Ditch the Statins: How to Naturally Lower Cholesterol With Lifestyle Changes | Dr. Aseem Malhotra

Have you ever wondered if cholesterol-lowering statins are as effective as they claim? In this episode, Dr. Mark Hyman and Dr. Aseem Malhotra reveal the truth about these medications and the pharmaceutical industry’s influence on your health. Discover why lifestyle changes like diet and exercise can be more powerful than pills, and how misleading studies have shaped what we believe about heart health. In this episode, we discuss: Big pharma’s influence on medical research The benefits, drawbacks, and misuse of statins The Role of Insulin Resistance in Heart Disease The Importance of Lifestyle Over Medication The Impact of Meditation on Heart Disease View Show Notes From This Episode Get Free Weekly Health Tips from Dr. Hyman Sign Up for Dr. Hyman’s Weekly Longevity Journal This episode is brought to you by BonCharge, Timeline, Paleovalley, and AirDoctor. Order BON CHARGE’s Max Red Light Therapy device today and get 15% off. Visit BonCharge.com and use code DRMARK for 15% off. Support essential mitochondrial health and save 10% on Mitopure. Visit Timeline.com/DrHyman to get 10% off today. Get nutrient-dense, whole foods. Head to Paleovalley.com/Hyman for 15% off your first purchase. Get cleaner air. Right now, you can get up to $300 off at AirDoctorPro.com/DRHYMAN.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Dr. Mark Hyman?

  Coming up on this episode, part of the problem with the statin research is that it's not that they're bad or good. Every drug has a role. It's a tool. Yeah. You know, it's like saying water is water, good or bad. Well, if you drink too much water, you can die of seizures, but you need water to survive, right? Everything has a role.

• 0:16Dr. Mark Hyman?

  Before we jump into today's episode, I'd like to note that while I wish I could help everyone via my personal practice, there's simply not enough time for me to do this at this scale. And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out Function Health for real time lab insights. If you're in need of deepening your knowledge around your health journey, check out my membership community, Hyman Hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website, Supplement Store, for a summary of my favorite and tested products.

• 0:52Dr. Mark Hyman?

  Hi, I'm Dr. Mark Hyman, a practicing physician and proponent of systems medicine, a framework to help you understand the why or the root cause of your symptoms. Welcome to The Doctor's Pharmacy. Every week I bring on interesting guests to discuss the latest topics in the field of functional medicine and do a deep dive on how these topics pertain to your health. In today's episode, I have some interesting discussions with other experts in the field. So let's just trump right in. So welcome back to the podcast. It seems great to have you back in person here in Austin, Texas, in my new studio.

• 1:20Speaker 01

  Yeah, it's so nice to see you again, Mark. I think, yeah, we did. It's been about, what, six years since I last podcast?

• 1:25Dr. Mark Hyman?

  Yeah, that's right.

• 1:25Speaker 01

  Yeah, we got a lot of, a lot of interest. So I think, yeah, let's, uh,

• 1:28Dr. Mark Hyman?

  We did. So as you heard from the 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 statins as our primary therapy for reducing cardiovascular disease, which is, after all, the number one killer in the world. And 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

• 2:10Dr. Mark Hyman?

  People need to be having around cardiovascular disease than high LDL cholesterol, bad cholesterol, take a statin, end of story. Yeah. Essentially what we all do in medicine. If we're trained in traditional medicine, high cholesterol equals statin. And if statin causes side effects, you can play with a bunch of other drugs like PCSK9 inhibitors. But we're going to start out at the, 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 Harcombe and Dr. Malcolm Kedrick against Associated Newspapers, which is the publisher of The Mail on Sunday.

• 2:52Dr. Mark Hyman?

  And there were a series of articles published in March of 2019. They 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 statins, which they described as, quote, deadly propaganda. The newspaper's article suggested that their statements led people to avoid taking statins, which was a big public health risk. In response to these articles, your colleagues filed a defamation lawsuit,

• 3:35Dr. Mark Hyman?

  arguing that these articles falsely portrayed them as deliberately spreading lies about statins. 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 been vindicated by the legal system that what you're raising in terms of concerns about statins, and I'm kind of quoting from you at this point, which is their, their data is flawed on statins.

• 4:18Dr. Mark Hyman?

  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, wheatgrass is good. It's basically looking at very nuanced science to help unpack what we know and what 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 how you have all been vindicated as a result of the legal decision around this court case that was basically defending you, essentially, not you were directly involved

• 5:02Dr. Mark Hyman?

  in the final suit, but you were kind of part of the whole thing, you said.

• 5:05Speaker 01

  And first of all, to clarify, Mark, the reason I did not decide, I mean, it was something I thought about to sue the Mail on Sunday. I think I was, at the time, there was a lot going on, my mum had just died.

• 5:17Speaker 01

  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 this situation before, which we'll talk about later. So, I decided that I wasn't going to sue them, but I'm so pleased and happy for Zoe and Malcolm because, you know, these sorts of things, they do have an impact on you. I, before I tell you 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. And by the way, I have an impeccable track record in terms of my clinical care, getting on with my colleagues. You know, I'm probably an unusual doctor and probably lucky as well,

• 6:02Speaker 01

  because throughout my whole career, 23-year 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 I tried, I applied and got.

• 6:21Dr. Mark Hyman?

  You got blacklisted.

• 6:22Speaker 01

  Basically, yeah. And it doesn't mean that all cardiologists were kind of against me, but the situation arises in hospitals, teaching hospitals, and I know a lot of cardiologists in London because I trained in, you know, some of these hospitals and had good relationships with with cardiologists there who respect my opinion. And it would be the case where, say, in a cardiology department of eight people, if seven of them said, it'd be great, let's have a seam here to do clinics and when working for a bit, just one of them would object. No chance, you can't get in. And and it was always, it came back to when I asked the reason, it was, you know, there are antibodies that have been developed against you because because of your statins, essentially, right?

• 6:59Dr. Mark Hyman?

  People are allergic to you because of your opinion on statins.

• 7:01Speaker 01

  Exactly. So but but also that. So what happened in the case is that, you know, this was a front page news story. What made the news story, and this is the 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 secu state for health at the time called Matt Hancock, you may have heard of him.

• 7:24Speaker 01

  To say that there was no place in the NHS for these sites of doctors who are spreading misinformation on statins. Now, interestingly, and and of course, one of the most extraordinary bits in in the actual newspaper, the editorial from the health editor headline was as there is a special place in hell for doctors who say statins don't work.

• 7:45Dr. Mark Hyman?

  Hmm, okay.

• 7:46Speaker 01

  And then imagine a picture of me, Zoe Arkham in Harlem, right?

• 7:49Dr. Mark Hyman?

  You have your corner in hell all picked out.

• 7:51Speaker 01

  Ah, 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, was. In fact, the the former Queen of England's doctor and the and the past president of Royal College of Physicians, Sir Richard Thompson, who I'm friends with. I mean, he called me up and he was so upset. He's like, this is unbelievable. How can they say, yeah, this is not what you say, blah, blah.

• 8:10Dr. Mark Hyman?

  Right.

• 8:10Speaker 01

  And I was calming him down, saying, Richard, 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.

• 8:20Dr. Mark Hyman?

  And who's their advertisers?

• 8:21Speaker 01

  Well, I don't, well, that's a, that's a fair point, but I think ultimately what came out in the case as well, Mark, and there's also, again, I'll, 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 were fueling the health editor 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 wasn't declared is that their institution has received hundreds of millions of dollars from drug companies that manufacture statins or new cholesterol lowering drugs.

• 9:04Dr. Mark Hyman?

  Yeah.

• 9:04Speaker 01

  Okay. So, listen, that for-

• 9:06Dr. Mark Hyman?

  I want to double click on that for a sec, 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, I remember Peter Libby, who you might have heard of, who was basically the editor in chief of the main cardiology textbook that all fellows take called Bronwynall's Cardiology. He, he, he is, you know, chairman of cardiovascular disease at, at Harvard. And I said, Peter, why don't you study lifestyle interventions

• 9:49Dr. Mark Hyman?

  for cardiovascular disease versus just studying medication? He says, Mark, I know 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 department, that's funding my staff, that's funding me. And it's the reality of how the system is set up. So you, you have to understand that, that, you know, there's, there's inherent bias in, in a lot of how we think about things in medicine because of, of the money. If you follow the money, you understand where things are driven from.

• 10:21Speaker 01

  Yeah, absolutely right, Mark. And that reminds me actually of somebody who I cite quite regularly. Professor John Ainietes, I refer to

• 10:29Dr. Mark Hyman?

  Stanford, yeah.

• 10:30Speaker 01

  In Stanford, I refer to him as a Stephen Hawking in medicine. He's the most cited medical researcher in the world. He is a professor of medicine and epidemiology and statistics at 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 Findings Are False." 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 findings are 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.

• 11:05Dr. Mark Hyman?

  The number one selling drug in the world.

• 11:06Speaker 01

  So start from that kind of overview to try and help explain what's going on and why these sort of, this confusion's happening and where the battle's 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 in a way that they can understand. We'll get there in a second. So what happened in the case? So we have this kind of defamatory, you know, 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 had agreed to meet me.

• 11:46Speaker 01

  He had, was aware of my work because of another politician who had lost 94 pounds from following my diet plan.

• 11:53Dr. Mark Hyman?

  This is the one who said you need to have a special place in hell, or?

• 11:56Speaker 01

  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 that, 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 and 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 news story is like, okay, we're getting something that's challenging our views on cholesterol, on on on low fat diets or whatever.

• 12:40Speaker 01

  So that was probably the peg, because that was getting a lot 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, DM'd him.

• 12:52Dr. Mark Hyman?

  Yeah.

• 12:52Speaker 01

  I was like, Matt, really? And he replied, Aseem, I had no idea they were referring to you or Zoe Harcom. And I was like, okay, this is very interesting. So I I kept that, obviously. When the case then evolved and went to court, the the lawyers for Zoe and Malcolm contacted me. And I gave them that evidence. And apparently during the case, and Malcolm fed 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 if Matt knew, because I'm I'm a, you know, for all intents and purposes, so probably. So this is what really changed the case. And I think that that is, yeah, that, well, it is what it is.

• 13:37Dr. Mark Hyman?

  So what what were you actually saying? And what was Zoe and Dr. Kendrick saying that raised that concern? And that why was why was the the Mail on Sunday so vocal about criticizing? What were they coming after?

• 13:50Speaker 01

  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 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 over 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?

• 14:34Dr. Mark Hyman?

  Yeah, and the only people don't know, Aseem, 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 that 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.

• 14:52Speaker 01

  No.

• 14:52Dr. Mark Hyman?

  So you're not seeing the full spectrum of what the data show. You're just saying cherry pick data that shows.

• 14:56Speaker 01

  Absolutely.

• 14:56Dr. Mark Hyman?

  That's massage and twisted, you know, I think it was Mark Twain said there's liars, there's damn liars and there's statisticians.

• 15:02Speaker 01

  Yeah.

• 15:02Dr. Mark Hyman?

  You know, and so it's part of the problem with the statin research is that it's not that they're bad or good. Every drug has a role. It's a tool.

• 15:09Speaker 01

  Yeah.

• 15:10Dr. Mark Hyman?

  You know, it's like saying water is water, good or bad. Well, if you drink too much water, you can die of seizures, but you need water to survive, right? Everything has a role. But how it's used, how frequently it's used, who it's prescribed, 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 warped view of how great these drugs are. And they're the number one class of drugs sold in the world globally.

• 15:39Speaker 01

  Absolutely. I mean, it's estimated between 200 million and 1 billion people that prescribe 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 interest to really understand the root cause of heart disease and how we can reverse it in the population. We hadn't, 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 to a patient coming with a heart attack and get telling the nurse to give it in them in the ER before they've even gone to the cardiac catheter lab for them to have a stem.

• 16:12Dr. Mark Hyman?

  I heard cardiologists thinking you should serve it at McDonald's with your, you know, brick shack and fries.

• 16:17Speaker 01

  I know.

• 16:17Dr. Mark Hyman?

  Or have it over the counter. I mean, there, there was in 2021 globally, it was $15 billion spent on statins. It's projected to reach 22 billion by 2032. I mean, this is a staggering amount of money on one drug.

• 16:31Speaker 01

  Absolutely.

• 16:31Dr. Mark Hyman?

  And it's, it's so, there's a lot at stake here.

• 16:34Speaker 01

  Hundred percent, hundred percent. So understanding that there's a barrier to the truth, which is essentially a financial barrier because of there's so much at stake, as you say, not just with statins alone, but the cholesterol lowering 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, not even close. It's an applied science. It's a science of human beings. It's a social science. It's constantly evolving.

• 17:16Speaker 01

  Right? We were also taught at 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.

• 17:27Dr. Mark Hyman?

  And we can't tell you which half.

• 17:28Speaker 01

  We 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? You know, all the stuff that they're getting through medical journals, looking at independent evidence. And then, you know, being able to try and get to something that a level of information that they can utilize for really benefiting and helping their patients. So it comes down to informed consent. And for me, one thing that, you know, I think it was Mark Twain 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 in nineteen ninety six. I love this. It's beautiful. I put it up in my talks. It's one of the first slides.

• 18:13Speaker 01

  And I say, listen, this is the most important slide 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 of the triad, our role as healthcare practitioners, as doctors, is to improve patient outcomes. Manage risks, treat illness, relieve suffering. How do we do that? There are three inputs. Our clinical experience, our knowledge, our, you know, 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 Tackett said, taking into consideration individual patient preferences and values.

• 18:58Speaker 01

  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?

• 19:06Dr. Mark Hyman?

  Well, that's really, I 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 is, not what the patient is experiencing, or what the clinician expert understands from their decades of experience, which are part of the evidence based trial.

• 19:24Speaker 01

  Hundred percent.

• 19:24Dr. Mark Hyman?

  And that's really the failure here. And evidence based medicine is held up as this holy, kind of idol in a sense that we bow to, but often we kind of think misinterpret what it means. And I think your explanation is really important because it's not just what the data show. And it's also which data and who funded the data and 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.

• 19:49Speaker 01

  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 is, okay, most publishers are finding they're false, et cetera. You know, you've got Richard Horton, editor of The Lancet in 2015, writing an editorial saying that possibly half the published literature is simply untrue. It's not just John I need is saying this. So you've got all these, so what happens ultimately is doctors invariably are making clinical decisions for patients

• 20:30Speaker 01

  unbiased, not saying 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 their only interest is 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 really.

• 20:52Dr. Mark Hyman?

  But I would challenge you, I think, I think a lot of people, it's 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 they're, and I think they're good people and they're trying to do good. They're not deliberately trying to harm people.

• 21:06Speaker 01

  Yeah.

• 21:06Dr. Mark Hyman?

  But, but they don't, they can't see what they don't see.

• 21:09Speaker 01

  Exactly.

• 21:10Dr. Mark Hyman?

  Because they're in this sort of almost.

• 21:11Speaker 01

  You know, really good point, Mark. And actually, you know, the way I would just summarize that is medical knowledge is under commercial control, but most doctors don't know that.

• 21:22Dr. Mark Hyman?

  Right.

• 21:23Speaker 01

  That's right.

• 21:23Dr. Mark Hyman?

  That's right.

• 21:24Speaker 01

  And and that's what we're trying to sort of get them to think outside the box because again, I hundred percent agree with you. Most healthcare professionals, most doctors genuinely want to help their patients and are well intentioned. And actually, you know, 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, you know, it would do our jobs and we have to.

• 21:52Dr. Mark Hyman?

  Yeah.

• 21:52Speaker 01

  And we're 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 as being gospel truth as a medical student, as a junior doctor, it's published in a medical journal, it's science, right? Didn't question it. I then came to realize that, oh, hold on a minute, there's a lot more to this. And I used, of course, the, you know, the heart disease paradigm to understanding why we hadn't curbed heart disease, even though it was predicted by Nobel Prize winners Brown and Goldstein, I think in the late nineties, who discovered the LDL receptor was involved in, you know, coronary artery disease. They predicted the end, the eradication of heart disease may

• 22:35Speaker 01

  completely end by the early 2000s.

• 22:38Dr. Mark Hyman?

  Hmm. Didn't happen. It's still the number one killer on the planet.

• 22:41Speaker 01

  Despite a mass prescription of STANDS.

• 22:43Dr. Mark Hyman?

  Right. More and more people are getting heart disease, but less people are dying from it. Is that accurate?

• 22:49Speaker 01

  Correct.

• 22:50Dr. Mark Hyman?

  Because we have better management, we can deal with risks, we can.

• 22:53Speaker 01

  Three reasons I can tell you, big low hanging fruit, why have we got less death rates from heart disease? If you were a smoker, your mortality rate increased 50%. Smoking reductions played a big role. Emergency treatment in specifically in in the acute setting of an acute heart attack, stenting or thrombolytics, which we used to use, right?

• 23:10Dr. Mark Hyman?

  Blood clot busters.

• 23:11Speaker 01

  But the third one, which the Bernard Laun, pioneer in cardio, just got the Nobel Prize for, was the defibrillator.

• 23:18Dr. Mark Hyman?

  Yeah.

• 23:18Speaker 01

  Right? So what used to happen is patients would be admitted to hospital with a heart attack. In the first 24 to 48 hours after having a 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 could develop cardiac.

• 23:31Dr. Mark Hyman?

  Better at saving people. People after they've had a problem.

• 23:34Speaker 01

  Completely.

• 23:34Dr. Mark Hyman?

  And that's kind of why there's less deaths.

• 23:36Speaker 01

  Hundred percent. It hasn't. Well, so the next question is, people think, oh, must be statins as well. Well, paper in the BMJ a few years ago looked at millions more people taking statins in Europe over a 10 year period to see was there any reduction in cardiovascular mortality in Europe because millions more people are taking statins. They found there was none, none, zero, no change. But how 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.

• 24:11Dr. Mark Hyman?

  Or a tap of butter, maybe?

• 24:13Speaker 01

  Actually, absolutely. Butter would be better. We remind me to come back about a butter story and me being hauled into a medical director's office to talk about butter, by the way. When I busted the myth of saturated fat and 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 a person that's had a heart attack, right? And say in their 50s, just over four days now.

• 24:45Dr. Mark Hyman?

  So we just to back that 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's high, your doctor gives you a drug like a statin.

• 24:55Speaker 01

  Yeah.

• 24:55Dr. Mark Hyman?

  Then there's 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 already have had a heart attack and you take a statin, it shows that you're only living extra four days.

• 25:07Speaker 01

  Yeah. If you look at the median increase in life expectancy in that group, another way that we use in medicine when I talk about informed consent, or I call it ethical, very controversial topic, ethical evidence based medical practice, Mark, which means true informed consent, which means telling patients the numbers needed to treat other absolute individual benefit. And you look 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?

• 25:33Dr. Mark Hyman?

  Yeah.

• 25:33Speaker 01

  And there's a great website, which is independently evaluated by doctors and it goes through peer review in the, one of the family physician journals in the US called the NNT. Dot com. Numbers need to treat. People look it up. It's great.

• 25:45Dr. Mark Hyman?

  And what that means, everybody, is how many people you need to treat with a certain drug to get a benefit?

• 25:49Speaker 01

  Yes.

• 25:49Dr. Mark Hyman?

  If you have a bladder infection or strep throat and I give you an antibiotic.

• 25:53Speaker 01

  Yeah.

• 25:53Dr. Mark Hyman?

  It's, you know, pretty much a hundred percent.

• 25:55Speaker 01

  Absolutely.

• 25:55Dr. Mark Hyman?

  It's like you need to treat one.

• 25:56Speaker 01

  Yes.

• 25:57Dr. Mark Hyman?

  Person to get one person better.

• 25:58Speaker 01

  Yeah.

• 25:59Dr. Mark Hyman?

  Or maybe if they have a resistant antibiotic, it's two.

• 26:01Speaker 01

  Yeah. Or you take paracetamol for a headache. It's like one in two. So it's like two.

• 26:04Dr. Mark Hyman?

  Right, right.

• 26:05Speaker 01

  Normally you treat two people. One will get their headache completely resolved.

• 26:07Dr. Mark Hyman?

  But with a statin, you have to treat eighty nine people for five years to prevent one heart attack?

• 26:13Speaker 01

  Yeah. So it's actually, so, so I know this stuff inside out. So if you've had a heart attack already, let's take the high risk group. You have to treat eighty three 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 thirty nine. Now, most people around the world, Mark, who prescribe statins are not in that group. They are in the either low risk.

• 26:35Dr. Mark Hyman?

  Seventy five percent, right?

• 26:36Speaker 01

  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 one percent in preventing a non fatal heart attack, a non disabling stroke, okay? But without prolonging your life by one day.

• 26:57Dr. Mark Hyman?

  So essentially, if you, if you've never had a heart attack and you have high cholesterol and you take a statin.

• 27:01Speaker 01

  Yeah.

• 27:02Dr. Mark Hyman?

  It won't prevent you from, it won't prevent one single death. It will maybe prevent a heart attack.

• 27:07Speaker 01

  Yes.

• 27:07Dr. Mark Hyman?

  If a hundred people take it.

• 27:08Speaker 01

  And one.

• 27:09Dr. Mark Hyman?

  It'll prevent one heart attack.

• 27:10Speaker 01

  Exactly.

• 27:11Dr. Mark Hyman?

  So ninety nine people taking it for five years will have no benefit.

• 27:13Speaker 01

  Yeah. So this again comes back to, now, this is just my opinion. It's like, oh, is a senior hot dog just cherry picking statistics here? Two thousand and nine, Gerd Gigerenzer, the director of the Max Planck Institute in, for health literacy in Berlin. Okay, this is the same institution that Einstein taught and trained in. Brilliant guy. He wrote in a WHO bulletin, two thousand and nine, 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, Mark, this is a problem.

• 27:55Speaker 01

  You should use it and tell patients, this is what I do. And I, a patient comes in, it's like, should I take a statin or not? I say, well, let me just, let me empower you with the information. Tell me what you think. Most patients with the one percent thing think, 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 Mark, 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, we're doing this campaign against too much medicine. They're talking about informed consent by use of N and Ts. We need to launch a campaign because over prescription is a big problem. We know there's a big problem with side effects.

• 28:36Speaker 01

  We know that one estimate suggests that prescribed medications is the 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 the BMJ. So I then wrote a paper, I was lead author, had the Chairman of the General Medical Council, the Chairman of the Medical Royal Colleges on that co-authored paper to say, okay, this is a campaign we can get and change medical education, change postgraduate medical training. And we got that into the media. It was a big news story, BBC, all over 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 less treatments. Now, who's going to suffer from that?

• 29:20Speaker 01

  The drug industry. They, in my view, it's very clear, it's not a conspiracy. This is clearly how they do business and this is what they want to do is they want to, they engage in a tactic called opposition fragmentation. Anyone that threatens their bottom line, they will do smearing, they will do all these things behind the scenes. There's a whole documented history of this.

• 29:39Dr. Mark Hyman?

  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 for pharma, big food and big ag that think trans fats, pesticides, smoking and, you know, glyphosate are all healthy for you. And I'm like, okay. And if they come up telling very, you know, air diet and smart.

• 29:58Speaker 01

  So you've experienced it, Mark, right?

• 30:00Dr. Mark Hyman?

  Science-based medicine, American Council on Science and Health, I mean, crack busters, crack watch. I mean, I've been there all through it.

• 30:07Speaker 01

  You get it.

• 30:08Dr. Mark Hyman?

  I totally get it. And I actually, I find a badge of honor, you know?

• 30:11Speaker 01

  It is. Well, no. So actually, in a way, it is, although you've got to grow a thick skin, right? Because, you know.

• 30:19Speaker 01

  One of the lessons in public health advocacy done by, written a great paper written by Simon Chapman, who took on big tobacco in Australia and talks about his thirty eight year career and taking on big tobacco. He says, as soon as your work threatens an industry or an ideological cabal, because also about this about minds. It's not just about money. It's about indoctrination in the brain, right? As soon as your work threatens an industry or an ideological cabal, you will be attacked, sometimes unrelentingly and viciously. So you have to grow a rhinoceros hide.

• 30:45Dr. Mark Hyman?

  Yeah.

• 30:46Speaker 01

  So for me, what happened after that is there was, I kept pushing this, this message, but they then, behind the scenes, Royal College physicians, I think, funded by farmers, some scientists funded by farmer, started making complaints to the Academy of Medical Royal Colleges, 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, all nonsense. And that, and that was so relentless that they then, um, in two thousand and eighteen, I got an, an email from the, 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, of, of stuff that I apparently said publicly on statins,

• 31:28Speaker 01

  even though everything in the newspapers that was written about statins for me was coming from medical journals. And I was a very strong advocate for informed consent. But again, this is what-

• 31:36Dr. Mark Hyman?

  Don't confuse me with the facts my mind's made up.

• 31:39Speaker 01

  Well, exactly. Yeah, exactly. So this is what they do. And of course, it does have its personal toll. And then it culminated, 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, uh, 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, almost single handedly. And he says, first they ignore you.

• 32:05Dr. Mark Hyman?

  Britain was bigger than the pharma companies, you know?

• 32:07Speaker 01

  Oh, it was. Absolutely. I mean, America was founded on anti corporate sentiment, taking on the British, British East India Company, right? It was, 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 they ignore you, then they laugh at you, then they fight you, then you win.

• 32:25Dr. Mark Hyman?

  Yeah.

• 32:25Speaker 01

  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. It's tough.

• 32:31Dr. Mark Hyman?

  So let, so, so essentially this, this interesting legal case that we started out with has sort of vindicated that you and your colleagues were speaking truth to power. So let's get into the details here because everybody's listening going, yeah, well, my doctor checked my cholesterol and my LDL was high and they recommend a statin. And like we said, it's the number one prescribed drug in the world.

• 32:53Speaker 01

  Yeah.

• 32:55Dr. Mark Hyman?

  Seventy-five percent of the prescriptions are for preventing heart attacks if you've never had one. It's called primary prevention. There's very weak data to show that that actually works, especially for women, especially for over a certain age.

• 33:05Speaker 01

  Yeah.

• 33:07Dr. Mark Hyman?

  There is benefit for people who've had a heart attack, no doubt. It's not like taking antibiotic for a strep throat, but there is a benefit. And and I'd love you to sort of unpack how you came to go from being a trained cardiologist who basically swallowed the gospel.

• 33:24Speaker 01

  Yep.

• 33:25Dr. Mark Hyman?

  To one who understands and has looked at the literature and has come to a different conclusion. Because it's not just that you're anti-drug or you're 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 statins to one who started to question statins to one who's come to understand that our approach to cardiovascular disease 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

• 33:59Speaker 01

  Yeah.

• 34:00Dr. Mark Hyman?

  everybody listening has noah's heard if their cholesterol is high to take a statin.

• 34:04Speaker 01

  Sure.

• 34:05Dr. Mark Hyman?

  And statins cause side effects, which they do for a lot of people, probably 20% get some muscle damage or some symptoms or increase the risk of diabetes. You know, we'll talk about that data. There's still, there's still a huge drive in our society for prescribing these and globally.

• 34:20Speaker 01

  Yeah, absolutely. So my interest in this came from really looking at the initially the obesity epidemic. So 2004 WHO announced it as an epidemic. You know, by 2010, I was a nine years qualified as a doctor. I was specialist registrar in my cardiology training. I was seeing more people this viscerally. I'm very sensitive to.

• 34:44Speaker 01

  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 own, two of my own, two of my parents both basically died because of failures in the system, because the system's under so much 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

• 35:29Speaker 01

  intake. It became quite clear, there was a clear correlation between that change in guidance in the late seventies in the US and early eighties in the UK, when the obesity epidemic started to then, you know, take its trajectory down the wrong way.

• 35:41Dr. Mark Hyman?

  Yeah, and I covered a lot of this in my book, Eat Fat, Get Thin, 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 with another drug, the G P one agonist, and, you know, just appetite and some of glut titers, and it's kind of crazy, right? We just kind of flipped it upside down.

• 36:01Speaker 01

  Oh, absolutely. So when I looked at that, and 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 in 2013 called saturated fat is not the major issue.

• 36:14Dr. Mark Hyman?

  I read it, that's how I first came across it.

• 36:15Speaker 01

  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 and heart disease. So if that's true.

• 36:36Speaker 01

  Then, and we know saturated fat raises LDL cholesterol. That means LDL cholesterol can't be that important. So, and if LDL cholesterol, or total cholesterol, isn't that important as a risk factor? How does statins work? But I knew statins had a separate effect to low in cholesterol, which is they're anti-inflammatory and they're 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 their cholesterol. Maybe some of the thinking was the lower the better, which we'll come on to as well. So it doesn't matter what their cholesterol's starting from. The lower your cholesterol, the better. In fact, 2011, 2011, a cardiologist, 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,

• 37:19Speaker 01

  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." Sounds crazy. "But as long as your cholesterol is low enough..."

• 37:32Dr. Mark Hyman?

  You're not gonna get a heart attack.

• 37:33Speaker 01

  "...you're not gonna get heart disease."

• 37:34Dr. Mark Hyman?

  That's crazy.

• 37:35Speaker 01

  Like, really? So, okay, I had to unpick that. And, and, and what I, what I also then did moving forward from 2013, so that's how I got down this track, realizing that our obsession with LDL lowering has, has been a problem.

• 37:48Dr. Mark Hyman?

  So you looked at the saturated fat literature and you weren't impressed? And data showed that it didn't seem to be...

• 37:51Speaker 01

  Both observational data and randomized controlled trials. No benefit, like in lowering it, no association, nothing.

• 37:57Dr. Mark Hyman?

  Right.

• 37:58Speaker 01

  Right? And when you look at all the data, so that was the first sort of bit that I was, okay.

• 38:01Dr. Mark Hyman?

  And some might even have been protective, like some of the dairy fat.

• 38:04Speaker 01

  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 hypothesis.

• 38:12Dr. Mark Hyman?

  By the way, you're not alone on this. I mean, there was a major paper published by Darius Shmazafarian from Tufts and others, looking at butter and, and actually showing that there really was an evidence that it was a problem.

• 38:22Speaker 01

  So Mark, this is what's interesting. That article I wrote, because creates such a, you know, a lot of headlines and backlash or whatever else, that's when people like Darius 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, and at the time, I was, I was writing this to a commentary, which was 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 is good. But the other aspect to 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 a risk factor? Yeah. So you have to go back to square one, right?

• 39:03Speaker 01

  So these are the Framingham studies that, you know, started in Massachusetts in nineteen forty eight 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. High cholesterol. And high cholesterol, right? So you go and look back at the Framingham studies and what, and just to summarize it without complicating the situation too much. William Castelli is a cardiologist and he published, he was a co-director of Framingham. And in nineteen ninety six, he published in one of the cardiology, major cardiology journals, a summary of Framingham, specifically looking at LDL cholesterol. Let's just, let's just look at LDL because that is the so-called bad cholesterol.

• 39:43Speaker 01

  And he said, from Framingham, unless your LDL was above seven point eight millimoles, which by the way, I think in your units is probably two fifty or three hundred? Two fifty probably, I think. Maybe we can look it up and calculate, but let's just say for argument's sake, around two fifty, which is very, very high, by the way. It absolutely had no, it was useless as a predictor for coronary artery disease. LDL. LDL. Now, why is that? When you correct for triglycerides and HDL, okay? Which by the way, is a more important predictor of 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.

• 40:26Speaker 01

  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 P C K nine inhibitors, whether it's statins, whatever. Is the, 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, and some diet trials, but many drug industry sponsored trials. All of the randomized control trials on cholesterol lowering drugs, statins, P C K nine, blah, blah, blah. Was there a clear relationship as you lowered LDL in low risk and high risk patients, Mark? Okay, over thirty studies. Yeah. Was there a relationship with lowering LDL and preventing cardiovascular events? No. Even in high risk patients?

• 41:11Speaker 01

  Even in high risk. It's nonsense. It's nonsense. So the question then is.

• 41:16Dr. Mark Hyman?

  Why do we also firmly believe?

• 41:18Speaker 01

  So 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 they're 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 argument sake, let's say there is a weak benefit in lowering LDL. What else is going on and what else are you ignoring? Right?

• 41:48Dr. Mark Hyman?

  Yeah.

• 41:48Speaker 01

  What else does statins do? They cause insulin resistance. Say, one in a hundred people get type 2 diabetes because of statins.

• 41:54Dr. Mark Hyman?

  One in two.

• 41:55Speaker 01

  One in a hundred.

• 41:56Dr. Mark Hyman?

  One in a hundred.

• 41:56Speaker 01

  Yeah, one in a hundred. So about one to 2%, but one in a hundred. Some studies say one in 50, right? Will get type 2 diabetes because of the statin, probably reversible still, but not ideal, right? If you're on the standard 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 and eat McDonald's, it's fine. And they, and they're getting more and more overweight, more insulin resistant, they're increasing their cardiovascular risk. They're not told the statin is going to give them a 1% benefit, i.e. 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

• 42:38Speaker 01

  and has actually been one of the main reasons why we have got this pandemic of chronic disease.

• 42:43Dr. Mark Hyman?

  Because we overemphasized an index on LDL cholesterol and forgotten everything else.

• 42:47Speaker 01

  Absolutely.

• 42:48Dr. Mark Hyman?

  Right. 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 metformin, but it's eh, and it fixed insulin resistance, you know, everybody'd be prescribing it. But we don't even diagnose it in most people because we don't have a drug for it.

• 43:06Speaker 01

  Exactly.

• 43:06Dr. Mark Hyman?

  And it's stunning to me that, you know, I was talking to the Lab director at Quest Laboratories, he said, what percent of your tests you get that 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 cardiometabolic risk factors, including insulin, including LP little a, including something called 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

• 43:48Dr. Mark Hyman?

  your cardiovascular risk. And then you know where to intervene. And in one of the studies that was so interesting to me was, actually from, I think, Scotland or Ireland, was where they looked basically at a series of patients who came into an 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 prediabetes, who had a heart attack, that that was really the big driver. Now, there's a subset of people have familial lipid disorders, you know, inherited genetic lipid disorders. And those people probably need to be treated more directly. But for the majority of people out there who are obese or have prediabetes or metabolic dysfunction, which is basically in America, 93% of Americans,

• 44:30Dr. Mark Hyman?

  that's what's driving probably most of the heart disease, not butter or saturated fat or LDL elevations.

• 44:37Speaker 01

  Well, something else to throw into the picture, right? So you could make the argument, okay, Dr. Malhotra, 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 a number of international scientists looked at, we decided to do a systematic review of observational data, looking at people over 60. Was there a relationship with LDL cholesterol and heart disease? And the reason we did this, by the way, is 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 and both sexes, right?

• 45:18Dr. Mark Hyman?

  For mortality.

• 45:19Speaker 01

  For 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-cause mortality. In other words, statistically, if you're over 60, the higher LDL, the less likely you are to die. So what's the reasoning for that? Well, something that's been forgotten or missed or not discussed. Cholesterol is, has a very vital role in many functions in the body, including, you know,

• 45:54Dr. Mark Hyman?

  Brain.

• 45:55Speaker 01

  The brain, hormone production, but also the immune system.

• 45:58Dr. Mark Hyman?

  Mm-hmm.

• 45:59Speaker 01

  And it's likely that that's where the protective benefit comes because older people are more vulnerable to dying from infections.

• 46:05Dr. Mark Hyman?

  Yeah.

• 46:05Speaker 01

  And we also know there is an association, I'll use this word, an association, right? Can't say it's definitely causal, between low cholesterol and cancer. Again, it's probably related to the immune system.

• 46:14Dr. Mark Hyman?

  Yeah, I mean, I think, I think

• 46:16Speaker 01

  Which is very interesting.

• 46:17Dr. Mark Hyman?

  Part of the problem with this data, though, is, and I'll just push back a little bit, is it's observational data and the data, like, from the Hawaii study, show that, you know, the, you're older and you have higher cholesterol, you know, you're more likely to live longer than if your cholesterol is lower.

• 46:28Speaker 01

  Yeah.

• 46:28Dr. Mark Hyman?

  But it may be because the people who have low cholesterol are malnourished, have cancer and other reasons.

• 46:32Speaker 01

  So let me push back on that. So we, we counted for that. And we found, actually, no, when you, when you count, like, time lag, you go back five or 10 years. No, it's not, it's not. That does happen, but it, no, it's independently, it does seem to be an issue.

• 46:43Dr. Mark Hyman?

  Okay, so you sort of looked 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 be, that statins work a little.

• 46:55Speaker 01

  Yeah.

• 46:55Dr. Mark Hyman?

  But not for the reasons we think. I mean, they lower inflammation and they may have other properties that may benefit. So we don't even know what called this pleiotropic effects. They, for example, they induce nitric oxide synthase, which dilutes your blood vessels and reduces inflammation and helps your lining of your blood vessels. All that's protective. And so it may be it stabilizes plaque, it may help in those ways, but it may not be the LDL lowering effect. In fact, Paul Rittger from Harvard, I remember he published a trial, I think it was the Jupiter trial, where they showed that if you, if you had a high LDL, But didn't have any inflammation, you didn't have that significant a risk of having heart disease. But if you had

• 47:31Speaker 01

  Interesting.

• 47:32Dr. Mark Hyman?

  A high level of inflammation, high 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, it was in the New England Journal of Medicine, over 20 years ago, I remember reading it.

• 47:41Speaker 01

  Yeah.

• 47:41Dr. Mark Hyman?

  By Paul Rittger and his crew, that really laid out how heart disease is not a plumbing problem, it's an immune problem.

• 47:48Speaker 01

  Hundred percent. It's a chronic inflammatory process exacerbated by metabolic risk factors or insufficiency. And I wrote

• 47:54Dr. Mark Hyman?

  Metabolic risk factors, by that you mean, probably your blood sugar and insulin.

• 47:57Speaker 01

  Insufficiency.

• 47:58Dr. Mark Hyman?

  And prediabetes.

• 47:58Speaker 01

  Hundred percent. And actually, we published an editorial with two cardiologists I did in British Journal of Sports Medicine in 2017, which was a very long title, but it got a lot of publicity and over more than a million downloads, which was saturated fat does not clog the arteries. Chronic 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 there, people, it's free access, people look it up and read it. But we talked that we've overdone the thing. And it wasn't just Dr. Malhotra, but his opinion being controversial. The two, my two co-authors were both editors of medical journals and cardiologists, Louisa Redberg, editor of Jarmot of Medicine, and Pascal Meyer, editor of BMJ Open Heart.

• 48:35Dr. Mark Hyman?

  Why, why, why is this not getting more play? Why, why is still the dogma and the orthodoxy that if you have a high LDL, you take a statin?

• 48:45Speaker 01

  Do you want my honest answer, Mark?

• 48:47Dr. Mark Hyman?

  Yeah. I mean, not all, I mean, I know doctors are usually very good hearted.

• 48:52Speaker 01

  Sure.

• 48:52Dr. Mark Hyman?

  Very smart, well intentioned, 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, why are they not hearing about this?

• 49:03Speaker 01

  Okay, so let's go to the root cause of the problem, even in society day. What's, 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, as being tyrannical. What all, what all, what, what also happens with these big corporations and 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

• 49:46Speaker 01

  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, Noam Chomsky says, the general public doesn't know what's happening, and they don't even know that they don't know.

• 50:17Dr. Mark Hyman?

  That's right.

• 50:17Speaker 01

  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 the drug companies that are already 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, they're afraid to speak out. And only a minority of the doctors that know what's going on will then speak out.

• 50:44Dr. Mark Hyman?

  It's hard. I mean, listen, you know, I practice medicine, I'm seeing patients, you're busy. Like, I literally had 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 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 what they get taught in their training. And they try to look at the evidence the best they can. But also, they're looking at sort of biased evidence.

• 51:10Speaker 01

  Completely. 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 a human being can go through, right? And that's where you need humility, right? John Kenneth Calbraith, the Canadian American economist, said, faced with the choice between changing one's mind and proving there's no reason to do so, almost everybody gets busy on the proof.

• 51:34Dr. Mark Hyman?

  Yeah.

• 51:35Speaker 01

  So for the medical profession, 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 After School, which I watch a few times. It's brilliant. It goes through like ancient wisdom and philosophy and psychology. And it says, one of the titles, you should look this up, Mark, you'll love it. Why do intelligent people believe stupid things?

• 51:58Speaker 01

  And

• 51:59Dr. Mark Hyman?

  And the answer is?

• 51:59Speaker 01

  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, 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. It ultimately 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 sadly, you know, and 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 have relatives here and I've been here a lot.

• 52:44Speaker 01

  But you have now the highest healthcare expenditure in the developed world over $4 trillion with the worst health outcomes.

• 52:51Dr. Mark Hyman?

  Oops.

• 52:52Speaker 01

  Right? So, so, so what's happened is, you know, because of all of this situation around corporate capture, so, you know, the, the counter, of course, from a philosophical point of view is that living a life in darkness has no meaning.

• 53:08Dr. Mark Hyman?

  Yeah.

• 53:08Speaker 01

  And we need to get people out of the, of this darkness to understand the root of the problem and then we can then start making solutions.

• 53:14Dr. Mark Hyman?

  You have to take time to think and learn. I mean, John F. 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 a 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.

• 53:58Speaker 01

  Yeah.

• 53:58Dr. Mark Hyman?

  Under 100. 17% had super optimal levels, under 70. But what they did found 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 the, that those with low HDL and high triglycerides.

• 54:17Dr. Mark Hyman?

  Which goes along with small dense cholesterol particles were much at a higher risk of having a heart attack. And so in fact, the average HDL in that group was 39, which is should be ideally over 50. And the average triglycerides 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 triglyceride to HDL ratio. It was the triglycerides and 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

• 55:00Dr. Mark Hyman?

  number of the particles. And the smaller dense particles are the ones that are more putting at risk. And those are the ones that are caused by sugar and starch, not fat. Fat fat actually improves the size of your lipid particles.

• 55:11Speaker 01

  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 randomized control trials done by, obviously by the drug companies and secondary prevention trials. And subgroup analysis found, so these are people with statins who had either either were high risk of a heart attack or had a heart attack, in the patients in the trials that had normal triglycerides and HDL, no benefit at all from statins. Think about that.

• 55:47Dr. Mark Hyman?

  So if your triglycerides or any show were good.

• 55:49Speaker 01

  Even people who've had a heart attack. There was no benefit from the statin at all. Which which fits with what you just said.

• 55:54Dr. Mark Hyman?

  And it's kind of interesting because, you know, you get the benefit in some ways of inflammation protection, but you also get increased insulin resistance.

• 56:01Speaker 01

  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, accept the four day increase over five years in high risk patients. One of 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.

• 56:22Dr. Mark Hyman?

  And why?

• 56:23Speaker 01

  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-

• 56:33Dr. Mark Hyman?

  That's a big-

• 56:33Speaker 01

  Well, how prevalent is that? And you look at the data and it's mixed, but anything from, in 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 it 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 gonna die at some point. What we want to live our lives in the best health we can for as long as possible. Right? That's the most, 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.

• 57:17Dr. Mark Hyman?

  So you're gonna sort of seal man the argument and argue the other side.

• 57:20Speaker 01

  Yeah.

• 57:21Dr. Mark Hyman?

  How would you argue against yourself for this? Because, you know, I've had these conversations with cardiologists, with experts, and they're like, listen, the data is just so strong about statins.

• 57:32Speaker 01

  Yeah.

• 57:33Dr. Mark Hyman?

  There's no question that they lower risk and there's no question their 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-off is worth the risk. And the data is so prevalent and so strong and so clear that we should all be taking steps.

• 57:52Speaker 01

  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 and I was taught by my dad and, you know, one of the reasons I got annoyed or pissed off in the hospital and got into 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 frustrated, I can't get any healthy food anywhere. That could be my bias, fine, but and I accept that.

• 58:31Speaker 01

  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 fat and 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 humility, 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, if statins didn't have side effects, or they were almost non-existent, I could actually say, put them in the water supply.

• 59:14Speaker 01

  Because even if, you know, there is a concept in medicine, you've got to treat the many to benefit a few. So let's just say that they save lives in, I don't know, on average, say, one in three hundred people are going to live longer because of statins, right?

• 59:28Dr. Mark Hyman?

  It's a public health.

• 59:28Speaker 01

  Yeah, for public health. So, you know, put it in the water supply, you know? Give to three billion people, we're gonna, are gonna have, you know, you're gonna save one in three hundred of those three billion, you know, whatever that is.

• 59:39Dr. Mark Hyman?

  It's a lot of people.

• 59:40Speaker 01

  It's a lot of people. It's, 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.

• 59:50Dr. Mark Hyman?

  Yeah.

• 59:51Speaker 01

  So, so, so I am very for, you know, and that, and that is an argument that has been put forward and.

• 59:56Dr. Mark Hyman?

  Because there's marginal benefit.

• 59:59Speaker 01

  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, then 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, 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 so 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.

• 1:00:31Dr. Mark Hyman?

  That's right. It's not working so good anymore.

• 1:00:33Speaker 01

  I'm about, I'm about shared decision making. I'm about explaining to patients a way that, that's, you know, in queue, that empowers them, that, that it's a more equal relationship, you know, and that, that's fine, that's a, maybe it's a philosophical disagreement, but that's the stance I'm gonna take. And I'm prepared to die on that hill.

• 1:00:49Dr. Mark Hyman?

  I think that's right. I mean, I think, you know. We have to sort of look at this at a high level. Like any tool, there is a use for statins. There's a use for the PCSK inhibitors. 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 as 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.

• 1:01:17Speaker 01

  Yeah.

• 1:01:17Dr. Mark Hyman?

  Right? Sugar can be tolerated more by some people, but not by others. I just came back from Utah and was in the Native American Reservation, the Napa Reservation. It was just staggering to see the amount of obesity. I mean, you look at, you know, 150 years ago, there wasn't a single overweight Native American.

• 1:01:32Speaker 01

  Yeah.

• 1:01:33Dr. Mark Hyman?

  Period. And, and why? It's because metabolically, they're genetically, they're different. So I think, I think, you know, I'd love to sort of explore who might benefit from these drugs. Cause there's a class of people, we refer to them as lean mass hyper responders where people like you and I, maybe who are athletic, who are fit, who may actually have an adverse response to increased saturated fat in the diet. Or who might have a family history of lipid disorders.

• 1:02:03Speaker 01

  Yeah.

• 1:02:03Dr. Mark Hyman?

  Actually have some genetic issues, which I do in my family. So how, how do you sort of handle those?

• 1:02:08Speaker 01

  Yeah. So I deal with those actually quite regularly. So interestingly 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 into resistance 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.

• 1:02:25Dr. Mark Hyman?

  Ron Kraus.

• 1:02:26Speaker 01

  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 people was more than 18% of your total calories. Right? Which is still very, very high. But again, that you're absolutely right. That might happen with, 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 family hyperlipidemia. So that's just lay it out for people, right?

• 1:02:59Dr. Mark Hyman?

  And I think there's more than just that one subtype. There's many different types of genetic lipid disorders.

• 1:03:05Speaker 01

  Of course.

• 1:03:05Dr. Mark Hyman?

  That I think we're just starting to figure out.

• 1:03:06Speaker 01

  There are, but you know, you talk about APOB and lipoprotein little A, 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. Right? Because what's the point? So you create unnecessary 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 on to 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 thirty 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?

• 1:03:52Speaker 01

  To keep their risk 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 about, okay, is it going to change anything? And am 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 partly because my dad was the same. I have moments of being a hypochondriac. And I know on the receiving end, like, you know, tests that are done that didn't need to be done. And now I'm like, okay, what does this mean? And you're going down a rabbit hole. So you'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.

• 1:04:33Dr. Mark Hyman?

  I guess it's true. We learned that in 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 I think there's a movement towards this deep phenomics. I've had Jeremy Nicholson in my podcast, Lee Warhood in my podcast. And they're about more data and dense, dynamic data clouds of information from your biomarkers, your metabolism, your microbiome, 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

• 1:05:10Speaker 01

  But it may not.

• 1:05:11Dr. Mark Hyman?

  Or may not. But I'd rather know if my insulin is going up over ten way before I get diabetes.

• 1:05:17Speaker 01

  No, I agree. So a hundred percent, I agree. There are definitely certain, yeah. So I think there's a nuance there again. There are certain things where we know. Okay, there is a very likely benefit here of you getting your insulin down, et cetera. I think some of the other biomarkers is still in a certain, you know, area. But again, Mark, you've said that, okay, you're a guy. And this is if I was having a conversation with you and it's your preference of values. You want the data, 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 then suddenly they come back. 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 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.

• 1:06:02Speaker 01

  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 just see a sigh of relief and say, doctor, thank God. I've been going on thinking that I'm, then that's again, missed use, not good use of maybe numbers or statistics. I've been going on thinking that I've got in the next five years, there's an 80% chance I'm going to die of a heart attack. I'm like, no, it's 2% in 10 years. Right. Right. So, so there's also that as well. So I just think we just did think a little bit carefully on it. But coming back to FH, FH affects familial hypolepidemia, genetically very high cholesterol. Okay, 50% of men and 70% of women, right?

• 1:06:47Speaker 01

  With FH untreated, big numbers, will not develop premature heart disease. But 30% of women will and 50%, which is a lot, will get even before maybe 50 or 60 will get heart disease. So I did actually a review paper with, with a number of international scientists as well. And we published it in BMBA Evidence-Based Medicine. And we thought, okay, that's interesting. 50% of men with FH, familial hypolepidemia, very high LDL, don't get heart disease and 50% 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. Ah, that's interesting. It can't be the LDL then. What is it? Well, we found, and this is a mark, you're going to like this.

• 1:07:30Speaker 01

  One of the lipoprotein little A was higher than the ones that dropped the heart disease. So FH, you should look at lipoprotein little A, definitely. That gives them a high risk. But what's most promising and interesting is when you correct for insulin resistance.

• 1:07:42Dr. Mark Hyman?

  Yeah.

• 1:07:43Speaker 01

  Right. 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 waist circumference and low insulin.

• 1:07:55Dr. Mark Hyman?

  Yeah.

• 1:07:56Speaker 01

  Now, how do you get there? Diet, right? Cutting out the sugar, processed foods, refined carbs.

• 1:08:02Dr. Mark Hyman?

  That's right.

• 1:08:02Speaker 01

  And it rapidly. So this is amazing. So I can, so what I do with those patients is I go through that with them. Now, if I think they're actually the high level of A and they're probably at high risk, I say, listen, the statin benefit is there, it's small, but why don't we do a halfway house? High dose statins are more likely to give you side effects. Let's do a low dose statin. 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 isn't discussed enough. And, you know, it comes out in my documentary film.

• 1:08:33Dr. Mark Hyman?

  Which is called?

• 1:08:35Speaker 01

  First Do No Farm, P H A R M, not F A R M.

• 1:08:38Dr. Mark Hyman?

  All right. How do you, how do you find that?

• 1:08:40Speaker 01

  We, it's released online at the moment, and you can download it for $10. And it's, the website is nofarmfilm.com. And the reviews have been, you know, pretty extraordinary.

• 1:08:51Dr. Mark Hyman?

  No Farm?

• 1:08:52Speaker 01

  Nofarmfilm.com.

• 1:08:53Dr. Mark Hyman?

  P H A R M?

• 1:08:54Speaker 01

  P H A R M.

• 1:08:55Dr. Mark Hyman?

  Okay.

• 1:08:55Speaker 01

  Yeah, yeah, yeah. Nofarmfilm.com. We screened it in the Leicester Square Odeon in London, which is the most famous cinema in the world. 790 people came. It was invite only, but celebrities, really good feedback. Screened it to doctors, Integrative Mental Health Conference in 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, it is, in my view, this film uncovers literally how we have got this pandemic of coronary disease, both with Big Pharma and Big Food capturing, we've got, you know, the medical knowledge, we've got very credible experts, four members of the BMJ. We go into some dark stuff in there, just how many people have been killed by research fraud. But we also give people hope with the lifestyle

• 1:09:40Speaker 01

  stuff. And one of the most interesting things I discovered in the, 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 coronary artery 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 it stabilized cornea disease, but it was like one or two percent in terms of the blockages. Cardioz in India for 20 years has been reversing heart disease to the level where, you know, one of his papers that he published showed a 20% reduction within two years.

• 1:10:15Dr. Mark Hyman?

  Of the narrowing of the artery.

• 1:10:16Speaker 01

  Seventy percent became 50, 50 became 30. So he did it through this healthy lifestyle program. It was a, they were devout Hindus, hundreds of patients, right? High fiber vegetarian diet, because they were devout Hindus, fine. Two 30 minute brisk walks a day. Okay. And then something called Raj yoga meditation. And when he did a, a deep dive analysis into what caused a reversal, the only independent factor for reversal of heart disease was 40 minutes of Raj yoga 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 myself. I trained in this stuff. I know this stuff inside out. It was unbelievable what I was seeing. I've seen those patients. I've seen the angiogram reports. There was clear reversal. In some patients, it was a complete 100% occlusion that then opened up.

• 1:10:59Dr. Mark Hyman?

  Wow.

• 1:11:00Speaker 01

  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 inflammation. We've talked about

• 1:11:43Speaker 01

  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.

• 1:11:51Dr. Mark Hyman?

  So kind of, kind of in wrapping up, you know, kind of, what I'm hearing is that stats have a role, but they're not all they're cracked up to be.

• 1:11:58Speaker 01

  Yeah. Just know, just know are they right 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?

• 1:12:05Dr. Mark Hyman?

  And that you have critiques of the way the research was done and how the studies sort of sort and sit through the statistics to show the benefit.

• 1:12:13Speaker 01

  Yeah.

• 1:12:14Dr. Mark Hyman?

  How it's reported as. 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?

• 1:12:24Speaker 01

  It's 1%, yeah.

• 1:12:25Dr. Mark Hyman?

  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've kind of critiqued, can you sort of unpack that a little bit? Because I think we didn't dive deep enough into that. I want people to understand this is not just sort of a heretical opinion, but this is after looking at the way these studies were designed, the way they were done, what the data actually show.

• 1:12:49Speaker 01

  So, 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 reports the side effects, because what the drug companies do, who control the, how the trials are designed, 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 run, in the trial. And for six weeks, for example, one of the trials, the heart protection study, a third of the patients, thousands of patients were removed before the trial began because of so-called non-compliance. In other words,

• 1:13:34Speaker 01

  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 who get them early on, and then report on that. So that's probably one of the reasons they're massively under-reported, the side effects. It's, I'm sorry, Mark, you know, it's fraud. I'm sorry, it's fraud. And let me be definitive about how I describe 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.

• 1:14:02Dr. Mark Hyman?

  So some of the independent studies also show benefit?

• 1:14:05Speaker 01

  Yeah. Well, the independent studies that have been done have shown very little benefit. But I, 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. The totality of evidence around statins, the raw data has never been independently evaluated for side effects. So we still don't know the true.

• 1:14:27Dr. Mark Hyman?

  So in other words, what we know is what's published, not what's actually been tracked because pharmaceutical companies don't have to release that data and they hold it.

• 1:14:35Speaker 01

  They hold it and and then then the reg you think the regulators are going to be able to ask for it and look for it. They rarely do that.

• 1:14:40Dr. Mark Hyman?

  Well, they have it, but they don't publish it, which is which is interesting to me. 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.

• 1:14:52Speaker 01

  Yeah.

• 1:14:52Dr. Mark Hyman?

  But it's not in the literature because it's not published. But the pharmaceutical company has to report all that data before a drug is approved.

• 1:14:59Speaker 01

  Yeah.

• 1:14:59Dr. Mark Hyman?

  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 published. But you know, all this other stuff shows that it really didn't work that way.

• 1:15:09Speaker 01

  Well, what they often give the FDA, Mark, is curated information from tens of thousands of pages of of of clinical study reports on patients in the trial. So the 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 conflicts of interest. Sixty five percent of the funding of the FDA in the US comes from Big Pharma. Eighty six percent of the funding in the UK of the MHRA comes from Big Pharma.

• 1:15:30Dr. Mark Hyman?

  And this is.

• 1:15:30Speaker 01

  This is a problem. They don't want to back the hand that feeds them. So there's a huge conflict.

• 1:15:32Dr. Mark Hyman?

  Does this explain why it seem that the American College of Cardiology and the American Heart Association still recommend statins for people with high LDL for primary prevention, meaning if you've never had a heart attack, which is seventy five percent of the prescriptions, you know,

• 1:15:47Dr. Mark Hyman?

  is it because they're captured too?

• 1:15:48Speaker 01

  I think it's a combination of factors, but yes, I think the root of it is flawed science, dogma and money. And then even if people know there's an issue, 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, pardon my language, shit show for healthcare. And that's why we are where we are in America right now. So it's time to, you know, I, you know, I think 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 is 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.

• 1:16:22Dr. Mark Hyman?

  Yeah, it's been co-opted unfortunately.

• 1:16:24Speaker 01

  And you can't.

• 1:16:25Dr. Mark Hyman?

  Trump campaign, but.

• 1:16:26Speaker 01

  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.

• 1:16:33Dr. Mark Hyman?

  Okay, I want to re-say that again. Commercial. Distortions of the scientific evidence.

• 1:16:37Speaker 01

  Is it, unless you correct that, you won't fix health.

• 1:16:40Dr. Mark Hyman?

  There'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 ag companies subvert public health and privatized profits. And it's a WHO report that's sort of partly published, but also coming out in a much, much bigger report. And it's going to be interesting when that hits because, you know, we talked about the social determinants of health, but this is really how, how the industry is driving it. And just the American Heart Association alone receives $192 million a year from food and pharma companies, right?

• 1:17:14Speaker 01

  Crazy, mind blowing.

• 1:17:16Dr. Mark Hyman?

  It's mind blowing.

• 1:17:17Speaker 01

  How can we, how can we trust that they're being independent with their information? Come on. I mean, it's, people need to just, you know, wake up, wake up.

• 1:17:25Dr. Mark Hyman?

  And, and you're not telling everybody who's on a statin to stop it. You're not telling them anybody.

• 1:17:29Speaker 01

  Let's get better informed.

• 1:17:30Dr. Mark Hyman?

  Get better informed.

• 1:17:31Speaker 01

  Yeah.

• 1:17:31Dr. Mark Hyman?

  Read the data. I, I wrote an article years ago called FAT, 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 it's still, I think there's more and more data coming out all the time. And I think they can check your books. Where, where do they learn more about your work and what you're doing?

• 1:17:47Speaker 01

  Yeah.

• 1:17:48Dr. Mark Hyman?

  How do they understand?

• 1:17:49Speaker 01

  Yeah, of course.

• 1:17:49Dr. Mark Hyman?

  Dig in a little bit more.

• 1:17:50Speaker 01

  But let's very quickly on that. I just, I love the fact you've 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 understand what that means. Strategies and approaches adopted by the private sector to promote products and choices that are detrimental to health. That's the definition of commercial determines of health.

• 1:18:07Dr. Mark Hyman?

  Yeah.

• 1:18:08Speaker 01

  I have evolved that. And in fact, reference in the Lancet, because Richard Horton, the editor, came to one of my lectures. And I've said that the, the way that, and drug companies, big corporations, conduct business, not individuals within it. I'm not pointing at individuals who work for them. As legal entities, the way they conduct their business actually fulfills the criteria for psychopath.

• 1:18:26Dr. Mark Hyman?

  Callous and concerned.

• 1:18:27Speaker 01

  No, but this comes from Robert Hare.

• 1:18:30Dr. Mark Hyman?

  Amoral, not immoral, right?

• 1:18:31Speaker 01

  Forensic, yeah. Forensic psychologist, Robert Hare, behind the original DSM criteria of psychopathy, defined them in the book Corporation. He said, so what does that mean? Callous and concerned for the safety of others, incapacity 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. Right? So this is what the root of the problem, right? And of course downstream effects, we know what's going on.

• 1:18:53Dr. Mark Hyman?

  Yeah.

• 1:18:54Speaker 01

  So, yeah, people can, I've got a website, drasim.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 Do No Farm 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 A Statin-Free Life. And I think that really breaks down all the cholesterol stuff and the statin stuff and the lifestyle stuff as well.

• 1:19:20Dr. Mark Hyman?

  Yeah. So in summary, you're not anti-science or anti-drug or anti-pharma. You're just for.

• 1:19:25Speaker 01

  Pro health, real health.

• 1:19:27Dr. Mark Hyman?

  Real health.

• 1:19:28Speaker 01

  Although I'm pro, I'm pro ethical evidence-based medical practice.

• 1:19:32Dr. Mark Hyman?

  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 in the British Medical Journal, or BMJ as they call it now. And your books, your films, and you're kind of a tireless advocate for a contrary opinion that is really advocating for a better approach to understanding nutrition, health and making informed choices as opposed to just swelling, hook lung and sinker, the dogma that we're all taught in this society, which is that the only path to success in medicine is through pharma. And I am not anti-pharma.

• 1:20:16Dr. Mark Hyman?

  I prescribe drugs regularly. However, I want to prescribe the right treatment for the problem.

• 1:20:22Speaker 01

  Yes.

• 1:20:22Dr. Mark Hyman?

  And because all we have in our toolkit as physicians is a prescription pad, that's all we know how to use.

• 1:20:27Speaker 01

  Yeah.

• 1:20:27Dr. Mark Hyman?

  Where diet and lifestyle work far better and are far more effective at achieving the same or even better results than drugs. And if there was a drug that could instantly reverse diabetes or fix insulin resistance or prevent heart attacks.

• 1:20:41Speaker 01

  No side effects.

• 1:20:41Dr. Mark Hyman?

  With no side effects.

• 1:20:42Speaker 01

  Yeah.

• 1:20:43Dr. Mark Hyman?

  I would do it, but you know, I've never seen anything work as well as food when applied in the right dose.

• 1:20:50Speaker 01

  Yeah.

• 1:20:51Dr. Mark Hyman?

  The right medicine.

• 1:20:52Speaker 01

  Yeah.

• 1:20:52Dr. Mark Hyman?

  And for the right duration.

• 1:20:53Speaker 01

  Hundred percent.

• 1:20:54Dr. Mark Hyman?

  And I think people don't understand that about food. It's not like, oh, food is medicine. It's some like hippie dippy term.

• 1:20:58Speaker 01

  Yeah.

• 1:20:58Dr. Mark Hyman?

  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 for a particular condition. You need to know the same about food. That's how nuanced and detailed 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.

• 1:21:21Speaker 01

  Hundred percent.

• 1:21:22Dr. Mark Hyman?

  Wow.

• 1:21:22Speaker 01

  And Mark, another point before we finish is that, you know, 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 without side effects by and large, and they improve your quality of life.

• 1:21:40Dr. Mark Hyman?

  Well, there are a lot of side effects. Uh, you feel better. You have more energy. You sleep better, better sex drive, less depression, you know? So all the side effects are good ones.

• 1:21:49Speaker 01

  Fair point, fair point, fair point. Positive side effects.

• 1:21:52Dr. Mark Hyman?

  Well, thanks again for being on the Doctor's Pharmacy and we'll see you next time. And keep up the good work, man.

• 1:21:55Speaker 01

  Thank you, Mark. Lovely to see.

• 1:21:59Dr. Mark Hyman?

  Thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts and follow me on all social media channels at Dr. Mark Hyman. And we'll see you next time on the Doctor's Pharmacy. I'm always getting questions about my favorite books, podcasts, gadgets, supplements, recipes and lots more. Now you can have access to all of this information by signing up for my free Mark's Picks newsletter at drhyman.com/marks picks. I promise I'll only email you once a week on Fridays and I'll never share your email address or send you anything else besides my recommendations. These are the things that have helped me on my health journey and I hope they'll help you too. Again, that's drhyman.com/marks picks. Thank you again, and we'll see you next time on the Doctor's Pharmacy.

• 1:22:47Dr. Mark Hyman?

  This podcast is separate from my clinical practice at the Ultra Wellness Center and my work at Cleveland Clinic and Function Health, where I'm the Chief Medical Officer. This podcast represents my opinions and my guests' opinions, and neither myself nor the podcast endorse the views or statements of my guests. This podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for your help in your journey, seek out a qualified medical practitioner. You can come see us at the Ultra Wellness Center in Lenox, Massachusetts. Just go to ultrawellnesscenter.com. If you're looking for a functional medicine practitioner near you, you can visit ifm.org and search "find a practitioner" database.

• 1:23:31Dr. Mark Hyman?

  It's important that you have someone in your corner who is trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health. Keeping this podcast free is part of my mission to bring practical ways of improving health to the general public. In keeping with that theme, I'd like to express gratitude to the sponsors that made today's podcast possible. When it comes to supplements, you only want the best for your body, the kind with the highest quality, cleanest, and most potent ingredients you can get. That's exactly what you'll find at my supplement store, where I've hand-selected each and every product to meet the most rigorous standards for safety, purity, and effectiveness. These are the only supplements I recommend to my patients, and they're also what I use myself. Whether you want to optimize longevity or reduce your disease risk, or you're looking

• 1:24:14Dr. Mark Hyman?

  to improve your sleep, blood sugar, metabolism, gut health, you name it, drhyman.com has the world's best selection of top-quality, premium supplements, all backed by science and expertly vetted by me, Dr. Mark Hyman. So check out drhyman.com, because when it comes to your health, nothing less than the very best will do. That's drhyman.com, D-R-H-Y-M-A-N dot com.