Welcome to the huberman Lab podcast where we discuss science and science based tools for everyday life. I'm Andrew huberman, and I'm a professor of neurobiology and Ophthalmology at Stanford School of Medicine. My guest today is dr. Robert lustig. Dr. Robert lustig is an endocrinologist. That is he's a specialist in the function of hormones in the body and a professor of Pediatric Endocrinology at the University of California San Francisco. He has authored more
than 100 peer-reviewed studies.
Exploring how different types of nutrients that is food impact our cellular functioning our organ functioning and
thereby our health during today's discussion. We discussed the idea of whether or not a calorie is indeed a calorie and whether or not our body
weight and body composition only reflects the number of calories. We eat versus the calories that we burn we talked about how different food types that is how the different
macronutrients protein fat and carbohydrates are processed in the body and the important role
that
/ and the gut microbiome plays in that process and we
pay particular attention to the topic of how different types of sugars and fructose in particular can indeed be addictive to the brain and can modify the way that hormones in the body in particular insulin impact our Liver Health Kidney Health and indeed the health of all of our cells and organs indeed. Dr. Lustig is an expert in how sugar impacts the brain and body we talked about how certain types of sugars can indeed be a
Given the same way that certain drugs of abuse and behaviors can become addictive. So in other words how sugar actually changes the way that the brain works and we discuss how the food industry that is the commoditization and sale of particular types of food has altered the way that we eat and indeed the foods that We crave today's discussion covers all of that and by the end of today's discussion, you'll have a thorough understanding of how foods are processed when they enter your body and how those different food choices are impacting your
Immediate and long-term Health before we begin I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is however part of my desire and effort to bring zero cost to Consumer information about science and science related tools to the general public in keeping with that theme. I'd like to thank the sponsors of today's podcast. Our first sponsor is eight sleep eight sleep makes Smart mattress covers with cooling Heating and sleep tracking capacity spoken many times before in this podcast about the fact that sleep is the foundation of Mental Health.
Physical health and performance now a key component of getting a great night's sleep is that in order to fall and stay deeply asleep your body temperature actually has to drop by about 1 to 3 degrees. And in order to wake up feeling refreshed and energized your body temperature actually has to increase by about 1 to 3 degrees one of the best ways to make sure that those temperature changes occur at the appropriate times at the beginning and throughout and at the end of your night when you wake up is to control the temperature of your sleeping environment, and that's what eight sleep allows you to do. It allows.
Allows you to program the temperature of your mattress and sleeping environment such that you fall and stay deeply asleep easily and wake up each morning feeling incredibly refreshed and energized. I've been sleeping on an eight Sleep mattress cover for almost three years now and it has dramatically improved the quality of my sleep so much so that when I travel and I'm at a hotel or an Airbnb and I don't have access to my eight sleep I very much look forward to getting home because my sleep is always better when I sleep on my eight Sleep mattress cover. If you'd like to try eight sleep you can go to eight sleep.com.
Huberman to get $150 off their pod three mattress cover each sleep currently ships in the USA Canada UK select countries in the EU and Australia again. That's eight sleep.com hubermann. Today's episode is also brought To Us by levels levels is a program that lets you see how different foods affect your health by giving you real time feedback on your diet using a continuous glucose monitor one of the most important factors in your immediate and long-term health is your blood sugar or blood glucose regulation with
Bowls, you can see how different foods and food combinations exercise and sleep patterns impact your blood glucose levels. It's very easy to use. You. Just put the monitor on the back of your arm. And then you take your phone and you scan it over that modern out again and it downloads the data about your blood sugar levels in the preceding hours using levels has allowed me to learn a tremendous amount about what works best for me in terms of nutrition exercise work schedules and sleep. So if you're interested in learning more about levels and trying a continuous glucose monitor,
You can go to levels dot link / huberman levels has launched a new CGM sensor that is smaller and has even better tracking than the previous version right now. They're also offering an additional two free months of membership again that's levels dot link / huberman to try the new sensor and to free months of membership. Today's episode is also brought To Us by Aeropress Aeropress is similar to a French press for making coffee, but is in fact a much better way to make coffee. I first learned about Aeropress well over 10 years ago.
Go and I've been using one ever since Aeropress was developed by Alan Adler who was an engineer at Stanford and I knew of Alan because he had also built the so-called Aerobie frisbee, which I believe at one time perhaps still now held the Guinness Book of World Records for furthest thrown object and I used to see Alan believe or not at parks around Palo Alto testing out different Aerobie frisbee. So he was sort of famous in our community for developing these different Feats of engineering that turned into
Marshall products now, I love coffee. I'm somebody that drinks coffee nearly every day. Usually about 90 to 120 minutes after I wake up in the morning. Although not always sometimes if I'm going to exercise I'll drink coffee first thing in the morning, but I love love love coffee and what I've personally found is that by using the Aeropress I can make the best possible tasting cup of coffee. I don't know what exactly it is in the Aeropress that allows the same beings to be prepared into a cup of coffee that tastes that much better as
Compared to any other form of Brewing that coffee even the traditional French press the Arrow Press is extremely easy to use and it's extremely compact. In fact, I take it with me whenever I travel and I use it on the road in hotels even on planes. I'll just ask for some hot water and I'll Brew my coffee or tea right there on the plane. If you'd like to try Aeropress, you can go to Arrow press.com huberman, that's 80 ROP ress.com huberman to get 20% off any Aeropress coffee maker Aeropress ships.
We're in the USA Canada and over 60 other countries around the world. Again, that's Arrow press.com huberman to get 20% off and now for my discussion with dr. Robert lustig. Dr. Robert lustig welcome pleasure. Truly just being here being invited high honor really appreciate it and it's not doctor has just robbed. Okay, Rob. I've been looking forward to this conversation for a long time. I've seen your
Now famous, we also say Infamous, but famous YouTube video about sugar will put a link to it in the show notes captions. It's been viewed many many millions of times. Yeah, and I still can't figure out why that is, you know, well, I didn't think my mother would watch it and she didn't but twenty four and a half million people did well, I think people are very interested in what to eat what not to eat and we'll start off simply talking about what most everyone believes and understands
Is that a calorie is a form of heat energy?
That's given off during the processing of some food bit or something. If that's mysterious to people just understand that a calorie is a unit of energy and I was taught and still many many people worldwide believe that a calorie is a calorie meaning if I consume more calories in whatever form then I metabolized by thinking feeling moving exercising etcetera. Then I will gain weight and if I
Consume fewer calories than I burn I will lose weight and we could talk a lot about where that weight loss comes from does it come from adipose body fat stores or from muscle or from protein or muscle of course is protein Etc. But let's start off with is a calorie truly a calorie when it comes to the processing of different types of calories. Everyone thinks that obesity is about energy balance.
Once that is calories in calories out there for two behaviors gluttony and sloth therefore. If you're fat, it's your fault therefore diet and exercise. Therefore any calorie can be part of a balanced diet. Therefore don't pick on our calories. Go pick on somebody else's calories. This is actually what the food industry uses to assuage their culpability.
For the change in the food supply and the rise in obesity and chronic disease like diabetes now, it is true that a calorie is that unit of energy that raises one gram of water one degree Centigrade. And so therefore a calorie burned is a calorie burnt. I don't argue that that's true. That's you know, the first law of thermodynamics.
But that doesn't mean a calorie eaten is a calorie eaten. That's not the same and that's where people get it wrong. So let me give you some examples of how that calorie eaten is not a calorie eaten.
You like almonds? I do me too. I'm these are great eat 160 calories in almonds. How many of those do absorb?
130
you eat 160 absorb 130 where the other 30 go in the processing of that food energy. No turns out the fiber in those almonds both soluble and insoluble fiber and by the way fibers sort of the key to the kingdom in the story.
Forms a gel on the inside of your intestine the insoluble fiber the cellulose forms a fishnet if you will a latticework on the inside of your duodenum the soluble fiber which are globular plug the holes in that fishnet together. They form a secondary barrier. You can actually see it on electron microscopy a whitish gel and that prevents absorption of those 30 calories. So yes 130 get absorbed but
Any of them don't they end up going further down the intestine to the next part called the jejunum and that's where the microbiome is. Now everyone knows about the microbiome nowadays, you know, it's all the bacteria, you know, we always say when women are pregnant you're eating for two. Well, we're always eating four hundred trillion. Now they have to eat. Well, what do they eat? They eat what you eat? The question is, how much should you get versus how much did they get? Well if you ate almonds,
They're getting those 30 calories. So even though you count the calories at your lips.
It doesn't matter what really matters is counting the calories at your intestinal brush border.
Okay, and they're not the same. So if you feed your gut that's a good thing because then your gut will take those calories and turn it into things like short-chain fatty acids, which end up being protective against chronic metabolic disease acetate propionate and butyrate Valerie. Those are actually good their anti-inflammatory antioxidant MERS because you fed your microbiome.
So even though you ate 160 you absorbed 130 so calorie eaten is not a calorie eaten because if you ate it with fiber it wasn't for you. It was for your bacteria, but that's not the way you count them up. So that's problem. Number one problem number two amino acids. So we all eat protein.
Let's say you eat too much protein you have you know the porterhouse steak right now if you're a bodybuilder.
Those amino acids might go to muscle and you might increase your muscle mass because you're a bodybuilder because you're putting excess force on those muscles and you're growing those muscles. Okay, but let's say you're not a bodybuilder. Let's say you're a mere mortal like me or let's say you're a kid going through puberty. We synthesizing a lot of muscle because they're lifting weights because they're Pros testosterones making it happen. Yeah, absolutely. But let's say you're not let's say, you know, you're just, you know, just slump.
For the street like Joe Schmo and you eat that porterhouse.
You've taken on all these amino acids. There's no place to store it other than muscle. So your liver takes the excess and D. Am a dates that amino acid takes the amino group off to turn it from amino acid into an organic acid and then that organic acid can then enter the Krebs cycle the tricarboxylic acid cycle what goes on in the mitochondria in order to generate ATP the chemical energy that your body needs in order to power itself? Okay.
Now that's a good thing. It takes double the amount of energy to prepare that amino acid for burning as it does to prepare a carbohydrate for burning or so that for because when asked about when you asked about almonds why the the 160 versus 130, I thought it was the processing turned out. It was fiber you're saying for protein legit. Let's make it realistic for a really nice big porterhouse steak, which I love by the way. Let's say
Okay, let's say 800 calories. Yeah. Well it turns out how much of that is is so that's what goes in your mouth right my mouth, right? How much of it is actually eaten in to stay with you your calorie is not a calorie eaten in the processing of that what percentage is actually goes into your total caloric intake, right? So about 10% of everything you eat goes to just maintaining body.
Sure, it's called the thermic effect of food. But when you're eating protein, you actually generate more Heat and the reason is because it takes two ATP to phosphorylate that organic acid as opposed to one ATP to phosphorylate that carbohydrate for consumption. So you actually have a net loss of energy because it was an amino acid versus a monosaccharide a show.
Sugar now you you brought up fat fat doesn't need to be phosphorylated. So it actually doesn't have any thermic effect of food at that point. So depends on what it is as to whether or not you have loss. Okay. So by the way in this let's make it actually realistic a sixteen hundred calorie Porter House with a nice slab of butter from grass-fed butter on there. Okay this every once in a while not not often, but some creamed spinach and maybe some mushrooms along.
The side I'll see ya when I'm eating a porterhouse. I don't want to adulterate The Taste okay with anything else except maybe some some butter, maybe a salad? Okay afterwards, but but let's say 1600 calories of it's got some fat in there for sure. Let's say 1,000 of those calories is protein. The other 600 are fat something like this something like that to find out how marbled it is. Okay. So based on what you just said about the thermic effect of food.
Food and protein in particular of that thousand calories how much actually is can we count? I'm not a calorie counter but does one include as calories truly ingested. Well if you ingested 1600 well, that's what went in the mouth. But but but but what is is going to go against your your burn deficit, right? So I would have to actually do the math to figure that out. But as a guess, yeah back of the envelope back of the envelope calculation. You're going to lose about 25.
None of that. Wow. So we're talking 750 calories. Yeah, you know so and to translate this a bit. So what we're saying here is if you're somebody who is trying to lose weight or maintain weight or perhaps even gain weight you eat 1600 calories porterhouse with a slab of butter on it 600 of those calories we're saying in this is just as fat with the remaining thousand calories. That's that all went in your mouth. So you count it at your mouth, right? But 700 but then when you compare it
Once your energy burn for that day to maintain temperature brain activity physical activity really it's only 750 calories. That's right. That's a huge difference. Exactly. And another reason why a calorie is not a calorie. Now, let's take the third. Let's take fats. So here we have omega-3s heart-healthy anti-inflammatory antioxidant armors save your life and over here. We have trans fats the devil incarnate consumable poison because you
To break the trans double bond. You don't have the desaturation to break that trans double bond. So it basically accumulates lines your arteries lines. Your liver causes chronic metabolic disease causes insulin resistance Omega-3s. Don't even get broken down for energy because they're so important. They stay intact because your brain needs them your heart needs them.
Whereas trans fats can't be broken down because of that trans double bond one save your life other one kill you. They're both nine calories per gram if you explode them in a bomb calorimeter because a calorie burned is a calorie burned but a calorie eaten is not a calorie eaten because one will save your life will kill you.
And finally the Big Kahuna the one that blows everything else out of the water fructose and glucose. All right now glucose is the energy of life. So here we're talking carbohydrates. I think most of our audience will be familiar with the so called macronutrients we talk about fat and this case almonds. There's some Fiber in there probably a little bit of carbohydrate little bit little bit talked about the porterhouse with butter right making me hungry already that's protein and fat very little if any carbohydrate she was 0 a sin.
Lee is it 100, yeah.
And then now we're talked about carbohydrates and we're going to subdivide that into glucose and fructose right galactose basically becomes glucose in the liver so we can dispense with that unless you have a disease called galactosemia, which is about 120,000 and closes neonatal meningitis. And you know, it's a disease as a pediatric endocrinologist. I would take care of but we can dispense with that for the moment. All right, so glucose fructose glucose is the energy of life.
Every cell on the planet Burns glucose for energy glucose is so damn important that if you don't consume it your body makes it so it will take an amino acid and turn it into glucose. That's gluconeogenesis going to Genesis. That's right. It will take a fatty acid and turn it into glucose and specifically the glycerol portion of the triglyceride will turn into glucose. So
the Inuit didn't have any place to grow carbohydrate that ice then whale blubber they still a serum glucose level and the reason is because you had to you have to have a serum glucose level in order to power your brain in order to power your heart. Yes, you you can use ketones. Of course you can but you know only if you're in a ketogenic state, will you use exclusively ketones and you also need glucose for
Structural changes in specific proteins and particularly hormones. So glucose molecules will stud TS H LH F sh different pituitary hormones in order to increase their potency. It's one of the reasons why aging leads to defective for Mona Genesis, for instance hypogonadism, hypothyroidism is the loss of glycosylation on individual.
Peptide hormones because of the inability to add glucose because those insulin no, it's no just it's an aging phenomenon. Okay, we'll come back to this because I think it's really important. Yeah the idea that ingestion of carbohydrates and the as you called it the studying of carbohydrate molecules on hormones can augment the function of those hormones and with aging that's a less efficient process. So let's efficient process, but it's not because of consumption. It's right.
We're still I see the the plenty of folks who are 65 and older eating plenty of carbohydrates. Yeah saying a lot of them have deficient thyroid testosterone estrogen right prolactin Etc. Because of the Wade's there's those carbohydrates are not studying the hormones exactly. So there the all of those are glycoprotein hormones. Let's tee that up for later because I think that's an interesting very important when you to go down. Okay, and there's and there's a disease in children.
In in babies called congenital disorders of glycosylation where you can't put glucose small molecules on specific proteins and of course has severe mental retardation all sorts of metabolic havoc, and a lot of those babies died for that matter. So that's an important thing. All right, but that's how important glucose is.
Fructose on the other hand this sweet molecule the molecule we seek the reason why the food industry studs every food in the grocery store in 73% of all items in the American Grocery Store have added sugar on purpose for the food industry's purposes not for yours because fructose is addictive activates the nucleus accumbens the reward center of the brain in the same way that hope cocaine heroin.
katene, alcoholedu and drive dopamine receptors down just like nicotine, you know alcohol, you know cocaine heroin do
that molecule fructose is number one completely vestigial to all vertebrate life. There is no biochemical reaction in any vertebrate that requires dietary fructose. That's number one. Number two is okay to sorry. I'm going to just answer it. So you're saying that even though we can process fructose. We have a limited capacity to process it in the same way. We have a limited capacity to metabolize alcohol now.
You have one drink a day.
You're okay. If you have two drinks a day depends on how big you are, you know you and I can promise I would argue to drinks a week is the maximum but let's not go there the but but in terms of you're saying when you say
fructose processing a fructose is vestigial what you're saying is that we don't need to do it. That's right. It's like the appendix. It's an organ for which it has no function exactly and fructose has no function in the human body.
Period you don't need it. You don't need it don't need it. But our diet is replete with it. In fact, our fructose consumption has gone up 25 fold since the beginning of the last century. I have to ask this now. I love fruit. I eat berries go lower especially since the price of berry seems to have come down. He used to be the only get them certain times a year. I'm what you call a drive-by blueberry eater. So I'll just walk past and just take a fistful.
You can't put them in front of me without me eating them. It was even difficult for me when other people I don't know or eating them. So lots of blueberries strawberries blackberries. If they're in season. I love them. No problem loaded with fructose know plenty of fiber low fructose low fructose and berries berries of the lowest fructose of all was worried about asking you this today. Not again, okay and fruit is okay because of the fiber so the molecule the fructose molecules the
Mmmmm, whether it's in a berry or in a banana or for that matter in a Coca-Cola. The fructose molecule is the same molecule. The difference is that in the berry it comes with a whole lot of fiber in the banana comes with whole lot less fiber and in the Coca-Cola. It doesn't come with any fiber and the fiber is what mitigates the absorption so when you consume the fructose with fiber, so your blueberries your
Feeding your microbiome that fructose wasn't for you. Got it such a relief and I must say recently had a whole body MRI as a okay pre-emptive thing. Someone is that it was it was great. I got to watch a Netflix in there and I never had a whole body MRI learned a few things that were useful to me. I've got a clean bill of health. So that's great. Well, that's what one of the pieces of feedback I got is that my gut was filled with this very high contrast.
Stuff, right and they asked you know, do you consume a lot of blueberries? And I said indeed I do why and they said because that high contrast of a shows of white on the scan is high concentrations of magnesium that we see in people that ingest large amounts of blueberries, which is pretty rare and yours are comparable to a bear in blueberry season. Wow, and basically my entire gut was filled with with blueberries. I suppose I need to cut back a little bit. But now I know that
Root is okay as especially if the fruit has a lot of fiber. Yeah, but fructose itself, especially if it's not partnered with fiber, yeah is first of all not required for survival at all, but you're telling me is problematic. Yeah and let me tell you why it's problematic. We haven't gotten to that yet. We're just talking about whether it's vestigial versus needed now, let's talk about what fructose does.
Turns out fructose inhibits three count em, three separate enzymes necessary for normal mitochondrial function. Now I old your mitochondria make ATP your mitochondria have to work at Peak efficiency. That's what metabolic health is is mitochondria working at Peak efficiency. Well, there are three enzymes that are inhibited by fructose number one a MP. Kinase. All right now,
MP kinase is the fuel gauge on the liver cell. It's the thing that tells the liver to make more mitochondria fresher mitochondria, because if you're a MP levels are high that means you've dephosphorylated a bunch of atp's and you have to regenerate them. So you need some more mitochondria. So it's a negative feedback pathway. Well, you need that amp kinase to generate that mitochondrial biogenesis signal except that fructose a metabolite of fructose called methylglyoxal MGO.
Sits in the active site of the gamma subunit of that a MP kinase and actually binds to arginines in that active site rendering that enzyme now dead. It's an irreversible inhibition because of the covalent bonding of that methylglyoxal that aldehyde to the Arginine and now that enzyme is dead Okay, so it basically acts like a key that doesn't turn the lock but prevents the the key.
You want in that lock from entering the deadlock? It's like it's like gluing a lock shut. Yeah, got it. All right. That's it. One of the enzymes. That's one. Okay. Second one egg head L acyl COA dehydrogenase long chain. So this is necessary to cleave two carbon fragments off fatty acids to prepare them for metabolism.
So inhibits that one and then finally it inhibits carnitine Paul middle transferase one now CP T1. Now that's the enzyme that regenerates carnitine carnitine is the shuttle mechanism by which you get the fatty acids from the outer mitochondrial membrane through to the inner mitochondrial membrane so that they can be beta oxidized for energy. So if you don't have that CP CP T1, you're basically
Was and therefore you can't generate beta-oxidation. You said fructose inhibits all three of these enzymatic Pathways. Yep, as a biologist. I have to ask you how potently does it inhibit them. I mean because there's there are drugs that block receptors and then their drugs that block receptors within unbelievable Affinity show, you know, I mean mechanistically in a dish meaning in vitro, you can see all sorts of things. But how significant is this for like for obesity for mitochondrial?
Function in Vivo in us. All right, so, you know the the dose determines the poison right paracelsus 1537. There are toxins that are parts per billion and will kill you like sarin ricin Cyanide by the cyanides a good analogy because it's working on mitochondria. It's basically causing mitochondrial to be different completely defective. All right, then there are
Intermediate toxins like Arsenic and carbon tetrachloride parts per million and they take a little longer to work than not gonna kill you on the spot. That's why I can eat an apple seed that has a little bit of arsenic in it, but I'm not going to die. Right and then finally there and by the tobacco smoke goes in there. And then finally you have weak toxins. All right, and you know where it's not one exposure that will kill you. It's you know, 10,000 exposures that will kill you like alcohol or toxic people.
Yeah, it sucks every well. Sometimes it only takes one could resist. Sorry. Sometimes it don't mildly toxic people. Anyway, the point is that fructose is in that last category. So it's not what you do one day that kills you. It's what you do every day the kills you and if you basically eat ultra-processed food high in sugar for 10 years in a row, it's going to show up in terms of your
It isn't and ultimately yeah, it will kill you and we have the data to show. You know, how many years you will lose. So right now in America, we pay an eight-year longevity tax. If you look at Japan who they have a mean age of death of 88. We have a mean age of 80. Okay, we're paying an eight-year longevity text just by living here and we're talking about the healthy people now if
If you have metabolic syndrome, it's a 15-year longevity tax. And sorry if you thought obesity is a 15-year longevity text if you have metabolic syndrome, it's a 20-year longevity tax. That is primarily not completely but primarily sugar. It's also, you know, Omega sixes. It's also trans fats, you know left over because now they're gone, but you know, people are still suffering the ravages of the trans fats, you know from the previous generation. Are they gone? I mean, I do remember as a kid.
Edwin we had margarine in our refrigerator. This is actually a big debate in my home one parent. I won't identify which was Pro margarine. The other was Pro butter anti margarine, right the marriage didn't last but there were other reasons. That's probably why I went butter butter butter is fine. In fact time declared, you know front cover Butters back margarine was the bad guy without question and we know
Oh now but you know back when we thought it was a calorie is a calorie. We thought oh margarine, you know, it's the same, you know, nine calories per gram and we said it lowers your triglycerides.
That I do it was because what it did was it lined your liver because you couldn't break that trans double bond and you know, so they're there now gone from our food supply. They're illegal they're illegal their band, but you can make trans fats in your own kitchen by taking olive oil and heating it to be on the smoking point. So they're not completely gone. They're just gone from Ultra processed food. So now sugars,
A problem because of these three enzymes that you are inhibiting. The point is we were we started this with a calorie is a calorie. Well, if you are inhibiting mitochondrial function, then a calorie is not a calorie is it you reducing the intensity of the Furnace? Yeah, exactly. So this whole calorie is a calorie just makes no sense and it hasn't worked at any level and there is no study that actually shows that cutting calories makes a difference and I can show you
You know voluminous data that shows that virtually every weight loss study that cause that led to you know caloric restriction basically didn't work not for any length of time just to round out our earlier discussion because I find it fascinating and I know other people will as well talked about that 160 calories that's actually 130 at the business end of things of almonds. We talked about the porterhouse steak with butter and the 25% reduction in what's actually quote unquote.
And I'll get back to this because this quote unquote issue. I think the problem is there's there's a lack of useful language to disassociate this stuff, you know even just calling fat fat people think it meets going to make you gain body fat total if we call the adipose tissue and lipids we would have avoided this confusion. So I don't want to get there just yet, but I want to make sure with the food industry. Does this on purpose? Really? Oh, absolutely. So Dave tell you a sugars or sugar which is not true. They tell
You a calorie is a calorie which is not true and they tell you a fat as a fat which is not true. Okay, this is very specifically. So when you're talking about sugar you talking about dietary sugar. Are you talking about blood sugar? Because blood sugar's blood glucose or nine Every Rose dietary cholesterol or circulating cholesterol or absolutely. Yeah. Okay. So we have done this, you know to ourselves but the food industry has really promulgated it because we farmed out new
Christian policy and information to the food industry so they actually use this for their purposes one of the problems in this field.
as we all know quality nutrition influences, of course our physical health, but also our mental health and our cognitive functioning our memory our ability to learn new things and to focus and we know that one of the most important features of high quality nutrition is making sure that we get enough vitamins and minerals from high-quality unprocessed or minimally processed sources as well as enough probiotics and prebiotics and fiber to support basically all the cellular functions in our body including the gut microbiome now, I like most everybody try
Get optimal nutrition from Whole Foods. Ideally mostly from minimally processed or non-processed Foods. However, one of the challenges that I and so many other people face is getting enough servings of high quality fruits and vegetables per day as well as fiber and probiotics that often accompany those fruits and vegetables. That's why way back in 2012 long before I ever had a podcast. I started drinking a G1 and so I'm delighted the ag-1 is sponsoring the huberman Lab podcast. The reason I started taking a G1 and the reason I still drink.
One once or twice a day is that it provides all of my foundational nutritional needs that is it provides insurance that I get the proper amounts of those vitamins minerals probiotics and fiber to ensure optimal mental health physical health and performance. If you'd like to try a G1 you can go to drink AG one.com huberman to claim a special offer. They're giving away five free travel packs plus a year supply of vitamin D3 K to again. That's drink AG one.com huberman to claim that
She'll offer for the third category of macronutrients carbohydrates you differentiated glucose and fructose if I ingest, let's say a half a bagel since we were talking about New York your city of origin and they have great Bagels on the west coast. And yeah. Yeah, it's not just it's pretty pitiful same with the pizza dough. It's like they claim. It's the the water whatever it is. It's different back there and it's better half a bagel.
Let's say 250 calories mostly carbohydrate. This isn't an unlined done. No cream. Cheese. No schmear as they call back there. No, no cream. Cheese. No butter. No that think just have some 150 calories. So that's what I ate. You're saying that a calorie is not a calorie in how much of that carbohydrate given that it's probably most let's assume it's mostly glucose. Let's do it this way. Yeah, it is. It's polymerize glucose. Okay Palermo flucos how much of that is actually utilized or burned versus
You know that the original 250. So if you look at what happens to energy in the body 65% of that which is ingested goes to resting energy expenditure just to power the body 10% goes to the thermic effect of food and then 25% ghost activity. That's the breakdown of where the energy goes and that's calories from fat protein and carbohydrate. Yeah from everything together and
And you know glucose is a perfectly good example of how that works. The point is though that when you ingest glucose, you're getting a big glucose Excursion in your bloodstream, so you're getting a big glucose Spike and that glucose Pike has to come down. Well, what makes it come down the hormone insulin insulin is the bad guy in the story The Higher your glucose goes the more your pancreas will release insulin in order to bring that.
Coach down Well turns out that glucose rise was not benign that glucose Rises led to endothelial dysfunction transient, but nonetheless endothelial dysfunction. Could you just remind people what endothelial cells are inside of your arteries? Okay, and it will change blood pressure. We've got plenty of data to demonstrate how a changes blood pressure and over time that will cause coronary artery disease that will cause kidney disease cetera, but
it's the insulin response that is really the bad guy. Now people think insulin is good because it lowers blood glucose after all diabetics take insulin, you know to lower their blood glucose. Okay, let's take a diabetic patient with diabetes blood sugar's 300. That's bad. We give them a shot of insulin in the arm blood sugar goes down to 100 blood sugar went from 300 to 100. Okay, where did the 200 points of
glucose go
I'm assuming that the insulin would sequestered it to where I'm assuming to the liver to the fat interesting for storage that's insulins job insulin takes whatever you're not burning and puts it into fat for storage. Insulin is not the diabetes hormone. Insulin is the energy storage hormone. How quickly does it do that because a quick because if I'm you know having a man at a very busy day or the diabetic person is having a very busy day and they're moving around a lot then you got
Insulin bound glucose in the bloodstream for hello. No insulin doesn't bind glucose insulin binds to its receptor. Sorry sir, and allows for glucose Transit sword has to work so so but for some period of time while that person is active There's an opportunity to utilize that glucose. Well, yeah, right. So how quickly is insulin managing that glucose we know that the spike comes down quickly, but the glucose is not available for energy utilization after what it's it.
It's sequestered to the the adipose to the fat tissue within an hour. Is that so about 90 minutes? Yeah, but I mean if you if you're if you're active if you eat, you know muffin and your active your muscles are going to take up that glucose irrespective of insulin. In fact muscles are insulin independent. They have glucose Transporters, but they are insulin independent because if they weren't then every patient in diabetic ketoacidosis,
This would be paralyzed. Okay, so glucose will end up in muscles irrespective of energy status and Insulin status and in muscles, it's used as immediate Fuel and glycogen both. Okay, beautiful and glycogen storage. Okay in the muscle, absolutely. All right. Now, if you're active then you will clear glucose into the muscle Therefore your blood glucose won't rise as much because it went into muscle.
And therefore your pancreas will put out less insulin because it doesn't have to clear as much from the bloodstream and that's okay. That's good. Right but let's say you didn't exercise. So you've got a big glucose Excursion. Now, you have a big insulin response and that insulin is going to take the excess that's in your blood. It has to clear it and it will go too fat for storage that insulin rise turns out to be particularly egregious in terms of metabolic disease and I can prove it.
There is a mouse my favorite Mouse. I love this mouse this mouse turns medicine on its head and teaches every doctor why they have to go back to medical school and learn it. Right. This mouse is called the pedir co Mouse pod. I RKO is discovered by Peter Coe. No, no is discovered in wrong consulate. I was manufactured in wrong Concepts. So this is a tissue-specific insulin.
Your knockout Mouse I RKO in some lacks the insulin receptor in specific kidney in the kidney and throws dirt. Koepka glomerular poda site insulin receptor knockout cows. We haven't talked too much about transgenic models and knock and knock out. So just in 10 seconds or less basically, these are mice that are genetically engineered to lack the receptor for insulin specifically in the glomerular parasite the kidney in the kidney.
And everywhere else in this mouse insulin does its thing normally exactly great. So these animals are you glycemic normal blood glucose levels. These animals are normally glucose tolerance that you know go up. They go down just like every other Mouse
These mice are not fat these mice are not thin these mice are mice, except they have the worst diabetic nephropathy on the planet. So they're nurturing of their kidney is degenerative their kidneys degenerate to nothing yikes. Now, they have normal blood glucose levels. They have normal glucose tolerance.
They have normal insulin tolerance whole body, but their kidneys are dying.
How come I can't be the glucose? It's the insulin.
Because insulins the bad guy insulins actually making the kidney disease. And so these animals that are insulin resistant. They have diabetic nephropathy without diabetes.
So the insulin is having a negative clearly negative effect on the kidneys without binding to the receptor. Exactly. So circulating insulin can do stuff without binding to its receptor. Well, it's no binds to its receptor in different parts of the body other parts of the body parts in the kidney. It can't because it's an odd because it's knockout right? The point is insulin does stuff by itself and it turns out insulin drives growth.
Now every cell in your body.
Wants to burn at one time in his life and wants to grow at another time in its life. Every cell has those two Pathways burning growth burning growth. What determines whether a cell?
Should be burning or whether a cell should be growing. I don't know what makes it burning but presumably to them has something to do with mitochondria. It has everything to do that. So every cell needs to burn and needs to grow at a different time in his life. Here's a way to think about it. We all start out as a sigh goat a single cell we end up in adult.
Now that single cell had to become two cells those two cells how to become four cells.
Those four cells had to become eight cells and on and on and on and on so every cycle there's a doubling how many doublings to get from a zygote to an adult. Let's in exponential growth. So yeah, I don't I don't know it off the top of my head 41.
41 41 to to the 41 doublings give you an organism 10 trillion cells were 10 trillion over 10 trillion. We know that yeah, okay to to the 41. Okay. Okay now of those 41 doublings some of them had to occur in utero.
Some of them had to occur postnatally.
So I need two numbers that add up to 41. How many in utero how many postnatally?
Well way more you start off with a lot more than you end up with but then you have cells that turnover throughout the lifespan. So this is a tough one. Okay, because skin cells turnover with neurons. It's pretty straightforward because you're going to somewhere but you again Lieutenant, right? Well, you're and you're born with somewhere between three and ten X of what you end up with depending on the brain structure. So but for whole body wide, I don't know how you come up with that number 36 and five.
Okay, 36 doublings prenatally 5 doublings. Postnatally. I can prove that to you too. Typical baby weighs 7 pounds first doubling 14 lb s doubling £28 sex doubling 56 pounds next doubling 112 pounds next doubling 224 pounds and hopefully it stops piece individually. Hopefully, it stops. There are not are not all people through a natural bounds are obese, but some people who are certain Heights or below or 212 are obese.
Got point is the cell has to know when to grow and when to burn it turns out that the signal for that is oxygen because oxygen is necessary for mitochondria to be able to burn in the absence of oxygen the cell only knows how to grow. This is actually why Otto Warburg won the Nobel Prize in 1931 for the Warburg effect. He asked the question.
How come cancer cells don't need oxygen to grow and the answers because no cell needs oxygen to grow. In fact oxygen is the thing that prevents growth famous article from the New England Journal of Medicine 1951 Mount Everest in utero because every fetus is oxygen deprived so normal partial pressure of oxygen hundred millimeters of mercury.
Here right if I checked your blood and be about 100, right? I hope so. How about a tumor cell gets the tumor cells probably it's a double about 44 wait, you just told Marshall pressure of oxygen in a tumor cell. It's about 44, but you just told me that will tumor cells which grow like wild right? They grow like wild because they don't have oxygen.
But they but there are some of the so here's what's peculiar about it.
Tumor cells are some of the most vascularized holes are tumors are held there asked crying. I mean, I mean one way to get a neutral one is to devascularized the tomb right? Yes, and you know angiogenesis inhibition etcetera as soon as a big deal, you know, Judah folkman and all that from Harvard, you know, so the excess blood to a tumor is the attempt to bring in oxygen that it's not getting that's right as opposed to delivering lots of oxygen and that's why it's growing that's right. Okay, but a fetus, what's the partial pressure in the
6231
so it's actually like a mile above Mount Everest. That's how much oxygen the fetus gets and it's that for that reason that you've got 36 doublings. And then as soon as you're out, you know, when you cut the cord and you start breathing and now you're partial pressures at 100, that's when growth slows down as there been any effort to treat tumors by oxygenating tumors. Yes. And what does that look like? It's hyperbaric oxygen therapy. It's a thing. Oh, yeah. Yeah. Yeah we are.
Do an episode on hyperbaric chambers? It's the the reason we haven't yet is it's pretty Niche and but there are people who own these things who sit in these things. Okay, so we got here by way of by way of carpet by The Bagel, right? So I just want to orient us that you just that 250 calories of the The Bagel we talked about glucose Excursion. Is that insulin rise that's driving the adiposity and social
driving the growth
Okay in the absence of oxygen because if you have oxygen then you don't need that much insulin.
Okay, so because you're going to burn instead of store got it.
In terms of the the the raw metabolism of carbohydrate though that glucose if I eat 250 calories of glucose how much of that it did I quote unquote actually eat. How much is is used how much it's use? Yeah, let's assume that. I'm at my desk working or I'm walking around a little bit. I'm not I'm not exercising hard in that in the subsequent our so used for what is the question? I'm going back to the calorie is a calorie calorie. Clearly. The answer is no be based on.
Processing of different types of calories we established it for fat the almonds. We establish it for protein right the porterhouse with butter and now we're trying to establish that for the 250 calories of bagel which is glucose. Right? So the glucose has to be phosphorylated. So you're going to lose an ATP in the process. So you're going to go ATP goes to ADP and then that ADP will go to a MP adenosine monophosphate, which will then go to I MP and also tall monophosphate which will then go to Uric.
Acid, okay, and that uric acid will be then released from the cell circulate in the bloodstream and hopefully go out in the kidney in the process that uric acid can inhibit mitochondrial function and it can also inhibit endothelial nitric oxide synthase, which is the enzyme in your vasculature that is your endogenous blood pressure lower right by expanding blood vessels and capillaries and exactly right? This is the mechanistic foundation of
The drugs that were originally used for improving prostate function, but are used to treat erectile dysfunction, which are the they pde5 Inhibitors which allow nitric oxide to be around longer and more of it right people use it for other purposes to I'm now no no forget if I cue it up with that example. We you know in the neonatal Intensive Care Unit at closes patent ductus arteriosus, which is a big deal in in the neonatal in the world. Well go I want to ask you about that but
But so I heard two things one is that glucose and the insulin that goes with it increases uric acid uric acid while it has certain important functions in health too much of it. You said Can inhibit nitric oxide? Yeah can inhibit nitric oxide. That means that the blood vessels and capillaries are going to stay more constricted. So blood pressure is going to be higher than it would be normal. Right and then uric acid is also inhibiting mitochondrial function. That's right. Okay, but eating
Half a bagel isn't necessarily a terrible thing. If it's within your caloric requirements it and it all depends on how much you clear and how high your insulin goes. Now. Let's compare that 250 calories of glucose to 250 calories of fructose. Right? Let's come up with a food example 250 calories of fructose would be trivial to consume in the form of high fructose corn syrup, right? So remember
High fructose corn syrup is half glucose have fucked up. Okay. So this is my 125 125. So let's not use that well, so let's assume so we talked about a soda for to get that that 250 calories easily, especially if it's not a can or a European size bottle or 8. Oz 8 ounce can of soda. Okay, so eight ounce can of soda and maybe a let's include a food item. Let's talk a like a store-bought packaged cookie couple of Oreos to Oreos. Okay, probably get you to that 250 or
beef or maybe three Oreos. Yeah. Okay Oreo lovers everywhere celebrating the three.
250 calories of fructose. What's the effect on uric acid? What's the effect on caloric burn? What's the effect on anything for that matter that we should be aware of? All right. So first of all, the Oreo has plenty of fructose in it. So keep that in mind. Okay, the if let's say you consumed 250 calories in a bagel because that's pretty much polymerized glucose versus say the soda. So the bagel versus the soda that's which equivalent calories right equivalent.
Ow, or the The Bagel versus let's say two Oreos and a little bit of an yeah two Oreos. Okay. So number one. There's only half the glucose in the soda because the other half is the fructose. So 125 125. So you are glucose rise won't be as high. Your glucose Excursion will be lower. This is actually one of the reasons why there's this thing called glycemic index and glycemic index is 0
Nord it's garbage. It is complete and utter BS the glycemic index. Absolutely. Yes. It's nothing. Nothing is more egregious in terms of argument than the glycemic index. And this is one of the things the dietitians as promote and a spouse and one of the things that's got to go. Okay. Well, this is an idea that must die. Okay, we'll get back to why the glycemic index has got to die. But so that
250 calories and actually can we can we make these equal just for sake of Simplicity. Can we say 250 calories of glucose from The Bagel versus 250 calories of fructose. How do we get 250 calories of pure fructose? We don't you can't okay, you gotta bring the glucose with lab fructose and have to make it unless they were the Oreos which is half glucose and fructose right that I mean, there is no fructose alone in nature even cracker some of the ones that are salty are all so sweet. They have fructose. Yeah. Absolutely I practiced
Surface. Yeah, that's why it's impossible to eat just one indeed. And so what's happening biochemically with as a consequence of the fructose components specifically, so the fructose will first of all go into the intestine. The intestine will metabolize some of that fructose through what is known as intestinal de novo lipogenesis about 10% of that fructose will be turned into fat right in the intestine and that's because fructose it just
Wants to be fat. Yeah fructose wants to be fat fructose is the Lipo genic substrate here. We're not talking about body fat. We're talking about fat molecules that can potentially be used as energy. That's right triglyceride molecule looks okay. So so ten percent of that fructose will be turned into triglyceride right in the intestine and be released into the bloodstream and it is the reason for a postprandial triglyceride response postprandial is and I'm including myself in this group is nerd speak for after eating logic typically its lunch and then
So that's actually one of the drivers of cardiovascular pathology that intestinal de novo lipogenesis turning that fructose into triglyceride right in the intestine. Now, there's a limit to how fast and how much the intestine can do that. The rest of the fructose will be absorbed into the portal vein, but not before some of that fructose will make it further down and it will nitrate tight.
Junction proteins now, okay portal vein in the kidney. So what have been goes to the liver?
Portal vein goes from the visceral from the intestine to the liver. No kid. He doesn't forgive me. Okay, so kidding.
Intestine to liver. Okay, but fructose nitrates tight Junction proteins and let me explain that to your audience.
Your intestine is a sewer.
Definition of a sewer a pipe with shit. Okay, that's it sewer. Our intestines are sewers.
There's junk in the center and the job of the intestine is to move the junk through to the anus absorbing the good stuff while you can the intestine is made up of cells intestinal epithelial cells that are bound together and they're bound with proteins that basically form a barrier. Those barriers are hold tight Junction proteins with like Cloud ins and things like that.
Zanya lenders the mailing one. Okay, there are others but zanya land is the one that goes is defective in Celiac disease what defines a tight Junction is it but is like completely impermeable or semi permeable completely impermeable unless it's function is inhibited turns out if you alter the phosphorylation status or the nitrate status of that tight Junction, it will become transiently permeable.
Okay, and so fructose nitrates tight Junction proteins causing them to be transiently permeable allowing some of the junk in your intestine to get through into your bloodstream. So this is leaky gut this is leaky gut this is what causes leaky gut fructose is a driver of leaky gut got it that causes inflammation at the level of the liver which ultimately leads to systemic inflammation. One of the reasons why High
CRP sensitivity CRP is high in patients who eat ultra-processed food CRP is C-reactive protein, which is a marker of a essentially an inflammatory immune response. Exactly. Yeah, you don't want it too high and 93% of Americans today are inflamed. Does that mean the 93% of Americans have leaky guts? Yeah, it does because that's where it comes from. So in addition to limiting fructose intake
What are things that support the tight junctions of the intestinal pathway? So there are three barriers in your intestine to keep the junk where it belongs in the center so that it can get pooped out the your behind. All right, three separate barriers one is a physical barrier called the mucin layer. So it's a layer of mucus that actually sits on top of the intestinal epithelial cells.
Now that mucin is a polysaccharide and the bacteria can use that mucin layer for its own purposes. It will eat your mucin layer. If you don't feed your bacteria, you must feed your bacteria or by your bacteria will feed on you. Okay, so you are in concert with your microbiome. If you deprive your microbiome of the food that it needs it will use you as its food and that's one of the reasons.
Why fiber is so important so fiber to build up this mucin layer is one way to reinforce the the fence that that is the tight junctions Etc between your intestine and the bloodstream. So this raises an interesting point about fasting I many people including myself do a sort of pseudo intermittent fasting may be my first meal somewhere between 11:00 and noon. I'm not strict about this the 11 versus Newton thing and probably eat my last bite of food somewhere around eight pm. And occasionally, it's outside that window. I've done this for a long.
Long time it just feels best to me. Right but other people use a shorter eating window. One thing that I learned from a colleague at Yale. He studies the gut microbiome that was surprising to me is that when you do when you eat in that way, there's a long stretch of time sometimes longer for people that have a shorter eating window longer fasting window that is where you're actually eating up your own intestinal lining that so this idea that fasting is so great for us on the one hand might be true on the other hand. You're
Consuming components of your you're not feeding your gut microbiome and you deplete it. But then here's where I was positively surprised. When you do eat provided that you eat enough fiber and in particular high quality fermented foods low sugar fermented foods. It seems that the lining of the gut and the gut microbiome is replenished to a level that is greater than if you had eaten for longer periods of the 24-hour cycle. Yeah, I have that right we do you do have it right and I don't know why that is true, but it does seem to be
Be the case and fermented foods based in part because they've got already short chain fatty acids in them. See that's a preferred food of the microbiome. Well, it's what the microbiome actually turns fiber into so it's probably helping your intestinal epithelial cells in the same way when the microbiome turning fiber into short-chain fatty acids helps. So it's what we call a post biotic so you have Prebiotic which is the food for the bacteria you have the
Which is the bacteria itself and you have the post biotic which is what the bacteria make in order to heal you God. Okay, and so short chain fatty acids are post biotics and there a lot of people selling short chain fatty acids, you know drinks and supplements and what have you whether they work or not is another story if I consume fructose in the form of let's say a highly processed food as minimal antioxidants. It's got plenty of calories typically
And it's disrupting the tight junctions making my gut leaky right? But I'm also eating fiber. Yeah, you know, I'm having a you know a meal that includes a salad. I'm having having some probiotics and then I want to like a couple Reese's Peanut Butter Cups, like the dark chocolate ones in particular. I don't do this anymore, but I used to eat like that more often as time has gone on I've become I don't like to call it stricter but more I tend to like healthier foods over time and I think you can get away with different things at different stages of life.
You work with young people. So we'll we'll get to very young people so we'll get to this but how how much damage am I doing by ingesting any fructose in the form of a highly processed food? So I'll make it very simple Andrew. I am for dessert.
For dessert I am not for dessert for breakfast lunch snacks and dinner. Okay. So if you want to have a couple of reasons peanut butter cups as your dessert in the same way as you might have a cognac for dessert.
That's fine. I have no problem with that. The question is are you going to eat Reese's peanut butter cups for breakfast.
Now I don't eat breakfast. Well, no, man. Should I ge see your point the National School breakfast program which 29% of school children today consume is a bowl of Froot Loops and a glass of orange juice. That is 41 g of sugar American Heart Association says that the upper limit for children should be 12 grams of added sugar per day. That's 41 grams of added sugar and it's just
Breakfast and that's for toast Rich. Totally right completely. So the question is which desert are we talking about? Okay and right and can we can we adjust that morning meal to a different reality? Because I agree that there are plenty of kids eating that or a muffin that might be the equivalent and down, but what about the parent whose as locate? Let's come up with a healthier option that the kids still likes like thinking back to my childhood like a Honey Nut Cheerios.
Or something so not Fruit Loops, which is kind of the extreme take a look at the side of the package it no difference. Now, let's say they go with some like waffles that are made. So with a premade mix some milk some butter, you know, so mom or dad is making waffles great. It sounds healthier. But then if you do the breakdown over still ending up at very high are we basically eating dessert for breakfast? Are we eating egg? Oh waffles. Are we making waffles?
De novo, you know from scratch in your own kitchen that lets say make difference.
Okay, because the Eggo waffles, you know replete with sugar on purpose because the food industry knows when they add it you buy more because it's addictive. Okay, and we actually have the demographic the mechanistic the Imaging and also the economic data to demonstrate that sugar is addictive and the food industry knows it. So if you ever heard of a phenomenon called price elasticity
Price elasticity is an economic term that is used to ask the question if the price of a given good goes up by one percent that should result in reduction in purchase or consumption because price influences consumption. How much does it influence it?
So if it's if something's price elastic when the price goes up consumption goes down equivalently a food that is price elastic the most price elastic food is eggs. So when the price of eggs goes up 1% consumption of eggs goes down point six eight percent meaning that eggs have a price elasticity of .32 got it. Got it.
No, what's the most price inelastic food the top three most price inelastic foods are fast food cereal .81. I like a good quiz. That's what .81 soft drinks at point seven nine and juice of .77. Meaning people will pay not whatever but they'll they're willing to pay more more more readily willing to pay more because of the sugar because it's addictive.
It because it's hedonic so many many years ago Andrew you probably remember something called Keynesian economics and Keynesian economics was based on this concept of the rational actor and the rational actor can determine value which is utility over cost. And if you are a rational actor, you should be able to say yeah, I'll buy that but I won't buy that right? Okay.
in 1979 Daniel Kahneman and Amos tversky
Nobel Prize winner Daniel Kahneman describe the irrational actor
now the rational actor cannot determine value and the reason is because he is risk-averse. So the cost is always too great. So the utility may be the same but the cost goes up because that's why they have, you know, aversive tendencies in the irrational actor. Jeffrey Sachs has described the hedonic actor.
Who also cannot determine value because it doesn't matter what it costs. They need their fix.
And this is what's going on in the food industry knows it and that's why every food in the store has been spiked.
I'd like to take a quick break to acknowledge. Our sponsor element element is an electrolyte drink that has everything you need and nothing you don't that means zero sugar and the appropriate ratios of the electrolyte sodium magnesium and potassium and that correct ratio of electrolytes is extremely important because every cell in your body, but especially your nerve cells or neurons relies on electrolytes in order to function properly. So when you're well hydrated and you have the appropriate amount of electrolytes in your system, your mental functioning and your physical
Is improved I drink one packet of element dissolved in about 16 to 32 ounces of water when I wake up in the morning as well as while I exercise and if I sweat a lot during that exercise, I often will drink a third element packet dissolved in about 32 ounces of water after I exercise element comes in a variety of different flavors all of which I find really tasty. I like the Citrus. I like the watermelon. I like the raspberry frankly. I can't pick just one. It also comes in chocolate and chocolate mint which I find tastes best if they are put into water.
Solved and then heated up I tend to do that in the winter months because of course you don't just need hydration on hot days and in the summer and spring months, but also in the winter when the temperatures are cold and the environment tends to be dry. If you'd like to try element. You can go to drink element spelled LMN t.com huberman to try a free sample pack again. That's drink element.com huberman. We talked about dessert for breakfast in the form of cereals. Yes, some of which are disguised.
Or couch does healthier, you know, I think of like Honey Nut Cheerios. It seems healthier than Fruit Loops. It looks healthier like the just by way of color. It looks kind of weedy, you know color so but let and in terms of lunch, I mean one of the things that I love about Europe is that the breads are amazing. Yeah. It's a terrific and I are and I like them because they're not as sweet exactly and so a sandwich from not every Deli but from a typical sandwich shop or that one makes with store-bought bread sliced bread in the US.
As a lot of fructose, I looked at it. I looked this up prior to it does discussion today. So in some ways dessert is being woven into foods that are that parents and orchids. Everyone thinks our Savory art. We're actually eating sweets exactly. Right but we can't but we don't taste them as sweet at a conscious level necessarily right are but our taste buds do right. That's exactly right. So the question is why do they do that? So question for your audience?
You buy a loaf of bread at the local bakery how soon before it's Tails two days to die cast. Yeah, if it's really great bread. That's right. The better the bread the quicker it's tails you buy a loaf of bread at the Neighborhood Grocery Store how soon before it's Tails. You've got probably a week and then there's a moldy pieces at the end. They trust that, you know, if you're in college and you were major and scrape that off,
But can last up to three weeks depending right you could throw it in the freezer. If I do that with the bakery bread, but it's never the same never this nice never the same. So the question is why is that the answer is sugar the answer is sugar. So the grocery store bread had sugar added to it on purpose because when you bake it, the sugar does not evaporate it stays in the bread and the sugar is hygroscopic meaning it holds onto water. This is a
And that the food industry uses cold water activity and so it will hold onto water and so we'll stay spongy and will not stale as quickly as the bakery store bread, which did not have that sugar added to it. So even something as benign as bread has been turned into something that ultimately leads to Chronic metabolic disease.
We've pivoted somewhat from carbohydrate divided into glucose glucose and fructose to a discussion of sugar. Could you tell us the link between sugar and fructose so table sugar what percentage of table sugar is fructose what percentage of brown sugar is fructose what percentage of the sugar that's added to food is high fructose corn syrup on average, you know, just because here what we're talking about is what you're describing as an intentional lacing of food with something that's addictive but
also processed very differently at the level of the kidney at the level of the liver and
it's bad. It's about to it's a bad situation. So when we talk about sugar, I think we need to be as careful in describing what we really mean as when we talk about a calorie. I completely agree. So let for your audience. Let's be very very clear on definitions.
Let's not use the word sugar because it has multiple definitions. Let's use sucrose sucrose is what you put in your coffee. It's the crystals. All right, it's cane sugar beet sugar, you know, the you know, the stuff that you teaspoons of right? This was all that was available for many many years.
That is one molecule glucose one molecule of fructose bound together for the chemists out there and o-glycosidic linkage the enzyme in your intestine called sucrase Cleaves this o-glycosidic linkage in about a nanosecond you absorb the two molecules separately. The glucose goes to the entire body generates an insulin response the fructose go straight to your liver generates fat.
That's sucrose high fructose corn syrup is essentially one molecule glucose one molecule of fructose not bound together no glow glycosidic linkage. So they're free the enzyme sucrase doesn't care because the bonds already broken ultimately they do the same thing and that's why high fructose corn syrup and sucrose are indistinguishable.
metabolically
what they are is they're very different economically. And the reason is because high fructose corn syrup is half the price of sucrose because sucrose we get from importing and high fructose corn syrup. We make it home.
Sucrose is in bags high fructose corn syrup is in barrels sucrose. You can sell at the store high-fructose corn syrup you sell to the you know, ultra-processed food manufacturer. You can't buy high fructose corn syrup at the you know at the grocery store. So they're very different in terms of what they're used for high fructose corn syrup is particularly egregious because it's so miscible because it's already a
So you've probably remember Chips Ahoy cookies and the old days they would often would seem like the sugar in the cookie had crystallized because the sugar content was so high. It's been a while since I've had one that they weren't particularly good. Yeah. Well now but you eat two of them and then you think they're good and then you want to eat for yeah. That's what's so odd. The first bite is indeed the and then it's bombs away. There you go.
Well now it's so chewy Chips Ahoy cookies. Oh, I remember the reason ships always remember to each of you that that's high fructose corn syrup because because the two molecules are free, they don't crystallized so you can actually up the dose several times throughout today's discussion. You've been talking about the quote-unquote food industry. Okay, so I'm not a conspiracy theorists I am but I am now, but I understand.
You know that most businesses exist to make money many businesses start off with good intentions and drift in order to stay to stay competitive and many many businesses as we know not all of which are entirely bad such as the pharmaceutical industry. All right, you were there are bad there instances of like the opioid crisis, but then there are drugs from the pharmaceutical industry that helped save lives.
I mean, that's my my stance the food industry. I think they're good actors and there are Bad actors, but we're talkin about the food industry here is okay when we talk about the exercise industry. We talked about the podcast industry. I mean, you got good actors and Bad actors indeed but what you've alluded to several times here and you're more informed than I am is a a
Concerted effort to lace food with a form of sugar that makes people crave more of that food and that is causing metabolic illness disrupting mitochondria and on and on exactly and you're the physician not me you've worked with patients or struggle with obesity and for various reasons, not me and so we could probably spend hours. If not days talking about all the terrible things that the quote unquote food industry is done.
But what do you think is that the pure motivation right? I don't think that they want people to be sick, but they want to sell product and this sells more product. So then it raises two questions if why is it that more people don't know about know this information. Although many more will know after today's conversation but and certainly in government. It's a mix regardless of what side of the aisle you're on or if you're right in between there. They're clearly people that care about
the health of themselves and others so
I can understand how things might have gotten to this point. But what do you think are the barriers to getting people to appreciate just what a problem this is and and getting people to change their choices in terms of what they're eating are. They truly addicted to the point where they are sick. They can't make good decisions like a like a drug addict who is highly addicted to heroin is a sick person. They have an illness and they need treatment. But until they get that treatment they can't make good decisions.
Let's take an analogy alcohol.
40% of Americans are teetotalers never touch the stuff 40% down 40% Don't drink great. I'm not a big fan of alcohol. I've never seen it make anyone better at anything that really mattered. So because kept drinking it's not doesn't completely vestigial. There's no biochemical reaction in the body that requires alcohol. Okay for the same reason by the way, fructose 40% or social drinkers. Yeah, it can pick up a beer put it down. I'm in that category.
10% are binge Drinkers and 10% are chronic alcoholics.
Now do you deprive the 40% of social drinkers because of the 20% of binge Drinkers and chronic alcoholics do I believe people should be in choice, but I believe people should know what they are doing so that they can be in Choice. Well write it like do is you I always say and I said this about the alcohol episode was turned out to be one of our most prolific episodes where I said that, you know more than two drinks zeros better than
Any and more than two drinks per week you need to do other things to offset that and it's problematic. That's what those are what the data say. But I but I would say do as you want but know what you're doing. Well, so I would say that that's exactly what the food industry wants you to think that's exact is the food industry's Mantra is you know, if your own choice personal responsibility
So the question is just personal responsibility work and the answer is no it doesn't every Public Health debacle in the history of mankind started out as a personal health issue before it became a Public Health crisis and you can pick your you know, personal responsibility issue, whether it be exposures whether it be addictions whether it be infections bottom line is ultimately it required.
A societal response. Okay, we can talk about syphilis. We can talk about tuberculosis ultimately needed a public health response. We can talk about teen pregnancy we can talk about tobacco. Tobacco ultimately needs a public health response because the sheer enormity of it and the the egregiousness of it requires that public health response Well turns out this is no different.
In order to exercise personal responsibility for criteria have to be met those four criteria are the following number one knowledge. You have to have the knowledge because if you don't have the knowledge and how can you exercise personal responsibility? Well, in fact the Public's being kept from the knowledge, we're doing this now in part two in you know to entrain that knowledge to get people to understand what the problem is. Yeah. I mean like
For myself pretty informed about nutrition and health but already today, I've learned two dozen facts about processing a fructose and calor calories. Generally that I had no knowledge of Prior. Well, that's good. Okay, because it's not about the math. It's about the science. Okay, they want it to be about calories. So we have this thing called food science. We have this thing called nutrition and we have this thing called metabolic Health. They are not the same food science.
What happens to food between the ground and the mouth nutrition is what happens to food between the mouth and the cell metabolic health is what happens to food inside the cell but all of the chronic diseases that we are suffering from type 2 diabetes hypertension dyslipidemia, cardiovascular disease cancer dementia fatty liver disease pause cystic ovarian disease those eight diseases which make up 75 percent of healthcare expenditures in this country today.
Are all inside the cell because they are all mitochondrial dysfunction. And there is no medicine that gets to the mitochondria although you and others at Stanford Harvard etcetera are starting this with it metabolic Psychiatry being one instance right and date and UCSF as well for giving hydrogen engine UCSF upfront your your home institution wonderful institution right up the road from Stanford. So, you know things are changing people are starting to think about mitochondrial who they are.
Okay, so you lift off the first the first thing you said therefore things that stand is very first one was knowledge. Okay second access because if you don't have access then how can you expect sighs person responsibilities access to healthier Alternatives exactly which means cost-effective. I mean, I love berries from the farmers market more than I love berries from the store. I love the farmers markets generally about takes time energy to go there and the cost is actually lower at the level of what you hand the
are typically right but volume is tough to achieve. They actually have me at a at a quota. I'm not allowed to buy as many barriers as I want because obviously there are other people who want various. Yeah. So there's that right people have to feed their family that you know, and well we were used to eating a lot of volume but you're able to at least go there sometimes okay, we're talking about people who live in quote food deserts. We also talking about people who live in food swamps. Okay, and when were talking about food swamps, we're not talking about an
Surah of healthy foods were talking about all the junk that's what they live in the swamp of junk. So if you live in the swamp of junk, how are you supposed to exercise personal responsibility number three or four debility? So you have to be able to afford your choice and Society has to be able to afford your choice. And right now we can't afford that choice because health care costs right now are at
one trillion dollars a year, but like so many things in behavioral economics and health. It's so hard for people to see that the immediate choice is leading to higher costs down the road. They're just too many nodes of separation for people to realize. Hey when I'm reaching for this cereal as opposed to making waffles for my kids from scratch or you know, they're thinking time efficiency cost efficiency volume the kids not throwing Tantrums because they're not no longer getting the cereal.
And it's very difficult to see this is the reason why health care costs are going up there just too many nodes of Separation couldn't agree more. But ultimately it's because the government separates in silos food industry profits from health care costs, if you actually combine those because they ultimately are the same you would see the problem. So globally the food industry grosses 9 trillion dollars a year.
Healthcare costs globally cost 11 trillion dollars a year dietary related healthcare costs environmental costs cost seven trillion dollars a year and productivity costs costs 1 trillion dollars a year. So when you do the math 9 minus 11 minus 7 minus 1 means that there is a 10 trillion dollar a year deficit because of us cleaning up the mess that the food
The street makes and while numbers let's not affordable. Right? I agree and while numbers like that land really hard. I find that for myself and for many people statistics like that are hard to keep in mind in a way. There's something about the human brain that hears that and goes. Whoa, we're like that War cost that much and this food issue cost that much and then we go to the store and we're hungry. Right and the kids are hungry and your and so those nodes of Separation. It's almost like an
Neural / memory / prefrontal cortex issue to me. And of course, I look at everything through the lens of neurobiology to you know, not everything but most everything and so how how could I not how could we not but then like the issue is well there still food on the shelves and you know, and so it's very what do we do to connect to bring closer together these notes. So what question would the government do so the question is is there food on the shelves. Let me finish the fourth one. And then I want to come back to that point. Let me just you know finish a car.
That so affordability and number for externalities your choice can't hurt anybody else. But what if your choice does hurt somebody else so like for tobacco secondhand smoke right for alcohol drunk driving. What was the argument for teen pregnancy that someone else was going to have to raise the kids exactly. But what about for food?
Okay. Well how about the fact that your employer Stanford University has to pay two thousand seven hundred and fifty dollars per year in obesity-related health care expenses that they have passed on to you even though you're not obese.
That is affecting you so that guy is obesity right there that is affecting you but there nowadays it's especially tricky even to have the conversation. I'm willing to have it now, which is that, you know, there's this whole concept of fat shaming right? So if somebody is obese whose fault is it and if we even talk about it,
Is are we subject to attack legitimate attack? You know, so so calling something someone obese at a clinical level? Like I mean, you're an expert in don't talk about you. Don't talk about obesity. Let's talk about diabetes. Okay, so talk different consequences of obesity. Yeah. Let's talk about the metabolic health issue itself.
Okay, the fact is that diabetes is now 11.4% of America. What was it 20 years ago? It was 20 years ago. It was about 8% I was wondering this earlier 20 years ago. There was a lot more margarine and refrigerators but people were thinner and there was less diabetes everything. He told us about margarine and trans fats is that it's bad bad bad now butter is back as Time Magazine and you said right so clearly can't be the transition away from
That's increased obesity. Well, no. No, so it's give me the increase in sugar and the increase in sugar and these hidden sugars and exactly that's right. The the key though is Pakistan and India because and China they are not fat but they have 14% diabetes rates and the thin.
And the reason is because of ultra-processed food, are there any countries in the world?
That don't allow high fructose corn syrup or at least not at the level that we do. Oh, they're free clothes. Okay, there are two boatloads of countries that don't import high fructose corn syrup or don't make it. So Scandinavian countries Scandinavian countries, most of Europe the other than the Asia Pacific Rim. So Japan has it. In fact, it was invented in Japan 1966 Saga medical school takasaki at all. Korea has it.
But Australia does not have it Thailand does not have it but they have just as much of an obesity and diabetes problem as we do because they have sucrose because high fructose corn syrup and sucrose are no different metabolically. So it doesn't really matter. Is that one to one? It's the one the one thing exactly of glucose and fructose. So here's the question Andrew. Okay, so I want to go back to that. You said all this food is still on the shelves?
Is it food? What is the definition of food?
Can I give the definition? I think most people would give that's not sure the one I would I would give but something that has contains caloric energy. Right? Like I could eat this microphone, but it's not going to provide much useful energy the definition of food straight from the dictionary and believe me. I looked it up and memorized it. I believe you substrate that contributes to either growth or burning of an organism interesting. That is the definition.
Inflammatory scientific 100% correct growth or burning. So any substrate that passes your lips that contributes to either growth or burning that's food. Okay, let's do it. Let's do burning first. I just showed you that Sugar which is the more curved ultra-processed food and 73% of the items in the grocery store are spiked with sugar inhibits burning it inhibits those three enzymes involved in mitochondrial function.
Now it's do growth. My colleague, dr. Are fraught Monson ego or non who is the chairman of nutrition at Hebrew University of Jerusalem actually looked at this question and showed that ultra-processed food actually inhibits growth. It inhibits cortical bone growth that inhibits trabecular bone growth. It inhibits cancellous bone growth. It inhibits linear bone growth, it hijacks growth for cancer because it inhibits mitochondria.
So you have to then grow instead of burn and this was work that was done in Vivo or in vitro in Vivo en Vivo. So these are people that are eating high amounts of Highly processed food. Exactly. How did he find those in the Middle East? They found in Israel? They found so bottom line is if a substrate does not contribute to growth and does not contribute to burning. Is it a food?
I see answer is no well, that's 73 percent of what's on the grocery store. So I would argue you said the foods there. No, it's not that's not food. In fact, it's consumable poison. So this leads to an important question of what's left, right? You remove all that what's left of just anecdotally and I would I sometimes call anak data, you know, I've had several friends in their 40s and early 50s.
These say they want to lose weight and get in shape and that the thing that's worked every every single time for them to lose significant amounts of weight quickly and keep it off and many of them were already exercising but then also increase their exercise was I just since I'm not a dietitian nutritionist or anything. I just say eat meat fish eggs vegetables fruits. You're not going to eat starches. You're not going to drink alcohol. You're not going to drink soda. You can still have coffee tea.
You can still have artificial sweeteners. I will go get to artificial. Yeah a little bit we have to go but and the reason I say no starches even though I personally eat rice oatmeal pasta things of that sort some in in moderation depending on on what sort of exercise and I'm doing and how much is because of the fact that nowadays many those things contains fructose and inevitably every one of those people was blown away by the fact that it quote unquote work.
And assumes that it's all because of reduced calorie intake overall and they lose like anywhere from 30 to 55 pounds and keep it off in there. Like hey, this is great. I can actually still eat ribeye steaks and salads and but they're not eating croutons there and so in some sense, it looks extreme. It sounds ketogenic, but it's nothing like that. You're just saying basically stay away from your limiting processed foods, you're eliminating liquid calories in general and on and on and so there's nothing
Sophisticated about it and my question to you is how much of that weight loss affect you think is a calories in versus calories out effect because they're eating a lot of food and in some cases and how much of it do you think is the elimination or near elimination of this fructose or this glucose fructose combination? It's nothing to do with the calories. It has everything to do with the insulin.
If you get the insulin down.
You're not shunting energy to Fat. You can lose weight your fat.
We'll give up the out of the the triglyceride stored in it. As soon as your insulin goes down. Insulin is pushing on your fat cell all the time. And as long as your insulins up your fat cell can't release it the minute your insulin goes down. You can now engage in what we call lipolysis hormone sensitive lipase is an enzyme in the fat cell that is inhibited by insulin as soon as
Insulin is gone hormone sensitive lipase can turn that stored triglyceride into free fatty acids and glycerol and release it and you can lose weight. So get the insulin down and it all work. So the question is what makes insulin go up. Well two things refined carbohydrate and sugar. Those are the two things that make insulin go up in addition Branch chain amino acids make insulin go up as well leucine isoleucine valine, which is in corn-fed beef chicken and fish processed food.
All right. Here's here's here's the deal in one concept my colleague. Dr. Carlos Montero who is a professor of Public Health at the University of Sao Paulo has done the world a great service. He has developed a system for categorization of food processing. It was called the Nova System just means new but he is basically categorized every food.
Anywhere in the world into one of four classes easiest way to explain this would be an example. Let's take an apple.
Nova class one would be an apple picked off a tree Nova Class 2 would be apple slices destem deseeded de skinned Maybe.
Nova class 3 would be apple sauce cooked macerated possibly at preservative added maybe some extra sugar maybe not.
Nova class for would be a McDonald's apple pie.
Does that McDonald's apple pie look anything like that? Apple know? Is there even any Apple in it? Maybe it's not Maybe not maybe a tiny bit. You know, it's all flavor enhanced etcetera. Okay turns out and this is epidemiologic data, but nonetheless prospective epidemiologic data, so it's not useless.
That Nova class for that ultra-processed food category, which is 73 percent of the American Grocery Store.
Is the class that is associated with all of these chronic metabolic diseases Noble class 1 through 3. No problem. Now when you say associate what percentage of one's daily total caloric intake needs to come from Nova class for before that statement you just made is true because I love the recommendation you made earlier or that let's just say the the Contour of a
You don't have to avoid dessert you can enjoy dessert but don't eat dessert at other times of day, right and maybe you don't need dessert every single night. I'm is there a rule that people have to eat dessert every single night. So the answer is about seven to ten percent would be the upper limit so you can get seven to 10% of your caloric intake daily caloric intake from these Nova class for foods and still still be. Okay still be okay. Yeah. So this is I know that's not what's happening right? I know some very healthy.
Shins who I used to observe how people a move because I would pay attention in my in our field right? I was like, oh, you know people all around me at Stanford UCSF. It's everywhere successful or else they wouldn't be there was like who looks healthy who can make it up the stairs and doesn't have to take the elevator how much exercise are people doing at a given age. Are they fanatic, you know, like 4:00 in the morning Runners. I'm not going to do that consistently unless I have to and I observe that, you know, many of the healthiest people I know.
They move a lot during the day. They ate very well many of them. Skip breakfast or lunch not always and then I also noticed that they would
Drink very little or no alcohol and then but they would enjoy like a there's one physician at UCSF in particular. I'm thinking who really enjoyed his dark chocolate Kit Kat after lunch and he sort of very ceremonial about the unraveling that the foil and the end of the and there's like, okay, so you're talking about that small percentage of calories if that's if that's all you do. Hey, you know God bless you, but that's not what people are doing. That's the problem bottom line that Nova class for is where all the action.
In terms of chronic metabolic disease. So the question is how can you avoid that? How do you know which is which we have a solution so my colleagues and I have developed a web-based tool that is available to the entire world right now and you'll put it in your show notes. I will put a link to this absolutely School. Perfect PE R fa CT and you can find it at Perfect dotco.
And what it is is it's a recommendation engine.
Not AI we're going to talk about AI in a minute, but it is a recommendation engine based on the science of human metabolism that categorises Foods based on not their nutrient content, but on their Metabolic Effect interesting and so there is a Nova filter which will filter out all the Nova class for stuff and it will go to your grocery store.
And we'll tell you what you can buy that will be a noble class 1 through 3, which turns out to only be 20% of the grocery store. It means basically saying on the periphery of the grocery store. That's that's general in general. Yeah. Yes produce the meet the dairy the all the things you mentioned in fact, so I'm not low carb. I'm low insulin and there are a lot of ways to get to low insulin get rid of the refined carbohydrate get rid of the sugar increase the fiber.
Get rid of the branched-chain amino acids. Okay. So eating fish is a good place to be even eating a steak is okay if it's a pasture fed steak. So let's talk about your steak. Would you have a better for the animals? Right? It is absolutely so you mention marbling before we love our marbling, right? You can cut our us grade-a steaks with a butter knife because they're so tender right? You ever been to Argentina?
My father's Argentina. That's right. Your aren't any. Yeah, they only know they only know grasp take the only the idea that the cows would eat anything but grass is sort of like the idea that there was an issue. It would fly. Absolutely New Zealand same thing. Okay, the meat is gorgeous. It's homogeneous. It's pink. It's delightful. I've been to Argentina at the the meat is fantastic, but you have to use a steak Knife. You can't use a butter and it takes more chewing it does and it takes I was showing Zach was just send you the
You know, it's a different experience entirely. It's delicious but it is kind of a little bit. You know tougher turns out that marbling is intra my oh cellular lipid that animal has metabolic syndrome. The American corn fed, the American corn fed animal because that corn is filled with Branch chain amino acids leucine isoleucine valine branched-chain amino acids are what's in protein powder. That's what you know bodybuilders.
As you know put in their smoothies, you know to build muscle and if you're building muscle, that's okay because 20% of the amino acids in muscle are branched chain. So, you know, if you've got a place to put them, you know have at it. Yeah, there's a need there because I'm breaking down my yeah fine. But if you're not if you're you know again a mere mortal like me you consume those excess branched-chain amino acids. They're going to go to the liver. They're going to be deaminated like we talked about earlier and they're going to end up as Branch chain.
Ganic acids, they're going to flood the mitochondria the mitochondria not going to be able to deal with the volume. And so they're going to divert the excess and turn that into fat and so now you've got hypertriglyceridemia and chance for fatty liver disease and insulin resistance. So what kind of meat you eat has a lot to do with your metabolic Health. What about the egg the whole egg near perfect.
Eat protein score in terms of its bioavailability exit terrific. Okay, there's nothing wrong with eggs. Now there are better eggs than others. So that's better. Well, there's yellow yolk eggs and their arrenge yolk eggs. What's the difference between a yellow? Okay gun and orange. Okay. I'm guessing that something about the feed of the mother chicken and I'm guessing it probably also has something to
Do with choline content Omega-3s. Ah, interesting. Okay, the orange yolk egg has a lot of Omega-3s in it. What are other great sources of Omega-3 is I've I know some off the top of my head, but I'd like to hear it from you. Okay. So marine life is number one. Okay, you know fish provided you're not bringing in heavy metals with well. Yes. So, I mean that's always the the argument. You know, the question is, you know, is it the Mercury is the theme I go 3s.
Ultimately, I think it's the Omega-3s that is more important. But yes, I do understand the Mercury issue ultimately. There are three Omega-3s. There's a la alpha-linolenic acid which you can get in vegetables. There is EPA eicosapentaenoic acid, which you can only get marine life fish oil causes liver oil, right and finally DHA don't go hexa inoue.
Which you also get from marine life, but you can get from algae so you can get algal oil which you know, the vegans will use do you personally take anything to increase your omega-3 intake. I know that there's even prescription Omega-3s. I take fish oil. You take a fish oil. Yeah, they only take 3 supplements. Okay. I'd like to know what those are I will say that I always always always say behaviors first, right? Do's and don'ts behaviors nutrition then.
Only if needed and one can afford it then supplementation and prescription drugs and I'm a big consumer of supplements and always have been frankly. So what are the three so you take fish oil the show and do you take to get above a certain threshold of EPA the about 1,000 milligrams of say about a gram a day Rama day. Okay vitamin C how much your vitamin C D 1000 milligrams a day you and Linus Pauling. Yeah. Well, it's actually for my rosacea. I've got skin issue and nobody helps me helps with helps with that interesting.
And finally vitamin D. Now. I will tell you vitamin D is a complicated one. All right length, and we can talk about vitamin D and how either important or not important it is because there's a there's a quirk to vitamin D and it's important for your audience to know about it because everybody in his brothers, you know touting vitamin D. What's the cure for everything? It's so funny because the you have your supplement lovers haters and agnostics but vitamin D some
Made it through the Chute. They everyone's like Pro vitamin D. It's really interesting. Somehow vitamin D. People are comfortable taking a vitamin D gel cap but like other supplements where you say. Oh, like maybe this might be good for you know, like Omega-3s and fish all them people are a little bit like more standoffish. It's really interesting that the kind of psychosis social stuff around this how much vitamin D. Do you personally take? I take 5,000 units a day. Okay. So do I vitamin D is complicated though?
Here's the problem. If you look at the literature vitamin D deficiency is associated with all these chronic metabolic diseases. However, supplementation with vitamin D has not fixed any of those. Hmm. So if your vitamin D deficient, why wouldn't supplementation fix it
Couple of reasons one one of the reasons for vitamin D deficiency is because everyone's drinking soft drinks. That's one reason but there's a more important reason sugar and artificially sweetened soft drinks. Yeah can deplete vitamin D utilize it. Well, you're not consuming Dairy because you're consuming soft drinks, but I can't tolerate milk anymore. Well, yeah, then you take vitamin D. But here's the here's the real nugget of Truth. And this is a little complicated but the endocrinologist
From the audience will get it vitamin D is a pre prohormone. It's not it's not active at all vitamin D is converted in the liver first step to a compound called 25 hydroxy vitamin D. That is a prohormone. It also is inactive. It has no activity whatsoever from there.
25 hydroxy vitamin D can be metabolized one of two ways.
It can either be 1 Alpha hydroxylated in the kidney to the active form 1 Alpha is 125 dihydroxy vitamin D, which will then do all of the business of vitamin D such as calcium absorption from the gut suppression of the immune system at the toll-like receptor 4 that sounds like a bad thing. No, that's a good thing. I know but I had to bring that up because it when you say suppression of the immune system. People are my immunosuppressed nobody that sounds like AIDS a good
It suppresses inflammation. It's a good thing. Okay suppression of information. And that's actually the point that we're getting to so there are a lot of good things about 125 dihydroxy vitamin D. However that 25 hydroxy D that came out of the liver can be metabolized a different way. It can be 24 hydroxylated in inflammatory tissue like tuberculosis.
Sarcoid gut inflammation and so you will end up taking your 25 hydroxy D which is a prohormone and turning it into the inactive 2425 dihydroxy D which then just gets excreted out. So in other words you consumed all this vitamin D and it didn't go where you needed it to go. And the reason was because you're inflamed you have to fix the inflammation before the vitamin D.
The effective and 93% of Americans are inflamed. So giving them vitamin D is not going to do a damn thing got it is reducing fructose intake that one of the primary ways to reduce systemic inflammation. Absolutely. What are some others reducing oxidative stress in general? So heavy metals like cadmium, you know cadmium is very high in chocolate. Especially South American chocolate. Sorry. I'm not a fan of chocolate I caging like
little dark chocolate But but so if people are going to eat chocolate, they should be careful how much chocolate they well especially if it's South American chocolate and processed chocolate. I mean the really good we're going to be on the hit list of so many Industries and yeah, so that's what comes out. All I can tell you is I've been on the hit list for a decade and I'm just you're just one big Target. Yeah, right. I got it. I got it. It's on my back, you know, technically I already got that there are
The main thing is to make that gut work, right so fiber short chain fatty acid production from fiber is a huge, you know, Moon and reduce inflammation reduce inflammation, but improving sleep. Is there any evidence that you know, chronic slight sleep deprivation can increase inflammation? Well, what it will do is increase cortisol and chronically increased cortisol will definitely lead to increased inflammation.
Which is funny because cortisol is usually considered the anti-inflammatory. But only acutely right chronic cortisol elevation does the opposite if we can always contribute to I have this secret agenda, which is not which is not a secret, which is that people think cortisol is bad when in fact acutely cortisol does wonderful things provided is happening at the right time of day right late shifted cortisol bad too much or too frequent cortisol bad, but cortisol, you need it. It's so essential.
And I think most people just hear cortisol and it's been associated with all things bad and maybe we can help shift that near yeah. I'm very happy. I mean as an endocrinologist the you know, this is you know, where is my wheelhouse is where I live cortisol is a good news/bad news deal like so many things short-term gain for long-term pain. Okay. So when you are in what we call a low stasis that is perturbation of homeostasis that is
a stress and acute stress cortisol is one of the things that helps you manage that bodily and mental stress. So an English test
Car accident running away from the lion, you know the famous, you know pygmy running away from the lion all of those require cortisol in order to manage and mitigate that stress the upcoming 2024 election. That's chronic stress that is not acute stress. I mean, that's the worst that they'll be the only mention of politics. Yes podcast and we don't have to go there but we're all chronically stressed.
425 dihydroxy D which then just gets excreted out. So in other words you consumed all this vitamin D and it didn't go where you need it to go. And the reason was because your inflamed you have to fix the inflammation before the vitamin D can be effective and 93% of Americans are inflamed. So giving them vitamin D is not going to do a damn thing got it is reducing Fork tosun.
Take that one of the primary ways to reduce systemic inflammation. Absolutely. What are some others reducing oxidative stress in general? So heavy metals like cadmium, you know cadmium is very high in chocolate. Especially South American chocolate. Sorry. I'm not a fan of chocolate. I caging like a little dark chocolate But but so if people are going to eat chocolate, they should be careful how much chocolate they well especially if it's South American chocolate and processed chocolate. I mean the really good we're
Be on the hit list of so many Industries. And yeah, so that's what comes actually
all I can tell you is I've been on the hit list for a decade and I'm just
you're just one big
Target. Yeah, right. I got it. I got it. It's on my back. You know, technically I already got that there are the main thing is to make that gut work, right so fiber short chain fatty acid production from fiber is a huge, you know.
Moon and reduce inflammation reduce inflammation but improving sleep. Is there any evidence that you know chronic slight sleep deprivation can increase
inflammation? Well, what it will do is increase cortisol and chronically increased cortisol will definitely lead to increased inflammation, you know, which is funny because cortisol is usually considered the anti-inflammatory. But only acutely right chronic cortisol elevation does the opposite
if we can always contribute to I have this secret agenda, which is not
Which is not a secret, which is that people think cortisol is bad when in fact acutely cortisol does wonderful things provided is happening at the right time of day right late shifted cortisol bad too much or too frequent cortisol bad, but cortisol, you need it. It's so essential and I think most people just hear cortisol and it's been associated with all things bad and maybe we can help shift that near
yeah. I'm very happy. I mean as an endocrinologist the you know, this is you know, where is my wheelhouse is where I live
cortisol is a good news/bad news deal like so many things short-term gain for long-term pain. Okay. So when you are in what we call a low stasis that is perturbation of homeostasis that is a stress and acute stress cortisol is one of the things that helps you manage that bodily and mental stress. So an English test
Car accident running away from the lion, you know the famous, you know pygmy running away from the lion all of those require cortisol in order to manage and mitigate that
stress the upcoming 2024 election. That's chronic stress.
That is not acute stress. I mean, that's the worst that that would be the only mention of politics. Yes podcast and we don't have to go there but we're all chronically stressed.
And we can talk about why that is and what's going on and I'm actually very interested in that and a colleague of mine in Paris and I have built a computational model of the limbic system which focuses on the stress center of the brain the amygdala to understand how chronic stress is different from acute stress and how that chronic stress ultimately leads to metabolic and mental health disaster
very interested in learning.
About that before we touch on that you've worked a lot with kids people age as you put it 0 to 19. I don't know about the exact numbers, but when I was growing up there were some kids in school that were overweight but it was the occasional kid right now. It seems depending on where one draws the threshold for overweight. It seems that there are a lot of kids that are
overweight. How about 25% obese?
And 40% overweight.
Okay, so obviously a serious problem serious now and going forward and what about adults in the u.s. I remember seeing at a meeting a map of obesity in the US and over time and it very quickly filled in from very few people were obese to very many Colorado was this was this like like Beacon of fit people, but now it's no longer and that's bullshit to. Oh, okay
cool. I'll tell you why the there are four things that can.
Is mitochondrial biogenesis
you can tell me altitude is cold. Yeah, cause why
Colorado's SOB's altitude that's why Colorado's less obese. And what were the other two, I furry butt and those were the reason it had nothing to do with being more fit. It had to do with cold and altitude example, Switzerland compared to Germany. They got the same crappy food, but Switzerland has half the Obesity the Germany does. Hello, Switzerland is higher.
Fire,
I love the food when I go to Munich. I love the schnitzels and his wonderful sauerkraut and they got that
in Switzerland to
okay, so that great food Switzerland is less
obese. It's same way Colorado's less obese. It's because of the altitude you
mentioned called many listeners this podcast are least interested in some also practice deliberate cold exposure cold showers cold plunge is mainly for the I think the best data are the increase in catecholamines up in effort norepinephrine dopamine.
In that are long lasting people feel a big state shift, they feel better. But when one looks at the effects on metabolism, they're pretty
slight. They aren't there
slight however studies like that to me always seem short sighted in the sense that if there's a longer Arc of effect on the mitochondria that's affecting other things in terms of how calories are processed.
Or how calories are feeding into mitochondrial function or dysfunction there? I could see how it might shift the shift this scale. So to speak I mean cold is is an amazingly powerful stimulus and I think of light cold food movement is kind of like the core four ways in which you can shift physiology
easily. All of these things are eminently manipulable and for almost zero dollars. Okay, but you have to know what you're doing.
And right now we've been actually kept from that knowledge and you know, if you're addicted it's really hard to under dick yourself.
So that brings us back to this thing about food industry conspiracies government conspiracies. And the rest boy, this is going to be an interesting we can go
Section
but
What do we do like, so if you and I go up to cap capitol hill which I've done. Yeah, which you've done and maybe I'll join you someday.
And you know your UCSF I'm down at Stanford your clinician. I'm a scientist and public health Advocate podcaster. And we explain to people Hey, listen, like there's that the food is laced with a drug. It's mine. It's not even really food. It's right. It's not food. It's an aggregate of food and non-food parts that make you think it's food. It's sort of like telling people. Hey your kids are you know, they're swimming in a swimming pool looks like water but it's actually part poison and it's and it's harming them. It's giving them, you know, if you say those kinds of things I mean Congress
Women are there like reasonably smart people right? I mean are they gonna do something about it? No, so where is the conflict is that the food industry has the government by the short
hairs? That's exactly right and they
have them by the short hairs where I mean, is it are they lining their pockets? I mean where where is The Leverage acts
actually exerted? Okay, so they are lining their pockets. That's number one. That is absolutely true. We have the data to support that Blanche Lincoln. Who was the senator from
From Arkansas who is the chairman of the nutrition committee? You had to see her campaign contributions every time she was up for re-election.
So it's all about getting re-elected or it's about them like having a like a third home in the
Hamptons. So I think it's the third home in the Hamptons.
Okay. Well, I think it's really as bad as it is as some of the documentaries without make us
believe without question. Good night. And we and we have the data there is a an organization that I absolutely want to call out because they are you know, the most egregious organ.
Political organization on the face of the Earth they're called the American legislative exchange Council Alec or Alec and they write bills. They are a bill Mill. Okay, and they are for whoever gives them money and who gives them money big Pharma big Agra big oil and big food
and you're so you're including big Pharma. You're a physician you've written scripts before you've written prescriptions for patients before is in that formula that provides the drug.
That allows your patients to feel
better. Well, the question is do they do they feel better? This is a big question lets you want to go get ready to go there but you're
writing the script. I mean, I mean, I'm just trying to I'm trying
to I'm knowledge
you but I see so you don't have to be instances where someone's thyroid efficient and you give them, you know,
absolutely. Okay. So if you've got a disease and a medicine will replace what's missing sure. Okay, so for deficiency diseases which as an endocrinologist
What I do absolutely and I did that, you know with no compunction of impropriety whatsoever. But that's not what we're talking about here. Let's talk about what we're really talking about. Let's start with statins.
statins lower LDL
okay to statins reduce heart disease yes or
no.
You know I seem to be with him today on all the quizzes and it's becoming flat for me at this level. I'm gonna go with no but but I will say, you know, my friend and I think his expert Physicians. Well, you know, Peter Atiya and others, you know has talked about some of the positive attributes of statins in certain cases
for certification certain cases. That's exactly right and I completely agree and by the way, Peter is a friend and you know, we someday will will you know all you know go out drinking together. Well, I won't drink buddy.
Well, how about we share a state shares their absolute? Okay, you got it.
You guys, I don't know if he
drinks a little bit if you're listening. Okay, he drinks a little Border House on me. Yeah, I
don't do the desert or the or the alcohol anymore. But um, but I'm and it's not so I can live to be 120 so I can wake up the next morning and keep up with you
guys. It's fine I get
So for primary prevention that is your ldls high you need a Statin that's primary prevention. You haven't declared yourself. You haven't had an event for primary prevention the mean increase in life span for being on a Statin is 4 days 4 days 4 days 4 days.
I'm back to chuckle that's that's and the risk for
diabetes.
Is 20 percent increase what about any
Improvement in quality of life done
for primary prevention now for secondary prevention for secondary, in other words, you've already declared yourself. You already have a problem for secondary prevention. That's where statins shine. So there's a value to them. I'm not arguing that and if you have familial hypercholesterolemia, which is 1 in 500. Okay, not only do you need a Statin Puccini to low-fat diet and a priest.
Okay, so there is definitely a value to statins but not for primary prevention. But that's what everybody what every doctor is doing. Oh your LDL it's over 80, you know, you need a Statin that's ridiculous. That is absolutely a joke. And the data show that in fact, in fact, my colleague is seem Malhotra in the UK participated in an analysis where they took the entire UK population and they took out
Everybody under age 65 so looking at people 65 to 90 and it turned out that the LDL level correlated with longevity the higher the LDL the longer they lived when you took out all the people who had problems. So LDL is not really the problem. And the reason is because there are two ldls there's one called large buoyant to there's one called small dense turns out dietary fat raises your large buoyant you large buoyant is ear
Irrelevant, it is cardiovascularly neutral but that's the one that statins affects the small dense. That's the atherogenic particle when you're small dense LDL is high. That means you are not clearing triglyceride peripherally because that's what small dense show you. That's that that's what happens to triglyceride is because they become small dance. Can
I take a guess and say that?
The best way to reduce small dents has to reduce
insulin. Yes by reducing sugar.
Because that triglyceride is made in the liver so palmitate and that's the only fat that the liver knows how to make and so triglyceride is your liver output of carbohydrate. That's how you have to look at triglyceride. So triglyceride turns out to be much more important as a cardiovascular risk factor than LDL ever
was so does the does big Pharma and big food do they know all of this?
Yes, I know.
You know because they've told me so and but they have statins
to sell.
And Foods in the the Nova class for
hmm. They know this too.
So, you know, I'm an optimist or you know, what what's it going to take to really move the needle. I mean you describe the four barriers. We're trying to add to the knowledge component. Now, you know, what's again take is it going to take, you know, having a president in an office or congress people in office that really understand and care about this stuff.
Yeah, I mean to really revamp the whole system. Yeah. So right now the system is completely and utterly broken completely and utterly broken and there's a reason why it's completely and utterly broken because the food industry likes it that way. Well,
it's profitable for them. Obviously.
There are 51 different federal agencies that manage our food 51 and none of them know what the other ones doing.
And the food industry the likes it that
way so communication across these 51 organizations would
help. Well if we had a centralized food Czar or food, you know, if we split the food off the FDA because you know, it's like it's not the FDA. It's the DEA or the FDA is not the Food and Drug Administration is the Federal Drug Administration. They spend a lot of time on drugs. They spend almost no time on
food.
Let's think about where there's been success so I can recall when people smoked on planes. I actually recall going to a gym in Europe and there was an ashtray molded into the squat rack that was telling ya I don't see people smoking cigarettes around Stanford Hospital anymore. But I remember when they initially said that people couldn't smoke anywhere except in with this one little designated area. And that's typically what you see nowadays and my understanding of the anti-smoking campaign at least for kids for people.
18 and younger was that telling people it was bad for their health didn't work that's showing them lungs that were decrepit didn't work did not what worked was showing them commercials of cackling hand Rising white guys who were talking about how much money they were making off of these naive kids who are buying cigarettes and other tobacco products, so it became a the the effective campaign to end smoking in Young.
Was to hijack their real inherent rebellious - of Youth and then they were like
no we're sticking to the man to
them. Like if you know that the as my friend calls it like the tube the two-finger business card like No And so that worked that were to something is making a comeback with a penis a separate episode. We won't get into that but because nicotine is still addictive but you don't see a lot of people smoking cigarettes. So it worked like something that you would never imagine.
Imagine could
ever work worked. Well, so yes. No, I mean that's part of it. I'm not going to tell you that it's not it is part of it and we actually have an example of how that could be applied to another toxic substance sugar. We had Berkeley versus big soda, you know, that's how Berkeley ended up with its soda tax that dates back to 2005 the city of Berkeley city of Berkeley it we just celebrated the five-year anniversary of the Berkeley soda tax.
And we've been able to actually look just a tional diabetes way down obesity down slightly not a lot but a little bit cardiovascular disease down Dean Schillinger and Chris Madsen at UCSF and UC Berkeley just presented at San Francisco General just three weeks
ago. So a certain facts like the cigarette tax like this makes soda
expensive exactly. So you're telling me that a can of
Coke.
That I buy on Shattuck Avenue in Berkeley cost more than a can of Coke that I buy in on University Avenue in Palo Alto. It does
huh? Okay by a dime
and that was and sufficient enough to to create this kind of
change well in yes, it is money hurts because money hurts. Exactly. So Andrew there have been four count them for cultural tectonic shifts in America in the last 30 years and they're all undeniable.
Your they are number one bicycle helmets and seat
belts. Are you everybody uses us
to smoking in public places Nobody Does that three drunk driving?
Hopefully if you were people are doing
that for condoms and bathrooms condoms in bathrooms bathrooms in public bathrooms. Yeah, you
see those more available.
Okay. Yeah. All right thirty years ago if a legislator stood up in a state house.
And proposed legislation for any one of those four and I don't care if it's in a state house or and Congress or Parliament during the Duma or anywhere else in the world. Then again laughed right out of town Nanny state liberty interest. Get out of my kitchen. Get out of my bathroom. Get out of my car. Okay today. We're all Facts of Life.
All right. Nobody's bellyaching about any of those point is we were able to solve those for
Public Health debacles, how did we do it? How did we solve those for no one could imagine that we would ever solve smoking? Right, but we did sort of and then we brought consumption down by half. Okay, that's pretty good when you think about it have an addictive. So how many
fewer people are dying of lung cancer nowadays
in the office? It's like 80% lower.
Wow. Well, there's also been improvements in treatment. But yeah, but
denies it but it's the in diagnosed with
Since the incident incident second amazing, okay, because tobacco has gone down. So the question is how did that happen? The answer is very sad and why did it take 30 years to do it. We taught the children the children grew up and they voted and the naysayers are dead.
That's how you make a cultural tectonic shift. So we now have this real food Movement. We have people who are arguing against Ultra processed food. We have kids who are demanding different in their schools. And by the way, what is the biggest fast food franchise?
In the United States,
I'm going to get this wrong. So try me again. I don't know. I've never tried it but I've heard of is it
Chick-fil-A? Nope, sit
McDonald's. I don't
know it is this nation's Public Schools? Ah, you can add up McDonald's Subway Burger King. Hey and Wendy's and every other.
Fast food franchise Jack-in-the-Box every fast food franchise in the entire country and would only be half.
Our nation's Public
Schools. So could you imagine a world where there were no class 3 or class for Nova Foods allowed in in public schools, and we're doing
it. So I am the chief science officer of a non-profit and put this in the show notes called Eat Real eat real dot-org and we have a new business model for public schools.
So in 1971.
The Department of Education issued an administrative ordinance called resolution 242 and they did this purely on monetary issue reasons. This was under Nixon and what this resolution 242 said was that all School cafeterias all throughout the country had to make book.
They had to basically cover their costs. They couldn't be lost leaders for the school. They had to fend for themselves. Well this sent every food service director in the country scurrying for you know, how am I going to do this? Because I got all these you know, you know Lunch Ladies, you know, which personnel and then food preparation equipment and and and costs, you know that they're you know mounting. How am I going to break even
They couldn't do it. So in walks, you know Aramark and Cisco and Guggenheim and McDonald's and they say hey, we'll do it for you will provide every kid in America with a nutritious meal Every Single Day hot lunch. Well, they didn't say hot. Okay, the just had lunch. Okay nutritious. They said nutritious and I put that in the air quotes to because it wasn't nutritious and here's the added benefit.
You can take your food preparation facilities and your footprint in the school and you can turn that into classrooms because you're going to need them.
And that was the goal because as soon as you've moved the food preparation facilities out of the school, you are now Hostage to the food industry for the rest of your life. And I could also see
how that allows room for them to use these commoditized Foods foods that have very long shelf life exactly. Right because you want to make sure that you know, if you only sold, you know two-thirds of the lunches that were prepared that on next Tuesday after the weekend, you could still give them food. That isn't moldy exactly right and I will tell you so
That's how it happened and you can actually Trace IQ scores and reading and math scores in this country down from 1971 to
today.
When I went to school, I was allowed to get I called it hot lunch because it was usually hot. It was allowed to get the school lunch one day a week one day we other days I had to bring my lunch that one day was pretty special like you felt like you were getting a treat. It was usually like corn dog or a hamburger. The hamburger was pretty paltry, but the the commoditized him. Yeah, come on sighs hamburger. You had to go looking for the Patty portion and the bread was sweet and so is it was different right? But
I don't remember nearly as much will be see I went to to high school in the early 90s. So you're saying that now if I went to a high school, it would be a lot more sodas and doughnuts and pizza and got
it. Yeah Pizza is a vegetable. Did you know they claim it's a vegetable Congress said pieces of vegetable. Amy Klobuchar made pizza a vegetable. Maybe they need their eyes because the biggest frozen pizza producer is in Minnesota, I mean Kolchak,
Jim is a
vegetable was it was a it was a stretch but at least it made sense on the Nova System of to going from tomato all the way to to
catch up to catch up since high fructose corn syrup is the primary ingredient in ketchup indeed. So the point is that our kids are suffering under the weight of the burden of this chronic disaster of ultra-processed food, which is not food and no wonder they're all obese.
And sick and you know doing so poorly in school. And by the way also depressed ultra-processed food has now been shown in three separate studies to correlate with depression in teenagers.
So what is the relationship between processed food or baby? We call it Nova System level 34 foods and depression and other psychiatric challenges and if you could you separate out
out metabolic syndrome from obesity in answering that look like is there something inherently depressing about carrying excess adipose tissue setting aside any kind of aesthetic stuff, you know how people want to look or perceived, you know, just is there anything bad about carrying a lot of body fat independent of the metabolic syndromes that for mood and an overall sense of
well-being? No, I'm really glad you asked that and room we should have actually covered this earlier.
Everyone thinks fattest fat as we've learned fat is not fat and a fat is not a fad but body fat is not body fat. There are three fat Depots and they are metabolically different. The first is the does this bathing suit make me look fat fat by the way, never answer that question that's called subcutaneous fat or big butt fat.
If you will, so here's the question how many pounds or kilos of subcutaneous fat? Do you have to gain before you become metabolically ill I'm no idea about 10 kilos about 22 pounds. Okay why the reason is because that subcutaneous fat drains into the systemic circulation.
So you have to have a lot of cytokines coming from those subcutaneous adipose sites to raise the blood level of cytokines to the point where it starts doing damage at the level of the liver.
So fats are releasing cytokines, which are pro-inflammatory exactly and they're doing that at rest any fat
cell any fat cell? Okay any fat cell, but if it's going to the systemic circulation you have a volume of distribution of six liters.
So you have to lose, you know have to have a lot of cytokines to get the concentration
up now just out of fairness to the fat.
How many cytokines does a muscle cell release I mean are we unfairly picking on adipose tissue? Because why would adipose tissue may be pro-inflammatory? I mean a single fat
cell? Okay. I've got a
fat cells sitting at you know, my shoulder someplace, right? I mean, I'm not a zero fat at my shoulder. Why would it be
pro-inflammatory? So in fact the fat cell itself is not here's what happens the fat cell has a fat vacuole. It has a
Storage place for this lipid droplet you stuff it stuff. It stuff it the fat vacuole gets bigger bigger bigger the Perry life and border that encompasses that fat vacuole that it borders the the space ultimately can't get any bigger and it starts breaking down when that happens. It's spills the grease into the fat cell the fat cell dies.
Becomes necrotic that calls macrophages in to clean up the grease and it's the macrophages that release the cytokines. All right. So in fact the fat cell is not the problem. It's the breakdown of the grease that leads to the macrophage activation. That's the problem. But when you do it in subcutaneous fat, it's going into the six liter tank.
And so the concentration doesn't go very much.
So 10 kilos before you start seeing some effect.
that Depot number to this rule or big belly fat
now how many pounds or kilos of big belly fat? They have to gain before you get metabolically ill
I don't know but I'm guessing it's less than 22 pounds. It's way less for once. I got an answer right to it.
That's all right about 5.5 pounds. Now question is why number one the visceral fat does not drain into this into the systemic circulation it drains into the portal vein, which goes straight to the liver.
You're getting a bigger load going straight to the liver of
cytokines. Not to the kidney. Not a good thing about getting an answer wrong folks is that you never forget the correct answer. That's why I always say tell my students right? So I'll never
forget that. Isn't it? Got it. And the question is what made the visceral fat in the first place. Was it Cal? No, it's cortisol. It's stress. It's the combination of the sympathetic nervous system and cortisol and the
Reason we know this is because you can take patients with major depressive disorder with endogenous depression who are suicidal who have to be admitted to the hospital to keep themselves from killing themselves stick them in a scanner and they are losing subcutaneous fat like crazy because they're not eating but they're gaining visceral fat because of the high cortisol on the stress.
So there's something about the adrenal cortical to receptors in that area that just preferentially Depot fat there when cortisol is high indeed
because that's the metabolically active fat and 5 pounds will do it. And then finally the third fat Depot the liver now how many pounds of fat can the liver store before you become metabolically ill
got to be even less because
The livers not nearly as large as the abdominal
region half a pound
quarter of a kilo. How much does a healthy liver way
a healthy liver ways 1500 grams.
Okay, so, you know, it's not very
translate quickly a pound. So we're going Metro we're going as a
standard. So 1500 grams would be 3 pounds. So, you know basically half a pound. Okay, so not very much.
Because that's where the action is. And so when you have fat in your liver, it causes metabolic dysfunction right away. And the question is where did that fat come from that came from alcohol or sugar so alcohol and sugar most metabolically egregious because it affects the liver directly stress second most because it affects the visceral fat and subcutaneous fat the
It's important in terms of metabolic derangement. So yes, it may not look good in a bathing suit, but from a metabolic standpoint. It is actually the least important. So the question then becomes all right. What are you trying to fix if you're trying to fix liver fat? It's really easy to get rid of the alcohol in the server, except of course, they're both addictive.
Well that also liberate any fat that's already in the
liver. Absolutely. And that's one of the reasons why intermittent fasting works.
Is because it gives your liver chance to basically offload what it's already stored. That's one of the things that intermittent fasting will buy you is a little less liver fat. So that's a good thing right now stress on the other hand as you know, and as we've talked about and as you know, you've had a doctor Atlas apple on your podcast before, you know stress is tough, you know, trying to mitigate stress, especially in
Today's environment and I hope you'll invite me back some time to talk about the role of stress on the amygdala gladly. Okay, and then finally, you know subcutaneous fat. So when people go on diets sweeteners,
what are they doing? Are they really reducing the fat and the answer is no
when you talk about artificial sweeteners
artificial diet sweeteners of any sort and you can pick your artificial sweetener so aspartame or you know, sucralose sucralose Stevia monk fruit the new ones, you know?
Yeah, the one that people are more excited about nowadays is Al Lo steel it's expensive. It tends to have less of an artificial sweetener.
People can detect right? So you're saying that regardless of oh and we should I'm remembering from the comment section. I do read them artificial sweeteners and non-caloric sweetener say, yes, because it was the moment you say artificial people. Say what about Stevia? What about a low low, so so let's just say non-caloric sweetener is can wrap our arms around all that entire category unless we need to distinguish among the different participants in that category. So you're saying that
even though people can lower their total caloric intake pretty effectively. I've seen the studies that show if you know dieters who consume water only as their you know main liquid versus diet sodas with aspartame typically or Stevia the diet soda drinkers actually lose more weight. We know that but you're saying there may be deposition of fat in the liver in those individuals be
Because of the artificial sweetener
because of the insulin turns out they're still in insulin response. So they're very famous study done in Copenhagen 100 normal individuals 25 in four different groups.
one group
1 1 L of sugared soda per day for 6 months only that's a lot of sugar. So yeah one group one liter of diet soda per day for six months. I probably did that in graduate school one group 1 liter of milk per day for six months probably did that when I was an infant and finally one final Group 1 liter of water per day for six months.
I do more than that. But yeah,
the one liter of soda per day in six months gain 10 kilos the sugary soda and sugary soda 10 kilos and kilos. No surprise the 1 liter of water per day lost two kilos also. No surprise. Those were the easy ones. Now, let's do the ones in the middle one liter of milk per day. No change
presumably that was full fat
milk, which I believe Europe.
Full family they like their full fat milk no change. Why is that?
They're taking on an enormous increase in total
caloric intake. I'm guessing that there is a blunted insulin response to the fat in the milk
and also because lactose is not a very big driver of insulin response. And because there's a satiety effect that's like they eat less. It's like food like food and finally the key the kicker to the whole thing diet soda.
The one leader died, sir. What would you predict their weight would do
more weight loss than in the water group based on my understanding of the
literature. They gained two kilos wild because they more well, you tell me why did they gain two kilos if they were consuming a leader of diet soda, which are zero calories the answer is because they still generated an insulin
response and that insulin response generated more hunger
more more weight.
And more hunger exactly and that's the key so they didn't gain the 10 kilos. They gained 2 kilos so it looks better compared to the sugared version but it looks like you know a problem compared to the water version or even the
milk version. So unless you bootstrap calories and hold that constant, you're going to see a weight gain due to artificial sweetener in
exactly right and that's been shown 50 ways from Sunday at a whole bunch of different studies. So,
Paired to Sugar. Yeah, it's better but compared to water. It's way worse. And the reason is the insulin response. You put something sweet on the tongue message goes tongue to brain sugars coming message goes brain to pancreas through the vagus nerve sugars coming release the insulin and so tongue doesn't know if it's sugar or not. It releases the ins the pancreas releases the insulin which drives energy into fat whether it was you know from the dye sweetener.
I saw some really interesting data from Dana Smalls group at Yale. Yep showing that when people have a diet soda with food, so there's like the diet coke with the sandwich or with the burger maybe even with the pasta the insulin response from the food and the insulin response from the diet soda are compounded but there's a classical conditioning effect pavlovian effect such that then later if they just drink the diet soda, they get an even bigger insulin response just to the diet soda, then they would have
Originally, if they only had the diet soda separate from food. So in other words the the insulin the food-induced insulin response is conditioning a greater insulin response from the diet
soda, and we actually have another study that demonstrates the same thing out of Singapore today at all American Journal clinical nutrition 2018. I believe that looked at a similar Paradigm. Here's what they did.
They took a bunch of people and they admitted them to their Clinical Research Center four times a week apart and they did him in random order and each time. They started the morning that fasting and they did either a sucrose tolerance test or an aspartate mm tolerance test or a sucralose tolerance test or a monk fruit tolerance test. So two hours, you know in
Testing one of the 31 of the for and measuring glucose and Insulin over the course of the next two hours fasted fasted. Okay? Okay, then it was time for lunch and they let them have whatever lunch they want. It was a metabolic Buffet. They could eat whatever they wanted off the buffet except that they were being clocked and the same for dinner. They were being clocked but they could eat whatever they want in a given period of time in the 24 hours, okay?
You know, we're you know from 7 a.m. To 7 p.m. Whenever they went home. Okay turned out the sucrose tolerance test generated an insulin response as you'd expect the monk fruit the steeper the sucralose and the aspartame did not but then when they ate lunch they if they had had one of the three diet sweeteners in the morning. They ate more lunch and more thinner and
An increased insulin response both at lunch and dinner so that the area under the curve for the whole day was exactly the same
so they ate a significantly
more. Yeah. Yeah because they had the diet soda in the morning
Wild Well, I drink drinks that contain Stevia and I don't worry about it too much. But what you're saying is even if I bootstrap my calories, there's a possibility that the insulin response could have.
Direct effects on the liver exactly
right and not for the better and not for the better now having said that
We have undertaken an interesting project, which I don't know if you know about.
In 2020 during the pandemic. I was approached by a food company in the Middle East called Kuwaiti Danish Dairy company ktd. It's the Nestle of the Middle East now. They make all sorts of junk frozen yogurt flavored milks ice cream confectionery biscuits tomato sauce, okay.
Kuwait has an 18% diabetes rate and an 80 percent. Obesity rate 80 80. Wow in the adults right now. The company recognized that they wanted to be a metabolically healthy company and they knew they weren't
They contacted me and said would you put together a scientific advisory team to advise us what we need to do to change the food in order to be a metabolically healthy company and we want to lead and I said we'd be happy I'd be happy to do that with one Proviso. We get to publish what we did so that it can serve as a roadmap for the rest of the food industry and they said fine and so I convened of scientific advisory team.
My colleague will from Alderson who started the very first farmers market in Los Angeles and is now actually the director of sustainability and nutrition for kdd. Tim Harlan. Who is the head of culinary medicine at George Washington University Rachel gal who is a fatty acid expert who ran the Omega-3 for add trial at the NIH and Andre has corn stock who's actually a computer scientist from Stanford.
and we basically
stripped down every single thing that ktd did in terms of procurement in terms of ingredients in terms of packaging. We submitted every single ingredient to biochemical analysis because you couldn't trust what the vendors were basically telling kdd was in the food. We had had to actually know what was in the food that was a half a million dollars all by itself. I mean, this was not a cheap little, you know sojourn into the woods. This was a big deal.
Basically re-engineered their entire 180 item portfolio and they have now turned over 10% of their products to be metabolically healthy and the precepts that we set in this paper, which is in Frontiers in nutrition in March of this year 2023 three things three principles. If you adhere to these three principles, you can turn any food healthy including
Ultra processed food number one protect the liver number to feed the gut number three support the brain if you have a food that does all three of those it is healthy. If you have a food that does none of those three, then it's poison because it's not food. It's not a I
was going to say it doesn't sound like flus that is the right the right descriptor in that
case. Exactly and if it's does one or two, but not all three then it's going to be somewhere in between. So the goal was to take
All of Katie these products and move them from you know, the lowest tier up to the highest here by adhering to these three principles and we came up with some very simple things number one. Got to get rid of the sugar. Number two. Gotta add fiber number three got to add omega-3's number for gotta do something about the emulsifiers.
Because the emulsifiers are causing the gut inflammation because after all emulsifiers are detergents, they hold fat and water together. They burn a hole in the mucin layer. So they're actually contributing to that gut inflammation and I'm also fires are you know stream throughout Ultra process food demand. We've
heard about hidden sugars a lot during today's episode and elsewhere but based on everything you've told us of about artificials. Excuse me low-calorie sweeteners.
It makes more sense to me. Now. Why foods that are not touted as diet foods would be laced with things like sucralose because it should drive the craving for that food through increases in insulin and craving of other Foods later that day and later that evening is that why non-caloric sweetener is are added to all sorts of foods now that because typically one things non-caloric sweetener is probably only added to quote unquote diet foods low calorie foods, but that's not that's their own.
You're right. It's not
That's not the case and they are adding diets die sweeteners to foods that you didn't know had died sweeteners in them. That's right. There are two reasons that this happens one is insulin because insulin blocks leptin signaling at the level of the hypothalamus and the nucleus accumbens. So if it blocks leptin leptin is the hormone that your fat cells make the tells your brain you've had enough. So if insulin block slept him, it makes you hungrier and it also extinguishes.
It stops the extinguishing of reward by that food so that you want more of it. So it does both because leptin normally suppresses food intake and reduces
craving. The analogy that comes to mind is a slot machine that encourages you to feed more money and hit go to pull the lever, but that also blinds you to the outcome. So even if you win you don't even know that you have wins. It's also blinding you to your losses. You're effectively
Coming home at on you of just eating without any conscious understanding of what you're bringing in or tasting the
food any longer exact
right? It's not this like and on a Lemke when she came on the podcast author of dopamine nation and obviously head over our dual diagnosis addiction Clinic a Noel talked about, you know, these these consumptive behaviors where people are scrolling social media are consuming porn or consuming drugs or alcohol in a way that like
Like they're not in touch with the pleasure of the substance or behavior anymore, right? They become am Hans, but they but if they don't do it, they feel lousy. So the pleasure is gone. The pain is definitely to
waiting tolerance Independence. That's the definition of addiction. So dopamine is an excitatory neurotransmitter. It excites the next neuron always there is no such thing as dopamine inhibiting a postsynaptic neuron dopamine stimulates the next neuron, and it doesn't matter which dopamine
After it is one through five. It's always excitatory now neurons like to be excited. That's why they have receptors but there's like to be tickled not bludgeoned chronic overstimulation of any neuron and you know, this leads to neuronal cell death and the reason is because the neuron needs energy the neuron is the most energy dependent tissue in the body. It needs those mitochondria to be
pumping out a teepee like crazy to engage in neurotransmission. Well, when you're firing non-stop, you risk cell death. So the excitatory neuron the postsynaptic neuron has a plan B it down regulates the receptor it down regulates the dopamine receptor. So there's less chance that any stray dopamine molecule will find a receptor to bind to
And this is its Plan B in order to try to mitigate the risk of dying.
Well, what does that mean in human terms? It means you get a hit you get a rush or step just go down. Next time. You need a bigger hit to get the same rush. I'm receptors go down and you need a bigger hit and a bigger hit and a bigger head until finally you need a huge hit to get nothing that's called tolerance. And then when the neurons do start to die that's called addiction.
That's what we've got. And that's what's happened in terms of food addiction. So the question is what's addictive is fat addictive? No, because if that was addictive then all the people on the Atkins diet or on the ketogenic diet would be gaining weight not losing
it and I'd be craving Ribeyes all day. I
like a revived pretty often
actually, but I know I know people say no, but hey, look my lipids are in in line, and I don't eat many starches and I certainly avoid sugar.
Although now I'm thinking I might want to really reduce my low calorie sweetener intake. I don't see myself reducing my Stevia and take 20 because it's in some things. I really
liked Andrew. I am not the food police. You know,
I always say that you I'm not a cop but the but but but data or data and and Health Data
are the potatoes say that that's not helping you any that's what the data say point is that
The fats not the problem the salts not the problem. The caffeine's our problem really fiends classic addictive substance at every
level. Yeah, but in terms of is a problem, but if one can cut out caffeine by the early afternoon or even sooner in the day and it's not consumed to excess and it's in the former coffee yerba mate some other form. That's healthy. You know, is it really that much of a
problem?
I
love
coffee. Me too. That's my addiction like with a
capital l underline
bold face. I I I I feel your pain and the answer is no one has shown that coffee is toxic it is addictive but it's not toxic. Now if you mix the coffee with alcohol now, you got Four Loko now it's toxic but in and of itself caffeine is not toxic and that's why there's a Starbucks on every street corner,
but it is highly reinforcing I didn't have
So don't caffeine we're covered some data that was published in the journal science. One of the three Apex journals. And if you put caffeine unbeknownst to the consumer into plain yogurt people will crave plain yogurt and they much more. I mean people like the feeling of being caffeinate as long as it's not creating anxiety levels of energy exact, huh? I'm going to stick with you. I think that's fine. Yeah, and so will I we've been talking about a little bit about the hypothalamus as well as some peripheral gut based.
For hunger and satiety. This is a great opportunity to talk about some of the glp-1 agonists that are now widely used. So things typically call those empik but glp-1 glucagon-like peptide one, right originally discovered in the Gila monster which eats very seldom and some really smart biologist. I love biology like this said how come they don't have to eat very much. Well, their blood is loaded with glp-1, right? And so they only have to eat one Whatever Gila monster.
Is the lighten per year or something outrageous like that humans make glp-1. It's well, my understanding is that glp-1 that that not that's injected, but that one makes naturally.
Is acting on both the brain and the gut to increase satiety
so is acting on the brain no argument, but the primary action is on the go.
glp-1 decreases the rate of gastric emptying
that is its primary driver. Yes. It does affect the brain. I'm not arguing that it does but the primary effect is to reduce the rate of gastric emptying. So you stay Fuller longer because the food doesn't move through the stomach and the intestine
interesting in South America just in Uruguay and Argentina. It was long thought that yerba mate consumption, which we know very modestly increases glp-1 and by the way a lot of other things do too
That people were taking it for its after meals for its laxative effect. Partially that's you know, it's not pleasant for but that's it. That's what the: that's at the level of the cone but stomach but it is used fairly effectively for people to space their meals without snacking that you're you know, and maybe it's the glp-1. Maybe it's something else but people are injecting themselves with GOP one analogs. Now,
I can have thirteen hundred dollars a month. Yeah, is that what it costs what it costs right
now, and it seems to be pretty effective.
Of at inducing weight loss although a significant around that we lost seems to be from a skeletal muscle
tissue and we're going to we need to talk about it.
So what are your thoughts on those epic as a crime are earlier you talked about primary and secondary control. Are you refer to it a little bit differently in the context of statins, right? So a kid comes in who's obese or slightly overweight right? It's like hmm. I don't know what to do. I'm trying to eat better exercise or a person comes in and says, hey, I've had a really hard time getting that last 29 pounds off for so many years.
Will you prescribe me those epic?
So the short answer is number one. I'm retired. So I'm not with the prescribing anything. But let's let's let's go with their the data show that glp-1 analogs like semi glue tide and outers appetite which is Lily's version. Majora is the diabetes versions at bound is the Obesity version. How same way that was epic is the diabetes version for Novo Nordisk.
TSK and would go V is the Obesity version. So they're all glp-1 neurology pukes glp-1 out of are synthesized in a lab. It looks like
glp-1 smells like glp-1 acts like glp-1 when
injected turns Epi tied. The Lily one actually has a dual function. It binds to the Gip receptor. So it might have double duty and the data showed that it's actually even slightly more effective at Weight Loss than the Novo Nordisk version. So we'll be seeing a shift in terms of
Consumer preference soon. No doubt
But here's the thing you look at the data one year of treatment 16 percent weight loss now, that sounds great and I'm not saying it's bad and good
people are not craving food all the time. Is that because people are feeling full longer, right? So
they're eating less they're eating less. This is the
calories in calories out
model they're eating less and so they are losing weight. I'm not arguing that and they
might be craving alcohol less According to some
recent. Yes.
Yeah, well we can go there for a minute to in a second. Here's the problem when you look at that 16 percent weight loss as you just said when you put people in a dexa scanner, they have lost equal amounts of fat and muscle now is a good to lose muscle. No, it is not good. Ask any little old lady who breaks her hip if she wishes she had a little bit more
muscle or somebody who died had lost a lot of muscle because they weren't offsetting the weight loss with resistance training or some other form of exercise.
Eyes and the amount of food that they can eat in order to maintain that weight to put it in scientific terms
socks and you know, we mentioned Peter Atia earlier. Okay, in outlive. He's made it very clear that sarcopenia lack of muscle mass is one of the drivers of mortality. So losing muscle is not a good idea. But you lose equal amounts of fat and muscle what else causes.
Loss of equal amounts of fat and muscle starvation. In fact, the reason that all these glp-1 analogs work is because you stopped eating like the hill starvation. Yeah, just like the old monster you
monsters look pretty chubby to me.
Well ask another Gila monster, but
unfortunately whatever answer it provided was not
interpreting. The point is that starvation is not so good and if you think about why it's working. It's
Reducing gastric the rate of gastric emptying. All right. Well, it turns out that that's the reason for its side effects the reduction in gastric emptying. That's why you get nausea. That's why you give vomiting. That's why you get pancreatitis and most importantly now gastro Paris your stomach turns to Stone.
And you can't move any food through your intestine at all and worse yet. When you stop the medicine the gastroparesis doesn't get better. This is not a good idea.
This is like the opposite of the Yerba mate induced effect, which as I sort of pro laxative gastric emptying maybe glp-1 agonists mm gosh. Okay, so it's obvious why people who struggled to lose weight like it especially if their struggle to lose weight was at least in their mind the consequences.
Being hungry all the time and needing
to eat more or was it because of the reward and the you know their dependence because in fact, yes, these glp-1 analogs reduce reward and that's one of the reasons why they've noticed that you know thing reduction in alcohol consumption as well. And that sounds like a good thing except there are also numerous cases.
Has now of major depressive disorder in response to these drugs.
It's almost like Naltrexone or something for the treatment of addiction. Well, which sometimes can be useful but now but they're attempting to remove the the the amplitude of that reward signal. I mean a lot on paper it makes sense, but the but it
doesn't always end in practice. It doesn't play out. That's right. And so I'm going to refer you now to an old literature that was from 2006. There was a drug.
That was approved in Europe called Ramon abandoned. Okay, a trade name acomplia and it was approved in Europe for weight loss and it was pretty good at Weight Loss. Ooh caused about 20 percent weight loss. It also caused severe depression and 21 suicides. So it's no longer available because it was the nth. Yeah, it was pulled from the European market never approved in the United States and the reason this happened was because this was the an time.
Marijuana drug. This was the anti Munchies drug. This was an endocannabinoid antagonist. Well when you reduce reward, you also reduce your desire to live and that's why this concern about reduction in alcohol consumption. We've already seen major depressive disorder in patients receiving those epic. So are we going to see the same thing play out as we did for Ramon abandoned? I'm worried about it or fen-phen.
Well fen-phen didn't have a cardiac it was cardiac. Yeah, we had cardiac problems due to the fifth floor mean because of the serotonin 1B receptor
agonists, right? I'm just referring to the fact that these these quote-unquote Blockbuster drugs for obesity. They tend to follow a contour of you know, very promising very exciting. A lot of people losing weight suicides are very promising. A lot of people losing weight cardiac issues. Very promising losing weight, and now you're saying this
Stomach turns to Stone sounds so
biblical well indeed. So that's the question and then finally we can really talk biblical. If everyone in America who qualified for ozone pick got it. That would be two point one trillion to the healthcare system, which is currently at four point one trillion. So that would be a greater than 50% increase in health care costs.
Okay at 1,300 a month.
Conversely if we just got sugar consumption down to USDA guidelines by basically, you know, putting some limits on how much added sugar the food industry can put into any given product like fruit loops.
We could reduce weight by 29% and save 3.0 trillion dollars. So we'd get better weight loss and we'd save five point one trillion dollars, which makes more sense to the US government.
Well earlier you were alluding to government big food big Pharma relationships. I mean, there's a huge win here for whoever's manufacturing these glp-1
Analogs indeed. But the question is who's paying the
tab? Well, we are now the question is why can't the government see that the answer is because the government's on the Dole to because the government through tariffs on us made Foods. Okay grosses 56 billion dollars a year.
So they're player. They're not just a regulator there an actor to
play Devil's Advocate a little bit less. I'm going to be the last person I'd step in and try and defend government as a unified body. I'm not qualified to do that, but you could see how it if you looked at it like Checkers instead of Chess you'd say, okay, here's a drug that's going to allow many millions of people to reduce their overall body weight overall body weight is a risk factor for a number of things.
And there will be savings on the back end as a consequence of that weight loss. So that's the
checkers version right? The
chest version is how you're describing it and I think that I mean clearly people in government are well most some perhaps are smart enough to play chess not Checkers or to least understand it, but there's very little incentive for the chest model. So what would quote unquote solve this problem is the same thing that happened to fen-phen or
This ROM ROM an amount of Entry, which is if suddenly there's a major issue with the drug, then everyone stops taking it and traditionally that's how it's gone. It sounds like these glp-1 analogs are going to make it through the Chute
though. Yeah. I mean there is a very clear downside to these medicines on the other hand, you know, there's an upside and so I'm not sad that these medicines exist. I'm for them. I'm not against them. I'm
For
the right patient and right now it's not the right patient who's
getting them just like the statins. So what if somebody who's taking one of these analogues makes it a point to do resistance training and here, you know, you mentioned bodybuilders early. I'm not I'm not suggesting they become bodybuilders, but we now know and I think Peter arati and others would agree that everybody should be doing some form of muscle loss offsetting resistance exercise a great at least past, you know, they're reaching into their adult height or something. You know, I know there are those that say wait,
During doesn't blend your height. But anyway, let's just say that from Hit train early 20s on word. Does he say something especially if you're on these
medicines right in order to maintain muscle mass. So that's a
different picture right? People are drinking less alcohol again. I'm playing devil's advocate here. So if we look at these these compounds not in a vacuum, but OK the person has been carrying that extra 30 pounds is now only carrying a few extra pounds of adipose tissue. They've lost a lot of muscle, but now they feel well enough to
Exercise the
depression part worries me. Yeah. But anyway, I'm just I'm just trying to around the Contour of it
what we've seen in children because that's who I took care. Was that often? They needed a jumpstart? Okay, and there were different ways to get them to jump start the stomach stapling. Well, that's not jumpstart. That's it. That was what a laydown will did. I know
I have a friend he's he was in sadly still is really big and he always talked about the stomach saving like if I could just get
£50 down quickly than I could exercise but exercise is painful this kind of thing and sadly he's continued to maintain her creep up in a very excessive weight. And that's the
point is you know, that this concept of jumpstart actually if you're only doing it yourself doesn't really work and the question is why is his weight creeping up if he's had the stomach stapling the answer is because he's a sugar addict.
Yeah. He's definitely addicted to the super big gulp soda.
If you drink your calories, it doesn't really matter does it
now and he's got such terrible psoriasis and joint pain and all this that the prospect of exercising is like a it you might as well tell them to like flap his wings and go to
Mars, you know fructose is a driver of immune dysfunction. If he got off you can tell him from me if he got off the sugar has psoriasis would get better his weight would get better. His arthritis would get better and he could have ventured that jump
start.
This is a perfect example to bridge to the brain component of all this because I've long wondered based on what I understand about neural circuitry neuroplasticity. I know we share in this knowledge that at some point carrying a lot of adipose tissue means that the brains were represents the body differently. I mean, we know they're these these somatotopic maps of self, you know, but that the neural Machinery in the hypothalamus sure, which is responsible for Motivated States Etc. But but also just the
Tire mapping of the self changes in other words, if one is fat long enough that it
becomes increasingly
hard to get to a healthy weight because of the way that the neural circuitry is impacted it basically remaps to maintain that that fat person not necessarily even just at the level of appetite but just in terms of what do you what do big animals do I had a bulldog that weighed 90 pounds Bulldog Mastiff. He was very
economical with his movement right here is extremely powerful. He could run at least in when he was younger. But if he could be still he was still as opposed to certain smaller animals that are like peripatetic right
because because he was leptin resistant. So leptin as we talked about briefly is the hormone that tells your brain you've had enough if you are leptin sensitive, you are happy to burn if you are leptin resistant your brain thinks you're
If your brain thinks you're starving is going to affect your behavior and two ways. It's going to make you want to eat and so we're going to make you want to conserve because the goal is to try to increase the leptin levels in order to overcome that resistance which of course you can never do because all you're going to do is lay down more fat and make more leptin and make so much sense because left in comes from the adipose tissue exactly. So that leptin resistance is what you have to be able to break through you have to fix
Fix the leptin sensitivity. Well, what's the driver of the leptin resistance insulin insulin inhibits leptin signaling and it does it at three separate places in the pom C neurons the probiem Alana Corton neuron in the hypothalamus. It does it at IRS to insulin receptor substrate to it doesnít Sox 3 suppressor cytokine signalling free and it does it at pip3 phosphatidyl inositol triphosphate those
Three separate arms of the leptin receptor are all basically put to sleep by high insulin insulin blocks leptin signaling. So the higher the insulin goes the more your brain thinks you're starving and the more your brain thinks you're starving the hungry you get and the less you want to move. So the gluttony and sloth that we've been talking about all all you know.
Podcast is really biochemical. It is secondary to this phenomenon of insulin blocking leptin signaling. You got to fix that first get the insulin down. Anyway, you can and the best way to get rid of the refined carbohydrate and sugar.
That's where you start.
It makes so much sense.
It works to how about that. That's always good it
is I once heard you say I think it was in a conversation with Peter t on his podcasts and this really stuck in my mind that when a person consumes glucose that it activates a number of different brain sites, you know neurons loving glucose mmm, but that when one ingest fructose that it preferentially
Activates neurons in the reward pathway. That's right Ed may be seven times the the magnitude or or
something like that glucose activates the basal ganglia. This is work from Warner house and Switzerland and also Eric Stice at
Oregon Health Sciences minted planning and
execution. Exactly. Okay, fructose basically stimulates the nucleus accumbens the reward center. It is just like heroin Just Like Cocaine just like nicotine it
It activates the reward center. It doesn't do anything for the basal ganglia. So it is addictive anything that stimulates the reward center in the extreme is addictive. So we have chemical addictions heroin cocaine nicotine alcohol sugar. We have behavioral addictions shopping gambling internet gaming social media pornography doesn't matter. They all stimulate dopamine in the reward center. And in the extreme, they are all addictive. So the
Is if you were addicted.
Is that personal responsibility? Well,
it's a very
it's a question I think about a lot because I know a lot of people in the addiction recovery Community both from the treatment and in the addict in yep, and there's always comes down to this question when somebody is suffering from an addiction of any kind and they're resistant to getting treatment.
If you look at it them as as being sick at least in that moment is a sick person in the best or worst or at least diminished position to guide their own treatment. So for instance somebody with dementia, would you ask them? Do you want to go see a neurologist? You might ask them that but are they the best person to make that decision?
This is the problem. So this is this is where personal responsibility falls down. So personal responsibility as you know, we talked about four criteria.
Have to be met none of them are met. That's the first issue second one is a little bit shall we say cheek gear?
Who invented personal
responsibility any idea I'm definitely get us this one wrong. Yeah, you're going to get
this wrong. Are you ready?
I don't know tobacco
industry
the notion of personal
responsibility. They invented it. There was no personal responsibility until tobacco in 1962 because they were getting killed on the science and they needed to invent another reason for you to smoke. In fact, there's a paper that came out Dorfman at all that looked at.
The New York Times in the Washington Post and they did a entire lit search of the entire of you know, all the output of those two newspapers for decades to look for the term personal responsibility. And the very first time it was ever mentioned was 1962 and it didn't pick up in speed until 1986 which was the same year as sip alone.
Evie Liggett in the at the Supreme Court, which basically said that the you know that the cigarette industry was was guilty of applying people with an addictive substance. So this is very specifically industry driven and we have the data to prove it amazing.
Well
I wonder along the lines of personal responsibility given that many listeners this conversation are going to be thinking about their own food intake and food choices that of their children and other relatives that we could play a little a little not a game but a little rapid ish fire QA never done this before in this podcast, but I think it's particularly appropriate for a discussion like this that weeks out into so many areas and I absolutely will invite you back.
I can perhaps a long pleasure Miss Apple to talk about some of the exciting work you guys are doing cuz there's so much we could cover but people are going to wonder in a very practical sense.
Whether or not they should or should not be consuming certain things. And I know you're not the food police. I'm not the foop. I'm not a cop and I do believe people should our should be in choice about these matters, but I also believe that because your guest on the podcast in your hand formed and and I've done with clinical work and research for so many years in this area and you have such a clear stance on the role of big food and and we really really appreciate your honesty and directness, but not you be willing to provide
Comment about a couple of different terms that all throughout and if you choose to say really nothing to say about that fine, that would be a quick pass. So here we go, and we covered a little bit of this earlier but fruit and whole form, so
Has fructose but has fiber so thumbs up thumbs sideways or thumbs down for fruit
consumption fruit is fine. Fruit. Juices. Not
great. Thank you. White rice versus brown rice and among the white rice has the sticky rice and the rice is with added sugars, which you find in a lot of a lot of restaurants brown
rice because of the fiber white rice polished, you know, number one all the vitamin B1 gone.
And of course much larger glucose Excursion that glycemic index thing which I've course. I hated it's glycemic load that matters and that is a very high glycemic
load. So brown rice. So brown rice is better than white rice. Yes, okay in a meaningful way in a meaningful way. Okay earlier, you mentioned tomato sauce. I love tomato sauce that's made from just tomatoes canned tomato is our most tomato sauce is filled with sugar.
Perfect. Our little recommendation engine looked at this question and it turns out that only 10% of the available tomato sauces out on the market don't have added sugar. So you have to know which ones what you can look yourself where you can look up perfect and it will tell you which ones you can
buy if people chose to consume bread, which many people do. Is there a way to just across the board without just baking your own.
Own or see or looking at the ingredients list to make a better choice is it like sourdough is tend to have less sugar than
blank will sourdough has been fermented. So it will actually consume some of the sugar so it would be a better choice. But really the best choice is the highest fiber breads now.
If you look at a week Barry.
It is 25% of fiber. The husk is 25% of the weight of that wheat berry, that means that the carbohydrate to fiber ratio of a week. Barry is 3 2 1
so a good bread should have a carbohydrate to fiber ratio of somewhere between 3 to 1 to 5 to 1 tops anything above that means that they've stripped the fiber away. So that's something you could do. But the easier way is to actually look it up on
perfect.
You mentioned meat and meat sourcing egg and chicken sourcing earlier. Maybe we just revisit that meat fish and eggs thumbs up thumbs sideways thumbs down or it
depends. It depends depends on where the meat came from. It depends on whether it was pasture-raised depends on whether it's organic or not. If they animal was injected with antibiotics stay away from it because those antibiotics are in the meat they're going to basically sterilize your gut and then the bad bacteria
You are going to take over we haven't really talked much about the microbiome today. But that's a whole podcast all by itself.
We can touch on it a little bit more from low sugar fermented foods thumbs up thumbs sideways tormented
Foods short-chain fatty acids. All good.
What are your favorite sources of fermented foods? I like
kimchi.
I like him chichay like some of the live
sauerkraut's. Yeah, that's the also good but with the right, you know the right accoutrement. The one thing I would be careful about is yogurt. Okay, so there are yogurts with live cultures and there are a whole lot of yogurts with dead cultures. And if it's a yogurt with dead cultures, it's kind of irrelevant and the chances are they've actually covered up the sourness with sugar so
You know large commercially available yogurt be very very careful. Okay, if it's a you know, Artisan yogurt, you know made by, you know people you know or trust, you know, that's a very different story, you know, yogurt with live cultures
intermittent fasting do you practice it and what do you think about
it? I don't practice it but I am for it for the right patient turns out who's the right patient the patient with liver fat because the reason it works
works is because it gives the liver chance to basically burn off the fat that it's
toward zero calorie soda got it is definite. No and I don't even have to ask about sugary
soda because that's that. That's basically just poison. I
can food combinations. I have a feeling I know what your answer is but the glycemic index which we do your feelings on now asserts that if you combine some fat with a sugary like like eating ice cream. You have a more blunted.
So in response, then if you were to eat pure sugar of equivalent calories, but what are your thoughts on food combinations as a way to blunt the insulin response
food combinations are great. If there's some Fiber associated with it comes back to fiver again. And by the way, and by the way, I you know full disclosure. I am the chief medical officer of a fiber company. What is it? It is called bioluminescence and it is a proprietary fiber it is a
Micro cellulose sponge 7 microns in diameter. So the size of a red blood cell you swallow it it goes to your stomach. It expands 70 fold over its original size. And so to give you a feeling of fullness because it's taking up space in your stomach but more importantly when it expands the nooks and the crannies in the sponge become available and embedded in those nooks and
crannies are a set of proprietary
hydrogels.
Soluble fiber which sequester glucose fructose sucrose simple starches and render them unavailable for early absorption in the duodenum. Thus reducing the glucose response reducing the insulin response protecting the liver and moving it through the intestine. So that microbiome can shoot up for its own purposes feeding the gut we can reduce glucose absorption by 36% fructose absorption by 38 percent sucrose absorption by 40%
ENT simple starch absorption by nine percent and increased short chain fatty acid production by 60% without an increase in gas.
When do people take this with
meals? Okay, so that would be it comes as a sachet 1 tea spoon sprinkle it on your food or take it as a you know, in a drink, you know, just mix it in and Slug it down and then eat breakfast lunch or dinner and it will
Basically act like you ate real food, it will turn processed food into real food in the intestine and we have clinical trial data that demonstrates that is it available as a commercial it is available. It is called Munch Munch. Now, I hate that name. I didn't make it up. Well
marketing Market that your marketing team sucks, but the product sounds amazing.
So by illumined dot
Tech great. Thank you for that. Sorry, Mom.
Munch marketing team, but you got to munch munch to a new product but it sounds like a very interesting project and it actually answered my next question which was about fiber supplements
fiber is good. But there are two kinds of fiber there's soluble and there's insoluble they are not the same so soluble is what goes into Fiber One bars, you know that psyllium inulin.
Pectin like we're holds jelly together. That's good. I'm not saying it's bad. But you need the inside able fiber the cellulose the stringy stuff in celery the cardboard. If you will together, they form this gel that we talked about earlier. If you only consume the soluble fiber, which is what the food industry will add to food because the insoluble fibers not miscible. If you only had the soluble fiber back you're not getting the benefits.
the entire fiber
compliment
earlier when talking about the Nova system and how most all of our foods are nine. Let's say I know seven to 10% Let's say 95% Let's err on the side of better 95% of our food should come from Nova System class 1 or Class 2 Foods or 3 or 3. Okay. Stay away from those Nova class for Foods. Could you give us some examples of Nova class one and class two Foods just broadly
speaking. Okay. Nova class one is any food without a label?
Period if you see a label on a food it's a warning label. Well, there's
ground ground beef has a label. Okay, so that's well, does it say you talk about Apple when I buy it? It has a label. I'm asking this because people are going to wonder so it doesn't have a nutrition facts label.
Is there a nutrition facts label on a thing of ground
beef I buy that that ground beef or I consume venison where if you flip it over it says how many calories how many protein and so there's a label?
But but it's just be for
venison. Okay. Okay, then that's class 10K egg egg is class 1
so and of course fruit apples oranges. Okay, so it doesn't matter if it has it has a name a name tag, as long as it doesn't have an egregious impacts label
got it real food does not need a label. It's only if they did something to it that it needs a label. So you have to look at every label as a warning label. Now the problem with the label is it only tells you what's in the food which you really need to know is what's
Done to the food because it's the ultra processed food. That's the problem. They don't want to tell you that that's secret. Okay secret from a proprietary standpoint, but also secret because if you knew what they did to it, you wouldn't need it. You would never buy it and they don't want you to know so they only tell you what's in the food that's not what's important. It's what's been done to the food that's important. And that's why this Noble class for so important and that's why perfect is so important because it'll do the work.
Look for you. I
will definitely provide links to all of these so
If you could pick one thing to recommend to people that want to improve their health get rid of sugar. Okay. Very clear. That's number one at number two.
Go for a walk.
That's the exercise
piece go for a walk.
And if you could recommend one thing that the general public can do to try and assist in this advocacy for not redefining.
Actually clearly defining what is food and what isn't and making people aware at the level of policy and change and school lunches. I mean if there were one thing what can we do? I mean, I you've clearly activated minor on surrounding like that the set of problems that exist and the paths to correct them, but should we be writing to our Congress people? Should we be getting angry at hospitals? Because they've got all these fast food machines and the cafeteria food is like wood because like is like illness promoting
UCSF we've got
Rid of all sugared beverages we have the healthy beverage initiative. So don't go can machines, you know Coke machines at UCSF and
Stanford check that out because you know, people always send me pictures of the of the coke machines in the school of medicine. I'm like listen, I didn't put them there but I
we have to model for the public, you know, I mean where where was the first place that smoking was banned hospitals? Okay, because we knew so if you get rid of the you know,
If you could get rid of the sugar soda at the hospital you're telling people something. So yeah, I think that every hospital and really every public venue in America needs to clear out the junk.
So post photos of junk that are supposed to be in in health-promoting institutions. And I guess the we're trying to
cancel junk we're
trying to shave I'm pretty opposed to cancel culture. But here we go. I'm Gonna Cancel it marvelous. It's actionable it straight.
Forward its low cost low time investment a zero cost very low Time Investments. Thank you for
that and look up eat real because we're doing it for your kids. So you need to help support it any school district in America can do it. So what do we do? We have a business model, whereby the Food Services director either purchases or rents a dilapidated Factory in the center. The district repurposes it
To a food preparation facility they can make 27 to 30 thousand meals a day. Okay with a you know, Skeleton Crew and then they and and you control what's in it and because you're buying in volume, it actually reduces the cost. So it's cheaper than buying it from Cisco or our marker Sodexo or wherever and then you farm it out via, you know truck or bus to all the different schools. So every kid gets a hot meal.
Made from scratch each day, and we can solve this.
Problem
can't help but ask this one last question for people that want to cut out sugar which you clearly stated is the most important thing to do for one's health.
How do we know how much sugar is in something? So should people be looking at labels and just looking for how much sugar how much carbohydrate or could we even go so far as to say if it says high fructose corn syrup, then it's on the no-fly list. Don't don't don't eat it.
So the problem the problem is that there are 262 names for sugar.
And the food industry uses all of them and the reason they use all of them is because they can include a different sugar as number five number six number seven number eight number nine on the list when you add it up it becomes number one.
They hide it in plain sight and they do it on purpose now.
Do I expect everybody to remember eyes all 262 names? No, of course not. Can you figure it out yourself? Well, the answer is no unless they have the line where it says added sugars if it says added sugars it is either sucrose or high fructose corn syrup. No one's adding lactose. Okay, that's not her glucose, then not even adding glucose because glucose isn't that sweet glucose is not that interesting. You don't see people going around.
Again Karo syrup. Do you okay that's glucose who cares? Yeah might be good in the Molasses cookie, but that's it. All right, so it's fructose. So you need to know what's been added. So if it says added sugars, that's a good place to start no greater than one teaspoon per serving no greater than 4 grams per serving of added sugars anything greater than that. Leave it the store
a name for those know.
Ava type
time-saver for no aim for Nova types one two, and three and if you don't know whether it's Nova type 1 2 or 3 you can use perfect and if you don't look at that, then go look at the nutrition facts label and anything that has more than four ingredients is Noble class
for Robert lustig. Thank you so much. You've provided such an incredible education in nutritional biochemistry the processing of fat protein carbohydrate sugar.
Fructose in particular the clear detriments of consuming fructose on so many different organ systems. I love love love that you separated out food science Nutrition and metabolic
health or not yourself.
That's just I that's a you know, that's a gazillion dollar delineation for people to understand and to shape their understanding of all the information that's out there and bins into these different categories. You've given us so many actionable tools.
New conceptual Frameworks you giving us a real tour de force today in just is oh so clear language. So I want to thank you. I learned a ton and and I know everyone else has as well and if people have questions they can of course put them in the comment section on YouTube. That's the best place will provide links to all the the companies and websites that you referenced and some of your other work and listen. I just I'm so
So grateful that you exist and that you've done the work that you've done and and your passion and your advocacy for health is its just oh so clear. So thank you so
much. So I want to I want to thank you. And the reason I want to thank you is first of all, you know inviting me. That's nice, you know, there's good, but the reason is because people need to understand science. I am completely in agreement with you the public needs to understand science. They listen to you.
You because you number one provide the science and number two. You don't talk down to them you treat them as equals and that is truly remarkable. And so I want to thank you for your
service. Well, you're most welcome. It's a labor of love and I think it was the great Max tell Brooke that said when teaching assume zero knowledge and infinite intelligence and I do believe that humans are infinitely intelligent. Although sometimes as a whole we mask it.
People deserve the the knowledge. So thank you so much for sharing that knowledge today. And let's absolutely have you back. My pleasure. Thank
you. Thank you for joining me for today's discussion with dr. Robert
lustig about nutrition and how sugar impacts the health of our brain and body to learn more about dr. Lustig's work and to find links to the many books that he's written on this and other topics. Please see the show note captions. If you're learning from and are enjoying this
podcast, please subscribe to our YouTube channel. That's a terrific zero cost way to support
us in
Addition, please subscribe to the
podcast on both
Spotify and apple and on both Spotify and apple you can leave us
up to a five star review. If you have questions
for me or comments about the podcast or guess you'd like me to consider on the huberman Lab podcast, please put those in the comment section on YouTube. I do read all the comments, please also check out the sponsors mentioned at the beginning and throughout today's episode. That's the best way to support this podcast not so much on today's episode. But on many previous episodes of the huberman lap podcast,
we discuss supplements while
supplements aren't
For everybody many people derive tremendous benefit from them for things like improving sleep for hormone support and for improving Focus to learn more about the supplements
discussed on the huberman Lab podcast.
Go to live momentous spell do you s so live momentous.com hubermann,
if you're not already following me on social
media. I am huberman lab on Instagram X formerly called Twitter LinkedIn Facebook and threads and at all of those places. I discuss science and science related
tools some of which overlaps with the content of the Huber.
Medlab
podcast but much of which is distinct from the content covered on the huberman Lab podcast. So again, it's huberman lab on all social media channels.
If you haven't already subscribe to our neural network newsletter.
Our neural network newsletter is a zero cost newsletter that comes out every
month. It includes podcast
summaries as well as protocols in the form of short PDFs of maybe just one two, three pages where I list out the specific protocols for instance for improving dopamine functioning or for improving your sleep or for deliberate cold.
Her deliberate heat exposure or Fitness protocols and on and on all of which are presented in brief fashion, very direct just the protocols listed out again completely zero
cost to sign up you simply go to
huberman lab.com go to the menu function scroll down to newsletter and enter your email, and I should point out that we do not share your email with anybody. Thank you. Once again for joining me for today's discussion with dr. Robert lustig and last but certainly not least. Thank you for your interest in science.
