282: Metabolic Dysfunction Disaster Fueling Skin Problems w/ Dr. Robert Lustig

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You go to the doctor, get blood panels run, but you're told you're fine. However, you don't feel well. Have you ever felt that maybe there's a step missing somewhere or something is just being overlooked?? Today you'll hear from someone who might be able to give you some insight on why things have shifted in the medical system and what you can do to support health, especially your mitochondrial health.

My guest today is Dr. Robert Lustig, MD, MSL. He is Emeritus Professor of Pediatrics in the Division of Endocrinology and Member of the Institute for Health Policy Studies at UCSF. Dr. Lustig is a neuroendocrinologist, with expertise in metabolism, obesity, and nutrition. He is one of the leaders of the current “anti-sugar” movement that is changing the food industry. Dr. Lustig graduated from MIT in 1976, and received his M.D. from Cornell University Medical College in 1980. He also received his Masters of Studies in Law (MSL) degree at University of California, Hastings College of the Law in 2013.

I'd love to hear if something really stuck out to you in this interview! Share with me in the comments below!

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In this episode:

  • What is metabolic health + what all does it affect?
  • Insight on the liver enzyme ALT + how it's normal range has changed
  • What are Dr. Lustig's “Hateful Eight” for metabolic health?
  • Thoughts about why the diabetes diagnosis is exploding
  • Glucose vs. fructose – which is worse?
  • The importance of fiber


“It makes sense that the disease of alcohol and the disease of sugar should be the same, and that's why children now get type 2 diabetes and fatty liver disease without alcohol.” [5:01]

“It turns out there are a whole lot of mitochondrial toxins out in our environment. But the mitochondrial toxin that you have the most control over, that you could deal with yourself in a flash and get rid of about 85% of the mitochondrial dysfunction in your body in one fell swoop, is the molecule fructose, which is one half of sugar.” [20:17]


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Get ALL of Dr. Lustig's books:

Looking for some healthy snacks made from REAL food? Try PaleoValley!

Healthy Skin Show ep. 007: How To Combat Your Chronic Skin Issues By Helping Your Liver w/ Dr. Alan Christianson

Healthy Skin Show ep. 047: Will A Liver Detox Help My Skin Rashes?

282: Metabolic Dysfunction Disaster Fueling Skin Problems w/ Dr. Robert Lustig FULL TRANSCRIPT

Jennifer Fugo: Dr. Lustig, thank you so much for joining me on the show today.

Dr. Robert Lustig: My pleasure, Jennifer. Happy to do it.

Jennifer: I'm excited, because we met at the Integrative Dermatology Symposium, and I've actually followed you for quite a while. And getting to see you talk about… And I had shared this with you, this was my general impression of your talk, that we are focusing on the wrong things when it comes to health and trying to help people get healthier. I know we're going to dive into a lot of this today, but I think while we may not be talking about skin specific, I think this topic cannot be ignored, because fundamental health principles are the things that we all… Whatever type of skin issue or chronic health issue you have, these apply.

Dr. Lustig: Well, what I would say is that what we need to focus on is metabolic health, because metabolic health is brain health. Metabolic health is gut health. Metabolic health is heart health. Metabolic health is liver health. And metabolic health is skin health. So, when you understand what's actually going on inside your cells, you will basically help all of your organs, including your skin, which happens to be the largest organ in your body.

Jennifer: Well, so, let's talk a little bit about this whole thing in terms of… I get a lot of clients that are concerned, that they don't understand. They go to the doctors. They get blood panels run. They don't feel well. They don't look well. But they're told they're fine.

Dr. Lustig: Happens all the time.

Jennifer: Why is this happening?

Dr. Lustig: Well, for one thing, how do you decide what's normal? So, let me give you an example. I started medical school in 1976, all right? And at that time, there was a liver test, standard liver test that everyone gets. It was called an ALT. Back then, it was called an SGPT. The name changed. The assay's the same, and what it means is the same, ALT, which is alanine aminotransferase. And what it's a sign of is liver fat. So, when your ALT goes up, chances are, you've got fat in your liver, and your liver's not supposed to have fat in there.

So, once upon a time, the upper limit of normal for an ALT was 25. Today, if you go to the doctor and you get your chem panel done, the upper limit for ALT is 40. And your doctor will look at your ALT and say, “Oh, you've got an ALT of 32. You're fine,” because it's under 40. An ALT of 32 is not fine. An ALT of 32 is fatty liver disease. Now, the question is, how come, 40 years ago, the upper limit was 25 and today it's 40? And the answer is, because the entire curve has shifted to the right. Everyone's got fatty liver.

The way you decide what's normal is you take a population of, say, 10,000 or 50,000 people. You run the assay. Okay? You figure out the mean and the two standard deviations, and you say, “Anything above that, okay, that's abnormal.” But if the entire curve has shifted to the right, guess what? That puts it at 40, but that doesn't make 40 normal, because everyone's got fatty liver disease. 45% of Americans today have fatty liver disease. This is a disease that we didn't even know existed before 1980. So when I went to medical school in 1976, if you had a high ALT, you were an alcoholic. But today, 25% of children have fatty liver disease, and they don't drink alcohol.

Jennifer: Oh my gosh.

Dr. Lustig: So the question is, what's causing it in them, and therefore, what's causing it in the 45% of adults that also have fatty liver that don't drink? And the answer is, well, there's another toxin that's affecting the liver. It's just not called alcohol. It's called sugar. And the reason is because sugar and alcohol are metabolized in the liver exactly the same way. And it makes sense that that would be the case, because after all, where do you get alcohol from? Fermentation of sugar. For alcohol, the yeast does the first step of metabolism called glycolysis. For sugar, we do our own first step, but after that, the mitochondria, the little energy burning factories inside your cells, they don't care where it came from.

And so, it makes sense that the disease of alcohol and the disease of sugar should be the same, and that's why children now get type 2 diabetes and fatty liver disease without alcohol. So, does sugar affect your ALT? Absolutely. Does sugar affect your heart? Absolutely. Does sugar affect your lipids? Absolutely. And does sugar affect your skin? Oh, you bet it does. Okay? Everybody out there, okay, you ever heard of wrinkles?

Jennifer: Yes.

Dr. Lustig: That's sugar working on the skin.

Jennifer: Well, can I also ask you too? ALT's not the only marker, I feel like, that's drifted.

Dr. Lustig: Yeah.

Jennifer: I feel like there's this drifting situation. I kind of recall at some point, even the hemoglobin A1C got moved.

Dr. Lustig: Sure.

Jennifer: It used used to be lower to be considered diabetic, and now, they set it higher.

Dr. Lustig: That's right, and the same thing for uric acid. All of these lab tests have shifted. So, you go to the doctor, and the doctor looks at your lab tests and say, “Ah, they're all normal,” because he's just reading off a column next to the number that says H or L, high or low, and if it doesn't say anything, then it's normal. But normal doesn't mean anything, because if the entire curve has shifted to the right, normal relative to what? So we have a lot of work to do. And the problem is, the doctors aren't taught this. So, this is one of the reasons I wrote the book behind me, Metabolical, is to explain this to physicians and to the public.

Jennifer: Yeah, it's really disturbing that there's such a disconnect between just this simple thing of, “I don't feel well,” but your labs look fine. And there's a lack of… I mean, there's a lot of things. I mean, I'm sure you and I… I mean, as I saw what my father went through being a doctor, and I'm sure what you're still experiencing now, there's plenty of fingers to be pointed at different issues and such, but I really do genuinely feel like we're focusing on the wrong things. We're looking for medications that could suppress and manage disease more so than actually looking at some of the underlying drivers. And you actually describe them as the Hateful Eight, which I know is in your book. Do you want to talk a little bit about this whole concept of maybe we're really missing the point of what we should be focused on.

Dr. Lustig: Sure. So, let me start with just sort of setting the paradigm for your audience. You find a wasp in your attic. What are you going to do, kill the wasp-

Jennifer: Probably.

Dr. Lustig: … or destroy the wasp's nest?

Jennifer: Oh, good point.

Dr. Lustig: Okay? Where there's one wasp, there's a thousand wasps, okay? All right. You ain't done. Okay? What we've been doing is we've been swatting wasps for the last 50 years in medicine, and we haven't worked upstream. If you're going to solve a problem, you have to work upstream of the problem. Working downstream of the problem only deals with the symptoms, not with the cause. And that's what we've been doing in medicine for the last 50 years, is we've been throwing medicines at symptoms of disease rather than actually dealing with the cause of disease. And that is what the whole part one of this book behind me is about, is explaining the difference between the two, and why medicine basically went so far off the rails. It's because in medical school, that's all you get taught, prescriptions and procedures. That's way downstream of the problem.

So the question is, how do you deal with the cause? Well, you have to understand what the cause is. And the point I make in the book, and to you and to your audience, is that the actual causes of disease are things you've never even heard of. And in the book, I call them the Hateful Eight. And I'm just going to list them right now. And you tell me how many of these you think your audience has heard of. Okay? Because there's no ICD-11 code for any of them. So doctors don't bring them up, because there's also no drug for any of them. Alrighty?

Here we go, number one, glycation; number two, oxidative stress; number three, mitochondrial dysfunction, maybe you've heard of that one; number four, insulin resistance, maybe they've heard of that one; number five, membrane instability; number six, inflammation, maybe they heard of that one; number seven, methylation; number eight, autophagy.

Now these are eight processes that go on inside all cells at all times, and they're necessary. If you're not doing them, you're dead, okay? They occur whether you like it or not. The question is, how fast? Because it turns out, if those reactions are running fast, you will be 40 years old in a wheelchair with two stumps on dialysis waiting for your next stroke.

Jennifer: Oh my gosh.

Dr. Lustig: But if they're running slow, then you'll be 110 playing tennis. These are the processes that lead to degenerative chronic disease. These are also the processes that lead to aging. They're all the same. And it makes sense that that would be the case. So the question is, is there a medicine for them? And the answer is, you can't get to where the medicine would need to work. There's no medication that can actually get inside the cell to fix the problems. The only thing that can actually fix the problems is food.

These eight subcellular pathologies that I just rattled off, and I didn't spend any time explaining them, because we only have 25 minutes, and if you really want to understand them, there's this book behind me. You can go get it on Amazon or Barnes and Noble or god knows where else. You buy a book, preferably in a local bookstore, because we need to support local bookstores. But the bottom line is that those processes are not druggable, but they're all foodable. But the question is, which food do you have to eat in order to improve them, and which foods are going to actually make them worse? And that's what I go into in the book.

Jennifer: Well, so I wanted to ask you a little bit about, in your talk, you had mentioned how there's actual research showing that some of these medications that are commonly prescribed to help with, say, insulin resistance and diabetes and whatnot, we have this idea… A lot of people are on statins. A lot of people are on high blood pressure medications. The diabetic market, I imagine, is a fairly huge market for medications.

Dr. Lustig: Indeed.

Jennifer: Do these medications help? I mean, don't want someone to go, “Oh my goodness, I need to stop my medication.” We're not saying any of that.

Dr. Lustig: No, no.

Jennifer: But are they as effective, or are there downsides that perhaps we aren't aware of?

Dr. Lustig: Indeed. There's downsides to every medication, because every medication is, quote, a selective poison, except they're not so selective. They poison other things too. Perfectly good example of that would be statins. So, statins lower your LDL. Now, you've heard a lot about LDL. Everyone's heard about LDL. LDL is bad, right? High LDL causes heart disease. Well, yeah, but not really. Not really.

There are two LDLs. There's not one. There's two. One LDL is called large buoyant, and the other one is called small dense. Turns out, only large buoyant… sorry, only small dense is the bad guy. And it turns out, when you're measuring LDL, you're actually measuring mostly large buoyant. So, in fact, we're throwing statins at a problem that doesn't need them being thrown at. In addition, statins affect your mitochondria, and that actually increases your risk by 20% of developing hyperglycemia, high blood glucose, which can manifest ultimately as diabetes.

So, the bottom line is, if you're going to use a statin, and I'm not saying that statins are worthless, you have to prescribe it for the right reason. And we're not, because these diseases are not diseases. These are symptoms of disease. The real pathology is going on inside the liver, and that's not where the LDL problem is, and that's not where the statin is designed to work. So, we are missing the problem.

Jennifer: Yeah, one of my dad's big concerns with statins was that he would commonly have patients, especially elderly patients, complaining of leg weakness and cramps.

Dr. Lustig: Yep, sure, rhabdomyolysis.

Jennifer: And he said to me… One concern is, it depletes CoQ10, which is necessary for your mitochondria. And he goes, “We have so many mitochondria in our heart and in our brain,” he's like, “I worry that this person could end up, if they deplete the CoQ10 too significantly, with being at a higher risk, potentially, for a cardiovascular event.”

Dr. Lustig: That's right. I completely agree. Your dad got it right. So that's one reason why things aren't going the way they should. Let me give you another reason, okay? Let's talk about blood glucose. So, everybody's got diabetes now. I mean, diabetes went from 2.5% of people over 65 back when I entered medical school to 9.4% of all adults today. All right? That's a lot of people. And other countries have it even worse than we do, like India and Pakistan and China have a higher diabetes rate, even though they're not fat. Everyone thinks it's because of obesity. It's not, because India, Pakistan, and China have a higher diabetes rate than we do. And the question is, why? And the answer is, because your mitochondria are screwed. That's why. Because when your mitochondria are screwed, you can't burn. And if you can't burn, you have to store. And if you store, it generates liver fat, which makes you insulin resistant, and that's what ultimately leads to the diabetes.

Now, we give people insulin or oral hypoglycemics to lower their blood glucose, and that does work. It lowers their blood glucose. The question is, what does it do for their longevity? Does it make them live longer? In fact, there are five separate studies, and I can name them for you if you want, but five separate studies that show that if you get the blood glucose down, if you get the hemoglobin A1C down in diabetics, you will reduce their nephropathy, kidney disease; neuropathy, neurologic disease; and retinopathy, eye disease, but they will die just at the same time anyway from their coronary heart disease or their Alzheimer's disease.

Jennifer: Wow.

Dr. Lustig: And the reason is because you have gotten their blood glucose down, but the glucose is only responsible for small vessel disease. You have not gotten their blood insulin down, and turns out, the insulin is actually the bad guy in the story. You need to get the insulin down, but what you're doing with all those medicines is you're making it go up. And so, you're actually making those macrovascular diseases and other metabolic phenomena, especially in the brain, worse.

So, we're fixing the symptom of the high blood glucose, but we're not fixing the problem, which is the insulin resistance and the metabolic dysfunction and the mitochondrial dysfunction. This is another example of how we've just gotten it completely wrong over the past 50 years. And when you start paying attention to those Hateful Eight, you actually know what you do need to do and how food can actually fix that insulin resistance problem, that mitochondrial dysfunction problem, that oxidative stress problem that leads to these diseases.

Jennifer: And with the mitochondrial issue, you've mentioned it a few times, and my audience is actually familiar with the mitochondria, because I do think it's a really important part of healthy living, but also to help people with their chronic skin problems, because a lot of times too, the mitochondria require a lot of nutrients. And when we become depleted in nutrients, that adds an added layer of stress.

So in terms of this, your… I loved the photo you shared in your talk of the different… based on the movie and then named them these different… the Hateful Eight. It was so great to put a character to a name. But how do you look at mitochondrial dysfunction? What do you feel is the biggest factor here of why people should care about their mitochondria?

Dr. Lustig: Right. So mitochondria are your little energy burning factories inside your cells. They make the chemical energy that your cell then uses to power all of its functions. So your mitochondria need to be at tip-top performance in all organs, but in particular in the high energy utilization organs. Those are the heart and the brain, and the liver too, but particularly the heart and the brain. If your mitochondria are not working well, that means that your cells can't generate the energy they need, and you're going to start seeing cell aging and ultimately, cell deaths, and then finally, human death. So, keeping your mitochondria in tip-top performance is absolutely essential.

Well, the way to do that is to remove any mitochondrial toxins. And it turns out there are a whole lot of mitochondrial toxins out in our environment. But the mitochondrial toxin that you have the most control over, that you could deal with yourself in a flash and get rid of about 85% of the mitochondrial dysfunction in your body in one fell swoop is the molecule fructose, which is one half of sugar.

Now, fructose is not all of mitochondrial dysfunction. There are other toxins as well. There's cadmium, and there's BPA, and there's diphenyl ethers, flame retardants, and others and phthalates and what have you. And there are all sorts of chemicals that have been spewed out by various companies throughout. And they now actually have a name. They're called environmental obesogens, compounds that actually make you fat that have nothing to do with Calories. All right?

So it's not like that doesn't exist. It does. But the one that is by far and away the most prevalence, the most pernicious, and the one we give to children and call it love, is sugar. Now, that fructose molecule, remember, sugar's made up of two molecules, glucose and fructose. Glucose actually makes your mitochondria work better. Glucose activates two, count them, two enzymes in the mitochondria that actually make them work better. It activates an enzyme called AMP kinase, which is the fuel gauge on the liver cell. That's good. It activates another enzyme inside the mitochondria called hydroxyacyl-CoA dehydrogenase or HADH. That's good. So the sum total of the effect of glucose on mitochondria is good.

Fructose, on the other hand, that other molecule, the sweet molecule, the molecule we crave, the molecule we seek, the molecule that basically runs our lives is a completely different animal, because fructose actually inhibits three, count them, three separate enzymes in the mitochondria. It inhibits AMP kinase, that fuel gauge, basically, so cells don't know how much energy they got, so they need to store more.

It inhibits an another enzyme called ACADL, Acyl-CoA dehydrogenase long chain. This is the same enzyme that aspirin inhibits, which is why aspirin causes Reye syndrome, which is like the quickest way to fatty liver disease that kids used to get when we used to give them aspirin way back when I was a resident. We've learned since.

And then finally, sugar, fructose, causes an increase in uric acid. And uric acid causes an inhibition of a third enzyme called CPT1 carnitine palmitoyltransferase I, which is the enzyme needed to regenerate this shuttle molecule called carnitine, which is what gets fats into the mitochondria to be burned in the first place.

So the sum total of fructose is that it actually inhibits your mitochondria from working. It poisons your mitochondria. And, in fact, the AMP kinase one, it poisons it irreversibly, so basically knocks it out, so you have to make new ones in order to actually be able to do anything. Now, over the course of time, your cells lose the ability to be able to do that. Well, guess what? That's going to age you. That's going to basically bring you that much closer to your demise.

And that's what the data show. The data shows that the more sugar you consume, the quicker you die, the more ultra processed food you consume, because that's where the sugar's hiding, in the ultra processed food, the quicker you die. And you die from cancer. You die from diabetes. You die from heart disease. You die from dementia. Basically, you die. And this is the single most malleable of the various things that you can do to reduce that Hateful Eight. Because all eight are subservient to our food supply. So if you ate real food instead of processed food, you'd help all eight, and you'd also help your skin while you're at it.

Jennifer: That is very true, agreed. Well, I have to ask, because I think a lot of my listeners are intelligent enough to know, when they hear fructose, they're thinking fruit. So can we just get clarity, when you say fructose, is fruit included in that, or is there some other form that is probably more problematic?

Dr. Lustig: Right. So everybody wants to know, so is fruit okay? And then the other question they want to know is, is diet sweeteners okay? Those are the two questions that always come up. So let me handle both of them right now, put this thing to rest. Fructose is, quote, fruit sugar, yes. It was originally isolated from fruit, true. Fructose is in fruit. Yes it is. It's the reason fruit is sweet, no argument. It is the same molecule that they put into the chocolate and put into the Coca-Cola and put into everything else that's sweet. It's the same molecule, agreed.

However, when you eat a piece of fruit, you're not just eating fructose, you're eating something else that you need even more, fiber. And it turns out, the fiber in the fruit, and there are two kinds, you need both, soluble and insoluble, so soluble is like pectins or inulin, like what holds jelly together. Insoluble fiber's like cellulose, the stringy stuff in celery. Together, they form a gel, a barrier on the inside of your intestine, and prevent absorption of that fructose. They actually inhibit your body's ability to absorb that fructose from your intestine and send it to your liver. And that's a good thing. You don't want to. You want to keep your liver safe. You want to protect your liver. And that fiber gel is one of the things that protects it. And you get it in fruit.

So even though the fruit has the poison, it has way more of the antidote. So when you consume a piece of fruit, the fructose in that fruit is not for you, because you're not absorbing it. It's going further down the intestine, where the bacteria, the microbiome in your intestine will chew it up for its purposes, and you'll never have gotten it. So even though it passed your lips, even though it registered as a Calorie, even though it registered as a gram of sugar consumed, your body never saw it, because it never got past your intestine. Your microbiome chewed it up instead, which is another reason why a Calorie's not a Calorie, because if it came with its inherent fiber, that Calorie wasn't for you. It was for your bacteria.

Jennifer: And would the same be-

Dr. Lustig: They always say what-

Jennifer: [inaudible 00:28:09]-

Dr. Lustig: Let me just finish the concept. When you're pregnant, they always say you're eating for two. You know what? You're always eating for 100 trillion. Okay? The question is, how much goes to you versus how much goes to your bacteria? And the answer is, when you're consuming your food with its inherent fiber, called real food, you're feeding your bacteria, which is a good thing, because those bacteria, when not fed, they will actually make you sick.

Jennifer: And does this still apply to fruit juice, where you are missing…? You're getting a fraction of the fruit.

Dr. Lustig: Right. Right. So fruit juice has had the insoluble fiber removed. That's what made it juice. So you still have the soluble fiber, the pectin and the inulin is still there, and it has some beneficial effects. There's six things that fiber, both soluble and insoluble, do for you that are metabolically healthy. They cause gastric distension, which helps with feeling of fullness, reducing total food intake. It forms this gel on the inside of the intestine that reduces the glucose load, thus reducing the glycation and the oxidative stress. And it also reduces the insulin response. It sends the food further down the intestine. That's where the microbiome can chew it up, so you're feeding your microbiome. That microbiome will then turn that fiber into short chain fatty acids, which are anti-inflammatory. You'll generate the peptide YY signal, which is the satiety signal, sooner, so you won't eat a second portion. And the fiber will also clear all the cancer cells out of your colon.

Jennifer: Wow.

Dr. Lustig: So, all the stuff that fiber does is really good. All those things are positive benefits. Now, when you juice the fruit and drink the juice instead, you're only getting two of those six. You've lost four. Now you could eat cardboard, which would be insoluble fiber, and you would also get two of the six, but you've lost four. So the two together, the soluble and the insoluble, eating it in the fruit itself, whole fruit, you are getting all six. You're getting a synergistic… more than additive effect. So fruit is good. Juice is bad. Just that simple.

Jennifer: All right. And then, in terms of the artificial sweeteners, what's your thoughts?

Dr. Lustig: Right. Right. So everybody says, “Well, yeah, I got to cut my sugar down, so let me consume diet sweeteners instead.” No fructose, no Calories, got to be good, right? Well, not quite. It's a little more complicated than that. So now we have several meta-analyses that show that the toxicity of one Coca-Cola equals the toxicity of two Diet Coca-Colas, half as bad. But half as bad does not mean good, means half as bad. Now you say, “How can that be?” because there's no fructose, no Calories, “How can there be any bad?” And the answer is because those diet sweeteners actually have metabolic effects of their own.

Number one, they still generate an insulin response, just the sweet taste on the tongue generates an insulin response, having nothing to do with raising your blood glucose. And that insulin then causes damage, like we talked about earlier. In addition, those diet sweeteners actually change your microbiome. And it's been shown now that those diet sweeteners are much more likely to cause leaky gut and therefore inflammation and therefore insulin resistance than virtually anything else in your diet. So it is true that sugar's worse, but that doesn't make diet sweeteners a whole lot better. So, people who think, “Oh, I'm not drinking Coke. I'm drinking Diet Coke, and because there's no Calories, I can have 10 of them,” that's not very bright.

Jennifer: And when we talk… if we kind of bounce back for a moment to fructose, so high fructose corn syrup or agave syrup as another example, is that essentially like fructose on steroids?

Dr. Lustig: Kind of sort of, yeah. I mean, agave is actually more fructose than glucose. Normally, there's no such thing as fructose alone in nature. The only place you can get fructose alone is in a laboratory. So wherever there's fructose in a food, there's glucose too. Now the normal ratio is 50/50, one glucose molecule, one fructose molecule. That's what's in fruit. That's what in cane sugar. That's what's in beet sugar. But then we have this thing called high fructose corn syrup.

Now, high fructose corn syrup, there are three standard commercial preparations. There's a 42% fructose preparation, a 55% fructose preparation, and there's even a 90% fructose preparation. And different users use different preparations. Now the one that's most commonly used is the 55%. That's the one that is used for the soda industry. So, a lot of the sodas are 55% fructose. Now 55%, 50%, no big difference. However, there are dispensers… That's for cans. But at the 7-Eleven or at McDonald's, they actually use 90%.

Jennifer: So the soda fountains-

Dr. Lustig: Fountains.

Jennifer: … where you can put the cup and fill your cup, that's 90%. So it's like double.

Dr. Lustig: 90%. Well, so what they do is they cut it back. They put in less than you would think so that it's not as bad. But the point is, it tends to still be over 55. So my colleague Michael Goran at University of Southern California and his postdoc fellow at the time, Emily Ventura, actually went around and sampled soda fountains from all over Los Angeles and then compared them to cans of soda being sold in the stores and sent them for HPLC analysis to figure out just what was the fructose content, and it turned out that a lot of the sodas were actually 65% fructose, so that would actually be worse.

Jennifer: And to be kind of fair from a serving size perspective, at least with a can, you're limited to 12 ounces, whereas those… Nobody… They don't sell small cups of soda anymore. It's huge cups.

Dr. Lustig: That's right. Well, and plus, if you go and you buy the cup, then you basically get free refills. So it's a problem every which way you look at it.

Jennifer: How did we get here, though? I mean, I know… We kind of talked about how the lab markers have drifted, right?

Dr. Lustig: Right.

Jennifer: We've had this drifting of what's normal. But the food industry… And we're being told… The government has these ridiculous things that they put out every so often advising us how to eat, and yet we are sicker and sicker and sicker.

Dr. Lustig: Indeed, indeed. And the reason is because they're focused on nutrients, not on food. They're also focused on what's in the food, not what's been done to the food. And what Metabolical says is that all food is inherently healthy. It's what we do to the food that's not. Processed food, which is the problem, and it's been shown that processed food is the problem. Processed food is high sugar, low fiber. Real food is low sugar, high fiber. Processed food is the problem. Processed food causes disease. Real food protects against disease. But processed food is what the food industry sells.

And the thing is that we buy it for two reasons, one, because they added sugar, and sugar's addictive. And the second reason is because we subsidize those same ingredients, the corn, the wheat, the soy, the sugar, so we make it cheaper. And so, we basically think that we're doing people a favor by lowering food prices, and all they do is get sicker, and they end up spending more money on healthcare than they did on the food.

So this is a losing proposition every which way. Everyone loses except the food industry. The problem is, the food industry should never been in the situation of being able to make this kind of money in the first place. This is what has to change. And so, I've been arguing that as long as we continue to have food subsidies in this country, we will never solve this problem. That's where you start, is get rid of all food subsidies, because they distort the market. Let the market work. Even libertarians should be able to get on board with that concept. So that's where I think the rubber hits the road. And until we fix the food subsidy issue, we can't fix the food issue. And until we fix the food issue, we can't fix the health issue.

Jennifer: And we end up sicker and sicker and sicker.

Dr. Lustig: Oh, and by the way, we won't be able to fix the environment issue either.

Jennifer: No. No. I mean, if you look at factory farming and what has happened, it's just so sad. And we're losing… Even in, I think, this past year, I mean, there's so much tremendous drought down south. We're losing water as a result of the way that we are farming.

Dr. Lustig: Right.

Jennifer: It's crazy. Well, I think that one thing that is wonderful is for those who are listening to this and feeling like they want to dig in further, and I would encourage you to dig in further, there is… We mentioned the book a few times, but it's called Metabolical: The Lore and Lies of Processed Food, Nutrition, and Modern Medicine.

Dr. Lustig: There you go. All right. [inaudible 00:38:59].

Jennifer: Yes, perfect. And Rob is very passionate about this. You can follow him on Instagram. He's got some great content over there, and he's got a website called eatreal.org. And I also want to throw in here that you are fighting for children to… The lunch situation, the food situation in schools has just… For many of us, we're horrified what has happened.

Dr. Lustig: The question is, and this is a quiz, what is the largest fast food franchise in America?

Jennifer: I would maybe think McDonald's.

Dr. Lustig: America's public schools, by far. By the way, Subway is second.

Jennifer: Oh.

Dr. Lustig: But the fact of the matter is, we need to get real food into K-12, and that's what our nonprofit Eat REAL does. That's our mission, and we are doing it. And we're not doing it one meal at a time. We're doing it one district at a time. And if your audience has any interest in getting better food for your kids into schools, log on to eatreal.org, see what we do, sign up for our newsletter, and donate. That would be a good thing. But we're doing it, and we've got a lot of momentum right now in terms of fixing the American food supply. Because if schools start procuring real food, guess what, food industry's going to have to start changing what they do in order to meet that demand. So there are ways to fix the problem.

In addition, keeping your blood glucose stable thereby stopping the glycation, stopping the hyperinsulinemia, stopping the oxidative stress. And I'm an advisor to a company called Levels Health that basically helps you figure out how your continuous glucose monitor can help you learn how your food affects your health. So, there are several methods and several things that one can do today to actually improve your metabolic health. It's not a fait accompli. You have agency. You have control. But you have to understand the problem first.

Jennifer: Yeah, that's a big part. That's usually the first step, is to understand the problem.

Dr. Lustig: Always.

Jennifer: And I think many people feel like something's not right. Why doesn't this make sense? And this explains a huge reason why we feel this tremendous disconnect between the two, like, “I don't feel well.” “But your labs look fine.” And they're not-

Dr. Lustig: Right. Well, this is why.

Jennifer: Well, thank you so much for being here. I really appreciate it. Hopefully, I can have you come back sometime, and we can dive into more of the Hateful Eight. But in the meantime, if anyone wants to check that out, the book is an excellent resource, and we'll probably provide… I imagine. There might be a little bit of anger mixed with probably some, I would say, inspiration to start making some changes. And I found… Like I said, Dr. Lustig has some amazing content that I think all of you could benefit from, and that's why I invited him here. Even though it's not skin-specific, so many of the conditions I talk about have these metabolic concerns wrapped into them to some degree, and so this is really important for everyone to hear this. So, thank you so much for being here.

Dr. Lustig: It's my pleasure, Jennifer.

"It makes sense that the disease of alcohol and the disease of sugar should be the same, and that's why children now get type 2 diabetes and fatty liver disease without alcohol."