We all know by now that sugar can lead to weight gain and cavities. But there is a lot about how sugar operates that we may not have realized before. The truth is that it ages us on the inside and out (causing wrinkles, for example). It shortens our lifespan. It leads to many modern diseases rooted in mitochondrial and metabolic dysfunction.
Dr. Robert Lustig, endocrinologist, professor, and author, explains just how serious the situation is, on today’s podcast. He uncovers the problem of hidden sugars in our food and how it weakens our immune system, making us vulnerable to sickness. He offers numerous suggestions for how to reduce our exposure to sugar and what to eat in its place.
Visit Robert’s website: robertlustig.com
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Within the below transcript the bolded text is Hilda
Sugar’s negative effects on the human body are better known than ever before. These include metabolic disorders, weakened immune systems and much more. Why is it that so many of us still seek out the sweet stuff knowing very well that it’s not good for us? This is episode 252 and our guest is Dr. Robert Lustig. He is an endocrinologist, a professor, author and sugar expert. Robert helps us understand why we find sugar so addicting and what we can do about it but he also digs deep into sugar’s detrimental effects.
He describes in detail what sugar does to us on a cellular level, including glycation and oxidative stress. He explains how it messes with mitochondrial function and leads to a cluster of diseases that we generally attribute to aging, such as cancer, dementia, diabetes and fatty liver disease. Importantly, Robert gives us ideas on how to avoid our exposure to sugar and why it’s so critical to do particularly with all that’s going on. Before we get into it, a quick shout out to our sponsors.
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Welcome to the show, Rob.
It’s my pleasure, Hilda. Thanks for having me.
We have all heard by now that sugar is bad for us. If we have heard the message so much, why is it that we are still consuming it so much, Rob?
For the same reason, we have heard that opioids are bad for us and we are still consuming those, too. Nicotine’s bad for us but we are still smoking cigarettes. That’s the definition of addiction. You know that something is hurting your health, family, economy, community and livelihood, and you are powerless to stop it. The difference is that for nicotine, heroin or street drugs, you know you are consuming it for sugar. You don’t know it because it’s in all the food that has been put there by the food industry specifically to keep you coming back. You don’t know that you are consuming it. You don’t know that there’s sugar in your salad dressing and in your bread. If you don’t know, then how would you be able to do anything about it?
Everyone is addictable to sugar, but that doesn’t mean everyone is addicted dead.
We think we have weak willpower because we are like, “I don’t know why I can’t stop eating this,” bread, chips or what have you. It’s because that sugar in there is keeping us addicted or at least that’s part of the equation.
Once upon a time, we didn’t even have the phenomenon of addiction. We assumed everyone had weak willpower. Now, we know a little bit more about the nature of the psychiatry involved in addiction. We classify it as a disease rather than a character flaw. The fact of the matter is everyone is addict-able to sugar. That doesn’t mean everyone is addicted. Like alcohol, so 40% of Americans are teetotalers. They don’t touch this stuff. Forty percent are social drinkers like me. I can pick up a beer and put it down and it’s no problem.
On the other hand, 20% have a hardcore problem and 10% are honest to goodness alcoholics. What determines which of those bins you are in? It’s probably about the same for sugar. We don’t know what those are yet. We have some data on it but we are still trying to fair out what constitutes sugar addiction in which patient.
Let’s say I fall into the bin of I can handle it. As I’m not addicted, I can take it or leave it. Is it still doing the damage to me that it’s doing to the person who can’t let it go?
Yes, it’s doing it to everybody because of the nature of the biochemistry of the fructose molecule. Fructose and glucose are the two molecules in dietary sugar. Sugar cane, high-fructose corn syrup, whatever. Glucose, for lack of a better word, is safe. It’s not really safe but it’s not nearly as bad as fructose. 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.
Glucose is necessary for life. It is not necessary to eat for life because your body makes it but it’s not sweet. Do you see people going around chugging Karo syrup? That’s glucose. Do you see people walking around chugging Molasses? That’s glucose. This is okay in a cookie but does anybody drink Blackstrap Molasses? No. Fructose, on the other hand, is the other molecule in sugar and it’s sweet. It is completely vestigial to all vertebrates. All your choreatic life.
There is no biochemical reaction in the body that requires dietary fructose but it is part of sugar. It is the molecule that stimulates the reward center. Glucose doesn’t. Fructose does. Anything that stimulates the reward center is going to keep you coming back for more because this feels good. I want more. The extreme leads to addiction. Fructose is the molecule that leads to addiction.
Fructose is the molecule that makes sugar addictive and makes it a problem that it is. The reason fructose is a problem is not because of its addiction. The reason is because of its toxic side effects and it does two things of glucose does not. One is it makes the liver turn fructose into liver fat and that liver fat drives chronic metabolic diseases like Type 2 diabetes and heart disease.
The second thing it does is it drives the aging, the browning or the Maillard Reaction. The reason banana is brown, we paint our ribs with barbecue sauce, we have wrinkles and we have cataracts. That’s all fructose binding to proteins in our body. When it does that, it makes those proteins less flexible. If it happens in your arteries, that gives you arteriosclerosis or hypertension. If it happens in your brain, you get Alzheimer’s disease. This phenomenon of glycation of the Maillard Reaction, which is driven by fructose seven times faster than glucose, is the reason why it causes all of these metabolic disturbances. That is the difference between fructose and glucose.
This is fascinating and mind-blowing. The first bit when you were mentioning about the liver getting more fatty. I had heard in the past that fatty liver disease was seen with a lot of alcoholics but now I have heard that more people have it. Do you think it’s because of this intake of fructose?
Why do children get a fatty liver disease? They don’t drink alcohol. Prior to 1980, if you saw a fatty liver disease in a patient or under a microscope, that was alcohol. In 1980, the first patient was diagnosed with non-alcoholic fatty liver disease. Now, 20% of all children have non-alcoholic fatty liver disease and 45% of all adults. As we have talked about, not that many adults consume alcohol. It’s because they consume sugar instead. The reason is that fructose and alcohol are metabolized almost exactly the same by the liver. After all, where do you get alcohol from? Fermentation of fructose. It’s called wine.
The big difference between the two is that for alcohol, the yeast does the first step called glycolysis. For fructose, we do our own first step. After that, the mitochondria in our liver, the little energy-burning factories inside our liver, don’t care where it came from. When they have to deal with excess, then they get sick so it can be alcohol or fructose. It could also be branched-chain Amino acids, which is what’s in corn-fed beef or it could be trans fats. All four of those are metabolized virtually, identically in the liver and so they all contribute to metabolic syndrome.
Rob, when you look around at the population, are you internally saying to yourself, “If only they knew this information.” I feel like people are burdening their bodies and think it’s a harmless little habit to have an extra piece of fruit after dinner or to have that piece of the pie.
Fruit is not as bad. The reason fruit is not as bad is that fruit has fiber. The fiber limits the absorption in the GI tract so that less of it gets to the liver in the first place and more of it ends up feeding your intestinal bacteria. Fruit in its native form is fine. Fruit juice, where the fibers were stripped away, that’s a problem. The pie is a different story. The fruit is not the problem. The pie is the problem.
Let’s be clear about what’s going on. Would it make a difference to people if they knew this? It would to some and it has to some. Unfortunately, it hasn’t to enough people and it certainly hasn’t to the food industry as they continue to apply more products with extra added sugar on purpose because they know that when they do, you buy more.
What is the metabolic syndrome that you mentioned? What does that look like?
Metabolic syndrome is a cluster of diseases, Type 2 diabetes, hypertension, cardiovascular disease, lipid problems, polycystic ovarian disease, non-alcoholic fatty liver disease, cancer, dementia. These are all chronic metabolic diseases that have at their core mitochondrial dysfunction. These mitochondria are not doing what they are supposed to do and because of it, these various phenomena occur. There is a count of eight sub-cellular pathologies that belie these diseases of metabolic syndrome. I can name them for you and fructose drives them all.
Number one, glycation. Glucose binding to proteins, the Maillard Reaction. Oxidative stress so every time that reaction occurs, a little hydrogen peroxide gets released, which can do its own damage like what you put on your wound on your skin but if that happens inside a cell, all that bubble and fizz that occurs inside your cell could kill you. Mitochondrial dysfunction because your mitochondria aren’t burning, so they turn it into liver fat. Insulin resistance because that extra liver fat drives pancreatic insulin secretion because the liver is not doing its job. The pancreas has to make more insulin.
Membrane and stability, so the membranes of your cell have to be deformable. When they are not, then the cell can break and that releases its contents and causes inflammation, the inflammation that comes with that. Methylation, which is when DNA gets a methyl group on it and it changes, whether or not it gets transcribed properly. It can alter various metabolic processes in the body.
Lastly, autophagy. Autophagy is clearing out old, dead senescent cellular debris so that it doesn’t build up like garbage at night. If you don’t have garbage night, your house is going to stink fast. If you don’t get rid of all the excess junk, you are going to end up very sick fast. Fructose damages each one of those eight sub-cellular pathologies. Each of those belie, these chronic metabolic diseases that we currently attribute to metabolic syndrome. We assume these are diseases of aging. They are not. They are diseases of diet.
We need to stick with that because I had heard that sugar ages us, Rob, but I thought they meant it ages our appearance. You are saying it ages us on the inside.
They ages ourselves. We know that because it changes telomere length, which is a marker for biological aging. It changes us on the outside because it’s the cause of wrinkles, the sun too. Sun does its own damage but sugar does its own damage and it causes wrinkles, cataracts, and cardiovascular disease because it causes decreased flexibility of your arteries, putting your coronary arteries.
Like we want our muscles and our bodies to be agile and flexible in terms of their strength and their ability to bend over to get something, we want the inside of us to be flexible, too.
The problem is that there’s no medicine for that. The only thing you can do is reduce the exposure but we can’t because our food has been contaminated.
Glucose is the energy of life. Every cell on the planet burns glucose for energy.
What would you recommend that we do then? I suppose if we ate a little bit more like the Wise Traditions folks do, a little more real whole food, we are not going to be getting that hidden sugar in there.
Sugar has been added to all processed food but real food is pretty low in sugar and high in fiber, which is exactly what you want in order to protect your liver and feed your gut. Those are the two things that ultimately determine, whether a food is healthy. Any food that does both protects your liver and feeds your gut is healthy food. Any food that does neither, that’s poison. Any food that does one or the other but not both, it’s in the middle somewhere. Real food does both.
Real food doesn’t usually come on the supermarket shelf with a label with words you can’t pronounce on the ingredient list.
What I tell people is if food comes with a label, it’s a warning label.
Coming up, Robert talks about the direct and indirect effects of sugar on the immune system and its role in making us more vulnerable to viruses.
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The one thing we haven’t talked about yet, Rob, is how sugar affects our immune system. Can you speak to that?
Sugar has direct and indirect effects on the immune system. The direct effect is probably mediated through a leaky gut. Leaky gut is a phenomenon in the intestine. This is a little complicated but I will try to explain it. Your intestine is outside your body. It’s a tube that runs through your body and nutrients get broken down into single molecules, then get absorbed across the intestinal epithelium and into your bloodstream.
Most of the other junk stays in the intestines and it goes out in your poop but the cells of your intestine approximate each other. They don’t let stuff get across that shouldn’t get across. The way those cells approximate each other is they have junctions that keep them tight. They are called tight junctions. These tight junctions have a protein called zonula occludens. These are the proteins that are defective in celiac disease.
What happens is when those zonulas are defective, the cells aren’t able to approximate each other. They can develop pores through, which bacteria or toxins from the intestine can get into the bloodstream. We call that leaky gut. When those toxins get into the bloodstream, your immune system will get hyperreactive to those. You will end up developing, say, an autoimmune disease, potentially a food allergy or you will generate white cells against toxins, which will cause inflammation and generate metabolic syndrome.
All three of these things, food allergies, autoimmune disease and metabolic syndrome have all been going up in the last several years since the advent of processed food. This concept of leaky gut is clear and real. The question is, “How does fructose, in particular, manage that? How does it make that happen?” That’s still a matter of research. It’s a bone of contention but what we think is that fructose depletes the intestinal cells of ATP, which is the energy of the cell. Those zonulas, proteins that keep the integrity of the intestine, the ones that are defective in celiac, those are ATP dependent. What would happen to cells that are trying to approximate each other when you take away their energy source? Leaky gut.
We know that sugar drives endotoxin production in the bloodstream, which you can then treat with antibiotics, which is not a good thing to do in humans for all sorts of reasons. Experimentally, we know that that happens. We can measure the lipopolysaccharide, the toxic substance that bacteria give off in the blood of animals and humans after they have consumed high-sugar meals. We think that intestinal changes, it is leading to alterations in our immune system because of the traversing of the intestinal barrier by toxins that are supposed to stay inside the gut lumen but ended up in the bloodstream because of the association of the integrity of the intestine.
This proves my little theory I would always tell my mom, “Mom stop drinking soda. Sugar isn’t just neutral. It’s a robber. It’s stealing you of things,” but I didn’t realize it was stealing the ATP.
That’s the direct effect, then there are indirect effects. Anything that generates a high insulin level is going to also alter your immune system through changes in toll-like receptors on cells like what vitamin D acts on. Vitamin D is an immune modulator as well. This whole COVID-19 thing has brought this to the fore. It turns out that the portal into cells for COVID-19 is called ACE2, Angiotensin-Converting Enzyme 2. It’s a hormone receptor that, as an endocrinologist, I deal with. It turns out that’s the door that the virus uses to inject its RNA into the cell to make the next cell infected and replicate, drive the disease. It turns out insulin regulates ACE2.
The higher your insulin goes, the more doors you have for COVID-19 to infect you and possibly kill you. It has been shown now numerous times in numerous cities that all the patients who are dying of the disease fall into three categories, Black, obese, and pre-existing conditions. All of those are diseases of metabolic syndrome like diabetes. What do those three demographic groups share? Process food.
Was that first category African-Americans?
Sixty percent more sugar per capita than Caucasians do. They have way higher insulin levels.
Without a thought, these food companies keep promoting their sugar-laden touting these poisons as wonderful foods for people and they are wreaking havoc on the population.
We are trying to do something about that but it is a very heavy lift, as you can imagine, especially because when people are stressed, what do they do? They go for processed food. If you go to the store, you will see what’s missing. The pasta, breakfast cereal and candy, which is exactly the wrong things to be purchased now.
Rob, that leads me to my next question. Let’s say we are ready to roll. We are like, “You have converted me. I want to go lower sugar. If not, no sugar.” Where would I start with that?
Be careful at the grocery store. If it has a label, it’s a warning label that almost always means that it has been processed in some fashion. Most of the time, what’s happened is that the fiber has been removed for shelf life and the sugar has been added for palatability and so you have to be very wary. Shop around the outside of the supermarket, as so many people have told you. The meats, dairy, produce, and pretty much anything that’s on a shelf must be considered toxic until proven otherwise.
Real food is low in sugar and high in fiber, which is exactly what you want to protect your liver and feed your gut.
It’s the way you should approach the supermarket. Best to go to a not whole foods but a farmer’s market where they are selling produce and meats without processing but that gets expensive. We recognize that eating right is unfortunately a privilege in this country, not a right. It’s one of these things that distinguishes social disparities in terms of disease and is through this mechanism. Processed food has to be considered poison at this point. Anybody who consumes it is leaving themselves all vulnerable.
These are wise words. I know Dr. Price would agree with you wholeheartedly. Our foundation’s first principle is to avoid denatured and refined foods. You are right on target with what you are saying. I hope we can take these to heart. I want to ask you, Rob, the question I often pose at the end. If the audience could do one thing to improve their health, what would you recommend that they do?
The standard answer is the single one thing. The problem is that people think Cheetos is food. As long as you think Cheetos is food, there’s no hope for you. It’s that simple. At this point, you have to read labels. Reading labels sucks. The information that you need to know isn’t even on the label. I’m writing a book now it will be out in 2022. The provisional title is Food Pharma Feds Fiasco. What I will argue in this book is that it’s not what’s in the food, it’s what has been done to the food that matters.
All food is inherently good. It’s what we did to the food that’s not. Unfortunately, what we did to the food is not listed on the label. The information you need to know is not even provided to you but there are some things you can glean that will help in terms of your understanding, what you are putting in your mouth. Have you ever seen a real farm fresh egg? The yolk is not yellow. It is deep orange.
A lot of people think, “That egg is spoiled because it is deep orange.” No, that egg is filled with Omega-3s, which is exactly what you want because the animal was pasture-raised as opposed to on a CAFO, Concentrated Animal Feeding Operation, where they get crafted. There are things you can know and things you can do to try to up the game on your own food intake. You have to be a discerning shopper.
We have a shopping guide. It’s available online for $3. We only include brands that we believe in that maybe have better ingredient lists. That reminds me, do you have any guides so people could know like what the code words are for sugar on the ingredient list or anything like that? Maybe we could make that available to the audience.
It’s on our website. My nonprofit’s website is called Eat REAL. There are 56 for sugar. There are more than that. I wrote an eBook called Sugar Has 56 Names: A Shopper’s Guide. There are names for sugar that you have never heard of before. Demerara, Panocha, all things that you didn’t know were sugar. The reason is that the food industry could list the ingredients by mass. A different sugar can be number 5, 6, 7, 8, 9, what you ended up with is number 1 and you don’t know that because they are further down the list. They do that on purpose. It’s a big problem. Unfortunately, the USDA and the FDA allow the food industry to get away with this on purpose so that they can sell food around the world.
What do you mean?
We have exported our food to the rest of the world and they make money and our government makes money on the tariffs. It’s good for them, the government and the food industry. It’s bad for us. If we told people what’s in the food, they probably wouldn’t buy it.
They think that what’s on the store shelves is food but it’s a Frankenfood as some people call it.
That’s one way to consider it. It’s what has been done to the food that matters. Until we have a rational labeling and classification system, we are still going to end up being in this boat. There is a system out of Brazil called the NOVA System that classifies food based on its degree of processing. There are NOVA Classes 1 through 4.
Four is the ultra-processed food where there are more than five ingredients and things have been taken out and things have been added in. Numerous studies have now shown that it is that Class 4 that causes disease. This would be a food classification system. We here in the United States could adopt but the USDA will have nothing to do with it because then the food industry would be banned.
You have given us a lot to think about. Thank you so much for your time.
It’s my pleasure. I wrote a real food cookbook back in 2014, called The Fat Chance Cookbook. Our nonprofit has put the contents of the cookbook online for free so that people during this COVID-19 pandemic have access to real food recipes that they can, then make at home. All one-half hour or less, the most complicated piece of equipment you need is a blender. They are all vetted by Mt Diablo High School students to be producible, consumable and delicious.
Thank you so much again, Rob. This has been great.
It’s my pleasure. Thank you.
Our guest was Dr. Robert Lustig. Visit his website, RobertLustig.com for more resources. You can find me at HolisticHilda.com. For a review from Apple Podcasts. “Love the fearless content,” is how Mrs. Ford starts. “The content shared on this show is fabulous. There is no topic too taboo to discuss and it is so refreshing to have a resource for this vital information. Thank you.” Thank you, Mrs. Ford, for your review. If you love this show, go for it. Rate and review it on Apple Podcasts and we may read your very review on an upcoming episode. Thank you so much for reading, my friend. Stay well. Hasta pronto.
About Dr. Robert Lustig
Dr. Robert Lustig is 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 the diabetes, obesity and metabolic syndrome epidemics, and on addressing changes in the food environment to reverse these chronic diseases.
In his New York Times best selling book Fat Chance: Beating the Odds Against Sugar, Processes Food, Obesity, and Disease, Robert documents both the science and the politics that have led to the current pandemic of obesity and chronic disease. In the Fat Chance Cookbook, Robert provides practical examples for applying healthy eating principles with recipes by Cindy Gershen.
Dr. Lustig is a neuroendocrinologist, with basic and clinical training relative to hypothalamic development, anatomy, and function. Prior to coming to San Francisco in 2001, he worked at St. Jude Children’s Research Hospital in Memphis, TN. There, he was charged with the endocrine care of many children whose hypothalami had been damaged by brain tumors, or subsequent surgery, radiation, or chemotherapy. Many patients who survived became massively obese. Dr. Lustig theorized that hypothalamic damage led to the inability to sense the hormone leptin, which in turn, led to the starvation response. Since repairing the hypothalamus was not an option, he looked downstream, and noted that these patients had increased activity of the vagus nerve (a manifestation of starvation) which increased insulin secretion. By administering the insulin suppressive agent octreotide, he was able to get them to lose weight; but more remarkably, they started to exercise spontaneously. He then demonstrated the same phenomenon in obese adults without CNS lesions.
The universality of these findings has enabled Dr. Lustig to weave these threads together into a novel unifying hypothesis regarding the etiology, prevention, and treatment of the current obesity epidemic, and the role of our environment in the biochemical changes that promote weight gain. This has led him to explore the specific role of fructose (half of sucrose and high-fructose corn syrup) as a specific mediator of both chronic disease, and continued caloric consumption. His acclaimed YouTube video, “Sugar: The Bitter Truth” continues its popularity with the lay public.
A native of Brooklyn, New York, Dr. Lustig went to Stuyvesant High School in Manhattan, graduated from Massachusetts Institute of Technology in 1976, and received his M.D. from Cornell University Medical College in 1980. He completed his pediatric residency at St. Louis Children’s Hospital in 1983, and his clinical fellowship at UCSF in 1984. From there, he spent six years as a post-doctoral fellow and research associate in neuroendocrinology at The Rockefeller University. He has also been a faculty member at the University of Wisconsin-Madison, and the University of Tennessee, Memphis. In 2013, Dr. Lustig received his Masters in the study of Law from University of California, Hastings to enable him to impact the food industry through policy change.
Dr. Lustig has authored 125 peer-reviewed articles and 73 reviews. He has mentored 20 pediatric endocrine fellows, and trained numerous other allied health professionals. He provides endocrinologic support to several protocols of the Children’s Oncology Group. He is the former Chairman of the Ad hoc Obesity Task Force of the Lawson Wilkins Pediatric Endocrine Society, a member of the Pediatric Obesity Practice Guidelines Subcommittee of The Endocrine Society, a member of the Obesity Task Force of the Endocrine Society, a member of the Pediatric Obesity Devices Committee of the U.S. Food and Drug Administration, a member of the Bay Area Board of Directors of the American Heart Association, and a member of the Steering Committee of Health Foods, Healthy Kids of the Culinary Institute of America. He also consults for several childhood obesity advocacy groups.
Dr. Lustig lives in San Francisco with his wife Julie and two daughters. Spare time (what little there is) is spent cooking, theater-going, and traveling.
- Robert Lustig
- Eat REAL
- Sugar Has 56 Names: A Shopper’s Guide
- The Fat Chance Cookbook
- Apple Podcasts – Wise Traditions
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