A book to correct erroneous notions about heart health without being dramatic or evangelical

In late 2013, young UK cardiologist Aseem Malhotra created a flutter in the medical community and the media by publishing an article in the British Medical Journal.

The article argued that the fear of saturated fat and cholesterol as bad for heart was unsubstantiated and had, paradoxically, made the population more susceptible to heart disease (as sugars soon replaced saturated fat, demonised for raising cholesterol, in food products).

The obsession with lowering total cholesterol in people, he lamented, had led to overmedication of millions with statins, a class of cholesterol-lowering drugs with common side effects and exaggerated benefits. Statin risks stated by Malhotra and another paper in the journal were contested and the debate on the drug raged for months.

Controversy has been a familiar affair for Malhotra, a vocal campaigner against added sugar, low-fat advice, overmedication and the pharma industry’s influence on drug regulation and health guidelines.

For over a decade he has been disputing the science and evidence behind the cholesterol-focused approach to preventing and treating heart disease in medical journals and the media. While academic debates are good for science and policy, they are of little use for the patient in need of practical advice.

Malhotra has now condensed his unconventional views into a practical guide for heart patients or anyone anxious about their cardiovascular health. His latest book, A Statin-Free Life, helps the layperson, who does not have the time, training or inclination to get into the science of it, assess individual risk, weigh the pros and cons of taking statins and adopt a heart-healthy lifestyle. It comes with a diet and health plan complete with recipes.

Malhotra’s contention is that most people taking statins do not benefit from it and a significant number suffer side effects. Use of statins becomes meaningful only in the case of high-risk individuals.

A professor of evidence-based medicine, he backs it with statistical evidence as well as case studies from his clinical practice. This does not match the perception of statins even among physicians because transparent communication of risks and benefits of drugs is not part of medical practice and training.

Pharmaceutical companies often present the results of drug trials in terms of relative risk reduction, which sounds impressive, rather than the more meaningful absolute risk reduction, which gives the true picture.

A more promising contention Malhotra makes is that compared to taking drugs, lifestyle changes are much more beneficial in preventing, treating and possibly reversing heart disease.

In a nutshell, his advice is not different from what any physician would give: Healthy diet, moderate exercise and stress reduction. But in substance, it diverges greatly on diet by telling people to have carbohydrates sparingly and not to worry about fat.

Behind this advice is the thrust of Malhotra’s career-long advocacy and arguments: To orient the treatment of heart disease away from lowering cholesterol, which is just a marker, and towards addressing the underlying causes of the disease.

Over the past few decades, the understanding of heart disease has evolved from the simplistic view as the clogging of arteries with excess cholesterol in the blood to an inflammation (body’s response to injury or infection) disorder driven by several factors, primarily insulin resistance.

A small but growing section of physicians and researchers see diets high in carbohydrates as the main culprit fuelling insulin resistance and resultant metabolic disorders.

Since Malhotra’s advice deviates from the accepted official opinion that the consumption of saturated fat should be limited to keep blood cholesterol in check, he devotes a good part of the book to bringing home the point that there is no consistent correlation between lowering the so-called bad LDL cholesterol and reduction in heart attacks.

Several other authors have done the job of challenging the currently accepted wisdom on cholesterol and fat by doing a deep dive into nutritional research. The value of this book lies in its simplicity.

Malhotra presents just enough evidence to support his unconventional views and gives only useful information to help people improve their health. This makes the book a quick and easy read. However, a little more light on inflammation and insulin could have given a clearer view of the heart disease without compromising on the focus and readability.

Spersed across the book are also some lesser known facts. For example, some studies suggest that too much exercise may lead to heart disease, that “bad” LDL cholesterol may be protective for the elderly.

A Statin-Free Life can correct some erroneous notions about heart and health among the general public without being dramatic or evangelical.

This was first published in the 1-15 December, 2021 edition of Down To Earth