The Glucose Expert: The Only Proven Way To Lose Weight Fast! Health Experts Are Wrong About Calorie Counting!

Poison or guilty pleasure, the REAL truth about sugar. Robert Lustig is a Professor of Paediatric Endocrinology and a public health expert on the impact of sugar on our health. He is the author of bestselling books such as, ‘Fat Chance’, ‘Metabolical’, and ‘The Hacking of the American Mind’. In this conversation, Robert and Steven discuss topics such as, how nearly 75% of grocery items have added sugar, that obesity rates have doubled, the health impacts of childhood obesity and how calorie counting doesn’t help you to lose weight. 00:00 Intro 00:58 Our Minds Have Been Hacked! 04:03 What Dopamine Does to Your Brain 06:53 Sugar Is A Big Problem In Today’s Society 09:28 Why Sugar Is Poison To Our Bodies 10:08 The Difference Between Sugar and Fructose 13:53 This Is How Sugar Is Damaging Your Body 17:29 Damaging Effects on the Brain from Sugar Consumption 21:20 How the Food Industry Is Making You Eat Crazy Amounts of Sugar 24:05 Health Side Effects 26:12 Diet Coke, Saviour or Villain? 34:17 Sugar and the Impact on Our Organs 39:08 How Important Are Calories as a Way to Lose Weight? 42:47 Sugar Addiction, Stress, and Other Triggers 45:03 The Only Foods That Don't Contain Sugar 47:31 Food Labels Are Sending Wrong and Inaccurate Messages 49:16 Babies Are Born Fatter Than Before 50:30 Research on Children's Obesity 53:20 Insulin Resistance 55:00 Can We Reverse Diabetes? 57:34 What Is Leptin & How It’s Involved In Weight Loss 01:01:23 What Are Obesogens & How They Impact Our Health 01:02:31 The 3 Different Types of Fat You Should Be Worried About 01:08:34 Fruit Consumption… Good or Bad? 01:10:45 Environmental Chemicals That Make Us Fat 01:13:16 What Is an Endocrine Disruptor & How Can We Deal with Them? 01:16:11 How To Identify Real Food 01:21:20 The Importance of Fibre in Food 01:26:02 Personal Responsibility 01:33:50 Should the Government Get Involved? 01:38:40 Are We Being Lied To? 01:41:09 The Four C's for Contentment 01:46:19 What Is the Cause of All Our Health Problems? 01:48:46 Last Question  You can purchase Robert’s book, ‘Metabolical’ here: https://amzn.to/4acaseZ Follow Robert: Twitter - https://bit.ly/4brlsG9 Watch the episodes on Youtube - https://g2ul0.app.link/3kxINCANKsb My new book! 'The 33 Laws Of Business & Life' is out now - https://smarturl.it/DOACbook Follow me: https://beacons.ai/diaryofaceo Learn more about your ad choices. Visit megaphone.fm/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  Anyone who ever uses the word calorie as a unit of measure, fire them. Because they don't get it. Calories are not the issue. This is all about... That's the problem. That's how you lose weight.

• 0:13Steven Bartlett?

  Dr. Robert Lustig, a leading public health authority on the role sugar has on fueling the world's most destructive human conditions.

• 0:20Speaker 02

  And answers how we can regain control of our health.

• 0:23Speaker 00

  If you consume one sugared beverage per day, your risk for diabetes goes up by 29%. So this is a big problem. We also know that if you have high sugar consumption, it's got multiple detrimental effects, such as mental health problems, cognitive decline, early death. We also know it's the primary driver of ADD. But the problem is, sugar's addictive. And 73% of all of the items in the grocery store are spiked with added sugar by the food industry because they know when they add it, you buy more. You can't believe what they're telling you. If they say something is healthy, it's usually the opposite. And I'm part of numerous lawsuits suing the food industry because they knew that sugar was a problem. But they paid off scientists to say it wasn't.

• 1:08Speaker 00

  You've been hurt.

• 1:09Steven Bartlett?

  But a lot of people don't have time to be doing a fine-tooth comb over every single thing that they're putting into their body. They're not a scientist.

• 1:16Speaker 00

  Agreed.

• 1:17Steven Bartlett?

  So what advice do we give that is simple and actionable?

• 1:20Speaker 00

  Food can be medicine. Food can also be poison. And the question is, how do you figure out which is which? So here's the secret.

• 1:32Steven Bartlett?

  Dr. Robert Lustig,

• 1:35Steven Bartlett?

  on the front of your book it says, "The Hacking of the Mind." Very strong words to use.

• 1:42Speaker 00

  Indeed.

• 1:43Steven Bartlett?

  Whose mind has been hacked? And who is doing the hacking?

• 1:46Speaker 00

  Yours. Mine. Everyone's. Who's been doing it? Well, pretty much anyone with a belief system that's not yours. And that's pretty much everybody. The bottom line is, we have been sold a bill of goods. We as a society, we as individuals, have been sold a bill of goods. And the idea of the book, the reason I put the book together, is because it actually makes us miserable. It has stolen our birthright, and our birthright is to be happy. And we are not. If anything, we're the opposite of happy.

• 2:30Speaker 00

  We're extraordinarily unhappy. Just look at the incidence of depression around the world, not just in America, not just in the UK, but everywhere. The World Health Organization now says that 5% of all of the people on the planet are clinically depressed. And here in America, it's at 22%. So we're really unhappy. The question is, why is this? If, you know, our goal is to be happy, it's in the Declaration of Independence, "life, liberty, and the pursuit of happiness." Well, we're not. So, why? And the reason is because we have substituted pleasure for happiness.

• 3:14Speaker 00

  What's the difference between pleasure and happiness? Well, pleasure is short-lived, happiness is long-lived. Pleasure is visceral, you feel it in your body. Happiness is ethereal, you feel it above the neck. Pleasure is taking, like from a casino. Happiness is giving, like habitats for humanity. Pleasure is experienced alone. Happiness is usually experienced in social groups. Pleasure can be achieved with substances. Happiness cannot be achieved with substances. The extremes of pleasure, whether they be substances or behaviors, so substances like

• 3:55Speaker 00

  cocaine, amphetamine, nicotine, alcohol, sugar, or behaviors, shopping, gambling, social media, internet gaming, pornography, in the extreme, all lead to addiction. There's an aholic after every one of those, shopaholic, sexaholic, chokoholic, alcoholic, etc. But there's no such thing as being addicted to too much happiness. And lastly, number seven, the one that is the reason for the book, pleasure's dopamine, happiness is serotonin. And they are not the same.

• 4:27Speaker 00

  So two different neurotransmitters, two different sets of receptors, two different areas of the brain, two different mechanisms of action, two different clearance mechanisms. Dopamine is an excitatory neurotransmitter.

• 4:42Steven Bartlett?

  What does that mean?

• 4:43Speaker 00

  Means when dopamine is released in the area of the reward center, the nucleus accumbens, it's an actual anatomic structure in the brain which you can see on imaging. When dopamine is released there and it binds to its receptor like so, you get the, you transduce the feelings of reward. Okay, and reward is good. Reward is what gets you out of bed in the morning. If you don't have reward, you know, basically you shrivel up and die. Okay, reward is essential to the survival of the species. Orgasm is reward. Okay, you know, you need it. It's, it's part of daily life.

• 5:25Speaker 00

  But, okay, too much reward is a different story. And the reason is because dopamine, because it's an excitatory neurotransmitter, it causes the next cell to fire. Well, if it causes the next cell to fire and fire and fire, that cell dies. Neurons want to be tickled, not bludgeoned. Chronic overstimulation of any neuron leads to neuronal cell death. So that postsynaptic neuron with the dopamine receptor, it's got a plan B. It's got a way of mitigating that negative response. It down-regulates the receptor. So now, more dopamine, less receptors, less chance that a molecule will find a receptor to bind to.

• 6:10Speaker 00

  Well, that means your, the gain, the amplitude on the reward is going down. More and more for less and less. The law of diminishing returns.

• 6:21Steven Bartlett?

  Like an addiction, like a...

• 6:22Speaker 00

  Tolerance.

• 6:23Steven Bartlett?

  Yeah.

• 6:23Speaker 00

  Tolerance is one half of addiction. And then when the neurons do start to die, that is addiction. Exactly right. So dopamine drives addiction. And it doesn't matter what the cause of the dopamine release is. In the extreme, it will be addictive. Now serotonin...

• 6:43Speaker 00

  Does not downregulate its own receptor because it's not an excitatory neurotransmitter, it's an inhibitory one. So, do you need to downregulate an inhibitory response? No.

• 6:54Steven Bartlett?

  And inhibitory means what?

• 6:55Speaker 00

  Well, it means puts the next neuron to rest.

• 6:58Steven Bartlett?

  Okay.

• 6:59Speaker 00

  Instead of stimulating, instead of firing, it's actually calming.

• 7:02Steven Bartlett?

  Okay.

• 7:03Speaker 00

  Right? So, there's no such thing as being addicted to too much happiness because the receptors are still there. But there's one thing that downregulates: serotonin. And that's dopamine. So, the more pleasure you seek, the more unhappy you get. And we've been told for the last hundred years that pleasure is happiness.

• 7:27Steven Bartlett?

  Neurologically, the pathways are entirely different, as you say, between pleasure and happiness. One of the ways that we have been hijacked neurologically and via our dopamine receptors is through what we eat. And your book Fat Chance covers this really profoundly, a New York Times bestseller. The first word in the subtitle there is the word sugar.

• 7:52Speaker 00

  Hmm.

• 7:53Steven Bartlett?

  I've heard a lot about sugar.

• 7:55Speaker 00

  Yep.

• 7:56Steven Bartlett?

  I see it in adverts, I turn over the back of anything I eat and it says this word, added sugar. Is sugar really a problem in society? Has it really hijacked us?

• 8:07Speaker 00

  Yes. The short answer is, not only is it a problem, I personally think it's the biggest problem. It's not the only problem, but I think it is the biggest one. Now, why do I say that? From a systemic health issue, the biggest problem was trans fats.

• 8:27Steven Bartlett?

  What's a trans fat?

• 8:29Speaker 00

  Trans fat is a fat that is, has a double bond in it.

• 8:35Speaker 00

  That is flipped. So, normal unsaturated fats like olive oil, like canola oil, like rapeseed oil, like sesame oil, like peanut oil, et cetera. They all have a double bond in them. But the double bond is in one direction. A trans fat has the double bond in the opposite direction. One way to make a trans fat is to heat it. You put enough heat across the double bond and it will flip by itself. So if you heat olive oil too high, you can actually make trans fats at home. But the food industry used trans fats for food stabilization, to increase shelf life.

• 9:18Speaker 00

  They've been using it in baked goods since the 1920s. The scientist who first figured out that trans fats were dangerous, Fred Kumero, figured this out in 1957. But it wasn't until 1988 that anybody took them seriously. And then we started doing research on it and realized, oh my god, this stuff is killing animals and killing people. And finally, in 2013, so over 60 years after the initial science, the FDA finally banned trans fats in our food. Without question, trans fats are the devil incarnate. Seriously, you know, consumable poison. No ifs, ands, or buts.

• 10:03Steven Bartlett?

  Is sugar poison?

• 10:05Speaker 00

  Sugar is like alcohol. So, is alcohol poison? Depends on the dose. Right? The dose determines the poison. Paracelsus, 1537. We have an innate capacity to metabolize alcohol, and if we stay below that, it doesn't do too much damage. If we go above it, different story. Same thing with sugar. Same thing with this molecule, the sweet molecule, fructose. And the reason is because fructose and alcohol are metabolized virtually identically.

• 10:43Steven Bartlett?

  What's the difference between sugar and fructose?

• 10:45Speaker 00

  So, sugar, dietary sugar, the sweet stuff, the crystals, the stuff you put in your coffee.

• 10:52Steven Bartlett?

  The stuff I've got over here?

• 10:53Speaker 00

  Yeah, like that stuff. [laughing] Yeah, that stuff. The five-pound bag right there. That's called sucrose.

• 11:02Steven Bartlett?

  Okay, this is sucrose.

• 11:03Speaker 00

  This is sucrose. Now sucrose is two molecules bound together. One molecule called glucose, one molecule called fructose. They are not the same. Now, the food industry will tell you they are the same. They are not the same. The reason they tell you they are the same is because that's the way they assuage their own culpability for what they've done to the food. But they are not the same. They will say, "A sugar is a sugar, a calorie is a calorie, a glucose and fructose both have four calories per gram, why should you care?" Oh, you care a lot. You care a whole lot. Now, glucose is the energy of life. Every cell on the planet burns glucose for energy.

• 11:45Speaker 00

  Glucose is so important that if you don't consume it, your body makes it. Okay? The Inuit had no carbohydrate. They had ice. They had whale blubber. They still had a serum glucose level.

• 11:58Steven Bartlett?

  Inuits are the people that live in the North Poles and stuff?

• 12:00Speaker 00

  That's right, yeah. They're formerly known as Eskimos. But they didn't have any carbohydrate. They ran off fat. But they still had a serum glucose level because your brain runs on glucose. It can also run on ketones, too. But, you know, your brain runs on glucose. My brain runs on glucose. And you need glucose because certain hormones and certain proteins in the body require glycosylation in order to be effective. An example? LH and FSH. When you don't have glycosylation of LH and FSH, the hormones that tell your testicle and your ovary to work, you are infertile.

• 12:45Speaker 00

  It's that simple. So, survival of the species says, "You need some glucose, but if you're not consuming it, you'll still get it because your body will make it." It will make it out of amino acids, it will make it out of fat. Gluconeogenesis, it's called. So, glucose is essential, it's just not essential to eat. Fructose, on the other hand, the sweet molecule in that bag.

• 13:09Steven Bartlett?

  Which is sort of one of the two parts of the grain of sugar that I see.

• 13:13Speaker 00

  That's right.

• 13:14Steven Bartlett?

  One part of it is fructose.

• 13:15Speaker 00

  That's right. It's the other half.

• 13:17Steven Bartlett?

  Right.

• 13:17Speaker 00

  It's the evil twin, if you will.

• 13:19Steven Bartlett?

  What are the two halves again?

• 13:20Speaker 00

  Glucose.

• 13:21Steven Bartlett?

  Yeah.

• 13:21Speaker 00

  Fructose.

• 13:22Steven Bartlett?

  Cool.

• 13:22Speaker 00

  Found together.

• 13:23Steven Bartlett?

  I need glucose to live. My body will figure that out. Fructose, do I need this?

• 13:28Speaker 00

  Not only do you not need it, but in high dose, it's toxic. Now, your liver has the innate ability to metabolize a small amount, on the order of about six to nine teaspoons per day of dietary sugar. So half of that being fructose. So about 12 grams. Your liver can manage about 12 grams of fructose a day. In the same way, it can manage about 12 grams of alcohol per day, without showing any signs of any metabolic derangement. But if you go above that, now you get problems.

• 14:10Steven Bartlett?

  Are we above that?

• 14:11Speaker 00

  Oh, we are so above that. We are at 50 grams of fructose per day, 100 grams of sugar per day. We're supposed to be at 25. We are at 100. We are quadruple our limit.

• 14:28Steven Bartlett?

  And also, just because grams are quite hard to wrap the head around, right?

• 14:31Speaker 00

  Okay.

• 14:32Steven Bartlett?

  So if I was to get a tablespoon.

• 14:34Speaker 00

  Well, do teaspoons.

• 14:35Steven Bartlett?

  A teaspoon.

• 14:35Speaker 00

  Teaspoons.

• 14:36Steven Bartlett?

  How many teaspoons of sugar would I have to consume to get to that level of fructose? Because I say this in part because most of us don't realize that we're consuming sugar.

• 14:44Speaker 00

  That's right, because it's hidden in all of the food. That's exactly right. We don't even know. We say, oh, I never even add sugar to my coffee, therefore my sugar consumption is zero. Wrong.

• 14:58Speaker 00

  That is not true, okay? Because it is hidden in plain sight in virtually every processed food in the entire grocery store. Seventy-three percent of all of the items in the American grocery store and in the British grocery store are spiked with added sugar by the food industry for its purposes, not for yours. Because they know when they add it, you buy more.

• 15:22Steven Bartlett?

  And how much does that look like in teaspoons, then?

• 15:24Speaker 00

  The upper limit is about six teaspoons of added sugar per day.

• 15:29Steven Bartlett?

  The allowance, the recommended allowance.

• 15:31Speaker 00

  The upper limit.

• 15:33Steven Bartlett?

  Okay.

• 15:33Speaker 00

  The recommended allowance is lower than that.

• 15:35Steven Bartlett?

  Yeah.

• 15:36Speaker 00

  Okay, but the upper limit is about six teaspoons of added sugar per day. So in alcohol terms, that'd be like one drink. So if you have a drink a day, you're staying below your threshold, and all is fine. What if you have two drinks per day? Now, it depends on how well your liver works, maybe how much exercise you have, how much total body mass you have, et cetera. What about if you have three drinks a day? You're gonna get pretty tipsy. Maybe you shouldn't be driving a car, right? What if you have four drinks per day? You know, they might have to, you know, scrape you off the floor of the bar with a spatula. And what if you have five drinks per day? You're a friggin' alcoholic, is what you are. All right?

• 16:20Speaker 00

  The point is, the dose determines the poison. Well, the same is true with sugar. So we have an innate capacity to metabolize about 12 grams of fructose per day. By the way, that's for adults. For children, it's one-third of that. Four grams of fructose per day. Okay? Four to six. So we're talking very little. Talking very little. But when you think about, for instance, kid in America, you know, 29% of kids in America consume the National School Breakfast Program breakfast in school. Okay? 29%. So what is the National School

• 17:05Speaker 00

  Breakfast Program breakfast? It's a bowl of Fruit Loops and a glass of orange juice. That is 41 grams of sugar. The upper limit for children in terms of their metabolism is 12 grams per day. They got 41 grams and it's just breakfast.

• 17:29Speaker 00

  What do you think that's going to do?

• 17:32Speaker 00

  Now, if a calorie were a calorie, and if glucose and fructose were the same, then you say, "Well, you've got to get your calories somewhere." But because fructose is not glucose, because fructose is more like alcohol, because fructose's toxicity has nothing to do with its calories, that is a huge overdose. And it has metabolic complications, systemic health complications, it has mental health complications, and ultimately it has societal complications.

• 18:04Steven Bartlett?

  Do you think it has neurological consequences?

• 18:06Speaker 00

  Without question, it's the primary driver of ADD. It's not the only driver, but it's one of them.

• 18:12Steven Bartlett?

  How do we know that?

• 18:13Speaker 00

  It's a primary driver of depression, because we have the data.

• 18:15Steven Bartlett?

  As it relates to ADD and ADHD and all those kinds of things, how do we know?

• 18:20Speaker 00

  We have functional MRI, we have performance data showing that when you take the sugar out, kids' scores get better. Okay, we did this ourselves at UCSF. We did a study where we took 43 children with obesity and metabolic syndrome, all high-sugar consumers, all low socioeconomic status children, Latino and African-American, all high-sugar consumers. And what we did was we figured out what they were eating on their home diet. We studied them on their home diet. And then for the next nine days, we catered their meals. No added sugar. We took the added sugar from 28 teaspoons of added sugar per day down to 10.

• 19:08Speaker 00

  Okay, so huge reduction. We gave them fruit. That was the only place they had sugar in their diet. Otherwise, we cut the sugar out. Now, if you do that, you're going to lose 350 to 400 calories per day out of your diet. So the goal was to keep their weight stable because if they lost weight, the critics would say, "Well, of course, they got better. They lost weight." So we needed to maintain their weight. So we had to put something back in that was equicaloric. We gave them extra starch. So in the vernacular, we took the pastries out. We put the bagels in. We took the sweetened yogurt out. We put the baked potato chips in. We took the chicken teriyaki out. We put the turkey hot dogs in. So we didn't give them good food. We gave them crappy food.

• 19:53Speaker 00

  We gave them Safeway food, you know, just CPG, you know, consumer packaged goods food, you know. Okay, so you didn't give them vegetables just... No, we didn't give them any vegetables. Okay. But it was no added sugar food. Okay, and it wasn't funky food. It was just food we bought at Safeway. But it was chosen to not be sugar containing. Okay? And we gave them a scale. And every day, we'd call them up on the phone. "What'd you weigh?" And if they were losing weight, "Eat more!" In order to maintain their weight for the whole 10 days of the study. And then we studied them on day 10. Every aspect of their metabolic health improved. Blood pressure went down. Blood glucose went down. Insulin went down.

• 20:37Speaker 00

  Their pancreas has started working right again. They had a serum lactate level. You're not supposed to have a lactate level. That means your mitochondria are dysfunctional if you have a lactate level. Okay? Their lactate cleared. Everything got better. Most importantly, for the first five days of that 10-day window, the kids were obnoxious. The parents would complain to us. "My kid is a disaster." And the reason was because of withdrawal.

• 21:11Speaker 00

  They were withdrawing off sugar, withdrawing off fructose. And then, like, you know, Moses, the sky cleared. And the kids started concentrating better. They started doing better in school. The parents noticed they were less irritable. The teachers noticed they weren't nuisances or trouble in school anymore. The kids noticed. They said, it's the first time my head hasn't been in the clouds. Five days, five days. And in 10 days, we could see all of the metabolic benefits, even though they maintained their weight, even though they maintained their calories.

• 21:55Steven Bartlett?

  Sounds like a bit of a scandal. When I hear that these kids are getting, almost 30% of kids are getting, you know, almost, you know, through three to four times their recommended daily allowance of sugar from school, and that it's having these sort of really adverse consequences on us. And the studies are there to prove that the consequences are very real. It sounds like a scandal in the sense that nobody's doing something about it.

• 22:22Speaker 00

  Ah, well, yes, that way it is. The point is that the food industry is very powerful. And they have, you know, swept virtually every aspect of this under the rug for 40 to 50 years. They knew back in the 1960s that sugar was a problem. But they paid off scientists to say it wasn't. And we actually have the documents from the food industry. They live at the UCSF Food Industry Documents Library. And we are doing research on corporate interference in health.

• 23:01Steven Bartlett?

  What do those documents show?

• 23:02Speaker 00

  They show that in 1965, the sugar industry came to two Harvard School of Public Health scientists, the head of the Department of Nutrition, Fred Stare, and his associate, Mark Hegstedt, who became the head of the USDA five years later, and paid them $50,000 in today's money to produce two articles for the New England Journal saying saturated fat was the bad guy and that sugar was exonerated.

• 23:36Steven Bartlett?

  And they did it.

• 23:37Speaker 00

  And they did it.

• 23:40Speaker 00

  That's just one thing they did. They also infiltrated the National Institute of Dental Research, NIDR, their study sections and their executive committee to take money away from nutrition research for dental health and put it toward a Karies vaccine.

• 24:05Steven Bartlett?

  A what?

• 24:05Speaker 00

  A dental Karies, a cavities vaccine. Okay, how's that cavities vaccine working for you?

• 24:13Speaker 00

  We have all of the data, in their own words, to demonstrate that they knew exactly what they were doing. This is not hallucination. This is hardcore fact, and we've published this. And we now have a center at UCSF devoted to understanding the corporate determinants of health.

• 24:40Steven Bartlett?

  And when we look across society at the consequences of this sort of corporate interference, some of the crazy stats in your book Fat Chance that I really sort of highlighted were that by 2050, obesity will become the norm, not the exception.

• 24:52Speaker 00

  Correct.

• 24:53Steven Bartlett?

  The World Health Organization said that the percentage of obese people globally has doubled in the last 28 years.

• 24:59Speaker 00

  Indeed.

• 25:00Steven Bartlett?

  And in the UK, 28% of adults are obese and 36% of them are overweight. That's not from your book, but that's from some research we did on the UK numbers as well.

• 25:09Speaker 00

  Well, you know, the UK is the fat man of Europe.

• 25:11Steven Bartlett?

  Yes, that's true. Having metabolic syndrome is equal to losing 15 to 20 years of life. That was in your book.

• 25:18Speaker 00

  That's correct.

• 25:19Steven Bartlett?

  Which is startling. And worldwide sugar consumption has tripled in just the last 50 years.

• 25:26Speaker 00

  Correct. All true. Now, you could say that's correlation, not causation. But we actually have the causation. We have the data. We have it in mechanistic terms. We have it in clinical interventional efforts. We have it in societal efforts. There is a method for determining proof that doesn't need randomized control trials. It's called econometric analysis. This is what we have for, for instance, climate change. There's no control group for climate change, but we still know it's true. This is what we have for tobacco and lung cancer. You know, you don't have naive people start smoking. That would be illegal, immoral, get you thrown in jail.

• 26:09Speaker 00

  But we still know that tobacco causes lung cancer. We know that football trauma causes chronic traumatic encephalopathy. Okay, none of these have control groups, but we know it's true through econometric analysis. This is a method of using natural history data over time to be able to determine proximate cause. And we have that for sugar and diabetes. And we have it for sugar and heart disease. And we have it for sugar and fatty liver disease. And of course, we have it for sugar and tooth decay. We're working on sugar and cancer and sugar and dementia. We're not there yet.

• 26:47Steven Bartlett?

  In your book Fat Chance, on page 120, there was something particularly curious because I think this is a... Yeah, here we go. It says, "The bottom line is, sugar consumption is a problem. Thirty-three percent of sugar consumption comes from beverages."

• 27:06Speaker 00

  Yes.

• 27:07Steven Bartlett?

  "And the biggest abuses are the poor and underserved."

• 27:10Speaker 00

  Indeed.

• 27:11Steven Bartlett?

  So let's talk about beverages to start with then. Diet beverages, are they fine? And how bad are the sort of fizzy pot beverages that most of us consume every day?

• 27:24Speaker 00

  So, let's do the sugared soft drinks first.

• 27:31Steven Bartlett?

  Okay.

• 27:31Speaker 00

  Okay. They are really bad. If you consume one sugared beverage per day, your risk for diabetes goes up by 29%.

• 27:43Speaker 00

  Wow. Okay. And diabetes. And that's if you have one. If you have two, 58%. And diabetes is now the main cause of death in 40% of death certificates. Exactly right. So this is a big problem. So that's demonstrating its toxicity at, shall we say, medium dose. At low dose, you can handle it. But as soon as you go above that dose, it's a problem. And we have the data for it. Okay? And all of these are factored in. These are all econometric analyses. We've shown that sugar is a proximate cause of diabetes. Whenever sugar availability changes in any country, diabetes prevalence changes three years later.

• 28:26Speaker 00

  And we've also done what's known as advanced Markov modeling, where we go into the future and show that when sugar consumption goes down in any country, diabetes levels change and reduce three years later. So it's a three-year window between the change in the diet and the change in the metabolic health consequences. We have those data. And the fact that they work both on the way up and on the way down is like, take it to the bank. Now, that's for the sugared beverages. You asked me about diet beverages. I've got one here. Let's look at it. All right. I've covered up the logos because I don't recall. Oh, I've never seen this before.

• 29:11Speaker 00

  I wonder what that is. The data now show, I mean, it took a while for these data to come in, but the data now show that the toxicity of one sugared soda equals the toxicity of two diet sodas. Half as bad. Half as bad does not mean good. Half as bad means half as bad. Well, it says zero sugar here, so how can it be bad? Well, because it's bad for a different reason. So, yes, zero fructose, zero calories, I agree. But that doesn't make it good. Makes it better than the sugared alternative, but it doesn't make it good.

• 29:56Speaker 00

  Why? Number one, you put something sweet on the tongue. Message goes tongue to brain, sugar's coming. Message goes brain to pancreas, sugar's coming, release the insulin.

• 30:09Steven Bartlett?

  So I still get an insulin release?

• 30:11Speaker 00

  You still get an insulin response. And the more other food you ate, the bigger the insulin response.

• 30:16Steven Bartlett?

  Okay.

• 30:17Speaker 00

  So you will have an accentuated insulin response because you were exposed to the diet sweetener. This is work from Yanina Papino, 2013, at Wash U St. Louis. And it's been corroborated multiple times since.

• 30:30Steven Bartlett?

  And why does that harm me, having an insulin response?

• 30:33Speaker 00

  Because insulin's a bad guy. So we always talk about glucose being a bad guy in terms of diabetes, and it is, of course. But insulin's a bad guy, too. Glucose causes small vessels to be dysfunctional. It causes endothelial cell dysfunction. It causes high blood pressure because it causes those small vessels to constrict. It interferes with nitric oxide, which is one of the things that relaxes the blood vessel. And it will, you know, basically reduce blood flow to specific organs. So high glucose is not good for you, and it's bad for small vessel disease.

• 31:13Speaker 00

  And that's why diabetics get retinopathy, nephropathy, neuropathy, kidney disease, nerve damage, and eye disease. But insulin is also a problem. Because what insulin does is it causes cell growth. Insulin is a growth factor. And it causes vascular smooth muscle growth, like in your coronary arteries. And it causes glandular growth. So it is one of the primary drivers of heart disease and cancer. So you can be a diabetic, a type 2 diabetic, and have your hemoglobin A1C, a measure of

• 31:52Speaker 00

  your glucose control, down near normal, near normal range, because you're on insulin or oral hypoglycemic, or even GLP-1 analogues for that matter, okay? And you will die just the same, because you will die of a heart attack or of a cancer. Because diabetics have a much higher incidence of cancer. They also have a higher incidence of dementia as well. And the reason is because of insulin. Because insulin's a bad guy in this story. Glucose causes microvascular disease. The insulin causes macrovascular disease.

• 32:34Speaker 00

  They're both bad. You need to control both of them. And this controls the glucose, it doesn't control the insulin.

• 32:44Steven Bartlett?

  Do you drink that stuff?

• 32:46Speaker 00

  Of course not.

• 32:47Steven Bartlett?

  Just checking. Is there any other physiological consequences to diet sodas outside of the insulin response?

• 32:55Speaker 00

  Indeed. So the other thing that we've learned about non-nutritive sweeteners across the board is that they alter the microbiome. Now, the microbiome is the bacteria that live in your gut. Now, you have to feed your microbiome, you have to feed your bacteria. Because if you don't feed your bacteria, your bacteria will feed on you. It will strip the mucin layer, a protective physical barrier, right off the surface of your intestinal epithelial cells. And when it does that, it denudes them and allows for other bacteria, toxic bacteria, to take up residence and cause irritable bowel syndrome, inflammatory bowel disease, and the junctions between the cells

• 33:37Speaker 00

  become dysfunctional as well. And so the cells become permeable. And so stuff in your intestine, the junk in your intestine, the SH, you know what, can actually make it through into the bloodstream. You can measure the endotoxins and the whole bacteria, the lipopolysaccharides, in the bloodstream when the intestine is damaged, even from diet soda. And what that does is that ultimately leads to systemic inflammation. And that systemic inflammation also leads to metabolic disease, mental health problems, cognitive decline, early death.

• 34:17Steven Bartlett?

  Is there a relationship between sugar and our hormone levels?

• 34:21Speaker 00

  Of course. I mean, the main one, of course, is diabetes, I mean, insulin. But high sugar, I mean, if you have high sugar consumption, it's going to cause changes in insulin response at the level of the liver. It's going to cause fatty liver disease. Okay, it can change your kidneys' function, which can ultimately increase blood pressure. So it's got multiple potential detrimental effects.

• 34:52Steven Bartlett?

  What impact does sugar have on our liver? What's going on there?

• 34:55Speaker 00

  So, as I mentioned, we have an innate capacity to metabolize a limited amount.

• 35:01Steven Bartlett?

  Yeah.

• 35:04Speaker 00

  Everyone says, "Oh, sugar's energy." Well, yeah, but not really, not really. So let's dissect that. The food industry says glucose is four calories per gram. The food industry says fructose is four calories per gram. Therefore, they're equal because they're four calories per gram. And if calories were the issue, then they would be right. But calories are not the issue. Okay? The whole issue of calories has to go down the tubes. Okay? As far as I'm concerned, that's the problem. And I am here to hashtag "kill the calorie" as a unit of measure.

• 35:46Speaker 00

  It has no place in our dialogue. It has no place in medicine. Calories suck. Now, why do I say that? If you take a mole of glucose and you throw it into a bomb calorimeter, you will get four calories per gram. That's true. If you take fructose and you throw it in a bomb calorimeter, you will get four calories per gram. That's true. We are not bomb calorimeters. Okay?

• 36:17Steven Bartlett?

  What's a bomb calorimeter?

• 36:19Speaker 00

  It's a contraption that explodes the whatever you put in it and measures the heat that's given off from it.

• 36:28Steven Bartlett?

  So it measures the amount of calories in something effectively?

• 36:30Speaker 00

  Yeah.

• 36:31Steven Bartlett?

  Using some kind of combustion?

• 36:32Speaker 00

  Because that's what calories are, is the amount of heat required to raise one gram of water, one degree centigrade.

• 36:37Steven Bartlett?

  Okay.

• 36:37Speaker 00

  So it's a measure of heat.

• 36:39Steven Bartlett?

  Yeah.

• 36:39Speaker 00

  Is what it is. That's what calories are. Now, we do our burning in these little organelles inside each of our cells called mitochondria. This is all about mitochondria. And when your mitochondria work efficiently and well, you can burn energy.

• 36:58Speaker 00

  To completion. And you can capture that energy in the form of chemical energy in your cell called ATP, adenosine triphosphate. And that's what your cell uses to power all of the functions that the cell needs. The little molecular motors and making stuff and, you know, basically, you know, and also cleaning house, you know, and recycling junk. Okay, in order to keep your cells thrive, thriving and alive. Okay. So mitochondria are essential. Now, glucose stimulates mitochondria to work better. Glucose is actually good.

• 37:39Speaker 00

  It stimulates two enzymes necessary for mitochondria to work. It stimulates an enzyme called AMP kinase, which is a, the enzyme that actually makes more mitochondria. And it's the fuel gauge on the liver cell. So it tells the liver, make more. And it also stimulates an enzyme called HADH, hydroxyacylcholine dehydrogenase, which is necessary to cleave two carbon fragments and burn them, oxidize them for energy too. So glucose, we can call good because it helps mitochondria. Fructose, on the other hand, this sweet molecule in sugar, in sucrose, it inhibits three enzymes in mitochondria.

• 38:25Speaker 00

  It inhibits that AMP kinase. It inhibits an enzyme called AKL, acylcholine dehydrogenase long chain. It inhibits CPT1 carnitine palmitol transferase1. That's the enzyme that regenerates carnitine, which is the shuttle by which fatty acids can get into the mitochondria to be burned. So the net effect of fructose is to inhibit mitochondrial function. So, does fructose constitute energy if fructose is actually keeping you from making chemical energy in your cell?

• 39:04Speaker 00

  This is the conundrum. What do you mean by energy? If we're talking heat, then fructose is energy. If you're talking ATP, fructose inhibits ATP. And that's what we're talking about. Because that's what leads to systemic health problems, not the heat. So, all of these people, as far as I'm concerned, anyone who ever uses the word calorie, fire them. Because they don't get it. They are part of the problem, not part of the solution.

• 39:43Steven Bartlett?

  Many people will say that sort of counting calories has helped them with their weight loss goals.

• 39:49Speaker 00

  You tell me. Virtually everybody who counts calories loses a little bit of weight, and then they plateau. And then they get tired of their diet, and the weight comes rushing back. Okay? Ninety percent of people who try to diet through caloric restriction regain and sometimes yo-yo back even higher. So, I don't accept that.

• 40:15Steven Bartlett?

  Are there studies that support this idea that sort of the yo-yo dieting is a by-product of caloric restriction?

• 40:22Speaker 00

  Not because of caloric restriction. It's a problem of insulin resistance. It's a problem of when you gain the weight back, did you gain it in the liver? It's liver fat. Because now you've got higher insulin, and insulin blocks this hormone that goes to the brain called leptin that is in charge of that set point. So, the higher your insulin goes, the less well your brain can see leptin. And so, the less well you can regulate. And so, that's what drives your weight up even higher. So, you don't regain the weight by eating fish and vegetables. You regain the weight because you went for the bread and the rice and the pasta and the potatoes and the sugar.

• 41:07Steven Bartlett?

  What's a better plan then? If I'm trying to cut a couple of pounds, what's a better approach to take versus sort of calorie counting or these kind of things?

• 41:16Speaker 00

  Get the insulin down. There is no weight gain without insulin. Insulin is the energy storage hormone.

• 41:26Speaker 00

  Twenty years ago, from doing the research on kids with hypothalamic tumors who released enormous amounts of insulin, we gave them a drug that suppressed insulin release. They lost weight and they started exercising spontaneously because we got their insulin down. We showed that the lower we got the insulin, the more weight they lost and the better they felt. Insulin is the bad guy in this story. So numerous investigators, you know, the world over, have now demonstrated that insulin is a primary driver of both obesity and diabetes and metabolic syndrome. You gotta get the insulin down. Okay, how do you get insulin down?

• 42:09Speaker 00

  Best way, don't let it go up. What makes it go up? Refined carbohydrate and sugar. All the stuff you have over there in that corner.

• 42:18Steven Bartlett?

  Just to be clear, he's not pointing at my lunch.

• 42:22Speaker 00

  No.

• 42:23Steven Bartlett?

  We have a pile of different sugar products that we brought for the interview over in the corner, including various things that you find on a shelf, everything from apple juice to some popular snacks to some like, some other things.

• 42:34Speaker 00

  Don't forget the peanut butter cups.

• 42:36Steven Bartlett?

  The peanut butter cups, yeah. And even this, this is just sort of, it looks like water, but it's flavored water, where they've added sugar to it.

• 42:43Speaker 00

  Right.

• 42:44Steven Bartlett?

  So yeah, all of that stuff over there.

• 42:47Speaker 00

  All of that stuff. So get the insulin down, all right? So cut the refined carbohydrate, cut the sugar, the dietary sugar. That is the single best way to mitigate this process by improving insulin resistance by getting the insulin down. And we have done this time and time again. Basically, I turned my obesity clinic into an insulin reduction clinic for this reason.

• 43:14Steven Bartlett?

  A lot of people at a sort of a prefrontal cortex logical level understand this. They understand that they shouldn't be having sugar.

• 43:22Speaker 00

  Well, they think it's about calories.

• 43:24Steven Bartlett?

  They do, some people do think it's about calories for sure, but even the ones that know that sugar is not something they should be having. Still struggle.

• 43:32Speaker 00

  They do.

• 43:33Steven Bartlett?

  It's easier said than done.

• 43:34Speaker 00

  Because sugar is addictive.

• 43:35Steven Bartlett?

  Right, yeah.

• 43:36Speaker 00

  They struggle because sugar is addictive. We know because fructose stimulates that nucleus accumbens.

• 43:41Steven Bartlett?

  Yeah.

• 43:41Speaker 00

  By the way, glucose does not.

• 43:43Steven Bartlett?

  When we get stressed, which is a facet of daily life now.

• 43:46Speaker 00

  That's right.

• 43:46Steven Bartlett?

  We're much more likely to grab a sugary snack.

• 43:48Speaker 00

  Indeed, and there's a reason for that, too. Because when you're stressed, that actually puts a greater burden on your amygdala. And your amygdala requires more energy, hippocampus too, by the way.

• 44:00Steven Bartlett?

  The amygdala is the emotional center of the brain.

• 44:02Speaker 00

  The fear center of the brain. Okay, and so you're trying to calm it. And so you have to increase the energy available. So because you need more ATP. And even though fructose inhibits ATP generation, you still reach for that because you're trying to mitigate the metabolic consequences acutely.

• 44:25Steven Bartlett?

  When I'm tired, I think I have a high propensity to grabbing sugar as well.

• 44:28Speaker 00

  Indeed.

• 44:29Steven Bartlett?

  Why's that?

• 44:30Speaker 00

  Because you're tired, you're stressed, and your amygdala is dysfunctional. And so it basically tells you, hell with it.

• 44:39Steven Bartlett?

  I don't have any sugar cravings in the morning. I've come to learn. I don't feel the need for sugar in the morning. It's sometimes when we get later into the evening.

• 44:46Speaker 00

  Right.

• 44:47Steven Bartlett?

  After a long day.

• 44:48Speaker 00

  Exactly.

• 44:48Steven Bartlett?

  It's when my cravings.

• 44:50Speaker 00

  You and everyone else, and me too, by the way. It's not like I'm immune to this. I, you know, I'm on record. I gained a lot of weight while I was a faculty member at UCSF. And every day at 4:00 PM, I just ran out of gas. And so I ran across the street to get a, you know, large chocolate chip cookie. Okay, and that was without question the primary driver of my weight gain. Okay, it wasn't until I actually started doing the research on this. And seeing that the kids felt better when we took the sugar out of their diet, that I actually put two and two together for myself.

• 45:33Speaker 00

  So now I don't do that and my energy level stays constant throughout the day.

• 45:38Steven Bartlett?

  So what advice do we give that is simple and actionable for Jennifer or Judith or Dave who's listening to this now, they are, you know, 40 years old potentially, they have a nine to five job, they're very busy, maybe they have some kids to feed at the same time, they don't have time to be like, you know, looking at doing a fine sort of tooth comb over every single thing that they're putting into their body, they're not a scientist.

• 46:03Speaker 00

  Agreed. It's a problem because the food industry has made the grocery store a minefield and it's really easy to set off an explosion. If you walk in, you've basically lost. That's how bad it is. Understood. So the simple rule is eat real food. So what's real food? Well, food that came out of the ground or animals that ate food that came out of the ground. The problem is we all lead busy lives and we're looking for labor-saving devices because people don't even have time to cook. Most people, 33% of Americans don't even know how to cook anymore. So like, what are they gonna do?

• 46:48Speaker 00

  So we understand this. I mean, it's a problem. Agreed. We need food that is metabolically healthy for us, not metabolically detrimental. And the problem is that as soon as you put added sugar in the food, you have made it metabolically detrimental. Now, the food industry will say, well, there are all these other good things in there, like vitamins and minerals, we fortify it, et cetera. So I'm here to tell you, toxin A plus antidote B still equals death.

• 47:20Speaker 00

  Okay, just because they put some vitamins in there, or you take a dietary supplement, if it's not solving your mitochondrial dysfunction, what's the point? So, you can't believe what the food industry is telling you. Okay? If they say something is healthy, it's usually the opposite. Whatever it says on the package, believe the opposite. Because they have an incentive to put wrong stuff on the package. And I'll be honest with you, I'm part of, you know, numerous lawsuits suing the food industry for deceptive advertising, misbranding, mislabeling. Seventy percent of all of the items in the American grocery store are misbranded or mislabeled.

• 48:05Speaker 00

  In what way? They say things that are not true. Give me some examples. Well, first of all, anytime they use the word "healthy", okay? They say "no added sugar", okay? But in fact, they put in apple puree, or raspberry puree, or evaporated cane juice. You know, they, they, there are 262 names for sugar. And the food industry uses all of them. And so, they will say that something's no added sugar, but that in fact is actually not the case. Okay? There's, there's a whole, you know, a whole host of this. Kellogg's has been sued for Raisin Bran. Okay? Everyone thinks "Raisin Bran", well, it's just raisins and bran.

• 48:49Speaker 00

  What color are the raisins in Raisin Bran? I've never seen it. Well, I mean, raisins are purple. Yeah. You know, purple brown? Yeah, yeah. Yeah? Yeah, normally. Well, the raisins in Raisin Bran are white. Why? Hmm. If you take the raisins in Raisin Bran, that's supposed to be 11 grams of sugar, but on the side of the package, it says that one serving is 18 grams of sugar. Where'd the other seven come from? It's the white. Because they've all been dipped in a sugar solution to make them sweeter.

• 49:34Speaker 00

  As an example. Okay. So Post has been sued, General Mills, theirs was dismissed. Mondelez, a whole host of companies are actually under the gun now to change their practices.

• 49:51Steven Bartlett?

  Why do you care so much?

• 49:52Speaker 00

  I am a pediatrician. My job is to take care of children. Children are vulnerable in the same way minorities are vulnerable, in the same way prisoners are vulnerable. Okay. They need a voice. My job is to give every kid a shot. Well, we now have neonatal obesity. We have babies being born. Israel, South Africa, Russia, United States, four separate studies showing that over the past 25 years, birth weight has gone up 200 grams, half a pound, in all four countries.

• 50:37Speaker 00

  And when you do DEXA scanning to look at body composition on those newborns, those 200 grams are all fat. We have neonatal obesity. These kids did not get obese by dieting and exercising, by gluttony and sloth. They came out of the womb behind the eight ball. It's my job as a pediatrician to fix the problem. That's what I care.

• 51:04Steven Bartlett?

  Can you just give me a little bit of brief overview of everything you're talking about, the studies you've referenced, all of that? What is the academic experience, background, research that you've done that's built all of the foundations of your knowledge?

• 51:21Speaker 00

  I spent the first 20 years of my medical practice, you know, in academia, basically, you know, doing what they told me to do, you know, the way I learned it. And I thought calories were the same, and I thought that, you know, it didn't matter, and this is not what you do, and this is not how you take care of patients. You, you know, do prescriptions and you do procedures, and that's how you do it. And then I started doing research because I was at St. Jude Children's Research Hospital taking care of these massively obese kids who had brain tumors.

• 51:57Speaker 00

  That were treated by surgery or radiation. And they became massively obese because of it, because their hypothalamus was damaged. Because they couldn't see that leptin signal that we talked about earlier.

• 52:08Steven Bartlett?

  Which is the hunger.

• 52:10Speaker 00

  Which is part of hunger, it's not the only hunger.

• 52:12Steven Bartlett?

  It's gremlin related.

• 52:13Speaker 00

  It's more of an energy sufficiency signal.

• 52:15Steven Bartlett?

  Okay, right.

• 52:16Speaker 00

  It's the energy sufficiency signal. Anyway, when we suppressed their insulin release with that drug I mentioned before, they lost weight and they started exercising spontaneously. So we did that with adults and guess what? Same thing happened. And we measured their energy expenditure and instead of it going down, as you'd expect when you lose weight, normally your energy expenditure goes down, their expenditure, energy expenditure went up. So what this told me was that insulin is blocking leptin and as long as your leptin's being blocked, you feel like crap. And you're hungry and you don't want to get off the couch. And as soon as your insulin goes down, now your brain can see the leptin and you're

• 53:01Speaker 00

  not hungry and you can start exercising. What this showed me was that the behaviors that we associate with obesity, the gluttony and the sloth are actually secondary to this biochemical phenomenon of insulin blocking leptin. And so this put me on the path of understanding insulin as the problem rather than insulin as the result. Fix the insulin, fix the problem. And so I've been doing that for the last 25 years.

• 53:35Steven Bartlett?

  And that's what brought you to the subject of sugar? Because sugar increases insulin levels.

• 53:42Speaker 00

  Well, sugar causes insulin resistance.

• 53:45Steven Bartlett?

  Okay.

• 53:46Speaker 00

  So there are two phenomena with insulin. Insulin release.

• 53:49Steven Bartlett?

  Yeah.

• 53:50Speaker 00

  Which is an acute phenomenon.

• 53:51Steven Bartlett?

  So that's when I eat something, there'll be some insulin released, which means I have an insulin spike.

• 53:56Speaker 00

  Right.

• 53:57Steven Bartlett?

  And then it comes back down nicely.

• 53:58Speaker 00

  Or not.

• 53:59Steven Bartlett?

  Or not.

• 54:00Speaker 00

  Or not.

• 54:01Steven Bartlett?

  Depending on how much and how consistently I've been eating sugar.

• 54:03Speaker 00

  Exactly right. So if your liver has fat in it, and 45% of American adults now have fat in their liver, and 25% of kids now have fat in their liver, and they never did before. I mean, before, 1980, if you saw fat in the liver, that was alcohol. But if 25% of kids who don't drink alcohol have fat in their liver, how'd the fat get there? Sugar, because sugar gets turned into fat in the liver. That's the driver of this. What that does is that causes a phenomenon called insulin resistance. Your liver doesn't work right, so your pancreas has to make more insulin to make your liver work right.

• 54:48Speaker 00

  You know, like having to put more people on the assembly line when, you know, people are goofing off or not getting their job done. All right? Same idea. So you have to basically goose the liver to do its job. Well, that raises insulin levels all over the body. And once that happens, now you're taking energy from your bloodstream and putting it in fat cells for storage. So by getting the insulin down, so if it's insulin resistance, fixing the insulin resistance by getting rid of the fat in the liver, or if it's the insulin release at the beginning by lowering your refined carbohydrate, because that's the primary stimulus of that first spike,

• 55:30Speaker 00

  either way, it's refined carbohydrate and sugar. Get the insulin down.

• 55:35Steven Bartlett?

  And diabetes is when?

• 55:37Speaker 00

  Your pancreas can't keep up.

• 55:39Steven Bartlett?

  Okay, so it's really so much insulin, it goes, forget this, I'm done.

• 55:42Speaker 00

  Right. It's the end result of both of these phenomena.

• 55:48Steven Bartlett?

  Which we've now realized is reversible. I think there was a school of thought once upon a time that diabetes couldn't be reversed.

• 55:52Speaker 00

  That's right.

• 55:53Steven Bartlett?

  But it is reversible.

• 55:54Speaker 00

  It is very reversible, for a while. So let's be clear and honest about this. There is absolutely no doubt that what doctors learn in medical school is wrong. We are told, and I know because I was told, that diabetes is a chronic, progressive, unrelenting disease that never gets better, and that you will need medication, whether it be insulin or hypoglycemic or whatever, for the rest of your life. Garbage. Total, complete trash. Now...

• 56:36Speaker 00

  Verta Health, numerous other studies of various diets show that you can absolutely reverse type 2 diabetes. In order to do so, you have to get the pancreas to make insulin properly. And the only way to do that is to get the liver to respond to insulin properly. One way is to not challenge the liver, give the liver a rest. Well, it's metabolizing all that refined carbohydrate and sugar. Drop the refined carbohydrate and sugar and make your liver work better. A little keto?

• 57:20Speaker 00

  So, a ketogenic diet's the extreme version of this. It's not the only way, but it is a way. Paleo diet is another version. Fasting? Intermittent fasting will give your liver a chance to burn off the fat that's accumulated over the last 16 hours. There are many ways to skin this cat. Calorie counting? Almost never. Calorie restriction? Yes, calorie restriction. But it's got to be consistent and long term. And we've shown, numerous studies have shown, that as you restrict calories, that leptin resistance does not get better quickly. It takes years for that leptin resistance to finally go away.

• 58:04Speaker 00

  Like five years before you change the set point. Let's take a step back. So what does leptin do again? It's about energy? So leptin is made in your fat cells. Yeah. In response to driving energy into fat, the cell will make leptin, the leptin will circulate in the bloodstream, will go to your brain, go to your hypothalamus, and say, hey, I've got enough energy on board. Okay. To engage in expensive metabolic processes. So we don't need any more? I don't need to eat more, I can engage in puberty, I can engage in pregnancy. Okay. Okay, both of which are high metabolic processes. Okay.

• 58:46Speaker 00

  Okay, so it is like the servo mechanism, like the thermostat on your house. Okay, you have a floor but no ceiling. So when you're, when it's cold in your house, the heat kicks in. But if you don't have air conditioning... It can go higher, right? Same idea with leptin. Floor, no ceiling. So when your leptin goes below a certain threshold, your brain will see that as starvation.

• 59:14Steven Bartlett?

  You get really hungry.

• 59:15Speaker 00

  And so you will get both hungry and you will also sit on the couch.

• 59:18Steven Bartlett?

  Okay. Okay. So that's the way the activity component comes in because your brain is saying, listen, don't waste this energy.

• 59:26Speaker 00

  Exactly. Conserve.

• 59:27Steven Bartlett?

  Okay.

• 59:28Speaker 00

  Because we're in trouble here. We're in trouble down here. Okay? So eat more and don't move. That's the biochemistry that drives the behavior.

• 59:41Steven Bartlett?

  Why don't they have leptin injections?

• 59:43Speaker 00

  Well, they do.

• 59:44Steven Bartlett?

  Oh, really?

• 59:45Speaker 00

  But it turns out it doesn't work in leptin resistance because the problem is not that you're missing leptin. The problem is you have too much leptin. It's just not working. So adding more leptin is like throwing kerosene on the fire.

• 59:58Steven Bartlett?

  The receptor sites have stopped.

• 59:59Speaker 00

  Receptor sites are not there. Either they've been downregulated or they're being blocked. One or the other. If insulin blocks it, okay? Or they can be downregulated too. Both. Now, if you're leptin deficient, and there are 14 patients with leptin deficiency, and quite a few of them, by the way, are in the UK of the 14. And Sadaf Farouki and Steve O'Reilly at Addenbrooke's Hospital in Cambridge are the people who've done the most work on leptin deficiency. If you take a patient who's leptin deficient, they basically start gaining weight as soon as they're born. By age six months, they're already massively obese. By the age of, you know, three,

• 1:00:43Speaker 00

  they can't even fit through the door. Okay? They eat everything in sight and they don't move. You give them a shot of leptin because they're deficient. You're replacing what's missing.

• 1:00:58Speaker 00

  And they slim down like that.

• 1:01:01Steven Bartlett?

  They're genetically leptin deficient.

• 1:01:02Speaker 00

  They're genetically leptin deficient. They have a mutation in their leptin gene.

• 1:01:07Steven Bartlett?

  So obesity could be genetic in some very, very small cases.

• 1:01:11Speaker 00

  Very small number of patients. It is genetic, but that's not what's going on in the rest of the population. So yes, is obesity genetic for a small fraction? Sure, we have leptin deficiency. We have leptin receptor deficiency. We have PC1 deficiency. We have melanocortin 4 receptor deficiency. We have SIM1 deficiency. There are a whole host of different genes and nobody has them. Nobody has them, all right? Like 14 people have them. It's very rare for the reason for general garden variety obesity out in the world to be due to a genetic problem.

• 1:01:56Speaker 00

  This is an environmental problem.

• 1:01:58Steven Bartlett?

  In your book, you talk about environmental obesogens. I've never heard that term before. What does it mean?

• 1:02:03Speaker 00

  So obesogens are chemicals in the environment that actually drive weight gain. They cause the differentiation of fat cells or they cause the growth of fat cells. Now, fat cells are complex. Okay? You have a certain number, but you can increase that number, especially early on in life. There's a critical period before age two where you can actually increase the fat cell number. And once a fat cell is developed, it wants to stay filled.

• 1:02:38Steven Bartlett?

  I mean, we've got to pause here just for a second because I think most people think that when we eat food, we increase the number of fat cells we have.

• 1:02:45Speaker 00

  No, we increase the size of the fat cells we have.

• 1:02:48Steven Bartlett?

  This was a really, I learned this a couple of, a couple of years ago, and it kind of changed the way I think about a lot of things, including liposuction.

• 1:02:55Speaker 00

  Yeah.

• 1:02:55Steven Bartlett?

  Because with liposuction, you kind of think that you're taking away fat cells that you've added to your body through diet. But actually the fat cells stay the same. They just grow and shrink.

• 1:03:06Speaker 00

  Well, there's also a problem with liposuction as well.

• 1:03:10Speaker 00

  There are three fat depots. Okay, and they're not the same. On the scale, they're the same because you weigh a certain amount. But from a metabolic standpoint, they are not the same. So let's take each of the fat depots separately so that your audience will understand what it is that they're actually concerned about. So the first fat depot is the obvious, what we call subcutaneous or big butt fat. Belly fat as well? No, that comes later. Oh. That's the second one. Okay, subcutaneous. Subcutaneous, big butt fat, or does this bathing suit make me look fat? Fat. So are you saying that's good or bad? It's actually good. I agree. It's protective.

• 1:03:54Speaker 00

  The more of it, the less likely that you will have metabolic disease. It is the place where your body wants to put excess energy because it's safe. Now, most of us have a certain ability to grow that fat to a certain level before it starts becoming a problem. Eventually, you can overload that subcutaneous fat where you will actually make the fat vacuole, the little pocket of fat within the fat cell, grow so much that it will actually cause the border of the vacuole to decompensate. And now you've spilled the grease into the cell.

• 1:04:39Speaker 00

  That will kill the cell and that will cause inflammatory cells to congregate to try to clean up the grease. And then they secrete proteins called cytokines, which end up causing the metabolic dysfunction. In any case, you can overload your subcutaneous fat, but you have to work at it. So about how much fat does your subcutaneous fat have to grow before you become metabolically ill? On average, about 10 kilos, 22 pounds, some more, some less. Okay? Now, let's take the second fat depot. Belly fat, visceral fat, this fat here.

• 1:05:23Speaker 00

  Everyone's worst type of fat. Well, yes, but not because of cosmetics, because of metabolism.

• 1:05:33Speaker 00

  In any case, the visceral fat, the belly fat, is that due to calories? Is that due to weight gain? That is actually due to cortisol. That's due to stress. And the reason we know that is because you can take patients who have endogenous clinical depression. Okay? They are anhedonic. They don't eat because they generate no reward from life. They generate no reward from eating. They are losing weight. They have to be admitted to the hospital to keep them from killing themselves. So these are with people with suicidal ideation, who have to be admitted to psychiatric hospitals. You put them in a scanner,

• 1:06:19Speaker 00

  and it turns out they're losing subcutaneous fat because they're not eating. They're gaining visceral fat. Because the cortisol from the stress that goes along with the depression is actually laying down more fat in their belly.

• 1:06:35Steven Bartlett?

  Why?

• 1:06:37Speaker 00

  It's what cortisol does. Because when you're stressed, you need a readily available and metabolically active source of energy in case you're being chased by the lion. So that metabolic fat, that visceral fat, is eminently retrievable rapidly.

• 1:06:56Steven Bartlett?

  Oh, okay. Interesting.

• 1:06:59Speaker 00

  Okay. Now,

• 1:07:02Speaker 00

  how many pounds or kilos of visceral fat do you have to gain before you become metabolically ill?

• 1:07:10Steven Bartlett?

  I'm gonna guess it's not a lot, based on...

• 1:07:12Speaker 00

  That's right, not a lot.

• 1:07:13Steven Bartlett?

  So subcutaneous was 10 kilograms.

• 1:07:15Speaker 00

  That's right. Now we're talking about 2 kilograms.

• 1:07:18Steven Bartlett?

  Okay, so 2 bags of sugar.

• 1:07:21Speaker 00

  Yeah, pretty much. Okay. Now, finally, the third fat depot, liver fat. Now, how many kilos of liver fat can you accrue before you become metabolically ill?

• 1:07:38Steven Bartlett?

  Liver's really small, I have no idea.

• 1:07:41Speaker 00

  Okay. 1/4 of a kilo.

• 1:07:45Speaker 00

  Half a pound.

• 1:07:47Steven Bartlett?

  And when you become metabolically ill, then all of the dysfunction we talked about previously happens.

• 1:07:52Speaker 00

  That's right. So you can become metabolically ill and be thin. Because your subcutaneous fat's okay. Even your visceral fat's okay. But if you've got liver fat, can you measure a quarter of a kilo on the scale? No.

• 1:08:09Steven Bartlett?

  Have you heard the phrase skinny fat?

• 1:08:10Speaker 00

  That's, this is skinny fat. So TOFI, T O F I, thin on the outside, fat on the inside. Skinny fat was actually coined by Dr. Jimmy Bell at University College London. A neuroimager. That's exactly right. So just because you're overweight doesn't mean you're sick. And just because you're thin doesn't mean you're healthy. Because of these three fat depots. This is exactly what we're talking about.

• 1:08:37Steven Bartlett?

  So are skinny fat people typically more stressed if we kind of?

• 1:08:40Speaker 00

  They often are.

• 1:08:41Steven Bartlett?

  Often are you?

• 1:08:42Speaker 00

  They often are. The question is, how did that liver fat get formed? And the answer is sugar and alcohol. Because that's where sugar and alcohol go in order to be processed. And so that's why so many people now have fatty liver disease that never had it before. That's why children have fatty liver disease, even though they don't drink alcohol. Because they drink something that is metabolized just like alcohol.

• 1:09:07Steven Bartlett?

  Like apple juice.

• 1:09:08Speaker 00

  Like apple juice.

• 1:09:09Steven Bartlett?

  I've got a bottle of apple juice here in front of me. And on it, it says 40%, in big letters, 40% less sugar than 100% apple juice. It says with added vitamins A, C, and E. They've added all three vitamins in there. That must be.

• 1:09:27Speaker 00

  So that's not apple juice, that's an apple drink. To be, to be clear.

• 1:09:31Steven Bartlett?

  It says apple juice beverage here on the front.

• 1:09:33Speaker 00

  Beverage, ah, they called it a juice beverage, not juice. There's a, that, that's technically correct. But there's a, you know, reason they have to declare that from the FDA.

• 1:09:44Steven Bartlett?

  Why?

• 1:09:45Speaker 00

  Because they can't call it juice if it's not juice, if they've done something to it.

• 1:09:49Steven Bartlett?

  I mean, how would I know? It says apple juice beverage.

• 1:09:51Speaker 00

  I, well, that, that's part of the subterfuge. That's one of the reasons for all of these lawsuits. They have to call it a juice beverage because they've done something to it.

• 1:10:03Steven Bartlett?

  Okay, so I've got this apple in my pocket. This apple here.

• 1:10:07Speaker 00

  Right.

• 1:10:08Steven Bartlett?

  This is healthy.

• 1:10:09Speaker 00

  That is healthy.

• 1:10:10Steven Bartlett?

  But if I blend this down, it looks like this, no?

• 1:10:13Speaker 00

  Well, the question is, what was lost in the process of blending it down?

• 1:10:19Speaker 00

  You took away the good part.

• 1:10:22Steven Bartlett?

  The fibre.

• 1:10:23Speaker 00

  The fibre. By the way, you don't know if that apple is as healthy as it could be. And the reason is because you don't know if it was sprayed with pesticides. Was it an organic apple? Or was it just a standard commercial apple? If it was a standard commercial apple, you might have to wash it first.

• 1:10:38Steven Bartlett?

  Why?

• 1:10:39Speaker 00

  Because the pesticides can be environmental obesogens. Many pesticides, such as, I mean, the famous one was DDT. Now, it's been gone since 1972. Rachel Carson, you know, Silent Spring, you know, it was all about how DDT was, you know, environmentally affecting, you know, the entire world. Okay, we banned DDT in 1972, but you can measure the metabolite of DDT called DDE in pregnant woman's urine today, 50 years later. And that level of DDE in that pregnant woman is predicting obesity in her offspring 11 years later.

• 1:11:20Steven Bartlett?

  So let's go over these two subjects then. We've got environmental obesogens.

• 1:11:24Speaker 00

  Right.

• 1:11:24Steven Bartlett?

  I think I've pronounced that correctly. Let's finish off on that and then I want to get on to fibre. So environmental obesogens, which might be on this apple. What are they and where are they?

• 1:11:34Speaker 00

  So an obesogen is a chemical that causes weight gain, not because of its calories.

• 1:11:44Speaker 00

  Now, you say, how can something cause weight gain if it doesn't have calories? And the answer is, if it causes the differentiation or growth of fat cells, it will cause weight gain unrelated to calories. So we have chemicals in our environment that are unescapable.

• 1:12:04Speaker 00

  You can't escape air pollution. You can't escape forever chemicals like, for instance, PFAS. What's that? Polyfluoralkylated substances, Teflon. Remember Teflon? Yeah, yeah, the material. The material that nonstick pans were coated with? Yeah. That's PFAS. That was perfluorocyanic acid. Turns out that causes obesity by itself. It causes the differentiation and growth of fat cells. Tributal tin. This is what you paint on the bottoms of boats to keep barnacles from attaching to the hull.

• 1:12:45Speaker 00

  It's in all of our food supply, all of our water supply, all over the world. That causes fat cells to grow before you're born. Exposures to all sorts of things. BPA, bisphenol A. Okay? When you get your receipt, your paper receipt from Target, that's bisphenol A. Phthalates are plasticizers. You stick a binky in a baby's mouth, a pacifier. That's a plasticizer. That's got phthalates in it. That causes obesity. Parabens in cosmetics will cause obesity. Vinyl flooring.

• 1:13:30Speaker 00

  Flame retardants in children's clothing and in mattresses. All of these things will drive different receptors in the body and act as what we call endocrine disruptors. And those endocrine disruptors will change the differentiation and the growth of fat cells to increase adiposity. So what's an endocrine disruptor? So our cells have receptors. That way, communication from one area of the body to another can occur, like hormones bind to receptors. Well, sometimes they're not hormones. Sometimes there are other chemicals that cause differentiation of different areas of the body to form different organs.

• 1:14:15Speaker 00

  For instance, this is one of the things that goes wrong in congenital defects, like congenital heart disease. Okay? Receptor alterations. So we have receptors on all of our cells for different processes, for different chemicals.

• 1:14:31Speaker 00

  There are things in our environment that basically mimic endogenous signals to our body and basically tell different tissues to do different things than they ought to be doing because those things are present. And one of them is obesity.

• 1:14:49Steven Bartlett?

  In my head, I think of it like a, remember those toys you used to play with when you were a kid and it shows like a triangle shape and a circle shape and a square shape? And you've got to pick up the corresponding piece and slot it in the hole.

• 1:15:01Speaker 00

  Right.

• 1:15:01Steven Bartlett?

  I see it as things in our environment are pretending to be those shapes.

• 1:15:06Speaker 00

  Exactly.

• 1:15:07Steven Bartlett?

  And so they're sort of impacting with our receptor site.

• 1:15:09Speaker 00

  That's right.

• 1:15:10Steven Bartlett?

  Which is the hole and causing us to do things that are dysfunctional.

• 1:15:14Speaker 00

  That's right. And this is well known, has been known for years. We, you know, it's one of the reasons for the decrease in fertility, the changes in reproductive capacity. It's one of the reasons the alligator population in the Everglades is disappearing is endocrine disruptors. Well, it also has effects on neurocognition and brain development. And potentially, I don't want to, you know, get too far afield, but potentially might play a role in autism. We haven't proven that yet. I want to make that clear. But without question, some of these chemicals can cause fat cells to differentiate and grow.

• 1:15:53Steven Bartlett?

  So if they're everywhere, what do I do about it? Because it feels like I can't touch the floor. I can't, I can't go to, I can't lay in a bed. I'm like.

• 1:15:59Speaker 00

  Well, you can't do much about air pollution. I mean, except as a society, we can do something. We can't do much about the Teflon in the, in the water or the TBT in the water, except to try to pass regulations to control those things. But, you know, get, get Congress or Parliament to do that. You know, that's a, that's a real trick.

• 1:16:20Steven Bartlett?

  Is there better water that I can drink? Sorry, just on that point?

• 1:16:23Speaker 00

  Well, you can try. Certainly tap water is going to be a problem. But the fact is some of the bottled waters still have obesogens. And to be honest with you, if they're, if it's bottled, the obesogen might be in the bottle. Canned foods.

• 1:16:42Speaker 00

  If you look at the inside of the can, what color is it? Is it? Silver, isn't it? Silver, or is it white?

• 1:16:50Speaker 00

  If it's white, that's BPA. So canned foods have high BPA levels. BPA is an estrogen, okay? And it doesn't take much to be an estrogen. 22 angstroms, two hydroxyl groups, you're an estrogen. There are a lot of chemicals in our environment that masquerade as estrogens, and BPA is one of them. And estrogen causes fat deposition. Just look at the curves of a woman. That's estrogen causing fat deposition. Well, BPA can do that, too.

• 1:17:23Speaker 00

  So as an example. But there are also things in our food that we think are food. And one example is fructose. Now, fructose has calories, true, but fructose has all these effects on mitochondria that have nothing to do with its calories. In the same way that alcohol has calories, but alcohol has toxic effects that have nothing to do with its calories. So just because something has calories doesn't make it a food. What's the definition of food, Stephen? I will tell you. I was gonna say, don't ask me. Substrate that contributes to either growth or burning of an organism. So here's the question.

• 1:18:07Speaker 00

  Does ultra-processed food contribute to growth? My colleague, Dr. Ephraim Manzenigo Ornan, who is the chairman of nutrition at Hebrew University of Jerusalem, has looked at this question. In fact, ultra-processed food inhibits growth. Populations that are exposed to high ultra-processed food consumption have lower final heights than populations that are not. So if it's inhibiting growth, not a food. Okay, now let's take burning. I've already told you that there are three enzymes that fructose, which is in 73% of the items in the American grocery store, it inhibits burning because it inhibits mitochondrial function.

• 1:18:51Speaker 00

  So if you don't stimulate growth and you don't stimulate burning, is that a food?

• 1:18:57Steven Bartlett?

  No.

• 1:18:58Speaker 00

  So if it's not a food, what is it?

• 1:19:00Steven Bartlett?

  Poison.

• 1:19:01Speaker 00

  So food can be medicine. Food can also be poison. And the question is, how do you figure out which is which? When you walk into the grocery store, it all looks the same. But in fact, there are things in there that will contribute to growth and burning, and there are things that will inhibit it. And we need some method for being able to distinguish those. We have it. We made it. It exists on your computer. It will ultimately, soon, exist on your phone. And you will actually be able to order your food to be metabolically healthy without ever having to walk into

• 1:19:46Speaker 00

  that minefield of a grocery store ever again. How would that be? And just buy the stuff that's good for you instead of chancing the stuff that's bad for you. It's called perfect. And what it does is it will filter out all of the stuff in the grocery store that's metabolically unhealthy for you. Not for the next guy, for you. You can apply specific filters that will, if you're gluten free, it will take out all the things that have gluten. So you don't have to look at the label. If you are, if you have metabolic syndrome, it will take all the refined carbohydrate and all the sugar things out. So you don't even have to look at them. If you specifically want to avoid the ultra-processed food,

• 1:20:31Speaker 00

  it will take those out. By the way, that will cut the items that you can see in the grocery store by 80%.

• 1:20:37Steven Bartlett?

  Let's talk then about fiber. We talked about it briefly, but I want to just really close off on the point of fiber. Because you said that when we take an apple here, like the apple in my hand, and we turn it into this thing in my hand, this apple juice.

• 1:20:50Speaker 00

  Right.

• 1:20:51Steven Bartlett?

  The harm is that they're removing the fiber. Why does that matter?

• 1:20:55Speaker 00

  So everyone thinks that fiber is the stuff you throw in the garbage after you've juiced the fruit. We were told forever that the juice had the essential vitamins and minerals, like the vitamin C, or the lycopene, if you're a tomato. And that's true, they do. But turns out, the fiber is essential. It's just not essential for you. It's essential for your bacteria. It's essential for your microbiome. That's what your bacteria want to eat.

• 1:21:38Speaker 00

  You have to feed your microbiome. You know, we always say, when women are pregnant, you're eating for two? Well, we're always eating for 100 trillion. Okay? The 100 trillion are in our intestine. And what you feed them matters. Because if you feed them well, you will have what we call bacterial diversity, and you will not have any one species overwhelming any other species. And that will actually contribute to metabolic health. It will allow for the barriers in the intestine to work properly. The mucin layer, the tight junctions, the immunologic barrier called the TH17 cells.

• 1:22:21Speaker 00

  Your intestine will present the appropriate barrier so that bad stuff in your intestine won't get into your bloodstream to cause systemic inflammation. So, feeding your gut is job one. And what does your gut like to eat? It likes to eat fiber. Now, we humans don't have the enzymes to digest fiber. You need specialized enzymes. The bacteria have them. So the fiber is the food for the bacteria. When you take the fiber out of the food, you're starving the bacteria. Now, how many grams of fiber are we supposed to eat every day?

• 1:23:04Speaker 00

  Our ancestors ate between 50 and 100 grams of fibre a day. The USDA says we're supposed to consume 25 grams of fibre per day. How many grams do we actually consume here in America? And by the way, UK's the same. Mean 12. So we're getting half the amount the USDA says and one quarter the amount our ancestors did. And the question is, does it matter? The answer is, oh yeah, it matters big. Because what happens is, when you feed fibre to the bacteria, you get multiple species instead of one, that basically crowd out all the others.

• 1:23:47Speaker 00

  And you get this metabolic biodiversity and it basically improves your metabolic health. In addition, the bacteria will chew that soluble fibre up into a compound called short-chain fatty acids. Acetate, propionate, butyrate, valerate. Butyrate is particularly helpful. It is an immune suppressant. It keeps your immune system in check. It's one of the reasons that Covid was worse for people who were obese and who had pre-existing conditions like metabolic syndrome and also, of course, minority populations.

• 1:24:30Speaker 00

  Because of ultra-processed food consumption and lack of fibre, lack of short-chain fatty acids, therefore, lack of ability to fend off foreign invaders because their immune systems were not tamped down. Where did the fibre go? They took it out. Why? Because you can't freeze fibre. So, that apple, okay? Yeah. Okay? Your homework assignment for tonight. Take that apple and put it in your freezer overnight.

• 1:25:06Speaker 00

  Take it out in the morning, put it on the kitchen countertop. Let it thaw. Try to eat it. See what you get.

• 1:25:14Steven Bartlett?

  What am I gonna get?

• 1:25:16Speaker 00

  Mush.

• 1:25:17Steven Bartlett?

  Oh, really?

• 1:25:18Speaker 00

  Now, why does that turn it into mush? The ice crystals that form will macerate the cell wall and let all the water rush in.

• 1:25:26Steven Bartlett?

  Okay.

• 1:25:27Speaker 00

  They turn it into mush. Food industry knows that. So what do they do? Squeeze it and freeze it. Now it lasts forever. Now you've got apple juice or frozen concentrated orange juice. You have taken a fruit, which is food, and you have turned it into a commodity. Storeable food, which you can sell on the commodities exchange because it won't go bad. So it has a price, and that price will fluctuate, and you can then bet on the commodities exchange. But you can't sell fruit like that because it'll go rancid by the time you've sold it anywhere.

• 1:26:05Steven Bartlett?

  So all these people are doing this to us. What responsibility do I have on a personal level? Because, you know, if these companies, the big companies with all this money, trillions of dollars, they're all manipulating me, bastardizing my food.

• 1:26:17Speaker 00

  Indeed.

• 1:26:18Steven Bartlett?

  They're, you know, they're hacking my brain, giving me these adverts.

• 1:26:21Speaker 00

  Yep.

• 1:26:22Steven Bartlett?

  I am, it's easy to fall into the trap of thinking, listen, I'm a victim here.

• 1:26:25Speaker 00

  Well, you are because you've been hacked as we started this, you know, the podcast. Okay, you've been told one thing, and the real world is actually something else. Okay, you've been hacked. You've specifically been hacked with the notion that processed food is food. Everyone thinks that because they called it processed food. Maybe they shouldn't call it processed food. Maybe they should call it processed nutrients. Because the stuff that's in it are nutrients, but it's not food. Because it doesn't do what food does, which is contribute to growth or burning.

• 1:27:05Speaker 00

  So the question is, what's your responsibility? And what's society's responsibility? So this is a very important question, and it's a question, you know, that comes up all the time.

• 1:27:21Speaker 00

  Personal responsibility, does it exist? Well, in order to exercise personal responsibility, first you have to exercise free will. That's a prerequisite. So, we can get into this and we probably would need about six hours. Okay, and we don't have it. But do we have free will? Yes or no? Complicated question.

• 1:27:45Steven Bartlett?

  It's a complicated question and it's one I've actually been researching this week, funnily enough, for a different project that I'm working on.

• 1:27:50Speaker 00

  Okay.

• 1:27:51Steven Bartlett?

  And I was trying to find, get to a point where I had a solid answer. Now, there's a couple of schools of thoughts here. One school of thought, when we look at the neurological processes, might suggest, and there's some early studies that suggest, that we have much less free will than we assume, because things happen in our brain before we make a decision. There's some studies that...

• 1:28:14Speaker 00

  Indeed.

• 1:28:15Steven Bartlett?

  But do we have free will to make our own decisions? I think we have a lot less free will than we think.

• 1:28:25Speaker 00

  We have very little free will.

• 1:28:27Steven Bartlett?

  Yeah.

• 1:28:28Speaker 00

  If at all. Here's the best way to think of it. Arthur Schopenhauer, famous German philosopher, famously said, "You are allowed to do what you want, but you are not allowed to want what you want." Those things are actually predetermined. So, you have choice in whether you want the candy bar or the ice cream, but you don't have choice about the fact that your nucleus accumbens is raging, saying, "Give me sugar." That's the choice. The choice is how you satisfy the biochemical drive. But the biochemical drive has, you know, is way beyond free will.

• 1:29:15Speaker 00

  So the question is, if you don't have free will, how can you exercise personal responsibility? Because that's a prerequisite in order to be able to do that. Because personal responsibility says, take the risks, suffer the consequences. But if you can't control the risks or the consequences, how can you exercise personal responsibility? I have just shown you that the behaviors associated with obesity, the gluttony and the sloth, are actually secondary to the biochemistry, which you have absolutely no control over. In fact, we have no ability to be able to mitigate that. And that's why we have this obesity pandemic.

• 1:29:58Speaker 00

  And you know, diet and exercise hasn't solved it for just that reason.

• 1:30:04Steven Bartlett?

  So who do we need to point the finger at? Who needs to resolve the issue?

• 1:30:07Speaker 00

  Well, it has to be resolved at several levels. It has to be resolved for the public. And that's why you and I are doing this podcast now. Because they have to understand what's really at issue. Okay, blaming the victim has never worked. When did it work? Did it work for HIV? Did it work for tobacco? It never worked. Okay, every personal responsibility issue becomes a public health crisis. Because personal responsibility hasn't solved any of them. It's a loser. It's a loser in terms of its mechanism. And it's a loser in terms of its efficacy. Doesn't work.

• 1:30:49Steven Bartlett?

  Can I throw a thought into there as well? Because in some areas of our lives where we do have discipline, we tend to have a bias towards assuming everyone else doesn't have discipline, and that's what they're missing.

• 1:31:00Speaker 00

  Right.

• 1:31:00Steven Bartlett?

  If that makes sense.

• 1:31:01Speaker 00

  Yeah, great way to blame.

• 1:31:03Steven Bartlett?

  People listening to this that don't struggle with diet and sugar and all of those things and whatever, all those subjects, well, their brain will probably be thinking, God, you can just choose not to. I choose not to all the time. I choose not to have the kind of fizzy drink all the time.

• 1:31:21Speaker 00

  Because their nucleus accumbens is not going off like a Christmas tree.

• 1:31:25Steven Bartlett?

  Why is it not going off like a Christmas tree?

• 1:31:26Speaker 00

  We don't know yet. Why do some people smoke and some people don't? Why do some people drink and some people don't? Look, 40% of Americans are teetotalers. Never touch the stuff. Forty percent are social drinkers, can pick it up, put it down, you know, no problem. I'm in that category. Twenty percent are binge drinkers, I'm sorry, ten percent are binge drinkers and ten percent are chronic alcoholics. What distinguishes the twenty percent who have a problem from the eighty percent who don't? We don't know yet. To this day, we still don't know, but we know that for that twenty percent, it is a problem. We also know there's this thing called sugar addiction. And there's going to be, on May seventeenth in London, the International Conference

• 1:32:09Speaker 00

  on Food Addiction, I will be the keynote speaker, to discuss exactly this issue. Is there such a thing as food addiction? And if there is such a thing as food addiction, does it portend a need for societal remediation? Or is this really just a personal responsibility issue? Well, everything that is both toxic and addictive has required some sort of societal intervention. Okay? So, you have things that are toxic but not addictive, like oxygen and water, you don't have to regulate those. You have things that are addictive but not toxic, like caffeine. Well, you don't have to really regulate that either, unless you add it to alcohol, in which case then you have foreloco, and then you get arrhythmias, and then you do

• 1:32:54Speaker 00

  have to regulate it. But what if you're both toxic and addictive, like cocaine, or alcohol, or nicotine, or heroin? For those, we all have societal intervention. You know, rehab for the personal, and laws for the societal.

• 1:33:14Speaker 00

  For sugar, for ultra-processed food, we have nothing.

• 1:33:20Speaker 00

  It's the same issue, nothing different.

• 1:33:24Steven Bartlett?

  So you want regulation from the government on sugar?

• 1:33:29Speaker 00

  I think that the industry has to be told what to do. They haven't yet. Now, the question is, would it work? And the answer is, yeah, it would. And actually, who found out that it would work? The UK. You did it. You did it back in the 2000s. So in 2003, the Blair government...

• 1:33:55Speaker 00

  Brought all of the UK food manufacturers to the table in secret. So Waitrose and Tesco and M&S and, you know, every other CPG purveyor in the UK. And had a secret meeting and were told and told them, look, hypertension is running rampant and stroke is breaking the NHS bank. And it's because of the sodium. We have to get the sodium levels in ultra-processed foods down. So every one of you is going to play by the same rules so that there's no competitive disadvantage.

• 1:34:40Speaker 00

  And you're all going to reduce the amount of sodium in each of your items by 10% per year over a three-year period so that there will be 30% less sodium three years from now. In 2006, it was 2007, I think, at the time. And they all did. And they didn't tell the public. And in 2011, famous paper in British Medical Journal showed a 40% reduction in hypertension and stroke due to this public health intervention that the Blair government did without telling the public. It works. Should've told the public. No, don't tell the public.

• 1:35:25Speaker 00

  So would this work for sugar? So I am working with a company in the Middle East right now. Okay, I don't take money. It's a, you know, I do this because it's the right thing to do. It's called Kuwaiti Danish Dairy, KDD. It's like the Nestle of the Middle East. And they make all sorts of junk. They make flavored milks, they make ice cream, they make frozen yogurt, they make biscuits, they make confectionery, they make tomato sauce. Okay, like all bad stuff. They came to me in 2020 and said, we want to be a metabolically healthy company. We want to do the right thing.

• 1:36:06Speaker 00

  Because right now Kuwait has an 18% diabetes rate and an 80% obesity rate, and we don't want to be the cause of it. Can you help us re-engineer our product portfolio to be metabolically healthy? And so we convened convened the scientific advisory team and we've worked for the past three years to develop a set of guidelines, a set of principles, and we have developed what we call the metabolic matrix. Three principles, three precepts, to turn food metabolically healthy. And here they are. Protect the liver, feed the gut, support the brain.

• 1:36:49Speaker 00

  Any food that does all three of those is healthy, whether it's ultra-processed or not. Any food that does none of the three is poison, whether it's ultra-processed or not. Now, why those three organs? Because if you, the data show in the literature, if you fix those three organs, all the downstream organs also get fixed. Whereas if you fix other organs, those three organs don't get fixed. So those three organs are primary. And all the data shows that if you fix those three, you can actually improve both morbidity and mortality. So that's the goal. That's the rubric.

• 1:37:32Speaker 00

  Protect the liver, feed the gut, support the brain. So, could we apply that principle to the food supply? Can any individual apply it to their own grocery purchases? Use perfect, you'll get it. Can the government do it? Yeah, they did it in the UK. They can do it again. It's not crazy. It can be done. The fact is, we're all carrying a belief system around. Okay? And now, where'd that belief system come from? The belief system is that ultra-processed food is food. Yeah. Where'd it come from? Came from the food industry. They told us so.

• 1:38:15Steven Bartlett?

  The scientists and governments told us so as well, though.

• 1:38:17Speaker 00

  Oh, yeah.

• 1:38:18Steven Bartlett?

  If you look back through history. So how do we know the scientists and governments are telling us the truth now?

• 1:38:22Speaker 00

  That's a very good question. That's a super question. How do you know what's true? We're in this problem right now.

• 1:38:33Steven Bartlett?

  I'm worried that in 20 years' time, I'm going to be sat around this podcast, if people are still listening, and I'm going to be sat with another scientist, and he's going to be saying, do you know that the Dr. Robert Lustig, who you had on 20 years ago? Everything he said has been disproved. And he's going to say fructose is the key. Apple juice is really important. We found out that vegetables are causing autism.

• 1:38:52Speaker 00

  Did you ever see the movie Sleeper?

• 1:38:54Steven Bartlett?

  No.

• 1:38:54Speaker 00

  Woody Allen, 1973.

• 1:38:56Steven Bartlett?

  Honestly, I've seen no movies.

• 1:38:58Speaker 00

  He wakes up after 200 years in suspended animation, and he finds out that hot fudge and deep fat are good for you. Said, oh, we've debunked all the stuff from before. So I get this question all the time. Everything we knew 10 years ago is already wrong. And everything we know today will be wrong 10 years from now. So if everything we know today will be wrong 10 years from now, why do anything about it? Because no matter what it is, it's likely to be wrong. This is known as the pessimistic meta-induction theory. This is how the Dark Ages started. The idea of dogma.

• 1:39:43Speaker 00

  There's only one dogma, Stephen. And the dogma is that there is no dogma. Because everything has to be refined.

• 1:39:53Steven Bartlett?

  Dogma. How do you define the word dogma?

• 1:39:55Speaker 00

  Dogma means you take it on faith.

• 1:39:58Steven Bartlett?

  Okay.

• 1:39:59Speaker 00

  You take it on faith. Okay, that's what science is for, is to debunk the previous generation's dogma. If we didn't do that, okay, we'd still be using leeches. Okay, we've debunked that dogma. We would still think that seizures were demonic possession. We've debunked that dogma. Okay, ultimately, science is not a straight line. It's a zigzag. But it still moves forward. So if I end up being discredited 10 years from now, 20 years from now, 30 years from now, hey, I was a cog in the wheel. At least I drove the vehicle forward. That's okay.

• 1:40:42Steven Bartlett?

  And science is really a process, isn't it?

• 1:40:45Speaker 00

  Exactly. It is a process.

• 1:40:47Steven Bartlett?

  It's not a religious belief. It's not a set of answers. It's just a process to uncovering information, I guess.

• 1:40:54Speaker 00

  But you have to then evaluate each piece of information for its veracity.

• 1:40:58Steven Bartlett?

  Yeah.

• 1:40:59Speaker 00

  Because the problem with information is we are now peppered with disinformation. And how do you determine what's real and what's not?

• 1:41:08Steven Bartlett?

  You say that to achieve contentment, you recommend following the four Cs for contentment.

• 1:41:14Speaker 00

  Indeed.

• 1:41:15Steven Bartlett?

  What are the four Cs?

• 1:41:16Speaker 00

  By the way, if you follow the four Cs, you will be a whole lot better off in terms of your understanding, information versus disinformation. So in my book, Hacking of the American or Contemporary Mind, I talk about ways to lower your dopamine, reduce your cortisol, and raise your serotonin. And they're all four things your mother told you, and they're all free, and they're all available to everyone on the planet. Number one, connect. Now, connect does not mean through Facebook. Connect does not mean digital connection.

• 1:42:01Speaker 00

  It means social connection. It means what we're doing right now, face to face, eye to eye. Now, why does Facebook not work? Why does Zoom not work? You're looking at somebody eye to eye.

• 1:42:15Speaker 00

  They've now done the imaging studies. Okay, there are a set of neurons in the back of your head in the occipital cortex called mirror neurons. And they are not just reading the lips of the person you're talking to. They are reading the facial structures and the muscle movements. And they are actually transducing the emotion from the person you're talking to. When you're watching on a screen, it flattens out, you can't tell. And so you don't get the same information. That information ultimately generates a serotonin signal. So you get contentment. So, social connection actually drives contentment. So that's number one.

• 1:42:58Speaker 00

  Number two, contribute. And that does not mean to your retirement account. It means contribute to others. Okay? Contribute with purpose, like Habitat for Humanity. Basically, giving to others. Because when you give to others, you feel better yourself. Okay? That generates a serotonin signal. So, you know, lottery winners, you know, are not happy. But the people who actually give their money away are. And that's one of the reasons why we have philanthropy. Makes people feel better.

• 1:43:36Steven Bartlett?

  Quite selfish in that regard then, isn't it?

• 1:43:38Speaker 00

  Well, yes, indeed. It seems selfless, but it's actually selfish, which is fine. It works just great. Number three, cope. And cope is three things. It's sleep, mindfulness, exercise, all of which are necessary to tamp down cortisol. Because if you're sleep deprived, your cortisol goes through the roof. If you are distracted, multitasking, your cortisol goes through the roof. Okay, and if you're sedentary, okay, number one, you're eating like crazy and your cortisol also goes through the roof. Sleep, mindfulness, exercise, all things to get your cortisol down. And finally, number four, the last C, cook.

• 1:44:20Speaker 00

  Why? Because there are three things that contribute to this dopamine serotonin imbalance. The first, tryptophan. Tryptophan is the precursor to serotonin. Tryptophan is not an ultra-processed food. It is the rarest amino acid. You find it in eggs, chicken, fish, not exactly ultra-processed food. Number two, fructose. Fructose reduces serotonin. Okay? And there's lots of fructose in the ultra-processed food. And finally, lastly, omega-3 fatty acids. And omega-3 fatty acids are in, again, eggs and in marine life. Okay? There's a little bit of omega-3s in vegetables, you know, ALA, which is, doesn't reach the brain.

• 1:45:03Speaker 00

  So that's not a, that's not a big winner for fixing this problem. So you need high tryptophan, low fructose, high omega-3s. Sounds like real food to me. So connect, contribute, cope, cook. It will tamp down your dopamine, reduce your cortisol, raise your serotonin, improve your mental health, improve your metabolic health, and will solve your problem. It won't solve societies. We have to work on getting the whole world to understand what the problem is before we can fix it.

• 1:45:45Steven Bartlett?

  Dr. Robert Lustig, what is the thing we haven't talked about? The most important topic we haven't talked about that we should have?

• 1:45:53Speaker 00

  Well, well, we have a systemic health crisis. Diabetes, metabolic syndrome, dementia, cancer. We have a mental health crisis, depression, suicide, schizophrenia, autism, ADD. We have a global health crisis. We have cyberbullying, we have social inequality, we have war, we have climate change, planet

• 1:46:36Speaker 00

  is immolating. All at the same time. Coincidence?

• 1:46:45Speaker 00

  Or are these somehow inextricably related? Are these the same thing? Or are these different things? If we believe they are separate, we're going to solve, try to solve each one individually and never get to the root cause. The root cause is our amygdala, the fear center of our brain. It's under attack. From all of the things we've talked about today, that dysfunctional amygdala is the driver of chronic disease. It is the driver of the mental health crisis.

• 1:47:26Speaker 00

  It is the driver of the global health and planetary crisis. There are four brakes on the amygdala, and they're all dysfunctional today. And they're all dysfunctional because of the things we've talked about today. Because of cortisol, because of stress, because of ultra-processed food, because of sleep deprivation, because of the change in the environment, because of air pollution, because of all the things that ultimately impact our brain's ability to transduce information. Until we recognize where the problem is, we're going to be spinning our wheels. We can do this.

• 1:48:10Speaker 00

  We can back out the same way we drove into this ditch. But you can't solve a problem until you know what the problem is.

• 1:48:21Steven Bartlett?

  Dr. Robert Lustig, thank you so much. We have a closing tradition on this podcast where the last guest leaves a question for the next guest, not knowing who they're leaving it for. And the question that's been left for you is, here we go, let's have a look. Okay, nice question. What would you tell your 20-year-old self that you wish you knew and that would have positively impacted your life and avoided pain?

• 1:48:52Speaker 00

  I wish I had known that I didn't have to please everyone.

• 1:49:03Speaker 00

  There's a book called The Courage of Being Disliked.

• 1:49:08Speaker 00

  It's courageous to be disliked. I was afraid of being disliked. And because I was afraid of being disliked, I was disliked.

• 1:49:22Steven Bartlett?

  It's such a paradox.

• 1:49:23Speaker 00

  I wish I had known that nugget of truth early on in my career.

• 1:49:32Steven Bartlett?

  Thank you so much, Dr. Rupert.

• 1:49:33Speaker 00

  My pleasure. Thank you, Stephen.

• 1:49:35Steven Bartlett?

  I have to say, your work is exceptional. Your books are incredible. I've got three of them here, but I know that there's many more. I'd recommend them all incredibly highly. The Hacking of the American Mind is a fantastic book. That doesn't just apply to Americans. It applies to all industries around the world, all Western economies around the world, which are set up in very similar ways. Fat Chance, another book that I've been through in detail, is about beating the odds against sugar processed food obesity and disease, which covers much of your work and the studies that you referenced today. An incredible, incredible book. And I also have this book called Metabolical. Did I pronounce that correctly?

• 1:50:10Speaker 00

  You did.

• 1:50:11Steven Bartlett?

  Metabolical: The Lure and the Lies of Processed Food Nutrition and Modern Medicine, which is a little bit of a bigger book, but it's, it gives more of the foundations around metabolism, which I think a lot of people don't understand. So, thank you. Thank you for your brilliance in so many ways. But thank you for your life's work, because your life's work is saving lives. It's propelling us forward. It's driving a conversation forward. And you do it in a way that's so unbelievably engaging that it's hard not to pay attention. So, thank you, Robert.

• 1:50:37Speaker 00

  Well, thank you. And thank you for doing what you do.