#14 – Robert Lustig, M.D., M.S.L.: fructose, processed food, NAFLD, and changing the food system

Sign up to receive Peter's email newsletter: https://bit.ly/4c602k2 Original release date: 9/10/2018 In this episode, Rob Lustig — a researcher, an expert in fructose metabolism, and a former pediatric endocrinologist — discusses what’s wrong with the current food environment, and what we can do to reduce our chances of becoming part of the obesity, diabetes, metabolic syndrome, and nonalcoholic fatty liver disease (NAFLD) epidemics. Rob recently earned a Master of Studies in Law because he believes that educating people about sugar from a scientific standpoint is only half the equation: the other half involves changing policy, which he explains in this episode. We discuss: -What’s the difference between glucose and fructose? [7:00]; -Do we have biomarkers that can give us some indication of average exposure to fructose over a given period of time? [14:20]; -What’s the difference between ALT and AST? [18:45]; -Inflammation, endothelial function, and uric acid [21:30]; -Is there something that fructose does better than glucose? [23:45]; -For children that undergo a remarkable shift from metabolic health to metabolic derangement, is there a concern that these kids suffer an epigenetic hit that makes it harder for them later in life? [26:15]; -How many times do you have to introduce a savory food vs a sugary food to an infant before they will accept it? [29:30]; -How are alcohol and fructose similar in how they affect the brain? [33:51]; -Advice for parents and kids for creating a sustainable environment that’s going to prevent them from running into metabolic problems [40:30]; -Why do some populations have a higher risk of NAFLD? [45:42]; -What causes NAFLD? [48:45]; -Is insulin resistance the result of NAFLD or is NAFLD the result of insulin resistance? [56:00]; -HRV, cortisol, and norepinephrine [1:00:30]; -What are the actual mechanisms that links metabolic syndrome, insulin resistance, fatty liver, and type 2 diabetes? [1:03:00]; -Is the food industry still saying that all calories contribute equally to adiposity and insulin resistance? [1:09:00]; -What is the difference between soluble and insoluble fiber and why do you need both? [1:13:00]; -How can we change the food system when 10 companies control almost 90 percent of the Calories we consume in the US? [1:15:00]; and -More. Show notes page: https://peterattiamd.com/roblustig/ About: The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…and a few other things. With over 10 million episodes downloaded, it features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more. Peter is the founder of Attia Medical, PC, a medical practice with offices in San Diego and New York City, focusing on the applied science of longevity. The practice applies nutritional biochemistry, exercise physiology, sleep physiology, techniques to increase distress tolerance, lipidology, pharmacology, and four-system endocrinology to increase lifespan (delaying the onset of chronic disease), while simultaneously improving healthspan (quality of life). Learn more: https://peterattiamd.com/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on: Facebook: http://bit.ly/PeterAttiaMDFB Twitter: http://bit.ly/PeterAttiaMDTW Instagram: http://bit.ly/PeterAttiaMDIG Subscribe to The Drive: Apple Podcast: http://bit.ly/TheDriveApplePodcasts Overcast: http://bit.ly/TheDriveOvercast Spotify: http://bit.ly/TheDriveSpotify Google Play: http://bit.ly/TheDriveGooglePlay

Peter AttiahostDr. Robert Lustigguest

Dec 23, 20191h 23mWatch on YouTube ↗

WHAT IT’S REALLY ABOUT

Lustig Explains Fructose, Processed Food, Fatty Liver, and Food System Reform

Lustig argues fructose differs from glucose biochemically and behaviorally, since it browns proteins faster, does not lower ghrelin, and activates the brain's reward center.
He and Attia describe uric acid and ALT as indirect markers of fructose toxicity and say the lab reference ranges have drifted upward as fatty liver became common.
Lustig makes the case that de novo lipogenesis, meaning sugar turned into liver fat, is the main driver of NAFLD, and he links liver dysfunction to insulin resistance, hyperinsulinemia, and chronic disease.
He says the real problem is processed food, which is high in sugar and low in functional fiber, and that real food with both soluble and insoluble fiber is the fix, though it is costlier and takes more time.
Lustig describes a food industry whose profit model depends on sugar and lays out four levers for change: public education, executive regulation, legislation, and litigation, with an emphasis on ending food subsidies.

IDEAS WORTH REMEMBERING

5 ideas

Fructose and glucose are not metabolically equivalent.

Lustig says fructose browns proteins about seven times faster, does not suppress ghrelin, and lights up the brain's reward center, which is why he rejects the idea that a calorie is a calorie.

Uric acid and ALT serve as practical proxies for fructose harm.

Since fructose consumption itself can't be measured well, Lustig and Attia use uric acid and ALT; Lustig says ALT should stay near 25 and uric acid near 5.5, and Attia targets ALT under 20 and uric acid under 5.

De novo lipogenesis is the main driver of fatty liver.

Lustig reasons by exclusion: dietary fat has fallen and export or oxidation defects are too rare to explain a 40% NAFLD rate, which leaves sugar turned into liver fat as the pathway that has risen.

Lowering glucose alone is not enough in diabetes.

Lustig says diabetes trials that improved A1c reduced small-vessel complications but not large-vessel disease or death, because insulin itself promotes inflammation and cell proliferation, so insulin sensitivity must improve through diet.

Fiber only works when you get both soluble and insoluble types.

Lustig explains that the two fibers together form a protective gel in the gut, so processed foods fortified with soluble fiber such as psyllium don't deliver the benefit, and lack of fiber may push gut bacteria to digest the mucin layer.

WORDS WORTH SAVING

5 quotes

Every diet that works is real food, and every diet that doesn't is because it's processed food.

— Dr. Robert Lustig

It's not the added sugar you know. It's the added sugar you don't know.

— Dr. Robert Lustig

neurons like to be tickled, not bludgeoned.

— Dr. Robert Lustig

So the idea is to feed your bacteria, or your bacteria will digest you.

— Dr. Robert Lustig

You can't outrun a bad diet. You have to fix the insulin problem, and exercise won't fix the insulin problem by itself.

— Dr. Robert Lustig

Fructose versus glucose metabolismUric acid and ALT as biomarkersNAFLD and de novo lipogenesisInsulin resistance and hyperinsulinemiaSoluble and insoluble fiberDopamine, tolerance, and addictionFeeding kids real food

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