Protecting the Liver, Feeding the Gut, and Changing Society with Dr. Robert Lustig

This month, Michael and Diana talk with Dr. Robert Lustig about his new book, Metabolical, The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine.  They talk about the health harms caused by processed foods and the massive increase in sugar consumption over the last several decades; possible societal interventions to address these problems; how the processed food public health battle is like the battle over tobacco; and more, including Dr. Lustig’s personal advice to all of us as to what healthy foods do: “Protect the liver, feed the gut.”

Dr. Robert Lustig is Professor emeritus of Pediatrics, Division of Endocrinology at the University of California, San Francisco (UCSF). He specializes in the field of neuroendocrinology, with an emphasis on the regulation of energy balance by the central nervous system.

Michael T. Roberts is the Executive Director of the Resnick Center for Food Law & Policy at UCLA Law.

Diana Winters is the Deputy Director of the Resnick Center for Food Law & Policy at UCLA Law.

You can order Dr. Lustig’s new book, Metabolical, here.
You can find Dr. Lustig’s previous book, The Hacking of the American Mind: The Science Behind the Corporate Takeover of Our Bodies and Brains, here, and his book, Fat Chance, here.

Transcript

Michael Roberts 0:07

Hello, welcome to Repast, a food law and policy podcast from the Resident Center for Food Law and Policy at UCLA Law. I'm Michael Roberts, the Executive Director of the Resident Center.

Diana Winters 0:19

And I'm Diana Winters, the Assistant Director of the Center. The Resident Center performs cutting-edge legal research and scholarship in food law and policy to improve health and quality of life for humans and the planet.

Michael Roberts 0:33

Each month we'll bring you an interview with thought leaders transforming food law and policy.

Diana Winters 0:45

Hello and welcome to Repast. Today, Michael Roberts and I are going to speak with Dr. Robert Lustig, New York Times bestselling author of Fat Chance, published in 2013, The Hacking of the American Mind, The Science Behind the Corporate Takeover of Our Bodies and Brains from 2017. And now, Metabolical: The Lore and the Lies of Processed Food, Nutrition, and Modern Medicine, published in May 2021. Welcome, Dr. Lustig.

Robert Lustig 1:15

Oh, thanks for having me. Both of you. This is a pleasure. Dr. Lustig or Rob, which which would you rather have me tell you? Absolutely. I am not your doctor.

Michael Roberts 1:25

Okay. It's so nice to have you here today, and uh it's a privilege for Diana and I to spend a few minutes with you. It's uh difficult for me to know how to introduce you because your credentials are so long, and I'm going to try to be brief, but they are important to our discussion because I think, as you mentioned in your book, they tell of your journey from being part of the medical establishment to being uh viewed as a critic of the medical establishment, pharma, and government. Your self-perceived role has evolved over time, and you document that very well in your book, which I think is interesting. But having said that, you are a renowned doctor and prolific author. You are a professor emeritus of pediatrics at the Division of Endocrinology at the University of California, San Francisco. You hold a bachelor's in science from MIT, a doctorate in medicine from Cornell University, Medical College, and a Master's of Studies in Law from UC Hastings College of the Law.

Robert Lustig 2:32

And I'm going to tell you, that's the second most thing I'm proud of after the MIT. Well, that's interesting. I love the fact that I went to law school, even if it was just for one year.

Michael Roberts 2:45

Well, I think it's it certainly speaks to your curiosity and and your ability and desire to kind of get out of whatever establishment you find yourself in because of your your credentials.

Robert Lustig 2:59

And no, you you end up exercising a different part of your brain. Right. And uh, you know, like anything, when you exercise it, it hurts. Um, but you know, it's it's you know it's worth it.

Michael Roberts 3:10

Well, it is an inspiration, but I do have to tell you that Diana and I probably are not going to go to medical school. Oh man.

Diana Winters 3:19

I can I keep threatening to go to medical school, and my my husband says, no more school.

Michael Roberts 3:24

So well, nevertheless, you have certainly fostered a global discussion of metabolic health and nutrition and exposing some of the leading myths that underlie the current pandemic of diet-related disease. And with this impressive background, the fact that you've authored books, many leading articles, I have to ask you this question: why this book and why now?

Robert Lustig 3:51

So the standard mantra amongst pretty much the entire cogniciente and government is you are what you eat. And in 2013, I wrote my first book, Fat Chance, and I restated that mantra as you are what you do with what you eat. In fact, metabolism is actually more important than calories or specific nutrients. And as the tobacco industry documents led to the food industry documents library at UCSF, and we learned a little bit, shall we say, of the internal politics of what went on, I came to the realization that I had stated it wrong and I need to restate it. You are what they did with what you eat. In fact, the food processing is actually more important than the food. All food is inherently good. It's what they do to the food that's not, and you can't figure that out from looking at the label. In fact, we're all just basically flying blind. And so I wrote this book to be the roadmap.

Michael Roberts 5:07

I've known you for several years now, and I should have mentioned that you also serve as a as a uh on the board for the outside advisory board for the residents center for food law and policy here at UCLA. And the one thing that I've noticed about you is you you have this, and and maybe this is where law served you well, is your ability to take a lot of complicated information and talk about it in simple terms. I appreciate understandable to lay people.

Robert Lustig 5:37

One of the things I seem to be able to do, recognizing that these we we have we have right now a health epidemic, we have a health care epidemic, we have an opioid epidemic, we have an environmental crisis. You know, Lancet called this a syndic, you know, the this conflagration of multiple epidemics. And when that happens, you realize this is a systems biology issue and that there's a lot of complicated information coming from different directions. And so because I have some training in, you know, many of the of these facets, it's much easier for me to be able to, you know, put it together into a package that makes sense. And that's what this book is.

Michael Roberts 6:20

Let's use the word healthy as an example of what you're talking about. It's it's a it's a word that's loaded legally, medically, uh, and in terms of public health for sure. Uh healthy, the word healthy is in my mind a lot like the word natural. Right. It has a lot of different meanings. The we know the FDA is currently grappling with its meaning. So, from your perspective, what does it really mean? And how does your definition stack up against the the historical definition offered by the FDA?

Robert Lustig 6:56

Right. So, first of all, you should know that the FDA has a definition of healthy. It is low insaturated fat and calories, uh, has vitamin D and a requisite amount of potassium and magnesium. Really? That's healthy? That's what that's what healthy means? I think not. USDA doesn't even define it, and that's on purpose because if they define healthy, then all these companies that have front of packaging claims to be healthy would basically have to wipe them out. So this is a big problem. There is really no working definition of healthy that means anything, which is why we're in this mess. So after looking at the science hard and, you know, knowing the physiology and this new phenomenon about the gut microbiome that, you know, has really sort of you know pervaded modern medicine now, you know, and how important this is, I've come to the realization that there are two precepts to being healthy. Protect the liver, feed the gut. Six words, two clauses, and they make sense. They make empiric sense and they actually make physiologic sense. So protect the liver from what? Well, protect the liver from the tsunami of sugar and refined carbohydrate that gets absorbed early in the duodenum, but shouldn't. Because in the old days, when we actually ate real food, that refined carbohydrate wasn't refined. It was unrefined carbohydrate. The sugar was extremely low. And so the liver wasn't pelted with the tsunami of carbohydrate that it had to deal with. Problem is the liver has no choice but to take the excess that it can't metabolize and turn it into liver fat. And it is that liver fat that is causing the insulin resistance and driving the chronic metabolic disease. In addition, protect it from branch chain amino acids, leucine, isolecine, baline, these are three essential amino acids. You have to eat them. It's what's in protein powder. It's the reason bodybuilders, you know, take scoops of protein powder and add it to their smoothies. Because if you're building muscle, you need them. They're 20% of the muscle. But what if you're not building muscle? What if you're a mere mortal like me and you are consuming excess branch chain amino acids, which, by the way, are in corn-fed beef, chicken, and fish. The answer is that they go to the liver. The liver takes the amino group off to turn it into an organic acid in order to be able to burn it for energy. You again overwhelm the liver's capacity to be able to metabolize it. The mitochondria in the liver can only run so fast. And so that gets thrown off as liver fat also. And so that also contributes to insulin resistance. In addition, you have to protect it from iron, you have to protect it from uh other heavy metals, you have to protect it from glyphosate roundup. Now, the other clause, feed the gut. Well, feed the gut. What? And why do you have to feed the gut? So each of us is cells, but we have a hundred trillion bacteria in our intestine, they outnumber us 10 to 1. Okay, they gotta eat. The question is, what do they eat? Well, they eat what you eat, but the question is what how much did you get versus how much did they get? And when you eat the food with its inherent fiber, the way nature intended it, most of that food actually moves through the duodenum into the jejunum, where the bacteria are, and they get to chew it up for their own purposes. So even though it passed your lips, it wasn't for you, it was for your bacteria. 25 to 30 percent of everything you eat is metabolized by your your bacteria. You never got it. That's why a calorie is not a calorie, because you measure calories at the lips, who cares? What matters is measuring calories at the portal vein because that's what enters your bloodstream, and also you'd have to measure it at the lymphatics because that's where the fat goes. Point is calories don't make sense because of that. In the meantime, if you don't feed those bacteria, your bacteria will feed on you. They will strip the mucin layer right off your intestinal epithelial cells, they will denude your intestine, creating the risk for leaky gut and the ability for lipopolysaccharides, cytokines, endotoxins, and even full bacteria in some cases, from getting from inside the intestine into your bloodstream and setting up systemic inflammation. And we now know that is one of the primary drivers of chronic metabolic disease. So you have to feed your gut. So protect the liver, feed the gut. And when you look at the empiric evidence that's in the literature, in the medical literature, in terms of what foods convey what level of health, this is what uh what works. So I am promoting this notion, and I'm asking people to take pot shots at it and try to prove it wrong.

Michael Roberts 11:55

Thank you for that two-part analysis: feeding the gut, protecting the liver. Diana?

Diana Winters 12:02

So in metabolical, you sketch the beginnings of a solution to these horrendous health problems our society is dealing with and the processed foods that are leading to these health problems. You talk about as personal interventions we can take, which relate to your description of healthy that you just gave us. And you also turn to societal interventions. And because we at the Resnick Center focus on law and policy as levers, we love to discuss these societal interventions. And I think too, I was thinking of this, this is where your law training comes in, because you were able to identify these potential policy levers. So, what do you think? Absolutely, how do you think we can begin to change these things as a society?

Robert Lustig 12:51

Right. So I I thank you. I exactly right. So the bottom line is you have to look at processed food as a substance of abuse, because it is. In fact, it's filled with a substance of abuse, it's filled with sugar and also caffeine, which are substances of abuse. Now, not everybody wants to believe that, but in fact, the data show that sugar is addictive in the same way alcohol is addictive. And pretty much education alone has not solved any substance of abuse. Did Nancy Reagan just say no work? We have an opioid crisis, you know. Bottom line is that's why these substances are addictive, because you can know that they are hurting your health, your family, your economy, your community, and you are powerless to do anything about it because the biochemical drive to consume is greater than your ability to cognitively inhibit your consumption. All right, and that's what we have with ultra-processed food, and the data show it. In fact, we even have an economic indicator of that called price elasticity. So, and you know, for the for your listeners, price elasticity says, how does consumption change if the price of a given food goes up by 1%? Now, if a food is price elastic, that means that consumption will go down when price goes up because you're reducing effective availability. But if a food is price inelastic, that means consumption will stay up, even though the price goes up. So if you look at the three most price inelastic foods, it's fast food, soda, juice, all sugar containing, because sugar is hedonic. It activates the reward center. And the problem is that in the extreme, anything that activates the reward center is addictive. Cocaine, heroin, nicotine, those are easy. Alcohol. Alcohol activates the reward center, but it's incomplete. So 40% of Americans are teetotalers, never touch the stuff. 40% are social drinkers, can pick up a beer, put it down, like me. 10% are binge drinkers, and 10% are hardcore alcoholics. Now, what distinguishes those 20% from the other 80%, we still don't know. But we do know that those people have downregulation of their dopamine receptors in the reward center. Therefore, a little doesn't do it. You need a lot. And basically, the more you consume, the less buzz you get. And that's what happens with sugar for the exact same reason. And so sugar is addictive virtually in the same way alcohol is addictive. In fact, it makes sense because after all, where do you get alcohol from? Fermentation of sugar. It's called wine. We do it in Napa and Sonoma every day. The big difference between the two is that for alcohol, the yeast does the first step of metabolism called glycolysis. For sugar, we do our own first step. But after that, they're virtually identical. And your body handles them the same, your liver handles them the same, and guess what? Your brain handles them the same. So if a food is toxic and addictive and ubiquitous and causes negative impact on society, the laws of public health say you should be able to regulate that. And that is certainly true of tobacco, and that is certainly true of alcohol. So the reason I went to law school was recognizing this fact back in the early 2010s, I wanted to ask and solve two questions for myself. When does a personal health issue become a public health crisis? And what are the legal doctrines that either support or refute that? And the second one was how did tobacco get away with it for 45 years without being lasso down to the ground? Because ultimately I realized that this processed food battle is the same as the tobacco battle. It's really virtually identical. And so that's why I went to law school and I got a master's in studies of law to answer those two questions. And, you know, for lack of a better word, I did. And so that's where I am, and that's what I'm trying to use the science to bring to the policy and to be able to answer the politics and the food industry talking points in order to be able to, you know, actually move this the ball forward.

Diana Winters 17:27

You talk about this struggle being identical or close to identical to the our struggle with tobacco. Do you see a difference here in causation in or in our ability to trace causation to harm, which was extremely clear eventually in the tobacco situation?

Robert Lustig 17:47

Right. So with tobacco, we never did have a randomized controlled trial to this day. There's still no randomized controlled trial. And there never will be because it would be unethical and illegal. We use a set of precepts which we can call econometric analysis. We use the Bradford Hill criteria. Austin Bradford Hill was a famous British epidemiologist who came up with the things that have to be true in order to be able to finger something as causative. This was back in the 1960s, and he did it for tobacco. And, you know, to make a very long story short, you have to basically demonstrate not just correlation, but you have to demonstrate causation. And in order to demonstrate causation, you have to show four factors. You have to show dose, more means more disease. You have to show duration, longer exposure means more disease. You have to show differentiality, that is, uh, you have to be able to show that where consumption goes up, there's more disease, and where consumption goes down, there's less disease. And finally, the last one, which is the most important one for causation, you have to show precedence. Because obviously, something can't cause something if it follows something. It has to precede something. So for tobacco, we had all of those. And of course, the dose issue was very, very clear because people who smoke tobacco were 20 times more likely to get lung cancer than people who did not smoke tobacco. So that was sort of a slam dunk, and we got there using econometric analysis. For sugar, it's a little harder. I'm not going to argue that. And part of the reason sugar is a little harder is because it has energy. It is calories. And so, you know, you can burn calories. There was no need for tobacco whatsoever. Sugar only supplies calories, it doesn't supply anything else. But it definitely complicates the question. And then it also because there's other stuff in food that could be bad for you, like for instance, bringe chain amino acids, you know, certain fats like omega-6 fatty acids and trans fats, et cetera. So there are things that can dilute the effect to make it much harder to be able to ferret out the specifics. So there are more confounders. Agreed. Uh, I don't argue that. However, we took that into account. And in 2013, my colleague, Dr. Sanjay Basou, who is here at UCSF now at Stanford Prevention Institute, who is a statistical genius, was able to actually take three data sets. The first, the FAO Stat, the Food and Agriculture Organization Statistics Database of the WHO, which lists not just uh that they list food availability, not consumption, availability, which is actually better in this case. And it does it for every country, and it does it per person per year for a decade in a row. We then melded that with the International Diabetes Federation database for diabetes prevalence for the exact same countries for the same years every year in a row for 10 years straight. And then we melt that with a third database, the World Bank Gross National Income Database, which controlled for all the confounders: poverty, urbanization, aging, physical activity, and obesity. And so we asked the question what about the world's diet? Predicted the change in diabetes between 2000 and 2010. And the answer sugar. Only sugar. Nothing else even remotely gave a signal, only sugar. So if a country had 150 calories extra over its normal within its borders, diabetes prevalence went up a total of 0.1%, which is nothing. If those calories happened to be sugar, say a can of soda, diabetes prevalence went up 11 fold to 1.1%. So tobacco 20 fold. For sugar, 11-fold. But we did the exact same analysis using the Bradford Hill criteria to demonstrate causation. So if today you believe that tobacco causes lung cancer, you cannot deny that the data support that sugar causes diabetes. In addition, we also have randomized controlled trials of taking the sugar out of kids' diets and substituting starch and showing that we can reverse metabolic syndrome. We can reverse their tendency toward diabetes. And you can do it within 10 days because we get rid of the liver fat. When you take the substrate away, the liver fat recedes. And when the liver fat recedes, the pancreas starts making insulin properly. In other words, we showed through an intervention that sugar was the primary cause of these kids' liver fat. So we have the data, we have causation. And so that's the rock, near the bedrock of being able to institute policy change. The food industry, of course, does not want to admit it.

Diana Winters 23:05

That's very compelling. Thank you for that explanation. And in terms of policy intervention, you talk about taxes and you talk about using taxes, and you also talk about how now we're really using taxes in a broad sense in conflict with each other. Can you talk about that a little bit in terms of processed foods and sugar?

Robert Lustig 23:30

Sure. So, well, this all you know revolves around a simple precept, which I learned very early on called the iron law of public health. And the iron law goes like this: reducing availability of a substance reduces consumption, which reduces health harms. True for alcohol, true for tobacco, true basically across the board. So the question is: if sugar is a bad guy in this story and sugar's in all the ultra-processed food, how can we reduce the effective availability of either sugar or ultra-processed food in general in a meaningful global way? And there are several levers that can be applied. The cheapest, the easiest, the simplest, the most immediate is taxes. Soda tax. Now, we have soda taxes in six places in America, and there are 28 countries around the world who have instituted it since 2013, which I'm actually very proud of. And I'm delighted, you know, and we also have the data to, by the way, show it works. It works. Now, having said that, it doesn't work as well as we would like, in part because of this price elasticity issue. Because sugar is addictive, people will still consume. So if you raise the price of a soda by 10%, which is what most taxes are, you only reduce consumption by 6%. And so the beverage industry actually said, see, it doesn't work. Actually, it works quite well, you know, recognizing that price elasticity is an issue. And it's durable, as shown in Mexico and as shown in Berkeley. So soda taxes work, which is of course is why they are fighting it so tooth and nail, because they do work. However, I'm actually semi-agnostic about this. As much as I want effective availability to reduce, as much as I want people to stop consuming so much sugar for their own health, I have a little bit of a problem with it. And the reason I have a problem is because it's not one tax, it's three. So let's talk about the three. The first tax is not called a tax, it's called a subsidy. So if you subsidize sugar to make it cheaper for the industry to purchase and use, that means you have to raise the price on everything else. So it may be a subsidy for one thing, but that means it's actually a tax on everything else, and you're going to end up paying more for it. So you're paying more for your food than you should be. And that's demonstrated in the consumer price index. Second, there's another tax. We don't call it a tax, we call it a fee, or we call it a premium. It's your insurance premium that you are paying extra for because of all of these chronic metabolic diseases. Because your employer has to pay $2,750 per employee per year for obesity-related health care, whether that particular employee is obese or not. You're paying for the other guy's diabetes, you're paying for the other guy's gout, you're paying for the other guy's heart disease, whether you like it or not, because your employer institutes that as a premium against your salary. So you're paying that. That's a tax. We just don't call it a tax. And then finally, we have the soda tax itself. So does it make sense to subsidize something only to tax it later on? That kind of seems kind of stupid to me. And, you know, while the tax does reduce effective availability and is successful, okay, I think what would be way more successful is just get rid of all the food subsidies, because subsidies distort the market. There's no economist on the planet that can defend food subsidies, except those that work for government because they're told to. Ultimately, even the libertarians can get on board with the idea of getting government out of the pricing of food. Let the market do its work. And if the market did its work, people say, well, then the price of food would go up. Actually, not. The Giannini Foundation at UC Berkeley actually did this exercise back in 2007. What would happen to the price of food if we got rid of all food subsidies? Answer, price of food wouldn't change, except for two items, corn and sugar. And that's exactly what we would want. Do we want those to go up in order to reduce the amount of sugar consumed?

Diana Winters 28:03

Fascinating. I wish the world worked as logically as you have laid it out.

Michael Roberts 28:10

Yeah, I wish too. Yes, thank you. I've uh thoroughly enjoyed listening to the two of you talk about the levers of policy and how they might uh work with respect to healthy foods. And as you have outlined in your book so nicely, what I'd like to do here, since we're at the end here, is is shift from this more specific focus on levers and move us back towards the bigger picture. I had read recently, I think it was um on the uh, in fact, I have it here in front of me, the uh review in the Wall Street Journal on May the 9th by Matthew Rees. And it was uh it was it was a good review. I I think you were probably pleased with it. I would be if I were in your shoes. The thing that struck me as I read the review is how things have changed. I I know that you have undergone a fair amount of criticism for your criticism of the food industry and the medical profession and and pharma.

Robert Lustig 29:14

Hey, it's gonna happen. You know, yesterday, yesterday CNN.com did a piece on the book, and they interviewed the president of the sugar association, Dr. Courtney Gain, and she was basically firing brimstone, talking about me and my inflammatory rhetoric, basically, you know, shooting every you know myself in the foot. You know, uh I don't know what to tell you.

Michael Roberts 29:37

Well, I I I guess you know you're making progress when folks focus on your rhetoric rather than the facts. But but the the the and and you are uh you do use colorful rhetoric. I mean, uh and you you do uh aim uh and you shoot hard.

Robert Lustig 29:53

Well, I do, but it's based on the science. You know, sir. I I can't I never say anything I can't back up.

Michael Roberts 30:00

Well, let's talk about the connection between the science and the way that people eat. And in fact, in the Wall Street Journal review, the question is how to get people to change their eating and drinking habits. And the article notes the big challenge that is. And as I think about shifts in people and their habits, you know, people I think now recognize more so today than they did a few years ago. For example, a calorie is not a calorie. So as I think about that, and I think about you and the the criticism of not just you, but also, quite frankly, the science and the facts as they stack up. But how do we continue to change society's attitude towards processed food and sugar, uh, ultra-processed food and sugar? And how do we continue to maintain this this uh shift that seems to be going in the right direction, albeit maybe not quickly enough?

Robert Lustig 30:57

Yeah, I I completely agree with you, Michael. So what I can say is uh a factual statement and an abstract one. So the factual statement is that the food industry is actually doing my work for me. Uh in uh the IFIC, which is the International Food Information Council, which is, you know, uh an arm of the food industry, does a survey every year. And in 2011, they asked the question what nutrient or what specific foodstuffs caused weight gain. And at that point in time, only 11% of people said refined carbohydrate and sugar, virtually all of them said a calorie is a calorie, all calories are the same, or they didn't know. They did the exact same, asked the exact same question in 2018, seven years later. And now 42% of people say refined carbohydrate and sugar, an increase of 33%. And the number of people who said a calorie is a calorie, and or I don't know, went down by the exact same amount. In other words, people have changed their minds. And the reason they've changed their minds is because the information is coming out. So education does work, however, it doesn't work alone. It's not enough. It's necessary, but not sufficient. Education and implementation are two different things, and you need both. But you can't do implementation without education because people have to know why you're doing it. So we're still in education mode. We're still not there. One of the reasons I write books, because we got to educate the public on as to what the real problem is. Because you can't solve a problem if you don't know if you don't know what the problem is. In addition, you have to work upstream of the problem if you're gonna solve a problem. Like I say in the book, you know, there's a wasp in your attic. What are you gonna do? Kill the wasp or destroy the wasp's nest? You know, yeah, you have to work upstream.

Michael Roberts 32:53

It also seems to me that that um uh it's always the next generation that seems to benefit. That seems to be the shift that occurs in society. Right. We think about seatbelts, smoking, and other examples. Exactly. Does that tie into your sort of philosophy as well?

Robert Lustig 33:10

Absolutely. So that's the abstract piece of it. So think of it this way: in the last 30 years, we have seen four, count them, four cultural tectonic shifts in American society. And here they are. One, bicycle helmets and seatbelts, two, smoking in public places, three, drunk driving, four, condoms and bathrooms. Thirty years ago, if a legislator had stood up in a statehouse or Congress, Parliament, or anywhere else in the world and had proposed legislation against any one of those four, they'd have gotten laughed right out of town. Nanny state, liberty interest, get out of my kitchen, get out of my bathroom, get out of my car. Okay? Today, they're all facts of life. No one's jumping up and down about any one of those four. And if you pull out of your driveway and you haven't clicked your seatbelt, your kids will scream at you. Now, how'd that happen? And why'd it take 30 years? Answer we taught the children, the children grew up and they voted, and the naysayers are dead. That's why this is a generational shift. That's why it takes a generation to induce a cultural tectonic shift. So, what I've learned in my travels through public health and policy is that you actually don't change people's minds. You teach new people so that they have new minds. And so this is a generational shift. I would say we're about seven to eight years into this one, and we're starting to see the benefits and the fruits of it, and like, for instance, soda taxes as, you know, sort of the low-hanging fruit, if you will. Okay. I think that someday sugar will be off the grass list. It will be off the generally recognized as safe list at the FDA. I think it will become a food additive. There have been two things that have been taken off the grass list in the last 60 years since its inception. Nitrates and trans fats. We had the science for both of them, and ultimately they both came off. Well, you have the science for sugar, and you know, ultimately we will get there. It's just going to take a while because of food industry interference, which I talk about in the book at great lengths. You know, ultimately, once upon actually, once upon a time, you would walk down the street and see somebody smoking a cigarette and think it was cool. And they were cool. And today, you know, it's a filthy, disgusting habit. It went from fashion to filthy habit in 30 years. How come? Because we taught the children. That's how. All right. Someday, I think we will you will walk down the street and see someone swinging a Coca-Cola, and you will feel sorry for them. That's when the ground shifts, and that's where we have to get.

Michael Roberts 36:07

Speaking of feeling sorry, I'm sorry that our time's running out, too.

Diana Winters 36:12

I think that's absolutely right. And that's fascinating. And my kids yell at me for a lot of things, and including not putting my seatbelt on fast enough. So you're absolutely right. Well, you probably deserve it, Diana. Exactly. And I'm trying to get breakfast cereal out of the house too. But thank you so much, Rob. This was this was wonderful. My pleasure, really.

Robert Lustig 36:35

Truly.

Diana Winters 36:36

We're going to put a link to your new book, Metabolical, as well as to your other books, in the show notes. So thank you to all of our listeners. And you can find Dr. Lustig's books at our show notes. Join us next month here at Repast on the cutting edge of food law and policy. Thank you.