WHY CHRONIC DISEASE IS EXPLODING

By: DR. ROBERT LUSTIG & MIGHTY PURSUIT

Dr. Robert Lustig is one of the world's global authorities on nutrition and chronic disease, in addition to being the New York Times bestselling author of three books. In this episode of the Mighty Pursuit Podcast, we discuss one of the main causes of chronic disease and the surprising cure that no one is talking about. Mighty Pursuit: All right. Welcome home to New York. Thank you for being here, Robert. Dr. Robert Lustig: Thanks for having me, Matt. Mighty Pursuit:I kind of want to start. So obviously, you wrote Metabolical. What was that, 2021? A couple of years ago. What compelled you to write that book? Dr. Robert Lustig: Covid. In simple terms. It was my Covid project. I was stuck in my bedroom and had to be productive or I'd lose my mind. And I knew that I was going to write it. But that's why I wrote it, then. You know, in 2013, I wrote my first book. Fat Chance. And that book said, you are not what you eat. You are what you do with what you eat. In the intervening eight years since Fat Chance came out, I learned an enormous amount about the dark underbelly of the food industry. And all of the subterfuge and all of the corporate determinants of health, we call them now. Actually, you know something we study in school. We've got lectures and you know, podcasts and what have you on corporate determinants of health. And so I actually realized, no I got it wrong in 2012. It's not “you are what you do with what you eat”. It's “you are what THEY did with what you eat”. And so that had to come out. And so that's why I wrote Metabolical. Mighty Pursuit: Kind of to begin, this is a little bit of a paraphrase, something you said in your book in Metabolical, but you wrote "it's generally accepted that modern medicine works to keep people healthy. The thought process goes, people live longer today than 100 years ago, and healthy people live longer. So people today must be healthy. And so I couldn't really think of a better place to start this conversation because how we perceive our own health and the state of modern medicine ultimately is the catalyst of any change that we hope to create. And so I think when people say these things, they don't realize that, let's just transport back to 1900. They don't realize what was killing people back then and what was causing disease back then. Combined with the fact they have such trust in the medical system. So can you kind of explain the state of what was happening there, what was killing people then versus the difference of what's happening now? Dr. Robert Lustig: Sure, sure. So 1900, median age of death of the average American was 47. Okay. And today it's 78. Now, you'd say that's a big win, right? So what made the difference? We actually made that up very, very quickly. And the reason we did was basically three things. Sanitation. Vaccination. And antibiotics. Those are the three things that made the difference in terms of longevity and lifespan. And the reason was because all three of those things have to do with infections. The primary vector of disease throughout our entire history as homo sapiens was bugs of various sorts. You know, pick your bug. That's what it was. And germ theory became a thing in the late 1880s. Louis Pasteur and Joseph Lister basically codified this notion. Oh, and Robert Koch, let's not forget him, about germ theory. And then Alexander Fleming in 1928 discovered penicillin.. And the very first patient who got penicillin was in 1941. And he had this overwhelming cellulitis of the face that would have killed him. And he got penicillin, and he didn't die. For six months. And then he died. But that was enough. And, as Peter Attia said in his book Outlive, we had medicine 1.0, which was the leeches. And then we had medicine 2.0. And that's the moment that medicine 2.0 started. It was the advent of penicillin. There's a pill for that. That's medicine 2.0. There's a pill for that. And that's been going on ever since. Well, you know what? We're not dying of infections anymore. We're dying of this thing called chronic metabolic disease. And I can sum that up. All these diseases, I can sum up all the diseases that fit under chronic metabolic disease. Here they are. Type two diabetes. Hypertension. Dyslipidemia. Cardiovascular disease. Cancer. Dementia. Fatty liver disease. Polycystic ovarian disease. Those eight diseases. Today, those eight diseases cost 75% of U.S. health care dollars. 75% for those eight diseases. All right. Dr. Robert Lustig: Every one of those is mitochondrial dysfunction. So hopefully your audience took 10th grade bio. And they've heard of the mitochondria. If they don't remember what it is. It's those little energy producing factories inside each cell that takes chemical substrate and turns it into chemical energy that your cells can use. And that chemical energy has a name. It's called ATP. Adenosine triphosphate and the phosphates have the energy in them. And every time you break an energy, a phosphate bond, you basically harness the energy to be able to power the cell, to be able to power the muscle, to be able to power the liver, to be able to power the brain, to be able to power, you know, any the heart. And that's basically what keeps you alive now, is that conversion of what came out of the ground, or the animal that ate what came out of the ground through this set of the stiff and metabolic processes to lead to ATP? And this all happens at the mitochondria. Every one of the diseases I just mentioned, all those chronic metabolic diseases are all mitochondrial dysfunction. So what is that telling us? That's telling us there's something wrong with our mitochondria.

THE DECLINE OF HEALTH

Mighty Pursuit:When you talk about those chronic diseases, obviously we could talk about it from a detached or philosophical perspective. But then if you actually come down with one of those diseases, it just unleashes kind of like a wave of suffering. And so kind of going back a little bit to what was killing us back then versus versus now. Would you say that you said we kind of made up those losses per se with infectious disease and stuff pretty quickly? So do you feel like we've been in a state of decline for a long time? If you were to remove the major wins that we would say for public health and then also something like the infant mortality rate, which in 1900 there was like 16% of babies were dying at birth. So if we remove all those things, would you say that, the average lifespan, maybe 100 years ago would have been higher than it is today? Given this. Dr. Robert Lustig: Well, here's what we know. If you look at life expectancy over time. For the OECD countries, the Organization of Economic Cooperation and Development. So of the 37 most developed richest countries, mostly Europe, Australia, there has been a slow and steady rise for 36 of those countries. But there's one that has gone like that. Mighty Pursuit: United States? Dr. Robert Lustig: The United States. We have so fallen off the rails. So if you look today the mean longevity in Japan is 86 years. The mean longevity in the United States is 78 years. We are paying an eight year longevity tax. Just by living here. And if you're obese, you're paying a 15 year longevity tax. Mighty Pursuit: And that doesn't even account for the idea of life span versus health span. The health span part. Dr. Robert Lustig: Yeah, yeah, yeah. And we're not even going there. We'll get to that. And then of course if you have metabolic syndrome, you're paying a 20 year longevity tax. And we're putting more money into health care like crazy. And we're getting less life span and health span out of it. In fact, the more we put in, the less we get. And the reason is because we're not addressing the problem. We have done everything but address the problem because the problem is not addressable with pills or procedures. The problem is only addressable with the third p -- prevention. And we don't do that here. Mighty Pursuit: You mentioned it briefly but let's go over the eight chronic diseases. So there's cancer, Alzheimer's.. Dr. Robert Lustig: Yeah, type two diabetes, hypertension, dyslipidemia, cardiovascular disease, cancer, dementia, fatty liver disease, polycystic ovarian disease. Mighty Pursuit: Okay, average listener right now, what is the likelihood that someone is going to get just ONE of these things in their lifetime? Dr. Robert Lustig: One of those diseases? 80%. Mighty Pursuit: 80% of the population? Dr. Robert Lustig: Yeah, will get one of them. Mighty Pursuit: That kind really drives home the relevance of this conversation because the with the trajectory that we're on before getting to the measures and the prevention and the care that we're gonna talk about today, the trajectory that we're on as a culture is if that's not happening to you right now, chances are that's going to be happening to you in the future if there aren't changes that are being made. And so we briefly referenced this, but the life span versus health span. Can you explain what those two terms mean? Dr. Robert Lustig: Lifespan is how long you live and healthspan is how long you live healthy, before you get sick. And the health span is so much shorter than the life span. Even though the life spans are going down. Okay, the point is when your health span goes, your productivity goes too. And when that happens, now you're taking money from the system instead of paying it into the system. And that's why Medicare and Social Security are going broke. It's not because we have more people. It's because we have more sick people. And there's no pension change or Social Security alteration or anything else that's going to be able to fix that problem. What it comes down to is you cannot fix health care until you fix health. You cannot fix health until you fix diet. And you cannot fix diet until you know what the hell is wrong. And what I'm saying is, we've gotten it wrong for the last 50 years, and we now have the battle scars to show for it. And it's time to actually rethink this war.

ULTRA-PROCESSED FOOD & DISEASE

Mighty Pursuit:Like you just said, it's killing the medical system. And so if 75% of the expenditure is going towards the cost of these diseases. And then it's just significantly lowering your quality of life and then you just end up dying of one of these things. It's such a grave circumstance. So obviously, the natural question becomes, why is this happening? And we're talking about the mitochondria. And you wrote in your book that -- if you were to look at a chart, right? You'd be able to pinpoint an approximate time when this started skyrocketing. So you see these diseases going up. And so what happened in 1970, around 1970, that caused chronic diseases to start skyrocketing? Dr. Robert Lustig:Two words. Ultra-processed food. That's two words. Mighty Pursuit:Almost three, but... Dr. Robert Lustig:Ultra-processed food happened. Okay. Ultra-processed food was an experiment. It was an experiment that we all ended up as research subjects for. But didn't sign informed consent. But we partook anyway, because we saw inherent value. And there was value. You know, it was cheaper, quicker. It allowed mothers less time in the kitchen so they could have two jobs instead of one or even three jobs. Okay, it let kids feed themselves. You know, like Froot Loops. What have you. I mean, there are all sorts of, shall we say, social improvements that occurred out of the notion of ultra-processed food. But the question that I need to pose to you and to your audience is, is ultra processed food, food? Food industry calls it that. Mighty Pursuit:A lot of people think so. Dr. Robert Lustig:Is it true? Just because they say it is doesn't mean it is. So is ultra processed food.. food? Is Cheetos food? Mighty Pursuit:Well, I think you equated ultra processed-food to slow poison. Dr. Robert Lustig:Well, why is that? I mean, and you know, for your audience, what does that mean? So the definition of food was straight from the dictionary. Okay. And I love this definition is 100% right on target. Energy substrate that contributes to either growth or burning of an organism. That is food. Growth or burning. That's exactly right. Anything that contributes to either growth or burning is food. Okay, so let's take that apart. We'll do burning first. Turns out glucose, which is starch, which is half of sugar. It's what's on your French fries. Glucose actually stimulates mitochondria to work better. It actually stimulates two enzymes in your mitochondria that actually make them work better. So you actually increase ATP generation, which of course is the whole goal of burning. It increases an enzyme called AMP kinase, which is the fuel gauge on the liver cell ratcheting up to make more mitochondria, fresher mitochondria. That's a good thing. And it also increases an enzyme called HADH, hydroxy acid CoA dehydrogenase, which is necessary to cleave fatty acids into two carbon fragments so that they can be burned by the mitochondria. So glucose, for lack of a better word, we'll call good. Dr. Robert Lustig:Okay. There are problems with carbohydrates, but for the moment from a burning standpoint, glucose is good. Now let's take this other molecule - fructose. Fructose is the other half of sugar. Fructose is the sweet molecule of sugar. Fructose is what they put in the ice cream and the candies and the cakes and the sodas and the salad dressings and the flavored yogurts and the tomato sauce and the bean dip. Okay. And the chicken teriyaki and everything else in the friggin grocery store. That fructose molecule inhibits three enzymes necessary to burn. It inhibits AMP kinase and inhibits it irreversibly, actually binds in the active cell and prevents it from working. It kills it. You have to make a new one. It inhibits acad L acyl CoA dehydrogenase long-chain necessary to cleave those two carbon fragments so they can be burned. And lastly, it inhibits an enzyme called CPT one, carnitine polymer transferase one, which is the enzyme that regenerates carnitine, which is the shuttle mechanism by which the fatty acids get into the mitochondria for burning in the first place. In other words, every single thing fructose does. Inhibits burning. Dr. Robert Lustig:73% of the items in the grocery store were spiked with added sugar. So is ultra--processed food contributing to burning? No. Okay, let's now take growth. My colleague, good friend, doctor, Dr. Efrat Monsonego Ornan, who is the head of nutrition at Hebrew University, Jerusalem looked at this question. Does ultra processed food actually contribute to growth? And so she looked at skeletal growth, bone growth, cancellous bone growth, trabecular bone growth, cortical bone growth, every aspect of growth that you can imagine. And guess what? It inhibits all of those. Okay. It causes osteoporosis. It inhibits tensile strength. Actually increases fracture rate okay. Does everything but contribute to growth. Basically it takes your bones apart. At every level. Okay. Does the opposite. And the cancer people know that fructose hijacks growth to basically make new cancer cells. So does ultra-processed food contribute to growth? Only if it's cancer growth. So if a substrate does not contribute to burning and does not contribute to growth, Is it a food? Mighty Pursuit:No, absolutely not. Dr. Robert Lustig:Absolutely not. Dr. Robert Lustig:Well, if it's not a food, what is it? It's a... Mighty Pursuit:Poison. Dr. Robert Lustig:Poison? Thank you. Mighty Pursuit:I don't have a conversation about vaccines, but one of the most ironic things that has happened over the past few years is there was this whole thing with Covid and this whole uproar about vaccines, because people don't want to put something in their body that they feel is harmful. That's generally the narrative. You're not getting the vaccine. You think that that's going to do something in your body. Meanwhile, most people -- Dr. Robert Lustig:We can argue that, by the way. I get the concept. Mighty Pursuit:Yeah, whether that's true or not. Regardless. But that's the reasoning that people have. And so based on the statistics, those very same people are consuming what we were talking about is essentially poison on a daily basis and not even really cognizant, they're not realizing that this is actually happening to their bodies and what they're actually putting in their food. Dr. Robert Lustig:Right, so that's the problem. The problem is twofold. That's one part of the problem. Problem is they don't know. Well why don't they know? Is it just ignorance? Just lack of knowledge? Or is it willful ignorance? That's being actually perpetrated on them by somebody else that they don't know. Mighty Pursuit:It's the second one. Dr. Robert Lustig:So this is a whole study of science all by itself too. So have you ever heard of the word agnotology? Mighty Pursuit:No, what is that? Dr. Robert Lustig:I'd never heard that word until last year. Agnotology is the science and study of ignorance. Now, not lack of knowledge ignorance, but willful ignorance. Either willful on the part of the person or willful on the part of an external actor to keep someone ignorant. Okay, so I went to this meeting at Stanford last year. Best meeting I've ever been to. 14 speakers. So we had the climate change people. We had the opioid people. We had the big meat people. We had the art people. Swear to God, the art people. We had the deep fake people. We had all the alcohol people. Smoking. You know, it was really remarkable. And then, of course, we had the medical people. That was me. Okay. And I gave a talk about personal responsibility and where personal responsibility came from. So here's a question for you. Who invented personal responsibility? Mighty Pursuit:You talked about this in the Andrew Huberman podcast. Dr. Robert Lustig:Tobacco industry. Dr. Robert Lustig:Okay. Wasn't invented in the Declaration of Independence. Wasn't invented in the Constitution or the Magna Carta or any state house. It was invented by the tobacco industry in 1962. Because they were getting killed on the science. And they had to invent another reason for you to smoke. Personal responsibility. Nobody put that cigarette in your mouth. Nobody lit it for you. You're in charge of your own actions. Or are you? Or are you? So this gets to the question of addiction. If you're addicted. Can you exercise free will? Is it hard or is it impossible? Mighty Pursuit:I wouldn't say it's impossible. Dr. Robert Lustig:It's pretty damn difficult. Dr. Robert Lustig:And that's the whole definition of addiction, because you can know that whatever it is that you're addicted to is hurting your life, your health, your family, your economy, your community, and you are powerless to do anything about it. And you may not know you're addicted. Okay. If you do, then it's bad. And if you don't, then it's even worse.

WHAT'S BEING DONE TO OUR FOOD?

Mighty Pursuit: Yeah. Well, the thing about personal responsibility, I think that's interesting. We had Dr. Anna Lembke on here two months ago and she was talking about this idea of self binding, when it comes to having distance with the thing that you're addicted to or that you have dependance on. And I think the idea of personal responsibility as it relates to ultra-processed food is really interesting because it's around you everywhere. It's everywhere. And then it's not only everywhere, but the people are paying slotting fees to put it right in your face at grocery stores, and then you're having ads around it and then you're having all this misinformation that is being circulated around it. And I think to really drill home the idea of why processed food is poison, you kind of need to understand what's being done to our food, which is like the crux of your book. And so you said, "all food is inherently good." And so going back to burning and growing -- Dr. Robert Lustig: All food is inherently good because it does one of those two things. Mighty Pursuit: "The problem is that in the course of food processing, poisons are either added or antidotes have been removed or both." And so there's really like three levels, which are chapter 18, 19 and 20 of your book, of what's actually happening to our food. And I think this idea if it's like ethereal or I don't know if it's actually true. I think it becomes very, very real and understandable for people when you understand these three things and how that inhibits the process of burning and growing. And so the first thing, if we want to unpack, I kind of called it the "contamination of our food supply" if that would be the most accurate term. Can you explain how our food supply is getting contaminated? Dr. Robert Lustig: Sure, so before we do that, let's talk about what the goals of health are. The goals of health. In order to improve health, we have to improve metabolic health. We have to improve mitochondrial health. That's what's missing. Acute medicine will take care of all the infections. This chronic metabolic disease, this metabolic health thing, only we can take care of that. There is no pill for this. Ozempic is not the answer. And we can go into that if you want. Okay, we have to fix the mitochondria. Ozempic does not fix mitochondria. So in order to do that, we have to do two things. We have to promote metabolism, and we have to suppress inflammation. Both of those causes mitochondrial dysfunction. Okay. Promote metabolism, suppress inflammation. All right. How do you promote metabolism? There are toxins to mitochondrial function. And there are many of them. They're not a few. There's a lot. All right, let's name some. The big one. The biggest one in the last 100 years. Mighty Pursuit: Sugar? Dr. Robert Lustig: Trans fats. Mighty Pursuit: Trans fats. Okay. Dr. Robert Lustig: Trans fats. Invented in 1902. Patented in 1911, called Crisco. Introduced to baked goods in 1920. And that's when we started seeing the heart disease prevalence in this country start to skyrocket. Not before that. Now you could say, well, because we weren't living long enough to have heart disease. And you might be right. But it was with the advent of trans fats that the rate of heart disease started to skyrocket. It's also with trans fats when the rate of diabetes started to skyrocket. So who was the first person to notice the increase in diabetes? In secular terms. In secular trend terms. And when was it? 1924. When the New York City Commissioner of Health, Haven Emerson noted that there were six times as many diabetics in New York City as there were ten years earlier. He was the first person to sound the alarm in 1924. Mighty Pursuit: That's a big jump. Dr. Robert Lustig: Okay. This is before added sugar started pervading and getting added to everything. So heart disease started to jump. Paul Dudley White at Mass General ended up being Eisenhower's physician when he had his heart attack back in the 50s and wrote about this. This is a big deal. And it was causing both heart disease and diabetes. Trans fats was the true big kahuna. The very first paper fingering trans fats as bad was in 1957. Mighty Pursuit: It's like 33 years later. Dr. Robert Lustig: 33 years later, before anybody even recognized that this was a problem. Okay? They all saw the problem in terms of the outcome, but no one understood the cause. And then the guy who wrote it basically got laughed at. His name was Fred Kummerow. He's a giant in this field. He died a couple of years ago at age 102 because he'd never eaten any trans fat. His work was ignored until 1988. Dr. Robert Lustig: So we basically went from 1924 to 1988 before anybody actually did anything about the trans fat problem. Trans fats are consumable poison. In no uncertain terms. And the reason is because the trans fats were added to the food, because the trans double bond cannot be digested by bacteria. They do not have the enzyme to break that double bond. And so therefore you can have the ten year old Twinkie. Because the bacteria will kill it. They will not chew it up. They will not make it go rancid. And so the food can stay on the shelf forever. Mighty Pursuit: So unnatural. Dr. Robert Lustig: Well guess what? Our mitochondria are refurbished bacteria. We don't have that enzyme either. So when we consume those trans fats, we're as good about doing something about it as the bacteria are. And so what do they do? They sit and they line our arteries and livers and basically contribute to metabolic syndrome, causing heart disease and diabetes. And now you're dead.That's why everybody was dying in their 50s from heart disease. And oh, add smoking to that, of course. Okay, so we were exposed to some big numbers in terms of toxicity, in terms of poisons, tobacco smoke, trans fats. That was enough to kill anybody. All right. That was before sugar. Well, in 2013 the FDA finally, finally banned trans fats. Mighty Pursuit: It's like 90 years later. Dr. Robert Lustig: 90 years later. And so they're coming out of our diet, right? Wrong. And here's why. The FDA, in its infinite wisdom, said to the food industry, "well you have to list trans fats on the side of the package now. But if a serving of a given processed food has 0.49g of trans fat or less, you can say that has zero trans fats." You can round down from 0.49 to zero. 0.50 or up you have to declare them but 0.49 to zero, you don't have to put it. Now it's been shown that you only need two grams of trans fats to kill you. You know, per day to kill you. So if you eat four candy bars, you're gonna die. And you're not going to know it. So this is being kept from the public. Has been all along. Okay. And it's, shall we say, I won't call it a conspiracy, per se, but it is basically not the due diligence that our government is supposed to be doing. Mighty Pursuit: Circling back to your quote earlier, all food is inherently good, but it's what's being added, it's what's being done to our food that is causing all these problems that are just completely unnatural. Dr. Robert Lustig: That's right. Dr. Robert Lustig:All right. But trans fats at least are, you know, way down. Okay, well, now it's sugar. So sugar turns out to be a mitochondrial toxin for the reasons we discussed earlier, because it inhibits those three enzymes. And 73% of the items in the American grocery store are spiked with added sugar. For the industry's purposes, not for yours. Okay. Because they know when they add it, you buy more. And the reason is because sugar is addictive. Sugar makes everything taste good. You can make dog poop taste good with enough sugar. Yeah, and they do. So that's the big one now. And we know that fructose is a direct mitochondrial toxin. And we even know how. Dr. Robert Lustig: Are we doing anything about sugar? Well we're trying to educate the public. There are some signs that the public is being educated. I have proof the food industry generated here for me. In 2011, the public relations arm of the food industry called IFIC, International Food Information Council. Every year they publish a yearly report, and every year they ask the public a question and they published the results of the question. And in 2011, the question was what single food stuff is the greatest contributor to obesity? And in 2011, 11% of the population said refined carbohydrates and sugar. 42% of the population said a calorie is a calorie or I don't know. Dr. Robert Lustig:They asked the exact same question the exact same way, with the exact same phrasing. In 2018, seven years later and now 33% of the population said refined carbohydrate and sugar and an equal number of people who had said a calorie is a calorie or I don't know went down. By that exact same amount. In other words, we had educated the public about the dangers of sugar. So it's taking, it's going, it's happening. And you can see it in other ways. You can see companies trying to provide no sugar alternatives. Heinz Ketchup now has a no sugar Heinz ketchup. Now, I'm not saying it's any good. And I'm not saying you should use it. But the fact that they're doing it means that they recognize that they have a problem. Either they have a nutritional problem or they have a marketing problem. Okay. Either one, I don't care. The bottom line is there's a move. There's a movement afoot, and people are starting to get it that this is a problem. Total sugar consumption in soft drinks. Way down. Now, unfortunately, diet drinks are way up. Are diet drinks okay? Is that the answer? Are diet sweeteners a good replacement for sugar? Not so good.

WHY SUGAR IS A PROBLEM

Mighty Pursuit: So why is sugar a problem and why is it bad for us? I mean, what is it actually doing in the body? Dr. Robert Lustig: So it is doing a bunch of things. The three things that sugar does, that fructose does, that glucose doesn't, it contributes to liver fat. It is a preferential substrate for liver fat. It undergoes this process called de novo lipogenesis, new fat making. And when your liver stores that fat, now you have insulin resistance, metabolic syndrome, risk for type two diabetes. That's number one. Second thing it does, it binds to proteins. It's the caramelization reaction. It is the browning reaction. It Is the reason you paint barbecue sauce on your ribs before you put them on the grill to get that nice caramel color. Well, that's happening inside your body all the time. That browning reaction, it's known as the Maillard reaction. And what it's doing is it's damaging proteins in your body. Those proteins then are inflexible. They become dysfunctional and they contribute to disease and death. And that's happening whether you like it or not. It is happening as a matter of course for the mitochondria. But the goal is for it to happen as little as possible. Well, if you had orange juice this morning, you are browning seven times faster. Dr. Robert Lustig: Okay. What is the composition of the national school breakfast program breakfast? Bowl of Froot Loops and a glass of orange juice. Has 41g of sugar for breakfast. The USDA says that the maximum amount for children should be 12g of sugar for the whole day. Mighty Pursuit: That's like four times. Dr. Robert Lustig: And that's 41g of sugar and it's just breakfast. So how much glycation, how much of this Maillard reaction is going on in our kids? Well we can measure it and it's huge. So that's the second problem. And then the third problem is fructose is addictive. Makes you want more. Mighty Pursuit: Why is that so controversial, though? Like, I saw this reaction online to the Huberman podcast with Dr. Layne Norton. He had this whole document about -- Dr. Robert Lustig: Yeah, I'll take Layne Norton apart limb from limb if you'd like. But the bottom line is there are two views of this question of food addiction. And I am actually the keynote speaker at the International Food Addiction Consensus Conference in London two weeks from today. I'm looking forward to it. On the European side of the pond. They think it's something called eating addiction. This side of the pond, we say it's a food addiction. Now, that's not semantics. Food addiction. Eating addiction. Okay, they sound similar, but they're not. Because if it's an eating addiction, then the onus is on the individual. If it's food addiction, the onus is on the industry to fix whatever it is. So it's not a little thing. The question is, is it real? And you know, I will go into chapter and verse as to how this controversy got started. My talk is called The Battle Over Food Addiction. And I will be very happy to dissemble Layne Norton limb from limb and he will not enjoy it. Mighty Pursuit: Based on our talk with Dr. Lembke, even reading her book, I mean, obviously I don't want to speak for her, but we talked about food and her definition of addiction obviously is to continue to compulsive consumption despite harm to yourself or others. And it just seems relatively obvious to me that sugar can be addictive. And given the spike in dopamine and what it's doing in your brain in large amounts. Dr. Robert Lustig: And so we have the demographic data, we have the epidemiologic data, we have the imaging data, we have the biochemical data, and we have the outcomes data to all demonstrate that sugar is addictive. Here's the problem. It's not addictive for everybody. Heroin's addictive to everybody. Nicotine is addictive in 80% [of people]. So, like, if you take drugs, you smoke, you're going to get addicted. And it's pretty much a fait accompli. Let's take something a little closer to home here. Alcohol. In America, 40% of Americans are teetotalers. Never touch this stuff. 40% are social drinkers. Go to a bar, pick up a beer. Put it down. Walk away. I'm in that group. 10% are binge drinkers and 10% of chronic alcoholics. That 20%. They're alcohol addicted. Now why 20%? What's different about the 20% versus the 80%? And if 80% of people are not addicted, does that mean that alcohol isn't addictive? Mighty Pursuit: No. Dr. Robert Lustig: Well, that's the Layne Norton response. That's my response to Layne Norton. Okay. You know, get with the program. The point is, just because it's not addictive for everybody doesn't mean that it's not addictive. Mighty Pursuit: Anna Lembke said the same thing about porn. Dr. Robert Lustig: Yeah, absolutely. Mighty Pursuit: Like 15% of the people. Dr. Robert Lustig: Gambling. Mighty Pursuit: Yeah, gambling. So it's not universally true. And then the impact, I guess, per person varies, but the actual properties of the substance itself can create that. Dr. Robert Lustig: So maybe Layne Norton's not addicted. Or maybe he is and doesn't want to tell everybody. But the bottom line is I don't really care. The point is that my guess, based on the literature, based on the demographic data that we have, is that 20% of people are sugar addicted. Mighty Pursuit: Yeah. I think the big thing that people need to understand about studies in general and him being, you know, I think it's nutritional biochemistry and also a doctor in this field, obviously, I would assume that he knows how to read the studies or whatever, but who funded the study? Dr. Robert Lustig: Well he's not an MD. Let's be clear about that. Mighty Pursuit: So, like, who funded the studies? Which, Dr. Marion Nestle, go back and watch that episode, talks about extensively, is that you are going to get people, if the sugar industry is funding studies that sugar is not harmful, and then now you get influencers online talking about oh, no it's not harmful and all the stuff. Then you're going to get a favorable outcome. And then also the parameters of the study. And so he cited these two studies. But I think when analyzing a study, for the average person it's really hard to understand or uncover who actually funded the study and it's corrupt. It's a corrupt system. Dr. Robert Lustig: Totally. So let me give you an example of that. Okay. In 2015, my nemesis, his name is John Stephen Piper. He is a PhD meta analysis expert at Saint Michael's Hospital at University of Toronto. He has a conflict of interest list longer than R. Kelly's rap sheet. Okay. I mean, it is just replete with every food industry concern. Plus, his wife works for Unilever. To boot. Okay. All right. And he goes to conferences all over the world basically saying sugar is not a problem. And he does meta analysis to prove that sugar is not a problem. And he is my nemesis. Okay. We have debated each other, direct contact in Vancouver at the International Diabetes Federation several years ago. Okay, he published a paper in 2015. In the Annals of Internal Medicine, a meta analysis. Does sugar cause obesity and diabetes? And in this meta analysis he identified 60 data points that he was going to do the analysis on. Dr. Robert Lustig: And when the analysis was complete, the bottom final line in Stephen Piper's article was the data are inconclusive. Therefore, there's no reason to consider sugar as being a primary modality for therapeutic intervention because the data are inconclusive. That's what he said. Okay. We knew this was hogwash. There's a group of scientists at UCSF that I belong to. We call ourselves the Sugarhill Gang. Okay. And it's Elissa Epel and Laura Schmidt and Ashley Mason and Stan Glantz and myself and Claire Brindis and Dean Schillinger and a few other people. Okay. And we sort of know the drill. So, Dean can do meta analyzes. He knows how to do them. And so he took this even Piper paper, and he pulled all 60 of the original studies, and he did his own meta analysis, exactly the way Stephen Piper did, so that it would be exactly the same data and exactly the same treatment. Except for one difference. He threw in one extra variable. Food company sponsorship. Which Stephen Piper conveniently neglected. Mighty Pursuit: Radically changes everything. Dr. Robert Lustig: So, 60 data points. 26 funded by the food industry. 34 funded independently. Of the 26 funded by the food industry, zero out of 26 said that sugar was a cause of obesity or diabetes. Of the 34 funded independently, 33 of the 34 said sugar was a primary driver of obesity and diabetes. So what does this tell you? It's telling you that the data is polluted. The entire medical literature is contaminated by the food industry specifically, so that then they can say, well, see, the data is inconclusive. I mean, this is basically what Fox News does. This is the same thing. Pollute the literature and then recall it yourself saying "somebody said". Yeah, it was me who said it. This is what's going on. And of course, the public is completely confused. It's my job to confuse them. But it's a tough job. Mighty Pursuit: Yeah. I mean, to take a quote out of Metabolical. I think it's pretty clear. Based on the research you wrote, "sugar sweetened beverages are causative for at least three diseases a metabolic syndrome type two diabetes, heart disease, fatty liver disease, plus tooth decay." But I also came across an episode that you did with Levels about, kind of early emerging research with sugar fructose. Is there a role that plays also in the acceleration of Alzheimer's as well? And so, I mean, there's just so much happening around this. And what I find to be interesting, obviously, is you said 73% of products obviously have added sugar in them. And one of the biggest characteristics of serial killers is the way they lure people in with their sweetness and charm. Knowing what they're about to do, obviously, they're masters of deception. This is the case with Ted Bundy. We just ran a post about Coca-Cola and Pepsi. Obviously, they're mass marketing. And so these products, like, literally, this is the only thing in there. So do you feel like it would be a stretch to say that Coca-Cola and Pepsi are serial killers in that sense? Dr. Robert Lustig: I don't want to say that. Not because it's not true. They know what they're doing. They know what they're doing. Okay. Now they will tell you that they're trying to undo it, and I know they're trying to undo it, but it's very difficult. Let me give you an example. 2011. Indra Nooyi. Ever heard of her? Mighty Pursuit: No. Dr. Robert Lustig: She was the CEO of PepsiCo. For 18 years. And in 2006, she knew that sugar was a problem. She was born in India, raised in Madras, India, Mount Chennai. And India has a 14% diabetes rate. The United States only has an 11.4% diabetes rate. At the time it was really only a 9% diabetes rate. It's gone up. Indra Nooyi is the head of the largest food conglomerate on the planet. And she knows that PepsiCo products are contributing to the diabetes burden of her home country. And she wants to do something about it. And she's the CEO. She should be able to do something about it. Right. So she hires Derek Yach, who's a PhD, public health expert away from the the W.H.O. He was the one who did most of the work on big tobacco for the W.H.O. Mighty Pursuit: World Health Organization? Dr. Robert Lustig: World Health Organization, right. And hires him away. And Derek starts to help engineer to try to figure out how to reposition Pepsi as a leader in purveying health. Mighty Pursuit: That's insane. Dr. Robert Lustig: Well, this is what happened. And they came up with the "good for you" line. So Pepsi's always had the "fun for you" line with Pepsi and the Doritos and then had the "better for you" line like the Slim Jims. Now they had the "good for you" line, like the hummus and the pretzels and the chia seeds and stuff like that. And in 2011, PepsiCo lost $349 million, and Wall Street was calling for Indra Nooyi's head on a silver platter. Because she took her eye off the ball. Mighty Pursuit: This is why the system is rigged. Dr. Robert Lustig: Well, you know. Wall Street Quarterly reports. Stockholder, shareholders to placate. You only have a three month horizon. What are you going to do? And so Nooyi survived that challenge. She stayed as CEO, but that was the end of the "good for you" line. You never heard from it again. Okay. It's gone into oblivion. And of course, Yach left and he started Vitality. It was a try and it was a complete abject failure. Another example is Denise Morrison, Campbell Soup. 2017. She starts a special request. Soup, 25% less sodium. She got fired. Next one up for grabs. Emmanuel Faber. CEO of Danone. Instructs Danone to reduce its added sugar portfolio by 14%. Now. 14%, better than zero. But 14%, is that good? 14%. When you're quadruple over your dose, will reducing by 14% make a damn bit of difference? Mighty Pursuit: No. Dr. Robert Lustig: Not really. No. Okay, well, they did it. I'm not saying they didn't. They did it. But he got fired. So anybody who touches the third rail of industrial food production. For any company that has a Wall Street Quarterly report. You know, they can't fix this from the inside. As much as they'd like to. And there are people within the food industry who would actually like to do the right thing. I'm not saying that all food industry executives are evil Snidely Whiplashes. But the bottom line is they can't fix it from the inside. It's got to be fixed from the outside.

THE PROBLEM OF FOOD ADDITIVES

Mighty Pursuit: The analogy that I used of a serial killer. Obviously, it could sound extreme and it seems like a weird thing to say. But if you really look at it, it's not in the sense that it's not one individual that is perpetuating the system, but it's like a force that's coming against you. And the reason why the serial killer analogy works is because of mass marketing. And so they know what the product is doing. They know all these diseases. Going back to what we just said about, sugar-sweetened beverages are causative for all these metabolic diseases and then people die. Obviously that's the end result. So it's like a kind of a slow death. But they are marketing these products, that are basically liquid poison and just facilitating it. And we've kind of only scratched the surface -- Dr. Robert Lustig: Oh yeah, there's more to go. Mighty Pursuit: On what's being done to our food. Because a product like Pepsi, for example, it's not just, the sugar is a huge component of it, but then you have the food additives that are being put into there. There's literally, if you look at the ingredients and go back to the thing that you just said about promoting growth and burn, there is nothing on that list of ingredients in Pepsi that is actual, real food. Dr. Robert Lustig: That's right. Mighty Pursuit: There's literally not even one ingredient, I don't think. And so can you talk about additives and that stuff as well. Dr. Robert Lustig: Sure, we talked about the two precepts that have to be followed in order to actually induce metabolic health. One is to promote metabolism. So we said you have to take away the mitochondrial toxins. Fructose is now the big one since trans fats went bye bye. But there are other mitochondrial toxins too. Cadmium is a mitochondrial toxin. Okay. Well, what's got cadmium? Chocolate. Especially South American chocolate. Big time cadmium. Lead too. Okay. So that's a problem. So they're trying to figure out ways to get the cadmium out of the chocolate and the working on it. But yeah not there yet. All right. What other mitochondrial toxins are there? There are a whole bunch of compounds in the environment. Not necessarily in the food, but sometimes in the food and in the water and in the air that are what we call environmental obesogens. Chemicals that induce adiposity unrelated to calories. That's the definition of environmental obesity. So like what kinds of things are we talking about? So in the air, we're talking about air pollution. PM 2.5 particulate matter 2.5 microns or smaller basically. New York City is obesogenic. Okay just for that reason. How about in the water? PFAs polyfluoroalkyl, eight alkylating substances. Teflon. Remember Teflon? Okay. You probably ate a whole bunch of meals off Teflon. Mighty Pursuit: There's a whole movie on this. 2019. Dark Waters. Dr. Robert Lustig: Mark Ruffalo. All about the Teflon scandal. And DuPont did everything they could to cover it up. Okay. So, turns out FAS is an environmental obesogen. Tributyltin. Okay. That's one you haven't heard of, but it's a really bad one. What that is, they use that to paint the bottom of boats to keep the barnacles from attaching to the hull. So it's in all of our water supply? It is a primary direct environmental obesogen. And this was work from Dr. Bruce Blumberg at UC Irvine. Okay. What else? Okay, how about chlorpyrifos? Standard insecticide? How about parabens in cosmetics? How about PBDE? Okay, that's flame retardants in your kids clothing and mattresses. Mighty Pursuit: It's going in our food. Dr. Robert Lustig: And how about phthalates? Those are in plasticizers, like in baby bottles and binky's. Okay. How about BPA? Okay. Which is in baby bottles and target receipts. And how about the inner lining of the canned food you buy at the grocery store? That white that's on the inside of the can? That's BPA. And all of these are environmental obesogens. And they're all interfering with mitochondrial function. Okay. So it's not just the obvious. But of those, a lot of them are hard to fix. The one that's easy to fix is the sugar. Because that's the one that was put there by the food industry for its purposes, not for yours. And that's why I spend the most of my time there. Mighty Pursuit: And so the response from someone on the other side would be, okay, well, these studies that are done on all these chemicals and additives, it's correlation, it's not causation. Dr. Robert Lustig: Well, we actually have causation for them now. Dr. Robert Lustig: We wrote a paper in 2022 in Biochemical Pharmacology listing all the studies. It's a very long paper. First author Hiddell, where we listed all the studies and we actually broke them up into what's correlation and what's causation. So we have causation. Mighty Pursuit: I think it would be great if we can link that study here. And, I would tend to agree with you, but even if someone is really resistant on the idea, I think the best case, the best case you can make with food out is even to go back to the the vaccine thing, it's like you're putting, with the food additives, you're putting foreign substances and chemicals in your body that were manufactured in the lab. And they're not nutrients. They're not real food, to the point that you just said, you're putting this crap in your body. And you're taking a real chance whether you want to believe that the science on this is pretty set or you're like, oh, I don't know if it's ambiguous. It's like you're taking a chance by putting this stuff in your body. Dr. Robert Lustig: Well, so as a pediatrician, yeah, I believe in vaccination. Okay. I have to state that. And if you had ever worked in a pediatric intensive care unit. And saw a patient with diphtheria or a patient with tetanus. Or a patient with epiglottis. You would know. that vaccination matters. Okay. Measles. Mumps. Rubella. You pick it. Okay. Vaccination matters. I am for vaccination. Mighty Pursuit: I would agree with you. Dr. Robert Lustig: Period. Now Covid was weird. First of all, it was a new disease. We didn't know anything about it. Okay. So we had to make decisions on the fly, which invariably, when you make decisions on the fly, you're going to get something wrong. And when you make the decisions on the fly based on emotion. You're going to get even more decisions wrong. So the question is, did the Covid vaccine work? And the answer is without question it worked because you could see the mortality rate drop like a stone as soon as people started getting vaccinated. What wasn't obvious was the fact that there were side effects. And there were. But there are side effects to every vaccination. And the side effects were more than we were led to believe. And worse yet, the side effects were covered up by the two companies that distributed the vaccine. Pfizer and Moderna. And that's not okay. So I'm not in any way supporting or extolling the virtues of Big Pharma in terms of what happened during this vaccination debacle. But at the same time, vaccination works. And I will take that to the bank and I'll take that and debate anybody about it, and I will take it to my grave. Because we have the data. Mighty Pursuit: The point of the additives and the correlation of the vaccine. The point, from my perspective, the reason why I bring it up, is not for people to be like, "oh, is it harmful? Is it not harmful?" It is speaking to the mindset of someone who is resistant, the duality of that of I'm resistant to vaccines, but I'm putting food additives and I'm putting these chemicals in my body all the time. And so I think that from that perspective, it's a real question because you're buying into these narratives from these food companies and whatever and it's a problem. It's at best an uncertainty. Dr. Robert Lustig: I agree with that. I'm not going to argue that. Anytime you put something in your body, you have to wonder why you're doing it.

HOW TO KNOW IF YOU'RE HEALTHY

Mighty Pursuit: Obviously we have pesticides, but just with time, go back and listen, Marion Nestle episode, we talked about pesticides. That's also being added into the food. So as we get into this, move along the conversation, like what does healthy even mean? And so it's common to assume, we talked about all this data, if you're not showing symptoms of disease or not being diagnosed with one, then you're healthy. But in your book, you said that 88% of the population is metabolically ill. Dr. Robert Lustig: Make that 93%. Mighty Pursuit: 93%? Dr. Robert Lustig: 93%. Mighty Pursuit: So what does that mean? Dr. Robert Lustig: What it means is that 93% of people's mitochondria are not working, right. That's what it means. And that they are at risk for chronic metabolic disease in the future. That's what it means. Mighty Pursuit: I want to bookmark this for later. But are there specific biomarkers that would indicate that we're on the road to getting one of these? Dr. Robert Lustig: Absolutely. Mighty Pursuit: Okay. All right. We'll get to that. Dr. Robert Lustig: Let me finish a concept that we started to promote metabolism, suppress inflammation. Remember to suppress inflammation. In order to be healthy, you have to limit inflammation. Inflammation is the driver of numerous problems in the body. Okay. It is a primary driver of cardiovascular disease, a primary driver of diabetes. Primary driver of Alzheimer's. Primary driver of everything. Now the question is why is everyone inflamed? Now, if you have an autoimmune disease. It's obvious your immune system is responding to some antigen that it thinks is foreign, even though it's not, and it's basically attacking the whole body. That's 10% of the public have an autoimmune disease. There are different kinds, you know Hashimoto's and there's Crohn's and there's rheumatoid arthritis cidp there's a whole bunch. And all these people know who they are. What about the other 90%? They're all inflamed, too. But they don't have an autoimmune disease. Where's the inflammation coming from? Dr. Robert Lustig: The gut? Your gut is a sewer. Okay. What's the definition of a sewer? A pipe with you know what in it. Okay, that's a sewer. Now, our intestine is a specialized sewer. Because it is not just a pipe that leads from your mouth to your anus. Yeah, it extracts the good stuff along the way, but keeps all the bad stuff in the center, in the lumen of the gut so it can ultimately leave. That's where the inflammation is coming from is all that junk. But the junk is not supposed to get into your bloodstream. But it is. Something's happened to the gut to prevent that. Prevents it from doing its job. And it turns out the gut has three barriers to do its job. Three. Dr. Robert Lustig: The first is a physical barrier that is called the mucin layer. It's a layer of mucus that, you know, is on top of every intestinal epithelial cell, basically as a physical barrier to protect it. The second barrier is called the biochemical barrier. They are proteins that hold the cells together like so. They are called tight junctions. The most famous of these are zonulins. And this is what goes wrong in celiac disease. And when these tight junctions fail, what happens is they do this. And now the pour between the cells becomes semi-permeable. And stuff can get from the inside of the intestine to your bloodstream. Because the door opened, if you will. Then the door can close again. It can be transient. And then the third barrier is the immunological barrier. So there's a whole bunch of lymphocytes patrolling. They were called IL17 cells, sorry TH17 cells, and they secrete a cytokine called IL 17, which is designed to basically recruit more cells into the area if there's a potential violation. So there are three barriers. Physical barrier. Biochemical barrier. Immunological barrier. Dr. Robert Lustig: They're all failing. All three. All at once, for different reasons. But there's one that basically is across the board. So here's what we've learned. Your intestine has bacteria in it, right? It's called the intestinal microbiome. By now, probably most of your audience have heard that term microbiome. It's the bacteria that live in your intestine. And they can either make you well or they can make you sick. Mighty Pursuit: I've had SIBO for like two years. Dr. Robert Lustig: You have SIBO? Mighty Pursuit: Small intestinal bacterial overgrowth. Dr. Robert Lustig: I had it too. I also had rosacea with it. And you know, I got rid of it. I stopped eating gluten. And my SIBO and my rosacea got better. So I understand. I live with you. How's that? Okay. And every time I pass a bakery, I go, oh, man. But that's the way it is. Dr. Robert Lustig: So, you've got to feed the bacteria. And what we've learned is if you don't feed your bacteria, your bacteria will feed on you. They will not die. They don't know how to die. They will strip the mucin layer off your intestinal epithelial cells and use that for their food. Rather than die. And when they do that, that actually denuded the intestinal epithelium. Yeah. And that renders them much more likely to be able to be attacked by, you know, a cytokine or a lipopolysaccharide or some other agent in the intestine. And that's what leads to irritable bowel syndrome, inflammatory bowel disease, etc.. And now you've got systemic inflammation. Dr. Robert Lustig: Second problem. Those proteins, the biochemical barrier, the zonulins. Turns out fructose nitrates tight junction proteins rendering them transiently and nonfunctional. And so guess what? You have this transient leak where bad stuff can get in. And number three. Mighty Pursuit: Is that leaky gut? Dr. Robert Lustig: That is leaky gut. Yes. That is leaky gut. And number three, those TH17 cells. So if you eat a regular diet, the TH17 cells are there. If you had a high fat diet, the TH17 cells are there. If you eat a cafeteria diet -- high fat, high sugar -- the TH17 cells are not there. They're replaced by TH1 cells that IL17 goes and stuff starts making its way across into the bloodstream. You've lost your barrier. So, sugar affects every single one of those barriers. Yeah. Now there are other things that affect those barriers, too. Don't get me wrong. But sugar is, you know, like the bad guy there. Dr. Robert Lustig: There's another thing that affects most of those emulsifiers. So what are emulsifiers? Emulsifiers are compounds that hold fat and water together. They have a polar one end and a nonpolar other end. Mighty Pursuit: And this is put in packaged food. This is put in an ultra-processed package? For shelf life? Dr. Robert Lustig: For shelf life, right. To keep things from separating out. To keep the fat and the water together. So what is an emulsifier? It is a detergent. A detergent keeps fat and water together. Like Tide What you use in your clothes washer. Okay. You're swallowing it. When you eat ultra processed food, you're swallowing Tide. So what do you think that detergent is going to do on the inside of your intestine? It's going to chew it up. And so it causes all of these problems with the intestine too, the inflammatory bowel disease, the irritable bowel syndrome, the leaky gut, etc. So what I've just described are the ways that ultra-processed food inhibits metabolism and promotes inflammation. Now the question is does real food do that? No real food works. Processed food doesn't. But processed food makes the food industry money. And what we have to understand is that that's the knife edge. Mighty Pursuit: So, obviously obesity has become one of the most controversial issues in our culture today. Obviously, that has to do more with, from a social justice standpoint, the way that larger people are treated in our society. Fat shaming, all that stuff. But one of the most interesting things, as we kind of talk about fat in the role of our health, from a esthetic standpoint, how big you are, or how much fat you have is not necessarily indicator of your metabolic health, which is kind of mind blowing because that's just not what people think. And so, can you explain why that is specifically related to subcutaneous fat and then versus visceral fat? Dr. Robert Lustig: Sure, sure. Yeah. So I don't know if you saw it, but just this past weekend, there was this big New York Times article on a lady who's a fat activist. By the name of Virginia Sole-Smith. Okay. And her message is a good one in that fat shaming has to stop. And I completely agree with that. Mighty Pursuit: Yeah, 100%. Dr. Robert Lustig: 100%. Fat shaming has to stop. Fat shaming is inappropriate. Because this is not a personal responsibility issue. I already explained that. This is a biochemical drive based on all of these environmental obesogens that people are exposed to, whether they like it or not. Okay. So the idea of denigrating someone because they carry extra pounds is anathema to me. And I spent my entire career battling this in my obesity clinic. And I am completely, completely in the corner of the notion of fat acceptance. But. There's a but. Big but. Fat acceptance and health acceptance are two different things. Now you can be fat and healthy. You can be thin and sick. Just because you're fat doesn't mean you're sick. And just because you're thin doesn't mean you're healthy. And there are plenty of thin sick people calling the fat healthy people the problem. And that's not okay either. All right now, Virginia Sole-Smith lets her kids eat chocolate before dinner. Because she says there's value to every food. Donuts and kale are the same. Mighty Pursuit: Well, based on everything we talked... Dr. Robert Lustig: I think not. I think not. They are metabolically very different for all the reasons that we've already discussed. And I don't care how much someone weighs. I care if someone's healthy. I'm a doctor. My job is to help people be healthy. Unfortunately, the message of Miss Sole-Smith is it doesn't matter. Oh, it matters a lot. So that's not okay. And so that's the point I want to make to your audience is it's fine if you carry a few extra pounds. So the question is, which few extra pounds can you carry? There are three fat depots. And people have to understand the difference between the three fat depots. When you stand on the scale, you're measuring all three fat depots together. That's irrelevant. That's the worst way to figure this out. Never stand on a scale. I agree with that. That's what Virginia Sole-Smith says, never stand on a scale. I actually agree with that. Dr. Robert Lustig: And the reason is because you can't discern the contribution of the three fat depots by doing that. Okay. So let's talk about these three fat depots so that your audience will get it. And what to do. All right. The first fat depot. The obvious one. Subcutaneous fat. Big butt fat. The fat as in does this bathing suit make me look fat, fat? Pro-tip never answer that question. Get you in a lot of trouble. Mighty Pursuit: So that's what people outwardly see? Dr. Robert Lustig: Outwardly. The fat you can see. That's subcutaneous fat. The fat you can see. Turns out that fat may be cosmetically undesirable, but from a metabolic standpoint, it is inert. It's where your body wants to put excess energy. Because it is metabolically inert. It's not going to hurt you. This is the reason we have people who are metabolically healthy obese. MHO, metabolically healthy obese. They have increased subcutaneous fat. Now different races tend to accumulate different amounts of subcutaneous fat. So people always say a BMI of 30. That's the cutoff for obesity. Well, that's the BMI cutoff for obesity for Caucasians. For African-Americans, it's a BMI of 35. For Asians, it's a BMI of 25. Because they carry different amounts of subcutaneous fat. The subcutaneous fat is not the problem. So how many pounds are kilos of subcutaneous fat do you have to accumulate before you actually start manifesting metabolic illness? Mighty Pursuit: 20? Dr. Robert Lustig: About 20, 22, 25, in that ballpark somewhere. Okay and the reason is because of the fat vacuole. The place in this is in the adipose tissue cell. Expands, expands. You know, you're forcing more fat as it gets bigger, bigger, bigger. Until finally the paralympian border that circles that back vacuole finally breaks down, the fat dumps into the cell, chokes off the cell. Cell dies, recruits macrophages, inflammatory cells into the fat to clean off the grease. Those macrophages then release cytokines which go to the liver through the systemic circulation in order to generate insulin resistance and the start of metabolic disease. But they have to go through the systemic circulation because the drainage of the subcutaneous fat is the general circulation, the systemic circulation. And how big is the systemic circulation? Six liters of blood. So it's the cytokines in six liters. Dr. Robert Lustig: Second fat depot, the visceral fat, the big belly fat. Now it turns out the big belly fat has nothing to do with food. The big belly fat has to do with stress. Stress. Now, how do we know this? Because you can take people who are clinically depressed with major depressive disorder, who have to be hospitalized for suicidal ideation, who have to be kept from themselves. By admitting them to the hospitals so they don't commit suicide. You stick them in a scanner and their subcutaneous fat is going down because they're not eating, because they're hedonic, they're basically not eating, but their visceral fat is increasing. Because their cortisol levels are high. And anything that drives cortisol up will drive your visceral fat up. So visceral fat is not related to food per se. So how many pounds of visceral fat do you have to store before you start getting sick? Mighty Pursuit: About 4 pounds. Dr. Robert Lustig: Four, maybe five. Mighty Pursuit: So significantly less. Dr. Robert Lustig: Significantly less than 22. Dr. Robert Lustig: And why? Because 4 pounds only has to drain into the portal vein to be carried to the liver. Now the systemic circulation. Six liters. But the portal circulation is only about 250 cc's. So that's 24 times smaller. So the concentration is going to go up a lot faster. So your liver is going to get sick a lot sooner. So you can't store much visceral fat before you get sick. But it's stress that caused it. Dr. Robert Lustig:Fat depot number three. Liver fat. That's where the action is because that's where the problem lies. And so how many fat pounds or kilos of fat can your liver stored before it gets sick. Mighty Pursuit: Probably even less. Dr. Robert Lustig: Half a pound. Can you measure half a pound of scale? Mighty Pursuit: Not really. It's very little. Dr. Robert Lustig: So that's why 45% of Americans have fatty liver disease and don't know it. Don't know it. Because they can't see it on the scale. The doctor didn't tell him. Mighty Pursuit: One of the things that confused me when I was reading your book, and just the literature on this subject is so if you said something like 20% of people that are quote unquote, whatever fat or obese, are metabolically healthy, right? And you said one way of measuring this is how large waist is proportionate to your height. Correct? And so it would seem to me that like people that are obese almost universally all have large waist size. Dr. Robert Lustig: Not automatically. Mighty Pursuit: Can you explain to me how that works? Dr. Robert Lustig: A lot of them do. But not all of them. Okay. There, some who don't. Fat and fit. I mean, there are people who work out like crazy and keep their waist circumference down. It's not automatic. It happens to be true that a lot of people who are stressed eat a lot. So the stress will cause the visceral fat and the eating will cause the subcutaneous fat. And so they co-migrate together. That's true. But not automatically. Mighty Pursuit: And then on the polar opposite side, obviously, you wrote "your body defends it's subcutaneous fat because that's the fat that makes leptin. And your body, really your brain, knows it's good for you." And so there is an obsession, especially with the case of bodybuilders, like, you know, 2%, 3% body fat is that? Is it unhealthy to have that low level of fat deposits in the body or no, not really? Dr. Robert Lustig: No, it's not unhealthy. Now there is a disease of too little fat. Bodybuilders don't have it. But there is a disease of too little fat called lipodystrophy. Mighty Pursuit: Yeah, you talked about that in Metabolical. Dr. Robert Lustig: HIV medicines tend to cause lipodystrophy, but they're congenital lipo dystrophies that as a pediatric endocrinologist I would take care of. And they don't make enough fat. They don't have the subcutaneous tissue to call upon to put extra energy in. Which means that they have to find other places for extra energy, like for instance, ectopic fat where it doesn't belong, like the viscera and also like the liver and also like the heart. And these patients have the worst metabolic syndrome of anybody because they don't have any place to put the fat except in bad places. And so they get diabetes like that, and they need thousands of units of insulin to bring their blood glucose down, and they die early. That's not a good thing to have. Okay. So too little fat is actually worse than too much. Mighty Pursuit: So I wanted to, briefly talk about you had two components to the definition of healthy, protect the liver, feed the gut -- Dr. Robert Lustig: And support the brain. It's another one that we added after Metabolical. I knew about it when we wrote Metabolical, but adding three was, like too much. The book was already too large.

THE "CURE" TO CHRONIC DISEASE

Mighty Pursuit: Probably the most surprising, shocking discovery that I found from your work, which really is just wild when we're talking about Big Pharma and all this stuff is, I wouldn't call it "the cure", but there's these eight subcellular processes that underlie all chronic conditions. And so the processes aren't negative or positive just by themselves, but like they can become a positive for you if they're working right. But then they can be a big negative. So can you just give a brief overview of these processes? Dr. Robert Lustig: So in Metabolical, I basically say that it's not about obesity. Obesity is a marker for the problem. It's not the problem itself. Well what is the problem? The problem is chronic metabolic disease. The problem is dysfunctional metabolic health. That's the problem. And I divide chronic metabolic disease into eight subcellular phenomena that go on every day in every cell. The question is how well do you handle those eight as to how healthy or sick you are. So when you handle these eight right, you will be 110 playing tennis. When you handle these eight wrong, you'll be 40 years old in the emergency room with two stumps on dialysis waiting for your next stroke. Your choice. Anything in-between too. So these eight matter. Dr. Robert Lustig: So what are the eight? We don't have time for all the science. So I'm going to give you a car analogy. You like cars. Okay. Every one of us. Okay. Has been gifted by God a brand new shiny red Ferrari. One problem. Two problems. No insurance policy and no owner's manual. Your job is to take that shiny red Ferrari and keep it brand spanking new, lest it become a jalopy. That's the analogy. So how do you keep a Ferrari running in tip top shape? Well, you have to do preventative maintenance. So what's preventative maintenance for your body? It is these eight phenomena. Dr. Robert Lustig: So these are eight sub-cellular pathologies. And I list them in the book. First glycation the binding of glucose or fructose to proteins that causes damage. You want to limit that. In car terms that would be like carbon deposits on your intake manifold. Number two. Rusting. Body or chassis. You're Rusting. I'm Rusting. We're rusting as we speak. Iron's doing it. Other chemicals are doing it. And the more you rust, the quicker you're a jalopy. Number three mitochondrial dysfunction. That would be like a defective transmission. Okay. You hit the gas and you can't move. Not responding. Number four. Insulin resistance. That'd be like a sticky carburetor. Going, vroom, vroom. But you're actually coming up putt-putt. Dr. Robert Lustig: Number five. Okay. Membrane stability. That would be like, clogged oil lines. Number six would be inflammation. That'd be rotted oil lines that catch fire underneath the hood. Number seven methylation. That would be like defective spark plugs. So instead of running on a V8, you're running on a V2. And finally number eight, autophagy. That would be like oil sludge. Okay, so that's something I hopefully your audience can identify with. If you want your Ferrari to run in tip top shape, you got to take care of all those eight. Well, if you want your body to run in tip-top shape, you have to take care of all those eight also. Mighty Pursuit: Yeah. And what I want people to really get because this is amazing because you called all eight of these processes "nutrient sensing". And so what's so crazy about our society is like they are nutrient sensing so they're foodable, not druggable as you talked about. And so we're spending all our money producing drugs because obviously that produces profits for Big Pharma. And we're not really focusing on real food, but the actual natural food in the environment, that is not kind of manipulated or altered in all the ways that we really talked about, helps these processes. And to your analogy keeps it in tip-top shape. Mighty Pursuit:And so I think what's confusing for people, obviously, is if we're wanting to keep these processes in tip-top shape and really optimize them, obviously you talked about prevention. About 2.5% of the health care budget in America goes to prevention, and 97.5% of the healthcare budget goes towards treatment. And so I think that like if I were to go to the average doctor, these things are not going to come up in a conversation, even though it's established science. And the average doctor's visit is kind of like clockwork. It's like I go there... and this actually happened with my SIBO, which is just like, "okay, I'm going to give you this drug." And like we just said they're not, they're not druggable. And so how would you suggest for the audience if they're approaching these eight processes in their health as a whole, to view the medical community, doctors in terms of tackling these things, right? Dr. Robert Lustig: Everything you said. Matthew is exactly right. Okay. I don't have any qualifications for what you just said. You got it exactly right to a tee. Medicine's broken. Medicine is broken and it's broken because of chronic metabolic disease. And it's because doctors never learned this. Your doctor doesn't know it. They know prescriptions and procedures because that's what they were taught. I know because I'm a doctor. I know what I was taught. Okay. I realized somewhere along the way that something was wrong. Okay. But it was research that brought me. It wasn't somebody telling me. It was the fact that the data wasn't coming out the way that it was supposed to. And the reason was because the precept was wrong. So how are you going to explain that to a regular doctor? They don't know. And they weren't trained. So expecting your doctor to help you with chronic metabolic diseases is the blind leading the blind. Now can your doctor be retrained? Yes. Do they want to be retrained? Probably not. Dr. Robert Lustig: Could the medical profession force them? You know, in San Francisco, in California, we had a mandate, we had to do 12 hours of palliative care. Everybody. Didn't matter what job they had. Had to do 12 hours of palliative care. Could we mandate everybody in New York state or any state for that matter, to have to do 12 hours of nutrition? In order to keep their license? Could we do that? Yeah, we could. Do we need to teach it in medical school? Of course we do. Okay. Today, 28% of medical schools have nutrition curricula, and those that do have a total of 19.6 contact hours median. Mighty Pursuit: 28%?! Dr. Robert Lustig: Out of the entire medical -- Mighty Pursuit: 28% and we just described these eight processes that are nutrient sensing. Dr. Robert Lustig: Right. Now you got it. That's right. And those that do have it, I mean, they're basically getting, like, nothing. Okay. So the way I look at it is 19.6 contact hours. I mean, a standard medical education is about 6000 contact hours. Okay. 19.6 contact hours to solve 75% of health care costs. Seems a little lopsided. Maybe we should be spending a little more time on prevention. Nutrition slash prevention. I think so. But, you know, the medical schools aren't going to think so, they got a lot of stuff to teach. Should medical school be five years instead of four years so that you can get all this in? I don't know. These are hard questions. These require some big thinkers at the table as to how we're going to do this. But to expect your doctor today to be able to actually figure this out for you is a friggin' joke. Mighty Pursuit: And I want to be clear with this, because if there's a doctor listening to this or whatever a clinical doctor, we talked about obviously modern medicine is very effective with surgery, it's effective with the acute diseases. Dr. Robert Lustig: Yeah, the acute stuff. Mighty Pursuit: So that stuff works. But when it comes to chronic disease, I also don't want to paint it like no one's making breakthroughs. So can you talk about functional medicine? And if you do have a functional doctor in your area or you can connect with them how they might aid this process of those eight sub-cellular processes. Dr. Robert Lustig: So there are these two medical subspecialties that the ivory tower medicine people call cults. But they're not. They're not cults that have sprung up around this issue to try to help the population. One is called integrative medicine, it was founded by Andrew Weil, and the other is functional medicine. I don't know who founded it, but Mark Hyman is one of the biggest proponents of it. He's a good friend. Andrew Weil is a good friend. They're both good friends. I love them both. So what's the difference between the two? Integrative medicine is primarily a holistic approach to the patient as opposed to systems based. And functional medicine is specifically looking for the root cause. And that's a good thing to do. I'm for the root cause. But what they often do is they tend to want to treat that root cause with supplements. And I don't know that that's necessarily the right thing to do. So yeah, that's where I sort of get off the train. Mighty Pursuit: Instead of food, you mean? Dr. Robert Lustig: Well, they believe in real food, but they think that supplements will basically help solve it. And I'm not sure that that's actually needed or the case. So I am neither a holistic medicine doctor or a functional medicine doctor, but I believe in the precepts. Famously, Desmond Tutu said if you're fishing all these people out of the river, you have to figure out who's pushing them upstream. You have to go upstream to find the cause. And I believe in that. And that's what we're trying to do here. That's what we're trying to explain to people, is there are root causes for all these diseases. And the other thing is they are not fait accompli. Okay. Type two diabetes. The American Diabetes Association today will tell you that type two diabetes is a chronic progressive unrelenting disorder that is primary genetic that requires lifelong medication. Mighty Pursuit: Which is crazy. Dr. Robert Lustig: Every single thing I just said is a fallacy. Every one of them is wrong. You know, verifiably wrong. That's what the American Diabetes Association says today. And in the Guardian just last week and the week before, there is now a series by Neil Barsky, outing the American Diabetes Association and by the way Diabetes UK while we're at it. And I'm going over there in two weeks we're going to take them friggin' apart. As far as I'm concerned, these organizations need to fold. They are actually doing harm. They're not doing well. Because they are telling people, they are giving disinformation. They're not telling people what the real story is. Dr. Robert Lustig: So when you have dark forces. And the reason, of course, is Big Pharma, because Big Pharma underwrites their entire budget for both of those. Because it works for them. So when you've got these dark forces working to basically alter the corporate determinants of health. And that's what this is, how do you battle against it? How did we do it for tobacco? How did we do it for opioids? How did we do it for alcohol? How are we going to do it for sugar? You know, these are the questions that I spend my time working on. Mighty Pursuit: I want to land on that in a second. So as we kind of close the conversation, I don't want people to come away with the assumption that if you get one of these chronic diseases, there are other reasons why you could get one of them, which Peter Attia talks about. His book, the whole crux of his book. And, I think if people are looking to optimize their health, I think obviously they look to exercise, which you're a big proponent of as well. Dr. Robert Lustig: I'm a huge proponent of exercise. Just know that exercise, of those eight substitute pathologies, exercise only helps four of them. Mighty Pursuit: So I wanted to clear something up. So in his book he wrote, "nutritional interventions can be powerful tools which restore someone's metabolic equilibrium and reduce the risk of chronic disease. But can they extend and improve lifespan and healthspan almost magically, the way that exercise does? I'm no longer convinced that they can." And so why does there seem to be a little dissension in terms of the hierarchy of importance in terms of food, nutrition, exercise, obviously everything is good. Dr. Robert Lustig: They're both important. The question is which one's more important. So it's funny you should mention this, in November, so almost six months ago now I participated in an academic debate. Oxford style rules. In Irvine, California, with my good friend and colleague, Dr. Dan Cooper, who is head of pulmonary physiology at UC Irvine Children's. And he is a big exercise researcher. And so the debate was between him and me. Is it the food or the fitness? And we laid out our arguments for 25 minutes each with rebuttal and judging. I wish I had the slide set with you, and I could take you through it. But the bottom line is that the hazard risk ratio for nutrition is 0.65. In other words, you reduce your risk for disease by 35%. For nutrition. And the hazard risk ratio for exercise is 0.75. In other words, you reduce it by 25%. So they're both good. But in fact, nutrition actually does a little bit better. And I think the reason is because nutrition solves all eight of those pathologies. And exercise only solves four of them. So I'm for exercise. But you cannot outrun a bad diet. Mighty Pursuit: Yeah. That's important. Yeah. So as we close obviously there's two aspects of this conversation. So how to kind of take your health into your own hands. People are like, don't WebMD your symptoms or stuff like that. I don't know what your opinion on that is. Dr. Robert Lustig: You know, I am not for WebMD.

TAKING CONTROL OF YOUR HEALTH

Mighty Pursuit: Okay. So when this is the climate of medicine and when we're facing the food industry, we're facing processed food everywhere. What is the step towards taking your health into your own hands? And if you want to say, diagnosing yourself, whatever? Dr. Robert Lustig: Three words, eat real food. Eat real food. Now, the problem is people think Cheetos is food. If you think Cheetos is food, nothing is going to help you. That's a belief system. And you have to undo faulty belief systems. How do you do that? How do you change somebody's belief system? Well, they have to want it changed. We have learned that in order to break a belief system, somebody has to want their belief system broken. Okay, that's not everybody. So you're never going to be able to solve it for everybody. The question is when someone's vulnerable can you intervene and can you intervene with science? Can you intervene with stories that can help people alter their belief system so that they can actually benefit from it? The answer is absolutely. You can. In fact, that's what you're doing right now with this podcast. And why do you think I'm sitting here with you? For just that reason. To help that person. So yes, you can do it. But it's a slow process. Of course it is. Mighty Pursuit: So obviously taking the steps of changing the system, eliminating ultra-processed food, reducing sugar intake, obviously are obvious things that we've been talking about. And then kind of more a quick word on you said, "what's become clear is that different people have different metabolic responses to different foods. So one diet doesn't fit all." And so obviously we're talking about SIBO, all these different things. There's an aspect of personalization that might be required with these interventions now. Dr. Robert Lustig:So different people are going to need different things. So how can anybody know what it is they should do? We've developed a computer program that will be an app soon. It's called Perfect, I'd recommend it to your audience. Perfect.co And what it does, it's a recommendation engine that will actually take your grocery store apart based on the principles of metabolic health. It will only show you the items in your grocery store that are healthy for you. So you can stay away from all that crap. Yeah. So you can become metabolically healthier. Mighty Pursuit: There's so many things as we close obviously, when it comes to this idea of vegan or carnivore or whatever. And I think it's understanding that based on your own individual metabolic responses, obviously you might respond differently to something than somebody else, but eliminating the ultra-processed foods, reducing the sugar intake, all that stuff, you're eliminating all these factors up to off the bat. Dr. Robert Lustig: Get rid of the sugar. Add the fiber. Those are the two basic precepts to metabolic health. Sugar is hurting your mitochondria. Fiber suppresses inflammation. You get both in real food. That's what real food is, is low sugar, high fiber. Processed foods are high in sugar, low in fiber. We have developed a proprietary fiber to help process food behave in the intestine like real food. It's called Biolumen. The product name is Munch Munch. You can find it online. MunchMunch.shop. And what it does is it's a micro cellulose sponge that soaks up glucose, fructose, sucrose, simple starches in the intestine, rendering them unavailable for early absorption, thus keeping your glucose down, keeping your insulin down, protecting your liver, and moving the food through the intestine faster so that you get the satiety signals sooner and the microbiome chews up all that carbohydrate for its own purposes, thus feeding the gut. Generating short chain fatty acids, which are anti-inflammatory, thus supporting the brain. In other words, we have turned the apple juice back into apples in the intestine. A new way to try to mitigate the metabolic burden of ultra-processed food. Mighty Pursuit: That's incredible. Well Robert, thank you for your time today. Appreciate the conversation. And I think it will really help a lot of people. Dr. Robert Lustig:I hope so.

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