8 Reasons Why Obesity Isn’t the Problem & Metabolic Dysfunction Is | Dr. Robert Lustig | Dave Asprey

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You're listening to Bulletproof Radio with Dave Asprey. My guest today is Robert Lustig, who is a pediatric neuroendocrinologist who spent 40 plus years treating and finding ways to prevent obesity, diabetes, New York Times bestselling author of several books about sugar, processed foods, and what happens when we get fat. And this is personal for me because I weighed 300 pounds. I got very heavy as a teenager. By the time I was 23, I hit 300 pounds. And if I'd have known what he knows, it wouldn't have happened. And if I'd have known of his work When I was 20, which did exist when I was 20, it would have helped me greatly. But I didn't. And his newest book is looking at eight pathologies that underlie everything that happens with chronic disease. And he just teaches us how processed food has impacted our health, our economy, our environment over the past 50 years. Basically, this is how we've been screwed by Big Food. In fact, you should have used that title. Welcome to the show, Dr. Lustig.

Thanks so much for having me. I appreciate the intro. I've only actually been doing obesity work for about 25 years, so. So before that I was taking care of short kids, but the short kids got fat on me.

Oh, man. I guess if you can't grow up, you grow out. Is that how it works?

Yeah, something like that. Horizontal, not vertical.

Essentially. Did you learn a lot from working with growth hormone deficient kids and all that? Did that tune you into metabolism?

Oh, absolutely. Growth hormone is extraordinarily important in terms of a metabolic. Not just growth factor in terms of height, but also metabolic factor in terms of lipolysis. So growth hormone deficient kids have fat depots in places they shouldn't have fat depots. My colleague here at ucsf, Ethan Weiss, has done a phenomenal job of being able to actually discern how growth hormone does what it does and why. Patients who have growth hormone receptor deficiency, I.e. laron dwarfism, even though they become markedly obese, are actually protected from chronic disease such as type 2 diabetes and heart disease, and has to do with what's going on in the liver versus what's going on in the fat.

Are you on growth hormone now?

Myself, I wish. No, I'm not.

What do you mean you wish you could get on growth hormone?

Oh, first of all, it's about 40,000 a year. Second of all, I don't have that kind of money. I'm an academic. And number three, I, um, I'M not that kind of guy. I rather do it with food.

If you could get growth hormone for free, would you take it now?

No, not at this point.

Okay. You wouldn't. I was. I was wondering about that. Because you know a thing or two more than the average bear about that.

I do.

Why wouldn't you go on growth hormone?

Well, in part because there's nothing that diet and exercise can't do that growth hormone does do, and why take the risk?

Fair point. And before we get into your new book, which has some pretty profound quotes on it, Dale Bredesen, who is just a fantastic doctor, a friend who's been on the show wrote the end of Alzheimer's. He calls you a modern Copernicus and says you have the expertise to recognize the charade of processed food encouraged to tell the truth, which is awesome. So, guys, if you're looking for the.

Book, it was quite the comment, and I thanked Dale for it. I don't know about the Copernicus part, but whatever.

At least he didn't call you Galileo because they burned that guy at the stake. So if you're going to have an old, wise person to be your spirit person. There you go. And Dale is one of those guys who just unpacked Alzheimer's. And the interview with him is one of my favorites on bulletproof radio.

Well, the fact is that what Dale showed is exactly what I show. And the reason is because Alzheimer's and type 2 diabetes are virtually identical in terms of what the mitochondria in either your liver or your brain are doing. So what Dale writes about is what I write about. The overlap is really remarkable.

If you get diabetes, your chances of getting, well, Alzheimer's or cancer or cardiovascular disease or pretty much having bad luck from a health perspective, seems like it goes up, right?

Absolutely.

And you've dialed in on diabetes.

So pre diabetes is thought by some to be the precursor to diabetes, and other people think it's a figment of other people's imagination. It's a complex issue. There was an article in Nature not too long ago that basically argued that prediabetes was really not a problem at all. I believe that it is a problem. Having said that, if you look at the number of prediabetics who go on to diabetes, it looks like it's about 33%. So just having prediabetes doesn't necessarily mean that the end is near. There are things that you can do to alter that. What we have determined is that prediabetes is a state of insulin resistance. With reduced insulin response. Now, the question is, can the pancreas recover? And the answer is absolutely. And this is where people don't, you know, sort of get it yet. The American Diabetes association says that diabetes is a chronic, progressive decline in beta cell functioning leading to insulin deficiency for the degree of resistance. This is complete, total hogwash.

Yes.

And the reason we know that is because. Yeah, go ahead.

Sorry, there's a lag on the line. I didn't mean to interrupt you. Tell me the reason I'm interested.

Well, the reason is because those beta cells that are releasing insulin in the pancreas, they are affected by in the same way the liver is affected. And we now know that these patients have non alcoholic fatty pancreas disease, not just non alcoholic fatty liver diseases. And so if they clear the fat from their pancreas, those beta cells can come back full force. And so you can reverse type 2 diabetes, and you can certainly reverse pre diabetes if you ate right. But if you don't eat right, what.

Does eating right mean?

Well, that's. That's the whole reason I wrote the book. Exactly. So I wrote Metabolical to basically explain what is healthy. And based on the empiric data, based on the science, based on the pathologies that I describe in the book that belie chronic disease, I distilled all of the information down to six words. Two precepts, six words. Protect the liver, feed the gut.

There you go.

Any food that does both of those is healthy.

So you recommend tequila.

That doesn't really protect the liver very well.

It slams both. What does protecting the liver really mean?

So protecting it from, number one, the onslaught of mono and disaccharides, so glucose and fructose, so sugar and refined carbohydrate being, shall we say, the big kahunas in the story. But it's also protecting it from excess branched chain amino acids, because branched chain amino acids ultimately become organic acids, go into the Krebs cycle in the liver, ultimately overwhelm the liver's capacity to be able to metabolize them, end up as fat as well, and also protecting it against various toxins, including heavy metals, including things like glyphosate, et cetera. So there are a lot of things that go into protecting the liver, and we're not protecting the liver at all. We're basically trying to kill it. And the second thing is feed the gut. And the question is, what does that mean? Well, as you've heard, there's this thing called the gut microbiome. And the gut microbiome Matters. It's not just good and bad bacteria, it's a whole slew of things. But in general, the bacterial content of the gut basically outnumbers us 10 to 1. There are 100 trillion bacteria in the intestine versus the 10 trillion cells we have in our body. And they make stuff. And the question is, does that stuff get across into our bloodstream to affect us? So there are barriers, there are junctions between the cells, and there are proteins called tight junctions, or zonulins. This is what goes wrong in celiac disease that keep whatever's in the intestine in the intestine. Now, the question is, does it ever get across? And the answer is, more and more, it does. And the reason is because those tight junctions are failing. And what's making them fail? Well, specific things in the food and also lack of energy. And the question is, while you're putting all this stuff into the intestine, why aren't they getting enough energy? Well, it turns out fructose actually depletes the ATP within the intestinal epithelial cell, because when the fructose enters, it has to be phosphorylated. And so it goes from fructose to fructose, one phosphate. That takes ATP down, and that leads to incompetency, transient incompetency of those tight junctions. So stuff can now get across. And if stuff gets across, you've got chance for inflammation, you've got chance for introducing a protein that might end up leading to an antibody response or a T cell response. Now you've got food allergy, and it's possible a lipopolysaccharide could get across and that could cause more inflammation and possibly insulin resistance. Ultimately, those same zonulins are in the brain as well as the intestines. So if something's affecting them in the intestine, maybe it's affecting them in the brain. And now you've got, you know, mitochondrial dysfunction and, you know, defective neurotransmission in the brain. Maybe you've got psychiatric disease, maybe you've got dementia. So all of these diseases that we are seeing increasing in frequency over the course of the last 50 years, commensurate with the advent of processed food in our diet, because we are not protecting the liver, because we are not feeding the gut, are basically inexorable. They are to be expected. And the problem is, as long as we eat badly, we will continue to suffer from these. And of course, they are breaking the medical bank of every country that has adopted the Western diet.

In your New Metabolical book. You certainly talk about this for listeners today. What are the three things that are the worst at poking holes in the gut that people can start paying attention to?

Well, the lack of fiber. So if you don't have fiber, basically you're not feeding your gut. The intestinal bacteria, if you're not feeding them, they will feed on you. So they will actually dissolve the mucin layer that surrounds each intestinal epithelial cell as a barrier. You can see it on electron microscopy. You can see the bacteria apposed app o s e d right on top of the intestinal epithelial cell. And this is probably one of the reasons for irritable bowel syndrome and also for inflammatory bowel disease, is that bacteria are supposed to be separated from the intestinal cell by this mucin layer. Well, if the bacteria doesn't have anything to eat, it'll eat that. So that's one thing. In addition, the colonic bacteria are very adept at eating soluble fiber and turning them into a product known as short chain fatty acids, propionate butyrate. And it turns out those are anti inflammatory and also anti insulin. They are insulin suppressive. They keep your insulin down. So feeding your gut is both a mechanical thing and it is a metabolic thing. And it is essential. The problem is we take the fiber out of food on purpose for shelf life because you can't freeze fiber.

Well, there's two kinds of fiber. There's what I call prebiotic fiber or soluble fiber. And I've been really big on that since all the research in my anti aging book. And then there's insoluble fiber, basically roughage.

Correct.

And I know that the soluble or prebiotic fiber is something that feeds makes butyric acid and propionic acid, which are both pro ketogenic as well. Like, just taking them will put you in ketosis to a certain extent.

Right.

At least it'll make ketones. And what I don't know though, is your perspective on the roughage or the insoluble fiber. How important is that?

Oh, it's extraordinarily important. The insoluble fiber is not there as food per se, but it is there for the barrier function that protect the liver. That insoluble fiber is essential. So think of it this way. You have a spaghetti colander, okay. Metal bowl with holes in it, right? You run the water. Water goes right through. Okay? Now take a blob of petroleum jelly and throw it into the center of the colander. Run the water. Water still goes through it. Might bounce off the petroleum jelly, but, you know, nothing's really changed. Now take your finger and rub that petroleum jelly all the way around the edges and into the center of that colander. Now run the water. Now you've got a barrier.

Not much is going to go.

That's right. Now you've got a barrier. And the point is that the insoluble fiber that we eat, the cellulose, the roughage, as you put it, acts as the colander, or another way to think of it, is the latticework of a fishnet. The soluble fiber acts as the petroleum jelly or say the kelp that the, you know, that the fishnet gets clogged with. Okay, together the soluble and insoluble fiber, plus the geometry, which is absolutely essential, form this impenetrable secondary barrier. And you can see it on electron microscopy. It's a whitish gel that forms on the inside of the duodenum. And what that's doing is it's preventing the transport of mono and disaccharides and other amino acids from the duodenum into the portal vein, which would then go straight to the liver. So the goal is to protect the liver, to protect it from the tsunami of stuff that would ultimately hit it if that fiber weren't there. The problem is, when you take the fiber out of food, whether it be the soluble fiber or the insoluble fiber, or both, which is standard, is to take both out, you now basically have put your liver at risk. So the insoluble fiber helps that barrier form. So it is absolutely essential. Now, if you don't have it, the soluble fiber still has benefits. It will still be metabolized by the colonic bacteria to short chain fatty acids, which is good. It will still move the food through the intestine faster, like greasing the skids, so that you will get the satiety signal, the peptide YY signal at the end of the intestine sooner. So you might not eat that second portion, which is still a good thing, but that protect the liver, it's gone. You haven't protected the liver at all. So interesting, there are six things that fiber does that are positive for your health. And if you take the insoluble fiber out, which is what happens when you make a smoothie because you've basically sheared the insoluble fiber to smithereens, you will get three out of the six benefits of the soluble fiber, but you will have lost three of the six benefits of the two together. So, you know those smoothies, if they're green smoothies. You don't have much to protect the liver from because there's not that much sugar in the first place. But if they're fruit smoothies, you know, you know, eat the fruit.

I was a vegan for a while on my path of trying all the different things, and I did lose a bunch of weight on that diet, and it gave me a bunch of autoimmune issues, oxalic acid issues. I was eating tons of fruit, you know, full of fructose. And it was. It was an experiment in having less weight but having a brain that didn't work, hormones that didn't work, and an immune system that didn't work. And I. I generally don't recommend a vegan diet for people, but I'm curious what your perspective is on that.

Yeah. So, you know, look, there's a war going on, and I'll tell you, I think it's a false war. I actually call it out in the book saying, you know, the vegans and the ketos, they're fighting with each other because, you know, you're either eating meat and you're a carnivore or, you know, you're eating plants and you're vegan, and, you know, there's no nothing in between. And, you know, these are the two polar extremes and they have nothing to do with each other. And I would argue that actually they are the same. Okay, they are actually the same. Yeah. What? Basically, if you protect the liver and feed the gut, they are the same. And a vegan diet, if it's done properly, and I, you know, couch that in very specific terms because there are a lot of ways to not do a vegan diet properly because Coke, Doritos, and Oreos are all vegan, okay? So if you're plant based, they're good for you. They're all plant based. They're crap, okay? They're total crap. So if you eat a truly vegan diet with, you know, twigs and sticks, as it were, Okay. I mean, like, kind of like what the Ornish diet is, it can work. And Dean Ornish has data that shows reversal of cardiovascular plaques over time. Now, I'm not.

If you meditate at the same time and the meditation shows the same benefits without the diet, but.

Well, so the point is you don't die on it. All right, That's a fair point. Okay? You don't die on it. And the. It's not that I'm specifically against veganism. I am against vegans telling me what to eat, that I'm against.

I think everyone's against that.

Well, no, not everyone is. The point is that what you eat should be a choice, and I am not against.