The BITTER TRUTH About Sugar & How It Causes INFLAMMATION | Robert Lustig

when you consume sugar you are poisoning your mitochondria sugar and cyanide do the same thing this is the toxin [Music] what are the key negatives when we consume the levels of sugar that many of us are currently consuming well first of all let's make it very clear that sugar is not the only problem in our diet it's the big one it's the 2 000 pound gorilla in our diet but there's other stuff too but sugar is a particularly egregious molecule once upon a time trans fats were the worst thing we consumed trans fats are the devil incarnate trans fats the bacteria can't chew it up which is why they put the trans fats in all right so that you know it would last forever you know the 10 year old twinkie well the fact is our mitochondria are little energy burning factories inside all our cells are really refurbished bacteria we can't chew it up either so the exact same reason for why they put the trans fats in the food is exactly why you shouldn't eat the food now we know that and they've come out of our diet so now sugar is public enemy number one so what does sugar do and the answer is a whole bunch of bad things the food industry says sugar's energy well they're correct if you're a bomb calorimeter if you just blow it up if you explode it yeah you get four calories per gram but we are not bum calorimeters turns out that sugar actually poisons the mitochondria okay it poisons it in three separate enzymes that are necessary for mitochondria to do their job the first one amp kinase which is the fuel gauge on the liver cell the second one acad l acelco a dehydrogenase long chain which is necessary to get fatty acids into the mitochondria to be able to oxidize them to create energy and the third one is cpt-1 carnitine palmital transferase one which is the enzyme that regenerates carnitine which is the shuttle mechanism that brings the fatty acids into the mitochondria in the first place in other words when you consume sugar you are poisoning your mitochondria you are generating less of the chemical energy that our cells get powered by called atp so if you're making less atp is that energy it's the opposite of energy so when you consume sugar you are actually inhibiting your body's energy production can you think of a chemical that inhibits your mitochondria and reduces atp production cyanide cyanide cyanide cyanide does that okay sugar and cyanide do the same thing now obviously not as severely okay you know cyanide parts per million kilo over and diet on the spot with sugar you know it's in the parts per thousand and you don't keel over on the spot but you feel lousy and over time it's going to take its toll but ultimately if you're inhibiting your mitochondria you are poisoning your body and we now have the data to show how that occurs so here's my question to you and your audience sugar is in virtually all ultra processed foods and ultra processed foods are now 56 of the uk diet and the amount of sugar that brits eat 62 of it is found in the ultra processed food category wow so my question to you and your audience is is ultra processed food food my view is that it's not really i would say no but i know to many people that is super controversial um which we're definitely going to talk about but yeah on a straight answer i would say no depends on your definition i guess because it's energy it's got some calories in it which we consume in our mouth enable us on one level to to sort of i guess you're saying it's actually uh reducing the energy production the sugar within it anyway but yeah on one level it sustains people and they can actually get on with their days at least in the short term anyway well you have to know what the definition of food is so if i if i had my webster's dictionary right here right now you guys you know in the uk probably don't use webster's you probably have something else but if i pulled it off the shelf it would say that the definition of food is the following and i have no problem with this definition substrate that contributes to either the growth or burning of an organism that's the definition i have no problem with that definition it's a fine definition all right substrate that contributes to either the growth or burning of an organism so we've just talked about burning sugar does not contribute to the burning of an organism it actually inhibits the burning of an organism and dr kevin hall at the nih did a study where he showed that when you give people ultra processed food they burn less and gain more weight when everything else is controlled for compared to the same diet in real food did this in 2019 so ultra processed food does not contribute to burning so now let's go to growth does ultra processed food contribute to growth my colleague dr efrat monsenigo ornan who is the chairman of the department of nutrition at hebrew university jerusalem just published three papers in bone research showing that ultra processed food actually inhibits skeletal growth inhibits the ability of bones to increase in length and in width and in addition we know from the neutronessante study and many other studies that in fact what sugar does is it feeds cancer cells it hijacks growth so sugar doesn't contribute to burning inhibits it doesn't contribute to growth inhibits it or hijacks it so i pose the question to you again ranga is ultra processed food food i'll go with my original answer which is no that is right it is no ding ding that's right but the point is that the food industry you know refuses to go there the populace refuses to go there the governments refuse to go there and you and i are both interested in mitigating chronic disease and you are right if you get people on a real food diet you can mitigate virtually any and all of their chronic diseases i completely agree you gave a tedx talk basically saying you can basically take away somebody's chronic disease i used to do that in my clinic but you know when i was practicing routinely yeah but only if they changed the food and if they didn't change the food no amount of medicine i threw at them could make a difference yeah i mean what strikes me as a really key message is that the majority of what we're buying to feed ourselves and our families is ultra-processed food whether it's here in the uk or with you in america and that is contributing to this tsunami of chronic ill health that we're seeing it's pretty you know it's pretty alarming but what i think is so key rob for me is that it's so normalized now like it's the norm everywhere schools hostels in fact if you want to go down the real food routes you almost feel like a bit of a like you know if you try to do with your kids you actually become a social outcast in in some ways it's i think this is the problem it's just it's the norm we've moved so far away from what we used to do in fact maybe this is a good time for you to explain what you used to do when you were eight years old because i believe you had a grand who lived in brooklyn and every saturday you would do something which i think beautifully illustrates his points that's right so yeah bottom line is i completely agree with you what we've done is we've normalized it once upon a time it was actually not normal to eat ultra processed food and today it is normal and i remember when that happens because it happened to me it happened to me in two ways so on saturday afternoons my family would go visit my grandparents who lived about oh i don't know eight miles away in brooklyn and my grandfather would walk me down to the corner uh grocery store to buy a comic book and a six and a half ounce bottle of coca-cola i remember you know pretty much every saturday afternoon and that was the big treat you know the comic book and the coca-cola that was on ocean avenue and avenue and in brooklyn um you know the fact is that that was once a week and it was six and a half ounces all right today you know children are consuming about i think 35 ounces a day um you know uh median so they are getting about six times the amount of sugar that i did from that one coke and they're doing it every day instead of once a week i mean let's just can we just pause on that for a second you're saying you had six ounces once a week and we're assuming back then that the rest of your diet throughout the week was low in sugar low in processed foods sort of a real food diets well my mother worked three jobs and so i ate a lot of swanson tv dinners when they first came out and i remember when they came out around 1964. you know the fried chicken the salisbury steak i hated that salisbury steak and i actually she trained me on how to turn the oven on and how to heat them up because often she wasn't home at night you know so you know to some extent i was a latchkey kid because my mother worked so hard you know my father was in manhattan all day and so you know i basically had it sort of take care of myself and sometimes i had to eat dinner you know out of the freezer and so i remember you know those swanson tv dinners and you know they they were a problem and there's still a problem so you put the two together and that was the beginning of you know the uh shall we say onslaught of processed food in the united states about the mid 60s then things picked up even more in 1975 when we started uh substituting high fructose corn syrup for sucrose because it was half as expensive and it was homegrown and then finally the piester resistance came in 1977 when uh the mcgovern commission released its report saying that we all needed to eat less fat to try to prevent cardiovascular disease well when you take the fat out of food it tastes like cardboard and so what did the food industry do it basically replaced the fat with sugar that's why we ended up with entenmann's fat free cakes and you know and the like and that was when the pasta craze you know first hit was you know refined carbohydrate because it was quote low in fat etc and you know now we're off to the races and it's just exploded ever since is it the sugar that's inherently bad in and of itself or is it the excess amounts i mean or is it both right because i think a lot of people might say well look you know what this never used to be a problem right and we we would have the odd sweet treat now and again um but so and actually there's quite there's quite a few prominent scientists as um you're you're well aware of you say actually sugar's not a problem sugar's actually completely fine i'm working on it we're working on it i i have a bone to pick with some of those scientists and we can argue that and talk about that if you like as to exactly why they say what they say so here's what i can tell you all right there are social drinkers and there are alcoholics now social drinkers can pick up a beer and put it down and they don't need one every day alcoholics pick up a whiskey and can't put it down and they need it three times a day right yeah did the one beer that the social drinker drink hurt them unlikely unlikely unlikely and the reason it's unlikely is because there is a what is known as a first pass effect you drink the alcohol in the beer first of all it's very low uh percentage right it's only a 3.6 percent in an um in a uh in a beer all right and that uh is about oh 60 calories worth or so of of alcohol and what happens is that the first pass effect the uh stomach and intestine metabolize that alcohol before any of it ever gets to the liver and so the amount that actually hits the liver that could do damage is exceedingly small and as long as you're not following up with a second beer and a third beer and a fourth beer and a fifth beer you know like can happen at the newcastle pub you don't usually have a big problem right but if you keep doing that then that is a problem so it's a dose-dependent phenomenon and your intestine is there to try to protect your liver from getting the onslaught before it will do damage same with sugar no difference so your intestine can take a small amount of sugar that you consume and can actually turn it into fat in the intestine intestinal de novo lipogenesis the process of converting sugar to fat into vldl in the intestine so that it will not go straight to your liver right and about 10 percent of the of an initial sugar bolus will undergo intestinal dnl and therefore be diverted away from the liver and into the bloodstream as the ldl now that vldl is not great for you because it could ultimately cause heart disease but it's protecting the liver but if you consume past your intestines capacity to do that now the rest of it's going to end up in your liver and the problem with sugar in the liver is exactly the same as the problem of alcohol in the liver because it causes the exact same processes it causes glycation it causes oxidative stress it causes mitochondrial dysfunction and basically drives insulin resistance this phenomenon that we now know is at the base of virtually all chronic metabolic diseases therefore your pancreas has to make extra insulin to make the liver do its job because now the liver is not working right because it's been poisoned and so insulin levels rise all over the body and now you've got you know the risk for alzheimer's you've got the risk for heart disease you've got the risk for virtu for cancer you've got the risk for virtually every other chronic metabolic disease on the plate all because of what happened to your liver yeah and fructose that sweet molecule and sugar basically has the same fate as alcohol so when people say oh you know little sugar is fine answers um yeah because your intestine diverts that little bit away from the liver as soon as you overwhelm that capacity now your liver is right in the cross hairs and that's when chronic disease is going to start yeah rob you're a pediatrician um i've seen videos of you talking with passion about this exact topic maybe 15 years ago still online something like that when was it when was the first time for you that you started to think you know what's going on here in the book you have been pretty um it's pretty provocative at times i actually agree with it so i like it you've really gone out there you've sort of you've ripped into modern medicine at times and we're definitely going to talk about that but when was it because you do have this sort of incredible passion and energy to get this message out there and i'm just wondering what was it in your clinical experience that actually really got you into thinking there must be another way here this can't be right right well so i had three aha three and that sort of got me to where i am today and why i'm saying what i am saying today the first aha moment came when i worked at saint jude children's research hospital in memphis tennessee pediatric cancer hospital and i went there in 1995 and i was presented with a cadre of about 40 children who would survive their brain tumors you know because of surgery and radiation sometimes chemotherapy who had become massively obese they were perfectly normal weight before the tumor and now they were on the order of 350 to 400 pounds okay normal kids before the tumor and now massively obese and there's a name for this it's called hypothalamic obesity was first you know written about first uh described in 1901 by frelick and babinski two of the you know greats of of of international neurology and i had all these kids with hypothalamic obesity that i had to take care of and like how do you get them to lose weight how do you get them to get better and it had been shown previously that diet exercise is useless in fact george bray the father of obesity research in america in 1975 had taken eight of these kids on his ward and fed them 500 calories a day for a month what do you think their weight did well you would expect it came down but i suspect in this case it probably didn't it went up yeah okay 500 calories a day and their weight went up like how does that happen the answer is it happens because they were burning it slower than they were taking it in because their metabolism of calories had actually come to a virtual standstill so even 500 calories a day was too much and these kids have like no energy they sit on a couch they're not interested in anything the parents would actually complain that that was the worst thing about this they'd say this is double jeopardy my kid has you know survived the tumor only to succumb to the therapy because my kid is a lump on a log and he's lost interest in everything he's lost interest in school he's lost interest in life he's lost interested in activity he's lost interest in friends he's lost just in everything all he wants to do is sit and sleep and so i had to take care of these kids so i went to the literature and i said oh the other thing was that this was exactly when the hormone leptin had been discovered leptin was discovered in 1994 and i was prepared for that discovery because i worked at rockefeller university with the guys who discovered it jeff friedman and rudy libel okay we were all the md's at rockefeller university all you know had to take call in the hospital together so we were always trading you know called call dates and everything so everybody knew what everybody else was doing so i knew that they were trying to clone this you know this hormone you know out of these mice and so when they did in 1994 i was very prepared for it so i moved to saint jude and i had these kids and it's like what am i going to do for them and i postulated right then that these kids must have leptin resistance these kids can't see their leptin and the reason is because their hypothalamus is dead because we killed it because of the tumor or the surgery the radiation and so because they can't see their leptin their brain thinks they're starving so the question was okay their brain thinks they're starving is there what's downstream of leptin what's actually making them gain the weight the starvation is why they're hungry but what's making him gain the weight well we knew that these kids made a lot of insulin and we knew that there's this uh animal model of damaging the hypothalamus and they put out enormous amounts of insulin and you could actually stop that by cutting the vagus nerve the vagus nerve is the nerve that leads from the brain to the pancreas and then the insulin would go down so i said well i can't cut their vagus nerve i'm not a surgeon and you know that's a little drastic but what if i gave them a medicine that suppressed their insulin release so we gave them a drug called octreotide a drug that you know is used by endocrinologists to usually suppress growth hormone release but it also suppresses insulin release so we repurposed it and we gave it to these kids and lo and behold they started losing weight and they couldn't lose weight before you know george brady showed they gained weight they were losing weight and something even more remarkable happened they started exercising spontaneously one kid started competitive swimming two kids started lifting weights at home one kid became the manager of his high school basketball team running around collecting all the basketballs i mean these were kids who sat on the couch ate doritos and slept and now they're active again and the parents would say oh my god i've got my kid back and the kid would say this is the first time my head hasn't been in the cloud since the tumor yeah so something had changed their relationship to the world not just their relationship to food but their relationship to the world so we said this is very interesting so we did a double-blind placebo control trial and this time built a quality of life measure into the protocol and sure enough the lower we got the insulin with the drug not only the more weight they lost but the more active they were so what this did the reason why this is so important and the reason i'm spending so much time on it wrong is because this turns the first law of thermodynamics on its head because the standard interpretation of the first law goes like this you know the first law is you know the total energy inside a closed system remains constant your energy can neither be created nor destroyed just shifted around okay the standard interpretation that we learn in medical school and what what the general public learns is if you eat it you better burn it or you're going to store it in which case the storing part the fat gain is secondary to the primary problems which are the eating and the burning the gluttony and the sloth therefore the weight gain is secondary to the gluttony and the sloth therefore it's about behavior fix the behavior fix the weight what we showed in these kids was it's exactly the opposite turn it around what we showed was if you're going to store it that is a high insulin level leading to obligate weight gain and you expect to burn it that is normal energy expenditure for normal quality of life because energy expenditure and quality of life are synonyms for each other then you're going to have to eat it and now the storage is primary and the behaviors are secondary the gluttony and sloth are actually because of leptin resistance so we get sick first and then the weight comes afterwards that's right we get sick first and the weight is secondary that's exactly right so this is you know monumental this is huge but of course you know it goes against everything that are taught and it goes against everything that you know doctors routinely believe but this was my first aha moment my second aha moment came in 2006. so i realized that insulin was the bad guy and we started then changing what we did in clinic instead of worrying about weight we worried about insulin we said get the insulin down any way you can and that's what my clinic became it became an insulin reduction clinic it didn't it wasn't a weight loss clinic it was an insulin reduction clinic and when we got the insulin down then they lost weight so in 2006 i was asked to give a talk at the nih okay specifically the international institute of environmental health sciences in research triangle park north carolina they were having their 100th anniversary of public health and it was a two-day symposium the first day was on their successes like lead poisoning and pollution and asthma things they'd figured out and you know been able to do something for the public health and the second day was on challenges and the morning was going to be obesity metabolic syndrome and this afternoon was going to be 80d in autism okay so they asked me to give a talk what do you think is the single most important environmental exposure that leads to obesity and metabolic syndrome and i figured that they probably figured i was gonna you know give a talk about some you know like bpa or some other you know environmental you know toxicant you know that's in the water or in the air or you know something like that and i thought i thought to myself how am i gonna you know make this worthwhile and i thought to myself all right wait a second let's let's let's go backwards here children today get two diseases they never got before type 2 diabetes and fatty liver disease those two children never got those before now lots of kids get them all right so i looked up type 2 diabetes and fatty liver disease and of course you know i know a lot about both of them but i very specifically looked for origins and causation it turns out that in the old days you know back in the 1970s before this pandemic of chronic disease started those both both those diseases were the diseases of alcohol type 2 diabetes and fatty liver disease were the diseases of alcohol but kids don't drink alcohol so i said all right is there something they're exposed to that's like alcohol i opened up my lenninger you know biochemistry textbook from 1974. sitting at this table that i'm at right now i said what the hell is like alcohol there it was and stared me right in the friggin face right off the page from 1974 and the answer was fructose fructose and alcohol are metabolized virtually identically and it makes sense that that would be the case because after all where do you get alcohol from fermentation of fructose it's called wine yeah we do it in nap and sonoma every day okay the big difference between fructose and alcohol is that for alcohol the yeast does the first step of metabolism called glycolysis for fructose we do our own first step of metabolism but after that what the mitochondria see are exactly the same as kilcoe it's just a question of which which was the substrate was it the ethanol or was it the fructose but ultimately they end up with the same fate so it's very clear all of a sudden right looking at that right there that this is the substrate that is driving both the type 2 diabetes and the fatty liver disease so i put together a talk and i went to north carolina and i said this is what i think is going on and here's why half hour talk and then there was the bathroom break and you know i got my applause and then everyone left the room [Music] and they didn't come back you know i'm standing there at the podium talking with you know this person that person and no one's coming back for the next session and then i had to use the bathroom so i went out and i actually got tackled in the freaking bathroom of the nih by a bunch of crazed toxicologists screaming at me saying oh my god oh my god you're right this makes perfect sense this is the toxin you have to tell everyone about this i guess i'm still doing it i guess you still ah so if the toxicologist went berserk might be true and then that was the so that was the second aha and then the third aha we'll be back to the conversation in just a moment now many of us struggle to find time to eat all of these incredible whole foods that's why i'm a big fan of good quality whole food supplements like this one that's been in my own life for over three years now it contains over 75 whole food source ingredients vitamins minerals pre and probiotics and can help us support our energy focus digestion and our immune system athletic greens are giving my audience a fantastic offer one year's free supply of vitamin d and five free travel packs with your first order you can see all the details at athletic greens dot com forward slash live more or simply click on the link below now back to the conversation it was not even my aha it was my colleagues aha but i i adopted it so we got very interested in sugar here at ucsf after that we actually have a group of us we call the sugar hill gang they're actually referenced in the book here um but uh my colleagues kristen karns laura schmidt and stan glance started looking at the paper trail of the food industry back in the 1960s and found the actual paper trail that showed that the food industry paid off scientists to exonerate sugar and figure saturated fat as the bad guy we actually found their documents that showed the money transfer and the communications you know just like what the january 6 committee is doing now follow the money and we so we actually proved that the sugar industry put their thumb on the scale back in the 1960s to exonerate their product because there had been data that had been coming out at that point showing that sugar was not good for you in fact that's what john yudkin found remember pure white and deadly and he had found you know shown that data and so people were starting to cast a a you know a fisheye at uh at sugar and so they had to go into overdrive mode and to to pr this problem away and so they approached the chairman of the department of nutrition at the harvard school of public health fred stare and his associate mark hegested who ended up becoming the head of the u.s department of agriculture in 1970 to pay them off 6 500 back then which would be about 50 000 today to write two review articles to appear in the new england journal of medicine that basically said saturated fat's the bad guy and sugar is no problem whatsoever that's the third aha moment it's all a scam the whole thing's a put up job and that's why i wrote metabolic sugar and alcohol i don't think people commonly would put the two things together people i think like you know joe public i think would would think okay alcohol i know if i drink too much it's not good for me it's going to cause problems with my liver i think there's that understanding and if i drink a little bit have some days off a week you know you know the odd glass of wine here and there's probably not going to be too bad for me i think is what most people tend to think that's true and and and if that were the case that would be true and that's true for about the forty percent of americans who are social drinkers you know forty percent of tea totalers don't touch your stuff okay forty percent of social drinkers can pick up a beer put it down like me okay but 10 of binge drinkers and 10 are hardcore alcoholics yeah but i don't think people think of sugar in the same way in terms of what it does for the liver um and i think that's that's a really i think eye-opening comparison for a lot of people the other thing you said which i think really beautifully ties into the start of this conversation is that you started running an insulin reduction clinic right and you know like you i'm very passionate in root causes and this idea that we've labelled all these so-called separate diseases we get taught about them at medical school those are all separate entities for this disease you you take this drug and you have this sort of treatment and we look at that downstream pathology don't we but you mentioned mitochondria at the start in terms of what sugar or excess sugar can do to mitochondria and that you know mitochondrial dysfunction sits at the heart of so many different conditions but also insulin resistance right so that insulin resistance that insulin lowering clinic actually would probably depend on who was coming in i appreciate your pediatrician but if if all of us as doctors ran insulin reduction clinics we would get rid of 75 percent of the chronic disease in america and in the world exactly it's that root cause again isn't it yeah absolutely i took completely agree which is what i'm trying to you know uh bring to you know medicine unfortunately you know medicine is provincial medicine doesn't you know uh respond very well to you know new ideas yeah it's uh you know it's a uh it's it's a cartel if you will you're very um critical of modern medicine in the book you say modern medicine treats symptoms uh you say modern medicine is not the solution i do indeed and i i agree with this it's it's something i'm it's one of my big frustrations in my what now 20 21 year career seeing patients it's like you know you know i sometimes wonder if doctors honestly ask themselves sometimes at the end of their day and obviously it depends where you work i'm not talking about intensive care i'm talking about you know chronic patients that and i did this once rob i i did this in general practice once i asked myself at the end of the day how many patients do you honestly think you've really helped today and you know quite a few years ago it was 20 percent i thought i've only helped 20 percent of people the other 80 i've done something i've i've sent them off for a test i've you know referred them or i've given them a drug but i kind of knew they'd be back i thought i'm not really getting to the heart of this problem i knew i kind of feel the patient knew it as well and that's kind of one of the things that led me on this journey to try and understand that there must be a different way and you know that's why i think metabolical is such a wonderful book it outlines the history it outlines the science but it also gives some really practical solutions and you know i love your you know we mentioned the liver a lot so far so one of your big messages in the book is protect the liver and feed the guts in terms of dietary advice for people and you know a lot's been written about food in the past but that's that's very fresh i think that's quite a new idea for people and i wonder if you could explain then what do you mean protect the liver and feed the guts sure well before we go into protect the liver feed the gut because that'll take up the whole rest of our podcast as you know explaining all that i want to just address the whole medical school thing you know and then you know how you felt as a doctor me too the bottom line is you know we uh treat medicine and unfortunately medical schools treat medicine like a big game of clue you know colonel mustard in the conservatory with the candlestick match the um uh symptom card with the diagnosis card with the treatment card and discharge your patient in fact in 1980 there was a game that was to play in residency you know on like sunday mornings before things got busy in the er called intern and that was what you did you basically took your symptoms you got a symptom card you got a diagnosis card and you got a treatment card and once you got the three of them together you got rid of the patient first uh you know player to discharge you know to discharge all their patients won the game you know and that's how we treated it so you know these diseases you know got a got a meningitis here's an antibiotic you know got a um uh you know cancer here's a chemotherapy you know but the fact is chronic disease doesn't you know really fit into that yeah there are there are eight count em eight chronic diseases that have completely taken over modern medicine eight and here they are type two diabetes hypertension dyslipidemia cardiovascular disease cancer dementia fatty liver disease polycystic ovarian disease those eight that those eight now account together for 75 of all health care costs and none of them have a cure none of them even have a treatment they all have a prevention we're not preventing it we're handing out you know um you know uh statins or you know oral hypoglycemics or you know antihypertensives you know like candy but that's treating the symptoms you know the manifestations of the disease not actually treating the cause and the reason is because those diseases are not really the diseases what's going on underneath to cause all eight of those diseases are exactly the same they're just in different organs and here are the eight things that i outline in the book what i call the diseases that are not diseases i call them the hateful eight and here they are okay and these are things that people don't know because they don't have icd-11 codes and doctors don't know what to do about them so they don't even mention them so no one's ever heard of them and they didn't learn them in medical school either so here they are eight number one glycation number two oxidative stress number three mitochondrial dysfunction number four insulin resistance number five membrane instability number six inflammation number seven methylation number eight autophagy now these are all normal phenomena that happen but they can be speeded up or slowed down by what you eat and it turns out when you have control over all eight of those things you will be 110 playing tennis when you don't have control over those eight things you will be 40 years old in a wheelchair with two stumps on dialysis waiting for your next stroke and of course everything in between so those are the choices those are the options and because none of those eight the hateful eight that i just mentioned any of none of them have a cure none of them even have a treatment they only have a prevention we're not preventing anything and that's why you felt like you were not helping any of your patients because you weren't addressing those eight root causes that you yourself know to be the big problem in medicine yeah it's like it's like a leaking roof isn't it the roofs leaking and you just putting a bucket there to pick up the water that's kind of what the drugs are doing yeah they that it's great it's there's no water there on the floor so you can live a bit a little bit better but you're not getting to the the cause right you need to fix the leak in the roof and then actually you no longer need the buckets right well and you won't the problem is if you don't fix the leak in the roof you won't have a house yeah that was one of my favorite parts of the book of these eight processes that are occurring in all of us and they're either promoting health and longevity or they're actually the opposite of creating illness and ultimately disease and i really love the way you say that actually medicines aren't really tackling those things and i just want to be really clear for people that anti-hypertensives or um you know drugs in general they have a role sometimes right they can be helpful in certain situations i think you're in agreement with that it's just we i'm not against them yeah okay i'm not against them per se but the problem is that if you don't fix the underlying problem what have you done okay so it's fine to give a statin to lower an ldl but what have you done have you actually fixed the problem you haven't done a damn thing about the problem the problem's still there okay so um you know the very first the very first sentence of the book okay starts like this you find a wasp in your attic what do you do kill the wasp or find the wasps nest you have to work upstream of a problem to solve a problem working downstream of a problem only fixes the result of the problem the problem's still there and if you don't if you can you can kill the wasp but then the next time you go up into the attic you're going to be stung into submission by all the other wasps yeah because you didn't fix the problem i i think we really need to i want to make sure everyone listening and watching this has got this that what you're talking about is really at the heart of pretty much every single chronic disease that's going on at the moment that is afflicting families it's overwhelming healthcare systems it's causing uh disability it's causing you know reduction in the quality of life and actually most of them are caused by you know malfunction in these eight in these eight areas but ultimately what you're making a very strong case for is that it's actually the modern food environments this highly ultra processed food that we are consuming in inordinate quantities is actually at the root cause and unless we deal with that as a root cause we're going to be struggling people are going to be suffering healthcare systems are going to be suffering and we're not going to get anywhere your your intro to the book was it it literally was so punchy like we could just do a podcast on the introduction frankly but i there's a couple of bits i've underlined which i think if you don't mind me reading it back to you your own book i so appreciate that you called my intro punchy because several people on you know amazon have said you know all he did was rant you know i guess it depends on how concerned you are about the problem yeah and this is this is such a big problem like it's arguably the biggest problem that's going on across the globe at the moment because well and you're seeing your kids right you see kids i i see kids and when you see a seven-year-old with pre-diabetes you're like this wasn't happening 20 25 years ago something is going on and we can't just give them metformin or we have to try and figure out what's causing this right can arrows if kids are the canaries in the coal mine and if you ignore it you know you do it at your own risk it's just that simple and that's what we're doing we've done we've ignored it the other thing is that everybody right now is completely distracted okay they're distracted by this thing called coven okay and i understand why and you know it's just it's certainly distracting however let's talk about that for a minute okay people are dying in droves in every country uk us you know you name it do you know where they're not dying they're not dying in countries that actually still have real food third world countries actually have a very low death rate and it's not because they're using masks or um hand washing you know or social distancing the reason is because they're eating real food we have the data on mortality rates of the different countries i can put it up on the screen if you want but the bottom line is it's only the developed countries that have the high mortality rates now why is that so we've identified the elderly and they have immune dysfunction we understand that they can't generate the same cytokine response that you need you know that that everyone else should be able to okay let's put the elderly aside for a moment because that's true everywhere it was true in italy too but the other three things the other three demographics that were shown to be you know uh related to covet mortality here they are people of color the obese and pre-existing conditions those three people of color the obese pre-existing conditions what do those three demographics share in common probably poor socioeconomic conditions um poor diets lots of highly processed food right ultra processed food consumption crappy diet ultra processed food consumption so why should your food make a difference as to whether you die from covet or not why is that here's why three reasons number one the virus is very smart it wants to attack all your cells and every cell in your body has a receptor that helps regulate water within the cell and that receptor is called ace2 ace2 angiotensin converting enzyme 2 it's an endocrine receptor okay and that's where angiotensin works and it involves water transport all right so every cell has it turns out the virus uses that protein as its injector point well high insulin increases ace2 because high insulin causes water retention and so there are more ace2s on all your cells so you are more at risk of being infected when your insulin is high and your insulin is high because of processed food that's one number two diabetes high blood glucose high blood glucose turns out the glucose actually crystallizes around the edges of those acetus holding them open making it even easier for the virus to inject its rna number three short chain fatty acids so short chain fatty acids come from fiber consumption and of course ultra-processed food is devoid of fiber short-chain fatty acids suppress the cytokine response and we now know it's not the virus that kills you it's your cytokine response that kills you because your cytokine response is basically sort of like a nuclear blast that affects even your normal cells but it's trying to get rid of the foreign invader but you have to temper it you have to be able to manage it you have to be able to pull it back you have to be able to minimize it short chain fatty acids that come from the digestion of fiber in the gut are one of the things that improves that cytokine response that's why fiber is anti-inflammatory and also improves insulin sensitivity but processed food doesn't have any fiber it's been you know that's been removed for shelf life so those three demographics people of color the obese pre-existing conditions big ultra processed food consumers high sugar low fiber processed food not real food the cdc and the nih and the mrc and every and everyone in public health england no one is talking about food in cobit yeah this is the fourth leg of the stool okay we all talked about masking and hand washing and social distancing garbage fix the food now i think when we're talking about foods i think we need to get clear on terminology for people who are listening and they think okay look i get this highly processed food is at the root cause of many of these chronic diseases over half of what we're consuming as a country as a western society are these foods so i guess we need to really help people understand you know what are these things there's this part in the introduction where you actually i've underlined it you said what if this slow consumable poison looks like everything else in the store how do you protect yourself and that's kind of part of the problem isn't it i don't it's so normalized that i think many people don't really understand anymore well what is a processed food what is real food you know so can you help us try and understand that right yeah one of the first questions we ask in in clinic you know we used to ask is you know mom you know the the mom and the kid come in you know for for you know uh obc clinic and we asked you know mom you know what do you consider food you know do you do you think cheetos is food if you think cheetos is food then basically nothing's going to help you so that's the first thing we do is we disavow them of this concept of this knowledge so what we did in our clinic to be effective and we actually studied this we published on it we validated it as an instrument what we did was we took all newcomers all new referrals to our clinic and we did a teaching breakfast so these kids came in fasting you know so we could get comorbidity and safety labs and we you know they saw the doctor they got their blood drawn they got their physical exam and then they went to the teaching breakfast six kids six parents around the table one dietitian english and spanish uh different you know different times all right so that everybody you know got a teaching breakfast and we got a 100 gift certificate from trader joe's every month to basically buy the food for the teaching breakfast and of course our dietitian went out and bought the right stuff not the wrong stuff and we would then she would then narrate for or he would narrate for an hour why these foods were on the table for breakfast and why the stuff they were buying at home was the wrong stuff okay and we would explain insulin and we would show them how much sugar was in each of the things that they were getting at home and versus you know what what was on the table and four things had to come out of that and we actually validated this four points four different points that conferred success number one the parent had to see the kid would eat the food number two the parent had to see the parent would eat the food number three the parent had to see other kids would eat the food because they got other kids at home number four we showed them the bill they had to see they could afford the food all four if we got all four boxes ticked those patients did well and then there was no going back so this was a training moment this was a teaching moment this was a way we could explain to to parents and to kids what was going on and model for them so they can do c one do one teach one more like we always do in medical school if you tell people what to do they will not do it if you show people what to do and they do it then they'll do it again yeah and not until the term real foods i like it you use it but it does get a bit of pushback from certain academics and you know i saw one i think on instagram just a couple of weeks ago a very prominent uh researcher and obesity in the uk um denigrating the term saying it smacks a privilege it's you know all kinds of things about it and here's the thing you know you know my view bob is that i found it to be very useful with my patients of course if my patients don't like it i'd come up with something else that they understand um but generally speaking i think the things like you know would your grandparents recognize it as foods i think people find it quite helpful or does the food packet have more than five ingredients on it or not as a kind of general referral they're not perfect but they're all kind of guidelines to try and help people make sense of this ultra process food environment in which they're living and i kind of i wonder why there's so much criticism it's like these things are there to help people if you find it helpful great if you don't fine use something else but i don't like i find a lot of people particularly in medicine and academia look down on these kind of what are considered simplistic terms yeah i i've i've heard those uh complaints also before and i've heard about the quote smacks of privilege also basically what we're saying is real food is food that came out of the ground or animals that ate the food that came out of the ground that's real food okay as soon as a human touched it now it's processed just a question of the degree of processing also and you know i'm sure you're familiar with carlos montero at university of sao paulo developed this system called the nova system for the degree of processing which i actually think is you know the right way to go it's not because that 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 and that's the point i try to make in the book and i have an entire section on what we did to the food that actually turned it from food into poison that classification system is brilliant and perhaps you could take a kind of readily available simple food and just explain how it can go through these four stages to help people really understand this sure i can do this in one minute let's take an apple class 1 on the nova system would be an apple class 2 on the nova system would be apple slices class 3 on the nova system would be apple sauce unsweetened class 4 on the nova system would be an apple pie there you go it turns out that only the class 4 foods are associated with chronic disease so we can have we can have minimally that's really incredible so we can have you know minimally processed foods that are done to make our life easier a little bit or you know but it's when it goes to that extreme where it's actually there's no resemblance to actually what actually came out of the ground in the first place that's right and so what is different about that apple pie versus the apple and the answer is the addition of sugar and the removal of fiber so this now brings us to the question you asked me earlier about the protect the liver feed the gut so the addition of sugar is what basically floods the liver because the liver only like alcohol only has an innate capacity to metabolize a small amount we know how much uh sugar we can metabolize and it's not that different from the amount of alcohol that we can metabolize because the treat you know the the uh the metabolism is virtually the same point is you can overwhelm your liver's capacity to metabolize sugar and when that happens just like what happens when you over metabolize alcohol is your liver can handle the onslaught and so it has to take the extra and turn it into fat there are enzymes in your liver that turns sugar into fat it's called de novo lipogenesis new fat making there are three enzymes that uh in concert that do this one's called uh atp citrate lyase the other one's called acetyl coa carboxylase and the last one is called fatty acid synthase these three enzymes are being driven by excess substrate and that substrate is fructose then turned into acetyl coa by glycolysis so bottom line you're flooding your liver and the goal is protect the liver and when you flood your liver now your liver makes fat and that fat precipitates now you got fatty liver and now you got insulin resistance yeah and now you got chronic metabolic disease so protect the liver second part feed the gut now a lot's been written about the microbiome okay and there are a lot of probiotics that are now you know in health food stores to try to restore the microbiome and everyone now knows that the microbiome talks to your brain which is true it does the question is with taking a probiotic a bacteria work would that fix the problem because boy if that could fix the problem that would be great wouldn't it the answer does it does it work is there any disease yet that has actually been ameliorated attenuated or cured by administration of a probiotic name one i mean it's helped i think it's helped with symptoms in things like ibs i think it's been shown to make you know general improvements in mood sometimes in the right individual but by and large ameliation of disease i don't think we've got that evidence yet do we well we certainly don't and the reason is because it does it doesn't happen so here's my here's my question to you wrong think think just think this out these probiotics they're bacteria they're live cultures right yeah they're alive you know whether they're in a pill or not they're alive you swallow them those bacteria should be able to populate your intestine grow take hold and basically you know contribute to your microbial diversity yes yeah concept right why do you have to keep taking them why shouldn't why can't you just take one why have to take them every day yeah well a lot of them just passed straight through don't they and that's right a lot of them pass straight through or they die right there in the intestine which is exactly what happened to the ones as to why you don't have them there in the first place because they're already dead because the intra-intestinal milieu that the bacteria find themselves in is not conducive to their growth sorry interrupts if you are enjoying this content there's loads more just like it on my channel so please do take a moment to press subscribe hit the notification bell and now back to the conversation the ones that you basically had before have already died and so you take them every single day and they're still not populating your intestine they still haven't actually taken hold and thrived and contributed to your microbial diversity so basically they're not doing very much which is why we haven't seen any amelioration of any disease yet because probiotics are not working upstream you have to change the intestinal milia first how do you do that that's what a prebiotic does so what's a prebiotic a prebiotic is food for those bacteria that will feed them so that they can grow and what's the nature's perfect prebiotic fiber fiber fiber is not food for you fiber is food for your bacteria but when we took the fiber out of the food to process it because fiber basically reduces shelf life when we took the fiber out of the food to process it we are now depriving our bacteria of the food they need to be able to live in symbiosis with us and so those bacteria the good bacteria are dead the bad bacteria have taken over and the bad bacteria is sending all sorts of bad signals actually suppressing serotonin generation in in the intestine thereby reducing the retrogra anterograde transport of serotonin back up into the nucleus tract to solitarius and that's called depression yeah okay also because you're not feeding those bacteria that bacteria are basically stripping the mucin layer right off your intestinal epithelial cells because they can eat that and that's then exposing and denuding the your intestine and uh and making it uh uh you know all the junk that's in your intestine basically can get through called leaky gut contributing to inflam inflammation inflammatory bowel disease irritable bowel syndrome and um insulin resistance all because you didn't feed your gut and that's and that's how the whole thing gets tied together here that very some very simple but very very brilliant advice protect the liver feed the gut but the modern food environments the ultra processing of food is overwhelming the liver with sugar and it's starving the gut through its lack of fiber and then the consequences are the liver could be you know fatty liver type 2 diabetes but the problem when the the gut gets starved and as you say leaky gut or increased intestinal permeability sets in then you're opening up for everything autoimmune disease food allergies um alzheimer's depression all all these things have been associated with increased permeability in the gut so it's a very simple maxim but one that actually again going to that nexus of the root cause it's kind of right there isn't it and that's you know this is the other thing i really liked rob is that you don't seem to have a preferred diet very much like me i'm always like you it's unprocess the diet first let's just get out the junk let's get the real food in and then let's see where we are so how does you feel that like a vegan diet or a low carb diet or a whole manner of diets can can fit this maxim of protecting the liver and feeding the guts yeah i'm agnostic as to the whole vegan keto thing i i you know look if people who want to be vegan you know fine whatever you want to be vegan great don't make anybody else feel bad about their choice but you know you can feel good about your choice that's fine okay um there are a lot of reasons to be vegan you know animal welfare religion um cost uh uh coolness if you will but met but metabolic health is not one of them okay and i can prove it because coke doritos and oreos are all vegan so you can do vegan right or you can do vegan wrong keto okay i'm not against keto i used ketogenic diets in my patients when their insulin resistance was so severe that nothing else would work where they were where they had insulin hypersecretion and basically we had to control their blood glucose rises in an attempt to try to stave off um continued weight gain either one so we use the ketogenic diet okay and i'm not against that the problem with the ketogenic diet is not the diet the problem with the diet is that it's really easy to fall off it because as soon as you have even a little bit of carbohydrate a little bit of carbohydrates going to raise your blood glucose therefore raise your blood insulin and therefore stop the ketogenesis because insulin blocks lipolysis at the level of the fat cell and there goes your lack of substrate and so it's been shown that people who are left to their own devices in terms of doing a ketogenic diet they can start with all good intentions and by two months into it they're basically you know not on they're not in ketogenic anymore you know they're not making ketones basically and then they're on the worst diet because they're on a high fat medium carbohydrate diet which generates both insulin and loads and loads of ldl that's kind of like the worst thing you can be on so if you're fastidious then the ketogenic diet is a great diet if you're not fastidious then you shouldn't be on a ketogenic diet so it kind of depends on whether or not you can actually you know keep it up and a lot of people you know fall prey to you know the the croissants on the you know you know that the other guy at work brought in so you know bottom line is i don't have a preferred diet i don't i'm agnostic on it i think there are a lot of ways to skin this cat i think ultimately we will learn the genetics of who does better with which diet and it will turn out that certain diets are better for certain people and other diets are better for other people and i'm very interested and uh you know involved in this personalized nutrition you know uh concept and and movement that's going on right now so it may be that there are certain people out there who are a vegan diet who ought to be on keto and there are certain people who are on a ketogenic diet who probably ought to be a vegan one um and they don't know it yet so why would you basically put all your marbles in one um you know goldfish bowl so i'm for both diets yeah the only diet i'm not for is the western diet and the reality is i think any clinician who has utilized food as one of their tools and their toolbox with their patients which i hope more and more are starting to do although it's clearly not enough you will see that different people thrive on different diets that's you know you you i i think real life clinical practice teaches you that well these guys here are literally rocking a low carb real food diet their markers look good their bloods look great and all these people here are doing great on a whole food vegan diet as you say the commonality is no processed food or very very low amount of ultra processed foods right commonality is low sugar high fiber both diets work when they're low sugar high fiber and so that's why i think those are the two sort of linchpins in this whole story but unfortunately that's exactly what processed food is not you used apples before to demonstrate those four categories of processing which i thought was a really nice example where would apple juice fit into that because that's something that many people are consuming every day thinking it's healthy hopefully they might be re-evaluating that at the end of this conversation but yeah where does that fit in so what happens with apple juice whether it's let's let's just let's just take apple juice that's not also uh sweetened right because you know sometimes they add extra sugar just taking an apple and putting it in the vitamix okay okay all right let's do that kind of apple juice okay apple juice that's been vitamix or the jamba juice okay people say that's great right because that's whole fruit well it was whole food now it's not so you have to understand the problem of fiber now fiber we've been talking about it like it's one thing and that's not correct fiber is two things two one's called soluble fiber and an example of that would be like inulin or pectins like what holds jelly together hydrogel that's what's in cream cheese and then there's a second fiber called insoluble fiber and that's like cellulose that's like the stringy stuff in celery it's also what's in cardboard okay so cream cheese cardboard okay both fiber haha all right well it turns out that real food has both okay now when you put the apple in the vitamix you are shearing the sm the uh the insoluble fiber the cellulose to smithereens you are cutting it up into such little small little fragments that it's not going to be functional after all after what afterward so here's how the soluble and insoluble fiber work together imagine a fish net all right so you know plastic you know uh matrix right with holes in it right and when the fishnet is um uh working okay what happens is you can catch fish but then the kelp the seaweed is going to plug the holes in the fish net and now you're not going to be able to drag it through and catch the fish anymore right so you've created a barrier so that the insoluble fiber is like the fish net itself and the soluble fiber is like the kelp and you so together they form a barrier or think of it this way like a spaghetti colander okay metal bowl with holes in it right you run the water water runs through now take a blob of petroleum jelly throw it into the center of the colander run the water still runs through now take your finger and rub the petroleum jelly all around the inside of the colander now run the water now the water doesn't run through you've created a barrier right and you needed three things you needed the colander you needed the jelly and lastly you needed the geometry of plugging all those holes all right for the fishnet you needed the net and you needed the kelp together right yeah if somebody came along and took a scissor to that fishnet you know all of a sudden now you don't have a barrier anymore so this is what's going on in your gut the insoluble fiber the cellulose the stringy stuff in the celery is forming a lattice work on the inside of your intestine the soluble fiber like the pectins and inulin they're globular they're plugging the holes in that lattice work and together they form a white issue gel on the inside of your intestine and that gel is a secondary barrier that prevents early absorption of glucose fructose sucrose simple starches so that they don't end up going to the liver so they don't flood the liver so that your liver doesn't turn them into fat so that your liver can stay healthy so the apple juice the vitamix to apple juice it still has the soluble fiber and that still has a benefit because that can still go down to your colon and make short-chain fatty acids and that's good but it won't protect your liver so you've taken one of the two cardinal phenomena of health and you've basically thrown it in the garbage can so apple juice better than soda because it has soluble fiber but not better than soda because it floods your liver but soda also floods your liver huge well absolutely yeah and what's the relationship we've obviously we're now moving from food into i guess drinks uh although apple juice of course comes from an apple um soft drinks diet drinks these are things which are routinely consumed perhaps you could talk about the relationship between these drinks and our wider health right so first of all it's now been shown 50 ways from sunday that sweetened beverages sugar sweetened beverages soft drinks are disastrous they're disastrous for adults they're disastrous for kids okay and we have quantitation on just how many deaths per year occur in both the us and the uk due to soft drinks alone this has been done by numerous investigators most notably the ones at tufts friedman um like darius mozafari and his granada mika et cetera no question so then you say okay that's true but what about diet drinks they have no fructose they have no calories they should work they should be fine right not so much so here's why a couple of studies have now shown exactly why a couple years ago i wouldn't have been able to tell you this but now we have the data that explains why this is all right number one you put something sweet on the tongue message goes tongue to brain sugar's coming message goes brain to pancreas sugar's coming release the insulin but then the sugar never comes because it was a diet sweetener what does the pancreas do does it say oh man i was waiting for that you know i get i'll just wait till tomorrow or does it go you know i got all these insulin vesicles sitting here where in the go okay i'm gonna go find me some calories to work on yeah and you end up overeating turns out it's the latter we now have the data to show us the latter so in fact all the studies of diet drinks show that caloric intake total caloric intake does not change so you think you're doing well by taking 150 calories in sugar out of your diet but it turns out you end up making up those 150 calories elsewhere in your diet it's been shown in different experimental conditions that basically it sensitizes your pancreas to actually make more insulin those diet drinks this is work from janina pepino when she worked with sam klein at washu st louis and also tay it all uh that showed that if you um consume diet sweeteners okay instead of sucrose you will not consume as much many calories in the morning because the because the diet soda that you drank in the morning but you will actually increase your food intake later on in the afternoon and evening so that the total number of calories you ate ends up being exactly the same which is why diet drinks have not caused anybody to lose weight because you end up making it up later that's number one number two we now know that certain diet sweeteners actually alter the microbiome in a negative fashion and contribute to leaky gut the most famous of which is sucralose you know splenda and worse yet we now know that adipocytes you know fat cells have receptors for diet sweeteners and so if you absorb those diet sweeteners they go through your bloodstream end up at your fat cell they can cause fat deposition in the fat irrespective of insulin so the bottom line is diet sweeteners might trick your tongue but they don't trick your body yeah and it kind of sort of makes sense doesn't it if we if we if we go back to the fact that you know our biology we've been wired over hundreds of thousands of years to you know respond a certain way to certain things in our environments we we've we've just changed that so much and you know did artificial sweetness exist 100 years ago 150 years ago you know has our biology learnt how to adapt of course it doesn't mean we can't learn but i've always i've all i know it's a very controversial area but my advice with my patients has always been look i'd be really cautious with this i i don't think you should go to that i think i'd much prefer water or you know something else but i've always taken that more precautionary principle i know many people um vocal on social media will say that there's no problem with artificial sweeteners but you think it's pretty clear now with artificial sweeteners yeah i think the data are in uh there was a paper that came out in the american general clinical nutrition about uh 2017. what they did was they said they showed we're using a meta-analysis that the toxicity of one coca-cola equals the toxicity of two diet coca-colas wow so half as bad that doesn't mean good that means half as bad now the problem is okay it's half as bad but people who are drinking diet soda say oh no fructose no calories i'll drink five of them yeah now it's two and a half times as bad we've mentioned sugar as a mitochondrial poison we've mentioned um [Music] insulin resistance as a root cause of many of these chronic diseases and we mentioned obesity and weight gain as a symptom rather than the cause what we haven't quite mentioned yet is thin people who think they're okay because they don't look overweight yet on the inside there's a very different story and i wonder if i could just frame that around the statistic which i've heard before you've written about it in your book that 88 of americans have a degree of metabolic dysfunction but i also love the way that you describe metabolic syndrome the you know maybe you could describe how you say it because i think it's a beautiful beautifully simplistic way of looking at it and then put it in the context of that thin person who thinks they're doing okay so here's the problem everybody thinks that the scale tells the truth the scale tells you how much you weigh who cares seriously who cares and here's why the scale lies because there's not one fat depot there are three three separate fat depots and they contribute differentially to your health here they are first one the one you can see the subcutaneous fat the big butt fat as it were as in do these genes make me look fat and never answer that question bad idea turns out the subcutaneous fat while potentially cosmetically undesirable is metabolically inert our subcutaneous fat is there very specifically to store energy for periods of famine right and it has an innate expansive capacity to a certain point before it gets into trouble in fact you can basically put on about 10 kilos of subcutaneous fat about 22 pounds of subcutaneous fat before you will have over expanded those cells those cells will then have choked off and died will have released their grease into the area will have recruited macrophages in to clean up the grease and will then have released cytokines into the bloodstream which will by the way go into the systemic circulation so you have to have a lot of grease in order to get a hot concentration high enough to go back to the liver to activate the cytokine response than the liver and cause insulin resistance so 10 kilos of subcutaneous fat before you get sick that's depot number one depot number two the visceral fat the belly fat okay the you know beer belly if you will fat right now that fat turns out not to be from beer that fat turns out to be from stress from stress you know a lot about stress that fat in your belly fat okay visceral fat is due to cortisol and cortisol is because our our world is now overly stressful and people are overly stressed like all the time so how do we know that the answer is because we can take patients with clinical depression endogenous clinical depression suicidal depression get admitted to the hospital to keep them from themselves put them in a scanner and quantitate the amount of visceral fat now they're losing weight because they're not eating they're losing sub-q fat because they're not eating but they're gaining visceral fat because their cortisol is so high that is metabolically active fat and it drains directly into the liver because it drains into the portal vein not into the systemic circulation so a small amount of visceral fat will generate enough cytokines for your liver to be able to see it because it's concentrated because it's not being diluted over the entire volume of distribution of your systemic circulation so turns out about five to six pounds of visceral fat before your liver gets sick so for sub-q fat 22 pounds for visceral fat five to six pounds now can you see five to six pounds on the scale maybe maybe not now let's do the third fat depot the liver fat the fat in your liver turns out to be the most egregious because it's right there it's causing the problem right where the action is right there in your liver okay it turns out only a half a pound of visceral fat i'm sorry liver fat half a pound of liver fat and you will end up with metabolic dysfunction insulin resistance can you see a half a pound on the scale no all right so three different fat deposits so the question is what makes the liver fat answer sugar because of this phenomenon the de novo lipogenesis that we've been talking about so you are mainlining it right into the organ that is the most susceptible to the problem yeah and you can't even see it on the scale so there are people walking around with fatty liver and don't know it because they say well i'm thin no problem except they have a problem and that's why 88 of americans now have some form of metabolic dysfunction because either sugar or alcohol is causing liver fat irrespective of what it's doing the rest of your body and they don't know it that's the nugget of truth that people you know that doctors are ignoring of course that begs the question how can people find that out i will say because we don't have much long left that i don't want to be respectful of your time that in your book there is a whole section on the various blood tests that you should go and get uh they're very simple and actually very readily available and actually you did a beautiful session on you know what the actual values are but also what's optimal what we should really be gunning for um obviously there's things like dexa scans there's ways to hit ratios that people can do um but i guess you know from in my culture a lot of people from my ethnicity are walking around it's quite it was almost a joke growing up like you'd see dad's not a joke but you'd see you know dad's friends after they hit a certain age they'd still be thin everywhere but the belly would just start to um go out but but thin arms thin legs just that belly and of course you know many south asians do have an increased risk of toffee thin on the outside fat on the inside and all those sort of things but um i really wanted to highlight this because i think many of us think oh it's all right for them they can eat whatever they want and they don't put on weight it's like well wait a minute yeah cosmetically they may not be looking uh they may look as though they're getting away with it but they may not be i also just want to finish off um on kids you just mentioned liver fats i've heard you say before you've had to send two children at least for liver transplants because that is absolutely alarming rob from soda drinking so maybe before we get to the final point i just wonder if you could there's many parents who listen to this podcast and of course a lot of people can take the advice of themselves right i need to have a low sugar diet i need to have high fiber whatever my preferences are but with kids like it seems to be quite different kids meals are a joke in most places it's like the adults can have proper food and the kids have the junk in bars and restaurants right it's the same in the u.s chicken nuggets and french fries and a coke and so what is it doing to kids at this early age when they're having regular juices regular soda drinks regular highly processed foods it's not really necessarily about their weight is it it's about is it setting the tone for later on in life and then what advice would you give to parents first of all sugar down regulates its own receptor on the tongue so the more sugar the less sweet therefore you need more sugar so it becomes a vicious cycle that's one thing second of all it still causes liver fat accumulation in kids we you know now show have shown that 20 of children have liver fat unrelated to obesity people who you know kids who have died in auto accidents you know autopsies show 20 of kids have liver fat twenty percent that's unrelated to their obesity you know to obesity you know where did they get liver fat from they never had it before this is where um the bottom line is that this phenomenon is also uh you know the sugar is also causing changes in behavior now we don't have enough time to go into this but sugar inhibits an enzyme in the brain in astrocytes called glutamine synthetase and glutamine synthetase is necessary to turn glutamate into glutamine which then will go to gaba gaba is the inhibitory neurotransmitter glutamate's the excitatory neurotransmitter so there's a balance between excitation and inhibition and sugar basically breaks that balance and so sugar's been associated with irritability it's been associated with violent behavior it's been associated with cognition problems it's been associated with dementia in adults it's been associated with changes in the prefrontal cortex thickness it's been associated with associated with problems in school uh it's been associated with um all sorts of problems now associations not causation we are still working on putting all the causation pieces together yeah so you know i'm not here to tell you that sugar's poisoning your brain yet but you know there's a lot of data and the data in animals is pretty darn good you know you really want to go this route people and you're not talking about just white table sugar you're talking about the processed foods you're talking about the fruit juices right absolutely what about the capri suns i'm talking about you know the stuff that the the parents are putting in the uh in the lunch box yeah and that that statistic 20 of kids have liver fat that's they could be parents listening to this who think my kids look fine weight wise you know so what's what's the problem with a glass of apple juice a day um and that's the problem yeah exactly and so i'm not this conversation's not meant to shame anyone it's just meant to try and raise awareness as something that we both feel could be really really helpful uh rob i've got to say that if people want more and i hope they do well at some point if we can get a second conversation i'd love that but the book metabolical is it's really thorough it's really comprehensive i really would recommend people who want to learn more about this to get a copy i think it's something you can keep dipping back in and out of over time i i really do think it's a fantastic reads and you cover the planet as well in it which we didn't get a chance to talk about today uh just to finish off um this podcast is called feel better live more when we feel better in ourselves we get more out of our lives and and if everything you've said if you have all your passion about this area i just wonder if you could just leave my audience with some of your final thoughts and a few top tips that they can think about applying into their lives now the most important thing people have to understand is and you say it yourself some i'm basically trumpeting what you say to solve a problem you have to solve the cause of the problem not the result of the problem doctors don't know how to do that and i can say that because i'm one of them okay and i did i didn't understand that going through medical school and i didn't understand that for the first 20 years of my practice i did what i was told i practiced the way they taught me to do i got woke you got woke there are doctors around now who are getting woke and they're starting to make some shall we say noise they're being cast off as you know heretics and you know rabble rousers and you know troublemakers and whatever and some of them have even gone on trial in their respective countries tim noakes in south africa carrie fetke in australia evelyn border roy and canada don't know if there are any in the uk that have had that happen but the bottom line is we are undergoing a a revolution in modern medicine we underwent a revolution back in the 1930s 40s with antibiotics where we thought a pill could treat everything now we're undergoing a revolution where we realized that was a mistake it's time to rethink health it's time to rethink health care you can't fix health care until you fix health you can't fix health until you fix diet and you can't fix diet until you know what the hell is wrong and what you thought was wrong was basically propaganda for the last 50 years we've had to undo that we've had to basically turn it over we've had to re-re-think all of modern medicine and for your audience out there what i'm telling you is not everything is wrong but a lot of it is when i went to medical school in 1976 a very very um uh famous clinician stood up in front of our class on the very first day and you've probably heard this yourself wrong and he said 50 of everything we teach you is wrong we just don't know which 50 this is the 50 percent robert lustig you have been doing incredible advocacy for many many years you continue to do it you're helping the lives of hundreds of thousands of people if not millions around the world thank you for joining us on the podcast and uh hopefully we'll get a chance to talk again in the future it's my pleasure hope to come to the uk and we'll have a beer just one if you enjoyed that conversation all about the negatives of eating too much sugar i think you are really going to enjoy this one about the specific foods that you can eat to prevent disease we are actually all forming cancers in our body all the time but if you can prevent tumors from growing their blood supply you can actually keep these cancers harmless so this is what foods are able to do

Channel: Dr Rangan Chatterjee

Views: 599,129

Keywords: the4pillarplan, thestresssolution, feelbetterin5, wellness, drchatterjee, feelbetterlivemore, ranganchatterjee, 4pillars, drchatterjee podcast, health tips, nutrition tips, health hacks, live longer, age in reverse, self help, self improvement, self development, personal development, motivation, inspiration, health interview, the bitter truth about sugar, university of california

Id: zXiQgTZZqPg

Length: 103min 14sec (6194 seconds)

Published: Fri Mar 11 2022