A (7:07)

Yeah. What strikes me as a really key message is that the majority of what we are buying to feed ourselves and our families is ultra processed food, whether it's here in the UK or with you in America. And that is contributing to this tsunami of chronic ill health that we're seeing. It's pretty, you know, it's pretty alarming. But what I think is so key, Rob, for me is that it's so normalized now. Like it's the norm everywhere. Schools, hospitals. In fact, if you want to go down the real food routes, you almost feel like a bit of a, like, you know, if you try and do it with your kids, you actually become a social outcast in some ways. And I think this is the problem. It's just, it's the norm. We've moved so far away from what we used to do. And you know, like you, I'm very passionate in root causes and this idea that we've labeled all these so called separate diseases. We get taught thought about them at medical school as though they're all separate entities. And then for this disease, you, you take this drug and you have this sort of treatment. And we look at that downstream pathology, don't we? But you mentioned mitochondria at the start in terms of what sugar or excess sugar can do to mitochondria. And that, you know, mitochondrial dysfunction sits at the heart of so many different conditions. But also insulin resistance, right? So is it the sugar that's inherently bad in and of itself or, or is it the excess amounts? I mean, or is it both? Right, Because I think a lot of people might say, well, look, you know what, this never used to be a problem, right? And we would have the odd sweet treat now. And again, there's quite a few prominent scientists, as you're well aware, where we say, actually sugar's not a problem. Sugar's actually completely fine.

B (8:59)

We're working on It I have a bone to pick with some of those scientists and we can argue that and talk about that if you like, as to exactly why they say what they say. Here's what I can tell you. There are social drinkers and there are alcoholics. Now social drinkers can pick up a beer and put it down and they don't need one. Every day alcoholics pick up a whiskey and can't put it down and they need it three times a day, right?

A (9:38)

Yeah.

B (9:39)

Did the one beer that the social drinker drink hurt them?

A (9:47)

Unlikely.

B (9:48)

Unlikely, Unlikely. The reason it's unlikely is because there is what is known as a first pass effect. You drink the alcohol in the beer, first of all, it's very low percentage, it's only 3.6% and that is about 60 calories worth or so of alcohol. What happens is that the first pass effect, the stomach and intestine metabolize that alcohol before any of it ever gets to the liver. The amount that actually hits the liver that could do damage is exceedingly small. As long as you're not following up with a second beer and a third beer and a fourth beer and a fifth beer like can happen at the Newcastle pub. You don't usually have a big problem, but if you keep doing that, then that is a problem. It's a dose dependent phenomenon. And your intestine is there to try to protect your liver from getting the onslaught before it will do damage. Same with sugar. No difference. Your intestine can take a small amount of sugar that you consume and can actually turn it into fat in the intestine. Intestinal de novo lipogenesis, the process of converting sugar to fat into VLDL in the intestine so that it will not go straight to your liver. About 10% of an initial sugar bolus will undergo intestinal DNL and therefore be diverted away from the liver and into the bloodstream as vldl. Now that VLDL is not great for you because it could ultimately cause heart disease, but it's protecting the liver. But if you consume past your intestines capacity to do that, now the rest of it's going to end up in your liver. The problem with sugar in the liver is exactly the same as the problem of alcohol in the liver because it causes the exact same processes. It causes glycation, it causes oxidative stress, it causes mitochondrial dysfunction and basically drives insulin resistance. This phenomenon that we now know is at the base of virtually all chronic metabolic diseases. Therefore your pancreas has to make extra insulin to make the liver do its job, because now the liver's not working right because it's been poisoned. And so insulin levels rise all over the body. And now you've got the risk for Alzheimer's, you've got the risk for heart disease, you've got the risk for cancer, you've got the risk for virtually every other chronic metabolic disease on the plate, all because of what happened to your liver. And fructose, that sweet molecule, and sugar basically has the same fate as alcohol. So when people say, oh, little sugar is fine, the answer is, yeah, because your intestine diverts that little bit away from the liver. As soon as you overwhelm that capacity now your liver is right in the crosshairs and that's when chronic disease is going to start.

A (13:25)

Yeah. The term real foods, I like it. You use it. You know, my view, Bob, is that I found it to be very useful with my patients. Of course, if my patients don't like it, I'd come up with something else that they understand. But generally speaking, I think the things like, would your grandparents recognize it as food? I think people find it quite helpful. Or does the food packet have more than five ingredients on it or not? As a kind of general rough rule, they're not perfect, but they're all kind of guidelines to try and help people make sense of this ultra processed food environment in which they're living. I find a lot of people, particularly in medicine and academia, look down on these kind of what are considered simplistic terms.

B (14:18)

Yeah, I've heard those complaints also before. Basically what we're saying is real food is food that came out of the ground or animals that ate the food that came out of the ground. That's real food. As soon as a human touched it, now it's processed. Just a question of the degree of processing also, and I'm sure you're familiar with Carlos Montero at University of Sao Paulo, developed this system called the Nova System, for the degree of processing, which I actually think is the right way to go, because it's not what's in the food, it's what's been done to the food that matters. All food is inherently good. It's what we do to the food that's not.

A (14:58)

That classification system is brilliant. And perhaps you could take a kind of readily available, simple food and just explain how it can go through these four stages to help people really understand this.

B (15:11)

Sure, I can do this in one minute. Take an apple. Class one on the Nova system would be an apple. Class two on the Nova system Would be apple slices. Class three on the nova system would be applesauce unsweetened. Class four on the nova system would be an apple pie. There you go. Turns out that only the Class 4 foods are associated with chronic disease.

A (15:47)

So we can have minimally processed foods that are done to make our life easier a little bit. But it's when it goes to that extreme where it actually bears no resemblance to actually what actually came out of the ground in the first place.

B (16:00)

That's right. And so what is different about that apple pie versus the apple? The answer is the addition of sugar and the removal of fiber. The addition of sugar is what basically floods the liver, because the liver, like alcohol, only has an innate capacity to metabolize a small amount. We know how much sugar we can metabolize, and it's not that different from the amount of alcohol that we can metabolize because the metabolism is virtually the same. Point is, you can overwhelm your liver's capacity to metabolize sugar. When that happens, just like what happens when you over metabolize alcohol, is your liver can handle the onslaught, and so it has to take the extra and turn it into fat. There are enzymes in your liver that turn sugar into fat. It's called de novo lipogenesis, new fat making. There are three enzymes that in concert that do. This one's called ATP citrate lyase. The other one's called acetyl coa carboxylase, and the last one's called fatty acid synthase. These three enzymes are being driven by excess substrate, and that substrate is fructose, then turned into acetyl coa by glycolysis. So, bottom line, you're flooding your liver, and the goal is protect the liver when you flood your liver. Now, your liver makes fat, and that fat precipitates. Now you got fatty liver, and now you got insulin resistance, and now you got chronic metabolic disease. So protect the liver. Second part, feed the gut. Everyone now knows that the microbiome talks to your brain, which is true. It does. So feed the gut. That's what a prebiotic does. So what's a prebiotic? A prebiotic is food for those bacteria that will feed them so that they can grow. And what's the nature's perfect prebiotic?

A (18:23)

Fiber.

B (18:24)

Fiber. Fiber is not food for you. Fiber is food for your bacteria. But when we took the fiber out of the food to process it, because fiber basically reduces shelf life, when we took the fiber out of the food to process it, we are now depriving our bacteria of the food, they need to be able to live in symbiosis with us. Those bacteria, the good bacteria are dead. The bad bacteria have taken over. And the bad bacteria sending also sorts of bad signals, actually suppressing serotonin generation in the intestine, thereby reducing the anterograde transport of serotonin back up into the nucleus tract to solitarius. And that's called depression. Also because you're not feeding those bacteria, the bacteria are basically stripping the mucin layer right off your intestinal epithelial cells because they can eat that. And that's then exposing and denuding your intestine and making it all the junk that's in your intestine basically can get through, called leaky gut, contributing to inflammation, inflammatory bowel disease, irritable bowel syndrome and insulin resistance, all because you didn't feed your gut.

A (19:46)

And that's how the whole thing gets tied together here. That some very simple but very, very brilliant advice. Protect the liver, feed the gut. But the modern food environment, the ultra processing of food is overwhelming the liver with sugar and it's starving the gut through its lack of fiber. And then the consequences are the liver could be fatty liver, type 2 diabetes. But the problem when the gut gets starved and as you say, leaky gut or increased intestinal permeability sets, then you're opening up for everything. Autoimmune disease, food allergies, Alzheimer's, depression, all these things have been associated with increased permeability in the gut. So it's a very simple maxim, but one that actually again, going to that nexus of the root cause, it's kind of right there, isn't it? This is the other thing I really liked, Rob, is that you don't seem to have a preferred diet very much like me, I'm always like you. Unprocess the diet first. Let's just get out the chunk, let's get the real food in and then let's see where we are. So how does you feel that like a vegan diet or a low carb diet or a whole manner of diets can fit this maxim of protecting the liver and feeding the guts?

B (21:09)

Yeah, I'm agnostic as to the whole vegan keto thing. People who want to be vegan, you know, fine, whatever. You want to be vegan, great. Don't make anybody else feel bad about their choice. But you know, you can feel good about your choice, that's fine. Okay. There are a lot of reasons to be vegan. You know, animal welfare, religion, cost coolness if you will, but metabolic Health is not one of them. Okay? And I can prove it because Coke, Doritos and Oreos are all vegan. So you can do vegan right or you can do vegan wrong. Keto, okay? I'm not against keto. You know, bottom line is I don't have a preferred diet. I don't. I'm agnostic on it. I think there are a lot of ways to skin this cat. I think ultimately we will learn the genetics of who does better with which diet and it will turn out that certain diets are better for certain people and other diets are better for other people. And I'm very interested and involved in this personalized nutrition concept and movement that's going on right now. So I'm for both diets. The only diet I'm not for is the Western diet.

A (22:35)

And the reality is, I think any clinician who has utilized food as one of their tools in their toolbox with their patients, which I hope more and more are starting to do, although it's clearly not enough, you will see that different people thrive on different diets. I think real life clinical practice teaches you that. Well, these guys here are literally rocking a low carb, real food diet. Their markers look good, their bloods look great, and all these people here are doing great on a whole food vegan diet. As you say, the commonality is no processed food or very, very low amount of ultra processed foods.

B (23:22)

The commonality is low sugar, high fiber. Both diets work when they're low sugar, high fiber. And so that's why I think those are the two sort of linchpins in this whole story.

A (23:35)

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