Drinks With Caroline
Caroline Levy, a veteran Wall Street analyst, delves deep into the world of beverages with some of her hero's.
Caroline’s quick wit, empathetic approach, and vibrant personality allow leaders to be vulnerable and speak truths not typically heard outside of closed-door conversations.
Drinks With Caroline
Dr. Robert Lustig - Renowned Neuro Endocrinologist - How Excess Sugar Compromises Your Health and Why A Calorie Is Not Just A Calorie
"Sugar is the 2,000-pound gorilla" says Dr. Robert Lustig. The renowned expert reveals how ultra-processed foods drive chronic disease by causing mitochondrial dysfunction. Want better health? Reducing sugar might be more effective than expensive medications. #NutritionFacts
What is the largest restaurant chain in the US?
Speaker 2:It is our nation's public schools. They're three times bigger than Subway, mcdonald's, burger King and Wendy's all combined. It's triple the size. And our kids are getting sicker and sicker.
Speaker 1:Hello friends, old and new, and welcome to Drinks with Caroline. I'm so happy you've joined me for what I believe will be another stimulating conversation with an industry expert, founder or otherwise fabulous person in the consumer industry. Dr Robert Lustig, welcome to Drinks with Caroline. I'm so excited to be asking you questions 11 years or so later, given that I got the wonderful job of doing this at the Hong Kong Forum when I worked for CLSA, and then we had a dinner afterwards and I was just blown away by all the facts that you gave us about the impact of sugar on our metabolisms. And I'm no less blown away in listening to Dr Andrew Huberman and you discussing this towards the end of last year, and so I'm just very grateful that you've agreed to come onto my podcast Drinks with Caroline. We are now supposed to split open a drink.
Speaker 2:Well, I'm just going to ask you would you rather it be a sparkling water, or would you rather it be a scotch? You choose.
Speaker 1:Well, I must admit, given it's still morning in LA, I am drinking a coffee right now. Well, how do you start your day, Robert?
Speaker 2:Black coffee only.
Speaker 1:Black only. Well, I've got to wean myself off oat milk, but unfortunately it has sugar in it and I'm addicted, so I think this is a great starting point. Dr Robert Lustig is an MD, a neuroendocrinologist, emeritus professor of pediatrics at UCSF and a best-selling author, and has appeared on many podcasts and other public forums to discuss the impact of sugar on the American diet. I just have to say that everything you've done the hard work and heavy lifting over decades now to try and raise awareness that protein and fat aren't bad and sugar is really causing mitochondrial disease and all sorts of other issues I'm in awe and I know that that takes a lot of courage.
Speaker 2:The food industry. Initially, for the first, I would say 15 years of my advocacy had painted a target on my back and did its ultimate to discredit me and the notion. And I think the reason is because sugar was their gravy train. Sugar is what brought them to the feeding trough. Sugar was what made the profit margin of virtually every CPG company go from 1% per year up to 5% per year. And the reason is because sugar is addictive. They did not want us to talk about sugar being a mitochondrial toxin, but the fact of the matter is it is. The data has shown it and people are starting to understand and incorporate that concept into their thinking.
Speaker 1:Could you just tell us a little bit about your background in working with children and then your observations that led you to where you are today?
Speaker 2:Before I get started on that, I want to make one thing clear to your audience, and that is it's not just sugar, it's ultra-processed food. In general, sugar is the 2,000-pound gorilla, but there are other issues with ultra-processed food as well, including the lack of fiber, the lack of omega-3s and also the presence of emulsifiers. All of these ultimately contribute to defective metabolism and increased inflammation, which are driving all the chronic diseases that we know of today. Having said that, the easy one, the thing that's, you know, sort of staring us in the face that needs to be fixed and we could fix it tomorrow if we had the political will is get rid of the sugar. So that's kind of where I start and where I finish. That's kind of the alpha and the omega of the story. So how do I get started? Look, I'm a pediatric neuroendocrinologist. I'm interested in how the brain controls hormones and how hormones control the brain. So I'm very interested in behavior.
Speaker 2:Well, obesity was kind of like the final frontier of endocrinology. We didn't really understand obesity until we discovered this hormone that goes from your fat cell to your brain, called leptin. So leptin was discovered in 1994, so 30 years ago, and I was, you know, right there, you know well placed. At the time of its discovery. I actually worked at Rockefeller University, which is where leptin was discovered, and sort of knew all of the protagonists in the leptin discovery story, and so I was very prepared and ready for it because I knew it was coming. I had just moved to St Jude Children's Research Hospital in Memphis, tennessee. So this is a pediatric cancer hospital, and at St Jude they had a cadre of about 40 children who had survived their brain tumors only to become massively obese afterward, either due to the tumor itself or the surgery or the radiation.
Speaker 2:So this form of obesity is well known in the literature. It's been known since 1901. It's called hypothalamic obesity because the hypothalamus is the brain area that controls energy balance. And clearly these children have a problem with their hypothalamus and that's why they become obese. And I now have 40 of them. And what am I going to do for them when they weigh 350 to 400 pounds? What can I possibly help them with?
Speaker 2:Previously these kids had been studied by other investigators, like, for instance, george Bray, who's the father of obesity research in America, and he admitted eight of these with. Previously these kids had been studied by other investigators, like, for instance, george Bray, who's the father of obesity research in America, and he admitted eight of these kids to his research unit at Harbor UCLA Medical Center back in 1975. And he locked them up and threw away the key and he fed them 500 calories a day for a month. What do you think their weight did on 500 calories a day? Plunged, it went up.
Speaker 2:Wow, the kids are on starvation diets and they're gaining weight on starvation diets. Are they breathing the calories in? No, turns out, because of the hypothalamic damage. Their brain thinks they're starving and the reason is because they can't see this hormone called leptin, because those neurons are dead. And when you can't see your leptin, your brain thinks you're starving. And so what they did was they went into energy conservation mode, their sympathetic nervous system, which normally burns energy, even at rest, even while you're sleeping, you still have. Even at rest, even while you're sleeping, you still have a body temperature. Even while you're sleeping, because your muscles are still working, they're still turning over ATP. Even while you're sleeping, even though you're not moving, well, their temperatures are way lower because they're actually trying to conserve energy. So, even on 500 calories a day, they're still gaining weight and, of course, they're hungry like crazy.
Speaker 2:And so I've got these kids, and what am I going to do for them? So I knew from my endocrine training that there was a nerve that led from the hypothalamus to the pancreas called the dorsal motor nucleus of the vagus nerve. People know about the vagus nerve called the dorsal motor nucleus of the vagus nerve. When people know about the vagus nerve, it's what gives you butterflies in your stomach. Maybe if we did something to suppress their insulin release, maybe they wouldn't gain the weight. So there's a drug that's available that I knew about, called octreotide, and normally it's used to suppress growth hormone, but it also suppresses insulin, and so we decided to repurpose it and see whether or not we could help these kids.
Speaker 2:And so we did a pilot trial with eight children with this very, you know, worrisome disorder called hypothalamic obesity. And lo and behold, they started losing weight. But something even more remarkable occurred Not only did they lose weight, they started exercising spontaneously. One kid became a competitive swimmer. Two kids started lifting weights at home. One kid became the manager of his high school basketball team, running around collecting all the basketballs. These are kids who sat on the couch, ate Doritos and slept, and now they're active and the parents are saying I've got my kid back and the kid's saying this is the first time my head hasn't been in the cloud since the tumor. This is really remarkable. The very first patient I treated with octreotide, you know, with this hypothalamic obesity. I tell the mother look, I don't know what's going to happen. This is your patient number one. I need you to call me in one week and tell me what's going on. She calls me in five days, frantic screaming in the phone.
Speaker 1:Dr Lustig, something's happening.
Speaker 2:And I'm going. Oh my God, oh my God, adverse event, shut this study down, go to jail. I'm waiting for the other shoe to drop. What happened? What happened? Well, normally we would go to Taco Bell and she would eat five tacos and an encharito and she'd still be hungry. We just went to Taco Bell and she ate two tacos and she was full and she just vacuumed the house. Wow, just vacuumed the house. I mean, this was a kid who did nothing, okay, and she vacuumed the house. So something was going on. And this was before she had ever had a chance to lose any weight. It was, you know, just five days. Okay, this kid weighed 220 pounds and she ended up losing 48 pounds on octreotype. So this was very, very interesting.
Speaker 2:And so we did the study again. This time we did it as a double-blind placebo control trial, and it worked again. And then we did the study again. This time we did it as a double-blind placebo-controlled trial, and it worked again. And then we asked the question could this be going on in normal people that don't have brain tumors, you know, obese people without a lesion in their hypothalamus? About 20% of the normal obese population of adults responded to octreotide the same way the kids did, with a suppression of insulin and an increase in activity. So what we learned from that experiment is that the two behaviors that we associate with obesity gluttony and sloth are actually mediated by the biochemical changes coming from the brain, that the behavior is actually due to the biochemistry. And this changed how I approached all of obesity and really what got me on the map in terms of obesity research.
Speaker 1:That's a real breakthrough and I can't even imagine how exciting and, at the time, mind blowing. I think more and more people, and particularly younger people and people who listen to the Huberman podcast there's a group that absolutely buys this. I wanted to ask you a little bit about calories in and calories out, the CICA, and there is definitely a group of people that still firmly believes it's how many calories you consume. Can we address that?
Speaker 2:All I can say is that calories in, calories out is a belief system, because you can't really determine whether the calories are going in or going out. You don't know. Okay, how are you going to figure that out?
Speaker 1:Well, what about these aura rings and things that measure the output?
Speaker 2:That doesn't tell you here's the issue.
Speaker 2:The whole world thinks a calorie is a calorie. Now, for your audience, what's a calorie? So a calorie is a unit of heat, it's a unit of physics. It is how much energy does it take to raise one gram of water? One degree centigrade, that's what a calorie is. Now, in 1902, wilbur Atwater figured out that fat had nine calories per gram of fat and protein had four calories per gram of protein and carbohydrate had four calories per gram of carbohydrate. Therefore, fat was more energy dense. Therefore, fat is fattening.
Speaker 1:Oh, wow.
Speaker 2:Because if a calorie is a calorie, then that would be true, that would work, except that that's ignoring several issues. Number one except that that's ignoring several issues. Number one insulin is the driver of weight gain, and we know that because all you have to do is look at a type one diabetic and look how much weight they lose, and then you put them on insulin and look at all the weight they gain back. Number one. Number two we are not bomb calorimeters. Okay, if you put, you know, fat in a bomb calorimeter, you get nine calories per gram, but we are not bomb calorimeters. Okay, if you put you know, fat in a bomb calorimeter, you get nine calories per gram, but we are not bomb calorimeters.
Speaker 2:We have these things in our cells called mitochondria, and mitochondria are not bomb calorimeters. Mitochondria can be dysfunctional. Mitochondria don't necessarily turn energy into heat, they turn it into ATP, and there are rules governing how that gets manufactured. So I'll give you four, you know, killers to the idea that a calorie is a calorie. Okay, let's start with fiber. Okay, fiber. You like almonds?
Speaker 1:I wish I did, I don't.
Speaker 2:Okay, well, I love almonds, so you just have to deal with it. Okay, you eat 160 calories in almonds. How many of those calories do you absorb? 130. You ate 160. You absorbed 130. Where'd the other 30 go? They were chewed up by the microbiome. You didn't absorb them because the fiber in the almonds prevented their absorption. So, even though they passed your lips, even though they registered as a calorie eaten, if you didn't absorb it, you didn't get it, and if your microbiome did, your microbiome might do something with that. That might actually change your behavior, like generate short chain fatty acids which might actually be immunosuppressive and anti-inflammatory and reduce your food intake.
Speaker 1:Just a question on that. Then If you drank almond milk, you would not see that happen, because you wouldn't get the fiber.
Speaker 2:There's no fiber, right? Almond milk has no fiber. Basically, the fiber got thrown in the garbage. Same thing when you juice a fruit you throw the fiber in the garbage. Turns out the fiber is the good part of the fruit. The juice is nature's way of getting you to eat your fiber.
Speaker 1:Robert, one of the things that stuck with me a decade is when you explained the difference between eating four oranges and trying to drink that much. Well, sorry, drinking that much orange juice was easy the juice of four oranges. Trying to eat four oranges would make you feel sick.
Speaker 2:You will throw up Right.
Speaker 1:And that just demonstrated the fiber issue.
Speaker 2:Yes, exactly so. If you only measured the calories at your mouth, you would think that there's something wrong, but in fact if you measure them at the intestine, then it makes much more sense. But then a calorie is not a calorie, because a calorie eaten is not a calorie eaten because if it came with fiber, that calorie wasn't for you, it was for your bacteria. Problem number one. Problem number two protein. So protein, as you know, is made up of amino acids and each amino acid can be used as a structural building block to create other proteins, or it can be used for energy. Now, as it turns out, if you use an amino acid for energy, the liver has to take the amino group off, so it becomes an organic acid, and then that organic acid can be used for energy. Well, in order to take that amino group off, it costs energy. You have to invest energy in order to get energy out. So the mean difference between what you can burn in a bomb calorimeter versus what your cells will do with it will be different, because you had to invest energy in your cells, whereas you didn't have to invest the energy in a bomb calorimeter. So a calorie is not a calorie because if it came from a protein, it ain't going to add up. Number three, fats. So over here we have omega-3s heart healthy, anti-inflammatory, anti-alzheimer's, save your life, single best thing you can put in your body. Over here we have trans fats, the devil incarnate, okay, consumable poison. They're both nine calories per gram. One will save your life, one will kill you, because a calorie is not a calorie.
Speaker 2:And finally, the big kahuna fructose and glucose. So glucose is the energy of life. Every cell on the planet burns glucose for energy. Glucose is so important that if you don't consume it, your body makes it. Fructose, on the other hand, is completely vestigial to all human life. There is absolutely no biochemical reaction in any vertebrate on this planet that requires fructose. It is a holdover from our plant ancestors. When we split off, they went with fructose, we went with glucose, and that's why they're plants and we're not the point is that's a great line.
Speaker 2:Okay, well, actually some humans are plants, let's be honest, but no plant is a human. The point is, fructose is metabolized in the liver completely differently from beta-glucose. And what fructose does is it drives liver fat because it poisons mitochondria specifically to generate the fat. And the reason is because fructose was only available one month a year. It was called harvest time, and what came after harvest time? Winter. So the goal of harvest was to snarf up all of this fructose as much as you could and get it turned into fat so that you could basically survive the winter.
Speaker 2:We call this phenomenon seasonal insulin resistance, and fructose is specifically a mitochondrial toxin so that your cells will turn away from burning it to energy, to ATP, and turn it toward generating fat. And that worked for us for hundreds of thousands of years as an adaptive evolutionary mechanism. But when fructose is available 24-7, 365, like it is now, we don't need that, but we've still got it and we're still turning it into fat, and so it's lining our arteries, it's lining our livers, it's causing insulin resistance and it's driving chronic metabolic disease because it is metabolized differently from that of glucose, because a calorie is not a calorie. So in a bomb calorimeter, sure, but we are not bomb calorimeters, and anybody who says a calorie is a calorie is obviously not listening and, to be honest with you, that's most people.
Speaker 1:So can we talk about addiction? And you make a really interesting point about the huge, the tectonic shifts in the world systems, particularly in the US, I guess, over the last 50 years or so. And how do you think sugar could play out?
Speaker 2:So the question is is sugar addictive? Now let's look at alcohol, because alcohol and sugar are very similar to each other. Because, after all, where do you get alcohol from Fermentation of sugar? They actually are metabolically equivalent and in the brain they're equivalent as well. 40% of Americans are teetotalers never touch the stuff. 40% are social drinkers. Can pick up a beer, put it down, I'm in there. 10% are binge drinkers and 10% are chronic alcoholics. So 20% of America have an alcohol problem.
Speaker 2:Now, what constitutes being an alcoholic? What constitutes being alcohol addicted? We don't know To this day. We don't know. We've been looking for the genetics of alcoholism, haven't found it. We've been looking for the genetics of smoking haven't found it. We don't know what leads one person to be addicted and another person to not be. But clearly some are and some aren't.
Speaker 2:Well, the same thing for sugar. Not everybody is addicted, but those that are are. And it's very easy to figure out who's who, because the sugar-addicted person will tell you oh, I have a horrible sweet tooth. That's sugar addiction, until proven otherwise. And the reason they'll tell you is because right now, that's socially acceptable. If, all of a sudden, sugar addiction was not socially acceptable, they wouldn't tell you that, just like they won't tell you they're an alcoholic and nowadays they won't even tell you they're a smoker, because it's not socially acceptable. So I figure 20 to 25% of America is sugar addicted. Okay, everyone likes it, but not everyone needs it. It's when you need it that's the problem.
Speaker 2:Now, how do you know that it's addictive? Well, because it activates the same reward mechanism as cocaine, heroin, nicotine, alcohol, sugar, and it does the exact same things. And you can measure it in the brain. You can see it in the brain, you can measure it biochemically, you can measure it with fMRI, you can measure it with PET scanning. It's doing the same thing and more and more for less and less. In other words, as the sugar dose goes up, you end up with less and less reward, the law of diminishing returns, also known as tolerance, which is one half of addiction. The other half is either withdrawal or dependence, and sugar shows that as well. So the bottom line is sugar meets all the criteria for addiction that cocaine, heroin, nicotine and alcohol do. There's going to be a special issue of the Frontiers in Psychiatry all on food addiction coming up later this year. All about food addiction. You know, when you actually come down to it. There are only really two items in food that are truly addictive, and they are sugar and caffeine.
Speaker 1:Is that why I'm enjoying my iced latte so much?
Speaker 2:You said it, I didn't.
Speaker 1:I'm going to be wearing a glucose monitor soon, dr Lustig, and I'm wondering what is going to happen when I put that on and then drink this.
Speaker 2:You'll find out and that will help you understand what your food is doing to your metabolic health, and it might alter your choices. And if you do, that will only be good. So I am an advisor to a company here in the United States called Levels Health, and what we do is we try to help people understand what food does to their metabolic health. One of the tools at our disposal is the use of continuous glucose monitors, because the higher the glucose goes, the more insulin is going to be released. The more insulin is going to be released, the more weight you're going to gain and the less well you're going to feel. Glucose is a proxy for insulin and insulin is the driver of weight gain. So we have data to show that people who use continuous glucose monitors gain less weight and, in many cases, lose weight, and they also feel better, in part because they're not having the highs and the lows, because those highs and the lows make you either irritable or they make you sleepy.
Speaker 1:That makes so much sense. You've also developed you talked about I think someone else developed the NOVA system. Can you talk a little bit about that?
Speaker 2:Sure, I did not develop the NOVA system. My colleague, dr Carlos Montero, who is a public health epidemiologist at the University of Sao Paulo in Brazil, he developed the NOVA system. So what the NOVA system does is it categorizes food. Instead of based on its nutritional value, it categorizes food based on its degree of processing. There are four classes in NOVA. So the easiest way to explain this is with an example.
Speaker 2:Let's take an apple. Nova class one would be an apple picked off a tree. Nova class two would be apple slices de-stemmed, de-seeded, maybe de-skinned. Nova class three would be apple sauce, macerated, cooked, possibly with a preservative added, maybe with extra sugar, maybe not. Nova class four would be a McDonald's apple pie. Now the question is how much Nova class 1 apple is in that Nova Class 4 McDonald's apple pie? And the answer is only McDonald's knows for sure. But the question is are all of these different types of Nova Class foods the same?
Speaker 2:If you believe a calorie is a calorie, it shouldn't matter where the calories came from. So it shouldn't matter where the calories came from. So it shouldn't matter if your calories came from, you know, carrots or cheesecake or Coca-Cola or kumquats, because if a calorie is a calorie, then they should all be equal. Well, it turns out when you look and Carlos did this when you look at all the disease in the data sets from all over the world in terms of what people are eating, all the disease is in that NOVA class four group. None of it is in NOVA class one through three.
Speaker 1:How is that being measured? When you say all the disease?
Speaker 2:The incidence of hypertension, the incidence of diabetes, the incidence of cardiovascular disease, the incidence of cancer, the incidence of dementia, the incidence of fatty liver disease, et cetera. All of these chronic metabolic diseases that are basically killing people all over the world and basically draining healthcare dollars from every single developed and developing country all over the world. $11 trillion deficit per year for the care and treatment of chronic metabolic disease, which is more than the US or globally. That's globally.
Speaker 1:It's insane.
Speaker 2:But it's more than what the food industry is making. So that's not sustainable. There's more money going out than is coming in. That's unsustainable. And all of them are mitochondrial diseases and none of them have treatments and all of them are driven by that. Nova Class 4 ultra-processed food category.
Speaker 1:It's interesting you say none of them have treatments, because I guess GLP-1 drugs are not a treatment. But what is your view of them?
Speaker 2:Okay, so how much time do we have? Carolyn, glp-1s are complicated and I'm going to be very honest with you, I don't know the right answer to them. I know a lot about them because I'm an endocrinologist. I was there when the first GLP-1 started being used, called Xenotide, back in 2006. And I've known about GLP-1 as a molecule as recently as 1987. Okay, so it's been around for a while, but NovoNordisk and Lilly have done very big things with it.
Speaker 2:I wear three hats I wear the clinician hat, I wear the scientist hat and I wear the public health policy wonk slash advocate hat, and how I feel about GLP-1s depends on which hat I'm wearing. So when I'm wearing my clinician hat, I'm glad they're here because they work. I'm not saying they don't work. They do work 16% weight loss for semaglutide, 20% weight loss for terzepatide. They work. And if you have morbid obesity and nothing else works, these do, and that's a big deal. So I'm glad they're here. So, from a clinician standpoint, I'm very positive about them. It just so happens most of the people who are taking it are not people who need it, like, you know, people in Hollywood. That's a different problem. That's an access problem, not a clinical problem. Now let me put my scientist hat on. Why do they work? Well, they work in two ways. They work in two places. The first place they work is on the brain, and they work on that reward center we talked about before to actually reduce reward, so that basically, sugar in particular is not as interesting, and so you cut down your consumption of sugar, ultra-processed food, et cetera, and that is good.
Speaker 2:Now we had a drug available to us 20 years ago out of France, from Sanofi, and the drug was called Ramanubant. It was the anti-marijuana drug, it was an endocannabinoid antagonist, it was the anti-munchies drug and it got approved for obesity in Europe. Never got approved in America, but in Europe it got approved. And within two months of its approval and people starting to use it, there were 21 suicides and the drug got immediately pulled. And what we learned from that little foray is rewards what gets you up in the morning, and if you shut reward off, there's no reason to live. Well, glp-1 shuts off reward, and so GLP-1 agonists are associated with an increased incidence of depression. We've been looking for suicide as a telltale sign of a problem. So it's still on the market, but there's no question that there is an increased risk of depression with the use of GLP-1s because of its effects on the brain.
Speaker 2:But remember I said there were two places it worked. The second place is on the GI tract, specifically on the stomach, and what it does is it reduces the rate of gastric emptying. It basically makes your GI tract move slower and so you don't want to eat because you still got stuff in your stomach. Right, so it's mechanical. But what that does is it causes the side effects the nausea, the vomiting, the pancreatitis and, most recently, the gastroparesis. Gastroparesis stomach turns to stone. 3.9% of people who use GLP-1 analogs get gastroparesis and, of course, package insert doesn't even say it. So this is actually a lawsuit going on right now against the GLP-1 companies for gastroparesis.
Speaker 1:Is it reversible or it just stays once you have it?
Speaker 2:So a lot of patients who have taken it and get gastroparesis. They go off it and the gastroparesis doesn't get better. So there's a big issue that's a little bit concerning, don't you think?
Speaker 1:It's a little terrifying, I think.
Speaker 2:And number three when you look at the weight loss, when you look at what's actually being lost, turns out to be equal amounts of fat and muscle. Losing fat is the good part, but losing muscle is not. Losing muscle is a bad thing. Ask any little old lady who breaks her hip whether she wishes she had a little bit more muscle. Losing muscle is associated with increased mortality, sarcopenia, so losing muscle is not such a good thing. So what else causes you to lose fat and muscle in equal amounts? Starvation, and why do you think it's working? It's because you're starving. Okay, is that the best way to lose weight? Starvation? I don't think so. Okay, it's been shown you know 50 ways from Sunday that that's not the best way to do this. Okay, and only one third of people who take GLP-1 analogs actually lose any weight. They only tell you about the responders. They don't tell you about the intent to treat model and responders. They don't tell you about the intent to treat model. And so many people get side effects that they stop taking it. Or because it's so expensive, they stop taking it and all the weight comes back plus some. So what that's telling you is it's not actually fixing the problem, it's just band-aiding the problem, because the weight all comes rushing back as soon as you stop it.
Speaker 2:Okay, let me put my third hat on, my public health advocate hat. All right, these drugs do work. I'm not saying they don't, they do. All right, 16% weight loss for semaglutide. 20% weight loss for zepatide. True, okay, if everyone in America who qualified for an analog got it, that would be $2.1 trillion to the healthcare system. But the healthcare system is $4.1 trillion in expenses, so that would be a 50% surcharge over what we're paying now. We're paying now. How are we going to afford a 50% increase? That's crazy, unless, of course, trump really means we're going to reduce drug costs. Ha ha, if you believe that I got a bridge to sell you. Conversely, and this is the important part, if we just got added sugar consumption in this country down to USDA guidelines of 12 teaspoons per day, how many grams in a teaspoon?
Speaker 2:Four, so 12 would be 48 to 50.
Speaker 1:That doesn't sound so punitive, that sounds very doable. Well, it's not.
Speaker 2:That's the point. It's not. We're consuming 94 grams, I mean. So basically it'd be cutting it in half. If we just cut our sugar consumption in half, we would lose 29% weight loss. We'd have 29% weight loss, so we'd have better weight loss, and instead of spending 2.1 trillion, we would save 3.0 trillion. So that's a $5.1 trillion swing with better weight loss and no side effects. So which one makes more sense to you?
Speaker 1:Yep, you make some really, really interesting points. Can we talk a little bit? I've seen the number that you threw out that 73% of what's sold in grocery stores has sugar in it or hidden sugars. You know, I think the availability of healthier food is something most of the population really does want now, and I think if sugar is hidden it makes it really hard to make good choices.
Speaker 2:Indeed, indeed, and there are 262 names for sugar, and the food industry uses all of them on purpose, because that way they can hide it in plain sight, and that's one of the reasons our consumption is at 94 grams per day. So we need fundamental reform of the entire food system. I completely agree with that. The question is will RFK be able to enact that?
Speaker 1:Does he want to do that.
Speaker 2:Well, he says he does, We'll see. But I'm actually quite concerned because his initial moves in this space do not portend confidence.
Speaker 1:Do you mean around the dyes, or do you mean his views on vaccines?
Speaker 2:Both. I'm holding my breath and biting my tongue and waiting, but the things that I see so far are not exciting me. Like, for instance, he wants to get rid of food dyes. So do I. We don't need them. I totally agree. On the other hand, instead of asking Congress to ban them, hand. Instead of asking Congress to ban them, okay. Or instead of getting HHS to you know, exert an administrative order to remove them, okay. He's basically said to the food industry please stop. And they haven't. So what good is that?
Speaker 1:Right, so I now live in LA. There's a lot of innovation. There are a lot of companies that do want to put good products on the shelves, and is it possible to have processed food that isn't bad for you?
Speaker 2:Yes, it is. So here's the issue Our ultra-processed food is killing us. Our ultra-processed food is decidedly unhealthy. I completely agree with that. The question is can ultra-processed food be?
Speaker 1:made healthy?
Speaker 2:That's a different question. I've been working for the last five years with a company in the Middle East. It's called Kuwaiti Danish Dairy Company, add, and they are like the Nestle of the Middle East and they make all sorts of bad stuff. They make flavored milks, they make frozen yogurts, they make ice cream, they make confectionery, they make biscuits, they make tomato sauce. Okay, like you know, problem stuff. In 2020, the CEO of KDD came to me and said look, we know we have a problem. Kuwait has an 18% diabetes rate and an 80% obesity rate.
Speaker 1:Did you say 80% obesity rate?
Speaker 2:An obesity rate, oh my gosh.
Speaker 2:And we don't want to be part of the problem, we want to be part of the solution. Can you help us turn KDD into a metabolically healthy company? And so I don't take any money for this. But I convened a group of scientific advisors and we basically stemmed the stern top to bottom, took all the stuff down to the studs, basically evaluated every aspect of KDD's operation in terms of ingredients that they buy from suppliers, processing techniques and their products, okay, and we sent them for biochemical analysis to actually determine what's in the stuff. And in doing so, we came up with a set of precepts to basically help KDD move their products from unhealthy to healthy.
Speaker 2:And there are three precepts that determine whether or not a given food is healthy. And here are the three Protect the liver, feed the gut, support the brain. Any food that does all three is healthy, ultra-processed or not. Any food that does none of the three is poison, ultra-processed or not. So, yes, ultra-processed food in America right now satisfies none of those three. But could it? Well, it would mean re-engineering ultra-processed food. Well, that's what we did with KDD, and so over the last two years, kdd has pulled or re-engineered 10% of their entire portfolio. Re-engineered 10% of their entire portfolio 18 items out of 180 items to become to be metabolically healthy. And then we've tested those in people to determine their metabolic responses either their glucose and insulin responses or their GI responses, et cetera to determine whether or not these maneuvers actually conferred health instead of harm to these products. And they are now on the market in Kuwait. So we wrote this up in Frontiers in Nutrition in 2023, and we offered it to the world as a roadmap for other companies that want to do the same thing.
Speaker 2:And what I can tell you is we've had no takers, and the answer is because, number one, they're afraid. Number two, sugar's their gravy train. And number three, while they would like to do something, they have to worry about their wall street quarterly reports and their stockholders. In addition, if they said to the public you know all that processed food, we've been, you know, serving up for the last, you know 70 years, it's really not've been, you know, serving up for the last, you know 70 years. It's really not that good for you because we're going to try to make it better. Okay. What they do is they lose market share, they lose reputation and they generate lawsuits. This is all because they're afraid.
Speaker 1:Demands of a shareholder group versus what most human beings actually do want to do and get right, I think.
Speaker 2:Well, you know, the food industry is filled with good people who want to do the right thing. The problem is, they work for a food company.
Speaker 1:Can we talk about non-nutritional sugars like replacements for sugar? What is your view on those?
Speaker 2:If you believe a calorie is a calorie, then they should be good because they're no calories. No fructose should be better. Right Turns out, the metabolic detriment of artificial sweeteners does not go through calories or fructose, it goes through other things. So the toxicity of one sugar beverage equals the toxicity of two diet beverages. Now you say to me, how can that be? No sugar, no fructose, no calories? Well, it turns out those diet sweeteners do other things. Number one they still generate an insulin response which still generates weight gain. And so it's been shown that through meta-analyses that diet sweetener consumption does not actually cause weight loss, whereas if they did work they should cause weight loss, but they actually don't because they still generate an insulin response. And the second thing is that several of the diet sweeteners not all of them, but several of them actually cause GI perturbations that lead to changes in the microbiome, glucose intolerance, leaky gut and therefore chronic inflammation and systemic insulin resistance, driving chronic metabolic disease. So even though these compounds are zero calorie, that doesn't mean they have zero effect.
Speaker 1:Which are the better diet sweeteners here.
Speaker 2:So we've done a full study of that for KDD and so I'm very prepared to discuss it.
Speaker 2:The one that seems to hold the most promise of all of them is this compound called allulose, and allulose is an epimer of fructose. It seems to lower LDL and raise HDL, which seems to be a good thing from a cardiovascular standpoint. It seems to be able to be used similar to sugar in terms of its bulking capacity and its humectant capacity and its hardening capacity, so that's good. It is 70% as sweet as sugar, so it can be used as a sugar extender probably better as a sugar extender than as a sugar replacement, but even so seems to have some benefit in value. The problem with allulose right now is that it's 12 times as expensive as sugar, so that's kind of keeping it out of the market, and also the European Food and Safety Administration has not approved it yet, in part because the way to make it is with GMO processes, which they're not happy with. So there are some questions. And also now there are two new ways of making allulose, so that should reduce the price significantly to maybe two times the cost of sugar.
Speaker 1:What is it made from?
Speaker 2:Glucose. It's made from starch.
Speaker 1:Does it have another name on the market?
Speaker 2:Allulose. Well, there are companies that sell it like RX sugar, but no, the name isn't allulose, it's three beta hydroxy fructose, whereas fructose is three alpha hydroxy fructose. So it's an epimer of fructose. It's not as sweet as fructose, obviously, but it seems to have some benefit.
Speaker 1:Whether that will hold up in long-term studies whether it will actually lead to weight loss, whether it will actually prevent leaky gut. We don't know yet because those studies are not yet finished, but at least from a big one. But there seems to be a growing belief that some of our depression, anxiety, is tied to what we eat.
Speaker 2:Yes. Well, there's no question that our depression and our food are related to each other. That I'm very confident in, 100%. The question, of course, is through what mechanism, and there are possibly several, so it's not that simple. One may have to do with the mitochondrial dysfunction that we talked about before. One may have to do with changes in neurotransmitters in the brain, like glutamate to GABA. So glutamate's an excitatory neurotransmitter, gaba is an inhibitory neurotransmitter. Gaba is an inhibitory neurotransmitter, okay, and sugar actually interferes with that conversion. Normally glutamate goes to GABA, but sugar actually prevents it. So you end up with increased excitatory, decreased inhibitory, and that may cause problems.
Speaker 2:In addition, insulin resistance causes changes in some of the trophic factors in the brain, such as leptin and BDNF, and these are trophic factors that cause neurite outgrowth and, in some cases, increased neurogenesis in certain parts of the brain. Then there's the microbiome story, which is, I think, what you're trying to get at, and so what might be happening with the microbiome is that these ultra-processed foods are actually altering microbial diversity and also short-chain fatty acid production. And short-chain fatty acids have effects on the brain. They circulate in the bloodstream, go to the brain and have anti-inflammatory effects. There are immune cells in the brain called microglia. There are immune cells in the brain called microglia and when you are inflamed peripherally and in the gut, that reaches the brain. That signal reaches the brain either through the blood or possibly through the vagus nerve, up the vagus nerve to activate those inflammatory cells, those microglia, and they go from an M2 lineage to an M1 lineage, which basically tells them we're in eating mode and that may actually be part of the cognitive decline and has been associated with the onset of Alzheimer's.
Speaker 2:So there's a lot of concern about what's going on with these various foods and what these different mechanisms, either blood-borne or possibly through the vagus nerve, might be doing to the brain to foment depression, Alzheimer's, possibly schizophrenia. We also know that patients with bipolar disorder and depression who start on a ketogenic diet get better. So is it because of the change in the mitochondria? Is it because of the change in the cytokines? Is it because of the change in the gut inflammation? Maybe all three? We don't know yet.
Speaker 1:As I think about companies again trying to make things that are good for us, better for us, improve what is being made available. What is the definition of food?
Speaker 2:So I know the definition of food, carolyn, do you, because I looked it up. So the dictionary definition of food, which I am very comfortable with, I'm 110% in line with this definition Substrate that contributes to either growth or burning of an organism. That is food. So let's take sugar. Does sugar contribute to burning? Well, if you think it's a bomb calorimeter, you'd say four calories per gram contributes to burning. Except we're not bomb calorimeters. We burn in our mitochondria and fructose inhibits mitochondrial ATP generation by inhibiting three separate enzymes that are involved in generating ATP.
Speaker 2:Fructose inhibits burning, it does not contribute to it, it inhibits it. What about growth? Turns out, fructose inhibits growth. My colleague, dr Efrat Monsenigo-Ornan, who runs the nutrition department in Hebrew University, jerusalem, who runs the nutrition department in Hebrew University, jerusalem, actually looked at this question and showed that in fact, ultra-processed food, and specifically sugar, inhibits long bone growth, cancellous bone growth, skeletal bone growth, trabecular bone growth, cortical bone growth, and in addition, it also does that in humans, not just in rats. Okay, so there are studies of sugar consumption and suppression of height in other countries. So it's obviously not contributing to growth. And, by the way, hijack of cells by, you know, cancer cells. You know they love fructose. They love feeding the cancer cell because the rest of the body can't use it, but the cancer cell can. So in essence, you're basically hijacking growth with cancer. So it's not contributing to burning, it's not contributing to normal growth, it's only hijacking growth in cancer cells.
Speaker 2:That doesn't sound like food to me, does it?
Speaker 1:So can we just look at 10 years In your perfect world with a good dose of realism, so imperfectly perfect world. Where could we get, with the will of the people behind you, in 10 years?
Speaker 2:To me, the line in the sand that has to be crossed is food subsidies. As long as there are food subsidies, we cannot solve this problem. People ask me all the time if you had a magic wand and you could do one thing that would stick, what would it be? I would get rid of all food subsidies, and the reason is because they distort the market. The reason ultra processed food is cheaper than real food is because of food subsidies. If we got rid of the food subsidies, then they wouldn't be, and so there wouldn't be an impetus for the food industry to rely on them and there wouldn't be an impetus for the public to purchase them.
Speaker 1:Is this specific to corn?
Speaker 2:Corn, wheat, soy, sugar, all of them and you'd have to get rid of all the subsidies for this to work. So this was actually looked at at UC Berkeley many years ago, called the Gene Eating Foundation, and they asked the question what would the price of food look like if we got rid of all food subsidies? And the answer is it wouldn't change, except for two items which would go up corn and sugar. And that's what we'd want to go up, because if you raise the price then you reduce effective availability. So you get rid of lower the dose on two poisons. So for me, the food subsidy issue has to be dealt with and has to be dealt with first. The problem with that is that that takes Congress.
Speaker 1:Or a president.
Speaker 2:Well, it takes something.
Speaker 1:And there's no will in Congress because of farmers, because they're all paid off.
Speaker 2:They're all paid off by the food and the farm industry. Have you ever heard of ALEC A-L-E-C, the American Legislative Exchange Council? They're a bill mill. They basically write bills and hand them to congressmen to introduce them. Those bills are for their benefactors. You know who's paying Alex bills and who are those the farm industry, the food industry, the oil industry, you know, and the opiate industry.
Speaker 1:I think you have said, though, that knowledge is probably the first frontier in change. Maybe I'm misphrasing, but do you see a big change in the knowledge of the general population about food?
Speaker 2:74% of Americans are trying to reduce their sugar consumption because of the work that's come out over the last 10 years. So mine and others. That's good. In addition, it used to be that people thought a calorie was a calorie and now they're thinking sugar is particularly egregious in terms of calories. And I didn't generate those data. Ific generated those data. The International Food Information Council, the public relations arm of the food industry, found that out. It used to be 11% of people thought it was sugar and now 40% of people think it's sugar that's driving the obesity and diabetes epidemics. The public is catching on. The public is now aware it's one of the reasons that RFK was able to create this Maha movement, because people say there's a problem with the food. Yeah, I've been saying it for a long time now, but people are starting to say it. The question is not does RFK have the right diagnosis? He does. The question is does he have the right prescription?
Speaker 1:Good point. You asked a brilliant question on the Huberman podcast, which is what is the largest restaurant chain in the US?
Speaker 2:It is our nation's public schools. Largest restaurant chain in the US, it is our nation's public schools. They're three times bigger than Subway, McDonald's, Burger King and Wendy's all combined it's triple the size. And our kids are getting sicker and sicker. So we have started a nonprofit here in California called Eat Real and our job is to get real food into K-12. Now to do that, we have to change the business model in each school or each school district to basically make real food the standard, to be able to actually buy food at scale, manufacture them in a centralized facility instead of in each school separately, which is what used to happen years ago. But now, because there's no footprint even for food preparation, because it's all been taken away by the schools to create new classrooms, you know the food has to be made off site. But we can basically teach school districts how to get real food to their students, and we now have the data. We're actually writing up the paper right now to show the improvement in academic scores when kids eat real food.
Speaker 1:Dr Robert Lustig, thank you for your tireless efforts to educate us and I've learned so much again today. I always learn from you. I hope that we do see more and more change. I hope people's sweet tooth declines.
Speaker 2:Well, Carolyn, you're part of the change.
Speaker 1:Onward and forward. I can't wait for your new products to come out of the company you're working with.
Speaker 2:We're doing our best. We have a new fiber that we're working on that we hope will start being incorporated into CPG products around the country and around the world, which we think will mitigate the metabolic burden of ultra-processed food and hopefully make things better.
Speaker 1:Thank you so much. Look forward to doing this again.
Speaker 2:My pleasure, Carolyn.
Speaker 1:If you enjoyed this session, please do comment, rate and follow us on Apple Podcasts, spotify or wherever you listen, and please share this with your friends and colleagues.