Transcript: Dr. Robert Lustig on Hostage Brain: Understanding Dopamine, Sugar Addiction, and Control – DOAC Podcast

And that area of the brain is known as the amygdala.

The amygdala is your fear center. It’s also your 24-hour sentry. But really what the amygdala is, it’s the point guard on your basketball team. So it surveys the entire court, sees the offense and the defense, and has to make split-second decisions who’s going to score.

Now, a lousy point guard takes all the shots. A good point guard passes off to the guy who has the best shot. A great point guard is going to be able to figure out if he’s going to score or if he’s going to pass it off to somebody else.

If you’re in control, your level of threat goes down. But really your control is an illusion. You really don’t have control. And the more you try to exert it, the more you realize you’re not in control. And what that does is that generates an enormous amount of stress and an enormous amount of pain.

Now that pain can turn inward and we call that depression. And right now, 29% of Americans are depressed and 4.4% of the entire world is depressed. These numbers were infinitesimal a generation ago, and they are basically just pushing up further and further. And the reason is because of this inappropriate illusion of control, and it’s causing an enormous amount of pain.

How do you mollify that pain? How do you basically deal with the psychological pain of lack of control that you yourself put upon yourself? Well, we have loads of ways: cocaine, amphetamine, nicotine, alcohol, sugar, gambling, social media, Internet gaming, pornography. Pick your poison. That’s dopamine.

Dopamine basically provides you with a little bit of pleasure on top of a whole lot of pain. The problem is that dopamine is addictive. And so when you apply a set of pleasures to try to deal with your pain of lack of control, that puts you into a never-ending cycle of consumption and misery. That’s the hostage brain.

Understanding Dopamine

STEVEN BARTLETT: What do I need to understand about dopamine in order to, because I think sometimes awareness is step one in being able to do something about a problem that you might have. So what do I need to understand about what dopamine is and what it’s doing in my brain and how it’s sort of associated with addiction to then be able to do something about it, which I consider step two?

DR. ROBERT LUSTIG: So dopamine basically has two functions. The first is learning. There’s no learning without dopamine. Anytime you learn something, whether it’s positive or negative, it’s because there was a dopamine release.

When you put your hand down on a hot stove when you were three years old and went, “Ah, I’m never doing that again,” that was dopamine that did that. And what it did was it went to your amygdala and it rewired it. That was a rewiring of your amygdala due to the excitatory neurostimulus of that dopamine affecting an area of your brain called the basolateral amygdala. And it laid down and it set up a circuit, and that circuit is still working in you right now.

So dopamine is the learning neurotransmitter. It can be for negative learning, it can be for positive learning. Either way, dopamine is also, when it’s going to another area of the brain called the nucleus accumbens, which is the reward center, that is a stimulus for reward. That is the motivation for reward. That is, in one word, foreplay. That is the excitement, the reason for continuing any given behavior.

You get both out of dopamine. And in short, small bursts, in the right venue, that’s how we navigate life. We navigate it through learning, and we navigate it through reward. You can’t do it without dopamine. Dopamine is good unless it’s bad. And as you know, everything in science is both good and bad.

The problem is chronic overstimulation of any neuron leads to neuronal cell death. Dopamine is a chronic stimulator. And so if you have chronic dopamine being released, what’s going to happen is you’re going to kill the next neuron.

Now, that neuron doesn’t want to die, so it down-regulates the receptors for dopamine so that it’s less likely that one dopamine over here is going to find the receptor over here to bind to, because there are fewer of them. So what this means is more and more for less and less. And we call that phenomenon tolerance. More dopamine, more tolerance. So the law of diminishing returns. So you get a hit, you get a rush.

STEVEN BARTLETT: Could be a sugar, alcohol, whatever it might be, pornography.

DR. ROBERT LUSTIG: Pick your poison, doesn’t matter. You get a hit, you get a rush, receptors go down. Next time you need a bigger hit to get the same rush, receptors go down. And then you need a bigger hit and a bigger hit and a bigger hit until finally you get a huge hit to get nothing. That’s called tolerance. And then when the neurons actually start to die, that’s called addiction. So tolerance is the start of addiction. And the problem is more dopamine, more tolerance, more tolerance, more addiction.

Sugar Addiction and the Brain

STEVEN BARTLETT: So people that are getting addicted to unhealthy foods and sugars and those kinds of things, what’s going on in their brain?

DR. ROBERT LUSTIG: So at first, the first time they taste it, whatever it is, whether it’s a Froot Loop or candy corn or Frappuccino or pick your poison, you get this big sort of sugar bomb going off in your head, and you go, “Wow, this is great. I want some more of this.”

STEVEN BARTLETT: And what is this?

DR. ROBERT LUSTIG: Bring it down, the whole Frappuccino. And what you’ve done is you’ve basically hit your nucleus accumbens with a big slug of dopamine, and you go, “Wow, that was great.” And then an hour later, it’s gone. And then you go, “God, I need that again.”

So the first time you got it, you liked it. The second time you did it, you wanted it. And the third time you needed it. So that’s the difference between liking and wanting and needing. Because liking, we all do and no one wants to take away liking. Wanting gets into problems because you can over-abuse things. Needing is when you actually have a biochemical and medical problem.

Breaking Free from Addiction

STEVEN BARTLETT: So with all of this in mind, if I’ve got a sugar problem or if I’ve got an addiction problem, I’m addicted to insert poison, what is the remedy? Just avoid it for a while? And then if that is the remedy, what’s going on in my brain? Is it fixing itself?

DR. ROBERT LUSTIG: There are many remedies, and they can all be used in conjunction with each other. Ultimately, the only thing that’s going to work is getting those dopamine receptors back up. Remember I told you dopamine down-regulates its own receptor. The only way you’re going to be able to fix the problem is for the dopamine receptors to come back up.

There’s a trend going on right now out in Silicon Valley, you may have heard of, called dopamine fasting.

STEVEN BARTLETT: Ah, okay, yeah, I’ve heard the word.

DR. ROBERT LUSTIG: Basically, people lock themselves up in a hotel room for three weeks. Don’t take a shower and, you know, basically take the TVs out of the room and try to commune with themselves and with nature with no stimuli, with no external stimuli in order to bring their dopamine receptors back up.

Particularly true of cocaine addicts because their dopamine receptors are way down. Because after all, cocaine is a dopamine reuptake inhibitor, so it’s flooding the zone with dopamine. Therefore, those receptors are down in the sewer.

Now, do you have to be that severe? No, of course not. But does it work? Takes three weeks. You want to do it for three weeks, then it works other ways. You can wean yourself off, you can do abstinence. And if you can do abstinence, that’s a good idea. Hard to do, especially when it’s staring at you and when it’s available 24/7, 365. Like sugar is. It’s everywhere. It’s on every street corner.

The Ketogenic Diet and Cravings

STEVEN BARTLETT: When I fast or when I do the ketogenic diet, I lose my apparent cravings.

DR. ROBERT LUSTIG: That’s right. Exactly right. And the reason is because no sugar in a ketogenic diet. So you’re basically removing the offensive stimulus.

STEVEN BARTLETT: I was so shocked. I love those cinnamon roll things. Not that I probably eat one every two years, but I love them nonetheless. I’m a big admirer, even though we don’t have a relationship anymore. And when I did the ketogenic diet for about, I was four weeks in of not having any sugar or carbohydrates, and I walked up to this concession in Cape Town with all these amazing cinnamon rolls that specialists and I looked at them and there was zero part of my brain that was interested in any of it. Zero part of my brain. And I was like, “Wow, my brain has been rewired or something just because I’ve removed sugar from my diet.”

DR. ROBERT LUSTIG: It happens, but it takes a while. It’s not something that you can turn on and off. It takes a fair amount of time, I will tell you that.

This is one of the things I did in my obesity clinic on a daily basis, was getting people off their sugar addiction. And sometimes you have to basically babysit them. You have to work with them and work with their parents in order to basically turn over the entire pantry because the sugar is hidden in all the foods. I mean, it’s the 262 names for sugar and the food industry uses all of them.

This is why we are trying to get sugar addiction and ultra-processed food addiction codified by the WHO and by the American Psychiatric Association as a bona fide diagnosis so that we can get remediation and therapy for people.

The Truth About Sugar Substitutes

STEVEN BARTLETT: One of the things that was one of the most popular parts of our conversation last time, Robert, was there’s a section where we talked about the different types of sugar and Diet Cokes and Coke Zeros and all these kinds of things. I can see a couple of cans on the desk over there where Jack is in the darkness that I can vaguely see. And these cans of fizzy drink, they all have some kind of sugar substitute?

DR. ROBERT LUSTIG: Yep.

STEVEN BARTLETT: Are those sugar substitutes harmless?

DR. ROBERT LUSTIG: No, of course not. A paper just came out three days ago in Annals of Neurology basically showing that non-nutritive sweetener consumption, so diet sweetener consumption, correlates with dementia. And we think we know why.

STEVEN BARTLETT: Why?

DR. ROBERT LUSTIG: Reactive oxygen species. So oxygen radicals, little chemicals that are given off from various substances that cause changes in energy metabolism in cells and also cause damage in cells. ROS, reactive oxygen species.

The famous ones are aspartame, sucralose. Now do monk fruit extract, do stevia, does allulose also cause reactive oxygen species? I very specifically looked for data on those, could not find it. But for aspartame and for sucralose, the two biggest ones that are available today, the ones that are used in a lot of diet drinks, huge amounts of ROS generation, reactive oxygen species generation. So anything that generates ROS contributes to dementia.

STEVEN BARTLETT: Is the evidence strong at this stage?

DR. ROBERT LUSTIG: Yeah, it’s pretty darn strong. I’m actually giving a talk about this next week in San Diego.

STEVEN BARTLETT: I heard you’ve got a new theory on the causes of Alzheimer’s dementia that’s somewhat linked. This is it?

DR. ROBERT LUSTIG: This is it. Yeah.

STEVEN BARTLETT: Can you explain that to me? And you’ve not talked about this publicly yet. You’re set to talk about it in a couple of days, right?

The Role of Mitochondria and ATP in Brain Function

DR. ROBERT LUSTIG: Here, let me take it back a step. There’s this organelle inside our brains called mitochondria. You’ve heard of mitochondria for your audience? Mitochondria, the little energy burning factories inside each of our cells. What they do is they take food energy and turn it into the chemical energy that your cell can actually use to power itself.

And that chemical energy has a name. It’s called ATP. Now, if you took biology in high school, you’ve heard of ATP. Adenosine triphosphate. The energy is in the phosphate bonds. So ATP will give up its energy and go to ADP diphosphate, which will then give up its energy and go to AMP monophosphate, which will then finally go to adenosine.

And adenosine binds to the adenosine receptor and makes you go to sleep. By the way, that’s where caffeine works. It blocks the adenosine receptor, keeping you awake so that the adenosine can’t bind to the adenosine receptor. So that ATP is the currency of the cell. That’s what makes the cell run. Anything that depletes ATP is going to put the cell at risk, because it doesn’t have the energy it needs to run.

STEVEN BARTLETT: Yeah, it’s gasoline.

DR. ROBERT LUSTIG: It’s like gasoline. So what happens when you start running out of gasoline?

STEVEN BARTLETT: Well, you break down.

The Energy Crisis in Brain Cells

DR. ROBERT LUSTIG: You’ll break down. So brain fog, difficulty concentrating, irritability, and ultimately all the way to depression. So the amount of ATP within any given neuron is the approximate cause of neuronal dysfunction that we see as neurocognitive and neurobehavioral change.

Now, how do mitochondria and how do reactive oxygen species fit into this? Mitochondria make ATP, but every time they make ATP, they also make reactive oxygen species. There are 11 steps in mitochondria and they all give off reactive oxygen species. Now, those reactive oxygen species are going to damage the cell. They have to be gotten rid of. They’re like toxic fumes, they got to be gotten rid of.

And so we have a pathway in each cell of our body to get rid of the toxic reactive oxygen species. They’re called antioxidants like glutathione, vitamin E, vitamin C, host of other flavonoids. Those basically quench those reactive oxygen species. They go to die. If you do that, then the reactive oxygen species basically just get funneled away and all is well and the cell can keep working.

But if for some reason those antioxidants aren’t up to par, if for instance, you’ve been eating ultra processed food and you can’t make your antioxidant complement, then the reactive oxygen species feedback and what happens is the reactive oxygen species are basically telling the cell, “Hey, you’re shunting too much energy down this pathway because I can’t clear them. So there’s too much stuff. So shut it down.”

And so what happens is that instead of funneling the glucose into the mitochondria to generate more ATP, it diverts it and it goes off into other directions like glycogen, which in the brain is not good, or fat, which is even worse. And bottom line, your cell is now not energy producing like it used to be. It has now been reduced in terms of its energy capacity. What’s that going to do? That’s going to reduce ATP generation. That’s step one.

Now step two, there’s this stuff called cortisol. Cortisol comes from stress, cortisol comes from sleep deprivation. Cortisol comes from exogenous glucocorticoids, like steroids being given to people for autoimmune disease or for other illnesses. That cortisol causes neurons to increase in metabolism, causes them to burn energy faster. So you now have an increased ATP utilization, so you have a decreased ATP generation. Now you have an increased ATP utilization. Now you’ve got an energy crisis inside each cell. Now your ATP can’t keep up with the needs of the cell. And when that happens, now you’ve got symptoms, whether it’s brain fog or irritability or all the way to frank depression.

The Path to Alzheimer’s Disease

Now step three. There are these proteins inside each neuron called amyloid precursor peptide. It’s a normal protein in all cells. Every cell in your body has amyloid precursor peptide. It needs to stay in solution. And in order for it to stay in solution, energy has to be applied to it in order to keep it in solution.

The minute the ATP in the cell goes down, they come out of solution and they start forming aggregates which we call plaques. And those plaques damage the cell, which then start an inflammatory process in the cells next door called the microglia in order to clean up the process. And now you’ve got plaques and an inflammation, and now you’ve got neuronal cell death. That’s dementia.

So it starts with an ATP energy crisis, moves through plaque and inflammation to generate neuronal cell death. Well, this is problematic to say the least. And by the way, anything that generates reactive oxygen species has been associated with Alzheimer’s, anything that increases ATP utilization, like stress, glucocorticoids, fever, autoimmune disease, also increases Alzheimer’s. So anything that increases step one, anything that increases step two ultimately leads to increased step three and Alzheimer’s.

STEVEN BARTLETT: So to simplify this in a couple of sentences for someone that has no scientific understanding, and we’re going to have to cut a few corners here scientifically in order for them to have a framework to understand it. How would you give me some sort of analogy for it, maybe in the context of, I guess, a petrol station and a car?

DR. ROBERT LUSTIG: Yeah. So, I mean, if we’re basically doing petrol, we’re talking energy only.

STEVEN BARTLETT: Yeah.

DR. ROBERT LUSTIG: So bottom line, your car runs on petrol. The petrol comes in, that’s the glucose, and the engine powers pistons, and the pistons then power an axle, and the axle then powers wheels. And you go. But there are a lot of things that have to go right for all of those things to happen.

Like, for instance, your energy, the gasoline, has to get into the engine in the first place. What if you have carbon deposits on your intake manifolds? And if you have a problem with any one of those steps, you’re going to end up with a jalopy instead of a sports car.

The Growing Alzheimer’s Crisis

STEVEN BARTLETT: I mean, that’s what we’re seeing in the United States. Over 7 million Americans live with Alzheimer’s, and this is expected to double to almost 13 million in the coming decades.

DR. ROBERT LUSTIG: Indeed, because we haven’t solved the problem.

STEVEN BARTLETT: That’s the mechanism. What is the cause?

DR. ROBERT LUSTIG: Right? So we know. We know that the cause is environmental. Now people say, “Oh, Alzheimer’s is genetic.” Garbage. There is a genetic component to Alzheimer’s. I’m not arguing that. There is this thing called APOE4. And if you have two copies of APOE4 on your genome, your risk for getting Alzheimer’s is nine times the general population. That is absolutely true. I don’t disagree with that. So APOE4 is not a good thing. I’m not arguing that.

Once upon a time in evolution, having two copies of APOE4 was good because it meant you got fat up to your brain pretty fast. But we don’t need that right now. That’s kind of an old news kind of issue. People who have double doses of APOE4 are at higher risk. There is absolutely no question about that. But they can mitigate that risk if they change their diet. They can eat a very low fat diet and improve their risk down to the general population.

Everything else in Alzheimer’s is not genetic, by the way, that genetic component is only 5% of all Alzheimer’s. So that means 95% of Alzheimer’s risk is environmental. Now the question is what in the environment? Well, air pollution, ionizing radiation, microplastics. There’s nothing you can do about any one of those three that’s baked into the cake. You can’t do anything about those today.

What other things? Sleep disordered breathing, medications, ultra processed food. What about ultra processed food? Fructose, my favorite hobby horse, the sweet molecule and sugar. Low omega 3s. So no fish, eggs, chicken. Lack of fiber, because fiber suppresses inflammation. Presence of emulsifiers, B vitamins, lack of B vitamins, particularly B6, B12, folate.

Those things are all associated with an increase in reactive oxygen species. You can manage those, you can mitigate those, thereby increasing mitochondrial function, increasing ATP generation and preventing that cellular energy crisis so that you don’t end up behind the eight ball and you don’t lose your neurons.

Ketones and Brain Performance

STEVEN BARTLETT: When people tell me that Alzheimer’s is associated with having a sort of energy crisis in the brain, I’m increasingly hearing people talk about ketones. It’s just, it’s remarkable, the improvement in cognitive performance that I feel when I’m fasted or I’m in a ketogenic diet. Whereas if I’m in a, if I’ve been eating a lot of carbohydrates or sugar, it’s like my brain is like backfiring. It’s stumbling over itself.

DR. ROBERT LUSTIG: I’m not surprised. You know, the food industry tells you, “Well, carbohydrates are energy.” Actually, that’s not true. Carbohydrates inhibit energy production.

STEVEN BARTLETT: How do you mean?

The Bomb Calorimeter Myth

DR. ROBERT LUSTIG: So there’s this thing called a bomb calorimeter, and there’s this thing called a mitochondria. They are not the same. A bomb calorimeter, you throw food into the bomb calorimeter, it explodes and it gives off heat. Captures the heat, measures the heat. And that’s how we know, for instance, fat burns at 9 calories per gram, protein burns at 4 calories per gram. Carbohydrate burns at 4 calories per gram, which is why fat is more energy dense than protein or carbohydrate, which is how we all determine that fat made you fat.

STEVEN BARTLETT: And the bomb calorimeter is also how they determine if a bag of crisps or chips or whatever you call it here is 200 calories. Because if you put them in there…

DR. ROBERT LUSTIG: Exactly.

STEVEN BARTLETT: It will release 200 calories of energy.

DR. ROBERT LUSTIG: Right, because a calorie is that amount of energy that raises 1 gram of water 1 degree centigrade. So it is a measure of physics, it’s a measure of heat generation.

Mitochondria are not bomb calorimeters. They are not capturing heat, they are giving off heat. They are capturing ATP. No bomb calorimeter captures ATP. Mitochondria capture and generate ATP. Now, turns out 35 to 40% of what mitochondria generate turns out to be heat. That’s why you have a body temperature is from that. And so you will never have a 100% energy efficient mitochondrion because if you did, you would have a body temperature of room temperature, and you’d be dead. That’s not the way it works.

Bottom line, that transfer of food energy to chemical energy loses energy in the process. The bomb calorimeter can’t tell the difference, but your mitochondria can. Ultimately, it’s how efficient are your mitochondria at converting food energy to ATP? The bomb calorimeter can’t tell you anything about that.

So these two phenomena, the concept of calories as fuel and the concept of calories as generators of ATP, have really very little to do with each other. And it turns out that there are individual things in food. The famous one is fructose, but there are others, lectins and others that actually inhibit the mitochondrial generation of ATP. So they actually inhibit your ability to turn food energy into chemical energy.

If that’s the case, even if they have calories per gram in a bomb calorimeter, if they’re interfering with mitochondrial function, are they food? What is the definition of food? Substrate that contributes either to growth or burning of an organism. Well, I just told you, fructose actually inhibits burning. Turns out fructose also inhibits growth. It inhibits cortical bone growth, trabecular bone growth, cancellous bone growth. Bottom line, people who eat ultra processed food end up shorter. We have the data for that.

So if a substrate that passes your lips does not contribute to growth and does not contribute to burning, is it a food?

STEVEN BARTLETT: I guess not.

DR. ROBERT LUSTIG: I guess not.

STEVEN BARTLETT: What is it then?

DR. ROBERT LUSTIG: It’s a poison.

The Problem with Ultra Processed Food

STEVEN BARTLETT: And how much of our diet do you think is poison?

DR. ROBERT LUSTIG: Fair amount. Ultra processed food is loaded with them. Real food is not loaded with them. You can still find them, but not loaded with them. Ultra processed food has, in my opinion, five things wrong with it.

Too much sugar, which poisons your mitochondria. Not enough fiber, which is necessary to suppress inflammation. Not enough omega 3 fatty acids, which are necessary to build your brain and conduct neurotransmission. Too many emulsifiers, which leads to gut inflammation and therefore systemic inflammation. And then we can throw on top of that the food dyes and food additives which are mutagenic because they’re petroleum based.

That’s ultra processed food. Ultra processed food has been associated with every single one of these diseases, including every single mental health disease, especially dementia, as we now have seen. Ultra processed food is specifically associated with dementia. And even diet sweeteners are associated with dementia through this reactive oxygen species pathway.

STEVEN BARTLETT: The sugar industry can’t be your biggest fan.

The Metabolic Matrix: Transforming Ultra-Processed Food

DR. ROBERT LUSTIG: They’re not. I’m trying to help them, though. I am trying to help them. Last year, not too long after we had our previous session, I was the keynote speaker at the 4th International Sugar Reduction Summit in Atlanta, Georgia. Daniel and the Lion’s Den. Why would they invite me? I am their conscience. I told them, I said, I don’t want to be your enemy. I want to be your conscience. I want you to do the right thing.

Ultimately, look, ultra-processed food’s not going away as much as I would like it to. It’s not going to go away. And I’m not even sure we want it to go away because we’ve got to feed 10 billion people by the year 2050, and we’re not going to have enough land and ocean to do it. Ultimately, ultra-processed food is here to stay. It is baked into the cake.

But the question is, can we make ultra-processed food healthy? Right now, they’re not. Right now, what’s going on in the US Food industry is doing the exact opposite. It’s making food disastrously disease producing. The question is, could you change that? And the answer is, yes, you can.

In fact, we’ve done it. We have been doing it. Five years ago, I started working with an offshore food company, Gratis, by the way. No money changed hands. And so they came to me and they said, look, we know we’re part of the problem, we want to be part of the solution. We know that Kuwait has an 18% diabetes rate and an 80% obesity rate. And we don’t want to be the reason, we want to be the help. Can you help us figure out how to make metabolically healthy processed food?

So I convened a scientific advisory team of five members and we worked for the next three years, looked at every single process, every procedure, every vendor, every ingredient, every product, sent them all for biochemical analysis to figure out what’s going into the food, what’s coming out of the food. Is the food metabolically healthy? What has to be done? How does it need to be re-engineered to lead to something that is metabolically healthy?

And we came up with a set of principles which we published in Frontiers in Nutrition in 2023. We call it the Metabolic Matrix. We basically collapsed it down to nine words, three clauses, nine words: “Protect the liver, feed the gut, support the brain.” That’s it. Those three things, anything that passes your lips, that protects the liver, feeds the gut, supports the brain, is healthy, whether it’s ultra-processed or not. Anything that passes your lips that does none of the three is poison, whether it’s ultra-processed or not.

So it’s actually not the ultra-processing, it’s whether or not it contributes to metabolic health. So then we started re-engineering products in the KDD line and they have 180 items in their portfolio. We have re-engineered 10% of them, 18 products to become metabolically healthy. And we have tested them on people in Kuwait to demonstrate their metabolic benefit and they are on the shelves now.

STEVEN BARTLETT: But is there a trade-off there? Because those products might sell worse now that you’ve removed the stuff that makes them addictive?

DR. ROBERT LUSTIG: No. So we didn’t tell the public that we were doing this, we just did it. And they just introduced them to the public and didn’t tell them and they didn’t miss a beat in terms of sales and in terms of profits. But I mean tell them and it works.

STEVEN BARTLETT: Logically though, the bad stuff often makes the food more addictive.

DR. ROBERT LUSTIG: And that’s why this is so cool. It didn’t change consumption and it didn’t change profits. And that’s what they care about ultimately. They don’t care if consumption changes as long as profits don’t. This can be done by other food industries. We’re trying to get them on board. And I have lots to say about RFK, but he has at least convened a discussion on what’s wrong with ultra-processed food. And we’re hoping to be able to enter that conversation.

RFK and the Health and Human Services Role

STEVEN BARTLETT: RFK is the health leader, I guess.

DR. ROBERT LUSTIG: Well, head of Health and Human Services here in the United States.

STEVEN BARTLETT: You have a lot to say about him.

DR. ROBERT LUSTIG: I have boatloads to say about him, most of which you can’t print.

STEVEN BARTLETT: What’s your general opinion of him in his role and what he’s doing?

DR. ROBERT LUSTIG: I have been asked to serve in this administration four times and I’ve said no each time. And it’s not because I don’t want to be. I do, but it’s because my opinion and his opinion would basically get me thrown out after about five seconds.

STEVEN BARTLETT: What’s the difference?

DR. ROBERT LUSTIG: I wouldn’t last a second.

STEVEN BARTLETT: What’s the difference in opinion?

DR. ROBERT LUSTIG: All right. RFK has five buckets in his portfolio. Food. I’m on board. Pharma Transparency. I’m on board. Chemicals in the environment. I’m on board. Water fluoridation. I’m partially on board. You could get the fluoride out of the water, but first you got to get the sugar out of the food. You can’t just take the fluoride out of the water or everybody will get Mountain Dew mouth all at the same time. And that would be a complete and utter disaster. Has to be done in a coordinated public health, PSA-driven campaign with everyone on board, including the food industry and the medical profession and government.

STEVEN BARTLETT: And to explain that there’s fluoride in the water in the United States because there’s so much sugar.

DR. ROBERT LUSTIG: There’s so much sugar in the food. You wouldn’t need fluoride in the water if you didn’t have sugar in the food.

STEVEN BARTLETT: Just explain this. So the United States put fluoride in…

DR. ROBERT LUSTIG: The water to stop dental caries.

STEVEN BARTLETT: Which protects people’s teeth.

The Fluoride Debate

DR. ROBERT LUSTIG: Which protects people’s teeth. The point is that only half the countries in the world have fluoride in the water. The others don’t. And the reason is because they don’t have sugar in the food. The only reason you need to put the fluoride in the water is because the sugar in the food causes the dental caries. Now, the fluoride reduces the prevalence of dental caries by about 30 to 40%.

STEVEN BARTLETT: Dental caries, cavities.

DR. ROBERT LUSTIG: Cavities by about 30 to 40%. Now, the problem with fluoride is at high dose it can be a neurotoxin. Now the goal is for public fluoridation to stay way below that. Now, do they? Not really. Sometimes they go above. So normal fluoride concentrations when you’re doing it as a public health effort should be between 0.3 and 0.9 parts per million. Sometimes it goes up to 1.5 parts per million. At 1.5, it becomes a neurotoxin. So it’s a purely dose issue.

But one of the reasons why people are screaming about getting fluoride out of the water is because it can be a neurotoxin. It’s not supposed to be in doses that are appropriate, but people don’t look at the data. Point is, you could get the fluoride out of the water, but if you got the fluoride out of the water and didn’t take the sugar out of the food, we’d have more dental caries, we’d have more anesthesias, we’d have more teeth pulling, we’d have more sepsis, we’d have more dental abscesses, we’d have more soldiers dying in the field. It’s a matter of national security. So you can’t just do it. It requires a coordinated effort.

STEVEN BARTLETT: Is there anything else you disagree with him on?

The Vaccine Debate

DR. ROBERT LUSTIG: And then finally, bucket number five, vaccines. I am a pediatrician. I am not a vaccine expert, to be sure. I am not an immunologist, to be sure, but I am a pediatrician, and I know a lot about vaccines, and I know a lot about the infectious diseases that those vaccines were set up to basically prevent. And I have taken care of all eight of the diseases that we have child immunizations for: mumps, measles, rubella, diphtheria, pertussis, tetanus, H flu, polio. I’ve taken care of all eight of those.

And I will tell you right now, when I take care of those, it’s because of someone who didn’t get vaccinated. And when I take care of those, the chances are 90% that that kid’s going to die. RFK is not. RFK says he can tell whether someone has mitochondrial dysfunction just by looking at them. I’m a mitochondriologist. I can’t.

Ultimately, RFK’s view of vaccines is, shall we say, his and his alone. And it’s not shared by the medical community. And I will not be part and parcel to 3,000 measles deaths because of a blanket disdain for vaccines and vaccine technology, which has worked beautifully to save 154 million people on this earth over the last 50 years.

STEVEN BARTLETT: Yeah, I don’t talk about this stuff a lot, but I was, I’m pretty sure at least one of my siblings was saved by vaccination when we were in Africa and we had malaria. I think if I’m accurate here, I had malaria, my brothers had malaria, and I think I was the one that didn’t get the malaria vaccine. And then I ended up in hospital at a very young age with malaria. I was hallucinating and stuff like that.

And obviously, as someone that was born in Africa, I think you probably have a clearer understanding of the role that vaccines can play in good health. It’s quite concerning because when you speak to any scientist, all of the majority of the leading scientists, they’re extremely pro-vaccine.

DR. ROBERT LUSTIG: But we’ve seen both sides. We’ve seen what happens when there’s no vaccine, and we’ve seen what happens when there is vaccine.

STEVEN BARTLETT: And this is not to say that there can be side effects to vaccines. The vaccine manufacturers and scientists talk about those side effects as well. But the thing that I think people should focus on is the net good that vaccines have done for the last centuries in eradicating illnesses and avoiding disease.

And my concern, just to close off on this point, my concern is if there is to be some kind of outbreak anytime soon, we’re in such a cloud of misinformation around vaccines that I worry people might make the wrong decisions. Interestingly, there was a measles outbreak in Texas recently, and RFK at one point did eventually prompt the federal deployment of MMR vaccines and expressed support for them because there was a big outbreak of measles in Texas very recently.

A Private Conversation with RFK

DR. ROBERT LUSTIG: I’m going to tell you something now that I have not talked about in public. I had a half an hour with RFK on the phone, one on one, back in December of 2024 after the Trump election, and RFK was starting to convene his team, and I was asked to join it. And so I got a half hour with him. And I will relate to you now for your public so that they understand what that conversation entailed.

Basically two threads, by the way. We’re supposed to talk about food. We didn’t talk about food. We talked about vaccines. And here were the two threads.

First thread, there are three papers in the medical literature that say that vaccines do more harm than good. And he quoted them at me and I wrote them down and I went and looked them up afterwards. And indeed, they say what he says. They said that it’s unconscionable that vaccines do more harm than good, and we’re giving them to newborns now. It is true that those three papers do say this. There are 50,000 that say opposite.

Second thing he said, a woman gives birth to a healthy baby, that healthy baby gets a shot under the skin, and now that baby is not healthy anymore. That’s a tort, a legal tort. And in fact, you could argue that that is, in fact a legal tort because, duty, negligence, all the way down to damages. What’s the remedy for tort? I said lawsuit. He says, right, but that mom can’t sue because of the Vaccine Indemnification Act of 1986. So that mom basically has a damaged baby and no recourse. That’s unconstitutional.

Those were the two threads of our half hour discussion. Now, everything he said is absolutely true and irrelevant. They demonstrate basically confirmation bias. And he’s a lawyer. He believes in precedent. I’m a doctor. I believe in probability. There’s always a risk-benefit ratio, unless you’re a lawyer, in which case there’s only risk. And that’s how he sees the world, sees the world as risk. I don’t. I wouldn’t have lasted five seconds.

Understanding Risk and Probability

STEVEN BARTLETT: I think we’re both on the same page in terms of making sure people have the right information as it relates to probability. Everything we do in our life is a factor of probability. Whether I got in a taxi to come here this morning, I understood the probability of that taxi crashing into another car. But I decided to get in the car and come here anyway.

DR. ROBERT LUSTIG: We all deal with these risks every single day.

STEVEN BARTLETT: I want to say on this point of vaccines that there’s obviously, it’s become quite a political issue, and there’s two sides. And one side, which is more of the RFK side, is incredibly skeptical and they have their opinion. Then there’s the other side, which tends to be dominated more by the scientists. I interview scientists a lot, so I know that pretty much everyone I’ve interviewed that’s a scientist would agree that there are side effects. But net, vaccines are very positive.

The Public Health Lens vs. Individual Experience

DR. ROBERT LUSTIG: It depends on how you look at it. If you look at it through a public health lens, the vaccines do more good than harm. And if you look at it from a purely individual lens, then you say, wait a second, I didn’t get the disease, but I got the shot and I have a vaccine injury, therefore I have been subjected to a tort.

STEVEN BARTLETT: I would just like to close this section by telling people that if there is a health crisis in the near future, some kind of viral outbreak like we saw with the pandemic, to make sure you get your information from sources that are highly credible. And those sources should not include, frankly, they should not include podcasts. They should not include social media.

They should include places like, I’d recommend checking out a website called Consensus. I have no affiliation with them, but Consensus allows you to type in a question you have about health, vaccines, whatever it might be, and it shows you what the peer reviewed studies say and what the consensus is.

So, for example, I was using the website a couple of days ago to try and understand something. I typed in, is this particular thing healthy or unhealthy? And it comes up with this bar the team will show on the screen and it shows you how much of the scientific research supports that idea. So it said 70% of the scientific research says it was positive. It said 25% said it was neutral and 5% said we kind of don’t know or negative.

And I think that’s a really great tool because there’s so much information out there and there’s so many studies and there’s one study that says this and another that says this. So using tools like that I think is a much better way to make your health decisions than podcasts like this or TikToks or Instagrams or tweets.

Because another thing I want to say is you might not know this, and I’m just speaking directly to my audience here, but you’re currently in an algorithmic echo chamber. And if you want to know what I mean by that is the algorithm that you have on any of your feeds has been personalized to give you more of the stuff that either scares you, frightens you, concerns you, et cetera.

And if you want to prove this, go and ask your best friend or someone else, a member of the public, to look at their feed. I remember probably two years ago, I asked my best friend if I could just look at his Twitter feed. And it was completely different from mine. For one, there was no Manchester United and it was all Liverpool. But then all of the information was completely different as well.

And so we’re living in these echo chambers where misinformation or things we believe is being reinforced, positively or negatively. So you need a strategy for information, especially as it relates to health.

DR. ROBERT LUSTIG: I couldn’t agree more. The fact of the matter is these algorithms are designed to keep you engaged. They are not designed to keep you informed. It’s just that simple. The other problem of course, is confirmation bias. If you have confirmation bias, you will only seek out the information that reconfirms your bias.

STEVEN BARTLETT: And that’s what’s about to happen.

DR. ROBERT LUSTIG: That’s what we didn’t used to have, but that’s what we have now.

Breaking Free from Echo Chambers

STEVEN BARTLETT: That’s what’s about to play out in the comment section. Whenever we talk about subjects like vaccines, there’ll be a group of people who have their own opinions on it and you’re entitled to your own opinion and they will go to war to confirm and prove that opinion and there’ll be another group of people that have a different opinion and they’ll go to war to confirm that opinion.

What I love and hopefully what I think my audience understand me for is I try and I try and remain open minded and that’s a really hard thing to do these days. I saw a journalist the other day, they said they were trying to place me politically and they said we think Stephen is apolitical. And I think that’s probably an apt description of my opinions because I have…

DR. ROBERT LUSTIG: I would consider that a high compliment.

STEVEN BARTLETT: It’s an amazing compliment. I have views, but I don’t sign up to any particular cult is the way I describe it. And you know you’re in a cult when your views 99% represent the person who’s also in the cult. Because logically that should never be the case.

DR. ROBERT LUSTIG: That should never be the case. I agree. You know, cults are part and parcel of society, unfortunately.

Practical Advice for Jenny and Dave

STEVEN BARTLETT: I want to get really practical, tactical here with the person that’s listening right now. And they have me and you in their ears and they know that sugar is bad, they know ultra processed food is bad. They still are struggling with a little bit of fat, other sort of diseases. They’re probably on the trajectory to some form of chronic disease, maybe Alzheimer’s, maybe dementia, maybe a form of cancer.

What do we have? If we’re talking direct, let’s name her or him, let’s call her Jenny. Jenny’s listening right now. Jenny and Dave, they both sat there, they’re the average American. What do we say to Jenny and Dave to get them to change their lives?

DR. ROBERT LUSTIG: The first thing that you have to say to them is who are you? Do you know? Do you know who you are? Because if they don’t know who they are, then nothing else is going to matter. They have to be comfortable in their own skin and they’re not.

The reason that they have glommed on to ultra processed food is it’s providing them with a dopamine hit. And it’s probably the only thing that even remotely gives them pleasure. And if that’s all the pleasure they get in their lives, you’re never going to fix it because that’s all they’ve got.

So the question is sorting your priorities at the individual level. What’s important to you? What’s of primary importance? Love, relationships. What’s of secondary importance? Pleasure, food, drugs.

If you don’t have any of the love, relationships, stability in your life, there’s no amount of food or drugs that’s going to be able to make up for that. So who are you? What is it that really matters to you? And until you answer that question honestly and affirmatively, you’re never going to get past this.

STEVEN BARTLETT: So let me role play as Jenny and Dave. You’ve asked me, who am I? I am 30 years old and I work this job. Job’s okay. I don’t love it. It’s not lighting me up. I’m single, I’m living in this city and yeah, I’m just trundling along kind of on the treadmill of life.

DR. ROBERT LUSTIG: And how much stress are you under?

STEVEN BARTLETT: A lot of stress.

DR. ROBERT LUSTIG: A whole lot of stress.

STEVEN BARTLETT: Every time I open my phone, it’s stressful. My emails, my work, there’s this thing going on with this person. I think my mom’s got a problem with this thing and her health is deteriorating.

DR. ROBERT LUSTIG: So imagine what that’s doing to the ATP in your brain.

STEVEN BARTLETT: What’s it doing?

The Impact of Stress on Brain Function

DR. ROBERT LUSTIG: It’s depleting it like crazy. Number one, you have mitochondrial dysfunction from all the shit you ate and from the air pollution you’ve been breathing and from the microplastics that have basically taken over your brain. One 200th of your brain right now, Stephen, is microplastics, whether you like it or not. So Jenny and Dave probably have more. And you eat well, they don’t.

All right, so here we are. This is the substrate, this is the base. The question is, how are we going to improve their ATP generation? How are we going to improve their mitochondrial function? How are we going to get their neurons to start responding properly? That’s the question.

STEVEN BARTLETT: And do you aim at stress as part of the solution?

DR. ROBERT LUSTIG: Yes, of course. You have to. How can you not? Let me give you another quick clinical vignette. Recently I had the opportunity to have an extended conversation with a hero of mine, Dr. Vivek Murthy, who is the former Surgeon General of the United States.

And we were in London together and I finally sat him down and I said, “You know, Vivek, I love your espousing of love, that we ultimately need to love each other to get over these systemic societal travails that we have, that love is what’s missing.” Here’s the problem. You can’t love if your brain is inflamed.

STEVEN BARTLETT: You can’t love if your brain is inflamed.

DR. ROBERT LUSTIG: If your brain is inflamed. Of course, the reason for the inflamed brain is the ultra processed food and all the things we talked about, the reactive oxygen species, the cortisol, et cetera that we talked about before.

STEVEN BARTLETT: So are you saying people that are metabolically unhealthy, that have inflamed brains, that are under stress, have a reduced ability to love?

DR. ROBERT LUSTIG: Yes, that’s exactly what I’m saying. They can’t love themselves and they can’t love anyone around them.

STEVEN BARTLETT: Explain the science there.

DR. ROBERT LUSTIG: Serotonin.

STEVEN BARTLETT: What is serotonin?

The Neuroscience of Love and Connection

DR. ROBERT LUSTIG: Serotonin is a neurotransmitter that is necessary for eudaimonia, for being able to be content. Oxytocin is the love neurotransmitter, the reproduction neurotransmitter, the safety neurotransmitter.

The cortisol causes the methylation of the oxytocin receptor. So now the oxytocin can’t work, so you can’t feel safe. And the serotonin is necessary to basically suppress that inflammation in the amygdala that’s actually causing the buckshot, the inability to surgically strike, like we talked about before, being that lousy point guard.

So I said to him, “You can’t love if your brain is inflamed.” And he thanked me and I thought that was the end of that and I’m not going to bother him anymore. Two weeks ago I got an email from Vivek saying, “I’ve thought about what you said and I’m halfway through your book and let’s talk.”

STEVEN BARTLETT: “You can’t love if your brain is inflamed.” I was just looking at a study that says high cortisol levels in a mom during pregnancy can affect the baby’s oxytocin receptors, meaning they’ll feel less safe.

DR. ROBERT LUSTIG: Exactly right. And it’s epigenetic. It happens even before birth.

STEVEN BARTLETT: I’m trying to play out, so I’m trying to form a couple of hypotheses here around what this might mean in practice. So I mean, in the case of the mother, if the mother was under a lot of stress that resulted in cortisol, then the baby’s oxytocin receptors, which are the bonding chemical within humans, the bonding hormone is going to be depleted.

So if I had a really stressful mother during my conception, during pregnancy…

DR. ROBERT LUSTIG: During pregnancy, gestation, yeah.

STEVEN BARTLETT: There’s a probability, there’s a causal probability that I might be less good at bonding with people.

DR. ROBERT LUSTIG: There we are. That’s exactly what we’re saying.

STEVEN BARTLETT: But I guess also that can take…

DR. ROBERT LUSTIG: Place after pregnancy, whereas chronic distress, it’s a continual process. The question is, can it be undone? And the answer is yes, but with a lot of work and you have to have the baseline substrate to be able to do it.

The Loneliness Epidemic

STEVEN BARTLETT: There’s a bit of, what’s the term when something becomes a little bit self fulfilling, tautology. What I’m saying is if someone’s lonely, extremely lonely, and they are in a single apartment alone, which is increasingly a lot of people…

DR. ROBERT LUSTIG: Yes.

STEVEN BARTLETT: Then basements. Well, even in major cities like London and New York, et cetera, so many people live in a little shoebox alone. And I saw the studies that show the average person used to have X amount of friends to turn to in a time of crisis. Now they have, on average it says 1 or 0. So loneliness is up.

And then I also saw some research that said when people are lonely, their body goes into a state where they sleep worse. They’re more stressed, they’re more bitter to people.

DR. ROBERT LUSTIG: Yes.

The Vicious Cycle of Loneliness and Stress

STEVEN BARTLETT: And I can’t remember the term for that, but it’s like this heightened sensitivity. And the thesis is that once upon a time, in an evolutionary context, if you lost your tribe, you would have to be more on edge to survive.

DR. ROBERT LUSTIG: That’s your amygdala.

STEVEN BARTLETT: And if that’s the case, then it means that it would suggest that if you’re lonely, you’re higher stress. Yes, but if you’re higher stress, you’re more likely to be lonely.

DR. ROBERT LUSTIG: That’s right. That’s the vicious cycle.

STEVEN BARTLETT: A vicious cycle. That’s the time I was looking at.

DR. ROBERT LUSTIG: That’s the vicious cycle. Absolutely. I couldn’t agree more. That’s what we’re trying to undo. So here’s a question for you. Quiz. All right. And you know the answer.

STEVEN BARTLETT: Okay.

DR. ROBERT LUSTIG: Okay. Because I’ve mentioned it already on this podcast. All right. Ready?

STEVEN BARTLETT: Yeah.

DR. ROBERT LUSTIG: What is the difference between loneliness and solitude?

STEVEN BARTLETT: Loneliness is a lack of human connection. And solitude is being alone.

DR. ROBERT LUSTIG: Well, both have a lack of human connection.

STEVEN BARTLETT: I don’t know. Tell me the answer. What’s the answer?

DR. ROBERT LUSTIG: Serotonin.

STEVEN BARTLETT: Okay.

DR. ROBERT LUSTIG: If your serotonin depleted, you’re lonely. If your serotonin replete, it’s solitude. You’re comfortable in your loneliness. You’re happy that you’re lonely because you’re not really lonely, you’re alone.

STEVEN BARTLETT: And how does that happen, that I become lonely in terms of the serotonin mechanism?

Serotonin: The Contentment Neurotransmitter

DR. ROBERT LUSTIG: Well, you choose to be alone when you’re in solitude. But the point is, that’s what you want. That’s what you chose. You could be with other people. You’ve chosen to be in solitude when you’re lonely. Okay. The reason, even when people are coming at you, even when you’re at a party and you are clearly not lonely, you feel like you are. You feel like you’re there all by yourself, even though all these people are around you. What is serotonin? And that’s because you’re serotonin depleted.

Serotonin is a neurotransmitter. It’s made from an amino acid called tryptophan. Tryptophan is the rarest amino acid in all of the proteins that we ingest. It’s the rarest amino acid on the planet. It’s found in eggs, chicken, fish. Not exactly ultra processed food. So people who eat ultra processed food at high rate are going to be tryptophan deficient and therefore serotonin deficient, are going to be somewhat irritable and also somewhat lonely.

And what it does is it inhibits the next neuron. It causes the next neuron not to fire. Instead of dopamine, which causes the next neuron to fire. They are very different. Serotonin, when it’s at normal dose, gives you a feeling of contentment, not necessarily happiness, but “this feels good, I don’t want or need any more.”

STEVEN BARTLETT: So it’s almost the opposite of dopamine.

DR. ROBERT LUSTIG: It’s the exact opposite of dopamine. Dopamine is “this feels good, I want more.” And serotonin is “this feels good, I don’t want or need anymore.”

STEVEN BARTLETT: And serotonin is predominantly made in the gut. 90%.

DR. ROBERT LUSTIG: So 90% is made in the gut. The question is, does the gut serotonin get to the brain? And the answer is through the afferent vagus nerve. So that afferent vagus has to be functional and has to basically conduct information from the gut up to the brain in order to be able to transduce that. That is what we call intuition. That is called gut feeling.

The Vagus Nerve and Gut Health

STEVEN BARTLETT: So I need my vagus nerve to be healthy.

DR. ROBERT LUSTIG: Yes, you do. And there are a lot of things that are causing that vagus nerve not to be healthy, including all of the gut inflammation that we talked about from the ultra processed food.

STEVEN BARTLETT: So how do I make my vagus nerve healthy?

DR. ROBERT LUSTIG: Eat real food.

STEVEN BARTLETT: What about those vagus nerve stimulators that everyone’s banging on about?

DR. ROBERT LUSTIG: So they’re interesting and they do have benefits for seizure control, for seizures. The vagus nerve for some reason transduces information up and down that help mitigate seizures. No one’s been able to demonstrate to my knowledge, that you can use a vagal nerve stimulator to actually change emotion.

STEVEN BARTLETT: I was looking at the research and it says exactly what you described, that a meta analysis and long term follow ups show a 30 to 50% reduction in seizures for patients who use vagal nerve stimulation. But outside of that, in terms of depression, the evidence is modest.

DR. ROBERT LUSTIG: Meager.

STEVEN BARTLETT: Meager, yeah. Around 15 to 25% show, which is above placebo. So it’s small. And then with anxiety it’s the same. There’s not, there’s only low quality and small scale work. They do say though, that implanted vagus nerve stimulators show the strongest evidence for epilepsy and depression. But the bottom line is it works well for seizures, as you said. And there’s still a lot unproven as it relates to stress and focus.

DR. ROBERT LUSTIG: I wish they worked.

There Are No Shortcuts in Life

STEVEN BARTLETT: I mean, it would be an easy. You know, one thing you learn from doing what I do with this podcast is you learn that in life there are really not many shortcuts. And everything that appears to be a shortcut, some device, some contraption that’s going to fix things actually either doesn’t work, is a scam, or has some hidden trade off.

DR. ROBERT LUSTIG: Right.

STEVEN BARTLETT: And so it goes back to this really important principle that I think everybody listening should embody, which is there’s no free lunch in life. If it appears to be the fast way, it’s probably fast way to something else. And the slow way is the fast way. The hard way is the fast way. This is kind of what I’ve learned.

Like I can try all these things to try and trick, to try and not, you know, to try and be able to eat sugar but be healthy. And there’s always some trade off. Like even Ozempic.

DR. ROBERT LUSTIG: Exactly. Everyone’s talking about it’s a band aid, not a fix.

STEVEN BARTLETT: What do you think of Ozempic?

DR. ROBERT LUSTIG: How much time you got?

STEVEN BARTLETT: Well, it depends what you’re thinking.

The Three Hats: A Clinician’s, Scientist’s, and Public Health Advocate’s View on GLP-1 Analogs

DR. ROBERT LUSTIG: People ask me this all the time. I wear three hats. Okay, so I’ll put my first hat on, my clinician hat. I’m glad they’re here. These GLP-1 analogs, they do work. I’m not saying they don’t. They do. And God knows, if you have a BMI of 40 to 45 and you have tried everything else and nothing else works and it’s a matter of life and death, then I am glad they’re here.

All right, now let me put my second hat on, my scientist hat. Okay. Why do they work? They work in two places. They work actually at that nucleus accumbens, which I mentioned before, the reward center. It actually seems to reduce reward. It’s one of the reasons why GLP-1 analogs are not just being used for obesity, but for alcoholism, for drug addiction, for many things, because they’re basically putting that reward system to rest, which is a good thing.

Now, we had a drug that did that back in 2006, put that reward system to rest. It was called rimonabant, trade name Acomplia. And what it was was an antiendocannabinoid. It was an endocannabinoid receptor antagonist. It was the anti marijuana drug, it was the anti munchies drug. And so it caused weight loss. And it got released in the European Union, the EFSA approved it in 2006, and within two months of its hitting the market, there were 21 suicides.

Okay? And the reason is because if you suppress reward, ain’t no reason to get out of bed in the morning. Okay, now the good news with these GLP-1 analogs is we’ve been looking for the suicide signal and haven’t seen it, but we also looking for the depression signal and we see that a lot. So it does seem to be having the same effect. Maybe not as severe as Rimonabant, but nonetheless, that’s a downside for sure.

Okay, now the second place, it works GI tract. It delays gastric emptying. It slows food going through the elementary canal, especially the stomach. Okay? That’s why it works, because you can’t eat more if your stomach’s still full because it didn’t move it along. Okay, that’s good. Sort of, except it gives you all the side effects. The nausea, the vomiting, the pancreatitis, the gastroparesis stomach turns to stone.

3.4% of all people who take GLP-1 analogs get gastroparesis. And guess what? When you stop the med, the gastroparesis doesn’t go away. And there is a lawsuit against Novo Nordisk right now over gastroparesis from GLP-1 analogs. Not so good.

In addition, you lose weight. Okay, what kind of weight? Turns out half muscle, half fat. Now, losing fat’s good. Losing muscle is not. Losing muscle is actually a risk factor for early demise. Sarcopenia is a risk factor for early demise. Now, what else causes loss of equal amounts of muscle and fat? Starvation. And that’s how the damn medicines work. They’re causing you to starve. Well, that’s not the best way to do this, people.

Also, only one third of people who take GLP-1 analogs actually respond. Two thirds don’t. They don’t tell you about those. They’re only telling you about the responders. And as soon as you stop taking it, all the way comes rushing back. Plus some, because you’ve only band aided the problem. You haven’t fixed the problem. Also not such a great thing.

And then finally, let me switch to my third hat, my public health advocate hat. Now, I did say these drugs work. 16% mean weight loss. True. Okay, if everyone in America who qualified for a GLP-1 analog got it, that would be $2.1 trillion to the health care system, which is currently $4.1 trillion. So that would be a 50% surcharge over what we’re currently paying. And Medicare is going to go broke by the year 2029 anyway without it. So you’re going to put another 50% on top of that. How the hell are you going to pay for that for a 16% weight loss?

Conversely, if we just got added sugar out of the diet, out of the American diet, to the level of USDA guidelines of 12 teaspoons of added sugar per day, no more, we could get a 29% weight loss and save $3.0 trillion. That’s a $5.1 trillion swing for double the weight loss and no side effects. Which one do you think is better? Yeah, that’s how I feel about it.

GLP-1s and Addiction: What the Research Shows

STEVEN BARTLETT: There was a recent animal research study that suggested that things like Ozempic semaglutides reduced cocaine self administration in rats by roughly 30% during treatment and cut their drug seeking behavior by 62% after a period of abstinence. Which speaks to some of the things you’re saying there about GLP-1 Ozempic’s role in the reward pathways in the brain. So it’s interesting. It’s interesting, but what is that saying? It’s saying that if you, in these rats, if they were given these GLP-1 antagonists, these Ozempic, these semaglutide, they were less likely to be addicted to things.

DR. ROBERT LUSTIG: Yeah, I mean, I wouldn’t say less likely to be addicted. They’re already addicted. They’re basically choosing not to continue to consume. And again, we don’t know if they’re addicted. They’re rats. But their behaviors suggest that they’re reducing the consumption of the addictive substance.

STEVEN BARTLETT: And what is this suggesting? This means that the GLP-1 is doing what?

DR. ROBERT LUSTIG: Well, number one, maybe the reason that they’re not consuming more is because their stomachs aren’t moving. If your stomach’s not moving, you don’t want to take any more, do you?

STEVEN BARTLETT: Maybe, yeah.

DR. ROBERT LUSTIG: Maybe it’s that we don’t know. That’s one possibility. There’s no question that the nucleus accumbens has GLP-1 receptors. The ventral tegmental area has GLP-1 receptors. And I actually gave a talk at the California Society of Addiction Medicine on Ozempic. So we know what you know, the data show we’re still, you know, researching this and trying to investigate and figure out what it is, you know, it.

That also wouldn’t explain the alcohol story because alcohol is not food, you know, it’s liquid. So it’s, you know, it’s a little different and it definitely reduces alcoholism, alcohol consumption. So there does seem to be an effect.

STEVEN BARTLETT: Understanding what dopamine does. From what you said earlier, it would appear that then these, like GLP-1s via Ozempic, are dampening dopamine’s release in some way because the rats, when you talked about motivation and dopamine, the rats are less motivated to go and get more cocaine.

DR. ROBERT LUSTIG: Correct. And that very well may be a good thing. And for certain people, I think we can absolutely use that phenomenon to assist them.

STEVEN BARTLETT: Is that correct?

DR. ROBERT LUSTIG: Perhaps that will be a good way to help with drug interdiction.

STEVEN BARTLETT: Could that also mean that I become less motivated, period?

DR. ROBERT LUSTIG: Yes.

STEVEN BARTLETT: Ah, that’s not good.

DR. ROBERT LUSTIG: Yes. That’s what I’m worried about.

Jenny and Dave’s Weight Loss Journey

STEVEN BARTLETT: Going back to Jenny and Dave. Jenny and Dave both have a little bit of extra weight on them. We’ve talked about, really interestingly, the whole idea that serotonin connection, love plays in a tremendous role and stress. And so Jenny and Dave, now they’re going to be thinking about their relationships and friendships and going to that run club as a way to help them downstream with addictions and other things they’re struggling with. Is there anything else that Jenny and Dave, who represent a typical American need to know to maybe shed some of that body fat?

DR. ROBERT LUSTIG: Number one, ultra processed food is obesogenic. Now, if Jenny and Dave are under stress, if Jenny and Dave are under financial stress, if Jenny and Dave are under time stress, it’s going to be really hard for them to turn away from ultra processed food. So don’t expect their weight to get any better until they fix their diet.

The one thing I am very sure of is that if you keep eating the same shit, don’t expect anything good to happen.

STEVEN BARTLETT: But it’s hard.

DR. ROBERT LUSTIG: It’s very hard. Some practical types of things, the first thing is that when they go to the store, don’t go hungry.

STEVEN BARTLETT: Okay, love, that’s the first one. I make that mistake a lot.

DR. ROBERT LUSTIG: The second thing.

STEVEN BARTLETT: Why? Let’s give some context there.

DR. ROBERT LUSTIG: Oh, because if they’re hungry, all bets are off. They’re done.

STEVEN BARTLETT: Because they’re more likely to reach for the bad stuff.

DR. ROBERT LUSTIG: The bad stuff, because the bad stuff’s calling to them. And by the way, the bad stuff’s on the end caps of each of the aisles of the grocery store and in the middle. In the middle. Well, if you’ve gone into the aisles, you’ve gone off the rails because that’s where the ultra processed food is.

STEVEN BARTLETT: To shop around the outside, you have.

DR. ROBERT LUSTIG: To shop around the outside, which is where the real food is. The fridges and the fridges and the produce and the meats and the dairy. Okay. Not to say that there isn’t ultra processed food and sugar hiding in those places too, but if you’ve gone into the standard aisles, that’s where all the ultra processed food is hiding. And 73% of the items in the American grocery store are poison. So if you go into the grocery store, you already have a problem.

STEVEN BARTLETT: So the first one is don’t go hungry. The second one is to stay on.

DR. ROBERT LUSTIG: The outside of the supermarket.

STEVEN BARTLETT: Yeah. Anything else for Jenny and Dave?

DR. ROBERT LUSTIG: And most importantly, you know, I don’t want them to have to read food labels because that’s kind of, you know, out of bounds. Okay. But they should. Basically, if a food has a label, it’s a warning label. That’s how they should look at it. Okay.

And if any food has a sugar in the first three items, the first three ingredients, it’s dessert. That’s how they should look at it. So, you know, Chinese chicken salad is dessert.

The Hidden Sugar in Everyday Products

STEVEN BARTLETT: You know, the other day I looked at my friend was drinking a can of Coca Cola, and I picked it up and I thought, I’ve not seen one of these in a while. I looked at the back of it, and it said the sugar quantity in it was something like 40% in that region.

DR. ROBERT LUSTIG: So it’s 39 grams in a can. Yeah, that’s right.

STEVEN BARTLETT: I say, so 40% of it is sugar is just sugar.

DR. ROBERT LUSTIG: Correct.

STEVEN BARTLETT: And people are just, there you go. No wonder.

DR. ROBERT LUSTIG: That’s why we have a fatty liver disease pandemic.

STEVEN BARTLETT: And sugar’s fundamentally linked to things like cancer as well, right?

DR. ROBERT LUSTIG: Yes, absolutely. And we know why now. We know how. Through what mechanisms.

STEVEN BARTLETT: What are the mechanisms for cancer? Yeah.

Sugar’s Connection to Cancer

DR. ROBERT LUSTIG: Okay. So first of all, anything that makes insulin go up increases your risk for cancer, because insulin is a growth factor.

Secondly, because insulin causes mitochondrial dysfunction, it increases these other phenomena, like, for instance, the pentose phosphate shunt and the Randle cycle and the de novo lipogenesis, which is what cancer cells need to be able to multiply and divide. Okay. So it’s basically feeding the cancer number three.

Certain cancers, particularly pancreatic cancer, have an enzyme in them called transketolase. And what that can do is that can take fructose and turn it into glucose in the cancer cell only. So that when you’re actually consuming sugar, you are feeding the cancer specifically. Yet what do we give cancer patients? Ensure, which is like straight fructose. So you are actually feeding the cancer. So that’s ridiculous.

In addition, because fructose interferes with mitochondrial function, that sends a feedback mechanism to the rest of the cell to divide. Because dividing cells are in growth phase. They don’t have mitochondria. That’s why cancer cells don’t have mitochondria. That’s why fetal cells don’t have mitochondria. Anaerobes don’t have mitochondria. They grow the fastest, you know, provided that the conditions are right.

So bottom line, anything that interferes with mitochondrial function puts you at risk for cancer.

STEVEN BARTLETT: And are we seeing cancers growing? There’s the incidence of people getting cancer that’s growing.

DR. ROBERT LUSTIG: Absolutely. And people getting cancer earlier and earlier, especially colorectal cancer. My God. You know, the mean age of colorectal cancer used to be 50 to 55. It is now we are seeing patients with, you know, colorectal cancer in their 30s and early 40s. This is why. Because of sugar. That’s a huge problem.

STEVEN BARTLETT: It is a huge problem.

The Challenge of Changing Diet

DR. ROBERT LUSTIG: So that’s what I would suggest Dave and Jenny do to start. Okay. But ultimately they have to get their sugar and ultra processed food consumption under control. And the question is, can they do it alone? Chances are, to be honest with you, they probably can’t.

And the reason is because they’re sugar addicted and because the food industry has basically made it impossible for them to avoid, that’s what we have to fix. We have to allow them the capability of being able to access real food. This is why I’m so upset with what’s going on with this argument here in the United States over SNAP. Are you familiar with SNAP?

STEVEN BARTLETT: No.

The SNAP Program and Food Policy

DR. ROBERT LUSTIG: SNAP is the supplementary nutrition assistance program. SNAP, also known as food stamps. Okay. I actually testified in front of Congress, in front of the House Appropriations Committee last year to fix SNAP now to get soda off SNAP, because soda is the worst thing. And it’s also the thing that most people use their SNAP dollars, you know, their SNAP vouchers to purchase. And it’s killing people.

And so I don’t think soda should be on SNAP. And so what I did was I testified, basically explaining the science, you know, in Congress. And I said that what we need to do is take the money that by banning soda sales on SNAP, if people want to spend their own money on soda, that’s their business. But we shouldn’t be, you know, using a federal government subsidy program to subsidize their death.

We should take the money that’s saved from the soda sales and utilize it to improve the nutrition of those same people, you know, real vegetables, dietary supplements, fiber, water, okay, things that will be healthy for them. In other words, divert the monies.

They didn’t hear that. The Republicans are trying to basically gut SNAP. They’re trying to get rid of it as an entity entirely. And if they don’t, they can’t gut it. They will basically make it so that they take the soda away, which is good, except it’s not going to improve the rest of their nutrition because they’re basically just going to take that money and repocket it.

So how you set these legislation agenda items up is super important and right now this government’s not doing it.

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The Most Common Question

STEVEN BARTLETT: Stan store the messages and emails that you get from people that have heard you on podcasts or have read your books or seen your work in other places. What is the typical question that those people ask? If you had to summarize the question into one question, what is it that people ask you the most?

DR. ROBERT LUSTIG: Is juice healthy really serious? That’s probably the most common question. You say sugar is bad, but isn’t juice healthy?

STEVEN BARTLETT: Is juice healthy?

Fruit vs. Juice: The Fiber Factor

DR. ROBERT LUSTIG: Juice is not healthy. Fruit is healthy. So what’s the difference between fruit and juice? The fiber. Okay, fruit has fiber. The fiber reduces the rate of absorption from the gut into the bloodstream. And in doing so you reduce the insulin response, you reduce the glucose response, you basically protect the liver.

And because you’ve prevented its early absorption, it goes further down the intestine where the microbiome can chew it up for its own purposes, thus feeding the gut and generating short chain fatty acids which are therefore metabolically beneficial anti inflammatory, anti Alzheimer’s. And the fiber acts like little scrubbies on the inside of the colon to get rid of colon cancer cells.

So you get all sorts of benefits from the fiber in the fruit, but as soon as you juice it, you’ve thrown the fiber in the garbage and so all you now have is sugar water. So eat the fruit, don’t drink the juice. Problem is, that’s not what the food industry is selling.

STEVEN BARTLETT: What if I put the fruit in a blender and then instead of throwing out the gunk, I keep all the little bits in there?

DR. ROBERT LUSTIG: So what happens is that the blades in the Breville or the Vitamix or the Nutribullet or whatever you use to make your smoothie, those blades are shearing that fiber into smithereens into such short pieces that it can’t actually act as a lattice work to sequester and prevent that absorption.

So the rate of absorption in the intestine is just as fast, and so the fructose and the glucose will still get to the liver just as fast as it did before when it was juice. So that’s not the answer. So making a smoothie out of it is not the answer.

Real Life Success Stories

STEVEN BARTLETT: I was looking at the top comments from our last conversation and they’re all extremely, I’d say similar, but they’re all incredibly inspiring. Someone here’s written the top comment, which I shall pre. I shall record the screen so Jack can throw it on the screen.

So, Stephen, I discovered Robert three years ago after my doctor told me I was pre diabetic. Three years on, my blood levels are completely normal and everyone tells me how good I look recently. This man should be on every TV in the world, but the food industry is trying to shut him up. Follow the work and you will change your life like he changed mine. Stuart J, 59 years old, male in the UK.

DR. ROBERT LUSTIG: That’s very heartening. I’m glad to hear that. Good for you.

STEVEN BARTLETT: Stuart, my friend was diagnosed with stage four prostate cancer and given one year to live. He found Dr. Lustig and rigorously followed his advice. Keto diet, intermittent fasting, regular walking. That was two years ago. He’s now in remission. The cancer is gone.

I was diagnosed with prediabetes fibromyalgia and decided to cut out all the sugar, including fruit. Not only did I lose 60 pounds in under a year, but my pain went from 10 to a 1 to 2.

DR. ROBERT LUSTIG: Wow.

STEVEN BARTLETT: I had more energy, my A1C dropped to normal levels and I went from being fully disabled to going back to work full time. Cutting out all the sugar is hard, I won’t lie. It’s also a constant, constant battle. But it is so worth it.

And lastly, I listened to this podcast last year, I made a decision on December 28, 2023, to stay away from all candy brownies, maple walnut scones, and all desserts. You get the idea. It is now approaching December 28, 2024. And besides rewatching this video, I have made another commitment to do the same thing I did last year.

It’s a shame that 73% of what’s in the aisles in a grocery store have hidden sugar in it. And so I haven’t gotten radical about it, but the changes I’ve made have made me feel terrific. Dr. Robert is the cat’s meow, and he has a giant part in me getting me back. Purring I’m 68 and play five days a week, two to four hours a day, pickleball.

DR. ROBERT LUSTIG: Wow.

STEVEN BARTLETT: I love the choices I’ve made. I love you, doctor.

The Power of Personal Transformation

DR. ROBERT LUSTIG: Oh, you know what? I love you too. And I’m 68. Maybe when I go to the UK, we’ll have a date.

STEVEN BARTLETT: Well, that’s Leslie. She’s quite a pretty.

DR. ROBERT LUSTIG: Oh, very nice.

STEVEN BARTLETT: How does that make you feel?

DR. ROBERT LUSTIG: Very heartened.

STEVEN BARTLETT: I can see the emotion in your face.

DR. ROBERT LUSTIG: I’m very heartened. But, you know, the problem is not fixed. The problem’s fixed for each of these people, but the problem’s not fixed. And because the problem’s not fixed, I still have a job to do. So it gives me more strength to do it, it gives me more purpose and gives me more reason to do it, but, you know, the problem’s not fixed.

The Most Impactful Health Change You Can Make

STEVEN BARTLETT: Do you think one of the most impactful things that we could all do for our health is just to reduce our sugar consumption?

DR. ROBERT LUSTIG: That’s job one. Okay. There are many things, but without question, that’s the easiest one. And to be honest with you, the food industry should be helping us do that. The only reason the sugar’s in the food is because they wanted it there. They put it there on purpose because they knew when they had it, you buy more.

STEVEN BARTLETT: And exercise, how does that impact my decision to reach for sugar or not reach for sugar?

DR. ROBERT LUSTIG: Well, it doesn’t really impact your desire to reach for sugar. It has its own metabolic benefits. Totally for exercise. Don’t get me wrong, I am completely for exercise. Exercise does many good things, but burning calories is not one of them. Okay. People think, oh, you know, exercise to work off the donut that I ate wrong. Forget it. That’s not what it’s about.

What does exercise do? Exercise increases mitochondria, and that’s good, because you need increased mitochondrial reserve in order to make all that ATP. Exercise increases brain trophic factors which are necessary for cognition. And it’s been shown now that exercise is one of the primary methods for mitigating the risk for dementia. Okay. It increases brain derived neurotrophic factor. It increases leptin. All of these are necessary to promote synaptogenesis and even increase neurogenesis, more neurons so that they don’t die. So I’m all for exercise.

Exercise also increases muscle mass and muscle mass is a mitigating factor for early demise. Like I said, sarcopenia is a risk factor for early demise. So exercise is the way to undo that. Having said that, none of that had anything to do with weight loss. So if you think exercise is going to make you lose weight, you are deluded. You are under a delusion. You have adopted the calorie hypothesis. I am here to dispel. I am here to destroy the calorie hypothesis. A calorie is not a calorie.

The Pre-Diabetes Epidemic

STEVEN BARTLETT: So many of the people that are listening to this conversation right now, if they’re in the United States or if they’re in other parts of the world that have similar health stats are diabetic or pre-diabetic. One in 10 people worldwide have diabetes. And in the United States, one in three to four of adults that are listening right now are pre-diabetic. Even if you don’t have a huge amount of fat on your body, it’s…

DR. ROBERT LUSTIG: Actually 40%, 4 out of 10.

STEVEN BARTLETT: Which is crazy.

DR. ROBERT LUSTIG: Yeah, that’s right.

STEVEN BARTLETT: It means that almost half of the people listening right now, whether you know it or not, could well be pre-diabetic if you fit into the statistics that we have here. I mean, terrifying.

DR. ROBERT LUSTIG: Oh, yeah.

STEVEN BARTLETT: So for those people that are pre-diabetic that I’ve just found out, because there was, I asked this question because there is a guy here that says his doctors just told him he’s pre-diabetic and he’s listening to the show probably again. So I wanted to offer him something. His doctor just told him that he’s pre-diabetic. What should he be doing?

DR. ROBERT LUSTIG: First thing, get rid of all ultra processed food from your diet. Okay. And in the process, you will have gotten rid of all the sugar from your diet. That’s the first thing. See how that works? Okay. Spend two weeks doing just that. If that works, fantastic. If that doesn’t work, add some exercise. Walk, walk your dog.

The Value of Continuous Glucose Monitors

STEVEN BARTLETT: Okay, so on the first point, should he be using a glucose monitor to help him because people can get on Amazon or these other websites very, you know, 20, $30, you can get glucose monitor for your arm.

DR. ROBERT LUSTIG: Yeah. So I am for glucose monitors and the reason is because they are a substitute, a proxy for insulin. When the glucose goes up, that means the insulin goes up and it’s the insulin that really makes the difference. So we have documentation of the fact that by monitoring your own glucose concentration, you can see improvements in metabolic health down the line.

You can food log, you can use the glucose monitoring. You don’t need to do glucose monitoring. You can just do it with the food logging and it will still work. Bottom line, there are a whole bunch of scientists who are against using glucose monitors for non-diabetics and they write about this routinely. They seem to write about it always in the New York Times. I am completely 180 degrees opposite on that. I think it is a very good idea.

The reason that they say it is a bad idea is because if you’re using the same outcome variables as for diabetes, time in range, time above range, time below range. Well, these are non-diabetic. So of course all of those numbers are going to be in the center. They’re going to be in the time in range. So it looks like there’s no benefit to that. Okay, that’s not the point. The point is the downstream outcomes which come three months later. They’re not looking at that. We have those data, we are looking at that. And the data are very good.

STEVEN BARTLETT: Do you know what, Joan, I think is really, really useful with those CGMs, those continuous glucose monitors that you can buy online super cheaply, is they just educate you on the impact that different foods you might have thought were healthy. Like the juices we talked about.

DR. ROBERT LUSTIG: Like rice.

STEVEN BARTLETT: Yeah. Like, oh my God, white rice. That’s actually one of the big things I learned. There’s two things that shocked, three things that shocked me over the last couple of years that I thought were healthy. So I grew up thinking that orange juices were healthy. I remember being a young kid and getting the Sunny Delight out of the fridge and glugging it. Because I’d seen on the advert it said vitamin C or something.

DR. ROBERT LUSTIG: Yep.

STEVEN BARTLETT: And I thought, oh, vitamin C. Good. Glug it.

DR. ROBERT LUSTIG: I’ve come to learn that was their subterfuge. And you were a victim.

STEVEN BARTLETT: I was a victim. And I would like compensation.

DR. ROBERT LUSTIG: Sunny D. I think the entire, you know, UK population, US population deserves compensation.

STEVEN BARTLETT: There’s a young lady in the comments section who watched our conversation last time. She said a quote from this doctor that I loved and I’ve never forgotten is “any food that is linked to a television commercial should not be consumed.” Brilliantly said. And a great boundary to put in place.

DR. ROBERT LUSTIG: Yep, that’s right.

STEVEN BARTLETT: “Any food that is linked to a television commercial should not be consumed.” It’s so true. They don’t put cucumbers in television commercials.

DR. ROBERT LUSTIG: Nope. Not enough marketing money, not enough margin.

STEVEN BARTLETT: So Sunny D, orange juices, generally. I don’t drink any juices anymore. I haven’t for years now. The other one was white rice. I thought that was healthy growing up. That was really, really healthy. And then I did a continuous glucose monitor with a company that I’m an investor in called Zoe.

DR. ROBERT LUSTIG: Yes.

STEVEN BARTLETT: And it gave me this. It was horrific. The impact on my gut microbiome and my glucose levels. And the third one was tomato ketchup. I didn’t know there was so much bloody sugar.

DR. ROBERT LUSTIG: Oh, yeah. In most ketchups, in fact, Heinz ketchup is half high fructose corn syrup madness.

STEVEN BARTLETT: And that’s the, I think that’s the value of getting a continuous glucose monitor, even if you just run it for 14 days, is you’ll learn your relationship with these things. You frequently eat, and most of us are frequent eaters, we eat the same kind of things. And you can make some trades. What is the most important thing we haven’t talked about that we should have talked about?

Understanding Psychedelics and Brain Rewiring

DR. ROBERT LUSTIG: Robert, I know we haven’t talked about psychedelics.

STEVEN BARTLETT: What would you like to talk about with psychedelics?

DR. ROBERT LUSTIG: Psychedelics are serotonin. A big dose, a big glug of serotonin all at once. What serotonin does is it provides you with this sense of complacency, of eudaimonia, of contentment. Serotonin is necessary to rewire areas of the brain. You can actually see it on MRI. It’s actually leading to synaptic rewiring. Think of it this way.

STEVEN BARTLETT: Can I just confirm that just on one point, you’re not saying that psychedelics create serotonin. You’re saying that they are the same.

DR. ROBERT LUSTIG: They’re a serotonin mimicker.

STEVEN BARTLETT: Okay. Yeah.

DR. ROBERT LUSTIG: They mimic serotonin.

STEVEN BARTLETT: Yeah.

DR. ROBERT LUSTIG: Think of it this way. You live on a mountain, okay, with snow. And you have to, every week go down to the general store at the base of the mountain and you ski down there, and you ski down there and you ski down there and the snow falls and you ski down there. And soon what you’ve done is you’ve created ridges in the snow. To get down the hill and they freeze. And soon the only way to get down the hill is through the ridges that you’ve created. You are now basically in a rut. You have trapped into that path. There’s no other way out your house other than those ridges that have frozen in place. That’s what’s happening in your brain.

You can’t unthink your way out of it because that’s the only way. You know, psychedelics are like a huge enormous blizzard filling in the ruts, filling in the ridges, so you end up with a pristine, you know, snow bank for you to be able to basically ski any which way you want. It’s your way out of your rut. And what we have in America and UK too is a whole lot of people with a set of belief systems that have put them into ruts that they can’t think their way out of.

Now, can this be done without psychedelics? Absolutely. But it’s hard. Psychedelics are a way to, shall we say, hack that belief system concept and allow you to rethink your own life and the life of the people around you and how you interact with them. And we need more research in this to solve mental illness and also improve the well being of sizable proportion of the population.

STEVEN BARTLETT: I’m a big fan of the research taking place in the psychedelic field. I actually spent a year of my life in what I believe is the biggest psychedelics company in the world as an investor and then as a director in a capacity where I was helping to drive fundraising through marketing. And then the company is now a public business that’s doing a lot of the clinical training studies.

DR. ROBERT LUSTIG: So which one is it?

STEVEN BARTLETT: It’s a Thai life sciences. I obviously Compass Pathways as well. I’m an investor in that company and I’m a big fan of what MAPS are doing as it relates to using these molecules for mental health disorders and treatment, resistant depression, PTSD, anxiety, et cetera. And it’s so shocking to me that, you know, it’s taken so long to…

DR. ROBERT LUSTIG: Yeah, well, you know, they got a bad rap from Nixon, you know, back in the 1970s. I understand why, by the way, no one should do psychedelics alone. Yeah, you do them with a guide, you do them with someone you completely trust where safety is paramount and they can be really remarkable.

STEVEN BARTLETT: And we talk about set and setting, which is hopefully they’ll be done in clinical settings with a, as you say, with a practitioner.

DR. ROBERT LUSTIG: Yes, that’s the only way they should be done.

The Closing Question

STEVEN BARTLETT: Dr. Robert, we have a closing tradition on this podcast where the last guest leaves a question for the next, not knowing who they’re leaving it for.

DR. ROBERT LUSTIG: I knew it was coming.

STEVEN BARTLETT: Yes, you did. Looking at your life and the lives of others, how would you describe the journey of life and how to approach it?

The Power of Questioning Belief Systems

DR. ROBERT LUSTIG: When you come out of the box, when you’re born, you already have neurons and synapses and neural pathways that have developed even though you’ve had no experience. The experience will either solidify those or destroy them.

Ultimately, those turn into belief systems. Almost every belief system that you thought you understood about how the world works is wrong. You have to be open to the fact that all the things you thought were true aren’t.

And if you are that open with yourself, you will know yourself. And if you know yourself, you can be happy. But if you believe your belief systems and you never question them, you’re never going to get there.

Closing Remarks and Gratitude

STEVEN BARTLETT: Amen. Robert, thank you so much. I mean, I say to some people sometimes at the end of these podcasts that they’re doing good in the world, but you’re, quite frankly, saving a lot of people’s lives.

I mean, the fact that all the top comments on the video seem to be dominated by the same narrative that you’ve saved someone’s life, you’ve improved their life, is there any higher work one can do with their life than improve the quality and duration and health of someone else’s life? And that’s exactly what you’re doing.

It’s what you’ve done through your public advocacy work. I know you recently spent some time with Prince Charles in the UK, which is incredibly exciting, the King of England, talking to him about health outcomes and all of the work that you’ve been doing. And what an honor it is to be invited by him to, you know, him asking for your opinions and your perspective on health, which I know is something that’s quite close to the heart of the King.

And then through these books, these incredible books that I have in front of me here, which I’m going to link all of them below. This one’s new, right?

DR. ROBERT LUSTIG: So this one, it’s coming out September 16th.

STEVEN BARTLETT: Okay, so that’ll be out by the time the conversation’s released, I believe. And these incredible books, I mean, there’s so many of them that I can’t pick a favorite child, but they’re all incredible, depending on where people are at in their lives and what they’re trying to understand. Robert, thank you so much.

DR. ROBERT LUSTIG: It’s been my pleasure.

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