Book ‘Metabolical’ by Robert H Lustig

PDF Excerpt 'Metabolical' by Robert H Lustig
The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine
Did you know that 62% of the food in our supermarkets is not only processed but 'ultra-processed' (ingredients from other foods are combined to make something 'new', often in colours that do not exist in nature) and that data shows that by eating this kind of food over time we are literally slowly poisoning ourselves? In the hard-hitting, ground-breaking tradition of his NY Times bestseller FAT CHANCE, which revealed the dangers of sugar, Dr Robert Lustig persuasively presents a stark exposé of how our addiction to processed foods (aided and abetted by the food industry, big ag, big pharma, institutional medicine and the government) is behind the lethal increase in major non-communicable diseases...
Publisher: Harper Wave (May 4, 2021)  Pages: 416 pages  ISBN-10: 0063027712  ISBN-13: 978-0063027718  ASIN: B08FD91PSM

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About the author: Robert H. Lustig, MD, MSL, is the editor of the academic volume Obesity Before Birth and the internationally acclaimed author of the popular works Fat ChanceSugar Has 56 NamesTheFat Chance Cookbook, and The Hacking of the American Mind. He is Emeritus Professor of Pediatrics in the Division of Endocrinology and a member of the Institute for Health Policy Studies at UCSF. He lectures globally and consults with numerous medical societies and policy organizations to improve population health. He lives with his family in San Francisco.

Book excerpt


I retired clinically from UCSF in 2017 after forty years practicing medicine, with the notion that I could spend more time doing what I wanted to do. But as usual, Man plans and God laughs. It’s been a rough five years for many reasons, including personal, professional, and health concerns—I’ve had my share. But my family is with me, and for pulling me through, this book is dedicated to them. Daughters Miriam and Meredith, wife Julie, sister Carole Berez, thank you—indeed, this book is the product of your love and patience, especially this past year. And to my extended family, neighbors Marcia and Mark Elias, my cookbook coauthor Cindy Gershen, my UCSF friends Elissa Epel and Jack Glaser, Walt Miller and Sindy Mellon, Ivy and Fred Aslan, and my editor Amy Dietz, for buoying me up when I needed it most. This book is your handiwork as much as mine.


It’s been a rough day, you’re finally home after a long commute, and you’re starving. You sit down at the kitchen table, turn on the TV, and inadvertently consume a plate of poison. It looks like food, it tastes like food, maybe it tastes even better than food. But what if something had been done to poison it?

No—this isn’t an episode of Game of Thrones; it’s what’s happening to most of us every day, every meal, every snack. In bygone times, kings employed food tasters and cupbearers to sample their food and drink first to determine if it had been poisoned. Those poor peons knew that each bite might be their last. But our food today is safe, right? Your cart at the grocery store is full of vacuum-wrapped, refrigerated or frozen, hermetically sealed, spoilage-resistant, irradiated, pathogen-tested, screened-at-the-border products that meet all USDA and FDA standards. But what if that food has been altered or adulterated in some fashion by some ne’er-do-wells before it’s even been harvested, while it’s being cooked, or even after it’s been packaged, in order to kill you? And by design? Not because they want your life—just your wallet?

We occasionally hear about E. coli in hamburger meat, Salmonella in eggs, Listeria in spinach, or even melamine in infant formula; a recall is announced, and the matter is forgotten. So our food’s safe, right? But what if it acts more like a slow poison, like cigarettes—one won’t kill you, but ten thousand consumed over ten years might? Unlike Salmonella, you won’t be feeling the effects immediately. But eventually, you’ll feel it . . . everywhere. In your heart, muscles, bladder, brain, and especially your wallet. What if this consumable poison is laced with additives that toy with your brain’s reward center, leading to addiction and needing ever more of it? Kind of like the pusher in the schoolyard who offers you your first toke for free—and then he’s got you. And the bigger and the more chronic the dose—the quicker you die.

Let’s take it a step further: what if this poison doesn’t just kill you chronically, but sets you up to be susceptible to acute illness—say, a viral pandemic—that could kill you even quicker? What if the USDA and FDA are aware that this slow consumable poison is sold in grocery stores nationwide, and they allow it to be promoted heavily? What if the entire world is exposed to the same toxic and addictive consumable poison, and has now started to get sick, too?

And finally—what if this slow consumable poison looks like everything else in the store? How do you protect yourself?

This is not a Stephen King novel. It’s real life and it’s happening now. This consumable poison is called processed food.

Food writer Mark Bittman has said that since food is defined as “a substance that provides nutrition and promotes growth” and poison is “a substance that promotes illness,” then “much of what is produced by industrial agriculture is, quite literally, not food but poison.” He was talking primarily about pesticide use versus sustainable farming, arguing that we have laced our food with poison. Yes, pesticides are one aspect of food toxicity—but only the tip of the iceberg, maybe about 10 percent of what ails us. The other 90 percent is due to the procedures of the processing, which has morphed what was food into this new slow-acting poison. Your box of cereal may tout that it’s “organic” and “all natural”—but it still may be poison. What’s important is the alchemy of how the food itself has become poison. Until you understand that, you can’t understand what has happened to our food—and to us. This book will explain it’s not what’s in the food —it’s what’s been done to the food that counts. And you can’t learn that from your doctor, dietitian, advertisement, internet blog, or even a Nutrition Facts label. Nope, you’re going to have to learn that yourself.

Nutrition is not the same as food science. Nutrition is what happens to food between the mouth and the cell. Food science is what happens to food between the ground and the mouth. Each is dependent on the other, yet both are “opaque” to the public. That’s on purpose—because the food industry and the government don’t want you to know that it’s the food processing that’s rendered the current concepts of nutrition moot.

Food processing isn’t listed on the Nutrition Facts food label. The label tells you what’s in the food. This is mostly irrelevant—what you really need to know is what’s been done to the food, and no label tells you that . In this book, I will make both nutrition and food science transparent. Essentially, all you need to know are two precepts, six words total: 1) protect the liver, 2) feed the gut. Those foods that satisfy both precepts are healthy; those that do neither are poison, and those that do one or the other are bad (but less bad)—no matter what the USDA and FDA allow to be stated on the package. Only items that meet both of these criteria qualify as Real Food, i.e., that hasn’t been stripped of its beneficial properties and sprinkled with toxins that will hasten our demise.

So buckle up—I’m going to take you on a ride. Now that you’re strapped in, we are going on a journey from the ultra-micro to the ultra-macro—from molecule to planet, and everything in between. We’re going to get both the subcellular and the thirty-thousand-foot view. And we’re going to travel through time, over the last fifty years. The reason for this bottom-to-top and backward-to-forward excursion is to answer these questions: why has our health status declined, our healthcare system devolved, and our climate immolated?

Some might argue that these alterations are unrelated to each other. But it all starts with the changes in our food supply chain that shifted five decades ago in order to support the production and consumption of processed food . To make and bolster this case, I’ve connected several dots for you: the food to the biochemistry; the biochemistry to the disease; the disease to the medicine; the medicine to the demographics; the demographics to the economy; the economy to the agriculture; the agriculture to the climate; the climate to the planet; and the planet back to the food yet again.

I know this sounds like a nightmare ride on an academic Tilt-A-Whirl, but I’m asking you to hold on to your seat. When you see how these factors are all interlinked with one another, two incontrovertible truths emerge. First, the change in food processing, starting about fifty years ago, has fueled a slow but unrelenting medical, economic, and climate vortex downward. It’s picked up speed with time and overwhelmed our medical resources, now evidenced and accentuated by the social disparities of the coronavirus pandemic. It threatens to overwhelm our planetary resources to boot. Second, in today’s society, food is the only possible lever that we can apply immediately to effect change. If you do not fix your food, you continue to court chronic disease and death. If we do not fix our food, we continue to court societal and planetary oblivion. This book explains what’s needed to fix both.

Most nutrition authors have a diet to sell to you, a single axe to grind, don’t take care of patients, can’t provide a diagnosis or medical advice, and think that there’s one diet that fits all. They can’t or won’t address nutritional issues based on age, sex, or race, because they only know one aspect of nutrition, and can’t meld it into context for individual readers. Frankly, we have a right to view them as co-opted.

Conversely, clinical health professionals are supposed to keep you healthy, but they can’t do that if they haven’t been taught how. For decades, the combined healthcare professions have subscribed to the inevitability of chronic disease and aging, and have been consistently dissuaded from keeping you healthy with the “lure of cure,” and more recently the “temptation of treatment”—because they don’t know otherwise. Doctors and dietitians and dentists have been part of the problem, but we can be part of the solution—but only by changing the paradigm. By elaborating the science and pathways of chronic disease in this book, I will demonstrate that our current processed food model is prima facie defective, and must be discarded in favor of a Real Food model.

Many people think Real Food is effete and snobbish, and that I must’ve had a privileged upbringing to eschew the Standard American Diet. Nothing could be further from the truth. My mother worked two jobs, by day a New York City school secretary, and by night the agent for my grandparents’ rental properties. I heated up and ate a whole lot of Swanson TV dinners (I hated the Salisbury steak). I also was a stress eater, and in medical school I was the master of the three-second lunch, as I would have to inhale a sandwich while transitioning from one clinic to another. Hardly a diet to be envied.

I didn’t just stumble into this problem, but like you, originally I yielded to the siren song of mainstream nutrition dogma. I majored in nutritional biochemistry at MIT, graduating in 1976. I was fascinated by how micronutrients such as vitamins could fix certain diseases, but not others. I was also intrigued by the tabloid headlines proclaiming that some people who consumed high-protein formula shakes for weight loss were dying from kidney failure. It was clear to me then that the science and the physiology of nutrition actually mattered. Then I went to Cornell University Medical College in New York City, where despite having one of the most distinguished nutritionists in the world on faculty (Professor Maurice Shils, 1914 – 2015), there was no nutrition curriculum, and they beat my scientific interest in it out of me. I was told that my undergraduate training was irrelevant in dealing with how to take care of patients. I succumbed to the “common wisdom” of calories, obesity, and the inevitability of aging—they taught that it was all about calories in and calories out, and I believed what I was told, even though it was the opposite of what I’d learned just one year prior. Hey, these were the doctors, the experts, and my parents were paying a big tuition bill for learning and incorporating the expertise of those doctors.

So, mea culpa—I practiced medicine for my first twenty years as a pediatric endocrinologist (glandular and hormone problems in children) without a real clue of what was truly right or wrong when it came to disease. Match the diagnosis to the disease, and then the treatment to the diagnosis. A big game of Clue: Colonel Mustard in the Conservatory with the Candlestick. And then throw some medicines at it. My colleagues eschewed seeing the obese children who were my patients, because they were steeped in that same common wisdom—it’s about energy balance; the kids eat too much and exercise too little; it’s all their fault. When I was at the University of Tennessee in the late 1990s, one divisional colleague sent a form letter to outside providers admonishing them for referring such patients, to dispel their belief that an endocrinologist could somehow cure obesity—such sacrilege!—that a doctor could somehow upend the first law of thermodynamics, which espouses a simple mantra: a calorie is a calorie. That mantra, recited with almost religious fervor, has set medicine back at least fifty years, and maybe more.

My own research showed me the inconsistencies of this mainstream nutritional dogma, and the true path forward. At UCSF we have a motto, “In God we trust, everyone else has to produce the data.” I guess everyone else trusted. But I produced the data. And it didn’t match the party line. The science said that not all calories are created equal; and it’s the food quality, not the quantity, that matters. I didn’t know it at the time, but that was my only salvation in terms of my reputation, personal integrity, and sanity. It also set up the second half of my career to be an iconoclast, relegated to the outside of both the medical establishment and the government.

You can therefore consider this book as both my act of contrition to you, the public, and my act of medical disobedience to the medical establishment. Perhaps I had to wait until I was retired from clinical practice to write this book, for no ivory tower academic bastion would want to take credit for the “medical heresy” that you’ll find sandwiched within these pages.

Doing the research myself was like taking the red pill from The Matrix (1999)—and now I know just how far down the rabbit hole goes. Iconic chef Anthony Bourdain, even in the face of his own personal demons, relished telling the full truth about his profession. My favorite Bourdain quote: “An ounce of sauce covers a multitude of sins.” That might as well be the motto of the entire food industry. And the healthcare industry. And the medical industry. And the pharma industry. And the chemical industry. And the insurance industry. And government, which is its own industry. But the truth will set you free. This book is my contribution to the truth—my Clinician Confidential. By educating you, the reader, this book is my attempt to eventually bring the medical profession to heel, and to heal.

There are two keys to understanding the breakdown of our health and healthcare model. The first key is the one the medical establishment doesn’t want you to know —that their drugs can’t and don’t treat chronic disease; they only treat the symptoms. Oh yes, they can treat the high blood pressure, high blood glucose, high blood lipids—but not the actual cause of any of these conditions. Modern Medicine has gotten the treatment of certain diseases right, such as infectious diseases (like polio), genetic diseases (like childhood leukemia), and some surgeries (like gallbladder or appendix removal). But for chronic noncommunicable diseases (NCDs)—such as diabetes, heart disease and stroke, fatty liver disease, cancer, and dementia, which kill more people, at earlier ages, and in the most debilitating of ways (think amputation, dialysis, blindness) and eat up 75 percent of all healthcare dollars—Modern Medicine has gotten it all wrong.

This book will explain in layman’s terms the science behind chronic disease. There are eight subcellular pathologies that underlie all chronic conditions—and all of them are nutrient-sensing (chapters 7 and 8), meaning that they respond positively or negatively to specific components in food; yet none of these are considered diseases themselves. When you look carefully at the science of these eight pathologies, you realize that none are druggable, which is why they don’t respond to our current medications, and why people keep getting sicker despite the doctors’ best efforts. But they are all foodable (Chapter 10). Despite the billions of dollars poured into pharmaceutical research, no drug can fix or treat any of these eight pathologies, because drugs are not nutrients. Only Real Food works. In fact, Big Pharma is adept at covering up this subterfuge by advertising directly to the consumer, pretending the symptoms are the disease. They’re not. And of course, the public wants to know—are these eight pathologies exercisable? Not completely; of the eight, only five are responsive to exercise. Physical activity is a useful adjunct, but you can’t outrun a bad diet. In this book, I’ll show you why.

The second key is the one that the food industry doesn’t want you to know —all food is inherently good; it’s what’s been done to the food that’s bad. The problem is that in the course of food processing, poisons are either added (stuffing the liver) or antidotes have been removed (starving the gut), or both. Minimally processed food (e.g., white rice, fruit juice) interferes with one or the other; while ultra-processed food (e.g., Cheetos) interferes with both. Now our livers are stuffed (from the sugar our bodies turn into fat) and we’ve literally turned ourselves into foie gras. Our guts used to be full of beneficial intestinal bacteria that munched on fiber and kept everything in our bodies copacetic. Now, that food has been stripped of its fiber, and those bacteria get so hungry they eat the mucin barrier off our intestinal cells, setting us up for inflammation and leaky gut.

The science also shows that ultra-processed food is the cause of other chronic diseases on the upswing, such as addiction, depression, obstructive sleep apnea, and autoimmune disease. While these diseases have always existed, their prevalence, severity, and death tolls are rising exponentially, especially in the Western world. And when we look for the source, it’s traced back to what we eat. Or really, what they did with what we eat.

Michael Pollan (full disclosure, he’s a friend), in his now-famous New York Times Magazine article, espoused seven simple words: Eat food, not too much, mostly plants. Three separate clauses, but I think that each clause is misleading. Eat food doesn’t take into account that some people may do better on a low-fat diet, while others may do better on a high-fat diet. Not too much doesn’t say how you are supposed to moderate that, as it doesn’t take into account food addiction or what generates satiety. And mostly plants doesn’t take into account that Coke, French fries, and Doritos are all plant-based. If you buy your organic, all-natural, GMO-free tortilla chips at Whole Foods, you’re still stuffing your liver and starving your gut—you’re just paying more for the privilege.

Similarly, Andrew Weil espouses the so-called anti-inflammatory diet, which is mostly plants. Seed oils are high in omega-6 fatty acids, which are highly pro-inflammatory; yet omega-3s, found in fish, are anti-inflammatory. It’s not the plants that are important. Furthermore, the low-fat diet, a bastardized version of the plant-based diet, has been a dismal failure, killing more people than cigarettes.

And now we have a new controversy—vegan vs. keto (Chapter 14). Movies like What the Health (2017) and The Game Changers (2018) argue that animal products kill people. Vegan proponents argue that meat is killing people and the planet. Are these arguments based in science? It seems like everyone, from the Lancet Commission to the Intergovernmental Panel on Climate Change, is advocating a plant-based diet for both our health and for the environment. If this were the easy answer, India, which in large part eschews beef, would be healthier. But its diabetes rate is 8.8 percent and growing—the rate in the US is 9.4 percent. By the same token Argentina and New Zealand, which both eat double the meat per capita that the US does, would be fat and sick—but their heart disease, diabetes, and cancer burden are lower than ours.

Conversely, keto devotees argue that carbohydrate is the root of disease, some saying that eating nothing but meat is the healthiest diet and can even reverse most diseases. Is this true for everyone, or is this just spin? Keto adherents can’t stomach the thought that there’s a difference between grass-fed and corn-fed animal products, and they pooh-pooh the data that demonstrates that processed meats are not just correlated with, but causative of diabetes and cancer.

This meat versus no-meat controversy has caused the public to take their eyes off the ball, much to the food industry’s delight. In fact, the vegan vs. keto battle is based on a false premise of metabolic health, and both diets can be abused, as the food industry peddles both processed carbs and processed meat. One of the goals of this book is to help bury the hatchet in this fake diet war by showing that real vegan and real keto can both work, as they have more in common than they realize. As I was writing this book, I thought, “Either I’ll be embraced by both sides because I’ll have validated their view, or I’ll be shunned by both sides because I’ll have validated the opposite view.” I’m not the enemy. Both factions should be allied with me against the real enemy—processed food.

Then there’s the environmental burden. While cows and sheep are indeed methane producers, the methane emissions from the animals (5 percent) turns out to be a pittance compared to the rest of agriculture (10 percent), and compared to industrial methane production (35 percent) and the transportation industry (50 percent). And the climate change impact of the animals is completely dwarfed by the nitrous oxide production resulting from synthetic fertilizer sprayed on all those plant-based products throughout the Midwest grain belt (see Chapter 25). I’m not against plants—plants can be Real Food. But they can also be processed food. Just like animals can be Real Food or processed food. Therefore, I propose that Michael Pollan’s seven words for healthy eating can be re-stipulated into these six words: 1) protect the liver, 2) feed the gut. This includes animals.

As I began in 2007 to debunk the nutritional mythology that has beset the field, it became apparent that the political mythology was even more egregious; in particular who stands to make a profit. The healthcare field has been plagued for decades by a philosophical concept known as moral hazard, which denotes a situation where the perpetrator knowingly profits off the victim’s suffering—an economic version of schadenfreude. An example of this is the health insurance industry. It didn’t create your disease, but it clearly profits from it, as it denies coverage and jacks up your rates. It operates on the casino model — pay to play, and set the rates. The industry was happy when you got sick—they could raise your rates and still say no to coverage. They cleaned up; and until very recently, the industry had no reason to change.

The deeper I dug, the more I realized that the problem was much bigger; in fact, I am coining a new term—immoral hazard—to denote when the perpetrator specifically rigs the game to create its profit, knowing full well the victim will suffer. One example is how Big Tobacco lied under oath about the addictive nature of its products; a second is the petroleum industry deep-sixing the research on climate change in the 1980s to continue to heat the world to its boiling point; a third is our current opioid crisis—we now know that Purdue Pharma was behind the Marino bill (2016), which reduced the DEA’s jurisdiction over opioids. But I will argue the subterfuge surrounding processed food is even worse, because no one ever said that tobacco or petroleum or opioids were supposed to be healthy, but you do have to eat and drink—and the food and beverage industries bait you with every box, bottle, can, and wrapper.

In this book, I will provide evidence for three separate, yet related immoral hazards perpetrated by Big Food, Big Pharma, and Big Government. As people get sicker, Big Pharma benefits from complicity, the food industry is protected from the costs of its actions, and the government profits from tariffs on processed food shipped to other unsuspecting countries. We’ve accepted this as normal. It’s not, and we have the power to change it, for ourselves and for society at large—for health and healthcare, for economics, and for the environment. It’s time to expose the maneuvers of the food industry and the pharma industry, and their influence on Congress to make us all fat, sick, and broke.

In the eight years since my first book, Fat Chance (2012), was released, the data on ultra-processed food has come in, and is absolutely damning. We now know the nature of the toxic metabolite of sugar in the liver, and the role it plays in cancer and dementia. We have the data to show that sugar is addictive and keeps us coming back for more. Conversely, we now know that dietary fat is not toxic (aside from trans -fat), and some fats can be therapeutic. We are beginning to understand the role of the gut and its microbiome in the development of autoimmune and psychiatric diseases. We have data on the side effects of diet sweeteners, and information on pesticides like glyphosate. The NOVA food classification system from Brazil categorizes the degree of processing, so we can determine what food industry practices are the most dangerous. I will show how and why this has occurred, and what each of us can do about it.

Now to the title. Metabolical is a portmanteau (a word blending two others) of “metabolic”—the workings of the body —and “diabolical”—the workings of food, pharma, and the Feds. All claim to be on your side, but they’re on their own sides, and you’re the victim of their propaganda.

This book will show you how what your doctor doesn’t know can kill you. Each person can screen for and diagnose his or her own risk for chronic disease; how to treat, and in many cases reverse, those diseases so you can get off your medicines; and, most important, how to prevent these diseases and conditions from occurring in the first place (see Chapter 9).

While nutrition seems inordinately complex to most people, it’s only become that way because of the competing messages, which unfortunately have also propagandized the medical, dental, and dietary professions. In fact, the education part of this book is very easy. I will battle the cacophony of conflicting information on food and chronic disease with these two easy precepts: 1) protect the liver, 2) feed the gut. Every nutrient, every food, every food pattern, every food timing paradigm obeys these two precepts. However, implementing them is difficult and only possible with Real Food—even though that’s not what Big Food is selling. The answers you need, in simple terms, to change your food, your health, and your life are all within these pages. There’s only one thing that’s not—the bibliography! Because there are 1,054 references (more than most textbooks), an end-of-book paper bibliography would have grown the size of the book by seventy pages; such a book would be heavier, less environmentally friendly, and more expensive. Instead, the bibliography, with all the hyperlinks to the primary source material, exists at, for anyone to access. The science is here, the politics are exposed, and the public is finally ready to discard the previous old, worn-out dogma. It’s time for us to understand the real story of food, and the story of Real Food.