General

Podcast #14 – Dr. Robert Lustig —

August 14, 2021

In the fifteenth episode of the Health podcast (which you can subscribe to via iTunes or RSS), we are joined by Dr. Robert Lustig, a pediatric endocrinologist at the University of California, San Francisco, and author of Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease. Dr. Lustig discusses his research on sugar, insulin, and childhood obesity, starting with the work in rats that first brought his research into the public eye. His message: Our diet is way too sweet, and it is causing serious health problems.

In the final episode of Every Voice, we talk to Dr. Robert Lustig , a professor of pediatrics at the University of California, San Francisco (UCSF) and director of the UCSF Center for Child Nutrition . Dr. Lustig ‘s research on sugar and fat has helped shape the obesity epidemic, and he’s also the author of a new book, Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease .

Dr. Robert Lustig is Professor of Pediatrics in the Division of Endocrinology at the University of California, San Francisco, and he is the author of the book, Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease, which exposes the health dangers of high fructose corn syrup and other forms of sugar. Dr. Lustig has become well known for his advocacy of sugar and obesity as well as for his efforts to educate the public about the risks of obesity and obesity-related diseases.

He’s spent his whole life battling juvenile obesity and researching the CNS control of energy balance. But, since this is blown up in front of his eyes, he understands it’s more than science that’s influencing it. As a result of his practice, he has seen the obesity and diabetes pandemic. And he’s recognized that it’ll take more than research to stop and reverse this trend; it’ll require public policy.

And that’s what makes it such an interesting discussion: he has such a broad understanding of the history of public policies, analogous scenarios of public policy, and how we can use that knowledge to try and help us stem this epidemic that we’re in the middle of, and what we can define as the possible causes: fructose, glucose, sucrose, sugar, all these terms get thrown around as if they’re synonymous.

We’ll speak about it a little bit to figure out the details, as well as processed food and how that plays into it, as well as so-called healthy natural fruit juices. So I really liked this conversation with Robert because he has such a good understanding of both science and public policy and how to assist us create a roadmap for getting out of this and turning it around.

So I really hope you like this conversation, and he’ll mention the many methods to contact him at the conclusion. He works for for-profits and nonprofits, and he’s authored a number of books, so stay tuned until the end to learn about all the things he’s engaged in, and if you want to hear more, there’s a lot more he has to say and create that is well worth reading and listening to. So sit back and enjoy this conversation with Dr. Robert Lustig.

Thank you very much, Dr. Lustig, for joining me on the DietDoctor podcast today.

Robert Lustig, M.D. : It’s my pleasure, but you’re dealing with Rob.

Rob, you got it, thank you. Bret: Rob, you got it, thank you. As a pediatric endocrinologist, you’ve watched this pandemic grow right in front of your eyes. It’s one thing for me to observe diabetes in adults and the repercussions that occur in their 50s, 60s, and 70s, as I’ve already said. But to see it in a juvenile population with type 2 diabetes and now nonalcoholic fatty liver disease, I mean, this had to be terrible to watch in children, and you’ve seen it explode.

Robert: I mean, I got into pediatrics to avoid chronic illness, and that’s all I do today. I started into pediatric endocrinology to help small children, but they grew to be obese on me. Instead of growing vertically, they grew horizontally. And that all occurred while I was watching. And, you know, they keep pouring in, and for every patient I see, ten more are on my doorway. Something isn’t right.

Of course, everyone is aware that something is wrong, but everyone seems to have a different explanation for what is wrong, and we are unable to connect the dots.

Bret: And that’s what’s really slowed things down. We can’t make any progress because of all of these various voices, ideas, and lack of a unified strategy.

Robert: Furthermore, some of the participants in this debate have a financial interest in it. As a result, there are dark forces working to preserve the current quo.

Bret: Please elaborate on it.

Robert: We could go on for hours, but the truth remains that the food business has a vested interest and, like tobacco, has gone to great lengths to protect it. Marion Nestle’s new book, Unsavory Truth, was just published this week.

My colleagues Aseem Malhotra and Grant Schofield and I wrote an essay earlier this year arguing that fighting obesity and type 2 diabetes with research alone is insufficient. First and foremost, entrenched interests’ opposition must be addressed. So now we know who’s on the other side of the fence. The issue is that the other side has a very big mouthpiece and a lot of money.

Bret: Right, a lot more money than scientists, institutions, and doctors, definitely as individuals, and even when grouped together.

So we’re trying our best. Robert: The good news is that we have the science, and it is extremely powerful, but not everyone is a scientist. Even scientists aren’t always scientists.

Bret: Your own track record suggests that fructose is the most serious issue.

Robert: I’m not going to say that, and I’m not going to say it’s the most pressing issue. Trans fats were previously the main source of concern. But we found it out, and it only took us 25 years to figure it out and get rid of it.

Bret: That demonstrates how slowly the needle on these moves.

Robert: Because there were also evil powers present. Now, I believe that sugar is not the cause of obesity, diabetes, or fatty liver disease, but it is the simplest to attack and target upfront because it is the most pliable, the low hanging fruit, and the one that is added to other foods especially for the food industry’s objectives.

Bret: Do you believe it is more essential to target sugar or to distinguish between fructose, glucose, and sucrose and break it down?

Robert: To tell you the truth, they’re the same thing. The food industry will tell you 11 ways from Sunday that a sugar is a sugar once you grasp what these distinct molecules, glucose and fructose, do in the body. It’s totally erroneous, and it’s also deceptive.

Glucose and fructose are not treated in the same way. Sucrose, high fructose corn syrup, agave, maple syrup, and honey are all made up of half glucose and half fructose, as it turns out. Glucose is now the life’s energy, and every cell on the earth uses it for fuel. Because glucose is so essential, your body will produce it if you don’t eat it.

We know this because Inuit who ate whale blubber, never saw a slice of bread, and never grew a strand of wheat had a blood glucose level. Vilhjalmur Stefansson and his aide, the renowned Arctic explorer, checked into Bellevue in 1928 and spent a year on their clinical study center eating nothing but beef. They still had a serum glucose level, but they were a lot healthier than the rest of the group.

Bret: That’s right.

Robert: So the idea that you need sugar to survive, or even glucose to live, is false. True, blood glucose is required for survival; but, food glucose is not required. Because it is critical that your liver survives. It will create it out of amino acids or fatty acids, depending on the situation. So, although glucose is necessary, it is not necessary to consume it.

Fructose, on the other hand, is not required for any metabolic process in any eukaryotic cell. It’s totally inert, and when eaten in large quantities, it performs three functions that glucose does not. One, it accelerates the formation of liver fat quicker than almost any other substance on the world. Second, it participates in the Maillard or agent reaction.

Now, glucose can do that, but fructose can do it seven times quicker, and it turns out that there is a fructose metabolite that can do it 250 times faster, which we’re working on. And, number three, fructose, rather than glucose, activates the brain’s reward center, therefore we have evidence that the fructose molecule in sugar is what makes it addictive.

Bret: Is it, therefore, addictive? Does it fit the definition of addiction and, as a result, should it be controlled as a potentially addictive substance?

Robert: To begin with, addictive drugs are not self-regulatory; otherwise, Starbucks would be out of business. And if you take away my Starbucks, I’ll murder you, okay? That is my compulsion. I’m not proud of it, but for the time being, it’s socially acceptable.

Bret: How many have you had so far today?

Robert: I’m down to three, and I’m in desperate need of a fourth. As a result, the fact that it is addictive is not a justification for regulation. When something is poisonous, addicting, and pervasive, as well as having negative social consequences, it fulfills the public health requirements for regulation. Sugar, in reality, satisfies those requirements. So, how does sugar become addictive? Sugar was not addictive in 2012. Sugar was addictive in 2013.

Bret: What’s the difference between the two?

So, what has changed? Robert: What happened to sugar? No, the definition has been altered. The American Psychiatric Association is the umpire that calls the balls and strikes when it comes to issues such as addiction. They also had to include gambling as a kind of addiction. It became apparent that behavioral addictions went through the same CNS process as chemical addictions, produced the same difficulties, and had to be treated in the same manner.

Up until 2013, the DSM-4 said that addiction required two factors. Tolerance and withdrawal were required. The impact of these drugs on the downregulation of dopamine receptors is known as tolerance.

Bret: That’s why, as time goes on, you’ll need more and more–

Robert: Tolerance is a phenomena where you do more and less to receive less and less. The APA went on to say that the second criteria for addiction was withdrawal. It turns out that withdrawal, which is true for all chemical addictive drugs, is a systemic impact that affects the body rather than the brain. Caffeine withdrawal affects the heart, vasculature, sweat glands, and other organs. Opioids affect the gastrointestinal system, the heart, and other organs.

They all have these noticeable side effects that lead to withdrawal. Now, gambling is not a chemical, and it has no effect on the body, but it does have an effect on the mind. The American Psychiatric Association has to alter its definition in order to offer therapeutic services within an addiction paradigm.

So, when the DSM-5 was released in 2013, the definition might have been tolerance and withdrawal or tolerance and dependence, as it is every 20 years. We don’t have time to go through each of the nine criteria for dependency… You can look them up on the internet.

And guess what? Gambling, gaming disorder, social networking, shopping, and pornography all have something in common with them. Sugar interacts with all of them. So there are behavioral addictions as well as chemical addictions. Sugar, on the other hand, is a chemical that causes both tolerance and dependency. Whoever says, “Oh, I have a terrible sweet tooth”… They have a sugar addiction.

Bret: Is understanding this, however, sufficient to alter public policy or people? Changing people’s actions and choices on their own is clearly insufficient. So, what more must be in place before we can declare, “This is a public health catastrophe that requires intervention.”

Robert: We’ll look at two different templates. Tobacco and alcohol are both harmful to one’s health. As a result, smoking was considered a liberty interest for many years. You were allowed to smoke because you had a liberty interest in doing so. A landmark New York State Supreme Court decision, Boreali v. Axelrod, said that you have a liberty interest in smoking, and you know what?

The New York state government, seeing the issue and realizing the tobacco industry’s deception, passed legislation prohibiting smoking in bars, atria, restaurants, schools, hospitals, and now even in cars with children.

And the problem is, people were screaming, “Nanny state, nanny state” when it first came out. That is no longer the case.

Bret: Part of it is due to the fact that “I’m smoking here, I’m going to influence you.”

Robert: That’s right.

Bret: I’m sipping my Coca-Cola right now, so don’t worry about it.

Yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes

Bret: What do you mean?

Robert: In terms of money. Since if I need to go to the emergency department, I won’t be able to get in because there will be gurneys full of patients waiting for their coronary bypasses or TPAs due to sugar beverage-related heart disease. And there won’t be enough money in the system to allow me to get health care in the first place.

Because of this, Medicare will be bankrupt by 2026, and Social Security will be bankrupt by 2034. While it is not an attack on your person in the same way that cigarettes or alcohol are in terms of automobile accidents, it is an assault on your person in terms of your finances. You might argue that this isn’t the same thing, but the reality remains that we must deal with it in the same way.

Bret: You’re right, our culture isn’t very adept at anticipating the next step. We’re great at seeing what’s going on right now–

Robert: It’s because we’re all hooked to something. Addiction is concerned with the now, while pleasure is concerned with the future. It’s all about making life better for the future. We are reward-oriented, not happiness-oriented; we choose immediate pleasure over delayed fulfillment.

Now, we physicians understand the concept of delayed gratification since we went through medical school, residency, fellowships, and other programs where we postponed seeing any money or providing patient care on our own for 10, 15, and sometimes even 20 years. We are experts on the subject of delayed gratification. The American public, on the other hand, does not.

Bret: And a lot of it has to do with industry and the options that have been placed in front of us. And we live in an on-demand culture, where we want immediate satisfaction, and that isn’t going to be simple to change.

Robert: 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, <i>The Hacking of the American Mind</i>; 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, without a doubt; they can sell you your reward; they can offer you instant satisfaction, without a doubt. “Are they selling you happiness?” you may wonder. And the truth is that they are really robbing you of your pleasure. So, what is the difference between the words pleasure and happiness?

To begin with, pleasure is fleeting, while happiness lasts a lifetime. Two, like all of other drugs with systemic effects, pleasure is visceral; you experience it in your body. Happiness has an airy quality to it; you can feel it above your neck. Pleasure is a taker, but happiness is a giver. Happiness is typically experienced in social groupings, while pleasure is usually experienced alone.

Pleasure may be obtained via drugs, but happiness cannot be obtained by substances. Extreme pleasure, whether in the form of drugs or activities… Substances such as cocaine, alcohol, nicotine, opiates, heroin, and sugar, as well as activities such as shopping, gambling, the Internet, social media, and pornography are examples. All of these things, taken to their logical conclusion, lead to addiction. Every one of them has a “-aholic” next to it. You know, shopaholic, sexaholic, alcoholic, chocoholic, and so forth.

Bret: There is no such thing as a “happyaholic.”

Robert: There is no such thing as a “happyaholic.” There is no such thing as too much happiness; it does not exist. Finally, serotonin, which is the dopamine bliss of pleasure, is number seven. Why should we care now? What difference does it make? This is why. Dopamine is a neurotransmitter that stimulates the brain. Dopamine crosses the synapse, attaches to its receptors on the next neuron, the neuron fires, and stimulates the next neuron every time it is released.

Neurons like being stimulated, which is why they have receptors. They like to be tickled rather than bludgeoned. Neuronal cell death is caused by chronic overstimulation of any neuron in the body. And we know this because children with long-term seizure disorders and status epilepticus must be brought to the ICU and their seizures must be stopped. Because the longer the seizures last, the more damage is done to the brain. As a result, we take note.

That second dopamine-receiving neuron doesn’t want to die; instead, it wants to defend itself. As a result, it features a failsafe and a backup plan. It works by reducing the number of receptors so that every given molecule of dopamine has a lower statistical probability of finding a receptor according to the law of mass action.

Bret: You’re correct.

Robert: 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 is what tolerance is all about. Then comes addiction, which occurs when the neurons begin to die. What’s more, guess what? Those neurons aren’t coming back after they’ve died. That is why addiction is so difficult to overcome.

Bret: And so, when we’re talking about sugar, you said that fructose has a higher level of addiction than glucose.

Robert: So fructose particularly activates the reward center, the nucleus accumbens, that portion of the limbic brain, when you conduct fMRI studies, and one of those studies was done by your previous guest, David Ludwig, and Cara Ebbeling, while glucose does not. Glucose is now a bit sweeter.

Glucose has a sweetness value of 74, while sucrose has a sweetness level of 100 and fructose has a sweetness index of 173. The cortex, the basal ganglia, and certain other regions of the brain are activated by glucose, but not the limbic system. Fructose activates the limbic system, which has two distinct functions in the brain.

And everything that affects on the nucleus accumbens causes dopamine release, which may lead to addiction in severe cases. Choose your content and your mannerisms. It’s also done by fructose. And we have empirical evidence that this happens in people.

Bret: Is there, however, a threshold level since fruit contains fructose? You know that eating an apple does not activate the reward system. So, it comes down to absorption and fiber, but even if you’re receiving pure fructose, is there a limit below which you’re safe?

Robert: Yes, very certainly, and it likely depends on who you are, your hepatic metabolism, different phenomena that are occurring, and how insulin resistant you are. Let me offer you an example: in their liver fat transcription machinery, Latinos have a very unique two sets of polymorphisms, not 1, 2, in their liver.

PNPLA3 (Patatin-like Phospholipase Protein domain A3) and SLC16A11 (SLC16A11) are two proteins involved in the conversion of sugar to fat in the liver. And, if you had a poor genotype for each of them, Latinos seemed to have a higher frequency of those issue alleles in the Latino population for whatever reason. If you have them, a little sugar turns into a lot of liver fat, and if that’s the case, the more sugar you consume, the sicker you get, and the faster you become, if you understand.

Bret: Of course.

Robert: Another thing we know is that the brain has an allele called type 1A allele. And having this allelic variant means you produce 30% less dopamine receptors to begin with.

Bret: Wow, that’s fascinating.

Robert: In this scenario, more substrate and dopamine are required to occupy fewer receptors at baseline. Which implies you’ll have to consume a lot more sugar to get any enjoyment out of it. And such individuals have been found to acquire weight and develop insulin resistance at a quicker pace than the general population.

Without a doubt, there are predisposing variables, some of which are hereditary, some of which are epigenetic, and some of which are very particularly environmental. It also depends on how much sugar and unhealthy food you’re exposed to. You have food deserts in lower SCS areas, and they are obviously the most vulnerable, as well as the ones pushing up health-care costs.

So, you’re aware that we have an issue. You must take care of the environment. So it isn’t simply genetic, but genetics have a part, and genetics can’t be fixed anyhow. So, let’s see what we can do. Let’s make the world a better place.

Bret: Yes, the amount that individuals are consuming is definitely causing substantial illness, regardless of your genetics.

Robert: Adult women should consume no more than 6 teaspoons of added sugar per day, or 25 grams, and adult males should consume no more than 9 teaspoons, or 37 and a half grams, according to statistics from the American Heart Association, which I signed on to. Today’s average weight in the United States is 94 grams. We would still be above our limit even if we reduced our usage by two-thirds.

Bret: Wow, and just for the record, how much cocaine is in a can?

Robert is 39 years old.

Bret: Okay, so that’s 39….

Robert: You’ve gone too far.

Bret: You’ve gone too far.

Robert: You’re done after one can of coke. You’ve completed the task.

Bret: Yes, and the size of coke cans has altered significantly as well. So that also affects the loudness and threshold effect?

Robert: Okay, so we’ve got the 20-ounce bottle now. Actually, it’s because of this issue that I’m trying to think of a marketing technique. Coke, as you may be aware, has released an 8-ounce can. Have a little coke, you know. Antman is really used to promote little amounts of cocaine. Look, anything that lowers consumption is a good thing.

The problem is, how do you do that on a large scale? How do you go about doing it for everyone? In the end, the only option is to reduce availability. This is the unbreakable rule of public health. You lower availability, which lowers consumption, which lowers health risks. The Iron Law of Public Health states that the availability of cigarettes and alcohol should be reduced.

You don’t want to outlaw it now, do you? It’s true that banning doesn’t work. You saw what happened when we tried it with booze. The 18th and 21st amendments were created as a result of this. That won’t happen again. To make it pain, you must first make it hurt. When you make anything accessible, it hurts. You make it more difficult to get efficiently.

So there’s the idea of soda taxes. I’m going to be completely honest with you. I believe in reducing and consuming as little as possible. I believe there is a far better, simpler, and more effective approach to address the problem of effective availability. Subsidies must be eliminated.

Bret: So, going back to the Nixon administration and his secretary Butz, and how they started this whole process to try to increase productivity and lower costs, which may have made sense at the time, but now, in a completely different environment, we’re stuck with the same subsidies with a completely different connotation of what they mean for our society.

Robert: For Nixon, that didn’t even make logic.

Bret: No, it didn’t work.

Robert: For Roosevelt, it made sense. It made sense for Franklin since we were dealing with two situations at the same time. In 1933, we had the Great Depression and the Dust Bowl. As a result, there was a homeless population in the American southwest. They were starving to death. And the issue was that all of the food and food businesses were located in the Northeast.

So, if you simply dumped the food on a train car and shipped it to the southwest, it would be rotten by the time it arrived. As a result, they had to process it. They had to essentially take the wheat, process it, remove the fiber, package it in 5-pound bags, and bake it locally. And subsidize it so that the American food sector sees the value in doing so.

And it made sense in 1933, and it made sense even throughout World War 2, but it stopped making sense after that, but people discovered, “Hey, I can make money with this.” So we doubled down, and then came Nixon, who had to deal with a lot of political turmoil. And he was well aware that food price fluctuations were a source of political instability. So he instructed Rusty Butz, his agricultural secretary, to make food cheap.

Butz stated three things: row by row, furrow by furrow, grow large or get out, whatever it takes to make food affordable. That’s exactly what he said. We had previously bribed farmers not to produce particular crops in order to artificially raise prices in their favor. That was approved by the boards. That was the last word on the subject. “We’re going to make it up in volume, and we’re going to subsidize those things to make them cheap,” he stated today.

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.

Bret: Right, and so many people’s lives rely on these subsidies today, and so much of our economy relies on these subsidies, and it seems to be too huge of an issue to solve, but if we think that way, this will continue to happen.

So we need to figure out a method to make the appropriate meals less costly, rather than the wrong foods, and to abandon the mono cropping civilization in favor of grasslands and rotational grazing, since we’re also killing the ecosystem. And I suppose that’s part of what prompted you to get your master’s degree in law and begin working in the policy and advocacy fields.

Robert: Right, I had two inquiries. For my master’s degree in law, I went to UC Hastings College of Law. I wasn’t attempting to get a JD, and I have no desire to practice law, but I do want to be able to communicate with them. As a result, I had to study their vocabulary. When I first started in 2012, I had two questions. When does a personal health problem turn into a public health emergency, and what legal theories support or contradict this? Especially when it comes to the Supreme Court.

Second, how did tobacco get away with it for the last 40 years? What was their game plan? Because, in the end, the food business follows the same script. So, if we research tobacco, we can figure out exactly what we should be doing here, and we are. I’m happy and proud of how things have progressed, and there have been changes. You can see the motions, but it takes some time.

Cultural tectonic changes don’t happen overnight, you know. Allow me to give you an example: In the past 30 years, the United States has seen four cultural tectonic changes. I’ll give them names: Helmets and seatbelts for cyclists, smoking in public areas, drunk driving, and condoms in restrooms are all issues that need to be addressed. If a politician stepped up in a statehouse or congress 30 years ago and proposed any of them, they would have been laughed out of town.

All of it was anathema… “Nanny State,” each and every one of them; nanny state, nanny state, nanny state, nanny state, nanny state, n They’re all realities of life nowadays. All of them are acceptable to us. In reality, it’s a case of click it or tick it, and if you find a child riding a bike without a helmet, contact the police. That’s when you should contact the police. It’s not like “gardening in the dark.” For the child who is riding without a helmet, call the police.

The point is that each of them needed public education first, which leveled the playing field and enabled for legislative and legal reforms. This is now happening with food. And we’re probably out of the 30 years, at around 7 years.

But, you know, it’s going to take a long; it’ll probably be another 20 years before we see any meaningful improvement. And I’ll tell you something: you’ve got what it takes. A generation is required. And do you know why a generation is required?

Bret: Unfortunately, people have to die.

Robert: That concludes Part A. The elderly who refuse to accept must die, and B, you must educate the young so that when they reach the age of 18, they may vote.

Robert: That’s how it works.

Bret: That’s correct.

So, we’re going to do it.

Bret: Yes, it’s an intriguing thing to ask, since that’s what’s going on. Where are the lines drawn? Because I used Coca-Cola as an example, it’s an obvious comparison, but what about freshly squeezed orange juice and all-natural fruit juice? Will they be safeguarded more than some of the other sugary beverages?

Nonetheless, they may all lead to the same issue. So part of it is figuring out where we’ll draw the line. And someone says we have to go after meat because epidemiological studies show that, therefore science is needed to help us make such choices.

Robert: You’re right. I couldn’t agree with you more. We need research to help us make those choices. The citrus farmers are enraged. They’re completely insane. They’re saying things like, “We didn’t add any sugar to our orange juice.” They didn’t, to be sure. They accomplish this by removing the fiber. When you remove the fiber from a fruit, what you’re left with is essentially a drink.

The reason for this is the fiber in the fruit, which comes in two types: soluble and insoluble. Soluble fibers, such as pectin or inulin, would keep jelly together, whereas insoluble fibers, such as cellulose, the stringy substance found in celery, would not. Fruit contains both. When you eat the entire fruit, you’re getting both soluble and insoluble fibers, which act together. They cause a gel to develop on the inside of your duodenum.

They build up the cellulose latticework after passing through the stomach. The soluble fiber, which is globular, coats the interior of the gut and subsequently plugs the gaps in the latticework. As a result, a secondary impermeable barrier forms, limiting the rate and quantity of monosaccharides absorbed from the duodenum into the portal vein, which transports them to the liver. As a result, you’re preserving your liver.

When you consume an orange, you avoid having to cope with the assault, the tsunami of monosaccharides that comes with orange juice. So the orange is all right. What happens if the rate of monosaccharide absorption in the duodenum is slowed? What happens to them? They keep traveling until they reach the jejunum.

What’s in the jejunum that the duodenum doesn’t have? The microbiome is a collection of microorganisms that live in So the duodenum has a pH of 1 because hydrochloric acid from the stomach, pancreatic juice, is secreted through the sphincter of Oddi, which is in the middle duodenum, and then it mixes with the chime, and the pH has gone from 1 to 7.4 by the time you reach the Treitz ligament, which is where the jejunum begins.

At pH 1, the bacteria can only travel back to pyloric and survive there, but at pH 7.4, they can all live. They’ve got to eat something, right? You have ten trillion cells in your body and a hundred trillion bacteria in your gut; they outnumber you by a factor of ten to one. Each of us is nothing more than a giant bag of germs with legs. They were able to consume some food. What do they consume, exactly? Are they going to eat what you eat?

How much did you receive in comparison to how much did they get? If you eat the fruit, such as an orange, you are nourishing your germs. So, despite the fact that you ingested it, you never received it. It was taken by the microbes. Now, all of these energy balance studies, all of these room calorimeter studies, all of these Kevin Hall studies will be slammed downstairs in a matter of minutes.

They’re all measuring the same thing. It is the bacterial unit of the human body. It isn’t the human’s fault. It’s impossible to determine whether the carbon dioxide originated from human or bacterial cellular activity.

Bret: That’s intriguing.

Robert: Those two are inextricably linked. So it doesn’t really matter because if you feed your bacteria, they’ll get healthy and you’ll have microbial variety. As the soluble fiber ferments farther down the colon, you get less cytokines and more short-chain fatty acids.

Fiber essentially implies that you’re providing food for your microorganisms. As a result, when you eat an orange, the fructose isn’t for you. It was for the sake of your microorganisms. As a result, I’m not too worried about fruit. Fruit juice worries me since the insoluble fiber has been eliminated.

Bret: So, although science says it’s the same, popular perception seems to be quite different. Is it going to make it a larger mountain to climb to overcome this, as it would in the case of a sugary beverage?

Robert: 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.

Bret: That’s correct.

Robert: Is it correct? Orange juice is good for you. “A day without orange juice is like a day without sunshine,” Anita Bryant remarked. You should probably take a medication. That is the issue. But, in the end, it must be science that triumphs. It does, however, take some time.

When we speak about teaching the public, especially a public that has been, shall we say, detached from science for a long time and has not been taught science in schools, nor has it been taught a scientific process, nor has it been taught scientific logical and scientific thinking. You should realize that this is a really difficult task.

Bret: You may mention all of them as they pertain to the general public. All of these may possibly be stated as they relate to doctors and some scientists.

Robert: I’m not going to argue.

Bret: And there have been films lately made in which a physician in a lab coat stared at the camera and said, “Sugar does not cause diabetes.”

Robert: Yes, Dr. Neal Barnard, I’d want to fight you in a duel. I’m going to call you out. I’ll meet you anywhere you want. We’ll leave our weapons at home and rely only on science to defeat you, and I’ll be the one to do it.

Bret: I was attempting to keep my identity a secret by not naming anyone, but evidently that’s not going to work here.

No, no, no, no, no, no, no, no, no, no, no, no I believe he has tainted America.

Bret: And it is a part of the issue. He has a name, he is well-liked in many areas, and hearing him make a remark like that is so perplexing to the American people.

Robert: You’re right.

Bret: So, in addition to battling external pressures and industry, we have to battle within ourselves, and that just makes it a–

Robert: Exactly. It makes it much more difficult. As a result, part of my duty, if you will, is to bring together the medical, dental, and nutritional professions to speak as one. The food business enjoys it when we get into fights with one another. It’s how they triumph. So here is Low-Carb USA, if we really were and can be unified.

I’ll be completely honest with you: I have nothing against low-carb or vegan diets. I honestly don’t think so. I have no animosity against any of them. The dogma is the only thing I have a problem with. That is something I have a lot of against.

Ornish has solid data that works, and I think it works, and the evidence backs it up, and you know what? When done correctly, low-carb, keto, and Atkins all work well. And the point is that there are many diets that are effective. You know how well the Mediterranean works.

Bret: Right, in what kind of lifestyle and in what kind of setting? Because Ornish’s research were part of a larger lifestyle program.

Robert: Without a doubt.

Bret: Mediterranean diet research focused on a specific Mediterranean lifestyle.

Robert: They may do it anywhere they want. I completely agree. The idea is that there is a diet for everyone, and it doesn’t matter where you go. It makes no difference to me whether you travel to Greenland and hunt for whale blubber. It makes no difference to me whether you travel to Africa and do the Masai, or if you speak about agricultural civilizations. I just don’t give a damn. It doesn’t matter.

The idea is that every healthy diet on the world is low in sugar and rich in fiber. Low sugar to keep your liver healthy and high fiber to keep your microbes happy. Processed foods have a high sugar content and a low fiber content. For palatability, there’s a lot of sugar, and there’s not a lot of fiber, so it lasts a long time It makes the food inexpensive, but it also makes it poisonous to eat.

Bret: So there’s a growing tide of a low-sugar, low-fiber diet, the all-meat carnivore diet, which according to anecdotal accounts is working extremely well for a lot of folks.

Robert: Insulin sensitivity will be improved. Insulin secretion will be reduced. In my clinic, I utilized low carb diets for patients who had severe insulin resistance and couldn’t be treated any other way. I’m aware that it works. That is why I am in favor of it. I didn’t say I was opposed to it. I’m in favor of it. But I’m also in favor of the other.

What’s more, you know what? People with hereditary hypercholesterolemia must diet differently. That depends on who you are, on your gene type, on the severity of your illness, on your family history, on your surroundings, and on a variety of other factors. The idea is that there is no one-size-fits-all solution.

There is now just one diet to follow. And the aim is to provide the appropriate diet to the appropriate individual at the appropriate time. But you can’t do that if everyone is on the same diet, and at my clinic, we separated individuals rather than lumping them together.

Bret: That’s a fantastic point, and even with a disease like familial hypercholesterolemia, you can’t necessarily group them all together, because if you have FH and he’s insulin resistant, pre diabetic, and has high inflammatory markers, you’re really cooking the pot for a poor result. You’ll have to deal with it as well, perhaps in a low-carb scenario.

Robert: The goal is to focus on the pathology. A physician’s motto is always to target the pathology. What do you target if you don’t know what the pathology is?

Bret: That brings us back to your lectures about metabolic syndrome, which you’re discussing at this conference. We have our own definition of the metabolic syndrome, which includes waist circumference and hypertension.

CARBage, Robert.

Bret: And you replied, “OK.” So, tell me more about it.

Robert: All of these are symptoms of metabolic malfunction. They’re all indicators of metabolic dysfunction, not causes. They do cluster together, there’s no denying it. Different individuals have different ones, and distinct ethnicities have different illness predispositions.

It’s because it’s not just one thing, but three. And I’ll tell you about it this morning. Obesity may be to blame. I’m not saying it won’t happen. However, I believe that this is one of the more uncommon causes of metabolic syndrome, rather than one of the most frequent. It can be from stress, since sad individuals lose weight but have metabolic syndrome, and visceral fat, and lastly, you can mainline it, fry your liver, and do so at a normal weight while also having metabolic syndrome.

So I believe there are three paths to get there, and I believe there are many foods that may either stop or add to behaviors, and I believe there are ways to parse those three paths in order to assist each individual cope with the issue that has created theirs. But if it’s a one-size-fits-all approach, it’ll never work.

Bret: Yes, that strategy appeals to me. Furthermore, the definition does not describe the illness; rather, it is mostly used for billing reasons.

Robert: You’re right. That’s correct. So, realize that this is metabolic dysfunction, and I’ll even call it that. It’s a case of mitochondrial dysfunction. In whichever tissue you’re looking at, metabolic syndrome involves mitochondrial excess. That is metabolic syndrome, and the evidence backs it up.

Bret: Thank you for taking the time to join me on the DietDoctor podcast today, Dr. Lustig.

Robert: It was Rob, I told you.

Bret: Rob here. Rob, I easily forget. – Thank you so much for taking the time to listen to me.

Robert: Thank you so much.

Bret: Now, where can we send those who want to learn more about you and hear more of what you have to say?

Robert: There is a website called robertlustig.com. There’s eatreal.org, a for-profit website called biolumen.tech that’s about a for-profit company attempting to bioengineer a solution to the problem, and a slew of other places. There are YouTube videos and a YouTube channel dedicated to my work. Fat Chance and Hacking of the American Mind are the two novels available. You know, there are a variety of methods to get information.

Bret: Without a doubt.

Robert: Sweet Revenge is a PBS documentary that shows individuals how to cure diabetes using real food in a variety of methods.

Bret: Well, this is clearly a major issue with serious implications, and I’m happy you’re on the front lines trying to find a solution. Rob, thank you so much.

Robert: I appreciate it.

pdf version of the transcript

In this episode, I interview Dr. Robert Lustig, co-author of the book Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease. Dr. Lustig is a pediatric endocrinologist and professor of pediatrics at the University of California, San Francisco and the director of the Center for Weight and Health at the University of California, San Francisco. He is also the author of the book, Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease , which has been called “an eye-opening, life-changing book.” (NPR). Read more about podcast app and let us know what you think.

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What is a podcast and how do they work?

A podcast is a digital audio file that you can download to your computer or listen to online. They are typically released in episodes and usually feature interviews, discussions, and commentary about various topics.