Dr. Aseem Malhotra:
If you go into a grocery store, the supermarket, whatever and you’re thinking about what to buy, pick up even bread, modern packaged bread, if you pick it up and you can count five or more ingredients and you can’t recognize some of them, they’re preservatives or additives, don’t eat it.
Dr. Mark Hyman:
Welcome to the Doctor’s Farmacy, I’m Dr. Mark Hyman and it’s Farmacy with an F, a place for conversations that matter. And if you’re wondering how to prevent COVID-19 in yourself and in communities and why we’re really seeing the staggering impact of COVID-19 on our economy, on our health care system, then this podcast is going to matter to you because it’s with one of the leading thinkers in the space of chronic disease, obesity and Health. Dr. Aseem Malhotra. Who’s a good friend of mine, coming to you from the United Kingdom where he’s recently published an article that caught my attention called COVID-19 and The Elephant In The Room and we’re going to talk about that elephant today. Which is a perfect metaphor because elephants are big and the problem we have is big and it’s because we’re all big.
Dr. Mark Hyman:
Dr. Malhotra is an honorary consulting cardiologist at Lister Hospital in Stevenson UK. He’s a visiting professor of evidence based medicine at the Biana School of Medicine and Public Health in Salvador, Brazil. He’s a founding member of Action On Sugar and was a lead campaign are highlighting the harm caused by excess sugar consumption in the United Kingdom, especially its role in Type 2 diabetes and obesity.
Dr. Mark Hyman:
In 2015, he coordinated the Choosing Wisely Campaign by the Academy of Medical Royal Ecologist as a lead author in the British Medical Journal or BMJ paper to highlight the risk of the overuse of medical treatments. He also became the youngest advisor in that same year to be appointed to the Board of Trustees of the UK health think tank, The King’s Fund that advises government on health policy. He’s all over the media. He’s published dozens and dozens of medical articles I’m journals like JAMA, Internal Medicine, Open Heart, British Medical Journal and many more. So I’m so happy to have Dr. Malhotra Aseem on my podcast today. Welcome all the way from the UK.
Dr. Aseem Malhotra:
Mark, it’s a pleasure to see you.
Dr. Mark Hyman:
It’s great to see you too. So are you staying safe over there in the UK?
Dr. Aseem Malhotra:
Yes, staying safe luckily at the moment and more importantly trying to keep sane I think like everybody.
Dr. Mark Hyman:
Are you on lockdown over there? Are you hiding out in your bedroom?
Dr. Aseem Malhotra:
Yeah, completely on lockdown, completely on lockdown, yeah. So it’s all focusing on all the important stuff right now. It’s good food, sleep, getting some exercise in there and trying to keep the stress levels down.
Dr. Mark Hyman:
Yeah, well, you’ve been also active in thinking about how we deal with this big issue of Coronavirus and why we’re really struggling. Because I don’t think most people realize that the reason that we’re sheltering in place, the reason we’re locked down, the reason businesses are shut, the reason we can’t go to sports games or university or schools is not actually because of Coronavirus, it’s because of us and how we’re a susceptible host to the virus. And if we were all super healthy, this would be a bad flu and we’d all be going about our business and we’d protect the very vulnerable and sick and old but most of us would be okay.
Dr. Mark Hyman:
So the UK went into lockdown on March 23rd. There’s been about 133,000 Coronavirus cases and 80,000 deaths and it’s changing every day. So by the time this podcast airs, it’s going to be far more. And a lot of the focus is on ramping up testing and vaccine development and medical treatments. But you’re actually helping us focus on something different. What you call the elephant in the room, the link between obesity and the health outcomes from COVID-19. So here in the United States it’s 75% of us are overweight. I think in the UK, it’s 63%. How are they related? How is obesity and COVID-19 related?
Dr. Aseem Malhotra:
Yeah, Mark so I think you’ve definitely hit the nail on the head. The real pandemic is a pandemic of metabolic disease that we have in the UK and in the US. And just to give you some perspective, there’s some very good data from the United States, which I referenced in my article in European Scientist, only one in eight adult Americans are metabolically healthy. I mean, that is extraordinary seven out of eight are not. And we’ll define that shortly. But what that means is we are more susceptible, not just to all these diseases that have been putting so much stress on our healthcare systems. But what is particularly interesting or what we found from the data that we’ve analyzed and looked at with COVID-19 and what the CDC has been talking about, is that if you have metabolic syndrome, if you have obesity, if you have Type 2 diabetes, your risk of mortality is up to 10 times more than somebody that doesn’t have it.
Dr. Aseem Malhotra:
Now, you mentioned earlier on that, if we had a better healthcare system, and we were a less stressed healthcare system and we were a healthier population, we may not have needed lockdown and that’s something I concluded with in the article. And I think you’re absolutely right there, Mark. Just to give some perspective to the viewers and the listeners on how lethal this virus is. So flu in itself, the overall mortality rate from the flu is about 0.1%, or one in 1000. The best estimates now suggests that for COVID-19, for Coronavirus, it’s probably somewhere between 0.5 and maybe 0.7%. So, even seven times more deadly if you like than the flu, and certainly as it’s a new virus, it’s more contagious.
Dr. Mark Hyman:
Yeah.
Dr. Aseem Malhotra:
You combine that with a healthcare system already, which is under stress, because we haven’t been dealing with the very diseases that you and I have been challenging and talking about for years, then it’s a recipe for a public health crisis and that’s what we’ve got. The reason why COVID-19 seems to be more lethal in people with a metabolic disease and obesity appears to be linked to essentially excess body fat and chronic inflation. So, we have very good data from previous… from the flu, from other respiratory viruses, which are similar in many ways to Coronavirus, which shows that people with obesity had higher mortality rates. So for example, in 2009 [crosstalk 00:06:13].
Dr. Mark Hyman:
If you are overweight, you’re more likely to die from just a regular flu.
Dr. Aseem Malhotra:
Yes, absolutely. Absolutely. And data, for example, in California showed in 2009 there was a flu pandemic then. And they found that 61% of people who died from that flu epidemic, that flu crisis then had obesity, and the biological mechanism seems to be related to excess body fat, and how that causes a dysregulated immune system, a dysregulated immune response to the virus, which then causes a cytokine storm that leads to ARDS or Adult Respiratory Distress Syndrome, which causes death. That seems to be the mechanism.
Dr. Aseem Malhotra:
Of course, there are other mechanisms as well. People with obesity have more restricted lung capacity. And this could also be a big player factor. And of course, the people with underlying conditions are probably also more likely to suffer things like heart attacks. We talk about all these risk factors, ultimately a big risk factors for heart disease. So you combine it all together, it’s really the perfect storm. But the good news Mark, and that’s something I think we need to talk about is, there are things you can do, which can rapidly reduce one’s risk, and really reverse a metabolic syndrome.
Dr. Mark Hyman:
Quickly.
Dr. Aseem Malhotra:
So I think maybe it’s a good opportunity for us to really talk about what those five metabolic markers are. Because it’s not something that is part of conventional practice in medicine. You know, that when you go to the doctor, they’ve got the standard, the what’s the blood pressure? Are you diabetic? What’s your cholesterol? And then we treat those individual so called risk factors with separate medications.
Dr. Mark Hyman:
Yeah.
Dr. Aseem Malhotra:
Well, the overlying theme is metabolic disease.
Dr. Mark Hyman:
You’re right and I want to, before we get into the assessment of how we look at that, and what we can do, I want to dig a little bit more into the data on how obesity is linked and overweight, not just obesity, and even what we call metabolically obese normal weight, which is I refer to as skinny fat. You look thin on the outside, but you’re fat on the inside. You’re metabolically unhealthy. And that is up to 20 to 40% of thin people who are metabolically unhealthy.
Dr. Mark Hyman:
So when you think 75% overweight, and then 30 to 40% of the rest of the 25% of people, that’s a quarter of the population is not great. You’re talking about like [crosstalk 00:08:34].
Dr. Aseem Malhotra:
Mark, you’re right. And I think that the most severe metabolic disease can affect absolutely 20 to 40% of people with normal BMI. But in a more sensitive way, and on the latest definitions, and that, again, is a very interesting paper that shows, looks at American data over several years. The most recent data shows that less than one in three people, less than one in three people with a normal body mass index between 18 and 25 are metabolically healthy. That means two thirds of people, of a normal weight are metabolically unhealthy. Which basically means, as I’ve said before, there’s no such thing as a healthy weight, only a healthy person.
Dr. Mark Hyman:
Yeah, well that’s a good point. So let’s get back to how the weight and obesity affect your immune system. Because you mentioned that it increases inflammation in the cytokine storm. We know that’s true because I’ve been saying you become pre-inflamed. If you’re pre-inflamed, when the virus hits, it’s like throwing gasoline on a fire. And when you look at the data, 94 to 97% of deaths are in people who are either overweight, obese or have a chronic illness, which is related to being in poor metabolic health, diabetes, heart disease, and so forth. Even cancer is a sign of often poor metabolic health.
Dr. Mark Hyman:
So we know that these are all conditions that are resulting in pre inflammation or inflammation. But there’s some other interesting data that I didn’t really realize about viral infections and obesity. For example, it suppresses white blood cell function, it actually increases viral shedding. So that if you’re overweight, you’re more likely to spread the disease because your body keeps shedding and you shed more virus. And then you’re like you wrote in your article, you’re susceptibility to responding to vaccines is decreased.
Dr. Mark Hyman:
So when you get a vaccination, it may not work if you’re overweight or obese, and we’re depending on this vaccination to save us. But what you said is that 90% of the population, essentially is metabolically unhealthy, and the vaccines aren’t going to work as well. Is that true?
Dr. Aseem Malhotra:
Yeah, that’s true, Mark. Certainly with the flu we’ve seen that, that’s the case. And I think that’s a really important message also moving forward, because that’s what’s happening at the moment. A lot of resources are being directed to waiting for the vaccine. But actually, even for the vaccines to work, you need to maximize your chances by improving your metabolic health.
Dr. Aseem Malhotra:
And in terms of the viral shedding, yes, certainly with the flu, it appears that if you’re obese, you have the virus for on average 42% longer than people who are not obese. And it’s an observation, of course, anecdote isn’t the highest quality of evidence, but it’s an interesting observation with what we know. Over here in this country, several members of our government ministers, cabinet, if you like, including the Prime Minister got afflicted with Coronavirus, the chief medical officer, the chief executive of the NHS, the Secretary for Health and Boris Johnson the Prime Minister.
Dr. Aseem Malhotra:
Now, Boris Johnson got the sickest. He got admitted to hospital and he’s overweight. In fact, I would say he’s probably obese. I worked for several years as an advisor to the London Food Board when Boris Johnson was mayor of London. And I won’t name this person, but someone very senior said to me, even the fact that Boris used to cycle a lot, when you see Boris on TV, he’s pushing the fitness thing and cycling everywhere, but he’s considerably overweight and this individual said to me, “Aseem, you’re a doctor, I’m very concerned about Boris, he doesn’t look well, he is obese.”
Dr. Aseem Malhotra:
And I think that also brings us on to the discussion briefly, I think that there is still a bit of a misperception or misunderstanding there, that you can be fat and fit. Sorry, you can’t. The data shows that even if you exercise, if you’ve got excess body fat, you are at higher risk. And I think that message also needs to go out to the public, because there still seems to be a lot of misinformation that you can outrun a bad diet, and as long as you’re working out… I’m sure you see, and America has probably lots of people are overweight or obese, who are exercising. Now, we’re not saying don’t exercise, of course, it’s a good thing to do for you. But actually, you’d be doing a lot better if you also change your diet and got your weight down.
Dr. Mark Hyman:
Yeah, I mean, I always say you can’t exercise your way out of a bad diet, that is far more an impact. And yes, if you clean up your diet and your exercise that’s ideal, and I do both. But if you… You see so many people who are very overweight who exercise a lot, it’s because their diet is not right. So that’s the key.
Dr. Mark Hyman:
And what was interesting, it’s not just any fat, it’s a certain type of fat and certain location of fat. So can you talk about this uniqueness of this type of belly fat that’s causing the problem?
Dr. Aseem Malhotra:
Yeah, it’s a visceral fat, isn’t it? So it’s a fat that really surrounds the vital organs, the liver, the pancreas, that is what causes the… Also, the dysfunction if you like of those organs that link to dysregulated metabolic control of glucose, insulin resistance, and over time, this is what causes all these always at the root of all these chronic diseases, heart disease, high blood pressure, Type 2 diabetes, probably also cancer and Alzheimer’s disease as well.
Dr. Mark Hyman:
Yeah.
Dr. Aseem Malhotra:
So that’s really the root of the problem. I mean, just a slightly interesting anecdote, Mark for you. I like to follow my own advice. For many years we’ve discussed this before, this isn’t about being preachy, we have been through situations in our life where before we became better informed, we had our own issues with adverse health because of bad diet. I was still very active, but I was getting through 40 teaspoons of sugar a day-
Dr. Mark Hyman:
What?
Dr. Aseem Malhotra:
[crosstalk 00:14:12] Yeah. This is what I did for many years until I read the science, and I thought, “What the hell am I doing to myself?”
Dr. Mark Hyman:
You’re a cardiologist, so it’s the fat, right?
Dr. Aseem Malhotra:
Well, I was a trainee doctor, I wasn’t a specialist in cardiology at that point. But once I looked at the science, I… And I had this belly fat, I wasn’t particularly overweight, but I had this belly fat. And as soon as I cut sugar from my diet, I lost about a stone all around my belly.
Dr. Mark Hyman:
Okay, what’s a stone, because most Americans don’t know what a stone is?
Dr. Aseem Malhotra:
A stone is probably, it’s about 12 pounds to 15 pounds?
Dr. Mark Hyman:
I think it’s 17 pounds.
Dr. Aseem Malhotra:
Oh, really? Okay, fine so it’s quite a lot, quite a lot of weight. And it was all around my belly. And the reason I’m telling you this is obviously, I’ve been trying to walk the talk following my own advice for several years now. And just before the lockdown happened, they have this very interesting exhibition in London, which is probably, I think it’s around the world because my relatives in San Francisco have seen it as well, Body World. So have you heard of Body World exhibition?
Dr. Mark Hyman:
No.
Dr. Aseem Malhotra:
So basically they take cadavers, human cadavers that are preserved and they educate the public and you can see organs in the body. And it’s fascinating. It’s really interesting, very educational, even for a doctor. But in this exhibition, they also have one of the highest type of body scans that look at your muscle mass, your body fat percentage, bone mass, all that kind of stuff. And I didn’t know this, but it gives you a metabolic age at the end of it all. So I thought, “Okay, I’m going to get this done, let’s just see what it is.” I’m 42 I’m not afraid to admit that. I’m 42 years old. My metabolic age on this scan came back at 29. So I’m pretty happy about that. I’m apparently 13 years younger, in terms of physically than my true age. So, I think maybe that should be an incentive for people.
Dr. Mark Hyman:
That’s right. Well I got my telomeres done [crosstalk 00:15:56].
Dr. Aseem Malhotra:
You’re going to get younger.
Dr. Mark Hyman:
I’m 39. I’m 60 years old, but I’m 39 years on my telomeres.
Dr. Aseem Malhotra:
Exactly.
Dr. Mark Hyman:
It’s great. So, getting back to this belly fat, because it’s not just there holding up your pants, it’s a nerd blob of fat around your belly. It’s an alive organ. And this is really what’s driving the crisis of COVID-19. Because this organ is producing what we call inflammatory cytokines. These are the messenger molecules of your immune system. And you basically have a belly on fire, and it also produces all sorts of hormones and appetite, dysregulating signals and all kinds of things that make you hungry and gain weight. It’s really bad news.
Dr. Mark Hyman:
So it’s not just the average kind of fat. So what are the ways in which, you mentioned 12% of Americans are metabolically healthy, that’s pretty shameful. What are the types of things you would measure to look to see if you’re metabolically healthy or not?
Dr. Aseem Malhotra:
Yeah, Mark really, really good question.
Dr. Mark Hyman:
They’re at risk for COVID-19 because they’re metabolically unhealthy. How would they know?
Dr. Aseem Malhotra:
Yeah, absolutely. Very good question. And before I answer that, I think the other thing also just from a personal perspective of my interest as a cardiologist, and it’s something that I read about in the BMJ many years ago that our focus should be metabolic syndrome. The three of the five that we’re going to talk about is that two thirds of people who suffer heart attacks have metabolic syndrome. Most of them have a normal cholesterol. So this is really the big elephant in the room is this is what we should be focusing on if we’re going to reduce heart disease as well, as well as improve people’s health.
Dr. Mark Hyman:
Yeah, people [are talking about 00:17:27] blood pressure and cholesterol, people don’t realize that most heart attacks are caused by sugar and not fat in stat.
Dr. Aseem Malhotra:
Absolutely, Mark. And now we’re trying to wind back these harms of years of people getting the wrong dietary advice. But to answer that specific question about what are the five factors? So the normal blood pressure means less than 120 millimeters systolic of mercury and less than 80 diastolic. Waist circumference for a man of less than 102 centimeters, and for a woman less than 88 centimeters.
Dr. Mark Hyman:
What’s that in inches?
Dr. Aseem Malhotra:
In inches is, I think that’s 40 inches for a man and 35 inches for a woman. You have to just check that but it’s-
Dr. Mark Hyman:
Yeah, I think that might be obese.
Dr. Aseem Malhotra:
2.5 inches or maybe it’s a bit less, so 2.5 inches to a [crosstalk 00:18:19].
Dr. Mark Hyman:
I think it’s 37 for a man and 34 for women or something, maybe.
Dr. Aseem Malhotra:
Yeah, I think [crosstalk 00:18:27]. So just convert those centimeters to inches if you’ve got calculator there, whoever’s listening and watching. And then in terms of, you might have to help me with the units for triglycerides over here we say triglycerides greater than 1.7 millimoles per liter and HDL cholesterol should be greater than one millimoles. So triglycerides should be less than 1.7 and HDL should be greater than one millimolar.
Dr. Mark Hyman:
Here they talk about triglycerides less than 150 although I think ideal is less than 70 and HDL over under 50 if you’re a woman, I think under 40 if you’re a man. But again, those are not optimal numbers. Those are…
Dr. Aseem Malhotra:
Sure, just for this specific definition of metabolic health. I agree, absolutely. And then finally, last but not least, as your HbA1c so you want to be not pre diabetic, so less than 5.7%. You want your hemoglobin HbA1c, again, I think you use millimoles over there in the United States.
Dr. Mark Hyman:
That’s the average blood sugar over the last six weeks basically. It should be less than 1.7, but again, ideal is probably less than five and a half.
Dr. Aseem Malhotra:
Yeah, absolutely. So if you’re in all of those parameters, and you’re metabolically healthy, and of course, if you have one, then you then come out of the optimal metabolic health. If you have any three abnormalities of those five, you’ve got metabolic syndrome, and that is associated with the worst outcomes in terms of all sorts of health problems. Also, with COVID-19.
Dr. Mark Hyman:
I think also they talk about a blood sugar over 100 in this country. And the other thing that people don’t measure which I’ve been measuring for 25 years, and is probably the most important measure, is fasting insulin, which is something that nobody looks at. Which is very strange, because your insulin goes way up before your blood sugar goes up. So getting your insulin measured is one of the most important things you can do. And if it’s normal, you may not be out of the woods even if your sugar is normal, because the best test is actually a glucose tolerance test where you take a load of sugar, the equivalent of two Coca Cola’s, and you’ll see what happens over one and two hours in fasting.
Dr. Mark Hyman:
And that will tell you… And I’ve seen this one woman in my practice she just stuck out like a sore thumb. She was very overweight. She had that big round apple belly, and she had normal blood pressure, her cholesterol was normal, and her blood sugar was normal. So I’m like, “What is going on here?” So I did a glucose tolerance test. Her blood sugar fasting was under 100. It never went over 110 after the glucose tolerance test, which is normal, which is great. Her insulin fasting was like 30 or 40, it should be less than five.
Dr. Aseem Malhotra:
Wow.
Dr. Mark Hyman:
Ideally it’s two. And at one in two hours, it was over 200.
Dr. Aseem Malhotra:
Wow. There’s a ticking bomb basically. She was wearing out her insulin.
Dr. Mark Hyman:
And so it taught me a lesson that you can’t just rely on blood sugar or even fasting insulin or any of these other biomarkers, that they’re all surrogates for the hyperinsulinemia or insulin resistance that we’re seeing with these patients.
Dr. Aseem Malhotra:
Absolutely.
Dr. Mark Hyman:
So let’s talk more about this other parameter that we look at called metabolically obese normal weight, and what is it? And you talked about something called sarcopenic obesity. So what are the dangers of not picking this up particularly in the elderly who have a normal weight, but are also really metabolically unhealthy?
Dr. Aseem Malhotra:
Yeah.
Dr. Mark Hyman:
Because we see a lot of the elderly having risks and it’s not because they’re old. It’s because they’re metabolically unhealthy because of what you call sarcopenia obesity.
Dr. Aseem Malhotra:
So essentially as you get older, Mark certainly after 50 into your 60s people tend to lose, it’s part of the aging process, muscle mass does tend to decline. You can’t stop it, but you can slow it down.
Dr. Mark Hyman:
I’m reversing it, I’m working out now. I’m at home with COVID-19 and it’s the first time I’m not on the road in 25 years, and I’m doing weights at least three times a week, and I can see massive improvements in my muscle.
Dr. Aseem Malhotra:
Yeah, you’re in great shape, Mark. You’re a great role model actually for that although I know you’re 39.
Dr. Mark Hyman:
My wife’s like, what’s going on with your shoulders?
Dr. Aseem Malhotra:
No, but I mean, that’s a really good point. And of course, and what’s really important as well is to get enough protein because there is a big issue certainly in the Western world as well with protein deficiency, a lot of older adults aren’t eating enough protein.
Dr. Aseem Malhotra:
Of course, the best sources come from animal products, but you can obviously get it slightly harder from vegetable products as well and pulses and things like that. But you need to be eating a lot of protein and of course, combining it you’re right with some strength and resistance training. It’s really important for older people. And that will then reduce the chances and probably stop sarcopenic obesity happening. Where essentially what happens is you lose the muscle mass, and you gain excess body fat, certainly around the midriff, which is again, part of the aging process seems to be that people do develop more insulin resistance with time.
Dr. Aseem Malhotra:
So actually, as you get older, I think it’s more important to be actually more strict about what you’re eating and thinking about it. And again, it’s never too late to change, as you’ve probably seen with your patients, as I’ve seen with my patients, even though they’re older in their 60s, their 70s, even 80 year olds, even from changing their diet dramatically, and just making some changes to their exercise levels. They can improve their health markers and also for them, that sense of well being they just feel mentally and physically better.
Dr. Mark Hyman:
Yeah, and I’ve sort of, I think the way we think about aging is just all wrong. It’s really we should be calling it inflamaging, which is inflammatory condition driven by our diet and our lack of exercise and lifestyle choices which are something that we have control over and I’ve seen patients at any age, whether they’re 60, 70, 80 get better as they get older. And I see this with myself, my numbers are all better, my fitness is better, my strength is better, my muscle mass is bigger. I’m not saying that to brag, I’m just saying that, I was so busy changing the world for the last 20 years that I neglected some things. I ate pretty well, but I didn’t do the kind of exercise that I really wanted to do and needed to do. And I wasn’t as diligent about sleep or meditation, and now I’m really good. And I just noticed that I am actually healthier at 60 than I was at 50.
Dr. Aseem Malhotra:
Yeah.
Dr. Mark Hyman:
So I think there’s a point at which that might not be true when I’m 90 or 100. But I think it’s more true than we think. And I think the reason we’re seeing people in the hospital dying is either because they’re overweight or obese, or because they’re older and they’re very connected. It’s not that they’re two separate problems. So, and I just talked to a friend who’s an ICU nurse and said, “There isn’t anybody,” and this may just be the one hospital, I don’t know how universally true this is. “But there isn’t anybody in the ICU under 250 pounds.”
Dr. Aseem Malhotra:
Wow.
Dr. Mark Hyman:
Which is such an incredible observation. Now, that might not be true in all hospitals, but that caught my attention. It’s like wow.
Dr. Aseem Malhotra:
Yeah, I think Mark as well what we should also just briefly mention as well, there seems to be a disproportionate effect for people who come from we described here as Baim background, so black and ethnic minority backgrounds. I know that there are some similar statistics over in the United States, some of it may be related to social inequalities. But it seems certainly from people from South Asian origin India, Pakistan, for example, Bangladesh, there is a much higher proportion amongst NHS staff of those people dying. In fact 70% of the people who have died, who are National Health Service workers are from Bain backgrounds, and only 14% of the population are from Bain background. So it’s hugely disproportionate.
Dr. Mark Hyman:
When you say Bain, what does that mean?
Dr. Aseem Malhotra:
They’re an ethnic minority. So from Indian or South Asian origin, and it’s probably because metabolic syndrome or metabolic diseases have a much higher prevalence in these communities, not because of genetics. It’s a complex, different factors, but it’s mainly lifestyle. And even when we talked about social inequalities, and you’ll hear a lot of that discussion. The question is, on a biological level, it’s still metabolic syndrome. And they’re obviously lots of factors playing into it. But as you know, Mark, people in America who come from the poor backgrounds also tend to have worse diets, they tend to… And for lots of different reasons, they may be struggling to make two ends meet, and they will go for the cheapest available food and often that’s high sugary, starchy, ultra processed junk. So, this is probably the big factor that’s driving this and I’m sure we’re obviously going to talk about food shortly. But this is another big problem that we need to think about.
Dr. Mark Hyman:
I think you’re right. I think there are a certain populations genetically that are susceptible: Native Americans, Pacific Islanders, Asians, Indians from India and Pakistan and so forth. And of course, African Americans, they’re all more susceptible. But that doesn’t mean that they’re predestined. They’re just predisposed.
Dr. Aseem Malhotra:
Yes.
Dr. Mark Hyman:
And when they get in a food environment that is harmful to them, which is our current food environment in the world, that’s what triggers it. And it’s pretty shocking in Chicago, in Louisiana, where they have good data, 30% of the population is African American and 70% of the deaths are in African Americans. And they’re white counties, and counties are compared and black counties have six fold higher risk of death. Now, people say, “Well, it’s their poor diet, they should take care of themselves. They don’t pay attention.” But you’ve written a lot about how this whole idea of blaming the victim, person responsibility is fundamentally flawed. Can you really talk about why we shouldn’t be blaming the people who are eating the bad food?
Dr. Aseem Malhotra:
Yeah, Mark, I think yeah, so person responsibility, I think we have to define it first. To exercise personal responsibility, two basic things you need is knowledge, you need the right information, and you need choice. You need to have access, you need to be affordable and you need to have access.
Dr. Aseem Malhotra:
So, ultimately, because the food environment is really what drives our behavior more than anything else, in terms of what we eat, and ultra processed foods have become unavoidable. It’s very difficult. So it’s much more difficult to exercise personal responsibility. And one great example of this, Mark and something I’ve campaigned heavily on in the UK and it’s there’s still a controversy going on over here at the moment, is around junk food in hospitals.
Dr. Aseem Malhotra:
So in the UK, and most recent-
Dr. Mark Hyman:
We couldn’t have McDonald’s and Krispy Kreme and Domino’s Pizza in the hospital? What’s wrong with that?
Dr. Aseem Malhotra:
It’s really quite shocking, Mark? Isn’t it though? We’re supposed to be promoting good health and be temples of health, yet we are selling the very foods and promoting the very foods in our own hostile environments that are responsible for the chronic diseases driving the people into the hospital in the first place. I mean, you really couldn’t make it up.
Dr. Aseem Malhotra:
In the UK 75% of food purchased is unhealthy. And more than 50% of National Health Service employees, doctors and nurses are overweight or obese, which is a clear example that education is ineffective when the food environment is working against you.
Dr. Mark Hyman:
Having all that food in the hospital is good for business, right? You just keep the patients and their family…
Dr. Aseem Malhotra:
It sounds that way, but I don’t think that’s the real reason. I think they do get money in the short term, but they’re not thinking outside of the box.
Dr. Mark Hyman:
[crosstalk 00:29:51] they do, they have contracts. At Cleveland Clinic, the CEO when he was hired, the last CEO, he decided to get McDonald’s out of the hospital. And he was just skewered by the media because it was owned by an African American and they’re like, “How can you do that? It’s racist.” And he got so in trouble and he had to wait till the contract expired which was a 20 year contract. And it was interesting, the day the contract expired, they brought a crew in, worked overnight and literally shut the whole thing off. And then they had a new restaurant in there very quickly. He got rid of all the sugar sweetened beverages, all the junk food gone from the hospital.
Dr. Aseem Malhotra:
Amazing.
Dr. Mark Hyman:
It still needs a lot of work, but-
Dr. Aseem Malhotra:
It does and I think, Mark the point as well is if you do change the food environment, it has an impact. [Alyssa Apple 00:30:42] from University of California, San Francisco, did a study in one of their hospitals where they removed, just removed all sugary sodas basically. And then they repeated and they took a sample of people that work at the hospital and then they looked at their markers of metabolic disease one year later, and there were significant improvements in things like passing insulin, waist circumference went down. This stuff works, it happens. And this is just by getting out there.
Dr. Aseem Malhotra:
We’re not saying people can’t have these treats if they really want to, they can buy them but they shouldn’t be literally, you know, they become unavoidable you can’t… And it basically also means that you displace healthier foods that’s going to be good for you, right? So, I think it’s a no brainer. And if people want to argue that choice, you should ask them also do they also think that we should bring back smoking in public places? Should we be smoking in hospitals? One cigarette will not kill you, neither will one donut. But over time, they cause significant damage to health and right now, the big issue of our time, what’s responsible for more disease and death globally than physical inactivity, smoking and alcohol combined, is poor diet. And ultra processed foods really are the low hanging fruit that we need to concentrate on. More than 50% of what we consume in the UK and I’m sure it’s similar in the US is ultra processed junk food, Mark.
Dr. Mark Hyman:
It’s 60% [crosstalk 00:32:04].
Dr. Aseem Malhotra:
More than 50% of our calories is junk.
Dr. Mark Hyman:
Yeah, it’s not a competition we want to win, but it’s 60%. Yeah, it’s pretty terrible. And I think what’s striking looking at the data is that over 70% of deaths worldwide, are not from infectious disease. They’re not from malaria or TB or AIDS or viral pandemics, they’re from lifestyle preventable, mostly diet preventable, chronic disease.
Dr. Aseem Malhotra:
Yeah.
Dr. Mark Hyman:
It’s something people don’t realize, and yet most of our resources are focused on infections pandemics, malaria, TB, AIDS, viral things. I mean, these are good things to support and deal with, but when you look at the Gates Foundation they’re the most influential foundation in health out there. And they’re not paying much attention to this. They’re starting to, but this has not been a focus. And I think this has just come out like a juggernaut over the last 40 years and people just haven’t been aware that this is happening. And now COVID-19 is what we call an acute on chronic problem in medicine.
Dr. Aseem Malhotra:
Yes.
Dr. Mark Hyman:
Someone is basically healthy, they’ll get sick it may not be too bad, they’ll be fine. But if someone’s metabolically unhealthy, like your prime minister, it’s going to hit them hard. And they’re already a sitting duck. And that’s what we call acute on chronic. If someone has emphysema and they get pneumonia, they’re in trouble. If an average person gets pneumonia, they’ll have a few uncomfortable weeks, and they’ll be fine. But this is really where we need to address this problem globally.
Dr. Aseem Malhotra:
So, and Mark actually, on that note, you started at the beginning talking about the focus being all about vaccines and treatments and all of that stuff. And I think that leads into another area of discussion, which is there is a cultural problem, a misperception about what modern medicine can achieve.
Dr. Aseem Malhotra:
We know for example, you and I know that the effects of all these drugs that people take for Type 2 diabetes and blood pressure and cholesterol are very marginal at best. But there was a very interesting study, which I published [crosstalk 00:34:01].
Dr. Mark Hyman:
It might offer effectiveness but they create great profit margins for the pharmaceuticals.
Dr. Aseem Malhotra:
Huge, huge. But there’s a very interesting paper I found which looked at, and educated people in United States and asked them since the mid 1800s, in United States to now there’s been an average increase in life expectancy of 40 years. And they asked these people in this survey, a lot of them were, some of them were public health students, how much of that do you think was because of modern medicine? 80% of the people replied, most of them thought it was 32 years, 32 out of 40 years increase in life expectancy in the United States since the mid 1800s was because of modern medicine. Nothing could be further from the truth.
Dr. Aseem Malhotra:
At best, three and a half years you can attribute to modern medicine, three and a half years or 40 years and most of that, Mark is because of acute care, vaccinations, certain, you know, that’s antibiotics for infection. These are the things, the big things that have helped modern medicine more than anything else. Most of the other stuff has been Public health interventions. Safe drinking water, seat belts in cars, [crosstalk 00:35:05] buildings, better working environments, safe working environments. This is what has contributed most to people’s longevity.
Dr. Aseem Malhotra:
So there’s a perception issue that we need to challenge because this stuff also influences how people behave, what politicians do, what policies we have, where the money gets distributed, it needs to go all the way into prevention now, and everyone needs to be educated of this all the way to the highest level politicians, these are the kind of people that need to really understand this stuff. And then we can change the system.
Dr. Mark Hyman:
I agree, I think we need sweeping policy changes. And I’ve written in my book about this food fix, which you’re featured in and I began to understand why we have this situation we have. It became very clear, this is not an accident. It’s not just a bunch of bad decisions that happen and then are going on with nobody really being accountable. There may have been early on a desire to feed a growing world, and a hungry population by using industrial agriculture to produce an abundance of cheap starchy calories, which we thought the time was a good thing. But now we understand the consequences of that.
Dr. Mark Hyman:
And when you look at the way in which the food industry acts, for the most part, it’s a deliberate way to subvert the truth and promote their products. One, they funded billions of dollars of “research,” that candy for example, is a healthy way for kids to lose weight. No kidding, that’s an actual study.
Dr. Aseem Malhotra:
Yeah.
Dr. Mark Hyman:
They fund $12 billion, compared to one billion from the National Institute of Health, which confuses the science and confuses the public. They co-op professional associations and you’ve talked about this, like the American Heart Association, American Diabetes Association, Academy of Nutrition and Dietetics, where they fund their work, which is why for example, the American Academy of Nutrition and Dietetics they actually created a sponsorship for Kraft singles as a healthy snack. Well, they can’t even call it cheese because it’s not 51% cheese and they got called out for that and had to pull it out. Then they co-oped social groups like Feeding America and the food policy and other groups that are trying to do good work around hunger, but they sit on their boards, they fund them.
Dr. Mark Hyman:
They fund groups like the NAACP, which is the African American group or Hispanic Federation, which is why they oppose soda taxes. They create friend groups that create propaganda like the American Council on Science and Health that says that pesticides, trans fats, smoking are not bad for you. And so are GMOs great, and they’re all funded by the usual cast of characters like Monsanto and the big food companies.
Dr. Mark Hyman:
So it’s a deliberate attempt across a wide range of sectors of society and science and government, not to mention the amount of lobbying they do in Washington. So you’ve got all these factors that are impeding our ability to create proper information, proper access to the right food and to actually support the growing of the right foods. So we’re in this real crisis at this moment where even if we want to, it’s not easy for people to do the right thing.
Dr. Aseem Malhotra:
Yeah, Mark, I couldn’t agree more. I think, I would sum that all up as that we have the corporate capture of public health, essentially. [inaudible 00:38:20] who I interviewed for an article in The Guardian, the former editor of [New England 00:38:24] Journal Medicine. He said the real battle we have in healthcare is one of truth versus money. But if you ask the public, I believe in democracy, Mark, this is about informed decision making. And if people were aware of it, if people were aware really what is the gross injustice being committed on them, they would find it unacceptable. It doesn’t matter what your political [crosstalk 00:38:41].
Dr. Mark Hyman:
And everybody should read my book Food Fix, because that’s what I talk about. Have you got a copy?
Dr. Aseem Malhotra:
Exactly.
Dr. Mark Hyman:
I’ve got to get you a copy.
Dr. Aseem Malhotra:
I look forward to reading it. So yeah, this is really what we need to get that information out there and make people aware. And then we can change the system because ultimately, what I think the COVID-19 also outbreak has highlighted, is that we’re all interconnected. And nothing… This is really unprecedented, this whole lockdown situation where people are really, seriously everybody is so worried about the future, what’s going to happen next. If a deadlier virus was to come along, would we as a society, as a population, would the world survive it? And I think this is hopefully a wake up call for people to realize actually, we have to all… We have to look after ourselves, Mark, we have to look after other people too.
Dr. Mark Hyman:
That’s right.
Dr. Aseem Malhotra:
Even if from a purely selfish perspective, we have to, we’re all interconnected. And that means thinking about all these social inequalities, the people that, you know, there was a very good point made by one economist, I think it was Noam Chomsky, but basically saying that we can survive, the world can survive without a few billionaires, but it can’t survive without the people that drive, that look after public transport, that look after the garbage, healthcare staff.
Dr. Mark Hyman:
[crosstalk 00:40:05].
Dr. Aseem Malhotra:
We’re all dependent on them. So we have to really help each other as well through this.
Dr. Mark Hyman:
I agree. I think it’s really an interesting moment in history where we’re going to have an opportunity to up-level our humanity and our mutual interdependence and reshape the way we’ve been going, which is in a narcissistic, individualistic, totalitarian pathway that I think has got to stop.
Dr. Aseem Malhotra:
Yeah, it’s not bringing us great happiness, Mark, either. There’s increasing depression as well, because of the way we live.
Dr. Mark Hyman:
True.
Dr. Aseem Malhotra:
I think we just need more compassion to help ourselves. Compassion for others to help ourselves.
Dr. Mark Hyman:
Absolutely. I want to come back to this question, what the heck is ultra processed food? You’ve used that term a number of times. I know a few of you know what it is, but what is ultra processed food?
Dr. Aseem Malhotra:
Let’s define it. So it comes from something called the Nova classification which came from Brazil. It’s an internationally recognized classification of different types of foods from minimally processed to ultra processed. Then group four is the ultra processed, the worst type of foods that is really linked to chronic metabolic disease, heart disease, cancer, obesity, Type 2 diabetes.
Dr. Aseem Malhotra:
And before I define it, what’s really interesting about, it appears these sorts of foods also encourage over consumption. So, Kevin Hall, a scientists in the states last year did a very interesting, what was described as a landmark randomized control trial, that just within two weeks of people eating ultra processed versus minimally processed foods. So it was a two kilogram difference, okay? So they were dis-encouraged to eat till fullness and people who had ultra processed food end up consuming more and end up gaining more weight.
Dr. Aseem Malhotra:
What is ultra processed food? Well, overall general term is usually mass packaged food that is deficient of nutrients and fiber and is high in sugar, in starch and unhealthy oils, additives and preservatives. And mostly, most of the time, quite often it’s five or more ingredients. So what I tell my patients in very simple terms-
Dr. Mark Hyman:
So it’s not a whole food?
Dr. Aseem Malhotra:
[crosstalk 00:42:19] a packet, and it has five or more ingredients, it’s ultra processed, don’t eat it. Very simple, very simple. So if you go into a grocery store, the supermarket whatever and you’re thinking about what to buy, pick up even bread, modern packaged bread, if you pick it up and you can count five or more ingredients and you can’t recognize some of them, they’re preservatives or additives, don’t eat it.
Dr. Mark Hyman:
Yeah, I’ve been making Indian food at home using all the spices, I might use like 20 different ingredients in my Indian cooking.
Dr. Aseem Malhotra:
I think that’s different though, isn’t it? Because you’re using all natural ingredients to cook at home. This is specifically packaged food with preservatives.
Dr. Mark Hyman:
I’m making my own tikka masala, [inaudible 00:42:55] and it’s so fun and I’m not even buying the mixes because I have time. I’m using all these incredible spices, toasting them, it’s so much better. Yeah, I agree. So ultra processed foods is bad. It’s also, it’s both the abundance of ultra processed foods, which are nutrient poor, mostly starchy and sugary, but also the absence of protective foods. So can you talk a little bit about what that is?
Dr. Aseem Malhotra:
Yeah, absolutely. So, this is something obviously I wrote a book about, but looking at all the evidence and we talked about chronic inflammation. So the way I look at is two things going on. How do you combat chronic inflammation from food? And how do you reduce the risk of you getting insulin resistance? So those are the twins, the terrible twins.
Dr. Mark Hyman:
And they’re related.
Dr. Aseem Malhotra:
That are going to be damaging to your body. So anti inflammatory foods, I think about that, I think about good nutrition. So, in particular, what I recommend people to have is something which is a low refined carbohydrate, Mediterranean inspired diet. So that means lots of whole vegetables, ideally low sugar fruits, nuts and seeds, meat that’s grass fed, oily fish, eggs, full fat dairy, and one that is devoid or certainly less of the starch and sugary stuff. So bread, pasta, rice and potatoes.
Dr. Aseem Malhotra:
Now, if you’re metabolically healthy, you can get away with more of that if you’re working out and doing a lot of resistance training, then you can have more of those foods. But the real issue in America and many of these Western countries is that we’re consuming too many low quality carbohydrates which come from ultra processed foods. The statistics in the US from the most recent data suggests 42% of all the calories being consumed in the United States comes from low quality carbohydrates, in particular, carbohydrates are basically refined, the sugary carbohydrates and carbohydrates and like fiber, basically.
Dr. Mark Hyman:
Yeah, flour and sugar, which is basically what we eat in America.
Dr. Aseem Malhotra:
Yeah, exactly. I think if people get that right, even if 80% of the time, Mark, I would say, it depends where you’re at. If you’re overweight or obese, you got Type 2 diabetes, go cold turkey, go extreme for the first month or two, I mean, you may have a different approach. And then when things settle down, it doesn’t mean you can’t ever have a pizza ever again, but really what I would say is that 80% of the time, and people get conditioned that they’re able to do it, you practice this 80% of the time and the other 20% of the time have your treats.
Dr. Mark Hyman:
I’m a little tougher than you. I’m like a 90 guy. Here’s the thing it’s so dependent on your metabolic health, right?
Dr. Aseem Malhotra:
Yes.
Dr. Mark Hyman:
So my goal as a functional medicine doctor is to make my patients more metabolically resilient, right? If you have diabetes, you are not metabolically resilient and you don’t have many degrees of freedom in that. But like you said, if you’re doing exercise and you’re eating healthy most of the time, and you want to have a little pasta, or a piece of bread, it’s not going to kill you, you’re going to be fine, you’ll be able to handle it.
Dr. Mark Hyman:
But if you look at my patients who have severe metabolic disease and diabetes, they need aggressive treatment. And some of our colleagues and friends are using ketogenic diets, which basically eliminate all the carbohydrates from the diet, which is 5% carbohydrates, it’s very, very low. And they’re seeing reversal of diabetes, Type 2 diabetes, which is not something we learned about in medical school, you can’t reverse Type 2 diabetes, but it actually can be reversed. But it requires an extraordinary and often heroic changing diet, which is not easy for people but if you’ve spent your life getting there, in decades and decades of ruining your metabolism, it actually doesn’t take that long within six months to a year you’re going to be really good if you do that.
Dr. Aseem Malhotra:
Yeah, I mean, even with some of my patients, Mark, I’m sure you’ve seen it as well, even within few weeks I’ve seen people send their Type 2 diabetes into remission in 28 days.
Dr. Mark Hyman:
Oh, yeah.
Dr. Aseem Malhotra:
I think that’s a really important message with COVID is that if people do these changes now, they are going to be metabolically more resilient, their immune system is going to be more resilient within the space of a month.
Dr. Mark Hyman:
Or less. I mean, I had a patient who I talked about in the book Genesis was diabetic, her BMI was 43, which was very, very overweight. She was on insulin, and within three days of changing her diet, she was off insulin. Within three months, she reversed her heart failure, her diabetes, her kidney failure, got off all her drugs.
Dr. Aseem Malhotra:
Amazing.
Dr. Mark Hyman:
I see it very often. And when you look at people who are getting bariatric surgery, gastric bypass surgery, within literally days to a week or so, if they’re diabetic, their blood sugars are normal. And they’re still very overweight, which is fascinating to me, because it means that it’s not the fat, it’s the food.
Dr. Aseem Malhotra:
Yeah, no, absolutely.
Dr. Mark Hyman:
Not the fat, it’s the food.
Dr. Aseem Malhotra:
Yeah.
Dr. Mark Hyman:
And if they focus on that-
Dr. Aseem Malhotra:
There are benefits independent with the weight loss, absolutely right, Mark. For sure.
Dr. Mark Hyman:
The food is that powerful and we always talk about our food is medicine. So that’s great. Now the problem for people and everybody’s at home and trying to figure out what to eat, and cooking, is that the refrain we often hear is it’s expensive, it’s difficult, it take too much time. Well, we have more time now. But the cost factor of eating whole foods is a big hurdle for people. Can you talk about that? Is it true? Is that a myth? And why are we buying into that?
Dr. Aseem Malhotra:
Yeah, I think to some degree, it’s more difficult. I mean, the cheap, the junk food tends to be a lot cheaper, that’s for sure. But you can, if you try on a budget, eat healthier foods. So for example, an apple cost less than a candy bar, certainly in the UK, but it is more difficult because a lot of these junk foods are very heavily promoted and marketed and more unavoidable and highly addictive.
Dr. Aseem Malhotra:
So I think that it is possible, but it’s hard. And that’s why I think again, government needs to act. So we had over here we’ve introduced a soda tax. And it’s definitely reduced consumption of sodas, of sugary drinks. We know that the most important factor which resulted in the decline of cigarette consumption in the United States and other countries was the taxation of cigarettes specifically, so increasing the price. That’s what needs to be done is that these sorts of foods need to be made more expensive. And then simultaneously, you need to make healthier foods more affordable.
Dr. Mark Hyman:
Yeah.
Dr. Aseem Malhotra:
And if you do that on a population level, then we would see much, we’d see differences very quickly. I mean, Darius Mozaffarian and Simon Capewell, who’s a professor of Public Health here in the UK, and Darius is overseas, is over there in the US is a big nutrition scientist that has done a lot of research on dietary population and public policy on diet for years.
Dr. Mark Hyman:
In fact, we just recently published an article in The Boston Globe about how COVID-19 is a diet related illness and how millions will die unnecessarily.
Dr. Aseem Malhotra:
Absolutely, absolutely. He pointed out that 11 million deaths a year are attributed just to poor diet. But actually, with policy changes just included slight improvements in people having more vegetables, more omega threes, cutting out the sodas within a year. Say if that happened globally, his estimates is that you could half literally half the deaths from heart disease, from 10 million to five million just within one year of people eating more fruit and vegetables and oily fish and nuts and seeds and cutting out the junk. So that’s pretty extraordinary.
Dr. Aseem Malhotra:
Now, of course, some of this data is not, you know, can be questioned in terms of how reliable it is it, because we haven’t got randomized controlled trials, but it’s still in the ballpark. I’m sure, I have no doubt that across the world if people change their diet, even slightly in a healthier side, then globally, we would be in a much better place.
Dr. Mark Hyman:
I think there is a myth about the expensive nature of good food. And I’ve had personal experience with this. I mean, the data is really clear that it maybe 50 cents or more a day, well, but maybe not. And that it may be the equivalent if you pick foods smartly. Beans and whole grains are cheap foods and a lot of vegetables can be cheap foods. Cabbage isn’t very expensive. There’s a lot of food that is cheap and there’s a guide called Good Food and A Tight Budget from the Environmental Working Group which I’m in the board of which explains how to eat well for less. Good for you, good for your wallet, good for the planet.
Dr. Mark Hyman:
And I did this with a family of five living in a trailer in South Carolina who was very overweight and sick and diabetic on kidney dialysis at 42, one of the father, it was terrible from diabetes. And they actually lived in one of the worst food deserts in America. And I showed him how to cook a simple meal from scratch. And I gave them this guide on how to eat well for less and a cookbook. And I said you can do this. And I was like, I don’t think they’re going to do it. Can they do it? They together lost 200 pounds in the year. The father lost enough weight so he could get a new kidney, the son lost 50, but gained it back because he went to work at Bojangles, which is a fast food restaurant. And then he eventually got sorted out and he lost 138 pounds and asked me to write a letter of recommendation for medical school.
Dr. Aseem Malhotra:
Wow.
Dr. Mark Hyman:
And they didn’t have a lot of money, and they didn’t know how to cook. They didn’t know what to shop, they didn’t have the skills, they didn’t have the information. They didn’t have the knowledge. And I think that is really the problem. It’s not a lack of money, it’s a lack of awareness, education and skill. That is really something that can be addressed effectively.
Dr. Mark Hyman:
And the other problem is it’s a real cost of our food, it’s not the price we pay at the checkout counter. So what is the cost of Twinkie when you buy it very little, what is the cost to human health? What is the cost to the environment by how we grow the food using industrial methods? What is the cost of the effect on our healthcare system? On our federal tax collections that we have to spend the most of it on healthcare? I mean, there’s so many costs that are not in the price that if we actually paid the real price, maybe a Twinkie would be $20 and a grass fed steak with vegetables would be like $5, right?
Dr. Aseem Malhotra:
Yeah, sure.
Dr. Mark Hyman:
Very different.
Dr. Aseem Malhotra:
Absolutely, Mark. And also, I think the cost down the line isn’t it to your health? I think people also need to think that even if they end up spending a little bit more now, they’re going to be saving money later.
Dr. Mark Hyman:
So how is this effort going in the UK? You’re probably the most vocal advocate of dietary change and the link between our diet and chronic disease and the burden on our healthcare system in the UK. How’s it going over there? Are you getting traction? Are people listening?
Dr. Aseem Malhotra:
Yeah, Mark, I think there is traction, certainly with the low carb movement in terms of Type 2 diabetes that seems to be improving, but I think there’s still a big cultural problem amongst the medical profession. And the reason I say that is, even to today, there was a new story based upon a tweet that I did yesterday. And the tweet was my response to the fact that one of the hospital trusts in the UK had endorsed and pushed out and congratulated Krispy Kreme Doughnuts for donating for free 1500 doughnuts to one hospital for the staff, 1500 doughnuts and there was a big issue around it.
Dr. Aseem Malhotra:
So I tweeted, I said this is disgraceful that in the middle of an obesity epidemic when the staff are overweight or obese, this is why are you endorsing this stuff? And it wasn’t just me speaking out from a personal perspective. I’ve campaigned to make sure that policies changed where the British Medical Association many years ago actually passed the motion to make it part of their policy through a cause I had made that we should ban the sell junk food in hospital. So it’s a marketing opportunity for these companies as you know. Big tobacco did the same thing, they used to use doctors to advertise cigarettes in the 50s. This is something-
Dr. Mark Hyman:
I actually, as you might have in my office an original ad that I got on eBay of Camel Cigarette ad which said, “113,000 doctors from coast to coast recommend Camel Cigarettes more than any other cigarette.” And it shows a doctor smoking at his desk with a white coat on. And I have it framed in my office.
Dr. Aseem Malhotra:
Wow. That’s extraordinary. It is extraordinary when you think about and the parallels are quite, they’re very chilling. They’re similar parallels with what the food industry do because for them, it’s a marketing opportunity. It’s a branding opportunity. Everybody’s looking at the health heroes right now, The National Health Service and clapping for people every week. We have the whole country basically stops for a minute on a Thursday evening, for several minutes actually at 8:00 PM to come out of the house. It’s amazing. It’s very moving. I had goosebumps when I experienced it.
Dr. Aseem Malhotra:
And literally there are people clapping in the streets which is just a morale boost for our healthcare workers. So the country is behind them, and these companies are exploiting our health heroes by basically using as a branding opportunity, by saying we’re giving all this for free, we’re being generous. But ultimately, it’s for them to make money out of it and then increase that brand later on down the line. That’s exactly what they’re doing.
Dr. Mark Hyman:
[crosstalk 00:56:09].
Dr. Aseem Malhotra:
And the reason I talk about this, Mark is that it causes huge Twitter storm. You can go and have a look later on, huge Twitter storm, my tweet got retweeted, loads of doctors piled in, how can you tell us what to eat? There’s nothing wrong with a doughnut. There was a diabetes and endocrine council-
Dr. Mark Hyman:
You’re the food police Dr. Malhotra
Dr. Aseem Malhotra:
Look at this Aseem, I’m really happy having, did a GIF of a giant donut biting into it and it was pretty extraordinary. But what was good in a way is it really exposed the fact that there’s a couple of things that, there are a few things that it highlights. One is doctors still have very poor training and lack of understanding in nutrition, it’s not part of medical training, and it’s still perpetuating itself. So, we’re part of a vocal minority and maybe we’re involved in a bit of an echo chamber, in terms of how we’re helping our patients, but how many diabetes specialists, Mark out there do you think in the United States, what percentage of them are regularly sending their Type 2 diabetes patients into remission with dietary prescriptions?
Dr. Mark Hyman:
And for those not watching the video I have my fingers up as a zero.
Dr. Aseem Malhotra:
It is absolutely, I mean it is extraordinary.
Dr. Mark Hyman:
There’s a few out there. There’s a few.
Dr. Aseem Malhotra:
I think there’s progress.
Dr. Mark Hyman:
We know a few of them but…
Dr. Aseem Malhotra:
Yeah, we still need to keep working on it and I’ve been involved in writing letters with other doctor saying we need to take a compulsory nutrition education in medical schools, they got publicity, the chair of the General Medical Council, the chair of the Medical Schools Committee all replied back saying yes, things are starting. And the younger generation and younger doctors have been contacting me and they are saying the same. You are saying what a lot of people are afraid to say, this is just scandalous. So I think we just need to keep talking about it. We need to keep being advocates for it.
Dr. Aseem Malhotra:
I then did a Twitter poll based upon an article I wrote for the King’s Fund. I’m a trustee of this health think tank called the King’s Fund. I did a blog for them highlighting the issue about doctors need to not just be advocates of looking after the individual patient in their consultation room, they need to think about population health. If you’re a cardiologist care about cardiovascular disease of your community too, what are you doing about that, to stop people coming in the first place, to improve the overall health of the population?
Dr. Aseem Malhotra:
And one of the things I wrote Mark, is I said, in my view, doctors who stay silent about the sale of the very junk foods that are driving chronic disease in the first place, are in my view, in neglect of their duty to patients. I wrote this in the blog. So I put it out as a tweet and I said, “Listen, this is what I think. This is a blog, so I’m making the case here, please read my blog, and then vote.” And it was about 1500 people voted, and I was still pleasantly surprised. We got a majority in favor, 58% agreed with me, 42% didn’t. And that is the most provocative thing one could say. I’m saying that you’re in neglect of your duty to patients by not speaking out against junk food.
Dr. Mark Hyman:
I agree. I think doctors and health care providers need to be on the front lines talking about this. And I hope this COVID-19 pandemic, however awful it is has a silver lining that allows us to recognize this pandemic of obesity and metabolic disease that is really underlying this health crisis and figure out a way collectively to address this. It’s what I’ve made my life’s work. I know it’s your life’s work, and it’s just so great to hear you doing this work over there across the pond.
Dr. Aseem Malhotra:
Yeah, Mark. Yeah, absolutely. And I think one thing I would like to say just before we finish is in England, we have something called the seven Nolan principles, which was actually created by the government in response to a scandal that happened in the mid 90s where it was exposed that for you, maybe it’s normal in America, but basically, members of parliament were being given cash by vested interest to ask questions in Parliament. That’s not allowed, and that was exposed.
Dr. Aseem Malhotra:
And then the government got a body together. They looked at the ethics of all of it, and they came up with a recommendation and in fact these are what’s supposed to be followed by all those in public life, which include Members of Parliament, so politicians and people who serve whose duty is to serve the public, including doctors, police officers, teachers. And those seven principles are these, and I read them, I thought, How can anyone argue with this? But it made me think how many people are following the seven Nolan principles? And these are, selflessness, integrity, accountability, honesty, openness, and leadership.
Dr. Aseem Malhotra:
And leadership also means being able to speak out against bad practice and behavior wherever it occurs. And it says that we’re all supposed to adhere to these principles. But actually, when I gave a talk in LA a few months ago, I said, just ask yourself if you’re a member of the public, or you’re a doctor, are you following these principles in your practice? And the reality is, and this isn’t blaming individuals or finger pointing, the system has failed doctors and patients because of all these corporate interests do not allow people, it becomes very difficult for people to actually even follow noble principles in their duty to serve the public.
Dr. Mark Hyman:
Yeah, crazy. Well, this has been an incredible conversation. I hope it’s been aligned for people to understand the connection between COVID-19 and the underlying metabolic problems we have as a society. You’re such a thought leader and advocate and rebel rouser trying to change the system. I feel like you’re a kindred soul. I’m happy to have you on the team.
Dr. Aseem Malhotra:
Totally a pleasure, Mark. Absolutely, a lovely team effort and thank you for all your work and inspiration. I think we need to keep shouting, banging the drum and things are changing and they will continue to change but hopefully sooner rather than later. I don’t think we can afford to let this carry on for another five or 10 years.
Dr. Mark Hyman:
Maybe this will be the catalyst. So thank you so much for being on the Doctors Farmacy. If you want to find out more about Dr. Aseem Malhotra, go to doctoraseem.com. Check out his book, The Pioppi Diet, which is fantastic. I think I gave him a quote for it, and just enjoy his brilliant writings. He’s been published in so many medical journals, and newspaper articles, so check him out. And I think you should share this podcast with everybody because it will help save your family, your friends and your community by taking action in what we talked about today. Please subscribe wherever you get your podcasts, leave a comment. We’d love to hear from you. And we’ll see you next time on the Doctor’s Farmacy.
