Episode 103

Dr. Robert Lustig
A CALORIE IS NOT A CALORIE

Today’s new podcast episode will impact your food choices from this day on.

New York Times bestselling author, Dr. Robert Lustig, is sounding the alarm on the problems caused by processed foods and sugar. His new book, Metabolical, takes a deep dive into what’s fueling the continual increase of lifestyle diseases. 

By now, you know these diseases by heart… type 2 diabetes, hypertension, lipid problems, cardiovascular disease, cancer, dementia, and the list goes on.

One of Robert’s defining messages is that these lifestyle diseases aren’t druggable, but they are foodable. You’re about to find out what that means in today’s episode.

Food is the only lever you have to affect biochemical change to improve your health. 

As Dr. Lustig says, “If we do not fix our food and change the way we eat, we will continue to court chronic disease, bankrupt healthcare, and threaten the planet.” 

Here are some highlights from the show… 

• “My job is to kill the calorie, I want it gone as a unit of measure because it is absolutely completely useless. It’s only gotten us into more and more trouble.”

• “All food is inherently good; it’s what’s been done to the food that can make it bad. All of your cells either respond positively or negatively to the specific components of your food.”
• “Essentially, all you need to know are two precepts, six words total: protect the liver, feed the gut.”

• “Everybody kept saying, ‘eat less, exercise more, eat less, exercise more.’ Guess what? We ate less, we exercised more, and we only gained more weight.”

Buckle up! 

FOLLOW ALONG WITH THE TRANSCRIPT 

DR. ROBERT LUSTIG: Well, thanks so much for having me, Kathy, it was my pleasure. 

I do and uh there is an international society of orthomolecular medicine inside of Canada, I’ve spoken at that in the past, and they are very, much into this question of you know, what’s gone wrong; and the fact is there are a lot of different people who are nibbling around the edges. What I try to do in my book “Metabolical” is basically stop nibbling and just take a really big bite and try to like fix itself. The problem is it doesn’t have a resolution; what it has is a prevention. And we Americans are not particularly good at preventing stuff. As you’ve seen, as we’re seeing you know now, that’s not what we — 

Well there are a lot of dark forces working to keep us very sick you know I’ve published on that we’ve you know here at UCSF we’ve actually you know unearthed some of the documents that have shown what’s gone on, the dark underbelly of the food industry to actually keep us fat, sick and stupid uhm, and uh the you know we’re trying to shall we say, undo that, but what we’ve learned is that there’s no pill for this. And the reason there’s no pill for this is because the pill can’t get where the problem is. And so, that begs the question, okay, where’s the problem? And I can sum that up in one word; the problem is in the mitochondria. Now, what’s a mitochondrion you would ask? 

Mito- alright-the mitochondria for your listeners are the little energy burning factories inside each cell that actually take the energy of substrate and turn it into chemical energy that der- cells can use to power them to stay alive to do the processes they need to do. That is the whole concept of metabolism, taking foods and then turning them into either building blocks for growth or substrate fir energy burning. Well, the mitochondria are in charge of the energy burning. The problem is that there’s no medicine that can get to the mitochondria. They’re inside cells you can’t get there. So, that actually then begs the question of, “What is nutrition?” 

To answer that question, I’m going to throw two other terms in: food science, metabolic health. So, food science is what happens to food between the ground and the mouth. Nutrition is what happens to food between the mouth and the cell. Metabolic health is what happens inside the cell. The problem is that all of the diseases that we are dealing with, type two Diabetes, Hypertension, Dyslipidemia, Cardiovascular Disease, Cancer, Dementia, Fatty Liver Disease, Polycystic Ovarian Disease, these are all inside the cell, so nutrition is only valuable as it informs metabolic health. And we are not fixing metabolic health, we’re actually only making it worse. And the reason is, because we can’t get to the mitochondria. 

KATHY: So, as you’re talking about this, you think about how we’ve been educated through the years, and that has always been about the calorie, calories in versus calories out. And even in fitness, we would teach fewer calories, exercise a little bit more, you’ll lose weight. And then, all of the sudden, this wasn’t happening. What was interesting, the experts, the Doctors, including yourself which you admit in your book were going down this path, and then the research shifted, and especially with your research, and it shifted into, which I love this, not all calories are created equal. So, can we just dive into that and what prompted you to change your mind about this calorie in and calories out, and then, working back to what’s on that box cover, that’s all we’re ever looking at. We’re only ever looking at, “Oh, this has 180 calories in a cup,” but it’s not telling the whole story. 

ROBERT: It’s not telling any story. It’s telling a mythology is what it is; it’s not telling any true story. My job is to kill the calorie, I want it gone as a unit of measure because it is absolutely completely useless. It’s only gotten us into more and more trouble. How come? Why this change, this 180-degree shift in this whole concept of dietary advice? 

People who studied obesity before World War Two knew that the problem of obesity was a problem of energy storage. They had just discovered the relationship between the brain and the pancreas in terms of insulin release. They had discovered cortisol, the stress hormone, and how it puts on visceral fat in the belly, a process called Cushing’s Syndrome, and so they were very, very attuned to the idea that there were things that made you gain weight. There were things that caused energy storage.

And then, World War Two happened, and the entire concept shifted. At that point, then the Psychiatrists got involved and they started talking about the fact that, oh, yes, that we had this thing called, “Stress eating,” and people were basically eating more in response to stress, and so they ended up noticing that people who were obese exercised less, which was true, but so they then decided that this was not really a problem of energy storage, they decided this was a problem of energy balance. That it was a question of what you eat versus what you burn. 

Well, somehow that took hold, and I know how, but it would take too long to explain. But that’s where the calorie came in, because the calorie was the unit of measure that went across both the eating and the burning. And so, calories came to dominate the whole landscape of obesity research, throughout the entire last half of the 20th Century. And so, everybody kept saying, “Eat less, exercise more, eat less, exercise more.” Guess what? We ate less, we exercised more, and we only gained more weight. And that was, of course, the problem.

Now, I was raised in this, I graduated Medical School in 1980, I got all of this from the gurus in Med School, but I had also actually studied Nutrition in College, graduating in 1976. And I learned that different foods were metabolized differently. And I learned that from some very heavy hitters in the nutrition field at MIT. Well then, I went to medical school, and they beat it out of me and said, none of that matters it’s just what the patient eats and what the patient burns therefore if you’re fat it’s your fault, and that’s what they practiced and that’s what they taught me to do too. Well, in 1995 I moved to St. Jude Children’s research hospital in Memphis, Tennessee which is a pediatric cancer hospital, and we had a lot of kids who have survived their brain tumours. Only to become massively obese in the process. Now this damage of the area of the brain the hypothalamus which controls weight. This form of obesity was called hypothalamic obesity because basically we’re damaging the hypothalamus and for that we’re using for some reason we’re basically exploding in terms of weight gain, and I had about 40 of these kids that I had to take care of. And the parents would come to me and say, this is double jeopardy my kid’s survived the tumour only to succumb to the therapy. And so behooved me to try to do something about it. Now, there was an animal model of this where you put an electrode in a rat’s hypothalamus, and you buzz it and all of a sudden that animal becomes massively obese. Well, the reason they became massively obese was because they started putting out insulin, the hormone insulin hand over fist. 

Now, insulin is known as the ‘diabetes hormone’ but it’s also the energy storage hormone, so insulin shunts energy to fat cells for storage, that’s it’s job. Well, these animals were putting out insulin hand over fist. But, you could stop it by cutting the nerve that went from the brain to the pancreas and then the insulin wouldn’t be released and the animal wouldn’t gain weight, so that told me that insulin was the bad guy in this story, so we did a study where we gave a medicine to these kids with this disorder, hypothalamic obesity where we supressed insulin release, and lo and behold, these kids started losing weight, they could only gain weight before and now they started losing weight but more importantly they started exercising spontaneously. I didn’t tell them to go exercising. 

One kid became a competitive swimmer, two kids started lifting weights at home, one kid became the manager of his high school basketball team, funning around collecting all the basketballs, these were kids who sat on the couch ate Doritos and slept because their bodies, because they were releasing so much insulin, they would rather store it than burn it. And now, because of the medicine, they were burning it! And they felt better. It changed their quality if life. We ended up doing this study four different ways, in four different directions in both adults and children and the sane thing came out, when you get the insulin down, not only do people reduce their food intake, but they actually increased their physical activity their energy expenditure, and what this showed us was, in fact the two behaviors that we associate with obesity, gluttony and sloth. They’re really just symptoms, they’re manifestations of the primary process of energy storage. Remember, energy storage, where it says energy balance-

KATHY: So, let me be devil’s advocate for a second here, just backtrack, you gave them- because I’m sure everybody’s listening going oh my gosh- 

ROBERT: What’s that medicine?! And they’re confused for good reasons, I admit that. 

KATHY: They gave them a medicine which dropped their insulin, can I take that medicine, is a part of it but also it gets back to the medicine helped them drop the insulin- 

ROBERT That’s right. 

KATHY: Let’s unpack insulin a little bit because typically, and I just went through, my bloodwork recently so it’s top of mine but typically we look at A1C and your fasting glucose levels 

ROBERT: Right, not enough. 

KATHY: Yea, and so that’s and I know your take on this but explain it to the audience because that’s the one we all look at are we prediabetes are we into metabolic syndrome are we okay and there’s a point and kind of unpack that Because people are a little confused about it. 

ROBERT: And they’re confused for good reasons. I admit that. So, the question is, which comes first? The obesity or the insulin? And our research says the insulin comes first. In fact, insulin always comes first. Now, there are different insulin problems, different people have different insulin problems and therefore have to be treated different ways; it’s not like everyone is the same. This is the concept of personalized obesity medicine, which now is actually starting to take hold and there are people actually doing this. There’s a guy at Mayo Clinic who is doing this, there’s the University of Minnesota, several people who are on this concept now that different foods affect insulin in different ways in different people, but there is no weight gain without insulin; insulin is required for energy storage. Therefore, insulin is a primary target of obesity therapy.

KATHY: So, I just want to stop you there. Even when you’re talking about going to the different institutions that are dealing with individualized and personalized medicine, so, and let’s just really break it down really simple. You eat, somebody eats oatmeal, two different people at oatmeal-

ROBERT: What kind of oatmeal?

KATHY: Let’s just say it’s steel cut oats with some, what I had this morning, some chia, some flax, some hemp seeds on it, and some walnuts sprinkled on there. Or let’s do the sugary type, making that more sugary.

ROBERT: The donut, right.

KATHY:  The donut, right, so what happens? It goes into your system.

ROBERT: So, if you consume 160 calories in steel cut oats, how many of those calories are you going to absorb? Probably only about 130. And the reason is because ethe fiber in the steel cut oats will actually inhibit absorption. The fibre in your food acts as a barrier for early absorption. So, think of it like a fishnet. The insoluble fibre, the cellulose, the stringy stuff in the celery, which is in the husk of the steel cut oats, forms a lattice work on the inside of your intestine, like a fishnet. And the soluble fibre, like the pectin’s and the inulin, they are globular, they plug the holes in the fishnet. So, together, those two, the soluble inulin and insoluble fibre, they form a secondary barrier on the inside of your duodenum, the first part of your intestine. And they prevent early absorption, therefore, you don’t get the big glucose rise, therefore you don’t get the big insulin rise, therefore you’re not going to shunt as much energy to fat. 

In addition, since you didn’t absorb it early, it goes further down the intestine, and what’s in the second part of the intestine that’s not in the first part? The bacteria, the microbiome. They’re going to chew that food up for their own purposes, so even though it passed your lips, it registered as a calorie consumed. It didn’t register as a calorie absorbed, because your microbiome chewed it up instead. So, this whole thing about calories is ridiculous, it’s worthless, because if you ate the food with fibre, that food wasn’t for you; it was for your bacteria. So, you’re measuring what happens here at your mouth, who cares? What you really want to do is measure what comes in at the level of your intestine where the food gets absorbed. But we’re not doing that, we don’t even have a way of doing that.

So, why bother with calories? That’s another reason why I want to kill the calorie, because that’s irrelevant. 

The second reason to kill the calorie; it was oatmeal, that’s glucose. That’s basically a form of starch. Now, glucose raises insulin, no argument there, it does. But, the donut, it didn’t just have glucose, it had fructose too. Also had some fat, but we’ll leave that aside for the moment. It had fructose, the sweet molecule in sugar, and that sweet molecule is handled completely differently from that of glucose. The liver actually handles fructose, that sweet molecule, in the same way that the liver handles alcohol. 

Now, you would never give a kid a shot of bourbon, would you? But in fact, when you give your kid a donut, that’s exactly what the liver is saying. No difference. Shot of bourbon, doughnut, which is okay 

KATHY: Or apple juice 

ROBERT: Well, or apple juice.

KATHY: Yeah 

ROBERT: Or orange juice, right. 

KATHY: Which is typically being handed to your child all the time. 

ROBERT: Take the national school breakfast program breakfast a bowl of Froot Loops and a glass of orange juice that’s 41 grams of sugar ok, that is two doughnuts. Or two shots of bourbon. Ok, would you ever think of giving your kid two shots of bourbon on the way to school? Well, if you actually feed your kid the normal US kid breakfast, that’s what you’ve done. So, calories are not handled the same a calorie is not a calorie because it might be for your bacteria and it’s not a calorie because if it got metabolized differently in your mitochondria then, it’s going to have a different effect. So, all of these things are important in terms of actually determining what constitutes an appropriate metabolic health. 

KATHY: Well it’s interesting on the show had Dr Wilbosowich a couple times abiggotdoctors Zachbush so we’ve talked about the gut and a lot about fibre so I love that you’re diving into that I love the visual with the fishnet I you’ve also I’ve heard you talk about like a colander where you Vaseline now that I like that also where you’re plugging up the holes makes perfect sense but what I want to jump over to is it that you have this in the book you repeated all the time if there’s it’s the two precepts it’s like if there’s anything you could talk to- if you could sum up your book, not that, you know, people should definitely buy what we’re going to talk more about that- the book, and to really understand the whole background in all of this, because really every page is fascinating. Your precepts are protect the liver, feed the gut. So, protect the liver, feed the gut.

We talked about feeding the gut. Let’s go to that first one, protect the liver, because I don’t think it’s an organ that most people understand. You think heart, intestines, kidneys and pancreas a lot with, since we’ve been talking sugars, but the liver is a powerhouse organ, and I’d love you to dive into it. And kind of get into how exactly do we protect the liver? And why is it so important?

ROBERT: The liver is a, it’s your primary detoxification and metabolism organ. It is required. And if your liver is not working right, you’re going to die, or you’re going to need a liver transplant. And by the way, fatty liver disease is now the leading cause of liver transplant in the United States, having overtaken Hepatitis C. 

45% of Americans now have fatty liver disease, and 25% of children have fatty liver disease. Now, prior to 190, if you were diagnosed with fatty liver disease, that meant you were an alcoholic, period. Full stop. Fatty liver disease = alcohol, that’s it. And then, we started seeing people who did not consume alcohol who had the same fatty liver disease, looked exactly the same under the microscope and ended up causing the exact same diseases and causing the exact same problems and people dying of it anyways, called, “Non-alcoholic,” or metabolically active fatty liver disease.

And then, we started finding it in children. I remember the very first patient htat I saw as a Paediatrician with fatty liver disease in 1993, and I went, “What the hell is this? I have never seen anything like this before.” And then, they all started coming, just like the obese kids. They all started coming. And they frequently were together, had the same problem. I mean, the fatty liver disease and the obesity. But every once in a while, you saw a thin kid with fatty liver disease, and you saw plenty of obese kids who didn’t. It became very clear they overlapped, but they weren’t exactly the same. 

So, the question was, what was causing the fatty liver disease? And that’s where this concept of alcohol and sugar came in. In 2006, I was asked by the National Institute of Environmental Health Sciences, part of the NIH to come give a talk on what I thought was the biggest problem in terms of exposure that was causing metabolic syndrome in the world. And they probably figured I was going to come talk about phthalates or bisphenol A or flame retardants or chlorpyriphos and insecticides or whatever, all of which are important and all of which are now what we all call, “Obesigens,” chemicals that actually cause weight gain because they bind to endocrine receptors and actually cause adipose tissue storage. 

Well, I did a reverse engineering, I said, “Wait a second, what are the two diseases that kids now get that they never got before?” Because kids are always the canaries in the coal mine, they’re always the most vulnerable. I said, well, the two diseases that they never got before but now get are type 2 Diabetes and fatty liver disease. I opened up my biochemistry text, I said, well those two diseases were the diseases of alcohol. So, I went to the page on alcohol, and right across was the metabolism of fructose, the sweet molecule in sugar. I traced them down and I went, “Wait a second, they’re exactly the same.” And they knew this back in 1974, that they were exactly the same, and it was very different from that of glucose, So, this whole concept of, “A calorie is a calorie,” just was never true, but it was what the food industry said to make us think that they could add more sugar to all of our food, and it would be fine, because it was just calories. Garbage. Garbage.

Then, I started realizing that this was actually a put-up job, that there was actually culpability here, and there was actually the dark forces that were actually at work here to try to keep us fat, sick and stupid. So, I started writing about this, and I went to that NIH meeting, and I said, “I think it’s sugar, and here’s why.” And I showed the two pathways that the alcohol and the fructose…and they mobbed me! And the end of the talk, they practically tackled me and said, “Oh my God, oh my God, you’re right!” These are toxicologists. Fructose is a toxin. It’s a chronic, dose-dependent, hypometabolic toxin, a liver toxin. Because that’s the liver’s job, is to metabolize toxins, to get rid of toxins. 

Well, the dose determines the poison, and there is an upper dose for any toxin that you can’t handle, that your liver basically has an upper limit. Well, our upper limit for fructose is a little higher than, say, our upper limit for cyanide, or our upper limit for VX gas or our upper limit for benzene or other toxins, but the fact of the matter is, there’s an upper limit. And when you exceed that upper limit, bad things happen.

KATHY: So, fructose, clarify fructose for a second because most people think fructose and they think, fruit. Okay, strawberries, berries, good for you, too much, not good.

ROBERT: That’s right, so bottom line is, fruit is good, and fruit juice is bad. And the reason is, number one, fruit has fibre. That fibre prevents the absorption. So, a lot of the fructose in fruit never got into your bloodstream; it was inhibited from being absorbed by that fibre. And so, the microbiome chewed it up instead, so that’s good. In addition, how many oranges can you eat before you throw up? Answer: four. How many glasses of orange juice can you drink before you throw up? Any amount. The fibre is-

KATHY:  I want to know how you know about the four-orange thing, how that was tested. 

ROBERT: Oh, because it’s an experiment we do. My colleague and my fellow cookbook co-author, Cindy Gershan, in the East Bay, she’s a Nutrition Educator, Mount Diablo High School, and they have a culinary arts class and she’s in charge. Every year, they start with the same experiment, the first day of the class. She takes two kids from the class, both of which haven’t eaten, because these are poor, low socioeconomic status kids for the most part, and she takes two kids from the class, and she hands each one six oranges. And she says to the first kid, “Here kid, here’s six oranges, make juice.” So, the kid squeezes the six oranges, gets 12 ounces, downs the whole thing, says, “Okay, what’s for breakfast?” Second kid, she says, “Here kid, here’s six oranges. Eat the six oranges.” Kid eats orange number one, kid eats orange number two, orange number three…gets to orange number four and throws up every single time on orange number four. Cindy’s got the vomit basin ready. 

KATHY: I hope these kids are a volunteer and are not chosen.

ROBERT: They volunteer, yes.

KATHY: No, so you have the fibre, and off the fruit, but then the big thing that happened in our country was the high fructose corn syrup, right? Was that the other thing that triggered so much of this response?

ROBERT: So, in 1966 a scientist in Japan figured out how to turn corn into high fructose corn syrup. It took a while for it to catch on here in America, probably into the late 70’s before we started seeing any meaningful amount of it. Then came hurricane Allen, which basically wiped out the Caribbean sugar crop in 1980, and all of the soft drink companies went scrambling. We don’t have enough sugar because of what happened to the Caribbean. And so, they realized they needed a home-grown source of sugar. And that’s when high fructose corn syrup started being made here on our shores, because corn was unlimited. By 1985, the industry had decided, yes, high fructose corn syrup is half the price, it is ubiquitous, it is easy to make, and so that was the switch from, remember, regular Coke to new Coke, 1985. 

Well, we rebelled, they went back to Coke classic, and then they slipped it in surreptitiously and didn’t tell anybody, and now it’s all new Coke and they just didn’t advertise it. The point is, the fructose molecule in high fructose corn syrup is the same fructose molecule as in sugar; there’s no difference between the two molecules. The difference is that high fructose corn syrup is half the price. And because it’s half the price, and also because it’s miscible, it won’t crystalize out, because the two, the glucose and the fructose are free, so they won’t crystalize out like they do in cookies. So, they stay soluble, so this ended up being a big boom for the processed food industry, because they could put more sugar in and not have it crystalize out. And they realized that the more sugar they added, the more people bought, because it’s addictive. 

And so, the molecule itself is the same, but high fructose corn syrup gave the food industry an extra advantage in terms of being able to ply more sugar into our diet, thus making us even sicker.

KATHY: Besides the sugar also, since you jumped onto processed foods, and you talk about it’s a large part of what you’re saying is causing so many problems is not just the sugars, but it’s the processing, so this idea that food in itself is not good or bad, or food is good, it’s what done to food-

ROBERT: All food is inherently good.

KATHY: It’s what’s done to the food that causes the issues, and it’s the processing. So, how much- get into the processing, because unless you’re on the perimeter of the grocery store, everything in the aisles I somewhat processed to one degree or another. Is there a degree of processing, is there something that you should look for, like, “Definitely stay away from this kind of processed foods,” or it’s a blanket statement that processing in itself, you should stay away from most processed foods?

ROBERT: This is actually a bone of contention right now throughout the entire world, as we try to figure out how to modify the food system to make it healthier. This is right at the top of my to-do pile, as it were. There is a classification system based on processing that was developed by my colleague, Dr. Carlos Montero at the University of Sao Paolo in Brazil, and it is called the “Nova System,” N-O-V-A, and what it does is it takes the different foods and classifies them based on how processed they are, rather than what’s in them. An example, a tart with an apple. So, class one would be an apple. Class two would be apple slices that have been destemmed, de-cored, deseeded. Class three would be apple sauce, which has been macerated and preservatives added and possibly even sugar added. And class four would be a hostess apple pie. The ultimate ultra-processed would last ten years and basically 50,000 ingredients and didn’t even resemble an apple anymore. So those are the four classes within the Nova System. And what Carlos has been able to show is that classes one, two and three are not correlated with chronic disease. But class four, that ultra-processed food category, that’s where all the disease is. Type two diabetes, heart disease, dyslipidemia, cardiovascular disease, cancer, dementia, mortality. All of them related to that class four grouping, and he’s got epidemic-logic data and we’ve now demonstrated causative data for why that would be so this is the reason why we think that it’s the processing that matters. Now, what’s being processed? Well, ultimately, the addition of sugar for palatability, and the removal of fibre, for shelf life. There are also a lot of chemicals along the way and a lot of them are not good for you, agreed, there’s also farming practices, in terms of insecticides and glyphosate ground up that is important in this as well this is all part if processing as well but processing an occur even before the wheat is harvested, you’ve already got a problem. There are a lot of different steps along the way in terms of what can go wrong but ultimately, it’s not the food, it’s what’s been done to the food that matters. And the two things that are the biggest are the addition of sugar and the removal of fibre. So, when you go into the store, the question is, how do I purchase a low-sugar high fibre diet? And the answer is, if you’ve gone not the shelves, you’ve gone off the rails. 

KATHY: That’s a good way to again, visualize it, off the rails. Now, let’s go, because we’re running short on time, but let’s go back to how I introduced the whole topic today and introduced you, and connect the dots here. So, we have all these diseases, and let’s use an example of, you go to the doctor, and you’re told, “Mrs. Jones, you have hypertension, your blood pressure is too high, we’re going to put you on medication to see if we can bring that down.” So, if you could, and I know it’s a tough challenge, if you could, could you take that and then bring it back to maybe, and tie it back to one of these eight pathologies or what’s happening, and what would be, what is actually happening, besides the pump saying, “Oh, my God, it’s 130/90 or whatever,” it’s above what it should be. What got it there, and what can be done about it besides taking the blood pressure, the blood pressure lowering medication?

ROBERT: Okay, perfect example. Everyone thinks that the reason for high blood pressure is because of salt. Well, we’ve taken our salt levels down from 15 grams per day, our ancestors consumed 15 grams a day of salt, and did not have hypertension, and now we consume 6.9 grams per day. So, we’ve cut our salt consumption by 60%, but our blood pressure has gone up, not down. Because it’s not the salt, okay? We thought it was the salt, it’s not the salt. Here’s why; there is something that causes your kidney to hold onto sodium, and it’s called insulin. The higher your insulin, the less well your kidney can excrete, remove, the sodium. When your insulin is high, your blood pressure will be high because you can’t get rid of the sodium, and water stays with it, so therefore your blood pressure goes up. You have to get your insulin down in order to get your blood pressure down. And getting rid of salt is not going to help you do that. In fact, getting rid of salt makes the food taste like s%#!@. The food industry actually makes all these low salt things, what do they do to cover up the fact that the food tastes like s%$#@? They add sugar. 

Well, it turns out the sugar is what caused the insulin to go up, and so if you got rid of the sugar, the insulin would go down, you’d be able to excrete the sodium and your blood pressure would go down. In addition, because sugar, when it’s metabolized, releases a reactive oxygen species, an oxygen radical known as, “Oxidative stress,” you are actually doing damage to the inside of your artery. In addition, sugar causes an increase in a compound called, “Uric acid,” and uric acid raises your blood pressure too. So, sugar for three separate reasons is the driver of both hypertension and the inflammation that ultimately leads to cardiovascular disease and stroke.

Get rid of the sugar, get rid of the uric acid, get rid of the insulin, get rid of the sodium, bring your blood pressure down, and all of the sudden, guess what? You’re healthy and you never needed to take that anti-hypertensive in the first place.

KATHY: So easy to say, and as we know, sometimes hard to do. Especially with sugar and processed food, and I think this is what we close on, is it’s addictive. So, even for myself, I have a very whole food diet that’s based on perimeter all the way and so, except, and it’s not even that big of a deal, but sugar. There’s something I’m eating now called, “Ochoa Bars,” and it’s dark chocolate covered coconut, but I can literally, I know that it’s too much sugar for my system. I sort of justify it, “Well, I’m going to work out,” and I love that you put this in the book, that exercise also has its own magic for all of these cellular and subcellular pathologies you’re talking about, only for some of them, but you can’t outrun a bad diet. It doesn’t matter how much you’re going out there, how many exercises, how many push-ups, whatever, if certain things are off than you’re going to get those blood results and they’re not going to look great. So, for me, it’s- I’m kind of stating the obvious, but you make the point in the book, and I don’t know if you make friends or enemies with this, but not who’s to blame, but in a sense, where are we pointing fingers? Is it the food industry? Is it government? Is it the medical community? Or is it me, myself and I? Is it the personal responsibility?

ROBERT: Look, once upon a time we did not have this problem. We have it now. Do you think that the entire world became gluttons and sloths in the span of 50 years? In countries that are developing countries. I mean, how is that possible? You want to ascribe it to the individual, then explain to me why we have an epidemic of obese newborns? They don’t diet and exercise. You want to blame them? It’s really to ascribe blame. Our entire society is about blaming someone else. It’s our litigious society, find someone else to blame. We’re seeing that right now in terms of our two-party system. Everybody is blaming somebody else. The fact of the matter is, there is somebody to blame, and it’s the food industry because they are the ones who spiked the food. And that’s what’s causing the disease. The two phenomenon that we associate with obesity, the two phenomenon we associate with all these diseases, gluttony and sloth, are easily explained by insulin. Because when you drop the insulin, the gluttony and the sloth go away, we have shown that. So, what’s making the insulin go up? The sugar. The sugar is the payload, the ultra-processed food is the vehicle.

Now, you could argue, “Well, we need processed food.” Because how are we going to feed ten billion people by the year 2050 without it? And that’s a good question, and it’s one I’m very interested in trying to solve. But the fact of the matter is, we have to fix the food system, and until we fix the food system, we will not solve this problem. That I can absolutely 100% guarantee you. And we haven’t fixed it yet, and until we do, we will not solve it.

KATHY: Well, I think we can end of that, and basically also saying that as consumers, we are pocketbooks and what we buy can determine some of this. Because a lot of us feel like, “How can we impact anything? How can as a consumer can I impact anything?” But stop buying-

ROBERT: You vote with your fork, and you vote 21 times a week. And the point is, that if you don’t purchase it, they won’t provide it. But if it’s addictive, what are you supposed to do?

KATHY: Break the habit.

ROBERT: Well, knowledge is where you start, that’s what we’re doing now.