Dr. Aseem Malhotra: STOP Believing the Lie About High Cholesterol | TUH #110

The greater the financial interest in a given field, the less likely the research findings are to be true. The most lucrative drug in the history of medicine are statins. Most of those people taking statins are either low risk or high risk. Primary prevention. Over a five year period taking a statin, the benefit is 1 in 100.

Big data proved otherwise, that there was no correlation between elevated LDL cholesterol and events of cardiovascular disease.

Actually, there is a correlation between LDL cholesterol and longevity. So the higher ldl, the longer you're going to live because it has a vital role in the immune system. So just because cholesterol is at the scene of the crime doesn't mean it's a perpetrator.

What causes this to become inflamed? How does stress directly impact that?

Chronic stress as a risk factor for heart disease proven to be equivalent to the risk of smoking, having high blood pressure or having type 2 diabetes.

And that is another one of those modifiable risk factors. Most chronic disease happens within us, not happens to us. So you recommend focusing on meditative therapies indirectly reduce your risk of cardiovascular disease.

This is really the root, you know, big part, if not the, the main part of the solution to.

Hey guys. Welcome back to the ultimate human podcast. Today's short is with British cardiologist Dr. Asim Malhotra. We just shot a full podcast. You got to go check out the full podcast. You also have to check out his documentary, do no Farm. P H A R M Farm. Fascinating. It's about two hours long. It's worth the watch. Get your family around and some popcorn and watch this documentary. But his work is just fascinating to me because he has gone from full blown cardiologist. Well, he's still a cardiologist. To really being an advocate for lifestyle intervention and lifestyle modification as a way to really impact the health and longevity of humanity. And as soon as the podcast ended, we started, we started talking about, you know, statin therapy and you know, we covered all kinds of things on the, on the, on the full length podcast and there's so many of you that have elevated levels of LDL cholesterol and the rest of your panel is, is normal. And I get so many questions about why am I, why do I try to vilify pharmaceutical intervention in, in statins? Well, I'm not a physician. Dr. Malhotra is, so I'd love to just open up a quick conversation with him about the history of statins and some of the work that he's published exposing the research into statin therapy for LDL cholesterol and how it may not be linked, may not be the villain for cardiovascular disease that it's been vilified to be. Does that sound accurate?

Yeah, yeah. I mean actually if you take a step back before I explain that John Ioannidis is, I call him the Stephen Hawking of medicine. He's professor of medicine at Stanford, most cited medical researcher in the world, statistical genius. And he published a paper which is the most downloaded paper in the history of medicine, Gary, in 2006 in PLOS One. Why Most Published research findings are false. And he gives risk factors for false research. And one of them he says is the greater the financial interests in a given field, the less likely the research findings are to be true.

No way.

Now that's relevant because the most lucrative drug in the history of medicine and one of the most lucrative trillion dollar industry are statins prescribed to between 200 million and maybe a billion people worldwide. Right. So what I did. So does it, can we apply that to statins, that concept? Absolutely. Most of those people taking statins are what we call haven't had a heart attack or been diagnosed with severe blockage. They are either low risk or what we call high risk. Primary prevention before having an event. And they're being prescribed a statin. What they are not told, Gary, is, and this is absolute fact, this is not me selecting data.

Right, Right. By the way, I'm going to pull some of this and put the links in the show notes so people can reference this.

So over a five year period, taking a statin based upon industry sponsored trials which have never been independently verified. So likely best case scenario, this is the exact conversation I have with patients. By the way, what I'm telling you, the benefit is 1 in 100. So in preventing a non fatal heart attack or stroke and not prolonging your life by one day. Now I tell the patients that information to help them make a decision. And most patients understand me. Gary say, well, to be honest Doc, I don't think that's very good odds.

Right.

And then there's anything else I can do. And of course we then talk about other lifestyle changes.

Right.

When it comes to LDL lowering, that is absolutely not part of what I do as a cardiologist because the data tells us, and you know this for many years, probably years before I understood.

This, without scientific data behind us, just because the statistics proved otherwise, the big data proved otherwise, that there was no correlation between elevated LDL cholesterol on its own.

Yes. And events of cardiovascular disease as an independent risk factor. When you correct for what we call triglycerides and hdl, which are all linked to insulin resistance, can be rapidly improved with diet. LDL is not an independent risk factor for heart disease.

And the ones that were independent risk factors or had an impact on independent risk factors like lipo didn't even have pharmaceutical options at the time to lower. In fact, I think as we sit here today, I'm not sure that there is any.

No, there isn't.

Pharmaceutical target.

There isn't. They try and get people on statins or other cholesterol lowering drugs. And that's the very single minded bad science approach, if you like. But the other side of it isn't just about the fact that lowering LDL has no harm. We know certainly in older populations that actually there is a correlation between LDL cholesterol and longevity. So the higher LDL.

Exactly.

If you're over 60, the longer you're going to live. Statistically.

Absolutely.

Because it has a vital role in the immune system.

Yes. So talk a little bit about the role of cholesterol in plaquing, scarring, narrowing of the arteries and how this mechanism. You know, I think earlier I use the analogy that, you know, when there's a fire, the firemen show up, it's called to that site. So cholesterol is kind of like the fireman. Right. It shows up to the site of damage. So is it the damage that is the risk factor or is it the cholesterol that is the risk factor? Can you expand upon that?

So just because cholesterol is at the scene of the crime, doesn't mean it's a perpetrator, right?

It didn't pull the trigger?

Absolutely not. And cholesterol really is a response. So we find cholesterol in these deposits, what you call these fatty deposits in the inner lining of the artery, we call these plaques, in layman's terms, that's furring of the arteries, but they're also there with lots of immune cells as well. So there's been a damage to the lining of the inner artery. Okay. Which is caused by things like smoking or sugar, high sugar diets, for example, Stress resistance. Stress, Right. And then the response to that damage to try and heal the artery is when you get these deposits and cholesterol is there. So cholesterol is not the driver, it just happens to be at the scene of the crime.

And when you say there's damage to the artery, I think people are like, what causes damage to the artery? I mean like glasses, not floating around your bloodstream, nicking your arteries. So what causes this arterial wall to become inflamed? How does stress directly impact that? Because that was another fascinating part of our discussion on the podcast and in my kitchen before the podcast. But can you touch on that, the impact of stress on cardiovascular disease? Because I don't think many of us.

Are realizing it's absolutely fascinating. So the mechanism, and that's been shown in one very interesting study published in the Lancet, is that when you have high levels of stress, your body produces more inflammatory cytokines, inflammatory markers, and more clotting factors. And that's the likely mechanism, the primary likely mechanism of how heart disease can be caused by chronic stress. And most of us are not dealing with it. And the level at which, why that's a problem, Gary, is that chronic stress as a risk factor for heart disease is now being proven to be equivalent to the risk of smoking 20 cigarettes a day, having high blood pressure, or having type 2 diabetes.

Wow. That is incredible. And that is another one of those modifiable risk factors.

Absolutely.

In mortality, we used to call these modifiable risk factors, and they would be things like diet, lifestyle, exercise, sleep, the things that the patient could control. And I think that there's a vast majority of people that really just feel like disease is something that happens to me. I woke up one day and I caught this disease. And the truth is that it happens within you.

Right.

I mean, most chronic disease happens within us, not happens to us, trauma happens to us. But rarely does disease just happen upon us. And so you recommend whole food, diets, exercise, but there was a very specific form of meditation that you told me was in this published study where they looked at the excitement of the amygdala, the emotional area of the brain, and how it correlated to the release of certain inflammatory factors and how, you know, focusing on meditative therapies could actually reduce these inflammatory factors and therefore indirectly reduce your risk of cardiovascular disease.

Yeah, pretty. To understand this as well, I think we have to start from understanding that or acknowledging that heart disease is not fixed. Again, we were taught in medical school, high blood pressure, type 2 diabetes, either chronic progressive disease, the same thing. Artery clogs up over time, gets bigger and bigger. You may have a heart attack at some point, you may have a complete blockage. But the reality is, because heart disease is a chronic inflammatory process, it means potentially it can be reversed. And the best data I've seen, the most extraordinary data I've seen, which comes out in the documentary, is from India, where this cardiologist for two decades has been adopting a lifestyle approach with his patients. But when he did a study looking at those patients, coronary arteries, where they had blockages that were at least 50 to 70%, so we'd say moderate to severe blockages, he found after a couple of years repeating their coronary angiograms, that their blockages had reduced by an average of 20% in the people that had adhered to the lifestyle program. But then he asked himself the question, what was it? Was it the high fiber vegetarian diet in this particular case, because they were devout Hindus? Was it the exercise, two 30 minute brisk walks a day? Was it the third intervention, something called Raj Yog meditation for 40 minutes a day? And the only independent factor in reversal of the blockages was the Raj yoga meditation?

That is fascinating to me, the reversal of the blockages, because I think most people that are watching this right now think that you can not continue to narrow an artery if you have a blockage, but there's no way that you could reverse that. And again, I'm not aware of any pharmaceutical interventions that target, you know, dissolving, fibrinogen clotting or fibrinogen clotting or what have you. So the thought that we could actually intervene and maybe reverse some of.

Yeah, it's extraordinary. I had to see it to believe it.

Right.

And you can see now people can argue if you're being a good scientist, okay, this wasn't a randomized study, et cetera, et cetera, but most cardiologists, in fact, I would say all cardiologists and doctors, won't even believe it's possible to reverse it. So I'm going there to India. I'm looking at these angiograms pre and post.

You physically went there and to see them myself.

And the patients came with their stories. There were scores of patients who turned up who wanted to tell their stories of their transformation of their lifestyle. But what they emphasized, Gary, which I think it takes things to another level, and I think we can give a plausible explanation for this even biologically, is it was a spiritual transformation for them. They introduced this sort of breath work, meditation practice, but it went beyond that. You know, he would get the families in with the cardiac patients for seven days in this ashram, talk about what's causing the manga and stress, their relationships, their work. And it was all of that, really treating all of that. And these people, you know, became more spiritual, if you like, broke addictions. And I think all of that together, you know, everything comes back ultimately to the mind in my view, and where we're going wrong in society is our loss of connection with what it means to be human, loss of connection to nature, loss of connection to each other. This is really the root is, you know, is a big part, if not the, the main part of the solution to saving humanity from the current trajectory we're going in, which is, is very, very bleak at the moment. And it gives us hope that there is something we can do as individuals, but also as a society.

So do you recommend that aside from, you know, dietary and lifestyle changes, where can someone find out, where could they start a journey towards meditation? Because, you know, as a full confession, I've tried many, many times to meditate. I've had guided meditation. My, my wife and I went to a nine day Ayurvedic retreat in the Boone Mountains in, in the Carolinas, which was amazing. And I got a lot out of it. You know, we did some chanting at the end of the day. We ate all, you know, Ayurvedic foods for the, for the week. And I did some guided meditation sessions. I do breath work every, every morning and I do horizon gazing and I allow sunlight in my eyes and immediately when I'm done that session, which cost me zero, I feel demonstratively better. And a part of it is I just try to focus on my breath. I horizon gaze and try actually not to allow thoughts to enter into my mind. And I do three rounds of 30 breaths. I would say of all the things that I have in my routine, that's not only the most consistent, but it's the one that is the most portable. I could take it anywhere that I go. When you have red light therapy beds or PMF mats in your bed, they're hard to, to take with you when you, when you travel, but the breath work can travel with. Where could somebody find out how to practice this, this style of meditation? And how long does it take for someone to do this? And do you do it?

Yeah, I actually, yeah, I, I tried to follow my own advice absolutely, Gary, I do. And especially, especially when you people like us, when we stick our head above the parapet, there are obviously lots of external, you know, obstacles that come, come our way. And, and yeah, I do about 40 minutes, 30 to 40 minutes of breath work first thing in the morning and do a diaphragmatic breathing. I personally, I learned this from a cardiac nurse who's in my documentary who, you know, individualizes a bit of psychotherapy and breath work for my patients. So she taught me how to do this but, you know, I've, I think if people, if they want a very easy, simple way, I think if they just go to YouTube and, you know, and look at doing breath work properly, and it's a form of diaphragmatic breathing specifically, they can at least start from that perspective.

Diaphragmatic breathing. And what was the form of meditation that you referred to?

It's called Raj Yoga.

Raj Yoga.

R A J, which means king Yoga. Yoga.

Raj Yoga. Okay. Raj Yoga meditation. So, guys, I just wanted to run a quick podcast short with Dr. Malhotra. Please check out the full length podcast. But what we've been saying for so many years, the big data is going to set us free. We knew years ago that big data was pointing to this fallacy that LDL cholesterol is linked to cardiovascular disease and that the lower the better, the higher the worse. Even though in the data that we were looking at, LDL cholesterol as it rose was a marker for longevity, not cardiovascular disease. So it's so nice to be vindicated by practicing cardiologists like yourself that have the data to back it up. And thank you again for taking the extra time to do this podcast short. And as always, guys, that's just science.