Dr. Lustig’s new book, The Hacking of the American Mind: The Science Behind the Corporate Takeover of Our Bodies and Minds, will be released September 12, 2017.
Chantal: Dr. Lustig, congratulations are in order for your Sugar the Bitter Truth video available on YouTube uploaded in July 2009 which has received more than 7,000,000 views! For a science/medicine video, this a record! The average educational YouTube video gets less than 10,000 views. Did you ever imagine that it would go “viral”?
Dr. Lustig: I didn’t even think my mother would watch it, let alone 7 million.
Chantal: How do you get 7 million people to sit still for a 90-minute treatise on carbohydrate biochemistry? Since the lecture was posted online, has your practice changed as a neuroendocrinologist and the type of research you do at UCSF?
Dr. Lustig: Well, I certainly get more referrals now. I don’t know that it has changed my “practice” per se, but it has focused my research on the causes of metabolic syndrome, even more than just worrying about obesity. We’ve determined that metabolic dysfunction occurs due to insulin resistance, which is due at least in part to liver fat, which is due at least in part due to sugar metabolism. So we now have a direct path from what kind of food we eat, to how we get sick.
Chantal: You were among the first to debunk the dogma that ” A calorie is not a calorie”. I am a Kinesiologist with a master’s degree in metabolism. Your lectures changed my whole frame of thinking about metabolic health and how I counseled my clients. Do you find that healthcare providers and nutritionists still cling to the old “calories in, calories out” model?
Dr. Lustig: I am constantly attempting to debunk this dogma. Calories imply “energy balance”, which infers physics. But obesity is about “energy deposition”, which infers biochemistry. And metabolic syndrome occurs in normal weight individuals too. So it can’t be about energy balance.
Chantal: Is this fundamental misunderstanding something you still have to explain or receive criticism for? Why does it seem so hard to let that myth die? Are you “anti-sugar”… “the sugar police”?
Dr. Lustig: I am NOT the food police. But people can’t change their behavior unless they know the real story. My job is to educate, not to pass judgment. Are some sugars better than others? Gram for gram, it doesn’t matter. High-fructose corn syrup has been called out as being worse than sucrose. But the metabolic studies say they are both equally bad. The only reason HFCS is worse is because it’s cheaper. That made sugar cheaper because of market competition. And that’s what let it get into every food in the supermarket.
Chantal: What are some small steps we can take to reduce sugar in our households, workplaces, schools, etc.?
Dr. Lustig: EAT REAL FOOD! Real food is low-sugar, high-fiber. Processed food is high-sugar, low-fiber. Real food works. Processed food doesn’t. But processed food is cheaper. Because it’s subsidized. The problem is that diabetes is even more expensive. But you don’t pay for it today, you pay for it tomorrow.
Chantal: You wrote “Fat Chance” two years after your video lecture Sugar: The Bitter Truth. It was on the New York times best-seller list for a long time. Why was it necessary to write the book and what was the response to it?
Dr. Lustig: A medical journal won’t publish a long-form essay. And the public doesn’t read medical journals. It was necessary to get the information into the hands of the public. That means a book. You took a one-year sabbatical to earn a master’s degree in law at UC Hastings.
Chantal: Why did you think it was necessary to continue your education?
Dr. Lustig: Science should drive policy, but the politics get in the way. I needed to understand: 1) when does a personal health problem become a public health crisis, and what are the legal doctrines that bring society to that point; and 2) how did Big Tobacco circumvent the law for so long? This meant going to law school, where I focused on Public Health Law and Food and Drug Law.
Chantal: How has this law degree helped you?
Dr. Lustig: It helped me formulate what legal doctrines can be used to intervene. This has helped focus the argument and get academics and various public health officials on board to take this on.
Chantal: In 2013, you were a founder of the Institute for Responsible Nutrition (IRN) to help educate and advocate for the public. A big emphasis for the IRN was to encourage folks to eat “real food” rather than adopting specific diets or macronutrient ratios. Why take the approach to change food culture and lifestyle versus a more prescriptive approach?
Dr. Lustig: We’ve been trying the target-based approach (treating obesity) for 40 years, and it hasn’t worked. And we’re talking about hedonic substances. Education alone has never solved any substance of abuse. Did Nancy Reagan’s “Just Say No” work? We’ve got an opioid crisis! No, this is a public health problem, and requires a public health approach.
Chantal: What do you mean when you talk about “real food”?
Dr. Lustig: Food that came out of the ground, or animals that ate the food that came out of the ground. Then either it’s got the right kinds of fats (e.g. fish, avocados), or it doesn’t have much carbohydrate (e.g. meat), or whatever carbohydrate it’s got it balanced by its requisite fiber (e.g. grains, fruit). This is what humans ate for millennia, and didn’t get chronic disease.
Chantal: The IRN merged with United States Healthful Food Council (www.eatreal.org). What prompted the merger and how do you see this furthering your objectives? What is the mission of Eat REAL?
Dr. Lustig: IRN and USHFC had the same mission statements: “to eradicate childhood obesity and type 2 diabetes”. But IRN was focused on the food in the grocery store, and USHFC was focused on the food in restaurants. There is a tremendous amount of synergy there. IRN had the science, and USHFC had the business model. It was a symbiotic merger, with both sides contributing to common goals. UCSF Food Services was the first hospital system to receive the REAL Certified stamp of approval.
Chantal: Was this a complicated process and what is the effect on the patients and consumers who eat there?
Dr. Lustig: Hospitals need to model appropriate health behaviors for the public. Tobacco was first banned in hospitals. Dan Henroid, the Director of food services at UCSF, totally gets it. It wasn’t a hard sell. We also have the UCSF Healthy Beverage Initiative. You can’t buy a sugared soda at UCSF. When visitors first realize this, they scratch their heads. But then they get it.
Chantal: In terms of healthcare providers, where do you think the most change is still needed in terms of understanding and promoting metabolic health and nutrition?
Dr. Lustig: We have to re-educate an entire army of physicians on the “new nutrition”. Physicians frequently experience “cognitive dissonance”; they’re told one thing, but experience another. They are hungry for the truth. We’re starting to make inroads at many levels. Papers, books, magazines, infographics, PSA’s, are all starting to carry the new messages. And people are getting it.
Chantal: Metabolic disease is most preventable, yet is the biggest killer and has the largest burden on healthcare systems and economies in the world. Why is there still so little recognition of this fact?
Dr. Lustig: People have been told that these diseases are due to obesity, and that obesity due to two behaviors — gluttony and sloth. Therefore, if you get diabetes, it’s your fault. The problem is that India and China have 11% prevalence of diabetes, and they’re not fat. The U.S. is the fattest nation, and we only have 9.3% diabetes. So obesity and diabetes are not the same. People and governments have not yoked food processing to diabetes. And processed food is cheap. So the epidemics go on and on. Chantal: What are some of the most urgent changes needed to reverse the epidemic?
Dr. Robert Lustig: Stop food subsidies. We subsidize corn, wheat, soy, and sugar; four crops that are killing us. This is the basis of our entire processed food supply. Let the markets dictate the price. Even libertarians can get on board with that message.
Chantal: Does the myth of the “low fat diet” persist?
Dr. Robert Lustig: “Low-fat” tastes like cardboard. When we went low-fat in the 1980’s, the food industry started adding sugar to make the food palatable. Now we have a toxic food supply.
Chantal: What other fundamental misunderstandings drive metabolic disease?
Dr. Lustig: The three myths are: 1. It’s about obesity. No, it’s about metabolic disease. 2. A calorie is a calorie. No, because sugar is metabolized like alcohol, and so children are getting the diseases of alcohol (type 2 diabetes and fatty liver disease) without alcohol. 3. It’s about personal responsibility. No, it’s about public health, and remaking the food supply so that metabolic diseases like diabetes are reversed. That’s what we do in our clinic at UCSF every day.
Chantal: How can the food industry be part of the solution, instead of the problem?
Dr. Lustig: Right now, the industry is rewarded for doing the wrong thing. We have to reward them for doing the right thing. That means turning the business model on its head.
Chantal: Can the food industry make a profit selling real food?
Dr. Lustig: They could, but not with the current food business model. We have to change the food business model so that the industry “wants” to sell real food. As an example, you could tax soda, and use the tax to pay for water. Differential subsidization.
Chantal: To make the industry want to do the right thing. You are publishing a new book September 12, 2017, called “The Hacking of the American Mind”. Why did you feel another book needs to be written and can share any clues to the content?
Dr. Lustig: Dopamine is the “reward” neurotransmitter that tells our brains “this feels good, I want more.” Yet too much dopamine leads to addiction. Serotonin is the “contentment” neurotransmitter that tells our brains “this feels good, I have enough.” Yet too little serotonin leads to depression. Ideally, both are in optimal supply. But dopamine evolved to overwhelm serotonin (our ancestors were more likely to survive if they were continually motivated). The result is that constant desire can destroy our ability to perceive happiness, while sending us down the slippery slope to addiction. Since government legislation and subsidies in the last forty years have promoted ever-available temptation (sugar, drugs, social media, porn) combined with constant stress (work, home, money, Internet), we are now faced with an unprecedented epidemic of misery. But there are ways to recoup happiness even in the face of overwhelming adversity.
Look for Dr. Lustig’s new book release September 12, 2017. You can preorder now on Amazon and get a 35% discount.
Chantal Bonneau B.Sc Kinesiology, M.Sc Metabolism and Nutrition