The Truth About Sugar Addiction And How It Affects Your Health

Coming up on this episode of the Doctor's Pharmacy.

We eat about 152 pounds of sugar per person. Yeah. That's almost half a pound a day of sugar. Yeah, it's crazy.

Well, it's hidden in every single thing that you could pick up.

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Episode of the Doctor's Pharmacy. Hi, this is Lauren F. Pion, one of the producers of the Doctor's Pharmacy Podcast. We know that sugar wreaks havoc on your body and your mind, yet the average American eats an astounding 152 pounds of refined sugar every year. Sugar not only causes weight gain by locking fat in the fat cells, it also creates a stress response by increasing adrenaline and cortisol, and it suppresses your immune system. In today's compilation episode, Dr. Hyman talks to Keegan Allen, Tom Hopper, Dr. Shivani Sethi-Daiya, and Dr. Casey Means. In these conversations, he explores the social component of eating sugary foods and how sugar affects mental health and leads to insulin resistance. Let's dive in.

The science of sugar is fascinating because it not only drives mechanisms that make you gain weight, 'cause it produces more insulin, so it stores belly fat. It makes you hungry, it slows your metabolism, and it locks the fat in the fat cell so it can't get out. It's like a one-way turnstile. You can't get out. When you look at the biology on the brain, it's even scarier. In really well-controlled studies, they've shown that by looking at brain imaging and blood tests, eating the exact amount of calories, protein, fat, carbs, and fiber in a shake, like a milkshake, They just swapped out the level of the kind of carbohydrate so that one raises your blood sugar a lot and one doesn't. It's like a slowly digested starch. When they did that, they found that the brain imaging showed that the addiction center, which is stimulated by heroin or cocaine or whatever, gets lit up like crazy by the sugar and their insulin goes up, their blood sugar goes up, their adrenaline goes up. So sugar causes your adrenaline to go up. your cortisol, which is the stress hormone, so it literally creates a biologic stress. And for those worried about coronavirus, one of the most important things you can do is cut out junk food and sugar because it suppresses your immune system. So Keegan, you were eating a lot of sugar.

Yeah.

And you were getting sick all the time. It wasn't a coincidence. Yeah, and I don't know if you're familiar with Dr. Raymond Francis, but Dr. Raymond Francis, there was like this video circulating about how he pretty much just He immediately was on like a news show and he talks about that sugar, even just a small, what is it?

It was like a teaspoon of sugar. He reduces it by 50%.

50%, your immunity goes down by 50%. And like, that's the other thing is like some people will go, well, there's no science in that. But the interesting thing, and I wanted to volley this back to you then, with your immune system, sugar is not the only culprit to lowering your immune system. There are canola oils, there are... Lifestyle as well.

Like I find stress and fatigue and lack of sleep are ones that can drop it for sure. That's a cycle, is that like if.

You eat sugar, if you eat processed foods, then you don't really sleep that well, then you don't really move that.

Well and it's just... Well, the other part about eating a diet of processed food and sugar is it depletes your nutrients. It actually doesn't have the vitamins and minerals and nutrients you need to metabolize stuff. So the people who are often the most nutritionally deficient are the most obese. Which is kind of surprising because how can you be malnourished and obese at the same time? The nutritional density of our food is so important and processed food just doesn't have it and sugar depletes our nutrients like B vitamins. And so when you have low levels of zinc, and you have low levels of vitamin D and low levels of omega-3 fats and low levels of iron and vitamin A, your immune system can't function. So in the developing world, we know very clearly that the kids who die from diarrhea or respiratory infections or measles is because they're malnourished. If a kid's get measles who's well-nourished in America, they're not gonna die from it usually. But in the developing world, these kids die all the time from basic disease because they're so malnourished. And I think we are a malnourished country. 90% of us are deficient. The best way to build your immune system is to eat whole food, cut out the sugar, make sure you take your vitamins, get enough sleep like you said, deal with stress as a huge factor. And I think something simple like just meditation.

Yeah.

It's so powerful.

Yeah, it's a thing that- It's going.

To be woo-woo, but it works.

We just don't talk about that enough, I think. And you as a functional medicine doctor, I'm sure you speak to your patients about how important this can be because it really is powerful. And my wife went through this whole process. Like she didn't do a lot of the hypnobirthing thing when she was pregnant with my son, Freddie. And then with truly my daughter, she went through this whole process of just making sure she was really, really relaxed all the time and do a lot of hypnobirthing meditation. And truly my daughter came out the most chilled baby. I mean, it was unbelievable. I don't know if there was a link there, with that, but she certainly thinks there's a link.

And epigenetics are so powerful. So whatever the mother eats, her level of exposure to stress, toxins, all these things have huge effects on the baby. And if studies are so clear, if the mother's eating a lot of sugar and processed food, the baby's more likely to get obese, to have heart disease, to get diabetes. Yeah, setting them up for that. Down the road. The data is so clear on this, and I think people just don't understand. And the fact that we eat about 152 pounds of sugar Per person. Yeah, that's almost half a pound a day. Yeah, it's crazy sugar.

Well it's hidden in every single thing that you could pick up when we.

Were at the gym.

Yeah, we go to the bar at the gym. They have like a smoothie or something.

Yeah.

Oh my god.

Yeah.

Everything that is laid out that says healthy, organic, gluten-free, it's so counterproductive at the gym.

And you know, all everything you see in there, there's like signs for Coca-Cola in some gyms. Yeah, it's awful.

You go to those like green smoothie things and you look at the label, it has more sugar sugar than a can of Coke.

Yeah.

I mean, that's just insane.

And then people become addicted to it because they're like, well, I'm eating healthy. I'm drinking this healthy juice. But what they're doing is they're spiking their insulin levels. They're becoming addicted to this fruit, fructose almost. I'm sure that some of it maybe even is a hidden, there's so many.

Different names for hidden sugars now. There's like 200 names for sugar. If you Google, names for sugar. You'll see it'll come up with a list of, like, 200 different things that you don't even know are sugar.

Yeah, that's. I mean, that's one of the things that started me on. On the Journey of, like, I'm just not going to eat anything that isn't a whole food. Because I remember thinking, well, there's all this other stuff in there now. Like, I started off just being. Trying to avoid sugar.

Yeah.

And then I looked at everything else.

Yes.

I was like, what is that? I can't even pronounce that, let alone, like. put it in my body and think it's actually going to do anything good. So I started to just go, no, I can't put that in anymore.

I mean, the average American eats three to five pounds of additives every year.

Yeah, I mean, unbelievable.

And I know that what's even more interesting too is I'm looking at your bookshelf right here and I see you have the Surrender Experiment by Michael A. Singer, Untethered Soul. This is important too, is that along with your eating, the reason I bring up Michael Eisenger, that untethered soul was amazing. And understanding meditation, Wim Hof is amazing. I don't know if you follow him.

I do, I know him very well.

Oh, he's amazing.

Cold showers are great.

It helps so much with anti-inflammatory, anti-inflammatory.

If I have any aches or pains, I take a steam and then I jump in an ice bath.

Yeah, I'm like, yeah, amazing. I did a thing for a while doing like contrast showers with like going in the sauna. In my apartment I was staying in Toronto and I was shooting recently, they had a sauna downstairs and I was like, oh amazing, great. So I started doing contrast, like heat. Hot cold. Yeah, hot cold. Man, I felt so good.

Yeah.

Yeah. I tried to do it in the morning and then before I do it like half an hour pre going to bed.

Yeah.

And you feel amazing, sleep so well. Yeah. Huge mental clarity in the morning, energy levels in the morning to get up and go and train. you feel good for the day, like it's brilliant. Like those little things that you don't think would make a huge difference, they really do.

It's so true. So Keegan, how did you then feel after you started to reset your diet?

Yeah, it took about three months. Like Tom was saying, and I'm sure you understand this, anybody that goes on this journey for themselves where they go, okay, now I'm gonna be accountable. I'm fully aware of my diet. I'm gonna look at everything. I'm gonna read the labels. I'm gonna do some research. I'm gonna follow health professionals like yourself, like Dr. Mark Hyman. and start to not just do the research, but put in the work. And I would, even with all of that and having this extraordinary world around me in Los Angeles of healthy places that I could eat, it still was difficult. I would still regress back to, okay, I'm gonna go and have a cupcake, or I'm gonna go and eat, like one little chocolate chip won't mess me up. And I immediately was sometimes caught in that. And Max Lugavere talks about this, that it's these are highly palatable foods.

Yeah.

And hyper palatable. It's like porn for your mouth.

Yeah.

And you eat these things and then you're just like, I can't, I actually physically cannot stop myself.

Yeah.

And my girlfriend, she's a very healthy person. She does not eat anything, any processed foods, no sugar, no nothing. She's very healthy. But she will tell me, I can't even take a bite of that because I will never be able to stop. And I never understood that until I was doing this.

Right.

And so going through that, understanding that it is an addiction and that the people that were enabling me and saying, well, come on, like, we'd go out.

It's like seeing an alcoholic. Just have one drink. Yeah.

That's it.

Yeah.

And you have to see yourself as an addict.

As an addict.

Yeah.

But then you start to recognize that almost everyone around you is. completely bonkers addiction, like addiction-wise with sugar or with these processed foods. And they would, they'll nudge you. They'll be like, it's not gonna kill you. Like one bite of this.

You know what those food pushers.

Yeah. Yeah.

And you gotta get rid of the.

Food pushers in your life.

But I went through all that, and I finally came out on the other side, recognizing that I felt I was a completely different person. And I was a, I was a person that I wanted to be. I felt good all the time. And then I started getting deeper into it. So, microbiome, understanding that, understanding probiotics, not getting junk, like actual real good probiotics, understanding how my gut and the certain foods that I was eating maybe weren't responding to me. Like, I can't have cauliflower. And cauliflower is great for other people.

Yeah, but some people might not.

And understanding that my mother went through a crazy amount of health issues. And it happened right at the time where I was very deeply into this. And one of the health issues was that she had a, you know, she was battling cancer for the last 11 years. She had stage five metastasized breast cancer into her spine. They put her on eye brands, all of these things. But then we discovered a neuroendocrine tumor on her pancreas.

And-- A neuroendocrine tumor.

Yeah.

And we went, okay, I went, okay. There's gotta be there's gotta be a way that there's gotta be something about this. What is your diet? What are you eating? She's like, well, I eat very healthy. I know, wait, wait, wait, hold on.

A lot of people think they eat healthy.

Yes, but they actually don't. They do not. And my own mother was under my radar because I didn't, you know, I didn't see her every day. I didn't know what she was putting in her mouth every single second. And I went, okay, well, let's go through exactly what you're actually ingesting. moment to moment. And if you're eating out, you gotta know what you're eating. And we went through and I realized her diet was really, really poor, like bad, bad. And we shifted a bunch of cancer. Yeah, and your body naturally creates glucose on its own, right? So we don't need all these extra sugars from sugar. But she was eating a lot of highly enriched flour, gluten, things that were very hyper inflammatory. So we cut all that out for about four months and we recognized that it went away. This tumor went away.

In her pancreas.

In her pancreas. She still has other cancers, but it has totally taken down a lot of that.

Most people don't realize that sugar is a big driver of cancer and the mechanisms are really understood now of how that works. The common cancers, particularly breast, colon, pancreatic, prostate, all of them are driven in large part by sugar.

Do you think that's just because it's an inflammatory thing for our bodies to consistently process and chaos?

Because insulin promotes something like insulin-like growth factor, which actually is in high levels can be carcinogenic. That's part of the problem. And I think sugar is the main fuel for cancer. So we're like hybrids. Humans are hybrids. We can run on fat. Or on carbs or sugar, right? We can run on ketones or glucose. Cancer can. So, a lot of the exciting research now around cancer is using ketogenic diets to help treat cancer and to actually accentuate the benefits of chemotherapy. So, actually...

Seeing a lot of research on this.

A lot of research. And this is not wacky, crazy people on the fringe.

Yeah, there's people like I said, I come across them that are like literally turning their cancer around. Yeah, from doing this, it's amazing.

A friend of mine had a, you know, a lung, throat cancer, and, you know, he was a little overweight and he ended up doing ketogenic diet and during the chemo and he said, they never seen anybody with better outcomes, less side effects from radiation, from chemo, and sailed through it and has been clear of cancer, which is amazing. And, you know, you were saying before about the addictive properties of it. This is not an accident. And there's a great book, Michael Mossro, who was on the podcast here called Salt, Sugar and Fat, and talks about 300 interviews he did with top executives and scientists in the food industry and what their tactics are. And I remember having dinner with the vice chairman of Big Soda Company, and I'm like, How's it going? We had a little bit of a bad taste.

That would have been an interesting conversation.

It was an interesting conversation. I was like, But he said, Mark, you know, we have an incredible research facility in New York. You should come visit. I'm like, why? He says, well, we've harvested taste buds from humans. And then we grow them in the petri dish, and then we can stimulate them and see which foods and things will actually activate the taste buds. And they have something called Taste Institutes, where they hire craving experts, and they manipulate the ingredients and the mouthfeel and the taste of food and the sugar to create what we call the bliss point. of food, which is that maximum thing. It's like you get that hit, like a cocaine hit. And then they actually look for how to sell that more to what we call heavy, they call heavy users. These are their own internal corporate terms. So it's hard to get you or me to start drinking a two-liter bottle of soda a day. But if someone's drinking a can of soda, then pushing more soda is easier on them. And so they have this whole category of people who are really heavy users and they target them and they're usually the poor minorities, people on food stamps and it's really deliberate. And the biology of addiction in the food is not like an emotional response. It's not because you have no willpower. It really is hijacking your brain chemistry and your metabolism in ways that we don't really understand. And so I've seen people within a very short time really transform that.

We know that consuming excessive amounts of sugar, processed foods, and refined carbohydrates lead to obesity, metabolic problems, fatty liver, heart disease, even cancer. There is evidence for this. And the body is really one whole system. And what happens in the body also affects the brain. The brain has a delicate balance of neurotransmitters or chemical messengers with more sugar and processed foods, these levels really become unbalanced and they're significantly off. So I'm talking about-- so wait, so.

Your brain chemistry gets screwed up when you eat processed food and sugar, is what you're saying?

Yeah, yeah. And I'm talking about ultra processed food also in particular, because I do think that there's a difference between processed food and ultra processed food. Ultra processed food is like the real sugar, the cookies, the cakes, the chips, the potato chips, these kind of highly processed things versus minimally processed foods, maybe some oils, you know, vegetables that are frozen, that's a little bit different than ultra processed food. And so the research is showing differences between those things in the brain. Yeah. And you need the right raw ingredients for chemical reactions to occur in the brain and elsewhere, like vitamins and minerals and nutrients. You need proper functioning, you know, of the brain. proper speed of transmitting signals, your brain is composed of electrical cells and it's a complicated web of signaling molecules. Those cells need fat to develop and to function properly, so you need those omega-3s in your diet. And if you eat sugar and ultra-processed foods, the chances are that you're likely not getting those important nutrients, those vitamins and minerals, for those important reactions that you need, nor are you absorbing them. Most people with metabolic dysfunction actually have nutritional deficiencies and are malnourished. So, you're saying it's people who are.

Overweight and obese often are very malnourished and vitamin and nutrient deficient. Yes, that's right.

That's sort of a paradox, right?

Right, right.

I think they're eating all this food.

Why are they nutritionally deficient? But they're actually among the most malnourished.

They are, they're looking in all the.

Wrong places for the nutrients. They're eating more and more food. I think a study from Kevin Hall and others showed that if you let people eat as much as they want and you give them ultra-processed food versus whole foods, they'll eat about 500 calories more a day of ultra-processed food because they'll keep eating and they're hungry and they keep driving. And you talk a lot about that in your work about the biology of what these do to your brain in terms of dopamine and the addiction reward pathways in the brain that make you literally become addicted to these compounds and how that affects you? Right.

So the rates of obesity and binge eating and addictive like eating are rising alongside the increasing dominance of ultra processed foods in the modern food environment. And there are several mechanisms as to how this works. Some which act directly on the brain and some that indirectly act through hormonal signaling. So our body is very complicated and the brain is connected to the body. And we used to learn in medical school that you have this blood-brain barrier that nothing can get across it. But that's not, it's like the Berlin Wall. But in reality, it does leak, right? And there are things that do cross.

And-- It's more like a coffee filter, you know, it's a sip.

Right. Yeah, so ultra-process food and sugar decrease our dopamine receptors and make us eat more compulsively, much like addictive drugs. The highly processed foods, they trigger dopamine reward pathways and they invoke addictive-like behaviors which have been well documented and include intense cravings, includes feelings of withdrawal when cutting down on ultra processed food. continuing to eat these things despite knowing the adverse consequences to it and repeated attempts to try to quit. I'm describing addiction here basically and the consumption of larger quantities over time than intended. People go through emotional eating, it's not.

Really biological true addiction. What you're saying is this is really a true biological addiction just like heroin or cocaine or alcohol that you get withdrawal. You get cravings, you get increased need for more and more of the substance to receive the same pleasure. You downregulate the receptors for pleasure, so you have to take more of the stuff to actually stimulate that reward pathway. And it's really this vicious cycle that people get into, and then they blame themselves and they feel guilty for doing it, and they think they just have no willpower. But you're saying it's much bigger than that.

Yeah, that's exactly right. So sugar, is an addictive substance. It's not just something we say. It has a straightforward neurochemical basis in the brain, just like any other drug. And I think of sugar as a, it's a recreational food. It's not a food that's essential for survival. We make sugar, you know, through the process of gluconeogenesis, through other foods that we consume. And so it's really about excess carbohydrates.

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Fine, but not breakfast, lunch, and dinner in the quantities we're having in America. Exactly, yeah. And we also, actually, I would like to share a story about this just during the era of COVID since we're in it. Yeah. Just to give context as to why I wrote about this and why I'm working on this as well and continuing to feel motivated to continue to do my work is the shelter-in-place order had come a couple of months back for my county and I'm in California. I live in Menlo Park. When it was announced, my husband, he's an infectious disease physician at Stanford and I'm a psychiatrist and a UCSD medicine physician as you mentioned, we both felt doubly invested in this pandemic. We went to our neighborhood Safeway grocery store and we saw many people loading up their carts with Pop-Tarts, Hawaiian Punch, popcorn, anything ultra processed basically. And they weren't loading up their carts with fresh vegetables or, you know, they were out of cookies at the grocery store.

Yeah. They were using toilet paper.

And toilet paper, exactly. And there were still, you know, produce left in the store. You know, it wasn't like they ran out of produce. No. So here I was.

I wasn't a run on broccoli.

No.

Here I was at the checkout counter and I was thinking to myself, you know, staring at the person's cart in front of me, that it's full of the recreational food, as I mentioned, the food that's not necessary for survival and detrimental to our health. I thought to myself, this is certainly not preparing them for the pandemic. or helping their immune system and if anything, weakening it. And this is our local Safeway. This is the heart of Silicon Valley. So in this context, it wasn't about affordability or access. That is what motivated me to kind of get that public message out on this topic.

Yeah, you did write a great article on the Hill and I read it. And you really talked about the way in which the pandemic we're facing is much more serious because of the underlying chronic disease pandemic we have in our society where it's driven by this ultra processed food that makes us overweight and sick and causes all these underlying chronic inflammatory issues like diabetes and heart disease and high blood pressure, which are really the same mechanisms. If you look at the mechanisms of high blood pressure, heart disease and diabetes, it's insulin resistance, it's oxidative stress, it's inflammation, and it's the same thing that's affecting our psychiatric illnesses, which is so fascinating. And most people don't think about using the doorway of food to help treat the brain. and you're doing that in your research and in your practice. So tell us some of the kinds of things you're seeing in your patients using this approach, because it's pretty radical. You're going all the way sometimes to ketogenic diets with these patients with bipolar disease, schizophrenia, depression. It's fascinating. Yes.

What I have noticed is that a lot of my patients that come for psychiatric treatment and evaluation, a lot of them have pre-diabetes and diabetes. And when I look up the statistics on this in our country, 44% of adults today in our country are either pre-diabetic or they have diabetes. And I wonder to myself, what is that doing to our brain? We know that affects all these different organ systems, the liver, the pancreas, the heart, But what is that doing to the brain? And so I'm happy to talk more about my research and patient care. But one thing that I felt I didn't completely answer before was how these hormones affect the brain with the addictive piece.

How does it drive inflammation and all that? Yeah. Yeah.

So going back to that, So I was talking about the definition of addiction. And we know that hormones like insulin and leptin, which is the hormone that tells us we're full, it sends a signal to our brain, and ghrelin that tells us that we're hungry. These hormones modify natural and drug reward pathways in the brain. I mean, they have so many effects on their brain. Our hunger hormones go awry and it can actually increase the reactivity itself of the dopamine system. And so this happens when we consume that excess sugar and the excess carbohydrates in our diet. And they cause these rapid shifts in blood glucose and insulin levels similar to other addictive substances. So My approach in patient care has been to work on this system to decrease these shifts that occur in our blood sugar and our hormone levels to kind of go back to the homeostatic state that our body and our brains were meant to be in. And so I treat the metabolic dysfunction and I look at how that improves both metabolic issues as well as psychiatric outcomes. Yeah, so it's fascinating.

So you basically are treating the body to fix the brain, right? You're dealing with these physiologic changes that have to do with our diet and nutritional psychiatry that most psychiatrists aren't thinking about. I mean, most psychiatrists are thinking about, you know, psycho-emotional issues or thinking about medication and prescribing antidepressants, but they don't really work as well. And I just found that the amount of benefit you get by addressing these underlying factors is so much greater than you get with medication, which are marginally effective for most people. I think, you know, unless you have really severe depression, but I think the data is just not that exciting about these drugs, right? I mean, they can be helpful for people and they can be life saving, but there are also other doorways that you're exploring which are seeming to be way more fruitful. Is that your experience?

So, you know, the field has come, you know, a long way. They've, there's a lot of research that's been done on the biological piece and neuroscience and looking at, you know, obviously the serotonin hypothesis, but that's the hypothesis and an observation from like 30 years ago. And all of these research and money has been thrown on developing drugs, but we're not necessarily addressing some of the root causes of why are these chemicals imbalanced? And so that's an important question that I and others are trying to study through research studies and clinical trials. And like you said, we know that although our medications are necessary and life-saving for many, they have undesirable side effects that can worsen metabolic health. And while it's helping in one domain, it may in some people also be hindering improvement in psychiatric symptoms, especially if the metabolic health is poor. So psychiatric treatment is never going to be a one-size-fits-all approach. Mental health conditions are varied. They're heterogeneous and they have different phenotypes or presentations. We don't have a single mutation or a gene that we can point to or a lesion. There's no smoking gun. It's a complex relationship of multiple genes and environment. And unfortunately, a metabolic assessment is not part of that routine care. And stigma certainly plays a role in this. Obesity stigmatized and so is mental health. Education about nutrition and metabolism is lacking in medical education. Most psychiatrists recognize this relationship.

They do. They understand the connection between food and mood.

They're starting to. They understand that there are side effects with psychotropic medications. I think they don't necessarily have the expertise to treat it or address it. They don't know necessarily what to do about it. But most psychiatrists that I speak with, and my department certainly has been very supportive of this idea. And if someone has to do the research and someone has to do the work to kind of move the field forward. There's a growing body of other researchers working on this, and we hope that evidence-based research has to be done to kind of change the mainstream's generative care.

Yeah, I mean, you were talking about metabolic psychiatry. I was also noticing that Harvard had a whole department of nutritional psychiatry, which is, you know, seems like bookends on the country. I don't know, the rest of the psychiatric world is thinking about this. But you mentioned earlier that you work with Bruce Ames, who's an incredible biochemist and nutritional scientist from California, one of the most published sort of scientists in the world. And, I spent a lot of time with him and he talks about this whole idea of a metabolic tune-up and that so many of our biochemical reactions are regulated by vitamins and minerals and that each of us have different needs for different components of those vitamins and minerals. I remember one guy, I was sitting in my office one day working on something. I was thinking I might have been working on that book and I was talking to somebody about folate and B12 and B6. He's like, oh, yeah, I had really bad depression and I took some of these B vitamins and that just went away. And, I think there are some people who have a higher need for, for example, folate or B6 or B12 based on these genetic variations that Bruce Ames talks about that really are so prevalent. In fact, one-third of our entire genome codes for enzymes and those enzymes all need helpers, which are vitamins and minerals, and we don't really pay much attention to that. So when I look at depression or psychiatric illness, you know, I see so many different things that are going on there, whether it's insulin resistance and prediabetes or vitamin D deficiency or folate insufficiency or zinc or magnesium, all these various nutrients play a role in brain function. And they're not something we really learn about when we learn about psychiatry, right? Is that changing?

I think that is changing. There's a complex relationship between metabolic dysfunction and nutrition, food, mental health. And I want to start off by saying that the idea of food as medicine is not a new concept in the field of nutritional psychiatry. It's really grown over the past few decades by several prominent psychiatrists and researchers However, the focus has largely been looking at specific foods or supplements, eliminating certain things from the diet, the microbiome. You know, we're looking at the Mediterranean diet, for example, affecting depression symptoms. And these are all very important questions. But what I thought was missing and why I named our clinic and our group, Sfwrk Metabolic Psychiatry, is to distinguish that this is a study of how treatment of metabolic dysfunction can affect psychiatric symptoms. Yeah. If a majority of us are suffering from obesity, type 2 diabetes, insulin resistance, metabolic syndrome, what is that doing to our brain? We know that these diseases affect multiple things, mental illness rates have increased over the past 20 years, in fact doubled. We know that mental illness like depression, bipolar disorder, psychosis, they're strongly associated with inflammation. That research is really indisputable. And research is also showing that there's an energy deficit in these brain illnesses, and the mitochondria, the energy powerhouses of our cells, are not functioning optimally, causing changes in brain signaling itself. And the thought is, if we can target inflammation, insulin resistance, the abnormal blood sugar, et cetera, as a method to improve mental health symptoms, then we can really improve our patients' lives further. And Again, mental illness has many different causes, but even if we, you know, can five to 10% of people have an improvement in these symptoms with this method, then I think that would be a pretty significant improvement of the overall mental and physical health of our country.

One of the big, big key players is the amount of sugar that we're eating in our diet. You know, the average American these days eats 152 pounds of refined sugar per year. 100, 200 years ago, we were probably eating around one pound of refined sugar per year. That's 152 times the amount of substrate that these poor little cells have to process. They break down. They just say no. And what that looks like is insulin resistance. As I'm sure many of you listeners know, when we eat carbohydrates and sugar, the body releases insulin, a hormone, to help you take that sugar out of the bloodstream into the cells so that it can be used for these metabolic processes. But when that's happening in all the time, day after day, huge spikes in blood sugar, the cells become resistant to this insulin. There's so much insulin being poured out, the cells are like, we cannot process all of this. This is too much and the cells block it. So now you've got this issue where you've got tons of this glucose substrate, you've got all this insulin being poured out, trying to force more glucose into the cells, the whole machinery essentially gets gets gummed up. And that's really the root of metabolic dysfunction. You've got poor energy production in the cells. So by day after day, like learning what is spiking our blood sugar and then learning how to optimize that, keep the blood sugar down, figure out what foods are affecting you, you essentially let the body rest a little bit. You know, if you can keep the glucose down day after day by learning what's affecting you, you can keep the insulin down. And then the cells start to perk up again to that signal and say, okay, we can do this. This factory can run a little bit better. So that's what Levels is helping people do is really to learn how different foods and these products that we may be told are healthy are actually affecting our blood sugar. With that information, it's the first time ever we've had a closed-loop biofeedback system about what we're putting in our body and what it's actually doing to our health. I believe that people should know what food is doing to their bodies. Right now it's kind of a black box and it's a mystery and we have to trust food marketing, we have to trust the different nutritional ideologies. And there's a lot of conflicting information out there. It's a hugely confusing landscape. And I really do feel that objective data, like through a wearable device that's giving you this real-time biofeedback, can just cut through A lot of that marketing, a lot of those loud voices, a lot of the information from governing bodies that we know is not actually helping us achieve our goals. You can just see, this works for me, this doesn't, and then improve your metabolism with that information.

Yeah, I mean, here's the thing, Casey, is that as doctors, we really don't learn about metabolics. We have nutritional biochemistry lessons and we study the Krebs cycle in first year medical school. and the joke among all the medical students is, you know, this is just a grunt class. Basically, you're gonna forget it as soon as you're finished. Just cram for the exam and don't worry about it. Turns out it's probably the most important class in medical school. And we don't understand metabolism as doctors. And we don't understand even blood sugar and insulin resistance. You know, 90% of the cases of pre-diabetes, which affects about one out of every two Americans, are not diagnosed because doctors don't know how to diagnose them. and they'll say, oh, your blood sugar is normal on your test. Well, what is normal? What is optimal? They'll say your A1C is great. You're fine. No problem. No problem. But after practicing this for decades, I have really learned that there are other ways to get the science of what's happening, which is sort of what you're really doing with levels, is you're giving people the opportunity to measure in real time what happens when their body ingests food and how that affects their particular blood sugar. Because everybody eating exactly the same food might have very profoundly different responses to that food. I can drink a can of Coke and my blood sugar and insulin might go to X and Y, somebody else might go to A, B, and B. And that's not something that you would inherently know. And the other thing that struck me was that the metrics that we have are just really poor. And I think, you know, I want to share a story of a patient which taught me so much about metabolic health. And this was a woman who had an enormous girth. I mean, she would look like the sort of Pillsbury Doughboy. She was just round around the middle, skinny arms and legs, just big circle around the middle. And clearly she was in poor metabolic health. Blood sugar was perfect. I measured her blood sugar. I said, well, maybe we should do a glucose tolerance test. Her A1C, which is the average blood sugar resistance, was perfect. Like, that wasn't like, oh, it was 100. It was like 80, you know, fasting, which is really optimal. And I said, let's do a glucose tolerance test and measure your blood sugar. And we're gonna also measure insulin because most doctors, and this was, this was probably 25 years ago, most doctors just never measure insulin. Even today, 25 years later, but probably, as we were discussing earlier, probably one of the most important tests. So her blood sugar after she took like the equivalent of two Coca-Colas, perfect, like never went over 110 even after drinking the equivalent of two Cokes. Her A1C was perfect. Her insulin, on the other hand, like normal should be about five or less. Hers was over 50 fasting, which should, which is super high, 10 times. And when she, she had the sugar drink, it went to 200. or 250, which you just almost never see. It should never go over 30 after a sugar drink. And I was like, wow, here's someone who if she went to a regular doctor would have a perfect test, even if they did a glucose tolerance test. And so, you know, the importance of really digging down to understand what's happening with your own body is so key. And that's what's so exciting to me about levels is it gives people real-time access to data through a continuous glucose monitor, which is a really relatively non-invasive procedure where you track your, your blood sugar on your phone. Super easy and fun and gives you so much insight. And, and like I, I was sharing a story before, I was, I was using the levels app and I was putting, I had the device on my arm, and this friend of mine, we're having a meal in Martha's Vineyard last summer, and it was a farm to table meal, but we got it brought in, it was because it was COVID, we didn't go out, we had it delivered, and it was a huge amount of extremely healthy food. And it was so delicious that we ate an enormous amount. But even the idea that you could eat healthy and it still causes a problem, if you overeat, it's nothing that most people really understand. So, you know, I can eat all this healthy stuff, but actually our sugars, both of our sugars really, really spiked, even though we're both really metabolically healthy. so it's kind of a fasting lesson and gee, you know, we don't really always know what's going on inside our bodies until we start looking.

I think that's absolutely right. And I think you bring up the great point about biochemical individuality when it comes to metabolic health and metabolism. What might affect you might affect me very, very differently. And I wonder, you know, if you and your friend at this dinner might have had actually eaten the same thing and had different responses, you know, and, and that is really an important piece. There was a really fascinating paper that was published in the journal Cell about five years ago by the Weissman Institute and it was called Personalized Nutrition by Prediction of Glycemic Responses.

This was based on the microbiome.

Yes, yes. They took 800 healthy people, so non-diabetic individuals, and they put continuous glucose monitors on them, these little devices that measure your glucose 24 hours a day, in real time sends that information to your smartphone and they give them standardized meals. So they said, you all are going to eat an identical meal or an identical cookie and see what happens. And based on what we know about the glycemic index, which is this idea that each food has sort of an inherent property of how much it will raise your blood sugar, they actually found something very different.

Wait, wait, wait. So people, what she's talking about, Casey's talking about, is that scientists had come up with this chart of if you eat a banana, it'll raise your blood sugar this much. If you eat an apple, it'll do this much. If you eat chicken, it's going to do this much. And what you're saying is that was all thrown out the window because it.

Depended on what was going on in the microbiome. Right, exactly. They had some people who raised 10 points to a banana and others that 10 glucose points and others that went up 100 milligrams per deciliter. So, what might be a really sort of okay metabolic choice for you might not actually be for me. And they actually found equal and opposite reactions between people. So person A could have a huge spike to a banana and no spike to a cookie, and person B could actually have the exact opposite. So this is where I think testing can be really helpful because we sort of have this culture where there's loud voices in the nutrition space saying there's a one-size-fits-all diet, but I do think there's probably some more nuance to that. So that gets into the kind of the nitty-gritty of the biochemical individuality. And like you said, in that study, the microbiome was a key determining factor of how people responded to those different foods differently, which was pretty fascinating.

So true. I had a patient once that taught me a lot also. I mean, most of the stuff I learned, I learned from my patients. You start looking at the biology and you start asking questions, start thinking. And, you know, most of us as doctors honestly just are pretty arrogant. Like we, we got trained in this Gild in which we were told that this is sacred knowledge that's true with a capital T, that anybody who questions it is a heretic and is not, quote, evidence based, which is the sort of the way we crusade against people who have ideas different than us. And we, and, you know, we're, you know, we're basically, you know, often blind to the very things that are in front of us. You know, when a patient gets better or changes something, pay attention. So this guy had this diabetic.

You.

Know, regulation problem where his sugars are really volatile and brittle and it was tough to control. And we did get dramatic improvements by changing his diet and putting him on a super low glycemic diet, but it still wasn't great. And he kept complaining about his gut, so we started working on his gut. and at one time, I was saying, oh, I'm just having all this gas. So why don't you just deal with your GI symptoms, just take some charcoal as a sort of an emergent, you know, stopgap measure to help fix what was going on with him. And next time I talked to him, he's like, that was a miracle. I said, what do you mean? He says, My sugar dropped 100 points when I took charcoal.

Right?

And I'm like, well, how did that happen? Right? It's not like the charcoal is not absorbing the sugar. what's happening is that in the intestinal tract, he had a whole bunch of bad bugs that were producing endotoxins, which are these really nasty toxins that certain bacteria produce called lipopolysaccharides. They get absorbed over the gut. They activate the immune system. The immune system, and this is just old technical stuff, but it activates these things called cytokines, which then bind to receptors on the cell that cause insulin resistance. So. basically these toxic bugs in his gut was causing his blood sugar to be all off and fixing that fixed his blood sugar. So it's very complicated. I want to get into something with you that I think is really important for people to understand because we sort of touched on metabolic health and poor metabolic health. But I wonder if you can take us through a story of like what actually are all the things that are happening? Because you create a list of conditions that are related to poor blood sugar, but what is the biology of what's happening when your blood sugar is out of control, what happens to your microbiome, to your immune system, to your brain, to your hormones. Take us through what actually happens in the body when you are eating the average American diet.

Yeah.

So there's sort of four things that I think are kind of worth focusing on. There's the direct effects of high blood sugar. So you eat something and your blood sugar spikes and then there's biological effects of that. And then there is a fourth thing which is the long-term so in terms of those short-term things, like you drink a Coke and your blood sugar goes up from 75 milligrams per deciliter to 150 milligrams per deciliter, that blood sugar spike can cause glycation. It can cause oxidative stress. What is glycation? So glycation is the process where sugar just sticks to things in your body. It's actually just like sugar molecules sticking to things like fats and proteins and, and DNA, and that can cause dysfunction. It can cause those cellular parts to be dysfunctional. And so that's an issue, we don't want that. It can generate inflammation immediately too. This huge surge of sugar is unusual for the body. It's like, what is going on? Why is this big change, this sort of homeostatic shift happening? We don't want that. And then it can cause oxidative stress, which is sort of this reaction where your body's producing metabolic byproducts that are reactive and can be damaging to the cells so these unpaired electrons that go around and want to bind with things, it's resting exactly. So big glucose spike, you can have immediate effects on oxido stress, glycation and inflammation. And then the fourth thing is this thing that's happening both immediately but also really has cumulative effects, which is the insulin surge. So when you have that big glucose spike, your pancreas is releasing all this insulin to help you soak up the glucose out of the bloodstream into the cells so it can be processed and bring the glucose back down. And what can happen there in the short term is that if you've got a big spike, so that big up and down, the insulin can actually sometimes overshoot. It can actually do too good a job in soaking up all that glucose and you can have what's called reactive hypoglycemia, which colloquially is known as the post-meal crash. So if you've had lunch and then after lunch feel tired and you want to have that second cup of coffee at 1:00 PM and maybe you feel a little bit more anxious, that might just be the fact that your blood sugar has gone up, you've released all this insulin, the insulin's kind of overshot, you've crashed down, and now you're in this dip and the body's trying to get back into balance.

And that roller coaster- that creates a.

Secondary cascade of hunger hormones and cravings. Exactly. And so that's happening in the short term. And then that insulin process, going back to what we were talking about before, can over time lead to that insulin resistance where the cells see that huge surge in insulin so frequently that they actually say, we can't keep doing this. This is too much insulin and we get numb to it. And that's insulin resistance. And then what happens is your insulin levels, they start creeping up because your body's trying to overcompensate for that block by producing more. And then that leads to so many of the downstream conditions that we've been talking about. When you've got this high insulin, one of the secondary effects of that Let's just, we can talk about obesity. You know, insulin is a signal to the body that glucose is around for energy. And it's also a signal to the body that because there's so much glucose around, we don't need to use fat for energy. Glucose and fat are the two main ways that we produce energy in the body. And when that insulin's high, it blocks us from tapping in to fat burning. It says to the body, nope, you don't need to tap into fat burning. We've got a bunch of glucose around. And so this is relevant to anyone who is trying to lose weight or who has the excess belly fat because that insulin is a real block on helping us achieve those goals. And so for us to tap into our copious fat stores in our body, we need the insulin to be lower. So by getting off that glucose roller coaster, by eating foods that keep us more flat and stable throughout the day, which is what we want for optimal health both in the short-term and the long-term, We give our body a break from producing that insulin, and that can have a real significant impact on our ability to lose weight, to get rid of that belly fat, to tap into this alternate metabolic fuel source, and to generate what we call metabolic flexibility, which is this ability of the body to flip between using glucose when it's around and using fat when it's not around. And that state of being able to do both is a really healthy state. It's adaptive. But the average American, with the vast majority of our calories coming from ultra-processed foods, and I believe more than 70% of processed foods in the US have refined sugar in them, and we've been told, of course, to eat six small meals a day, you are on, as an American, this up and down glucose roller coaster all day. And so you're really never giving your body this time in a low insulin state. you really do have to be quite aware and think differently. I mean, the reality is, as an American adult, you're on a treadmill towards being overweight and chronic disease. And unless you are doing something different, you will end up sick. I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below. Until next time, thanks tuning in.

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