“This Is Worse Than Alcohol – And You’re Eating It Every Day” | Dr. Robert Lustig

1. 0:00 – 0:48

   Sugar vs alcohol: why the liver connection matters

   1. RCDr. Rangan Chatterjee0:00

      Sugar and alcohol, I don't think people commonly would put the two things together. People, I think, like, you know, Joe Public, I think would, would think, "Okay, alcohol I know if I drink too much, it's not good for me. It's gonna cause problems with my liver."

   2. RLDr. Robert Lustig0:18

      Right.

   3. RCDr. Rangan Chatterjee0:18

      "I think there's that understanding, and if I drink a little bit, have some days off a week, you know, you know, the odd glass of wine here and there is probably not gonna be too bad for me," I think is what most people tend to think.

   4. RLDr. Robert Lustig0:29

      That's true. Now, and, and, and that, and if that were the case, that would be true. And that's true for about the 40% of Americans who are social drinkers. You know, 40% are teetotalers, don't touch the stuff. Okay. 40% are social drinkers, can pick up a beer, put it down, like me. Okay. But 10% are binge drinkers and 10% are hardcore alcoholics.

2. 0:48 – 2:09

   Insulin resistance as the common upstream driver of chronic disease

   1. RCDr. Rangan Chatterjee0:48

      Yeah. But I don't think people think of sugar in the same way in terms of what it does for the liver. Um, and, and I think that's, that's a really, I think, eye-opening comparison for a lot of people. The other thing you said which I think really beautifully ties into the start of this conversation is that you started running an insulin reduction clinic.

   2. RLDr. Robert Lustig1:11

      Right.

   3. RCDr. Rangan Chatterjee1:12

      And, you know, like you, I'm very passionate in root causes, and-

   4. RLDr. Robert Lustig1:16

      Right. Right

   5. RCDr. Rangan Chatterjee1:16

      ... this idea that we've labeled all these so-called separate diseases. We get taught about them at medical school as, "Oh, they're all separate entities. For this disease, you-

   6. RLDr. Robert Lustig1:24

      Right

   7. RCDr. Rangan Chatterjee1:24

      ... you take this drug, and you have this sort of treatment." And we look at that downstream pathology, don't we? But you mentioned mitochondria at the start in terms of what sugar or excess sugar can do to mitochondria, and that, you know, mitochondrial dysfunction sits at the heart of so many different conditions-

   8. RLDr. Robert Lustig1:42

      Right

   9. RCDr. Rangan Chatterjee1:42

      ... but also insulin resistance, right? So that insulin-

   10. RLDr. Robert Lustig1:45

       Right

   11. RCDr. Rangan Chatterjee1:45

       ... resistance, that insulin lowering clinic actually would probably, depending on who was coming in, and I appreciate you're a pediatrician, but if, if all of us as doctors ran insulin reduction clinics-

   12. RLDr. Robert Lustig2:02

       We would get rid of 75% of the chronic disease in Amer- in, in the world.

   13. RCDr. Rangan Chatterjee2:05

       Exactly. It's that root cause again, isn't it?

3. 2:09 – 4:21

   Why modern medicine struggles with new ideas and root-cause care

   1. RLDr. Robert Lustig2:09

      Yeah, absolutely. I to- completely agree. Which is what I'm trying to, you know, uh, bring to, you know, medicine. Unfortunately, you know, medicine is provincial. Medicine doesn't, you know, uh, respond very well to, you know, new ideas.

   2. RCDr. Rangan Chatterjee2:25

      Yeah.

   3. RLDr. Robert Lustig2:26

      It's, uh, you know, it's a, uh, it's, i- it's a cartel, if you will.

   4. RCDr. Rangan Chatterjee2:31

      You, you're very, um, critical of modern medicine in the book. You say modern medicine treats symptoms. Uh, you say modern medicine is not the solution.

   5. RLDr. Robert Lustig2:40

      You say that too. That's right.

   6. RCDr. Rangan Chatterjee2:41

      I do indeed.

   7. RLDr. Robert Lustig2:41

      That's right.

   8. RCDr. Rangan Chatterjee2:41

      And I, I agree with this. It's, it's something I'm... It's one of my big frustrations in my, what now, 20, 21 year career of seeing patients of, it's like, you know, the, uh, I, you know, I sometimes wonder if doctors honestly ask themselves sometimes at the end of their day, and obviously it depends where you work, I'm not talking about intensive care, I'm talking about, you know, chronic patients that... And I did this once, Rob. I, I did this in general practice once. I asked myself at the end of the day, "How many patients do you honestly think you've really helped today?" And, you know, quite a few years ago, it was 20%. And I thought, "I've only helped 20% of people." The other 80%, I've done something, I've, I've sent them off for a test, I've, you know, referred them or I've given them a drug. But I kinda knew they'd be back. I thought, "I'm not really getting to the heart of this problem."

   9. RLDr. Robert Lustig3:32

      That's right.

   10. RCDr. Rangan Chatterjee3:32

       I knew it, and I kinda feel the patient knew it as well, and that's kind of one of the things that led me on this journey to try and understand that there must be a different way. And, you know, that's why I think Metabolical is such a wonderful book. It, it outlines the history, it outlines the science, but it also gives some really practical solutions. And, you know, I love your... You know, we mentioned the liver a lot so far. So one of your big messages in the book is protect the liver and feed the gut.

   11. RLDr. Robert Lustig4:03

       Right.

   12. RCDr. Rangan Chatterjee4:04

       In terms of dietary advice for people, and, you know, a lot's been written about food in the past, but that's, that's very fresh, I think. That's quite a new idea for people, and I wonder if you could explain then, what, what do you mean protect the liver and feed the gut?

4. 4:21 – 5:42

   ‘Clue’ medicine: matching symptoms to drugs instead of mechanisms

   1. RLDr. Robert Lustig4:21

      Sure. Well, uh, uh, before we go into protect the liver, feed the gut, 'cause that'll take up the whole rest of our podcast is, you know, explaining all that, I wanna j- just address the whole medical school thing, you know, and, and, and, you know, how you felt as a doctor. Me too. The bottom line is, you know, we, uh, treat medicine and, and unfortunately medical schools treat medicine like a big game of Clue. You know? Um, Colonel Mustard in the ca- conservatory with the candlestick. Match the, um, uh, symptom card with the diagnosis card with the treatment card and discharge your patient. In fact, in 1980, there was a game that we used to play in residency, you know, on like Sunday mornings before things got busy in the ER, called Intern. And that was what you did. You basically took your symptom c- You, you got a symptom card, you got a diagnosis card, and you got a treatment card, and once you got the three of them together, you got rid of the patient. First, uh, you know, player to discharge, you know, to discharge all their patients won the game. You know? And that's how we treated it. So, you know, these diseases, you know, got a, got a, a meningitis? Here's an antibiotic. You know, got a, um, uh, you know, cancer? Here's a chemotherapy. You know. But the fact is, chronic disease doesn't, you know, really fit into that.

   2. RCDr. Rangan Chatterjee5:41

      Yeah.

5. 5:42 – 6:49

   The eight chronic diseases dominating healthcare—and why they lack cures

   1. RLDr. Robert Lustig5:42

      There are, there are eight, count 'em, eight chronic diseases that have completely taken over modern medicine. Eight, and here they are. Type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, cancer, dementia, fatty liver disease, polycystic ovarian disease. Those eight.That those eight now account together for 75% of all healthcare costs.

   2. RCDr. Rangan Chatterjee6:12

      Wow.

   3. RLDr. Robert Lustig6:12

      And none of them have a cure. None of them even have a treatment, but they all have a prevention. We're not preventing it. We're handing out, you know, um, you know, um, statins or, you know, oral hypoglycemics or, you know, antihypertensives, you know, like candy, but that's treating the symptoms, you know, the manifestations of the disease, not actually treating the cause. And the reason is 'cause those diseases are not really the diseases.

   4. RCDr. Rangan Chatterjee6:49

      Yeah.

6. 6:49 – 8:51

   The ‘Hateful Eight’: the real processes underneath chronic disease

   1. RLDr. Robert Lustig6:49

      What's going on underneath to cause all eight of those diseases are exactly the same. They're just in different organs. And here are the eight things, uh, that I outline in the book, what I call the diseases that are not diseases. I call them the hateful eight, and here they are. Okay? And these are things that people don't know, because they don't have ICD-11 codes, and doctors don't know what to do about them-

   2. RCDr. Rangan Chatterjee7:12

      Yeah

   3. RLDr. Robert Lustig7:12

      ... so they don't even mention them. So no one's ever heard of them, and they didn't learn them in medical school either. So here they are. Eight. Number one, glycation. Number two, oxidative stress. Number three, mitochondrial dysfunction. Number four, insulin resistance. Number five, membrane instability. Number six, inflammation. Number seven, methylation. Number eight, autophagy. Now, these are all normal phenomena that happen, but they can be speeded up or slowed down by what you eat. Now, it turns out when you have control over all eight of those things, you will be 110 playing tennis. And when you don't have control over those eight things, you will be 40 years old in a wheelchair with two stumps, on dialysis, waiting for your next stroke. And of course, everything in between. So those are the choices. Those are the options. And because none of those eight, the hateful eight that I just mentioned ha- any of- none of them have a cure, none of them even have a treatment, they only have a prevention. We're not preventing anything, and that's why you felt like you were not helping any of your patients, 'cause you weren't addressing those eight root causes that you yourself know to be the big problem in medicine.

7. 8:51 – 10:05

   Buckets vs fixing the roof: why symptom control isn’t enough

   1. RCDr. Rangan Chatterjee8:51

      Yeah. It's like a, it's like a leaking roof, isn't it? The, the roof's leaking, and you're just putting a bucket there to pick up the water. That's kinda what the drugs are doing. Yeah, they, they're... It's great. It's... There's no water there on the floor, so you can live a bit, a little bit better, but you're not getting to the, the cause, right? You need to fix the leak in the roof, and then actually you no longer-

   2. RLDr. Robert Lustig9:09

      Well, you-

   3. RCDr. Rangan Chatterjee9:09

      ... need the buckets.

   4. RLDr. Robert Lustig9:10

      Right. Well, and you won't h- uh, the problem is if you don't fix the leak in the roof, you won't have a house.

   5. RCDr. Rangan Chatterjee9:15

      Yeah. That was one of my favorite parts of the book, these eight processes that are occurring in all of us, and they're either promoting health and longevity, or they're actually-

   6. RLDr. Robert Lustig9:32

      The opposite

   7. RCDr. Rangan Chatterjee9:32

      ... the opposite and creating illness and ultimately disease. And I really love the way you said actually medicines aren't really tackling those things. Uh-

   8. RLDr. Robert Lustig9:43

      No, they-

   9. RCDr. Rangan Chatterjee9:43

      And I just wanna be really clear for people that antihypertensives or, um, you know, drugs in general, they have a role sometimes, right? They can be helpful in certain situations. I think you're in agreement with that. It's just-

   10. RLDr. Robert Lustig10:01

       I, I'm not a-

   11. RCDr. Rangan Chatterjee10:01

       We overuse-

   12. RLDr. Robert Lustig10:02

       I'm not against them.

   13. RCDr. Rangan Chatterjee10:03

       Yeah.

8. 10:05 – 11:19

   Wasp-in-the-attic principle: go upstream or the problem returns

   1. RLDr. Robert Lustig10:05

      Okay? I'm not against them per se, but the problem is that if you don't fix the underlying problem, what have you done? Okay? So it's fine to give a statin to lower an LDL, but h- what have you done? Have you actually fixed the problem? You haven't done a damn thing about the problem. The problem's still there. Okay? So, um, y- uh, y- you know, I, and the, the very first, the very first sentence of the book, okay, starts like this: You find a wasp in your attic. What do you do? Kill the wasp or find the wasp's nest? You have to work upstream of a problem to solve a problem. Working downstream of a problem only fixes the result of the problem. The problem's still there. And if you don't f- if you can k- you can kill the wasp, but then the next time you go up into the attic, you're gonna be stung into submission by all the other wasps-

   2. RCDr. Rangan Chatterjee11:16

      Yeah

   3. RLDr. Robert Lustig11:16

      ... 'cause you didn't fix the problem.

9. 11:19 – 13:07

   Ultra-processed food as the central driver of metabolic dysfunction

   1. RCDr. Rangan Chatterjee11:19

      I, I, I think we, we really need to... I w- I wanna make sure everyone listening and watching this has got this, that what you're talking about is really at the heart of pretty much every single chronic disease that's going on at the moment, that is afflicting families, it's overwhelming healthcare systems, it's causing, uh, disability, it's causing, you know, reduction in the quality of life, and actually most of them are caused by, you know, malfunction in these eight, in these eight areas. But ultimately, what you're making a very strong case for is that it's actually the modern food environments, this highly ultra-processed food that we are consuming in inordinate quantities is actually at the root cause, and unless we deal with that as a root cause, we're gonna be struggling. People are gonna be suffering, healthcare systems are gonna be suffering, and we're not gonna get anywhere. Your, your, your intro to the book wasIt, it literally was so punchy. Like [laughs] we could just do a podcast on the introduction, frankly

   2. RLDr. Robert Lustig12:21

      [laughs]

   3. RCDr. Rangan Chatterjee12:21

      But I... There's a couple of bits I've underlined, which I th- if you don't mind me reading it back to you, your own book

   4. RLDr. Robert Lustig12:26

      I, I so, I so appreciate that you called my intro punchy, because several people on, you know, Amazon have said, you know, "He, all he did was rant."

   5. RCDr. Rangan Chatterjee12:36

      I, um-

   6. RLDr. Robert Lustig12:36

      You know? I guess it depends on how concerned you are about the problem.

   7. RCDr. Rangan Chatterjee12:40

      Yeah. And this is w- this is such a big problem. Like, it's arguably the biggest problem that's going on across the globe at the moment. Because-

   8. RLDr. Robert Lustig12:49

      Well, let's talk about that

   9. RCDr. Rangan Chatterjee12:49

      ... and, and you see it in your kids, right? You see kids. I, I see kids, and when you see a seven-year-old with pre-diabetes, you're like, "This wasn't happening 20, 25 years ago."

   10. RLDr. Robert Lustig13:01

       No.

   11. RCDr. Rangan Chatterjee13:01

       Something is going on, and we can't just give them-

   12. RLDr. Robert Lustig13:03

       Right

   13. RCDr. Rangan Chatterjee13:03

       ... metformin or what- we have to try and figure out what's causing this.

10. 13:07 – 15:46

    COVID severity, developed countries, and the ‘real food’ hypothesis

    1. RLDr. Robert Lustig13:07

       Right. Canaries, uh, uh, kids are the canaries in the coalmine, and if you ignore it, you know, you do it at your own risk. It's just that simple, and that's what we're do- we've done. We've ignored it. Um, the other thing is that everybody right now is completely distracted. Okay? They're distracted by this thing called COVID. Okay, and I understand why, and you know, it's just, it's certainly distracting. However, let's talk about that for a minute, okay? People are dying in droves in every country. UK, US, you know, you name it. Do you know where they're not dying? They're not dying in countries that actually still have real food. Third world countries actually have a very low death rate, and it's not because they're using masks or, um, hand washing, you know, or social distancing. The reason is 'cause they're eating real food. And we have the data on mortality rates of the different countries. I can put it up on the screen if you want. But the bottom line is it's only the developed countries that have the high mortality rates. Now, why is that? So, we've identified the elderly, and they have immune dysfunction. We understand that. They can't generate the same cytokine response that you n- you know, that, that, that everyone else should be able to. Okay, let's put the elderly aside for a moment, 'cause that's true everywhere. It was true in Italy, too. But the other three things, the other three demographics that, who were shown to be, you know, uh, related to COVID mortality, here they are. People of color, the obese, and preexisting conditions. Those three. People of color, the obese, preexisting conditions. What do those three demographics share in common?

    2. RCDr. Rangan Chatterjee15:03

       Probably poor socioeconomic conditions, um, poor diet, lots of highly processed food-

    3. RLDr. Robert Lustig15:10

       Poor diet. Right. Ultra-processed food consumption. Crappy diet, ultra-processed food consumption. So why should your food make a difference as to whether you die from COVID or not? Why is that?

    4. RCDr. Rangan Chatterjee15:22

       Sorry to interrupt. If you're enjoying this video and you want to learn more, then do check out my free special guide which contains the six crucial steps you need to take in your life to not only build healthy habits, but also to make them stick. If you wanna get ahold of this free guide, all you have to do is click on the link in the description box below.

11. 15:46 – 18:20

    Three mechanistic links: insulin, glucose, fiber, and immune overreaction

    1. RLDr. Robert Lustig15:46

       Here's why. Three reasons. Number one, the virus is very smart. It wants to attack all your cells, and every cell in your body has a receptor that helps regulate water within the cell, and that receptor's called ACE2, A-C-E-2, angiotensin-converting enzyme 2. It's an endocrine receptor, okay? And that's where angiotensin works, and it involves water transport. All right? So every cell has it. Turns out the, uh, virus uses that protein as its injector point. Well, high insulin increases ACE2, 'cause high insulin causes water retention. And so there are more ACE2s on all your cells, so you are more at risk of being infected when your insulin's high, and your insulin's high 'cause of processed food. That's one. Number two, diabetes, high blood glucose. High blood glucose, turns out the glucose actually crystallizes around the edges of those ACE2s, holding them open, making it even easier for the virus to inject its RNA. Number three, short-chain fatty acids. So short-chain fatty acids come from fiber consumption, and of course, ultra-processed food is devoid of fiber. Short-chain fatty acids suppress the c- cytokine response, and we now know it's not the virus that kills you. It's your cytokine response that kills you, because your cytokine response is basically sort of like a nuclear blast that affects even your normal cells, but it's, uh, trying to get rid of the foreign invader. But you have to temper it. You have to be able to m- manage it. You have to be able to pull it back. You have to be able to, uh, uh, um, minimize it. Short-chain fatty acids that come from the, um, digestion of fiber in the gut are one of the things that improves that cytokine response, and that's why f- um, uh, sh- fiber's anti-inflammatory and also improves insulin sensitivity. But processed food doesn't have any fiber. It's been, you know, that's been removed for shelf life. So those three demographics, people of color, the obese, preexisting conditions, big ultra-processed food consumers, high sugar, low fiber, processed food, not real food. The

12. 18:20 – 19:01

    Public health blind spot: ‘the fourth leg of the stool’ is food

    1. RLDr. Robert Lustig18:20

       CDC and the NIH and the MRC and every- e- and everyone, and Public Health England, no one is talking about food and COVID.

    2. RCDr. Rangan Chatterjee18:32

       Yeah.

    3. RLDr. Robert Lustig18:32

       This is the fourth leg of the stool. Okay? We all talked about masking and hand washing and social distancing. Garbage. Fix the food. [upbeat music]

    4. RCDr. Rangan Chatterjee18:42

       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: 19:03