The Cardiologist Who Stopped Prescribing Statins Explains the Real Cause of Heart Attacks | Dr. Aseem Malhotra - ENCORE

So today we're revisiting one of our most popular episodes of 2025. My conversation with esteemed UK cardiologist Dr. Assim Elhotra, a physician who went from being a top prescriber of statins to one of their most vocal and well-informed critics. A stance that ultimately cost him his job and led to a major legal battle with the media. And this eye-opening conversation Dr. Melhotra pulls back the curtain on the commercial distortions of scientific evidence that has shaped our understanding cholesterol and heart disease. He explains the statistical sleight of hand often used in clinical trials, the data pharmaceutical companies don't want the public to see, and why our decades-long obsession with lowering LDL cholesterol may have done more harm than good. This conversation sparked so much engagement and reflection and change within our community, and it deserves another spotlight. 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Experience the SANA everyone's talking about. Your body and mind will thank you. Head over to Sunlighten.com and save up to $1,400 on your purchase with Code Heimony. So welcome back to the podcast. It seems great to have you back in person here in Austin, Texas. So my new studio. Yeah. It's so nice to see you again, Mark. I think, yeah, we did. It's been about six years since I've had a podcast. That's right. We've got a lot of a lot of interest. So I think, yeah, let's uh, we did. So as you heard from introduction, it seems an esteemed cardiologist from the UK who's been a vocal critic of a lot of the mainstream ways of thinking about cardiovascular risk, cardiovascular health and the use of stands as our primary therapy for reducing cardiovascular disease, which is after all the number one killer in the world. We're going to dive deep into the issues around these drugs, around what we need to actually be looking at for cardiovascular disease. And I think your opinion is going to be a little bit jarring for people because it goes against the conventional wisdom, which isn't necessarily always wise. And I think it's a much more nuanced conversation that people need to be having around cardiovascular disease than high LDL cholesterol, bad cholesterol, take a statin and a story. Yeah. Essentially what we all do in medicine is for training, traditional medicine, high cholesterol equals statin. And if statin causes side effects, you can play with a bunch of other drugs like PCS, can I never? But we're going to start out at the end, which is this lawsuit that was filed by two of your colleagues that you were going to be a part of but decided not to be for various reasons because you couldn't actually talk about the issues that you care about, which I guess has a lot of integrity. But the case was brought by Zoe Harcom and Dr. Malachadric against associated newspapers, which is the publisher of the mail on Sunday. And there were series of articles published in March of 2019 that were part of a campaign called Fight, Fake, Health News. This is even before COVID, and the whole misinformation. And in these articles, they named the claimants and statin deniers, including you, which isn't actually true. And they accused you among and your colleagues of spreading misinformation about stands, which they described as quote, deadly propaganda. The newspaper's article suggested that there's statements led people to avoid taking stands, which was a big public health risk. In response to these articles, your colleagues filed a defamation lawsuit arguing that these articles falsely portrayed them as deliberately spreading lies about stands. Now, the high court has seen multiple legal arguments, particularly around the public interest defense under the defamation act of 2013 in the UK. But in 2024, just recently, the case was ruled in favor of your colleagues against the newspaper. So in some ways, you've indicated by the legal system that what you're raising in terms of concerns about stands, and I'm kind of quoting from you at this point, which is their data is flawed on stands. It's overemphasized, it's overprescribed, it has risks, and there are other factors that need to be considered that are often being missed. And you know, it's a more nuanced view that you have. It's not just drugs are bad, you know, food is good or drugs are bad and you know, weak grass is good. It's basically looking at very nuanced science to help unpack what we know, we don't know about cholesterol and cardiovascular risk. So kind of walk us through what happened with that case and what the findings were and and and and how you how you have all been indicated as a result of the legal decision around this this court case that was basically defending you essentially not you were directly involved in the final suit, but you were kind of part of the whole thing. Yeah, I'm festival to clarify Mark the reason I did not decide, I mean, it was something I thought about to suit the male and Sunday. I think I was at the time there was a lot going on. My mom had just died. You know, for me as an activist and a campaigner, I made the decision that I'm going to keep talking about this issue and carry on and just take it on the chin. I've been in the situation before which we'll talk about later. So I decided that I wasn't going to suit them, but I'm so pleased and happy for for Zoe and Malcolm because you know, these sorts of things, they do have an impact on you. I before I tell you that what happened in the case specifically because of that newspaper article about a month later because my hospital was named in the article and obviously they got a bit panicky. I was told that my services were no longer required. So I lost my NHS job. I and by the way, I have an impeccable track record in terms of my clinical care, getting all my colleagues, you know, I'm probably an unusual doctor and probably lucky as well because I throughout my whole career, 23 career career as a doctor, I've never had a single patient complaint which is unusual because you know, that can happen for any reason. It doesn't mean the doctor's done something wrong. So with all of that background, that's what happened. And then I wasn't able to get a job back in the NHS. I applied and got to get a blacklisted. Basically, yeah. And it doesn't mean that all cardiologists were kind of against me, but the situation arises in hospitals, teaching hospitals and a lot of cardiologists in London because I trained in, you know, some of these hospitals had good relationships with cardiologists there who are a respect my opinion. And it would be the case where say in a cardiology department of eight people, if seven of them said to be great, let's have a seam here to do clinics and when worker for a bit, just one of them would object no chance. You can't get in. And it was always, it came back to when I asked the reason. It was, you know, their antibodies have been developed against you because of your statins essentially, right? People are allergic to you because you've your opinion on statins. Exactly. But also that, so what happened in the case is that, you know, this was a front page new story. What made the new story, and this is a really interesting bit around the evidence of what happened during the case that I submitted because I was asked to, is that the front page linked article said essentially got the secure state for health at the time called Matt Hancock. You may have heard of him to say that there was no place in the NHS for these sites of doctors who were spreading misinformation on statins. Now, interestingly, and of course, one of the most extraordinary bits in the actual newspaper, the editorial from the health editor headline was, there was a special place in hell for doctors who say statins don't work. Okay. And imagine the picture of me, Zoe Arkham and Halton, right? It's that it's got your corner in hell. I'll picked out. Oh, exactly. Right. I mean, it's, it's, I mean, I find it funny to be honest. I mean, of course, a lot of other people were more upset than I were. It was. In fact, the former Queen of England's doctor and the past president of the Royal College of Physicians, Sir Richard Thompson, who I'm friends with, I mean, he called me up and he was so upset. He said, this is unbelievable. How can they say this is not what you say, Barbara? Right. And I was coming down and saying, we're to this, you know, we take this as a backhanded compliment, you're over the target, you get one of the most powerful influential newspapers in the world to go for you like this. You know, and I'm someone that, and who's their advertisers? Well, I don't, well, that's, that's a fair point. But I think ultimately what came out in the case is well, Mark. And there's also, again, I'll mention this crucial bit of evidence, which is extraordinary and helped, I think, shift the case and win it. Is that the people who are fueling the health editors to write the article and the people who are commenting on it were all connected or part of something called the CTT, the cholesterol trialist collaboration in Oxford. These are the most powerful statin promoters and some of the most powerful doctors in the world in medical research. But, again, what's wasn't declared is that their institution has received hundreds of millions of dollars from drug companies that manufacture statins or new cholesterol-learning drugs. Okay. So listen, that fit. I want to double click on that for a second. Just so people understand, we think academic institutions are squeaky clean, they're neutral, they're objective, they're scientific, medical schools, researchers. But the truth is that a lot of their funding comes from pharma who are funding trials that they're executing. And I remember Peter Libby, who you might have heard of, who's basically the editor in chief of the main cardiology textbook that all fellows take called Brunel's cardiology. He is, you know, a terminal cardiovascular disease at Harvard. And I said, Peter, why don't you study lifestyle interventions for cardiovascular disease versus just studying medication? Is it more like I know a lifestyle works? But I can't get $5 to study lifestyle. I can get $150 million to study a drug. And that's funding my apartment, that's funding my staff, that's funding me. And it's the reality of how the system is set up. So you have to understand that, you know, there's inherent bias in a lot of how we think about things in medicine because of the money. If you follow the money, you understand where things are driven from. Yeah. Absolutely right. Mark, that reminds me actually of somebody who I cite quite regularly, Professor John Aeneidis, I refer to Stanford. I refer to him as a Steven Hawking in Medicine. He's the most cited medical researcher in the world. He is a professor of medicine and epidemiology and statistics as Stanford. He's a mathematical genius. And he published a paper in 2006 that we've talked about before, I think, which is called why most published research finding the faults. And one of the risk factors for false research is this, the greater the financial and other prejudices in a given field, the less likely the research finds it to be true. Think about that. So when you start with statins, you're talking about one of the most lucrative drugs in the history of medicine. It's a trillion dollar industry. Everyone's telling you driving the world. So start from that kind of overview to try and help explain what's going on and why these sort of this confusion is happening and where they're about happening. And then you can make your own decision who you trust more, but also the most important thing is to try and give people information the way they can understand. We'll get there in a second. So what happened in the case? So we have this kind of defamatory attack on us. But what made the story was the Secretary of State for Health getting involved. Now, interestingly, one week earlier, just before this new story broke, I was speaking in parliament about type 2 diabetes reversal. And the benefits of for example, of a low carbohydrate, you know, real food diet for that purpose. Matt Hancock agreed to meet me. He had was aware of my work because of another politician who had lost 94 pounds from following my diet plan. This is the one who said you need to have his petri place in hell or no, that was the editor of the of the actual of the of the newspaper. So Hancock, all Hancock was involved in the story because he had basically said he'd been contacted by the mail on Sunday and said, there were these doctors saying this. Do you have a can you give us a comment? And he gave a generic comment saying there's no place for this misinformation, right? And it looked as if he knew who we were and we were. So I met Matt Hancock a week before and gave him a copy of my book. He was very respectful, very appreciative of what I'm doing in lifestyle. And gave my lecture in in parliament, which got a lot of attention by the way, as well, which may have been the reason why they decided to suddenly do this, you know, the new story is like, okay, we're getting something that's challenging our views on cholesterol on on on low fat diets or whatever. So that was probably the peg because that was getting all of attention to then come back and have a go at me and two other people. I think that's probably what happened. That's why it happened at that particular time. So I texted Matt through Twitter, DMed him. I was like, Matt, really? And he replied, I see, I had no idea they were referring to you or Zoe Harkham. And I was like, okay, this is very interesting. So I kept that obviously. When the case then evolved and went to court, the lawyers for Zoe and Malcolm contacted me. And I gave them that evidence and apparently during the case in Malcolm Fed, but this back to me, Malcolm Kendrick, he said, this turned the judge because they put Barney Kalman, who was the health editor on the stand. And essentially made him admit that, you know, that in a way that they had misled Matt Hancock because they hadn't told him because if Matt knew, because I'm a, you know, four and ten to four. So probably, so this is what really changed the case. And I think that that is, yeah, that, well, it is what, what were you actually saying? And what was Zoe and Dr Kendrick saying that raised that concern and that why was them the the me on Sunday so vocal about criticizing? What were they coming after? So this is basically based upon probably both Malcolm and Zoe and my public advocacy on the over prescription of statins, the lack of informed consent, the lack of access to the raw data, which is a still an ongoing problem going over a decade or so. So I think because this story and the statin saga had been getting more and more of an airing and Mark, I've been publishing in medical journals on informed consent and a lot of, I've been publishing a lot about the prescription of statins and the conflicts of interest and not knowing the true benefits and harms, right? Because as you've said already, a lot of the data that we get from drug industry, sponsored trials, if not most of it, is never independently evaluated. Most people don't know this, right? Yeah, I mean, people don't know the same is that is that when studies are done, they don't have to be published. So if studies come out that are showing not a positive benefit for a particular drug, there has to be submitted to the FDA or whatever the equivalent is in the UK, but they don't actually have to be published in a medical journal. So you're not seeing the full spectrum of what the data show. You're just seeing cherry-picked data that shows this massage and twisted. I think was Mark Twain said there's liars or damn liars and there's statisticians. Yeah, you know, and so absolutely. This part of the problem with the statin research is that if not that they're bad or good, every drug has a role, it's a tool. Yeah. It's like saying water is water good or bad, or if you drink too much water, you can dive seizures, but you need water to survive, right? Everything has a role. But how is use, how frequent is use to it's described, how often it's prescribed? The manipulation of the medical system, the manipulation of the scientific research and the lack of transparency about the data, the lack of publication of all the data gives us a more view of how great these drugs are. And they're the number one class of drugs sold in the world globally. Absolutely. I mean, it's estimated between 200 million and one billion people have described this drug. So it's a big deal. And especially for me as a cardiologist whose primary purpose is to help my patients and also with my special interests to really understand the root cause of heart disease and how we can reverse it in the population. We hadn't done that. That's how my journey started. I was somebody that believed in statins. I was one of the biggest prescribers. I was giving it in the ER. So patient coming with a heart attack and telling the nurse to give it in them in the ER before they've even gone to the cardiac catheter. I heard cardiologists saying she should serve it at McDonald's with your, you know, for example, I know or have it over the count. I mean, there was a in 2021 globally, it was $15 billion spent on stands. It's projected to maybe 22 billion by 2032. I mean, this is a staggering amount of money on one drug. Absolutely. And it's so there's a lot of stake here. 100%. So understanding that there's a barrier to the truth, which is essentially a financial barrier because of the so much as take you say, not just with statins alone, but the clustering or industry, the low fat food movement, the fear of cholesterol is a trillion dollar industry. Right. So I think people need to understand that. So how have we got here? And what is the truth? Or what is the greater truth? Okay. And the reason I say what is the greater truth? This is another myth that we need to bust for people listening to kind of try and get cut through the confusion. The first thing is we have to understand the public needs to know. Doctors even need to know this. Medicine is not an exact science. It's not even close. It's an applied science. It's a science of human beings. It's a social scientist constantly evolving. Right. We were also taught a medical school by the founding father of the evidence-based medicine movement. Half of what you learn will turn out to be either outdated or dead wrong within five years of your graduation. Or we can tell you which half. I mean, you can't tell you which half. So you have to learn to learn in your own. Right. But how many doctors have got the time or the skill to try and cut through, all the stuff that they're getting through medical journals, looking at independent evidence, and then being able to try and get to something that a level of information that they can utilize for really benefiting from helping their patients. So it comes down to inform consent. And for me, one thing that I think was marked train that said that truth often lies in simplicity. And the most elegant analytical framework we have for teaching and practicing medicine is called the evidence-based medicine triad. Right. Published in the BMJ 1996. I love this. It's beautiful. I put it up in my talks. It's one of the first slides. And I say, listen, this is the most important side of my talk. If you get this, you can probably not only understand why our health is going the wrong direction, but you can probably explain most problems in the world as well. Right. So what does that mean? Okay. In the middle of the triad, our role as healthcare practitioners as doctors is to improve patient outcomes. Manage risks, tree illness, relief suffering. How do we do that? There are three inputs. Our clinical experience, our knowledge, our intuition as doctors over many, many years. The best available evidence on a drug, on a lifestyle, on a surgical intervention, on ordering a test. And last but not least, David Sackett said, taking an into consideration individual patient preferences and values. Right. That's where the informed consent comes in. So what's the problem? What are the limitations? Why have we not really advanced evidence? Well, you know, we, that's really just want to double click on that too, because when we hear evidence-based medicine, what it usually is interpreted as is only what the science says. Now, what the patient is experiencing or what the clinician expert understands from their decades of experience, which are part of the evidence-based try 100%. And that's really the failure here. And evidence-based medicine is held up as this holy kind of, I don't know, in a sense, that we, that we bow to, but often we kind of think, Mr. Turbo, what it means. And I think your, your explanation is, is, is really important, because it's not just what the data show. And it's also which data and who funded the data. And so what wasn't studied? And the absence of evidence is in the evidence of absence. So there's a whole bunch of stuff that's going on. So then you pick up. So then the next stage is, okay, so if you accept this is a pretty solid framework for improving patient outcomes, it doesn't take a rocket scientist to figure out that if there's anything wrong with one or all of these, at best, you're going to get suboptimal outcomes. And at worst, you're going to do harm, so in terms of these inputs, right? So if we just take the best available evidence, and I've just said already, John, I need this. Okay, most publishers are finding their faults, etc. You know, you've got Richard Horton editor, the Lancet in 2015 writing an editorial saying that possibly half the published literature is simply untrue. It's not just John, I need to saying this. So you've got all these fun. So what happens ultimately is doctors invariably are making clinical decisions for patients on biased, not completely false, biased and corrupted information, which invariably will exaggerate the benefit and safety of those drugs because that's in the interest of the drug industry who want to get as many people taking them because they're only interested as profit. They're not here to give you the best treatment. So once you acknowledge all of that, then it's for me, and as a cardiologist and as an expert who has spent a decade. I would challenge you. I think a lot of people are like the Truman show. People in the system it's like the Truman show. They think they're in this perfect world and that they're doing good. And I think they're good people and they're trying to do good. They're not deliberately trying to harm people. But they can't see what they don't see. Because they're in this sort of almost really good point. And actually, the way I would just summarize that is medical knowledge is under commercial control, but most doctors don't know that. And that's what we're trying to sort of get them to think outside the box because again, I 100% agree with you. Most healthcare professionals, most doctors genuinely want to help their patients and are well intentioned. And actually, I'm very proud of being a doctor because I think of all the professions. I know things are changing and we have to protect our profession. I think we are people that actually have some of the strongest ethical principles, right? When it comes to how we do our jobs. And we have to. And we held in that esteem because of that reason. So for me, trying to break out of that conventional paradigm happened because I came to realize that the information that I believed is being gospel truth as a medical student is a junior doctor, it's published in a medical journal, it's science, right? Didn't question it. I then came to realize that hold on a minute, there's a lot more to this. And I used of course the, you know, the heart disease paradigms understanding why we hadn't curbed heart disease, even though it's predicted by Nobel Prize winners, Brown and Goldstein, I think in the late 90s who discovered the LDL receptor was involved in, you know, coronal heart disease, they predicted the end. The eradication of heart disease may come completely end by the early 2000s. Didn't happen. Still that everyone killer has a plan. And despite this, a vast prescription of standards, despite more and more people are getting heart disease. But less people are dying from it. Is that correct? Correct. Because we have better management. We can, the other risks, we can... Three reasons I can tell you, big low-hang fruit, why have we got less death rates from heart disease? If you were a smoker, your mortality rate increased 50%, with smoking reductions played a big role. Emergency treatment in specifically, in the acute setting of an acute heart attack stenting, or thrombolytics which I used to use, right? Cloud busters. But the third one, which the burn and the lown, pioneering cardio, and Scott the Nobel Prize for, was the defibrillator. Right? So what used to happen in patients would be admitted to hospital with a heart attack. And the first 24 to 48 hours after having heart attack, you're most vulnerable to having a cardiac arrhythmia that causes you to have a cardiac arrest, right? And patients would die. They develop cardiovascular pain. Better saving people after they've had a problem. Completely. And that's kind of why there's less death. 100%. It hasn't... Well, so the next question is people think, oh, must be stent as well. Well, paper in the BMJ, a few years ago, looked at millions more people taking stent in Europe over a 10-year period to see, was there any reduction in cardiovascular mortality in Europe because millions more people are taking stentings? They found there was none, none. Zero. No change. But you can actually explain that, Mark, because one way of looking at the statistics, looking at industry-sponsored trials, which we've already alluded to, should be taken with a grain of salt because they are best-case scenario, they're curated information. Or a cababutter. Yeah. Well, actually, absolutely. But it would be better. We're... We might need to come back about a butter story, and be being hauled into a medical director's office to talk about butter, by the way, when I busted the myth of saturated fan heart disease. You know, when you look at the data from industry-sponsored trials, and you look at the statistics that looks at the average or median increase in life expectancy, over five years, right? In the highest risk groups, where there is a greater benefit, the median increase in life expectancy over a five-year period in the person that's had a heart attack, right? In saying they're 50s, just over four days. Now. So, we just sit back and up for people. So, there's two kinds of treatments for cholesterol that are happening. One is we call primary prevention. You've never had a heart attack, but your cholesterol is higher, Dr. Yev, you would drug like a stab. Yeah. And their secondary prevention means you already had an event, and it's trying to prevent a second event. And that's what you're just talking about. If you've already had a heart attack, and you take a statin, it shows that you're only living extra four days. Yeah. If you look at the median increase in life expectancy in that group, another way that we use in medicine when talking about informed consent, or I call it ethical, very controversial topic, ethical evidence-based medical practice, which means true informed consent, which means telling patients the numbers need to be treated, or they're absolute individual benefit. And he looked at the totality of evidence. I know there are lots of studies we can talk about, but for me, it's about what does the totality of evidence tell us, right? And there's a great website, which is independently evaluated by doctors, and it goes to a peer review in the one of the family physician journals in the US called the nnt.com numbers needed to treat. People look at it as great sites. And what that means, everybody, is how many people you need to treat with a certain drug to get a benefit? Yes. If you have a bladder infection or strep throat, and I give you an antibiotic, it's pretty much 100%. It's like you need to treat one person to get one person better, or maybe they've resistant antibiotics. It's two. Oh, we take paracetinal for a headache. It's like one and two. So it's like two people. One will get the headache completely. But with a stat, we're going to treat 89 people for five years to prevent one heart attack. Yeah. So it's actually, so I know this stuff inside out. So if you've had a heart attack already, let's say the high risk group, you have to treat 83 people over five years for one to have their life saved or life prolonged. Right. Okay. And for preventing a further heart attack, one in 39. Now, most people around the world, Mark, who prescribed statins are not in that group. They are in the either low risk. 75% right? Yeah. Exactly. Low risk or what we call high risk primary prevention. Now, the benefits of a statin over a five year period in that group at best is 1% in preventing a non fatal heart attack, a non-disabling stroke. Okay. 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I love how one simple ritual keeps me centered, boosts my metabolism, and even nourishes my skin from within with detoxifying antioxidants. Transform your wellness from the inside out and get up to 20% off for life plus a complimentary gift. Explore peaks radiant wellness products at peaklive.com slash hymen. That's p-i-q-u-e-live.com slash hymen. So it's up to you if you've never had architect and you're my cholesterol and you take a statin. Yeah. It won't prevent you from, it won't prevent one single death. It may have been a heart attack. Yes. 100 people take it. It'll prevent one heart attack. 99 people taking it for five years will have no benefit. Yeah. So this again comes back to now. This is just my opinion. It's like, oh, is it same as what you're just charging picking statistics here. 2009, Good Gigerenza, the director of the Max Planck Institute for Health, literacy in Berlin. There's the same institution that Einstein Tittort and trained in. Brilliant guy. He wrote in a WHO Bulletin 2009, it is an ethical imperative for every doctor to understand the difference between absolute risk reduction, numbers need to treat, and relative risk reduction. And he said to protect patients from unnecessary anxiety and manipulation. So in other words, I paraphrase this, if you have that information, and again, most doctors are not trained this way, this is a problem. You should use it and tell patients this is what I do. And I, a patient comes in and it's like, should I take a statin or not? I say, well, let me just, let me empower you with the information and tell me what you think. Most patients with a one percent thing thing, hold on a minute, I don't think that's that great doc. And then they'll say, well, is there anything else I can do? And of course, you and I are empowered with understanding lifestyle, right? So this is what how we should be practicing medicine, but one quick thing is that I didn't just talk about this. I wrote about it. And I even got this in front of every Royal College president in the UK saying that the British Medical Journal were doing this campaigning, it's too much medicine. They're talking about informed consent by use of entities. We need to launch a campaign because over prescription is a big problem. We know there's a big problem with side effects. We know that one estimate suggests that prescribed medications is a third most common cause of death after heart disease and cancer globally because of side effects. It didn't take long for me to convince the Royal College presidents. I was an ambassador for the overall Academy of Royal Colleges at the time. And to say that we should have a joint campaign with a BMJ. So I then wrote a paper as lead author had the chairman of the general medical council, the chairman of the medical colleges on that call the paper to say, okay, this is a campaign we can get and change medical education, change postgraduate medical training. And we got that it's in the media. It was a big new story. BBC all of the news front page of British newspapers, campaigns obviously need to be sustained. But what happened is, of course, if you engage in true informed consent with patients, most patients will choose last treatments. Now, who's going to suffer from that? The drug industry. In my view, it's very clear. It's not conspiracy. This is clearly how they do business. And this is what they want to do is they want to engage in a tactic called opposition fragmentation. Anyone that threats threatens their bottom line, they will do smearing. They will do all these things behind the scenes. There's a whole documented history of the book. I'm about to go do it for you. If you Google me, you'll find many groups that are attacking me like the American Council on Science and Health, which sounds great. But it's actually a front group performer, big food and big ag that think trans fats, pesticides smoking and glyphosate are all healthy for you. Okay. And it's a come up tongue very, you know, airy diet and smart. So you've experienced them all. You've got a mobile guy, right? And then space medicine, you know, I was on the Science and Health. I mean, I wonder crack busters, crack watch. I mean, I've been there all all through it. And you get it. I totally get it. And I actually, I find a badge of honor. It is. Well, no. So actually, in a way, it is, although you've got to grow a thick skin, right? Because you know, one of the lessons in public health advocacy done by written, great paper, written by Simon Chapman who took on Big tobacco in Australia and talked by his 30th year career and taking on Big tobacco, he says, as soon as you'll work threatens an industry or an ideological cabal, because also about this about mind is not just about money. It's about indoctrination in the brain, right? As soon as you work threatens an industry or an ideological cabal, you will be attacked sometimes unrelentingly and viciously. So you have to grow a rhinoceros side. Right. So for me, what happened after that is there was, I kept pushing this message, but they then behind the scenes were all called physicians, I think, funded by farmers. Sometimes it's funded by farmer, started making complaints to the Academy of Medical College is where I was one of their ambassadors for seven years, right? To say this guy's got his own agenda. He's exploiting people for his own agenda. He's trying to make money off all nonsense. And that was so relentless that they then, in 2018, I got an email from the new chair of the Royal Colleges saying that the campaign that I had started or was that they had took on and instigated that I was no longer part of that because of stuff that I apparently said publicly on statins. Even though everything the newspapers that was written about statins for me was coming from medical journals and I was very strong advocate for informed consent. But again, that's what gives me with the facts, my mind is made up. Well, exactly. So this is what they do. And of course, it does have his personal toll. And then it culminates in coming back to where we started is that because we were having an effect, Mark, and of course, you're absolutely doing the same thing. One of my inspirations, right, revolutionaries, Mahatma Gandhi. And one of his quotes, which I love is, you know, and he took on the system. I mean, he got British colonialists out of India. I mean, it almost single handedly. And he says, first, say, ignore you. I mean, Britain was bigger than the farmer companies. Absolutely. I mean, America was founded on anti-corporate sentiment, taking on the British India company, right? It was a big corporate tyrannical system. And now we've come back to the same problem right now. But what he said was first, say, ignore you. Then they laugh at you. Then they fight you. Then you win. So when you're getting attacked, you're getting you're over the target and you're closing to you're getting closer to winning. But you have to it's it's tough. So let this so essentially this is an interesting legal case that we started out with has sort of indicated that you and your colleagues were speaking truth to power. Yeah. So let's get into the details here because everybody's listening. I'm going, yeah, well, my doctor checked my cholesterol and my all the others high. And they recommended a statin. And like we said, it's the number one prescribed drug in the world. Yeah. 75% of the prescriptions are for preventing heart attacks if you've never had one. It's called primary prevention. And it's very weak data to show that that actually works, especially for women, especially for over a certain age. Yeah. There is benefit for people who've had a heart attack. No doubt. It's not like taking antibiotic first trip throat, but there is a benefit. And I'm going to sort of unpack how you came to go from being a trained cardiologist who AC swallowed the gospel. Yeah. To one who understands and is looked at the literature and has come to a different conclusion, because it's not just that you're antitrug or your anti medical care anti the system. You're for the truth and for science and for an objective look at the facts. So the question I have is how did you go from being a trained cardiologist who believed in stans to one who started a question stands to one who's come to understand that our post-acarabacities might be a little bit misguided. And we'll talk about what the right approach should be later. But I kind of want to start with unpack unpack the science for us because yeah, everybody listening has no as heard of their cholesterol is high to take a stat. So, and statins cause side effects, which they do for a lot of people probably 20% get some muscle damage or some symptoms or increased risk of diabetes. You know, we'll talk about that data. They're still a still a huge drive in our society for prescribing these and globally. Yeah, absolutely. So my interest in this came from really looking at the initially the abyss epidemic. So 2004, WHO announced it as an epidemic. You know, by 2010, I was at nine years qualified as a doctor. I was especially registered in my cardiology training. I was seeing more people this viscerally. I'm very sensitive to how to put it. Suffering around me if you like, but also seeing my colleagues under more stress in the system. And I was like hold on a minute. If we carry on down this trajectory, the whole healthcare system is going to collapse. We want to even manage people acutely if they are ill, right? I never thought that would happen. And ultimately that one of my two of my two of my parents both of them basically died because of the failings in the system because the systems under some stress, right? Never predicted that would happen. But that's where I started from. And when I looked into the issue of obesity, you know, I concluded that one of the root causes, Mark, if not the main root cause, was this flawed hypothesis that we should have low fat diets to prevent heart disease, food industry exploited that increasing sugar intake, increasing refined carbohydrate intake. It became quite clear. There was a clear correlation between that change in guidance in the late 70s in the US and early 80s in the UK when the obesity epidemic started to then take its trajectory on the wrong way. Yeah, and I covered a lot of this in my book, each fat sit then, which I was sort of unpacked the whole history of how we got this low fat craze, led to this high sugar starch craze that then led to this dramatic rise in obesity, which now of course we're treating another drug, the Juppie one agonist, and you know, just appetite and some of glutiter, and some big and matured. It's kind of crazy, right? It's kind of flipped it upside down. Oh, absolutely. So when I looked at that, it started looking at the data and spending years and months and years looking at it and looking at different bits of data. I was able to put it all together and I wrote a piece in the BMJ 2013 called saturated fat is not the major issue. I read it that's how it first came across. Yeah, and that got a lot of attention, right? It was international news and British news and CNN international and whatever, you know, because obviously suddenly you've got a cardiologist busting this myth that we think butter has been bad for our cholesterol. But when I did that, okay, so what I looked at the data and it was very clear, there was no clear association with saturated fat consumption in heart disease. So if that's true, then and we know saturated fat raises LDL cholesterol. That means LDL cholesterol can't be that important. So and if LDL cholesterol, the total cholesterol isn't that important as a risk factor, how does statins work? But I knew statins had a separate effect on low cholesterol, which is their anti-inflammatory and their anti-clotting. And I knew this even it's well known within cardiology circles, you know, I trained as an interventional cardiologist and that means key all heart surgery stents, for example. Patient comes in. We didn't even check the cholesterol. Maybe some of the thinking was a lower the better, which will come on too as well. So it doesn't matter what their cholesterol starting from, the lower your cholesterol the better. In fact, 2011, 2011, a cardiologist at one of the editors I think of the American Journal of Cardiology wrote an article which I, I mentioned in my book, A Statin Free Life, which was entitled, It's the cholesterol stupid, right? And what did he say in that? He said, you can be an obese diabetic smoker that doesn't exercise. It sounds crazy. But as long as your cholesterol is low enough, you're not going to get heart disease. That's crazy. Like really? So, okay, I had to unpick that. And what I also then did moving forward from 2007, so that's how I got down this track realizing that our obsession with LDL lowering has been a part of the saturated fat literature and your worn impressed and data showed that it didn't see the difference. Both observational data and randomized control trials, no benefit, like in lowering it, no association, nothing. Right. And when you look at all the data, so that was the first sort of bit that I was okay. Some might even be in protective like some of the dairy fat. Well, we know now, yes, there is there is some suggestion that dairy fat could be protective absolutely. So there's all that. And then coming back to the LDL high. By the way, you're not alone in this. I mean, it was a major paper published by Daryl Schmuss of Farron from Tusson Others looking at butter and yeah, actually showing that there really wasn't evidence that it was. So Mark, this is what's interesting. That article I wrote because creates such a, you know, a lot of headlines and backlash, whatever else. That's when people like Darryl started looking at this again. So it was all really from the back of that BMJ piece. It all came together. So then everybody's like, you know, I know at the time I was writing this to a commentary, which is peer reviewed, but I could have got it wrong. I could have. But I was like, you know what, there's enough here for me to provoke the thoughts. Right. And then it all got proven that, you know, what I'd written had validity, right? Which was good. But the other aspect of this, if we go back and you mentioned cholesterol. So the, so is cholesterol, so is high cholesterol a risk factor for heart disease? And is LDL cholesterol risk factor? So you have to go back to square one, right? So these are the framing of studies that, you know, started in Massachusetts in 1948 and went over decades, looking at thousands of people where a lot of risk factors emerged for heart disease, whether it's diabetes, high blood pressure, smoking, for example, now cholesterol and high cholesterol, right? So you go and look back at the framing of studies and what and just to summarize it without complicating the situation too much, William Castelli is a cardiologist and he published, who's a co-director of framing him. And in 1996, he published in one of the cardiology, major cardiology journeys, a summary of framing him, specifically looking at LDL cholesterol. Let's just look at LDL because that is the so-called bad cholesterol. And he said, from framing him, unless your LDL was above 7.8 millimoles, which by the way, I think in your units is probably 250 or 300, 250 probably, I think? Maybe we can look it up in Calcutta. But let's just say for argument, say, around 250, which is very, very high, by the way, it absolutely had no, it was useless as a predictor for coronary artery. LDL. LDL. Now, why is that? When you correct for triglycerides in HDL? Okay, which by the way, is more important predictive heart disease. LDL loses its significance completely. So then if that's true, and I'm saying that means LDL isn't really a risk factor of heart disease, and I believe with everything I know now that to be the case, okay, let's, let's unpick every part of it. Does lowering LDL cholesterol from diet or drugs, but more specifically drugs, because they're the most potent ways of lowering LDL cholesterol, whether it's PCK9 inhibitors, whether it stands, whatever, is there a clear correlation? Is this dogma true that the lower the better? So myself and two cardiologists did a systematic review of the totality of drug industry sponsored trials, by the way, in some diet trials, many drug industry sponsored trials, all of the randomized control trials on cholesterol, lowering drugs, statins, PCK9, blah, blah, was there a clear relationship as you lowered LDL in low risk and high risk patients mark? Okay, over 30 studies, was there a relationship with lowering LDL and preventing cardiovascular events? No, even in high risk patients, even in high risk, it's nonsense. It's nonsense. So the question then is, no, does that mean statin, but then I said, well, of course, statins have a role, they do have a benefit from the RCT data, which is small, because I knew already their anti-inflammatory and anti-clotting, so it's nothing. In my view, listen, I could be proven wrong here, but the evidence at the moment looks very clear that there is no consistent relationship, right? It's definitely not a clear relationship. So if, even if it's a weak relationship, Mark, let's just argue and say, let's say there is a weak benefit in lowering LDL, what else is going on and what else are you ignoring? Right? What else does statins do? They cause interresistant, say, one in a hundred people get typed to diabetes because of statins. One in a hundred. Yeah, one in a hundred. So about one to two percent, but one in a hundred. Some, some study say one in fifty, right? We'll get typed to diabetes because of the statin, probably reversible still, but not ideal, right? If you're on a statin drug, the second thing is, look at the whole patient coming in. We have the illusion of protection. We have patients I used to see coming in and they thought, my cholesterol is low, I can go any in McDonald's, it's fine. And they're eating, and they're getting more and more of a weight, more interresistant, they're increasing their cardiovascular risk. They're not told the statin is going to give them a one percent benefit. I more likely than not, they're not going to benefit. So you could imagine that concept that the overall net effect of the way that statins are prescribed and the dogma around them, in my view, has been negative and has actually been one of the main reasons why we have got this pandemic of chronic disease because we overemphasized an index on LDL cholesterol and forgotten everything else. Absolutely. Because there's a drug for it. It was interesting to me, if there was a drug for insulin resistance that worked really well, and we have met for them, but it's and it fixed insulin resistance, everybody be prescribing it, but we don't even diagnose it in most people because we don't have a drug for it. And it's stunning to me that I was talking to the live director at Quest, laboratories, he said, what percent of your tests you get to come in are measuring insulin, which is I think one of the most important things you need to know about your biomarkers. And he was like less than 1%. And it's part of why I co-founded this company Function Health to really look at a deep biomarker set around cardiovascular risk factors, including insulin, including L.P. Little A, including what they call APOB, which I want to talk to you about. Not just your total LDL, HDL, triglyceride levels, but also particle number, particle size, inflammation markers, all the things that are often missed, but that are much better at giving you a holistic picture of your cardiovascular risk. And then you know where to intervene. And in what one of the studies that it was so interesting to me was actually from I think Scotland or Ireland was when they looked basically a series of patients who came into any emergency room with a heart attack. And they did glucose tolerance tests on everybody who came in with a heart attack. And they found that two thirds either had diabetes or fully diabetes. Yeah, who had a heart attack? Yeah, that was really the big driver. Now there's a subset of people who have familial lipid disorders, you know, inherited genetic lipid disorders. And not most people probably need to be treating more directly. But for the majority of people out there who are obese or have pre-dibodies or metabolic dysfunction, which is basically an American, 93% of Americans, that's what's driving probably most of the heart disease. Not 100% butter or saturated fat or LDL elevations. Well, something else to throw into the picture, right? So you could make the argument, okay, Dr. Mahottra, you're saying there's no consistent relationship, there may be a benefit. Why not just lower your LDL? Okay. So 2016, and the reason we did this, me and the number of international scientists looked to, we decided a systematic review of observational data looking at people over 60 was a relationship with LDL cholesterol and heart disease. And the reason we did this, by the way, is that another thing that was interesting from framing, which wasn't well publicized, is that when after people hit 50 years old, as their cholesterol dropped their mortality increased. So we thought, okay, is there something, you know, because for it to be a risk factor for heart disease, it should be consistent really across all age groups in both sexes, right? So mortality. And mortality, yeah, but even for heart disease as well, right? That's a good point. So we looked at, was there first of all any association, if you're over 60, with LDL cholesterol and heart disease, right? We found none. Okay, interesting. But what was surprising was there was an inverse association with LDL cholesterol and all-course mortality. In other words, statistically, if you're over 60, the higher LDL, the less likely you ought to die. So what's the reasoning for that? Well, something that's been forgotten or missed or not discussed, cholesterol has a very vital role in many functions in the body, including, you know, brain, the brain, hormone production, but also the immune system. And it's likely that that's where the protective benefit comes because older people are more vulnerable to dying from infections. And we also know there is an associate on, so I'll use this word, an association, right? Consist definitely causal between low cholesterol and cancer. Again, it's probably related to the immune system. Yeah, I mean, I think it's very interesting. Which is very interesting. The problem in this data though is, I'll just push back a little bit, is it's it's an observation data and data like from the Hawaii studies show that, you know, the you're older and you're at higher cholesterol, you know, you're more likely to live longer than if your cholesterol is lower. Yeah. But it may be because the people at low cholesterol are malnourished, have cancer and other reasons. So let me push back on that. So we counted for that. And we found actually know when you you count like time lag, you go back five or 10 years. No, it's not, it's not the, that does happen. But it no, it's independently. It does seem to be an issue. Okay, so you sort of look at all the data and you came up with this very kind of contrary opinion, which is that LDL isn't all it's cracked up to me that stands work a little. Yeah, but not for the reasons we think, meaning they lower inflammation and they may have other properties that may benefit. So we don't even know what called this pleatropic effects. So they, for example, they induce nitric oxide synthase, which dialythriplod vessels and reduce inflammation and helps your lining of your blood vessels. All that's protective. And so it may be stabilized as plaque. It may help in those ways, but it may not be the LDL lowering effect. In fact, Paul Rittger from Harvard published trial. I think it was the Jupiter trial where they show that if you, if you had a high LDL, but didn't have any inflammation, you didn't have that significant risk of having heart disease. But if you had a high level of inflammation, I LDL, you had a much higher risk. So it was the inflammation that was really driving the heart disease. And that was really the seminal paper was the new and the journal medicine over 20 years. I remember reading it. Yeah. I published your and his crew that really laid out how heart disease is not a plumbing problem. It's an immune problem. 100%. It's a chronic inflammatory process exacerbated by metabolic risk factors or insulin resistance. And I wrote an metabolic risk factors by that. You mean, probably your blood sugar and insulin resistance. And predabits. 100%. And actually, we published an editorial with two cardiologists. I didn't British on Sports Medicine in 2017, which was a very long title, but I got a lot of publicity and more than a million downloads, which was saturated fat does not call the arteries. Coronate artery disease is a chronic inflammatory condition, which can be effectively managed with lifestyle changes. That was the title of this thing. But it's all that people it's free access. People look it up and read it. But we talk that we've over done the thing and the doctor, Dr. Mahat trip, his opinion being controversial. The two my two of co authors were both editors of medical journals and cardiologists, which read Bergerto, Jarmato, medicine and Pascal Meyer, editor of BMJ Open up. So why is this not getting more play? Why is still the dogma and the orthodoxy that if you have a high LDL, you take a stat. Do you want my honest answer, Mark? Yeah. I mean, not all, I mean, I know doctors are usually very good-hearted. Sure. Very smart. Well intention. Don't want to hurt their patients. Try to do what's in the best interest of their patients and follow the science. So why are they not hearing about this? Okay. So let's go to the root cause of the problem, even in society today. What's the big issue in health? We have commercial distortions of the scientific evidence. Who is behind that? And who has more power and control over medical education, medical training, the media than ever before? Big corporations. In this case, Big Pharma. And the level of this control and power, Mark, has got to a level where it can be very easily and rationally, not in an inflammatory way or overplaying it as being tyrannical. What also happens with these big corporations in the way they exert their power is that they want to avoid conflict, right? They want to avoid the truth coming out. So there's a debate and discussion because ultimately people like myself, like you who are obsessed with the truth, who want to get it out to help patients, when we speak and act from a place of integrity and truth, it has a very powerful resonance with people. And it can very quickly destroy all these other dogmas that people have created because of that power that the truth has, they want that conflict to remain latent to remain hidden. So that, you know, Numczomski says, the general public doesn't know what's happening and they don't even know that they don't know. That's right. Right. So a lot of these doctors, and I agree are well-intentioned, but they don't, they're living, you know, in many ways, they're living, they're climbing up the wrong wall to success when it comes to helping patients because it's a drug companies that are really calling the shots. So we are under a situation of tyranny and the reason I call it tyrannical is because there are doctors that know this mark. There are a few doctors that kind of know this, but then they're less than afraid to speak out. And only a minority of the doctors that know what's going on will then speak out. That's hard. I mean, listen, you know, I practice medicine. I'm a seeing patients, you're busy, like I literally have to lock myself in a room, you know, download every paper on this, read it carefully myself, synthesize it all, try to make sense of it. And it's still confusing. And I wrote a whole book about it. And I'll call you back then. And I think it's still hard. So the average doctor doesn't have time to kind of do that. They kind of take it face value when they get taught in their training. And they try to look at the evidence best they can. But also they're looking at sort of biased evidence is public. Absolutely. Absolutely. And then of course, there's a psychological side of it as well. Because as human beings, you know, they say changing one's mind is one of the most, you know, emotionally traumatic things that human beings can go through. Right? And that's where you need humility. Right. John Kenneth Calbraith, the Canadian American economist said, face with the choice between changing one's mind and proving there's no reason to do so. Almost everybody gets busy on the proof. Yeah. So for the medical fashion, we need to have also more humility. I mean, one of the interesting like there's a great, there's a great YouTube channel called Afterschool, which I watch a few times as brilliant. It goes through like ancient wisdom and philosophy and psychology. And it says one of the titles, you should look at this at Mark, you love it. Why do intelligent people believe stupid things? And the answer is, and well, because our intelligence evolved not for seeking objective truth, but more about belonging to a tribe, you know, for personal gain, whatever else. So what is it? What do we need to break out of that? There are two characteristics in the human being that are most important for you to think outside the box and be willing to change your mind and not being afraid of it. One is humility. And the other one is curiosity. So also it comes down to character. And we've got a system over the years that has become more and more corporatized. Right. You have in America suddenly, you know, I consider this my, honestly, I'm, I'm, you know, I, I consider America my second home. So I have a lot of love for America and the American people because I've relatives here and I've been here a lot. But you have now the highest healthcare expenditure in the developed world over $4 trillion with the worst health outcomes. Oops. Right. So, so, so what's happened is, you know, because of all of this situation around corporate captures. So, you know, the, the, the counter, of course, from a philosophical point of view is that living a life in darkness has no meaning. Yeah. And we need to get people out of this, of this darkness to understand the root of the problem. And then we can, you have to think about, you have to take time to think and learn. I mean, John, if Kennedy said we enjoy the comfort of opinion without the discomfort of thought. And I think it's hard to kind of sort through it all. I mean, I found it very hard. You know, I just sort of reflect back on some of the data that I uncovered as I was sort of researching this. And it was just one very large study showing that that it was, I think, 231,000 people in 541 hospitals that had had a heart attack. And it was looked at over six year period and they looked at cholesterol lipid levels for everybody. They found that 75% of people who had a heart attack had, quote, a normal LDL under 130, which is what's considered normal. 50% had optimal levels. Yep. Under 100. 17% had super optimal levels under 70. But what they did, that was really interesting. And again, it confirms this whole metabolic hypothesis of heart disease that it's really related to mostly insulin resistance that, that, that those with low HDL and high triglysteroids, which goes along with small dense cholesterol particles, or much at a higher risk of having a heart attack. And so, in fact, the average HDL in that group was 39, which should be, ideally, over 50. And the average triglysteroids was 160 should be probably under 100, ideally under 70. And it didn't really seem that that LDL was really the driver. It was the triglysteroid HDL. Ratio, it was the triglysteroids in the HDL. And it was what is what we generally call an atherogenic lipid profile, which is not just about the total number of cholesterol or the LDL number. It's about the quality of your cholesterol, which is the size and number of the particles. And the smaller dense particles are the ones that are more putting a risk. And those are the ones that are caused by sugar and starch, not that that fat actually improves the size of your lipid particles. Yeah. No, fascinating. And it makes sense. But also, interesting, something else that I came across in the last few years, which you'll find fascinating, Mark. And I don't know if you know this. David Diamond, who's a cholesterol researcher, published a paper, I can't remember which journal it was in very recently. And they looked at the primary prevention randomised control trials done by, obviously, by the drug companies and secondary prevention trials. And subgroup analysis found. So these are people who were starting to have neither either a high risk of a heart attack or a heart attack in the patients in the trials that had normal triglycerides in HDL. No benefit at all from statins. Think about that. So if you're a triglycerides, you're going to be sure we're good. Even people who've had a heart attack. There was no benefit from the statin at all. Which fits with what you just said. And it's kind of interesting because you know, you get benefit in some ways of inflammation protection, but you also get increased insulin resistance. You do. And of course, we haven't even talked about side effects. And that's another issue, right? So if you look at, you know, to try and explain why there's no reduction in cardiovascular mortality, even if we expect, except the four day increase over five years in high risk patients. One of the, my explanations is this, in the real world, at least 50% of patients prescribe statins, even in high risk groups will stop taking it within a couple of years. And when you do surveys, most of them say they felt they got side effects, muscle fatigue, muscle pain, brain fog, erectile dysfunction, and how prevalent that's a big, well, how prevalent is that? And you look at the data in this mix, but anything from, and my experience, anything from 20 to 50% of patients, at some point, I've had patients who took statins for 20 years and then get side effects for 20 years, and then they got side effects and it gets better when you stop the statin. So they're very prevalent. I wouldn't say they were serious or life-threatening, but you know, the question I ask the patient always does this interfere with your quality of life, right? And it's very simple. You know that, as a person, it's a very subjective answer. Yes or no? If it does, we need to do something about it. Because listen, we're all going to die at some point. What we want to live our lives in the best health we can for as long as possible, right? In many ways, that's probably more important than longevity, right? It's having good quality of life. So that is something that I address with patients as well. So you're going to sort of see a man the argument and argue the other side. How would you argue against yourself for this? Because you know, I'm having this conversation with a cardiologist for experts and they're like, listen, the data is just so strong about stats. And there's no question that they lower risk and there's no question they're benefit. And yes, there are side effects. It can cause mitochondrial injury, it can cause muscle pain, it can cause insulin resistance, but the trade office worth the risk. And in the data is so prevalent, so strong and so clear that we should all be kicking stats. I think, I think, you know, the arguments to be made on interpretations of the evidence, trust in the evidence and different bits of evidence. So all I can say, Mark, for me is that we all have our biases. And you could argue that I have a bias because I have an obsession with lifestyle and I'm a foodie and I started cooking when I was 16. I was taught by my dad and, you know, one of the reasons I got annoyed or pissed off in the hospital and gotten this whole, my campaigning started about hospital and just, you know, why are we giving junk food to patients? Because I also as a doctor was like, for Australia, I can't get any healthy food anywhere. That could be my bias. Fine. But, and I accept that. One of the things I do myself, and I think the reason I've been through a process where I've had to change my mind several times on saturated found sugar, on low fat diets, on statin prescriptions, on cholesterol, on something more recent and more controversial, which we're not talking about, is you have to have an element of humanity. But when I do that, my analysis myself, I try and counter my own arguments and then try and find a way of a nuance. I can't really see a strong counter argument. And I'm not saying this from a place of hubris because, okay, let me get, let me give you one argument. So, so if, and this is a hypothetical, hypothetical, if statins didn't have side effects or they were almost non-existent, I could actually say put them in water supply. Because even if there is a concept in medicine, you've got to treat them any to benefit a few. So, let's just say that they save lives in, I don't know, on average, say one in 300 people are going to live longer because statins, right? It's a public health. Yeah, for public health. So, put in the water supply. You know, three billion people, we're going to have, you know, you're going to save one in 300 of those three billion, you know, whatever that is. For a lot of people. It's a lot of people. It's, it's tens of millions of people, at least not hundreds of millions. So, you could make that case, but that isn't true though. That's just simply not true. Yeah, if there were no side effects. So, so I am very for, you know, and that, and that is an argument that has been put forward and the issue is that there's marginal benefit. Yeah, but I'm saying that if you, it's a, it's a public health intervention that doesn't have any downside. But, but if it doesn't have any downside, that's fine. And go for it. Put it in the water supply. But unfortunately, it does. And that, that's simply just not true. So, therefore, you then have to then talk about, you know, and some of the doctors come from a mindset mark where they don't, even they, they, and this is a different school of thought, but I, I don't agree with it. It's not about agreement. I mean, okay, maybe it's my opinion. Is that they think that there should be an old school paternalistic practice of medicine. Doctor knows best patient do what I say. That's right. I'm in a way. I'm in a way. I'm in a way. I'm in a way. I'm in a way that's, you know, in cue that empowers them that, that it's a more equal relationship. You know, and that's fine. That's a, maybe it's a philosophical disagreement, but that's the stance I'm going to take. And I'm prepared to die on that hill. I think that's right. I mean, I think, you know, we, we, we, we, we have to sort of look at this data high level. Like any tool, there is a use for stands. There's a use for the PCS can I am here. There's a use for the new CTP drugs that are coming out. There are people who benefit and I don't think it's heterogeneous. And I think we have to sort of, and I've noticed this is sort of the doctor's been doing this for 40 years. Not everybody's the same. Saturated fat is fine for most people, but not for some people. Yeah. Right. Sugar can be tolerated more by some people, but not by others. I just came back from Utah. It was in the Native American reservation, the novel reservation. It was just staggering. It's the amount of obesity. I mean, you look at, you know, 100, 500 years ago, there wasn't a single overweight Native American, you know, period. And, and why is because the metabolic, they're genetically different. So I think, I think, you know, and let's sort of explore who might benefit from these drugs. Because there's a class of people we, we, we, we, we further than this lean mass hyper responders were people like you and I, maybe who were athletic, who were fit, who may actually have an adverse response to increased saturated fat to diet, or who might have a family history of lipid disorders. Yeah. And actually have some genetic issues, which I do in my family. So how do you sort of handle those? Yeah. So I deal with those actually quite regularly. So interesting me about the saturated fat. I think you're right, Mark. There are definitely a subgroup of people who have more, who have very high saturated fat intake. Actually, it does affect their interresistance or make their triglycerides go up. And in fact, there was a paper done by, I think his name's Ronald Kraft, if I'm not wrong. Ron Kraus. Ron Kraus, sorry, Kraus, you're right. And he showed, and he showed there was an abnormal effect on lipids. If your saturated fat consumption in this, obviously, certain groups of it was more than 18% of your total calories, right? It's still very, very high. But again, that you're absolutely right. That might happen with a certain subgroup of people. I've seen, for example, a patient on a carnivore diet, who actually had something like that. And when they, when they reduce their saturated fat intake, their lipid profile got better. That's all they changed. So I agree with you. There are going to be a subset of people. What do you do with FH? The people with the familiar high-pilipidemia. So that's just lay it out for people, right? And I think there's more than just that. One subtype, there's many different types of genetic lipid disorders. Of course. That I think we're just trying to figure out. There are. But you know, you talk about APOB and lipoproetinolay, which are all these other extra markers of risk that are added in. Basic teaching in medical school. Certainly, why I teach medical students and junior doctors, right? Don't organize a test, unless it's going to change your management plan. Because what's the point? So you create an essay anxiety, for example, for some people. Now, I get it. People may want to know, and if that's what they want to know, that's fine. But you know, and we'll come onto management as well. If you're not going to add in a statin or whatever else, and okay, maybe those people need to be more extreme in the lifestyle, maybe that's a reason to do it, saying you need to be like, instead of meditating for 30 minutes a day, I want you to meditate for an hour, right? No, fine. I mean, maybe that's the best we're going to offer them, right? Yeah, yeah. To keep the wrist down. So we've got to just be a little bit careful about how we about ordering these tests, and then but thinking a little bit more, okay, is it going to change anything? And I'm I just going to give this patient unnecessary extra anxiety. And I'm listen, I'm a doctor. Doctors are the worst patients. I probably have a party because my dad was the same. I have moments of being a hypercontract. And I know on the receiving end, like, you know, tests that are done that didn't need to be done. And I'm like, okay, what does this mean? And you go down a rabbit hole. So we've got to think about that as well, right? In terms of if you haven't got a clear solution, then then don't order the test. I'm not saying don't do the test, but I just want us to think about that a little bit. I mean, I'm just I truly learned that medicine. I'm not sure I have the same view because I think that the more data you have, the better you can make sense of what's going on. And then I think because the movement towards this deep phytomics, I've had Jeremy Nicholson in my podcast, Sly, or Huda My Podcasts. And they're about more data and dense dynamic data, cause of information from your biomarkers from a tablet, or biome, your genome, your transcriptome, that all teach you about sort of subtle changes that may not represent a disease today, or they don't have a drug treatment today. But that if you left untended, would ultimately lead to a disease or but it may not or may not, but I'd rather know if my insulin is going up over 10 way before I get diabetes. No, I agree. So 100% I agree. There are definitely certain. Yeah. So I think there's a new one there again. There are certain things where we know, okay, there's a very likely benefit here. You're getting your insulin down, etc. I think some of the other biomarkers is still in a certain, you know, area. But again, Mark, you said that, okay, you're a guy. And this is if I was having a conversation with you and you're preference of values, you want the day that that's your preference of values. I want to know more and more and more. And that's fine, Mark. I'm going to help you and let's do all these tests for you. Somebody else comes in, you know, and suddenly they come. And the thing is I see this, this is what happens with the whole cholesterol hypothesis, right? I've got patients coming to me for a second opinion as a cardiologist. I do, you know, international consults and virtual and whatever else, all around the world. And they and I talked to them and I just started to tell me what's been going on and they they've been living in absolute fear of death for months. And some of them break down in tears when I just say to them, listen, I've just done a cardiovascular risk here. Your LDL cholesterol is so-called high, but it's not an issue and you're fine and your risk is only 2% and you can see a sigh of relief and say, Dr. Thank God. I've been going on thinking that I'm been that's again misuse not good use of maybe numbers or statistics. I mean, going on thinking that I have got in the next five years as a 80% chance I'm going to die of a heart attack. I'm like, no, it's 2% in 10 years. Right. Right. So there's also that as well. So I do think we just think a little bit, Kaffir, but could we have to FH? FH effects. Familiar happy lipidemia. Genetically very high cholesterol. Okay. 50% of men and 70% of women, right? With FH untreated, big numbers will not develop premature heart disease, but 30% of women well and 5% which is a lot will get me even before maybe 50 or 60 will get heart disease. So why did it actually review paper with with a number of intracial scientists as well? And we published it in BMJ over in Space Medicine and we thought, okay, that's interesting. 50% of men with FH familiar happy lipidemia, very high LDL don't get heart disease and 5% do. Is there anything we can find that's different between them that highlights the subgroup like what is the difference between them? First thing, was it the LDL? Is the LDL higher in those ones that get heart disease versus the ones that don't? No difference at all. That's interesting. It can't be the LDL then. What is it? Well, we found, and this is a mark you going to like this, one of the, like a protein little A was higher in the one that dropped the heart disease. So FH, you should look at I like a protein little A definitely that gives them a high risk. But what's most promising and interesting is when you correct for ins and resistance, yeah, right? Or their level of risk of heart disease for FH patients almost comes back to someone who's completely healthy. It's only slightly higher. So what were the two markers? Normal waste of comforts and low insulin. Yeah. Now how do you get there? Diet, right? Cutting out the sugar, processed foods, refined carbs. That's right. And it rapidly. So this is amazing. So I could, so what I do with those patients is I go through that with them. Now, if I think they're actually the high low, protein little A and they're probably a high risk, I say listen, the starting benefit is there it's small. But why don't we do a halfway house, high dose statins are more like to give you side effects. Let's do a low dose stand. Let's do the lifestyle. The lifestyle is most important for you. And I go really hard on that with them, including the diet, the exercise and actually the one that I think I didn't discuss enough. And you know, it comes out in my documentary film, which is called first do no farm PHA RM, not F A RM. All right. How do you how do you find that? It's released online at the moment. And you can download it for $10 and it's the website is no farmfilm.com. And the reviews have been, you know, pretty extraordinary. No farm, no farmfilm.com. PHA RM. PHA RM. Okay. Yeah. Yeah. Yeah. No farmfilm.com. We screened it in the lesser square Odin in London, which is the most famous film, Cinemond the World, 790 people came. It was in bite only, but so are British. Really good feedback. Screened it to doctors, intergovernmental health conference on Washington DC. Really amazing feedback there. And so far, you know, we're getting reviews that are giving it sort of 9.7 out of 10, which is great. I'm proud of that. But most importantly, Mark, it is a, it is in my view, this film uncovers literally how we have got this pandemic or chronic disease, both with big farming and big food capturing this. We've got the medical knowledge. We've got very credible experts for medicine, the BMJ. We going to some dark stuff in there. Just how many people have been killed by research fraud, but we also give people hope with a lifestyle stuff. And one of the most interesting things I discovered in the film or in my research is that for me, pushing the boundaries on heart disease is also the next phase is, can you reverse the blockages of chronic heart disease? And the only, there's not a lot of research out there. We know of course Dean Ornish did his trial many years ago, but the reversal was very, very, you know, listen, at least very least, at stabilized chronic disease, but it was like one or two percent in terms of blockages. Cardioles in India for 20 years has been reversing heart disease to the level where, you know, one of his papers that you published showed a 20 percent reduction within two, three, two years. Of the narrow areas. 70 percent became 50, 50 became 30. So he did it through this healthy lifestyle program. It was a, there were devout Hindus, hundreds of patients, right? High fiber vegetarian diet, because they were devout Hindus fine. Two, 30 minute wrist walks a day, okay? And then some called Rajyoga meditation. And when he did a deep dive analysis into what caused a reversal, the only independent factor for reversal of heart disease was 40 minutes of Rajyoga meditation a day. So I went to India and I thought, let me just, is this true? Is this real? Let me look at the angiograms on myself. I trained in this stuff. I know this stuff inside out. It was unbelievable while seeing, I've seen those patients, I've seen the angiogram reports, there was clear reversal. In some patients, it was a complete 100 percent occlusion that then opened up. Wow. Right? So I think it's because you've turned down the chronic inflammation by getting on top of the stress, but it wasn't just about breath work and meditation. This comes into something that we are dealing with right now in society, which is a crisis of morality. Okay? It was a spiritual transformation. These people changed their mindset. They became less materialistic. They became more spiritual. They thought how to reduce their anger. They were, you know, he got them into the ashram with their wives, for example, the men and vice versa, to talk about why were they getting more angry? Like, how is your relationship? What's going on with your work? It was a real spiritual transformation that reduced probably the stress. And I think that probably has a scientific basis because we know chronic stress increases chronic low grade information. We've talked about heart disease being a chronic inflammatory process. You turn down the inflammation and the body can heal. The body has a capacity to heal itself. So kind of in wrapping up, you know, kind of what I'm hearing is it stands have a role, but they're not all that cracked up to be. Yeah. Just know where they write for you. Are you being told the absolute benefit is? And then what do you think? Like, you know, do you want to take it or not? And that you have critiques of the way the research was done and how the studies sort of sort of stood and sit to true the statistics to show the benefit. Yeah. How it's reported is relative risk versus absolute risk. If you get a risk reduction from 3% to 2%, that's a 30% risk reduction. Sounds great, but it's really a 3% to 2%, right? It's just 1%. Yeah. 1% and and you know, there are there are flaws in the ways in which a lot of these studies are done. So could you sort of for some of the big data that you kind of critique? Can you sort of unpack that a little bit? Because I think we didn't dive deep enough into that. I want good understanding. This is not just sort of a heretical opinion, but if you're looking at the way these studies were designed and they were done with the data you show. So when they do the randomized trials where you're trying to compare two groups which are the same and you're trying to get show a benefit of an intervention, what's reported in the results often underestimates massively under report society effects because what the drug companies do control the how the trials are designed and how they're conducted. Think about that. They're only interested in profit, not looking after you. So they will try and design the trials to maximize ultimately the sales of the drugs. They have what we call a pre-randomization run in phase where they get these volunteers who are interested in being in the trial. And for six weeks, for example, one of the trials, the hot protection study, a third of the patients, thousands of patients who were removed before the trial began because of so-called noncompliance. In other words, they got side effects. So imagine they take the people out with side effects at the beginning and then they only start the trial once they've taken the people out with side effects to get them early on and then report on that. So that's probably one of the reasons they're massively under reported with side effects. It's, I'm sorry, Mark, you know, it's fraud. I'm sorry, it's fraud. And that would be definitive about how I described that. What's the definition of fraud? Deliberate deception in order to make money. I'm sorry, that's the way I interpret it. This is fraud. Right? The system is fraudulent. Some of the independent studies also show a benefit. Yeah. Well, the independent studies that have been done have shown very little benefit. But I agree that I think there is a small benefit. But the question then is you also look at the side effects issue. And the independent studies have never been able to get hold of the raw data as well on statins. A totality of evidence around statins, the raw data has never been independently evaluated for side effects. So we still don't know the true side effects. Well, we know as what's published, not what's actually been tracked because pharmaceutical companies don't have to release that data. Exactly. And that hold it. They hold it. And then the regular thing, the regulators are going to be able to ask for it and look for it. They really do that. Well, they have it, but they don't publish it. Which is interesting to me of the FDA does this because, you know, if you probably dig far enough and deep enough, you can find it online or through the FDA databases. Yeah. But it's not in the literature because they're not published. But the pharmaceutical company has to report all that data before it's approved. Yeah. They can't cherry pick what they provide the FDA. But it's not published. And the FDA doesn't do a good job of saying, hey, yeah, this is what they publish. But you know, all this other stuff shows that it really didn't work that well. What they often give the FDA mark is curated information from 10 to 1000s of pages of clinical study reports on patients in the trial. So the FDA normally doesn't go and then reanalyze it. They just trust what the drug industry, the summary results. And then the other issue is, of course, the financial conflict of interest, 65% of the funding of the FDA in the US comes from big farmer, 86% of the funding in the UK of the MHRA comes from big farmer. And this is a point they don't want to buy the 100 feet. So this is a huge conflict. Why is it seen that the American College of Cardiology and the American Heart Association still recommends patents for people with high LDL for primary prevention, meaning if you've never had an architect, which is 75% of the prescriptions. You know, um, is it because they're captured too? I think it's a combination of factors. But yes, I think other route of it is flawed science, dogma, and money. And then even if people know there's an issue, um, they're afraid to speak out because they're worried about their jobs. But if we're all doing this collectively, it's going to be a complete part of my language, a shit show for healthcare. And that's why we are where we are in America right now. So it's time to, you know, uh, you know, I think, um, I love this phrase. I know this is not a political podcast and it shouldn't be. But, you know, a good friend of mine and good friend of yours of Robert Kennedy, Jr. And I love the fact that he's come out with this make America healthy again. I think we should all get behind that. Yeah. It's been co-opted unfortunately. And you can't, but, well, no, but you can't make America healthy again until you remove commercial distortions of the scientific evidence. And that, unless that is addressed head on, we're not going anywhere. Okay. I want to restate again commercial distortions of the scientific evidence. Is it, unless you correct that, you won't fix health. It's actually a paper. I'm going to link to it in the show notes called the commercial determinants of health, talking about the data on how multinational corporations like Pharma, food and egg companies, severed public health and privatized profits. And it's a WHO report that's sort of partly published, but also coming out to a much, much bigger report. And it's going to be interesting when that hits because, you know, we talk about the social determinants of health. But this is really how the industry is driving it. And I just, the American Heart Association alone receives $192 million a year from food and pharma companies. Right? Crazy. So mind blowing. It's mind blowing. How can we, how can we trust that being independent with the information? Come on. I mean, it's people need to just, you know, wake up, wake up. And you're not telling everybody who's on a stand to stop it. You're not telling them anybody. You just get better informed. Get better informed. Yeah. Read the data. I wrote an article years ago called, sat, what I got wrong, what I got right, which goes through a lot of this data. Yeah, it was published about eight years ago. But still, I think there's more and more data coming out all the time. And I think they can check your books. Where do they learn more about your work and what you're doing? Yeah. So I understand. Yeah. Well, it's very quickly on that. I just, I love the fact you bring up brought up commercial determinants of health. There's a definition in public health because I talk about this as well. So just so people ensemble that means strategies and approaches adopted by the private sector to promote products and choices that are detrimental to health. That's a definition of commercial determinants. I have evolved that. And in fact, reference in the landscape, because Richard Horton, the editor, came to one of my lectures. And I've said that the way that drug companies, big corporations conduct business, not individuals within it. I'm not putting individuals who work for them as legal entities, the way they conduct their business, actually fulfills the criteria for psychopath. Calison concern. No, but this comes from Robert. Robert, I'm not in moral, right? Forensic. Yeah. Forensic psychologist Robert, behind the original DSM criteria of psychopathy, define them the book corporation. He said, so what does that mean? Calison concern for the safety of others in capacity to experience guilt, repeated lying and conning others for profit. So there's another one to throw in there. Maybe next time, psychopathic determinants of health is my new term. So this is what the root of the problem, right? And of course downstream effects, we know what's going on. So yeah, people can, I've got a website.procime.com. I think to be honest, if they want to get an overview of this, it's a one hour, 50 minutes, it's an educational tool. Please go and download first, you know, from nofarmfilm.com. And if you want to read about statins in particular, but we cover this in the film a little bit, the whole drama of statins, which is quite interesting. My third book is called The statin free life. And I think that really breaks down all the cholesterol stuff and the statin stuff and the lifestyle stuff as well. Yeah. So in summer, you're not anti-science or anti-drug or anti-farmile. You're just for pro health. Real health. Real health. Real health. I'm pro ethical evidence based medical practice. There you go. So it's really been an amazing conversation. I could talk to you for hours. Unfortunately, we have stuff to do. And I encourage people to dig deep into the scientific work you published, which is where I first came across your work with the British Medical Journal or BMJ as they call it now. And your books, your films, in you're kind of a tireless advocate for a country opinion that is really advocating for a better approach to understanding nutrition, health, and making informed choices as opposed to just swallowing, hook-lung, and sinker, the dogma that we're all taught in the society, which is that the only path that success in medicine is through pharma. And I am not any pharma. I prescribe drugs regularly. However, I want to prescribe the right treatment for the problem. Yes. And because all we have in our Tukitus Physicians is a prescription pad. That's all we know how to use. We're diet and lifestyle work far better and are far more effective at achieving the same or even better results than in drugs. And if there was a drug that could instantly reverse diabetes or fix insulin resistance or prepare for sex. With no side effects. With no side effects. Yeah. I would do it. But I never seen anything work as well as food when applied in the right dose. Yeah. The right medicine. Yeah. And for the right duration. 100%. And I think people don't understand that about food. It's not like, oh, food is medicine. It's kind of like hippy-dippy term. Yeah. It's actually very precise. Just like you need to know the drug. You need to know the pharmacology. You need to know the dose. You need to know the frequency. You need to know the duration of a drug that you're prescribing from a particular condition. You need to know the same about food. That's how nuance and detail it is because food is full of tens of thousands of molecules that regulate every single aspect of your biology and understanding how to leverage that tool for healing is profound. 100%. And another point before we finish is that, which you've just raised, is that these pills for chronic disease rarely improve your quality of life. They may affect a blood marker. They may reduce your risk to some degree in the long term. But lifestyle changes come with outside effects by and large and they improve your quality of life. Well, there are a lot of side effects. You feel better. You have a brain energy. You sleep better. You're a better sex drive. You less depression. So all the side effects are good ones. If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review and subscribe to the Dr. Hyman show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic and Function Health where I am Chief Medical Officer. This podcast represents my opinions and my guest's opinions, neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. 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