Join Professor Jeffrey Sachs and New York Times-bestselling author Dr. Robert Lustig for their discussion of Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine, Dr. Lustig's newest book about the interconnected strands of nutrition, health/disease, medicine, environment, and society.
Together, they discuss the relationship between nutrition and non-communicable disease, the dangers of processed foods, and the ways in which the entrenched interests of Big Food, Big Pharma, and Big Government influence our current healthcare paradigm.
The Book Club with Jeffrey Sachs is brought to you by the SDG Academy, the flagship education initiative of the UN Sustainable Development Solutions Network. Learn more and get involved at bookclubwithjeffreysachs.org.
Footnotes:
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➡️ Website: bookclubwithjeffreysachs.org
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Join Professor Jeffrey Sachs and New York Times-bestselling author Dr. Robert Lustig for their discussion of Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine, Dr. Lustig's newest book about the interconnected strands of nutrition, health/disease, medicine, environment, and society.
Together, they discuss the relationship between nutrition and non-communicable disease, the dangers of processed foods, and the ways in which the entrenched interests of Big Food, Big Pharma, and Big Government influence our current healthcare paradigm.
The Book Club with Jeffrey Sachs is brought to you by the SDG Academy, the flagship education initiative of the UN Sustainable Development Solutions Network. Learn more and get involved at bookclubwithjeffreysachs.org.
Footnotes:
⭐️ Thank you for listening!
➡️ Sign up for the newsletter: https://bit.ly/subscribeBCJS
➡️ Website: bookclubwithjeffreysachs.org
🎉 Don't forget to subscribe and share your favorite episode with your friends!
📣 Leave a rating and tell us what you thought about this episode!
Jeffrey Sachs 00:02
Hello, I'm Jeffrey Sachs. Welcome to Book Club, a monthly conversation with world-leading authors who have written scintillating, inspiring, and remarkably important books about history, social justices, and the challenges of building a decent world. Professor Robert Lustig is a world-leading scientist out to solve the massive pandemic of noncommunicable diseases (NCDs), including diabetes, dementia, cardiovascular diseases, obesity, and others. His new book, Metabolical, puts the source of these epidemics in our food system, especially highly processed foods that cause a cascade of bodily harms, starting with liver disease and spreading to other bodily systems. This session is a unique opportunity to hear from a world-leading scientist on key solutions to some of the most pressing health challenges facing humanity. Metabolical has a subtitle, "The lure and the lies of processed food, nutrition and modern medicine." It takes on a very big topic. And that's where I'd like to start, Rob. First, maybe you could explain what an endocrinologist is, so that we know what it is you do for a living, what it is, the kinds of patients you've been seeing for decades, and how that relates to your advocacy for healthy food.
Robert Lustig 01:28
First of all, Jeff, thank you so much. I got to tell you, I've been doing a lot of podcasting lately, because of the book coming out. I have had this highlighted with red around it for the last, you know, two months. So excited; I cannot tell you what a joy it is to be here. Now you want to know what an endocrinologist is. Maybe I'll explain that when you tell me what an economist is.
Jeffrey Sachs 01:54
I'm going to give you a secret, which you know, also: I'm actually married to an endocrinologist, a pediatric endocrinologist. So I think I know in 41 years of happy marriage, but I think you should let the rest of us know.
Robert Lustig 02:08
Right, and love to Sonia. So, an endocrinologist is a doctor who studies the hormones of the body. And in particular, the system that has come to the fore is obesity. In 1994, we discovered a hormone called leptin. And leptin is a hormone that goes from your fat cells to your brain and tells your brain, "You know what, I've got enough energy on board to engage in normal expensive metabolic processes. I can burn energy at a normal rate, I can feel good, I can go through puberty, I can go through pregnancy is essential for the survival of the species."
Robert Lustig 02:46
However, when leptin is not working, your brain says, "Wait a second, where's all that energy? I must be starving. Therefore, I better ratchet my energy expenditure down, I better sit on the couch. And while I'm at it, I better eat the Doritos in order to be able to actually create more leptin." So it is this phenomenon of inability to see one's leptin that has led to this obesity pandemic. As an endocrinologist, my job was to figure out what's the cause of that. And so that's how I got into this food issue and trying to understand exactly what the metabolic parameters were that surround our current obesity epidemic. And in the process, what I learned was that this noncommunicable disease pandemic of type two diabetes, hypertension, dyslipidemia, cardiovascular disease, cancer, dementia, fatty liver disease, Polycystic Ovarian disease–these eight diseases, which are going up inexorably and faster than obesity is going up–you know, what is the link? And so I have basically spent the last 25 years trying to put this all together.
Jeffrey Sachs 04:07
Rob, there's a lot of word wealth that I would like everybody to learn and to accumulate in this. So one key phrase you just used is noncommunicable disease. I think that's really important for people were living in COVID-19 pandemic; that's a communicable disease. It's a disease that spreads from one person to another. What is noncommunicable disease? And how does it relate to this story?
Robert Lustig 04:33
So noncommunicable disease are the diseases of the environment; things that don't necessarily spread through an infectious route, but through an environmental route. So, noncommunicable disease means that you don't necessarily give it to your neighbor or to your family member directly through secretions or through the air, but ultimately, you're all exposed to the same thing. So the way to think about this is basically dissecting obesity. If you look at the obese population of the United States.. so we have 240 million adults in the United States, and 30% of them are obese. So BMI over 30...
Jeffrey Sachs 05:21
BMI: explain it quickly.
Robert Lustig 05:23
BMI is weight over height squared. It's a method for being able to take people at a paucity and put it on an index that makes sense.
Jeffrey Sachs 05:31
And if in the scale, you're over 30, you're classified as obese, and over 25, typically, you're called overweight.
Robert Lustig 05:39
Correct. And if you're under 15, you're actually in big trouble in the other direction. So 15 to 25 is the normal range. We unfortunately now have a mean BMI in this country of about 27; we used to have a mean BMI in this country of about 22. So we are, you know, on average, five BMI points higher than we used to be. And there are a whole lot of people that are skewed to the right, you know, with BMIs way over 30. And we know that as BMI increases, your risk for disease increases.
Jeffrey Sachs 06:16
Since you were a pediatric endocrinologist, right, you're seeing kids coming in obese as well. So this is a an epidemic, meaning this unusual explosion of some phenomenon of this illness that was affecting young kids as well as adults.
[Audio clip] 06:33
I have talked about the statistics, we have all heard about them, but they always bear repeating, how nearly one in three children in this country are overweight and obese, one in three kids will suffer from diabetes at some point in their lifetime as a result, and how we're spending $150 billion a year to treat obesity related conditions like heart disease and cancer.
Robert Lustig 06:59
Exactly right. Kids are always the canary in the coal mine. Why? Well, you know, my colleague, Paul Wise at Stanford, famously said that pediatricians are the witnesses to failed social policy. And in fact, that's exactly right. This obesity epidemic that has affected everyone has affected kids the worst, because kids were never obese. We now actually have an epidemic of obese newborns. Now they don't diet and exercise. How come we have an entire cadre of obese newborns? And we know that because the mean birth weight in Israel, Russia, South Africa, US have increased 200 grams. Okay, so that's basically half a pound over the past 25 years. And when you do dexa scanning to determine body composition on those newborns, it's all fat. So how come newborns are being born with it half pound extra fat? That can't be from behavior. That has to be from exposure. It's just not an infection. It turns out the exposure is the food. And that's what I've been studying for the past 25 years.
Jeffrey Sachs 08:16
And just to explain to everybody, because in Metabolical you emphasize that–I think I have the term right–obesity is actually a biomarker. The disease is not necessarily obesity; obesity is a reflection of disease, and so too is the higher rate of dementia, so too is the cardiovascular disease. In other words, we're seeing an epidemic not just of people who are overweight or obese, but we're seeing an epidemic of a very wide range of diseases, saying something in our body is going amiss. And this is, it's happened in timescale, relatively recently, from the 1970s onward.
Robert Lustig 09:04
This has all happened on my watch. You know, I entered medical school in 1976. And back then, only 2.5% of the adults over age 65 had type two diabetes. Today, it's 9.4% of the entire population, rather than just the aged. And one out of every three new diagnoses of diabetes in children is type two. This is a disease we never saw before. 1980.
Jeffrey Sachs 09:35
And by the way, wasn't type two diabetes, which is not from a pancreatic failure, but somehow acquired from the environment, as you say, called adult-onset traditionally, if I'm correct, right? So this is now being seen in children; that whole term makes no sense because it's happening in children, not just in adults.
Robert Lustig 09:56
And that's why the term changed, for exactly that reason. Point is, back in 1970, if you saw a patient with type two diabetes, if you saw a patient with fatty liver disease, which, by the way, is the other huge epidemic, because 45% of American adults now have fatty liver disease, they just don't know it, because it doesn't necessarily manifest until much later as cirrhosis and then you need to either a liver transplant or you're dead. When children get these diseases, which they never got before, you know something's got to be wrong. Well, prior to 1980, those two diseases, type two diabetes and fatty liver disease, were the diseases of alcohol. So if you saw a patient with fatty liver, that was an alcoholic until proven otherwise.
Jeffrey Sachs 10:45
Cirrhosis of the liver, that's an alcoholic.
Robert Lustig 10:48
Exactly. Not anymore. That's the point. And today, 20% of children, normal weight children, have fatty liver, and 40% of obese children. So these are the diseases of alcohol, but kids don't drink alcohol. So the question is, what could be affecting their bodies in such a way as to cause these diseases? So what we've learned over the past 40 years is that these are not just the diseases of aging. These are not just the diseases of alcohol. These are the diseases of mitochondria. Now, mitochondria are the little energy burning factories inside all of our cells. And our cells have to make a chemical energy called ATP in order to power the cell. The only cells that don't make ATP are the cells that are dead. Every cell makes ATP; it is crucial for survival. And what we've learned is that we now, because of this epidemic, we've learned that we have components of mitochondrial dysfunction. Our mitochondria are not working like they should, they are not burning energy like they should. And in the process, we are laying down fat, and we're laying down fat in places we never laid it down before, such as, for instance, the liver, and also the pancreas. And they are now contributing to these chronic metabolic diseases: type two diabetes, lipid problems, fatty liver disease, etc.
Jeffrey Sachs 12:23
So fatty liver disease plays such an important role in in this story. Could you explain what it is?
Robert Lustig 12:31
So normally, your pancreas tells your liver what to do. And it does it by releasing the hormone insulin. Insulin goes from the pancreas to the liver. Now normally, other hormones when they're released from their organs, they go into the vena cava to the heart, but insulin's different. Insulin goes from the pancreas to the liver, because the liver is the primary target of insulin action. So when fat builds up in your liver, your liver gets sick, it doesn't work, right? It doesn't process nutrients like it's supposed to. And there's a reflex that tells the pancreas, "You know what? Just like you have on an assembly line, if you had workers that were out, okay, you'd have backup." And so things slow down, and the pancreas ultimately makes more insulin to try to make the liver do its job. This raises insulin levels all over the body. And so you end up with a phenomenon called hyperinsulinemia. And it turns out insulin is a growth factor. So it is true, it helps shunt energy into cells for utilization, it helps shunt energy into fat cells for storage. But it also is a growth factor. It causes cells to divide–like, for instance, coronary artery muscle cells to divide–and when they divide, you know what happens? Your coronary arteries narrow, and you know what happens, then you get a heart attack. It also causes breast cells to divide. And what happens when breast cells divide: you get breast cancer. And so insulin is the linchpin that connects our food to all of these chronic metabolic diseases. And so the question is, where is this liver fat coming from? Why is our insulin so high? Because when we solve those two questions, we will be able to mitigate this pandemic of chronic metabolic disease.
Jeffrey Sachs 14:31
By the way, when I go to the doctor and get a routine blood test, I may be wrong, but I've never heard of my insulin level being tested. Am I wrong about that?
Robert Lustig 14:43
No, you're absolutely right. But I think that's the first thing they should test. Now, I will be very honest with you. The American Diabetes Association right on their website says, "Don't draw a fasting insulin on people," and they say it for two reasons. Since both of which are disingenuous and untrue, here's the reason they say that. They say that the insulin essay is not standardized across all laboratories, therefore it's inconsistent. That's true, but it's true for a different reason. Turns out our pancreases, when they are stressed, when they are working so hard, they don't have a chance to process the insulin molecule correctly, because they're trying to push it all out as fast as they can, because our livers are so sick. And so what happens is there's a piece of the insulin molecule that has to be cleaved out, it's called C peptide, in order to turn pro-insulin into insulin. So you end up secreting pro-insulin as well as insulin. And that gets picked up in the insulin essay. And it turns out pro-insulin only has 5% of the activity of the actual insulin molecule. So the more the pancreas works, the worse the stuff that comes out of it. But it still gets picked up in the essay. So unfortunately, cheap essays don't distinguish those two species. So that's, but that's irrelevant.
Jeffrey Sachs 16:14
That sounds like a solvable problem, by the way.
Robert Lustig 16:16
Well, it is a solvable problem, but it's a moot problem too, because if your levels are high, your levels are high. The second reason they say don't draw an insulin level is because insulin levels don't correlate with obesity. That's right. They don't. They correlate with chronic metabolic disease. And there are thin people who have chronic metabolic disease. 40% of the normal weight population have the exact same diseases as the obese; they get type two diabetes, hypertension, lipid problems, cardiovascular disease, cancer, dementia also, but they get it at a normal weight. So yes, it's true, fasting insulin does not correlate with BMI, it correlates with disease. So I think the fasting insulin is the most important.
Jeffrey Sachs 17:02
It's such a different story from the story that we normally hear or that our doctors tell us. And I don't think that it is a mainstream idea that Americans are sick with liver disease. Again, it's not something that you normally hear. But just to make sure that I understand and help everyone to understand, the argument you're making with all of the science behind it, of course, is that when the liver has this fatty liver disease or cirrhosis, it causes a cascade of malfunctions in the body. And the most notable one is that there's insulin resistance of the liver. And because of that, that normal thermostat of insulin production–if I could mix metaphors–but the normal control isn't working. And so the pancreas is pushing out more and more of this hormone. And that affects the whole body. Because insulin has all of these powerful biological effects, causing growth of tissues or causing other kinds of disease outcomes. And so a sick liver can show up as cardiovascular disease, it can show up as type two diabetes–not adult onset diabetes, it can show up as type two diabetes–and it can show up as dementia. It's incredible. But the point is that insulin is such a central part of overall metabolism that when it's dysfunctional, so many things become dysfunctional in the body. That's one of the things you point out and again–I want to make sure I understand this–is that this hyper insulin anemia is also part of what makes that appetite signaling go wrong. Did I get that right? That it actually blocks the brain's uptake of the leptin, which is what you started by telling us keeps our appetite under control?
Robert Lustig 19:10
That's exactly right. So this basically is a vicious cycle. Because your leptin doesn't work. Your brain thinks you're starving, so you need to eat more. So we started with the question, "Well, what causes that leptin resistance? What is preventing the leptin signaling from working in the brain?" And it turns out, the answer is insulin. Insulin blocks leptin signaling, and you'd say to me, "Well, why should that be? What's the selective advantage in nature, when you see this kind of thing?" There's always a selective advantage. And the answer to that is, there are two times in your life when you actually don't want your leptin to work perfectly. And they are puberty and pregnancy. Because if your leptin always worked right, you couldn't go through puberty and if your leptin always worked right, you couldn't carry a baby to term. So it's essential for the survival of the species that you be able to block leptin signaling so that you can gain the weight, to be able to go through puberty, to be able to carry a baby to term. But then when puberty is over, when the baby's out, you need to be able to revert back to where it was before. The point is that we now have leptin resistance 24/7/365, all the time. And the reason is because we have high insulin 24/7/365. And the question is, why do we have high insulin? Because our livers are sick. And why is our liver sick? Because there's fat in the liver. And why is there fat in the liver? Because their mitochondria not working. And why are their mitochondria not working? And the answer is...
Jeffrey Sachs 20:50
That's where we're getting to, right?
Robert Lustig 20:54
The two word answer is processed food. And the one word answer is sugar.
Jeffrey Sachs 21:01
Okay, please explain that, because that's important. And we like sugar.
Robert Lustig 21:10
Well, we do.
Jeffrey Sachs 21:11
How could the cascade go from something so good as sugar or something so tasty as sugar to now, if I got it right, from sugar to the mitochondria, to the fatty liver, to the insulin, and to all of the problems that cascade from the sugar? Oh, my God, what is that about? Right? And why the liver? Right?
Robert Lustig 21:39
So it turns out that the food industry has been telling you for 50 years now that sugar is energy and you need sugar to live. Neither of those things are true. Okay, those are distinct falsehoods. They are eminently disprovable. And in the book, I lay out the entire argument as to just how fallacious both of those terms, those statements are. Sugar is energy. That's true, but that doesn't necessarily make it a food. So can you name an energy source that is energy, it's got calories, but there's no biochemical reaction in the body that requires it? That when consumed in excess, it is toxic to cells to humans and causes death. And we love it anyway. And it's addictive. The answer is alcohol. So alcohol's energy is seven calories per gram. But alcohol is not a food. There's no dietician on the planet who would call alcohol a food, even though it's energy. Okay, it damages cells, it damages humans, it causes death. And it's addictive. So just because something has energy doesn't mean it's okay. There's no biochemical reaction in the body that requires alcohol, none.
Robert Lustig 23:07
Okay, so we have now debunked the idea that energy equals food. Well, turns out sugar is metabolized exactly like alcohol. And alcohol damages mitochondria. Well guess what? Sugar damages mitochondria. A metabolite of sugar, which we've now isolated, called methylglyoxal, actually poisons mitochondria at three separate places in the mitochondrial life cycle. And so we now have the data to show that sugar induces mitochondrial dysfunction even in children. And when your mitochondria don't work, guess what, neither do you. And this is the basis of why sugar is not a food. In fact, sugar is a poison. Now, our livers have a capacity to metabolize poisons, but only up to a certain point.
Jeffrey Sachs 24:04
So just to say that the analogy with alcohol is not merely an analogy, it's a metabolic parallel. And it's a metabolic parallel, also, how it implicates the liver, because both of them lead to liver disease, both alcohol and sugar.
Robert Lustig 24:25
And that's why children now get cirrhosis for just that reason. So it's not just a metabolic parallel in terms of its metabolism. It's also metabolic parallel, in terms of its addiction capacity. And it's also metabolic. It's also parallel in terms of how it's marketed.
Jeffrey Sachs 24:43
Yeah. So a basic point, not to divert us too much, but there's sugar and there's sugar, as I understand from the book. So there's glucose, there's sucrose, there's fructose; what am I to make of all of this and what is the takeaway of this? Because if I understand correctly, it's not all sugars, but a particular kind of sugar.
Robert Lustig 25:08
So there are monosaccharides, there are disaccharides, there are starches, you know, this is where things get a little bit complicated from a biochemical point of view. And the food industry uses that complicated paradigm to confuse and obfuscate the truth. So I will make it very clear in what I'm saying. Dietary sugar, okay, is not blood sugar. Blood sugar is glucose. Dietary sugar is glucose, fructose. Two different molecules joined together to form something called sucrose, table sugar, cane sugar, beet sugar, the crystals you put in your coffee. However, if those are separate and not bound together, we call that high fructose corn syrup. No difference. The two molecules one glucose, one fructose, the only difference is are they joined or are they free. That's the difference. So people say high fructose corn syrup is the the evil one. No, they're all evil. The difference is high fructose corn syrup is cheaper. And because it's cheaper, because it's homegrown, because we have a steady supply of it, also, because it's miscible, because it's already in liquid, it's a syrup, it doesn't precipitate out, it doesn't crystallize out. This is what gave us Chips Ahoy chewy cookies. Okay, the bottom line is the food industry, because it was half the price of sugar, and because it didn't crystallize out, and because you could ship it around the world in big tubs, it basically took over from sugar for quite a while. And so our consumption went straight up. And it is that increase in total sugar because of that fructose molecule. And we'll talk about that in just a minute. The increase in our sugar consumption because it became so cheap that basically unraveled and unleashed all of these chronic metabolic diseases since the 1970s, when high fructose corn syrup first came to our shores.
Robert Lustig 27:20
Now the question is what is going on with that fructose molecule. So glucose, that other molecule, which is in starch, you know, it's in bread, it's in pasta, it's in rice and potatoes, okay, that's just straight glucose. Now, it's not that glucose is good, per se. It causes an insulin response. And we've just learned that, you know, high insulin is bad. And it is. But compared to fructose, glucose is a walk in the park. Fructose, there's no biochemical reaction in the body that requires it. It is completely vestigial from human life, it is a leftover remnant from our plant ancestors way back in the evolutionary tree. Before we all split off prokaryotes from eukaryotes, you know, as far back as the evolutionary tree goes, it's a storage form of energy for plants. It acts differently. It is not our energy source: glucose is. And because it's not our energy source, only the liver has the capacity to metabolize it, only the liver has the glucose transporter that transports fructose, too. And there's a limit to how much your liver can process, just the same way there's a limit to how much alcohol your liver can process. Once you exceed that amount, you get spillover. Guess what? Then it goes to your brain, and now you're drunk. Alright, with fructose, you don't get drunk, you get irritable instead. So that's the big difference. Okay? But in terms of what your liver sees, and what your liver does with it, it's pretty much the same. And so when your liver's overwhelmed by the fructose tsunami, so from, say, a soft drink, your liver has no choice but to take the excess and do something with it. It turns it into liver fat. And then that liver fat precipitates as a lipid droplet in the liver, and now you've got fatty liver disease. And now you've got the start of all of the chronic metabolic diseases that we've been talking about this whole hour.
Jeffrey Sachs 29:30
So fructose sounds like fruit. Fruit does have fructose: is fruit bad for us?
Robert Lustig 29:37
So fruit is glucose and fructose, just like table sugar, cane sugar. The difference is number one, there's not that much sugar in fruit. Yes, it's sweet, but it's not that much and the antidote is there as well. The fiber. So, turns out, fiber is the nutrient you don't absorb. And the reason is because it's not the nutrient for you, it's the nutrient for your bacteria in your intestine, your intestinal microbiome. This is the work that's really gone on in the last 10 years in medicine is understanding the role of the gut microbiome.
Jeffrey Sachs 30:17
We have trillions of microbes, all of us, as many or more microbes in our gut as our cells in our body, if I understand correctly.
Robert Lustig 30:27
10 times as many. So they got to eat. So the question is, what do they eat? Well, they eat what you eat. The question is, how much did you get versus how much did they get? When you consume an apple, that is glucose and fructose with fiber. Turns out that most of the glucose and fructose never actually made it into your circulation. It was blocked from being absorbed early on in the duodenum, the first part of the intestine, by the fiber. The fiber sets up a gel on the inside of the intestine that blocks early absorption. That keeps your liver from getting the tsunami, so it stays healthy. What it also means is that more of that sugar goes further down the intestine to where the bacteria are, and then the bacteria chew it up for its own purposes. So when you eat the apple, you're feeding your bacteria.
Jeffrey Sachs 31:21
And that's a nice thing to do.
Robert Lustig 31:23
And that's a good thing to do. When you drink the apple juice, where the fiber has been removed and stripped out, now you're flooding your liver. So you have basically turned something that was healthy into something that was poison, just by processing it.
Jeffrey Sachs 31:37
I don't know if it's possible: could you bake with glucose rather than fructose? Or could you basically have the kind of sugar that isn't going to kill the liver?
Robert Lustig 31:47
Sure. So basically, glucose alone is like Caro syrup or molasses. Now, can you bake with molasses? Sure, there are molasses cookies. But you know what? They're not that sweet. They have a very different flavor. And it doesn't do the same thing to your reward system.
Jeffrey Sachs 32:07
In other words, if you want to make profits, get into the addiction business.
Robert Lustig 32:13
That's right. And fructose, as it turns out, activates that reward center in the same way alcohol does. And in the same way cocaine, heroin, and nicotine, also do. So the fact of the matter is in the extreme, fructose is addictive. And we have the data to demonstrate how that works, and why. Well, guess what? Food industry knows that. But it's legal. You know, if they could put cocaine in the food, they would, but you know, they can't. So they do this instead. And it works just as well.
Jeffrey Sachs 32:42
And as we know from history, when the Europeans discovered that you could make sugarcane in the Caribbean or in other colonies at mass scale, the sugar addiction in Europe was so overwhelming that it created the empires of slavery, ruthlessness of Empire; the motivating factor of sugar is what we know in the 20th century of a different kind of "energy of oil." It led to wars, slavery, and so forth, because the addiction was so powerful from a sociological point of view.
Robert Lustig 33:19
Indeed, addiction has driven much of what's gone wrong in the world. We can go all the way back to the Opium Wars of the 1800s in China; we can talk about oil, you know, and what it's done to our economy; and you know, now sugar being you know, the one that's ultimately impacting our individual metabolisms, and ultimately, basically, train-wrecking modern medicine and health care around the world at the same time.
Jeffrey Sachs 33:47
So if I want to summarize accurately, is it right to say, when you introduce the problem of processed foods as the two words and sugar as the single word, processed foods are foods with added sugar, and taking away the fiber. Is that the main two facts that combined are making them particularly dangerous?
Robert Lustig 34:12
So processed food is a lot of things. But if I had to sum it up in, you know, in a simple, sentence, I would say processed food is high sugar, low fiber food. Now, there are other things too. There's branched chain amino acids, there's glyphosate, there's pesticides, there's a whole host of various things, none of which are good for us metabolically, and I go through them in the book. There's an entire part of the book that is dedicated to explaining what all of those ingredients are on the side of the package and how they are affecting your body's metabolism and, in particular, your mitochondria. But by far and away the Big Kahunas in the story are the amount of sugar and the lack of fiber.
Jeffrey Sachs 34:59
And if we lived in a normal world, what happened yesterday, interestingly, to go back to the oil analogy for a moment, there had to be a shareholder revolt against Exxon, Chevron, and there was a lawsuit against Shell. So three events happened recently in which this oil industry, which is doing so much damage to the world, was confronted.
[Audio clip] 35:27
And then today, all of a sudden, boom, it all just happened all at once. Remarkable day, and it's still seen as sort of a business news, business pages piece of news. But it's more than that. I mean, first of all, this morning at the The Hague in the Netherlands, a Dutch court issued a ruling, a court order, that requires the massive oil company, Royal Dutch Shell, that's the biggest oil company in the world outside of China, the court order is going to require that company to cut its emissions by 45% by the end of this decade. Then, right after that, boom, it happens to Chevron. This is also today. A shareholders meeting, an overwhelming vote by Chevron shareholders requiring Chevron to radically cut its emissions, too. And then boom, another one all in the same day, a huge one, Exxon.
Jeffrey Sachs 36:19
Because even though we know that the CEOs know about the damage, they said, "Well, that's not our problem. We're making money." So naively, I would have thought that by the time the United States arrived at an obesity epidemic, a fatty liver disease epidemic, a cardiovascular disease epidemic, a dementia disease epidemic, and the science was pointing more and more that this sudden change from the 1970s onward has a common factor, I would have thought, stupidly, but let me just say it, that the CEO of Coca Cola and PepsiCo and Kraft and others would say, "Oh my god, what are we doing? Dr. Lustig, what should we be doing?" Is that how the story goes?
Robert Lustig 37:19
So, no, unfortunately, that's not how the story goes. And it's just the same thing as what happened with tobacco and what's happening now with the oil industry. The pressure is coming from the outside, not from the inside. So in the book, I actually talk about three separate people who have tried to change the industry from the inside who recognize the problem. Indra Nooyi CEO of PepsiCo realized, I'm making my own home country diabetic.
Jeffrey Sachs 37:50
Which is amazing, because that's a case where in India, there's a lot of diabetes, in other words, a lot of metabolic syndrome. But it doesn't show up as obesity.
Robert Lustig 38:03
India has an 11% diabetes rate. Ours is 9.4%. They have a higher diabetes rate than we do and they're not obese. Again, pointing to the fact that this is not about obesity. This is about metabolic derangement and it can happen anywhere, including India. So Indra Nooyi tried, she even hired Derek Yach away from the WHO and he was Mr. Anti-tobacco in an attempt to try to fix the problem from within. And in 2011, she lost $349 million and Wall Street called for her head on a spear because she "took her eye off the ball." She tried, she failed. Denise Morrison, CEO of Campbell's Soup, tried to fix it. She ended up being fired. And most recently, Emmanuel Faber at Danone actually was able to reduce the portfolio, the total consumption of a portfolio of sugar in the Danone line by 14%. Now whether that's good or bad, we can discuss; the point was he was making an effort, and he's gone too. So the fact of the matter is this can't happen from the inside, because it's about the money. This is going to have to happen from the outside, just like it did with tobacco. And just like as you showed, yesterday, as you talked about yesterday, with the oil companies coming from the outside. Same thing with the opioids by the way. So bottom line, anything that's addictive has to come from the outside.
Jeffrey Sachs 39:34
Look at tobacco, sugar, the opioids and the Sackler family, which was producing opioids, knowing that these were addictive and leading to suicides, leading to such unhappiness, and yet they persisted. And till today, they're trying to save their billions, which is disgusting, because why should you have any return on this other than disgrace, after deliberately putting addictive products into the bodies of the public.
[Audio clip] 40:07
This year has led to the beginnings of a reckoning for the manufacturers, marketers and distributors of opioids. The epidemic has taken hundreds of 1000s of American lives over the past two decades. Multi-billion dollar settlements have been announced. But there is great anger. Many states say there is not enough accountability and transparency over the companies' roles. Purdue Pharma, which created Oxycontin and is controlled by the Sackler family, is the biggest target.
Robert Lustig 40:37
Jeff, I'm going to basically you know, usurp your line, as an economist: "It's all about the money. It's always been about the money." You know, and unfortunately, you know, we're dying for it.
Jeffrey Sachs 40:51
Where in this story has Coca Cola been? Because this is probably the most iconic single brand in the world. You've been making this point through so many important scientific discoveries, and then bringing this to the attention of the public, as in this wonderful book. And what does the industry say to you, other than trying to ignore you somehow, or wishing you would just go away?
Robert Lustig 41:19
Well, you know, like Gandhi said, you know, first they ignore you, then they laugh at you, then they fight you, then you win. You know, we're in the fight now. The fact is, you know, Coke has tried to discredit me. And it's not just Coke. I mean, you know, it's multiple vendors, not just Coca Cola, but Coca Cola is sort of the prototypical 2000 lb gorilla in this. The fact is, they continue, to this day, to hold on to this notion of calories. And the reason is because that's the only thing they can hide behind. And, you know, what we're doing is we're basically stripping that veneer away, and demonstrating that metabolic health is really the important thing here. It's not about calories. It's not about obesity, for all the reasons we've discussed already, and you know, people are starting to understand that and Coke sales, without question, have gone down. In fact, soft drink sales all over the world.
Jeffrey Sachs 42:15
The oil companies are being sued right now for the damage that they've done. And some of these cases are winning in the Supreme Court of different countries. Could you sue the food industry till it gets on the case?
Robert Lustig 42:28
We are, we already are. There have been several cases and I've expert witnessed for some of them. You may notice, if you go into the store today, that Raisin Bran is now not healthy. So there was a lawsuit against Kellogg's and there was a lawsuit against Post, both of which were won by the plaintiffs. There are current lawsuits, which I won't mention right now, because they're in process. But these have to do with advertising and deceptive advertising rather than actual faulty product. And ultimately, no one wants litigation from the bench. No one wants regulation from the bench. Ultimately, it behooves the food industry to understand that they can actually make more money doing the right thing. The problem is that right now, they're addicted to the food subsidies. And until we get rid of the food subsidies, and get the food industry recognizing that they can actually make money by selling real food rather than processed food, you know, we will not find our way out of this. And that's where government comes in. And that's where people like you and I come in.
Jeffrey Sachs 43:34
Rob, in the remaining moments, can we ping you for some advice for our individual health? What should we be doing in the midst of all of this right now? What lessons should we take in terms of how we're eating so that we can avoid all of this story that is so powerfully told in this book?
Robert Lustig 43:54
So in the book, I have a chapter, "What does healthy really mean?" And that's what it all comes down to is how do you know if any given food is healthy, whether you should put it in your mouth or not. And I basically narrow it down to two precepts; six words, two precepts. One: Protect the Liver. Two: Feed the Gut. Any food that does both is healthy. Any food that does neither is poison. Any food that does one or the other, but not both, is somewhere in the middle. Now, if you understand what you're trying to protect the liver from, and protect it from the onslaught of simple sugars, refined carbohydrates, glyphosate, iron and heavy metals, that's what you're trying to protect it from, you'll choose appropriately. If you realize you have to feed the gut. Well, what does the gut like to eat? Well, the gut likes to eat fiber, but it needs to eat both soluble and insoluble fiber. So FiberOne bars are not the answer, because they are only soluble fiber. But if you recognize that food that came out of the ground has its inherent fiber, you know, you're good to go. Basically, it's called real food. Real food does not have a label, because it doesn't need a label, because nothing's been done to it. So what you need to realize is if a food has a label, it's a warning label. And that's how you have to approach it.
Jeffrey Sachs 45:20
Rob, we have come to the end of an hour. This book, Metabolical, covers a remarkable body of science, so much of which you have led and partnered with, to help us understand what is going on in our society and around the world that is leading to this multiple epidemics of noncommunicable diseases. You have shown us how to take on the food industry, which you and I and others are going to continue to do that and I'm sure many people listening in are already engaged in that. It is like taking on Big Oil or Big Tobacco or the other poisoners that operate on greed rather than on the common good. And also, thank you for giving us six words: Protect the Liver; Feed the Gut. Thank you so much for being together with us. Thanks to all of the listeners. Metabolical, Professor Robert Lustig's tremendous new book. Thank you for joining Book Club with Jeffrey Sachs.
Robert Lustig 46:23
Can I just say that, Jeffrey, you have been an inspiration to me for decades, and it has been the greatest pleasure to get to know you and call you my friend.
Jeffrey Sachs 46:32
Next month, I will be speaking with Professor Patricia Sullivan, about her new and outstanding book, "Justice Rising: Robert Kennedy's America in Black and White." "Justice Rising" is a landmark biography of Robert Kennedy and his great legacy. Professor Sullivan's path-breaking research, including government records, RFK's personal papers, and oral interviews, reveals Kennedy's remarkable moral depth and commitment, and describes vividly and compellingly how he emerged as a transformational leader.
Jeffrey Sachs 47:10
Thank you for joining in the conversation. Please subscribe, rate, and write a review on whatever platform you listen for your podcast. I would love to hear your thoughts as we continue to develop the series.