Sugar, Statins and Heart Health

Coming up on this week's episode of the Doctor's Pharmacy.

It turns out that all the separate diseases we see may be linked by.

This one common mechanism, insulin resistance. More than 100 million Americans suffer from insulin resistance, which is not only a precursor to developing type 2 diabetes, but can lead to many other health challenges, including heart disease. Hi, I'm Kaya Perowne, one of the producers of the Doctor's Pharmacy. In this mini episode, Dr. Hyman sits down with Dr. Aseem Malhotra, a pioneer of the lifestyle medicine movement in the UK. Together, they talk about the effectiveness of statin drugs on heart disease. Dr. Mohottapola discusses why he believes that reducing insulin resistance may be the key to better heart health.

Let's dig in here to one area you know a lot about, which happens to be the most prescribed drug probably on the planet, which are statins. Psychiatric drugs as a whole are up there and acid blocking drugs are up there, but statins are up there. And they've been prescribed not just to prevent a heart attack if you've already had one, but for preventing people who never had heart attacks from getting one. And you challenge this as a sort of flawed idea. Can you kind of talk about, as a cardiologist, how you came to this heresy and why we should believe you?

Okay, let's talk about statins. Do I think statins work? I think probably yes, but in such a small number that actually in the real world, The benefit really, it's failed. It's failed to reduce heart disease. I mean, the reason we still have an epidemic of heart disease and it's still the number one killer mark, you know, there was a prediction by people pushing the cholesterol hypothesis and when statins came on the market that we would end heart disease, the epidemic, by the 21st century. And we haven't. And the global, you know, campaign has failed. One, because the drugs are not as effective as we thought they were. Two, because side effects are real and underreported, but in the real world people stop taking their drug. and three, the cholesterol hypothesis itself is flawed because it's not the most important risk factor for heart disease, which is insulin resistance. Now, as someone that's treated, you know, thousands of people with heart disease, done over a thousand angiograms and treated people with heart attacks and has been on the ward round after people coming with heart attacks and the wards, we prescribe statins like smarties. We put everyone on a high dose. We rarely even check cholesterol because the guidance was saying, doesn't matter what the cholesterol is, get them on a high dose statin. Yeah, I would be the guy, Mark, In the ER, in A&E, we say in England, in the US, we say ER. I would be the guy when the chap's been diagnosed with a heart attack before we take him even to the cath lab. Throw it down to statin. I'm telling the nurse, give him 80 milligrams of torvastatin. Because I genuinely believe that the effects were immediate and it was anti-inflammatory. Interestingly, when you look at the data, actually there is no acute benefit from statins at all for event reduction for several months, no benefit in death rates, event reduction. So if you're a patient and get side effect within a few weeks of taking a statin, Stopping a statin certainly is not going to increase your risk of death or a heart attack at all. Now, when you look at the real world evidence mark in community studies about statin prescriptions and patients taking statins, in the United States, the statin usage survey, which is over 10,000 people surveyed, I was flabbergasted myself when I saw this statistic. 75% of people prescribed a statin in the community will stop it within a year of prescription. When asked why, 62% of those said it was because of side effects. And many of those tried different statins that had the same problem. The side effect most commonly reported is fatigue and muscle pain.

And you know, you're talking about these side effects, but the way they work is inhibiting an enzyme. HMG-CoA reductase, which also produces something called CoQ10 or coenzyme Q10, which is an essential part of making energy in your muscle cells and all cells. So when that gets blocked, not as a side effect, but as an effect, it leads to a reduction in energy production. So it's like you just ran a mile or 10 miles as fast as you can and you get muscle pain. And that's what happens to these people. And it also affects the brain. It also affects sexual hormones because your LDL and your cholesterol is what you.

Make testosterone and other hormones from. So another way of looking at the statistics from the trials on statins in people with heart disease is that if you take a statin every day for five years, what's your median, which is a crude way of saying average, not exactly the same, but what's your median increase in life expectancy for taking a statin? If you've had a heart attack every day for five years, 4.2 days.

4.2 days.

That's if you average it all out.

And those days are typically with muscle pain.

Well, you know actually probably people who have tolerated the drug. But what it tells me is if you think about that, and you also realise more than 50% of people over the age of 65 If you take a statin with heart disease, Mark will stop the statin within two years. This is people who have had heart attacks, again, because of muscle symptoms. You can understand why there is no reduction in the population because actually many people stop taking their statin. The benefits are marginal anyway. One of the websites I actually tell my patients to go to, which is great, it's an independent website called the nnt.com.

I wrote about that in my book.

In fact, at the end, right? It's fantastic. And when you look at the totality of the data on the nnt.com and all the statin trials, for people with heart disease, so we'll come back to healthy people first, but people with heart disease, your mortality benefit is one in 83, as in it will, there's a one in 83 chance it will delay your death.

Listen, we're all gonna die.

That means 82 people will take statins with no impact. And no impact on their mortality. And about one in 39 to prevent.

A non, a recurrent non-fatal heart attack. That's if you've already had a heart attack.

Yeah.

Then you have to treat 39 people before you prevent another heart attack. Prevent another heart attack.

One heart attack and 83 before you prevent one death.

And I published an editorial with Rita.

Redberg, who is here also for the conference, and Pascal Meier, both editors of medical journals, both practicing cardiologists. We said, the paradigm shift needs to happen where we need to concentrate on really reducing insulin resistance, which is, you know, really the number one risk factor for heart attack, certainly in young men. and actually that would actually tackle many other chronic diseases because it's a precursor for type two. It's responsible for 50 to 70% of people with high blood pressure.

So you just mentioned something and I think it's sort of the flip side of the story, which is insulin resistance. And that is a mechanism in the body that happens where your body becomes numb to the effects of insulin when you eat too much sugar and starch. And it turns out that all the separate diseases we see may be linked by this one common mechanism, heart disease, many cancers, type two diabetes, obviously obesity, even things like dementia, which are now called type three diabetes. These are the major killers. They're all driven by the same mechanism. Now, if that's true, you know, you know, we are living in a society where we're all at risk because sugar is everywhere.

I describe it in an article I wrote in the Observer newspaper that, you know, it's public enemy number one in the Western diet because It's become so prevalent because it's been added to so many processed foods in the States. It's estimated 50% of foods that people don't think are junk foods have added sugar in them. And our estimates suggest in the States and in the UK, people on average are eating anything between 20 and 25 teaspoons of added sugar in their diet a day, which is extraordinary. And kids about 35. Yeah. And the recommendations from the World Health Organization now, who were put under pressure, say maximum limit of six, but they say limit, they don't say you should have it because actually for optimal health- that's the upper limit. You don't need any added sugar in your diet. I mean, there's no nutrition in it, there's nothing. The ultra-processed food consumption in the average.

British diet, Mark, 50% of the diet.

Half of the diet is coming from ultra-processed food. Now, if you break that down- In America, it's almost 60%. Is it really? Wow. I mean, but if you break down the ultra-processed food, where is it coming from? More than 70% is coming from starch, sugar, sugary drinks, ultra processed fruit and vegetables. Most of it is starch and sugar. It's not coming from saturated fat or fat or meat or dairy.

There are processed dairy and meat as well.

We're told to cut the fat and cut the meat. But the public health crisis we have is actually the big macronutrient, the big problem we're over consuming, which is the key component of ultra processed food, is starch and sugar. And this is what we need to get down. And that should be the public health message.

Sugar is the core ingredient used by the food industry to make bad ingredients taste good. You can find sugar lurking in foods that might not taste that sweet, like dressings and condiments, and also in foods that are positioned as healthy, like bottled smoothies. And we are programmed to genetically crave sugar and refined carbs. Have you ever wondered why you could devour a box of cookies but you wouldn't binge on broccoli? The reason isn't because you lack self-discipline or are weak-willed. Some of us are biologically addicted to sugar, and willpower alone doesn't work here. This is why it's so important to eat real food. Eating real, nutrient-dense whole food is the key to overcoming cravings for processed carbs and refined sugars. Be sure to include healthy fats and quality protein in each of your meals, as well as whole food carbohydrates like veggies, legumes, nuts, and seeds. Dr. Hyman also recommends limiting or eliminating refined sugars, sodas, fruit juices, and artificial sweeteners from your diet, as these all fuel sugar addiction. If you feel confused, ask yourself one question: Is this man-made or nature-made? Nature made an avocado, but not a Twinkie. Eating healthy is often that simple. I hope you enjoyed this mini episode of the Doctor's Pharmacy. Thanks for tuning in.

Hi everyone. I hope you enjoyed the interview. Just a reminder, this podcast is for educational purposes only. This podcast is not, I repeat, it's not, not a substitute for professional care by a doctor or otherwise qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a provider database. It's important that you have somebody in your corner that's qualified, that's trained, that's a licensed healthcare practitioner helping you make changes, especially when it comes to your health.

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