Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine.

become a sustaining member of the commonwealth  club for just ten dollars a month join today greetings and welcome to today's program this  meeting of the commonwealth club of california   i'm patty james of the club's health and medicine  member-led forum and chair of this program   and now it's my pleasure to introduce dr robert  lustig dr lustig is a professor emeritus of   pediatrics in the division of endocrinology  and member of the institute for health policy   studies at the university of california san  francisco dr lustig is a neuroendocrinologist and   an international authority on obesity diabetes  nutrition and neuroscience dr lustig graduated   from mit in 1976 and received his md from cornell  university medical college in 1980 he completed   his pediatric residency at st louis children's  hospital in 1983 and the clinical fellowship at   ucsf in 1984. from there he spent six years at  a research association in neuroendocrinology at   the rockefeller university in 2013 he received his  master's studies of law from uc hastings dr lustig   is one of the leaders of the global anti-sugar and  real food movements to improve global health he is   author of over 200 academic works which connect  the science of food and metabolism to the policy   and the politics of obesity and diabetes pandemics  he also comments on the role of industry tactics   to promote hedonic substances and behaviors  and the resulting aftermath of health care   and societal devolution dr lustig is the author  of the new york times bestseller's fat chance   beating the odds against sugar processed food  obesity and disease the hacking of the american   mind the science behind the corporate takeover of  our bodies and brains and of course uh the reason   that we're here today and that he'll be talking  about his book new book metabolical the lure   and lies of processed food nutrition and modern  medicine welcome dr lustig oh thanks so much for   having me patty i got to tell you i don't know who  you were talking about but that was a really long   introduction it's amazing isn't it wow well and  that's that was the short version just so you know   so so you're a physician who also went to law  school and in my mind metabolical is you making   your case so you weave together the dangers  of processed foods and what it's doing to our   bodies nutrition well or the lack thereof as  well as modern medicine which a no holds bar   approach to certain medical establishments such  as the american diabetes association and others   and of course the effect that the aforementioned  have on our economy um we're not going to talk   a lot about economy today because i do  know you're talking to jeffrey sachs the   very well-known economist at at the end of the  month so what i let let's start with um how is   metabolical um different from fat chance and  then after that we'll go into the two main   tenets which i'll talk about in a moment  so how's it going thanks for asking so um   the standard mantra that you know the  world learned was you are what you eat and   when i started doing research it became very clear  that that was not the case and so in fat chance   i stated my case that in fact you are what you  do with what you eat that actually metabolism   is even more important than nutrients or calories  well to be honest with you i got it wrong too   and over the last eight years more and more data  has come forward and i came to realize i needed to   restate it as well and now metabolical states you  are what they did with what you eat in fact it's   the food processing that takes food and turns it  into poison it's a basically a wicked alchemy that   makes you think you're eating healthy but  actually killing yourself and you know that   sounds rash and it sounds strident but in  fact you know that's what the data show   okay yeah so everything in this book and again  we talked a little bit about what everything   that's in this book but everything in the book  goes back to two main tenets and that is protect   the liver and feed the gut so so let's start  there and then we'll go into chronic illnesses   and and then you know what are we having for  dinner based on everything that we just learned   so the liver what are we protecting it from right  so first of all you have to understand that nobody   knows what the word healthy means in fact the fda  uh has a definition and it's ridiculous it says   low in saturated fat has vitamin d and enough  potassium and um yeah no it doesn't say forward   oh okay usda refuses to define healthy in part  because then if they defined it then um well   the food industry couldn't put healthy all over  its packaging um the fact of the matter is no   one knows what healthy is and so you know  people get away with uh true truly murder   um i define it and i define it scientifically  and the two precepts are protect the liver   feed the gut 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 the   empiric data actually bear this out all right so  protect the liver you know protect it from what   protect it from the onslaught of mono  and disaccharides simple sugars and   starch breaking down to glucose because the  liver has a limited capacity to metabolize   those molecules and if you overwhelm the liver's  capacity if you provide a tsunami of sugar early   on in the duodenum you know after the stomach it  goes straight to the liver the liver can't handle   it and it takes the excess and turns it into liver  fat and that's when chronic disease starts if the   liver can export it out it's triglyceride and it's  a set up for heart disease or for obesity if the   liver can't export it out then it precipitates  in the liver as a lipid droplet now you've got   non-alcoholic fatty liver disease and you have  the set up for type 2 diabetes and cirrhosis and   all the other diseases that go along with insulin  resistance such as cancer and alzheimer's so   bottom line protect the liver you  also have to protect it from branch   chain amino acids which most people think  are good and if you're building muscle they   are good but if you're not building muscle  then they get turned into liver fat as well   protected from iron which is an oxidative  stress protected from uh glyphosate you know   roundup um you protect it from uh heavy metals  which you know we've now found in baby food so   protect the liver the liver is your detoxification  organ but it has a breaking point and we are   way beyond it so that's part one part two feed the  gut feed the gut what well the gut the bacteria   in your gut they eat what you eat the question is  how much did you get versus how much did they get   if you starve the gut the gut gets  unhappy those bacteria will feed on you   they will strip the mucin layer right  off your intestinal epithelial cells   to provide its own food at your expense and now  the bacteria are opposed right to your intestinal   epithelial cell with no barrier and that starts  in irritable bowel syndrome inflammatory bowel   disease leaky gut the transfer of cytokines  and lipopolysaccharides and whole bacteria   into your portal vein now you've got systemic  inflammation and that if it even gets to the brain   can actually cause behavioral health disorders  such as depression or even psychiatric disease   like psychosis so the bottom line is you have  to feed your bacteria if you feed your bacteria   your bacteria will be happy and the pro the  question is well what do they eat well they love   fiber soluble and insoluble and  unfortunately processed food of course is   fiberless food on purpose because you can't  freeze fiber prove it take an orange put it in   your freezer overnight take it out in the next day  let it thaw try to eat it see what you get you get   mush how come you get mush the ice  crystals macerate the cell wall inside the   orange the water rushes in turns it to mush hey  food industry knows that but they can squeeze it   and freeze it and now it lasts forever now it's  frozen concentrated orange juice you can sell it   on the commodities exchange storable food so  an orange is not a commodity but orange juice   is all right so they've processed it to reduce  depreciation increase profit the problem is   they just deprived your microbiome of what  it needs to survive and so you get sick yeah   let's go back to the liver for a little bit um  i've heard uh you say that there are uh when   people go for their yearly physicals um sometimes  they have their their liver tested just you know   i want my liver test how's my liver doing  type thing but you mentioned that um the lab   tests have changed since the 1970s basically  that the goal posts have moved so so talk about   if somebody wants to make sure that their liver  is healthy or then what lab tests should they get   and what are their doctors going to tell them  right so the biggest issue is that your doctor   doesn't know how to figure this out and i know  because i'm the one who has to teach it at ucsf   so i know what they're what they're teaching and  i know what doctors are not learning so you order   your chem pad you know your doctor gets your  chem panel and a whole bunch of tests come back   one of those tests is particularly interesting  it's called an alt alanine amino transferase   now next to the alt will be your number and then  there'll be a a column where it'll say high or low   okay and it'll say the reference range  now that reference range says that an alt   up to the number 40 is fine that that's the  break point for abnormal is 40. no it isn't   it's 25. how do i know that because when i entered  medical school in 1976 the upper limit for alt was   25 but today the upper limit for alt same assay  is 40. how come yeah answer because everyone has   fatty liver disease today 45 percent of adults in  america have fatty liver disease and nobody had   fatty liver disease except alcoholics back in 1976  the entire curve has shifted to the right now the   lab doesn't know that the lab thinks oh you know  they're healthy so they take you know the median   and they find two standard deviations from the  mean and that's where they cut do the cut points   and that happens to be at 40. so they say well  if you're below 40 it's normal so you go to your   doctor and you've got a 33 on your alt and the  doctor says well your tests are normal no they're   not not even remotely the point is and that's  very sensitive not specific but very sensitive   that alt your doctor doesn't know that because  your doctor wasn't in medical school in 1976   so how are they going to figure this out when  that's not what's there a second test very similar   uric acid so uric acid is what causes gout it  also causes hypertension it also is a marker   for metabolic syndrome as well the upper  limit of normal on the lab slip is seven   no it's not it's 5.5 if you're if you have a  uric acid over 5.5 that's a question mark to be   sure and the reason is it's a proxy for  sugar consumption it's also a proxy for   protein consumption but it's a proxy for sugar  consumption so more sugar means more atp loss   because the fructose has to be phosphorylated and  there goes the atp down to adp and then that goes   to uric acid uric acid is the endogenous inhibitor  of an enzyme in your blood vessels that keep your   blood pressure down called night endogenous nitric  oxide synthase so if you inhibit that your blood   pressure goes up so you know people think salt is  the big problem with blood pressure you know our   ancestors you know because everything was salt  packed and salt cured back on those schooners   back in the atlantic ocean before there were um  you know steam engines or refrigerators you know   they had to basically pack all the fish and salt  our ancestors consumed like 15 grams of salt a day   and they didn't have hypertension and the reason  is because their kidneys could excrete out the   rest but insulin the hormone insulin causes the  kidney to resorb all of that excess sodium and   that's what raises the blood pressure the question  is how come the insulin is high it's the sugar   so if you get rid of the sugar in your diet you  can actually excrete all that sodium and your   blood pressure will go down and i actually wrote a  paper years ago just a spoonful of sugar helps the   blood pressure go up so you got all these people  worried about salt really what they should be   worried about it should well you know gout used to  be called you know the the disease of uh of a rich   person who could afford to eat that kind of food  that's right and now it's sort of the opposite   it's the junky food and then you talk about  insulin and you talk about sugar and we talk about   fatty liver and it's all tied in uh yeah sugar  but the ultra processed food i i think when people   next time everybody who's listening goes to  their doctor and wants to get their liver   tested based on what you just told us that they  should be doing and watching for i think there   a lot of people right now think well i don't drink  that much alcohol so my liver is fine without   putting it in their heads that yeah alcohol is  damaging but it's spelled to process food that's   doing the bulk of the damage well in particular  the sugar in the in the ultra processed foods   so 56 percent of all of the food consumed in  america today is ultra processed and that's 62   of the sugar load is in the ultra processed food  so you know you are getting a big dose if you are   basically you know going into the aisles of the  supermarket that's where it's coming from you know   people say well how can sugar be doing that and  the answer is sugar is like alcohol because sugar   and alcohol are metabolized in the liver virtually  identically and it makes sense that that'd be the   case because after all where do you get alcohol  from fermentation of sugar it's called wine we   do it in epinephrine every day the big difference  between the two is that for alcohol the yeast does   the first step of metabolism called glycolysis  for sugar we do our own first step but after that   the intermediate pyruvate that goes to the  mitochondria mitochondria don't care where it came   from all it knows is it's being overwhelmed and  then it has no choice but to take the excess and   divert it via a process called de novo lipogenesis  into liver fat and once that liver fat gets made   that's when the chronic disease starts and that's  what the empiric data show and 45 of americans now   have fatty liver disease when zero percent had  it in 1980. so two things um and of course uh   um children and fatty liver disease uh there's  two things but that's that's the first one that   comes to mind right now so talk about children and  fatty non-alcoholic fatty liver disease right so   you know children don't drink alcohol yeah 20  of children who die at autopsy have fatty liver   today and 40 percent of obese children and the  question is well where did the fat come from   well if it didn't come from alcohol where it came  from the sugar and that's why children now get   two diseases of alcohol type 2 diabetes and  fatty liver disease these were the diseases   of alcoholics these were the diseases of aging  and now five-year-olds get it okay and that's   one of the reasons why i had to write this book  is to make people understand that children are   the canaries in the coal mine if children are  getting the diseases of aging if they're getting   the diseases of alcohol okay you know something's  wrong so the question is what's wrong well it's   the ultra processed food and the science shows  it now um i want to talk about glucose but first   let's finish up something on ultra processed  food there's processed food and there's ultra   processed food hamburgers are processed food it's  been ground up you know so there's there's that   so explain the difference between processed food  sure and ulcer processed food so my colleague dr   carlos montero at the university of sao paulo has  set up a very good method for thinking this out   it's not the nova system and i like it very much  and it actually the the data fit you know that   it's been validated so here's a way to think  about it let's take an apple all right an apple   is unprocessed and an apple also does not have  a food label because you don't need a food label   for nothing for a food that's nothing's been done  to so there's no food label for an apple or for   a broccoli or for a radish or for an orange  for that matter okay that's nova class one   next let's take apple slices so it's been  processed it's been sliced it's been potentially   de-stemmed maybe the seeds have been removed  etc okay and they put them in a you know plastic   bag that's got a food label because something's  been done to it that's nova class 2 not too bad   next let's take apple sauce so applesauce has gone  through a vitamix or a breville or something to   basically you know chew the fiber to smithereens  maybe sugar's been added maybe not you know some   are unsweetened okay that would be nova class  three and finally let's take an apple drink okay   you know like in one of those little packages  like a capri sun okay is there any apple left   in that well you know maybe there's a little  bit of juice that started it but there's also   preservatives and there's uh added sugar etc and  all the fiber has been removed that would be nova   class 4. so you go from apple to apple slice to  apple sauce to apple drink and it's the apple   drink that's the dangerous one now people might  say they understand that oh yeah okay fine   but in fact that's 56 of our current diet and  that's what's killing us and there's data from   france there's data from the uk there's data from  the u.s now that demonstrates that nova class 4   that predicts disease and that unfortunately  is what the food industry is selling 90   of the food in our diet today is controlled  by 10 conglomerates bottom line if a food has   a logo you've heard of it's ultra processed and  it's also all the uh you know the food colorings   that you want i don't generally walk down the food  aisle or the soda aisle i don't need that kind of   food but you walk down and all the colors that you  know you're an onslaught of colors and and i see   the other day a couple days ago that the eu is now  um warning not to consume titanium dioxide and so   it's it's the apple is like you said the class iv  is maybe an ultra processed food but i think of   things also that people eat all the time which  are chips and candy and cereal if you want to   call it cereal it's really just sugar um that have  all these additives in it and i've heard you say   it's it's not just the food it's what they do  to the food i think you mentioned that earlier   but it's all the additives that's right it's  not what's in the food it's what's been done   to the food that matters all food is inherently  good it's what we do to the food that's not   let me give you another example meat so you  buy the meat in the store and there's no   food label right right okay so you think  everything's okay right necessarily depends   that if that animal grew up on a cafe yeah on  a concentrated animal feeding operation say in   kansas okay where it's lying in its own excrement  okay uh that animal in order to survive in order   so that animal didn't die of dysentery  of its own you know of the the bacteria   from some other cow okay they had to  pump that animal full of antibiotics   okay and those antibiotics guess what they're  they've changed that cow's microbiome and we can   talk about the methane story because that's where  the methane comes from is the change of the cow's   microbiome but it also pervades the meat and so  then we eat that meat it changes our microbiome   and so now we are not feeding the gut we are  actually causing gut uh dysfunction in the process   and that food you would think is non-processed  well actually if it's grown on a cake if that   animal has been fed on a cafe it's processed too  so you know you have to know the tricks of the   trade you have to know what's been done to the  food and the problem is that's not on the label   and the food industry doesn't have to disclose  any of that which is why i had to write the book   so i want to explain to those listening if  you see me looking over uh not at you or not   at rob dr lesbig i'm looking at my questions  which i haven't looked at at all quite frankly and i i have a lot of audience  questions that i'm going to read   to see if it's appropriate to ask any of them  now but in the meantime you mentioned insulin um   but you you haven't explained glucose so if  you would uh insulin but glucose well i i   listen and read these comments absolutely so the  the point is people think glucose is the problem   that the glucose excursion the rise in the glucose  is the problem well in fact the rise in the   glucose is really a proxy for the rise in insulin  because the higher the glucose goes the higher the   insulin goes and it's that insulin that drives the  chronic metabolic disease so what does insulin do   well diabetics take shots of insulin it lowers  blood glucose i i hear you okay and god knows if   you're a diabetic and you're on insulin you know  i'm not telling you to stop your insulin shots   however however you have to understand that  insulin has two functions the first is metabolic   and the second is cell growth there are two  separate signal transduction pathways in each cell   one is to take up glucose and that will lower the  blood sugar and that will help with retinopathy   nephropathy neuropathy because high blood glucose  causes small vessel disease okay and so that's   one of the reasons why diabetics have to get  their blood glucose down they have to get their   hemoglobin a1c down is to prevent retinopathy  nephropathy neuropathy and i'm for that i'm not   against that that's good however the insulin also  drives a second pathway called map kinase and that   causes cell division it causes coronary artery  muscle smooth muscle cell division well that   tightens up your coronary arteries and makes  it much more likely you'll have a heart attack   it does the same thing in your carotid arteries  that's more likely you're going to get a stroke   and also that insulin is driving breast glandular  cells causing increase in division rate and making   it much more likely you will end up with cancer  and we have learned that insulin is the driver   not of cancer initiation but of cancer growth so  you got to get the insulin down now glucose is the   thing that makes insulin go up right that's one  of the reasons why the ketogenic diet has taken   you know the world by storm if you will is because  it keeps your glucose down therefore it keeps your   insulin down and that is true if you can stay on  it which is not so easy and it's actually very   difficult to stay on the ketogenic diet but what's  missing from that calculus is the fructose so the   fructose is the sweet molecule in sugar it doesn't  raise the serum glucose it raises the serum   fructose you don't measure that in the glucose  test now it turns out that serum fructose is   way more dangerous way worse seven times worse and  actually at the liver it's 250 times worse and we   have now learned that is that fructose even though  it doesn't make the insulin go up immediately it   causes the chronic metabolic disease because it  generates the insulin resistance in your cells   particularly in the liver and that raises insulin  levels all over the body and now chronic disease   is off to the races um i i'm going to mention  right now and then it's appropriate to ask some   of these questions but first i want to tell people  when you do get dr leslie's book and read it which   i recommend that you do it's amazing there are no  references in the back because there are what 1100   references and it would have made the book 70 page  longer and cost like what do you say five dollars   yeah yeah so all the references everything that  dr lustig is talking about today is available   all the references are in the book but they're not  actually printed in the book it's the first time   that harper collins has ever done this because um  there's so many references it's actually available   online i just wanted to mention that briefly  so you can go to metabolical.com and that will   um you will see all the references sorry about  that you'll see all the references 1054 references   to the primary literature okay we're not talking  about you know like to you know newspaper you know   uh you know fan mail we're talking about you know  hardcore science for those of you and i actually   wrote this book to be uh usable in medical schools  you know to teach nutrition to medical students   and so it's got all of the data and all the  references needed to you know make the case okay   so um some of these questions might be more  appropriate for when we get to the um the   diet section at the end of our talk today keto and  vegan and everything else but like the first very   first question here was is about gmos we're going  to get back to that but um i think i'm going to   you've already brought up branch chain amino acids  and um there are questions um that one question is   about would you not consume protein powder as  a protein supplement unless the individual is   working to build muscle i believe you already  answered that um you say that too many branched   chain amino acids are are not good for you but um  so unless you're building muscle um you would not   recommend protein powder as a protein supplement  that's right i mean basically muscle is 20   branched chain amino acids so if you're building  muscle and you're pumping iron and you're going   to the gym and you're a gym rat you know then have  at it because that's you know you can't build the   muscle without those brain stimulances and they're  all essential amino acids you have to consume them   your body can't make them so i understand that  however what if you're not a bodybuilder what   if you're mere mortal like me and you're consuming  excess branched chain amino acids which by the way   are higher in corn fed beef chicken and fish okay  because that's what's in corn those branched chain   amino acids well now those branched chain amino  acids go to the liver i mean you're not building   muscle so you've got this excess what happens to  it they go to the liver the liver takes the amino   group off now they're branched chain organic acids  they enter the krebs cycle the tri-carboxylic acid   cycle which burns it to go to atp it overwhelms  the mitochondria's capacity to be able to do it   throws it off as citrate and then that citrate  then causes that phenomenon called de novo   lipogenesis that i mentioned earlier new fat  making so branched chain amino acids result   in liver fat and insulin resistance also this is  work of dr christopher neugaard at duke university   okay um impact of of the processed food  which we're also talking about now but   on the brain you mentioned the brain i think  you might have already answered this question   because you mentioned the brain a little bit uh  so is there something you want to add about um   highly processed food and brain you can you did  say they can lead to you know depression and other   things but so we've always assumed glucose  is the energy of the brain and that is true   it is but we're also learning that fructose  gets across we never thought it did but it does   and it seems to actually poison mitochondria it  poisons mitochondria in the liver that we're sure   of and it seems to putting some mitochondria not  in the neurons per se but in the astrocytes and   the astrocytes are the ones that feed the neurons  and so if those mitochondria are being uh altered   or and are now defective you can imagine that  might have effects on cognitive function might   have effects on behavioral health and so we  are now learning that you know that there are   certain metabolic uh abnormalities in the brain of  people with for instance major depressive disorder   possibly schizophrenia and now there's a  whole move afoot on using the ketogenic diet   to treat for instance bipolar disorder in fact i  just had a meeting about this issue just yesterday   at ucsf so there is um you know that there's  a wealth of information about how food affects   the brain and the this probably the single most  problematic food stuff in terms of brain health   is sugar yeah we have a lot of questions about  fruit um can because you mentioned you know   orange juice and you freeze it and then you  know and people going people asking well i   buy frozen berries is is that not good now um  how many pieces of fruit can i eat a day and um   and also uh yeah it's a fruit but it's  been fermented how much alcohol can i drink   so um lots just about fruit taco talk about fruit  a little bit because people everybody everybody   wants to know about fruit i mean yeah they hear  fruit doesn't go for oh fructose and fruit yes   well the amount of sugar in a p any fruit okay  is dwarfed by the amount of fiber and the fiber   it prevents that sugar absorption from the gut  into the bloodstream you are protecting the liver   so there are two kinds of fiber in  fruit soluble and insoluble okay soluble   is like pectins or inulin things  that like would hold jelly together   cellulose cellulose is like insoluble fiber the  stringy stuff in celery all right so you need   both fruit has both now if you consume a piece of  whole piece of fruit you are getting both and what   happens is the insoluble fiber forms a latticework  on the inside of the duodenum like a fishnet   the soluble fiber are globular those molecules  are globule they plug the holes in the fishnet   you can actually see it on electron microscopy  this whitish gel that forms on the inside of   the duodenum and that acts as a secondary barrier  and that prevents early absorption of all of those   mono and disaccharides all that sugar from getting  to the liver so you are protecting the liver   well if you don't absorb it early what happens  to it well it goes further down the intestine   goes to the next part of the intestine called  the jejunum and that's where the bacteria are   and so the bacteria will chew it up for its  own purposes so even though you consumed it   even though it passed your lips even though it  registered as a quote calorie unquote okay we'll   do that later in fact you never absorbed  it because your bacteria got it instead   so you are feeding your gut so you're protecting  your liver and you're feeding your gut so even   though you consumed the fruit the sugar wasn't for  you it was for your microbiome so fruit is fine   now if you strain that fiber out if you put it  in a breville or a vitamix and you basically   destroy the insoluble fiber and shear it to  smithereens you can't set up that fish net you've   basically cut too many holes in the fish net for  it to work to be a barrier and now the mono and   disaccharides will flood your liver just like  i talked about before and so that's not so good   now the soluble fiber will still be there so you  might be feeding your gut and this is a case like   i said at the beginning where you know it doesn't  do one of the two things it doesn't protect your   liver but it does feed your gut and so the data  show that juice is sort of halfway in between   it's not as good as fruit but it's better than say  soda yeah so for people um and again i'm jumping   the gun with but but you mentioned smoothies  already so and i've heard you say before you   know and you just said it try not to have fruit  smoothies because you've just as you put it as   made them into you know no longer useful or  as useful as they could be so eat the fruit   and if you're going to have a smoothie make sure  it's mostly vegetables with maybe yeah i mean if   you look if it's a green smoothie there's nothing  to protect the liver from in which case then it's   not a big problem but fruit smoothies can be an  issue okay two more questions and then we're going   to move on to diets but before going back a little  bit because we talked about lab tests and what to   ask your doctor for uh with regards to your your  liver but how do you test um the question is how   do you test for glucose and insulin well so you  can do a fasting glucose and insulin that's what   is typically done and you should um now i  will tell you that i believe fasting insulin   is probably the single best lab test to determine  metabolic health the american diabetes association   says very specifically on its website that  you should not do this you should not check   fasting insulin and i think it's the single best  test there is now why is this that the american   diabetes association says one thing and i'm  saying the exact opposite why is that here's why   okay number one they say that fasting insulin  is not consistent across laboratory uh   different laboratories it's it's  a it's an inconsistent um uh assay   that's almost true yeah there's  some truth to that so it turns out   there is a species of insulin that is released  from your pancreas when your pancreas is stressed   called pro-insulin now pro-insulin only  has five percent of the activity of insulin   when your beta cells in your pancreas are  chugging like crazy as they are in diabetes   okay it doesn't have time to cleave the c-peptide  out of the pro-insulin molecule to create the   insulin and then package the insulin into vesicles  and get it out because it's working overtime and   so it will end up releasing the pro-insulin and  the pro-insulin in bad insulin assays can be   mistaken for the actual insulin molecule itself  because they look a lot alike because after all   one's the precursor the other so it is true that  bad insulin assays will measure pro-insulin but   that's actually the point and if it's high that's  telling you that your beta cells are not happy   so that's really kind of a dumb reason not to  do it you know for for the ada second reason   they say fasting insulin doesn't correlate with  obesity and that is true also who said it should   in fact there are a lot of reasons for obesity  other than insulin resistance fasting insulin   tells you about insulin resistance there are a lot  of reasons for weight gain having nothing to do   with that fasting insulin the point is fasting  insulin is a very good indicator of metabolic   health and lots of thin people are metabolically  ill too in fact forty percent of thin people are   metabolically ill and how would they know if they  didn't get a fasting insulin there's an actual   medical term for that right um fin on the inside  battle no uh fat on the inside that's right it's   called tofi tofi thin on the outside fat on the  inside so that's one of the best ways to figure   out whether you're a tofy it's one of the first  things your doctor should be doing so the bottom   line is the ada has their reasons for saying no  and i'm telling you that's why i wrote the book some somebody asked the question it really isn't  appropriate except i can't i had a little chuckle   privately here which companies do we sue   well you know that's that's a good question well  all i can say is that there are several lawsuits   against the food industry for different things  and for specific things i know about a fair number   of them because i actually serve as an expert  witness in an attempt to try to fix this problem   i will say i do not have any vested interest in  the outcome of those trials i so i i'm i'm not   here as a shill for the plaintiff's bar yeah  this is the one we talked about last week um   about processed food and how sugar does it isn't  really a danger well i won't i don't want to talk   names so i yeah i'll take that back but anyway  can fatty liver disease be reversed so so there's   there's the point there's there's fatty liver  and then there's fatty liver plus inflammation   so fatty liver is called hepatic steatosis fatty  liver plus inflammation is called non-alcoholic   steatohepatitis now most of the people of fatty  liver disease have just uh fatty liver without   inflammation just steatosis and if you have  just steatosis you can absolutely reverse it   once you pass over the threshold to inflammation  then the scarring starts and when the scarring   starts that cannot be reversed then it's forever  and so the goal is to make sure you've reversed   this before you get to that point because once  the scarring starts then you are on your way to   cirrhosis okay and now non-alcoholic fatty liver  disease is the leading cause of liver transplant   in the united states having overtaken hepatitis  c and the reason is because people don't know   they have fatty liver because their doctor thinks  that an alt of 33 is okay and all of a sudden now   they've got fatty liver plus inflammation and  now they've got a problem that won't go away   so the goal is to figure this out before the  point of no return another reason i wrote the book   so um lots of great questions um it's hard to know  which ones to read um but this is kind of more of   a comment than a question um it's kind of a nice  comment lots of nice comments uh thanking you   for for this book and how everybody should have  it and read it and i definitely agree but this   person says my daughter has crohn's disease and  has achieved clinical remission through diet alone   eating only real food no meds which more doctors  would realize the value of nutrition for healing   boy isn't that the truth right well you know i'm  not going to tell you i know this because i don't   i've only have anecdotal uh evidence and that  is not evidence and i'm very clear that ends of   one are not science however i've had many people  with crohn's disease tell me that when they got   off processed food their crohn's disease got  better that's a relatively common uh refrain   now that doesn't mean that ultra-processed food  is the cause of crohn's but it is interesting   that so many people seem to get better right  and for those who aren't in this world perhaps   they might not know what that n of one means so  maybe just explain the n of one that you well i'm   a scientist okay and you know an n of one means  an anecdote you know one person and it means that   wasn't done scientifically okay i'm a scientist  i believe in data i believe in statistics   you know you have to prove things to me okay  but once you've proven them to me i adopt them   the problem with the medical profession is you  can provide some you know proof to some people and   they will never change their minds because they  are completely recalcitrant they are calcified   in their beliefs and the reason invariably  is because they have money writing on it   like grant money or you know um you know  they've written their own book or whatever   right so i've heard you say that certain disease  states such as type 2 diabetes are the symptoms   are not the problem quote um real diseases are  the subcellu subcellular pathways unquote but   before you dial into that i want to briefly also  talk about kovid and here's another quote from you   um i've heard coven 19 referred to as  a beast because it doesn't distinguish   it doesn't distinguish in point of fact it  does distinguish who doesn't distinguish who   it infects but it does distinguish who it kills  other than the elderly it's those who are black   obese and or have pre-existing conditions  what distinguish these three demographics   ultra-processed food because the ultra processed  food sets you up for inflammation which cova 19 is   happy to exploit just another way processed food  kills time to rethink your menu so talk about   that as you talk about what does real diseases  are the subcellular pathologies mean sure so let's   talk about cobalt first uh my non-profit called  eat real and you can find it online eatreal.org   and we're getting real food into schools all over  the country because you know american schools are   the largest fast food franchise in the world we  gotta fix that um we published a medical alert   where we basically called out the nih and the cdc  for screwing up and i mean that very specifically   they screwed up here's how they've told us three  things to do and i'm all for those three things   masking social distancing hand washing i'm for  those but they didn't tell us about the fourth   yeah the food you never hear anyone  at nih or cdc ever mention the food   turns out those three groups those three  demographics bypac obese pre-existing conditions   they share one thing in common ultra-processed  food so why does ultra processed food make people   with covid die answer three ways first the virus  is very smart it in uses a receptor on virtually   every cell in your body as its injector point and  it's called ace2 angiotensin converting enzyme 2   happens to be an endocrine receptor something  i take care of okay involved in water transport   the the more h2 receptors the more  infective the covalent virus is   well turns out insulin resistance high  insulin levels drive those h2 receptors up   giving the virus more of a chance to infect all  your cells at once therefore a bigger viral load   number two the lack of fiber the lack of fiber  those colonic bacteria love that soluble fiber   they turn that soluble fiber into short chain  fatty acids called butyrate and propionate and   these have been shown to be immune suppressive  they suppress the cytokine storm of covid19   and they also are anti-insulin so they help you  know prevent weight gain too so the fiber helps   mitigate the covered nastiness if you will but the  problem is ultra-processed food is fiberless food   and then finally number three diabetes itself  high blood glucose the glucose crystallizes   around the edges of those ace twos and holds it  open so that the virus has an even easier time   to inject so bottom line ultra processed food  makes doesn't cause you to get infected with covid   that's what the hand washing and the masking and  the social distancing is supposed to prevent is   supposed to prevent infectivity but morbidity and  mortality it's about the food and you don't hear   the nih or cdc saying word one about this okay  and so i have a bone to pick with tony fauci   okay for not dealing with it let's pick it what  is it exactly well that's that that's it you want   him to vote more on on food on the food they  should have been doing this from the beginning   we showed at ucsf um back in 2015 that  we can reverse the metabolic health   the metabolic dysfunction in any kid in nine  days flat by getting sugar at a kid's diet   yeah talk about that study because i think  that's absolutely fascinating and that will   segue into uh the diet questions i have and the  diet questions that most of our listeners have so   first talk about that amazing study you did with  children so we call this the kids study we took   43 children from our obesity clinic at ucsf latino  and african american so low socioeconomic status   all high processed food consumers all high sugar  consumers and what we did was we studied them on   their home diet at baseline and then for  the next nine days we catered their meals   no added sugar we took the percent of  calories from sugar in their diet from 28   down to 10 percent we gave them fruit that's  where they got their sugar but all the other   food was no added sugar now if you remove that  percent from 28 to 10 you're going to lose about   350 to 400 calories a day out of the diet and  if you do that for 10 days you might lose weight   we didn't want our patients to lose weight because  if they lost weight and they got better people   say of course they got better they lost weight we  didn't want them to lose weight we wanted them to   stay the same weight or even gain right right so  what we did was we instead we took the sugar out   what we did was we put the excess starch in okay  we gave them processed starch so in the vernacular   we took the pastries out we put the bagels in we  took the sweetened yogurt out we put the baked   potato chips in we took the chicken teriyaki out  we put the turkey hot dogs in so we didn't give   him good food we gave him crappy food we gave him  processed food ultra processed food we gave him   kid food food kids would eat but it was no added  sugar food and we gave them a scale and every day   we'd call them up on the phone which away and if  it turned out they were losing weight eat more in   order to keep weight stable through the entire  10-day period and then we studied them again   every aspect of their metabolic health got better   and without change in subcutaneous fat but  the liver fat went down 22 percent and as   just by switching from sugar from sugar to starch  the liver fat went away and the insulin secretion   got better as the fat went away so we know it  was the fat that was you know because the liver   was sick the pancreas had to make extra insulin  to make the liver do its job so when you fix the   liver the pancreas got better too we reversed  these kids metabolic syndrome with no change   in calories and no change in weight which is why  a calorie is not a calorie and a sugar is not a   sugar and to be honest with you a fat's not a fat  and a protein is not a protein and the problem is   the food industry doesn't want you to know that  which is another reason i had to write the book so um okay so you um i think we're going to  move into diets now because again that's where   um most of these questions are and so um and that  was going to be my segue in which you already just   said uh a calorie and you i've been hearing you  say this for years calorie is as a calorie sugar   is sugar drives you nuts and food mat is what  they do to food we've already covered a little   bit about what food manufacturers do to food  but before we go into keto and you know vegan   and specifics of diets and answer these questions  because it's it's 10 to 11. we we're we're good   with time here let's start by explaining exactly  why a calorie is not a calorie and sugar is not a   sugar it's not position yeah sure where was that  well i've already kind of explained it to some   extent let me let let's take an example let's take  almonds okay okay you eat 160 calories in almonds   how many do you absorb turns out you absorb 130  okay you 860 you absorb 130 where'd the other 30   go the fiber in the almonds set up that gel and  so you didn't absorb them early they went further   down the intestine and the bacteria chewed them up  instead so because those calories came in almonds   those calories weren't for you they were  for your bacteria you know when people   are pregnant you say well you're eating for two  well we're always eating for a hundred trillion   okay and the question is how much did you  get versus how much did they get the more   ultra processed it is the more you get the more  unprocessed the more they get so even though it   passed your lips even though it registered as  a quote calorie who cares if it if it didn't   enter your bloodstream what's the difference in  fact you fed your bacteria which is a good thing   so calories not a calorie if it was if it came  with fiber because your bacteria got it instead   and you fed your gut you protected your liver and  you fed your gut that made it healthy irrespective   of the calories that's one reason second reason  protein now if you're building protein the   amino acids go to making the protein fair but if  you're not building protein and you eat protein   where does this where's the protein go because  you're not building muscle and you're not building   muscle or anything else or bone or you know if  you're not in growth phase okay got it you're   not a kid and you're growing okay where does  that where do those where does the protein go   it gets chopped up into amino acids the amino  acids go to the liver and the liver is going to   turn those amino acids into energy now it turns  out in order to take the amino group off of an   amino acid and turn it into an organic acid so it  can be burned for energy you have to invest energy   you have to actually sink energy into the process  and so you lose there's a net loss of energy   when you're turning a protein calorie into  energy as opposed to a carbohydrate calorie   so on net you derive fewer atps you derive  fewer energy molecules because it was a protein   so a calorie is not a calorie because it was  protein it's not the same as a carbohydrate fat   so over here on this side we have omega-3  fatty acids heart healthy anti-alzheimer's   anti-inflammatory save your life single best  thing you can put in your body you find them   in marine oils over here you got trans fats  the devil incarnate okay consumable poison   okay and we now know that and the fda finally has  gotten rid of them out of our food supply thank   god only took them 25 years really um they're both  nine calories per gram one will save your life one   will kill you so a calorie is not a calorie  because they have different effects on your   metabolic health and on your longevity and finally  fructose and glucose like we talked about before   so glucose is the energy of life fructose is a  completely vestigial molecule that only plants use   as an energy source okay it just so happens it's  really sweet and it activates the reward center   and it's addictive that's all yeah that's all  now um back to a little bit to omega-3 fatty   acids marine but what about um talk about epa dha  so and the differences thereof right so they're   both important epa and dha e epa stands for  icosopentanoic acid dha stands for docohexaenoic   acid do not worry you will not be quizzed on  this but it is in the book if you you know say   as a reference they're both important they both  are involved in structural membranes especially   in neurons and so they're very important in terms  of brain health and brain development especially   for babies which is why now they are both put into  baby formula to help babies grow their brains um   and also they are anti-inflammatory they um  activate and you know an immune cascade and that   that basically keeps the immune system from going  hog wild conversely we have other uh fatty acids   called omega-6 fatty acids linoleic acid this is  what's basically in corn oil soybean oil a lot of   the seed oils now they're important too it's not  that they're bad okay but they are the precursors   to arachidonic acid which is pro-inflammatory  that's the inflammatory uh uh fatty acid   and it causes prostagla it's the the precursor  prostaglandins which cause pain and inflammation   and you know and you need inflammation because if  you didn't have inflammation you'd be eaten by the   maggots i mean you would have an immune deficiency  all right so you need to be able to do that   on the other hand you don't want to do it too much  and the problem is the more omega-6s you consume   the more you're doing it at baseline whether  you have an infection or not and so we now know   that omega-6s are sort of bad guys in the story  and you don't want to be consuming too many of   them but ultra-processed food is virtually like  straight omega-6 yeah okay so we have a lot of   questions that have come in i haven't even looked  at yet so um and i think they're mostly about um   food um i'll read these while you're explaining  i've heard you talk about um uh diet diet wards   you know we're talking vegan keto other the  people you say it's their false wars yeah and so   and then we already talked about the study  with the children but i've heard you say   that you know you don't need a diet to eat real  food so talk while i'm going through these um   audience member questions um  explain the differences of these   eating waste people eat vegan you know which  are like the opposite extremes and the kind of   the religious fervor um yeah it's very religious  and it's and it's inappropriate i will tell you   not not not because it's inappropriate but to have  religious fervor over it is what's inappropriate   because this is not religion okay this is science  and we have the data now i am not against vegan   yeah i'm also not for it i'm not against keto i'm  also not for it i'm basically i'm for real food   okay and vegan can be real food and keto can be  real food but vegan can also not be real food   yeah just like keto cannot be real food  you know it depends on how you're doing it   so for instance coke doritos and oreos are all  vegan okay that doesn't make them good clearly   so vegan means plants okay i get it and i  also understand that you know people are   worried about the environment they're worried  about cows yeah right and i'll quote you before   here's your quote about cows quote the cows  are not the freaking problem i'm questioning   that's right that is correct um so the cows are  not the friggin problem for two reasons okay   the first is when you actually look at the amount  of methane produced by cows it's not that much   it's half of agricultural methane compared to  what industry and transportation is doing it's a   drop in the pocket yes it's a drop in the bucket  that could be controlled i don't argue that but   think of it this way there are three greenhouse  gases not one there are three there's carbon   dioxide now its heat trapping capacity is low but  there's a whole lot of it there's nitrous oxide   its heat trapping capacity is 250 times higher  than carbon dioxide and there's a fair amount   of it and where does it come from it comes  from nitrogen fertilizer that fertilized all   the vegetables and the plants because the cows  aren't on the farm pooping and manuring and you   know fixing the nitrogen in the soil so instead  of it being soil it's dirt and if you want to grow   corn in dirt you have to spray it with  nitrogen fertilizer so it has something to grow   and that you know contaminates the water tables  and it ends up you know causing dead zones in the   gulf of mexico and climate change etc etc okay and  that all came from plants and then finally there's   methane now methane is 25 times more heat trapping  than carbon dioxide so yes that's a problem but   there's not that much of it it's actually pretty  low and so on the you know big damage scale and   it doesn't last that long in the atmosphere only  lasts nine years as compared compared to carbon   dioxide which lasts 33 years and nitrous oxide  which lasts 114 years so on the big scale of the   three greenhouse gases methane is like the lowest  it's the least concerning of all the greenhouse   gases but that's the one cows make all right now  there's another reason to not be mad at the cows   in 1968 there were more heads of cattle in america  than there are today and they made one-fifth the   methane that the cows today make how come there  are fewer cows but five times more methane   the answer is antibiotics the antibiotics  we give to the cows who live on the kfo   basically killed off their regular bacteria allows  the methanogens like acromancia and archaea to   populate and basically these cows are now you know  making methane hand over fist compared to what   they used to do but guess what so are we yeah we  make more methane too okay no one's talking about   getting rid of us okay it's not the cows it's what  we did to the cows so let's undo that leave the   cows alone take them off the kefo put them back on  the farm so they can poop and make the corn grow   okay that's called regenerative farming and that's  what we need to do to fix the climate change   crisis but we can't do that until we get rid  of the food subsidies because that's what's   causing all the growers to grow the wrong  stuff in the first place okay so i'm going   to summarize what you said and then we're going  to try to answer um some of these uh questions um   but we're going to have to do it quickly  because we only have about five minutes left   um so keto it's not like you said it's not  keto it's not vegan it is eat real food   um keto is fine i have nothing against keto it's  hard to stay on but if you can stay on it that's   good if you fall off keto and it's easy to fall  off because you know all you have to do is raise   your insulin and now you're not on keto anymore  now you're on a high fat medium carbohydrate   diet which is like the worst possible diet yeah  yeah if you're really in keto fine i'm i'm i'm   a supporter i'm a fan no problem if you're vegan  you know that's fine too you can be vegan i'm not   against vegan you know please you know you want to  be vegan fine just don't make everybody else vegan   yeah real food answers both issues and to be  honest with you vegans and the keto is really   on the same side it's the processed  food that's on the other side right   so okay we're going to let's see if you can do  this uh rob this is going to be interesting so   we i'd like to get through the next three  minutes as many of these questions we can   so see if you can do a a really great answer to  these and i know that these aren't answers okay   one part answers um do the gmo vegetables that  we see at walmart fall under real food realm   um as those also include fiber does real food mean  organic or conventional conventional one sentence   answer right organic doesn't mean good okay  organic means no pesticides but doesn't mean good   gmo we don't have the data yet the only thing  we know is glyphosate's a bad guy okay got it   okay we've already answered these questions um  uh what is your guidance on appropriate alcohol   alcohol consumption is wine nightly okay  one glass a day is fine how big a glass   uh you know there's also four to five ounce  glass of wine is fine if you're an adult okay um let's see by freezing  full berries do we significantly   impact the fiber i think we already covered that  one have the lowest sugar highest fiber ratio okay   um so do you are you are you saying to  not consume or cook with frozen vegetables   no you can cook with frozen vegetables if you're  making a stew but you know frozen vegetables are   mushy and most people don't like mushy yeah  no okay we already answered the question   about fatty liver disease being reversed the  risks of certain fructose does that mean or   fructose as you say i uh i i've got it yeah  well we've been frucked is what we are okay does that mean there's a limit to the amount  of fresh fruit no we already answered this one   okay fresh fruit's fine yeah um when you refer  to sugars is it primarily cane sugar and high   fructose corn syrup that we need to be concerned  about or do we also need to be limit sugar from   fruit honey and maple syrup so honey maple syrup  agave all the same as sucrose and high fructose   corn syrup fruit is got fiber those the other  ones don't what is your view on powdered forms   of adaptogens and superfoods please uh some  of them are okay and some of them are hyped   i know you don't like to talk about  your own diet but i have three questions   yeah i figured yeah i know so basically you  know i can say that i've known you for 12 or   13 years now and and i think you eat pretty well  right i i used to eat terribly you know i used to   be the master of the three second lunch you know  because you know when you go to medical school   you don't have a whole lot of time to eat and  i used to basically think of you know food is   an afterthought but you know my work in this  field has you know certainly changed what i do   my wife and i used to eat out three times a  week and now we eat out maybe once a month   if that there you go so we already talked about  the crohn's disease love the coveted morbidity   and mortality connection dogs for processed  food losing description okay that wasn't dr   david cass has been a proponent of health  and nutrition educator in response to covet   please what are your thoughts about for okay  that was just a comment then please what are   your thoughts about fermented foods like cheeses  and organic plain yogurt ingredients only milk and   bacteria and whole grains breads oh that's a i  was going to bring that up too um whole grains   there's a difference between a whole grain and  an attached intact brain so that fermented food   yogurt is fine fermented foods are fine nothing  wrong with them go for it um in fact they may   actually be you know helpful in terms of probiotic  restitution of your microbiome in terms of whole   grain it's very simple is it really a whole grain  just because they say ho it's whole grain doesn't   mean it is in fact usually it's not they can say  it because it started with whole grain as soon as   they pulverized it it ain't whole the horse is  out of the barn the starch is out it will get   uh absorbed rapidly and you will be flooding  your liver so if it actually stays as a kernel   so like a weak berry yeah then it's fine as  soon as you've taken a a mortar and pestle   to it or a mill or pulverizer or whatever else  or eaten any of you know any food that's fluffy   you're done it's just okay you know we definitely  went a little bit over here i'm going to close out   but i want you to answer one word is popcorn high  fiber popcorn is not high fiber okay that's enough   of that so so wow that was a lot of information  that was it was just amazing rapid fire   lightning round no lightning round so anyway it  goes on password so in closing uh thank you all   for joining us today on our thanks to dr  robert lustig for your comments here today   the video will soon be posted on the club's  website and we encourage you to visit online   at commonwealthclub.org and to view this  and other programs and now the meeting of   the commonwealth club of california commemorating  118 years of enlightened discussion is adjourned you

Channel: Commonwealth Club of California

Views: 322,857

Keywords: CommonwealthClub, CommonwealthClubofCalifornia, Sanfrancisco, Nonprofitmedia, nonprofitvideo, politics, Currentevents, CaliforniaCurrentEvents, #newyoutubevideo, #youtubechannel, #youtubechannels, pattyjames, drroberthlustig

Id: pcU0eEkV7Eg

Length: 70min 33sec (4233 seconds)

Published: Tue May 18 2021