Why Cholesterol May Not Be the Cause of Heart Disease with Dr. Aseem Malhotra

So welcome, Dr. Malhotra. We're here at the Swiss re British Medical Journal conference about food for thought, the science and the politics of obesity, which is and food, which is really what you've been focusing on. And you're kind of an extraordinary doctor. You're a cardiologist from the UK. You're one of the leading voices there in fighting obesity and disease, and challenging the orthodoxy around cardiology, statins, fat, and you're taking a lot of flack from it. But you're also out there courageously sort of breaking through the noise and people are listening. And I read that you had been working with a member of parliament and he had type two diabetes and you're able to get him off his British Dietetic Association guidelines and eat a higher fat, lower carb diet. dramatically reversed his diabetes, lowered his insulin, and he wrote a letter to the Prime Minister of England, which is pretty amazing. How did you end up going from being a cardiologist that was trained that LDL cholesterol was the bad guy, that statins were God's gift to mankind, and that we shall all be eating a low-fat diet to your perspective now, which is quite opposite, which is statins aren't the miracle drug we thought they were, and that saturated fat is not the enemy, according to your British Medical Journal article that I read years ago. How did you come to that from the traditional view?

You know, Mark, I think for me, I had a realization many years ago, probably around 2010, having qualified as a doctor in 2001, and then decided to specialize in cardiology much later on. I looked at basically what was happening with my patients. So I noticed more, my observation was more and more people coming in with multiple chronic diseases, more obesity. And at the same time, you're hearing the statistics in the media because 2004, it was 14 years that the World Health Organization announced obesity as being a global problem, major issue.

Yeah, we haven't made much progress.

We hadn't made much progress. So I was trying to initially look into the root cause of that because ultimately I felt as a doctor there was more pressure on the system. And then I went to investigate the evidence behind, you know, the conventional wisdom around cholesterol or unsaturated fat.

You actually looked at the data.

I looked at the data, looked at all the research, but also I think, Mark, one of the other things that's really important is that when you look at the hierarchy of what's driving the obesity epidemic, even if you take what we think is flawed dietary guidelines aside, The food environment was saturated with junk food. My own hospital, the hospital. So I thought to myself, how can we be advocates for our patients for good health if we are basically selling sickness in the hospital grounds?

I mean, half of the healthcare workers are overweight.

Yeah, absolutely. And it's the same for doctors, for nurses, for non-clinical staff. The statistics are the same. So there's clearly something wrong. And I knew that obviously the food environment was contributing. But when I looked deeper, I realized that what essentially had happened is that when you go into the roots of it all, the change in dietary guidelines, which happened in 1977 in the US and 1983 in the UK, which essentially said we should get only 30% of our calories from fat and reduce saturated fat consumption to less than 10% based.

By the way, on no randomized clinical.

Trials, which should be the opposite. Absolutely. It was Ancel Keys, you know, the.

American side of Ancel Keys from his Seven Countries Study, which correlated saturated fat.

Cholesterol and heart disease.

One very passionate, determined scientist.

Absolutely. And I think he genuinely believed in what he was doing. But actually, when you look at where we are now, Mark, and we come forward and look at the totality of evidence, and that's crucial, and that's what we're going to be discussing in this conference, is that people in very powerful positions, in powerful organizations who have a lot of influence, are ignoring the totality of evidence.

And when you look at the totality.

Of evidence, it's very cherry picking it. Absolutely, cherry picking. But it could be confirmation bias. It could be that they just, ignoring evidence that challenges their own dogma in there. But you see, we also have to exercise as doctors, Mark, more humility and less hubris. One of the founding fathers of the evidence-based medicine movement said half of what you learn in medical school will turn out to be dead wrong or outdated within five years of your graduation. The trouble is no one can tell you which half.

Which half? That's what my dean said when I- My first day of medical school.

No, so- yeah. And you have to, therefore, you have to learn to learn on your own. And actually, many doctors, because of the nature of the job, often don't critically analyze a lot of the research.

We're not trained in that. It's really remarkably... We are handed down a set of beliefs and dogmas that we take to be true because our teachers tell us that. But they don't actually teach us how to critically evaluate science, how to read literature, how to understand. I mean, it took me years before I understood the difference between an observational.

Study and a randomized controlled trial. Sure, absolutely. And I had to learn all of this myself because I didn't learn any of this in medical school. And in fact, the other aspect to this as well, we learn nothing really of evidence-based lifestyle interventions and the evidence behind that to help our patients in medical school or even in postgraduate education. I've been working on getting that into.

The curriculum as well.

You didn't have a year's worth of nutrition in medical school?

Not a single lecture.

Not a single lecture. It's extraordinary. You didn't learn about scurvy? Well, okay. Rickets? Yeah, okay. Some of that stuff, of course. But in terms of chronic disease, you know, no, no, no. So I think that there is, really a lot of misinformation amongst doctors. But I think as a profession, we also have to be more skeptical about medicine itself. I mean, it's interesting. Richard Smith, the former editor of the BMJ, wrote an article not so long ago where he said that 90% of people when asked of members of the public thought that medicine was an exact science. When in fact, it's not an exact science. As I teach my medical students, I say this is more the practice of the art of probabilities. And if you think about the information that we've been given, whether it's to do with nutrition or whether it's to do even with prescribing medications. We now know that that information is biased. It has lots of limitations. And if we're making clinical decisions on biased information, Mark? -Biased because the way the research was.

Done, because it was influenced by industry, because- -A number of factors.

-So the quality of the research, the reliability of it, the fact that results are not replicated, the fact that there is industry influence on the studies. So we know, for example, biased funding of research is a big issue. And if a study is funded by the industry, then it's 7.61 times more likely to show outcomes positive in favor of those industries interests versus independent research.

That's 7%, seven times.

Seven times.

That's like 700% more likely.

Absolutely. So, Mark, when we look around us at the moment, and what I'm going to be speaking about later today is the question that we're going to be asked in our panel discussion is, what evidence can you trust? I think the first thing we can say is the Current true real world evidence is that more than 50% of the adult UK population and even US and many European countries are overweight or obese.

70% of the UK population.

At least one chronic disease, that in my view is a symptom that we have failed in our healthcare system and we are failing our patients. And we know what the root causes are, but most doctors also don't know. For example, there was a very good paper published by John Ioannidis, who will be speaking through from Stanford during the conference. And I'm very much looking forward to what he has to say because... And.

He'S a guy who basically questions the whole research paradigm and the quality of the research we have and the assumptions we make and the conclusions we draw and how we over interpret. And a lot of our guidelines and.

Our recommendations are based on very weak evidence. Absolutely, Mark. And I would describe, and I gave a talk recently and I would describe John Ioannidis because of his academic prowess. He's a professor of medicine at Stanford and a statistician as well. I would call him the Stephen Hawking-like character of medicine. And when he writes an article and he says only 7% estimates only 7% of clinical studies for medical therapies fulfill criteria for being both high quality and relevant to patients, that's a huge problem.

It is. It is. We think in American College of Cardiology, I almost psych here, but there are guidelines that are, we think, are established recommendations from the field based on science. And yet, JAMA published an article showing only 10% of the American College of Cardiology guidelines. And by the way, cardiology has been the most researched field in medicine. Only 10% of those guidelines are based on good science. Absolutely.

Most of the guidelines are too. And they're in space. 90% are based on expert opinion. Of course. So that, you know, so one of the ways of tackling this, no doctor, everybody, listen, I believe most people intrinsically want to do the right thing. Almost every doctor goes into medical school because they really want to help their patients and they have a responsibility to scientific integrity. But lack of knowledge of these problems, Mark, is one of the reasons we're not able to tackle it. So the more people, more doctors are made aware, they will not accept this. And also the other thing, Mark, is I think doctors are realizing that the way we have, there's something seriously wrong in the system if we've got this.

Huge epidemic of chronic disease and misery, essentially. Yeah, we keep prescribing pills, but they don't get better. In fact, you said that prescribing pills and medication is the third leading cause of death.

Yeah, the estimate comes from- and that's.

For- prescribing pills in the right way for the right patient for the right.

Reason, not drug errors. No, absolutely. So well, actually, so Peter Gotscha, who's one of the co-founders of the Cochrane Collaboration, he estimated that the third most common cause of death, as you say, after heart disease and cancer is prescribed drugs. And his estimates, 50% of those are because of side effects and 50% of those are because of medication errors. But I think the point he makes, which I think is really interesting, I even had a discussion with my patient yesterday about this who came in, who's asked me all about different side effects that I was not aware of in a particular drug. And I said, listen, many drugs that are prescribed, and although they tend to be, they wouldn't come on the market, you would hope, if they were very common side effects. But side effects that exist, many drugs have 20 or 30 side effects, potential side effects. Most doctors, we don't know all of these side effects for every drug.

And most of them aren't side effects. They're effects that we don't want. Absolutely. Like statins, which you talked about.

If you have muscle damage, that's not a side effect. No, that's an effect of the drug. That's an effect of the drug. Yeah, no, absolutely. Absolutely. So, I think that we need to take a little bit of a step back and actually look at what we're doing in medicine. I think the overall view, in my view now, Marc, is we need a global campaign coming from the highest authorities in medicine, even the World Health Organization, to say, we have a public health crisis of an over-medicated population, and we need to now work towards getting people on less drugs and push more lifestyle. Because the reality is this, Marc, good health rarely comes out of a medicine bottle.

That's true. So it comes out of a fork, right? At the end of your fork. Yeah. As I say, what you find at the end of your fork is more powerful than what you'll find mostly in prescription bottles. So let's, 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 people to prevent heart disease, I mean 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?

Well, I think the first thing to think to talk about is cholesterol. as a risk factor for heart disease. Yeah, LDL. So LDL is so-called bad cholesterol, as everybody knows about this. I mean, the campaign has been so good, so strong, that everybody around the world, when you mention cholesterol, there is an element of fear when people are told about high cholesterol, and they immediately associate with heart disease. So LDL cholesterol was sanctified as a.

Major risk factor for heart disease, and.

Most of that information- I love that word, sanctified. Absolutely. Like a priest. Well, no, in a way, there is almost, you know, there is a very strong belief that getting your LDL lower is the way to combat heart disease. But if you look at the original Framingham data, to Framingham in the United States, which was a town where several thousand people were followed up over decades to look at, to try and draw out risk factors for heart disease, high cholesterol was one of those risk factors. When they looked at the overall data, they realized that the actual risk, the most reliable risk factor for heart disease from cholesterol is your total cholesterol to HDL. So total cholesterol divided by your so-called good cholesterol, HDL. LDL didn't feature. HDL, right. Now, William Castelli, one of the co-directors of Framingham, he looked back in 1996 and published a paper in atherosclerosis. And even I found this extraordinary mark. He wrote that unless, when they looked at the data from Framingham, unless LDL was above 7.8 millimoles, which I think in your terms in the States, I think is well over 250, probably over 300, Unless it was over that value, in isolation, it was essentially useless as a biomarker in predicting heart disease. I mean, that's extraordinary. Most patients we see, Mark, don't have.

LDLs anywhere near that.

Unless they have a genetic disorder. Unless they have a genetic disorder. So people with what we call familial hyperlipidemia. And we know from the data that people have genetic disorder where their cholesterol is high, which affects less than 1% of the population, probably anything between 1 and 501%. 70% of women with untreated FH will have a normal lifespan and 50% of men. So actually there is a huge proportion that will be have premature death because of heart disease. But what's interesting is there is now data to suggest, well, is it the cholesterol or is it something else that's going on? Now, when you look at the lowering of cholesterol of LDL specifically from lots of different drugs, including statins, When you look at the totality of data, Mark, actually there were 44 randomized control trials, both mainly involving drugs, also involving diet, that very robust studies in themselves had no reduction in mortality, no reduction in CV mortality, cardiovascular mortality. Cardiovascular mortality. Most of them had no reduction in any event reduction, even non-fatal heart attack or stroke, and some showed harm. And that information and evidence is being ignored now. Okay, let's talk about statins. What does the totality of data tell us? And I'm going to bring in some caveats as well. Because what I'm saying to you now, I often have this conversation with people.

Before you dig in there, I just got to go back. That was sort of breathtaking what you just said, which was that 44 randomized trials lowering LDL cholesterol with lifestyle or diet had no impact on heart attacks, death or any- well lowering cholesterol, a.

Lot of those LDL. And what's interesting is there was no also link between how much you lowered the LDL and whether it was an event reduction. Because there is an academic community out there that believe the lower the better and papers are published, which in my view is selective reporting and cherry picking data and making it look as if actually the lower your LDL, the greater benefit you have. The overall totality of the data tells us that is false.

Amazing.

Absolutely false. Now, when you look at statins and 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, get then, right?

It's fantastic, isn't it? And it's useful because this website is created by independent researchers. There are no conflicts, there's no funding or advertising, and they synthesize all the best high quality data and put it together to basically calculate for patients what is important outcomes to them, but also for doctors. So, for example, heart attacks, deaths, those are the most important outcomes for most people from taking a drug. That's what they want to know. 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, if you take the statin religiously every day for five years, your mortality benefit is 1 in 83, as in there's a 1 in 83 chance it will delay your death. Listen, we're all going to die.

That means 82 people will take statins with no impact.

-No impact on their mortality. -And about 1 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 in 83 before you prevent one death.

Now, what I say also to my patients, this likely represents even the very best case scenario because all of the data on statins essentially comes from industry sponsored studies. And not only is it industry sponsored studies, but when you look at the patients or participants in them, it's known now that the side effects are underreported and many people who either experienced side effects before the trial started or had characteristics that made them likely to get muscle symptoms, because that's the most common symptom we see, actually were taken out of the trial. 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 because this statistic, which I'm about to tell you, is based upon people having no this is before any media scaremongering or awareness about side effects. So these are people who are most likely being prescribed by their doctor in the community to say, this is like a magic pill. It's going to reduce your risk of heart attack. 75% of people prescribed a statin in the community will stop it within a year of prescription. And 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. Now, that is a huge discrepancy mark between the clinical trial data, which tells us really less than 1% really get muscle symptoms, maybe one in 10,000 get a serious myositis. It's a huge discrepancy mark between the clinical trial data and what we experience in the real world. Now, I'll tell you something else very interesting that most people don't know. People think conventional wisdom, even I thought this, in fact, I published a paper where I even said statins have reduced mortality and secondary prevention of the population.

I didn't use a citation.

It was just my understanding that it had done.

A dogma you learned from your- what's that?

Absolutely my dogma is presumed in secondary prevention because in the trial data there is benefit, but it's very small, really, for many people.

Well, right, I always say, you know, it's absolute versus relative risk. The risk goes down by 30%.

That means it's going down from 3% to 2% in the population. I know, I know. And absolutely, and in fact, we should be giving, having that conversation with patients because if you don't, then you're being non-transparent in your communication of risk and.

That will exaggerate the benefits.

And often minimize our harms because of underreporting.

But actually- so what I think was Roger Williams or Mark Twain said, there's liars, there's damn liars, and there's statisticians.

Who can manipulate the data to say whatever they want. Exactly. That's another concern, isn't it? But when you look at the, there was a study published in the BMJ in 2016, and they looked at Western European countries over 12 years and looked at cardiovascular death rate reduction from statins in different risk groups, including secondary prevention. no reduction in death rates in cardiovascular mortality in the people who are.

High risk.

-How do you explain that? Well, from a scientific perspective, I can explain it. Even if we presume that the data is absolutely correct from the trials. 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? And when I ask the audience and ask people this, they come up with figures like they'd add five years to your life, several months, whatever, 4.2 days.

4.2 days.

And that's if you average it all out.

And those days are typically with muscle pain.

Well, you know, actually probably people who haven't, who have tolerated the drug. But what it tells me is if you think about that, and you also realize more than 50% 50% of people over the age of 65 who 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. 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, There was a prediction by people pushing the cholesterol hypothesis, and when statins came on the market, that we would end heart disease, the epidemic by the 21st century. And we haven't. And the global campaign has failed. One, because the drugs are not as effective as we thought they were. Two, because side effects are real and underreported, but in the real world people stop taking 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, Ancel Keys told the New York Times, this is the man who was the most influential man in many ways in nutrition and medicine.

He was the guy who said we.

Should cut out fat and unsaturated fat. Absolutely. The Seven Countries Study author influenced the guidelines in a big way, probably more than anybody else. In 1987, he told the New York Times, I've come to realize cholesterol is not as important as we used to believe it was.

I mean, the fact that he says that is a big statement. I mean, you look at the Jupiter trial where we found that the statin drugs may not act by lowering cholesterol or LDL, may act by other factors such as anti-inflammatory factors or antioxidant factors. And in the study where they looked at lowering LDL, if they didn't lower inflammation levels, but they lowered LDL, there was no benefit. Only when the inflammation went down was there benefit.

That's extraordinary, Mark. You're right. And in fact, my BMJ saturated fat piece in 2013, I postulated that as well, that my own personal view. And in fact, I was also reflecting the view of my cardiology colleagues as someone that's treated, 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. 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 that when the chap's been diagnosed with a heart attack, before we take him even to the cath lab, you 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. If you're a patient and get side effect within a few weeks of taking a statin, stopping a statin certainly is not gonna increase your risk of death or a heart attack at all.

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 these are not side effects. They're effects, and they may affect different people differently. And there's a lot of genetic variation in this, but the whole philosophy of driving down LDL as low as possible doesn't seem to make sense. These new drugs, these PK whatever C-19 things, they are dropping people's cholesterol to seven or 10 in LDL. And does that make sense?

No, it doesn't make sense to me at all. In fact, I was part of a team of people that published a systematic review in the BMJ specifically looking at people over 60 to see the association of LDL. How strong was the association with LDL and heart disease? and we were even quite shocked by the findings. There was no association with LDL and heart disease, and there was an inverse association with all-cause mortality. How do you explain that? Well, we know cholesterol is a vital molecule in the body. We produce it for a reason. Without it, we would die.

It's not bad. It's just there are certain forms of.

It that are worse. Absolutely. And probably influenced by various factors as well. Like sugar. Absolutely. And when we looked at that, there was good data to suggest that cholesterol is involved in the immune system. Elderly people are particularly vulnerable. to dying from infections such as pneumonia or, you know, stomach infections. And it's probably the mechanism is probably protective in the elderly because of their protecting you from those infections. So I actually say to some of my patients that have come in who have, you know, patients have been referred to me by their general practitioner, a lady over 60, for example, with a high-ish LDL and said she was very worried. And she came in the room with a look, you know, looked like she'd seen a ghost. She was so fearful. because she thought he was going to have a heart attack. And I said, congratulations, you're going to live longer. And I explained it all to her and she walked out of my consultation room with a smile on her face.

Well, it's true. The Honolulu Heart Study was fascinating where they found that actually the higher your.

Cholesterol as you're older, the healthier and longer you lived. Yeah, it's extraordinary. So I think the paradigm needs to shift, Mark. And I think when you look at the data that's there, and I published an editorial with Rita Redberg, who is here also for the conference, and Pascal Meier, both editors of medical journals, both practicing cardiologists, we said that the paradigm shift needs to happen. where we need to concentrate on really reducing insulin resistance, which is, you know, really the number one risk factor for heart attacks, certainly in young men. And, 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. And, Mark, I am, you know, advising many patients to follow a low sugar, low refined carbohydrate, what I call a high fat olive oil based Mediterranean style diet. and people are coming off their blood pressure pills within weeks to months. No, we see- Cardiovascular risk markers are improving, they feel better. It's extraordinary now. Okay, let's critique it. Have we got long-term data to show that from randomized controlled trials to show this Mediterranean lifestyle approach is superior and going to reduce death rates? We don't, and we need more of that. However, their risk markers improve, there's no side effects, their quality of life gets better, And if they come off medications, you know, it's a win-win for the patient and for the healthcare system. Right.

It's biology. So you, you just mentioned something that I think is sort of the flip side of the story, which is insulin resistance. And that is a mechanism in the body that happens where your body becomes numb to the effects of insulin when you eat too much sugar and starch. And it turns out that all the separate diseases we see may be linked by this one common mechanism. heart disease, many cancers, type 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. And you've been the one of the most vocal proponents of sugar sort of, you know, you sort of remind me a little bit of Jamie Oliver, you know, who, who's a chef where he, on his Ted stage, poured out, you know, like a whole wheelbarrow of sugar and said, this is what we're eating in a year. And you, you've been very active about this. And you wrote an editorial recently in the Journal of insulin resistance called the science against sugar alone is insufficient in tackling obesity and type two diabetes crises. We must over also overcome opposition from vested interests. So this is a very powerful statement. So it's not just a matter of science, it's a matter of politics and our policies that are driven by the food industry. And you're taking this head on. Tell us what are the biggest drivers in that and how do we begin to deal with those?

Well, I think you're right about sugar being, I describe it in an article I wrote in the Observer newspaper that it's public enemy number one in the Western diet because It's become so prevalent because it's been added to so many processed foods in the States. It's estimated 50% of foods that people don't think are junk foods have added sugar in them. And our estimates suggest, you know, in the States and in the UK, people are, on average, are eating anything between 20 and 25 teaspoons of added sugar in their diet day, which is extraordinary.

Now the- and kids are about 35. Yeah.

And, you know, and the recommendations from the World Health Organization now, who are put under pressure, say maximum limit of six, but they say limit, they don't say you should have it because actually for optimal health- 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.

It's a tree.

There's no biological requirement for it. Or sugar or carbohydrates, by the way. Well, you're actually right. There is actually no essential requirement for carbohydrates either. But with sugar, yeah, you can get, you know, you can very easily have.

A very, very healthy life with zero sugar in your life.

Now, when we wrote this paper- I.

Would rephrase that, you will have a very healthy life.

You're right. It might take you a few weeks to reach that point. You might be a little bit gnarly for a while before you get there when you're breaking the addiction, but yeah, no, you're absolutely right. And so the first thing to say is, well, how do we combat this? And we can learn from lessons. We need to learn from history, Mark. If you don't learn from history, you're bound to live through it again. And I think there's, in some ways, we're doing that because tobacco, big tobacco, we're able to stall what we call effective population interventions to reduce tobacco consumption by really adopting a strategy of denying cigarettes were harmful, planting doubt, confusing the public, even buying the law to of scientists who would write papers and not declare they're taking money from tobacco, saying they don't think tobacco is harmful. And they did this for 50 years from when the first links between smoking and lung cancer were published. And actually, eventually when we did manage to reduce tobacco consumption, which was actually- Only through a lawsuit, wasn't even a government policy.

And ultimately government policies followed, but it.

Was, you know, I talk about the three A's in public health, tackling the availability, the affordability and the acceptability. So public education campaigns, cigarettes are harmful, banning tobacco advertising, smoke-free buildings. When you combine those, that was responsible for most of the decline in death rates, cardiovascular mortality, Yeah. In the US and the UK and Western European countries, certainly, you know, in the last sort of 40 or 50 years. And, you know, that is actually what's most the biggest decline was only when regulation was introduced really from governments because governments have a duty and responsibility to protect citizens from excesses and manipulations of industry because ultimately people were lied to. People were lied to. People were misinformed. They were making decisions about their health based upon misinformation that was coming from industry. And actually, government had to intervene. And when the science was there, that wasn't enough, because there had to be a battle. There were campaigners and people had to keep pushing this message. And we see the same sort of things, which we have to realize the same sort of things exist with sugar because- Same playbook.

And they often were the same company.

But Mark, yeah, exactly. But we've also got to have... We can't be naive about this. There are you know, they're very powerful vested interests. There's a lot of money invested in flawed science, in, you know, pushing a message or a hypothesis that's so flawed and harmful, you know, that people make a lot of money out of this. I mean, the cholesterol, fear of cholesterol, lowering saturated fat, I mean, it's a multi-billion dollar industry that profits from that message. So it's not going to change overnight. And what industry do and people who support industry who get funding from industry, often not obvious or declared, they will engage in tactics to go after people like me or other public health campaigners.

Like me?

No, absolutely. We are here trying to push a message of truth and transparency and openness. And we will get called names. We will say that what we're promoting is junk science or whatever we reference in terms of design. This is what they do. This is the science.

There was an article about me in Forbes magazine. totally discrediting me. And I read the author was part of this group called the Genetic Literacy Project. And as I began to dig into that, it turned out that's fully funded by Monsanto. So, wonder about the credibility of that story.

No, sure. And Mark, you know, this is an important point for journalists as well, because actually my view is this, there should be full declarations of interest in terms of financial interests, specifically, you know, before people are asked to comment. And I think this even applies to scientists because otherwise, I mean, it makes a big difference. It's a huge bias. It doesn't mean they can't comment, but people need to know that these people really are acting as frontmen for industry interests. Because if we don't do that, Mark, we're not really adhering to what I believe are true principles of democracy, because people wouldn't change their opinion in their decision if they know somebody who's giving them information is being funded by the very organizations that profits from what they're telling us.

So true. Coca-Cola is funding research on soda and obesity. Of course, it's going to find that it's, you know, not harmful. And you mentioned this article that there were 128 articles and 471 authors that were not disclosed by Coca-Cola and 19 academic investigators who we think are independent had direct email contact with Coke. That's completely unethical. Yeah, absolutely. And it's not actually reported in the studies.

Yeah, so it's not reported in studies, but I'll add something else onto this, which is interesting is that I think declarations are important. But actually, they're always a footnote at the end. They aren't the headline. They're not mentioned in the news stories. And actually, declaration doesn't remove bias. In fact, there's one in one of the law journals. It was a very interesting article that showed that it can actually exacerbate bias sometimes. So an audience listening to a speaker who declares his interest in something, initially the credibility momentarily may drop slightly. But then what that does is it gives the speaker, the person with the vested interest, a moral license. to exaggerate their claims even further. So actually, there's no net reduction in that. In fact, it can sometimes make things worse.

What are the implications? Well, I'm supported by them, but I'm.

Independent in my opinion. Yeah, and because I'm declaring it, you can see this, and then that then gives them that they're done, let's just move on. And in fact, actually, it doesn't, the declarations are extremely important. I think that is something we need to adhere to for everybody, every scientist, everyone who's publishing something, but it does not remove bias.

No. So what are the other things that are happening besides the scientists being corrupted? The public health experts being affected by this?

So I think the-.

You- talked about Brenda Fitzgerald, who was the disgraced director of the CDC, which partnered with Coca-Cola when she was Georgia's Public Health Commissioner and bankrolled something called the Global Energy Balance Network, which was a consortium of three academics that said that actually it was all about calories in, calories out, and that exercise was the solution. And eventually they were exposed by the New York Times and said, well, we have to shut down the global energy balance network because we have resource limitations. I don't know if Coke has resource limitations. It's surprising to me, but I thought that was fascinating. So that's just as sort of the tip of the iceberg. You've got a woman who's running the Center for Disease Control. which is the nation's most independent scientific public health organization, partnering with Coca-Cola to push a concept that's not founded in science, that all calories are the same and saying that we should focus on exercise.

Yeah, it is extraordinary and it's sad. And I think Brenda really is just a product of a really a system failure mark because Really in this battle against misinformation, the greatest weapon we have is transparency. The more of this, people need to be aware of it because most people wouldn't accept this than as being independent advice. But when I look at the situation as it is, we've got to understand as well that these industries, whether it's the drug industry or the food industry, they're there. They have a fiduciary obligation to make profits for their shareholders. They're not, pharmaceutical industry don't have a A fiduciary obligation or legal obligation to give you the best treatment, although most people think that would be the case. The food industry there to sell food, not look after your health. And they can mislead and market and- They talk about getting more stomachs in the share. Yeah, absolutely. But the real scandal, Mark, is that those with a responsibility to patients and scientific integrity, that includes academics, medical journals, institutions, they collude with industry for financial gain. And that's the real problem we have. And we talk about government guidelines and we realize, for example, I was part of this campaign to get sugar reduction down in the UK. And when I came out and wrote an article in the BMJ saying the dietary advice on added sugar needs emergency surgery, where I had, from my own investigation, figured out that in Europe people were effectively being told from sugar labeling of sugar on products to consume as part of their healthy diet, guideline daily amount, 22 and a half teaspoons of sugar a day.

And I thought, how is there a recommended amount?

It's crazy. I'm a practicing cardiologist. I'm not a nutrition scientist. I had to do all this research on my own. And then I asked the Scientific Advisory Committee on Nutrition. They're basically the academic group that advise government and producer guidelines that they need to sort this out quickly. And eventually they succumbed, but they only succumbed after an investigation by Channel 4 despatches program and the Sunday Times newspaper in the UK. Interestingly, they were exposed that several of the members of this panel had direct financial, institutional, personal links to manufacturers of sugar, big sugar. That just doesn't make any sense to me. So, am I saying these people are corrupt? No, I'm not. I'm saying that there is a bias there. And I think that when it comes to giving advice that influences millions of people that is supposed to be independent, it needs to be independent, it needs to even have the perception of independence Mark.

And be transparent.

Completely transparent. And this has clearly not been the case. And this is one of the root problems why we have this epidemic of chronic disease and other medication that we have is because actually those people who should be doing better should know better, those people in positions of power and influence are too close to industry. And I will not name this person. He's a very, he's quite a well-known individual, but somebody very senior in the Department of Health in the UK, when I went to this person and said, I'm very concerned about scientific integrity, fraud in the research community in the UK, too much influenced by industry, manipulation of data. You must be very popular over there.

Well, you know, Mark, I mean, popular.

Amongst two, at the end of the day, my job and duty is to do what is best for my patients. That's ultimately what we're here to do, isn't it? Totally. And he looked at me and he didn't look at me in the eye and he said, Asim, All I can tell you is the Department of Health is too close to industry. And that was enough for me to know what he was saying. Yeah.

No, it's true. I remember speaking with a former Secretary of the US Department of Agriculture and Veneman, and I said to her, why are our dietary guidelines not matching the science? Why do we say that we should have three glasses of milk a day? Why are we not recommending the right kinds of fats? Why our food stamp program spends $85 billion a year for the poor? serving mostly junk food and $7 billion a year just on soda, or 20 billion servings a year for the poor. Why do we have subsidies that support commodity crops that are turned into processed food that are consumed by Americans that make them sick and fat? She says, Mark, unfortunately, the industry has a lock on Congress and the White House. And I remember during the filming of Fed Up, Michelle Obama was filmed early on in the movie. kicking out all guns blazing against the food industry and was excited and passionate, engaged. And then later on in the movie, she was filmed standing on stage with a lot of top food industry executives looking totally dejected and forlorn announcing this great initiative to remove six trillion calories from the food supply, which sounded wonderful if you believe the calories are the problem. Turns out what they were doing was making an Oreo cookie 90 calories instead of a hundred calories. which gives them more profit and us less sugar, but still is junk. And that's the kind of thing we see. And it's frightening. And you see it across the halls of government. I mean, $500 million is spent just lobbying one bill, the farm bill, which is our major food bill in America. And that is not transparent and people don't understand why that's happening. And so you've got corrupt scientists, you've got corrupt public health organizations like the American Heart Association, which essentially gets hundreds of thousands of dollars from the food industry for giving them their heart healthy seal for things like Trix are for kids, which has seven teaspoons of sugar and all kinds of dyes and additives. I mean, how is, you know, a highly sugary cereal, a heart healthy cereal? So that's crazy. 40% of the Academy of Nutrition and Dietetics in America's budget is funded by the food industry, Pepsi, Coke, Nestle, all the big food companies. how can that be independent? So we have the government, we have scientists, we have public health organizations, we even have them usurping things in the community using corporate social responsibility, like funding groups like the NAACP or Hispanic Federation, which is why they oppose soda taxes. So we have this really screwed up system where the industry is so heavy-handed how do we begin to sort of work to protect ourselves from that? You, you and this article laid out a whole series of initiatives and policies that you thought could make a difference. Can you talk a little bit about what we can do? Because it sounds kind of hopeless.

Yeah, I think there's a number of things we can do, Mark. In fact, on that note, one of our recommendations is we said that any organization, including, for example, the British Dietetic Association or the American Academy of Dietetics, if they take funding and sponsorship from food industry, they cannot claim their advice is independent. And we made that very strongly as one of our recommendations. We actually think- They should just put.

We'Re a shill for the food industry.

Well, you know, Mark, I mean, that's one interpretation. Absolutely. I know, and people would think that. And in fact, actually, that also brings into, you know, I believe in democracy and very much, but, you know, if you ask most members of the public, do you think this is acceptable? If you tell them, do you really think most people would agree? No, they would find it quite extraordinary. They would be surprised, probably. And they would find it unacceptable that their dietary advice is coming, is being influenced by the very industry that wants to sell them food that is contributing to chronic disease. So I think it's about transparency. But ultimately, the recommendations really concentrate from our paper on reducing sugar consumption through environmental change through regulation. So it's about getting, if we get the consumption of sugar down by at least 20% in the next few years, if we ban junk food advertising, essentially we reduce the consumption of processed carbohydrates significantly. we could very easily, if those were implemented, Mark, we could very easily reverse type 2 diabetes epidemic within three years. And on that note, when one looks at ultra-processed food, which is the major issue, there was a recent study published reporting in the Guardian newspaper in one of the nutrition journals that showed an association, very strong association, between ultra-processed food consumption in European countries and prevalence of obesity. And the UK came at top Okay? And even I was shocked the ultra processed food consumption in the average British diet, Mark, 50% of the diet, half of the diet is coming from ultra processed food.

Now, if you break that down- 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 were told to cut the fat.

And cut the meat. And we listen. The public health crisis we have is actually the big macronutrient, the big problem we're over consuming, which is the key component of ultra processed food, is starch and sugar. And this is what we need to get down. And that should be the public health message because we still hear, even in the UK, we need to get down the fat, sugar and salt. Why are we not discussing starch, ultra processed carbohydrates? Why are we not discussing that?

That is the big issue. Yeah, and you also talk about other initiatives like changing subsidies for commodity crops that get turned into processed food that artificially suppress the prices of the bad stuff and inflate the prices of the good stuff. Yeah, so, you know, we have to.

Make it affordable, Mark. I think one of the things that's also very true is that actually some people believe that falling a healthy diet, I think you can fall a healthy diet in a budget, but it's more difficult. A lot of the ultra processed foods are extremely cheap and the slightly healthy ones are more expensive. What we want to do is we need to shift that. And again, that will need government regulation so that we can make junk food more expensive. And we know that will automatically across the population will change eating behavior. And even those small changes, but if it was across a population, would have impact on public health. And again, I always look at these from a point of view of, are there any harms from this for the public or for my patients, you know, as doctors first do no harm. There's no harm. It's only positive.

And you also talk about, you know, other initiatives that change the food environment. that we live in because, you know, I had a patient once that said, you know, if I'm in this food environment, it's like an alcoholic living in a bar. It's hard to resist. So you talked about, for example, changing food advertising and banning advertising at sports events and getting celebrities to come out against junk food and soda instead of like Steph Curry and Tom Brady, who don't actually promote any of that junk, whereas others like the Ryan- They're setting.

A really good example. And, you know, this is what happened with tobacco. Eco is exactly the same thing. We can learn from that and do the same. Big Sugar is the same. We need, we know, the reason there's advertising and association with sport, it's a branding opportunity for them, increases their sales. So it's a very, and also there are certain things, you know, why are we allowing sporting events or the Olympic games? You know, I did a report for the BBC in 2012 as the angry cardiologist who said, we've got an obesity epidemic. Why are our main sponsors, the London Olympics, McDonald's, Coca-Cola, Heineken, Cadbury's. It doesn't make sense.

It's true. I had a friend who owns a basketball team and owns a stadium. And I said, why are you having these big jugs of Gatorade on the sidelines with the players? That's one bad for them and two, promoting some product that's mostly sugar and color and dye. He goes, well, we have to because we have contracts, but actually what's in there is not Gatorade because the players won't drink it.

Wow. That's really interesting. Yeah. So that, I mean that people need to know that, you know.

And also changing the environment, you know, how our supermarkets are structured, you know, changing what's at the checkout counter, changing what the end caps of the aisles makes a difference in behavior, those behavioral economics and studies that have shown that.

Yeah. You know, so we need political traction, Mark. And I think one of the things, reason I went to European Parliament, So, one of these members of European Parliament, Nathan Gill, who actually had type 1 diabetes, managed to reduce his insulin by 50% by going low carb. But only ten days ago, and this will be- It's low carb, higher fat.

Absolutely, of course, because the protein doesn't.

Really change much and you end up eating more fat for sure, 100%. And, you know, I wrote a book on this, as you know, which you've been talking about, the Pyeopie diet. Everybody should get. You know, which really tries to put, from my interpretation of all the evidence of where the best components of food of the Mediterranean and diet are and we need to reduce our starch and sugar and having really good effects and a lot of good feedback. But what was interesting is only 10 days ago, I got a phone call from the deputy leader of the Labour Party in the UK, Tom Watson, and the opposition party, he's a deputy leader. And he said to me essentially, he'd messaged me a few months ago and he said he'd lost 56 pounds effortlessly from cutting out starch and glucose from his diet essentially. And he'd followed my diet plan. And I was like, wow, this is amazing. And he's sustaining it. And I think when the politicians in influence of power, they almost have an emotional... They emotionally wedded to this because it's helped them as well. I think that kind of thing ultimately will have an impact because these are the people ultimately that can really change things in terms of government. And when they know what's going on and they realize, I'm sure in their own minds that they've probably been misled because they probably didn't deliberately think they were going to get addicted to sugar or the effects it was having on them. And then they got better. I think they realize actually, you know what? Everybody should have this opportunity too, and what is our role as politicians to help improve the food environment? So I think these things are happening and I think they will happen.

How do you suggest fighting this view that it's going to create a nanny state where we lose our freedom, a free market?

Yeah. So when people talk about freedom, so markets function, first of all, I've got to say, Mark, markets function best on perfect information. Right? So we're not actually practicing, you know, the current system is far from the perfect market. If people are not getting what they think they're getting, you know, the payer and the transactor need to know exactly what they're getting. And if people are being misled, then there's something wrong with the regulation. That isn't, I don't think society anyone would want to live in. So, and when you talk about nanny state, this is a term that's really used, in my view, is propaganda from people who want to keep perpetuating the status quo where they're benefiting and profiting from regulations that are so weak that they can mislead people into buying their products that ultimately causes them harm. Let's just talk about what at the heart of the nanny state is about personal responsibility. Yeah, let's dig into that one. So to define personal responsibility, you need to have knowledge, the correct information, which you don't have if you're being misled to buy something that's high in sugar that's got the American Heart Association label on it. Yeah. Okay, that's extremely misleading. That's not quite the right knowledge. and you need to have choice. And if sugar becomes so prevalent that.

It becomes unavoidable, you don't have choice. And it's also biologically addictive, which makes choice even more difficult.

Of course. Once you get hooked, it's hard to get off. Absolutely. So there's more reason for regulation. And actually, this nanny state argument doesn't stand up to evidence. Let's talk about evidence. The evidence tells us this doesn't stand up. This is nonsense. This is propaganda. People need to, these organizations need to be exposed. and if we don't do this, Mark, then really we are, we're in a big, we're already in a big mess in terms of chronic disease. Yeah.

I mean, think about it. Cars, you know, we, we all drive cars. Why shouldn't we be able to drive cars without seat belts and no airbags and, you know, no safety standards and poor emissions? Because it's not good for society and it saves lives if we do those things.

And those are all regulated. We don't call that a nanny state. No, we don't. And, and initially when seat belts were being brought in, The industry actually opposed it. The car industry opposed seat belts initially because obviously it was going to be more cost to them, more work, et cetera. And once they're in, same with smoking. I spoke to people who initially opposed the public smoking ban, but now realize it was a good thing. So those vested interests eventually- They had.

Airplanes and people lighting up on airplanes and they had a smoking section. That was sort of a joke.

Absolutely. So I think as the awareness grows and people become more aware, then I think this nanny state argument will not stand up and the politicians will respond to the public. But the way the public get their information is also through the media. In terms of getting it mass media has a huge impact on public opinion. So we really need to engage journalists and editors as well to realize that actually these discussions need to be had. You can't keep this information from the public. how long can you keep it from the public?

And it's also not a free market system. When the government, I don't know when it's in the UK, but in the US, 99% of subsidies in agriculture are for commodity crops that get turned into processed food, high fructose corn syrup, white flour, refined soybean oil, and 1% are for specialty crops. And we spend three quarters of a trillion dollars supporting junk food industry through food stamps. about, I think 18% of the annual revenue of, I mean, of Walmart is from food stamps. I think Coca-Cola has one-fifth their revenue in the US coming from food stamps and soda. No, you know, this is not a free market system.

It's not at all. It's not really a true free market. So I believe in the free market, but it isn't a free market. And people need to know that. And that means industry will do better. and if industry do better, great, because I'm going to quote my friend Robert Lustig here. He said to me once, Asim, I have no problem with people making money doing the right thing, but I have a problem with people making money doing the wrong thing. We need more people making money doing the right thing, Mark, and we don't have that right now.

So when you talked about the right thing in the European Parliament for two hours, which was extraordinary, what was the response? Did people listen? Did they shut you down? Did they try to kick you out?

No, I think a lot of people- They heckle you. No, I think a lot of people are hearing this information for the first time. And what was good, and I was particularly pleased when I did this, so I wanted people to know what was being talked about and to get the awareness out there. Because for me, it's not about Asimul Hotra, this is about the message, not the messenger. And the more people that hear the message, the more chance we have on winning this battle against chronic disease or the battle of truth versus money, as Marcie Angel, the former editor of New England Medicine, told me on the phone recently. This is what it's about. But the response has been generally positive. I think people are becoming more aware. It was front page of the i-Newspaper, in the UK, the fact that this was happening in the European Parliament, I had other people with me as well who were the former Queen of England's physician for 21 years. So Richard Thompson, he's fully on board with this. Absolutely. And he's had a lot of experience, a lot more experience than I am. He's been a doctor for, he's well over 70, I think he's close to 80 if I can't remember his exact age, but he's very smart and very experienced. And he says, Aseem, we need to keep going with this because this is the major issue. So the response has been positive. I then debated also the CEO of AstraZeneca. I was invited to speak at the Cambridge University Union.

Must have been fun.

And the motion was, this house believes we need more new drugs. And I basically said, actually, we need less drugs. We need more lifestyle. And this is the evidence of why we need that because the current paradigm, the current approach is failing our patients. So, you know, it's good that I've got an opportunity to get that message at that sort of level. But, you know, these people as I meet them, you know, he was a very friendly, nice guy. I thought he was a bit misinformed, to be honest, with the things he was saying. But I don't think these people individually are bad people. I think this is all again a product of a system failure, Mark. Yeah. You know, and we need to change that system. And the only way to change it is to tackle it at its root.

So then if you're if you're king for a day, the King of England or the King of the World, what would you do to change policy or a law or something that would make a difference in shifting this whole problem?

Wow, there's a lot of things, I think.

You can have a list, you got a whole day.

I'm into it, yeah.

What could you do in a day?

Well, I think, you know, make more and more people aware, patients aware, the public aware that actually we can use food as medicine, you know? It sounds a bit cliched, but it's true because we know how important, you know, we all need food to survive, but we need good food to stay healthy. Right? So, I would get that message out to every single person. I would empower every doctor to be able to prescribe food as medicine with the best available evidence. I would tell- Should that be paid.

For by insurance, by the NHS and Medicare?

Food prescriptions? Well, it's a good question. I think ideally not. I think ideally what you want is to make those foods affordable for everybody in society. So, even people who don't go to their doctor can can have the, you know, the opportunity to have a healthy dinner and see their doctor. But I would make, again, the healthy food affordable. I do whatever I could to do that. I would, you know, highlight the harms of the fact we have a, that, you know, that your best way to good health is not through taking lots of pills. To know that there are small benefits and you can choose to take it or not, because I believe in informed choice. Most people, I think, would probably choose not to take a pill for many of these conditions they have. And again, it's about also right care, getting the right care to the right patient, because When we're investing lots of money and spending it on very marginal or no gains through chronic disease with lots of pills for type two or blood pressure or cholesterol, we're also taking away resources from the people who need it most. So there's another ethical consideration there. So it's about redistribution of resources. At the moment we have a mild distribution of resources. So that's what I would also do. And the other things I think we're not going to speak a lot about in this particular conference, I think, but I think The other aspects that are so important to good health, Mark, are, as you know, and we've discussed this at length, is, okay, keep moving, don't be sedentary. It was a mindful movement rather than exercise. What about your, how good are your relationships with people, sense of community? Are you spending time with friends? Are you sitting down and having lunch together with your friends? Are you sitting on your own and having fast food? Are you sleeping well? What your stress levels like? All of these things we need to concentrate on together as a community, and then we will all be healthier and happier. And that really is the key. I think we need to put that to the very forefront. It's how do we, and this is not just about health. I mean, this is about happiness, this is about economic productivity. It's all of these things combined. So we're all going to win as a society now. If we tackle the obesity epidemic properly, there will be A few losers. I'm going to say a few losers. I'm talking about industry that have made a lot of money from selling junk food. And if you really tackle the food industry, there will be a few losers in that. But if we don't tackle the food industry, don't tackle junk food, Mark, everyone loses. Absolutely.

And they're trying to reconfigure. And these big companies are seeing the trend coming and they're buying up innovative food companies and they're trying to rejigger how they think about agriculture. It's just too slow.

Yeah, exactly. So we need to just keep pushing and we need to keep fighting for this message and we need to get it out there and we need to keep going. And there's no room for complacency, to be honest. We can't take our foot off the accelerator. I think we're at a tipping point, but we just got to keep going and see where it takes us. And our patience, Mark, as you know, and you've got this amazing clinic in Cleveland, which I look forward to visiting one day. And you've pined this well before even I was on the scene. But we know from our patients.

How.

Much better they get when they change their lifestyle. And it's not difficult. And they're so grateful, they feel better. And that's why we became doctors. And it's so rewarding when we see this happen. And when we know this works in our patients.

It's powerful.

We have to get that. Everybody needs to be doing this.

Well, I'm so thankful for you, Dr. Malhotra, because since you arrived in the scene, feel not so alone and I can relax a little bit. Someone else out there crying in the wilderness for what the truth is. And I just respect you immensely. I can't wait to see what's next and how we're going to do this change. And we're all working together as a whole coalition of us trying to make the change. And we're here at this meeting and we're working together and collaborating in all sorts of ways. And I'm just really grateful for your courage and your wisdom and your willingness to dig into the science, to look at the truth of what's happening in the politics and to call it out in ways that people can hear and listen. It's really inspiring. Thank you. Thank you, Mark. Thank you. And so you've been listening to the Doctor's Pharmacy with Dr. Asim Malhotra from the UK breaking down our views about saturated fat, statins, sugar, politics, and lots more. I hope you've enjoyed this podcast. And if you have, please leave a comment. It matters to us. Subscribe on iTunes wherever you get your podcasts, share with your friends and family, and we'll see you next time on the Doctor's Pharmacy. [Speaking of the foreign] Hey everybody, I hope you enjoyed the interview. Just a reminder that 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. If you're looking for help in your journey, seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, you can visit ifm.org and search there, find a practitioner database. It's important that you have someone in your corner who's trained, who's licensed, and who's a health care. It's important that you have someone in your corner who's a trained, sorry. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner and can help you make changes especially when it comes to your health. Don't forget, there's a way to listen completely ad-free. With Hyman Plus on Apple Podcasts, you can enjoy every episode without any breaks. Just open Apple Podcasts and tap Try Free to start your seven-day free trial.