Why Lowering Cholesterol Won’t Save You: A New Approach to Heart Health with Dr. Aseem Malhotra

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I'm JJ Virgin, PhD dropout. Sorry, mom turned four time New York Times bestselling author. Yes, I'm a Certified Nutrition Specialist, Fitness.

Hall of Fame, and I speak at.

Health conferences and trainings around the globe.

But I'm driven by my insatiable curiosity and love of science to keep asking.

Questions, digging for answers, and sharing the.

Information I uncover with as many people as I can. And that's why I created the well.

Beyond 40 podcast to synthesize and simplify.

The science of health into actionable strategies.

To help you thrive. In each episode, we'll talk about what's working in the world of wellness, from personalized nutrition and healing your metabolism to.

Healthy aging and prescriptive fitness.

Join me on the journey to better health so you can love how you look and feel right now and have the energy to play full out at 100. Heart disease is the leading killer of.

Women in the United States.

Now, we've been told that lowering cholesterol.

And avoiding fat is key to prevention.

Yet cardiovascular issues continue to rise. So what are we missing?

Think about it. Despite all of our advancements in medical.

Science, we're popping statins like candy and more people than ever are suffering from heart disease. Something just doesn't add up. In today's episode, I'm talking with Dr. Aseem Malhotra about the real causes of heart disease. And guess what? It's not what you've been led to believe. We're talking about the role of inflammation, insulin resistance, and yes, even stress in heart health. And we're going to explore why focusing solely on cholesterol might be missing the forest for the trees. Dr. Malhotra is a cardiologist who's been turning heads in the medical community for years. He's been named one of the most influential science and medicine figures in the UK alongside Stephen Hawking, and has enlisted celebrities like Jamie Oliver. And in his crusade to improve public health, his research on the true causes of heart disease has garnered global attention with his publications achieving one of the highest impact scores worldwide for a doctor. From challenging the sugar industry to taking on Big Pharma, Dr. Malhotra brings a fresh, evidence based perspective to Cardiovascular Health Dr. Malhotra will share his groundbreaking approach to heart disease prevention and treatment based on years of research and clinical experience. We'll unpack the complexities of medical research, explore the influence of industry on health policies, and discover how targeted lifestyle changes can dramatically impact your heart health.

This was a great conversation and I.

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Dr. Aseem Malhotra I am super excited to be here in London with you.

Lovely to meet you.

It's very fun. So when I was coming to London I was looking at who do I want to make sure that I get to sit down with Lori Roman who used to work with Dr. Mark Hyman, said, you must go find Dr. Aseem and here you are in the flesh. So I am thrilled to be unpacking a lot around heart health because it isn't something that we've talked much about. I know that a lot of what you've talked about, you've got some criticism on public health and I want to dig into that. Where do you see that in terms of the Dietary Guidelines for Women to Prevent Heart Disease? Where are we going wrong?

It's a great question. It's a very big topic, something I've been researching and being an advocate on for well over a decade to answer that question. I think one needs to try and understand what is at the root cause of heart disease. On the diet side. One thing I realized certainly since I qualified as a doctor in 2001, is that the, the traditional thinking, which is still, I think very prevalent, is that if you eat low fat foods then you are going to help prevent heart disease. And that is based upon again, flawed science which tells us or tells people that lowering fat means lower cholesterol and low cholesterol is the roots of preventing heart disease. And I realized quite early on that that was very flawed. And I think one thing people need to acknowledge in terms of how we even change the narrative about modern medicine and medical science is that 50% of what you learn in medical school will turn out to be either outdated or dead wrong within five years of your graduation. The trouble is nobody can tell you which half. So you have to learn to learn on your own. Because medicine is not an exact science, it never has been. And it's constantly evolving. It's a science of human beings, it's an art. So there was a flaw in the original hypothesis around cholesterol. And then what happened was it got captured and taken over by the big food and big pharma. And this is probably a trillion dollar industry beyond even that when it comes to how much money is made from these so called low fat foods which often then replace the fat with sugar. And everyone knows the story around that. So I think we start from that point and my own independent research published in peer reviewed journals, in fact, one in 2020 actually showed that even drugs are very potent at lowering LDL cholesterol, the so called bad cholesterol. There was no consistent relationship even from drug company sponsored clinical trials with it preventing heart attacks. So for me, and I say this very openly and I say it to my patients and I write it in my notes and no one's Been able to challenge me on this because I'm very precise. Focusing on lowering cholesterol essentially for the sake of. It is a waste of time, complete waste of time in preventing heart disease. And it's not just a waste of time. There's an indirect effect. If people focus on lowering cholesterol, it's not going to prevent heart attacks. They are going to detract from more meaningful solutions to prevent heart disease, which essentially the big, sort of the biggest cluster or biggest risk factor is insulin resistance. And that's pretty clear in the literature. It's just not well publicized and partly because there's no market for the message because how do you combat insulin resistance? Lifestyle essentially dietary changes, eating real food, avoiding refined sugars, refined carbohydrates, moderate exercise, reducing stress. That is essentially the be all and end all of tackling, preventing and even reversing heart disease.

I'm surprised you could even get what you got published. Published.

Yeah, it's very interesting. I first created that so called controversy in 2013 in the BMJ and the title of the article, and it was just a commentary, it was peer reviewed, but 800 words it was called Saturated fat is not the major issue. And the BMJ press released it and I didn't expect it to have the impact it did, but it was a front page of three British newspapers. I was on CNN International, Fox News, Chicago, all over the world. And I think I committed, in some respects I'm for the truth, right? And I was trying to advance the discussion, but in some ways I had committed medical heresy because I had, in that one, 800 word piece I'd basically said we've got it completely wrong about saturated fat, we've got it wrong about cholesterol, we've over medicated millions of people on statins and actually we should be focusing on sugar. So in that piece, that wasn't the intention. I was trying to put the jigsaw together. I'd essentially taken out two industries as well as medical dogma. So you can imagine the backlash that happened.

Yeah, I'm surprised you didn't need a bodyguard on that one.

There was huge backlash actually. But there was also the advancement of the debate and then more studies started to basically confirm what I had said is to be true. And we are where we are now.

Thank God for your courage. I wrote this book called the Sugar Impact Diet. And when I was writing it, I did a lot of research to try to figure out how we got so wrong in this, you know, low fat, high carb situation. And when I dug through it, it was two guys. Now I'm trying to remember, it was Ames. No, it was not Ames. There was two guys. One guy said, everything is because of sugar, basically. Another guy was like, everything's because of fat. And he completely discredited the sugar guy.

Yeah. John Yudkin and Ansel Keys.

Yes, yes, yes. Ansel Keys, yes. One of the most problematic people. I'm sure he didn't do it. He wasn't trying to do it. He truly believed it, but, boy, did he create a major mess for all of our.

Absolutely 100%. And, yeah, you're right. I think he genuinely believed what he was saying was correct.

And a huge industry. Think about it, that was back when, and I remember I was in LA at that time and doing nutrition and fitness consulting and everything was eat as close to zero fat as possible. I was actually working out of the Pritikin center. So it was 10% of your calories from fat.

Yeah, yeah. I mean, yeah. The sugar industry also funded Ancel Keys, and I think that didn't help the situation as well.

Wow.

Yeah.

Wow, wow, wow.

Okay, so that you. So you. Now, one other question before we get into insulin resistance.

How did you start to see all this?

You were trained in a very specific thing, you know, how did you start to go, wow, what if what I learned is not correct?

It's interesting. I think part of my nature has always been somebody that I have a very curious mind. I have always. And maybe I was brought up that way. I've always had a healthy skepticism of authority and power, especially because it's abused. And for me, a lot of my advocacy started was informed by my patient experience. So seeing all these patients, I worked in frontline in the NHS and I trained in interventional cardiology, which is essentially keyhole heart surgery. But I was just. I'm very sensitive to my environment and to suffering around me, and I'm very curious. So I think that combination made me think, hold on, something's not right here. Patients are not getting better. More and more pills. Statistically, we could see heart disease. We had not eradicated heart disease, even though it was predicted by the late 90s that because the cholesterol hypothesis had gained so much traction, there was a prediction when statins came on the market that actually we're now going to see the end of heart disease. And it didn't happen. And because of that, I thought, okay, something's not quite right here. So then I think my curious mind then led me to look into more and more alternatives and other research and then. And think about that carefully with my patients. So that's how I kind of, I think, went down that road.

So statins are still. Still like this primary intervention and cholesterol is still the bad guy.

Yeah.

And, you know, what can you say to someone, because I still get pinged all the time on social about this. How can you help someone see that this maybe isn't the right direction so they feel more comfortable about it? Because I still think there's a lot of fear around it and that I need to be on a statin.

Yeah. So it needs a conversation. I think if people want resources, you know, one of the. I think the. One of the best mediums in a easy to understand, concise fashion probably is the third book I wrote, which is called A Statin Free Life, where I talk people through it. But essentially, I think we start from a position of understanding that cholesterol is essential for life. Without cholesterol we would die. It has so many important functions, whether it's hormone synthesis, whether it has. It's important for brain cognitive function, it's important in the immune system. So if you start from that, actually cholesterol is something that we produce naturally, so it has a role to play. So we start from there. I think the next thing is then to help people understand that a lot of the current belief system around cholesterol was based upon flawed science. And then talk them through that and then give them an alternative that they can focus on around their dietary patterns. I think with the cholesterol issue, it's a little bit more nuanced. The traditional thinking has been there's a bad cholesterol and good cholesterol ldl. We need to keep that as low as possible to prevent heart disease. But actually, when you look at all of the data, the most predictive aspect of cholesterol profile for heart disease is your triglycerides and your HDL within the cholesterol profile. So you want your triglycerides to be less than your hdl. And the best way to achieve that from a.

You want your triglycerides to be less than your hdl?

Ideally, yes, ideally.

So where do you like to see? Is it just that it's less or are there specific numbers you're looking for?

Yeah, actually, I think it's a bit complicated because in the UK we use millimoles per liter, but I think in the US use milligrams per deciliter. So the way. So I know both, because I was.

Like going wow, that's really low. Triglycerides and high. Mine actually are, but I think that might be.

Yeah. When you convert it to millimoles, which you can do, then you want the ratio probably will look better, but essentially you want your triglycerides to be less than 150 milligrams per deciliter, if I remember correctly, in the US units.

Yeah. Which I think is still too high.

Yeah. And your HDI agree. And your HDL should be above 50 milligrams per decibel. Okay.

Yeah. And we do it as a ratio.

Yeah. If you got it there, then you're in pretty good shape.

So as long as it's a 3 to 1, but ideally more like a 2 to 1 ratio.

Absolutely.

Are there other markers beyond triglycerides and HDL that you would recommend looking at?

Absolutely. HBA1C. So you want. You need not to be pre diabetic, essentially. Right. So you want your HBO1C to be normal.

And what do you consider normal?

Well, in UK units, less than 5.7%.

We're the same.

Yeah, fine. So less than 5.7%.

So actually, where do you really want someone to be?

Well, it's interesting because I think we can get a bit obsessed about this, over focusing on biomarkers, thinking that if it's, you know, is a 5 better than a 5.2 probably doesn't make much difference. You know, they're kind of. I think there are. There's a spectrum and as long as you're in less than 5.7, to be honest, it's going to vary from person to person. And then the other thing that's really important is blood pressure. So you want your blood pressure to be Ideally less than 120 over 80. Above 120 over 80, you get into pre hypertension and then it becomes mild hypertension. So high blood pressure. So less than 120 over 80 is good. So if your blood pressure is less than 120 over 80, your HPA receive less than 5.7, your triglycerides and HDL normal, and then your waist circumference for a Caucasian female should be less than 90cm around the belly button.

We'll translate that into inches.

That will probably be around. So it's 2.5 centimeters to an inch, isn't it? So math on the fly, 35, roughly.

So I like to do. You should be half or more your height.

That's another way of looking. Absolutely, yeah. 100%.

Well.

And it's because being 6ft tall, you know, I always went, surely my waist, ideal waist circumference is not the same as a woman who's 5ft tall. This makes no sense. But yeah, and tell everyone why it's so important to look at a waist circumference.

So it's an indirect marker of essentially belly fat and your belly fat, stomach fat is an indicator of risk because visceral fat, the intra abdominal fat, is a substrate for chronic inflammation in the body, essentially, which is not good because heart disease, actually. So one of the. I published a paper in 2017 in one of the BMJ journals and again, that created big news headlines because there were two kinds of.

You're just a troublemaker.

Yeah, well, I actually write things for the sake of having impact, otherwise I don't bother, you know, as in it's not for the sake of publication. Like, if I'm going to say something and I believe in it and I've spent time on it, then I will do everything I can to maximize the impact of that. And often that involves the journal press releasing it. In fact, that broke the record, interestingly, for the journal, like more than a million downloads for a medical journal article.

Wow.

But this time it wasn't a Seymour Hotra on his own. I had two editors of medical journals who were both cardiologists. So Pascal Meyer, who's the editor of BMJ Open Heart, and then Rita Redberg, actually, she is probably the most eminent female cardiologist in the world. So she was editor of JAMA Internal Medicine, she's based in California. And I spoke to them, said, yeah, we need to do this article. And part of the article again was saying that we've overdone it on cholesterol. And actually we need to understand that heart disease is a chronic inflammatory condition which can be best managed with lifestyle changes.

Now, well, being a lifestyle person, like, I love this. I feel like finally the exercise physiologists and nutritionists are the rock stars here. Too bad we can't create some kind of prescription patent something around us. Are you doing anything to assess inflammation directly?

Yeah. So interestingly, insulin resistance and inflammation tend to go together. So if you sort out the insulin resistance, get your markers in the right range, we call that metabolic health in general for a lot of people who are in the abnormal range, if they've got. And I'll talk about the inflammation markers a second, once they correct that with dietary changes, for example, then the inflammatory markers tend to get better. Probably the most important, I mean, there are lots of inflammatory markers, you can use. And there is obviously there's also a little bit of a culture which you have to be careful of, of over testing and doing lots and lots of tests because, you know, one of the most important things we learned in medical school, don't organize a test unless it's going to change your management plan. Right. But I think one of the most reliable ones is high sensitivity CRP C reactive protein. And that's quite a sensitive marker of chronic inflammation. So if that's also normal and your metabolic markers are also normal, you're probably at very, very, very low risk of developing heart disease in your life.

And you're one of the few in the U.S. at this point.

Yes.

Gosh, it's less than 7%. It's crazy.

Absolutely.

And are you looking at fasting insulins as well or no.

Are you assuming you can do that too? That's a good point. I think that's an extra one to add in. Fasting insulin can be very helpful too.

Yeah. I always feel like when they're looking at blood sugar, if we looked at insulin, we'd see it before we'd see it on the blood sugar.

That's true.

See it on.

So I mean, insulin resistance and a raised fasting insulin can predate type 2 diabetes for about 20 years.

I love all this because I know one of the fastest ways to improve insulin sensitivity is just get people to exercise. So makes me thrilled. What are you. What is your recommendations? Because I know you also wrote a book Piopi or Pipi Diet.

My first diet was Piopi diet. Yeah.

Okay.

Which is based upon actually the home of the Mediterranean diet where Ancel Key spent a lot of time doing his research.

Ah, yes. Okay. So tell us about the diet and what you would someone coming to you now what would you. That. That has. Let's say they've got their hemoglobin A1C is 6. They've got a big waist circumference. Are you doing. Are you doing more advanced body. Body composition? Are you looking at Dexa's?

No, I don't feel I need to.

You got an. Again, it's a waste.

Yeah. Because I think again, for me, you know, one of the things I'm very conscious of, jj, and it's a big issue is medical and healthcare practitioners and I say this broadly exploiting patients for money. Right now you can have a mindset where you think actually it's good to do lots of tests, but if you know your stuff well, then actually I try and minimize the amount of tests that people need because the management plan is going to be the same anyway. So I don't tend to do all that stuff because, you know, I get them on a plan. And of course people can do that if they're interested. There's no issue, there's no necessary harm from it. But I don't think you need to do it.

For most people, yeah, you can pretty much guess it if they've got a big waist circumference. So they come in, they have that.

What.

What do you recommend?

So my first of all, I think so my, in the Piopi diet book and even my second book, the Immunity plan, one of the narratives that needs to change, and I'm sure you know this very well, jj, is that people's health markers of disease, and heart disease in particular, actually can get rapidly improved just within a few weeks of changing diet. 21 days. Actually, you know, I've had patients who have sent their type 2 diabetes into. To remission in 21 to 28 days of just diet, not exercise, just. I'm not saying exercise isn't good, it's important. But that's the biggest impact on your, on your biggest lever.

I like doing that first too, because if you give them both, they do nothing. So.

No, of course.

Right.

And also I think sometimes actually if you over, especially people quite overweight, and I'm sure you have a lot more experience in this space than I do with the exercise side is actually sometimes the over exercising and the diet stuff, it can be not very good for their body, their joints. So it's like get to a kind of healthier weight and then actually the movement becomes easier because otherwise injuries, all that kind of stuff can happen. Right. So I keep the exercise quite simple initially to say just do 30 minutes of a brisk walk a day or whatever else. You know, just keep it simple, focus on the diet. So my default diet, and there are different approaches to this, when you look at it from a heart disease perspective, I call it a low carb. When I say low carb, I mean refined carb people still, I recommend lots of vegetables and low sugar fruits, A low refined carbohydrate Mediterranean diet. So eliminate the refined starches and the sugar. Focus on anti inflammatory foods which have an evidence based behind them. Right. Nutrition science unfortunately is not great in terms of the literature for lots of reasons. But the stuff that's there, there's enough, enough to tell us that extra virgin olive oil, nuts and seeds, omega 3s from oily fish, a mixture of whole fruit and vegetables if you get that as your sort of staple diet, you eliminate the refined carbs, then I've got no issue with people having cheese or steak or whatever else. And that tends to work for patients.

Yeah, I mean that's, that's like my diet too. It's very simple. It's not hard.

No.

Eat protein first. Get your vegetables in, eat some healthy fats. Done a little bit of fruit. Have you been following the latest? I don't know if it's just in the States. Some research article came out about omega 3s being bad for your heart health.

I haven't seen that, but interestingly, when I looked at the literature, when I wrote my books, that was there and I was hoping that we would see it. Overall, the evidence based on Omega 3 supplements doesn't seem to show. When you look at all the evidence doesn't seem to show much impact on heart disease. And one of the reasons for that, JJ could be that the benefits of Omega 3 seem to be in the foods with the synergy of the omega 3 with other foods. For example, something else within the fish, maybe the olive oil as well. So I think that may be a reason why it's not on its own. Doesn't seem to have very clear impact. But if some of the patients, for example, if you're vegan or whatever else, or they're, well, they may, or they.

Hate fish or whatever.

Yeah. Then fine, I don't see any harm from it. But I haven't seen that in the latest research on that.

Yeah, it is so hard with nutrition research to keep everything the same. You have to put them in a metabolic ward. So that's the other part you look at and go, did they do an omega 3 index? But there was all this blow up around us and it's like, you know, I think they. I had a son with a traumatic brain injury who we basically brought back using high dose fish oil.

Amazing.

And I, I think we just can optimize that. But if you're eating a lot of fish, great. But most of our people aren't.

No, they're not.

So there you go.

And also you've got to look at the funding of these sometimes. I mean, you know, who benefits from telling people Omega 3 supplements are no good? Well, it can benefit the pharmaceutical industry. Say, well, okay, you can take a statin instead.

Right.

So you've got to look. There's all these other sort of factors at play in some of this literature, which becomes obviously very confusing for people.

Yes, I know. I think if you were an Alien and you came down to this planet and you walked into a bookstore and went to the diet section. What the heck would you do?

Sure.

It's ridiculous. Where if you really look at the foundation of all of them, it's eat real food first.

Absolutely.

So let's just say on that, yeah.

Again, it's ultra processed foods. Right. 60% of the calories in the US same in the UK coming from ultra processed foods which are designed by the food industry to be hyper palatable, probably addictive, you know, and are going to cause you chronic disease, which is great for the big pharma.

We were amazed though. We went to a grocery store yesterday and my husband poured, pointed out, he goes, we're in this grocery store and.

We'Re in the middle aisles and it's.

Refrigerated in real food. And way in the back was some food that was processed, but it wasn't even the ultra processed garbage. I'm like, I mean, even our whole foods and sprouts don't have that. They still have all this junk food posing as health food, which I think is even worse because people think they're in a safe space, right? Absolutely.

Again, that's another, another. You know, it highlights the fact that this is predominantly the obesity epidemic is predominantly a food environment problem.

Well, how could it not be? Look at the 1900s. Like that's when I was writing Sugar Impact Diet. It was the average person ate five pounds of sugar a year. There were no ultra processed foods and now it's 150 pounds. You know, and I still remember when all of that. I was raised on Pop Tarts and Captain Crunch and Cocoa Puffs.

So was I so right.

We got through it. I rebelled at.

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Chicago, IL 12 what about so for women? Because I know once women go through menopause and I'm just wondering, my hypothesis is the reason women are at higher risk for heart disease postmenopausal is because of the Women's Health Initiative, that if they are replacing hormones, well that their risk would be the same as pre likely. I don't know if that's right or not. But women signs of heart disease or heart attack. How does this differ from men?

That's a good question. So the classic symptoms of heart disease, certainly angina, which is a symptom of a blockage that is likely there in your heart arteries, which manifests itself with a, a discomfort usually with exercise, relieved by rest. The classic symptom is a central chest heaviness that may go into so not left sided, so left sided pain. Interesting. Is what we call atypical. That's not typical heart pain. Central chest heaviness that goes up into the neck, down the arms, for example. With women it can sometimes present differently. It can actually be on the left side, et cetera, it can be in the stomach. So the way we normally when we, you know, we take a history, I mean 80% of your diagnosis in medicine comes from the conversation. We call it the history. If you're a good doctor, the bad doctors do not take good histories and rely on tests. And then the tests can be flawed and it becomes, it takes a long time to get. So good doctors know 80% of your diagnosis will come from the conversation asking the right questions in terms of understanding what the symptoms are. So usually with women, again I would take the history what kind of pain or discomfort you're getting, Is it happening with stress or with exercise, even if it's left sided. But again also do they have any risk factors? So if you've got like a 4 year old woman who is slim, has not got high blood pressure, no family history, non smoker and comes with chest pain, the first thing before I've even gone into detail about the chest pain, I am almost excluding the likelihood of it being hot. So you have to look at all.

Of that together and what role do hormones play.

Our traditional thinking on? So up until the menopause, women tend to get very low heart disease rates compared to men. And that's why still on average women live about 10 years longer than men do. Right. Because heart disease usually is the bigger killer in older age. That seems once they hit the menopause, the rates of heart disease then start to level out a little bit, tend to become similar to men. And the thinking is estrogen is protective. So that's probably the reason I think more than anything else, estrogen probably has a protective role. Now does hormone replacement therapy have some protection? Again, it's a controversial area. We seem to think there is evidence that it does, but now it's being contradicted. So it's difficult to know for sure. To be honest, I wouldn't have an answer for you on that right now. But. But, sorry. But of course, the stuff we're talking about is actually the most important anyway. The lifestyle stuff.

Right. Everything that's going to improve insulin sensitivity.

Absolutely.

Which I think of three things. Change your diet and again, just what you described. Do resistance training, because now your muscles can soak up the glucose. And sleep.

Yeah, yeah, absolutely. Sleep and chronic stress. Big one. Which is ignored. I think it's going to get a lot more attention as we move forward in the next few years. But that's a really, really important one, actually.

Yeah. I think the challenge has always been, you know, you can measure muscle, you can measure. And like all these other things are very easy to measure. And now we're starting to have some ways we can measure stress. You know, at least we have hrv. At least we have some things.

Absolutely. And I think that, to be honest with the way society is at the moment, my default now, almost all the patients I speak to, all the women who've had heart attacks or whatever, the default is they are super stressed.

And how are you just getting that from talking to them?

Yeah. So I think there is definitely some validity in the subjective discussion. I start with a very basic question. On a scale of 0 to 10, how bad are your stress levels in the last few years? And I say zero being no stress. Think of a Buddhist monk meditating on a mountain and tend to be very high levels. And almost everybody JJ is above a 7. And then, okay, what are you doing about it? And they don't really. They're not really doing anything. So then we have to get a little bit more into that. You know, one of the things I do prescribe is meditation and breath work. The strongest data we have on heart disease reversal actually is meditation.

Really.

So there was a paper published in one of the Indian journals, and I actually went to meet this cardiologist and we'll come on later on to my documentary, which will. This will come out in my documentary, but it was called the Mount Abu Hat Trial. So the cardiologist in India in the early 2000s, he took several hundred patients who were diagnosed and they met male and female diagnosed with at least moderate to severe blockages. So they had at least a 50 to 70% narrowing in their blood vessels, in their coronary arteries. For some reason, they either couldn't afford or didn't want a stent or a bypass operation. He put them On a healthy lifestyle program. No drugs involved, really, pre stents. And that lifestyle program in India, because a lot of them were devout Hindus, involved a high fiber vegetarian diet, two 30 minute brisk walks a day for exercise, and something called Raj yoga meditation. And then he repeated their coronary angiograms after a couple of years. And in the people that had adhered to the lifestyle plan, there was an average reduction in the narrowing of 20%, which is unheard of. If you ask them as cardiologists, can you reverse blockage? They'll say, no, it's not possible. And this is what happened. So then he did a deep dive and looked at what was. Was it the diet, was it the exercise, or was it the meditation? By far the only independent predictor of reversal of the blockages was 40 minutes of Raj yoga meditation per day. Now, that involved a form of breath work, but actually it was much more than that which comes out in the documentary. It was almost like a spiritual transformation. It was about thinking about how you process stress, anger, your relationships with your family, with your partner, all of that, and even got their family members involved. And they spent a week in this ashram, if you like, in India to help them understand how the mindset is actually affecting heart disease. It's extraordinary. And we have biological mechanisms of how this happens. Lancet published a paper in 2020. They took subjective stress scores on people. These are young, healthy people. And they correlated that with an MRI scan of the brain, looking at an isotope that essentially became lit up in the amygdala, which is the emotional center of the brain. And then they measured inflammatory markers in the blood, and there was a perfect correlation. And then also that correlated with outcomes in terms of heart attacks. So chronic stress essentially increases clotting factors and inflammatory markers in the blood.

Gosh, it'd be great to do a repeat study of that where the only variable was the meditation.

Absolutely. 100% that needs to be done.

I mean, that's crazy.

Yeah. And this guy in India actually did. Did a randomized control trial, because I.

Said, how do you randomize control meditation?

Well, what he did was he basically did two groups where he put them on usual care and then one group with the lifestyle plan, which included meditation. And this is not the original study he put in.

So one was with the lifestyle that. And the other one included the meditation.

Yes, essentially. And he followed them up and he found there was a significant improvement. I said, why have you not published this? Well, he basically said that. That there's a resistance within the medical journals. Because they're all captured by pharma.

Right.

And he said, I remember when I had a chat with him, he told me that it was one of the American heart groups, I can't remember the. Aha. They came to see him in India and he presented their data and words to the effect he was told politely that this is not going to get published because it will affect the stent business.

Well, let's talk about your documentary. This needs to come out. I'm so super excited about this. This is a great lead up to what you have done here. This first do no Farm.

Yeah.

Which is a great name. And that's P H A R M. Yes. So let's talk about this documentary and what's in it.

So my work over the last 10 years, other than trying to change the paradigm on heart disease, is also trying to understand how have we what in the system is suppressing good quality information for patients to improve their health. And in that journey, jj, I discovered that essentially the top line, if you like, is that medical knowledge is under commercial control. But most doctors don't know that.

So what does it not know that they know where their education is funded by? Right.

Well, they think, I think that the information that they use to make clinical decisions on, say, a particular drug has gone through a process of approval by regulators, even though they know drug companies are there to make money. But what they don't know is that they design the clinical. A lot of them don't know this, that drug companies design the trials themselves. Right. And what happens is. And this will be exposed in the documentary in a more detailed fashion, and these people will probably find this really extraordinary. Before the drug companies have even done the trial on the drug themselves and conducted the clinical trial and drug, they say, we've got this drug. How do we want to market this? How many people do we want? How much money do we want to make? They start from there. They reverse engineer it, they reverse engineer it, they then design the trials, they do their own analyses, they hold onto the raw data. And what they do is they give the summary results of those trials. Summary results. And often the raw data is thousands and thousands of pages, which needs independent verification, but never happens. They give the summary results to the regulators. Our regulators only rely on the summary results. But also there's another bias. They get most of their funding now from pharma. So The FDA gets 65% of its funding from pharma. The regulator in the UK gets 86% of its funding from pharma in Australia. It's 96%. It's crazy. Again, most doctors don't know this. I gave a talk a couple of years ago and the chair of the British Medical association came to my talk, and he didn't even believe. He was gobsmacked. When I showed information from an investigation in the British Medical Journal showing these conflicts, he couldn't believe it even. This is the chairman of the British Medical Association. So a lot of this is ignorance. And then what happens is the regulators approve those drugs and then doctors think. And then another way of bias is the way the data is presented in the medical journals is also biased as well, where they underplay that. So ultimately what happens is the way that the data is produced will grossly exaggerate the safety and the benefits of that drug. So there's no informed consent going on. Then you've got the doctor in the consultation room prescribing the pill, whether it's a statin or a blood pressure pill or a diabetes drug. And the patient is completely misinformed. So the way I describe it is that we have a pandemic of misinformed doctors and misinformed and unwittingly harmed patients. And the factors behind it are biased funding of research, research that's funded because it's likely to be profitable, not beneficial for patients, bias reporting in medical journals, biased reporting in the media, biased patient pamphlets, commercial conflicts of interest, and then an inability of doctors to understand and then communicate health statistics. Imagine all of those layers resulting in a patient taking a pill if they were fully informed. Jj, in many, if not most cases would not take the pill. And then we're not even telling about lifestyle. So this is a mess. This is. Yeah.

And yet when I go and speak at a medical conference on diet and lifestyle, I have to disclose, if I'm hooked up with a nutrition, with the supplement company, like, I have to disclose everything.

Yeah, I know.

And I'm questioned and you're questioned by.

People who are actually even, you know, listen, we've all got conflicts. It's part of, you know, we've got biases, we've all got conflicts. We declare them, we understand them, we acknowledge them, et cetera. That's important. But what's happening here is likely you are maybe getting, you know, criticized, let's just say, by people with much greater conflicts of interest. Right, and that. And that. And that's again, part of the corporate strategy is big corporations is, you know, John Cleese, who was Monty Python, he tweeted something once which was quite funny, but had Many truths behind it. He said, one of the old rules of the kgb, always accuse your enemy of exactly what you were doing.

Oh.

So I know all of the tactics. So when you do this stuff in my advocacy, you get pushed back. But I know exactly, exactly what they're doing, and that empowers me a little bit. Say, okay, you know, you got to grow a rhinoceros.

I think we need a bodyguard with you at all times.

Yeah, well, you know, we said the.

Same to Dr. Joe Dispenza because, you know, when he started to show that he could use meditation to. And Covid wouldn't enter the cells, we're like, of course that didn't get published.

Sure.

Yes.

Wow.

That's.

That's just pretty dark forces, what it is.

Well, and the bigger challenge with all of that too, that you hear, and I'm just going to bring it back because I think a lot of the viewers will relate to the Women's Health initiative that really like took women, a whole generation of women, and took them out of getting the hormone replacement therapy they needed with the media reporting this and never when this all comes out and it's been found to be incorrect. And the data was like, it was like, you know, one more person got breast cancer who was on the drug than not. And they just lied with statistics, which we all know how to do once you take one statistics class. Yes, right. But, you know, where's the.

Where's the copper? Where's the.

Where is it? You know, where do we come back out and say this shift?

And this is why in the documentary we're saying that we go very deep in the documentary, we're basically saying that what people need to understand is that the system, the current economic system that has been created by policies that probably well intentioned, but was to try and allow in this mindset that we just. We create a completely free market where we deregulate big companies and the market will correct itself. Yes. So I think people need to understand that first and foremost, drug companies have a legal obligation to make profit for their shareholders, not to give you the best treatment. Although most people would think that to be the case. And a major part of the scandal is that those with a responsibility to scientific integrity in patients, doctors, academic institutions and medical journals, they collude with industry for financial gain. But if you go to the root of it, what's happening is those corporations, big corporations, we can apply it to big food as well.

We call it big food, big pharma, big healthcare, big insurance.

They are pathologically self interested when it comes to extracting money. And that means they will lie for profit even, and even if it causes harm to people. And that's really what people need to understand, but that we have kind of been unwittingly complicit in the system because it's happened in some ways behind the scenes. But policies that were implemented with good intentions from the likes of Ronald Reagan and Margaret Thatcher in the 80s, to really deregulate these corporations has given themselves so much power through this fraudulent sort of mechanism of making money that now we have to really row back and change the system back to just greater transparency, something very simple which doesn't matter what political ideology you have. People just want clean information. We don't have that in health care anymore. The information has been curated to manipulate people, to exploit them for financial gain. And that's why we've got a healthcare crisis. That's why we've got a deteriorating mental health crisis. So once we expose that, that people identify the problem first and foremost, then we can offer solutions to change it. And it needs laws, it needs laws to protect people from these excesses and manipulations. It's very straightforward actually. And one simple solution JJ would be all clinical trial data conducted by drug companies. Companies, they can develop drugs but they should no longer be allowed to test them.

That seems obvious.

They can't be trusted. They should be independently verified. And if they think their product is so great, why not get independent verifications?

They'd want to, they'd want everyone to test it.

Exactly.

Because they just look better and better and better.

And it's self defeating because it doesn't encourage innovation. You know, most new drugs now copies of old ones. What they do is they take an old, you know, off patent drug, they change a few molecules here or there, they then give it another name, they market it in a different way, they make God knows billions of dollars and then they move on to the next drug and while simultaneously hiding the data on harms. And it's no surprise that one credible estimate now, and this is pre pandemic, the third most common cause of death after heart disease and cancer globally is prescribed medications, what your doctor prescribes for you because of side effects.

So if you look at this and we take cancer out because I think that's a toxic soup over there. But if we looked at just heart disease and then prescription drugs, and what if you were approaching heart disease the way you've described it, you wouldn't need the prescription drugs. If you went through all of this and just did it in the way of diet and lifestyle, you would save a lot of money.

Yes.

You'd have better quality of life. It really can be that simple.

It's a win win. It's a win win. And that's the conversation I have with my patients. And they get it. And when they go on the plan or whatever, I empower them with a lifestyle plan and they notice the benefits very quickly, they're more likely to sustain it. But again, this will only take us so far, jj, because the system is still working against them. And even with the food stuff, a lot of people fall off the wagon. I'm sure you have patients that kind of, you know, they do really well initially and then they start recovering, gaining weight, because the environment is encouraging them actually to be sick. And they're having to constantly battle the environment. And that brings us also to an understanding that, okay, modern medicine has had an important role to play. But if you think about, if you look at the increase in life expectancy that we've had in the last 150 years, we've added about 40 years. Average life expectancy in 1850 was about 40 years old. Now we're saying we're 80. Although it's going downhill. Right. In America now of those 40 years, you can attribute maybe three and a half to five years maximum to modern medicine. Most of the increase in life expectancy actually happened through an understanding. Yeah, absolutely. Safe drinking water, seatbelts in cars, safer work environments. People just die at work, you know, because there was no health and safety and, you know, smoke free buildings, you know, all that kind of stuff. And they were, they were people. I know this, that partly because industry has been behind it, they've created this narrative that the word regulation is a bad thing. Actually, you know, we function cohesively in a society because laws have been created for the greater good for people. Even things like simple things like traffic lights, seat belts in cars. These are regulatory interventions. People don't like people interfering with their lives and their freedoms. And that's fine, I get it. But collective, we should think, hold on, what is actually for the greater good of us all. And that needs implementation through laws a lot of the time. That's it, you know, that's all we need to talk about.

Well, I thank you for all of this. This is some seriously courageous work. I would imagine that as you started to see it, you couldn't unsee it.

Yes.

And so, you know, but not everyone would be compelled to go out there and do something about it. So thank you for doing something, something about it. And, and again, as I listen to all of this, the bottom line is it's actually very simple. Health is actually very simple. We've just complicated it all up here. We don't have to.

Yeah. And I think just one other thing to say as well, J.J. is that, you know, the World Health Organization have got a lot of, been under a lot of heat recently for different reasons, which I won't go into, but the original definition of health, I love 1946, a state of complete mental, physical and social well being, not merely the absence of disease or infirmity. For me, my purpose, and I think everybody's purpose actually really in life is to reach a state where we can flourish and have optimal for us mental, physical, social, well being. But they're intertwined. You, you can't have optimal mental health without having optimal physical health. And you can't have optimal physical health without having optimal mental health. And part of having optimal mental health actually is also coming to a place of even spirituality, of thinking about behaving and acting in an ethical way. And that means speaking the truth and not being afraid to speak the truth. Our system has now created a culture where people are afraid to speak the truth that is not conducive to a healthy society.

So we would love to support you both in our well beyond 40 community and our mindshare community. Where can people learn more about everything you've got going on?

That's very kind, thank you. So I have a website called it's just doctoraseem.com as in doctor-o c t o r aseem.com a s e e m A S E e M I'm on Twitter. I'm quite active on Twitter as this Dr.Aseem Malhotra. And then for the movie we've got got a landing page where people can Support us. It's NoFarmFilm.com N O Farm P H-A-R M Film.com we're hoping to get the movie out in September. We're still in a situation where we still need a little bit more funding to really maximize distribution impact, et cetera. But we're getting there and we've got some amazing people who are involved and interviewed within the doco.

Perfect. We'll put that all@jjvirgin.com aseemas eem and thank you again.

Thank you.

Be sure to join me next time.

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