Click Here for full video: Robert Lustig, WARNING-Ultra Processed Foods Fueling Neurological problem

The question is, why the FDA do this? Well, DSHEA was written by Senator Orrin Hatch of Utah, whose son ran a supplement company.

Interesting. I didn't know that.

Yeah, stick around.

Good morning, everyone. Welcome back to the Emery Pharma podcast series with the amazing Dr. Robert Lustig. My name is Dr. Ana Najafi. I'm the director of Strategic Pharmaceutical Development here at Emory Pharma. We are a contract research organization and our mission is to help pharmaceutical companies develop safe drugs to treat various diseases. We are so honored to have Dr. Lustig back here today. The last time he was here, we talked about ultra processed foods and the link to central nervous system diseases, including psychiatric diseases. Today we'd like to follow up and discuss some of the questions that came up during that last presentation. So thank you for being here, Dr. Lustig.

Always my pleasure, Anna.

So, first off, one thing I've been wondering myself since your last presentation is what kind of foods would you consider to be ultra processed, quote unquote, versus less or moderately processed foods? And how do those foods specifically affect mental health compared to less processed alternatives?

So this is a big question is, you know, how do you define ultra processed foods? Depends on who you ask. From a purely working definition, I like Marion Nestle's the best. And she said, if you can't make it in your own kitchen, it's ultra processed. That's a good way. If it has any ingredient you can't pronounce, it's ultra processed. There are different ways, you know, different people have different definitions. There is a categorization scheme that was developed by Dr. Carlos Montero, who is a professor of epidemiology and public health at the University of Sao Paulo in Brazil. And it's called the NOVA system. Just means new. But the easiest way to explain the NOVA system is with an example. So let's take an apple. So Nova Class 1 would be an apple picked off the tree. Nova Class 2 would be Apple slices, de stemmed, de seeded, de skinned. Maybe Nova Class 3 would be applesauce macerated, possibly cooked, possibly a preservative added, maybe even a little extra added sugar. Nova Class 4 would be a McDonald's apple pie.

Super processed.

Is there any apple in that McDonald's apple pie? Probably not more like apple flavor than there is apple. If there's any Nova Class 1 in a an item, the chances are it doesn't make it to Nova Class 4. All right, well, it turns out that it's only that Nova Class 4 that is associated with all of these chronic metabolic diseases. So type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, dementia, cancer, fatty liver disease, polycystic ovarian disease, and on and on. Only Nova Class 4. So does that prove causation? No, that's association, not causation. And I understand the difference. Nonetheless, we actually have mechanisms by which these various ultra processed foods do ultimately wreak metabolic havoc on the cells. And we do have the, you know, prospective correlation and we have, you know, mechanistic plausibility.

So you talked about this a little bit in your last talk and of course today. So is there truly just a correlation? Have you seen any evidence for causation or any scientific studies?

Well, it's very hard to do these studies in people for obvious reasons, because people eat a panoply of foods and these diseases take, you know, years to decades to develop. So it's very difficult. You know, what you'd have to be able to do is determine how much someone was eating today and how much someone was eating next year, and how much someone was eating 10 years from now, and how much someone was eating 40 years from now and then still look at the prevalence and incidence of these various diseases. Obviously no one has done that and no one's going to do that. And there's no money in the world that could pay for that. That's not going to happen. Right, so what do we have instead? So we have prospective correlation where we look at baseline consumption of various ultra processed foods and look at the development of diseases that we have. We also have, of course, snapshots in time. That's easy. You know, what are you eating now and what disease do you have now? But that does not infer causation because you can have reverse causes, causation or intermediate causation, or it could just be an epiphenomenon. So you can't necessarily prove direct causation. So that's the problem with most of the nutrition studies that have been done throughout time immemorial. There is one way to do it, and that is called econometric analysis. So an econometric analysis is a natural history study where you look at either the consumption or the availability of a specific foodstuff today, next year, the year after. And you have to have the movie, it has to have time as a factor. And then you look at the change in the prevalence of a specific disease over that exact same period. So you have to have that movie as well. So you have to have the two movies running concurrently. And you also have to be able to factor out all potential Confounders. That's an econometric analysis. And we do have that. We have it for sugar and diabetes, where we've actually shown that the change in sugar availability country by country predicts the change in diabetes prevalence country by country or over a decade. That's causation.

Right. And a lot of these studies are, you know, very broad scale. And as you mentioned, a lot of these foods were not around 50 years ago. So we're seeing overall, you know, much higher prevalence of these diseases. So can you elaborate a little bit on, you know, the neurological impact of ultra processed foods and potentially the, you know, psychiatric impact?

So ultra processed foods could be affecting the brain and the central nervous system in multiple different ways. One way is through changes in mitochondrial energetics. Now, you know that your brain uses the most glucose of any organ per gram. It is a basically a machine for generating energy because neurotransmission is so magnificent, metabolically intensive and energy expensive. So, you know, a three pound organ consumes 20% of the glucose that you ingest. If your mitochondria, which are basically turning that glucose into energy, are either inhibited or defective in any way, that's going to end up leading to defective neurotransmission, which might have, for instance, behavioral sequelae, like, for instance, depression. We have data on mitochondrial dysfunction because of sugar, because of the molecule fructose. So it turns out glucose actually increases mitochondrial function, but fructose inhibits mitochondrial function. It inhibits three separate enzymes that are necessary for mitochondria to do their job correctly. It inhibits AMP kinase, it inhibits acyl COA dehydrogenase long chain, and IT inhibits carnitine pulmidoyltransferase 1. These are three enzymes that are necessary to be able to turn either glucose or fat into ATP. So we have that. Another possible way ultra processed food could affect brain function is neurotransmitters. Now, there's one neurotransmitter called glutamate. There's another neurotransmitter called gaba. Glutamate is an excitatory neurotransmitter. GABA is an inhibitory neurotransmitter. But glutamate is a precursor to gaba. You have to turn glutamate into gaba. There's an enzyme in between and it is called glutamine synthase. So glutamate goes to glutamine, glutamine goes to gaba. Turns out that pesky molecule fructose inhibits glutamine synthase. And so we have the data to show that in the presence of fructose, glutamate levels are high and GABA levels are low. Well, that has ultimately behavioral and medical consequences. So that's a possible reason. A third possible reason is insulin. And insulin blocks another hormone in the brain called leptin. Leptin is a trophic hormone. Leptin actually causes neurons to branch out and connect with each other. Another one that does that is called bdnf. Brain derived neurotrophic factor. Well, we know that insulin blocks leptin signaling. So there might be some alteration in how neurons connect to each other and, and how they communicate with each other based on the high levels of insulin. Well, there are a lot of things that drive insulin up, but ultra processed food is the ultimate insulin driver. And finally there's the microbiome. The microbiome is fascinating because it releases substances called short chain fatty acids, which actually are anti inflammatory in the brain. And also the microbiome changes the afferent vagus nerve. And the afferent vagus nerve feeds the brain information. So it might be working at two different levels to alter brain function. And we know that that pesky molecule, fructose, affects mitochondrial function, glutamine synthase, insulin, which then inhibits leptin signaling and also alters the microbiome and reduces both short chain fatty acids and afferent vagal neurotransmission. So that's kind of the, you know, telltale sign of a problem.

Right, right. And you know, a lot of the times these physiological, you know, impacts end up impacting your mental health as well. As you discussed last time, what mental health conditions would you say are most exacerbated by ultra processed foods, sugar, etc.

Without question. And this has been done, this has been looked at, without question. Ultra processed food is most associated with depression. Several people, several studies have demonstrated that. Now they tend to be epidemiologic studies for obvious reasons, but we have some data on giving sugar to people and seeing their mental health questionnaires go down. The Whitehall 2 study showed this. Sapien Labs study showed this. There are numerous other studies. What's interesting is that that effect can actually be mitigated by increased consumption of omega 3s. That's very interesting.

So if you're eating ultra processed foods, but you're also taking Omega 3s, there's.

A little bit of a, there may be some mitigation there. In addition, we've learned that there's another way that ultra Processed foods might be altering brain function through B vitamins. So through folate, through B6, which are pyridoxine, through B12, all of these are necessary for normal brain function. And all of them are very low in the ultra processed food diet. So B vitamin supplementation can sometimes mitigate some of these neurological manifestations, including, by the way, Alzheimer's.

Right, right. And a lot of our listeners, I think in the comments I was reading, have talked about friends, family members who suffer from schizophrenia, bipolar disorder, and by changing their diet, they've been able to kind of curb that a little bit. Do you see that as well?

So Christopher Palmer, who's a professor of psychiatry at Harvard Medical School, has looked at this directly and has numerous studies going on right now where he's basically administered a ketogenic diet to patients with depression and schizophrenia, bipolar disorder, and has seen improvements in all of them. And the reason is because ketones are metabolized by the mitochondria much more rapidly, much more effectively, much more efficiently than than glucose or fructose ever were. And so ketogenic diet seems to actually lift people out of their psychiatric disturbance. Dr. Palmer has written a book called Brain Energy where he describes all of these studies and the phenomena. And it's a wonderful book. I can't recommend it enough.

Okay, we'll have to take a look. What are the components of ultra processed foods that make it most harmful to human health?

Without question, sugar. Sugar, of course, that's, that's, you know.

Let'S get that one out of the way.

That's the alpha, the omega, and everything else in between. Right, right there. There are others, though, of course. Another one that may be extremely important and really has gone under the wire is emulsifiers.

Interesting.

Okay, so carboxymethyl cellulose, polysorbate 80, carrageenan, lecithin, even. These are all things that hold fat to water. Okay. And so they're absolutely essential for ultra processed food. Otherwise your microwave lasagna would layer out in the microwave.

Right.

So you have to basically be able to bind fat to water if it's some. If something's going to have any meaningful shelf life and be able to survive cooking.

Right.

So ultra processed foods are very high in emulsifiers. Well, turns out emulsifiers are detergents. That's what you put in your clothes washer. That's what tide is. It binds fat to water and that's how you were able to lift the stain out of your clothes. The point is, what happens when you swallow a Detergent, it burns a hole in your intestine. Now, obviously, if it's an emulsifier in food, it's not going to burn a hole, but what it does do is it chews through the mucin layer, which is a layer of mucus that sits on top of the intestinal endothelial cell in an attempt to protect it. It's one of the barriers of the intestine. There are three barriers in the the physical barrier, the mucin layer, there's the biochemical barrier, the tight junctions that hold cells together called zonulins, and there's also the immunologic barrier, the TH17 cells that make a cytokine called IL17. Well, emulsifiers destroy that mucin layer and then bacteria that are in your intestine, in your gut, can get through into your bloodstream and then drive insulin resistance or worse, you know, can actually go to the brain and generate its own inflammation. So without question, emulsifiers are part of the issue as well. Vitamin deficiencies. Because once you strip the germ out of, say, whole grain bread and the fiber out of whole grain bread, it renders it somewhat vitamin deficient. That's why they have to add folate back to bread. Because they found back in the early 1980s that ultra processed bread, this grocery store bread, was leading to an enormous increase in spina bifida in babies. I was a budding pediatrician at the time, you know, when this was happening. And so they started adding folate back to bread because all these women were folate deficient.

Oh, wow.

So, you know, we know, we've known for, you know, decades that, you know, food processing alters nutrient composition. Well, that has ultimately, you know, systemic and cerebral manifestations. And so, you know, ultra processed food drives these. We've known this for a long time.

And where does bread fall in this nova scale? How processed would you.

Well, it depends on the bread. You know, the different kinds of bread.

Right, right.

So the best bread is the bread that has the fiber still surrounding the starch. Okay. So the fiber, the husk, the kernel is about 25% of the weight of any, for instance, wheat, berry, or, you know, what you would make bread from originally. Okay, well, it turns out the germ has all the nucleic acids, the polyphenols, and the vitamins. The husk is the fiber. And then, of course, you have the starchy endosperm. That's basically what makes the bread fluffy. Well, are there any breads that keep the kernel intact? And the answer is yes, there Are okay. They tend to be very expensive. They tend to be specialty. You tend to buy them at Whole foods. An example would be say German fitness bread. So these are breads that are the loaf. It's a pound loaf, but it's about the size of a brick and it's also about the weight and density of a brick. And if you threw it at somebody's head, you'd knock them out. That's how you know, that's how you know if you can knock them out. That's. That's good bread.

Right?

Right. Grocery store bought bread though is, you know, this fluffy, you know, glutenous, you know, mass and it's, you know, three times as large. And if you threw it at somebody's head, it would bounce off and then they'd come and beat you up.

That's an easy tell way.

That's not good bread because you will get beaten up if you throw it. But the, that has had all of the fiber removed. Now how can you tell? Well, you look at it and you feel it. That's one way. But you can also look at the nutrition facts label. So the carbohydrate to fiber ratio will tell you because since the Fiber is about 25% of the total weight, therefore the carb to fiber ratio of a good bread should be about 3 to 1. As soon as it starts going up to 6 to 17 to 1, 8 to 1, you know, the fiber has been stripped away. You know that that's not whole grain bread anymore. And that's the bread that can ultimately convene specific metabolic perturbations.

So the heavier, more brick like bread, the better.

Well, yes, but the problem is it makes a lousy sandwich.

Right, Right. I can relate to that. So you think that there, do you believe that there is a healthy way to have a relationship with bread? Gluten? I know that, you know, gluten intolerances are prevalent.

And yeah, the best bread is the bread that you make at home or that you buy at the local bakery. And the reason is because, number one, they can adjust how fine they grind it. They can also they don't add sugar to it. Now grocery store bread has sugar added to it. And the reason is because the sugar doesn't boil off when they put it in the oven, it stays there and holds on to water. It is hygroscopic. So that's a phenomenon called water activity and that allows the bread to be sold for much longer. That's why a grocery store bread has a sell by date. That's three weeks from now, as opposed to say a bakery bread which will stale in about a day or two because the water stays where the sugar is.

So I know that I was taught this and I'm not really sure if it's the case anymore, but in a western diet, you really should be getting all the nutrients that you require through food.

You should be able to nowadays.

Do you see that that's the case.

Or that this is exactly the point? Donna, ultra processed food is nutrient deficient food, right? Oh, it's got certain things that are in excess.

Right.

For sure. Like sugar.

Right.

Okay. But it is ultimately nutritionally deficient. And so in order to be able to get enough nutrients, you'd have to eat more of them. That's potentially at least, you know, some people think one reason for obesity, I happen to think that that's not the case, but that is one of the theories that's out there, is that enough to get enough protein, for instance, you have to end up eating more because so much ultra processed food is protein deficient. Now whether that's true or not, we can leave for another day. But ultimately, ultra processed food leaves a lot to be desired. If you ate whole real food that came out of the ground or animals that ate the food that came out of the ground, you would be getting a nutritionally replete diet and almost assuredly you would be metabolically healthy.

So in the case of individuals that are eating, you know, quite a bit of ultra processed food, do you believe that there is a need for supplementation of vitamins and you know, specifically like the B vitamins, etc.

So, so people have done those studies and there's no question that for certain vitamins, supplementation may be beneficial. For instance, like the B vitamins, vitamin C possibly depending. Vitamin D is the complicated one. Everybody and his brother says we're vitamin D deficient and indeed we are. The question is why?

Right.

Because you can drink a quart of vitamin D milk every day and still be vitamin D deficient. Turns out vitamin D is a little more complicated. So vitamin D is a pre pro hormone. Pre pro, pre pro. Pre pro. Which means it has no activity whatsoever in its, you know, vitamin D form. First thing that happens when you swallow vitamin D is it go, or even if you're skin makes it, you know, from sunlight is it goes to the liver and gets turned into the pro hormone, which is called 25 hydroxy vitamin D. Now that still has no activity, then something has to happen to that 25 hydroxy vitamin D To activate it. What happens is it goes to the kidney and there's an enzyme in the kidney called 1 alpha hydroxylase that turns it into 125 dihydroxy vitamin D. That is the active form. That is the form that works on the gut to absorb more calcium and to work on the bone to lay down more calcium. Okay. That is the active form of vitamin D. However, you could also turn that 25 hydroxy vitamin D into an inactive form called 2425 dihydroxyvitamin D by the enzyme 24 hydroxylase. So where does that live? That lives in all inflammatory tissue. And it doesn't matter what kind of inflammatory tissue. Neutrophils, macrophages, sarcoid, tuberculosis, and the list goes on. Well, 93% of America is inflamed. We have the data to prove it. So their 24 hydroxylase has been revved up by the fact that they have all of this active inflammatory tissue. And the reason is because the inflammatory tissue is trying to inactivate that vitamin D. Because that vitamin D would be an immune modulator and you're trying to be inflamed. So you have to be able to generate active vitamin D. And just taking it by mouth isn't good enough.

So how does one make sure they're.

Getting enough suppress the inflammation. That means eat real food.

That's what it all comes back to.

That's what it all comes back to.

Right. And you know, in the case of vitamin D, you know, as a pharmacist, I know that there, you know, has been some regulation around doses that are, you know, potentially toxic or available by prescription only. And as you know, we did some work on vitamin B6 and you know, the FDA petition that we filed, which we have not heard back from the fda, and I'm sure the vitamin and supplement industry has potentially something to do with that. But how do you feel about kind of off topic? But some of these vitamins and supplements that are available over the counter and the doses leading to toxicity.

Right. So vitamin D can be toxic because it's fat soluble. Any fat soluble vitamin in extreme excess over chronic long term period could potentially be toxic. And I have seen hypervitaminosis D and it is ugly.

I have too.

It looks like, I'm not gonna argue.

It mimics symptoms of diabetes almost.

I've seen it in some cases. Yeah. It can shut down your kidneys without question. So it's not that it's not real. It is, but you have to work at it.

Right?

You really have to work at it. I mean, the fact is, we have kids who are vitamin D deficient who, who used to give what was known as STOS therapy, where we would give them 250,000 units of vitamin D in an intramuscular injection. And, you know, it cured their vitamin D deficiency, it cured their rickets, but it didn't cause hypervitaminosis D. So you have to really work at it, and you have to do it for a very long time. I mean, basically, you almost have to be psychopathic, you know, to do that. To do that.

Right.

The problem is that vitamins and supplements are not really regulated by the fda.

Yes.

They slide in under a provision, you know, a specific act, specific law called DSHEA, the Dietary Supplement Health and Education act of 1994. And what that, that. What DSHEA says is that in order for a supplement to be pulled from the market, you actually have to prove harm.

Right.

Okay. So anything's allowed to call itself a supplement and somebody, it behooves somebody else to actually prove harm. And the question is, why the FDA do this? Well, DSHEA was written by Senator Orrin Hatch of Utah, whose son ran a supplement company.

Interesting. I didn't know that.

Stick around, you'll learn more.

Right? That is very interesting. Yeah. No, the vitamin. I mean, I did significant work on this with our B6 petition and read numerous articles about how most Americans don't even realize that the vitamin and supplement industry goes. Ultra processed foods is what is one thing our listeners can do today to change the trajectory of their health? I think I know the answer, but.

Well, I'll give them two. How's that?

Okay.

Eat real food. Cut out sugar and walk 15 minutes.

Oh, okay.

How's that? Well, if you eat real food, you're cutting out the sugar.

Right?

Okay. I mean, that's ingrained in that. Okay. But ultimately, I think sugar trans fats were the worst thing you could put in your body. But they've come out of our diet because the FDA has now banned them, which is good. So now sugar is, you know, basically public enemy number one. If you ate real food, you'd be reducing your sugar consumption by somewhere between 80 and 90%. And that would be pretty good.

One more thing I was wondering is, you know, what about fat? What kinds of fat do you think are good? If somebody says something is non fat, milk, what are your thoughts on that?

So for 50 years, we were told, fat is bad, fat is evil, fat is the boogeyman. It is patently untrue. And they actually Knew it at the time, too, because we have the data to show that they knew what they were doing. There are seven classes of fats. Seven. Two of them are not good. Five of them are actually okay. And some of them are absolutely essential. So let's take the seven in order of best to worst. Omega 3s. Heart, healthy, anti Alzheimer's, save your life. Okay. The fewer omega 3s you have, the quicker you die and the more depressed you'll be, the more miserable your life will be. All right, but where do you get omega 3s? From? Wild fish. Wild fish. Not farmed fish. Wild fish. Farm fish have omega sixes because they eat corn. Number two, monounsaturated fatty acids, like olive oil, turns out good for your liver. Number three, polyunsaturated fatty acids. Turns out they do a lot of decent things around the body in different ways, and they're good for energy transport. The only problem is if you overheat them, and also if you overdo them, they can cause some immune dysfunction. Number four, saturated fat. Saturated fat is cardiovascularly and diabetes neutral. Not good, not bad. Everyone thinks saturated fat is the enemy. That's why they took the fat out of the milk. Couldn't be more untrue. In fact, dairy saturated fat is different from red meat saturated fat because dairy saturated fat is odd chain with a specific phospholipid signature that confers metabolic health as opposed to red meat saturated fat, which is even chain fatty acids without that phospholipid signature. Number five, medium chain triglycerides like coconut oil. Now, is that okay? And the answer is if that's all you're eating. Yeah. But if you're also consuming large amounts of saturated fat plus medium chain triglycerides, then you can overwhelm your liver's mitochondria. Number six, omega sixes. Okay. That's what's in seed oils. That's what's in corn oil and soybean oil. Okay. That's what the food industry uses. And the reason is because it has a high heating point. Okay? It's. And it's cheap. Turns out it is pro inflammatory. It is the precursor to arachidonic acid, which is the precursor to thromboxanes, leukotrienes.

And the inflammatory cascade.

And the inflammatory cascade, exactly. All right. And finally, number seven, the devil incarnate trans fats, which are now gone mostly. There are some natural trans fats, but they're, you know, pretty low in. In abundance.

And where do you see those?

In milk.

Milk. Okay. And do you think that there is a healthy way to have a relationship with dairy. What is your take on?

I think there's I think dairy is very good. And in fact, there's lots of data to support the use of dairy throughout. You know, as Time magazine declared back in 2015, Butter's back, baby.

Great news.

Way better than margarine, that's for sure.

Right. Well, great news for cheese lovers out there like myself. Well, I think that wraps up all my questions for today. Thank you so much, Dr. Lustig, as always, you are a wealth of knowledge. We learned so much from you today. We appreciate you taking the time to speak with us. And we look forward to your presentation today. It's going to be on personal responsibility versus public health. Stay tuned.

Sa.