THIS Is Worse For Your HEART Than FAT… | Dr Aseem Malhotra

Summary

In this video, the speaker emphasizes the importance of lifestyle changes, particularly diet, in preventing heart disease. They discuss the role of insulin resistance as a key driver of heart disease and highlight the excessive sugar consumption in the average American diet. The speaker advocates for a shift towards whole foods and away from ultra-processed foods, which are often high in added sugars. They also touch on the potential societal impact of measures like sugar taxes, drawing parallels with the successful reduction in smoking rates.

Takeaways

• 💊 The speaker discusses the limited life extension benefits of taking statins for heart attack survivors, suggesting only a 4.2-day increase over five years based on industry-sponsored trials.
• ⏳ The potential benefits of statins are questioned when extrapolated over longer periods, with the speaker implying that lifestyle changes could offer more significant health improvements.
• 🍽️ The conversation emphasizes the importance of lifestyle and dietary changes, particularly focusing on reducing sugar intake, to prevent heart disease and improve overall health.
• 📉 The speaker points out that 80% of heart disease is linked to environmental and lifestyle factors, suggesting that changes in these areas could have a substantial impact on heart health.
• 📈 Insulin resistance is identified as a key driver of heart disease development, with poor diet being a significant contributor to this condition.
• 🚫 The script highlights that there is no nutritional requirement for added or table sugar, and its consumption should be minimized for health reasons.
• 🌍 The World Health Organization recommends a maximum daily limit of six teaspoons of added sugar for adults, a limit easily exceeded by common sugary drinks and snacks.
• 🍬 The average American consumes at least 20 teaspoons of sugar daily, significantly exceeding health recommendations and increasing the risk of heart disease and other health issues.
• 🛒 The food industry's role in promoting sugar consumption through the addition of sugar to a wide range of products is criticized, with the speaker advocating for awareness and changes in consumption habits.
• 🏥 The script calls for societal changes, including the taxation of sugary drinks and the reduction of ultra-processed foods, to combat the prevalence of heart disease and other sugar-related health issues.

Q & A

What is the expected life extension from taking a statin drug over a 5-year period according to the industry-sponsored trials?

The expected life extension from taking a statin drug over a 5-year period, as per industry-sponsored trials, is approximately 4.2 days.

What is insulin resistance and why is it significant in the context of heart disease?

Insulin resistance is a condition where the body's cells become less responsive to the hormone insulin, leading to high levels of insulin in the blood. It is significant in the context of heart disease because it is a major driver of the development of plaques and blockages in the arteries.

What percentage of heart disease is linked to environmental and lifestyle factors?

Approximately 80% of heart disease is linked to environmental and lifestyle factors.

What is the maximum daily limit of added sugar recommended by the World Health Organization for an average adult?

The World Health Organization recommends a maximum daily limit of six teaspoons of added sugar for an average adult.

How much sugar does the average American consume daily, and how does it compare to the recommended limit?

The average American consumes at least 20 teaspoons of added sugar daily, which is significantly higher than the recommended limit of six teaspoons.

What is the impact of consuming sugary drinks on the daily sugar intake limit?

Consuming one can of a typical sugary drink can contain up to nine teaspoons of sugar, which exceeds the recommended daily maximum limit of six teaspoons.

Why is it important to consider whole fruits differently from fruit juices when discussing sugar intake?

Whole fruits contain fiber that helps slow down the absorption of sugar, whereas fruit juices often have high sugar content without the fiber, leading to rapid increases in blood sugar levels and insulin spikes.

What is the role of ultra-processed foods in the context of sugar consumption and heart disease?

Ultra-processed foods, which often contain added sugars, are a major contributor to excessive sugar consumption and are associated with an increased risk of heart disease and other health conditions.

What is metabolic syndrome, and how is it related to heart disease?

Metabolic syndrome is a condition characterized by a group of risk factors that increase the risk of heart disease and other health problems. It is diagnosed when three or more of the following parameters are abnormal: waist circumference, blood triglycerides, HDL cholesterol, blood pressure, and blood sugar levels.

How can dietary changes potentially reduce the global death rates from heart disease?

Estimates suggest that by eliminating ultra-processed foods and encouraging the consumption of nuts, seeds, oily fish, whole fruits, and vegetables, the death rates from heart disease could be halved within one year globally.

What is the significance of the five components of metabolic health in relation to heart disease risk?

The five components of metabolic health—waist circumference, blood triglycerides, HDL cholesterol, blood pressure, and blood sugar levels—are significant as they help identify individuals at risk for heart disease and metabolic syndrome.

Outlines

00:00

💊 The Impact of Statins and Insulin Resistance on Heart Health

The speaker discusses the expectations versus reality of statin drugs for heart attack survivors. They express a personal hope for a year of life extension from taking statins over five years, but the actual industry-sponsored trial data shows an average increase of only 4.2 days over the same period. The conversation shifts to the importance of lifestyle changes in preventing heart disease, focusing on insulin resistance as a key factor. The speaker explains that insulin, a hormone released by the pancreas, is crucial for maintaining optimal blood glucose levels for cellular function. However, chronic high insulin levels or cellular resistance to insulin can lead to the development of arterial blockages, a major cause of heart disease. The speaker emphasizes the role of diet, particularly the consumption of added sugars, in contributing to insulin resistance.

05:02

🍬 The Overconsumption of Sugar and Its Health Ramifications

The speaker highlights the excessive sugar consumption in the average American diet, which far exceeds the World Health Organization's recommended daily limit of six teaspoons. They use a visual aid to demonstrate the amount of sugar in common sugary drinks and snacks, which can contain up to nine teaspoons of sugar per serving. The discussion points out that sugary foods and drinks can cause rapid spikes in insulin levels, leading to increased hunger and a higher risk of chronic diseases like heart disease and type 2 diabetes. The speaker advocates for societal changes, such as taxes on sugary drinks, to mirror successful strategies used in reducing tobacco consumption. They also stress the need to avoid ultra-processed foods, which are often high in added sugars and can contribute to metabolic syndrome and heart disease.

10:04

🏥 Addressing the Prevalence of Metabolic Syndrome and Heart Disease

The speaker delves into the prevalence of metabolic syndrome and its association with heart disease. They discuss the five components of metabolic health, including waist circumference, blood triglycerides, HDL cholesterol levels, blood sugar levels, and blood pressure, which can indicate an individual's risk for heart disease. The speaker notes that a significant portion of the population has abnormal readings in at least three of these parameters, classifying them with metabolic syndrome. They emphasize the importance of dietary changes, such as reducing ultra-processed foods and increasing the intake of whole foods like nuts, seeds, and oily fish, to improve metabolic health and reduce the risk of heart disease. The speaker concludes by suggesting that such dietary shifts could significantly reduce global heart disease mortality rates and improve overall longevity and quality of life.

Keywords

💡Heart Attack

A heart attack, also known as a myocardial infarction, occurs when blood flow to the heart muscle is blocked, usually by a blood clot. In the script, the discussion begins with the scenario of surviving a heart attack and the subsequent medical advice to take medication, illustrating the serious health implications and the importance of managing risk factors.

💡Statins

Statins are a class of drugs used to lower cholesterol levels in the blood, which can help prevent cardiovascular diseases. The script mentions statins as a medication prescribed after a heart attack, highlighting their role in managing cholesterol and the debate around their effectiveness and side effects.

💡Life Extension

Life extension refers to the increase in the maximum or average lifespan of an organism, particularly humans. The script discusses the expected life extension from taking statins, with a focus on the actual data from trials, which is a critical aspect of evaluating treatment efficacy.

💡Insulin Resistance

Insulin resistance is a condition in which the body's cells do not respond properly to the hormone insulin, leading to high blood sugar levels. The script identifies insulin resistance as a key biological phenomenon linked to heart disease, emphasizing the importance of understanding and managing this condition to prevent heart disease.

💡Lifestyle Changes

Lifestyle changes refer to modifications in daily habits and behaviors that can improve health and well-being. The script suggests that lifestyle changes are crucial in managing heart disease risk, positioning them as an alternative to medication with the potential for better quality of life and fewer side effects.

💡Sugar

Sugar, particularly added sugar, is highlighted in the script as a significant contributor to insulin resistance and heart disease. The discussion includes the World Health Organization's guidelines on sugar consumption and the contrast between recommended limits and actual consumption.

💡Ultra-Processed Foods

Ultra-processed foods are industrial formulations made mostly or entirely from substances derived from foods and additives, often high in sugar, fat, and salt. The script argues that these foods are a major contributor to health issues, including heart disease, and advocates for their reduction in the diet.

💡Metabolic Syndrome

Metabolic syndrome is a cluster of conditions that increase the risk of heart disease, stroke, and diabetes. The script uses metabolic syndrome as an indicator of heart disease risk, noting that many patients with heart attacks have this condition and that it is linked to poor diet and lifestyle.

💡Taxation

Taxation, as discussed in the script, refers to the strategy of levying a tax on sugary drinks or tobacco products to reduce consumption and raise awareness of health risks. The script draws a parallel between the historical impact of tobacco taxation and the potential benefits of similar measures for sugar.

💡Dietary Sugar

Dietary sugar refers to the sugar consumed through food and beverages. The script emphasizes that there is no nutritional requirement for added sugar, and it can contribute to health issues when consumed in excess, as is common in many diets.

💡Prevalence

Prevalence in this context refers to the proportion of a population that has a particular condition or characteristic at a given time. The script discusses the prevalence of heart disease and related conditions like pre-diabetes, highlighting the widespread nature of these health issues.

Highlights

The discussion centers on the impact of statins on life expectancy, suggesting a potential 25% increase in life over a 5-year period.

The actual industry-sponsored trial data indicates a life extension of just 4.2 days over five years from taking statins.

Extrapolation of benefits suggests an increase in life extension to 8 days over 10 years and 16 days over 20 years.

The importance of considering lifestyle changes to prevent heart disease without side effects is emphasized.

Insulin resistance is identified as the core biological phenomenon leading to heart disease.

Diet, particularly the consumption of sugar, is a significant factor in the development of insulin resistance.

There is no nutritional requirement for added sugar; the body can produce glucose from fat and protein.

The World Health Organization recommends a maximum of six teaspoons of sugar per day for adults.

Many everyday foods, including those marketed as healthy, contain high levels of added sugar.

The average American consumes at least 20 teaspoons of sugar daily,远超 WHO recommendations.

Ultra-processed foods, often high in added sugars, are linked to multiple health conditions.

A shift towards healthier eating habits could halve global heart disease mortality rates within one year.

Metabolic health, including factors like waist circumference and blood pressure, is crucial in assessing heart disease risk.

Only one in eight American adults have all metabolic health parameters within the normal range.

The potential societal impact of reducing sugar and ultra-processed food consumption is significant for heart health.

Taxation and awareness campaigns, similar to those for tobacco, could be effective in reducing sugar consumption.

Transcripts

okay let's just throw this question to

you say you've had a heart attack you

survived a heart attack doctor says take

this drug and and over a 5-year period

how much extra life ex life extension

would you hope or hope it would add over

that 5 years you can you know you can do

it over whether 20 years but just say

five years to start with how much longer

would you hope to live from taking that

stat in okay so over five years then I'd

say um maybe a year okay 25% more okay

fine that sounds that sounds Prett good

20% more yeah okay um the actual figure

not disputed from industry sponsor

trials right 4.2 days just over four

days is that because they haven't done

it over a long enough period of time no

I mean I know if you then extrapolate it

out if you presume the benefits are

going to keep going on you could then

argue well over 10 years it'll be eight

days and over 20 years it'll be 16 days

or whatever right so so that's the

information so this the reason I'm I'm

I'm I'm telling you this Steve is that

this information is important I'm not

just a doctor I'm a potential patient I

ask myself what would I want to know

right I'm here to try and improve my

quality of life and my health what is

important to me what is important to

patients this information is important

especially Steve because it's not that

I'm saying don't take statins a lot of

people would say okay I'll take the drug

right and if they don't get side effects

why not you know it might be a bit of a

lottery but why not take the drug and

the people say that to me and that's

fine and if they get side effects but

the thing that's missing Steve is and

this is where we come on to the question

you asked me about how to prevent heart

disease

is there an

alternative that doesn't give me side

effects improves my quality of life and

likely is going to help prevent stop me

getting heart disease so what is that

lifestyle changes absolutely so 80% of

heart disease is linked to environment

and lifestyle okay so what is the the

core most important biological

phenomenon in the body that leads to

heart disease which is not disputed but

doesn't get it doesn't get much of a um

there's no market for the message

because there is no you can't commodify

this this is an interesting thing right

so but it's it's really important

information it's called insulin

resistance insulin is a very important

hormone in the body released by the

pancreas helps maintain blood glucose

within certain ranges so our cells can

function optimally all right over time

if your insulin is chronically rais too

high or if your cells become resistant

to them for whatever reason that is the

most important driver of the development

of these so-called plars these furring

these blockages in the

arteries so what causes inser resistance

and how can you combat it or how you

know how can you prevent and and

potentially you know stabilize and even

reverse we'll get on reversal as well

because that's a fascinating

area most important

components diet okay I would say in big

figure

terms now probably 50% of heart dis

disease around the world can be linked

to poor

diet okay so let's start with diet then

I've actually got a bag of sugar that

I've brought with me because um when I

think about insulin glucose bad diet the

first thing my my brain thinks about is

sugar so I've got this bag of sugar here

that I brought with me um and I've got

two look at us we've we've written sugar

on it and covered up the brand because

they didn't pay us but if there is a

sugar brown that would like to do a

brand deal please get in touch we're big

fans if we need to be um what I actually

would like you to to show me is how much

sugar do I need to function and to be

healthy okay the amount of sugar that

you need to function and be healthy is

zero there is no nutritional requirement

whatsoever of of of this what we call

added sugar or table sugar none at all

so I don't need any you don't need any

and the reason for that is very briefly

our bodies need glucose to survive but

you don't need any dietary source of

glucose to survive right because your

people go on what we call ketogenic

diets and they literally eliminate all

starch as well which also contains

glucose um from their diet your body

will make it itself from fat and protein

so in terms of diets there is no value

from sugar whatsoever it can give you

energy of course yes but you can get

energy from other things but there's no

nutritional value whatsoever zero so

from a from a health perspective there

is zero requirement for dietary sugar so

when we say say that Americans are

consuming a lot of sugar every day are

we talking about added sugar yeah we're

talking about so the way that so the

World Health Organization

now um after I was involved in this

campaign you know and there was a lot of

attention on it they revised their

guidelines so they recommend a maximum

limit for the average adult of actually

six teaspoons of either um so maximum

limit okay which you don't need it but

maximum Li limit because after that

that's when the health consequences

start to accumulate one

two

three

four

five six okay so that's the maximum

daily limit maximum daily limit okay but

just to give you an example that's not

let's so one sugary drink we don't name

any Brands right you would have to would

often a 330 mil let's say the most

famous sugary drink uh in the world I

have no idea who you're talking about

would have nine teaspoons on nine spoons

in one of those right and that's just in

the 330 Mill imagine going to the

cinemon and having half a liter or

whatever else right Jesus so one can of

beep um has nine teaspoons of sugar in

yes which is yeah which is so four yeah

absolutely so four grams is one teaspoon

okay which is well above the daily

recommend daily maximum one chocolate

bar yeah like a standard siiz chocolate

bar what we grew up with about the same

leave leave chocolate out of it right

right well listen you have dark

chocolate I love chocolate right you

know um for children the US Department

of Agriculture for the average four to

8y old child think about kids as well

they're the most vulnerable to a lot of

this Pro these problems of sugar they

recommend a maximum limit of three

teaspoons yeah now the average person in

this country in America is consuming at

least 20 teaspoons now when we talk

about sugar we're talking about World

Health they they the word they use is

free sugar so means this sort of sugar

added right to Foods um but it also

includes fruit

juice honey and

syrups same effect on your body the the

I fruit whole fruit is fine but if you

think about it um a glass of orange

juice for example would usually have the

uh the juice of six

oranges okay you couldn't eat six

oranges that easily you'd have one

orange for example and there's fiber and

the fiber does it has a counteracting

effect on terms of the way that the um

the glucose and fructose is affected

absorbed in your body a lot of it to do

with the rapid increase in the

bloodstream of blood glucose and and

that causes huge spikes in insulin and

the problem with that over time of

course is you get chronically raiseed

insulin and heart disease but also

interestingly the more rapidly you have

a food that causes a glucose Spike the

more quickly you're going to get a crash

because insulin goes up quite quickly

and it causes it to come down and it

drives hunger yeah so that's another

problem so the the food industry I think

knew for a long time that's why you know

in America and it may be similar here

70% of foods purchased in supermarket in

America will have added sugar because

they knew that it increases the

palatability and the consumption of

course they're there to sell food not

look after your health so you said 20

teaspoons is the average for an American

at least 20 is probably much higher I'm

going to have I'm going to have to ask

you to show us that yeah just so I can

see what that looks like in a glass it's

disgusting that's disgusting when you

see it like that and you don't you don't

realize that you're having that much

sugar in a day but I mean technically

that's what two cans of fizy drink yeah

yeah but the thing is a lot of the sugar

that's been consumed are in foods that

people wouldn't think have sugar in them

they're not the usual junk food your

cakes and biscuits and whatever else you

know um they're in things even marketed

as being healthy lowfat foods Etc low

fat yogurts so could you just summarize

what we have here then these two glasses

yeah so this is the maximum daily

recommended limit by the World Health

Organization of sugar consumption after

which you then start to in see increases

risks of disease um and this is what at

least I think what most people are

consuming at the

moment are you hopeful that there's

something we can do about this at a

society level well I think one important

step was the fact that we in you know

this levy on sugary drinks definitely

would have some um impact partly based

upon what we learned from Big tobacco

you know Steve you know 50% of it's

interesting crazy when you think about

it now in

1970 50% of adults in the UK were

smokers right we've got that down to

about 17% now but massive reduction

right and it happened education was

important but the real the real

intervention that had more um impact

than anything else was actually taxation

of cigarettes and it had twofold effect

of course you make it a little bit more

expensive you know you know this with

your business background right it's

going to reduce the the consumption but

it was a way of also increasing

awareness that this is harmful so I

think the the sugar stuff is ongoing and

I think a lot of people have Awareness

on it I think now which is linked to

sugar and I've written about this we

need to treat ultr processed food which

a lot of the ult pro food has added

sugar as the new

tobacco right this is more than 50% of

the calories in the UK and more than 60%

of the calories in the US is of people's

daily consumption is coming from ultr

processed foods essentially described as

if it comes out of a packet industrially

produced and you can read more than five

ingredients usually with additives and

preservatives it's Ultra processed and

best avoided and all of the research

that's been done only points in One

Direction and I think there are at least

32 different conditions or diseases now

that are associated with the consumption

of ultrapress food that is the major

issue so because this is a predominantly

an environmental problem right our our

our food our food environment is

saturated with this stuff even Hospital

Steve I mean I the first campaign I got

involved with is trying to get this

stuff out of hospital I was like hold on

we're treating patients with obesity

related conditions yet we're serving

them junk food in hospitals the staff

50% of any staff are overweight or abuse

what's the probability that if I'm

because I want to talk about Ultra

processed foods as well as the sh what's

the probability that if I'm having that

much sugar a day the big glass that I'm

going to end up in

your practice with some kind of heart

disease I I wouldn't be able to give you

a figure but you're definitely

significantly increasing your risk well

if that's the average American then

what's the average American's chance of

ending up in I guess causation needs to

be established yeah of course and it

depends what else they're having as well

but but it's definitely putting them at

significant increased risk of type two

diabetes I think the figure Now in

America if I'm not wrong is that a third

to a half of adult Americans now are um

pre-diabetic um the the broad so to

answer your question in in a better way

cuz we're already there

unfortunately um the way

to understand insul resistance on a

personal level in terms of measurements

body measurements there something called

metabolic health and there are five

components which are very easy to

measure of metabolic Health okay um it's

your waist circumference right it's your

blood triglycerides which is a form of

the cholesterol being above 1.7 milles

okay

um it's your HDL cholesterol the good

cholesterol being less than 1

Millo it's being pre-diabetic okay

having a hba1c of more than

5.7% um or being prehypertensive so your

blood pressure is above 120 over 80

average if you have um three of those

that are abnormal you have something

called metabolic syndrome but you the

highest risk of heart disease and at

least 50% if not more patients admitted

with heart attacks will have metabolic

syndrome but all those five parameters

being in the normal range in America

only one in eight adults have all of

those in the normal range and only one

in four people age between 20 and

40 think about that for a second so

seven out of eight adult will have

abnormal metabolic Health if we within a

year if we just shifted a little bit

people's eating habits and let's say we

eliminated Ultra processed food we got

people to eat more nuts and seeds oily

fish you know whole fruit and

vegetables it's been estimated that you

would half the death rates from heart

disease within globally within one year

from 20 million to 10 million you'd be

out of

business there a heart

doctor um no there's still be a lot of

people to treat we got to help the other

10 million as well right but but I think

the other thing as well is um what it

does Steve though is it shifts the age

so instead instead of someone having

saying a dying prematurely having a

heart attack at the age of say 65 you

know they'll live to 85 so all we'll be

doing as doctors will be managing old

people but that's fine you know we've

improved longevity we improved quality

of life as well if you love the dver CEO

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