Dr. Robert Lustig: How Sugar & Processed Foods Impact Your Health

Welcome to the huberman Lab podcast where we discuss science and science-based tools for everyday life. I'm Andrew Huberman and I'm a professor of neurobiology and ophthalmology at Stanford Medical School. My guest today is Dr. Robert Lustig. Dr. Robert Lustig is an endocrinologist, a specialist in the function of hormones in the body, and a professor of pediatric endocrinology at the University of California, San Francisco. He is the author of over 100 peer-reviewed studies exploring how different types of nutrients in

foods

impact

our cellular functioning. the functioning of our organs and therefore our

health

, during today's discussion we discussed the idea of ​​whether a calorie is really a calorie and whether our weight and body composition only reflect the number of calories we eat versus the calories we burn . about how different types of

foods

are

processed

in the body, this is how different macronutrients, proteins, fats and carbohydrates are

processed

in the body and the important role that fiber and the gut microbiome play in that process, and we pay special attention to the topic of how different types of

sugar

s, and fructose in particular, can be addictive to the brain and can change the way the body's hormones, particularly insulin, affect liver

health

, kidney health, and, in fact, the health of all our cells and organs.

In fact, Dr. Lustig is an expert on how

sugar

affects the brain. brain and body we talked about how certain types of sugars can be addictive in the same way that certain drugs of abuse and behaviors can become addictive; in other words, how sugar really changes the way the brain works and we discuss how the food industry works. That is, the commodification and sale of particular types of food has altered the way we eat and, indeed, the foods we crave. Today's discussion covers all of that and by the end of today's discussion you will have a deep understanding of how food is processed. when they enter

your

body and how those different food choices are

impact

ing

your

immediate and long-term health Before we begin, I would like to emphasize that this podcast is independent of my teaching and research duties at Stanford;

However, it is part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the general public in line with that theme. I would like to thank the sponsors of today's podcast our first sponsor is eight sleep eight sleep ago Smart mattress covers with cooling Heating and sleep tracking capabilities I've talked many times before on this podcast about the fact that sleep is the foundation of mental health, physical health and performance, now a key component to achieving a good night's sleep is that, to fall and stay deeply asleep, your body temperature actually has to drop by 1 to 3 degrees and, to wake up feeling refreshed and energized, the temperature of your body actually needs to rise by 1-3°, one of the best ways to make sure those temperature changes happen at the right time.

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I'm looking forward to getting home because my sleep is always better when I sleep in my eight. Mattress cover for sleeping if you wish. To try Eights Sleep, you can visit 8sleep.com/huberman to get $150 off their Pod Three mattress cover. Eight Sleep is currently shipping to the US, Canada, UK, select EU countries and Australia again. That's 8sleep.com Huberman. Today's episode also comes to Us by levels levels is a program that allows you to see how different foods affect your health by giving you real-time feedback on your diet through a continuous glucose monitor, one of the most important factors in your immediate and future health. long term is your blood sugar level. or blood glucose regulation with levels, you can see how different foods and food combinations, exercise and sleep patterns impact your blood glucose levels.

It's very easy to use, just place the monitor on the back of your arm and then take your phone and scan it. Check that monitor from time to time and download data on your blood sugar levels in the previous hours. Using levels has allowed me to learn a ton about what works best for me in terms of nutrition, exercise, work schedules, and sleep, so if you are interested in learning more about levels and trying a continuous glucose monitor, you can go to Levels. l/ Huberman Levels has released a new CGM sensor that is smaller and has even better tracking than the previous version.

Right now, they're also offering two extra months of free membership again, that's Levels. linkhub to try the new sensor and two free months of membership. Today's episode is also brought to us by Aeropress. Aeropress is similar to a French press for brewing coffee, but it's actually a much better way to brew coffee. I learned about Aeropress over 10 years ago. years ago and I've been using one since Aeropress was developed by Allan Adler, who was an engineer at Stanford and knew Allen because he had also built the so-called aobi frisbee, which I think at some point maybe still has the Guinness Book of World Records for the furthest object from the Throne and I used to see Allan, believe it or not, in parks around Paloalto testing different frisbee aobi, so he was kind of famous in our community for developing these different engineering feats that became commercials . products now I love coffee.

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I'll just order some hot water and make my coffee or tea right there on the plane. If you want to try Aeropress, you can go to Aero press.com huberman. ar or p rs.com huberman to get 20% off any Aeropress coffee maker Aeropress ships anywhere in the US, Canada and over 60 countries around the world again, that's Aero press.com huberman to get a 20 % off and now for my conversation with Dr. Robert

lustig

Dr. Robert

lustig

welcome pleasure indeed uh just being here being a guest uh great honor I really appreciate it and it's not a doctor it's just Rob okay Rob I've been waiting for this conversation for a long time I have seen that now you are famous can we? also say Infamous but famous YouTube video about sugar.

We'll put a link to it in the subtitles of the show notes. He's been watched many millions of times, yes, and I still can't understand why. You know, I didn't think my mother saw it and she didn't, but 24 and a half million people did well. I think people are very interested in what to eat and what not to eat and we'll start by just talking about what most people believe and understand, which is that. A calorie is a form of thermal energy that is given off during the processing of some food or something, if that's mysterious to people, just understand that a calorie is a unit of energy and I was taught and still many people around the world world believe that a calorie is a calorie which means if I consume more calories in any form then I metabolize them by thinking, feeling moving, exercising etc then I will gain weight and if I consume less calories than I burn then I will lose weight and We could talk a lot about where that weight loss comes from.

Does it come from adapted body fat stores or from muscle or from protein or muscle? Of course, it's protein, etc., but let's start with a calorie, really a calorie when it comes to the processing of different types of calories. Everyone thinks it's obesity. energy balance i.e. calories burned calories burned therefore two behaviors gluttony and laziness therefore if you are fat it is your fault therefore diet and exercise therefore any calorie can be part of a balanced diet therefore don't mess with our calories, choose someone else's calories this is actually what the food industry uses to mitigate its guilt over the changing food supply and the rise in obesity and chronic diseases like diabetes.

Now, it is true that a calorie is that unit of energy that raises a gram of water one degree. Centigrade and therefore a calorie burned is a calorie burned. I do not maintain that that is true. You know the first law of thermodynamics, but that doesn't mean that a calorie consumed is not the same thing and that's where people get it wrong. So let me give you some examples of how that calorie consumed is not a calorie. Eat yourself like almonds. I do that too. Almonds are great. Alright. You eat 160 calories in almonds. How many of them do you absorb? 130 You eat 160.

You absorb 130. Where? the other 30 go to food energy processing, you don't get the fiber from those almonds, both soluble and insoluble fiber and by the way, fiber is kind of the key to the kingdom in this story, it forms a gel in the interior of the intestine. insoluble fiber cellulose forms a fishing net if F A lattice works inside its dadum the soluble fiber that is globular covers the holes in that fishing net together they form a secondary barrier, in fact a gel can be seen in electron microscopy whitish and that prevents absorption of those 30 calories, so yes, 130 are absorbed, but many of them do not end up going down the intestine to the next part called junam and that is where the microbiome is.

Now everyone knows about the microbiome nowadays. You know that's all. bacteria, you know, we always say when women are pregnant, you eat for two, well we always eat for 100 trillion, now they have to eat well, what do they eat, eat what you eat, the question is, how much did you get versus? How much improved if you ate almonds, they're getting those 30 calories, so even if you count the calories on your lips, that doesn't matter, what really matters is counting the calories Cal on the edge of the intestinal brush, okay and they're. It's not the same thing, so if you feed your gut, that's a good thing because then your gut will take those calories and convert them into things like short chain fatty acids that end up protecting against chronic metabolic diseases. acetate propionate butyrate rate those are really good.

They are anti-inflammatory and anti-Alzheimer's because you fed your microbiome, so even though you ate 160 you absorbed 130, so a calorie consumed is not a calorie consumed because if you ate it with fiber it was not for you, it was for your bacteria, but that is not the way you count them, so that's problem number one, problem number two, amino acids, so we all eat protein, let's say you eat too much protein, yeah, you know Porter House steak. If you're a bodybuilder, those amino acids could go to the muscle and you could increase your muscle mass because you're a bodybuilder because you're putting excess force on those muscles and you're growing those muscles, okay, but let's say you're not a bodybuilder, let's say you're a mere moral like me or let's say you are a boy who is going through puberty and who is synthesizing a large amount of muscle, not because he is lifting weights, but because testosterone makes it possible, yes, absolutely, but let's say no, Let's say you.

I know you just collapse on the street like, uh, you know, Joe, okay and you eat that Porter House that you had with all these amino acids, there's no place to store them other than muscle, so your liver takes the excess and deamidates that amino acid removes the amino group to convert it from an amino acid to an organic acid and then that organic acid can enter the Kreb cycle, the tricarboxylic acid cycle, which happens in the mitochondria to generate ATP, energy chemical that your body needs to eat well, that's good, it takes twice as much energy to prepare that amino acid to burn as it does to prepare acarb to burn or fat because when I asked you about when you asked about almonds why 160 versus 130 I thought it was the processing it turned out it was fiber what you're saying is protein let's make it realistic for a really good big porterhouse steak that for right, I love, let's say, let's say 800 calories, yeah.

Well, it turns out that how much of that is, uh, so that's what goes into your mouth, right, my mouth, right, how much of that is actually eaten, to keep the calorie consumed, it's not a calorie consumed. in processing that. These percentages are actually included in your total caloric intake, so about 10% of everything you eat goes towards simply maintaining body temperature. It's called the thermic effect of food, but when you eat protein, you actually generate more heat and the reason is that it takes ATP to phosphorize that organic acid rather than an ATP to phosphorize that carbohydrate for consumption, so you actually have a net loss of energy because it was an amino acid versus a monosaccharide, a sugar, now that you mentioned fat, not fat. they need to be phosphated so you don't really have any thermally effective food at that point so it depends on what it is whether you're leaky or not that's fine but on this let's make it really realistic a 1600 calorie Porter House with a good A piece of butter fed there.

I make this from time to time, not very often, with a little creamed spinach and maybe some mushrooms on the side. Honestly, when I eat a porter house, I don't want to adulterate the flavor. It's fine with anything else, except maybe a little butter, maybe a salad, it's fine afterwards, but let's say 1,1600 calories have some fat in them, sure, uh, let's say, um, a thousand of those calories are protein, mhm, the other 600 are fat. So, depending on how marbled is okay, depending on what you just said about the thermic effect of foods and proteins in particular, yeah, of those thousand calories, how many is that actually?

We can count? I'm not a calorie counter, but yes. Include as calories actually ingested if you ate well 1600, that's what went into your mouth, but, but what's going to go against your burning deficit, so you'd have to do the math to figure it out, but as a guess? Yeah, on the back of the envelope, on the back of the envelope, you're going to calculate that you're going to lose about 25% of that wow, so we're talking about 750 calories, yeah, you know that and to translate this a little bit, what we're saying here is Yes If you are someone who is trying to lose weight or maintain it or maybe even gain weight, you eat a 1600 calorie Porter House with a piece of butter, 600 of those calories that we are saying in this case are fat and the remaining thousand calories, that's all. everything went in your mouth, so you count it in your mouth, but 700, but then when you compare it with the energy consumption that day to maintain the temperature, the brain activity, the physical activity, it's actually only 750 calories, that's right, it's a big difference exactly and another reason. why a calorie is not a calorie now let's take the third, let's take the fats, so here we have omega-3, heart healthy, anti-inflammatory, anti-Alzheimer's, save your life and here we have trans fats, the devil incarnate, poison consumable because you can.

To break the trans double bond, you don't have the desaturates to break that trans double bond, so it basically builds up lines in your arteries, lines in your liver, causes chronic metabolic diseases, causes insulin resistance. Omega-3s don't even break down for energy because they're so important that they stay intact because your brain needs them, your heart needs them, while trans fats can't be broken down because of that trans double bond, one saves your life. , the other one kills you, both have nine calories per gram if you explode. them in a bomb calorimeter because a calorie burned is a calorie burned but a calorie consumed is not a calorie consumed because one will save your life, it will kill you and finally the Big Kahuna the one who takes everything else out of the ose and glucose water, very okay, now glucose is the energy of life, so we're talking about carbohydrates here.

I think most of our audience will be familiar with so-called macronutrients, so we talk about fats, in this case almonds, there is some fiber, probably a little bit. of carbs a little bit I talked a little bit about Porter House with butter, right, I'm already getting hungry, that's protein and M fat, very little of any carb, it should be zero essentially maybe one zero zero mmm and now we're talking about carbs and let's subdivide that into glucose and fructose, galactose is basically converted to glucose in the liver, so we can do without that unless you have a disease called galactosemia, which is about one in 20,000 um and causes neonatal menitis and you know that It is a disease. as a pediatric endocrinologist I would deal with that, but we can do without that for the moment, okay, so glucose, fructose, glucose is the energy of life, every cell on the planet burns glucose for energy, glucose is so important that if you don't consume it.

If your body makes it, it will take an amino acid and turn it into glucose, that's gluconeogenesis, glucogenesis, that's right, it will take a fatty acid and turn it into glucose and specifically the glycerol portion of the triglyceride will turn into glucose, so the Inuit did not. They don't have any place to grow carbohydrates, they had ice, they had whale blubber, they still have a serum glucose level and the reason is you had to have a serum glucose level to be able to feed your brain, to be able to feed your heart, Yeah. You can use ketones, of course you can, but know that only if you are in a ketogenic state will you exclusively use ketones and you will also need glucose for structural changes in specific proteins and particularly hormones, so glucose molecules will bind to TSH LH FSH in different pituitaries. hormones to increase their potency is one of the reasons why aging leads to defective hormonegenesis, for example hypogonadism, hypothyroidism is the loss of glycosylation in individual peptide hormones due to the inability to add glucose due to insulin, it is simply an aging phenomenon.

Well, we'll come back to this because I think it's very important, yes, the idea that the ingestion of carbohydrates and, as you called it, the study of carbohydrate molecules in hormones can increase the function of those hormones and with aging it is a less efficient process. It is a less efficient process, but it is not due to consumption, it is true, people still are. I see that there are many people 65 years old and older who eat a lot of carbohydrates. You're saying that many of them are deficient in thyroid, testosterone, estrogen, truth, prolactin, etc. because of Wes, those carbs aren't exactly studying hormones, so they're all glycoprotein hormones.

Let's leave that for later because I think it's an interesting avenue to go down, okay and there is a disease in children. In babies it's called congenital glycosylation disorders where you can't put glucose molecules on specific proteins and this causes severe mental retardation, all kinds of metabolic havoc and a lot of those babies die, so that's a big deal for everyone. . true, but that's how important glucose is, fructose, on the other hand, this sweet molecule, the molecule that we look for, the reason why the food industry crosses off every food in the supermarket, you know, 73% of all Items in the American supermarket have sugar added on purpose for the food industry's purpose is not yours because fructose is addictive it activates the nucleus accumbens, the reward center of the brain, in the same way that cocaine, heroin does , nicotine, alcohol, and it reduces dopamine receptors, just like nicotine, you know, alcohol, cocaine, heroin, that molecule does.

Fructose is number one, uh, completely vestigial to all vertebrate life, there is no biochemical reaction in any vertebrate that requires fructose in the diet, that's number one, number two, okay, sorry, I'm going to be more fair, so you're saying that although we can process fructose, we have a limited ability to process it in the same way that we have a limited ability to metabolize alcohol now if you have one drink a day you're fine if you have two drinks a day It depends on how big you are you know you and I can probably say two drinks a week is the maximum, but let's not go there, um, but in terms of what you're saying when you say processing fructose, a fructose is vestigial, which you're saying is that we don't need to do it it's like the appendix is ​​an organ that it has no function for exactly and fructose has no function in the human body period you don't need it you don't need it you don't need it but our diet is full of it in fact , our fructose consumption has increased 25-fold since the beginning of the last century.

I have to ask this now. I love fruit. I eat plenty of berries, especially since the price of berries seems to have gone down. It used to be that you only got them. At certain times of the year I'm what's called a blueberry eater, so I just stop by and grab a fist full. You can't put them in front of me without me eating them. This is even hard for me when other people I don't know eat them, so, um, lots of blueberries, strawberries, blackberries, if they're in season, I love them, no problem, they're loaded with fructose, they don't have a lot of fiber, they're low in fructose, they are low in fructose and berries, berries are the lowest in fructose of all.

I'm worried about asking you this today. Well, and fruit is fine because of the fiber, so the molecule, the fructose molecule, is the same, whether in a berry or in a banana or, in fact, in a Coca-Cola, the fructose molecule is the same. molecule the difference is that in the berry it comes with a lot of fiber and the banana comes with much less fiber and in Coca-Cola it does not come with any fiber and the fiber is what mitigates absorption so when you consume fructose with fiber, then your blueberries you're feeding your microbiome that fructose was not for you it gave you great relief and um I have to say I recently had a full body MRI as a preventative someone who was like that.

Great, I was able to watch Netflix there and I never had a full body MRI. I learned some things that were useful to me. I'm in good health, so that's great. One of the comments I received is um. that my gut was full of this very high contrast stuff, right, and they asked me: do you know if you consume a lot of blueberries? and I said, sure enough, why and they told me, because that high contrast appears white on the scan. high concentrations of magnesium MH um that we see in people who eat large amounts of blueberries, which is pretty rare and yours is comparable to a bear in blueberry season wow um and basically my entire intestine was full of blueberries, I guess I need reduce it. a little bit, but now I know that fruit is okay, especially if the fruit has a lot of fiber, yes, but fructose itself, especially if it is not associated with fiber, yes, it is not necessary to survive in the first place, but I you're saying yes. problematic, yes, and let me tell you why it's problematic, we're not there yet, we're just talking about whether it's vestigial or necessary.

Now let's talk about what fructose does. It turns out that fructose inhibits three, count them as three separate enzymes necessary for normal mitochondria. works now your mitochondria produce ATP your mitochondria have to work at maximum efficiency, that's what metabolic health is, the mitochondria are working at maximum efficiency, well there are three enzymes that are inhibited by fructose number one, amp kines , right now, amp kinas is the fuel gauge on. the liver cell is what tells the liver to make more mitochondria, fresher mitochondria because if your amp levels are high, that means you've definitely phosphorated a lot of atps and you have to regenerate them, so you need more mitochondria, so it's a negative feedback pathway, well, you need amp kines to generate that mitochondrial biogenesis signal, except that fructose, a metabolite of fructose called methylglyoxal MGO, is in the active site of the gamma subunit of that amp kines and it actually binds to the arginines in that active site, which makes uh uh, the enzyme is now dead, it's an irreversible inhibition due to the Cove valent bond of that methylglyoxal that alahh to the arginine and now that enzyme is dead.

Well, it basically acts like a key that doesn't open the lock but prevents the key from opening. I want that lock to go into the lock it's like gluing a lock shut yeah I got it all right so that's one of the enzymes that's okay the second and the long chain of L asyl COA dehydrogenase so This is necessary to split two carbon fragments from fat. acids to prepare them for metabolism, so it inhibits that and finally it inhibits carnitine pidal transferase now cpt1, that's the enzyme that regenerates carnitine. Carnitine is the transport mechanism by which nutrients are obtained.The intestine is made up of intestinal epithelial cells that are joined together and bound with proteins. that basically forms a barrier those barriers called tight junction proteins things like cloudin and things like that um zulin is the main one okay, there are others, but zulin is the one that goes is defective in celiac disease what defines a tight junction is like completely waterproof or semi-permeable completely waterproof is fine, unless its function is inhibited.

It turns out that if you alter the phosphorylation state or the nitrate state of that tight junction, it will become transiently permeable, okay, so fructose nitrates cause the TI junction proteins to be transiently permeable. leaky, allowing some of the garbage from your gut to pass into your bloodstream, so this is leaky gut, this is leaky gut, this is what causes leaky gut, fructose is a driver of leaky gut, which It causes inflammation at the level of the liver, which ultimately leads to systemic inflammation, one of the reasons why sensitivity to high-sensitivity CRP CRP is high in patients eating ultrapress foods.

CRP is C-reactive protein, which is a marker of an essentially inflammatory immune response, exactly yes, you don't want it too high and 93% of Americans today are inflamed, does that mean 93% of Americans have Leaky intestines? Yes, it does because that's where it comes from. Besides limiting fructose intake, MH, what are the things that support tight junctions in the intestinal tract? three barriers in your intestine to keep garbage where it belongs, in the center, so it can be expelled. You're behind, all right, three separate barriers, one is a physical barrier called the muin layer, so it's a layer of mucus that actually settles. on top of the intestinal epithelial cells now that mucin is a polysaccharide and bacteria can use that mucin layer for their own purposes it will eat your mucin layer if you don't feed your bacteria you must feed your bacteria or your bacteria will feed In you, MH, okay, so you are in concert with your microbiome, if you deprive your microbiome of the food it needs, it will use you as food and that is one of the reasons why fire fiber is so important, for what the fiber builds this muin layer.

It's a way of reinforcing the fence, which is the tight junctions, etc., ex um between the intestine and the bloodstream. Exactly this raises an interesting point about fasting. Many people, including me, do a type of pseudo-intermittent fasting. Like my first meal somewhere. between 11:00 and noon. I'm not strict about this 11 vs. noon thing and probably eat my last bite of food around 8:00 p.m. and occasionally it's outside that window. I have done this for a long time. I find it better, but other people use a shorter eating window. One thing I learned from a colleague at Yale who studies the gut microbiome that surprised me is that when you do, when you eat that way, there's a long period of time, sometimes longer for people who have an eating period. shorter, longer fasts, what you know is that, yes, where you're actually eating your own intestinal lining, so this idea that fasting is so good for us, on the one hand, may be true, on the other hand.

On the other hand, you're actually consuming components of your gut microbiome, you're not feeding your gut microbiome and depleting it, but this is where I was positively surprised when you do that. As long as you eat enough fiber and, in particular, high-quality fermented foods, low-sugar fermented foods, it appears that the lining of the gut and the gut microbiome are replenished to a higher level than if you had eaten for longer periods.the cycle of 24 hours, am I right, we, you're right and I don't know why it's true, but it seems to be the case and fermented foods B partly because they already have short chain fats. acids in them, um, let's look at the microbiome's preferred food, it's what the microbiome actually converts fiber into, so it's probably helping the intestinal epithelial cells in the same way that the microbiome helps by converting fiber into short chain fatty acids, so it is what we call a postbiotic. so you have the prebiotic, which is the food for the bacteria, you have the probiotic, which is the bacteria itself, and then you have the postbiotic, which is what the bacteria produce to heal you, so short chain fatty acids are postbiotics and There are a lot of people selling short chain fatty acids, you know, drinks and supplements, and whatever, whether they work or not, it's another story if I consume fructose in the form of, say, a highly processed food that has minimal antioxidants. but it has many calories. normally um And and it's disrupting the tight junctions making my gut leaky, but I'm also eating fiber and you know, I'm having a meal that includes a salad, I'm taking some probiotics and then I want like a a couple cups of butter from Rees peanuts, like the dark chocolate ones in particular.

I don't do this anymore, but I used to eat like this more often as time went on. I don't like to call it stricter, but more. I tend to like healthier foods over time and I think you can get away with different things at different stages of life, although you work with young people, so we'll get to very young people, so we'll get to this, but what? How much damage am I doing by eating fructose in the form of a highly processed food? So I'm going to keep it very simple Andrew, I'm a dessert for dessert, I'm not a dessert for breakfast, lunch, snacks and dinner, okay, so if you want. have a couple of Ree's peanut butter cups for dessert the same way you might have a cognac for dessert, that's fine.

I do not have any problem with that. The question is: are you going to eat Ree's peanut butter for breakfast? No, i do not do it. I didn't have breakfast, but no, I got it, but I see your point: the national school breakfast program consumed by 29% of school-aged children today is a plate of fro loops and a glass of orange juice containing 41 grams of sugar. American Heart Associate says the top limit for kids should be 12 grams of added sugar per day, that's 41 grams of added sugar and that's just breakfast and that's fructose. Totally delicious, so the question is what dessert are we talking about and is it correct, and can we adjust that breakfast? to a different reality because I agree that there are many children eating that or a muffin that could be the equivalent, but what about the parent who is fine?

Let's think of a healthier option that the kids will still like. I'm thinking. Going back to my childhood, I eat Honey Nut Cheerios or something, not Froot Loops, which is kind of extreme, take a look at the side of the package, there's no difference and now let's say they go with some, like waffles, that are made with a with a premade U mix some milk a little bit of butter, you know, so mom or dad is making great waffles, it sounds healthier, but then if you do the breakdown or we still end up at a very high level, we're basically eating dessert for breakfast?

Cas, are we eating ego waffles or are we making uh denovo waffles, you know, from scratch in your own kitchen, let's just say there's a big difference, okay, because Eggo waffles, you know, are full of sugar on purpose because the The food industry knows that when they add it, you buy more because it's addictive, okay, and we actually have the demographic um uh uh, the mechanistic, the images and also the economic data to prove that sugar is addictive and the food industry knows it. . Have you ever heard of a phenomenon called price elasticity? Well, price elasticity is an economic term. which is used to ask the question if the price of a given good increases by 1%, that should result in a reduction in purchase or consumption because price influences consumption, how much does it influence consumption?

So if something is price elastic when the price goes up. consumption falls in an equivalent manner to a food that is price elastic, the most price elastic food is eggs, so when the price of eggs rises by 1%, egg consumption falls by 68%, which It means that eggs have a price elasticity of. 32 I understood, I understood what the highest price is for elastic foods. The three inelastic foods with the highest price are fast food. Cal can1. I like a good fast food quiz 081 um uh uh, soda at 79 and juice at 77, which means people won't pay anything. but they will be willing to pay more more willing to pay more because of sugar because it is addictive because it is honest many years ago Andrew, you probably remember something called Keynesian economics and Keynesian economics was based on this concept of the rational actor and the rational actor can determine value, which is utility over cost and if you're a rational actor you should be able to say yes, I'll buy it but I won't buy it, well, in 1979 Daniel Canaman and Amos.

Fski Nobel Prize winner Daniel Canaman describes the irrational actor. Now the irrational actor cannot determine the value and the reason is that he is risk averse so the cost is always too large so the utility may be the same but the cost increases because that is why they have Ya You know, the aversive tendencies, the irrational actor Jeffrey Sachs has described the honest actor who also can't determine value because no matter what it costs, they need their fix and this is what's happening and the food industry knows it and that's why they every food in the store has been increased I would like to take a quick break to recognize our sponsor element elements is an electrolyte drink that has everything you need and nothing you don't, that means zero sugar and the right electrolyte ratios sodium, magnesium and potassium. and that correct ratio of electrolytes is extremely important because every cell in your body, but especially nerve cells, your neurons depend on electrolytes to function properly, so when you are well hydrated and have the proper amount of electrolytes in your system, Your mental system functioning and your physical functioning improves.

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I tend to do this in the winter months because of course you don't just need hydration on hot days and in the summer. spring months, but also in winter, when temperatures are cold and the environment tends to be dry. If you want to try Element, you can go to Drink Element spelled el.com huberman to try a free sample pack again, that's Drink Element.com. Huberman we talked about dessert for breakfast in the form of cereals, some of which are disguised or presented as healthier, you know, I think of Nut Cheerios, it looks healthier than Froot Loops, it looks healthier just because of the color, He looks nice. of weed, you know, the color, but leave it, and in terms of lunch, I mean, one of the things that I love about Europe is that the breads are amazing, yes, the breads there are fantastic and I like them because they are not exactly so sweet, so sandwich not from every Deli, but from a typical sandwich shop or one that is made with store-bought bread.

Sliced ​​bread in the US has a lot of fructose. Look. I looked this up before our discussion today, so it's kind of woven into the dessert. in foods that are that parents and children all think our salty ones are actually we are eating sweets exactly right but we can't, but we don't taste them as sweet on a necessarily correct conscious level, but our taste buds do just fine. Exactly right, so the question is why they do that. Ask your audience: You buy a loaf of bread at the local bakery, how long before it goes stale, two days at best?

Yes, if it really is staple bread, that's right, the better the bread, the faster. When you buy a loaf of bread at the neighborhood grocery store, how long before it goes stale? You probably have a week and then there are the moldy bits at the end that you taste. You know, if you're in college and I try. take it out, um, but it can last up to 3 weeks, depending, you can throw it in the freezer, you probably do it with bakery bread, but it's never the same, it's never the same, so the question is why is that and the answer . is sugar, the answer is sugar, so the supermarket bread had sugar added on purpose because when you bake it, the sugar does not evaporate, it stays in the bread and the sugar is hygroscopic, whichIt means it retains water.

This is a phenomenon that The food industry uses the so-called water activity, so it will retain water and stay spongy and will not go stale as quickly as bread from the bakery that does not have that sugar added, so even something as benign as bread. It has become something that ultimately leads to chronic metabolic disease. We've moved a bit from carbohydrates divided into GL glucose and fructose to a discussion of sugar. Could you tell us the link between sugar and fructose? So what is the percentage of table sugar? fructose What percentage of brown sugar is fructose?

What percentage of the sugar added to foods is high fructose corn syrup? On average, you know because what we're talking about here is what you're describing as an intentional combination of food with something. that's addictive but it's also processed very differently at the level of the kidney at the level of the liver um well, and it's bad, it's bad, it's a bad situation, so when we talk about sugar, I think we should take the same care in describing What I really want to say is that when we talk about a calorie I completely agree, so for your audience let's be very clear on the definitions.

Okay, let's not use the word sugar because it has multiple definitions. Let's use sucrose. Sucrose is what you put in your coffee, it's the crystals. Okay, it's cane sugar, beach sugar, you know, you know, the real teaspoons, this was all that was available for many years, that is, one molecule of glucose, one molecule of fructose attached, uh, to chemicals, an Oly acid bond. Okay, the enzyme in your intestine called sucra cleaves this glycosidic bond by about a nanc, you absorb the two molecules separately, glucose goes throughout the body generates an insulin response, fructose goes directly to the liver generates fat, which is sucrose, high fructose corn syrup is essentially a molecule of glucose a molecule of fructose not linked without an acid bond Oly so they are free the sucra enzyme does not care because the blond is already broken in the end they do the same and it is This is why high fructose corn syrup and sucrose are metabolically indistinguishable.

They are very different economically and the reason is that high fructose corn costs half the price of sucrose because we get sucrose from imports and high fructose corn. We make it at home. The sucrose is in bags. High fructose corn syrup is in sucrose barrels. You can sell high-fructose corn syrup at the store that you sell to the ultra-processed food manufacturer you know. You can't buy high fructose corn syrup at the grocery store, so they are very different in terms of what they are. The repurposed use for high corn syrup is particularly egregious because it can be wasted because it's already a liquid, which is why you probably remember chips and cookies from the old days.

Well, it would often seem like the sugar in the cookie had crystallized due to the sugar content. It was so high it's been a while since I've had one, they weren't particularly good yeah but you eat two and then you think they're good and then you want to eat four, that's what's so strange, the first bite is kind. of likes and then it explodes, there you go, well now it's Chips of Hoy chewy cookies, oh I remember the chewy chips, remember the Chewy Chips, well that's high fructose corn syrup because because the two molecules are free they don't crystallize, so you can In fact, I raised the dose several times throughout today's discussion.

You've been talking about the food industry, in quotes. Mhm, okay, so I'm not a conspiracy theorist. I am, but now I understand. You know that most companies exist to make money, yes, many. Companies start with good intentions and drift to stay competitive, and many, many companies, as we know, not all of them are all bad, like the pharmaceutical industry, right? They are bad, examples like the opioid crisis , but then there are drugs from the pharmaceutical industry that help save lives. I mean, that's my stance on the food industry. I think there are good actors and there are bad actors, but we are talking about the food industry.

Well, we talked about. In the fitness industry, we talk about the podcast industry, I mean, you have good actors and bad actors, but what you've alluded to several times here and are more informed than I am is a concerted effort to marry food with a form . of sugar that makes people crave more of that food and that is causing metabolic diseases that disrupt the mitochondria and so on exactly and you are the doctor, not me, um, you have worked with patients who struggle with obesity and for various reasons um, not me, and um so we could probably spend hours, if not days, talking about all the terrible things the food industry has done, quote unquote, but what do you think the pure motivation is?

I don't think they want people to get sick, but they want to sell. product and this sells more product, then two questions arise: why don't more people know this information, although many more will know after today's conversation, but certainly in government it is a mixed bag no matter which side of the aisle on the one you're in or if you're right in the middle, these are clearly people who care about their health and the health of others, so I can understand how things could have gotten to this point, but what do you think the barriers are? to get people to appreciate what a problem this is and to get people to change their choices in terms of what they eat.

Are they really addicted to the point of getting sick? They can't make good decisions like it's a drug. The addict who is highly addicted to heroin is a sick person, he has a disease and needs treatment, but until he receives that treatment he cannot make good decisions. Let's take an analogy with alcohol. 40% of Americans are tolerant to tea, never touching the substance. 40% don't I don't drink 40% I don't drink very well I'm not a big fan of alcohol. I've never seen it improve anyone in anything that really matters. No, because except drinking and completely residual matter there is no biochemical reaction in the body that requires alcohol, okay, for the same reason, by the way, fructose, um, 40% are social drinkers, you know you can have a beer , leave it, I'm in that category, 10%% are binge drinkers and 10% are chronic alcoholics, okay?

Deprive 40% of social drinkers due to 20% of binge drinkers and chronic alcoholics. No, I think people should be able to choose, but I think people should know what they are doing so they can choose. Well, it's true, like you. I always say uh and I said this about the alcohol episode which turned out to be one of our most prolific Epis episodes where I said, you know, more than two drinks, zero is better than any and more than two drinks a week, you need to do other things. to compensate for that and it's problematic, that's what the data says, but I would say do what you want, but you have to know what you're doing right, so I would say that's exactly what the food industry wants you to think.

The food industry mantra is you have your own choice of personal responsibility, so the question is: does personal responsibility work? and the answer is no, it doesn't work. Every public health debacle in human history began as a personal health problem before becoming a Public Health Crisis, and you can choose your personal responsibility problem, whether it's exposures, whether it's addictions, whether it's infections. , ultimately it requires a social response, okay, we can talk about syphilis, we can talk about tuberculosis, ultimately it needs an audience. health response that we can talk about, um, teen pregnancy, we can talk about tobacco, tobacco ultimately needs a public health response because its enormity and its atrocity requires that public health response Well, it turns out that this is not It is different to exercise personal responsibility four criteria must be met those four criteria are as follows: knowledge number one, you must have the knowledge, because if you don't have the knowledge, then how can you exercise personal responsibility well?

In fact, the public is kept away from knowledge. We're doing this now in part to, you know, incorporate that knowledge so people understand what the problem is. Yeah, I mean, I consider myself pretty knowledgeable about nutrition and health, but I've already learned two dozen facts about processing today. of fructose and calories in general, which I was not aware of before, well that's okay, that's okay, because it's not about math, it's about science, okay, they want it to be about calories, so we have this called food science, we have this thing called nutrition and they have this thing called metabolic health, they are not the same thing food science is what happens to food between the soil and the mouth nutrition is what happens to food between the mouth and the cell metabolic health is what happens to the food inside the cell, but all the chronic diseases we suffer from type two diabetes hypertension dyslipidemia cardiovascular disease cancer dementia fatty liver disease polycystic ovary disease those eight diseases that represent 75 % of health care expenditures in this country today are all inside the cell because they are all mitochondrial dysfunction and there is no drug that reaches the mitochondria, although you and others at Stanford, Harvard, etc.

They are starting this with metabolic psychiatry being a correct case and UCSF too, forgive me. I must mention UCSF at the beginning, your home institution, a wonderful institution just down the road. from Stanford, so you know things are changing, people are starting to think about mitochondrial health, okay, so you list the first thing and you said there are four things that remain: being the first, one was knowledge, okay, second access, because if I don't have access, then how can you exercise your personal responsibility? Access to healthier alternatives, exactly what cost-effective means. I mean, I love berries from the farmers market more than the ones from the store.

I love farmers markets in general, but it takes time and energy to get there. there and the costs are actually lower at the level of what you normally deliver to the supplier, but the volume is difficult to achieve. Actually, they have me on a quota. I can't buy as many berries as I want because Obviously, there are other people who want berries, so the right people have to feed their family, they know it and they want it. We are used to eating a lot of volume, but at least sometimes we can go there, okay, yes. Speaking of people living in food deserts, we're also talking about people living in food swamps.

Well, when we talk about food swamps, we're not talking about a lot of healthy food, we're talking about all the garbage out there. they live in the garbage swamp so if you live in the garbage swamp how are you supposed to exercise personal responsibility number three uh or affordability so you have to be able to afford choice and society has to be able to afford you yours? choice and right now we can't afford that choice because healthcare costs right now are $4.1 trillion a year, but like so many things in behavioral economics and health, it's very difficult for people to see that choice immediate is leading to higher cost in the future, there are simply too many separation nodes for people to realize, hey, when I'm looking for this cereal instead of making waffles for my kids from scratch or you know they're thinking about efficiency time, cost efficiency, volume, kids not throwing tantrums because they don't get the cereal anymore and it's very hard to see that this is the reason why healthcare costs are going up there, just many separation nodes wouldn't be more than agreement, but ultimately it is because the government separates. and silos um food industry benefits from healthcare costs if you really combine them because ultimately they are the same you would see the problem so globally the food industry rakes in $9 trillion a year healthcare cost globally costs 1 trillion a year diet related health costs environmental costs cost 7 trillion dollars a year and productivity costs cost 1 trillion dollars a year so when you do the math 9 - 11 - 7 -1 means that There is a deficit of 10 billion a year because we clean up the mess that the food industry creates and while Numbers like that are not affordable, right?

I agree, and although numbers like that are really difficult, I find that for me and a lot of people statistics like that are difficult to take into account in some ways, there is something in the human brain that hears that and says wow! We are like this. The war cost so much and this problemof food costs so much and then we go to the store and we're hungry, right, and the kids are hungry and you're and then those Separation nodes are For me, it's almost like a prefrontal cortex problem of neural SL memory and, of course, I look at everything through the lens of neurobiology, you know not everything, but almost everything, so how could I not, how could I not, but then the problem is good, there is still food on the shelves and you know , then it is very important: what do we do to connect and bring these notes closer together?

What would the government do? So the question is: is there food on the shelves? Let me finish the fourth and then I want to Come back to that point, let me know, finish a concept so that affordability and externalities number four your choice can't hurt anyone else, but what if your choice hurts someone else, for example , for tobacco, secondhand smoke, the right for alcohol, drunk driving, what was the The argument in favor of teenage pregnancy is that someone else was going to have to raise the children exactly right, but would what about the food? Well, how about the fact that your employer, Stanford University, has to pay $2,750 uh per year in obesity-related health care expenses?

It happened to you even though you're not obese, that's affecting you, so obesity of that type that's affecting you, ah, but nowadays it's especially difficult to even have the conversation. I'm willing to have it now, which is what you know. There's this whole concept of fat shaming, so if someone is obese whose fault is it and if we even talk about it, are we subject to legitimate attack? you are an expert, don't talk about obesity, let's talk about diabetes, okay, then talk about the consequences of obesity, yes, let's talk about the problem of metabolic health itself, okay, the fact is that diabetes now affects 11 .4% of Americans, as it was 20 years ago. it was 20 years ago it was around 8% I was wondering this before 20 years ago there was a lot more margarine in the refrigerators but people were thinner and there was less diabetes all you told us about margarine and trans fats is that it's bad, bad bad.

Now butter has appeared in Time magazine again and you said well, clearly it can't be the transition from trans fats that increases obesity, well no, then it will be the increase in sugar and the increase in sugar and these hidden sugars , that's exactly how it is. Okay, the key is Pakistan and India because, and China, they're not fat, but they have 14% diabetes rates and they're thin, and the reason is because of ultra-processed foods. Is there any country in the world that doesn't do it? We will not allow high fructose corn syrup or at least not at the level we allow it.

Oh, free ships, okay, there are plenty of countries that don't import high fructose corn syrup or don't make it so Scandinavian. countries Scandinavian countries most of Europe um the other than the edge of Asia and the Pacific so Japan has it it was actually invented in Japan 1966 Saga Takasaki School of Medicine at all um uh Korea has it um but Australia doesn't have it Thailand doesn't have but they have as much of an obesity and diabetes problem as we do because they have sucrose because hypose corn syrup and sucrose are not different metabolically so it doesn't really matter is that one to one is exactly one to one. glucose and fructose, so here's the question, Andrew, okay, so I want to go back to what you said: all this food is still on the shelves, is it food?

What is the definition of food? Can I give the definition that I think most people would give? It's not necessarily what I would give, but something that contains caloric energy like me. I could eat this microphone, but it's not going to provide much useful power. The definition of food straight from the dictionary and believe me, I looked it up and memorized it. I think the substrate that contributes to the growth or burning of an organism is interesting, that is the definition of food. I'm a free scientist for 100% correct growth or burning, so any substrate that passes your lips that contributes to growth or burning is food, fine.

Let's do it, let's burn first. I just showed you that sugar, which is the marker of ultra-processed foods and 73% of the items in the supermarket are enriched with sugar, inhibits burning, inhibits those three enzymes involved in mitochondrial function. Now let's do growth. My colleague, Dr. Arrat Maneno Oran, who was chair of nutrition at the Hebrew University of Jerusalem, examined this question and showed that ultra-processed foods actually inhibit growth, inhibit cortical bone growth, inhibit growth of the tricular bone, inhibit the growth of cancellous bone. linear bone growth hijacks growth for cancer because it inhibits mitochondria so then you have to grow instead of burning and this was work that was done in Vivo or in vitro inv Vivo inv Vivo so these are people who eat large amounts of highly processed foods exactly how you found them in the Middle East, you found them in Israel, you found them, so the bottom line is if a substrate doesn't contribute to growth and it doesn't contribute to burning, is it a food? ?

The answer is no, well that's 73% of what's in the supermarket, so I'd say you said the food is there, no it's not food, in fact it's consumable poison, so this leads to an important question about what's left, well, you delete everything that's left, um. only anecdotally and what I sometimes call anec. Dat um, you know, I've had several friends in their 40s and 50s who said they wanted to lose weight and get in shape and what has worked for them every time to lose significant amounts of weight quickly and keep it off, and many of them already They were exercising, but then they also increased their exercise.

Only since I'm not a dietician, nutritionist or anything, I'm just saying eat meat, fish, eggs, vegetables, fruits, you're not going to eat starches, you're not going to drink alcohol, you're not going to drink soda, you can still drink coffee, tea, you can still drink artificial sweeteners. I'll get to the artificial sweeteners in a moment we have to go there, but um and the reason I say no starches even though I personally eat rice, oatmeal, pasta and things like that, some in moderation, depending on the type of exercise you're doing and how much, is due to the fact that a lot of those things today contain fructose and Inevitably, each of those people is impressed by the fact that, quote, it works and assumes that everything it's due to reduced overall calorie intake and they lose 30 to 55 pounds and keep it off and they're like, hey, this is great.

In fact, they can still eat riye steaks and salads, but they don't eat croutons, so in some ways it seems extreme, it sounds ketogenic, but it's nothing like that. You're just saying to basically stay away from processed foods. you're eliminating liquid calories overall and so on, so there's nothing sophisticated about it and my question to you is how much of that weight loss effect do you think is the effect of calories in versus calories out because they're eating ? a lot of food and in some cases, how much do you think is the elimination or almost elimination of this fructose or this combination of glucose and fructose?

It has nothing to do with calories, it has everything to do with insulin, if you get insulin. down you are not diverting energy to fat you can lose weight your fat will leave it ad the triglycerides stored in it as soon as your insulin goes down insulin is pushing on your fat cells all the time and while your insulin goes up your fat cells can't releasing it the moment your insulin drops, you can now engage in what we call lipolysis. Hormone-sensitive lipase is an enzyme in fat cells that is inhibited by insulin as soon as insulin becomes sensitive to hormones. lipase can convert stored triglycerides into free fatty acids and glycerol and release them and you can lose weight so insulin goes down and everything works so the question is what makes insulin go up well two things refining carbs and sugar, those are the two things. which cause insulin to rise in addition Branched chain amino acids also cause insulin to rise Lucine isoline veine found in corn-fed beef, chicken and fish, processed foods, here it is, here's the deal in one concept, my colleague, Dr.

Carlos Montero, who is a professor of Public Health at the University of Sa Paulo, has provided a great service to the world. He has developed a system to categorize food processing. It's called the Nova System, it simply means new, but it has basically categorized all foods anywhere in the world into one of four classes. The easiest way to explain this would be an example, let's take an apple Nova class one would be an apple plucked from a tree Nova class two would be apple slices D stem without skin maybe Nova class 3 would be cooked applesauce coupled possibly with added preservative maybe a little extra sugar maybe not Nova class 4 would be the McDonald's apple pie now, does that McDonald's apple pie look anything like that Apple?

It turns out that this is epidemiological data, but it is nonetheless prospective epidemiological data, so it is not useless that Nova class 4, that category of ultra-processed foods that represents 7.3% of American grocery stores, is the class associated with all these chronic metabolic diseases. From 1 to three there is no problem now when you say associate what percentage of the total daily caloric intake must come from Nova class 4 before that statement that you just made is true because I love the recommendation that you made before or let's just say the Contour. By the way, you don't have to avoid dessert, you can enjoy it, but don't eat it at other times of the day, and maybe don't eat dessert every night, right?

Is there a rule that people have to eat dessert every night? a single night, so the answer is about 7-10% would be the upper limit for you to be able to get 7-10% of your daily caloric intake from these Nova class 4 foods and still be fine and still be fine, yeah, so this is I know, but that's not what's happening, right. I know some very healthy doctors who used to watch how people ate and moved because I paid attention in my field, right. I was like, oh, you know the people around me at Stanford UCSF ET.

They were successful or else they wouldn't be there. I was like, you know? Who looks healthy? Who can climb the stairs and doesn't have to take the elevator? How much exercise do people get at a certain age? Are they fans? Know? four in the morning Runners, I'm not going to do that constantly unless I have to um and I noticed that you know a lot of the healthiest people I know, they move a lot during the day, they ate very well, a lot of them skip breakfast. or lunch not always and then I also noticed that they drank very little or no alcohol and then they enjoyed like... uh, there's one doctor at UCSF in particular.

I'm thinking about who really enjoyed their dark chocolate Kit Kat after lunch and sort of ceremonial about the unraveling of that uh, the aluminum foil and you and it was like okay, so you're talking about that small percentage of calories if That's all you do. Hey, you know, God bless you, but that's not what people are doing, that's the fundamental problem: Nova class 4 is where all the action is in terms of chronic metabolic disease, so The question is how can you avoid that, how do you know which is which? We have a solution, so my colleagues and I have developed a web-based tool that is available to everyone right now and you will put it in your show notes.

Yes, we will link to this. It's called absolutely perfect p r f a and you can find it at perfect. Co and what it is is a recommendation engine, not AI, we'll talk about AI in a minute, but it is a recommendation engine based on the science of human metabolism that classifies foods not according to their nutrient content but according to their metabolic effect. It's interesting, so there's a Nova filter that will filter out all the Nova class 4 stuff and it will go to your supermarket and tell you what you can buy, which will be a Nova class 1 to three, which turns out to be only 20% of the Nova store. groceries, it basically means staying on the periphery of the grocery store, in general, in general, produce, meat, dairy, all the things mentioned, in fact, so I'm not low carb, I have low insulin and there are many. of ways to get to low insulin get rid of refined carbs get rid of sugar increase fiber get rid of branched chain amino acids okay so eating fish is a good place to be um even eating a steak is okay if it's a uh grass fed steak so let's talk about your steak which is also better for animals right it's absolutely so you mentioned marbling before we like our marbling right?

We can cut our grade A steaks with a butter knife because they are veryeminently manipulable and for almost zero dollars, that's fine, but you have to know what you are doing and right now we have been deprived of that knowledge and you know that if you are addicted, it is very difficult to get rid of the addiction. That brings us back to this food industry conspiracies, government conspiracy and the rest, boy, this is going to be an interesting section, we can go, but what do we like? If you and I go up to Cap Capitol Hill, I've done, yeah, what you've done and maybe I'll join you someday. um and you know you're from UCSF.

I'm at Stanford. You are a doctor. I am a scientist and public health advocate. podcaster right and we explain to people Hey, listen, like food is laced with a drug, it's not even really food, it's not an addition of food and non-f food parts that make you think it's food, it's like tell people. Hey, your kids, you know, they're swimming in a pool, it looks like water, but it's actually part poison and it's hurting them, it's giving them, you know, if you say that kind of thing, I mean, the congressmen and women are like. Reasonably intelligent people, right, I mean AR, aren't they going to do something about it?

No, so where is the conflict? Is it that the food industry has the government on the short end of the stick? That's exactly right and they have them by the skin of their teeth where I I mean, are they lining their pockets? I mean, where, where, where is it? The ACC leverage really worked well, so they're lining their pockets, that's number one, that's absolutely true, we have the data to support that white Lincoln who was a senator from Arkansas, who was the chairwoman of the committee Nutrition, you had to see her campaign contributions every time she ran for re-election, so it's about getting re-elected or it's about having a third home in the Hamptons, so I think it's the third home more than anything. wow, okay, so it's really as bad as some of the documentaries would have us believe without a doubt, goodness and we and we and we have the data, there's a uh uh an organization that I absolutely want to call because they're, you know, the most atrocious political organizing body on the face of the Earth, they are called the American Legislative Exchange Council, Alec or Alic, and they write bills, they are a bill, Mill is fine and for whoever gives them money and whoever gives them . them money, Big Pharma, Big Agra, Big Oil and, uh, Big Food, and you're including Big Pharma, you're a doctor, you've written scripts before, you've written prescriptions for patients before, isn't that It is the pharmaceutical company that provides the medications that allow your patients to feel better.

The question is whether they feel better. This is a great question. Come on, you want to go. You are writing but you are writing the script. I mean, I'm just trying. I'm not trying to challenge you, but I see it, so don't do it. There have to be cases where someone has a thyroid deficiency and you give them an AB medication, if so, if you have a disease and a medication. will replace what's missing, sure, okay, so for deficiency diseases, which as an endocrinologist, that's absolutely what I do and I did it, you know, without any qualms about uh or any impropriety, but that's not what we're talking about here, let's talk about what we really are.

Speaking of, let's start with statins. Statins lower LDL. Okay, do statins reduce heart disease? Yes or no. Know. It seems like I'm sniffing out all the quizzes today and it's getting fun for me at this level. I'm going to go with no, but but I will say you know my friend and I think his medical expert you also know Peter AA and others that you know have talked about some of the positive attributes of statens in certain cases for a certain Pati in certain cases that's exactly right and I completely agree and by the way, Peter is a friend and you know one day we will know, you know everything you know, we will go out drinking together, well I won't drink, but how about we share a steak?

No, I don't know if you drink, drink a little yes, if you're listening, okay, drink some house with me, yes, I don't make dessert or alcohol anymore, but, and it's not so I can live to be 120, it's so to be able to wake up the next morning and, keep with you, okay, I understand that for primary prevention, their LDL is high, they need a statin, which is primary prevention. has not been declared has not had an event for primary prevention the average increase in life expectancy from being on a statin is four days four days four days four days so, for laughs, that is, and the risk of diabetes is a 20% increase. about any improvement in quality of life none for primary prevention now for secondary prevention for secondary in other words you've already stated that you already have a problem for secondary prevention that's where statins shine so they have a worth.

I'm not arguing. that and if you have familial hypercholesterolemia, which is one in 500, okay, you don't need a statin, but you need a low-fat diet and a priest, okay, so statins definitely have value, but not for primary prevention, but that's what every doctor is doing oh your LDL is over 80 you know you need a statin that's ridiculous that's absolutely a joke and the data shows that in fact my colleague aim Malhotra in the UK participated in an analysis in the which took the entire UK population and I took out everyone under 65, so we're looking at people from 65 to 90 and it turned out that LDL level correlated with longevity, the higher the LDL, The longer they lived when we took out all the people who had problems, so LDL is not really the problem and the reason is that there are two LDLs, there is one called large buoyant, there is one called small dents, it turns out that dietary fat increases the large buoyant, the large buoyant is irrelevant, it is cardiovascularly neutral, but that is the one that affects statins, the small dense one, that is the atherogenic particle when your small dense LDL is high, that means you are not removing the triglycerides peripherally because that's what the small dense ones show you, that's what happens to triglycerides: they become small and dense.

Can I guess and tell you the best way to reduce them? Small Dens is reducing insulin, yes, reducing sugar, because triglycerides are produced in the liver, it's all palmitate and that's the only fat the liver knows how to make, so triglycerides are the liver's carbohydrate production , this is how you have to look at triglycerides. So, triglycerides turn out to be much more important as a cardiovascular risk factor than LDL. So do big pharma and big food companies. Do you know all this? Yes, I know they know because they have told me and they have statins. to sell and Food in the Nova 4 mhm class, they know that too so you know I'm optimistic or you know what it's going to take to really move the needle.

I mean, you described the four barriers that we're trying. to add to the knowledge component now, um, you know, having a president in office or a congressman in office who really understands and cares about these things, yeah, I mean really revamping the whole system, yeah, right now the system is completely and completely broken completely and completely broken and there is a reason why it is completely and completely broken because the food industry likes it that way, it's profitable for them obviously there are 51 different federal agencies that manage our food 51 and None of them know what the other ones are doing and the food industry likes it that way, so communication between these 51 organizations would be a big help if we had a centralized food um or food, you know, if we divided FDA foods because you know it's like it's not the FDA.

It's the day or the FDA it's not the Food and Drug Administration it's the Federal Drug Administration they spend a lot of time on medications they spend almost no time on food well, let's think about where there has been success so we can remember when people smoked in the airplanes In fact, I remember going to a gym in Europe and there was an ashtray molded into the squat rack, yeah, that said: Yeah, I don't see people smoking cigarettes at Stanford Hospital anymore, but I remember they initially said people don't You couldn't smoke anywhere except in this little designated area and that's typically what you see nowadays and my understanding of the anti-smoking campaign, at least for kids 18 and under, was that telling people it was bad for them. their health didn't work, showing them lungs that were decrepit didn't work what worked was showing them commercials of white kids talking about how much money they were making from these naive kids buying cigarettes and other tobacco products, so it became the A campaign effective in ending smoking among young people was to hijack their inherent rebelliousness of youth and then they said, "No, we're not going to impose this on them like, you know, what my friend calls it, like both of them, both of them." business card with the finger like No And that worked, it worked, vaping is making a comeback, vaping is a separate episode, we won't get into that, but since nicotine is still addictive, but you don't see many people smoking cigarettes, it worked like something which you would never imagine could work well, so yeah, no, I mean, that's part of it.

I'm not going to tell you it's not, it's part of this, um and we actually have an example of how it could be applied. to another toxic substance, sugar, we had Berkeley versus big soda, you know, that's how Berkeley ended their soda tax that dates back to 2015, the city of Berkeley, city of Berkeley, we just celebrated the fifth anniversary of soda from Berkeley. taxes and we have been able to observe stationary diabetes, obesity, a little, not much, but a little, cardiovascular diseases. Dean Schillinger and Chris Madson of UCSF and UC Berkeley just presented at San Francisco General just three weeks ago.

So a soda tax like a cigarette tax simply makes soda expensive. So, you're telling me that a can of Coke I buy on Shatak Avenue in Berkeley costs more than a can of Coke I buy on University Avenue in Pal Alto? okay for a dime and that was enough to create this kind of change well yeah money hurts because money hurts exactly so Andrew there have been four, count them, four cultural tectonic shifts in America in the last 30 years and they're all undeniable here it's number one bike helmets and seat belts oh yeah everyone uses those two for smoking in public places Nobody does that three uh drunk driving hopefully less people do that four condoms and bathrooms condoms in the bathrooms in the bathrooms in the public bathrooms yeah, you see those more available, okay, yeah, okay, 30 years ago, if a legislator stood up in a statehouse and proposed legislation for any of those four and I don't care whether it is a state chamber or in Congress or in Parliament or in the Duma or anywhere else in the world, okay, they have been laughed at from the city, babysitter, state freedom, interest, get out of my kitchen, get out of my bathroom, get out of my car, okay, today, they are all facts of life, right, no one has a tummy ache. about any of them, the point is that we were able to solve the public health debacles, how we did it, how we solved those four, no one could imagine that we would ever solve smoking well, but in a way we did, I mean, we reduced consumption . half is fine, that's pretty good if you think about addictive sub how many less people are dying from lung cancer today in the US it's like 80% less.

Well, there have also been improvements in treatment, but yes, but no, but it is the one diagnosed with inci the incidence decreased incredibly well because tobacco has decreased so the question is how did that happen the answer is very and why did it take 30 years to do it? We teach the kids, kids grew up and voted and the naysayers are dead, that's how you make a cultural tectonic shift, so now we have this real food movement, we have people who are arguing against ultra-processed foods, we have kids. who demand something different in their schools and, by the way, what is the largest fast food franchise in the world?

United States I'm going to misunderstand, so try again. I don't know. I've never tried it, but I've heard of Chick-fil-A. No. Is it McDonald? I don't know. The public schools of this nation, oh, you can add McDonald's, Subway, Burger King, Chickfila and Wendy's and all the other fast food franchises, Jack in the Box, all the fast food franchises across the country, and they would just be the half of our nation's public schools. Wow, can you imagine? a world where class three or four Nova Foods weren't allowed in public schools and we're doing it so I'm the scientific director of a nonprofit and I put this in the show notes called Eat Real e.org and We have a new business model proposed for Public Schools, so in 1971 the Department of Education issued an administrative ordinance calledthey gained 10 kilos they gained two kilos so it looks better compared to the sugary version uh uh but it seems like you already know a problem compared to the water version or even the milk version, so unless I increase the calories and keep them constant, you will see weight gain from the artificial sweetener exactly as you should and that's been proven 50 ways since Sunday in a ton of different studies, so compared to sugar, yes, it's better , but compared to water, it is much worse and the reason is the insulin response: you put something sweet on your tongue.

The message goes from the tongue to the brain. The message that comes from sugar goes from the brain to the pancreas through the vus nerve. The arrival of the sugar releases the insulin, so the tongue doesn't know if it's sugar or not, it releases it into the pancreas it releases insulin which converts the energy into fat, whether you know it from the dietary sweetener or not. I saw some really interesting data from Dana Small's group at Yale showing that when people drink a diet soda with their meal, it's like Diet Coke with their sandwich or hamburger, maybe even with pasta, the response of the The insulin response from the meal and the insulin response from the diet soda are aggravated, but there is a classic Pavlovian conditioning effect such that then if they only drink the diet soda, they get an even greater insulin response just to the diet soda than they would have. originally if they just drank the diet soda separate from the food, in other words, the insulin the food-induced insulin response is driving a greater insulin response from the diet soda and we actually have another study that shows the same thing in Singapore, um teay at all, uh in American Journal Clinical Nutrition 2018.

I think he looked at a similar paradigm. This is what they did, they took a group of people and they admitted them to their Clinical Research Center four times a week and they did them in random order and every time they started the morning they fasted and they gave them a sucrose tolerance test or an aspartame test. tolerance test or a sucralose tolerance test or a monk fruit tolerance test, so two hours you know, taking one of the three, one of the four and measuring glucose and insulin over the course of the next two hours fasting, fasting, okay, okay, then it was time for lunch. and they were allowed to have whatever lunch they wanted, it was a metabolic buffet, they could eat whatever they wanted from the buffet except they were being timed and the same for dinner, they were being timed but they could eat whatever they wanted in a certain period. of time in the 24 hours okay you know or you know from 7:00 a.m. to 7:00 p.m.

Every time they returned home, it turned out that the sucrose tolerance test generated an insulin response, as expected, monk fruit, Ste, Uh U sucros and aspartame did not, but then when ate lunch, if they had had one of the three diets. sweeteners in the morning, ate more at lunch and more at dinner, and generated a greater insulin response at both lunch and dinner, so the area under the curve for the entire day was exactly the same, so who ate significantly more, yes, yes, because they had the morning diet soda Wild Well, I drink drinks that contain Stevia and I don't worry too much, but what you are saying is that even if I consume calories there is a possibility that the response of insulin can have direct effects on the liver exactly well and not for the better and not for the better, having said that, we have undertaken an interesting project that I don't know if you know about um in 2020, during the pandemic, I was approached by a food company in the middle east it's called kuwaiti danish dairy company kdd is the nestle of the middle east now they make all kinds of crap frozen yogurt flavored milks ice cream sweets cookies ketchup well kuwait has a diabetes rate of 18% and an obesity rate of 80% 80 zero wow on Adults, at this point, the company recognized that they wanted to be a metabolically healthy company and they knew they weren't, and they reached out to me and said, could you put together a scientific advisory team to advise us on what we need to do to change the food in To be a metabolically healthy company and we want to lead and I said we would be.

I'd be happy to do it on one condition: we can publish what we did so it can serve as a roadmap for the rest. from the food industry and they said okay, so I convened a scientific advisory team with my colleague wol from Alderson, who started the first farmers market in Los Angeles and is now the director of sustainability and nutrition at kdd um uh Tim Harland , who is the head of culinary medicine at George Washington University, Rachel, who is a fatty acid expert who did additional omega-3 testing at the NIH, and Andreas Cornat, who is actually a computer scientist at Stanford, and we basically took apart every single thing that kdd made in terms of procurement in terms of ingredients in terms of packaging we subjected every ingredient to a biochemical analysis because you couldn't trust what the sellers basically said that kdd was in the food, we had to really know what was in the food and that was half a million dollars alone.

I mean, this wasn't a little cheap, you know, you know, a stay in the woods, this was a big deal, we basically redesigned their entire 180-item portfolio. and now they have delivered 10% of their products. to be metabolically healthy and the precepts that we established in this document found in Frontiers and nutrition in March of this year 2023 three things three principles if you comply with these three principles you can turn any food into healthy, including ultra-processed foods, number one to protect the liver number two feed the gut number three support the brain if you have a food that does all three it is healthy if you have a food that doesn't do any of those three then it is poison because it is not food I was going to say No food seems to be the correct descriptor, in that case exactly, and if it contains one or two, but not all three, then it will be somewhere in the middle, so the goal was to take all the KD products and move them. from the lowest level to the highest level by adhering to these three principles and we came up with some very simple things: the first, get rid of sugar; the second, add fiber; the third, add Omega-3 number four, I have to do something about the emulsifiers because the emulsifiers are causing intestinal inflammation because after all, emulsifiers are detergents, they hold fat and water together, they burn a hole in the layer of mucin, so they're actually contributing to that intestinal inflammation and the emulsifiers, right?

Learn about the tension in ultra-processed foods. We've heard a lot about hidden sugars during today's episode and elsewhere, but based on everything you told us about artificial sweeteners, excuse me, low calorie, it now makes more sense to me why foods that aren't. Promoted as diet foods they would be mixed with things like sucralose because it should drive the desire for that food through increases in insulin and the desire for other foods later that day and later that night, which is why non-caloric sweeteners are added to all kinds of foods now because normally there are things that non-caloric sweeteners are probably only added in quotes to diet foods, low calorie foods, but that's not the case, you're right, that's not the case and they're adding dietary sweeteners to foods you didn't know were dietary. contain sweeteners, that's right, there are two reasons why this happens: one is insulin, because insulin blocks leptin signaling at the level of the hypothalamus and the nucleus accumbants, so if it blocks leptin, leptin is the hormone that fat cells produce that tells the brain that you've had enough, so if insulin blocks leptin, it makes you more hungry and also extinguishes it, it stops the extinction of the reward for that food, so you want more and does both because leptin normally suppresses food intake and reduces the desire to eat analogy.

What comes to mind is a slot machine that encourages you to feed more money and press Go to pull the lever, but that also blinds you to the outcome, so even if you win you don't even know you have winnings, it also blinds you to the outcome. blind For your losses, you are effectively becoming an automaton, yes, of simply eating without any kind of conscious understanding of what you are bringing or tasting the food already exactly well, it is not like that and Anna lmy when she came to the The author of the podcast Dopamine Nation and obviously head of our dual diagnosis addiction clinic at Stanford talked about these consumptive behaviors where people are scrolling through social media or consuming porn or eh.

Using drugs or alcohol in a way that as if they're no longer in contact with the pleasure of the substance or behavior, they become automatons, but if they don't do it they feel bad, so the pleasure disappears, the pain disappears. definitely expecting tolerance and dependence that is the definition of addiction so dopamine is an excitatory neurotransmitter that excites the next neuron there was always no dopamine that inhibits a postoptic neuron dopamine stimulates the next neuron and it doesn't matter which dopamine receptor one is until the five is always excitatory, now neurons like to be excited, that's why they have receptors, but neurons like to be tickled, not hit, chronic overstimulation of any neuron and you know this leads to the death of the neurons. neuronal cells and the reason is that the neuron needs energy, the neuron is the most energy-dependent tissue in the body, it needs those mitochondria to pump ATP like crazy to participate well in neurotransmission.

When you're firing nonstop, you run the risk of cell death, so the excitatory neuron, the poptic neuron, has a plan B: it downregulates the receptor, it downregulates the dopamine receptor, so there's less Chances are that any lost dopamine molecule will find a receptor to bind to and this is your Plan B to try to mitigate the risk of dying well, what does that mean in human terms? with one hit you get a burst, the receivers go down the next time you need a bigger hit to get the same burst and the receivers go down and you need a bigger hit and a bigger hit and a bigger hit until finally you need a huge blow to get nothing.

It's called tolerance and then when the neurons start to die, that's called addiction, that's what we have and that's what happened in terms of food addiction, so the question is what is addictive, is fat addictive? No, because if fat were addictive, then everyone on the Atkins diet or the ketogenic diet would mean gaining weight, not losing it, and would crave steak all day. I actually like ribeye quite often, but I know people say no, but look, my lipids are in line and I. I don't eat a lot of starches and I certainly avoid sugar, although now I'm thinking I might want to reduce my consumption of low-calorie sweeteners.

I don't see myself reducing my Stevia consumption to zero because there are some things I really like, Andrew. I'm not the food police um, you know, I always say that to people that I'm not a police officer, but um but but but data is data and and health data is data they say that doesn't help you at all, that's it. what The data says mhm um, the point is that fat is not the problem, salt is not the problem, caffeine is a problem, really the classic addictive substance of caffeine on all levels, yes, but sugar It is a problem, but you can eliminate caffeine early in the afternoon or even earlier. in the day and it is not consumed in excess um and it is in the form of coffee or shake some other form that is healthy, you know?

Is it really a big problem? um I love coffee in your that's my addiction like capital l underlined bold highlighted face I I I I I feel your pain and the answer is no one has proven that coffee is toxic, it's addictive but it's not toxic now if you mix coffee with alcohol now you have four Loco now it's toxic but caffeine itself is not um toxic and that's why there's a Starbucks on every corner, but it's very reinforcing. I did an episode on caffeine where I covered some data that was published in Science magazine, one of the three Apex magazines, and if you put caffeine in without the public knowing. consumer who consumes plain yogurt, people will crave plain yogurt much more.

I mean, people like the feeling of having caffeine as long as it doesn't exactly create anxiety levels of energy to stick with the caffeine, that's fine, yeah, and I too, we've been talking a little bit. a little about the hypothalamus, as well as some peripheral gut mechanisms for hunger and satiety. This is a great opportunity to talk about some of the glp1 agonists that are now widely used, which is why they are typically called zic, but gp1 gluc glucon-like peptide. one, true, originally discovered in theheila monster, who eats very rarely and a very intelligent biologist. I love biology like this, she said, how come they don't have to eat very well?

Their blood is loaded with gp1, right, and that's why they only have to eat one, whatever the monsters helila um delight per year or something scandalous like humans also make glp1, I understand that gp1, which is not injected, but that one um produces naturally, acts on both the brain and the gut to increase satiety. It is acting on the brain, there is no argument, but the main action is on the intestine. gp1 decreases the rate of gastric emptying, which is its main driver. Yes, it affects the brain. I'm not saying it does, but the main effect is to reduce the rate of gastric emptying so that you stay fuller longer because the food is not moving through the stomach and intestine interesting in South America in Uruguay in Argentina for a long time time it was thought that the consumption of mate um yeram, which we know very modestly increases lpg and, by the way, many other things also work, people took it after meals for its partially laxative effect, you know, it's not pleasant , but also in the colon, which is at the level of the stomach, but is used quite effectively. so people can space out their meals without snacking on something, you know, and maybe it's the glp1, maybe it's something else, um, but people are injecting themselves with gp1 analogs now, $1,300 a month, that's what it cost , that's what he lost, right, um, and it seems.

It's quite effective at inducing weight loss, although a significant amount of that weight loss appears to come from skeletal muscle tissue and we think we need to talk about that, so what do you think about OIC as a major? You talked about primary and secondary control, you talked about it a little differently in the context of statins, right, then a child comes along who is obese or slightly overweight it's like I don't know what to do, I'm trying to eat better, exercise or a person comes in and says, "Hey, I've had a hard time losing those last 20 pounds for so many years.

Would you prescribe those microphones for me? So the short answer is number one. I'm retired, so I don't prescribe anything, but let's go with the data that shows that gp1 analogs like um semaglutide and now tepati, which is Li's version, Manjaro, is the diabetes version Zepbound is the obesity version, in the same way that OIC is the obesity version. diabetes um uh novonordisk and wovi is the Obesity version so they are all glp1 they are all GP analogs gp1 there synthesized in a lab it looks like gp1 smells like gp1 acts like gp1 when injected tepati the uh Lily actually It has a dual function.

It binds to the Gip receptor receptor, so it could do double duty and the data shows that it is actually even a little more effective for weight loss than the Nova Nordisk version, so we will soon see a change in terms of consumer preference, without a doubt. but here's the thing if you look at the data from a year of treatment, 16% weight loss now, that sounds great and I'm not saying it's bad, it's good and people don't have food cravings all the time, it's because People feel full longer, right? so they're eating less, they're eating less, this is the pattern of calories in and calories out, they're eating less and therefore they're losing weight.

I'm not arguing that and they may have less desire to drink alcohol. According to some recent reports, yeah, well. We can also go there for a minute in a second. Here's the problem when you look at that 16% weight loss, like you just said, when you put people in a Dexas scanner, they've lost equal amounts of fat and muscle. Now, is it good? lose muscle no it's not good ask any old lady who breaks her hip if she wishes she had a little more muscle or someone who dieted lost a lot of muscle because they weren't compensating for the weight loss with resistance training or something else The way to exercise and the amount of food they can eat to maintain that weight, to put it scientifically, it sucks and, you know, we mentioned Peter AA earlier.

Well, by surviving, he made it very clear that sarcopenia, the lack of muscle mass, is one of the causes. of the drivers of mortality, so losing muscle is not a good idea, but you lose equal amounts of fat and muscle, what else causes losing equal amounts of fat and muscle starvation? In fact, the reason all these glp1 analogues work is because you stop eating like him, yes, like Heil's monster, Heil's monsters seem quite chubby to me, well, ask someone else, I cured a monster, I did, but unfortunately, any answer they gave me was not interpretable, in fact the point is that starving yourself is not that good and if you think about it why it is working, it is reducing the rate of gastric emptying, well it turns out that that's the reason for its side effects, reduced gastric emptying, that's why you have nausea, that's why you have vomiting, that's why you have pain, pancreatitis, and most importantly, now. gastroparesis your stomach turns to stone and you cannot move any food through your intestine and even worse, when you stop taking the medication the gastroparesis does not improve, this is not a good idea, it is like the opposite of the effect induced by yerbamate . which has a kind of prolax gastric emptying.

Maybe glp1 agonism, my goodness, okay, so it's obvious why people who have struggled to lose weight like it, especially if they have struggled to lose weight, at least in their mind it was the consequence of being hungry all the time. time. and need to eat more or was it because of the reward and you know their dependency because, in fact, yes, uh, uh, these go1 analogs reduce the reward and that's one of the reasons why they've noticed that you know, uh, uh, reduction in alcohol consumption. Oh, also, and that sounds like a good thing, except now there are also numerous cases of major depressive disorder in response to these drugs, so it's almost like an Al treone or something for addiction treatment, which sometimes it may be useful, but now, but the attempt to eliminate the amplitude of that reward signal, I mean a lot on paper, it makes sense, but it doesn't always work and in practice it doesn't work, that's right, so I'll forward it now to some old literature that was from 2006 there was a drug that was approved in Europe called raniban, okay, a trade name ACC complia and it was approved in Europe for weight loss and it was pretty good for weight loss, it caused about 20% weight. loss, it also caused severe depression and 21 suicides, so it is no longer available because it was and yes, it was withdrawn from the European market, it was never approved in the United States and the reason this happened was because this was the drug against marijuana, this was the anti-munchies drug this was an endoc cannabis antagonist well, when you reduce the reward you also reduce your desire to live and that is why this concern about reducing alcohol consumption we have already seen major depressive disorder in patients receiving OIC, so let's see The same thing happened that we did with Rabant.

I'm worried about that or fenfen well, fenfen didn't have um uh no, it was cardiac, it was cardiac, right, we had cardiac problems because of the fenfluramine because of the serotonin 1B receptor agonism. right, I'm just talking about the fact that these, quote-unquote, Blockbuster obesity drugs tend to follow a contour of, you know, very promising, very exciting, a lot of people lose weight, suicides or very promising, a lot of people lose weight, um cardiac. very promising topics for weight loss and now you say the stomach turns to Stone sounds so biblical huh well that's the question and we can finally talk really biblical if everyone in America who qualified for the OIC got it it would be 2.1 billion to the health care system, which is currently 4.1 billion, so it would be an increase of more than 50% in health care costs, well at 300 per month, conversely, if we reduced sugar consumption to the USDA guidelines, basically, you know, putting some limits on the amount. added sugar that the food industry can put in any product like Froot Loops, we could reduce weight by 29% and save $3.0 billion, so we would get better weight loss and save $5.1 billion, which It makes more sense for the US government.

You were earlier alluding to the relationships between the government, Big Food, and Big Pharma. I mean, there's a big win here for whoever makes these gp1 analogs, actually, but the question is who's footing the bill. Well, we, now, the question is why can't the government see that and the answer is because the government is also in the Dole because the government, through tariffs on foods manufactured in the United States, collects about 56 billion a year, so they're an actor, they're not just a regulator, they're an actor to play the devil Devil's Advocate a little listen I'm going to be the last person to step in and try to defend the government as a unified body.

I'm not qualified to do that, but you could see what it's like if you looked. Looking at it like checkers instead of chess, you would say okay, here is a drug that will allow many millions of people to reduce their overall body weight. Overall body weight is a risk factor for several things, and there will be savings on the back end. ends up as a consequence of that weight loss, I mean, that's the checkers version, right, the chess version is like you're describing it and I think, um, I mean, clearly the people in the government are fine, most Some may be smart enough to play chess, no.

Checkers or at least understand it, but there are very few incentives for the chess model, so, what would, quote, solve this problem is the same thing that happened to Fenfen or Ro Roman, which is if suddenly there is a major problem with the drug, then everyone stops taking it and traditionally that's how it's happened, it seems like these gp1 analogs are going to go through the shoes, although yeah, I mean, there's a very clear downside to these drugs, on the other hand, you know there's an advantage and that is why I am not sad that these medications exist.

I am in favor of them. I'm not against them. I am in favor of them. For the right patient and right now it's not the right patient getting them, like the ones at Statens, so what? If someone who is taking one of these analogues intends to do resistance training and here you know you mentioned bodybuilders earlier. I'm not suggesting they become bodybuilders, but now we know and I think Petera and others would agree with that. Everyone should do some type of resistance exercise to compensate for muscle loss. Okay, at least after you know they're reaching their adult height or something you know.

I know there are those who say that weight training doesn't reduce your height, but anyway, let's say it from the beginning. Starting in your 20s, especially if you're taking these medications correctly to maintain adequate muscle mass, so that's a different picture. People are drinking less alcohol again. I'm playing devil's advocate here. So if we look at these compounds, no. in a vacuum, but that's okay, the person who has been carrying those extra 30 pounds is now only carrying a few extra pounds of adapted tissue, they have lost a lot of muscle but now feel good enough to exercise.

The depression part worries me, yes, but still. I'm just trying to round out the outline of what we've seen in children, you know, because what I dealt with was that they often needed a good start and there were different ways to achieve that. Start stapling the stomach, well, that's not a push, but that's what a lot of people did. I know I have a friend, he was and unfortunately still is very big and he always talked about saving his stomach as if he could gain 50 pounds. lose quickly then he could exercise, but exercise is painful this type of thing and unfortunately he continues to maintain or gain a very excessive weight and that's the point is that you know that this concept of momentum actually if you're just doing it yourself It doesn't really work and the question is why your weight is increasing if you have a tight stomach.

The answer is because he is a sugar addict. Yeah, he definitely he's addicted to super big soda and if you drink your calories. It doesn't really matter, does it? And he has such terrible psoriasis and joint pain and everything that the prospect of working out is like telling him to flap his wings and go to Mars. You know, fructose is a driver of immune dysfunction if he went down, you can tell him for me if he gave up sugar his psoriasis would improve his weight would improve his arthritis would improve and he could have that boost this is a perfect example to link to the brain component of everything This is because for a long time I have wondered about what I understand about neural circuits and neuroplasticity.

I know we share this knowledge that at some point having a lot of adapted tissue means the brain represents the body differently. I mean, we know that there are these somatotopic M maps of the self, you know, but the neural machinery in the hypothalamussurely it is responsible for motivated states, etc., but also the entire mapping of the self, yes, it changes, in other words, if one fat for long enough, mhm, it becomes increasingly difficult to achieve a healthy weight because to the way that the neural circuit is affected, it is basically remapped to keep that person fat not necessarily even just on the level of appetite but just in terms of What do large animals do?

He had a bulldog that weighed 90 pounds. Bulldog Mastiff. He was very economical with his movements. He was extremely powerful. He could run at least when he was younger, but if he could stand still, he was still the same. Unlike certain smaller animals that are like peretics, because because it was leptin resistant, leptin, as we briefly talked about, is the hormone that tells your brain that you've had enough, if you're leptin sensitive. , you're happy to burn it if you're LEP. and resistant, your brain thinks you are starving and if your brain thinks you are starving it will affect your behavior in two ways: it will make you want to eat and it will also make you want to conserve because the goal is to try to increase leptin levels to overcome that resistance, which of course you will never be able to do because all you are going to do is accumulate more fat and produce more leptin, which makes a lot of sense because the leptin comes from exactly the adapted tissue.

That leptin resistance is what you have to be able to overcome, you have to fix leptin sensitivity well, what is the driver of leptin resistance? hypothalamus does it in um irs2 insulin receptor substrate 2 does it in socks 3 suppressor of cytological signaling 3 and does it in pip 3 phosphol andosol triphosphate those three separate arms of the leptin receptor uh uh basically put to sleep by the high Insulin Insulin blocks Le In signals, so the higher the insulin, the more your brain will think you're starving, and the more your brain thinks you're starving, the hungrier you'll be and the less you'll want to move. , so gluttony and laziness we have.

I've been talking about everything you know, the podcast is really biochemical, it's secondary to this phenomenon of insulin blocking leptin signaling. You have to fix that, first, reduce insulin any way you can and the best way is to get rid of refined carbs and sugar. that's where you start makes a lot of sense it also works how about that? that's always good. I once heard you say, I think it was in a conversation with Peter AA on his podcast, and this really stuck with me: when a person consumes glucose, it activates several different sites in the brain, you know, the neurons love glucose, but when you ingest fructose, you preferentially activate neurons in the reward pathway, which is maybe seven times the magnitude or something, well, glucose activates basil. ganglia uh this is a work by Walner Housen and uh Switzerland and also Eric stce in or for movement in planning and execution exactly right, fructose basically stimulates the nucleus towards the reward center, it's like heroin, like cocaine , like nicotine, activates the reward center does nothing for the basil ganglia, so it is addictive, anything that stimulates the reward center to the extreme is addictive, which is why we have chemical addictions, heroin, cocaine, nicotine , alcohol, sugar, we have behavioral addictions, shopping, gambling, internet gaming, social media, pornography.

It doesn't matter, they all stimulate dopamine in the reward center and, to the extreme, they are all addictive, so the question is if you are addicted, is that personal responsibility? Well, it's a question I think about a lot because I know a lot. of people in the addiction recovery community, both from the treatment side and from the addict side, yes, and this question always comes up when someone suffers from an addiction of any kind and is resistant to treatment if you look at it. Like being sick, at least at that moment, is a sick person in the best or worst or at least worst position to guide their own treatment.

So, for example, would you ask someone with dementia if they want to go see a neurologist? them, but are they the best person to make that decision? Well, this is the problem, so this is where personal responsibility falls, so personal responsibility, as you know, we talk about four criteria that must be met, none of them are met. the first number, the second is a bit, let's say, cheeky team, who invented personal responsibility? Any ideas, I'm definitely going to get this wrong, yeah, you're going to get this one wrong, are you ready, yeah, I'm not. The tobacco industry knows the notion of personal responsibility.

They invented it. There was no personal responsibility until tobacco in 1962. CU was killing them for science and they needed to invent another reason to smoke. In fact, there is an article that Dorfman published. In all of this, they looked at the New York. Times and the Washington Post and did an exhaustive search across the entire output of those two new newspapers over decades to look for the term personal responsibility and the first. The time it was mentioned was in 1962 and it didn't pick up steam until 1986, which was the same year that cipolone V liot came up in the Supreme Court, which basically said that, you know, the cigarette industry was, um, was guilty from U from um uh applying people an addictive substance, so this is very specifically industry driven and we have the data to prove it surprisingly well, I wonder in the sense of personal responsibility, given that many listeners to this conversation are going to be thinking about your own food intake and choices, that of your children and other family members, who we could play a little, a little, uh, not a game, but a little quick, it's fire.

Q&A I've never done this before on this podcast, but I think it's particularly appropriate for a discussion like this that covers so many areas and I'll definitely invite you back and maybe along with um lle to talk about some of the interesting work that's going on. doing because there is a lot we could cover, but people will wonder in a It makes a very practical sense whether or not they should consume certain things and I know that you are not the food police. I'm not the food police and I'm not a police officer and I think people should be able to choose. about these topics, but I also think that because you are a guest on the podcast and you are so knowledgeable and you have done clinical work and research for so many years in this area and you have such a clear stance on the role of big food and we really appreciate your honesty and openness, but I wouldn't be willing to comment on a couple of different terms that I'll throw out and if you choose not to have anything to say about that, that would be fine. be a quick pass so here we go and we covered a little bit of this before but fruit in its whole form has fructose but it has fiber so thumbs up, thumbs sideways or thumbs down for fruit consumption, fruit is fine, fruit juice is not great, thanks white rice versus brown rice and between white rice there is sticky rice and rice with added sugars that are found in many restaurants brown rice because to the grain of polished white rice, you know, number one. all the vitamin B1 disappeared and, of course, much higher glucose.

Excursion to that glycemic index which of course I hate it's the glycemic load that matters and that's a very high glycemic load so brown rice is better than white rice. Yes that's fine. in a meaningful way in a meaningful way okay, you mentioned tomato sauce earlier. I love tomato sauce made only with tomatoes. 10% of the tomato sauces available on the market have no added sugar so you have to know which ones you can look at yourself or you can search for the perfect one and it will tell you which ones you can buy if people decide to consume them. bread a lot of people make, is there a way to make it across the board without just baking your own or seeing or looking at the ingredients list to make a better choice?

It's as if sourdoughs tend to have less sugar than white ones. Well, the sourdough has been fermented. so you will actually have consumed some sugar, so it would be a better option, but actually the best option is breads with higher fiber content. Now, if you look at a wheat berry, it is 25% fiber, the peel is 25% of its weight. wheat berry, that means the carbohydrate-to-fiber ratio of a wheat berry is 3:1, so a good bread should have a carbohydrate-to-fiber ratio between 3:1 and 5:1, which exceeds any value above, which means they've removed the fiber, so that's something you could do, but the easiest way is to look for it in perfect.

You mentioned meat and sourcing meat, egg and chicken, maybe let's just review that meat, fish and eggs, uh, thumbs up, thumbs sideways, thumbs down or it depends depends depends on where the meat came from depends on whether it was raised on grass depends on if it's organic or not if the animal was injected with antibiotics stay away because those antibiotics are in the meat they're going to use basically sterilize your gut and then the bad bacteria will take over. We haven't really talked much about the microbiome today, but that's a whole podcast in itself, well, we can touch on it a little more.

F low sugar fermented. foods thumbs up thumbs sideways thumbs fermented foods short chain fatty acids all good what are your favorite sources of fermented foods I like kimchi yes, I like kimchi too I like some of the live sauerkraut yes, that's too well but with the right you know the right uh air conditioning accessories um the only thing I would be careful with is yogurt okay so there are yogurts with live cultures and there are a lot of yogurts with dead cultures and if it's a yogurt with dead cultures it's kind of irrelevant and most likely In fact, I've covered the acidity with sugar, so comm, you know, commercially available large yogurt, be very, very careful, okay, if it's an artisanal yogurt that you know, made by people you know or trust, you know it's a very different story um you know yogurts with live cultures intermittent fasting do you practice it and what do you think about it um I don't practice it but I'm for it turns out the right patient turns out who is the right patient the patient with liver fat because the reason it works is because it gives the liver a chance to basically burn the fat that is stored.

Calorie-free soda, I have it, I definitely don't and I don't even have to ask about sugary soda because that's basically poison. in a can, food combinations, uh, I have a feeling I know what your answer is, but the glycemic index that we know your feelings about now states that if you combine some fat with something sugary like eating ice cream, you have a response of more attenuated insulin. than if you ate pure calorie-equivalent sugar, but what do you think about food combinations as a way to mitigate the insulin response? Food combinations are great if there's some fiber associated with it, it's fiber again and by the way, By the way, you know, I'm the medical director of a fiber company.

What is it? It's called biolumina and it's a patented fiber. It is a microcellulose sponge seven microns in diameter, that is, the size of a red blood cell. you swallow it, it goes to your stomach, it expands 70 times more than its original size and that's why it will give you a feeling of fullness because it takes up space in your stomach, but the most important thing is that when it expands, the nooks and crannies of the sponge become available and embedded in those nooks and crannies are a set of proprietary soluble fiber hydrogels that sequester glucose, fructose, sucrose, simple starches and make them unavailable for early absorption in the dadum, thus reducing the glucose response, by reducing the insulin response, protecting the liver and moving it through the intestine so that the microbiome can chew it for its own purposes by feeding the intestine we can reduce glucose absorption by 36% fructose absorption by 38% absorption of sucrose by 40% the absorption of simple starch by 9% and increase the production of short chain A fatty acids by 60% % without an increase in gas, when do people take this with meals?

So, it comes in a sachet form, a teaspoon, sprinkle it on your food or have it like you know, in a drink, just mix it up and drink it. and then have breakfast, lunch or dinner and it will basically act as if you ate real food, it will convert processed food into real food in the gut and we have clinical trial data showing that it is available as a commercial product, it is available and it is called Munch. Munch now I hate that name. I didn't make it up right. Yes, your marketing team sucks, but the product sounds amazing.

What a biol. Great technology, thanks for sorry, Munch Munch marketing team, but you have to chew on a new product name, but it sounds like a very interesting product and it actually answered my next question, which was about fiber supplements, the fiber is good, but there are two types of fiber, soluble and insoluble, they are notsame so soluble is what's included in the Fiber One bars you know psyllium um inulin uh um uh uh pectin like what holds the gelatin together um that's good I'm not saying it's bad but you need the insoluble fiber , the cellulose, the celery fibers, the cardboard, if you put it together, they form this gel that we talked about before, if you only consume the soluble fiber, which is what the food industry will add to foods because insoluble fiber It is not impossible if just add the soluble fiber, you're not going to get the benefits of the full fiber supplement before when you're talking about the Nova system and, uh, most of our foods, let's say I know it was 7 to 10%.

Let's say 95% let's vent on the better side, uh, 95% of our food should come from Nova System class one or class two foods, or three or three, okay, stay away from those Nova Class 4 foods, could you give us some examples of Nova? Class one and class 2 foods um, just BR, generally speaking, okay, Nova class one is any food without a label period, if you see a label on a food, it's a warning label, well, there's ground beef. it has a label, okay, so that's it. I'm talking about Apple, well, when I buy it it has a label.

I ask because people will wonder. It does not have a nutrition facts label. Is there a nutrition label on some ground beef I buy? that ground beef where I eat venison, where if you turn it over it says how many calories, how much protein, so there's a label, but it's just beef for venison, okay, so that's class one, okay, the egg, the egg is class one, etc. of course, fruit, apples, orange, okay, so it doesn't matter if it has a name, a name tag, as long as it doesn't have an ingredient, the lab got it, real food doesn't need a label, it's just if they did something to It's that it needs a label, so you have to look at each label as a warning label.

Now the problem with the label is that it only tells you what is in the food. What you really need to know is what has been done to the food because it is the last thing. processed food, that's the problem, they don't want to tell you that that's a secret, okay, it's a secret from an ownership point of view, but it's also a secret because if you knew what they did to him you wouldn't need it, you would never need it. you would buy and they wouldn't. I want you to know so that they only tell you what is in the food, that is not what is important, it is what has been done to the food that is important and that is why this Nova class 4 is so important and that is why That's why perfect is so important because it will get the job done.

For you, okay, I'll definitely give you links to all of these, so if you could pick one thing to recommend to people who want to improve their health, get rid of sugar, okay, period, very clear, that's number one, the Number two, go for a walk, exercise. Yes, go for a walk and if you could recommend something that the general public can do to try to help in this advocacy of not redefining, but clearly defining what is food and what is not and raising awareness at the level of policy and change and lunches schoolchildren I mean, if there was one thing, what can we do?

I mean, you've clearly activated my surrounding neurons, like the set of problems that exist and the paths to correct them, but should we write to our Congressional People, should we get mad at the hospitals because they have all these fast food machines and that the Cafeteria food is like disease promotion at UCSF, we have gotten rid of sugary and oily drinks, do we have a healthy drink initiative? So there are no Coca-Cola machines at UC There are no Coca-Cola machines at UCSS wow Stanford look at that because you know people always send me pictures of the Coca-Cola machines at the School of Medicine.

I say, listen, I didn't put it there, but I, I, uh. we have to model for the public, you know, I mean, where was the first place that banned smoking? The hospitals are fine because we knew it. If you get rid of the sodas, you know, uh, if you get rid of the sugary sodas in the hospital. We're telling people something, so yeah, I think all hospitals and really all public places in America should clean up their trash, so post pictures of trash that's supposed to be in health-promoting institutions and I guess that we are trying. to cancel junk food we're trying to cancel junk food I'm pretty opposed to cancel culture but here we go let's cancel um wonderful it's actionable it's easy it's low cost low time investment zero cost um very low time investment so thank you for that and look into real eating because we're doing it for your kids so you need to help support it.

Any school district in the United States can do it. Then what do we do? We have a business model whereby the director of Food Services, um. He buys or rents a dilapidated factory in the center of the district and repurposes it into a food preparation facility. They can prepare 27 to 30,000 meals a day. Okay, with a Skeleton Crew, you know, and then they and you control what's in it and why you. By buying in volume, you actually reduce the cost, so it's cheaper than buying it at Cisco, Aromar, Sedexo or wherever and then you distribute it via truck or bus to the different schools so that each child receives a meal hot made from scratch. day and we can solve this problem, I can't help but ask this last question for people who want to eliminate sugar, which you clearly indicated is the most important thing for health, how do we know how much sugar is in something?

So should people look at labels and just look for the amount of sugar and the amount of carbohydrates or could we even go as far as to say that if it says high fructose corn syrup then it's on the fly list, do not do it? I don't eat it so the problem is there are 262 names for sugar and the food industry uses them all and the reason they use them all is because they can include a different sugar like number five, number six, number seven, the number eight. number nine on the list when you add it up becomes number one they hide in plain sight and they do it on purpose now i hope everyone memorizes all 262 names no of course not can you find out yourself?

The answer is no. unless they have the line where it says added sugars, if it says added sugars, it's sugars or high fructose corn syrup, no one adds lactose, okay, that's not Happ or glucose, they don't even add glucose because glucose doesn't is so sweet. It's not that interesting, you don't see people drinking Kos syrup, are you okay? That's glucose, who cares? Yes, it may be good in the molasses cookie, but that's okay, it's fructose, so you need to know what's been added, so if it says added sugars, that's a good starting point, no more than a teaspoon per serving, no more than four sets per serving of added sugars, anything more than that, leave it at the store and aim for the Nova type, type one, no aim for the Nova types, one, two and three and if you don't know if it's Nova type one, two or three, you can use perfect and if you don't look at that, look at the nutrition label and anything that has more than four ingredients is Nova class 4, Robert. lustig thank you so much, you have provided such an incredible educational background in nutritional biochemistry, the processing of fats, proteins, carbohydrates, sugar, fructose, in particular, the clear detriments of fructose consumption on so many different organ systems.

I love, love, love that you separated science from food. Nutrition. and metabolic health or personal health, that's just me, that's a million dollar delineation for people to understand and shape their understanding of all the information that exists and is grouped into these different categories. It's given us so many practical, um new tools. Conceptual Frameworks: Today you gave us a real tour of the force in such clear language, so I want to thank you, I have learned a lot and I know everyone else has too and if people have questions they can of course ask them. them in the comments section on YouTube which is the best place where we will provide links to all the companies and websites that he referenced and some of his other work and I will listen.

I'm very grateful that it exists and that you've done the work that you've done and your passion and your advocacy for health is um it's very clear thank you so much for that I want to thank you and the reason I want to thank you is First of all place, you know, inviting me, that's good, you know, that's good, but the reason is that people need to understand the science. I completely agree with you, the public needs to understand the science, they listen to you because you, number one, provide the science and number two. you don't talk down to them, you treat them as equals and that's really extraordinary, so I want to thank you for your service, well you're welcome, it's a labor of love and I think it was the great Max Del Brook.

That said, when teaching, assume zero knowledge and infinite intelligence and I believe that humans are infinitely intelligent, although sometimes we collectively mask it. People deserve knowledge, so thank you very much for sharing that knowledge today and we will definitely have it back. It's my pleasure, thank you, thank you for joining me for today's discussion with Dr. Robert Lustig about nutrition and how sugar affects the health of our brain and body to learn more about Dr. Lustig's work and find links to the many books he has written on this and other topics, check out the subtitles in the show notes, if you are learning from Andor, please join this podcast, subscribe to our YouTube channel which is a great way to support us at no cost, plus , subscribe to the podcast on both Spotify and Apple and on Spotify and Apple, you can leave us a review of up to five stars if you have questions for me or comments about the podcast or think you'd like me to consider it on the Hubman Lab podcast.

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