You May Never Eat It Again After Watching This!
Dr. Robert Lustig and Dr. Rangan Chatterjee
My guest on this week’s Feel Better Live More podcast is Dr Robert Lustig, Professor of Paediatric Endocrinology at the University of California. He’s a leading public health expert who has long been exposing the myths of modern medicine and the food industry. His passion is communicating how sugar and ultra-processed food is fuelling the chronic disease epidemic that we are all facing today.
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Dr Lustig’s BRAND NEW book: Metabolical: The truth about processed food and how it poisons people and the planet https://amzn.to/3pX7iaL Connect with Dr Lustig: Website https://robertlustig.com Twitter / robertlustigmd Facebook / drrobertlustig YouTube @RobertLustigMD #feelbetterlivemore#feelbetterlivemorepodcast ——- Sign up to my new newsletter – Friday Five https://drchatterjee.com/fridayfive Order Happy Mind Happy Life. UK version https://amzn.to/304opgJ, US & Canada version https://amzn.to/3DRxjgp Feel Great Lose Weight is available to order in the UK https://amzn.to/2W6bsOE and in the US & Canada https://amzn.to/2GWPgls Dr Chatterjee’s book Feel Better in 5 is out now in the UK https://amzn.to/2G0XK7l and in the US and Canada https://amzn.to/2EB2oM0 Order Dr Chatterjee’s book The Stress Solution https://amzn.to/2MZ8u8h Find Dr Chatterjee’s 4 Pillars of Health in The 4 Pillar Plan available via http://amzn.to/2yGfpuB The US version, How to Make Disease Disappear is available via https://amzn.to/2Gj1YEL —– Listen to all previous podcast episodes on https://drchatterjee.com/podcast or via these podcast platforms by searching for ‘Feel Better, Live More’. Apple Podcasts – https://podcasts.apple.com/us/podcast… Acast – https://www.acast.com/feelbetterlivemore Stitcher – https://www.stitcher.com/podcast/feel… Spotify – https://open.spotify.com/show/6NyPQfc… —– Follow Dr Chatterjee at: Website: https://drchatterjee.com/ Facebook: / drchatterjee Twitter: / drchatterjeeuk Instagram: / drchatterjee Newsletter: https://drchatterjee.com/subscription DISCLAIMER: The content in the podcast and on this webpage is not intended to constitute or be a substitute for professional medical advice, diagnosis, or treatment. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.
Transcript
0:00when you consume sugar you are poisoning your mitochondria sugar and cyanide do
0:06the same thing this is the toxin [Music]
What does sugar do
0:13what are the key negatives when we consume the levels of sugar that many of
0:18us are currently consuming well first of all let’s make it very clear that sugar is not the only problem
0:25in our diet it’s the big one it’s the 2 000 pound gorilla in our diet
0:31but there’s other stuff too but sugar is a particularly egregious molecule once
0:37upon a time trans fats were the worst thing we consumed trans fats are the devil incarnate trans fats the bacteria
0:45can’t chew it up which is why they put the trans fats in all right so that you know it would last
0:51forever you know the 10 year old twinkie well the fact is our mitochondria are little energy burning factories inside
0:57all our cells are really refurbished bacteria we can’t chew it up either so
1:02the exact same reason for why they put the trans fats in the food is exactly why you shouldn’t eat the food
1:10now we know that and they’ve come out of our diet so now sugar is public enemy
1:15number one so what does sugar do and the answer is
1:21a whole bunch of bad things the food industry says sugar’s energy
1:27well they’re correct if you’re a bomb calorimeter
1:34if you just blow it up if you explode it yeah you get four calories per gram
1:40but we are not bum calorimeters turns out that sugar actually poisons the
1:48mitochondria okay it poisons it in three separate enzymes that are
1:55necessary for mitochondria to do their job the first one amp kinase which is the
2:00fuel gauge on the liver cell the second one acad l acelco a dehydrogenase long chain which is
2:07necessary to get fatty acids into the mitochondria to be able to oxidize them to create energy and the third one is
2:15cpt-1 carnitine palmital transferase one which is the enzyme that regenerates carnitine which
2:21is the shuttle mechanism that brings the fatty acids into the mitochondria in the first place in other words
2:27when you consume sugar you are poisoning your mitochondria
2:32you are generating less of the chemical energy that our cells
2:38get powered by called atp so if you’re making less atp
2:44is that energy it’s the opposite of energy so when you consume sugar you are
2:51actually inhibiting your body’s energy production
2:56can you think of a chemical that inhibits your mitochondria and
3:02reduces atp production cyanide cyanide cyanide cyanide does that
3:09okay sugar and cyanide do the same thing now obviously
3:15not as severely okay you know cyanide parts per million kilo over and diet on
3:20the spot with sugar you know it’s in the parts per thousand and you don’t keel
3:26over on the spot but you feel lousy and over time it’s going to take its toll
3:32but ultimately if you’re inhibiting your mitochondria you are poisoning your body
3:37and we now have the data to show how that occurs so here’s my question to you and your
3:44audience sugar is in virtually all ultra processed foods
3:51and ultra processed foods are now 56 of the uk diet
3:58and the amount of sugar that brits eat 62 of it is found in the ultra processed
4:05food category wow so my question to you and your audience is is ultra processed food
4:13food my view
4:20is that it’s not really i would say no but i know to many people that is super controversial
4:27um which we’re definitely going to talk about but yeah on a straight answer i would say no depends on your definition i guess
4:33because it’s energy it’s got some calories in it which we consume in our
4:40mouth enable us on one level to to sort of i guess you’re saying it’s actually uh
4:46reducing the energy production the sugar within it anyway but yeah on one level it sustains people and they can actually
4:53get on with their days at least in the short term anyway well
4:58you have to know what the definition of food is so if i if i had my webster’s dictionary
5:06right here right now you guys you know in the uk probably don’t use webster’s you probably have something else but if i pulled it off
5:12the shelf it would say that the definition of food is the following and i have no problem with this definition
5:18substrate that contributes to either the growth or burning of an organism
5:24that’s the definition i have no problem with that definition it’s a fine definition all right substrate that
5:30contributes to either the growth or burning of an organism
5:35so we’ve just talked about burning sugar does not contribute
5:41to the burning of an organism it actually inhibits the burning of an organism
5:46and dr kevin hall at the nih did a study where he showed that when
5:51you give people ultra processed food they burn less and gain more weight when everything else is controlled for
5:58compared to the same diet in real food did this in 2019
6:03so ultra processed food does not contribute to burning
6:10so now let’s go to growth does ultra processed food contribute to growth
6:16my colleague dr efrat monsenigo ornan who is the chairman of the department of
6:21nutrition at hebrew university jerusalem just published three papers
6:26in bone research showing that ultra processed food actually inhibits
6:32skeletal growth inhibits the ability of bones to increase in length and in width
6:40and in addition we know from the neutronessante study and many other studies that in fact what sugar does is
6:47it feeds cancer cells it hijacks growth so
6:52sugar doesn’t contribute to burning inhibits it doesn’t contribute to
6:59growth inhibits it or hijacks it so i pose the question to you again
7:05ranga is ultra processed food food i’ll go with my original answer which is
7:12no that is right it is no ding ding that’s right but the point is that the
7:20food industry you know refuses to go there the populace refuses to go there the
7:27governments refuse to go there and you and i are both interested in
7:35mitigating chronic disease and you are right if you get people on a
7:40real food diet you can mitigate virtually any and all of their chronic diseases i completely agree you gave a
7:47tedx talk basically saying you can basically take away somebody’s chronic disease i used to do that in my clinic
7:54but you know when i was practicing routinely yeah but only if they changed the food
8:01and if they didn’t change the food no amount of medicine i threw at them could make a difference yeah i mean what
8:07strikes me as a really key message is that the
Ultraprocessed food
8:14majority of what we’re buying to feed ourselves and our families
8:19is ultra-processed food whether it’s here in the uk or with you in america and that is contributing to this tsunami
8:26of chronic ill health that we’re seeing it’s pretty
8:32you know it’s pretty alarming but what i think is so key rob for me is that
8:38it’s so normalized now like it’s the norm everywhere schools hostels in fact if you want to go down
8:45the real food routes you almost feel like a bit of a like you know if you try to do with your kids you actually become
8:50a social outcast in in some ways it’s i think this is the problem it’s just
8:56it’s the norm we’ve moved so far away from what we used to do in fact maybe this is a good time for you to explain
9:03what you used to do when you were eight years old because i believe you had a grand who lived in brooklyn and every saturday
9:10you would do something which i think beautifully illustrates his points that’s right so yeah
9:16bottom line is i completely agree with you what we’ve done is we’ve normalized it once upon a time it was actually not
9:23normal to eat ultra processed food and today it is normal and i remember when
9:29that happens because it happened to me it happened to me in two ways so on
9:34saturday afternoons my family would go visit my grandparents who lived about oh
9:39i don’t know eight miles away in brooklyn and my grandfather would walk me down to the corner uh
9:46grocery store to buy a comic book and a six and a half ounce bottle of coca-cola i remember you know pretty much every
9:52saturday afternoon and that was the big treat you know the comic book and the coca-cola that was on ocean avenue and
9:59avenue and in brooklyn um you know the fact is that that was once
10:04a week and it was six and a half ounces all right today you know children are consuming about i
10:13think 35 ounces a day um you know uh median
10:19so they are getting about six times the amount of sugar that i did from that one
10:26coke and they’re doing it every day instead of once a week i mean let’s just can we just pause on
10:31that for a second you’re saying you had six ounces once a week and we’re assuming back then
Low in sugar diets
10:38that the rest of your diet throughout the week was low in sugar low in processed foods sort
10:44of a real food diets well my mother worked three jobs
10:50and so i ate a lot of swanson tv dinners when they first came out and i remember
10:56when they came out around 1964. you know the fried chicken the salisbury steak i hated that salisbury
11:03steak and i actually she trained me on how to turn the oven on and how to heat them up
11:10because often she wasn’t home at night you know so you know to some extent i
11:15was a latchkey kid because my mother worked so hard you know my father was in manhattan all day
11:21and so you know i basically had it sort of take care of myself and sometimes i had to eat dinner you
11:27know out of the freezer and so i remember you know those swanson tv dinners and you know
11:35they they were a problem and there’s still a problem so you put the two together
11:40and that was the beginning of you know the uh shall we say onslaught of
11:45processed food in the united states about the mid 60s
11:50then things picked up even more in 1975 when we started uh substituting high
11:58fructose corn syrup for sucrose because it was half as expensive and it was homegrown and then
12:06finally the piester resistance came in 1977 when uh the mcgovern commission released
12:13its report saying that we all needed to eat less fat to try to prevent
12:18cardiovascular disease well when you take the fat out of food it tastes like cardboard and so what did the food
12:23industry do it basically replaced the fat with sugar that’s why we ended up with entenmann’s
12:30fat free cakes and you know and the like and that was when the pasta craze you know first hit was you know refined
12:36carbohydrate because it was quote low in fat etc and you know now we’re off to the races
12:43and it’s just exploded ever since is it the sugar that’s inherently bad in
Is sugar inherently bad
12:50and of itself or is it the excess amounts i mean or is it both right because i think a lot of people might
12:56say well look you know what this never used to be a problem right and we we would have the odd sweet treat now and again um
13:04but so and actually there’s quite there’s quite a few prominent scientists as um you’re you’re well aware of you
13:09say actually sugar’s not a problem sugar’s actually completely fine i’m working on it we’re
13:14working on it i i have a bone to pick with some of those scientists and we can argue that and talk about that if you
13:20like as to exactly why they say what they say so here’s what i can tell you
13:26all right there are social drinkers
13:33and there are alcoholics now social drinkers can pick up a beer
13:40and put it down and they don’t need one every day alcoholics
13:45pick up a whiskey and can’t put it down and they need it three times a day
13:52right yeah did the one beer that the social drinker
13:57drink hurt them unlikely
14:03unlikely unlikely and the reason it’s unlikely is because
14:08there is a what is known as a first pass effect you drink the alcohol in the beer first
14:14of all it’s very low uh percentage right it’s only a 3.6 percent in an um in a uh in a beer
14:22all right and that uh is about oh 60 calories worth or so of of alcohol and what
14:30happens is that the first pass effect the uh stomach and intestine metabolize
14:35that alcohol before any of it ever gets to the liver and so the amount that actually hits the
14:42liver that could do damage is exceedingly small
14:47and as long as you’re not following up with a second beer and a third beer and a fourth beer and a fifth beer you know
14:53like can happen at the newcastle pub you don’t usually have a big problem
14:59right but if you keep doing that then that is a problem so it’s a
15:04dose-dependent phenomenon and your intestine is there to try to
15:12protect your liver from getting the onslaught before it will do damage
15:19same with sugar no difference
15:25so your intestine can take a small amount of sugar that you consume
15:32and can actually turn it into fat in the intestine intestinal de novo lipogenesis
15:39the process of converting sugar to fat into vldl in the intestine so that it will
15:47not go straight to your liver right and about 10 percent
15:53of the of an initial sugar bolus will undergo intestinal dnl and therefore be diverted away from the
16:00liver and into the bloodstream as the ldl now that vldl is not great for you because
16:06it could ultimately cause heart disease but it’s protecting the liver but if you consume past your intestines
16:14capacity to do that now the rest of it’s going to end up in your liver and the problem with sugar in the liver
16:22is exactly the same as the problem of alcohol in the liver because it causes the exact same processes
16:29it causes glycation it causes oxidative stress it causes mitochondrial dysfunction and basically drives insulin
16:38resistance this phenomenon that we now know is at the base of virtually all
16:43chronic metabolic diseases therefore your pancreas has to make extra insulin to make the liver do its
16:50job because now the liver is not working right because it’s been poisoned and so insulin levels rise all over the
16:56body and now you’ve got you know the risk for alzheimer’s you’ve got the risk for heart disease you’ve
17:02got the risk for virtu for cancer you’ve got the risk for virtually every other
17:08chronic metabolic disease on the plate all because of what happened to your
17:13liver yeah and fructose that sweet molecule and sugar
17:18basically has the same fate as alcohol
17:24so when people say oh you know little sugar is fine answers um yeah because
17:31your intestine diverts that little bit away from the liver as soon as you
17:36overwhelm that capacity now your liver is right in the cross hairs
17:41and that’s when chronic disease is going to start yeah rob you’re a
When was the first time you started to think
17:47pediatrician um i’ve seen videos of you talking with
17:53passion about this exact topic maybe 15 years ago still online
17:59something like that when was it when was the first time for you that you
18:05started to think you know what’s going on here in the book you have been pretty um
18:11it’s pretty provocative at times i actually agree with it so i like it you’ve really gone out there you’ve sort
18:16of you’ve ripped into modern medicine at times and we’re definitely going to talk about that
18:21but when was it because you do have this sort of incredible passion and energy to get
18:27this message out there and i’m just wondering what was it in your clinical experience that actually
18:33really got you into thinking there must be another way here this can’t be right right well so i had three aha
18:41three and that sort of got me to where i am today and why i’m saying what i am
18:47saying today the first aha moment came when i worked at saint jude
18:52children’s research hospital in memphis tennessee pediatric cancer hospital
18:57and i went there in 1995 and i was presented with a cadre
19:05of about 40 children who would survive their brain
19:10tumors you know because of surgery and radiation sometimes chemotherapy
19:16who had become massively obese they were perfectly normal weight before
19:22the tumor and now they were on the order of 350 to 400 pounds
19:28okay normal kids before the tumor and now massively obese
19:34and there’s a name for this it’s called hypothalamic obesity was first you know written about first uh
19:41described in 1901 by frelick and babinski two of the you know greats of
19:48of of international neurology and i had all these kids with hypothalamic
19:56obesity that i had to take care of and like how do you get them to lose weight how
20:04do you get them to get better and it had been shown previously that diet exercise is useless
20:10in fact george bray the father of obesity research in america in 1975
20:18had taken eight of these kids on his ward and fed them 500 calories a day for
20:25a month what do you think their weight did
What do you think their weight did
20:32well you would expect it came down but i suspect in this case it probably didn’t
20:37it went up yeah okay 500 calories a day and their weight
20:42went up like how does that happen the answer is it happens
20:48because they were burning it slower
20:54than they were taking it in because their metabolism of
21:00calories had actually come to a virtual standstill
21:05so even 500 calories a day was too much and these kids have like no energy they
21:12sit on a couch they’re not interested in anything the parents would actually complain that that was the worst thing
21:18about this they’d say this is double jeopardy my kid has you know survived the tumor only to succumb to the therapy
21:25because my kid is a lump on a log and he’s lost interest in everything he’s
21:30lost interest in school he’s lost interest in life he’s lost interested in activity he’s lost interest in friends
21:35he’s lost just in everything all he wants to do is sit and sleep
21:42and so i had to take care of these kids so i went to the literature and i said oh
21:49the other thing was that this was exactly when the hormone leptin
21:54had been discovered leptin was discovered in 1994 and i was prepared for that discovery
22:01because i worked at rockefeller university with the guys who discovered it jeff friedman and rudy libel okay we
22:07were all the md’s at rockefeller university all you know had to take call
22:12in the hospital together so we were always trading you know called call dates and everything so everybody knew
22:18what everybody else was doing so i knew that they were trying to clone this you know this hormone you know out of these
22:24mice and so when they did in 1994 i was very prepared for it
22:30so i moved to saint jude and i had these kids and it’s like what am i going to do for
22:35them and i postulated right then that these kids
22:41must have leptin resistance these kids can’t see their leptin and
22:48the reason is because their hypothalamus is dead because we killed it because of the tumor or the surgery the radiation
22:54and so because they can’t see their leptin their brain thinks they’re starving
23:01so the question was okay their brain thinks they’re starving is there what’s downstream of leptin
23:08what’s actually making them gain the weight the starvation is why they’re hungry but what’s making him
23:14gain the weight well we knew that these kids made a lot of insulin and we knew that there’s this uh animal
23:22model of damaging the hypothalamus and they put out enormous amounts of insulin and you could actually stop that by
23:28cutting the vagus nerve the vagus nerve is the nerve that leads from the brain to the pancreas and then
23:34the insulin would go down so i said well i can’t cut their vagus nerve i’m not a surgeon and you know
23:40that’s a little drastic but what if i gave them a medicine that suppressed their insulin release
23:47so we gave them a drug called octreotide a drug that you know is used by
23:53endocrinologists to usually suppress growth hormone release but it also suppresses insulin release so we
23:59repurposed it and we gave it to these kids and lo and behold
24:06they started losing weight and they couldn’t lose weight before you know george brady showed they gained
24:12weight they were losing weight and something even more remarkable happened
24:18they started exercising spontaneously
24:23one kid started competitive swimming two kids started lifting weights at home one kid became the manager of his high
24:29school basketball team running around collecting all the basketballs i mean these were kids who sat on the couch ate
24:34doritos and slept and now they’re active again and the parents would say oh my god i’ve got my
24:39kid back and the kid would say this is the first time my head hasn’t been in the cloud since the tumor
24:44yeah so something had changed
24:51their relationship to the world not just their relationship to food
24:56but their relationship to the world so we said this is very interesting so we did a double-blind placebo control
25:03trial and this time built a quality of life measure into the protocol
25:08and sure enough the lower we got the insulin with the drug not only the more weight they lost but
25:15the more active they were so what this did the reason why this is
25:22so important and the reason i’m spending so much time on it wrong is because this turns the first
25:30law of thermodynamics on its head because the standard interpretation of
25:36the first law goes like this you know the first law is you know the total energy inside a closed system
25:42remains constant your energy can neither be created nor destroyed just shifted around okay
25:47the standard interpretation that we learn in medical school and what what the general public learns
25:54is if you eat it you better burn it or you’re going to store it
25:59in which case the storing part the fat gain
26:04is secondary to the primary problems which are the
26:09eating and the burning the gluttony and the sloth
26:15therefore the weight gain is secondary to the gluttony and the sloth therefore
26:21it’s about behavior fix the behavior fix the weight
26:28what we showed in these kids was it’s exactly the opposite
26:33turn it around what we showed was if you’re going to store it that is a high insulin level
26:41leading to obligate weight gain and you expect to burn it
26:46that is normal energy expenditure for normal quality of life because energy expenditure and quality of life are
26:52synonyms for each other then you’re going to have to eat it and now
26:58the storage is primary and the behaviors are secondary the gluttony and sloth are
27:04actually because of leptin resistance so we get sick first and then
We get sick first
27:13the weight comes afterwards that’s right we get sick first and the weight is
27:20secondary that’s exactly right so this is you know
27:25monumental this is huge but of course you know it goes against
27:31everything that are taught and it goes against everything that you know doctors routinely believe but this was my first
27:39aha moment my second aha moment
27:45came in 2006. so i realized that insulin was the bad
27:50guy and we started then changing what we did in clinic
27:55instead of worrying about weight we worried about insulin we said get the insulin down any way you can and that’s
28:02what my clinic became it became an insulin reduction clinic it didn’t it wasn’t a weight loss clinic it was an
28:09insulin reduction clinic and when we got the insulin down then they lost weight
28:14so in 2006 i was asked to give a talk at the nih
28:20okay specifically the international institute of environmental health sciences in research triangle park north
28:25carolina they were having their 100th anniversary of public health
28:32and it was a two-day symposium the first day was on their successes like lead
28:38poisoning and pollution and asthma things they’d figured out and you know been able to do something for the public
28:43health and the second day was on challenges and the morning was going to be obesity
28:48metabolic syndrome and this afternoon was going to be 80d in autism okay
28:54so they asked me to give a talk what do you think is the single most important
29:02environmental exposure that leads to obesity and metabolic syndrome
29:11and i figured that they probably figured i was gonna you know give a talk about some you know like bpa or some other you
29:18know environmental you know toxicant you know that’s in the water or in the air or you
29:23know something like that and i thought i thought to myself how am
29:28i gonna you know make this worthwhile and i thought to myself all right wait a second let’s let’s let’s go backwards
29:35here children today get two diseases they never got before
29:43type 2 diabetes and fatty liver disease those two children never got those
29:49before now lots of kids get them all right so
29:55i looked up type 2 diabetes and fatty liver disease and of course you know i know a lot about both of them but i very
30:01specifically looked for origins and causation it turns out that in the old days
30:08you know back in the 1970s before this pandemic of chronic disease started
30:15those both both those diseases were the diseases of alcohol
30:21type 2 diabetes and fatty liver disease were the diseases of alcohol
30:26but kids don’t drink alcohol so i said all right is there something
30:31they’re exposed to that’s like alcohol i opened up my lenninger you know
30:38biochemistry textbook from 1974. sitting at this table that i’m at right
30:43now i said what the hell is like alcohol
30:50there it was and stared me right in the friggin face right off the page from 1974 and the
30:57answer was fructose fructose and alcohol are metabolized virtually identically
31:04and it makes sense that that would be the case because after all where do you get alcohol from
31:09fermentation of fructose it’s called wine yeah we do it in nap and sonoma every day
31:16okay the big difference between fructose and alcohol is that for alcohol the
31:21yeast does the first step of metabolism called glycolysis for fructose we do our own first step of
31:28metabolism but after that what the mitochondria see are exactly the same as kilcoe it’s just a question of which
31:36which was the substrate was it the ethanol or was it the fructose but ultimately they end up with the same
31:42fate so it’s very clear all of a sudden right looking at that
31:48right there that this is the substrate that is driving both the type 2 diabetes
31:54and the fatty liver disease so i put together a talk and i went to
32:00north carolina and i said this is what i think is going on and here’s why
32:06half hour talk and then there was the bathroom break and you know i got my applause and then
32:12everyone left the room [Music] and they didn’t come back
32:18you know i’m standing there at the podium talking with you know this person that person and
32:23no one’s coming back for the next session and then i had to use the bathroom so i went out
32:29and i actually got tackled in the freaking bathroom of the nih
32:35by a bunch of crazed toxicologists
32:40screaming at me saying oh my god oh my god
32:46you’re right this makes perfect sense this is the toxin
32:52you have to tell everyone about this
32:58i guess i’m still doing it i guess you still ah
33:03so if the toxicologist went berserk
33:10might be true and then that was the so that was the second aha and then the third aha
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34:02now back to the conversation it was not even my aha it was my colleagues aha but i i adopted
Sugar Hill Gang
34:09it so we got very interested in sugar here at ucsf after that we actually have a group
34:16of us we call the sugar hill gang they’re actually referenced in the book here
34:21um but uh my colleagues kristen karns laura schmidt and stan glance
34:27started looking at the paper trail of the food industry back in the 1960s
34:35and found the actual paper trail that showed that the food industry paid off
34:42scientists to exonerate sugar and figure saturated fat as the bad guy
34:49we actually found their documents that showed the money transfer
34:54and the communications you know just like what the january 6 committee is doing now
35:00follow the money and we so we actually proved that the sugar industry put their
35:05thumb on the scale back in the 1960s to exonerate their product because there had been data that
35:12had been coming out at that point showing that sugar was not good for you in fact that’s what john
35:18yudkin found remember pure white and deadly and he had found you know shown that data and
35:25so people were starting to cast a a you know a fisheye at uh at sugar
35:31and so they had to go into overdrive mode and to to pr this problem away
35:38and so they approached the chairman of the department of nutrition at the harvard school of public health fred stare and his associate mark hegested
35:45who ended up becoming the head of the u.s department of agriculture in 1970 to pay them off 6 500 back then which
35:53would be about 50 000 today to write two review articles to appear in the new england journal of medicine that
35:59basically said saturated fat’s the bad guy and sugar is no problem whatsoever
36:08that’s the third aha moment it’s all a scam the whole thing’s a put up job
36:16and that’s why i wrote metabolic
Alcohol
36:23sugar and alcohol i don’t think people commonly
36:29would put the two things together people i think like you know joe public i think
36:34would would think okay alcohol i know if i drink too much it’s not good for me it’s going to cause problems with my
36:40liver i think there’s that understanding and if i drink a little bit have some days off a week
36:45you know you know the odd glass of wine here and there’s probably not going to be too bad for me i think is what most
36:50people tend to think that’s true and and and if that were the case that would be true
36:57and that’s true for about the forty percent of americans who are social drinkers you know forty percent of tea
37:02totalers don’t touch your stuff okay forty percent of social drinkers can pick up a beer put it down like me okay
37:08but 10 of binge drinkers and 10 are hardcore alcoholics yeah
Root causes
37:14but i don’t think people think of sugar in the same way in terms of what it does for the liver
37:19um and i think that’s that’s a really i think eye-opening comparison for a lot of people the other
37:25thing you said which i think really beautifully ties into the start of this conversation is that you
37:31started running an insulin reduction clinic right and you know like you i’m very
37:37passionate in root causes and this idea that we’ve labelled all these so-called separate diseases we get
37:43taught about them at medical school those are all separate entities for this disease you you take this drug and you
37:49have this sort of treatment and we look at that downstream pathology don’t we but you mentioned mitochondria at the
37:55start in terms of what sugar or excess sugar can do to mitochondria and that
38:00you know mitochondrial dysfunction sits at the heart of so many different conditions but also insulin resistance
38:07right so that insulin resistance that insulin lowering clinic
38:13actually would probably depend on who was coming in i appreciate your pediatrician but if
38:19if all of us as doctors ran insulin reduction clinics
38:25we would get rid of 75 percent of the chronic disease in america and in the world exactly
38:30it’s that root cause again isn’t it yeah absolutely i took completely agree which is what i’m trying to you know uh bring
38:36to you know medicine unfortunately you know medicine is provincial
38:43medicine doesn’t you know uh respond very well to you know new ideas yeah
38:49it’s uh you know it’s a uh it’s it’s a cartel if you will
Modern medicine
38:54you’re very um critical of modern medicine in the book you say modern medicine treats symptoms
39:00uh you say modern medicine is not the solution i do indeed and i i agree with this it’s
39:06it’s something i’m it’s one of my big frustrations in my what now 20 21 year career seeing
39:12patients it’s like you know you know i sometimes wonder
39:20if doctors honestly ask themselves sometimes at the end of their day and obviously it depends where you work i’m not talking about intensive care i’m
39:26talking about you know chronic patients that and i did this once rob i i did this in general practice once i asked myself at
39:33the end of the day how many patients do you honestly think you’ve really helped today
39:38and you know quite a few years ago it was 20 percent i thought i’ve only helped 20 percent of
39:44people the other 80 i’ve done something i’ve i’ve sent them off for a test i’ve you know referred them or i’ve given
39:50them a drug but i kind of knew they’d be back i thought i’m not really getting to the heart of this problem i knew i kind
39:56of feel the patient knew it as well and that’s kind of one of the things that led me on this journey to try and
40:01understand that there must be a different way and you know that’s why i think metabolical
40:08is such a wonderful book it outlines the history it outlines the science
40:13but it also gives some really practical solutions and you know i love your
40:18you know we mentioned the liver a lot so far so one of your big messages in the book is protect the liver
40:25and feed the guts in terms of dietary advice for people
40:30and you know a lot’s been written about food in the past but that’s that’s
40:35very fresh i think that’s quite a new idea for people and i wonder if you could explain then what do you mean
40:41protect the liver and feed the guts sure well before we go into protect the liver feed
40:47the gut because that’ll take up the whole rest of our podcast as you know explaining all that i want to just
40:52address the whole medical school thing you know and then you know how you felt as a doctor me too the bottom line is
40:59you know we uh treat medicine and unfortunately medical schools treat
41:04medicine like a big game of clue you know colonel mustard in the conservatory with
41:11the candlestick match the um uh symptom card with the diagnosis card with the
41:17treatment card and discharge your patient in fact in 1980 there was a game that
41:23was to play in residency you know on like sunday mornings before things got busy in the er called intern
41:29and that was what you did you basically took your symptoms you got a symptom card you got a diagnosis card and you
41:35got a treatment card and once you got the three of them together you got rid of the patient first uh you know player to discharge you know to discharge all
41:42their patients won the game you know and that’s how we treated it so you know these diseases
41:50you know got a got a meningitis here’s an antibiotic you know got a um uh you know
41:57cancer here’s a chemotherapy you know but the fact is chronic disease doesn’t you know really fit into that yeah there
42:05are there are eight count em eight chronic diseases that have completely taken over modern
42:12medicine eight and here they are type two diabetes hypertension
42:19dyslipidemia cardiovascular disease cancer dementia fatty liver disease
42:24polycystic ovarian disease those eight that those eight now
42:30account together for 75 of all health care costs
42:35and none of them have a cure none of them even have a treatment
42:44they all have a prevention we’re not preventing it
42:51we’re handing out you know um you know uh statins or you know oral hypoglycemics
42:57or you know antihypertensives you know like candy but that’s treating the symptoms you know
43:04the manifestations of the disease not actually treating the cause and the
43:09reason is because those diseases are not really the diseases what’s going on underneath to cause all
43:14eight of those diseases are exactly the same they’re just in different organs
43:20and here are the eight things that i outline in the book what i call the diseases that are not
43:26diseases i call them the hateful eight and here they are okay and these are things that people don’t know because
43:31they don’t have icd-11 codes and doctors don’t know what to do about them so they don’t even mention them so
43:37no one’s ever heard of them and they didn’t learn them in medical school either so here they are eight
43:43number one glycation number two oxidative stress number three mitochondrial dysfunction number four
43:50insulin resistance number five membrane instability number six inflammation number seven methylation number eight
43:57autophagy now these are all normal phenomena that
44:03happen but they can be speeded up or slowed down by what you eat
44:09and it turns out when you have control over all eight of those things
44:16you will be 110 playing tennis when you don’t have control over those
44:21eight things you will be 40 years old in a wheelchair with two stumps on dialysis waiting for
44:28your next stroke and of course everything in between
44:35so those are the choices those are the options and because none
44:41of those eight the hateful eight that i just mentioned any of none of them have a
44:47cure none of them even have a treatment they only have a prevention
44:54we’re not preventing anything and that’s why you felt
44:59like you were not helping any of your patients because you weren’t addressing
45:04those eight root causes that you yourself
45:10know to be the big problem in medicine yeah it’s like it’s like a leaking roof
Fixing the problem
45:16isn’t it the roofs leaking and you just putting a bucket there to pick up the water that’s kind of what the drugs are
45:21doing yeah they that it’s great it’s there’s no water there on the floor so you can live a bit a little bit better
45:26but you’re not getting to the the cause right you need to fix the leak in the roof and then actually you no longer
45:32need the buckets right well and you won’t the problem is if you don’t fix the leak in the roof you won’t have a house yeah
45:40that was one of my favorite parts of the book of these eight
45:45processes that are occurring in all of us and they’re either promoting health and longevity
45:52or they’re actually the opposite of creating illness and
45:57ultimately disease and i really love the way you say that actually medicines aren’t really
46:04tackling those things and i just want to be really clear for people that
46:10anti-hypertensives or um you know drugs in general they have a role sometimes right they
46:17can be helpful in certain situations i think you’re in agreement with that
46:23it’s just we i’m not against them yeah okay i’m not
46:28against them per se but the problem is that if you don’t fix the underlying
46:34problem what have you done
46:39okay so it’s fine to give a statin to lower an ldl
46:44but what have you done have you actually fixed the problem you haven’t done a damn thing about the problem the problem’s still there
46:52okay so um you know the very first the very first sentence
46:59of the book okay starts like this you find a wasp in your attic
47:06what do you do kill the wasp or find the wasps nest
47:15you have to work upstream of a problem to solve a problem
47:20working downstream of a problem only fixes the result of the problem the problem’s still there
47:27and if you don’t if you can you can kill the wasp but then the next time you go up into
47:33the attic you’re going to be stung into submission by all the other wasps yeah because you
47:40didn’t fix the problem i i think we really need to i want to make sure everyone listening
The root cause
47:47and watching this has got this that what you’re talking about is really at the heart of pretty much every single
47:53chronic disease that’s going on at the moment that is afflicting families it’s overwhelming healthcare systems it’s
47:59causing uh disability it’s causing you know reduction in the quality of life
48:05and actually most of them are caused by you know malfunction in these eight in
48:11these eight areas but ultimately what you’re making a very strong case for is that it’s actually the modern
48:18food environments this highly ultra processed food that we are consuming in
48:23inordinate quantities is actually at the root cause and unless we deal with that
48:28as a root cause we’re going to be struggling people are going to be suffering healthcare systems are going to be suffering and we’re not
48:33going to get anywhere your your intro to the book was it it literally was so punchy like
48:42we could just do a podcast on the introduction frankly but i there’s a couple of bits i’ve underlined which i think if you don’t mind me reading it
48:48back to you your own book i so appreciate that you called my intro punchy because several people on you
48:55know amazon have said you know all he did was rant you know i guess it depends on how
49:02concerned you are about the problem yeah and this is this is such a big problem like it’s arguably the biggest problem
49:09that’s going on across the globe at the moment because well and you’re seeing your kids right you see kids i i see
49:16kids and when you see a seven-year-old with pre-diabetes you’re like this
49:21wasn’t happening 20 25 years ago something is going on and we can’t just give them metformin or we have to try
49:28and figure out what’s causing this right can arrows if kids are the canaries in the coal mine and if you
49:34ignore it you know you do it at your own risk it’s just that simple and that’s what we’re doing we’ve done we’ve
49:39ignored it the other thing is that everybody right now is completely distracted
49:45okay they’re distracted by this thing called coven okay and i understand why and you know it’s just it’s certainly distracting
49:52however let’s talk about that for a minute okay people are dying in droves in every
50:00country uk us you know you name it do you know where they’re not dying
50:07they’re not dying in countries that actually still have real food
50:13third world countries actually have a very low death rate and it’s not because they’re using masks or um hand washing
50:21you know or social distancing the reason is because they’re eating real food we have the data on mortality
50:27rates of the different countries i can put it up on the screen if you want but the bottom line is
50:33it’s only the developed countries that have the high mortality rates
50:38now why is that so we’ve identified the elderly and they
50:44have immune dysfunction we understand that they can’t generate the same cytokine response that you need you know
50:49that that everyone else should be able to okay let’s put the elderly aside for a moment
50:54because that’s true everywhere it was true in italy too but the other three things the other
51:01three demographics that were shown to be you know uh related to covet mortality
51:07here they are people of color the obese
51:12and pre-existing conditions those three people of color
51:18the obese pre-existing conditions what do those three demographics share
51:25in common probably poor socioeconomic conditions um poor diets lots of highly processed
Why your food matters
51:32food right ultra processed food consumption crappy diet ultra processed food
51:37consumption so why should your food make a difference as to whether you die from covet or not
51:44why is that here’s why three reasons
51:50number one the virus is very smart it wants to
51:56attack all your cells and every cell in your body has a receptor
52:01that helps regulate water within the cell and that receptor is called ace2
52:06ace2 angiotensin converting enzyme 2 it’s an endocrine receptor okay and that’s where
52:13angiotensin works and it involves water transport all right so every cell has it
52:19turns out the virus uses that protein as its injector
52:25point well high insulin increases ace2 because
52:30high insulin causes water retention and so there are more ace2s
52:36on all your cells so you are more at risk of being infected
52:43when your insulin is high and your insulin is high because of processed food that’s one
52:49number two diabetes high blood glucose high blood glucose turns out the glucose
52:55actually crystallizes around the edges of those acetus holding them open making it even easier
53:01for the virus to inject its rna number three
53:06short chain fatty acids so short chain fatty acids come from fiber consumption and of course
53:13ultra-processed food is devoid of fiber short-chain fatty acids suppress the
53:18cytokine response and we now know it’s not the virus that kills you it’s your cytokine response
53:24that kills you because your cytokine response is basically sort of like a nuclear blast
53:31that affects even your normal cells but it’s trying to get rid of the foreign invader but you have to temper it you
53:38have to be able to manage it you have to be able to pull it back you have to be able to
53:43minimize it short chain fatty acids that come from the digestion of fiber in the gut
53:50are one of the things that improves that cytokine response that’s why
53:56fiber is anti-inflammatory and also improves insulin sensitivity but processed food doesn’t have any fiber
54:03it’s been you know that’s been removed for shelf life so those three demographics people of color
54:10the obese pre-existing conditions big ultra processed food consumers high
54:15sugar low fiber processed food not real food
54:20the cdc and the nih and the mrc and every and everyone in public health
54:26england no one is talking about food
54:31in cobit yeah this is the fourth leg of the stool okay we all talked about masking and
54:38hand washing and social distancing garbage fix the food
Food terminology
54:43now i think when we’re talking about foods i think we need to get clear on
54:49terminology for people who are listening and they think okay look i get this highly processed food is at the
54:56root cause of many of these chronic diseases over half of what we’re consuming as a
55:01country as a western society are these foods so i guess we need to
55:07really help people understand you know what are these things there’s this part in the introduction where you actually i’ve underlined it you said
55:13what if this slow consumable poison looks like everything else in the store how do you protect yourself and that’s
55:20kind of part of the problem isn’t it i don’t it’s so normalized that i think many people don’t really understand
55:26anymore well what is a processed food what is real food you know so can you help us try and understand that
55:32right yeah one of the first questions we ask in in clinic you know we used to ask is you
55:38know mom you know the the mom and the kid come in you know for for you know uh obc clinic and we asked
55:45you know mom you know what do you consider food you know do you do you
55:50think cheetos is food if you think cheetos is food then
55:55basically nothing’s going to help you so that’s the first thing we do is we disavow them of this concept of this
56:02knowledge so what we did in our clinic to be effective and we actually studied this we
56:08published on it we validated it as an instrument what we did was we
56:14took all newcomers all new referrals to our clinic and we did a teaching breakfast
56:22so these kids came in fasting you know so we could get comorbidity and safety labs
56:28and we you know they saw the doctor they got their blood drawn they got their physical exam and then they went to the
56:35teaching breakfast six kids six parents around the table one dietitian english and spanish uh
56:42different you know different times all right so that everybody you know got a teaching breakfast
56:47and we got a 100 gift certificate from trader joe’s every month to basically
56:54buy the food for the teaching breakfast and of course our dietitian went out and
56:59bought the right stuff not the wrong stuff and we would then she would then narrate for
57:07or he would narrate for an hour why these foods were on the table for
57:13breakfast and why the stuff they were buying at home was the wrong stuff
57:21okay and we would explain insulin and we would show them how much sugar was in each of the things that they were
57:26getting at home and versus you know what what was on the table and four things had to come out of that
57:33and we actually validated this four points
57:38four different points that conferred success
57:43number one the parent had to see the kid would eat the food number two the parent had to see the
57:50parent would eat the food number three the parent had to see other kids would eat the food because they got
57:57other kids at home number four we showed them the bill they had to see they could afford the food
58:05all four if we got all four boxes ticked
58:11those patients did well and then there was no going back
58:18so this was a training moment this was a teaching moment this was a way we could
58:24explain to to parents and to kids what was going on
58:29and model for them so they can do c one do one teach one more like we always do in medical school
58:35if you tell people what to do they will not do it if you show people what to do
58:41and they do it then they’ll do it again yeah and not until
58:50the term real foods i like it you use it
58:57but it does get a bit of pushback from certain academics and you know i saw one i think on instagram
59:03just a couple of weeks ago a very prominent uh researcher and obesity in the uk
59:09um denigrating the term saying it smacks a privilege it’s you know
59:15all kinds of things about it and here’s the thing you know you know my view bob is that
59:22i found it to be very useful with my patients of course if my patients don’t like it i’d come up with something else
59:28that they understand um but generally speaking i think the things like
59:33you know would your grandparents recognize it as foods i think people find it quite helpful or does the food
59:40packet have more than five ingredients on it or not as a kind of general referral they’re not perfect
59:45but they’re all kind of guidelines to try and help people make sense of this ultra process food environment in
59:52which they’re living and i kind of i wonder why there’s so much criticism it’s like these things are there to help people if
59:59you find it helpful great if you don’t fine use something else but i don’t like i find a lot of people particularly
1:00:05in medicine and academia look down on these kind of what are considered simplistic terms
1:00:12yeah i i’ve i’ve heard those uh complaints also before and i’ve heard about the
1:00:18quote smacks of privilege also basically what we’re saying is real food is food that came out of the ground or
1:00:24animals that ate the food that came out of the ground that’s real food okay
1:00:30as soon as a human touched it now it’s processed just a question of the degree of processing also and you
1:00:36know i’m sure you’re familiar with carlos montero at university of sao paulo developed this system called the
1:00:41nova system for the degree of processing which i actually think is you know the right way to go it’s not because that
1:00:48it’s not what’s in the food it’s what’s been done to the food that matters all food is inherently good
1:00:53it’s what we do to the food that’s not and that’s the point i try to make in the book and i have an entire section on
1:00:59what we did to the food that actually turned it from food into poison that classification system is brilliant and
1:01:07perhaps you could take a kind of readily available simple food
1:01:12and just explain how it can go through these four stages to help people really understand this
1:01:17sure i can do this in one minute let’s take an apple class 1 on the nova system would be an
1:01:25apple class 2 on the nova system would be apple slices
1:01:32class 3 on the nova system would be apple sauce unsweetened
1:01:38class 4 on the nova system would be an apple pie
1:01:44there you go it turns out that only the class 4
1:01:49foods are associated with chronic disease
1:01:56so we can have we can have minimally that’s really incredible so we can have you know minimally processed foods that
1:02:03are done to make our life easier a little bit or you know but it’s when it goes to that extreme where it’s actually there’s no
1:02:10resemblance to actually what actually came out of the ground in the first place that’s right and so what is different
1:02:16about that apple pie versus the apple and the answer is the addition of sugar and the removal of fiber
1:02:24so this now brings us to the question you asked me earlier about the protect the liver feed the gut
1:02:31so the addition of sugar is what basically floods the liver
1:02:36because the liver only like alcohol only has an innate capacity to metabolize a small
1:02:44amount we know how much uh sugar we can metabolize
1:02:51and it’s not that different from the amount of alcohol that we can metabolize because the
1:02:57treat you know the the uh the metabolism is virtually the same point is you can overwhelm your liver’s capacity to
1:03:03metabolize sugar and when that happens just like what happens when you over metabolize alcohol
1:03:09is your liver can handle the onslaught and so it has to take the extra and turn
1:03:14it into fat there are enzymes in your liver that turns sugar into fat it’s called de novo
1:03:22lipogenesis new fat making there are three enzymes that uh in concert that do
1:03:28this one’s called uh atp citrate lyase the other one’s called acetyl coa carboxylase and the last one
1:03:35is called fatty acid synthase these three enzymes are being driven
1:03:40by excess substrate and that substrate is fructose then turned into acetyl coa by
1:03:48glycolysis so bottom line you’re flooding your liver
1:03:54and the goal is protect the liver and when you flood your liver now your liver makes fat and that fat
1:04:02precipitates now you got fatty liver and now you got insulin resistance yeah
1:04:07and now you got chronic metabolic disease so protect the liver
1:04:13second part feed the gut now a lot’s been written about the
1:04:18microbiome okay and there are a lot of probiotics
1:04:23that are now you know in health food stores to try to restore the microbiome
1:04:29and everyone now knows that the microbiome talks to your brain which is true it does
1:04:35the question is with taking a probiotic
1:04:42a bacteria work would that fix the problem because boy
1:04:49if that could fix the problem that would be great wouldn’t it the answer
1:04:54does it does it work is there any disease yet
1:05:01that has actually been ameliorated attenuated or cured by administration of a probiotic
1:05:08name one i mean it’s helped i think it’s helped with symptoms in things like ibs i think
1:05:15it’s been shown to make you know general improvements in mood sometimes in the right individual but by and large
1:05:22ameliation of disease i don’t think we’ve got that evidence yet do we well we certainly don’t and the reason
1:05:27is because it does it doesn’t happen so here’s my here’s my question to you wrong think think just think this out
1:05:35these probiotics they’re bacteria they’re live cultures right yeah they’re alive
1:05:42you know whether they’re in a pill or not they’re alive you swallow them
1:05:48those bacteria should be able to populate your intestine grow take hold
1:05:54and basically you know contribute to your microbial
1:06:00diversity yes yeah concept right
1:06:06why do you have to keep taking them why shouldn’t why can’t you just take
1:06:12one why have to take them every day
1:06:17yeah well a lot of them just passed straight through don’t they and that’s right a lot of them pass straight
1:06:22through or they die right there in the intestine
1:06:28which is exactly what happened to the ones as to why you don’t have them there in the first place because they’re
1:06:34already dead because the intra-intestinal milieu that the
1:06:40bacteria find themselves in is not conducive to their growth
1:06:45sorry interrupts if you are enjoying this content there’s loads more just like it on my channel so please do take
1:06:51a moment to press subscribe hit the notification bell and now back to the conversation
1:06:59the ones that you basically had before have already died and so you take them every single day
1:07:06and they’re still not populating your intestine they still haven’t actually taken hold and thrived and
1:07:13contributed to your microbial diversity so basically they’re not doing very much which is why
1:07:19we haven’t seen any amelioration of any disease yet because probiotics
1:07:26are not working upstream
1:07:31you have to change the intestinal milia first how do you do that
1:07:38that’s what a prebiotic does so what’s a prebiotic a prebiotic is
1:07:44food for those bacteria that will feed them so that they can grow
1:07:50and what’s the nature’s perfect prebiotic
1:07:57fiber fiber fiber is not food for you fiber is food
1:08:03for your bacteria but when we took the fiber out of the food to process it
1:08:08because fiber basically reduces shelf life when we took the fiber out of the food
1:08:14to process it we are now depriving our bacteria of the food they need to be
1:08:20able to live in symbiosis with us and so those bacteria the good bacteria
1:08:26are dead the bad bacteria have taken over and the bad bacteria is sending all sorts of bad signals
1:08:34actually suppressing serotonin generation in in the intestine thereby reducing the retrogra
1:08:42anterograde transport of serotonin back up into the nucleus tract to solitarius and that’s called depression
1:08:49yeah okay also because you’re not feeding those bacteria that bacteria are basically
1:08:56stripping the mucin layer right off your intestinal epithelial cells because they can eat that
1:09:01and that’s then exposing and denuding the your intestine and uh
1:09:06and making it uh uh you know all the junk that’s in your intestine basically can get through called leaky gut
1:09:14contributing to inflam inflammation inflammatory bowel disease irritable bowel syndrome and um
1:09:21insulin resistance all because you didn’t feed your gut and
1:09:26that’s and that’s how the whole thing gets tied together here that
1:09:32very some very simple but very very brilliant advice protect the liver feed the gut but the modern food environments
1:09:41the ultra processing of food is overwhelming the liver with sugar
1:09:47and it’s starving the gut through its lack of fiber and then the consequences are the liver could be you know fatty
1:09:54liver type 2 diabetes but the problem when the the gut gets starved and as you say leaky gut or
1:10:01increased intestinal permeability sets in then you’re opening up for everything
1:10:07autoimmune disease food allergies um alzheimer’s depression all all these things have been associated with
1:10:14increased permeability in the gut so it’s a very simple maxim but one that actually
1:10:20again going to that nexus of the root cause it’s kind of right there isn’t it and that’s
1:10:25you know this is the other thing i really liked rob is that you don’t seem to have a preferred
1:10:31diet very much like me i’m always like you it’s unprocess the diet first let’s just get
1:10:37out the junk let’s get the real food in and then let’s see where we are so how does you feel that like a vegan diet
1:10:45or a low carb diet or a whole manner of diets can can fit this maxim of
1:10:50protecting the liver and feeding the guts yeah i’m agnostic as to the whole vegan keto thing i i you know look if people
1:10:58who want to be vegan you know fine whatever you want to be vegan great don’t make anybody else
1:11:04feel bad about their choice but you know you can feel good about your choice that’s fine okay
1:11:10um there are a lot of reasons to be vegan you know animal welfare religion um cost uh
1:11:18uh coolness if you will but met but metabolic health is not one
1:11:24of them okay and i can prove it because coke doritos and oreos are all
1:11:30vegan so you can do vegan right
1:11:37or you can do vegan wrong keto
1:11:42okay i’m not against keto i used ketogenic diets in my patients
1:11:48when their insulin resistance was so severe that nothing else would work where they were where they had insulin
1:11:53hypersecretion and basically we had to control their blood glucose rises in an attempt to try
1:12:00to stave off um continued weight gain either one so we use the ketogenic diet okay and i’m
1:12:07not against that the problem with the ketogenic diet is not the diet the problem with the diet
1:12:12is that it’s really easy to fall off it because as soon as you have
1:12:19even a little bit of carbohydrate a little bit of carbohydrates going to raise your blood glucose therefore raise
1:12:25your blood insulin and therefore stop the ketogenesis because insulin blocks lipolysis
1:12:33at the level of the fat cell and there goes your lack of substrate and so
1:12:39it’s been shown that people who are left to their own devices in terms of doing a ketogenic diet
1:12:47they can start with all good intentions and by two months into it they’re basically you know not on
1:12:54they’re not in ketogenic anymore you know they’re not making ketones basically and then they’re on the worst
1:13:00diet because they’re on a high fat medium carbohydrate diet which generates both insulin and loads
1:13:06and loads of ldl that’s kind of like the worst thing you can be on so if you’re fastidious
1:13:12then the ketogenic diet is a great diet if you’re not fastidious then you shouldn’t be on a ketogenic
1:13:18diet so it kind of depends on whether or not you can actually you know keep it up
1:13:24and a lot of people you know fall prey to you know the the croissants on the you know
1:13:30you know that the other guy at work brought in so you know bottom line is
1:13:36i don’t have a preferred diet i don’t i’m agnostic on it i think there are a
1:13:41lot of ways to skin this cat i think ultimately we will learn the genetics
1:13:46of who does better with which diet and it will turn out that certain diets are better for certain people and other
1:13:52diets are better for other people and i’m very interested and uh you know involved in this personalized nutrition
1:13:59you know uh concept and and movement that’s going on right now so it may be that there are certain
1:14:05people out there who are a vegan diet who ought to be on keto and there are certain people who are on a ketogenic diet who probably ought to be a vegan
1:14:10one um and they don’t know it yet so why would you basically put all your
1:14:17marbles in one um you know goldfish bowl
1:14:22so i’m for both diets yeah the only diet i’m not for
1:14:28is the western diet
1:14:34and the reality is i think any clinician who
1:14:40has utilized food as one of their tools and their toolbox with their patients which i hope more
1:14:46and more are starting to do although it’s clearly not enough
1:14:51you will see that different people thrive on different diets that’s you know you you
1:14:58i i think real life clinical practice teaches you that well these guys here are literally rocking a
1:15:05low carb real food diet their markers look good their bloods look great and all these people
1:15:12here are doing great on a whole food vegan diet as you say the commonality is
1:15:18no processed food or very very low amount of ultra processed foods right commonality is low sugar high fiber
1:15:27both diets work when they’re low sugar high fiber and so that’s why i think those are the
1:15:32two sort of linchpins in this whole story but unfortunately that’s exactly
1:15:38what processed food is not you used apples before to demonstrate those four
1:15:44categories of processing which i thought was a really nice example where would apple juice fit
1:15:51into that because that’s something that many people are consuming every day thinking it’s healthy
1:15:57hopefully they might be re-evaluating that at the end of this conversation but yeah where does that fit in
1:16:03so what happens with apple juice whether it’s let’s let’s just let’s just take apple juice that’s not also uh sweetened
1:16:11right because you know sometimes they add extra sugar just taking an apple and putting it in the vitamix okay okay all
1:16:18right let’s do that kind of apple juice okay apple juice that’s been vitamix or the jamba juice okay people say that’s
1:16:26great right because that’s whole fruit well it was whole food now it’s not
1:16:32so you have to understand the problem of fiber now fiber
1:16:37we’ve been talking about it like it’s one thing and that’s not correct fiber is two things
1:16:44two one’s called soluble fiber and an example of that would be like inulin or
1:16:50pectins like what holds jelly together hydrogel that’s what’s in cream cheese
1:16:57and then there’s a second fiber called insoluble fiber and that’s like
1:17:02cellulose that’s like the stringy stuff in celery it’s also what’s in cardboard okay
1:17:08so cream cheese cardboard okay both fiber haha
1:17:15all right well it turns out that real food has both
1:17:21okay now when you put the apple in the vitamix
1:17:29you are shearing the sm the uh the insoluble fiber the cellulose to
1:17:34smithereens you are cutting it up into such little small little fragments that
1:17:41it’s not going to be functional after all after what afterward
1:17:47so here’s how the soluble and insoluble fiber work together
1:17:53imagine a fish net all right so you know plastic you know uh matrix
1:18:00right with holes in it right and when the fishnet is
1:18:06um uh working okay what happens is you can catch fish but then the kelp
1:18:14the seaweed is going to plug the holes in the fish net and now you’re not going to be able to drag it through and catch
1:18:19the fish anymore right so you’ve created a barrier so that the insoluble fiber is
1:18:25like the fish net itself and the soluble fiber is like the kelp and you so together they form a barrier
1:18:32or think of it this way like a spaghetti colander okay metal bowl with holes in it right you run the water water runs
1:18:39through now take a blob of petroleum jelly throw it into the center of the colander run
1:18:45the water still runs through now take your finger and rub the
1:18:50petroleum jelly all around the inside of the colander now run the water now the
1:18:56water doesn’t run through you’ve created a barrier right and you needed three things you
1:19:02needed the colander you needed the jelly and lastly you needed the geometry
1:19:10of plugging all those holes all right for the fishnet you needed the net and
1:19:16you needed the kelp together right yeah if somebody came along and took a scissor to that fishnet you know
1:19:24all of a sudden now you don’t have a barrier anymore so this is what’s going on in your gut
1:19:29the insoluble fiber the cellulose the stringy stuff in the celery is forming a lattice work on the inside of your
1:19:35intestine the soluble fiber like the pectins and inulin they’re globular
1:19:42they’re plugging the holes in that lattice work and together they form a white issue gel on the inside of
1:19:49your intestine and that gel is a secondary barrier that prevents
1:19:55early absorption of glucose fructose sucrose simple starches so that they
1:20:01don’t end up going to the liver so they don’t flood the liver
1:20:07so that your liver doesn’t turn them into fat so that your liver can stay healthy
1:20:15so the apple juice the vitamix to apple juice
1:20:20it still has the soluble fiber and that still has a benefit because
1:20:26that can still go down to your colon and make short-chain fatty acids and that’s good
1:20:32but it won’t protect your liver so you’ve taken one of the two cardinal
1:20:38phenomena of health and you’ve basically thrown it in the garbage can
1:20:46so apple juice better than soda because it has soluble fiber
1:20:52but not better than soda because it floods your liver
1:20:59but soda also floods your liver huge well absolutely yeah
1:21:04and what’s the relationship we’ve obviously we’re now moving from food into i guess
1:21:10drinks uh although apple juice of course comes from an apple um
1:21:16soft drinks diet drinks these are things which are routinely consumed
1:21:22perhaps you could talk about the relationship between these drinks and our wider health right so first of all it’s now been
1:21:29shown 50 ways from sunday that sweetened beverages sugar sweetened
1:21:35beverages soft drinks are disastrous they’re disastrous for adults they’re
1:21:40disastrous for kids okay and we have quantitation on just
1:21:45how many deaths per year occur in both the us and the uk due to soft drinks alone this has been done by numerous
1:21:53investigators most notably the ones at tufts friedman um like darius mozafari and his granada
1:22:00mika et cetera no question so then you say okay
1:22:05that’s true but what about diet drinks they have no fructose
1:22:11they have no calories they should work they should be fine right
1:22:17not so much so here’s why a couple of studies have now shown
1:22:24exactly why a couple years ago i wouldn’t have been able to tell you this but now we have the data that explains why this is
1:22:30all right number one you put something sweet on the tongue
1:22:36message goes tongue to brain sugar’s coming message goes brain to
1:22:42pancreas sugar’s coming release the insulin but then the sugar never comes because
1:22:48it was a diet sweetener what does the pancreas do
1:22:54does it say oh man i was waiting for that you know
1:23:00i get i’ll just wait till tomorrow or does it go you know i got all these
1:23:05insulin vesicles sitting here where in the go okay i’m gonna go find me some calories
1:23:10to work on yeah and you end up overeating turns out it’s the latter we now have the data to
1:23:16show us the latter so in fact all the studies of diet
1:23:21drinks show that caloric intake total caloric intake does not change
1:23:28so you think you’re doing well by taking 150 calories in sugar out of your
1:23:35diet but it turns out you end up making up those 150 calories elsewhere in your
1:23:41diet it’s been shown in different experimental conditions that
1:23:47basically it sensitizes your pancreas to actually make more insulin
1:23:52those diet drinks this is work from janina pepino when she worked with sam klein at washu st louis and also tay it
1:23:59all uh that showed that if you um consume diet sweeteners
1:24:05okay instead of sucrose you will not consume as much many calories in the
1:24:11morning because the because the diet soda that you drank in the morning but you will actually increase your food
1:24:17intake later on in the afternoon and evening so that the total number of calories you
1:24:22ate ends up being exactly the same which is why diet drinks have not caused anybody to lose weight
1:24:29because you end up making it up later that’s number one number two we now know that certain diet sweeteners
1:24:35actually alter the microbiome in a negative fashion and contribute to leaky gut the most famous of which is sucralose
1:24:42you know splenda and worse yet we now know that adipocytes
1:24:49you know fat cells have receptors for diet sweeteners and so if you absorb those diet sweeteners they go through
1:24:54your bloodstream end up at your fat cell they can cause fat deposition in the fat
1:25:01irrespective of insulin so the bottom line is diet sweeteners
1:25:07might trick your tongue but they don’t trick your body
1:25:13yeah and it kind of sort of makes sense doesn’t it if we if we if we go back to the fact that you know
1:25:20our biology we’ve been wired over hundreds of thousands of years to you know respond a certain way to
1:25:26certain things in our environments we we’ve we’ve just changed that so much and you know did artificial sweetness
1:25:33exist 100 years ago 150 years ago you know has our biology learnt how to adapt
1:25:39of course it doesn’t mean we can’t learn but i’ve always i’ve all i know it’s a very controversial area but my advice with my
1:25:45patients has always been look i’d be really cautious with this i i don’t think you should go to that i
1:25:50think i’d much prefer water or you know something else but i’ve always taken that more
1:25:56precautionary principle i know many people um vocal on social media will say that
1:26:03there’s no problem with artificial sweeteners but you think it’s pretty clear now with artificial sweeteners
1:26:08yeah i think the data are in uh there was a paper that came out in the american general clinical nutrition about uh 2017. what they did was they
1:26:16said they showed we’re using a meta-analysis that the toxicity of one coca-cola
1:26:24equals the toxicity of two diet coca-colas
1:26:29wow so half as bad that doesn’t mean good
1:26:34that means half as bad now the problem is okay it’s half as bad
1:26:41but people who are drinking diet soda say oh no fructose no calories i’ll drink five
1:26:47of them yeah now it’s two and a half times as bad we’ve mentioned
1:26:54sugar as a mitochondrial poison we’ve mentioned um [Music]
1:27:00insulin resistance as a root cause of many of these chronic diseases
1:27:06and we mentioned obesity and weight gain as a symptom rather than the cause
1:27:12what we haven’t quite mentioned yet is thin people who think they’re okay
1:27:18because they don’t look overweight yet on the inside there’s a very different story and i wonder if i could just frame
1:27:24that around the statistic which i’ve heard before you’ve written about it in your book that 88 of americans have a
1:27:30degree of metabolic dysfunction but i also love the way that you describe
1:27:35metabolic syndrome the you know maybe you could describe how you say it because i think it’s a beautiful
1:27:41beautifully simplistic way of looking at it and then put it in the context of that thin person who thinks they’re doing
1:27:47okay so here’s the problem everybody thinks that the scale tells
1:27:53the truth the scale tells you how much you
1:27:58weigh who cares seriously who cares
1:28:05and here’s why the scale lies because there’s not one fat depot
1:28:14there are three three separate fat depots and they
1:28:19contribute differentially to your health
1:28:25here they are first one the one you can see
1:28:30the subcutaneous fat the big butt fat as it were
1:28:36as in do these genes make me look fat and never answer that question
1:28:45bad idea turns out the subcutaneous fat
1:28:51while potentially cosmetically undesirable is metabolically inert
1:28:58our subcutaneous fat is there very specifically to store energy for periods
1:29:04of famine right and it has an innate expansive capacity
1:29:11to a certain point before it gets into trouble in fact you can basically put on about
1:29:1810 kilos of subcutaneous fat about 22 pounds of subcutaneous fat
1:29:24before you will have over expanded those cells
1:29:30those cells will then have choked off and died will have released their grease
1:29:35into the area will have recruited macrophages in to clean up the grease and will then have released cytokines
1:29:42into the bloodstream which will by the way go into the systemic circulation so
1:29:48you have to have a lot of grease in order to get a hot concentration high enough to go back to the liver to
1:29:54activate the cytokine response than the liver and cause insulin resistance
1:30:01so 10 kilos of subcutaneous fat before you get sick
1:30:09that’s depot number one depot number two
1:30:15the visceral fat the belly fat okay the you know beer belly if you will
1:30:22fat right now that fat turns out not to be from beer that fat turns out to be
1:30:29from stress from stress
1:30:35you know a lot about stress that fat in your belly fat okay visceral fat
1:30:41is due to cortisol and cortisol is because our our world is now overly
1:30:48stressful and people are overly stressed like all the time so how do we know that the answer is because we can take
1:30:53patients with clinical depression endogenous clinical depression suicidal depression
1:30:59get admitted to the hospital to keep them from themselves put them in a scanner
1:31:05and quantitate the amount of visceral fat now they’re losing weight because they’re not eating they’re losing sub-q fat because they’re
1:31:12not eating but they’re gaining visceral fat because their cortisol is so high
1:31:19that is metabolically active fat and it drains directly into the liver
1:31:25because it drains into the portal vein not into the systemic circulation so a small amount of visceral fat will
1:31:34generate enough cytokines for your liver to be able to see it because it’s concentrated because it’s
1:31:39not being diluted over the entire volume of distribution of your systemic circulation
1:31:45so turns out about five to six pounds of visceral fat
1:31:51before your liver gets sick so for sub-q fat
1:31:5822 pounds for visceral fat five to six pounds
1:32:03now can you see five to six pounds on the scale maybe maybe not
1:32:09now let’s do the third fat depot the liver fat
1:32:15the fat in your liver turns out to be the most egregious because it’s right there it’s causing the problem right
1:32:21where the action is right there in your liver okay it turns out only a half a pound of
1:32:28visceral fat i’m sorry liver fat half a pound of liver fat and you will end up with metabolic dysfunction insulin
1:32:34resistance can you see a half a pound on the scale
1:32:40no all right so three different fat deposits so the
1:32:45question is what makes the liver fat answer sugar
1:32:51because of this phenomenon the de novo lipogenesis that we’ve been talking about so
1:32:57you are mainlining it right into the organ that is the most
1:33:02susceptible to the problem yeah and you can’t even see it on the scale
1:33:11so there are people walking around with fatty liver and don’t know it because they say well i’m thin
1:33:17no problem except they have a problem and that’s why 88 of americans now have
1:33:24some form of metabolic dysfunction because either sugar or alcohol is causing liver fat irrespective of what
1:33:30it’s doing the rest of your body and they don’t know it that’s the nugget
1:33:35of truth that people you know that doctors are ignoring
1:33:42of course that begs the question how can people find that out i will say because we don’t have much long left
1:33:48that i don’t want to be respectful of your time that in your book there is a whole section on
1:33:56the various blood tests that you should go and get uh they’re very simple and actually very readily available and
1:34:01actually you did a beautiful session on you know what the actual values are but also what’s optimal what we should
1:34:07really be gunning for um obviously there’s things like dexa scans there’s ways to hit ratios that people
1:34:13can do um but i guess you know from in my culture a lot of people from my
1:34:19ethnicity are walking around it’s quite it was almost a joke growing up like you’d see dad’s not a joke but you’d see
1:34:24you know dad’s friends after they hit a certain age they’d still be thin everywhere but the belly would just start to
1:34:30um go out but but thin arms thin legs just that belly and of course you know many south asians do have an
1:34:37increased risk of toffee thin on the outside fat on the inside and all those sort of things but
1:34:42um i really wanted to highlight this because i think many of us think oh it’s all right for them they can eat whatever
1:34:48they want and they don’t put on weight it’s like well wait a minute yeah cosmetically they may not be looking uh
1:34:54they may look as though they’re getting away with it but they may not be i also just want to finish off um
1:35:00on kids you just mentioned liver fats i’ve heard you say before you’ve had to
1:35:05send two children at least for liver transplants because that is absolutely alarming rob
1:35:14from soda drinking so maybe before we get to the final point i just wonder if you could there’s
1:35:21many parents who listen to this podcast and of course a lot of people can take the
1:35:27advice of themselves right i need to have a low sugar diet i need to have high fiber whatever my preferences are
1:35:33but with kids like it seems to be quite different kids meals are a joke in most places it’s
1:35:38like the adults can have proper food and the kids have the junk in bars and restaurants right it’s the same in the
1:35:43u.s chicken nuggets and french fries and a coke and so what is it doing to kids at
1:35:49this early age when they’re having regular juices regular soda drinks regular highly processed foods it’s not
1:35:56really necessarily about their weight is it it’s about is it setting the tone for later on in
1:36:02life and then what advice would you give to parents first of all sugar down regulates its own receptor on
1:36:10the tongue so the more sugar the less sweet therefore you need more sugar so it
1:36:15becomes a vicious cycle that’s one thing second of all it still causes liver fat accumulation in kids we you know now
1:36:22show have shown that 20 of children have liver fat unrelated to obesity
1:36:30people who you know kids who have died in auto accidents you know autopsies show 20 of kids have liver fat
1:36:38twenty percent that’s unrelated to their obesity you know to obesity you know where did they get liver fat
1:36:44from they never had it before this is where um the bottom line is that
1:36:50this phenomenon is also uh you know the sugar is also causing changes in
1:36:55behavior now we don’t have enough time to go into this but
1:37:00sugar inhibits an enzyme in the brain in
1:37:06astrocytes called glutamine synthetase and glutamine synthetase is necessary to
1:37:12turn glutamate into glutamine which then will go to gaba
1:37:17gaba is the inhibitory neurotransmitter glutamate’s the excitatory neurotransmitter so there’s a balance
1:37:23between excitation and inhibition and sugar basically breaks that balance
1:37:29and so sugar’s been associated with irritability it’s been associated with violent behavior it’s been associated
1:37:36with cognition problems it’s been associated with dementia in adults
1:37:41it’s been associated with changes in the prefrontal cortex thickness it’s been
1:37:47associated with associated with problems in school uh it’s been
1:37:52associated with um all sorts of problems now associations not causation
1:37:57we are still working on putting all the causation pieces together yeah so you know i’m not here to tell
1:38:04you that sugar’s poisoning your brain yet but
1:38:10you know there’s a lot of data and the data in animals is pretty darn good you know you really want to go this route
1:38:16people and you’re not talking about just white table sugar you’re talking
1:38:22about the processed foods you’re talking about the fruit juices right absolutely what about the capri
1:38:27suns i’m talking about you know the stuff that the the parents are putting in the uh in the lunch box yeah
1:38:33and that that statistic 20 of kids have liver fat that’s
1:38:38they could be parents listening to this who think my kids look fine weight wise
1:38:44you know so what’s what’s the problem with a glass of apple juice a day um and that’s the problem
1:38:50yeah exactly and so i’m not this conversation’s not meant to shame anyone it’s just meant to try and raise awareness as something that we both feel
1:38:57could be really really helpful uh rob i’ve got to say that if people want more and i hope they do well at some
1:39:04point if we can get a second conversation i’d love that but the book metabolical is
1:39:09it’s really thorough it’s really comprehensive i really would recommend people who want to learn more about this to get a copy
1:39:15i think it’s something you can keep dipping back in and out of over time i i really do think it’s a fantastic reads
1:39:21and you cover the planet as well in it which we didn’t get a chance to talk about today
1:39:26uh just to finish off um this podcast is called feel better live more when we feel better in ourselves
1:39:33we get more out of our lives and and if everything you’ve said if you have all your passion about this area i
1:39:39just wonder if you could just leave my audience with some of your final thoughts and a few
1:39:45top tips that they can think about applying into their lives
1:39:51now the most important thing people have to understand is and you say it yourself some i’m
1:39:57basically trumpeting what you say to solve a problem you have to solve the
1:40:03cause of the problem not the result of the problem doctors
1:40:09don’t know how to do that and i can say that because i’m one of them
1:40:15okay and i did i didn’t understand that going through medical school and i didn’t understand
1:40:21that for the first 20 years of my practice i did what i was told i practiced the way they taught me to do
1:40:29i got woke you got woke there are doctors around now who are
1:40:35getting woke and they’re starting to make some shall we say noise they’re being cast off as you know
1:40:42heretics and you know rabble rousers and you know troublemakers and whatever and
1:40:48some of them have even gone on trial in their respective countries tim noakes
1:40:53in south africa carrie fetke in australia evelyn border roy and canada
1:40:59don’t know if there are any in the uk that have had that happen but the bottom line is
1:41:04we are undergoing a a revolution in modern medicine
1:41:10we underwent a revolution back in the 1930s 40s with antibiotics where we
1:41:16thought a pill could treat everything now we’re undergoing a revolution where we realized that was a mistake
1:41:22it’s time to rethink health it’s time to rethink health care
1:41:29you can’t fix health care until you fix health you can’t fix health until you fix diet
1:41:35and you can’t fix diet until you know what the hell is wrong and what you thought was wrong
1:41:42was basically propaganda for the last 50 years we’ve had to undo that we’ve had to
1:41:49basically turn it over we’ve had to re-re-think all of modern medicine
1:41:56and for your audience out there what i’m telling you is
1:42:04not everything is wrong but a lot of it is when i went to medical school in 1976
1:42:11a very very um uh famous clinician stood up in front of our class
1:42:17on the very first day and you’ve probably heard this yourself wrong and he said 50 of everything we teach you is
1:42:23wrong we just don’t know which 50 this is the 50 percent
1:42:32robert lustig you have been doing incredible advocacy for many many years you continue to do it you’re helping the
1:42:39lives of hundreds of thousands of people if not millions around the world thank you for joining us on the podcast and uh
1:42:45hopefully we’ll get a chance to talk again in the future it’s my pleasure hope to come to the uk
1:42:50and we’ll have a beer just one if you enjoyed that conversation all
1:42:56about the negatives of eating too much sugar i think you are really going to enjoy this one about the specific foods
1:43:02that you can eat to prevent disease we are actually all forming cancers in our body all the time but if you can prevent
1:43:08tumors from growing their blood supply you can actually keep these cancers harmless so this is what foods are able
1:43:13to do
