"The focus has been on cholesterol, weight and burning calories—it’s all fatally flawed. The root cause driving heart disease and diabetes is insulin resistance. What drives insulin resistance is a diet that is high in sugar and refined carbohydrates" - Dr Aseem Malhotra
Dr Aseem Malhotra orders a double helping of cheese. At Li Veli, an Italian bistro in Covent Garden, he picks a plate of Italian cheeses as a starter and then tucks into aubergine Parmigiana, a gratin with mozzarella and Parmesan.
This isn’t a “sod the diet” day, though. Malhotra is a cardiologist, and this is how he thinks we should all eat. He puts grass-fed butter on his vegetables, and extra-virgin olive oil on everything else. And in his new documentary, The Big Fat Fix, he sets out why fat is not the enemy but sugar is, and how refined carbohydrates—white bread and white pasta—are false friends, to be consumed only in moderation.
“Some people have an outdated fear of fat,” the 38-year-old says. “It’s nonsense. We’ve got better data than we had years ago when it was said that fat was the problem. Full-fat, non-processed dairy is good for the heart and fat keeps you fuller for longer.”
What about the old bogeyman of the food industry, saturated fat? “There are different types. Extra virgin olive oil—amazing for health—has about 14 to 20 per cent saturated fat. We should move towards food-based, not food-group, guidelines.”
Malhotra dismisses the current health consensus: “The focus has been on cholesterol, weight and burning calories—it’s all fatally flawed. The root cause driving heart disease and diabetes is insulin resistance. Insulin is a hormone that helps control glucose levels in the blood. What drives insulin resistance is a diet that is high in sugar and refined carbohydrates.”
In The Big Fat Fix, Malhotra travels to Pioppi, southern Italy, where residents enjoy longevity and a healthy old-age with low rates of heart disease, diabetes and dementia. Britain’s bastardisation of the Italian diet means we think pizza and pasta. It doesn’t. It means oily fish and lots of vegetables. Pizza is a once-a-month treat; pasta is a starter. And in Pioppi, even a rare pudding is cooked in olive oil.
The Pioppi Protocol should be our dietary model, Malhotra says. His first advice to patients (he works at the Lister Hospital in Stevenage) is that they should eat a handful of nuts a day. Then they should cut all processed and refined sugar. They should never buy anything marked low-fat but should eat lots of vegetables and oily fish, which is high in Omega 3. Counting calories is out, too. “It’s the quality of the calories you are eating that matters, not the number,” he asserts.
The effects, he says, are dramatic: “I don’t mean weight loss—although you may lose weight as a side-effect—I mean with health. We should focus on health; the weight will correct itself.”
Even the slim should heed this advice. Many have the “illusion of protection”, Malhotra says, because they aren’t struggling to button up their jeans. “Many of my patients’ measure of success is their weight and doctors focus too much on it, too. There’s no such thing as a healthy weight. Forty per cent of people with a normal BMI will still get lifestyle diseases. The biggest risk factor for them is waist circumference.”
Malhotra was not always this way. He used to eat sugary cereal for breakfast. Finding himself starving at 11am, he would reach for a KitKat. For lunch he might have pasta, while dinner could be a curry with lots of rice. Since changing his diet, he has lost a stone—and it is all from around the waist. What changed his view was seeing, as a junior doctor, the pressure on England's National Health Service. “There was ever more misery, ever more people who were overweight or with type II diabetes.” He believed our dietary advice must be wrong, started investigating and noted conflicts of interest in the promotion of a low-fat diet. “I have been eating and sleeping this for five years.”
The Big Fat Fix also looks at exercise (there is even a training montage). Previously, Malhotra was a drive-to-the-gym-and-pound-the-treadmill type. But then he spoke to orthopaedic surgeons, who said they were seeing people in their forties needing hip and knee replacements, and that no one should run on the pavement, or even treadmills.
Now he does a lot of squats, and focuses on compound movement. “Try not to sit for more than 45 minutes at your desk. Just stretch for 15 seconds or do a squat. For heart health, keep moving. Do what you enjoy: whether it’s cycling or walking.” In Pioppi there are no gyms. “If you look at the Mediterranean culture in the film, they walk everywhere. These people are living until 90!” He also reckons we should have more sex—to reduce the odds of heart disease, obviously.
He is frustrated that so much focus is on working off calories. “It angers me that people are measuring how many they burn on a treadmill. The body doesn’t work that way. The amount you burn from exercise is minimal compared to what people eat. If you want to put on weight, we tell you to exercise because it increases appetite.”
He calls for a revolution in how we think about energy from food. “About 75 per cent of the calories we burn are just for keeping your organs going. I need energy for my brain, my heart. I don’t want to be fuelling that with stuff that’s going to give me heart disease and type II diabetes. The idea that it doesn’t matter where the calories come from, you can just burn it off, is nonsense.”
Malhotra’s mission now is to take these messages to the masses. “A doctor’s duty goes beyond individual patients, to the whole population.”
What the doctor prescribes
* Fat is not the enemy: cheese and butter are off the banned list, and olive oil and nuts are your dietary new best friends
* Stop counting calories. What really matters is the quality of the calories you eat
* Cut out processed and refined sugar. You can still eat fruit, but try to get the majority of your five-a-day from vegetables
* Reduce your consumption of refined carbohydrates by eating as the Italians actually do—pasta is not a main course and pizza is a treat
* If you sit at a desk all day, set a timer and every 45 minutes do 15 seconds of stretching, a squat or walk to the water cooler
* To combat stress, get 10 minutes a day (you can break it up) of deep breathing or tai chi exercises, where you switch off