The Diary Of A CEO Clips - THIS Is Worse For Your HEART Than FAT… | Dr Aseem Malhotra

Okay, let's just throw this question to you. Say you've had a heart attack and you survived it. Your doctor says take this drug, and over a 5-year period, how much extra life extension would you hope it would add over that 5 years? You can do it over whether 20 years, but just say five years to start with. How much longer would you hope to live from taking that drug in? Okay, so over five years, I'd say maybe a year. Okay, 25% more. Okay, fine, that sounds pretty good. 20% more, yeah. Okay, the actual figure, not disputed from industry-sponsored trials, right, is 4.2 days, just over four days. Is that because they haven't done it over a long enough period of time? No, I mean, if you then extrapolate it out and presume the benefits are going to keep going on, you could then argue that over 10 years it'll be eight days, and over 20 years it'll be 16 days, or whatever. Right, so that's the information. The reason I'm telling you this, Steve, is that this information is important. I'm not just a doctor, I'm a potential patient. I ask myself what I would want to know. I'm here to try and improve my quality of life and my health. What is important to me is what is important to patients, and this information is important, especially, Steve, because it's not that I'm saying don't take statins. A lot of people would say, okay, I'll take the drug, and if they don't get side effects, why not? It might be a bit of a lottery, but why not take the drug? People say that to me, and that's fine. And if they get side effects, the thing that's missing, Steve, and this is where we come on to the question you asked me about how to prevent heart disease, is there an alternative that doesn't give me side effects, improves my quality of life, and is likely to help prevent or stop me getting heart disease? So what is that? Lifestyle changes. Absolutely. So 80% of heart disease is linked to environment and lifestyle. Okay, so what is the core, most important biological phenomenon in the body that leads to heart disease? It's not disputed, but it doesn't get much of a... there's no market for the message, because you can't commodify this. This is an interesting thing, right. But it's really important information. It's called insulin resistance. Insulin is a very important hormone in the body, released by the pancreas, and it helps maintain blood glucose within certain ranges so our cells can function optimally. Over time, if your insulin is chronically raised too high, or if your cells become resistant to it for whatever reason, that is the most important driver of the development of these so-called plaques, these furring-up blockages in the arteries. So what causes insulin resistance, and how can you combat it? How can you prevent it, and potentially stabilize and even reverse it? We'll get on to reversal as well, because that's a fascinating area. The most important component is diet. In big-figure terms, probably 50% of heart disease around the world can be linked to poor diet. So let's start with diet. I've actually brought a bag of sugar with me, because when I think about insulin, glucose, and bad diet, the first thing my brain thinks about is sugar. So I've got this bag of sugar here, and I've got two. Look at us, we've written "sugar" on it and covered up the brand because they didn't pay us. But if there is a sugar brand that would like to do a brand deal, please get in touch. We're big fans, if we need to be. What I'd actually like you to show me is how much sugar I need to function and be healthy. The amount of sugar that you need to function and be healthy is zero. There is no nutritional requirement whatsoever for what we call added sugar or table sugar. None at all. So I don't need any. You don't need any, and the reason for that, very briefly, is that our bodies need glucose to survive, but you don't need any dietary source of glucose to survive. People go on what we call ketogenic diets, and they literally eliminate all starch as well, which also contains glucose, from their diet. Your body will make it itself from fat and protein. So in terms of diet, there is no value from sugar whatsoever. It can give you energy, of course, yes, but you can get energy from other things. There's no nutritional value whatsoever, zero. From a health perspective, there is zero requirement for dietary sugar. So when we say that Americans are consuming a lot of sugar every day, are we talking about added sugar? Yeah, we're talking about added sugar. The World Health Organization now, after I was involved in this campaign and there was a lot of attention on it, revised their guidelines. They recommend a maximum limit for the average adult of six teaspoons. So, a maximum limit. You don't need it, but it's a maximum limit, because after that is when the health consequences start to accumulate. One, two, three, four, five, six. That's the maximum daily limit. Just to give you an example, we don't name any brands, but one sugary drink, a 330 ml can of the most famous sugary drink in the world, I have no idea who you're talking about, would have nine teaspoons in it, right? And that's just the 330 ml. Imagine going to the cinema and having half a litre or whatever else. Jesus. So one can has nine teaspoons of sugar in it? Yes, which is so... four grams is one teaspoon, so that's well above the daily recommended maximum. One chocolate bar, a standard-size chocolate bar like what we grew up with, about the same. Leave chocolate out of it. Well, listen, you have dark chocolate. I love chocolate. For children, the US Department of Agriculture recommends, for the average four to eight-year-old child, and think about kids as well, they're the most vulnerable to a lot of these problems of sugar, a maximum limit of three teaspoons. Now, the average person in America is consuming at least 20 teaspoons. When we talk about sugar, the World Health Organization's word is "free sugar," which means sugar added to foods, but it also includes fruit juice, honey, and syrups, with the same effect on your body. Whole fruit is fine, but if you think about it, a glass of orange juice, for example, would usually have the juice of six oranges. You couldn't eat six oranges that easily. You'd have one orange, and there's fibre, and the fibre has a counteracting effect on the way glucose and fructose are absorbed in your body. A lot of it has to do with the rapid increase in blood glucose in the bloodstream, and that causes huge spikes in insulin. The problem with that over time is that you get chronically raised insulin and heart disease. Interestingly, the more rapidly a food causes a glucose spike, the more quickly you're going to get a crash, because insulin goes up quite quickly and then causes it to come down, and that drives hunger. So that's another problem. The food industry knew for a long time, and it may be similar here, that 70% of foods purchased in American supermarkets will have added sugar, because they knew it increases palatability and consumption. Of course, they're there to sell food, not to look after your health. You said 20 teaspoons is the average for an American, and at least 20 is probably much higher. I'm going to have to ask you to show us that, just so I can see what it looks like in a glass. It's disgusting. When you see it like that, you don't realise you're having that much sugar in a day. Technically, that's what two cans of fizzy drink are. Yeah, but a lot of the sugar consumed is in foods people wouldn't think have sugar in them. They're not the usual junk food, your cakes and biscuits and whatever else. They're in things even marketed as healthy, low-fat foods, low-fat yogurts. So could you just summarise what we have here, these two glasses? Yeah, so this is the maximum daily recommended limit of sugar consumption by the World Health Organization, after which you start to see increased risks of disease. And this is what, at least I think, most people are consuming at the moment. Are you hopeful there's something we can do about this at a society level? Well, I think one important step was the levy on sugary drinks, which would definitely have some impact, partly based on what we learned from Big Tobacco. Steve, 50% of... it's interesting, crazy when you think about it. In 1970, 50% of adults in the UK were smokers. We've got that down to about 17% now, a massive reduction. Education was important, but the real intervention that had more impact than anything else was taxation of cigarettes, and it had a twofold effect. Of course, you make it a little more expensive, and you know this with your business background, it's going to reduce consumption, but it was also a way of increasing awareness that this is harmful. So I think the sugar issue is ongoing, and I think a lot of people now have awareness of the link between sugar and disease. I've written about this: we need to treat ultra-processed food, much of which has added sugar, as the new tobacco. Ultra-processed food is more than 50% of the calories consumed in the UK and more than 60% of the calories in the US, from people's daily consumption. It's essentially described as food that comes out of a packet, industrially produced, where you can read more than five ingredients, usually with additives and preservatives. It's ultra-processed and best avoided. All of the research that's been done only points in one direction. I think there are at least 32 different conditions or diseases now associated with the consumption of ultra-processed food. That is the major issue. Because this is predominantly an environmental problem, our food environment is saturated with this stuff. Even hospitals, Steve. The first campaign I got involved with was trying to get this stuff out of hospitals. I was like, hold on, we're treating patients with obesity-related conditions, yet we're serving them junk food in hospitals. Fifty percent of any staff are overweight or abuse... What's the probability that if I'm having that much sugar a day, the big glass I'm going to end up in your practice with some kind of heart disease? I wouldn't be able to give you a figure, but you're definitely significantly increasing your risk. Well, if that's the average American, what's the average American's chance of ending up there? I guess causation needs to be established. Yeah, of course, and it depends what else they're having as well, but it's definitely putting them at significantly increased risk of type two diabetes. I think the figure now in America, if I'm not wrong, is that a third to a half of adult Americans are pre-diabetic. To answer your question in a better way, because we're already there, unfortunately, the way to understand insulin resistance on a personal level, in terms of body measurements, is something called metabolic health. There are five components, which are very easy to measure. Waist circumference. Blood triglycerides, a form of cholesterol, above 1.7 mmol/L. HDL cholesterol, the good cholesterol, being less than 1 mmol/L. Being pre-diabetic, having an HbA1c of more than 5.7%. Or being pre-hypertensive, so your blood pressure is above 120 over 80 on average. If you have three of those that are abnormal, you have something called metabolic syndrome, and you have the highest risk of heart disease. At least 50%, if not more, of patients admitted with heart attacks will have metabolic syndrome. But all five parameters being in the normal range, in America, only one in eight adults have all of those in the normal range, and only one in four people aged between 20 and 40. Think about that for a second: seven out of eight adults will have abnormal metabolic health. If within a year we just shifted people's eating habits a little, and let's say we eliminated ultra-processed food and got people to eat more nuts and seeds, oily fish, whole fruit and vegetables, it has been estimated that you would halve the death rates from heart disease globally within one year, from 20 million to 10 million. You'd be out of business as a heart doctor? No, there'd still be a lot of people to treat. We've got to help the other 10 million as well. But the other thing is what it does, Steve. It shifts the age. Instead of someone dying prematurely from a heart attack at the age of, say, 65, they'll live to 85. So all we'll be doing as doctors is managing old people, but that's fine. We've improved longevity and quality of life. 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