January 31, 2024 • 20 mins
An interview on rethinking sugar, diet, and health through the lens of insulin dynamics with Robert Lustig, MD, Professor of Pediatric Endocrinology at UCSF.
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Episode Transcript
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David Klonoff (00:15):
Welcome to Diabetes Technology Report.
This is the podcast that coversdiabetes technology.
I'm David Klonoff, I'm anendocrinologist at Sutter Health
and UCSF and we have a veryeminent guest today who I've
been following for many years.
I'm going to turn the podcastover to my associate
(00:39):
endocrinologist, dr David Kerr.
David Kerr (00:42):
Thank you, david, and welcome to everyone.
It's an enormous pleasure toinvite or to hear from Dr Robert
Lustig today.
We've been following you formany years.
You're a very eminent pediatricendocrinologist, but you also
have a unique perspective onglucose and insulin and now, of
course, with the use ofcontinuous glucose monitoring.
(01:03):
Robert, why are you interested?
What sparked this interest foryou?
Robert Lustig (01:10):
Well, once upon a time I took care of short kids
and then the short kids got faton me and this entire childhood
obesity epidemic and reallypandemic occurred on my watch
and no one could understand whatwas going on and everyone just
said well, you know, they'regluttonous and sloths, they eat
(01:31):
too much, they exercise toolittle.
And of course, nobody gotbetter.
Things only got worse.
About almost 30 years ago now,I was working at St Jude
Children's Research Hospital,the cancer hospital in Memphis,
tennessee, and I had a cadre ofabout 40 children who were
(01:56):
normal weight until their braintumor and then they would
receive surgery, radiation,sometimes chemotherapy, and they
would become massively obese,30 pounds a year, ad nauseam, ad
infinitum, and this was clearlynot due to gluttony and sloth.
Something had happened to themand it was up to me to try to
(02:19):
figure out what that was.
Now I knew, because I'm aneuroendocrinologist and I knew
my basic science.
I knew that there was aconnection between the
hypothalamus and the pancreas,called the vagus nerve, and we
knew that if you lesion thehypothalamus and rats, they
became massively obese.
(02:40):
Presumably this was the animalprototype of this clinical
disease called hypothalamicobesity.
I was taken care of.
We also knew that if you cutthe vagus nerve, it didn't
happen.
So the assumption was there's amessage from the brain to the
pancreas release insulin.
Well, I'm not a surgeon, Ican't cut a vagus nerve, but I
(03:03):
can give a medicine to lowerinsulin release, and that
medicine was called octriotide,and normally it's used for
growth hormone secreting tumors,but we repurposed it for this
insulin suppression.
So we gave octriotide to thesekids and, lo and behold, they
started losing weight.
(03:23):
And not only did they loseweight, but they started
exercising spontaneously.
These were kids who sat, youknow, like lumps on a log,
eating Doritos and sleeping, andnow, all of a sudden, they're
physically active.
Like the mothers would say youknow this, I've got my kid back.
And the kids would say this isthe first time my head hasn't
(03:45):
been in the clouds since thetumor.
It was really remarkable, andso we did this at a double blind
placebo control trial.
And, lo and behold, it workedagain and I said wow, this is
really an important pathway.
Maybe this is true in general,adult obesity having nothing to
(04:06):
do with brain tumors.
So we did a pilot trial in 44adults with no brain tumor, and
eight, eight, eight out of the44 responded just like the kids
did.
Now the other 36 did not.
So the question was what wasdifferent about the eight?
And the answer was they hadinsulin dynamics just like the
(04:30):
kids Early insulin release,quick peak and then drop off.
They had what we termed insulinhypersecretion.
We gave them octretide and theylost weight too.
And then we did that in adouble blind placebo control
trial and it worked again inthose same patients.
(04:51):
So we found a subset ofpatients where the insulin was
driving the weight gain asopposed to the weight gain
driving the insulin, and thiswas very important.
But then we asked the questionwell, yeah, that's great for the
eight, what about the other 36?
They also had high insulin, butthey didn't have those same
(05:14):
insulin kinetics.
They had what we now, of course, commonly call insulin
resistance, and the question waswhat was wrong with them?
And that's where sugar came inand that's where the food supply
came in.
And now I'm realizing and Ithink the whole world is
(05:35):
realizing, that our ultraprocess food diet is the driver
of this phenomenon calledinsulin resistance, which is
then driving weight gain andchronic metabolic disease.
And it turns out insulin is itsown metabolic perturbation.
(05:55):
We always talk about glucosebeing bad for you, the glucose
spikes.
Well, the insulin spikes areequally bad for you.
The goal is to get the glucosedown and the insulin down.
Now, to do that, you have toknow what's going on with both
the glucose and the insulin.
David Kerr (06:13):
Yeah, I was really interested in hearing this
because you're also involvedwith continuous glucose
monitoring and I'm wondering ifyou see that as a beyond
measuring glucose, it's actuallytelling us something about
insulin.
Robert Lustig (06:29):
Absolutely so.
Without question, the glucoseexcursion, the change in glucose
fluctuation, is exceedinglyimportant in terms of vascular
health.
No argument, I'm completely inagreement with that.
We all know that hyperglycemiacauses retinopathy, neuropathy
(06:50):
basically all the small vesseldisease that we know about.
The point is that that'sbecause of the high glucose.
What we've learned is that highinsulin causes macrovascular
disease like, for instance,coronary arteriopathy and
(07:13):
aneurysms, and also, of course,cancer.
So you need to be able to lowerblood for glucose and the
insulin.
The good news is that yourglucose excursion is a proxy for
your insulin excursion too, soyou can learn about both when
you know what the glucose isdoing in real time.
(07:34):
And that's why, even though Idon't take care of diabetic
patients anymore because Iretired, I'm still very
interested in continuous glucosemonitoring as a proxy for
insulin dynamics.
David Klonoff (07:51):
Robert, I'd like to ask you about some of the
work you've done about which arehealthy and which are unhealthy
foods to eat.
Do you think that every calorieis equal, and are there certain
foods you think areparticularly unhealthy and
should be avoided?
Robert Lustig (08:07):
Right.
So you know, the food industrywill tell you a calorie is a
calorie, a sugar is a sugar, afat is a fat, a protein is a
protein and the fiber is a fiber.
Nothing could be further fromthe truth.
Now, they want you to thinkthat, because then their food
(08:29):
looks as good as anybody else'sfood, but the fact of the matter
is none of those things aretrue.
We have the data to demonstratethat this is really a canard,
and it's something that the foodindustry is very specifically
doing to assuage their ownculpability in terms of the
metabolic disease pandemic thathas gone on all around the world
(08:49):
.
In fact, the goal is get theinsulin down any way you can.
Well, how do you do that?
Well, don't let the insulin goup.
Well, there are two things thatmake insulin go up.
You know what they are refinedcarbohydrate and sugar.
Also some branched chain aminoacids.
(09:12):
Leucine, of course, affectsinsulin release directly as well
, but there's something elsethat keeps insulin down, and
that is fiber.
So what we need is a lowrefined carbohydrate, low sugar,
low branched chain amino acid,high fiber diet.
Well, that's called real food,and so I am the chief medical
(09:38):
officer and also co-founder of anon-profit here in the Bay Area
called Eat Real, where we'regetting real food into K-12
public schools around thecountry very specifically to try
to lower these kids' insolencein order to mitigate their
chronic metabolic disease and,by the way, improve their grades
(09:59):
.
David Klonoff (10:00):
Robert, what kind of work have you done in the
public policy arena to get largegroups of people to be eating
healthier food Right?
Robert Lustig (10:09):
Well so for kids.
You may know, david, that thestate of California just passed
SB348, which limits the amountof added sugar in school meals
to only 5% of calories.
Eat Real was a co-sine.
On to that, along with NancySkinner, was a state legislator.
(10:30):
So that's one thing we've doneand we're hoping that will go
national.
I am working right now to try toget soda off SNAP, the
Supplementary NutritionAssistance Program, because food
stamps is a disaster.
40% of all purchases on foodstamps are soft drinks and this
(10:51):
is consumable poison.
This is a big problem and onethat the food industry does not
want to solve.
So I'm working feverishly totry to fix that problem and we
can talk offline about how we'redoing that.
There are other things thatwe're doing, but basically what
we need to do is we need to getthe food industry to understand
(11:15):
what it is that they're doing tothe food, and the best way to
do that is by example.
I've been working with a foodindustry concern offshore in the
Middle East called KuwaitiDanish Dairy Company.
This is the Nestle of theMiddle East.
They made all sorts of badstuff like flavored milks and
(11:36):
frozen yogurts and ice cream andconfectionery and biscuits and
tomato sauce and, of course,kuwaiti has an 18% diabetes rate
and an 80% obesity rate.
The company recognized theywere part of the problem and
they wanted to be part of thesolution, and so they came to me
four years ago and said we wantyou to convene a scientific
(11:59):
advisory team to advise us howto fix our food so that we can
be a metabolically healthycompany.
And we have done that.
We published what we did inFrontiers in Nutrition last
March and we are now workingwith other companies to try to
do the same thing to develop theroadmap for how companies can
(12:22):
actually change the food that'son the shelves so that people
will benefit rather than be hurtfrom.
David Kerr (12:29):
Robert, can I just?
We've done some work again withchildren and young people,
trying to educate them about thelink between food choices and
biological and psychologicalhealth, and wearable technology
seems to be at least a way intothis.
So just going back to the CGM,I mean, who do you think they
(12:51):
should be more widely available?
I mean, who should be?
Should we all be using wearinga CGM at some point to assess
our own metabolic responses?
Robert Lustig (13:01):
Right.
So there are some people whothink more information is better
, and there are some people whothink less information is better
, and you know this is one ofthose.
You know, shall we say,contempt in a teapot.
As far as I'm concerned, thebottom line is that we shouldn't
need to have to look at ourCGMs.
Okay, but we do have to becausethe environment is so polluted.
(13:24):
All right, you know, if youlived in a place with a lot of
radiation, you'd need a Geigercounter.
Well, you know, we live in aplace with an environmental
pollutant it's called sugar andso we need some method for being
able to know when we've beenexposed and when we haven't.
Now, does CGM work fornon-diabetics?
(13:47):
And the answer is it does.
It absolutely does.
But the studies to do that arein process and have not been
presented to the FDA, and so theFDA cannot in good conscience
approve them until those studiesare complete and submitted.
They are in process, I can tellyou, being an advisor to a
(14:10):
company called Levels Health,which you're probably familiar
with.
Basically, we teach people whatfood does to their health, and
you don't even have to use a CGMto know, because there are ways
to learn about it, irrespectiveof what it does to your glucose
.
But nonetheless we do take CGMdata, integrate it and then
(14:35):
disseminate it to the individualso that they can learn about
their food choices, so theywon't make the same mistake
twice.
David Kerr (14:43):
I need to ask you the political question.
Years ago we did a study wherewe demonized Coca-Cola in the UK
for children.
We actually prevented excessweight gain.
So sugar tax Is this a goodidea or a bad mistake?
Robert Lustig (14:58):
No, no, it's a great idea and we have the data.
So in Berkeley we've now hadthe soda tax available for five
years and just two months ago mycolleagues Dean Schillinger and
Chris Madsen gave grand roundsat San Francisco General on the
outcome, the metabolic outcomes,of the Berkeley soda tax.
(15:19):
We have reduced gestationaldiabetes in the city of Berkeley
by 77% since the advent of thesoda tax, as an example, and
there are other examples ofimprovement as well, but that's
the most, shall we say, glaringexample.
So no, there's no question thatthe soda tax works, but in
(15:43):
order for it to work, you haveto make it high enough to hurt.
What we've learned is it's theiron law of public health.
Reducing availability of asubstance reduces consumption,
which reduces health, harms.
The tax reduces effectiveavailability of sugar.
Robert how high is the tax inBerkeley?
(16:03):
Well, it's only 10%.
And what we've learned is thata 10% tax will reduce
consumption by 6%, and this istrue in Mexico as well.
Now, obviously, the foodindustry will say see, it didn't
work because you did a 10% taxand you'd only reduced it by 6%.
It should reduce it by 10%.
But in fact, addictivesubstances like sugar you're
(16:30):
going to see what we call pricein elasticity, that is, the
price can go up and theconsumption will only go down a
little bit, but it still goesdown and the effect is durable.
David Klonoff (16:43):
Robert, one last question I'd like to ask you is
if you could comment about a newtype of product that I heard
you're working on that will helppeople with eating less Sure.
Robert Lustig (16:55):
Well, so I don't know that they're going to be
eating less.
But I will tell you about thisproduct.
I you know full disclosure.
I am the chief medical officerof a fiber company and the fiber
is called BioLumen.
Okay, and the product is calledMonschMonsch M-O-N-C-H,
m-o-n-c-h, and your audience canfind it at MonschMonschshop.
All right, what it is is it is amicrocellulose sponge and seven
(17:23):
microns in diameter, so it'sthe size of a red blood cell.
You it's.
It's colorless, odorless,tasteless, texturless.
You can put it in a drink oryou can add it to food and you
swallow it.
It goes into your stomach.
It expands 70 fold from itsoriginal size, giving you a
(17:44):
feeling of fullness.
But that's not the main way itworks.
Inside the sponge, impregnatedinto the nooks and the crannies
of the sponge, are a series ofproprietary hydrogels, soluble
fiber.
And what those hydrogels do isthey soak up, sequester, absorb
glucose, fructose sucrose,simple starches.
(18:06):
One gram of MonschMonschsequesters six grams of
carbohydrate, rendering itunavailable for early absorption
.
That reduces the glucoseexcursion After all, the you
know, the glucose rise mattersand that reduces the insulin
excursion, thus protecting theliver and reducing the burden of
(18:29):
metabolic disease.
In addition, because it's beensequestered, the fiber moves the
, the carbohydrate, through theintestine to the lower intestine
, to the jujuna monilium, andthat's where the microbiome is.
And so the microbiome will chewit up for its purposes instead
and generate short chain fattyacids in the process.
And short chain fatty acids areanti-inflammatory,
(18:52):
anti-alzheimer's, you know,protect the lining of the gut,
basically improving inflammation.
So we are protecting the liverand feeding the gut, and we have
clinical data from two studiesone in India, one in Australia
that indeed that is exactly whatwe do and, most importantly, no
side effects.
(19:13):
Not one person in either studystopped taking it because of
problems with their GI tract.
In fact, if they had problemswith their GI tract, this made
it better.
It improved diarrhea, itimproved constipation, it
improved pain, it improvedbloating.
It's really remarkable.
(19:33):
So we hope that this is a wayto ultimately make processed
food not as much of a metabolicrisk.
What we are doing is we'retaking apple juice and turning
it back into apples in theintestine.
David Klonoff (19:49):
Well, you're really doing something about the
obesity situation, not justtalking.
Robert, thank you for being onthis podcast with us.
Thank you, I've enjoyedcatching up with what you're
doing.
We look forward to futurepodcasts and we invite listeners
to join us.
You can find the DiabetesTechnology Report on the
(20:11):
Diabetes Technology Societywebsite, and you can find this
podcast also on Spotify and atthe Apple Store.
So until the next podcast, it'sbeen a pleasure.
Bye-bye.
David Kerr (20:25):
Thank you very much.
Bye-bye, thank you.
Welcome to Diabetes Technology Report.
This is the podcast that coversdiabetes technology.
I'm David Klonoff, I'm anendocrinologist at Sutter Health
and UCSF and we have a veryeminent guest today who I've
been following for many years.
I'm going to turn the podcastover to my associate
(00:39):
endocrinologist, dr David Kerr.
David Kerr (00:42):
Thank you, david, and welcome to everyone.
It's an enormous pleasure toinvite or to hear from Dr Robert
Lustig today.
We've been following you formany years.
You're a very eminent pediatricendocrinologist, but you also
have a unique perspective onglucose and insulin and now, of
course, with the use ofcontinuous glucose monitoring.
(01:03):
Robert, why are you interested?
What sparked this interest foryou?
Robert Lustig (01:10):
Well, once upon a time I took care of short kids
and then the short kids got faton me and this entire childhood
obesity epidemic and reallypandemic occurred on my watch
and no one could understand whatwas going on and everyone just
said well, you know, they'regluttonous and sloths, they eat
(01:31):
too much, they exercise toolittle.
And of course, nobody gotbetter.
Things only got worse.
About almost 30 years ago now,I was working at St Jude
Children's Research Hospital,the cancer hospital in Memphis,
tennessee, and I had a cadre ofabout 40 children who were
(01:56):
normal weight until their braintumor and then they would
receive surgery, radiation,sometimes chemotherapy, and they
would become massively obese,30 pounds a year, ad nauseam, ad
infinitum, and this was clearlynot due to gluttony and sloth.
Something had happened to themand it was up to me to try to
(02:19):
figure out what that was.
Now I knew, because I'm aneuroendocrinologist and I knew
my basic science.
I knew that there was aconnection between the
hypothalamus and the pancreas,called the vagus nerve, and we
knew that if you lesion thehypothalamus and rats, they
became massively obese.
(02:40):
Presumably this was the animalprototype of this clinical
disease called hypothalamicobesity.
I was taken care of.
We also knew that if you cutthe vagus nerve, it didn't
happen.
So the assumption was there's amessage from the brain to the
pancreas release insulin.
Well, I'm not a surgeon, Ican't cut a vagus nerve, but I
(03:03):
can give a medicine to lowerinsulin release, and that
medicine was called octriotide,and normally it's used for
growth hormone secreting tumors,but we repurposed it for this
insulin suppression.
So we gave octriotide to thesekids and, lo and behold, they
started losing weight.
(03:23):
And not only did they loseweight, but they started
exercising spontaneously.
These were kids who sat, youknow, like lumps on a log,
eating Doritos and sleeping, andnow, all of a sudden, they're
physically active.
Like the mothers would say youknow this, I've got my kid back.
And the kids would say this isthe first time my head hasn't
(03:45):
been in the clouds since thetumor.
It was really remarkable, andso we did this at a double blind
placebo control trial.
And, lo and behold, it workedagain and I said wow, this is
really an important pathway.
Maybe this is true in general,adult obesity having nothing to
(04:06):
do with brain tumors.
So we did a pilot trial in 44adults with no brain tumor, and
eight, eight, eight out of the44 responded just like the kids
did.
Now the other 36 did not.
So the question was what wasdifferent about the eight?
And the answer was they hadinsulin dynamics just like the
(04:30):
kids Early insulin release,quick peak and then drop off.
They had what we termed insulinhypersecretion.
We gave them octretide and theylost weight too.
And then we did that in adouble blind placebo control
trial and it worked again inthose same patients.
(04:51):
So we found a subset ofpatients where the insulin was
driving the weight gain asopposed to the weight gain
driving the insulin, and thiswas very important.
But then we asked the questionwell, yeah, that's great for the
eight, what about the other 36?
They also had high insulin, butthey didn't have those same
(05:14):
insulin kinetics.
They had what we now, of course, commonly call insulin
resistance, and the question waswhat was wrong with them?
And that's where sugar came inand that's where the food supply
came in.
And now I'm realizing and Ithink the whole world is
(05:35):
realizing, that our ultraprocess food diet is the driver
of this phenomenon calledinsulin resistance, which is
then driving weight gain andchronic metabolic disease.
And it turns out insulin is itsown metabolic perturbation.
(05:55):
We always talk about glucosebeing bad for you, the glucose
spikes.
Well, the insulin spikes areequally bad for you.
The goal is to get the glucosedown and the insulin down.
Now, to do that, you have toknow what's going on with both
the glucose and the insulin.
David Kerr (06:13):
Yeah, I was really interested in hearing this
because you're also involvedwith continuous glucose
monitoring and I'm wondering ifyou see that as a beyond
measuring glucose, it's actuallytelling us something about
insulin.
Robert Lustig (06:29):
Absolutely so.
Without question, the glucoseexcursion, the change in glucose
fluctuation, is exceedinglyimportant in terms of vascular
health.
No argument, I'm completely inagreement with that.
We all know that hyperglycemiacauses retinopathy, neuropathy
(06:50):
basically all the small vesseldisease that we know about.
The point is that that'sbecause of the high glucose.
What we've learned is that highinsulin causes macrovascular
disease like, for instance,coronary arteriopathy and
(07:13):
aneurysms, and also, of course,cancer.
So you need to be able to lowerblood for glucose and the
insulin.
The good news is that yourglucose excursion is a proxy for
your insulin excursion too, soyou can learn about both when
you know what the glucose isdoing in real time.
(07:34):
And that's why, even though Idon't take care of diabetic
patients anymore because Iretired, I'm still very
interested in continuous glucosemonitoring as a proxy for
insulin dynamics.
David Klonoff (07:51):
Robert, I'd like to ask you about some of the
work you've done about which arehealthy and which are unhealthy
foods to eat.
Do you think that every calorieis equal, and are there certain
foods you think areparticularly unhealthy and
should be avoided?
Robert Lustig (08:07):
Right.
So you know, the food industrywill tell you a calorie is a
calorie, a sugar is a sugar, afat is a fat, a protein is a
protein and the fiber is a fiber.
Nothing could be further fromthe truth.
Now, they want you to thinkthat, because then their food
(08:29):
looks as good as anybody else'sfood, but the fact of the matter
is none of those things aretrue.
We have the data to demonstratethat this is really a canard,
and it's something that the foodindustry is very specifically
doing to assuage their ownculpability in terms of the
metabolic disease pandemic thathas gone on all around the world
(08:49):
.
In fact, the goal is get theinsulin down any way you can.
Well, how do you do that?
Well, don't let the insulin goup.
Well, there are two things thatmake insulin go up.
You know what they are refinedcarbohydrate and sugar.
Also some branched chain aminoacids.
(09:12):
Leucine, of course, affectsinsulin release directly as well
, but there's something elsethat keeps insulin down, and
that is fiber.
So what we need is a lowrefined carbohydrate, low sugar,
low branched chain amino acid,high fiber diet.
Well, that's called real food,and so I am the chief medical
(09:38):
officer and also co-founder of anon-profit here in the Bay Area
called Eat Real, where we'regetting real food into K-12
public schools around thecountry very specifically to try
to lower these kids' insolencein order to mitigate their
chronic metabolic disease and,by the way, improve their grades
(09:59):
.
David Klonoff (10:00):
Robert, what kind of work have you done in the
public policy arena to get largegroups of people to be eating
healthier food Right?
Robert Lustig (10:09):
Well so for kids.
You may know, david, that thestate of California just passed
SB348, which limits the amountof added sugar in school meals
to only 5% of calories.
Eat Real was a co-sine.
On to that, along with NancySkinner, was a state legislator.
(10:30):
So that's one thing we've doneand we're hoping that will go
national.
I am working right now to try toget soda off SNAP, the
Supplementary NutritionAssistance Program, because food
stamps is a disaster.
40% of all purchases on foodstamps are soft drinks and this
(10:51):
is consumable poison.
This is a big problem and onethat the food industry does not
want to solve.
So I'm working feverishly totry to fix that problem and we
can talk offline about how we'redoing that.
There are other things thatwe're doing, but basically what
we need to do is we need to getthe food industry to understand
(11:15):
what it is that they're doing tothe food, and the best way to
do that is by example.
I've been working with a foodindustry concern offshore in the
Middle East called KuwaitiDanish Dairy Company.
This is the Nestle of theMiddle East.
They made all sorts of badstuff like flavored milks and
(11:36):
frozen yogurts and ice cream andconfectionery and biscuits and
tomato sauce and, of course,kuwaiti has an 18% diabetes rate
and an 80% obesity rate.
The company recognized theywere part of the problem and
they wanted to be part of thesolution, and so they came to me
four years ago and said we wantyou to convene a scientific
(11:59):
advisory team to advise us howto fix our food so that we can
be a metabolically healthycompany.
And we have done that.
We published what we did inFrontiers in Nutrition last
March and we are now workingwith other companies to try to
do the same thing to develop theroadmap for how companies can
(12:22):
actually change the food that'son the shelves so that people
will benefit rather than be hurtfrom.
David Kerr (12:29):
Robert, can I just?
We've done some work again withchildren and young people,
trying to educate them about thelink between food choices and
biological and psychologicalhealth, and wearable technology
seems to be at least a way intothis.
So just going back to the CGM,I mean, who do you think they
(12:51):
should be more widely available?
I mean, who should be?
Should we all be using wearinga CGM at some point to assess
our own metabolic responses?
Robert Lustig (13:01):
Right.
So there are some people whothink more information is better
, and there are some people whothink less information is better
, and you know this is one ofthose.
You know, shall we say,contempt in a teapot.
As far as I'm concerned, thebottom line is that we shouldn't
need to have to look at ourCGMs.
Okay, but we do have to becausethe environment is so polluted.
(13:24):
All right, you know, if youlived in a place with a lot of
radiation, you'd need a Geigercounter.
Well, you know, we live in aplace with an environmental
pollutant it's called sugar andso we need some method for being
able to know when we've beenexposed and when we haven't.
Now, does CGM work fornon-diabetics?
(13:47):
And the answer is it does.
It absolutely does.
But the studies to do that arein process and have not been
presented to the FDA, and so theFDA cannot in good conscience
approve them until those studiesare complete and submitted.
They are in process, I can tellyou, being an advisor to a
(14:10):
company called Levels Health,which you're probably familiar
with.
Basically, we teach people whatfood does to their health, and
you don't even have to use a CGMto know, because there are ways
to learn about it, irrespectiveof what it does to your glucose
.
But nonetheless we do take CGMdata, integrate it and then
(14:35):
disseminate it to the individualso that they can learn about
their food choices, so theywon't make the same mistake
twice.
David Kerr (14:43):
I need to ask you the political question.
Years ago we did a study wherewe demonized Coca-Cola in the UK
for children.
We actually prevented excessweight gain.
So sugar tax Is this a goodidea or a bad mistake?
Robert Lustig (14:58):
No, no, it's a great idea and we have the data.
So in Berkeley we've now hadthe soda tax available for five
years and just two months ago mycolleagues Dean Schillinger and
Chris Madsen gave grand roundsat San Francisco General on the
outcome, the metabolic outcomes,of the Berkeley soda tax.
(15:19):
We have reduced gestationaldiabetes in the city of Berkeley
by 77% since the advent of thesoda tax, as an example, and
there are other examples ofimprovement as well, but that's
the most, shall we say, glaringexample.
So no, there's no question thatthe soda tax works, but in
(15:43):
order for it to work, you haveto make it high enough to hurt.
What we've learned is it's theiron law of public health.
Reducing availability of asubstance reduces consumption,
which reduces health, harms.
The tax reduces effectiveavailability of sugar.
Robert how high is the tax inBerkeley?
(16:03):
Well, it's only 10%.
And what we've learned is thata 10% tax will reduce
consumption by 6%, and this istrue in Mexico as well.
Now, obviously, the foodindustry will say see, it didn't
work because you did a 10% taxand you'd only reduced it by 6%.
It should reduce it by 10%.
But in fact, addictivesubstances like sugar you're
(16:30):
going to see what we call pricein elasticity, that is, the
price can go up and theconsumption will only go down a
little bit, but it still goesdown and the effect is durable.
David Klonoff (16:43):
Robert, one last question I'd like to ask you is
if you could comment about a newtype of product that I heard
you're working on that will helppeople with eating less Sure.
Robert Lustig (16:55):
Well, so I don't know that they're going to be
eating less.
But I will tell you about thisproduct.
I you know full disclosure.
I am the chief medical officerof a fiber company and the fiber
is called BioLumen.
Okay, and the product is calledMonschMonsch M-O-N-C-H,
m-o-n-c-h, and your audience canfind it at MonschMonschshop.
All right, what it is is it is amicrocellulose sponge and seven
(17:23):
microns in diameter, so it'sthe size of a red blood cell.
You it's.
It's colorless, odorless,tasteless, texturless.
You can put it in a drink oryou can add it to food and you
swallow it.
It goes into your stomach.
It expands 70 fold from itsoriginal size, giving you a
(17:44):
feeling of fullness.
But that's not the main way itworks.
Inside the sponge, impregnatedinto the nooks and the crannies
of the sponge, are a series ofproprietary hydrogels, soluble
fiber.
And what those hydrogels do isthey soak up, sequester, absorb
glucose, fructose sucrose,simple starches.
(18:06):
One gram of MonschMonschsequesters six grams of
carbohydrate, rendering itunavailable for early absorption
.
That reduces the glucoseexcursion After all, the you
know, the glucose rise mattersand that reduces the insulin
excursion, thus protecting theliver and reducing the burden of
(18:29):
metabolic disease.
In addition, because it's beensequestered, the fiber moves the
, the carbohydrate, through theintestine to the lower intestine
, to the jujuna monilium, andthat's where the microbiome is.
And so the microbiome will chewit up for its purposes instead
and generate short chain fattyacids in the process.
And short chain fatty acids areanti-inflammatory,
(18:52):
anti-alzheimer's, you know,protect the lining of the gut,
basically improving inflammation.
So we are protecting the liverand feeding the gut, and we have
clinical data from two studiesone in India, one in Australia
that indeed that is exactly whatwe do and, most importantly, no
side effects.
(19:13):
Not one person in either studystopped taking it because of
problems with their GI tract.
In fact, if they had problemswith their GI tract, this made
it better.
It improved diarrhea, itimproved constipation, it
improved pain, it improvedbloating.
It's really remarkable.
(19:33):
So we hope that this is a wayto ultimately make processed
food not as much of a metabolicrisk.
What we are doing is we'retaking apple juice and turning
it back into apples in theintestine.
David Klonoff (19:49):
Well, you're really doing something about the
obesity situation, not justtalking.
Robert, thank you for being onthis podcast with us.
Thank you, I've enjoyedcatching up with what you're
doing.
We look forward to futurepodcasts and we invite listeners
to join us.
You can find the DiabetesTechnology Report on the
(20:11):
Diabetes Technology Societywebsite, and you can find this
podcast also on Spotify and atthe Apple Store.
So until the next podcast, it'sbeen a pleasure.
Bye-bye.
David Kerr (20:25):
Thank you very much.
Bye-bye, thank you.
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