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 School of Medicine. My guest today is Dr. Robert Lustig. Dr. Robert Lustig is an endocrinologist that is he's a specialist in the function of hormones in the body and a professor of pediatric

endocrinology at the University of California, San Francisco. He has authored more than 100 peer-reviewed studies exploring how different types of nutrients, that is food, impact our cellular functioning, our organ functioning and thereby our health. During today's discussion, we discuss the idea of whether or not a calorie is indeed a calorie and whether or not our body weight and body composition only reflects the number of calories we eat versus the calories

that we burn. We talk about how different food types, that is how the different macronutrients, protein fat and carbohydrates are processed in the body and the important role that fiber and the gut microbiome plays in that process and we pay particular attention to the topic of how different types of sugars and fructose in particular can indeed be addictive to the brain and can modify the way that hormones in the body in particular insulin impact our

liver health, kidney health and indeed the health of all of our cells and organs. Indeed, Dr. Lustig is an expert in how sugar impacts the brain and body. We talk about how certain types of sugars can indeed be addictive in the same way that certain drugs of abuse and behaviors can become addictive. So in other words, how sugar actually changes the way that the brain works and we discuss how the food industry, that is the commodization and sale of particular types of

food has altered the way that we eat and indeed the foods that we crave. Today's discussion covers all of that and by the end of today's discussion you'll have a thorough understanding of how foods are processed when they enter your body and how those different food choices are impacting your immediate and long-term health. Before we begin, I'd like to emphasize that this podcast is separate

from my teaching and research roles at Stanford. It is however part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the general public. In keeping with that theme, I'd like to thank the sponsors of today's podcast. Our first sponsor is 8 Sleep. 8 Sleep makes smart mattress covers with cooling, heating and sleep tracking capacity. I've spoken many times before on this podcast about the fact that sleep is the foundation of mental

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to get $150 off their pod 3 mattress cover. 8 sleep currently ships in the USA, Canada, UK, select countries in the EU and Australia. Again that's 8sleep.com slash Huberman. Today's episode is also brought to us by levels. Levels is a program that lets you see how different foods affect your health by giving you real-time feedback on your diet using a continuous glucose monitor. One of the most important factors in your immediate and long-term health is your blood

sugar 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 you just put the monitor on the back of your arm and then you take your phone and you scan it over that monitor now and again and it downloads the data about your blood sugar levels in the preceding hours. Using levels has allowed me to learn a tremendous amount about what works best for me in terms of

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brought to us by Aeropress. Aeropress is similar to a French press for making coffee but is in fact a much better way to make coffee. I first learned about Aeropress well over 10 years ago and I've been using one ever since. Aeropress was developed by Alan Adler who was an engineer at Stanford and I knew of Alan because he had also built the so-called aerobie Frisbee which I believe at one time. Perhaps still now held the Guinness Book of World Records for furthest throne object and I

used to see Alan believe or not at parks around Palo Alto testing out different aerobie Frisbee. So he was sort of famous in our community for developing these different feats of engineering that turned into commercial products. Now I love coffee. I'm somebody that drinks coffee nearly every day usually about 90

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discussion with Dr. Robert Lustig. Dr. Robert Lustig, welcome. Pleasure truly just being here, being invited, high honor really appreciate it and it's not Dr. Hiss just Rob. Okay Rob I've been looking forward to this conversation for a long time. I've seen you're now famous. We also say infamous but the famous YouTube video about sugar will put a link to it in the show note captions. It's been viewed many many millions of times. Yeah and I still can't figure out why that is. You know well I

think my mother would watch it and she didn't but 24 and a half million people did. Well I think people are very interested in what to eat what not to eat and we'll start off simply talking about what most everyone believes and understands which is that a calorie is a form of heat energy

that's given off during the processing of some food bit or some thing. If that's mysterious to people just understand that a calorie is a unit of energy and I was taught and still many many people worldwide believe that a calorie is a calorie meaning if I consume more calories in whatever

form then I metabolize by thinking feeling moving exercising etc then I will gain weight and if I consume fewer calories than I burn I will lose weight and we could talk a lot about where that weight loss comes from does it come from adipose body fat stores or from muscle or from protein or muscle of course is protein etc but let's start off with is a calorie truly a calorie when it

comes to the processing of different types of calories. Everyone thinks that obesity is about energy balance that is calories in calories out therefore two behaviors gluttony and sloth therefore if you're fat it's your fault therefore diet and exercise therefore any calorie can be part of

a balanced diet therefore don't pick on our calories go pick on somebody else's calories this is actually what the food industry uses to assuage their culpability for the change in the food supply and the rise in obesity and chronic disease like diabetes now it is true that a calorie is

that unit of energy that raises one gram of water one degree centigrade and so therefore a calorie burned is a calorie burned I don't argue that that's true that's you know the first law thermodynamics looks but that doesn't mean a calorie eaten is a calorie eaten that's not the same and that's

where people get it wrong so let me give you some examples of how that calorie eaten is not a calorie eaten you like almonds I do me too almonds are great you eat 160 calories in almonds how many of those do you absorb 130 you eat 160 absorb 130 where are the other 30 go in the processing of that

food energy no turned out the fiber in those almonds both soluble and insoluble fiber and by the way fiber is sort of the key to the kingdom in this story forms a gel on the inside of your intestine the insoluble fiber the cellulose forms a fishnet if you will alattice work on the inside

of your duodenum the soluble fiber which are globular plug the holes in that fishnet together they form a secondary barrier you can actually see it on electron microscopy a whitish gel and that prevents absorption of those 30 calories so yes 130 get absorbed but many of them don't

they end up going further down the intestine to the next part called the jajunum and that's where the microbiome is now everyone knows about the microbiome nowadays you know it's all the bacteria you know we always say when women are pregnant you're eating for two well we're always eating for

100 trillion now they have to eat well what do they eat they eat what do you eat the question is how much did you get versus how much did they get well if you ate almonds they're getting those 30 calories so even though you count the calories at your lips that doesn't matter what really

matters is counting the calories at your intestinal brushboarder okay and they're not the same so if you feed your gut that's a good thing because then your gut will take those calories and turn it into things like short-chain fatty acids which end up being protective against chronic metabolic

disease acetate propine butyrate valorate those are actually good their anti-inflammatory anti-alcymers because you fed your microbiome so even though you ate 160 you absorbed 130 so calorie eaten is not a calorie eaten because if you ate it with fiber it wasn't for you it was for your

bacteria but that's not the way you count them up so that's problem number one problem number two amino acids so we all eat protein let's say you eat too much protein you have you know the porterhouse steak all right now if you're a bodybuilder those amino acids might go to muscle and you might 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 mortal like me or let's say you're a kid going through puberty who's synthesizing a lot of muscle yeah because they're lifting weights because there are because testosterone's making it happen yeah absolutely but let's say you're not let's say you know you're just you know just slump off the the street like you know Joe Schmo and you eat that porterhouse you've taken on all these amino acids there's no place to store it other than muscle so your liver takes the excess

and de-amidates that amino acid takes the amino group off to turn it from amino acid into an organic acid and then that organic acid can then enter the creb cycle the tri-carbic silica acid cycle what goes on in the mitochondria in order to generate ATP the chemical energy that your body needs

in order to power itself okay now that's a good thing it takes double the amount of energy to prepare that amino acid for burning as it does to prepare a carbohydrate for burning or so the fruit because when I asked about when you asked about almonds why the the 160 versus 130 I thought

it was the processing internet it was fiber you're saying for protein let's let's make it realistic for a really nice big porterhouse steak which I love by the way let's say let's say 800 calories yeah well how much of that is is so that's what goes in your mouth right my mouth right how much of it

is actually um eaten in uh to stay with the your calorie and it's not a calorie in in the processing of that what percentage is actually goes into your total caloric intake right so about 10% of everything you eat goes to just maintaining body temperature it's called the thermic effective food but when you're eating protein you actually generate more heat and the reason is because it takes two ATP to phosphorylate that organic acid as opposed to one ATP to uh phosphorylate that carbohydrate

for consumption so you actually have a net loss of energy because it was a amino acid versus a monosaccharide a sugar now you you brought up fat fat doesn't need to be phosphorylated so it actually doesn't have any um thermic effective food at that point so it depends on what it is as

to whether or not you have loss okay so but with this um let's make it actually realistic a 1600 calorie porterhouse with a nice slab of of uh grass bed butter on there okay this every once in a while not not often with some cream spinach and maybe some mushrooms along the side honestly I

say when I'm eating a porterhouse I don't want to adulterate the taste okay with anything else except maybe some some butter maybe a salad okay afterwards but but let's say 1600 calories of of it's got some fat in there for sure um let's say um uh a thousand of those calories is protein

the other 600 are fat something like something like that depending on how marble it is okay so based on what you just said about the thermic effective food and protein in particular yeah of that thousand calories how much actually is can we count I'm not a calorie counter but

does one include as calories truly ingested well if you ingest at 1600 well that's what went in the mouth but but but but what is is gonna go against your your uh burn deficit right so I would have to actually do the math to figure that out but yeah as a guess yeah back of the envelope

back of the envelope calculation you're gonna lose about 25% of that wow so we're talking 750 calories yeah you know so it and to translate this a bit so what we're saying here is if you're somebody who is trying to lose weight or maintain weight or perhaps even gain weight you eat a 1600

calorie porterhouse with a slab of butter on it 600 of those calories we're saying in this is this is fat with the remaining thousand calories that's that all went in your mouth so you count it at your mouth right but 700 but then when you compare it against your energy burn for that day

to maintain temperature brain activity physical activity really it's only 750 calories that's right that's a huge difference exactly and another reason why a calorie is not a calorie now let's take the third let's take fats so we're here we have omega-3s hard healthy anti inflammatory anti

Alzheimer's save your life and over here we have trans fats the devil incarnate consumable poison because you can't break the trans double bond you don't have the desaturate to break that trans double bond so it basically accumulates lines your arteries lines your liver causes chronic metabolic

disease causes insulin resistance omega-3s don't even get broken down for energy because they're so important they stay intact because your brain needs them your heart needs them whereas trans fats can't be broken down because of that trans double bond one save your life other one kill you

they're both nine calories per gram if you explode them in a bomb calorimeter because a calorie burns is a calorie burned but a calorie eaten is not a calorie eaten because one will save your life one will kill you and finally the big kahuna the one that blows everything else out of the water

fructose and glucose all right now glucose is the energy of life so here we're talking carbohydrates I think most of our audience will be familiar with the so-called macronutrients we talked about fat in this case almonds there's somewhat fiber in there probably a little bit of carbohydrate a little

bit talked about the porterhouse with butter right you can be hungry already that's protein and fat very little if any carbohydrate zero essentially and then now we're talking about carbohydrates and we're going to subdivide that into glucose and fructose right galactose basically

becomes glucose in the liver so we we can dispense with that unless you have a disease called galactycemia which is about one in twenty thousand and causes neonatal meningitis and you know so disease as a pediatric endocrinologist I would take care of but we can dispense with that for

the moment all right so glucose fructose glucose is the energy of life every cell on the planet burns glucose for energy glucose is so damn important that if you don't consume it your body makes it so it will take an amino acid and turn it into glucose that's glucose neogeneres

glucose neogeneres 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 inuid they didn't have any place to grow carbohydrate that ice they had whale blubber they still have serum glucose level

and the reason is because you had to you have to have a serum glucose level in order to power your brain in order to power your heart yes you you can use ketones of course you can but you know only if you're in a ketogenic state will you use exclusively ketones and you also need glucose

for structural changes in specific proteins and particularly hormones so glucose molecules will stud TSH LH FSH different pituitary hormones in order to increase their potency it's one of the reasons why aging leads to defective hormonogenesis for instance hypogonatism hypothyroidism is the

loss of glycosylation on individual peptide hormones because of the inability to add glucose because of insulin no no just it's an aging phenomenon okay we'll come back to this because I think it's really important yeah the idea that ingestion of carbohydrates and the as you call

that the studying of carbohydrate molecules on hormones can augment the function of those hormones and with aging that's a less efficient process so less efficient process but it's not because of consumption it's right people are still I see the the plenty of folks who are 65 and older eating

plenty of carbohydrates you're saying a lot of them have deficient thyroid testosterone estrogen prolactin etc because of the way those carbohydrates are not studying the the hormones exactly so they're all of those are glycoprotein hormones let's tee that up for later because I think

that's interesting it's a very important you to go down okay and there's a and there's a disease in children in in babies called congenital disorders of glycosylation where you can't put uh glucose molecules on specific proteins and of course this severe mental retardation all

sorts of metabolic havoc and a lot of those babies die for that matter so that's an important thing all right but that's how important glucose is fructose on the other hand this sweet molecule the molecule we seek the reason why the food industry studs every food in the grocery store you know 73

percent of all items in the American grocery store have added sugar on purpose for the food industries purposes not for yours because fructose is addictive activates the nucleus accumbens the reward center of the brain in the same way that cocaine heroin nicotine alcohol do and

drives dopamine receptors down just like nicotine you know alcohol you know cocaine heroin do you that molecule fructose is number one uh completely vestigial to all vertebrate life there is no biochemical reaction in any vertebrate that requires dietary fructose that's number one

number two okay sorry I'm gonna just insert so you're saying that even though we can process fructose we have a limited capacity to process it in the same way we have a limited capacity to metabolize alcohol now if you have one drink a day you're okay if you have two drinks a day

depends on how big you are you know you and I can probably argue two drinks a week is the maximum but let's not go there the um but but in terms of you're saying when you say fructose processing of fructose is vestigial what you're saying is that we don't need to do it that's it's like the

appendix it's an organ for which it has no function exactly and fructose has no function in the human body period you don't need it you don't need it don't need it but our diet is replete with it in fact our fructose consumption has gone up 25 fold

since the beginning of the last century I have to ask this now I love fruit I eat berries galore especially since the price of berry seems to have come down it used to be the only get them a certain times a year I'm what you call a drive by blueberry eater so I'll just walk

past and just take a fistful you can't put them in front of me without me eating them has this is even difficult for me when other people I don't know are eating them so I eat lots of blueberries strawberries blackberries if they're in season I love them no problem loaded with fructose no plenty

of fiber low fructose low fructose berries berries are the lowest fructose of all I was so worried about asking you this today not okay okay and fruit is okay because of the fiber so the molecule the fructose molecule is the same whether it's in a berry or in a banana or for that matter in

a Coca-Cola the fructose molecule is the same molecule the difference is that in the berry it comes with a whole lot of fiber and the banana comes with a whole lot less fiber and in the Coca-Cola doesn't come with any fiber and the fiber is what mitigates the absorption so when you consume

the fructose with fiber so your blueberries you're feeding your microbiome that fructose wasn't for you got it such a relief and I must say recently I had a whole body MRI as an okay preemptive thing someone's that it was it was great I got to watch a Netflix in there and I never had a whole

body MRI I learned a few things that were useful to me I've got a clean bill of health so that's great one of the pieces of feedback I got is that my gut was filled with this very high contrast stuff right and they asked you know do you consume a lot of blueberries and I said

indeed I do why and they said because that high contrast of it shows up white on the scan yeah is high concentrations of magnesium that we see in people that ingest large amounts of blueberries which is pretty rare and yours are comparable to a bearer in blueberry season wow

and basically my entire gut was filled with blueberries I suppose I need to cut back a little bit but now I know that fruit is okay especially if the fruit has a lot of fiber yeah but fructose itself especially if it's not partnered with fiber yeah is first of all not required for survival at all

but your timing is problematic yeah and let me tell you why it's problematic we haven't gotten to that yet we're just talking about whether it's vestigial versus needed now let's talk about what fructose does turns out fructose inhibits three count them three separate enzymes necessary for normal

mitochondrial function now I hold your mitochondria make ATP your mitochondria have to work at peak efficiency that's what metabolic health is is mitochondria working at peak efficiency well there are three enzymes that are inhibited by fructose number one AMP kinase all right now AMP kinase is the

fuel gauge on the liver cell it's the thing that tells the liver to make more mitochondria fresh or mitochondria because if your AMP levels are high that means you've defrost-forilated a bunch of ATP's and you have to regenerate them so you need some more mitochondria so it's a negative

feedback pathway well you need that AMP kinase to generate that mitochondrial biogenesis signal except that fructose a metabolite of fructose called methylglyoxyl MGO sits in the active site of the gamma subunit of that AMP kinase and actually binds to arginines

in that active site rendering that enzyme now dead it's an irreversible inhibition because of the covalent bonding of that methylglyoxyl that aldehyde to the arginine and now that enzyme is dead okay so it basically acts like a key that doesn't turn the lock but prevents the the key that you

want in that lock fermenting the lock it's like it's like gluing a lock shut yeah got it all right that's one of the enzymes that's one okay second one acad L acyl coad dehydrogen acelone chain so this is necessary to cleave two carbon fragments off fatty acids to prepare them for

metabolism so inhibits that one and then finally inhibits carnitine palmitol transferase one now CPT one now that's the enzyme that regenerates carnitine carnitine is the shuttle mechanism by which you get the fatty acids from the outer mitochondrial membrane through to the inner mitochondrial

membrane so that they can be beta oxidized for energy so if you don't have that CPT one you're basically carnitinous and therefore you can't generate beta oxidation you said fructose inhibits all three of these enzymatic pathways yep as a biologist I have to ask you know

how potently does it inhibit them I mean because there's there are drugs that block receptors and then there are drugs that block receptors with unbelievable affinity so you know I mean mechanistically in a dish meaning in vitro you can see all sorts of things but how significant is this for like

for obesity for mitochondrial function in vivo in us all right so you know the dose determines the poison right paracelsis 1537 there are toxins that are parts per billion and will kill you like seren rice and cyanide by the way cyanide is a good analogy because it's working on mitochondria

it's basically causing mitochondrial to be completely defective all right then there are intermediate toxins like arsenic and carbon tetra chloride parts per million and they take a little longer to work they're not gonna kill you on the spot that's why I can eat an apple seed

that has a little bit of arsenic in it but I'm not gonna die right and then finally there and by the tobacco smoke goes in there and then finally you have weak toxins all right and you know where it's not one exposure that will kill you it's you know 10,000 exposures that'll kill you

like alcohol for toxic people yeah well sometimes it all takes on cuneurysic sorry sometimes it don't mildly toxic people anyway the point is that fructose is in that last category so it's not what you do one day that kills you it's what you do every day that kills you and if you

basically eat ultra-process food high in sugar for 10 years in a row it's gonna show up in terms of your comorbidities and ultimately yeah it will kill you and we have the data to show you know how many years you will lose so right now in America we pay an eight-year longevity tax

if you look at Japan who they have a mean age of death of 88 we have a mean age of 80 okay we're paying an eight-year longevity tax just by living here and we're talking about the healthy people now if you have metabolic syndrome it's a 15-year longevity tax and sorry if you obesity it's a 15-year

longevity tax if you have metabolic syndrome it's a 20-year longevity tax that is primarily not completely but primarily sugar it's also you know omega-6 is it's also trans fats you know leftover because now they're gone but you know people who still suffering the ravages of the

trans fats you know from the previous generation are they gone I mean I do remember as a kid when we had margarine in our refrigerator this is actually a big debate in my home one parent I won't identify which was pro-margarine the other was pro-butter anti-margarine right the marriage had

lasted there were other reasons that's probably why I went butter butter butter is fine in fact time declared you know front cover butters back you know margarine was the bad guy without question and we know now but you know back when we thought it was a calorie it was a calorie we thought oh

margarine you know it's the same you know nine calories program and we said it lowers your triglycerides that idea it was because what it did was it lined your liver because you couldn't break that trans double bond and you know so they're they're now gone from our food supply they're

illegal they're illegal they're banned but you can make trans fats in your own kitchen by taking olive oil and heating it to beyond the smoking point so they're not completely gone they're just gone from ultra-process food so now sugar is the big problem because of these three enzymes that

you are inhibiting the point is we were we started this with a calorie is a calorie well if you are inhibiting mitochondrial function then a calorie is not a calorie is it you're reducing the intensity of the furnace yeah exactly so this whole calories a calorie just makes no sense and it

hasn't worked at any level and there is no study that actually shows that cutting calories makes a difference and I can show you you know voluminous data that shows that virtually every weight loss study that caused that led to you know caloric restriction basically didn't work not for any length

of time just to round out our earlier discussion because I find it fascinating and I know other people will as well talked about that 160 calories that's actually 130 at the business end of things of almonds we talked about the porterhouse steak with butter and the 25% reduction in what's

actually quote-unquote eaten and I'll get back to this because this quote-unquote issue I think the problem is there's there's a lack of useful language to dissociate this stuff yeah you know even just calling fat fat people think it's gonna make you gain body fat totally if we call the adipose

tissue and lipids we would have avoided this confusion so I don't want to get there just yet but I want to make sure the food industry does this on purpose really oh absolutely so they tell you a sugar is a sugar which is not true they tell you a calories a calorie which is not true

and they tell you a fat is a fat which is not true okay this is very specifically so when you're talking about sugar you're talking about dietary sugar are you talking about blood sugar because blood sugar is blood glucose or I never use dietary cholesterol or circulating cholesterol

or yeah absolutely yeah okay so we've done this you know to ourselves but the food industry has really promulgated it because we farmed out nutrition policy and information to the food industry so they actually use this for their purposes it's one of the problems in this field

as we all know quality nutrition influences of course our physical health but also our mental health and our cognitive functioning our memory our ability to learn new things and to focus and we know that one of the most important features of high quality nutrition is making sure that

we get enough vitamins and minerals from high quality unprocessed or minimally processed sources as well as enough probiotics and prebiotics and fiber to support basically all the cellular functions in our body including the gut microbiome now I like most everybody try to get optimal nutrition

from whole foods ideally mostly from minimally processed or non-processed foods however one of the challenges that I and so many other people face is getting enough servings of high quality fruits and vegetables per day as well as fiber and probiotics that often accompany those fruits and

vegetables that's why way back in 2012 long before I ever had a podcast I started drinking AG1 and so I'm delighted the AG1 is sponsoring the Hubertman Lab podcast the reason I started taking AG1 and the reason I still drink AG1 once or twice a day is that it provides all of my foundational

nutritional needs that is it provides insurance that I get the proper amounts of those vitamins, minerals, probiotics and fiber to ensure optimal mental health physical health and performance if you'd like to try AG1 you can go to drinkag1.com slash Hubertman to claim a special offer

they're giving away five free travel packs plus a year supply of vitamin D3K2 again that's drink AG1.com slash Hubertman to claim that special offer for the third category of macronutrients carbohydrates you differentiated glucose and fructose if I ingest let's say a half a bagel since we were

talking about New York your city of origin they have great bagels on the west coast yeah yeah it's not the same it's pretty pitiful same with the pizza dough it's like they claim it's the the water whatever it is it's different back there and it's better the half a bagel let's say

250 calories mostly carbohydrate this is an in unlined on no cream cheese no smear as they call back there no no cream cheese no butter no nothing just half a bagel 250 calories so that's what I ate you're saying that a calorie eaten is not a calorie eaten how much of that carbohydrate given

that it's probably most let's assume it's mostly glucose let's do it this way yeah it is it's polymerized glucose okay polymerized glucose how much of that is actually utilized or burned versus you know the the original 250 so if you look at what happens to energy in the body

65% of that which is ingested goes to resting energy expenditure just to power the body 10% goes to the thermic effective food and then 25% goes to activity that's the breakdown of where the energy goes and that's calories from fat protein and carbohydrates from everything together

and you know glucose is a perfectly good example of how that works the point is though that when you ingest glucose you're getting a big glucose excursion in your bloodstream so you're getting a big glucose spike and that glucose spike has to come down well what makes it come down

before I'm on insulin insulin is the bad guy in this story the higher your glucose goes the more your pancreas will release insulin in order to bring that glucose down well turns out that glucose rise was not benign that glucose rise led to endothelial dysfunction transient but nonetheless endothelial dysfunction could you just remind people what endothelial cells are inside of your arteries okay and it will change blood pressure we've got plenty of data to demonstrate how it changes blood

pressure and over time that will cause coronary artery disease that will cause kidney disease etc but it's the insulin response that is really the bad guy now people think insulin is good because it lowers blood glucose after all diabetics take insulin you know to lower their blood glucose

okay let's take a diabetic patient with diabetes blood sugar is 300 that's bad we give a shot of insulin in the arm blood sugar goes down to 100 blood sugar went from 300 to 100 okay where did the 200 points of blood glucose go

I'm assuming that the insulin would sequester it to where I'm assuming to the liver to the fat interesting for storage that's insulin's job insulin takes whatever you're not burning and puts it into fat for storage insulin is not the diabetes hormone insulin is the energy storage hormone

how quickly does it do that because because if I'm you know having a very busy day mm-hmm or that diabetic person is having a very busy day and they're moving around a lot mm-hmm then you got insulin bound glucose in the bloodstream for how no insulin doesn't bind glucose

insulin binds to its receptor sure sorry so it allows for glucose transporter so so but for some period of time while that person is active there's an opportunity to utilize that glucose well yeah right um but so how quickly is insulin managing that glucose we know that the spike comes

down quickly but the glucose is not available for energy utilization after what it's it's it's it's sequester to the the adipose to the fat tissue within an hour so about 90 minutes yeah but okay I mean if you if you're if you're active if you eat you know a muffin and you're active okay

your muscles are going to take up that glucose irrespective of insulin in fact muscles are insulin independent they have glucose transporters but they are insulin independent because if they weren't then every patient in diabetic ketoacidosis would be paralyzed okay so glucose will end

up in muscles irrespective of energy status and insulin status and in muscles it's used as immediate fuel and glycogen both okay immediately and glycogen storage okay in the muscle absolutely all right now if you're active then you will clear glucose into muscle therefore your

blood glucose won't rise as much because it went into muscle and therefore your pancreas will put out less insulin because it doesn't have to clear as much from the bloodstream and that's okay that's good right but let's say you didn't exercise so you've got a big glucose excursion now you

have a big insulin response and that insulin is going to take the excess that's in your blood it has to clear it and it will go to fat for storage that insulin rise turns out to be particularly egregious in terms of metabolic disease and I can prove it there is a mouse my favorite mouse

I love this mouse this mouse turns medicine on its head and teaches every doctor why they have to go back to medical school and learn it right this mouse is called the paderco mouse podi iar k.o is discovered by paderco no no is discovered in wrong cons lab it was manufactured in

wrong cons lab so this is a tissue specific insulin receptor knockout mouse okay iar k.o. insulin receptor in specific kidney in the kidney in the indecisive durko glomerular podocyte insulin receptor knockout mouse we haven't talked too much about

transgenic models and knockout and knockout so just in 10 seconds or less basically these are mice that are genetically engineered to lack the receptor for insulin specifically in the glomerular podocyte the kidney in the kidney and everywhere else in this mouse insulin does

its thing normally exactly great so these animals are euglycemic normal blood glucose levels these animals are normally glucose tolerant you know go up they go down just like every other mouse these mice are not fat these mice are not thin these mice are mice

except they have the worst diabetic nephropathy on the planet so they're oh their kidney is degenerative their kidneys degenerate to nothing yikes now they have normal blood glucose levels they have normal glucose tolerance they have normal insulin tolerance whole body but their kidneys are dying

how come can't be the glucose it's the insulin because insulin is the bad guy insulin is actually making the kidney disease and so these animals that are insulin resistant they have diabetic nephropathy without diabetes so the insulin is having a negative clearly negative effect on the

kidneys without binding to the receptor exactly so circulating insulin can do stuff without binding to its receptor well it's no binds to its receptor in different parts of the body other parts of the body of the kidney it can't because it's a knockout because it's knockout

right the point is insulin does stuff by itself and it turns out insulin drives growth now every cell in your body wants to burn at one time in its life and wants to grow at another time in its life every cell has those two pathways burning growth burning growth what determines whether a

cell should be burning whether a cell should be growing I don't know what makes it burning but presumably it's in them has only to do with mitochondria it has everything to do that so every cell needs to burn and needs to grow at a different time in its life here's a way to

think about it we all start out as a zygote a single cell we end up an adult now that single cell had to become two cells those two cells had to become four cells those four cells had to become eight cells and on and on and on and on so every cycle there's a doubling how many

doublings to get from a zygote to an adult what's an exponential growth so yeah I don't I don't know it off the top of my head 41 41 41 2 to the 41 doublings gives you an organ is a 10 trillion cells we're 10 trillion or 10 trillion we know that yeah okay 2 to the 41 okay now of those 41

doublings some of them had to occur in utero some of them had to occur postnatally so I need two numbers that add up to 41 how many in utero how many postnatally well way more you start off with a lot more than you end up with but then you have cells that turn over throughout the life spans

this is a tough one okay because skin cells turn over sure I'm with neurons it's it's pretty straightforward because you're gonna somewhere but you get right well you're and you're born with somewhere between three and 10 acts of what you end up with depending on the brain structure

so but for whole body wide I don't know how you'd come up with that number 36 and 5 okay 36 doublings prenatally five doublings postnatally and I can prove that to you too typical baby weighs seven pounds first doubling 14 pounds second doubling twenty eight pounds sex doubling 56 pounds

next doubling 112 pounds next doubling 224 pounds hopefully it's tough we'll be syndromes hopefully it's toughs there not not all people two under 12 pounds are obese but some people who are certain heights or below are two under 12 are obese okay point is the cell has to

know when to grow and when to burn it turns out that the signal for that is oxygen because oxygen is necessary for mitochondria to be able to burn in the absence of oxygen the cell only knows how to grow this is actually why out of warburg won the Nobel Prize in 1931

for the warburg effect he asked the question how come cancer cells don't need oxygen to grow and the answer is because no cell needs oxygen to grow in fact oxygen is the thing that prevents growth famous article from the New England Journal of Medicine 1951 Mount Everest in utero because every

fetus is oxygen deprived so normal partial pressure of oxygen 100 millimeters of mercury out here right if you if I checked your blood and be about a hundred right I hope so how about a tumor cell guessing tumor cells probably it's a double about 44 wait you just told our pressure of oxygen

in a tumor cell it's about 44 but you just told me that well tumor cells which grow like wild right they grow like wild because they don't have oxygen but they but there's some of the so here's what's peculiar about it tumor cells are some of the most vascularized cells or tumors are

have been asked by I mean one way to get a new kill one is to de vascularize the tumor cell yes and you know angiogenesis inhibition etc as you know it's a big deal you know jute folk moon and all that from Harvard you know so the excess blood to a tumor is the attempt to bring

in oxygen that it's not getting that's right as opposed to delivering lots of oxygen and that's why it's growing that's right okay but a fetus what's the partial pressure in the placenta 6 to 31 so it's actually like a mile above Mount Everest that's how much oxygen the

fetus gets and it's that for that reason that you've got 36 doublings and then as soon as you're out you know then you cut the cord and you start breathing and now your partial pressure is at 100 that's when growth slows down as there been any effort to treat tumors by oxygenating tumors

yes and what does that look like it's hyperbaric oxygen therapy it's a thing oh yeah yeah we will probably do an episode on hyperbaric chambers it's the the reason we haven't yet is it's pretty niche in it but there are people who own these things who sit in these things um yeah okay so

we got here by way of by way of carped by the bagel right um so I just want to orient us that you just that 250 calories of the the bagel we talked about glucose excursions that insulin rise that's driving the out of positing and also driving the growth okay in the absence

of oxygen because if you have oxygen then you don't need that much insulin okay so because you're gonna burn instead of store got it in terms of the the the raw metabolism of carbohydrate though that glucose if I eat 250 calories a glucose how much of that did I quote unquote actually eat

how much is used how much is used yeah let's assume that I'm at my desk working or I'm walking around a little bit I'm not I'm not exercising hard in the in the subsequent hour so used for what is the question I'm getting back to the calorie is the calorie a calorie clearly the answer is no

based on the processing of different types of calories we established it for fat the almonds we established it for protein right the porterhouse with butter and now we're we're trying to establish that for the 250 calories of a bagel which is glucose right so the glucose has to be fuss

correlated so you're gonna lose an ATP in the process so you're gonna go ATP goes to ADP and then that ADP will go to AMP a denosing monophosphate which will then go to IMP anositol monophosphate which will then go to uric acid okay and that uric acid will be then released from

the cell circulate in the bloodstream and hopefully go out in the kidney in the process that uric acid can inhibit mitochondrial function and it can also inhibit endothelial nitric oxide synthase which is the enzyme in your vasculature that is your endogenous blood pressure lower

right by expanding blood vessels and capillaries exactly right this is the mechanistic foundation of the drugs that were originally used for improving prostate function but are used to treat erectile dysfunction which are the the PD5 inhibitors which allow nitric oxide to be around longer and more

of it right people use it for other purposes too I'm now known I'll forget if I cue it up with that example we we you know in the neonatal intensive care unit it closes patent ductus arteriosus which is a big deal in in the neonatal world well okay I want to ask you about that but but so I

heard two things one is that glucose and the insulin that goes with it increases uric acid uric acid while it has certain important functions in health too much of it you said can inhibit nitric oxide yeah can inhibit nitric oxide so that means that the blood vessels and capillaries

are going to stay more constricted so blood pressure is going to be higher than it would be normally and then uric acid is also inhibiting mitochondrial function that's right okay but eating half a bagel isn't necessarily a terrible thing if it's within your caloric requirements it and it it all

depends on how much you clear and how high your insulin goes now let's compare that 250 calories of glucose to 250 calories of fructose right let's let's come up with a food example 250 calories of fructose would be trivial to consume in the form of high fructose corn syrup right well so

remember the high fructose corn syrup is half glucose half fructose okay so let's not use that well so let's assume so we can talk about a soda for to get that that 250 calories easily right especially if it's not a can or a European-sized bottle or eight ounce can of soda okay so eight

ounce can of soda and maybe let's include a food item let's talk like a store bought packaged cookie couple Oreos two Oreos okay probably get you to that 250 or maybe four or maybe three Oreos yeah okay Oreo lovers everywhere celebrating three 250 calories of fructose

what's the effect on uric acid what's the effect on caloric burn what's the effect on anything for that matter that we should be aware of all right so first of all the Oreo has plenty of fructose in it so keep that in mind okay the if let's say you consumed 250 calories in a bagel because

that's pretty much polymerized glucose versus say the soda so the bagel versus the soda that's what you're equivalent calories right equivalent calories or the the bagel versus let's say two Oreos and a little bit of and yeah two Oreos okay so number one there's only half the glucose

in the soda because the other half is the fructose so 125 or 125 so your glucose rise won't be as high your glucose excursion will be lower this is actually one of the reasons why there's this thing called glycemic index and glycemic index is anard it's garbage it is

complete and utter BS the glycemic index absolutely yes well nothing nothing is more uh uh egregious in terms of argument than then then the glycemic index and this is one of the things that dieticians as promote and espouse and one of the things that's gotta go okay well this

is an idea that must die okay we'll get back to why the glycemic index has gotta die uh but so so that 250 calories and actually can we can we make these equal just for sake of simplicity can we say 250 calories of glucose from the bagel versus 250 calories of fructose how do we get 250

calories of pure fructose we don't you can't okay you gotta bring the glucose we lab lab fructose you have to make it then let's stay with the Oreos which is a half glucose half fructose right that's I mean there is no fructose alone in nature even crackers some of the ones that are salty are also sweet they have fructose in yeah absolutely high fructose corn purpose yeah that's why it's impossible to eat just one indeed and um so what's happening biochemically with as a

consequence of the fructose component specifically so the fructose will first of all go into the intestine the intestine will metabolize some of that fructose through what is known as intestinal denova lipogenesis about 10% of that fructose will be turned into fat right in the intestine

and that's because fructose it just wants to be fat yeah fructose wants to be fat fructose is the lipogenic substrate here we're not talking about body fat we're talking about fat molecules that can potentially be used as energy that's right triglyceride molecules okay so that so 10%

of that fructose will be turned into triglyceride right in the intestine and be released into the bloodstream and it is the reason for a post-prandial triglyceride response post-prandial is uh and i'm including myself in this group is nerd speak for after eating ludge it typically it's

ludge and the so that's actually one of the drivers of cardiovascular pathology that intestinal denova lipogenesis turning that fructose into triglyceride right in the intestine now there's a limit to how fast and how much the intestine can do that the rest of the fructose will be absorbed

into the portal vein but not before some of that fructose will make it further down and it will nitrate tight junction proteins okay portal vein of the kidney so portal vein goes to the liver portal vein goes from the visceral from the intestine to the liver no kid it doesn't go

getting okay okay in intestine to liver okay okay but fructose nitrates tight junction proteins now let me explain that to your audience your intestine is a sewer definition of a sewer a pipe with shitton okay that's its sewer our intestines are sewers there's junk in the center

and the job of the intestine is to move the junk through to the anus absorbing the good stuff while you can't the intestine is made up of cells intestinal epithelial cells that are bound together and they're bound with proteins that basically form a barrier those barriers are

called tight junction proteins it's like cloudings and things like that um zonulin is the main one okay there are others but zonulin is the one that goes is defective in celiac disease what defines a tight junction is it that is like completely impermeable or semi permeable completely impermeable

okay unless its function is inhibited turns out if you alter the phosphorylation status or the nitrate status of that tight junction it will become transiently permeable okay and so fructose nitrates tight junction proteins causing them to be transiently permeable allowing some of the

junk in your intestine to get through 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 got it that causes inflammation at the level of the liver which ultimately leads to systemic inflammation one of the reasons why

high-sensitivity CRP is high in patients who eat ultra-process food CRP is c-reactive protein which is a marker of essentially inflammatory immune response exactly yeah you don't want it to high and 93% of Americans today are inflamed does that mean that 93% of Americans have leaky guts

yeah it does because that's where it comes from so in addition to limiting fructose intake what are things that support the tight junctions of the intestinal pathway so there are three barriers in your intestine to keep the junk where it belongs in the center so that it can get pooped out the

your behind all right three separate barriers one is a physical barrier called the musin layer so it's a layer of mucus that actually sits on top of the intestinal epithelial cells now that musin is a polysaccharide and the bacteria can use that musin layer for its own purposes

it will eat your musin layer if you don't feed your bacteria you must feed your bacteria or your bacteria will feed on you okay so you are in concert with your microbiome if you deprive your microbiome of the food that it needs it will use you as its food and that's one of the reasons

why fiber is so important so fiber to build up this musin layer is one way to reinforce the the the fence that that is the tight junctions etc. between your intestine and the bloodstream exactly this raises an interesting point about fasting many people including myself do a sort of pseudo intermittent fasting I might eat my first meal somewhere between 11 and noon I'm not strict about this the 11 versus noon thing and probably eat my last bite of food somewhere around 8 p.m.

and occasionally it's outside that window I've done this for a long time it just feels best to me right but other people use a shorter eating window one thing that I learned from a colleague at Yale the studies that got microbiome that was surprising to me is that when you do when you eat in that way there's a long stretch of time sometimes longer for people that have a shorter eating window longer fasting window that is where you're actually eating up your own intestinal lining

so this idea that fasting is so great for us on the one hand might be true on the other hand you're actually consuming components of your you're not feeding your gut microbiome and you deplete it but that here's where I was so positively surprised when you do eat provided that you eat

enough fiber and in particular high quality fermented foods lotion fermented foods it seems that the the lining of the gut and the gut microbiome is replenished to a level that is greater than if you had eaten for longer periods of the 24 hour cycle yeah I have that right we do you do have it right

and I don't know why that is true but it does seem to be the case and fermented foods they it part because they've got already short-chain fatty acids in them seems to prefer food of the microbiome well it's what the microbiome actually turns fiber into so it's probably helping your

intestinal epithelial cells in the same way what the microbiome turning fiber into short-chain fatty acids helps so it's what we call a postbiotic so you have 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 make in order to heal you okay and 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 what have you whether they work or not as another story if I consume fructose in the form of let's say a highly processed food has minimal antioxidants but it's got plenty of calories typically and it's disrupting the tight junctions making my gut leaky right but I'm also eating fiber yeah

you know I'm having a you know a meal that includes a salad I'm having having some probiotics and then I want to like a couple of resus peanut butter cups like in the dark chocolate ones in particular I don't do this anymore but I used to eat like that more often as time has gone on I've

become 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 how how much damage am I

doing by ingesting any fructose in the form of a highly processed food so I'll make it very simple Andrew I am for dessert for dessert I am not for dessert for breakfast lunch snacks and dinner okay so if you want to have a couple of resus peanut butter cups as your dessert in the same way

as you might have a cognac for dessert that's fine I have no problem with that the question is are you going to eat resus peanut butter cups for breakfast no I don't eat breakfast well no but I guess your point the national school breakfast program which 29% of school children today consume

is a bowl of fruit loops in the glass of orange juice that is 41 grams of sugar American Heart Association says that the upper limit for children should be 12 grams of added sugar per day that's 41 grams of added sugar and it's just breakfast and that's fructose rich totally

completely so the question is which dessert are we talking about and right and can we can we adjust that morning meal to a different reality because I agree that there are plenty of kids eating that or a muffin that might be the equivalent and do but what about the parent who says okay let's come

up with a healthier option that the kid still likes like a I'm thinking back to my childhood like a honey nut Cheerios or something so not fruit loops which is kind of the extreme take a look at the side of the package no difference now let's say they go with some like waffles that are made so with

a with a premade mix some milk some butter you know so mom or dad is making waffles great sounds healthier but then if you do the breakdown or we're still ending up at very high are we basically eating dessert for breakfast are we eating egg o' waffles are we making waffles denovo you know from

scratch in your own kitchen let's say big difference okay because the egg o' waffles you know repeat with sugar on purpose because the food industry knows when they add it you buy more because it's addictive okay and we actually have the demographic the mechanistic the imaging

and also the economic data to demonstrate that sugar's addictive and the food industry knows it so have you ever heard of a phenomenon called price elasticity okay price elasticity is an economic term that is used to ask the question if the price of a given good goes up by 1%

that should result in reduction in purchase or consumption because price influences consumption how much does it influence it so if it's if something's price elastic when the price goes up consumption goes down equivalently a food that is price elastic the most price elastic food is eggs

so when the price of eggs goes up 1% consumption of eggs goes down 0.68% meaning that eggs have a price elasticity of 0.32 got it got it now what's the most price any elastic food the top three most price any elastic foods are fast food cereal 0.81 I like a good quiz that's food 0.81

soft drinks at 0.79 and juice at 0.77 meaning people will pay not whatever but they'll they're willing to pay more more more readily willing to pay more because of the sugar because it's addictive because it's hedonic so many many years ago Andrew you probably remember something called

canesian economics and canesian 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 yeah I'll buy that but I won't buy that right okay in 1979 Daniel

Kaneman and Amist first ski Nobel Prize winner Daniel Kaneman described the irrational actor now the irrational actor cannot determine value and the reason is because he is a risk of verse so the cost is always too great so the utility may be the same but the cost goes up because

that's why they have you know a verse of tendencies the irrational actor Jeffrey Sachs has described the hedonic actor who also cannot determine value because it doesn't matter what a cost they need their fix and this is what's going on and the food industry knows it and that's why

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like to try element you can go to drink elements spelled elementy dot com slash huberman to try a free sample pack again that's drink element dot com slash huberman we talked about dessert for breakfast in the form of cereals some of which are disguised or couched as healthier you know I

think of like honey nuturio so it seems healthier than fruit loops it looks healthier like the cut just by way of color it looks kind of weedy you know color so but let and in terms of lunch I mean one of the things that I love about Europe is that the breads are amazing yeah

and terrific and I like and I like them because they're not as sweet exactly and so a sandwich from not every deli but from a typical sandwich shopper that one makes with store bought bread slice bread in the u.s. has a lot of fructose I look that looked this up prior to the discussion today so in

some ways dessert is being woven into foods that are that parents and or kids everyone thinks our savory are we're actually eating sweets exactly right but we can't but we don't taste them as sweet at a conscious level necessarily right but our taste buds do right that's exactly right

so the question is why do they do that so question for your audience you buy a loaf of bread at the local bakery how soon before it stales two days to your best yeah if it's really great bread that's right the better the bread the quicker it stales you buy a loaf of bread at the

neighborhood grocery store how soon before it stales well you've got probably a week and then there's the moldy pieces at the end they can truck they you know if you're in college and you were me trying to take that off but can last up to three weeks depending right you could throw it

in the freezer yeah probably do that with the bakery bread but it's never the same never the same never the same so the question is why is that and the answer is sugar the answer is sugar so the grocery store bread had sugar added to it on purpose because when you bake it the sugar

does not evaporate it stays in the bread and the sugar is high gross scopic meaning it holds on to water this is a phenomenon that the food industry uses cold water activity okay and so it will hold on to water and so it will stay spongy and it will not stale as quickly as the bakery store

bread which did not have that sugar added to it so even something as benign as bread has been turned into something that ultimately leads to chronic metabolic disease we've pivoted somewhat from carbohydrate divided into glucose and fructose to a discussion of sugar could you tell us the

link between sugar and fructose so table sugar what percentage of table sugar is fructose what percentage of brown sugar is fructose what percentage of the sugar that's added to food is high fructose corn syrup on average you know just because here what we're talking about is what you're

describing as an intentional lacing of food with something that's addictive but that's also processed very differently at the level of the kidney at the level of the liver and it's bad it's a bad it's a bad situation so so when we talk about sugar I think we need to be as careful in describing

what we really mean as when we talk about a calorie I completely agree so let for your audience let's be very very clear on 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 all right it's

cane sugar beach sugar you know the you know the stuff the teaspoons of right this was all that was available for many many years that is one molecule glucose one molecule of fructose bound together for the chemist out there an o glycositic linkage okay the enzyme in your

intestine called sucrose cleaves this o glycositic linkage in about a nanosecond you absorb the two molecules separately the glucose goes to the entire body generates an insulin response the fructose goes straight to your liver generates fat that's sucrose high fructose corn syrup is

essentially one molecule glucose one molecule of fructose not bound together no o glycositic linkage so they're free the enzyme sucrose doesn't care because the blondes already broken ultimately they do the same thing and that's why high fructose corn syrup and sucrose are indistinguishable

metabolically what they are is they're very different economically and the reason is because high fructose corn syrup half the price of sucrose because sucrose we get from importing and high fructose corn syrup we make it home sucrose is in bags high fructose corn syrup is in barrels sucrose you

can sell at the store high fructose corn syrup you sell to the you know ultra-process food manufacturer you can't buy high fructose corn syrup at the at the grocery store so they're very different in terms of what they're used for high fructose corn syrup is particularly

egregious because it's so missable because it's already a liquid so you've probably remember chips of white cookies in the old days okay they would often would seem like the sugar in the cookie had crystallized because the sugar content was so high it's been well since I've had one they

weren't particularly good yeah well you eat two of them and then you think they're good and then you want to eat four yeah that's what's so odd the first bite is called and then it's bombs away there you go well now it's a chewy chips of white cookies oh I remember the reason chips of

it remember chewy chips of that that's high fructose corn syrup because because the two molecules are free they don't crystallize so you can actually up the dose several times throughout today's discussion you've been talking about the quote unquote food industry okay so I'm not a conspiracy

theorist but I know but I understand you know that most businesses exist to make money yeah many businesses start off with good intentions and drift in order to stay to stay competitive and many many businesses as we know not all of which are entirely bad such as the pharmaceutical

industry right you were they're bad their instances of like the opioid crisis but then there are drugs from the pharmaceutical industry that help save lives I mean that's my my stance the food industry I think they're good actors and they're bad actors but we're talking about

the food industry okay well we talk about the exercise industry we talk about the podcast industry I mean you got good actors and bad actors but what you've alluded to several times here and you're more informed than I am is a a concerted effort to lace food with a form of sugar that makes people

crave more of that food and that is causing metabolic illness disrupting mitochondria and on and on exactly and you're the physician not me you've worked with patients who struggle with obesity and for various reasons not me and so we could probably spend hours if not days talking about all

the terrible things that the quote unquote food industry has done but what do you think is that the pure motivation right I don't think that they want people to be sick but they want to sell product and this sells more product so then it raises two questions if why is it that more people don't

know about know this information although many more will know after today's conversation but and certainly in government it's a mix regardless of what side of the aisle you're on or if you're right in between they're they're clearly people that care about the health of themselves and others so

I can understand how things might have gotten to this point but what do you think are the barriers to getting people to appreciate just what a problem this is and and getting people to change their choices in terms of what they're eating are they truly addicted to the point where they are sick

they can't make good decisions like a like a drug addict who is highly addicted to heroin is a sick person they have an illness and they need treatment but until they get that treatment they can't make good decisions let's take an analogy alcohol 40% of Americans are T totalers never touch

your stuff 40% don't drink great I'm not a big fan of alcohol I've never seen it make anyone better at anything that really mattered no because it's drinking it's also completely vestigial there's no biochemical reaction in the body that requires alcohol okay for the same reason by the way

for us 40% are social drinkers yeah can pick up a beer put it down I'm in that category 10% are binge drinkers and 10% are chronic alcoholics okay now do you deprive the 40% of social drinkers because of the 20% of binge drinkers and chronic alcoholics no I believe

people should be in choice but I believe people should know what they are doing so that they can be in choice well right like do as you I always say and I said this about the alcohol episode which turned out to be one of our most prolific episodes where I said that you know more than two

drinks zero is better than any and more than two drinks per week you you need to do other things to offset that and it's problematic that's what those are what the data say but I but I would say do as you want but know what you're doing well so I would say that that's exactly what the food

industry wants you to think that's it that is the food industry's mantra is you have your own choice personal responsibility so the question is does personal responsibility work and the answer is no it doesn't every public health debacle in the history of mankind started out as a personal

health issue before before it became a public health crisis and you can pick your you know personal responsibility issue whether it be exposures whether it be addictions whether it be infections bottom line is ultimately it required a societal response okay we can talk about

syphilis we can talk about tuberculosis ultimately needed a public health response we can talk about teen pregnancy we can talk about tobacco tobacco ultimately needs a public health response because the sheer enormity of it and the the egregiousness of it requires that public health

response well turns out this is no different in order to exercise personal responsibility four criteria have to be met those four criteria are the following number one knowledge you have to have the knowledge because if you don't have the knowledge and how can you exercise personal

responsibility well in fact the public's being kept from the knowledge we're doing this now in part to in you know to entrain that knowledge to to get people to understand what the problem is yeah I mean I consider myself pretty informed about nutrition and health but I already today I've

learned two dozen facts about processing of fructose and colore calories generally that I had no knowledge of prior well that's good okay because it's not about the math it's about the science okay they want it to be about calories so we have this thing called food science we have this

thing called nutrition and we have this thing called metabolic health they are not the same hmm food science is what happens to food between the ground and the mouth nutrition is what happens to food between the mouth and the cell metabolic health is what happens to food inside the cell

but all of the chronic diseases that we are suffering from type 2 diabetes hypertension dyslipidemia cardiovascular disease cancer dementia fatty liver disease paucisticovarian disease those eight diseases which make up 75% of health care expenditures in this country today

are all inside the cell because they are all mitochondrial dysfunction and there is no medicine that gets to the mitochondria although you and others at Stanford Harvard etc are starting this with the metabolic psychiatry being one instance right indeed and UCSF as well for giving

you had just mentioned UCSF up front your your home institution wonderful institution right up the road from Stanford so you know things are changing people are starting to think about mitochondrial health they are okay so you list up the first the first thing you said there

four things that stand as bare first one was a knowledge okay second access because if you don't have access then how can you exercise personal responsibilities access to healthier alternatives exactly which means cost effect I mean I love berries from the farmers market more than I love

berries from the store I love the farmers markets generally but it takes time energy to go there and the cost is actually lower at the level of what you hand the vendor typically right but volume is tough to achieve right they actually have me at a quota I'm not allowed to buy as many

berries as I want because obviously there are other people who want berries yep so there's that right people have to feed their family that you know and well we're used to eating a lot of volume but you're able to at least go there sometimes okay yeah we're talking about people who

live in quote food deserts we're also talking about people who live in food swamps okay and when we're talking about food swamps we're not talking about and plethora of healthy foods we're talking about all the junk that's what they they live in the swamp of junk so if you live in the swamp of

junk how are you supposed to exercise personal responsibility number three or fordability so you have to be able to afford your choice and society has to be able to afford your choice and right now we can't afford that choice because health care costs right now are at 4.1 trillion dollars a

year but like so many things in behavioral economics and health it's so hard for people to see that the immediate choice is leading to a higher cost down the road there just too many nodes of separation for people who realize hey when I'm reaching for this cereal as opposed to making waffles for my

kids from scratch or you know they're thinking time efficiency cost efficiency volume the kids not throwing canterms because they're not no longer getting the cereal and it's very difficult to see this is the reason why health care costs are going up there just too many nodes of separation

couldn't agree more but the ultimately it's because the government separates and silos food industry profits from health care costs if you actually combine those because they ultimately are the same you would see the problem so globally the food industry grosses $9 trillion a year

health care costs globally cost $11 trillion a year dietary related health care costs environmental costs cost $7 trillion a year and productivity costs cost $1 trillion a year so when you do the math 9 minus 11 minus 7 minus 1 means that there is a $10 trillion a year deficit

because of us cleaning up the mess that the food industry makes and while numbers like that that's not affordable right I agree and while numbers like that land really hard I find that for myself and for many people statistics like that are hard to keep in mind in a way there's

something about the human brain that hears that and goes whoa we're like that war cost that much and this food issue costs that much and then we go to the store and we're hungry right and the kids are are are hungry and you're and so those nodes of separation it's it's almost like a

neural slash memory slash prefrontal cortex issue to me and of course I look at everything through the lens of neurobiology you know not everything but most everything and so how how could I not how could we not but then like the issue is well there's still food on the shelves and you know and so

it's very how what do we do to connect to bring closer together these nodes so the question is the government do so the question is is there food on the shelves let me finish the fourth one and then I want to come back to that point let me just you know finish a concept so affordability

and number four externalities your choice can't hurt anybody else but what if your choice does hurt somebody else so like for tobacco second-hand smoke right for alcohol drunk driving but what's the argument for teen pregnancy that someone else was going to have to raise the kids exactly

all right but what about for food okay well how about the fact that your employer Stanford University has to pay $2,750 per year in obesity related healthcare expenses that they have passed on to you even though you're not obese that is affecting you so that guy's obesity right there

that is affecting you but there nowadays it's especially tricky even to have the conversation I'm willing to have it now yeah which is that you know there's this whole concept of fat shaming right so somebody's obese whose fault is it and if we even talk about it is are we subject to

attack legitimate attack you know so like so calling something oh someone obese at a clinical level like having here you're an expert in don't talk about don't talk about obesity let's talk about diabetes okay so different consequence of obesity yeah let's talk about the metabolic health

issue itself okay the fact is that diabetes is now 11.4% of America what was it 20 years ago it was 20 years ago it was about 8% I was wondering this earlier 20 years ago there was a lot more margin in refrigerators but people were thinner and there was less diabetes yeah everything you

talk about margin and trans fats is that it's bad bad bad now butter is back as time magazine and you said right so clearly can't be the transition away from trans fats that's increased obesity well no no so it's going to be the increase in sugar and increase in sugar and these hidden sugars in

exactly that's right the the the key though is Pakistan and India because and China they are not fat but they have 14% diabetes rates and they're thin and the reason is because of ultra-process food are there any countries in the world that don't allow hyphurictus corn syrup or at least not

at the level that that we do oh they're free to use okay there are boat loads of countries that don't import hyphurictus corn syrup or don't make it so Scandinavian countries Scandinavian countries most of Europe the other than the Asia Pacific Rim so Japan has it in fact it was invented in

Japan 1966 saga medical school Takasaki at all Korea has it but Australia does not have it Thailand does not have it but they have just as much of an obesity and diabetes problem as we do because they have sucrose because hyphurictus corn syrup and sucrose are no different

metabolically so it doesn't really matter is that one to one it's the one to one thing exactly a glucose and fructose so here's the question Andrew okay I want so I want to go back to that you said all this food is still on the shelves is it food what is the definition of food

could I give the definition I think most people would give that's not so the one I would I would give but something that has contains caloric energy or like I could eat this microphone but it's not going to provide much useful energy the definition of food straight from the

dictionary and believe me I looked it up and memorized it I believe you substrate that contributes to either growth or burning of an organism interesting that is the definition of food free scientific 100% correct growth or burning so any substrate that passes your lips that

contributes to either growth or burning that's food okay let's do it let's do burning first I just showed you that sugar which is the marker of ultra processed food and 73% of the items in the grocery store are spiked with sugar inhibits burning inhibits those three enzymes involved in

mitochondrial function now let's do growth my colleague doctor a fraught monsanigo or none who is the chairman of nutrition at Hebrew University Jerusalem actually looked at this question and showed that ultra processed food actually inhibits growth it inhibits cortical bone growth it inhibits

a trabecular bone growth it inhibits a cancelous bone growth inhibits linear bone growth it hijacks growth for cancer because it inhibits mitochondria and so you have to then grow instead of burn and this was work that was done in in vivo or in vitro in vivo in vivo so these are people that

are eating high amounts of highly processed food exactly how did you find those in the in the in the middle east they found in Israel they found so bottom line is if a substrate does not contribute to growth and does not contribute to burning is it a food I see answer is no well that's 73%

of what's on the grocery store so I would argue you said the food's there no it's not that's not food in fact it's consumable poison so this leads to an important question of what's left right you remove all that what's left just anecdotally and I what I sometimes call anecdata you know I've had

several friends in their 40s and early 50s say they want to lose weight and get in shape and the the thing that's worked every every single time for them to lose significant amounts of weight quickly and keep it off and many of them were already exercising but then also increase their

exercise was I just since I'm not a dietitian nutritionist or anything I just say 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 have coffee tea you can still have artificial sweeteners

I will get to artificial sweeteners a little bit we have to go but um and the reason I say no starches even though I personally eat rice oatmeal pasta things that sort some in in moderation depending on on what sort of exercise and I'm doing and how much is because of the fact that

nowadays many of those things contain fructose and inevitably every one of those people is blown away by the fact that it quote unquote works and assumes that it's all because of reduced calorie intake overall and they lose like anywhere from 30 to 55 pounds and keep it off and they're like

hey this is great I can actually still eat rib-i-stakes and salads and but they're not eating croutons they're and so in some sense it looks extreme it sounds ketogenic but it's nothing like that you're just saying basically stay away from you're limiting process foods you're eliminating liquid

calories in in general you in on and on and so there's nothing sophisticated about it and my question to you is how much of that weight loss effect do you think is a calories versus calories out effect because they're eating a lot of food and in some cases and how much of it do you think

is the elimination or near elimination of this fructose or this glucose fructose combination it's nothing to do with the calories it has everything to do with the insulin if you get the insulin down you're not shunting energy to fat you can lose weight your fat will give up

the the the the the triglyceride stored in it as soon as your insulin goes down insulin is pushing on your fat cell all the time and as long as your insulin's up your fat cell can't release it the minute your insulin goes down you can now engage in what we call lipolysis hormone sensitive

lipase is an enzyme in the fat cell that is inhibited by insulin as soon as the insulin's gone hormone sensitive lipase can turn that stored triglyceride into free fatty acids anglycerol and release it and you can lose weight so get the insulin down and it all works so the question

is what makes insulin go up well two things we're fine carbohydrate and sugar those are the two things that make insulin go up in addition branch chain amino acids make insulin go up as well Lucy nice Lucy Bailey which is in corn fed beef chicken and fish process food all right

here's here's here's the deal in one concept my colleague dr. Carlos Montero who is a professor public health at the University of São Paulo has done the world a great service he has developed a system for categorization of food processing it is called the nova system it just means new but

he is basically categorized every food anywhere in the world into one of four classes easiest way to explain this would be an example let's take an apple nova class one would be an apple picked off a tree nova class two would be apple slices

de-stemd deceited de-skinned maybe nova class three would be apple sauce cooked macerated possibly at the preservative added maybe some extra sugar maybe not nova class four would be a McDonald's apple pie now does that McDonald's apple pie look anything like that apple no is there even

any apple in it maybe a tiny bit maybe a tiny bit you know it's all flavor enhanced etc okay turns out this is epidemiologic data but nonetheless prospective epidemiologic data so it's not useless that nova class four that ultra-process food category which is 73% of the american grocery

store is the class that is associated with all of these chronic metabolic diseases nova class one two three no problem no when you say associate what percentage of one's daily total caloric intake needs to come from nova class four before that statement you just made is true because it i love the recommendation you made earlier or that let's just say the the contour of uh you don't have to avoid dessert you can enjoy dessert but don't eat dessert at other times of day right and maybe

you don't eat dessert every single night right and is there a rule that people have to eat dessert every single night so the answer is about seven to ten percent would be the upper limit so you can get seven to ten percent of your caloric intake daily caloric intake from these nova class four foods and still still be okay still be okay yeah so this is i know that's not what's happening right i know some

very healthy physicians who i used to um observe how people ate and moved because i i would pay attention in my now we're field right i was like oh you know people all around me at Stanford UCSF it's our worst successful or else they wouldn't be there i was like you know who looks healthy who can make it up the stairs doesn't have to take the elevator how much exercise are people doing at a given age are they fanatic you know like four in the morning runners i'm not going to do that consistently

unless i have to um and i and i observe that you know many of the healthiest people i know they move a lot during the day they hate very well many of them skip breakfast or lunch not always and then i also noticed that they would drink very little or no alcohol and then but they would enjoy like a

there's one physician at UCSF in particular i'm thinking of who really enjoyed his dark chocolate kickcat after lunch and he's sort of very um ceremonial about the unraveling that uh the foil and the in the day and i was like okay so you're talking about that small percentage of calories if that's

if that's all you do hey you know god bless you but that's not what people are doing that's the problem bottom line that nova class four 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 the entire world right now and you'll put it in your show notes yeah we'll put a link to this absolutely it's called perfect p-e-r-f-a-c-t and you can find that it perfect dot co and what it is is it's a

recommendation engine not AI we're going to talk about AI in a minute but it is a recommendation engine based on the science of human metabolism that categorizes foods based on not their nutrient content but on their metabolic effect interesting and so there is a nova filter which will filter out

all the nova class four stuff and it will go to your grocery store and we'll tell you what you can buy that will be a nova class one through three which turns out to only be 20% of the grocery store it means basically saying on the periphery of the grocery store that's in general yeah yeah produce

the meat the dairy the all the things you mentioned in fact so i'm not low carb i'm low insulin and there are a lot of ways to get to low insulin get rid of the refined carbohydrate get rid of the sugar increase the fiber get rid of the branch chain amino acids okay so eating fish is a good

place to be even eating a steak is okay if it's a pasture fed steak so let's talk about your steak right what's the better for the animals right it is absolutely so you mentioned marbling before we love our marbling right we can cut our u.s. grade A steaks with a butter knife because they're so

tender right you ever been to argentina yeah my father's argentina oh right that's right you're argentinian yeah they only know of course they only know grass but the on the idea that cows would eat anything but grass is sort of like the idea that um then those of them would would would fly

absolutely New Zealand's same thing yeah okay the meat is gorgeous it's homogeneous it's pink it's the the life I've been to argentina the meat is fantastic but you have to use a steak knife you can't use a butter and it takes more chewing and it takes more chewing because it's a it's a different

experience entirely it's delicious but it is kind of a little bit you know tougher all right turns out that marbling is intramiosellular lipid that animal has metabolic syndrome the american corn fed the american corn fed animal because that corn is filled with branch chain amino acids loose

in isolucine valine branch chain amino acids or what's in protein powder that's what um you know bodybuilders you know put in their smoothies you know to build muscle and if you're building muscle that's okay because 20% of the amino acids in muscle are branch chain so um so you know if

you've got a place to put them you know have at it yeah there's a need there because they're breaking down muscle yeah fine but if you're not if you're you know again a mere mortal like me you consume those excess branch chain amino acids they're going to go to the liver they're

going to be deamidated like we talked about earlier and they're going to end up as branch chain organic acids they're going to flood the mitochondria the mitochondria not going to be able to deal with the volume and so they're going to divert the excess and turn that into fat

and so now you've got hypertrianglecyroidemia and chance for fatty liver disease and insulin resistance so what kind of meat you eat has a lot to do with your metabolic health what about the egg the whole egg near near perfect protein score in terms of its bioavailability exit terrific okay there's

nothing wrong with eggs now there are better eggs than others so that's sure so well there's yellow yolk eggs and there are orange yolk eggs what's the difference between a yellow egg and an orange yolk egg I'm guessing that's something about the the feed of the the mother chicken and I'm guessing

it probably also has something to do with colon content omega-3s ah interesting okay the orange yolk egg has a lot of omega-3s in it what are other great sources of omega-3s I know some off the top of my head but I'd like to hear it from you okay so marine life is number one okay you know fish

provided you're not bringing in heavy metals with it well yes so I mean that's always the the argument you know the question is you know is it the mercury is the t-mega-3s and ultimately I think it's the omega-3s that is more important but yes I do understand the mercury issue

um uh ultimately there are three omega-3s there's L.A. alpha linoleic acid which you can get in vegetables there is EPA icosapenta enoac acid which you can only get marine life fish oil, cod liver oil right and finally DHA doko hexa enoac acid which you also get from marine life but you can get from algae so you can get algal oil which you know the vegans will use do you um personally take anything to increase your omega-3 intake yeah I know there's even prescription

omega-3s I take out your oil you take official yeah yeah I the I only take three I only take three supplements okay I'd like to know what those are I will say that I always always always say behaviors first right do's and don't yeah behaviors nutrition then only if needed and one can afford it

then supplementation and prescription drugs and I'm a big consumer of supplements and always have been frankly so what are the three so you take fish oil and do you take to get above a certain threshold of EPA yeah about a thousand milligrams I say about a gram a day gram a day okay uh vitamin C

how much of vitamin C do you have a thousand milligrams a day you in line is Paul yeah well it's actually from my rosacea I've got uh skin issue and vitamin C helps with that interesting and finally vitamin D now I will tell you vitamin D is a complicated one all right uh let and we can

talk about vitamin D and how either important or non-important it is because there's a there's a quirk to vitamin D and uh it's important for your audience to know about it because everybody knows brothers you know touting vitamin D it's for every it's sort of funny because you have your

supplement lovers haters and agnostics but vitamin D somehow made it through the shoot like everyone is like pro vitamin D it's really interesting somehow vitamin D people are comfortable taking a jet vitamin D gel cap but like other supplements where you say oh like maybe um this might be good for

you know like omega-3s and fish oil then people are a little bit like more standoff is it's really interesting that the kind of psychoso social stuff around this how much vitamin D do you personally take I take five thousand units a day okay so do I vitamin D is complicated though here's the problem

if you look at the literature vitamin D deficiency is associated with all these chronic metabolic diseases however supplementation with vitamin D has not fixed any of those so if you're vitamin D deficient why wouldn't supplementation fix it a couple of reasons one one of the reasons for

vitamin D deficiency is because everyone's drinking soft drinks that's one reason but there's a more important reason uh sugar and artificially sweetened soft drinks yeah can deplete vitamin D utilization well you're not consuming dairy because you're consuming soft drinks but I can't

tolerate milk anymore well yeah then you take vitamin D but here's the here's the real nugget of truth and this is a little complicated but the endocrinologist and the audience will get it vitamin D is a pre pro hormone it's not it's not active at all vitamin D is converted in the liver

first step to a compound called 25 hydroxy vitamin D that is a pro hormone it also is inactive it has no activity whatsoever from there 25 hydroxy vitamin D can be metabolized one of two ways it can either be one alpha hydroxylated in the kidney to the active form one alpha it's one

25 dihydroxy vitamin D which will then do all of the business of vitamin D such as calcium absorption from the gut suppression of the immune system at the toll like receptor four that sounds like a bad thing no that's a good thing I know but I had to bring that up because when you say suppression

in the immune system people are my immunosuppressed nobody that sounds like AIDS a good it suppresses inflammation it's a good thing okay suppression of the inflammation and that's actually the point that we're getting to so there are a lot of good things about 125 dihydroxy vitamin D however that

25 hydroxy D that came out of the liver can be metabolized a different way it can be 24 hydroxylated in inflammatory tissue like tuberculosis sarcoid gut inflammation and so you will end up taking your 25 hydroxy D which is a pro hormone and turning it into the inactive 24 25 dihydroxy D which

then just gets excreted out so in other words you consumed all this vitamin D and it didn't go where you needed it to go and the reason was because you're inflamed you have to fix the inflammation before the vitamin D can be effective and 93% of Americans are inflamed so giving them vitamin D

is not going to do a damn thing is reducing fructose intake that one of the primary ways to reduce systemic inflammation absolutely what are some others reducing oxidative stress in general so heavy metals like cadmium you know cadmium is very high in chocolate especially South American

chocolate sorry no I'm not a fan of chocolate I occasionally like a little dark chocolate but okay but so if people are going to chocolate they should be careful how much chocolate they well in terms of its South American chocolate and process chocolate I mean the really good

we're gonna be on the hit list of so many industries out of the so it comes out yeah all I can tell you is I've been on the hit list for a decade you're you're just one big target yeah right got it I got it I it's on my back you know kicked me I already got that um there are uh the main thing is to make that gut work right so fiber short chain fatty acid production from fiber uh is a huge you know uh boon and reduce inflammation reduce inflammation how about improving sleep is there any evidence

that you know chronic slight sleep deprivation can increase inflammation well what it will do is increase cortisol and chronically increase cortisol will definitely lead to increased inflammation you know which is funny because cortisol is usually considered the anti-inflammatory

but only acutely right chronic cortisol elevation does the opposite if we can contribute to I have this secret agenda which is which is not a secret which is that people think cortisol is bad when in fact acutely cortisol does wonderful things provided it's happening at the right time of

day right late shifted cortisol bad right too much or too frequent cortisol bad but cortisol you need it it's so essential and I think most people just hear cortisol and it's been associated with all things bad and and maybe we can help shift that narrative yeah I'm very happy I mean it's an

endocrinologist you know this is you know where there's my wheelhouses where I live um cortisol is a good news bad news deal like so many things short-term gain for long-term pain okay so when you are in what we call alo stasis that is perturbation of homeostasis that is a stress and

acute stress cortisol is one of the things that helps you manage that bodily and mental stress so an English test a car accident running away from the lion you know the famous you know pig me running away from the lion all of those require cortisol in order to manage and mitigate

that stress the upcoming 2024 election that's chronic stress I just not acute stress that's the worst there will be the only mention of politics yes podcast and we don't have to go there but we're all chronically stressed and we can talk about why that is and what's going on and I'm actually very

interested in that and a colleague of mine in Paris and I have built a computational model of the limbic system which focuses on the stress center of the brain the amygdala to understand how chronic stress

is different from acute stress and how that chronic stress ultimately leads to metabolic and mental health disaster very interested in learning more about that before we touch on that you've worked a lot with kids people age as you put it zero to nineteen I don't know about the exact numbers but

when I was growing up there were some kids in school that were overweight but it was the occasional kid right now it seems depending on where one draws the threshold for overweight it seems that there are a lot of kids that are overweight how about 25% obese and 40% overweight okay so obviously

a serious problem serious now and going forward and what about adults in the US I remember seeing at a meeting a map of obesity in the US and over time and it very quickly filled in from very few people were obese to very many Colorado was this was this like like beacon of fit people but

now it's no longer and that's bullshit too okay cool I'll tell you why there are four things that could increase mitochondrial biogenesis you can tell me altitude is cold yeah cold that's why Colorado's less obese altitude that's why Colorado's less obese and what were the other two

I forgot but those were the reason it had nothing to do with being more fit it had to do with cold and altitude example Switzerland compared to Germany they got the same crappy food but Switzerland has half the obesity the Germany does I love Switzerland is higher I love the food when I go to

Munich I love the schnitzel's wonderful sourcrow and they got that in Switzerland too okay so that great food Switzerland's less obese and it's same way Colorado's less obese it's because of the altitude you mentioned cold many listeners this podcast are at least interested in some also practice

deliberate cold exposure cold showers cold plunges mainly for the I think the best data are the increases in catacole means up in effort north in effort dopamine that are long lasting people feel a big state shift they feel better yeah but when one looks at the effects on metabolism

they're pretty slight they are they're slight however studies like that to me always seem short-sighted in the sense that if there's a longer arc of effect on the mitochondria that's affecting other things in terms of how calories are processed or how calories are feeding into

mitochondrial function or dysfunction there I could see how it might shift the shift the scale so to speak I mean cold is an amazingly powerful stimulus and I think of light cold food movement it's kind of like the core four ways in which you can shift physiology easily all

of these things are eminently manipulable and for almost zero dollars okay but you have to know what you're doing and right now we've been actually kept from that knowledge and you know what if you're addicted it's really hard to unaddict yourself so that brings us back to this thing about

food industry conspiracies government conspiracies and the rest boy this is going to be an interesting we can go to a section but what do we do like so if you and I go up to cap capitol hill which I've done yeah which you've done and maybe I'll join you someday um and you know your

UCSF I'm down at Stanford your clinician I'm a scientist and public health advocate um podcaster and we explain to people hey listen like there's the food is laced with a drug it's my it's not even really food it's not food it's an aggregate of food and non-food parts that

make you think it's food it's sort of like something people hey your kids are you know they're swimming in a swimming pool looks like water but it's actually part poison and it's and it's harming them it's giving them you know if you say those kinds of things I mean congressmen and

women are they're like reasonably smart people right I mean aren't they going to do something about it no so where is the conflict is it that the food industry has um the government by the short hairs that's exactly right and they have them by the short hairs where I mean is it are they

lining their pockets I mean where where where is the leverage acts that actually exerted okay so they are lining their pockets that's number one that is absolutely true we have the data to support that blanche Lincoln who was the senator from Arkansas who was the chairman of the nutrition

committee you had to see her campaign contributions every time she was up for re-election so it's all about getting re-elected or it's about them like having a like a third home in the Hamptons it's so I think it's the third home in the Hamptons okay wow okay so it's really as bad as it is

as some of the documentaries without make us believe without question good news and we and we have the data there is a an organization that I absolutely want to call out because they are you know the most egregious organization a political organization on the face of the earth

they're called the American Legislative Exchange Council Alec or Alec and they write bills they are a bill mill okay and they are for whoever gives them money and who gives them money big pharma big agra big oil and a big food and you're so you're including big pharma your

physician you've written scripts before you've written prescriptions for patients before isn't that pharma that provides the drugs that allows your patients to feel better well the question is do they do they feel better this is a big question let's you want to go but you're writing the script I mean I mean I'm just trying I'm not trying to I'm not trying to challenge you but I see so you don't there have to be instances where someone's thyroid deficient and you give them you know

absolutely so if so if if you've got a disease and a medicine will replace what's missing sure okay so for the deficiency diseases which as an endocrinologist that's what I do absolutely and I did that you know with no compunction of impropriety whatsoever but that's not

what we're talking about here let's talk about what we're really talking about let's start with statins statins lower LDL okay the statins reduce heart disease yes or no you know I seem to be whiffing today on all the quizzes and it's kind of becoming fun for me at this level I'm going to

go with no but I will say you know my friend and I think is it expert physicians well you know Peter Attia has talked about some of the positive attributes of statins in certain cases for certain patients certain cases that's exactly right and I completely agree and by the way Peter's a friend

and you know we some day we'll we'll you know all you know go out drinking together yeah well I won't drink but all right well how about we share a state share a state there absolute okay you got it you guys I don't I don't know if you drink a little if you're listening

okay he drinks a little more of house on me yeah I don't do the dessert or the or the alcohol anymore but up but I'm and it's not so I can live to be 120 it's so I can wake up the next morning and and keep up with you guys it's fine I get the so for primary prevention that is

your LDL's high you need a statin that's primary prevention you haven't declared yourself you haven't had an event for primary prevention the mean increase in lifespan for being on a statin is four days four days four days four days and that's that's and the risk for diabetes is 20%

increase what about any improvement in in quality of life done for primary prevention now for secondary prevention for secondary in other words you've already declared yourself you already have a problem for secondary prevention that's where statins shine so there's a value to them I'm not

arguing that and if you have familial hypercholesterolemia which is one and 500 okay not only do you need a statin but you need a low-fat diet and a priest okay so there is definitely a value to statins but not for primary prevention but that's what every but what every doctor's doing oh

your LDL it's over 80 you know you need a statin that's ridiculous that is absolutely a joke and the data show that in fact in fact my colleague has seen malhotra in the UK participated in an analysis where they took the entire UK population and they took out everybody under age 65 so you're

looking at people 65 to 90 and it turned out that the LDL level correlated with longevity the higher the LDL the longer they lived when you took out all the people who had problems so LDL is not really the problem and the reason is because there are two LDLs there's one called large buoyant there's

one called small dense turns out dietary fat raises your large buoyant your large buoyant is irrelevant it is cardiovascularly neutral but that's the one that statins effects the small dense that's the atherogenic particle when your small dense LDL is high that means you are not

clearing triglyceride peripherally because that's what small dense show you that's that's what happens to triglyceride is because they become small dense can I take a guess and say that the best way to reduce small dense is to reduce insulin yes by reducing sugar because that triglyceride is

made in the liver it's all pulmitate and that's the only fat that the liver knows how to make and so triglyceride is your liver output of carbohydrate that's how you have to look at triglyceride so triglyceride turns out to be much more important as a cardiovascular risk factor than LDL

ever was so does the does big pharma and big food do they know all of this yes I know they know because they've told me so and but they have statins to sell and foods in the the nova class four they know this too so you know I'm an optimist or you know what what's it going to take to really

move the needle I mean you just grab the four barriers we're trying to add to the knowledge component now you know what's it going to take you know having a president in office or a congress people in office that really understand and care about this stuff yeah I mean to really revamp the whole

system yeah so right now the system is completely and utterly broken completely and utterly broken and there's a reason why it's completely and utterly broken because the food industry likes it that way well 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 one's doing and the food industry likes it that way so communication across these 51 organizations would help well if we had a centralized food czar or food you know if we split the food off the FDA because you know it's like it's not

the FDA it's the DA or the FDA is not the food and drug administration it's the federal drug administration they spend a lot of time on drugs they spend almost no time on food well let's think about where there's been success so I can recall when people smoked on planes I actually recall

going to a gym in Europe and there was an aftrey molded into the squat rack yep that was telling yeah I don't see people smoking cigarettes around Stanford hospital anymore but I remember when they initially said that people couldn't smoke anywhere except in with this one little designated

area right and that's typically what you see nowadays and my understanding of the anti-smoking campaign at least for kids for people 18 and younger was that telling people it was bad for their health didn't work showing them lungs that were decrepit didn't work didn't what worked was

showing them commercials of cackling handwriting white guys who were talking about how much money they were making off of these naive kids who were buying cigarettes and other tobacco products so it became a the the effective campaign to end smoking in young people was to hijack their inherit

rebelliousness of youth and then they were like no stick it to the man stick it to them like you know that the as my friend calls it like the two the two finger business car like no and so that worked that worked something's making a comeback we vaping is a separate episode we

won't get into that but because nicotine is still addictive but you don't see a lot of people smoking cigarettes so it works like something that you would never imagine could ever work worked well so yes no I mean that's part of it I'm not going to tell you that it's not it is part of it

and we actually have an example of how that could be applied to another toxic substance sugar we had Berkeley versus Big Soda you know that's how Berkeley ended up with its soda tax that dates back to two thousand and fifty a city of Berkeley city of Berkeley

it we just celebrated the five-year anniversary of the Berkeley soda tax and we've been able to actually look gestational diabetes way down obesity down slightly not a lot but a little bit cardiovascular disease down Dean Schillinger and Chris Madsen at UCSF and UC Berkeley just presented

at San Francisco general just three weeks ago so a soda tax like the cigarette tax like this makes soda expensive exactly so you're telling me that a can of coke that I buy on Shadok Avenue in Berkeley costs more than a can of coke that I buy in on University Avenue in Palo Alto

it does huh okay buy a dime and that was and sufficient enough to to create this kind of change well and yes it is 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 they are number one bicycle helmets and seatbelts everybody uses those two smoking in public places nobody does that three drunk driving hopefully if you or people are doing that four condoms and bathrooms condoms in bathrooms in public bathrooms yeah you see those more

available okay yeah right 30 years ago if a legislator stood up in a state house and proposed legislation for any one of those four and I don't care if it's a state house or in Congress or in parliament or in the Duma or anywhere else in the world okay then I got laughed right out of town

nanny state liberty and trust get out of my kitchen get out of my bathroom get out of my car okay today roll fax life right nobody's belly aching about any of those point is we were able to solve those four public health debacles how did we do it how did we solve those four no one could

imagine that we would ever solve smoking right but we did sort of I mean we brought consumption down by half okay that's pretty good when you think about it for an addictive stuff how many fewer people are dying of lung cancer nowadays in the US it's like this 80 percent lower well there's

also been improvements in treatment but yeah no but it's it's the it's the incidence it's the incidence incident amazing okay because tobacco is gone down so the question is how did that happen the answer is very and why did it take 30 years to do it we taught the children the children grew up

and they voted and the naysayers are dead that's how you make a cultural tectonic shift so we now have this real food movement we have people who are arguing against ultra-process food we have kids who are demanding different in their schools and by the way what is the biggest fast food franchise in the United States I'm gonna get this wrong so try me again I don't know I've never tried it but I've heard of is it Chick-fil-A nope it's at McDonald's I don't know it is this nation's

public schools you can add up McDonald's subway Burger King Chick-fil-A and Wendy's and every other fast food franchise jack-in-the-box every fast food franchise in the entire country and would only be half our nation's public schools so could you imagine a world where there were no

class three or class four Nova foods allowed in in public schools and we're doing it so I am the chief science officer of a nonprofit and put this in the show notes called eatreal eatreal.org and we have a new business model for public schools so in 1971 the Department of Education

issued an administrative ordinance called resolution 242 and they did this purely on monetary issues reasons this was under Nixon and what this resolution 242 said was that all school cafeterias all throughout the country had to make book they had to basically cover their costs they couldn't

be lost leaders for the school they had to fend for themselves well this sent every food service director in the country scurrying for you know how am I going to do this because I got all these you know you know lunch ladies you know which you know personnel and food preparation equipment and

and and costs you know that they're you know mounting how am I going to break even they couldn't do it so in walks you know aramark and sisco and uh gouganheim and mcdonalds and they say hey we'll do it for you we'll provide every kid in america with a nutritious meal every single day hot lunch

well they didn't say hot okay they just said lunch okay nutritious they said nutritious okay and I put that in the air quotes too because it wasn't nutritious and here's the added benefit you can take your food preparation facilities and your um uh footprint in the school and you can turn that

into classrooms because you're going to need them and that was the goal because as soon as you've moved the food preparation facilities out of the school you're now hostage to the food industry for the rest of your life uh and I could also see how that allows room for them to use these

commoditized foods foods that have very long shelf life exactly right because you want to make sure that you know if you only sold um you know two-thirds of the lunches that were prepared that on next Tuesday after the weekend you could still give them food that isn't moldy exactly right

and I will tell you so that's how it happened and you can actually trace iq scores and reading and math scores in this country down from 1971 to today when i went to school i was allowed to get i called it hot lunch because it was usually hot it was um allowed to get the school lunch one day

a week one day a week one day a week other days i had to bring my lunch that one day was pretty special like you felt like you were getting a treat it was usually like corn dog or a hamburger the hamburger was pretty paltry but the um it's a commoditized hamburger yeah commoditized hamburger um

you had to go looking for the patty portion um and the bread was sweetened and so it was different right but um i don't remember nearly as much obesity i went to to high school in the early 90s um um so you're saying that now if i went to a high school it would be a lot more sodas and donuts and

oh pizza and got it yeah pizza is a vegetable didn't you know it's they claim it's a vegetable congress said pizzas of etchable Amy Klobuchar made pizza of etchable maybe they made their eyes because the biggest frozen pizza uh uh uh producer is in Minnesota i mean ketchup is a vegetable was

it was a was a stretch but at least it it made sense on the novice system of going from tomato all the way to uh to uh to catch up to catch up since high fructose corn syrup is the primary ingredient in ketchup indeed so the point is that our kids are suffering under the weight the burden of this

chronic disaster of ultra-process food which is not food and no wonder they're all obese and uh uh sick and um uh you know doing so poorly in school and by the way also depressed ultra-process food has now been shown in three separate studies to correlate with depression in teenagers

so what is the relationship between processed food or maybe we call it novice system level three four foods and depression and other psychiatric challenges and if you could you separate out metabolic syndrome from obesity um in answering that like like is there something inherently depressing

about carrying excess adipose tissue setting aside any kind of aesthetic um stuff you know how how people want to look or are perceived you know just is there anything bad about carrying a lot about body fat independent of the metabolic syndrome for mood and overall sense of well-being

no i'm really glad you asked that and we should have actually covered this earlier um everyone thinks fat is fat as we've learned fat is not fat and afat is not afat but um body fat is not body fat there are three fat depots and they are metabolically different first is the

does this bathing suit make me look fat fat by the way never answer that question okay that's called subcutaneous fat or big butt fat if you will so here's a question how many pounds or kilos of subcutaneous fat do you have to gain before you become metabolically ill

i'm no idea about 10 kilos about 22 pounds okay why the reason is because that subcutaneous fat drains into the systemic circulation so you have to have a lot of cytokines coming from those subcutaneous adipocytes to raise the blood level of cytokines to the point where it starts

doing damage at the level of the liver so fats are releasing cytokines which are pro and flammatory exactly and they're doing that at rest any fat cell any fat cell okay any fat cell but if it's going to the systemic circulation you have a volume of distribution of six liters so you have to

lose you know you have to have a lot of cytokines to get the concentration up now just out of fairness to the fat how many cytokines does a muscle cell release i mean are we unfairly picking on adipose tissue because why would adipose tissue be pro and flammatory i mean a single fat cell

okay okay i've got a fat cell sitting in you know my shoulder someplace right i mean i'm not zero fat at my shoulder why would it be pro and flammatory so in fact the fat cell itself is not here's what happens the fat cell has a fat vacuole it has a storage place for this lipid droplet

you stuff it you stuff it you stuff it the fat vacuole gets bigger bigger bigger the perilipan border that encompasses that fat vacuole that borders the the the space ultimately can't get any bigger and it starts breaking down when that happens it spills the grease into the fat cell

the fat cell dies becomes necrotic that calls macrophages in to clean up the grease and it's the macrophages that release the cytokines all right so in fact the fat cell is not the problem it's the breakdown of the grease that leads to the macrophage activation that's the problem but when

you do it in subcutaneous fat it's going into this six liter tank and so the concentration doesn't go up very much so ten kilos before you start seeing some effect fat depot number two visceral or big belly fat now how many pounds or kilos of big belly fat they have to gain

before you get metabolic leal i don't know but i'm guessing it's less than 22 pounds it's way less for once i got an answer right to that's right about five about five pounds now questions why number one the visceral fat does not drain into the into the systemic circulation

it drains into the portal vein which goes straight to the liver so you're getting a bigger load going straight to the liver of cytokines not to the kidney not the good thing about getting an answer wrong folks is that you never forget the correct answer that's why i always say it

tells my students right so i'll never forget that indeed got it and the question is what made the visceral fat in the first place was it calories no it's cortisol it's stress it's the combination of the sympathetic nervous system and cortisol and the reason we know this is because you can take

patients with major depressive disorder with endogenous depression who are suicidal who have to be admitted to the hospital to keep themselves from killing themselves stick them in a scanner and they are losing subcutaneous fat like crazy because they're not eating but they're gaining visceral

fat because of the high cortisol and the stress so there's something about the adrenocordocord receptors in that area that just preferentially depot fat there when forzol is high indeed because that's the metabolically active fat right and five pounds will do it and then finally

the third fat depot the liver now how many pounds of fat can the liver store before you become metabolically ill i got to be even less because the liver is not nearly as large as the sort of abdominal region half a pound quarter of a kilo how much does a healthy liver weigh healthy liver

weighs 1500 grams okay okay so you know it's not very tri-translate quickly pounds who we're going met we're going as a standard so 1500 grams would be three pounds so you know basically half a pound okay so not very much because that's where the action is and so when you have fat in your liver

it causes metabolic dysfunction right away and the question is where did that fat come from that came from alcohol or sugar so alcohol and sugar most metabolically egregious because it affects the liver directly stress second most because it affects the visceral fat and subcutaneous fat the

least important in terms of metabolic derangement so yes it may not look good in a bathing suit but from a metabolic standpoint it is actually the least important so the question then becomes all right what are you trying to fix if you're trying to fix liver fat it's really easy get rid

of the alcohol in the sugar except of course they're both addictive will that also liberate any fat that's already in the liver absolutely that's one of the reasons why intermittent fasting works is because it gives your liver a chance to basically offload what it's already stored that's one

of the things that intermittent fasting will buy you is a little less liver fat so that's a good thing right now stress on the other hand as you know and as we've talked about and as you know you've had a doctor at Lis Apple on your podcast before you know stress is tough you know trying

to mitigate stress especially in today's environment and I hope you'll invite me back some time to talk about the role of stress on the amygdala now gladly okay and then finally you know subcutaneous fat so when people go on diet sweeteners what are they doing are they really reducing

the fat and the answer is no when you talk about artificial sweeteners are the diet sweeteners of any sort you can pick your artificial sweetener so a spartane or you know sucrose sucrose stevia stevia monk fruit of the new ones you know yeah the one that people are

more excited about nowadays is alo it's expensive it tends to have less of an artificial sweetener taste that people can detect right so you're saying that regardless of oh and we should I'm remembering from the comment section I do read them artificial sweeteners and non caloric sweeteners

yes because in one the moment you say artificial people say what about stevia what about alo so so let's just say non caloric sweeteners can wrap our arms around all that entire category sure unless we need to distinguish among the different participants in that category so you're

saying that even though people can lower their total chloric intake pretty effectively I've seen the studies that show if you know dieters who consume water only as their you know main liquid versus diet sodas with aspartame typically or stevia the diet soda drinkers actually lose more weight

but we know that but you're saying there may be deposition of fat in the liver in those individuals be specifically because of the artificial sweetener because of the insulin turns out they're still an insulin response so very very famous study done in Copenhagen 100 normal individuals

25 in four different groups one group one one one liter of sugared soda per day for six months one liter that's a lot of sugar so yeah one group one liter of diesoda per day for six months I probably did that in graduate school

one group one liter of milk per day for six months I probably did that when I was an infant and finally one final group one liter of water per day for six months I do that now I do more than that but yeah the one liter of soda per day in six months gain 10 kilos the sugary soda the sugary soda

10 kilos okay no surprise the one liter of water per day lost two kilos also no surprise those were the easy ones now let's do the ones in the middle one liter of milk per day no change presumably that was full fat milk full fat milk yeah they like their yeah full fat milk no change why is that

they're taking on an enormous increase in total caloric intake I'm guessing that there was a blunted insulin response due to the fat in the milk and also because lactose is not a very big driver of insulin response and because there's a satiety effect it's like food eat less

yeah it's like food like food and finally the key the kicker to the whole thing diet soda the one liter of diet soda what what would you predict their weight would do more weight loss than in the water group based on my understanding of the literature they gained two kilos

wild because they eat more well you tell me why did they gain two kilos if they were consuming a liter of diacoda which are zero calories the answer is because they still generated insulin response and that insulin response generated more hunger more more weight and more hunger

exactly and that's the key so if they didn't gain the 10 kilos they gained two kilos so it looks better compared to the sugared uh uh uh version but it looks like you know a problem compared to the water version or even the milk version so unless you bootstrap calories and hold that constant

you're going to see a weight gain due to artificial sweetener and exactly right and that's been shown 50 ways from Sunday at a whole bunch of different studies so compared to sugar yeah it's better but compared to water it's way worse and the reason is the insulin response

you put something sweet on the tongue message goes tongue to brain sugars coming message goes brain to pancreas through the biggest nerve sugars coming release the insulin and so tongue doesn't know if it's sugar or not it releases the ends the pancreas releases the insulin

which drives energy into fat whether it was you know from the uh dietsweetener or not I saw some really interesting data from Dana Small's group at Yale yeah showing that when people have a diet soda with food so this is like the diet coke with the sandwich or with the burger

maybe even with the pasta the insulin response from the food and the insulin response from the diet soda are compounded but there's a classical conditioning effect Pavlovian effect such that then later if they just drink the diet soda they get an even bigger insulin response just to the

diet soda than they would have originally if they only had the diet soda separate from food so in other words the the insulin the food-induced insulin response is conditioning a greater insulin response from the diet soda and we actually have another study that demonstrates the same thing

out of Singapore um te at all uh in the American Journal Clinical Nutrition 2018 I believe that looked at a similar paradigm here's what they did they took a bunch of people and they admitted them to their clinical research center four times a week apart and they did them in random order

and each time they uh started the morning they're fasting and they did either a sucrose tolerance test or an aspartame tolerance test or a sucralose tolerance test or a monk fruit tolerance test so two hours you know ingesting one of the three one of the four and measuring glucose and insulin

over the course of the next two hours fasted fasted okay okay then it was time for lunch and they let them have whatever lunch they want it was a metabolic buffet they could eat whatever they wanted off the buffet except that they were being being clocked and the same for dinner they were

being clocked but they could eat whatever they want in a given period of time in the 24 hours okay and you know or you know from 7 a.m. to 7 p.m. whenever they went home okay turned out the sucrose tolerance test generated an insulin response as you'd expect the monk fruit the the sucralose and

the aspartame did not but then when they ate lunch they if they had had one of the three diet sweeteners in the morning they ate more at lunch and more at dinner and generated an increased insulin response both at lunch and dinner so that the area under the curve for the whole day was exactly

the same so they ate a significantly more yeah yeah because they had the diet soda in the morning while the while I drink drinks that contain stevia and I don't worry about it too much but what you're saying is even if I food strap my calories there's a possibility that the insulin response

could have direct effects on the liver exactly right and not for the better and not for the better now having said that we have undertaken an interesting project which I don't know if you know about in 2020 during the pandemic I was approached by a food company in the Middle East

called Kuwaiti Danish dairy company KDD it's the Nestle of the Middle East now they make all sorts of junk frozen yogurt flavored milks ice cream confectionery biscuits tomato sauce okay Kuwaiti has an 18% diabetes rate and an 80% obesity rate 80 80 wow in the adults all right now

the company recognized that they wanted to be a metabolically healthy company and they knew they weren't they contacted me and said would you put together a scientific advisory team to advise us what we need to do to change the food in order to be a metabolically healthy company

and we want to lead and I said we'd be happy I'd be happy to do that with one proviso we get to publish what we did so that it can serve as a road map for the rest of the food industry and they said fine and so I convened a scientific advisory team with my colleague Wolfram Alderson who started the

very first farmers market in Los Angeles and is now actually the director of sustainability and nutrition for KDD Tim Harlan who is the head of culinary medicine at George Washington University Rachel Gow who is a fatty acid expert who ran the omega-3 for ADD trial at the NIH

and Andreas Cornch dot who's actually a computer scientist from Stanford and we basically stripped down every single thing that KDD did in terms of procurement in terms of ingredients in terms of packaging we submitted every single ingredient to biochemical analysis because you

couldn't trust what the vendors were basically telling KDD was in the food we had to actually know what was in the food that was a half a million dollars all by itself I mean this was not a cheap little you know you know sojourn into the woods this was a big deal we basically re-engineered

their entire 180 item portfolio and they have now turned over 10% of their products to be metabolically healthy and the precepts that we set in this paper which is in frontiers in nutrition in March of this year 2023 three things three principles if you adhere to these three

principles you can turn any food healthy including ultra process food number one protect the liver number two feed the gut number three support the brain if you have a food that does all three of those it is healthy if you have a food that doesn't none of those three then it's poison because

it's not food it's not I was going to say it doesn't sound like food is the right the right descriptor in that case exactly and if it's does one or two but not all three then it's going to be somewhere in between so the goal was to take all of KDD's products and move them from

you know the lowest tier up to the highest tier by adhering to these three principles and we came up with some very simple things number one got to get rid of the sugar number two got to add fiber number three got to add omega-3s number four got to do something about the emulsifiers

because the emulsifiers are causing the gut inflammation because after all emulsifiers are detergents they hold fat and water together they burn a hole in the mucin layer so they're actually contributing to that gut inflammation and emulsifiers are you know strewn throughout ultra-processed

food them we've heard about hidden sugars a lot during today's episode and elsewhere but based on everything you told us about artificial excuse me low calories sweet nursing um it makes more sense to be now white foods that are not touted as diet foods would be

laced with things like sucralose because it should drive the craving for that food through increases in insulin and craving of other foods later that day and later that evening is that why non-caloric sweeteners are added to all sorts of foods now that because typically one thing's

non-caloric sweeteners probably only added to quote unquote diet foods low calorie foods but that's not that's their only right it's not that's not the case and they are adding diets diet sweeteners to foods that you didn't know had diet sweeteners in them that's right um

there are two reasons that this happens one is insulin because insulin blocks leptin signaling at the level of the hypothalamus and the nucleus accumbens so with a block slept in leptin is the hormone that your fat cells make the cells your brain you've had enough so if insulin blocks

leptin it makes you hungrier and it also extinguishes it stops the extinguishing of reward by that food so that you want more of it so it does both because leptin normally suppresses food intake and reduces craving the analogy that comes to mind is um a slot machine that

encourages you to feed more money and hit go to pull the lever but that also blinds you to the outcome so even if you win you don't even know that you have wins it's also blinding you to your losses you're effectively becoming a haumaton of just eating without any um kind of conscious

understanding of what you're you're bringing in or tasting the food any longer. Exactly right it's not this like an analelemiquy when she came on the podcast author of dopamine nation and obviously had a dual diagnosis addiction clinic at Stanford talked about you know these these

consumptive behaviors where people are scrolling social media are consuming porn or consuming drugs or alcohol in a way that like they're not in touch with the pleasure of the substance or behavior anymore right they become a taumatons but they but if they don't do it

they feel lousy so the pleasure is gone the pain is definitely awaiting tolerance independence that's the definition of addiction so dopamine is an excitatory neurotransmitter it excites the next neuron always there's no such thing as dopamine inhibiting a post-anaptic neuron dopamine

stimulates the next neuron and it doesn't matter which dopamine receptor it is one through five it's always excitatory now neurons like to be excited that's why they have receptors but neurons like to be tickled not bludgeoned chronic overstimulation of any neuron and you know

this leads to neuronal cell death and the reason is because the neuron needs energy the neuron is the most energy dependent tissue in the body it needs those mitochondria to be pumping out ATP like crazy to engage in neurotransmission well when you're firing nonstop

you risk cell death so the excitatory neuron the the post-anaptic neuron has a plan B it down regulates the receptor it down regulates the dopamine receptor so there's less chance that any stray dopamine molecule will find a receptor to bind to and this is its plan B in order to

try to mitigate the risk of dying well what does that mean in human terms it means you get a hit you get a rush receptors go down next time you need a bigger hit to get the same rush I'm receptors go down and you need a bigger hit and a bigger hit and a bigger hit until finally

you need a huge hit to get nothing that's called tolerance and then when the neurons do start to die that's called addiction that's what we've got and that's what's happened in terms of food addiction so the question is what's addictive is fat addictive no because if fat was addictive

then all the people on the Atkins diet or on the ketogenic diet would be gaining weight not losing it and I'd be craving revise all day I like a revive pretty often actually but I know I know people say no but hey look my lipids are in in line and I I don't eat many starches it and I

certainly avoid sugar although now I'm thinking I might want to really reduce my low calories a sweet nerient take I don't see myself reducing my stevia intake to zero because it's in some things I really like Andrew I am not the food police you know I always say that I'm not a cop but the

um but but but data are data and and health data are the the data say that that's not helping you any that's what the data say um point is that the fat's not the problem the salts not the problem the caffeine's a problem real caffeine's classic addictive substance at every level yeah but

and the sugar problem but if one can cut out caffeine by the early afternoon or even sooner in the day and it's not consumed to excess um and it's in the former coffee or bimote some other form that's healthy you know is it really that much of a problem um I love coffee

me too that's my addiction like with a capital L underlying bold face I like I I I I feel your pain and the answer is no one has shown that coffee is toxic it is addictive but it's not toxic now if you mix the coffee with alcohol now you got four loco now it's toxic but in and of itself

caffeine is not um toxic and that's why there's a Starbucks on every street corner but it is highly reinforcing I did an episode on caffeine where it um that covered some data that was published in the journal science one of the three apex journals um and if you put caffeine

unbeknownst to the consumer into plain yogurt people will crave plain yogurt indeed much more I mean people like the feeling of being caffeine as long as it's not creating anxiety levels of energy exact I'm gonna stick with caffeine that's fine yeah and so why we've been talking a little bit

about the hypothalamus as well as some peripheral gut-based mechanisms for hunger and satiety um this is a great opportunity to talk about some of the GLP1 agonists that are now um widely used so thing typically called ozempic but GLP1 glucococoon like peptide one right originally discovered

in the heel monster which eats very seldom and some really smart biologists I love biology like this is it how come they don't have to eat very much well they have their blood is loaded with GLP1 right um and so they only have to eat one whatever heel monsters um the light in per year

or something outrageous like that humans make GLP1 as well my understanding is that GLP1 that that not that's injected but that one um makes naturally is acting on both the brain and the gut to increase satiety so is acting on the brain or argument but the primary action

is on the gut GLP1 decreases the rate of gastric emptium that is its primary driver yes it does affect the brain I'm not arguing that it does but the primary effect is to reduce the rate of gastric emptying so you stay fuller longer because the food doesn't move through the stomach of the intestine

interesting in South America and it will require an argentina it was long thought that um your brahmate consumption which we know very modestly increases GLP1 like and by the way a lot of other things do too um that people are taking it for its after meals for its laxative effect partially

that's you know it's not pleasant for that's that's the colon that's at the level of the colon but stomach but it is used fairly effectively for people to space their meals without snacking that you're you know and maybe it's the GLP1 maybe it's something else um but people are injecting

themselves with GLP1 analogs now back in the 13 hundred dollars a month yes is that what it costs that's what it costs right um and it seems to be pretty effective at inducing weight loss although a significant amount of that weight loss seems to be from a skeletal muscle tissue and we need to

talk about this so what are your thoughts on those mpick as a primary uh earlier you talked about primary and secondary control are you referred to it a little bit differently in the context of statin right um so a kid comes in his obese or slightly overweight right and it's like mmm I want to do

I'm trying to eat better exercise or a person comes in says hey I've I've had a really hard time getting that last 29 pounds off for so many years yep will you prescribe me those mpick so the short answer is number one I'm retired so I'm not the prescribe on anything but let's let's let's let's go with there the data show that GLP1 analogs like um semi-glutide and now terzepatide which is lilies version uh manjaro is the diabetes version zep bound is the obesity version in the same way

that ozepic is the diabetes version for uh novonordis and wagovii is the obesity version so they're all GLP1 analogs they're all gp the GLP1 analogs they're synthesizing lab it looks like GLP1 smells like GLP1 acts like GLP1 when injected terzepatide the lily1 actually has a dual function it

binds to the gip receptor so it might have double duty and the data show that it's actually even slightly more effective at weight loss than the novonordis version so we'll be seeing a shift in terms of uh consumer preference soon no doubt but here's the thing you look at the data one year

uh of treatment 16% weight loss now that sounds great and i'm not saying it's bad and people are not craving food all the time is that because people are feeling full longer right so they're eating less they're eating less this is a calorie and calorie out model they're eating less and so

they are losing weight i'm not arguing that and they might be craving alcohol less according to some reason yes yeah well we can go there for a minute too in a second here's the problem when you look at that 16% weight loss as you just said when you put people in a dexascanner they have lost

equal amounts of fat and muscle now is it good to lose muscle no it is not good ask any little low lady who breaks her hip if she was she shat a little bit more muscle or somebody who died it lost a lot of muscle because they weren't offsetting the weight loss with resistance training

or some other form of exercise and the amount of food that they can eat in order to maintain that weight to put it in scientific terms sucks and you know we mentioned Peter atiya earlier okay in outlive he's made it very clear that sarcopenia lack of muscle mass is one 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 loss of equal amounts of fat and muscle starvation in fact the reason that all these GLP1 analogs work is because you stop eating like the heel monster yeah just like the ill monster

the ill monsters look pretty chubby to me well ask another heal monster but unfortunately whatever answer it provided was not in terms of the point is that starvation is not so good and if you think about why it's working it's reducing gastric the rate of gastric emptying all right well

it turns out that that's the reason for its side effects the reduction in gastric emptying that's why you get nausea that's why you get vomiting that's why you get pancreatitis and most importantly now gastroparesis your stomach turns to stone and you can't move any food through your intestine

at all and worse yet when you stop the medicine the gastroparesis doesn't get better this is not a good idea this is like the opposite of the year but my pain doose defect which has a sort of pro laxative gastroke emptying maybe GLP1 agonism gosh okay so it's obviously why people who've struggled

to lose weight like it especially if their struggle to lose weight was at least in their mind the consequence of being hungry all the time and needing to eat more or was it because of the reward and you know their dependence because in fact yes these GLP1 analogs reduce reward and that's

one of the reasons why they've noticed that you know thing reduction in alcohol consumption as well and that sounds like a good thing except there are also numerous cases now of major depressive disorder in response to these drugs that's almost like now trexone or something

for the treatment of addiction well sometimes can be useful but now but the attempting to remove the the um the amplitude of that reward signal I mean a lot on paper it makes sense but the but it doesn't always practice it doesn't play out that's right and so I'm going to refer you now to

an old literature that was from 2006 there was a drug that was approved in Europe called Romana Bant okay a trade name Accomplia and it was approved in Europe for weight loss and it was pretty good at weight loss it caused about 20 percent weight loss it also caused severe depression

and 21 suicides so it's no longer available because it was the end yeah it was pulled from the European market never approved in the United States and the reason this happened was because this was the anti marijuana drug this was the anti-munchies drug this was an endocannabinoid antagonist

well when you reduce reward you also reduce your desire to live and that's why this concern about reduction in alcohol consumption we've already seen major depressive disorder in patients receiving ozampic so are we going to see the same thing play out as we did for Romana Bant I'm worried about it

or fenn fenn well fenn fenn didn't have um no it was cardiac it was cardiac right we had cardiac problems due to the fenn fluoramine because of the serotonin 1b receptor agonism right I'm just referring to the fact that these these quote-unquote blockbuster drugs for obesity they tend to follow

a contour of you know very promising very exciting a lot of people losing weight suicides or very promising a lot of people losing weight cardiac issues very promising losing weight and now you're saying the stomach turns to stone sounds so biblical well indeed so that's the question and then

finally we can really talk biblical if everyone in America who qualified for ozampic got it that would be 2.1 trillion to the health care system which is currently at 4.1 trillion so that would be a greater than 50% increase in health care costs okay at 1300 a month conversely

if we just got sugar consumption down to USDA guidelines by basically you know putting some limits on how much added sugar the food industry can put into any given product like fruit loops we could reduce weight by 29% and save 3.0 trillion dollars so we'd get better weight loss

and we'd save 5.1 trillion dollars which makes more sense to the US government well earlier you are alluding to government big food big pharma relationships I mean there's a huge win here for whoever's manufacturing these chlp1 analogs in the but the question is who's paying the tab well we

are now the question is why can't the government see that and the answer is because the government's on the dole 2 because the government through tariffs on us made foods okay grosses 56 billion dollars a year so they're a player they're not just a regulator they're an actor to play devil's advocate

a little bit listen I'm gonna be the last person to step in and try and defend government as a unified body I'm not qualified to do that but you could see how it if you looked at it like checkers instead of chess you'd say okay here's a drug that's going to allow many millions of people

to reduce their overall body weight overall body weight is a risk factor for a number of things and there will be savings on the back end as a consequence of that weight loss I mean so that's the checkers version right the chess version is how you're describing it and I think that I mean

clearly people in government are are well most some perhaps are smart enough to play chess not checkers or to at least understand it but there's very little incentive for the chess model so what would quote unquote solve this problem is the same thing that happened a fenn fenn or this

Romana which is if suddenly there's a major issue with the drug then everyone stops taking it and traditionally that's how it's going it sounds like these chlp1 analogs are gonna make it through the shoot though yeah I mean there is a very clear downside to these medicines on the other hand

you know there's an upside and so I'm not sad that these medicines exist I'm for them I'm not against them I'm for them for the right patient and right now it's not the right patient who's getting them just like the statins so what if somebody who's taking one of these analogs makes it

a point to do resistance training and here you know you mentioned bodybuilders early I'm not I'm not suggesting they become bodybuilders but we now know and I think Peter or Tia and others would agree that everybody should be doing some form of muscle loss offsetting resistance exercise

I agree at least past you know they're reaching their adult height or something you know I I know there are those that say weight training doesn't blunt in your height anyway let's just say that from hit your early 20s onward especially especially if you're on these medicines right in

order to maintain muscle mass right so that's a different picture right people are drinking less alcohol again I'm playing devil's advocate here so if we look at these these compounds not in a vacuum but okay the person who's been carrying that extra 30 pounds is now only carrying a few extra

pounds of adipose tissue they've lost a lot of muscle but now they feel well enough to exercise the depression part worries me yeah but anyway I'm just I'm just trying to round the contour of it what we've seen in children you know because that's who I took care was that often they needed a

jumpstart okay and there were different ways to get them to jumpstart stomach stapling well that's not jumpstart that's what that was what a lot of people did I know I have a friend he's he was and sadly still is really big and he always talked about the stomach stapling like if I could just

get 50 pounds down quickly then I could exercise but exercise is painful this kind of thing and sadly he's he's continued to maintain her creep up in a very excessive weight and that's the point is you know that this concept of jumpstart actually if you're only doing it yourself doesn't really

work and the question is why is his weight creeping up if he's had the stomach stapling the answer is because he's a sugar addict yeah he's definitely addicted to the super big gulp soda if you drink your calories it doesn't really matter does it no and and he's got such terrible psoriasis and

joint pain and all this that the prospect of exercising is like a it you might as well tell him that to like flap his wings and go to Mars you know fructose is a driver of immune dysfunction if he got off you can tell him from me if he got off the sugar his psoriasis would get better his weight

would get better his arthritis would get better and he could have then that jumpstart this is a perfect example to bridge to the brain component of all this because I've long wondered based on what I understand about neural circuitry and neuroplasticity I know we share in this knowledge that

at some point carrying a lot of adipose tissue means that the brain sort of represents the body differently I mean we know there these these somatotopic maps of self you know but that the neural machinery in the hypothalamus sure which is responsible for motivated states etc but but also

just the entire mapping of the self changes in other words if one is fat long enough that it becomes increasingly hard to get to a healthy weight because of the way that the neural circuitry is impacted it basically remaps to maintain that that fat person not necessarily

even just at the level of appetite but just in terms of what do you what do big animals do I had a bulldog the way 90 pounds bulldog massive he was very economical with his movement right he's extremely powerful he could run at least in when he was younger and but if he could be still he

was still as opposed to certain smaller animals that are like parry patatic right because because he was leptin resistant so leptin as we talked about briefly is the hormone that tells your brain you've had enough if you are leptin sensitive you are happy to burn if you are leptin resistant

your brain thinks you're starving if your brain thinks you're starving it's going to affect your behavior in two ways it's going to make you want to eat and so also going to make you want to conserve because the goal is to try to increase the leptin levels in order to overcome that resistance

which of course you can never do because all you're going to do is lay down more fat and make more leptin and make so much sense because leptin comes from the adiposterous exactly so that leptin resistance is what you have to be able to break through you have to fix the leptin sensitivity

well what's the driver of the leptin resistance insulin insulin inhibits leptin signaling and it does it at three separate places in the palm-seen neuron the pro-opium melana cortin neuron in the hypothalamus it does it at irs two insulin receptor substrate two it does

it at socks three suppressor cytokine signaling three and it does it at pip three phosphatidal and osteoport triphosphate those three separate arms of the leptin receptor are all basically put to sleep by high insulin insulin blocks leptin signaling so the higher the insulin goes the more

your brain thinks you're starving and the more your brain thinks you're starving the hunger you get and the less you want to move so the gluttony and sloth that we've been talking about all all you know podcast is really biochemical it is secondary to this phenomenon of insulin

blocking leptin signaling you got to fix that first get the insulin down any way you can and the best way get rid of the refined carbohydrate and sugar that's where you start it makes so much sense it works too how about that that's always good it is i once heard you say i think it

was in a conversation with peter t on his podcast and this really stuck in my mind that when a person consumes glucose that it activates a number of different brain sites you know neurons loving glucose but that when one ingest fructose that it preferentially activates neurons in the

reward pathway that's right at maybe seven times the the magnitude or or something like that glucose activates the basal ganglia this is work from walner house and and also Eric steis at our health and amusement planning and execution exactly okay fructose basically stimulates the

nucleus accumbens the reward center it is just like heroin just like cocaine just like nicotine it activates the reward center it doesn't do anything for the basal ganglia so it is addictive anything that stimulates the reward center in the extreme is addictive so we have chemical

addictions heroin cocaine nicotine alcohol sugar we have behavioral addictions shopping gambling internet gaming social media pornography done matter they all stimulate dopamine in the reward center and in the extreme they are all addictive so the question is if you are addicted

is that personal responsibility well it's a very 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 end in the addicton yeah and there's always comes down to this question when somebody is suffering from an addiction

of any kind and they're resistant to getting treatment if you look at it them as as being sick at least in that moment is a sick person in the best or worst or at least diminished position to guide their own treatment so for instance somebody with dementia would you ask them do you

want to go see a neurologist you might ask them that but are they the best person to make that decision well this is the problem so this is this is where personal responsibility falls down so personal responsibility as we you know we talked about four criteria have to be met none of them

are met that's the first issue second one is a little bit shall we say cheekier who invented personal responsibility any idea I'm definitely gonna get this one wrong yeah you're gonna get this one wrong are you ready I don't know the tobacco industry the notion of personal responsibility they

invented it there was no personal responsibility until tobacco in 1962 because they were getting killed on the science and they needed to invent another reason for you to smoke in fact there's a paper that came out dorfman at all that looked at the New York Times in the Washington Post and they

did a entire lit search of the entire of you know the all the output of those two newspapers for decades to look for the term personal responsibility and the very first time it was ever mentioned was 1962 and it didn't pick up in speed until 1986 which was the same year as sipelony v-ligate

in the at the supreme court which basically said that the you know that the cigarette industry was was guilty of of applying people with an addictive substance so this is very specifically industry driven and we have the data to prove it amazing well I wonder

along the lines of personal responsibility given that many listeners to this conversation are going to be thinking about their own food intake and food choices that of their children and other relatives then that we could play a little a little a little not a game but a little rapid-ish fire

Q&A never done this before in this podcast but I think it's particularly appropriate for a discussion like this that wakes out into so many areas and I absolutely will invite you back and I'm perhaps along with this apple to talk about some of the exciting work you guys are doing because

there's so much we could cover but people are going to wonder in a very practical sense whether or not they should or should not be consuming certain things and I know you're not the food police I'm not the food police and I'm not a cop and I do believe people should

are should be in choice about these matters but I also believe that because you're guest on the podcast and you're highly informed and and I've 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 really appreciate

your honesty and directness but not you'd be willing to provide a comment about a couple of different terms that all throw out and if you choose to say really nothing to say about that fine that would be a quick pass so here we go and we covered a little bit of this earlier but

fruit in whole form so it 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 thank you white rice versus brown rice and among the white rice is the sticky rice and the rice is with added sugars which you

find in in a lot of in a lot of restaurants brown rice because of the fiber white rice polished you know number one all the vitamin B1 gone and of course a much larger glucose excursion that glycemic index thing which of course I hate is it's glycemic load that matters and that is a

very high glycemic load so brown rice so brown rice is better than white rice yes okay in a meaningful way in a meaningful way okay earlier you mentioned tomato sauce I love tomato sauce that's made from just tomatoes can to make so is our most tomato sauces filled with sugar perfect our little

recommendation engine looked at this question and it turns out that only 10% of the available tomato sauces out on the market don't have added sugar so you have to know which ones well you can look yourself or you can look up perfect and it will tell you which ones you can buy

if people chose to consume bread which many people do is there a way to just across the board without just baking your own or see or looking at the ingredients list to make a better choice is it like sourdough is tend to have less sugar than blank well sourdough has been fermented so it will

have actually consumed some of the sugar so it would be a better choice but really the best choice is the highest fiber breads now if you look at a wheatberry it is 25% fiber the husk is 25% of the weight of that wheatberry that means that the carbohydrate to fiber ratio of a wheatberry is 3 to 1

so a good bread should have a carbohydrate to fiber ratio of somewhere between 3 to 1 to 5 to 1 tops anything above that means that they've stripped the fiber away so that's something you could do but the easier way is to actually look it up on perfect you mentioned meat and meat sourcing

egg and chicken sourcing earlier maybe we just revisit that meat fish and eggs thumbs up thumbs sideways thumbs down or it depends it depends depends on where the meat came from it depends on whether it was pasture raised depends on whether it's organic or not if the animal was injected

with antibiotics stay away from it because those antibiotics are in the meat they're going to basically sterilize your gut and then the bad bacteria are going to take over we haven't really talked much about the microbiome today but that's a whole podcast all by itself well we can touch on it a little bit more from low sugar fermented foods thumbs up thumbs sideways thumbs down fermented foods short chain fatty acids all good what are your favorite sources of fermented foods?

I like kimchi yeah I like kimchi too I like some of the live sour crouts yeah that's also good but with the right you know with the right accoutrement the one thing I would be careful about is yogurt okay so there are yogurts with live cultures and there are a whole lot of yogurts with

dead cultures and if it's a yogurt with dead cultures it's kind of irrelevant and the chances are they've actually covered up the sourness with sugar so come or you know large commercially available yogurt be very very careful okay if it's a you know artisan yogurt you know made by a you know people you know or trust you know that's a very different story you know yogurts with

live cultures intermittent fasting do you practice it and what do you think about it? I don't practice it but I am for it for the right patient turns out who's the right patient the patient with liver fat because the reason it works is because it gives the liver a chance to basically burn off the fat that it's stored zero calorie soda got it that's definite no and I don't even have to ask about sugary soda because that's that's that's basically just poison and it can food combinations

I have a feeling I know what your answer is but the glycemic index which we know your feelings on now asserts that if you combine some fat with a sugary like like eating ice cream you have a more blunted insulin response then if you were to eat pure sugar of equivalent calories but what are your thoughts on food combinations as a way to blunt the insulin response?

food combinations are great if there's some fiber associated with it comes back to fiber again and by the way and by the way I you know full disclosure I am the chief medical officer of a fiber company what is it? it is called biolumine and it is a proprietary fiber it is a microcellulose sponge seven microns in diameter so the size of a red blood cell you swallow it it goes to your stomach it expands 70 fold over its original

size and so it'll give you a feeling of fullness because it's taking up space in the stomach but more importantly when it expands the nooks and the crannies in the sponge become available and embedded in those nooks and crannies are a set of proprietary hydrogels soluble fiber

which sequester glucose fructose sucrose simple starches and render them unavailable for early absorption in the duodenum thus reducing the glucose response reducing the insulin response protecting the liver and moving it through the intestine so that microbiome can shoot up for

its own purposes feeding the gut we can reduce glucose absorption by 36% fructose absorption by 38% sucrose absorption by 40% simple starch absorption by 9% and increase short chain fatty acid production by 60% without an increase in gas when do people take this with meals okay so it comes

as a sachet one teaspoon sprinkle it on your food or take it as a you know in a drink you know just mix it in and slug it down and then eat breakfast lunch or dinner and it will basically act like you ate real food it will turn processed food into real food in the intestine and we have

clinical trial data that demonstrates that is it available is it is available it is called munch munch now I hate that name I didn't make it up well you're marketing team sucks but the product sounds amazing biolum and dot tech great thank you for that sorry munch munch marketing team

but you got a munch munch to a new product name but it sounds like a very interesting product and it actually answered my next question which was about fiber supplements fiber is good but there are two kinds of fiber there's soluble and there's insoluble and they are not the same so soluble

is what goes into fiber one bars you know that's psyllium inulin pectin well like we're holds jelly together that's good I'm not saying it's bad but you need the insoluble fiber the cellulose the stringy stuff in celery the cardboard if you will together they form this gel that we talked

about earlier if you only consume the soluble fiber which is what the food industry will add to food because the insoluble fiber is not missable if you only add the soluble fiber back you're not getting the benefits of the entire fiber complement earlier when talking about the nova system and

how most all of our foods are nine let's say I know it's seven to ten percent let's say 95 percent let's air on the side of better 95 percent of our food should come from nova system class one or class two foods four three or three okay staying away from those nova class four

foods could you give us some examples of nova class one and class two foods it just brought broadly 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 ground beef has a label okay so that's well

does it so you're talking about apple well when I buy it it has a label I'm asking this because people are gonna wonder so well it doesn't have a nutrition facts label is there a nutrition facts label on a single ground beef I buy that's that ground beef where I consume venison where if

you flip it over it says how many calories how many protein it so there's a label but it's just beef or venison okay and that's class one okay egg egg is class one so and then of course fruit apples orange okay so it doesn't matter if it has it has a name a name tag as long as it doesn't

have any green and vegetable got it real food does not need a label it's only if they did something to it that it needs a label so you have to look at every label as a warning label now the problem with the label is it only tells you what's in the food what you really need to know is what's

been done to the food because it's the ultra processed food that's the problem they don't want to tell you that that's secret okay secret from a proprietary standpoint but also secret because if you knew what they did to it you wouldn't need it you would never buy it and they don't want

you to know so they only tell you what's in the food that's not what's important it's what's been done to the food that's important and that's why this noble class for so important and that's why perfect is so important because it'll do the work for you okay we'll definitely provide links

to all of these so if you could pick one thing to recommend to people that want to improve their health get rid of sugar period very clear that's number one at number two go for a walk the exercise piece yeah go for a walk and if you could recommend one thing that the general

public can do to try and assist in this advocacy for not redefining but actually clearly defining what is food and what isn't and making people aware at the level of policy and change and school lunches I mean if there were one thing what can we do I mean I you've clearly activated minor

on surrounding like the set of problems that exist and the paths to correct them but should we be writing to our congresspeople should we be getting angry at hospitals because they've got all these fast food machines and that the cafeteria food is like is like illness promoting at UCSF

we've gotten rid of all sugar beverages we have the healthy beverage initiative so no machines at UCSF Stanford check that out because you know people always send me pictures of the of the coke machines in the school of medicine I'm like listen I didn't put them there but I

I we have to model for the public you know I mean where where was the first place that smoking was banned hospitals okay because we knew so if you get rid of the you know soda if you get rid of the sugar soda at the hospital you're telling people something so yeah I think that every

hospital and really every public venue in America needs to clear out the junk so post photos of junk that are supposed to be in in health promoting institutions and I guess we're trying to cancel junky we're trying to shave I'm pretty opposed to cancel culture but here we go and it can't

so marvelous it's actionable it's straightforward it's low cost low time investment a zero cost very low time investment thank you for that and look up eat real because we're doing it for your kids so you need to help support it any school district in America can do it so what do we do we

have a business model whereby the food services director either purchases or rents a dilapidated factory in the center of the district repurposes it into a food preparation facility they can make 27 to 30 thousand meals a day okay with a you know skeleton crew and then they and and you control

what's in it and because you're buying in volume it actually reduces the cost so it's cheaper than buying it from Cisco or arrow marker Cadex or wherever and then you farm it out via you know trucker bus to all the different schools so every kid gets a hot meal made from scratch each day

and we can solve this problem can't help but ask this one last question for people that want to cut out sugar which you clearly stated is the most important thing to do for one's health how do we know how much sugar is in something so should people be looking at labels and just looking

for how much sugar how much carbohydrate or could we even go so far as to say if it says high fructose corn syrup then it's on the no fly list don't don't don't eat it so the problem the problem is that there are 262 names for sugar and the food entry uses all of them and the reason

they use all of them is because they can include a different sugar as number five number six number seven number eight number nine on the list when you add it up it becomes number one they hide it in plain sight and they do it on purpose now do I expect everybody to memorize all 262 names no of

course not can you figure it out yourself well the answers no unless they have the line where it says added sugars if it says added sugars it is either sucrose or high fructose corn syrup no one's adding lactose okay that's not more glucose they're not even adding glucose because glucose isn't that sweet glucose is not that interesting you don't see people going around chugging carose syrup do you okay that's glucose who cares yeah might be good in the molasses cookie but that's it all right so

it's fructose so you need to know what's been added so if it says added sugars that's a good place to start no greater than one teaspoon per serving no greater than four grams per serving of added sugars anything greater than that leave it the store and aim for those nova type type one

type for no aim for nova types one two and three and if you don't know whether it's nova type one two or three you can use perfect and if you don't look at that then go look at the nutrition facts label and anything that has more than four ingredients is nova class four robert lusting thank you so

much you've provided such an incredible education in nutritional biochemistry the processing of fat protein carbohydrate sugar fructose in particular the clear detriment of consuming fructose on so many different organ systems I love love love that you separated out food science nutrition and

metabolic health or self that's just I that's a you know that's a gazillion dollar delineation for people to understand and to shape their understanding of all the information that's out there and bins into these different categories you've given us so many actionable tools new

conceptual frameworks you've given us a real tour de force today in a just oh so clear language so I want to thank you I learned a ton and and I know everyone else has as well and if people have questions they can of course put them in the comment section on youtube that's the best place we'll

provide links to all the the companies and websites that that you referenced and some of your other work and listen I just I'm so so grateful that you exist and that you've done the work that you've done and and your passion and your advocacy for health is it's just oh so clear so thank

you so much so I want to I want to thank you and the reason I want to thank you is first of all you know inviting me that's nice you know that's good but the reason is because people need to understand science I am completely in agreement with you the public needs to understand 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 is truly remarkable and so I want to thank you for your serves well you're most welcome it's a labor of love and I think it was the great max

Delbrook that said when teaching assume zero knowledge and infinite intelligence and I do believe that humans are infinitely intelligent although sometimes as a whole we mask it people deserve the the knowledge so thank you so much for sharing that knowledge today and let's absolutely have you

back my pleasure thank you thank you for joining me for today's discussion with Dr. Robert Lustig about nutrition and how sugar impacts the health of our brain and body to learn more about Dr Lustig's work and to find links to the many books that he's written on this and other topics

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