Welcome to the DietDoctor podcast
with Dr. Bret Scher. Today is my pleasure to be joined
by Dr. Robert Lustig. Dr. Lustig is a pediatric endocrinologist
recently retired from clinical practice at UCSF but still very active in research and now even having gone to get
a Masters of law from the Hastings College so that he can get more involved
into the public policy side of things. Because his whole life
he’s been fighting childhood obesity and he’s been studying the CNS regulation
of energy balance. But he knows it’s more than science
that is affecting this because this is blown up
in front of his eyes. He has seen this epidemic of obesity and
diabetes take place as he’s been practicing. And he’s realized that it’s going to take
more than science; it’s going to take public policy to halt this
and reverse it. And that’s what makes it
such an interesting discussion, he has such a great depth of knowledge
of the history of public policies, of analogous scenarios of public policy
and how we can use that information to try and help us stem this this epidemic
that we’re in the middle of and what can we define
as the possible causes: fructose, glucose, sucrose, sugar, all these terms get thrown around
as if they were one thing. We’ll we talk a little bit about that
to identify the specifics of it and also just the processed food
and how that plays into it as well, the so-called healthy natural fruit juices. So I really enjoyed this discussion
with Robert because he has such a great grasp
on both the science and the public policy and how to help us draw a roadmap
on how to get out of this and reverse it. So I really hope you’ll enjoy this discussion and in the end he’ll list the different ways
to get in touch with him. He’s involved in for-profits and nonprofits,
he’s written a number of books, so definitely stay tuned to the end so you
can learn all the things he’s involved in and if you want to hear more because there’s a lot more that
he has to say and has produced that is very worthwhile
to read and listen to. So enjoy this interview
with Dr. Robert Lustig. Dr. Lustig thank you so much for joining me
on the DietDoctor podcast today. My pleasure,
but it’s Rob to you. Rob, you got it, thank you. Now in your career you have seen
this epidemic rise in front of your face as a pediatric endocrinologist. I mean it’s one thing,
I’ve said this before, it’s one thing for me to see diabetes
in adults and the consequences that happen
in their 50s, 60s and 70s. But to see it in a pediatric population
with type 2 diabetes and now nonalcoholic fatty liver disease, I mean this must be heartbreaking to see
in kids and you’ve seen it just exploding. Yeah, I mean I went into pediatrics
to stay away from chronic disease and now that’s all I do. I went into pediatric endocrinology
to take care of short kids and they got fat on me. They grew horizontally
rather than vertically. And that happened on my watch. And, you know, they’re coming in and for every patient I take care of,
10 more show up on the doorstep. Something is wrong. And of course everybody knows
that something’s wrong, but everyone seems to have
a different answer for what’s wrong and we can’t tie it together. And that’s what has really halted
any progress. All these different voices, different theories,
without a unifying approach has just really made it
so we can’t make any progress. Plus unfortunately some
of the stakeholders in this discussion have money associated with it. So there are dark forces actually
trying to maintain the status quo. Tell me some more about that. We can go on for hours but the fact of the matter is that
the food industry has a vested interest and have pulled out all the stops
in the same way that tobacco did. Marion Nestle just released this week
a book calledUnsavory Truth.My colleagues, Aseem Malhotra
and Grant Schofield and I published an article earlier this year
that the science against sugar alone is not enough to win the battle
against obesity and type 2 diabetes. Opposition from vested interests
must be taken first. So we know who’s on the other side. And the problem is that the other side
has a very large mouthpiece and a whole bunch of money. Right, a lot more money than scientists
and universities and physicians, certainly as individuals and even trying
to group together can’t come close. So we’re doing our best. The good news is we’ve got the science
and the science is very potent, but, you know,
not everyone’s a scientist. Sometimes not even scientists
are scientists. Your own record is basically saying that
fructose is probably the number one concern. I’m not going to say that,
I won’t say it’s the number one concern. Trans fats used to be
the number one concern. But we figured that out, it took 25 years
to figure it out and finally get rid of it. Which shows how slow
the needle moves on these. Well because there were dark forces
there as well. Now I think that sugar is not the cause
of obesity, diabetes, fatty liver disease etc. but it’s the most malleable,
is the one that is the low hanging fruit, it is the one that’s added to other foods
specifically for the food industry’s purposes, therefore it is the easiest one
to attack and target upfront. Now do you think it’s most important
to target sugar or to differentiate it between fructose,
glucose, sucrose and sort of break it down? To be honest with you,
they’re the same thing. Once you understand what these different
chemicals do in the body that is glucose and fructose,
they are not the same, the food industry will tell you
11 ways from Sunday, a sugar is a sugar. It is absolutely completely fallacious
and it’s disingenuous to boot. They are not handled the same,
glucose and fructose. As it turns out sucrose, high fructose
corn syrup, agave, maple syrup, honey, are all basically equivalent,
they’re all half glucose, half fructose. 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. And we know that because the Inuit
who ate whale blubber, who didn’t ever see a piece of bread
or grow a strand of wheat still had a serum glucose level. Vilhjalmur Stefansson and his assistant,
the famous Arctic explorer, checked himself into Bellevue in 1928 and they ate nothing but meat for one year
on their clinical research Center. They still had a serum glucose level and they were a hell of a lot healthier
than everybody else. Yeah. So the notion that you need sugar to live or that you even need glucose to live
is disingenuous. You need a blood glucose to live,
that is true, you don’t need dietary glucose to live. Because it’s so important
that your liver will make it. It will make it out of amino acids
or fatty acids as needed. So glucose is essential…
it is just not essential to eat. Fructose on the other hand… there is no biochemical reaction
in any eukaryotic organism that requires it. It’s completely vestigial
and when consumed in excess, because of its unique metabolism does three things that glucose does not do. One, it drives liver fat accumulation faster than virtually any other item
on the planet. Number two, it engages in the Maillard
or the agent reaction. Now glucose does it too,
but fructose does it seven times faster and it turns out there is a metabolite
of fructose that does it 250 times faster and we’re working on that. And number three, fructose rather than glucose
stimulates the reward center of the brain and therefore we have the data that shows that the fructose molecule of sugar
is what it makes it addictive. So is it addictive?
Does it meet classification of addiction and therefore should it be regulated
as an addictive component? So, first of all, addictive substances are
not regulated all by themselves, otherwise Starbucks would be
out of business. And if you take my Starbucks away from me
I will kill you, okay? That’s my addiction. I’m not proud of it, but at least
it’s socially acceptable this week. How many have you had this morning? Three and I need my fourth. So the fact that is addictive
is not the reason for regulation. However when something is both toxic
and addictive and ubiquitous
and has detrimental effects on society then it meets the public health criteria
for regulation. In fact sugar does meet those criteria. So how is sugar addictive? In 2012 sugar was not addictive. In 2013 sugar was addictive. What’s the difference?
So what changed? Sugar changed?
No, the definition changed. The American Psychiatric Association,
they are the umpire, they call the balls and strikes
on things like addiction. And they had to add gambling
as an addiction. It became very clear that behavioral addictions
went through the same CNS process, caused the same problems and had to be dealt with in the same ways
as chemical addictions. Now up till 2013 the DSM-4 said
you needed two things for addiction. You needed tolerance and withdrawal. Tolerance is the effect of these substances
on down regulation of dopamine receptors. That’s why you need more and more
over time– More and more to get less and less,
that’s this phenomenon called tolerance. Now the second criterion that the APA said
you had to have for addiction was withdrawal. Now turns out withdrawal, which is true
for all the chemical addictive substances, those are all effects that occur systemically
on the body, not on the brain. Caffeine withdrawal has effects on the heart,
on the vasculature, on sweat glands, etc. Opioids have effects on the G.I. tract,
have effects on the heart etc. They all have these effects that you can feel
and they cause withdrawal. Now gambling is not a chemical, gambling does not affect the body,
but it sure does affect the brain. And in order to be able to provide clinical
services under an addiction paradigm, the American Psychiatric Association
had to change the definition. So when they broke out the DSM-5 in 2013, and they do this every 20 years, now the definition could be
tolerance and withdrawal or tolerance and dependence. There is nine criteria for dependence,
we don’t have time for each one… You can look them up, they’re online. And gambling meets all of them,
gaming disorder meets all of them, social media meets all of them,
shopping meets all of them, pornography meets all of them and
guess what? Sugar meets all of them too. So we have substance addictions and
we also have behavioral addictions. And sugar happens to be a substance that
induces both tolerance and dependence. Anyone who says,
“Oh, I have a horrible sweet tooth”… They’re sugar addict. But is knowing that enough to change
public policy or to change people? Certainly not enough to change
people’s activities on their own and change their decisions. So what else has to be in place for us to be able to say, “This is a public health
crisis that we need intervene upon?” We have two templates to look at. Tobacco and alcohol. So for years smoking was a liberty interest. You had a liberty interest to smoke. Boreali v. Axelrod, a famous New York State
Supreme Court case said you have a liberty interest to smoke
and you know what? The New York state legislature
understanding what the problem was and understanding that
the tobacco industry was disingenuous started passing laws that said you can’t
smoke in bars, you can’t smoke in atria, you can’t smoke in restaurants,
you can’t smoke in schools, you can’t smoke in hospitals and now you can’t even smoke in your car
if there’s a kid in it. And the thing is
when it first started coming out people were yelling,
“Nanny state, nanny state”. They’re not doing that anymore. Part of that though is because of,
“I’m smoking here, I’m going to affect you”. Exactly. I’m drinking my Coca-Cola here,
that’s not going to affect you. -Oh, yes it is.
-How? Monetarily. Because if I have to go
to the emergency room I won’t be able to get in
because there will be gurneys filled with people with sugar beverage
associated heart disease waiting for their coronary bypasses
or their TPA. And there won’t be any money
in the system for me to be able to access
that health care in the first place. Medicare will be broke by the year 2026,
Social Security will be broke by 2034 because of this. So while it is not an assault on your person like tobacco is or like alcohol is
in terms of car accidents, it is an assault on your person
in terms of your economy. Now you could argue
that’s not the same but the fact of the matter is
we still have to deal with it the same. Right, our society is not good
at seeing that next step. We’re very good at seeing
the immediate– And the reason is
because we’re all addicted. Addiction is about now
and happiness is about the future. It’s about basically making life better
for later. We are into reward,
we are not into happiness, we are into instant gratification,
we are not into delayed gratification. Now, we doctors, know everything about
delayed gratification, because we went through med school,
residency, fellowship, etc. and we delayed, you know,
being able to see any money or, you know, even patient care on our own
for 10, 15 sometimes even 20 years. We know everything there is to know
about delayed gratification. The fact of the matter is
the American public does not. And a lot of that has to do with industry and what has been put in front of us
in terms of choices we can make. And we are in an on-demand society,
we are in an instant gratification society and that’s not something
that’s going to be easy to fix. We are a dopamine society…
that is what it is. It is dopamine, call it what it is. So this is why I wrote this book,
The Hacking of the American Mind; is to differentiate these two phenomena,
one called pleasure, one called happiness. Washington DC, Las Vegas,
Madison Avenue, Wall Street, Silicon Valley have confused and conflated
these two terms on purpose. Because then they can “sell” you happiness. They can sell you pleasure,
no argument there, they can sell your reward,
they can sell you immediate gratification, I have no problem saying that. The question is,
“Are they selling you happiness”? And the fact of the matter is
they’re actually taking away your happiness. So what is the difference between these
two terms, pleasure and happiness? Number one, pleasure is short-lived,
happiness is long. Two, pleasure is visceral,
you feel it in your body, like all of those substances
having those systemic effects. Happiness is ethereal,
you feel it above the neck. Pleasure is taking,
happiness is giving. 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’d be substances or behaviors… So substances like cocaine, alcohol,
nicotine, opioids, heroin, sugar or behaviors – shopping, gambling,
Internet, social media, porn. In the extreme all lead to addiction. There’s an “-aholic”
next to every one of those. Shopaholic, sexaholic, alcoholic, chocoholic
you know, down the list. There’s no “happyaholic”. There’s no “happyaholic”. You can’t be overdosed
on too much happiness, don’t exist. And then finally number seven,
pleasure’s dopamine happiness is serotonin. Now why do we care?
What does it matter? Here’s why. Dopamine is an excitatory
neurotransmitter. Every time dopamine is released,
it crosses the synapse, binds to its receptors on the next neuron,
the neuron fires, it excites the next neuron. Now neurons like to be excited,
that’s why they have receptors. But they like to be tickled,
not bludgeoned. Chronic overstimulation of any neuron
anywhere in the body will lead to neuronal cell death. And we know this because kids who have
chronic long-term seizure disorders and status epilepticus have to be rushed to the ICU
and we have to stop their seizures. Because the longer the seizures go on,
the more brain damage occurs. So we notice. That second neuron that’s receiving
the dopamine signal, it doesn’t want to die,
it wants to protect itself. So it has a failsafe, it has a plan B. What it does is it down regulates
the number of receptors so that there is less chance, statistically,
through the law of mass action that any given molecule of dopamine
will find a receptor. It makes sense. Thereby reducing the game. So what does this mean in human terms? You get a hit, you get a rush,
receptors go down. Next time you need a bigger hit
to get the same rush, receptors go down, then a bigger hit, bigger hit. Until finally you need a huge hit
to get nothing. That’s called tolerance. And then when the neurons
actually do start to die, that’s called addiction. And guess what? When those neurons die,
they ain’t coming back. Which is why addiction is so hard to treat. And now when we talk about sugar, you mentioned that fructose specifically
has this addictive property more so than glucose itself. So fructose when you do
the fMRI studies and one of those studies was done
by your previous guest, David Ludwig, and Cara Ebbeling, specifically stimulates the reward center,
the nucleus accumbens, that part of the limbic system,
and it turns out that glucose does not. Now glucose is a little sweet. Glucose has a sweetness index of 74 compared to sucrose of 100
or fructose of 173. Glucose activates the cortex,
the basal ganglia, certain other parts, but not the limbic system. Fructose stimulates the limbic system so they act at two completely
different places in the brain. And anything, anything that acts
at the nucleus accumbens leads to dopamine release and anything that does has,
in its extreme, addiction. Pick your substance, pick your behavior.
Fructose does it too. And we have the empiric data
to show that this occurs in humans. Now, is there a threshold level though
because fruit has fructose in it? You know if you eat an apple
you’re not stimulating the reward system. So, that comes into absorption,
it comes into fiber, but also even if you’re getting
straight fructose, is there still some threshold level
below which you’re okay? Almost assuredly yes, and probably
depends on who you are, probably depends
on your hepatic metabolism, probably depends on various phenomena
that are going on, probably depends on how insulin resistant
you are as well. For instance, let me give you an example; Latinos have a very specific
two sets of polymorphisms, not 1, 2 in their liver fat transcription machinery,
in their liver. First one is called PNPLA3
Patatin-like Phospholipase Protein domain A3, and the other one is called SLC16A11, both of these are involved in how the liver
turns sugar into fat. And, if you have the bad genotype
for each of these and Latinos for whatever reason
seemed to have the more frequency of those problem
alleles in the Latino population. If you have those, a little sugar
makes a lot of liver fat, and if that’s the case then the more
sugar you eat, the sicker you get, the quicker you get if you understand. Sure. Another thing that we know there is
an allele in the brain, called type 1A allele. And if you have this allelic variation you make 30% fewer dopamine receptors
to start. Oh interesting. In which case that means you need
more substrate more dopamine in order to occupy fewer receptors
at baseline. Which means you got to eat
a whole a lot more sugar to get any sort of pleasure out of it. And those people have been shown
to increase their rate of weight gain and increase their insulin resistance
faster than even the general population. So without doubt there are probably
predisposing factors that some of them being genetic,
some being epigenetic, some being very specifically
environmental. Also depends on how much sugar and how
much bad food is around you. You know you have food desserts
in lower SCS neighborhoods, and clearly they are the most susceptible and they’re also the ones
driving health care through the roof. So, you know we’ve got a problem. You’ve got to deal with the environment. So this isn’t just genetic,
although genetics play a role, and we can’t fix genetics anyway. So you know let’s fix what we can.
Let’s fix the environment. Yes, there’s clearly the volume
that people are ingesting, it wouldn’t matter what your genetics are,
still causing significant disease. The data from the American Heart Association,
and I signed on to this statement, said that the adult women
should be consuming no more than 60 spoons of added sugar
per day, that’s 25 grams, and adult men 9 teaspoons,
that’s 37 and a half grams. The median for the United States today
is 94 grams. So even if we cut our consumption
by two thirds we would still be over our limit. Wow, and for reference
how much is in one can of coke? 39. 39, so that’s…. -You’re over.
-You’re over. One can of coke you’re over.
You’re done. Yes, and also the size of the cans of coke
have changed dramatically. So that goes into the volume
and the threshold effect as well? Well so now we have
the 20 ounce bottle. Actually because of this problem in an attempt to try to, you know, have
a marketing ploy Coke as you know has come out
with its 8 ounce can. You know have a little coke. You know, they actually use Antman
to pedal little coke. You know, look… anything that reduces
consumption is good. The question is how do you do that
on mass? How do you that for everyone? Ultimately the only way
is to decrease availability. This is the iron law of public health. You decrease availability which decreases
consumption, which decreases health harms. The Iron Law of public health,
true for tobacco, true for alcohol, decrease availability. Now you don’t want to ban it.
You know, banning doesn’t work. We tried that with alcohol and you saw
what happened. That was called the 18th amendment
and the 21st amendment. We’re not doing that again. What you have to do
is you have to make it hurt. You make it available you make it hurt.
You make it harder to get effectively. So that’s this notion of soda taxes. I’ll be very honest with you. I am for reduction and consumption
however it can be done. I think there’s a way better, easier,
much more effective way of dealing with this issue
of effective availability. Get rid of the subsidies. So going back to Nixon era
and with his secretary Butz and how they sort of started this whole
process to try and increase productivity and decrease cost,
which maybe at that time made sense, but now in a whole different environment
we’re stuck with the same subsidies with a completely different connotation
of what it means for our society. -It didn’t even make sense for Nixon.
-It didn’t. It made sense for Roosevelt. So for Franklin, it made sense because
we had 2 things going on at the same time. We had the Depression
and the Dust Bowl in 1933. So we had a destitute population
in the American southwest. They were dying of famine. And the problem was all the food and all
the food companies were in the Northeast. So if you just dump the food in a railroad
car and sent it to the southwest, by the time it got there,
it would be rancid. So they had to process it. They had to basically take the wheat,
and process it, get rid of the fiber, put in a 5 pound bags
and then bake it up locally. And subsidize it to make it worth the while
of the American food industry to do so. And in 1933 that made sense, and even
made sense through World War 2 but after that it stopped making sense, but people realized,
“Hey I can make money with this”. So we doubled down,
and then Nixon came along and he had to deal with political unrest,
a lot of it. And he knew that fluctuating food prices
caused political unrest. And so he told his agriculture secretarial
Rusty Butz, to make food cheap. Whatever it took, to make food cheap,
and so Butz said 3 things, row to row, furrow to furrow,
get big or get out. That’s what he said. Up to that point we had paid the farmers
not to grow certain crops to artificially inflate prices,
to benefit the farmer. That went by the boards.
That was the end of that. What he now said was “We’re going
to make it up in volume, and we’re going to subsidize those foods
in order to make them cheap”. And we did, but that also led
to monoculture. So all the corn is now in Iowa
and all the cattle are now in Kansas, and so because there’s no manure in Iowa you got to spray them with petroleum
products which poisoned the water, and because there’s no grain
or grass in Kansas, they’re all on feedlots,
you have to give them antibiotics which is changing our microbiome
to make things even worse. In other words we dissembled
a food paradigm that actually worked. For one that was cheaper
but way more dangerous, and we have to un-dissemble that
and the only way to do that is with policy. Right and so many livelihoods
depend on these subsidies now, and so much of our economy
depends on these subsidies and it seems it’s too big of a problem
to tackle but if we think that way
then this will just keep perpetuating. So we have to find a way to make
the right foods less expensive, instead of the wrong food
so to speak less expensive and to get rid
of this mono cropping culture to get back to grasslands
and rotational grazing, because we’re destroying our environment
at the same time. And I guess that’s part of what’s spurred you
to go get your masters in law, and start getting into the policy side of
things and the advocacy side of things. Right, I had 2 questions. I went to UC Hastings College of Law
for a masters in law. I wasn’t trying to get a JD,
and I don’t want to be a lawyer but I want to be able to talk to them. So I had to learn their vocabulary. And I had
2 questions when I entered in 2012. When does a personal health issue
become a public health crisis, and what are the legal doctrines
that either support or refute that? Especially, at the supreme court. And number two – How did tobacco
get away with it for 40 years? What was their playbook? Because ultimately the food industry
is using the same playbook. So if we study tobacco we can actually figure
what we ought to be doing here, and in fact we’re doing it. I’m very pleased and proud of how things
have gone and there have been movements. And, you can see the movements,
it takes a while. You know, cultural tectonic shifts
do not happen overnight. I’ll give you an example: There have been 4 cultural tectonic shifts
in the United States in the last 30 years. I’ll name them: Bicycle helmets and seatbelts,
smoking in public places, drunk driving,
and condoms in bathrooms. 30 years ago, if a legislator had stood up
in a statehouse or in congress to propose any of those,
would’ve been laughed right out of town. All those were anathema… “Nanny State”,
every single one of them; nanny state. Today they’re all facts of life.
We accept all of them. In fact, it’s click it or tick it and God forbid, you see a kid riding his bike
without a helmet you call the cops. That’s what you should be calling cops for. Not you know, “gardening while black”. Call the cops for the kid
who’s riding without a helmet. The point is every single one of these
required public education first, and then that softened
the playing field and allowed for changes
in legislation and litigation. This is going on now with food. And we’re probably out of the 30 years,
we’re probably about 7 years. You know, but it’s going to take a while, it’s still going to take a good 20 years
before we’re going to see the real change. And I’ll tell you, you know what it takes?
It takes a generation. And you know why it takes a generation? People need to die, unfortunately. That’s part A. The old people who won’t accept
need to die, and B, you have to teach the children
because then when they get over 18 they vote. -That’s what happens.
-Right. So we’re doing it. Yes, one of the interesting questions to
say, as that’s happenings
where are the lines being drawn? Because I’ve used Coca Cola as an example,
they’re an easy example, but what about the fresh squeezed
orange juice and the all-natural fruit juice and you know are those
going to be protected more than some
of the other sugary beverages? Yet they can all cause the same problem. So part of it is, where are we going
to draw the line? And someone say we have to go after meat,
because poor epidemiological studies say meat, so, we need science
to inform those decisions. Indeed. I couldn’t agree more.
We need science to inform those decisions. The citrus growers are ballistic.
They’re absolutely ballistic. You know, they’re saying,
“We didn’t add any sugar to our orange juice”. That’s true, they didn’t.
What they do is they took out the fiber. Now, when you take the fiber
out of the fruit basically what your left is with, is a soda. Here’s why, the fiber in the fruit
and there’re two kinds, they’re soluble and insoluble. So soluble like pectin or inulin,
would hold jelly together, insoluble fiber like cellulose,
the stringy stuff in celery. So fruit has both. Now when you consume the whole fruit, you’re consuming both fibers,
soluble and insoluble, and they work together. What they do is they form a gel
on the inside of your duodenum. After they pass the stomach they set up
the latticework of the cellulose. Coats the inside of the intestine and then
the soluble fiber which are globular plug the holes in that latticework. And you end up
a secondary impenetrable barrier which limits the rate and the amount
of monosaccharides that are absorbed from the duodenum
into the portal vein which go to the liver. So what you’re doing
is you’re saving your liver. You’re preventing from having to deal
with the onslaught, the tsunami of monosaccharides
that come with an orange juice when you eat an orange. So the orange is okay. What happens if you reduce the rate of
absorption of monosaccharides in the duodenum? Where do they go? Well, they keep going,
they go to the jejunum. What’s in the jejunum
that’s not in the duodenum? The microbiome. So the duodenum has a pH of 1 because hydrochloric acid
from the stomach, the pancreatic juice is secreted
through the sphincter of Oddi, which is in the middle duodenum, and then it mixes with the chime and so then by the time
you hit the ligament of Treitz which is where the jejunum starts,
the pH has gone from 1 to 7.4. The bacteria can’t live at pH 1, only they
will go back to pyloric and live there, but at 7.4 they can all live. Well they got to eat something, you know? You got 10 trillion cells in your body, you got a hundred trillion bacteria
in your intestine, they outnumber you 10 to 1. Each of us is just a big bag of bacteria
with legs. They got to eat something. Question is what do they eat?
Will they what you eat? The questions, how much did you get
versus how much did they get? If you ate the fruit, if you ate the orange,
what you’re doing is, you’re feeding your bacteria. So even though you consumed it
you never got it. The bacteria got it. Now, all of these energy balance studies,
all of these room calorimeter studies, all of these Kevin Hall studies, that will be lambasted in about
a few minutes downstairs at this meeting. They are all measuring a unit. It is the human bacterial unit. It is not the human. You cannot tell the carbon dioxide, if it came from cellular metabolism
of humans or cellular metabolism of bacteria. Interesting. You cannot separate out those two. So it really doesn’t matter because if you
feed your bacteria then they get healthy, and you get what’s known
as microbial diversity. You get fewer cytokines, and you get
short-chain fatty acids from the soluble fiber as it’s fermented further down the colon. So fiber basically means
that you’re feeding your bacteria. So when you consume an orange,
that fructose wasn’t for you. It was for your bacteria. So I’m not really concerned about fruit. I am concerned about fruit juice because
the insoluble fiber has been removed. So the science would say it’s the same yet the public opinion seems to be
markedly different. So is that going to make it a bigger hill
to climb to fight that, and it would in added sugary beverage? Yes, and it has been
and will continue to be, and in part because the food industry
points to that as the excuse. That’s their method for swaging
their culpability. This orange juice. Right. Okay? Orange juice is healthy. Anita Bryant said, “A day without orange
juice is like a day without sunshine.” You know take a frigging pill.
This is the problem. But it’s the science that ultimately
has to win out. But it takes a while. You know, when we’re talking
about educating the public, particularly a public that has been, shall we say divorced from science
for a long time and not taught science in schools,
and not taught a scientific method, and not taught the scientific rational
and scientific thinking. You know, this is a very heavy lift. You can state all those
as they apply to the public. You could probably state all those as they apply to physicians
and some scientists as well. No argument. And you can have documentaries
that have been produced recently where a physician wearing a lab coat
was staring to the camera and say, “Sugar does not cause diabetes.” Yes, Dr. Neal Barnard,
I want to have a duel with you. I am calling you out. I will meet you anywhere you say. We will leave our guns at home
we will be armed only with the science and I am going to take you down. I was trying to be clandestine
and not come out with names, but apparently that’s not going to fly here. No it’s not.
I think he has poisoned America. And that’s part of the problem. I mean he’s got a name,
he’s respected in many circles and they hear him make a comment like that
is just so confusing for the American public. Indeed. And so we have to fight
amongst ourselves in addition to fighting external influences
and industry and that just makes it a– Makes it even that much harder, exactly. And so part of my job,
if you will, is to ally the medical, the dental and dietary
professions to speak with one voice. The food industry loves
that we fight with each other. It’s how they win. If we actually were united and we can be
united– So this is Low-Carb USA. I’ll be very honest with you,
I have nothing against low-carb, I also have nothing against vegan. I really don’t. I don’t have anything
against either of them. The only thing I have something against
is the dogma. That I have, a lot of against. You know, Ornish has good data that works, and I believe it works and the data
show that it works, and you know what? So does low-carb, so does keto,
and so does Atkins when you do it right. And the point is there are
a lot of diets that work. Mediterranean works, you know. Right, in what lifestyle what context? Because Ornish’s studies was
in a comprehensive lifestyle program. Totally. Mediterranean diet studies where
in a certain lifestyle of Mediterranean. Where they can do it.
I totally agree. The point is that every single diet
that works, and I don’t care where you go. I don’t care if you go to Greenland
and do whale blubber. I don’t care of you go to Africa
and do the Masai, I don’t care if you’re talking
about agrarian cultures. I just don’t care.
It’s irrelevant. The point is every diet that works
on the planet is low sugar high fiber. Low sugar so your liver doesn’t get sick,
high fiber so you feed your bacteria. Processed food is
high sugar low fiber. High sugar for palatability
and low fiber for shelf life. Makes the food cheap
but turned it into consumable poison. So there’s a rising tide
of a low sugar low fiber diet, the all meat carnivore which is working
very well for a number of people in a number of anecdotal reports. It will improve insulin sensitivity.
It will decrease insulin secretion. I used low carb diets in my clinic for patients
who had massive insulin resistance, who could not be treated any other way. I know it works.
That’s why I am for it. I didn’t say I was against it. I’m for it. But I’m for the other too.
And you know what? People who have familial hypercholesterolemia
have to eat the other way. That depends on who you are,
it depends on your gene type, depends on your disease burden,
depends on your family history, depends on your environment,
depends on a lot of things. The point is there’s no cookie cutter answer.
There is now one diet. And the goal is to bring the right diet
to the right person at the right time. But you can’t do that
if you’re all in one diet and in my clinic we parsed people
instead of lumped them. That’s a great point and even in a condition
like familial hypercholesterolemia you can’t necessarily lump them
into one category, because you get someone who’s got FH
and he’s insulin resistant, pre diabetic, and high inflammatory markers, and now you’re really stewing the pot
for a bad outcome. You have to address that possibly
into a low-carb situation as well. Point is target the pathology. Always that’s a physician’s mantra,
target the pathology. If you don’t know what the pathology is
then what do you target? Right, and that comes back to your talks
about metabolic syndrome, what you’re talking about
here at this conference. You know we define, we have our definition
of the metabolic syndrome about the waist circumference
and hypertension. CARBage. And you said, alright.
So tell me about that. They are all manifestations
of the metabolic dysfunction. They’re all markers for metabolic dysfunction,
they’re not the causes. Yes they cluster together,
no argument there. Different people have different ones, different races have different predilections
to different diseases. The reason’s because it’s not one thing,
it’s 3. And I will describe that this morning. It can be from obesity.
I’m not saying it can’t. But I think that’s actually one of the rare
causes of metabolic syndrome not one of the common ones. Can be from stress
because depressed people lose weight but have metabolic syndrome,
and with visceral fat and finally, you can mainline it, you can basically fry your liver
and you can do that at a normal weight and having metabolic syndrome. So I think there are 3 ways to get there and I think there are different food stuffs that can end behaviors,
that can contribute to them, and I think
there are ways to parse those 3 path ways in order to be able to help each person deal
with the problem that has caused theirs. But if it’s one size fits all,
it will never work. Yes, I like that approach. And the definition doesn’t define
the disease, the definition is basically for billing
purposes more than anything else. Indeed. That’s right. So understand this is metabolic dysfunction
and I’ll even give it a better name. It’s mitochondrial overload. Metabolic syndrome is mitochondrial overload
in whatever tissue you’re looking at. That is metabolic syndrome
and we have the data to prove it. Thank you Dr. Lustig for taking the time
to join me today on the DietDoctor podcast. -I told you it was Rob.
-It’s Rob. I quickly forget, Rob. -Thank you so much for joining me.
-My pleasure. Now for audience who wants to learn
more about you and hear more about what you have to say
where can we direct them? Well, there’s a website
robertlustig.com. There is eatreal.org, there will shortly be
a for-profit website biolumen.tech, about a for-profit venture in an attempt
to bio engineer a solution to this crisis and also numerous other venues. There are YouTube videos, there’s a YouTube channel
with a lot of my stuff. There is the 2 books, there’sFat Chance
andHacking of the American Mind. You know, there’s ways
to get the information. Absolutely.Sweet Revengeis a PBS video, that teaches people how to reverse their
diabetes with real food, there’re lot of ways. Well this is a obviously big problem
with real consequences, and I’m glad you’re in the front line,
hoping to find the solution. Thank you Rob. Thank you.