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Metabolical Book Summary

Metabolical Book Summary – Robert H. Lustig MD

What you will learn from reading Metabolical:

The Impact of Processed Foods: showing their role in chronic diseases and obesity due to high sugar, salt, and unhealthy fat content.

– Industry Practices and Misinformation: The book exposes misleading practices of the food industry, including deceptive labeling and marketing strategies.

– Importance of Whole Foods: why whole foods and nutrient-rich diets, free from processed additives, are crucial for maintaining optimal health and preventing chronic diseases.


How food has become poison:

Food writer Mark Bittman has made a striking observation, stating that according to the definition of food as “a substance that provides nutrition and promotes growth,” much of what is produced by industrial agriculture can be considered poison rather than food. While pesticides are often associated with food toxicity, they represent just the tip of the iceberg, accounting for only about 10 percent of the issue. The remaining 90 percent is attributed to the processing procedures that have transformed what was once food into a slow-acting poison.

Understanding the alchemy of how food itself has become toxic is crucial in comprehending the current state of our food system and its impact on our health. This book delves into the intricacies of how food has been processed and transformed, shedding light on the fact that it’s not just what’s in the food that matters, but rather what has been done to the food. By unraveling this reality, we can gain a deeper understanding of the challenges our food system faces and the consequences it has for our health and well-being.


The difference between nutrition and food science:

Nutrition and food science are distinct but interconnected fields. While nutrition focuses on the changes that occur to food from the moment it enters the mouth until it reaches the cells in our body, food science encompasses the various processes that take place from the ground to the mouth. Both are interdependent, yet often misunderstood by the general public due to their complexity.

Unfortunately, food processing, which plays a significant role in shaping the nutritional quality of our food, is not adequately disclosed on food labels. The Nutrition Facts label primarily provides information on the composition of the food, which may not reveal the full story. What truly matters is understanding the extent of food processing and modifications that have been done to the food, and this crucial information is often not included in food labels, leaving consumers in the dark about the true nature of their food.


The scope of the book:

This book delves into the intricate web of connections between various aspects of our lives: from food to biochemistry, biochemistry to disease, disease to medicine, medicine to demographics, demographics to economy, economy to agriculture, agriculture to climate, climate to the planet, and back to food once again.

Through these interrelated factors, two undeniable truths come to light. Firstly, the changes in food processing that started several decades ago have triggered a downward spiral of declining health, economic challenges, and environmental degradation, with the impact becoming more pronounced over time and exacerbated by the disparities highlighted by the COVID-19 pandemic.

Secondly, in today’s society, food holds a unique and immediate potential for creating positive change. Neglecting to address the role of food in our lives would only perpetuate the rise of chronic diseases and premature deaths, and contribute to societal and planetary crises. Fixing our food systems is a crucial step towards a healthier, more sustainable future.


There are two keys to understanding the breakdown of our health and healthcare model.

The first key is that the medical establishment doesn’t openly share is that their drugs are not designed to treat chronic diseases, but merely to alleviate the symptoms associated with them.

The second key revelation is one that the food industry would rather keep hidden: all food is inherently beneficial, but it is the processing and alteration of food that can have negative effects on our health.

In the past, our guts were populated with beneficial bacteria that thrived on fibre-rich foods and contributed to our overall well-being. However, modern food processing has stripped much of the fibre from our diets, leaving these bacteria starving and leading to them devouring the protective mucin barrier on our intestinal cells. This, in turn, sets the stage for inflammation and the dreaded leaky gut syndrome.

Michael Pollan’s seven words for healthy eating can be re-stipulated into these six words: 1) protect the liver, 2) feed the gut.


The immoral Hazard:

For years, the healthcare field has grappled with the concept of moral hazard, which refers to a situation where the one responsible profits from the suffering of the victim, akin to an economic form of schadenfreude.

However, Robert Lustig, realised that the issue was much more pervasive. He introduced a new term – “immoral hazard” – to describe a situation where the perpetrator intentionally manipulates the system to generate profits, fully aware that the victim will suffer as a result.

The term “Metabolical” is a combination of “metabolic,” which pertains to the inner workings of the body, and “diabolical,” which refers to the sinister workings of the food industry, pharmaceutical companies, and government agencies. Despite their claims of being on your side, these entities are primarily concerned with their own interests, and you, as the victim, are often subject to their propaganda.Part I Debunking “Modern Medicine”


Chapter 1 “Treatment” Is Not “Cure”—It’s Not Even Treatment

When faced with a wasp buzzing around your attic, you have two options: kill the wasp or get rid of the wasp’s nest. The latter approach involves working upstream of the problem, addressing the root cause, while the former only provides a temporary solution to the immediate symptom. Similarly, in healthcare, we have been predominantly working downstream, focusing on treating the symptoms of diseases rather than addressing the underlying causes.


Modern Medicine Is Not the Solution to the Problem, Modern Medicine Is the Problem

It is commonly accepted that Modern Medicine is focused on maintaining people’s health. The prevailing belief is that people today are living longer than those a century ago, and since healthy individuals tend to live longer, it is assumed that people today are healthier. However, is this assumption accurate?

Data shows that patients with five or more chronic conditions spend significantly more on health services, as much as fourteen times more, compared to those with no chronic conditions. Despite this fact, the debate around the merits of Medicare for All continues.

The crux of the issue is that Modern Medicine aims to fix healthcare, but fails to address the root cause of poor health, which is often related to diet and nutrition. While there is a lot of talk about healthcare, there is limited focus on improving health, and hardly any attention given to the role of food in health.

It is important to note that Modern Medicine excels in screening, diagnostics, and treatment. However, it falls short in preventing or reversing non-communicable diseases (NCDs), leading to a decline in overall health. As a result, more people are living longer but not necessarily healthier, leading to increased healthcare costs in the United States.

Efforts to improve medical resource allocation or efficiency miss the point, as they primarily focus on treatment after the fact. The key to truly addressing health issues lies in addressing the underlying causes, including nutrition and lifestyle factors, to prevent and reverse chronic diseases, rather than simply treating their symptoms.


Chapter 2 “Modern Medicine” Treats Symptoms, Not Disease

Insulin 101

We all need insulin—it’s the hormone that allows glucose (your body’s primary source of fuel) to enter the cells of your body so it can be burned. But insulin resistance occurs when the cells in your muscles, fat, and liver no longer respond to the insulin signal. The glucose can’t get in—the cells are starving—so they send signals to the pancreas to crank out even more, but to no avail.

The glucose builds up in your blood at the same time that your cells are starving, adding insult to injury. You’ll see that it’s this condition that is the underlying cause of most of our troubles. Insulin resistance is the primary defect in metabolic syndrome, the cluster of NCDs. Insulin resistance manifests itself in a myriad of tissues and ways, which may vary from person to person.


Obesity Is a “Red Herring”

Obesity is like a red herring, a clue that distracts from the real issue. While doctors often target obesity as the problem, it is actually just another symptom, not the root cause of metabolic dysfunction.

Contrary to common belief, it’s not always that you gain weight and then get sick. In fact, 80 percent of the time, it’s the other way around. People often get sick first, such as having metabolic syndrome, which then leads to insulin resistance and high insulin levels, resulting in weight gain. This means that weight gain can be a biomarker for metabolic dysfunction, rather than the cause of it.

Metabolic syndrome is the improper storage of energy in cells that are not supposed to store it. Only three types of cells in the body are meant to store excess energy: subcutaneous adipose tissue (i.e., stored in the buttocks), visceral adipose tissue (i.e., stored in the belly), and muscle and liver tissue (which store excess energy as glycogen). When energy is stored in the wrong form in other cells, it can lead to metabolic dysfunction and related health issues.

It’s important to shift the focus from targeting obesity as the problem to addressing the underlying metabolic dysfunction. By understanding the true causes of metabolic syndrome and related health issues, we can develop more effective strategies for prevention and treatment, and improve overall health outcomes.



Cholesterol is an essential component of cell membranes and serves as a precursor for steroid hormones, making it crucial for our survival. Even if you don’t consume cholesterol through your diet, your body will produce it because of its importance.

Let’s focus on low-density lipoprotein cholesterol (LDL-C), often labeled as the “bad” cholesterol and considered a classic biomarker for the risk of future heart attacks. Clinicians often prescribe statins, which inhibit cholesterol synthesis, to treat high LDL-C levels. This approach is based on the current mindset among clinicians, which emphasises reducing LDL-C levels through low-fat diets and medications.

While it is true that the number of deaths due to heart attacks has decreased in high-income countries like the US (although low-income countries still face high mortality rates), this statistic does not paint the whole picture. More people are actually experiencing heart attacks, even though fewer are dying from them.

Through this approach, we have learned that targeting LDL-C with statins may not address the root cause of the problem. Statins primarily reduce the harmless type A large buoyant LDL, while leaving the problematic type B small dense LDL unaffected. This is significant because small dense LDL-C is associated with insulin resistance and metabolic dysfunction, indicating that the focus should be on addressing these underlying issues.

In fact, the number one risk factor for heart disease is not LDL-C, but rather insulin resistance, which is often linked to metabolic syndrome. Triglyceride levels, rather than LDL-C, may be a more accurate biomarker for assessing this risk. This challenges the conventional approach of solely focusing on LDL-C and underscores the importance of addressing insulin resistance and metabolic dysfunction in the prevention and management of heart disease.


The Blood Pressure Blow-out

High blood pressure, or hypertension, is universally recognised as detrimental to health. When a blood pressure cuff is strapped on at the doctor’s office, it measures how effectively the heart is pumping blood and supplying the body’s organs and tissues.

There are two numbers that convey this information: systolic blood pressure, which is the first number and indicates the pressure exerted by blood against artery walls when the heart beats; and diastolic blood pressure, the second number, which indicates the pressure exerted by blood against artery walls while the heart is resting between beats.

Over the years, the definition of hypertension has evolved. In the past, about fifty years ago, a diagnosis of hypertension was made when the systolic blood pressure was 100 plus the patient’s age. For example, a systolic blood pressure of 140 was considered hypertensive for a forty-year-old. However, this threshold has been gradually lowered, with the American Heart Association recently recommending a systolic blood pressure threshold of 125 instead of 130. This change has been influenced by the increasing availability of hypertension treatments in the market and advocacy by the pharmaceutical industry to prescribe more medications to more people.


Blood Glucose—Dude, Are You High?

Insulin has two actions in cells: 1) metabolic (lowers glucose, stores energy); and 2) cell proliferation (meaning growth and division). Every insulin molecule your pancreas makes is both good and bad for you, all at the same time—short-term gain (blood-glucose lowering) for long-term pain (vascular dysfunction and cancer).

The point is that high blood glucose is the symptom of the disease, not the disease itself. Yet blood glucose has become so important to Modern Medicine (because we can measure it!) that even some non-diabetics are now walking around with continuous glucose monitors (CGMs) attached to their arms, in an effort to lower their glucose excursions and therefore improve their metabolic control.

Glucose levels are a poor man’s proxy for insulin levels, and not a very good one. The costs to the system of worrying about high blood glucose instead of high blood insulin aren’t insignificant.


Chapter 3 Doctors Need to “Unlearn” Nutrition

Does Science Advance “One Funeral at a Time”? This offhand comment made by German physicist Max Planck at the turn of the twentieth century was based on his observation that scientists are like mafiosi—they exert a stranglehold on their fields, preventing new ideas from percolating to the surface and, like Don Corleone, you had to wait for them to die in order for science to move forward.


Conflict or Confluence of Interest?

There is another group of thinkers who seem unwilling to change their views, as their financial interests are at stake. This seems to be particularly prevalent in the field of nutrition.

In the United States, there are numerous academic medical societies, many of which overlap in their areas of focus, and all of which have political implications. Take diabetes, for example. There are multiple organisations claiming authority in this area, including the Endocrine Society, Pediatric Endocrine Society, Juvenile Diabetes Research Foundation, American Association of Clinical Endocrinology, Diabetes Technology Society, and the influential American Diabetes Association (ADA).

These societies claim to issue clinical guidelines to establish and maintain “standards of care” within the medical profession. However, one might question whether their true motive is to maintain control over the narrative and discourse.

Why do the ADA and Diabetes UK deny that sugar causes diabetes, while the International Diabetes Federation (IDF) advocates for taxing sugar to prevent type 2 diabetes? Perhaps it’s because many of the IDF’s member countries are economically disadvantaged and cannot afford the costs associated with storing and administering insulin. As a result, they prioritize disease prevention by addressing food choices. However, implementing similar changes in the US, UK, and Australia would require the acknowledgment that they have been wrong for decades. It may be easier for them to prescribe medications and dismiss critics.

The ADA ranks #100 in terms of profitable charities, with annual revenues of $182 million, 40 percent of which comes from pharmaceutical corporate donations. Interestingly, during the period from 2002 to 2013, when the ADA declared diabetes as a treatable disease with medications, thereby expanding the market, the cost of insulin tripled. One may question whether a nonprofit organisation dedicated to eradicating a disease would truly want that disease to be eradicated.

Despite evidence suggesting that type 2 diabetes can be prevented and treated through sugar restriction, the diabetes associations in the US, UK, and Australia refuse to acknowledge this approach and instead prefer to rely on prescription medications. Could it be because preventing diabetes would impact their financial interests and potentially put them out of business?


What holds clinicians back?

What prevents clinicians from advocating for what’s best for their patients when they know the truth?

The first obstacle is that doctors tend to be narrow-minded, relying mostly on information from other doctors through journal articles, clinical meetings, and webinars. Unfortunately, many of these avenues are sponsored by Big Pharma to promote their products, as you can easily verify by checking the funding sources of satellite events at conferences like the ADA.

The second challenge is that doctors are often followers, conforming to the practices of their peers. This is driven, in part, by the fear of receiving poor evaluations on platforms like Healthgrade if they deviate from established medical guidelines.

The third hurdle is that many doctors do not listen to their patients. Instead, they do most of the talking, partly due to the constraints imposed by insurance companies, which limit patient appointments to a mere ten minutes. As a result, clinicians tend to quickly arrive at a provisional diagnosis and prescribe the most convenient and expedient treatment, whether or not it is truly the most effective option, with their hand already on the doorknob to move on to the next patient.


Nutritional “Know-Nothings”

Only 28 percent of medical schools currently offer a formal nutrition curriculum, which is even fewer than in 1977 when Congress mandated the inclusion of more nutrition science in medical education as part of the Dietary Guidelines.

The primary focus of medical school education is on treatment methods such as drugs, devices, and surgery, as these tend to generate profits for physicians, Big Pharma, and Med-Tech. In fact, many medical schools rely on funding from pharmaceutical companies to cover their operating costs.

Unfortunately, patients often disregard medical advice, even when it pertains to their own health and longevity. Many struggle to make dietary or lifestyle changes, even when recommended by their doctors. Research conducted by Stanford nutritionist Christopher Gardner revealed that most dietary interventions tend to regress to the mean, with subjects returning to their previous eating habits within just two months of the intervention.

Compounding the issue, there has been limited funding for nutrition research, leading Big Food companies to step in and conduct their own studies. However, these studies are often biased and more likely to support their own products, resulting in a pollution of professional journals with research that can be used to challenge the validity of established nutritional principles as “unsettled science.”


Who’s on the Hot Seat?

A troubling aspect of the medical field is when professionals who think outside the traditional box are unfairly treated as criminals by their own community.

Some doctors have faced charges and accusations for providing “medical advice” on platforms such as radio or lectures, especially in relation to low-carb, high-fat (LCHF)/ketogenic diets. These charges are often brought forth by the dietetics board of each country, without any solid evidence or alleged victims of the supposed “dangerous” medical advice coming forward.

The fact is, there is mounting evidence that sugar and processed foods are major drivers of obesity, heart disease, stroke, diabetes, fatty liver disease, and potentially even cancer and dementia. Furthermore, low-carbohydrate diets have shown promise in reversing these diseases in some cases. Despite this evidence, the medical establishment often resists reeducation and instead chooses to prosecute those who dare to challenge the status quo.


Chapter 4 Dietitians Lost Their Mind

Dieticians have long relied on the notion that a patient’s food intake can be calculated using a simple arithmetic approach. However, the reality is that our bodies are far more complex. The Atwater equation, which has been commonly used to estimate caloric intake, fails to take into account the role of the intestinal microbiome, which metabolises approximately 25 to 30 percent of the food we eat, as well as the impact of dietary fibre on this process.

Fibre, while not contributing any calories to the total, can significantly alter the percentage of calories absorbed, resulting in a discrepancy between the number of calories eaten versus the number metabolised.

In 1921, the discovery of insulin was a breakthrough for diabetes treatment, as it allowed for carbohydrates to be reintroduced into the diet of diabetics and made treatment easier. However, it also shifted the focus from prevention to treatment, and the high-fat paradigm for managing diabetes was largely abandoned (until much later).

One thing that can be stated unequivocally is that despite the undeniable decline in American health over the past fifty years, the message from organisations such as the Academy of Nutrition and Dietetics (AND) has remained largely unchanged for the past hundred years. Instead of addressing systemic issues, the blame is often shifted onto patients, with claims of noncompliance with medical and dietary advice by the entire healthcare establishment.


Chapter 5 Dentists Lost Their Way

Dental caries, or tooth decay, is a relatively recent phenomenon in human history. Our ancestors did not brush their teeth, yet they had minimal cases of dental caries. Analysis of fossils from the Paleolithic era reveals that tooth mineralization was generally healthy, with only occasional issues of dental alignment, and dental caries were rare.

In the past, the human mouth harboured a diverse array of bacterial species that contributed to overall bacterial diversity. However, with the advent of the Industrial Revolution, this diversity has significantly diminished, and new bacteria, previously considered “alien,” have colonised the oral environment. Among these, Streptococcus mutans, a particularly troublesome species of bacteria, has emerged as a prime suspect in the development of dental caries. This bacterium is known to be a major producer of lactic acid, which demineralises teeth and leads to the formation of cavities. While other factors may also contribute to dental caries, Streptococcus mutans is believed to play a significant role in this modern dental problem.


Carbohydrates and dental health:

Carbohydrates are often assumed to be a primary driver of dental caries, even by dentists. However, this assumption can be misleading and misses the point. Despite our ancestors consuming carbohydrates in large quantities as foragers and gatherers, they did not develop dental caries.

There are three forms of digestible carbohydrates: monosaccharides (single sugar molecules such as glucose, fructose, or galactose), disaccharides (two sugar molecules bound together such as maltose, sucrose, and lactose), and starch (a string of glucose molecules polymerised together). However, only monosaccharides and disaccharides can cause dental caries.

The reason behind this is that oral bacteria can only metabolise “fermentable” carbohydrates, which are single free molecules. This is particularly relevant in sugared beverages, where glucose and fructose are not bound and are readily available to bacteria.

In contrast, starch, being polymerised, is not immediately fermentable by bacteria. In fact, it can contribute to the biofilm surrounding the tooth, providing a protective effect against dental caries. This highlights that not all carbohydrates are equal when it comes to their impact on dental health.


The discovery of Fluoride

Team Tooth discovered that a simple compound, sodium fluoride, at a low concentration of 0.1 parts per million, could inhibit the formation of dental caries.

As a result, the government stepped in and fluoride began to be added to drinking water worldwide, resulting in a significant reduction in the prevalence rate of dental caries. This was considered a major victory for public health.

However, this development also had unintended consequences. Dentists began to express concerns, lamenting, “If we eliminate dental caries, who will fill our chairs?” Preventing caries became a public health issue for countries, but promoting caries became an economic issue for dentists and Big Business. This led to the proliferation of toothpastes, mouthwashes, dental x-rays, and sealants, all marketed to promote dental health.

Slowly but surely, many dentists moved away from Weston Price’s original anti-sugar stance, and an increasing number of them started offering lollipops to children after their exams. This shift reflected the changing landscape of dentistry, where economic interests and marketing strategies began to influence practices, despite the significant strides made in caries prevention through the use of fluoride.


The problems with Fluoride:

The dental profession has heavily relied on fluoride and is unlikely to relinquish it easily. However, there has been a recent wave of public dissent and distrust regarding fluoride across the country.

There are various pseudo-reasons cited by those advocating for the removal of fluoride. Some believe that it benefits the sugar lobby by allowing people to consume more sweets without developing cavities, while others think that health officials are hesitant to discontinue fluoridation after supporting it for decades. There are even conspiracy theorists who claim that fluoride is part of a Soviet plot for mind control.

However, it’s important to note that the effect of fluoride is relatively small, and correlation does not imply causation. As someone who is not an expert on fluoride, Lustig remains agnostic on the issue. What he does know is that while fluoride is a proven adjunct to prevention, it is not a standalone solution for primary prevention. If it were, the dental profession would have achieved more than a 50 percent reduction in caries.

The positive news is that dentists are now returning to the anti-sugar stance, as they feel supported by the medical profession, which is increasingly demonstrating the metabolic and cardiovascular risks associated with sugar toxicity. This has led to a resurgence of awareness and advocacy against sugar consumption within the dental community.


Chapter 6 Because Big Pharma Was Their Teacher

The birth of Big Pharma:

The Flexner Report is widely regarded by medical experts as a turning point in the evolution of evidence-based medicine. In the 19th century, medical practices in the United States were unregulated, with snake oil salesmen peddling dubious remedies, and cocaine and heroin available without prescription. Medical schools had varying curricula and lacked standardisation.

In 1897, Frederick Gates, an avid reader, came across Osler’s book “The Principles and Practice of Medicine” and recognised the chaos in the American medical profession. He believed that American medicine needed the same kind of discipline that Rockefeller brought to Standard Oil, and urged Rockefeller to fund the establishment of a medical institute in his name.

Rockefeller saw an opportunity in coal tar, a by-product of coal mining and oil refining, which was used by medical practitioners at that time to treat skin diseases. He founded the Rockefeller Institute to conduct medical research, as long as it focused on the benefits of coal tar, to create a mass market for his product.

By the early 1900s, the pharmaceutical industry had emerged, with drugs such as aspirin, salvarsan (used for syphilis), and novocaine. Rockefeller recognised this as a new opportunity, but realised that American physicians were not familiar with these new pharmaceuticals due to gaps in their medical education. He initiated a project to evaluate and revamp the American medical school system to prioritise medical research and drug therapy, with the American Medical Association (AMA) becoming the regulatory body for medical education.

In 1910, Flexner published his Flexner Report, which criticised American medical education for its lack of evidence-based medicine, a critique that is echoed even today. He advocated for comprehensive reforms in medical training. Flexner was skeptical of any medicine that wasn’t based on research, dismissing them as quackery, although some of it was indeed questionable.

Notably, nutrition was overlooked in the new medical curriculum, as neither of the Flexner brothers saw it as profitable. The Flexner Report caused controversy, resulting in the closure of many rural medical schools and complementary and alternative therapy schools.

Rockefeller, Pritchett, and the AMA presented the Flexner Report to Congress in 1911, and it was adopted without changes. However, the report has never been updated since then. It aligned with Flexner’s, the AMA’s, and Johns Hopkins’s ambitions to establish preeminence among American medical schools, as well as the nascent pharmaceutical industry’s objectives, including those of Rockefeller.


Big Pharma on the Rampage

The marketing budget of every major pharmaceutical company surpasses its research and development (R&D) budget. In fact, some companies, like Johnson & Johnson, allocate double the amount of their R&D budget for marketing purposes.

The underlying business strategy of Big Pharma revolves around maximising profits by generating multiple products from a single drug. This is achieved through various means such as creating minor variations of the drug to extend its patent life, employing clinical trial administration and research publication, engaging in regulatory lobbying, conducting physician and patient education, setting drug pricing, and utilising advertising and point-of-use promotion to establish unique marketing profiles and foster brand loyalty among similar products. This approach is adopted to counter the lower cost of generic drugs. By making slight modifications to the ingredient list, they can obtain additional time for patent protection.


Polypharmacy Kills People

In the United States, individuals aged sixty-five and above make up 16 percent of the population and account for one-third of all prescription drug consumption. Shockingly, 20 percent of seniors in this age group are taking five or more medications. Similarly, in the United Kingdom, this age group constitutes 18 percent of the population and consumes nearly 45 percent of all prescription drugs.

Numerous prospective studies on this subject, though mostly limited in scope to specific regions, have arrived at a damning conclusion: polypharmacy, defined as the use of five or more prescription drugs daily, is linked to an increased risk of mortality. Notably, this risk is not solely attributable to age. In fact, prescription medications are currently the third leading cause of death.

While doctors are trained to prescribe medications in medical school and serve as the primary prescribers, they are also targeted by Big Pharma’s educational campaigns. At present, a staggering 70 percent of the U.S. population is taking at least one prescribed medication. Does this imply that 70 percent of the population is unwell? Surprisingly, yes. In reality, it is estimated that 88 percent of the population suffers from metabolic illnesses. However, does that necessarily mean that medication is the only solution?

According to Big Pharma, the answer is a resounding yes. Since the government’s withdrawal from medical research, the pharmaceutical industry has gained significant influence and freedom to operate.


Who funds medical research?

Most government and university-backed clinical research has been significantly reduced, leaving a gap that Big Pharma has exploited to prioritize profits over public health. However, the reliability of Big Pharma’s own research reports is highly questionable. A meta-analysis conducted by the Cochrane Institute revealed that studies sponsored by Big Pharma often had less transparency, disregarded methodological limitations, and drew more favorable conclusions compared to independently funded studies evaluating the same drugs.

In recent years, Big Pharma has primarily focused on extending the lives of chronically ill patients, such as those with cancer or diabetes, to maximize profits. The lack of governmental regulation has allowed drug prices to skyrocket, with some medicines that have been around for decades tripling in price within a decade.

Big Pharma relies heavily on doctors to prescribe their drugs, as only a small portion of their profits come from over-the-counter medications. To maintain this relationship, Big Pharma exerts control over medical school curricula by providing funding and resources. This perpetuates a vicious cycle where doctors are trained to prioritize treatment over prevention or cure, due to the influence of Big Pharma in medical education.

In summary, Big Pharma’s influence on clinical research, pricing of medications, and medical education has resulted in a symbiotic yet uneasy relationship with doctors, where profits often take precedence over public health.


Disease A Plus Treatment B Still Equals Death

Medicines are essentially selective toxins that target specific pathways in the body, poisoning them to achieve their intended effects. The success of antibiotics in the 1950s, which targeted bacteria without harming human cells, led to the growth of the pharmaceutical industry and the eradication of many acute infectious diseases.

However, when it comes to chronic conditions, the dysfunctional pathways are often within human cells, particularly in the mitochondria, which are responsible for energy metabolism. Unfortunately, there are no medications that can effectively target and fix mitochondrial issues. In fact, the use of antibiotics for acute infections may have disrupted the balance of bacteria in the gut, leading to the emergence of new and resistant bacteria.

By focusing solely on alleviating the symptoms of diseases, the pharmaceutical industry has created a false sense of security for patients, without addressing the underlying causes. There is no quick fix or pill to address the root causes of chronic conditions.

Big Pharma, as discussed in this book, is the first of the three immoral hazards outlined, as it contributes to the problem and profits from the misfortunes of others.


Part II Debunking “Chronic Disease”

Chapter 7 The “Diseases” That Aren’t Diseases

Diseases tend to have difficult medical-technical names that no mere mortal can pronounce, so they’re often assigned more manageable monikers, based on the name of the doctor who first described it (e.g., Alzheimer’s disease), or its most famous patient (e.g., Lou Gehrig’s disease). Sometimes it’s even based on the country of origin (e.g., Jamaican vomiting sickness), on the tissue of interest (e.g., foot-and-mouth disease, polycystic ovarian syndrome), or on the symptoms expressed (e.g., fibromyalgia).

Metabolic dysfunction, often referred to as the “disease without a name,” involves the impairment of eight intracellular processes in the body, including those in the brain. These processes are not independent and can interact with each other, leading to various outcomes.

When these processes are functioning properly, they can work in your favour, allowing you to live a long and healthy life. However, when they go awry, they can have detrimental effects, resulting in disabilities, depression, kidney failure, or premature death. Moreover, these processes often do not occur in isolation, but rather cluster together, exacerbating their impact on overall health.


Cell Bio 101

To explain these eight sub-cellular pathologies, I first have to explain a cell and its contents. That means an ultra-short course in cell biology. For this exercise, I’ll limit the syllabus to energy metabolism only, which is the root of all eight sub-cellular pathways.

In order to stay alive, a cell has to burn energy. Any cell can (and normally does) burn glucose, a simple sugar and the building block of starch. The liver and adipose (fat) tissue need the hormone insulin (released from the pancreas) to open the metabolic door within the membrane, the bag that holds the cell together, to let the…

if glucose is in short supply and insulin levels are low, then adipose tissue will give up some of its stored fatty acids to enter the bloodstream, and the liver will turn those fatty acids into ketones, which then seep back into the bloodstream, so…

Once inside the cell (Fig. 7–1), glucose undergoes breakdown through a series of metabolic steps called glycolysis to the intermediate pyruvic acid, releasing only a small amount of energy, which is captured…

From there, the pyruvic acid has one of two choices: 1) either enter the mitochondria (the energy-burning factories inside the cell), where the metabolic breakdown continues, a process called the Krebs cycle, to yield a lot more ATP (and making the waste product carbon dioxide, which you breathe out from the lungs); or 2) if the mitochondria are busy or dysfunctional, the pyruvic acid diverts to a process called de novo lipogenesis (new fat-making) to turn into a fatty acid…

These two pathways of energy metabolism, especially within the mitochondria, consistently release toxic by-products inside the cell called oxygen radicals (kind of like what hydrogen peroxide does on a wound). If not detoxified, these can damage the cell, and even cause it to die. Therefore, the cell has another structure called a…


1. Glycation:

Why do we get cataracts and wrinkles as we get older? Each of these is an example of an undeniable and inevitable fact of life—the Maillard or glycation.

It’s a by-product of living, yet it’s the primary reason for dying. We’re all browning, all the time, and the only way to stop it is by dying. The faster the Maillard reaction occurs, the faster you age—you get wrinkles, your arteries become sclerotic, and you eventually reach the pearly gates. But you can slow this…

The Maillard reaction only needs two molecules to occur: a carbohydrate (fructose or glucose), plus an amino acid (e.g., proteins). Put them together and the protein starts to “brown” and become less flexible. Ideally, these damaged proteins will be cleared away by cellular waste processing systems, but if the reaction occurs faster than the waste can be cleared,

One might think that glucose and fructose, both being molecules found in dietary sugar (sucrose, high-fructose corn syrup, honey, maple syrup, agave—they’re all metabolically the same; take your pick), would drive…

glucose has a six-member-ring structure (see Fig. 7–2), it’s more stable and engages in the Maillard reaction relatively slowly. Conversely, fructose’s five-member ring is more easily broken apart, and engages in the Maillard reaction seven times faster than…

All in all, when it comes to ageing, fructose is worse than glucose, and therefore sugar is worse than starch.


2. Oxidative Stress

Oxygen, or O2, is a unique molecule with diverse effects on the body. While the brain is highly dependent on oxygen and can quickly suffer irreversible damage without it, certain cells, such as cancer cells, can thrive in low-oxygen environments. Oxygen also has the ability to create an unfavourable environment for both foreign invaders and our own cells.

Within our cells, there are specialised sub-cellular organelles called peroxisomes that contain antioxidants. These antioxidants neutralise oxygen radicals, preventing them from causing harm to lipids, proteins, or DNA, and ultimately leading to cellular dysfunction or even cell death.

To maintain a healthy balance, it is crucial to consume Real Food with vibrant colours, as these indicate the presence of antioxidants that our bodies cannot produce on their own. This helps to counteract oxidative stress caused by an excess of oxygen radicals and promotes overall cellular health.


3. Mitochondrial Dysfunction

Consider an old-style factory powered by a coal-burning furnace. The furnace requires a steady supply of coal brought in by railroad cars, and skilled furnace stokers who work in shifts to keep it fed. When the rate of coal arrival matches the offload rate by the stokers, the factory operates at full capacity, producing high-quality products.

However, if the furnace stokers are unable to generate enough energy due to age, illness, or other factors, the furnace will not burn at full capacity, resulting in subpar product output. Additionally, if the railroad cars filled with coal start arriving faster than the stokers can unload, the factory floor becomes overwhelmed, leading to shutdown.

Now, imagine both of these issues occurring simultaneously. This is similar to mitochondrial dysfunction, where the cells’ energy production process is impaired. Chronic disease is essentially mitochondrial dysfunction, and mitochondrial dysfunction is chronic disease. They are interconnected and synonymous with each other.

Mitochondria, fascinatingly, are bacteria that made a decision long ago to reside within animal cells rather than braving the harsh external environment on their own. Bacteria were adept at generating energy, while animal cells excelled at defending against invaders. This symbiotic arrangement allowed them to thrive together.

Even today, mitochondria possess their own distinct DNA and genetic programming separate from the human DNA housed in the cell nucleus. However, like shift workers, mitochondria are prone to dysfunction and damage due to oxidative stress as they age.

The most effective stimulus for generating new and healthy mitochondria is exercise. However, even with optimal mitochondrial function, a poor diet cannot be outrun.

When glucose and oxygen availability, as well as mitochondrial capacity, are well-matched, cellular processes run smoothly. Using the analogy of a coal factory, if glucose influx exceeds the mitochondria’s processing capacity, the excess can overwhelm the system, and the mitochondria are forced to convert excess pyruvic acid into fat, a process known as de novo lipogenesis.

It’s worth noting that the health of your mitochondria plays a crucial role in your lifespan. Organs that require abundant mitochondria and energy production, such as the brain and hormone-secreting organs, are particularly vulnerable to mitochondrial dysfunction, as neurotransmission and hormone secretion are energy-intensive processes.


4. Insulin Resistance

Insulin is commonly viewed as the hormone that combats diabetes by lowering blood glucose levels and preventing microvascular complications like eye, kidney, and nerve diseases. However, this is only part of the story. Insulin’s primary role is actually to store energy for future use, akin to saving for a rainy day.

In your body, only two organs, the liver and adipose tissue, require insulin for proper function. When there is an excess of insulin, it can impede glucose clearance from the bloodstream into tissues, leading to hypoglycemia or inadequate glucose delivery to the brain, which can cause symptoms like dizziness, unconsciousness, seizures, or even death in severe cases.

However, in modern times, the opposite issue is more prevalent: various cells in the body become resistant to insulin, a condition known as insulin resistance. When certain cells are unable to take up glucose, they experience a state of starvation, resulting in dysfunction of the affected organs. Insulin resistance in the liver or muscles can cause glucose to accumulate in the blood, leading to diabetes.

Elevated insulin levels contribute to cellular dysfunction, ultimately leading to chronic diseases, morbidity, and premature mortality. Insulin resistance is a central issue in metabolic syndrome, and there can be various reasons for its occurrence in different individuals. However, processed food is widely recognised as the predominant factor contributing to insulin resistance.


5. Membrane Integrity

The outer membrane of every cell serves as a protective barrier, containing its contents. However, when these membranes are damaged, it can result in the release of cellular contents, leading to cell dysfunction and eventual death.

There are two primary mechanisms through which cell membranes can be damaged: damage to the lipids themselves, caused by toxins or oxidative stress.

Ideally, cell membranes should be flexible and malleable, similar to a balloon, which is referred to as membrane fluidity. When membranes lose their flexibility, they can rupture.

Unsaturated fats are generally considered healthier than saturated fats, as they are less problematic in relation to metabolic syndrome. However, there are two issues with unsaturated fats. First, the cis-double bonds in unsaturated fats are susceptible to damage by toxins and oxidative stress, which can oxidise these double bonds and release oxygen radicals. Second, when unsaturated fats are heated beyond their smoking point, the cis-double bond can undergo a “flip”, resulting in the formation of trans-fats, which are harmful to cells. Although the FDA has banned trans-fats in commercial foods, it is still possible to unintentionally produce them when cooking at home.


6. Inflammation

Foreign invaders such as viruses and bacteria can directly damage cells in our body. In response, our body has developed an inflammatory response, where various white blood cells are recruited to release toxins like oxygen radicals and cytokines, which have killing activity, to destroy the invaders.

However, there are several downsides to this inflammatory response:

  1. Normal tissues can also be damaged in the process, leading to long-term damage even after the invader is cleared.
  2. The inflammatory process can sometimes be triggered against the body’s own tissues, as certain body tissues may molecularly resemble foreign invaders, a phenomenon known as molecular mimicry.
  3. Imbalances in the gut environment can cause harmful bacteria to proliferate, leading to the predominance of pathogenic bacteria such as Streptococcus mutans in the mouth, leading to dental caries. The resulting inflammatory reaction can also cause breaks in the intestinal barrier, allowing toxins and bacteria to pass into the bloodstream, leading to liver inflammation and insulin resistance, a condition known as leaky gut.
  4. Body fat, whether subcutaneous or visceral fat, can release inflammatory lipids such as palmitate, which can further drive the inflammatory response.

It’s important to note that these problems – nutrition, metabolism, inflammation, and immunity – are interconnected and not separate issues. Disruption in one area can impact the others, leading to a cascade of health problems.


7. Epigenetics

While much research has focused on identifying genetic factors associated with metabolic syndrome, studies indicate that only about 15 percent of metabolic syndrome can be attributed to genetics, while the majority is influenced by environmental factors. However, it’s important to note that environmental factors can also impact genes through a phenomenon called epigenetics.

Epigenetics refers to changes in the areas surrounding our genes that can cause them to be turned on or off, often inappropriately. These changes can alter responses to various pathologies and, over time, can contribute to the development of different diseases. In other words, our environment can influence how our genes are expressed, leading to changes in our health outcomes.

This highlights the complex interplay between genetics and the environment in the development of metabolic syndrome and other diseases. While genetic factors play a role, environmental factors, including lifestyle, diet, stress, and other external influences, also have a significant impact on our health and can shape our genetic expression through epigenetic changes.


8. Autophagy

What happens when there’s no more space to dispose of garbage? Or worse, what if there’s no one to collect the trash? It’s much better to clear the garbage rather than letting it pile up. This principle applies to the human body as well.

Clearing out biological waste products is a vital process known as autophagy, which plays a crucial role in healthy aging, especially in the brain. The brain, being the most energy-demanding organ, generates a significant amount of mitochondrial waste and oxidative damage.

However, the brain has limited space for waste storage, so it has to efficiently and rapidly remove debris. This is where sleep comes in. During sleep, the intracerebral pressure decreases, allowing small pores called glymphatics to open up in the brain. This allows for the slow and steady removal of damaged cellular components into the bloodstream for disposal. In essence, every night is garbage night for the brain during sleep. If you don’t get enough sleep, it’s like having your brain’s garbage collectors on strike.


As you can see, none of these eight processes mentioned inherently cause diseases. In fact, when they are functioning properly, they contribute to longevity and good health. However, if a few of these processes go awry, it can result in a shorter and less enjoyable life. It’s crucial to maintain the proper functioning of these processes for overall well-being.


Chapter 8 Checkpoints Alpha, Bravo, Charlie: Nutrient-Sensing and Chronic Disease

Food drives both illness and wellness; it’s the poison and the antidote. Metabolic syndrome could colloquially be redefined as cells eating badly, as every one of the eight sub-cellular pathologies is made worse by providing the wrong food in the wrong place at the wrong time.


Oxygen Is So Overrated

Do living organisms need oxygen? While plants don’t require oxygen for their survival, as they produce oxygen as a by-product during photosynthesis, animal cells, including regular cells and cancer cells, do need oxygen for their normal functioning. However, an interesting observation made by German biochemist Otto Warburg in 1924 was that cancer cells can grow without oxygen.

Despite the fact that regular cells need oxygen, cancer cells, which divide rapidly, can thrive in low-oxygen environments, such as the gut where oxygen levels are typically low. This is because the intestinal microbiome, which is comprised of bacteria, has adapted to function without oxygen. Many bacteria in our gut, known as obligate anaerobes, can grow and survive without oxygen and do not possess mitochondria, the cellular structures responsible for oxygen-dependent energy production.

In fact, cells that are in a growth phase without access to oxygen may not even need mitochondria, as they can produce energy through alternative pathways that generate lactic acid as a by-product. Increased production of lactic acid is associated with certain conditions like post-exercise, cancer, mitochondrial diseases, and metabolic syndrome, all of which involve mitochondrial dysfunction or lack of oxygen availability.


Two Metabolic Programs—One for Growth, One for Burning

Cells undergoing growth require various building blocks to divide and create new cells. These include lipids for membranes, ribose for DNA and RNA, and amino acids for proteins. There are two main pathways that provide these building blocks.

The first pathway is called glycolysis, which prepares glucose for use in structural components. The end product of glycolysis is pyruvic acid, which can either be used for burning in the next stage or leave the cell as lactic acid. One notable feature of glycolysis is that it can generate two ATPs (adenosine triphosphate), which are energy molecules, without requiring oxygen.

The second pathway is known as the Krebs cycle, which occurs in the mitochondria. In the Krebs cycle, pyruvic acid is completely burned, resulting in the production of 28 ATPs and carbon dioxide. When the goal is burning energy, such as during aerobic exercise, both glycolysis and the Krebs cycle work together. However, when the goal is to provide structural components for growth, as in cases like blood flow restriction or high-intensity interval training for building muscle mass, only glycolysis is needed and the pyruvic acid is diverted for building muscle.

Both glycolysis and the Krebs cycle are adaptive pathways that allow cells to meet their energy and structural needs depending on the specific requirements of growth or burning energy.


Checkpoint Alpha: Phosphatidylinositol-3-kinase (PI3-kinase)

The enzyme known as PI3-kinase plays a crucial role in opening the floodgates of glucose entry into the cell. When there is an abundance of glucose available, the cell can obtain fuel to power itself even without the need for mitochondria or oxygen. This explains why cancer cells and fetal cells, which require high levels of energy, often have elevated levels of PI3-kinase.

Insulin, a hormone that regulates blood sugar levels, plays a significant role in driving cancer cell growth by facilitating the entry of glucose into the cell. Insulin acts like a key, unlocking the door to allow glucose to enter the cell, and PI3-kinase determines the extent to which the door swings open. Together, insulin and PI3-kinase work in tandem to flood the cell with glucose, providing the energy needed for cell growth and proliferation.


Checkpoint Bravo: Adenosine Monophosphate-kinase (AMP-kinase)

After glucose enters the cell, the next step is determining whether the cell needs to burn the glucose for energy. This is where the second checkpoint, AMP-kinase, comes into play. AMP-kinase acts as the cell’s fuel gauge, distinguishing between a full or empty energy state.

Activities such as exercise or the use of the anti-diabetes drug metformin can stimulate AMP-kinase, helping to maintain optimal functioning of mitochondria and improving insulin sensitivity. On the other hand, factors that impair AMP-kinase can lead to fat synthesis and worsen insulin resistance. Among the various factors that can impair AMP-kinase, sugar-rich foods have been shown to have the most significant impact.


Checkpoint Charlie: Mammalian Target of Rapamycin (mTOR)

When it comes to a cell’s fate, whether it divides, remains in a quiescent state, or undergoes autophagy (cellular self-degradation), the third checkpoint, mTOR, plays a crucial role. mTOR acts as a signaling pathway that determines a cell’s commitment to growth, quiescence, or death, and thus plays a pivotal role in regulating cell fate.

mTOR serves as the major regulator of growth in animals and is the key link between the internal state of the cell and its fate. It determines whether a cell lives or dies, and thus plays a critical role in autophagy, the process of clearing out cellular debris. Notably, mTOR is also the target of many current longevity drugs, as it is considered the holy grail of cell fate.

Diet has a significant impact on mTOR activity. A high-protein diet can activate mTOR, promoting cell division, development of lean body mass, insulin sensitivity, and bone and cardiovascular health. In contrast, caloric deprivation or low ATP levels can reduce mTOR activity, making growth an impossibility.

In summary, mTOR serves as the crucial checkpoint that determines a cell’s commitment to growth, quiescence, or death, and is highly sensitive to diet and energy levels, making it a central player in regulating cell fate and a potential target for longevity interventions.


These three enzyme checkpoints

These three enzyme checkpoints together explain how the cell metabolises energy: PI3-kinase imports glucose into the cell; AMP-kinase directs the energy to mitochondria for burning; and mTOR determines whether a cell lives or dies.

Cell metabolism is primarily driven by the chemical signals that reach the cell, particularly the mitochondria, and not by calories. The enzymes PI3-kinase, AMP-kinase, and mTOR play crucial roles in regulating cell growth, burning of energy, and determining cell fate. These enzymes are influenced by the chemicals present in the cell, rather than simply the calorie content of the diet, challenging conventional notions about nutrition.

The traditional focus on calories as the sole determinant of metabolism is being redefined by our understanding of these enzymes and their intricate roles in cellular processes. It is becoming clear that it is not just the quantity of calories, but also the quality and composition of the diet that significantly impact cell metabolism and overall cellular health.


Chapter 9 Assembling the Clues to Diagnose Yourself

Don’t take “normal” for an answer.

The term “normal” should be avoided and questioned when used by doctors, oneself, or others. After all, what does “normal” truly mean? Normal for whom? At what age? And in what specific circumstance? This vague term should be eliminated from our vocabulary, including the medical field.

The concept of “normal” is subjective and can vary greatly depending on individual differences, age, and specific situations. Relying on the notion of normality can lead to misconceptions, unrealistic expectations, and potential stigmatisation. Instead, it is crucial to consider a person’s unique characteristics, medical history, and context when evaluating health or well-being.

Family history.

The good news is that you are likely to know your family history better than your doctor does. It’s important to create a written list of diseases that your parents, grandparents, aunts, and uncles had, along with information about how they passed away, and share it with your doctor. However, it’s important to note that having a family history of a certain disease does not necessarily mean it is solely due to genetics. In fact, almost every chronic disease is influenced by a combination of multiple genes (polygenic).

The significance of family history goes beyond genetics as it also takes into account epigenetics, which involves how genes are influenced by various environmental factors. It’s important to understand that having a family history of a disease does not necessarily mean it is a death sentence. While you cannot alter your genetic predisposition to chronic diseases, you can still take actions to improve outcomes once you are aware of the risks.

Vital signs.

In general, your vital signs are always normal or you wouldn’t be walking around or reading this book. Pulse rate and blood pressure are both highly variable, and much of the variability depends on age, sex, race, BMI, pregnancy, exercise capacity, and, most important, diet—especially processed food.

Waist circumference.

Waist circumference is a sign of either visceral (belly) fat, liver fat, or both. All the diseases of metabolic syndrome are associated with increased waist circumference—even in normal weight people—and so waist circumference is much more sensitive for disease risk than is BMI; in fact, waist circumference is increasing faster than BMI in the population, because it’s the visceral fat that’s going up more than the subcutaneous fat.


Fasting lab tests.

Extracting valuable information from fasting lab tests requires the expertise of an experienced clinician who is up-to-date with medical knowledge and interpretation skills.

Here is a list of tests that you should make sure your doctor orders: lipid profile (including LDL-C, HDL-C, and TG), homocysteine (Hcy) level, alanine aminotransferase and aspartate aminotransferase (ALT and AST), uric acid, fasting insulin, fasting glucose, and hemoglobin A1c. These tests provide crucial insights into various aspects of your health, including diet and risk for heart disease.

When assessing heart health, it’s important to look at the pattern and ratio of the lipid fractions. The TG:HDL (high-density lipoprotein) ratio is a powerful biomarker of small dense LDL, cardiovascular disease, insulin resistance, and metabolic syndrome. Additionally, HDL levels above 60 are indicative of good cardiovascular health, while HDL levels below 40 (men) or 50 (women) may signal a higher predisposition for heart disease.

LDL-cholesterol, when below 100, indicates that the small dense fraction is unlikely to be harmful. Diet and liver function can be assessed by measuring ALT, which is reasonably sensitive and specific for liver fat accumulation. If ALT levels are above 25, further investigation is warranted.

Uric acid levels can provide insights into diet and mitochondrial function, as high uric acid levels are associated with sugar consumption, gout, hypertension, and liver fat generation. Uric acid is a by-product of liver carbohydrate metabolism, particularly in sugar metabolism.

Glucose control parameters should also be investigated. Fasting glucose, while commonly measured for type 2 diabetes, is not the most sensitive parameter as it changes late in the disease progression. Other markers such as fasting insulin and hemoglobin A1c may provide better insights into glucose control.


Further Checks:

Your waist circumference can serve as a crucial indicator of your metabolic health. If your waist circumference is high, it may signal an underlying metabolic issue, and dietary changes may be necessary to improve insulin resistance.

When both waist circumference and blood pressure are high, it’s important to consider sugar, rather than salt, as a potential culprit. Conversely, if blood pressure is high but waist circumference is low, salt or stress may be contributing factors.

High uric acid and high homocysteine levels can be indicative of poor mitochondrial function, while elevated ALT and fasting insulin levels may suggest liver fat accumulation. High triglyceride levels and low HDL levels may also indicate poor peripheral clearance of fat.

Understanding these signs and their implications can provide valuable insights into your health status and guide appropriate dietary and lifestyle interventions to improve your metabolic health and reduce associated risks. Consultation with a healthcare professional is recommended for proper assessment and personalised recommendations.


Chapter 10 Foodable, Not Druggable

There are three key characteristics shared by all diseases classified as metabolic syndrome: 1) despite efforts to combat them, these diseases are increasing in incidence, prevalence, and severity at a faster rate than obesity; 2) while obesity may exacerbate them, it is not necessarily the sole cause of these diseases; and 3) although drugs are available to address the symptoms of these diseases, including obesity, there are no medications that can effectively treat, cure, or prevent the diseases themselves.

When examining the underlying biochemical processes at the sub-cellular level, all of these diseases are driven by specific components of food, and as a result, can be influenced by dietary interventions with Real Food, which can effectively penetrate the cells where they are needed.

It’s a common misconception that supplements can counteract the effects of poor food choices. However, Real Food should be considered as the treatment, while unhealthy food should be seen as the poison. Simply relying on supplements is not sufficient to address the root causes of metabolic syndrome, and a holistic approach that prioritises whole, nutrient-rich foods is essential for managing and preventing these diseases.


Diabetes—the Modern Scourge

The consumption of refined carbohydrates, particularly dietary sugar, is strongly associated with the development of type 2 diabetes. In fact, dietary sugar, more so than starch, is known to trigger the metabolic reactions that contribute to the onset of type 2 diabetes, particularly through its effects on mitochondria.

When glucose from dietary sugar is absorbed, it stimulates the release of insulin, which in turn promotes weight gain. Meanwhile, fructose from dietary sugar drives the accumulation of fat in the liver, leading to insulin resistance. Processed foods are a major source of these detrimental effects.

The conclusion drawn from comprehensive scientific analysis is that processed food accelerates the progression of the eight sub-cellular pathologies that underlie metabolic dysfunction, inappropriate cell proliferation, and cell death. On the other hand, nutrition is the overarching paradigm for achieving a long and healthy life free from disease. Prioritising whole, unprocessed foods is crucial for preventing and managing metabolic syndrome and related conditions, including type 2 diabetes.


Part III Notes from the Nutritional Battlefield

Chapter 11 What Does “Healthy” Really Mean?

Since the release of “The Omnivore’s Dilemma” by food journalist Michael Pollan in 2006, he has argued that nutrition has become akin to a religion, as it often requires belief without direct observation. The concept of nutritionism arose with the discovery of the first vitamin, thiamine (B1), in 1912, which led scientists to believe that food contains both beneficial and detrimental chemicals. This has resulted in the belief that nutrients are the fundamental elements of any dietary approach, giving rise to the phenomenon of nutritionism.

Many nutrition experts and pundits often have vested interests in promoting certain dietary approaches, either by selling drugs, supplements, or diets, if they have financial investments. In today’s age of declining life span and health span, nutritional mythology has become particularly fervent, with people seeking someone or something to blame, including the author of this statement.


Nutrition mythology

Individuals with metabolic syndrome often face the paradox of being both over-nourished and undernourished. Despite consuming ample calories, they may suffer from deficiencies in essential amino acids such as tryptophan, which is needed for serotonin production, and methionine, which is crucial for glutathione synthesis, a potent liver antioxidant.

The prevalence of nutrition mythology over truth can be attributed to various reasons, including limitations in nutritional epidemiology, which is often conducted by pundits in the field who are not bench scientists or clinicians. Epidemiological studies focus on correlation rather than causation, akin to John Snow’s cholera investigation of the Broad Street pump, serving as a starting point for posing important questions. However, answering these questions requires proper study design, as correlation alone does not imply cause-and-effect relationships. Reverse causality, intermediate causality, or other confounding factors may be at play, leading to misleading interpretations.

Despite this, the media often portrays epidemiological studies as causation, further contributing to public misconceptions. Some researchers and news sources rely on meta-analyses, considered the gold standard in proving a point by consolidating multiple studies. However, the reliability of meta-analyses depends on the quality of the underlying data, which can be compromised when influenced by industry interests, leading to the principle of “Garbage in, garbage out” (GIGO).

Most nutritional studies rely on self-reported data obtained through food questionnaires, which are prone to inaccuracies due to memory recall issues. Asking individuals about their food intake over a period of time often yields unreliable results, as people struggle to recall their dietary habits accurately. Furthermore, unintentional biases or intentional misreporting may further impact the data quality.

In conclusion, the science of nutrition has been muddled by various factors, including limitations in nutritional epidemiology, misleading media portrayals, reliance on meta-analyses based on compromised data, and inaccuracies in self-reported data from food questionnaires. Careful consideration and critical evaluation of research findings are necessary to discern truth from nutrition mythology.


Roberts Definition of “Healthy”

The key to preventing chronic diseases lies in optimising eight subcellular pathways, and achieving this can be accomplished through two simple guidelines:

1. Safeguard the liver: Protection of the liver from various stressors such as fructose, glucose, branched-chain amino acids, omega-6 fatty acids, and iron is crucial to prevent fat accumulation, liver damage, and insulin resistance. This can be achieved by either reducing the intake of dietary liver stressors, such as adopting a low-sugar diet, or reducing their flux, for example, by incorporating a high-fibre diet that blocks sugar absorption, thus slowing down the rate at which fructose and branched-chain amino acids reach the liver.

2.  Nourish the gut: Properly nourishing your gut microbiome is essential, as an unhealthy microbiome can disrupt the protective mucin layer that shields the intestinal epithelial cells, leading to leaky gut, inflammation, and increased insulin resistance. To promote gut health, it is important to provide adequate nutrients to the microbiome farther down the intestine, which can be achieved through a high-fibre diet that supports a healthy gut microbiome.

By following these two simple directives of protecting the liver and nourishing the gut, one can optimise the functioning of the subcellular pathways and significantly reduce the risk of chronic diseases.

Fibre is a vital nutrient that benefits not only you but also your microbiome. There are two types of fibre found in Real Food: soluble fibre, which is globular in nature and resembles the consistency of jelly (e.g., psyllium, pectin, inulin), and insoluble fibre, which is stringy in nature and similar to the fibres found in celery (e.g., cellulose, chitin, peptidoglycan). Both types of fibre serve different functions and are essential for overall health.

Intact fibre, which is found in Real Food, offers numerous benefits beyond just producing short-chain fatty acids (SCFAs). In the processed food industry, the germ of the grain, which contains nucleic acids, flavonoids, and polyphenols, is often removed along with the fibre because it can become rancid.

There are two simple principles to follow for optimal health: protect the liver and feed the gut. Real Food, which is low in sugar and high in fibre, fulfills both of these requirements. In contrast, processed food, which is high in sugar and low in fibre, fails to meet these criteria and does not support liver health or nourish the gut.


Chapter 12 Nutrition “Unwrapped”

The notion that “a calorie is a calorie” is a myth, and here are five examples that disprove it:

1.  Fibre: When you consume almonds, which contain 160 calories, your body only absorbs 130 calories. The remaining 30 calories are not absorbed early in the duodenum (early intestine) due to the fibre present in almonds. Instead, the fibre prevents their absorption, allowing bacteria in the jejunum and ileum (middle and late intestine) to utilise them for their own purposes. Although you consumed these 30 calories, they are not counted as calories that you actually obtained (your gut bacteria did).

2.  Protein: Amino acids from protein need to undergo a process in the liver to be converted into organic acids (such as aspartate to oxaloacetate) for energy metabolism. This conversion process requires two ATPs, whereas carbohydrate requires only one ATP. This phenomenon is known as the thermic effect of food (TEF). Protein has a much higher TEF compared to fats and carbohydrates, ranging from 25 to 30 percent. This means that it takes more energy to burn protein compared to carbohydrates.

3.  Fat: While all dietary fats would theoretically release 9 calories per gram when burned, not all fats are utilised in the same way. Omega-3 fatty acids, for example, are not burned for energy. Instead, they are stored as they are essential for cell membranes and neurons in the brain. Additionally, trans-fats cannot be burned as humans lack the enzyme to break the trans-double bond.

4.  Sugar: Added sugar consists of equal amounts of glucose and fructose. Although both provide the same number of calories, they are metabolised differently in the liver and have distinct roles in the brain. Glucose can be utilised by all tissues in the body, with only 20 percent of a glucose load going to the liver, where it is converted into glycogen (liver starch) under the influence of insulin. On the other hand, fructose can only be metabolised by the liver, resulting in the entire fructose load being processed by the liver. This can overwhelm the mitochondria, leading to liver fat accumulation and driving insulin resistance, as insulin has little effect on fructose metabolism.

5.  Different fat depots: It’s not just about whether a calorie is stored, but also where it is stored. There are three types of fat depots in the body: subcutaneous fat (found in the buttocks), visceral fat (found in the belly), and liver fat. Each of these depots poses different risks for the development of metabolic diseases. Subcutaneous fat requires a significant amount (about 22 pounds) to negatively impact health, whereas visceral fat (around 5 pounds) and liver fat (as little as 0.3 pounds) can have detrimental effects on health with much smaller amounts. Furthermore, most of the calories from added sugar tend to accumulate as liver fat.


Pharmacokinetics and Pharmacodynamics:

The distinction between pharmacokinetics, which refers to how the body processes a drug, and pharmacodynamics, which relates to how a drug affects the body, is crucial. While there is pharmacokinetic data available for diet sweeteners to assess short-term safety, as mandated by the FDA, there is a notable lack of information on their long-term effects, which falls outside the FDA’s scope. The reality is that we do not have comprehensive knowledge of how these diet sweeteners impact factors such as long-term food intake, body weight, body fat, or metabolic health. The reason for this gap in research is that conducting such studies can be costly, and the food industry, which manufactures and sells these sweeteners, often avoids funding them to safeguard sales. The responsibility is shifted to the NIH, but they argue that it is the food industry’s responsibility. Consequently, these critical studies are left undone.

Furthermore, health concerns related to diet sweeteners tend to be overlooked. A report from the University of Sussex revealed that during the original approval of aspartame by the European Food Safety Authority (EFSA), 100 percent of the studies indicating harm from aspartame were disregarded, while 84 percent of studies showing no harm were accepted. This highlights the potential for selective acceptance of research findings, raising concerns about the validity of safety assessments for diet sweeteners.


A Fibre Is Not a Fibre

As previously mentioned, there are two types of fibre – soluble and insoluble – and both are essential for a healthy diet.

The reason why doctors advocate for a plant-based diet is not solely because of the plant origin itself, but rather because plants naturally contain both types of fibre. When these two types of fibre come together, they form a gel-like substance in the duodenum, which reduces the absorption of nutrients in the intestine by 25 to 30 percent, thereby providing protection to the liver.

In return, a significant portion of what you consume remains in the intestine, providing nourishment for the gut bacteria, allowing them to thrive and flourish.

However, it’s important to be cautious of processed foods that claim to have “added fibre” in them. While the food industry may add back some soluble fibre, such as psyllium found in Fibre One bars, they cannot replicate the insoluble fibre that is lost during processing. Once fibre is removed during processing, it cannot be put back, and the benefits of insoluble fibre may be lost in such products.


A Carb Is Not a Carb

For many years, the American Heart Association, American Diabetes Association, and American Medical Association have promoted a low-fat diet, which inherently translates to a high-carbohydrate diet. However, is this trade-off truly beneficial? Just as the concepts of “a calorie is not a calorie” and “a fibre is not a fibre” hold true, it’s important to recognise that not all carbohydrates are the same, and “a carb is not a carb.”

Sugar vs. starch.  When comparing sugar to starch, it’s important to note that sugars are monosaccharides and disaccharides, consisting of only one or two molecules. In contrast, starch is a complex polymer made up of many molecules. Due to their simple structure, sugars can be quickly digested and absorbed in the duodenum, especially when they are isolated from a food matrix, as is often the case in soda, fruit juice, and alcohol. On the other hand, starch has more bonds to break, leading to slower digestion and absorption. As a result, sugar consumption typically results in a more rapid and higher insulin response compared to starch.

Type of starch (the two “Amys”): Not all starches are created equal, as there are two types of starch with distinct properties: amylose and amylopectin.

Amylose is commonly found in brown foods such as beans, lentils, and legumes, and it is characterised by its slow digestion and absorption. This is because amylose is made up of a string of glucoses with two ends, which means that only two enzymes can break it down at a time, resulting in a slower process.

On the other hand, amylopectin is typically found in white foods like wheat, pasta, rice, and potatoes, and it is known for its rapid digestion and absorption. Amylopectin resembles a tree of glucoses with numerous branch points, allowing for many enzymes to break it down simultaneously, leading to a quicker release of glucose into the bloodstream. This rapid release of glucose can potentially overwhelm the liver, resulting in a larger insulin response.

In terms of health benefits, amylose is generally considered to be better for you due to its slower digestion and absorption, which helps to regulate blood sugar levels and prevent spikes in insulin. In contrast, amylopectin, with its faster digestion and absorption, may contribute to a more rapid increase in blood sugar and insulin levels.


Carbs and Glycemic Index (GI)

Regrettably, the Glycemic Index (GI) is not the miraculous solution that some enthusiasts claim it to be. GI is a measure of how much your blood glucose levels rise in response to 50 grams of carbohydrate in a particular food, compared to the glucose response triggered by 50 grams of pure starch, such as white bread. However, there are several conceptual issues with GI:

GI is an indirect proxy for insulin. While rapid glucose spikes after refined starch lead to glycation and oxidative stress, it’s the insulin fluctuation that induces the other six subcellular pathologies, drives excess energy intake, and promotes obesity.

GI assumes everyone responds to the same food in the same way. GI is computed based on responses of healthy people to certain foods, even though 88 percent of people have some form of metabolic dysfunction.

The important parameter is glycemic load (GL). GL is different from GI—how much food do you have to eat to get the 50 grams of carbohydrate? GL takes into account the beneficial effect of fibre. A good example is carrots, which are high-GI (lots of carbohydrate) but low-GL (even more fibre). More fibre means a larger portion, because there’s less digestible carbohydrate.

Fructose: Fructose is a major culprit in the development of liver insulin resistance and metabolic syndrome due to its distinct metabolism in the liver. Unlike glucose, fructose does not raise blood glucose levels when consumed (it is not measured in glucose assays). In fact, fructose is considered low-GI by definition, as it does not contain glucose. However, this fact has not deterred the food industry from attempting to capitalise on the popularity of low-GI foods by adding fructose to various food products.


A Protein Is Not a Protein

Companies are increasingly promoting protein as a miracle solution for weight loss, muscle gain, and overall health. You can find protein in various forms, such as shakes, cookies, snack bars, and even coffee. While protein is indeed a vital nutrient necessary for normal growth, it’s important to understand that consuming excessive amounts of protein can have negative effects on the kidneys. This is because the kidneys have a limited capacity to eliminate the by-products of protein metabolism, and over excretion can potentially lead to kidney damage. Therefore, not only the quantity but also the quality of protein is crucial.

Dietary protein is composed of twenty different amino acids that are combined in varying amounts and combinations. Among these amino acids, tryptophan is particularly important as it serves as a precursor for serotonin, a vital neurotransmitter in the brain. Eggs, poultry, and fish are excellent sources of tryptophan, while beans contain relatively low levels of this amino acid. On the other hand, if you are focused on building muscle, you may require additional protein, particularly branched-chain amino acids (BCAAs) such as leucine, isoleucine, and valine, which make up about 20 percent of muscle tissue. Corn products are known to be rich in BCAAs and are often found in protein powders sold at health food stores. It’s crucial to consider both the type and amount of protein you consume, depending on your specific dietary needs and goals.


Chapter 13 Food in the Time of Corona

No notes.


Chapter 14 What and How Adults Eat

There are two primary caveats to using supplements for metabolic syndrome: a supplement can be used to treat a deficiency, but not an excess; and a supplement will work only if it can be absorbed and transported into the cell.

Here are why supplements can’t help the 8 subcelluar pathways:

1. Glycation. This is due to carbohydrate excess and can’t be stopped just with a supplement.

2. Oxidative stress. Oxygen radicals must be quenched by antioxidants or they will do damage. Many studies demonstrate negative correlations between blood levels of antioxidants and metabolic syndrome. But this can’t be fixed by just adding a supplement.

3. Mitochondrial dysfunction. Mitochondrial “boosters” are currently de rigueur. And if they worked, they would be a big win. But they don’t get where they need to go.

4. Insulin resistance. Lots of compounds, such as alpha-lipoic acid, chromium, berberine, bergamot, and resveratrol, show promise in animals. However, when the rubber hits the road, the human data don’t support their use, because insulin resistance is due to nutrient excess, not nutrient deficiency.

5.  Membrane integrity. Here, we see beneficial effects of omega-3 fatty acids, because of their role in suppressing inflammation, improving insulin sensitivity, reducing triglyceride levels, and improving cognitive function. Omega-3s work because they are correcting a deficiency in the Western diet.

6. Inflammation. Polyphenols, such as curcumin, are thought to be valuable, as they would be correcting a nutrient deficiency; however, the scientific data has been anything but conclusive. One anti-inflammatory that holds promise is vitamin D, which has specific beneficial effects on the immune system via a set of toll-like receptors.

7. Epigenetics. Folate has been added to your bread in the grocery store to provide the recommended daily allowance, because our processed food diet meant that we were woefully deficient. Pregnant women, people on chemotherapy, and those with specific malabsorption or autoimmune conditions need more.

8.  Autophagy. Spermidine, a polyamine found in cheese and mushrooms, can improve cardiovascular and cancer risk in animals. However, thus far no formulation has boosted levels enough to get it into the liver of humans. But the best way to increase spermidine in the blood is to change the gut microbiota, which is done with a prebiotic.


How to repopulate your unhappy gut:

To restore a healthy gut, it’s important to repopulate it with probiotics. Probiotics are living bacteria that, logically, should multiply and thrive once consumed. However, in reality, they don’t. Processed food has created an inhospitable environment in the intestines, making it difficult for good bacteria to survive and thrive. It’s like sending humans to Mars without an atmosphere – no matter how many probiotics you consume, they won’t be able to survive in such an environment.

Feeding your gut is essential, and processed food actually starves it. Increased processing of food leads to more functional intestinal problems, autoimmune diseases, and metabolic syndrome. Probiotics alone cannot fix this issue because they cannot survive in the unhealthy gut environment.

The simplest and most effective solution for a healthy gut is not found in a supplement, but in dietary fibre. Adopting a high-fibre diet can positively change the microbiome within just a couple of days. When combined with a probiotic that contains a prebiotic, you can create a more favourable environment for the bacteria to thrive and take hold in your gut, leading to improved gut health.


Chapter 15 What and How Children and Adolescents Eat

Breakfast Is a Dangerous Meal

Breakfast, often touted as the most crucial meal of the day, is a belief that traces back to Lenna Cooper channeling John Harvey Kellogg. However, breakfast does have its merits, as it jumpstarts your kid’s brain in the morning, increases the thermic effect of food (which accounts for about 10 percent of energy expenditure), and curbs ghrelin, the hunger hormone, to prevent overeating at lunch.

Unfortunately, many breakfast options marketed to kids and their parents, such as cold cereal, instant oatmeal, granola bars, protein bars, and yogurt smoothies, are loaded with sugar. The National Diet and Nutrition Survey has revealed that these seemingly innocent choices can actually contribute to a significant sugar overload, accounting for about half of a child’s daily sugar intake on average.

To make matters worse, the food industry often conceals the true sugar content through the use of 262 different names for sugar. By incorporating various types of sugar as the fifth, sixth, seventh, and eighth ingredients, the overall sugar content can quickly add up, making it the dominant component of these breakfast options.


Fructose effects on Brain:

The brain, despite weighing just three pounds and comprising only 2 percent of the body’s weight, is a voracious consumer of energy, utilising a significant 20 percent of all the glucose present in the bloodstream at any given time. However, when it comes to fructose, what does the brain do with it? While the majority of fructose is cleared by the intestine and liver, an excessive intake, such as from a large 20-ounce soft drink, can overwhelm their capacities and allow a substantial portion of fructose to enter the brain.

Fructose has been found to fundamentally alter brain metabolism, particularly in astrocytes, which are cells that provide nourishment to neurons. Instead of fueling these cells, fructose drives two of the eight subcellular pathologies, namely glycation and oxidative stress. However, it’s worth noting that some of the detrimental effects of fructose on the brain can be mitigated by consuming higher amounts of omega-3s, which have been shown to have beneficial effects.


Three Impacts of Sugar on Your Kid’s Brain

Teachers are well aware that excessive sugar intake can negatively impact education as it alters kids’ brain function in multiple ways, including behaviour, cognition, and affect. Sugared beverages have been linked to behavioural problems in children, irritability in preschoolers, and even violent behaviour in middle-schoolers. However, it’s important to note that these links are correlations and not necessarily causations, as not every child who consumes sugary snacks turns into a hyperactive Tasmanian devil.

Cognitive decline and increased impulsivity are being observed in more and more young people who develop metabolic syndrome early in life. Brain scans of adolescents with metabolic syndrome reveal white matter lesions, smaller hippocampi (the memory centre of the brain), and reduced prefrontal cortex mass (the executive function centre of the brain). While not yet proven, these changes in the prefrontal cortex may be an underlying cause of distractibility and the development of attention deficit disorder in children.

It’s worth noting that the World Health Organization (WHO) and the U.S. Department of Agriculture (USDA) have established upper limits for sugar intake because dietary sugar can have detrimental effects on kids’ liver and brain, much like alcohol. While alcohol provides calories (7 kcal/gram), it lacks essential nutrition. Similarly, fructose, which is a component of dietary sugar along with glucose, is vestigial to humans and not required for any biochemical reactions. However, fructose is metabolised in the liver in a manner similar to alcohol, and when consumed excessively and chronically, it can be toxic and abused, irrespective of its calorie content or effects on weight.

It’s important to recognise that diet can impact biochemistry, which in turn can influence behaviour, and vice versa. Therefore, when observing changes in behaviour, it’s crucial to consider the potential changes in biochemistry and address the diet accordingly. A holistic approach that takes into account the relationship between diet, biochemistry, and behaviour can lead to effective strategies for promoting optimal health and well-being.


Chapter 16 What and How Fetuses, Infants, and Toddlers Eat

It is indeed a fact that the liver has the capability to produce fat from carbohydrates, a process referred to as de novo lipogenesis, a subject our research team at UCSF and Touro University has been studying. However, it is important to note that the liver primarily generates palmitate, a 16-carbon saturated free fatty acid which can be harmful (as discussed in Chapter 12). It does not produce other types of fats such as monounsaturated, polyunsaturated, or omega-3 fatty acids, all of which are crucial for the development of infants’ brains and bodies. Consequently, a vegan diet inherently lacks these essential fats needed for infant growth.

Infants have unique metabolic requirements compared to adults. A newborn’s brain, for instance, is only 33 percent the size of an adult’s, but it grows almost 1 percent daily. By three months, the brain has grown 64 percent from birth, reaching 55 percent of adult brain size. Considering that the brain is composed of 60 percent fat, this rapid development necessitates a high intake of specific fats, particularly omega-3 fatty acids.

Omega-3 fatty acids are unique due to their three double-bonds, making them more flexible and capable of bending in various directions. This property is crucial as it allows them to be integrated into cell membranes, particularly those of neurons, enhancing membrane fluidity. This flexibility aids in preventing cell aging and premature cell death, and omega-3s also play a role in reducing inflammation at nerve terminals, facilitating better neural communication.

Milk is an essential food for babies, particularly for the growth of two critical areas: the brain and the immune system. Galactose, a vital component of brain fats such as cerebrosides and ceramides, is produced exclusively in the mammary gland, underscoring its importance in infant nutrition.

Furthermore, galactose is crucial in the development of both innate and adaptive immune systems. A rare genetic condition, galactosemia, where the liver cannot convert galactose into glucose, is associated with immune complications.

A 2015 study by the U.S. Centers for Disease Control and Prevention on the nutritional content of 1,074 infant and toddler food products revealed concerning facts. Around 32 percent of toddler meals, a majority of child-focused snacks, and juices targeted at infants contained at least one form of added sugar. Moreover, 35 percent of the calories in these foods and beverages came from sugar.

This situation may be exacerbated by the presence of 262 different names for added sugar, making it challenging for consumers to identify. This issue is significant as data shows that by six months, 60 percent of US infants are consuming added sugars daily, a figure that rises to 98 percent after six months.


Part IV (Processed) Food Fight

Chapter 17 Food Classifications

Processed food is defined by seven engineering criteria:

  1. mass produced
  2. consistent batch to batch
  3. consistent country to country
  4. uses specialised ingredients from specialised companies
  5. consists of pre-frozen macronutrients
  6. must stay emulsified so that the fat and water do not layer out
  7. must have a long shelf life or freezer life It’s exactly these engineering issues that make processed food toxic to human physiology by promoting the eight sub-cellular pathologies.

One of the originators of the Food Pyramid, Luise Light, is quoted as saying: “Ultimately, the food industry dictates the government’s food advice, shaping the nutrition agenda delivered to the public. In fact, to the food industry, the purpose of food guides is to persuade consumers that all foods (especially those that they’re selling) fit into a healthful diet.”

The Food Pyramid came under immediate fire, even from those within government. In response to the growing obesity crisis, the USDA was forced to back away from it, and in 2011 introduced MyPlate, which endorsed the low-fat myth. To its credit, at least MyPlate didn’t tout refined carbohydrates; however, its low-fat imperative continues to miss the point and it somehow still categorises fruit juice and fruit and veggie straws as a vegetable.


Super NOVA

Perhaps the most innovative (and in my opinion useful) food classification system comes out of Brazil. The brainchild of São Paulo public health nutritionist Carlos Monteiro, the NOVA system is a giant step forward in how food should be viewed because it assumes all food is inherently good and ascribes different levels to the degree of processing.


NOVA divides food into four groups:

  1. unprocessed or minimally processed foods (such as fresh or frozen vegetables and fruits; plain nuts; pulses, grains, flours, and pasta; eggs; pasteurised milk and plain yogurt; chilled or frozen meat, etc.—these should be the basis of the diet);
  2. processed culinary ingredients (substances extracted from group 1 foods or from nature, such as oils and fats, sugar, and salt—to be used in small amounts in the conversion of group 1 foods into dishes and meals);
  3. processed foods (group 1 foods added of substances from group 2, such as freshly made breads and cheeses—to be consumed, also in small amounts, as part of dishes and meals based on group 1 foods); and
  4. ultra-processed foods (formulation of several ingredients, most of exclusive industrial use, such as soft drinks, sweet or savoury snacks, reconstituted meat products, “instant” meals, and industrial desserts—to be avoided).


Chapter 18 Food Adulterations

Food is food all over the world, right? Not exactly. Not every plot of land is the same, not every farm grows crops the same, not every ranch feeds animals the same, and not every chef cooks the same. You shouldn’t be surprised to know that your health could differ as well, not due to conscious food subtractions or food additions , but rather due to food adulterations that result in untoward food quality and propensity for chronic metabolic disease.


Toxins and Heavy Metals:

Environmental toxins build up in animals and plants, unleashing their metabolic havoc inside us. Although ostensibly they’re not added by the industry, some are the by-products of industrial chemical and food processing. For instance, mercury contamination of seafood is a well-documented problem.

You might be lured into complacency thinking that eating plants instead of fish or animals would fix this problem, but you would be wrong. Heavy metals concentrate in underground and aboveground plant parts, inhibiting the process of photosynthesis. To avoid toxicity, plants have developed specific mechanisms by which toxic elements are excluded, retained at root level, or transformed into physiologically tolerant forms—for them, not for us. For instance, arsenic, cadmium, chromium, mercury, antimony, and lead have been found in American rice


Branched-Chain Amino Acids (BCAAs)

The Italian and Argentinean cows were raised on grass from birth to slaughter in eighteen months. The meat is pink and homogeneous. These steaks taste phenomenal, but they’re a little on the tough side. The US cow, on the other hand, was raised on corn from birth to slaughter in six months. Corn fattens them up faster, so they can go to market sooner—good for cash flow.

How does corn perform this magic? It’s replete in valine, leucine, and isoleucine, known collectively as branched-chain amino acids, or BCAAs.

If you’re a bodybuilder, you need lots of them. But what if you’re not? What if you’re a mere mortal, and you consume more BCAAs than your muscles need? The excess travels to the liver to be metabolised for energy. There, the amino group is removed by an enzyme called branched-chain amino-acyl transferase (BCAAT), where they’re turned into organic acids like oxaloacetate. They then enter the mitochondria either for burning or to be turned into liver fat. Like fructose, this can predispose people to insulin resistance.


Omega-6 Fatty Acids:

A rapid switch to seed oils occurred in the 1980s—and our diet became replete in omega-6 fatty acids through industrial processing of corn and soybean oils. The problem is that omega-6 fatty acids are pro-inflammatory.

Nutritionists talk about our omega-6 to omega-3 ratio as an index of inflammation balance; it’s supposed to be 1:1. On a processed food diet, this rises to 20:1. The good news is that grass-fed animals have lower levels of omega-6s and higher levels of omega-3s, so consuming less processed options can bring your ratio closer to 3:1


Cooking Your Goose

Perhaps the most neglected but insidious adulterations are what we do ourselves in the process of cooking.

Trans-fats are very low in Real Food, but you can make them right on your stove from any unsaturated fat. In fact, you can turn one of the healthiest fats in your kitchen (olive oil) into the deadliest (trans-fat) with just extra heat. The reason? Unsaturated fats have cis-double bonds. If you heat an unsaturated fat past its smoking point, that cis-double bond can isomerise (flip) into a trans-double bond, and voilà—a trans-fat.

The lower the oil’s smoking point, the easier it is to turn it into a trans-fat. Extra virgin olive oil has the lowest smoking point of all the fats, at 160oC

Even though lard got a bad name as a saturated fat, it’s way safer to fry in than any other oil. This cis-fat to trans-fat conversion is probably one of the biggest conundrums in trying to sort out nutritional epidemiologic data, because investigators can’t measure how hot the stove is in each kitchen.


Polycyclic Aromatic Hydrocarbons (PAHs)

There’s no doubt that PAHs, which are found in coal and gasoline, lead to cancer.

Essentially, PAHs bind to DNA bases, generating oxygen radicals, which can cause cellular mutations. Of course, PAHs from vehicle exhaust and tire erosion promote lung disease and various cancers, but barbecuing or even smoking your meat leads to PAH formation as well.


Dietary Advanced Glycation

End Products (Dietary AGEs) and Acrylamide Glycation occurs naturally in the body and in food—especially in response to heat. Have you ever made slow cooker caramel? You take white sweetened condensed milk in a can, heat it very hot, and you get brown caramel. This is because the heat drives the Maillard reaction to cause the glucose and fructose to bind to the milk proteins, which makes AGEs. This happens in many processed foods, because heating is a method for killing bacterial contaminants.

One particular dietary AGE, called acrylamide, has garnered the most attention. It is formed when carbohydrate and fat meet at high temperature. It’s one of the things we love about French fries—that great crunch. Acrylamide is also a by-product of the coffee roasting process.


Raw Data To cook or not to cook?

Raw restaurants have been popping up in trendy urban areas, primarily with a vegan menu. Ostensibly, eating raw food is better for nutrition, since heating can destroy as much as 50 percent of vitamins B and C. But of course, this has to be balanced against the inactivation of any viruses or bacteria during cooking.


Chapter 19 Food Subtractions

Real Food is chock-full of all sorts of health-promoting biochemical bonuses. Why in the world would Big Food want to strip it of its inherent nutritional value? Well, for one, the micronutrients themselves aren’t all that tasty, and two, these compounds are metabolically active. Upon exposure to oxygen they either lose potency or turn rancid, or both.


Fiber One or Fiber Zero

What do all grains share? Bran, endosperm, and germ. Jones demonstrated that, during the process of milling, between 20 and 30 percent of the weight of the grain is the husk, the fiber. That’s a lot of waste.

Fiber is perhaps the single most important nutrient for health, because it both protects the liver and feeds the gut. Yet it’s the nutrient you don’t absorb, because the fiber isn’t for you, it’s for your gut bacteria. You have to consume it to make them happy. You’re not eating for two—but for a hundred trillion.

You can mill the kernel, but now the protective husk has been breached; the starch is out and readily available for digestion and absorption, thus raising the glucose and insulin response. The processed food industry can claim that their product is whole grain because it started with whole grain, but it’s not what’s in the food, rather it’s what’s been done to the food that really counts.


What happens when we make Juice:

When intact, the fiber in Real Food does double duty in both protecting the liver and feeding the gut. The best fiber is the combination of both soluble and insoluble fiber, and that’s pretty much everything that comes out of the ground—until it’s processed.

Insoluble fiber doesn’t freeze well. To see for yourself. Take an orange, put it in the freezer overnight. Take it out the next morning, and let it thaw. Then try to eat it. It’s not an orange anymore. It’s turned to mush. The ice crystals have macerated the cell walls of the orange, so that upon thawing, the water rushes in, destroying the texture of the orange. Of course, Big Food knows this. So what do they do? They squeeze it and freeze it. Now it lasts forever and there’s no depreciation. They’ve turned an orange into a commodity, that is, storable food.

Is anything lost nutritionally in the process of juicing? The answer is an emphatic yes—all of the insoluble fiber is now gone. The soluble fiber alone still has some benefit; orange juice moves the food through the intestine faster (to generate the satiety signal sooner), and the soluble fiber can be converted to short-chain fatty acids.

What about smoothies? The blades of the Vitamix, Breville, or Magic Bullet shear the insoluble fiber to smithereens, same as juice. As a result, the fiber can’t assemble the latticework for the gel in the duodenum—so it’s not protecting the liver from the onslaught of the sugar in the fruit smoothie.


Raiding the Goodie Bag:

The bran surrounding the wheat kernel provides one kind of health benefit, while the germ confers a second. It’s a little goodie bag filled with cofactors needed to keep the eight subcellular pathologies at bay. When you make bread or any grain product, our current methods of processing strip away all the good stuff.

Antioxidants such as vitamins C and E, carotenoids, and alpha-lipoic acid within the germ are also removed during processing, which are then thrown away along with the fiber fraction or are diverted to nutritional supplement companies who isolate and sell them under their own brand.


Grass and Omega-3s

Omega-3s are fish oil, not snake oil. Omega-3s might just be the healthiest thing you can put in your mouth. There are two kinds—docosahexaenoic (DHA) and eicosapentaenoic acids (EPA)—both of which reduce the inflammatory response in the fat cell and prevent the release of free fatty acids.

Omega-3s also indirectly affect serotonin release from nerve terminals throughout the brain. When the area surrounding the nerve terminal releasing serotonin is inflamed, it inhibits serotonin release, which may explain why people whose bodies and brains are undergoing inflammation tend to be so irritable, even if they’re taking an SSRI or other antidepressant.

So, where are omega-3s in the diet? Normally they’re found in fish, but not just any fish—wild fish. When omega-3s are made by algae, wild fish eat the algae, and in turn we eat the fish. However, farmed fish eat corn—filled with omega-6s and branched-chain amino acids. You can also get omega-3s from eggs, but only from pasture-raised chickens, because they’re eating grass as opposed to corn feed.


Chapter 20 Food Additions

The ultra-processed food industry adds chemicals at various points. They may add it to the animal while it’s maturing to prevent infection, or they may add it to the plant while it’s growing to prevent infestation. They may also add chemicals to the food during processing for flavor, color, texture, and/or preservation. In any case, when they add it to the animal or plant or food, they add it to you as well.


Germ Theory

Feedlot animals eating corn are not only carbohydrate- and BCAA-overloaded, but they’re also micronutrient malnourished, which leaves them open to infection. Furthermore, pathogenic bacteria can take hold in the unsanitary conditions of confined feedlots, so animals are routinely given low doses of antibiotics to prevent sickness, promote rapid growth, and therefore maintain cash flow.


Flavour Enhancers

Today, everyone expects bold flavours from their food. Scratch cooks can add spices. But processed food companies have to appeal to a wide array of palates, and many of those spices lose potency on the shelf. The industry has instead developed flavour enhancers to pique the palate of processed food consumers.



Diacetyl is used as a butter flavouring in microwave popcorn and butterscotch. It easily decomposes to acetaldehyde, which is a known lung and liver toxin. Diacetyl is also associated with a severe and irreversible respiratory condition called bronchiolitis obliterans, which leads to inflammation and permanent scarring of the airways.



Bromate Potassium bromate is used to strengthen bread and cracker dough, helping it rise during baking. It’s listed as a known carcinogen by the state of California, and a possible carcinogen by the International Agency for Research on Cancer. The process of baking converts most of the potassium bromate to benign potassium bromide, but not necessarily all of it.


Natural Flavors

Did you ever wonder what a “natural” or “artificial” flavor was? Aside from salt, sugar, and water, natural or artificial flavor is the most commonly listed item, appearing on one out of seven food ingredient lists on the Nutrition Facts label. But what are they exactly? They’re chemicals, and the company doesn’t have to tell you what’s in it, and the FDA doesn’t require them to. Since most flavors are nonpolar, it usually means there’s an emulsifier (e.g., polysorbate 80), a solvent (e.g., propylene glycol), and a preservative (e.g., butylated hydroxyanisole; BHA), although it could be several of one hundred different items.



Lecithin (chocolate), polysorbate 80 (shortening), carboxymethylcellulose (salad dressing), and carrageenan (ice cream) are added to foods to maintain food consistency upon storage. After all, who wants clumpy ice cream? These molecules have one polar end and another nonpolar end, so they’re able to bind fat and water together to keep them from separating.


Butylated Hydroxyanisole (BHA) and Butylated Hydroxytoluene (BHT)

These are standard preservatives for chips and meats. However, the International Agency for Research on Cancer categorizes BHA as a possible human carcinogen, and it’s listed as a known carcinogen under California’s Proposition 65.


Propyl Gallate

Propyl gallate is a preservative in products that contain fats, such as sausage, vegetable oil, soup bases, and even chewing gum. There’s some evidence that suggests it may also have estrogenic activity.


Nitrates and Nitrites

Nitrates and nitrites are the preservatives in cured meats, such as bacon, salami, sausages, and hot dogs. Although they can prolong a food’s shelf life and give it an attractive hue, they’re directly implicated in human disease.



Trans-fats were probably the single most important reason for the advent and success of processed food. Invented in 1911, the first trans-fat, called Crisco, hit the market, and by 1920 virtually every bakery product sold in America was laced with it, since it acts as a preservative and a hardening agent. Trans-fats can’t go rancid, because the trans-double bond can’t be oxidized by bacteria, as they don’t possess the enzyme to cleave it.


Chapter 21 Food Addictions

There’s no doubt that we eat more than we used to. But why? We have a negative feedback system in our brains called leptin, which, until fifty years ago, told us that we had enough energy to burn, and therefore prevented us from overeating.

As explained earlier insulin blocks leptin signaling (leptin resistance) at the hypothalamus, mimicking brain starvation, which causes us to overeat in an attempt to drive the leptin level higher.


Fast Food Nation

Americans have a notable penchant for fast food, with up to 37 percent of adults consuming it daily. Fast food, known for its highly processed nature, typically lacks essential nutrients and fiber, but is designed to appeal to the taste buds with eye-catching packaging.

Four specific ingredients in fast food have been scrutinized for their potentially addictive qualities: salt, fat, caffeine, and sugar.

Salt: Traditionally, salt intake in humans is seen more as a learned preference rather than an addiction. Fast foods, however, are notorious for their high salt content, which contributes to their energy density and caloric value. Interestingly, studies indicate that people can adjust their palate to prefer less salty foods. This adaptation has been observed in teens who cut back on salty pizza and in hypertensive adults who switched to a low-sodium diet over a period of eight to twelve weeks.

Fat: The high fat content in fast food is a key factor in its appeal. Some individuals may exhibit a ‘high-fat phenotype,’ marked by a particular fondness for high-fat foods and a diminished sense of fullness after consuming them, which can be a contributing factor to obesity.

Caffeine: Caffeine is recognized as a classic substance of dependence, fulfilling all the criteria for addiction across different age groups, including children, teens, and adults. Habitual caffeine consumers not only develop a tolerance but can also experience physical withdrawal symptoms when attempting to abstain from it.

Sugar: Apart from caffeine, sugar scores highly on the Yale Food Addiction Scale (YFAS). Adding a soda to a fast food meal can multiply its sugar content by ten times. Multivariate analyses have found that soft drink consumption, rather than the intake of animal products, is more closely linked with changes in Body Mass Index (BMI).


The addictive qualities of Sugar:

Animal studies also show that sugar, and specifically the fructose molecule, is addictive. Sugar administration induces behavioural alterations consistent with dependence (i.e., bingeing, withdrawal, craving, and cross-sensitisation to other drugs of abuse, consistent with addiction). Indeed, sweetness surpasses cocaine as a reward in rats. In fact, addicting rats to opioids makes them binge on fructose instead, because of alterations in the reward centre, and especially in adolescent rats.

The hedonic nature of sugar is also revealed by examining its economics. For instance, coffee is price-inelastic (i.e., increasing price doesn’t reduce consumption). For example, when prices jumped in 2014 due to decreased supply, Starbucks sales didn’t budge an inch. As consumables go, soft drinks are the second most price inelastic, just below fast food. Raise the price 10 percent (e.g., with taxes), and consumption drops only 7.6 percent, mostly among the poor, as we saw in Mexico.


What’s necessary for survival:

It’s true that certain foods are necessary for survival—while others aren’t. We need essential nutrients that our body can’t make out of other nutrients, but there are only five classes: 1) essential amino acids (nine out of the possible twenty found in proteins); 2) essential fatty acids (such as omega-3s and linoleic acid); 3) vitamins; 4) minerals; and 5) fibre.

Furthermore, none of these essential nutrients are remotely addictive. Of the hedonic substances found in food, only alcohol, caffeine, and sugar are addictive—and these are food additives, not foods in themselves.


Sugar is a drug:

When you process and purify something, you change its properties. Coca leaves are medicinal in Bolivia, but cocaine is a drug. Opium poppies were medicinal, but heroin is a drug.

Refined sucrose is the same compound found in fruit, but the fibre has been removed, and it’s been crystallised for purity. This process of purification turns sugar from food into drug, just like alcohol and caffeine.


Chapter 22 Food Fraud

When asked to comment on food fraud, an executive of a well-known food manufacturer said, “We don’t want our company name and the words ‘food fraud’ in the same sentence.” Right. Don’t ask, don’t tell. This is the food industry’s dirty little secret, and they’ll do anything to keep it that way, because all food companies trade on trust.

We could literally be consuming anything and everything known to man—I’m sure some things not even known to man!—and remain completely oblivious to it.

Still think your food is what you thought it was? OK, here’s your reality check—is the farmed salmon really pink, or is it the food dye astaxanthin?

Are there only tea leaves in that tea bag? Is that ground coffee really 100 percent ground-up coffee beans or was something else mixed in? How about the spices? You’re constantly being cheated without even knowing it—and sure, sometimes it doesn’t matter, but other times it will cause you to inadvertently compromise your buying, religious, and health practices.


Guilty of Passing Bad Food

Food fraud is literally defined as “misrepresentation as to the state of the food.” There are six different forms of it and some engender health risks while others don’t, but they all share three things in common—alteration of the food itself, lying to the consumer, and a profit motive.

Below are six examples of food fraud that reached your restaurant’s or grocery store’s shelves without your knowledge:

1. Dilution/adulteration. Something is added to the food to disguise or extend it. Another dilution is olive oil; it’s estimated that up to 80 percent of Italian virgin olive oil is neither Italian nor virgin.

2. Substitution. It’s common for restaurants or food stands to substitute something of lesser value in an attempt to reap a higher profit. Vendors in New York City got caught selling beef gyros or goat gyros advertised as lamb; this occurs more frequently when the meat is shredded and mixed together.

3. Intentional contamination/concealment. An example is Parmesan cheese. In 2012, cellulose, a by-product of wood digestion, was added to several brands; in fact, one brand didn’t even have any cheese in the product at all.

4. Country of origin. Many food items are prized because they come from unique places. But what if that place isn’t so unique? For instance, beer-battered pollock might come fresh from the waters of Alaska, or it might come frozen from a basin in China.

5. Organic. You might think that buying organic would save you from fraud. You would be wrong. The markup on organic is enormous, anywhere from 25 percent for avocados to 65 percent for milk. Furthermore, there’s a clear economic impetus to mark individual items as organic, as the only way to be caught is through laboratory analysis.

6. Counterfeiting. Perhaps the most brazen of all food fraud occurs in the luxury space. Finding out that some high rollers were duped by the counterfeiting of rare wines and scotches may give you a moment of schadenfreude satisfaction, but this is a very alarming issue.


The Decline of the American Hive

Another frequent fraud is honey, which is in increasingly short supply.

The people who buy honey from around the world and put it in bottles are called packers. Most packers blend foreign honey with domestic, but the foreign honey (especially that coming out of Asia) is adulterated. So perfectly good domestic honey is cut with several different kinds of sugars to dilute the product, many of which are not detectable by testing.

Food fraud is already negatively impacting us, economically and environmentally. We just don’t know about it because of the forces at play to cover it up.


Big Food’s Albatross

You might think food fraud would be the purview of just a few bad apples, but it’s even more prevalent with processed food, where the source and identity of individual food components can be a “trade secret.”


Don’t Make a Federal Case

When it affects public health (think melamine), we expect our USDA and FDA to spring into action. But do they? Can they? The FDA has largely steered clear of the issues of processed food fraud because they don’t have boots on the ground in every food-producing country in the world, and their charter is to ensure food is safe, not authentic.

In the UK, the food industry plays nice with the regulators—that way, if they get caught, they can ante up a settlement and keep it out of the newspapers. Their business is based on trust, which could be rapidly undermined if consumers really knew just how pervasive food fraud is.

Big Food, trade associations, and some academics remain in an unholy alliance to cover up and paper this over. How are they entitled to self-regulate when they’re complicit in deceiving the public? But here’s the real problem: why is Big Food more worried about consumers’ trust regarding food fraud (which rarely kills), but less concerned about consumers’ trust about processed food and NCDs (which kill millions)? Because it’s easier for the public to understand and be horrified by horsemeat, rather than the science behind what will actually poison, addict, and kill them.

Right now, Big Food’s methods for detecting and remediating food fraud rest with the corporate executives in charge of safety, who aren’t fraud professionals. Rather, the food fraud professionals are those in charge of risk management, supply chain security, procurement, brand protection, and international law. They’re trained to combat fraud, but corporate execs are under orders to buy food at the lowest possible price, with the magical expectation that the food they are buying is authentic and high quality. Every day they go to work inherently conflicted.

Big Food’s procurement system is like the Wild West; they’re at the mercy of other countries who supply us. But why does Big Food outsource in the first place? Big Food has done the cost calculations down to the hundredth of a penny. Legitimate producers who grow or procure authentic food can’t compete with cheap imports.

Just wait for the mistake that costs lives. It happened with Katrina, Sandy, and coronavirus. It will happen with food fraud. Consumers will demand explanations, and Big Food will finger-point at the USDA, who will finger-point at the FDA, who will finger-point right back. At the end of the day, consumers must realize how vulnerable they really are.


Food Sleuths

Testing for food fraud is very much in its infancy. DNA testing for seafood and meats is well established, but labs struggle when food is in liquid or ground-up form.

There are only a handful of food testing laboratories around the world who do food authenticity testing. They use sophisticated technologies that can run in the millions of dollars, like nuclear magnetic resonance spectroscopy (NMR) to identify certain sugars, or liquid chromatography–mass spectrometry (LC-MS) to measure pesticides and antibiotics. These tools have great potential, but like most technology, they’re only as good as the data that goes into them.

Therein lies the problem. Without the intelligence about how food fraud is being committed, the tools are nothing more than expensive toys. Science can provide evidence, but intelligence is the key to providing cause, placement, and authenticity. Science alone cannot keep up with the criminals.

Since the horsemeat scandal of 2013, the UK has tried to share information with the US about food fraud. However, producers, retailers, academics, and law enforcement have conflicting interests, and don’t trust one another. Laboratories are supposed to be independent of food industry funding, but they take dirty money anyway.


What can you, the consumer, do to protect your health and your wallet from food fraud?

There are three precepts to remember:

  1. The more ingredients, the more risk (e.g., salted peanuts have three ingredients, Oreos have eleven ingredients). Avoid highly processed food.
  2. Buying organic may decrease your risk for cancer, but it increases the risk of fraud because fraudsters focus on organic due to the higher profit margin.
  3. Buy from the supplier directly (e.g., the farmer or the farmer’s market). Fewer middlemen mean fewer entities jacking up the price and people to hide behind, as well as more direct and face-to-face responsibility to the consumer.


Part V Where Are the Food Police When You Need Them?

Chapter 23 The Party Line

The sugar industry is one of the most egregious villains in the bunch. Based on our current recognition of sugar’s toxicity and their responses to litigation thus far, one might assume that Big Sugar learned its tricks from Big Tobacco. But it’s actually the other way around—the Sugar Research Foundation was founded in 1943, and one of its executives, Dr. Robert Hockett, peddled his manipulation tactics to the Tobacco Industry Research Committee in 1954. In any case, the playbooks are almost identical—deny, deflect, distract, delay.

The entire processed food industry has adopted this policy. Some tactics involve influencing scientists, others influence public opinion, and even more influence governments and the courts.


Distracting away from the real problem.

As we explored earlier we have the data to demonstrate that processed food is a primary causative factor for diabetes, fatty liver disease, heart disease, and tooth decay; correlative for cancer, dementia, hypertension, addiction to other substances, and depression; as well as plausible for autoimmune disease and anxiety. But when the food industry addresses these issues in public, they only refer to the “obesity epidemic.” Until about 2010, they ignored the problem entirely, deflecting the issue back to the consumer and using the tobacco industry meme of “personal responsibility.”

The industry regurgitates its mantra that “a calorie is a calorie”; therefore it’s about energy balance, gluttony and sloth, diet and exercise, and if you’re fat, it’s your fault. Yet, when weight and calories are factored out, the correlation between sugar consumption and diabetes becomes much stronger—in other words, the effect of other calories on weight gain dilutes out the specific effects of sugar on diabetes.


Following the money.

The sugar industry has a long history of co-opting scientists. My UCSF colleagues Cristin Kearns, Laura Schmidt, and Stanton Glantz have discovered the paper trail of influence by the Sugar Research Foundation.

More recently, an analysis of Web of Science citations from 2008 to 2016 identified 779 articles with Coca-Cola conflicts of interest regarding funding. A subsequent comparison with Coca-Cola’s own transparency website (established in 2016 after the New York Times exposé on the Global Energy Balance Network) identified 128 articles and 471 authors who weren’t disclosed by Coca-Cola, as well 19 academic investigators who had direct email contact with the company.


Obfuscating scientific research.

One would expect the totality of evidence on the detrimental effects of sugar to be reflected in systematic reviews or meta-analyses; however, many of these publications yield inconsistent results. It’s a classic rewrite of the tobacco playbook. One problem is that many of these studies are funded by the food industry, with the intention of diluting the available data, specifically to paper over any significant effects.

We shouldn’t be surprised to find that studies funded by industry are 7.4 times more likely to show a favorable conclusion, and in cases when the data didn’t fit the industry’s narrative, they just deep-sixed it.



Co-opting public health experts.

For years as part of their public relations machinery, soft drink companies would push lack of physical activity as a cause of obesity. However, the evidence reveals that the impact of physical activity on chronic disease is minimal. You just can’t outrun a bad diet.


Influencing Public Opinion—the Meme of “Personal Responsibility”

The concept of “personal responsibility” as it relates to energy balance and obesity is a controversial one, often interpreted as a blunt assertion that being overweight is solely an individual’s fault. This viewpoint, however, ignores several critical factors necessary for a person to genuinely exercise personal responsibility: knowledge, access, affordability, and the broader impact of one’s actions on society. If any of these elements are lacking, the notion of personal responsibility becomes questionable.

The origin of this ideology is intriguing. While some might argue it has divine or historical roots, its strong association with modern consumer behavior can be traced back to the tobacco industry. In 1962, this industry adopted the mantra of personal responsibility to shift the focus away from corporate accountability, using it to justify continued smoking and making it a part of popular culture, epitomized by figures like the Marlboro Man. The food industry later adopted this approach, emphasizing personal choice in a realm where, unlike smoking, eating is not optional.

  1. Knowledge: Trusting the food industry to accurately inform consumers about healthy choices is problematic. Many people are unaware of what they’re consuming. The Nutrition Labeling and Education Act of 1990 introduced our current food labels, intended to inform consumers about the contents of their food. However, these labels often fail to highlight how the food has been altered or processed in potentially harmful ways.
  2. Access: With about 74 percent of supermarket foods containing added sugar, avoiding such ingredients is a significant challenge. Processed foods are ubiquitous, found everywhere from workplaces to schools, making them a common, yet potentially unhealthy, dietary staple.
  3. Affordability: Even if someone desires and can access healthier food options, they must also afford them. Studies have shown that fresh produce and whole foods are substantially more expensive than processed alternatives. This disparity in cost also extends to the time and resources needed for meal preparation, making it a broader social justice issue. For those juggling multiple jobs and family responsibilities, cheap and convenient food options are often the only viable choice.
  4. Externalities: The idea that individual actions have no broader societal impact is flawed. Similar to how smoking affects not just the smoker but also imposes financial burdens on their employer, the wider societal costs of obesity are substantial. Employers bear additional costs due to obesity-related health issues, impacting the economy and healthcare system.

In summary, the simplification of obesity and weight management to a matter of personal responsibility overlooks the complex interplay of various factors that influence an individual’s ability to make healthy choices. This perspective fails to account for the broader socio-economic and environmental contexts in which people make decisions about their diet and health.


Influencing Government and the Courts

In the 1960s Ralph Nader and Unsafe at Any Speed (1965) spearheaded the American consumer movement. Environmentalism was gaining speed. Regulatory agencies like OSHA and the EPA were founded. Distrust of Big Business was at its peak. But then in the 1970s something happened. Big Industry, of which Big Food is a major player, started to wage a propaganda war in the halls of Congress and the Supreme Court to take back what they viewed was rightfully theirs. How did they do it?

Disinformation campaigns and legislation.

The 1970s also saw the rise of the American Legislative Exchange Council (ALEC), a bill mill that writes legislation beneficial to the oil, pharma, tobacco/alcohol, and food industries. Through contributions from affiliated groups and individuals, it effectively pays off congressmen to introduce these bills in order to make sure the playing field is not kept level, that these industries are protected. This goes all the way to the top.

Trade organizations.

Trade organizations are sponsored by many companies within an industry to lobby and further the needs and profits of the industry as a whole.

Scientific organisations.

In Australia and New Zealand, there’s the Sugar Research Advisory Service, renamed the Sugar Nutrition Resource Centre. The claim is that this is a scientific information service for health professionals, academics, and the media that aims to provide “an evidence-based view of the role of sugars in nutrition and health.” It is fronted by academics and health professionals receiving money directly from the industry, and is blatantly pro-sugar.

When Nonprofits Profit

Perhaps the most egregious organization of all is the International Life Sciences Institute (ILSI). Its mission, according to its website, is “to provide science that improves human health and well-being and safeguards the environment.” This organization, though nonprofit and private, is really a corporate lobby group.

Astroturf groups are “citizens” or nonprofit groups that mask their sponsors to appear as though they’re grassroots organizations. The U.S. Center for Organizational Research and Education (CORE; formerly the Center for Consumer Freedom) is an organization with a name deliberately designed to divert attention away from industry connection. They claim to be “dedicated to protect consumer choices and promoting common sense.” In fact, they’re funded by the fast food, meat, alcohol, and tobacco industries.


Chapter 24 The USDA and the FDA Don’t Kill People; Rather They Let Them Die

The USDA is the political arm of the food industry, and the FDA is the political arm of the drug industry. The USDA is supposed to support American agriculture in all its guises and to all its consumers, including you. The FDA is supposed to make sure your food and drugs are safe and effective. Both organizations are supposed to be independent of the industries they regulate, yet they do their bidding. Known as “agency capture,” both have a revolving door policy between government and industry about hiring and lobbying. Furthermore, the heads of both come from the private sector and return to it.

USDA and DGAC Starting in 1977 with the McGovern Commission and every five years since, the USDA has issued successive sets of its Dietary Guidelines for Americans. The USDA’s charter of 1862 entails two roles: to ensure a sufficient and reliable food supply; and to provide useful information on subjects related to agriculture.

Commensurate with the initial 1977 guidelines, American (and indeed global) health has declined, as measured by increasing obesity and chronic disease rates, as well as reduction in life span and health span. The percent of GDP spent on healthcare also rose from 7 percent to 17.9 percent.

Those original 1977 guidelines have been exposed for the sham that they were—the McGovern Commission first issuing a missive to “eat less fat, salt, and sugar,” but after concerted pressure from the food industry, changed to “eat more low-fat alternatives,” which inherently meant people ate more sugar to make their food palatable.

What the DGAC said and what the USDA did with what they said were two completely different things. At the end of the day, DGAC is advisory, not enforceable. They have no teeth. And they’re not allowed to complain to the USDA about it. The food industry appoints half the committee. Needless to say, I was not appointed.

American agribusiness produces 3,900 calories per person per day, but Americans can only eat 1,800 to 2,000 of them. Where does all the excess food go? The Supplemental Nutrition Assistance Program (SNAP; also known as food stamps), run by the USDA, is designed to “provide improved levels of nutrition among low-income households.”

Where does such a determination on expenditures come from? It’s based on what the USDA considers a nutritionally adequate diet at minimal cost. We already know what the USDA considers adequate nutrition.


FDA and Food Safety

The FDA is supposed to guarantee the safety of our food supply. It’s in their charter—the Food, Drug, and Cosmetic Act (FDCA) of 1938. But when it comes to food, the charter only provides for screening for acute toxicity—things that will make you keel over and die,

But nowhere does the FDCA mention chronic toxicity, where one exposure isn’t toxic but rather cumulative exposure will kill you. This loophole lets the food industry get away with all sorts of slow murder.

A perfect example is tobacco. Do cigarettes kill? Yes, but not one, and not today, and not even tomorrow; but ten thousand smoked over ten years just might. As a result, the FDA couldn’t and didn’t regulate tobacco, because it didn’t fit under the heading of “acute toxicity.”


FDA and Food vs. Health Claims

The FDA does exercise some regulatory authority over food labeling, ensuring that companies can’t make completely false statements, such as denying the presence of allergens like peanuts in products processed with them. However, the nuances of FDA regulations allow food companies to navigate a fine line between outright deceit and suggestive marketing, particularly in the way they use structure-function claims versus health claims.

Structure-function claims are statements on food packaging that avoid directly referencing diseases. Phrases like “Now with vitamin C,” “Helps build strong bodies 12 ways,” “Good source of fiber,” or “Calcium builds strong bones and teeth” fall into this category. These claims hint at health benefits but stop short of explicitly stating them, thus not directly implicating any disease or health condition.

Health claims, on the other hand, explicitly mention specific diseases or health processes. When a product claims to “help prevent osteoporosis” or asserts that it “helps reduce heart disease,” these are health claims. The FDA closely monitors and regulates these statements, requiring companies to back them up with scientific evidence.

The challenge lies in the gray area between these two types of claims, where the food industry often employs creative language to imply health benefits without making direct health claims, thus evading stricter FDA scrutiny. An ongoing legal debate, for instance, revolves around what constitutes “lightly sweetened” and how much sugar this includes, with products like certain cereals being at the centre of this controversy.

Another tactic used by some companies is to ignore FDA guidelines altogether, as seen in the use of the term “evaporated cane juice” (ECJ). Marketed as a healthier option due to its “juice” label, ECJ is not officially recognised by the FDA, which only sanctions ten specific sweeteners.

Additionally, the FDA’s guidelines on what constitutes “healthy” are also controversial. According to the FDA, a food product is considered “healthy” if it is not low in total fat but predominantly contains mono- and polyunsaturated fats, or if it provides at least 10 percent of the Daily Value of potassium or vitamin D. This definition, however, doesn’t necessarily align with broader nutritional perspectives, especially concerning ultra-processed foods.

The term “natural” is another contentious label. While many consumers equate “natural” with “organic” (a legally defined term) or inherently healthy, the FDA has not formally defined “natural.” This leads to confusion, as even refined sugar, despite its known health risks, could be considered “natural” by some, blurring the lines further in consumer understanding.


Generally Recognised as Safe (GRAS) list.

GRAS, an acronym for “Generally Recognized as Safe,” is a classification created by a 1958 congressional act to simplify the regulation of various food additives, bypassing specific FDA scrutiny. According to U.S. law [U.S.C. 321(s)], a substance is deemed GRAS if it is widely acknowledged by scientifically trained and experienced experts as safe for its intended use, based on scientific analysis or, for substances used in food before 1958, established safety through general use in food. The crucial concept here is “intended use,” which implies a considered dosage, including a maximum limit.

This concept echoes the words of Paracelsus in 1537: “the dose determines the poison.”

Before 1997, companies needed to petition the FDA to have a substance approved as GRAS. However, the process has since been privatized, and there’s no longer a centralized GRAS list. Nowadays, a group of scientists, often funded by the very company proposing the substance, can simply convene and declare a substance GRAS without any obligation to inform the FDA. It is believed that over three thousand items on the current GRAS list haven’t been formally reviewed, and for about a thousand of these, the FDA may not have been notified. This raises significant concerns about transparency and disclosure.

Terms like “Healthy,” “Natural,” and “Generally Recognized as Safe” are often more about marketing spin than factual accuracy, potentially misleading consumers about the nature, content, and health implications of products. Furthermore, the USDA and FDA’s guidance on these matters often lacks enforcement power, raising questions about their effectiveness in regulation.

Regarding nutraceuticals, a significant portion of the American population, including 77% of all adults and an even higher percentage among older individuals, regularly use dietary supplements. This rate includes about a third of children, perhaps indicating a need to replace micronutrients lost during the processing of food. These statistics highlight the widespread reliance on supplements in modern diets, underscoring concerns about the nutritional quality of processed foods.


USDA, FDA, and the Third Immoral Hazard

Since when has government led the public astray (before Trump)? And why? There’s a long history of screwups, but usually when the screwup becomes evident, someone fixes it. The cost of inaction is greater than that of action.

The government is co-opted by the profits they accrue on selling the industrial global diet to the rest of the world and by the international sale of the medicines of Big Pharma to try to assuage the guilt and the gore.

There’s also the money that funnels in from think tanks like the American Legislative Exchange Council, a political front group for the food and drug (and oil) industries—which pays off more than half of Congress. Taking money to keep people down—this is the third immoral hazard.

The icing on the cake of this third immoral hazard is that the USDA is doing everything it can to disavow its role by reducing its regulatory footprint, in order to give the food industry carte blanche.


Chapter 25 Real Food Is Good for the Planet

No notes for this chapter.


Chapter 26 Real Food Is Good for the Wallet

If you don’t have one of these preexisting conditions or an eating disorder, then the only reason you need a dietary supplement is that you’re not getting the micronutrients you need from your food. This only happens if you’re eating processed food, in which the vitamins, minerals, micronutrients, and especially the fiber have been stripped out.


Chapter 27 Un-processing Our Food Supply

There are lessons to be learned from tobacco and alcohol control. There are two general strategies: personal intervention (i.e., rehab), and societal intervention (i.e., laws). They’re both important, but neither works without the other.


What Doesn’t Work—Education Alone:

One the most important things we’ve learned from tobacco and alcohol policy research is that public education, despite being the most popular and necessary component of prevention, doesn’t work alone. Evidence from the US suggests that government labels warning consumers about the health effects of excessive drinking have no effect on alcohol consumption, but might have limited effect on risky drinking patterns, such as drunk driving.

Education alone hasn’t solved any substance abuse. It didn’t solve alcohol and it didn’t solve tobacco. It didn’t solve heroin or crystal meth or cocaine. And it’s not going to solve sugar.

Nonetheless, education is the cornerstone of successful intervention—it just doesn’t work alone. Rather, it softens the playing field, so that societal policy interventions can become acceptable and take hold.


What Does Work—the Iron Law

We must take a look at what works to reduce the consumption of addictive substances. Research on alcohol policy demonstrates that regulatory controls on pricing, marketing, and distribution are highly effective worldwide in reducing the negative impacts of consumption. This strategy has also been effective with tobacco—not perfect, but clearly better.

All of these policies build upon the premise of the Iron Law of Public Health, which clearly states: reducing availability reduces consumption, which reduces health harms. If you make bad stuff (like processed food) harder to get, people won’t get sick in the first place.

There are three ways to reduce availability: pricing strategies (e.g., taxation), restriction of access (e.g., blue laws), and interdiction (e.g., banning).


The public health criteria for regulation of a substance are:

Ubiquity. Sugar has been added to virtually every processed food, limiting consumer choice.

Toxicity. Every country consuming the Western diet has increased its prevalence of NCDs, and sugar is the driver. Fructose increases liver fat, drives the glycation reaction, and inhibits mitochondrial function, all of which underlie NCDs

Abuse. Sugar is clearly abused, because it’s addictive in a percentage of the population. Like tobacco and alcohol, it acts on the reward center to encourage subsequent intake. It also meets the criteria for tolerance and dependence

Externalities. Your consumption affects me, therefore I get to say something about it


Sin Taxes Aren’t about Sins, They’re about Dopamine

Which addictive substance is the cheapest to produce and procure, yet the most expensive burden to society? Nicotine used to be the cheapest. At its worst, lung cancer claimed 443,000 people a year and cost healthcare $14 billion annually. But it also made the US government lots of money, because the median smoker died at age sixty-four, before they started collecting Social Security and Medicare.

Even after the removal of ads from television, Big Tobacco still scored big; cigarette taxes netted $12.5 billion for the government.

Alcohol? Each year, alcohol causes ten thousand deaths from drunk driving and twenty-five thousand deaths from cirrhosis and other diseases, and underlies many other disorders—costing the medical system $100 billion annually. But it generates $5.6 billion per year for state and local governments in taxes.

Sin taxes have been around for about as long as there’s been sin. And they work. Society accepts them because they affect only people who use those products. In fact, when individual states run a deficit, a sin tax is often the first tax to which lawmakers turn to help them fill the budget gap.

The question is, what’s the real goal? Making money for the state? Or reduction in consumption? Because if you reduce consumption, you limit revenue generation. And it’s been shown that for a sin tax to work, it has to hurt.

Despite concerted efforts by the beverage industry to the contrary, soda taxes are now a fact of life in many countries. In fact, twenty-eight countries around the world have passed some form of sugar taxation—the most notable in the UK.

Furthermore, the American commodities market is rife with hedonic substances. In fact, numbers one (crude oil), two (coffee), four (sugar), five (cocoa), and eight (corn, which is turned into alcohol) are all hedonic. It drives our economy. Today, we tax cigarettes and alcohol, but the US government still subsidizes tobacco production.

Real Food costs more than processed food—usually double—so they’re selling cheap food that’s subsidized and making an enormous profit on it. The annual profit margin of the food industry prior to 1970 was 1 percent. Well, the population increased annually by 1 percent. In other words, they made money by selling the same per capita amount of food to more people.


Chapter 28 The Case for Real Food

But if processed food is so good, why are so many countries interested in its antithesis—sustainable agriculture and regenerative farming? Why are European banks and financiers starting sustainable food equity funds? Maybe because they know processed food isn’t so good after all?

The industry blames the consumer for choosing processed food over Real Food. Based on the percentage of food consumed in the US (62 percent processed), they have a point. But why do people choose processed food? Because it tastes better? Reduced spoilage and depreciation? Cost? Cooking and cleanup time? Marketing? Or maybe it’s just addictive? Big Food simultaneously exploits the two laws of marketing—give the public what it wants, and if you build it they will come.

It turns out, most people think that deciding what to make for dinner and then buying the ingredients is an enormous hassle. They want what is good for their household, but trying to pick out food based on health and ingredients is impossible, and the inadequacy of our current food label becomes overwhelming. They don’t know how to read packaging (wonder why—because there’s nothing on the label that’s worth reading? See Chapter 17), and they certainly don’t know how to make food choices based on it. When they enter the supermarket, it’s like walking into the opium den with a cacophony of voices on the endcaps of the aisles, shrieking “buy me.” They fall prey to the siren songs of the tortilla chips, soft drinks, and cookies.

There are only two potential losers in this game: Big Food and Big Pharma. The reason they currently make out like bandits is because of our current food model, which subsidizes the commodity crops that are the backbone of processed food, as well as our pharmaceutical model, which rewards pharma companies for abandoning acute care medicines like antibiotics in favor of chronic care medicines.


7 Shopping rules:

Here are the seven shopping rules to abide by, even before you walk into the store (or order online), that will keep you from stepping on any of the landmines the store has placed in your way.

  1. Don’t go shopping hungry.
  2. Shop the edges of the supermarket. If you’ve gone into the aisles, you’ve gone off the rails.
  3. If a product is on the endcap of the aisle, the company paid to have it placed there. Don’t be a stooge.
  4. Any food that has a logo you’ve heard of or any food with a Nutrition Facts label has been processed.
  5. If a product lists a structure-function claim on the package, don’t buy it. Example: any food that says low-fat or no trans-fats is poison, because something else is in there instead.
  6. If it doesn’t say whole grain, it isn’t. And even if it does say whole grain, it probably isn’t. If the carbohydrate to fiber ratio is greater than 10 to 1, don’t buy it.
  7. If any form of sugar is one of the first three ingredients, it’s a dessert.


Here are seven proposals that could be implemented immediately, if we had the political will to do it:

Nutrition education for the public should emphasise that there’s no biological requirement for, or nutritional value of, added sugar.

The industry should be forced to label “added sugars” (because that’s what they added!) on food products in teaspoons rather than grams, which will make it easier to understand.

There should be a complete ban of companies associated with sugary products from sponsoring sporting events.

Like alcohol and tobacco, there should be a ban on loss leading (discounting products) in supermarkets of processed foods and drinks.

Soda taxes should be everywhere, and should extend to sugary foods as well. The tax should be on the amount of the sugar, not the volume of the soft drink.

There should be a complete ban of all sugary drink advertising (including fruit juice) on TV and internet demand services.

There should be a discontinuation of all governmental food subsidies, especially commodity crops such as sugar, which have been shown to contribute to health detriments.