 of the, lipoprotein little a was higher than the 1 that dropped heart disease. So FH, you should look at lipoprotein little a definitely. That gives them a high risk. But what's most promising and interesting is when you correct for insulin resistance
Dr. Mark Hyman
Yeah.
Dr. Aseem Malhotra
Right, it all their level of risk of heart disease for FH patients almost comes back to someone who's completely healthy. It's only slightly higher. So what were the two two markers? Normal waist circumference and low insulin. Yeah.
Now how do you get there? Diet. Right? Cutting out the sugar, processed foods, refined carbs.
Dr. Mark Hyman
That's right.
Dr. Aseem Malhotra
And it rapidly so this is amazing. So I could so what I do with those patients is I go through that with them. Now if I think they're actually the high low propylene, little a, and they're probably at high risk, I say, listen. The statin benefit is there. It's small.
But why don't we do a halfway house? High dose statins are more likely to give you side effects. Let's do a low dose statin. Let's do the lifestyle. The lifestyle's most important for you.
And I go really hard on that with them, including the diet, the exercise, and, actually, the the 1 that I think isn't discussed enough and, you know, it it comes out in my my documentary film. Which is called? First Do No Farm, p h a r m, not f a r m.
Dr. Mark Hyman
Oh, and how do you how do you find that?
Dr. Aseem Malhotra
We it's released online at the moment, and you can download it for for $10, and it's, the website is nofarmfilm.com. And the reviews have been, you know, pretty extraordinary. Nofarm? No farm film Com. P h
Dr. Mark Hyman
a r m? P h
Dr. Aseem Malhotra
a r m. Okay. Yeah. Yeah. Yeah.
Nofarmfilm.com. We screened it in in the Leicester Square Odeon in London, which is the most famous cinema in the world. Seven ninety people came. It was invite only, but celebrities. Really good feedback.
Screened it to doctors, integrated mental health conference in Washington DC. Really amazing feedback there. And so far, you know, we're getting reviews that are giving it sort of 9.7 out of 10, which is great. I'm proud of that. But most importantly, Mark, it is a it is in my view, this film uncovers, literally how we have got this pandemic of chronic disease, both with big pharma and big food capturing this.
We've got, you know, medical knowledge. We've got very credible experts, formats of the BMJ. We go into some dark stuff in there, just how many people have been killed by research fraud, but we also give people hope with the lifestyle stuff. And 1 of the most interesting things I discovered in the film or in my own research is that for me, pushing the boundaries on heart disease is also the next phase is can you reverse the blockages of coronary artery disease? And the only there's not a lot of research out there.
We know, of course, Dean Ornish did his trial many years ago, but the reversal was very, very you know, listen, at least very least it stabilized coronary disease, but it was like one or two percent in terms of blockages. Cardiology in India for twenty years has been reversing heart disease to the level where, you know, 1 of his papers that he published showed a twenty percent reduction within two to two years.
Dr. Mark Hyman
Of the of the narrowing the arteries.
Dr. Aseem Malhotra
Seventy percent became 50, 50 became 30. So he did it through this healthy lifestyle program. It was a they were devout Hindus, hundreds of patients, right, high fiber vegetarian diet, because they were devout Hindus, fine, two thirty minute brisk walks a day, okay, and then something called Raj yoga meditation. And when he did a a deep dive analysis into what caused a reversal, the only independent factor for reversal of heart disease was forty minutes of raja yoga meditation a day. So I went to India and I thought, let me just is this true?
Is this real? Let me look at the angiograms on myself. I trained in this stuff. I know this stuff inside out. It was unbelievable what I was seeing.
I've seen those patients. I've seen the angiogram reports. There was clear reversal. In some patients, there was a complete % occlusion that then opened up. Wow.
Right? So I think it's because you've turned down the chronic inflammation by getting on top of the stress, But it wasn't just about breath work and meditation. This comes into something that we are dealing with right now in society, which is, a crisis of morality. Okay? It was a spiritual transformation.
These people changed their mindset. They became less materialistic. They became more spiritual. They had thought how to reduce their anger. They were you know, he got them into the ashram with their wives, for example, the men, and and and vice versa, to talk about why were they getting more angry.
Like, how is your relationship? What's going on with your work? Yeah. It was a real spiritual transformation that reduced probably the stress. And I think that probably has a scientific basis because we know chronic stress increases chronic low grade inflammation.
We've talked about heart disease being a chronic inflammatory process. You turn down the inflammation, and the body can heal. The body has a capacity to heal itself.
Dr. Mark Hyman
So kind of kind of in wrapping up, you know, kind of what I'm hearing is that statins have a role, but they're not all they're cracked up to be. Yeah.
Dr. Aseem Malhotra
Just know just know are they right for you? Are you being told the absolute benefit is? And then what do you think? Like, you know, do you wanna take it or not?
Dr. Mark Hyman
And then do you have critiques of the way the research was done and how the studies sort of sort and sit through the statistics to show the benefit? Yeah. How it's reported as relative risk versus absolute risk. So if you get a risk reduction from three percent to two percent, that's a thirty percent risk reduction. Sounds great, but it's really a three percent to two percent.
Right? It's
Dr. Aseem Malhotra
1%. Yeah.
Dr. Mark Hyman
1%. And and, you know, there are there are flaws in the ways in which a lot of these studies are done. So could you sort of some of the big data that you kind of critique, can you sort of unpack that a little bit? Because I think we didn't dive deep enough into that. I I want people to understand this is not just sort sort of a heretical opinion, but this is what you're looking at, the way these studies were designed, the way they were done, what the data actually show.
So so
Dr. Aseem Malhotra
when they do the randomized trials where you're trying to compare 2 groups which are the same and you're trying to get show a benefit of of an intervention, What's reported in the results often underestimates, massively underreports the side effects because what the drug companies do, who control the how the trials are designed, how they're conducted, think about that. They're only interested in profit, not looking after you, so they will try and design the trials to maximize ultimately the sales of the drugs. They have what we call a pre randomization run-in phase where they get these volunteers who are interested in being the run-in the trial. And for six weeks, for example, 1 of the trials, the heart protection study, a third of the patients, thousands of patients were removed before the trial began because, of so called noncompliance. In other words, they got side effects.
So imagine, they take the people out with side effects at the beginning, and then they only start the trial once they've taken the people out with side effects to get them early on and then report. And then so that's probably 1 of the reasons they're massively underreported, the side effects. It's I'm sorry, Mark. You know, it's fraud. I'm sorry.
It's fraud. And and let me be definitive about how I describe that. What's the definition of fraud? Deliberate deception in order to make money. I'm sorry.
That's the way I interpret it.
Dr. Mark Hyman
Yeah. Yeah.
Dr. Aseem Malhotra
This is fraud. Yeah. Yeah. Right? The system is fraudulent.
Dr. Mark Hyman
No. Some some of the independent studies also show benefit.
Dr. Aseem Malhotra
Yeah. Well, the independent studies that have been done have shown very little benefit, but I I agree that I think there is a small benefit. But the question then is you also look at the side effects issue. And the independent studies have never been able to get hold of the raw data as well on statins. The totality of evidence around statins.
The raw data has never been independently evaluated for side effects. So we still don't know the true side effects for the while.
Dr. Mark Hyman
What we know is what's published, not what's actually been tracked because pharmaceutical companies don't have to release that data and they hold it.
Dr. Aseem Malhotra
They hold it. And and then then the reg you think the regulators are gonna be able to ask for it and look for it. They rarely do that. And Well,
Dr. Mark Hyman
they have it, but they don't publish it, which is which is interesting to me that the FDA does this because Yeah. You know, if you probably dig far enough and deep enough, you can find it online or through the FDA databases. Yep. But it's not in the literature because they're not published. But the pharmaceutical company has to report all that data before a drug is approved.
Yeah. They can't cherry pick what they provide the FDA, but it's not published. So and the FDA doesn't do a good job of saying, hey. Yeah. This is what they published, but, you know, all this other stuff shows that it really didn't work that way.
Dr. Aseem Malhotra
Well, what they often give the FDA, Mark, is curated information from tens of thousands of pages of of of of clinical study reports on patients in the trial. So the the FDA normally doesn't go and then reanalyze it. They just trust what the drug industry, their summary results. And then the other issue is, of course, the financial conflicts of interest. 65% of the funding in the FDA in The US comes from big pharma.
86% of the funding The UK of the MHRA comes from big pharma.
Dr. Mark Hyman
And this
Dr. Aseem Malhotra
is quite why They don't wanna back the hand that feeds them. So this is a huge compliment.
Dr. Mark Hyman
Explain why, Hassim, that the American College of Cardiology and the American Heart Association still recommend statins for people with high LDL for primary prevention, meaning if you've never had a heart attack, which is seventy five percent of prescriptions, you know, is it because they're captured too?
Dr. Aseem Malhotra
I think it's a combination of factors, but, yes, I think at the root of it is flawed science, dogma, and money. And then even if people know there's an issue, they're afraid to speak out because they're worried about their jobs. But if we're all doing this collectively, it's gonna be a complete, pardon my language, a shit show for health care, and that's why we are where we are in America right now. So it's time to, you know, I I you know, I think, I love this phrase. I know this is not a political podcast, and it shouldn't be.
But, you know, a good friend of mine and good friend of yours is Robert Kennedy Junior. And I love the fact that he's come out with this make America healthy again. I think we should all get behind that.
Dr. Mark Hyman
Yeah. It's been co opted, unfortunately. And you can't Trump campaign.
Dr. Aseem Malhotra
But Well, no. But you can't make America healthy again until you remove commercial distortions of the scientific evidence. And that unless that is addressed head on, we're not going anywhere.
Dr. Mark Hyman
Okay. I wanna resend it again. Commercial distortions of the scientific evidence.
Dr. Aseem Malhotra
Is it unless you correct that, you won't fix health care.
Dr. Mark Hyman
There's actually a paper, I'm gonna link to it in the show notes, called the commercial determinants of health, talking about the data on how multinational corporations like pharma, food, and ag companies subvert public health and privatize profits. And it's a WHO report that's sort of part partly published, but also coming out Mhmm. Much, much bigger report. And it's gonna be interesting when that hits because, you know, we talk about the social determinants of health, but this is really how how the industry is driving it. And I, you know, just the American Heart Association alone receives a hundred and $92,000,000 a year from food and pharma companies.
Right? Crazy.
Dr. Aseem Malhotra
Mind blowing.
Dr. Mark Hyman
It's mind blowing.
Dr. Aseem Malhotra
And How can we how can we trust that they're being independent with their information? Come on. I mean, it's people need to just, you know, wake up wake up.
Dr. Mark Hyman
And and you're not telling everybody who's on a statin to stop it. You're not telling them anybody you you need Let's get better informed. Get better informed. Yeah. Read the data.
I I wrote an article years ago called fat, what I got wrong, what I got right, which goes through a lot of this data. Yeah. It was published about, eight years ago, but it's still, I think, there's more and more data coming out all the time. And I think they can check your books. Where where do they learn more about your work and what you're doing?
Yeah. Exactly. How do they understand how
Dr. Aseem Malhotra
this being
Dr. Mark Hyman
in a little bit more?
Dr. Aseem Malhotra
But let's very quickly on that. I just I love the fact you bring up brought up commercial determinants of health. There's a definition in public health because I talk about this as well. So just so people understand what that means. Strategies and approaches adopted by the private sector to promote products and choices that are detrimental to health.
That's the definition of commercial attempts of health. Yeah. I have evolved that. And in fact, referenced in The Lancet, because Richard Horton, the editor, came to 1 of my lectures, and I've said that the the way that end drug companies, big corporations, conduct business, not individuals within them, I'm not putting individuals who work for them, as legal entities, the way they conduct their business actually fulfills the criteria for psychopath. Cowell?
Concern no. But but this this comes from Robert Hare.
Dr. Mark Hyman
Immoral, not immoral. Right? For forensic
Dr. Aseem Malhotra
for yeah. Forensic psychologist Robert Hare behind the original DSM criteria of psychopathy defined them in the book corporation. He said, so what does that mean? Callison concern for the safety of others, incapacity to experience guilt, repeated lying, and conning others for profit. So there's another 1 to throw in there.
Maybe next time
Dr. Mark Hyman
for it now.
Dr. Aseem Malhotra
Psychopathic determinants of health is my new term. Right? So this is what the root of the problem. Right? And, of course, downstream effects, we know what's going on.
Yeah. So, yeah, people can, I've got a website.praseem.com. I think, to be honest, if they wanna get an overview of this, it's a one hour fifty minutes. It's an educational tool. Please go and download First Do No Farm from nofarmfilm.com.
And if you wanna read about statins in particular, but we we cover this in the film a little bit, the whole drama statins, which is quite interesting. My third book is called A Statin Free Life, and I think that really breaks down all the cholesterol stuff and the statins stuff and the lifestyle stuff as well.
Dr. Mark Hyman
Yeah. So in summary, you're not anti science or anti drug or anti pharma. You're just for Pro health.
Dr. Aseem Malhotra
Real life.
Dr. Mark Hyman
Real health. Real health.
Dr. Aseem Malhotra
Real health. Although, I'm pro I'm pro ethical evidence based medical practice.
Dr. Mark Hyman
There you go. That's it. So it's, really been an amazing conversation. I could talk to you for hours. Unfortunately, we have stuff to do.
And, I encourage people to dig deep into the scientific work you published, which is where I first came across your work in the British Medical Journal or BMJ as they call it now. Yeah. And, your books, your films. And you're kind of a tireless advocate for a country opinion that is really advocating for a better approach to understanding nutrition, health, and and making informed choices as opposed to just swallowing hook, lung, and sinker the dogma that we're all taught in this society, which is that the only path to success in medicine is through pharma. And and I am not anti pharma.
I prescribe drugs regularly. However, I wanna prescribe the right treatment for the problem. Yes. And because all we have in our toolkit as physicians is a prescription pad, that's all we know how to use. Yeah.
Where diet and lifestyle work far better and are far more effective at achieving the same or even better results
Dr. Aseem Malhotra
than I'm upset.
Dr. Mark Hyman
Than drugs.
Dr. Aseem Malhotra
I'm upset.
Dr. Mark Hyman
And if there was a drug that could, you know, instantly reverse diabetes or fix insulin resistance or prevent
Dr. Aseem Malhotra
heart attack side effects?
Dr. Mark Hyman
Those side effects? Yeah. I would do it. But but I, you know, I I've never seen anything work as well as food. When applied in the right dose Yeah.
The right medicine Yeah. In the for the right duration.
Dr. Aseem Malhotra
%. And I
Dr. Mark Hyman
think that people don't understand that about food. It's not like, oh, food is medicine. It's something like hippie dippy term. Yeah. It's actually very precise.
Just like you need to know the drug. You need to know the pharmacology. You need to know the dose. You need to know the frequency. You need to know the duration of a drug that you're prescribing for a particular condition.
You need to know the same about food. That's how nuanced and detailed it is because food is full of tens of thousands of molecules that regulate every single aspect of your biology. And understanding how to leverage that tool for healing is profound.
Dr. Aseem Malhotra
%. Wow. And and and, Mark, and and another point before we finish is that, you know, you which you just raised is that these pills for chronic disease rarely improve your quality of life. They may affect a blood marker. They may reduce your risk to some degree in the long term.
But lifestyle changes come without side effects, by and large, and they improve your quality of life.
Dr. Mark Hyman
Well, there
Dr. Aseem Malhotra
are a
Dr. Mark Hyman
lot of side effects. You feel better, you have more energy, you sleep better, better sex drive, less depression, you know. So Yeah. All the side effects are good ones. Fair point.
Dr. Aseem Malhotra
Fair point. Fair point. Positive side effects.
Dr. Mark Hyman
Well, thanks again for being on the Doctors' Pharmacy, and we'll see you next time, and keep up the good work, man.
Dr. Aseem Malhotra
Thank you, Mark. Lovely to see.
Dr. Mark Hyman
Thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts. And follow me on all social media channels at doctor Mark Hyman, and we'll see you next time on the doctor's pharmacy. I'm always getting questions about my favorite books, podcasts, gadgets, supplements, recipes, and lots more.
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This podcast is separate from my clinical practice at the Ultra Wellness Center and my work at Cleveland Clinic and function Health where I'm the chief medical officer. This podcast represents my opinions and my guest opinions, and neither myself nor the podcast endorsed the views or statements of my guests. This podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services.
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