Ep 13 - Dr. Robert Lustig on Longevity, Diet, and Sugar

macular degeneration is a leading cause of vision loss with 15% of Americans being at risk or already affected scientific evidence proves that by using mezzo zeaxanthin lutein and zeaxanthin together replenishes the macular pigment and promotes healthier vision this formula comes in only one product Mac you hope [Music] hello and welcome to the open your eyes podcast I'm dr. Kerry gal the host of the documentary open your eyes according to the Journal of circulation 180,000 people die each year from sugary beverages such as soda and sports drinks in addition we've been told by experts for the past 40 years to eat low fat and count calories to prevent obesity diabetes and chronic disease consequently over the past 40 years obesity diabetes and chronic disease has skyrocketed today's guest dr. Robert Lustig pediatric neuroendocrinologist is a world expert on this topic he has authored numerous books including New York Times bestseller fat chance and the hacking of the American mind dr. Lustig has authored over a hundred and twenty peer-reviewed articles but he's probably best known for his life-changing YouTube lecture with over 10.5 million views sugar the bitter truth dr. Lustig thank you for joining me today I don't thanks so much dr. yalda I appreciated every time I hear that number I just sort of freaked out it's like why in the world would anyone want to watch but it was really an amazing I really was life-changing for me back ten years ago when I watched it and you know every so often I'll check to see how many views it gets and it seems like it gets a hundred thousand a week it's really incredible what's the backstory with that lecture had that happened well it was just part of a series that UCSF my school does for the public mini med school for the public and there was a six-week nutrition module and they asked me to speak and they didn't care what I spoke about as long as it was about nutrition and so I gave a talk and I thought I was giving a talk to 200 people in the audience and that was the end of that and I didn't even know it was being videotaped if I'd known I had watered weren't a better tie you know got a lot of flack over that my mother giving me that time so anyway the next thing I know things climbing and people are recognizing me on the street mitts it's been pretty bizarre I have to say it it certainly made it very clear what the word viral needs so take me to the beginning where did the whole low-fat diet come from and calories don't matter where do we go wrong 4050 years ago okay so calories don't matter okay and the reason calories don't many everyone takes calories matter right and the reason they think that is because of a an equation from 1916 called the Attwater equation that was basically trying to equipment generate equivalence between protein carbohydrate fat and when you burn protein or carbohydrate fat in a bomb calorimeter you know they give off different amounts of energy and so it was assumed that if you ate something that was high energy well and that contributed to weight gain that was discounting so many different things including the microbiome which we now know about it was excluding the fact that there's this thing called nutritional biochemistry that we're not every calorie gets burned the same way so a calorie eaten might even be a cover eaten but a calorie burned is not a calorie burned so the whole thing just falls apart but nonetheless you know it became the standard for the American Dietetic Association and the reason was because that was math you could do math and you know equation you know they and you know but it was really science and science is hard math is easy science is hard anyway it caught and there are a lot of people who were you know very married to this idea there still are you know we're just chipping away at this very very slowly so that was the notion of the calorie story the second thing was the fats story and that dates back to the years in the 1950s and 1960s when we thought that saturated fat was the bad guy now why did we think that because Eisenhower had a heart attack in 1955 and everybody wanted to know what was going on with the increasing incidence of heart attacks across the country and two camps came out one was that it was saturated fat and that was led by a gentleman by the name of Ancel Keys who became very famous was on the front cover of Time magazine back in the in the in 1980 I believe and the other one was a British physiologist nutritionist by the name of John Yadkin who said that sugar was the bad guy and these two duked it out over the course of a 20-year period and Keyes was very forceful and pretty obnoxious he was kind of like the Donald Trump of nutrition at the time and no one was gonna get in his way and yet come was much more unassuming and you know would never like call out names in public you know so it was a very very similar vibe to what we see today but there were three things that we learned in the 1970s that sort of Keys one and Yadkin got thrown under the bus first was we learned about this molecule in the bloodstream called LDL we learned that LDL was you know a bad guy in heart disease then we learned about the fact that dietary fat raised your LDL and then the last thing we learned in the late 70s was that LDL levels in large populations correlate with heart disease so if dietary fat is a and LDL is B and heart disease is C we learned well if a leads to B & B correlates with C therefore a must lead to C therefore no a no C get rid of the dietary fat the LDL levels will fall and heart disease will go away and that was the end of John Yeager and we adopted the low fat diet and the first Dietary Guidelines called for reduction in fat now why did the food industry go along with that because then they got to create two sets of foodstuffs regular fat and low fat and it's not like the fat just disappeared like for instance when they skimmed the cream off the milk they didn't just you know that didn't just disappear what they do they made cheese okay then they got two products for the price of one you know great business strategy all right and even you know the the beef industry learned to adapt it's not like our meat consumption went down yeah they were poor for lower fat alternatives and various uh you know cuts of meat so this actually worked for the food industry and we all went look fat and you know my father ate those Entenmann's fat-free cakes and there's no doubt in my mind that's how he got his heart attack so this this notion you know continues to pervade even today it is very hard to debunk mythology as I'm sure you know but we are doing it step by step and what we have learned is LDL is not the problem triglycerides are the problem and triglycerides are actually the manifestation of what the liver does to sugar because when you sugar over floats the liver the liver has no choice but to take that into turn into liver fat and it gets packaged as triglycerides and hazard risk ratio for LDL is only 1.3 the hazard risk ratio for triglycerides heart disease is 1.8 so we've been focusing on the wrong Maalik in what we've been focusing on the wrong substrate we've basically turned the food pyramid and it on its head get you know increasing the amount of carbohydrate and decreasing the amount of fat and all it has done is made us sicker and sicker and of course Einstein's theory of insanity doing the same thing over and over expecting a different result well you know what it's time for a new paradigm and people are finally ready for it there's another myth everything in moderation can you talk about that so that sounds good you know that plays well on a bumper sticker but the fact that matter is there is no moderation so where does moderation come from so there is a hormone in your fat cells called leptin and leptin goes from your fat cells to your brain and tells your brain hey I have enough energy on board to engage in expensive metabolic processes such as puberty pregnancy you don't go into puberty until your leptin levels hit a certain amount you can't support a pregnancy unless your leptin levels are above a certain threshold okay so what leptin is is it's not the satiety signal it's the starvation signal if your leptin level is below a set point in your brain your brain infers that as starvation that there's not enough energy on board and that you have to both eat more and conserve and so there's your gluttony and sloth so the behaviors that we manifest around food are actually being driven by this hormone called leptin now the point is you're supposed to eat you're supposed to then make more leptin and therefore the leptin should tell the brain hey I'm finished and that should be the yin-yang negative energy balance you know keep doing in homeostasis so that you don't gain more weight however turns out that the hormone insulin the one that drives the energy into fat also blocks the leptin signal at the level of the brain and there's you know two reasons why insulin would block leptin because there are two times in your life you actually have to gain weight one is puberty and the other is pregnancy and if you if your left and worked all the time then you couldn't go into puberty and you couldn't go into pregnancy and the species would die out so it's actually adaptive for leptin to block insulin two times in your life but the problem is now our insulin is up 24/7 365 and the insulin is blocking the leptin signal all the time our brains think we're starving all the time and so that's the reason for the increased food intake so in the face of a leptin resistance in the face of leptin not working moderation is useless there's you know there is no moderation because this is biochemically driven so when we look at when we're addicted to food fat so sugar mixed together to create a Bliss point the the scientists at the food companies are very sharp at being able to find that Bliss point to make us addicted what can we do to help prevent it and can you go into that in a little bit of detail so you brought up a new new concept and that is food addiction so leptin actually also extinguishes reward at the level of the reward center of the brain called the nucleus accumbens so when your leptin levels are high you don't get all that reward you don't need all that candy or that chocolate or you know that Cinnabon but when your leptin resistance haha you sure do so the question is what drives the reward signal and it turns out there's only one thing sugar salt does not drive the reward signal fat does not drive the reward sing only sugar sugar is for lack of a better word addictive now and it makes sense that that would be the case you hear people saying all the time oh I have a horrible sweet tooth you know what that is that's sugar addiction so not everyone is addicted to the same extent I mean think of it like this okay if you're exposed to heroin for three days you're an addict if you're exposed to cocaine for a week you're an addict if you're exposed to a cigarettes for a month you're an addict if you're exposed to alcohol maybe you are or maybe you're not 40 percent of America or teetotalers 40 percent of social drinkers pick up a beer put it down no problem 20 percent have a real alcohol problem and 10 percent are hardcore alcoholics yeah what determines who's who I don't know we don't know the answer to that yet but it's very clear that alcohol is not uniformly addicting same with sugar there are some people who are not addicted by sugar and there are some people who are extraordinarily addicted by show so the question is if you are a sugar act and your reward centers going hog-wild and you can't stay away from the stuff how can you fix it that's complicated we have modalities there are ways a lot of them are the same things we use for alcoholics and the same thing we use for smoking cold turkey does work but there is a withdrawal a phase lasts about five days those five days are pretty darn unpleasant okay but you can come out the other side not too bad you know get the shakes or the DTS like you would with alcohol but you know you know you're you're still squirming in your seat but you can get past it there are medications that can be used like wellbutrin and now Trek's own and some other things you know but but those are heavy duty and you need a doctor's help you know for any of those what I can say is that the people who are the most sugar addicted are the people who can't turn away from processed food because processed food is where the sugar is hiding and the thing is that you can try and get off sugar you can stop the ice cream and the candies and the sweets and the you know and the cookies but the fact that matter is half of the sugar in your diet is includes you didn't even know had it like yogurt barbecue sauce hamburger buns and burger beef salad dressing so if you're gonna go cold turkey that means you got a basically stop process you gotta eat real food food without a food label so if a food has a label that means it's been processed it for food as a label it's a warning label so if we if you can get people who are sugar addicted onto real food they will do great but you know getting them to understand why and you know stick with it that's the tough part there are plenty of people that do well and then at night they get these terrible cravings what can they do instead of eating something sugary can they eat a fruit to kind of get them through that for those five days yes and fruit has sugar so people say wow fruit all the time the answer is fruit is sweet and that's okay okay the question is does the sugar enter your bloodstream the answer is not that much most of the sugar ends up staying in your intestine because the fruit has fiber there are two kinds of fiber soluble and insoluble so soluble fiber is locked pectins likely holds jelly together in soluble fiber is like cellulose that the stringy stuff and celery okay hold fruit as both when you consume a piece of whole fruit the insoluble fiber forms like a fish net like a latticework on the inside of your intestines inside your duodenum first part of your intestine the soluble fiber are like globules they plug the holes in that lattice work and together they form an impenetrable secondary barrier on the inside of your intestine you can actually see it on electron microscopy and what that does is it prevents about thirty to forty percent of what you ate from being absorbed early because of this barrier and what that means is that the liver doesn't get the onslaught and that means that the liver is not going to turn it into liver fat which means you're not going to get insulin resistant so that's good in addition because you didn't absorb it early it goes further down the intestine to the next part called the jejunum and that's where the bacteria our microbiome and they chew it up instead so even though you consumed it you never received it because your bacteria hijacked it before you had a chance to absorb it and you will fed your bacteria so any food that protects the liver and feeds the gut protecting the liver from the glycemic excursion and for making liver fat and feeds the gut so that the microbiome is happy and so you don't end up with inflammation any food that does both is healthy any food that does neither is poison and any food that does one or the other but not both is somewhere in the middle and of course processed food does neither have a fruit juice fruit juice has soluble fiber so it does one thing so yes it does have the soluble fiber in the soluble fiber will go along with the juice but the insoluble fiber has been strained out and that insoluble fiber is what allows that gel to form so you are not protecting your liver so your liver is getting the onslaught anyway and so that and it's been shown that fruit juice predicts diabetes and heart disease just as sugared beverages you know soda does a little you know not quite as potent but still very clinically significant are there any times when you want to eat what you want to eat foods that have sugar in it like if you're a high intense athlete to store the glycogen so you don't need to eat sugar if you're a high intensity athlete and you've been say on the gridiron for three hours you are glycogen depleted and you want to replete the glycogen now over the course of 24 hours when you go out onto the gridiron again you will have repleted you blackridge okay so you don't have to consume sugar to do that however it has been shown that the molecule fructose the sweet molecule and sugar will replete your glycogen faster if you are glycogen depleted so that's why there's Gatorade is because it will actually replete your glycogen stores fast as opposed to slow so I suppose there is a value to for the elite athlete however if you have not burned off your glycogen stores and you consume that sports drink instead all you're doing is flooding the liver turning that into liver fat because your liver only stores so much glycogen and when you get the onslaught that's gonna become liver fat that's gonna drive chronic metabolic disease and that's gonna try the insulin resistance that gonna drive metabolic syndrome heart disease diabetes etcetera so the bottom line is there's a place for it it's just shouldn't be in the supermarket it should just be on the you know on the side of the you know the football training table so when you these little kids that go to elementary school with Gatorade in their lunchbox that's pure marketing you know so that's just pure marketing so let's talk about fructose I mean you're an ex-world expert off fructose tell me the difference between fructose and and glucose and but before we do that what's the difference between Glueck and fasting blood sugar the the blood sugar we have in our body very good excellent questions okay there are three not one but three separate terms that have been misused by the food industry on purpose and that's part of what I'm doing here is helping to debunk okay one is weight because weight is now synonymous with health and that couldn't be further from the truth there are plenty of thin sick people and there plenty of fat healthy people now the second one is that because there's dietary fat and then there's the fat around your middle and they're not the same either and it turns out dietary fat does not contribute to the fat around your middle and then finally but what you just talked about which is sugar there is dietary sugar the sweet stuff the stuff in the cookies the cakes the ice cream and there is blood sugar they are not the same either so dietary sugar is two molecules hooked together one glucose one fructose hooked together high fructose corn syrup is one glucose one fructose just not hooked together free the enzyme in your intestine Cleaves that bond between them in about a nanosecond you absorb the two molecules so sucrose table sugar and high fructose corn syrup are exactly the same because they're one glucose one fructose no difference now the question is blood sugar versus dietary sugar so dietary sugars these two molecules blood sugar is just glucose now it is true that if you consume glucose your blood glucose will rise that's true if you consume fructose does your blood glucose rise no because fructose is not glucose instead of your blood glucose rising your blood front toast Rises you don't capture that in a blood glucose so there are people who say well sugar is good because it's low glycemic index this not notion that you know how high your blood glucose Rises after a given meal has something to do with weight gain and disease that is complete canard that is total trash it has got to be deposited in the circular file and I will show you why there are two reasons that that is just a bad thesis okay so it is true that if you eat something with glucose your blood glucose will rocks that is true so white bread will make your blood glucose rise fastest that is has a glycemic index of 100 okay let's take something else let's take carrots can carrots are good for you right yup vitamin A helps with the eyesight a lot alright turns orange whether carrots have a glycemic index of 94 now that's high 94 glycemic index so there are dietitians out there who say oh don't eat carrots they have a high glycemic index crap completely utter crap here's why it is true that carrots have a glycemic index of 94 so what does that mean that means that if you consume 50 grams of carbohydrate in carrots your blood glucose will go pretty high that's true it doesn't matter the reason is because how many grams of carrots do you have to eat to get the 50 grams of carbohydrate turns out you have to eat 700 grams of carrots 1.4 pounds of carrots in order to get 50 grams of carbohydrate so it is true that carrots have a high light index but they have a low glycemic load GL not GI glycemic load and that's what counts cuz the fiber mitigates all of these things because you're not gonna eat the 50 grams of carbohydrate and carrots and because you stopped eating way before that because of the fiber so that's the first reason why this whole concept of GI glycemic index is a canard because all real food is low glycemic load because all real food comes with its inherent fiber the second reason why glycemic index is a joke is because a fructose so fructose has a very low glycemic index it has a glycemic index of 19 that's very low and the reason is because it doesn't raise your serum glucose it raises your share in front dose and the problem is when you're served from toast Rises it does seven times the same level of damage that glucose does in terms of oxygen radicals in terms of what we call oxidative stress in terms of the Browning or the Byard reaction which are all the things that happen in aging so when you consume an orange juice you are aging seven times faster so and that's not captured within the concept of glycemic index so real food fixes the problem processed food creates the problem and glycemic index is irrelevant vision edge gives you less eye strain and reduced damage caused by blue light we like to call visionary I it all starts with your highest level of visual performance only achievable through scientifically proven vision edge is there a difference between high fructose corn syrup and corn syrup a slight one yes so corn syrup is like what you put in a cake all right like Cairo syrup high fructose corn syrup has had an enzyme reaction done which has taken some called glucose oxidase which has taken some of the glucose and turned into fructose to make it sweeter so corn syrup gets converted to high fructose corn syrup by an enzymatic reaction specifically to generate the fructose molecule to make it sweeter so there is a slight difference and the reaction on the body is there much of a difference a little bit I mean because you know glucose will right will make your insulin go up that's true but fructose will make that liver fat so they are not absolutely equivalent so how does fructose affect insulin so fructose does three things that glucose does not the first is fructose can only be metabolized in the liver glucose can be metabolized in all organs every cell on the planet can burn glucose for energy glucose is so goddamn important that if you don't consume it your body makes it they will turn amino acids or fatty acids into glucose okay it's process called gluconeogenesis it's what the Eskimos do it's what the people who are on a ketogenic diet do they still have a serum glucose level even though they're not consuming any glucose because their liver will make it now fructose is only metabolized by the liver as opposed to glucose where all the cells metabolized so when you consume a fructose load it all ends up in the liver the liver does not turn it into glycogen whereas it does turn glucose into glycogen and it will go further down the glycolytic pathway to a molecule called pyruvate which then enters the mitochondria and the mitochondria are those little energy burning factories you know like coal burning factories inside each cell that generate the chemical energy called ATP but each mitochondrion in your cell has a limited capacity it can be overwhelmed if you supply too much energy to a mitochondria it can deal with the tsunami it will then divert the excess back out on the mitochondria through a side door and called citrate and that citrate will then act as the nightís first during this process called de novo lipogenesis new fat making and so you will have turned sugar or fructose into fat and this is what john Yadkin originally postulated but couldn't prove we've proven it we've shown how this works and at what level and then that fat has one of two fates it can either be exported out of the liver as triglyceride remember we talked about triglyceride which increases your risk for heart disease or it won't make it out it will precipitate as a lipid droplet and now you have fatty liver disease in which case now you are insulin resistant and now you will have are at risk for type 2 diabetes so when you make fat out of sugar you're courting disaster because you're gonna die of an chronic disease and fructose is the primary driver of this process so that's one way fructose is different the second way fructose is different is fructose causes that Browning reaction the mired reaction and this is important actually for optometrists because that mired reaction is going on in the retina and it's one of the reasons for macular degeneration it's one of the reasons for cataracts because what's happening is it's denaturing the proteins in the lens because the glucose molecules or the fructose molecules are binding to it and it turns out that the my reaction is driven seven times faster by fructose than by glucose so sugar causes wrinkles sugar causes cataracts sugar causes you know eye disease in general and of course sugar causes every other chronic metabolic disease type 2 diabetes hypertension lipid problems cardiovascular dementia and part of the reason is because of glycation and oxidative stress and fructose does it seven times faster the third reason fructose is different is because fructose stimulates the reward center driving that addiction that we talked about before glucose does not stimulate the reward center it stimulates other parts of the brain but not the reward syndrome and so when you get a little sugar you want a lot more because this feels good I want more and glucose doesn't really do that you don't see people going around chugging Caro syrup that's glucose so those three pathways de novo lipogenesis the aging reaction and continued consumption because of reward those are the ways fructose is different from glucose let's talk about pre-diabetes if we could prevent people from getting diabetes what are some of the signs and some of the symptoms and some of the blood tests the labs that you recommend that people do to see if you're at risk for a pre of your pre-diabetic and at risk for becoming diabetic okay so actually all of this is going to be addressed in a new book that I am writing which will be out in March the provisional title at the moment is food Pharma feds Fiasco bill chains led what they may change that on you they may but there are five more EPS to go but behind that there's fat farm fructose and fiber and when I can't say on so I don't know we'll see that that title may change but anyway what I do is I actually tell the reader what lab tests they have to tell their doctor to get and how to interpret them because it's likely their doctor doesn't know how to ensure everyone thinks the lab tests to do is a hemoglobin a1c that's the standard test to look for diabetes that's true it is the standard test over diabetes it's also the standard test look for pre-diabetes if your hemoglobin a1c is going up you are so far behind the eight-ball the horse is so far out of the barn okay it is the last thing to change five the last thing to change okay you should be looking upstream at things that change earlier in order to be able to stop the process rather than have to recoup at that late date okay so how can you tell whether or not you have metabolic disease or metabolically ill in any way there are several lab tests that can help you answer that but first it is not even a lab test it's cheap free in fact it's a waist circumference there's a waist circumference tells you about visceral fat and liver fat and if your visceral and liver fat are up because your waist circumference is up okay you already have a metabolic problem and that's free now after that then the tests get a little bit more expensive what you need is a fasting insulin level and the American Diabetes Association doesn't believe in fasting insulin because fasting insulin does not correlate with obesity and that is true it correlates with metabolic disease because there are thin sick people and fat healthy people it's not about the obesity trying to get this through to the American Diabetes Association has you know really a string I gotta tell you another test that you need is an alt alanine aminotransferase this is a test that tells you about fatty liver now if you look at the side of the lab slip you know there's a column that has an H or an L in it high low you know why there's a column that's ten bucks and that's an interpretation you get to touch charge ten bucks for them when you look there it's because there's a reference range when the reference range for a LT is up to forty garbage when I entered medical school in 1976 the upper limit for Al 2 was 25 today it's 40 same test we went from 25 to 40 how come why 25 normal then and 40 normal now this we're all getting flattered because everyone's got fatty liver disease okay and they don't know it and so the whole curve shifted to the right so 25 is the upper limit of normal but that's not what the lamb slip says so you have to know that in order to be able to interpret it right so if your alt is 30 you got a problem already and that will show up a lot sooner than your a1 hemoglobin a1c another one that's important is uric acid uric acid is a proxy for sugar consumption and the higher it is then probably more sugar you're consuming so so proxy for meat consumption as well so you have to be a little careful in terms of evaluating but it's still very helpful so these are the tests and then of course you know fasting glucose again horses out of the barn and there are a couple of other tests that are you know a little bit more specific and selective but they cost a lot more money and you know they're listed in the book but those are the tests that I think are the most important fasting insulin alt and uric acid you pretty much can figure out who's got metabolic disease from those with your your Gatsby and you could talk about how kids that have high blood pressure from eating fructose and given allopurinol and lowering the blood pressure you can tell that story I can so the reason that people think salt is the bad guy for hypertension and I'm not gonna tell you salts a good guy for hypertension it's not a good guy but it's not nearly the bad guy it's made out to be it is true that some people about 20% of the population are exquisitely salt sensitive and Richard lifting at Yale has done all the genetics on this ok but most people can actually excrete a salt load okay all right and then the old days remember I mean how did we use to preserve fish and meats we used to salt cure them so in the old days you know prior to refrigeration we used to get 15 grams of salt a day and we didn't have hypertension today we get six point nine grams of salt on average okay and 40% of people have high blood pressure so how come we you know we're eating you know one-third the amount of salt we used to and now we've got high blood pressure and the reason is because it's not really about the salt it is for some but not for most turns out sugar causes high blood pressure and the reason is because sugar increases the excretion from the liver of uric acid when fructose or glucose for that matter but fructose primarily because it's in the liver is phosphorylated in order to prepare it for energy metabolism you have to add an a phosphate group so fructose becomes fructose one phosphate that has to come from ATP so ATP has to be converted to adp adenosine diphosphate which then becomes uric acid and so uric acid is a necessary byproduct of sugar metabolism that uric acid then leaves the liver circulates in the blood stream ba binds to an enzyme in your blood vessels called endothelial nitric oxide synthase enos and inhibits it and nitric oxide is your endogenous blood pressure lower it's the thing that relaxes the vascular smooth muscle all over your body and keeps your blood pressure down but if you're inhibiting the enzyme that makes it your blood pressure goes up and so shrimp consumption is associated with both uric acid and hypertension and if you block uric acid synthesis with a medicine such as allopurinol which is what we give people for gout you'll also make their blood pressure go down so you know this is a big issue colleague of mine Stephanie win and I once wrote a an article called just a spoonful of sugar helps the blood pressure go up yeah so people would fasting but there are patients that have high fasting blood sugar but their blood sugar is normal throughout the day the only time their blood sugar is high is in the morning what does that mean hell if I know it's not clear some people have a very high cortisol rise and so they get a bigger blood glucose boost in the morning some people don't you know some people you know have glucokinase mutation and so they're not clearing blood glucose at the same level so they tend to run higher blood glucoses really it's the postprandial glucose excursion that dictates what's going to happen so that higher blood glucose in the morning may or may not be a problem you know I mean certainly pre-diabetics if it's a sign of pre-diabetes then you know yes you need to deal with it our insulin level have gone up over the last 4050 years like two and a half percent or more or more fold which is more dangerous high insulin high glucose are they equally dangerous why don't doctors check for insulin right very good question but again so the answer is they're both important they both predict disease but they predict different diseases so high blood glucose predicts micro vascular disease small vessel disease retinopathy nephropathy neuropathy the small vessel disease of diabetes okay and so glycemic excursion will contribute to small vessel disease no argument there absolutely but insulin contributes to large vessel disease like coronary disease or aortic disease okay or you know iliac you know louisa senator love you know not enough blood going to the to the legs and that will kill you just as well and so it's been shown many times over now in numerous studies the UKPDS the advanced study the Accord study that control of the blood glucose in type 2 diabetics will reduce your hemoglobin a1c will reduce your nephropathy neuropathy and retinopathy that's true and you will die just the same and you will have died of heart disease anyway and the reason is because you have actually made your large vessel disease worse by giving more insulin and the reason is because insulin has its own effects because it causes vascular smooth muscle proliferation so insulin has two separate pathways in the cell one is called a K T and a K T is the metabolic piece of insulins effects and getting a KT up will get your glucose down which is why the small vessel disease gets better but there's a second pathway that insulin effects and it's called map kinase map kinase is the cell proliferation pathway and so insulin is a growth modulator it is a cell proliferator it causes vascular smooth muscle proliferation it causes cancer high insulin drives cancer causes cell division well you don't want that the problem is every Unser molecule gives you both at the same time you can't dissociate those two you know sub cellular pathways so insulin is both good for you and bad for you the goal is get your insulin down by being insulin sensitive that's the goal so that's why they're both important but for different reasons what are the best ways to get insulin levels down real food are there any supplements that you could recommend people that switch to real food but they still have high insulin is there a genetic component because I've seen it where they go to real food they go low carb they do everything that's supposed to there they're fasting and to our insulin is still is still high what could help them right I I know what you're talking about so real food will help the overwhelming majority of people yes there are some outliers who do not seem to be helped as much those people might need a ketogenic diet or you know a very low carb diet and I would try that first there are other medicines that can help with insulin sensitivity like metformin so that Foreman is I you know definitely you know back pocket drug that we use pretty routinely in terms of trying to improve insulin sensitivity and the reason is because metformin works in the right place it works on the liver which is where it's needed and it also works on the processes that are driving chronic disease okay it's working on both insulins that resistance sentence also working on auto AG which is the clearing out of senescent dead cells which is one of the problems in in chronic disease so it's it's well targeted so metformin is a good adjunct to dietary change but metformin won't work without the dietary change you got to do the dietary change first anyway and then there are some other drugs that are being you know tried that are in clinical trials to try to improve things as well there's some longevity drugs that are sort of out there like anything right aside other things as well so but they're not they're not really ready for primetime yet because then you bring up nad some people are recommending metformin as anti-aging yeah absolutely you know Barzilai at Albert Einstein College of Medicine is doing an entire double-blind placebo-controlled trial of that form in an agent and I understand why that could work and should work and I'm for it you know in terms of the trial I am for it in terms of everyone going out they can't perform and how about this nad use what kind of potential you see what they potentially it also acts at a specific place in the aging pathway it's possible it could work but it certainly works in the dish but you know getting a some cellular nutrient to the right place in the cell is actually a lot harder than a books so the fact that it works in a dish it doesn't mean it works in a person and I know that there is a company you know Elysium you know that that's specifically you know you know targeted to this issue and I know Lenny warranty from MIT we've had coffee together twice we're going to panel together you know it's it's it's yet to be determined let's talk about some of the medications that he use for diabetes medications that raise insulin such as the sulfur your ears insulin itself and what what how about some of the new medication such as the sglt2 inhibitors so these are all for diabetes they're not for insulin resistance per se the sglt2 inhibitors seem to be a useful adjunct for treating the diabetes and the reason is because it gets the blood glucose down because it makes the kidney lose glucose that's what so if it's leaving the blood stream through the kidney not so bad right and we're still trying to figure out whether or not all that glucose was running through the kidney is hurting the kidney or not there's some data suggesting that maybe there's that's not so benign here's the problem what you were doing there with any of those drugs is you are treating a symptom high blood glucose you are not treating the cause which is the metabolic dysfunction that belies the diabetes so high glucose lower glucose that's treating the symptom my glucose is a symptom of the problem not the problem high LDL treat the LDL we're treating a symptom of the problem you're not treating the problem the problem is the metabolic dysfunction underneath high blood pressure treat the blood pressure we're treating the symptom of the problem you're not treating the problem you have to work upstream of the problem to treat the problem if you're treating the symptom horses out of the barn and while treating the symptom is better than treating nothing the problem is still there and it's still going on underneath and it's still gonna make you die so having fixing the problem before the problem occurs preventing the problem is what we should be doing and we're actually in a sense deluding ourselves that were fixing the problem by giving these medications I have to ask you about baby formula it's like a milkshake there's so much there's so much sugar and baby formula well so it depends on which formula so I mean there's lactose containing formula like Similac and ice and though not as bad although turns out Similac does have sugar I said no not so much eat johnson has done a better job than Abbott in terms of you know clearing the sugar out of there out of the formula lactose free formula so ice in though that's the big problem because what they did was they took the lactose out they put sucrose in so ice ml is ten point three percent sucrose a coke is 10.5% secret it's a baby milkshake so for parents that have to use baby formula if they're a brand there's a type that you happen to know offhand that you would that you could recommend like someone who adopted a child and they can't nurse right so obviously there's a reason for formula and it's not that I am against formula I have to be for formula I'm a pediatrician okay if you didn't have a formula there would be a lot of babies who would be dead all right the point is the formula should be a last resort not a first one okay like so many things in our society we've you know done things for convenience okay formula should be a last resort I'm not here to you know promote or pimp any formula for what from what I would say is that there are a lot of kids who are put on lactose free formulas who don't need to be that's a common thing that pediatricians do is they say oh you know kid had a little diarrhea let's put the kid on a lactose free formula that is not a wise choice you should be trying to use a lactose containing formula and and you know which formula I'm going to leave to you know the pediatricians discretion how about smoothies you see these smoothie places opening up all over people think they're going in there getting health food right of course well so here's the thing is that a fruit smoothie err is a green smoothie so if it's a green smoothie no fructose what is green if it's a fruit smoothie lots of fructose the thing that prevented the absorption was the fiber but as soon as you stick the fruit in the Breville or the Vitamix or you know whatever the magic bullet or whatever you use it okay what you've done is you have sheared the insoluble fiber smithereens take all that stringy stuff it's gone because it has been just chopped up into such little pieces you can't make that fish net anymore so you can't plug the holes because there aren't there's no fish net to plug the holes up and so what it does is it increases the rate of absorption and so you flood the liver now it is true the soluble fiber is still there you haven't destroyed that because those were globular that's not going to be sued by the blades and the soluble fiber does have its own inherent benefits for instance it gets turned into short chain fatty acids which can be anti-inflammatory by the colonic bacteria so there is still a potential benefit but the main thing is whether or not you set up that gel and when you put the fruit fruit in this movie machine you ain't gonna get no gel you are done so I think that is not such a good idea now if you want us cure a or you know smoothie your green vegetables to get them down because you refuse to eat them whole whatever have at it you know there's no fructose to limit the absorption of you're not gonna flood the liver it's your choice so as we're getting close to the end just if you could give us your plan to get healthy I know it's really kind of simple you know real food and feed your gut but if you could go into that in a little bit more detail okay so if you've got walk into the grocery store okay you've already lost the game because you are now under attack I mean you're going to attack from in every end cap and every sale item and everything that's in the store you have to go into the store sing with a single-minded focus okay it has to be ate a moment of concentration okay what do I need all right and if you go in hungry you're you're lost okay it's alright you're already in trouble you have to stay out of the aisles okay you have to shop the perimeter like they tell you and even when you shop the perimeter you have to be careful about shopping the perimeter like for instance the yogurts on the perimeter and the free you know the refrigerator case what kind of yogurt are you gonna buy you're gonna buy plain yogurt which has 7 grams of sugar all lactose okay fine or you gonna buy a strawberry yogurt which has 23 grams of sugar now you tell me which one you good bye so you still have to be careful there are still lots of lots of things you can do to screw up your grocery store experience but if food has a label it is a warning label real food doesn't have a label because it doesn't need a label because nothing was done to it the problem is that real food number one costs more number two takes more time to produce you know to prepare at home so that has to become sort of become a priority that has to become important to you in terms of what you think your time is best spent doing and most people haven't yet figured out that this is really important and that those those extra minutes translate into extra years and so you recoup it another thing that people don't understand is the role of exercise and it doesn't have to be vigorous exercise 15 minutes a day of walking will extend your life by 3 years 15 minutes a day will extend your life by 3 years now if you do 15 minutes a day times 3 years you get 279 hours that's 279 hours of walking in a three-year period but you get 3 years so let's forget about the sleeping time let's just do the the the waking time okay so 16 hours a day times 3 years okay so that is a fifty five hundred percent return on investment that's an ROI of fifty five hundred percent now if you were in the stock market how would you feel if I offered you a fifty five five hundred percent ROI thing you'd be friggin clicking your heels okay so that's a pretty good deal and it does very good things for these eight subcellular pathologies that are underlying disease so if you ate real food and you walked 15 minutes a day you are so far ahead of the game it's not even funny what could you do after that you know obviously Food Matters maybe some you know if you are old you might need a supplement or two there are you know for instance vitamin D has been shown to be anti-inflammatory it might actually be very important in this whole Koga 19-story you know we're working on that and then you know and vitamin C as an antioxidant might be helpful as well so you know and and Oh finally omega-3 fatty acids really important no one gets enough unless you live on a coast and you live in a fishing village and you get fishel with no so I said you have a comment about helping to prevent getting covert as far as diet and nutrition well won't help you nothing will prevent you from getting it okay if you're in the wrong place at the wrong time you're gonna get it okay ain't nothing you can do about it except you know social distance and wear a mask and you know wash your hands that's how you've proven getting it well if you got it the way to prevent from dying from it that's what we want to know how do you die from it turns out let's look at the three demographics that are at most risk aside from the elderly who have their own you know immune issues blacks and Latinos obese diabetics blacks and Latinos obese diabetics those are the people who have much higher rates of dying from koban 19 what is the what are what is the one thing that ties our those three demographics together processed food blacks and Latinos sick 2% more processed food than Caucasians obese clearly and diabetics diabetes type 2 diabetes is processed food disease so there are reasons having to do with the receptor on the cell called ace 2 angiotensin converting enzyme - that's the portal that's the place where the virus injects its RNA into the cell that's its entry way and it turns out that insulin resistance makes ace to levels on your cells go sky-high so basically you're giving yourselves more places for the ACE to the for the virus to enter also process food because of those colonic bacteria can make butyrate computer rate is immunosuppressive and so you can help suppress the cytokine storm and then diabetes because of the high blood glucose seems to do something to that ace - that holds it open and also it got Consulate's that that spiked protein that they're talking about which seems to make it more variant so it's kind of like holding the thing open so all three demographics groups that are made worse by you know that have the highest death rates due to kovin 19 or it's almost assuredly due to our process with diet so real food is a great way to go especially since this thing's gonna be around for a while in general do you have a feeling about intermittent fasting yeah so why is it even fasting work works for two reasons one it clear it gives your liver chance to clear out the fat that was developed and the question is why'd the fat end up there in the first place because he ate crap that's why so if you ate crap you wouldn't have any liver fat that you needed to get rid of so that you know start with eating right and then you wouldn't have to intermittently fast but if you're already sick intermittent fasting is a way to deal with it the second reason that intermittent fasting works is because that intermittent fasting actually stimulates that process we call talked about called Auto Fuji and notify G is like garbage night what it does is it clears out all the old dead cells if you don't clear out all the old dead cells guess what you're living in a pigsty and if you're living in a pigsty okay you can't build new proteins on top to sort of you know we we you know re-engineer your cells to be to be healthy and so the process of getting rid of old of senescence cells and you know material that's been used up okay that happens you know throughout your body and it especially happens in your brain and it is why you sleep sleep is garbage night for your brain every night and you need it and if you don't do garbage and I guess what you die so you know this process of autophagy is extraordinarily important in terms of metabolic health and intermittent fasting has been shown to induce the enzymes that stimulate a talk which is your favorite way of intamin fasting probably the eight hours on 16 hours off makes the most sense and doesn't matter when the eight hours are I don't think I know what's shown that it matters I think you know if you do like you know 10 a.m. to 6 p.m. I think you're fine I have to ask you one last question I have a 10 year old and I have obviously friends that have 10 year olds and these kids are are addicted to these computer games these games I know this can't be good can you know about the bad things about it if there's anything good and how to get them from using them yes someone's gonna win the Nobel Prize it's not gonna be me this is problem I mean look if something toxic and addictive we keep it out of the hands of children okay toxic and addictive we keep it out of the hands of children we keep alcohol out of the hands of children we keep cocaine out of the hands of children we keep heroin out of the hands of children we keep nicotine out of the hands of children right there are two things that are toxic and addictive that we handed children and call it love sugar and technology all right they're both toxic and addictive and it's been shown well you know we've got the studies to demonstrate how that is but we haven't done anything about either of them and one of the reasons I think is because the adults are addicted to so the first thing we have to do is we have to role model for our kids because like why in the world should they stop what we do it too crazy rank if these video games how I think that they are and they're and they're created to be so well I want to thank dr. Robert let's take he's a wealth of information for joining me today dr. Lustig if somebody wants to find you I know it's not that difficult but if they find you way through they go so I have a website called Robert Lustig comm so that's a good place to start I'm on you know the Internet in various places Linkedin etc you know I'm I'm pretty darn easy to find I do answer my email so you know and my email is not you know unlisted so you can find me pretty easy I feel funk phone calls and emails from people right now I'm writing a book so don't do it right now I love that cartoon they made of you on your website it's almost perfect don't ever do that they did a great job again thank you very much for joining me today dr. Robert Lustig this is dr. Carey gal4 open your eyes until next time thank you [Music] since I bought safe for you my dad makes me clean is both its natural yes un producto every time I go back to school my mom always make sure that I have my seat for you products I bring extra I my roommate certainly don't mind it's a good thing I have safe for you to clean up after this one okay when my hands get dry I like to wash them with safe for you and most importantly the reason why I buy safe for you because it's safe for me and you

Channel: Dr. Kerry Gelb

Views: 37,263

Keywords: diet, sugar, longevity, lifestyle, health, wellness, podcast

Id: gYfiSBcpok8

Length: 67min 6sec (4026 seconds)

Published: Mon Jul 13 2020