The One with Dr Aseem Malhotra - 'The Elephant In The Room'

Podcast COVID-19 Special

The One With Dr Aseem Malhotra

‘The Elephant In The Room’ 

Could the two most under prescribed treatments for disease be the answer to COVID-19?

Why are overweight and obese people ten times more likely to die from COVID-19? 

Why are COVID-19 deaths also 4 x higher in those with Diabetes & Hyperglycaemia?

Why are companies like Krispy Kreme and Dominos giving ‘free’ snacks to health care workers? 

Is lockdown the answer and could a change in diet and exercise now prevent a second spike of this virus?

Find out the answer to all in this extremely special edition of ‘The Jason Vale Podcast Lockdown Mini Series’ 

DISCLAIMER: 

Although diet and exercise clearly play a huge role in all metabolic disease I am more than aware, at the same time, that telling people to simply change their diet is akin to telling someone in quicksand to simply ‘get out’. Food addiction is real and it transcends intelligence and logic, as all addiction does. This is why this special edition podcast is an awareness exercise and pointing out that if you can get a handle on your diet you stand a much better chance of protecting yourself against all forms of disease, including things like virus’s of this nature. I will be recoding my ‘ASK NOT WHAT THE NHS CAN DO FOR YOU BUT WHAT CAN YOU DO FOR THE NHS?’ Podcast later this week to add more weight on the back of this interview. Hope you like the discussion and also hope it may just trigger something so you can make any changes diet wise you may need to. Thanks for listening! 

Available on Apple, Spotify and YouTube. 

Transcript

Jason Vale:   0:03
Hi everyone, and welcome to what is a very special episode of the Jason Vale podcast. Usually at this stage, of course, I'm asking while you're listening to this, are you in the gym? Are you on an airplane? Are you traveling somewhere? Are you on a beach? however, I think it's safe to say, given the fact that actually I'm recording this during the COVID-19 outbreak, I think it's safe to say, unless you're a key worker, you'll be very much in the house. Now there is a saying, of course, 'there is a doctor in the house', and I am privileged to say that actually as part of this podcast, we do indeed have a doctor in the house. My next guest, he is a cardiologist. He's a writer. He's a researcher, campaigner. He's a man on a mission to save lives a million at a time.The reason why I have him on, because this week I've seen him on several news bulletins. He's been getting some stick, I think unnecessarily. I think there's a conversation I feel that we do need to have, he is terming this as The Elephant in the Room. i.e. A subject that really has been brushed under the carpet, but one, that I feel, and I know that he feels very strongly because he's been doing it on national television and in newspapers writing incredible articles, that needs to be brought to the forefront, and that is the link essentially between what we are putting into our mouths in terms of just diet general in health and what we're seeing with the current COVID-19. So, I'd like to welcome Dr Aseem Malhotra. Welcome!

Dr Aseem Malhotra:   1:34
Thank you, Jason.  Lovely to be able to speak to you.

Jason Vale:   1:37
Yeah, really nice to speak to you. It's funny because before I do any kind of podcast, I often put it out on social media and say who I'm going to be interviewing, some of the questions. Do they have any questions? And an interesting thing happened because usually because the podcast is normally like a show like a Steve Wright in the afternoon, and we don't get into things that seriously, but we're in a crisis. We're in a serious zone. And it's interesting to see some of the questions already coming through. Not questions, but " I've had a few already this morning. "Why are you having him on your show?" I mean, this is an interesting thing. I mean, I followed your work for many, many years. I don't see, genuinely, anything controversial in what you are saying and what you're doing.So, when you talk about, just for those that are new maybe to you in your work when you talk about the elephant in the room in this particular guise, what are you referring to? 

Dr Aseem Malhotra:   2:31
The  Elephant in the Room, Jason, in this regard, is the fact that the mortality rates from COVID-19, clearly, you know, we're all affected by this global pandemic right now, seem to be significantly higher in people with diet related diseases, which include conditions like type two diabetes, high blood pressure, and heart disease, which is obviously my primary specialty. And that really is something that hasn't been discussed enough in the mainstream until certainly the last few days, which is, you know, I'm pleased to have had an opportunity to highlight that message because we really need to get on top of this issue, not just in the short term. We can talk about the science around how we can improve these risk factors very quickly, but also the fact we have failed, collectively failed, over a number of years, going well over a decade in terms of tackling biggest threat to our health globally and certainly in the UK, which is, obesity and its associated conditions, again, multifactorial. But the most important factor, with the data that we have, is poor diet. And just to give you some perspective on that and for your listeners, Jason, A lot of people get quite shocked with this statistic, but it's estimated that poor diet globally is responsible for 11 million deaths per year. And if you add chronic disease to that poor diet and chronic disease, is, basically responsible for more disease and death than physical inactivity, smoking and alcohol combined. So, it is the biggest issue of our times, but unfortunately it does seem to be also an adverse prognostic risk factor for people dying from COVID-19. 

Jason Vale:   4:11
And you're also, I mean, I'm reading, here's where you mentioned the other day on, and actually I thought they gave you a good amount of time on Good Morning Britain. But it's very unusual. I mean, when people are being interviewed in particular by what has become quite an aggressive Piers Morgan lately and even Susanna Reid is, becoming more of an attack journalist than asking questions. They gave you, a nice amount of space. And actually, I felt that they, they didn't attack you and were willing to listen and we can actually hear your answers. And one of the things that struck me, which I didn't realize until I was watching the interview, I mean, you put there obviously that poor diets were responsible for 11 million deaths a year, and it's worth repeating that point again, because that number, when you think of potential COVID-19 deaths, you know, pale into insignificance. If you really weigh up those two things, but ten, but 10 times more likely, you're 10 times more likely to die from COVID-19 if you're overweight or obese. You're four times higher, if you have diabetes and hyperglycemia. And yet, obviously I've seen, I've seen the attacks happen over the last few weeks when you've mentioned some of these things.That almost personal responsibility is taken out the window. The argument seems to be, well, this is indiscriminate. So, when I read well, this is indiscriminate. COVID-19 kills people that are a normal weight, that have no underlying health conditions at all.And I remember I debated with somebody, I said, well, I mean, maybe you could come forward with this as well, but surely the same argument could be levelled with smoking in the sense that not every person who smoked cigarettes their entire life will get lung cancer and die. But the vast, vast, vast majority will.We're talking about ratio here, cause the numbers of people dying of COVID-19 that are young, no underlying health conditions, that have pretty good body mass index and so on. Presumably the numbers are very low compared to anything else, aren't they?

Dr Aseem Malhotra:   6:00
Yeah, I know. It's trying to make sense and dig through all the data, Jason, so I think there's a couple of issues here. One is that obesity really is a marker. So, BMI is, you know, Jason is quite a crude measure of health to some degree, although it is associated with increased risk of problems because it just looks at your height and weight. And when you look at the associated conditions with obesity, what is more useful and clinically helpful and more predictive, of adverse health consequences is something called the Metabolic Syndrome.Now, let me just expand a little bit on this. So, the real big issue in health is what we call chronic metabolic diseases, which include things like type II diabetes, high blood pressure, but also these chronic diseases linked to excess weight through waist circumference are also likely to be big factors even behind cancer and dementia. In fact, Alzheimer's, for example, there's been big debate about renaming Alzheimer's type III diabetes because a significant proportion of people, the majority of people in fact, with type II diabetes at some point, end up with some sort of dementia. And Alzheimer's seems to be the big issue there.So, all of these things seem to be rooted in, again, you know, things are multifactorial, but core diet is a big one. And you're right, there are going to be people who have absolutely no explanation for why they suffer from COVID-19 and die in terms of their underlying background health. But that's medicine. I mean, I have treated and managed tens of thousands of patients in my almost 20-year career in the NHS. You know, I've operated on hundreds of people putting heart stents, in doing keyhole heart surgery. I've done diagnostic angiograms. And you do come across patients who have heart attacks they're young, they're fit they're lean they're active, they've got good diets, and they have heart attacks and you can never fully understand why. So, this is just part and parcel of medicine, but you're absolutely right. You know, this is about degree of risk. And. it's whether, one, what is the awareness of that risk?And then as individuals and informing people in the public is about what you can do to reduce that risk significantly through those lifestyle changes. But also, it's about sense of wellbeing as you know, when people improve their health and their weight, and all these metabolic risk factors. They also, it's not just about the potential long-term benefits, the short-term benefits in terms of sense of wellbeing.Now, just to come back to this issue about chronic metabolic disease, just to give some perspective on this, in America and our prevalence of obesity and conditions like type II diabetes is quite similar to America. Probably a little bit better, but not far off. Only one in eight Americans are estimated to be metabolically healthy.Which is pretty extraordinary, and our figures are likely similar. I've got specific data here, but it's likely quite similar. What does that mean? Well, there are five most important factors that are responsible for chronic metabolic disease, which leads to heart attacks and strokes, and probably also linked to dementia and cancer. And these are: having normal blood pressure. So, what new criteria suggests, if your blood pressure is over 120 systolic or over 80 millimetres of mercury diastolic, that gives us one factor. having an increased waist circumference and not BMI for men more than 102 centimetres for women, more than 88.Having cholesterol profile, not a high cholesterol, but a cholesterol profile that is abnormal and linked again to this underlying problem of what we call insulin resistance, which I'll expand on shortly, which is characterized by having either high blood triglycerides of greater than 1.7 millimoles per litre or a low good cholesterol, less than one millimole per litre.And last but not least is, having blood glucose in the prediabetic or type II diabetic range. So above 5.7. So metabolically healthy is really absence of all of these. And that is a small proportion of people, sadly now probably most of the Western world. So, this is really the gold standard that we should be trying to move towards.For individuals, and I see that in my patients, and this is what I do, my interest is in reversing these risk factors for people and reducing their risk of heart attack. Because also what's interesting is if you have three of those five factors, it constitutes metabolic syndrome, and that's where you have this tenfold increased risk, from CDC data, of mortality, likely, you know, because obviously the data is still evolving. So that's where that comes. Having three of those five factors is called metabolic syndrome. And as a cardiologist, that's particularly important to me because two thirds of people, 66% of people now, who are admitted with heart attacks, have metabolic syndrome.

Jason Vale:   10:24
Wow! I've been saying it for about a year. I wrote an article last year and I always want to do a podcast and this original podcast was going to be just me talking to the mic essentially. Because it seemed like a good time to bring this up without being attacked. I've always been of the opinion: ask not what the NHS can do for you, but what can you do for the NHS and what I mean by that is going beyond banging a few drums and clapping your hands at 8:00 PM on a Thursday. Not that there's anything wrong with that. And I think it's very encouraging, and I think that with the current climate, of course, there's nothing wrong with that, but surely it shouldn't be ‘stay a home, protect the NHS’. It should be ‘protect yourself - protect the NHS’. And why do you think people are so resistant or angry? They get very angry the very second that somebody would even remotely suggest that some of this may be in their hands. Not in every case because they'll always come up with the Uncle Fred Syndrome. And Uncle Fred, of course, smokes 60 cigarettes a day. He drank a bottle of scotch every day. He lived until he was 150 of course, because it was exaggerated, and he never had a day’s illness his entire life. So, everybody clings to uncle Fred as their one-man piece of market research, convenient, ignoring the millions of people that are cut down in their prime, because of what they put into their body.I also don't understand why it's very clear when it comes to a vehicle, to use a very old analogy, but it's very clear that if you do put diesel into a petrol car, it will splutter and not work very well. The human body is a bit more efficient than that. So, it will take pretty much any fuel that we give it and do whatever it possibly can in order to survive. Survival's first, health it comes second of course. But inevitably we will get symptoms of dis-ease where we are at dis-ease with ourselves and we will have some symptoms. But why do so many people, do you think, feel that actually it's not in their control. It doesn't matter what they eat, that's what nothing to do with it. It's all just hereditary. And actually, if there's an outside virus, there's nothing we can do about it. Why do you think they get so angry when even it suggested? 

Dr Aseem Malhotra:   12:28
I think, you know, Jason, to be honest, that this is something talk about in my lectures, is have an epidemic of misinformation. So, we have an epidemic of misinformed doctors, and misinformed patients, and this is rooted in number of factors.So, you know, just going to the roots of it and I'll come back to the individual sort of attacks or people who feel very vulnerable, and, and sort of hit back at people who are trying to make public noise, such as myself, about tackling this problem. There are seven sins that contribute to this epidemic of misinformation.They are: Biased funding of research. So, this is research that's funded because it's likely to be profitable, not beneficial for patients. Right. Biased reporting in medical journals.Biased reporting in the media Biased patient pamphlets. And also, it's because of, an inability amongst doctors and the public sometimes to comprehend, health statistics.So, when you combine all of these together. You know, they contribute to this epidemic of misinformation. So, some of it is lack of knowledge. To answer your question specifically, as you said, you know, because people, you're right, there are people out there that somehow have been led to believe that diet isn't that important.And, therefore They will be misinformed by a lot of stuff that is through marketing for vested interests that want to sell you something. And they shape their beliefs about their health around that. And then, you know, there's actually quite a lot of research and studies showing that, for example, people will buy foods based on the way they're marketed, not the nutritional value. So we've had this whole, as you know, over a number of years, the whole low fat movement, and lot of these foods that people were buying because they thought was healthy, was actually loaded with lots and lots of sugar and would have an opposite effects on their health.So, there's, lack of knowledge. I think there's also understandably a sensitivity amongst a lot of people who suffer with weight issues because it's so prevalent now, Jason. You know a quarter... well, in fact, 29% of UK adults are obese and 63% are overweight or obese. That's a massive group of the population and this affects NHS staff as well.more than half of NHS staff are also overweight or obese, and about 62% of nurses specifically are overweight or obese. And that's because, and I've worked in this environment for a number of years, the food environment in hospitals is also pretty atrocious. So, three quarters of food purchased in hospitals is unhealthy.So, the roots of it is the food environment, and to actually tackle it, and I'm all for, you know, giving people, empowering people so they can exercise personal responsibility. But the problem is when it comes to our behaviour, we kind of, how should I put it we're swimming against the current, you know, and that it makes it harder.So even if people, and I see many of my patients to dramatically improve their health, one of the concerns I have is sustainability of it, because the default option's still the unhealthy one. And they will end up, potentially going back to the, you know, if we don't sort of clean environment out, it just makes it easier they're going to relapse. So, until we thought that out... 

Jason Vale:   15:20
And there's two, and there's two-fold in that I think, I mean, is addiction. studied addiction psychology way before I got involved in juicing, in fact for another podcast, another time, is that I still to this day, don't know how I became the juice guy, but anyway that was never meant to be.it was more about addiction psychology. And there's no question, of course, when we say, why do people get angry and fearful at the thought of having to change their diet in order to benefit themselves. It's fear, of course. All addiction is fear. The fear that they think that they can't enjoy themselves or cope with life in the same way without what they perceive to be a friend, crutch, or pleasure.So you've got  the addiction side, obviously laced within the refined fat, salt and sugar hitting the bliss point area, but then also, conversely, which has happened this week, which you've really highlighted, and been attacked for, surprisingly - I really didn't understand why you were attacked. Maybe they just didn't understand where you were coming from.

Dr Aseem Malhotra:   16:12
Sorry, Jason, just expand on the 'attack' bit. Is this the stuff, social media trolls and stuff?

Jason Vale:   16:15
I'm talking about silly… yeah… I'm not talking about people actually. I mean, let's be fair here. When I say attacked, I am talking about the keyboard warrior idiots, and let's be honest. I mean, yeah, social media trolls.Sorry. Yeah, you're not. In fairness... 

Dr Aseem Malhotra:   16:32
But no, it's a really important point you make because there is a lot of that stuff that I've had to experience and other people, you know, in a similar space, have done over the years. And some of it is just from people who are, how should I put it? ‘Unsavoury characters’ is probably politest way to describe them. And, some of it is actually coming from the very vested interests that feels threatened in terms of their profits. And they will, be funding people, some of them are anonymous, some of them are, you know, open scientists, but not declaring that they're getting money from, you know, sugar industry, et cetera, who will then go on the attack against people like me with that message because they feel threatened.

Jason Vale:   17:08
Of course. Because, because some of it’s doctors. I mean, I've seen some doctors on social media equally quoting some of your stuff and chastising it in ways that are completely unfair and actually just completely unbalanced.And then you've got what I call the new Instagram experts, which most of the time I don't take a great deal of notice of. But one in particular ... one in particular is talking about, ED - eating disorders and the irony seems to be completely lost on this particular person, saying that you are encouraging eating disorders. In fact, you should be brought down because you're encouraging eating disorders when the whole purpose, everything behind everything that you do, from what I've read, I read your book as well, and everything else is the complete antithesis. It's to remove the eating disorders caused by essentially the chemicals that are being produced in food.And one of the examples this week, obviously, has been Krispy Kreme donuts and, and, and, and Domino’s. So, at the time of recording, in case people are listening to this years in the future, it's hard to imagine now. but you know, I am currently in Spain as on recording this. I think Dr Aseem is in London. Are you in London? So, London has been on semi lockdown. I'm talking about semi; we'll talk about lockdown in a second. In Spain, we've been on what I describe as real lockdown. There are various degrees of it, and I'll give you some example: we are now seven weeks into lockdown here in Spain, and only up until two days ago, was I allowed to even take my child out for a walk. You could take your dog out for a walk, but you can't take a child out for a walk. Some of this doesn't make any sense at all? but anyway, that's something else. but I see in the UK, you got a Krispy Kreme.So, we, I think five weeks in or four weeks in, in the UK into semi locked down. And of course, people are, rightly so, saying the NHS, the front workers, look what they're risking. But you've got companies like Krispy Kreme who. I mean, it's phenomenal marketing. It's very clever. And those that don't see through it, you wonder why they haven't seen through it. And they just thought it was a nice gesture. there's more focus on the NHS than ever in our history at the moment. which is slightly unfair because we should have always given them a clap every week anyway, before this.But we've got Krispy Kreme donuts, and it's on social media everywhere. It's the biggest advertisement. I'm doing it myself. I'm talking about them too. Well, I mean, I'm guilty of it now on this podcast. I'm giving them publicity, and then of course, Dominos are doing the same thing. Aren't we doing something nice by delivering?Now you made a comment, along with people like Joanna Blythman who put herself on the forefront and you know, she's put 15,000 donuts donated as a "treat" for NHS frontline workers produced copious publicity that money could never buy. Smiling staff posed on Twitter holding up the boxes of these synthetic sugary confections.You said something similar to an article, which I actually agreed with, but then you've got the layperson going, come on. Come on, these people need a treat. A donut didn't kill anyone. But surely you can argue the same, that one cigarette a day didn't kill anyone either. The point is, it's the addictive nature of these things and the fact that we're linking them to reward.I think that's the biggest bug bear that I have.

Dr Aseem Malhotra:   20:17
Well, it's interesting. So, you know, I'm obviously a campaigner. I'm a public health advocate. For me, my primary motivation / interest is to help as many people get healthy as possible through policy changes so that we can protect the NHS properly.I mean, this is what motivated my campaigning going back a decade because I was experiencing all this chronic stress on the system and tried to get the roots of it all. So, just, you know, listeners understand. That's my primary motivation. But you know, having studied this in great detail and being one of the first people, certainly in the UK, to highlight that there was problem with our sugar consumption.And also, at the time faced so many attacks at that point. You know, a lot of people saying, you know, who's this guy saying, extra sugar is bad for you, et cetera, he's a quack, et cetera. Now we've got policies involved in including sugary drinks tax. So, things do evolve, and people do change. But you're absolutely right, Jason.the analogy with tobacco is a very good one. Because what many people won't know, and certainly people within the NHS is that this was straight from the corporate playbook, I would call it dirty tricks, playbook of big tobacco. So, in the thirties and forties when more than half the population were smokers, adults. I mean, it's extraordinary thing about it now. More than half of people were smoking. You go everywhere, you know, you was smoking on airplanes, you know. in doctor's offices when more than half the people were smoking, and there were certain initial concerns about adverse health effects of smoking, big tobacco then as part of their kind of PR campaign, managed to get doctors in the fifties on advertisements because that would legitimize that these are fine. And companies like Krispy Kreme and Domino’s are using that near there. They're companies that make profit, but to be honest, they're absolutely, there's no Goodwill involved in my view at all. This is purely a marketing stunt. And by legitimizing, you know, by getting NHS workers that currently having a lot of attention at the moment, and understandably so, this is just, it's brilliant PR. Unfortunately, I can assure you, if you know, this is about empowering people with knowledge. If those doctors and nurses were aware this is what's going on, they're being exploited in the middle of obesity epidemic. And you know the fact that even NHS workers themselves have the same health problems. If they knew they were being deliberately exploited, I can promise you they would not be putting photographs up of them standing with Krispy Kremes. They might as well as you said, they might as well go up there and say, look, we've got this pack of cigarettes. Because you're right. You know, one donut will not kill you. One cigarette will not kill you. But over time, we know that these foods are ultimately at the root cause of the chronic disease epidemic. And we shouldn't associate them with health in any way with hospitals. So yeah, of course. 

Jason Vale:   22:45
And it's funny because you brought up cigarettes and it's funny cause you look back now at some of the adverts, I was a heavy smoker. I remember I used to smoke 20 40 cigarettes every single day. I mean I, you know, I grew up in the era where when you went round somebody's house, there was always these almost marble encased cigarette holders with these massive marble lighters that was always on the table. So that when you went round you could just lift one up and everybody would offer them around. and we're in that situation, the adverts at the time, of course, I remember one in particular was, you know, more doctors smoke camels than any other brand. You know, anything you look back now, you think that's crazy, but where you're going and I believe this is true, we'll look back in 20, 30 years from now and we will not believe that we are seeing doctors and nurses holding up Krispy Kremes. But actually, it's even worse, because I went Guy's hospital years ago in London. I don't know if it's still there, you'd be able to clarify or not, but I couldn't believe that McDonald's was part of the building. It wasn't even just slightly to the side of it.It was almost as if they were renting. I think there's three Burger Kings in various hospitals, around the UK. If you look at the quote unquote food offering in hospitals, I often call it ' The Ping', 'the Ping Diet'. You wouldn't have heard that. I've just made it up. The Ping, the Ping Diet in hospitals is, you know, whenever you hear a ping, then you know, the food's ready.It's just microwave Ping stuff. You know, the world health organization at one point said that, you know, 85% of all lifestyle diseases are caused by what we do, what we put into our mouth, essentially. Sure. And yet at the same time, they wouldn't look at that as a cure either.I mean, you know, changing your lifestyle might change your lifestyle disease. When it comes to lockdown... I just want to cover this base. Now I've a very strong view on this. I'm sure I'll get hammered after this podcast. My genuine belief, and only future will tell us, but I believe that the side effects of lockdown will cause way more health problems than if lockdown hadn't happened. Now I know it's a big statement. There's no way of me knowing that. I'm not in the medical profession, but what I do know is with Childline calls going up by 700%, by 400% increase in domestic violence, by suicide's going through the roof, by people losing their jobs, and the list can go on and on and on. Now, is this the only time that you can think, of as a doctor, that the side effects of a treatment have never been looked at before the treatment was rolled out? So, what I'm trying to say is the COVID-19, a virus, the treatment for this virus at the moment is lockdown because they've got no other treatment. So, the treatment could be deemed as lockdown. The side effects that that will ultimately cause, and is causing, that wasn't ever weighed up. Now, in your view, do you feel that a lockdown should have happened? Should it have happened to the extent that it has already happened? Do you think that the COVID-19 virus would have gone in a natural curve as it has done in many countries that haven't locked down, in a very similar directory?  What would be your viewpoint on it? And presumably we're midway through this, so obviously hindsight will tell us a lot more, but your gut feeling at the moment on this whole lockdown issue? 

Dr Aseem Malhotra:   26:08
Jason, I think your point's very legitimate and there are many respectable people in this slightly polarized debate who are arguing that, that, they are concerned that the deaths and harm from lockdown will be more than coronavirus itself.The reality is, you've said already is we don't really know. And because it was a novel virus and there was predictions of without lockdown, potentially, you know, 500,000, maybe a million people dying in the UK from COVID-19. That was part of the reason that drove the lockdown.But if you remember very early on, the main reason given by government for the lockdown was to protect the NHS from being overwhelmed. That was the primary reason. And it hasn't luckily been overwhelmed. We've managed to, deal with it, but at the same time, there were a lot of people who are not coming in, there are obviously, diagnosis and cancer treatments have been, massively delayed. Heart attack admissions have reduced, which means people are probably having heart attacks at home rather than coming to hospital. So, there is all these problems and you can never, ultimately when they introduce a lockdown envisage exactly what's going to happen until it happens.But it's a very difficult one. I don't think there's a definitive answer. And part of the reason for that, going with a lockdown approach, Jason, was the uncertainty about the true infection fatality rate. So actually, how deadly is this virus? And comparisons have been made to the flu. So, the flu mortality rates. So, people who are infected with the flu, on average, about 0.1% of those people will die. So, one in a thousand. Now things have evolved, and the data at the moment suggests that it's probably for COVID-19 something between 0.5 and maybe 0.7 but that's still a sevenfold increase.And you know, if we predicted that with the current state of the NHS that it's in, even a bad flu season, you know, doubling mortality would have caused an overwhelming of the NHS. So, from that purpose, I think the lockdown was the right one. But really, yeah, I think, you know, it's, it's hindsight. will tell us and in fact, hopefully help us predict and prepare better if for the, when the next pandemic occurs. 

Jason Vale:   28:10
And also, because this is a brand-new virus in a brand-new pandemic, although various strains of COVID have been around, but this particular strain, of course, is brand new. Now there are some things that are floating around that now, some people in the medical profession, some professors and so on are saying there is no evidence whatsoever. It was a figure plucked out of thin air. What I'm talking about there is, social distancing. So, the social distancing. kind of obsession at the moment with two meters, cause my understanding, which again, from a very non-medical perspective, which is why I'm glad you're here, is that for things that I've read, outdoors, the chances of it transmitting outside in an outside environment such as a football match, Cheltenham Festival, whatever the case is. If there's a degree of social distancing are far, far, far, far, far lower than if you are inside an air-conditioned building…Dr Aseem Malhotra: Absolutely correct.…that that is circulating. Now, if you are in an air conditioned building or just a heated building and it's circulating, just logically, and again, I've got nothing to go by with this, but my logic tells me that if I'm at a restaurant and I'm two metres away from certain people and the restaurant is now only a third open, which is what they are kind of suggesting is going to happen, which means that most businesses won't be able to open because a third open, you're not going to make any money and you're going to fold anyway, so that's not going to work. But if they do come in with this, you must be two metres away scenario, from the tables, if it's in the air, which is what I gather it is, then if you're four meters away or six meters away, but you're in the same room and there's locked doors, isn't your chance of contracting it just as high as if you're next to them?

Dr Aseem Malhotra:   30:03
I genuinely don't know, Jason, but no it would fall to the floor. So that the two-metre rule is basically because if you cough or sneeze, the data suggest at that point, around two meters is where that distance is a safe distance. and I think just to reassure people that to some degree, I think obviously the doing it properly is important. It's better to be safe than sorry. But in terms of being near somebody who isn't coughing, for example, that risk is only really there if you are less than two metres for more than 15 minutes. But obviously that's a very difficult thing to, to implement. So, it's best for people to stick to two meters.  But circulation in the, in the vicinity.And I'm sure that, it's very possible, that, say someone coughs or sneezes and it blows it in a, further distance, for example. But it won't linger just in the air. It will fall to the floor.

:   30:40


Jason Vale:   30:51
I see. Okay. And, and your view, because somebody said there was another professor that said actually stays in the air for three hours. So that was all that's, you know, there's various stuff that goes around all the time. Dr Aseem Malhotra: I'm not aware of that, Jason. Jason Vale: It's very difficult for the lay person to really understand what to believe, because obviously there are experts in this field a bit like global warming not all the experts agree.Facemasks is one of those areas that seems to be incredibly confusing. So, one minute you have somebody on Good Morning Britain, Dr Hilary (Jones), a few months ago saying, absolute waste of time, they don't do anything. And then recently he's saying it's a good idea to wear them and it's the same doctor and you go, well… 

Dr Aseem Malhotra:   31:30
What's important at face masks is that it doesn't protect you. as an individual from getting the virus because of these very tiny micro particles can travel through the face mask. But what it does is, if you're infectious, it reduces the risk of you passing onto someone else through breathing and coughing or whatever.So that's basically how it works. 

Jason Vale:   31:53
No, I understand that. But do you think it's sometimes it's bringing out the worried. They're worried, obviously based on, there's a lot of stuff going around, unfortunately, in some ways we have the internet, you know, whenever I see somebody in a car by themselves with a face mask on, I almost want to take them off the electoral register because I almost want to say, you're in a car on your own. You've got a mask on.  

Dr Aseem Malhotra:   32:14
I mean, I think it's just, you know, I can understand. It's just a huge fear, that's being created around this virus, of death. And of course, people will do things that aren't necessarily based upon, good evidence, to make themselves feel more comfortable. And if that makes them more comfortable and isn't harming anyone else, and it psychologically reduces their stress levels, then why not? 

Jason Vale:   32:37
And do you think there was any argument for, again, my, my brain goes off in all kinds of directions at most of the time in wrong ones, which is nice to have a debate.But when this first occurred, one of the things that I said to my partner at the time was, what I'm not understanding is shutting down everything. if this thing kills essentially 0.1% of the population, which is hard to know because of course there hasn't been enough testing done. Dr Aseem Malhotra: It would probably be more than that. Probably a lot more than that, but yeah. Jason Vale: Yeah. Okay. No, I appreciate that, but it's hard to know If you tested everybody and you realize that actually instead of 80% it's 90% that are asymptomatic from it, then it's very difficult to know at this moment in time. However, let's just, based on 

Dr Aseem Malhotra:   33:23
The excess deaths in hospital or another kind of indirect guide though that it more lethal than the flu. I think that's the key. I think that's the key marker. 

Jason Vale:   33:32
I think it's definitely, I think, I think there's no question that it is more lethal than the flu. I don't know. To this point, anybody's, um, well, there are some, uh, debating that. I'm certainly not. There's no question. They're not the same animal.The question would be is if it primarily and by long way affects people with underlying health conditions and people of a certain age,  there have been an argument at the very start of this that actually if we are going to effectively throw hundreds of billions of pounds at this and crash the economy, which is what's happened anyway, would've there been an argument to say,  well look, instead of isolating everybody, shutting down every airport, shutting down everything, that actually, why don't we isolate the people that are vulnerable, look after them, deliver them food, do whatever we need to do over the next 12 weeks, 10 weeks, whatever it is, but actually we just keep everything else going?And I don't know whether that was an argument.  It seems strange that, one of the first times ever in history is that we're isolating the healthy, and the non-vulnerable. So, I don't know, was it ever an argument? listen, I could, well, be talking out of my arse as usual.I'm just wondering if...

Jason Vale:   35:23
But is funny, isn't it? Because you can't, just because there are too many contributing factors for that.So, for example, my uncle who's 76 who genuinely is fit as a butcher's dog, right? So, there's, you know, like this guy is unbelievably fit, perfect body mass index, looking great, you know, worked all of his life, everything else. And some 35-year olds that are the size of the Napa Valley that have type II diabetes see, you just go.Just be, just because they are below 50 it's so difficult. Listen, I do not envy the government at all. I don't, you know, and it's very easy for anybody on there. horse and say they should have done this. That's just a very hindsight approach.I'm just asking I wonder in the future whether certain things might have been. better way forward or more, logical to have a different approach then tanking the economy. Because I tell you what, one of the things that I have now, I used to live in a council flat one parent family, no brothers, no sisters, no father.I mean literally, you know, we found a pound once and it was like, do we buy cigarettes or food with it? And this isn't the world's smallest violin. This is just how life was. We lived in a squat. We was on the street. I know what it's like to live in a tower block. I know what it's like when you're in that tower block on the 31st floor and there's four kids running around.and you're there with maybe a partner that before lockdown, you wish you'd finished with, and now you're regretting it. And all of a sudden, the stress that that is having. That's very different to what I call some of the blue tick brigade in their ivory towers on Twitter saying, well, you know, they went through worse than the war. We've all just got to ride it out as they're lying down having their pina colada next to their swimming pool, and I think it's very easy to have two different opinions on whether we need to come out a lock down sooner rather than later. The ones that are losing their jobs, the ones that have suicide pacts, which happened only two days ago, suicide pack that went wrong in the UK, because it was the final straw because in the end he couldn't see any future, the job had gone, this, that, and the other. So, the argument of saving the economy versus saving lives, I think is flawed because aren't they both saving lives? That's the whole point. It's just how many lives do you save? 

Dr Aseem Malhotra:   37:29
Yeah, I agree, Jason. I think, again, we won't really be able to fully analyse the effects of this even for maybe a few years to see 

Jason Vale:   37:37
exactly. The final one. What do you think of this? Because I thought this as well. When it comes to normal medical drugs, I understand there's a level of collateral damage that is accepted, widely accepted in your profession? Would you agree with that? That pharmaceutical industry and so on, that actually in order for the greater good, in order to save more people, sometimes there will be, during the testing phase and even beyond the testing phase, there will be a certain amount of people that will have adverse drug reactions that could potentially cause death in the long run.But ultimately it saves more lives than it kills, and it's called collateral damage. And I think it's very well known in the pharmaceutical industry, and they talk about it quite a lot. When it came to COVID-19, the mere suggestion that Boris once had, because he was trying to model the Swedish model at the time, and then did a complete U-turn on it.But he alluded to on This Morning television once, talking about herd immunity, which now seems to be a very dirty term. but he was talking about herd immunity, and he was alluding to the point that actually, without saying it, there may be an element of collateral damage, but ultimately, you know, 70% of these people are going to die this year anyway. So, if we have herd immunity, maybe this is the way forward. And, of course, he got absolutely attacked for it, but when it comes to pharmaceutical drugs, it seems to be very well accepted. Nobody seems to question it. And I wonder why that same approach cannot be used here, as harsh as it is? 

Dr Aseem Malhotra:   39:09
Because of the unknowns, Jason, to be honest, as I said, you know, with those drugs that come from the trials, they have relatively reliable, although I'm one of the advocates for greater transparency with all of these things. I think a lot of the problems with these drugs is that they are trialled in very controlled circumstances with selected people and then when you expand them out to the rest of the population, side effects do seem to be much more prevalent than what was published in the original paper.But There is more information, more reliable information already there before a drug then gets put on the market and then gets prescribed by doctors. In this situation there was no one coming out and saying, exactly, this is what's going to happen. This is how many people are gonna die.There was none of that. It made sense, but there was no precision. And then it's about balancing it. Do we take the risk that half a million or a million people may die from novel virus that, is killing one in three people who get hospitalized with it.or, do we lockdown. reduce its impact on the NHS, reduce its spread, by us more time, reduce, hopefully, its severity with time. and that's a very difficult decision. And obviously different countries have adopted different measures, but one of the arguments is that, yeah, I can that ultimately over that year, even if we were to get this peak, you know, say that we were overwhelmed in the NHS with a very high peak, that the total number of deaths wouldn't change anyway because there's a very good chance that most of us, at some point, you're going to contract the virus because the vaccine is not going to be ready for probably a year and a half.So that's another argument that has been made, but these are ethical discussions and 

Jason Vale:   40:46
it'll be interesting to see, won't it? No. take on all your points and they are incredibly valid. And it'd interesting, see here in Spain, for argument's sake, where they have fully, fully, fully, fully locked down. I mean, you can't go out.I mean, it's like, I mean, I'm right next to the ocean and I'm not allowed in it. not that COVID-19 lives in the sea, but still never mind, there's some logic, but I can't get my head around. but the point is they've locked down to such an extent that there would be, I would argue, there'd be no degree whatsoever of herd immunity or whatever you want to call it.So, I mean, it's hard to know again, but my gut reaction tells me the chances of a second peak in countries like this would be far greater than those in the UK. They've pretty much have a halfway house. I know it is locked down there, but compared to Spain, I mean, you can go and exercise, you can still this, there's people on tubes, there's people on this.There's, you know, it's not the same as. Literally 

Dr Aseem Malhotra:   41:37
I would. Yeah, sure. I think that that's also an important, I think the problem is that we also have this, which has been highlighted with the number of deaths here we're now on course to be the... I think already one of the highest in Europe in terms of death rates. May well be second in the world after the United States, is again, this problem of, a huge prevalence of chronic disease and an aging population combined.

Jason Vale:   41:58
And do you think an argument also with the words with and from, are you on that kind of board, because at the moment, from my understanding is that, you know, somebody like my mom unfortunately died of stage four lung cancer and so on. So, she, in arguments sake, if she was around at this moment in time and she was nearing the end   essentially if she'd gone into hospital and chances of getting COVID-19 in hospital are probably far greater than anywhere else at the moment. there was a little trace within her system. My understanding is, no matter whether it was slight contributing factor, or it just happens to be in the bloodstream or as a major factor. It just goes down as a COVID death, period. 

Dr Aseem Malhotra:   42:34
I mean, some reporting has suggested that, Jason, but having worked and written out God knows lots of death certificates myself and been involved in people who have been ill, you have to make a clinical judgment about what the primary cause of death is.And, it’s sometimes not easy to do that  

Jason Vale:   42:49
I take your point that you just said, I don't know how. People in your profession constantly have to make so many different decisions all the time off the cuff, and then go and see someone else.So, you think it's very unfair sometimes including the government's in an equal position, that when you've got someone at the moment, like Piers Morgan or whoever, who are absolutely chastising attacking. the government and literally saying they've got blood on their hands and so on.Do you think that's fair when it comes to a new virus when actually everybody's just trying to move with it and do whatever they can as best at the time? 

Dr Aseem Malhotra:   43:25
Yeah, I think there's a lot of questions being asked about the government. No, it's not just about the lockdown. It was one, the U-turn. The probably.Many deaths would have, could have been prevented if there was a lockdown that was introduced earlier. But there's also issues about, I think more importantly, lack of testing and PPE because another issue, with this, Jason, is that one of the reasons that lockdown has been extended et cetera is because we haven't had the adequate testing where you can isolate and therefore manage the situation much better.And then frontline health care staff haven't had their personal protective equipment, which probably would have protected many people from succumbing to the illness and dying. So, these are sort of some of the other major issues, which I think Piers Morgan has done very well to hold the government accountable for.

Jason Vale:   44:07
But would you, would you, would you equally say, cause it's very easy in your armchair studio to run a country from there.And you know, I know I run a very small business. You start. Put in the out to the size of the NHS and everything else. So, time as always is not on our side. And I could talk to you for hours and hours and hours, and I'm hoping you'll come back for a second wave of a podcast away from lockdown just to talk in more general terms, because it isn't just now about ‘Ask not what the NHS can do for you’, but what you can do for the NHS. I saw what you did with politicians like Tom Watson, but that's just the start of it. I'm fascinated by your book as well that you've written. I want to talk all about that, those that don't know The Pioppi Diet, which I think is a fascinating read. And I do know, although the on some levels. Obviously when it comes down to certain elements of juicing or when it comes down to high protein or whatever, we might not see eye to eye on everything, but I think, I could be wrong, but it's fair to say that actually the aim, the ultimate aim is the removal of white refined sugars, refined fats, the false advertising, and bringing people's ultimate body weight down so that they're in a better position to deal with anything that comes along. Dr Aseem Malhotra: A hundred percent, Jason. Jason Vale: Absolutely. So, listen, I thank you for your time. Thank you for all you're doing. I thank you for staying strong in amongst some of the naysayers that are out there.It really does require people like you to stay strong. Could you never shake. And I like that. That means that somebody, you know, that really does know and believes what they're saying. So, look, you've probably got a billion other interviews to do today, and I've taken way too much of your time.Thank you very much indeed, Dr Aseem, for your time and everything you do. Thank you very much. Dr Aseem Malhotra: My pleasure, Jason. Thank you.