Transcript for:
Importance of Sugar Control with Dr. Robert Lustig

Let's be clear and honest about this. Calories are not the issue. This is all about. That's the problem. That's how you lose weight. Dr. Robert Lustig is an endocrinologist whose first-hand research has explored the role sugar has on fueling the world's most destructive human conditions and answers how we can regain control of our health. If you consume one sugared beverage per day, your risk for diabetes goes up by 29%. So this is a big problem. We also know that if you have high sugar consumption, it's got multiple detrimental effects, such as mental health problems, cognitive decline, early death. We also know it's the primary driver of ADD, but the problem is sugar is addictive. And 73% of all of the items in the grocery store are spiked with added sugar by the food industry because they know when they add it, you buy more. You can't believe what they're telling you. If they say something is healthy, it's usually the opposite. and I'm part of numerous lawsuits suing the food industry because they knew that sugar was a problem, but they paid off scientists to say it wasn't. You've been happy. But a lot of people don't have time to be doing a fine tooth coma about every single thing that they're putting into their body. They're not a scientist. Agreed. So what advice do we give that is simple and actionable? Food can be medicine. Food can also be poison. And the question is, how do you figure out which is which? So here's the secret. Congratulations Dioverseo gang, we've made some progress. 63% of you that listen to this podcast regularly don't subscribe, which is down from 69%. Our goal is 50%. So if you've ever liked any of the videos we've posted, if you like this channel, can you do me a quick favour and hit the subscribe button? It helps this channel more than you know and the bigger the channel gets, as you've seen, the bigger the guests get. Thank you and enjoy this episode. Dr. Robert Lustig On the front of your book it says, the hacking of the mind. Very strong words to use. Indeed. Whose mind has been hacked and who is doing the hacking? Yours. Mine. Everyone's. Who's been doing it? Well, pretty much anyone with a belief system that's not yours. And that's pretty much everybody. The bottom line is we have been sold a bill of goods. We as a society, we as individuals, have been sold a bill of goods. And the idea of the book, the reason I put the book together, is because it actually makes us miserable. It has stolen... our birthright. And our birthright is to be happy. And we are not. If anything, we're the opposite of happy. We're extraordinarily unhappy. Just look at the incidence of depression around the world, not just in America, not just in the UK, but everywhere. The World Health Organization now says that 5% of all of the people on the planet are clinically depressed. And here in America, it's at 22%. So we're really unhappy. The question is, why is this? If, you know, our goal is to be happy, it's in the Declaration of Independence, life, liberty, and the pursuit of happiness. Well, we're not. So why? The reason is because we have substituted pleasure for happiness. What's the difference between pleasure and happiness? Well, pleasure is short-lived, happiness is long-lived. Pleasure is visceral, you feel it in your body. Happiness is ethereal, you feel it above the neck. Pleasure is taking, like from a casino. Happiness is giving, like habitats for humanity. Pleasure is experienced alone. Happiness is usually experienced in social groups. Pleasure can be achieved with substances. Happiness cannot be achieved with substances. The extremes of pleasure, whether they be substances or behaviors, so substances like cocaine, amphetamine, nicotine, alcohol, sugar, or behaviors, shopping, gambling, social media, internet gaming, pornography, in the extreme all lead to addiction. There's an alcoholic after every one of those, shopaholic, sexaholic, chocoholic, alcoholic, etc. But there's no such thing as being addicted to too much happiness. And last but not least, Lastly, number seven, the one that is the reason for the book, pleasure is dopamine, happiness is serotonin. And they're not the same. So two different neurotransmitters, two different sets of receptors, two different areas of the brain, two different mechanisms of action, two different clearance mechanisms. is an excitatory neurotransmitter. What does that mean? It means when dopamine is released in the area of the reward center, the nucleus accumbens, it's an actual anatomic structure in the brain which you can see on imaging. When dopamine is released there and it binds to its receptor like so, you transduce the feelings of reward. Okay? And reward is good. Reward is what gets you out of bed in the morning. If you don't have reward, you know, basically you shrivel up and die. Okay? Reward is essential to the survival of the species. Orgasm is reward. Okay? You know, you need it. It's part of daily life. But, okay, too much reward is a different story. And the reason is because dopamine, because it's an excitatory neurotransmitter, it... causes the next cell to fire. Well, if it causes the next cell to fire and fire and fire, that cell dies. Neurons want to be tickled, not bludgeoned. Chronic overstimulation of any neuron leads to neuronal cell death. So that postsynaptic neuron with the dopamine receptor, it's got a plan B. It's got a way of mitigating that negative response. It downregulates the receptor. So now, more dopamine, less receptors, less chance that a molecule will find a receptor to bind to. Well, that means the gain, the amplitude on the reward is going down more and more for less and less. The law of diminishing returns. Like an addiction, like a... Tolerance. Yeah. Tolerance is one half of addiction. And then when the neurons do start to die, that is addiction. Exactly right. So, dopamine drives addiction, and it doesn't matter what the cause of the dopamine release is, in the extreme, it will be addictive. Now, serotonin... does not downregulate its own receptor because it's not an excitatory neurotransmitter, it's an inhibitory one. So do you need to downregulate an inhibitory response? No. An inhibitory means what? Well, it means it puts the next neuron to rest. Okay. Instead of stimulating, instead of firing, it's actually calming. okay right so there's no such thing as being addicted to too much happiness because the receptors are still there but there's one thing that down regulates serotonin and that's dopamine so the more pleasure you seek the more unhappy you get and we've been told for the last hundred years that pleasure is happiness Neurologically the pathways are entirely different as you say, between pleasure and happiness. One of the ways that we have been hijacked. neurologically and via our dopamine receptors is through what we eat. And your book, Fat Chance, covers this really profoundly in New York Times bestseller. The first word in the subtitle there is the word sugar. I've heard a lot about sugar. I see it in adverts. I turn over the back of anything I eat and it says this word added sugar. Is sugar really a problem in society? Has it really hijacked us? Yes. The short answer is. Not only is it a problem, I personally think it's the biggest problem. It's not the only problem, but I think it is the biggest one. Now, why do I say that? From a systemic health issue, the biggest problem was trans fats. What's a trans fat? Trans fat is a fat that has a double bond in it that is flipped. So normal unsaturated fats like olive oil, like canola oil, like rapeseed oil, like sesame oil, like peanut oil, et cetera, they all have a double bond in them. But the double bond is in one direction. A trans fat has the double bond in the opposite direction. one way to make a trans fat is to heat it. You put enough heat across the double bond, and it will flip by itself. So if you heat olive oil too high, you can actually make trans fats at home. But the food industry used trans fats for food stabilization, to increase shelf life. They've been using it in baked goods since the 1920s. The scientists who first figured out that trans fats were dangerous Fred Kummerow figured this out in 1957, but it wasn't until 1988 that anybody took him seriously. And then we started doing research on it and realized, oh my God, this stuff is killing animals and killing people. And finally in So, over 60 years after the initial science, the FDA finally banned trans fats in our food. Without question, trans fats are the devil incarnate. Seriously, you know, consumable poison. No ifs, ands, or buts. Is sugar poison? Sugar is like alcohol. So, is alcohol poison? Depends on the dose. right? The dose determines the poison. Paracelsus, 1537. We have an innate capacity to metabolize alcohol. And if we stay below that, it doesn't do too much damage. If we go above it, different story. Same thing with sugar. Same thing with this molecule, the sweet molecule, fructose. And the reason is because fructose and alcohol are metabolized virtually identically. What's the difference between sugar and fructose? So, sugar, dietary sugar, the sweet stuff, the crystals, the stuff you put in your coffee. The stuff I've got over here? Yeah, like that stuff. Yeah, that stuff. The five-pound bag right there. That's called sucrose. Okay, this is sucrose. This is sucrose. Now, sucrose is two molecules bound together. One molecule called glucose. one molecule called fructose. They are not the same. Now, the food industry will tell you they are the same. They are not the same. The reason they tell you they are the same is because that's the way they assuage their own culpability for what they've done to the food. But they are not the same. They will say, a sugar is a sugar, a calorie is a calorie, a glucose and fructose both have four calories per gram. Why should you care? Oh, you care a lot. you care a whole lot. Now, glucose is the energy of life. Every cell on the planet burns glucose for energy. Glucose is so important that if you don't consume it, your body makes it. okay the Inuit had no carbohydrate they had ice they had whale blubber they still had a serum glucose level Inuits are the people that live in the uh north poles and stuff that's right yeah they'd be formerly known as Eskimos right but they they didn't have any carbohydrate they ran off fat but they still had a serum glucose level because your brain runs on glucose. It can also run on ketones too, but your brain runs on glucose. My brain runs on glucose. And you need glucose because certain hormones and certain proteins in the body require glycosylation. in order to be effective. An example, LH and FSH. When you don't have glycosylation of LH and FSH, the hormones that tell your testicle and your ovary to work, you are infertile. It's that simple. So survival of the species says you need some glucose, but if you're not consuming it, you'll still get it because your body will make it. It will make it out of amino acids. It will make it out of fat. Gluconeogenesis it's called. So glucose is essential. It's just not essential to eat. Fructose, on the other hand, the sweet molecule in that bag. Which is sort of one of the two parts of the grain of sugar that I see. One part of it is fructose. That's right. It's the other half. It's the evil twin, if you will. What are the two halves again? Glucose. Fructose. Found together. I need glucose to live. My body will figure that out. Fructose. Do I need this? Not only do you not need it. but in high dose, it's toxic. Now, your liver has the innate ability to metabolize a small amount, on the order of about six to nine teaspoons per day. of dietary sugar, so half of that being fructose. So about 12 grams. Your liver can manage about 12 grams of fructose a day. In the same way it can manage about 12 grams of alcohol per day without showing any signs of any metabolic derangement. But if you go above that, now you get problems. Are we above that? Oh, we are so above that. We are at 50 grams of fructose. fructose per day, 100 grams of sugar per day. We're supposed to be at 25. We are at 100. We are quadruple our limit. And also, just because grams are quite hard to wrap the head around, right? Okay. So if I was to get a tablespoon... Well, do teaspoons. A teaspoon. Teaspoons. How many teaspoons of sugar would I have to consume to get to that level of fructose? I say this in part because most of us don't realize that we're consuming sugar. That's right, because it's hidden in all of the food. That's exactly right. We don't even know. We say, oh, I never even add sugar to my coffee, therefore my sugar consumption is zero. Wrong. That is not true, okay? Because it is hidden in plain sight in virtually every processed food in the entire grocery store. 73% of all of the items in the American grocery store and... in the British grocery store, are spiked with added sugar by the food industry for its purposes, not for yours. Because they know when they add it, you buy more. And how much does that look like in teaspoons then? The upper limit is about six teaspoons of added sugar per day. The allowance, the recommended allowance. The upper limit. The recommended allowance is lower than that. But the upper limit is about 16 spoons of added sugar per day. So in alcohol terms, that'd be like one drink. So if you have a drink a day, you're staying below your threshold and all is fine. What if you have two drinks per day? Well, it depends on how well your liver works. Maybe how much exercise you have, how much total body mass you have, etc. What about if you have three drinks a day? You're going to get pretty tipsy. Maybe you shouldn't be driving a car, right? What if you have four drinks per day? You know, they might have to, you know, scrape you off the floor of the bar with a spatula. And what if you have five drinks per day? You're a frigging alcoholic is what you are. All right? The point is... the dose determines the poison. Well, the same is true with sugar. So we have an innate capacity to metabolize about 12 grams of fructose per day. By the way, that's for adults. For children, it's one third of that, four grams of fructose per day. Okay, four to six. So we're talking very little, talking very little. But when you think about, for instance, kid in America, you know, 29% of kids in America consume the National School Breakfast Program breakfast in school. Okay, 29%. So what is the National School Breakfast Program breakfast? It's a bowl of Froot Loops and a glass of orange juice. That is 41 grams of sugar. The upper limit for children in terms of their metabolism is 12 grams per day. They got 41 grams and it's just breakfast. What do you think that's going to do? Now, if a calorie were a calorie, and if glucose and fructose were the same, then you say, well, you got to get your calorie somewhere. But because fructose is not glucose, because fructose is more like alcohol, because fructose's toxicity has nothing to do with its calories. That is a huge overdose. And it has metabolic complications, it has systemic health complications, it has mental health complications, and ultimately it has societal complications. Do you think it has neurological consequences? Without question. It's the primary driver of ADD. It's not the only driver, but it's one of them. How do we know that? It's the primary driver of depression, because we have the data. As it relates to ADD and ADHD and all those kinds of things, how do we know? We have functional. MRI, we have performance data showing that when you take the sugar out, kids'scores get better. Okay, we did this ourselves at UCSF. We did a study where we took 43 children with obesity and metabolic syndrome, all high sugar consumers, all low socioeconomic status children, Latino and African American, all high sugar consumers. And what we do is we figured out what they were eating on their home diet. We studied them on their home diet. And then for the next nine days, we catered their meals. No added sugar. We took the added sugar from 28 teaspoons of added sugar per day down to 10. Okay? So, huge reduction. We gave them fruit. That was the only place they had sugar in their diet. Otherwise, we cut the sugar out. Now, if you do that, you're going to lose 350 to 400 calories per day out of your diet. All right? So the goal was to keep their weight stable because if they lost weight, the critics would say, well, of course they got better. They lost weight. So we needed to maintain their weight. So we had to put something back in that was equichloric. We gave them extra starch. So, in the vernacular, we took the pastries out, we put the bagels in. We took the sweetened yogurt out, we put the baked potato chips in. We took the chicken teriyaki out, we put the turkey hot dogs in. So we didn't give them good food, we gave them crappy food. We gave them Safeway food, you know, just CPG, you know, consumer packaged goods food. Okay, so you didn't give them vegetables. No, we didn't give them any vegetables. Okay. But it was no added sugar food. Okay, and it wasn't funky food. It was just food we bought at Safeway, but it was chosen to not be sugar-containing. Okay? And we gave them a scale, and every day we'd call them up on the phone, what'd you weigh? And if they were losing weight, eat more, in order to maintain their weight for the whole 10 days of the study. And then we studied them on day 10. Every aspect of their metabolic health improved. blood pressure went down, blood glucose went down, insulin went down, their pancreases started working right again. They had a serum lactate level. You're not supposed to have a lactate level. That means your mitochondria are dysfunctional if you have a lactate level. Okay. Their lactate cleared. Everything got better. Most importantly, for the first five days of that 10-day window. the kids were obnoxious. The parents would complain to us, my kid is a disaster. And the reason was because of withdrawal. They were withdrawing all the sugar, withdrawing all the fructose. And then, like, you know, Moses, the sky cleared, and the kids... started concentrating better, they started doing better in school. The parents noticed they were less irritable. The teachers noticed they weren't nuisances or trouble in school anymore. The kids noticed. They said, this is the first time my head hasn't been in the clouds. Five days. Five days. And in ten days, we could see all of the metabolic benefits. even though they maintain their weight, even though they maintain their calories. Sounds like a bit of a scandal. When I hear that these kids are getting, almost 30% of kids are getting, you know, almost, you know, three to four times their recommended daily. allowance of sugar from school and that it's having these sort of really adverse consequences on us and the studies are there to prove that the consequences are very real. It sounds like a scandal in the sense that nobody's doing something about it. Ah, well, yes, that way it is. The point is that the food industry is very powerful and they have, you know, swept virtually every aspect of this under the rug for 40 to 50 years. They I knew back in the 1960s. that sugar was a problem. But they paid off scientists to say it wasn't. And we actually have the documents from the food industry. They live at the UCSF Food Industry Documents Library, and we are doing research on corporate interference in health. What do those documents show? They show that in 1965, the sugar industry came to two Harvard School of Public Health scientists the head of the Department of Nutrition, Fred Stare, and his associate, Mark Hegstead, who became the head of the USDA five years later, and paid them $50,000 in today's money to produce two articles for the New England Journal saying saturated fat was the bad guy and that sugar was exonerated. And they did it. And they did it. That's just one thing they did. They also infiltrated the National Institute of Dental Research, NIDR, their study sections and their executive committee to take money away from nutrition research for dental health and put it toward a caries vaccine. A what? A dental cavities vaccine. Okay. How's that cavities vaccine working for you? Okay. We have all of the data in their own words. to demonstrate that they knew exactly what they were doing. This is not a hallucination. This is hardcore fact, and we've published this. And we now have a center at UCSF devoted to understanding the corporate determinants of health. And when we look across society at the consequences of this sort of corporate interference, some of the crazy stats in your book Fat Chance that I really sort of highlighted were that by 2050 obesity will become the norm, not the exception. Correct. The World Health Organization said that the percentage of obese people globally has doubled in the last 28 years. Indeed. And in the UK, 28% of adults are obese and 36% of them are. overweight. That's not from your book, but that's from some research we did on the UK numbers as well. Well, you know, the UK is the fat man of Europe. Yes, that's true. Having metabolic syndrome is equal to losing 15 to 20 years of life. That was in your book. That's correct. Which is startling. And worldwide sugar consumption has tripled in just the last 50 years. Correct. All true. Now, you could say that's correlation, not causation, but we actually have the causation. We have the data. We have it in mechanistic terms. We have it in clinical interventional efforts. We have it in societal efforts. There is a method for determining proof that doesn't need randomized control trials. It's called econometric analysis. This is what we have for, for instance, climate change. There's no control group for climate change, but we still know it's true. This is what we have for tobacco and lung cancer. You don't have naive people start smoking. That would be illegal, immoral, get you thrown in jail. But we still know that tobacco causes lung cancer. We know that football trauma causes chronic traumatic encephalopathy. None of these have control groups, but we know it's true through econometric analysis. This is a method of using natural history data over time. to be able to determine proximate cause. And we have that for sugar and diabetes, and we have it for sugar and heart disease, and we have it for sugar and fatty liver disease, and of course we have it for sugar and tooth decay. We're working on sugar and cancer and sugar and dementia. We're not there yet. In your book, Fat Chance, on page 120, there was something particularly curious, because I think this is a... Yeah, here we go. It says, the bottom line is sugar consumption is a problem. 33% of sugar consumption comes from beverages. Yes. And the biggest abusers are the poor and underserved. Indeed. So let's talk about beverages to start with then. diet beverages, are they fine? And how bad are the sort of fizzy pot beverages that most of us consume every day? So let's do the sugared soft drinks first. Okay. Okay. They are really bad. If you consume one sugared beverage per day, your risk for diabetes goes up by 29%. Wow. Okay. And that's if you have one. If you have two, 58%. And diabetes is now the main cause of death in 40% of death certificates. Exactly right. So this is a big problem. So, you know, that's demonstrating its toxicity at, you know, shall we say medium dose. You know, at low dose, you can handle it. But, you know, as soon as you go above that dose, it's a problem. And we have the data for it. Okay. And all of these are factored in. And these are all econometric analyses. We've shown that sugar is a proximate cause of diabetes. Whenever sugar availability changes in any country, diabetes prevalence changes three years later. And we've also done what's known as advanced Markov modeling, where we go into the future and show that when sugar consumption goes down in any country, diabetes levels change and, you know, reduce three years later. So it's a three-year window between the change in the diet and the change in the metabolic health consequences. We have those data. And the fact that they work both on the way up and on the way down is like, you know, take it to the bank. Now, That's for the sugared beverages. You asked me about diet beverages. I've got one here. Let's look at it. All right. Let's move it up the leg. Oh, I've never seen this before. I wonder what that is. The data now show, I mean, it took a while for these data to come in, but the data now show that the toxicity of one sugared soda equals the toxicity of two diet sodas. Half as bad. Half as bad does not mean good. Half as bad means half as bad. Well, it says zero sugar here, so how can it be bad? Well, because it's bad for a different reason. So, yes, zero fructose, zero calories. I agree. But that doesn't make it good. Makes it better than the sugared alternative, but it doesn't make it good. Why? Number one, you put something sweet on the tongue. Message goes tongue to brain, sugar's coming. Message goes brain to pancreas, sugar's coming. Release the insulin. So I still get an insulin release? You still get an insulin response. And the more other food you ate, the bigger the insulin response. So you will have an accentuated insulin response because you're exposed to the diet sweetener. This is work from Janina Pepino, 2013 at Wash U St. Louis. And it's been corroborated multiple times since. And why does that harm me, having an insulin response? Because insulin is a bad guy. So we always talk about glucose being a bad guy in terms of diabetes. And it is. It is, of course, but insulin's a bad guy, too. Glucose causes small vessels. to be dysfunctional, causes endothelial cell dysfunction. It causes high blood pressure because it causes those small vessels to constrict. It interferes with nitric oxide, which is one of the things that relaxes the blood vessel. And it will, you know, basically reduce blood flow to specific organs. So high glucose is not good for you. And it's bad for small vessel disease. And that's why diabetics get retinopathy, nephropathy. neuropathy, kidney disease, nerve damage, and eye disease. But insulin is also a problem because what insulin does is it causes cell growth. Insulin is a growth factor, and it causes vascular smooth muscle growth like in your coronary arteries, and it causes glandular growth. So it is one of the primary drivers of heart disease and cancer. So, you can be a diabetic, a type 2 diabetic, and have your hemoglobin A1c, a measure of your glucose control, down near normal range because you're on insulin or oral hypoglycemics or even GLP-1 analogs for that matter. And you will die just the same because you will die of a heart attack or of a cancer because diabetics have a much higher incidence of cancer. They also have a higher incidence of dementia as well. And the reason is because of insulin because insulin is a bad guy in this story. Glucose causes microvascular disease. The insulin causes macrovascular disease. They're both bad. You need to control both of them. And this controls the glucose, it doesn't control the insulin. Do you drink that stuff? Of course not. Just checking. Is there any other physiological consequences to diet sodas? outside of the insulin response. Indeed. So the other thing that we've learned about non-nutritive sweeteners across the board is that they alter the microbiome. Now, the microbiome is the bacteria that live in your gut. Now, you have to feed your microbiome. You have to feed your bacteria. Because if you don't feed your bacteria, your bacteria will feed on you. It will strip the mucin layer, a protective physical barrier, right off the surface of your intestinal epithelial cells. And when it does, that it denudes them and allows for other bacteria, toxic bacteria, to take up residence and cause irritable bowel syndrome, inflammatory bowel disease, and the junctions between the cells become dysfunctional as well. And so the cells become permeable. And so stuff in your intestine, the junk in your intestine, the SH, you know what? can actually make it through into the bloodstream. You can measure the endotoxins and the whole bacteria, the lipopolysaccharides, in the bloodstream when the intestine is damaged, even from diet soda. And what that does is that ultimately leads to systemic inflammation. And that systemic inflammation also leads to metabolic disease, mental health problems, cognitive decline, early death. Is there a relationship between sugar and our hormone levels? Of course. I mean, the main one, of course, is diabetes. I mean, you know, insulin. But high sugar, if you have high sugar consumption, it's going to cause changes in insulin response at the level of the liver. It's going to cause fatty liver disease. It can change your kidneys function, which can ultimately increase blood pressure. So it's got multiple potential detrimental effects. What impact does sugar have on our liver? What's going on there? So, as I mentioned, we have an innate capacity to metabolize a limited amount. Yeah. Everyone says, oh, sugar's energy. Well, yeah, but not really. Not really. So let's dissect that. the food industry says glucose is four calories per gram. The food industry says fructose is four calories per gram. Therefore, they're equal because they're four calories per gram. And if calories were the issue, then they would be right. But calories are not the issue. okay? The whole issue of calories has to go down the tubes, okay? As far as I'm concerned, that's the problem. And I am here to hashtag kill the calorie as a unit of measure. It has no place in our dialogue. It has no place in medicine. Calories suck. Now, why do I say that? If you take a mole of glucose and you throw it into a bomb calorimeter, you will get four calories per gram. That's true. If you take fructose and you throw it in a bomb calorimeter, you will get four calories per gram. That's true. We are not bomb calorimeters. Okay? What's a bomb calorimeter? It's a contraption that explodes whatever you put in it and measures the heat that's given off from it. So it measures the amount of calories in something effectively using some... Because that's what calories are, is the amount of heat required to raise one gram of water one degree centigrade. Okay. So it's a measure of heat. Yeah. That's what it is. That's what calories are. Now, we do our burning in these little organelles inside each of our cells called mitochondria. This is all about mitochondria. And when your mitochondria work efficiently and well, you can burn energy to completion, and you can capture that energy in the form of chemical energy in your cell called ATP, adenosine triphosphate, and that's what your cell uses to power all of the functions that the cell needs. the little molecular motors and making stuff and, you know, basically, you know, and also cleaning house, you know, and recycling junk, okay, in order to keep your cells thriving and alive. Okay, so mitochondria are essential. Now, And glucose stimulates mitochondria to work better. Glucose is actually good. It stimulates two enzymes necessary for mitochondria to work. It stimulates an enzyme called AMP kinase, which is the enzyme that actually makes more mitochondria. And it's the fuel gauge on the liver cell. So it tells the liver, make more. And it also stimulates an enzyme called HADH, hydroxyacyl-CoA dehydrogenase, which is necessary to cleave two carbon fragments and burn them, oxidize them for energy too. So glucose we can call good because it helps mitochondria. Fructose, on the other hand, this sweet molecule in sugar, in sucrose, it inhibits three enzymes. in the mitochondria. It inhibits that AMP kinase. It inhibits an enzyme called ACADL, acyl-CoA dehydrogenase long chain. It inhibits CPT1, carnitine palmitoyltransferase 1. That's the enzyme that regenerates carnitine, which is the shuttle by which fatty acids can get into the mitochondria to be burned. So the net effect of fructose is to inhibit mitochondrial function. So. Does fructose constitute energy if fructose is actually keeping you from making chemical energy in your cell? This is the conundrum. What do you mean by energy? If we're talking heat, then fructose is energy. If you're talking ATP, fructose inhibits ATP. And that's what we're talking about, because that's what leads to systemic health problems, not the heat. So all of these people, as far as I'm concerned, anyone who ever uses the word calorie, fire them. Because they don't get it. They are part of the problem, not part of the solution. Many people will say that sort of counting calories has helped them with their weight loss goals. You tell me. virtually everybody who counts calories loses a little bit of weight and then they plateau and then they get, you know, tired of their diet and the weight comes rushing back. Okay. 90% of people who try to diet through caloric restriction regain and sometimes yo-yo back even higher. So I don't accept that. Are there studies that support this idea that sort of the yo-yo dieting is a... byproduct of calorific restriction? Not because of caloric restriction. It's a problem of insulin resistance. It's a problem of when you gain the weight back, did you gain it in the liver? It's liver fat because now you've got higher insulin and insulin blocks this hormone that goes to the brain called leptin that is in charge of that set point. So the higher your insulin goes, the less well your brain can see leptin. And so the less well you can regulate. And so that's what drives your weight up even higher. So you don't regain the weight by eating fish and vegetables. You regain the weight because you went for the bread and the rice and the pasta and the potatoes and the sugar. What's a better plan than if I'm trying to cut a couple of pounds? What's a better approach to take versus calorie counting or these kind of things? Get the insulin down. There is no weight gain without insulin. Insulin is the energy storage hormone. 20 years ago, from doing the research on kids with hypothalamic tumors who released enormous amounts of insulin, we gave them a drug that suppressed insulin release. They lost weight and they started exercising spontaneously because we got their insulin down. We showed that the lower we got the insulin, the more weight they lost and the better they felt. Insulin is the bad guy in this story. So. Numerous investigators, you know, the world over, have now demonstrated that insulin is a primary driver of both obesity and diabetes and metabolic syndrome. You gotta get the insulin down. Okay, how do you get insulin down? Best way, don't let it go up. What makes it go up? refined carbohydrate and sugar, all the stuff you have over there in that corner. Just to be clear, he's not pointing at my lunch. No. We have a pile of different sugar products that we brought for the interview over in the corner, including various things that you find on a shelf, everything from apple juice to some popular snacks to some other things. Don't forget the peanut butter cups. The peanut butter cups, yeah. And even this, this is just sort of sugar. it looks like water, but it's flavored water where they've added sugar to it. So yeah, all of that stuff over there. All of that stuff. So get the insulin down. All right? So cut the refined carbohydrate, cut the sugar, the dietary sugar. That is the single best way to mitigate this process by improving insulin resistance, by getting the insulin down. And we have done this time and time again. Basically, I turned my obesity clinic into an insulin reduction clinic for this reason. A lot of people at sort of a prefrontal cortex logical level understand this. They understand that They shouldn't be having sugar. Well, they think it's about calories. Some people do think it's about calories for sure. But even the ones that know that sugar is not something they should be having. still struggle. They do. It's easier to get them done. Because sugar is addictive. Right, yeah. They struggle because sugar is addictive. We know, because fructose stimulates that nucleus accumbens. Yeah. And when we get stressed, when we get stressed, which is a facet of daily life now, we're much more likely to grab a sugary snack. Indeed. And there's a reason for that too, because when you're stressed, that actually puts a greater burden. on your amygdala. And your amygdala requires more energy. Hippocampus too, by the way. The amygdala is the emotional center. The fear center of the brain. And so you're trying to calm it. And so you have to increase the energy available because you need more ATP. And even though fructose inhibits ATP generation, you still reach for that because you're trying to mitigate the metabolic consequences acutely. When I'm tired, I think I have a high propensity to grabbing sugar as well. Indeed. Why is that? Because you're tired, you're stressed, and your amygdala is dysfunctional. And so it basically tells you, hell with it. I don't have any sugar cravings in the morning. I've come to learn. I don't feel the need for sugar in the morning. It's sometimes when we get later into the evening, after a long day. Exactly. My cravings. You and everyone else. And me too, by the way. It's not like I'm immune to this. I, you know, I'm on record. I gained a lot of weight while I was a faculty member at UCSF. And every day at 4 p.m., I just ran out of gas. And so I ran across the street to get a large chocolate chip cookie. Okay, and that was without question the primary driver of my weight gain. Okay, it wasn't until I actually started doing the research on this and seeing that the kids felt better when we took the sugar out of their diet that I actually put two and two together for myself. So now I don't do that, and my energy level stays constant throughout the day. So what advice do we give that is simple and actionable for Jennifer or Judith or Dave who's listening to this now? They are, you know, 40 years old potentially. They have a 9-to-5 job. They're very busy. Maybe they have some kids to feed at the same time. They don't have time to be like, you know, looking at doing a fine... sort of tooth comb over every single thing that they're putting into their body. They're not a scientist. Agreed. It's a problem because the food industry has made the grocery store a minefield and it's really easy to set off an explosion. If you walk in, you've basically lost. That's how bad it is. Understood. So the simple rule is eat real food. So what's real food? Well, food that came out of the ground or animals that ate food that came out of the ground. The problem is we all lead busy lives and we're looking for labor-saving devices because people don't even have time to cook. Most people, 33% of Americans don't even know how to cook anymore. So, like, what are they going to do? So we understand this. I mean, it's a problem. Agreed. we need food that is metabolically healthy for us, not metabolically detrimental. And the problem is that as soon as you put added sugar in the food, you have made it metabolically detrimental. Now, the food industry will say, well, there are all these other good things in there, like vitamins and minerals. We fortify it, et cetera. So I'm here to tell you, toxin A plus antidote B still equals death. okay, just because they put some vitamins in there or you take a dietary supplement, if it's not solving your mitochondrial dysfunction, what's the point? So you can't believe what the food industry is telling you, okay? If they say something is healthy, it's usually the opposite. Whatever it says on the package, believe the opposite. because they have an incentive to put wrong stuff on the package. And I'll be honest with you, I'm part of numerous lawsuits suing the food industry for deceptive advertising, misbranding, mislabeling. 70% of all of the items in the American grocery store are misbranded or mislabeled. In what way? They say things that are not true. Give me some examples. Well, first of all, any time they use the word healthy, Okay. They say no added sugar. okay, but in fact they put in apple puree or raspberry puree or evaporated cane juice, you know, there are 262 names for sugar and the food industry uses all of them. And so they will say that something's no added sugar, but that in fact is actually not the case. Okay, there's a whole, you know, whole host of this. Kellogg's has been sued for Raisin Bran. Okay, everyone thinks raisin bran. Well, it's just raisins and bran. What color are the raisins in raisin bran? I've never seen it. Well, I mean, raisins are purple. Yeah. You know, purple-brown. Yeah, yeah. Yeah? Yeah, normally. Well, the raisins in raisin bran are white. Why? If you take the raisins in raisin bran, that's supposed to be 11 grams of sugar, but on the side of the package, it says that one serving is 18 grams of sugar. Where'd the other seven come from? It's the white, because they've all been dipped in a sugar solution to make them sweeter. as an example. Okay? So, post has been sued, General Mills, theirs was dismissed. Mondelez, a whole host of companies are actually under the gun now to change their practices. Why do you care so much? I am a pediatrician. My job is to take care of children. Children are vulnerable in the same way minorities are vulnerable, in the same way prisoners are vulnerable. They need a voice. My job is to give every kid a shot. Well, we now have neonatal obesity. We have babies being born, Israel, South Africa, Russia, United States, four separate studies showing that over the past 25 years, birth weight has gone up 200 grams, half a pound, in all four countries. And when you do DEXA scanning to look at body composition on those newborns, those 200 grams are all fat. We have a neonatal obesity. These kids did not get obese by dieting and exercising, by gluttony and sloth. They came out of the womb behind the eight ball. It's my job as a pediatrician to fix the problem. That's why I care. Can you just give me a little bit of brief overview of everything you're talking about, the studies you've referenced, all of that. What is the academic... experience, background, research that you've done that's built all of the foundations of your knowledge. I spent the first 20 years of my medical practice. you know, in academia, basically, you know, doing what they told me to do, you know, the way I learned it. And I thought calories were the same. And I thought that, you know, it didn't matter. And this is not what you do. And this is not how you take care of patients. You, you know, do prescriptions and you do procedures and that's how you do it. And then I started doing research because I was at St. Jude Children's Research Hospital, taking care of these massively obese kids who had brain tumors. that were treated by surgery or radiation, and they became massively obese because of it, because their hypothalamus was damaged, because they couldn't see that leptin signal that we talked about earlier. Which is the hunger. Which is part of hunger. It's not the only hunger. It's ghrelin related. It's more of an energy sufficiency signal. Okay, right. It's the energy sufficiency signal. Anyway, when we suppressed their insulin release with that drug I mentioned before, they lost weight and they started exercising spontaneously. So we did that with adults and guess what? Same thing happened. And we measured their energy expenditure and instead of it going down as you'd expect when you lose weight, normally your energy expenditure goes down, their energy expenditure went up. So what this told me was that insulin is blocking leptin, and as long as your leptin's being blocked, you feel like crap. And you're hungry, and you don't want to get off the couch. And as soon as your insulin goes down, now your brain can see the leptin, and you're not hungry, and you can start exercising. What this showed me was that the behaviors that we associate with obesity, the gluttony and the sloth, are actually secondary. to this biochemical phenomenon of insulin blocking leptin. And so this put me on the path of understanding insulin as the problem rather than insulin as the result. Fix the insulin, fix the problem. And so I've been doing that for the last 25 years. And that's what brought you to the subject of sugar, because sugar increases insulin levels. Well, sugar causes insulin resistance. Okay. So there are two phenomena with insulin. Insulin release, which is an acute phenomenon. So that's when I eat something, there'll be some insulin release, which means I have an insulin spike. Right. And then it comes back down nicely. Or not. Or not. Or not. Depending on how much and how consistently I've been eating sugar. Exactly right. So if your liver has fat in it, and 45% of American adults now have fat in their liver, and 25% of kids now have fat in their liver, and they never did before. I mean, before 1980, if you saw fat in the liver, that was alcohol. But if 25% of kids who don't drink alcohol have fat in their liver, how'd the fat get there? Yeah. sugar, because sugar gets turned into fat in the liver. That's the driver of this. What that does is that causes a phenomenon called insulin resistance. Your liver doesn't work right, so your pancreas has to make more insulin to make your liver work right. You know, like having to put more people on the assembly line when, you know... people are goofing off or not getting their job done. Same idea. So you have to basically goose the liver to do its job. Well, that raises insulin levels all over the body. And once that happens, now you're taking energy from your bloodstream and putting it in fat cells for storage. So by getting the insulin down, So if it's insulin resistance, fixing the insulin resistance by getting rid of the fat in the liver, or if it's the insulin release at the beginning by lowering your refined carbohydrate because that's the primary stimulus of that first spike. Either way, it's refined carbohydrate and sugar. Get the insulin down. And diabetes is when? Your pancreas can't keep up. Okay, so it's really so much insulin, it goes, forget this, I'm done. Right. It's the end result of both of these phenomena. Which we've now realized is reversible. I think there was a school of thought once upon a time that diabetes couldn't be reversed. That's right. It is reversible. It is very reversible for a while. So let's be clear and honest about this. There is absolutely no doubt that what doctors learn in medical school is wrong. We are told, and I know because I was told, that diabetes is a chronic, progressive, unrelenting disease. that never gets better, and that you will need medication, whether it be insulin or hypoglycemics or whatever, for the rest of your life. Garbage. Total, complete trash. Now, Virta Health, numerous other studies of various diets show that you can absolutely reverse type 2 diabetes. In order to do so, you have to get the pancreas to make insulin properly. And the only way to do that is to get the liver to respond to insulin properly. One way is to not challenge the liver. Give the liver a rest. well, it's metabolizing all that refined carbohydrate and sugar. Drop the refined carbohydrate and sugar and make your liver work better. A little keto. So, a ketogenic diet is the extreme version of this. It's not the only way, but it is a way. Paleo diet is another version. Fasting? Intermittent fasting will give your liver a chance to burn off the fat that's accumulated over the last 16 hours. There are many ways to skin this cat. Calorie counting? Almost never. Calorie restriction? yes, calorie restriction, but it's got to be consistent and long-term. And we've shown, numerous studies have shown, that as you restrict calories, that leptin resistance does not get better quickly. It takes years for that leptin resistance to finally go away. like five years before you change the set point. Let's take a step back. So what does leptin do again? It's about energy. So leptin is made in your fat cells. Yeah. In response to driving energy into fat, the cell will make leptin. The leptin will circulate in the bloodstream. It will go to your brain, go to your hypothalamus and say, hey, I've got enough energy on board to engage in expensive metabolic processes. So we don't need any more. I don't need to eat more. I can engage in puberty. I can engage in pregnancy. Okay. Okay. Both of which are high metabolic processes. Okay. Okay. So it is like the servo mechanism, like the thermostat on your house. Okay. You have a floor, but no ceiling. So when it's cold in your house, the heat kicks in. But if you don't have air conditioning, It can go higher, right? Same idea with leptin. Floor, no ceiling. So when your leptin goes below a certain threshold, your brain will see that as starvation. You get really hungry. And so you will get both hungry and you will also sit on the couch. Okay. Okay. So that's the way the activity component comes in because your brain is saying, listen, don't waste this energy. Exactly. Conserve. Okay. Because we're in trouble here. Right. We're in trouble down here. Okay. So, eat more and don't move. That's the biochemistry that drives the behavior. Why don't they have leptin injections? Well, they do. Oh, really? But it turns out it doesn't work in leptin resistance because the problem is not that you're missing leptin. the problem is you have too much leptin. It's just not working. So adding more leptin is like throwing kerosene on the fire. The receptor sites have stopped. Receptor sites are not there. Either they've been downregulated or they're being blocked, one or the other. Insulin blocks it. Or they can be downregulated too, both. Now, if you're leptin deficient, and there are 14 patients with leptin deficiency, and quite a few of them, by the way, are in the UK of the 14, and Sadaf Farooqi and Steve O'Reilly at Addenbrookes Hospital in Cambridge are the people who've done the most work on leptin deficiency. If you take a patient who's leptin deficient, they basically start gaining weight as soon as they're born. By age six months, they're already massively obese. By the age of three, they can't even fit through the door. They eat everything in sight and they don't move. You give them a shot of leptin because they're deficient, you're replacing what's missing. And they slim down like that. They're genetically leptin deficient. They're genetically leptin deficient. They have a mutation in their leptin gene. So obesity could be genetic in some very, very small cases. Very small number of patients. It is genetic, but that's not what's going on in the rest of the population. So yes, is obesity genetic for a small fraction? Sure, we have leptin deficiency, we have leptin receptor deficiency, we have PC1 deficiency, we have melanocortin-4 receptor deficiency, we have CYM1 deficiency. There are a whole host of different genes and nobody has them. nobody has them, all right? Like 14 people have them. It's very rare for the reason for general garden variety obesity out in the world to be due to a genetic problem. This is an environmental problem. In your book, you talk about environmental obesogens. I've never heard that term before. What does it mean? So, obesogens are chemicals in the environment that actually drive weight gain. They cause the differentiation of fat cells or they cause the growth of fat cells. Now, fat cells are complex, okay? you have a certain number, but you can increase that number, especially early on in life. There's a critical period before age two where you can actually increase the fat cell number. And once a fat cell is developed, it wants to stay filled. I mean, we've got to pause here just for a second because I think most people think that when we eat food, we increase the number of fat cells we have. No, we increase the size of the fat cells we have. This was a really, I learned this a couple of years ago and it... kind of changed the way I think about a lot of things, including liposuction. Yeah. Because with liposuction, you kind of think that you're taking away fat cells that you've added to your body through diet, but actually the fat cells stay the same. They just grow and shrink. Well, there's also a problem with liposuction as well. Um, there are three fat depots, okay? And they're not the same. on the scale they're the same because you weigh a certain amount, but from a metabolic standpoint, they are not the same. So let's take each of the fat depots separately so that your audience will understand what it is that they're actually concerned about. So the first fat depot is the obvious, what we call subcutaneous or big butt fat. Belly fat as well? No, that comes later. Oh. That's the second one. Okay, subcutaneous. Subcutaneous. Big butt fat or does this bathing suit make me look fat? So are you saying that's good or bad? It's actually good. I agree. It's protective. The more of it, the less likely that you will have metabolic disease. it is the place where your body wants to put excess energy because it's safe. Now, most of us have a certain ability to grow that fat to a certain level. before it starts becoming a problem. Eventually, you can overload that subcutaneous fat where you will actually make the fat vacuole, the little pocket of fat within the fat cell, grow so much that it will actually cause the border of the vacuole to decompensate. And now you've spilled the grease into the cell. That will kill the cell, and that will cause... inflammatory cells to congregate to try to clean up the grease and then they secrete proteins called cytokines which end up causing the metabolic dysfunction In any case, you can overload your subcutaneous fat, but you have to work at it. So about how much fat does your subcutaneous fat have to grow before you become metabolically ill? On average, about 10 kilos, 22 pounds, some more, some less. Okay, now let's take the second fat depot, belly fat, visceral fat. this fat here. Everyone's worst type of fat. Well, yes, but not because of cosmetics, because of metabolism. In any case, the visceral fat, the belly fat, is that due to calories? Is that due to weight gain? That is actually due to cortisol. That's due to stress. And the reason we know that is because you can take patients who have endogenous clinical depression. okay? They are anhedonic. They don't eat because they generate no reward from life. They generate no reward from eating. They are losing weight. They have to be admitted to the hospital to keep them from killing themselves. So these are people with suicidal ideation who have to be admitted to psychiatric hospitals. You put them in a scanner. And it turns out they're losing subcutaneous fat because they're not eating. They're gaining visceral fat. Because the cortisol from the stress that goes along with the depression is actually laying down more fat in their belly. Why? That's what cortisol does because when you're stressed, you need a readily available and metabolically active source of energy in case you're being chased by the lion. So that metabolic fat, that visceral fat is eminently retrievable rapidly. Oh, okay. Interesting. Okay. Now. how many pounds or kilos of visceral fat do you have to gain before you become metabolically ill? I'm going to guess it's not a lot. That's right, not a lot. So subcutaneous was 10 kilograms. That's right. Now we're talking about two kilograms. Okay, so two kind of bags of sugar. Yeah, pretty much. Okay. Now, finally, the third fat depot, liver fat. Now. How many kilos of liver fat can you accrue before you become metabolically ill? My liver's really small. I have no idea. Okay. One quarter of a kilo. Half a pound. And when you become metabolically ill, then all of the dysfunction we talked about previously happens. That's right. So you can become metabolically ill and be thin. Because your subcutaneous fat's okay, even your visceral fat's okay. But if you've got liver fat, can you measure a quarter of a kilo on the scale? No. Have you heard the phrase skinny fat? This is skinny fat. So TOFI, T-O-F-I, thin on the outside, fat on the inside. Skinny fat was actually coined by Dr. Jimmy Bell at University College London, a neuroimager. That's exactly right. So just because you're overweight doesn't mean you're sick. And just because you're thin doesn't mean you're healthy. Because of these three fat depots. This is exactly what we're talking about. So are skinny fat people typically more stressed if we kind of... They often are. Often are, yeah. They often are. The question is, how did that liver fat get formed? And the answer is sugar and alcohol. Because that's where sugar and alcohol go in order to be processed. Okay. And so that's why so many people now have fatty liver disease that never had it before. That's why children have fatty liver disease. Even though they don't... drink alcohol because they drink something that is metabolized just like alcohol. Like apple juice. Like apple juice. I've got a bottle of apple juice here in front of me. On it, it says 40% less sugar than 100% apple juice. It says with added vitamins A, C, and E. They've added all three vitamins in there. That must be. So that's not apple juice. That's an apple drink. to be clear. It says apple juice beverage here on the front. Ah, they called it a juice beverage, not juice. That's technically correct, but there's a reason they have to declare that from the FDA. Why? Because they can't call it juice if it's not juice, if they've done something to it. I mean, how would I know? It says apple juice beverage. Well, that's part of the subterfuge. That's one of the reasons for all of these lawsuits. They have to call it a juice beverage because they've done something to it. Okay, so I've got this apple in my pocket. This apple here. Right. This is healthy. That is healthy. But if I blend this down, it looks like this, no? Well, the question is what was lost in the process of blending it down? You took away the good part. The fiber. The fiber. By the way, you don't know if that apple is as healthy as it could be. And the reason is because you don't know if it was sprayed with pesticides. Was it an organic apple or was it just a standard commercial apple? If it was a standard commercial apple, you might have to wash it first. Why? Because the pesticides can be environmental obesogens. Many pesticides, such as, I mean, the famous one was DDT. Now, it's been gone since 1972. Rachel Carson, Silent Spring, it was all about... how DDT was, you know, environmentally affecting, you know, the entire world. Okay, we banned DDT in 1972, but you can measure the metabolite of DDT called DDE in pregnant woman's urine today, 50 years later. And that level of DDE in that pregnant woman is predicting obesity in her offspring. 11 years later. So let's go over these two subjects then. We've got environmental obesogens. I think I've pronounced that correctly. Let's finish off on that and then I want to get on to fiber. So environmental obesogens, which might be on this apple. What are they and where are they? So... And an obesogen is a chemical that causes weight gain not because of its calories. Now, you say, how can something cause weight gain if it doesn't have calories? And the answer is, if it causes the differentiation or growth of fat cells, it will cause weight gain unrelated to calories. So, we have chemicals in our environment that are unescapable. you can't escape air pollution. You can't escape forever chemicals, like, for instance, PFAS. What's that? Polyfluoroalkylated substances. Teflon. Remember Teflon? Yeah, yeah, the material. The material that nonstick pans were coated with? Yeah. That's PFAS. That was perfluoroactanoic acid. Turns out that causes obesity by itself. it causes the differentiation and growth of fat cells. Tributal tin, this is what you paint on the bottoms of boats to keep barnacles from attaching to the hull. It's in all of our food supply, all of our water supply, all over the world. That causes fat cells to grow before you're born. exposures to all sorts of things. BPA, bisphenol A. When you get your receipt, your paper receipt from Target, that's bisphenol A. Phthalates are plasticizers. You stick a binky in a baby's mouth, a pacifier. That's a plasticizer. That's got phthalates in it. That causes obesity. Parabens in cosmetics. will cause obesity. Vinyl flooring, flame retardants in children's clothing and in mattresses, all of these things will drive different receptors in the body and act as what we call endocrine disruptors. And those endocrine disruptors will change the differentiation and the growth of fat cells to increase adiposity. So what's an endocrine disruptor? So our cells have receptors. That way, communication from one area of the body to another can occur, like hormones bind to receptors. Well, sometimes they're not hormones. Sometimes there are other chemicals that cause differentiation of different areas of the body to form different organs. For instance, this is one of the things that goes wrong in congenital defects. like congenital heart disease, receptor alterations. So we have receptors on all of our cells for different processes, for different chemicals. There are things in our environment that basically mimic endogenous signals to our body and basically tell different tissues to do different things than they ought to be doing because those things are present. And one of them is obesity. In my head I think of it like a... Remember those toys you used to play with when you were a kid and it shows like a triangle shape and a circle shape and a square shape and you've got to pick up the corresponding piece and slot it in the hole. Right. I see it as things in our environment are pretending to be those shapes. Exactly. sort of impacting with our receptor site, which is the hole, and causing us to do things that are dysfunctional. That's right. And this is well known, has been known for years. It's one of the reasons for the decrease in fertility, the changes in reproductive capacity. It's one of the reasons the alligator population in the Everglades is disappearing as endocrine disruptors. Well, it also has effects on neurocognition and brain development. And potentially, I don't want to get too far afield, but potentially might play a role in autism. We haven't proven that yet. I want to make that clear. But without question, some of these chemicals can cause fat cells to differentiate and grow. So if they're everywhere, what do I do about it? Because it feels like I can't touch the floor. I can't lay in a bed. Well, you can't do much about air pollution. I mean, except as a society, we can do something. We can't do much about... the Teflon in the water or the TBT in the water, except to try to pass regulations to control those things. But, you know, get Congress or Parliament to do that. You know, that's a real trick. Is there better water that I can drink? Sorry, just on that point. Well, you can try. Certainly tap water is going to be a problem. But the fact is, some of the bottled water still have obesogens. And to be honest with you, if it's bottled, the obesogen might be in the bottle. Canned foods. If you look at the inside of the can, what color is it? Is it... Silver, isn't it? Silver, or is it white? If it's white, that's BPA. So canned foods have high BPA levels. BPA is an estrogen, okay? And it doesn't take much to be an estrogen. 22 angstroms, two hydroxyl groups, you're an estrogen, okay? There are a lot of chemicals in our environment that masquerade as estrogens, and BPA is one of them. And estrogen causes fat deposition. Just look at the curves of a woman. That's estrogen causing fat deposition. Well, BPA can do that too. So, as an example. But there are also things in our food that we think are food. And one example is fructose. Now, fructose has calories, true, but fructose has all these effects on mitochondria that have nothing to do with its calories. In the same way that alcohol has calories, but alcohol has toxic effects that have nothing to do with its calories. So just because something has calories doesn't make it a food. What's the definition of food, Stephen? I will tell you. I was going to say, don't ask me. Substrate that contributes to either growth or burning of an organism. So here's the question. Does ultra-processed food contribute... to growth. My colleague, Dr. Efrat Monsenigo-Ornan, who is the chairman of nutrition at Hebrew University Jerusalem, has looked at this question. In fact, ultra-processed food inhibits growth. Populations that are exposed to high ultra-processed food consumption have lower final heights than populations that are not. So if it's inhibiting growth, not a food. Okay, now let's take burning. I've already told you that there are three enzymes that fructose, which is in 73% of the items in the American grocery store, it inhibits burning because it inhibits mitochondrial function. So if you don't stimulate growth and you don't stimulate burning, is that a food? No. So if it's not a food, what is it? Poison. So food can be medicine. Food can also be poison. And the question is, how do you figure out which is which? When you walk into the grocery store, it all looks the same. But in fact, there are things in there that will contribute to growth and burning, and there are things that will inhibit it. And we need some method for being able to distinguish. those. We have it. We made it. It exists on your computer. It will ultimately soon exist on your phone. And you will actually be able to order your food to be metabolically healthy without ever having to walk into that minefield of a grocery store ever again. how would that be? And just buy the stuff that's good for you instead of chancing the stuff that's bad for you. It's called Perfect. And what it does is it will filter out all of the stuff in the grocery store that's metabolically unhealthy for you. not for the next guy, for you. You can apply specific filters that will, if you're gluten-free, it will take out all the things that have gluten, so you don't have to look at the label. If you have metabolic syndrome, it will take all the refined carbohydrate and all the sugar things out, so you don't even have to look at them. If you specifically want to avoid the ultra-processed food, it will take those out. By the way, that will cut the items that you can see in the grocery store by 80%. Thank you. How many of you started thinking about your long-term health when you hit 30? For me, this was a wake-up moment of me thinking to myself, okay, I probably need to start paying a little bit more attention now. I already felt a change in myself when I hit 30 with things like my metabolism, my energy levels. So this year is no different. Zoe, which is a company I've invested in, but also a company that are a sponsor of this podcast, helps me to make smarter food choices, all based on their world-leading science and my own test results. If I'm ordering food, I know how to make my takeaway so much smarter by adding things like a side of vegetables to eat first or choosing the option with the most fiber. Zoe helps me to make that choice. It guides me and coaches me. It's my personalized nutrition coach that I have on me 24-7. And to help you start your Zoe journey and start making smarter food choices, I'm giving you guys 10% off when you join Zoe now. All you've got to do is use code CEO10 at the checkout when you sign up. Enjoy! and let me know how you get on. Let's talk then about fiber. We talked about it briefly, but I want to just really close off on the point of fiber because you said that when we take an apple here, like the apple in my hand, and we turn it into this thing in my hand, this apple juice, the harm is that they're removing the fiber. Why does that matter? So everyone thinks that fiber is the stuff you throw in the garbage after you've juiced the fruit. We were told forever that the juice had the essential vitamins and minerals, like the vitamin C or the lycopene if you're a tomato. That's true, they do. But turns out the fiber... is essential. It's just not essential for you. It's essential for your bacteria. It's essential for your microbiome. That's what your bacteria want to eat. You have to feed your microbiome. You know, we always say, when women are pregnant, you're eating for two. Well, we're always eating for 100 trillion. Okay? The hundred trillion are in our intestine and what you feed them matters. Because if you feed them well, you will have what we call bacterial diversity, and you will not have any one species overwhelming any other species, and that will actually contribute to metabolic health. It will allow for the barriers in the intestine to work properly, the mucin layer, the tight junctions, the immunologic barrier called the Th17 cells. Your intestine will present the appropriate barriers so that Bad stuff in your intestine won't get into your bloodstream to cause systemic inflammation. So, feeding your gut is job one. And what does your gut like to eat? It likes to eat fiber. Now, we humans don't have the enzymes to digest fiber. You need specialized enzymes. The bacteria have them. So, the fiber is the food for the bacteria. When you take the fiber out of the food, you're starving the bacteria. Now, how many grams of fiber are we supposed to eat every day? our ancestors ate between 50 and 100 grams of fiber a day. The USDA says we're supposed to consume 25 grams of fiber per day. How many grams do we actually consume here in America? And by the way, UK's the same. Mean 12. So we're getting half the amount the USDA says and one quarter the amount our ancestors did. And the question is, does it matter? The answer is, oh yeah, it matters big. Because what happens is when you feed fiber to the bacteria, you get multiple species instead of one that basically crowd out all the others. And you get this metabolic biodiversity and it basically... improves your metabolic health. In addition, the bacteria will chew that soluble fiber up into a compound called short-chain fatty acids. Acetate, propionate, butyrate, valerate. Butyrate is particularly helpful. It is an immune suppressant. It keeps your immune system in check. It's one of the reasons that COVID was worse. For people who were obese and who had pre-existing conditions like metabolic syndrome and also, of course, minority populations, because of ultra-processed food consumption and lack of fiber, lack of short-chain fatty acids, therefore, lack of ability to fend off foreign invaders because their immune systems were not tamped down. Where did the fiber go? they took it out. Why? Because you can't freeze fiber. So that apple, okay? Yeah. Okay? Your homework assignment for tonight, take that apple and put it in your freezer overnight. Take it out in the morning, put it on the kitchen countertop, let it thaw, try to eat it, see what you get. What am I going to get? Mush. Oh, really? Now, why does that turn it into mush? The ice crystals that form will macerate the cell wall and let all the water rush in. Okay. They turn it into mush. Food industry knows that. So what do they do? Squeeze it and freeze it. Now it lasts forever. Now you've got apple juice or frozen concentrated orange juice. You have taken a fruit, which is food, and you have turned it into a commodity. storable food, which you can sell on the commodities exchange because it won't go bad. So it has a price and that price will fluctuate and you can then bet on the commodities exchange. But you can't sell fruit like that because it'll go rancid by the time you've sold it anywhere. So all these people are doing this to us. What responsibility do I have on a personal level? Because, you know, if these big companies with all this money, trillions of dollars, they're all manipulating me, bastardizing my food, hacking my brain, giving me these adverts. It's easy to fall into the trap of thinking, listen, I'm a victim here. Well, you are. because you've been hacked as we started this, you know, the podcast. Okay, you've been told one thing and the real world is actually something else. Okay, you've been hacked. You've specifically been hacked with the notion that processed food is food. everyone thinks that because they called it processed food. Maybe they shouldn't call it processed food. Maybe they should call it processed nutrients because the stuff that's in it are nutrients, but it's not food. because it doesn't do what food does, which is contribute to growth or burning. So the question is, what's your responsibility? And what's society's responsibility? So this is a very important question. And it's a question, you know, that comes up all the time. personal responsibility, does it exist? Well, in order to exercise personal responsibility, first you have to exercise free will. That's a prerequisite. So we can get into this, and we probably would need about six hours, okay? And we don't have it. But do we have free will? Yes or no? complicated question it's a complicated question and it's one i've actually been researching this week funnily enough for a different project that i'm working on okay and i was trying to find get to a point um where i had a solid answer now there's a couple of schools of thoughts here one school of thought when we look at the neurological um processes might suggest and there's some early studies that suggest that we have much less free will than we assume because things happen in our brain before we make a decision there's some studies that but do we have free will to make our own decisions? I think we have a lot less free will than we think. We have very little free will, if at all. Here's the best way to think of it. Arthur Schopenhauer, famous German philosopher, famously said, you are allowed to do what you want, but you're not allowed to want what you want. those things are actually predetermined. So you have choice in whether you want the candy bar or the ice cream. but you don't have choice about the fact that your nucleus accumbens is raging, saying, give me sugar. That's the choice. The choice is how you satisfy the biochemical drive. But the biochemical drive... is way beyond free will. So the question is, if you don't have free will, how can you exercise personal responsibility? Because that's a prerequisite in order to be able to do that. Because personal responsibility says, take the risks, suffer the consequences. But if you can't control... the risks or the consequences, how can you exercise personal responsibility? I have just shown you that the behaviors associated with obesity, the gluttony and the sloth, are actually secondary to the biochemistry, which you have absolutely no control over. In fact, we have no ability to be able to mitigate that, and that's why... we have this obesity pandemic and, you know, diet and exercise hasn't solved it for just that reason. So who do we need to point the finger at? Who needs to resolve the issue? Well, it has to be resolved at several levels. It has to be resolved for the public. That's why you and I are doing this podcast now, because they have to understand what's really at issue. Okay. Blaming the victim has never worked. When did it work? Did it work for HIV? Did it work for tobacco? It never worked. Okay. Every personal responsibility issue becomes a public health crisis. because personal responsibility hasn't solved any of them. It's a loser. It's a loser in terms of its mechanism, and it's a loser in terms of its efficacy. Doesn't work. Can I throw a thought into there as well? Because in some areas of our lives where we do have discipline, we tend to have a bias towards assuming everyone else doesn't have... discipline and that's what they're missing. Right. If that makes sense. Yeah. Great way to blame. People listening to this that don't struggle with diet and sugar and all of those things and exercise, whatever, all those subjects. Well, their brain will probably be thinking, God, you can just choose not to. I choose not to all the time. I choose not to have the can of fizzy drink all the time. Because their nucleus accumbens is not going off like a Christmas tree. Why is it not going off like a Christmas tree? We don't know yet. Why do some people smoke and some people don't? Why do some people drink and some people don't? Look, 40% of Americans are teetotalers. Never touch the stuff. 40% are social drinkers, can pick it up, put it down, you know, no problem. I'm in that category. 20% are binge drinkers. I'm sorry, 10% are binge drinkers and 10% are chronic alcoholics. What distinguishes the 20% who have a problem from the 80% who don't? We don't know yet. To this day, we still don't know. But we know that for that 20%, it is a problem. We also know there's this thing called sugar addiction. And there's going to be on May 17th. In London, the International Conference on Food Addiction, I will be the keynote speaker, to discuss exactly this issue. Is there such a thing as food addiction? And if there is such a thing as food addiction, does it portend need for societal remediation? Or is this really just a personal responsibility issue? Well, everything that is both toxic and addictive has required some sort of societal intervention. Okay? So, you have things that are toxic but not addictive, like oxygen and water. You don't have to regulate those. You have things that are addictive but not toxic, like caffeine. Well, you don't have to really regulate that either unless you add it to alcohol, in which case then you have 4-Loco. And then you get arrhythmias, and then you do have to regulate it. but what if you're both toxic and addictive, like cocaine or alcohol or nicotine or heroin? For those, we all have societal intervention, you know, rehab for the personal and laws for the societal. For sugar, for ultra-processed food, we have nothing. It's the same issue, nothing different. So you won regulation from the government on sugar. I think that the industry has to be told what to do. They haven't yet. Now, the question is, would it work? And the answer is, yeah, it would. And actually, who found out that it would work? The UK. You did it. You did it back in the 2000s. So in 2003. The Blair government brought all of the UK food manufacturers to the table in secret. So Waitrose and Tesco and M&S and every other CPG purveyor in the UK and had a secret meeting. And we're told, and told them, look, hypertension is running rampant and stroke is breaking the NHS bank. and it's because of the sodium. We have to get the sodium levels in ultra-processed foods down. So every one of you is going to play by the same rules so that there's no competitive disadvantage. And you're all going to reduce the amount of sodium in each of your items by 10% per year over a three-year period so that there will be 30% less sodium. three years from now, in 2006. It was 2007, I think, at the time. And they all did. And they didn't tell the public. And in 2011, a famous paper in British Medical Journal showed a 40% reduction in hypertension and stroke due to this public health intervention that the Blair government did. without telling the public. It works. Should I tell the public? No. Don't tell the public. So, would this work for sugar? So I am working with a company in the Middle East right now. Okay. I don't take money. Okay. It's a, um, you know, they do this because it's the right thing to do. Uh, it's called Kuwaiti Danish Dairy, KDD. It's like the Nestle of the Middle East. And they make all sorts of junk. They make flavored milks. They make ice cream. They make frozen yogurt. They make biscuits. They make confectionery. They make tomato sauce. Okay. Like all bad stuff. they came to me in 2020 and said, we want to be a metabolically healthy company. We want to do the right thing. Because right now, Kuwait has an 18% diabetes rate and an 80% obesity rate, and we don't want to be the cause of it. Can you help us re-engineer our product portfolio to be metabolically healthy? And so we convened the scientific advisory team, and we've worked for the past three years to develop a set of guidelines, a set of principles, and we have developed what we call the metabolic matrix. three principles, three precepts to turn food metabolically healthy. And here they are. Protect the liver, feed the gut, support the brain. Any food that does all three of those is healthy, whether it's ultra-processed or not. Any food that does none of the three... is poison, whether it's ultra-processed or not. Now, why those three organs? Because the data show in the literature, if you fix those three organs, all the downstream organs also get fixed. whereas if you fix other organs, those three organs don't get fixed. So those three organs are primary. And all the data shows that if you fix those three, you can actually improve both morbidity and mortality. So that's the goal. That's the rubric. Protect the liver, feed the gut, support the brain. So... Would we apply that principle to the food supply? Can any individual apply it to their own grocery purchases? Use Perfect, you'll get it. Can the government do it? Yeah, they did it in the UK. They can do it again. It's not crazy. It can be done. The fact is we're all carrying a belief system around. Okay? And now where did that belief system come from? The belief system is that ultra-processed food is food. Yeah. Where did it come from? It came from the food industry. They told us so. The scientists and governments told us so as well though, if you look at history. Oh yeah. So how do we know the scientists and governments are telling us the truth now? That's a very good question. That's a super question. How do you know what's true? we're in this problem right now. I'm worried that in 20 years'time, I'm going to be sat on this podcast if people are still listening, and I'm going to be sat with another scientist, and he's going to be saying, do you know that Dr. Robert Lustig, who you had on 20 years ago, everything he said has been disproved. And he's going to say, fructose is the key, apple juice is really important. We found out that vegetables are causing autism. Did you ever see the movie Sleeper? No. Woody Allen, 1973. No movies. He wakes up after 200 years in suspended animation and he finds out that hot fudge and deep fat are good for you. He said, oh, we've debunked all the stuff from before. So I get this question all the time. Everything we knew 10 years ago is already wrong. And everything we know today will be wrong 10 years from now. So if everything we know today will be wrong 10 years from now. why do anything about it? Because no matter what it is, it's likely to be wrong. This is known as the pessimistic meta-induction theory. This is how the dark ages started. The idea of dogma. There's only one dogma, Stephen. And the dogma is that there is no dogma. because everything has to be refined. Dogma. How do you define the word dogma? Dogma means you take it on faith. Okay. You take it on faith. That's what science is for, is to debunk the previous generation's dogma. If we didn't do that, we'd still be using leeches. Okay, we've debunked that dogma. We would still think that seizures were demonic possession. We've debunked that dogma. Okay, ultimately, science is not a straight line. It's a zigzag. but it still moves forward. So if I end up being discredited 10 years from now, 20 years from now, 30 years from now, hey, I was a cog in the wheel. At least I drove the vehicle forward. That's okay. And science is really a process, isn't it? Exactly. It is a process. It's not a set of religious beliefs, it's not a set of answers, it's just a process to uncovering information, I guess. But you have to then evaluate each piece of information for its veracity. Yeah. Because the problem with information is we're now peppered with disinformation. And how do you determine what's real and what's not? You say that to achieve contentment. You recommend following the four C's for contentment. Indeed. What are the four C's? By the way, if you follow the four C's, you will be a whole lot better off in terms of your understanding information versus disinformation. So, in my book, Hacking of the American or Contemporary Mind, I talk about ways to lower your dopamine, reduce your cortisol, and raise your serotonin. And they're all four things your mother told you, and they're all free, and they're all available to everyone on the planet. Number one, connect. Connect now. connect does not mean through Facebook. Connect does not mean digital connection. It means social connection. It means what we're doing right now, face-to-face, eye-to-eye. Now, why does Facebook not work? Why does Zoom not work? You're looking at somebody eye-to-eye. They've now done the imaging studies. Okay, there are a set of neurons in the back of your head in the occipital cortex called mirror neurons. and they are not just reading the lips of the person you're talking to. They are reading the facial structures and the muscle movements, and they are actually transducing the emotion from the person you're talking to. When you're watching on a screen, it flattens out. You can't tell, so you don't get the same information. That information ultimately generates a serotonin signal. so you get contentment. So social connection actually drives contentment. So that's number one. Number two, contribute. And that does not mean to your retirement account. It means contribute to others, okay? Contribute with purpose. like Habitat for Humanity, basically giving to others, because when you give to others, you feel better yourself. That generates a serotonin signal. so you know lottery winners you know are not happy but the people who actually give their money away are that's one of the reasons why we have philanthropy makes people feel better quite selfish in that regard then isn't it well yes indeed it it seems selfless but it's actually selfish which is fine it works just great number three cope you And COPE is three things. It's sleep, mindfulness, exercise, all of which are necessary to tamp down cortisol. because if you're sleep-deprived, your cortisol goes through the roof. If you are distracted, multitasking, your cortisol goes through the roof. And if you're sedentary, number one, you're eating like crazy, and your cortisol also goes through the roof. Sleep, mindfulness, exercise, all things to get your cortisol down. And finally, number four, the last C, cook. Why? Because there are three things. that contribute to this dopamine-serotonin imbalance. The first, tryptophan. Tryptophan is the precursor to serotonin. Tryptophan is not an ultra-processed food. It is the rarest amino acid. You find it in eggs, chicken, fish. Not exactly ultra-processed food. Number two, fructose. Fructose reduces serotonin. And there's lots of fructose in the ultra-processed food. And finally, lastly, omega-3 fatty acids. And omega-3 fatty acids are in, again, eggs and in marine life. There's a little bit of omega-3s in vegetables, you know, ALA, which doesn't reach the brain. So that's not a big winner for fixing this problem. So, you need high tryptophan, low fructose, high omega-3s. Sounds like real food to me. So, connect, contribute, cope, cook. It will tamp down your dopamine, reduce your cortisol, raise your serotonin, improve your mental health, improve your metabolic health, and will solve your problem. it won't solve societies. We have to work on getting the whole world to understand what the problem is before we can fix it. Dr. Robert Lustin, what is the thing we haven't talked about, the most important topic we haven't talked about that we should have? Well, we have a systemic health crisis. diabetes, metabolic syndrome, dementia, cancer. We have a mental health crisis, depression, suicide, schizophrenia, autism, ADD. We have a global health crisis. We have cyberbullying. We have social inequality. We have war. We have climate change. The planet is immolating. All at the same time. Coincidence? Or are these somehow inextricably related? Are these the same thing? Or are these different things? If we believe they are separate, we're going to try to solve each one individually and never get to the root cause. The root cause is our amygdala, the fear center of our brain. it's under attack. From all of the things we've talked about today, that dysfunctional amygdala is the driver of chronic disease. It is the driver of the mental health crisis. It is the driver of the global health and planetary crisis. There are four breaks on the amygdala, and they're all dysfunctional today. And they're all dysfunctional because of the things we've talked about today. Because of cortisol, because of stress, because of ultra-processed food, because of sleep deprivation, because of the change in the environment, because of air pollution, because of all the things that ultimately impact. our brain's ability to transduce information. Until we recognize where the problem is, we're going to be spinning our wheels. we can do this. We can back out the same way we drove into this ditch. But you can't solve a problem until you know what the problem is. Dr. Robert Lustig, thank you so much. We have a closing tradition on this podcast where the last guest leaves a question for the next guest, not knowing who they're leaving it for. And the question that's been left for you is, here we go, let's have a look. Okay, nice question. What would you tell your 20-year-old self that you wish you knew and that would have positively impacted your life and avoided pain? I wish I had known that... I didn't have to please everyone. There's a book called The Courage of Being Disliked. It's courageous to be disliked. I was afraid of being disliked. And because I was afraid of being disliked, I was disliked. I wish I had known that nugget of truth early on in my career. Thank you so much, Dr. Rook. My pleasure. Thank you, Stephen. I have to say your work is exceptional. Your books are incredible. I've got... three of them here, but I know that there's many more. I'd recommend them all incredibly highly. The Hacking of the American Mind is a fantastic book that doesn't just apply to Americans, it applies to all industries around the world, all Western economies around the world, which are set up in very similar ways. Fat Chance, another book that I've been through in detail, is about beating the odds against sugar-processed food, obesity, and disease, which covers much of your work and the studies that you referenced today. An incredible, incredible book. and I also have this book called Metabolical did I pronounce that correctly? you did Metabolical The Lur and the Lies of Processed Food Nutrition and Modern Medicine which is a little bit of a bigger book but it gives more of the foundations around metabolism which I think a lot of people don't understand so thank you thank you for your brilliance in so many ways but thank you for your life's work because your life's work is saving lives. It's propelling us forward. It's driving a conversation forward. And you do it in a way that's so unbelievably engaging that it's hard not to pay attention. So thank you, Robert. Well, thank you. And thank you for doing what you do.