Processed Food and Modern Medicine With Robert Lustig


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Katie: Hello, and welcome to the “Wellness Mama” podcast. I’m Katie from and That’s Wellnesse with an E on the end. It’s my new personal care line. And I am here today with someone whose work I have followed for a very long time. Robert Lustig is a professor of pediatrics in the division of endocrinology and a member for the Institute for Health Policy Studies at the University of California at San Francisco. He has authored 130 peer-reviewed articles, 80 academic chapters and reviews, and dozens of other papers. His 2009 YouTube lecture, “Sugar: The Bitter Truth,” has accrued 12 million views and is how I first found him. And he’s the former chairman of the Obesity Task Force of the Pediatric Endocrinology Society, as well as many more things. His resume is long. And I have him here today to talk about his new book, “Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine.” And it is really, really well written. I got to read an advanced copy.

In this episode, we go deep on topics like what it means to actually be metabolically healthy, the things you might be accidentally eating that are poisoning your mitochondria without knowing it, why things like dementia are on the rise so much, and how this directly relates to food, how disease is actually just a symptom of the actual problem, and eight factors that you may or may not have even heard of that really directly contribute to your health. And these are especially important right now, in general, as we’re seeing rates of so many problems skyrocket and also when it comes to overall health and susceptibility to any kind of illness. He makes a really strong case, as controversial as it may seem to some, for why there is no place for sugar and processed food in our lives. And I think that you will find this episode both fascinating and challenging. Without further ado, let’s join Dr. Lustig. Dr. Lustig, welcome to the podcast.

Dr. Lustig: Thanks so much for having me, Katie. My pleasure.

Katie: Well, I’m excited to chat with you. I’ve known of you for years and your work around sugar. You have some great resources related to that, that I’ll make sure are linked in the show notes. But I’m most excited to chat with you now, because of your new work that I got a preview copy to read called “Metabolical.” And you go deep on a lot of topics in this one. But to start broad, can you kind of walk us through the ties to everything that’s happening, specifically right now, and why this was such an important work for you to put out?

Dr. Lustig: Well, in a nutshell, we haven’t fixed the problem. We’ve had a problem now for the last 50 years of chronic disease and environmental collapse if you will. And everything’s coming to a head right now. And the problem is that people don’t understand the relationship between the two. They don’t understand how our chronic disease and our environmental problems, and in fact, our economic disaster that currently has befallen us vis-à-vis COVID are related to each other. In fact, they are one and the same. We don’t have three problems, we have one. And it’s a big one. And actually, believe it or not, starts with the food. Now, you can say, well, the virus has nothing to do with the food. Actually, it does. And our immune systems are not dealing with this virus in part because of our food. And you can look around the world at what countries are doing better than us and you can see that all the countries that are metabolically ill are doing worse and those countries that are doing metabolically better are doing better. So, in fact, there is a relationship between our food, our health, our economics, and our climate.

The question is, what’s wrong with the food? And the argument that I make in the book is that it’s not what’s in the food. It’s what’s been done to the food that matters. And you can’t figure that out from any food label because they don’t want you to know what’s been done to the food. So you can’t actually reverse engineer your diet based on what you read in the store. So this is the crux of the problem. Food processing is the problem. All food is inherently good. It’s what we do to the food that’s not. And what I do in this book, “Metabolical” and the subtitle of it is “The Lure and the Lies of Processed Food Nutrition in Modern Medicine,” is actually take people through from the molecular, all the way to the planetary view, and through the last 50 years of what has happened to our health, what has happened to our healthcare, what has happened to our environment as our food has been changed under our eyes and with our tacit approval. And when you understand what the real problem is, then you can solve it. You cannot solve a problem if you don’t know what the problem is. And for the last 50 years, we have been trying to solve the wrong problem.

Katie: Yeah, that really struck me in your writing. And you mentioned the countries being metabolically better off or worse off than we are. And I think this is such an important conversation around the idea of what does it actually mean to be metabolically healthy? Because I think it’s no secret that we’re seeing, for instance, obesity is drastically on the rise, most chronic diseases are on the rise. Same with the big killers like cancer and heart disease. We know these problems are happening. And I completely agree with you that we’re trying to solve the wrong problem and that’s why we haven’t solved it. But what does it mean to be metabolically healthy? Like, when we look at us versus other countries or even individuals kind of on that scale, what are some of the metrics of being metabolically healthy?

Dr. Lustig: So I can explain it to you in a cellular biological way, and I can explain it to you in a more medicine way, and I can explain it to you more in a holistic way. So, let’s start with the cellular way. To be metabolically healthy means to have mitochondria that work. And right now, our mitochondria don’t. All the chronic diseases that we know of, type 2 diabetes, hypertension, lipid problems, cardiovascular disease, cancer, dementia, fatty liver disease, these are all diseases of mitochondria. And when your mitochondria don’t work, you don’t work. And the problem is that food is supposed to make your mitochondria work, except that there are certain things in our diet that actually poison mitochondria. And so, understanding what those chemicals are, and some of them are listed as food, the most important one, of course, being sugar and the second most important one being trans fats, but we know that and so they’re coming out of our diet already, but sugar’s not, these actually make our mitochondria not work as well. So, that’s the cellular biological construct.

From a medical construct, we have all of these diseases and they’re all getting worse, including dementia. The fact is that when you fix the food, all these diseases reverse. And when you understand the pathways of these diseases and how these diseases come to being, what you realize is that the disease itself is not really the problem. The disease is the symptom of the problem. So, high LDL. High LDL is not the problem, it’s the symptom of the metabolic dysfunction. High glucose. High glucose is not the problem. It’s a symptom of the metabolic dysfunction. High blood pressure, symptom. Osteoporosis, symptom. In every single case, these are the symptoms of the problem. The real problem is lying underneath. Okay? So in order to fix a problem, you have to work upstream of the problem. So you have to understand where the pathology is.

So right now, I’m going to give you eight terms you have never heard of. And these are the eight subcellular pathologies that belie all these chronic diseases. And none of them have an ICD 11 code. None of them are billable. And most importantly, none of them have a medicine. And here they are. Number one, glycation, number two, oxidative stress, number three, mitochondrial dysfunction, number four, insulin resistance, number five, membrane instability, number six, inflammation, number seven, methylation, and number eight, autophagy. Now, none of those are billable. None of those are anything that a doctor knows about because there’s no medicine for it. None of those are druggable. They’re all foodable. You can fix all of those with food, but we’re not. And that’s why we’re all sick. And so, by giving somebody a statin, all you’re doing is papering over the problem. By giving somebody an antihypertensive, all you’re doing is temporarily fixing the problem. It’s like giving an aspirin to a patient with a brain tumor because they have a headache. Okay? It might help their headache, but it’s not solving their brain tumor. So this is what’s going on throughout all of modern medicine. This is what chronic disease is and does. And we doctors aren’t touching it.

And so, then finally, we have the societal problem, you know, the planetary view. we have climate immolation in part, you know, not solely, but in part because of our current food supply because we have advocated the idea of real food for processed food. And in doing so, we have created a monoculture food system where the cattle are in Kansas and the corn is in Iowa. So, the cattle make the manure and the manure make the cattle sick. And so we have to give them antibiotics, which then poisons their gut and ours. And the corn in Iowa would normally have been fertilized by that manure, but since there’s no manure, we have to spray them with nitrogen fertilizer instead and the nitrogen runoff leads to nitric oxide. And that ultimately causes a global warming, climate change, and algae blooms, toxic algae blooms, and destroys waterways, and it’s changing the temperature in the oceans.

So, all of this comes from this notion that we can, you know, grow our food, and I mean that with animals too, in this willy-nilly fashion, basically, ignoring the precepts that kept us alive for zillions of years. And in the process, we are not just getting sick metabolically, our whole planet is getting sick in the process. So, how do we reverse that? And that’s what the book is about, is to explain how all the stakeholders benefit by changing from processed food to real food, how everyone actually wins. And it’s like the Arab-Israeli conflict. There are too many stakeholders. You can’t find a situation that works for everyone, except that there is. There is one that works for everyone. But they have to be shown how. And so this book is hopefully going to point people in the right direction and be able to get people to sit down with the same set of facts and talk to each other about how to fix our broken food system so that we can fix ourselves, our healthcare system, and our planet.

Katie: Yeah, I think this conversation is more necessary than it ever has been. And I agree, people have heard me say on here before, you are your own primary healthcare provider. We are each individually responsible for…And the majority of factors, like you just explained and, like, we’re gonna go deeper on, is we each choose what goes in our body multiple times a day, every single day. It’s important to work certainly with practitioners if you have a chronic condition who know what they’re doing and who can be your partner in that. But at the end of the day, the responsibility lies with each of us. And you make such a strong case for how together, and individually, we can make a really drastic change that is absolutely critical right now.

And it drives me nuts. I’m sure you’ve seen some of this as well. I’ve seen these going around that, you know, food doesn’t really affect your chronic disease risk or your risk of getting any particular virus, including the one going around right now and that that’s not a big factor, sugar doesn’t matter. And it frustrates me. I can only imagine how frustrated that makes you. But just give us a little more clear detail on…because I know we now know that, we know the connection between any kind of metabolic dysfunction and higher risk from more severe outcomes of almost any disease. So for me to see marketing that it doesn’t matter, it’s so frustrating, and I’m sure frustrating to you as well. But why is that so important right now?

Dr. Lustig: Well, right now we’ve got this COVID crisis. Okay? So everybody’s got, you know, their eyes on, you know, that prize and appropriately so. I’m not in any way belittling the COVID epidemic. If anything, I’m trying to help fix it. I think that the NIH and the CDC have actually made things worse. I think that they have done us a severe disservice. And here’s why. They’ve told us three things that we need to do: masking, social distancing, hand washing. And I’m all for all three of those. No problem there. But they left out the fourth, and they left it out on purpose. The fourth is eat real food. Now, why does processed food matter for COVID? Well, here’s what we know. There are three groups, aside from the elderly, who have their own reasons for immune dysfunction. Aside from the elderly, there are three demographics that have an increased morbidity and mortality with this virus, people of color, the obese, and those with diabetes. Those are the patients who get the sickest and who end up in the ICUs, and who die at a greater frequency than everyone else. Okay? Everyone is in agreement with those things.

Question is what do those three demographic groups share? They share process food. That’s what they share. So why? Well, people of color, processed food is cheaper. No argument there. We understand that. Here’s the issue. There is a portal on each of your cells in your body. And that portal is where the virus injects the RNA into the cell so that the cell can be ultimately taken over by the virus and then the virus spreads throughout the body. That portal is called ACE2, A-C-E 2, angiotensin-converting enzyme 2. This is an endocrine receptor that’s involved in water balance in each cell. And each cell, of course, needs to have their water balanced or it will swell and die. So, this is a ubiquitous receptor that is throughout the entire body. And the virus is very ingenious and has figured out how to use this receptor as its injection point.

Well, turns out that insulin, the hormone insulin and all of these people are insulin-resistant, that’s the definition of being metabolically ill. And 88% of America is metabolically ill because they have a high insulin. Turns out insulin increases the number of ACE2 molecules on each cell. And what that’s doing is that’s increasing the risk that any individual cell is going to take up the virus, and ultimately, cause it spread throughout your body. So, you are increasing your infectivity of this virus by eating crap. Second, we now know that the reason you die from this virus is not the virus itself. It is from the immune response, what we call the cytokine storm. So when you get sick with say, a cold, or even the flu, you know, you mount a cytokine response in an attempt to try to kill off the cells that have that virus in order to clear that virus from your body.

But if you’re unable to do it, then your immune system has to ratchet it up and ratchet it up and ratchet it up and make you sicker and sicker in an attempt to try to get rid of that virus, and in the process ultimately kills you. It is the cytokine response, the proteins that basically kill cells, it is that response that ultimately kills you. And it turns out that you need to be able to modulate down that cytokine response. And the thing that helps you do that are something that comes from your gut called short-chain fatty acids. And short-chain fatty acids are anti-inflammatory. They’re also anti-insulin. And so, if you make a lot of short-chain fatty acids, you will be in better metabolic shape. So where do you get short-chain fatty acids from? You get it from the digestion of fiber. Soluble fiber. Well, our food is devoid of fiber because processed food is fiberless food. So we’re not getting the thing we need in order to be able to make the short-chain fatty acids in order to be able to damp down the cytokine response. Therefore, we are in much worse shape handling this virus.

And then finally, number three, turns out diabetes, high blood glucose, the glucose molecules crystallize around that ACE2 opening and hold it open so that the virus has an easier time injecting anyway. And so, it actually increases the risk of infectivity and virus burden as well. So the higher your blood glucose, the worse off you are. And, of course, how’d you get that high blood glucose? Well, because you’re metabolically ill from the food. So, three different ways, ACE2, short-chain fatty acids, and high blood glucose holding open the portals. Each of these are related to our processed food diet. And we have shown, in our studies, that we can fix that metabolic risk in people in nine days just by taking the sugar out of their diet. So, that’s pretty significant. And I think that the CDC and the NIH have been remiss and have actually done us a disservice in not explaining this to the general population.

Katie: That is a lot shorter than I expected you to say, only nine days because that was gonna be my next question is how long does it take? I’m sure we can’t fully undo all the metabolic damage in nine days. But to reduce those risk factors, that happens that quickly?

Dr. Lustig: Well, we can get the fasting insulin down by 25% in 9 days.

Katie: So obviously, processed food, you’ve made a strong case, and in the book even a stronger one for why that’s the thing we need to be most cautious about. Are there any other…Like, are you restricting carbohydrates during that period or is it just turning to real food? What other guidelines are you using?

Dr. Lustig: So, the book doesn’t discuss specific diets, you know, or endorse any specific diet. What I basically say is there are different ways to get your insulin down. There are different diets that work. Any diet that gets your insulin down works, but any diet that gets your insulin down is real food. So it doesn’t matter if you’re vegan or keto or anything in the middle, paleo, Mediterranean, you know, I mean, there’s a zillion diets that work. And the problem is that every dietitian has a diet to sell you. Every nutritionist has a diet to sell you. Every doctor pundit on TV has a diet to sell you. I don’t have a diet to sell you. Okay? A lot of different diets work and I don’t really care what diet you’re on as long as it’s real food. The only diet that doesn’t work is the processed food diet. And that’s the diet, unfortunately, that America is selling. And that is our problem. And unfortunately, we’ve been buying it. And the reason we’ve been buying it is because the food industry knows how to make that processed food diet addictive, add the sugar.

Katie: Yeah. That was the next thing I really wanted to touch on with you because you talk about that in the book about it being, like, not just as a way of saying that, but truly, like, addictive within the body. Like, there’s a whole hormone response that’s happening to that, that it actually becomes truly addictive. And as a mom, this really raises concern for me because I think most of the things that are considered kid food, which I hate even that word, but that are kid food in our society are extremely processed food. And we’re teaching our kids at a very young age to like those foods and then starting, kind of, that whole addiction pathway. But I know you’ve explained this, you’ve even explained this years and years ago when hearing you talk about sugar, but explain what’s happening biochemically that these foods can become so addictive so quickly.

Dr. Lustig: Well, we now have data, this data came out from the Monell Chemical Senses Center in Philadelphia that it’s already programmed into your tongue before you’re even born based on what mother consumed during the pregnancy. So we always assume that the sweet molecule and sugar called fructose doesn’t reach the baby. That was always the assumption. And the reason we assume that is because the placenta doesn’t have the transporter for fructose called the GLUT5 transporter. That’s true, it doesn’t have the GLUT5 transporter. It has the GLUT7, 9, and 11 transporters, which actually do it even better. Now the GLUT5 transporter is the one that is fructose-specific. So everyone assumed it’s the one that’s fructose only. Turns out that’s not true. There are other transporters that can do it also. And the placenta’s got plenty of them. And there are now data that show that what mother ate and what mother likes is what ends up being what baby likes, even right out of the box, in terms of newborns.

So, there is some pre-programming, there’s some developmental programming that’s going on within the taste, the gustatory, and also, you know, the hypothalamus, the systems in the brain that are actually driving this later on. So it’s not just what you feed the baby, it’s what you feed the pregnant mom before she even gives birth that matters. And that means that we have to fix all the food across the board. It’s not just the baby food, but it is the baby food and it’s the baby food for several reasons. Number one, your baby has to grow. All right, well, turns out that in order to grow, you need oxygen. And in order to have oxygen, enough oxygen, you have to have an airway. And if you don’t have a big enough airway, you’re gonna end up with obstructive sleep apnea. And we now have babies and certainly young children who have obstructive sleep apnea because their airway didn’t grow.

The question is, why didn’t their airway grow? The answer is because they didn’t grow their mouths, their palatal vault, the hard palate wide enough because they didn’t put enough pressure on it from their tongue during human breastfeeding. Turns out bottle feeding, using that different nipple, doesn’t generate nearly the pressure to grow the incisive suture that’s in the hard palate in order to be able to increase the width of the palatal vault in order to be able to increase the width of that airway. So, breastfeeding, we know is better than bottle feeding. And, of course, fructose because it poisons mitochondria causes you not to be able to utilize that oxygen.

And then number three, after breastfeeding is over, What do we do? We give these kids pureed food. And it turns out pureed food is a problem also because the kids don’t have to chew. And chewing is actually very important for growing that airway also. So there are four muscles, the masseter, the temporalis, and the medial and lateral pterygoids. And those get stronger and bigger and pull the airway apart to make it larger when you chew. So if you go back before there was baby food, before there was Gerber, before there was Beechnut, before there was Carnation, you know, those started in 1901. But, you know, there were thousands of years where mothers had to give their babies, or, you know, their toddlers, food. How did they do it before they even had teeth? What was the method?

The mothers would actually pre-masticate, they would chew up a little bit of the food, and then they plop it in the baby’s mouth. Birds do this. And we used to do this too before there was baby food. And the kids would gum it to death. And that actually increased the strength of these muscles making that airway wider. And I can prove that this is the case because you can go back to dental fossils from, you know, pre-baby food days, and the chin, the mandible, the size of the jaw is markedly increased in size compared to what’s going on today. And I can prove it societally because there’s one facial hairstyle that came in the 1970s and has never left. You know, we had mutton chops, and we had sideburns, and we had goatees, and Van Dykes, beards. Beards never left. And the reason is because they’re hiding short chins. So, we even have a cultural societal marker for this problem. And this is a sign that, you know, our entire airway has been compromised, which then creates the risk for chronic disease later on in life, all related to the food, all related to processed food.

Katie: Wow. That’s fascinating. I would never have connected that about the beards, but the airway…

Dr. Lustig: Well, this is Wellness Mama, so you gotta know what you’re doing to your kid.

Katie: Yeah, I understood the airway and oxygen and chewing connection. And probably 12 years ago now I read Dr. Weston A. Price’s “Nutrition and Physical Degeneration.” And he talks a little bit about that chewing and the jaw structure. And he has pictures of how drastically different people on more natural diets, how their jaw develops differently. So I was aware of that. I had just never thought about…the beard thing completely makes sense. I would assume obviously preconception would be the best time to start. And if you’re gonna reverse that, is that part reversible in those of us who are already adults or who have kids who are already born?

Dr. Lustig: Well, it’s semi-reversible. I mean, you can’t…Once the cartilage in the mandible is fixed and once the maxilla has expanded to whatever its maximum capacity is, and then it fills in through what’s known as cancellous bone growth, you can’t make it bigger except by surgery. But, you know, people have jaw-expanding surgeries. If you get to kids before puberty, you can use appliances like Crozats to try to grow the width of the palatal vault by applying pressure against it in an attempt to try to increase the airway size. And so this is something now that, you know, pediatric orthodontists are all over and realize that, you know, in fact, they need to start seeing babies before babies even have teeth. They need to start seeing babies at 6 months of age. And there’s actually a white paper from the pediatric orthodontic society saying that they need to start seeing babies before they even have teeth in order to make sure that the airway is patent and expanded as much as possible.

Katie: Yeah, I’ll put a link. I’ve done that a little bit with my kids as well. Thankfully, I did know quite a bit about fat-soluble vitamins so I was careful about that. And I really didn’t consume too much sugar when I was pregnant, which I’m even more grateful for after reading your work. And when you talk about food being addictive, and I agree with you, I’ve seen that in my own life when I changed my diet and certainly with other people as well there, I mean, it seems to be an incredibly addictive substance. It’s certainly encouraging to hear that it could take as little as nine days to break that cycle. But any other tips for the actual process of breaking that cycle? Is it pure willpower or considering what sugar does to the body and that whole biochemical cascade, are there other things we can do that are supportive in that switch and making sure that our body’s being properly nourished while we’re trying to break that cycle?

Dr. Lustig: Right. That’s a very good question, Katie. And what I can say is, you know, this is addiction medicine we’re talking here. And physicians, and dietitians too, have to understand the addiction model and the addiction paradigm in order to be able to help people through this. They need their hand held whenever they try to come off process food, and they need to…you know, they can’t be left to their own devices for the exact same reason you couldn’t leave a heroin addict to their own devices and expect somehow they’re gonna get off heroin without any outside help. All right? This is an addiction model and it is those first five days of sugar restriction that, you know, basically, tank virtually every diet that, you know, anyone gets started on. And the reason is because the processed food diet is loaded with sugar and it’s loaded with sugar on purpose because the food industry knows when they add it, you buy more. And I can prove it culturally. There is a phenomenon called price elasticity. You ever heard of that? Price elasticity?

Katie: Yes, I’ve heard of it a little bit. Yeah.

Dr. Lustig: So, this is the phenomenon, the economic phenomenon, you know, economists measure this, where if you raise the price of a given food, then that food should end up being consumed less. So you raise the price, consumption goes down. Now, if you raise the price 1% and consumption goes down 1% that means you have a price elasticity of 0. If you raise the price 1% and people still buy exactly the same amount, then you have a price elasticity of 1.0. Okay? So 0 to 1.0. The most price-inelastic items in the grocery store are fast food, soft drinks, and juice. What do all three share? Sugar. So, when the price goes up, you barely blink an eye, and you’re willing to fork over your hard-earned dollars, despite the fact that the price went up. The most price-elastic item in the grocery store is eggs. So, when the price of eggs go up, people stop eating eggs because there’s no sugar in eggs.

So, in fact, the food industry adds the sugar to the food because they know they can add it and you will buy more. That is their hook. That’s their gravy train. That’s why the food is just overladen with sugar. It didn’t used to be but it is now. And the reason is because the food industry figured out that we like it. And we don’t just like it, we’re addicted to it. And the data in the literature, not just my data, you know, Ashley Gearhardt, Nicole Avena, many scientists on this side of the Atlantic…by the way, the Europeans do not believe this, and it’s interesting why. There was just a debate in the American Journal of Clinical Nutrition about this, and we can talk about that if you want.

But in America, we’re very clear on the fact that sugar is addictive. And that’s why all the food has sugar. The problem is that the fructose, which is the addictive molecule, is also the molecule that poisons the mitochondria and causes them to not work as well. So you end up having both the toxicity, and the addictiveness, and the ubiquity, and, of course, the effects on other people. And all of those are the criteria for needing regulation. And so, that is one of the reasons that I have been arguing for changing the food supply, possibly through taxation and through other methods for trying to alter the composition of specific foods and holding the food industry accountable.

Katie: That makes complete sense.

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Another thing you touch on in the book that I think is really important to highlight is kind of this false dichotomy and false war, I think, as you call it, between these different dietary approaches. And I appreciate you saying you don’t have just a prescriptive diet because certainly my own journey has been realizing that there is so much individualization and personalization when it comes to diet that once you get rid of the junk, there’s still experimentation to figure out what exact combinations and foods are gonna help you feel your best. And so it frustrates me when someone says this is the exact protocol, just follow it to a tee, eat what I eat, and you’ll look like me. It doesn’t seem to work like that.

But there does seem to be, kind of, this false dichotomy that seems like a distraction between all of these more dogmatic approaches, fighting for their way being the best. And what I’ve noticed over time, kind of stepping back from that is that when you look at it, almost all of those are aligned. Like you mentioned, the Mediterranean, and keto, and even vegan, and paleo, they’re all aligned on many, many things. And they’re also all very anti-processed food. But rather than focusing on the commonalities, it seems like people tend to get into battles over the little bits of differences. And you bring this up in the book. So, walk us through why this is a false war and why it’s distracting from the real point.

Dr. Lustig: Ultimately, you gotta get the insulin down. Okay? That’s it. You gotta get the insulin down. Well, there are two ways to get the insulin down. Don’t let it go up or don’t let it get absorbed. Okay? I’m sorry, don’t let the carbohydrate get into your bloodstream and don’t let it get absorbed. So you can either remove it from the diet, that would be called the ketogenic diet, or you can inhibit its absorption at the level of the gut. And that’s called the high fiber diet. Because sugar is the thing that makes you sick and fiber is the antidote. So, a low-sugar, high-fiber diet works. A high-sugar, low-fiber diet doesn’t. A low-sugar, high-fiber diet is called real food. A high-sugar, low-fiber diet is called processed food. Now, within a low-sugar, high-fiber diet, you can have a ketogenic diet, or you can have a vegan diet, or you can have a Mediterranean diet, or you can have a paleo diet, or you can have, you know, a South Beach diet. You can have a host of different diets if you really wanna be on a diet. And to be honest with you, I don’t think anybody really wants to be on a diet. And the fact of the matter is, you don’t have to be on a diet. Okay?

The two things that you have to be careful of are the amount of sugar and the amount of fiber. And if you eat a low-sugar, high-fiber diet, you are solving your metabolic perturbation. Whether you are on the extreme at the keto end or you’re at the extreme on the vegan end is irrelevant. And by the way, you can do keto wrong and you can do vegan wrong. I mean, Coke, Doritos, and Oreos are vegan, all right, but they’re not low sugar, high fiber, they’re high sugar, low fiber. So, just being vegan doesn’t mean anything. So, I’m not against veganism, per se. I think it’s a choice. I think that if you wanna be on a vegan diet, that’s fine, although you may have to supplement certain B vitamins and certain Omega 3 fatty acids. That’s fine if that’s what you wanna do. If you wanna be keto, that’s fine too, as long as you eat some green vegetables to go along with it to up your fiber content. So, I think there are ways to do it right and I think there are more ways to do it wrong.

And I think people don’t understand what those diets are for and why they work when they work. And the fact is, most people don’t stay on a diet because Christopher Gardner showed very nicely in his A to Z study that virtually everybody who goes on a diet, two months later, they’re not on that diet because all diets regress to the mean because you basically slip. So I’m not for slipping. I’m for, you know, basically powering through. But you don’t have to power through with one specific diet. You just have to get rid of the sugar and make sure you’re eating enough fiber and you will fix your metabolic problem.

Katie: What do you say to the people because I’m guessing there are some listening right now who are thinking, “Well, that sounds too extreme, and, “Everything in moderation,” and, “Sugar should be fine in moderation,” or, “I have a friend who stays thin and she eats sugar?” Kind of I know those objections come up when I talk about sugar and why there’s truly no dietary or biological need for it whatsoever, that we get plenty of carbohydrates like you mentioned paired with fiber in foods like fruits and vegetables, but how do you respond to people who say that?

Dr. Lustig: Right. So basically what they’re doing is they’re just reverting to this notion that it’s about calories. So, when you talk about the fact that you can have sugar, what you’re saying is you can have discretionary calories. What we’ve learned is that calories don’t work. Calories are a mistake. Calories were a canard. Calories never made sense. And my job is to kill the calorie because it was never an appropriate measure of what’s in the food or what the composition of the food is. All of the issues that we are talking about have nothing to do with calories. Let me give you an example. Alcohol has calories. Is alcohol a food?

Katie: That’s an interesting corollary.

Dr. Lustig: Is alcohol a food? It has calories.

Katie: Yeah, but technically, no.

Dr. Lustig: Okay. There’s no diet on the planet who would say that alcohol is a food, but alcohol has calories. Well, sugar has calories, but sugar is not a food either for the same reason. In fact, sugar is metabolized virtually identically to that of alcohol. And that’s why kids today are getting the diseases of alcohol without alcohol. Fatty liver disease and type 2 diabetes used to be the diseases of alcohol. Today, you know, 10-year-olds get it. And the reason is because your liver can’t tell the difference. For alcohol, the big difference between alcohol and sugar is that for alcohol, the yeast does the first step of metabolism called glycolysis. For sugar, we do our own first step. But after that, it doesn’t really matter where it came from. The liver handles it exactly the same. And when you overload your liver mitochondria, then your liver has no choice but to take the excess and turn it into fat. And that’s where the liver fat comes from. It comes from sugar. It’s not from eating fat. It’s from eating sugar and converting it to fat, a process we call de novo lipogenesis, new fat making. And this is what’s going on in the liver. And it happens with alcohol. And it happens with sugar.

And so, sugar and alcohol are virtually identical. And no one would say alcohol is dangerous because it’s calories. Alcohol is dangerous because it’s alcohol. Well, sugar is not dangerous because of its calories. Sugar is dangerous because it’s sugar. It’s not about the calories. It’s about the biochemistry of the compound itself, which has nothing to do with its calories. Another example, trans fats. Trans fats have the exact same caloric content if you burn them in a bomb calorimeter as Omega 3s. Omega 3s will save your life. Trans fats will kill you. Omega 3s are the single most important thing you can put in your body. Trans fats, there is no acceptable amount of trans fats that is okay for your diet. Every trans fat you eat knocks off a few more cells. Okay?

It is a quantitative poison. But it’s 9 calories per gram, just like Omega 3s are because it has nothing to do with the calories. It has to do with the biochemistry of the molecule. And I can do this until the cows come home, Katie, explaining the difference between the biochemistry of a specific nutrient and its calories, and they have nothing to do with each other. So, this notion that you can eat in moderation because you are afforded discretionary calories is a friggin joke. Okay? But it is a joke that the food industry continues to promulgate because that’s their gravy chain, that’s their juggernaut, and that’s what keeps you coming back for more. And that’s what gives them license to be able to put whatever they want in the food. And that’s what gives them the ability to deny culpability.

Katie: To highlight something you just said, I think is really important that we’re seeing kids have the diseases of alcohol, especially related to the liver. And you talk a lot about the liver in this book. And I think that’s a really important piece that is not focused on enough and that you’re doing a really good job of educating about. You’re talking about things like non-alcoholic fatty liver disease, and how eating fat doesn’t cause that, eating sugar does. But I think especially for the parents listening, this is really, really important to understand because that’s metabolic dysfunction that’s happening at a very young age. And that is harder and harder to reverse the longer it goes on. So, what are some ways that we can specifically support the liver both in those of us as adults who maybe have already experienced some of these problems, and then especially in our kids to make sure they don’t?

Dr. Lustig: So, in the book, I asked the question, chapter 11, “What is healthy? How do you define healthy?” In fact, the NIH can’t define it. The USDA can’t define it. The FDA can’t define it. There is no definition of healthy, except there is. Okay? The problem is they don’t know what it is. So in the book, I explain to you what the definition of healthy is. And it is two things. And they’re very simple, except they’re not so simple. And here they are. Number one, protect the liver. Number two, feed the gut. Protect the liver means no liver fat and, therefore, normal insulin sensitivity. Feed the gut means let your microbiome do the work and generate those short-chain fatty acids to be anti-inflammatory, anti-insulin, and also so you don’t get leaky gut to lead to inflammation, which also causes insulin resistance. Protect the liver, feed the gut. Any food that does both is healthy. Any food that does neither is poison. Any food that does one or the other, but not both, is somewhere in the middle.

Example, apples versus apple juice. So, it’s the exact same food, isn’t it? Apples and apple juice, aren’t they the same? No, they’re not. Why not? Because apple juice is missing the fiber. The fiber set up a barrier on the inside of the intestine that protected the liver. The apples had it, the apple juice doesn’t. So, the sugar in the apple juice floods the liver. It does feed the gut because they’re soluble fiber still in the apple juice. So, it’s somewhere in the middle. It’s not as bad as soda but it is certainly worse than apples. And if you look at the data on glucose excursion and insulin response between apples, apple sauce, and apple juice, where do you think apple sauce comes down? Is it more like apples or is it more like apple juice?

Katie: I guess maybe more like apple juice.

Dr. Lustig: It’s more like apple juice. That’s right. So, in fact, even simple processing alters the biochemical effects in the gut and ultimately altering what’s happening to the liver and to the intestine. So, it is the food processing, not the food itself that matters. And the problem is you can’t know how the food’s been processed by reading the label. The label is essentially useless. And what I think is we need a new label, not what is in the food, but what’s been done to the food. And the more things that have been done to the food, the more you need to leave it on the shelf.

Katie: It seems like it also goes back to that simple idea of just shopping the outside of the grocery store and buying food that is ingredients not that has ingredients because if you prepare it at home, you have a lot more control over what happens to it. I think that’s one of the silver linings, at least I’ve seen in my own little community, of the past year and the lockdowns and all the changes is that people are, in a lot of areas, cooking at home a lot more.

Dr. Lustig: Well, they are but the question is, what are they cooking? Kraft can’t keep up with the macaroni and cheese. So, it depends. Yes, people are cooking more, and that is good, and I’m not saying that’s bad, that is good but depends what they’re cooking. And that’s where things can get a little bit sticky and dicey. Here’s a simple tidbit for all of your listeners to take away. If a food has a label, it’s a warning label because real food doesn’t have a label. Is there a label on broccoli? Is there a label on radishes? Is there a label on carrots? You don’t need a label. You only need a label…The USDA says you only need a label, the FDA says you only need a label if you’ve done something to the food. So, food without a label is automatically real food. So, if it’s a label, it’s a warning label. And the question is what’s been done to the food?

And there are ways you can read what’s on the label and figure out what’s been done to the food when you have some clues when you’ve gotten some training. And that’s in the book too, is how to actually figure out what’s going on. There’s also a full chapter in the book on how to diagnose yourself and figure out where your metabolic dysfunction is and what to do about it. So, this book is designed to be a manifesto and also a tutorial, and also a handbook on how to navigate your life and how to navigate the grocery store all at once. And ultimately, the goal is to get enough people educated so they can start putting pressure on both the food industry, the pharma industry, and government to fix the problem because again, you can’t fix the problem if you don’t know what the problem is.

Katie: I know that we’re getting to the end of our time and it’s more than we can cover in a podcast. But can you give us just a brief overview of a couple of those ways you said you can diagnose yourself and, kind of, known your own biochemical type or where you are on the spectrum? Can you just, kind of, give us a little bit of that biochemical profile overview?

Dr. Lustig: Sure. So there are four things you need to know. You need to know your family history. You need to know your waist circumference. You need to know your heart rate and blood pressure. And you need to have some basic labs that your doctor can draw, your doctor has drawn, you just need the numbers. The one thing you cannot do is you cannot walk out of your doctor’s office with him or her saying, “Oh, your labs are normal.” There is no such thing as normal. Never accept normal as an answer. You need the numbers. And in the book, I actually give the ranges that for each of the lab tests that matter, in terms of understanding your metabolic status and how to be able to convert that information into something that makes sense in terms of your health and also something makes sense in terms of your food.

Katie: Perfect. Yeah, and you explained it so well n the book. Like I said, it’s more than we can go into here. But some of those, like your waist size and your waist-to-hip ratio, those are ones that we can measure at home and track at home that are easy and free. And I’m glad that you give people such actionable tools. I promised I would respect your time, and I will. But a question I love to ask toward the end of interviews is other than your own, of course, if there is a book or a number of books that have had a profound impact on your life, and if so what they are and why?

Dr. Lustig: Yeah, it’s a really good question, Katie. So I would say that there are three books that have had an impact on my life. One I read when I was in eighth grade and I still think it’s the best book ever written. It’s called “Catch 22.” And what “Catch 22” explained to me at a very early age is that the inmates are in charge of the asylum. And, institutional administration is almost always faulty. And to not trust anyone. The second book that I read that was really important to me, I read in medical school, and it was “The Lives of a Cell” by Lewis Thomas. And what that book explained to me was how everything’s connected, how the different parts of the cell are connected, and how we’re connected to the planet. And that really set me up for being able to understand what’s going on now.

And then the third book that I read, and I read this much more recently, in 2008, was a book called “Pure White and Deadly” by British physiologist, nutritionist by the name of John Yudkin. And he was the first person to say that sugar was the danger. And he got thrown under the bus by the food industry and by his nemesis, Ancel Keys, who believed that it was fat that was the problem, not sugar. And “Pure White and Deadly” is basically a prophecy about what will happen to us if we just keep going down this route. Yudkin wrote the book in 1972. And I couldn’t even find it. I had to access it from another library, another medical library. And the fact matter is Yudkin was very prescient, and he was prophetic. And he got thrown under the bus anyway. So, that really explained to me how the system works. And I have been an iconoclast ever since because I see what the problem is and I’m trying to get other people to see the problem, too. So, I would say those three books have been most instructive and informative for me for being, you know, able to, sort of, take this message out and do something with it.

Katie: Excellent. I will put links to all of those in the show notes. Those are new ones for me as well. I’ll have to check them out. And I’m appreciative of your new book as well. It was a great read. I definitely encourage you guys to pick up a copy. And you make such a strong case for some simple shifts that make a huge difference and I think, like we talked about in the very beginning, are even more necessary than ever right now. Thank you for your work, for all the years that you have been educating and speaking out about these things, and for your time here today.

Dr. Lustig: Oh, thank you, Katie, and thanks for being on top of this and being such a good interviewer.

Katie: Oh, thank you. And thanks to all of you as always for listening, for sharing your most valuable resources, your time, and your energy with us today. We’re so grateful that you’re here, and I hope that you will join me again on the next episode of the “Wellness Mama” podcast.

If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.


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