Comments on The Bitter Truth

Join host Tom Butler as he shares his awesome first bikepacking adventure and his newfound interest in the Zwift indoor cycling app. In this episode, Tom dives into the topic of sugar and its detrimental impact on health.

Tom presents clips from the groundbreaking documentary "The Bitter Truth," featuring Professor Robert Lustig, M.D. This 15-year-old video remains highly relevant as Tom discusses ongoing high levels of sugar consumption and the connection to obesity, diabetes, and other chronic diseases.

Whether you're a seasoned cyclist, a health enthusiast, or simply curious about the hidden dangers of sugar, this episode offers a thought-provoking exploration of a pressing issue. Don't miss Tom's insightful commentary and updated information on this crucial topic.

Links
The Bitter Truth Video: youtu.be/dBnniua6-oM?si=gz17NCTtEDCCDjbn
Huberman and Lustig Discussion: youtu.be/n28W4AmvMDE?si=nN4fMQNXykXBLqBF

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Please send comments, questions and especially content suggestions to me at tom.butler@teleiomedia.com

Show music is "Come On Out" by Dan Lebowitz. Find him here : lebomusic.com

Chapters

• 0:23 Weekly Update
• 7:30 Calories In, Calories Out Debunked
• 12:10 We Are All Eating More
• 26:18 Dietary Fat and Flawed Logic
• 32:29 Comparing Alcohol and Sucrose
• 44:14 The Dangers of Excess Fructose Consumption
• 45:56 Wrap Up

Transcript

Tom Butler: 0:04

This is the Cycling Over 60 Podcast, season 3, episode 5, comments on the Better Truth. And I'm your host, tom Butler. I did something different for the podcast again this week, which, some of you might have noticed, delayed the release of the episode. Before I explain this, here's a brief update. We did our first bikepacking trip. I loved it and we'll definitely be doing more. It didn't go exactly how we planned it, but it worked out well.

Tom Butler: 0:39

For our first trip, we planned on riding our bikes onto a ferry and taking it to San Juan Island. Unfortunately, we were running pretty late, so we decided to leave the bikes on the car and drive on the ferry. If we hadn't made that decision, we would have missed the ferry for sure. My daughter McKenna had decided to join us for the camping, but she didn't bring her bike. That meant we could unload the bikes on the island and she could take the car. We originally didn't plan on having a car with us, but it ended up being a help having her provide drive support in a way.

Tom Butler: 1:11

The main thing I wanted to experience was how the bike handled being loaded down with camping gear. I was able to get a good feel for this for sure. The route we did covered 24 miles, included 1,800 feet of elevation. That was plenty to get an idea about what kind of challenge it would be to climb with 35 pounds of gear on board. My legs did get tested. A good example is a segment called Youngquist Hill. You drop down to a really beautiful point that is the San Juan Islands National Monument. Of course that means that you need to climb back up 196 feet and a half mile to climb back up 196 feet and a half mile. So the climb averaged 6.5%, with a section above 11%. That was enough to test me, but I'm happy that I was able to stay under my heart rate limit. I could imagine a scenario where I would need to step off the bike on a hill with it totally loaded with camping gear, but I don't think there will be many times like that.

Tom Butler: 2:03

We camped at San Juan County Park for the night and I was very happy with my setup. We only planned on one meal that we would prepare at the camp, so a few things might have been adjusted if we're preparing more meals. Because of a really late start, the next day went very different from what we had planned. The place we chose for breakfast was really popular and, in addition to the late start, we spent a lot of time there, but the food at the Lime Kiln Cafe in Roach Harbor was absolutely worth it. We decided to cancel the plan for that day to ride a second island and just got on the ferry and headed home. It was a good thing, because we ended up getting in pretty late because of a lot of heavy traffic. It was such a beautiful weekend. I think there were just a lot of people out and about and that tends to slow things down on Sunday night. So I am 100% going to do more bike camping. We already are planning to ride the Cascade to Palouse Trail and find camping there. Cascade to Palouse is a gravel trail so we'll have to see if that changes anything. Another change is that my wife Kelly wants to join in on that trip, so we'll have to do some work to get her some gear and then figure out what she can carry on her bike. I'm expecting it's going to be really easy to get those things worked out and I'm really looking forward to getting out as a family and doing some bike camping.

Tom Butler: 3:21

Another new cycling experience for me that some of you might have noticed is that I am now on Zwift. I'm still trying to figure out how to best use Zwift to improve my cycling performance. I haven't had power data before, so I find that intriguing. From doing some research, I think in the short term I would like to be able to maintain 2.5 watts per kilo. Right now I think I'm somewhere around 1.75 watts per kilo. I think if I look around, I'll be able to find plenty of power building workouts on Zwift. One thing I'm still getting used to is how to respond to hills in the app. It seems very different than in real life. If anyone has a suggestion for training on Zwift that is challenging but something that won't totally crush me, I would appreciate the advice. Another thing I would like to explore is how to do group rides on Zwift. I would really enjoy meeting people online and it would be very cool to do a Zoom call. At the same time, I downloaded the Zwift Companion app and created a Cycling Over 60 club. Let me know what you all think. Is there any interest out there in doing some virtual rides and chatting together over Zoom? I'm looking forward to having Zwift as an option, but I spent quite a few times riding Zwift instead of going outside and I'm missing being out in the fresh air. As you all probably know, it's just not really the same.

Tom Butler: 4:51

As I've mentioned a couple times, part of the focus of season three of Cycling Over 60 is to get more into the impact of personalized medicine on my health strategies. My health journey over the last year was heavily influenced by listening to Dr Robert Lustig. Dr Lustig is one of the leading voices in the field of metabolic syndrome. His work includes the book Metabolical. I thought it would be good for podcast listeners to have some of the information that Lustig shares. 15 years ago, the University of California uploaded a lecture by Dr Lustig called the Bitter Truth. The lecture focuses on the damage that is done by eating sugar. It has about 25 million views now. Instead of an interview for this episode, I have provided some audio clips from the video that I think are important for everyone to hear. I have also included my thoughts on the clips. The original lecture is an hour and a half long, so I have cut out a lot. I would recommend that, if you find this interesting, that you listen to the whole video. Here we go.

Robert Lustig: 5:46

So the Atkins diet, of course, is all fat, no carb. The Japanese diet is all carb, no fat. They both work right. So what do they share in common? They both eliminate the sugar fructose. Okay. So with that, think about what it means to be on a diet and what macronutrients you're eating and which ones you're not, and then we'll go from there and I'll try to explain how this all works.

Robert Lustig: 6:15

So you've all heard about the obesity epidemic. Here are the numbers. These are the NHANES database body mass index. Everybody knows what that is now Histograms Marching ever rightward as time has gone on. This was what was projected for 2008 in blue. We had so far exceeded and surpassed. This is not even funny. This was from 2003. The reason I show this is not just to show that the obese are getting obese-er. Of course that's true, but in fact the entire curve has shifted. We all weigh 25 pounds more today than we did 25 years ago all of us.

Robert Lustig: 6:52

Now, it is often said that obesity is the ultimate interaction between genetics and environment, and Dr Christian Weiss, who's sitting in the back of the room, will be talking to you next week about the genetic component, which I am also very interested in. But having said that, our genetic pool did not change in the last 30 years, but boy oh boy, has our environment sure changed. So tonight we're going to talk about the environment rather than genes. In order to talk about the environment, we need to talk about what is obesity. Of course, you're all familiar with the basic concept of the first law of thermodynamics, which states that the total energy inside a closed system remains constant. Now, in human terms, the standard interpretation of this law is the following If you eat it, you better burn it or you're going to store it. Now, who here believes that? Oh, come on, you all do. I used to believe that, I don't anymore. I think that's a mistake. I think that is the biggest mistake and that is the phenomenon I'm going to try to debunk over the course of the next hour, because I think there's another way to state the law which is much more relevant and much more to the point.

Robert Lustig: 8:09

Before I get there, of course, if you believe that these are the two problems, right Calories in, calories out, two behaviors, right Gluttony and sloth. After all, you see anybody on the street. Oh, he's a glutton and a sloth. That's all there is to it. Tommy Thompson said it on the TV show we just eat too damn much. Well, if that were the case, how did the Japanese do this? Why are they doing bariatric surgery on children at Tokyo Children's Hospital today? Why are the Chinese? Why are the Koreans? Why are the Australians? I mean, all these countries who've adopted our diet all suffer now from the same problem. And we're going to get even further in a minute.

Robert Lustig: 8:50

There's another way to state this first law, and that is if you're going to store it, that is, biochemical forces that drive energy storage and we'll talk about what they are in a few minutes and you expect to burn it. That is normal energy expenditure for normal quality of life, because energy expenditure and quality of life are the same thing. Things that make your energy expenditure go up make you feel good, like ephedrine it's off the market Coffee For two hours. Then you need another hit, like me. Things that make your energy expenditure go down, like starvation, hypothyroidism, make you feel lousy, and how many calories you burn and how good you feel are synonymous. So if you're going to store it, that is an obligate weight gain set up by a biochemical process and you expect to burn it. That is normal energy expenditure for normal quality of life, then you're going to have to eat it. And now, all of a sudden, these two behaviors, the gluttony and the sloth, are actually secondary to a biochemical process which is primary, and that's a different way to think about the process, and it also alleviates the obese person from being the perpetrator but rather the victim, which is how obese people really feel, because no one chooses to be obese.

Robert Lustig: 10:11

Certainly no child chooses to be obese. Oh, you say, oh, yeah, sure, I know some adults who don't care, but the kids I take care of in obesity clinic do not choose to be obese. In fact, this is the exception that proves the rule. We have an epidemic of obese six-month-olds. Now, if you want to say that it's all about diet and exercise, then you have to explain this to me. So any hypothesis that you want to proffer that explains the obesity epidemic. You've got to explain this one too. Okay, and this is not just in America, these six-month-old obese kids, but these are around the world. Now, all right, so open your minds and let's go and figure out what the real story is. Okay.

Tom Butler: 11:01

We have to consider that Dr Lustig was a practicing pediatric endocrinologist at this time. He was clearly seeing the dramatic rise in childhood obesity in the patients that he treated every day. I can imagine that seeing those children and knowing the physical consequences that they would face later had a dramatic impact on him. The Robert Wood Johnson Foundation makes the following statement impact on him. The Robert Wood Johnson Foundation makes the following statement. After increasing steadily for decades, the national childhood obesity rate has leveled off, but it is still alarmingly high. Compared to a generation ago. The obesity rate among children 6 to 11 has more than quadrupled in the last 40 years For adolescents 12 to 19,. It has more than tripled. Among young children 2 to 5, rates more than doubled between the mid-1970s and 2000s before beginning a decline. It is no wonder that Lustig was passionate about the issue 15 years ago and remains one of the leading voices against sugar consumption today.

Robert Lustig: 12:02

Now let's talk about calorie intake, because that's what today is about. We're going to talk about the energy intake side of the equation. Sure enough, we are all eating more now than we did 20 years ago. Teen boys are eating 275 calories more. American adult males are eating 187 calories more per day. American adult females are eating 335 calories more per day. No question, we're all eating more. Question is why? How come? Because it's all there. You know what it was there before. We're all eating more. There's a system in our body, which you've heard about over the last couple of weeks, called leptin. Everybody heard of leptin. It's this hormone that comes from your fat cell, tells your brain you know what, I've had enough, I don't need to eat anymore, I'm done and I can burn energy properly. Well, you know what? If you're eating 187 or 335 calories more today than you were 20 years ago, your leptin ain't working, because if it were, you wouldn't be doing it, whether the food was there or not. So there's something wrong with our biochemical negative feedback system that normally controls energy balance.

Tom Butler: 13:15

To update those figures in 2021, american adults were consuming 3,540 calories per day. In 1968, it was 2,880 calories. So that is a daily increase of 660 calories. That means an hour of cycling at 200 watts just to meet that daily increase. Calculated for an annual increase, that would be about 241,000 additional calories.

Robert Lustig: 13:46

And we have to figure out what caused it and how to reverse it. And that's what tonight is about. But nonetheless, there are 275 calories we have to account for. So where are they? Are they in the fat? No, they're not in the fat. Five grams, 45 calories out of the 275, nothing, in fact, it's all in the carbohydrate 57 grams, 228 calories. We're all eating more carbohydrate Now.

Robert Lustig: 14:13

You all know, back in 1982, the American Heart Association, the American Medical Association and the US Department of Agriculture admonished us to reduce our total fat consumption from 40 to 30%. Everybody remember that. That's how Intamin's fat-free cakes came into being. Remember that. So what happened? We did it. We've done it 40% down to 30%.

Robert Lustig: 14:42

And look what's happened to the obesity, metabolic syndrome, non-alcoholic fatty liver disease, cardiovascular disease, stroke prevalence, all jacked way up as our total fat consumption as a percent has gone down. It ain't the fat, people, it ain't the fat. So what is it? Well, it's the carbohydrate. Specifically, which carbohydrate? Well, beverage intake right. Specifically which carbohydrate? Well, beverage intake right. 41%. Increase in soft drinks 35%. Increase in fruit drinks, fruit aids, whatever you want to call them.

Robert Lustig: 15:15

Okay, just remember down here, one can of soda a day is 150 calories. Multiply that by 365 days a year and then divide that by the magic number of 3,500 calories per pound. If you eat or drink 3,500 calories more than you burn, you will gain one pound of fat. That's the first law of thermodynamics. No argument there. That's worth 15.5 pounds of fat per year. One soda a day is 15.5 pounds per year. Now, you've all heard that before. That's not news to you. The question is how come we don't respond? How come leptin doesn't work? How come we can't stay energy stable? That's what we're going to get to regulating our weight.

Tom Butler: 15:57

You see it in the book Nature Wants Us to Be Fat by Richard Johnson. When we look at animals in nature, their weight is well regulated. It only makes sense that we are doing something to short circuit the natural weight regulation system that is in our bodies.

Robert Lustig: 16:18

So are soft drinks the cause of obesity? Well, it depends on who you ask. If you ask the scientists for the National Soft Drink Association, they'll tell you there's absolutely no association between sugar consumption and obesity. If you ask my colleague, dr David Ludwig remember I'm lustic, he's Ludwig. He does what I do at Boston Children's Hospital Someday we're going to open a law firm.

Robert Lustig: 16:39

Each additional sugared sweetened drink increase over a 19-month follow-up period in kids increased their BMI by this much and their odds-risk ratio for obesity by 60%. Okay, that's a prospective study on soft drinks and obesity. The real deal. If you look at meta-analyses, everybody know what a meta-analysis is. Okay, it's a conglomeration of numerous studies subjected to rigorous statistical analysis. Okay, 88 cross-sectional and longitudinal studies regressing soft drink consumption against energy intake, body weight, milk and calcium intake, adequate nutrition, all showing significant associations and some of these being longitudinal. This came from Kelly Brownell's group at Yale.

Robert Lustig: 17:19

Okay, I should comment a disclaimer those studies that were funded by the beverage industry showed consistently smaller effects than those that were independent. Wonder why? Now how about the converse? What if you take the soft drinks away? So this was the fizzy drink study from Christ Church England, james et al British Medical Journal, where they went into schools and they took the soda machines out, just like we did here in California. We haven't seen the data yet, but they went and did it for a year. So the prevalence of obesity in the intervention school stayed absolutely constant no change whereas the prevalence of obesity in the control schools, where nothing changed, continued to rise over the year.

Tom Butler: 18:00

I couldn't find anything that indicated that eliminating soda machines in schools actually reduced consumption. It might be out there, but I couldn't find it. I did see that the key is reducing access to sugar-sweetened beverages at home. That being said, I believe it is feasible that banning soda sales at schools helped to send a clear message that sugary beverages are a health risk. Seems reasonable that that shift in public opinion is a major factor in soda sales.

Robert Lustig: 18:30

So how about type 2 diabetes? Are soft drinks the cause of type 2 diabetes? Well, this study from JAMA in 2004 looked at the relative risk ratio of all soft drinks cola, fruit punch and found a very statistically significant trend of sugared soft drinks, fruit aids, et cetera, causing type 2 diabetes. And you know, we've got just as big a problem with type 2 diabetes as we do with obesity. For the same reasons and this was a sugared, sweetened beverage against risk for type 2 diabetes in African American women. Looking here at sugared sweetened soft drinks, just the downward arrow shows that there was a significant rise as the number of drinks went up you can see that here whereas orange and grapefruit juice interestingly did not. So two different studies, two different increases in type 2 diabetes relative to soft drink consumption.

Robert Lustig: 19:22

So what's in soft drinks? Well, in America it's this stuff, right? High fructose corn syrup. Everybody's heard of it. Right, it's been demonized, something awful, so much so that the corn refiners industry has launched a mega campaign to try to absolve high fructose corn syrup of any problem. This is something we were never exposed to before 1975. And currently we are consuming 63 pounds per person per year, every one of us.

Tom Butler: 19:51

We have seen a decrease in soft drink consumption. In the last 15 years, soft drink consumption climbed by 60%. We still consume 42.4 gallons per person per year. That's almost 17,500 grams of sugar. Someone is consuming my 42.4 gallons because I'm doing zero. There was also a 73% increase in energy drink sales from 2018 to 2023. And then there is coffee 62% of people in the US drink coffee, with 50% of those people sweetening it.

Robert Lustig: 20:26

63 pounds of high fructose corn syrup.

Robert Lustig: 20:28

That's American, yes. Now what is high fructose corn syrup? Well, you'll see in a minute. It's one glucose, one fructose. We'll talk about those at great length.

Robert Lustig: 20:38

One of the reasons we use high fructose corn syrup is because it's sweeter. So here's sucrose. This is cane or beet sugar, standard table sugar. You know the white stuff, and we give that an index in sweetness of 100. So here's high fructose corn syrup. It's actually sweeter, it's about 120. So you should be able to use less, right, Wrong, we use just as much. In fact we use more.

Robert Lustig: 21:02

So here's lab fructose over here, crystalline fructose, and they're starting to put crystalline fructose into some of the soft drinks. They're actually advertising it as a good thing and that's got a sweetness of 173. So you should be able to cut that way back, right? They're not Lactose down here, milk sugar, it's not sweet at all. And glucose, I should point out, over here is 74. It's not particularly sweet and we're going to get to that at the end and what goes on with glucose. But anyway, there's why we use it it's sweeter. So here's high fructose corn syrup, One glucose, one fructose. Notice, the glucose is a six-membered ring, the fructose is a five-membered ring. They are not the same. Believe me, they're not the same. That's what this whole talk is about is how they're not the same. And here's sucrose and they're just bound together by this ether linkage. We have this enzyme in our gut called sucrase. It kills that bond in two seconds flat and you absorb it. And basically, high fructose corn syrup sucrose. It's a non-issue.

Tom Butler: 22:07

It's a wash. They're the same. The consumption of high fructose corn syrup peaked in 1999. But in 2021, the average American still consumed 39.4 pounds of it. If you're curious, there are three factors contributing to the decrease in the use of high fructose corn syrup. One is competition from refined cane sugar and beet sugar. The second is that customers started looking for products without high fructose corn syrup. One is competition from refined cane sugar and beet sugar. The second is that customers started looking for products without high fructose corn syrup. And finally, higher corn prices means that high fructose corn syrup is no longer so cheap. However, 80% of the foods in a typical grocery store have sugar added to them, and that sugar still has fructose.

Robert Lustig: 22:45

High fructose, corn syrup and sucrose are exactly the same. They're both equally bad. Okay, they're both dangerous. They're both poison. Okay, I said it, poison. My charge before the end of tonight is to demonstrate that fructose is a poison.

Tom Butler: 23:08

Tonight is to demonstrate that fructose is a poison. This was the main message of this video 15 years ago and remains Lustig's message today Fructose is a poison. It might seem like a strong message, but he goes on here in quite a bit of detail about the biochemistry that backs up what he is saying. I'm not going to include all the biochemistry here. If you want that, pull up the original video. These are the parts that I think are important.

Robert Lustig: 23:31

Before we had food processing we used to get our fructose from fruits and vegetables and if we did that today we would consume about 15 grams per day of fructose, not sugar fructose. So sugar would be 30 grams. It would be double. We're just talking about fructose, not sugar fructose. So sugar would be 30 grams. It would be double. We're just talking about fructose today.

Robert Lustig: 23:49

Prior to World War II, before it got rationed again, we were up to about 16 to 24, about 20 grams. So a small increase from the beginning of the century to World War II. Then in 1977, just as high fructose corn syrup was hit in the market, we had increased that. We had basically doubled up to 37 grams per day, or 8% of total caloric intake. By 1994, we were up to 55 grams of the stuff per day. Remember, if you want to do sugar, then double the number. So that's 10.2. So you can see that more and more of our caloric intake, higher percentage, is being accounted for by sugar every single year. So it's not just that we're eating more, we're eating more sugar. And for adolescents today we're up to almost 75 grams, 12% of total caloric intake. 25% of the adolescents today consume at least 15% of their calories from fructose alone. This is a disaster, an absolute, unmitigated disaster. The fat's going down, the sugar is going up and we're all getting sick.

Tom Butler: 25:03

Between 2017 and 2018, the average daily intake of added sugar was 17 teaspoons for adults age 20 or older. The standard American diet is a term that is used to encapsulate just how poorly we eat. Only one of the aspects of the standard American diet is sugar consumption. The presence of way too much ultra-processed foods makes the standard American diet really hazardous. Now I would love to see the US adopt the NOVA N-O-V-A food classification system developed in Brazil. I would recommend checking it out and, if you have an opportunity to advocate for the use of the NOVA food classification system, do so. Okay, back to Lustig.

Robert Lustig: 25:46

That thing that happened in 1982, the USDA, the American Heart Association, the American Medical Association, all telling us we had to reduce our consumption of fat. Now, why did they tell us that? To stop what? To stop heart disease? Did we? No, we didn't, did we. In fact, it's worked the exact opposite. We've only created more. So now, how did this come to be? Why did they tell us to stop eating fat?

Robert Lustig: 26:18

Well, in the early 1970s, we discovered something in our blood called LDL, low-density lipoproteins. You've heard of that, right? Is it good or bad? Not so bad, we'll talk about it. In the mid-1970s, we learned that dietary fat raised your LDL. So if dietary fat is A and LDL is B, we learned that A led to B. Dietary fat definitely increases your LDL. No argument, it's true. And then, finally, in the late 1970s, we learned that LDL correlated with cardiovascular disease. So let's call cardiovascular disease C. So we learned that B led to C.

Robert Lustig: 26:59

So the thought process by some very smart nutritionists, et cetera, the USDA, et cetera, said well, if A leads to B and B leads to C, then A must lead to C. Therefore, no A, no C. This was the logic. Now any logicians in the room, anybody, see any problems with that logic? Go ahead. That's right. The premise is incorrect. And I'll tell you why the premise is incorrect, because this suggests that this is all transitive, but in fact only the contrapositive is transitive. So it's not no A, no C, it's no C, no A. Okay, so the logic isn't even right. There's faulty logic here. Okay, so this doesn't work on any level. There's faulty logic here.

Tom Butler: 27:46

So this doesn't work on any level. In 2015, the Dietary Guidelines for Americans removed the upper limit of total fat intake. That shifted the emphasis away from low-fat diets. Instead, the focus became on the type of fat consumed. That change specifically recognized that people were consuming too much carbohydrate in place of good fats. If you want to know more about how dietary fat became such a focus in the US, you need to look up how Ancel Keys that is, a-n-c-e-l last name Keys like door keys, how his research that we now see as flawed was instrumental in sidetracking dietary recommendations For the purpose of what Lustig is trying to convey.

Tom Butler: 28:28

It is important to understand that the bad dietary advice left the door open to pumping up sugar in basically everything we eat. That availability of sugar completely overwhelmed the ability of our bodies to cope. It's interesting that there was an alternative. It's interesting that there was an alternative. In 1972, john Yudkin, a British nutritionist, wrote a book called Pure, white and Deadly. Yudkin argued that sugars shouldn't provide more than 6 to 10% of total dietary intake. Not for the criticism of Ancel Keys and the processed food industry, yudkin could have significantly influenced the dietary recommendations at that time.

Robert Lustig: 29:09

So we've had our food supply adulterated, contaminated, poisoned, tainted on purpose, and we've allowed it and we've let it through. The addition of fructose for palatability, especially because of the decreased fat, and also as an ostensibly browning agent, which actually has its own issues, Because why it browns so well with the sugar in it actually is what's going on in your arteries, because that's causing what we call protein glycation and cross-linking, which is actually contributing to atherosclerosis. So it works on your steak on the grill. It works in your arteries the same way. Okay, and removal of fiber also.

Robert Lustig: 29:50

Now, why did we remove fiber from our diet? We, as human beings walking the earth 50,000 years ago, used to consume 100 to 300 grams of fiber per day. We now consume 12. Why? What did we do? We took the fiber out. So why did we take the fiber out?

Robert Lustig: 30:13

It takes too long to cook, takes too long to eat and shelf life. So people ask me what's the definition of fast food, Fiberless food? I dare you, other than a salad, I dare you to go to any fast food restaurant and find anything on their menu that they actually have to cook that has more than one gram of fiber in it. Because there isn't any. And that's on purpose, because they take the fiber out, because that way they can freeze it, ship it around the world and cook it up fast. And not only is it fast cooking, but it's fast eating which also causes its own satiety issues. Bottom line, we have a typhoon on our hands. And then, finally, the last issue was the substitution of trans fats, which are clearly a disaster, but those have been going down because we know that those are a problem. So we've actually gotten rid of most trans fats not completely, but most. So this is it. This is what we've done over the last 30 years.

Tom Butler: 31:04

Lustig says here that we have done this to our food over the last 30 years. Remember, he's saying this 15 years ago and things haven't changed that much at all. So now we're talking about the last 45 years. I think it is time to make massive change Now. One note on fiber. If you listen to Lustig today, you will find that he really emphasizes fiber. In the last 15 years we have learned a lot about the importance of the gut microbiome and the role of fiber in maintaining a healthy microbiome. So what he says about the removal of fiber from processed food is seen as even more important today as it was then. As I mentioned, I'm skipping a bunch of biochemistry and you can pull up the original video or, if you're really interested, look up a detailed explanation of glucose metabolism. I'm learning more and more about this all the time and I can tell you it is complicated. Khan Academy has several videos that explain carbohydrate metabolism. Here are the things that I feel are important to highlight.

Robert Lustig: 32:07

Now, glycogen is the storage form of glucose in the liver. Okay, because glycogen is easy to fish the glucose out with glucagon and epinephrine. So my question to you and granted, this is a physiology question is how much glycogen can your liver store before it gets sick? The answer is any amount. It's unlimited. We have carb loaders who run marathons right, does it hurt them at all? We have kids with a disease where they can't get the glucose out of the glycogen, called glycogen storage disease, type 1a or von Gierke's disease. They've got livers down to their knees. They're so big, they're hypoglycemic, like well, get out because they can't lift the glucose out of their liver. But they don't go into liver failure because glycogen is a non-toxic storage form of glucose in the liver.

Robert Lustig: 32:58

So the whole goal of glucose is to replete your glycogen. So this is good. This is not bad. This is good. In addition, because the insulin went up in response to the glucose. Your brain sees that signal and it knows that that is supposed to shut off further eating. In other words, hey, I'm busy metabolizing my breakfast, I don't need lunch, and so you have a nice negative feedback loop between glucose consumption, the liver, the pancreas and the brain. To keep you in normal negative yin-yang energy balance. This is good. This is not dangerous. This is what's supposed to happen.

Tom Butler: 33:42

Here is an example of how all calories are not the same. When you consume table sugar, you get calories from glucose and fructose. As Lustig says here, the glucose gets stored as glycogen and is not toxic to the liver, and because of the insulin response to glucose, sending a signal to the brain that more food is not needed, the calories from glucose make us less hungry. Lustig now goes on to show that fructose does not operate the same way at all.

Robert Lustig: 34:11

All right. So now let's talk about a different carbohydrate. Let's talk about my favorite carbohydrate, maybe yours too Ethanol. Ethanol is a carbohydrate, isn't it? Here's the structure Carbon hydrogen oxygen. It's a carbohydrate, but we all know that ethanol is a toxin, right? A poison, right? You can wrap your Lamborghini around a tree or you can fry your liver. Your choice Depends on how much you drink and how often, right? Okay. So we know that ethanol is not good for you, except, of course, a little bit is good for you, right? So we can talk about that too later, if you want. Okay, but let's talk about how it's bad for you. So here's acute ethanol exposure Okay. Cns, depression, vasodilatation, hypothermia, tachycardia, myocardial depression, pupillary responses, respiratory depression, diuresis, hypoglycemia, loss of fine motor control. Here's fructose. Nothing Doesn't do any of those, because the brain doesn't metabolize fructose. Alcohol gets metabolized in the brain to cause all of those things, but fructose doesn't. So fructose is not an acute toxin, ethanol is.

Robert Lustig: 35:28

We control ethanol, don't we? We have something called the Bureau of Alcohol, tobacco and Firearms. We have all sorts of things. We tax ethanol, we do all sorts of things to limit consumption of ethanol. The Nordic countries, all the liquor stores are state-run in an attempt to try to set the price of ethanol high enough so as to discourage consumption for public health reasons. We have 1,500 years of alcohol control policy in this world to draw on in terms of how to limit consumption. Got it? Because ethanol is a toxin and we know it.

Robert Lustig: 36:07

So let's talk about fructose. Fructose is sweet. We like it a lot. We like it in everything. We like it in our bread, we like it in our pretzels, we like it everywhere we look. So let's consume 120 calories in sucrose, a glass of orange juice, everybody got it. So two slices of white bread, a shot of Maker's Mark, a glass of orange juice, All the same 120 calories, but three different substrates.

Robert Lustig: 36:38

Let's see what happens to the fructose. So number one, the glucose. Remember, because sucrose is half glucose, half fructose. So 60 of the calories of the 120 are glucose, 12 are going to make it into the liver, 48 out here for the rest of the body. Okay, the same 20-80 split we had before with glucose. So far, so good. But all 60 calories of fructose are going to be metabolized by the liver. Why? Because only the liver can metabolize fructose. So what do we call it? Where, when you take in a compound that's far into your body and only the liver can metabolize it and in the process generates various problems. What do we call that? We call that a poison.

Tom Butler: 37:24

Lustig is talking about ethanol or, just to be very clear, he is talking about the alcohol that we drink. He is doing this for one reason he wants to make the point that a carbohydrate can be bad for us in excess. Alcohol in excess is something that has been accepted as bad for a long time. It is only recently that we've had access to fructose in quantities that makes it possible to have excess consumption of this carbohydrate. Once again, let's Dig goes into a lot of biochemistry and if you want to see the detail, you can pull up the original video. But here's the bottom line.

Tom Butler: 37:57

As we all know, heavy drinking leads to liver disease. The best stat that I could find was that there are a little over 45,000 deaths from alcohol liver disease a year and, in addition, excess alcohol consumption also leads to damaging substances being released into the bloodstream. We have an easy time conceptualizing that alcohol can be a poison, but fructose in excess is also a poison. As Lustig pointed out, fructose is in almost everything, so it is very easy to get it in excess, and fructose does not require insulin, so there's nothing that shuts off our drive to keep eating. I think it is worth it to hear all the biochemical processes that go on in the liver that are damaged by fructose. But I will leave that biochemistry up to you to pursue. There is now even more information about the negative impact of fructose consumption compared to what Lustick was using 15 years ago. The link between fructose consumption compared to what Lustig was using 15 years ago, the link between fructose and metabolic disorder, is very clear.

Robert Lustig: 39:05

So here's normal medical students, if you can call them normal. Taking in a glucose load notice, almost none of it ends up as fat. Taking in a fructose load, same number of calories 30% of it ends up as fat. So when you consume fructose, you're not consuming a carbohydrate, you're consuming fat. So everybody talks about a high-fat diet. Well, a high-sugar diet is a high-fat diet. That's the point. That's exactly the point. Okay, this is a study where they gave acute administration of fructose and you can see the triglycerides going up compared to the control. Okay, serum triglyceride right there. Here's normal medical students. Again, six days of high fructose feeding. Triglycerides doubled De novo. Lipogenesis went up five times higher. And here's free fatty acids, which then cause insulin resistance doubled Six days.

Robert Lustig: 40:06

So here's the dyslipidemia of fructose consumption. We're not done. Some of the fat won't make it out of the liver, just like with ethanol, and now you've got a lipid droplet. So now you've got this non-alcoholic steatohepatitis. So this is work that we did in our clinic. Okay, looking at sugar-sweetened beverage consumption against the liver enzyme marker, alt, alanine aminotransferase, which tells you about fatty liver, and sure enough, here's sugar-sweetened beverages against ALT. And you can see a nice linear relationship. In Caucasians, african-americans. It's a different relationship and that's a whole other story all by itself. So there's the lipid droplet of non-alcoholic steatohepatitis. Some of it will come out of free fatty acids and populate the muscle. It will also tell the insulin to go up higher.

Tom Butler: 40:57

When I first heard about the impact of fructose, it really got my attention.

Tom Butler: 41:02

Only a couple of years ago my doctor wasn't focused on my blood sugar as a major problem for me, but he should have been. I should have been looking at what was happening with my liver at least five years ago, probably 10 years ago. If I had been looking, I would have seen some evidence of insulin resistance and my insulin going up, higher and higher. I wouldn't have been able to measure it, but I would have been able to assume that there was insulin resistance going on within my liver as well, and I should have been aware much sooner of the impact on me of consuming so much fructose. Now, while I am doing some really good things, I am still working with a liver that already has been damaged by fructose. I have to find ways of repairing as much of that damage as I can as I move forward. As Lestik talks about the results of consuming fructose the way we do in the standard American diet, these results are very much in line with where I found myself two years ago and what I'm fighting now.

Robert Lustig: 42:04

So here we are Hypertension, inflammation, hepatic insulin resistance, hyperinsulinemia, dyslipidemia, muscle insulin resistance, obesity and continued consumption. Looks like metabolic syndrome to me. So here are the phenomena associated with chronic ethanol exposure Hematologic disorders, electrolyte abnormalities, hypertension, cardiac dilatation, cardiomyopathy, dyslipidemia, pancreatitis, malnutrition, obesity, hepatic dysfunction that's alcoholic steatohepatitis, fetal alcohol syndrome and addiction. Here's fructose. Eight out of twelve. Why? Because they do the same thing, because they're metabolized the same way, because they are the same. They come from the same place, right? How do you make ethanol Naturally? Right, you ferment.

Robert Lustig: 42:58

Sugar Hasn't changed. Because it has all the same properties, because it's basically taken care of by the liver in exactly the same way and for the same reason, because sugar and ethanol are the same Every which way you turn. Now you wouldn't think twice about not giving your kid a Budweiser, but you don't think twice about giving your kid a can of Coke. But they're the same, in the same dosing, for the same reason, through the same mechanism. Fructose is ethanol without the buzz. So fructose is a carbohydrate? Yes, it is, but fructose is metabolized like a fat and I've just shown you that 30% of any ingested fructose load ends up as fat.

Robert Lustig: 43:50

Okay, so when people talk about high-fat diets doing bad things. No, what they're really talking about is high-fructose diets, and that's what Ancel Keys was looking at. So the corollary to that is, in America at least, and around the world too, a low-fat diet isn't really a low-fat diet because the fructose, or sucrose, doubles as fat. It's really a high-fat diet. That's why our diets don't work. And fructose, just like ethanol, for the same reason, through the same mechanism and in the same dosing, is also a toxin. Fructose is a chronic toxin, right. Acute fructose exposure did nothing, remember? Because the brain doesn't metabolize fructose, the liver does, and the liver doesn't get sick after one fructose meal. It gets sick after a thousand fructose meals, but that's how many we eat. So the FDA isn't touching this.

Tom Butler: 44:43

Lustig is very passionate about his message here, and you see that he hits it really hard. Part of his passion comes from the observation that fructose will not be regulated as a toxin. That means we all have to make a smart decision for ourselves and our families to avoid sugar. I fully understand that this is tough, because sweet things have become extremely important to us. I see this because I don't eat sweet things, but that means that I notice so many sugary treats at every celebration. There's definitely an emotional component to it as well.

Tom Butler: 45:16

The drive to consume sweets was okay when sugar wasn't affordable. There was a time when only the affluent experienced non-alcoholic fatty liver disease. But now sugary treats, pastries, cakes, candy soda and everything else is very cheap and used for every celebration. We have a big one coming up 600 million pounds of candy will be sold in the US for Halloween. I think it is time that we really confront the danger of so much consumption of such a toxic. I don't know if this was a great way to present this information, but I hope that I have at least got the message across that we need to know a lot more about the negative impact of excess fructose consumption. For more information, you can listen to the full video online Just search for the Bitter Truth.

Tom Butler: 46:13

But I would also encourage everyone to take the time to listen to the discussion between Andrew Huberman and Dr Lustig that was uploaded on December 18, 2023 on Huberman's YouTube channel. It is three and a half hours long, but they really dive into what I see as an important issue about how to stay healthy longer. I am inviting everybody I know to avoid sugar. Now, if you try to give up sugar and find that it is too compelling, I get that, and for many people, sugar needs to be seen as addictive. You might be one of those people. That is the case. It is really worth it to find some help to leave sugar behind. I do hope that all of you are adding good nutrition to the activity you are getting on the bike, and I hope the energy that you get from that nutrition is fueling some awesome cycling adventures. And remember age is just a gear change.