Doctor Sounds The Alarm: "You May Never Eat Sugar Again After Watching This" | Robert Lustig

1. 0:00 – 1:08

   Sugar replaces trans fats as the biggest modern dietary threat

   1. RCDr. Rangan Chatterjee0:00

      What are the key negatives when we consume the levels of sugar that many of us are currently consuming?

   2. RLDr. Robert Lustig0:07

      Well, first of all, let's make it very clear that sugar's not the only problem in our diet. It's the big one, it's the 2,000-pound gorilla in our diet, but there's other stuff too. But sugar is a particularly egregious molecule. Once upon a time, trans fats were the worst thing we consumed. Trans fats are the devil incarnate. Trans fats, the bacteria can't chew it up, which is why they put the trans fats in, all right? So that, you know, it would last forever, you know, the 10-year-old Twinkie. Well, the fact is our mitochondria, our little energy-burning factories inside all our cells, are really refurbished bacteria. We can't chew it up either. So the exact same reason for why they put the trans fats in the food is exactly why you shouldn't eat the food. Now, we know that, and they've come out of our diet. So now sugar is public enemy number one. So what does sugar do? And the answer is

2. 1:08 – 2:40

   How sugar impairs mitochondria and reduces cellular energy

   1. RLDr. Robert Lustig1:08

      a whole bunch of bad things. The food industry says sugar's energy. Well, they're correct if you're a bomb calorimeter. If you just blow it up, if you explode it, yeah, you get four calories per gram. But we are not bomb calorimeters. Turns out that sugar actually poisons the mitochondria. Okay? It poisons it in th- uh, three separate enzymes that are necessary for mitochondria to do their job. The first one, AMP kinase, which is the fuel gauge on the liver cell. The second one, ACADL, acyl-CoA dehydrogenase long chain, which is necessary to get fatty acids into the mitochondria to be able to oxidize them to create energy. And the third one is CPT-1, carnitine palmitoyltransferase 1, which is the, um, enzyme that regenerates carnitine, which is the shuttle mechanism that brings the fatty acids into the mitochondria in the first place. In other words, when you consume sugar, you are poisoning your mitochondria. You are generating less of the chemical energy that our p- cells get powered by, called ATP. So if you're making less ATP, is that energy? It's the opposite of energy. So when you consume sugar, you are actually inhibiting

3. 2:40 – 3:24

   The cyanide analogy: slow toxicity vs acute poisoning

   1. RLDr. Robert Lustig2:40

      your s- body's energy production. Can you think of a chemical that inhibits your mitochondria and reduces ATP production? Cyanide.

   2. RCDr. Rangan Chatterjee2:52

      Cyanide.

   3. RLDr. Robert Lustig2:53

      Cyanide. Cyanide does that, okay? Sugar and cyanide do the same thing. Now, obviously not as severely, okay? You know, cyanide, parts per million, keel over and die on the spot. With sugar, you know, it's in the parts per thousand, and you don't keel over on the spot, but you feel lousy, and over time it's gonna take its toll. But ultimately, if you're inhibiting your mitochondria, you are poisoning your body,

4. 3:24 – 4:44

   Ultra-processed foods dominate intake—so are they really “food”?

   1. RLDr. Robert Lustig3:24

      and we now have the data to show how that occurs. So here's my question to you and your audience. Sugar is in virtually all ultra-processed foods, and u- ultra-processed foods are now 56% of the UK diet, and the, uh, amount of sugar that Brits eat, 62% of it is found in the ultra-processed food category.

   2. RCDr. Rangan Chatterjee3:53

      Wow.

   3. RLDr. Robert Lustig3:54

      So my question to you, and your audience, is, is ultra-processed food food?

   4. RCDr. Rangan Chatterjee4:04

      My view is that it's not really. I w- I would say no, but I know to many people that is super controversial, um, which we're definitely gonna talk about. But yeah, on a straight answer, I would say no. Depends on your definition, I guess, 'cause it's energy.

   5. RLDr. Robert Lustig4:22

      Okay.

   6. RCDr. Rangan Chatterjee4:22

      It's got some calories in it which we consume in our mouth, uh, enable us on one level to, to sort of... I guess you're saying it's actually, uh, reducing the energy production, the sugar within it anyway. But yeah, on one level it sustains people and they can actually get on with their days, at least in the short term anyway.

5. 4:44 – 7:02

   Defining ‘food’ by growth or burning—and testing UPFs against it

   1. RLDr. Robert Lustig4:44

      Well, you have to know what the definition of food is. So if, if I, if I had my Webster's dictionary right here right now, um, you, you guys, you know, in the UK probably don't use Webster's, you probably have something else, but if I pulled it off the shelf, it would say that the definition of food is the following, and I have no problem with this definition, "Substrate that contributes to either the growth or burning of an organism." That's the definition. I have no problem with that definition. It's a fine definition. All right? "Substrate that contributes to either the growth or burning of an organism." So we've just talked about burning. Sugar does not contribute to the burning of an organism, it actually inhibits the burning of an organism. And Dr Kevin Hall at the NIH did a study where he showed that when you give people ultra-processed food, they burn less and gain more weight, when everything else is controlled for compared-

   2. RCDr. Rangan Chatterjee5:46

      Yeah

   3. RLDr. Robert Lustig5:46

      ... to the same diet in real food. Did this in 2019. So ultra-processed food does not contribute to burning. So now let's go to growth. Does ultra-processed food contribute to growth?My colleague, Dr. Efrat Monsonigo-Ornan, who is the, uh, chairman of the Department of Nutrition at Hebrew University Jerusalem, uh, just published three papers in Bone Research showing that ultra-processed food actually inhibits skeletal growth, inhibits the ability of bones to increase in length and in width. And in addition, we know from the NutriNet-Santé study and many other studies that, in fact, what sugar does is it feeds cancer cells, it hijacks growth. So sugar doesn't contribute to burning, inhibits it. Doesn't contribute to, uh, uh, growth, inhibits it or hijacks it. So I pose the question to you again, Rangan, is ultra-processed food food?

   4. RCDr. Rangan Chatterjee6:57

      I, I'll go with my original answer, which is no.

   5. RLDr. Robert Lustig7:00

      That is right. It is no.

   6. RCDr. Rangan Chatterjee7:02

      [laughs]

6. 7:02 – 7:54

   Why this matters clinically: real food as the lever for chronic disease

   1. RLDr. Robert Lustig7:02

      Ding, ding. That's right. But the point is that the food industry, you know, refuses to go there. The populace refuses to go there. The governments refuse to go there. And you and I are both interested in mitigating chronic disease.

   2. RCDr. Rangan Chatterjee7:23

      Yeah.

   3. RLDr. Robert Lustig7:24

      And you are right. If you get people on a real food diet, you can mitigate virtually any and all of their chronic diseases. I completely agree. You gave a TEDx talk basically saying you can basically take away somebody's chronic disease. I used to do that in my clinic, you know, when I was practicing, routinely.

   4. RCDr. Rangan Chatterjee7:44

      Yeah.

   5. RLDr. Robert Lustig7:45

      But only if they changed the food. And if they didn't change the food, no amount of medicine I threw at them could make a difference.

7. 7:54 – 9:00

   Normalization and social pressure: UPFs as the default everywhere

   1. RCDr. Rangan Chatterjee7:54

      Yeah. I mean, what strikes me as a really key message is that the majority of what we're buying to feed ourselves and our families is ultra-processed food, whether it's here in the UK or with you in America, and that is contributing to this tsunami of chronic ill health that we're seeing. It's pretty... You know, it's pretty alarming. But what, what I think is so key, Rob, for me, is that it's so normalized now.

   2. RLDr. Robert Lustig8:28

      Yeah. That's the-

   3. RCDr. Rangan Chatterjee8:28

      Like, it's the norm everywhere, schools, hospitals. In fact, if you wanna go down the real food route, you almost feel like a bit of a... Like, you know, if you try and do it with your kids, you actually become a social outcast in, in some ways. It's-

   4. RLDr. Robert Lustig8:40

      Yep. You're a pariah.

   5. RCDr. Rangan Chatterjee8:41

      And I think this is the problem. It's just, it's the norm. We've moved so far away from what we used to do. In fact, maybe this is a good time for you to explain what you used to do when you were eight years old, 'cause I believe you had a granddad who lived in Brooklyn.

   6. RLDr. Robert Lustig8:56

      [laughs]

   7. RCDr. Rangan Chatterjee8:56

      And every Saturday you would do something which I think beautifully illustrates this point.

8. 9:00 – 11:37

   A personal timeline: treats, early convenience foods, and the mid-century shift

   1. RLDr. Robert Lustig9:00

      Well, that's right. So yeah, um, uh, bottom line is I completely agree with you. What we've done is we've normalized it. Once upon a time, it was actually not normal to eat ultra-processed food, and today it is normal. And I remember when that happened, because it happened to me. It happened to me in two ways. So on Saturday afternoons, my family would go visit my grandparents, who lived about, oh, I don't know, eight miles away in Brooklyn. And my grandfather would walk me down to the corner, um, uh, grocery store to buy a comic book and a six-and-a-half ounce bottle of Coca-Cola, and I remem- you know, pretty much every Saturday afternoon. And that was the big treat, you know, the comic book and the Coca-Cola. That was at, on Ocean Avenue and Avenue N in Brooklyn. Um, you know, the fact is that that was once a week, and it was six and a half ounces, right? Today, you know, children are consuming about, I think, 35 ounces a day, um, you know, uh, median. So they are getting about six times the amount of sugar that I did from that one Coke, and they're doing it every day instead of once a week. In addition-

   2. RCDr. Rangan Chatterjee10:17

      I mean, let's just... C- can we just pause on that for a second? You're saying you had six ounces once a week, and we're assuming back then that the rest of your diet throughout the week was low in sugar, low in processed food, sort of a real food diet?

   3. RLDr. Robert Lustig10:33

      Well, my mother worked three jobs, and so I ate a lot of Swanson TV dinners when they first came out.

   4. RCDr. Rangan Chatterjee10:43

      Right.

   5. RLDr. Robert Lustig10:43

      And I remember when they came out, around 1964. You know, the, the fried chicken, the Salisbury steak. I hated that Salisbury steak. And I... Actually, she trained me on how to turn the oven on and how to heat 'em up, because often she wasn't home at night, you know? So, you know, to some extent I was a latchkey kid because my mother worked so hard.

   6. RCDr. Rangan Chatterjee11:06

      Yeah.

   7. RLDr. Robert Lustig11:06

      You know, my father was in Manhattan all day. And so, you know, I basically had to sort of take care of myself, and sometimes I had to eat dinner, you know, out of the freezer. And so I remember, you know, those Swanson TV dinners, and, you know, they, they, they were a problem, and they're still a problem. Um, so you put the two together, and that was the beginning of, you know, the, uh, shall we say, onslaught of processed food in the United States, about the mid-'60s. Um,

9. 11:37 – 12:34

   Policy and industry inflection points: HFCS and low-fat guidance increased sugar exposure

   1. RLDr. Robert Lustig11:37

      then things picked up even more in 1975 when we started, uh, substituting high-fructose corn syrup for sucrose because it was half as, uh, uh, expensive and it was homegrown. And then finally, the pièce de résistance came in 1977 when, uh, the McGovern Commission released its report saying that we all needed to eat less fat to try to prevent cardiovascular disease. Well, when you take the fat out of food, it tastes like cardboard. And so what did the food industry do?It basically replaced the fat with sugar. That's why we ended up with Entenmann's fat-free cakes and, you know, and the like. And that was when the pasta craze, you know, first hit, was, you know, c- refined carbohydrate 'cause it was-

   2. RCDr. Rangan Chatterjee12:25

      Yeah

   3. RLDr. Robert Lustig12:25

      ... quote, low in fat, et cetera. And, you know, now we're off to the races, and it's just exploded ever since.

10. 12:34 – 13:50

    Is sugar inherently harmful or mainly a problem of dose? The alcohol analogy

    1. RCDr. Rangan Chatterjee12:34

       Is it the sugar that's inherently bad in and of itself? Or is it-

    2. RLDr. Robert Lustig12:38

       Yes

    3. RCDr. Rangan Chatterjee12:39

       ... the excess amounts? I mean, or is it both, right? Because I think a lot of people might say, "Well, look, you know what? This never used to be a problem," right?

    4. RLDr. Robert Lustig12:46

       Right.

    5. RCDr. Rangan Chatterjee12:46

       And we, we would have the odd sweet treat now and again. Um-

    6. RLDr. Robert Lustig12:50

       Right

    7. RCDr. Rangan Chatterjee12:50

       ... but so, a- and actually, there's quite, there's quite a few prominent scientists as, as, um, you're, you're well aware of, Rob, who say actually sugar's not a problem. Sugar's actually-

    8. RLDr. Robert Lustig12:59

       Yeah

    9. RCDr. Rangan Chatterjee12:59

       ... completely fine.

    10. RLDr. Robert Lustig13:00

        Yeah, we're working on it. We're working on it. The, I, I, uh, I have a bone to pick with some of those scientists, and we can argue that and talk about that if you'd like, um, as to exactly why they say what they say. So here, here's what I can tell you. All right, there are social drinkers and there are alcoholics. Now, social drinkers can pick up a beer and put it down, and they don't need one every day. Alcoholics pick up a whiskey and can't put it down, and they need it three times a day, right?

    11. RCDr. Rangan Chatterjee13:40

        Yeah.

    12. RLDr. Robert Lustig13:41

        Did the one beer that the social drinker drank hurt them?

    13. RCDr. Rangan Chatterjee13:49

        Unlikely.

11. 13:50 – 17:02

    First-pass protection, liver overload, and the pathway to insulin resistance

    1. RLDr. Robert Lustig13:50

       Unlikely. Unlikely. And the reason it's unlikely is because there is a f- what is known as a first pass effect. You drink the alcohol in the beer. First of all, it's r- very low, uh, percentage, right? It's only about 3.6% in an, um, in a, uh, in a beer. All right? And that, uh, is about, oh, 60 calories worth or so of, uh, of alcohol. And what happens is that the first pass effect, the, uh, stomach and intestine metabolize that alcohol before any of it ever gets to the liver. And so the amount that actually hits the liver that could do damage is exceedingly small. And as long as you're not following up with anec- a second beer and a third beer and fourth beer and fifth beer, you know, like can happen at the Newcastle pub-

    2. RCDr. Rangan Chatterjee14:42

       [laughs]

    3. RLDr. Robert Lustig14:42

       ... you know, you don't usually have a big problem, right? But if you keep doing that, then that is a problem. So it's a dose-dependent phenomenon, and, um, your intestine is there to try to protect your liver from getting the onslaught before it will do damage. Same with sugar. No difference. So your intestine can take a small amount of sugar that you consume and can actually turn it into fat in the intestine. Intestinal de novo lipogenesis, the process of converting sugar to fat, into VLDL in the intestine so that it will not go straight to your liver, right? And about 10% of the, of an initial sugar bolus will undergo intestinal DNL, and therefore be diverted away from the liver and into the bloodstream as VLDL. Now, that VLDL's not great for you, 'cause it could ultimately cause heart disease, but it's protecting the liver. But if you consume past your intestine's capacity to do that, now the rest of it's gonna end up in your liver, and the problem with sugar in the liver is exactly the same as the problem of alcohol in the liver, because it causes the exact same processes. It causes glycation, it causes oxidative stress, it causes mitochondrial dysfunction, and basically drives insulin resistance, this phenomenon that we now know is at the base of virtually all chronic metabolic diseases. Therefore, your pancreas has to make extra insulin to make the liver do its job, because now the liver's not working right 'cause it's been poisoned. And so insulin levels rise all over the body, and now you've got, uh, you know, the risk for Alzheimer's. You've got the risk for heart disease. You've got the risk for virt- uh, for cancer. You've got the risk for virtually every other chronic metabolic disease on the plate, all because of what happened to your liver.

    4. RCDr. Rangan Chatterjee17:01

       Yeah.

12. 17:02 – 17:50

    Fructose as ‘alcohol without the buzz’ and the threshold where harm begins

    1. RLDr. Robert Lustig17:02

       And fructose, that sweet molecule in sugar, basically has the same fate as alcohol. So when people say, "Oh, uh, you know, a little sugar's fine," the answer's, um, yeah, because your intestine diverts that little bit away from the liver. As soon as you overwhelm that capacity, now your liver is right in the crosshairs, and that's when chronic disease is gonna start.

    2. RCDr. Rangan Chatterjee17:30

       [upbeat music] If you enjoyed that short clip, I think you are really going to enjoy the full conversation, which you can check out here. [upbeat music]

Episode duration: 17:51