Since 1977, health experts have been promoting the idea that saturated fat increases the risk of heart disease by raising levels of LDL (low-density lipoprotein) cholesterol. According to conventional wisdom, saturated fat intake can also raise the risk of Alzheimer’s disease, cancer, and diabetes, while a combination of fatty foods and lack of exercise is largely to blame for the global obesity epidemic.
Dr. Aseem Malhotra, a cardiologist at Frimley Health NHS Foundation Trust and consultant clinical associate to the Academy of Medical Royal Colleges, rejects the claim that saturated fat plays a significant role in heart disease. He contends that misinformation about cholesterol has not only led doctors to overmedicate patients on a mass scale, but has also encouraged the populace to adopt a high-sugar diet, which he feels is one of the root causes of the current spike in obesity and type 2 diabetes.
As a founding member of the lobbying group Action on Sugar and an advisor to the National Obesity Forum, Dr. Malhotra is pushing for a reduction in the amount of added sugar in processed foods. “The average U.K. citizen is now consuming at least two to three times what is now being recommended by the World Health Organization as the maximum — not that you should have it, but a limit of around six teaspoons of sugar per day for an average adult,” he notes.
Speaking by phone from the United Kingdom, the friendly, high-energy cardiologist shared some insights with Reset.
Reset: What evidence have you found that sugar plays a major role in disease and obesity?
Aseem Malhotra: One of the studies that looks at population sugar consumption worldwide was published in PLOS ONE in early 2013. Looking at sugar availability for consumption for 175 countries, they found that for every excess 150 calories of availability of sugar above one’s normal quota of calories per day for the average person, there was an elevenfold increase in the prevalence of type 2 diabetes, independent of body mass index and independent of physical activity, compared to calories from another source — compared to fat calories or protein, for example. And one thing that’s irrefutable is that there is no biological requirement for added sugar whatsoever, and we know that sugar directly corrodes tooth enamel more than anything else. Now, that’s an issue, because in the U.K., the commonest cause of hospital admissions in children is tooth decay, and the commonest cause of chronic pain in children is also tooth decay. And any small amount of sugar consumption will incrementally increase the risk of tooth decay. Then you go into the metabolic effects and adverse effects on insulin resistance, and there are lots of studies implicating the fructose component of sugar, specifically.
Reset: Tell me about the goals of Action on Sugar.
AM: I think the main goals are ultimately to get the population’s sugar consumption down through a number of [means]. One of them is to get the food industry to reduce the amount of sugar they’re adding to processed foods by about 40 percent over four years. According to the Department of Health over here [in the U.K.], that would be enough to at least halt, if not reverse, obesity. On top of that, we are advocating for a 20 percent tax on sugary drinks, which would reduce the amount of people in the U.K. becoming obese by about 180,000. But this is if you just look at calories. Now, I would argue that the sugar issue is way beyond calories. There’s good evidence that suggests that adverse impact on health is independent of calories and independent even of physical activity, and therefore we are all vulnerable. To add to that, we know that about 40 percent of people with a normal body mass index will harbor metabolic abnormalities that people with obesity have, such as type 2 diabetes, high blood pressure, fatty liver disease, and insulin resistance. So basically, we need to focus more on insulin resistance rather than looking at body mass index per se. You’ll hit a much larger portion of the population in terms of improving people’s health.
Reset: What similarities do you see between the ways that the sugar and tobacco industries have promoted their products?
AM: I think we can say that the tactics adopted by the tobacco industry for the 50 years between the [publication of the] first links between smoking and lung cancer rate in the BMJ [British Medical Journal] and [the implementation of] any effective regulation — the “corporate playbook,” as I call it — are very similar. That’s one of denialism, one of planting doubt, one of confusing the public, and also buying the loyalty of scientists. We see the same thing happening with sugar. The difference, I would say, is that in some ways, the effects of sugar on population health are actually far worse, because to some degree, tobacco is avoidable. Sugar being added to more than 80 percent of processed foods has become unavoidable, and the tobacco industry didn’t target children in the same way the sugar industry has. And when you look at the last Global Burden of Disease reports, poor diets globally contribute to more disease and death than smoking, physical inactivity, and alcohol combined.
Reset: Why should people avoid low-fat and reduced-cholesterol foods?
AM: A lot of foods that are marketed as low-fat replace the fat with sugar — low-fat yogurt, for example. What I would say is: concentrate on good nutrition rather than buying foods marketed as healthy, because if you need to market something as healthy, there’s usually a process where something else is added. There’s certainly no evidence of benefit, and often [there’s evidence of] harm. There isn’t a big market around oily fish or whole food and vegetables. That’s because they are generally healthy; you don’t need to market them. When you look at the data as well, foods that have higher fat and are lower in refined carbs and sugar certainly seem to be more beneficial for cardiovascular health in preventing heart attack and stroke, prolonging life, and delaying death. And even when it comes to obesity, if you follow a low-refined-carbohydrate diet and have more fats from foods like oily fish, olive oil, nuts, and even including full-fat dairy such as cheese and yogurt, you’re going to be in better metabolic health. Specifically focusing on the dairy for a second, very good, extensive research published by Cambridge Medical Research Council looking at consumption of dairy foods has found that full-fat dairy consumption — in particular, cheese and yogurt, and the saturated fats that come from those — are associated strongly with reducing the risk of developing type 2 diabetes and heart disease.
Reset: You’ve said that exercise isn’t especially conducive to weight loss. Can you explain?
AM: I would say it’s a myth. Exercise has many benefits for health — I myself am pretty obsessive about exercising in a certain way — but when it comes to obesity, the impact is minimal at best. I think some people’s perception is that you can eat what you like as long as you exercise; I would say you can’t outrun a bad diet. 75 percent of all the calories we burn happen from doing nothing. Cell division, your heart beating, organs functioning — this is where most of the calorie burning happens. So you want to be putting the right fuel into your body, and you don’t want to be getting it from nutritionally poor foods or foods high in sugar. And of course, if you do lots of exercise, you are going to burn calories, but overall, when it comes to obesity, when you look at the average exercise level in the American population in the last 30 years, if anything, it has slightly increased, if not stayed the same. Yet obesity has rocketed, which basically points the finger purely at the types of foods we’re eating, not exercise.
Reset: Any final comments?
AM: I think people should be a little bit skeptical about where their dietary advice comes from, and I think unfortunately, there are many organizations that have unwittingly been influenced by industry, whether it’s dietary organizations or scientific bodies that give dietary advice. I don’t think they’re deliberately giving the wrong advice, but I think that has biased their view. We’re now dealing with the consequences of this. I think the science is evolving, and people are realizing that this has been unhelpful and damaging, and what we need is completely independent scientific advice on moving forward so that we can rapidly reduce the impact of type 2 diabetes and obesity. We need to act quickly, because it’s wrecking our health care system and bringing it towards bankruptcy. The future of health is not going to come out of a bottle; it’s not going to come out of pharma; it’s going to come from healthier lifestyles, which are going to have a much bigger impact on your health than any pill you can take.