This Predicts How Long You'll Live - Holy Grail Of Weight Gain, Cancer & Fatty Liver | Robert Lustig

Dr. Rangan Chatterjee 0:00 Tell us why should we care about the liver?

Dr. Robert Lustig 0:02 'Cause when your liver works right, every other cell in your body works right. We've a- and we've actually looked at this. This is one of the reasons why in Metabolical, I, you know, espouse to protect the liver.

Dr. Rangan Chatterjee 0:17 Mm.

Dr. Robert Lustig 0:18 Okay? Promote metabolism, suppress inflammation. So promo- those are the two things that you have to do to be metabolically healthy. Promote metabolism, suppress inflammation. Promote metabolism where? Well, the liver, 'cause that's what does the metabolism. That's where virtually all the metabolism in your body gets done. It's where detoxification of poisons come, comes in. It's what ultimately sends out energy to the rest of the body, 'cause the liver is in charge of turning that energy into stuff that the rest of the body can use, whether it be ketones or glucose, okay? It is the thing that ultimately impacts on your blood glucose control, because it's where insulin works. Insulin works at the liver. That's why the pancreas is in series with the liver. That's why the pancreatic vein drains into the portal vein to go to the liver, not to the entire general circulation, because the liver is ground zero. Good liver, good body, and all the data shows that when you screw up the liver, everything upstream of the liver gets worse. That's what we've shown. So yes, you gotta protect your liver. And what do you have to protect it from? Well, you have to protect it from toxins. And what are those toxins? Well, the big one is fructose. Not the only one, but it's the big one, okay? Are there others? Sure. Cadmium, arsenic, you know, a lot of heavy metals are, you know, big ones there, and of course alcohol is the other, you know, huge one. And if your liver works right, you will be healthy.

Dr. Rangan Chatterjee 1:57 What is the best way for someone to assess the state of their liver?

Dr. Robert Lustig 2:03 Yeah. So that's a little bit harder, um, and it's a little more complicated. Uh, the easiest way, the cheapest way, the free way, if you will, but unfortunately th- not the specific way, is a waist circumference. So that anyone can do. But unfortunately it doesn't necessarily tell you everything you need to know, but it's a good start-

Dr. Rangan Chatterjee 2:27 Uh, and what-

Dr. Robert Lustig 2:28 ... and it's free.

Dr. Rangan Chatterjee 2:28 And what do you look for?

Dr. Robert Lustig 2:30 Well, uh, if you're a male, uh, over 40 inches, if you're female, over 35 means you probably have a liver problem.

Dr. Rangan Chatterjee 2:36 But that's, can I just say on that, that's interesting, and you've also said that it's not perfect. If I think about that through the lens of myself, I'm naturally slim. Now yes, I do look after myself and I pay close attention to the way I live my life, but I would say I'm naturally slim. If I got up to, I would say, a 37-inch waist, that would be huge for me, right? So the, the, so the reason I'm bringing that up is purely for the fact that 40 inches, it kind of depends on your starting point as well, 'cause I would even argue if I got to 36, 36.5, I would say for me, I'm carrying extra fat around my abdomen. So-

Dr. Robert Lustig 3:18 No question. Uh, uh, no question, this is racially determined as well. Um, you know, Asians, uh, will have liver fat at a much lower BMI.

Dr. Rangan Chatterjee 3:28 Yeah.

Dr. Robert Lustig 3:28 African Americans will have liver fat at a much higher BMI. So it's very, it's very individual and, and it- it's got race, uh, uh, dependency and sex dependency and age dependency.

Dr. Rangan Chatterjee 3:40 Okay.

Dr. Robert Lustig 3:41 Um, so it, that's one of the reasons why it's not that easy to use. Number two, lab tests. All right? What lab tests? Well, the easiest lab test and the one that pretty much everyone gets once a year is an ALT.

Dr. Rangan Chatterjee 3:58 Yeah.

Dr. Robert Lustig 3:59 Alanine aminotransferase. Now, the problem with alanine aminotransferase is it's sensitive but not specific. If your ALT is high, it usually means you have liver fat. Doesn't tell you why you have liver fat, but it usually means you have liver fat. But the question is, what's the cutoff? And this is where-

Dr. Rangan Chatterjee 4:22 Mm

Dr. Robert Lustig 4:22 ... things get a little dicey, because the doctor will look at the lab slip and say, "Oh, your ALT is 30. You're fine." And the reason is because the upper limit of normal is 40 on the lab slip. Like hell it is. The upper limit of ALT should be 25. When I entered medical school in 1976, the upper limit for ALT was 25.

Dr. Rangan Chatterjee 4:50 Yeah.

Dr. Robert Lustig 4:51 And it should be 20 for African Americans, okay? 25. But today it's 40. Did they change the assay? They changed the name, but they didn't change the assay. Are they changing what they're measuring? No, they're still measuring the same thing. So why is it that 50 years ago the upper limit for ALT was 25 and today the upper limit is 40? Very simple. 'Cause everyone has fatty liver now. 45% of the American population have fatty liver. So if you take 100,000 lab specimens from 100,000 people who say they're healthy-

Dr. Rangan Chatterjee 5:28 Yeah

Dr. Robert Lustig 5:28 ... and you run the ALT and you measure the mean and then you measure two standard deviations from the mean, and that's where you draw the line for, you know, what's abnormal, the entire curve has shifted to the right 'cause everyone's got fatty liver. And so two standard deviations from the mean is now 40. So that's what they put on the lab slip. So if your doctor's reading off the lab slip, "Oh, your ALT is 30, so you're fine," no you're not fine. You're not fine at all, okay? You're consistent with the general population.

Dr. Rangan Chatterjee 6:03 Mm.

Dr. Robert Lustig 6:04 But the general population is not fine either.

Dr. Rangan Chatterjee 6:07 Yeah.

Dr. Robert Lustig 6:09 So you have to be able to interpret the number properly. So that's the problem there. And then once you get past ALT, now we're getting into the rarefied air and the expensive stuff, and the imaging like ultrasound or the magnetic resonance spectroscopy or the pancre-

Dr. Rangan Chatterjee 6:28 Yeah

Dr. Robert Lustig 6:29 ... or, or the, uh, uh, uh, elastography. There's this thing, uh, you know, there's this, uh, calculation called FibroScan that will, you know, give you a little bit better answer. Um, but you know, now we're talking, you know, like real money.

Dr. Rangan Chatterjee 6:42 Yeah. I think the first two you mentioned there a- a- are so accessible [laughs] and cheap, right? Waist circumference, anyone can do that themselves at home just to get an idea. Even if they track that themselves, like over time, every six months, let's say you put it in your diary, you track it, and you see which way it's going. That would be something really helpful to give you an indication of what might be going on inside, something that you can't see potentially. But also the ALT test. Now, I know people watch and listen to the show all over the world, but for anyone in the UK, that is available on the NHS. I mean, you can get that. Any adult can go in pretty much and get an ALT. It's a very, very cheap test. And we-

Dr. Robert Lustig 7:28 Standard test on a standard chem profile. The only thing to admonish your listeners, do not take normal-

Dr. Rangan Chatterjee 7:38 Yeah

Dr. Robert Lustig 7:38 ... for an answer.

Dr. Rangan Chatterjee 7:39 Yeah, find out what it is.

Dr. Robert Lustig 7:40 Get the number.

Dr. Rangan Chatterjee 7:41 Get the number, and then maybe track it once a year and see which, which direction it's going in. And if you're concerned, discuss it with your doctor. I think that's really useful. I mean, that's how you can look for it in yourself, but it's a pretty reasonable assumption [laughs] that most of us, most of the population have got more liver fat than they would want. Is, is, is that a fair assumption?

Dr. Robert Lustig 8:06 That is a very fair assumption.

Dr. Rangan Chatterjee 8:08 Okay.

Dr. Robert Lustig 8:08 Much more common than anyone realized.

Dr. Rangan Chatterjee 8:11 Yeah, because you can't see it.

Dr. Robert Lustig 8:13 And do you know what else is common? Nonalcoholic fatty pancreas disease.

Dr. Rangan Chatterjee 8:21 Wow.

Dr. Robert Lustig 8:21 Whoa. Not fatty liver, fatty pancreas disease. Okay. Now, how do you find that? Well, you have to set the MRI in a very special way to be able to actually see that, but we did that, and we found nonalcoholic fatty pancreas disease, and it correlated with insulin release negatively.

Dr. Rangan Chatterjee 8:48 Mm.

Dr. Robert Lustig 8:48 So the more fat in the pancreas, the less insulin released. So it's very possible that the fat being laid down in the pancreas is actually one of the drivers of diabetes, which of course is responsive to sugar.

Dr. Rangan Chatterjee 9:00 I mean, if we had another hour, I'd, I'd love to go down that rabbit hole, but we'll save that for part three, Rob.

Dr. Robert Lustig 9:06 [laughs]

Dr. Rangan Chatterjee 9:06 Um, that is really interesting. But there's a, there's a wider point there for me. I was thinking about this today. In our first conversation, we spoke at length about nonalcoholic fatty liver disease, okay? And I thought the term's interesting. You know, it, it's ... We're, we're kind of not really saying what it is. We're saying nonalcoholic, right? So we, we, we could say fructose-driven liver disease or sugar-driven liver disease, couldn't we? Or, you know, something else, but, but ... Or, or ultra-processed food-driven liver disease, but we just say nonalcoholic. So it kind of doesn't quite land for us that what we're doing may be impacting our liver fats.

Dr. Robert Lustig 9:48 So the, the hepatologists here in the United States, in their infinite wisdom, have rebranded the disease. They've got a new name for it.

Dr. Rangan Chatterjee 9:57 Okay. [laughs]

Dr. Robert Lustig 9:59 [laughs] What is it? Okay. It is, ready? MASLD. MASLD. [laughs] Instead of NAFLD, it's MASLD.

Dr. Rangan Chatterjee 10:09 Okay.

Dr. Robert Lustig 10:10 And what is MASLD? Metabolic-associated steatotic liver disease. Now, which one of those two, NAFLD or MASLD-

Dr. Rangan Chatterjee 10:23 [laughs]

Dr. Robert Lustig 10:24 ... tells you what's going on? Neither. [laughs] Neither. I would like to call it processed food fatty liver disease. That's what I would call it.

Dr. Rangan Chatterjee 10:38 Yeah.

Dr. Robert Lustig 10:38 But that's not on the table, unfortunately. [laughs]

Dr. Rangan Chatterjee 10:45 How early does this liver fat start to accumulate? Are we seeing it in children now, for example?

Dr. Robert Lustig 10:52 Oh yeah. No, we can see it in five-year-olds. I've seen it in three-year-olds.

Dr. Rangan Chatterjee 10:56 And, and hold on a minute.

Dr. Robert Lustig 10:56 Yeah.

Dr. Rangan Chatterjee 10:56 Let's just be really clear here. Uh, is it ... Should we be having zero liver fat? Is that what normal is?

Dr. Robert Lustig 11:04 Normal is zero.

Dr. Rangan Chatterjee 11:05 Right. Okay. So-

Dr. Robert Lustig 11:07 Up to, up to 5% usually means no damage.

Dr. Rangan Chatterjee 11:13 But, but really we should be aiming for zero ideally.

Dr. Robert Lustig 11:16 Should be aiming ... Should ... I- ideally zero to maybe .5%.

Dr. Rangan Chatterjee 11:20 So, so if, if we just go back to, again, the opening question, right? The three fat depots, which really appears to have been the theme of this entire conversation this time round. Is it possible then if, if [laughs] ... Theoretical question. If excess fructose and alcohol, and yes, trans fats and, you know, excess branched-chain amino acids if you're not working out regularly, if those are-

Dr. Robert Lustig 11:50 Mm-hmm

Dr. Rangan Chatterjee 11:50 ... the key drivers of liver fat, right?

Dr. Robert Lustig 11:53 Mm.

Dr. Rangan Chatterjee 11:54 Is it, in theory, possible then if you are having a completely whole food diet, but you're probably eating certain ... a little bit too much of that whole food diet for your daily needs, and you have low to non-existing stress levels, so you're not driving visceral fat, and you're not having excess fructose, and you don't drink alcohol- Is it in theory then possible that you will have subcutaneous fats but no visceral fats, no liver fats, and therefore be metabolically healthy?

Dr. Robert Lustig 12:31 20%. 20% of obese people are just that. They are metabolically healthy obese. We even have a name for 'em, MHO, metabolically healthy obese. They will live a completely normal life, die at a completely normal age, not cost the taxpayer a dime. They just have increased subcutaneous fat tissue. So what?

Dr. Rangan Chatterjee 13:00 And if we were to look at their bloods, they probably have a normal-ish HbA1c, normal triglycerides, um, normal ALT that we just spoke about. So for all intents and purposes, it would just be a cosmetic, um... I wouldn't even c- I don't even wanna say i-issue. It's not an issue. But it, the way-

Dr. Robert Lustig 13:20 It's not an issue

Dr. Rangan Chatterjee 13:21 ... the way society looks at it-

Dr. Robert Lustig 13:23 It's only an issue in your own head.

Dr. Rangan Chatterjee 13:25 Yeah.

Dr. Robert Lustig 13:26 If it's an issue, it's because you made it an issue, not because it is an issue. But yes, unfortunately, society is very cruel.

Dr. Rangan Chatterjee 13:35 Yeah.

Dr. Robert Lustig 13:35 And, you know, they, they will punish people for just about anything. Um-

Dr. Rangan Chatterjee 13:39 But that's interesting, isn't it? 20% are metabolically healthy.

Dr. Robert Lustig 13:44 Yeah.

Dr. Rangan Chatterjee 13:44 You know?

Dr. Robert Lustig 13:45 20% of the obese population's metabolically healthy. Conversely, 60% of the normal weight population is metabolically ill.

Dr. Rangan Chatterjee 13:56 Mm.

Dr. Robert Lustig 13:58 So just 'cause you're fat doesn't mean you're sick, and just because you're thin doesn't mean you're healthy. And this is why it's so important for people to know who they are and what they are and what caused them to be who or what they are. And that's one of the reasons for gathering these data-

Dr. Rangan Chatterjee 14:17 Mm

Dr. Robert Lustig 14:17 ... and figuring it out. And don't just let your doctor say, "Ah, your labs are normal. Go away."

Dr. Rangan Chatterjee 14:27 I've got two kids, Rob, 13-year-old and an 11-year-old. Given everything you have researched throughout your career, given all the patients you've seen, if you were sitting in front of my children right now and you were gonna educate them on health and the importance of how they treat their bodies, what are the key things that you would say to them?

Dr. Robert Lustig 14:56 Eat real food.

Dr. Rangan Chatterjee 15:01 And if they say to you, "Dr. Lustig, what does that mean? What's real food?" What would you say?

Dr. Robert Lustig 15:06 [laughs] So real food is what came out of the ground or animals what, that ate what came out of the ground. [laughs] Real food does not have a label 'cause it doesn't need a label 'cause it's real. In fact, the only foods that have labels are foods that had had something done to it. So every label is a warning label. Does a radish have a label? Does a broccoli have a label? Does a steak have a label? None of them have labels because they're real food. Now, if something's been done to it, then there's a label. So the question is, okay, what is it that's been done to it? Maybe it, what was done to it was okay, like it got, you know, it was milk that got irradiated f- you know, to i- up the vitamin D. Maybe that's a good thing. Um, maybe they added some, you know, um, uh, preservatives so that it ha- you know, stabilized the shelf life. Maybe that's a good thing, or maybe it's not a good thing 'cause we're now learning that certain preservatives are actually mitochondrial toxins. So 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 why I wrote this book, Metabolical, is to explain to people what's been done to their food that they don't know about because the food industry doesn't want you to know about it. 'Cause if you knew what they did to it, you wouldn't buy it.

Dr. Rangan Chatterjee 16:45 Yeah.

Dr. Robert Lustig 16:46 So eat real food, and the way you know you're eating real food is it doesn't have a label.

Dr. Rangan Chatterjee 16:57 That's good advice. I h- I hope, I very much hope [laughs] , I very much hope my children know that by now. [laughs] They certainly-

Dr. Robert Lustig 17:05 [laughs]

Dr. Rangan Chatterjee 17:05 I certainly think they do know that. Um-

Dr. Robert Lustig 17:09 Look, if you think Cheetos is food, you know, all, you know, it's, it's all over. That, you know, we have to undo this concept, you know, that people think that this is the case. So here's a question for you. We'll, we, we can end on this, all right, uh, Rangan. Okay? In order to understand this, you have to actually know the definition of food. So what's the definition of food? Well, I'll tell you right now from the dictionary, okay? I memorized it. Substrate that contributes to either the growth or burning of an organism. That is the definition of food. Substrate that contributes to either growth or burning of an organism.

Dr. Rangan Chatterjee 17:57 What does that mean, burning of an organism?

Dr. Robert Lustig 18:00 In other words, used for energy utilization. Burning. Okay? That's a perfectly fine definition. It is a 100% definition, okay? I have zero problem with that definition. Okay. So let's go to burning first. Bottom line- Fructose inhibits burning. Fructose has been added to 73% of the items in the American grocery store.

Dr. Rangan Chatterjee 18:28 Wow.

Dr. Robert Lustig 18:29 Okay? That's burning. Now let's take growth. My colleague, Dr. Efrat Monsonego-Ornan, who is the head of nutrition at Hebrew University Jerusalem, has actually studied this. It turns out that ultra-processed food inhibits growth. It inhibits skeletal growth, it inhibits trabecular bone, bone growth, it inhibits cancellous bone growth, it inhibits cortical bone growth. You can actually see it on electron microscopy. You can see the holes eaten out of the bone. You can see the problem with the epiphyses not m- you know, uh, uh, uh, gaining in, in, in length. Okay, you can measure the bone, you can measure the tensile strength of the bone. Basically, the bones break. One of the reasons for osteoporosis, one of the primary reasons for osteoporosis. So if a substrate does not contribute to growth and does not contribute to burning, is it a food?

Dr. Rangan Chatterjee 19:28 Yeah.

Dr. Robert Lustig 19:29 We have to teach that. We have to explain to people that ultra-processed food is not food. Just because the food industry called it that doesn't make it true.

Dr. Rangan Chatterjee 19:41 What, what if a child was to say to you, "Rob, okay, I, I get that, Dr. Lustig. This sounds really interesting. Um, but what happens if I want a bag of sweets once a week," right? That's probably not food by your definition or by, or by the definition that you're, you're referring to. Is that okay? And I think what I'm trying to get to is where is the balance point for people? Because very few people are going to eat exclusively just real foods. And so people wanna know, you know, well, how much? [laughs] You know, what, what can I get away with, as it were?

Dr. Robert Lustig 20:18 I totally understand. I, yeah, I, I get it. I get it. So I'm gonna give you two things. T- uh, one is a tool and the other's a concept. Here's the concept. I, Robert Lustig, am for dessert. For dessert. I am not for dessert for breakfast, lunch, snacks, and dinner. So if you're gonna eat that bag of candy and that's dessert, hey, have at it. But that bag of candy has as much sugar as the Froot Loops you ate at breakfast and the Chinese chicken salad you ate at lunch and the chicken teriyaki you ate at dinner. So in fact, you ate four desserts today.

Dr. Rangan Chatterjee 21:09 Hmm.

Dr. Robert Lustig 21:11 So that's the problem. It's not the f- uh, uh, the, the sugar in the candy that's really the problem because you identified it as such. The problem is the sugar in everything else.

Dr. Rangan Chatterjee 21:24 Yeah.

Dr. Robert Lustig 21:25 The sugar in the 73% of the items in the grocery store that you didn't know had it, like the tomato sauce and, you know, the, the, the, the bread, and so that's, that's, that's the concept. Now the tool. My colleagues and I have developed a tool to help people at the grocery store, and it is called PERFACT, P-E-R-F-A-C-T. And you can find it online at PERFACT, P-E-R-F-A-C-T.co, perfect.co. And what it is, is it's a recommendation engine. Now, right now it's for the United States. We would like it to be for the UK, but it needs a branded foods database that lives online, and right now, the only one that exists like that that we know of is Waitrose. So we need Tesco and we need, uh, Marks & Spencer, and we need, you know, all of your other stores to sort of ante up. So for Waitrose, we can do it. Um, but in the United States, we can basically tell you any given food at your grocery store, not only what's in it, but what's been done to it.

Dr. Rangan Chatterjee 22:39 Hmm.

Dr. Robert Lustig 22:39 And so you can apply specific filters based on your metabolic status, whether it... you're, have metabolic syndrome, whether you're trying to avoid carbs, whether you're trying to avoid oxalate, whether you're trying to avoid peanuts, whether you're trying to avoid, um, uh, animal products 'cause you're vegan. Okay? And you can basically filter out everything in the store that is metabolically unhealthy for you.

Dr. Rangan Chatterjee 23:07 Yeah.

Dr. Robert Lustig 23:08 And it's free.

Dr. Rangan Chatterjee 23:09 Yeah. Brilliant. Well, we'll put that in the show notes, Rob, for people who wanna check that out. Robert, you're just doing such incredible work. You know, one of the, one of the most gratifying things about researching your work for these conversations is if you go and watch any of your YouTube videos, the amount of comments underneath from people who have literally said, "Dr. Lustig has changed my life. Dr. Lustig got me onto a low sugar, high fiber diet. Dr. Lustig really connects with me. For the first time, he told it straight up how it is, and that's what I needed to change my life." I know you get a lot of naysayers, particularly as you're growing and your, your message is growing, but that must be very gratifying to, to, to read and to, to hear from so many people what an impact you've had on them.

Dr. Robert Lustig 23:53 I, I, it, it is. It, it, I... There's no question. Uh, and I love to hear those stories because they give me purpose. They-

Dr. Rangan Chatterjee 24:02 Yeah

Dr. Robert Lustig 24:02 ... make me feel like I'm doing something valuable. What I don't like, and I truly don't like it, is when people, you know, it, when they f- think somehow I'm sort of like some rock star. You know? Like, no, no. It's the message, not the messenger. Okay? I would very much like to be anonymous. I would very much like to basically, you know, have this problem go away.

Dr. Rangan Chatterjee 24:27 Yeah

Dr. Robert Lustig 24:28 You know? But it's not going away

Dr. Rangan Chatterjee 24:30 Yeah

Dr. Robert Lustig 24:30 And unfortunately, it's gonna need people like you and me to make it go away.

Dr. Rangan Chatterjee 24:35 Well, Robert, it's always a pleasure. You mentioned that eat real food is the key message you wanna give to children. I'm guessing that's the same message you wanna give to adults. Apart from that as a take-home for people, is there any final bit of wisdom you wanna impart to people in terms of what they can do immediately to improve their health?

Dr. Robert Lustig 24:53 Um, you can't solve a problem unless you know what the problem is. And for the last 50 years, we've been told the wrong thing. So this is, what we have is we have a belief system, okay? So here's a, here's a, here's a new construct for you, Rangan. Okay? Are you Hindu?

Dr. Rangan Chatterjee 25:17 Uh, yeah, my family are. I was certainly raised that way.

Dr. Robert Lustig 25:20 Okay. You... Right. Do you ever think about being Jewish?

Dr. Rangan Chatterjee 25:25 Not really, no.

Dr. Robert Lustig 25:26 Oh, okay, 'cause Hindu worked for you, right?

Dr. Rangan Chatterjee 25:30 Okay.

Dr. Robert Lustig 25:31 In America, in America only, it, when I was a kid, you know, 1970 or so, only 2% of people changed religions. Today, it's 24%. Why is that? 'Cause whatever their religion is, it's not working for them. Okay? So they were taught a belief system, and they found that the belief system ultimately did not solve their issues or s- a- answer their questions, and so they are looking for something else. Well, we have had a belief system called calories for the past 50 years, and that's all it is, is a belief system. And believe it or not, it didn't work, and it hasn't worked, and the reason is 'cause it's not true. And so what I'm trying to do is I'm trying to reorient people so that they can actually understand what the truth, what the science says and so that they can form their own narrative that will work for them. That's what I'm trying to do.

Dr. Rangan Chatterjee 26:39 The term real foods, I like it, you use it, but it does get a bit of pushback from certain academics. And-

Dr. Robert Lustig 26:50 Yeah

Dr. Rangan Chatterjee 26:50 ... you know, I saw one, I think on Instagram, just a couple of weeks ago, a very prominent, uh, researcher in obesity in the UK, um, denigrating the term, saying it smacks of privilege. It's, you know-

Dr. Robert Lustig 27:03 Yeah

Dr. Rangan Chatterjee 27:03 ... all kinds of things about it. And here's the thing-

Dr. Robert Lustig 27:06 Yeah

Dr. Rangan Chatterjee 27:06 ... 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.

Dr. Robert Lustig 28:01 Yeah. I, I, I've, I've heard those, uh, complaints also before, and I've heard about the 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-

Dr. Rangan Chatterjee 28:27 Yeah

Dr. Robert Lustig 28:27 ... 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.

Dr. Rangan Chatterjee 28:46 Yeah.

Dr. Robert Lustig 28:46 And I have an entire section on what we did to the food that actually turned it from food into poison.

Dr. Rangan Chatterjee 28:52 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-

Dr. Robert Lustig 29:04 Sure

Dr. Rangan Chatterjee 29:04 ... to, to help people really understand this.

Dr. Robert Lustig 29:06 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 applesauce, 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.

Dr. Rangan Chatterjee 29:45 So we can have-

Dr. Robert Lustig 29:46 That's because-

Dr. Rangan Chatterjee 29:46 We can have minimally... That's really inter- So we can have, you know, minimally processed foods that are done to make-

Dr. Robert Lustig 29:52 Minimally processed

Dr. Rangan Chatterjee 29:52 ... our life easier a little bit or-

Dr. Robert Lustig 29:54 Yeah.

Dr. Rangan Chatterjee 29:55 You know?

Dr. Robert Lustig 29:55 Yeah.

Dr. Rangan Chatterjee 29:55 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. 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.

Dr. Robert Lustig 30:25 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.

30:35 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 h- like alcohol, only has an innate capacity to metabolize a small amount. We 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.

Dr. Rangan Chatterjee 32:17 Yeah.

Dr. Robert Lustig 32:18 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.

Dr. Rangan Chatterjee 33:21 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?

Dr. Robert Lustig 33:36 Well, we certainly don't, and the reason is 'cause it does- it doesn't happen. So here's my q- here's my question to you, Rangan, and think, think this, think this out. These probiotics, they're bacteria. They're live cultures, right?

Dr. Rangan Chatterjee 33:51 Yeah.

Dr. Robert Lustig 33:51 They're live. You know, whether they're in a pill or not, they're live. You swallow 'em. Those bacteria should be able to populate your intestine, grow, take hold, and basically f- you know, in- contribute to your microbial diversity. Yes?

Dr. Rangan Chatterjee 34:14 Yeah.

Dr. Robert Lustig 34:14 Concept, right? Why do you have to keep taking them? Why shouldn't, why can't you just take one? Why have to take them every day?

Dr. Rangan Chatterjee 34:27 Yeah, well, a lot of them just pass straight through, don't they? And-

Dr. Robert Lustig 34:30 That's right. A lot of them pass straight through, or they die right there in the intestine-

Dr. Rangan Chatterjee 34:38 Yeah

Dr. Robert Lustig 34:38 ... which is exactly what happened to the ones as to why you don't have 'em 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. 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 amelioration of any disease yet, because probiotics are not working upstream. You 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 wor- nature's perfect prebiotic?

Dr. Rangan Chatterjee 35:56 Fiber.

Dr. Robert Lustig 35:57 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 taken over, and the bad bacteria are sending all sorts of bad signals, actually suppressing serotonin generation in, um, in the intestine, thereby reducing the w- retrograde, ra- uh, anterograde transport of serotonin back up into the nucleus tractus solitarius, and that's called depression

Dr. Rangan Chatterjee 36:48 Yeah

Dr. Robert Lustig 36:49 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, u- 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, [lips smack] insulin resistance, all because you didn't feed your gut.

Dr. Rangan Chatterjee 37:26 And that, and that's-

Dr. Robert Lustig 37:26 You didn't feed your microbiome

Dr. Rangan Chatterjee 37:27 ... and, and that's how the whole thing gets tied together here. That's very- some very simple but very, very brilliant advice. Protect the liver, feed the gut. But the modern-

Dr. Robert Lustig 37:38 Yes

Dr. Rangan Chatterjee 37:38 ... food environment, the ultra-processing of food is overwhelming the liver with sugar, and it's starving the gut through its lack of fiber.

Dr. Robert Lustig 37:50 Yes, sir.

Dr. Rangan Chatterjee 37:50 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 ki- all these things have been associated with increased permeability in the gut. So it's a very simple maxim, but one that actually, [lips smack] again, going to that nexus of the root cause, it's kind of right there, isn't it? And that's g- 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.

Dr. Robert Lustig 38:36 Exactly.

Dr. Rangan Chatterjee 38:36 Let's just get out the junk [laughs] , let's get the real food in, and then-

Dr. Robert Lustig 38:40 Right

Dr. Rangan Chatterjee 38:40 ... let's see where we are. So how does-

Dr. Robert Lustig 38:42 Right

Dr. Rangan Chatterjee 38:42 ... you feel that, like, a vegan diet or a low-carb diet or a whole manner of diets can, can fit this maxim of protecting the liver and feeding the guts?

Dr. Robert Lustig 38:51 Yeah, I'm agnostic as to the whole vegan keto thing. Uh, y- 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 [laughs] 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. I... But m- me- but metabolic health is not one of 'em, 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. [lips smack] 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.

Dr. Rangan Chatterjee 39:54 Yeah

Dr. Robert Lustig 39:54 And basically we had to control their blood glucose rises in o- 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 bi- 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 k- 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 de- 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 croissant some, the, uh, you know, uh, you know, the, the, the, that the other guy at work brought in. So [lips smack] 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-

Dr. Rangan Chatterjee 41:46 Yeah

Dr. Robert Lustig 41:46 ... of who does better with which diet, and it t- 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- 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-

Dr. Rangan Chatterjee 42:05 Yeah

Dr. Robert Lustig 42:05 ... 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.

Dr. Rangan Chatterjee 42:24 Yeah.

Dr. Robert Lustig 42:24 The only diet I'm not for is the Western diet.

Dr. Rangan Chatterjee 42:28 [laughs] And the reality is I think any clinician who has utilized food as one of their tools in their toolbox with their patients, which I hope more and more are starting to do, although it's clearly not enough- Now, you, you will see that different people thrive on different diets. That's, you know... You, you, you, you... I, I think real-life clinical practice teaches you that, well, these guys here are literally rocking a low-carb, real food diet. Their markers look good, their, uh, bloods look great, and all these people here are doing great on a whole food vegan diets. As you say-

Dr. Robert Lustig 43:15 Yeah

Dr. Rangan Chatterjee 43:15 ... the commonality is no processed food, or very, very low amounts of ultra-processed foods. Um-

Dr. Robert Lustig 43:22 Right. The commonality is low sugar, high fiber.

Dr. Rangan Chatterjee 43:26 Yeah.

Dr. Robert Lustig 43:26 The di- both diets work when they're low sugar, high fiber. And so that's why I think those are the two sort of linchpins in this whole story. But unfortunately, that's exactly what processed food is not.

Dr. Rangan Chatterjee 43:40 You used apples before, uh, to demonstrate those four categories of processing, which I thought was-

Dr. Robert Lustig 43:46 Okay

Dr. Rangan Chatterjee 43:46 ... a really nice example. Where would apple juice fit into that?

Dr. Robert Lustig 43:51 Oh, apple j-

Dr. Rangan Chatterjee 43:51 Because that's something that many people are consuming every day, thinking it's healthy. Hopefully, they might be reevaluating [laughs] that at the end of this conversation, but yeah, where does that fit in?

Dr. Robert Lustig 44:02 So what happens with apple juice, whether it's... Let's, let's just, let's just take apple juice that's not a- also, uh, sweetened, right? 'Cause, you know, sometimes they add extra sugar. Just taking an apple and putting it in the Vitamix.

Dr. Rangan Chatterjee 44:16 Okay.

Dr. Robert Lustig 44:16 Okay? All right? Let's do that kind of apple juice, okay? Apple juice that's been Vitamixed, or the Jom- Jamba Juice. Okay? People say, "That's great, right? 'Cause that's whole fruit." Well, it was whole fruit. Now it's not. So you have to understand the problem of fiber. Now, fiber, we've been talking about it like it's one thing, and that's not correct. Fiber is two things. Two. One's called soluble fiber, and an example of that would be like inulin or pectins, like what holds jelly together. Hydrogel, it's what's in cream cheese. And then there's a second fiber called insoluble fiber, and that's like cellulose. That's like the stringy stuff in celery. It's also what's in cardboard. Okay? So cream cheese, cardboard, okay? Both fiber, ha ha. [laughs] All right? Well, it turns out that real food has both. Okay? Now, when you put the apple in the Vitamix, you are shearing the s- the, uh, the insoluble fiber, the cellulose, to smithereens. You are cutting it up into such little, small, little fragments that it's not going to be functional afterw- afterw- afterward. So here's how the soluble and insoluble fiber work together. Imagine a fish net, all right? So, you know, plastic, you know, uh, matrix, right?

Dr. Rangan Chatterjee 46:00 Yeah.

Dr. Robert Lustig 46:00 With holes in it, right? And when the fish net is, um, uh, working, okay, what happens is you can catch fish, but then the kelp, the seaweed, is gonna plug the holes in the fish net, and now you're not gonna be able to drag it through and catch the fish anymore, right? So you've created a barrier, so that the insoluble fiber is like the fish net itself, and the soluble fiber is like the kelp. And you... So together, they form a barrier. Or think of it this way, like a spaghetti colander, okay? Metal bowl with holes in it, right?

Dr. Rangan Chatterjee 46:36 Yeah.

Dr. Robert Lustig 46:37 You run the water; water runs through. Now take a blob of petroleum jelly, throw it into the center of the colander. Run the water; still runs through. Now take your finger and rub the petroleum jelly all around the inside of the colander. Now run the water. Now the water doesn't run through. You've created a barrier, right? And you needed three things. You needed the colander, you needed the jelly, and lastly, you needed the geometry of plugging all those holes, right? For the fish net, you needed the net and you needed the kelp together, right?

Dr. Rangan Chatterjee 47:18 Yeah.

Dr. Robert Lustig 47:18 If somebody came along and took a scissor to that fish net, you know, all of a sudden, now you don't have a barrier anymore. So this is what's going on in your gut. The insoluble fiber, the cellulose, the stringy stuff in the celery, is forming a latticework on the inside of your intestine. The soluble fiber, like the pectins and inulin, they're globular, they're plugging the holes in that latticework. And together they form a whitish gel on the inside of your intestine, and that gel is y- a secondary barrier that prevents early absorption of glucose, fructose, sucrose, simple starches, so that they don't end up going to the liver. So they don't flood the liver. So that your liver doesn't turn them into fat. So that your liver can stay healthy. So the apple juice, the Vitamixed apple juice, it still has the soluble fiber, and that still has a benefit, because that can still go down to your colon and make short-chain fatty acids. And that's good. But it won't protect your liver. So you've taken one of the two cardinal-

Dr. Rangan Chatterjee 48:37 Mm-hmm

Dr. Robert Lustig 48:38 ... phenomena of health, and you've basically thrown it in the garbage can. So apple juice, better than soda, 'cause it has soluble fiber. But not better than soda, because it floods your liver

Dr. Rangan Chatterjee 48:57 The eight subcellular pathologies that underpin pretty much all of the chronic diseases that we have, you know, glycation, oxidative stress, mitochondrial dysfunction, insulin resistance, et cetera, et cetera. I underlined a section in the insulin resistance part which I think really relates to this part of our conversation. You wrote this, "Even those who are overweight and those who are under stress don't exhibit metabolic syndrome if their diet is unprocessed."

Dr. Robert Lustig 49:32 Yeah.

Dr. Rangan Chatterjee 49:33 That's really interesting because, look, as you say, you know, stress, too much stress for too long a period of time will drive us to eat poor quality food. At the same time, eating lots of poor quality food is a stressor on the body.

Dr. Robert Lustig 49:49 Exactly.

Dr. Rangan Chatterjee 49:49 So why is it, why is it that even if you're under chronic stress and you're overweight, why is it that people don't develop metabolic syndrome in the absence of these ultra-processed foods?

Dr. Robert Lustig 50:02 Um, I can sum it up in one word. Reactive oxygen species. You have to be able to handle your reactive oxygen species. Every one of these things, including cortisol, generates reactive oxygen species. Mitochondria generate reactive oxygen species. The cytokines, you know, that are released from visceral fat bind to their receptors and activate NADPH oxidase to generate reactive oxygen species. Those reactive oxygen species do damage, the damage of metabolic syndrome, and it can be whether you're thin or whether you're fat. Now, you gotta get rid of the reactive oxygen species because they're the mover in terms of the damage, okay? And they are part of life. You can't get rid... The only way to get rid of reactive oxygen species is to be dead, all right? They are going to be manufactured. The, you know, it is part of energy metabolism. It is part of protein metabolism. It is part of lipid metabolism to generate reactive oxygen species, all right? Little oxygen radicals, little hydrogen peroxides running around your cells, okay? Turns out those change energy metabolism. So you gotta clear the ROSs. Well, where do you clear the ROSs? A subcellular organ in the cell called the peroxisome. That's where the, that's where the antioxidants are. So the peroxisome is where ROSs go to die. That's where you quench-

Dr. Rangan Chatterjee 51:40 Mm

Dr. Robert Lustig 51:40 ... the effect of the reactive oxygen species. And it turns out that every mitochondrion is next to a peroxisome on purpose, to be able to basically get rid of that ROS before it does damage, because that ROS will peroxidate a lipid or it'll denature a protein or whatever. It's gonna cause cellular dysfunction. Now, let's say you don't have enough antioxidants to cover your ROS burden, that your ROSs are greater than your antioxidant capacity. Now you can't clear them. So where do they go? They go to the endoplasmic reticulum, which is where proteins, as you know, get built. There's a little, you know, a little assembly line of adding amino acids. The transfer RNA is bringing the amino acids, you know, you're using the genetic code in order to build up, uh, proteins and then fold them, right? Well, if you don't fold them right because of the ROSs, you have what we call ER stress, endoplasmic reticulum stress, also known as the unfolded protein response, also known as the pathogenesis of metabolic syndrome. Those three terms are synonymous. So if you can't fold your insulin molecule, you got type 2 diabetes. If you can't fold your insulin receptor molecule, you've got metabolic syndrome, insulin resistance, and possibly Alzheimer's, and possibly, um, uh, cardiovascular disease, and possibly fatty liver disease, et cetera, et cetera. So getting rid of the ROSs is super important, and there's only one way to get rid of the ROSs, antioxidants, and there's only one way to get the antioxidants. You can't breathe them in. Ain't no antioxidants in your, in, in the air. You gotta get it in your food. So when you eat food, you can mitigate that metabolic syndrome pathology. But unfortunately, ultra-processed food only, because it's antioxidant poor, only contributes to an increase in reactive oxygen species. Because you're bringing on all of this carbohydrate, you're bringing on all of these trans fats, you're bringing on all of these things that generate ROSs without bringing on the antioxidants that can quench them.

Dr. Rangan Chatterjee 54:16 When you say antioxidants and you get these antioxidants from foods and from real foods-

Dr. Robert Lustig 54:22 Real food. And, and in part- and in particular, fruits and vegetables. You know, I mean, that's one... That's the primary, you know, uh, source of antioxidants. I mean, you know... I mean, you know, there, there are amino acids that are antioxidant, but y- what you really need are, you know, the, the, the biotin, the ans- the cyanines, the, you know, flavonoids, the various other things that come from a, shall we say, a real food diet.

Dr. Rangan Chatterjee 54:52 A lot of the foods that contain those wonderful compounds, as you said, are fruits and vegetables, let's say.

Dr. Robert Lustig 54:57 Right.

Dr. Rangan Chatterjee 54:58 You know, blueberries, for example, would be an, an example of a food that is rich in all the compounds you've just mentioned, which will help- dampen down the ROS, the reactive oxygen species, right?

Dr. Robert Lustig 55:10 Yeah.

Dr. Rangan Chatterjee 55:10 How do you put that together with your take on fructose? So fructose is something you've spoken about on our first podcast together about the problems of excess fructose in our diet, and of course, fruit also contains fructose. So could you just help tease that apart for us? I don't-- I, I genuinely want this conversation to be helpful for people so they understand what's going on and they know what they can do. So I think that would be quite helpful if you don't mind.

Dr. Robert Lustig 55:39 All right. It's very simple. Number one, berries, like blueberries, they don't have much fructose. I mean, they have a little, yeah. Okay, yeah. They're, they're mildly sweet, but n- not, like, ridiculously so, number one. Number two, they got a lot of fiber, okay? And fiber turns out to be the antidote to sugar, and we'll show-- and I'll show you in a why in a minute. And number three, they have all these antioxidants, right? Now, um, sugar is the bad guy, and the reason is 'cause fructose, this sweet molecule in sugar, is not glucose. Glucose is the energy of life. Every cell on the planet can, you know, u- uh, utilize glucose for energy. Glucose is so important that if you don't consume it, your body makes it. There, this, there's this process called gluconeogenesis where fat breakdown can generate glucose in the liver. Amino acid breakdown can generate glucose in the liver. So glucose is a- so essential you don't have to consume it. That's how essential it is, okay? It is essential to have. It is not essential to consume. Now, fructose, on the other hand, is totally non-essential. There's no enzyme in the body that requires it. There is no, uh, benefit to it other than the fact that it incorporates energy, you know, h- h- has a certain amount of energy associated with it, okay? But it is completely vestigial to all animal life, all the way down to the amoeba, okay? I always used to say all vertebrate life, but in fact, all animal cell life. There is no reaction in any animal cell on the planet that requires fructose. Not necessary. Completely vestigial. It's a holdover from our plant ancestors, okay? Now, it, it does have energy. I'm not saying it doesn't. If you throw it into a bomb calorimeter, it'll burn at four calories per gram.

Dr. Rangan Chatterjee 57:42 Mm-hmm.

Dr. Robert Lustig 57:42 Yes, we can harness some of that energy, and, you know, that's of course ostensibly why it's in sports drinks. But the fact of the matter is, it is metabolized a completely different way from that of glucose. And instead of going to either ATP and carbon dioxide or to glycogen, which is a storage form of glucose, fructose goes straight to the mitochondria. If the mitochondria are overwhelmed and can't process all of it, then the mitochondria throw off the excess, and then the cell turns that into fat.

Dr. Rangan Chatterjee 58:18 Mm.

Dr. Robert Lustig 58:18 And we have just talked about liver fat being the worst of the bunch, and fructose is a primary d- driver of liver fat accumulation, and therefore, a primary driver of metabolic syndrome. Oh, and by the way, a primary driver of reactive oxygen species. Because of the stereochemistry of the fructose molecule, it engages in that reactive oxygen species generation seven times faster than glucose does. So it is a lipogenic substrate, and it is an oxidative stress all by itself. Now, but I said f- fruit is good, right? You-- I mean, you said fruit is good. It-- The reason the fruit is good is 'cause number one, it has the fiber, and number two, it has the antioxidants. It's not good because it has the fructose. The fructose is what makes you eat it. But it's not-- That's not why it's good. So how does the fiber act to mitigate the negative effects of fructose? There are two kinds of fiber, soluble and insoluble. You need both. So insoluble fiber is like, um, uh, cellulose, you know, like the stringy stuff in celery. Uh, soluble fiber is like pectins or inulin, like what holds jelly together, right?

Dr. Rangan Chatterjee 59:42 Mm.

Dr. Robert Lustig 59:43 You need both. Together, what happens is that the cellulose acts like a latticework, like a fish net on the inside of your intestine. The soluble fiber, the pectins and the inulin, they plug the holes in the fish net, and so together they form a secondary barrier.

Dr. Rangan Chatterjee 59:59 Mm-hmm.

Dr. Robert Lustig 1:00:00 And that prevents-

Dr. Rangan Chatterjee 1:00:02 Sorry to interrupt. If you're enjoying this video and want to learn more, you can download my free special guide containing six simple breathing practices that will help you calm your mind, lower stress, and improve your energy. To get hold of this guide, all you have to do is click on the link in the description box below

Dr. Robert Lustig 1:00:22 ... transport of glucose, fructose, sucrose, simple starches from the intestinal lumen into the, uh, portal circulation so that it never reaches-

Dr. Rangan Chatterjee 1:00:32 Yeah

Dr. Robert Lustig 1:00:32 ... the liver. And if it doesn't reach the liver, it goes further down the intestine, and the bacteria chew it up for its own purposes. You have fed the microbiome. You have to feed your gut. Well, the fiber is the food for the gut. And so it takes the pressure off your liver, so fewer ROS, and it feeds your gut so your microbiome can, number one, work for you, generate short chain fatty acids, suppress inflammation, maintain the intestinal barrier integrity so that you don't get inflamed, so you don't get metabolic syndrome. So yes, even though the fructose is in the fruit, the antioxidants and the fiber-

Dr. Rangan Chatterjee 1:01:20 Mm

Dr. Robert Lustig 1:01:21 ... more than make up for it. But as soon as you squeeze it, now the fiber's gone.

Dr. Rangan Chatterjee 1:01:28 Yeah.

Dr. Robert Lustig 1:01:28 The antioxidants will still be there, that's true, but the fiber's gone, and so now you're gonna get this big fructose load hitting your liver.

Dr. Rangan Chatterjee 1:01:36 Yeah.

Dr. Robert Lustig 1:01:36 That's why I tell people, "Eat the fruit, don't drink the juice."

Dr. Rangan Chatterjee 1:01:39 The-

Dr. Rangan Chatterjee 1:01:39 there's a couple of things which have just come up for me as, as you were explaining that. First one, Rob, is to do with the fact that, that... It's to do with the fact that fruit does have fructose within it, just not that much, and your message, I think, is that it's the excess fructose that we're consuming that's causing problems. So-

Dr. Robert Lustig 1:02:04 Especially in the absence of the reactive oxygen species and fiber. Yeah

Dr. Rangan Chatterjee 1:02:09 Yeah. So let's say someone is in perfect metabolic health, and we compare that to someone who has really poor metabolic health, like much of the US population, much of the UK population, and frankly much of the global population these days. Is the way they're going to... Let, let's take a high-sugar fruit like a mango for, for, for example.

Dr. Robert Lustig 1:02:36 Mm.

Dr. Rangan Chatterjee 1:02:36 If you're in perfect metabolic health, everything's working great, that mango is gonna have one effect on you, I'm guessing, compared to someone who has advanced metabolic syndrome and is very insulin resistant. I guess the point I'm trying to get to is too often I think we're trying to say, "This is good, this is bad. This food is good, this food is bad." Context matters massively. The state of your cellular health, the state of your mitochondrial health, the state of your insulin sensitivity, all that plays into whether that particular fruit is gonna be helpful. Because I think the truth is for some people who've got type 2 diabetes, actually having as much fruit as they want because it contains antioxidants, I personally haven't seen it to be the best idea. But then people will get very black and white. You're saying fruit is good or fruit is bad. It's like, well, no, hold on a minute. I'm saying for this individual patient who's very, very insulin resistant and is struggling, I'm not sure they need to be having lots of high-sugar fruits. How do you see it?

Dr. Robert Lustig 1:03:41 Uh, first of all, Rangan, I couldn't agree with you more, okay? You are 150% right, okay? The-- You have said nothing I disagree with. In fact, I subscribe to it wholeheartedly, completely. People are black and white. People want rules. People want to be told, "This is good, this is bad. This is helpful, this is hurtful. This is good, this is evil." They said... And it's never that simple.

Dr. Rangan Chatterjee 1:04:14 Mm.

Dr. Robert Lustig 1:04:15 It's never that simple. What we have learned is that different foods affect different people different ways. That is what we have learnt. And there's absolutely no question that you take somebody who's in the prime of health, who is completely insulin sensitive, who's a marathon runner, and you give them a glass of orange juice, it's gonna have a different effect on them metabolically than if you take a, you know, 70-year-old sedentary Type 2 diabetic who's got vascular, uh, uh, uh, problems and, you know, potentially kidney problems, and you give them a glass of-- the same glass of orange juice. It's gonna have much worse effects. No argument. Completely. How do you know who you are? How do you know whether or not this food is okay for you and that food is not? We're still in the process of trying to figure all of that out. We have some tools. There are a few things that we can do now. Right? Now, there are some general global things, you know, like for instance this thing called glycemic index, which I hate, okay? I think glycemic index needs to be blown up but, you know, the dieticians still subscribe to it.

Dr. Rangan Chatterjee 1:05:36 Before you move on, Rob, could you explain why that is? 'Cause a lot of people will know that term and, and they, they'd be very interested to know why you're not a big fan of that term.

Dr. Robert Lustig 1:05:46 Not a big fan is being-- is an understatement, okay?

Dr. Rangan Chatterjee 1:05:49 [laughs]

Dr. Robert Lustig 1:05:50 Like, kill the glycemic index now. Right? So let me explain for your audience what this is, okay? It is a tool that dieticians developed, um, that tells you how high does your plasma glucose rise after you eat 50 grams of carbohydrate in any given food. That's what glycemic index is. And it's all standardized against the rise that you would see with white bread. White bread would have a glycemic index of 100. Okay? So it's straight glucose. There's nothing else in it. It's, it's a polymerized carbohydrate, straight glucose. So if you eat a piece of white bread, you're gonna get a big glucose rise in your bloodstream, and everything else is compared against that. All right. The pro- S- That sounds good because when you generate a glucose response, you also generate an insulin response, and the glucose does one thing. It causes vascular endothelial s- uh, cell dysfunction, and the insulin does another thing. It causes vascular smooth muscle proliferation and cell growth. Okay? So they both have problems. The glucose has a problem, and the insulin that follows it has a problem. So obviously the higher the glucose goes, the worse off you are metabolically. Now, that's true. That is true. I don't say that that's not true. But glycemic index is not the way to figure it out, and here's why. Two reasons. First, let's take carrots. Carrots are good. If you eat 50 grams of carbohydrate in carrots, your blood glucose is gonna go pretty high. So carrots have a high glycemic index. The question is, how many carrots do you have to eat to get 50 grams? You have to eat 700 grams of carrots to get 50 grams of carbohydrate. What's the rest? Fiber. So you are taking in 650 grams of fiber to get 50 grams of carbohydrate. Okay? So it's not about glycemic index, it's about glycemic load.

Dr. Rangan Chatterjee 1:08:06 Mm-hmm.

Dr. Robert Lustig 1:08:07 Okay? You have to eat 1.4 pounds of carrots to get 50 grams of carbohydrate in carrots. Okay, you tell me who does that other than Bugs Bunny?

Dr. Rangan Chatterjee 1:08:15 [laughs]

Dr. Robert Lustig 1:08:18 All right? So the concept of glycemic index is useless. G- glycemic load, that makes more sense because that takes into account the fiber issue. So that's the first reason. Second reason, fructose. So remember, glycemic index is how high does your blood glucose rise. Doesn't say anything about high do- how high does your blood fructose rise, 'cause you don't measure the blood fructose in the glucose level.

Dr. Rangan Chatterjee 1:08:47 Mm-hmm.

Dr. Robert Lustig 1:08:47 So when something is sugar, it's half glucose, half fructose, which means it w- the g- blood glucose will only rise half as high because the rest is fructose, and it's not captured in the measurement. Yet fructose is seven times worse in terms of re- generating reactive oxygen species and in terms of generating liver fat, both of which drive the phenomena of metabolic syndrome. That's not captured-

Dr. Rangan Chatterjee 1:09:14 Mm

Dr. Robert Lustig 1:09:14 ... in glycemic index 'cause it's only concerned about the glucose. It's not concerned about the fructose.

Dr. Rangan Chatterjee 1:09:20 Mm-hmm. I guess the other issue is we're all highly individual, aren't we? We're learning that more and more over the last, what, five, 10 years, that we all have different responses to the same food.

Dr. Robert Lustig 1:09:33 Exactly, and that's what Levels Health showed us by n- normal people wearing continuous glucose monitors. Now, the FDA says, "Don't do that," and the government says, "Don't do that," but the fact of the matter is we are learning a lot by having normal people wear continuous glucose monitors because we are seeing the variation that occurs across populations, and what kinds of things actually influence the glucose excursions which we know have information in them, and we also know have pathology in them.

Dr. Rangan Chatterjee 1:10:10 Mm.

Dr. Robert Lustig 1:10:10 And the goal is to keep your glucose down, in part because keeping your glucose down means less endothelial cell dysfunction, and also, if you keep your glucose down, it means keeping your insulin down.

Dr. Rangan Chatterjee 1:10:24 Mm.

Dr. Robert Lustig 1:10:24 And that means less cell growth, less chance for chronic metabolic disease also. So knowing how your body responds to a specific food turns out to actually be quite important.

Dr. Rangan Chatterjee 1:10:38 Yeah.

Dr. Robert Lustig 1:10:38 And there's no way to know that unless you're wearing a monitor.

Dr. Rangan Chatterjee 1:10:41 It's interesting that you said that you're looking at normal people wearing CGMs, wearing continuous glucose monitors, and seeing how they respond to certain foods. The word normal's quite interesting, isn't it? Because-

Dr. Robert Lustig 1:10:55 Yeah, 'cause no one's normal

Dr. Rangan Chatterjee 1:10:56 ... what, you know, 88%, we, we, we hear of the US population have a degree of meta-

Dr. Robert Lustig 1:11:02 No, 93

Dr. Rangan Chatterjee 1:11:02 93% has gone up

Dr. Robert Lustig 1:11:04 93% are metabolically dysfunctional.

Dr. Rangan Chatterjee 1:11:05 So when you wrote Metabolical and the first time you came on my podcast, I think the figure was 88%. So already-

Dr. Robert Lustig 1:11:12 Yeah

Dr. Rangan Chatterjee 1:11:12 ... in the space of, what, a year or two, that's gone up to 93%.

Dr. Robert Lustig 1:11:15 Right. There were two papers. The, the first paper was 2019, Araujo et al., and it was at 88%, and then the other pa- the next paper from, uh, Mozaffarian's group out of Tufts ca- uh, actually categorized it in 2021 at 93%. Maybe it was c- maybe it was COVID that did that, I don't know.

Dr. Rangan Chatterjee 1:11:34 Well, let's just pause on that for a minute because for anyone who's watching this or listening to this conversation and they haven't heard our first one, just explain what that means. 93% of the US population have a degree of metabolic dysfunction. Are you able to very succinctly summarize what is metabolic dysfunction, and why should people be worried about that statistic?

Dr. Robert Lustig 1:11:55 So metabolic dysfunction means mitochondrial dysfunction. That's what it means. So mitochondria are the little energy-burning factories inside each of your cells. Mitochondria are how you turn chemical compounds into energy to power cells. That's what mitochondria do. Mitochondria are refurbished bacteria, okay? They have their own DNA. They made an alliance with us back, you know, five billion years ago to basically be our powerhouse if we gave them, um, uh, safety and comfort [laughs] is basically the way it worked. It was a symbiotic relationship between the, the animals and the plants because bacteria, you know, came from plants. So the prokaryote, the eukaryote. But they have their own DNA. They act on their own, and what we have to do is we have to be nice to our mitochondria, and that means not exposing them to toxins that can hurt them, and it means not exposing them to overwhelming nutrients that basically overwhelm them, okay? We have to be nice to our mitochondria. Our mitochondria have a set of, uh, proteins- In order to maintain their, uh, proton gradient to allow them to work.

Dr. Rangan Chatterjee 1:13:27 Mm-hmm.

Dr. Robert Lustig 1:13:27 And they're called complex one, complex two, complex three, complex four, complex five. And turns out there's this one at the end, which is sort of the molecular motor of the mitochondria, and it's called ATP synthase. And all of the food you eat, ultimately the electrons from that food end up going through the mitochondria and coming out as ATP through this ATP synthase. So when your mitochondria work, you can efficiently turn food into energy. But when your mitochondria are not working, and there are ways to knock your mitochondria off their game, stress, cortisol will do it. Um, uh, toxins in the environment will do it. Um, uh, the wrong fatty acids will do it, because the mitochondria are made of fatty acids. There are a whole bunch of things that can basically make your mitochondria not work right, and a lot of them are toxins in the environment, and unfortunately, stress is, is a big one-

Dr. Rangan Chatterjee 1:14:38 Mm

Dr. Robert Lustig 1:14:38 ... as we've talked about. So when your mitochondria are working subpar, you are not turning chemical, uh, uh, uh, energy into motor energy to power the cell properly.

Dr. Rangan Chatterjee 1:14:55 Mm.

Dr. Robert Lustig 1:14:56 That will generate the reactive oxygen species that will damage the cell, that will ultimately make you feel lousy and tired because you don't have the energy that you think you should have.

Dr. Rangan Chatterjee 1:15:07 Yeah.

Dr. Robert Lustig 1:15:07 And this is, of course, what happens in aging, this is what happens, uh, in stress, this is what happens in eating bad food.

Dr. Rangan Chatterjee 1:15:16 Yeah.

Dr. Robert Lustig 1:15:17 So, um, all of, all of these things are inexorably tied to how well your cells work, and ultimately, how well your mitochondria work. So maintaining mitochondrial integrity ha- has to be job one.

Dr. Rangan Chatterjee 1:15:35 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."

Dr. Robert Lustig 1:15:52 Right.

Dr. Rangan Chatterjee 1:15:52 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.

Dr. Robert Lustig 1:16:04 That's true. And, 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.

Dr. Rangan Chatterjee 1:16:23 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.

Dr. Robert Lustig 1:16:46 Right.

Dr. Rangan Chatterjee 1:16:46 And, you know, like you, I'm very passionate in root causes, and-

Dr. Robert Lustig 1:16:51 Right. Right

Dr. Rangan Chatterjee 1:16:51 ... this idea that we've labeled all these so-called separate diseases, we get taught about them at medical school. They say, "Oh, they're all separate entities. For this disease, you-

Dr. Robert Lustig 1:16:59 Right

Dr. Rangan Chatterjee 1:16:59 ... 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.

Dr. Robert Lustig 1:17:17 Absolutely.

Dr. Rangan Chatterjee 1:17:17 But also insulin resistance, right? So that-

Dr. Robert Lustig 1:17:19 Absolutely

Dr. Rangan Chatterjee 1:17:19 ... insulin 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-

Dr. Robert Lustig 1:17:36 We would get rid of 75% of the chronic disease in Amer- in, in the world.

Dr. Rangan Chatterjee 1:17:40 Exactly. It's that root cause again, isn't it?

Dr. Robert Lustig 1:17:43 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.

Dr. Rangan Chatterjee 1:18:00 Yeah.

Dr. Robert Lustig 1:18:00 It's, uh, you know, it's a, uh, it's, uh, it's a cartel, if

Dr. Robert Lustig 1:18:05 you will.

Dr. Rangan Chatterjee 1:18:06 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.

Dr. Robert Lustig 1:18:15 You say that too. That's right. That's right.

Dr. Rangan Chatterjee 1:18:15 I do indeed, 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 seeing patients of, it's like, you know, b- 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.

Dr. Robert Lustig 1:19:06 Absolutely.

Dr. Rangan Chatterjee 1:19:06 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 guts-

Dr. Robert Lustig 1:19:38 Right

Dr. Rangan Chatterjee 1:19:38 ... 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 guts?

Dr. Robert Lustig 1:19:56 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-

Dr. Rangan Chatterjee 1:20:01 [laughs]

Dr. Robert Lustig 1:20:01 ... 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, uh, meningitis? Here's an antibiotic. You know, got a, um, uh, you know, a cancer? Here's a chemotherapy. You know? But the fact is, chronic disease doesn't, you know, really fit into that.

Dr. Rangan Chatterjee 1:21:16 Yeah.

Dr. Robert Lustig 1:21:16 There are- there are eight, count them, 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.

Dr. Rangan Chatterjee 1:21:47 Wow.

Dr. Robert Lustig 1:21:47 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.

Dr. Rangan Chatterjee 1:22:24 Yeah, yeah.

Dr. Robert Lustig 1:22:24 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, so they don't-

Dr. Rangan Chatterjee 1:22:47 Yeah

Dr. Robert Lustig 1:22:47 ... 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. And 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, h- 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.

Dr. Rangan Chatterjee 1:24:26 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 kind of 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-

Dr. Robert Lustig 1:24:44 But you won't-

Dr. Rangan Chatterjee 1:24:44 ... need the buckets.

Dr. Robert Lustig 1:24:45 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.

Dr. Rangan Chatterjee 1:24:49 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-

Dr. Robert Lustig 1:25:05 They're opposite

Dr. Rangan Chatterjee 1:25:06 ... 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-

Dr. Robert Lustig 1:25:18 No

Dr. Rangan Chatterjee 1:25:18 ... 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-

Dr. Robert Lustig 1:25:35 I, I'm not ag-

Dr. Rangan Chatterjee 1:25:36 We overuse-

Dr. Robert Lustig 1:25:37 I'm not against them

Dr. Rangan Chatterjee 1:25:38 Yeah.

Dr. Robert Lustig 1:25:39 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- it... You know, I, I, 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 a 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-

Dr. Rangan Chatterjee 1:26:51 Yeah

Dr. Robert Lustig 1:26:51 ... 'cause you didn't fix the problem.

Dr. Rangan Chatterjee 1:26:54 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 environment, 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 was, it, it literally was so punchy. Like [laughs] we could just do a podcast on the introduction, frankly.

Dr. Robert Lustig 1:27:56 [laughs]

Dr. Rangan Chatterjee 1:27:56 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.

Dr. Robert Lustig 1:28:01 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.

Dr. Rangan Chatterjee 1:28:10 I, I-

Dr. Robert Lustig 1:28:11 But, you know, I guess it depends on how concerned you are about the problem.

Dr. Rangan Chatterjee 1:28:15 Yeah. And this is r- this is such a big problem, like it's arguably the biggest problem that's going on across the globe at the moment, because-

Dr. Robert Lustig 1:28:24 Well, let's talk about that

Dr. Rangan Chatterjee 1:28:24 ... 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."

Dr. Robert Lustig 1:28:36 No.

Dr. Rangan Chatterjee 1:28:36 Something is going on, and we can't just-

Dr. Robert Lustig 1:28:38 Exactly

Dr. Rangan Chatterjee 1:28:38 ... give them metformin or what- we have to try and figure out what's causing this.

Dr. Robert Lustig 1:28:42 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 wh- 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?

Dr. Rangan Chatterjee 1:30:38 Probably poor socioeconomic conditions, um, poor diet, lots of highly-

Dr. Robert Lustig 1:30:43 Poor diet

Dr. Rangan Chatterjee 1:30:44 ... processed food.

Dr. Robert Lustig 1:30:45 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? 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 in- 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 it 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, and 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, 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, pre-existing conditions, big ultra-processed food consumers, high sugar, low fiber, processed food, not real food. The CDC and the NIH and the MRC and every- a- and everyone in Public Health England, no one is talking about food and COVID.

Dr. Rangan Chatterjee 1:33:44 Yeah.

Dr. Robert Lustig 1:33:45 This is the fourth leg of the stool. Okay? We all talked about masking and hand washing and social distancing. Garbage. Fix the food.

Dr. Rangan Chatterjee 1:33:54 Now, I think 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, 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?"

Dr. Robert Lustig 1:34:31 Right.

Dr. Rangan Chatterjee 1:34:31 And that's kind of part of the problem, isn't it? I don't... It's so normalized that-

Dr. Robert Lustig 1:34:35 For sure

Dr. Rangan Chatterjee 1:34:36 ... 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-

Dr. Robert Lustig 1:34:42 Right

Dr. Rangan Chatterjee 1:34:42 ... try and understand that?

Dr. Robert Lustig 1:34:44 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, 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. 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, 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.

Dr. Rangan Chatterjee 1:37:14 [laughs]

Dr. Robert Lustig 1:37:17 All four. If we got all four boxes ticked, those patients did well, and then there was no going back.

Dr. Rangan Chatterjee 1:37:30 Yeah.

Dr. Robert Lustig 1:37:30 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. We're like-

Dr. Rangan Chatterjee 1:37:44 Yeah

Dr. Robert Lustig 1:37:44 ... we always 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.

Dr. Rangan Chatterjee 1:37:55 Yeah.

Dr. Robert Lustig 1:37:57 And not until.

Dr. Rangan Chatterjee 1:37:58 If you enjoyed that conversation, I think you're really going to enjoy this one about the things that you can do right now to heal your body and prevent disease.

Guest 1:38:07 How much vitamin D do you need to not get rickets? Probably 30 units. How much vitamin D do you need to optimize your immune system and prevent cancer and heart disease and all these other benefits? Probably 2 to 4,000