Coronavirus well to discuss that im now joined by asking malhotra a Consultant Cardiologist bestselling author and one of the u. K. s leading active b. C. Can painters thats on the whole train so good to talk to you thank you very much for your time likewise ticks on i know that you are now writing your new book about the link between the worst complications from called at 19 and poor Metabolic Health and i heard you mention the u. K. Prime minister Boris Johnson as a manifestation of that what exactly do you mean. Well lets rate important issues your phrase oksana so this is something ive been looking at so many months on life in the recess and they said and its quite clear 1st and foremost that people get seems to suffer the worst complications that might seem almost certainly have some underlying condition and when you look at those conditions such as such diabetes i took the role really in lifestyle and most specifically what we put in some outs that we and well you know how this became a bit more. I should have put it it was a lot of awareness 7. Buchanan internationally of course you know there was a great scare here in britain when our Prime Minister for sensible admits ospital was some some come in 19 in my 1st observation as a doc so we observed things you know we always you know think about things from the very basic level when we when we even treat patients we look at our parents 1st thing we think you know is autistic it was quite terrible because to me with my background knowledge. Boris johnsons weight which we know you know hes had problems with it for a long time hes been open about that in his b. M. I. In the sort of 3536 category so base. What was the link because hes also a mission then you know its to explain it all essential i mean very simple terms access god he thought basically isnt just a respect to so many diseases it appears to be something that a sexy immune system in an adverse way but im sure you would agree with me in that it may be ok for the doctors to observe the a patients body type but its certainly considered it implied if not outright offensive to make any comments on a persons appearance especially. You know how he or she looks and i want you bad you know this social taboo is one of the reasons why it is so difficult to discuss this elephant in the room that access body fat in fact makes these virus so much deadlier and so much more dangerous yeah its a good point osama and i think as doc says we obviously have to be very sensitive in the way that we discuss these particular issues ive treated tens of thousands of patients and managed many people on the street with all the sex and cheating many people with weight issues and not once have i ever had somebody complaining about i phrased it but it has to be done in a sense to way because you know ultimately theres such a huge proportion of the population 7 brits and most of people on our way were basics and the population so i think you need to be approached this sensitive way unfortunately i think you raise a. Rave on point there are certain sections certainly within the media and people who think this is a customer responsibility issue and when they see somebody who is overweight or obese they suddenly automatically come up with the fact they must be greedy every 2nd you must be you know lazy and i think that thats absolutely wrong that we shouldnt be doing that because it isnt really a post response but ceased well i think part of the difficulty separating the psychology of obesity and the physiology of it people are rightfully opposed to fat shaming and other forms of myth mistreatment but they often miss the point that obesity is a serious disease of the adipose tissue and adipose tissue is a vital organ immune organ as well as and the criminal organ so with any other progressing pathological condition he wouldnt be encouraging people to just accept themselves a lot of themselves the way there are and yet when it comes to obesity that seems to be the message. And also you do raise an important point and i agree with you in the sense that we cant ignore it and but its a i said about how we approach these patients so theres no evidence for example that if you actually shame people and you know you come down very strict on them and stop saying you know that you know making them feel bad about. That is unlikely and so you know in my experience you know it is unlikely to really help and it certainly can actually impair and you know be a barrier to good docs of patient relationships and look at when i would try to pray someone did that but when people say that its not a personal responsibility what i hear as a formal happiest person is that you can do nothing about it when in fact i know for a fact that there is a lot of things that people can do you know about it and change that probably mean theyre relatively short amount of time so lets talk about this responsibility i think when we talk about it we need to be able to define and to define 1st responsibility to do it for people to act with press responsibility you need to have the right information you need to have choice you need to have access and it comes to food needs to be affordable if you havent got the right information oxana say for example you know we can talk about later the dietary guidelines say that people are being misled by for example the low fat movement for very long you know people eating foods thinking it was good for the health think it was going to help in this way it was loaded with sugar it was interfering with their appetite or eating more they feel hungry to them playing themselves and actually the blame lies in what they receive in the way that misinformed we cant really say that because of press responsibility in this Food Environment were not so its well the point is its so saturated with ultra process you know the analogy i use is like asking a child that grows up in a sweet shop to not eat sweets we need to you know we need to help people so that they can empower themselves to try and change or die in the right way but i think we should always constantly be aware how one of the. Thats why for example diets and general dont work away all starts for many most people some people of the calorie restriction all that kind of stuff and one of the possible reasons from my perspective is you can do this for so much time this will cower sure you can excise well but if the environment is working against you its harder to sustain and people benefit. The environment is always working against you on any issue i want to give you one example i was just at a coffee shop yesterday and there was this overweight guy who was telling off their clients when not wearing a mask in public but while buying a bunch of act layers and i think this is such a poignant illustration of whats wrong with this whole debate because he felt protected and even selfrighteous by the fact that wearing a mask without even understanding or willing to admit to himself that his own food choices have a much more dangerous impact on his chances of getting and surviving the this virus is just to the point that. I read that information and that you know would environment the war and how cool it environment would have heard but at the end of the day the decision lies ahead there within an individual us on if it comes at some very basic if you look at behavioral science the environment has a much bigger impact so yes of course we make our choices but the environment is much bigger impact on how we behave than this socalled pest responsibility aspect of it and thats very well known well ive been a sight cynical some cretins how think that paired with shows making the difficult choice a healthy choice will have a much bigger impact on the population than socalled individual counseling or education so thats one thing i would say i think the other thing is we have to also be a way out son and this is something that doesnt get discussed enough is it for certain sections society who got job insecurity who are very low paid jobs actually having a healthy diet is is almost unavoidable you know children who are growing up in environments where their parents cant even afford them to get healthy food and they have some to growth or they develop conditions related to obesity so me thats just plain wrong thats a gross injustice so we have to think about that as well in this context the other thing id like to raise with you as well oksana is you know you talk about this issue of a press responsibly. The information that people have been given for a long time lets talk about the dietary guidelines that changed in the late seventys and early eightys and us in the u. K. Was all about putting you know the base of the diet starchy foods and we now know these are the very food that contributes to all these Metabolic Diseases type 2 diabetes etc so people get confused and that thats another big issue the Food Industry have kind of hijacked information and weve you know this whole culture presents low fat junk food has come on the you know common saturate this environment people have gotten sick and that also needs to change but the problem is the the Food Industry have too much control so that even the dicey guidelines are influenced. I want to ask you something about this mask growing controversy that i mentioned because i find it very interesting i think at the heart of it is ultimately a debate about you know how much courage to say how much discipline the way expect from one another in dealing with a major disease and i see obesity and Metabolic Health and they might the same context its ultimately as far as im concerned about how much youre willing to put upon himself or do yourself in order to protect your own health and the health of the people around you because we know im sure you would agree with me that obesity cons at a huge huge huge cost of this aside is it an appropriate comparison. And i agree i think thats a really important point around the fact that you know were all interconnected it was so i mean we know that you know viruses can travel around the world within the space of days to weeks you know us and so in fact saying that so many people from all different backgrounds right so were all interconnected in the same way youre absolutely right you know we also have to think about you know for me for example with with my work my advocacy i always think about how can i always love my how i help me to visualization how do i help the population i think about. Because really its a can exit and actually its you know and ive got a little bit philosophical here but you know for a society to function effectively for people to be you know if you have a good quality of life to have good health to be happy where we are dependent on each other you know week we cant really i dont think you can ask people who people can live in to tunes and there are some people are extremely happy to be addicted to completely isolated from the rest of society not just the stuff doesnt happen so i think the point youre raising and i which i agree with is that we have to pull the good of the community for everybody we have to think about the way we act and whether its about where you masts and falling back guidance or about reducing the of the date of the city but that means its also. All our responsibility to look at the roots and thats what you that means speaking out against my Health Misinformation speaking out against the corruption of science you know one of the things i say in the beginning my talks and thats because misinformation house has become so widespread you know all these docs there was no longer practice on this medicine you know we have an epidemic of misinformed oxes misinformed patients you know rooted in so many issues that i think i think he actually put it in even starker terms he has said that more than medicine is a major threat to public how thats a pretty strong statement but lets discuss it after every short break we have to take a minute here right now but well be back in just a few moments. The world is driven by a dream shaped by one person of those great. Day or thinks. We dare to ask. Join me every thursday on the alex salmond show and ill be speaking to guests of the world of politics or business im show business ill see you then. Welcome back to well the part that i see my whole track down south in cardiologist and bestselling author dr mahathir just before the break we were talking about how one of madison has become a major threat to Public Health and im sure its gone i mean some doctors are some nurses working double shifts in hospitals will take that as a as an offense he actually reconciled both of the statements our clinicians being heroes who are putting their lives on the line but also serving a system that doesnt have the best interest of patients at heart yeah its a its a very its an interesting one to reconcile so the way i would start off 1st looks on is i think what medicine that youve many great savings but most of what we do which is that the really good stuff in modern medicine to see if you care the emergency treatments that treating people with trauma im treating life threatening its. Action with answers audix training heart attacks with emergency hot standing for example something i did for a lot of my career but the big issue in health care now is a management as chronic diseases and the management of chronic disease is a 1st and foremost primary focus our intervention is drugs and when you look at the data on those drugs im im talking about drugs you know Blood Pressure cholesterol pills im talking about drugs for diabetes you know for the overwhelming majority of these patients being treated it doesnt give them any benefit whatsoever and it comes with side effects at the same time were detracting from giving them. Prescribed lifestyle advice so thats where the imbalance is but just to put in perspective for you of us the issue around the pharmaceutical industry influence over guidelines and drug prescribing practices has become such a big issue that one of the cofounders of the very eminent respectable cochrane collaboration pizza goetia his own estimates suggest that the 3rd most screening cause of death after Heart Disease and cancer now is prescribed medications what your prescribe and what your doctor prescribe sphere and he educates about 50 percent of that digs medication errors and about 50 percent jitsu side effects can i ask you something about Metabolic Diseases that i could never understand. We are usually taught that this is something that you have for your entire lifetime and yet we know it now for a fact that thats a type 2 diabetes hypertension inflammation a 2nd out immune disease all of that is reversible and reversible in a relatively short amount of time why even medicine men taining this long term view all through the disease when its taken from a false and when they actually have the tools to and very cheap tools to give to that patients to you know improve their health in a matter of weeks and months at most ill give you one word answer and then ill expand on that money. I interviewed the former. Of one of the most british guys Impact Medical jones a world medicine masi angel and i wrote about this in a guardian article and she said to me the real battle we have in health care oksana is one of truth versus money so you know basically whats happening is the science is there but that isnt enough you know we have to overcome these nested interests that have got a grip over modern medicine the reality is often i can tell you how the overwhelming majority of doctors go into the profession to do the right thing by their patients a want to help their patients get better but they are being said information which they do not realize is heavily by state in corrupted by the industry and until we change the system at its root it will carry on as it is part of the issue around what why were not weve got this ounce wrong is also lack of knowledge about lifestyle stuff so for example i didnt get to know anything about basic nutrition and how it impacts the metabolic disease so we medical school but that was almost 20 years ago and of course the signs of all the diseases have become more prevalent and now were now realizing with you know small studies lets be honest that you can reverse many of these medical disease but if you eat i see it with my patients and i think that is going to gather momentum it has to governments and because what weve doing isnt not just working is causing huge damage to Public Health absolutely and i think the doctors and the nurse of the home you mentioned sometimes the price make timbs of that you wrote recently that i think more than half away and h s s thoth are overweight and these people are now over exerting themselves and missing out on sleep theyre working double shifts theyre probably eating the junk food that has still and that is still being served in british hospitals and im sure in other countries this is jason is not much different its its almost like you know in the system is eating its own here is 1st and foremost. Yeah absolutely so more than 50 percent your right of doctors and nurses in the n. H. S. Are either overweight or obese and that really comes back to the point about the 1st responsibility issue because you would expect them to be the most educated and be aware of it ok of i the not educated probably more important is the socalled hostile couldnt harm in the you know its similar if not worse than the high street 75 percent of food coaches in hospitals is considered ultra processed or health state so its not a surprise looks on unfortunately and that also goes again theres an element of lack of knowledge because people have been so this information its about counting calories its about you know and its a balance its about you know it doesnt matter what you eat as long as you exercise enough and some of these people who are overweight a sadly unfortunately i think blaming themselves thinking its because theyre not doing enough exercise when all they need to do is actually just change the what they eat in fact you know im very much said ive looked at stress i said what about say thoughts of detract from the benefits of the lord even look or who is former Shadow Health minister when market sasha was Prime Minister and you know he actually said something which i wrote in my i quoted in my last book he says and obese custom doesnt need to do one iota of exercise in order to lose weight they just need to eat less and the one of the reason the basic reasons for that is we actually you know just by breathing for our organ functions or the blood pumping or on the body for ourselves to function we use a pose lot of energy doing the oxen that we do you know at least 161700 calories just from doing that doesnt mean we should exercise or do some of the activity of course we should both when it comes to weight its all about what you eat. How much it and what exactly it lets talk more about that because one of the things that all is also difficult to grasp is why nutrition has been such an orphan child of medicine because i mean weve known since hippocrates that we are what we eat and yet do these they people are pretending that that calories are calories theyre all. The same is that you can indeed alderaan the poor diet do you also put that on to bastid interest or is it some sort of i dont know sometimes i think that its magic thinking that people want to maintain that i can eat whatever i want to damn you know tomorrow either medicine or my sports instructor will help me shut it off. Yeah i think its probably a number of factors i think one of it is we have you know over the last few decades i think we as a society have exaggerated in our own minds our perception of what many modern medicine can do has been grossly exaggerates it and i think that has detracted from the very basic simple things that weve lost and the way we live were looking for a quick Fix Solutions we have this system that we live in this modern capitalist system if you like where you know its all about you know producing some sort of product and that Mass Marketing and then you know selling it and of course you thats also infiltrates of modern medicine as well and thats really one of the reasons why does this destruction has happened to be honest so i think we need to kind of just get back to realizing that modern medicine has achieved some great things but actually when it comes to what has increased our Life Expectancy what im saying also in the last 4 or 5 you know the last sort of 150 is most of it has been Public Health you know modern medicine can be attributes its adding maybe 3 and off to 5 year Life Expectancy over an increase of 40 years in the last century in heart and thats again something that people probably find quite surprising quite shocking you know i personally tend to be very harsh overweight people and thats because i hated my own the visit and how much of a cripple me but one of the interesting point that i heard your race is that looking at the external fat is actually very misleading and that people with. Suck it tanny as fat deposits that as big butts and why hips may actually be in a much better mid to ball like position than people with a normal b. M. I. But with lots of this or all fat around their organ say its not about the appearance actually its how they those fat deposits actually function so absolutely spot on you know the statistics basically tell as you know there are some ethnic disparities but if youre normal be m. R. I. About 40 percent of people who. Come for example from south asian origin and this is not a small number of people in the world this is a you know you look at the indian subcontinent the oh talking about was 2000000000 people around the world. Who are vulnerable to this so this is you know 40 percent of south asians and about 20 percent cocoa asians as well so essentially were all vulnerable and thats why i also say theres no such thing as a healthy way only a healthy person based on the metabolic counts and the reasons for that are not fully understood but basically for those certain people with for genetic reasons they seem to develop these problems these conditions of disease is a much to lower levels of excess body and that does tend to store itself youre right its called we call it visceral fat its since the store itself in the liver the pancreas and thats where the problem lies in many people on unfortunately just vic just because were focusing on on b. M. I. Who are normal b. M. I. Will have the illusion of protection when in fact they actually could be very much publicly unhealthy in very high risk and therefore not identified and not treated properly as well they ask how moment that they saw me add came when i understood that adipose tissue is it is a real organ and that it starts functioning differently once you reach a 2nd on how fee a level of access that and in fact i think most of us have learned then you werent during the spend demi cytokines so if yes size producing less and made my choice more cytokines damaging cytokines and as a result of that we are essentially poisoning our bodies every single day and then they covet 1000 cons and it makes it all that all the worries but am i right in thinking that at the root of all of that is one substance and that is sugar yeah absolutely so we know from data thats been coming in about people types of diabetes are. Much higher risk of death so if youre a type 2 diabetic treatment is hospital you have a spiritual high risk of death of your type 14 fold higher. Probably a combination now where youve got exogenous insulin being being injected insulin itself is actually proton a treat so you know and then you go i look absolutely sugar so high the glucose the high the risk of death we know that from all infections that thats a diabetes sense in most of the comments section certainly and we say it was code it was actually raised the question is well its on about the types of foods or eating some of these people are eating and we can you know highlight you know this is something that caused a bit of control so twitter with that is you know one Hospital Trust in london was you know promoting if you like or a congratulate same krispy kreme donuts for giving you know 1500 donuts to stash ill spittle and for me who understands estates a very well you know people will say one dont concho you but actually if you eat one donut then even if youre healthy mentally healthy it will save you cause you know you know so theyre not ready you should stop labeling their foods proinflammatory should call them corrupt calvi and because thats what i actually they they do because i mean from the studies that i have looked at its pretty clear that you know a few days on side diet and your risk of. Contracting disease and dealing poorly with if increases substantially but on the good side and this is that the last question to you you made the point that once you make those die there it changes you can turn your buy around and then pretty sure the amount of time and i absolutely have side effects where you starting off from absolutely already medical of being healthy if youre overweight or obese and its not Rocket Science its about cutting out the us across this foods its about eating high quality called hydrates its about eating 2 to 3 meals a day not snacking you know i see patients to you know send type 2 diabetes into remission within just a few weeks of changing their diet and people feel better they just feel better themselves im sure you know we dont know. You know i still sort of im sure you probably feel much better in yourself that you used to do absolutely and that i feel much better not only about myself but also about my children because i dont want to have you know my my children to take care of me when i lose my memory view to sugar and use dementia for example or i dont want the society of you know 2030 years from now to be responsible for my poor poor Health Choices so i think thats thats a very interesting combination of both personal and social responsibility but when we talk about. Those issues i think people need to keep in mind that its not only about Wearing Masks its absolutely about what you put in the mouth behind that mask absolutely and why one of the things i wrote about a lot of coal you know for european scientists and that sort of telegraph newspaper was actually the message in the u. K. Going forward should be the Public Health message except he repeats it you know each real sued. You know protect the n. H. S. And save lifes and that that needs to Everybody Needs to know that but the problem is we need to now educate people about it what well see it is because a lot of people dont even know what real speed is anymore while theyll tell us the track home this interview contributes a tiny little bit to informing the people anyway we have to leave it there thank you very much for sharing your insights and im looking forward to your new book my pleasure thank you example and thank you for watching i hope to see you again next week on well the part. We go to work. Straight home