Aseem Malhotra
Aseem Malhotra is a British cardiologist, public health campaigner, author of several books, and writer of articles in newspapers. In 2018 he was a visiting professor at Escola Bahiana de Medicina e Saúde Pública. He campaigns in particular for people to reduce sugar in their diet and was the first science director of Action on Sugar in 2014. He also campaigns for reducing the overprescribing of medicines. He has been listed as one of "The Sunday Times" 500 most influential people, identified as one of the top ten "Smart Set" in the London "Evening Standard", and was twice  recognized as one of the top 50 black and minority ethnic (BME) community member pioneers in the UK National Health Service by the "Health Service Journal". He promotes a low carb, high fat diet and is co-author of a book called"The Pioppi Diet". Maholtra's views on diet and health have been criticized by the British Heart Foundation as "misleading and wrong", and his public questioning of the need ever to use statins has been condemned as a danger to public health. His "Pioppi diet" was named by the British Dietetic Association as one of the "top 5 worst  celeb diets to avoid in 2018". During the COVID-19 pandemic Malhotra published a book called "The 21-Day Immunity Plan" making claims that following the diet could quickly help people reduce their risk from the virus; critics point out that such claims are not backed by medical research evidence. Biography. Early Influences. Malhotra was born in New Delhi in India in October 1977. He was the younger son of two doctors: Kailash Chand and Anisha Malhotra. The family moved to Britain in 1978 when his father had a clinical attachment at Alder Hey Hospital and was studying for a Diploma  in Tropical Medicine at Liverpool University. Both parents became General Practitioners in Ashton-under-Lyme, Greater Manchester. In 1988 Malhotra's brother Amit, who was two years older than Malhotra and had been born with Down's syndrome, died of heart failure aged thirteen. This inspired Malhotra with the ambition to become a cardiologist. Malhotra was educated at Manchester Grammar School. Malhotra's father went on to become the first Asian to be elected as honorary vice-president and deputy chair of the council of the British Medical Association and received an O.B.E for long-standing service to the NHS . Malhotra has said that he had a unique relationship with his father, who was his best friend and the most loving and amazing father. Malhotra's mother's religious faith was important to her and Malhotra observed that she fasted weekly by only consuming one meal on a fast day. She died in 2018 aged 68 after several years of illness when she was cared for by her husband. Three months later, Malhotra who blamed her obesity, years of illness and premature death on her vegetarian diet that he said was high in sugar and ultra-processed foods and low  in protein said "I very much hope that her premature and painful death was not in vain and we can learn that much of these ills are preventable." Malhotra's father died suddenly in 2021 after suffering a cardiac arrest. Career. Malhotra studied medicine at the University of Edinburgh and graduated in 2001. He was already ambitious to become a cardiologist when he spent his foundation years as a doctor in Scotland, at Wishaw General Hospital then at the Royal Infirmary of Edinburgh and finally at Liberton Hospital which specialises in care of the elderly. He completed his post-graduate  medical diploma during two years working at the Manchester Royal Infirmary. He held specialist registrar positions at St James's University Hospital in Leeds and Blackpool Victoria Hospital. In 2018, Malhotra was described as a charming and telegenic young cardiologist in private practice. He has held cardiology posts with the UK National Health Service as a cardiology specialist registrar at Harefield Hospital, at the Royal Free Hospital in Hampstead and as an Honorary Consultant Cardiologist at Frimley Park Hospital. He is a former Consultant Clinical Associate to the Academy of Medical Royal Colleges and is a visiting professor at Bahiana  School of Medicine and Public Health, Salvador, Brazil. In 2015 he was appointed as a trustee of the King's Fund and was reappointed for a further three years in 2018. In addition to his work as a cardiologist, he has been described as a "highly regarded public health campaigner" and an anti-obesity expert who is "passionate about tackling the companies and policies responsible for creating ... an obesogenic environment". Malhotra explains that his professional work has motivated his public health campaigning:" ..having seen the unspeakable suffering caused by diet-related diseases, I would much rather these patients did not  develop them in the first place." In 2013 he was recognized in the inaugural list of the top 50 BME Pioneers in the NHS Health Service Journal, for his research on sugar rich diets and obesity and cardio-vascular disease and for his public health campaigns, including profit-making of big corporations at the expense of public health, unhealthy hospital meals and sale of junk food in hospitals The judges commented that "Yes. He challenges people". In 2014 he was recognized for a second year running in the Health Services Journal top 50 BME Pioneers: described by the judges as  An upcoming star, the entry recognized that he had ignited a debate about over-investigation, over-diagnosis and overmedication and brought media attention to the BMJ's "Too much medicine" campaign. At the end of 2013, Malhotra won the accolade of being named a "Food Hero" for the Children's Food Campaign for his campaigning against junk food being marketed to children and sugar filled vending machines in hospitals. When Action on Sugar was founded in 2014, he was its first Science Director. Later in that year, his campaigning on sugar led to his being featured in the Evening Standard  as being one of ten of London's brightest stars working in science and technology. Malhotra was named as one of the 500 most influential people in Britain in the Sunday Times-Debretts list of 2016, for his campaigning about high levels of sugar in the diet. In 2018 though, the Guardian's health correspondent, Sarah Boseley, labelled Malhotra as a "dissident scientist", "statin critic" and "cholesterol sceptic". In 2021, Malhotra was appointed chair of the charity The Public Health Collaboration. Interests. Malhotra lists his interests as cooking, playing guitar, watching movies, keeping fit and playing sport. Public Health Campaigns  and Controversies. Reducing the consumption of sugar and junk foods. Malhotra campaigns about reducing the consumption of sugar and junk foods, particularly in the diet of children. The fact that most people in Britain, including children, eat too much sugar and that this contributes to obesity is acknowledged by the NHS healthy eating guidelines. However, Malhotra argues that it is unrealistic to expect individuals to avoid cheap, unhealthy, heavily marketed foods and that changes to regulation are needed. He draws analogies to the regulations on tobacco that were necessary to reduce smoking. He also thinks that vending machines in hospitals  selling sweets and junk foods send the wrong message. At the time of the London Olympics in 2012, he criticized the choice of sponsors: writing that "In the context of an obesity epidemic I find it obscene that the Olympics chooses to associate itself with fast food, sugary drinks, chocolate and alcohol." His campaigns on these topics have brought him recognition and accolades including as a children's food hero in 2013, one of the top 50 BME pioneers in the NHS in 2013, one of London's brightest stars working in Science and Technology in 2014, and one of  the top 500 most influential people in the UK in 2016. Pioppi diet and low carb diet advocacy. The established consensus on what constitutes a healthy diet for the general population of adults in the UK is described in the NHS Eatwell plate Guidelines. The recommendation is for a balanced diet consisting of carbohydrates, protein and fat. This should include at least 5 portions of fruit and vegetables per day, meals based on higher fibre starchy foods, plenty of fluids, some protein, some dairy or dairy alternatives and limited amounts of fat, which should be unsaturated. Foods high in fat , salt or sugar, should be not be eaten often and should be eaten only in small amounts. The NHS makes the points that most people are overweight or obese and need to reduce the amount of calories they eat, and most people don't eat enough vegetables or fruit, fibre or fish. The guidelines also state that people should eat less red meat and less processed meat. The guidelines apply to the general population of adults: people with medical conditions should consult their doctor for individual advice and people with medical or dietary conditions may need to consult a dietician  to tailor the guidelines. Malhotra is a proponent of low-carbohydrate diets and in 2017 he co-authored a low carb diet book called the "Pioppi diet", which provides a 21-day eating plan. Malhotra's personal royalties from the book are donated to charity. The book recommends the daily consumption of two to four table spoons of extra-virgin olive oil, a small handful of tree nuts, five to seven portions of fibrous vegetables and low sugar fruits and oily fish at least three times a week. It advises people to avoid all added sugars, fruit juice, honey, and  syrups, packaged refined carbohydrates, in particular anything flour based including all bread, pastries, cakes, biscuits, muesli bars, packaged noodles, pasta, couscous and rice and seed oils. Very dark chocolate, butter, coconut oil, cheese, yoghurt are allowed. The moderate consumption of alcohol is allowed but only within the limits set by the NHS and a maximum of 500g of red meat per week is recommended in line with the recommendations of the World Cancer Research Fund. It promotes a higher fat intake with fewer carbs than the NHS reference intakes. The diet is called Pioppi after the Italian village recognized  as the home of the Mediterranean diet. The authors use the lifestyles of residents of the town to explain the principles of a healthier Lifestyle and the book also explains how policy changes are needed to change the obesogenic environment. The Pioppi diet book has endorsements from then Member of Parliament (MP) Andy Burnham and Dame Sue Bailey, Chair of the Academy of Medical Royal Colleges. Keith Vaz, who was the chair of the all-party parliamentary group on diabetes, promoted it to fellow MPs and then MP and Labour Deputy Leader, Tom Watson, lost seven stones in less than  twelve months by following the diet, putting his type 2 diabetes into remission in the process. The British Nutrition Foundation's response to the Pioppi diet explained that there is no single definition of the Mediterranean diet, which is generally considered to be a healthy way of eating. However they identified that the advice in the Pioppi diet to cut out starchy carbohydrates is not consistent with a Mediterranean diet which would include bread, pasta and rice. In addition, Mediterranean diets are normally low in saturated fat which is contrary to the advice in the book that people can eat  as much saturated fat as they like. Rosemary Stanton also says that in most traditional Mediterranean diets, bread would be a part of every meal. The Pioppi diet was listed as one of the "top 5 worst celeb diets to avoid in 2018" by the British Dietetic Association. According to the BDA and others, it is a new spin on a low-carb high fat diet that "hijacked" the term Mediterranean diet: substituting cauliflower for rice or pizza base and cooking with coconut oil are not parts of the traditional diet of the villagers of Pioppi. Saturated Fat, Cholesterol and  Statins. The UK National Health Service website on healthy eating states that "Too much fat in your diet, especially saturated fats, can raise your cholesterol, which increases the risk of heart disease". This advice is part of a medical and dietary mainstream consensus about saturated fat shared with the World Health Organization and the health authorities of many other nations. Current guidelines for doctors from the UK National Institute for Health and Care Excellence for reduction of the risk of cardiovascular disease include giving advice on lifestyle changes before prescribing statins. The UK National Health Service website explains to patients  that the lifestyle changes that doctors will recommend before prescribing statins include eating a healthy diet, exercising, stopping smoking, limiting alcohol and maintaining a healthy weight. Prof Mark Baker, Director of the Centre for Guidelines at NICE, stated that the use of statins in people with established heart disease was not controversial and expanding the prescription of statins to people with a 10% risk of disease was recent but based on robust evidence. Malhotra believes that saturated fat is part of a healthy diet: he is known to put a tablespoon of butter and coconut oil into his coffee. He  has attacked the standard advice on saturated fat consumption to reduce the risk of cardiovascular disease. Malhotra instead directs his attention to the effects of sugar and in particular to its role in diabetes. In 2017 Malhotra wrote an opinion piece for the "British Journal of Sports Medicine" which made the claim that saturated fat did "not clog the arteries" and that heart disease can be cured with a daily walk and "eating real food". The British Heart Foundation criticised these "misleading and wrong" claims and several researchers took issue with the methodology of the report on which Malhotra based  his claims. Prof Louis Levy, the head of nutrition science at Public Health England says "There is good evidence that a high intake of saturated fat increases your risk of heart disease". Malhotra denounces what he calls the government's "obsession" with levels of total cholesterol, which, he says, has led to the overmedication of millions of people with statins, and has diverted attention from the "more egregious" risk factor of atherogenic dyslipidaemia. He has questioned the worth of statins, saying they may not be of benefit to anybody. With Robert H. Lustig and Maryanne Demasi, Malhotra authored a 2017  article in "The Pharmaceutical Journal" which disputes the Lipid hypothesis, the link between blood cholesterol levels and occurrence of heart disease. The article was criticized by two medical experts, for being based on cherry-picked science and for creating the impression that most doctors don't believe that diet and exercise are as important as drugs, and that drugs and lifestyle changes are an either/or option. Cardiologist Tim Chico commented that "high cholesterol has been proven beyond all doubt to contribute to coronary artery disease and heart attack ... to say the cholesterol hypothesis is dead is simply incorrect." Rory  Collins, an Oxford medical professor, has also sharply criticised pronouncements about statins, and accused Malhotra of endangering lives. Rory Collins has been quoted as saying that scare stories about statins could be as dangerous to public health as Andrew Wakefield's bogus claims about vaccination and autism. Too Much Medicine. He believes that over-diagnosis and over-treatment is "the greatest threat to our healthcare system". He says that in the UK at least £2bn is wasted each year on unnecessary tests and treatment. He co-ordinated the Too Much Medicine campaign by the BMJ and the Academy of  Medical Royal Colleges. His claims are supported by Sir Richard Thompson a past president of the Royal College of Physicians. COVID-19. In 2020 during the COVID-19 pandemic and before there were any approved vaccines for COVID-19, Malhotra published a book claiming that following his dietary advice could grant "metabolic optimization" which would, in 21 days, decrease the risk of viral infection. David Gorski criticized the book because the biggest single risk factor for COVID-19 infection is age, which people cannot change. Gorski said that while Malhotra had a germ of a good point and that it was undeniable that  losing weight for someone who is obese would reduce their risk of complications, the claims about the book were massively exaggerated and there was no specific evidence for the impact of lifestyle recommendations on the risk of COVID-19 or that Malhotra's version of a healthy diet was better or worse than any other healthy lifestyle recommendation. Gorski was also concerned that telling people that they should be in control of their susceptibility to disease may have an element of victim blaming because that shifts responsibility for disease onto individuals, many of whom are unable to follow the kind of  diet Malhotra advocates. In November 2021, Malhotra appeared on GB News to discuss an abstract for an academic poster published by Steven Gundry and which the American Heart Association had warned may contain "potential errors". Malhotra claimed that the abstract supported "a significantly increased risk from 11% at five years, the risk of heart attack, to 25%." after taking mRNA vaccines against COVID-19. Full Fact warned that "Serious concerns have been raised as to the quality of the research".