episode #148

The Lies Of Processed Food. Nutrition, and Modern Medicine With Dr. Robert Lustig


Episode 148: The Lies Of Processed Food. Nutrition, and Modern Medicine With Dr. Robert Lustig

This week we welcome Dr. Robert Lustig. Robert is a Professor of Pediatric Endocrinology at the University of California, San Francisco. Dr. Lustig has become a leading public health authority on the impact sugar has on fueling diabetes, obesity, and metabolic syndrome epidemics, and on addressing changes in the food environment to reverse these chronic diseases. In this episode, we discuss the difference between glucose and fructose, understanding the different fat depots in the body and the roles they may play in disease, and the eight modern diseases that aren’t actually a disease. We also dive into the modern myth that a calorie is a calorie, and how the food industry used convenience to control you.

Episode Overview: 

  • 8:30 Introduction
  • 18:45 Glucose vs Fructose
  • 31:00 Is there a way to measure Fructose?
  • 38:30 Fat Depots: Subcutaneous Fat, Visceral Fat, Liver Fat
  • 43:00 Glucose For Fructose Exchange Experiment
  • 49:40 The 8 Modern Diseases That Aren’t Disease
  • 55:53 The 3 Checkpoints – Insulin and PI3-kinase, AMP-kinase, mTOR
  • 60:00 The Calorie Myth – A Calorie Is Not A Calorie
  • 62:00 Diseases Are Occurring Earlier and Earlier
  • 1:00:34 How The Food Industry Used Convenience To Control You
  • 1:09:00 Examples Of Food Fraud
  • 1:21:00 Climate Change, Meat, Nutritional Security
  • 1:25:13 Influences Of Big Pharma Influence on Medicine
  • 1:32:20 Concluding Thoughts

David’s Website

Eat Real – https://eatreal.org/about/

“Metabolical” Book – https://metabolical.com/

Join Hello Betty here

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Join The Better! Community On Facebook.

More information about the book at The Betty Body Book


Dr. Stephanie Estima (00:00:49):
Welcome to better with Dr. Stephanie. I am your host, Dr. Stephanie Estima. This show is for women, just like you with a deeper desire for learning self-actualization and becoming more of who you already are. Every week, we are going to deconstruct how to build a better bodies, better minds, better relationships, better sex, and better families. I’ll be giving you access to world-class thought leaders to help give you the tools to answer this question. What are the simplest things that you can do today to get better? Tomorrow? I am Parky for magic and want to share the juiciest questions, topics, and often taboo conversations that I think I’ve always wanted to be a part of and I wanted to be having. So let’s get better together.

Dr. Stephanie Estima (00:01:46):
Welcome back to better with Dr. Stephanie. It is me your host, Dr. Stephanie Estima today. We are talking with Dr. Robert Lustig, and we are talking about his newly released book, metabolically, very clever portmanteau between the words, metabolically and or metabolic and diabolical. Now, Dr. Robert Lustig is an MD. He’s a professor of pediatrics in the division of endocrinology and a member of the Institute for health policy studies at the university of California in San Francisco. He’s authored 130 peer reviewed articles, 80 academic chapters and reviews and dozen dozens of op-eds for the public, his 2009 YouTube lecture sugar. The bitter truth has accrued 12 million views. He’s the former chairman of the obesity task force of the pediatric endocrine society and a member of the obesity task force of the endocrine society and a member of the pediatric obesity devices, committee of the us food and drug administration.

Dr. Stephanie Estima (00:02:54):
Now, as you can tell by his intro, he is a very respected medical doctor and in his new book, metabolically, this is like a tell all a kiss and tell all of big food, big pharma, and a big medicine. And we talk about a very wide variety of topics. They are all related to each other. We start off talking about some of the science that he covers in his book. We talk about the difference between glucose and fructose that we talk about the eight modern diseases that he talks about in his book of those being glycation, oxidative, stress, metabolic dysfunction, insulin resistance, membrane, integrity, inflammation, epigenetics, and autophagy. And we go into quite a bit of detail about that. We also talk about what he calls human flaw Gras or nonalcoholic fatty liver disease. We talk about its inception, the increase in its occurrence in modern society and why he thinks that’s happening.

Dr. Stephanie Estima (00:04:03):
And then we get into big food and big pharma. So we talk about the idea of how big, the inception of big pharma and its relationship to the Rockefellers and the desire to create a second stream of income for that family. How big pharma has infiltrated medical schools and influenced the training, the curriculum of medical doctors and how this bias is they’re thinking, of course, when they’re out in practice, we talk about nutritional education in medical school, a spoiler. There’s not a week of it. There’s not even the equivalent of a week of it in the medical curriculum. And then we talk about big food and how the two big pharma and big food are in bed with each other and how we see big food, infiltrating schools, how we have sodas and, you know, cafeterias that are being replaced with packaged foods.

Dr. Stephanie Estima (00:05:04):
And we are essentially creating patients out of our young children. And this is he, his name’s in the book. Like there is like no holds Bard. And he talks about, we even get into like lab markers and how as a patient, you can be empowered to go speak to your medical doctor with an informed, like, I would like this. I would like to look at my serum homocysteine. I would like to look at my transferees is my alt my ASD. We talk about all of those as well in our conversation, all in all, this was an incredible, incredible conversation. I almost felt like he was a, you know, a, a woke doctor. And I actually said that to him in closing that he speaks like you know, a lot of the alternative healthcare medicine has for a long time that we really do need to be focusing on the basics like nutrition, which unfortunately make a lot of money for big pharmaceuticals.

Dr. Stephanie Estima (00:06:00):
Because when you’re having real food, you are usually healthy and you don’t need any of their product, namely medicine. And he, you know, you were going to just absolutely enjoy his passion. You can tell from the ease with which he speaks, he’s a great order, great teacher. And he also knows his stuff. So without further ado, please enjoy my conversation with Dr. Robert Lustig today’s podcast is brought to you by athletic greens, the most comprehensive daily nutritional beverage that I have personally ever tried. One scoop of athletic greens contains 75 vitamins minerals and whole food sourced ingredients, including a multi a multimineral a probiotic, a greens, superfood blend, and much more. And these all work together to fill in the nutritional gaps in your diet to increase your energy and your focus to help with digestion. And of course it helps to support a healthy immune system.

Dr. Stephanie Estima (00:07:07):
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Dr. Stephanie Estima (00:08:03):
So we have the link in the show notes, but you can just simply visit athletic greens.com forward slash Stephanie. And you will get your free year supply of vitamin D and the free travel packs with your first purchase. And you will join the health experts, athletes, and health conscious go-getters around the world. People just like you, who want to make a daily commitment to their health every day. So that is athletic greens.com. That’s a T H L E T I C G R E N s.com forward slash Stephanie and Stephanie is spelled S T E P H a N I E. Dr. Robert Lustig. I am thrilled to welcome you to the podcast. Welcome doc. Thanks having me really appreciate

Speaker 3 (00:08:56):
You being here.

Dr. Stephanie Estima (00:08:57):
Yeah. And we, today are going to be talking about your new book metabolically, which is a very clever portmanteau between the words metabolic and diabolical. And we were just talking in the pre-chat about how this is very much an expos, a of, some of the, you know, darker forces that are trying to keep us as a society, sick and diseased, and how profiteering can really really does make the policy decisions of the day. But we, and we’re going to talk about that today, but I wanted to start with some science because my audience, we love geeky science, and we’re going to go on a geeky magic carpet ride, hopefully together today. And one of the primary tenants and really a through line of the book is this idea that if you protect the liver and you feed the gut all will be well.

Dr. Stephanie Estima (00:09:53):
And we’ll kind of layer that through our conversation as we go through some of the different tenants that we were talking about, and I thought we could start with sugar. I think that a lot of people, when they say sugar, they don’t realize that there are different kinds of sugar. You know, women will say, Oh, I got to touch a sugar, my blood sugar’s a little high, but maybe we can defer to the subject matter expert here. You, and you can maybe talk a little bit about the delineate, the difference between, you know, glucose and fructose are the two ones that I’m most interested in. And you know, what are some of the different physiological effects on the body from those two?

Speaker 3 (00:10:28):
Yeah, happy to help. So let me, let me start out by saying the food industry doesn’t want you to know any of this. And so they’ve actually created a whole marketing campaign around various concepts that are completely untrue. The most important ones are a calorie is a calorie, which is completely untrue. And also a sugar is a sugar, which is also completely untrue and sounds good on the back of a breakfast cereal box, but it actually is, you know, complete, completely fallacious and is so completely fallacious that lawyers are now starting to Sue food companies and starting to win for deceptive advertising. So you know that something’s up. So let’s start with this word sugar. It means two things. There’s blood sugar like with diabetics check, which is a blood glucose and glucose 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. So if you never consumed a molecule of glucose in your life, it wouldn’t matter. The Intuit, you know, they didn’t have any place to grow a carbohydrate. They had ice, they had a whale blubber, okay. They still had a certain glucose level. And the reason is because it’s so important, your body has a method for being able to turn other macronutrients, fats, or proteins into glucose. So glucose is essential. It’s just not essential to eat

Speaker 4 (00:12:22):
If you will.

Speaker 3 (00:12:24):
And then there is this other molecule called fructose. Now fructose is completely vestigial. There is no biochemical reaction in any, you carry out an organism that is any animal cell on the planet that needs it. It is absolutely unrelated to life. It is a storage form of energy for plants.

Speaker 4 (00:12:52):

Speaker 3 (00:12:52):
When we evolved off of plants, way back in our evolutionary tree, we basically stopped needing it. And that’s just good. Otherwise we’d all just be a sticker corn. Instead of being, you know, who we are today, it allow us to grow our brains. The bottom line is fructose is completely unnecessary for life. So if you never had another molecule of fructose in your diet, not only would you survive, but you would actually be better. And the reason is because fructose is vestigial because it’s not necessary. It is an energy source. It can be converted into ATP, the chemical form of energy that our cells use to power itself. That’s true, but it’s not necessary. It’s completely vestigial. Just like alcohol. Alcohol is not necessary either. If you never consumed a molecule of alcohol in your life, you would be better to, and you would live longer. You might not have as much fun, but the bottom line is you don’t need alcohol for love for life yet. It’s calories, it’s energy. It can be converted into ATP also just because something can be converted into ATP. Doesn’t make it good for

Speaker 4 (00:14:13):
You. Trans

Speaker 3 (00:14:15):
Fats can be converted into ATP and we know they’re the devil incarnate. So just because something has calories doesn’t mean it’s okay. Therefore, a calorie is a calorie is complete an utter BS, but that is the food industry’s method for basically getting you to eat whatever they want you to eat. And that’s how they’ve been so successful for the last 50 years is on this basis of a calorie is a calorie. So that is the first thing that has to be debunked. And it’s debunked with science, but is absolutely politically motivated to understand that, okay, now let’s get into this glucose fructose and what fructose does. So glucose yet it raises your serum glucose, and yes, that raises your insulin response. And insulin is the bad guy in this story. Insulin makes fat insulin is the hormone that takes whatever’s in your blood that you’re not using to burn and diverts it into fat cells for storage that’s insulin’s job.

Speaker 3 (00:15:27):
So if you’re not storing, you don’t need enough, very much insulin, but when you consume any glucose, your glucose level in your blood will rise. That’s what diabetics check with their blood sugar. That’s the blood glucose with their little, you know, with the, with the medicines. So the mini med or, you know, the Accu-Chek or whatever, or the continuous glucose monitor. Now, either one, any of them they’re checking the serum, glucose, the blood glucose. They’re not checking the blood fructose and the fructose that you consume raises the fructose levels in your blood, but you don’t measure that. The only way to measure that is in a research lab. So you don’t know what you’re actually doing. So when something says it’s low in the glycemic index, that means that the blood glucose doesn’t rise very high. Therefore the insulin response doesn’t rise very high, therefore, hopefully less of what you age will end up in fat cells. That’s the idea behind glycaemic index.

Dr. Stephanie Estima (00:16:32):
The backdoor there is that if it’s filled with fructose, that’s not going to affect your blood glucose anyway.

Speaker 3 (00:16:37):
Well, and that’s the problem. And that’s also a lie. So people say low GI, you know, they actually sell, bought bags of sugar down on Australia, let’s say low GI cane, which is like the biggest joke on the planet. So it sounds good. Oh yeah. Let’s keep the insulin down. Except that practice does, is it doesn’t raise your serum glucose. Of course it doesn’t, it’s fructose. What it does instead is it goes to your liver, the liver can’t metabolize all of it. It metabolizes what it can and the rest of it has to be diverted. And what happens is it gets turned into fat fat in the liver, and then that fat in the liver can, has one of two faiths. It can either be exported out as triglyceride and then cause heart disease or obesity, or it can precipitate in the liver. And now you’ve got fatty liver disease and that will precipitate diabetes and Alzheimer’s and many other chronic diseases. So that fat in the liver and how you make that fat. The liver has everything to do with the CA with the specific of specifics of what

Dr. Robert Ludwig (00:17:57):
Eat, not the calories, but

Speaker 3 (00:18:00):
Of the actual molecules themselves. The fructose can either be packaged as triglyceride and be exported out of the liver and then lead to cardiovascular disease and or obesity,

Dr. Robert Ludwig (00:18:15):
Or it can precipitate

Speaker 3 (00:18:16):
In the liver as a lipid droplet. Now you’ve got fatty liver disease

Dr. Robert Ludwig (00:18:20):
And that causes a liver

Speaker 3 (00:18:22):
Insulin resistance, which causes hyperinsulinemia despite the fact

Dr. Robert Ludwig (00:18:26):
That the glucose didn’t

Speaker 3 (00:18:29):
Raise the insulin. In fact,

Dr. Robert Ludwig (00:18:31):
The liver dysfunction raise the insulin, but that’s not

Speaker 3 (00:18:35):
Measured in glycaemic index. And it turns out that that’s way worse for you because your baseline insulin is with you 24 hours a day. Whereas your insulin peaks from your meals are only with you about two,

Dr. Robert Ludwig (00:18:49):
Two hours a day. So that liver is

Speaker 3 (00:18:52):
Where the action is. And that’s where fructose causes all of the standards because it gets turned into fed yeah.

Dr. Robert Ludwig (00:18:59):
In the liver, whereas yet fructose drives

Speaker 3 (00:19:06):
Specific reaction, which we’re all very familiar with. It’s the reaction that we use to when we paint our ribs with barbecue sauce, it’s called the mired reaction where the Browning reaction we like to caramelize, you know, certain foods because, well, it tastes better, you know, like caramel apples, you know, like candy apples. And, and and like I said, ribs and you know, various other things that we can be that

Dr. Robert Ludwig (00:19:38):
Browning is actually bad for you. That Browning

Speaker 3 (00:19:43):
Is destroying proteins in your cells and it is causing your cells to function less well. So that’s a process called glycation is the reason why diabetics check a lab test called the hemoglobin A1C. It’s the reason that diabetics have problems with their eyes and their nerves and their kidneys is because of this glycation problem of glucose binding to proteins and causing protein dysfunction.

Dr. Robert Ludwig (00:20:21):
So glucose does that. Productos does it seven times worse? So

Speaker 3 (00:20:28):
When you drink a glass of orange juice at breakfast, you are driving the aging reaction,

Dr. Robert Ludwig (00:20:35):
You’re driving

Speaker 3 (00:20:36):
The reaction that causes wrinkles, you’re driving the reaction that causes cataracts. You are driving the reaction that causes nerve problems

Dr. Robert Ludwig (00:20:46):
And the you drink the worse it is. So that fructose molecule doesn’t get registered in the serum glucose. It doesn’t get registered in glycaemic index. It doesn’t get registered. Even in hemoglobin A1C, it does its own damage. And it’s not because it’s calories it’s because it’s a fructose molecule and worse yet that fructose molecule goes to the reward center of the brain and triggers it and says, this feels good. I want more is a hedonic substance and had done acceptances in the extreme are addicting. So cocaine is addicting. Heroin is addicting. Nicotine’s addicting. Alcohol is addicting, not everyone, but in a sizeable proportion of the population. Well guess what sugar is too. And for the same reason that alcohol is not everyone, but how many people do you know who say, Oh, I have a horrible sweet tooth. That’s sugar addiction is socially acceptable. So they don’t mind telling you, I mean, they don’t come up to you and say, gee, I have a horrible alcohol problem. No, that’s not socially acceptable, but for sugar, you know, mother, you know mother’s day Apple pie, 4th of July, you know, Valentine’s day and it’s everywhere. And not only that, but your grandma’s a pusher. Right?

Dr. Stephanie Estima (00:22:15):
Right. And so when we think about, you know, you mentioned hemoglobin A1C, this is a proxy for measuring, you know, the average blood glucose that an individual has had over the last three months. Do we have, because we can’t see fructose that’s being monitored by these CGMs or these finger prick tests that you mentioned. Do we have any reasonable proxies that can look at fructose levels in the blood that would be similar to, or maybe, you know, indirectly, maybe transferees is in the liver or is there, is there something that we can look at that might reasonably indirectly potentially approximate our fructose consumption?

Dr. Robert Ludwig (00:22:57):
So you’re asking, is there a biomarker that’s correct. And I totally get it. The answer is we have indirect ones, not direct ones. So for glucose, we have direct ones and that’s good fructose. It generates a certain fructose level, but we don’t measure that unless you have a research lab and it’s done in very few places around the world. There is no hemoglobin A1C because that is glucose bound to the position. One of hemoglobin there is a hemoglobin lysine, 66 and one 10, which is fructose specific. And if you’re set up to measure that, then you can measure it, but that’s not a standard clinical lab test that you can do. So these would be the ones that would be direct. There are indirect measures of fructose consumption, and there were two the fur, but neither the measure fructose directly. Okay. The first one is the serum, a L T alanine amino transferase.

Dr. Robert Ludwig (00:24:04):
This is a liver function test and it is sensitive, although not specific for fatty liver and fatty liver can be for a bunch of reasons, but fructose being the primary one. Now the problem with alt, I mean, everyone gets it. It’s on your extended clinical lab panel, so everyone should know their alt level. Okay. And do not let your doctor tell you it’s normal because your doctor doesn’t know what normal is. So if you look at the panel, you look at the lab slip, you know, there’s the, the analyte, then there’s the reference range. And then in the third column, there’s either an H or an L you know, is high, low, you know why that H and the ELA there that’s 10 bucks as an interpretation. Okay. The lab gets to charge for that H and L, which is the biggest joke on the planet, but nonetheless, that’s, what’s there.

Dr. Robert Ludwig (00:24:59):
So the doctor looks across and says, Oh, your alt is 33. That’s normal because the upper limit of alt is 40. So your alt is normal. No, it’s not, not at all. Here’s what happened. When I went to medical school in 1976, the upper limit for alt was 25. Today is 40 same Tassie. They changed the name. It used to be called SGP T. Now it’s called alt doesn’t matter, same assay, but 50 years ago, it was 25. And today is 40. What happened? Well, turns out everyone’s got fatty liver disease. 45% of the United States population has fatty liver that you can detect on ultrasound. This is the biggest problem. Biggest epidemic in the history of mankind is so out classes COVID-19 and HIV and syphilis and tuberculosis and influenza all put together because 45% of the entire us adult population has fatty liver. And 25% of the rest of the world has fatty liver.

Dr. Robert Ludwig (00:26:19):
Do you know how many billions and billions of people we are talking about that now have fat in their liver that they never did before? So this was a, the first diagnosis, the first report of non-alcoholic fatty liver disease. I mean, if you had fatty liver prior to 1980, it was alcohol. You were, yeah, you were an alcoholic, you’re an alcoholic. And then all of a sudden, you know, just things started showing up starting in 1980. And so the question is what happened in 1980? Well, process food is what happened in 1980. And we now know that that non-alcoholic fatty liver disease is primarily driven by sugar consumption. So that alt which had an upper limit of 25 in 1976, the entire curve has shifted to the right. And so now they cut off for two standard deviations above the mean, is it 40? The point is, if you had an alt of 33, you’ve got fatty liver and your doctor doesn’t know it.

Dr. Robert Ludwig (00:27:27):
So that’s one marker it’s indirect, but it sensitive, not specific. The second biomarker is a little harder is called uric acid. Uric acid is also on a standard Campo, but uric acid measures two things, not one is famous for measuring puring consumption. So pairings get converted to uric acid periods, or, you know, what’s in DNA, nucleic acids add needs. I mean, et cetera. And when they get metabolized, they go to uric acid. That’s true. But it also is an indirect proxy for sugar consumption. And the reason is because when a fructose molecule enters the liver, it gets phosphorylated to fructose one phosphate. Therefore ATP has to donate a phosphate, becomes a DP, and then that breaks down all the way to uric acid. So uric acid levels in the blood are a indirect proxy of total sugar consumption as well. And the uric acid level, if you look at the labs, that is also a problem because it will say anything up to seven is normal. If your, your gas is about 5.5, you’ve got a problem.

Dr. Robert Ludwig (00:28:50):
So there are ways to be able to use the lab tests that we have available to us to get good assessments on your consumption and on the, on the health risks that they pose. You just has to be able to read them properly. And I guarantee you, your doctor doesn’t know how, because they were never taught. They were never trained. And that’s one of the reasons I wrote the book chapter nine is how to diagnose yourself, show it to your doctor and let him or her learn how to use the lab test to your advantage.

Dr. Stephanie Estima (00:29:28):
Yeah. I love everything about this. And I think, you know, in the book, you really go into a lot of detail around some of the physiological impacts that fructose has. So you’ve already mentioned, you know, when we, when we consume glucose, for example, the, it has a D you know, our grill in our satiety hormones are affected. We F we say, Hey, there’s some street coming in. And our satiety levels will gradually increase until the point where, you know, leptin reaches a critical mass. And we say, okay, it’s time to put the fork down. But when we contrast that with fructose, that doesn’t happen. So when we consume fructose, like the, you know, the energy drinks and the, you know, the caramelized candy, you know, as you were saying, the Carmel is the caramelized candy apples, and the sugars and things that ghrelin doesn’t actually change. So what ends up happening of course is you’re consuming this fructose. You’re not feeling full. You’re not getting that satiety signal from these appetite regulation centers in the brain, and you continue to consume calories. And of course, obesity and weight gain and SUSE, and eventually over time, that compounded effect leads to obesity and other, you know, lifestyle diseases that happen with it.

Dr. Robert Ludwig (00:30:35):
That’s right. Well, the, I want to point I want to make is that there are actually three separate fat depots and they contribute differently, and people are all worried about the obvious one. The one you can see the subcutaneous or big buck fat, if you will, because it’s cosmetically undesirable, but from a metabolic standpoint is relatively inert. So having a big butt doesn’t mean you’re sick there. So 80% of obese people are metabolically ill. They get type two diabetes, hypertension, liver problems, cardiovascular disease, cancer, dementia, fatty liver, disease, polycystic, ovarian disease, all of these chronic metabolic diseases that are all going up in the general population faster than we can deal with them. That’s all true. 80% of obese people have these diseases, but that means that 20% do not 20% of obese people are metabolically healthy. We actually have a name for them. And H Oh, metabolically healthy, obese.

Dr. Robert Ludwig (00:31:47):
They will live a completely normal lifestyle, a completely normal age, not cost the taxpayer, a dime. They even have normal length telomeres, the edges of the chromosomes, the ends that ultimately when they unravel that causes cellular aging. And ultimately that causes human aging and death. They have normal length telomeres, these 20%. So just because you wait more than you should doesn’t mean you’re sick from it. Conversely, and this is the important part, 40% of a normal weight population BMI under 30, have the exact same diseases as do the obese normal way. People get hypertension, lipid problems, cardiovascular disease, cancer, dementia, diabetes, et cetera. Now they get it at a lower BMI. Okay. They get it at a lower prevalence, 40% rather than 80%. But when you actually do the math, they’re actually more thin sick people in America than there are fat sick people. And when you do the math, when you do the math on the two of them together, it’s more than half the us population.

Dr. Robert Ludwig (00:33:09):
And if normal way people get it too, how can it be about behavior? Right? It’s actually, it looks more like exposure. This looks more like cholera or influenza, tuberculosis, or COVID-19 for that matter. You know, some people in a, in a, in a, in a house will get it and some people won’t. So the fact is that normal weight people have this problem too. And the reason they have it is not because of the subcutaneous fat. The reason they have it is either because of the visceral fat, the belly fat, and the belly fat only contributes about four to five kilos on a scale, you know, maybe eight to 12 pounds. So that doesn’t necessarily put you into the obese range or worse yet the liver fat and the liver fat only has to rise by about 400 grams, less than a pound. And you definitely can’t see that on the scale or fatty liver, you can be sticks in and still be just as sick as you know, somebody who has got a BMI of 45.

Dr. Robert Ludwig (00:34:17):
So it’s not the fat. You can see that matters is the fat you can’t. And the problem is most people don’t know that, and they don’t know if they’ve got that problem. And there’s a name for this. It’s called TOFI T O F I sit on the outside fat on the inside real medical term, 1500 Medline citations coined by Dr. Jimmy bell at university college, London. So my question, not to you, but to your audience, is, are you a TOFI? How would you know, how could, you know, does your doctor know if your doctor knows, why isn’t your doctor telling you? And if your doctor does know, what would they do about it? How would they fix it? These are the questions that people have to ask themselves, and they can’t ask it if they don’t understand it. And that’s the reason I wrote the book.

Dr. Stephanie Estima (00:35:04):
Yeah. And I think, you know, when we think about, you know, NAFLD deep, when we think about non-alcoholic fatty liver disease, as you were saying, it used to be that it was, you know, the alcoholics problem that leads to cirrhosis of the liver, et cetera. And now, you know, this human flaw Gras, you very accurately describe in the book. You know, some of the, you know, I think some of the common line thinking might be, well, this might be because of the consumption over consumption of fat or over consumption of calories, or, you know, it’s obesity. But I think that you, you present this art argument that you can really point to fructose as disproportionately driving this snaffle D versus some of these other factors because of the, the tow fees, right? Because of the people who are the skinny fats are the thin on the outside fat on the inside. And you don’t necessarily, you’re not necessarily going to be obese if you’re over consuming fructose, correct.

Dr. Robert Ludwig (00:36:01):
That’s right. It has nothing to do with whether you’re obese or not has to do with whether or not your liver is obese or not. That’s really what it comes down to. We get a study that I think really sort of addresses this point that you just made. We took it, we did this at UCLA who we’ve published several papers on it, and we actually have a few more to go. What we did is we took 43 children from our obesity clinic at UCLA, all with metabolic syndrome, Latino, and African-American all low socioeconomic status, all high sugar consumers, cause they’re all ultra processed food consumers. Okay. And we knew that they had metabolic syndrome because they had the stuff on the back of the neck and they had lab tests that documented it. Right? So what we did was we figured out what they were eating at home and figured out their home diet, two questionnaires and pictures.

Dr. Robert Ludwig (00:36:57):
We studied them on their home diet. And then for the next nine days, we catered their meals, no added sugar. We took the added sugar out of their diet. We took their percent calories from added sugar down from 28% of calories down to 10% of calories. We gave them fruit. That’s the only place they got sugar. All the other food was chosen to be no added sugar. We kept their fat content of their diet. The same. We kept the protein content of the diet, the same. And we kept the carbohydrate content of the diet. The same. Now, if you take 20, if you go from 28% of cow, or it was a shirt down, down the 10% of calories or sugar, that’s 350 to 400 calories a day gone. And the carbohydrate content of the diet goes down, right? Well, we didn’t want that to happen.

Dr. Robert Ludwig (00:37:59):
What we did was we said, we want to keep the carbohydrate content the same, and we want to keep the calorie content the same. So for every molecule of fructose, we took out of their diet. We substituted a molecule of glucose. We gave them extra starch. We gave them more refined starch. So in the vernacular, we took the pastries out. We put the bagels and we took the sweetened yogurt out. We put the baked potato chips in, we took the chicken teriyaki out. We put the Turkey hot dog. Okay. So we didn’t give them good food. We gave them crappy food. We gave him all the trip, process food. We gave them kid food. We gave them food. Kids would eat, but it was no added sugar food. And we gave them a scale. And every day they’d stand on the scale. We call them up on the phone, which away. And if they were losing weight in order to keep their weight constant or even potentially gain weight during the course of the nine days.

Dr. Stephanie Estima (00:39:02):
So you’re controlling for calories. And you were just modifying. Even the macronutrients you were controlling for you are just changing the type of carbohydrate. Yeah.

Dr. Robert Ludwig (00:39:10):
This is a glucose for fructose exchange. That’s what we did. ISO caloric glucose for fructose exchange. That’s how we refer to the study. And then we, at the end of 10 days, we re studied all of them. Every aspect of their metabolic health, improved everything, their blood pressure went down by five points. Their blood glucose went down by five points. They had a lactate level at baseline. They didn’t anymore. You’re not supposed to have a lactate level at baseline, but if your mitochondria are not working, then you have a lactate level. They did. And when we took the sugar out of their diet, they didn’t we their, their glucose area under the curve went down 8%. Their insulin area under the curve went down 25%, which is enormous in normal with no change in calories, no change in weight. And most importantly, their subcutaneous fat stayed exactly the same because they didn’t lose any weight.

Dr. Robert Ludwig (00:40:12):
Their visceral fat belly fat went down 7%. That’s good. Their liver fat went down 22% in 10 days with no change in calories, no change in weight. And as their liver fat went down, their insulin secretion got better. In other words, we reversed the biochemical process that was leading to their insulin resistance and their diabetes. In other words, we reversed their metabolic syndrome, right, just by getting the sugar out of their diet and substituting starch. So could you imagine if we didn’t substitute the starch, how much better they would have been? So this proved to us, number one, fructose is bad. Number two, a calorie is not a calorie. Number three, a sugar is not a sugar. And number four, it’s the sugar that’s in the process. Foods that the food industry put there that is specifically causing the disease. And you can undo it even without changing your calories or your way,

Dr. Stephanie Estima (00:41:20):
Let let’s talk. Let’s, let’s go just one layer deeper in terms of this geeky science. So that I have my listeners who can understand what is happening at the cellular level. And I think this will lead us really nicely into the eight you call the eight modern diseases. They’re not really diseases that we’ll, that we’ll touch on and even talking about blood sugar. And we wanted to, we want to contrast that with insulin, right? So we’ve talked about this idea that, you know, diabetics and even, you know, in the biohacking kind of human optimization camp, if you will, you know, CGM, continuous glucose monitors have been, have become of interest, but you talk about in the book that these two PR. So when we look at blood glucose, this can often be completely unrelated to blood insulin. And I wanted to, I wanted to have you walk through, can you talk about these different checkpoints and again, sort of putting the nail in the coffin that a calorie is not a calorie, it’s actually what your body does with the substrate that matters. So when we talk about, you know, check we’ll check point ABC or alpha Bravo, Charlie, I think you call it. So we talk about the first piece. So we have insulin and then it meets sort of the first checkpoint, which is a PI three kinase you know, phosphatidyl, and also at all three counties. So let’s talk about how insulin and three, how they collaborate to flood the cell with glucose. What happens there?

Dr. Robert Ludwig (00:42:51):
So in order, so I’m glad you brought it up. So let’s, let’s step back. One step short, you mentioned the eight modern diseases that aren’t diseases, because it’s important to understand that before we get into the checkpoints, great people think diabetes is a disease. It’s not, it’s the symptom of the disease. People think heart disease is the disease. It’s not, it’s the symptom of the disease. People think Heidi LDL is the problem. No, it’s not. It’s a symptom of the problem, high blood pressure symptom of the problem. Well, what is the problem? And by the way, we only have medicines to treat the symptoms. We don’t have medicines to treat the disease. And the reason is because the disease is actually inside the cell unavailable, and we can’t get there. These true pathologies what’s going on inside the cells are not druggable, but they are a food rubble.

Dr. Robert Ludwig (00:43:50):
We can fix it with food. So here they are. I’m going to list C eight and we can talk about each and every one of them or not. Depending on time, one glycation, we mentioned this mired reaction, the Browning to oxidative stress. Every time this reaction occurs, you release a little hydrogen peroxide, which can do damage, which has to be quenched by an antioxidant. What if you don’t have enough antioxidants because you’re eating ultra processed food, number three, mitochondrial dysfunction, where your mitochondria don’t work. And we showed that because the lactate went away, right? When we actually got the mitochondria to work right by taking away the substrate, that was the, the sugar

Speaker 3 (00:44:32):
Number four insulin resistance, which we’ve mentioned now a couple of times, if your insulin is not working at your liver, then your pancreas has to make more, that raises levels all over the body and drives chronic disease elsewhere. Number five, membrane, instability, imagine yourselves or balloons. Okay. You can put, you know, try to push your finger into a balloon and it’ll come straight back. That’s called membrane fluidity. The flexibility of that. But what if you use a pin instead pumped? Okay. The point is that the more that you are a balloon is stretched. The easier it is to pump. And there are certain fatty acids that go into the membranes that give you our membranes, resiliency, the main one being Omega threes, and we’re not eating enough of those number six inflammation. And the inflammation can occur in many places in the body.

Speaker 3 (00:45:29):
But the biggest source of the inflammation is in your gut having to do with leaky gut, having to do with problems with your gut, not functioning as the barrier that it should. And it’s partly because of your microbiome. And it’s partly because of your food number seven methylation. So there’s a particular a metabolite called homocysteine that has to be cleared or it causes disease. And one of the things that helps you do that is folate. And the problem is there’s an enzyme that you need in order to do that called Metro methyltetrahydrofolic reductase. And a lot of people have mutations in it. And if you don’t, then you have to take a whole lot more folic acid to make the thing work. So methylation is a problem and it causes problems with the DNA. And finally, number eight, sort of my personal favorite called autophagy.

Speaker 3 (00:46:24):
So autophagy is garbage night for the cell. Okay. Your cell has to clear crap that it made over the course of the day. So defective membranes, mitochondria that had dysfunctional various protein aggregates that have accumulated, okay. And it, the more these accumulate, the less, well your cell works, and finally your cell will die. Okay? You got to get rid of them. And there’s a process in the cell for getting rid of them, by the way, in the brain. It happens when you sleep. And it’s the reason you need to sleep. Sleep is garbage night for the brain to get rid of all the crap that developed over the previous 16 hours. You got to sleep. And if you don’t sleep, guess what? You get dementia. And I’m not paper just came out this morning about that. So sleep is absolutely essential and it gives your body a chance to basically get rid of the junk that got made over the course of the last 24 hours. Well, food affects every single one of eight mechanisms,

Dr. Robert Ludwig (00:47:31):
And we don’t have medicines for any one of those eight, that work. So that’s why food is so important. That’s why I wrote the book. Okay. Now, to these checkpoints, each cell in your body, no matter where it is, and no matter what it is at one time in its life, it had to grow. And in another lifetime in its life, it has to burn. How does a cell know whether it should be growing or burning? Both are appropriate, but only a certain times what happens if a cell should be burning, but it’s not it’s growing. What happens if a cell should be growing, but it’s not. It’s burning. What happens? The answer is you get sick. Turns out there are three enzymes in each cell in your body that dictate growing or burning and living or dying. And those three enzymes have they’ve names.

Dr. Robert Ludwig (00:48:28):
They’re all kinases. They’re all enzymes. The first one is called PI three kinase phosphatidyl and us toll three kinase. It’s the doorway for glucose to enter the cell. It works with insulin and insulin is necessary, but PFE kindness is also necessary. It’s the enzyme that’s revved up in cancer. It’s the cell. It’s the enzyme that lets all the glucose in, in cancer. You’ve heard that cancer cells are sure hogs and they are. And the reason is because they are growing and they need energy and they need it big time. And PI three kinase is the way that the cell is able to transfer that energy from the outside to the inside. So that’s the first one. The second enzyme is called amp kinase, adenosine. Monophosphate kindness. That is the enzyme that ultimately determines whether your mitochondria are burning or turn or turning off so that you can use the carbon backbones of the glucose for other things like, for instance, DNA or lipids, where amino acids for growth.

Dr. Robert Ludwig (00:49:41):
So cancer cells don’t have mitochondria cancer cells don’t need money to country. They get their ATP from fermentation, from glycolysis, from, you know, the same way yeast do it the same way we do it in with wine. All right, they do not need oxygen. Cancer cells do not meet oxygen and auto Warburg in 1931 won the Nobel prize for figuring out the cancer cells don’t need oxygen. They need lots of glucose. And the reason is because the glycolysis generates enough ATP to power the cell. And then the cell can use the backbones of the glucose for structural phenomena. It’s like having a piece of furniture in your, in your house. Okay. You can use that piece of furniture, that wouldn’t piece of furniture for two things, you can sit on it or you can throw it in the fire and burn it, but you can’t do both at the same time.

Dr. Robert Ludwig (00:50:40):
Okay? So you can either burn it or you can grow it, but you can’t do both. The so and be is determines whether you’re burning it, whether that fireplace is going and whether you’re throwing it into the, into the furnace or not. And then the third enzyme is called [inaudible] mammalian target of rapamycin. And this is the enzyme that ultimately determines whether a cell lives or dies. So if it’s growing and it’s living, then you get growth, you know, organismal growth. This is what happens in the placenta, in the fetus. And it’s what happens in cancer. You’ve got PI three kinase going, great guns. You’ve got an P kinase turned off. Then you’ve got M Tor turned on that’s growth. On the other side, you have burning where PI three kinase is turned off and be kindness is turned on and mTOR is turned off and that’s burning.

Dr. Robert Ludwig (00:51:35):
And so you can grow, you can burn. But what happens if those three enzymes are not in order, turns out every time that one of those enzymes is dyssynchronous with the others, that’s chronic disease, different kinds of chronic disease, but chronic disease. And what makes those enzymes dyssynchronous are food. So when you eat the right food, your enzymes work together and you’ll either grow or burn depending. And when you’re eating the wrong food, you might be turning off your amp kinase. When you should be turning it on, you might be turning on your PI three kinase when you should be turning it off. And what will happen is you will flood yourself. Your cell won’t know what to do with the excess. We’ll turn it into fat. And now you’ve got chronic disease. Yeah.

Dr. Stephanie Estima (00:52:26):
And this is, this is why, you know, kind of coming back to that point where a calorie is not just a calorie, it has nothing to, you know, in some ways it’s nothing to, it has everything to do with what happens to the substrate, what ha like the cellular metabolism. And this brings us to those sub cellular pathologies that you just so eloquently described,

Dr. Robert Ludwig (00:52:50):
Right? The problem is that the calorie myth persists to this day and, you know, there are medical professionals, you know, married tourists, and, you know, they, that’s how they make their living. Some of them are doctors. A lot of them are dieticians, fuel, even dentists. But the bottom line is my job in this book is to drive the final silver stake through the heart of the calorie. The calorie must die. It when the calorie dies, then we can come out from under and we can actually start addressing the real problem, which is metabolic health, the real driver, which is insulin. And then we can actually change the food so that we can actually get healthy. But not until

Dr. Stephanie Estima (00:53:44):
Let’s talk a little bit about the intersection of your work and your career as a pediatric endocrinologist. And some of the patterns that you observed in children, you said in the book, something like, you know, pediatricians are witness to all the failed social policies that that happen in government and, and sort of the downstream effects of that. Right?

Dr. Robert Ludwig (00:54:06):
My, my colleague at Stanford, Paul Wise said that, but I totally agree with that.

Dr. Stephanie Estima (00:54:11):
So when we, when we think about, and we can, we can marry this with a conversation around big food, because I think that what we, what I have seen and you, you may have similar or you know, more color to give here is that we’re starting to see, you know, the NAFA D and some of these sub settler pathologies happening earlier and earlier and earlier, like we used to think of like, NAFLD D is like this 50 year old, you know, alcoholic. And now it’s, you know, we see it in 12 year olds and we see it in eight year olds. Is that, is that a lie alongside with what

Dr. Robert Ludwig (00:54:43):
Absolutely. So the diseases diseases are occurring earlier and earlier. So here’s what we know, type two diabetes used to be rare type two diabetes was 2.5% of the population and 5% of the population over 65 back in 1976, when I entered medical school today, it is 9.4% of the population. So it has basically quadrupled in the span of 45 years quadrupled. And everyone has no somebody who’s diabetic today. And that’s why every diabetes drug is advertised on TV directly to the patient. Okay. I mean, who would have, who’d ever thought that, but you know, this was a rare disease. Well, guess what? Now, one third of all diabetes diagnoses in children is type two, a disease we never saw in children. I actually went into pediatrics to avoid chronic disease. And now that’s all I do.

Dr. Robert Ludwig (00:55:51):
Number two, disease, fatty liver disease. So we talked about 45% of adults now have fatty liver worldwide in the America. And 25% worldwide children have fatty liver disease, autopsy specimens of Pete, of kids who die for other causes demonstrate a 15% prevalence and a 38% prevalence in obese kids, fatty liver. Now, like we said, prior to 1980, if you fatty liver, it was cause you drank alcohol. Well, kids don’t drink alcohol. So how did they get fatty liver? And the answer is they’re drinking. Sure. And sugar and alcohol are metabolized the same way. Fructose and alcohol are virtually metabolized identically. The big difference between the two is that for alcohol, the yeast does the first step of glycolysis, the fermentation for sugar. We do our own first step, but after that, the mitochondria become overwhelmed. And the mitochondria don’t care where the substrate came from. It doesn’t care if it came from fructose or it came from alcohol, ultimately, all it knows is it can handle the load and it has no choice, but to take that extra and turn it into fat. So it can, so the liver can try to get rid of it. Most of the time, it’s not very successful. And then it precipitates in the liver. Now you’ve got fatty liver disease, and that’s how kids get the diseases of alcohol type two diabetes and fatty liver disease without alcohol.

Dr. Robert Ludwig (00:57:34):
And all you have to do is look what we’re serving them from breakfast. So I wrote a editorial back in the guardian back in 2017. If, if if alcohol is the disease of the child sorry, the disease of alcohol now, the disease of the child, how do we let it breakfast cereal dominate the breakfast table, right? So, you know, if you look at the national school breakfast program is a bowl of fruit loops and a glass of orange juice as 41 grams of sugar. We’re not supposed to be giving children more than three teaspoons of sugar. That’s 12 grams. So we’re giving them 41 when their maximum for the day is 12. We are giving them triple to quadruple their total daily allotment. And it’s just breakfast. So what do saying is going to happen.

Dr. Robert Ludwig (00:58:39):
Yeah. And it’s, it’s so easy to have these modern conveniences, right? Like I know that there’s parents that are listening to this and like, Oh, but the cereal takes two minutes, the sugared oatmeal, I just put hot water and it’s there, that’s their plan. That’s why they do it. That’s exactly why they do it. That’s how the food industry infiltrated the entire us school system basically saying, give us the, you know, the the keys to your kid and we’ll provide them with quote, healthy unquote meals. And you can take your kitchens and your lunch ladies, you can take your kitchens and tournaments, you know, more classrooms, you know, for infrastructure. And you can take your lunch ladies and fire them because, you know, we don’t need food prepped in the schools and you can save money. And, you know, once you do that, and once you take those kitchens and use it for infrastructure that are going to come back, you know, it’s not like you’re going to remake the kitchen and that was their plan all along.

Dr. Robert Ludwig (00:59:50):
And, you know, if you don’t know how to cook, you’re hostage to the food industry for the rest of your life and schools today don’t know how to cook. Well, we started a nonprofit here in the Bay area called eat real, and I want all of your listeners to, you know, go online and look at, eat real.org. Our job is to get real food back into schools to fix this problem. And we have a very specific food procurement and preparation model that can be adapted and, you know Duke reduplicated in any school district in the country. And we are doing that with 213 school districts right now,

Dr. Stephanie Estima (01:00:34):
Credible. And I’ll make sure that that’s in our show notes as well for my listeners that are that want to find out more information about that. And that’s like the big, that’s like the beginning of, you know, creating the patient, right? It’s like you give them the 41 grams of sugar in the morning. And of course, they’re going to exceed that through the, you know, the next meals through the day. And you, one of the things you talked about, you know, kind of getting into big food and processed food is this idea of it’s not necessarily what the food is, but what has been done to the food that we don’t see. And I wondered if you can give a couple examples of maybe some of the, what you call fraudulent food practices or some of the things that we see in big food that parents might be like, God, I never, you know, for one of the things that I was, I I thought was really interesting was the Italian olive oil. It was in the, you know, dilution piece. You said most Italian, olive oil is neither like Italian, or, yeah. So can you talk a little bit about some examples of food fraud that we may be seeing in, in grocery stores and

Dr. Robert Ludwig (01:01:38):
There’s quite a bit of food fraud. There’s honey is the biggest one. Honey is huge. Basically if you’re buying honey in a grocery store, it’s not honey it’s chorus or with a, you know, few colorings added to it, but it doesn’t even resemble anything close to honey. There’s actually a new certified honey program that’s going on. And the problem is that those honeys, those sheep, you know, crappy non non-nutritive honeys have basically taken over the entire market. And so real honey producers can’t even sell their honey because they have nobody to sell it to because it’s too expensive. So it’s a big issue. As an example, the same is true for scotches and wines and everything, you know, on the high end too. But it’s, it’s a major problem in in in terms of food fraud around, around the world, not just in America, but it’s even more importantly is, as you said, it’s, what’s been done to the food.

Dr. Robert Ludwig (01:02:40):
So let me give you an example of what’s been done to the food that matters. Hey, let’s take meat. Okay. Do we eat meat? Okay, good. I mean, you know, some people have dumped and there are reasons and you know, sometimes it’s religious and sometimes it’s, you know, environmental and sometimes it’s, you know, costs. And, but a lot of it has to do with metabolism. People think red meat will kill you, you know, but you’ve been told by so many different sources that, you know, red meat is just going to kill you. It’s a possible carcinogen. That’s what we here at class three. You hear that too. I’m here to tell you that that is not automatically the case. Let me give you an example. In the book, I show a picture of a window. I took a Rome restaurant window when I was in Rome in 2016 and on the top was Italian beef.

Dr. Robert Ludwig (01:03:41):
And in the middle was Argentinian beef at the bottom was U S great, a prime choice, corn fed beef. And there was a very clear difference between the USB and the other two, because the USB was marbled. Now we value that marbling. We prize our meat on the basis of that marbling. Cause that marbling is where the taste is. And that marbling is where it makes it, you know, you can cut it with a butter knife. You know, you go to the you go to the steak restaurant and you know, you can practically, you know, it practically drips off the side of the plate. Right. And it’s enormous to boot, right? It’s like this, you know, you know what I’m talking about? So here’s the question is me supposed to have marbling.

Dr. Robert Ludwig (01:04:36):
I would venture no. I mean, that sounds like sarcopenia obesity in the cow sorta. Yeah. that marbling that we prize that’s intro myo cellular lipid, that’s livid inside the muscle. That animal has a metabolic syndrome, right? That animal has the same disease. We have that animal goes from birth to slaughter in six months, a normal cow from Argentina or Italy goes from birth to slaughter in 18. But Hey, birth disorder is six months has cashflow, right. Three times as fast, three times as fast. And they do it by eating corn, corn fed beef. What do cattle normally eat? They eat grass, right? And that’s why they have four stomachs. Okay. That’s why they’re ruminants. But when you eat corn, you don’t need four stomachs. The bottom line is the branch chain. Amino acids isolate seem to the Lucien and the veiling in those, in the corn, which by the way, is not just fed to the beef.

Dr. Robert Ludwig (01:05:55):
It’s fed to the chicken and the fish to those branch chain, amino acids. They flood our liver. Our liver cannot use all of them to build muscle unless you’re a body builder. So what does the body do? What does the liver do with all those excess branch chain amino acids? It has to take the amino group off has to deaminate that amino acid. So that branch chain amino acid becomes a branch chain, organic acid, such as oxaloacetate enters the Krebs cycle. Krebs cycle becomes overwhelmed in the same way. Sure. Overwhelmed it. And it throws off as fat. And so that’s the fat that those animals are producing that ends up and ending up in the muscle that leads to the marbling. That animal has metabolic syndrome. Same as us. We just kill it before it gets sick. So how do you do that? Well, you give the animal corn and you don’t just give the animal corn on the farm.

Dr. Robert Ludwig (01:07:01):
You give the animal, the corn on the KFO, the concentrated animal feeding operation, which is the in Kansas, but the corn is in Iowa. So the corn gets grown in Iowa and gets put on a railroad car and gets taken to the CAFO in Kansas where the animal eats the corn and then becomes massively obese and gets metabolic syndrome. And then we kill it. Okay. So what’s wrong with this picture? How about everything? Everything is wrong with everything. So the, the farm in Iowa used to be a family farm and there would be the cows and there would be the corn. And then the cows would eat the corn. And then the male side ate the alfalfa and the Clover and everything else that was on the farm. And they would poop. Okay. And the poop had all this nitrogen in it. And the nitrogen would that have fixed inside the ground and the grass that would, the nitrates would serve as the fertilizer for the corn so that the corn could grow. And this was an ecosystem. So the corn fed the cows, the cows fed the corn and all was right with world.

Dr. Robert Ludwig (01:08:18):
And it was, and it was solid. So it was fixed in the ground. Then we took the cows and we moved them to Kansas because we were told back in 1971 by Richard Nixon’s agriculture, secretary Earl rusty butts was that the U S agriculture enterprise had to get lean and mean. And the, he said, three things wrote a row for the furrow, get bigger, get out. That was buses message to Nebraska and Kansas and Missouri and the entire Midwest. So that led to the new monoculture paradigm, put the cattle in Kansas on the KFO and leave the farm to the corn in Iowa. Well, when you do that, you don’t have any fertilizer for the corn. So what do you have to do? You have to spray the corn with nitrogen fertilizer, that nitrogen fertilizer leads to runoff damages. The water tables ends up in the Missouri river, then the Mississippi river.

Dr. Robert Ludwig (01:09:36):
And this is the reason why we have the desert zone in the Gulf of Mexico, where you can’t fish. And we’re algae blooms are now raising temperatures around the world because of nitrogen fertilizer. And the reason you have to spray the nitrogen fertilizer is cause there’s no cows. So you were destroying your, I mean, you’re, you’re growing the corn, but you’re destroying the environment. Now you move the cows to Kansas, the cows eat the corn. [inaudible] Turns out the corn isn’t enough. They that’s actually malnutrition. It makes them obese, but it doesn’t actually gives them the nutrition to be able to stave off all of the infectious diseases that occur on the KFO with all of these cattle. So cramped together, eating they’re eating each other’s, excuse my French. So then we have to then be able to keep them from dying. We have to give them antibiotics.

Dr. Robert Ludwig (01:10:40):
And so what happens, the antibiotics kept them from dying so that they could make it to slaughter. Okay, that’s true. But the antibiotics Kearney ate the meat. We eat the antibiotics. When we eat the meat, we change our own intestinal microbiome. And so now we have both obesity and we also have irritable bowel syndrome and other inflammatory bowel disease and possibly food allergy and even other autoimmune diseases that occur because of the changes in the microbiome and what we call gut because of the antibiotics. We said the cows in order to keep them alive. In addition, we ain’t done yet.

Dr. Robert Ludwig (01:11:25):
The good bacteria in the cows and testing are very susceptible to those antibiotics. The bad bacteria are not, they tend to proliferate and a lot of them are what are known as meth antigens. They make methane. So everyone complains that the cows are bad because they make methane. And that we got to get rid of the cows in order to solve climate change, because there’s too much messing well. So happens. If you look at the amount of methane that cows produced back in 1968, there was one quarter of the amount of methane they produce today. And we had more heads of cattle back then. And the reason is because the massages have taken over. And the only reason mismanaged mismanages took over is because we had to give them antibiotics. We’re going to have to give them antibiotics. This was, we moved them out under the K phone. And the only reason we moved them on the K folk was cashflow. So we are screwing ourselves a thousand times over both in terms of the food and in terms of our health and in terms of our climate for our current ultra processed food processing paradigm, this is what the book is about.

Dr. Stephanie Estima (01:12:47):
And there are big forces there a bit, you know, and we can, you know, we don’t have to get into veganism and sort of sometimes I’ve had Rob Wolf on the podcast and he talks about this sort of a we’ll call it vegan fantasy, where, you know, we get rid of all the meat and we solve the problem. But as you’re, it’s much more complex than that. And when we, when we think about regenerative agricultural practices, as you were talking about where the cows are pooping and peeing all over the place and there, you know, the soil is, is soil. It’s not dirt, you know, it’s alive. And it has the ability to absorb some of these carbon dioxide. You know, offgassing, that’s how, that’s how we improve climate change. It’s it’s, the animals are an essential part of that.

Dr. Robert Ludwig (01:13:31):
That’s right. Soil is alive and dirt is dead. Now you can grow crops in dirt, but only if you give them a lot of fertilizer. Right. And the problem is that that leads to the runoff that leads to the climate problems. So, you know, this is not a sustainable method for agriculture. Ultimately what we used to do, work, what we do today, doesn’t the only difference is now the food’s cheaper and more quality. So is that okay? Does that make sense? And the, you know, some people are worried about food insecurity and then they say, you know, we’ve got to have enough food. You know, the fact the matter is we have an obesity disaster, particularly amongst the people who are most food insecure. And the reason is not because they don’t get enough food, they don’t get enough, good food. And Tom, Vilsack our new Agra, new, old agriculture secretary in his confirmation hearing on March 4th famously said, we have to pivot from food security to nutritional security, not to be honest with you, that is a tacit admission that our food sucks, because why would we need to do that if it didn’t right.

Dr. Robert Ludwig (01:14:50):
And the fact matter is he now gets that this is the real problem in today, but we cannot fix it with our process food culture. The only way to do this is to rethink the food we eat at, you know, at the most basic level. And the science has to drive the policy and we have the science and we have the, you know, the concepts for the policy. The problem is we also have the politics and that’s the current stumbling block. And so we have to elevate this problem in, you know, in, in Congress, you know, in the Biden administration to basically take this on, we certainly got no traction from the previous administration. We had a president who was a fast food junkie, okay. Who actually deep six, the added sugar on the on the nutrition facts label. But I would argue, and I argue in the book that is not what’s on the label.

Dr. Robert Ludwig (01:15:52):
That matters is what’s not on the label because what’s, what’s on the label is what’s in the food. What I argue is it’s actually, what’s been done to the food that matters. All food is inherently good, is what we do to the food. That’s not, then the two things that are the most famous that we do to the food. That’s not is we add sugar for palatability. We subtract fiber for shelf life. Now there are many other things like the branch chain, amino acids and the Pollyanna secret guy, romantic hydrocarbons from cooking, and then a whole bunch of other things that we do. And they’re all listed in the book and all the additives and all the food additions whose attractions, you know, food adulterations of various sorts. But if we could just agree on sugar and fiber, we would solve 80% of our food problem

Dr. Stephanie Estima (01:16:44):
In the just looking at the time, I want to be respectful of your time. We’ll you talked about politics and I wanted to make sure that we touched on the, some of the other dark forces that are keeping the sub-cellular pathologies alive and well today. And that is through you know, the we’ll call it the deep 16 from from big pharma. And you, you talk about, you know, your own education, your own experience as a medical doctor going through medical school. And I was so happy to read this. I was telling this to you in the pre-chat because, you know, so often we defer to the medical doctor as the cultural authority, for all things, health, everything from nutrition and movement and rehab and lifestyle all the way through to drugs and surgery and, you know, any, any type of intervention.

Dr. Stephanie Estima (01:17:33):
And you talk about in the book that the average medical school, I mean, we’ll talk about how, you know, big pharma tends to fund the curriculum, but the, in the curriculum, in and of itself, you know, 19.6, I think was the 19 points, like just shy of 20 hours of nutritional education in a four year medical degree, which is not even a week, it’s not a week of nutrition. So you, you make this case in the book that modern medicine is not the solution to the problem that it is the problem. Can you expand a little bit on the influences that big pharma has on educating? Because I believe that all doctors, irrespective of the letters behind your name, you get into the game because you want to make this place a better, a better world. You want to help people. And I think a lot of I’ve have a lot of friends who are medical doctors who become disenfranchised and really disappointed in the way things are and the things that they thought they could influence. They know they can’t because of, you know, regulation and standards of care and, you know, et cetera. Can you, can you explain a little bit about big pharma’s influence on on our medical?

Dr. Robert Ludwig (01:18:40):
Well, it starts at the beginning. You’re absolutely right. It starts with in the Flexner report, right? So the Flexner report came out in 1910. It’s written by Abraham Flexner, who was an educator. His brother was Simon Flexner, who was the president of the Rockefeller Institute for medical research, which became the Rockefeller university where I worked actually flexor was charged by John D Rockefeller himself to overturn the current med, the medical school paradigm of the time to make it more scientifically based. And he did that. And there were a lot of good things about the flexor report in terms of, you know, demand the evidence-base for most of the things. Because up to that point, there was a lot of folk remedy and, you know you know, a lot of, you know, just bloodletting and yeah, you know, chronology, you know, flashing it did that, but he, he was charged very specifically.

Dr. Robert Ludwig (01:19:45):
And so was Simon Flexner very specifically with helping Rockefeller into a new industry. So obviously, you know, the oil industry, you know, standard oil standard oil created a huge amount of a bi-product cold, cold tar. And he didn’t what to do all that cold hard, but it was found back in the late 18 hundreds, the culture was good for various problems, medical problems, such as eczema and psoriasis, and several other things, when you paint it on actually ends up causing cancer. But he didn’t know that at the time. But actually called tar is still used as a base for many, many other products. And he wanted basically to, to push coltart. And so Rockefeller Institute set up in 1901 to investigate the uses admitted medicinal uses of cold tar in order to grow John D Rockefeller’s second business. That’s what happened well in the process, nutrition was completely left out.

Dr. Robert Ludwig (01:20:56):
Now the Flexner report came out in 1910, the first vitamin Simon was isolated and discovered and published on in 1912, there was nothing in the Flexner report about nutrition, nothing. Well, now we know that there are vitamins and then after Simon came, you know, niacin and then came, you know, the whole slew, riboflavin, et cetera. And, and, you know, I mean, we were in the grand stage of, you know, vitamin a understanding of nutritional deficiencies. Did it change medical school, education or practice? No. Did it change the Flexner report? Was there an identity? No. In fact, the matter is big pharma grew up from that Flexner report and they started funding medical education. And the last thing in the world they wanted you to know was that you could actually fix any diseases with food. And so doctors don’t learn nutrition. And today 28% of medical schools have a nutrition curriculum.

Dr. Robert Ludwig (01:22:03):
What about the rest of them? And as you said, even the ones that do only get about 19.6 hours. So the bottom line is doctors don’t know a thing about nutrition. The only reason I did it was because I majored in nutritional biochemistry in college. So perhaps I was set up for this, you know, ready for this. In fact, when I went in and talked about, you know, nutritional biochemistry to my professors in medical school, I was basically shut down. I said, no, we don’t do that. You know, it’s all about calories. And so my finger, you know, these are the guys, you know, who practicing medicine, I guess, you know, I better listen to them. And so for the first 20 years of my career, I practiced like they did, and I wasn’t making anybody better. And, you know, then I started doing research and on this, on this subject, I had been doing the research on sex differentiation of the brain up to that point. But then I started doing obesity research and cause leptin had been discovered. So I was trying to figure out what the story was left in was, and you know what the data didn’t match the party line. In fact, the data matched what I had learned back in college. And so it became very clear to me that there was something going on to suppress this information,

Dr. Stephanie Estima (01:23:20):
Like consensus medicine, like what we would call consensus. You know, it’s like the majority of people are gonna agree on it. And then we’re not really going to discuss it. There’s no scientific discourse around different ideas.

Dr. Robert Ludwig (01:23:33):
That’s right. And what I’ve come to realize is that big pharma has more than a vested stake in the outcome. And so they want to keep the status quo. And so in the book, I very specifically say, doctors need to unlearn nutrition. Dieticians lost their mind. They still believe in calories. Yeah. Dentists lost their way because of fluoride. And the last is because big pharma was their teacher, right?

Dr. Stephanie Estima (01:24:06):
Hello, big pharma wants big pharma gets, you know, like they have for every, I think there’s a stat. You said in the book, every dollar that they spend on R and D there’s like 19 or 20 bucks spent on promotion of said product.

Dr. Robert Ludwig (01:24:19):
That’s exactly right. Yeah. So this is what’s wrong. And the question is, can we fix it? And the answer is we can fix it, but we have to want to fix it. But when you realize that there’s really no choice that what we’ve got today is unsustainable. I mean, we’ve got $1.9 trillion a year, going down a rat hole in healthcare for things that don’t make anybody any better. And you know, that social security and Medicare will both be broke by the year 20, 29. We really have no choice. We have to, you cannot fix healthcare until you fix health. You cannot fix health until you fix the diet. Then you cannot fix diet until you know what the hell is wrong. And we know what the hell is wrong, but we have to want to fix it.

Dr. Stephanie Estima (01:25:12):
You are my friend, a woke doctor. This book, I cannot recommend this book enough. I was telling you the pre-chat, I’ll tell my listeners like 70 pages of notes. I took on this bad boy and tell people where they can find the book where they can find more of your work. This is not your first rodeo with writing books. You have previous books tell people where they can find you your work and where they can purchase.

Dr. Robert Ludwig (01:25:40):
Thank you. So so I have a website that Robert lustig.com where you know, you can find my entire CV, you know, LinkedIn, et cetera, metabolically.com is the website for the book. I want to mention that the book has 1000 just before references to the primary literature on purpose. Now, if we put those 1054 regiments is between the coverage, that would have been an extra 70 pages. And that would have been, I don’t know how many thousands of trees and it would have been five extra bucks per copy. So we made a conscious decision to Harper Collins and our rights that we would put the bibliography online. So you go to metabolically.com. You pick the chapter, you’re in, you look at the page number and the links for all of 1054 references are right there. And we have to do is click. And it will take you right to the primary source information so that you can know that I am making this crap up.

Dr. Stephanie Estima (01:26:47):
Amazing. So we will have those Robert lustig.com, metabolically.com. And you wrote fat chance, I believe with your previous book back in, was it 2012?

Dr. Robert Ludwig (01:26:57):
Yeah. 2013 was about diet and physical health. The hacking of the American mind in 2017 was about diet and behavioral health. So addiction and depression, and now metabolically tries to combine both the physical and mental health issues by explaining that is not what you eat. It’s what you do with what you eat, except that’s not even right, is really what they did with what you eat. And that is the reason I wrote the book. Fat chance argued. It’s what you do with what you eat is the metabolism that matters. And this book argues that the reason our metabolism has to console rye is because of what they did to you. You need to know it in order to protect yourself and in order to fix it,

Dr. Stephanie Estima (01:27:53):
I can’t tell you how much I appreciate your time today and your brilliance. And it really does read like a like a kiss and tell, as you’re saying

Dr. Robert Ludwig (01:28:02):
Diabetes, that’s really a person.

Dr. Stephanie Estima (01:28:05):
Yeah. I love it. And I, I think this book is just extraordinary and I I’m wishing you the best of luck with it. And we will shout this far and wide, and this will come out the week that your book also debuts. So thank you for your time today. And and your work. I cannot tell you,

Dr. Robert Ludwig (01:28:21):
Thank you for, you know, you know, shall we say devouring it, I have devoured it. Yeah. It’s pretty sick,

Dr. Stephanie Estima (01:28:32):
But not marble.

Dr. Stephanie Estima (01:28:39):
All right. There was my awesome conversation with Dr. Lustig. I hope that you enjoyed it. Please pick up his book. And I wanted to take the time to shout out one of a podcast review that recently came in. And I think that these are really special. I think that what is so impressive to me is that people, the time to write reviews to let me know what they’re thinking of, the podcast, both the good and the bad. I read them all. And I take all of them in with love. This is coming from more than clean co from the U S of a the podcast review title is brilliant and beautifully done. I’m so thankful. One of my friends, heart Haven mentioned this brilliant beauty in a post several months ago. Not only is listening to her pleasing to my ears, but my body is getting better for it.

Dr. Stephanie Estima (01:29:35):
I love all the topics and all the guest speakers. Thank you, Dr. Stephanie, for sharing your wisdom and your love. Well, thank you for taking the time to write this review and thank you to heart Haven for mentioning the pod. Of course, I’m always, you know, whenever you get a review where it’s like, you know what you really got to listen to, you gotta listen to Dr. Stephanie or what I’m hearing with the book. The Betty body is that there are book clubs now for the Betty body, that women are buying it for their girlfriends. Like those are the best ways that you can thank me. You know, I do have, I read a lot. I have a lot to share both my brain and my heart, and this is one of the highest compliments that I can receive. So thank you very much. And if you feel like this podcast is worth reviewing, please do so on iTunes, on Spotify, wherever you listen to the pod. I know that an iTunes, you can either leave a five-star review or five-star rating rather, or a written review. And I would love to see those come on in.

Speaker 5 (01:30:34):
Thank you again, and we’ll see you next time. I hope you enjoyed today’s episode for those of you who want to continue on this week’s geeky magic carpet ride with me, visit better show.co forward slash show notes. You’ll find research links, summary notes, musing that I prepared in preparation for the podcast. And I often throw in some of my best practices, bonuses, and links. All the juicy bits are in there for you.

I’m Dr. Stephanie

Part geek, part magic, and all the way passionate about being a well-lived woman.

I want to throw my grandkids in the air in my 70’s. I want to be squatting even more weight than I am now, and putting my OWN luggage in the overhead bin. Sound like weird goals? For me these are just some of the little things that represent a life well-lived.

My health is MY job – I’ll be damned if I rely on luck, ‘good genes’ or a cocktail of drugs that over promise and under deliver.

The Betty Body is my first book-baby, and a collection of what I’ve learned after thousands of clinical hours, hundreds of conversations with the world’s top experts, and most importantly…

This book is an outline of what took ME from “rock-bottom health” at 38, to being my own version of a Betty in my perimenopausal mid 40’s. A woman who is physically strong, full of energy, enjoys mental clarity, great sex and a joyful family life. Is it all roses? Of course not. But I have the stamina and tools to deal with the push and pull of life so that it doesn’t turn into chronic stress.

I want this for you too. Let’s go Bettys!