Dr. Robert Lustig: How Sugar & Processed Foods Impact Your Health

welcome to the huberman Lab podcast

where we discuss science and

science-based tools for everyday

[Music]

life I'm Andrew huberman and I'm a

professor of neurobiology and

Opthalmology at Stanford School of

Medicine my guest today is Dr Robert

lustig Dr Robert lustig is an

endocrinologist that is he's a

specialist in the function of hormones

in the body and a professor of Pediatric

Endocrinology at the University of

California San Francisco he has authored

more than 100 peer-reviewed studies

exploring how different types of

nutrients that is food impact our

cellular functioning our organ

functioning and thereby our health

during today's discussion we discussed

the idea of whether or not a calorie is

indeed a calorie and whether or not our

body weight and body composition only

reflects the number of calories we eat

versus the calories that we burn we talk

about how different food types that is

how the different macronutrients protein

fat and carbohydrates are processed in

the body and the important role that

fiber and the gut microbiome plays in

that process and we pay particular

attention to the topic of how different

types of sugars and fructose in

particular can indeed be addictive to

the brain and can modify the way that

hormones in the body in particular

insulin impact our Liver Health Kidney

Health and indeed the health of all of

our cells and organs indeed Dr lustig is

an expert in how sugar impacts the brain

and body we talk about how certain types

of sugars can indeed be addictive in the

same way that certain drugs of abuse and

behaviors can become addictive so in

other words how sugar actually changes

the way that the brain works and we

discuss how the food industry that is

the commoditization and sale of

particular types of food has altered the

way that we eat and indeed the foods

that We crave today's discussion covers

all of that and by the end of today's

discussion you'll have a thorough

understanding of how foods are processed

when they enter your body and how those

different food choices are impacting

your immediate and long-term Health

before we begin I'd like to emphasize

that this podcast is separate from my

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Dr Robert lustig Dr Robert lustig

welcome pleasure truly uh just being

here being invited uh high honor really

appreciate it and it's not doctor it's

just Rob okay Rob I've been looking

forward to this conversation for a long

time I've seen your your now famous can

we also say Infamous but famous YouTube

video about sugar we'll put a link to it

in the show note captions it's been

viewed many many millions of times yeah

and I still can't figure out why that is

you know I didn't think my mother would

watch it and she didn't but 24 and a

half million people did well I think

people are very interested in what to

eat what not to eat and we'll start off

simply talking about what most everyone

believes and understands

which is that a calorie is a form of

heat

energy that's given off during the

processing of some food bit or something

if that's mysterious to people just

understand that a calorie is a unit of

energy and I was taught and still many

many people worldwide believe that a

calorie is a calorie meaning if I

consume more calories in whatever form

then I metabolize by thinking feeling

moving exercising Etc then I will gain

weight and if I consume fewer calories

than I burn I will lose weight and we

could talk a lot about where that weight

loss comes from does it come from

adapost body fat stores or from muscle

or from protein or muscle of course is

protein Etc but let's start off with is

a calorie truly a calorie when it comes

to the processing of different types of

calories everyone thinks that obesity is

about energy

balance that is calories in calories out

therefore two behaviors gluttony and

sloth therefore if you're fat it's your

fault

therefore diet and exercise therefore

any calorie can be part of a balanced

diet therefore don't pick on our

calories go pick on somebody else's

calories this is actually what the food

industry uses to assuage their

culpability for the change in the food

supply and the rise in obesity and

chronic disease like diabetes now it is

true that a calorie is that unit of

energy that raises one gram of water one

degree Centigrade and so therefore a

calorie burned is a calorie burned I

don't argue that that's true that's you

know the first law

thermodynamics but that doesn't mean a

calorie eaten is a calorie eaten that's

not the same and that's where people get

it wrong so let me give you some

examples of how that calorie eaten is

not a calorie

eating you like almonds I do me too

almonds are great okay you eat 160

calories in

almonds how many of those do you

absorb

130 you eat 160 you absorb 130 where'

the other 30 go in the processing of

that food energy

no turn out the fiber in those almonds

both soluble and insoluble fiber and by

the way fiber is sort of the key to the

kingdom in this

story forms a gel on the inside of your

intestine the insoluble fiber the

cellulose forms a fishnet if F A lattice

work on the inside of your dadum the

soluble fiber which are globular plug

the holes in that fish net together they

form a secondary barrier you can

actually see it on electron microscopy a

whitish gel and that prevents absorption

of those 30 calories so yes 130 get

absorbed but many of them don't they end

up going further down the intestine to

the next part called the junam and

that's where the microbiome is now now

everyone knows about the microbiome

nowadays you know it's all the bacteria

you know we always say when women are

pregnant you're eating for two well

we're always eating for 100

trillion now they have to eat well what

do they eat they eat what you eat the

question is how much did you get versus

how much did they get well if you ate

almonds they're getting those 30

calories so even though you count the

calories at your

lips that doesn't matter what really

matters is counting the Cal calories at

your intestinal brush

border okay and they're not the same so

if you feed your gut that's a good thing

because then your gut will take those

calories and turn it into things like

short chain fatty acids which end up

being protective against chronic

metabolic disease acetate propionate

butyrate valorate those are actually

good they're anti-inflammatory

anti-alzheimer's because you fed your

microbiome so even though you ate 160

you absorbed 130 so a calorie eaten is

not a calorie eaten because if you ate

it with fiber it wasn't for you it was

for your bacteria but that's not the way

you count them up so that's problem

number one problem number two amino

acids so we all eat

protein let's say you eat too much

protein you yeah you know the Porter

House steak all right now if you're a

bodybuilder

those amino acids might go to muscle and

you might increase your muscle mass

because you're a bodybuilder because

you're putting uh excess uh force on

those muscles and you're growing those

muscles okay but let's say you're not a

bodybuilder let's say you're a mere

moral like me or let's say you're a kid

going through puberty who's synthesizing

a lot of muscle not because they're

lifting weights because they're because

testosterone's making it happen yeah

absolutely but let's say you're not

let's say you know you're just you know

just slump off the the street like uh

you know joeo okay and you eat that

Porter

House you've taken on all these amino

acids there's no place to store it other

than muscle so your liver takes the

excess and deamidates that amino acid

takes the amino group off to turn it

from a amino acid into an organic acid

and then that organic acid can then

enter the kreb cycle the tricarboxylic

acid cycle what goes on in the

mitochondria in order to generate ATP

the chemical energy that your body needs

in order to power itself okay now that's

a good thing it takes double the amount

of energy to prepare that amino acid for

burning as it does to uh prepare a

carbohydrate for burning or fat for

because when I asked about when you

asked about almonds why the the 160

versus 130 I thought it was the

processing it turned out it was fiber

you're saying for protein let let's make

it realistic for a a really nice big

porterhouse steak which I love by the

way let's say let's say 800 calories

yeah well it turns out how much of that

is is uh so that's what goes in your

mouth right my mouth right how much of

it is actually um eaten in uh to stay

with the your calorie eaten is not a

calorie eaten in the processing of that

what percentages actually goes into your

total caloric intake right so about 10%

of everything you eat goes to just

maintaining body temperature it's called

the thermic effect of food but when

you're eating protein you actually

generate more Heat and the reason is

because it takes to ATP to phosphorate

that organic acid as opposed to one ATP

to uh phosphorate that carbohydrate for

uh consumption so you actually have a

net loss of energy because it was a an

amino acid versus a monosaccharide a

sugar now you you brought up fat fat

doesn't need to be phosphorated so it

actually doesn't have any um thermic

effective food at that point so depends

on what it is as to whether or not you

have loss okay so but in this um let's

make it actually realistic a 1600

calorie uh Porter House with a nice slab

of of uh of fed butter on there I do

this every once in a while not not often

with some cream spinach and maybe some

mushrooms along the side honestly I when

I'm eating a porter house I don't want

to adulterate The Taste okay with

anything else except maybe some some

butter maybe a salad okay afterwards but

but let's say 1 1600 calories of of it's

got some fat in there for sure uh let's

say um uh a thousand of those calories

is protein mhm the other 600 are

fat something like that like that

depending on how marbled it is okay so

based on what you just said about the

thermic effect of food and protein in

particular yeah of that thousand

calories how much actually is can we

count I'm not a calorie counter but does

one include as calories truly ingested

well if you ingested 1600 well that's

what went in the mouth but but but what

is is going to go against your your uh

burn deficit right so I would have to

actually do the math to figure that out

but as a guess yeah back of the envelope

back of the envelope calculation you're

going to lose about 25% of that wow so

we're talking 750 calories yeah you know

so and to translate this a bit so what

we're saying here is if you're somebody

who is trying to lose weight or maintain

weight or perhaps even gain weight you

eat a 1600 calorie Porter House with a

slab of butter on it 600 of those

calories we're saying in this instance

is fat with the remaining thousand

calories that's that all went in your

mouth so you count it at your mouth

right but 700 but then when you compare

it against your energy burn for that day

to maintain temperature brain activity

physical activity really it's only 750

calories that's right that's a huge

difference exactly and another reason

why a calorie is not a calorie now let's

take the third let's take fats so over

here we have omega-3s heart healthy

anti-inflammatory anti-alzheimer's save

your life and over here we have trans

fats the devil incarnate consumable

poison because you can't break the trans

double bond you don't have the

desaturates to break that trans double

bond so it basically accumulates lines

your arteries lines your liver causes

chronic metabolic disease causes insulin

resistance

Omega-3s don't even get broken down for

energy because they're so important they

stay intact because your brain needs

them your heart needs

them whereas trans fats can't be broken

down because of that trans double bond

one save your life other one kill you

they're both nine calories per gram if

you explode them in a bomb calorimeter

because a calorie burned is a calorie

burned but a calorie eaten is not a

calorie eaten because one will save your

life one will kill

you and finally the Big Kahuna the one

that blows everything else out of the

water from ose and glucose all right now

glucose is the energy of life so here

we're talking carbohydrates I think most

of our audience will be familiar with

the so-call macronutrients so we talked

about fat in this case almonds there's

some Fiber in there probably a little

bit of carbohydrate a little bit little

bit talked about the Porter House with

butter right making me hungry already

that's protein and fat M very little of

any carbohydrate it should be zero

essentially maybe one zero zero y

um and then now we're talking about

carbohydrates and we're going to

subdivide that into glucose and fructose

right galactose basically becomes

glucose in the liver so we we can

dispense with that unless you have a

disease called galactosemia which is

about one in 20,000 um and causes

neonatal menitis and you know it's a

disease as a pediatric endocrinologist I

would take care of but we can dispense

with that for the moment all right so

glucose fructose glucose is the energy

of life every cell on the planet Burns

glucose for energy glucose is so damn

important that if you don't consume it

your body makes it so it will take an

amino acid and turn it into glucose

that's gluconeogenesis glucogenesis

that's right it will take a fatty acid

and turn it into glucose and

specifically the glycerol portion of the

triglyceride will turn into

glucose

so the

Inuit they didn't have any place to grow

carbohydrate they had ice they had whale

blubber they still have serum glucose

level and the reason is because you had

to you have to have a serum glucose

level in order to power your brain in

order to power your heart yes you you

can use ketones of course you can but

you know only if you're in a ketogenic

state will you use exclusively ketones

and you also need glucose for structural

changes in specific proteins and

particularly hormones so glucose

molecules will stud TSH LH FSH different

pituitary hormones in order to increase

their potency it's one of the reasons

why aging leads to defective

hormonogenesis for instance hypogonadism

hypothyroidism is the loss of

glycosilation on individual um uh uh

peptide hormones because of uh the

inability to add glucose because of

insulin just it's an aging phenomenon

okay we'll come back to this cuz I think

that's really important yeah the idea

that ingestion of

carbohydrates and the as you called it

the studing of carbohydrate molecules on

hormones can augment the function of

those hormones and with aging that's a

less efficient process it's a less

efficient process but it's not because

of consumption it's right people are

still I I see the the uh plenty of folks

who are uh 65 and older eating plenty of

carbohydrates you're saying a lot of

them have deficient thyroid testosterone

estrogen right um prolactin Etc because

of the Wes those carbohydrates are not

studing the uh the hormones exactly so

they're all of those are glycoprotein

hormones let's tea that up for later

because I think that's an interesting

Avenue to go down okay and there's a and

there's a disease in children in in

babies called congenital disorders of

glycosilation where you can't put uh uh

glucose Mo uh molecules on specific

proteins and it causes severe mental

retardation all sorts of metabolic havoc

and a lot of those babies die for that

matter so that's an important thing all

right but that's how important glucose

is fructose on the other hand this sweet

molecule the molecule we seek the reason

why the food industry studs every food

in the grocery store you know 73% of all

items in the American Grocery Store have

added sugar on purpose for the food

industry's purpose is not for yours

because fructose is addictive activates

the nucleus accumbens the reward center

of the brain in the same way that

cocaine heroin nicotine alcohol do and

drives dopamine receptors down just like

nicotine you know alcohol you know

cocaine heroin

do that molecule

fructose is number one uh completely

vestigial to all vertebrate life there

is no biochemical reaction in any

vertebrate that requires dietary

fructose that's number one number two

okay sorry I'm going to juster so you're

saying that even though we can process

fructose we have a limited capacity to

process it in the same way we have a

limited capacity to metabolize

alcohol now if you have one drink a day

you you're okay if you have two drinks a

day depends on how big you are you know

you and I can probably I would argue two

drinks a week is the maximum but but

let's not go there the um but but in

terms of you're saying when you

say fructose processing a fructose is

vestigal what you're saying is that we

don't need to do it it's like the

appendix it's an organ for which it has

no function exactly and fructose has no

function in the human body period you

don't need it you don't need it don't

need it but our diet is replete with it

in fact our fructose consumption has

gone up 25 fold since the beginning of

the last century I have to ask this now

I love fruit I eat berries Galore

especially since the price of berries

seems to have come down it used to be

that you only get them certain times of

year I'm what you call a drive by

blueberry eater so I'll just walk past

and just take a fist full you can't put

them in front of me without me eating

them this is even difficult for me when

other people I don't know are eating

them so um I lots of blueberries

strawberries blackberries if they're in

season I love them no problem loaded

with fructose no plenty of fiber low

fructose low fructose and berries

berries are the lowest fructose of all

the so worried about asking you this

today okay um and fruit is okay because

of the fiber so the molecule the

fructose molecule is the same whether

it's in a berry or in a banana or for

that matter in in a Coca-Cola the

fructose molecule is the same molecule

the difference is that in the berry it

comes with a whole lot of fiber and the

banana comes with a whole lot less fiber

and in the Coca-Cola it doesn't come

with any fiber and the fiber is what

mitigates the

absorption so when you consume the

fructose with fiber so your blueberries

you're feeding your

microbiome that fructose wasn't for you

got it such a relief and um

I I must say recently I had a whole body

MRI as a preemptive thing uh someone

that it was it was great I got to watch

a Netflix in there and um I never had a

whole body MRI I learned a few things

that were useful to me I've got a clean

bill of health so that's great one of

the pie of feedback I got is um that my

gut was filled with this very high

contrast um stuff right and they asked

you know do you consume a lot of

blueberries and I said indeed I do why

and they said um because that high

contrast offf it shows up white on the

scan is um high concentrations of

magnesium MH um that we see in people

that ingest large amounts of blueberries

which is pretty rare and yours are

comparable to a bear in blueberry season

wow um and basically my entire gut was

filled with with blueberries I suppose I

need to cut back a little bit but now I

know that fruit is okay especially if

the fruit has a lot of fiber yeah but

fructose itself especially if it's not

partnered with fiber yeah is first of

all not required for survival at all but

you're telling me is uh problematic yeah

and let me tell you why it's problematic

we haven't gotten to that yet we're just

talking about whether it's vestigal

versus needed now let's talk about what

fructose

does turns out fructose inhibits three

count them three separate enzymes

necessary for normal mitochondrial

function now your mitochondrial make ATP

your mitochondria have to work at Peak

efficiency that's what metabolic health

is is mitochondri are working at Peak

efficiency well there are three enzymes

that are inhibited by fructose number

one amp kinas all right now amp kinas is

the fuel gauge on the liver cell it's

the thing that tells the liver to make

more mitochondria fresher mitochondria

because if your amp levels are high that

means means you've def phosphorated a

bunch of atps and you have to regenerate

them so you need some more mitochondria

so it's a negative feedback pathway well

you need that amp kinas to generate that

mitochondrial biogenesis signal except

that fructose a metabolite of fructose

called methylglyoxal

MGO sits in the active site of the gamma

subunit of that amp kinas and actually

binds to arginines in that active site

rendering that uh uh enzyme now dead

it's an irreversible inhibition because

of the Cove valent bonding of that

methylglyoxal that alahh to the Arginine

and now that enzyme is dead Okay so it

basically acts like a key that doesn't

turn the lock but prevents the the key

that you want in that lock from entering

the the lock it's like it's like gluing

a lock shut yeah got it all right so

that's one of the enzymes that's one

okay second one aad L asil COA

dehydrogenase longchain so this is

necessary to cleave two carbon fragments

of fatty acids to prepare them for uh uh

metabolism so it inhibits that one and

then finally it inhibits carnitine pidal

transferase one now cpt1 now that's the

enzyme that regenerates carnitine

carnitine is the shuttle mechanism by

which you get the uh fatty acids from

the outer mitochondrial membrane

through to the inner mitochondrial

membrane so that they can be beta

oxidized for energy so if you don't have

that c uh

cpt1 you're basically carnitin lless and

therefore you can't generate um beta

oxidation you said fructose inhibits all

three of these enzymatic Pathways y as a

biologist I have to ask you know how

potently does it inhibit them I mean

because there's there are drugs that

block receptors and then there are drugs

that block receptors with in

unbelievable Affinity so you know I mean

mechanistically in a dish meaning in

vitro you can see all sorts of things

but how how significant is this for like

for obesity for mitochondrial function

in Vivo in us all right so look you know

the the dose determines the poison right

paracelsus

1537 um there are toxins that are parts

per billion and will kill you like sarin

rysen Cyanide by the way I is a good

analogy because it's working on

mitochondria it's basically causing

mitochondria to be completely defective

all right then there are um intermediate

toxins like Arsenic and carbon

tetrachloride parts per million and they

take a little longer to work they're not

going to kill you on the spot that's why

I can eat an apple seed that has a

little bit of arsenic in it but I'm not

going to die right and then finally

there and by the tobacco smoke goes in

there and then finally you have um uh

weak toxins all right and you know where

it's not one exposure that will kill you

it's you know 10,000 exposures that'll

kill you like alcohol or toxic people

yeah or toxic

well toxic couldn't resist sorry

sometimes it don't mildly toxic people

anyway the point is that fructose is in

that last category so it's not what you

do one day that kills you it's what you

do every day that kills you and if you

basically eat Ultra processed food high

in sugar for 10 years in a row it's

going to show up in terms of your

comorbidities and ultimately yeah it

will kill you and we have the data to

show you know how many years you will

lose so right now in America we pay an

8year longevity tax if you look at Japan

who uh they have a mean age of death of

88 we have a mean age of 80 okay we're

paying an eight-year longevity tax just

by living here and we're talking about

the healthy people now if you have

metabolic syndrome it's a 15-year

longevity tax and uh sorry if you

obesity it's a 15year longevity taxt and

if you have metabolic syndrome it's a

20-year longevity

taxt that is primarily not completely

but primarily sugar it's also you know

omega-6 it's also trans fats you know

left over because now they're gone but

you know people are still suffering the

ravages of the trans fats you know from

the previous generation are they gone I

mean I do remember as a kid when we had

margarine in our refrigerator this is

actually a big debate in my home one

parent I won't identify which um was Pro

margarine the other was Pro butter anti-

margarine right um the marriage didn't

last but there were other reasons that's

probably why I went butter um butter is

fine in fact time declared you know

front cover Butter's back you know um

margarine was the bad guy without

question U and we know now but you know

back when we thought it was a calorie

was a calorie we thought oh margarine

you know it's the same you know nine

calories per gram and we said it lowers

your

triglycerides bad idea it was because

what it did was it lined your liver

because you couldn't break that trans

double

bond and um you know so they're they're

now gone from our uh food supply they're

illegal they're illegal they're banned

but you can make trans fats in your own

kitchen by taking olive oil and heating

it to beyond the smoking point so

they're not completely gone they're just

gone from ultr processed food so now

sugar is the big problem because of

these three enzymes that you are

inhibiting the point is we were we

started this with a calorie is a calorie

well if you are inhibiting mitochondrial

function then a calorie is not a calorie

is it you're reducing the um intensity

of the Furnace yeah exactly so this

whole calories of calorie just makes no

sense and it hasn't worked at any level

and there is no study that actually

shows that cutting calories makes a

difference and I can show you you know

voluminous data that shows that virtu Al

every weight loss study that caus that

led to you know caloric restriction

basically didn't work not for any length

of time just to round out our earlier

discussion because I find it fascinating

and I know other people will as well

talked about that 160 calories that's

actually 130 at the business end of

things uh of almonds we talked about the

Porter House steak with butter and the

25% reduction in what's actually quote

unquote eaten and I'll get back to this

because this quote unquote is I think

the problem is there's there's a lack of

useful language to dissociate this stuff

you know even just calling fat fat

people think it it's going to make you

gain body fat totally if we called it

adapost tissue and lipids we would have

avoided this confusion so I I don't want

to get there just yet but I I want to

make sure with the food industry does

this on purpose oh absolutely so they

tell you a sugar is a sugar which is not

true they tell you a calor is a calorie

which is not true and they tell you a

fat is a fat which is not true okay this

is very specifically so when you're

talking about sugar you're talking about

dietary sugar are you talking about

blood sugar because blood sugar is blood

glucose or dietary cholesterol or

circulating cholesterol or you

absolutely okay so we we've done this um

you know uh to ourselves but the food

industry has really promulgated it

because we farmed out nutrition policy

and information to the food in so they

actually use this for their purposes

it's one of the problems in this

field as we all know quality nutrition

influences of course our physical health

but also our mental health and our

cognitive functioning our memory our

ability to learn new things and to focus

and we know that one of the most

important features of highquality

nutrition is making sure that we get

enough vitamins and minerals from

highquality unprocessed or minimally

processed sources as well as enough

probiotics and prebiotics and fiber to

support basically basally all the

cellular functions in our body including

the gut microbiome now I like most

everybody try to get optimal nutrition

from Whole Foods ideally mostly from

minimally processed or non-processed

Foods however one of the challenges that

I and so many other people face is

getting enough servings of high quality

fruits and vegetables per day as well as

fiber and probiotics that often

accompany those fruits and vegetables

that's why way back in 2012 long before

I ever had a podcast I started drinking

ag1 and so I'm Ed the ag1 is sponsoring

the hubman Lab podcast the reason I

started taking ag1 and the reason I

still drink ag1 once or twice a day is

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if you'd like to try ag1 you can go to

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the third category of macronutrients

carbohydrates you differentiated um

glucose and fructose MH if I ingest um

let's say a half a bagel um since we

were talking about New York your city of

origin they have great Bagels on the

west coast yeah know not the same it's

it's pretty pitiful same with the pizza

dough it's like they claim it's the the

the water whatever it is it's different

back there and it's better indeed half a

bagel let's say 250 calories mostly

carbohydrate mhm this is an an unlined

un no cream cheese no shmear as they

call back there no no cream cheese no

butter none that just half a bagel 250

calories so that's what I ate you're

saying that a calorie eaten is not a

calorie eaten how much of that

carbohydrate given that it's probably

most let's assume it's mostly glucose

let's do it this way yeah it is it's

polymerized glucose okay glucose how

much of that is actually utilized or

burned versus um you know the original

250 so if you look at what happens to

energy in the body

65% of that which is ingested goes to

resting energy expenditure just to power

the body 10% goes to the thermic effect

of food and then 25% goes to activity

that's the breakdown of where the uh

energy goes and that's calories from fat

protein and carbohydrates yeah from

everything together and you know glucose

is a perfectly good example of how that

works the point is though that when you

ingest glucose you're getting a big

glucose Excursion in your bloodstream so

you're getting a big glucose Spike and

that glucose Spike has to come down well

what makes it come down the hormone

insulin insulin is the bad guy in the

story

the higher your glucose goes the more

your pancreas will release insulin in

order to bring that glucose down Well

turns out that glucose rise was not

benign that glucose rise led to

endothelial dysfunction transient but

nonetheless endothelial dysfunction

could you just um remind people what

endothelial cells are the inside of your

arteries okay and it will change blood

pressure we've got plenty of data to

demonstrate how it changes blood

pressure and over time that will cause

coronary artery disease that will cause

kidney disease Etc but it's the insulin

response that is really the bad guy now

people think insulin is good because it

lowers blood glucose after all diabetics

take insulin you know to lower their

blood

glucose okay let's take a diabetic

patient with diabetes blood sugar's 300

that's bad we give them a shot of

insulin in the arm blood sugar goes down

down to 100 blood sugar went from 300 to

100 okay where did the 200 points of

blood glucose

go I'm assuming that the insulin was

sequestered it to where I'm assuming to

the liver to the fat interesting for

storage that's insulin's job insulin

takes whatever you're not burning and

puts it into fat for storage insulin is

not the diabetes hormone insulin is the

energy stor hormone how quickly does it

do that because because if I'm you know

having a a very busy day mhm or that a

diabetic person is having a very busy

day and they're moving around a lot then

you got insulin bound glucose in the

bloodstream uh for how long no no

insulin doesn't bind glucose insulin

binds to its receptor sure sorry Sor and

allows for glucose Transporters to work

so so but for some period of time while

that person is active There's an

opportunity to utilize that glucose yeah

right yeah um so how quickly is insulin

managing that glucose uh we know that

the spike comes down quickly but the

glucose is not available for energy

utilization after what it's or it's it's

sequestered to the the adapost to the

fat tissue at within an hour is that

about so about 90 minutes yeah but I

mean if if you're if you're active if

you eat uh you know a muffin and you're

active Okay your muscles are going to

take up that glucose IR perspective of

insulin in fact muscles are insulin

independent they have glucose

Transporters but they are insulin

independent because if they weren't then

every patient in diabetic keto acidosis

would be paralyzed okay so glucose will

end up in muscles irrespective of energy

status and uh insulin status and in

muscles it's used as immediate Fuel and

glycogen both okay met Fuel and glycogen

storage okay in the muscle

absolutely all right now if you're

active then you will clear glucose into

muscle Therefore your blood glucose

won't rise as much because it went into

muscle and therefore your pancreas will

put out less insulin because it doesn't

have to clear as much from the

bloodstream and that's okay that's good

right but let's say you didn't exercise

so you've got a big glucose Excursion

now you have a big insulin response and

that insulin is going to take the excess

that's in your blood it has to clear it

and it will go to fat for storage that

insulin rise turns out to be

particularly egregious in terms of

metabolic disease and I can prove it

there is a mouse my favorite Mouse I

love this mouse this mouse turns

medicine on its head and teaches every

doctor why they have to go back to

medical school and learn it

right this mouse is called the padco

mouse p o d i r KO is it discovered by

padco no no it was uh discovered in Ron

K it was manufactured in Ron cons lab so

this is a tissue specific insulin

receptor knockout Mouse Okay IR KO

insulin LAX insulin receptor in specific

the kidney in the kidney interco

glomular poicy insulin receptor knockout

we haven't talked too much about

transgenic models and knockins and

Knockouts so uh just in 10 seconds or Le

basically these are mice that are

genetically engineered to lack the

receptor for insulin specifically in the

glul poite the kidney in the in the

kidney and everywhere else in this mouse

insulin does its thing normally exactly

great so these animals are ug glycemic

normal blood glucose levels these

animals are normally glucose tolerant

they you know go up they go down just

like every other

Mouse these mice are not fat these mice

are not thin these mice are

mice except they have the worst diabetic

nephropathy on the planet so their ner

oh their kidney is degenerative their

kidneys is degenerate to nothing yikes

now they have normal blood glucose

levels they have normal glucose

tolerance they have normal insulin

tolerance whole body but they're kidneys

are

dying how come can't be the

glucose it's the

insulin because insulin is the bad guy

insulin's actually making the kidney

disease and so these animals that are

insulin resistant they have diabetic

nephropathy without

diabetes so the insulin is having a

negative clearly negative effect on the

kidneys without binding to the receptor

exactly so circulating insulin can do

stuff without binding to its receptor

well it's no it binds to its receptor in

different parts of the body other parts

of the body party it can't because it's

a knockout because it's knockout right

the point is insulin does stuff by

itself and it turns out insulin drives

growth now every cell in your

body wants to burn at one time in its

life and wants to grow at another time

in life every cell has those two

Pathways burning growth burning growth

what determines whether a

cell should be burning or whether a cell

should be growing I don't know what

makes it um burning but presumably it's

in the has something to do with

mitochondria it has everything to do

with mitochondria right so every cell

needs to burn and needs to grow at a

different time in its life here's a way

to think about it we all start out as a

zygote a single

cell we end up an

adult now that single cell had to become

two

cells those two cells had to become four

cells those four cells had to become

eight cells and on and on and on and on

so every cycle there's a

doubling how many doublings to get from

a zygote to an adult what's an

exponential growth so yeah I don't I

don't know it off the top of my head

41 41 41 two to the 41 doublings giv you

an organism 10 trillion cells we're 10

trillion cells we're 10 trillion cells

did we know that yeah okay two to the 41

okay okay now of those 41 doublings some

of them had to occur in

utero some of them had to occur

postnatally so I need two numbers that

add up to 41 how many in utero how many

postnatally well way

more you start off with a lot more than

you end up with but then you have cells

that turn over throughout the lifespan

so this is a tough one okay because skin

cells turnover I I with neurons it's

it's pretty straightforward because

you're going to somewhere between three

and 10 right well you're and you're born

with somewhere between 3 and 10x of what

you end up with depending on the brain

structure so but for whole body I don't

know how you'd come up with that number

36 and

five okay 36 doublings

prenatally five doublings postnatally

and I can prove that to you too typical

baby weighs s pounds first doubling 14

pounds second doubling 208 lb next

doubling 56 lb next doubling 112 lb next

doubling 224 lb that's hopefully it

stops OB division hopefully it stops

there not not all people 212 lbs are

obese um but some people who are of

certain Heights or below are 212 aerobes

okay point is the cell has to know when

to grow and when to burn it turns out

that the signal for that is

oxygen because oxygen is necessary for

mitochondria to be able to burn in the

absence of oxygen the cell only knows

how to grow this is actually why OT

warberg won the Nobel Prize in 19 1931

for the warberg effect he asked the

question how come cancer cells don't

need oxygen to grow and the answer is

because no cell needs oxygen to grow in

fact oxygen is the thing that prevents

growth famous article from the New

England Journal of Medicine 1951 Mount

Everest in utero because every

fetus is oxygen

deprived so normal

partial pressure of oxygen 100 millim of

mercury out here right if if I checked

your blood it'd be about 100 right I

hope so how about a tumor cell um

guessing tumor cell is

probably is it double about 44 wait you

just told me partial pressure of of

oxygen in a tumor cell it's about 44

well you just told me that well tumor

cells which grow like wild right they

grow like wild because they don't have

oxygen

but they but there's some of the so

here's what's peculiar about it um tumor

cells are some of the most vascularized

cells or tumors are are heavily

vascularized I mean I mean one way to

one way to try and kill one is to to

devascularize the tumor yes and you know

Ang Genesis inhibition Etc you it's a

big deal you know Judah folman and all

that from Harvard you know so the excess

blood to a tumor is the attempt to bring

in oxygen that it's not getting that's

right as opposed to deliv in lots of

oxygen and that's why it's growing

that's right okay but a fetus what's the

partial pressure in the placenta I don't

know 6 to

31 so it's actually like a mile above

Mount Everest that's how much oxygen the

fetus gets and it's that for that reason

that you've got 36 doublings and then as

soon as you're out you know you cut the

cord and you start breathing and now

your partial pressure is at 100 that's

when growth slows down

has there been any effort to treat

tumors by oxygenating tumors yes and

what does that look like it's hyperbaric

oxygen therapy it's a thing oh yeah yeah

yeah we we'll probably do an episode on

hyperbaric chambers it's the the the

reason we haven't yet is it's pretty

niche in but there are people who own

these things who sit in these things um

okay so we got here by way of by way of

car by The Bagel right um so I just want

to orient us um that you just that 250

calories of the The Bagel we talked

about glucose excursions but it's that

insulin rise that's driving the atopos

it's also driving the

growth okay in the absence of oxygen

because if you have oxygen then you

don't need that much

insulin okay

so because you're going to burn instead

of store got

it in terms of the the uh the raw

metabolism

of carbohydrate though that glucose if I

eat 250 calories of glucose how much of

that did I quote unquote actually eat

how much is is used how much is used

yeah let's assume that I'm I'm at my

desk working or I'm walking around a

little bit I'm not I'm not exercising

hard in the in the subsequent hour so

used for what is the question I'm

getting back to the calorie is is a

calorie a calorie clearly the answer is

no based on the processing of different

types of calories we established it for

fat the almonds we establish it for

protein

the Porter House with butter and now

we're we're trying to establish that for

the 250 calories of of bagel which is

glucose right so the glucose has to be

phosphorated so you're going to lose uh

an ATP in the process so you're going to

go ATP goes to ADP and then that ADP

will go to am a denzine monophosphate

which will then go to im an ocol

monophosphate which will then go to uric

acid okay and that uric acid will be

then released from the cell circulate in

the bloodstream and hopefully go out in

the kidney in the process that uric acid

can inhibit mitochondrial function and

it can also inhibit endothelial nitric

oxide synthese which is the enzyme in

your vasculature that is your endogenous

blood pressure lowerer right by

expanding blood vessels and capillaries

exactly right this is the mechanistic uh

foundation of the drugs that were

originally used for uh improving

prostate function but are used to treat

erectile dysfunction which are the the

PD Inhibitors which allow nitric oxide

to be uh around longer and more of it

right people use it for other purposes

too um now no one will forget if I queue

it up with that that example well we we

uh you know in the neonatal Intensive

Care Unit it closes patent ductus

arteriosis which is a big deal in uh in

the neonatal uh uh World okay I I want

to ask you about that but but um so I

heard two things one is that um gluc ose

and the insulin that goes with it

increases uric acid MH uric acid while

it has certain important functions in

health too much of it you said Can

inhibit nitric oxide yeah can inhibit

nitric oxide so that means that the

blood vessels and capillaries are going

to stay more constricted so blood

pressure is going to be higher than it

would be normally that's right and then

uric acid is also inhibiting

mitochondrial function that's right okay

um but eating half a bagel isn't

necessarily a terrible thing if it's

within your caloric require requirements

it and it it all depends on how much uh

you clear and how high your insulin goes

now let's compare that 250 calories of

glucose to 250 calories of fructose

right uh let's let's come up with a food

example 250 calories of fructose would

be trivial to uh consume in the form of

high fructose corn syrup right well so

remember that high fructose corn syrup

is half glucose half fructose 125 125 so

let's not use that well so let's assume

um so we can talk about a soda for uh to

get that that uh 250 calories easily um

especially if it's not a can or a

European siiz bottle or can 8 o 8 oz can

of soda okay so 8 oce can of soda um and

maybe let's include a food item let's

talk like a store-bought packaged cookie

couple Oreos two Oreos okay probably get

you to that 250 or maybe four Oreos

maybe three Oreos yeah okay um Oreo

lovers everywhere celebrate

three 250 calories of

fructose what's the effect on uric acid

what's the effect on caloric burn what's

the effect on anything for that matter

that uh we should be aware of all right

so first of all the Oreo has plenty of

fructose in it so keep that in mind okay

the um if let's say you consumed uh 250

calories in a bagel because that's

pretty much polymerized glucose versus

say the soda so the bagel versus the

soda that's what you're equalent

calories equalent calories or the The

Bagel versus let's say two Oreos and a

little bit of um and yeah two Oreos okay

so number one there's only half the

glucose in the soda because the other

half is the fructose it's 125125 so your

glucose rise won't be as high your

glucose Excursion will be lower this is

actually one of the reasons why there's

this thing called glycemic index

glycemic index is a Canard it's garbage

it is complete and utter BS the glycemic

index absolute BS nothing nothing is

more um uh egregious in terms of uh

argument than then than the glycemic

index and this is one of the things that

dietitians promote and espouse and one

of the things that's got to go okay this

is an idea that must die okay we'll get

back to why the glycemic index has got

to die uh but so so the 250 calories and

actually can we can we make these equal

just for sake of of Simplicity can we

say 250 calories of glucose from The

Bagel versus 250 calories of fructose

how do we get 250 calories of pure

fructose we don't you can't okay you got

to bring the glucose with lab Lab

fructose you'd have to make it with the

Oreos which is half glucose half

fructose right I mean there is no

fructose alone in nature even crackers

some of the ones that are salty are also

sweet they have fructose in them

Abus yeah that's why it's impossible to

eat just one indeed um so what's

happening biochemically as a consequence

of the fructose component specifically

so the fructose will first of all go

into the intestine the intestine will

metabolize some of that fructose through

what is known as intestinal denova

lipogenesis about 10% of that fructose

will be turned into fat right in the

intestine and that's cuz fructose it

just wants to be fat yeah fructose wants

to be fat fructose is the lipogenic

substrate here we're not talking about

body fat we're talking about fat

molecules that can potentially be used

as energy that's right triglyceride

molecules okay so that so 10% of that

fructose will be turned into

triglyceride right in the intestine and

be released into the bloodstream and it

is the reason for a post prandial

triglyceride response postprandial is uh

and I'm including myself in this group

is nerd speak for after eating lunch

typically it's

lunch so that's actually one of the

drivers of cardiovascular pathology that

intestinal denova lipogenesis turning

that fructose into triglyceride right in

the intestine now there's a limit to how

fast and how much the intestine can do

that the rest of the fructose will be uh

absorbed into the portal vein but not

before some of that fructose will make

it further down and it will Nitro create

tight Junction proteins now okay portal

ve the kidney portal ve goes to the

liver portal vean goes from the visceral

from the intestine to the liver no K

doesn't feed the kidney no

kidney intestine to liver okay okay but

fructose nitrates tight Junction

proteins now let me explain that to your

audience your intestine is a

sewer definition of a sewer a pipe with

in it okay that's a sewer our

intestines are

sewers there's junk in the center and

the job of the intestine is to move the

junk through to the anus absorbing the

good stuff while you can the intestine

is made up of cells intestinal

epithelial cells that are bound together

and they're bound with proteins that

basically form a barrier those barriers

called tight Junction proteins things

like cloudin and things like that um

zulin is the main one okay there are

others but zulin is the one that goes is

defective in the celiac disease what

defines a tight Junction is it is like

completely impermeable or semi-permeable

completely impermeable okay unless its

function is inhibited turns out if you

alter the um phosphorilation status or

the nitrate status of that tight

Junction it will will become transiently

permeable okay and so fructose nitrates

TI Junction proteins causing them to be

transiently permeable allowing some of

the junk in your intestine to get

through into your bloodstream so this is

leaky gut this is leaky gut this is what

causes leaky gut fructose is a driver of

leaky gut got it that causes

inflammation at the level of the liver

which ultimately leads to systemic

inflammation one of the reasons why High

Sensi CRP sensitivity CRP is high in

patients who eat ultrapress food CRP is

C reactive protein which is a marker of

a essentially inflammatory immune

response exactly yeah you don't want it

too high and 93% of Americans today are

inflamed does that mean that 93% of

Americans have leaky guts yeah it does

because that's where it comes from so in

addition to limiting fructose intake

MH what are things that um support the

tight junctions of of the intestinal

pathway so there are three barriers in

your intestine to keep the junk where it

belongs in the center so that it can get

pooped out the you're behind all right

three separate barriers one is a

physical barrier called the muin layer

so it's a layer of mucus that actually

sits on top of the intestinal epithelial

cells now now that mucin is a

polysaccharide and the bacteria can use

that mucin layer for its own purposes it

will eat your mucin layer if you don't

feed your bacteria you must feed your

bacteria or your bacteria will feed on

you MH okay so you are in concert with

your microbiome if you deprive your

microbiome of the food that it needs it

will use you as its food and that's one

of the reasons why fire fiber is so

important so fiber to build up this muin

layer is one way to reinforce the the uh

the fence that that is the tight

junctions Etc ex um between your

intestine and the bloodstream exactly

this raises an interesting point about

fasting many people including myself do

a sort of pseudo intermittent fasting I

eat my first meal somewhere between 11:

and noon I'm not strict about this the

11 versus noon thing and probably eat my

last bite of food somewhere around 8:00

p.m. and occasionally it's outside that

window I've done this for a long time

it's feels best to me right but other

people use a shorter eating window one

thing that I learned from a colleague at

Yale who studies the gut microbiome that

was surprising to me is that when you do

when you eat in that way there's a long

stretch of time sometimes longer for

people that have a shorter eating window

longer fasting what know that is yeah

where you're actually eating up your own

intestinal lining so this idea that

fasting is so great for us on the one

hand might be true on the other hand

you're you're actually consuming

assuming components of your you're not

feeding your gut microbiome and you

deplete it but then here's where I was

positively surprised when you do eat

provided that you eat enough fiber and

in particular high quality fermented

foods low sugar fermented foods it seems

that the the lining of the gut and the

gut microbiome is replenished to a level

that is greater than if you had eaten

for longer periods of the 24-hour cycle

do I have that right we do you do have

it right and I don't know why that is

true but it does seem to be the case and

fermented foods B in part because

they've got already short chain fatty

acids in them um see the preferred food

of the microbiome well it's what the

microbiome actually turns fiber into so

it's probably helping your intestinal

epithelial cells in the same way what

the microbiome turning fiber into short

chain fatty acids helps so it's what we

call a postbiotic so you have Prebiotic

which is the food for the bacteria you

have the probiotic which is the the

bacteria itself and then you have the

postbiotic which is what the bacteria

make in order to heal you okay and so

short chain fatty acids are postbiotics

and there are a lot of people selling

short chain fatty acids you know drinks

and supplements and what have you

whether they work or not is another

story if I consume fructose in the uh

form of let's say a highly processed

food has minimal antioxidants but it's

got plenty of calories typically um Y

and it's disrupting the tight junctions

making my gut leaky right but I'm also

eating fiber y you know I'm having a you

know a meal that includes a salad I'm

having having some probiotics and then I

want like a couple rees's peanut butter

cups like in the dark chocolate ones in

particular I don't do this anymore but I

used to eat like that more often as as

time has gone on I've become I don't

like to call it stricter but more I I I

tend to like healthier foods over time

and I think you can get away with

different things at different stages of

Life although you work with young people

so we'll uh we'll get to very young

people so we'll get to this but how how

much damage am I doing by ingesting any

fructose in the form of a highly

processed food so I'll make it very

simple

Andrew I am for

dessert for dessert I am not for dessert

for breakfast lunch snacks and dinner

okay so if you want to have a couple of

ree's peanut butter cups as your dessert

in the same way as you might have a

conac for

dessert that's fine I have no problem

with that the question is are you going

to eat re's peanut butter cuffs for

breakfast no I don't eat breakfast but

no I got but I see your point the

National School breakfast program which

29% of school children today consume is

a bowl of fro loops and a glass of

orange juice that is 41 gam of sugar

American Heart associate says that the

upper limit for children should be 12

gram of added sugar per day that's 41

grams of added sugar and it's just

breakfast and that's fructose Rich

totally completely so the question is

which dessert are we talking about and

right and can we can we adjust that

morning meal um to a different reality

cuz I agree that there are plenty of

kids eating that or a muffin that might

be the equivalent um but what about the

parent who's has okay let's come up with

a healthier option that the kids still

likes like a I'm thinking back to my

childhood like a honeynut Cheerios or

something so not Froot Loops which is

kind of the extreme um take a look at

the side of the package no difference

and now let's say they go with um some

uh like waffles that are made so with a

with a pre-made U mix some milk some

butter um you know so mom or dad is

making waffles great it sounds healthier

but then if you do the breakdown or

we're still ending up at very high are

we basically eating dessert for

breakfast in Cas are we eating ego

waffles or we uh making waffles uh

denovo you know from scratch in your own

kitchen let's say big

difference okay because the Eggo waffles

you know replete with sugar on purpose

because the food industry knows when

they add it you buy more because it's

addictive okay and we actually have the

um uh uh demographic the mechanistic the

Imaging and also the economic data to

demonstrate that Sugar's addictive and

the food industry knows it so have you

ever heard of a phenomenon called price

elasticity okay price elasticity is an

economic term that is used to ask the

question if the price of a given good

goes up by

1% that should result in reduction in

purchase or consumption because price

influences

consumption how much does it influence

it so if it's if something's price

elastic when the price goes up

consumption goes down

equivalently a food that is price

elastic the most price elastic food is

eggs so when the price of eggs goes up

1% consumption of eggs goes down

68% meaning that eggs have a price

elasticity of.

32 got it got it now what's the most

pric in elastic

food the top three most price inelastic

foods are fast food Cal can1 I like a

good quiz fast food 081 um uh uh soft

drinks at 79 and juice at 77 meaning

people will pay not whatever but they'll

they're willing to pay more more more

readily willing to pay more because of

the sugar because it's addictive because

it's honic so many many years ago Andrew

you probably remember something called

Keynesian economics and Keynesian

economics was based on this concept of

the rational actor and the rational

actor can determine value which is

utility over

cost and if you're a rational actor you

should be able to say yeah I'll buy that

but I won't buy that right

okay in

1979 Daniel canaman and Amos

fski Nobel Prize winner Daniel canaman

describ the irrational

actor now the irrational actor cannot

determine value and the reason is

because he is risk averse so the cost is

always too great so the utility may be

the same but the cost goes up because

that's why they have you know aversive

Tendencies the irrational actor Jeffrey

Sachs has described the honic actor who

also cannot determine value because it

doesn't matter what it costs they need

their

fix and this is what's going on and the

food industry knows it and that's why

every food in the store has been

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huberman we talked about dessert for

breakfast in the the form of cereals

some of which are um disguised or

couched as healthier you know I think of

like honeynut Cheerios it seems

healthier than Froot Loops it looks

healthier like the just by way of color

it looks kind of weedy you know color so

but let and in terms of lunch I mean one

of the things that I love about Europe

is that the breads are amazing yeah

breads are terrific there and I like

them because they're not as sweet

exactly and so a sandwich from not every

Deli but from a typical sandwich shop or

that one makes with store-bought bread

sliced bread in the US has a lot of

fructose I looked I looked this up prior

to to our discussion today so in some

ways dessert is being woven into foods

that

are that parents Andor kids everyone

thinks our Savory are we're actually

eating sweets exactly right but we can't

but we don't taste them as sweet at a

conscious level necessarily right but

our but our taste buds do right that's

exactly right so the question is why do

they do that so

question for your audience you buy a

loaf of bread at the local bakery how

soon before it stales two days at best

yeah if it's really grap bread that's

right the better the bread the quicker

it

stals you buy a loaf of bread at the uh

Neighborhood Grocery Store how soon

before it stales w you've got probably a

week and then there's the moldy pieces

at the end that you try you know if

you're in college and me try and scrape

that off um but can last up to 3 weeks

depending right you could throw it in

the freezer you probably do that with

the bakery bread but it's never the same

never the same it's never the same so

the question is why is that and the

answer is

sugar the answer is sugar so the grocery

store bread had sugar added to it on

purpose because when you bake it the

sugar does not evaporate it stays in the

bread and the sugar is hygroscopic

meaning it holds holds on to water this

is a phenomenon that the food industry

uses called water activity okay and so

it will hold on to water and so it will

stay spongy and it will not stale as

quickly as the bakery store bread which

did not have that sugar added to it so

even something as benign as bread has

been turned into something that

ultimately leads to Chronic metabolic

disease we've pivoted somewhat from

carbohydrate divided in to GL glucose

and fructose to a discussion of sugar

could you tell us the link between sugar

and fructose so table sugar what

percentage of table sugar is fructose

what percentage of brown sugar is

fructose what percentage of the sugar

that's added to food is high fructose

corn syrup on average you know just

because here what we're talking about is

um what you're describing as an

intentional lacing of food with

something that's addictive but that's

also processed very differently at the

level of the kidney at the level of the

liver um right

and it's bad it's a bad it's a bad

situation so when we talk about sugar I

think we need to be as careful in

describing what we really mean as when

we talk about a calorie I completely

agree so let for your audience let's be

very very clear on definitions okay

let's not use the word sugar because it

has multiple

definitions let's use

sucrose sucrose is what you put in your

coffee it's the crystals all right it's

cane sugar Beach

sugar you know the you know the stuff

that teaspoons of right this was all

that was available for many many

years that is one molecule of

glucose one molecule of fructose bound

together uh for the chemists out there

an Oly acidic linkage

okay the enzyme in your intestine called

sucra Cleaves this glycosidic linkage in

about a nanc you absorb the two

molecules separately the glucose goes to

the entire body generates an insulin

response the fructose goes straight to

your liver generates

fat that's sucrose high fructose corn

syrup is essentially one molecule

glucose one molecule of fructose not

bound together no Oly acidic linkage so

they're

free the enzyme sucra doesn't care

because the blond's already

broken ultimately they do the same thing

and that's why high fructose corn syrup

and sucrose are indistinguishable

metabolically what they are is they're

very different economically and the

reason is because high fructose corn

serbs half the price of sucrose because

sucrose we get from importing and high

fructose corn Sy we make it

home sucrose is in bags high fructose

corn syrup is in barrels sucrose you can

sell at the store high fructose corn

syrup you sell to the you know ultr

processed food manufacturer you can't

buy high fructose corn syrup at the uh

you know at the grocery store so they're

very different in terms of what they're

used for high corn syrup is particularly

egregious because it's so missable

because it's already a liquid so you've

probably remember chips aoy cookies in

the old days okay they would often would

seem like the sugar in the uh cookie had

crystallized cu the sugar content was so

high it's been a while since I've had

one they weren't particularly good yeah

but you eat two of them and then you

think they're good and then you want to

eat four that's what so odd the first

bite is kind of like and then it bombs

away there you go well now it's a chewy

Chips of Hoy cookies oh I remember the

chew chips remember chewy Chips well

that that's high fructose corn syrup

because because the two molecules are

free they don't crystallize so you can

actually up the dose several times

throughout today's discussion you've

been talking about the quote unquote

food industry mhm okay so I'm not a

conspiracy theorist I am but I now but I

understand um you know that most

businesses exist to make money yeah many

businesses start off with good

intentions and drift in order to stay um

to stay competitive um and many many

businesses as we know um not all of

which are entirely bad such as the

pharmaceutical industry right you

they're bad they're instances of like

the opioid crisis but then there are

drugs from the pharmaceutical industry

that help save lives I mean that's my my

stance um the food industry I think they

are good actors and there are Bad actors

but we're talking about the food

industry okay well we talk about the

exercise industry we talk about the

podcast industry I mean you got good

actors and Bad actors but but what

you've alluded to several times here and

you're more informed than I am is a uh

a concerted effort to lace food with a

form of sugar that makes people crave

more of that food and that is causing

metabolic illness disrupting

mitochondria and on and on exactly and

you're the physician not me um you've

worked with patients who struggle with

obesity and for various reasons um not

me and um so we could probably spend

hours if not days talking about all the

terrible things that the quote unquote

food industry has done but what do you

think is the the pure pure motivation

right I don't think that they want

people to be sick but they want to sell

product and this sells more product so

then it raises two

questions if why is it that more people

don't know about know this information

although many more will know after

today's conversation but and certainly

in government it's it's a mix regardless

of what side of the aisle you're on or

if you're right in between they're

they're clearly people that care about

the health of themselves and others

so I can understand how things might

have gotten to this point but what do

you think are the barriers to getting

people to appreciate just what a problem

this is and and getting people to change

their choices in terms of what they're

eating are they truly addicted to the

point where they are sick they can't

make good decisions like a like a drug

addict who's highly addicted to heroin

is a sick person they have an illness

and they need treatment but until they

get that treatment they can't make good

decisions let's take an analogy

alcohol 40% of Americans are tea tolers

never touch the stuff 40% don't drink

40% don't drink great I'm not a big fan

of alcohol I've never seen it make

anyone better at anything that really

mattered no because except drinking and

matter completely vestigal there's no uh

biochemical reaction in the body that

requires alcohol okay for the same

reason by the way

fructose um 40% are social drinkers you

know you can pick up a beer put it down

I'm in that category 10% % are binge

Drinkers and 10% are chronic

alcoholics okay now do you

deprive the 40% of social drinkers

because of the

20% of binge Drinkers and chronic

alcoholics no I believe people should be

in choice but I believe people should

know what they are doing so that they

can be in Choice well right like do as

you I always say uh and I said this

about the alcohol episode which turned

out to be one of our most prolific Epis

episodes where I said you know more than

two drinks zero is better than any and

more than two drinks per week you need

to do other things to offset that and

it's problematic that's what those are

what the data say but I but I would say

do as you want but know what you're

doing well so I would say that that's

exactly what the food industry wants you

to think that's that is the food

industry's Mantra is you have your own

choice personal

responsibility so the question is does

personal responsibility work and the

answer is no it doesn't

every uh Public Health debacle in the

history of mankind started out as a

personal health issue before it became a

Public Health crisis and you can pick

your uh you know personal responsibility

issue whether it be exposures whether it

be addictions whether it be

infections bottom line is ultimately it

required a societal response okay we can

talk about syphilis we can talk about

tuberculosis ultimately needed a public

health response we can talk about um uh

teen pregnancy we can talk about tobacco

tobacco ultimately needs a public health

response because the sheer enormity of

it and the uh the egregiousness of it

requires that public health response

Well turns out this is no

different in order to exercise personal

responsibility four criteria have to be

met those four criteria are the

following number one knowledge you have

to have the knowledge because if you

don't have the knowledge then how can

you exercise personal responsibility

well in fact the Public's being kept

from the knowledge we're doing this now

in part to in you know to entrain that

knowledge to to get people to understand

what the problem is yeah I mean I

consider myself pretty informed about

nutrition and health but

already today I've learned two dozen

facts about processing of fructose and

calories generally that I had no

knowledge of Prior well that's good okay

because it's not about the math it's

about the science okay they want it to

be about calories so we have this thing

called food science we have this thing

called nutrition and we have this thing

called metabolic Health they are not the

same food science is what happens to

food between the ground and the mouth

nutrition is what happens to food

between the mouth and the cell metabolic

health is what happens to food inside

the cell but all of the chronic diseases

that we are suffering from type two

diabetes hypertension dyslipidemia

cardiovascular disease cancer dementia

fatty liver disease polycystic ovarian

disease those eight diseases which make

up 75% of healthc care expenditures in

this country

today are all inside the cell because

they are all mitochondrial dysfunction

and there is no medicine that gets to

the mitochondria although you and others

at Stanford Harvard Etc are starting

this with the metabolic Psychiatry being

one instance righted and UCSF as well

forgive me I should mentioned UCSF up

front your your home institution

wonderful institution right up the road

from Stanford so you know things are

changing people are starting to think

about mitochondrial Health they are okay

so you list off the first the first

thing and you said there are four things

that stand is be first one was knowledge

okay second access

because if you don't have access then

how can you exercise personal

responsibility access to healthier

Alternatives exactly which means cost

effective I mean I love berries from the

farmers market more than I love berries

from the store I love the farmers

markets generally but it takes time

energy to go there and the costs are

actually lower at the level of what you

hand the vendor typically right but uh

volume is tough to achieve right they

actually have me at a at a quota I'm not

not allowed to buy as many berries as I

want because obviously there are other

people who want berries so there's that

right people have to feed their family

that you know and they want we're used

to eating a lot of volume but you're

able to at least go there sometimes okay

yeah we're talking about people who live

in quote food deserts we're also talking

about people who live in food swamps

okay when we're talking about food

swamps we're not talking about an

plethora of healthy foods we're talking

about all the junk that's what they they

live in the swamp of junk so

if you live in the swamp of junk how are

you supposed to exercise personal

responsibility number three uh or

affordability so you have to be able to

afford your choice and Society has to be

able to afford your choice and right now

we can't afford that choice

because health care costs right now are

at $4.1 trillion a year but like so many

things in uh behavioral economics and

health it's so hard for people to see

that the the immediate choice is leading

to a higher cost down the road there

just too many nodes of separation for

people to realize hey when I'm reaching

for this cereal as opposed to making

waffles for my kids from scratch or you

know they're thinking time efficiency

cost efficiency volume the kids's not

throwing Tantrums because they're not no

longer getting the cereal and it's a

very difficult to see this is the reason

why healthc care costs are going up

there just too many nodes of separation

wouldn't agree more but the ultimately

it's because the government separates

and

silos um food industry profits from

health care costs if you actually

combine those because they ultim are the

same you would see the problem so

globally the food industry grosses $9

trillion a year health care cost

globally cost1 trillion a year dietary

related health costs environmental costs

cost $7 trillion a year and productivity

costs cost $1 trillion a year so when

you do the math 9 - 11 - 7 -1 means that

there is a 10 trillion a year

deficit because of us cleaning up the

mess that the food industry makes and

while numbers like that that's not

affordable right I agree and while

numbers like that land really hard I

find that for myself and for many people

statistics like that are hard to keep in

mind in a way there's something about

the human brain that hears that and goes

whoa we're like that War cost that much

and this food issue costs that much and

then we go to the store and we're hungry

right and the kids are are are are

hungry and and you're and so those nodes

of Separation it's it's almost like a

neural SL memory SL prefrontal cortex

issue to me and of course I look at

everything through the lens of

neurobiology you know not everything but

most everything and so how how could I

not how could we not but then like the

issue is well there's still food on the

shelves and you know and so it's very

what do we do to connect to bring closer

together these notes what would the

government do so the question is is

there food on the shelves let me finish

the fourth one and then I want to come

back to that point let me just you know

finish a concept so affordability and

number four externalities your choice

can't hurt anybody else but what if your

choice does hurt somebody else so like

for tobacco secondhand smoke right for

alcohol drunk driving what was the

argument for teen pregnancy that someone

else was going to have to raise the kids

exactly all right but what about for

food okay well how about the fact that

your employer Stanford University has to

pay

$2,750 uh per year in obesity related

health care expenses that they have

passed on to you even though you're not

obese that is affecting you so that

guy's obesity right there that is

affecting you ah but there nowadays it's

especially tricky even to have the

conversation I'm willing to have it now

which is that you know there's this

whole concept of fat shaming right so if

somebody's obese whose fault is it and

if we even talk about it is uh are we

subject to um attack legitimate attack

you know so like so calling something o

o someone obese at a clinical level like

I mean you're an expert

iny don't talk about obesity let's talk

about diabetes okay so talk about

consequence of obesity yeah let's talk

about the metabolic health issue

itself okay the fact is that diabetes is

now

11.4% of America what was it 20 years

ago it was 20 years ago it was about 8%

I was wondering this earlier 20 years

ago there was a lot more margarine in

refrigerators but people were thinner

and there was less diabetes everything

you told us about margarine and trans

fats is that it's bad bad bad now butter

is back as Time Magazine and you said

right so clearly can't be the transition

away from trans fats that's increased

obesity well no no so it's going to be

the increase in sugar and increase in

sugar and these hidden sugars in exactly

that's right all right the the the the

key though is Pakistan and India because

uh and China they are not fat but they

have 14% diabetes rates and they're thin

and the reason is because of ultr

processed food are there any countries

in the

world that don't allow high fructose

corn syrup or at least not at the level

that that we do oh the fre boats okay

there are boatloads of countries that uh

don't don't import high fructose corn

syrup or don't make it so uh

Scandinavian countries Scandinavian

countries most of Europe um the other

than the asia-pacific rim so uh Japan

has it in fact it was invented in Japan

1966 Saga medical school

takasaki at all um uh Korea has it um

but Australia does not have it Thailand

does not have it but they have just as

much of an uh obesity and diabetes

problem as we do because they have

sucrose

because hypose corn syrup and sucrose

are no different metabolically so it

doesn't really matter is that one to one

it's one to one thing exactly of glucose

and fructose so here's the question

Andrew okay so I want to go back to that

you said all this food is still on the

shelves is it food what is the

definition of

food can I give the definition I think

most people would give that's not

necessarily the one I would I would give

but um

something that has contains caloric

energy right like I I could eat this

microphone um but it's not going to

provide much useful energy the

definition of food straight from the

dictionary and believe me I looked it up

and memorized it I believe you substrate

that contributes to either growth or

burning of an organism interesting that

is the definition of food I'm free

scientific for

100% correct growth or burning so any

substrate that passes your lips that

contributes to either growth or burning

that's food okay let's do it let's do

burning first I just showed you that

Sugar which is the marker of ultra

processed food and 73% of the items in

the grocery store are spiked with sugar

inhibits burning it inhibits those three

enzymes involved in mitochondrial

function now let's do growth my

colleague Dr arrat maneno Oran who is

was the chairman of nutrition at Hebrew

University

Jerusalem actually looked at this

question and showed that Ultra processed

food actually inhibits growth it

inhibits cortical bone growth it

inhibits uh tricular bone growth it

inhibits uh cancelous bone growth it

inhibits linear bone growth it hijacks

growth for cancer because it inhibits

mitochondria and so you have to then

grow instead of burn and this was work

that was done in in Vivo or in vitro inv

Vivo inv Vivo so these are people that

are eating high amounts of Highly

processed food exactly how did he find

those in in the in the Middle

East they they found in Israel they

found it so the bottom line is if a

substrate does not contribute to growth

and does not contribute to burning is it

a

food I the answer is no well that's 73%

of what's in the grocery store so I

would argue you said the food food's

there no it's not that's not food in

fact it's consumable poison so this

leads to an important question of what's

left right you remove all that what's

left um just anecdotally and what I

sometimes call anec Dat um you know I've

had several friends in their 40s and

early 50s say they wanted to lose weight

and get in shape and the the thing

that's worked every every single time

for them to lose significant amounts of

weight quickly and keep it off and many

of them were already exercising but then

also increase their exercise was I just

since I'm not a dietitian nutritionist

or anything I just say eat meat fish

eggs vegetables fruits you're not going

to eat starches you're not going to

drink alcohol you're not going to drink

soda you can still have coffee tea you

can still have artificial sweeteners I

we go get to artificial sweeters in a

little bit we have to go there but um

and the reason I say no starches even

though I personally eat rice oatmeal

pasta things of that sort some in in

moderation depending on on what sort of

exercise and I'm doing and how much is

because of the fact that nowadays many

of those things contain fructose and

inevitably every one of those people is

blown away by the fact that it quote

unquote works and assumes that it's all

because of reduced calorie intake

overall and they lose like anywhere from

30 to 55 pound and keep it off and they

like hey this is great I can actually

still eat riye steaks and salads and but

they're not eating croutons they're and

so in some sense it looks extreme it

sounds ketogenic but it's nothing like

that you're just saying basically stay

away from you're eliminating processed

foods you're eliminating liquid calories

in in general you and on and on and so

there's nothing sophisticated about it

and my question to you is how much of

that weight loss effect do you think is

calories in versus calories out out

effect because they're eating a lot of

food and in some cases and how much of

it do you think is the elimination or

near elimination of this fructose or

this glucose fructose combination it's

nothing to do with the calories it has

everything to do with the

insulin if you get the insulin down

you're not shunting energy to Fat you

can lose weight your

fat will give up

it the ad the uh the triglyceride stored

in it as soon as your insulin goes down

insulin is pushing on your fat cell all

the time and as long as your insulin's

up your fat cell can't release it the

minute your insulin goes down you can

now engage in what we call lipolysis

hormone sensitive lipase is a an enzyme

in the fat cell that is U inhibited by

insulin as soon as the insulin's gone

hormone sensitive lipase can turn that

stored triglyceride into free fatty

acids and glycerol and release it and

you can lose weight so get the insulin

down and it all works so the question is

what makes insulin go up well two things

refine carbohydrate and sugar those are

the two things that make insulin go up

in addition Branch chain amino acids

make insulin go up as well Lucine

isoline veine which is in cornfed beef

chicken and fish processed food all

right here's here's here's the deal in

one concept my colleague Dr Carlos

Montero who is a professor of Public

Health at the University of sa Paulo has

done the world a great service he has

developed a system for categorization of

food processing it is called the Nova

System just means new but he has

basically categorized every

food anywhere in the world into one of

four

classes easiest way to explain this

would be an example let's take an

apple Nova class one would be an apple

picked off a tree Nova class two would

be apple slices D stem deed deskinned

maybe Nova class 3 would be

applesauce cooked mated possibly at

preservative added maybe some extra

sugar maybe not Nova class 4 would be

McDonald's apple

pie now does that McDonald's apple pie

look anything like that Apple no is

there even any Apple in it maybe a tiny

bit maybe not maybe a tiny bit you know

it's it's all flavor enhanced Etc okay

turns out and this is epidemiologic data

but nonetheless prospective

epidemiologic data so it's not

useless that Nova class 4 that ultr

processed food category which is 7 3% of

the American grocery

store is the class that is associated

with all of these chronic metabolic

diseases Nova class 1 through three no

problem now when you say associate what

percentage of one's daily total caloric

intake needs to come from Nova class 4

before that statement you just made is

true because it I love the

recommendation you made earlier or the

let's just say the the Contour of a you

don't have to

avoid dessert you can enjoy dessert but

don't eat dessert at other times of day

right and maybe you don't eat dessert

every single night right I is there a

rule that people have to eat dessert

every single night so the answer is

about 7 to

10% would be the upper limit so you can

get 7 to 10% of your caloric intake

daily caloric intake from these Nova

class 4 foods and still still be okay

and still be okay yeah so this is I know

but that's not what's happening right I

know some very healthy Physicians who I

used to um observe how people ate and

moved because I I would pay attention in

my in our field right I I was like oh

you know people all around me at

Stanford UCSF ET were successful or else

they wouldn't be there I was like you

know who looks healthy who can make it

up the stairs and doesn't have to take

the elevator how much exercise are

people doing at a given age are they

fanatic you know like four in the

morning Runners I'm not going to do that

consistently unless I have to um and and

I observed that you know many of the

healthiest people I know they move a lot

during the day they ate very well many

of them skip breakfast or lunch not

always and then I also noticed that they

would drink very little or no alcohol

and then but they would enjoy like a uh

there's one physician at UCSF in

particular I'm thinking of who really

enjoyed his dark chocolate Kit Kat after

lunch and he sort of very um ceremonial

about the unraveling of that uh the foil

and you and it was like okay so you're

talking about that small percentage of

calories if that if that's if that's all

you do hey you know God bless you but

that's not what people are doing that's

the problem bottom line that Nova class

4 is where all the action is in terms of

chronic metabolic disease so the

question is how can you avoid that how

do you know which is which we have a

solution so my colleagues and I have

developed a web-based tool that is

available to the entire world right now

and you'll put it in your show notes

yeah we'll put a link to this absolutely

it's called perfect p r f a and you can

find it at perfect.

Co and what it is is it's a

recommendation

engine not AI we're going to talk about

AI in a minute but it is a

recommendation engine based on the

science of human

metabolism that categorizes Foods based

on not their nutrients content but on

their Metabolic Effect interesting and

so there is a Nova filter which will

filter out all the Nova class 4 stuff

and it will go to your grocery

store and will tell you what you can buy

that will be a Nova class 1 through

three which turns out to only be 20% of

the grocery store it means basically

staying on the periphery of the grocery

store right general in general the

produce the meat the dairy the all the

things

mentioned in fact so I'm not low carb

I'm low insulin and there are a lot of

ways to get to low insulin get rid of

the refined carbohydrate get rid of the

sugar increase the fiber get rid of the

branch chain amino acids okay so eating

fish is a good place to be um even

eating a steak is okay if it's a uh

pasture fed steak so let's talk about

your steak which is also better for the

animals right it is absolutely so you

mentioned marbling before we love our

marbling right we can cut our us grade A

steaks with a butter knife because

they're so tender right you ever been to

Argentina yeah my father's argentin oh

right that's right you're Argentinian

yeah they only know they only know grass

F steak the only the idea that that cows

would eat anything but grass is sort of

like the idea that um fish would would

would fly absolutely New Zealand same

thing yeah okay the meat is gorgeous

it's homogeneous it's pink it's

delightful I've been to Argentina the

meat is fantastic but you have to use a

steak Knife you can't use a butter knife

and it takes more chewing it and it

takes more chewing because there's senu

there you know it's a it's a different

experience entirely it's delicious but

it is kind of a little bit you know

tougher all right turns out that

marbling is intramyocellular

lipid that animal has metabolic syndrome

the American cornfed the American

cornfed animal because that corn is

filled with Branch chain amino acids

Lucine isoline veine Branch chain amino

acids are what's in protein powder

that's what um you know bodybuilders you

know put in their smoothies you know to

build muscle and if you're building

muscle that's okay because 20% of the

amino acids in muscle are Branch chain

um so you know if you've got a place to

put them you know have at it yeah

there's a need there cuz they're down

musle yeah fine but if you're not if

you're you know again a mere mortal like

me you consume those excess branchin

amino acids they're going to go to the

liver they're going to be deamidated

like we talked about earlier and they're

going to end up as Branch chain organic

acids they're going to flood the

mitochondria the mitochondria are not

going to be able to deal with the volume

and so they're going to divert the

excess and turn that into fat and so now

you've got hyper

triglyceridemia and chance for fatty

liver disease

and insulin resistance

so what kind of meat you eat has a lot

to do with your metabolic Health what

about the egg the whole egg near near

perfect protein score in terms of its um

uh

bioavailability um eggs are terrific

okay there's nothing wrong with eggs now

there are better eggs than others so

there so well there's yellow uh yolk

eggs and there are orange yolk eggs

what's the difference between a yellow

Oak egg and an orange Oak egg I'm

guessing that something about the uh the

feed of the the mother chicken um and

I'm guessing it probably also has

something to do with choline content

Omega-3s ah interesting okay the orange

uh yolk egg has a lot of Omega-3s in it

what are other great sources of Omega-3s

I I I know some off the top of my head

but I'd like to hear it from you okay so

marine life is number number one okay um

you know fish provided you're not

bringing in heavy metals with it well

yes so I mean that's always the the the

argument you know the question is you

know is it the Mercury or is it the

Omega-3s ultimately I think it's the

Omega-3s that is more important but yes

I do understand the Mercury issue um uh

ultimately there are three Omega-3s

there's ala alpha linolenic acid which

you can get in vegetables there is EPA

eicosapentanoic acid which you can only

get in marine life fish oil cod liver

oil right and finally DHA dooh heex

enoic acid which you also get from

marine life but you can get from algae

so you can get algal oil which you know

the vegans will use do you um personally

take anything to increase your omega-3

intake I I know that there's even

prescription Omega-3s I take fish oil

you take a fish o yeah uh the the thres

I only take three I only take three

supplements okay I'd like to know what

those are I will say that I always

always always say behaviors first right

dos and don'ts behaviors

nutrition then only if needed and one

can afford it then supplementation and

prescription drugs and I'm a big

consumer of supplements and always have

been frankly so what are the three so

you take fish oil fish oil and do you

take to get above a certain threshold of

EPA about a th000 milligrams say about a

gram a day OFA okay uh vitamin C how

much vitamin C do you a th000 milligrams

a day you line is Pauling yeah well it's

actually for my rosacea I've got the um

skin issue and vitamin C helps with

helps with that interesting and finally

vitamin D now I will tell you vitamin D

is a complicated one all right uh let

and we can talk about vitamin D and how

either important or non-important it is

because there's a there's a quirk to

vitamin D and uh uh it it's important

for your audience to know about it

because everybody in his brother's you

know touting vitamin D a cure for

everything it's sort of funny because

that you have your supplement lovers

haters and agnostics but vitamin D

somehow made it through the shoot like

everyone's like Pro vitamin D it's

really interesting somehow vitamin D

people are comfortable taking a gel a

vitamin D gel cap but like other

supplements where you say oh like maybe

um this might be good for uh you know

like Omega-3s and fish them people are a

little bit like more standoff it's

really interesting that the kind of

psychos social stuff around this how

much vitamin D do you personally take I

take 5,000 units a day okay so do I

vitamin D is complicated though here's

the problem if you look at the

literature vitamin D deficiency is

associated with all these chronic

metabolic

diseases however

supplementation with vitamin D has not

fixed any of

those so so if you're vitamin D

deficient why wouldn't supplementation

fix

it couple of reasons one one of the

reasons for vitamin D deficiency is

because everyone's drinking soft drinks

that's one reason but there's a more

important reason uh sugar and

artificially sweetened soft drinks yeah

can deplete vitamin D utiliz well you're

not consuming Dairy because you're

consuming soft drinks but I can't

tolerate milk anymore well then you take

vitamin D but here's the here's the real

nugget of Truth and this is a little

complicated but the endocrinologists and

the audience will get

it vitamin D is a pre-pro hormone it's

not it's not active at all vitamin D is

converted in the liver first step to a

compound called 25 hydroxy vitamin D

that is a pro hormone it also is

inactive it has no activity whatsoever

from there 25 hydroxy vitamin D can be