At the Metabolic Health Summit in 2019, Dr. Malhotra’s presentation entitled: “Rapidly Reducing Cardiovascular Risk from Lifestyle Changes” highlighted the dire need for evidence based medicine and for the reconsideration of LDL’s role in cardiovascular disease. In addition, he discussed how insulin resistance and chronic inflammation are more likely at the root of our issues, and how these can be reduced through diet and lifestyle interventions.

For decades the belief has been that high LDL cholesterol is the major driver of cardiovascular disease, and that saturated fat is the major dietary culprit. This narrative was built on faulty and misleading science that influenced our dietary guidelines as far back at the 1970s, further exploited by the food industry. Steadily over the ensuing decades, the “low fat” mantra seeped into our basic understanding of a “healthy” diet, the repercussion of which has been an increase in refined carbohydrate consumption coinciding with the increased prevalence of obesity, type-2 diabetes, and paradoxically, cardiovascular disease.  

Only within recent years has the perception of saturated fat on heart disease been challenged by experts like Dr. Malhotra. The re-evaluation and re-analysis of the data used to demonize LDL cholesterol as well as saturated fat has revealed that removing saturated fat from the diet to reduce cardiovascular disease risk may very well have done the opposite. By replacing fat in the diet with refined carbohydrates and ultra-processed foods, global health has been declining, and instead of introducing lifestyle factors known to reduce the risk of heart disease, various drugs, including statins, are recommended in their place.

Dr. Malhotra presents the data to show that statins do not reduce cardiovascular disease mortality, and that this transparency is lacking when prescribed to patients. Worse yet, statins are often prescribed with the illusion that as long as you are taking them you are protected from the ill-effects of a poor diet. Dr. Malhotra suggests that rather than focusing on an isolated macronutrient, that we must focus on whole foods while avoiding ultra-processed foods. The evidence is clear that diet and exercise are far superior to taking drugs to reduce the risk of heart disease. A quote from Professor Rita Redberg that really drives home his message: “Focusing on cholesterol lowering has been counterproductive. Who cares about cholesterol lowering if it doesn’t translate into a benefit for patients?”

Dr. Malhotra is an honorary Consultant Cardiologist at Lister Hospital in Stevenage, UK and visiting Professor of Evidence Based Medicine, Bahiana School of Medicine and Public Health, in Salvador, Brazil. He is a founding member of Action on Sugar and has led work highlighting the harm caused by excess sugar consumption in the diet, particularly its role in type 2 diabetes and obesity. He has also been prominent in challenging mainstream advice on the role of saturated fat and cholesterol in the development of cardiovascular disease.

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NAFLD correlates strongly with the increased rates of insulin resistance, type-2 diabetes, obesity, and metabolic syndrome, which are all considered risk factors for NAFLD.

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