David Kessler on Why Junk Food Is America’s Nicotine

Summary

The Gist – August 25, 2025

David Kessler on Why Junk Food Is America’s Nicotine

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Episode Overview

In this episode of The Gist, host Mike Pesca interviews Dr. David Kessler, former FDA commissioner and author of "Diet, Drugs, and Dopamine: The New Science of Achieving a Healthy Weight". The discussion centers around Kessler’s recent citizen petition to the FDA, which calls for reconsidering the “generally recognized as safe” (GRAS) status for processed refined carbohydrates in ultra-processed foods. Drawing a provocative analogy between the modern food industry and Big Tobacco, Kessler argues that junk food is engineered to be addictive and is a prime driver of America’s chronic disease epidemic. The episode digs into the regulatory landscape, the science of food addiction, and the personal as well as societal challenges of weight loss—culminating in a compelling conversation about GLP-1 weight loss drugs and the broader potential for meaningful public health change.

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Key Discussion Points & Insights

1. Citizen Petition: Challenging “Generally Recognized as Safe” Status

• Background: Kessler explains his recent petition to the FDA to revoke GRAS status for specific ultra-processed ingredients—primarily processed refined carbohydrates, such as corn syrups and maltodextrins.
  • Historical Parallel: Recalls a pivotal citizen petition in the 1990s that ultimately led the FDA to assert jurisdiction over nicotine in cigarettes ([13:01]).
  • Food Safety Law: By law, substances must be proven with “reasonable certainty of no harm.” GRAS offers a loophole—many ingredients were considered “safe” decades ago without sufficient evidence of long-term harm ([18:21]).
• New Science/FDA Inaction: Science since the 1970s and 80s shows strong links between these ingredients and obesity, diabetes, and cardiovascular disease, contradicting the original GRAS rationale.
  • Quote: “Fast forward four decades… these same processed refined carbohydrates [are] linked to obesity, cardiovascular disease and diabetes.” – David Kessler [18:21]
• The Regulatory Strategy: The burden is not on FDA to prove harm, but on industry to prove safety if expert consensus is lost ([19:35], [20:43]).
• Analogy to Tobacco: Pesca notes, “That was your nicotine, to analogize it to the low-tar cigarette suit.”
  Kessler responds: “Just as nicotine caused millions to be addicted and sickened by tobacco, so processed, refined carbohydrates… cause much of America’s chronic disease.” [17:13–17:21]

2. What Makes Ultra-Processed Foods So Harmful and Addictive?

• Kessler’s Definition: Prefers “ultra-formulated” foods to “ultra-processed”; focuses on the “perfect trifecta” of fat, sugar, and salt designed to exploit the brain’s reward circuits ([31:37], [32:11]).
• Core Ingredients: Refined carbohydrates, added sugars, and processed flours/starches, combined with additives like emulsifiers and stabilizers, are rapidly absorbed and drive overconsumption.
  • “You couldn’t have designed a better weapon to blow up the American body.” – David Kessler [14:50]
• Biological Hijack: These foods trigger dopamine-driven cravings, creating patterns of compulsive consumption akin to addiction ([32:11]).
• Historical Perspective: In environments of scarcity, brains that craved high-energy foods survived. Today’s abundance of engineered hyperpalatable food hijacks these same circuits ([38:10]).

3. Diet Education Isn’t Enough—Why Willpower Often Fails

• Pesca Skepticism: Host questions the efficacy of public education campaigns as the main solution to obesity: “Printing up the pamphlets and having a slogan… actually changing behavior [is] so much harder.” [34:43]
• Biological Reality: Kessler describes how the “pull” of food, driven by reward circuits and metabolism, easily overrides conscious control ([35:34], [34:43]).
  • “It’s not about weight. It should not be about BMI… It’s this toxic fat, visceral adipose capacity, that is killing us.” – David Kessler [37:18]
• Fat Distribution (“Toxic Fat”): The focus should be on visceral, metabolically active fat rather than overall weight or BMI ([35:34], [37:23]).

4. The Promise and Pitfalls of GLP-1 Weight Loss Drugs

• GLP-1 Drugs (e.g., Ozempic): Dubbed a “major game changer” for weight management ([28:47]).
  • They change the landscape by showing it’s not about willpower, but about biology ([28:47]).
  • These drugs shut down food cravings by slowing gastric emptying and activating aversive rather than reward circuits ([39:31], [41:43]).
  • “They can be used along with other tools. If you want to reclaim your health… only about 12% of us are metabolically healthy… These drugs are one tool that we can use to reclaim our health.” – David Kessler [28:47]
• Limits of Pharmacology: The drugs only work while you take them; long-term sustainable change requires learning new eating behaviors ([41:43]).
  • “They crack food addiction, but only while you’re on them. So what you have to do—certainly for me—was I had to learn to relearn to eat.” – David Kessler [44:15]
• Caveats: Not everyone tolerates the drugs well; post-drug relapse is common ([44:15–45:05]).
• Broader Implications: The approval and use of these drugs further shifts the narrative from personal blame to systemic, biological, and environmental factors.

5. Public Health and Regulatory Path Forward

• FDA’s Opportunity: Kessler insists FDA leadership could act now to revoke the GRAS status for refined carbohydrates without new legislation ([22:15], [23:24]).
  • “It doesn’t need a new law, doesn’t need to prove these are unsafe. The record… there’s no longer an expert consensus—he can act.” – David Kessler [23:24]
• Industry on Uncertain Ground: The entire ultra-processed food industry stands on shaky legal-regulatory footing—something must give ([22:15], [23:56]).
• Long-Term Perspective: Change will be incremental (“chipping away… it took years for tobacco”), but Kessler is hopeful for meaningful progress ([24:39]).

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Notable Quotes & Memorable Moments

• On Big Food vs. Big Tobacco:
  • “Just as nicotine caused millions to be addicted and sickened by tobacco, so processed, refined carbohydrates cause much of America’s chronic disease.”
    — Dr. David Kessler [17:21]
• On Defining the Problem:
  • “You couldn’t have designed a better weapon to blow up the American body.”
    — Dr. David Kessler [14:50]
• On Addictive Circuits:
  • “These circuits are part of all of us… We are wired to focus on the most salient stimuli in our environment. Switch that environment to one of abundance, put fat, sugar, and salt on every corner… many of us, not all of us, we’re living in a food circus.”
    — Dr. David Kessler [38:10]
• On GLP-1 Drugs:
  • “They tamp down these food addictive circuits. They crack food addiction, but only while you’re on them. So what you have to do (…) is relearn to eat… There should be no shame, no stigma.”
    — Dr. David Kessler [44:15]

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Timestamps for Key Segments

• [12:53] — Introduction to Kessler, citizen petition, and the context for FDA action
• [13:01]–[19:23] — Regulatory history, analogy to tobacco, what’s at stake in the GRAS petition
• [20:21]–[24:39] — How processed foods short-circuit consumption and regulatory action pathways
• [27:15]–[29:48] — Rise of GLP-1 drugs and Kessler’s personal weight gain during COVID
• [31:37]–[32:11] — “Ultra-formulated” foods and the reward system
• [34:43]–[37:23] — Limitations of “education first” strategies; visceral versus general fat
• [38:03]–[39:31] — How our brains are mismatched to the modern food environment
• [39:43]–[45:05] — GLP-1 mechanism, real-world experience, the challenge of lasting change
• [45:05] — Episode closing and preview of the next segment with Kessler

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Conclusion

Mike Pesca’s conversation with David Kessler contextualizes the modern American diet as not simply a matter of personal responsibility, but as a complex interplay of biology, food science, and policy—one that mirrors the decades-long struggle with tobacco. Kessler’s regulatory challenge to the FDA, compelling analogies between junk food and nicotine, and nuanced view of pharmacological versus behavioral solutions, offer a timely, science-driven roadmap to confronting America’s chronic disease burden. This episode is a must-listen for anyone interested in food policy, public health, or the future of weight loss.

Transcript

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We are at the gist@mike pesca.com if you have any interest or know of someone with interest in this part time job. Social Media Manager the gist@mike pesca.com It's Monday, August 25, 2025 from Pete Fish Productions it's the Gist. I'm Mike Pesca, Trump Admin Administration Lowers FBI Recruitment standards in a deeply ironic twist. That's the MSNBC headline. It is not a deeply ironic twist. I don't even think it qualifies as a shallowly twist. It is par for the course. The recruitment standards were lowered when Cash Patel was hired to run the agency. Now, to be fair, I'm going to say too fair to Cash Patel. He has run government agencies before on an interim basis because he's a veteran of the Trump administration and worked as a federal prosecutor. But the standards were thrown out the door, set on fire and run over back and forth with a dump truck and then later the USC marching band when Dan Bongino was hired as the number two. I read some more coverage. The Daily Beast Looking at things glass half full, Lower standards will allow the Bureau to draw recruits from other federal law enforcement agencies, particularly criminal investigators classified as 1811s. 1811s who currently work for ICE and the ATF, among other agencies. What happened was the FBI is not exactly firing, but pushing out about 5,000 of its 13,000 agents. They need someone else in there. Let us change the standards. Open the doors. I found a very good analysis by a guy named Roman Clee who writes the American Peace Officer blog. Sensitive FBI plans appear in the media with startling regularity, usually attributed to unnamed sources. Speaking on condition of anonymity, he writes, I hadn't thought of this aspect of what's going on with the standards at the FBI and how lowering standards won't be good because he writes about these leaks, that they erode confidence, obviously in the Bureau's internal discipline and raise questions about whether its own employees are held to the same standards it demands of others. This is striking because the FBI is the nation's gatekeeper of the Criminal Justice Information Service system, the central hub for criminal records, warrants and intelligence. Misuse, mishandling or even accidental improper disposal of information could result in severe consequences. Careers have ended over a single violation. Yet clear, writes the FBI itself, the agency that mandates these uncompromising standards has become one of the most reliable sources of leaks in the federal government. It's another troubling example of the Trump administration's petty tyranny and petty foggery. They get in front of a judge and it's all terrible arguments to try to justify their programs. And then they go and they authorize Cash Patel to run the FBI as he sees fit, which is not in comportment with any standard of fitness. They raid the house of John Bolton just because he is a political enemy of Donald Trump. And I hate to sorry Just because he is a political enemy of Donald Trump. And this is not good. It's not something the public by and large is going to vote Trump out of office about. But it is. What's the word? Well, I'll quote David Masteo, who is a Sacramento Bees editor of something called the Point, sort of a right leaning columnist who says he doesn't like to use the word fascist. It's a powerful word that to mean that to me means pure evil. And he thinks that Trump does a lot of things and everything he does gets called fascist. I've seen it used for conservative things I agree with, like cutting environmental red tape and moderate things backed by 3/4 of Americans, like keeping boys out of girls, sports. Just put those aside for a second. But here is Mastio working out through his head things like Marines on the streets, but especially the investigation by the FBI of John Bolton. And he writes today I said the F word in a column. I hope you'll give it a read and let me explain why I didn't take it lightly. I agree. I'm with him. FBI's lowering standards is a nice way of saying that they've thrown the standards out the window in a way that doesn't please any constituency except those who want to authorize Trump to punish his political enemies. And what do we call it when you use the government to punish your political enemies? Dave Mastio already articulated that point on the show Today I have an interview with a former head of the fda. In fact, let me allow you a little behind the curtain. We interviewed David Kessler a couple months ago when his new book Diet Drugs and Dopamine the New Science of Achieving a Healthy Weight came out. And then like I said a couple months ago, then maybe a month later, a couple weeks later, we were holding this interview, it comes out that Kessler has filed a citizen petition with the fda. And this is a real thing that, as Kessler will tell you, was filed in regards to tobacco when he was in charge of the fda. And he said all these things that I'm writing about with diet and drugs and with ingredients. I was head of the fda. I know the FDA allows for these citizen petitions and I know the FDA grants a status to a number of substances and that status is the generally recognized as safe status. And Kessler is arguing in his petition and with me up next that ultra processed, highly processed foods are just not safe. But more to the point, of the FDA standards should not be generally recognized as safe because the science has come around on them. So what we did was we called him up again. We did a pre interview, another interview about the citizen petition and then it will lead to the full interview about weight loss diet. Kind of laying out the case behind why he filed this petition to the fba. So two parts today, in fact, one part tomorrow. It's a very important, very interesting subject with a very qualified guest, David Kessler. Up next, ever wondered why you keep getting endless spam calls, phishing emails, or even those creepy ads that seem to know way too much about you? Not a coincidence. It's data brokers. These companies collect and sell your personal information, things like your phone number, address, even details about your family, and then publish or resell it to whoever's buying. And it's not just annoying. 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We had that conversation. And then a couple of weeks later, Dr. Kassler was in the news because he had submitted a citizen petition to the fda, basically trying to put into action what his critique was putting into the ether as commentary. So I wanted to have him back to talk about this citizen petition and what he's trying to do and if it will work. Dr. Kessler, welcome back. We're going to hear the full interview we did a couple of weeks ago after this. But I wanted to talk to you about the citizen petition first. Okay.

[B]

Of course. Great to be here.

[A]

When you were head of the fda, did you get citizen petitions? What did you do about them?

[B]

Well, we got a pretty famous citizens petition. And in fact, it had been sitting around for a while, was filed in 1988, but we didn't act on it until 19, actually. 94. And that citizens petition that came in called on FDA to regulate low tar cigarettes as a drug. Pretty big move. But it was interesting. It was focused on the, you know, quote, healthier cigarettes, the low tar cigarettes. But it was the regulatory hook under the act that for the first time gave, you know, asserted that FDA had jurisdiction to regulate cigarettes. They considered low tar cigarettes a drug. So that would give FDA the hook. Took us about several years to think that through low tar cigarettes is a drug? No. Is tobacco the drug? Yeah. But we finally settled on the question, is nicotine in cigarettes a drug? And that basically gave FDA the regulatory hook, the jurisdiction to look at its jurisdiction of whether nicotine was a drug. Up to now, ultra processed foods. People go, well, what is that? What's that definition? The Food and Drug act gives the ability of the agency to act on ingredients not processing per se. And we all know, I mean in the book the End of Overeating and diet Drugs and dopamine, we know it's fat and sugar, fat and salt, fat, sugar and salt. But how do you regulate fat, sugar and salt, right?

[A]

So.

[B]

You ever have an idea and you don't know exactly when that idea pops in your head, you go back and say, well, when did that idea. So you go back to diet drugs and dopamine. And there's a chapter in there that said, you couldn't have designed a better weapon to blow up the American body. A pretty provocative title. And it really talked about these processed foods, these ultra processed foods. I use the term ultra formulated. That's a small nuance. And you can't really just regulate ultra processed foods. So what I was thinking, what are the major components of those ultra processed foods? Those processed foods? I mean, there's salt in there, right? There's fat in oils. I mean there's sort of four legs of the stool, there's salt, fat and oils, there's refined sweeteners, and then there's these processed flour and starches. And those are the four main ingredients. Three are structural. Salt's not really structural. And the question that I sort of asked was because this processed food goes down in a wash, right? It's this reformulation of these energy dense ingredients that get so rapidly absorbed, right? That hit the bloodstream, creates this hyperinsulinemia. We know you eat 500 calories more when there's nothing that slows down that eating. And you know, and along the way I said, well, let's, let's focus not on ultra processed foods per se, but we can't focus on everything. The statistician doesn't get to deal with every problem. But let's focus on the major core. What's the underbelly of these ultra processed foods? And I realized it's really these, it's these processed, refined carbohydrates, these sweeteners, I mean, these ingredients. I mean, you ever pick up a label and you see it says maltose, xylose, invert, sugar, dextrose, maltodextrin. You go, what is that stuff? And then you have a lot of flour and starch that goes through extrusion technology. And then you have a lot of these processed, refined carbohydrates. Used with emulsifiers and humectants and conditioners and stabilizers. So I said, let's just look at processed refined carbohydrates.

[A]

That was the processed, refined carbohydrates. That was your nicotine, to analogize it to the botar cigarette suit.

[B]

Just as nicotine caused millions to be addicted and sickened by tobacco, so processed, refined carbohydrates, I mean, I assert, cause much of America's chronic disease. It's not everything. But if you go into that supermarket and look at processed, you know, processed foods, ultra processed foods, and I'm not talking about, look, nothing, this doesn't touch sugar, doesn't touch flour, you know, it doesn't touch starch. Nothing you use at the home, only when it's used in this ultra processing. Right? But I mean, I mean, at the core, right, I think it's these process refined carbohydrates that certainly, you know, my guess is right, 80, 90% of all processed foods have as the core, not just this, right? But it's really the underbelly. And back then I went and I looked and what was the justification for this stuff to get on the market.

[A]

Originally, Right, Right, originally.

[B]

So the nation has very strict food safety laws. Everything that's added to food, food additive has to be generally recognized, has to be reasonable certainty of no harm. It's not a risk benefit, very high standard, reasonable certainty of no harm.

[A]

And.

[B]

And the industry has to prove that there's one loophole, and that's this thing called grass, generally recognized as safe. And back in the 70s and 80s, and you go back and you look and you can see the grass, the determinations for grass, for these process refined carbohydrates, they call them nutritive saccharides, corn syrups, corn solids, dextrose. And they concluded that there was no effect on obesity, on diabetes and on cardiovascular disease. Fast forward four decades, go look at the dietary guidance written in 2015, 2020, these same process refined carbohydrates linked to obesity, cardiovascular disease and diabetes.

[A]

So the recognition, when they were originally approved there was that general recognition. And now your petition is pointing out that they should not be generally recognized as safe. We have found, we have come to a different recognition.

[B]

Bingo. Right? You got to know, what the law requires is just let me give you a couple other pieces. Just because you were found to be grass in the 1970s is a continuing burden and it stays on the manufacturer. The FDA doesn't have to show this is unsafe. All FDA has to show is that these substances are no longer general. There's no longer an expert consensus. And clearly there's no longer an expert consensus. And then the burden is not on the FDA to show their safety burden is on the industry to show that it's safe. And more importantly, it has to be done at realistic doses, as doses that it's actually consumed at. And it's.

[A]

Well, that's what. Yeah, that's what I wanted to ask about the dose question, because it doesn't analogize to low tariff cigarettes. There is no dose that could be healthy in any way. But with food, the whole thing is about dose. You're essentially arguing that this short circuits our ability to limit the dosage or the amount of food we're taking in. So yes, please do address that.

[B]

So, so first of all, what the law requires is that it look at the cumulative effect of these substances. So you can't say simply, all right, what about one can of this stuff? I mean, you know, or one bowl of this stuff. You have to take into consideration how it's actually being consumed and how it's actually being consumed with other similar like substances. So if you're using these refined carbohydrates with fat and oils and that's really, I mean the cumulative effect and we know that there's 500 extra calories being consumed just cause this stuff gets, goes down so quickly and so rapidly absorbed in addition to the metabolic and the addictive properties of this stuff. I mean, I think there's no longer a, there's no expert consensus to refined carbohydrates in ultra processed foods are safe under the present conditions of use. Very simple, very simple. Back four decades ago, FDA determined this was safe. But you know, I think this leaves with FDA with no choice but to determine the process. We find carbohydrates as a matter of science and law can no longer consider be grass and thus be thus need to be removed from the market.

[A]

So thinking about the analogy with the tobacco citizen petition that was, as you say, sitting around for many years, what compels the FDA to have to take this on.

[B]

The general recognition of safety? If you just pick up the dietary guidelines last several volumes clearly says there's no expert consensus on these processed refined carbohydrates. There's no longer a basis. The industry is now vulnerable. Understand that for the first time that maybe it's not this administration, they're selling products that the record shows maybe it was grass. We can argue back four or five decades ago, but certainly under the way it was Being used, not today, not the way they're being used in processed foods. In some ways, the industry needs a fix because they're living on a very uncertain footing because the regulatory status of these products can be challenged at any time. I hope this administration has the opportunity. RFK Jr says, Secretary says he wants to do something about it. Doesn't need a new law, doesn't need to prove these are unsafe. I mean, the record, you know, you look at the petition, there's no longer an expert consensus he can act.

[A]

Yeah. So you're giving him, oh, it's a little, an overused phrase, a permission structure. You're giving him a way in. You're pointing out, you're doing a couple things. You're pointing out they're out of compliance. You're in fact affecting the general consensus by getting attention, raising these issues. It's a little like the experimenters affecting the experiment, but you are affecting what the general consensus is. And you're telling any so inclined commissioner that this is a possible path to pursue.

[B]

Correct. And it's the commissioner and the secretary. Because the act is, you know, actually the secretary has the authority. He delegates it to the commissioner. So it's both. Am I giving him a gift or am I giving him a challenge?

[A]

And so the last thing is, has anyone actually inside HHS or the fda, people who might be in decision making abilities back channeled you or talked to you? You have any clue how this is landing?

[B]

I have no clue how this is officially landing.

[A]

Officially?

[B]

Officially.

[A]

What do you think?

[B]

I am sure that at the highest levels this is being discussed.

[A]

And are you hopeful that some change could come someday?

[B]

How long did it take us in tobacco? This is a chipping away. These are chapters. But I think it's. I mean, in some ways I had to write three books. I had to live through tobacco. I had to be commissioner. I had to go to law school. I had to figure out this very simple question. It's pretty obvious law requires this, these ingredients to be generally recognized as safe. It's very apparent. There's certainly a lot of concern and evidence and hard science. Just look around us. What's happened in the last four decades to the American body. You see a lot of questions about that. I think it's a very easy call. We have not taken and enforce the nation's food safety laws. Seriously, how did this stuff end up on the market? You have to ask. But once it's on the market, I mean, I think FDA is left with no choice but to ask the hard questions.

[A]

Here, Dr. David Kessler was commissioner of the FDA, and not only is he the author of the forthcoming book Diet Drugs and Dopamine, but you're going to hear us talk about them forthwith. Thank you once again, Dr. Kessler.

[B]

Thanks for having me.

[A]

And we'll be back with more of David Kessler to talk about his book, specifically Diet Drugs and dopamine. And that'll be in a minute. From the Cascades to PDX to your kitchen, we recycle like we live here. That's why governments, brands, and recycling companies are all joining together to bring change, to make recycling better. As in trusting that your recyclables end up in the right places to be made into new things and having brands help fund the cost of recycling. You can find the Latest [e-mail] Oregon. From Mount Hood to the bin under your desk, together we can do this. David Kessler has been the commissioner of the fda, the dean of Yale Law School, and a guy in charge of making sure your COVID vaccine got into your arm. His new book is Diet Drinking Drugs and Dopamine, in which he argues that the food most Americans eat is less nourishing than it is narcotic. It is a substance designed to hijack your brain's reward system and make moderation a biological impossibility. Which brings us to GLP1 drugs and why junk Food works like a slot machine or maybe like tick tock. Dr. Kessler, welcome to the gist.

[B]

Thanks for having me.

[A]

So I, I did not read, but I read of your book before this. Fast Carbs, Slow Carbs, the Simple Truth about Food, Weight and Disease. That was written about five years ago. Looking back, is that book a little like a polio doctor writing about hot springs before the Jonas Valk, the Jonas Salk vaccine?

[B]

Yeah. You know, I wrote that book. The publication date, I think it was March 2020. The book came out and I went into federal service the next day. The book stands and I think really focused on this rapidly absorbable glucose in our metabolism. Didn't focus on weight, it didn't focus as much on our health as, you know, diet drugs and dopamine, but was sort of essential for me to do, to be able to do this book right.

[A]

Because there was a lot about dopamine, there was a lot about craving, and you broke it down. Why it's so hard to break that cycle now that we have these drugs to break the cycle. That's not the end all, be all. So it's not really a vaccine like Polio, where you just have to take it on a sugar cube once. But how much of a game changer are these drugs, do you think?

[B]

I think they're a major game changer. They change the landscape of weight, that mystery of weight. They show it's not willpower, they show its biology. They help us crack food addiction. But there are only one tool. They are not a magic pill. But for the first time, and I think this is the key, I mean, they can be used along with other tools. I mean, if you want to reclaim your health. I mean, the fact is, for most of us, this is certainly where I was coming out of COVID after I had the opportunity to co lead operation Warp Speed. The American Body is ill. I had gained 40 pounds. Only about 12% of us are metabolically healthy. These drugs are one tool that we can use to reclaim our health. Mm.

[A]

Did you gain 40 pounds because you couldn't work out, you couldn't move as much as you wanted to, or you resorted to stress eating and the food that was prominent in the American diet became your diet?

[B]

All of the above. This was, you know, this was an intense period for all of us. I think we still have not fully recognized, you know, the effects it has had on us. I was working seven days a week, 676 million vaccines within five miles, you know, free we got over that period. But I would find myself 10 o' clock at night, having to work another four or five hours. That thought that goes through your head, hey, I need to cognitively focus. I need energy. That refrigerator downstairs, should I go? Should I not? Is it good for me? That noise in your head, that conversation, you know, I look at how I, you know, I eat. I eat to calm, I eat to stimulate. I eat when I'm bored. My guess is if I were born two or three decades earlier, I would have been a smoker. Watch a smoker. It's very much the same way, you know, I just was grazing throughout the day and night.

[A]

So how much of that. I think your experience is like a lot of our experience. But the main narrative which is true about the American diet talks a lot about, and you don't like to use the word processed or ultra processed food. Your phrase for this is what I.

[B]

Call it ultra formulated. I focus more on that perfect trifecta. Fat, sugar and salt, fat and sugar, fat and salt, fat, sugar and salt. They trigger the reward system. Processing tends to focus on things like emulsifiers and stabilizers and preservatives. You know, I go right for the Reward system of our brain. It's the addictive circuits that, that bliss point. That's why I, you know, make that subtle distinction.

[A]

Right. So thinking about the 40 pounds you gained, however much weight I gained, how much of it? Because I always have this conversation. Well, it's the quality of the foods, and our foods addict us. Not untrue. But I never thought that that was what was going on with me. I would eat a lot of things that were in isolation, quote, unquote healthy. I wouldn't eat a lot of Doritos or nachos or even ice cream. So how much of weight gain in your case or in a lot of people's cases is independent of this other fact that there are the combinations of fats and salts that are very hard to avoid?

[B]

Look, whether it's diet drugs, surgery, I mean, if you want to lose weight, the only way you can do it is to eat less. Now, the mantra, eat less, exercise more has been a failure. Why has it been a failure? Because we just can't do it. Why can't we do it? You know, I mean, we're all different. There's great variability, but for many of us, not all. You know, I mean, these reward circuits, I have a hard time stopping once I start, I get cued. You know, I could be a cue, can be the time of day, it can be a smell, it could be, you know, just a thought coming into my head. And it stimulates that wanting. So that cue induced wanting, when you try to resist, I mean, that's, you know, that's the craving. I mean, and for me, every time I, you know, I gained and lost my body weight throughout my lifetime, multiple times, I'd always lose the weight, I thought I was done, and I'd always gain it back. And the fact is, you know, after you lose the weight, I mean, that's when the hard work really starts. But, you know, it's very much excess. You know, you're taking in more than you're burning. And for some of us, right, it's not only the quantity, but the composition of the foods. For those of us who are insulin, more insulin resistant, hyperinsulinemic, some of these rapidly absorbable carbs are just, you know, we're just adding fuel to the fire and we're into this vicious cycle. So it's the addictive circuits as well as our metabolism, I think. Yeah, I always driving us.

[A]

I was always suspicious of the government intervention. Not that it shouldn't be done, but just the idea that educating people about food was Going to have a large impact. I always saw that as people who themselves thought they were educated, thought that even if they were overweight and needed to eat less, thought that there are a whole population that just didn't understand the basics of nutrition. And if they understood the basics, things would change. And that's where my suspicion was. I thought that this was always such a tiny, tiny part of it. It was just the easiest thing to do. The easiest thing to do. We have pretty good information, right? Printing up the pamphlets and having a slogan that's kind of easy to do, having those pamphlets and slogans actually change behavior thought was so much harder than the people who are advocating these interventions seem.

[B]

But what's that? What's that poll of food? Tell me what that polar food is. I mean, tell me why. I mean, is it the pull of food? Is it starting? Is it stopping? Where do you find, you know, the difficulty? Because, you know, if you want to eat less, you know, why is it so hard for so many of us to do that? It's biology. Look, let's get one thing established. First of all, this is not about weight. I don't care how big you are, I don't care how small you are. I mean, this is not about weight. It should not be about bmi. I mean, I'm a doc. I think increasingly what I care about is what I call this toxic fat, this visceral adipose capacity. It's the fat around our midsection, it's the fat that is metabolically active, it's the fat that gets into our liver, that spews out more fatty acids and inflammatory molecules, fat that gets into our pancreas and into our heart. This is the basis of a vast majority of cardiac, kidney, renal disease, as well as metabolic diseases, prediabetes, diabetes, several forms of cancer, possibly neurodegenerative. The issue is this visceral adiposity, this toxic fat, that's what I care about. And you know, that beer belly, I mean, that was part of the American culture. I mean, I mean, I mean, us guys, I mean, it was. It was celebrated, right?

[A]

We'd be strong a little bit maybe.

[B]

But.

[A]

But it, hey, it was joked about. It was. It was countenanced, let's say.

[B]

Yeah, it was, right? It's not cool. I mean, it's killing us. It's that visceral adiposity, right? And the only way to reduce that visceral adiposity, right? I mean, is to be in an energy deficit situation, right? I mean, you got to be taking in less energy than you're burning, there's no way to get around that. But it's that toxic fat that to me is number one. I mean, it's as big as tobacco. Mm.

[A]

Yeah. And a very hard thing about being in the energy deficit is what does your body want to do when you are in an energy deficit?

[B]

And what are those circuits? Those are both the metabolic circuits. There's metabolic adaptation, but there's also, I would say, those reward circuits. So when you try to deprive yourself, that's where those thoughts of wanting, that craving that we all experience. So, you know, look, I think, you know, I think we have to redefine, you know, when I use the word addiction, right? I mean, you know, addiction, this is not something for the weak or the downtrodden. I'm just saying these circuits are part of all of us. I mean, you go back thousands of years, I mean, into an environment of scarcity. Those of us who survived, you know, were, would have. Those whose neural circuits focused on the most energy dense foods in our environment. They, they gated our attention. If you're a bird, you know, and you need to find that, that food, your attention would be captured. Because we are wired to focus on the most salient stimuli in our environment. It's different for all of us. Switch that environment to an environment of abundance. Put fat, sugar and salt on every corner. Make it available 24 7, make it socially acceptable to eat anytime. Many of us, not all of us, we're living in a food circus.

[A]

Yeah. So is that what the GLP1 drugs do they interrupt? Well, you tell me, what are they actually interrupting? The noise, the craving, the narration within your head, what, all of that.

[B]

But how do they do that? Right, so you have. The reward circuits are very powerful, right? And again, everyone's going to be different and they're going to have different effects on everyone. I don't think the companies have fully leveled with everyone. I mean, on what the mechanism. And some of this is still being worked out, but the, the drugs work, you know, scientific phrase here, they delay gastric emptying, basically they just keep food in your stomach longer, right? Food, your intestines don't move along that food. I mean, as quickly once you're on these drugs or food stays in your stomach longer, you and I have experienced it, right? You have the flu and when you have the flu, food stays in your stomach longer. You know, we've all lost our appetite. You know, when we become ill. You ever have food poisoning? I mean, and that food just Builds up and it's just not moving out of your stomach. The last thing you want to do is to put anything in. What's strong enough to overcome the reward circuits? What's strong enough to overcome these addictive circuits? There are a set of circuits that are called the aversive circuits, right. And what basically happens, these drugs are triggering those and they counterbalance, they tamp down the addiction addictive circuits. So you don't have this food noise. Now that only works when you're on the drugs, right? Go off the drugs and those circuits are still there. Go back into your environment. It may take a little while. I mean, the great thing about these drugs, right, is that it's, I mean, certainly for me, and I could, you know, you have this cascade, this, this spectrum, you know, of, you know, you know, when you're satisfied, you eat. When you're full, you eat. And then this Thanksgiving fullness. And then, and now I could push.

[A]

You characterized by this sound.

[B]

Yeah. Now I'm going to push you to the edge of nausea, right. I won't quite ask you to make the sound there, right. But you could imagine. And then, I mean, if too much of the drug, I can push you over that edge of nausea into real GI distress, right. So if you get that right dose, I mean, you can counterbalance those addictive circuits. But you know, they, so they, they tamp down these food addictive circuits. They crack food addiction, but only while you're on that. So what you have to do certainly for me was I had to learn to relearn to eat. I mean, I mean, when I'm on these drugs, I don't want to put anything else in my stomach, right. I mean, I just, I eat smaller amounts. I change what, what I eat. I eat vegetables for the first time. I don't want to put, you know, heavy fat and sugar things, I mean, in my stomach because it's just gonna stay there longer. So I, I, I changed my relationship with food that now I, I didn't, you know, I was on these drugs for about six, seven months. That's what the average, you know, person is, less than a year. The, the, the premise of the company is they want you on it for a lifetime. I mean, obviously you understand, and they argue this is no different than blood pressure or lipid lowering drugs. But again, these drugs are much more expensive than those. They have an adverse profile, adverse event profile that is, you know, some people can tolerate fine, some don't have any adverse events. Some have serious adverse events. I started having some Abdominal pain after a while, and I just wanted to get off it. So the question is, if you can relearn to eat while you're on these drugs, can you carry that over after? Or can you, you know, can you try to condition yourself to eat differently or do you like many. I mean, increasingly, you know, the average duration is about seven to eight months. But a 20% of people, from the data I've seen, go back on these drugs intermittently. We don't have data about whether that's safe or that that will work in the long run. I think fda, the companies have to get data on how these drugs should be used in the real world. They are, again, very important tools, right, but they work by shutting down how much we put in. We're eating less, and in some cases we're eating a lot less. And some people, and again, the companies don't. There's not a lot of data out there on this people on these drugs over the first couple of months, some of them eating less than a thousand calories, some are eating 600, 800 calories. I mean, that's almost semi starvation. And you have to do this. Look, it's not about willpower. The real decision is if you have this, this toxic fat, if you have this visceral adiposity, if you're starting to see impacts on your, on your health, the real decision is do you want to do something about it? But for the first time you can do something about it and it will work, but you need help. You can't deal with these addictive circuits. You can't mean with these drugs by yourself. This requires good care. You need a good doc, you need a dietitian. You need to do it, I mean, you know, with some help. And there should be no shame, no stigma.

[A]

David Kessler, former commissioner of the fda, is the author of Diet Drugs and Dopamine. And tomorrow we'll be speaking more about what can be done with the ingredients in food, how we eat, how GLP1s might change all of America, and what his weight loss journey was, his journey to healthiness, his journey to consciousness. David Kessler will be back on tomorrow. And that's it for today's show. Cory Wara produces the gist and Ashley Khan is our production coordinator. Astra Green, well, she's still running our socials, but we need someone else to apply. Within Leo Bounds, our internal, Michelle Pesca oversees it all. You know Kathleen Sykes and Philip Swissgood, they've been extra instrumental in the GIST list today. That's another thing you can subscribe to to help the gist. So many calls to action. Or just keep listening Peru. G Peru. Do Peru and thanks for listening. Marketing is hard, but I'll tell you a little secret. It doesn't have to be.

[B]

Let me point something out. You're listening to a podcast right now and it's great. You love the host. You seek it out and download it.

[A]

You listen to it while driving, working.

[B]

Out, cooking, even going to the bathroom. Podcasts are a pretty close companion. And this is a podcast ad. Did I get your attention?

[A]

You can reach great listeners like yourself.

[B]

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[A]

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[B]

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