Who let Colonel Mustard into the mansion? (w/ Dr. Robert Lustig)

In this episode we’re discussing Metabolical a new book out by one of our advisors, Dr. Robert Lustig. He’s the author of six books, including Fat Chance, Hacking of the American Mind, and most recently Metabolical. He’s a professor emeritus of pediatrics division of endocrinology at the University of California, San Francisco. We dive into:

• How medical systems have students playing Clue
• The damage on the medical profession caused by health crisis
• The challenges of a system that promotes processed foods
• Why solving problems by moving upstream is blocked by big pharma
• How processed food is poison not fuel

We teach Clue not systems biology in medical school

Medical education encourages students to diagnose symptoms and optimize for discharged patients without solving the underlying causes of the issue.

This is a systems biology issue, and we don’t teach systems biology in medical school. What we teach is how to play Clue. We learn Colonel Mustard in the conservatory with the candlestick. That’s what we learn. And so that’s how you play medicine. You play Clue. When I was a resident back in St. Louis in 1980, there was a game called intern. We used to play it on weekends before the emergency room started getting busy and you’d have patient cards and you’d have diagnosis cards and you’d have disposition cards. And when you match the up the cards, you basically got to discharge your patient and the first player to discharge all their patients won the game. And of course you could transfer the patients to different services, like neurology or OBGYN or whatever. And it was actually kind of fun. But the point was, that’s actually how we played medicine and that is just plain wrong. But that’s what we did. The point is not was Colonel Mustard in the conservatory with the candlestick, the question is how did Colonel Mustard get into the mansion in the first place? Okay. And that’s not a question that we were answering and that’s the question we needed to answer. So you have to find root causes of problems in order to solve problems.

Challenging the status quo with science to make progress

During his career Dr.Lustig has consistently challenged authority with deeply researched arguments and a grasp of science wielded as his sword.

I have had sort of a shall we say, disdain for authority and the recognition that the gurus don’t necessarily know everything, but in order to be effective, you have to basically know what you’re talking about. And so everything I do is documented with the science because the science is my sword. It’s also my shield. And the good news is I’ve got a good grasp of the science and I’m smart enough to be able to make that relevant and make it work. And so I’ve got this stuff in my background that says do right by children and don’t let anybody steer you wrong.

Public health crisis are leaving the medical profession damaged

Crisis like HIV, smoking and now metabolic health have turned doctors into providers and away from addressing the root causes.

HIV set up an enormous conflict between the people who basically said these people were perpetrators and the group that said these people were victims. Now that went on for a long time. For a decade. And it really wasn’t until we had protease inhibitors and things started to calm down in terms of the incidents of HIV, that basically it all got sort of forgotten. And now there’s no issue. It’s basically gone. And this is what happens. This happened during smallpox, it happened with syphilis, it’s happened countless times when there’s a public health crisis, you get these different factions warring at each other. This will go away. But the question is, what does it leave in its wake? And what it leaves is a medical profession that is just that much more damaged. And the fact of the matter is we have been damaged for decades. We used to be doctors. Now we’re providers. And now there are all these other ancillary quote providers that provide shall we say contrary in views, which maybe I’m one of them since I present a contrarian view about diet to what they think. So the goal of research is not a straight line, ultimately it’s a zigzag and there are shall we say blockages and things along the way, but ultimately you have to be able to solve this problem en masse.

For science to advance new ideas must be allowed to grow

Empirical studies show that for new ideas to take hold the gurus who published the previously held norms must often pass away.

Max Plank, the famous German physicist famously said science advance is one funeral at a time. And you’ve heard that phrase. What he basically meant by that was that science is held hostage by the gurus at the top. And they have to die before new ideas can come forward.

Working upstream vs downstream to solve problems

Solving for downstream of problems only solves for results vs root causes. To truly make progress towards long term solutions the current medical school curriculum needs disruption.

The way I describe it in the book, it’s the first sentence of the book. There’s a wasp in your attic. What are you going to do? Kill the wasp or find the wasps nest? You have to work up stream of a problem to solve a problem. Working downstream of a problem only solves the results of the problem. The problem is still there and that’s what modern medicine does. And the only way to do that is a systems biology framework. Now the question is, how do you get that into medical school? That’s what you ask. And the answer is I don’t have a frigging clue. And the reason I don’t have a frigging clue is because pharma controls the medical school curriculum because they underwrite 80% of medical school costs. And so they’re not going to let it. So this is going to require a groundswell of awakening amongst physicians all over the country and really all over the world in order to be able to actually make this happen.

The system that promotes processed foods has to change

Access to real food is driven in large part by social and economic factors. Society has convinced us that eating healthy foods is an elite thing to do.

There are huge swaths of the country that do not have access to healthy unprocessed real food. And of the system is obviously rigged against them with the fact that unhealthy food is heavily subsidized by the US government, our public food programs promote the eating of processed foods, et cetera. So that’s all the reality. But the question I have for you is about being effective in this situation. So how have you landed on a communications approach or a strategy approach that you think allows the message that you have to get out of healthy eating to be received and land in a way that’s going to be most effective for the type of encouraging and empowering future we’d like to see around food and individual diet because at the end of the day, the system has to change.

Processed fuel or poison?

Food by definition is for burning and growth. Processed food inhibits these processes and is a significant contributor to cancer growth.

Ultra processed food by its very definition inhibits growth and inhibits burning. So it’s not food. It’s actually poison. Now that’s not taking a pejorative view. That’s taking a very, shall we say, epistemological view of this. And it’s not conferring any social inequity phenomenon. Okay. Because lots of elite people eat ultra processed food too. But what it’s doing is it’s calling attention to the science and then using people’s brains to basically turn that science into their own rational policy.

Dr. Robert Lustig:

This is a systems biology issue, and we don’t teach systems biology in medical school. What we teach is how to play Clue. We learn Colonel Mustard in the conservatory with the candlestick. That’s what we learn. And so that’s how you play medicine. You play Clue. When I was a resident back in St. Louis in 1980, there was a game called intern. We used to play it on weekends before the emergency room started getting busy and you’d have patient cards and you’d have diagnosis cards and you’d have disposition cards.

Dr. Robert Lustig:

And when you match the up the cards, you basically got to discharge your patient and the first player to discharge all their patients won the game. And of course you could transfer the patients to different services, like neurology or OBGYN or whatever. And it was actually kind of fun. But the point was, that’s actually how we played medicine and that is just plain wrong. But that’s what we did. The point is not was Colonel Mustard in the conservatory with the candlestick, the question is how did Colonel Mustard get into the mansion in the first place? Okay. And that’s not a question that we were answering and that’s the question we needed to answer. So you have to find root causes of problems in order to solve problems.

Ben Grynol:

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.

Ben Grynol:

When the Levels community, the Levels team and our advisors come together, it’s something pretty special. And that’s what happened in this session. It was a book club. A book club based on a book called Metabolical a new book out by one of our advisors, Dr. Robert Lustig. And we had this opportunity to all come together in an open form and have a conversation around the book and really just metabolic health.

Ben Grynol:

There’s no seek to it, but metabolic health has so much more to do than just measuring glucose. And that’s something that we uncovered in this Q&A. It was pretty eye opening to hear some of Rob, as you’ll hear he prefers to be called. Rob has this lens that there are so many things that can be measured and should be measured as a true measure of metabolic health. So Rob is one of our advisors. He’s the author of six books, including Fat Chance, Hacking of the American Mind, and most recently Metabolical. He’s a professor emeritus of pediatrics division of endocrinology at the University of California, San Francisco. You can find more about Rob’s work at robertlustig.com. So here’s where we kicked it off.

Dr. Casey Means:

How are you doing Dr. Lustig?

Dr. Robert Lustig:

I got to tell you, Casey, I’ve done an enough of these webinars or conversations or book clubs, but I am the most nervous for this one and it’s because the questions you posed to me last night for me to vet are about the meatiest and the deepest and the most thought provoking. And I just hope I have answers for them.

Dr. Casey Means:

Thank you. I approach this as… I’ve been reading your work for about 10 years, and I just wanted to ask you selfishly all the things that I’ve been dying to ask you for the last decade of being inspired and consumed by your work. So let’s just jump in.

Dr. Robert Lustig:

I’m handcuffed. So I guess this is the chance.

Dr. Casey Means:

The first question I have for you is just kind of a personal one of how you became the way that you are. A person that is really changing the world and changing the way we think about food in our own health and bodies. So in your book, you mentioned that your exposing of the inconsistencies of mainstream medicine and nutritional dogma has made you an iconoclast and has kind of relegated you to the outside of the mainstream medical establishment, and actually relegated you to the outside of some political circles.

Dr. Casey Means:

And you did mention in the book that your commitment to producing high quality data has kind of been the saving grace to keep your reputation intact. But, you’re one of the most independent and critical thinkers I think out there in the world today and have been pounding this pavement of sort of a contrarian view for decades now. And so I’m just curious, growing up and throughout your life, how did you become this way?

Dr. Casey Means:

Someone who can approach things from such a critical lens and be so vocal about it and second, how do you maintain that emotional and personal resilience to wake up every day with the energy and dedication to continue pushing this ball forward, despite intense pushback from multi-trillion dollar industries that are threatened by what you have to say?

Dr. Robert Lustig:

Those are, shall we say, as deep as they can go, I’m a doctor, okay? Doctors are supposed to help people. Doctors are supposed to save people. I get a tremendous amount of life satisfaction by seeing a kid do better because of my work, because of my advice. It’s one of the things that drives me is that life satisfaction, that doing a good job for a child does. What I realized growing up is that children are rarely perpetrators, but they are frequently victims. And what I saw when the obesity epidemic came around was that children were being portrayed as perpetrators. It’s their fault. And I knew that wasn’t true. Having been a fat kid myself got treated as a perpetrator. I just knew that wasn’t so, so trying to do right by children has always sort of been my north star.

Dr. Robert Lustig:

In terms of the iconoclast, in terms of wanting to get it right and making sure that the people who got it wrong get there to just desserts as it were, when you asked me the question last night, I sort of recalled a very specific episode in my own medical school training that I think sort of set me on this path. Yeah, I was a third year medical student at Cornell and my medicine rotation had six week blocks and we had two different tutors for the six weeks. The first tutor was a famous cancer endocrinologist at Memorial Sloan Kettering. And we would meet with him three times a week and we all had to present stuff and we all had cases to do. And the usual that you know about having gone to medical school yourself. And I remember us having to talk about thyroid function in both cancer and the difference between hyper and hypothyroidism.

Dr. Robert Lustig:

And it just so happens that just that week I had read a new paper that had come out in, I believe it was Annals of Internal Medicine on the effects of propylthiouracil and how it worked and how it blocked peripheral conversion of T4 to T3. And so I brought that up and this guy is a cancer endocrinologist and a thyroid and a thyroidologist and he told me that I was completely wrong, that I didn’t know what I was talking about. And I brought up the paper and I actually quoted the paper and he failed me. He failed me.

Dr. Robert Lustig:

Now, the good news was… Seriously, for the six week rotation, he failed me. Good news was that the second guy gave me honors. And so I ended up with a pass and I didn’t have to repeat the year, but he failed me. I have had sort of a, shall we say, disdain for authority and the recognition that the gurus don’t necessarily know everything, but in order to be effective, you have to basically know what you’re talking about. And so everything I do is documented with the science because the science is my sword. It’s also my shield. And the good news is I’ve got a good grasp of the science and I’m smart enough to be able to make that relevant and make it work. And so I’ve got this stuff in my background that says do right by children and don’t let anybody steer you wrong.

Dr. Casey Means:

Wow. Thank you. Thank you for sharing all that. And that memory that you shared brings to mind one that is in my mind, sort of an indelible memory from my surgical training, where I was on my sinus rotation and I brought in a stack of papers about the relationship between certain foods and risk of chronic rhinosinusitis, which we typically treat with surgery when steroids and antibiotics fail. And the look on every everyone’s face when I brought up this idea of should we counsel people about the dietary factors that could lead to sinusitis, that look of everyone thinking why are we talking about this? We don’t counsel people on nutrition. We’re not nutritionist, it was something that someone said. It’s burned into my mind. And it motivates me almost every day.

Dr. Robert Lustig:

I hear you. Basically what medical school teaches you is how to use a prescription pad-

Dr. Casey Means:

And a scalpel.

Dr. Robert Lustig:

… but that’s it.

Dr. Casey Means:

Yeah. So yeah, that was a moment where I really became convicted. Wait, there’s a lot of data here and it’s not in our guidelines. And before I cut someone, which is a pretty severe thing to do and makes a whole lot of money, I’m going to figure out whether there’s maybe another way to help people keep out. That story just really resonates with me. And I think gets us to sort of my next question, which has to do with trying to bring a different vision into the medical world and how hard that can be and kind of circling to COVID. So I would say it’s been fairly disappointing to see that during even COVID, the magnitude of this pandemic could not get us as a country on a public health level and a policy level and a healthcare policy level to care about metabolic health.

Dr. Casey Means:

And I think individuals have picked up and cared, but we don’t have a public policy. We don’t have anything from the top down telling us to improve our metabolic health to help with COVID outcomes despite the fact that since April of last year, we’ve known with hundreds of research papers that metabolic health is deterministic of our COVID outcomes. So if this couldn’t shift things at the highest levels, what do you think can shift things to sort of a more approach that really helps people improve their health and resilience and what can we learn maybe from the smoking playbook, which was a bit more of a subtle evolution towards significant progress about what might happen with metabolic health? And I think the last part of this question is, do you think that we will get there? Do you think we will become a metabolically healthy country and how do you see those dominoes happening?

Dr. Robert Lustig:

Yeah. Well, so how many parts of that question?

Dr. Robert Lustig:

Let’s talk about public health challenges in the past and how we’ve dealt with them and what it means for our current crisis. Let’s take the most recent. Tobacco, HIV. HIV set up an enormous conflict between the people who basically said these people were perpetrators and the group that said these people were victims. Now that went on for a long time. For a decade. And it really wasn’t until we had protease inhibitors and things started to calm down in terms of the incidents of HIV, that basically it all got sort of forgotten. And now there’s no issue. It’s basically gone. And this is what happens. This happened during smallpox, it happened with syphilis, it’s happened countless times when there’s a public health crisis, you get these different factions warring at each other.

Dr. Robert Lustig:

This will go away. But the question is, what does it leave in its wake? And what it leaves is a medical profession that is just that much more damaged. And the fact of the matter is we have been damaged for decades. We used to be doctors. Now we’re providers. And now there are all these other ancillary quote providers that provide shall we say contrary in views, which maybe I’m one of them since I present a contrarian view about diet to what they think. So the goal of research is not a straight line, ultimately it’s a zigzag and there are shall we say blockages and things along the way, but ultimately you have to be able to solve this problem en masse.

Dr. Robert Lustig:

And when there are dark forces working against you, you’re going to have this problem. And with COVID, there are clearly dark forces working against us in many different ways. One of them happens to be orange and lives in Florida. So this is part of the problem. Here’s a way to look at it. And I find this very, very, shall we say prescient and disheartening, but at the same time, I know that it can be fixed, but it takes a while to fix. Max Plank, the famous German physicist famously said science advance is one funeral at a time. And you’ve heard that phrase. What he basically meant by that was that science is held hostage by the gurus at the top. And they have to die before new ideas can come forward. Now he said it as an offhand comment.

Dr. Robert Lustig:

The question is, is it true? Well, how do you figure that out? Turns out the National Bureau of Economic Research headed by Pierre Azoulay at MIT actually did an empiric study, an empiric trial of that question. I love this study. What they did, he and his colleagues did, was they went to the National Academy of Science and the National Institute of Medicine roster for 20 years. So from 1995 to 2015, and they gathered up all the names of all the gurus and they created a database for each of the gurus. And they looked at all the papers of the gurus and what they did was they looked at all the co-authors of the gurus and they made a database for those co-authors as well. And the question was not what happened to the guru, the question was what happened to the co-authors? And what they did was in that 20 year period, some of the gurus will have died, right?

Dr. Robert Lustig:

And so they asked the question, what happened to the co-authors paper productivity after their mentor, their protector, as it were, passed away? And it turned out they were all publishing, publishing, publishing, as soon as the guru died, right into the sewer. So then the questions all right, these people stopped publishing. Well, who was publishing in that field and what were they saying? And so they used mesh terms on those papers to figure out who was now publishing in that field. Turned out it was an entirely new crop of people with entirely new sets of ideas. So indeed they proved empirically sciences advances one funeral at a time. So it turns out I’m an iconoclast because I recognize that because some ideas have to be retired or die. There’s actually a book called This Idea Must Die. And I read it, it’s got eight ideas in it all of which we thought were absolute dogma and turned out are all completely wrong and what happened to them. So this question about diet, it’s one of the ideas that must die.

Dr. Casey Means:

Amazing. Well, I certainly am looking forward to the day when the idea that there is still a tenuous link between sugar and diabetes, that that idea will die because I think as recently as 2009, the head of the ADA has been saying things like that. So slowly but surely those ideas will peter out, that this sort of gas lighting that’s very unclear relationship between these things. And that’s really interesting. So the next question I have for you really, it kind of stems off this, but has to do with ideas in medicine and what we’re taught as doctors, because fundamentally what we learn in the walls of medical school ends up becoming how we practice and how patients are cared for and the approach.

Dr. Casey Means:

And two of the most I think electrifying chapters of the book were chapter seven and eight, where you talk about the subcellular pathologies that lead to most disease. This is a systems biology approach, very different from what we’re taught in medical school, which is a labeling approach to medicine. We look at downstream symptoms, we put labels on them and then that’s a very sort of convenient way to pick medications or interventions that we can approach these labels with. And the systems biology approach helps us realize that diseases are interconnected on the most fundamental cellular level versus more the conventional approach where we look at diseases as siloed and separate things which really promotes the polypharmacy, a drug for every ill that we see today. And this has to happen independently in medical school. You have to figure out, you have to step back and think and when you realize that the system’s biology approach is really how we should be approaching medicine, to me it feels like waking up from the matrix.

Dr. Robert Lustig:

I agree. Couldn’t agree more.

Dr. Casey Means:

Oh my God, we’re not treating the pathology that leads to disease, which if we did could potentially be a huge swath across all these symptoms that a patient has and you can’t go back. And so my question for you is how do you see things playing out in terms of the medical system shifting its thinking towards treating the subcellular pathologies that lead to disease and not the down symptoms? How is this going to work its way into medical school? How are we going to start treating that way? Because it’s going to look very different. A slight follow up question to that is that we actually can’t test right now a lot of the subcellular pathology disease, things like oxidative stress, glycation level, epigenetics, autophagy, which are some of the subcellular pathologies. We actually don’t have clinical tests for outside of the research lab. So how do you see this shifting both culturally, but also in the way that… Companies are going to have to invest in research to figure out how to clinically monitor these things. But since we’re not thinking this way, it’s tough.

Dr. Robert Lustig:

Casey, you have just summed up what’s wrong with modern medicine in a question. And I will be very honest with you, I don’t have answers to virtually any of those portions of that question. You’re absolutely right. This is a systems biology issue and we don’t teach systems biology in medical school. What we teach is how to play Clue. Okay. We learn Colonel Mustard in the conservatory with the candlestick. That’s what we learn. All right. And so that’s how you play medicine, you play Clue. So when I was a resident back in St. Louis in 1980, I don’t know if it was still around. Maybe it’s long gone. There was a game called intern. All right. We used to play it on weekends before the emergency room started getting busy and you’d have patient cards and you’d have diagnosis cards and you’d have disposition cards.

Dr. Robert Lustig:

And when you matched up the cards you basically got to discharge your patient and the first player to discharge all their patients won the game. All right. And of course you could transfer the patients to different in services, like neurology or OBGYN or whatever. It was actually kind of fun. But the point was that’s actually how we played medicine and that is just plain wrong. Okay. But that’s what we did. And we did it for years. The point is not as Colonel Mustard in the conservatory with the candlestick, the question is how did Colonel Mustard get into the mansion in the first place? Okay. And that’s not a question that we were answering and that’s the question we needed to answer. So you have to find root causes of problems in order to solve problems.

Dr. Robert Lustig:

The way I describe it in the book, it’s the first sentence of the book. There’s a wasp in your attic. What are you going to do? Kill the wasp or find the wasps nest? You have to work up stream of a problem to solve a problem. Working downstream of a problem only solves the results of the problem. The problem is still there and that’s what modern medicine does. And the only way to do that is a systems biology framework. Now the question is, how do you get that into medical school? That’s what you ask. And the answer is I don’t have a frigging clue.

Dr. Robert Lustig:

And the reason I don’t have a frigging clue is because pharma controls the medical school curriculum because they underwrite 80% of medical school costs. And so they’re not going to let it. So this is going to require a groundswell of awakening amongst physicians all over the country and really all over the world in order to be able to actually make this happen. And there are a whole bunch of obstacles to that occurring as I think everyone on this call knows. So how to do that? I actually don’t know how to do that. I wrote Metabolical as hopefully an impetus, a conversation starter to get there. But no, I don’t know how to do that. That’s bigger than me. That’s above my pay grade.

Dr. Casey Means:

Well, I think history has shown us that writing can be an incredible catalyst for these types of things. And part of the purpose of having book clubs, just like this and spreading this message is for exactly what you’re saying. Get this in the water, get it in front of more eyeballs because at least in my personal experience and I think just from reading your book, yours too, once you start thinking about these things, once you’re exposed to them, it’s really hard to go back.

Dr. Robert Lustig:

Yeah, it’s the right red pill for sure. I don’t argue that. It is the red pill and now we know how deep the rabbit hole goes but that doesn’t mean you get to climb out.

Dr. Casey Means:

Right. Yeah. Your story about Clue made me laugh. If anyone on the call is looking for a great weekend, read the book House of God, is a novel from 1978.

Dr. Robert Lustig:

I love that book. I love that book. I actually know all the people in that book, because I was an undergraduate doing research at Beth Israel hospital in Boston.

Dr. Casey Means:

It’s painful to read.

Dr. Robert Lustig:

My boss was Pincus.

Dr. Casey Means:

No.

Dr. Robert Lustig:

Yeah. So I know all of them. The Lego and every one of them. The fat man. The guy who would never know. I love that book.

Dr. Casey Means:

Well That’s so funny. I’m not surprised that this was your real life experience. And sadly 30 years later, it was exactly my experience in residency too with is the game that you talked about, where it’s actually literally gamified culturally within the residents and whatnot where-

Dr. Robert Lustig:

Well, your patients were the enemy.

Dr. Casey Means:

And your goal is to get them out or get them transferred and get your list down to zero. And so in that ecosystem, subcellular pathology of disease not brought up very much, but average doctor has great intentions and is going into medicine to help people. I have absolutely no question about that. That the person going to medical school is looking to help people, unfortunately, but I think we both agree with that, but the system, it is what it is and it’s very difficult.

Dr. Robert Lustig:

But that’s why we’re both out of medicine now.

Dr. Casey Means:

Right. Well, I think we have time for one last question and there’s just so many more I want to ask you and thank you for your thoughtful answers on all these, but…

Dr. Robert Lustig:

Well, it’s time for dinner, Casey. We have to have dinner.

Dr. Casey Means:

The participants in the book club have so many great questions for you, too. So I want to make sure we get to those. But my last question is to get where we need to go, which is a metabolically healthy country, truly metabolically healthy country, the reality is that people have to make a choice every single day to put unprocessed real food on their forks day after day. There’s no other way to get there. Fork, real food, in your mouth, every day. That’s why I wore my fork earrings for you guys. But in some sense it’s become controversial to talk about healthy eating and almost can be seen as subversive against the mainstream healthcare system. It can even be considered discriminatory and that’s for good reason because there are systems issues. Oh, sorry, go ahead.

Dr. Robert Lustig:

That’s right. No, no. The reason is because of social inequality. Because it’s the social equity of health issue and because basically what healthy eating has become is elitist.

Dr. Casey Means:

Exactly. And in a lot of ways, it is because there are huge swaths of the country that do not have access to healthy unprocessed real food. And of the system is obviously rigged against them with the fact that unhealthy food is heavily subsidized by the US government, our public food programs promote the eating of processed foods, et cetera. So that’s all the reality. But the question I have for you is about being effective in this situation. So how have you landed on a communications approach or a strategy approach that you think allows the message that you have to get out of healthy eating to be received and land in a way that’s going to be most effective for the type of encouraging and empowering future we’d like to see around food and individual diet because at the end of the day, the system has to change.

Dr. Casey Means:

But also, there is an element of personal choice and personal accountability that comes into this where when we choose a meal, it has to be this unprocessed real food. So how do you talk about that and how have you landed on the approach that makes the message effective? Because I think this is something that at Levels and as all of the people on this call who care about this topic, as you talk about it at dinner parties and this and that you want it to be the most effective and compassionate approach possible.

Dr. Robert Lustig:

I hear you and I’m not sure I have. I’m not going to tell you that I have been effective. I’ve been effective with a very small percentage of people and what’s preventing the other people from being able to glom onto it? I’m not a touchy feely guy. I’m a give it to you straight kind of guy. I’ve settled on a recent paradigm that I think actually seems to be gaining traction and I’ve tried it out in a few venues really in the last couple of months. So I’ll try it out on you and see how you like it and see how the audience likes it. Okay? Here we are talking about food. What is food? What’s the definition of food. Anybody got a definition? Anyone?

Dr. Casey Means:

Anyone want to chime in?

Dr. Robert Lustig:

So in fact, if you actually go to Websters and you look at the definition of food, it is substrate that contributes to either the growth or burning of an organism. So all of those who said fuel, all those who said energy, you got the burning part, but you missed the growth part. Growth or burning of an organism. Now, as it turns out any substrate that you would use can either cause growth or it can cause burning, but it can’t do both at the same time, kind of like a piece of wood in your house. It can be used for building furniture or it can be used for firewood, but it can’t be used for both. All right. Any specific molecule that you consume can either be burned down to carbon dioxide and ATP, that’s the burning, or it can be used for its structural components to form lipids, amino acids, ribose, et cetera, for cell growth. Those are your choices. Okay. And they’re actually three enzymes in each cell that determine which way the substrate goes.

Dr. Robert Lustig:

All right. And those enzymes, they’re kinases and they have receptors and transcription factors that run them, et cetera. All right. So that’s the definition of food, but what if a substrate actually inhibited burning? In fact, the molecule fructose, the sweet molecule in sugar, inhibits three, count them, three separate enzymes in mitochondria that actually prevent burning. AMP kinase, ACADL, CPT1. Okay. If you want, I can send you to a link that will explain these. All right. So in fact, the primary component of ultra processed food actually inhibits burning. Now let’s take growth. If something causes growth, that would make it food. But what if a substrate actually inhibited growth? My colleague, who is the chairman of nutrition at Hebrew University, Jerusalem just wrote big paper on how ultra processed food actually inhibits skeletal growth, calcium accretion, and actually causes inhibition of structural growth.

Dr. Robert Lustig:

In addition, we know that those exact same things actually promote cancer development. So ultra processed food by its very definition inhibits growth and inhibits burning. So it’s not food. It’s actually poison. Now that’s not taking a pejorative view. That’s taking a very, shall we say, epistemological view of this. And it’s not conferring any social inequity phenomenon. Okay. Because lots of elite people eat ultra processed food too. But what it’s doing is it’s calling attention to the science and then using people’s brains to basically turn that science into their own rational policy.

Dr. Robert Lustig:

This is what I’m currently working on, trying to get in. And I’m actually giving a talk at the UN Food Systems Summit on this issue next week or sorry, two weeks. So we’re trying. And so this is the tenor of the argument that I’m trying to make and how does that bounce off all of you? Raise your hand if you think that that works. If you don’t think it, it works tell me. I would like to hear and certainly during the comments section when we open up to questions, tell me what you think.

Dr. Casey Means:

What really lands with me about that is the idea that you give people the science and then I think your exact phrasing was use people’s brains to turn that science into their own rational policy. Because that makes a lot of sense to me because it’s essentially coming to your own conclusion, which is always going to be a stronger place to be than if you’re told something or that you should do something. And this is actually really the foundation and the premise of Levels, which is we give you a very important… One of many potential important data streams around how food is impacting your body, but the conclusions come from you. How do I feel after this spike? I don’t think I liked it. It wasn’t great. I should maybe tweak this a little bit.

Dr. Casey Means:

And then we give you of course the support to lower that spike and have a better positive subjective and objective outcome. So that really does land with me and is a lot of how we sort of shape because we approach the member as an adult who can make their own decisions and is going to make their own decisions, but information is power and we deserve to know what food is doing to our bodies.

Dr. Casey Means:

So I just want to thank you so much Dr. Lestig.

Dr. Robert Lustig:

If you call me Dr. Lestig one more time I’m going to…

Dr. Casey Means:

Rob. is there a blanket statement everyone can call you Rob on the call?

Dr. Robert Lustig:

Absolutely. I am not your doctor.