Ep. 161 – The Nutritional Battlefield & Debunking Chronic Diseases: How Most Food Has Become Poison with Dr. Robert Lustig

Presenter: This is Everyday Wellness, a podcast dedicated to helping you achieve your health and wellness goals and provide practical strategies that you can use in your real life. Now here’s your host, Nurse Practitioner Cynthia Thurlow.

Cynthia Thurlow: Today I am joined by Dr. Robert Lustig. He’s an emeritus Professor of Pediatrics in the Division of endocrinology, and a member of the Institute for Health Policy Studies at UCSF. Dr. Lustig is a neuro endocrinologist with expertise in metabolism, obesity and nutrition. He is one of the leaders of the current anti-sugar movement that is changing the food industry. He graduated from MIT, received his MD from Cornell, received his master’s of studies in law degree at the University of California Hastings School of College of Law. He is the author of the popular books, Fat Chance, The Hacking of the American Mind, and the just-released Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine.

Pleasure to have you with me this afternoon. Thank you so much for carving time out of your busy schedule.

Robert Lustig: It’s my pleasure, Cynthia. It’s part of my job now, so it’s quite all right.

Cynthia Thurlow: Talk to us about how food has largely become poison. I read your most recent book with great interest. I think for many people, the assumption is made that if it’s in the grocery store, or if it’s at the corner market, it’s obviously healthy. You and I would both agree that most of the food-like substances that people are consuming nowadays are anything but real or anything that is metabolically supportive of a healthy lifestyle or healthy body.

Robert Lustig: Well, first, you have to know what healthy means. In order to know what healthy means, you have to know what health means. I will tell you right now, healthcare don’t know, and government don’t know, and to be honest with you, modern medicine don’t know. I lived within that ecosystem for 40 years. I was trained to do exactly what all the other doctors were trained to do. And then, I started doing research. What I realized was that the data that I was generating did not conform to the party line. The more data, the more I realized it.

In 2007, I started speaking out about what I thought was the biggest problem in nutrition, which was [unintelligible 00:02:28] sugar, and I got a lot of pushback, for obvious reasons, from many different directions, including academia, but certainly food industry. We did more research and things continued to fall out. What I then realized was that there was an entire treasure trove of work, of research that had been done back in the 1940s, 1950s, 1960s, before the original dietary guidelines for Americans, and it had been basically deep sixed. When we realized who deep sixed it, realized it was the food industry.

We’ve been sort of living a fraud for the last 50 years, and we’ve watched our population get sicker and sicker and chew through more and more healthcare resources. It just became painfully obvious that we needed individually and also as a society, a metabolic reset. Originally, I wrote my first book, Fat Chance, back in 2013, to dispel the standard notion that people had, which was, you are what you eat. Now, I will tell you, that was actually never stated. What was stated was, tell me what you eat, and I will tell you what you are, that was Brillat-Savarin back in 1825. Ultimately that got bastardized to, you are what you eat, which are not the same thing. Who did it? The food industry. But that’s what everyone believes for want of a better answer. Nobody else had any reason to say otherwise. I knew that that was not true.

In 2013, I published Fat Chance to restate the argument. You are what you do with what you eat. What you metabolize, that metabolism is more important than calories, for instance. Calories are basically useless. In Metabolical, basically, I do my ultimate best to try to kill the calorie, and that is my goal now. I’m the unspoken leader of kill the calorie. If I will be known for anything and in my next life, it will be as the guy who killed the calorie. Fat Chance was you are what you do with what you eat. But then, over the last eight years, working in this field and working with colleagues who were working on the industry side of this, the public policy side of this, it became painfully apparent that there was this treasure trove of information that had been deep sixed and that the food industry was basically writing its own narrative to keep us consuming. Then, I realized that I had to rewrite the book, if you will. And the point of Metabolical is to state you are what they did with what you eat.

Cynthia Thurlow: Beautifully said, and there’s so much to unpack there. I think there’s such a large degree of cognitive dissonance, it makes people very uncomfortable– not just patients but clinicians and makes us very uncomfortable because it bucks along with how I was trained, I trained in a big research institution myself, and certainly the information that I was given in the 1990s, both as a nurse and later as a nurse practitioner, is completely contrary to what I now know and believe. Do you think it was a byproduct of– we use the term ‘multifactorial’ when we’re in the medical environment. I think there are so many reasons for why we got so derailed. I think, a great deal about what I have learned through Ancel Keys’ work, conversations of how with Nina Teicholz, and Gary Taubes who’ve done a beautiful job as well as you, kind of illustrating the history of how this is all evolved.

I do think a large amount of this is also exacerbated by the fact that we as healthcare professionals are given little to no education. I know in your book, you did a really beautiful job talking about registered dieticians, and I definitely want to touch on that as well that they’ve propagated and aligned themselves largely, although I do know some evolved RDs, have aligned themselves with the processed food industry and Big Ag and all of these industries that benefit from keeping us in the dark, misinformed and metabolically unhealthy.

Robert Lustig: Indeed. Ultimately, dieticians can be part of the problem, or they can be part of the solution. The sad part is that the Academy of Nutrition and Dietetics has chosen to be part of the problem. The reason is because they get 90% of their operating budget from Big Food. There are plenty of dietitians who are “woke,” who get, who understand that it’s not about calories. What I do in the book is, I basically rephrase this for them. It’s not what’s in the food. That’s what dietitians are trained to add up, because it’s mass. Rather, it’s what’s been done to the food. That’s processing, and that’s something dietitians are not trained to know anything about. Dietitians basically have to understand the science, they have to understand the science of nutrition, sure. They also have to understand the science of food processing, food science, if you will, and they’re not the same.

A lot of dietitians, a lot of doctors think they are the same. Nutrition is what happens between the mouth and the cell. Food science is what happens between the ground and the mouth. What we’ve learned is that when you alter the food science, you alter the nutrition. You need to understand how those two work in concert. The problem is when you alter the nutrition, you don’t alter the food science, because the food science is upstream. That’s where the efforts have to be. So, that’s why I spend an entire part of the book, part four, on explaining what they did to the food to make it poison.

Now, people say, “Well, food is not poisoned. Food is food.” Well actually, that’s not true. I’ll give you my favorite example because it’s the easiest example for me to talk about since it’s my research, and that’s sugar. When you talk about poison, you’re talking about what? Keel over and die? Yeah, that’s one kind of poison. That’s an acute poison. There are plenty of acute poisons, cyanide, ricin, sarin, VX gas, things like that. Okay, that’s all true, and that’s parts per billion, keel over and die ultra. They’re also chronic poisons, they don’t kill you immediately. They kill you over time. Arsenic, or carbon tetrachloride or tobacco smoke. One cigarette won’t kill you, but 10,000 over 10 years certainly might and will.

Well, processed food is in that same category, and in particular, because it carries a chronic toxin. That chronic toxin is called sugar. You say, “Wait a second. Sugar, it’s energy.” Well, actually, it’s not. If you burn it in a bomb calorimeter, it’s energy. It releases four calories per gram, just like carbohydrate does, just like protein does. Those are all four calories per gram when you burn them in a bomb colorimeter but we’re not bomb colorimeters, and that’s where the dietitians get it wrong, because that’s what calories are, is what do you get when you burn them in a bomb calorimeter. Who cares because we’re not bomb colorimeters. Now, turns out sugar, fructose, the molecule in sugar that is sweet, the molecule that is enticing, molecule that is, in fact, addictive also inhibits three separate mitochondrial enzymes. One called AMP kinase, which is responsible for manufacturing new mitochondria, and keeping them up to date and fresh. Number two, ACADL, acyl-CoA dehydrogenase, long chain, which is necessary for being able to oxidize fatty acids to make ATP out of them, which is the mitochondria’s job. if you’re inhibiting it, you’re inhibiting mitochondrial function. Number three, carnitine palmitoyltransferase I, which is the shuttle mechanism by which fatty acids get into the mitochondria for burning in the first place, the transport is through a molecule called carnitine, which I know as cardiology preventative nurse, you know lots about, but you have to regenerate the carnitine and the molecule that the enzyme that does that is the CPT1.

Well, fructose inhibits CPT1 through its effects on malonyl-CoA via uric acid. Two direct inhibitions and one indirect inhibition of mitochondrial function. You say fructose is energy, because it generates four calories per gram. But if fructose stops you from being able to make ATP in your cells, how is that energy? This whole concept of calories just has to go through the friggin’ window. My job is to kill the calorie. The Economist magazine published a wonderful article last year called The Death of the Calorie explaining all of this in scientific terms. Bottom line is, if your dietitian believes in calories, fire them, that simple. Fire them, or worse, because that means they’re only focused on the math, not the science. This is where the dieticians either get on the bus or get off the bus. If there are any dietitians out there listening, go ahead. I’m calling you out now. Email me, we can have the debate. I will win, I promise.

Cynthia Thurlow: I’m so glad that we’re having this discussion. It is probably the most common question I get on social media because I talk a lot about intermittent fasting. People say, “Well, how many calories a day do you eat?” I was like, “I don’t count calories. My body doesn’t recognize the calories.” One of the quotes in the book is, “Calories are the industry shield. That’s how they hide from culpability.” I think that’s really profound. For people that are listening, if you still embrace the calories in, calories out, that CICO, or you don’t think that there’s more to it than that, it’s just a little too convenient to think that that’s all our bodies recognize.

Robert Lustig: People say, “Well, you eat too much, you exercise too little.” I’m not arguing that. I mean, we do eat too much. We 300 to 400 calories more than we used to 25 years ago. That’s true. Exercise too little. There’s some data to actually support that, although it’s a little bit fuzzier. The question is, why? Not do we, but question is why do we? The answer is leptin resistance. There is this hormone made by your fat cells called leptin. Leptin, when your fat cells fill up with fat, your fat cell makes leptin, it goes into the bloodstream, it goes to the brain and says to the brain, “Hey, I’ve got enough energy on board to engage in expensive metabolic processes, because I’m not starving.” Leptin means I’m not starving. I can burn energy at a normal rate. Therefore, I can exercise and will want to. I can go through puberty. I can go through pregnancy because I can carry a baby to term because there’s enough energy onboard to be able to do it. Starved people can’t carry a baby to term, their leptin levels are low, and it keeps their brain from actually being able to support a pregnancy.

Leptin signaling tells your brain I’m not starving. Therefore, the effective leptin signaling tells your brain, I am starving. Obese people are not getting the leptin signal. They got plenty of leptin, but it’s not getting to the brain. The brain’s not interpreting it. So, they have what we call leptin resistance, high leptin and low leptin effect, and because they have a high leptin and low leptin effect, their brains tell their bodies, “Hey, I need more leptin, so I need to eat more,” and it also tells their muscles, “Hey, I’m starving. So, you better sit on the couch instead of going and playing tennis.” The gluttony and the sloth that we associate with obesity is really a manifestation of a biochemical process called leptin resistance. Then, you say to me, “Okay, well, alright, that’s fine. Well, what’s causing the leptin resistance? How come the leptin is not working?” The short answer to that is the hormone, insulin. Insulin blocks leptin. That insulin is the hormone that drives the energy into fat in the first place. It’s telling your fat cells store, but normally your insulin tells your brain, “Hey, I’m in the middle of metabolizing a meal, I don’t need anymore.” That’s part of the stop signal.

Insulin is kind of weird, because it tells your fat cell one thing store, and it tells your brain the opposite stop, except when your brain is insulin resistant, then now the insulin doesn’t work, and now your leptin doesn’t work, and now, you keep eating like there’s no tomorrow. Insulin resistance causes leptin resistance, which causes both gluttony and sloth. In other words, your biochemistry drives your behavior. What we learn to do at UCSF in our obesity clinic, we did this for 17 years, while I was director of the obesity clinic, get the insulin down. When you get the insulin down, now the leptin can be seen, now the leptin works. Now, guess what? Your food intake goes down, and your exercise goes up spontaneously, by itself. We’ve done all the controlled studies to demonstrate this pathway, this mechanism. Then, you say, okay, well, so the insulin is high, so we’ve got to get the insulin down. Well, what made the insulin go up? And that’s where we get to sugar.

Cynthia Thurlow: It’s interesting to me, as I’ve watched patient population become increasingly sicker, more diseased over the last 20 plus years, and how we’re starting to see a shift where there’s more focus on the hormones that are mitigating a lot of these behavioral choices and recognizing that it’s not that someone doesn’t want to stop eating, it’s that their brain, as you mentioned, and their stomach and their fat cells, there’s this lack of communication. It explains why when my children were younger, they noticed and they were asking, as young children do, they ask questions, just really from a place of wanting clarification. Well, someone that they saw sitting at a restaurant had so much food in front of them, and they were obviously morbidly obese and having to explain that there’s a hormone miscommunication going on in their bodies.

Especially as a healthcare provider, when you can look at it from that perspective, it gives you profound pause in terms of how you want to view what has grown to be an increasingly disease population, I think the statistic I looked at was 88% of Americans have metabolic syndrome have this dysregulation. That’s unbelievable. You’re really an outlier if you don’t.

Robert Lustig: That’s right. In fact, it’s much more common to have metabolic dysfunction than not nowadays. All you have to do is look at the data on the eight chronic metabolic diseases that are due to mitochondria. Here they are, type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, cancer, dementia, fatty liver disease, polycystic ovarian disease. These are eight diseases, or the diseases of mitochondrial dysfunction. That’s why they tend to travel together, because if your mitochondria are not working in one organ, chances are they’re probably not working in another organ also. So, that’s why these eight diseases have cropped up to basically take over health care. And that’s why it is breaking the medical bank. Worse yet, and this is the point I try to stress in the book. There’s no pill for this, because there’s no pill that gets to the mitochondria, and makes it work. The only thing you can do is prevent the mitochondrial dysfunction by preventing the toxin from reaching it.

Well, that means cut your sugar, increase your fiber, because fiber also is important in terms of inhibiting sugar absorption early on, and it also helps feed the gut in terms of feeding the microbiome, which has its own beneficial effects in terms of insulin suppression, and immune suppression as well. Bottom line, you need to have a low sugar, high fiber diet. That’s what we need. That’s called real food. Unfortunately, that’s not what the 10 major food conglomerates are selling. They’re selling a high sugar, low fiber diet. That’s called processed food.

It comes back to the very first question you asked me about, what’s healthy? The FDA doesn’t have a definition for healthy. The USDA doesn’t have a definition for healthy, they’re trying to come up with a definition for healthy. I actually, in the book propose a definition for healthy. Two clauses, six words. Protect the liver, feed the gut. Any food that does both is healthy. Any food that does neither is poison. Any food that does one or the other, but not both, is somewhere in the middle. That’s actually what the empiric data bear out and I show in the book, how that works.

Example, juice. So, juice is not as bad as soda. That’s true. It’s still bad, but it’s not as bad as soda, and I agree with that. Okay, but it’s still bad. Now the juice companies are saying, “Oh, it’s got vitamin C. Quick energy, raises your blood sugar, especially if you’re hypoglycemic,” etc. Okay, all garbage. Juice does have soluble fiber, the inulin, pectins, juice still has those. That’s good, but it doesn’t have the insoluble fiber, that’s been removed, The insoluble fiber is the cellulose, the stringy stuff. You need both, because when you have both, the insoluble fiber, like the cellulose forms like the latticework on the inside of your duodenum, and the soluble fiber like the pectins and inulin, plug the holes in that latticework. Together, they form an impenetrable secondary barrier that lines your duodenal, your intestinal lumen, you can actually see it on electron microscopy, a whitish barrier. What that barrier does is, it prevents early absorption of simple sugars, glucose, fructose, sucrose, from getting into the portal vein going to the liver, thereby protecting your liver. But if you don’t have the cellulose, because it’s been stripped away, because it’s juice, or because you put it in a smoothie machine [unintelligible [00:21:55], you’ve basically chopped that latticework up into smithereens, it can’t form that latticework, that fish net. So, you can’t assemble that barrier. You still end up flooding the liver because you can’t block it.

Now, the soluble fiber will still be there. It will go further down the intestine. The intestinal bacteria will be able to metabolize it for its own purposes, because that’s the food for the bacteria. They will turn it into short chain fatty acids, butyrate, propionate, and those are good. I’m not saying that’s bad. That’s good. Those suppress insulin, and those also suppress your cytokine response. So, that’s actually important for COVID. Those are good things, but you still poisoned your liver. When you look at the data, the empiric data on juice, it’s not as bad as soda, but it’s still bad. I can show you a zillion meta-analyses that show that juice predisposes you, causes diabetes, as well.

Cynthia Thurlow: I think that in so many ways, it’s thought of as being so benign. I recall, I’m rounding with the cardiology group I worked for in the hospital, sometimes the ICU and the cardiology step down units. What were my cardiac patients being given for breakfast? It was white bread, with faux butter, because God forbid you give them real butter. And there was always juice, they have their choice of juice, and then they always had soda. I thought to myself, what is going on that we have gotten to a point where we think that these things are beneficial for our patients. The fiber piece is one that even myself as I was reading your book, and I eat quite a bit of vegetables and very diligent about that, non-starchy vegetables really caused me a pause, because I believe that fiber sometimes gets a bad rap. The irony is, I was thinking about those Fiber One bars as I was reading your book– not because I consume them. I think I’ve only consumed one once and it made me so gassy. It was distressing.

The point being that fiber is thought of as being, I think, in many ways, a negative thing. Yet, what you’re clearly delineating is how critically important it is to help protect the integrity of our digestive system, and ultimately, our blood sugar, our liver, and our gut health.

Robert Lustig: Right. Well, the fact is, the food industry doesn’t want you to like fiber. They very specifically don’t, because fiber means decreased eating time for food. It doesn’t last as long on the shelf. The more fiber it has, the quicker it will spoil. It’s easier to squeeze it, freeze it, lasts forever. You’ve turned a food into a commodity that you can sell on the commodities exchange. Since it doesn’t go bad, it’s there forever, so let the price work. Bottom line is, fiber works against the food industry’s profit into interests, but fiber works for our health interests. This is a direct contradiction between what’s good for us versus what’s good for them. Ultimately, when it comes down to processed food, whatever’s good for them is bad for you, and whatever’s good for you is bad for them. This is a war. The difference is that it is an asymmetric war because you’ve got to eat. It’s also an asymmetric war, because they have the information and you don’t, and they’re winning.

Cynthia Thurlow: And they like to keep consumers ignorant to what is actually going on.

Robert Lustig: Exactly.

Cynthia Thurlow: One of the things I love that you kind of alluded to and discussed in the book is the role in Big Pharma. For anyone that’s listening, we have largely conditioned our patient population that a symptom requires a pharmaceutical drug. Big Pharma has profited enormously off of our health. One of the statistics I wanted to make sure I share with listeners, of the top 11 pharmaceutical companies, the net profits are $75 billion a year. The industry is two-thirds of the FDA’s budget. There are over 1300 lobbyists in Washington, DC, to push their agenda. And they spend more on marketing than they do on research and development. They do everything they can to drive our desire to ask for prescriptive medications, instead of really changing the way that we fuel our bodies and live our lives. This is incredibly distressing. The other thing that I thought was interesting is for every $1 of research, Big Pharma spends $19 on promotions and advertising.

Robert Lustig: That’s right. They know where their bread is buttered, as it were. That’s what makes them money. They’re not doing it because they’re losing it, that’s for sure. We have to basically look askance at their practices and determine, why are they doing this, and why is this affecting us? What I try to do in the book is basically lay that out, so that people can understand what the issues are. Ultimately, Big Pharma has generated a pill for type 2 diabetes, they’ve generated a pill for hypertension, they’ve generated a pill for cardiovascular disease. They’ve generated a pill, for just about everything. Now, we even have a medicine for dementia. Whether it works or not, is another story.

The bottom line is, these pills, statins, oral hypoglycemics, antihypertensives, they are not treating the disease. They are treating the symptom of the disease, because the disease is actually subcellular, it’s going on inside the cell. Mitochondrial dysfunction is sort of the outgrowth of all of that. But there are actually eight subcellular pathologies, and those pills don’t touch any of them. Here they are, one, glycation. Two, oxidative stress. Three, mitochondrial dysfunction. Four, insulin resistance. Five, membrane instability. Six, inflammation. Seven, methylation. Eight, autophagy. These eight subcellular pathologies are the difference between whether you will be 110 playing tennis, or 40 years old with two stumps on a dialysis machine waiting for your next stroke. Those eight subcellular pathologies, I call them in the book, The Hateful or The Grateful Eight.

When you look at the molecular mechanisms by which those occur, there are no drug targets, but they all respond to food, but what kind of food? They respond to omega-3s, they respond to vitamin D, they respond to a host of other components in food, and all of them are killed by fructose, they’re all killed by sugar. The bottom line is, if you want those eight pathologies to be working for you, instead of against you, you have eat real food. The pharma industry doesn’t want you to know they’re just treating symptoms of disease rather than the actual disease. This is the problem. This is the dichotomy.

In order to solve a problem, you have to work upstream of a problem. An easy analogy and easy metaphor, which I start the book with, is a wasp buzzing around your attic. What do you do? Kill the wasp or find the wasps’ nest? You have to work upstream of a problem to solve a problem. Working downstream of a problem only solves the result of the problem. It doesn’t solve the cause of the problem. If you want this problem to go away, you have to deal with the cause, not the result. And we’re not doing that. We haven’t done that for the last 50 years, which is why modern medicine has gone to hell in a handbasket.

Cynthia Thurlow: I agree. It’s interesting because you bring up so many different nuances to this problem. A lot of it’s policy related, a lot of it requires that the government actually take a stand. Whether or not that’s more easily said than done, and you probably would agree that it would be like moving mountains. What are some of the things that the USDA could be doing to help from a nutritional standpoint that would be of benefit? What are some of the impediments to this actually happening? Because there are some financial things that are driving, continuing on this path and pretending to play ostrich and dig our heads in the sand and pretend there isn’t actually a larger issue?

Robert Lustig: I couldn’t agree more. In the book, I describe all these issues, and people ask me all the time, like, if you had a magic wand, and you could do one thing, what would you get the most bang for your buck out of to try to fix this problem, if you can fix one thing? What I say is, I would get rid of food subsidies. I would get rid of all food subsidies, because they distort the market. That’s the nature of food subsidies, is to distort the market. There’s no economist on the planet that believes in distorting the market, let the market work. I agree with that. Even libertarians should be able to agree with that. Food subsidies do not make sense. Now, once upon a time, food subsidies did make sense. That was 1933, we had a Depression, we had a Dust Bowl, we had a destitute population in the American Southwest, and we had all the food in the northeast. We had to get the food from the northeast to the southwest. The problem was, if you just put the food on the cargo, railroad cars, by the time it reached the Southwest, it would all have gone rancid.

The processed food industry kicked into high gear, and started processing all the wheat and all the barley and everything, and basically put it into 10-pound bags and shipped it that way. And then they would bake it up where they got and we saved an entire population. You know what? That made sense. The subsidies rewarded those companies for doing this. That made sense all the way through World War II. But after World War II, we didn’t have a Dust Bowl, we didn’t have a Depression. We didn’t need those policies to stay in place. But the food industry had figured out, “Hey, we can make money doing this.” So, they lobbied and then we doubled down and we actually supported even further subsidies. Then, in 1971, Richard Nixon carrying on Johnson’s war against poverty, realized that fluctuating food prices cause political unrest. He told his agriculture secretary, Earl Rusty Butz, love that name.

Cynthia Thurlow: [laughs]

Robert Lustig: Make food cheap. Butz went out to the heartland to Nebraska, and Kansas, Iowa, and said, basically, three things, row to row, furrow to furrow, get bigger, get out. That was his way to fix this problem. What that did was that ushered in the era of monoculture. So, that’s why all the corn is in Iowa and all the cattle are in Kansas. Cattle used to be in Iowa living on the farm, and pooping on the farm, and the poop was the fertilizer for the farm, and that worked. Then, we move the cattle to Kansas. Now, the poop is in Kansas, and nothing to do with it, except make the other cows sick. So, we have to give them antibiotics to keep them alive. otherwise succumbing to some GI dysentery, because all the CAFOs are completely overrun. And we have all the corn in Iowa, and it’s got to get sprayed with nitrogen fertilizer, because there’s no nitrogen because the cows are in Kansas, and there’s no poop. The nitrogen fertilizer makes the corn grow. That’s fine, except for one problem. It’s growing in dirt rather than soil, so the soil is dead, but the corn grows. The problem is that the nitrogen runoff creates nitric oxide, which is the worst greenhouse gas.

Everybody talks about methane and the cows. Nitrous oxide is way worse, way worse. It has 250 times the heat-trapping capacity of carbon dioxide, and it lasts 114 years. The more nitrogen fertilizer we spray, the worse our climate gets. All of this occurred because of the change in our food system to promote and procure and to cheapen the cost of processed food. How can you undo that? How can you unravel that? The answer is, don’t make it so cheap for the food industry to make processed food, get rid of the food subsidy. Could we do that? The answer is absolutely we could.

People say, “Wait a second, that would make food more expensive.” Well, the Giannini Foundation at UC Berkeley actually did this modeling exercise back in 2007. What would the price of food look like if we got rid of all food subsidies? That turns out price of food wouldn’t change, except for two items, which would go up. Corn and sugar, exactly what we would want to go up. To me, the first thing that has to be done is get rid of food subsidies. The problem is only government can do that. Problem is, government doesn’t want to do that. The reason? It’s because the processed food industry owns the government.

Cynthia Thurlow: Out of curiosity, and for the benefit of the listeners, do you know how many items are actually subsidized right now?

Robert Lustig: I’m not sure how many but there are quite a few. Basically, corn, wheat, soy, sugar. [crosstalk] 

Cynthia Thurlow: Yeah, that’s what it’s proliferative in the processed industry. It’s interesting that it was thought to be an altruistic and kind thing to do has turned into monocropping on so many levels is detrimental. I had Robb Wolf on and he was talking about how that’s really impacted things adversely from an agricultural perspective, and yet– this could be a segue into talking about meat, but the reality is that there’s a lot of suppression of information so that people aren’t able to make good decisions. This just propagates one after another. It’s like, one seemingly benign decision leads to a proliferation of poor decisions.

Robert Lustig: Absolutely. Unfortunately, American history is filled with this kind of thing. You have ostensibly the right reasons for instituting a specific policy measure, and then people figure out how to corrupt it, and that’s what we’ve got. We have to basically dismantle that, which means we have to dismantle our current food system model. The food industry should be rewarded for doing the right thing, not the wrong thing. Now, they say, “Well, then they would not make money.” The answer is actually, they would make probably more money, if we rewarded them for doing the right thing. The problem is, they’re scared. They don’t want to go there, because any change is bad as far as they’re concerned.

Example, look at seatbelts. Seatbelts save lives. Yes? Of course, they do. 1968, Australia instituted seatbelt laws, saved lives, they had the data. The big three, now, the big two, in part, because of this kicking and screaming throughout the entire 1970s did not want a seatbelt law. Finally, in 1979, there was an act of Congress, that all new cars built in America had to have seatbelts. Did seatbelts save lives? No, because there was no mandate to wear them. Seatbelts don’t do a damn thing if you don’t wear them. It took Mothers Against Drunk Driving working through the 1980s to petition every state house in America that seatbelt use was mandatory, Click it or Ticket. Now, do seatbelts save lives? Absolutely.

You have to have the education, you have to have the implementation, and you have to have the correct implementation strategy. Now, could we do that for food? Yes, we could. In the book, I outline what each stakeholder in this argument has to be able to come up with and to produce in order to make it work. If we all did it together, it would absolutely work, but that means everyone has to work together. And right now, no one’s working together.

Cynthia Thurlow: Absolutely not. I guess one of the questions I have because I trained in inner city of Baltimore and had a kind of an eye-opening perspective on how people in urban centers really don’t have access to a lot of the things that us, suburbanites, take for granted. For individuals who’ve grown up eating out of the processed food industries, treasure trove of options, and that’s what they’ve eaten from the beginning of their life to the end of their life, how do we get real food to people, even if they don’t want it? Or, even if they don’t see the value in those changes? Because one of the things that I was privy, and I’m sure you have as well, being inside of a large US city, was this disparity that you see in a lot of urban environments where people have this legacy of multigenerational people that are dealing with the same health problems. They’re just getting worse with each subsequent generation.

Robert Lustig: They think it’s genetic, [chuckles] because, “Oh, my mother had diabetes. Of course, I’m going to get it.” Yeah, because you ate the same crap. That’s why. It’s not genetic. It’s environmental, but you live in the same environment, so don’t be surprised. The short answer to this is that there has to be policy directive to making this happen. We can divide policy directives into two forms, carrots and sticks. Inducements and punishments. What the data show is that no inducement works, no punishment works. But if you yoke the inducement and the punishment together and do both at the same time, that is what Cass Sunstein and Michael Thaler called Nudge, they wrote a book called Nudge about the carrot and the stick together yoked. Example. I afford this example in the book.

1977, Norway, Sweden, Denmark, Scandinavian countries, huge alcohol problem. It was a problem on both sides of the ledger. It was a problem on the positive side of the ledger in terms of people calling in on their benders on Monday morning, because they’ve been drinking all weekend. It was also a problem on the negative side of the ledger because of car accidents and cirrhosis of the liver. These three countries, recognizing the problem, banded together and passed two pieces of related yoked legislation. The first was, they nationalized all the liquor stores. Everyone sold the same fare at the same price. You couldn’t go someplace else and buy it cheaper. The price was the price. The second piece of legislation was they taxed high-alcohol spirits, and they used the money from the tax to subsidize low-alcohol beer. Zero sum game for the countries, they didn’t make any money off of it, but what they did was they provided the punishment, a tax, with the inducement, the subsidy. Differential subsidization it’s called.

Lo and behold, the entire population of Norway, Sweden, Denmark, gravitated toward low-alcohol beer. Sure enough, productivity went up, and car accidents and cirrhosis of the liver went down. They plotted that over a 20-year period and showed the decline, and then it leveled out. It’s still low, and so those policies are still in place today, if you go to visit those countries, because it worked. Carrot and stick.

How could you do this for the American food industry? Why couldn’t we tax soda and use the money from the tax to subsidize water as an example? There are things we could do, there are ways to make this happen. There are ways to provide inducements that basically– you could make them an offer they can’t refuse. In addition, we can get insurance to play. What if people ate healthier, and the insurance company paid for the healthy food, but actually provided a tax or an increase in fees if people ate less well? There’s an inducement to try to eat healthier.

I work with a company, a startup that has built a digital platform called Foogal, F-O-O-G-A-L, which I described in the book, which is basically a platform that ties for stakeholders together, the patient, the doctor, the grocery store, and the insurance company, to provide healthy food and have it paid for by the insurance company. The insurance company’s happy to do it, because the cost of the food is one-tenth of the cost of the medicine, and the insurance company gets to keep the rest.

Cynthia Thurlow: Incredible incentive.

Robert Lustig: There are ways to do it. We have to want to. The problem is, at this point, people are still on calories. They think it’s your own fault, which it’s not, and so that’s why I had to write the book, is to explain what the real problem is. But haters gonna hate.

Cynthia Thurlow: Well, I think it comes down to the significant degree of cognitive dissonance that people want to believe what they want to believe and whether it’s hanging on to that calories in, we call it CICO, calories in, calories out, and that’s the mentality they want to ascribe to. I know just personally, I mean, there’s not one day on social media that I don’t get a question about calories, and having to dispel, it’s more about hormones than about calories, but people don’t really–[crosstalk]

Robert Lustig: Insulin, it’s all about insulin. Calories have very little to do with insulin because the thing that has the most calories is fat, generates the lowest insulin response.

Cynthia Thurlow: Someone that wears a continuous glucose monitor intermittently throughout the year, it’s been amazing, in a metabolically healthy individual, to see the impact of different types of macronutrients. Now, I want to be respectful of your time, but I did get quite a few questions about seed oils. There are quite a few people who are curious to know what your opinion was seed oils. Which are these oils that are touted as being superior to other types of oils?

Robert Lustig: Garbage. [laughs]

Cynthia Thurlow: Exactly.

Robert Lustig: Seed oils are primarily omega-6s, linoleic acid. You need omega-6s, I’m not saying you don’t. Omega-6s are the precursors for arachidonic acid, which is the primary driver of inflammation. It gets turned into prostaglandins, other compounds that are involved in the inflammatory response. If you don’t have an inflammatory response, you’ll be eaten by the maggots. So, you need inflammation, you need to be able to generate inflammation. But it turns out the more omega-6s, the more inflammation and we now know that inflammation is bad for cardiovascular health, and for longevity. We are supposed to have an omega-6 to omega-3 ratio of about between one to one and three to one. We currently have an omega-6 to omega-3 ratio of about 20 to 1, in some cases, 25 to 1. We need to bring the omega-6s down and bring the omega-3s up. Well, the omega-6s are what’s in seed oils, because you can put those on a shelf, and the omega-3s, unfortunately they rot, and they smell like fish. They don’t really go into processed food very easily. Basically, if you’re eating a processed food diet, you’re not getting your omega-3s, and you’re getting way too many omega-6s. Guess what? You’re going to get sick from that.

Cynthia Thurlow: I think that they’re probably the worst thing next to sugar. Sugar is the number one but distinctive number two based on what I’ve been seeing in the last several years are soybean oil, I think Ben Bikman was saying is the number one consumed fat in the United States– [crosstalk]

Robert Lustig: Yeah, probably so, because we have a lot of soybeans because they’re a commodity. This is the problem. We were told that these were good things. Oh, vegetable oils good because it’s not animal fat. Well, you know what? Actually, animal fat is cardiovascularly neutral. Saturated fat is not good for you or not making it good for you. It’s not bad for you. It’s in the middle. There are seven classes of fats. Here they are in order of good to bad. Omega-3s, save your life. Monounsaturates, generate PPR alpha in the liver, which is a fuel gauge in your liver. Number three, polyunsaturated fatty acids, the problem with them is they easily turn into trans fats when you fry them too high. Number four, the saturated fat, cardiovascularly neutral, but very good to fry in. Number five, medium chain triglycerides.

Now, everybody wants MCTs to work and they can work, but only if you haven’t also eaten a lot of saturated fat with it because then your liver gets overwhelmed and then you end up with fatty liver. Number six, omega-6s, which, again, proinflammatory. Finally, number seven, trans fats which are the devil incarnate, but we know that now and they’re coming out of our food. Seven different classes of fats, they’re all nine calories per gram. Calories are the same. One will save your life, one will kill you, and everything in between. Calories are useless, calories are worthless. It’s the biochemistry of the molecule that’s called science. Dieticians learn science.

Cynthia Thurlow: I’ve been so thrilled and excited. I could talk to you for hours. I want to be respectful of your time. What are you doing that’s new? Obviously, your book just came out fairly recently. What else are you up to?

Robert Lustig: Oh, I’m up to a lot of stuff.

[laughter]

Robert Lustig: I got a lot of stuff on my plate. I am the Chief Medical Officer of four separate companies. We are evaluating different ways to try to improve metabolic health. I am working with an international food conglomerate, to basically redo their entire portfolio to make metabolic health its North Star. It is outside the United States, but it’s sort of as a role model for other companies to be able to come to do. I’m also an advisor to several companies that are in the metabolic health sphere looking for instance at continuous glucose monitoring and other facets of metabolism that might help. A surgical company that is using magnets to change GI physiology, to benefit obese patients, various things.

Cynthia Thurlow: Well, that sounds amazing. How can my listeners connect with you, purchase your new book which is going to be on my list of must reads for 2021? What’s the easiest way to connect with you on social media or off your website?

Robert Lustig: Well, I have a website, robertlustig.com. The book has its own website, metabolical.com, they’re linked. The reference list for the book is on metabolical.com because reference list is 1054 references and would have basically taken up 70 pages and $5 per book, so we put it online instead. Bottom line is, I’m very available, I’m easy to find, I’m easy to reach. If you’re going to buy Metabolical, I prefer you buy it at a bookstore, not from Amazon. And the reason is because we have to support our local bookstores, because bookstores are happiness. People learn in bookstores. They don’t learn on Amazon. I promise you, you’ll be happier walking into a bookstore. Please support your local bookstore. I have a Twitter account. I have a LinkedIn account. I try to stay off Instagram. That’s kind of a bad place to be. God knows you’ll never find me on Reddit. [laughs] But I’m easy to find.

Cynthia Thurlow: Fair enough. Well, it’s been a pleasure this afternoon. As I said, before, I could talk to you all day long, you are speaking my language and obviously talking about things I’m really passionate about. Thank you again for your time.

Robert Lustig: My pleasure, Ms. Thurlow. Bottom line is, we healthcare professionals, we need to get woke. We need to stick together. We can help solve this crisis, but only if we know what we’re doing. So, thank you for your advocacy.

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