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Jan. 26, 2010 - Freedomain Radio - Stefan Molyneux
32:19
1565 The Politics of Obesity - The Freedomain Radio Interview with Dr. Robert H. Lustig - Freedomain Radio

An interview uncovering the political and medical causes of the current obesity crisis.

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Hello, everybody. This is Stefan Molyneux from Free Domain Radio.
I have on the line Dr. Robert Lustig, who is a professor of clinical pediatrics in the division of endocrinology, director of the weight assessment for teen and child health for the WATCH program at UCSF. Thank you so much for taking the time, Dr.
Lustig. I really do appreciate it.
And the one thing that I think is absolutely fascinating about the work that you're doing and which I hope to do my small part in gaining a wider audience for, is that you seem to have found the smoking gun that so many people are looking for with regards to the current obesity epidemic and I think that the information that you provide both on the web and the information that you sent to me is really really essential for helping people to understand just what is going on to the diet and to the health of what should be a spectacular leap forward in terms of our wealth for our health but is in fact a spectacular leap backwards Well,
first of all, I'm not the one who found the smoking gun.
People have been thinking about this and have been writing about this for years prior to my ever getting into this business.
I would have to say that this case against sugar has been building probably now for the past I would say 60 years and people have just built on top of previous work.
So I certainly cannot take credit for this.
I came at this very much through the back door.
As a neuroendocrinologist, I am interested in how the brain controls hormones and vice versa.
The phenomenon of energy balance is sort of the final frontier of this phenomenon.
In terms of being able to understand what actually happens to lead to obesity and why this phenomenon has occurred so significantly over the past 30 years.
Well, our genes have not changed, but our environment sure has.
And the question was, you know, what about our environment has changed?
Well, several things changed all at once.
One thing that changed was that we've started consuming Enormous amounts of sugar.
We, as human beings, our ancestors used to consume about 15 grams of fructose.
That's the sweet part of sugar.
Glucose and fructose make up sucrose.
That's table sugar. High fructose corn syrup is glucose and fructose, just not bound together.
High fructose corn syrup is cheaper than sucrose, but other than that, they're biochemically equivalent.
We started out eating 15 grams of fructose in 1900.
By World War II, we were up to about 20 grams because candy and sugar for your tea had entered the standard diet.
By 1977, we were up to 37 grams a day.
By 1994, we were up to 50 grams a day.
And by 2008, Adolescents were up to about 90 grams a day.
So bottom line, in 100 years we have increased our fructose consumption six-fold.
Pretty much everything else in our diet has stayed about the same.
Protein, fat.
Now we were remanded by the American Heart Association, the American Medical Association, and the U.S. Department of Agriculture back in 1982.
To reduce our consumption of dietary fat from 40% to 30%.
Well, in the last 25 years, we have done that.
We have gotten from 40% to 30%, but in absolute terms, we have not changed our dietary fat intake at all.
It's exactly the same as it was.
So our protein intake is the same, our fat intake is the same.
The one thing that has changed is our carbohydrate intake.
It has gone through the roof and the majority of that carbohydrate is sugar.
Now, why do we care?
Because sugar is not just calories.
If it were just calories, we have a system in our body called leptin.
There is a hormone that our fat cells make called leptin It goes to your brain and tells your brain you've had enough.
You've eaten enough.
You don't need to eat anymore.
You have the energy stores on board to engage in normal expensive metabolic processes.
You can feel good.
You can burn energy.
You can exercise. You're not starved and all is right with the world.
And this system, this leptin, has worked for us for a million years now.
And all of a sudden in the last 30 Stopped working because our leptins are super high and they're going higher and we keep gaining weight and despite the fact that our leptin is going up, our brain isn't seeing it.
What got me interested in this whole question is I'm very interested in what the brain sees as a neuroendocrinologist and clearly the brain wasn't seeing leptin.
Work that I did in the early part of the 2000s, from 2000 to 2005, Demonstrated that the block for leptin's effect was the hormone insulin.
And we're all putting out double the insulin we used to.
There are studies that have been shown from 1975.
If you look at the insulin response to a glucose tolerance test in normal teenagers from 30 years ago versus that same response to that same glucose tolerance today, the kids today are putting out double the insulin that they used to 30 years ago.
If I understand this rightly, that's a lot to do with the increased prevalence of high fructose corn syrup and other kinds of sucrosis.
Which is a result of dropping the fat that they've attempted to replace the flavor that was removed by dropping the fat with other things that are in many ways worse for your health.
Well, that's the obvious indirect proof, if you will, of what I'm talking about.
The question became, why did we become hyperinsulinemic?
And the answer is sugar. Because again, sugar is not just calories.
If it was just calories, Leptin would still work and it would stop us from eating more, but sugar is not.
Sugar is beyond leptin.
Sugar is beyond insulin.
Sugar is in and of itself a liver toxin.
It actually causes the liver to have problems.
In fact, the way sugar is metabolized by the liver is what this is really all about because sugar is, fructose in particular, is metabolized Like another chronic liver toxin that we're all a little bit more familiar with called ethanol,
alcohol. And I guess if there's one thing that I've contributed to this entire line of reasoning, it's demonstrating the congruence, demonstrating the similarity between what fructose does in the liver and what ethanol does in the liver.
And pretty much across the board, and it doesn't matter what aspect of liver metabolism you want to look at, pretty much everything fructose does, ethanol does too.
And we know that ethanol is a chronic dose-dependent hepatotoxin.
We keep it out of the hands of children.
We also know that the threshold for negative effects on the liver is about 50 grams of ethanol a day.
Well, it would appear based on when we got sick and when our level of fructose reached a certain critical point, it would appear that fructose has the same threshold, about 50 grams a day.
The problem is we're way above that and we have been now for the past two decades.
That's right, we're over.
I think you had cited that if you count the sugars that are in fruit drinks, fruit juice drinks, That were over 110 or was it 113 per day?
Absolutely, depending on just how many of these you drink.
Some kids are at around 150 grams of fructose a day.
It's insane. We'll come to another issue in a minute about why this is, but I just want to point out one other thing.
If you know anything about biochemistry and metabolism, and some of your Listeners may and some may not.
There are two phenomena that go on in your liver.
The first one's called glycolysis, where your substrate like glucose or fructose or galactose, which is milk sugar, gets converted down to a form that your mitochondria can then use called acetyl-CoA.
The second is the burning of that acetyl-CoA in the mitochondria, which is called the Krebs cycle.
So those are the two Different phenomena that go on in the liver.
Glycolysis, Krebs cycle.
Glycolysis, Krebs cycle.
Fructose, we have to do the glycolysis and the Krebs cycle.
Ethanol, the yeast did the glycolysis and we then have to do the Krebs cycle.
Bottom line, they both end up doing the same thing.
They both end up poisoning our mitochondria at the same dose for the same reason through the same pathway And everything that ethanol does, fructose does too.
And ethanol causes metabolic syndrome by poisoning the liver and fructose does too.
And I guess my contribution to this field is pointing this out.
Now just and I appreciate that and just so my listeners can understand and we certainly do have a fair number of med students and doctors in the listenership so I'm sure they understand but for the others, metabolic syndrome if I remember rightly in your presentations is a cluster.
of associated ailments that I think we're all familiar with but we may not see that common ingredient of fructose.
Well, there are some people who don't believe in metabolic syndrome and the reason is because not everybody gets every part of it.
So there are five things in metabolic syndrome.
There is type 2 diabetes, there is obesity, There is dyslipidemia, so, you know, lipid problems in the bloodstream, there is hypertension, and there is cardiovascular disease.
But in fact, there's way more.
There is kidney disease, there is non-alcoholic fatty liver disease, there is polycystic ovarian syndrome, and don't quote me because we don't know this for sure yet, but it's early and the data is not mature yet, but it's starting to look like it, about All of these are phenomena associated with metabolic syndrome.
Now, not everybody gets every one of these.
Different people get different versions of these in different clusters.
So, some people say, well, who cares?
You just have to treat each one separately.
But if there's a common cause for all of these, then we do care.
And the bottom line is fructose, because of its hepatic metabolism, can do every single one of those.
And that's what the paper that I sent you earlier looks at.
Perhaps you want to post that paper online for people to be able to peruse themselves.
It's an article I wrote for the bariatrician.
We've got another paper coming out shortly in Nature Reviews that will also talk about this.
Bottom line is, this stuff hurts your liver.
In addition, it does one more thing that is absolutely essential to this obesity epidemic.
And you mentioned it before. That is, we've got adolescents who are drinking seemingly gallons of the stuff.
And the question is, why are they doing that?
We at our clinic, it's just fascinating, we at our clinic take care of pretty much every racial group across the board.
We take care of Caucasians, we take care of Asians, we take care of Latinos, Pacific Islanders, and we take care of African Americans.
And they're all massively obese and they all have various components of metabolic syndrome.
And we teach them.
We sit them down and we actually do something in our clinic which we think is very revolutionary, novel, and very effective.
It's called the teaching breakfast that our dietician Andrea Garber originated.
She gets great credit for this.
And we basically feed the kids.
They come fasting so we can get their blood.
And we feed the parents and the children so that they can see what breakfast should look like.
And what we do is a high-fiber, low-fructose breakfast.
So high-fiber muffins, plain yogurt with real fruit mix-ins instead of processed yogurt, various things like that, natural peanut butter on whole grain bread, things like that.
And the parents get to see that the kids actually will eat this stuff, that they'll actually eat.
It's actually good. It actually tastes good when it's not being covered up with all the sugar.
And so the parents will actually go buy the stuff and of course the main thing we teach them is that they've got to get rid of every soft drink in the house.
So we have four messages out of our clinic and these are four messages your readership, your listenership can take away.
These are the four things that we preach in our clinic.
Number one, get rid of every sugar liquid in the house.
Number two, eat your carbohydrate with fiber because fiber is the antidote to carbohydrate.
Number three, wait 20 minutes for second portions to allow the satiety signal to occur so that you won't eat that second portion.
And number four is the hardest one.
Buy your screen time with activity.
If you're watching TV, you're walking on a treadmill.
That's a tough one because the parents, for the most part, use the TV as the babysitter.
So that one's a little harder.
But those are our four precepts.
Do you think it works? Absolutely.
Absolutely. It works. Here's who it works in.
It works in the Caucasians.
It works in the Asians.
It works in Latinos.
And it works in the Pacific Islanders.
And the reason is because their consumption of sugar-sweetened beverages goes down like a rock.
African Americans consume double the sugar-sweetened beverages at baseline as the other four groups.
And when they come back at three months, they haven't changed their consumption At all.
None. Zero. They have not altered their consumption.
Because we've clocked this.
So we ask them, why haven't you made this change?
Clearly, everyone else got the same message at the same table during the same education session.
They did it. Why were you not able to make this change?
And there's one answer. Want to guess?
I'm addicted. It's cultural.
No, I can't think of a good answer.
Because water doesn't taste good.
Well, but there are other options than water, right?
Water doesn't taste good.
It's not supposed to taste good.
It's water. This is the point.
So we turn to the parents and say, I mean, you didn't grow up drinking soda or Kool-Aid.
And then you start getting...
A sense of what's really going on.
And the fact of the matter is that these kids are addicted because when we finally do explain it, we finally do get them to recognize that their weight gain is completely and totally tied to their consumption of sugar-sweetened beverages and they try to get off.
You know what happens to them?
They get withdrawal.
They get sugar withdrawal because sugar is addicting.
And that actually is not something that I discovered.
This is something that has been worked out by numerous investigators, including Bart Hobel at Princeton University, who's done a very good job.
There are four phenomena that you have to satisfy, according to the American Psychological Association, to classify a substance as addicting.
Number one, binging.
Number two, withdrawal.
Number three, craving.
And number four, cross-sensitization with other drugs of abuse.
Sugar does them all.
Right. With the addition of course that it has a highly negative impact on your quality of life if not the length of your life itself which makes it even more dangerous.
Absolutely. So here we have a vicious cycle then set up by fructose consumption because as the fructose acts on your liver you become more insulin resistant and then that insulin resistance helps contribute to this addiction phenomenon.
Where your reward system basically can't be extinguished by your leptin signal, causing you to want and ingest more fructose, keeping the vicious cycle going.
If there's any contribution that I've made to this field, it's basically recognizing how this vicious cycle works and how fructose consumption As insidious as it is, you know, has led to this obesity epidemic.
I would mention that pretty much across the board, the various people who have logged on to the YouTube video that was made of a lecture that I gave, which your readership can certainly do as well, called Sugar the Bitter Truth, pretty much across the board, those people who came off sugar almost immediately lose weight.
I'm pretty comfortable at this point, both scientifically and experientially, with this notion that we're basically screwed by sugar.
That's a Latin phrase, if I remember rightly.
Yes, it is. That is definitely Latin.
Really can't get away from it because it's been put in everything we eat.
And the reason it's been put in everything we eat ostensibly is for palatability.
Well, yes, that's exactly right.
For palatability, because the food companies know that when they add it, we buy more.
And given the addictive properties of it, the more they add, the more we're going to buy in a way.
Exactly. They've found a legal addiction.
Right. I was really struck...
I'm sorry to interrupt. I was really struck.
I did watch Sugar the Bitter Truth and I will put a link to it in the video and highly, highly recommend it.
It's lengthy and you may have to pause and you may have to look up some other things because it's quite technical.
There will be potty breaks for sure.
Absolutely, but it's a fascinating presentation and I was really, really struck by the political implications and you said something very, very striking around the politics of food, which is Something that you don't really think about, but when you start to look into the way that this evolved in society and the degree to which this harm is underreported, to say the least, you said America exports...
There's three things that America is still the world leader in the exporting of, and the one is weapons, the second is education, and the third is food.
No, entertainment. Sorry, weapons, entertainment, and food, and I thought that was just...
They don't want our cars. They don't want our steel.
They don't want our computers. What do they want of ours?
Weapons, entertainment, and food.
Look at what happened when that downer cow crossed the Canadian-Washington border.
It stopped meat sales to Britain and South Korea for two years.
The spinach E. coli epidemic.
The bottom line is, it's essential for our government To maintain the perception that our food is safe.
What do you think would happen if all of a sudden we came around and said, you know, the fact that we've been adding fructose, either in the form of high fructose corn syrup or sucrose, to every single processed food item in the American diet, you know, it really wasn't all that good for us.
What do you think would happen? Well, I think obviously there would be huge problems.
There would be huge problems and I think economically the food producers in the US would lose the competitive advantage of this hidden goody that people aren't really aware of the dangers of.
That's right. So there's a lot of people lined up on the other side willing to take pot shots.
But you know the science is clear.
The science should drive the policy.
Unfortunately in America sometimes that's not the case.
And, you know, it's my job as a scientist and as a physician and as someone who actually gives a damn to make it very clear to the American public that if they want their health back, they're going to have to do something about it.
It's often been said that we wouldn't need health care reform if we had obesity reform, and I totally believe that.
That's very, very powerful stuff.
And again, I'm very sensitive to that I'm encroaching upon family time, so I don't want to keep this very long.
But I just wanted to thank you for making the material available for free.
I think it's a hugely, hugely important thing that you're doing.
I have certainly found that A reduction in sugar is associated with weight loss and a significant improvement in mood and concentration and it really is like taking a pair of shackles off your leg and without even knowing that you had them on to the degree to which you have mobility and dance moves and jogging is fantastic.
I certainly, you know, amateur, off-the-cuff feedback is that it certainly has worked very, very well for me, and I just really wanted to thank you for putting all of the material out there for free.
I'll certainly link to as much of it as I can, and I really do appreciate the time that you've taken to help the listeners understand this hugely important issue.
My pleasure, but I do want to make one thing clear before we go off the air.
Please do. Somebody is going to write you or write me because of this and say, well, what about fruit?
I want to head those questions off at the pass because I don't have time to answer them all by email.
Fruit is okay. It's juice that's not.
Number one, fruit has fiber and that's the main nutrient in fruit.
Forget vitamin C. Take a pill.
Fiber is the most important thing that you can get out of a piece of fruit.
Which would you rather consume?
An orange, which has 30 calories, 15 of which are fructose and loads of fiber, or a glass of orange juice, which has 120 calories, 60 of which are fructose and no fiber.
How many oranges can you eat in one sitting?
Not that many, for sure.
One. One.
Okay? Did you ever see somebody eat two oranges at a sitting?
I mean, come on. But you wouldn't think twice about two glasses of orange juice at brunch.
I mean, this is the problem.
It's not satiating and the fiber reduces the rate of sugar absorption from the gut into the bloodstream, thereby keeping your insulin down.
And if you keep the insulin down, then your leptin can work.
But if you take it as juice and it You get this huge bolus.
You get this huge rise in your glucose and fructose levels in your bloodstream, which then causes this huge insulin rise.
Basically, you're going to shunt everything that you took into fat and you're going to block leptin at the same time, causing you to consume more.
So eat your fruit.
Don't drink it.
The fruit The juice is nature's way of getting you to eat your fiber.
When God made the poison, he packaged it with the antidote.
I think that's an excellent point.
Unless you're willing to mix in a sludge-like mixture of Metamucil with your fruit juice, it's much better to go with the fruit itself.
Exogenous dietary fiber, such as Metamucil or psyllium or something else, really doesn't work.
Fiber does three things.
The first, as I mentioned, is the reduction of glucose absorption from the gut into the bloodstream, keeping your insulin down.
That's very important. The second thing it does is it prevents fat absorption in the distal ileum.
And if you don't absorb your fat in the distal ileum, then the bacteria in your colon get it and they chew it up into short-chain fatty acids.
And when you absorb those short-chain fatty acids, it suppresses insulin.
So it's actually good to keep your fats from being absorbed in your distal ileum.
The only bad thing about that is that when your colonic bacteria digest the fats, they do make some gas.
So, as far as I'm concerned in this world, we got two options: fat or fart.
In addition, the third reason why fiber works is because it increases the transit, the speed of transit of the food through the intestine to get the satiety signal which is in the distal ileum sooner.
Of those three mechanisms, the only one that added dietary fiber such as psyllium works on is the transit time.
So if you really want to get the beneficial effects of fiber, You have to eat it with the fruit, not add it separately.
Right. Okay. Okay.
Makes sense. Makes sense.
Oh, and sorry, there was one other thing that I wanted to, I just wanted you to clarify just before having this sort of sign off again, but you emphasize in the video, and I think it's very, very important for people to understand that exercise will not Reduce the calories to the point where you're going to lose weight.
I think you had a great example that one Big Mac is 10 hours of mountain biking and 20 minutes of jogging is one chocolate chip cookie.
Exercise is a great complement to any weight reduction program but it can't really be a core part of it because it simply can't chew the calories up fast enough.
That's right. Bottom line, diet is about weight.
Exercise is about health.
Diet is about pounds.
Exercise is about inches.
It's been shown by several people now that exercise has no effect on your weight or your BMI. The Cochrane reviews have shown this in a meta-analysis.
Boyd Swinburne and Eric Ravison had an abstract at the European Congress of Obesity back in 2009 demonstrating that they have shown mathematically that it's all about the diet.
It's not about the energy expenditure, this obesity epidemic.
I'm totally for exercise.
Don't get me wrong. I think exercise is essential.
It's absolutely essential, but know what it's for and it's not for losing weight.
It's for improving hepatic insulin sensitivity so that your liver won't put out all the toxins that ultimately are going to clog your arteries.
So, is exercise good for you?
Absolutely, but don't think that by exercising That it's going to change your weight.
So when you get on the scale and it doesn't make the weight go down, don't get depressed.
And do you have any sort of very brief strategies for people who are, when I sort of became more aware of this and began going through the grocery store looking for foods that did not contain some of this horrid stuff, you know, it is a little bit of a needle in a haystack.
Do you have any particular suggestions for people who are looking to eliminate as much as possible of this stuff From their diet, ways that they can approach that, which is going to be not too horrendous.
Yeah, stay off the shelves. You know, it's often been said, if you want to control your weight, just shop around the supermarket on the periphery, on the perimeter.
Don't go in the shelves, because if it's in the shelves, it means it's processed.
And if it's processed, it means they added fructose.
Period. Right.
It really is shocking when you think about...
Michael Pollan said. Sorry, go ahead. As Michael Pollan said, he just said, eat real food.
Right. Right.
It really is shocking the degree to which something like tobacco, of course, is a known carcinogen and is heavily regulated and yet this stuff seems to have deleterious health effects.
Completely outside the range of tobacco and yet it's not controlled or regulated or there's no warning labels saying this can lead to X, Y, and Z. And in fact, certain government policies seem to have really driven this, both in terms of keeping the price of sugar high through import restrictions and also this reduction of fat which resulted in all of this unregulated stuff going into the food.
I think you really have to look to your own health and not to some of the guidelines that are out there.
Well, without question. I mean, if you look at the food pyramid, I mean, you know, you can get sick just looking at it.
You know, it's very clear that we've got a problem here.
I think, personally, that what we need to do with that food pyramid is, instead of having three macronutrients, fat, protein, and carbohydrate, carbohydrate is not just carbohydrate.
I think what we need to do is we need to split them up.
And what we should have is five macronutrients.
We should have fat, protein, Starch, fiber, and sugar slash ethanol as its own group.
And then, when we do that, we'll be able to see which macronutrient actually causes the problems.
But until we do that, none of the data that comes out of the USDA is going to be worth a damn.
And I've made that very clear to the USDA. Unfortunately, they've made it very clear that they have no intention of doing so.
Well, the farm lobby is pretty powerful, and the food manufacturing lobby is pretty powerful.
I mean, we pay all those subsidies, and they're not going to want to upset the apple cart, so to speak.
That's right. It's a multi-billion dollar business, and they want to sell food.
Remember, the USDA, they have one charge, and it's to sell food.
It's not American public health.
Right, right. Well again, I really wanted to thank you for taking the time and I don't want to delve into more knowledge which is easily available through me being able to link the video but I really do appreciate the time and I know this is a very strong crusade for you and I think it's a wonderful way to be spending your time and I'm certainly happy to help try and get the word out as much as possible so thank you so much and I guess good eating and good health to you.
Same to you. All the best.
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