Doctors Don't Warn You! - "Healthy" Foods Making You Sick & Obese | Robert Lustig

1. 0:00 – 0:49

   Why ultra-processed foods are hard to spot (and why terminology matters)

   1. RCDr. Rangan Chatterjee0:00

      When we're talking about foods, I think we need to get clear on terminology for people who are listening and they think, "Okay, look, I get this. Pr- highly processed food is at the root cause of many of these chronic diseases." Over half of what we're consuming as a country, as a Western society, are these foods. So I guess we need to really help people understand, you know, what are these foods. There's a, there's this part in the introduction where you actually... I've, I've underlined it. You said, "What if this slow consumable poison looks like everything else in the store? How do you protect yourself?"

   2. RLDr. Robert Lustig0:36

      Right.

   3. RCDr. Rangan Chatterjee0:36

      And that's kind of part of the problem, isn't it? I don't- it's so normalized that-

   4. RLDr. Robert Lustig0:40

      That's right

   5. RCDr. Rangan Chatterjee0:40

      ... I think many people don't really understand anymore, well, what is a processed food? What is real food, you know? So can you help us-

   6. RLDr. Robert Lustig0:47

      Right

   7. RCDr. Rangan Chatterjee0:47

      ... try and understand that?

2. 0:49 – 1:20

   The obesity-clinic wake-up call: redefining what counts as food

   1. RLDr. Robert Lustig0:49

      Right. Yeah. One of the first questions we ask in, uh, uh, in, in clinic, you know, we used to ask, is, you know, "Mom," you know, the, the, the mom and the kid come in, you know, for, for, you know, uh, obesity clinic, and we ask the g- uh, you know, "Mom," you know, "what do you consider food?" You know, "Do you, do you think Cheetos is food? If you think Cheetos is food, then basically nothing's gonna help you." So that's the first thing we do, is we disavow them of this concept, of this knowledge.

3. 1:20 – 2:51

   The “teaching breakfast” intervention that actually changed behavior

   1. RLDr. Robert Lustig1:20

      So what we did in our clinic to be effective, and we actually studied this, we published on it, we validated it as an instrument. What we did was we, um, took all newcomers, all new referrals to our clinic, and we did a teaching breakfast. So these kids came in fasting, you know, so we could get comorbidity and safety labs. And we, you know, they saw the doctor, they got their blood drawn, they got their physical exam, and then they went to the teaching breakfast. Six kids, six parents around a table, one dietician, English and Spanish, uh, diff- you know, different times. All right? So that everybody, you know, got a teaching breakfast. And we got $100 gift certificate from Trader Joe's every month to basically buy the food for the teaching breakfast. And of course, our dietician went out and bought the, the right stuff, not the wrong stuff. [laughs] And we would then, she would then narrate for an- or he would narrate for an hour why these foods were on the table for breakfast, and why the stuff they were buying at home was the wrong stuff. Okay? And we would explain insulin, and we would show them how much sugar was in each of the things that they were getting at home and versus, you know, what, what was on the table. And four things had to come out of that, and we actually, um,

4. 2:51 – 4:07

   The four “success conditions”: eat it, like it, normalize it, afford it

   1. RLDr. Robert Lustig2:51

      validated this. Four points, four different points that conferred success. Number one, the parent had to see the kid would eat the food. Number two, the parent had to see the parent would eat the food. Number three, the parent had to see other kids would eat the food, 'cause they got other kids at home. Number four, we showed them the bill. They had to see they could afford the food.

   2. RCDr. Rangan Chatterjee3:20

      [laughs]

   3. RLDr. Robert Lustig3:21

      All four. If we got all four boxes ticked, those patients did well, and then there was no going back. So this was a training moment. This was a teaching moment. This was a way we could explain to, to parents and to kids what was going on, and model for them so they can do see one, do one, teach one, where like we always-

   4. RCDr. Rangan Chatterjee3:50

      Yeah

   5. RLDr. Robert Lustig3:50

      ... do in medical school. If you tell people what to do, they will not do it. If you show people what to do, and they do it, then they'll do it again.

   6. RCDr. Rangan Chatterjee4:00

      Yeah.

   7. RLDr. Robert Lustig4:02

      And not until.

5. 4:07 – 5:29

   Why “real food” gets criticized—and Lustig’s definition of it

   1. RCDr. Rangan Chatterjee4:07

      The term real foods, I like it, you use it, but it does get a bit of pushback from certain academics. And-

   2. RLDr. Robert Lustig4:18

      Right. Yeah

   3. RCDr. Rangan Chatterjee4:18

      ... you know, I saw one, I think, on Instagram just a couple of weeks ago, very prominent, uh, researcher in obesity in the UK, um, denigrating the term, saying it smacks of privilege. It's, you know-

   4. RLDr. Robert Lustig4:31

      Yeah

   5. RCDr. Rangan Chatterjee4:31

      ... all kinds of things about it. And here's the thing-

   6. RLDr. Robert Lustig4:34

      Yeah

   7. RCDr. Rangan Chatterjee4:34

      ... you know, the, you know, my view, Bob, is that I found it to be very useful with my patients. Of course, if my patients don't like it, I'd come up with something else that, that they understand. Um, but generally speaking, I think the things like, you know, would your grandparents recognize it as foods, I, I think people find it quite helpful. Or does the food packet have more than five ingredients on it or not, as a kind of general rough rule. They're not perfect, but they're all kind of guidelines to try and help people make sense of this ultra-processed food environment in which they're living. And I kind of, I wonder why there's so much criticism. It's like, these things are there to help people. If you find it helpful, great. If you don't, fine. Use something else. But I don't... Like, I find a lot of people, particularly in medicine and academia, look down on these kind of, uh, what are considered simplistic terms.

6. 5:29 – 6:34

   NOVA classification: it’s not what’s in the food, it’s what was done to it

   1. RLDr. Robert Lustig5:29

      Yeah. I, uh, I've, I've heard those, uh, complaints also before, and I've heard about the quote, quote, "smacks of privilege" also. Basically, what we're saying is real food is food that came out of the ground, or animals that ate the food that came out of the ground. That's real food, okay? As soon as a human touched it, now it's processed. [laughs] Just a question of the degree of processing also. And, you know, I'm sure you're familiar with Carlos Monteiro at, uh, at University of São Paulo, developed this system called the NOVA system for the degree of processing, which I h- actually think is, you know, the right way to go. It's not... 'Cause that, it's not what's in the food, it's what's been done to the food that matters. All food is inherently good.It's what we do to the food that's not, and that's the point I try to make in the book.

   2. RCDr. Rangan Chatterjee6:14

      Yeah

   3. RLDr. Robert Lustig6:14

      And I have an entire section on what we did to the food that actually turned it from food into poison.

   4. RCDr. Rangan Chatterjee6:20

      That classification system is brilliant, and perhaps you could take a kind of readily available simple food and just explain how it can go through these four stages-

   5. RLDr. Robert Lustig6:32

      Sure

   6. RCDr. Rangan Chatterjee6:32

      ... to, to help people really understand this.

7. 6:34 – 7:30

   Apple to apple pie: a one-minute guide to the four processing stages

   1. RLDr. Robert Lustig6:34

      Sure, I can do this in one minute. Let's take an apple. Class one on the NOVA system would be an apple. Class two on the NOVA system would be apple slices. Class three on the NOVA system would be apple sauce, unsweetened. Class four on the NOVA system would be an apple pie. There you go. Turns out that only the class four foods are associated with chronic disease. And that's because-

   2. RCDr. Rangan Chatterjee7:13

      So we can have, we can have minimally... That's really inter- So we can have, you know, minimally processed foods that are done to make-

   3. RLDr. Robert Lustig7:20

      Minimally processed

   4. RCDr. Rangan Chatterjee7:20

      ... our life easier a little bit or-

   5. RLDr. Robert Lustig7:22

      Yeah, yeah

   6. RCDr. Rangan Chatterjee7:22

      ... you know, but it, it's when it goes to that extreme where it's actually bears no resemblance to actually what actually came out of the ground in the first place.

8. 7:30 – 8:02

   What changed in ultra-processing: added sugar and removed fiber

   1. RLDr. Robert Lustig7:30

      That's right. And so what is different about that apple pie versus the apple? And the answer is the addition of sugar and the removal of fiber. So this now brings us to the question you asked me earlier about the protect the liver, feed the gut. So the addition of sugar is what basically floods the liver, 'cause the liver only ha- like alcohol, only has an innate capacity to metabolize a small amount. We

9. 8:02 – 9:23

   Protect the liver: how excess sugar drives fatty liver and insulin resistance

   1. RLDr. Robert Lustig8:02

      know how much, uh, sugar we can metabolize, and it's not that different from the amount of alcohol that we can metabolize, 'cause the treat- you know, the, the, uh, the metabolism is virtually the same. Point is, you can overwhelm your liver's capacity to metabolize sugar, and when that happens, just like what happens when you over-metabolize alcohol, is your liver can't handle the onslaught, and so it has to take the extra and turn it into fat, and there are enzymes in your liver that turn sugar into fat. It's called de novo lipogenesis, new fat making, and there are three enzymes that, uh, in concert that do this. One's called, uh, A- uh, ATP citrate lyase. The other one's called acetyl-CoA carboxylase, and the last one's called fatty acid synthase. These three enzymes are being driven by excess substrate, and that substrate is fructose then turned into acetyl-CoA by glycolysis. So bottom line, you're flooding your liver, and the goal is protect the liver. And when you flood your liver, now your liver makes fat, and that fat precipitates. Now you got fatty liver, and now you got insulin resistance.

   2. RCDr. Rangan Chatterjee9:23

      Yeah.

10. 9:23 – 12:47

    Feed the gut: why probiotics don’t fix the root problem

    1. RLDr. Robert Lustig9:23

       And now you got chronic metabolic disease. So protect the liver. Second part, feed the gut. Now, a lot's been written about the microbiome. Okay? And there are a lot of probiotics that are now, you know, in health food stores to try to restore the microbiome, and everyone now knows that the microbiome talks to your brain, which is true. It does. The question is, would taking a probiotic, a bacteria, work? Would that fix the problem? 'Cause boy, if that could fix the problem, that would be great, wouldn't it? The answer, does it, does it work? Is there any disease yet that has actually been ameliorated, attenuated, or cured by administration of a probiotic? Name one.

    2. RCDr. Rangan Chatterjee10:27

       I mean, it's, it's helped w- I think it's helped with symptoms in things like IBS. I think it's been shown to make, you know, general improvements in mood sometimes in the right individual. But by and large, amelioration of disease, I don't think we've got that evidence yet, do we?

    3. RLDr. Robert Lustig10:42

       Well, we certainly don't, and the reason is 'cause it does- it doesn't happen. So here's my qu- here's my question to you, Rangan, and think, think this, think this out. These probiotics, they're bacteria. They're live cultures, right?

    4. RCDr. Rangan Chatterjee10:57

       Yeah.

    5. RLDr. Robert Lustig10:57

       They're live. You know, whether they're in a pill or not, they're live. You swallow them. Those bacteria should be able to populate your intestine, grow, take hold, and basically f- you know, in- contribute to your microbial diversity. Yes?

    6. RCDr. Rangan Chatterjee11:19

       Yeah.

    7. RLDr. Robert Lustig11:20

       Concept, right? Why do you have to keep taking them? Why should... Why can't you just take one? Why have to take them every day?

    8. RCDr. Rangan Chatterjee11:33

       Yeah, well, a lot of them just pass straight through, don't they? And-

    9. RLDr. Robert Lustig11:36

       That's right. A lot of them pass straight through, or they die right there in the intestine.

    10. RCDr. Rangan Chatterjee11:43

        Yeah, yeah.

    11. RLDr. Robert Lustig11:44

        Which is exactly what happened to the ones as to why you don't have them there in the first place, 'cause they're already dead. Because the intra-intestinal milieu that the bacteria find themselves in is not conducive to their growth.

    12. RCDr. Rangan Chatterjee12:02

        Sorry to interrupt. If you are enjoying this content, there's loads more just like it on my channel, so please do take a moment to press Subscribe, hit the notification bell, and now back to the conversation

    13. RLDr. Robert Lustig12:15

        The ones that you basically had before have already died, and so you take them every single day and they're still not populating your intestine. They still haven't actually taken hold and thrived and contributed to mi- your microbial diversity. So basically, they're not doing very much, which is why we haven't seen any melioration of any disease yet. Because probiotics are not working upstream. You

11. 12:47 – 13:44

    Prebiotics and fiber: rebuilding the intestinal environment

    1. RLDr. Robert Lustig12:47

       have to change the intestinal milieu first. How do you do that? That's what a prebiotic does. So what's a prebiotic? A prebiotic is food for those bacteria that will feed them so that they can grow. And what's the w- nature's perfect prebiotic?

    2. RCDr. Rangan Chatterjee13:13

       Fiber.

    3. RLDr. Robert Lustig13:14

       Fiber. Fiber is not food for you. Fiber is food for your bacteria. But when we took the fiber out of the food to process it, because f- fiber basically reduces shelf life, when we took the fiber out of the food to process it, we are now depriving our bacteria of the food they need to be able to live in symbiosis with us. And so those bacteria, the good bacteria are dead, the bad bacteria have

12. 13:44 – 15:37

    Downstream effects: mood, leaky gut, inflammation, and metabolic disease

    1. RLDr. Robert Lustig13:44

       taken over, and the bad bacteria's sending all sorts of bad signals, actually suppressing serotonin generation in, um, in the intestine, thereby reducing the retrograde, re- uh, anterograde transport of serotonin back up into the nucleus tractus solitarius, and that's called depression.

    2. RCDr. Rangan Chatterjee14:06

       Yeah.

    3. RLDr. Robert Lustig14:06

       Okay? Also, because you're not feeding those bacteria, the bacteria are basically stripping the mucin layer right off your intestinal epithelial cells, 'cause they can eat that, and that's then exposing and denuding the, your intestine and, uh, uh, and making it, um, uh, you know, m- all the junk that's in your intestine basically can get through, called leaky gut, and contributing to infla- inflammation, inflammatory bowel disease, i- irritable bowel syndrome, and, um, insulin resistance, all because you didn't feed your gut.

    4. RCDr. Rangan Chatterjee14:43

       And that, and that's-

    5. RLDr. Robert Lustig14:43

       You didn't feed your microbiome

    6. RCDr. Rangan Chatterjee14:44

       ... and, and that's how the whole thing gets tied together here, that very, some very simple but very, very brilliant advice. Protect the liver, feed the gut. But the modern-

    7. RLDr. Robert Lustig14:55

       That's right

    8. RCDr. Rangan Chatterjee14:55

       ... food environments, the ultra-processing of food is overwhelming the liver with sugar, and it's starving the gut through its lack of fiber.

    9. RLDr. Robert Lustig15:07

       That's it.

    10. RCDr. Rangan Chatterjee15:07

        And then the consequences are the liver could be, you know, fatty liver, uh, type 2 diabetes. But the problem when the, the gut gets starved and, as you say, leaky gut or increased intestinal permeability sets in, then you're opening up for everything, autoimmune disease, food allergies, um, Alzheimer's, depression, all c- all these things have been associated with increased permeability in the gut. So it's a very simple maxim, but one that actually, again, going

13. 15:37 – 20:27

    Diet wars reframed: unprocess first, then personalize (vegan vs keto)

    1. RCDr. Rangan Chatterjee15:37

       to that nexus of the root cause, it's kind of right there, isn't it? And that's... You know, this is the other thing I really liked, uh, Rob, is that you don't seem to have a preferred, uh, diet. Very much like me, I'm, I'm always like you, it's unprocess the diet first.

    2. RLDr. Robert Lustig15:53

       That's right.

    3. RCDr. Rangan Chatterjee15:53

       Let's just get out the junk [laughs] , let's get the real food in, and then-

    4. RLDr. Robert Lustig15:57

       Right

    5. RCDr. Rangan Chatterjee15:57

       ... let's see where we are. So how does-

    6. RLDr. Robert Lustig15:59

       Right

    7. RCDr. Rangan Chatterjee15:59

       ... you feel that, like, a vegan diet or a low-carb diet or a whole manner of diets can, can fit... Sorry to interrupt. If you're enjoying this video and want to dive deeper into the topic of nutrition, I have created a free special guide which contains the five most important changes I think we all need to make when it comes to our diet. If you wanna get hold of this free guide, all you have to do is click on the link in the description box below. This maxim of protecting the liver and feeding the guts?

    8. RLDr. Robert Lustig16:30

       Yeah. I'm agnostic as to the whole vegan keto thing. Uh, uh, I, you know, look, if y- people who wanna be vegan, you know, fine, whatever. You wanna be vegan? Great. Don't make anybody else feel bad about their choice, but, you know, you can feel good about your choice. That's fine. Okay? Um, there are a lot of reasons to be vegan, you know, animal welfare, religion, um, cost, uh, um, uh, coolness, if you will. Why? But m- me- but metabolic health is not one of them, okay? And I can prove it, because Coke, Doritos, and Oreos are all vegan. So you can do vegan right or you can do vegan wrong. Keto. Okay? I'm not against keto. I used ketogenic diets in my patients when their insulin resistance was so severe that nothing else would work, where they were ha- where they had insulin hypersecretion.

    9. RCDr. Rangan Chatterjee17:32

       Yeah.

    10. RLDr. Robert Lustig17:33

        And basically, we had to control their blood glucose rises in or- in an attempt to try to stave off, um, continued weight gain. Either one. So we use the ketogenic diet, okay? And I'm not against that. The problem with the ketogenic diet is not the diet. The problem with the diet is that it's really easy to fall off it, because as soon as you have even a little bit of carbohydrate, a little b- bit of carbohydrate's gonna raise your blood glucose, therefore raise your blood insulin, and therefore stop the ketogenesis, because insulin blocks lipolysis at the level of the fat cell, and there goes your lack of substrate. And so it's been shown that people who are left to their own devices in terms of doing a ketogenic diet-They can start with all good intentions, and by two months into it, they're basically, you know, not on, they're not in ketogenic anymore. They're, you know, they're, they're not making ketones basically. And then they're on the worst diet because they're on a high-fat, medium-carbohydrate diet, which generates both insulin and loads and loads of LDL, and that's kind of like the worst thing you can be on. So if you're fastidious, then the ketogenic diet is a great diet. If you're not fastidious, then you shouldn't be on a ketogenic diet. So it d- kind of depends on whether or not you can actually, you know, keep it up, and a lot of people, you know, fall prey to, you know, the, the croissants on the, uh, you know, uh, you know, the, the, that the other guy at work brought in. So, you know, bottom line is I don't have a preferred diet. I don't. I'm agnostic on it. I think there are a lot of ways to skin this cat. I think ultimately we will learn the genetics-

    11. RCDr. Rangan Chatterjee19:25

        Yeah

    12. RLDr. Robert Lustig19:25

        ... of who does better with which diet, and it will turn out that certain diets are better for certain people, and other diets are better for other people. And I'm very interested and, uh, you know, i- involved in this personalized nutrition, you know, uh, concept and, and, and movement that's going on right now. So it may be that there are certain people-

    13. RCDr. Rangan Chatterjee19:44

        Yeah

    14. RLDr. Robert Lustig19:44

        ... out there who are on a vegan diet who ought to be on keto, and there are certain people who are on a ketogenic diet who probably ought to be on a vegan one. Um, and they don't know it yet. So why would you basically put all your marbles in one, um, you know, goldfish bowl? So I'm for both diets.

    15. RCDr. Rangan Chatterjee20:03

        Yeah.

    16. RLDr. Robert Lustig20:03

        The only diet I'm not for is the Western diet.

    17. RCDr. Rangan Chatterjee20:08

        [instrumental 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: 20:29