How You've Been Lied To About Calories, Dieting, Exercise & Losing Weight

Mark Hyman, MD

Dr. Mark Hyman is leading a health revolution—one focused on using food as medicine to support longevity, energy, mental clarity, happiness, and so much more. Mark Hyman, MD is a practicing family physician and an internationally recognized leader, speaker, educator, and advocate in the field of Functional Medicine. He is the founder and director of The UltraWellness Center, Founder and Senior Advisor for the Cleveland Clinic Center for Functional Medicine, a fifteen-time New York Times best-selling author, and Board President for Clinical Affairs for The Institute for Functional Medicine. He is the founder and chairman of the Food Fix Campaign, dedicated to transforming our food and agriculture system through policy.

He is a co-founder and the Chief Medical Officer of Function Health. He is the host of one of the leading health podcasts, The Doctor’s Farmacy with 150+ million downloads. Dr. Hyman is a regular medical contributor to several television shows and networks, including CBS This Morning, Today, Good Morning America, The View, Fox, and CNN.

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Full Transcript

Automatically generated. Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Dr. Robert Lustig: Most everybody has this insulin resistance problem that is called metabolic syndrome, but insulin's the bad guy. No matter how you look at it. There is no weight gain without insulin. You got to get the insulin down. Bottom line is anything that gets the insulin down ultimately leads to weight loss.

Dr. Mark Hyman: Welcome back to the doctor's Farmacy. Robert, it's so good to have you back.

Dr. Robert Lustig: Oh, listen, you and I are like thelman Louise. Yeah.

Dr. Mark Hyman: Are we going to drive off the cliff in a convertible? We're going

Dr. Robert Lustig: To do our

Dr. Mark Hyman:Best. Sometimes you have to sacrifice yourself to get to the truth, but I think we met first as part of this film called The Fed Up. We essentially fed up with the food industry, making all of our children sick and fat and killing them and needing liver transplants as teenagers and bariatric surgery as teenagers. And this movie did quite well. Oh yeah.

Dr. Robert Lustig:
Theatrical release. I mean, you and I were the two talking heads sort of, but we didn't get to meet until the LA premiere.
Dr. Mark Hyman:
That's right. We met at the premier and it was a really impactful movie for me because I realized in that scene that I was working in the movie where I was working with this family of five that lived in a trailer on food stamps and disability that had the father was 42 and had dialysis from diabetes. The mother was a hundred plus pounds overweight. The 16-year-old kid was almost diabetic with a body composition. We did DEXA scans of 50% fat, 50% at six years old, and they lost 200 pounds in the first year. The father lost 45, so able to get a new kidney. The son lost and ultimately 132 pounds and went to medical school. Amazing
Dr. Robert Lustig:
What good food will
Dr. Mark Hyman:
Do. Well, it just taught me that people that don't know the impact of all the ultra processed food they're eating, they were trying to do the right things. And it really set me to understand that it's really not that hard if people understand the biology of how their body works.
Dr. Robert Lustig:
Well, the fact of the matter is they've been fed a myth and the myth is that ultra processed food is food.
Dr. Mark Hyman:
Yeah. Well, it was interesting. They had all this stuff in their kitchen that they thought was low fat diet, this healthy fat, and it was all processed junk that had high sugar. Even the cool whip, which they thought was a healthy dessert topping, said zero trans fat on the label and in the container, if you read the ingredient list, forget the front of the package labeling, which is so misleading. I always say if it has a health claim on the label, it's the opposite. It's dangerous for you gluten-free potato chips, and it says zero trans fat, but it was only because it's mostly air. And the FDA through a loophole that the food industry forced them to do, they basically have captured these agencies said, if it's less than half a gram per serving of trans fat, you don't have to say trans fat. Exactly.
But when you read the ingredients, it was high fructose corn syrup and partially hydrogenated soybean oil. That was it. And I was like, whoa. So it was so powerful and it kind of made me realize that we really have a problem of awareness and education and how our bodies work. And so your work's been so important because it unpacks the biology of how food interacts with our hormones, our gut microbiome, our immune system, our metabolism in ways that it's really information. So food is instructions, and there's a huge debate out there which drives me crazy, which is this debate that I want to get into today around the idea of is a calorie a calorie? Because this is what we've been taught. And I'm just going to set this up and I'm going to let you roll. So I'm going to set this up and let you roll.
I know you can roll for hours. The whole debate is a calorie, A calorie and is weight loss just about eating less and exercising more, which has an implicit bias toward blaming the person for not exercising more and eating enough so it blames the victim. In my view, it doesn't understand the real root causes. It's great for the food industry. Like, oh, it doesn't matter what calories you eat, it could be a Coca-Cola calorie or a twine calorie. And it's the same as a broccoli calorie as long as you don't go over your calorie count. And then there's the other extreme of the model, which is the carbohydrate insulin hypothesis, which essentially states that it's not what you eat, it's not how much you eat, it's what you eat, and that the quality of the calories matter. And that different macronutrients has different effects on your body, on your hormones and your metabolism and your gut microbiome and your immune system, all of which impact your weight.
And there's other schools of thought around obesogens, which are environmental toxins that screw up your biochemistry and make you gain weight. And there's oxidative stress theory. There's a lot of theories out there, and there's nutrition is one of those really poor black sheep of the family in medicine where it doesn't get funding for real research. And we need to be studying these things. But we do know enough, I think, and you and my friend David Ludwig have really helped understand a lot about the role of sugar and fructose and how carbohydrates refine carbohydrates affect our metabolism. So can you help us navigate this whole story and tell us, lay out the insulin hypothesis versus the energy balanced hypothesis versus the obesogen hypothesis and how they all interconnect and are they all sort of right.
Dr. Robert Lustig:
They are all sort of
Dr. Mark Hyman:
Right, they're all sort of right,
Dr. Robert Lustig:
And they're all sort of wrong.
Dr. Mark Hyman:
They're all sort of wrong. Exactly. So help us understand whether we should be just ducal counting or we should just be focusing on quality or we should be detoxing our bodies, or we should be like, I don't dunno what. So tell us because we're all lost.
Dr. Robert Lustig:
The short answer is they're all right and they're all wrong altogether. Last month, a group of four authors of which I was one, the first author is Heindel Jerry Heindel, who was the head of the Environmental Endocrine Disruptors group at the National Institute of Environmental Health Sciences. And myself and Sarah Howard, who runs Heeds, which is Healthy environment endocrine disruptors, and also Barbara Corky, who is the named professor at Boston U, won the Banting Award for the American Diabetes Association. So not exactly lightweights. We came out with a paper in International Journal of Obesity, which we're very proud of, and it's called obesogens, A Unifying Hypothesis for the Pathogenesis of Obesity. Now, how does this work? There are four prevailing models right now on weight gain and how it works. You've mentioned all four, but let's put some meat on those bones. Energy balance, calories eat too much. You exercise too little. And there is absolutely no question that people who are obese have been shown to eat more and exercise less. And I don't argue that the question is, is that cause or effect?
Dr. Mark Hyman:
Right?
Dr. Robert Lustig:
Right. Okay. Is it a cause of phenomenon? Is it a ative phenomenon or is it an epi phenomenon? Okay. And they can't tell us which. So keep that in mind. There is nobody in the energy balance model camp who can actually say that that's the reason for weight gain. Alright. Could it be the cause? Could it be the result? So keep that in mind. Now, there is no question we are eating more as a society. Okay, 175 calories per day, more for adult men, 335 calories per day, more for adult women, 275 calories per day, more for teen boys. Okay, everyone's eating more.
Dr. Mark Hyman:
And I just want to make a point on this before you dive into that. Yes, we're eating more calories per person, but if you look at the data from 2000, and this is from the NHANES data, the National Health Nutrition Examination Survey, which is a national survey of tens and tens, a hundred thousand people. And what they found was from 2000 until now, calorie counts have gone down as obesity rates have gone up, which is kind of a paradox. It's hard to explain, but the energy balance hypothesis, right?
Dr. Robert Lustig:
Well, in fact, the food industry actually argues that sugar consumption's gone down as obesity rates have gone up in that same 20 year period. So they say, well, it can't be the calories and it can't be the sugar. Well wait a second. It
Dr. Mark Hyman:
Depends how you define sugar.
Dr. Robert Lustig:
There are a lot of it's
Dr. Mark Hyman:
Cane sugar maybe, but that's some other reasons.
Dr. Robert Lustig:
There are a lot of wise and wear fors to that and we'll get there. Now all of that is true. In addition, people say, well, we're exercising less and we are exercising less, except not in the last 20 years. In fact, the exercise rates have actually stabilized
Dr. Mark Hyman:
Out. Yeah, it's crazy. I see gyms on every corner, orange theory, solid core, all these
Dr. Robert Lustig:
Businesses popping up. But that doesn't really work because you don't know what they're doing in those gyms. They're paying their money in for initiation and then you don't know if they're actually being used. So gym memberships does not.
Dr. Mark Hyman:
Fair enough. I don't want to go into places that kicks my ass into
Dr. Robert Lustig:
Energy expenditure. And remember, there are three kinds of energy expenditure. There's a resting energy expenditure just living, which is 65% of energy burning. There is the thermic effect of food, which is 10% of energy burning. That is just the metabolism of food itself. That generates heat.
Dr. Mark Hyman:
It takes work to digest your
Dr. Robert Lustig:
Food, takes work to digest
Dr. Mark Hyman:
Food, so energy
Dr. Robert Lustig:
And that gives you body heat. And then finally, there's voluntary energy expenditure which runs between 25 and 35% of total energy expenditure. So if energy expenditure is going down, which it's not, but if it was going down, which of those three buckets actually explain it? Well, in fact, none of them do. So there are a whole bunch of issues with regards the energy balance model to start with. In addition, it doesn't explain why when people lose weight, they plateau. Because if they eat less and they lose weight, you'd expect them to continue to lose weight. But they don't. They plateau. And of course that gets everybody crazy. And then they say, oh, I'm a failure. And then they go eat the Ben and Jerry's and it's all over and they've back up to where they belong in the first place. So if energy balance were the only issue, that phenomenon would not occur. So there are a whole bunch of things wrong with energy balance. In addition, energy balance does not explain why we have newborn obesity.
Dr. Mark Hyman:
Yeah. Why little kids come out,
Dr. Robert Lustig:
Why babies come out obese. Now, four separate studies, one in Israel, one in South Africa, one in Russia, one in the United States over the last 25 years, newborns weigh 200 grams more than they did 25 years ago. And when you stick 'em in DEXA scanners to figure out what the 200 grams is, it's all fat.
Dr. Mark Hyman:
Almost half a pound is what you're saying.
Dr. Robert Lustig:
Half a pound of extra fat before they even had a chance to eat mother's milk. Nevermind Ben and Jerry's. Okay. So whatever phenomenon, whatever model you want to proffer to me about what the cause of obesity is, you have to explain that. And you can't not with the energy balance model.
Dr. Mark Hyman:
It's right. And I think just to kind of double down on this, calories do matter, obviously, but it's really about the quality of those calories and what they do to your body. You always have this saying that a calorie burn is a calorie burn. Red calorie eaten is not a calorie eaten. Exactly. Heard you say that a hundred times. And what that means is when you eat food, it interacts with your microbiome, it interacts with your immune system, it interacts with your hormones. So it's not the same. And when people say it's all about calories, then I say, well, how do you explain the fact that a type one diabetic can eat 10,000 calories a day and lose weight at the same time because they have no insulin?
Dr. Robert Lustig:
Because they have no insulin. And so that's where the second model comes in, the carbohydrate insulin model. Now I will tell you until about two years ago, three years ago, I was a proponent of the carbohydrate insulin model because I had done research in it myself. So this is a model that has been particularly proffered by David Ludwig and appropriately. And I was, it's
Dr. Mark Hyman:
A Harvard professor,
Dr. Robert Lustig:
Basically. He does what I do except at Boston
Dr. Mark Hyman:
Shoulders. And he's one of the few people who do randomized clinical trials. Absolutely. And cross, he does most rigorous kind research, not just population data, but he does it on humans and it's a lot of money. But he does it
Dr. Robert Lustig:
Prospective clinical trials done with appropriate controls. David's a top-notch scientist. I have zero concerns about the quality of accuracy, the quality or the veracity of his data or of his thinking. Yeah, he's solid. Yeah, absolutely. Okay. Across the board. And he's a friend. Full disclosure. Me
Dr. Mark Hyman:
Too. Yeah, he's a good friend. Yeah. Alright.
Dr. Robert Lustig:
Now, I was a proponent of that model too. And the reason that I was a proponent of that model was because I did a similar experiment when I worked at St. Jude Children's Research Hospital in Memphis, Tennessee. So you're probably familiar with this phenomenon called hypothalamic obesity. So these are kids for the most part, adults too, but mostly kids who get tumors of the posterior fossa, the hypothalamus mostly. And they require surgery, they require radiation, they end up with hypothalamic damage and now they can't see their leptin. Leptin is a hormone that your fat cells make that feeds back on the brain and tells your brain, Hey, I've eaten enough. I don't need to eat anymore and I can burn energy at a normal rate because I have enough energy stored in the body. So it's a servo mechanism, just like the thermostat on your house.
So leptin's basically telling you the heat's high enough, we don't need anymore heat so you don't have to eat anymore. Okay, well, these kids lost their ability to see their leptin because those neurons were dead. And so number one, they like crazy. And number two, their energy expenditure was in the sewer and the catecholamine levels in their urine were zero because their sympathetic nervous system was basically shut down because they're trying to conserve because the sympathetic nervous system is what innervates the muscles to work. The sympathetic nervous system is what innervates the fat cells to give up their fat so they can't give up their fat and they can't burn. So they're eating like crazy and they're burning like zero. And so they're gaining weight out of sight, 30 pounds, 40 pounds a year, add infinitum, and there's nothing that anyone could do about
Dr. Mark Hyman:
It. The governor is off. The thing that tells you, oh, I'm full is just off ther
Dr. Robert Lustig:
Thermostat's broken. Right? So I inherited a cadre of about 40 of these kids at St. Jude who had survived their brain tumors but became massively obese because of the therapy. And the parents would scream at me, this is double jeopardy. My kids survived the tumor only to succumb to the therapy. And that was unfair, to say the least. And it was up to me to do something about it. Now as a neuroendocrinologist, I did know that there was this literature about something called the VMH lesioned rat, the ventral medial hypothalamus lesioned rat. So you put an electrode in the hypothalamus, you go B, and those animals become massively obese also. But what was interesting was you could cut the vagus nerve, the nerve that connected the brain to the pancreas and then they wouldn't.
Dr. Mark Hyman:
That's interesting.
Dr. Robert Lustig:
We assumed at that point in time, this was 1995 now, so almost 30 years ago, dark ages, the days of the giants. Remember them.
Dr. Mark Hyman:
I was there. I graduated medical school in 87. So yeah, I was there.
Dr. Robert Lustig:
So we assumed that these kids couldn't see their leptins, so their brains thought they were starving. So their sympathetic nervous system was in the sewer, and their vagus nerve was telling their pancreas to release more insulin in order to drive whatever they did eat into fat to raise the leptin. But they still couldn't see it because
Dr. Mark Hyman:
The body thought it was starving because the body thought it was starving. And even though there was plenty of food without leptin saying, stop, the body's like, I'm hungry, so all the time, let's store fat. Let's get everything stored because I don't know when I'm going to get my next meal. And insulin is that fast storage hormone. Right?
Dr. Robert Lustig:
Exactly. So insulin was the business end of the equation. So I'm not a neurosurgeon. I can't cut a vagus nerve, but could I do something similar? So we gave them a drug that suppressed beta cell insulin release. So that drug is called octreotide. It happens to be used usually for acromegaly, for growth hormone secreting tumors. But we repurposed it because it also suppresses pancreatic insulin release because there are somatostatin receptors on the pancreas on the beta cell. And we gave these patients octreotide, and lo and behold,
Dr. Mark Hyman:
They lost
Dr. Robert Lustig:
Weight. They lost weight. But something even more remarkable occurred. They started exercising spontaneously.
One kid became a competitive swimmer, two kids started lifting weights at home. One kid became the manager of his high school basketball team. These were kids who sat on the couch, ate Doritos and slept. They had lost all touch with the world around them because they felt like crap awful. They felt like crap all the time. And all of a sudden they woke up and the parents would, within a week they would say, before there was any weight loss, they'd say, I got my kid back. And the kids were active and they were saying, my head, this is the first time my head hasn't been in the clouds since the tumor.
Dr. Mark Hyman:
So what did that teach you?
Dr. Robert Lustig:
Well, so we did a double blind placebo control trial, proved it again. Then what we did was we did a study in
Dr. Mark Hyman:
Taking this trial, taking the drug, and then blocking the effect,
Dr. Robert Lustig:
Blocking the effect of insulin. Insulin. So then we ask the question, are there adults without brain tumors who might manifest the same problem? That is leptin resistance, not being able to see their leptin, high insulin release driving their weight gain and driving their sloth.
Dr. Mark Hyman:
By the way, with leptin resistance, just like insulin resistance, you see high levels of leptin in the blood, so you can measure it. Oh yeah. Super high
Dr. Robert Lustig:
Because their fat was so large that their leptins were in the stratosphere.
Dr. Mark Hyman:
And the company I co-founded function health where people can ask for their labs. Their basic lab panel includes leptin, insulin, and adiponectin. Three things you need to know that are really important for understanding insulin and carbohydrate metabolism.
Dr. Robert Lustig:
Without question, explain that to the American Diabetes Association.
Dr. Mark Hyman:
I know.
Dr. Robert Lustig:
So we said, are there adults who might have the same pathophysiology that is leptin resistance, insulin release, driving their weight gain, and if we gave them octreotide, would they lose weight? And sure enough, they did. Not every patient, only 20% of the total, eight out of 44. But what was interesting about the eight was that their insulin response to glucose was markedly different from the patients who did not respond. Yeah. Number one,
Dr. Mark Hyman:
Meaning they had higher levels of insulin, they had higher spiking levels after eating sugar. Right.
Dr. Robert Lustig:
And what we did in that study was we measured resting energy expenditure with a metabolic cart before and six
Dr. Mark Hyman:
Months, your basic metabolic rate. Your basal metabolic
Dr. Robert Lustig:
Rate. And what we saw was that the patients who lost the weight, the responders who had the high insulin response, their energy expenditure did not go down even though they lost weight, you'd expect it to go down because once you lose weight, you conserve their energy expenditure went up
Dr. Mark Hyman:
Really
Dr. Robert Lustig:
Because we got the insulin
Dr. Mark Hyman:
Down down.
Dr. Robert Lustig:
So there is a subset of patients with obesity that are just like these kids. And so insulin is a linchpin in driving weight gain in everyone. But not everybody has this insulin release problem that the kids did. Most everybody has this insulin resistance problem that is called metabolic syndrome to
Dr. Mark Hyman:
Some degree or another.
Dr. Robert Lustig:
Right? Some degree or other.
Dr. Mark Hyman:
And what is, but
Dr. Robert Lustig:
Insulin's the bad guy. No matter how you look at it, there is no weight gain without insulin. You got to get the insulin down. And so once I learned this, I changed my clinic practice completely. And instead of being a weight loss program, it was an insulin reduction program. Get the insulin down any way you can. And I have been trying to promulgate this as a modality, as a model for other obesity programs. And only my former fellows do it that way. It's been
Dr. Mark Hyman:
Doing this for an ultra wellness center for, it's just crazy 25 years. So absolutely. I just want to sort of highlight this point because just to go back to this diabetes type one diabetes, if you have no insulin, like a type one diabetic, you can eat 10,000 calories and you'll lose weight.
Dr. Robert Lustig:
Absolutely.
Dr. Mark Hyman:
But if you eat very little and you have high insulin, you're going to store all that fat. Exactly. And I had a patient once that just was one of those teaching patients, you know how you think you learn medical school and you learn shit? No, it's actually the patients that teach you, of course. And this patient, she looked like an apple. She had big round belly. I was convinced she was going to have a high blood sugar, high A1C, she was going to be having diabetes, checked her blood sugar, it was perfect. So I said, let's do a glucose tolerance test, but measure insulin also fasting. And after one hour and two hours, her blood sugar never changed. It was a 90 and then it went to 110 and then 105 at two hours, it was like perfect blood sugar. You never would've thought she had any issues. And that's what doctors do, but they don't measure insulin. Insulin. Her insulin fasting was like, I think 50 and it went up to two or 300, two
Dr. Robert Lustig:
Or 300,
Dr. Mark Hyman:
Two or 300 after
Dr. Robert Lustig:
My kids went up to 1200.
Dr. Mark Hyman:
Oh yeah, I never saw that. But you're a pediatric 1200, you're a pediatric endocrinologist. You see the worst of the worst. But I was like, oh wow, okay. Insulin is the problem here for her. She's spiking so much insulin, she can't lose weight and she's storing all around her belly.
Dr. Robert Lustig:
Bottom line is anything that gets the insulin down ultimately leads to weight loss. And there are different ways to be able to do that. Obviously, caloric restriction will get insulin down, carbohydrate restriction will get insulin down. The ketogenic diet, which is the extreme of carbohydrate restriction, will get insulin down, Metformin will get insulin down. And all of those are clear,
Dr. Mark Hyman:
Having lots of fiber.
Dr. Robert Lustig:
Yeah, high fiber diet will get insulin down. Thank you. Exactly right. All of these are modalities that basically impact insulin response, the insulin kinetics. And so there is absolutely no doubt that insulin is the linchpin in weight gain. So the carbohydrate insulin model that David helped promulgate, which I subscribed to because of the work I had done, I was in that camp until about two to three years
Dr. Mark Hyman:
Ago. Interesting.
Dr. Robert Lustig:
When I learned a little more. Okay. That's why you did see me.
Dr. Mark Hyman:
The thing about everything is that we polarize everything and there's truth in everything. It's not one thing. And in functional medicine, we understand the network effect in biology, it's basically an ecosystem, a set of biological networks that all interplay with each other. And there are many variables that can create the same outcome. Right?
Dr. Robert Lustig:
Agreed. So the bottom line is, if you think it's a nutritional issue, you'll stick with nutrition. If you think it's an endocrinologic issue, you'll stick with the endocrinology. If you think it's a GI issue, you'll stick with the gi. We have siloed medicines. So severely, the fact is this is a systems biology
Dr. Mark Hyman:
Issue. Yeah, exactly. I mean, you can do a fecal transplant and make someone less insulin resistant by changing their microbiome. Exactly. Right. So if you just do a poop transplant, you can lose weight and improve your diabetes. Well, how does that make sense? Even not changing your diet. Exactly. So many variables. Right.
Dr. Robert Lustig:
Well, and because there are so many different nodes, because energy is so integral to survival of the species that there's redundancy built into the system.
Dr. Mark Hyman:
That's right. You don't make energy, you're dead in a couple minutes. That's what cyanide does.
Dr. Robert Lustig:
Right? Exactly. Exactly. Alright, and why? Because it affects the mitochondria. So we're going to go back to the mitochondria again. Again,
Dr. Mark Hyman:
That's your little energy factory,
Dr. Robert Lustig:
Right? Because our systems biology 1 0 1 for today is the mitochondria. You're going to hear this a lot people. Alright, so about three years ago, Jerry Heindel put together a meeting on environmental obesogens. I've done some of this work as well because I worked along with my colleagues at uc, Berkeley on a study called the CHAMACOS Study, which is children and mothers of the S Valley, valley Farm workers, farm
Dr. Mark Hyman:
Workers. I know about this, I wrote about it in my book.
Dr. Robert Lustig:
And these kids, these were the offspring of mothers who were exposed to high doses of pesticides through their pregnancy. And so they measured the pesticides in the pregnant mother's urine and then watched the outcome of the babies as they grew up. And we looked at several different phenomena. We looked at growth, we looked at reproductive capacity, we looked at neurologic
Dr. Mark Hyman:
Iq. We were 41 million IQ points lost in that cohort. That was just striking to me.
Dr. Robert Lustig:
And of course we looked at puberty, we looked at obesity. And so we know that pregnant mothers, DDE levels, which is a metabolite of DDT, which hasn't been around since 1972,
Dr. Mark Hyman:
But it's still everywhere. It's
Dr. Robert Lustig:
Still everywhere. It's a forever chemical predicted obesity in their five-year-olds. So this clearly means that there's something going on even before birth. Like for instance, those newborn obese kids we just talked about. So trying to understand how obesogens that is, environmental factors that can lead to weight gain. What might be the reason for that? Well, we wrote three papers back in 2022 about this. 44 authors. I was lead author on one of the three papers. And there are a lot of different ways that you can make a fat cell. Okay. Estrogen will make a fat cell, androgen will make a fat cell. PP or GAM will make a fat cell. The aero hydrocarbon receptor will make a
Dr. Mark Hyman:
Fat cell, make a fat cell bigger or make a new fat cell. Both
Dr. Robert Lustig:
Different ones at different times. And there are windows of critical periods. So the question is, does the energy balance model explain this? No. Does the carbohydrate insulin model explain this?
Dr. Mark Hyman:
No. No. Okay,
Dr. Robert Lustig:
So
Dr. Mark Hyman:
Clearly
Dr. Robert Lustig:
We needed some more. And so the question is what ties all of this together? In walks Barbara Corky, who has done a lot of this work, and she had done work on reactive oxygen species, both in the addition and the animal. And it turns out reactive oxygen species, which are things you can't get away from if you're alive, you've got Ros's. Okay. Because mitochondria make R
Dr. Mark Hyman:
Os. It's a part of normal biology. It it's out of control. Anything like your blood pressure, your blood sugar or whatever, it's normal, but you don't want it too much.
Dr. Robert Lustig:
Oss change the phosphorylation status of the enzymes in the cell
Dr. Mark Hyman:
In English, please.
Dr. Robert Lustig:
Every cell in its lifetime has to grow or burn,
Dr. Mark Hyman:
Make energy,
Dr. Robert Lustig:
Utilize energy, but not both. They do one or the other. And there's an energy metabolism pathway in every cell to teach that cell whether it's going to burn or grow. And there are three enzymes. One is PI three kinase, phosphatidyl and acetol three kinase. This is the enzyme that lu cantley at first at Harvard. Then Cornell found is basically predictive of cancer because what it does is it opens the spigot for glucose to enter the cell in high concentration. The second one is a MP kinase, that is the fuel gauge on the liver cell pretty much every cell. And
Dr. Mark Hyman:
That's regulated by metformin, which is drug use for diabetes.
Dr. Robert Lustig:
Exactly. And so what it does is it tells the cell to make more mitochondria because
Dr. Mark Hyman:
The energy is low. When energy is low, that's goes up. I call that one of the longevity switches. It's part of our hallmarks of aging. Yeah, correct.
Dr. Robert Lustig:
And then finally the third enzyme is mTOR, mammalian target of rapamycin. That's a kinase. Also, all three of these are kinase.
Dr. Mark Hyman:
Again, I call that one of the longevity switches, which makes protein and good, but it could also be overdone.
Dr. Robert Lustig:
Well, it tells the cell to divide. It's the division signal. So if you're dividing, you're growing, but if you're burning, you're not growing, you're doing one or the other. No cell does both at the same time. So there is two pathways and the switches are these three enzymes. Well, these three enzymes are kinases, which means they're phosphorylation status dictates whether they're on or off.
Dr. Mark Hyman:
That's just a chemical reaction that kind of regulates whether they're working or not working. Right? That's
Dr. Robert Lustig:
Right. And guess what makes that phosphorylation occur? Reactive oxygen species. So we started looking with Barbara at the question of whether or not all of the things that we know cause weight gain, whether it be inflammatory things like for instance, air pollution has been associated with weight gain or environmental obesogens like phthalates or BPA and parabens, whether they
Dr. Mark Hyman:
Generate all the petrochemical things that are everywhere from pesticides to plastics and everything in between,
Dr. Robert Lustig:
And whether they cause reactive oxygen species to drive the weight gain. And Bruce Bloomberg at uc Irvine has shown that tribunal tin is a great model for this because not only does it cause reactive oxygen species, but it changes the genome, the epigenome I should say, so that it carries forward for at least four generations because of reactive oxygen species. And then we looked at the diet and sure enough, everything in our western diet generates more reactive oxygen species.
Dr. Mark Hyman:
Now just the inflammatory processed food in general. Exactly. Not necessarily containing toxins, but just pulverized science food projects.
Dr. Robert Lustig:
As soon as you generate more R oss that you can quench and antioxidants are the quencher. Yeah. So
Dr. Mark Hyman:
R
Dr. Robert Lustig:
Os is
Dr. Mark Hyman:
A reactive oxygen. It's basically like rusting. So we talking about is like when you get wrinkles in your face, your car rust or cataracts, cataracts that's going on in your body inside, not just outside. And that's normal, but if you have too much of it, it causes damage to your cells
Dr. Robert Lustig:
Faster. You die faster. Yeah. Basically it is the aging reaction sped up and it turns out ultra processed food does all of that. And so the question is can we use this paradigm of reactive oxygen species generation and lack of quenching as the model for being able to actually do something about obesity? Yeah, a hundred percent. And we are now in the process of designing the study to do that.
Dr. Mark Hyman:
Yeah. So it's interesting, Robert, in 2007, I wrote an article, it was titled Systems Biology, toxins, obesity and Functional Medicine. And I literally wrote, and that was almost 20 years ago, writing about my observations that there were certain patients that were struggling with weight that weren't because of what they were eating or not exercising. There was something else. I had one woman, she was a fitness trainer, she ate perfectly and she couldn't lose the 40 pounds that were hanging on her body. I'm like, geez, I don't know. But I think there's some data that shows that environmental toxins maybe an issue. Why don't we check? Well, we can check. We checked heavy metal and she had high mercury and we got the mercury out of her system. We detoxified. She lost 40 pounds like that, and
Dr. Robert Lustig:
Her blood pressure probably came
Dr. Mark Hyman:
Back the normal. And I started looking at the data and there was data on how environmental toxins are interfering with every cellular process, including metabolism and drive insulin resistance and also affect thyroid. One of the interesting things is people lose weight. You mentioned the plateau, but when you lose weight, where are the toxins stored? They're stored in your fat tissue. So they get released and then they start to interrupt your metabolism. So they interrupt the conversion of T four to T three, which is the act of thyroid hormone, which is your metabolic rate. So the science then was in its infancy, but I saw it and I actually had a chapter in my book in 2005 called Love Your Liver and Ultra Metabolism to help people understand that detoxification and getting rid of these chemicals from their environment and the lifestyle and also from their bodies by a scientific detoxification approach really works.
Dr. Robert Lustig:
So there are a whole bunch of different things that we are exposed to that affect different aspects of our energy burning pathway. The one that we are now most interested in and most concerned about is the mitochondria. Because after all, that's where a TP generation occurs.
Dr. Mark Hyman:
That's what your metabolism is essentially is isn't your mitochondria. Right.
Dr. Robert Lustig:
So we can talk about environmental obesogens, we can talk about food or we can talk about stress. And it turns out stress does it too. Yeah,
Dr. Mark Hyman:
For sure.
Dr. Robert Lustig:
So pretty much everything that drives weight gain and drives these chronic metabolic diseases can be basically bundled into one of these three bins. The food, the environmental exposures or the stress.
Dr. Mark Hyman:
And I would say
Dr. Robert Lustig:
None of this has anything to do with genetics.
Dr. Mark Hyman:
And I would say the calorie quality and the amount matter. So it's not like it's an either or. You need to pay attention to. Well, yeah,
Dr. Robert Lustig:
Of course. Because calorie amount means more R oss. Yeah. So it's not
Dr. Mark Hyman:
That. And actually noticed this one second, I'm just to interrupt because I'm just thinking of all these things, but I had this meal in Martha's Vineyard once on a summer with a friend and we ordered from this organic regenerative thing. We ordered so much food and it was so delicious. And both of us are basically fit healthy guys who have no metabolic issues. And we ate enormous amount of food, of healthy food. And we had our continuous glucose monitors on, and we call each other at 10 o'clock and I'm like, Hey Michael, what is going on? Your blood sugar high? My blood sugar's high. So it was like my blood sugar until like 150. It was the amount of food also had this effect.
Dr. Robert Lustig:
Well, of course, I mean there's no question you can overwhelm your body's ability to handle or to clear glucose. And so that brings us to the question of should we be monitoring glucose, this phenomenon, glucose and insulin. So I believe that insulin is the bad guy. I wish that we had a method for monitoring continuous
Dr. Mark Hyman:
Insulin monitor monitoring. When are we getting that? I've been asking that for 20 years. Five years. Five years. Five years. Serious. I can patch five
Dr. Robert Lustig:
Years or
Dr. Mark Hyman:
It coming. That's
Dr. Robert Lustig:
Going to be a game changer. Changer. It's coming because
Dr. Mark Hyman:
Glucose is sort of fine, but it's the last thing to go up. It's
Dr. Robert Lustig:
Coming. Yeah. Okay. Everybody's interested and everybody knows that's where the action going to be. But we don't have insulin right now, but we do have
Dr. Mark Hyman:
Glucose. But you can measure your blood test for insulin
Dr. Robert Lustig:
Fasting and you can also do postprandial insulins if you know how and if your doctor actually understands what they're doing. And if you can find a lab that will actually stick you for glucose and insulin and send all of them. For the most part, the insurance company won't
Dr. Mark Hyman:
Pay for that. They'll pay for it. But it's not that expensive. And I've been doing it for 25 years, so you can get it done easily. I did
Dr. Robert Lustig:
Oral glucose tolerance tests with simultaneously insulin levels on all of my obese patients. That's how I came to the realization insulin was the bad
Dr. Mark Hyman:
Guy. Yeah, me too. Me too. Exactly.
Dr. Robert Lustig:
Right. So when is the rest of medicine going to wake up? When we have the continuous insulin monitor? That's when, but it's coming. It's just not here yet. Point is we can use glucose as a proxy for insulin. Now, glucose is bad by itself because high glucose leads to endothelial dysfunction. It changes the cells inside your arteries. It's one of the reasons for high blood pressure. It's one of the reasons. And also generates uric acid, which also increases blood pressure. And there's neuropathy, nephropathy, retinopathy, all small vessel disease related to severe fluctuations in glucose. Glucose is a bad guy in the story, but there are two worst guys in the
Dr. Mark Hyman:
Story.
Dr. Robert Lustig:
One of them is insulin
Dr. Mark Hyman:
And
Dr. Robert Lustig:
The other one is fructose, which is not measured in the serum glucose.
Dr. Mark Hyman:
No, you don't measure.
Dr. Robert Lustig:
It's a different phenomenon.
Dr. Mark Hyman:
You can measure KELO one A, one C. We used to measure.
Dr. Robert Lustig:
Yeah. But fructosamine is a measure of glucose. It's not a measure of
Dr. Mark Hyman:
Fructose.
Dr. Robert Lustig:
I wish it were true. I would be measuring it on everybody, but it's not true. Okay. I wish it were. So anyway, bottom line is there are other things to know other than glucose. Glucose is in my estimation, about 10% of the equation on metabolic health. Interesting. But that's a 10% we have now. And we can glean the information on both insulin release, which is its own problem phenomenon and insulin resistance, which is its own problem phenomenon, and be able to figure out which is, and then be able to address our therapies to the appropriate pathology by understanding what's going on with glucose. So I am for continuous glucose monitoring even in non-diabetics. And of course that's one reason why both you and I full disclosure are advisors to company called Levels Health. And that's exactly what they do. I have to say that we have data that shows that exercise affects that glucose response that we have data that shows sleep affects that glucose response in non-diabetics in normal weight people. And we also have data that shows that if you know your glucose, you lose weight.
Dr. Mark Hyman:
Yeah. It's a feedback mechanism. It is. It's like electric shock. Like, oh, my blood sugar is high when I ate that, whatever cookie, I'm not going to eat that again. So
Dr. Robert Lustig:
There's data to be had that we can access today. Is it perfect? No, of course not. Do we need more information? Absolutely. But to ignore this possibility, I think is not serving our patients properly. I will tell you, I recently just within the last week had dinner with two of my former trainees and they didn't know a thing about this. I mean their pediatric endocrinologist, and they didn't know a thing about
Dr. Mark Hyman:
This. Tell me about my daughter's a third year medical student learn about insulin resistance. Not really.
Dr. Robert Lustig:
So there is this big hole
Dr. Mark Hyman:
About nutrition. Nope. No, none. Medical school.
Dr. Robert Lustig:
Yeah. There's a big hole in medical education. And the reason I think is because what we learn in medical school, and we've talked about this, there's a pill for that. Yeah. Well, there is no pill for this. That's what we've learned. There is no pill for chronic metabolic disease.
Dr. Mark Hyman:
Well, ozempic,
Dr. Robert Lustig:
No.
Dr. Mark Hyman:
Okay. Lemme just unpack what you said because it's so important. I want to make sure people got all the things we talked about. So there's basically three to four hypotheses that are needed to explain all the facts. So science is designed to try to explain the facts that are observed. However, a lot of times in science, we misinterpret the facts and we create meaning in ways that actually aren't true. For example, I'm reading book called Rethinking Diabetes by our friend Gary TAs. It's this fascinating history of diabetes. And he talks about how in the early days with type one diabetics, you had to give them a high fat keto diet or they would die.
Dr. Robert Lustig:
So Elliot Joslyn knew this joslyn, right? Glucose is of no use to the body. That's a direct quote from Elliot Joslyn before he knew what insulin was. 1893, right? He said this right. And Fred Allen, who took over for Joslyn in 1919 published a treatise textbook. Yeah. Basically saying the way to treat type one diabetics was a 70% fat 8% carbohydrate diet.
Dr. Mark Hyman:
So they said that, but then what happened was years later when they started getting insulin, they saw that all these people were dying of premature heart disease and atherosclerosis. So they made the observation that the fat and the arteries was happening in these patients. And they hypothesized based on that set of facts, that it was the high fat diet that they ate when they were younger that caused C clogged arteries. They just misinterpreted those facts. So why I brought that up is we have to agree that we have a whole set of facts that don't meet all the theories. So we need multiple theories to actually understand it. So is the energy hypothesis wrong? Not completely. Is the carbohydrate insulin model wrong? No, it's actually mostly right. But this doesn't explain everything. Is the obesogen model the entire story? No, not exactly. Because stress plays a role.
For example, stress. I found out when I was researching one of my books that your vagus nerve and your sympathetic nervous system innervates every one of your fat cells. That's right. So when you're stressed, it literally sends a nervous signal, a nervous signal to your fat cells to say, stop burning calories. So these are the four things we talked about that all play a role and have to be encountered, and you have to personalize the approach to each person. It's not like, oh, this is going to work for this person. That doesn't work for that person. There is no one size fits all.
Dr. Robert Lustig:
So to that point, and I'm glad you brought that up, people think that the sympathetic nervous system results in lipolysis because you exercise
Dr. Mark Hyman:
That's burning fat,
Dr. Robert Lustig:
Burn fat. Right. And that is true in the acute situation. In the acute situation, you release norepinephrine from your sympathetic nervous system, the norepinephrine via the intermediate lateral cell column and the peripheral sympathetic nerves go to each fat cell bind to the beta three adrenergic receptor activate. Hormone sensitive lipase ultimately leads to dissolution of the triac glycerol into free fatty acids and glycerol, which then circulate back in the bloodstream to the liver, which then turns them into ketones for the rest of the body to use. That's lipolysis. And that's what acute sympathetic nervous system activation, the exercise does acute.
Dr. Mark Hyman:
And by the way, everybody should know that insulin blocks lipolysis. So basically insulin prevents the fat breakdown. So long as your insulin's high, it's hard to lose weight.
Dr. Robert Lustig:
That's exactly right. Insulin blocks your ability to be able to lose weight. That's why getting insulin down is job one for just that reason. Exactly. Right. Now here's the problem with that.
Dr. Mark Hyman:
Chronic
Dr. Robert Lustig:
Activation of the sympathetic nervous system does the opposite. Now how come? So every sympathetic neuron in your body, whether it's in your spinal cord or in your brain, doesn't matter, releases norepinephrine, but also releases a neuropeptide called neuropeptide, YNPY. They are co released and it turns out NPY binds to its receptor. In the case of the fat cell, it's the Y two receptor. And what it does is it shuts off that hormone sensitive lipase. So the lack of insulin and the sympathetic nervous system. Now instead of generating lipolysis, you are actually generating lipogenesis.
Dr. Mark Hyman:
You mean you bailed fat instead of burn fat? Yes.
Dr. Robert Lustig:
Yeah, exactly. And so chronic stress,
Dr. Mark Hyman:
Because I'm sorry, I'm not like how Obama had his anger translator. I'm the Robert Lust translator.
Dr. Robert Lustig:
Absolutely. The point is, chronic stress does the opposite. And we all know that chronic stress is the bad guy in the story. Acute stress is for the most part, adaptive, but chronic stress is clearly maladaptive. It's all
Dr. Mark Hyman:
Sorts of, and it's not just when you're stressed who eat that pint, Ben and Jerry's, it's another mechanism.
Dr. Robert Lustig:
It's another mechanism.
Dr. Mark Hyman:
If you eat that pin, Bening Jerry's on top of it, it makes it even worse. But it's,
Dr. Robert Lustig:
Well, the pint Bening Jerry's is because of what's happening at the amygdala in the brain, at the fear center of the brain. Because dopamine is one of the ways to basically placate that amygdala at least short term. And so that's what stress eating's about. And I'm a card carrying member of the stress eating club.
Dr. Mark Hyman:
Yeah,
Dr. Robert Lustig:
Me until I did the research and understood it better, and now I'm a whole lot more
Dr. Mark Hyman:
Appropriate. I know last night I was really tired. I had a very stressful weekend and I flew from New York to LA and I was really, you looked
Dr. Robert Lustig:
Pretty good. No,
Dr. Mark Hyman:
I was really tired and I went shopping and I was really hungry. I went shopping in Eron and literally this voice in my head was buy the ice cream, buy the ice cream, buy the ice cream. And I literally had to override that. I knew if I brought it home, I would eat the whole thing, of course. But I was able to manage my higher self, kind of kicked in and told that guy to shut the F up, and I was able to sort of manage the store. It was very tough, but I got out of the store safe, didn't bring it home, but I would've eaten it. Even though I know everything I know. I've written 19 books about this. It is not something you can willfully control.
Dr. Robert Lustig:
So the bottom line is we have to, number one, get insulin down, and number two, we have to get the amygdala working properly. Those are our two most important things. Now, how do you get the insulin down? Well, number one, don't let it go up.
Dr. Mark Hyman:
Well, can I just interrupt for a sec, because you're basically laying out these different hypothesis, but I hear you. Going back to insulin, are you always leaning more towards the carbohydrate insulin hypothesis?
Dr. Robert Lustig:
Well, I'm leaning more toward the R os hypothesis. So the question is what does R OSS do to your beta cell? Turns out it makes more insulin release. R OSS in the beta cell actually generate bigger insulin response. So basically
Dr. Mark Hyman:
Oxidative stress from anything, environmental, toxins, sugar, ultra processed food, our microbiome being messed up, chronic stress, chronic stress, all these variables have to be looked at. So it's not just a, I mean obesity is not ozempic deficiency, is it?
Dr. Robert Lustig:
And we'll talk about that in a minute. That's right. The point is, everybody who's got metabolic disease, which is 93% of America has a problem with one or more of the five things you just mentioned.
Dr. Mark Hyman:
That's staggering. Robert, 93% of Americans have some degree of this problem, even though 75% of our weight. So you don't have to be overweight to have this problem. You can be what we call skinny fat or metabolically obese normal weight or tophi thin on the outside, fat on the inside.
Dr. Robert Lustig:
What we know is that those patients have liver fat. So just because you don't have subcutaneous fat doesn't mean you don't have liver fat. So just because healthy doesn't mean well, and just because you're fat doesn't mean you're sick.
Dr. Mark Hyman:
Yes. Interesting.
Dr. Robert Lustig:
Okay. The overlap is huge. So if this is a problem for everybody, and so the question is what do you do about it? How do you figure it out? Are you at risk? Does your doctor know it? Will they help you? And if not, how are you going to figure it out for yourself? Well, that's what you and I are doing this frigging podcast for, is to try to help people understand that. Exactly right. Okay. Point is insulin is one of the drivers, promote metabolism, get insulin down. The other one is suppress inflammation because inflammation drives insulin resistance
Dr. Mark Hyman:
Too or anything an infection. Viruses have been linked to obesity, right? Adenovirus?
Dr. Robert Lustig:
Absolutely. Adenovirus 36 for one and others too. But mostly AD 36 point is inflammation drives R oss because inflammation drives N-A-D-P-H oxidase at the level of the liver driving those R oss. That's what N-A-D-P-H oxidase makes is R oss. Okay. Now thes,
Dr. Mark Hyman:
That's part of your mitochondrial processing of the food you eat and oxygen you breathe and it sort of has these little pathways and when it goes kind of awry, it's like going on the wrong pinball thing and it doesn't go where you want it to go. Exactly. And ends up causing more damage.
Dr. Robert Lustig:
Exactly. Right. R oss have to be quenched. Now the quenching occurs in the peroxisome, and that's where the antioxidants live. So in the liver, it's glutathione or maybe vitamin E. In other cells it might be other
Dr. Mark Hyman:
SOD, catalase, glutathione peroxide. These are all antioxidants that your body makes. And they're so powerful and they're often, they're overwhelmed. And often we don't support their function with the right nutrients. Right,
Dr. Robert Lustig:
Exactly. So for instance, glutathione needs methionine. Well, methionine is the second rarest amino acid after tryptophan. That's the rarest. And you need tryptophan in order to be able to turn that amygdala off. But methionine is necessary to be able to make denal methionine, which then contributes the methyl group for glutathione. Well, if you're methionine deficient, you got a problem.
Dr. Mark Hyman:
And glutathione is like the King Kong of antioxidants essentially. Exactly.
Dr. Robert Lustig:
My
Dr. Mark Hyman:
Colleague, your body makes it
Dr. Robert Lustig:
My colleague Jackie Mar at San Francisco General studies, the methionine choline deficient rat, the MCD rat, poor rat, poor rat. Not the McDonald's rat, but it might as well be okay. This is the fastest way to fatty liver disease. There is, and the reason is because without methionine, you can't generate glutathione. So you're going to get nafld, non-alcoholic fat, liver disease, fatty liver disease, and also choline. Choline makes phosphatidylcholine, which is part of a OB, which helps export the fat out of the liver so it can go to the adipocyte instead. So without choline, you can't get the fat out of the liver. So you make too much and you can't clear it. And so these animals have fatty liver like crazy
Dr. Mark Hyman:
About almost a hundred million Americans.
Dr. Robert Lustig:
Point is methionine and choline are things that you don't find much in processed food.
Dr. Mark Hyman:
No, no. Where are they found?
Dr. Robert Lustig:
Well, they're found in real food. I mean, methionine is found in basically good protein. When I say good protein, fish, poultry, eggs, meat. Oh, sure. Red meat. Absolutely. Absolutely. And also you need iron for this too.
Dr. Mark Hyman:
And choline is where,
Dr. Robert Lustig:
And choline is in red meat as well. Eggs. Eggs and eggs.
Dr. Mark Hyman:
Yes. Sardines. Sardines, yes. Which I have a can of sardines here with me now for lunch.
Dr. Robert Lustig:
The problem with choline is that choline can be acted on by the intestinal microbiome to form trimethylamine,
Dr. Mark Hyman:
TMIO.
Dr. Robert Lustig:
And then that gets oxidized. Stanley Hayes in Cleveland Clinic where you by the way, are working as well with Michael Roy in their wellness program. So even though sometimes things are good, sometimes too much of a good thing is not so good. And so we have this problem in nutrition also, that we have inverted U-shaped curves for certain things like choline. Choline used to be called vitamin B four. So it's essential. It's essential. Right? It's essential. So these are the things that are wrong that we have to
Dr. Mark Hyman:
Fix. And you're saying you were going about inflammation with diet, right? You're going, inflammation is driving this. So where inflammation is coming from, if it's coming from stress, if it's coming from toxin, it's coming from sugar, coming from microbiome coming
Dr. Robert Lustig:
From, it's coming from our diet. Diet. That's where it's coming from. So if you have an autoimmune disease, it's coming from your immune system. But if you don't have an autoimmune disease, which is 90% of us, 10% do, but 90% of us coming from your gut. Now your gut is a sewer. What's the definition of a sewer? A pipe with you know what in it? Yes. Okay. That's what the gut is. It's a sewer. Well, all that junk in there is bad for you. You don't want it in your bloodstream. It stays in your gut. So there are three barriers in your intestine to keep the junk out of your blood. The first is the physical barrier, the mucin layer,
Dr. Mark Hyman:
The mucus,
Dr. Robert Lustig:
And it lines the intestinal epithelium all the way through. The second is the biochemical barrier, which is the zonulin, the tight junctions that hold the intestinal epithelial cells together.
Dr. Mark Hyman:
Like Lego blocks suck together.
Dr. Robert Lustig:
Yes. Kind of. Sort of like Lego blocks. And when they become dysfunctional, then they get permeable, and that leads to what we call leaky gut. And the third is the immunologic barrier. And those are called th 17 cells, and they make a cytokine called IL 17. So those are
Dr. Mark Hyman:
White blood cells and they're making inflammatory
Dr. Robert Lustig:
Compounds, right? Exactly. To get rid of foreign invaders. Yeah. Okay, so three
Dr. Mark Hyman:
Separate, it's like the frontline of the military on the front lines, right? Yeah.
Dr. Robert Lustig:
Well, you've got the guys at the front, the pawns, then you got the knights, and then you got the bishops right before you get to the king, right? I mean you have all of these things in defense of your bloodstream. The point is all three of those are failing today because of ultra processed food. The mucin layer, because of the lack of fiber, the microbiome will actually chew up the mucin layer for its own purposes because it otherwise is starving. Fiber is the food for your microbiome. Fiber is the food for your bacteria. Fiber is the nutrient you don't absorb because it's not for you, it's for your bacteria. But our food is fiber fiberless on purpose because you can't freeze fiber. Exactly. So the food industry took it out. Well, we got to put it back in and that's what
Dr. Mark Hyman:
This, yeah. What is that? You got that packet.
Dr. Robert Lustig:
So full disclosure, I am the chief medical officer and co-founder of a fiber company, and it's called Bio Lumen, and the product is called Mamo, and we just released it end of November. It's doing very well.
Dr. Mark Hyman:
And what's in it?
Dr. Robert Lustig:
What is in it? These are micro cellulose sponges. Seven microns in diameter. So the size of a red blood cell. So it flows like a powder. It's colorless, odorless, tasteless, textless. Because your tongue can't tell six microns. It's got to be 12 microns or greater for your tongue to be able to discern that it's there. So it can go into bean dip, it can go into chocolate, it can go into smoothie, ice cream and smoothies, yogurt, anything. Well, you can put it in water and then drink it right away. Drink it right away. If you leave it, it'll swell
Dr. Mark Hyman:
Terms of a gel and you can put a spoon and it stands straight up, right?
Dr. Robert Lustig:
We don't want to do that. Then no one will drink it. You swallow it in the food or otherwise in the stomach, it'll start expanding. It expands 70 fold over its original size. Incredible. So that'll give you a feeling of fullness, which helps. And when it expands, it exhibits the nooks and the crannies in the sponge. Right? The kitchen sponge has the holes in it, impregnated in. All of those are a set of proprietary hydrogels soluble fiber, which sequester, absorb, soak up glucose, fructose, sucrose, simple starches
Dr. Mark Hyman:
And fat too.
Dr. Robert Lustig:
No, not fat. Not
Dr. Mark Hyman:
Fat. Not fat. It doesn't limit cholesterol. A lot of the fibers will like muse. So will this one
Dr. Robert Lustig:
Reduce
Dr. Mark Hyman:
Cholesterol
Dr. Robert Lustig:
Absorption? Yeah, but this one won't.
Dr. Mark Hyman:
Interesting.
Dr. Robert Lustig:
So that's one of the geniuses of this is it only works on carbohydrate.
Dr. Mark Hyman:
Interesting.
Dr. Robert Lustig:
Because you don't want to absorb fat because if you absorb fat, number one, you get bad GI side effects. That's what happens
Dr. Mark Hyman:
If you
Dr. Robert Lustig:
Want to xena calorie or
Dr. Mark Hyman:
You don't prevent the absorption of fat.
Dr. Robert Lustig:
Right, exactly. Fat with
Dr. Mark Hyman:
Or less fat in that fat blocker everybody was having disaster pants with. Right. So
Dr. Robert Lustig:
This is basically what's in regular food. And everything that's in this packet is food. All the components are food. They're food grade. We get 'em on Amazon, we just assemble 'em in a specific proprietary
Dr. Mark Hyman:
Way. So you take it before you eat, essentially.
Dr. Robert Lustig:
You take it with you.
Dr. Mark Hyman:
The field. I just came back from Tanzania and I met with the honey hunters I the za, which are this incredible tribe, the last hunter gathered tribe. And they hunt and they gather and 20% of their diet is honey. Honey, the other part of their diet is an enormous amount of fiber. They eat
Dr. Robert Lustig:
Enormous
Dr. Mark Hyman:
Amount of 50 grams of fiber. A, we literally dug a root out of a bottom of tree. It was kind of a wild yam, and they eat that. So we all ate about a hundred to 150 grams of fiber per person a day. Now we eat about eight or less and it's destroying our microbiome. It's making us metabolically and healthy. And it's hard to get that much unless you're eating,
Dr. Robert Lustig:
Unless you're a,
Dr. Mark Hyman:
Yeah. Hot eating tons of fiber all the time. And it's hard. And I think the data is really clear on other studies too, from Metamucil and even things like poly glycol from Gluc, Manin helps and some of that in there, right?
Dr. Robert Lustig:
So the concept is right, I mean, so this is both insoluble fiber cellulose and soluble fiber, these hydrogels. And so it's unusual because it's a combination of both.
Dr. Mark Hyman:
So it's going to do a couple things. Tell us the things that it does. So number one, multiple actions in terms of its effects,
Dr. Robert Lustig:
Six separate effects. So the first thing is it gives you a feeling of fullness. Second, it absorbs carbohydrate and especially simple sugars in the duodenum preventing their ability to cross into the bloodstream. Thus you reduce the glucose response, you reduce the insulin response. We just said that's the most important thing, putting
Dr. Mark Hyman:
A slow absorption of sugar into your blood and it prevents this glucose spike and the insulin spike that makes you gain weight. Correct.
Dr. Robert Lustig:
In addition, it moves the food through the intestine faster because fiber is a
Dr. Mark Hyman:
Lot Transit time, we call it transit
Dr. Robert Lustig:
Time. Transit time decreases. That means that you get your satiety signal sooner because it's at the end of the intestine. The peptide YY signal at the end in the ileum, the end of the intestine in addition. So
Dr. Mark Hyman:
What you just said there was you feel full, the satiety signal, which is PYY, and others that get released in the lower part of the intestine get activated from the fiber. So that makes you actually shut your brain down from wanting food.
Dr. Robert Lustig:
Correct. Which by the way is what GLP one does. Yeah. Okay. And we'll get to that. Number four, it feeds the microbiome. So it increases microbial diversity, which is a way to prevent inflammation
Dr. Mark Hyman:
Like bugs that are good bugs in your gut and bad bugs. And when you process the food, you grow bad bugs. When you eat fiber, you grow good bugs.
Dr. Robert Lustig:
Exactly.
Dr. Mark Hyman:
Okay. And the good bugs are anti-inflammatory. And the bad bugs are inflammatory. So it doesn't matter what you eat. If you have inflammatory bugs, you get something called metabolic endotoxemia, which means your inflammation from your bugs causes insulin resistance independent of your diet.
Dr. Robert Lustig:
And do you know what does that sugar? Because sugar nitrates those tight junctions and makes them nonfunctional. And so transiently increases leaky
Dr. Mark Hyman:
Gut. Yeah. And gluten
Dr. Robert Lustig:
And gluten
Dr. Mark Hyman:
Course gluten and all the food additives, the emulsifiers, which destroy the lining of the gut. Yeah,
Dr. Robert Lustig:
That's destroying that mucus layer. That's right. Number five, the soluble fiber acts as food for the colonic bacteria generating short chain fatty acids, which have been shown to be anti-inflammatory, anti Alzheimer's, anti-cancer. And finally, the insoluble fiber helps clear cancer cells from sloughing from the colon. So basically, I think
Dr. Mark Hyman:
There's one more, one more. But we'll use secrete extra toxins from your liver into your bile. It goes in your gut. And so you have environmental toxins that get pushed out as well faster. Sure, absolutely. So you have have seven there. Yeah, seven. Seven is a lucky number.
Dr. Robert Lustig:
We haven't studied that one yet, but that's actually very true. The point is, what this does is it recapitulates the effect of the fiber that was in the food to start with before the food industry got to
Dr. Mark Hyman:
It. But it doesn't mean you can take that and eat ultra processed food. You want to still eat healthy food. Right.
Dr. Robert Lustig:
Well, ultimately the question is can you have your cake and eat it too? And that, by the way, that was just an article in The Guardian three days ago. Interesting. With that title. I'm not proposing we abandon trying to fix ultrapro. So I just have
Dr. Mark Hyman:
One of those before my pin and Ben and Jerry's or what?
Dr. Robert Lustig:
We need all the
Dr. Mark Hyman:
Tools we get. I bet that's what people are thinking.
Dr. Robert Lustig:
Well, we need all the tools we can get. Okay. There are sugar addicts out there who no matter what information we give them, they're going to continue hitting the sodas, hitting the Ben and Jerry's. And we have to provide them with methods for dealing with their problem as well. Think of it this way, you got a heroin addict? Okay, why is heroin bad?
Dr. Mark Hyman:
Because it's addictive.
Dr. Robert Lustig:
Because it's addictive. Well, caffeine's addictive, but there's a Starbucks on every street corner.
Dr. Mark Hyman:
True.
Dr. Robert Lustig:
So why is heroin such a problem? Because during the withdrawal phase you go steal a car. That's why. So what did society do? We came up with this thing called methadone. And methadone basically is an oral opioid, which basically takes the edge off the peaks in the valleys. Think of this as methadone for your sugar.
Dr. Mark Hyman:
That's incredible
Dr. Robert Lustig:
Addiction. How do you like
Dr. Mark Hyman:
That? I like that. I would rather doesn
Dr. Robert Lustig:
Sugar doesn. It doesn't fix the problem, but it helps mitigate them.
Dr. Mark Hyman:
It's also not addictive. Methadone is of course not. Methadone is addictive. So not quite methadone. But I think I just want to bring this up because there are a lot of criticisms about this whole food addiction theory and there are a lot of people who are pushing back and saying it's not a problem, that it's really just people's gluttony. And then it's not really a biological phenomenon and it doesn't meet the criteria.
Dr. Robert Lustig:
Actually it does
Dr. Mark Hyman:
Meet the, but if you look at, I mean listen, Kelly Burnell has created a whole Yale food addiction score. It's a validating.
Dr. Robert Lustig:
Ashley Gerhard has done enormous work. Nicole Lavina has demonstrated sugar addiction in animals and now in humans. And I just met with her, we just did the Commonwealth Club last week. We're going to meet in New York next week as well. There's a food addiction symposium in London in May.
Dr. Mark Hyman:
There's different degrees of it. There's different degrees. But there was a really interesting meta-analysis of systematic review of 281 studies from 36 countries. And they found that overall the prevalence of food addiction, according to the Yale Food Addiction Score, which is a validated metric, was 14% now adults and 12% in kids, and 14% of the population is alcohol addicted. So it's like the same as alcoholism. And tobacco is about 18%.
Dr. Robert Lustig:
So let's use alcohol as the template for this. Okay, let's take the American population. 40% of Americans are teaters never touches stuff. 40% are social drinkers. Pick up a beer, put it down. I'm in that
Dr. Mark Hyman:
Category.
Dr. Robert Lustig:
10% are binge drinkers and 10% are chronic alcoholics. So even though alcohol is available everywhere, 80% of the population does not seem to have a problem.
Dr. Mark Hyman:
But
Dr. Robert Lustig:
20% do. And the question is, what are you going to do for that 20%?
Dr. Mark Hyman:
And why do they have it and
Dr. Robert Lustig:
Why do they have it? Well, it turns out they're probably the same people. So the idea that there's no sugar addiction doesn't make sense just because not everyone's addicted. Nobody has it. Right? Doesn't mean it doesn't exist. In fact, sugar and alcohol are metabolized virtually identically. The fructose molecule and the ethanol molecule basically do the exact same thing at the level of the mitochondria. So it shouldn't be surprising that children who don't drink alcohol have the same diseases as alcoholics type two diabetes and fatty liver disease, even without alcohol because they have a substitute. They have sugar.
Dr. Mark Hyman:
Yeah, it's really interesting. I mean, I think the food addiction thing is fascinating because even there's, people say, where are the randomized controlled trials? Well, David Ludwig did one where he basically took, it was fascinating study. I call it the milkshake study. I know about this study. Basically a group of overweight guys, and you gave them on different times, different milkshakes, but they were identical in terms of calories, carb fiber,
Dr. Robert Lustig:
But they were different. Sugar,
Dr. Mark Hyman:
Protein, fat. And the speed of the absorption of the sugar was the only difference. So one had a rapidly spiking sugar and the one didn't. And they measured their brain MRIs and they measured their blood chemistries. And even though they were identical in calories, the group that had, and they tasted the same, the group didn't know which one they were eating. The ones that had the high spiking sugar carbohydrate had higher levels of insulin, higher levels of glucose, higher triglycerides, more inflammation and higher cortisol, higher adrenaline. And their brains in the area of addiction, the nucleus accumbens lit up like a Christmas tree. Exactly. And that's the same area that lights up with heroin and cocaine. And I think
Dr. Robert Lustig:
Anything that makes that nucleus accumbens activate in the extreme is
Dr. Mark Hyman:
Addictive. And now we know there's genetics that play a role. So I dunno if you do this, but we haven't
Dr. Robert Lustig:
Found the genetic locus yet. For alcohol or for nicotine or
Dr. Mark Hyman:
For sugar? Not yet. Well, may not know exactly, but we do know that there's difference in dopamine receptors. So we can measure genes for dopamine receptors and dopamine is the receptor that feels pleasure. So in these people with dopamine receptor problems, they end up needing more stimulation to feel the same. Goodness.
Dr. Robert Lustig:
Because the dopamine receptor has been downregulate, the law diminishing returns basically.
Dr. Mark Hyman:
Well, it's both, right?
Dr. Robert Lustig:
Logs down-regulate. Well,
Dr. Mark Hyman:
There's habitation, but there's genetics also, right?
Dr. Robert Lustig:
Well, yeah. So the attack a one allele of the dopamine receptor, it's in about 20% of people. Turns out they make 30% fewer dopamine receptors. Their neurons, they gain more weight.
Dr. Mark Hyman:
And those are the people more likely to be addicted or gain weight or have sugar addiction. So you're right, it's not people, oh, sugar addiction. Not everybody's alcohol addicted, not everybody's sugar addicted, but it's a thing and it's as big a thing as alcoholism
Dr. Robert Lustig:
And it's causing societal devolution in the same way alcohol did. And so then the question is, alright, if you know that something is both toxic and addictive like cocaine, heroin, nicotine, alcohol, you have societal interventions that deal with it. We call it public health. What do we have for sugar?
Dr. Mark Hyman:
Not here. I mean, I just came back from Chile in Argentina and you're right, they have incredible laws that have really radically changed their food consumption patterns and to reduce the amount of refined sugars and carbohydrates and junk food because they put black box warnings on the front of the package. They have eliminated advertising. They got rid of Tony the Tiger, they have no junk food in school. So there's a lot of ways that we actually can fix this. And policy, you're working on policy. I'm working on policy stuff. So we have to get this done.
Dr. Robert Lustig:
So to that point, we've got standards for sugar in California down to 5% of calories in schools. It's called SB 3 48. And my nonprofit Eat Real, which you're very familiar with.
Dr. Mark Hyman:
Yeah, I help support. And
Dr. Robert Lustig:
My CEO Nora Latori is good friend Force of Nature. She's amazing. Okay. Worked with Nancy Skinner of the California legislature to push this through and we're trying to make this national. And just today the White House announced that Eat Real is now one of its model programs for dealing with childhood obesity. Going into 2025, we are going to be taking 1 billion meals in schools and making them low sugar and zero processed foods. That's
Dr. Mark Hyman:
God's work. I mean, our kids are our future and we poison our kids. I mean, we have 40% plus overweight, 25% are obese. We have decreased performance in school, decreased job performance, GQs earning capacity, shorter life expectancy, 13 years of you're obese as a kid. I mean it's really a big deal. It
Dr. Robert Lustig:
Is. Well, so let's the audience understand how this occurred because ultimately when you drive into a ditch, you have to know how you drove in order to be able to back out. You can't just hit the accelerator and expect to be able to come out the other side of the ditch. You have to back yourself out. So you have to know how you drove in. Why did this happen? So when you and I were kids and we're about the same age, we had school and we had cafeterias and we had lunch ladies,
Dr. Mark Hyman:
I dunno, my mom always made my lunch.
Dr. Robert Lustig:
Okay, alright. Well, my mom made me 200 fish sandwich every day and I could kill her to this day. We
Dr. Mark Hyman:
Didn't have school food when I was in the, I don't
Dr. Robert Lustig:
Remember that. Well, they had the blue hairs with the hair nets and the lunch I used. Okay, in 1971, the Department of Education passed an ordinance administrative law called Resolution 2 42, which basically said that all cafeterias in the United States and public schools had to make book that is they could not lose money for the school. They had to basically fend for themselves with their own budget.
Now that sent every food services director in every school in America running for cover. What are we going to do? How are we going to solve this? Because the biggest issue was the personnel and the infrastructure keeping it running to be able to make school food. So in walks, Aramark and Cisco and Guggenheim and McDonald's and Pizza Hu, it says, Hey, we'll do it for you. We'll provide every kid with an air quote nutritious on air quote meal every single day. And you won't have to do anything. We'll take care of it. And most importantly, because we'll take care of it, you can take your infrastructure, you can take your food preparation facilities, get rid of the kitchens, and get rid of the kitchen and turn it into classrooms. And that was the goal
Dr. Mark Hyman:
Was plan even is plan deep frying a microwave and you're fine.
Dr. Robert Lustig:
And the point is that once you take the equipment out, now you're hostage to the food industry for the rest of your life. That's right. And 1971, you can track when grades in elementary school started.
Dr. Mark Hyman:
And the reverse is true. I dunno if you know about my friend Jill Shaw, who created a program called My Way Cafe in Boston where she basically paid for, so philanthropists paid for the reti institution of a kitchen in a school showed, showed how powerful it was. It got the entire Boston City schools do it. And now the entire inner city, Boston schools all have kitchens. The menus have all been designed by top chefs. The food's delicious, the kid eat it, they don't throw it out. It meets the school budget guidelines, the federal guidelines for school lunches and everybody's winning. And they're not getting food shipped in across state lines and packages with plastic, with who knows what kind of toxins that infiltrating the food in addition to the junk that in the food that's heated up in microwaves and deep fryers.
Dr. Robert Lustig:
The point is, there are a lot of business models that work. So Eat Real is dedicated to finding the business model that would work within any district. So for instance, we started out in Contra Costa County right across from San Francisco, enterprising Food services director, wonderful guy, Dominic Mackey. He purchased a dilapidated factory, repurposed it into a food preparation facility for the entire district. 27 schools, 27,000 kids. They made 27,000 lunches per day. And because they were buying at scale, they could buy cheaper and they could control what was in the food. And so they could get rid of, get this 10 pounds of sugar per kid per year. They got rid of 100,000 pounds of sugar in the first year. We have now gotten rid of 5 million pounds of sugar from Kids Diet.
Dr. Mark Hyman:
It was some great visual that Jamie Oliver did on a TED Talk. We took a bathtub full of sugar, a school bus
Dr. Robert Lustig:
Full of sugar. That's
Dr. Mark Hyman:
What an average kid eats in a year, right?
Dr. Robert Lustig:
The point is Dominic was able to actually save money because they could buy at scale. And so they made it in the one central facility and then shipped it out to the 27 schools each day. And so every kid got a real nutritious meal, a hot food meal where we could control what was actually in it.
Dr. Mark Hyman:
And you saw performance get better,
Dr. Robert Lustig:
Everything got better.
Dr. Mark Hyman:
Attendance got better behavior issues got better. Exactly. Weight got better.
Dr. Robert Lustig:
Another example, and this was not our example, this was in Israel 15 years ago, the Ramah School District in the West Bank had a 27% graduation rate,
Dr. Mark Hyman:
27%. That's not
Dr. Robert Lustig:
Good. And if you don't graduate, what happens to you? There's the likelihood marginalized, you can marginalize the terrorists, whatever, not good. And the Israeli government did not know what to do with this. A entrepreneur who's done very well in the tech industry, Yossi Vardy went to Netanyahu, said, give me the Ramallah School District. I will take care of it. And they were only too happy to divest themselves of it. And Vardy did one thing,
Dr. Mark Hyman:
Change the food,
Dr. Robert Lustig:
He fed them. He didn't even change the food, he fed them. That's
Dr. Mark Hyman:
So
Dr. Robert Lustig:
Right. And they went from a 27% graduation rate to a 95% graduation rate in two years.
Dr. Mark Hyman:
Yeah, no, I've seen this. I just came back from Kenya and I went to this school called Little Lions, where it's in the worst slum, kabira slum in Kenya. It's the worst lum in Africa. I went and visited there, walked around, it was incredible. People live on $3 a day. There's garbage everywhere. I mean, it's awful. And this friend of mine started this whole school and his main thing was feed these kids three meals a day. Real food. And these kids are thriving. They're performing academically. They're going to be doctors now and getting out of their poverty. Well, why
Dr. Robert Lustig:
Are we surprised? Yeah. Not surprising. Your brain needs nutrients. Well,
Dr. Mark Hyman:
Let's back up a little thought.
Dr. Robert Lustig:
Not just glucose. It needs fatty acids. It needs protein. Yeah, it needs food. It needs anthocyanins it, it needs selenium, it needs zinc, it needs omega threes. Where are you going to get 'em? Except your
Dr. Mark Hyman:
Food. So I want to back up because clearly we need to fix our school system. We need to fix schools. Eat Reel is an amazing nonprofit. I encourage people to check it out. I am a huge fan of it. I'm a friend and a supporter of the whole program and Jordan slain and Nora and you. So it's great. Thank you. But I want to back up because we spent a lot of the conversation talking about these four different, not opposing, but different models of thinking about the causation of obesity. And if we're going to address this obesity epidemic, I mean, yeah, we can all take Ozempic and spend 5 trillion a year and bankrupt the country and cause all these side effects and bowel obstruction and so forth. Or we can really address the cause. Exactly. And so you talked about the energy balance hypothesis, which is essentially this calories and calories out.
The carbohydrate insulin hypothesis, which is eat too much sugar in carbs causes too much insulin, which makes you gain weight and prevent fat loss and dysregulate your brain. You talked about environmental toxins or obesogens that disrupt things in many ways by destroying our mitochondria, by screening up our microbiome, by causing inflammation, by causing octave stress, by thyroid function, by so many different mechanisms, which I actually outlined in that paper. I should send it to you, you'll love it. It's like 20 years old. But I saw it coming. And then lastly, this whole redox hypothesis, which is all these things also cause too much ative stress. So for the average person listening, they're like, well, that's cool, interesting science, but what the heck? Heck do I do? So let's take the rest of the time to break down what are the action steps to address these things and how do we create an integrated model? And what is the average person going to do? Who is struggling with weight gain? Who's struggling trying to lose weight? Who's trying to understand all this conflicting biology? Who's hearing one Instagram influencer saying this is garbage? Another one's saying, this is garbage. No, this is true. No, that's true. Eat this. Be a carnivore, be a vegan. Don't eat fat, eat fat, eat carbs. Don't eat carbs. It's like you're going to go,
Dr. Robert Lustig:
It's a
Dr. Mark Hyman:
Mess. It's a mess. It is. It's a total mess. So help us from a scientific perspective, how do we break down the action steps for the average person listening who wants to understand how do we take these scientific advances, which are really remarkable in our understanding of obesity and metabolism, and turn those into action steps that people can do to help their lives get better and lose weight.
Dr. Robert Lustig:
So I am on record. You can't fix healthcare until you fix health. You can't fix health until you fix diet. And you can't fix diet until you know what the hell is wrong. And for the last 50 years, we've been barking up the completely wrong tree. We've been working on the idea that fat was the bad guy. Fat ain't the bad guy. Now what is the bad guy? Well, it's a bunch of things. Basically anything that makes R oss, alright, well what makes the most R oss? Okay, turns out trans fats make the most R oss. Yeah,
Dr. Mark Hyman:
Shortening.
Dr. Robert Lustig:
But we now know that and it's basically been banned from the American diet. Finally,
Dr. Mark Hyman:
You know why they call it shortening, right?
Dr. Robert Lustig:
No, it shortens
Dr. Mark Hyman:
Your life. Oh yeah,
Dr. Robert Lustig:
Fair enough.
Dr. Mark Hyman:
But no, this is like Crisco, right? Back in the day. Indeed. But it's been regulated as non grass, which means generally now not recognized as safe. Correct. However, it's still in
Dr. Robert Lustig:
The food. In the food. Yes
Dr. Mark Hyman:
It is. You go to the grocery store, it should not be there. It was almost 10 years ago. And you can still find that crap everywhere you
Dr. Robert Lustig:
Are. Exactly right. And for the exact reason you said, because they round down. So
Dr. Mark Hyman:
Read the label. In other words,
Dr. Robert Lustig:
Scott Grundy years ago showed that two grams of trans fat per day is enough to lead to diabetes and cardiovascular disease. Two grams per day. Okay? If a serving of ultra processed food in America has 0.49
Dr. Mark Hyman:
Grams less than 0.5,
Dr. Robert Lustig:
Right? Less than 0.5, okay, they can say it's zero zero, right? Because of rounding down. So if you consume four servings of whatever that is,
Dr. Mark Hyman:
Which is not hard,
Dr. Robert Lustig:
Which is not hard, okay? You have achieved your two grams, that is all still a problem. So you are absolutely right. We have actually not completely solved the problem
Dr. Mark Hyman:
With trans. Okay? So trans fasts are bad. Next is,
Dr. Robert Lustig:
Okay, so the question is what to do about all of these issues.
Dr. Mark Hyman:
So anything that causes a reactive oxygen species
Dr. Robert Lustig:
Is a problem, is a
Dr. Mark Hyman:
Bad guy. So there's a lot of things.
Dr. Robert Lustig:
Well, what's the next thing? Fructose. Fructose causes the mayard reaction, the glycation reaction, the browning reaction, seven times crispy chicken
Dr. Mark Hyman:
Glucose, creme brulee,
Dr. Robert Lustig:
Bananas, anything that browns, okay. Barber suited Q sauce on the grill.
Dr. Mark Hyman:
And that's an oxidative stress
Dr. Robert Lustig:
Reaction. That's and generates 100 times the reactive oxygen species.
Dr. Mark Hyman:
It creates ages, right? We call it advanced location end products, otherwise
Dr. Robert Lustig:
Known to age you. It can happen in your cell or you can eat it. So dietary ages. So basically if you take a can of sweetened condensed milk and you put it in a pressure cooker for an hour, you get pudding. It went from white to brown. That's the myd reaction. It occurs in the food. The point is the sugar is what drives those advanced glycation but's.
Dr. Mark Hyman:
Fructose, right? Any kind of sugar will
Dr. Robert Lustig:
Cross. Well, glucose will do it, but fructose does it seven times faster and generates 100 times the R oss because of the stereochemistry of the molecule. So fructose is particularly egregious. Yes. Glucose does it too, but fructose does it way more lactose. Lactose much less. So lactose is not a big problem. People think dairy is a problem. It's not a problem.
Dr. Mark Hyman:
Okay? So don't quit your breast milk,
Dr. Robert Lustig:
Don't quit your breast milk.
Dr. Mark Hyman:
Don't
Dr. Robert Lustig:
Quit the breast. Milk. Milk. And we can talk about neonatal nutrition maybe on another podcast. But the bottom line is the amount of sugar in our diet is a mess. The third thing is the inflammation, because that's generating the Ros's and that there, it's the emulsifiers because the emulsifiers are leading to that leaky gut.
Dr. Mark Hyman:
So name some
Dr. Robert Lustig:
Carboxy, methylcellulose, polysorbate. 80 carrageenan, by the way, which food has the most carrageenan?
Dr. Mark Hyman:
Your almond milk? Ice cream. Ice
Dr. Robert Lustig:
Cream. Ice cream. And who introduced caran to ice cream as a quiz?
Dr. Mark Hyman:
I don't know the Eskimos. It seaweed. Margaret Thatcher. Margaret Thatcher.
Dr. Robert Lustig:
Margaret Thatcher.
Dr. Mark Hyman:
Did she like her ice cream thicker? She
Dr. Robert Lustig:
Was an ice cream chemist before she was an mp.
Dr. Mark Hyman:
What? That's a good little trivia. Yeah. Okay, so there's other ones. Xanthin gum. Gu gum, all these thickeners that you see in even health foods.
Dr. Robert Lustig:
Well, the thickeners don't necessarily mean they're emulsifiers. Emulsifiers very specifically hold fat and water together. So the thickeners are yet another issue.
Dr. Mark Hyman:
And they've been linked to autoimmune disease. Absolutely, because they cause leaky
Dr. Robert Lustig:
Gut. No question. Okay, another thing that's a big problem is monog cyl acids. Okay? And three NCPD, it's a compound called E 4 71.
Dr. Mark Hyman:
But you don't see it on the label of a food.
Dr. Robert Lustig:
Well no, you do see it. It just doesn't call. They don't call it one what? Call it four seven one monog cyl esters. So those are a problem as well. So bottom line is here's what we need to
Dr. Mark Hyman:
Do. And the food itself is inflammatory, right? So if you're eating trans, you sugar, if you, of course ultra processed food, just by nature it's inflammatory exactly. Through a whole series of mechanisms. So
Dr. Robert Lustig:
We have to promote metabolism best way, get rid of the sugar, and we have to
Dr. Mark Hyman:
Sugar you say you also mean flour, you also mean
Dr. Robert Lustig:
Anything. Sugar refine carbohydrate, refine
Dr. Mark Hyman:
And sugar and carbohydrates.
Dr. Robert Lustig:
And we have to suppress inflammation. And how do we do that? Increase the fiber. Get rid of the emulsifiers, increase the omega threes. Okay, so get rid of the sugar, increase the fiber, increase the omega threes, and decrease the emulsifiers. Alright? What food looks like that?
Dr. Mark Hyman:
Sardines eat the bones. I don't know.
Dr. Robert Lustig:
Well,
Dr. Mark Hyman:
Real food. Real food, right?
Dr. Robert Lustig:
Real food. I mean fish in particular, yes. I mean I am a big proponent of fish. They got omega threes. But remember it's not the fish that make the omega threes the fish eat the omega threes, the algae, make the omega threes the fish, eat the algae. We eat the fish. That's why small fish have more omega threes than large fish.
Dr. Mark Hyman:
Sardines. Large
Dr. Robert Lustig:
Fish
Dr. Mark Hyman:
Eat small fish mackerel. Yeah, right,
Dr. Robert Lustig:
Exactly. So how do we do that? So in 2020 I was contacted by a company in the, but I noticed
Dr. Mark Hyman:
You didn't say reduced calories. No,
Dr. Robert Lustig:
Nothing
Dr. Mark Hyman:
About calories. You didn't say it's not about calories. Yeah.
Dr. Robert Lustig:
Okay, not about calories. In 2020, I was contacted by a company in the Middle East called Kuwaiti Danish Dairy, and they recognized that they wanted to be part of the solution, not part of the problem. Kuwait has an 18% diabetes rate and an 80% obesity
Dr. Mark Hyman:
Rate. Yeah, it's about 10% here. So it's almost double.
Dr. Robert Lustig:
It's 11.4 right now.
Dr. Mark Hyman:
Okay. Jesus. I can't keep track.
Dr. Robert Lustig:
Oh, I know, I know. Every day it keeps going up. They wanted to become a metabolically health company and they wanted to lead the way. And they're a privately held company so they could take the long view. They didn't have Wall Street quarterly reports to have to deal with. So their business model was make better food and make it at a price point that they could still make a profit. That was what they wanted to do. So they contacted me to convene a scientific advisory team to help them re-engineer their entire food portfolio. 180 items.
Dr. Mark Hyman:
That's amazing.
Dr. Robert Lustig:
And so do you know Tim Harlan, who is the head of culinary medicine at George Washington University? Rachel Gao, who ran the Omega-3 for a DD trial at the NIH. Andreas Corns, who was a computer scientist out of Stanford and Wolfram Alderson, who's been in the food business longer than all of us, started the first farmer's market in Los Angeles back in 1979. We convened the scientific advisory team to basically deconstruct the entire portfolio of this company to determine what were they doing, what ingredients were they using, did they actually meet criteria for healthfulness or not? Were the vendors actually telling them the truth about what was in the things that they were selling them? And what could we do about the production and the packaging in order to actually improve the healthfulness of the food? And we came up with three precepts. And these are the precepts of metabolic health. I love, and we call it the metabolic matrix. I love this. Here we go. Protect the liver, feed the gut, support the brain. Any food that does all three of those is healthy, irrespective of its processed or ultra processed. Any food that does none of the three is poison.
Dr. Mark Hyman:
So feed the gut, support your liver, help the
Dr. Robert Lustig:
Brain, protect the liver, support the brain. Those are the three precepts. And you can actually determine
Dr. Mark Hyman:
How do you do that?
Dr. Robert Lustig:
How do you do that? Well, it's easy when you know what each of the foods, what each of the ingredients do within the body. So you have to understand metabolic health to be able to do that. So nutrition does not answer those questions. So there's this thing called food science. There's this thing called nutrition. There's this thing called metabolic health. They're not the same. Food science is what happens to food between the ground and the mouth.
Dr. Mark Hyman:
Nutrition in a laboratory. In
Dr. Robert Lustig:
The laboratory,
Dr. Mark Hyman:
Not when you buy an apple in the grocery store, there's no food science there.
Dr. Robert Lustig:
Nutrition is what happens to food between the mouth and the cell. Metabolic health is what happens inside the cell. But all of these metabolic diseases are all happening inside the cell. So nutrition is only valuable as it informs metabolic health. Food science is only valuable as it informs metabolic health, but they are one or two steps divorced from metabolic health. So if you use metabolic health as the north star, as the watchword, as the goal, and the World Economic Forum has endorsed this, they came out a white paper called the True Purpose of Nutrition. And the World Business Council for Sustainable Development is coming on board with that as well. If you use metabolic health as the north star and gear your food, re-engineering efforts to vast concept of protect the liver, feed the gut, support the brain, you can actually make healthy food even if it's ultra processed. And that's what we have done in Kuwait and they have turned 10% of their portfolio over in the last two years. That's amazing. Based on
Dr. Mark Hyman:
These food. So if you're not eating kudi Danish food, what do you eat?
Dr. Robert Lustig:
Well, we need to impress upon the food industry here
Dr. Mark Hyman:
In America here to do the same thing. To do the
Dr. Robert Lustig:
Same thing. A hundred percent. It is a uphill battle to say the least. I
Dr. Mark Hyman:
Love this because everybody's looking for solutions. So this is really a well thought
Dr. Robert Lustig:
Out solution. I am a advisor to the scientific advisor to the Innovation Institute for Food and Health at uc Davis, who has lines to all of the food industry at different levels, startups and CPG companies. And the goal is to get companies to understand what it is that they are doing. Basically ditching the idea of nutrition and focusing on metabolic health instead. Example, Unilever and Danone in the last two years reduced their carbon, their sugar footprint, both of the companies by 14%. Now you think that's good? Or bed?
Dr. Mark Hyman:
I don't know, 14%. I think it sounds good, but there's a catch.
Dr. Robert Lustig:
Well, I mean it's better than not, but 14% when you use triple your limit in the food going down by 14% doesn't quite get
Dr. Mark Hyman:
You there. Yeah, it's like when they said they're going to take 6 trillion calories out of the food supply by making Oreo cookies 90 calories instead of a hundred calories. Exactly. It's Bs.
Dr. Robert Lustig:
Exactly. bs. That's exactly right. And they did that in 2014 and it was a piece of crap then. And it's a piece of crap now.
Dr. Mark Hyman:
Exactly. I'll how you really feel, Robert. I'll, how about,
Dr. Robert Lustig:
So the point is 14% sounds good. It actually got a manual favor fired at Danone because of it At KDD, at this Kuwaiti Danish dairy, we have reduced the sugar footprint of that company by 78%.
Dr. Mark Hyman:
That's amazing. That's
Dr. Robert Lustig:
Amazing. 78%.
Dr. Mark Hyman:
So again, what people without
Dr. Robert Lustig:
Changing
Dr. Mark Hyman:
Taste, what do people eat for lunch? The this thing, they're, this all sounds great, mark, this all sounds great Dr. Wig. But what the F do I eat for lunch?
Dr. Robert Lustig:
Alright, so obviously the easy answer is real food. So what's real food? Food that came out of the ground or animals that ate what came out of the ground? That's real food.
Dr. Mark Hyman:
Alright, I make it simple. I say eat the food that God may leave the food that man made. Right? Egg. No.
Dr. Robert Lustig:
If you think Cheetos is food, I mean you're sunk, right? It's just that simple. So we have to redefine food population. What is food? What is food? Okay, so what is food? What is the definition of food? Mark?
Dr. Mark Hyman:
It's something that provides nutrition to the cells.
Dr. Robert Lustig:
No, that's not the dictionary definition of it's something
Dr. Mark Hyman:
You eat. I don't know. Substrate. I should know I written a book about that. Yes, you should.
Dr. Robert Lustig:
Substrate that contributes to either growth or burning of an organism. Growth or burning. Okay. Remember we said at beginning, every cell has to grow at one point in its life. Every cell has to burn at one point in its life, but it can't do both at the same time. Burning or growing. Okay, so does ultra processed food contribute to burning? Well, sugar inhibits three mitochondrial enzymes. We named them before sugar actually inhibits burning. And 73% of the items in the grocery store are overdose with sugar. Does sugar contribute to growth? Does ultrapro food contribute to growth? Yeah.
Dr. Mark Hyman:
Kind of makes you
Dr. Robert Lustig:
Grow. My colleague, Dr. Montego, the head of nutrition at Hebrew University of Jerusalem has looked at this question. It actually inhibits trabecular bone growth, cortical bone growth, skeletal bone growth, cancellous bone growth.
Dr. Mark Hyman:
But it makes belly growth bigger. Yeah,
Dr. Robert Lustig:
It hijacks growth actually drives cancer formation. Okay. Point is it does not contribute to growth. So if a food stuff, if a compound that passes your lips does not contribute to growth and does not contribute to burning, is it a food?
Dr. Mark Hyman:
No.
Dr. Robert Lustig:
Well, if it's not a food, what is it? It's a
Dr. Mark Hyman:
Food like substance. Poison. Poison. Right?
Dr. Robert Lustig:
And so we have to start redefining what we need. It's true. So you are big in food as medicine. Okay. Dari Safari big in food as medicine. I am here to say food can be medicine or can be poisoned, can also be poisoned. Yeah. And when we start
Dr. Mark Hyman:
Differentiate, food is heal or food is slayer, it's like the both, right?
Dr. Robert Lustig:
As soon as we start teaching the public the difference, that's when things will start changing. But not until, so education has to come first. Now, can we provide the public with tools to help them? My colleagues working with KDD, we have developed a tool that everyone right now online can use. This minute, you can look it up. It's called Perfect P-E-R-F-A, CT not perfect. Perfect. And you can find it at http slash slash perfect.co. And what it is, is it's a recommendation engine with a set of filters that will filter your grocery store, your grocery store, not any grocery store. Your grocery store to basically only show you the things that are metabolically healthy for you. So if you have a gluten problem, it will only show you the gluten-free stuff. If you have a metabolic syndrome problem, it will show you all the things that have refined carbohydrate or sugar or trans fats, et cetera. If you have a problem with oxalate, it will show you the low oxalate items if you have a problem with.
Dr. Mark Hyman:
So it helps you navigate this confusing landscape of nutrition and figure out what's going to be good or bad for you. Because
Dr. Robert Lustig:
As soon as you walk in the store, you're sunk because all of those nutrition facts labels are staring you in the face. There are 40,000 items whatcha going to do? Read 40,000 nutrition facts,
Dr. Mark Hyman:
Labels. Even if you go to Whole Foods, it's
Dr. Robert Lustig:
Still it's impossible zone. It's still impossible. Point is this does it for you. Okay. And it does it based on what you want it to look for, not what they want you to look for. So everyone can use this. And there are four filters right now. There is a metabolic matrix filter that does protect the liver, feed the gut to support the brain. There's a raw elastic filter that is no added sugar, no artificial sweeteners. Okay. There is a Nova filter, our colleague Carlos Montera. So basically takes all the NOVA class four items off's, 80, 80% of the store food. Right? Right. Okay. So
Dr. Mark Hyman:
It's a guide for people to shop and it's really helpful. And where can they find that?
Dr. Robert Lustig:
Perfect.co. It's free.
Dr. Mark Hyman:
Okay, spell that again.
Dr. Robert Lustig:
P-E-R-F-A-C-T.
Dr. Mark Hyman:
Okay. We're going to put that in the show notes. And we're also going to put the link to levels because people want to know what their blood sugar, it's levels link slash hymen if you want to get access to the special offer to sign up to get your own blood sugar looked at, because that's really important to track things that are going on. So actually what's happening with your own biology? Exactly. And you have this whole framework of the metabolic matrix, feed the gut, protect the liver, support the brain, which you've written a lot about. And we're going to link to all your articles, all your TED talks, all your videos and your books, which are incredible. And I think people need to take a look at them. I read most of them are that Chance was the one I read through all the way through Hacking the American mind and Metabolic, metabolic. Metabolic, I don't want to say metabolic, but like diabolical, but Well, it is, yeah. And so your work is so important. I feel like we literally just scratched the surface. Oh yeah.
Dr. Robert Lustig:
We
Dr. Mark Hyman:
Started, I mean, this has been a phenomenal conversation and a frustrating conversation because everything, I want to spend an hour or two just talking about that. And I got to have you back because we just touched on things like artificial sweeteners. We touched on some of these high level constant about toxins. But I think just to summarize for people as we close, obesity is complex. Weight is complex. It's not a one theory. It's understanding the full matrix of the science and all the data and trying to help understand where the data actually supports one idea or another. And it's understanding how this all fit together. So the energy balance, hypothesis, calories do matter, but maybe not in the way we think carbohydrate insulin is a real thing, but it's more complicated. The gut microbiome plays a role. Absolutely. Environmental toxins play a role. Redox plays a role.
And I think all these things are really, really important in understanding how we deal with our weight and our metabolism. And so the science now is better than ever before. And what we're trying to do, what you do, what I do is try to get this out there to people to help them understand this, to talk about it. You slept all the way down here from San Francisco because you want to talk to me. And I'm grateful for that. Not a bit. And I thinks fine. I think we're going to have to do this again, Robert, because I just, I'm just up
Dr. Robert Lustig:
The road. It's only 400 miles.
Dr. Mark Hyman:
So thank you for your work. Thank you for being the advocate across policy, science, business. And you could be playing golf right now, but you're not. You're actually doing the right thing and helping us all understand this complexity. And I think anybody who kind of tries to reduce any of us, me, you, any of who are talking about this, to some simple soundbite, it's just unfortunate because we really have such a deep understanding of the biology from our clinical work, from our scientific work, from understanding of all the literature. And we put it together in a way that I think is the right way. And I think all the things you came to are things that I've been thinking about for decades and it all makes sense. Right?
Dr. Robert Lustig:
Right. Absolutely. And the point is, thank you for acknowledging my work, but vice versa. I mean we, I hate to say it, but we're two very lonely warriors. I mean, there are people coming on board there. There are a few. But I got to tell you, I have been very, very disappointed in the standard medical architecture. Only 28% of medical schools even have a nutrition curriculum. I
Dr. Mark Hyman:
Wonder if it's because a MA gets $192 million from an industry and
Dr. Robert Lustig:
Pharma. Exactly. And 80% of the medical curriculum is underwritten by big pharma. They don't want to know this. They don't want to know. There's this thing called prevention. They don't want to know. There's this thing called public health. They want the pill, they want the procedure because that's where the money is.
Dr. Mark Hyman:
And I would say prevention is so important, but I would also say what we're talking about is treatment. It actually can reverse these conditions. It's not like you're one way street. So people should check out the per fact. They should check out Lumen, which you're a part of, which helps create this fiber that you're talking about. Where can they find that?
Dr. Robert Lustig:
They can find it at Monch Monch Shop. Spell that. So M-O-N-C-H-M-O-N-C-H. Shop.
Dr. Mark Hyman:
Shop. That's where they can purchase it. We'll put all that in the show notes. We'll put all your work. Thank you for coming. Let's do this again soon because I am, like
Dr. Robert Lustig:
I told you, we got to hang out.
Dr. Mark Hyman:
I feel like I'm in a marathon and I'm at a hundred yard line and I still have another 26 plus miles to go with you to unpack all this stuff. So thanks again for being here and coming all the way down and being on the podcast. My pleasure, mark. Alright, thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts. And follow me on all social media channels at Dr. Mark Hyman and we'll see you next time on The Doctor's Farmacy. This podcast is separate from my clinical practice at the Ultra Wellness Center and my work at Cleveland Clinic and Function Health, where I'm the Chief Medical Officer. This podcast represents my opinions and my guest opinions, and neither myself nor the podcast endorse the views or statements of my guests.
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