The BITTER TRUTH About Sugar & How It Causes DISEASE! | Dr. Robert Lustig

Summary

Highlights

• Dr. Robert Lustig calls out the food industry's misleading claims about sugar. 🎤
• Fructose leads to de novo lipogenesis in the liver, contributing to metabolic diseases. 🩸
• Artificial sweeteners like those in diet sodas aren't the safe alternative they're marketed to be. ⚠️
• Many chronic diseases are symptoms of larger metabolic issues, not standalone problems. 🔍
• Sugary drinks and processed foods should be minimized for better health outcomes. 🍹

Key Takeaways

• Fructose is metabolized differently by the liver, leading to fat production and metabolic diseases. 🍭
• The food industry's notion that 'calories are calories' is misleading and harmful. 🚨
• Glucose is necessary for energy, but fructose is uniquely harmful and contributes to liver fat. ❌
• Artificial sweeteners are not a harmless substitute and can still contribute to health issues. 🚫
• Whole fruits are healthier than fruit juices due to fiber content, which regulates sugar absorption. 🍊

Overview

Chapters

• 00:00 - 00:30: Introduction and Health Consequences of Excessive Fructose Consumption The introduction discusses the various health consequences associated with excessive fructose consumption, such as type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, cancer, dementia, fatty liver disease, and polycystic ovarian disease. The problems arise due to a process called de novo lipogenesis in a liver overwhelmed by fructose. The speaker expresses excitement over having a guest on the podcast known for their expertise in the field, specifically in pediatric endocrinology. The focus of the discussion appears set to continue on the effects of fructose.
• 00:30 - 02:00: Defining Sugar and Its Primary Harms The chapter discusses the definition of sugar and its potential health consequences due to overconsumption. It begins by stressing the importance of agreeing on a definition of sugar, as not everyone shares the same understanding.
• 02:00 - 04:00: Dietary Sugar: Glucose and Fructose The chapter addresses various forms of dietary sugars such as sucrose, high fructose corn syrup, maple syrup, honey, and agave. It clarifies that the discussion is about sugars consumed in the diet, not blood sugar.
• 04:00 - 06:00: Glucose as Essential Energy Source The chapter discusses the essential role of glucose as an energy source. It explains that glucose is a critical component of blood sugar, distinct from dietary sugar, which is a mix of glucose and fructose. Glucose is described as the 'energy of life,' vital to every cell's energy production processes. The summary also notes the importance of glucose to the extent that the human body will synthesize it if not consumed. As a real-world example, the chapter mentions the Inuit people, who historically consumed a diet absent of plant-based carbohydrates, yet their bodies adapt to produce glucose.
• 06:00 - 10:00: Fructose Metabolism in the Liver The chapter discusses the role of the liver in fructose metabolism, specifically focusing on how the liver can convert whale blubber into glucose through a process called gluconeogenesis. This process involves transforming lipids through glycerol, or amino acids, into glucose, demonstrating that while glucose is essential for the body, consuming it directly is not necessarily required.
• 10:00 - 16:00: Fructose's Impact on Liver and Health The chapter discusses the impact of fructose on liver and overall health, emphasizing the brain's requirement for glucose. It explains that while the brain needs glucose, it can alternatively use ketones. This understanding is part of why the ketogenic diet, which provides ketones as an energy source, can be effective, particularly for patients with seizures.
• 16:00 - 23:00: Impact of Fiber on Fructose Absorption The chapter discusses the brain's energy requirements, specifically highlighting how it functions on both glucose and ketones. It describes a scenario where individuals experienced seizures due to the brain's inability to utilize glucose, which were alleviated by ketones. The chapter emphasizes that while glucose is necessary for energy, ketones can also fulfill this energy requirement, suggesting that the brain may perform better on ketones.
• 23:00 - 29:00: Comparison of Fructose Sources This chapter explores the topic of dietary sugar, specifically focusing on glucose and fructose. It discusses the non-essential nature of dietary sugar, explaining that while glucose is not necessary in the diet, the intake can vary widely depending on dietary choices. For instance, a person on a carnivore diet may consume little to no glucose.
• 29:00 - 36:00: Role of Saturated Fat in Health The chapter challenges the common belief that a vegan diet is always healthy by emphasizing that the main culprit in health issues is not dietary glucose but fructose, which is a component of sugar and differs significantly from glucose. The narrative argues against the food industry's claim that all sugars and calories are the same, suggesting a more nuanced understanding of different types of sugars and their impact on health.
• 36:00 - 44:00: Historical Perspectives on Saturated Fat and Sugar This chapter delves into the historical context and misconceptions surrounding saturated fat and sugar consumption. It criticizes the oversimplified notion that all calories are equivalent, suggesting that this view has allowed harmful dietary components to persist in our food supply. The chapter challenges the reader to reconsider the impact of calorie sources on health, particularly emphasizing the role of corporate and industrial interests in perpetuating these myths.
• 44:00 - 51:00: Misconceptions in Nutrition Science The chapter titled 'Misconceptions in Nutrition Science' explores various myths surrounding diet and exercise. It challenges the notion that 'calories are fungible,' highlighting that not all calories are equal due to the structural differences in sugars, such as fructose and glucose. The chapter stresses that excessive or insufficient exercise and diet do not solely define one's health and cautions against simplistic narratives like 'you are what you eat' or blaming individuals for being overweight.
• 51:00 - 59:00: Understanding Metabolic Health Understanding Metabolic Health explains the different ways the liver metabolizes fructose and glucose. While glucose is turned into glycogen or liver starch, which is stored as energy for activities like marathon running, fructose is processed differently, indicating diverse pathways for liver metabolism.
• 59:00 - 74:00: The Role of Calories and Nutrient Metabolism The chapter titled 'The Role of Calories and Nutrient Metabolism' delves into the distinct metabolic pathways of glucose and fructose. It highlights that pasta, primarily made of polymerized glucose, is processed differently compared to fructose. While glucose involves insulin regulation and contributes to glycogen storage, fructose does not. Fructose's metabolism bypasses these pathways; it doesn't trigger insulin release, leptin response in fat cells, or suppresses ghrelin, the hunger hormone. Instead, fructose is metabolized by the liver but does not contribute to glycogen storage.
• 74:00 - 83:00: Fructose and Metabolic Disease The chapter discusses the impact of fructose on metabolic diseases. It explains how excessive intake of fructose, such as from a 20-ounce Coke, overwhelms the liver's mitochondria, which are responsible for burning energy. Unable to process this energy surge efficiently, the liver converts fructose into fat. This process involves a substrate called acetyl-coa, which plays a significant role when the liver is unable to handle the energy input.
• 83:00 - 89:00: The Aging Reaction and Fructose The chapter titled 'The Aging Reaction and Fructose' explores the metabolic processes involving fructose and its byproducts. It highlights how fructose, similar to glucose, is metabolized but is uniquely diverted from energy production in the mitochondria to fat formation. This process, known as de novo lipogenesis, involves the liver converting sugar into fat, subsequently increasing triglyceride levels in the bloodstream.
• 89:00 - 94:00: Fructose as an Addictive Substance The chapter titled 'Fructose as an Addictive Substance' explains how fructose can contribute to health issues such as fatty liver disease. It describes the process where triglycerides increase in the liver due to fructose intake. If triglycerides are not exported, they turn into lipid droplets inside liver cells, leading to fatty liver disease. This accumulation interferes with normal insulin signaling, resulting in insulin resistance.
• 94:00 - 99:00: Sugary Foods to Avoid This chapter discusses the harmful effects of sugary foods, specifically focusing on how high insulin levels contribute to chronic metabolic diseases. These include type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, cancer, dementia, fatty liver disease, and polycystic ovarian disease. The chapter highlights the role of fatty liver and de novo lipogenesis, which are exacerbated by excessive fructose consumption, leading to the liver's inability to manage the sugar intake.
• 99:00 - 107:00: Artificial Sweeteners and Metabolic Health The chapter discusses the importance of distinguishing between fructose found in whole fruits and fructose in soft drinks. It highlights that while the fructose molecule is the same, the difference lies in the dose and absorption. Whole fruits, like bananas and apples, provide fructose in smaller, more manageable doses compared to the concentrated amounts found in soft drinks. The chapter uses examples like an orange and orange juice to illustrate these differences.
• 107:00 - 110:00: Conclusion - Dessert Consumption Recommendations The chapter discusses the calorie and fructose content in orange juice versus an actual orange. It states that an eight-ounce glass of standard size orange juice contains approximately 120 calories with 60 calories coming from fructose. In comparison, an orange has 40 calories, 20 of which are from fructose, thereby showing that a glass of orange juice has three times the fructose content of an orange.

The BITTER TRUTH About Sugar & How It Causes DISEASE! | Dr. Robert Lustig Transcription

• 00:00 - 00:30 type 2 diabetes hypertension dyslipidemia cardiovascular disease cancer dementia fatty liver disease polycystic ovarian disease all because of fatty liver all because of de novo lipogenesis all because of excessive fructose consumption with a liver that couldn't handle it well i'm excited to have you on the podcast because i've been familiar with your work for some time now you're an og in the space you've got this incredible background in pediatric endocrinology but let's make the focus of this next
• 00:30 - 01:00 hour of the show sugar because this is a topic that you talk a lot about the potential health consequences with consuming too much of it what are in your eyes the primary harms to come with the over consumption of sugar so the first question is what is sugar because you sort of can't go forward until you're in agreement on what it means and i will tell you not everybody has the same definition so let me describe what i'm
• 01:00 - 01:30 eating when i use the word sugar i am talking dietary sugar i'm talking about sugar in the diet i am talking about sucrose table sugar cane sugar beet sugar the stuff you put in your coffee the crystals i'm talking about high fructose corn syrup i am talking about maple syrup honey and agave those five compounds i am not talking about blood sugar blood
• 01:30 - 02:00 sugar is blood glucose that's different dietary sugar is a combination of glucose and fructose basically a one-to-one combination glucose for lack of a better word is the energy of life every cell on the planet burns glucose for energy glucose is so important that if you don't consume it your body makes it the inuit had no place to grow a carbohydrate they had no glucose in their diet
• 02:00 - 02:30 they still had a serum glucose level the reason is because their livers would take the whale blubber and turn the lipids via glycerol into glucose a process called gluconeogenesis or the amino acids into glucose also gluconeogenesis so glucose is essential but consuming glucose is not essential
• 02:30 - 03:00 that's a big difference a very important distinction because the brain has a minimum requirement of sugar correct absolutely the brain requires glucose unless it has another energy source which is even easier to use and those are called ketones which is one of the reasons why the ketogenic diet works one of the reasons the ketogenic diet was developed in the first place because patients with seizures who
• 03:00 - 03:30 whose brains couldn't utilize glucose properly and that's why they were seizing the seizures would stop when they would get ketones instead so yes the brain needs glucose but the brain actually functions even better on ketones so it's not a it's not an absolute requirement it is an absolute requirement for energy but the energy can come in two different formats
• 03:30 - 04:00 got it now when you say that sugar is dietary sugar is non-essential does that mean that the optimal amount of glucose that we ingest is zero so the amount of dietary glucose that we ingest can be anywhere from zero up to several hundred grams depending on what kind of diet you're on whether you're on a carnivore diet
• 04:00 - 04:30 whether you're on a vegan diet ultimately that's not what's causing disease that's the key that glucose that dietary glucose is not the big problem it is the other molecule in sugar which is called fructose now fructose is completely different from that of glucose the food industry will tell you calories of calories sugars are sugar they this is their mantra it's how they
• 04:30 - 05:00 get away with poisoning our food to be honest with you is by you know stating this patently false dictum which is eminently disprovable in any laboratory or in any court of law but they keep saying it because it's the only thing they can hide behind is the idea that what does it matter because if a calorie is a calorie you know where what does it matter where you get your calories from the problems obesity the problems you know you eat
• 05:00 - 05:30 too much exercise too little therefore sugar can be part of a balanced diet you know diet and exercise you know you are what you eat if you're fat it's your fault you know don't pick on our calories go pick on somebody else's calories all that comes from the notion that calories are fungible and sugars are fungible so fructose is not glucose glucose is a six-membered ring fructose is a five-membered ring
• 05:30 - 06:00 they are not the same they don't even look the same on paper and it turns out that the liver metabolizes fructose completely differently from that of glucose when glucose gets into the liver the liver turns it into glycogen liver starch this is what your liver wants to do with excess energy is you know store it as liver starch this is why marathoners carb load before a race eating all that pasta okay because
• 06:00 - 06:30 that pasta is just polymerized glucose however fructose does not go to glycogen fructose is not regulated by insulin fructose doesn't generate a leptin response in adipose tissue cells fructose does not suppress ghrelin the hunger hormone okay and fructose when it is uh metabolized by the liver instead of going to glycogen
• 06:30 - 07:00 it goes to fat gets converted to fat the mitochondria of your liver cells the energy burning factories inside your liver cells can't handle the onslaught of a 20 20-ounce coke it can't deal with the energy that's being provided and so it has a pop-off valve and it turns on the substrate called acetyl-coa one
• 07:00 - 07:30 of the metabolic byproducts of fructose glucose too but fructose and then we'll divert it instead of to energy production in the mitochondria it will divert it to fat formation this is a process called de novo lipogenesis new fat making it's how your liver turns sugar to fat and that fat then raises triglyceride levels in your bloodstream
• 07:30 - 08:00 and it will also raise triglyceride levels in your liver and if the triglyceride doesn't make it out if it doesn't get exported now the triglyceride precipitates in the liver now you have a lipid droplet in a cell that's not supposed to have a lipid droplet now you have fatty liver disease and that fat in the liver gunks up how normal insulin signaling occurs now you have insulin resistance
• 08:00 - 08:30 and that high insulin level is what causes all the chronic metabolic diseases that we know of today type 2 diabetes hypertension dyslipidemia cardiovascular disease cancer dementia fatty liver disease polycystic ovarian disease all because of fatty liver all because of de novo lipogenesis all because of excessive fructose consumption with a liver that couldn't handle it now can you that's only one
• 08:30 - 09:00 we've got two more to go two more is it is it important to draw the distinction between the fructose found in whole fruit for example a banana or an apple right versus the fructose found in a soft drink right so the molecule is the same there's no difference in the molecule the question is the dose and the absorption that's the question so here's an orange here's orange juice
• 09:00 - 09:30 okay an eight ounce glass of orange juice standard size glass of orange juice okay has about 120 calories and half of that is fructose 60 calories of fructose an orange has 40 calories 20 of which are fructose so the glass of orange juice has three times the fructose content
• 09:30 - 10:00 of the orange now my colleague and cookbook co-author cindy gershon who's a nutrition educator in the east bay in the mount diablo high school every year she starts her class her nutrition class with the same experiment she takes two kids from the class and these are poor kids with you know who pro haven't eaten breakfast you know they're all food insecure and they're all 300 pounds or worse
• 10:00 - 10:30 she starts the class with the sa the exact same experiment she takes two kids first kid she says here kid here's six oranges make juice kid squeezes the six oranges gets 12 and a half ounces of you know juice downs the whole thing says okay what's for breakfast second kid cindy says here kid here's six oranges eat the six oranges
• 10:30 - 11:00 kid eats orange number one orange number two orange number three gets to orange number four and throws up every single time on orange number four like clockwork she has the vomit basin ready because she knows it's coming right and the kid goes i'm gonna die
• 11:00 - 11:30 and then the kid doesn't eat lunch or dinner either what happened the fiber happened the orange had fiber the orange juice didn't the fiber reduced the ability of the human to be able to consume that enormous load of fructose it was self-limiting that's number one number two
• 11:30 - 12:00 the fiber soluble and insoluble and you need both and an orange has both soluble is pectins and inulin like what holds jelly together like orange marmalade okay and the other is insoluble fiber you know cellulose like the stringy stuff and celery and orange has both okay the insoluble fiber forms a latticework on the inside of the intestine like a fish net with holes the soluble fiber the pectins and the
• 12:00 - 12:30 inulin they plug the holes in the fish net and so together with the geometry they form an impenetrable barrier which reduces the fructose absorption from the gut into the bloodstream so even though you consumed it even though it passed your lips you actually didn't get it it stayed in your intestine went further down the intestine your liver was protected you didn't end up having to turn that energy into fat at the nova lipogenesis because
• 12:30 - 13:00 you didn't absorb it it goes further down the intestine and what's in the rest of the intestine that's not in the duodenum the microbiome the bacteria so each of us has 10 trillion cells in our body but we have 100 trillion bacteria in our intestine each of us is just a big bag of bacteria with legs okay those bacteria have to eat something what do they eat well they eat what you eat the question is how much did you give us how much did they get when you consumed that orange with its fiber
• 13:00 - 13:30 that sugar that glucose fructose wasn't for you it was for your bacteria went further down and the bacteria chewed it up for its own purposes so even though it passed your lips it didn't register on your body as calories because the bacteria chewed it up instead so fruit good because fruit has fiber juice
• 13:30 - 14:00 not good because the fiber has been thrown in the garbage so molecule the same vehicle not the same mechanism not the same metabolism not the same fascinating is there is there something is so is fructose uniquely uh fattening to the liver there are four things that we put in our mouth
• 14:00 - 14:30 and that do the same thing as fructose four total so fructose is one alcohol is two [Music] because fructose and alcohol are metabolized virtually identically that's why children now get fatty liver disease when they never did before and they don't drink alcohol because the liver handles alcohol virtually identically the way it does fructose wow branched chain amino acids
• 14:30 - 15:00 leucine isoleucine valine these are three essential amino acids you must consume your body can't make them you have to you know ingest them right they are 20 of muscle those three so they're very very concentrated in muscle and if you are building muscle you need them this is why bodybuilders consume protein powder in their smoothie shakes is to up their branch chain amino acid consumption in order to be able to build
• 15:00 - 15:30 muscle and if you don't consume them you can't make the muscle all right so they're essential it's not like they're bad i mean they're good okay except when you consume too many of them so what if you're not building muscle what if you're a mere mortal like me okay and you consume excess branched chain amino acids they go to the liver they have no place else to go because you're not building muscle they go to the liver the liver takes the amino
• 15:30 - 16:00 group off the amino acid now you have a branched chain organic acid and then that brainstein organic acid will enter the krebs cycle in the mitochondria overwhelm the mitochondria just like the fructose did and then the cell will turn the excess into liver fat just like it did the fructose so excess branched chain amino acids which are by the way high in corn fed animal products beef chicken fish
• 16:00 - 16:30 okay so processed meat all right are high in branched chain amino acids they will lead to liver fat also and finally number four trans fats trans fats will lead to liver fat as well but we know that trans fats are bad and they're coming out of the diet now right right took 25 years for the fda to finally agree that trans fats were bad but they finally did and so
• 16:30 - 17:00 trans fats won't be a problem going forward but there have been a problem in the past so four foodstuffs four count up four that all lead to liver fat fructose alcohol branched cinnamon acids trans fats sounds like processed food to me well but branched chain amino i mean branched chain amino acids are found in whole protein right i mean a a chicken breast is is rich in branched chambers absolutely isn't this a bit like
• 17:00 - 17:30 comparing apples to oranges no pun intended in the sense that protein is generally considered a good thing it's good for satiating our appetite it's good for preserving and growing lean mass sure but there are amino acids that are in very low quantity and high demand like for instance tryptophan tryptophan is the rarest amino acid in our diet and we need lots of tryptophan because tryptophan is the precursor
• 17:30 - 18:00 to serotonin and serotonin is necessary for normal gut functioning and normal brain functioning and your liver has a detoxification pathway that will actually take tryptophan that you've consumed and diverted away from serotonin and you have to get the tryptophan into the brain which is a whole another level of complexity because of the aromatic amino acid transporter and competition
• 18:00 - 18:30 so getting tryptophane into your brain is absolutely job one and it ain't easy to do and it's the rarest amino acid in your diet so you want to be consuming high tryptophan foods so what are those eggs poultry fish okay not too much in beef surprisingly okay so you know not exactly the same
• 18:30 - 19:00 methionine methionine is the next most essential amino acid methionine is necessary to re-make glutathione which is the liver antioxidant to keep your liver from frying okay and methionine is also necessary to make structural proteins because it has sulfhydryl groups it's it's its own antioxidant all right so this is good and you know we don't get enough methionine
• 19:00 - 19:30 in fact the best way the the the animal that has the fastest route to fatty liver is the methionine choline deficient rat the choline 2 which is also in red meat so it's true that yes branch chain amino acids are in protein but you know all proteins are not alike there are some that are you know shall we say stocked in essential amino acids that are rare and
• 19:30 - 20:00 therefore better for you than others interesting you touched on the relationship between choline and fatty liver choline is actually can be used as a as a treatment of sorts for fats can it not so choline is a component of phosphatidylcholine and phosphatidylcholine is necessary to make the package that the liver uses to export fat out called
• 20:00 - 20:30 apob 100 so basically the way it works is your liver makes the fat that process i talked about de novo lipogenesis then it packages that fat into a molecule a a particle that called vldl very low density lipoprotein so it pitches that fat onto a phosphatidylcholine so you need the choline to make the phosphatidylcholine and you have to consume the choline your
• 20:30 - 21:00 body doesn't make choline in fact choline had used to be called vitamin b4 once once upon a time okay they don't call it that anymore but it's still you know essential and you still need it and then you can and then you can export it out we've actually shown that kids with fatty liver not only do they have fat in their liver but they have less choline wow where do you where do you find choline in the diet red meat wait so this is conflicting information
• 21:00 - 21:30 because on the one hand you're saying avoid red meat because it it doesn't have it it's it doesn't it mostly is branched chain amino acids it doesn't have the the rarer amino acid it's not as concentrated in the rarer amino acids like tryptophan but on the other hand red meat is a great choline source so what i said was corn fed beef chicken and fish that was the key there is this thing called grass-fed beef chicken beef and chicken and fish too for that matter so
• 21:30 - 22:00 um uh you know there's the way the u.s grows beef and then there's the way argentina or italy grows or new zealand grows beef okay in america cattle are raised on cafos concentrated animal feeding operations okay and basically you know all the cattle you know um you know ten thousand head of cattle in one spot okay no no grass
• 22:00 - 22:30 okay they get corn to eat in their feeding troughs they also don't get to exercise and there's no free ranging because there ain't no ground for them to free range on and they you know poop right where they eat you know which is always a bad idea all right um that's uh how americans fatten up their cattle in the mendoza valley in argentina they're eating grass in italy they're eating grass and when
• 22:30 - 23:00 you look at the meat it's completely different you can actually see the difference and in my book metabolical i actually have a picture of a rome restaurant window with you know argentinian beef italian beef and then usa prime grade you know a you know choice of corn fed beef and what you can see is the marbling in the beef well that marbling is fat that's intra-myocellular lipid that was lipid that was laid down in the muscle by that
• 23:00 - 23:30 animal because it couldn't export it wow and so it precipitated the muscle that animal has metabolic syndrome so we in america make our meat to be sickening i mean it is because the animals are sick in argentina and italy they don't do that so the red meat in america is very different from the red meat in the rest of the world so actually it's not a contradiction in
• 23:30 - 24:00 terms yes you need choline i agree but what you really need is low branch chain amino acid beef that's called grass-fed beef i i preferentially reach for a grass-fed beef um it's it's leaner in general it's got the fatty acid profile is is different um is there is there an effect of saturated fat on on the predisposition to developing fatty liver
• 24:00 - 24:30 so for decades we were told saturated fat is bad and i know why that happened it was wrong okay it was a mistake and then um shall we say the food industry got involved and made it even worse and they propagandized it so this is a whole story in and of itself what happened to saturated fat and what
• 24:30 - 25:00 its role in disease is in 1955 president eisenhower had a heart attack and everybody was wondering why heart disease in america continued to increase in upward spiral in the early 1900s heart attacks were almost unheard of by 1955 they were by far and away the leading cause of death okay they had a rate of increase even
• 25:00 - 25:30 faster than diabetes today and everybody wanted to know why well two camps came up during the 50s the first camp was led by a british physiologist nutritionist physician by the name of john yudkin john yudkin [Music] had correlative data that said that sugar consumption was the root cause of heart disease and the root cause of gout and the root
• 25:30 - 26:00 cause of diabetes and the root cause of several other chronic diseases at the same time a minnesota epidemiologist by the name of ansel keyes came up with the notion that saturated fat was the bad guy and that saturated fat was the cause of heart disease didn't even talk about diabetes just talk about heart disease now keys had spent he was by the way keys was the
• 26:00 - 26:30 inventor of the k ration during world war ii 12 000 calories in a little tin box that you know soldiers could carry on into battle you know and live on if they had to you know if they got caught behind enemy lines so he was kind of famous already right so people listened to him you know they he knew something about nutrition 1952 keys did a sabbatical at um uh in london and then he went to pop italy what he
• 26:30 - 27:00 saw in london was a lot of people dying of heart disease and he saw that they were eating fish and chips so he thought saturated fat was bad then he went to peop italy which is the home of the mediterranean diet and he saw that people were not eating you know foods fried in oil like fish and chips and you know we're eating relatively
• 27:00 - 27:30 little meat because there's not that much meat in the mediterranean diet okay there was more fish and there was more vegetables and so between the two he was convinced that saturated fat was the bad guy and he was going to set out to prove it so he did a study called the seven countries study and the seven countries study was published initially in 1971 and then there was a bigger you know book
• 27:30 - 28:00 of it in 1980 the bottom line was a seven country study wasn't the seven country study it was really the 22 country study when you actually put the 22 countries study on the graph of heart disease death against saturated fat there was virtually no correlation interesting so he cherry-picked these seven countries he picked the seven countries to make it look like there was an association wow
• 28:00 - 28:30 now these two guys keys and yudkin duked it out over the course of the 60s and 70s ultimately keys won and yudkin was thrown under the bus now why did keys win three things happened in the 1970s that you know where keys emerged the victor and yet can you know was relegated to the dustbin history
• 28:30 - 29:00 three things first brown and goldstein scientists at ut southwestern dallas discovered this molecule called ldl and they discovered the molecule the the receptor for it called the ldl receptor and they showed that children with a disorder called familial hypercholesterolemia where they had cholesterol levels up in the hundreds you know 300 400 500 these kids died at age 18 of heart attacks
• 29:00 - 29:30 so they were convinced ldl was a bad guy and i'm not here to tell you ldl is a good guy but you know they were sure ldl was the bad guy for this reason later on other doctors other scientists showed that ldl goes up when you eat dietary fat and then finally epidemiologic studies in the late 70s showed that ldl levels in large
• 29:30 - 30:00 populations correlated with risk for heart disease so if dietary fats a and ldl is b and heart disease is c what we learned was well a leads to b b correlates with c so a must lead to c therefore no a no c get rid of the dietary fat lower your ldl levels and heart disease will go away
• 30:00 - 30:30 and key is one and ginga thrown under the bus and that was the last anybody heard of john yetkin they even took his office away at university of london wow okay he was completely discredited and truly relegated to the dustbin history and died in ignominy in 1995. how ridiculous now as it turns out as it turns out a does lead to b and i
• 30:30 - 31:00 don't argue that you know i mean dietary fat raises your ldl i don't i don't disagree with that and you know what ldl levels do correlate with heart disease but at a hazard risk ratio of 1.3 which is not very tight that's not a robust effect to say the least in fact the public health community says it has to be 1.3 or greater for us to even be worried about it and it came in at 1.3 doesn't it doesn't it i thought it had to be uh two or over it has to be at
• 31:00 - 31:30 least doubling no well if you're going to do tobacco that has to be toro 1.3 is something public health officials say you know becomes a public health concern 1.3 bottom line you know we have since learned that that legit the logistics of that argument were just completely wrong yes a can lead to b can also lead to d e f g h and i never come back to c and we
• 31:30 - 32:00 also learned that the contrapositive of an argument is not no a no c it's no c no a so it didn't even make sense on logistical grounds and then we learned about a different molecule a different particle we learned about triglycerides and triglycerides it turns out have a hazard risk ratio for heart disease of 1.8
• 32:00 - 32:30 much higher than 1.3 got it and triglycerides are fat in the blood fat they're fat in the blood and where do they come from they come from the liver and what makes them i just told you sugar so it turned out that this whole dietary saturated fat story was wrong it was wrong at several levels but you know
• 32:30 - 33:00 that's what happens when you do science badly the problem is millions of people died in the process of figuring it out so saturated fat is complicated first of all there are two saturated fats there's not one there's red meat saturated fat and there's dairy saturated fat now every study under the sun combines the two together like they're the same they're not
• 33:00 - 33:30 red meat saturated fat or even chain fatty acids dairy saturated fat are odd chain fatty acids with a specific phospholipid signature that is completely different from the red meat and it turns out that red meat saturated fat is neutral cardiovascularly neutral for heart disease and diabetes but dairy saturated fat is actually protective fascinating
• 33:30 - 34:00 protective all right but we said dairy saturated fat was bad because it was saturated fat so we got rid of the fat we made skim milk right but the skim milk tasted like dish water so what did we do we had to make the milk palatable for children we added the chocolate or the strawberry so we took something out that was protective and added something that was dangerous duh okay and then on top of that what did we do with the saturated fat after we skimmed it off the milk
• 34:00 - 34:30 we made cheese and the kids are still eating the cheese okay so the the dairy industry was delighted because they got two uh products out of one they got to charge double well they charge for the milk they charge for the cheese so is she is cheese is she's uh cardiovascularly beneficial no
• 34:30 - 35:00 [Music] it's basically you know i mean it's it's basically uh it's very fat it's yeah but it's a wash it's a wash there's other there's other crap in it it's a wash it's not it's not any better it's not any worse got it if it's processed if it's a processed cheese there are some cheeses that are that are very commonly consumed in the medi in the mediterranean of course absolutely absolutely you know french cheeses you know fantastic okay but you know we're talking about u.s government shoes here okay that government cheese well because
• 35:00 - 35:30 because it's here in america because you know that's the way we do it they don't do that over in uh france and italy they only do that here all right so it's not quite the same so the bottom line is we got nutrition all wrong now you know looking at the history of it i understand how we got nutrition overall but you know there were industries putting their thumb on the scale and we actually have the data to show how the sugar industry influenced
• 35:30 - 36:00 dietary policy throughout the 60s and 70s they actually commissioned the head of the department of nutrition at the harvard school of public health and his assistants to produce two review articles in the new england journal in 1967 that exonerated sugar and fingered saturated fat as the bad guy and the sugar research foundation didn't even disclose that they were in charge of it horrible yeah i remember i remember when that was revealed
• 36:00 - 36:30 right say the the new york times the whole thing's been a put up job but we basically have to relearn this concept of metabolic health and you'll notice i used the term metabolic health i did not use the word nutrition i'm trying to wipe the word nutrition off the face of the earth why is that i'm trying to wipe two words off the face of the earth okay i am the calorie killer
• 36:30 - 37:00 and i'm going to be the nutrition killer even though my diploma says nutrition and food science okay it's wrong so let's talk about the difference between those three terms food science is what happens to food between the ground and the mouth nutrition is what happens to food between the mouth and the cell metabolic health is what happens inside the cell but it turns out all of the chronic
• 37:00 - 37:30 diseases that we're we've been talking about all happen inside the cell so metabolic health should be our north star and that's science that's not nutrition because nutrition is math it's adding up a bunch of columns of you know this this nutrient or that nutrient then yes it meets rda requirements or you know whatever garbage total complete bs that's what went wrong this notion that
• 37:30 - 38:00 you could actually add up columns of figures and figure out what was going on this is very reductionist well metabolic health can be reductionist too so i don't wanna i don't wanna you know i'm a reductionist okay i'm a reductionist with some it's a little bit different all right and that's the point is that metabolic health is really what the where the action is and you need to understand the biochemical mechanisms you need to understand what the cells are doing you
• 38:00 - 38:30 need to understand the subcellular pathologies that are going wrong in chronic metabolic disease in order to be able to reverse it now people think type 2 diabetes hypertension dyslipidemia cardiovascular disease cancer dementia fatty liver disease car polycystic ovarian disease they think those are diseases wrong they are symptoms of disease
• 38:30 - 39:00 they're what we see outwardly but they are symptoms of disease the high ldl that's the symptom of a problem the high blood pressure that's a symptom of the problem it's not the problem itself it's a symptom of the problem okay and when you give medicines for these you're treating the symptom you're not treating the problem it's like giving an aspirin to a patient with a brain tumor because they have a headache i'd help the headache
• 39:00 - 39:30 won't do a damn thing for the brain tumor brain tumor's still there still going to kill you and that's the point all of these statins and oral hypoglycemic agents and antihypertensives et cetera et cetera okay they're treating the symptom of the disease not the disease makes the doctor feel like he's doing something but to be honest with you you're doing nothing and i know because i'm a doctor so what about calories i mean i'm i'm a
• 39:30 - 40:00 big stickler for food quality and um you know and i personally don't count or track my calories but some would argue that calorie counting is a tool that can that can allow you to eat whatever it is ultimately that you want and still cheat achieve uh improved health garbage total trash again and it's for the same reasons let me i'll give you five reasons the calories are garbage
• 40:00 - 40:30 all right ready one you like almonds love them good i do too 160 calories in almonds okay you eat 160 calories in almonds how many of those calories do you absorb i'm guessing not 100 well like what percent uh hmm that's 70 no that's about right you eat 160 calories you absorb 130 wow
• 40:30 - 41:00 where'd the other 30 go and you poop them out no oh they feed the gut bacteria they feed the gut bacteria right because the soluble and insoluble fibers in the almonds form that gel i talked about before you're feeding your microbiome so even though it passed your lips even though it registered as a calorie eat on your balance sheet you didn't get it your bacteria did and it's a good thing your bacteria did
• 41:00 - 41:30 because you've got to feed your bacteria or your bacteria will feed on you it will actually strip the mucin layer right off your intestinal epithelial cells denuding them and now you've got bacterial apposition on top of your intestinal epithelial cells secreting cytokines and lipopolysaccharides causing those cells to shrivel up and exposing the uh spaces in between the intestinal epithelial cells that are normally blockaded by these proteins called tight junctions but now
• 41:30 - 42:00 you've got big wide spaces and now you know junk in your intestinal lumen you know the the bacteria i mean your poop basically will be able to traverse from the intestinal lumen into your bloodstream because of this phenomenon called leaky gut wow now you're off to the races because it goes straight to your liver and causes liver inflammation which causes insulin resistance which causes hyperinsulinemia which causes chronic metabolic disease and it had nothing to do with your calories
• 42:00 - 42:30 fair problem number one problem number two protein so we were just talking about amino acids and how they get metabolized right we said that for instance branch chain amino acids when they get metabolized for energy right because they're not building muscle if i mean if they're building muscle great but if they're not building muscle they have to be metabolized for energy and so the liver will take the amino
• 42:30 - 43:00 group off right now they become a branched chain organic acid we just talked about this you know half an hour ago all right that process of deamidating that amino acid costs energy you have to invest energy for that process to occur you have to lose two atps adenosine triphosphates you lose two now when you phosphorylate a carbohydrate to get it ready for
• 43:00 - 43:30 metabolism you only lose one atp so you actually lose double the amount of energy preparing an amino acid for metabolism as you do a carbohydrate for metabolism even though you get the same number of atp out the other end so protein metabolism is actually more inefficient you end up with fewer atp at the end even though you started with the same number of calories
• 43:30 - 44:00 so a calorie is not a calorie because if it was a protein you're not going to have as many atp therefore you're not going to have as much energy therefore you're not going to be able to lay down as much fat and that inefficiency is a net benefit for us because we end up i mean that's one of the reasons why you know you eat protein you end up getting a bit of a caloric free ride absolutely and protein is more satiating so calories not a calorie number three over here we have omega-3
• 44:00 - 44:30 fatty acids anti-inflammatory anti-alzheimer's save your life single best thing you can put in your body bar none over here we have trans fats the devil incarnate consumable poison okay seriously you know i mean like the worst thing you can put in your body okay best thing worst thing they're both nine calories per gram because a calorie is not a calorie because they have other functions
• 44:30 - 45:00 other than being calories and finally fructose and glucose and glucose as i said is the energy of life and fructose is completely vestigial and causes liver fat and insulin resistance so you really want to tell me that worrying about calories is where you want to go no worrying about metabolic health is where you want to go and it has nothing to do with calories another example alcohol alcohols seven calories per gram okay
• 45:00 - 45:30 fat is nine calories per gram so if calories are important then you would say that drinking alcohol is better than eating fat is it definitely not ethanol so so excuse my french but f the calorie i love it is is sugar uniquely fattening so when we talk about fattening you are
• 45:30 - 46:00 talking about obesity right obesity there are three fat depots in your body three the first one is called subcutaneous fat or big butt fat or does this bathing suit make me look fat fat never answer that question all right that's the fat you can see fructose is not uniquely
• 46:00 - 46:30 [Music] responsible for subcutaneous fat that can be from glucose that can be from fatty acids that can be from protein that can be from virtually anything that has a calorie okay subcutaneous fat is all about how high does your insulin go okay and different foods can make that happen fructose being only one of them
• 46:30 - 47:00 there's a second fat depot it's called visceral fat or big belly fat it turns out big belly fat is much more metabolically dangerous than the subcutaneous or big butt fat you know the whole apples pears thing the apples you know with the big belly you know that's much more metabolically worrisome why is that because the fat that comes that that gets stored in the viscera in in the omentum in the in the belly
• 47:00 - 47:30 when it gets broken down it goes straight to the liver through the portal vein when the subcutaneous fat breaks down it goes into the systemic circulation so the liver doesn't see the onslaught wow okay it's called the portal system and there are two portal systems in the body this is one of them right insulin also goes straight to the liver via the portal system it does not go into the systemic circulation because the liver is the primary target
• 47:30 - 48:00 it's the primary target of the visceral fat it's the primary target of insulin action it's the primary detoxification organ the liver is where it's all at and so the goal is to keep the liver healthy protect the liver that's the goal okay and that's where fructose falls down because it's basically hurting the liver directly right and then finally the liver fat is the third one and that's what we just talked about so fructose is uniquely dangerous to for liver fat which is the worst fat the
• 48:00 - 48:30 most dangerous fat how many kilos of subcutaneous fat do you have to gain before you start getting sick about 10 22 pounds how many kilos of visceral fat do you have to gain before you start getting sick about two to three kilos about you know five to seven pounds how many kilos of liver fat do you have
• 48:30 - 49:00 to gain before you start getting sick a half a kilo wow so liver fat is way worse than the other two and fructose is uniquely positioned to cause liver fat formation which is why now 45 of all americans have it is there sort of a like a a schedule of where we tend to accumulate fat when on a hyper-energetic
• 49:00 - 49:30 diet i mean do we do it does our subcutaneous fat silos do those fill up first and then we get the visceral fat and then we get the liver fat right is it sort of an order of operations normally that would be the case but it depends on the patient that's one of the things that distinguishes for instance african americans who can store way more subcutaneous fat from say asians who can store way little subcutaneous fat that's why african americans can become
• 49:30 - 50:00 you know basically get to a bmi of about 35 before they start getting sick whereas uh uh asian pacific islanders you know start getting sicker around a bmi of 25. so they want so certain genetic certain populations with certain genetic backgrounds can look lean and be sick wow that's right and it's called tofi tofi thin on the outside fat on the inside real medical term 1500 medline citations wow so that's the key to this whole thing is
• 50:00 - 50:30 it's not the fat you can see it's the fat you can't see and particularly the fat in the liver that you can't see that matters in terms of metabolic health but like i said all the things we've been talking about so far that's only one problem we've got two more to go so the second problem is the aging reaction known as the mayard reaction or the browning reaction it's the reason you paste pink barbecue
• 50:30 - 51:00 sauce on your ribs before you put them on the grill to get that nice caramel browning color well turns out we're all browning all the time okay browning is fact of life okay the only way not to be browning is to be dead but the browning reaction is the aging reaction the faster it runs the quicker you die and it turns out that glucose causes that browning reaction any carbohydrate will cause the browning reaction but fructose does it seven times faster
• 51:00 - 51:30 wow and every time that browning reaction occurs you've released a reactive oxygen species a little hydrogen peroxide an oxygen radical which can damage other cells and so fructose is uniquely lypogenic and it's also um uh uh makes more oxygen radicals and you know engages in this mild reaction more
• 51:30 - 52:00 this is basically aging pro this is pro-aging absolutely so basically sugar is the cause of wrinkles sugars that cause a cataracts okay that's all glycation and oxidative stress just what we described and then third [Music] fructose is addictive and glucose is not interesting so the area of the brain that contr that that controls reward known as the nucleus accumbens it's like right over here right over here okay it lights up with
• 52:00 - 52:30 fructose when you consume glucose it doesn't light up when you consume fat it doesn't light up when you consume protein it doesn't light up it only lights up with fructose and caffeine those two are addictive we know caffeine's addictive that's that's old news okay but fructose does it too so
• 52:30 - 53:00 cocaine alcohol nicotine heroin sugar [Music] and of course you know shopping gambling internet gaming social media pornography there are a lot of ways to reward yourself there's a lot of things that will stimulate the reward center but in the extreme every single one of the things i just mentioned every one of those 10 has an aholic after it shopaholic
• 53:00 - 53:30 sexaholic alcoholic chocoholic you name it okay the bottom line is anything that stimulates the reward center in the extreme is addictive and fructose stimulates the reward center and about 20 of americans are sugar addicted wow how come we don't see people on the like in the in the you know shadows of the of the street mainlining fructose oh easy because it's everywhere
• 53:30 - 54:00 if cocaine were everywhere you wouldn't see them on the street either it's just so easy to get these days absolutely it's the it's the cheap pleasure that everyone can afford and your grandmother's a pusher okay so what are the what are the kinds of things that we should be avoiding then you mentioned i mean soft drinks obviously but yeah um surely soft drinks can't be the the salt juice fruit juice fruit juice yeah eat the fruit don't drink the juice feed your bacteria
• 54:00 - 54:30 don't feed you all right so that's uh so that's easy okay then of course there's candy cakes ice cream you know that's you know old news also you know people say to me all the time oh you know you do you ever eat dessert you know so i'm here right now max to tell you and your audience i am for dessert we love that for dessert i am not for dessert for
• 54:30 - 55:00 breakfast lunch snacks and dinner and right now in america breakfast is dessert amen so true okay a bowl of fruit loops and a glass of orange juice that is the national school breakfast program breakfast 29 of children in america eat a bowl of fruit loops and a glass of orange juice every single morning that is 41 grams of sugar
• 55:00 - 55:30 the american heart association says that for children the upper limit should be 12 grams 12 grams for the whole day wow they're eating almost four times as much and it's just breakfast yikes so is it any wonder the kids are doing so badly in school is it any wonder that kids are massively obese and have fatty liver disease they're getting poisoned at school
• 55:30 - 56:00 yeah adults too and then and then and they wonder why but i mean this is something that you you're a pediatrician by by trade i mean you must you must see some really heartbreaking um cases in your in your clinic absolutely and that's you know that's what drives me you know because i ain't doing it for the money that's for sure you know i'm i'm for social justice i am for every kid
• 56:00 - 56:30 having an equal shot and they don't [Music] yeah it's it's very sad are you um i i feel like you are the person who popularized the list of all the different names that sugar goes by well yeah so i wrote a an ebook which is still available called sugar has 56 names a shopper's guide well guess what we've actually found 262 names wow
• 56:30 - 57:00 and if you go on my website it will send you to a link to the hypoglycemia support foundation where all 262 are listed crazy so you know and the food industry uses all of them on purpose because you know you have to list by mass so you can put several different kinds of sugar as number five number six number seven number eight number nine on the list okay when you add them up it's number one it's a way of hiding it in plain sight
• 57:00 - 57:30 are you a fan of uh of non-nutritive sweeteners artificial sweeteners right so until about three years ago people would always ask me that and i would say i don't know because we don't have the data but we actually do have the data now here's the story i'll give you the story in one sentence the toxicity of one coca-cola equals the toxicity of two diet coca-colas half as bad not good
• 57:30 - 58:00 [Music] half as bad right okay the problem is because people say oh geico no calories i can have 10 of them well now it's five times as bad all right and so you know because they're zero calories you say well zero calories zero fructose what's to worry well still generates an insulin response number one okay and that insulin response is what
• 58:00 - 58:30 drives energy deposition and chronic disease it's that keeping the insulin down is job one and artificial sweeteners don't do it that's number one and number two turns out that several of the artificial sweeteners tested actually caused that leaky gut and that's systemic inflammation so there are no studies zero studies anywhere in the world that show that using diet sweeteners to substitute for sugar actually improve metabolic health
• 58:30 - 59:00 yeah i mean and you're an endocrinologist so i mean this is your this is definitely your your wheelhouse um fascinating i personally i don't uh consume i avoid artificial sweeteners but i do i will use stevia on occasion monk fruit some of these more quote unquote natural non-nutritive sweeteners i got it would you rather consume like for dessert for example would you would you personally rather consume something with a little bit of sugar
• 59:00 - 59:30 or something with a non-nutritive like a stevia based sweetener so what i say is dessert should be safe and rare okay if you're i'm i'm for dessert okay but like do you have to have dessert every day like have dessert once a week [Music] make it a treat make it special and make it you know dynamite make it like the best dessert okay homemade desserts where you
• 59:30 - 60:00 can control the amount of sugar tastes way better than a store-bought dessert in you know across the board all right so by all means have that dessert just don't have it every freaking day hey if you like that video you need to check out this one here and i'll see you there eating your food in the right order during a meal so veggies first proteins and fat seconds and starches and sugars last and if you eat your food in this order you can reduce the glucose spike by up to 75
• 60:00 - 60:30 and the insulin spike by up to 40 without having changed without having to change what you're eating