Dr. Robert Lustig: A conversation on Why All Roads Lead to Metabolism
Dr. Robert Lustig, MD, MSL is Professor Emeritus of Pediatrics, Division of Endocrinology at the University of California at San Francisco. He also serves on the Scientific Advisory Board of Blue Oak Nutraceuticals, Inc. Dr. Lustig is author of several best-selling books including Fat Chance, Hacking of the American Mind, and Metabolical.
Note: This content has been lightly edited for readability and conciseness.
Can you elaborate on your phrase - All Roads Lead to Metabolism
Dr. Lustig – People don’t even know what metabolism is. It’s really remarkable how this word that’s been flitting around in the zeitgeist for so long and nobody really, really understands it.
Metabolism is basically how you take anything from the outside and make it part of your inside.
And, they are all defects in energy metabolism.
Ultimately, I’ll even go further. They’re all defects in the mitochondria because the mitochondria are the parts of the cell that process the food energy to turn it into chemical energy for use by your body. When those are screwed, so are you.
You've said that people don't die of obesity but they die of the diseases that travel with it.
Dr. Lustig – Obesity – nobody even knows what it means.
They’re about to redefine obesity; it used to mean increased BMI. They are now going to say it is excess adiposity; but, excess adiposity where? Because there are three fat depots and they’re not the same; and, they contribute to disease differently.
The fat depot that everyone talks about, of course, is the subcutaneous fat or the big butt fat, as in does this bathing suit make me look fat? (Never answer that question!)
That fat is actually metabolically inert and is not the cause of disease. Now, just so happens we have a lot of it and we can make more of it. And the more we make of it, the more likely that one of the other two fat depots are also going to start enlarging as well. And, that’s where the disease comes from.
What are those other two fatty depots? There’s the visceral fat, the big belly fat – you don’t need a lot of big belly fat to get sick. We know that from patients with depression. We know that from patients with Cushing’s syndrome. They don’t necessarily gain a lot of weight, but they gain a lot of belly fat and so they get sick. The reason is belly fat drains into the liver, and the liver is ground zero for all of this energy and metabolism. Belly fat then disrupts the liver and that’s why you end up with chronic disease.
And then finally, the third fat depot is the liver itself, that is liver fat. It used to be that if you had fat in your liver, you were an alcoholic. But, now we have five year olds with fat in their liver. In fact, 25% of all children have fatty liver disease today and they don’t drink alcohol.
What causes their fatty liver? The same thing that caused their Type 2 diabetes, blood pressure, mitochondrial dysfunction, insulin resistance.
And, what is that? Well, in most cases, it’s sugar. Sugar and alcohol are metabolized in the liver the same way. So three different fat depots, three different risks in terms of chronic metabolic disease.
You frequently speak about the fact that there is no medicalised prevention of chronic metabolic disease. Is that really true?
Dr. Lustig – If you take a look at all of those eight diseases that I just rattled off, there are medicines for them. For instance, statin for heart disease; does the statin fix heart disease? No. There are oral hypoglycemics for Type 2 diabetes. Do they fix diabetes? No. And, we can go on and on. The antihypertensives. Do they fix hypertension? No.
What we’re doing is we’re treating the symptoms of the disease rather than treating the disease itself. In fact, there is no treatment for any of those diseases. There is treatment for symptoms.
But so what?
In order for us to have a healthy American population, we actually have to fix the diseases, not treat the symptoms. It’s like putting a Band-Aid on it. It’s like giving an aspirin to a patient with a brain tumor; it might help the headache but it ain’t going to do a thing for the brain tumor
That’s what we’re doing with medicine today. So we have to address where the problem is, and we haven’t even come close.
What can a regular person do to solve the problem of chronic metabolic disease? What do you recommend?
Dr. Lustig – To solve the problem of chronic metabolic disease, we have to make our mitochondria work better. Right now, our mitochondria are screwed. They are basically working at about 90% efficiency capacity and we need them at 100%. In fact, if you even go down 1%, you can see the effects. So our mitochondria are not doing their job.
The question is what’s keeping them from doing their job?
And, the answer is how much time do you have?
We have ionizing radiation, we have air pollution, we have toxins in the water, we have toxins in the food, we have microplastics, we have a whole host of things.
But the biggest one, the one that sort of blows all the others out of the water is our diet. Because our diet is filled with mitochondrial toxins.
The biggest one, as I mentioned before, is sugar.
There are others, but that’s the one we could get rid of tomorrow if we had the political will to do so.