#97 – How environmental chemicals are making us sick and fat (Dr. Rob Lustig & Dr. Casey Means)

Dr. Rob Lustig, along with dozens of other scientists, recently published groundbreaking research in Biochemical Pharmacology demonstrating how a subclass of environmental chemicals called obesogens cause obesity. Levels Co-founder and Chief Medical Officer Dr. Casey Means sat down with Dr. Lustig to talk about what obesogens are, where these chemicals show up in our daily lives, how they impact our cells and cause metabolic dysfunction, and what we can do to protect ourselves.

07:58 – It’s not just correlative, it’s causative

Rob explained the foundation of the scientific papers on obesogens and how proving causation is a turning point for dealing with obesogens.

There are a lot of reasons that people have ignored this field, but the toxicologists have known about it and have been studying this now for about, I would say, 15 years, and I’ve been aware of it since 2007. The NIH has specifically funded research in this field to try to bring it to fruition, to determine whether or not this is a real cause of obesity that we have to be concerned about or whether this is just another thing along for the ride or just a diversion. This paper that’s coming out now, which has 44 authors, all basic scientists and clinicians in Biochemical Pharmacology, real journal, 48 pages long, basically puts the marker down. It’s the line in the sand and says, “This is a real thing, and it is not just correlative, it is causative for obesity.” Now, it is not the whole enchilada. It’s not like everything is an obesogen. Diet still plays a major role. Exercise still plays a supportive role. Not a major role, but a supportive role. But these obese probably account for a good 15% to 20% of the obesity problem. The sad part is most of these obesogens are forever chemicals and they’re not going away any time soon.

10:51 – Obesogens bind to our cell proteins

Obesogens are chemicals that bind to our cell’s protein receptors and ultimately change the way our bodies function.

Obesogens are chemicals that bind to receptors. Receptors are proteins in cells that take information from the outside and alter what happens to the cell on the inside, and in the process, those cells then take up extra energy and lay it down as fat. Now, some of the obesogens are caloric, like for instance, fructose are my favorite compound. But most of the obesogens are things that are found in everyday items within the home, outside the home, and in particular, things like agricultural products.

11:27 – Everyday products contain obesogens

Rob gave extensive examples of where we can find these chemicals in daily life and how ubiquitous they really are.

Let me give you some places where you might not think about obesogens being. How about vinyl flooring? How about flame retardants? How about electronics? How about pesticides? How about disinfectants? How about thermal paper and resins? How about personal care products like lipsticks? How about drugs, prescription drugs? All of these have the capacity to bind to receptors in the body, and there are several receptors that are involved. The important ones are the insulin receptor, the glucocorticoid receptor, a receptor called PPAR-gamma, peroxisome proliferation-activated receptor gamma. There’s aryl hydrocarbon receptor. There’s the farnesoid X receptor, there’s the androstane receptor. There’s a whole host of receptors. Several chemicals in our environment are promiscuous and will bind to these receptors and cause the cell to change how it processes energy, and in the process you lay down fat. This is a real thing, and the point of the paper was to not just demonstrate that these mechanisms are associated with obesity, but actually that they are causative. We can’t ignore this problem anymore.

14:37 – Babies and children are the most vulnerable

Obesogens are most dangerous to developing fetuses, newborns, and young children since they dictate the child’s biology for the rest of their lives.

These mechanisms can be occurring actually before birth. They can be occurring in the womb, in utero. These things can be going on. We have the data to show that women who are exposed to these compounds end up having offspring that are both more obese and have metabolic syndrome later. We found that fetal and early childhood is actually the most vulnerable time. This is a time when you can’t blame the patient. You cannot blame the four-month-olds. The problem is that four-month-olds are exposed to lots of these. For instance, baby bottle nipples have BPA, as an example, or phthalates. These are compounds that are plasticizers that are pretty ubiquitous throughout. If you ever open a can of food and you see a white lining on the inside, that’s BPA. It’s in all of our food. BPA is one of the primary drivers of this problem. It’s also when you get a thermal receipt from Target or from any other store, there’s BPA in that thermal paper. We’re all exposed to this stuff all the time, and it is having effects on all aspects of energy metabolism within the cells at the molecular level, and it’s causing, like I said, changes in epigenetics. It’s changing, not the DNA coding, but the DNA expression.

24:34 – Obesogens stick around even after being banned

Rob explained how these dangerous chemicals are still around today and affecting our health, even though they’re out of production.

We’ve now learned that DDT, which was the first pesticide that was used commercially starting back in the 1940s, is an obesogen and caused not just birth defects, but significant obesity. This was, of course, the book that Rachel Carson wrote called Silent Spring back in 1962, which started the environmental movement. Well, guess what? DDT is not around anymore, but it’s metabolite, DDE, is and DDE is an obesogen. It still can be measured in pregnant women urine. This stuff, it stopped being produced in 1972, but we could measure it in the urine of pregnant women in 1999. 27 years later, this stuff’s still around, and the amount of this stuff predicted the obesity in the offspring of those women. This is extraordinarily worrisome, because if it’s still around and it’s not going away, what are we going to do?

32:19 – Food is more than calories

Rob said calories don’t account for everything in food, and obesogens show up in a majority of our harvested and processed food.

The fact of the matter is food is more than just its calories. There are a lot of things in food that shouldn’t really be in food. There have been a lot of food additives that the food industry specifically adds to stuff like emulsifiers, which can cause inflammation in the intestine, which can lead to leaky gut, and, therefore, metabolic syndrome. That inflammation can ultimately lead to insulin resistance and the insulin resistance can lead to obesity. But how you grow the food. One of the compounds that we spend a lot of time talking about in this paper is a compound that everyone’s now heard of called glyphosate or Roundup. Who hasn’t heard of Roundup? First made by Monsanto, and then Monsanto was bought by Bayer in Germany. Glyphosate’s been associated with cancer, with lymphoma in particular. But the fact is glyphosate has also now been shown to be causative of obesity, and glyphosate is in almost every food. The calories cannot easily be dissociated from the glyphosate.

43:05 – Obesogens are unregulated

Because these chemicals do not claim to cure any illness, they do not need approval by any governmental organization like the FDA.

There are compounds that are selective poisons. Drugs, medicines that we buy at the pharmacy and stand on line to get our prescriptions are selective toxins. That’s the definition of a drug. It is a selective toxin. These compounds are selective toxins. The only difference between the drug you get at the pharmacy and the drug or chemical that dump into the water supply or the food supply is that they don’t make any claims that it’s going to cure any disease or treat any disease. That’s the difference. If they claim that it was going to cure or treat a disease, then it has to go through all the FDA hoops in order to get approval. If they just dump it into the water, I don’t have to say a thing about it. The burden of proof is on you to demonstrate that it’s actually a problem. That’s what happened with Teflon.

51:05 – Cell alterations last for generations

Obesogens change how our cells function and those changes pass down through pregnancy.

Scientists have shown that those can persist generation after generation, at least four generations, and in some cases even longer. Basically, it’s not what your mother ate, it’s what your great grandmother ate that made a difference, and what she was exposed to and that these things, it’s the gift that keeps on giving throughout the lineage all the way down. Now, those are things you can’t fix because you had nothing to do with them. The question is what could a pregnant woman avoid that could fix something?

01:54:00 – We need to get the EPA on board

Now that we know the causation between harmful obesogens and obesity, it is up to environmental and governmental institutions to protect us from the industries producing the chemicals.

This paper tells the government, “Hey, you’re on notice. You got to do something. All right? Here’s what you need to do.” We need government to help us with these things because the food industry and the agricultural tech industry and the chemical industry basically gotten a free pass for all these years. That’s why the EPA was developed back in 1970, was to stop air pollution and water pollution. Well, this is environmental pollution, and the EPA should be on top of this. But currently they’re not because basically they didn’t think obesogens were a problem, but they need to start getting their act together, and, hopefully, they will now and people need to pressure government and their Congressmen to get the EPA on board with this.

01:02:15 – Buy organic

The best answer to mitigate your individual exposure to obesogens through food is to choose organic produce at the store and avoid preservatives.

Now what can individuals do themselves? The answer is buy organic because a lot of these things are pesticides, use PFAS-free frying pans, which now are the only ones sold. But if you have old ones, you probably need to get rid of them. Be wary of food preservatives that are added to foods and basically real food. Real food is the answer here.

Dr. Rob Lustig (00:00:06):

There’s a whole host of receptors, and several chemicals in our environment are promiscuous and will bind to these receptors and cause the cell to change how it processes energy. In the process, you lay down fat. This is a real thing, and the point of the paper was to not just demonstrate that these mechanisms are associated with obesity, but actually that they are causative. We can’t ignore problem anymore.

Ben Grynol (00:00:48):

I’m Ben Grynol, part of the early startup team here at Levels. We’re building tech that helps people to understand their metabolic health, and this is your front row seat to everything we do. This is A Whole New Level. If he followed the work of Dr. Lustig, we’ll stop calling him that from here on out. He’s very much Rob, and he’s first to say, “Not your doctor.”

Ben Grynol (00:01:23):

Well, Rob and Dr. Casey Means, the two of them sat down and they discussed these new papers that Rob was involved in contributing to. The goal of these papers is to push forward research in the world pertaining to things like obesogens, those being chemicals that could influence or promote obesity in humans or animals. It’s very important to understand what these are and how they can contribute to things like metabolic syndrome. Casey and Rob sat down and they deconstructed these papers.

Ben Grynol (00:01:50):

They discussed the findings in them and they discussed the importance of understanding how to break down some of these studies. These papers are important to push forward research learning education in the world and to get people aligned on how policy changes of over time when we learn new information. It was a very interesting conversation and here’s where they kick things off.

Dr. Casey Means (00:02:14):

Friends, welcome to A Whole New Level. This is Dr. Casey Means, co-founder and chief medical officer of Levels, and I am so excited about this episode because it’s a topic that we do not talk about enough, which is the role of environmental toxins and how they affect our metabolism and our propensity to gain weight. I often talk about the eight pillars that contribute to metabolic health, which include sleep, exercise, stress management, micronutrients, microbiome, exposure to sunlight and exposure to environmental toxins.

Dr. Casey Means (00:02:53):

I think that last one honestly gets the least airtime. But today we’re devoting the entire episode to this, and we’re talking with Dr. Rob Lustig about this topic, and specifically about obesogens, which are these invisible, small molecules that exist all throughout our environment that are minimally regulated and that actually, through several mechanisms that we talk about today, impact our core metabolic physiology. These are chemicals that are put into our food, our water, they’re in our air, our soil, our home care products.

Dr. Casey Means (00:03:26):

They’re in our personal care products. They’re in our mattresses. They’re in our furniture. They’re in the containers that we store our food in. They’re really everywhere. Rob has public, along with 44 other authors, a series of papers that are coming out today that are landmark papers looking at the mechanisms of obesity, but also one of the three papers specifically talks about obesogens, which are these compounds in our environment that are now mechanistically shown directly cause obesity and may actually contribute to about 15% of what actually leads to obesity.

Dr. Casey Means (00:04:08):

Because obviously, it’s the multifactorial issue, but this is a key one that we’re now showing actually is not correlation, but positively related to obesity. Since 74% of American adults are dealing with overweight or obesity, this is a topic that is relevant to almost everyone. What’s really important to tune into is that these toxins actually also affect the genetics of our eggs and our sperm, our sex cells, and so can have impacts on the next generation and on our offspring. Something we really need to be aware of. We are so fortunate today to be joined by Dr. Rob Lustig to talk about the details of this incredible paper that he is putting out today.

Dr. Casey Means (00:04:53):

We’re going to be talking about one of the three papers that are coming out in a group today, and that is the one on obesogens, these environmental toxins. As you know, Rob is a Levels advisor, he’s the author of Fat Chance, Metabolical Hacking of the American Mind, three of my favorite books in the entire world. He’s a professor emeritus at UCSF, he’s a regular on A Whole New Level, and he has one of my absolute personal heroes and guides. We are so thrilled to have him today, and we will jump right in. Rob, welcome to A Whole New Level. We’re so excited to have you back.

Dr. Rob Lustig (00:05:30):

It’s always my pleasure, Casey. I’d rather spend time with you than anybody else.

Dr. Casey Means (00:05:36):

Well, thank you. I agree, and I am so excited about this topic we’re discussing today. It’s so important because it is so under recognized. Jumping right in, what this incredible landmark paper that is coming out today is telling people is that one of the elements of metabolic dysfunction and weight gain that we don’t think about or talk about a lot is environmental toxins and how they affect our physiology at the deepest level. If diet and exercise weren’t enough for us to get on top of, now we’re realizing that actually chemicals in our food, our water, our air, our personal care products, our home products actually may be directly contributing to weight gain and obesity.

Dr. Casey Means (00:06:23):

I think this might be fairly shocking to people who already feel like we’re up against a lot in terms of being healthy in the US, and now there’s all these little invisible chemicals that we need to worry about and it’s scary. I think my first question for you is, why do you think that this topic has flown so under the radar so far, that these chemicals that are everywhere are actually directly promoting weight gain?

Dr. Rob Lustig (00:06:49):

Well, ask the same question about why all these chemicals out there are causing cancer, and why that flew under the radar for so along. The fact is you can’t see them, you can’t determine what’s got them and what doesn’t, you can’t determine whether there’s cause and effect unless you do large studies, which are hard to do to start with and hard to fund. The fact of the matter is we had a belief system that said that obesity is due to too much going in and too little going out.

Dr. Rob Lustig (00:07:31):

It’s all about calories. If you believe that the problem is calories, then why in the world would you be looking for chemicals that specifically cause weight gain. After all, those chemicals don’t necessarily have any calories. There are a lot of reasons that people have ignored this field, but the toxicologists have known about it and have been studying this now for about, I would say, 15 years and I’ve been aware of it since 2007.

Dr. Rob Lustig (00:08:07):

The NIH has specifically funded research in this field to try to bring it to fruition, to determine whether or not this is a real cause of obesity that we have to be concerned about or whether this is just another thing along for the ride or just a diversion. This paper that’s coming out now, which has 44 authors, all basic scientists and clinicians in biochemical pharmacology, real journal, 48 pages long, basically puts the marker down.

Dr. Rob Lustig (00:08:53):

It’s the line in the sand and says, “This is a real thing, and it is not just correlative, it is causative for obesity.” Now, it is not the whole [angulata 00:09:05]. It’s not like everything is an obesogen. Diet still plays a major role. Exercise still plays a supportive role. Not a major role, but a supportive role. But these obese probably account for a good 15% to 20% of the obesity problem. The sad part is most of these obesogens are forever chemicals and they’re not going away any time soon.

Dr. Casey Means (00:09:39):

Let’s define some terms here. First of all, the paper talks a lot about this term endocrine disrupting chemicals, EDCs, and then of course the term obesogen. These might be new to people. Can you talk about what these mean? Also, maybe mention what you mean by forever chemicals, and where are they found in our environment?

Dr. Rob Lustig (00:10:01):

Right. First of all, what’s an obesogen? An obesogen is a chemical that specifically drives fat cell accumulation, and that fat cell accumulation can occur in subcutaneous fat, as in, does this swimsuit make me look fat? Or it can drive visceral fat, as in my belly is fat. Or it can drive liver fat or muscle fat and not necessarily even show, but it will cause chronic metabolic disease. Obesogens are chemicals that bind to receptors.

Dr. Rob Lustig (00:10:46):

Receptors are proteins in cells that take information from the outside and alter what happens to the cell on the inside, and in the process, those cells then take up extra energy and lay it down as fat. Now, some of the obesogens are caloric, like for instance, fructose are my favorite compound. But most of the obesogens are things that are found in everyday items within the home, outside the home, and in particular, things like agricultural products.

Dr. Rob Lustig (00:11:27):

Let me give you some places where you might not think about obesogens being. How about vinyl flooring? How about flame retardants? How about electronics? How about pesticides? How about disinfectants? How about thermal paper and resins? How about personal care products like lipsticks? How about drugs, prescription drugs? All of these have the capacity to bind to receptors in the body, and there are several receptors that are involved. The important ones are the insulin receptor, the glucocorticoid receptor, a receptor called PPAR-gamma, peroxisome proliferation-activated receptor gamma.

Dr. Rob Lustig (00:12:32):

There’s aryl hydrocarbon receptor. There’s the farnesoid X receptor, there’s the androstane receptor. There’s a whole host of receptors. Several chemicals in our environment are promiscuous and will bind to these receptors and cause the cell to change how it processes energy, and in the process you lay down fat. This is a real thing, and the point of the paper and the point … This is a year in the making this paper, was to not just demonstrate that these mechanisms are associated with obesity, but actually that they are causative. We can’t ignore this problem anymore.

Dr. Casey Means (00:13:28):

Interesting. Just drilling in on something you just said there. In terms of what these molecules are doing, they are in some way changing the way that the body is able to make energy, this fundamental core pathway of metabolism, and when that gets perturbed and we’re not producing energy properly in the body, it causes us to lay down more fat. That sounds like a key concept people need to understand, is that anything that disrupts our energy producing pathways of the body can in turn lead us to essentially accumulating more fat.

Dr. Rob Lustig (00:14:04):

Absolutely. There are several different mechanisms that are involved. There’s epigenetics, DNA methylation, there’s histone modifications, there’s RNA methylation, there’s chromatin remodeling, there’s micro RNAs, and then of course there’s direct receptor effects of their own. These mechanisms can be occurring actually before birth. They can be occurring in the womb, in utero. These things can be going on. We have the data to show that women who are exposed to these compounds end up having offspring that are both more obese and have metabolic syndrome later.

Dr. Rob Lustig (00:14:59):

We found that fetal and early childhood is actually the most vulnerable time. This is a time when you can’t blame the patient. You cannot blame the four-months-old. The problem is that four-months-olds are exposed to lots of these. For instance, baby bottle nipples have BPA, as an example, or phthalates. These are compounds that are plasticizers that are pretty ubiquitous throughout. If you ever open a can of food and you see a white lining on the inside, that’s BPA. It’s in all of our food.

Dr. Rob Lustig (00:15:55):

BPA is one of the primary drivers of this problem. It’s also when you get a thermal receipt from Target or from any other store, there’s BPA in that thermal paper. We’re all exposed to this stuff all the time, and it is having effects on all aspects of energy metabolism within the cells at the molecular level, and it’s causing, like I said, changes in epigenetics. It’s changing, not the DNA coding, but the DNA expression. It is binding to these protein receptors to drive fat cell accumulation, also to drive mitochondrial dysfunction, to cause mitochondrial to not function as well, thereby reducing the rate of energy burning.

Dr. Rob Lustig (00:16:53):

It’s been shown now that body temperature has gone down like a half a degree across the board over the last 25 years. You cannot explain that on the basis of diet. Why is body temperature lower today than it was 25 years ago? It’s because our mitochondria aren’t burning energy and giving off heat at the same rate. What’s causing that? Well, it’s very likely these obesogens that are affecting mitochondria function.

Dr. Casey Means (00:17:29):

That is so interesting about the temperature going down and just thinking about our bodies as these poorly work furnaces that are not generating heat appropriately. When we think about the fact that we’ve got these 37 trillion or so cells in our body, and every single one needs cellular energy to function, and that we’re surrounded by these invisible chemicals that are essentially making that harder to do, it’s ominous.

Dr. Rob Lustig (00:18:01):

It is.

Dr. Casey Means (00:18:01):

Several follow-up questions for you there. I think the first is getting into mechanism, and you alluded to this a little bit. You talk about some of the mechanisms. This paper, to give people over [inaudible 00:18:13] definitely recommend reading the whole thing. It actually is really … I think it’s a read that almost … It’s got a lot of technical terms in it, but it’s very, very well articulated, I think, for anyone.

Dr. Casey Means (00:18:23):

But you go through dozens of different chemicals that are found in our environment that can lead to problems in our obesogens. You talk about several mechanisms of how they’re actually doing their harm. You just mentioned epigenetics, you talked about direct receptor targets. You talked about mitochondrial dysfunction. Can you go through each mechanism briefly? You mentioned four main ones in the paper. Just to give people a sense, take us into the level of the cell.

Dr. Casey Means (00:18:56):

The cell is maybe a thing that some people listening haven’t thought about a lot, but what are the different areas that these chemical compounds are acting on? Then the downstream effect being that it’s essentially screwing up our fundamental energy production, but this is happening from all different directions. Maybe just speak to some of those that people should be aware of.

Dr. Rob Lustig (00:19:19):

Okay. The first thing the audience should know is that there actually is not one paper. There are three, and they’re being published as a group in Biochemical Pharmacology. The first one, which I am the first author on, is an overview and also the molecular and biochemical mechanisms by which obesity occurs in cells. The second is the one that we’re talking about that actually lists the obesogens and how they work and demonstrating that they are causative of obesity, not just associated.

Dr. Rob Lustig (00:19:57):

Then the third paper is a little bit more technical. It’s on obesity assays. How do you determine whether or not a chemical is an obesogen? What criteria does it have to meet? That’s its own paper, and each paper stands alone. The two papers, the obesity one and obesity two that we’re really talking about today, you have to understand that cells take in information, and they take in the information through proteins that are on the surface of the cell or inside the cell.

Dr. Rob Lustig (00:20:34):

These proteins are called receptors. The receptors are for hormones, and there are receptors for chemicals. Some chemicals mimic hormones and some chemicals just bind straight to the chemical receptor. Now, those receptors can ultimately have effects on adipose tissue differentiation. They can take stem cells and turn them in into adipocytes.

Dr. Casey Means (00:21:11):

Fat cells.

Dr. Rob Lustig (00:21:12):

Basically you increase the number of fat cells. This is particularly problematic in utero and in the baby. Babies who are exposed to these chemicals will end up being more obese because they have more fat cells. It’s often been said that your number of fat cells are determined by the time you are two years old. That’s likely true and we have some data based on atomic bomb testing that has shown us that, in fact, the adipose tissue number doesn’t change that much after age two, but the adipose tissue has to be growing before that age two.

Dr. Rob Lustig (00:21:54):

These receptors are very, very attuned. If you are exposed to these chemicals, and I know this because I took care of these children in Salinas, which is in the middle of the California Central Valley, where lots and lots of crops are grown. It’s an agricultural community, mostly immigrant from Mexico. We’ve done a study along with UC Berkeley called the CHAMACOS study, where we measured these chemicals in the urine of pregnant women about 25 years ago, and have watched what happened to the offspring in terms of cognition, in terms of puberty, in terms of obesity ever since.

Dr. Rob Lustig (00:22:48):

What we’ve shown is that the amount of chemicals in the urine of pregnant women specifically predicted what would happen to the child afterward in terms of puberty and obesity. We now have these data to show that we’re basically poisoning our fetuses, and the people who are most vulnerable are the people who are exposed to these at the earliest time points. That’s one issue. Second issue is that, as you know, when men are different from men. Women have curves. Well, those curves are subcutaneous fat, and those curves are determined by estrogen binding to the estrogen receptor.

Dr. Rob Lustig (00:23:44):

Well, it turns out that the estrogen receptor is the most promiscuous molecule on the planet. All you have to be to be an estrogen is have two hydroxyl groups, 22 angstroms apart, and you’re an estrogen. Now, we’ve known for decades now that women who were given DES, diethylstilbestrol, when they were pregnant back in the 1950s, ended up with babies with significant birth defects. DES has since been banned. That’s good. But turns out that low levels of DES didn’t cause birth defects, it caused obesity.

Dr. Rob Lustig (00:24:34):

We’ve now learned that DDT, which was the first pesticide that was used commercially starting back in the 1940s, is an obesogen and caused not just birth defects, but significant obesity. This was, of course, the book that Rachel Carson wrote called Silent Spring back in 1962, which started the environmental movement. Well, guess what? DDT is not around anymore, but it’s metabolite, DDE, is and DDE is an obesogen. It still can be measured in pregnant women urine. This stuff, it stopped being produced in 1972, but we could measure it in the urine of pregnant women in 1999.

Dr. Rob Lustig (00:25:30):

27 years later, this stuff’s still around, and the amount of this stuff predicted the obesity in the offspring of those women. This is extraordinarily worrisome, because if it’s still around and it’s not going away, what are we going to do? Well, PFOA, perfluorooctanoic acid, also known as Teflon. Remember Teflon? You don’t see any frying pans made with Teflon anymore. If you ever see the movie, Dark Waters, with Mark Ruffalo, came out in 2009, it’s all about the Teflon scandal and what DuPont did to hide the information.

Dr. Rob Lustig (00:26:18):

The fact of the matter is PFOAs are still around. PFASes, they’re called. polyfluoroalkyl substances. These things are causing obesity even though they’ve since been taken off the market. Aside from those obvious ones, phthalates, like I talked about, plasticizers, PBDEs, flame retardants that are in mattresses and in baby clothing, these are all thing that are still around and are potentially in any given baby causing harm by laying down more fat and causing metabolic syndrome later on in the baby. This is particularly worrisome and it’s not going away.

Dr. Casey Means (00:27:29):

One thing I found striking about this paper, obesity two, mechanisms that were mentioned. You just talked about some of the effects of these small molecules directly on receptors on the cell membrane, so acting almost like an estrogen to bind to these receptors we already have, and having these downstream cascades and then the effect on epigenetics, so actually how our genome is expressed, how it’s folded and how that can affect us in our current life, but also can affect the next generation because epigenetic changes as can be heritable.

Dr. Casey Means (00:28:06):

Some of the other mechanisms that were mentioned were things like how these chemicals actually impact inflammation in the body, how they impact oxidative stress. You mentioned mitochondrial dysfunction, microbiome. What struck me reading through this was that a lot of these were the exact same mechanisms that you talked about in chapter seven of your book, Metabolical, which is-

Dr. Rob Lustig (00:28:25):

Absolutely.

Dr. Casey Means (00:28:25):

… my favorite chapter, I think, of any book ever written, but it’s basically the overview of systems biology, and why this idea that all the diseases we talk about and the 42 medical specialties, everything being so separate, actually there are just a small set of core physiologic disturbances that lead to almost all disease. Some of these, in the book, that you talk about are oxidative stress, mitochondrial dysfunction, inflammation, insulin resistance. It’s all the same stuff that we’re talking about in terms of how obesogens disturb the body to create obesity. That leads me to two questions.

Dr. Casey Means (00:29:07):

One is it seems like this is a far bigger problem than just obesity. Obesity is a big [crosstalk 00:29:13] problem, but this is not … It’s almost like the word obesogen limits too much, the magnitude of what’s happening here, because if it’s affecting all of these different pathways, our core hormonal pathways, our core energy producing pathways and our core mitochondrial dysfunction, inflammation, Oxidative stress, et cetera, then this could affect all aspects of health. Do you get the sense that this is actually, these chemicals are not just about making us fat, but actually making us sick in all sorts of other ways?

Dr. Rob Lustig (00:29:42):

Well, what you’re describing, Casey, is the fact that there is this larger grouping called EDCs, endocrine disrupting chemicals. Then within that, there is a subset of endocrine disrupting chemicals called obesogens. Endocrine disrupting chemicals basically do what you just said, which is bind to any receptor, cause any epigenetic problem leading to some aspect of cellular metabolic change that can lead ultimately to disease, and that can be reproductive, that can be cognitive, that can be cardiovascular or endocrine or cancer.

Dr. Rob Lustig (00:30:33):

These are all endocrine disrupting chemicals, and there are many, many different types and there are many different ways they work. This set of papers is just talking about the subset called obesogens. All of the ones we’re talking about are specifically related to weight gain in some fashion. But if you want to take the whole EDC field, we know about EDCs because we have cancer and we’ve shown 50 ways from Sunday that EDCs are important in the development of cancer.

Dr. Rob Lustig (00:31:14):

That’s already on the map. The reason this set of papers are important is because the concept of obesogens has deep-sixed by a lot of scientists as being not relevant or not the big issue, or it’s still about calories. The fact that we’ve shown in these papers that obesogen are causative, not just correlative, not just the result of a problem, but the cause of a problem, is the big reason why I’m happy to talk to you about this now and the big reason why everybody should look at these papers.

Dr. Rob Lustig (00:31:59):

The other thing that I want to make clear to the audience is that people are focused on food. Hey, I’m focused on food. I wrote several books about food. The fact of the matter is food is more than just its calories. There are a lot of things in food that shouldn’t really be in food. There have been a lot of food additives that the food industry specifically adds to stuff like emulsifiers, which can cause inflammation in the intestine, which can lead to leaky gut, and therefore metabolic syndrome.

Dr. Rob Lustig (00:32:37):

That inflammation can ultimately lead to insulin resistance and the insulin resistance can lead to obesity. But how you grow the food. One of the compounds that we spend a lot of time talking about in this paper is a compound that everyone’s now heard of called glyphosate or Roundup. Okay? Who hasn’t heard of Roundup? Right? First made by Monsanto, and then Monsanto was bought by Bayer in Germany. Glyphosate’s been associated with cancer, with lymphoma in particular. But the fact is glyphosate has also now been shown to be causative of obesity, and glyphosate is in almost every food.

Dr. Rob Lustig (00:33:35):

The calories cannot easily be dissociated from the glyphosate. That is part of the calories because glyphosate is an amino acid. Things get very complicated and very hairy in terms of trying to explain all of this. Can you get GMO-free? Can you get glyphosate-free? Can you get herbicide-free food? The answer is, yes, you can. But boy, oh boy, is it expensive, and it’s hard and there are parts of the country that can’t get it. This is a perennial problem. This is a problem that’s not going away, and this is a problem that the food industry continues to promulgate and just then hiding behind the concept of calories.

Dr. Casey Means (00:34:32):

That brings me to the question of really what is driving this problem? First of all, are most of these … I noticed that some of the obesogens are naturally occurring. I think cadmium was one of them and arsenic, and then some of them are obviously synthetic, like glyphosate and phthalates and things like that. These are industrially manufactured. Can you talk a little bit about how these split between naturally occurring things and synthetically created things, and I guess who’s the bad guy here?

Dr. Rob Lustig (00:35:11):

Yeah. Well, couple of bad guys. But yes, you’re absolutely right. Most of the obesogens are synthetic chemicals. Okay? Only a couple are naturally occurring. You’re right. Cadmium is one. Arsenic’s another. Arsenic is found in certain water supplies. Cadmium is mostly … It’s found in other products, but the main product that has cadmium is coco, and in particular, cocoa from South America. Don’t know why, but that’s where there’s a high cadmium burden. In general, shall we say cheap cocoa, tends to come from South America?

Dr. Rob Lustig (00:36:04):

There’s cocoa plantations all over the world, but that’s the primary place where you find cadmium. Most of the other compounds are synthetic in some fashion. They may have started out as natural products and then be then been modified to be synthetic. A lot of them, as I said, are pesticides, like DDT, DDE, like glyphosate. They’re very specifically sprayed on food to keep the pests from getting into them. Neonicotinoid pesticides. Permethrin, for instance, is another example of that kind of obesogen.

Dr. Rob Lustig (00:36:54):

Hey, air pollution. Air pollution, particulate matter causes inflammation and inflammation causes insulin resistance and insulin resistance leads to obesity as well. Diesel exhaust. Now, who would’ve thought diesel exhaust would’ve been an obesogen? But it is. The fact is the closer you live to a freeway, the more weight you gain. People thought, “Well, that’s because people who live close to free freeways are lower socioeconomic status people,” because that’s where they build housing projects, et cetera.

Dr. Rob Lustig (00:37:39):

While that’s true, that’s all been factored in, and it has now been shown not just to be associative, but actually causative. We have the mechanisms by which causation occurs. We have now instead of just correlative data, we have causative data. There are two kinds of causative data. There’s experimental causation, where you do interventional data. You don’t do that in humans. You do that in animals.

Dr. Rob Lustig (00:38:09):

But we also have what’s known as econometric data where you can look at natural history studies. You can show that the change in weight or the change in obesity rates are predicted by these changes and they’re not explained by anything else, and that they predate the change in obesity. That’s called econometric analysis, and we now have that data. That’s the point of the paper, is explaining what level of data we have to show this.

Dr. Rob Lustig (00:38:47):

We also show what aspect of the fat cell process is being affected, whether it’s differentiation of stem cells into adipocytes, whether it’s the laying down of fat in the liver, whether it’s the dyslipidemia in the bloodstream, whether it’s the fatty liver itself, whether it’s a neurological problem or food, an energy problem, or mitochondrial problem, or a microbiome problem in the intestine. We now have the pathways for each of these chemicals, and we discuss the gradation of the veracity of the data, the quality of the data to demonstrate when we know causation and when we don’t. Boy, oh boy, do we know causation.

Dr. Casey Means (00:39:45):

Is there a world in which our computing capabilities get good enough and our mechanisms understanding is strong enough that we could screen for chemicals that are being created in the industrial industry and know what’s going to be a problem and what’s not ahead of time, and/or retroactively do this such that we can start eliminating some of these things? What’s the path forward from the industry perspective?

Dr. Rob Lustig (00:40:11):

Absolutely, and that’s the reason for the third paper, is the obesity assays. The fact is that virtually all of these compounds have been put into our environment without any meaningful regulation or assessment by the FDA or the EPA or the USDA. All Right?

Dr. Casey Means (00:40:37):

That’s mind-blowing.

Dr. Rob Lustig (00:40:37):

They’re released into the environment. They’re “safe.” Who says they’re safe? How do you find out if they’re safe? We thought dioxin was safe for decades, and only found out about the cancer that dioxin caused 40 years after they started appearing. They started being manufactured in 1902, and it wasn’t until a factory in Sovico, Italy, blew up in the 1960s that we really learned about what dioxins were really doing. How does this stuff get into our environment?

Dr. Rob Lustig (00:41:22):

How does it get into our food supply? How does it get into our water supply in the first place? The answer is no one’s looking. That’s the real reason. Well, the reason for these papers are important is because we now give the government, and it has to be the government because who else is going to do it? The industry’s not going to do it. They’re the ones perpetrating the crime. Okay? Somebody’s got to be watching out.

Dr. Rob Lustig (00:41:48):

Well, we give the government the tools to be able to actually determine whether or not any given compound is an obesogen. It ultimately is incumbent upon them to use this information, to determine what should be allowed and what should not. Thus far, the government’s been asleep at the switch.

Dr. Casey Means (00:42:12):

What’s so perplexing to me is that if you like Google Molecules, which sometimes I’ll do for fun. [inaudible 00:42:19] like, “What’s the structure of this thing?” It’s like you look at drugs, all of these are just these small molecules. A lot of them are little molecules, hydrocarbons, a few other. It’s like, basically, are allowing with these industrial chemicals … It’s like how is it different than drugs in a way?

Dr. Casey Means (00:42:37):

Basically these chemicals are acting on us like pharmaceuticals are, yet are totally unregulated, and it’s like [crosstalk 00:42:44] what is that distinction between a company comes up with a food additive or comes up with some sort of flame retardant and puts it in everything, versus developing a drug and then marketing that, and then having that go through FDA approval? It feels like there’s a really strange disconnect between basically just what people call these things, but they are essentially drugs, right?

Dr. Rob Lustig (00:43:04):

Of course. That’s exactly right. There are compounds that are selective poisons. Drugs, medicines that we buy at the pharmacy and stand on line to get our prescriptions are selective toxins. That’s the definition of a drug. It is a selective toxin. These compounds are selective toxins. The only difference between the drug you get at the pharmacy and the drug or chemical that dump into the water supply or the food supply is that they don’t make any claims that it’s going to cure any disease or treat any disease.

Dr. Rob Lustig (00:43:45):

That’s the difference. If they claim that it was going to cure or treat a disease, then it has to go through all the FDA hoops in order to get approval. If they just dump it into the water, I don’t have to say a thing about it. The burden of proof is on you to demonstrate that it’s actually a problem. That’s what happened with Teflon.

Dr. Casey Means (00:44:10):

Interesting. Something you talk about in the paper is that these obesogens can actually change our desire, our food seeking behavior, and the way we actually interact with food on the psychological level. I wanted to ask you about this because, of course, one of your books is Hacking of the American Mind, which is the [crosstalk 00:44:31] ultimate tour de force manifesto about our dopamine and serotonin reward systems, and honestly required reading for anyone in my life.

Dr. Casey Means (00:44:41):

Because I feel like if we don’t understand what’s driving us between and how we’re hooked on the dopamine roller coaster, we basically don’t understand our behavior and how we’re being controlled by external forces. I wanted to get your thoughts on just maybe explaining to people how these obesogens can also affect our dopaminergic reward system and impulsivity in our brains, and what we should know about that.

Dr. Rob Lustig (00:45:04):

Right. We actually got a little flack from the reviewer about including fructose and artificial sweeteners, in this paper on obesogens. They said, “How can fructose be an obesogen when it’s caloric?” The answer is because it lays down more fat than its calories. Yes, it is caloric, but it lays down more fat than its calories. [crosstalk 00:45:33]

Dr. Casey Means (00:45:32):

Wait, that’s really interesting. Is that part of the definition? Is that even though … You’d expect it to lay down a certain amount of fat because it’s actually doing more-

Dr. Rob Lustig (00:45:42):

That’s right.

Dr. Casey Means (00:45:43):

… stimulating fat growth in some way, so it fits the criteria of obesogen?

Dr. Rob Lustig (00:45:47):

That’s right. Exactly.

Dr. Casey Means (00:45:48):

That’s so fascinating. Okay.

Dr. Rob Lustig (00:45:50):

We had to explain that, and the reason is because it’s affecting mitochondria. If it’s affecting mitochondria, then you’re going to lay down more fat because you’re burning less. Maybe that’s the reason why body temperature’s gone down, is because all the sugar in our environment. I don’t know. I’m not going to tell you I know the answer to that, but it’s not impossible that that could be the reason. Artificial sweeteners. Turns out artificial sweeteners make your brain think sugar’s coming, so you release more insulin.

Dr. Rob Lustig (00:46:23):

Even though they don’t have any calories themselves, because you release more insulin, you drive more energy into fat. They are an obesogen even though they’re zero calories, as an example. All right? The fact is that anything that makes your insulin go up is a potential obesogen, and some of those things are specifically added to food on purpose. Yes, that is exactly right. These things are throughout our food supply.

Dr. Rob Lustig (00:47:03):

Again, some of them, we didn’t know cause these problems, for instance, glyphosate and [inaudible 00:47:12] is another one. There are the carboxymethyl cellulose, which is an emulsifier that’s used in ice cream. You’d say, “Well, of course ice cream’s fating.” Well, yes. I’m not saying it’s not, but the fact is the carboxymethyl cellulose makes it more fattening.

Dr. Casey Means (00:47:33):

Yeah. Yep.

Dr. Rob Lustig (00:47:34):

All right?

Dr. Casey Means (00:47:34):

What is this doing to our brain in terms of actually signaling for us to want more food? What’s the mechanism there?

Dr. Rob Lustig (00:47:43):

Well, for fructose, it’s the direct mechanism. For other molecules, it’s the insulin. The insulin going up blocking leptin, which causes it. Then for certain compounds, like BPA, it appears to have some effects that are consistent with hyperactivity and attention deficit disorder, which then cause food intake as well. The dopaminergic system expresses obesogen targets, and I don’t know why. I don’t know. I don’t have the reason for why that should be, but that does seem to be the case in animal studies.

Dr. Casey Means (00:48:26):

It’s still interesting.

Dr. Rob Lustig (00:48:28):

That might be some of the reasons, at least, why we see people eating more and out of the blue. Several medicines that people are on, like SSRIs, can cause you to eat more. Atypical antipsychotics cause insulin resistance, cause you to eat more. Certain pharmaceuticals that we take for other reasons might also cause increased weight gain and [inaudible 00:48:58] in this paper as well.

Dr. Casey Means (00:49:03):

What is fascinating, I think going back to the epigenetic part of the conversation, is that some of these impacts of obesogens are heritable. I want to talk about the … Interestingly, the average Levels customer is a woman between the ages of about 30 and 50. Reproductive age, and obviously everyone wants to do best by their offspring and have the healthiest pregnancy. You talk about, in the paper, these sensitive windows of vulnerability for endocrine disrupting chemicals, including obesogens.

Dr. Casey Means (00:49:40):

And that there are periods of time where we are most sensitive to the effects of these things, and some of those are during developmental periods, and you mentioned even in utero. Can you talk a little bit about those sensitive windows of vulnerability, what this means for how we should maybe be approaching preconception, conception pregnancy, early childhood development differently in our country and individually? Maybe also touch on the heritability part and how these things are actually affecting our germline, meaning our actual reproductive sex cells.

Dr. Rob Lustig (00:50:20):

Right. Several of these compounds do affect the germline. If they affect the germline, it’s likely that it’s not just an obesity issue. There’ll be other issues as well, including reproductive and birth defect and things like that as well. [crosstalk 00:50:39]

Dr. Casey Means (00:50:38):

Can you define germline for people? Because I bet [crosstalk 00:50:40] most people don’t know what that means.

Dr. Rob Lustig (00:50:42):

Germline means that the eggs or the sperm are affected, and therefore once the zygote is made by the egg binding to the … the sperm entering the egg, now those genetics are fixed, and-

Dr. Casey Means (00:51:04):

The entire offspring cells, all their cells?

Dr. Rob Lustig (00:51:05):

That’s right. Scientists have shown that those can persist generation after generation, at least four generations, and in some cases even longer. Basically, it’s not what your mother ate, it’s what your great grandmother ate that made a difference, and what she was exposed to and that these things, it’s the gift that keeps on giving throughout the lineage all the way down. Now, those are things you can’t fix because you had nothing to do with them. The question is what could a pregnant woman avoid that could fix something?

Dr. Rob Lustig (00:51:47):

Well, one thing she could do is stop smoking. Okay? That’s the easy one. That’s the slam dunk, is if you’re smoking, you better stop it. Passive smoking, secondhand smoke, also has been shown to cause an increased BMI and waist circumference in the offspring. There are probably several reasons, including nicotine, including the fact that it changes the oxygen tension, the carbon dioxide and carbon monoxide changes the oxygen tension going to the baby while the baby is developing. That’s the obvious one. Another thing that we’re very concerned about are these artificial sweeteners and they seem to get across.

Dr. Rob Lustig (00:52:46):

It turns out that adipocytes have receptors for artificial sweeteners. Why? If they’re non-caloric, why do adipocytes have receptors for artificial sweeteners? If the mother’s drinking a diet Coke during pregnancy, is that artificial sweetener getting across the placenta and actually causing fat cell differentiation in the fetus, even though it was a diet Coke? We know that fructose is a problem and we know that actually if you look at the placenta, okay? The placenta of mothers who drink Coke … Or not Coke, but I mean soda. I shouldn’t just pick on Coca-Cola because then everybody will go out and drink Mountain Dew instead.

Dr. Casey Means (00:53:42):

All soda.

Dr. Rob Lustig (00:53:44):

All soda. All soda, okay? Everybody don’t … It’s not just Coke. But there are two parts to the placenta lining. One’s called the labyrinth and one’s called the decidua, and it turns out that if you take in a lot of fructose, the labyrinth gets smaller and the decidua gets bigger, and that ultimately is associated with insulin resistance. Well, it turns out artificial sweeteners affect that as well. Why it does that, I don’t know, but it does.

Dr. Rob Lustig (00:54:20):

Don’t smoke and try to limit your sugar assumption and try to stay away from artificial sweeteners as much as possible, I would say are the easy things to try to do during pregnancy because fetal life and early neonatal life are the most susceptible times because that’s the time when your fat cells are still in dividing mode. You don’t want them to keep dividing unless that’s necessary. That’s what I would say is probably the single lesson for pregnant women.

Dr. Casey Means (00:55:10):

When we’re thinking about the sensitive windows of vulnerability for obesogens, is the take home point that you just said that because our fat cells divide only until really a certain point and then they go into more growth mode and less about creating. Like you said in the beginning, we have a certain number of fat cells early in life, and we think that’s still fairly fixed and it’s more getting overweight is a function of them growing as opposed to dividing more.

Dr. Rob Lustig (00:55:38):

That’s correct.

Dr. Casey Means (00:55:39):

Because that’s happening early in life and obesogens promote laying down more fat cells, that’s part of the reason why it’s such a problem to be exposed to these early on. Is that accurate or? Okay.

Dr. Rob Lustig (00:55:52):

That’s exactly accurate. That’s exactly-

Dr. Casey Means (00:55:54):

We’re potentially … What are those sensitive windows? Is it pregnancy specifically? Is it a wider period?

Dr. Rob Lustig (00:56:02):

Pregnancy is the big one, without question. Early childhood too. There are other things that go on in early childhood, the growth of the mouth. One thing that we’ve learned that has nothing to do with obesogens is that the tongue pressure on the hard pallet is necessary to grow the airway and to lead to enough oxygen being able to get into the body.

Dr. Rob Lustig (00:56:34):

If you don’t put that pressure on the hard palate to expand it, you end up with malocclusion, which will ultimately need braces, and you are at increased risk for obstructive sleep apnea, which as you know, Casey, being a former ENT, is the gateway to virtually all of the chronic metabolic diseases that we know of.

Dr. Casey Means (00:57:01):

How do people … In terms of the tongue pressure, what are the determining factors of whether a child is going to have that pressure?

Dr. Rob Lustig (00:57:10):

Well, breastfeeding.

Dr. Casey Means (00:57:11):

Breastfeeding.

Dr. Rob Lustig (00:57:12):

It turns out that it’s actually work to latch onto a human nipple and suck hard enough to be able to express milk. Artificial nipples, baby bottles and binkies, by the way, pacifiers, actually cause less pressure and don’t grow that hard palette in such a way as to lead to appropriate airway development and expansion. Best to ditch the binky, and if at all possible, mothers should breastfeed.

Dr. Casey Means (00:57:57):

Well, I definitely … At some point, it would be so thrilling to do an episode with you on some of the airway stuff given my background and given some of the amazing stuff you’ve written on this topic, because I think it also … Basically a root of health is our ability to breathe properly, and so much of how we’re approaching the first year of life in terms of nutrition is changing the way our jaw’s developing and therefore setting up our airway for a lifetime of problems that end up in the ear, nose and throat doctor’s office and operating room. There’s just so much we can do to basically create bigger jaws in babies through lifestyle, and that can actually change our risk of chronic disease longterm.

Dr. Rob Lustig (00:58:46):

On April 11th, my colleague, Dr. Kevin Boyd, who is a periodontist at Lurie Children’s Hospital in Chicago, and I are giving a talk to the American Association of Physiologic Medicine and Dentistry, AAPMD, called Toddlers in the Crosshairs, talking about exactly this problem.

Dr. Casey Means (00:59:07):

Amazing. Amazing. I can’t wait to tune in and we’ll share that with our Levels network, for sure. Okay. Summing up here, we are surrounded by chemicals and small molecules in our food, water, food additives, food packaging, storage containers for food, cosmetics, personal care products, furniture, electronics, air, pesticides, disinfectants, sunscreens, plastics, household products, antidepressants, and antidiabetic drugs and cigarette smoke.

Dr. Rob Lustig (00:59:36):

There you go.

Dr. Casey Means (00:59:37):

Just a few places that these chemicals-

Dr. Rob Lustig (00:59:39):

That’s it.

Dr. Casey Means (00:59:40):

… live and so-

Dr. Rob Lustig (00:59:42):

[Crosstalk 00:59:42] the wall.

Dr. Casey Means (00:59:43):

… super easy to avoid all these. What’s the strategy here?What do we do?

Dr. Rob Lustig (00:59:51):

What is the strategy?

Dr. Casey Means (00:59:53):

Because it sounds like we’re screwed.

Dr. Rob Lustig (00:59:55):

Well …

Dr. Casey Means (00:59:58):

But I know there’s hope.

Dr. Rob Lustig (01:00:00):

Yeah, let’s put this way. If we do nothing, then we are screwed, yes. Okay? The point is that we can do something. All right. First of all, we have to be cognizant of ourselves because no one’s going to protect you better than you can protect yourself. That’s number one. If you don’t know that this is a problem, then you can’t protect yourself. All right? That’s why this paper finally getting it out was so important. Like I said, it’s been a long time coming. This particular paper’s been a year in the making, but we’ve known about the problem since 2007.

Dr. Rob Lustig (01:00:37):

That’s number one, education about the problem. Okay? Because you can’t fix a problem if you don’t know what the problem is. Second, this paper tells the government, “Hey, you’re on notice. You got to do something. All right? Here’s what you need to do.” We need government to help us with these things because the food industry and the … What do you call it? The agricultural tech industry and the chemical industry basically gotten a free pass for all these years. That’s why the EPA was developed back in 1970, was to stop air pollution and water pollution.

Dr. Rob Lustig (01:01:22):

Well, this is environmental pollution, and the EPA should be on top of this. But currently they’re not because basically they didn’t think obesogens were a problem, but they need to start getting their act together, and hopefully they will now and people need to pressure government and their Congressmen to get the EPA on board with this. The EPA was basically dismantled under the previous administration. You actually had people who were oil drillers running the EPA. We’ve lost a lot of time on this. Now what can individuals do themselves?

Dr. Rob Lustig (01:02:09):

The answer is buy organic because a lot of these things are pesticides, use PFAS-free frying pans, which now are the only ones sold. But if you have old ones, you probably need to get rid of them. Be wary of food preservatives that are added to foods and basically real food. Real food is the answer here. BPA is now known it’s in all these plastic bottles, it’s in baby bottles, it’s in nipples, et cetera. These are hard truths, and they’re not going to go away easily. But we have to start working at mitigating some of these over time, and it’s not going to happen fast, but you got to start somewhere.

Dr. Casey Means (01:03:18):

Yap. Okay. I’m hearing buy organic. Previously in the episode we’ve talked about obviously don’t smoke, avoid artificial sweeteners. This is sucralose, aspartame. Not necessarily, we’re not talking about natural non-nutritive sweeteners here, like stevia, monk fruit or allulose. Is that right?

Dr. Rob Lustig (01:03:37):

Well, they can still raise insulin. They’re not completely-

Dr. Casey Means (01:03:44):

Free pass.

Dr. Rob Lustig (01:03:46):

Innocent. But there are some that are worse than others. Sucralose is famous for causing leaky gut and glucose intolerance. That’s a particularly bad guy in the story. In the paper itself in figure four, we list all of the bad guys, and there are quite a few of them. There’s aspartame, there’s acesulfame K, saccharin, sucralose. Stevia is on there. neotame, alitame, monk fruit, miraculin.

Dr. Casey Means (01:04:15):

Wow.

Dr. Rob Lustig (01:04:16):

They’re all there. It’s not [crosstalk 01:04:20] It’s not just one.

Dr. Casey Means (01:04:22):

That’s a good clarification. I actually didn’t see that, that stevia and monk fruit were on there, and that’s helpful. I’m assuming that’s because, in some research, it’s been shown that they raise insulin, like what you talked about.

Dr. Rob Lustig (01:04:35):

Yeah. They raise insulin. If they raise insulin, they’re going to drive the insulin receptor, and the insulin receptor’s going to lay down fat.

Dr. Casey Means (01:04:40):

Generally, things that are sweet may impact our cephalic insulin response, make our brains think something sweet’s coming and release insulin. Okay. We’ve got artificial sweeteners, you talked about cigarettes, air pollution, organic food. What about personal care products and home care products?

Dr. Rob Lustig (01:05:00):

Yeah. Parabens are in lipstick, and that’s a big one. Yes, these are all concerns. Let me tell you about a patient that I took care of years ago. It was a five-year-old girl who started developing breasts. I worked her up for precocious puberty and it turned out that her hypothalamus was fine and her ovaries weren’t even working. Where was she getting the breasts from? I did an entire … I thought maybe she’s consuming mom’s birth control pills.

Dr. Rob Lustig (01:05:40):

No, that wasn’t it. We went through everything, and finally I asked the mother, “What do you use in the bath water?” It turned out she bathed the kid in Victoria’s Secret bath gel. I asked her to bring it in, and it said right on it, “For adult use only.” The reason is because it contained genistein, which is a plant estrogen. Okay? Phytoestrogens, and so caused breast development. Well, guess what? It also causes weight gain.

Dr. Casey Means (01:06:18):

Interesting, and I’m assuming … The phytoestrogen concept is really interesting cause people bring this up a lot with soy. I’m assuming that this is the differential effect in a child, is it because they’re not making much estrogen pre-puberty that any estrogen in the body is going to have a clinical impact.

Dr. Rob Lustig (01:06:39):

Exactly.

Dr. Casey Means (01:06:40):

Fascinating. In terms of personal care products, this is a topic that’s near and dear to me because I love cosmetics, I love all of it, and over … I love this stuff, and I think that my journey over the years has been very much moving from standard products with fragrances, bath and the body works, all these things to just as simple as humanly possible, the minimal ingredients, like organic castile soap for almost every soap that I use, using 100% jojoba oil for moisturizer.

Dr. Casey Means (01:07:17):

Things that just don’t have the 50 chemicals. One of the websites that has been really useful in my figuring out what to use is the Environmental Working Group’s website, which has a list of thousands and thousands of home care and personal care products and ranks them based on toxicity. What are your feelings on EWG?

Dr. Rob Lustig (01:07:39):

I use EWG also, and Ken Cook, the head of EWG, is a good friend. Yes, that’s a great place to go to get both sugar information, like in breakfast cereals, and also environmental pollution information on various things. Yes, I strongly recommend them.

Dr. Casey Means (01:08:04):

Yeah. Then what are your thoughts on air and water filtration?

Dr. Rob Lustig (01:08:10):

Well, [crosstalk 01:08:11]

Dr. Casey Means (01:08:10):

Helpful, not helpful?

Dr. Rob Lustig (01:08:12):

Everyone should have an air filter in their house because there’s junk in the air anyway, and it’ll help with your allergies. Obviously, hey, don’t live too close to a freeway. What can I say? Particulate matter causes inflammation, and inflammation causes insulin resistance, and insulin resistance causes weight gain. It’s a problem. How to fix that problem, I don’t know how to fix that problem yet.

Dr. Casey Means (01:08:43):

Any other last pearls for people listening to this episode of how they can think about avoiding these things in their life. Any other things that you do in your life or that the research shows that are really effective in terms of reducing the body burden of this stuff? Maybe also, just I’d be curious to hear your thoughts on … We’re talking mostly about avoidance of these things and elimination of these things, but is there [crosstalk 01:09:12] anything we can do to [crosstalk 01:09:14]

Dr. Rob Lustig (01:09:15):

There’s no medicine for this. There’s no medicine for this that people need to understand. Do not go to your nature path and have him chelate you. It’s not going to work. All right? That’s not the way to answer this problem. The best way to handle this problem, unfortunately, is avoidance and that makes it hard, and I’m not going to tell you it’s not because you can’t see it. How do you avoid something you can’t see? That’s where the education comes in.

Dr. Casey Means (01:09:45):

Is there anything we can do to set our bodies up to be more resilient to this type of thing and also to potentially get these chemicals out of our body?

Dr. Rob Lustig (01:09:54):

Well, as I said, the best way to get these chemicals out of body is hydration, PML, and-

Dr. Casey Means (01:10:02):

Interesting.

Dr. Rob Lustig (01:10:05):

… that’s about what we’ve got at this point. Maybe we’ll start working on how to find ways of mitigating this problem on a biochemical level, but I don’t know what it is.

Dr. Casey Means (01:10:19):

I think that’s going to be fascinating follow-up to this type of work. This lays the groundwork for, I feel like, a lot of future directions, and one of those that would be so interesting to think about is how is each one detoxified by the body? Is it the liver? Is it in the stool? What are the different pathways involved and how can we optimize those things? That’ll be interesting to follow this field as it emerges.

Dr. Casey Means (01:10:45):

I think there was one last thing I wanted to ask you about, which is that in the paper, there was a mention of how we might be able to, in the future, personally monitor these things in our bodies to see what’s going on with our toxic burden. What do you think the likelihood of that happening is in the near future?

Dr. Rob Lustig (01:11:05):

Look, we’re already talking about other small molecule monitoring for Levels. We’re talking about various channels that could be unwearable, and there’s no reason why we wouldn’t be able to do that for compounds that exist in nature. It would require some engineering to be sure. But if you’re wearing a wearable, adding a couple of channels to look for other stuff is not so crazy or impossible. Maybe that’ll be the way to do it.

Dr. Casey Means (01:11:39):

That’s definitely a world that I think would be interesting because they are invisible, and a lot of the effects are lagging given that some of them are epigenetic and some of them take years to develop, which I thought was a really interesting concept that was brought up in the paper as, is that some of these effects aren’t immediate. You’re not going to see-

Dr. Rob Lustig (01:11:55):

Yes. Absolutely.

Dr. Casey Means (01:11:55):

… the next day that this obesogen is affecting you. That’s where sometimes-

Dr. Rob Lustig (01:11:59):

That’s right.

Dr. Casey Means (01:12:00):

…having that more closed loop bio feedback can be so helpful, and also-

Dr. Rob Lustig (01:12:03):

Just like tobacco smoke.

Dr. Casey Means (01:12:05):

Yes.

Dr. Rob Lustig (01:12:05):

You don’t know that it’s a problem until it’s a problem.

Dr. Casey Means (01:12:09):

Well, thank you so much, Rob, for chatting about all of this and it’s such a fascinating topic. This paper is I think going to do a lot to just totally change the world as all your work does, and we literally look forward to spreading the message and helping get this information out there. Thank you so much.

Dr. Rob Lustig (01:12:28):

I just want to say that this is the work of 44 separate scientists, and they all deserve an enormous amount of credit. I particularly want to thank Jerry Heimdall who basically was the task master to keep this 44 herd of cats herded and got this done. He deserves a lot of credit. Jerry, if you’re listening, hats off to you.