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

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 teaching and research roles at Stanford it is however part of my desire and effort to bring zero cost to Consumer information about science and science related tools to the general public in keeping with that theme I'd like to thank the sponsors of today's podcast our first sponsor is eight sleep eight sleep makes Smart mattress covers with cooling Heating and sleep tracking capacity I've spoken many times before in this podcast about the fact that sleep is the foundation of Mental Health physical health and performance now a key component of getting a great night's sleep is that in order to fall and stay deeply asleep your body temperature actually has to drop by about 1 to 3 de and in order to wake up feeling refreshed and energized your body temperature actually has to increase by about 1 to 3° one of the best ways to 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and Australia again that's 8sleep.com huberman today's episode is also brought To Us by levels levels is a program that lets you see how different foods affect your health by giving you real-time feedback on your diet using a continuous glucose monitor one of the most important factors in your immediate and long-term health is your blood sugar or blood glucose regulation with levels you can see how different foods and food combinations exercise and sleep patterns impact your blood glucose levels it's very easy to use you just put the monitor on the back of your arm and then you take your phone and you scan it over that monitor now and again and it downloads the data about your blood sugar levels in the preceding hours using levels has allowed me to learn a tremendous amount about what works best for me in terms of nutrition exercise work schedules and sleep so if you're interested in learning more about levels and trying a continuous glucose monitor you can go to levels. l/ huberman levels has launched a new CGM sensor that is smaller and has even better tracking than the previous version right now they're also offering an additional two free months of membership again that's levels. linkhub to try the new sensor and two free months of membership today's episode is also brought To Us by Aeropress Aeropress is similar to a French press for making coffee but is in fact a much better way to make coffee I first learned about Aeropress well over 10 years ago and I've been using one ever since Aeropress was developed by Allan Adler who was an engineer at Stanford and I knew of Allen because he had also built the so-called aobi frisbee which I believe at one time perhaps still now held the Guinness Book of World Records for furthest Throne object and I used to see Allan believe it or not at parks around paloalto testing out different aobi frisbees so he was sort of famous in our community for developing these different Feats of engineering that turned into commercial 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maker Aeropress sh anywhere in the USA Canada and over 60 other countries around the world again that's Aero press.com huberman to get 20% off and now for my discussion with 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 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 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 degre centigrate 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 intestin the insoluble fiber the cellulose forms a fishnet if you will 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 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 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 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 mmortal 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 schlump 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 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's it 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 how 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 phosphorilated 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 grass-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 say 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 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 something 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 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 1 1600 calorie Porter House with a slab of butter on it 600 of those calories we're saying in this instance is fat of the remaining thousand calories that's that all 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 fructose and glucose all right now glucose is the energy Al life so here we're talking carbohydrates I think most of our audience will be familiar with the so-called 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 MH very little of any carbohydrate it should be zero essentially maybe one zero zero yep 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 uh 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 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 la 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 insens just it's an aging phenomenon okay we'll come come back to this because I think it's really important yeah the idea that ingestion of carbohydrates and the as you called it the studying of carbohydrate molecules on hormones can augment the function of those hormones and with aging that's a less efficient process 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 defic thyroid testosterone estrogen um prolactin Etc because of the way that 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 73% of all items in the American Grocery Store have added sugar on purpose for the food industry's purposes 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 sigil to all vertebrate life there is no biochemical reaction in any vertebrate that requires dietary fructose that's number one number two okay so sorry I'm going to just answer 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 yeah 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 fistful 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 eat lots of blueberri 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 thank you 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 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 in 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 the 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 stuff it shows up white on the scan is um high concentrations of magnesium 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 mitochondria make at TP your mitochondria have to work at Peak efficiency that's what metabolic health is is mitochondria working at Peak efficiency well there are three enzymes that are inhibited by fructose number one amyas 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 am levels are high that means you've 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 kyes to generate that mitochondrial biogenesis signal except that fructose a metaboli 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 um 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 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 cyanide 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 wellx 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 k 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 8ye 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 8-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 have obesity it's a 15-year 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 sixes it's also so 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 butter is fine in fact time declared you know a front cover Butters 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 Ultra process 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 virtually every way loss study that CA that led to you know caloric restriction basically didn't work not for any length of time just a 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 issue I think the problem is there's there's a lack of useful language to dissociate this stuff yeah 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 really you oh absolutely so they tell you a sugar is a sugar which is not true they tell you a calorie 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 talking about dietary sugar or you talking about blood sugar because blood sugar is blood glucose use dietary cholesterol or circulating cholesterol or you know absolutely yeah 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 industry 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 all the cell 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 nonprocessed 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 delighted that ag1 is sponsoring the huberman Lab podcast the reason I started taking ag1 and the reason I still drink ag1 once or twice a day is that it provides all of my foundational nutritional needs that is it provides insurance that I get the proper amounts of those vitamins minerals probiotics and fiber to ensure optimal mental health physical health and performance if you'd like to try ag1 you can go to drink a1.com huberman to claim a special offer they're giving away five free travel packs plus a year supply of V Vin D3 K2 again that's drink a1.com huberman to claim that special offer for 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 I know it's not the same 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 thing 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 polymerized glucose how much of that is actually utilized or burned versus um you know the 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 is 300 that's bad we give them a shot of insulin in the arm blood sugar goes 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 storage hormone quickly does it do that because because if I'm you know having a a very busy day mhm or that 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 sorry 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 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 you're 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 irrespective of in 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 metu 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 agrees 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 paduro mouse p d RKO is it discovered by pedco no no it was uh discovered in ronon La it was manufactured in ronon lab so this is a tissue specific insulin receptor knockout Mouse Okay IR KO insul LAX insulin receptor in specific the kidney in the kidney interco glomular ptoy insulin receptor knockout mous we haven't talked too much about transgenic models and knockins and Knockouts so uh just in 10 seconds or less basically the 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 they ner oh their kidney is degenerative their kidneys degenerate to nothing yikes now they have normal blood glucose levels they have normal glucose tolerance they have normal insulin tolerance whole body but their 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 in the kidney 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 its 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 gives you an organism 10 trillion cells we're 10 trillion cells we're 10 trillion cells do 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 turn over 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 yeah so but whole body wide I don't know how you'd come up put 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 20 uh 8B next doubling 56 lb next doubling 112 lb next doubling 224b that's hopefully it's top obes individ hopefully it's tops 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 1931 for the war effect he asked the question how come cancer cells don't need oxygen to grow and the answer is cuz 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 millimeters 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 but 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 are 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 vascular I mean I mean one way to one way to try and kill one is to to devascularize the tumor cell yes and and you know angiogenesis inhibition Etc you know 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 delivering lots of oxygen in 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 then 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 the calorie a calorie clearly the answer is no but based on the processing of different types of calories we established it for fat the almonds we established it for protein right 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 a denzine monophosphate which will then go to im an ocol monophosphate which will then go to Uric acidd okay and that uric acid will be then released from the cell circulate in the blood 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 itile 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 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 Paton ductus arteriosis which is a big deal in uh in the uh 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 glucose and the insulin that goes with it increases uric acid mhm uric acid uh 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 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 so remember that high fructose corn syrup is half glucose half fructose 125 125 so let's use that well so let's assume um so we talk about a soda for uh to get that that uh 250 calories easily right um especially if it's not a can or a European siiz bottle or can 8 o 8 O can of soda okay so 8 oz 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 celebrating 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 equivalent calories right equivalent Cal 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 125 125 so you're 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 than than the glycemic index and this is one of the things dietitians promote and espouse and one of the things that's got to go this this is an idea that must die okay we'll get back to why the gmic index has got to die uh but so so that 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 have to make it 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 high fructose purp 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 because 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 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 post prandial 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 nitrate tight Junction proteins now okay portal vein of the kidney portal vein goes to the liver portal vein goes from the visceral from the intestine to the liver no kid it doesn't feed the kidney okay 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 are 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 uh phosphorilation status or the nitrate status of that tight Junction it will become transiently permeable okay and so fructose nitrates tight 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 sensitive CRP sensitivity CRP is high in patients who eat ultr processed food CRP is C reactive protein which is a marker of a essentially an 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 mhm 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 your 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 that m muin 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 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 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 exct 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 800 p.m and occasionally it's outside that window I've done this for a long time it just feels best to me right 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 components of your you're not 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 seem is that 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 bacteria itself and you 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 uh and it's disrupting the tight junctions making my gut leaky right but I'm also eating fiber yeah 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 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 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 Froot Loops and a glass of orange juice that is 41 gam of sugar American Heart Association 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 kid still likes like uh 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 are we're still ending up at very high are we basically eating dessert for breakfast 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 ego 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 priced in elastic food the top three most price in elastic foods are fast food cereal1 I like a good quiz fast food 081 um uh uh soft drinks at 79 9 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 tki Nobel Prize winner uh Daniel canaman described 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 spiked I'd like to take a quick break to acknowledge our sponsor element element is an electrolyte drink that has everything you need and nothing you don't that means zero sugar and the appropriate ratios of the electrolytes sodium magnesium and potassium and that correct ratio of electrolytes is extremely important because every cell in your body but especially your nerve cells your neurons relies on electrolytes in order to function properly so when you're well hydrated and you have the appropriate amount of electrolytes your system your mental functioning and your physical functioning is improved I drink one packet of element dissolved in about 16 to 32 ounces of water when I wake up in the morning as well as while I exercise and if I've sweat a lot during that exercise I often will drink a third element packet dissolved in about 32 ounces of water after I exercise element comes in a variety of different flavors all of which I find really tasty I like the Citrus I like the watermelon I like the raspberry frankly I can't pick just one it also comes in chocolate and chocolate mint which I find tastes best if they are put into water dissolved and then heated up I tend to do that in the winter months because of course you don't just need hydration on hot days and in the summer and spring months but also in the winter when the temperatures are cold and the environment tends to be dry if you'd like to try element you can go to drink element spelled lm.com huberman to try a free sample pack again that's drink element.com huberman we talked about dessert for breakfast in the form of cereals some of which are um disguised or couched as healthier you know I think of like Honey Nut 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 Shopper that one makes with store 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 are 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 best yeah if it's really grape bread that's right the better the bread the quicker it stales you buy a loaf of bread at the uh Neighborhood Grocery Store how soon before it stals 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 you were me try and scrape that off um it 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 on to water 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 into GL glucose and fr ose 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 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 of glucose one molecule of fructose not bound together no o glycidic 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 servs half the price of sucrose because sucrose we get from import in and high fructose corn syrup 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 fructose corn syrup is particularly egregious because it's so missable because it's already a liquid so you've probably remember chipsahoy 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 now but you eat two of them and then you think they're good and then you want to eat four that's what's so odd the first bite is kind of like this and then it bombs away there you go well now it's a chewy Chips aoy cookies oh I remember the Reas chips are 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 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're 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 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 quot food industry is done but what do you think is the the 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 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 totals 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 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 well 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 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 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 learned two dozen facts about processing of fructose and calor 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 healthcare expenditures in this country today are all inside the cell because they are all mitochondrial dysfunction and there is no Med 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 as 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 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 not throwing Tantrums because they're not no longer getting the cereal and it's very difficult to see this is the reason why healthc care costs are going up there just too many nodes of Separation well couldn'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 UL are the same you would see the problem so globally the food industry grosses $9 trillion a year health care costs globally cost 11 trillion a year dietary related healthcare 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$1 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 or like that war costs 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 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 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 question 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 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 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 the 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 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 Andre sugar and these hidden sugars in exactly that's right all right the the the the key though is 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 ultra 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 loads okay there are boatloads of countries that uh don't import high fructose corn syrup or don't make so 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 sucros because High fructus corn syp and sucr are no different metabolically so it doesn't really matter it's that one to one it's the one to one thing exactly of glucose and frose 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 cic energy 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 pretty 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 the chairman of nutrition at Hebrew University Jerusalem actually looked at this question and showed that ultrapress 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 in 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 them 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'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 aneca um you know I've had several friends in their MH 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 increased 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'll go get to artificial sweeteners in a little bit we have to go there but um and the reason I say no starches even though I person 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 MH 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 PBS and keep it off and they like hey this is great actually still eat ribeye 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 effect because they're eating a lot of food 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 the ad the uh the 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 uh 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 2 would be apple slices dest stemmed deeded deskinned maybe Nova class 3 would be apple sauce cooked mated possibly a preservative added maybe some extra sugar maybe not Nova class 4 would be a 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 73% of the American Grocery Store is the class that is associated with all of these chronic metabolic diseases Nova class 1 through3 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 and maybe you don't eat dessert every single night is there a rule that people have to eat dessert every single night so the 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 still be okay 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 Etc 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 the end and I 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 webbased 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 nutrient content but on their metap olic 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 in 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 yeah the produce the meat the dairy the all the things you 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 gr a steaks with a butter knife because they're so tender right you ever been to Argentina yeah my father's Argentina oh right that's right you're Argentinian yeah they only know they only know Grass 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 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 breaking down muscle yeah fine but if you're not if you're you know again a mere mortal like me you consume those excess Branch chin 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 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 they're orange yolk eggs what's the difference between a yellow Oak egg and an orange 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 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 I aoic 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 oil yeah uh the 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 Behavior 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 th000 milligrams you say about a gram a Daya okay uh vitamin C how much vitamin C do you th000 milligrams a day you line is paing yeah well it's actually for my rosacea I've got a 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 brothers 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 standoffish it's really interesting that the kind of PS 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 if you're vitamin D deficient why wouldn't some 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 and 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 metabolized one of two ways it can either be one alpha hydroxylated in the kidney to the active form one alpha one uh 25 dihydroxy vitamin D which will then do all of the business of vitamin D such as calcium absorption from the gut suppression of the immune system at the toll like receptor 4 that sounds like a bad thing no that's a good thing I know but I had to bring that up because when you say suppression immune system people go I'm immunosuppressed nobody that sounds like AIDS a good it suppresses inflammation got it it's a good thing okay suppression of inflamation and that's actually the point that we're we're getting to so there are a lot of good things about 125 dihydroxy vitamin D however that 25 hydroxy D that came out of the liver can be metabolized a different way it can be 24 hydroxy in in inflammatory tissue like tuberculosis sarcoid gut inflammation and so you will end up taking your 25 hydroxy D which is a pro hormone and turning it into the inactive 2425 dihydroxy D which then just gets excreted out so in other words you consumed all this vitamin D and it didn't go where you needed it to go and the reason was because you're inflamed you you have to fix the inflammation before the vitamin D can be effective and 93% of Americans are inflamed so giving them vitamin D is not going to do a damn thing got it is reducing fructose intake the one of the primary ways to reduce systemic inflammation absolutely what are some others reducing oxidative stress in general so heavy metals like cadmium you know cadmium is very high in chocolate especially South America chocolate sorry no I I'm not a fan of chocolate I occasionally like a little dark chocolate but but um so if people are going to uh eat chocolate they should be careful how much chocolate they eat well especially if it's South American chocolate and processed chocolate I mean the really good we're going to be on the hit list of so many Industries after this episode comes out all I can tell you is I've been on the hit list for a decade and I'm still you're you're just one big Target yeah right got it I got to I it's on my back you know kick me everywhere I already got that um uh there are uh uh the main thing is to make that gut work right so fiber short chain fatty acid production from fiber uh is a huge you know uh Boon and to reduce inflammation to reduce inflammation how about improving sleep is there any evidence that you know chronic slight sleep deprivation can increase inflammation well what it will do is it'll increase cortisol and chronically increased cortisol will definitely lead to increased inflammation you know which is funny because cortisol is usually considered the anti-inflammatory but only acutely right chronic cortisol elevation does the opposite if if we can contribute to I have this secret uh agenda which is not which is not a secret which is that people think cortisol is bad when in fact acutely cortisol does wonderful things provided it's happening at the right time of day right late shifted cortisol bad right too much or too frequent cortisol bad but cortisol you you need it it's so essential and I think most people just hear cortisol and it's been associated with all things bad and and maybe we can help shift that narrative yeah I'm I'm very happy I mean as an endocrinologist you know this is you know where this my wheelhouse is where I live um cortisol is a good news bad news deal like so many things short-term gain for long-term pain okay so when you are in what we call allostasis that is Pur ation of homeostasis that is a stress an acute stress cortisol is one of the things that helps you manage that bodily and mental stress so an English test a car accident running away from the lion you know the famous you know pygmy running away from the lion all of those require cortisol in order to manage and mitigate that stress the upcoming 2024 election that's chronic stress that is not acute stress didn't mean that's the worst that'll be the only mention of Politics on this podcast uh and we don't have to go there but we're all chronically stressed and we can talk about why that is and what's going on and I'm actually very interested in that and a colleague of mine in Paris and I have built a computational model of the lyic system which focuses on the stress center of the brain the amydala to understand how chronic stress is different from acute stress and how that chronic stress ultimately leads to metabolic and mental health disaster very interested in learning more about that before we touch on that you've worked a lot with kids MH um people age as you put it 0 to 19 I don't know about the exact numbers but when I was growing up there were some kids in school that were overweight but it was the occasional kid right now it seems depending on where one draws the threshold for overweight it seems that there are a lot of kids that are overweight um how about 25% obese and 40% overweight okay so obviously a serious problem now and going forward what about adults in the US um I remember seeing at a meeting a map of obesity in the US and um over time and it very quickly filled in from very few people were obese to very many Colorado was this um was this like like Beacon of of of fit people but now it's no longer and that's too oh okay cool I'll tell you why there there are four things that can increase mitochondrial uh uh uh biogenesis you going to tell me altitude is one cold yeah that's why Colorado is less obese altitude that's why Colorado is less obese and um uh were the other two I for but those were the reason it had nothing to do with being more fit it had to do with cold and altitude example Switzerland compared to Germany they got the same crappy food but Switzerland has half the Obesity that Germany does because Switzerland is higher oh I love the food when I go to Munich I love the Schnitzel and the sauerkraut and wonder they got that in Switzerland too okay so they have great food Switzerland's less obese right same way Colorado's less obese it's because of the altitude you you mentioned cold uh many listeners of this podcast are at least interested in some uh also practice deliberate cold exposure cold showers cold plunges mainly for the um I think the best data are the increases in catacol Mees epinephrine nephrine dopamine that are long-lasting people feel a big state shift they feel better yeah but when one looks at the effects on metabolism they're pretty slight they are they're slight however studies like that to me always seem um shortsighted in the sense that if there's a longer Arc of effect on the mitochondria that's affecting other things in terms of how calories are processed or how calories are feeding into mitochondrial function or dysfunction there I could see how it might shift the um shift the scal so to speak I mean cold is is an amazingly powerful stimulus it is and um I think of light cold food movement it's kind of like the core four way in which you can shift physiology easily all of these things are imminently manipulable and for almost Z okay but you have to know what you're doing and right now we've been actually kept from that knowledge and you know if you're addicted it's really hard to un addict yourself so that brings us back to this thing about um food industry conspiracies government conspiracies and the rest boy this is going to be interesting um we can go uh section but what do we do like so if you and I go up to cap capitol hill which I've done yeah which you've done and and maybe I'll join you someday um and you know you're UCSF I'm down at Stanford you're a clinician I'm a scientist and and a public health Advocate um podcaster right and we explain to people Hey listen like there's the food is laced with a drug it's it's not even really food it's it's not food an aggregate of food and non-food parts that make you think it's food it's sort of like telling people hey your kids are you know they're swimming in a swimming pool looks like water but it's actually part poison and it's and it's harming them it's giving them you know if you say those kinds of things I mean congressmen and women are they're like reasonably smart people right I mean AR aren't they going to do something about it no so where is the conflict is it that the food industry has um the government by the short hairs that's exactly right and they have them by the short hairs where I mean is it are they lining their pockets I mean where where where is The Leverage act actually exerted okay so they're they are lining their pockets that's number one that is absolutely true we have the data to support that blanch Lincoln who was a senator from Arkansas who is the chairman of the nutrition committee you had to see her campaign contributions every time she was up for re-election so it's all about getting reelected or it's about them like having a like a third home in the Hamptons so I think it's the third home in the Hamptons more than anything wow okay so it's really as bad as as as some of the documentaries make us believe without question good and we and and we have the data there is a uh uh an organization that I absolutely want to call out because they are you know the most egregious organ you political organization on the face of the Earth they're called the American legislative exchange Council Alec or alic and they write bills they are a bill Mill okay and they are for whoever gives them money and who gives them money big Pharma big Agra big oil and uh big food and you're so you're including big Pharma you're a physician you've written scripts before you've written prescriptions for patients before isn't that Pharma that provides the drugs that allows your patients to feel better well the question is do they do they feel better this is a big question let's you want to go there but you're writing the script I mean I mean I'm just trying I'm not trying to trying to challenge you but I see so so you don't uh there have to be instances where someone's thyroid deficient and you give them you know drug AB so if so if if you've got a disease and a medicine will replace what's missing sure okay so for deficiency diseases which as an endocrinologist that's what I do absolutely and I did that you know with no compunction of uh of impropriety whatsoever but that's not what we're talking about here let's talk about what we're really talking about let's start with stattin Statin lower LDL okay does statins reduce heart disease yes or no you know I seem to be whiffing today on all the quizzes and it's kind of becoming fun for me at this level I'm going to go with no but but I will say you know my friend and I think his expert uh physician as well you know Peter AA and others you know has talked about some of the positive attributes of Statin in certain cases for certain PA in certain cases that's exactly right and I completely agree and by the way Peter's a friend and you know we someday we'll we'll you know all you know go out drinking together well I won't drink but how about we share a steak share a absolutely you got it you guys I don't I don't know if he drink he drinks a little bit if if you're listening okay he drinks a little bit house on me yeah I don't do the dessert or the or the alcohol anymore but but I'm and it's not so I can live to be 120 it's so I can wake up the next morning and and uh keep up with you guys it's fine yeah I get the so for primary prevention that is your LDL is high you need a Statin that's primary prevention you haven't declared yourself you haven't had an event for primary prevention the mean increase in lifespan for being on a Statin is four days four days four days four days S I have to chuckle that's that's uh and the risk for diabetes is 20% increase what about any Improvement in in quality of life done for primary prevention now for secondary prevention for secondary in other words you've already declared yourself you already have a problem for secondary prevention that's where Statin shine so there's a value to them I'm not arguing that and if you have familial hypercholesterolemia which is one in 500 okay not only do you need a Statin but you need a lowfat diet and a priest okay so there is definitely a value to stattin but not for primary prevention but that's what everybody what every doctor is doing oh your LDL it's over 80 you know you need a Statin that's ridiculous that is absolutely a joke and the data show that in fact in fact my colleague aim Malhotra in the UK participated in an analysis where they took the entire UK population and they took out everybody under age 65 so looking at people 65 to 90 and it turned out that the LDL level correlated with longevity the higher the LDL the longer they lived when you took out all the people who had problems so LDL is not really the problem and the reason is because there are two ldls there's one called large buoyant there's one called small D turns out dietary fat raises your large buoyant your large buoyant is irrelevant it is cardiovascularly neutral but that's the one that statins affects the small dense that's the atherogenic particle when your small dense LDL is high that means you are not clearing triglyceride peripherally because that's what small D show you that's that that's what happens to triglyceride is become they become small dense can I take a guess and say that the best way to reduce small dens is to reduce insulin yes by reducing sugar because that triglyceride is made in the liver it's all palmitate and that's the only fat that the liver knows how to make and so triglyceride is your liver output of carbohydrate that's how you have to look at triglyceride so triglyceride turns out to be much more important as a cardiovascular risk factor than LDL ever was so does the does big Pharma and big food do they know all of this yes I know they know because they've told me so and but they have statins to sell and Foods in the uh the Nova class 4 mhm they know this too so you know I'm an optimist or you know what what's it going to take to really move the needle I mean you described the four barriers um we're trying to add to the knowledge component now um you know what's it going to take is it going to take uh you know having a president in an office or uh Congress people in office that really understand and care about this stuff yeah I mean to really revamp the whole system yeah so right now the system is completely and utterly broken completely and utterly broken and there's a reason why it's completely and utterly broken because the food industry likes it that way well it's profitable for them obviously there are 51 different federal agencies that manage our food 51 and none of them know what the other ones doing and the food industry likes it that way so communication across these 51 organizations would help well if we had a centralized food um zor or food uh you know if we split the food off the FDA because you know it's like it's not the FDA it's the da or the FDA is not the Food and Drug Administration it's the Federal Drug Administration they spend a lot of time on drugs they spend almost no time on food well let's think about where there's been success so I can recall when people smoked on planes I actually recall going to a gym in Europe and there was an ashtray molded into the squat rack yep that was telling y I don't see people smoking cigarettes around Stanford Hospital anymore but I remember when they initially said that people couldn't smoke any where except in this one little designated area right and that's typically what you see nowadays and my understanding of the anti-smoking campaign at least for kids for people 18 and younger was that telling people it was bad for their health didn't work showing them lungs that were decrepit didn't work what worked was showing them commercials of cackling handwriting um white guys who were talking about how much money they were making off of these um uh naive kids who were buying cigarettes and other tobacco products so it became a the the effective campaign to end smoking in young people was to hijack their re inherent rebelliousness of Youth and then they were like no we're not going to stick it to them like you know the the as my friend calls it like the two the two-finger business card like No And so that worked that worked vaping's making a comeback we vaping is a sep episode we won't get into that but because nicotine is still addictive but you don't see a lot of people smoking cigarettes so it worked like something that you would never imagine could ever work worked well so yes no I mean that's part of it I'm not going to tell you that it's not it is part of it um and we actually have an example of how that could be applied to another uh uh uh toxic substance sugar we had Berkeley versus big soda you know that's how Berkeley ended up with its soda tax that dates back to 2015 the city of Berkeley city of Berkeley it we just celebrated the 5year anniversary of the Berkeley soda teex and we've been able to actually look gestational diabetes way down obesity down slightly not a lot but a little bit um cardiovascular disease down Dean Schillinger and Chris Madson at UCSF and UC Berkeley just presented at San Francisco General just um three weeks ago so a soda tax like the cigarette tax just makes soda expensive exactly so you're telling me that a can of Coke that I buy on shatak Avenue in Berkeley costs more than a can of Coke that I buy in on University Avenue in pal Alto it does huh okay by buy a dime and that was and sufficient enough to to create this kind of change well yes it money hurts cuz money hurts exactly so Andrew there have been four count them four cultural tectonic shifts in America in the last 30 years and they're all undeniable here they are number one bicycle helmets and seat bels oh everybody uses those two smoking in public places Nobody Does that three um drunk driving hopefully fewer people are doing that four condoms and bathrooms condoms in bathrooms in bathrooms in public bathrooms yeah you see those more available okay yeah all right 30 years ago if a legislator stood up in a state house and proposed legislation for any one of those four and I don't care if it's in a state house or in Congress or in Parliament or in the Duma or anywhere else in the world okay they have gotten laughed right out of town Nanny state liberty interest get out of my kitchen get out of my bathroom get out of my car okay today they Ro Facts of Life right nobody's belly aching about any of those the point is we were able to solve those four Public Health tobacco how did we do it how did we solve those four no one could imagine that we would ever solve smoking right but we did sort of I mean we brought consumption down by half okay that's pretty good when you think about it for an addictive substance how many fewer people are dying of lung cancer nowadays in the US um it's like 80% lower wow well there's also been improvements in treatment but yeah but no but it's it's the in diagnosed with in inci incidence gone down amazing okay because tobacco's gone down so the question is how did that happen the answer is very and why did it take 30 years to do it we taught the children the children grew up and they voted and the naysayers are dead that's how you make a cultural tectonic shift so we now have this real food Movement we have people who are arguing against ultr processed food we have kids who are demanding different in their schools and by the way what is the biggest fast food franchise in the United States I'm going to get this wrong so try me again I don't know I've never tried it but I've heard of uh is it Chick-fil-A nope is it McDonald's I don't know it is this nation's Public Schools ah you can add up McDonald's Subway Burger King chickfila and uh Wendy's and every other uh fast food franchise Jack in the Box every fast food franchise in the entire country and would only be half our nation's Public Schools wow so could you imagine a world where there were no class three or class four Nova Foods allowed in uh in public schools and we're doing it so I am the chief science officer of a nonprofit and put this in the show notes called eat e.org and we have a new business model for public schools so in 197 71 the Department of Education issued an administrative ordinance called resolution 242 and they did this purely on monetary ISS reasons this was under Nixon and what this resolution 242 said was that all School cafeterias all throughout the country had to make book they had to basically cover their costs they couldn't be lost leaders for the school they had to fend for themselves well this sent every food service director in the country scurrying for you know how am I going to do this because I got all these you know uh you know Lunch Ladies you know which you know personnel and and food preparation equipment and and and costs you know that are you know mounting how am I going to break even they couldn't do it so in walk walks you know Aramark and Cisco and uh Guggenheim and McDonald's and they say hey we'll do it for you we'll provide every kid in America with a nutritious meal Every Single Day hot lunch well they didn't say hot okay they just said lunch okay nutritious they said nutritious and I put that in air quotes too because it wasn't nutritious and here's the added benefit you can take your food preparation facilities and your um uh footprint in the school and you can turn that into classrooms because you're going to need them and that was the goal because as soon as you've moved the food preparation facilities out of the school you are now Hostage to the food industry for the rest of your life uh and I could also see how that allows room for them to use these commoditized Foods foods that have very long shelf life exactly right because you want to make sure that you know if you only sold um you know two-thirds of the lunches that were prepared that on next Tuesday after after the weekend you could still give them food that isn't moldy exactly right and I will tell you so that's how it happened and you can actually Trace IQ scores and reading and math scores in this country down from 1971 to today when I went to school I was allowed to get I called it hot lunch because it was usually hot I was um allowed to get the school lunch one day a week one day a week the other days I had to bring my lunch mhm that one day was pretty special like you felt like you were getting a treat it was usually like a corn dog or a hamburger the hamburger was pretty poultry but the um it's a commoditized hamburger yeah commoditized hamburger um you had to go looking for the Patty portion um and the bread was sweetened and so it was different right but um I don't remember nearly as much obesity I went to to high school in the early 90s MH um so you're saying that now if I went to a high school it would be a lot more sodas and donuts and pizza and got it yeah Pizza is a vegetable didn't you know they claim it's a vegetable Congress said Pizza is a vegetable Amy kashar made pizza of vegetable maybe they need their eyes Che because the biggest frozen pizza uh uh uh producer is in Minnesota I mean the ketchup as a vegetable was was a was a stretch but at least it it made sense on the Nova System of going from tomato all the way to uh to uh ketchup ketchup since high fructose corn syrup is the primary ingredient in ketchup indeed so the point is that our kids are suffering under the weight the burden of this chronic disaster of ultra processed food which is not food and no wonder they're all obese and uh um uh sick and um uh you know doing so poorly in school and by the way also depressed Ultra processed food has now been shown in three separate studies to correlate with depression in teenagers so what is the relationship between processed food or maybe we call it Nova System level 34 foods and depression and other psychiatric challenges and if you could you separate out metabolic syndrome from obesity um in answering that like like is there something inherently depressing about carrying excess adapost tissue a setting aside any kind of aesthetic um uh stuff you know how people want to look or are perceived you know just is there anything bad about carrying a lot of body fat independent of the metabolic syndrome for mood and and overall sense of well-being no I'm really glad you asked that Andrew we should have actually covered this earlier um everyone thinks fat is fat as we've learned fat is not fat and a fat is not a fat but um body fat is not body fat there are three fat Depot and they are metabolically different the first is the does this bathing suit make me look fat fat by the way never answer that question that's called subcutaneous fat or big butt fat if you will so here's the question how many pounds or kilos of subcutaneous fat do you have to gain before you become metabolically ill I have no idea about 10 kilos about 22 pounds okay why the reason is because that subcutaneous fat drains into the systemic circulation so you have to have a lot of cyto kindes coming from those subcutaneous adipocytes to raise the blood level of cyto kindes to the point where it starts doing damage at the level of the liver so fat are releasing cytoid which are pro-inflammatory exactly and they're doing that at rest any fat cell any fat cell okay any fat cell but if it's going to the systemic circulation you have a volume of distribution of six liters so you have to lose you know you have to have a lot of cyto kindes to get the concentration up now just out of fairness to the fat how many cyto kindes does a muscle cell release I mean are we unfairly picking on adapost tissue because why would adapost tissue be pro-inflammatory I mean a single fat cell I've got a fat cell sitting at you know on my shoulder someplace right I mean I'm not zero fat at my shoulder why would it be pro-inflammatory so in fact the fat cell itself is not here's what happens the fat cell has a fat vacu it has a storage place for this lipid droplet you stuff it you stuff it you stuff it the fat vacu gets big bigger bigger bigger the perpen border that encompasses that fat vacu that borders the the this the space ultimately can't get any bigger and it starts breaking down when that happens it spills the grease into the fat cell the fat cell dies becomes necrotic that calls macras in to clean up the grease and it's the Mac rages that release the cyto kindes all right so in fact the fat cell is not the problem it's the breakdown of the grease that lead leads to the maccrage activation that's the problem but when you do it in subcutaneous fat it's going into this six lit tank and so the concentration doesn't go up very much so 10 kilos before before you start seeing some effect fat Depot number two visceral or big belly fat now how many pounds or kilos of big belly fat do you have to gain before you get metabolic leil I don't know but I'm guessing it's less than 22 pounds it's way less oh for once I got an answer right today that's right about five about five pounds now question is why number one the visceral fat does not drain into the into the systemic circulation it drains into the portal vein which goes straight to the liver so you're getting a bigger load going straight to the liver of cyto kindes not to the kidney good thing about getting an answer wrong folks is that you never forget the correct answer that's what I always tell my students right so I'll never forget that indeed got it and the question is what made the visceral fat in the first place was it calories no it's cortisol it's stress it's the combination of the sympathetic nervous system and cortisol and the reason we know this is because you can take patients with major depressive disorder with endogenous depression who are suicidal who have to be admitted to the hospital to keep themselves from killing themselves stick them in a scanner and they are losing subcutaneous fat like crazy because they're not eating but they're gaining visceral fat because of the high cortisol and the stress so there's something about the adrenocorticoid receptors in that area that just preferentially Depot fat there when cortisol is high indeed because that's the metabolically active fat right and five pounds will do it and then finally the third fat Depot the liver now how many pounds of fat can the liver store before you become metabolically ill I got to be even less because the liver is not nearly as large as the sort of abdominal region half a pound quarter of a kilo how much does a healthy liver weigh healthy liver weighs 1500 grams okay okay so you know it's not very I'm trying to translate quickly pound so we're going metri we're going a standard so, 1500 Gram would be 3 lb so you know basically half a pound okay so not very much because that's where the action is and so when you have fat in your liver it causes metabolic dysfunction right away and the question is where did that fat come from that came from alcohol or sugar so alcohol and sugar most metabolically egregious because it affects the liver directly stress second most because it affects the visceral fat and subcutaneous fat the least important in terms of metabolic derangement so yes it may not look good in the bathing suit but from a metabolic standpoint it is actually the least important so the question then becomes all right what are you trying to fix if you're trying to fix liver fat it's really easy get rid of the alcohol and the sugar except of course they're both addictive well that also liberate any fat that's already in the liver absolutely and that's one of the reasons why intermittent fasting works is because it gives your liver a chance to basically offload what it's already stored that's one of the things that intermittent fasting will buy you is a little e uh less liver fat so that's a good thing right now stress on the other hand as you know and as we've talked about and as you know you've had Dr lle on your podcast before you know stress is tough you know trying to mitigate stress especially in today's environment and I hope you'll invite me back sometime to talk about the the role of stress on um the amydala yeah gladly okay um and then finally you know subcutaneous fat so when people go on diet sweeteners what are they doing are they really reducing the fat and the answer is no when you're talking about artificial sweeteners artificial diet sweeteners of any sort you can pick your artificial sweetener so aspartame or you know uh suc sucos Stevia monk fruit uh um uh the new ones you know yeah the one that people are more excited about nowadays is alos Al it's expensive it tends to have less of an artificial sweetener taste that people can detect right um so you're saying that regardless of oh and we should I'm remembering from the comment section I do read them artificial sweeteners and non caloric sweeteners yes because the moment you say artificial people say what about Stevia what about alalo so so let's just say um non-caloric sweeteners can wrap our arms around all that entire category unless we need to distinguish among the different participants in that category so you're saying that even though people can um lower their total choric intake pretty effectively I've seen the studies that show if you know dieters who consume um water only as their you know main liquid versus diet sodas with aspartame typically or Stevia the diet soda drinkers actually lose more weight but we know that but you're saying there may be deposition of fat in the liver in those individuals be specifically because of the artificial sweetener because of the insulin turns out there's still an insulin resp response it's a fa very famous study done in um Copenhagen 100 normal individuals 25 in four different groups one group uh one uh one liter of sugared soda per day for six months one liter that's a lot of sugar soda yeah one group one liter of diet soda per day for six months I probably did that in graduate school one group one liter of milk per day for six months I probably did that when I was an infant and finally one final group one liter of water per day for 6 months I do that now I do more than that but yeah the one liter of soda per day in six months gained 10 kilos the sugary soda the sugary soda 10 kilos okay 10 kilos no surprise the one liter of water per day lost two kilos also no surprise those were the easy ones now let's do the ones in the middle one liter of milk per day no change presumably that was full fat milk we're talking about milk full fat milk yeah they like their their full fat milk no change why is that they're taking on an enormous increase in total caloric intake I'm guessing that there was a blunted insulin response due to the fat and the milk and also because lactose is not a very uh uh Big Driver of insulin response and because there's a satiety effect that's like food eat less yeah it's like food like food and finally the key the kicker to the whole thing diet soda the one liter of diet soda what what would you predict their weight would do more weight loss than in the water group based on my understanding of the literature they gained two kilos wild because they ate more well you tell me why why did they gain 2 kilos if they were consuming a liter of dioda which are zero calories the answer is because they still generated an insulin response and that insulin response generated more hunger more more weight and more hunger exactly and that's the key so they didn't gain the 10 kilos they gained two kilos so it looks better compared to the sugar uh uh version but it looks like you know a problem compared to the water version or even the milk version so unless you bootstrap calories and hold that constant you're going to see a weight gain due to artificial sweetener exactly right and that's been shown 50 ways from Sunday at a whole bunch of different studies so compared to Sugar yeah it's better but compared to water it's way worse and the reason is the insulin response you put something sweet on the tongue message goes tongue to brain Sugar's coming message goes brain to pancreas through the vus nerve Sugar's coming release the insulin and so tongue doesn't know if it's sugar or not it releases the ins the pancreas releases the insulin which drives energy into fat whether it was you know from the uh diet sweetener or not I I saw some really interesting data from Dana Small's group at Yale showing that when people have a diet soda with food so this is like the diet coke with the sandwich or with the burger maybe with the pasta the insulin response from the food and the insulin response from the diet soda are compounded but there's a classical conditioning effect pavlovian effect such that then later if they just drink the diet soda they get an even bigger insulin response just to the diet soda than they would have originally if they only had the diet soda separate from food so in other words the the insulin the food induced insulin response is conditioning a greater insulin response from the diet soda and we actually have another study that demonstrates the same thing out of Singapore um teay at all uh American Journal clinical nutrition 2018 I believe that looked at a similar Paradigm here's what they did they took a bunch of people and they admitted them to their Clinical Research Center four times a week apart and they did it in random order and each time they uh started the morning they fasting and they did either a sucrose tolerance test or an aspartame tolerance test or a sucralose tolerance test or a monk fruit tolerance test so two hours you know ingesting one of the three one of the four and measuring glucose and Insulin over the course of the next two hours fasted fasted okay okay then it was time for lunch and they let them have whatever lunch they want it was a metabolic Buffet they could eat whatever they wanted off the buffet except that they were being clocked and the same for dinner they were being clocked but they could eat whatever they wanted in a given period of time in the 24 hours okay you know or you know from 7:00 a. to 7 p.m. whenever they went home okay turned out the sucrose tolerance test generated an insulin response as you'd expect the monk fruit the Ste the uh U uh sucralose and the aspartame did not but then when they ate lunch they if they had had one of the three diet sweeteners in the morning they ate more at lunch and more at dinner and generated an increased insulin response both at lunch and dinner so that the area under the curve for the whole day was exactly the same so they ate a significantly more yeah yeah because they had the diet soda in the morning Wild Well I drink drinks that contain Stevia and I don't worry about it it too much but what you're saying is even if I bootstrap my calories there's a possibility that the insulin response could have Direct effects on the liver exactly right and not for the better and not for the better now having said that um we have undertaken an interesting project which I don't know if you know about um in 2020 during the pandemic I was approached by a food company in the Middle East called Kuwaiti Danish Dairy company kdd it's the Nestle of the Middle East now they make all sorts of junk frozen yogurt flavored milks ice cream confectionary biscuits tomato sauce okay Kuwait has an 18% diabetes rate and an 80% obesity rate 8 Z 8 Z wow in the adults all right now the company recognized that they wanted to be a metabolically healthy company and they knew they weren't they contacted me and said would you put together a scientific advisory team to advise us what we need to do to change the food in order to be a metabolically healthy company and we want to lead and I said we'd be ha I'd be happy to do that with one Proviso we get to publish what what we did so that it can serve as a road map for the rest of the food industry and they said fine and so I convened a scientific advisory team with my colleague wolf from Alderson who started the very first farmers market in Los Angeles and is now actually the director of sustainability and nutrition for kdd um uh Tim Harland who is the head of culinary medicine at George Washington University Rachel Gaal who is a fatty acid expert who ran the Omega-3 for add trial at the NIH and Andreas corot who's actually a computer scientist from Stanford and we basically stripped down every single thing that kdd did in terms of procurement in terms of ingredients in terms of packaging we submitted every single ingredient to biochemical analysis because you couldn't trust what the vendors were basically telling kdd was in the food we had had to actually know what was in the food and that was a half a million dollars all by itself I mean this was not a cheap little uh you know uh you know sojourn into the woods this was a big deal we basically re-engineered their entire 180 item portfolio and they have now turned over 10% of their products to be metabolically healthy and the precepts that we set in this paper which is in Frontiers and nutrition in March of this year 2023 three things three principles if you adhere to these three principles you can turn any food healthy including Ultra processed food number one protect the liver number two feed the gut number three support the brain if you have a food that does all three of those it is healthy if you have a food that does none of those three then it's poison because it's not food it's I was going to say it doesn't sound like food is is the right um the right descriptor in that case exactly and if it's does one or two but not all three then it's going to be somewhere in between so the goal was to take all of KD's products and move them from you know the lowest tier up to the highest tier by adhering to these three principles and we came up with some very simple things number one got to get rid of the sugar number two got to add fiber number three got to add Omega-3s number four got to do something about the emulsifiers because the emulsifiers are causing the gut inflammation because after all msif fires are detergents they hold fat and water together they burn a hole in the mucin layer so they're actually contributing to that gut inflammation and emulsifiers are you know strewn throughout ultr processed food them we've heard about hidden sugars a lot um during today's episode and elsewhere but based on everything you told us of about artificial excuse me low calorie sweeteners um it makes more sense to me now why foods that are not touted as diet foods would be laced with things like sucralose because it should drive the craving for that food through increases in insulin and craving of other Foods later that day and later that evening is that why non-caloric sweeteners are added to all sorts of foods now that because typically one thing non-caloric sweet probably only added to quote unquote diet foods low calorie foods but that's not their only you're right it's that that's not the case and they are adding diet diet sweeteners to foods that you didn't know had diet sweeteners in them that's right um there are two reasons that this happens one is insulin because insulin blocks leptin signaling at the level of the hypothalamus and the nucleus accumbent so if it blocks leptin leptin is the hormone that your fat cells make that tells your brain you've had enough so if insulin blocks leptin it makes you hungrier and it also extinguishes it it stops the extinguishing of reward by that food so that you want more of it so it does both because leptin normally suppresses food intake and reduces craving the analogy that comes to mind is um a slot machine that encourages you to feed more money and hit go to pull the lever but that also blinds you to the outcome so even if you win you don't even know that you have wins it's also blinding you to your losses you're effectively becoming automaton yeah of just eating without any um kind of conscious understanding of what you're you're bringing in or tasting the food any longer exactly right it's not this like and Anna lmy when she came on the podcast author of dopamine nation and obviously head of our dual diagnosis addiction clinic at Stanford talked about you know these these consumptive behaviors where people are scrolling social media or consuming porn or uh consuming drugs or alcohol in a way that like they're not in touch with the pleasure of the of the substance or behavior anymore they become automatons but they but if they don't do it they feel lousy so the pleasure is gone the pain is definitely waiting tolerance and dependence that's the definition of addiction so dopamine is an excitatory neurotransmitter it excites the next neuron always there was no such thing as dopamine inh iting a postoptic neuron dopamine stimulates the next neuron and it doesn't matter which dopamine receptor it is 1 through five it's always excitatory now neurons like to be excited that's why they have receptors but neurons like to be tickled not bludgeoned chronic overstimulation of any neuron and you know this leads to neuronal cell death and the reason is because the neuron needs energy the neuron is the most energy dependent uh tissue in the body it needs those mitochondria to be pumping out ATP like crazy to engage in neurotransmission well when you're firing nonstop you risk cell death so the excitatory neuron the the poptic neuron has a plan B it downregulates the receptor it downregulates the dopamine receptor so there's less chance that any stray dopamine molecule will find a receptor to bind to and this is its Plan B in order to try to mitigate the risk of dying well what does that mean in human terms it means you get a hit you get a rush receptors go down next time you need a bigger hit to get the same rush and receptors go down and you need a bigger hit and a bigger hit and a bigger hit until finally you need a huge hit to get nothing that's called tolerance and then when the neurons do start to die that's called addiction that's what we've got and that's what's happened in terms of food addiction so the question is what's addictive is fat addictive no because if fat was addictive then all the people on the Atkins diet or on the ketogenic diet would be gaining weight not losing it and I'd be craving ribe eyes all day I like a ribeye pretty often actually but I know I know people say no but hey look my lip lipids are in in line and I I don't eat many starches and I certainly avoid sugar although now I'm thinking I might want to really reduce my uh low calorie sweetener intake I don't see myself reducing my Stevia intake to zero because it's in some things I really like Andrew I am not the food police um you know I always say that to people I'm not a cop but the um but but but data are data and and and Health Data are the the the data say that that's not helping you any that's what the data say mhm um point is that the Fat's not the problem the salt's not the problem the caffeine's a problem really caffeine's classic addictive substance at every level yeah but in term su's a problem but if if one can cut out caffeine by the early afternoon or even sooner in the day and it's not consumed to excess um and it's in the form or coffee orate some other form that's healthy you know is it really that much of a problem um I love coffee in your that's my addiction like with a capital l underline bold face highlight I I I I I feel your pain and the answer is no one has shown that coffee is toxic it is addictive but it's not toxic now if you mix the coffee with alcohol now you got four Loco now it's toxic but in and of itself caffeine is not um toxic and that's why there's a Starbucks on every street corner but it is highly reinforcing I did an episode on caffeine where um covered some data that was published in the journal science one of the three Apex journals um and if you put caffeine unbeknownst to the consumer into plain yogurt people will crave plain yogurt indeed much more I mean people will like the feeling of being caffein as long as it's not creating anxiety levels of energy exactly I'm going to stick with caffeine that's fine yeah and so will I we've been talking about a little bit about the hypothalamus as well as some peripheral gut-based mechanisms for hunger and satiety right um this is a great opportunity to talk about some of the glp1 agonists that are now um widely used so things T typically called those zic but gop1 gluc glucon like peptide one right um originally discovered in the hila monster which eats very seldom and some really smart biologist I love biology like this said how come they don't have to eat very much well they their blood is loaded with g P1 right um and so they only have to eat one Whatever Hilo monsters um Delight in per year or something outrage just like that humans make glp1 as well my understanding is that glp1 that that not that's injected but that one um makes naturally is acting on both the brain and the gut to increase satiety so it is acting on the brain no argument but the primary action is on the gut glp1 decreases the rate of gastric emptying that is its primary driver yes it does affect the brain I'm not arguing that it does but the primary effect is to reduce the rate of gastric emptying so you stay Fuller longer because the food doesn't move through the stomach and the intestine interesting in South America in uguay and Argentina it was long thought that um y bam mate consumption which we know very modestly increases glp1 and by the way a lot of other things do too um that people were taking it for its uh after meals for its laxative effect partially but that's you know it's not pleasant for but that's but that's also at the colon that's at the level of rather stomach but it is used fairly effectively for people to space their meals without snacking that you're you know and maybe it's the glp1 maybe it's something else um but people are injecting themselves with glp1 analog now $1,300 a month is that what it cost that's what it costs right now um and it seems to be pretty effective at inducing weight loss although a significant amount of that weight loss seems to be from a skeletal muscle tissue and we're going we need to talk about that so what are your thoughts on OIC as as a primary uh earlier you talked about primary and secondary control you referred to it a little bit differently in the context of Statin right um so a kid comes in who's obese or slightly overweight right it's like I don't know what to do I'm trying to eat better exercise or a person comes in and says hey i' I've had a really hard time getting that last 20 9 PBS off for so many years will you prescribing those zic so the short answer is number one I'm retired so I'm not prescribing anything but let's let's let's go with there the data show that gp1 analoges like um semaglutide and now tepati which is uh Lily's version uh Manjaro is the diabetes version Z bound is the Obesity version the same way that OIC is the diabetes version for um uh novonordisk and woi is the Obesity version so they're all glp1 they're all G gp1 analog they synthesized in a lab it looks like glp1 smells like glp1 acts like G1 when injected tepati the uh Lily one actually has a dual function it uh binds to the Gip receptor so it might have double duty and the data show that it's actually even slightly more effective at Weight Loss than the Nova Nordisk version so we'll be seeing a shift in terms of uh uh consumer preference soon no doubt but here's the thing you look at the data one year uh of treatment 16% weight loss now that sounds great and I'm not saying it's bad and people are not craving food all the time is that because people are feeling full longer right so they're eating less they're eating less this is the calorie in calorie out model they're eating less and so they are losing weight I'm not arguing that and they might be craving alcohol less According to some recent reports yeah well we can go there for a minute too in a second here's the problem when you look at that 16% weight loss as you just said when you put people in a dexa scanner they have lost equal amounts of fat and muscle now is it good to lose muscle no it is not good ask any little old lady who breaks her hip if she wishes she had a little bit more muscle or somebody who died had lost a lot of muscle because they weren't offsetting the weight loss with resistance training or some other form of exercise and the amount of food that they can eat in order to maintain that weight to put it in scientific terms sucks and um you know we mentioned Peter AA earlier okay in outli he's made it very clear that sarcopenia lack of muscle mass is one of the driver of mortality so losing muscle is not a uh a a good idea but you lose equal amounts of fat and muscle what else causes loss of equal amounts of fat and muscle starvation in fact the reason that all these glp1 analogues work is because you stop eating starvation yeah just like the Heil mus the he monsters look pretty chubby to me well ask another heila monster I did but but unfortunately whatever answer it provided was not interpretable indeed the point is that starvation is not so good and if you think about why it's working it's reducing gastric the rate of gastric emptying all right well it turns out that that's the reason for its side effects the reduction in gastric emptying that's why you get nausea that's why you get vomiting that's why you get pancreatitis and most importantly now gastroparesis your stomach turns to Stone and you can't move any food through your intestine at all and worse yet when you stop the medicine the gastroparesis doesn't get better this is not a good idea this is like the opposite of the yerbamate induced effect which has a sort of prolax gastri camine maybe glp1 agonism gosh okay so it's obvious why people who've struggled to lose weight like it especially if their struggle to lose weight was at least in their mind the consequence of being hungry all the time and needing to eat more or was it because of the reward and you know their dependence because in fact yes uh uh uh these gop1 analoges reduce reward and that's one of the reasons why they've noticed that you know thing uh uh reduction in alcohol consumption uh as well and that that sounds like a good thing except there are also numerous cases now of major depressive disorder in response to these drugs so it's almost like an alone or something for the treatment of addiction which sometimes can be useful but but the attempting to remove the the um the amplitude of that reward signal I mean a lot on paper it makes sense but the but it doesn't always play in practice it doesn't play out that's right and so I'm going to refer you now to an old uh literature that uh was from 2006 there was a drug that was approved in Europe called raniban okay a trade name ACC complia and it was approved in uh Europe for weight loss and it was pretty good at Weight Loss it caused about 20% weight loss it also caused severe depression and 21 suicides so it's no longer available because it was the an yeah it was from the European market never approved in the United States and the reason this happened was because this was the anti-marijuana drug this was the anti- munchies drug this was an endoc canabo antagonist well when you reduce reward you also reduce your desire to live and that's why this concern about reduction in alcohol consumption we've already seen major depressive disorder in patients receiving OIC so are we going to see the same thing play out as we did for rabant I'm worried about it or fenfen well fenfen didn't have um uh no it was cardiac it was cardiac right we had cardiac problems uh due to the fenfluramine because of the uh serotonin 1B receptor agonism right I'm just referring to the fact that these these quote unquote Blockbuster drugs for obesity they tend to follow a contour of you know very promising very exciting a lot of people losing weight suicides or very promising a lot of people losing weight um cardiac issues very promising losing weight and now you're saying the stomach turns to Stone sound sounds so biblical uh well indeed so that's the question and then finally we can really talk biblical if everyone in America who qualified for OIC got it that would be 2.1 trillion to the Health Care system which is currently at 4.1 trillion so that would be a greater than 50% increase in health care costs okay at 13300 a month conversely if we just got sugar consumption down to USDA guidelines by basically you know putting some limits on how much added sugar the food industry can put into any given product like Froot Loops we could reduce weight by 29% and save $3.0 trillion so so we'd get better weight loss and we'd save $5.1 trillion which makes more sense to the US government well earlier you were alluding to government uh big food big Pharma relationships I mean there's a huge win here for whoever's manufacturing these um gp1 analoges indeed um but the question is who's paying the tab well we are um now the question is why can't the government see that and the answer is because the government's on the Dole too because the government uh uh through tariffs on USM made Foods okay grosses um $ 56 billion a year so they're a player they're not just a regulator they're an actor to play devil Devil's Advocate a little bit listen I'm going to be the last person to step in and try and defend government as a as a unified body I'm not qualified to do that but you could see how it if you looked at it like Checkers instead of Chess you'd say okay here's a drug that's going to allow many millions of people to reduce their overall body weight overall body weight is a risk factor for a number of things um and there will be savings on the back end as a consequence of that weight loss I mean so that's the Checker version right the chess version is how you're describing it and I think that um I mean clearly people in government are are well well most some perhaps are smart enough to play chess not Checkers or to at least understand it but there's very little incentive for the chess model so um what would quote unquote solve this problem is the same thing that happened to fenfen or this Ro Roman which is if suddenly there's a major issue with the drug then everyone stops taking it and traditionally that's how it's gone it sounds like these gp1 analoges are going to make it through the shoot though yeah I mean there is a very clear downside to these medicines on the other hand you know there's an upside and so I'm not sad that these medicines exist I'm for them I'm not against them I'm for them for the right patient and right now it's not the right patient who's getting them just like the statins so what if somebody who's taking uh one of these analoges makes it a point to do resistance training and here you know you mentioned bodybuilders earlier I'm not I'm not suggesting they become bodybuilders but we now know and I think Peter Tia and others would agree that everybody should be doing some form of muscle loss offsetting resistance exercise agree at least past you know their reaching their adult height or something you know I know there are those that say weight training doesn't blunt your height but anyway let's just say that from early 20s onward doing especially if you're on these medicines right in order to maintain muscle mess right so that's a different picture right um people are drinking less alcohol again I'm playing devil's advocate here here um so if we look at these these compounds not in a vacuum but okay the person who's been carrying that extra 30 lb is now only carrying a few extra pounds of adapost tissue they've lost a lot of muscle but now they feel well enough to exercise um the depression part worries me yeah but anyway I'm just I'm just trying to round the Contour of it what we've seen in children you know cuz that's who I took care of was that often they needed a jump start okay and were different ways to get him to jump start stomach stapling well that's not jump start that's but that was what a lot of people did I know I have a friend he's he was and sadly still is really big and he always talked about the stomach stapling like if I could just get 50 pounds down quickly than I could exercise but exercise is painful this kind of thing and and sadly he's he's continued to maintain or creep up in in a very excessive weight and that's the point is you know that this concept of jump start actually it if you're only doing it yourself doesn't really work and the question is why is his weight creeping up if he's had the stomach stapling the answer is cuz he's a sugar addict yeah he's definitely addicted to the super big gulp soda and if you drink your calories it doesn't really matter does it no and and he's got such terrible psoriasis and joint pain and all this that the prospect of exercising is like a you might as well tell him to to like flap his wings and go to Mars you know fructose is was a driver of immune dysfunction if he got off you can tell him from me if he got off the sugar his psoriasis would get better his weight would get better his arthritis would get better and he could have then that jump start this is a perfect example to bridge to the brain component of all this because I've long wondered based on what I understand about neural circuitry and neuroplasticity I know we share in this knowledge that at some point carrying a lot of adapost tissue means that the brain sort of represents the body differently I mean we know there are these these somatotopic M maps of self um you know but that the neural Machinery in the hypothalamus sure which is responsible for Motivated States Etc but but also just the entire mapping of the self y changes in other words if one is fat long enough MH that it becomes increasingly hard to get to a a healthy weight because of the way the neural circuitry is impacted it basically remaps to maintain that that um fat person not necessarily even just at the level of appetite but just in terms of what do you what do big animals do I had a bulldog that weigh 90 PB Bulldog Mastiff he was very economical with his movement right he's extremely powerful he could run at least in when he was younger but if he could be still he was still as opposed to certain smaller animals that are like paripe right because because he was leptin resistant M so leptin as we talked about briefly is um the hormone that tells your brain you've had enough if you are leptin sensitive you are happy to burn if you are leptin resistant your brain thinks you're starving and if your brain thinks you're starving it's going to affect your behavior in two ways it's going to make you want to eat and it's also going to make you want to conserve because the goal is to try to increase the leptin levels in order to overcome that resistance which of course you can never do because all you're GNA do is lay down more fat and make more leptin that makes so much sense because leptin comes from the adapost tisue exactly so that leptin resistance is what you have to be able to break through you have to fix the leptin sensitivity well what's the driver of the leptin resistance insulin insulin inhibits leptin signaling and it does it at three separate places in the palcy neur on the proopiomelanocortin neuron in the hypothalamus it does it at um irs2 insulin receptor substrate 2 it does it at sock 3 suppressor of cocine signaling three and it does it at pip 3 phospha andosol triphosphate those three separate arms of the uh uh leptin receptor are all basically put to sleep by high insulin insulin blocks leptin signaling so the higher the insulin goes the more more your brain thinks you're starving and the more your brain thinks you're starving the hungrier you get and the less you want to move so the gluttony and sloth that we've been talking about all all you know podcast is really biochemical it is secondary to this phenomenon of insulin blocking leptin signaling you got to fix that first get the insulin down any way you can and the best way get rid of the refined carbohydrate and sugar that's where you start it makes so much sense it works too how about that that's always good it is I once heard you say I think it was in a conversation with Peter AA on his podcast and this really stuck in my mind that when a person consumes glucose that it activates a number of different brain sides you know neurons loving glucos MH but that when one ingests fructose that it preferentially activates neurons in the reward pathway that's right at maybe seven times the the magnitude or or something like that well uh glucose activates the basil ganglia uh this is work from walner hous and uh Switzerland and also Eric stce at or S mov planning and execution exactly okay um fructose basically stimulates the nucleus the reward center it is just like heroin Just Like Cocaine just like uh nicotine it activates the reward center it doesn't do anything for the basil ganglia so it is addictive anything that stimulates the reward center in the extreme is addictive so we have chemical addictions heroin cocaine nicotine alcohol sugar we have behavioral addictions shopping gambling internet gaming social media pornography doesn't matter they all ulate dopamine in the reward center and in the extreme they are all addictive so the question is if you are addicted is that personal responsibility well it's uh a very um it's a question I think about a lot because uh I know a lot of people in the addiction recovery Community um both from the treatment end and the addict end yeah and there's always comes down to this question when somebody is suffering from an addiction of any kind and they're resistant to getting treatment if you look at it them as a as being sick at least in that moment is a sick person in the best or worst or at least diminished position to guide their own treatment so for instance somebody with dementia would you ask them do you want to go see a neurologist you might ask them that but are they the best person to make that decision well this is the problem so this is this is where personal responsibility falls down so personal responsibility as you know we talked about four criteria have to be met none of them are met that's first issue second one is a little bit shall we say cheek gear who invented personal responsibility any idea I'm definitely going to get this this one wrong yeah you're gonna get this one wrong are you ready goad I don't know the tobacco industry the notion of personal responsibility they invented it there was no personal responsibility on until tobacco in 1962 because they were getting killed on the science and they needed to invent another reason for you to smoke in fact there's a paper that came out Dorfman at all that looked at the New York Times And The Washington Post and they did a entire lit search of the entire of uh you know the all of the output of those two newspapers for decades to look for the term person responsibility and the very first time it was ever mentioned was 1962 and it didn't pick up in speed until 1986 which was the same year as calone V liot in this at the Supreme Court which basically said that the U you know that uh uh the cigarette industry was um was guilty of uh of um applying people with an addictive substance so this is is very specifically industry-driven and we have the data to prove it amazing well I wonder along the lines of personal responsibility um given that many listeners this conversation are going to be thinking about their own food intake and food choices that of their children and other relatives that we could play a little a little uh not a game but a little rapid is fire cu Q and A never done this before in this podcast but I think it's particularly appropriate for a discussion like this that Wicks out into so many areas and I absolutely will invite you back and perhaps along with um Lissa eel to talk about some of the exciting work you guys are doing because there's so much we could cover but people are going to wonder in a very practical sense whether or not they should or should not be consuming certain things and I know you're not the food police I'm not the food police and I'm not a cop and I do believe people should are should be in choice about the matters but I also believe that because you're a guest on the podcast and you're highly informed and and I've done clinical work and research for so many years in this area and you have such a clear stance on the role of big food and and we really really appreciate your honesty and directness but not you'd be willing to provide a comment about couple of different terms that I'll throw out and if you choose to say really nothing to say about that fine that would be a quick pass so um here we go um and we covered a little bit of this earlier but um fruit in whole form so um has fructose but has fiber so thumbs up thumbs sideways or thumbs down for fruit consumption fruit is fine fruit juice is not great thank you white rice versus brown rice and among the white Rices the sticky rice um and the Rices with added sugars which you find in in a lot of um in a lot of restaurants brown rice because of the fiber white rice polished you know number one all the vitamin B1 gone and of course a much larger glucose Excursion that glycemic index thing which of course I hate is it's glycemic load that matters and that is a very high glycemic load so brown rice so brown rice is better than white rice yes okay in a meaningful way in a meaningful way okay um earlier you mentioned tomato sauce I love tomato sauce that's made from just tomato can Tom so is are most tomato sauces filled with sugar perfect our little uh recommendation engine looked at this question and it turns out that only 10% of the available tomato sauces out on the market don't have added sugar so you have to know which ones well you can look yourself or you can look up perfect and it will tell you which ones you can buy if people chose to consume bread which many people do uh is there a way to just across the board without just baking your own or see or looking at the ingredients list to make a better choice is it like sourdough tend to have less sugar than blank um well sourdough has been fermented so it will have actually consumed some of the sugar so it would be a better choice but really the best choice is the highest fiber breads now if you look at a wheat berry it is 25% fiber the husk is 25% of the weight of that wheat berry that means that the carbohydrate to fiber ratio of a wheat berry is 3: one so a good bread should have a carbohydrate to fiber ratio of somewhere between 3:1 to 5:1 tops anything above that means that they've stripped the fiber away so that's something you could do but the easier way is to actually look it up on perfect you mentioned meat and meat sourcing um egg and chicken sourcing earlier maybe we just revisit that um meat fish and eggs uh thumbs up thumbs sideways thumbs down or it depends it depends it depends on where the meat came from it depends on whether it was pasture raised depends on whether it's organic or not if the uh animal was injected with antibiotics stay away from it because those antibiotics are in the meat they're going to basically sterilize your gut and then the bad bacteria are going to take over we haven't really talked much about the microbiome today but that's a whole podcast all by itself well we can touch on it a little bit more uh F low sugar fermented foods thumbs up thumbs sideways thumbs down fermented foods short chain fatty acids all good what are your favorite sources of fermented foods I like kimchi yeah I like kimchi too I like some of the live sourkrauts yeah that's also good but with the right you know the right uh AC accouterment um the one thing I would be uh uh careful about is yogurt okay so there are yogurts with live cultures and there are whole lot of yogurts with dead cultures and if it's a yogurt with dead cultures it's kind of irrelevant and the chances are they've actually covered up the sourness with sugar so Comm you know large commercially available yogurt be very very careful okay if it's a you know Artisan yogurt you know made by a you know people you know or trust you know that's a very different story um you know yogurts with live cultures intermittent fasting do you practice it and what do you think about it um I don't practice it but I am for it for the right patient turns out who's the right patient the patient with liver fat because the reason it works is because it gives the liver a chance to basically burn off the fat that it's stored zero calorie soda got it it's definite no and I don't even have to ask about sugary soda because that's uh that that's basically just poison in a can food combinations uh I have a feeling I know what your answer is but the glycemic index which we know your feelings on now um asserts that if you combine some fat with a sugary like like eating ice cream you have a more blunted insulin response than if you were to eat pure sugar of equivalent calories but um what are your thoughts on food combinations as a way to blunt the insulin response food combinations are great if there's some Fiber associated with it so it comes back to fiber again and by the way and by the way uh I you know full disclosure I am the chief medical officer of a fiber company what is it it is called biolumin and it is a proprietary fiber it is a uh microcellulose sponge seven microns in diameter so the size of a red blood cell you swallow it it goes your stomach it expands 70 fold over its original size and so it'll give you a feeling of fullness because it's taking up space in the stomach but more importantly when it expands the nooks and the crannies in the sponge become available and embedded in those nooks and crannies are a set of proprietary hydrogels soluble fiber which sequester glucose fructose sucrose simple starches and render them unavailable for early absorption in the dadum thus reducing the glucose response reducing the insulin response protecting the liver and moving it through the intestin so that microbiome can chew it up for its own purposes feeding the gut we can reduce glucose absorption by 36% fructose absorption by 38% sucrose absorption by 40% simple starch absorption by 9% and increase short chain fatty acid production by 60% without an increase in gas when do people take this with meals okay so B it it comes as a sachche u one teaspoon sprinkle it on your food or take it as a you know in a drink you know just mix it in and Slug it down and then eat breakfast lunch or dinner and it will basically act like you ate real food it will turn processed food into real food in the intestine and we have clinical trial data that demonstrates that is it available as a commercial it is available it is called Munch Munch now I hate that name I didn't make it up well get maret your marketing team sucks but the product sounds amazing um so biol. Tech great thank you for that sorry Munch Munch marketing team but you got a Munch Munch to a new product name um but it sounds like a a very interesting product and it actually answered my next question which was about um fiber supplements fiber is good but there are two kinds of fiber there's soluble and there's insoluble they are not the same so soluble is what goes into Fiber One bars you know that psyllium um inulin uh um uh uh pectin like what holds jelly together um that's good I'm not saying it's bad but you need the insoluble fiber the cellulose the stringy stuff in celery the cardboard if you will um together they form this gel that we talked about earlier if you only consume the soluble fiber which is what the food industry will add to to food because the insoluble fiber is not missible if you only add the soluble fiber back you're not getting the benefits of the entire fiber complement earlier when talking about the Nova System and uh how most all of our Foods so n let's say I know it was 7 to 10% let's say 95% let's a on the side of better uh 95% of our food should come from Nova System class one or class two Foods or three or three okay staying away from those um Nova class 4 Foods could you give us some examples of Nova class one and class two Foods um just broad broadly speaking okay Nova class one is any food without a label period if you see a label on a food it's a warning label well there's ground ground beef has a label okay so that's well does it so you're talking about Apple well when I buy it it has a label I'm asking this because people are going to wonder so well it does have a nutrition facts label is there a nutrition facts label on a thing of ground beef I buy that that uh ground beef where I consume venison um where if you flip it over it says how many calories how many protein so there's a label um but but it's just B for venison okay then that's class one okay egg egg is class one so and then of course fruit apples orange okay so it doesn't matter if it has it has a name a name tag as long as it it doesn't have an ingredi label got it real food does not need a label it's only if they did something to it that it needs a label so you have to look at every label as a warning label now the problem with the label is it only tells you what's in the food what you really need to know is what's been done to the food because it's the ultr processed food that's the problem they don't want to tell you that that's secret okay secret from a proprietary standpoint but also secret because if you knew what they did to it you wouldn't need it you would never buy it and they don't want you to know so they only tell you what's in the food that's not what's important it's what's been done to the food that's important and that's why this Nova class 4 is so important and that's why perfect is so important because it'll do the work for you okay we'll definitely um provide links to all of these so if you could pick one thing to recommend to people that want to improve their health get rid of the sugar okay period very clear that's number one number two go for a walk the exercise piece yeah go for a walk and if you could recommend one thing that the general public can do to try and um assist in this advocacy for not redefining but actually clearly defining what is food and what isn't and making people aware um at the level of policy and change and school lunches I mean if there were one thing what can we do I mean I I you've clearly activated my neurons surrounding like the the set of problems that exist and the paths to correct them but should we be writing to our Congress people should we be um getting angry at hospitals because they've got all these fast food machines and that the cafeteria food is like is like is like illness promoting at UCSF we've gotten rid of all sugar beverages we have the healthy beverage initiative so no Coke machines at UC No Coke machines at ucss wow Stanford check that out cuz you know people always send me pictures of the of the coke machines in the school of medicine I'm like listen I didn't put them there but I I I uh we have to model for the public you know I mean where where was the first place that smoking was banned hospitals okay because we knew so if you get rid of the you know uh uh soda if if you get rid of the sugared soda at the hospital you're telling people something so yeah I think that every hospital and really every public venue in America needs to clear out the junk so post photos of junk that are supposed to be in uh in health promoting institutions and um I guess we're trying to cancel junk food we're trying to cancel junk food I'm pretty opposed to cancel culture but here we go we're going to cancel um marvelous it's actionable it's straightforward it's low cost low time investment zero cost um very low time investment so thank you for that and look up eat real because we're doing it for your kids so you need to help support it any school district in America can do it so what do we do we have a business model whereby the uh Food Services director um either purchases or rents a dilapidated Factory in the center of the district repurposes it into a food preparation facility they can make 27 to 30,000 meals a day okay with a you know Skeleton Crew and then they and and you control what's in it and because you're buying in volume it actually reduces the cost so it's cheaper than buying it from Cisco or aromar or sedexo or wherever and then you farm it out via you know truck or bus to all the different schools so every kid gets a hot meal made from scratch each day and we can solve this problem can't help but ask this one last question for people that want to cut out sugar which you clearly stated is the most important thing to do for one's Health how do we know how much sugar is in something I so should people be looking at labels and just looking for how much sugar how much carbohydrate or could we even go so far as to say if it says um high fructose corn syrup then it's it's on the nfly list don't don't don't eat it so the problem the problem is that there are 262 names for sugar and the food industry uses all of them and the reason they use all of them is because they can include a different sugar as number five number six number seven number eight number nine on the list when you add it up it becomes number one they hide it in plain sight and they do it on purpose now do I expect everybody to memorize all 262 names no of course not can you figure it out yourself well the answer is no unless they have the line where it says added sugars if it says added sugars it is either sucrose or high fructose corn syrup no one's adding lactose okay that's not Happ or glucose they're not even adding glucose because glucose isn't that sweet glucose is not that interesting you don't see people going around chugging Kos syrup do you okay that's glucose who cares yeah might be good in the Molasses cookie but that's it all right so it's fructose so you need to know what's been added so if it says added sugars that's a good place to start no greater than one teaspoon per serving no greater than four gram per serving of added sugars anything greater than that leave at the store and aim for those Nova type type one for nov aim for Nova types one two and three and if you don't know whether it's Nova type one two or three you can use perfect and if you don't look at that then go look at the nutrition facts label and anything that has more than four ingredients is Nova class 4 Robert lustig thank you so much you've provided such an incredible education in nutritional biochemistry the processing of fat protein carbohydrate sugar fructose in particular the clear detriments of consuming fructose on so many different organ systems I love love love that you separated out food science Nutrition and metabolic health or self that's just I that's a you know that's a gazillion dollar delineation for people to understand and to shape their understanding of all the information that's out there and bends into these different categories you've given us so many actionable tools um new conceptual Frameworks youve given us a real tour to force today in a just oh so clear language so I want to thank you I've learned a ton and um and I know everyone else has as well and if people have questions they can of course put them in the comment section on YouTube that's the best place we'll provide links to all the the companies and uh websites that that you referenced and some of your other work and listen I just I'm so so grateful that you exist and that you've done the work that you've done and and your passion and your advocacy for health is um it's just oh so clear so thank you so much so I want I want to thank you and the reason I want to thank you is first of all you know inviting me that's nice you know that's good but the reason is because people need to understand science I am completely in agreement with you the public needs to understand science they listen to you because you number one provide the science and number two you don't talk down to them you treat them as equals and that is truly remarkable and so I want to thank you for your service well you're most welcome it's a labor of love and um I think it was the great Max delbrook that said uh when teaching assume zero knowledge and infinite intelligence and I do believe that humans are infinitely intelligent although sometimes as a whole we mask asket um people deserve the the knowledge so thank you so much for sharing that knowledge today and let's absolutely have you back my pleasure thank you thank you for joining me for today's discussion with Dr Robert lustig about nutrition and how sugar impacts the health of our brain and body to learn more about Dr lustig's work and to find links to the many books that he's written on this and other topics please see the show note captions if you're learning from and or 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zero cost to sign up you simply go to huberman lab.com go to the menu function scroll down to newsletter and enter your email and I should point out that we do not share your email with anybody thank you once again for joining me for today's discussion with Dr Robert lustic and last but certainly not least thank you for your interest in science [Music]